Union Calendar No. 268
103D CONGRESS
2D SESSION
H. R. 4013
[Report No. 103–477]
A BILL
To amend title 38, United States Code, to provide
the Secretary of Veterans Affairs with necessary
flexibility in staffing the Veterans Health Admin-
istration, to authorize the Secretary to establish
pilot programs for health care delivery, and for
other purposes.
APRIL 14, 1994
Reported with amendments, committed to the Committee
of the Whole House on the State of the Union, and or-
dered to be printed
IB
Union Calendar No. 268
103D CONGRESS
2D SESSION
H. R. 4013
[Report No. 103–477]
To amend title 38, United States Code, to provide the Secretary of Veterans
Affairs with necessary flexibility in staffing the Veterans Health Adminis-
tration, to authorize the Secretary to establish pilot programs for health
care delivery, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
MARCH 11, 1994
Mr. ROWLAND (for himself, Mr. MONTGOMERY, Mr. STUMP, and Mr. SMITH
of New Jersey) introduced the following bill; which was referred to the
Committee on Veterans’ Affairs
APRIL 14, 1994
Additional sponsors: Mr. BISHOP, Mr. KREIDLER, Mr. WILLIAMS, Ms. BROWN
of Florida, Mr. SANDERS, Mr. SANGMEISTER, Mr. STEARNS, Mr. HUTCH-
INSON, Mr. BILIRAKIS, Mr. EVERETT, Mr. QUINN, Mr. HEFNER, Mr.
RICHARDSON, Mr. STENHOLM, Mr. PAYNE of Virginia, and Mr. PARKER
APRIL 14, 1994
Reported with amendments, committed to the Committee of the Whole House
on the State of the Union, and ordered to be printed
[Omit the part struck through and insert the part printed in italic]
A BILL
To amend title 38, United States Code, to provide the Sec-
retary of Veterans Affairs with necessary flexibility in
staffing the Veterans Health Administration, to authorize
the Secretary to establish pilot programs for health care
delivery, 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 ‘‘Veterans Health
Programs Improvement Act of 1994’’.
TITLE I—VETERANS HEALTH AD-
MINISTRATION 
STAFFING
LEVELS
SEC. 101. FINDINGS.
The Congress makes the following findings:
(1) Under proposals for national health care re-
form, the Department of Veterans Affairs would be
required to establish an enrollment system for veter-
ans and to provide health care on a competitive basis
with other, private health care providers.
(2) In order to be able to implement changes
contemplated by proposals for national health care
reform, the Secretary of Veterans Affairs must have
flexibility to restructure and reform the Veterans
Health Administration as necessary without exter-
nally imposed constraints on full-time equivalent em-
ployee (FTEE) positions levels.
(3) The Office of Management and Budget, as
part of an announced plan to require a reduction
over five years of 252,000 FTEE positions in the
executive branch, proposes to require reductions of
FTEE positions totaling 25,493 in personnel of the
Veterans Health Administration, a reduction in per-
sonnel which would severely impede the ability of the
Department of Veterans Affairs to implement na-
tional health care reform and to meet the respon-
sibilities of the Department under existing law.
SEC. 102. EMPLOYMENT LEVEL IN VETERANS HEALTH AD-
MINISTRATION.
(a) IN GENERAL.—Chapter 7 of title 38, United
States Code, is amended by adding at the end the follow-
ing new section:
‘‘§ 713. Full-time equivalent employees: limitation on
reduction
‘‘(a) During the five-year period beginning on Octo-
ber 1, 1994, no reduction may be made in the number
of full-time equivalent employees in the Veterans Health
Administration other than as specifically required by a law
directing reductions in personnel or positions of the Veter-
ans Health Administration or by the availability of funds.
During that period, the personnel of the Veterans Health
Administration shall be managed on the basis of the needs
of eligible veterans and the availability of funds.
‘‘(b) During the period specified in subsection (a), no
law imposing a restriction on hiring by executive agencies
for the purpose of achieving workforce reductions shall
apply to the Veterans Health Administration.
‘‘(c) No law may be construed as suspending or modi-
fying this section unless such law specifically refers to or
amends this section.’’.
(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. Full-time equivalent employees: limitation on reduction.’’.
SEC. 103. REPORT ON STREAMLINING.
Not later than January 15, 1995, the Secretary of
Veterans Affairs shall submit to the Committees on Veter-
ans’ Affairs of the Senate and House of Representatives
a report on streamlining activities in the Veterans Health
Administration. The report shall include a description
of—
(1) opportunities to improve the efficiency and
effectiveness of delivery of health care services in the
Veterans Health Administration through consolida-
tion, reorganization, or other means;
(2) plans and actions taken to realize such effi-
ciencies; and
(3) impediments to implementing particular
plans.
TITLE II—PILOT PROGRAMS
SEC. 201. SHORT TITLE.
