MODIFICATIONS TO ACCESS STANDARDS FOR CARE FURNISHED THROUGH COMMUNITY CARE PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS.

SEC. 125. MODIFICATIONS TO ACCESS STANDARDS FOR CARE FURNISHED THROUGH COMMUNITY CARE PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS.(a) Access Standards.—Section 1703B of title 38, United States Code, is amended—(1) by striking subsections (f) and (g) and inserting the following:“(f)(1) Subject to paragraph (3), the Secretary shall meet the access standards established under subsection (a) when furnishing hospital care, medical services, or extended care services to a covered veteran under section 1703 of this title and shall ensure that meeting such access standards is reflected in the contractual requirements of Third Party Administrators. “(2) The Secretary shall ensure that health care providers specified under section 1703(c) of this title are able to comply with the access standards established under subsection (a) for such providers.136 STAT. 5417 “(3)(A) A Third Party Administrator may request a waiver to the requirement under this subsection to meet the access standards established under subsection (a) if—“(i)(I) the scarcity of available providers or facilities in the region precludes the Third Party Administrator from meeting those access standards; or “(II) the landscape of providers or facilities has changed, and certain providers or facilities are not available such that the Third Party Administrator is not able to meet those access standards; and “(ii) to address the scarcity of available providers or the change in the provider or facility landscape, as the case may be, the Third Party Administrator has contracted with other providers or facilities that may not meet those access standards but are the currently available providers or facilities most accessible to veterans within the region of responsibility of the Third Party Administrator. “(B) Any waiver requested by a Third Party Administrator under subparagraph (A) must be requested in writing and submitted to the Office of Integrated Veteran Care of the Department for approval by that office. “(C) As part of any waiver request under subparagraph (A), a Third Party Administrator must include conclusive evidence and documentation that the access standards established under subsection (a) cannot be met because of scarcity of available providers or changes to the landscape of providers or facilities. “(D) In evaluating a waiver request under subparagraph (A), the Secretary shall consider the following:“(i) The number and geographic distribution of eligible health care providers available within the geographic area and specialty referenced in the waiver request. “(ii) The prevailing market conditions within the geographic area and specialty referenced in the waiver request, which shall include the number and distribution of health care providers contracting with other health care plans (including commercial plans and the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.)) operating in the geographic area and specialty referenced in the waiver request. “(iii) Whether the service area is comprised of highly rural, rural, or urban areas or some combination of such areas. “(iv) How significantly the waiver request differs from the access standards established under subsection (a). “(v) The rates offered to providers in the geographic area covered by the waiver. “(E) The Secretary shall not consider inability to contract as a valid sole rationale for granting a waiver under subparagraph (A). “(g)(1) The Secretary shall publish in the Federal Register and on a publicly available internet website of the Department the designated access standards established under this section for purposes of section 1703(d)(1)(D) of this title. “(2) The Secretary shall publish on a publicly available internet website of the Department the access standards established under subsection (a).” ; and (2) in subsection (i), by adding at the end the following new paragraphs:136 STAT. 5418 “(3) The term ‘inability to contract’, with respect to a Third Party Administrator, means the inability of the Third Party Administrator to successfully negotiate and establish a community care network contract with a provider or facility. “(4) 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 this title.” . (b) Prevention of Suspension of Veterans Community Care Program.—Section 1703(a) of such title is amended by adding at the end the following new paragraph:“(4) Nothing in this section shall be construed to authorize the Secretary to suspend the program established under paragraph (1).” .