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[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 2424 Introduced in Senate (IS)]

113th CONGRESS
  2d Session
                                S. 2424

    To provide veterans with the choice of medical providers and to 
increase transparency and accountability of operations of the Veterans 
 Health Administration of the Department of Veterans Affairs, and for 
                            other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                              June 3, 2014

Mr. McCain (for himself, Mr. Coburn, Mr. Burr, Mr. Flake, Mr. Isakson, 
   Mr. Inhofe, Mr. Grassley, Mr. Roberts, Mr. Hoeven, Mr. Coats, Mr. 
Barrasso, Mr. Johanns, Mr. Rubio, Mr. Cornyn, Mr. Alexander, Mr. Kirk, 
  Mr. Wicker, Mrs. Fischer, Mr. Portman, Mr. Toomey, Mr. Boozman, Mr. 
 Moran, Mr. Thune, Mr. Scott, Mr. Enzi, and Mr. Graham) introduced the 
 following bill; which was read twice and referred to the Committee on 
                           Veterans' Affairs

_______________________________________________________________________

                                 A BILL

 
    To provide veterans with the choice of medical providers and to 
increase transparency and accountability of operations of the Veterans 
 Health Administration of the Department of Veterans Affairs, 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 ``Veterans Choice Act of 2014''.

SEC. 2. EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL SERVICES FOR 
              VETERANS THROUGH THE USE OF CONTRACTS.

