S. 1868 — Critical Access for Veterans Care Act

This section expands the Veterans Community Care Program (VCCP)—which furnishes hospital care, medical services, and extended care services to covered veterans (i.e., VA-enrolled veterans or those otherwise eligible under 38 U.S.C. 1705(c)(2)) through non-VA providers when access standards are not met—by adding a new condition in subsection (d)(1)(F) under which the VA must provide such care: when a covered veteran resides within 35 miles of a critical access hospital (CAH) or provider-based rural health clinic affiliated with such hospital (including care from a specified provider in the surrounding community due to a referral from the hospital or clinic). It further (1) eliminates the prior authorization or referral requirement for care under the new condition (via exceptions in subsections (a)(3) and new (d)(5)); (2) requires payment for such CAH care at the Medicare critical access hospital rate (instead of the VCCP service-based rate) and for affiliated clinic care at the Medicare rate under Social Security Act section 1833, with claims including a specific identifier, reimbursed at Medicare cost-based levels, processed with CMS guidance, and paid within 60 days of submission (new subsection (i)(7)); and (3) defines "critical access hospital" by reference to Social Security Act section 1861(mm) (i.e., small rural Medicare-designated facilities reimbursed on reasonable costs to ensure access) (new subsection (o)(2)). Finally, this section requires the VA Secretary to submit to Congress, not later than one year after enactment, a report on implementation by third-party administrators and community care providers, including timely claims payments under the new condition and user experience.