US SB1868

Veterans residing within 35 miles of a critical access hospital or affiliated provider-based rural health clinic become eligible for community care at those facilities under the Veterans Community Care Program

Eliminates prior authorization and referral requirements for veterans seeking care at critical access hospitals and affiliated rural health clinics under this new eligibility pathway

Establishes Medicare-based reimbursement rates for critical access hospitals (cost-based rates) and affiliated rural health clinics, replacing VA service-based rates

Requires claims for care under this provision to be reviewed and paid within 60 days of submission, with claims including an identifier denoting the care was provided under this subsection

Mandates a report to Congress within one year on implementation, including timely approval and payment of claims and overall user experience with third party administrators and community care providers