I 

108TH CONGRESS 

1ST SESSION H. R. 2475

To amend title 38, United States Code, to provide an enhanced funding 

process to ensure an adequate level of funding for veterans health care 

programs of the Department of Veterans Affairs, to establish standards 

of access to care for veterans seeking health care from the Department 

of Veterans Affairs, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 16, 2003

Mr. SMITH of New Jersey (for himself, Mr. SIMMONS, Mr. BROWN of South 

Carolina, Mr. BAKER, Mr. MILLER of Florida, Mr. BOOZMAN, Mr. BRADLEY of New Hampshire, Ms. GINNY BROWN-WAITE of Florida, Mr. 

RENZI, Mr. MURPHY, Mr. GIBBONS, Mr. TOM DAVIS of Virginia, Mr. 

GOSS, Mr. LAHOOD, Mr. HEFLEY, Mr. JONES of North Carolina, Mr. 

PICKERING, Mr. PALLONE, Mr. GILLMOR, Mr. PEARCE, Mr. LOBIONDO, 

Mrs. JO ANN DAVIS of Virginia, Mr. TERRY, Mrs. KELLY, Mr. ISSA, 

Mrs. CAPITO, Mr. VITTER, Mr. CALVERT, Mr. JENKINS, Mr. GILCHREST, 

Mr. PAUL, Mr. KING of New York, Mr. HOUGHTON, Mr. PLATTS, Ms. 

HART, Mr. WILSON of South Carolina, Mr. WHITFIELD, Mr. HAYES, and 

Mr. SAXTON) introduced the following bill; which was referred to the 

Committee on Veterans’ Affairs 

A BILL

To amend title 38, United States Code, to provide an enhanced funding process to ensure an adequate level of 

funding for veterans health care programs of the Department of Veterans Affairs, to establish standards of access 

to care for veterans seeking health care from the Department of Veterans Affairs, and for other purposes.
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1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Veterans Health Care 

5 Full Funding Act’’. 

6 SEC. 2. ENHANCED PROCESS FOR FUNDING VETERANS 

7 HEALTH CARE PROGRAMS. 

8 (a) IN GENERAL.—(1) Chapter 3 of title 38, United 

9 States Code, is amended by adding at the end the fol10 lowing new section: 

11 ‘‘§ 320. Enhanced funding process for veterans health 

12 care 

13 ‘‘(a) In the President’s budget for each fiscal year 

14 transmitted under section 1105 of title 31, amounts shall 

15 be requested for veterans health care programs in accord16 ance with this section. Amounts appropriated for veterans 

17 health care programs shall be available for obligation for 

18 a period of two consecutive fiscal years. 

19 ‘‘(b)(1) For each fiscal year (beginning with fiscal 

20 year 2005), the Veterans Health Care Funding Review 

21 Board shall determine the level of funding needed for vet22 erans health care programs for that fiscal year and the 

23 next fiscal year. The Board shall make such determina24 tion, and shall publish such determination in the Federal 

25 Register, not later than November 1 of the year preceding 
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1 the year in which the budget for such fiscal year is trans2 mitted to Congress. 

3 ‘‘(2) In making any such determination under para4 graph (1), the Board shall take into consideration the 

5 most recent information relating to economic assumptions 

6 provided to the Board by the Director of the Office of 

7 Management and Budget pursuant to subsection (f)(4)(b). 

8 ‘‘(c) The amount determined under subsection (b) for 

9 any two-fiscal-year period is the amount needed to be ap10 propriated to the Department for that two-fiscal-year pe11 riod for veterans health care programs. The President 

12 shall include the full amount so determined in the budget 

13 transmitted to Congress under section 1105 of title 31 for 

14 the first fiscal year in such two-year period and shall in15 clude the amount of the second fiscal year as a budget 

16 forecast year. 

17 ‘‘(d)(1) The Board shall make its determination of 

18 the level of funding needed for veterans health care pro19 grams for any two-fiscal-year period under subsection (b) 

20 based upon an annual review of those programs and of 

21 veterans health care needs. 

