(a)
(2) The Secretary shall coordinate the furnishing of hospital care, medical services, and extended care services under this section to covered veterans, including coordination of, at a minimum, the following:
(A) Ensuring the scheduling of medical appointments in a timely manner and the establishment of a mechanism to receive medical records from non-Department providers.
(B) Ensuring continuity of care and services.
(C) Ensuring coordination among regional networks if the covered veteran accesses care and services in a different network than the regional network in which the covered veteran resides.
(D) Ensuring that covered veterans do not experience a lapse in care resulting from errors or delays by the Department or its contractors or an unusual or excessive burden in accessing hospital care, medical services, or extended care services.
(3) A covered veteran may only receive care or services under this section upon the authorization of such care or services by the Secretary.
(b)
(1) is enrolled in the system of annual patient enrollment established and operated under section 1705 of this title; or
(2) is not enrolled in such system but is otherwise entitled to hospital care, medical services, or extended care services under subsection (c)(2) of such section.
(c)
(1) Any health care provider that is participating in the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), including any physician furnishing services under such a program.
(2) The Department of Defense.
(3) The Indian Health Service.
(4) Any Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1396d(l)(2)(B))).
(5) Any health care provider not otherwise covered under any of paragraphs (1) through (4) that meets criteria established by the Secretary for purposes of this section.
(d)
(A) the Department does not offer the care or services the veteran requires;
(B) the Department does not operate a full-service medical facility in the State in which the covered veteran resides;
(C)(i) the covered veteran was an eligible veteran under section 101(b)(2)(B) of the Veterans Access, Choice, and Accountability Act of 2014 (
(ii) continues to reside in a location that would qualify the veteran for eligibility under such section; and
(iii) either-
(I) resides in one of the five States with the lowest population density as determined by data from the 2010 decennial census; or
(II) resides in a State not described in subclause (I) and-
(aa) received care or services under this title in the year preceding the enactment of the Caring for Our Veterans Act of 2018; and
(bb) is seeking care or services within 2 years of the date of the enactment of the Caring for Our Veterans Act of 2018;
(D) the covered veteran has contacted the Department to request care or services and the Department is not able to furnish such care or services in a manner that complies with designated access standards developed by the Secretary under section 1703B of this title; or
(E) the covered veteran and the covered veteran's referring clinician agree that furnishing care and services through a non-Department entity or provider would be in the best medical interest of the covered veteran based upon criteria developed by the Secretary.
(2) The Secretary shall ensure that the criteria developed under paragraph (1)(E) include consideration of the following:
(A) The distance between the covered veteran and the facility that provides the hospital care, medical services, or extended care services the veteran needs.
(B) The nature of the hospital care, medical services, or extended care services required.
(C) The frequency that the hospital care, medical services, or extended care services needs to be furnished.
(D) The timeliness of available appointments for the hospital care, medical services, or extended care services the veteran needs.
(E) Whether the covered veteran faces an unusual or excessive burden to access hospital care, medical services, or extended care services from the Department medical facility where a covered veteran seeks hospital care, medical services, or extended care services, which shall include consideration of the following:
(i) Whether the covered veteran faces an excessive driving distance, geographical challenge, or environmental factor that impedes the access of the covered veteran.
(ii) Whether the hospital care, medical services, or extended care services sought by the veteran is provided by a medical facility of the Department that is reasonably accessible to a covered veteran.
(iii) Whether a medical condition of the covered veteran affects the ability of the covered veteran to travel.
(iv) Whether there is compelling reason, as determined by the Secretary, that the veteran needs to receive hospital care, medical services, or extended care services from a medical facility other than a medical facility of the Department.
(v) Such other considerations as the Secretary considers appropriate.
(3) If the Secretary has determined that the Department does not offer the care or services the covered veteran requires under subparagraph (A) of paragraph (1), that the Department does not operate a full-service medical facility in the State in which the covered veteran resides under subparagraph (B) of such paragraph, that the covered veteran is described under subparagraph (C) of such paragraph, or that the Department is not able to furnish care or services in a manner that complies with designated access standards developed by the Secretary under section 1703B of this title under subparagraph (D) of such paragraph, the decision to receive hospital care, medical services, or extended care services under such subparagraphs from a health care provider specified in subsection (c) shall be at the election of the veteran.
