House Veterans’ Affairs Committee Issues Report on VA Care in Community Act (Part 2 of 3)
Hearings
There were no Subcommittee hearings held on H.R. 4242, as amended.
On
The following witnesses testified:
The Honorable
Statements for the record were submitted by:
Subcommittee Consideration
There was no Subcommittee consideration of H.R. 4242, as amended.
Committee Consideration
On
During consideration of the bill, the following amendments were considered en bloc and agreed to via voice:
An amendment offered by Representative
An amendment offered by Representative
An amendment offered by Representative
An amendment offered by Representative
An amendment offered by Representative
An amendment offered by Representative
During consideration of the bill, the following amendments were considered:
An amendment offered and then withdrawn by Representative
An amendment offered and then withdrawn by Representative
An amendment offered by Representative
An amendment offered and then withdrawn by Representative
An amendment offered by Representative
An amendment offered by Representative
An amendment offered by Representative
An amendment offered by Representative
An amendment offered by Representative
An amendment offered by Representative
An amendment in the nature of a substitute offered by Representative
Committee Votes
Clause 3(b) of rule XIII of the Rules of the
An amendment offered by Representative
An amendment offered by Representative
An amendment in the nature of a substitute offered by Representative
A motion by Representative
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII and clause (2)(b)(1) of rule X of the Rules of the
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules of the
In compliance with clause 3(c)(2) of rule XIII of the Rules of the
Earmarks and Tax and Tariff Benefits
H.R. 4242, as amended, does not contain any Congressional earmarks, limited tax benefits, or limited tariff benefits as defined in clause 9 of rule XXI of the Rules of the
Committee Cost Estimate
The Committee adopts as its own the cost estimate on H.R. 4242, as amended, prepared by the Director of the
Congressional Budget Office Cost Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
U.S.
Hon.
Chairman,
Dear Mr. Chairman: The
If you wish further details on this estimate, we will be pleased to provide them. The CBO staff contact is
Sincerely,
Director.
Enclosure.
H.R. 4242--VA Care in the Community Act
Summary: H.R. 4242 would increase the use of community health care and long-term care by the
Enacting the bill would not affect direct spending or revenues; therefore, pay-as-you-go procedures do not apply.
CBO estimates that enacting H.R. 4242 would not increase net direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2028.
H.R. 4242 would impose an intergovernmental mandate as defined in the Unfunded Mandates Reform Act (UMRA) by preempting state laws that prohibit
The bill contains no private-sector mandates as defined in UMRA.
Estimated cost to the Federal Government: The estimated budgetary effects of H.R. 4242 are shown in the following table. The costs of this legislation fall within budget function 700 (veterans benefits and services).
(TABLE OMITTED)
Basis of estimate: For this estimate, CBO assumes that the bill will be enacted early in calendar year 2018 and that the estimated amounts will be appropriated each year. Estimated outlays are based on historical spending patterns for the affected programs.
VA Care in the Community Program. Section 102 would establish the VA Care in the Community Program. Through that program, the department would establish networks of health care providers outside of
The veteran would face excessive challenges in receiving care at a
The veteran believes that the assignment to a particular primary care physician or PACT at a
The veteran would face long wait times for care at a
The veteran resides in a state without a full-service medical facility (such as
Veterans may later choose to receive care at a
The bill would require
The VA Care in the Community Program is similar to the Veterans Choice Program (VCP), which CBO expects will end in 2018. The VCP provides community care to veterans who face excessive wait times or live 40 miles or more from a
CBO expects that the VA Care in the Community Program would cost more than the VCP for the following reasons:
Veterans would make more visits for community health care because once they are referred for community care they could see network providers for primary care for at least one year without additional authorization from
Veterans would be eligible for community care under the new program in more circumstances.
However, there are several factors that CBO expects would constrain that cost growth:
Diverting more veterans to community care could shorten wait times at
Regulations that need to be written to implement the program could curtail use.
Veterans would need approval from
The size and scope of community care networks could be limited, particularly in rural areas, reducing the accessibility of such care.