22 ‘‘(2) The Board shall ensure that its determination 

23 of the level of funding needed for veterans health care pro24 grams for any period is in an amount sufficient to provide 

25 for—
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1 ‘‘(A) the health care needs of veterans esti2 mated to be enrolled in the Department health care 

3 system under section 1705(a) of this title (other 

4 than veterans described in paragraph (8) of such 

5 section); 

6 ‘‘(B) the health care needs of veterans with 

7 service-connected disabilities who are not required to 

8 enroll in such health care system; 

9 ‘‘(C) timely access to health care under stand10 ards for access prescribed under section 1703(d)(1) 

11 of this title; 

12 ‘‘(D) maintenance of capacities of Department 

13 nursing home facilities as required by section 

14 1710B(b) of this title and of specialized programs as 

15 required by section 1706(b)(1) of this title; 

16 ‘‘(E) the health care needs of persons eligible 

17 for benefits under chapter 17 of this title based 

18 upon subchapter VIII of that chapter; 

19 ‘‘(F) the necessary maintenance, improvement, 

20 upgrading, expanding, repairing, and replacing of 

21 major and minor medical facilities, capital equip22 ment, and systems to ensure that health care facili23 ties of the Department are adequate for the pur24 poses of programs and benefits authorized for the 

25 care of veterans under chapter 17 of this title; and 
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1 ‘‘(G) unanticipated requirements, including—

2 ‘‘(i) changes in benefits; 

3 ‘‘(ii) changes in beneficiaries; 

4 ‘‘(iii) changes in economic conditions or as5 sumptions; and 

6 ‘‘(iv) such other factors as the Board con7 siders appropriate. 

8 ‘‘(3) Each such review under paragraph (1) shall con9 sider—

10 ‘‘(A) demographic information; 

11 ‘‘(B) utilization and cost trends for veterans en12 rolled under section 1705 of this title and other De13 partment health-care beneficiaries; 

14 ‘‘(C) requirements for support of other core 

15 missions of the Department related to health care; 

16 ‘‘(D) the degree of efficiency (or the lack of ef17 ficiency) by which the Secretary actually delivers 

18 health care services to veterans; and 

19 ‘‘(E) such other factors as the Board considers 

20 appropriate. 

21 ‘‘(4)(A) The Board shall submit to Congress an an22 nual report, not later than the date on which the President 

23 transmits the budget to Congress under section 1105 of 

24 title 31 each year, on its most recent determination under 
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1 subsection (b) and its most recent review under paragraph 

2 (1). 

3 ‘‘(B) The report shall include the following: 

4 ‘‘(i) A statement of the amount determined for 

5 each of the two fiscal years covered by such deter6 mination under subsection (b). 

7 ‘‘(ii) A description of the economic assumptions 

8 and other assumptions made by the Board in mak9 ing such determination and how that determination 

10 was developed. 

11 ‘‘(iii) Any recommendations to Congress or the 

12 Secretary that the Board considers appropriate con13 cerning the means and methods for the Secretary to 

14 achieve optimal efficiencies or savings in delivering 

15 health care to veterans. 

16 ‘‘(5) Following the submission of the report under 

17 paragraph (4) each year, the Board shall review and re18 consider the matters contained in the report and shall, 

19 during the five-day period ending on May 1 of that year, 

20 submit to Congress a report updating the matters in the 

21 report submitted under paragraph (4). The Board shall 

22 include in that report any revision it considers appropriate 

23 to its most recent determination under subsection (b), to24 gether with the reasons for any such revision. 
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1 ‘‘(e) For purposes of this section, the term ‘veterans 

2 health care programs’ means programs, functions, and ac3 tivities of the Veterans Health Administration other 

4 than—

5 ‘‘(1) medical and prosthetic research; and 

6 ‘‘(2) grants under subchapter III of chapter 81 

7 of this title. 

8 ‘‘(f)(1) There is established in the Department of 

9 Veterans Affairs a Veterans Health Care Funding Review 

10 Board. The Board shall consist of three members who 

11 shall be appointed by the Secretary. Persons appointed to 

12 the Board shall have professional backgrounds and experi13 ence in health care policy analysis, health care statistics, 

14 health care insurance, or health care economics or have 

15 similar qualifications considered suitable by the Secretary. 

16 ‘‘(2)(A) Except as provided in subparagraph (B), the 

17 members of the Board shall serve for a term of 15 years, 

18 except that a member of the Board appointed to fill a va19 cancy occurring before the end of the term for which the 

20 member’s predecessor was appointed shall only serve until 

21 the end of such term. A member may serve after the end 

22 of the term of the member until the successor of that 

23 member has taken office. A member of the Board may 

24 be removed by the Secretary for misconduct or failure to 
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1 perform functions vested in the Board, and for no other 

2 reason. 

3 ‘‘(B) Of the members of the Board who are first ap4 pointed under this paragraph, one each shall be appointed 

5 for terms ending five, ten, and 15 years, respectively, after 

6 the date of appointment, as designated by the Secretary 

7 at the time of appointment. 