(e)
(B) In carrying out subparagraph (A), the Secretary shall-
(i) measure timeliness of the medical service line at a facility of the Department when compared with the same medical service line at different Department facilities; and
(ii) measure quality at a medical service line of a facility of the Department by comparing it with two or more distinct and appropriate quality measures at non-Department medical service lines.
(C)(i) The Secretary may not concurrently furnish hospital care, medical services, or extended care services under subparagraph (A) with respect to more than three medical service lines described in such subparagraph at any one health care facility of the Department.
(ii) The Secretary may not concurrently furnish hospital care, medical services, or extended care services under subparagraph (A) with respect to more than 36 medical service lines nationally described in such subparagraph.
(2) The Secretary may limit the types of hospital care, medical services, or extended care services covered veterans may receive under paragraph (1) in terms of the length of time such care and services will be available, the location at which such care and services will be available, and the clinical care and services that will be available.
(3)(A) Except as provided for in subparagraph (B), the hospital care, medical services, and extended care services authorized under paragraph (1) with respect to a medical service line shall cease when the remediation described in section 1706A with respect to such medical service line is complete.
(B) The Secretary shall ensure continuity and coordination of care for any veteran who elects to receive care or services under paragraph (1) from a health care provider specified in subsection (c) through the completion of an episode of care.
(4) The Secretary shall publish in the Federal Register, and shall take all reasonable steps to provide direct notice to covered veterans affected under this subsection, at least once each year stating the time period during which such care and services will be available, the location or locations where such care and services will be available, and the clinical services available at each location under this subsection in accordance with regulations the Secretary shall prescribe.
(5) When the Secretary exercises the authority under paragraph (1), the decision to receive care or services under such paragraph from a health care provider specified in subsection (c) shall be at the election of the covered veteran.
(f)
(g)
(2) In developing a tiered provider network of eligible providers under paragraph (1), the Secretary shall not prioritize providers in a tier over providers in any other tier in a manner that limits the choice of a covered veteran in selecting a health care provider specified in subsection (c) for receipt of hospital care, medical services, or extended care services under this section.
(h)
(B) For purposes of subparagraph (A), the requirement to enter into consolidated, competitively bid contracts shall not restrict the authority of the Secretary under other provisions of law when modifying such a contract after entering into the contract.
(2)(A) The Secretary shall, to the extent practicable, ensure that covered veterans are able to make their own appointments using advanced technology.
(B) To the extent practicable, the Secretary shall be responsible for the scheduling of appointments for hospital care, medical services, and extended care services under this section.
(3)(A) The Secretary may terminate a contract with an entity entered into under paragraph (1) at such time and upon such notice to the entity as the Secretary may specify for purposes of this section, if the Secretary notifies the appropriate committees of Congress that, at a minimum-
(i) the entity-
(I) failed to comply substantially with the provisions of the contract or with the provisions of this section and the regulations prescribed under this section;
(II) failed to comply with the access standards or the standards for quality established by the Secretary;
(III) is excluded from participation in a Federal health care program (as defined in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a–7b(f))) under section 1128 or 1128A of the Social Security Act (42 U.S.C. 1320a–7 and 1320a–7a);
(IV) is identified as an excluded source on the list maintained in the System for Award Management, or any successor system; or
(V) has been convicted of a felony or other serious offense under Federal or State law and the continued participation of the entity would be detrimental to the best interests of veterans or the Department;
(ii) it is reasonable to terminate the contract based on the health care needs of veterans; or
(iii) it is reasonable to terminate the contract based on coverage provided by contracts or sharing agreements entered into under authorities other than this section.
(B) Nothing in subparagraph (A) may be construed to restrict the authority of the Secretary to terminate a contract entered into under paragraph (1) under any other provision of law.
(4) Whenever the Secretary provides notice to an entity that the entity is failing to meet contractual obligations entered into under paragraph (1), the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on such failure. Such report shall include the following:
(A) An explanation of the reasons for providing such notice.
(B) A description of the effect of such failure, including with respect to cost, schedule, and requirements.
(C) A description of the actions taken by the Secretary to mitigate such failure.
(D) A description of the actions taken by the contractor to address such failure.
(E) A description of any effect on the community provider market for veterans in the affected area.
(5)(A) The Secretary shall instruct each entity awarded a contract under paragraph (1) to recognize and accept, on an interim basis, the credentials and qualifications of health care providers who are authorized to furnish hospital care and medical services to veterans under a community care program of the Department in effect as of the day before the effective date specified in section 101(b) of the Caring for Our Veterans Act of 2018, including under the Patient-Centered Community Care Program and the Veterans Choice Program under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (
(B) The interim acceptance period under subparagraph (A) shall be determined by the Secretary based on the following criteria:
(i) With respect to a health care provider, when the current certification agreement for the health care provider expires.