CBO expects that the new program would be implemented gradually and by 2022, usage of the new program would be 30 percent greater than for the VCP. CBO estimates that eventually usage of the new program would be about 75 percent greater than that of the VCP.
In 2017,
Veterans Care Agreements. Section 103 would allow
Under current law,
According to
For 2018, the
Agreements for
According to
As a result, after factoring in a gradual phaseout of existing non-FAR agreements, CBO estimates that enacting this provision would cost
In 2010, CMMI received
CMMI received
In total, CBO estimates that implementing section 210 would cost
Ambulance Services. Section 201 would require
Using data from the
Transplant Donors. Section 109 would allow
Section 109 would authorize
Using information from the
Health Professional Scholarship Program. Section 301 would extend the Health Professional Scholarship Program, currently set to expire on
Loan Repayment for
Under a similar loan repayment program,
Health Care Productivity. Section 205 would require that
On the basis of information from
As a result, CBO estimates that implementing section 205 would cost
Scholarship Program. Section 303 would require
On the basis of the average costs to attend a private medical school, which includes tuition, books, fees, and technical equipment, CBO estimates that annual costs would average
The
In total, CBO estimates that implementing section 303 would cost
Pay-As-You-Go considerations: None.
Increase in long-term direct spending and deficits: CBO estimates that enacting H.R. 4242 would not increase net direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2028.
Mandates: H.R. 4242 would impose an intergovernmental mandate as defined in UMRA by preempting state laws that prohibit
The bill contains no private-sector mandates as defined in UMRA.
Previous CBO estimates: On
Estimate prepared by: Federal costs:
Estimate approved by:
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal mandates regarding H.R. 4242, as amended, prepared by the Director of the
Advisory Committee Statement
No advisory committees within the meaning of section 5(b) of the Federal Advisory Committee Act would be created by H.R. 4242, as amended.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States Constitution, H.R. 4242, as amended is authorized by
Applicability to Legislative Branch
The Committee finds that H.R. 4242, as amended, does not relate to the terms and conditions of employment or access to public services or accommodations within the meaning of section 102(b)(3) of the Congressional Accountability Act.
Statement on Duplication of Federal Programs
Pursuant to section 3(g) of
Disclosure of Directed Rulemaking
Pursuant to section 3(i) of
Section-by-Section Analysis of the Legislation
TITLE I--IMPROVED ACCESS FOR VETERANS TO NONDEPARTMENT OF VETERANS AFFAIRS
Sec 101. Assignment of veterans to primary care providers
Section 101 of the bill would amend Section 1706 of Title 38, U.S.C., by adding a new subsection (d).
Section 1706(d) requires
Section 102. Establishment of VA Care in the Community Program
Section 102(a) of the bill would amend section 1703 of title 38, U.S.C., by inserting after section 1703 a new section 1703A:
Section 1703A(a) of the bill would establish a permanent authority for the VA Care in the Community program to provide hospital care, medical services and extended care to eligible veterans through contracts and agreements. Under this section,
Section 1703A(b) allows for a veteran to choose a provider from among network providers located in a regional network (or adjacent network, if closer) if
Section 1703A(c) establishes that care shall be authorized through the completion of an episode of care to include all specialty and ancillary services deemed necessary. This section requires
Section 1703A(d) establishes that the rates for non-
Section 1703A(e) establishes a 180 day requirement for claim submissions and states that all parties shall pay or notify of denial of a claim no later than 45 days for "clean" claims and 30 days for electronic claims with an additional 30 days to respond. If a claim is overdue, the penalty will be prorated daily, accrue from overdue date, computed at
Section 1703A(f) establishes that veterans who would pay a copay within the
Section 1703A(g) requires network providers to provide medical records to veterans upon request and to the
Section 1703A(h) requires
Section 1703A(i) states that formulary prescriptions can be submitted by community providers to the
Section 1703A(j) requires the Secretary to use the quality of care standards as set by the
Section 1703A(k) requires
Section 1703A(l) requires
Section 1703A(m) requires
Section 1703A(n) establishes definitions for the terms: clean claim, covered claimant, covered payer, eligible veteran, and fraudulent claim.
