In the House of Representatives, U. S., 

June 18, 2014. 

Resolved, That the House agree to the amendment of the 

Senate to the title of the bill (H.R. 3230) entitled ‘‘An Act 

making continuing appropriations during a Government shutdown to provide pay and allowances to members of the reserve components of the Armed Forces who perform inactiveduty training during such period.’’ and be it further 

Resolved, That the House agree to the amendment of the 

Senate to the text of the aforementioned bill, with the following 

HOUSE AMENDMENT TO SENATE AMENDMENT 

In lieu of the matter proposed to be inserted by the 

amendment of the Senate to the text of the bill, insert 

the following: 

1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Veteran Access to Care 

3 Act of 2014’’. 
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1 SEC. 2. PROVISION OF HOSPITAL CARE AND MEDICAL SERV2 ICES AT NON-DEPARTMENT OF VETERANS AF3 FAIRS FACILITIES FOR DEPARTMENT OF VET4 ERANS AFFAIRS PATIENTS WITH EXTENDED 

5 WAITING TIMES FOR APPOINTMENTS AT DE6 PARTMENT FACILITIES. 

7 (a) IN GENERAL.—As authorized by section 1710 of 

8 title 38, United States Code, the Secretary of Veterans Af9 fairs (in this Act referred to as the ‘‘Secretary’’) shall enter 

10 into contracts with such non-Department facilities as may 

11 be necessary in order to furnish hospital care and medical 

12 services to covered veterans who are eligible for such care 

13 and services under chapter 17 of title 38, United States 

14 Code. To the greatest extent possible, the Secretary shall 

15 carry out this section using contracts entered into before 

16 the date of the enactment of this Act. 

17 (b) COVERED VETERANS.—For purposes of this sec18 tion, the term ‘‘covered veteran’’ means a veteran— 

19 (1) who is enrolled in the patient enrollment sys20 tem under section 1705 of title 38, United States 

21 Code; 

22 (2) who— 

23 (A) has waited longer than the wait-time 

24 goals of the Veterans Health Administration (as 

25 of June 1, 2014) for an appointment for hospital 
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1 care or medical services in a facility of the De2 partment; 

3 (B) has been notified by a facility of the 

4 Department that an appointment for hospital 

5 care or medical services is not available within 

6 such wait-time goals; or 

7 (C) resides more than 40 miles from the 

8 medical facility of the Department of Veterans 

9 Affairs, including a community-based outpatient 

10 clinic, that is closest to the residence of the vet11 eran; and 

12 (3) who makes an election to receive such care or 

13 services in a non-Department facility. 

14 (c) FOLLOW-UP CARE.—In carrying out this section, 

15 the Secretary shall ensure that, at the election of a covered 

16 veteran who receives hospital care or medical services at 

17 a non-Department facility in an episode of care under this 

18 section, the veteran receives such hospital care and medical 

19 services at such non-Department facility through the com20 pletion of the episode of care (but for a period not exceeding 

21 60 days), including all specialty and ancillary services 

22 deemed necessary as part of the treatment recommended in 

23 the course of such hospital care or medical services. 

24 (d) REPORT.—The Secretary shall submit to Congress 

25 a quarterly report on hospital care and medical services 
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1 furnished pursuant to this section. Such report shall include 

2 information, for the quarter covered by the report, regard3 ing— 

4 (1) the number of veterans who received care or 

5 services at non-Department facilities pursuant to this 

6 section; 

7 (2) the number of veterans who were eligible to 

8 receive care or services pursuant to this section but 

9 who elected to continue waiting for an appointment 

10 at a Department facility; 

11 (3) the purchase methods used to provide the care 

12 and services at non-Department facilities, including 

13 the rate of payment for individual authorizations for 

14 such care and services; and 

15 (4) any other matters the Secretary determines 

16 appropriate. 

