In the House of Representatives, U. S., 
June 18, 2014. 
Resolved, That the House agree to the amendment of the 
Senate to the title of the bill (H.R. 3230) entitled ‘‘An Act 
making continuing appropriations during a Government shut-
down to provide pay and allowances to members of the re-
serve components of the Armed Forces who perform inactive- 
duty training during such period.’’ and be it further 
Resolved, That the House agree to the amendment of the 
Senate to the text of the aforementioned bill, with the fol-
lowing 
HOUSE AMENDMENT TO SENATE AMENDMENT 
In lieu of the matter proposed to be inserted by the 
amendment of the Senate to the text of the bill, insert 
the following: 
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 SERV-
ICES AT NON-DEPARTMENT OF VETERANS AF-
FAIRS FACILITIES FOR DEPARTMENT OF VET-
ERANS AFFAIRS PATIENTS WITH EXTENDED 
WAITING TIMES FOR APPOINTMENTS AT DE-
PARTMENT FACILITIES. 
(a) IN GENERAL.—As authorized by section 1710 of 
title 38, United States Code, the Secretary of Veterans Af-
fairs (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 sec-
tion, the term ‘‘covered veteran’’ means a veteran— 
(1) who is enrolled in the patient enrollment sys-
tem 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 De-
partment; 
(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. 
(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 com-
pletion 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, regard-
ing— 
(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 fa-
cilities’’, ‘‘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 im-
plementing 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 oth-
erwise 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 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-De-
partment 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 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 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 Sec-
erwise 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 con-
tract 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 fa-
cilities of the Department of Veterans Affairs. Such assess-
ment 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 Depart-
ment, 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 fa-
cilities through the completion of episodes of care. 
(4) The appropriate system-wide access standard 
applicable to hospital care and medical services fur-
nished by and through the Department of Veterans 
Affairs and recommendations relating to access stand-
ards 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 stand-
ards, including a comparison with industry perform-
ance percentiles. 
(7) Information technology strategies of the Vet-
erans 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 Ad-
ministration, including non-Department care, insur-
ance identification, third-party revenue collection, 
and vendor reimbursement. 
(b) ASSESSMENT OUTCOMES.—The assessment con-
ducted pursuant to subsection (a) shall include the fol-
lowing: 
(1) An identification of improvement areas out-
lined both qualitatively and quantitatively, taking 
into consideration Department of Veterans Affairs di-
rectives and industry benchmarks from outside the 
Federal Government. 
(2) Recommendations for how to address the im-
provement areas identified under paragraph (1) relat-
ing to structure, accountability, process changes, tech-
nology, 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 as-
sessments 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 con-
tract under subsection (a), the Secretary shall submit 
to the Committees on Veterans’ Affairs of the Senate 
and House of Representatives the findings and rec-
ommendations 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 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. 
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 Appropria-
tions, the Budget, and Veterans’ Affairs of the House of Rep-
resentatives 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. 
SEC. 7. REMOVAL OF SENIOR EXECUTIVE SERVICE EMPLOY-
EES OF THE DEPARTMENT OF VETERANS AF-
FAIRS FOR PERFORMANCE. 
(a) IN GENERAL.—Chapter 7 of title 38, United States 
Code, is amended by adding at the end the following new 
section:
‘‘§ 713. Senior Executive Service: removal based on 
performance 
‘‘(a) IN GENERAL.—Notwithstanding any other provi-
sion of law, the Secretary may remove any individual from 
the Senior Executive Service if the Secretary determines the 
performance of the individual warrants such removal. If the 
Secretary so removes such an individual, the Secretary 
may— 
‘‘(1) remove the individual from Federal service; 
or 
‘‘(2) transfer the individual to a General Sched-
ule 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 paragraph (1), the Secretary shall submit to 
the Committees on Veterans’ Affairs of the Senate and 
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.’’. 
SEC. 8. BUDGETARY EFFECTS OF ACT. 
The budgetary effects of this Act, for the purpose of 
complying with the Statutory Pay-As-You-Go Act of 2010, 
shall be determined by reference to the latest statement titled 
‘‘Budgetary Effects of PAYGO Legislation’’ for this Act, 
submitted for printing in the Congressional Record by the 
Chairman of the House Budget Committee, provided that 
such statement has been submitted prior to the vote on pas-
sage. 
Attest: 
Clerk.
113TH CONGRESS 
2D SESSION 
H.R. 3230 
HOUSE AMENDMENT TO 
SENATE AMENDMENT