I 

109TH CONGRESS 

1ST SESSION H. R. 2735 

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 

MAY 26, 2005 

Mr. SMITH of New Jersey (for himself, Mr. FITZPATRICK of Pennsylvania, 

and Mr. MURPHY) 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. 

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’’. 
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1 SEC. 2. ENHANCED PROCESS FOR FUNDING VETERANS 

2 HEALTH CARE PROGRAMS. 

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

4 States Code, is amended by adding at the end the fol5 lowing new section: 

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

7 care 

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

9 transmitted under section 1105 of title 31, amounts shall 

10 be requested for veterans health care programs in accord11 ance with this section. Amounts appropriated for veterans 

12 health care programs shall be available for obligation for 

13 a period of two consecutive fiscal years. 

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

15 year 2008), the Veterans Health Care Funding Review 

16 Board shall determine the level of funding needed for vet17 erans health care programs for that fiscal year and the 

18 next fiscal year. The Board shall make such determina19 tion, and shall publish such determination in the Federal 

20 Register, not later than November 1 of the year preceding 

21 the year in which the budget for such fiscal year is trans22 mitted to Congress. 

23 ‘‘(2) In making any such determination under para24 graph (1), the Board shall take into consideration the 

25 most recent information relating to economic assumptions 
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1 provided to the Board by the Director of the Office of 

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

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

4 any two-fiscal-year period is the amount needed to be ap5 propriated to the Department for that two-fiscal-year pe6 riod for veterans health care programs. The President 

7 shall include the full amount so determined in the budget 

8 transmitted to Congress under section 1105 of title 31 for 

9 the first fiscal year in such two-year period and shall in10 clude the amount of the second fiscal year as a budget 

11 forecast year. 

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

13 the level of funding needed for veterans health care pro14 grams for any two-fiscal-year period under subsection (b) 

15 based upon an annual review of those programs and of 

16 veterans health care needs. 

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

18 of the level of funding needed for veterans health care pro19 grams for any period is in an amount sufficient to provide 

20 for— 

21 ‘‘(A) the health care needs of veterans esti22 mated to be enrolled in the Department health care 

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

24 than veterans described in paragraph (8) of such 

25 section); 
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1 ‘‘(B) the health care needs of veterans with 

2 service-connected disabilities who are not required to 

3 enroll in such health care system; 

4 ‘‘(C) timely access to health care under stand5 ards for access prescribed under section 1703(d)(1) 

6 of this title; 

7 ‘‘(D) maintenance of capacities of Department 

8 nursing home facilities as required by section 

9 1710B(b) of this title and of specialized programs as 

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

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

12 for benefits under chapter 17 of this title based 

13 upon subchapter VIII of that chapter; 

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

15 upgrading, expanding, repairing, and replacing of 

16 major and minor medical facilities, capital equip17 ment, and systems to ensure that health care facili18 ties of the Department are adequate for the pur19 poses of programs and benefits authorized for the 

20 care of veterans under chapter 17 of this title; and 

21 ‘‘(G) unanticipated requirements, including— 

22 ‘‘(i) changes in benefits; 

23 ‘‘(ii) changes in beneficiaries; 

24 ‘‘(iii) changes in economic conditions or as25 sumptions; and 
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1 ‘‘(iv) such other factors as the Board con2 siders appropriate. 

3 ‘‘(3) Each such review under paragraph (1) shall con4 sider— 

5 ‘‘(A) demographic information; 

6 ‘‘(B) utilization and cost trends for veterans en7 rolled under section 1705 of this title and other De8 partment health-care beneficiaries; 

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

10 missions of the Department related to health care; 

11 ‘‘(D) the degree of efficiency (or the lack of ef12 ficiency) by which the Secretary actually delivers 

13 health care services to veterans; and 

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

15 appropriate. 

16 ‘‘(4)(A) The Board shall submit to Congress an an17 nual report, not later than the date on which the President 

18 transmits the budget to Congress under section 1105 of 

19 title 31 each year, on its most recent determination under 

20 subsection (b) and its most recent review under paragraph 

21 (1). 

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

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

24 each of the two fiscal years covered by such deter25 mination under subsection (b). 
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1 ‘‘(ii) A description of the economic assumptions 

2 and other assumptions made by the Board in mak3 ing such determination and how that determination 

4 was developed. 

