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Updates to contracting requirements under Veterans Community Care Program

Title VI: Veterans’ Assuring Critical Care Expansions to Support Servicemembers · Subtitle A: Improvement of Veterans Community Care Program

Plain-language summaryAI

Contracts under the Veterans Community Care Program can be ended if a provider fails to meet contract terms, is excluded from federal health programs, has serious legal convictions, or if ending the contract better serves veterans' health needs. Providers who are ineligible may be publicly listed, and contracts must include requirements for legal compliance, provider accreditation, qualified staff, and proof of licensure for specialized services. Waivers for certain exclusions can be granted for one year but must be reported to Congress.

AI-generated from this section’s text — a quick orientation, not a substitute for the full text below. Not legal advice.

Section Text · Sec. 609.
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(1)

in paragraph (3)—

(A)

by amending subparagraph (A) to read as follows:

(A)

The Secretary may terminate a contract with an entity entered into under paragraph (1) at such time and upon such notice to the entity as the Secretary may specify for purposes of this section, if the Secretary notifies the appropriate committees of Congress that, at a minimum—

(i)

the entity failed to comply substantially with the provisions of the contract or with the provisions of this section and the regulations prescribed under this section, including with respect to access, quality, training, and medical documentation;

(ii)

it is reasonable to terminate the contract based on the health care needs of veterans; or

(iii)

it is reasonable to terminate the contract based on coverage provided by contracts or sharing agreements entered into under authorities other than this section.

(B)

by redesignating subparagraph (B) as subparagraph (D);

(C)

by inserting after subparagraph (A) the following new subparagraphs:

(B)
(i)

The Secretary shall terminate a contract with an entity entered into under paragraph (1) at such a time and upon such notice to the entity as the Secretary may specify for the purposes of this section, if the entity—

(ii)

The Secretary may issue a waiver for entities subject to clause (i) for a one-year period, and such a waiver shall be reported to Congress not later than 30 days after such waiver is issued.

(C)

Any entities ineligible to enter into contracts with the Department due to one or more reasons specified in this paragraph may be listed on a publicly available website of the Department or appropriate third party administrator.

(D)

in subparagraph (D), as redesignated by subparagraph (B) of this paragraph, by striking in subparagraph (A) and inserting in this paragraph ; and

(2)

by adding at the end the following new paragraph:

(7)

Any contract or agreement between the Department and a third party administrator or between a third party administrator and a health care provider specified in subsection (c) that is made with respect to care or services provided under this section shall include—

(A)

notice of obligations to comply with Federal laws and the consequences for failure to comply with those laws, including specific information regarding claims for payment and consequences for any false claims, statements, or documents, or concealment of a material fact;

(B)

confirmation by the health care provider that they are accredited to provide any specialized services subject to the contract or agreement and that they will only use qualified staff to provide those services; and

(C)

confirmation that the health care provider will identify any individuals providing specialized services or treatments included in the contract or agreement and provide proof of the licensure of those individuals to the Department.