II 113th CONGRESS 2d Session S. 2424 IN THE SENATE OF THE UNITED STATES June 3, 2014 Mr. McCain (for himself, Mr. Coburn , Mr. Burr , Mr. Flake , Mr. Isakson , Mr. Inhofe , Mr. Grassley , Mr. Roberts , Mr. Hoeven , Mr. Coats , Mr. Barrasso , Mr. Johanns , Mr. Rubio , Mr. Cornyn , Mr. Alexander , Mr. Kirk , Mr. Wicker , Mrs. Fischer , Mr. Portman , Mr. Toomey , Mr. Boozman , Mr. Moran , Mr. Thune , Mr. Scott , Mr. Enzi , and Mr. Graham ) introduced the following bill; which was read twice and referred to the Committee on Veterans' Affairs A BILL To provide veterans with the choice of medical providers and to increase transparency and accountability of operations of the Veterans Health Administration of the Department of Veterans Affairs, and for other purposes.

1. Short title This Act may be cited as the Veterans Choice Act of 2014 . 2. Expanded availability of hospital care and medical services for veterans through the use of contracts (a) Expansion of available care and services (1) In general Hospital care and medical services under chapter 17 of title 38, United States Code, shall be furnished to an eligible veteran described in subsection (b), at the election of such veteran, through contracts authorized under subsection (d), or any other law administered by the Secretary of Veterans Affairs, 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.) for the furnishing of such care and services to veterans. (2) Choice of provider An eligible veteran who elects to receive care and services under this section may select the provider of such care and services from among any source of provider of such care and services specified in paragraph (1) that is accessible to the veteran. (b) Eligible veterans A veteran is an eligible veteran for purposes of this section if— (1) (A) the veteran is enrolled in the patient enrollment system of the Department of Veterans Affairs 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 and medical services from the Department, and has contacted the Department seeking an initial appointment from the Department for the receipt of such care and services; and (2) the veteran either— (A) (i) attempts, or has attempted under paragraph (1)(B), to schedule an appointment for the receipt of such care and services but is unable to schedule an appointment within the current wait-time goals of the Veterans Health Administration for the delivery of such care and services; and (ii) elects, and is authorized, to be furnished such care or services pursuant to subsection (c)(2); or (B) resides more than 40 miles from the nearest medical facility of the Department, including a community-based outpatient clinic, that is closest to the residence of the veteran. (c) Election and authorization 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 current wait-time goals of the Department for the furnishing of such care or services, the Secretary shall, at the election of the eligible veteran— (1) place such eligible veteran on an electronic waiting list for such an appointment that is maintained by the Department and accessible to the veteran via www.myhealth.va.gov or any successor website; or (2) (A) authorize that such care and services be furnished to the eligible veteran under this section for a period of time specified by the Secretary; and (B) send a letter to the eligible veteran describing the care and services the eligible veteran is eligible to receive under this section. (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 contract under this subsection, the Secretary shall— (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 negotiated pursuant to clause (i) as provided in such contract. (B) Limit on rates Rates negotiated under subparagraph (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. (C) Limit on collection For the furnishing of care and services pursuant to a contract 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 procedures 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 authorized care and services furnished to eligible veterans under this section. (B) Access to a telephone hotline maintained by the Department that such health care provider may call for information on the following: (i) Procedures for furnishing care and services under this section. (ii) Procedures for submitting bills or claims for authorized care and services furnished to eligible veterans under this section and being reimbursed for furnishing such care and services. (iii) Whether particular care or services 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 provider 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 . (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 eligible veteran that is not the social security number of the eligible veteran. (C) The contact information of an appropriate office of the Department for health care providers to confirm that care and services under this section is authorized for the eligible veteran. (D) Contact information and other relevant 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 Department of Veterans Affairs. Please call the Department 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 Secretary shall provide the eligible veteran with information clearly stating the circumstances under which the veteran may be eligible for care and services 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 enrollment 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 medical 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 maintain at