S. 1868: Critical Access for Veterans Care Act

This bill, titled the "Critical Access for Veterans Care Act," aims to enhance access for veterans to critical access hospitals and their affiliated clinics as part of the Veterans Community Care Program. Here are the main provisions of the bill:

Expansion of Veteran Access

The bill amends existing law to allow covered veterans to receive care or services at a critical access hospital or its affiliated provider-based rural health clinic if they live within 35 miles of that facility. This addition is meant to simplify the process for veterans seeking care in rural areas.

Prior Authorization and Referrals

Under the proposed legislation, veterans will not need prior authorization or referral to receive care or services from critical access hospitals and affiliated clinics. This change is intended to streamline access to care for veterans, making it easier for them to obtain necessary services without bureaucratic delays.

Payment and Claims Process

The bill also addresses the payment rates for services provided under the Veterans Community Care Program:

• If care is provided at a critical access hospital, the payment will be based on the Medicare rate established under the Medicare program, rather than a service-based rate.
• At provider-based rural health clinics affiliated with critical access hospitals, the payment will follow a specified rate under the Social Security Act.
• Claims submitted for care provided under this bill will have to include a specific identifier and will be reimbursed at the cost-based level under the Medicare program.
• The Secretary of Veterans Affairs must ensure claims are processed and payment issued within 60 days of submission.

Definitions

The term "critical access hospital" is defined in accordance with existing law, ensuring clarity on what qualifies as such a facility under this bill.

Reporting Requirements

The Secretary of Veterans Affairs is required to submit a report to Congress within one year of the bill's enactment. This report must cover the performance of third-party administrators and community care providers regarding the approval and payment of claims tied to the new provisions, as well as the overall experience of veterans receiving care.

Relevant Companies

None found.