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38 U.S.C. § 1703F — Credentialing verification requirements for providers of non-Department health care services
Federal law — U.S. Code and appendices · legal_authorities
**(a) In General.—** The Secretary shall ensure that Third Party Administrators and credentials verification organizations comply with the requirements specified in subsection (b) to help ensure certain health care providers are excluded from providing non-Department health care services.
**(b) Requirements Specified.—** The Secretary shall require Third Party Administrators and credentials verification organizations to carry out the following:
(1) Hold and maintain an active credential verification accreditation from a national health care accreditation body.
(2) Conduct initial verification of provider history and license sanctions for all States and United States territories for a period of time—
(A) that includes the period before the provider began providing non-Department health care services; and
(B) dating back not less than 10 years.
(3) Not less frequently than every three years, perform recredentialing, including verifying provider history and license sanctions for all States and United States territories.
(4) Implement continuous monitoring of each provider through the National Practitioner Data Bank established pursuant to the Health Care Quality Improvement Act of 1986 ([42 U.S.C. 11101](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section11101&num=0&edition=prelim) et seq.).
(5) Perform other forms of credentialing verification as the Secretary considers appropriate.
**(c) Definitions.—** In this section:
(1) The term “credentials verification organization” means an entity that manages the provider credentialing process and performs credentialing verification for non-Department providers that participate in the Veterans Community Care Program under [section 1703 of this title](https://uscode.house.gov/view.xhtml?req=g
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Source location: Title 38, Chapter 17, § 1703F; chapter-017-hospital-nursing-home-domiciliary-and-medical-care.md
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**(a) In General.—** The Secretary shall ensure that Third Party Administrators and credentials verification organizations comply with the requirements specified in subsection (b) to help ensure certain health care providers are excluded from providing non-Department health care services.
**(b) Requirements Specified.—** The Secretary shall require Third Party Administrators and credentials verification organizations to carry out the following:
(1) Hold and maintain an active credential verification accreditation from a national health care accreditation body.
(2) Conduct initial verification of provider history and license sanctions for all States and United States territories for a period of time—
(A) that includes the period before the provider began providing non-Department health care services; and
(B) dating back not less than 10 years.
(3) Not less frequently than every three years, perform recredentialing, including verifying provider history and license sanctions for all States and United States territories.
(4) Implement continuous monitoring of each provider through the National Practitioner Data Bank established pursuant to the Health Care Quality Improvement Act of 1986 ([42 U.S.C. 11101](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section11101&num=0&edition=prelim) et seq.).
(5) Perform other forms of credentialing verification as the Secretary considers appropriate.
**(c) Definitions.—** In this section:
(1) The term “credentials verification organization” means an entity that manages the provider credentialing process and performs credentialing verification for non-Department providers that participate in the Veterans Community Care Program under [section 1703 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1703&num=0&edition=prelim) through a Veterans Care Agreement.
(2) 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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1703&num=0&edition=prelim).
(3) The term “Veterans Care Agreement” means an agreement for non-Department health care services entered into under [section 1703A of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1703a&num=0&edition=prelim).
(4) The term “non-Department health care services” means services—
(A) provided under this subchapter at non-Department facilities (as defined in [section 1701 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1701&num=0&edition=prelim));
(B) provided under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; [38 U.S.C. 1701](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1701&num=0&edition=prelim) note);
(C) purchased through the Medical Community Care account of the Department; or
(D) purchased with amounts deposited in the Veterans Choice Fund under section 802 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; [38 U.S.C. 1701](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1701&num=0&edition=prelim) note).
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Annual reports to Congress** The Secretary shall report to Congress, annually during the three years after November 14, 1986, on the implementation of this chapter.
**(b) Memoranda of understanding** The Secretary of Health and Human Services shall seek to enter into memoranda of understanding with the Secretary of Defense and the Administrator of Veterans’ Affairs to apply the provisions of subchapter II of this chapter to hospitals and other facilities and health care providers under the jurisdiction of the Secretary or Administrator, respectively. The Secretary shall report to Congress, not later than two years after November 14, 1986, on any such memoranda and on the cooperation among such officials in establishing such memoranda.
**(c) Memorandum of understanding with Drug Enforcement Administration** The Secretary of Health and Human Services shall seek to enter into a memorandum of understanding with the Administrator of Drug Enforcement relating to providing for the reporting by the Administrator to the Secretary of information respecting physicians and other practitioners whose registration to dispense controlled substances has been suspended or revoked under [section 824 of title 21](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title21-section824&num=0&edition=prelim). The Secretary shall report to Congress, not later than two years after November 14, 1986, on any such memorandum and on the cooperation between the Secretary and the Administrator in establishing such a memorandum.
