Credentialing verification requirements for providers of non-Department health care services

Source Credit

(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 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 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.
(3) The term "Veterans Care Agreement" means an agreement for non-Department health care services entered into under section 1703A of this title.
(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);
(B) provided under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 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 note).

History

(Added Pub. L. 117–328, div. U, title I, §141(a)(1), Dec. 29, 2022, 136 Stat. 5422.)

Editorial Notes

Editorial Notes

References in Text
The Health Care Quality Improvement Act of 1986, referred to in subsec. (b)(4), is title IV of Pub. L. 99–660, Nov. 14, 1986, 100 Stat. 3784, 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 section 11101 of Title 42 and Tables.

Statutory Notes and Related Subsidiaries

Deadline for Implementation
Pub. L. 117–328, div. U, title I, §141(b), Dec. 29, 2022, 136 Stat. 5423, provided that: "Not later than 180 days after the date of the enactment of this Act [Dec. 29, 2022], the Secretary of Veterans Affairs shall commence the implementation of section 1703F of title 38, United States Code, as added by subsection (a)(1)."