I 
113TH CONGRESS 
2D SESSION 
H. R. 4841 
To improve the access of veterans to medical services from the Department 
of Veterans Affairs, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 11, 2014 
Mrs. KIRKPATRICK (for herself, Mr. MICHAUD, Mr. BARBER, Mr. GRIJALVA, 
and Mr. PASTOR of Arizona) introduced the following bill; which was re-
ferred to the Committee on Veterans’ Affairs, and in addition to the 
Committees on Oversight and Government Reform and the Budget, for 
a period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To improve the access of veterans to medical services from 
the Department of Veterans Affairs, 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; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Veterans’ Access to Care through Choice, Accountability, 
and Transparency Act of 2014’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
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Sec. 1. Short title; table of contents. 
TITLE I—IMPROVEMENT OF SCHEDULING SYSTEM FOR HEALTH 
CARE APPOINTMENTS 
Sec. 101. Independent assessment of the scheduling of appointments and other 
health care management processes of the Department of Vet-
erans Affairs. 
Sec. 102. Technology task force on review of scheduling system and software 
of the Department of Veterans Affairs. 
TITLE II—TRAINING AND HIRING OF HEALTH CARE STAFF 
Sec. 201. Treatment of staffing shortage and biannual report on staffing of 
medical facilities of the Department of Veterans Affairs. 
Sec. 202. Clinic management training for managers and health care providers 
of the Department of Veterans Affairs. 
Sec. 203. Use of unobligated amounts to hire additional health care providers 
for the Veterans Health Administration. 
TITLE III—IMPROVEMENT OF ACCESS TO CARE FROM NON- 
DEPARTMENT OF VETERANS AFFAIRS PROVIDERS 
Sec. 301. Expanded availability of hospital care and medical services for vet-
erans through the use of contracts. 
Sec. 302. Transfer of authority for payments for hospital care, medical services, 
and other health care from non-Department providers to the 
Chief Business Office of the Veterans Health Administration of 
the Department. 
Sec. 303. Enhancement of collaboration between Department of Veterans Af-
fairs and Indian Health Service. 
Sec. 304. Enhancement of collaboration between Department of Veterans Af-
fairs and Native Hawaiian health care systems. 
Sec. 305. Sense of Congress on prompt payment by Department of Veterans 
Affairs. 
TITLE IV—HEALTH CARE ADMINISTRATIVE MATTERS 
Sec. 401. Improvement of access of veterans to mobile vet centers of the De-
partment of Veterans Affairs. 
Sec. 402. Commission on construction projects of the Department of Veterans 
Affairs. 
Sec. 403. Commission on Access to Care. 
Sec. 404. Improved performance metrics for health care provided by Depart-
ment of Veterans Affairs. 
Sec. 405. Improved transparency concerning health care provided by Depart-
ment of Veterans Affairs. 
Sec. 406. Information for veterans on the credentials of Department of Vet-
erans Affairs physicians. 
Sec. 407. Information in annual budget of the President on hospital care and 
medical services furnished through expanded use of contracts 
for such care. 
Sec. 408. Prohibition on falsification of data concerning wait times and quality 
measures at Department of Veterans Affairs. 
Sec. 409. Removal of Senior Executive Service employees of the Department of 
Veterans Affairs for performance. 
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TITLE V—HEALTH CARE RELATED TO SEXUAL TRAUMA 
Sec. 501. Expansion of eligibility for sexual trauma counseling and treatment 
to veterans on inactive duty training. 
Sec. 502. Provision of counseling and treatment for sexual trauma by the De-
partment of Veterans Affairs to members of the Armed Forces. 
Sec. 503. Reports on military sexual trauma. 
TITLE VI—MAJOR MEDICAL FACILITY LEASES 
Sec. 601. Authorization of major medical facility leases. 
Sec. 602. Budgetary treatment of Department of Veterans Affairs major med-
ical facilities leases. 
TITLE VII—VETERANS BENEFITS MATTERS 
Sec. 701. Expansion of Marine Gunnery Sergeant John David Fry Scholarship. 
Sec. 702. Approval of courses of education provided by public institutions of 
higher learning for purposes of All-Volunteer Force Edu-
cational Assistance Program and Post-9/11 Educational Assist-
ance conditional on in-State tuition rate for veterans. 
TITLE VIII—APPROPRIATION AND EMERGENCY DESIGNATIONS 
Sec. 801. Appropriation of emergency amounts. 
Sec. 802. Emergency designations. 
TITLE 
I—IMPROVEMENT 
OF 
SCHEDULING 
SYSTEM 
FOR 
HEALTH 
CARE 
APPOINT-
MENTS 
SEC. 101. INDEPENDENT ASSESSMENT OF THE SCHED-
ULING 
OF 
APPOINTMENTS 
AND 
OTHER 
HEALTH CARE MANAGEMENT PROCESSES OF 
THE DEPARTMENT OF VETERANS AFFAIRS. 
(a) INDEPENDENT ASSESSMENT.— 
(1) ASSESSMENT.—Not later than 30 days 
after the date of the enactment of this Act, the Sec-
retary of Veterans Affairs shall enter into a contract 
with an independent third party to assess the fol-
lowing: 
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(A) The process at each medical facility of 
the Department of Veterans Affairs for sched-
uling appointments for veterans to receive hos-
pital care, medical services, or other health care 
from the Department. 
