Critical Access for Veterans Care Act

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

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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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