(ii) Whether the Department has enacted certification and eligibility criteria and regulatory procedures by which non-Department providers will be authorized under this section.
(6) The Secretary shall establish a system or systems for monitoring the quality of care provided to covered veterans through a network under this subsection and for assessing the quality of hospital care, medical services, and extended care services furnished through such network before the renewal of the contract for such network.
(i)
(2)(A) A higher rate than the rate paid by the United States as described in paragraph (1) may be negotiated with respect to the furnishing of care or services to a covered veteran who resides in a highly rural area.
(B) In this paragraph, the term "highly rural area" means an area located in a county that has fewer than seven individuals residing in that county per square mile.
(3) With respect to furnishing care or services under this section in Alaska, the Alaska Fee Schedule of the Department of Veterans Affairs shall be followed, except for when another payment agreement, including a contract or provider agreement, is in effect.
(4) With respect to furnishing hospital care, medical services, or extended care services under this section in a State with an All-Payer Model Agreement under section 1814(b)(3) of the Social Security Act (42 U.S.C. 1395f(b)(3)) that became effective on or after January 1, 2014, the Medicare payment rates under paragraph (2)(A) shall be calculated based on the payment rates under such agreement.
(5) Notwithstanding paragraph (1), the Secretary may incorporate, to the extent practicable, the use of value-based reimbursement models to promote the provision of high-quality care.
(6) With respect to hospital care, medical services, or extended care services for which there is not a rate paid under the Medicare program as described in paragraph (1), the rate paid for such care or services shall be determined by the Secretary.
(j)
(k)
(l)
(2) A covered veteran described in this paragraph-
(A) requires an organ or bone marrow transplant; and
(B) has, in the opinion of the primary care provider of the veteran, a medically compelling reason to travel outside the region of the Organ Procurement and Transplantation Network, established under section 372 of the National Organ Transplantation Act 1 (
(m)
(B) The review submitted under subparagraph (A) shall include an assessment of the following:
(i) The top 25 percent of types of care and services most frequently provided under subsection (d) due to the Department not offering such care and services.
(ii) The frequency such care and services were sought by covered veterans under this section.
(iii) An analysis of the reasons the Department was unable to provide such care and services.
(iv) Any steps the Department took to provide such care and services at a medical facility of the Department.
(v) The cost of such care and services.
(2) In monitoring the hospital care, medical services, and extended care services furnished under this section, the Secretary shall do the following:
(A) With respect to hospital care, medical services, and extended care services furnished through provider networks established under subsection (i)-
(i) compile data on the types of hospital care, medical services, and extended care services furnished through such networks and how many patients used each type of care and service;
(ii) identify gaps in hospital care, medical services, or extended care services furnished through such networks;
(iii) identify how such gaps may be fixed through new contracts within such networks or changes in the manner in which hospital care, medical services, or extended care services are furnished through such networks;
(iv) assess the total amounts spent by the Department on hospital care, medical services, and extended care services furnished through such networks;
(v) assess the timeliness of the Department in referring hospital care, medical services, and extended care services to such networks; and
(vi) assess the timeliness of such networks in-
(I) accepting referrals; and
(II) scheduling and completing appointments.
(B) Report the number of medical service lines the Secretary has determined under subsection (e)(1) not to be providing hospital care, medical services, or extended care services that comply with the standards for quality established by the Secretary.
(C) Assess the use of academic affiliates and centers of excellence of the Department to furnish hospital care, medical services, and extended care services to covered veterans under this section.
(D) Assess the hospital care, medical services, and extended care services furnished to covered veterans under this section by medical facilities operated by Federal agencies other than the Department.
(3) Not later than 540 days after the date of the enactment of the Caring for Our Veterans Act of 2018 and not less frequently than once each year thereafter, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the information gathered under paragraph (2).
(n)
(2) No provision in this section may be construed to alter or modify any other provision of law establishing specific eligibility criteria for certain hospital care, medical services, or extended care services.
(o)
(1) The term "appropriate committees of Congress" means-
(A) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives.
(2) The term "medical service line" means a clinic within a Department medical center.
