[House Report 115-65]
[From the U.S. Government Publishing Office]
115th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 115-65
======================================================================
TO ELIMINATE THE SUNSET OF THE VETERANS CHOICE PROGRAM, AND FOR OTHER
PURPOSES
_______
March 29, 2017.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Roe of Tennessee, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
together with
MINORITY VIEWS
[To accompany H.R. 369]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 369) to eliminate the sunset of the Veterans
Choice Program, and for other purposes, having considered the
same, report favorably thereon with an amendment and recommend
that the bill as amended do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 3
Hearings......................................................... 5
Subcommittee Consideration....................................... 5
Committee Consideration.......................................... 5
Committee Votes.................................................. 6
Committee Oversight Findings..................................... 6
Statement of General Performance Goals and Objectives............ 6
New Budget Authority, Entitlement Authority, and Tax Expenditures 6
Earmarks and Tax and Tariff Benefits............................. 6
Committee Cost Estimate.......................................... 6
Congressional Budget Office Estimate............................. 6
Federal Mandates Statement....................................... 8
Advisory Committee Statement..................................... 8
Constitutional Authority Statement............................... 8
Applicability to Legislative Branch.............................. 8
Statement on Duplication of Federal Programs..................... 8
Disclosure of Directed Rulemaking................................ 8
Section-by-Section Analysis of the Legislation................... 9
Changes in Existing Law Made by the Bill as Reported............. 9
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. ELIMINATION OF SUNSET OF THE VETERANS CHOICE PROGRAM.
Section 101(p)(2) of the Veterans Access, Choice, and Accountability
Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is amended by
striking all that follows ``section 802'' and inserting a period.
SEC. 2. ELIMINATION OF REQUIREMENT TO ACT AS SECONDARY PAYER FOR CARE
RELATING TO NON-SERVICE-CONNECTED DISABILITIES AND
RECOVERY OF COSTS FOR CERTAIN CARE UNDER CHOICE
PROGRAM.
(a) In General.--Section 101(e) of the Veterans Access, Choice, and
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is
amended--
(1) in the subsection heading, by striking ``Other Health-
Care Plan'' and inserting ``Responsibility for Costs of Certain
Care'';
(2) in paragraph (1), in the paragraph heading, by striking
``to secretary'' and inserting ``on health-care plans'';
(3) by striking paragraphs (2) and (3);
(4) by redesignating paragraph (4) as paragraph (2); and
(5) by adding at the end the following new paragraph:
``(3) Recovery of costs for certain care.--
``(A) In general.--In any case in which an eligible
veteran is furnished hospital care or medical services
under this section for a non-service-connected
disability described in subsection (a)(2) of section
1729 of title 38, United States Code, or for a
condition for which recovery is authorized or with
respect to which the United States is deemed to be a
third party beneficiary under Public Law 87-693,
commonly known as the `Federal Medical Care Recovery
Act' (42 U.S.C. 2651 et seq.), the Secretary shall
recover or collect from a third party (as defined in
subsection (i) of such section 1729) reasonable charges
for such care or services to the extent that the
veteran (or the provider of the care or services) would
be eligible to receive payment for such care or
services from such third party if the care or services
had not been furnished by a department or agency of the
United States.
``(B) Use of amounts.--Amounts collected by the
Secretary under subparagraph (A) shall be deposited in
the Medical Community Care account of the Department.
Amounts so deposited shall remain available until
expended.''.
(b) Conforming Amendment.--Paragraph (1) of such section is amended
by striking ``paragraph (4)'' and inserting ``paragraph (2)''.
SEC. 3. AUTHORITY TO DISCLOSE CERTAIN MEDICAL RECORDS OF VETERANS WHO
RECEIVE NON-DEPARTMENT OF VETERANS AFFAIRS HEALTH
CARE.
Section 7332(b)(2) of title 38, United States Code, is amended by
adding at the end the following new subparagraph:
``(H)(i) To a non-Department entity (including private
entities and other Federal agencies) that provides hospital
care or medical services to veterans.
``(ii) An entity to which a record is disclosed under this
subparagraph may not redisclose or use such record for a
purpose other than that for which the disclosure was made.''.
Purpose and Summary
H.R. 369 was introduced by Representative David P. Roe of
Tennessee, the Chairman of the Committee on Veterans' Affairs,
on January 9, 2017. H.R. 369, as amended, would: (1) remove the
three-year sunset date for the Veterans Choice program; (2)
make the Department of Veterans Affairs (VA) the primary payer
for the Choice program; and (3) authorize VA to share medical
record information with a public or private health care
provider in order to provide care or treatment to a shared
patient.
Background and Need for Legislation
Section 1. Elimination of sunset of the Veterans Choice Program
VA has been collaborating with medical providers in the
community to provide timely, quality care to veteran patients
since 1945. There are a variety of statutory authorities and
programs that the Veterans Health Administration (VHA)--which
operates and oversees the VA health care system--uses to refer
veterans to community providers. The most recent community care
program is the Choice program (hereinafter referred to as
``Choice'').
Choice was established by section 101 of the Veterans
Access, Choice, and Accountability Act of 2014 (Public Law 113-
146) (the Act). Choice expanded the availability of community
care to veteran patients by setting specific triggers that
would require VA to give veterans the option of receiving care
in the community rather than in a VA medical facility. In
general, veterans are eligible to receive care through Choice
if they are unable to secure an appointment at a VA medical
facility within 30 days or if they reside more than 40 miles
from the nearest VA medical facility. More than 1.2 million
veterans have used Choice since its creation to receive needed
care and, in fiscal year (FY) 2016, 23 percent of all of VA
community care appointments resulted from the Choice program.
To fund Choice, section 802 of the Act created--and
deposited $10 billion into--the Veterans Choice Fund and
stipulated that Choice will sunset either when the money in the
Choice fund is fully expended or three years after enactment of
the Act. Since the law was enacted on August 7, 2014, three
years after enactment of the Act would be August 7, 2017. At
the time of the Act's passage, Congress expected that the money
in the Veterans Choice Fund would be fully expended within
three years. However, VA currently expects to have anywhere
from $800 million to $1.2 billion left in the Veterans Choice
Fund on August 7, 2017. Absent legislation to remove the
current sunset date, Choice would end on August 7, 2017, and
any funds remaining in the Veterans Choice Fund must then be
returned to the Treasury.