(B) The staffing level and productivity of 
each medical facility of the Department, includ-
ing the following: 
(i) The case load of each health care 
provider of the Department. 
(ii) The time spent by each health 
care provider of the Department on mat-
ters other than the case load of such 
health care provider, including time spent 
by such health care provider as follows: 
(I) At a medical facility that is 
affiliated with the Department. 
(II) Conducting research. 
(III) Training or overseeing other 
health care professionals of the De-
partment. 
(C) The organization, processes, and tools 
used by the Department to support clinical doc-
umentation and the subsequent coding of inpa-
tient services. 
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(D) The purchasing, distribution, and use 
of pharmaceuticals, medical and surgical sup-
plies, and medical devices by the Department, 
including the following: 
(i) The prices paid for, standardiza-
tion of, and use by the Department of the 
following: 
(I) High-cost pharmaceuticals. 
(II) Medical and surgical sup-
plies. 
(III) Medical devices. 
(ii) The use by the Department of 
group purchasing arrangements to pur-
chase pharmaceuticals, medical and sur-
gical supplies, medical devices, and health 
care related services. 
(iii) The strategy used by the Depart-
ment to distribute pharmaceuticals, med-
ical and surgical supplies, and medical de-
vices to Veterans Integrated Service Net-
works and medical facilities of the Depart-
ment. 
(E) The performance of the Department in 
paying amounts owed to third parties and col-
lecting amounts owed to the Department with 
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respect to hospital care, medical services, and 
other health care, including any recommenda-
tions of the independent third party as follows: 
(i) To avoid the payment of penalties 
to vendors. 
(ii) To increase the collection of 
amounts owed to the Department for hos-
pital care, medical services, or other health 
care provided by the Department for which 
reimbursement from a third party is au-
thorized. 
(iii) To increase the collection of any 
other amounts owed to the Department. 
(2) 
ELEMENTS
OF
SCHEDULING
ASSESS-
MENT.—In carrying out the assessment required by 
paragraph (1)(A), the independent third party shall 
do the following: 
(A) Review all training materials per-
taining to scheduling of appointments at each 
medical facility of the Department. 
(B) Assess whether all employees of the 
Department conducting tasks related to sched-
uling are properly trained for conducting such 
tasks. 
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(C) Assess whether changes in the tech-
nology or system used in scheduling appoint-
ments are necessary to limit access to the sys-
tem to only those employees that have been 
properly trained in conducting such tasks. 
(D) Assess whether health care providers 
of the Department are making changes to their 
schedules that hinder the ability of employees 
conducting such tasks to perform such tasks. 
(E) Assess whether the establishment of a 
centralized call center throughout the Depart-
ment for scheduling appointments at medical 
facilities of the Department would improve the 
process of scheduling such appointments. 
(F) Assess whether booking templates for 
each medical facility or clinic of the Depart-
ment would improve the process of scheduling 
such appointments. 
(G) Recommend any actions to be taken by 
the Department to improve the process for 
scheduling such appointments, including the fol-
lowing: 
(i) Changes in training materials pro-
vided to employees of the Department with 
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respect to conducting tasks related to 
scheduling such appointments. 
(ii) Changes in monitoring and assess-
ment conducted by the Department of wait 
times of veterans for such appointments. 
(iii) Changes in the system used to 
schedule such appointments, including 
changes to improve how the Department— 
(I) measures wait times of vet-
erans for such appointments; 
(II) monitors the availability of 
health care providers of the Depart-
ment; and 
(III) provides veterans the ability 
to schedule such appointments. 
(iv) Such other actions as the inde-
pendent third party considers appropriate. 
(3) TIMING.—The independent third party car-
rying out the assessment required by paragraph (1) 
shall complete such assessment not later than 180 
days after entering into the contract described in 
such paragraph. 
(b) REPORT.— 
(1) IN GENERAL.—Not later than 90 days after 
the date on which the independent third party com-
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pletes the assessment under this section, the Sec-
retary shall submit to the Committee on Veterans’ 
Affairs of the Senate and the Committee on Vet-
erans’ Affairs of the House of Representatives a re-
port on the results of such assessment. 
(2) PUBLICATION.—Not later than 30 days 
after submitting the report under paragraph (1), the 
Secretary shall publish such report in the Federal 
Register and on an Internet website of the Depart-
ment accessible to the public. 
SEC. 102. TECHNOLOGY TASK FORCE ON REVIEW OF 
SCHEDULING SYSTEM AND SOFTWARE OF 
THE DEPARTMENT OF VETERANS AFFAIRS. 
(a) TASK FORCE REVIEW.— 
(1) IN GENERAL.—The Secretary of Veterans 
Affairs shall, through the use of a technology task 
force, conduct a review of the needs of the Depart-
ment of Veterans Affairs with respect to the sched-
uling system and scheduling software of the Depart-
ment of Veterans Affairs that is used by the Depart-
ment to schedule appointments for veterans for hos-
pital care, medical services, and other health care 
from the Department. 
(2) AGREEMENT.— 
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(A) Proposals for specific actions to be 
taken by the Department to improve the sched-
uling system and scheduling software of the De-
partment described in subsection (a)(1). 
