(d) CLARIFICATION OF WAIT TIMES.—Subparagraph 
(A) of subsection (b)(2) of such section is amended to read 
as follows: 
‘‘(A) attempts, or has attempted, to sched-
ule an appointment for the receipt of hospital 
care or medical services under chapter 17 of 
title 38, United States Code, but is unable to 
schedule an appointment within— 
‘‘(i) the wait-time goals of the Vet-
erans Health Administration for the fur-
nishing of such care or services; or 
‘‘(ii) with respect to such care or serv-
ices that are clinically necessary, the period 
determined necessary for such care or serv-
ices if such period is shorter than such 
wait-time goals;’’. 
(e) MODIFICATION OF DISTANCE REQUIREMENT.— 
Subparagraph (B) of subsection (b)(2) of such section is 
amended to read as follows: 
‘‘(B) resides more than 40 miles (as cal-
culated based on distance traveled) from— 
‘‘(i) with respect to a veteran who is 
seeking primary care, a medical facility of 
the Department, including a community- 
based outpatient clinic, that is able to pro-
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vide such primary care by a full-time pri-
mary care physician; or 
‘‘(ii) with respect to a veteran not cov-
ered under clause (i), the medical facility 
of the Department, including a community- 
based outpatient clinic, that is closest to 
the residence of the veteran;’’. 
SEC. 4006. LIMITATION ON DIALYSIS PILOT PROGRAM. 
(a) LIMITATION.—None of the funds authorized to 
be appropriated or otherwise made available to the Sec-
retary of Veterans Affairs may be used to expand the di-
alysis pilot program or to create any new dialysis capa-
bility provided by the Department in a facility that is not 
an initial facility under the dialysis pilot program until— 
(1) an independent analysis of the dialysis pilot 
program is conducted for each such initial facility; 
(2) the Secretary submits to the appropriate 
congressional committees the report under sub-
section (b); and 
(3) a period of 180 days has elapsed following 
the date on which the Secretary submits such report. 
(b) REPORT.—The Secretary shall submit to the ap-
propriate congressional committees a report containing 
the following: 
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(1) The independent analysis described in sub-
section (a)(1). 
(2) A five-year dialysis investment plan explain-
ing all of the options of the Secretary for delivering 
dialysis care to veterans, including how and where 
such care will be delivered. 
(c) DEFINITIONS.—In this section: 
(1) The term ‘‘appropriate congressional com-
mittees’’ means— 
(A) the Committee on Veterans’ Affairs 
and the Committee on Appropriations of the 
House of Representatives; and 
(B) the Committee on Veterans’ Affairs 
and the Committee on Appropriations of the 
Senate. 
(2) The term ‘‘dialysis pilot program’’ means 
the pilot demonstration program approved by the 
Under Secretary of Veterans Affairs for Health in 
August 2010 and by the Secretary of Veterans Af-
fairs in September 2010 to provide dialysis care to 
patients at certain outpatient facilities operated by 
the Department of Veterans Affairs. 
(3) The term ‘‘initial facility’’ means one of the 
four outpatient facilities identified by the Secretary 
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to participate in the dialysis pilot program prior to 
the date of the enactment of this Act. 
SEC. 4007. AMENDMENTS TO INTERNAL REVENUE CODE 
WITH RESPECT TO HEALTH COVERAGE OF 
VETERANS. 
(a) EXEMPTION IN DETERMINATION OF EMPLOYER 
HEALTH INSURANCE MANDATE.— 
(1) IN GENERAL.—Section 4980H(c)(2) of the 
Internal Revenue Code of 1986 is amended by add-
ing at the end the following: 
‘‘(F) EXEMPTION FOR HEALTH COVERAGE 
UNDER TRICARE OR THE VETERANS ADMINIS-
TRATION.—Solely for purposes of determining 
whether an employer is an applicable large em-
ployer under this paragraph for any month, an 
individual shall not be taken into account as an 
employee for such month if such individual has 
medical coverage for such month under— 
‘‘(i) chapter 55 of title 10, United 
States Code, including coverage under the 
TRICARE program, or 
‘‘(ii) under a health care program 
under chapter 17 or 18 of title 38, United 
States Code, as determined by the Sec-
retary of Veterans Affairs, in coordination 
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with the Secretary of Health and Human 
Services and the Secretary.’’. 
(2) EFFECTIVE DATE.—The amendment made 
by this subsection shall apply to months beginning 
after December 31, 2013. 
(b) ELIGIBILITY FOR HEALTH SAVINGS ACCOUNT 
NOT AFFECTED BY RECEIPT OF MEDICAL CARE FOR 
SERVICE-CONNECTED DISABILITY.— 
(1) IN GENERAL.—Section 223(c)(1) of the In-
ternal Revenue Code of 1986 is amended by adding 
at the end the following new subparagraph: 
‘‘(C) SPECIAL RULE FOR INDIVIDUALS ELI-
GIBLE FOR CERTAIN VETERANS BENEFITS.—An 
individual shall not fail to be treated as an eli-
gible individual for any period merely because 
the individual receives hospital care or medical 
services under any law administered by the Sec-
retary of Veterans Affairs for a service-con-
nected disability (within the meaning of section 
101(16) of title 38, United States Code).’’. 
(2) EFFECTIVE DATE.—The amendment made 
by this subsection shall apply to months beginning 
after December 31, 2015. 
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