HR6526-119

What This Bill Does

The Clarity on Care Options Act targets a specific CHAMPVA access problem: beneficiaries may not know which VA community-care network providers accept CHAMPVA assignment, meaning the provider agrees to accept the CHAMPVA allowable amount as full payment. The bill requires VA to make every entity administering a provider network under 38 U.S.C. 1703 query each network provider annually about whether it accepts CHAMPVA assignments and submit the results to VA. VA must use those results plus other available information to establish and maintain a public directory of network providers that accept CHAMPVA assignments. The first provider queries are due within 90 days, the first directory within 180 days, and VA must report to Congress for five years on the number and percentage of accepting and nonaccepting providers, broken down by State and Veterans Integrated Service Network, including geographic areas where beneficiaries live but accepting providers are absent.

Who Benefits and How

CHAMPVA beneficiaries benefit because the public directory should make it easier to find providers willing to accept CHAMPVA assignment. Surviving spouses, dependents, and caregivers using CHAMPVA benefit from clearer geographic access information. Providers that accept CHAMPVA assignment benefit from public visibility in the VA directory. Congress benefits from annual State and VISN data on acceptance rates and access gaps.

Who Bears the Burden and How

VA must build, maintain, and update the public directory and produce annual congressional reports for five years. Community-care network administrators must query each provider every year and submit results to VA. Network providers must respond to assignment-status queries. Providers that accept assignment must accept the CHAMPVA allowable amount as full payment for covered services and supplies. VA data staff must break reports down by State, Veterans Integrated Service Network, acceptance percentage, and beneficiary access gaps.

Key Provisions

• Requires VA network administrators to query each community-care provider annually about CHAMPVA assignment acceptance.
• Establishes a public VA directory of network providers that accept CHAMPVA assignments.
• Requires first provider queries within 90 days and first public directory within 180 days.
• Directs annual congressional reports for five years with State and VISN acceptance rates and geographic access gaps.
• Defines CHAMPVA assignment as accepting the CHAMPVA allowable amount as full payment.