The expiration of Choice this year could have a negative
impact on access to care for veteran patients. VA's non-Choice
community care account is not sufficiently resourced to absorb
the additional demand for care resulting from Choice.
Furthermore, during a Committee hearing on March 7, 2017,
Secretary Shulkin testified that, ``[the] looming expiration
[of Choice] is a cause for concern among veterans, providers,
and VA staff . . . [as] . . . [w]ithout Congressional action,
veterans will have to face longer wait times for care.''\1\ The
Secretary went on to claim that, if Choice is not extended past
the current sunset date, it would be ``a disaster for American
veterans.''\2\ VA has already started halting referrals to
Choice in anticipation of the program's expiration. Services
that typically require months-long episodes of care, such as
maternity and oncology care, are already experiencing
significant impacts as they are likely to outlast the current
sunset date. However, a ``large number of veterans'' are not
going to be able to access Choice care ``towards to end of
April to May [2017],'' should the program not be extended, per
the Secretary's testimony in early March.\3\
---------------------------------------------------------------------------
\1\March, 8, 2017; Committee on Veterans' Affairs, U.S. House of
Representatives, ``Shaping the Future: Consolidating and Improving VA
Community Care,'' https://veterans.house.gov/hearings/shaping-future-
consolidating-and-improving-va-community-care.
\2\Ibid.
\3\Ibid.
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To that end, Section 101 of the bill would remove the
current August 7, 2017, sunset date for the Choice program,
which would allow the program to continue operating until all
of the money remaining in the Veterans Choice Fund is fully
expended. The Committee recognizes that Choice, in its current
form, is flawed and in need of improvement to ensure its
optimal functioning for veterans, VA, community providers, and
taxpayers alike. The Committee is strongly committed to the
expeditious development of legislation to improve VA community
care, in general, and Choice, in particular. However, the
Committee also recognizes that veterans could be unduly harmed
by the expiration of Choice on the current sunset date.
Enactment of Section 101 of the bill would ensure that, as
Congress moves forward with efforts to improve the provision of
care in the community to veteran patients, veterans can
continue to access needed care from Choice and continue to
benefit from the full amount of money Congress appropriated
into the Veterans Choice Fund for this intended purpose.
Section 2. Elimination of requirement to act as secondary payer for
care relating to non-service connected disabilities and
recovery of costs for certain care under Choice Program
Section 101(e) of the Act stipulates that VA is secondarily
responsible for costs associated with non-service connected
care provided pursuant to Choice. In other words, VA is a
secondary payer for non-service connected care provided under
Choice. This is different from standard protocol for VA's non-
Choice community care programs wherein VA is the primary payer
for both service-connected and non-service-connected care and
collects reasonable charges from a veteran's third party
insurer--where applicable--for non-service connected care. VA
claims that the requirement for VA to be the secondary payer
for Choice has created significant confusion for veterans and
community providers and that making VA the primary payer under
Choice, consistent with VA's other care in the community
programs, would result in timelier and more consistent payments
to community providers.\4\
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\4\January 30, 2017, VA Office the Inspector General report 15-
04673-333, ``Review of the Implementation of the Veterans Choice
Program,'' https://www.va.gov/oig/pubs/VAOIG-15-04673-333.pdf.
---------------------------------------------------------------------------
Section 2 of the bill would eliminate the requirement for
VA to act as the secondary payer for non-service connected care
provided under Choice. While the Committee has continued
concerns regarding VA's ability to efficiently and fully
collect reimbursements from third parties, the Committee
understands that the requirement for VA to be a secondary payer
for non-service connected care has created unforeseen
challenges that have impeded Choice care in certain instances.
As such, the Committee is supportive of removing the secondary
payer requirement to bring Choice fully in line with VA's other
care in the community programs and to make Choice care more
efficient.
Section 3. Authority to disclose certain medical records of veterans
who receive non-Department of Veterans Affairs health care
Since FY 2014, VA community care appointments have
increased by 61 percent overall and by 41 percent as a
percentage of total VA appointments.\5\ In FY 2016 alone, 25.5
million appointments--or 30 percent of all VA appointments--
occurred in the community rather than in VA medical
facilities.\6\ Given the dramatic increase in VA community care
demand in recent years and the need to ensure that the care
veterans receive in the community is coordinated and of the
highest quality, the Committee believes that it is critically
important for VA and community providers to be able to share
pertinent medical record information about the veteran patients
they are jointly treating.
---------------------------------------------------------------------------
\5\January 11, 2017, MyVA Advisory Committee Meeting, Georgetown
University, Washington, D.C.
\6\Ibid.
---------------------------------------------------------------------------
Accordingly, Section 3 of the bill would authorize VA to
share medical record information with a public or private
health care provider in order to provide care or treatment to a
shared patient but prohibit any subsequent re-disclosure of
medical record information for a purpose other than that for
which the original disclosure was made.The Committee believes
this would improve the provision of care to veteran patients
from both VA providers and community providers while also
ensuring that personal patient information is safeguarded from
inappropriate disclosure.
Hearings
There were no Subcommittee hearings held on H.R. 369.
On March 7, 2017, the full Committee held an oversight and
legislative hearing that included a discussion of H.R. 369. The
following witnesses testified:
The Honorable John McCain of Arizona, U.S. Senate;
the Honorable David J. Shulkin M.D., Secretary of the
U.S. Department of Veterans Affairs, who was
accompanied by Baligh Yehia M.D., the Deputy Under
Secretary for Health for Community Care for the
Veterans Health Administration of the U.S. Department
of Veterans Affairs; The Honorable Michael J. Missal,
Inspector General of the U.S. Department of Veterans
Affairs; and Randy Williamson, Health Care Director for
the U.S. Government Accountability Office.
Statements for the record were submitted by:
The American Legion, the Disabled American Veterans,
the Paralyzed Veterans of America, the Veterans of
Foreign Wars of the United States, and TriWest
Healthcare Alliance.
Subcommittee Consideration
There was no Subcommittee markup of H.R. 369.
