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. LAM-
BORN, 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 Wash-
ington, 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. HAR-
PER, 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 Cali-
fornia, Mr. OWENS, Mr. GIBBS, Mrs. BLACK, Mr. GIBSON, Mr. CREN-
SHAW, 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 Mis-
souri, 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. MCIN-
TYRE, 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 fol-
lowing 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 ex-
tended waiting times for appointments at Department 
facilities, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives 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 VET-
ERANS AFFAIRS FACILITIES FOR DEPART-
MENT 
OF 
VETERANS 
AFFAIRS 
PATIENTS 
WITH EXTENDED WAITING TIMES FOR AP-
POINTMENTS 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 
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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 sec-
tion, 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 hos-
pital 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 vet-
eran; and 
(3) who makes an election to receive such care 
or services in a non-Department facility. 
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(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 med-
ical 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 rec-
ommended in the course of such hospital care or medical 
services. 
(d) REPORT.—The Secretary shall submit to Con-
gress a quarterly report on hospital care and medical serv-
ices 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, in-
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cluding the rate of payment for individual authoriza-
tions 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. 
(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. 
(g) TERMINATION.—The authority of the Secretary 
under this section shall terminate with respect to any hos-
pital 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 
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of such episode of care but not to exceed a period of 60 
days. 
SEC. 3. EXPANDED ACCESS TO HOSPITAL CARE AND MED-
ICAL 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 un-
able 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-Depart-
ment 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 serv-
ices 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 reim-
bursement for such care or services established by 
the Secretary of Veterans Affairs. 
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(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 reim-
bursement 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 sec-
tion, 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 hos-
pital 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 
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(C) who resides more than 40 miles from 
the medical facility of the Department of Vet-
erans Affairs, including a community-based out-
patient 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 
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this Act, the Secretary of Veterans Affairs shall enter into 
a contract or contracts with a private sector entity or enti-
ties with experience in the delivery systems of the Veterans 
Health Administration and the private sector and in 
health care management to conduct an independent as-
sessment of hospital care and medical services furnished 
in medical facilities of the Department of Veterans Af-
fairs. 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 capa-
bilities and resources of the Department, including 
hospital care and medical services furnished by non- 
Department facilities under contract with the De-
partment, to provide timely and accessible care to el-
igible veterans. 
(3) The authorities and mechanisms under 
which the Secretary may furnish hospital care and 
medical services at non-Department facilities, includ-
ing 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. 
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(4) The appropriate system-wide access stand-
ard applicable to hospital care and medical services 
furnished by and through the Department of Vet-
erans Affairs and recommendations relating to ac-
cess standards specific to individual specialties and 
standards for post-care rehabilitation. 
(5) The current organization, processes, and 
tools used to support clinical staffing and docu-
mentation. 
(6) The staffing levels and productivity stand-
ards, including a comparison with industry perform-
ance percentiles. 
(7) Information technology strategies of the 
Veterans Health Administration, including an identi-
fication 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, in-
surance identification, third-party revenue collection, 
and vendor reimbursement. 
(b) ASSESSMENT OUTCOMES.—The assessment con-
ducted pursuant to subsection (a) shall include the fol-
lowing: 
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(1) An identification of improvement areas out-
lined 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 inte-
grator shall be responsible for coordinating the outcomes 
of the assessments conducted by the private entities pur-
suant to such contracts. 
(d) SUBMITTAL OF REPORTS TO CONGRESS.— 
(1) REPORT ON INDEPENDENT ASSESSMENT.— 
Not later than 10 months after entering into the 
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contract under subsection (a), the Secretary shall 
submit to the Committees on Veterans’ Affairs of 
the Senate and House of Representatives the find-
ings and recommendations of the independent as-
sessment required by such subsection. 
(2) REPORT ON VA ACTION PLAN TO IMPLE-
MENT
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 re-
sponse to the findings of the assessment and shall 
include an action plan, including a timeline, for fully 
implementing the recommendations of the assess-
ment. 
SEC. 5. LIMITATION ON AWARDS AND BONUSES TO EM-
PLOYEES OF DEPARTMENT OF VETERANS AF-
FAIRS. 
For each of fiscal years 2014 through 2016, the Sec-
retary 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. 
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SEC. 6. OMB ESTIMATE OF BUDGETARY EFFECTS AND 
NEEDED TRANSFER AUTHORITY. 
Not later than 30 days after the date of the enact-
ment of this Act, the Director of the Office of Manage-
ment and Budget shall transmit to the Committees on Ap-
propriations, the Budget, and Veterans’ Affairs of the 
House of Representatives and of the Senate— 
(1) an estimate of the budgetary effects of sec-
tions 2 and 3; 
(2) any transfer authority needed to utilize the 
savings from section 5 to satisfy such budgetary ef-
fects; 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. 
Æ 
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