17 (e) DEFINITIONS.—For purposes of this section, the 

18 terms ‘‘facilities of the Department’’, ‘‘non-Department fa19 cilities’’, ‘‘hospital care’’, and ‘‘medical services’’ have the 

20 meanings given such terms in section 1701 of title 38, 

21 United States Code. 

22 (f) IMPLEMENTATION.—The Secretary shall begin im23 plementing this section on the date of the enactment of this 

24 Act. 
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1 (g) CONSTRUCTION.—Nothing in this section shall be 

2 construed to authorize payment for care or services not oth3 erwise covered under chapter 17 of title 38, United States 

4 Code. 

5 (h) TERMINATION.—The authority of the Secretary 

6 under this section shall terminate with respect to any hos7 pital care or medical services furnished after the end of the 

8 2-year period beginning on the date of the enactment of this 

9 Act, except that in the case of an episode of care for which 

10 hospital care or medical services is furnished in a non-De11 partment facility pursuant to this section before the end 

12 of such period, such termination shall not apply to such 

13 care and services furnished during the remainder of such 

14 episode of care but not to exceed a period of 60 days. 

15 SEC. 3. EXPANDED ACCESS TO HOSPITAL CARE AND MED16 ICAL SERVICES. 

17 (a) IN GENERAL.—To the extent that appropriations 

18 are available for the Veterans Health Administration of the 

19 Department of Veterans Affairs for medical services, to the 

20 extent that the Secretary of Veterans Affairs is unable to 

21 provide access, within the wait-time goals of the Veterans 

22 Health Administration (as of June 1, 2014), to hospital 

23 care or medical services to a covered veteran who is eligible 

24 for such care or services under chapter 17 of title 38, United 

25 States Code, under contracts described in section 2, the Sec-
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1 retary shall reimburse any non-Department facility with 

2 which the Secretary has not entered into a contract to fur3 nish hospital care or medical services for furnishing such 

4 hospital care or medical services to such veteran, if the vet5 eran elects to receive such care or services from the non6 Department facility. The Secretary shall reimburse the fa7 cility for the care or services furnished to the veteran at 

8 the greatest of the following rates: 

9 (1) VA PAYMENT RATE.—The rate of reimburse10 ment for such care or services established by the Sec11 retary of Veterans Affairs. 

12 (2) MEDICARE PAYMENT RATE.—The payment 

13 rate for such care or services or comparable care or 

14 services under the Medicare program under title 

15 XVIII of the Social Security Act. 

16 (3) TRICARE PAYMENT RATE.—The reimburse17 ment rate for such care or services furnished to a 

18 member of the Armed Forces under chapter 55 of title 

19 10, United States Code. 

20 (b) COVERED VETERANS.—For purposes of this sec21 tion, the term ‘‘covered veteran’’ means a veteran— 

22 (1) who is enrolled in the patient enrollment sys23 tem under section 1705 of title 38, United States 

24 Code; and 

25 (2) who— 
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1 (A) has waited longer than the wait-time 

2 goals of the Veterans Health Administration (as 

3 of June 1, 2014) for an appointment for hospital 

4 care or medical services in a facility of the De5 partment; 

6 (B) has been notified by a facility of the 

7 Department that an appointment for hospital 

8 care or medical services is not available within 

9 such wait-time goals after the date for which the 

10 veteran requests the appointment; or 

11 (C) who resides more than 40 miles from 

12 the medical facility of the Department of Vet13 erans Affairs, including a community-based out14 patient clinic, that is closest to the residence of 

15 the veteran. 

16 (c) DEFINITIONS.—For purposes of this section, the 

17 terms ‘‘facilities of the Department’’, ‘‘non-Department fa18 cilities’’, ‘‘hospital care’’, and ‘‘medical services’’ have the 

19 meanings given such terms in section 1701 of title 38, 

20 United States Code. 

21 (d) IMPLEMENTATION.—The Secretary shall begin im22 plementing this section on the date of the enactment of this 

23 Act. 

24 (e) CONSTRUCTION.—Nothing in this section shall be 

25 construed to authorize payment for care or services not oth-
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1 erwise covered under chapter 17 of title 38, United States 

2 Code. 

3 (f) TERMINATION.—The authority of the Secretary 

4 under this section shall terminate with respect to care or 

5 services furnished after the date that is 2 years after the 

6 date of the enactment of this Act. 