Committee Consideration
On March 8, 2017, the full Committee met in open markup
session, a quorum being present, and ordered H.R. 369, as
amended, favorably reported to the House of Representatives by
voice vote. During consideration of the bill, the following
amendment was considered and agreed to by voice vote:
An Amendment to H.R. 369 offered by Representative
Tim Walz of Minnesota, the Ranking Member of the
Committee on Veterans' Affairs.
Committee Votes
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, there were no recorded votes
taken on amendments or in connection with ordering H.R. 369, as
amended, reported to the House. A motion by Representative Tim
Walz of Minnesota, the Ranking Member of the Committee on
Veterans' Affairs, to report H.R. 369, as amended, favorably to
the House of Representatives was agreed to by voice vote.
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 House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are to extend and improve the Choice
program.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee adopts as its
own the estimate of new budget authority, entitlement
authority, or tax expenditures or revenues contained in the
cost estimate prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
Earmarks and Tax and Tariff Benefits
H.R. 369, 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 House of
Representatives.
Committee Cost Estimate
The Committee adopts as its own the cost estimate on H.R.
369, as amended, prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
Congressional Budget Office Cost Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
for H.R. 369, as amended, provided by the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act
of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, March 20, 2017.
Hon. Phil Roe, M.D.,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 369, a bill to
eliminate the sunset of the Veterans Choice Program, and for
other purposes.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Ann E.
Futrell.
Sincerely,
Mark P. Hadley
(For Keith Hall, Director).
Enclosure.
H.R. 369--A bill to eliminate the sunset of the Veterans Choice
Program, and for other purposes
The Veterans Choice Program (VCP), enacted on August 7,
2014, provided $10 billion to the Department of Veterans
Affairs (VA) to pay for certain veterans to receive health care
from participating providers in the private sector through the
earlier of August 7, 2017, or the date when funds are
exhausted. H.R. 369 would eliminate the sunset date of August
7, 2017, and allow VA to operate VCP until the $10 billion in
funding is exhausted.
The bill also would require VA to act as the primary payer
rather than a secondary payer for care provided under VCP.
Currently, VA acts as primary payer only for those veterans who
are receiving care for service-connected conditions. Under this
provision, CBO expects that VA would cover more of the health
care costs for veterans being treated for conditions that are
not related to military service.
Through the end of fiscal year 2016, VCP spending totaled
roughly $6.6 billion for health care appointments, Hepatitis C
drugs, and other community care. In the January 2017 baseline,
CBO estimates that VA would obligate all but $200 million of
the remaining funds for VCP by August 7, 2017. Enacting H.R.
369 would allow VA to obligate and spend the $200 million that
would otherwise be unavailable after August 7, 2017; such
spending is classified as direct spending. (Since we prepared
our current baseline, VA has released new information that
indicates that as much as $1 billion of the funding for VCP
could remain unobligated by August 7, 2017; to the extent that
unobligated funds are higher than our baseline estimate, direct
spending under this bill would also be higher.)
Because CBO estimates that enacting H.R. 369 would increase
direct spending by $200 million over the 2017-2027 period, pay-
as-you-go procedures apply. Enacting H.R. 369 would not affect
revenues.
CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR H.R. 369 AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON VETERANS' AFFAIRS ON MARCH 8, 2017
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
--------------------------------------------------------------------------------------------------
2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2017-2022 2017-2027
--------------------------------------------------------------------------------------------------------------------------------------------------------
NET INCREASE IN THE DEFICIT
Statutory Pay-As-You-Go Impact....................... 0 200 0 0 0 0 0 0 0 0 0 200 200
--------------------------------------------------------------------------------------------------------------------------------------------------------
CBO estimates that enacting H.R. 369 would not increase net
direct spending or on-budget deficits in any of the four
consecutive 10-year periods beginning in 2028.
H.R. 369 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act and
would impost no costs on state, local, or tribal governments.
The CBO staff contact for this estimate is Ann E. Futrell.
The estimate was approved by H. Samuel Papenfuss, Deputy
Assistant Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 369, as amended, prepared by the
Director of the Congressional Budget Office pursuant to section
423 of the Unfunded Mandates Reform Act.
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.
369, as amended.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 369, as amended, is authorized by Congress'
power to ``provide for the common Defense and general Welfare
of the United States.''
Applicability to Legislative Branch
The Committee finds that H.R. 369, 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 clause 3(c)(5) of rule XIII of the Rules of the
House of Representatives, the Committee finds that no provision
of H.R. 369, as amended, establishes or reauthorizes a program
of the Federal Government known to be duplicative of another
Federal program, a program that was included in any report from
the Government Accountability Office to Congress pursuant to
section 21 of Public Law 111-139, or a program related to a
program identified in the most recent Catalog of Federal
Domestic Assistance.
Disclosure of Directed Rulemaking
Pursuant to section 3(i) of H. Res. 5, 115th Cong. (2017),
the Committee estimates that H.R. 369, as amended, contains no
directed rulemaking that would require the Secretary to
prescribe regulations.
Section-by-Section Analysis of the Legislation
Section 1. Elimination of sunset of the Veterans Choice Program
Section 1 of the bill would amend section 101(p)(2) of the
Veterans Access, Choice, and Accountability Act of 2014 (Public
Law 113-146) by striking ``section 802'' and inserting a
period.
Section 2. Elimination of requirement to act as secondary payer for
care relating to non-service connected disabilities and
recovery of costs for certain care under Choice Program
Section 2(a) of the bill would amend section 101(e) of the
Veterans Access, Choice, and Accountability Act of 2014:
(1) in the subsection heading, by striking ``Other
Health-Care Plan'' and inserting ``Responsibility for
Costs of Certain Care'';
(2) in paragraph (1) in the paragraph heading, by
striking ``to secretary'' and inserting ``on health-
care plans'';
(3) by striking paragraphs (2) and (3);
(4) by redesignating paragraph (4) as paragraph (2);
and
(5) by adding at the end a new paragraph entitled,
``(3) Recovery of costs for certain care''. This new
paragraph would stipulate that in any case in which an
eligible veteran is furnished hospital care or medical
services under this Section for a non-service connected
disability or for a condition in which recovery is
authorized or with respect to which the United States
is deemed to be a third party beneficiary under the
Federal Medical Care Recovery Act (Public Law 87-693),
that the Secretary shall recover or collect from a
third party reasonable charges for such care or
services to the extent that the veteran or the provider
of the care or services would be eligible to receive
payment for such care or services from such third party
if the care or services had not been furnished by a
department or agency of the United States and that the
amounts collected by the Secretary under paragraph (A)
are required to be deposited in the Medical Community
Care account to remain available until expended.