(B) A determination as to whether an ex-
isting off-the-shelf system would— 
(i) meet the needs of the Department 
to schedule appointments for veterans for 
hospital care, medical services, and other 
health care from the Department; and 
(ii) improve the access of veterans to 
such care and services. 
(3) PUBLICATION.—Not later than 30 days 
after the receipt of the report required by paragraph 
(1), the Secretary shall publish such report in the 
Federal Register and on an Internet website of the 
Department accessible to the public. 
(c) IMPLEMENTATION
OF
TASK
FORCE
REC-
OMMENDATIONS.—Not later than one year after the re-
ceipt of the report required by subsection (b)(1), the Sec-
retary shall implement the recommendations set forth in 
such report that the Secretary considers are feasible, ad-
visable, and cost-effective. 
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TITLE II—TRAINING AND HIRING 
OF HEALTH CARE STAFF 
SEC. 201. TREATMENT OF STAFFING SHORTAGE AND BIAN-
NUAL REPORT ON STAFFING OF MEDICAL FA-
CILITIES OF THE DEPARTMENT OF VET-
ERANS AFFAIRS. 
(a) STAFFING SHORTAGE.— 
(1) IN
GENERAL.—Not later than 180 days 
after the date of the enactment of this Act, and not 
later than September 30 each year thereafter, the 
Inspector General of the Department of Veterans 
Affairs shall determine, and the Secretary of Vet-
erans Affairs shall publish in the Federal Register, 
the five occupations of health care providers of the 
Department of Veterans Affairs for which there is 
the largest staffing shortage throughout the Depart-
ment. 
(2) RECRUITMENT
AND
APPOINTMENT.—Not-
withstanding sections 3304 and 3309 through 3318 
of title 5, United States Code, the Secretary may, 
upon a determination by the Inspector General 
under paragraph (1) that there is a staffing short-
age throughout the Department with respect to a 
particular occupation of health care provider, recruit 
and directly appoint highly qualified health care pro-
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viders to serve as health care providers in that par-
ticular occupation for the Department. 
(3) PRIORITY IN HEALTH PROFESSIONALS EDU-
CATIONAL ASSISTANCE PROGRAM TO CERTAIN PRO-
VIDERS.—Section 7612(b)(5) of title 38, United 
States Code, is amended— 
(A) in subparagraph (A), by striking 
‘‘and’’ at the end; 
(B) by redesignating subparagraph (B) as 
subparagraph (C); and 
(C) by inserting after subparagraph (A) 
the following new subparagraph (B): 
‘‘(B) shall give priority to applicants pursuing 
a course of education or training towards a career 
in an occupation for which the Secretary has, in the 
most current determination published in the Federal 
Register pursuant to section 201(a)(1) of the Vet-
erans’ Access to Care through Choice, Account-
ability, and Transparency Act of 2014, determined 
that there is one of the largest staffing shortages 
throughout the Department with respect to such oc-
cupation; and’’. 
(b) REPORTS.— 
(1) IN
GENERAL.—Not later than 180 days 
after the date of the enactment of this Act, and not 
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later than December 31 of each even numbered year 
thereafter until 2024, the Secretary of Veterans Af-
fairs shall submit to the Committee on Veterans’ Af-
fairs of the Senate and the Committee on Veterans’ 
Affairs of the House of Representatives a report as-
sessing the staffing of each medical facility of the 
Department of Veterans Affairs. 
(2) ELEMENTS.—Each report submitted under 
paragraph (1) shall include the following: 
(A) The results of a system-wide assess-
ment of all medical facilities of the Department 
to ensure the following: 
(i) Appropriate staffing levels for 
health care providers to meet the goals of 
the Secretary for timely access to care for 
veterans. 
(ii) Appropriate staffing levels for 
support personnel, including clerks. 
(iii) Appropriate sizes for clinical pan-
els. 
(iv) Appropriate numbers of full-time 
staff, or full-time equivalents, dedicated to 
direct care of patients. 
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(v) Appropriate physical plant space 
to meet the capacity needs of the Depart-
ment in that area. 
(vi) Such other factors as the Sec-
retary considers necessary. 
(B) A plan for addressing any issues iden-
tified in the assessment described in subpara-
graph (A), including a timeline for addressing 
such issues. 
(C) A list of the current wait times and 
workload levels for the following clinics in each 
medical facility: 
(i) Mental health. 
(ii) Primary care. 
(iii) Gastroenterology. 
(iv) Women’s health. 
(v) Such other clinics as the Secretary 
considers appropriate. 
(D) A description of the results of the 
most current determination of the Inspector 
General under paragraph (1) of subsection (a) 
and a plan to use direct appointment authority 
under paragraph (2) of such subsection to fill 
staffing shortages, including recommendations 
for 
improving 
the 
speed 
at 
which 
the 
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credentialing and privileging process can be 
conducted. 
(E) The current staffing models of the De-
partment for the following clinics, including rec-
ommendations for changes to such models: 
(i) Mental health. 
(ii) Primary care. 
(iii) Gastroenterology. 
(iv) Women’s health. 
(v) Such other clinics as the Secretary 
considers appropriate. 
