SEC. 4001. Short Title.
This title may be cited as the “VA Budget and Choice Improvement Act”.
Title IV — Veterans Provisions
TITLE IV Veterans Provisions
SEC. 4002. Plan to Consolidate Programs of Department of Veterans Affairs to Improve Access to Care.
Plan.— The Secretary of Veterans Affairs shall develop a plan to consolidate all non-Department provider programs by establishing a new, single program to be known as the “Veterans Choice Program” to furnish hospital care and medical services to veterans enrolled in the system of patient enrollment established under section 1705(a) of title 38, United States Code, at non-Department facilities.
Elements.— The plan developed under subsection (a) to establish the Veterans Choice Program to furnish hospital care and medical services at non-Department facilities shall include, at a minimum, the following:
A standardized method to furnish such care and services that incorporates the strengths of the non-Department provider programs into a single streamlined program that the Secretary administers uniformly in each Veterans Service Integrated Network and throughout the medical system of the Veterans Health Administration.
An identification of the eligibility requirements for any such care and services, including with respect to service-connected disabilities and non-service-connected disabilities.
A description of the authorization process for such care or medical services, including with respect to identifying the roles of clinicians, schedulers, any third-party administrators, the Chief Business Office of the Department, and any other entity involved in the authorization process.
The structuring of the billing and reimbursement process, including the use of third-party medical claims adjudicators or technology that supports automatic adjudication.
A description of the reimbursement rate to be paid to health care providers under such program.
An identification of how the Secretary will determine the eligibility requirements of health care providers at non-Department facilities to participate in such program, including how the Secretary plans to structure a non-Department care network to allow the maximum amount of flexibility in providing care and services under the program.
An explanation of the processes to be used to ensure that the Secretary will fully comply with all requirements of chapter 39 of title 31, United States Code (commonly referred to as the “Prompt Payment Act”), in paying for such care and services furnished at non-Department facilities.
A description of how, to the greatest extent practicable, the Secretary plans to use infrastructure and networks of non-Department provider programs that exist as of the date of the plan to implement such program.
A description of how—
health care providers at non-Department facilities that furnish such care or services to veterans under such program will have access to, and transmit back to the Department, the medical records of such veterans; and
the Department will receive from such non-Department providers such medical records and any other relevant information.
A description of how the Secretary plans to ensure an efficient transition to such program for veterans who participate in the non-Department provider programs, including a timeline, milestones, and estimated costs for implementation, outreach, and training.
Submission.— Not later than November 1, 2015, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report containing—
a description of each non-Department provider program and the statutory authority for each such program;
the plan under subsection (a);
the estimated costs and budgetary requirements to implement the plan and to furnish hospital care and medical services pursuant to such plan; and
any recommendations for legislative proposals the Secretary determines necessary to implement such plan.
Definitions.— In this section:
The term “non-Department facility” has the meaning given that term in section 1701 of title 38, United States Code.
The term “non-Department provider programs” means each program administered by the Secretary of Veterans Affairs under which the Secretary enters into contracts or other agreements with health care providers at non-Department facilities to furnish hospital care and medical services to veterans, including pursuant to the following:
The Veterans Choice Program established by section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note).
The Patient Centered Community Care Program (known as “PC3”).
The pilot program established by section 403 of the Veterans’ Mental Health and Other Care Improvements Act of 2008 (Public Law 110–387; 38 U.S.C. 1703 note) (known as “Project ARCH”).
Contracts relating to dialysis.
Agreements entered into by the Secretary with—
the Secretary of Defense, the Director of the Indian Health Service, or any the head of any other department or agency of the Federal Government; or
any academic affiliate or other non-governmental entity.
Programs relating to emergency care, including under sections 1725 and 1728 of title 38, United States Code.
SEC. 4003. Funding Account for Non-Department Care.