Section 2(b) of the bill would provide a conforming
amendment to paragraph (1) of section 101(e) of the Veterans
Access, Choice, and Accountability Act of 2014, particularly by
striking ``paragraph (4)'' and inserting, ``paragraph (2)''.
Section 3. Authority to disclose certain medical records of veterans
who receive non-Department of Veterans Affairs health care
Section 3 of the bill would amend section 7332(b)(2) of
title 38, U.S.C., by adding a new paragraph (H).
Section 7332(b)(2)(H) would authorize VA to disclose
medical record information to a non-Department entity
(including private entities and other Federal agencies) that
provide hospital care or medical services to veterans and
stipulate that such an entity may not redisclose or use the
medical record information for a purpose other than that for
which the disclosure was made.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, and existing law in which no
change is proposed is shown in roman):
VETERANS ACCESS, CHOICE, AND ACCOUNTABILITY ACT OF 2014
* * * * * * *
TITLE I--IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT OF VETERANS
AFFAIRS PROVIDERS
SEC. 101. EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL SERVICES
FOR VETERANS THROUGH THE USE OF AGREEMENTS WITH
NON-DEPARTMENT OF VETERANS AFFAIRS ENTITIES.
(a) Expansion of Available Care and Services.--
(1) Furnishing of care.--
(A) In General.--Hospital care and medical
services under chapter 17 of title 38, United
States Code, shall be furnished to an eligible
veteran described in subsection (b), at the
election of such veteran, through agreements
authorized under subsection (d), or any other
law administered by the Secretary of Veterans
Affairs, with entities specified in
subparagraph (B) for the furnishing of such
care and services to veterans.
(B) Entities specified.--The entities
specified in this subparagraph are the
following:
(i) 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 program.
(ii) 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))).
(iii) The Department of Defense.
(iv) The Indian Health Service.
(v) Subject to subsection (d)(5), a
health care provider not otherwise
covered under any of clauses (i)
through (iv).
(2) Choice of provider.--An eligible veteran who
makes an election under subsection (c) to receive
hospital care or medical services under this section
may select a provider of such care or services from
among the entities specified in paragraph (1)(B) that
are accessible to the veteran.
(3) Coordination of care and services.--The Secretary
shall coordinate, through the Non-VA Care Coordination
Program of the Department of Veterans Affairs, the
furnishing of care and services under this section to
eligible veterans, including by ensuring that an
eligible veteran receives an appointment for such care
and services within the wait-time goals of the Veterans
Health Administration for the furnishing of hospital
care and medical services.
(b) Eligible Veterans.--A veteran is an eligible veteran for
purposes of this section if--
(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
(2) the veteran--
(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;
(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;
(C) resides--
(i) in a State without a medical
facility of the Department that
provides--
(I) hospital care;
(II) emergency medical
services; and
(III) surgical care rated by
the Secretary as having a
surgical complexity of
standard; and
(ii) more than 20 miles from a
medical facility of the Department
described in clause (i); or
(D)(i) resides in a location, other than a
location in Guam, American Samoa, or the
Republic of the Philippines, that is 40 miles
or less from a medical facility of the
Department, including a community-based
outpatient clinic; and
(ii)(I) is required to travel by air,
boat, or ferry to reach each medical
facility described in clause (i) that
is 40 miles or less from the residence
of the veteran; or
(II) faces an unusual or excessive
burden in traveling to such a medical
facility of the Department based on--
(aa) geographical challenges;
(bb) environmental factors,
such as roads that are not
accessible to the general
public, traffic, or hazardous
weather;
(cc) a medical condition that
impacts the ability to travel;
or
(dd) other factors, as
determined by the Secretary.
(c) Election and Authorization.--
(1) In general.--In the case of an eligible veteran
described in subsection (b)(2)(A), the Secretary shall,
at the election of the eligible veteran--
(A) provide the veteran an appointment that
exceeds the wait-time goals described in such
subsection or place such eligible veteran on an
electronic waiting list described in paragraph
(2) for an appointment for hospital care or
medical services the veteran has elected to
receive under this section; or
(B)(i) authorize that such care or services
be furnished to the eligible veteran under this
section for a period of time specified by the
Secretary; and
(ii) notify the eligible veteran by
the most effective means available,
including electronic communication or
notification in writing, describing the
care or services the eligible veteran
is eligible to receive under this
section.
(2) Electronic waiting list.--The electronic waiting
list described in this paragraph shall be maintained by
the Department and allow access by each eligible
veteran via www.myhealth.va.gov or any successor
website (or other digital channel) for the following
purposes:
(A) To determine the place of such eligible
veteran on the waiting list.
(B) To determine the average length of time
an individual spends on the waiting list,
disaggregated by medical facility of the
Department and type of care or service needed,
for purposes of allowing such eligible veteran
to make an informed election under paragraph
(1).
(d) Care and Services Through Agreements.--
(1) Agreements.--
(A) In general.--The Secretary shall enter
into agreements for furnishing care and
services to eligible veterans under this
section with entities specified in subsection
(a)(1)(B). An agreement entered into pursuant
to this subparagraph may not be treated as a
Federal contract for the acquisition of goods
or services and is not subject to any provision
of law governing Federal contracts for the
acquisition of goods or services. Before
entering into an agreement pursuant to this
subparagraph, the Secretary shall, to the
maximum extent practicable and consistent with
the requirements of this section, furnish such
care and services to such veterans under this
section with such entities pursuant to sharing
agreements, existing contracts entered into by
the Secretary, or other processes available at
medical facilities of the Department.
(B) Agreement defined.--In this paragraph,
the term ``agreement'' includes contracts,
intergovernmental agreements, and provider
agreements, as appropriate.
