38 U.S.C. § 1729A — Department of Veterans Affairs Medical

Page 464 TITLE 38—VETERANS’ BENEFITS § 1729A ‘‘(ii) is not modified or renewed on or after such date. ‘‘(B) In the case of a health-plan contract (as so de- fined) that was entered into before such date and which is modified or renewed on or after such date, the amendment made by subsection (a) [amending this sec- tion] shall apply— ‘‘(i) with respect to such plan as of the day after the date that it is so modified or renewed; and ‘‘(ii) with respect to care and services provided after such date of modification or renewal. ‘‘(3) For purposes of paragraph (2), the term ‘modi- fied’ includes any change in premium or coverage.’’ EFFECTIVE DATE Pub. L. 97–72, title I, § 106(b), Nov. 3, 1981, 95 Stat. 1051, provided that: ‘‘Section 629 [now 1729] of title 38, United States Code, as added by subsection (a), shall apply with respect to care and services furnished under chap- ter 17 of title 38, United States Code, on or after the date of the enactment of this Act [Nov. 3, 1981].’’ HEALTHCARE FACILITIES CERTIFIED AS MEDICARE AND MEDICAID PROVIDERS FOR COLLECTION PURPOSES Pub. L. 107–206, title I, Aug. 2, 2002, 116 Stat. 888, pro- vided in part: ‘‘That for the purposes of enabling the collection from third-party insurance carriers for non- service related medical care of veterans, all Depart- ment of Veterans Affairs healthcare facilities are here- by certified as Medicare and Medicaid providers and the Centers for Medicare and Medicaid Services within the Department of Health and Human Services shall issue each Department of Veterans Affairs healthcare facil- ity a provider number as soon as practicable after the date of enactment of this Act [Aug. 2, 2002]: Provided further, That nothing in the preceding proviso shall be construed to enable the Department of Veterans Affairs to bill Medicare or Medicaid for any medical services provided by the Veterans Health Administration or to require the Centers for Medicare and Medicaid Services to pay for any medical services provided by the Depart- ment of Veterans Affairs’’. DISPOSITION OF FUNDS IN AND TERMINATION OF DE- PARTMENT OF VETERANS AFFAIRS MEDICAL-CARE COST RECOVERY FUND Pub. L. 105–33, title VIII, § 8023(c), Aug. 5, 1997, 111 Stat. 667, provided that: ‘‘The amount of the unobli- gated balance remaining in the Department of Veterans Affairs Medical-Care Cost Recovery Fund (established pursuant to section 1729(g)(1) of title 38, United States Code) at the close of June 30, 1997, shall be deposited, not later than December 31, 1997, in the Treasury as miscellaneous receipts, and the Department of Vet- erans Affairs Medical-Care Cost Recovery Fund shall be terminated when the deposit is made.’’ TRANSFERS TO MEDICAL-CARE COST RECOVERY FUND Pub. L. 101–508, title VIII, § 8011(d), Nov. 5, 1990, 104 Stat. 1388–345, as amended by Pub. L. 102–83, § 5(c)(2), Aug. 6, 1991, 105 Stat. 406, provided that the Secretary of the Treasury was to transfer $25,000,000 from the De- partment of Veterans Affairs Loan Guaranty Revolving Fund to the Department of Veterans Affairs Medical- Care Cost Recovery Fund and that the amount so transferred was to be available until the end of Sept. 30, 1991, for the support of the equivalent of 800 full-time employees and other expenses described in former sub- sec. (g)(3) of this section, and provided that the first $25,000,000 recovered or collected by the Department of Veterans Affairs during fiscal year 1991 as a result of third-party medical recovery activities was to be cred- ited to the Department of Veterans Affairs Loan Guar- anty Revolving Fund. REPORTS ON IMPLEMENTATION OF 1986 AMENDMENT Pub. L. 99–272, title XIX, § 19013(c), Apr. 7, 1986, 100 Stat. 385, directed Administrator of Veterans’ Affairs, not later than six months after Apr. 7, 1986, to submit to Committees on Veterans’ Affairs of Senate and House of Representatives a report on the process for and results of implementation of this section, as amended by subsection (a), such report to show costs of administration (and a detailed breakdown of such costs) and the amount of receipts and collections under this section, and not later than Feb. 1, 1988, to submit to such Committees a report updating the information in the report previously submitted and providing infor- mation on the process and results of such implementa- tion through at least the end of fiscal year 1987. § 1729A. Department of Veterans Affairs Medical Care Collections Fund (a) There is in the Treasury a fund to be known as the Department of Veterans Affairs Medical Care Collections Fund. (b) Amounts recovered or collected under any of the following provisions of law shall be depos- ited in the fund: (1) Section 1710(f) of this title. (2) Section 1710(g) of this title. (3) Section 1711 of this title. (4) Section 1722A of this title. (5) Section 