(F) A detailed analysis of succession plan-
ning at medical facilities of the Department, in-
cluding the following: 
(i) The number of positions in medical 
facilities throughout the Department that 
are not filled by a permanent employee. 
(ii) The length of time each position 
described in clause (i) remained vacant or 
filled by a temporary or acting employee. 
(iii) A description of any barriers to 
filling the positions described in clause (i). 
(iv) A plan for filling any positions 
that are vacant or filled by a temporary or 
acting employee for more than 180 days. 
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(v) A plan for handling emergency cir-
cumstances, such as administrative leave 
or sudden medical leave for senior officials. 
(G) The number of health care providers of 
the Department who have been removed from 
their positions, have retired, or have left their 
positions for another reason, disaggregated by 
provider type, during the two-year period pre-
ceding the submittal of the report. 
(H) Of the health care providers specified 
in subparagraph (G) who have been removed 
from their positions, the following: 
(i) The number of such health care 
providers who were reassigned to other po-
sitions in the Department. 
(ii) The number of such health care 
providers who left the Department. 
(iii) The number of such health care 
providers who left the Department and 
were subsequently rehired by the Depart-
ment. 
SEC. 202. CLINIC MANAGEMENT TRAINING FOR MANAGERS 
AND HEALTH CARE PROVIDERS OF THE DE-
PARTMENT OF VETERANS AFFAIRS. 
(a) CLINIC MANAGEMENT TRAINING PROGRAM.— 
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(1) IN
GENERAL.—Not later than 180 days 
after the date of the enactment of this Act, the Sec-
retary of Veterans Affairs shall commence a clinic 
management training program to provide in-person, 
standardized education on health care management 
to all managers of, and health care providers at, 
medical facilities of the Department of Veterans Af-
fairs. 
(2) ELEMENTS.—The clinic management train-
ing program required by paragraph (1) shall include 
the following: 
(A) Training on how to manage the sched-
ules of health care providers of the Department, 
including the following: 
(i) Maintaining such schedules in a 
manner that allows appointments to be 
booked at least eight weeks in advance. 
(ii) Proper planning procedures for 
vacation, leave, and graduate medical edu-
cation training schedules. 
(B) Training on the appropriate number of 
appointments that a health care provider should 
conduct on a daily basis, based on specialty. 
(C) Training on how to determine whether 
there are enough available appointment slots to 
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manage demand for different appointment types 
and mechanisms for alerting management of in-
sufficient slots. 
(D) Training on how to properly use the 
appointment scheduling system of the Depart-
ment, including any new scheduling system im-
plemented by the Department. 
(E) Training on how to optimize the use of 
technology, including the following: 
(i) Telemedicine. 
(ii) Electronic mail. 
(iii) Text messaging. 
(iv) Such other technologies as speci-
fied by the Secretary. 
(F) Training on how to properly use phys-
ical plant space at medical facilities of the De-
partment to ensure efficient flow and privacy 
for patients and staff. 
(3) SUNSET.—The clinic management training 
program required by paragraph (1) shall terminate 
on the date that is two years after the date on which 
the Secretary commences such program. 
(b) TRAINING MATERIALS.— 
(1) IN GENERAL.—After the termination of the 
clinic management training program required by 
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subsection (a), the Secretary shall provide training 
materials on health care management to each of the 
following employees of the Department upon the 
commencement of employment of such employee: 
(A) Any manager of a medical facility of 
the Department. 
(B) Any health care provider at a medical 
facility of the Department. 
(C) Such other employees of the Depart-
ment as the Secretary considers appropriate. 
(2) UPDATE.—The Secretary shall regularly up-
date the training materials required under para-
graph (1). 
SEC. 203. USE OF UNOBLIGATED AMOUNTS TO HIRE ADDI-
TIONAL HEALTH CARE PROVIDERS FOR THE 
VETERANS HEALTH ADMINISTRATION. 
(a) IN GENERAL.—At the end of each of fiscal years 
2014 and 2015, all covered amounts shall be made avail-
able to the Secretary of Veterans Affairs to hire additional 
health care providers for the Veterans Health Administra-
tion of the Department of Veterans Affairs, or to carry 
out any provision of this Act or the amendments made 
by this Act, and shall remain available until expended. 
(b) PRIORITY
IN
HIRING.—The Secretary shall 
prioritize hiring additional health care providers under 
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subsection (a) at medical facilities of the Department and 
in geographic areas in which the Secretary identifies the 
greatest shortage of health care providers. 
(c) COVERED AMOUNTS DEFINED.—In this section, 
the term ‘‘covered amounts’’ means amounts— 
(1) that are made available to the Veterans 
Health Administration of the Department for an ap-
propriations account— 
(A) under the heading ‘‘MEDICAL
SERV-
ICES’’; 
(B) under the heading ‘‘MEDICAL SUPPORT 
AND COMPLIANCE’’; or 
(C) under the heading ‘‘MEDICAL FACILI-
TIES’’; and 
(2) that are unobligated at the end of the appli-
cable fiscal year. 
TITLE 
III—IMPROVEMENT 
OF 
ACCESS TO CARE FROM NON- 
DEPARTMENT OF VETERANS 
AFFAIRS PROVIDERS 
SEC. 301. EXPANDED AVAILABILITY OF HOSPITAL CARE 
AND MEDICAL SERVICES FOR VETERANS 
THROUGH THE USE OF CONTRACTS. 
