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Requirements relating to quality of community care providers

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

Plain-language summaryAI

The Department of Veterans Affairs must ensure that community care providers are regularly checked against exclusion lists to prevent those with quality of care issues from participating in the Veterans Community Care Program. It requires updating provider information quarterly, removing providers who are excluded or have left VA employment under investigation, and developing processes to identify and exclude providers terminated or resigning due to quality concerns. The section also mandates revising procedures to improve automated matching of provider data with exclusion systems.

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Section Text · Sec. 611.
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(a) Monthly checks against list of excluded individuals or entities

The Secretary of Veterans Affairs shall ensure that third party administrators under the Veterans Community Care Program perform automated monthly checks for all community care providers against the list of excluded individuals or entities set forth by the Office of Inspector General of the Department of Health and Human Services using national provider identifier records or other unique identifiers.

(b) Revision of provider exclusion standard operating procedures

Not later than 90 days after the date of the enactment of this Act, the Secretary shall ensure that the Office of Integrated Veteran Care or successor office revises its provider exclusion standard operating procedures to require automated matching of community care providers in the provider profile management system of the Department of Veterans Affairs to the system for award management exclusions of the General Services Administration using both taxpayer identification number and national provider identifier as identifiers.

(c) Process to identify department providers terminated or resigning from employment

Not later than 90 days after the date of the enactment of this Act, the Secretary shall ensure that the Under Secretary for Health of the Department of Veterans Affairs develops a process to identify health care providers that are terminated, retire, or resign from employment with the Department for quality of care concerns or while under investigation for quality of care concerns so those health care providers can be prevented from participating in the Veterans Community Care Program.

(d) Update of information on providers

Not later than one year after the date of the enactment of this Act, the Secretary, through the Office of Integrated Veteran Care or successor office, shall develop a process to ensure that third party administrators regularly, not less frequently than quarterly—

(1)

update their lists of community care providers to reflect accurate provider contact information;

(2)

annotate providers that are not currently accepting patients under the Veterans Community Care Program; and

(3)

remove providers from the provider profile management system that—

(A)

are on the list of excluded individuals or entities set forth by the Office of Inspector General of the Department of Health and Human Services;

(B)

are in the system for award management exclusions of the General Services Administration; or

(C)

have been terminated from employment with the Department of Veterans Affairs due to quality of care concerns or left such employment voluntarily, through resignation, or through retirement, while under investigation for quality of care concerns.

(e) Definitions

In this section:

(1) Community care provider

The term community care provider means a health care provider specified under section 1703(c) of title 38, United States Code.

(2) Veterans Community Care Program

The term Veterans Community Care Program means the Veterans Community Care Program under section 1703 of title 38, United States Code.