7 SEC. 4. INDEPENDENT ASSESSMENT OF VETERANS HEALTH 

8 ADMINISTRATION PERFORMANCE. 

9 (a) INDEPENDENT ASSESSMENT REQUIRED.—Not 

10 later than 120 days after the date of the enactment of this 

11 Act, the Secretary of Veterans Affairs shall enter into a con12 tract or contracts with a private sector entity or entities 

13 with experience in the delivery systems of the Veterans 

14 Health Administration and the private sector and in health 

15 care management to conduct an independent assessment of 

16 hospital care and medical services furnished in medical fa17 cilities of the Department of Veterans Affairs. Such assess18 ment shall address each of the following: 

19 (1) The current and projected demographics and 

20 unique care needs of the patient population served by 

21 the Department of Veterans Affairs. 

22 (2) The current and projected health care capa23 bilities and resources of the Department, including 

24 hospital care and medical services furnished by non25 Department facilities under contract with the Depart-
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1 ment, to provide timely and accessible care to eligible 

2 veterans. 

3 (3) The authorities and mechanisms under which 

4 the Secretary may furnish hospital care and medical 

5 services at non-Department facilities, including an 

6 assessment of whether the Secretary should have the 

7 authority to furnish such care and services at such fa8 cilities through the completion of episodes of care. 

9 (4) The appropriate system-wide access standard 

10 applicable to hospital care and medical services fur11 nished by and through the Department of Veterans 

12 Affairs and recommendations relating to access stand13 ards specific to individual specialties and standards 

14 for post-care rehabilitation. 

15 (5) The current organization, processes, and tools 

16 used to support clinical staffing and documentation. 

17 (6) The staffing levels and productivity stand18 ards, including a comparison with industry perform19 ance percentiles. 

20 (7) Information technology strategies of the Vet21 erans Health Administration, including an identi22 fication of technology weaknesses and opportunities, 

23 especially as they apply to clinical documentation of 

24 hospital care and medical services provided in non25 Department facilities. 
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1 (8) Business processes of the Veterans Health Ad2 ministration, including non-Department care, insur3 ance identification, third-party revenue collection, 

4 and vendor reimbursement. 

5 (b) ASSESSMENT OUTCOMES.—The assessment con6 ducted pursuant to subsection (a) shall include the fol7 lowing: 

8 (1) An identification of improvement areas out9 lined both qualitatively and quantitatively, taking 

10 into consideration Department of Veterans Affairs di11 rectives and industry benchmarks from outside the 

12 Federal Government. 

13 (2) Recommendations for how to address the im14 provement areas identified under paragraph (1) relat15 ing to structure, accountability, process changes, tech16 nology, and other relevant drivers of performance. 

17 (3) The business case associated with making the 

18 improvements and recommendations identified in 

19 paragraphs (1) and (2). 

20 (4) Findings and supporting analysis on how 

21 credible conclusions were established. 

22 (c) PROGRAM INTEGRATOR.—If the Secretary enters 

23 into contracts with more than one private sector entity 

24 under subsection (a), the Secretary shall designate one such 

25 entity as the program integrator. The program integrator 
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1 shall be responsible for coordinating the outcomes of the as2 sessments conducted by the private entities pursuant to such 

3 contracts. 

4 (d) SUBMITTAL OF REPORTS TO CONGRESS.— 

5 (1) REPORT ON INDEPENDENT ASSESSMENT.— 

6 Not later than 10 months after entering into the con7 tract under subsection (a), the Secretary shall submit 

8 to the Committees on Veterans’ Affairs of the Senate 

9 and House of Representatives the findings and rec10 ommendations of the independent assessment required 

11 by such subsection. 

