§1703F Credentialing Verification Requirements for Providers of Non-department Health Care Services

Summary

The Secretary must make sure Third Party Administrators and credentials verification organizations follow rules that keep unqualified or sanctioned providers from giving care outside VA facilities. Those organizations must keep a current national credentialing accreditation; check a provider’s history and license sanctions across all States and U.S. territories going back at least 10 years and including the time before the provider started giving non‑VA care; recheck credentials at least every 3 years; continuously monitor each provider through the National Practitioner Data Bank (created under the Health Care Quality Improvement Act of 1986, 42 U.S.C. 11101 et seq.); and do any other credential checks the Secretary requires. Definitions in one line each: credentials verification organization — an entity that handles credential checks for non‑VA providers in the Veterans Community Care Program; Third Party Administrator — an entity that runs a provider network and related administrative services for that program; Veterans Care Agreement — an agreement to buy non‑VA health care; non‑Department health care services — care provided outside VA facilities or bought under programs such as the Veterans Access, Choice, and Accountability Act of 2014 and the Department’s Medical Community Care account or the Veterans Choice Fund.