§1703F Credentialing verification requirements for providers of non-Department health care services

Summary

The Secretary must make sure Third Party Administrators (TPAs) and credentials verification organizations (CVOs) follow certain rules so providers who should be kept out do not give non‑Department health care. These groups must keep a current national credentialing accreditation. They must check a provider’s work history and any license sanctions for all States and U.S. territories, including the time before the provider started giving care, and going back at least 10 years. They must recheck credentials and licenses at least every three years. They must watch each provider continuously using the National Practitioner Data Bank from the Health Care Quality Improvement Act of 1986. The Secretary can also require other checks as needed. Credentials verification organization: handles credential checks for non‑Department providers in the Veterans Community Care Program under a Veterans Care Agreement (section 1703A). Third Party Administrator: runs a provider network and related admin services in that program. Veterans Care Agreement: an agreement for non‑Department health care under section 1703A. Non‑Department health care services: care at non‑Department facilities, care under section 101 of the Veterans Access, Choice, and Accountability Act of 2014, care bought through the Department’s Medical Community Care account, or care paid with money from the Veterans Choice Fund under section 802 of that Act.