least the same or similar credentials and licenses as those credentials and licenses that are required of health care providers of the Department, as determined by the Secretary for purposes of this section. (h) Cost-Sharing The Secretary shall require an eligible veteran to pay a copayment to the Department for the receipt of care and services under this section only if the eligible veteran would be required to pay such copayment 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 services furnished to eligible veterans under this section. (2) Regulations Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall prescribe regulations for the implementation of the efficient nationwide system required by paragraph (1). (j) Continuity of medical records The Secretary shall ensure that medical records of veterans maintained by the Department are updated to accurately reflect any care and services furnished under this section. (k) Tracking of missed appointments The Secretary shall implement a mechanism to track any missed appointments for care and services under this section by eligible veterans to ensure that the Department does not pay for such care and services that were not furnished. (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. (m) Inspector General audit Not later than 540 days after the publication of the interim final regulations under subsection (l), the Inspector General of the Department shall conduct an audit of care and services furnished under this section to ensure the accuracy of payments by the Department for the cost of care and services furnished under this section. (n) Termination The requirement of the Secretary to furnish care and services under this section terminates on the date that is two years after the date on which the Secretary publishes the interim final regulations under subsection (l). (o) Reports Not less frequently than once every 90 days, the Secretary shall submit to Congress a report on the furnishing of care and services under this section that includes the following: (1) The number of veterans who have received care and services under this section during the 90-day period preceding the submittal of the report. (2) A description of the type of care and services furnished to veterans under this section during such 90-day period. 3. Sense of Congress on prompt payment by Department of Veterans Affairs It is the sense of Congress that the Secretary of Veterans Affairs shall comply with section 1315 of title 5, Code of Federal Regulations (commonly known as the prompt payment rule ), or any corresponding similar regulation or ruling, in paying for health care pursuant to contracts entered into with non-Department of Veterans Affairs providers to provide health care under the laws administered by the Secretary. 4. Improved performance metrics for health care provided by Department of Veterans Affairs (a) Prohibition on use of scheduling and wait-Time metrics in determination of performance awards The Secretary shall ensure that scheduling and wait-time metrics or goals are not used as factors in determining the performance of the following employees for purposes of determining whether to pay performance awards to such employees: (1) Directors, associate directors, assistant directors, deputy directors, chiefs of staff, and clinical leads of medical centers of the Department. (2) Directors, assistant directors, and quality management officers of Veterans Integrated Service Networks of the Department. (b) Modification of performance plans (1) In general Not later than 30 days after the date of the enactment of this Act, the Secretary shall modify the performance plans of the directors of the medical centers of the Department and the directors of the Veterans Integrated Service Networks to ensure that such plans are based on the quality of care received by veterans at the health care facilities under the jurisdictions of such directors. (2) Factors In modifying performance plans under paragraph (1), the Secretary shall ensure that assessment of the quality of care provided at health care facilities under the jurisdiction of a director described in paragraph (1) includes consideration of the following: (A) Recent reviews by the Joint Commission (formerly known as the Joint Commission on Accreditation of Healthcare Organizations ) of such facilities. (B) The number and nature of recommendations concerning such facilities by the Inspector General of the Department in reviews conducted through Combined Assessment Program (CAP) reviews, in the reviews by the Inspector General of community-based outpatient clinics and primary care clinics, and in reviews conducted through the Office of Healthcare Inspections during the two most recently completed fiscal years. (C) The number of recommendations described in subparagraph (B) that the Inspector General of the Department determines have not been carried out satisfactorily with respect to such facilities. (D) Reviews of such facilities by the Commission on Accreditation of Rehabilitation Facilities. (E) The number and outcomes of administrative investigation boards, root cause analysis, and peer reviews conducted at such facilities during the fiscal year for which the assessment is being conducted. (F) The effectiveness of any remedial actions or plans resulting from any Inspector General recommendations in the reviews and analyses described in subparagraphs (A) through (E). (3) Additional leadership positions To the degree practicable, the Secretary shall assess the performance of other employees of the Department in leadership positions at Department medical centers, including associate directors, assistant directors, deputy directors, chiefs of staff, and clinical leads, and in Veterans Integrated Service Networks, including assistant directors and quality management officers, using factors and criteria similar to those used in the performance plans modified under paragraph (1). 