```

[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4810 Engrossed in House (EH)]

113th CONGRESS
  2d Session
                                H. R. 4810

_______________________________________________________________________

                                 AN ACT

 
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.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Veteran Access to Care Act of 
2014''.

SEC. 2. 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.

    (a) In General.--As authorized by section 1710 of title 38, United 
States Code, the Secretary of Veterans Affairs (in this Act referred to 
as the ``Secretary'') shall enter into contracts with such non-
Department facilities as may be necessary in order to furnish hospital 
care and medical services to covered veterans who are eligible for such 
care and services under chapter 17 of title 38, United States Code. To 
the greatest extent possible, the Secretary shall carry out this 
section using contracts entered into before the date of the enactment 
of this Act.
    (b) Covered Veterans.--For purposes of this section, the term 
``covered veteran'' means a veteran--
            (1) who is enrolled in the patient enrollment system under 
        section 1705 of title 38, United States Code;
            (2) who--
                    (A) has waited longer than the wait-time goals of 
                the Veterans Health Administration (as of June 1, 2014) 
                for an appointment for hospital care or medical 
                services in a facility of the Department;
                    (B) has been notified by a facility of the 
                Department that an appointment for hospital care or 
                medical services is not available within such wait-time 
                goals; or
                    (C) resides more than 40 miles from the medical 
                facility of the Department of Veterans Affairs, 
                including a community-based outpatient clinic, that is 
                closest to the residence of the veteran; and
            (3) who makes an election to receive such care or services 
        in a non-Department facility.
    (c) Follow-Up Care.--In carrying out this section, the Secretary 
shall ensure that, at the election of a covered veteran who receives 
hospital care or medical services at a non-Department facility in an 
episode of care under this section, the veteran receives such hospital 
care and medical services at such non-Department facility through the 
completion of the episode of care (but for a period not exceeding 60 
days), including all specialty and ancillary services deemed necessary 
as part of the treatment recommended in the course of such hospital 
care or medical services.
    (d) Report.--The Secretary shall submit to Congress a quarterly 
report on hospital care and medical services furnished pursuant to this 
section. Such report shall include information, for the quarter covered 
by the report, regarding--
            (1) the number of veterans who received care or services at 
        non-Department facilities pursuant to this section;
            (2) the number of veterans who were eligible to receive 
        care or services pursuant to this section but who elected to 
        continue waiting for an appointment at a Department facility;
            (3) the purchase methods used to provide the care and 
        services at non-Department facilities, including the rate of 
        payment for individual authorizations for such care and 
        services; and
            (4) any other matters the Secretary determines appropriate.
    (e) Definitions.--For purposes of this section, the terms 
``facilities of the Department'', ``non-Department facilities'', 
``hospital care'', and ``medical services'' have the meanings given 
such terms in section 1701 of title 38, United States Code.
    (f) Implementation.--The Secretary shall begin implementing this 
section on the date of the enactment of this Act.
    (g) Construction.--Nothing in this section shall be construed to 
authorize payment for care or services not otherwise covered under 
chapter 17 of title 38, United States Code.
    (h) Termination.--The authority of the Secretary under this section 
shall terminate with respect to any hospital care or medical services 
furnished after the end of the 2-year period beginning on the date of 
the enactment of this Act, except that in the case of an episode of 
care for which hospital care or medical services is furnished in a non-
Department facility pursuant to this section before the end of such 
period, such termination shall not apply to such care and services 
furnished during the remainder of such episode of care but not to 
exceed a period of 60 days.

SEC. 3. EXPANDED ACCESS TO HOSPITAL CARE AND MEDICAL SERVICES.

    (a) In General.--To the extent that appropriations are available 
for the Veterans Health Administration of the Department of Veterans 
Affairs for medical services, to the extent that the Secretary of 
Veterans Affairs is unable to provide access, within the wait-time 
goals of the Veterans Health Administration (as of June 1, 2014), to 
hospital care or medical services to a covered veteran who is eligible 
for such care or services under chapter 17 of title 38, United States 
Code, under contracts described in section 2, the Secretary shall 
reimburse any non-Department facility with which the Secretary has not 
entered into a contract to furnish hospital care or medical services 
for furnishing such hospital care or medical services to such veteran, 
if the veteran elects to receive such care or services from the non-
Department facility. The Secretary shall reimburse the facility for the 
care or services furnished to the veteran at the greatest of the 
following rates:
            (1) VA payment rate.--The rate of reimbursement for such 
        care or services established by the Secretary of Veterans 
        Affairs.
            (2) Medicare payment rate.--The payment rate for such care 
        or services or comparable care or services under the Medicare 
        program under title XVIII of the Social Security Act.
            (3) TRICARE payment rate.--The reimbursement rate for such 
        care or services furnished to a member of the Armed Forces 
        under chapter 55 of title 10, United States Code.
    (b) Covered Veterans.--For purposes of this section, the term 
``covered veteran'' means a veteran--
            (1) who is enrolled in the patient enrollment system under 
        section 1705 of title 38, United States Code; and
            (2) who--
                    (A) has waited longer than the wait-time goals of 
                the Veterans Health Administration (as of June 1, 2014) 
                for an appointment for hospital care or medical 
                services in a facility of the Department;
                    (B) has been notified by a facility of the 
                Department that an appointment for hospital care or 
                medical services is not available within such wait-time 
                goals after the date for which the veteran requests the 
                appointment; or
                    (C) who resides more than 40 miles from the medical 
                facility of the Department of Veterans Affairs, 
                including a community-based outpatient clinic, that is 
                closest to the residence of the veteran.