(a) EXPANSION OF AVAILABLE CARE AND SERV-
ICES.— 
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(1) FURNISHING OF CARE.— 
(A) IN GENERAL.—Hospital care and med-
ical services under chapter 17 of title 38, 
United States Code, shall be furnished to an el-
igible veteran described in subsection (b), at the 
election of such veteran, through contracts au-
thorized under subsection (d), or any other law 
administered by the Secretary of Veterans Af-
fairs, with entities specified in subparagraph 
(B) for the furnishing of such care and services 
to veterans. 
(B) ENTITIES
SPECIFIED.—The entities 
specified in this subparagraph are the following: 
(i) Any health care provider that is 
participating in the Medicare program 
under title XVIII of the Social Security 
Act (42 U.S.C. 1395 et seq.). 
(ii) Any Federally-qualified health 
center (as defined in section 1905(l)(2)(B) 
of the Social Security Act (42 U.S.C. 
1396d(l)(2)(B))). 
(iii) The Department of Defense. 
(iv) The Indian Health Service. 
(2) CHOICE OF PROVIDER.—An eligible veteran 
who elects to receive care and services under this 
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section may select the provider of such care and 
services from among any source of provider of such 
care and services through an entity specified in 
paragraph (1)(B) that is accessible to the veteran. 
(3) COORDINATION OF CARE AND SERVICES.— 
The Secretary shall coordinate, through the Non-VA 
Care Coordination Program of the Department of 
Veterans Affairs, the furnishing of care and services 
under this section to eligible veterans, including by 
ensuring that an eligible veteran receives an appoint-
ment for such care and services within the current 
wait-time goals of the Veterans Health Administra-
tion for the furnishing of hospital care and medical 
services. 
(b) ELIGIBLE VETERANS.—A veteran is an eligible 
veteran for purposes of this section if— 
(1)(A) the veteran is enrolled in the patient en-
rollment system of the Department of Veterans Af-
fairs established and operated under section 1705 of 
title 38, United States Code; or 
(B) the veteran is enrolled in such system, has 
not received hospital care or medical services from 
the Department, and has contacted the Department 
seeking an initial appointment from the Department 
for the receipt of such care or services; and 
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(2) the veteran— 
(A)(i) attempts, or has attempted under 
paragraph (1)(B), to schedule an appointment 
for the receipt of hospital care or medical serv-
ices under chapter 17 of title 38, United States 
Code, but is unable to schedule an appointment 
within the current wait-time goals of the Vet-
erans Health Administration for the furnishing 
of such care or services; and 
(ii) elects, and is authorized, to be fur-
nished such care or services pursuant to sub-
section (c)(2); 
(B) resides more than 40 miles from the 
nearest medical facility of the Department, in-
cluding a community-based outpatient clinic, 
that is closest to the residence of the veteran; 
or 
(C) resides— 
(i) in a State without a medical facil-
ity of the Department that provides— 
(I) hospital care; 
(II) emergency medical services; 
and 
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(III) surgical care rated by the 
Secretary as having a surgical com-
plexity of standard; and 
(ii) more than 20 miles from a med-
ical facility of the Department described in 
clause (i). 
(c) ELECTION AND AUTHORIZATION.— 
(1) IN
GENERAL.—If the Secretary confirms 
that an appointment for an eligible veteran described 
in subsection (b)(2)(A) for the receipt of hospital 
care or medical services under chapter 17 of title 38, 
United States Code, is unavailable within the cur-
rent wait-time goals of the Department for the fur-
nishing of such care or services, the Secretary shall, 
at the election of the eligible veteran— 
(A) place such eligible veteran on an elec-
tronic waiting list described in paragraph (2) 
for such an appointment; or 
(B)(i) authorize that such care and serv-
ices be furnished to the eligible veteran under 
this section for a period of time specified by the 
Secretary; and 
(ii) send a letter to the eligible veteran de-
scribing the care and services the eligible vet-
eran is eligible to receive under this section. 
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(2) ELECTRONIC
WAITING
LIST.—The elec-
tronic waiting list described in this paragraph shall 
be maintained by the Department and allow access 
by each eligible veteran via www.myhealth.va.gov or 
any successor website for the following purposes: 
(A) To determine the place of such eligible 
veteran on the waiting list. 
(B) To determine the average length of 
time an individual spends on the waiting list, 
disaggregated by medical facility of the Depart-
ment and type of care or service needed, for 
purposes of allowing such eligible veteran to 
make an informed election under paragraph 
(1). 
(d) CARE AND SERVICES THROUGH CONTRACTS.— 
(1) IN
GENERAL.—The Secretary shall enter 
into contracts with health care providers that are 
participating in the Medicare program under title 
XVIII of the Social Security Act (42 U.S.C. 1395 et 
seq.) to furnish care and services to eligible veterans 
under this section. 
(2) RATES AND REIMBURSEMENT.— 
(A) IN GENERAL.—In entering into a con-
tract under this subsection, the Secretary 
shall— 
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(i) negotiate rates for the furnishing 
of care and services under this section; and 
(ii) reimburse the health care provider 
for such care and services at the rates ne-
gotiated pursuant to clause (i) as provided 
in such contract. 