    (a) Expansion of Available Care and Services.--
            (1) In general.--Hospital care and medical services under 
        chapter 17 of title 38, United States Code, shall be furnished 
        to an eligible veteran described in subsection (b), at the 
        election of such veteran, through contracts authorized under 
        subsection (d), or any other law administered by the Secretary 
        of Veterans Affairs, with health care providers that are 
        participating in the Medicare program under title XVIII of the 
        Social Security Act (42 U.S.C. 1395 et seq.) for the furnishing 
        of such care and services to veterans.
            (2) Choice of provider.--An eligible veteran who elects to 
        receive care and services under this section may select the 
        provider of such care and services from among any source of 
        provider of such care and services specified in paragraph (1) 
        that is accessible to the veteran.
    (b) Eligible Veterans.--A veteran is an eligible veteran for 
purposes of this section if--
            (1)(A) the veteran is enrolled in the patient enrollment 
        system of the Department of Veterans Affairs established and 
        operated under section 1705 of title 38, United States Code; or
            (B) the veteran is enrolled in such system, has not 
        received hospital care and medical services from the 
        Department, and has contacted the Department seeking an initial 
        appointment from the Department for the receipt of such care 
        and services; and
            (2) the veteran either--
                    (A)(i) attempts, or has attempted under paragraph 
                (1)(B), to schedule an appointment for the receipt of 
                such care and services but is unable to schedule an 
                appointment within the current wait-time goals of the 
                Veterans Health Administration for the delivery of such 
                care and services; and
                    (ii) elects, and is authorized, to be furnished 
                such care or services pursuant to subsection (c)(2); or
                    (B) resides more than 40 miles from the nearest 
                medical facility of the Department, including a 
                community-based outpatient clinic, that is closest to 
                the residence of the veteran.
    (c) Election and Authorization.--If the Secretary confirms that an 
appointment for an eligible veteran described in subsection (b)(2)(A) 
for the receipt of hospital care or medical services under chapter 17 
of title 38, United States Code, is unavailable within the current 
wait-time goals of the Department for the furnishing of such care or 
services, the Secretary shall, at the election of the eligible 
veteran--
            (1) place such eligible veteran on an electronic waiting 
        list for such an appointment that is maintained by the 
        Department and accessible to the veteran via 
        www.myhealth.va.gov or any successor website; or
            (2)(A) authorize that such care and services be furnished 
        to the eligible veteran under this section for a period of time 
        specified by the Secretary; and
            (B) send a letter to the eligible veteran describing the 
        care and services the eligible veteran is eligible to receive 
        under this section.
    (d) Care and Services Through Contracts.--
            (1) In general.--The Secretary shall enter into contracts 
        with health care providers that are participating in the 
        Medicare program under title XVIII of the Social Security Act 
        (42 U.S.C. 1395 et seq.) to furnish care and services to 
        eligible veterans under this section.
            (2) Rates and reimbursement.--
                    (A) In general.--In entering into a contract under 
                this subsection, the Secretary shall--
                            (i) negotiate rates for the furnishing of 
                        care and services under this section; and
                            (ii) reimburse the health care provider for 
                        such care and services at the rates negotiated 
                        pursuant to clause (i) as provided in such 
                        contract.
                    (B) Limit on rates.--Rates negotiated under 
                subparagraph (A)(i) shall not be more than the rates 
                paid by the United States to a provider of services (as 
                defined in section 1861(u) of the Social Security Act 
                (42 U.S.C. 1395x(u))) or a supplier (as defined in 
                section 1861(d) of such Act (42 U.S.C. 1395x(d))) under 
                the Medicare program under title XVIII of the Social 
                Security Act (42 U.S.C. 1395 et seq.) for the same care 
                and services.
                    (C) Limit on collection.--For the furnishing of 
                care and services pursuant to a contract under this 
                section, a health care provider may not collect any 
                amount that is greater than the rate negotiated 
                pursuant to subparagraph (A)(i).
            (3) Information on policies and procedures.--The Secretary 
        shall provide to any health care provider with which the 
        Secretary has entered into a contract under paragraph (1) the 
        following:
                    (A) Information on applicable policies and 
                procedures for submitting bills or claims for 
                authorized care and services furnished to eligible 
                veterans under this section.
                    (B) Access to a telephone hotline maintained by the 
                Department that such health care provider may call for 
                information on the following:
                            (i) Procedures for furnishing care and 
                        services under this section.
                            (ii) Procedures for submitting bills or 
                        claims for authorized care and services 
                        furnished to eligible veterans under this 
                        section and being reimbursed for furnishing 
                        such care and services.
                            (iii) Whether particular care or services 
                        under this section are authorized, and the 
                        procedures for authorization of such care or 
                        services.
    (e) Choice Card.--
            (1) In general.--For purposes of receiving care and 
        services under this section, the Secretary shall issue to each 
        eligible veteran a card that the eligible veteran shall present 
        to a health care provider that is eligible to furnish care and 
        services under this section before receiving such care and 
        services.
            (2) Name of card.--Each card issued under paragraph (1) 
        shall be known as a ``Choice Card''.
            (3) Details of card.--Each Choice Card issued to an 
        eligible veteran under paragraph (1) shall include the 
        following:
                    (A) The name of the eligible veteran.
                    (B) An identification number for the eligible 
                veteran that is not the social security number of the 
                eligible veteran.
                    (C) The contact information of an appropriate 
                office of the Department for health care providers to 
                confirm that care and services under this section is 
                authorized for the eligible veteran.
                    (D) Contact information and other relevant 
                information for the submittal of claims or bills for 
                the furnishing of care and services under this section.
                    (E) The following statement: ``This card is for 
                qualifying medical care outside the Department of 
                Veterans Affairs. Please call the Department of 
                Veterans Affairs phone number specified on this card to 
                ensure that treatment has been authorized.''.
            (4) Information on use of card.--Upon issuing a Choice Card 
        to an eligible veteran, the Secretary shall provide the 
        eligible veteran with information clearly stating the 
        circumstances under which the veteran may be eligible for care 
        and services under this section.
    (f) Information on Availability of Care.--The Secretary shall 
provide information to a veteran about the availability of care and 
services under this section in the following circumstances:
            (1) When the veteran enrolls in the patient enrollment 
        system of the Department under section 1705 of title 38, United 
        States Code.
            (2) When the veteran attempts to schedule an appointment 
        for the receipt of hospital care or medical services from the 
        Department but is unable to schedule an appointment within the 
        current wait-time goals of the Veterans Health Administration 
        for delivery of such care or services.
    (g) Providers.--To be eligible to furnish care and services under 
this section, a health care provider must maintain at least the same or 
similar credentials and licenses as those credentials and licenses that 
are required of health care providers of the Department, as determined 
by the Secretary for purposes of this section.
    (h) Cost-Sharing.--The Secretary shall require an eligible veteran 
to pay a copayment to the Department for the receipt of care and 
services under this section only if the eligible veteran would be 
required to pay such copayment for the receipt of such care and 
services at a medical facility of the Department.
    (i) Claims Processing System.--
            (1) In general.--The Secretary shall provide for an 
        efficient nationwide system for processing and paying bills or 
        claims for authorized care and services furnished to eligible 
        veterans under this section.
            (2) Regulations.--Not later than 90 days after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall prescribe regulations for the implementation of the 
        efficient nationwide system required by paragraph (1).
    (j) Continuity of Medical Records.--The Secretary shall ensure that 
medical records of veterans maintained by the Department are updated to 
accurately reflect any care and services furnished under this section.
    (k) Tracking of Missed Appointments.--The Secretary shall implement 
a mechanism to track any missed appointments for care and services 
under this section by eligible veterans to ensure that the Department 
does not pay for such care and services that were not furnished.
    (l) Implementation.--Not later than 90 days after the date of the 
enactment of this Act, the Secretary shall prescribe interim final 
regulations on the implementation of this section and publish such 
regulations in the Federal Register.
    (m) Inspector General Audit.--Not later than 540 days after the 
publication of the interim final regulations under subsection (l), the 
Inspector General of the Department shall conduct an audit of care and 
services furnished under this section to ensure the accuracy of 
payments by the Department for the cost of care and services furnished 
under this section.
    (n) Termination.--The requirement of the Secretary to furnish care 
and services under this section terminates on the date that is two 
years after the date on which the Secretary publishes the interim final 
regulations under subsection (l).
    (o) Reports.--Not less frequently than once every 90 days, the 
Secretary shall submit to Congress a report on the furnishing of care 
and services under this section that includes the following:
            (1) The number of veterans who have received care and 
        services under this section during the 90-day period preceding 
        the submittal of the report.
            (2) A description of the type of care and services 
        furnished to veterans under this section during such 90-day 
        period.

SEC. 3. SENSE OF CONGRESS ON PROMPT PAYMENT BY DEPARTMENT OF VETERANS 
              AFFAIRS.

    It is the sense of Congress that the Secretary of Veterans Affairs 
shall comply with section 1315 of title 5, Code of Federal Regulations 
(commonly known as the ``prompt payment rule''), or any corresponding 
similar regulation or ruling, in paying for health care pursuant to 
contracts entered into with non-Department of Veterans Affairs 
providers to provide health care under the laws administered by the 
Secretary.

SEC. 4. IMPROVED PERFORMANCE METRICS FOR HEALTH CARE PROVIDED BY 
              DEPARTMENT OF VETERANS AFFAIRS.

    (a) Prohibition on Use of Scheduling and Wait-Time Metrics in 
Determination of Performance Awards.--The Secretary shall ensure that 
scheduling and wait-time metrics or goals are not used as factors in 
determining the performance of the following employees for purposes of 
determining whether to pay performance awards to such employees:
            (1) Directors, associate directors, assistant directors, 
        deputy directors, chiefs of staff, and clinical leads of 
        medical centers of the Department.
            (2) Directors, assistant directors, and quality management 
        officers of Veterans Integrated Service Networks of the 
        Department.
    (b) Modification of Performance Plans.--
            (1) In general.--Not later than 30 days after the date of 
        the enactment of this Act, the Secretary shall modify the 
        performance plans of the directors of the medical centers of 
        the Department and the directors of the Veterans Integrated 
        Service Networks to ensure that such plans are based on the 
        quality of care received by veterans at the health care 
        facilities under the jurisdictions of such directors.
            (2) Factors.--In modifying performance plans under 
        paragraph (1), the Secretary shall ensure that assessment of 
        the quality of care provided at health care facilities under 
        the jurisdiction of a director described in paragraph (1) 
        includes consideration of the following:
                    (A) Recent reviews by the Joint Commission 
                (formerly known as the ``Joint Commission on 
                Accreditation of Healthcare Organizations'') of such 
                facilities.
                    (B) The number and nature of recommendations 
                concerning such facilities by the Inspector General of 
                the Department in reviews conducted through Combined 
                Assessment Program (CAP) reviews, in the reviews by the 
                Inspector General of community-based outpatient clinics 
                and primary care clinics, and in reviews conducted 
                through the Office of Healthcare Inspections during the 
                two most recently completed fiscal years.
                    (C) The number of recommendations described in 
                subparagraph (B) that the Inspector General of the 
                Department determines have not been carried out 
                satisfactorily with respect to such facilities.
                    (D) Reviews of such facilities by the Commission on 
                Accreditation of Rehabilitation Facilities.
                    (E) The number and outcomes of administrative 
                investigation boards, root cause analysis, and peer 
                reviews conducted at such facilities during the fiscal 
                year for which the assessment is being conducted.
                    (F) The effectiveness of any remedial actions or 
                plans resulting from any Inspector General 
                recommendations in the reviews and analyses described 
                in subparagraphs (A) through (E).
            (3) Additional leadership positions.--To the degree 
        practicable, the Secretary shall assess the performance of 
        other employees of the Department in leadership positions at 
        Department medical centers, including associate directors, 
        assistant directors, deputy directors, chiefs of staff, and 
        clinical leads, and in Veterans Integrated Service Networks, 
        including assistant directors and quality management officers, 
        using factors and criteria similar to those used in the 
        performance plans modified under paragraph (1).

SEC. 5. IMPROVED TRANSPARENCY CONCERNING HEALTH CARE PROVIDED BY 
              DEPARTMENT OF VETERANS AFFAIRS.

    (a) Publication of Wait Times.--
            (1) Goals.--
                    (A) Initial.--Not later than 90 days after the date 
                of the enactment of this Act, the Secretary of Veterans 
                Affairs shall publish in the Federal Register, and on 
                an Internet website accessible to the public of each 
                medical center of the Department of Veterans Affairs, 
                the wait-time goals of the Department for the 
                scheduling of an appointment by a veteran for the 
                receipt of health care from the Department.
                    (B) Subsequent changes.--
                            (i) In general.--If the Secretary modifies 
                        the wait-time goals described in subparagraph 
                        (A), the Secretary shall publish the new wait-
                        time goals--
                                    (I) on an Internet website 
                                accessible to the public of each 
                                medical center of the Department not 
                                later than 30 days after such 
                                modification; and
                                    (II) in the Federal Register not 
                                later than 90 days after such 
                                modification.
                            (ii) Effective date.--Any modification 
                        under clause (i) shall take effect on the date 
                        of publication in the Federal Register.
                    (C) Goals described.--Wait-time goals published 
                under this paragraph shall include goals for primary 
                care appointments, specialty care appointments, and 
                goals for such appointments based on the general 
                severity of the condition of the veteran.
            (2) Wait times at medical centers of the department.--Not 
        later than one year after the date of the enactment of this 
        Act, the Secretary of Veterans Affairs shall publish on an 
        Internet website accessible to the public of each medical 
        center of the Department the current wait time for an 
        appointment for primary care and specialty care at the medical 
        center.
    (b) Publicly Available Database of Patient Safety, Quality of Care, 
and Outcome Measures.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, the Secretary shall develop and make 
        available to the public a comprehensive database containing all 
        applicable patient safety, quality of care, and outcome 
        measures for health care provided by the Department that are 
        tracked by the Secretary.
            (2) Update frequency.--The Secretary shall update the 
        database required by paragraph (1) not less frequently than 
        once each year.
            (3) Unavailable measures.--For all measures that the 
        Secretary would otherwise publish in the database required by 
        paragraph (1) but has not done so because such measures are not 
        available, the Secretary shall publish notice in the database 
        of the reason for such unavailability and a timeline for making 
        such measures available in the database.
            (4) Accessibility.--The Secretary shall ensure that the 
        database required by paragraph (1) is accessible to the public 
        through the primary Internet website of the Department and 
        through each primary Internet website of a Department medical 
        center.
    (c) Hospital Compare Website of Department of Health and Human 
Services.--
            (1) Agreement required.--Not later than 180 days after the 
        date of the enactment of this Act, the Secretary of Veterans 
        Affairs shall enter into an agreement with the Secretary of 
        Health and Human Services for the provision by the Secretary of 
        Veterans Affairs of such information as the Secretary of Health 
        and Human Services may require to report and make publicly 
        available patient quality and outcome information concerning 
        Department of Veterans Affairs medical centers through the 
        Hospital Compare Internet website of the Department of Health 
        and Human Services or any successor Internet website.
            (2) Information provided.--The information provided by the 
        Secretary of Veterans Affairs to the Secretary of Health and 
        Human Services under paragraph (1) shall include the following:
                    (A) Measures of timely and effective health care.
                    (B) Measures of readmissions, complications of 
                death, including with respect to 30-day mortality rates 
                and 30-day readmission rates, surgical complication 
                measures, and health care related infection measures.
                    (C) Survey data of patient experiences, including 
                the Hospital Consumer Assessment of Healthcare 
                Providers and Systems or any similar successor survey 
                developed by the Department of Health and Human 
                Services.
                    (D) Any other measures required of or reported with 
                respect to hospitals participating in the Medicare 
                program under title XVIII of the Social Security Act 
                (42 U.S.C. 1395 et seq.).
            (3) Unavailable information.--For any applicable metric 
        collected by the Department of Veterans Affairs or required to 
        be provided under paragraph (2) and withheld from or 
        unavailable in the Hospital Compare Internet website, the 
        Secretary of Veterans Affairs shall publish a notice in the 
        Federal Register stating the reason why such metric was 
        withheld from public disclosure and a timeline for making such 
        metric available, if applicable.
    (d) Comptroller General Review of Publicly Available Safety and 
Quality Metrics.--Not later than three years after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall conduct a review of the safety and quality metrics made publicly 
available by the Secretary of Veterans Affairs under this section to 
assess the degree to which the Secretary is complying with the 
provisions of this section.

SEC. 6. INFORMATION FOR VETERANS ON THE CREDENTIALS OF DEPARTMENT OF 
              VETERANS AFFAIRS PHYSICIANS.

    (a) Improvement of ``Our Providers'' Internet Website Links.--
            (1) Availability through department of veterans affairs 
        homepage.--A link to the ``Our Providers'' health care 
        providers database of the Department of Veterans Affairs, or 
        any successor database, shall be available on and through the 
        homepage of the Internet website of the Department that is 
        accessible to the public.
            (2) Information on location of residency training.--The 
        Internet website of the Department that is accessible to the 
        public shall include under the link to the ``Our Providers'' 
        health care providers database of the Department, or any 
        successor database, the location of residency training of each 
        licensed physician of the Department.
            (3) Information on physicians at particular facilities.--
        The ``Our Providers'' health care providers database of the 
        Department, or any successor database, shall identify whether 
        each licensed physician of the Department is a physician in 
        residency.
    (b) Information on Credentials of Physicians for Veterans 
Undergoing Surgical Procedures.--Each veteran who is undergoing a 
surgical procedure by or through the Department shall be provided, at 
such time in advance of the procedure as is appropriate to permit such 
veteran to evaluate such information, information on the credentials of 
the surgeon to be performing such procedure.
    (c) GAO Report.--Not later than two years after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall submit to the Committees on Veterans' Affairs of the Senate and 
the House of Representatives a report setting forth an assessment by 
the Comptroller General of the following:
            (1) The manner in which contractors under the Patient-
        Centered Community Care initiative of the Department perform 
        oversight of the credentials of physicians within the networks 
        of such contractors under the initiative.
            (2) The oversight by the Department of the contracts under 
        the Patient-Centered Community Care initiative.