(2) Rates and reimbursement.--
(A) In general.--In entering into an
agreement under paragraph (1) with an entity
specified in subsection (a)(1)(B), the
Secretary shall--
(i) negotiate rates for the
furnishing of care and services under
this section; and
(ii) reimburse the entity for such
care and services at the rates
negotiated pursuant to clause (i) as
provided in such agreement.
(B) Limit on rates.--
(i) In general.--Except as provided
in clause (ii), rates negotiated under
subparagraph (A)(i) shall not be more
than the rates paid by the United
States to a provider of services (as
defined in section 1861(u) of the
Social Security Act (42 U.S.C.
1395x(u))) or a supplier (as defined in
section 1861(d) of such Act (42 U.S.C.
1395x(d))) under the Medicare program
under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.)
for the same care or services.
(ii) Exception.--
(I) In general.--The
Secretary may negotiate a rate
that is more than the rate paid
by the United States as
described in clause (i) with
respect to the furnishing of
care or services under this
section to an eligible veteran
who resides in a highly rural
area.
(II) Highly rural area
defined.--In this clause, 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.
(III) Other exceptions.--With
respect to furnishing care or
services under this section in
Alaska, the Alaska Fee Schedule
of the Department of Veterans
Affairs will be followed,
except for when another payment
agreement, including a contract
or provider agreement, is in
place. With respect to care or
services furnished under this
section in a State with an All-
Payer Model Agreement under the
Social Security Act that became
effective on January 1, 2014,
the Medicare payment rates
under clause (i) shall be
calculated based on the payment
rates under such agreement.
(C) Limit on collection.--For the furnishing
of care or services pursuant to an agreement
under paragraph (1), an entity specified in
subsection (a)(1)(B) may not collect any amount
that is greater than the rate negotiated
pursuant to subparagraph (A)(i).
(3) Certain procedures.--
(A) In general.--In entering into an
agreement under paragraph (1) with an entity
described in subparagraph (B), the Secretary
may use the procedures, including those
procedures relating to reimbursement, available
for entering into provider agreements under
section 1866(a) of the Social Security Act (42
U.S.C. 1395cc(a)) and participation agreements
under section 1842(h) of such Act (42 U.S.C.
1395u(h)). During the period in which such
entity furnishes care or services pursuant to
this section, such entity may not be treated as
a Federal contractor or subcontractor by the
Office of Federal Contract Compliance Programs
of the Department of Labor by virtue of
furnishing such care or services.
(B) Entities described.--The entities
described in this subparagraph are the
following:
(i) In the case of the Medicare
program, any provider of services that
has entered into a provider agreement
under section 1866(a) of the Social
Security Act (42 U.S.C. 1395cc(a)) and
any physician or other supplier who has
entered into a participation agreement
under section 1842(h) of such Act (42
U.S.C. 1395u(h)); and
(ii) In the case of the Medicaid
program, any provider participating
under a State plan under title XIX of
such Act (42 U.S.C. 1396 et seq.).
(4) Information on policies and procedures.--The
Secretary shall provide to any entity with which the
Secretary has entered into an agreement under paragraph
(1) the following:
(A) Information on applicable policies and
procedures for submitting bills or claims for
authorized care or services furnished to
eligible veterans under this section.
(B) Access to a telephone hotline maintained
by the Department that such entity may call for
information on the following:
(i) Procedures for furnishing care
and services under this section.
(ii) Procedures for submitting bills
or claims for authorized care and
services furnished to eligible veterans
under this section and being reimbursed
for furnishing such care and services.
(iii) Whether particular care or
services under this section are
authorized, and the procedures for
authorization of such care or services.
(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.
(e) [Other Health-Care Plan] Responsibility for Costs of
Certain Care.--
(1) Submittal of information [to secretary] on
health-care plans.--Before receiving hospital care or
medical services under this section, an eligible
veteran shall provide to the Secretary information on
any health-care plan described in [paragraph (4)]
paragraph (2) under which the eligible veteran is
covered.
[(2) Disclosure of information to non-department
entity.--Notwithstanding section 5701 of title 38,
United States Code, for purposes of furnishing hospital
care or medical services to an eligible veteran under
this section, the Secretary shall disclose to the
entity specified in paragraph (1)(B) of subsection (a)
with which the Secretary has entered into an agreement
described in such subsection--
[(A) whether the eligible veteran is covered
under a health-care plan described in paragraph
(4); and
[(B) whether the hospital care or medical
services sought by the eligible veteran is for
a medical condition that is related to a non-
service-connected disability described in
paragraph (3)(C).
[(3) Care for which the department is secondarily
responsible.--
[(A) In general.--If an eligible veteran is
covered under a health-care plan described in
paragraph (4) and receives hospital care or
medical services for a non-service-connected
disability described in subparagraph (C), such
health-care plan shall be primarily responsible
for paying for such care or services, to the
extent such care or services is covered by such
health-care plan, and the Secretary shall be
secondarily responsible for paying for such
care or services in accordance with
subparagraph (B)(ii).
[(B) Responsibility for costs of care.--In a
case in which the Secretary is secondarily
responsible for paying for hospital care or
medical services as described in subparagraph
(A)--
[(i) the health care provider that
furnishes such care or services
pursuant to an agreement described in
subsection (a) shall be responsible for
seeking reimbursement for the cost of
such care or services from the health-
care plan described in paragraph (4)
under which the eligible veteran is
covered; and
[(ii) the Secretary shall be
responsible for promptly paying only
the amount that is not covered by such
health-care plan, except that such
responsibility for payment may not
exceed the rate determined for such
care or services pursuant to subsection
(d)(2).