Each budget of the President submitted to Congress under section 1105 of title 31, United States Code, for fiscal year 2017 and each fiscal year thereafter shall include an appropriations account for non-Department provider programs (as defined in section 2(d)) to be comprised of—
discretionary medical services funding that is designated for hospital care and medical services furnished at non-Department facilities; and
any funds transferred for such purpose from the Veterans Choice Fund established by section 802 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 128 Stat. 1802).
SEC. 4004. Temporary Authorization of Use of Veterans Choice Funds for Certain Programs.
In General.— Subsection (c) of section 802 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 128 Stat. 1802) is amended—
in paragraph (1), by striking “ Any amounts” and inserting “ Except as provided by paragraph (3), any amounts”; and
by adding at the end the following paragraph:
“(3) Temporary authority for other uses.—
“(A) Other non-department care.—In addition to the use of amounts described in paragraph (1), of the amounts deposited in the Veterans Choice Fund, not more than $3,348,500,000 may be used by the Secretary during the period described in subparagraph (C) for amounts obligated by the Secretary on or after May 1, 2015, to furnish health care to individuals pursuant to chapter 17 of title 38, United States Code, at non-Department facilities, including pursuant to non-Department provider programs other than the program established by section 101.
“(B) Hepatitis c.—Of the amount specified in subparagraph (A), not more than $500,000,000 may be used by the Secretary during the period described in subparagraph (C) for pharmaceutical expenses relating to the treatment of Hepatitis C.
“(C) Period described.—The period described in this subparagraph is the period beginning on the date of the enactment of the VA Budget and Choice Improvement Act and ending on October 1, 2015.
“(D) Reports.—Not later than 14 days after the date of the enactment of the VA Budget and Choice Improvement Act, and not less frequently than once every 14-day period thereafter during the period described in subparagraph (C), the Secretary shall submit to the appropriate congressional committees a report detailing—
“(i) the amounts used by the Secretary pursuant to subparagraphs (A) and (B); and
“(ii) an identification of such amounts listed by the non-Department provider program for which the amounts were used.
“(E) Definitions.—In this paragraph:
“(i) The term ‘appropriate congressional committees’ means—
“(I) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives; and
“(II) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate.
“(ii) The term ‘non-Department facilities’ has the meaning given that term in section 1701 of title 38, United States Code.
“(iii) The term ‘non-Department provider program’ has the meaning given that term in section 4002(d) of the VA Budget and Choice Improvement Act.”
Conforming Amendment.— Subsection (d)(1) of such section is amended by inserting before the period at the end the following: “ (or for hospital care and medical services pursuant to subsection (c)(3) of this section)”.
SEC. 4005. Modifications of Veterans Choice Program.
Increased Period of Follow-Up Care.— Subsection (h) of section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note) is amended by striking “ (but for a period not exceeding 60 days)”.
Expansion of Eligibility.— Such section is further amended—
by striking paragraph (1) of subsection (b) and inserting the following new paragraph:
“(1) the veteran is enrolled in the patient enrollment system of the Department of Veterans Affairs established and operated under section 1705 of title 38, United States Code, including any such veteran who has not received hospital care or medical services from the Department and has contacted the Department seeking an initial appointment from the Department for the receipt of such care or services; and”
; and
in subsection (g)(1), by striking “ In the case” and all that follows through “ , when” and insert “ When”.
Expansion of Providers.— Such section is further amended—
in subsection (a)(1)(B), by adding at the end the following new clause:
“(v) Subject to subsection (d)(5), a health care provider not otherwise covered under any of clauses (i) through (iv).”
; and
in subsection (d), by adding at the end the following new paragraph:
“(5) Agreements with other providers.—In accordance with the rates determined pursuant to paragraph (2), the Secretary may enter into agreements under paragraph (1) for furnishing care and services to eligible veterans under this section with an entity specified in subsection (a)(1)(B)(v) if the entity meets criteria established by the Secretary for purposes of this section.”
