H. R. 3723
IN THE HOUSE OF REPRESENTATIVES
December 16, 2011
Mr. Schilling (for himself, Mr. Hultgren, Mr. McKinley, Mr. Schock, and Mr. Walsh of Illinois) introduced the following bill; which was referred to the Committee on Veterans’ Affairs
To amend title 38, United States Code, to direct the Secretary of Veterans Affairs to enter into contracts with health care providers to improve access to health care for veterans who have difficulty receiving treatment at a health care facility of the Department of Veterans Affairs, and for other purposes.
Short title; sense of Congress
This Act may be cited
Enhanced Veteran Healthcare
Experience Act of 2011.
Sense of Congress
It is the sense of Congress that—
the current health care system of the Department of Veterans Affairs is neither fiscally efficient nor effective in providing easily accessible treatment for all veterans;
health care can be provided more efficiently to provide veterans with care that is available closer to where they live and to allow veterans more flexibility in choosing their own doctors; and
better health care can be provided to veterans at little-to-no increased cost to the taxpayer by replacing the fee-based care system of the Department with the veterans enhanced care program, as described under section 2, and reprogramming funds to this program.
Enhanced contract care authority for health care needs of veterans
Type of care
Subsection (a) of section 1703 of title 38, United States Code, is amended to read as follows:
The Secretary shall provide an eligible veteran with covered health services that are provided by a non-Department provider whom the Secretary enters into a contract with under this section if the Secretary determines that facilities of the Department are not capable of—
economically furnishing covered health services to such veteran because of geographical inaccessibility; or
furnishing covered health services to such veteran because such facilities lack the required personnel, resources, or ability.
In this subsection:
The term covered health services means, with respect to an eligible veteran, any hospital care, medical service, rehabilitative service, or preventative health service that is authorized to be provided by the Secretary to the veteran under this chapter or any other provision of law.
The term eligible veteran means a veteran enrolled in the health care system established under section 1705(a) of this title who elects to receive care under this section.
Qualified providers; quality of care
Such section is amended by adding at the end the following new subsections:
The Secretary may enter into a contract with a non-Department provider under this section if such provider—
demonstrates the ability to provide non-Department health care services to veterans;
meets or exceeds internal credentialing standards of the Department and standards of the Utilization Review Accreditation Commission;
has care coordinators who help veterans make, confirm, and keep medical appointments;
a system that allows veterans to file complaints; and
a demonstrated ability to respond to potential quality indicators and patient safety events; and
has the ability to—
process claims from others in the network of the provider;
bill a third party (as defined in section 1725(f)(2) of this title) for care provided under this section, as appropriate; and
transmit directly to the Secretary any amounts received pursuant to subparagraph (B).
In carrying out this section, the Secretary shall ensure the following:
With respect to each medical center of the Department, the Secretary is consistent in determining the eligibility of veterans under subsection (a).
The Secretary includes care coordinators of a non-Department provider described in subsection (e)(3) in initiatives of the Department to provide patient-centered care and uses such coordinators when the Secretary is unable to assign a veteran a case manager from the Department.
The Department and a non-Department provider under this section exchange clinical information to improve both clinical decision-making and the care a veteran receives.
Both non-Department facilities under this section and Department facilities meet performance metrics regarding—
the quality of health care provided; and
the satisfaction of veterans.
A non-Department facility under this section or employee of the Department who exceeds performance metrics under paragraph (4) are eligible for incentive or bonus payments.
Not later than October 31 of each year, the Secretary shall submit to the Committee of Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on care provided under this section, including—
the cost to the Department;
the number of veterans receiving care under this section;
the quality of such care and the satisfaction of such veterans; and
other matters the Secretary considers appropriate.
Not later than March 1 of each odd-numbered year, the Secretary shall submit to the Committee of Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the allocation of resources with respect to care provided by the Department and by non-Department facilities.
The amendments made by paragraphs (1) and (2) shall take effect on October 1, 2012.
Authorization of appropriations
There is authorized to be appropriated to the Secretary to carry out section 1703 of title 38, United States Code, as amended by this section, for fiscal year 2013 $5,000,000,000.