[(C) Non-service-connected disability
described.--A non-service-connected disability
described in this subsection is a non-service-
connected disability (as defined in section 101
of title 38, United States Code)--
[(i) that is incurred incident to a
veteran's employment and that is
covered under a workers' compensation
law or plan that provides for payment
for the cost of health care and
services provided to the veteran by
reason of the disability;
[(ii) that is incurred as the result
of a motor vehicle accident to which
applies a State law that requires the
owners or operators of motor vehicles
registered in that State to have in
force automobile accident reparations
insurance;
[(iii) that is incurred as the result
of a crime of personal violence that
occurred in a State, or a political
subdivision of a State, in which a
person injured as the result of such a
crime is entitled to receive health
care and services at such State's or
subdivision's expense for personal
injuries suffered as the result of such
crime;
[(iv) that is incurred by a veteran--
[(I) who does not have a
service-connected disability;
and
[(II) who is entitled to care
(or payment of the expenses of
care) under a health-care plan;
or
[(v) for which care and services are
furnished under this section to a
veteran who--
[(I) has a service-connected
disability; and
[(II) is entitled to care (or
payment of the expenses of
care) under a health-care
plan.]
[(4)] (2) Health-care plan.--A health-care plan
described in this paragraph--
(A) is an insurance policy or contract,
medical or hospital service agreement,
membership or subscription contract, or similar
arrangement not administered by the Secretary
of Veterans Affairs, under which health
services for individuals are provided or the
expenses of such services are paid; and
(B) does not include any such policy,
contract, agreement, or similar arrangement
pursuant to title XVIII or XIX of the Social
Security Act (42 U.S.C. 1395 et seq.) or
chapter 55 of title 10, United States Code.
(3) Recovery of costs for certain care.--
(A) In general.--In any case in which an
eligible veteran is furnished hospital care or
medical services under this section for a non-
service-connected disability described in
subsection (a)(2) of section 1729 of title 38,
United States Code, or for a condition for
which recovery is authorized or with respect to
which the United States is deemed to be a third
party beneficiary under Public Law 87-693,
commonly known as the ``Federal Medical Care
Recovery Act'' (42 U.S.C. 2651 et seq.), the
Secretary shall recover or collect from a third
party (as defined in subsection (i) of such
section 1729) reasonable charges for such care
or services to the extent that the veteran (or
the provider of the care or services) would be
eligible to receive payment for such care or
services from such third party if the care or
services had not been furnished by a department
or agency of the United States.
(B) Use of amounts.--Amounts collected by the
Secretary under subparagraph (A) shall be
deposited in the Medical Community Care account
of the Department. Amounts so deposited shall
remain available until expended.
(f) Veterans Choice Card.--
(1) In general.--For purposes of receiving care and
services under this section, the Secretary shall, not
later than 90 days after the date of the enactment of
this Act, issue to each veteran described in subsection
(b)(1) a card that may be presented to a health care
provider to facilitate the receipt of care or services
under this section.
(2) Name of card.--Each card issued under paragraph
(1) shall be known as a ``Veterans Choice Card''.
(3) Details of card.--Each Veterans Choice Card
issued to a veteran under paragraph (1) shall include
the following:
(A) The name of the veteran.
(B) An identification number for the veteran
that is not the social security number of the
veteran.
(C) The contact information of an appropriate
office of the Department for health care
providers to confirm that care or services
under this section are authorized for the
veteran.
(D) Contact information and other relevant
information for the submittal of claims or
bills for the furnishing of care or services
under this section.
(E) The following statement: ``This card is
for qualifying medical care outside the
Department of Veterans Affairs. Please call the
Department of Veterans Affairs phone number
specified on this card to ensure that treatment
has been authorized.''.
(4) Information on use of card.--Upon issuing a
Veterans Choice Card to a veteran, the Secretary shall
provide the veteran with information clearly stating
the circumstances under which the veteran may be
eligible for care or services under this section.
(g) Information on Availability of Care.--The Secretary shall
provide information to a veteran about the availability of care
and services under this section in the following circumstances:
(1) When the veteran enrolls in the patient
enrollment system of the Department under section 1705
of title 38, United States Code.
(2) When the veteran attempts to schedule an
appointment for the receipt of hospital care or medical
services from the Department but is unable to schedule
an appointment within the wait-time goals of the
Veterans Health Administration for the furnishing of
such care or services.
(3) When the veteran becomes eligible for hospital
care or medical services under this section under
subparagraph (B), (C), or (D) of subsection (b)(2).
(h) Follow-Up Care.--In carrying out this section, the
Secretary shall ensure that, at the election of an eligible
veteran who receives hospital care or medical services from a
health care provider in an episode of care under this section,
the veteran receives such hospital care and medical services
from such health care provider through the completion of the
episode of care, including all specialty and ancillary services
deemed necessary as part of the treatment recommended in the
course of such hospital care or medical services.
(i) Providers.--To be eligible to furnish care or services
under this section, a health care provider must--
(1) maintain at least the same or similar credentials
and licenses as those credentials and licenses that are
required of health care providers of the Department, as
determined by the Secretary for purposes of this
section; and
(2) submit, not less frequently than once each year
during the period in which the Secretary is authorized
to carry out this section pursuant to subsection (p),
verification of such licenses and credentials
maintained by such health care provider.
(j) Cost-Sharing.--
(1) In general.--The Secretary shall require an
eligible veteran to pay a copayment for the receipt of
care or services under this section only if such
eligible veteran would be required to pay a copayment
for the receipt of such care or services at a medical
facility of the Department or from a health care
provider of the Department pursuant to chapter 17 of
title 38, United States Code.
(2) Limitation.--The amount of a copayment charged
under paragraph (1) may not exceed the amount of the
copayment that would be payable by such eligible
veteran for the receipt of such care or services at a
medical facility of the Department or from a health
care provider of the Department pursuant to chapter 17
of title 38, United States Code.
(3) Collection of copayment.--A health care provider
that furnishes care or services to an eligible veteran
under this section shall collect the copayment required
under paragraph (1) from such eligible veteran at the
time of furnishing such care or services.
(k) Claims processing system.--
(1) In general.--The Secretary shall provide for an
efficient nationwide system for processing and paying
bills or claims for authorized care and services
furnished to eligible veterans under this section.
(2) Regulations.--Not later than 90 days after the
date of the enactment of this Act, the Secretary of
Veterans Affairs shall prescribe regulations for the
implementation of such system.
(3) Oversight.--The Chief Business Office of the
Veterans Health Administration shall oversee the
implementation and maintenance of such system.
(4) Accuracy of payment.--
(A) In general.--The Secretary shall ensure
that such system meets such goals for accuracy
of payment as the Secretary shall specify for
purposes of this section.
