I 
108TH CONGRESS 
1ST SESSION H. R. 2475
To amend title 38, United States Code, to provide an enhanced funding 
process to ensure an adequate level of funding for veterans health care 
programs of the Department of Veterans Affairs, to establish standards 
of access to care for veterans seeking health care from the Department 
of Veterans Affairs, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 16, 2003
Mr. SMITH of New Jersey (for himself, Mr. SIMMONS, Mr. BROWN of South 
Carolina, Mr. BAKER, Mr. MILLER of Florida, Mr. BOOZMAN, Mr. BRAD-
LEY of New Hampshire, Ms. GINNY BROWN-WAITE of Florida, Mr. 
RENZI, Mr. MURPHY, Mr. GIBBONS, Mr. TOM DAVIS of Virginia, Mr. 
GOSS, Mr. LAHOOD, Mr. HEFLEY, Mr. JONES of North Carolina, Mr. 
PICKERING, Mr. PALLONE, Mr. GILLMOR, Mr. PEARCE, Mr. LOBIONDO, 
Mrs. JO ANN DAVIS of Virginia, Mr. TERRY, Mrs. KELLY, Mr. ISSA, 
Mrs. CAPITO, Mr. VITTER, Mr. CALVERT, Mr. JENKINS, Mr. GILCHREST, 
Mr. PAUL, Mr. KING of New York, Mr. HOUGHTON, Mr. PLATTS, Ms. 
HART, Mr. WILSON of South Carolina, Mr. WHITFIELD, Mr. HAYES, and 
Mr. SAXTON) introduced the following bill; which was referred to the 
Committee on Veterans’ Affairs 
A BILL 
To amend title 38, United States Code, to provide an en-
hanced funding process to ensure an adequate level of 
funding for veterans health care programs of the Depart-
ment of Veterans Affairs, to establish standards of access 
to care for veterans seeking health care from the Depart-
ment 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. 
This Act may be cited as the ‘‘Veterans Health Care 
Full Funding Act’’. 
SEC. 2. ENHANCED PROCESS FOR FUNDING VETERANS 
HEALTH CARE PROGRAMS. 
(a) IN GENERAL.—(1) Chapter 3 of title 38, United 
States Code, is amended by adding at the end the fol-
lowing new section: 
‘‘§ 320. Enhanced funding process for veterans health 
care 
‘‘(a) In the President’s budget for each fiscal year 
transmitted under section 1105 of title 31, amounts shall 
be requested for veterans health care programs in accord-
ance with this section. Amounts appropriated for veterans 
health care programs shall be available for obligation for 
a period of two consecutive fiscal years. 
‘‘(b)(1) For each fiscal year (beginning with fiscal 
year 2005), the Veterans Health Care Funding Review 
Board shall determine the level of funding needed for vet-
erans health care programs for that fiscal year and the 
next fiscal year. The Board shall make such determina-
tion, and shall publish such determination in the Federal 
Register, not later than November 1 of the year preceding
the year in which the budget for such fiscal year is trans-
mitted to Congress. 
‘‘(2) In making any such determination under para-
graph (1), the Board shall take into consideration the 
most recent information relating to economic assumptions 
provided to the Board by the Director of the Office of 
Management and Budget pursuant to subsection (f)(4)(b). 
‘‘(c) The amount determined under subsection (b) for 
any two-fiscal-year period is the amount needed to be ap-
propriated to the Department for that two-fiscal-year pe-
riod for veterans health care programs. The President 
shall include the full amount so determined in the budget 
transmitted to Congress under section 1105 of title 31 for 
the first fiscal year in such two-year period and shall in-
clude the amount of the second fiscal year as a budget 
forecast year. 
‘‘(d)(1) The Board shall make its determination of 
the level of funding needed for veterans health care pro-
grams for any two-fiscal-year period under subsection (b) 
based upon an annual review of those programs and of 
veterans health care needs. 