5. Improved transparency concerning health care provided by Department of Veterans Affairs (a) Publication of wait times (1) Goals (A) Initial Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall publish in the Federal Register, and on an Internet website accessible to the public of each medical center of the Department of Veterans Affairs, the wait-time goals of the Department for the scheduling of an appointment by a veteran for the receipt of health care from the Department. (B) Subsequent changes (i) In general If the Secretary modifies the wait-time goals described in subparagraph (A), the Secretary shall publish the new wait-time goals— (I) on an Internet website accessible to the public of each medical center of the Department not later than 30 days after such modification; and (II) in the Federal Register not later than 90 days after such modification. (ii) Effective date Any modification under clause (i) shall take effect on the date of publication in the Federal Register. (C) Goals described Wait-time goals published under this paragraph shall include goals for primary care appointments, specialty care appointments, and goals for such appointments based on the general severity of the condition of the veteran. (2) Wait times at medical centers of the Department Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall publish on an Internet website accessible to the public of each medical center of the Department the current wait time for an appointment for primary care and specialty care at the medical center. (b) Publicly available database of patient safety, quality of care, and outcome measures (1) In general Not later than 180 days after the date of the enactment of this Act, the Secretary shall develop and make available to the public a comprehensive database containing all applicable patient safety, quality of care, and outcome measures for health care provided by the Department that are tracked by the Secretary. (2) Update frequency The Secretary shall update the database required by paragraph (1) not less frequently than once each year. (3) Unavailable measures For all measures that the Secretary would otherwise publish in the database required by paragraph (1) but has not done so because such measures are not available, the Secretary shall publish notice in the database of the reason for such unavailability and a timeline for making such measures available in the database. (4) Accessibility The Secretary shall ensure that the database required by paragraph (1) is accessible to the public through the primary Internet website of the Department and through each primary Internet website of a Department medical center. (c) Hospital Compare website of Department of Health and Human Services (1) Agreement required Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall enter into an agreement with the Secretary of Health and Human Services for the provision by the Secretary of Veterans Affairs of such information as the Secretary of Health and Human Services may require to report and make publicly available patient quality and outcome information concerning Department of Veterans Affairs medical centers through the Hospital Compare Internet website of the Department of Health and Human Services or any successor Internet website. (2) Information provided The information provided by the Secretary of Veterans Affairs to the Secretary of Health and Human Services under paragraph (1) shall include the following: (A) Measures of timely and effective health care. (B) Measures of readmissions, complications of death, including with respect to 30-day mortality rates and 30-day readmission rates, surgical complication measures, and health care related infection measures. (C) Survey data of patient experiences, including the Hospital Consumer Assessment of Healthcare Providers and Systems or any similar successor survey developed by the Department of Health and Human Services. (D) Any other measures required of or reported with respect to hospitals participating in the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.). (3) Unavailable information For any applicable metric collected by the Department of Veterans Affairs or required to be provided under paragraph (2) and withheld from or unavailable in the Hospital Compare Internet website, the Secretary of Veterans Affairs shall publish a notice in the Federal Register stating the reason why such metric was withheld from public disclosure and a timeline for making such metric available, if applicable. (d) Comptroller General review of publicly available safety and quality metrics Not later than three years after the date of the enactment of this Act, the Comptroller General of the United States shall conduct a review of the safety and quality metrics made publicly available by the Secretary of Veterans Affairs under this section to assess the degree to which the Secretary is complying with the provisions of this section. 