I 

113TH CONGRESS 

2D SESSION H. R. 4810 

To direct the Secretary of Veterans Affairs to enter into contracts for the 

provision of hospital care and medical services at non-Department of 

Veterans Affairs facilities for Department of Veterans Affairs patients 

with extended waiting times for appointments at Department facilities, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 9, 2014 

Mr. MILLER of Florida (for himself, Mr. MCCARTHY of California, Mr. LAMBORN, Mr. BILIRAKIS, Mr. ROE of Tennessee, Mr. FLORES, Mr. RUNYAN, 

Mr. BENISHEK, Mr. HUELSKAMP, Mr. COFFMAN, Mr. WENSTRUP, Mr. 

COOK, Mrs. WALORSKI, Mr. JOLLY, Mrs. KIRKPATRICK, Mr. BARBER, 

Mr. BARR, Mr. BURGESS, Mr. CASSIDY, Mr. CRAMER, Mr. CRAWFORD, 

Mr. CULBERSON, Mr. GINGREY of Georgia, Mr. HASTINGS of Washington, Mr. HUIZENGA of Michigan, Mr. JOHNSON of Ohio, Mr. LATTA, 

Mr. NUNNELEE, Mr. MCKINLEY, Mrs. MCMORRIS RODGERS, Mr. 

RIBBLE, Ms. ROS-LEHTINEN, Mr. RUIZ, Mr. SALMON, Mr. DAVID SCOTT

of Georgia, Ms. SINEMA, Mr. STOCKMAN, Mr. SOUTHERLAND, Mr. 

UPTON, Mr. VALADAO, Mr. VELA, Mr. WHITFIELD, Ms. DUCKWORTH, 

Mr. MICHAUD, Mr. ROGERS of Alabama, Mr. PALAZZO, Mr. NUNES, Mr. 

RIGELL, Mr. DAINES, Mr. BUCHANAN, Mr. THORNBERRY, Mr. WILSON

of South Carolina, Mr. FARENTHOLD, Mr. LANCE, Mr. FALEOMAVAEGA, 

Mr. COTTON, Mr. BUCSHON, Mr. NEUGEBAUER, Mr. AMASH, Mr. HARPER, Mrs. MILLER of Michigan, Mr. PEARCE, Mr. BARROW of Georgia, 

Mr. WALBERG, Mr. CUELLAR, Mr. MICA, Mr. O’ROURKE, Mr. DUNCAN

of Tennessee, Mr. MURPHY of Pennsylvania, Ms. BROWNLEY of California, Mr. OWENS, Mr. GIBBS, Mrs. BLACK, Mr. GIBSON, Mr. CRENSHAW, Mr. FORBES, Mr. STIVERS, Mr. COLE, Mr. GRIMM, Mr. BARTON, 

Mr. SMITH of Texas, Mr. SCHOCK, Mr. TIBERI, Mr. RODNEY DAVIS of 

Illinois, Mr. CALVERT, Mr. GUTHRIE, Mr. REED, Mr. WITTMAN, Mr. 

KLINE, Ms. BORDALLO, Mr. HUDSON, Mr. COSTA, Mr. SMITH of Missouri, Mr. SABLAN, Mr. WEBSTER of Florida, Mr. SAM JOHNSON of 

Texas, Mr. BUTTERFIELD, Mr. ROTHFUS, Mr. FLEISCHMANN, Mr. 

POSEY, Mr. JOYCE, Mr. WOMACK, Mr. BISHOP of Georgia, Mr. MCINTYRE, Mr. ROYCE, Mr. NUGENT, Mr. HECK of Nevada, Ms. KUSTER, Mr. 

