I 

109TH CONGRESS 

1ST SESSION H. R. 1346 

To amend title 38, United States Code, to provide for a more equitable 

geographic allocation of funds appropriated to the Department of Veterans Affairs for medical care. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 16, 2005 

Mr. LARSON of Connecticut (for himself, Mr. ABERCROMBIE, Mr. CASE, Mr. 

DELAHUNT, Ms. DELAURO, Mr. GREEN of Wisconsin, Mr. GRIJALVA, 

Ms. JACKSON-LEE of Texas, Mr. MCCOTTER, Ms. NORTON, and Mr. 

PALLONE) introduced the following bill; which was referred to the Committee on Veterans’ Affairs 

A BILL 

To amend title 38, United States Code, to provide for a 

more equitable geographic allocation of funds appropriated to the Department of Veterans Affairs for medical care. 

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 ‘‘21st Century Veterans 

5 Equitable Treatment Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 
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1 (1) Veterans were promised by the Federal 

2 Government that for their service to the country 

3 they would be provided a lifetime of health care serv4 ices, as well as their own health care service net5 work. 

6 (2) The current allocation system for appropria7 tions made to the Department of Veterans Affairs 

8 for medical care, known as the Veterans Equitable 

9 Resource Allocation (VERA) formula and estab10 lished by the Secretary of Veterans Affairs pursuant 

11 to section 429 of the Departments of Veterans Af12 fairs and Housing and Urban Development, and 

13 Independent Agencies Appropriations Act, 1997 

14 (Public Law 104–204; 110 Stat. 2929), has proved 

15 to be an ineffective means of allocating such funds 

16 fairly across the 22 national service regions, known 

17 as Veterans Integrated Service Networks (VISNs), 

18 of the Department of Veterans Affairs. 

19 (3) The VERA formula has resulted in a sys20 tem in which veterans in some regions of the country 

21 are forced to compete with veterans in other regions 

22 for critical medical care funds, whereas the system 

23 should be providing the funding necessary to meet 

24 the health care needs of all veterans, regardless of 

25 where they live, to ensure that all veterans have ac-
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1 cess to the level and quality of care that they have 

2 all earned and deserve. 

3 (4) The Secretary of Veterans Affairs estab4 lished a set of performance goals in fiscal year 2000, 

5 which are referred to as ‘‘30–30–20’’, representing 

6 the Secretary’s goal to schedule nonurgent primary 

7 care visits within 30 days, specialty care visits within 

8 30 days, and the maximum amount of time veterans 

9 must wait once they arrive to be seen by a doctor 

10 as 20 minutes. 

11 (5) According to the Department’s Performance 

12 Report for Fiscal Year 2001, nationally 87 percent 

13 of primary care appointments were scheduled within 

14 30 days of the desired date and 84 percent of spe15 cialty care appointments were scheduled within 30 

16 days of the desired date, while in VISN 1, only 82 

17 percent of primary care appointments were sched18 uled within 30 days of the desired date and only 80 

19 percent of specialty care appointments were sched20 uled within 30 days of the desired date. 

21 (6) Until the VERA formula is changed to en22 sure a more equitable and adequate distribution of 

23 medical care funding within the Department of Vet24 erans Affairs system, providing appropriate access to 

25 medical care for the Nation’s veterans must remain 
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1 a national priority with a method found to provide 

2 a safety net that will ensure that veterans have ac3 cess to the health care they need without under4 mining the existing health care network of the De5 partment of Veterans Affairs. 

6 SEC. 3. STANDARD FOR TIME FOR REFERRAL FOR SPE7 CIALIST CARE. 

8 (a) TIME FOR SPECIALIST APPOINTMENTS.—(1) The 

9 Secretary of Veterans Affairs shall establish by regulation 

10 a maximum specialist referral period, subject to such ex11 ceptions as the Secretary considers necessary. 