‘‘(2) The Board shall ensure that its determination 
of the level of funding needed for veterans health care pro-
grams for any period is in an amount sufficient to provide 
for—
‘‘(A) the health care needs of veterans esti-
mated to be enrolled in the Department health care 
system under section 1705(a) of this title (other 
than veterans described in paragraph (8) of such 
section); 
‘‘(B) the health care needs of veterans with 
service-connected disabilities who are not required to 
enroll in such health care system; 
‘‘(C) timely access to health care under stand-
ards for access prescribed under section 1703(d)(1) 
of this title; 
‘‘(D) maintenance of capacities of Department 
nursing home facilities as required by section 
1710B(b) of this title and of specialized programs as 
required by section 1706(b)(1) of this title; 
‘‘(E) the health care needs of persons eligible 
for benefits under chapter 17 of this title based 
upon subchapter VIII of that chapter; 
‘‘(F) the necessary maintenance, improvement, 
upgrading, expanding, repairing, and replacing of 
major and minor medical facilities, capital equip-
ment, and systems to ensure that health care facili-
ties of the Department are adequate for the pur-
poses of programs and benefits authorized for the 
care of veterans under chapter 17 of this title; and
‘‘(G) unanticipated requirements, including—
‘‘(i) changes in benefits; 
‘‘(ii) changes in beneficiaries; 
‘‘(iii) changes in economic conditions or as-
sumptions; and 
‘‘(iv) such other factors as the Board con-
siders appropriate. 
‘‘(3) Each such review under paragraph (1) shall con-
sider—
‘‘(A) demographic information; 
‘‘(B) utilization and cost trends for veterans en-
rolled under section 1705 of this title and other De-
partment health-care beneficiaries; 
‘‘(C) requirements for support of other core 
missions of the Department related to health care; 
‘‘(D) the degree of efficiency (or the lack of ef-
ficiency) by which the Secretary actually delivers 
health care services to veterans; and 
‘‘(E) such other factors as the Board considers 
appropriate. 
‘‘(4)(A) The Board shall submit to Congress an an-
nual report, not later than the date on which the President 
transmits the budget to Congress under section 1105 of 
title 31 each year, on its most recent determination under
subsection (b) and its most recent review under paragraph 
(1). 
‘‘(B) The report shall include the following: 
‘‘(i) A statement of the amount determined for 
each of the two fiscal years covered by such deter-
mination under subsection (b). 
‘‘(ii) A description of the economic assumptions 
and other assumptions made by the Board in mak-
ing such determination and how that determination 
was developed. 
‘‘(iii) Any recommendations to Congress or the 
Secretary that the Board considers appropriate con-
cerning the means and methods for the Secretary to 
achieve optimal efficiencies or savings in delivering 
health care to veterans. 
‘‘(5) Following the submission of the report under 
paragraph (4) each year, the Board shall review and re-
consider the matters contained in the report and shall, 
during the five-day period ending on May 1 of that year, 
submit to Congress a report updating the matters in the 
report submitted under paragraph (4). The Board shall 
include in that report any revision it considers appropriate 
to its most recent determination under subsection (b), to-
gether with the reasons for any such revision.
‘‘(e) For purposes of this section, the term ‘veterans 
health care programs’ means programs, functions, and ac-
tivities of the Veterans Health Administration other 
than—
‘‘(1) medical and prosthetic research; and 
‘‘(2) grants under subchapter III of chapter 81 
of this title. 
‘‘(f)(1) There is established in the Department of 
Veterans Affairs a Veterans Health Care Funding Review 
Board. The Board shall consist of three members who 
shall be appointed by the Secretary. Persons appointed to 
the Board shall have professional backgrounds and experi-
ence in health care policy analysis, health care statistics, 
health care insurance, or health care economics or have 
similar qualifications considered suitable by the Secretary. 
‘‘(2)(A) Except as provided in subparagraph (B), the 
members of the Board shall serve for a term of 15 years, 
except that a member of the Board appointed to fill a va-
cancy occurring before the end of the term for which the 
member’s predecessor was appointed shall only serve until 
the end of such term. A member may serve after the end 
of the term of the member until the successor of that 
member has taken office. A member of the Board may 
be removed by the Secretary for misconduct or failure to
perform functions vested in the Board, and for no other 
reason. 