GRIFFIN of Arkansas, Mr. MEEHAN, Mr. BRIDENSTINE, Mr. GERLACH, 

Mr. DENHAM, Mr. SCHWEIKERT, and Mr. POMPEO) introduced the following bill; which was referred to the Committee on Veterans’ Affairs 


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A BILL 

To direct the Secretary of Veterans Affairs to enter into 

contracts for the provision of hospital care and medical 

services at non-Department of Veterans Affairs facilities 

for Department of Veterans Affairs patients with extended waiting times for appointments at Department 

facilities, 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 ‘‘Veteran Access to Care 

5 Act of 2014’’. 

6 SEC. 2. PROVISION OF HOSPITAL CARE AND MEDICAL 

7 SERVICES AT NON-DEPARTMENT OF VET8 ERANS AFFAIRS FACILITIES FOR DEPART9 MENT OF VETERANS AFFAIRS PATIENTS 

10 WITH EXTENDED WAITING TIMES FOR AP11 POINTMENTS AT DEPARTMENT FACILITIES. 

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

13 title 38, United States Code, the Secretary of Veterans 

14 Affairs (in this Act referred to as the ‘‘Secretary’’) shall 

15 enter into contracts with such non-Department facilities 

16 as may be necessary in order to furnish hospital care and 

17 medical services to covered veterans who are eligible for 

18 such care and services under chapter 17 of title 38, United 

19 States Code. To the greatest extent possible, the Secretary 


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1 shall carry out this section using contracts entered into 

2 before the date of the enactment of this Act. 

3 (b) COVERED VETERANS.—For purposes of this sec4 tion, the term ‘‘covered veteran’’ means a veteran— 

5 (1) who is enrolled in the patient enrollment 

6 system under section 1705 of title 38, United States 

7 Code; 

8 (2) who— 

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

10 goals of the Veterans Health Administration (as 

11 of June 1, 2014) for an appointment for hos12 pital care or medical services in a facility of the 

13 Department; 

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

15 Department that an appointment for hospital 

16 care or medical services is not available within 

17 such wait-time goals; or 

18 (C) resides more than 40 miles from the 

19 medical facility of the Department of Veterans 

20 Affairs, including a community-based outpatient 

21 clinic, that is closest to the residence of the vet22 eran; and 

23 (3) who makes an election to receive such care 

24 or services in a non-Department facility. 


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

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

3 veteran who receives hospital care or medical services at 

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

5 section, the veteran receives such hospital care and med6 ical services at such non-Department facility through the 

7 completion of the episode of care (but for a period not 

8 exceeding 60 days), including all specialty and ancillary 

9 services deemed necessary as part of the treatment rec10 ommended in the course of such hospital care or medical 

11 services. 

12 (d) REPORT.—The Secretary shall submit to Con13 gress a quarterly report on hospital care and medical serv14 ices furnished pursuant to this section. Such report shall 

15 include information, for the quarter covered by the report, 

16 regarding— 

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

18 services at non-Department facilities pursuant to 

19 this section; 

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

21 receive care or services pursuant to this section but 

22 who elected to continue waiting for an appointment 

23 at a Department facility; 

24 (3) the purchase methods used to provide the 

25 care and services at non-Department facilities, inVerDate Mar 15 2010 02:21 Jun 10, 2014 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4810.IH H4810

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1 cluding the rate of payment for individual authoriza2 tions for such care and services; and 

3 (4) any other matters the Secretary determines 

4 appropriate. 

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

6 terms ‘‘facilities of the Department’’, ‘‘non-Department 

7 facilities’’, ‘‘hospital care’’, and ‘‘medical services’’ have 

8 the meanings given such terms in section 1701 of title 38, 

9 United States Code. 

10 (f) IMPLEMENTATION.—The Secretary shall begin 

11 implementing this section on the date of the enactment 

12 of this Act. 

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

14 construed to authorize payment for care or services not 

15 otherwise covered under chapter 17 of title 38, United 

16 States Code. 

17 (g) TERMINATION.—The authority of the Secretary 

18 under this section shall terminate with respect to any hos19 pital care or medical services furnished after the end of 

20 the 2-year period beginning on the date of the enactment 

21 of this Act, except that in the case of an episode of care 

22 for which hospital care or medical services is furnished in 

23 a non-Department facility pursuant to this section before 

24 the end of such period, such termination shall not apply 

25 to such care and services furnished during the remainder 


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1 of such episode of care but not to exceed a period of 60 

2 days. 