1725 of this title. (6) Section 1729 of this title. (7) Section 1784 of this title. (8) Section 8165(a) of this title. (9) Section 113 of the Veterans Millennium Health Care and Benefits Act (Public Law 106–117; 38 U.S.C. 8111 note). (10) Public Law 87–693, popularly known as the ‘‘Federal Medical Care Recovery Act’’ (42 U.S.C. 2651 et seq.), to the extent that a recov- ery or collection under that law is based on medical care or services furnished under this chapter. (c)(1) Subject to the provisions of appropria- tions Acts, amounts in the fund shall be avail- able, without fiscal year limitation, to the Sec- retary for the following purposes: (A) Furnishing medical care and services under this chapter, to be available during any fiscal year for the same purposes and subject to the same limitations (other than with re- spect to the period of availability for obliga- tion) as apply to amounts appropriated from the general fund of the Treasury for that fiscal year for medical care. (B) Expenses of the Department for the iden- tification, billing, auditing, and collection of amounts owed the United States by reason of medical care and services furnished under this chapter. (2) Amounts available under paragraph (1) may not be used for any purpose other than a purpose set forth in subparagraph (A) or (B) of that para- graph. (d) Of the total amount recovered or collected by the Department during a fiscal year under the provisions of law referred to in subsection (b) and made available from the fund, the Sec- retary shall make available to each Department health care facility of the Department an amount that bears the same ratio to the total amount so made available as the amount recov- ered or collected by such facility during that fis- cal year under such provisions of law bears to such total amount recovered or collected during that fiscal year. The Secretary shall make avail- able to each facility the entirety of the amount Page 465 TITLE 38—VETERANS’ BENEFITS § 1729A specified to be made available to such facility by the preceding sentence. (e) Amounts recovered or collected under the provisions of law referred to in subsection (b) shall be treated for the purposes of sections 251 and 252 of the Balanced Budget and Emergency Deficit Control Act of 1985 (2 U.S.C. 901, 902) as offsets to discretionary appropriations (rather than as offsets to direct spending) to the extent that such amounts are made available for ex- penditure in appropriations Acts for the pur- poses specified in subsection (c). (Added Pub. L. 105–33, title VIII, § 8023(a)(1), Aug. 5, 1997, 111 Stat. 665; amended Pub. L. 106–117, title I, § 111(b)(1), title II, § 203, Nov. 30, 1999, 113 Stat. 1556, 1561; Pub. L. 107–135, title II, § 208(e)(5), Jan. 23, 2002, 115 Stat. 2463; Pub. L. 108–7, div. K, title I, § 113(b), Feb. 20, 2003, 117 Stat. 482; Pub. L. 108–183, title VII, § 708(a)(2), Dec. 16, 2003, 117 Stat. 2673.) Editorial Notes REFERENCES IN TEXT Public Law 87–693, popularly known as the Federal Medical Care Recovery Act, referred to in subsec. (b)(10), is Pub. L. 87–693, Sept. 25, 1962, 76 Stat. 593, which is classified generally to chapter 32 (§ 2651 et seq.) of Title 42, The Public Health and Welfare. For com- plete classification of this Act to the Code, see Tables. AMENDMENTS 2003—Subsec. (b). Pub. L. 108–183, § 708(a)(2)(A), struck out ‘‘after June 30, 1997,’’ after ‘‘collected’’ in introduc- tory provisions. Subsec. (b)(8) to (10). Pub. L. 108–7 added pars. (8) and (9) and redesignated former par. (8) as (10). Subsec. (c)(3). Pub. L. 108–183, § 708(a)(2)(B), struck out par. (3) which related to duties of the Secretary for fis- cal year 1998. Subsecs. (e), (f). Pub. L. 108–183, § 708(a)(2)(C), (D), re- designated subsec. (f) as (e) and struck out former sub- sec. (e) which required the Secretary to submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives quarterly reports on the oper- ation of the section for fiscal years 1998, 1999, and 2000 and for the first quarter of fiscal year 2001. 2002—Subsec. (b)(7), (8). Pub. L. 107–135 added par. (7) and redesignated former par. (7) as (8). 1999—Subsec. (b)(5) to (7). Pub. L. 106–117, § 111(b)(1), added par. (5) and redesignated former pars. (5) and (6) as (6) and (7), respectively. Subsec. (d). Pub. L. 106–117, § 203, struck out par. (1) designation, substituted ‘‘each Department health care facility’’ for ‘‘each designated health care region’’ and ‘‘each facility’’ for ‘‘each region’’, substituted ‘‘such fa- cility’’ for ‘‘such region’’ in two places, and struck out par. (2) which read as follows: ‘‘In this subsection, the term ‘designated health care regions of the Depart- ment’ means the geographic areas designated by the Secretary for purposes of the management of, and allo- cation of resources for, health care services provided by the Department.’’ Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 1999 AMENDMENT Amendment by section 111(b)(1) of Pub. L. 106–117 ef- fective 180 days after Nov. 30, 1999, see section 111(c) of Pub. L. 106–117, set out as an Effective Date note under section 1725 of this title. EFFECTIVE DATE Section effective Oct. 1, 1997, see section 8023(g) of Pub. L. 105–33, set out as an Effective Date of 1997 Amendment note under section 1710 of this title. IMPROVEMENTS FOR RECOVERY AND COLLECTION OF AMOUNTS FOR DEPARTMENT OF VETERANS AFFAIRS MEDICAL CARE COLLECTIONS FUND Pub. L. 112–154, title I, § 111, Aug. 6, 2012, 126 Stat. 1175, provided that: ‘‘(a) DEVELOPMENT AND IMPLEMENTATION OF PLAN FOR RECOVERY AND COLLECTION.— ‘‘(1) IN GENERAL.—Not later than 270 days after the date of the enactment of this Act [Aug. 6, 2012], the Secretary of Veterans Affairs shall develop and im- plement a plan to ensure the recovery and collection of amounts under the provisions of law described in section 1729A(b) of title 38, United States Code, for deposit in the Department of Veterans Affairs Med- ical Care Collections Fund. ‘‘(2) ELEMENTS.—The plan required by paragraph (1) shall include the following: ‘‘(A) An effective process to identify billable fee claims. ‘‘(B) Effective and practicable policies and proce- dures that ensure recovery and collection of amounts described in section 1729A(b) of such title. ‘‘(C) The training of employees of the Depart- ment, on or before September 30, 2013, who are re- sponsible for the recovery or collection of such amounts to enable such employees to comply with the process required by subparagraph (A) and the policies and procedures required by subparagraph (B). ‘‘(D) Fee revenue goals for the Department. ‘‘(E) An effective monitoring system to ensure achievement of goals described in subparagraph (D) and compliance with the policies and procedures de- scribed in subparagraph (B). ‘‘(b) MONITORING OF THIRD-PARTY COLLECTIONS.—The Secretary shall monitor the recovery and collection of amounts from third parties (as defined in section 1729(i) of such title) for deposit in such fund.’’ MEDICAL SERVICES ACCOUNTS Pub. L. 108–447, div. I, title I, § 115, Dec. 8, 2004, 118 Stat. 3293, provided that: ‘‘(a) Hereafter receipts that would otherwise be cred- ited to the accounts listed in subsection (c) shall be de- posited into the Medical Care Collections Fund, and shall be transferred to and merged with the ‘Medical services’ account, in fiscal year 2005 and subsequent years, to remain available until expended, to carry out the purposes of the ‘Medical services’ account. ‘‘(b) The unobligated balances in the accounts listed in subsection (c), shall be transferred to and merged with the ‘Medical services’ account in fiscal year 2005 and subsequent years, and remain available until ex- pended, to carry out the purposes of the ‘Medical serv- ices’ account: Provided, That the obligated balances in these accounts may be transferred to the ‘Medical serv- ices’ account at the discretion of the Secretary of Vet- erans Affairs and shall remain available until ex- pended. ‘‘(c) Veterans Extended Care Revolving Fund; Med- ical Facilities Revolving Fund; Special Therapeutic and Rehabilitation Fund; Nursing Home Revolving Fund; Veterans Health Services Improvement Fund; and Parking Revolving Fund.’’ Similar provisions were contained in the following prior appropriation act: Pub. L. 108–199, div. G, title I, § 115, Jan. 23, 2004, 118 Stat. 370. REPORT ON IMPLEMENTATION OF SECTION 8023 OF PUB. L. 105–33 Pub. L. 105–33, title VIII, § 8023(f), Aug. 5, 1997, 111 Stat. 667, provided that: ‘‘Not later than January 1, 1999, the Secretary of Veterans Affairs shall submit to Page 466 TITLE 38—VETERANS’ BENEFITS § 1729B the Committees on Veterans’ Affairs of the Senate and House of Representatives a report on the implementa- tion of this section [enacting this section, amending sections 712, 1710, 1722A, and 1729 of this title, and en- acting provisions set out as notes under sections 712 and 1729 of this title]. The report shall describe the col- lections under each of the provisions specified in sec- tion 1729A(b) of title 38, United States Code, as added by subsection (a). Information on such collections shall be shown for each of the health service networks (known as Veterans Integrated Service Networks) and, to the extent practicable for each facility within each such network. The Secretary shall include in the report an analysis of differences among the networks with re- spect to (A) the market in which the networks oper- ates, (B) the effort expended to achieve collections, (C) the efficiency of such effort, and (D) any other relevant information.’’ § 1729B. Consolidated patient accounting centers (a) IN GENERAL.