(Added
The Social Security Act, referred to in subsecs. (c)(1) and (i)(1), is act Aug. 14, 1935, ch. 531,
The date of the enactment of the Caring for Our Veterans Act of 2018, referred to in subsecs. (d)(1)(C) and (m)(1), (3), is the date of enactment of
For the effective date specified in section 101(b) of the Caring for Our Veterans Act of 2018, referred to in subsec. (h)(5)(A), see section 101(b) of
Section 372 of the National Organ Transplantation Act, referred to in subsec. (l)(2)(B), probably means section 372 of the Public Health Service Act, act July 1, 1944, ch. 373, which was enacted by section 201 of the National Organ Transplant Act,
2018-
Subsec. (h)(1).
Subsec. (h)(5)(A).
2011-Subsec. (d)(4).
2008-Subsec. (d)(4).
2005-Subsec. (d)(2).
2004-Subsec. (d).
1996-Subsec. (a).
Subsec. (a)(2)(A).
Subsec. (a)(2)(B).
Subsec. (a)(2)(C).
Subsec. (a)(7).
1992-Subsec. (a)(1)(C).
1991-
Subsec. (a).
Subsec. (a)(2)(B).
Subsec. (a)(7).
Subsec. (a)(8).
Subsec. (b).
Subsec. (c).
1988-Subsec. (a).
Subsec. (a)(1).
Subsec. (a)(2).
Subsec. (a)(2)(B).
Subsec. (a)(2)(C).
Subsec. (a)(3).
Subsec. (a)(4), (5).
Subsec. (a)(6).
Subsec. (a)(7).
Subsec. (a)(8).
Subsec. (c).
1986-Subsec. (a)(5).
1985-Subsec. (a)(5).
"(1) the date that is 30 days after the date on which the Secretary of Veterans Affairs submits the report required under section 101(q)(2) of the Veterans Access, Choice, and Accountability Act of 2014 (
"(2) the date on which the Secretary promulgates regulations pursuant to subsection (c) [set out as a Regulations note below] [regulations effective June 6, 2019, see 84 F.R. 26278]."
"(1)
"(2)
"(A)
"(B)
"(C)
"(i) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate; and
"(ii) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives."
"(1)
"(2)
"(a)
"(1) Establishing a partnership between the Department of Veterans Affairs and the Centers for Medicare and Medicaid Services of the Department of Health and Human Services to coordinate care for veterans in rural areas at critical access hospitals (as designated or certified under section 1820 of the Social Security Act (42 U.S.C. 1395i–4)).
"(2) Establishing a partnership between the Department of Veterans Affairs and the Department of Health and Human Services to coordinate care for veterans in rural areas at community health centers.
"(3) Expanding coordination between the Department of Veterans Affairs and the Indian Health Service to expand care for Indian veterans.
"(b)
"(c)
"(1) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate; and
"(2) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives.
"(d)
"(a)
"(1)
"(2)
"(3)
"(4)
"(A) Veterans Integrated Service Network 1.
"(B) Veterans Integrated Service Network 6.
"(C) Veterans Integrated Service Network 15.
"(D) Veterans Integrated Service Network 18.
"(E) Veterans Integrated Service Network 19.
"(b)
"(1) is-
"(A) enrolled in the system of patient enrollment established under section 1705(a) of title 38, United States Code, as of August 1, 2014; or
"(B) eligible for health care under section 1710(e)(3) of such title; and
"(2) resides in a location that is-
"(A) more than 60 minutes driving distance from the nearest Department health care facility providing primary care services, if the veteran is seeking such services;
"(B) more than 120 minutes driving distance from the nearest Department health care facility providing acute hospital care, if the veteran is seeking such care; or
"(C) more than 240 minutes driving distance from the nearest Department health care facility providing tertiary care, if the veteran is seeking such care.
"(c)
"(d)
"(e)
"(f)
"(g)
"(h)
"(1) are scheduled not later than 5 days after the date on which the appointment is requested; and
"(2) occur not later than 30 days after such date.
"(i)
"(j)
"(k)
"(1) the assessment of the Secretary of the pilot program during the preceding year, including its cost, volume, quality, patient satisfaction, benefit to veterans, and such other findings and conclusions with respect to pilot program as the Secretary considers appropriate; and
"(2) such recommendations as the Secretary considers appropriate regarding-
"(A) the continuation of the pilot program;
"(B) extension of the pilot program to other or all Veterans Integrated Service Networks of the Department; and
"(C) making the pilot program permanent."
Section 1503(c) of
1 See References in Text note below.