IIB 

113TH CONGRESS 

2D SESSION H. R. 4810 

IN THE SENATE OF THE UNITED STATES 

JUNE 11, 2014 

Received; read twice and referred to the Committee on Veterans’ Affairs 

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. 


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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 

20 shall carry out this section using contracts entered into 

21 before the date of the enactment of this Act. 

22 (b) COVERED VETERANS.—For purposes of this sec23 tion, the term ‘‘covered veteran’’ means a veteran— 


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1 (1) who is enrolled in the patient enrollment 

2 system under section 1705 of title 38, United States 

3 Code; 

4 (2) who— 

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

6 goals of the Veterans Health Administration (as 

7 of June 1, 2014) for an appointment for hos8 pital care or medical services in a facility of the 

9 Department; 

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

11 Department that an appointment for hospital 

12 care or medical services is not available within 

13 such wait-time goals; or 

14 (C) resides more than 40 miles from the 

15 medical facility of the Department of Veterans 

16 Affairs, including a community-based outpatient 

17 clinic, that is closest to the residence of the vet18 eran; and 

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

20 or services in a non-Department facility. 

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

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

23 veteran who receives hospital care or medical services at 

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

25 section, the veteran receives such hospital care and medVerDate Mar 15 2010 00:53 Jun 12, 2014 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4810.RFS H4810

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1 ical services at such non-Department facility through the 

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

3 exceeding 60 days), including all specialty and ancillary 

4 services deemed necessary as part of the treatment rec5 ommended in the course of such hospital care or medical 

6 services. 

7 (d) REPORT.—The Secretary shall submit to Con8 gress a quarterly report on hospital care and medical serv9 ices furnished pursuant to this section. Such report shall 

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

11 regarding— 

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

13 services at non-Department facilities pursuant to 

14 this section; 

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

16 receive care or services pursuant to this section but 

17 who elected to continue waiting for an appointment 

18 at a Department facility; 

19 (3) the purchase methods used to provide the 

20 care and services at non-Department facilities, in21 cluding the rate of payment for individual authoriza22 tions for such care and services; and 

23 (4) any other matters the Secretary determines 

24 appropriate. 


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

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

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

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

5 United States Code. 

6 (f) IMPLEMENTATION.—The Secretary shall begin 

7 implementing this section on the date of the enactment 

8 of this Act. 

9 (g) CONSTRUCTION.—Nothing in this section shall be 

10 construed to authorize payment for care or services not 

11 otherwise covered under chapter 17 of title 38, United 

12 States Code. 

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

14 under this section shall terminate with respect to any hos15 pital care or medical services furnished after the end of 

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

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

18 for which hospital care or medical services is furnished in 

19 a non-Department facility pursuant to this section before 

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

21 to such care and services furnished during the remainder 

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

23 days. 


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1 SEC. 3. EXPANDED ACCESS TO HOSPITAL CARE AND MED2 ICAL SERVICES. 

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

4 are available for the Veterans Health Administration of 

5 the Department of Veterans Affairs for medical services, 

6 to the extent that the Secretary of Veterans Affairs is un7 able to provide access, within the wait-time goals of the 

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

9 hospital care or medical services to a covered veteran who 

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

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

12 section 2, the Secretary shall reimburse any non-Depart13 ment facility with which the Secretary has not entered into 

14 a contract to furnish hospital care or medical services for 

15 furnishing such hospital care or medical services to such 

16 veteran, if the veteran elects to receive such care or serv17 ices from the non-Department facility. The Secretary shall 

18 reimburse the facility for the care or services furnished 

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

20 (1) VA PAYMENT RATE.—The rate of reim21 bursement for such care or services established by 

22 the Secretary of Veterans Affairs. 

23 (2) MEDICARE PAYMENT RATE.—The payment 

24 rate for such care or services or comparable care or 

25 services under the Medicare program under title 

26 XVIII of the Social Security Act. 


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1 (3) TRICARE PAYMENT RATE.—The reim2 bursement rate for such care or services furnished to 

3 a member of the Armed Forces under chapter 55 of 

4 title 10, United States Code. 

5 (b) COVERED VETERANS.—For purposes of this sec6 tion, the term ‘‘covered veteran’’ means a veteran— 

7 (1) who is enrolled in the patient enrollment 

8 system under section 1705 of title 38, United States 

9 Code; and 

10 (2) who— 

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

12 goals of the Veterans Health Administration (as 

13 of June 1, 2014) for an appointment for hos14 pital care or medical services in a facility of the 

15 Department; 

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

17 Department that an appointment for hospital 

18 care or medical services is not available within 

19 such wait-time goals after the date for which 

20 the veteran requests the appointment; or 

21 (C) who resides more than 40 miles from 

22 the medical facility of the Department of Vet23 erans Affairs, including a community-based out24 patient clinic, that is closest to the residence of 

25 the veteran. 


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

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

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

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

5 United States Code. 

6 (d) IMPLEMENTATION.—The Secretary shall begin 

7 implementing this section on the date of the enactment 

8 of this Act. 

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

10 construed to authorize payment for care or services not 

11 otherwise covered under chapter 17 of title 38, United 

12 States Code. 

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

14 under this section shall terminate with respect to care or 

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

16 date of the enactment of this Act. 