This title may be cited as the ‘‘Veterans Health-Care
Pilot Program Act of 1994’’.
SEC. 202. PILOT PROGRAM AUTHORITY.
(a) IN GENERAL.—Subject to section 203, the Sec-
retary of Veterans Affairs may establish and operate a
pilot program under this Act in up to five States which
have established a State reform plan.
(b) STATE REFORM PLANS.—For purposes of this
Act, a State reform plan shall be considered to have been
established in a State if the Secretary determines that the
State has enacted legislation that is intended, at least in
part, to provide residents of that State who lack, or have
inadequate, health insurance coverage access to health
care services.
(c) AUTHORITY OF SECRETARY UNDER PILOT PRO-
GRAM.—Notwithstanding any other law, the Secretary, in
carrying out a pilot program in a State under this title,
may do the following:
(1) Provide health-care services on the same or
similar basis as the State reform plan mandates to
veterans, members of the family of a veteran who
participates in the pilot program, and individuals de-
scribed in section 1713(a) of title 38, United States
Code, including the establishment of one or more
health plans in that State through Department of
Veterans Affairs health care facilities in the State
and the implementation of an enrollment option for
eligible beneficiaries.
(2) Comply with such requirements of State law
applicable to the establishment and operation of a
health plan under a State reform plan, or to func-
tioning as a participant in, member of, or contractor
to, such a health plan, as the Secretary considers
appropriate for application to a Federal department.
(3) Conduct the pilot program in some or all
Department of Veterans Affairs health-care facilities
located in the State.
(4) Establish such catchment areas for enroll-
ment in the pilot programs as the Secretary deter-
mines appropriate.
SEC. 203. CONDITIONS OF PARTICIPATION.
(a) IN GENERAL.—The Secretary may establish and
operate a pilot program in a State under section 202 only
if—
(1) the Secretary has determined, based on
such factors as the Secretary considers relevant
(which shall include the factors specified in sub-
section (b)) that, in the absence of an enrollment op-
tion through a Department of Veterans Affairs plan
in that State, the projected workload in one or more
Department of Veterans Affairs health care facilities
in the State would decline to a level that—
(A) would threaten to impair the capability
of those facilities to meet one or more assigned
mission of those facilities; or
(B) would result in a deterioration in the
quality of service-delivery to a degree that it
would not be reasonable to continue to provide
a needed service or services in such facility or
facilities and satisfactory alternative arrange-
ments could not feasibly be provided;
(2) the Secretary has taken action to ensure
that in designing and establishing a health plan
under the pilot program, provisions are made, to the
extent feasible, for the applicability and compatibil-
ity of the components of the plan with other Depart-
ment health care facilities that are not participants
in the pilot program in that State; and
(3) the Secretary has provided for an evaluation
of the pilot program to assess (A) appropriate meas-
ures of (i) access to service, (ii) cost of care, (iii)
quality of service to patients, and (iv) quality of
care, (B) the ability of such plans to attract enroll-
ees, and (C) such other matters as the Secretary de-
termines appropriate.; and
(4) the Secretary has required the director of
each medical center that is to participate in the pilot
program to establish, and to consult regularly with,
a committee, which shall include veteran and other
patient representatives, regarding the delivery of serv-
ices and conduct of the pilot program.
(b) FACTORS TO BE CONSIDERED.—Factors consid-
ered by the Secretary for purposes of subsection (a)(1)
shall include—
(1) the relative universality of coverage afforded
State residents under the State reform plan;
(2) the scope of benefits offered under such
plan; and
(3) the extent of financing supporting such
plan.
(c) SUBMISSION OF PLAN TO CONGRESS.—The Sec-
retary may implement a pilot program under section 202
only after—
(1) the Secretary has submitted a report to the
Committees on Veterans’ Affairs of the Senate and
House of Representatives on the proposed plan, as
specified in subsection (d); and
(2) a period of 30 days during which Congress
has been in continuous session has elapsed since
submission of the report under paragraph (1).
For purposes of paragraph (2), continuity of a session of
Congress is broken only by adjournment sine die, and
there shall be excluded from the computation of such 30-
day period any day during which either House of Congress
is not in session during an adjournment of more than
three days to a day certain.
(d) MATTERS TO BE INCLUDED IN REPORT.—Each
report under subsection (c) shall include the following:
(1) A detailed description of the rationale (as it
relates to the determinations described in sub-
sections (a)(1) and (g) of this section) for proposed
participation in the State reform plan which shall
specifically address the determinations under such
provisions.
(2) A description of the extent to which applica-
ble provisions of State law specifically accommodate
and facilitate participation by the Department in the
State reform plan.
(3) A detailed business plan for the Depart-
ment’s participation under the State reform plan.
(4) A description of the actions the Secretary
has taken to consult with veterans on the Depart-