In the Senate of the United States, 
August 6, 2009. 
Resolved, That the bill from the House of Representa-
tives (H.R. 1016) entitled ‘‘An Act to amend title 38, United 
States Code, to provide advance appropriations authority for 
certain accounts of the Department of Veterans Affairs, and 
for other purposes.’’, do pass with the following 
AMENDMENT: 
Strike out all after the enacting clause and insert: 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Veterans Health Care 
Budget Reform and Transparency Act of 2009’’. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) Title 38, United States Code, authorizes the 
Secretary of Veterans Affairs to furnish hospital and 
domiciliary care, medical services, nursing home care, 
and related services to eligible and enrolled veterans,
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but only to the extent that appropriated resources and 
facilities are available for such purposes. 
(2) For 19 of the past 22 fiscal years, funds have 
not been appropriated for the Department of Veterans 
Affairs for the provision of health care as of the com-
mencement of the new fiscal year, causing the Depart-
ment great challenges in planning and managing 
care for enrolled veterans, to the detriment of vet-
erans. 
(3) The cumulative effect of insufficient, late, 
and unpredictable funding for the Department for 
health care endangers the viability of the health care 
system of the Department and impairs the specialized 
health care resources the Department requires to 
maintain and improve the health of sick and disabled 
veterans. 
(4) Appropriations for the health care programs 
of the Department have too often proven insufficient 
over the past decade, requiring the Secretary to ration 
health care and Congress to approve supplemental ap-
propriations for those programs. 
(5) Providing sufficient, timely, and predictable 
funding would ensure the Government meets its obli-
gation to provide health care to sick and disabled vet-
erans and ensure that all veterans enrolled for health
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care through the Department have ready access to 
timely and high quality care. 
(6) Providing sufficient, timely, and predictable 
funding would allow the Department to properly plan 
for and meet the needs of veterans. 
SEC. 3. TWO-FISCAL YEAR BUDGET AUTHORITY FOR CER-
TAIN MEDICAL CARE ACCOUNTS OF THE DE-
PARTMENT OF VETERANS AFFAIRS. 
(a) TWO-FISCAL YEAR BUDGET AUTHORITY.— 
(1) IN GENERAL.—Chapter 1 of title 38, United 
States Code, is amended by inserting after section 113 
the following new section: 
‘‘§ 113A. Two-fiscal year budget authority for certain 
medical care accounts 
‘‘(a) IN GENERAL.—Beginning with fiscal year 2011, 
new discretionary budget authority provided in an appro-
priations Act for the appropriations accounts of the Depart-
ment specified in subsection (b) shall be made available for 
the fiscal year involved, and shall include new discretionary 
budget authority for such appropriations accounts that first 
become available for the first fiscal year after such fiscal 
year. 
‘‘(b) MEDICAL CARE ACCOUNTS.—The medical care 
accounts of the Department specified in this subsection are
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the medical care accounts of the Veterans Health Adminis-
tration as follows: 
‘‘(1) Medical Services. 
‘‘(2) Medical Support and Compliance. 
‘‘(3) Medical Facilities.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of chapter 1 of such title is 
amended by inserting after the item relating to sec-
tion 113 the following new item: 
‘‘113A. Two-fiscal year budget authority for certain medical care accounts.’’. 
SEC. 4. COMPTROLLER GENERAL OF THE UNITED STATES 
STUDY ON ADEQUACY AND ACCURACY OF 
BASELINE MODEL PROJECTIONS OF THE DE-
PARTMENT 
OF 
VETERANS 
AFFAIRS 
FOR 
HEALTH CARE EXPENDITURES. 
(a) STUDY OF ADEQUACY AND ACCURACY OF BASE-
LINE MODEL PROJECTIONS.—The Comptroller General of 
the United States shall conduct a study of the adequacy 
and accuracy of the budget projections made by the Enrollee 
Health Care Projection Model, its equivalent, or other meth-
odologies, as utilized for the purpose of estimating and pro-
jecting health care expenditures of the Department of Vet-
erans Affairs (in this section referred to as the ‘‘Model’’) 
with respect to the fiscal year involved and the subsequent 
four fiscal years. 
(b) REPORTS.—
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(1) IN GENERAL.—Not later than the date of 
each year in 2011, 2012, and 2013, on which the 
President submits the budget request for the next fis-
cal year under section 1105 of title 31, United States 
Code, the Comptroller General shall submit to the ap-
propriate committees of Congress and to the Secretary 
a report. 
(2) ELEMENTS.—Each report under this para-
graph shall include, for the fiscal year beginning in 
the year in which such report is submitted, the fol-
lowing: 
(A) A statement whether the amount re-
quested in the budget of the President for expend-
itures of the Department for health care in such 
fiscal year is consistent with anticipated expend-
itures of the Department for health care in such 
fiscal year as determined utilizing the Model. 
(B) The basis for such statement. 
(C) Such additional information as the 
Comptroller General determines appropriate. 
(3) AVAILABILITY TO THE PUBLIC.—Each report 
submitted under this subsection shall also be made 
available to the public.
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(4) APPROPRIATE
COMMITTEES
OF
CONGRESS 
DEFINED.—In this subsection, the term ‘‘appropriate 
committees of Congress’’ means— 
(A) the Committees on Veterans’ Affairs, 
Appropriations, and the Budget of the Senate; 
and 
(B) the Committees on Veterans’ Affairs, 
Appropriations, and the Budget of the House of 
Representatives. 
Attest: 
Secretary.