II 

113TH CONGRESS 

1ST SESSION S. 1604 

To amend title 38, United States Code, to expand and enhance eligibility 

for health care and services through the Department of Veterans Affairs, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 29, 2013 

Mr. SANDERS introduced the following bill; which was read twice and referred 

to the Committee on Veterans’ Affairs 

A BILL 

To amend title 38, United States Code, to expand and enhance eligibility for health care and services through 

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 Eligibility Expansion and Enhancement Act of 2013’’. 


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1 SEC. 2. ENHANCEMENT OF NATURE OF ELIGIBILITY FOR 

2 CARE OF CERTAIN VETERANS. 

3 Section 1710(a)(3) of title 38, United States Code, 

4 is amended by striking ‘‘may, to the extent resources and 

5 facilities are available and’’ and inserting ‘‘shall,’’. 

6 SEC. 3. REQUIREMENT FOR ENROLLMENT IN PATIENT EN7 ROLLMENT SYSTEM OF DEPARTMENT OF 

8 VETERANS AFFAIRS OF CERTAIN VETERANS 

9 ELIGIBLE FOR ENROLLMENT BY LAW BUT 

10 NOT CURRENTLY PERMITTED TO ENROLL. 

11 (a) REQUIREMENT FOR ENROLLMENT.—Section 

12 1705 of title 38, United States Code, is amended by add13 ing at the end the following new subsection: 

14 ‘‘(d)(1) The Secretary shall provide for the enroll15 ment in the patient enrollment system of veterans speci16 fied in paragraph (2) by not later than December 31, 

17 2014. 

18 ‘‘(2) Veterans specified in this paragraph are as fol19 lows: 

20 ‘‘(A) Veterans with noncompensable service-con21 nected disabilities rated as zero percent disabling 

22 who— 

23 ‘‘(i) are not otherwise permitted to enroll 

24 in the system as of the date of the enactment 

25 of the Veterans Health Care Eligibility Expan26 sion and Enhancement Act of 2013; and 


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1 ‘‘(ii) as of the date of enrollment under 

2 this section, do not have access to health insur3 ance except through a health exchange estab4 lished pursuant to section 1311 of the Patient 

5 Protection and Affordable Care Act (42 U.S.C. 

6 18031). 

7 ‘‘(B) Veterans without service-connected dis8 ability who— 

9 ‘‘(i) are not otherwise permitted to enroll 

10 in the system as of the date of the enactment 

11 of the Veterans Health Care Eligibility Expan12 sion and Enhancement Act of 2013; and 

13 ‘‘(ii) as of the date of enrollment under 

14 this section, do not have access to health insur15 ance except through a health exchange estab16 lished pursuant to section 1311 of the Patient 

17 Protection and Affordable Care Act. 

18 ‘‘(3) The Secretary shall determine whether a veteran 

19 does not have access to health insurance except through 

20 a health exchange for purposes of paragraph (2) using in21 formation obtained by the Secretary of Health and 

22 Human Services and the Secretary of the Treasury for 

23 purposes of determining whether the veteran maintains 

24 minimum essential coverage as required by section 5000A 

25 of the Internal Revenue Code of 1986 and reported as reVerDate Mar 15 2010 02:12 Oct 30, 2013 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1604.IS S1604

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1 quired by section 6055 of the Internal Revenue Code of 

2 1986. 

3 ‘‘(4) A veteran who, after enrolling in the patient en4 rollment system pursuant to this subsection, obtains ac5 cess to health insurance other than through a health ex6 change shall remain enrolled in the patient enrollment sys7 tem notwithstanding obtaining access to such health in8 surance. 

9 ‘‘(5) A veteran enrolled in the patient enrollment sys10 tem pursuant to this subsection shall maintain the priority 

11 for care of the veteran at the time of enrollment unless 

12 and until a change in circumstances of the veteran results 

13 in a higher priority for care of the veteran under sub14 section (a).’’. 

15 (b) PUBLIC NOTICE OF COMMENCEMENT OF EN16 ROLLMENT.—The Secretary of Veterans Affairs shall pub17 lish in the Federal Register, and shall make available to 

18 the public on an Internet website of the Department of 

19 Veterans Affairs, a notice regarding the date on which vet20 erans covered by subsection (d) of section 1705 of title 

21 38, United States Code (as added by subsection (a) of this 

22 section), may commence enrollment in the patient enroll23 ment system required by that section. 


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1 SEC. 4. FURTHER EXTENSION OF PERIOD OF ELIGIBILITY 

2 FOR HEALTH CARE FOR VETERANS OF COM3 BAT SERVICE DURING CERTAIN PERIODS OF 

4 HOSTILITIES AND WAR. 

5 Section 1710(e)(3) of title 38, United States Code, 

6 is amended— 

7 (1) in subparagraph (A), by striking ‘‘the date 

8 that is five years before the date of the enactment 

9 of the National Defense Authorization Act for Fiscal 

10 Year 2008, after a period of five years’’ and insert11 ing ‘‘January 27, 2003, after a period of 10 years’’; 

12 and 

13 (2) in subparagraph (B), by striking ‘‘more 

14 than five years’’ and all that follows and inserting 

15 ‘‘before January 28, 2003, and who did not enroll 

16 in the patient enrollment system under section 1705 

17 of this title before January 28, 2008, after January 

18 27, 2018.’’. 