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 11101
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Federal law — U.S. Code and appendices · legal_authorities
**(a) In General.—**
(1) There is established a program to furnish hospital care, medical services, and extended care services to covered veterans through health care providers specified in subsection (c).
(2) The Secretary shall coordinate the furnishing of hospital care, medical services, and extended care services under this section to covered veterans, including coordination of, at a minimum, the following:
(A) Ensuring the scheduling of medical appointments in a timely manner and the establishment of a mechanism to receive medical records from non-Department providers.
(B) Ensuring continuity of care and services.
(C) Ensuring coordination among regional networks if the covered veteran accesses care and services in a different network than the regional network in which the covered veteran resides.
(D) Ensuring that covered veterans do not experience a lapse in care resulting from errors or delays by the Department or its contractors or an unusual or excessive burden in accessing hospital care, medical services, or extended care services.
(3) A covered veteran may only receive care or services under this section upon the authorization of such care or services by the Secretary.
(4) Nothing in this section shall be construed to authorize the Secretary to suspend the program established under paragraph (1).
**(b) Covered Veterans.—** For purposes of this section, a covered veteran is any veteran who—
(1) is enrolled in the system of annual patient enrollment established and operated under [section 1705 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1705&num=0&edition=prelim); or
(2) is not enrolled in such system but is otherwise entitled to hospital care, medical services, or extended care services under s
Source: Supplied U.S. Code snapshot — release unconfirmed · 38 U.S.C. § 1703
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Federal law — U.S. Code and appendices · legal_authorities
For the purposes of this chapter—
(1) The term “disability” means a disease, injury, or other physical or mental defect.
(2) The term “veteran of any war” includes any veteran awarded the Medal of Honor.
(3) The term “facilities of the Department” means—
(A) facilities over which the Secretary has direct jurisdiction;
(B) Government facilities for which the Secretary contracts; and
(C) public or private facilities at which the Secretary provides recreational activities for patients receiving care under [section 1710 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1710&num=0&edition=prelim).
(4) The term “non-Department facilities” means facilities other than Department facilities.
(5) The term “hospital care” includes—
(A)
(i) medical services rendered in the course of the hospitalization of any veteran, and (ii) travel and incidental expenses pursuant to the provisions of [section 111 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section111&num=0&edition=prelim);
(B) such mental health services, consultation, professional counseling, marriage and family counseling, and training for the members of the immediate family or legal guardian of a veteran, or the individual in whose household such veteran certifies an intention to live, as the Secretary considers appropriate for the effective treatment and rehabilitation of a veteran or dependent or survivor of a veteran receiving care under the last sentence of [section 1781(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1781/b&num=0&edition=prelim); and
(C)
(i) medical services rendered in the course of the hospitalization of a dependent or survivor of a veteran rece
Source: Supplied U.S. Code snapshot — release unconfirmed · 38 U.S.C. § 1701
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Federal law — U.S. Code and appendices · legal_authorities
Page 266
TITLE 38—VETERANS’ BENEFITS
§ 1701
1999—Pub. L. 106–117, title I, §§ 101(a)(2), (c)(2),
111(b)(2), title II, § 202(b), Nov. 30, 1999, 113 Stat. 1548,
1549, 1556, 1561, added items 1710A, 1710B, 1725, and 1729B.
1998—Pub. L. 105–368, title IX, § 901(b), Nov. 11, 1998,
112 Stat. 3360, added item 1720E.
1997—Pub. L. 105–114, title II, §§ 202(d), 206(b)(3), Nov.
21, 1997, 111 Stat. 2287, 2289, substituted ‘‘Treatment and
rehabilitative services for persons with drug or alcohol
dependency’’ for ‘‘Treatment and rehabilitation for al-
cohol or drug dependence or abuse disabilities’’ in item
1720A, struck out ‘‘: pilot program’’ after ‘‘home care’’
in item 1720C, and added item for subchapter VII and
items 1771 to 1774.
Pub. L. 105–33, title VIII, § 8023(a)(2), Aug. 5, 1997, 111
Stat. 667, added item 1729A.
Pub. L. 105–12, § 9(i)(2), Apr. 30, 1997, 111 Stat. 27, added
item 1707.
1996—Pub. L. 104–262, title I, §§ 101(c)(2)(B), 104(a)(2),
Oct. 9, 1996, 110 Stat. 3179, 3184, added items 1705 and
1706 and substituted ‘‘Dental care; drugs and medicines
for certain disabled veterans; vaccines’’ for ‘‘Eligibility
for outpatient services’’ in item 1712.