6. Information for veterans on the credentials of Department of Veterans Affairs physicians (a) Improvement of Our Providers Internet website links (1) Availability through Department of Veterans Affairs homepage A link to the Our Providers health care providers database of the Department of Veterans Affairs, or any successor database, shall be available on and through the homepage of the Internet website of the Department that is accessible to the public. (2) Information on location of residency training The Internet website of the Department that is accessible to the public shall include under the link to the Our Providers health care providers database of the Department, or any successor database, the location of residency training of each licensed physician of the Department. (3) Information on physicians at particular facilities The Our Providers health care providers database of the Department, or any successor database, shall identify whether each licensed physician of the Department is a physician in residency. (b) Information on credentials of physicians for veterans undergoing surgical procedures Each veteran who is undergoing a surgical procedure by or through the Department shall be provided, at such time in advance of the procedure as is appropriate to permit such veteran to evaluate such information, information on the credentials of the surgeon to be performing such procedure. (c) GAO report Not later than two years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a report setting forth an assessment by the Comptroller General of the following: (1) The manner in which contractors under the Patient-Centered Community Care initiative of the Department perform oversight of the credentials of physicians within the networks of such contractors under the initiative. (2) The oversight by the Department of the contracts under the Patient-Centered Community Care initiative. 7. Information in annual budget of the President on hospital care and medical services provided under section 2 The materials on the Department of Veterans Affairs in the budget of the President for a fiscal year, as submitted to Congress pursuant to section 1105(a) of title 31, United States Code, shall set forth the following: (1) The number of veterans who received hospital care and medical services under section 2 of this Act during the fiscal year preceding the fiscal year in which such budget is submitted. (2) The amount expended by the Department on furnishing care and services under such section during the fiscal year preceding the fiscal year in which such budget is submitted. (3) The amount requested in such budget for the costs of furnishing care and services under such section during the fiscal year covered by such budget, set forth in aggregate and by amounts for each account for which amounts are so requested. (4) The number of veterans that the Department estimates will receive hospital care and medical services under such section during the fiscal years covered by the budget submission. (5) The number of employees of the Department on paid administrative leave at any point during the fiscal year preceding the fiscal year in which such budget is submitted. 8. Prohibition on falsification of data concerning wait times and quality measures at Department of Veterans Affairs Not later than 60 days after the date of the enactment of this Act, and in accordance with title 5, United States Code, the Secretary of Veterans Affairs shall establish policies whereby any employee of the Department of Veterans Affairs who knowingly submits false data concerning wait times for health care or quality measures with respect to health care to another employee of the Department or knowingly requires another employee of the Department to submit false data concerning such wait times or quality measures to another employee of the Department is subject to a penalty the Secretary considers appropriate after notice and an opportunity for a hearing, including civil penalties, unpaid suspensions, or termination. 9. Removal of Senior Executive Service employees of the Department of Veterans Affairs for performance (a) In general Chapter 7 of title 38, United States Code, is amended by adding at the end the following new section: 713. Senior Executive Service: removal based on performance (a) In general (1) Notwithstanding subchapter V of chapter 35 of title 5, subchapter V of chapter 75 of title 5, or any other provision of law, the Secretary may remove any individual who is an employee of the Department from a Senior Executive Service position (as defined in section 3132(a) of title 5) if the Secretary determines the performance of the individual warrants such removal. (2) If the Secretary so removes such an individual, the Secretary may— (A) remove the individual from the civil service (as defined in section 2101 of title 5); or (B) appoint the individual to a General Schedule position at any grade of the General Schedule the Secretary determines appropriate. (b) Notice to Congress Not later than 30 days after removing an individual from the Senior Executive Service under subsection (a), the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives notice in writing of such removal and the reason for such removal. (c) Manner of removal A removal under this section shall be done in the same manner as the removal of a professional staff member employed by a Member of Congress. . (b) Clerical amendment The table of sections at the beginning of such chapter is amended by adding at the end the following new item: 713. Senior Executive Service: removal based on performance. .