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119-hr-874119th CongressWALLET

To amend title 38, United States Code, to modify the rate of pay for care or services provided under the Community Care Program of the Department of Veterans Affairs based on the location at which such care or services were provided, and for other purposes.

Sponsored By: Representative McCormick, Richard [R-GA-7]

In Committee

Summary

Creates location-specific payment rates for the VA Community Care Program and requires a location-specific national provider identifier code for each claim. It would also require the VA to pay the lowest applicable rate when more than one rate could apply and take effect January 1, 2026.

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  • Veterans and families: Care would be classified by five location types for payment purposes — inpatient hospital, on-campus hospital outpatient department, off-campus hospital outpatient department, ambulatory surgical center, and physician office. This changes how VA reimburses care by where it was provided.
  • Providers: Providers would need to include a geographically specific national provider identifier code (NPI) for the exact location that furnished care when submitting claims. Payments to providers would be set by location and the VA would pay the lowest applicable rate if multiple rates could apply.
  • VA administration: The Secretary would be required to establish and apply separate payment rates for those five location types for claims under the Community Care Program.

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Bill Overview

Analyzed Economic Effects

1 provisions identified: 0 benefits, 0 costs, 1 mixed.

New location-based pay rules for VA care

If enacted, VA would pay different rates for community care based on where care is given, not the provider’s headquarters. The five site types are inpatient hospital, hospital outpatient on- or off-campus, ambulatory surgery center, and a doctor’s office. If more than one rate could apply, VA would pay the lowest rate. Claims would need a location-specific National Provider Identifier, and these rules would start January 1, 2026.

Sponsors & CoSponsors

Sponsor

McCormick, Richard [R-GA-7]

GA • R

Cosponsors

  • Rep. Crane, Elijah [R-AZ-2]

    AZ • R

    Sponsored 2/11/2025

Roll Call Votes

No roll call votes available for this bill.

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