Clarification of Wait Times.— Subparagraph (A) of subsection (b)(2) of such section is amended to read as follows:
“(A) attempts, or has attempted, to schedule an appointment for the receipt of hospital care or medical services under chapter 17 of title 38, United States Code, but is unable to schedule an appointment within—
“(i) the wait-time goals of the Veterans Health Administration for the furnishing of such care or services; or
“(ii) with respect to such care or services that are clinically necessary, the period determined necessary for such care or services if such period is shorter than such wait-time goals;”
Modification of Distance Requirement.— Subparagraph (B) of subsection (b)(2) of such section is amended to read as follows:
“(B) resides more than 40 miles (as calculated based on distance traveled) from—
“(i) with respect to a veteran who is seeking primary care, a medical facility of the Department, including a community-based outpatient clinic, that is able to provide such primary care by a full-time primary care physician; or
“(ii) with respect to a veteran not covered under clause (i), the medical facility of the Department, including a community-based outpatient clinic, that is closest to the residence of the veteran;”
SEC. 4006. Limitation on Dialysis Pilot Program.
Limitation.— None of the funds authorized to be appropriated or otherwise made available to the Secretary of Veterans Affairs may be used to expand the dialysis pilot program or to create any new dialysis capability provided by the Department in a facility that is not an initial facility under the dialysis pilot program until—
an independent analysis of the dialysis pilot program is conducted for each such initial facility;
the Secretary submits to the appropriate congressional committees the report under subsection (b); and
a period of 180 days has elapsed following the date on which the Secretary submits such report.
Report.— The Secretary shall submit to the appropriate congressional committees a report containing the following:
The independent analysis described in subsection (a)(1).
A five-year dialysis investment plan explaining all of the options of the Secretary for delivering dialysis care to veterans, including how and where such care will be delivered.
Definitions.— In this section:
The term “appropriate congressional committees” means—
the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives; and
the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate.
The term “dialysis pilot program” means the pilot demonstration program approved by the Under Secretary of Veterans Affairs for Health in August 2010 and by the Secretary of Veterans Affairs in September 2010 to provide dialysis care to patients at certain outpatient facilities operated by the Department of Veterans Affairs.
The term “initial facility” means one of the four outpatient facilities identified by the Secretary to participate in the dialysis pilot program prior to the date of the enactment of this Act.
SEC. 4007. Amendments to Internal Revenue Code with Respect to Health Coverage of Veterans.
Exemption in Determination of Employer Health Insurance Mandate.—
In general.— Section 4980H(c)(2) of the Internal Revenue Code of 1986 is amended by adding at the end the following:
“(F) Exemption for health coverage under tricare or the veterans administration.—Solely for purposes of determining whether an employer is an applicable large employer under this paragraph for any month, an individual shall not be taken into account as an employee for such month if such individual has medical coverage for such month under—
“(i) chapter 55 of title 10, United States Code, including coverage under the TRICARE program, or
“(ii) under a health care program under chapter 17 or 18 of title 38, United States Code, as determined by the Secretary of Veterans Affairs, in coordination with the Secretary of Health and Human Services and the Secretary.”
Effective date.— The amendment made by this subsection shall apply to months beginning after December 31, 2013.
Eligibility for Health Savings Account Not Affected by Receipt of Medical Care for Service-Connected Disability.—
In general.— Section 223(c)(1) of the Internal Revenue Code of 1986 is amended by adding at the end the following new subparagraph:
“(C) Special rule for individuals eligible for certain veterans benefits.—An individual shall not fail to be treated as an eligible individual for any period merely because the individual receives hospital care or medical services under any law administered by the Secretary of Veterans Affairs for a service-connected disability (within the meaning of section 101(16) of title 38, United States Code).”
Effective date.— The amendment made by this subsection shall apply to months beginning after December 31, 2015.
SEC. 4008. Emergency Designations.
In General.— This title, except for section 4007, is designated as an emergency requirement pursuant to section 4(g) of the Statutory Pay-As-You-Go Act of 2010 (2 U.S.C. 933(g)).
Designation in Senate.— In the Senate, this title, except for section 4007, is designated as an emergency requirement pursuant to section 403(a) of S. Con. Res. 13 (111th Congress), the concurrent resolution on the budget for fiscal year 2010.