17 SEC. 4. INDEPENDENT ASSESSMENT OF VETERANS HEALTH 

18 ADMINISTRATION PERFORMANCE. 

19 (a) INDEPENDENT ASSESSMENT REQUIRED.—Not 

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

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

22 a contract or contracts with a private sector entity or enti23 ties with experience in the delivery systems of the Veterans 

24 Health Administration and the private sector and in 

25 health care management to conduct an independent asVerDate Mar 15 2010 00:53 Jun 12, 2014 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4810.RFS H4810

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1 sessment of hospital care and medical services furnished 

2 in medical facilities of the Department of Veterans Af3 fairs. Such assessment shall address each of the following: 

4 (1) The current and projected demographics 

5 and unique care needs of the patient population 

6 served by the Department of Veterans Affairs. 

7 (2) The current and projected health care capa8 bilities and resources of the Department, including 

9 hospital care and medical services furnished by non10 Department facilities under contract with the De11 partment, to provide timely and accessible care to el12 igible veterans. 

13 (3) The authorities and mechanisms under 

14 which the Secretary may furnish hospital care and 

15 medical services at non-Department facilities, includ16 ing an assessment of whether the Secretary should 

17 have the authority to furnish such care and services 

18 at such facilities through the completion of episodes 

19 of care. 

20 (4) The appropriate system-wide access stand21 ard applicable to hospital care and medical services 

22 furnished by and through the Department of Vet23 erans Affairs and recommendations relating to ac24 cess standards specific to individual specialties and 

25 standards for post-care rehabilitation. 


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1 (5) The current organization, processes, and 

2 tools used to support clinical staffing and docu3 mentation. 

4 (6) The staffing levels and productivity stand5 ards, including a comparison with industry perform6 ance percentiles. 

7 (7) Information technology strategies of the 

8 Veterans Health Administration, including an identi9 fication of technology weaknesses and opportunities, 

10 especially as they apply to clinical documentation of 

11 hospital care and medical services provided in non12 Department facilities. 

13 (8) Business processes of the Veterans Health 

14 Administration, including non-Department care, in15 surance identification, third-party revenue collection, 

16 and vendor reimbursement. 

17 (b) ASSESSMENT OUTCOMES.—The assessment con18 ducted pursuant to subsection (a) shall include the fol19 lowing: 

20 (1) An identification of improvement areas out21 lined both qualitatively and quantitatively, taking 

22 into consideration Department of Veterans Affairs 

23 directives and industry benchmarks from outside the 

24 Federal Government. 


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1 (2) Recommendations for how to address the 

2 improvement areas identified under paragraph (1) 

3 relating to structure, accountability, process 

4 changes, technology, and other relevant drivers of 

5 performance. 

6 (3) The business case associated with making 

7 the improvements and recommendations identified in 

8 paragraphs (1) and (2). 

9 (4) Findings and supporting analysis on how 

10 credible conclusions were established. 

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

12 into contracts with more than one private sector entity 

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

14 such entity as the program integrator. The program inte15 grator shall be responsible for coordinating the outcomes 

16 of the assessments conducted by the private entities pur17 suant to such contracts. 

18 (d) SUBMITTAL OF REPORTS TO CONGRESS.— 

19 (1) REPORT ON INDEPENDENT ASSESSMENT.— 

20 Not later than 10 months after entering into the 

21 contract under subsection (a), the Secretary shall 

22 submit to the Committees on Veterans’ Affairs of 

23 the Senate and House of Representatives the find24 ings and recommendations of the independent as25 sessment required by such subsection. 


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1 (2) REPORT ON VA ACTION PLAN TO IMPLE2 MENT RECOMMENDATIONS IN ASSESSMENT.—Not 

3 later than 120 days after the date of submission of 

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

5 submit to such Committees on the Secretary’s re6 sponse to the findings of the assessment and shall 

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

8 implementing the recommendations of the assess9 ment. 

10 SEC. 5. LIMITATION ON AWARDS AND BONUSES TO EM11 PLOYEES OF DEPARTMENT OF VETERANS AF12 FAIRS. 

13 For each of fiscal years 2014 through 2016, the Sec14 retary of Veterans Affairs may not pay awards or bonuses 

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

16 or any other awards or bonuses authorized under such 

17 title. 

18 SEC. 6. OMB ESTIMATE OF BUDGETARY EFFECTS AND 

19 NEEDED TRANSFER AUTHORITY. 

20 Not later than 30 days after the date of the enact21 ment of this Act, the Director of the Office of Manage22 ment and Budget shall transmit to the Committees on Ap23 propriations, the Budget, and Veterans’ Affairs of the 

24 House of Representatives and of the Senate— 


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1 (1) an estimate of the budgetary effects of sec2 tions 2 and 3; 

3 (2) any transfer authority needed to utilize the 

4 savings from section 5 to satisfy such budgetary ef5 fects; and 

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

7 budgetary resources, or transfers or reprogramming 

8 of existing budgetary resources, necessary to provide 

9 funding for sections 2 and 3. 

Passed the House of Representatives June 10, 2014. 

Attest: KAREN L. HAAS, 

Clerk. 


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