119-s1868

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 1868 Introduced in Senate

    (IS) ]

<DOC>

119th CONGRESS
 1st Session
 S. 1868

To amend title 38, United States Code, to expand access by veterans to 
 critical access hospitals and affiliated clinics under the Veterans 
 Community Care Program, and for other purposes.

_______________________________________________________________________

 IN THE SENATE OF THE UNITED STATES

 May 22, 2025

Mr. Cramer (for himself and Mr. Sheehy) introduced the following bill; 
which was read twice and referred to the Committee on Veterans' Affairs

_______________________________________________________________________

 A BILL

To amend title 38, United States Code, to expand access by veterans to 
 critical access hospitals and affiliated clinics under the Veterans 
 Community Care Program, and for other purposes.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Critical Access for Veterans Care 
Act''.

SEC. 2. EXPANSION OF ACCESS BY VETERANS TO CRITICAL ACCESS HOSPITALS 
 AND AFFILIATED CLINICS UNDER VETERANS COMMUNITY CARE 
 PROGRAM.

    (a) In General.--Subsection
            (d) (1) of 

section 1703 of title 38, 
United States Code, is amended--

    (1) in subparagraph
            (D) , by striking ``; or'' and inserting 
 a semicolon;

    (2) in subparagraph
        (E) , by striking the period at the end 
 and inserting ``; or''; and

    (3) by adding at the end the following new subparagraph:
 ``
        (F) with respect to care or services sought by a covered veteran 
at a critical access hospital or provider-based rural health clinic 
affiliated with such hospital (including any care or services sought 
from a health care provider specified in subsection
            (c) located in the 
surrounding community of such hospital or clinic due to a referral from 
such hospital or clinic), the veteran resides within 35 miles of such 
hospital or clinic.''.

    (b) Prior Authorization and Referral.--Such section is further 
amended--

    (1) in subsection

    (a)

    (3) , by striking ``A covered veteran'' 
 and inserting ``Except as provided in subsection
            (d) (5) , a 
 covered veteran''; and

    (2) in subsection
            (d) , by adding at the end the following 
 new paragraph:
 ``

    (5) The Secretary may not require a covered veteran to receive 
authorization or a referral prior to the receipt of care or services 
under paragraph

    (1)
        (F) .''.
            (c) Payment Rate and Claims for Care and Services.--Subsection
            (i) of such section is amended by adding at the end the following new 
paragraph:
 ``

    (7)
        (A) With respect to care or services furnished under this 
section--
 ``
            (i) at a critical access hospital, including pursuant to 
 subsection
            (d) (1)
        (F) , the critical access hospital rate 
 established under the Medicare program under title XVIII of the 
 Social Security Act (42 U.S.C. 1395 et seq.) shall apply 
 instead of the service-based rate; and
 ``
            (ii) at a provider-based rural health clinic affiliated 
 with such hospital, including pursuant to subsection
            (d) (1)
        (F) , 
 the rate specified under 

section 1833 of the Social Security 
 Act (42 U.S.C. 1395l) shall apply.
 ``
        (B) Claims for covered veterans receiving care under subsection
            (d) (1)
        (F) shall include an identifier denoting the care or services 
provided under such subsection and shall be reimbursed at the cost-
based level under the Medicare program.
 ``
            (C) The Secretary, in consultation with the Administrator of the 
Centers for Medicare & Medicaid Services, may furnish additional 
guidance regarding the claims process under this paragraph in 
accordance with the best practices of medicare administrative 
contractors (as defined in 

section 1874A

    (a)

    (3) of the Social Security 
Act (42 U.S.C. 1395kk-1

    (a)

    (3) )) in processing cost-based reimbursement 
for services furnished at critical access hospitals or provider-based 
rural health clinics affiliated with such hospitals.
 ``
            (D) Claims for covered veterans receiving care under subsection
            (d) (1)
        (F) shall be reviewed and payment shall be issued in accordance 
with the findings of such review not later than 60 days after the 
submission of the claim.''.
            (d) === Definitions. ===
-Subsection

    (o) of such section is amended--

    (1) by redesignating paragraph

    (2) as paragraph

    (3) ; and

    (2) by inserting after paragraph

    (1) the following new 
 paragraph

    (2) :
 ``

    (2) The term `critical access hospital' has the meaning 
 given that term in 

section 1861
            (mm) of the Social Security Act 
 (42 U.S.C. 1395x
            (mm) ).''.

    (e) Report.--

    (1) In general.--Not later than one year after the date of 
 the enactment of this Act, the Secretary of Veterans Affairs 
 shall submit to Congress a report on third party administrators 
 and community care providers concerning the implementation of 
 the amendments made by this section, including timely approval 
 and payment of claims under 

section 1703
            (d) (1)
        (F) , as added by 
 subsection

    (a) , and overall user experience associated with 
 care or services provided pursuant to such amendments.

    (2) === Definitions. ===
-In this subsection:
        (A) Community care provider.--The term ``community 
 care provider'' means a health care provider specified 
 in paragraph

    (1) or

    (5) of 

section 1703
            (c) of title 38, 
 United States Code.
        (B) Third party administrator.--The term ``third 
 party administrator'' means an entity that manages a 
 provider network and performs administrative services 
 related to such network within the Veterans Community 
 Care Program under 

section 1703 of title 38, United 
 States Code.
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