12 (2) For purposes of paragraph (1), the term ‘‘spe13 cialist referral period’’ means the period of time between 

14 (A) the date on which a veteran is referred to a specialty 

15 clinic of the Department by the veteran’s primary care 

16 physician within the Department of Veterans Affairs 

17 health care system, and (B) the date for which the veteran 

18 is scheduled for an appointment with a Department spe19 cialist pursuant to such referral. 

20 (3) In establishing a maximum specialist referral pe21 riod under paragraph (1), the Secretary shall act in a 

22 manner consistent with the current treatment policies of 

23 the Department based on clinical need and with the estab24 lished 30–30–20 performance goal of the Department for 

25 such a referral period. 
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1 (b) STANDARD FOR TRANSPORTATION.—The Sec2 retary shall take such steps as necessary to ensure that 

3 the Department of Veterans Affairs is able to provide ap4 propriate transportation services for qualified veterans 

5 within a reasonable time period of a scheduled appoint6 ment. 

7 SEC. 4. CONTRACT CARE TO BE PROVIDED WHEN DEPART8 MENT OF VETERANS AFFAIRS CARE NOT 

9 AVAILABLE IN ACCORDANCE WITH STAND10 ARDS. 

11 (a) CONTRACT CARE.—In any case in which the Sec12 retary of Veterans Affairs is not able to provide hospital 

13 care or medical services in accordance with the standard 

14 prescribed under section 3(a) or to provide transportation 

15 services in accordance with section 3(b), the Secretary 

16 shall promptly provide for such care or transportation 

17 from a private source. Hospital care or medical services 

18 so provided shall be those for which the veteran is other19 wise eligible within the Department of Veterans Affairs 

20 medical care system. 

21 (b) REIMBURSEMENT RATE.—Whenever care or serv22 ices are provided under subsection (a), the Secretary shall 

23 reimburse the provider of such care or services for the rea24 sonable value of such care or services, as determined by 

25 the Secretary. Such reimbursement shall be provided in 
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1 the same manner as applies to reimbursement for emer2 gency treatment under section 1725 of title 38, United 

3 States Code, subject to such of the terms and conditions 

4 otherwise applicable to such reimbursements under such 

5 section as the Secretary determines to be appropriate for 

6 purposes of this section. 

7 (c) EXPEDITED REIMBURSEMENT PROCEDURES.— 

8 The Secretary shall take appropriate steps to expedite the 

9 reimbursement required by subsection (b). Such steps may 

10 include steps to take advantage of modern technology, in11 cluding so-called ‘‘smart card’’ technology that would 

12 allow claims for such reimbursement to be processed elec13 tronically. The Secretary shall, to the extent possible, also 

14 apply such steps for expediting reimbursement to claims 

15 for emergency services provided to veterans for which the 

16 Secretary provides reimbursement under provisions of law 

17 in effect before the date of the enactment of this Act. 

18 SEC. 5. TERMINATION OF 24–MONTH RULE FOR REIM19 BURSEMENT FOR EMERGENCY SERVICES. 

20 The provisions of subparagraph (B) of section 

21 1725(b)(2) of title 38, United States Code, shall not apply 

22 with respect to emergency treatment furnished on or after 

23 the date of the enactment of this Act. 
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1 SEC. 6. MEDICAL ADMINISTRATOR PERFORMANCE RAT2 INGS. 

3 The Secretary of Veterans Affairs shall include in the 

4 standards of performance used for measuring performance 

5 of administrators in the Department of Veterans Affairs 

6 medical care system a standard of assessing improvements 

7 in appointment waiting times. 

8 SEC. 7. REPORTS. 

9 The Secretary of Veterans Affairs shall submit to the 

10 Committees on Veterans’ Affairs of the Senate and House 

11 of Representatives a report at the end of each fiscal-year 

12 quarter on the waiting times for appointments in the De13 partment of Veterans Affairs medical care system. The re14 port shall describe any reductions in such waiting times 

15 and any experience with appointment delays. 

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