12 (2) REPORT ON VA ACTION PLAN TO IMPLEMENT

13 RECOMMENDATIONS IN ASSESSMENT.—Not later than 

14 120 days after the date of submission of the report 

15 under paragraph (1), the Secretary shall submit to 

16 such Committees on the Secretary’s response to the 

17 findings of the assessment and shall include an action 

18 plan, including a timeline, for fully implementing the 

19 recommendations of the assessment. 

20 SEC. 5. LIMITATION ON AWARDS AND BONUSES TO EM21 PLOYEES OF DEPARTMENT OF VETERANS AF22 FAIRS. 

23 For each of fiscal years 2014 through 2016, the Sec24 retary of Veterans Affairs may not pay awards or bonuses 
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1 under chapter 45 or 53 of title 5, United States Code, or 

2 any other awards or bonuses authorized under such title. 

3 SEC. 6. OMB ESTIMATE OF BUDGETARY EFFECTS AND 

4 NEEDED TRANSFER AUTHORITY. 

5 Not later than 30 days after the date of the enactment 

6 of this Act, the Director of the Office of Management and 

7 Budget shall transmit to the Committees on Appropria8 tions, the Budget, and Veterans’ Affairs of the House of Rep9 resentatives and of the Senate— 

10 (1) an estimate of the budgetary effects of sec11 tions 2 and 3; 

12 (2) any transfer authority needed to utilize the 

13 savings from section 5 to satisfy such budgetary ef14 fects; and 

15 (3) if necessary, a request for any additional 

16 budgetary resources, or transfers or reprogramming of 

17 existing budgetary resources, necessary to provide 

18 funding for sections 2 and 3. 

19 SEC. 7. REMOVAL OF SENIOR EXECUTIVE SERVICE EMPLOY20 EES OF THE DEPARTMENT OF VETERANS AF21 FAIRS FOR PERFORMANCE. 

22 (a) IN GENERAL.—Chapter 7 of title 38, United States 

23 Code, is amended by adding at the end the following new 

24 section: 
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1 ‘‘§ 713. Senior Executive Service: removal based on 

2 performance 

3 ‘‘(a) IN GENERAL.—Notwithstanding any other provi4 sion of law, the Secretary may remove any individual from 

5 the Senior Executive Service if the Secretary determines the 

6 performance of the individual warrants such removal. If the 

7 Secretary so removes such an individual, the Secretary 

8 may— 

9 ‘‘(1) remove the individual from Federal service; 

10 or 

11 ‘‘(2) transfer the individual to a General Sched12 ule position at any grade of the General Schedule the 

13 Secretary determines appropriate. 

14 ‘‘(b) NOTICE TO CONGRESS.—Not later than 30 days 

15 after removing an individual from the Senior Executive 

16 Service under paragraph (1), the Secretary shall submit to 

17 the Committees on Veterans’ Affairs of the Senate and 

18 House of Representatives notice in writing of such removal 

19 and the reason for such removal. 

20 ‘‘(c) MANNER OF REMOVAL.—A removal under this 

21 section shall be done in the same manner as the removal 

22 of a professional staff member employed by a Member of 

23 Congress.’’. 
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1 (b) CLERICAL AMENDMENT.—The table of sections at 

2 the beginning of such chapter is amended by adding at the 

3 end the following new item: 

‘‘713. Senior Executive Service: removal based on performance.’’. 

4 SEC. 8. BUDGETARY EFFECTS OF ACT. 

5 The budgetary effects of this Act, for the purpose of 

6 complying with the Statutory Pay-As-You-Go Act of 2010, 

7 shall be determined by reference to the latest statement titled 

8 ‘‘Budgetary Effects of PAYGO Legislation’’ for this Act, 

9 submitted for printing in the Congressional Record by the 

10 Chairman of the House Budget Committee, provided that 

11 such statement has been submitted prior to the vote on pas12 sage. 

Attest: 

Clerk. 

113TH CONGRESS 

2D SESSION H.R. 3230 

HOUSE AMENDMENT TO 

SENATE AMENDMENT