38 U.S.C. § 1703F | Credentialing verification requirements for providers of non-Department health care services

(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)

42 U.S.C. 11101 Implement continuous monitoring of each provider through the National Practitioner Data Bank established pursuant to the Health Care Quality Improvement Act of 1986 ( et seq.).

(5)

Perform other forms of credentialing verification as the Secretary considers appropriate.

(c)

Definitions .—

In this section:

(1)

section 1703 of this title 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 through a Veterans Care Agreement.

(2)

section 1703 of this title 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 .

(3)

section 1703A of this title The term “Veterans Care Agreement” means an agreement for non-Department health care services entered into under .

(4)

The term “non-Department health care services” means services—

(A)

section 1701 of this title provided under this subchapter at non-Department facilities (as defined in );

(B)

Public Law 113–146 38 U.S.C. 1701 provided under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (; note);

(C)

purchased through the Medical Community Care account of the Department; or

(D)

Public Law 113–146 38 U.S.C. 1701 purchased with amounts deposited in the Veterans Choice Fund under section 802 of the Veterans Access, Choice, and Accountability Act of 2014 (; note).

Pub. L. 117–328, div. U, title I, § 141(a)(1)Dec. 29, 2022136 Stat. 5422(Added , , .)

Editorial Notes

References in Text

Pub. L. 99–660Nov. 14, 1986100 Stat. 3784 section 11101 of Title 42The Health Care Quality Improvement Act of 1986, referred to in subsec. (b)(4), is title IV of , , , which is classified generally to chapter 117 (§ 11101 et seq.) of Title 42, The Public Health and Welfare. For complete classification of this Act to the Code, see Short Title note set out under and Tables.

Statutory Notes and Related Subsidiaries

Deadline for Implementation

Pub. L. 117–328, div. U, title I, § 141(b)Dec. 29, 2022136 Stat. 5423

Dec. 29, 2022section 1703F of title 38“Not later than 180 days after the date of the enactment of this Act [], the Secretary of Veterans Affairs shall commence the implementation of , United States Code, as added by subsection (a)(1).”

, , , provided that: