I 

108TH CONGRESS 

1ST SESSION H. R. 890

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 

FEBRUARY 25, 2003

Mr. LARSON of Connecticut (for himself, Mr. PALLONE, Mr. HEFLEY, Ms. 

NORTON, Mrs. JONES of Ohio, Mr. LATOURETTE, Mr. GRIJALVA, Mr. 

CARSON of Oklahoma, Mrs. MUSGRAVE, Mr. RYAN of Ohio, Ms. GINNY

BROWN-WAITE of Florida, Mr. ABERCROMBIE, Mr. BROWN of Ohio, Mr. 

RAHALL, Ms. KILPATRICK, Ms. DELAURO, and Mr. FRANK of Massachusetts) 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’’. 
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1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) Veterans were promised by the Federal 

4 Government that for their service to the country 

5 they would be provided a lifetime of health care serv6 ices, as well as their own health care service net7 work. 

8 (2) The current allocation system for appropria9 tions made to the Department of Veterans Affairs 

10 for medical care, known as the Veterans Equitable 

11 Resource Allocation (VERA) formula and estab12 lished by the Secretary of Veterans Affairs pursuant 

13 to section 429 of the Departments of Veterans Af14 fairs and Housing and Urban Development, and 

15 Independent Agencies Appropriations Act, 1997 

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

17 to be an ineffective means of allocating such funds 

18 fairly across the 22 national service regions, known 

19 as Veterans Integrated Service Networks (VISNs), 

20 of the Department of Veterans Affairs. 

21 (3) The VERA formula has resulted in a sys22 tem in which veterans in some regions of the country 

23 are forced to compete with veterans in other regions 

24 for critical medical care funds, whereas the system 

25 should be providing the funding necessary to meet 

26 the health care needs of all veterans, regardless of 
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1 where they live, to ensure that all veterans have ac2 cess to the level and quality of care that they have 

3 all earned and deserve. 

4 (4) The Secretary of Veterans Affairs estab5 lished a set of performance goals in fiscal year 2000, 

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

7 the Secretary’s goal to schedule nonurgent primary 

8 care visits within 30 days, specialty care visits within 

9 30 days, and the maximum amount of time veterans 

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

11 as 20 minutes. 

12 (5) According to the Department’s Performance 

13 Report for Fiscal Year 2001, nationally 87 percent 

14 of primary care appointments were scheduled within 

15 30 days of the desired date and 84 percent of spe16 cialty care appointments were scheduled within 30 

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

18 percent of primary care appointments were sched19 uled within 30 days of the desired date and only 80 

20 percent of specialty care appointments were sched21 uled within 30 days of the desired date. 

22 (6) Until the VERA formula is changed to en23 sure a more equitable and adequate distribution of 

24 medical care funding within the Department of Vet25 erans Affairs system, providing appropriate access to 
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1 medical care for the Nation’s veterans must remain 

2 a national priority with a method found to provide 

3 a safety net that will ensure that veterans have ac4 cess to the health care they need without under5 mining the existing health care network of the De6 partment of Veterans Affairs. 

7 SEC. 3. STANDARD FOR TIME FOR REFERRAL FOR SPE8 CIALIST CARE. 

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

10 Secretary of Veterans Affairs shall establish by regulation 

11 a maximum specialist referral period, subject to such ex12 ceptions as the Secretary considers necessary. 

13 (2) For purposes of paragraph (1), the term ‘‘spe14 cialist referral period’’ means the period of time between 

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

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

17 physician within the Department of Veterans Affairs 

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

19 is scheduled for an appointment with a Department spe20 cialist pursuant to such referral. 

21 (3) In establishing a maximum specialist referral pe22 riod under paragraph (1), the Secretary shall act in a 

23 manner consistent with the current treatment policies of 

24 the Department based on clinical need and with the estab-
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1 lished 30–30–20 performance goal of the Department for 

2 such a referral period. 

3 (b) STANDARD FOR TRANSPORTATION.—The Sec4 retary shall take such steps as necessary to ensure that 

5 the Department of Veterans Affairs is able to provide ap6 propriate transportation services for qualified veterans 

7 within a reasonable time period of a scheduled appoint8 ment. 

9 SEC. 4. CONTRACT CARE TO BE PROVIDED WHEN DEPART10 MENT OF VETERANS AFFAIRS CARE NOT 

11 AVAILABLE IN ACCORDANCE WITH STAND12 ARDS. 

13 (a) CONTRACT CARE.—In any case in which the Sec14 retary of Veterans Affairs is not able to provide hospital 

15 care or medical services in accordance with the standard 

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

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

18 shall promptly provide for such care or transportation 

19 from a private source. Hospital care or medical services 

20 so provided shall be those for which the veteran is other21 wise eligible within the Department of Veterans Affairs 

22 medical care system. 

23 (b) REIMBURSEMENT RATE.—Whenever care or serv24 ices are provided under subsection (a), the Secretary shall 

25 reimburse the provider of such care or services for the rea-
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1 sonable value of such care or services, as determined by 

2 the Secretary. Such reimbursement shall be provided in 

3 the same manner as applies to reimbursement for emer4 gency treatment under section 1725 of title 38, United 

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

6 otherwise applicable to such reimbursements under such 

7 section as the Secretary determines to be appropriate for 

8 purposes of this section. 

9 (c) EXPEDITED REIMBURSEMENT PROCEDURES.—

10 The Secretary shall take appropriate steps to expedite the 

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

12 include steps to take advantage of modern technology, in13 cluding so-called ‘‘smart card’’ technology that would 

14 allow claims for such reimbursement to be processed elec15 tronically. The Secretary shall, to the extent possible, also 

16 apply such steps for expediting reimbursement to claims 

17 for emergency services provided to veterans for which the 

18 Secretary provides reimbursement under provisions of law 

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

20 SEC. 5. TERMINATION OF 24-MONTH RULE FOR REIM21 BURSEMENT FOR EMERGENCY SERVICES. 

22 The provisions of subparagraph (B) of section 

23 1725(b)(2) of title 38, United States Code, shall not apply 

24 with respect to emergency treatment furnished on or after 

25 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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