3 SEC. 3. EXPANDED ACCESS TO HOSPITAL CARE AND MED4 ICAL SERVICES. 

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

6 are available for the Veterans Health Administration of 

7 the Department of Veterans Affairs for medical services, 

8 to the extent that the Secretary of Veterans Affairs is un9 able to provide access, within the wait-time goals of the 

10 Veterans Health Administration (as of June 1, 2014), to 

11 hospital care or medical services to a covered veteran who 

12 is eligible for such care or services under chapter 17 of 

13 title 38, United States Code, under contracts described in 

14 section 2, the Secretary shall reimburse any non-Depart15 ment facility with which the Secretary has not entered into 

16 a contract to furnish hospital care or medical services for 

17 furnishing such hospital care or medical services to such 

18 veteran, if the veteran elects to receive such care or serv19 ices from the non-Department facility. The Secretary shall 

20 reimburse the facility for the care or services furnished 

21 to the veteran at the greatest of the following rates: 

22 (1) VA PAYMENT RATE.—The rate of reim23 bursement for such care or services established by 

24 the Secretary of Veterans Affairs. 


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1 (2) MEDICARE PAYMENT RATE.—The payment 

2 rate for such care or services or comparable care or 

3 services under the Medicare program under title 

4 XVIII of the Social Security Act. 

5 (3) TRICARE PAYMENT RATE.—The reim6 bursement rate for such care or services furnished to 

7 a member of the Armed Forces under chapter 55 of 

8 title 10, United States Code. 

9 (b) COVERED VETERANS.—For purposes of this sec10 tion, the term ‘‘covered veteran’’ means a veteran— 

11 (1) who is enrolled in the patient enrollment 

12 system under section 1705 of title 38, United States 

13 Code; and 

14 (2) who— 

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

16 goals of the Veterans Health Administration (as 

17 of June 1, 2014) for an appointment for hos18 pital care or medical services in a facility of the 

19 Department; 

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

21 Department that an appointment for hospital 

22 care or medical services is not available within 

23 such wait-time goals after the date for which 

24 the veteran requests the appointment; or 


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1 (C) who resides more than 40 miles from 

2 the medical facility of the Department of Vet3 erans Affairs, including a community-based out4 patient clinic, that is closest to the residence of 

5 the veteran. 

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

7 terms ‘‘facilities of the Department’’, ‘‘non-Department 

8 facilities’’, ‘‘hospital care’’, and ‘‘medical services’’ have 

9 the meanings given such terms in section 1701 of title 38, 

10 United States Code. 

11 (d) IMPLEMENTATION.—The Secretary shall begin 

12 implementing this section on the date of the enactment 

13 of this Act. 

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

15 construed to authorize payment for care or services not 

16 otherwise covered under chapter 17 of title 38, United 

17 States Code. 

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

19 under this section shall terminate with respect to care or 

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

21 date of the enactment of this Act. 

22 SEC. 4. INDEPENDENT ASSESSMENT OF VETERANS HEALTH 

23 ADMINISTRATION PERFORMANCE. 

24 (a) INDEPENDENT ASSESSMENT REQUIRED.—Not 

25 later than 120 days after the date of the enactment of 


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1 this Act, the Secretary of Veterans Affairs shall enter into 

2 a contract or contracts with a private sector entity or enti3 ties with experience in the delivery systems of the Veterans 

4 Health Administration and the private sector and in 

5 health care management to conduct an independent as6 sessment of hospital care and medical services furnished 

7 in medical facilities of the Department of Veterans Af8 fairs. Such assessment shall address each of the following: 

9 (1) The current and projected demographics 

10 and unique care needs of the patient population 

11 served by the Department of Veterans Affairs. 

12 (2) The current and projected health care capa13 bilities and resources of the Department, including 

14 hospital care and medical services furnished by non15 Department facilities under contract with the De16 partment, to provide timely and accessible care to el17 igible veterans. 

18 (3) The authorities and mechanisms under 

19 which the Secretary may furnish hospital care and 

20 medical services at non-Department facilities, includ21 ing an assessment of whether the Secretary should 

22 have the authority to furnish such care and services 

23 at such facilities through the completion of episodes 

24 of care. 


