S. 1868

[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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