(B) LIMIT ON RATES.— 
(i) IN GENERAL.—Except as provided 
in clause (ii), rates negotiated under sub-
paragraph (A)(i) shall not be more than 
the rates paid by the United States to a 
provider of services (as defined in section 
1861(u) of the Social Security Act (42 
U.S.C. 1395x(u))) or a supplier (as defined 
in section 1861(d) of such Act (42 U.S.C. 
1395x(d))) under the Medicare program 
under title XVIII of the Social Security 
Act (42 U.S.C. 1395 et seq.) for the same 
care and services. 
(ii) EXCEPTION.—The Secretary may 
negotiate a rate that is more than the rate 
paid by the United States as described in 
clause (i) with respect to the furnishing of 
care or services under this section to an el-
igible veteran if the Secretary determines 
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that there is no health care provider that 
will provide such care or services to such 
eligible veteran at the rate required under 
such clause— 
(I) within the current wait-time 
goals of the Veterans Health Adminis-
tration for the furnishing of such care 
or services; and 
(II) at a location not more than 
40 miles from the residence of such 
eligible veteran. 
(C) LIMIT ON COLLECTION.—For the fur-
nishing of care and services pursuant to a con-
tract under this section, a health care provider 
may not collect any amount that is greater than 
the rate negotiated pursuant to subparagraph 
(A)(i). 
(3) INFORMATION
ON
POLICIES
AND
PROCE-
DURES.—The Secretary shall provide to any health 
care provider with which the Secretary has entered 
into a contract under paragraph (1) the following: 
(A) Information on applicable policies and 
procedures for submitting bills or claims for au-
thorized care and services furnished to eligible 
veterans under this section. 
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(B) Access to a telephone hotline main-
tained by the Department that such health care 
provider may call for information on the fol-
lowing: 
(i) Procedures for furnishing care and 
services under this section. 
(ii) Procedures for submitting bills or 
claims for authorized care and services fur-
nished to eligible veterans under this sec-
tion and being reimbursed for furnishing 
such care and services. 
(iii) Whether particular care or serv-
ices under this section are authorized, and 
the procedures for authorization of such 
care or services. 
(e) CHOICE CARD.— 
(1) IN
GENERAL.—For purposes of receiving 
care and services under this section, the Secretary 
shall issue to each eligible veteran a card that the 
eligible veteran shall present to a health care pro-
vider that is eligible to furnish care and services 
under this section before receiving such care and 
services. 
(2) NAME OF CARD.—Each card issued under 
paragraph (1) shall be known as a ‘‘Choice Card’’. 
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(3) DETAILS
OF
CARD.—Each Choice Card 
issued to an eligible veteran under paragraph (1) 
shall include the following: 
(A) The name of the eligible veteran. 
(B) An identification number for the eligi-
ble veteran that is not the social security num-
ber of the eligible veteran. 
(C) The contact information of an appro-
priate office of the Department for health care 
providers to confirm that care and services 
under this section are authorized for the eligible 
veteran. 
(D) Contact information and other rel-
evant information for the submittal of claims or 
bills for the furnishing of care and services 
under this section. 
(E) The following statement: ‘‘This card is 
for qualifying medical care outside the Depart-
ment of Veterans Affairs. Please call the De-
partment of Veterans Affairs phone number 
specified on this card to ensure that treatment 
has been authorized.’’. 
(4) INFORMATION
ON
USE
OF
CARD.—Upon 
issuing a Choice Card to an eligible veteran, the Sec-
retary shall provide the eligible veteran with infor-
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mation clearly stating the circumstances under 
which the veteran may be eligible for care and serv-
ices under this section. 
(f) INFORMATION ON AVAILABILITY OF CARE.—The 
Secretary shall provide information to a veteran about the 
availability of care and services under this section in the 
following circumstances: 
(1) When the veteran enrolls in the patient en-
rollment system of the Department under section 
1705 of title 38, United States Code. 
(2) When the veteran attempts to schedule an 
appointment for the receipt of hospital care or med-
ical services from the Department but is unable to 
schedule an appointment within the current wait- 
time goals of the Veterans Health Administration 
for delivery of such care or services. 
(g) PROVIDERS.—To be eligible to furnish care and 
services under this section, a health care provider must— 
(1) maintain at least the same or similar cre-
dentials and licenses as those credentials and li-
censes that are required of health care providers of 
the Department, as determined by the Secretary for 
purposes of this section; and 
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(2) submit, not less frequently than once each 
year, verification of such licenses and credentials 
maintained by such health care provider. 
(h) COST-SHARING.— 
(1) IN GENERAL.—The Secretary shall require 
an eligible veteran to pay a copayment to the De-
partment for the receipt of care and services under 
this section only if such eligible veteran would be re-
quired to pay such copayment for the receipt of such 
care and services at a medical facility of the Depart-
ment. 
(2) LIMITATION.—The copayment required 
under paragraph (1) shall not be greater than the 
copayment required of such eligible veteran by the 
Department for the receipt of such care and services 
at a medical facility of the Department. 