‘‘(B) Of the members of the Board who are first ap-
pointed under this paragraph, one each shall be appointed 
for terms ending five, ten, and 15 years, respectively, after 
the date of appointment, as designated by the Secretary 
at the time of appointment. 
‘‘(3) A member of the Board who is not otherwise 
an employee of the United States is entitled to receive pay 
at the daily equivalent of the annual rate of basic pay of 
the highest rate of basic pay under the General Schedule 
of subchapter III of chapter 53 of title 5, for each day 
the member is engaged in the performance of duties vested 
in the Board, and is entitled to travel expenses, including 
a per diem allowance, in accordance with section 5703 of 
title 5. 
‘‘(4)(A) The Secretary shall furnish the Board all pa-
pers, records, information, and other materials it requires 
in order to carry out its functions under this section. 
‘‘(B) The Director of the Office of Management and 
Budget shall furnish to the Board complete information 
on the economic assumptions (including assumptions as 
to inflation, unemployment, revenues and expenses, and 
energy costs) that inform or guide the President’s overall 
budgetary presentation to Congress, including those as-
sumptions that would be expected to particularly affect 
health care costs in the Department, or the cost of care 
to veterans. 
‘‘(5) Funds for the expenses of the Board for any 
fiscal year shall be provided from amounts available for 
that fiscal year for veterans health care programs. The 
Board shall include consideration of its own budget re-
quirements in determinations under subsection (b).’’. 
(2) The table of sections at the beginning of such 
chapter is amended by adding at the end the following 
new item:
‘‘320. Enhanced funding process for veterans health care.’’.
(b) EFFECTIVE DATE.—Sections 320 of title 38, 
United States Code, as added by subsection (a), shall take 
effect on January 1, 2004. 
(c) REPEAL OF CONSTRUCTION AUTHORIZATION RE-
QUIREMENT.—Effective October 1, 2004, subsections (a), 
(b), (c), and (d) of section 8104 of title 38, United States 
Code, are repealed. 
(d) APPOINTMENT
OF
INITIAL
MEMBERS
OF 
BOARD.—The initial appointment of the members of the 
Board established under subsection (f) of section 320 of 
title 38, United States Code, as added by subsection (a), 
shall be completed not later than 90 days after the date 
of the enactment of this Act.
(e) INITIAL FUNDING FOR BOARD.—For fiscal year 
2004, the Secretary of Veterans Affairs shall provide 
amounts needed for the operation of the Board established 
under subsection (f) of section 320 of title 38, United 
States Code, as added by subsection (a), in a total amount 
not to exceed $2,000,000, from amounts appropriated to 
the Department of Veterans Affairs for that fiscal year 
for Medical Care. 
SEC. 3. ACCESS TO CARE STANDARDS. 
(a) REQUIRED STANDARD FOR ACCESS TO CARE.—
Section 1703 of title 38, United States Code, is amended 
by adding at the end the following new subsection: 
‘‘(d)(1) The following are the standards for access to 
care for the Department: 
‘‘(A) For a veteran seeking primary care, the 
standard for access is 30 days, determined from the 
date on which the veteran contacts the Department 
seeking an appointment until the date on which a 
visit with a primary care provider is completed. 
‘‘(B) For a veteran seeking specialized care, the 
standard for access is 30 days, determined from the 
date on which the veteran is referred for specialty 
care by a primary care provider until the date on 
which a visit with an appropriate specialty primary 
care provider is completed.
‘‘(2) The Secretary shall develop and disseminate an 
appropriate standard of waiting time, determined from the 
time at which the veteran’s visit is scheduled until the vet-
eran is seen by the provider. The Secretary shall periodi-
cally review performance of Department facilities com-
pared to that standard. The Secretary shall annually re-
port to the Committees on Veterans’ Affairs of the Senate 
and House of Representatives an assessment of the De-
partment’s performance against that standard. 
‘‘(3) In a case in which the Secretary is unable to 
meet the standard for access to care, the Secretary shall 
use the authority of subsection (a) to furnish health care 
and services for that veteran in a non-Department facil-
ity.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect on the first day of the first 
month beginning more than six months after the date of 
the enactment of this Act.
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