Section 102(b) provides conforming amendments to the bill.
Section 102(c) provides definitions for the following terms: Network Provider, VA Care in the Community.
Section 102(d) requires that the bill may not be construed to affect obligations entered into via prior agreements or contracts.
Sec. 103. Veterans Care Agreements
Section 103 of the bill would amend Section 1706 of Title 38, U.S.C., by inserting after section 1703A, added by section 102, a new section 1703B--Veterans Care Agreements with non- network providers:
Section 1703B(a) authorizes the use of provider agreements in addition to contracts for care and services when contracts are impractical or inadvisable. This section requires
Section 1703B(b) establishes the requirements for network provider participation under the program.
Section 1703B(c) requires
Section 1703B(d) requires that agreements be applied in the same manner as Section 1703A of Title 38, U.S.C.
Section 1703B(e) stipulates that network providers are not subject to any provision that providers of Medicare and Medicaid are not subject to, as well as other provisions of law regarding integrity, ethics, fraud, protection of whistleblowers, and Title VII of the Civil Rights Act of 1964.
Section 1703B(f) states that agreements can be terminated by
Section 1703B(g) requires
Section 1703B(h) states that, in the course of an episode of care,
Section 1703B(i) requires
Section 1703B(j) requires
Section 1703B(k) states that the authority to enter into and terminate agreements shall not be delegated to below the VISN Director or Director of a Network Contracting Office.
Section 1703B(l) provides definitions for the following terms: Appropriate Congressional Committees, Eligible Veteran.
Section 103(b) provides a clerical amendment to this section.
Sec. 104. Modification of authority to enter into agreements with state homes to provide nursing home care
Section 104(a) allows for the use of agreements under the program.
Section 104(b) exempts
Section 104(c) requires
Sec. 105. Electronic interface for processing of claims
Section 105(a) establishes requirements for
Section 105(b) ensures that all federal information protection requirements are met.
Section 105(c) allows for
Section 105(d) sets definitions for the following terms: electronic protected health information, covered non-department health care providers, secure development requirements, VA Care in the Community Program.
Sec. 106. Funding for VA Care in the Community Program
Section 106(a) requires all funds for Section 1703B to be derived from the Medical Community Care Account.
Section 106(b) requires that all unobligated amounts from Sec. 802 of PL 113-146 shall be transferred to the Medical Community Care Account on the later of the following: one year after enactment; or, the date on which the Secretary certifies implementation of Section 1703A to
Section 106(c) defines the VA Care in the Community Program.
Sec. 107. Termination of certain provisions authorizing care to veterans through non-
Section 107(a)(1) of the bill would amend Section 1703 of Title 38, U.S.C., adding a new subsection (e):
Section 1703(e) of title 38, U.S.C., terminates Section 1703 of Title 38, U.S.C., upon
Section 107(b) repeals an authority for
Section 107(c) sets an effective date for amendments under this section of the date on which the Secretary certifies that Section 1073A of Title 38 is fully implemented.
Sec. 108. Implementation and transitions
Section 108(a) states that implementation of Sections 1703A and 1703B of title 38, U.S.C., shall commence no later than one year after enactment and that
Section 108(b) requires the Secretary to certify that providers and employees are trained to furnish care and services under this program. This section requires
Sec. 109. Transplant procedures with live donors and related services
Section 109(a) of the bill would amend subchapter I of chapter 17 of title 38, U.S.C. by inserting after Section 1703B of title 38, U.S.C., Section 1703C--"Transplant Procedures with Live Donors and Related Services."
Section 1703C(a) of subchapter I, if a veteran is eligible for a transplant procedure from the Department, the Secretary may provide for a transplant operation on a live donor notwithstanding the live donor's eligibility for health care from the
Section 1703C(b) of subchapter I authorizes
Section1703C(c) of subchapter I would allow for non-
Continues with Part 3 of 3
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House Veterans’ Affairs Committee Issues Report on VA Care in Community Act (Part 1 of 3)
Senate Veterans’ Affairs Committee Issues Report on Caring for Our Veterans Act (Part 5 of 7)
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