Veterans Choice Improvement Act of 2016

Veterans Choice Improvement Act of 2016

This bill codifies, revises, and makes permanent the Veterans Choice Program (VCP) of the Department of Veterans Affairs (VA).

The VCP is enlarged to include additional health care providers that meet specified VA criteria.

Veterans eligibility provisions are revised, including by:

• eliminating the August 1, 2014, deadline for enrollment in the VA patient enrollment system;
• requiring that a veteran does not live within 40 miles driving distance of a VA medical facility with a full-time primary care physician or within 20 miles of a VA medical facility that provides hospital care, emergency medical services, and surgical care rated as having a surgical complexity of standard; and
• providing eligibility for a veteran enrolled in the VCP pilot program that provides hospital or medical care through qualifying non-VA health care providers to veterans in highly rural areas.

Medical service rate exceptions are provided for: (1) highly rural areas, (2) Alaska, and (3) states that have an All-Payer Model Agreement.

The VA shall provide for a nationwide claims processing system.

The following VA programs, contracts, and agreements shall be consolidated into the VCP by December 31, 2017:

• the patient-centered community care program;
• contracts for kidney dialysis services;
• contracts through the retail VA pharmacy network; and
• health care agreements with federal entities or federally-funded entities, including the Department of Defense, the Indian Health Service, tribal health programs, federally-qualified health centers, and academic teaching affiliates.

VCP funds shall be derived from the appropriations account established under the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015.

The VA shall ensure that VCP health care provider payments comply with the Prompt Payment Act and the requirements of this bill.

VCP claims, with a limited exception, must be submitted electronically as of January 1, 2019. The VA shall establish an electronic claims interface by such date.

This bill terminates certain provisions authorizing medical care through non-VA facilities.

The Veterans' Mental Health and Other Care Improvements Act of 2008 is amended to extend the pilot program under which the VA provides covered health services in highly rural areas to covered veterans through qualifying non-VA health care providers.

The VA may, if unable to furnish hospital care, medical services, or extended care at VA facilities or under other authorized contracts or sharing agreements, enter into a Veterans Care Agreement with an eligible provider to furnish such care and services.

An eligible provider is:

• a physician, supplier, or service provider that has entered into an agreement under the Social Security Act;
• a provider of items and services receiving payments under a state Medicaid plan;
• an aging and disability resource center, an area agency on aging, or a center for independent living; or
• a provider located in a health shortage area.

The VA shall reimburse an ambulance provider or other entity that provides emergency transportation to a non-VA facility for a veteran who is an active VA health care participant who is personally liable for emergency treatment in a non-VA facility.

A veteran seeking VA hospital care or medical services shall provide the VA with information about other health plan coverage.

If the VA establishes or has established a presumption of service connection for disability compensation for a specified illness/condition incurred by a veteran who served at Camp Lejeune, North Carolina, the VA shall commence payment of such compensation within 90 days of: (1) establishing such presumption, or (2) enactment of this bill for such a presumption established prior to enactment.