(B) Quarterly report.--
(i) In general.--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 quarterly report on
the accuracy of such system.
(ii) Elements.--Each report required
by clause (i) shall include the
following:
(I) A description of the
goals for accuracy for such
system specified by the
Secretary under subparagraph
(A).
(II) An assessment of the
success of the Department in
meeting such goals during the
quarter covered by the report.
(iii) Deadline.--The Secretary shall
submit each report required by clause
(i) not later than 20 days after the
end of the quarter covered by the
report.
(l) Medical Records.--
(1) In general.--The Secretary shall ensure that any
health care provider that furnishes care or services
under this section to an eligible veteran submits to
the Department a copy of any medical record related to
the care or services provided to such eligible veteran
by such health care provider for inclusion in the
electronic medical record of such eligible veteran
maintained by the Department upon the completion of the
provision of such care or services to such eligible
veteran.
(2) Electronic format.--Any medical record submitted
to the Department under paragraph (1) shall, to the
extent possible, be in an electronic format.
(m) Tracking of Missed Appointments.--The Secretary shall
implement a mechanism to track any missed appointments for care
or services under this section by eligible veterans to ensure
that the Department does not pay for such care or services that
were not furnished to an eligible veteran.
(n) Implementation.--Not later than 90 days after the date of
the enactment of this Act, the Secretary shall prescribe
interim final regulations on the implementation of this section
and publish such regulations in the Federal Register.
(o) Inspector General Report.--Not later than 30 days after
the date on which the Secretary determines that 75 percent of
the amounts deposited in the Veterans Choice Fund established
by section 802 have been exhausted, the Inspector General of
the Department shall submit to the Secretary a report on the
results of an audit of the care and services furnished under
this section to ensure the accuracy and timeliness of payments
by the Department for the cost of such care and services,
including any findings and recommendations of the Inspector
General.
(p) Authority To Furnish Care and Services.--
(1) In general.--The Secretary may not use the
authority under this section to furnish care and
services after the date specified in paragraph (2).
(2) Date specified.--The date specified in this
paragraph is the date on which the Secretary has
exhausted all amounts deposited in the Veterans Choice
Fund established by section 802[, or the date that is 3
years after the date of the enactment of this Act,
whichever occurs first.].
(3) Publication.--The Secretary shall publish such
date in the Federal Register and on an Internet website
of the Department available to the public not later
than 30 days before such date.
(q) Reports.--
(1) Initial report.--Not later than 90 days after the
publication of the interim final regulations under
subsection (n), 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 furnishing of care and
services under this section that includes the
following:
(A) The number of eligible veterans who have
received care or services under this section.
(B) A description of the types of care and
services furnished to eligible veterans under
this section.
(2) Final report.--Not later than 30 days after the
date on which the Secretary determines that 75 percent
of the amounts deposited in the Veterans Choice Fund
established by section 802 have been exhausted, 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
furnishing of care and services under this section that
includes the following:
(A) The total number of eligible veterans who
have received care or services under this
section, disaggregated by--
(i) eligible veterans described in
subsection (b)(2)(A);
(ii) eligible veterans described in
subsection (b)(2)(B);
(iii) eligible veterans described in
subsection (b)(2)(C); and
(iv) eligible veterans described in
subsection (b)(2)(D).
(B) A description of the types of care and
services furnished to eligible veterans under
this section.
(C) An accounting of the total cost of
furnishing care and services to eligible
veterans under this section.
(D) The results of a survey of eligible
veterans who have received care or services
under this section on the satisfaction of such
eligible veterans with the care or services
received by such eligible veterans under this
section.
(E) An assessment of the effect of furnishing
care and services under this section on wait
times for appointments for the receipt of
hospital care and medical services from the
Department.
(F) An assessment of the feasibility and
advisability of continuing furnishing care and
services under this section after the
termination date specified in subsection (p).
(r) Rule of Construction.--Nothing in this section shall be
construed to alter the process of the Department for filling
and paying for prescription medications.
(s) Wait-Time Goals of the Veterans Health Administration.--
(1) In general.--Except as provided in paragraph (2),
in this section, the term ``wait-time goals of the
Veterans Health Administration'' means not more than 30
days from the date on which a veteran requests an
appointment for hospital care or medical services from
the Department.
(2) Alternate goals.--If the Secretary submits to
Congress, not later than 60 days after the date of the
enactment of this Act, a report stating that the actual
wait-time goals of the Veterans Health Administration
are different from the wait-time goals specified in
paragraph (1)--
(A) for purposes of this section, the wait-
time goals of the Veterans Health
Administration shall be the wait-time goals
submitted by the Secretary under this
paragraph; and
(B) the Secretary shall publish such wait-
time goals in the Federal Register and on an
Internet website of the Department available to
the public.
(t) Waiver of Certain Printing Requirements.--Section 501 of
title 44, United States Code, shall not apply in carrying out
this section.
* * * * * * *
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TITLE 38, UNITED STATES CODE
* * * * * * *
PART V--BOARDS, ADMINISTRATIONS, AND SERVICES
* * * * * * *
CHAPTER 73--VETERANS HEALTH ADMINISTRATION - ORGANIZATION AND FUNCTIONS
* * * * * * *
SUBCHAPTER III--PROTECTION OF PATIENT RIGHTS
* * * * * * *
Sec. 7332. Confidentiality of certain medical records
(a)(1) Records of the identity, diagnosis, prognosis, or
treatment of any patient or subject which are maintained in
connection with the performance of any program or activity
(including education, training, treatment, rehabilitation, or
research) relating to drug abuse, alcoholism or alcohol abuse,
infection with the human immunodeficiency virus, or sickle cell
anemia which is carried out by or for the Department under this
title shall, except as provided in subsections (e) and (f), be
confidential, and (section 5701 of this title to the contrary
notwithstanding) such records may be disclosed only for the
purposes and under the circumstances expressly authorized under
subsection (b).
(2) Paragraph (1) prohibits the disclosure to any person or
entity other than the patient or subject concerned of the fact
that a special written consent is required in order for such
records to be disclosed.
