House FY18 Military Construction Veteran Affairs Appropriation Bill Report

The language in the Military Construction, Veterans Affairs Appropriations Bill provides more detail on the report requirement, on pages 58-9 of this link:

“Services to Indian veterans.—In 2010, VA entered into a memorandum of understanding (MOU) with the Indian Health Service (IHS). On January 17, 2017, the MOU was extended through June 30, 2019. Under this agreement with IHS, VA reimburses care provided to Indian veterans at IHS facilities and Tribal health programs. The agreement benefits VA, which cannot reasonably maintain full service VA facilities in low population, highly rural areas.  Reimbursement rates are substantially above customary rates because of costs of providing service in highly rural locations. There is community interest in extending the VA special reimbursements to Indian urban clinics. In order to understand the impact of this expansion, the Committee requests VA to provide a comprehensive report describing how an expansion of the current agreement with IHS would integrate with care currently provided to Indian veterans in VA clinics in urban areas and through the Choice program of non-VA community care.

“The report should include: (1) estimates of the number of veterans who are likely to leave the VA healthcare system in urban areas to seek service through Indian urban clinics; (2) the annual estimated cost differential for VA to reimburse IHS rather than provide services directly in urban areas; (3) the potential for Indian urban clinics to qualify as providers in VA Choice provider networks; (4) estimated capacity of Indian urban clinics to treat increased Indian veteran caseloads; and (5) any data supporting the use of the higher negotiated reimbursement rate in urban settings versus highly rural areas. VA should consult with IHS in the preparation of this report, which should be provided to the Committee not later than 90 days after enactment of this Act.”