8 ‘‘(3) A member of the Board who is not otherwise 

9 an employee of the United States is entitled to receive pay 

10 at the daily equivalent of the annual rate of basic pay of 

11 the highest rate of basic pay under the General Schedule 

12 of subchapter III of chapter 53 of title 5, for each day 

13 the member is engaged in the performance of duties vested 

14 in the Board, and is entitled to travel expenses, including 

15 a per diem allowance, in accordance with section 5703 of 

16 title 5. 

17 ‘‘(4)(A) The Secretary shall furnish the Board all pa18 pers, records, information, and other materials it requires 

19 in order to carry out its functions under this section. 

20 ‘‘(B) The Director of the Office of Management and 

21 Budget shall furnish to the Board complete information 

22 on the economic assumptions (including assumptions as 

23 to inflation, unemployment, revenues and expenses, and 

24 energy costs) that inform or guide the President’s overall 

25 budgetary presentation to Congress, including those as-
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1 sumptions that would be expected to particularly affect 

2 health care costs in the Department, or the cost of care 

3 to veterans. 

4 ‘‘(5) Funds for the expenses of the Board for any 

5 fiscal year shall be provided from amounts available for 

6 that fiscal year for veterans health care programs. The 

7 Board shall include consideration of its own budget re8 quirements in determinations under subsection (b).’’. 

9 (2) The table of sections at the beginning of such 

10 chapter is amended by adding at the end the following 

11 new item:

‘‘320. Enhanced funding process for veterans health care.’’.

12 (b) EFFECTIVE DATE.—Sections 320 of title 38, 

13 United States Code, as added by subsection (a), shall take 

14 effect on January 1, 2004. 

15 (c) REPEAL OF CONSTRUCTION AUTHORIZATION RE16 QUIREMENT.—Effective October 1, 2004, subsections (a), 

17 (b), (c), and (d) of section 8104 of title 38, United States 

18 Code, are repealed. 

19 (d) APPOINTMENT OF INITIAL MEMBERS OF

20 BOARD.—The initial appointment of the members of the 

21 Board established under subsection (f) of section 320 of 

22 title 38, United States Code, as added by subsection (a), 

23 shall be completed not later than 90 days after the date 

24 of the enactment of this Act. 
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1 (e) INITIAL FUNDING FOR BOARD.—For fiscal year 

2 2004, the Secretary of Veterans Affairs shall provide 

3 amounts needed for the operation of the Board established 

4 under subsection (f) of section 320 of title 38, United 

5 States Code, as added by subsection (a), in a total amount 

6 not to exceed $2,000,000, from amounts appropriated to 

7 the Department of Veterans Affairs for that fiscal year 

8 for Medical Care. 

9 SEC. 3. ACCESS TO CARE STANDARDS. 

10 (a) REQUIRED STANDARD FOR ACCESS TO CARE.—

11 Section 1703 of title 38, United States Code, is amended 

12 by adding at the end the following new subsection: 

13 ‘‘(d)(1) The following are the standards for access to 

14 care for the Department: 

15 ‘‘(A) For a veteran seeking primary care, the 

16 standard for access is 30 days, determined from the 

17 date on which the veteran contacts the Department 

18 seeking an appointment until the date on which a 

19 visit with a primary care provider is completed. 

20 ‘‘(B) For a veteran seeking specialized care, the 

21 standard for access is 30 days, determined from the 

22 date on which the veteran is referred for specialty 

23 care by a primary care provider until the date on 

24 which a visit with an appropriate specialty primary 

25 care provider is completed. 
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1 ‘‘(2) The Secretary shall develop and disseminate an 

2 appropriate standard of waiting time, determined from the 

3 time at which the veteran’s visit is scheduled until the vet4 eran is seen by the provider. The Secretary shall periodi5 cally review performance of Department facilities com6 pared to that standard. The Secretary shall annually re7 port to the Committees on Veterans’ Affairs of the Senate 

8 and House of Representatives an assessment of the De9 partment’s performance against that standard. 

10 ‘‘(3) In a case in which the Secretary is unable to 

11 meet the standard for access to care, the Secretary shall 

12 use the authority of subsection (a) to furnish health care 

13 and services for that veteran in a non-Department facil14 ity.’’. 

15 (b) EFFECTIVE DATE.—The amendment made by 

16 subsection (a) shall take effect on the first day of the first 

17 month beginning more than six months after the date of 

18 the enactment of this Act.

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