—Not later than five years after the date of the enactment of this section, the Secretary of Veterans Affairs shall establish not more than seven consolidated patient ac- counting centers for conducting industry-mod- eled regionalized billing and collection activi- ties of the Department. (b) FUNCTIONS.—The centers shall carry out the following functions: (1) Reengineer and integrate all business processes of the revenue cycle of the Depart- ment. (2) Standardize and coordinate all activities of the Department related to the revenue cycle for all health care services furnished to veterans for non-service-connected medical conditions. (3) Apply commercial industry standards for measures of access, timeliness, and perform- ance metrics with respect to revenue enhance- ment of the Department. (4) Apply other requirements with respect to such revenue cycle improvement as the Sec- retary may specify. (Added Pub. L. 110–387, title IV, § 406(a), Oct. 10, 2008, 122 Stat. 4129.) Editorial Notes REFERENCES IN TEXT The date of the enactment of this section, referred to in subsec. (a), is the date of enactment of Pub. L. 110–387, which was approved Oct. 10, 2008. PRIOR PROVISIONS A prior section 1729B, added Pub. L. 106–117, title II, § 202(a), Nov. 30, 1999, 113 Stat. 1561; amended Pub. L. 107–103, title V, § 509(c), Dec. 27, 2001, 115 Stat. 997; Pub. L. 107–330, title III, § 308(g)(7), Dec. 6, 2002, 116 Stat. 2829, related to the Department of Veterans Affairs Health Services Improvement Fund, prior to repeal by Pub. L. 108–7, div. K, title I, § 113(a)(1), Feb. 20, 2003, 117 Stat. 482. Statutory Notes and Related Subsidiaries TRANSFER OF BALANCE Pub. L. 108–7, div. K, title I, § 113(a)(1), Feb. 20, 2003, 117 Stat. 482, repealed former section 1729B of this title and provided that any balance as of Feb. 20, 2003, in the Department of Veterans Affairs Health Services Im- provement Fund established under former section 1729B was to be transferred to the Department of Veterans Affairs Medical Care Collections Fund established under section 1729A of this title. § 1730. Community residential care (a) Subject to this section and regulations to be prescribed by the Secretary under this sec- tion, the Secretary may assist a veteran by re- ferring such veteran for placement in, and aid- ing such veteran in obtaining placement in, a community residential-care facility if— (1) at the time of initiating the assistance the Secretary— (A) is furnishing the veteran medical serv- ices on an outpatient basis or hospital, domiciliary, or nursing home care; or (B) has furnished the veteran such care or services within the preceding 12 months; and (2) placement of the veteran in a community residential-care facility is appropriate. (b)(1) The Secretary may not provide assist- ance under subsection (a) of this section with re- spect to a community residential-care facility unless such facility is approved by the Secretary for the purposes of this section. (2) The Secretary’s approval of a facility for the purposes of this section shall be based upon the Secretary’s determination, after inspection of the facility, that the facility meets the stand- ards established in regulations prescribed under this section. Such standards shall include the following: (A) Health and safety criteria, including a requirement of compliance with applicable State laws and local ordinances relating to health and safety. (B) A requirement that the costs charged for care by a facility be reasonable, as determined by the Secretary, giving consideration to such factors as (i) the level of care, supervision, and other services to be provided, (ii) the cost of goods and services in the geographic area in which the facility is located, and (iii) com- parability with other facilities in such area providing similar services. (C) Criteria for determining the resources that a facility needs in order to provide an ap- propriate level of services to veterans. (D) Such other criteria as the Secretary de- termines are appropriate to protect the wel- fare of veterans placed in a facility under this section. (3) Payment of the charges of a community residential-care facility for any care or service provided to a veteran whom the Secretary has referred to that facility under this section is not the responsibility of the United States or of the Department. (c)(1) In order to determine continued compli- ance by community residential-care facilities that have been approved under subsection (b) of this section with the standards established in regulations prescribed under this section, the Secretary shall provide for periodic inspection of such facilities. (2) If the Secretary determines that a facility is not in compliance with such standards, the Secretary (in accordance with regulations pre- scribed under this section)— (A) shall cease to refer veterans to such fa- cility; and (B) may, with the permission of the veteran (or the person or entity authorized by law to