1994—Pub. L. 103–452, title I, § 101(f)(2)(B), Nov. 2, 1994,
108 Stat. 4784, substituted ‘‘and treatment’’ for ‘‘to
women veterans’’ in item 1720D.
1992—Pub. L. 102–585, title I, § 102(a)(2), title V,
§§ 512(b), 514(b), Nov. 4, 1992, 106 Stat. 4946, 4958, added
items 1704 and 1720D and struck out subchapter VII
heading ‘‘PREVENTIVE HEALTH-CARE SERVICES
PILOT PROGRAM’’ and items 1761 ‘‘Purpose’’, 1762
‘‘Definition’’, 1763 ‘‘Preventive health-care services’’,
and 1764 ‘‘Reports’’.
1991—Pub. L. 102–83, § 5(b)(1), Aug. 6, 1991, 105 Stat. 406,
renumbered items 601 to 664 as 1701 to 1764, respec-
tivel
Source: Supplied 2024 U.S. Code historical extraction · 38 U.S.C. § 1701
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Federal law — U.S. Code and appendices · legal_authorities
Page 332
TITLE 38—VETERANS’ BENEFITS
§ 1703F
(A) the quality of care furnished under the
model, including the measurement of patient-
level outcomes and patient-centeredness cri-
teria determined appropriate by the Sec-
retary; and
(B) the changes in spending by reason of that
model.
(2) The Secretary shall make the results of
each evaluation under this subsection available
to the public in a timely fashion and may estab-
lish requirements for other entities partici-
pating in the testing of models under this sec-
tion to collect and report information that the
Secretary determines is necessary to monitor
and evaluate such models.
(i) COORDINATION
AND ADVICE.—(1) The Sec-
retary shall obtain advice from the Under Sec-
retary for Health and the Special Medical Advi-
sory Group established pursuant to section 7312
of this title in the development and implementa-
tion of any pilot program operated under this
section.
(2) In carrying out the duties under this sec-
tion, the Secretary shall consult representatives
of relevant Federal agencies, and clinical and
analytical experts with expertise in medicine
and health care management. The Secretary
shall use appropriate mechanisms to seek input
from interested parties.
(j) EXPANSION
OF
SUCCESSFUL
PILOT
PRO-
GRAMS.—Taking into account the evaluation
under
subsection
(f),
the
Secretary
may,
through rulemaking, expand (including imple-
mentation on a nationwide basis) the duration
and the scope of a model that is being tested
under subsection (a) to the extent determined
appropriate by the Secretary, if—
(1) the Secretary determines that such ex-
pansion is expected to—
(A) reduce spending without reducing the
quality of care; or
(B) improve the quality of patient care
without increasing spending; an
Source: Supplied 2024 U.S. Code historical extraction · 38 U.S.C. § 1703F
Stored review status: historical_2024_not_currentness_verified. Same stored citation; legal effect and authority still require review.
Federal law — U.S. Code and appendices · legal_authorities
Page 8114
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 11101
1 So in original. Probably should be ‘‘for purposes of subpara-
graph (A),’’.
Sec.
11115.
Construction.
SUBCHAPTER II—REPORTING OF INFORMATION
11131.
Requiring reports on medical malpractice
payments.
11132.
Reporting of sanctions taken by Boards of
Medical Examiners.
11133.
Reporting of certain professional review ac-
tions taken by health care entities.
11134.
Form of reporting.
11135.
Duty of hospitals to obtain information.
11136.
Disclosure and correction of information.
11137.
Miscellaneous provisions.
SUBCHAPTER III—DEFINITIONS AND REPORTS
11151.
Definitions.
11152.
Reports and memoranda of understanding.
§ 11101. Findings
The Congress finds the following:
(1) The increasing occurrence of medical
malpractice and the need to improve the qual-
ity of medical care have become nationwide
problems that warrant greater efforts than
those that can be undertaken by any indi-
vidual State.
(2) There is a national need to restrict the
ability of incompetent physicians to move
from State to State without disclosure or dis-
covery of the physician’s previous damaging
or incompetent performance.
(3) This nationwide problem can be remedied
through effective professional peer review.
(4) The threat of private money damage li-
ability under Federal laws, including treble
damage liability under Federal antitrust law,
unreasonably discourages physicians from par-
ticipating in effective professional peer re-
view.
(5) There is an overriding national need to
provide incentive and protection for physi-
cians engaging in effective professional peer
review.
(Pub. L. 99–660, title IV, § 402, Nov. 14, 1986, 100
Stat. 3784.)
Statutory Notes and Related Subsidiaries
SHORT TITLE
Pub. L.
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 11101
Stored review status: historical_2024_not_currentness_verified. The source passage cites 42 U.S.C. § 11101. This identifies an authority to review, not proof of applicability.