(i) CLAIMS PROCESSING SYSTEM.— 
(1) IN GENERAL.—The Secretary shall provide 
for an efficient nationwide system for processing and 
paying bills or claims for authorized care and serv-
ices furnished to eligible veterans under this section. 
(2) REGULATIONS.—Not later than 90 days 
after the date of the enactment of this Act, the Sec-
retary of Veterans Affairs shall prescribe regulations 
for the implementation of such system. 
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(3) OVERSIGHT.—The Chief Business Office of 
the Veterans Health Administration shall oversee the 
implementation and maintenance of such system. 
(4) ACCURACY OF PAYMENT.— 
(A) IN GENERAL.—The Secretary shall en-
sure that such system meets such goals for ac-
curacy of payment as the Secretary shall specify 
for purposes of this section. 
(B) ANNUAL REPORT.— 
(i) IN GENERAL.—Not later than one 
year after the date of the enactment of this 
Act, and annually thereafter until the ter-
mination date specified in subsection (n), 
the Secretary shall submit to the Com-
mittee on Veterans’ Affairs of the Senate 
and the Committee on Veterans’ Affairs of 
the House of Representatives a report on 
the goals for accuracy of such system. 
(ii) ELEMENTS.—Each report re-
quired by clause (i) shall include the fol-
lowing: 
(I) A description of the goals for 
accuracy for such system specified by 
the Secretary under subparagraph 
(A). 
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(II) An assessment of the success 
of the Department in meeting such 
goals during the year preceding the 
submittal of the report. 
(j) MEDICAL RECORDS.—The Secretary shall ensure 
that any health care provider that furnishes care and serv-
ices under this section to an eligible veteran submits to 
the Department any medical record related to the care and 
services provided to such eligible veteran by such health 
care provider for inclusion in the electronic medical record 
of such eligible veteran maintained by the Department 
upon the completion of the provision of such care and serv-
ices to such eligible veteran. 
(k) TRACKING
OF MISSED APPOINTMENTS.—The 
Secretary shall implement a mechanism to track any 
missed appointments for care and services under this sec-
tion by eligible veterans to ensure that the Department 
does not pay for such care and services that were not fur-
nished to an eligible veteran. 
(l) IMPLEMENTATION.—Not later than 90 days after 
the date of the enactment of this Act, the Secretary shall 
prescribe interim final regulations on the implementation 
of this section and publish such regulations in the Federal 
Register. 
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(m) INSPECTOR GENERAL REPORT.—Not later than 
540 days after the publication of the interim final regula-
tions under subsection (l), the Inspector General of the 
Department shall submit to the Secretary a report on the 
results of an audit of the care and services furnished 
under this section to ensure the accuracy and timeliness 
of payments by the Department for the cost of such care 
and services, including any findings and recommendations 
of the Inspector General. 
(n) TERMINATION.—The requirement of the Sec-
retary to furnish care and services under this section ter-
minates on the date that is two years after the date on 
which the Secretary publishes the interim final regulations 
under subsection (l). 
(o) REPORTS.— 
(1) INITIAL REPORT.—Not later than 90 days 
after the publication of the interim final regulations 
under subsection (l), the Secretary shall submit to 
the Committee on Veterans’ Affairs of the Senate 
and the Committee on Veterans’ Affairs of the 
House of Representatives a report on the furnishing 
of care and services under this section that includes 
the following: 
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(A) The number of eligible veterans who 
have received care and services under this sec-
tion. 
(B) A description of the type of care and 
services furnished to eligible veterans under this 
section. 
(2) FINAL REPORT.—Not later than 540 days 
after the publication of the interim final regulations 
under subsection (l), the Secretary shall submit to 
the Committee on Veterans’ Affairs of the Senate 
and the Committee on Veterans’ Affairs of the 
House of Representatives a report on the furnishing 
of care and services under this section that includes 
the following: 
(A) The total number of eligible veterans 
who have received care and services under this 
section, disaggregated by— 
(i) eligible veterans described in sub-
section (b)(2)(A); and 
(ii) eligible veterans described in sub-
section (b)(2)(B). 
(B) A description of the type of care and 
services furnished to eligible veterans under this 
section. 
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(C) An accounting of the total cost of fur-
nishing care and services to eligible veterans 
under this section. 
(D) The results of a survey of eligible vet-
erans who have received care or services under 
this section on the satisfaction of such eligible 
veterans with the care or services received by 
such eligible veterans under this section. 
(E) An assessment of the effect of fur-
nishing care and services under this section on 
wait times for an appointment for the receipt of 
hospital care and medical services from the De-
partment. 
(F) An assessment of the feasibility and 
advisability of continuing furnishing care and 
services under this section after the termination 
date specified in subsection (n). 
(p) RULES OF CONSTRUCTION.— 
(1) NO MODIFICATION OF CONTRACTS.—Noth-
ing in this section shall be construed to require the 
Secretary to renegotiate contracts for the furnishing 
of hospital care or medical services to veterans en-
tered into by the Department before the date of the 
enactment of this Act. 
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(2) FILLING AND PAYING FOR PRESCRIPTION 
MEDICATIONS.—Nothing in this section shall be con-
strued to alter the process of the Department for 
filling and paying for prescription medications. 