(b)(1) The content of any record referred to in subsection
(a) may be disclosed by the Secretary in accordance with the
prior written consent of the patient or subject with respect to
whom such record is maintained, but only to such extent, under
such circumstances, and for such purposes as may be allowed in
regulations prescribed by the Secretary.
(2) Whether or not any patient or subject, with respect to
whom any given record referred to in subsection (a) is
maintained, gives written consent, the content of such record
may be disclosed by the Secretary as follows:
(A) To medical personnel to the extent necessary to
meet a bona fide medical emergency.
(B) To qualified personnel for the purpose of
conducting scientific research, management audits,
financial audits, or program evaluation, but such
personnel may not identify, directly or indirectly, any
individual patient or subject in any report of such
research, audit, or evaluation, or otherwise disclose
patient or subject identities in any manner.
(C)(i) In the case of any record which is maintained
in connection with the performance of any program or
activity relating to infection with the human
immunodeficiency virus, to a Federal, State, or local
public-health authority charged under Federal or State
law with the protection of the public health, and to
which Federal or State law requires disclosure of such
record, if a qualified representative of such authority
has made a written request that such record be provided
as required pursuant to such law for a purpose
authorized by such law.
(ii) A person to whom a record is disclosed under
this paragraph may not redisclose or use such record
for a purpose other than that for which the disclosure
was made.
(D) If authorized by an appropriate order of a court
of competent jurisdiction granted after application
showing good cause therefor. In assessing good cause
the court shall weigh the public interest and the need
for disclosure against the injury to the patient or
subject, to the physician-patient relationship, and to
the treatment services. Upon the granting of such
order, the court, in determining the extent to which
any disclosure of all or any part of any record is
necessary, shall impose appropriate safeguards against
unauthorized disclosure.
(E) To an entity described in paragraph (1)(B) of
section 5701(k) of this title, but only to the extent
authorized by such section.
(F)(i) To a representative of a patient who lacks
decision-making capacity, when a practitioner deems the
content of the given record necessary for that
representative to make an informed decision regarding
the patient's treatment.
(ii) In this subparagraph, the term
``representative'' means an individual, organization,
or other body authorized under section 7331 of this
title and its implementing regulations to give informed
consent on behalf of a patient who lacks decision-
making capacity.
(G) To a State controlled substance monitoring
program, including a program approved by the Secretary
of Health and Human Services under section 399O of the
Public Health Service Act (42 U.S.C. 280g-3), to the
extent necessary to prevent misuse and diversion of
prescription medicines.
(H)(i) To a non-Department entity (including private
entities and other Federal agencies) that provides
hospital care or medical services to veterans.
(ii) An entity to which a record is disclosed under
this subparagraph may not redisclose or use such record
for a purpose other than that for which the disclosure
was made.
(3) In the event that the patient or subject who is the
subject of any record referred to in subsection (a) is
deceased, the content of any such record may be disclosed by
the Secretary only upon the prior written request of the next
of kin, executor, administrator, or other personal
representative of such patient or subject and only if the
Secretary determines that such disclosure is necessary for such
survivor to obtain benefits to which such survivor may be
entitled, including the pursuit of legal action, but then only
to the extent, under such circumstances, and for such purposes
as may be allowed in regulations prescribed pursuant to section
7334 of this title.
(c) Except as authorized by a court order granted under
subsection (b)(2)(D), no record referred to in subsection (a)
may be used to initiate or substantiate any criminal charges
against, or to conduct any investigation of, a patient or
subject.
(d) The prohibitions of this section shall continue to apply
to records concerning any person who has been a patient or
subject, irrespective of whether or when such person ceases to
be a patient.
(e) The prohibitions of this section shall not prevent any
interchange of records--
(1) within and among those components of the
Department furnishing health care to veterans, or
determining eligibility for benefits under this title;
or
(2) between such components furnishing health care to
veterans and the Armed Forces.
(f)(1) Notwithstanding subsection (a) but subject to
paragraph (2), a physician or a professional counselor may
disclose information or records indicating that a patient or
subject is infected with the human immunodeficiency virus if
the disclosure is made to (A) the spouse of the patient or
subject, or (B) to an individual whom the patient or subject
has, during the process of professional counseling or of
testing to determine whether the patient or subject is infected
with such virus, identified as being a sexual partner of such
patient or subject.
(2)(A) A disclosure under paragraph (1) may be made only if
the physician or counselor, after making reasonable efforts to
counsel and encourage the patient or subject to provide the
information to the spouse or sexual partner, reasonably
believes that the patient or subject will not provide the
information to the spouse or sexual partner and that the
disclosure is necessary to protect the health of the spouse or
sexual partner.
(B) A disclosure under such paragraph may be made by a
physician or counselor other than the physician or counselor
referred to in subparagraph (A) if such physician or counselor
is unavailable by reason of absence or termination of
employment to make the disclosure.
(g) Any person who violates any provision of this section or
any regulation issued pursuant to this section shall be fined,
in the case of a first offense, up to the maximum amount
provided under section 5701(f) of this title for a first
offense under that section and, in the case of a subsequent
offense, up to the maximum amount provided under section
5701(f) of this title for a subsequent offense under that
section.
* * * * * * *
MINORITY VIEWS
We interpret section 1 of H.R. 369 as amended, as granting
the VA Secretary the authority to spend only the remaining
funds in the Veterans Choice Fund under section 802 of the
Veterans Access, Choice, and Accountability Act of 2014 (Choice
Act).\1\ Section 1 does not grant authorization to appropriate
funds in section 802 of the Choice Act, or grant the VA
Secretary the authority to obligate funds for the Veterans
Choice Program under section 101 of the Choice Act from other
existing medical care accounts including the separate account
for medical community care established under section 4003 of
the Surface Transportation and Veterans Health Care Choice
Improvement Act of 2015.\2\
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\1\P.L. 113-146
\2\P.L. 114-41
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We are pleased that our amendment to H.R. 369 was
considered and adopted in full Committee markup. This showing
of bipartisanship demonstrates that when we work together as a
Committee, we can champion meaningful policies that help our
veterans.
Timothy J. Walz.
Mark Takano.
Scott H. Peters.
Julia Brownley.
Kathleen M. Rice.
Ann M. Kuster.
J. Luis Correa.
Elizabeth H. Esty.
[all]