    (c) Definitions.--For purposes of this section, the terms 
``facilities of the Department'', ``non-Department facilities'', 
``hospital care'', and ``medical services'' have the meanings given 
such terms in section 1701 of title 38, United States Code.
    (d) Implementation.--The Secretary shall begin implementing this 
section on the date of the enactment of this Act.
    (e) Construction.--Nothing in this section shall be construed to 
authorize payment for care or services not otherwise covered under 
chapter 17 of title 38, United States Code.
    (f) Termination.--The authority of the Secretary under this section 
shall terminate with respect to care or services furnished after the 
date that is 2 years after the date of the enactment of this Act.

SEC. 4. INDEPENDENT ASSESSMENT OF VETERANS HEALTH ADMINISTRATION 
              PERFORMANCE.

    (a) Independent Assessment Required.--Not later than 120 days after 
the date of the enactment of this Act, the Secretary of Veterans 
Affairs shall enter into a contract or contracts with a private sector 
entity or entities with experience in the delivery systems of the 
Veterans Health Administration and the private sector and in health 
care management to conduct an independent assessment of hospital care 
and medical services furnished in medical facilities of the Department 
of Veterans Affairs. Such assessment shall address each of the 
following:
            (1) The current and projected demographics and unique care 
        needs of the patient population served by the Department of 
        Veterans Affairs.
            (2) The current and projected health care capabilities and 
        resources of the Department, including hospital care and 
        medical services furnished by non-Department facilities under 
        contract with the Department, to provide timely and accessible 
        care to eligible veterans.
            (3) The authorities and mechanisms under which the 
        Secretary may furnish hospital care and medical services at 
        non-Department facilities, including an assessment of whether 
        the Secretary should have the authority to furnish such care 
        and services at such facilities through the completion of 
        episodes of care.
            (4) The appropriate system-wide access standard applicable 
        to hospital care and medical services furnished by and through 
        the Department of Veterans Affairs and recommendations relating 
        to access standards specific to individual specialties and 
        standards for post-care rehabilitation.
            (5) The current organization, processes, and tools used to 
        support clinical staffing and documentation.
            (6) The staffing levels and productivity standards, 
        including a comparison with industry performance percentiles.
            (7) Information technology strategies of the Veterans 
        Health Administration, including an identification of 
        technology weaknesses and opportunities, especially as they 
        apply to clinical documentation of hospital care and medical 
        services provided in non-Department facilities.
            (8) Business processes of the Veterans Health 
        Administration, including non-Department care, insurance 
        identification, third-party revenue collection, and vendor 
        reimbursement.
    (b) Assessment Outcomes.--The assessment conducted pursuant to 
subsection (a) shall include the following:
            (1) An identification of improvement areas outlined both 
        qualitatively and quantitatively, taking into consideration 
        Department of Veterans Affairs directives and industry 
        benchmarks from outside the Federal Government.
            (2) Recommendations for how to address the improvement 
        areas identified under paragraph (1) relating to structure, 
        accountability, process changes, technology, and other relevant 
        drivers of performance.
            (3) The business case associated with making the 
        improvements and recommendations identified in paragraphs (1) 
        and (2).
            (4) Findings and supporting analysis on how credible 
        conclusions were established.
    (c) Program Integrator.--If the Secretary enters into contracts 
with more than one private sector entity under subsection (a), the 
Secretary shall designate one such entity as the program integrator. 
The program integrator shall be responsible for coordinating the 
outcomes of the assessments conducted by the private entities pursuant 
to such contracts.
    (d) Submittal of Reports to Congress.--
            (1) Report on independent assessment.--Not later than 10 
        months after entering into the contract under subsection (a), 
        the Secretary shall submit to the Committees on Veterans' 
        Affairs of the Senate and House of Representatives the findings 
        and recommendations of the independent assessment required by 
        such subsection.
            (2) Report on va action plan to implement recommendations 
        in assessment.--Not later than 120 days after the date of 
        submission of the report under paragraph (1), the Secretary 
        shall submit to such Committees on the Secretary's response to 
        the findings of the assessment and shall include an action 
        plan, including a timeline, for fully implementing the 
        recommendations of the assessment.

SEC. 5. LIMITATION ON AWARDS AND BONUSES TO EMPLOYEES OF DEPARTMENT OF 
              VETERANS AFFAIRS.

    For each of fiscal years 2014 through 2016, the Secretary of 
Veterans Affairs may not pay awards or bonuses under chapter 45 or 53 
of title 5, United States Code, or any other awards or bonuses 
authorized under such title.

SEC. 6. OMB ESTIMATE OF BUDGETARY EFFECTS AND NEEDED TRANSFER 
              AUTHORITY.

    Not later than 30 days after the date of the enactment of this Act, 
the Director of the Office of Management and Budget shall transmit to 
the Committees on Appropriations, the Budget, and Veterans' Affairs of 
the House of Representatives and of the Senate--
            (1) an estimate of the budgetary effects of sections 2 and 
        3;
            (2) any transfer authority needed to utilize the savings 
        from section 5 to satisfy such budgetary effects; and
            (3) if necessary, a request for any additional budgetary 
        resources, or transfers or reprogramming of existing budgetary 
        resources, necessary to provide funding for sections 2 and 3.

            Passed the House of Representatives June 10, 2014.

            Attest:

                                                                 Clerk.
113th CONGRESS

  2d Session

                               H. R. 4810

_______________________________________________________________________

                                 AN ACT

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.
```