19 SEC. 5. RELOCATION AND RESTATEMENT OF LIMITATION 

20 ON REQUIREMENTS TO FURNISH CERTAIN 

21 CARE AND SERVICES CONTINGENT ON THE 

22 AVAILABILITY OF APPROPRIATIONS. 

23 (a) RELOCATION AND RESTATEMENT.—Section 1707 

24 of title 38, United States Code, is amended by adding at 

25 the end the following new subsection: 


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1 ‘‘(c)(1) The requirements specified in paragraph (2) 

2 shall be effective in any fiscal year only to the extent and 

3 in the amount provided in advance in appropriations Acts 

4 for such purposes. 

5 ‘‘(2) The requirements specified in this paragraph are 

6 as follows: 

7 ‘‘(A) The requirement in paragraphs (1), (2), 

8 and (3) of section 1710(a) of this title that the Sec9 retary provide hospital care and medical services. 

10 ‘‘(B) The requirement in section 1710A(a) of 

11 this title that the Secretary provide nursing home 

12 care. 

13 ‘‘(C) The requirement in section 1710B of this 

14 title that the Secretary provide a program of ex15 tended care services. 

16 ‘‘(D) The requirement in section 1745 of this 

17 title that the Secretary provide nursing home care 

18 and prescription medicines to veterans with service19 connected disabilities in State homes.’’. 

20 (b) CONFORMING REPEAL OF SUPERSEDED LIMITA21 TION.—Section 1710(a) of such title is amended— 

22 (1) by striking paragraph (4); and 

23 (2) by redesignating paragraph (5) as para24 graph (4). 


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1 SEC. 6. MODIFICATION OF DETERMINATION OF ELIGI2 BILITY OF VETERANS FOR TREATMENT AS A 

3 LOW-INCOME FAMILY FOR PURPOSES OF EN4 ROLLMENT IN THE PATIENT ENROLLMENT 

5 SYSTEM OF THE DEPARTMENT OF VETERANS 

6 AFFAIRS. 

7 (a) AREAS OF RESIDENCE.—The Secretary of Vet8 erans Affairs shall modify the areas in which veterans re9 side as specified for purposes of determining whether vet10 erans qualify for treatment as low-income families for en11 rollment in the patient enrollment system of the Depart12 ment of Veterans Affairs under section 1705(a)(7) of title 

13 38, United States Code, to meet the requirements as fol14 lows: 

15 (1) Any area so specified shall be within only 

16 one State. 

17 (2) Any area so specified shall be co-extensive 

18 with one or more counties (or similar political sub19 divisions) in the State concerned. 

20 (b) VARIABLE INCOME THRESHOLDS.—The Sec21 retary shall modify the thresholds for income as specified 

22 for purposes of determining whether veterans qualify for 

23 treatment as low-income families for enrollment in the pa24 tient enrollment system referred to in subsection (a) to 

25 meet the requirements as follows: 


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1 (1) There shall be one income threshold for 

2 each State, equal to the highest income threshold 

3 among the counties within such State. 

4 (2) The calculation of the highest income 

5 threshold of a county shall be consistent with the 

6 calculation used for purposes of section 3(b) of the 

7 United States Housing Act of 1937 (42 U.S.C. 

8 1437a(b)). 

9 (3) The timing and methodology for imple10 menting any modifications in geographic income 

11 thresholds pursuant to paragraph (1) shall be deter12 mined by the Secretary in such a manner as to per13 mit the Department to build capacity for enrolling 

14 such additional veterans in the patient enrollment 

15 system of the Department as become eligible for en16 rollment as a result of such modifications, except 

17 that all required modifications shall be completed 

18 not later than five years after date of the enactment 

19 of this Act. 

20 SEC. 7. CONTRACTING FOR HEALTH CARE. 

21 (a) USE OF CAPITATION-BASED RESOURCE ALLOCA22 TION IN ENTRY INTO CONTRACTS.—In entering into con23 tracts for the furnishing of health care services under the 

24 laws administered by the Secretary of Veterans Affairs 

25 (including under this Act and the amendments made by 


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1 this Act), the Secretary shall use the capitation-based re2 source allocation model of the Department of Veterans Af3 fairs. 

4 (b) PRIORITY FOR CONTRACTS WITH CERTAIN ENTI5 TIES.—In entering into contracts for the furnishing of 

6 health care services under the laws administered by the 

7 Secretary, the Secretary shall afford a priority for entry 

8 into contracts for Federally Qualified Health Centers 

9 (FQHCs) and Community Health Centers (CHCs), when10 ever appropriate. 

11 (c) BEST PRACTICES.—The Secretary shall modify 

12 the guidance of the Department of Veterans Affairs on 

13 contracts for health care services in order to provide for 

14 the incorporation into such contracts of standardized re15 quirements for such best practices under such contracts, 

16 including the following: 

17 (1) Requirements that contracts provide the 

18 Department on a regular basis information on 

19 scheduling and appearance for appointments for 

20 health care on a per-patient basis. 

21 (2) Such other best practices requirements as 

22 the Secretary considers appropriate. 

Æ 


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