SEC. 302. TRANSFER OF AUTHORITY FOR PAYMENTS FOR 
HOSPITAL CARE, MEDICAL SERVICES, AND 
OTHER HEALTH CARE FROM NON-DEPART-
MENT PROVIDERS TO THE CHIEF BUSINESS 
OFFICE OF THE VETERANS HEALTH ADMINIS-
TRATION OF THE DEPARTMENT. 
(a) TRANSFER OF AUTHORITY.— 
(1) IN
GENERAL.—Effective on October 1, 
2014, the Secretary of Veterans Affairs shall trans-
fer the authority to pay for hospital care, medical 
services, and other health care through non-Depart-
ment providers to the Chief Business Office of the 
Veterans Health Administration of the Department 
of Veterans Affairs from the Veterans Integrated 
Service Networks and medical centers of the Depart-
ment of Veterans Affairs. 
(2) MANNER
OF
CARE.—The Chief Business 
Office shall work in consultation with the Office of 
Clinical Operations and Management of the Depart-
ment of Veterans Affairs to ensure that care and 
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services described in paragraph (1) are provided in 
a manner that is clinically appropriate and effective. 
(3) NO DELAY IN PAYMENT.—The transfer of 
authority under paragraph (1) shall be carried out 
in a manner that does not delay or impede any pay-
ment by the Department for hospital care, medical 
services, or other health care provided through a 
non-Department provider under the laws adminis-
tered by the Secretary. 
(b) BUDGETARY EFFECT.—The Secretary shall, for 
each fiscal year that begins after the date of the enact-
ment of this Act— 
(1) include in the budget for the Chief Business 
Office of the Veterans Health Administration 
amounts to pay for hospital care, medical services, 
and other health care provided through non-Depart-
ment providers, including any amounts necessary to 
carry out the transfer of authority to pay for such 
care and services under subsection (a), including any 
increase in staff; and 
(2) not include in the budget of each Veterans 
Integrated Service Network and medical center of 
the Department amounts to pay for such care and 
services. 
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SEC. 303. ENHANCEMENT OF COLLABORATION BETWEEN 
DEPARTMENT OF VETERANS AFFAIRS AND 
INDIAN HEALTH SERVICE. 
(a) OUTREACH TO TRIBAL-RUN MEDICAL FACILI-
TIES.—The Secretary of Veterans Affairs shall, in con-
sultation with the Director of the Indian Health Service, 
conduct outreach to each medical facility operated by an 
Indian tribe or tribal organization through a contract or 
compact with the Indian Health Service under the Indian 
Self-Determination and Education Assistance Act (25 
U.S.C. 450 et seq.) to raise awareness of the ability of 
such facilities, Indian tribes, and tribal organizations to 
enter into agreements with the Department of Veterans 
Affairs under which the Secretary reimburses such facili-
ties, Indian tribes, or tribal organizations, as the case may 
be, for health care provided to veterans eligible for health 
care at such facilities. 
(b) METRICS
FOR
MEMORANDUM
OF
UNDER-
STANDING PERFORMANCE.—The Secretary of Veterans 
Affairs shall implement performance metrics for assessing 
the performance by the Department of Veterans Affairs 
and the Indian Health Service under the memorandum of 
understanding entitled ‘‘Memorandum of Understanding 
between the Department of Veterans Affairs (VA) and the 
Indian Health Service (IHS)’’ in increasing access to 
health care, improving quality and coordination of health 
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care, promoting effective patient-centered collaboration 
and partnerships between the Department and the Serv-
ice, and ensuring health-promotion and disease-prevention 
services are appropriately funded and available for bene-
ficiaries under both health care systems. 
(c) REPORT.—Not later than 180 days after the date 
of the enactment of this Act, the Secretary of Veterans 
Affairs and the Director of the Indian Health Service shall 
jointly submit to Congress a report on the feasibility and 
advisability of the following: 
(1) Entering into agreements for the reimburse-
ment by the Secretary of the costs of direct care 
services provided through organizations receiving 
amounts pursuant to grants made or contracts en-
tered into under section 503 of the Indian Health 
Care Improvement Act (25 U.S.C. 1653) to veterans 
who are otherwise eligible to receive health care from 
such organizations. 
(2) Including the reimbursement of the costs of 
direct care services provided to veterans who are not 
Indians in agreements between the Department and 
the following: 
(A) The Indian Health Service. 
(B) An Indian tribe or tribal organization 
operating a medical facility through a contract 
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or compact with the Indian Health Service 
under the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450 et seq.). 
(C) A medical facility of the Indian Health 
Service. 
(d) DEFINITIONS.—In this section: 
(1) INDIAN.—The terms ‘‘Indian’’ and ‘‘Indian 
tribe’’ have the meanings given those terms in sec-
tion 4 of the Indian Health Care Improvement Act 
(25 U.S.C. 1603). 
(2) 
MEDICAL
FACILITY
OF
THE
INDIAN 
HEALTH
SERVICE.—The term ‘‘medical facility of 
the Indian Health Service’’ includes a facility oper-
ated by an Indian tribe or tribal organization 
through a contract or compact with the Indian 
Health Service under the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450 et 
seq.). 
(3) TRIBAL ORGANIZATION.—The term ‘‘tribal 
organization’’ has the meaning given the term in 
section 4 of the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450b). 
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