II 113th CONGRESS 1st Session S. 1604 IN THE SENATE OF THE UNITED STATES October 29, 2013 Mr. Sanders introduced the following bill; which was read twice and referred to the Committee on Veterans' Affairs A BILL To amend title 38, United States Code, to expand and enhance eligibility for health care and services through the Department of Veterans Affairs, and for other purposes.

1. Short title This Act may be cited as the Veterans Health Care Eligibility Expansion and Enhancement Act of 2013 . 2. Enhancement of nature of eligibility for care of certain veterans Section 1710(a)(3) of title 38, United States Code, is amended by striking may, to the extent resources and facilities are available and and inserting shall, . 3. Requirement for enrollment in patient enrollment system of Department of Veterans Affairs of certain veterans eligible for enrollment by law but not currently permitted to enroll (a) Requirement for enrollment Section 1705 of title 38, United States Code, is amended by adding at the end the following new subsection: (d) (1) The Secretary shall provide for the enrollment in the patient enrollment system of veterans specified in paragraph (2) by not later than December 31, 2014. (2) Veterans specified in this paragraph are as follows: (A) Veterans with noncompensable service-connected disabilities rated as zero percent disabling who— (i) are not otherwise permitted to enroll in the system as of the date of the enactment of the Veterans Health Care Eligibility Expansion and Enhancement Act of 2013; and (ii) as of the date of enrollment under this section, do not have access to health insurance except through a health exchange established pursuant to section 1311 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18031 ). (B) Veterans without service-connected disability who— (i) are not otherwise permitted to enroll in the system as of the date of the enactment of the Veterans Health Care Eligibility Expansion and Enhancement Act of 2013; and (ii) as of the date of enrollment under this section, do not have access to health insurance except through a health exchange established pursuant to section 1311 of the Patient Protection and Affordable Care Act. (3) The Secretary shall determine whether a veteran does not have access to health insurance except through a health exchange for purposes of paragraph (2) using information obtained by the Secretary of Health and Human Services and the Secretary of the Treasury for purposes of determining whether the veteran maintains minimum essential coverage as required by section 5000A of the Internal Revenue Code of 1986 and reported as required by section 6055 of the Internal Revenue Code of 1986. (4) A veteran who, after enrolling in the patient enrollment system pursuant to this subsection, obtains access to health insurance other than through a health exchange shall remain enrolled in the patient enrollment system notwithstanding obtaining access to such health insurance. (5) A veteran enrolled in the patient enrollment system pursuant to this subsection shall maintain the priority for care of the veteran at the time of enrollment unless and until a change in circumstances of the veteran results in a higher priority for care of the veteran under subsection (a). . (b) Public notice of commencement of enrollment The Secretary of Veterans Affairs shall publish in the Federal Register, and shall make available to the public on an Internet website of the Department of Veterans Affairs, a notice regarding the date on which veterans covered by subsection (d) of section 1705 of title 38, United States Code (as added by subsection (a) of this section), may commence enrollment in the patient enrollment system required by that section. 4. Further extension of period of eligibility for health care for veterans of combat service during certain periods of hostilities and war Section 1710(e)(3) of title 38, United States Code, is amended— (1) in subparagraph (A), by striking the date that is five years before the date of the enactment of the National Defense Authorization Act for Fiscal Year 2008, after a period of five years and inserting January 27, 2003, after a period of 10 years ; and (2) in subparagraph (B), by striking more than five years and all that follows and inserting before January 28, 2003, and who did not enroll in the patient enrollment system under section 1705 of this title before January 28, 2008, after January 27, 2018. . 5. Relocation and restatement of limitation on requirements to furnish certain care and services contingent on the availability of appropriations (a) Relocation and restatement Section 1707 of title 38, United States Code, is amended by adding at the end the following new subsection: (c) (1) The requirements specified in paragraph (2) shall be effective in any fiscal year only to the extent and in the amount provided in advance in appropriations Acts for such purposes. (2) The requirements specified in this paragraph are as follows: (A) The requirement in paragraphs (1), (2), and (3) of section 1710(a) of this title that the Secretary provide hospital care and medical services. (B) The requirement in section 1710A(a) of this title that the Secretary provide nursing home care. (C) The requirement in section 1710B of this title that the Secretary provide a program of extended care services. (D) The requirement in section 1745 of this title that the Secretary provide nursing home care and prescription medicines to veterans with service-connected disabilities in State homes. . (b) Conforming repeal of superseded limitation Section 1710(a) of such title is amended— (1) by striking paragraph (4); and (2) by redesignating paragraph (5) as paragraph (4). 6. Modification of determination of eligibility of veterans for treatment as a low-income family for purposes of enrollment in the patient enrollment system of the Department of Veterans Affairs (a) Areas of residence The Secretary of Veterans Affairs shall modify the areas in which veterans reside as specified for purposes of determining whether veterans qualify for treatment as low-income families for enrollment in the patient enrollment system of the Department of Veterans Affairs under section 1705(a)(7) of title 38, United States Code, to meet the requirements as follows: (1) Any area so specified shall be within only one State. (2) Any area so specified shall be co-extensive with one or more counties (or similar political subdivisions) in the State concerned. (b) Variable income thresholds The Secretary shall modify the thresholds for income as specified for purposes of determining whether veterans qualify for treatment as low-income families for enrollment in the patient enrollment system referred to in subsection (a) to meet the requirements as follows: (1) There shall be one income threshold for each State, equal to the highest income threshold among the counties within such State. (2) The calculation of the highest income threshold of a county shall be consistent with the calculation used for purposes of section 3(b) of the United States Housing Act of 1937 ( 42 U.S.C. 1437a(b) ). (3) The timing and methodology for implementing any modifications in geographic income thresholds pursuant to paragraph (1) shall be determined by the Secretary in such a manner as to permit the Department to build capacity for enrolling such additional veterans in the patient enrollment system of the Department as become eligible for enrollment as a result of such modifications, except that all required modifications shall be completed not later than five years after date of the enactment of this Act. 7. Contracting for health care (a) Use of capitation-Based resource allocation in entry into contracts In entering into contracts for the furnishing of health care services under the laws administered by the Secretary of Veterans Affairs (including under this Act and the amendments made by this Act), the Secretary shall use the capitation-based resource allocation model of the Department of Veterans Affairs. (b) Priority for contracts with certain entities In entering into contracts for the furnishing of health care services under the laws administered by the Secretary, the Secretary shall afford a priority for entry into contracts for Federally Qualified Health Centers (FQHCs) and Community Health Centers (CHCs), whenever appropriate. (c) Best practices The Secretary shall modify the guidance of the Department of Veterans Affairs on contracts for health care services in order to provide for the incorporation into such contracts of standardized requirements for such best practices under such contracts, including the following: (1) Requirements that contracts provide the Department on a regular basis information on scheduling and appearance for appointments for health care on a per-patient basis. (2) Such other best practices requirements as the Secretary considers appropriate.