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1 (4) The appropriate system-wide access stand2 ard applicable to hospital care and medical services 

3 furnished by and through the Department of Vet4 erans Affairs and recommendations relating to ac5 cess standards specific to individual specialties and 

6 standards for post-care rehabilitation. 

7 (5) The current organization, processes, and 

8 tools used to support clinical staffing and docu9 mentation. 

10 (6) The staffing levels and productivity stand11 ards, including a comparison with industry perform12 ance percentiles. 

13 (7) Information technology strategies of the 

14 Veterans Health Administration, including an identi15 fication of technology weaknesses and opportunities, 

16 especially as they apply to clinical documentation of 

17 hospital care and medical services provided in non18 Department facilities. 

19 (8) Business processes of the Veterans Health 

20 Administration, including non-Department care, in21 surance identification, third-party revenue collection, 

22 and vendor reimbursement. 

23 (b) ASSESSMENT OUTCOMES.—The assessment con24 ducted pursuant to subsection (a) shall include the fol25 lowing: 


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1 (1) An identification of improvement areas out2 lined both qualitatively and quantitatively, taking 

3 into consideration Department of Veterans Affairs 

4 directives and industry benchmarks from outside the 

5 Federal Government. 

6 (2) Recommendations for how to address the 

7 improvement areas identified under paragraph (1) 

8 relating to structure, accountability, process 

9 changes, technology, and other relevant drivers of 

10 performance. 

11 (3) The business case associated with making 

12 the improvements and recommendations identified in 

13 paragraphs (1) and (2). 

14 (4) Findings and supporting analysis on how 

15 credible conclusions were established. 

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

17 into contracts with more than one private sector entity 

18 under subsection (a), the Secretary shall designate one 

19 such entity as the program integrator. The program inte20 grator shall be responsible for coordinating the outcomes 

21 of the assessments conducted by the private entities pur22 suant to such contracts. 

23 (d) SUBMITTAL OF REPORTS TO CONGRESS.— 

24 (1) REPORT ON INDEPENDENT ASSESSMENT.— 

25 Not later than 10 months after entering into the 


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1 contract under subsection (a), the Secretary shall 

2 submit to the Committees on Veterans’ Affairs of 

3 the Senate and House of Representatives the find4 ings and recommendations of the independent as5 sessment required by such subsection. 

6 (2) REPORT ON VA ACTION PLAN TO IMPLE7 MENT RECOMMENDATIONS IN ASSESSMENT.—Not 

8 later than 120 days after the date of submission of 

9 the report under paragraph (1), the Secretary shall 

10 submit to such Committees on the Secretary’s re11 sponse to the findings of the assessment and shall 

12 include an action plan, including a timeline, for fully 

13 implementing the recommendations of the assess14 ment. 

15 SEC. 5. LIMITATION ON AWARDS AND BONUSES TO EM16 PLOYEES OF DEPARTMENT OF VETERANS AF17 FAIRS. 

18 For each of fiscal years 2014 through 2016, the Sec19 retary of Veterans Affairs may not pay awards or bonuses 

20 under chapter 45 or 53 of title 5, United States Code, 

21 or any other awards or bonuses authorized under such 

22 title. 


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1 SEC. 6. OMB ESTIMATE OF BUDGETARY EFFECTS AND 

2 NEEDED TRANSFER AUTHORITY. 

3 Not later than 30 days after the date of the enact4 ment of this Act, the Director of the Office of Manage5 ment and Budget shall transmit to the Committees on Ap6 propriations, the Budget, and Veterans’ Affairs of the 

7 House of Representatives and of the Senate— 

8 (1) an estimate of the budgetary effects of sec9 tions 2 and 3; 

10 (2) any transfer authority needed to utilize the 

11 savings from section 5 to satisfy such budgetary ef12 fects; and 

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

14 budgetary resources, or transfers or reprogramming 

15 of existing budgetary resources, necessary to provide 

16 funding for sections 2 and 3. 

Æ 


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