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

6 Secretary that the Board considers appropriate con7 cerning the means and methods for the Secretary to 

8 achieve optimal efficiencies or savings in delivering 

9 health care to veterans. 

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

11 paragraph (4) each year, the Board shall review and re12 consider the matters contained in the report and shall, 

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

14 submit to Congress a report updating the matters in the 

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

16 include in that report any revision it considers appropriate 

17 to its most recent determination under subsection (b), to18 gether with the reasons for any such revision. 

19 ‘‘(e) For purposes of this section, the term ‘veterans 

20 health care programs’ means programs, functions, and ac21 tivities of the Veterans Health Administration other 

22 than— 

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

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

25 of this title. 
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1 ‘‘(f)(1) There is established in the Department of 

2 Veterans Affairs a Veterans Health Care Funding Review 

3 Board. The Board shall consist of three members who 

4 shall be appointed by the Secretary. Persons appointed to 

5 the Board shall have professional backgrounds and experi6 ence in health care policy analysis, health care statistics, 

7 health care insurance, or health care economics or have 

8 similar qualifications considered suitable by the Secretary. 

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

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

11 except that a member of the Board appointed to fill a va12 cancy occurring before the end of the term for which the 

13 member’s predecessor was appointed shall only serve until 

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

15 of the term of the member until the successor of that 

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

17 be removed by the Secretary for misconduct or failure to 

18 perform functions vested in the Board, and for no other 

19 reason. 

20 ‘‘(B) Of the members of the Board who are first ap21 pointed under this paragraph, one each shall be appointed 

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

23 the date of appointment, as designated by the Secretary 

24 at the time of appointment. 
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1 ‘‘(3) A member of the Board who is not otherwise 

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

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

4 the highest rate of basic pay under the General Schedule 

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

6 the member is engaged in the performance of duties vested 

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

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

9 title 5. 

10 ‘‘(4)(A) The Secretary shall furnish the Board all pa11 pers, records, information, and other materials it requires 

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

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

14 Budget shall furnish to the Board complete information 

15 on the economic assumptions (including assumptions as 

16 to inflation, unemployment, revenues and expenses, and 

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

18 budgetary presentation to Congress, including those as19 sumptions that would be expected to particularly affect 

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

21 to veterans. 

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

23 fiscal year shall be provided from amounts available for 

24 that fiscal year for veterans health care programs. The 
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1 Board shall include consideration of its own budget re2 quirements in determinations under subsection (b).’’. 

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

4 chapter is amended by adding at the end the following 

5 new item: 

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

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

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

8 effect on January 1, 2006. 

9 (c) REPEAL OF CONSTRUCTION AUTHORIZATION RE10 QUIREMENT.—Effective October 1, 2006, subsections (a), 

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

12 Code, are repealed. 

13 (d) APPOINTMENT OF INITIAL MEMBERS OF

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

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

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

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

18 of the enactment of this Act. 

19 (e) INITIAL FUNDING FOR BOARD.—For fiscal year 

20 2006, the Secretary of Veterans Affairs shall provide 

21 amounts needed for the operation of the Board established 

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

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

24 not to exceed $2,000,000, from amounts appropriated to 
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1 the Department of Veterans Affairs for that fiscal year 

2 for Medical Care. 

3 SEC. 3. ACCESS TO CARE STANDARDS. 

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

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

6 by adding at the end the following new subsection: 

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

8 care for the Department: 

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

10 standard for access is 30 days, determined from the 

11 date on which the veteran contacts the Department 

12 seeking an appointment until the date on which a 

13 visit with a primary care provider is completed. 

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

15 standard for access is 30 days, determined from the 

16 date on which the veteran is referred for specialty 

17 care by a primary care provider until the date on 

18 which a visit with an appropriate specialty primary 

19 care provider is completed. 

20 ‘‘(2) The Secretary shall develop and disseminate an 

21 appropriate standard of waiting time, determined from the 

22 time at which the veteran’s visit is scheduled until the vet23 eran is seen by the provider. The Secretary shall periodi24 cally review performance of Department facilities com25 pared to that standard. The Secretary shall annually re-
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1 port to the Committees on Veterans’ Affairs of the Senate 

2 and House of Representatives an assessment of the De3 partment’s performance against that standard. 

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

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

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

7 and services for that veteran in a non-Department facil8 ity.’’. 

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

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

11 month beginning more than six months after the date of 

12 the enactment of this Act. 

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