SEC. 7. INFORMATION IN ANNUAL BUDGET OF THE PRESIDENT ON HOSPITAL CARE 
              AND MEDICAL SERVICES PROVIDED UNDER SECTION 2.

    The materials on the Department of Veterans Affairs in the budget 
of the President for a fiscal year, as submitted to Congress pursuant 
to section 1105(a) of title 31, United States Code, shall set forth the 
following:
            (1) The number of veterans who received hospital care and 
        medical services under section 2 of this Act during the fiscal 
        year preceding the fiscal year in which such budget is 
        submitted.
            (2) The amount expended by the Department on furnishing 
        care and services under such section during the fiscal year 
        preceding the fiscal year in which such budget is submitted.
            (3) The amount requested in such budget for the costs of 
        furnishing care and services under such section during the 
        fiscal year covered by such budget, set forth in aggregate and 
        by amounts for each account for which amounts are so requested.
            (4) The number of veterans that the Department estimates 
        will receive hospital care and medical services under such 
        section during the fiscal years covered by the budget 
        submission.
            (5) The number of employees of the Department on paid 
        administrative leave at any point during the fiscal year 
        preceding the fiscal year in which such budget is submitted.

SEC. 8. PROHIBITION ON FALSIFICATION OF DATA CONCERNING WAIT TIMES AND 
              QUALITY MEASURES AT DEPARTMENT OF VETERANS AFFAIRS.

    Not later than 60 days after the date of the enactment of this Act, 
and in accordance with title 5, United States Code, the Secretary of 
Veterans Affairs shall establish policies whereby any employee of the 
Department of Veterans Affairs who knowingly submits false data 
concerning wait times for health care or quality measures with respect 
to health care to another employee of the Department or knowingly 
requires another employee of the Department to submit false data 
concerning such wait times or quality measures to another employee of 
the Department is subject to a penalty the Secretary considers 
appropriate after notice and an opportunity for a hearing, including 
civil penalties, unpaid suspensions, or termination.

SEC. 9. REMOVAL OF SENIOR EXECUTIVE SERVICE EMPLOYEES OF THE DEPARTMENT 
              OF VETERANS AFFAIRS FOR PERFORMANCE.

    (a) In General.--Chapter 7 of title 38, United States Code, is 
amended by adding at the end the following new section:
``Sec. 713. Senior Executive Service: removal based on performance
    ``(a) In General.--(1) Notwithstanding subchapter V of chapter 35 
of title 5, subchapter V of chapter 75 of title 5, or any other 
provision of law, the Secretary may remove any individual who is an 
employee of the Department from a Senior Executive Service position (as 
defined in section 3132(a) of title 5) if the Secretary determines the 
performance of the individual warrants such removal.
    ``(2) If the Secretary so removes such an individual, the Secretary 
may--
            ``(A) remove the individual from the civil service (as 
        defined in section 2101 of title 5); or
            ``(B) appoint the individual to a General Schedule position 
        at any grade of the General Schedule the Secretary determines 
        appropriate.
    ``(b) Notice to Congress.--Not later than 30 days after removing an 
individual from the Senior Executive Service under subsection (a), the 
Secretary shall submit to the Committee on Veterans' Affairs of the 
Senate and the Committee on Veterans' Affairs of the House of 
Representatives notice in writing of such removal and the reason for 
such removal.
    ``(c) Manner of Removal.--A removal under this section shall be 
done in the same manner as the removal of a professional staff member 
employed by a Member of Congress.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by adding at the end the following new item:

``713. Senior Executive Service: removal based on performance.''.
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