I 
109TH CONGRESS 
1ST SESSION H. R. 1346 
To amend title 38, United States Code, to provide for a more equitable 
geographic allocation of funds appropriated to the Department of Vet-
erans Affairs for medical care. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 16, 2005 
Mr. LARSON of Connecticut (for himself, Mr. ABERCROMBIE, Mr. CASE, Mr. 
DELAHUNT, Ms. DELAURO, Mr. GREEN of Wisconsin, Mr. GRIJALVA, 
Ms. JACKSON-LEE of Texas, Mr. MCCOTTER, Ms. NORTON, and Mr. 
PALLONE) introduced the following bill; which was referred to the Com-
mittee on Veterans’ Affairs 
A BILL 
To amend title 38, United States Code, to provide for a 
more equitable geographic allocation of funds appro-
priated to the Department of Veterans Affairs for med-
ical care. 
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 ‘‘21st Century Veterans 
Equitable Treatment Act’’. 
SEC. 2. FINDINGS. 
Congress makes the following findings:
(1) Veterans were promised by the Federal 
Government that for their service to the country 
they would be provided a lifetime of health care serv-
ices, as well as their own health care service net-
work. 
(2) The current allocation system for appropria-
tions made to the Department of Veterans Affairs 
for medical care, known as the Veterans Equitable 
Resource Allocation (VERA) formula and estab-
lished by the Secretary of Veterans Affairs pursuant 
to section 429 of the Departments of Veterans Af-
fairs and Housing and Urban Development, and 
Independent Agencies Appropriations Act, 1997 
(Public Law 104–204; 110 Stat. 2929), has proved 
to be an ineffective means of allocating such funds 
fairly across the 22 national service regions, known 
as Veterans Integrated Service Networks (VISNs), 
of the Department of Veterans Affairs. 
(3) The VERA formula has resulted in a sys-
tem in which veterans in some regions of the country 
are forced to compete with veterans in other regions 
for critical medical care funds, whereas the system 
should be providing the funding necessary to meet 
the health care needs of all veterans, regardless of 
where they live, to ensure that all veterans have ac-
cess to the level and quality of care that they have 
all earned and deserve. 
(4) The Secretary of Veterans Affairs estab-
lished a set of performance goals in fiscal year 2000, 
which are referred to as ‘‘30–30–20’’, representing 
the Secretary’s goal to schedule nonurgent primary 
care visits within 30 days, specialty care visits within 
30 days, and the maximum amount of time veterans 
must wait once they arrive to be seen by a doctor 
as 20 minutes. 
(5) According to the Department’s Performance 
Report for Fiscal Year 2001, nationally 87 percent 
of primary care appointments were scheduled within 
30 days of the desired date and 84 percent of spe-
cialty care appointments were scheduled within 30 
days of the desired date, while in VISN 1, only 82 
percent of primary care appointments were sched-
uled within 30 days of the desired date and only 80 
percent of specialty care appointments were sched-
uled within 30 days of the desired date. 
(6) Until the VERA formula is changed to en-
sure a more equitable and adequate distribution of 
medical care funding within the Department of Vet-
erans Affairs system, providing appropriate access to 
medical care for the Nation’s veterans must remain
a national priority with a method found to provide 
a safety net that will ensure that veterans have ac-
cess to the health care they need without under-
mining the existing health care network of the De-
partment of Veterans Affairs. 
SEC. 3. STANDARD FOR TIME FOR REFERRAL FOR SPE-
CIALIST CARE. 
(a) TIME FOR SPECIALIST APPOINTMENTS.—(1) The 
Secretary of Veterans Affairs shall establish by regulation 
a maximum specialist referral period, subject to such ex-
ceptions as the Secretary considers necessary. 
(2) For purposes of paragraph (1), the term ‘‘spe-
cialist referral period’’ means the period of time between 
(A) the date on which a veteran is referred to a specialty 
clinic of the Department by the veteran’s primary care 
physician within the Department of Veterans Affairs 
health care system, and (B) the date for which the veteran 
is scheduled for an appointment with a Department spe-
cialist pursuant to such referral. 
(3) In establishing a maximum specialist referral pe-
riod under paragraph (1), the Secretary shall act in a 
manner consistent with the current treatment policies of 
the Department based on clinical need and with the estab-
lished 30–30–20 performance goal of the Department for 
such a referral period.
(b) STANDARD
FOR TRANSPORTATION.—The Sec-
retary shall take such steps as necessary to ensure that 
the Department of Veterans Affairs is able to provide ap-
propriate transportation services for qualified veterans 
within a reasonable time period of a scheduled appoint-
ment. 
SEC. 4. CONTRACT CARE TO BE PROVIDED WHEN DEPART-
MENT OF VETERANS AFFAIRS CARE NOT 
AVAILABLE IN ACCORDANCE WITH STAND-
ARDS. 
(a) CONTRACT CARE.—In any case in which the Sec-
retary of Veterans Affairs is not able to provide hospital 
care or medical services in accordance with the standard 
prescribed under section 3(a) or to provide transportation 
services in accordance with section 3(b), the Secretary 
shall promptly provide for such care or transportation 
from a private source. Hospital care or medical services 
so provided shall be those for which the veteran is other-
wise eligible within the Department of Veterans Affairs 
medical care system. 
(b) REIMBURSEMENT RATE.—Whenever care or serv-
ices are provided under subsection (a), the Secretary shall 
reimburse the provider of such care or services for the rea-
sonable value of such care or services, as determined by 
the Secretary. Such reimbursement shall be provided in
the same manner as applies to reimbursement for emer-
gency treatment under section 1725 of title 38, United 
States Code, subject to such of the terms and conditions 
otherwise applicable to such reimbursements under such 
section as the Secretary determines to be appropriate for 
purposes of this section. 
(c) EXPEDITED REIMBURSEMENT PROCEDURES.— 
The Secretary shall take appropriate steps to expedite the 
reimbursement required by subsection (b). Such steps may 
include steps to take advantage of modern technology, in-
cluding so-called ‘‘smart card’’ technology that would 
allow claims for such reimbursement to be processed elec-
tronically. The Secretary shall, to the extent possible, also 
apply such steps for expediting reimbursement to claims 
for emergency services provided to veterans for which the 
Secretary provides reimbursement under provisions of law 
in effect before the date of the enactment of this Act. 
SEC. 5. TERMINATION OF 24–MONTH RULE FOR REIM-
BURSEMENT FOR EMERGENCY SERVICES. 
The provisions of subparagraph (B) of section 
1725(b)(2) of title 38, United States Code, shall not apply 
with respect to emergency treatment furnished on or after 
the date of the enactment of this Act.
SEC. 6. MEDICAL ADMINISTRATOR PERFORMANCE RAT-
INGS. 
The Secretary of Veterans Affairs shall include in the 
standards of performance used for measuring performance 
of administrators in the Department of Veterans Affairs 
medical care system a standard of assessing improvements 
in appointment waiting times. 
SEC. 7. REPORTS. 
The Secretary of Veterans Affairs shall submit to the 
Committees on Veterans’ Affairs of the Senate and House 
of Representatives a report at the end of each fiscal-year 
quarter on the waiting times for appointments in the De-
partment of Veterans Affairs medical care system. The re-
port shall describe any reductions in such waiting times 
and any experience with appointment delays. 
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