[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3230 Engrossed Amendment House (EAH)]
In the House of Representatives, U. S.,
June 18, 2014.
Resolved, That the House agree to the amendment of the Senate to
the title of the bill (H.R. 3230) entitled ``An Act making continuing
appropriations during a Government shutdown to provide pay and
allowances to members of the reserve components of the Armed Forces who
perform inactive-duty training during such period.'' and be it further
Resolved, That the House agree to the amendment of the Senate to
the text of the aforementioned bill, with the following
HOUSE AMENDMENT TO SENATE AMENDMENT
In lieu of the matter proposed to be inserted by the
amendment of the Senate to the text of the bill, insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Veteran Access to Care Act of
2014''.
SEC. 2. PROVISION OF HOSPITAL CARE AND MEDICAL SERVICES AT NON-
DEPARTMENT OF VETERANS AFFAIRS FACILITIES FOR DEPARTMENT
OF VETERANS AFFAIRS PATIENTS WITH EXTENDED WAITING TIMES
FOR APPOINTMENTS AT DEPARTMENT FACILITIES.
(a) In General.--As authorized by section 1710 of title 38, United
States Code, the Secretary of Veterans Affairs (in this Act referred to
as the ``Secretary'') shall enter into contracts with such non-
Department facilities as may be necessary in order to furnish hospital
care and medical services to covered veterans who are eligible for such
care and services under chapter 17 of title 38, United States Code. To
the greatest extent possible, the Secretary shall carry out this
section using contracts entered into before the date of the enactment
of this Act.
(b) Covered Veterans.--For purposes of this section, the term
``covered veteran'' means a veteran--
(1) who is enrolled in the patient enrollment system under
section 1705 of title 38, United States Code;
(2) who--
(A) has waited longer than the wait-time goals of
the Veterans Health Administration (as of June 1, 2014)
for an appointment for hospital care or medical
services in a facility of the Department;
(B) has been notified by a facility of the
Department that an appointment for hospital care or
medical services is not available within such wait-time
goals; or
(C) resides more than 40 miles from the medical
facility of the Department of Veterans Affairs,
including a community-based outpatient clinic, that is
closest to the residence of the veteran; and
(3) who makes an election to receive such care or services
in a non-Department facility.
(c) Follow-Up Care.--In carrying out this section, the Secretary
shall ensure that, at the election of a covered veteran who receives
hospital care or medical services at a non-Department facility in an
episode of care under this section, the veteran receives such hospital
care and medical services at such non-Department facility through the
completion of the episode of care (but for a period not exceeding 60
days), including all specialty and ancillary services deemed necessary
as part of the treatment recommended in the course of such hospital
care or medical services.
(d) Report.--The Secretary shall submit to Congress a quarterly
report on hospital care and medical services furnished pursuant to this
section. Such report shall include information, for the quarter covered
by the report, regarding--
(1) the number of veterans who received care or services at
non-Department facilities pursuant to this section;
(2) the number of veterans who were eligible to receive
care or services pursuant to this section but who elected to
continue waiting for an appointment at a Department facility;
(3) the purchase methods used to provide the care and
services at non-Department facilities, including the rate of
payment for individual authorizations for such care and
services; and
(4) any other matters the Secretary determines appropriate.
(e) Definitions.--For purposes of this section, the terms
``facilities of the Department'', ``non-Department facilities'',
``hospital care'', and ``medical services'' have the meanings given
such terms in section 1701 of title 38, United States Code.
(f) Implementation.--The Secretary shall begin implementing this
section on the date of the enactment of this Act.
(g) Construction.--Nothing in this section shall be construed to
authorize payment for care or services not otherwise covered under
chapter 17 of title 38, United States Code.
(h) Termination.--The authority of the Secretary under this section
shall terminate with respect to any hospital care or medical services
furnished after the end of the 2-year period beginning on the date of
the enactment of this Act, except that in the case of an episode of
care for which hospital care or medical services is furnished in a non-
Department facility pursuant to this section before the end of such
period, such termination shall not apply to such care and services
furnished during the remainder of such episode of care but not to
exceed a period of 60 days.
SEC. 3. EXPANDED ACCESS TO HOSPITAL CARE AND MEDICAL SERVICES.
(a) In General.--To the extent that appropriations are available
for the Veterans Health Administration of the Department of Veterans
Affairs for medical services, to the extent that the Secretary of
Veterans Affairs is unable to provide access, within the wait-time
goals of the Veterans Health Administration (as of June 1, 2014), to
hospital care or medical services to a covered veteran who is eligible
for such care or services under chapter 17 of title 38, United States
Code, under contracts described in section 2, the Secretary shall
reimburse any non-Department facility with which the Secretary has not
entered into a contract to furnish hospital care or medical services
for furnishing such hospital care or medical services to such veteran,
if the veteran elects to receive such care or services from the non-
Department facility. The Secretary shall reimburse the facility for the
care or services furnished to the veteran at the greatest of the
following rates:
(1) VA payment rate.--The rate of reimbursement for such
care or services established by the Secretary of Veterans
Affairs.
(2) Medicare payment rate.--The payment rate for such care
or services or comparable care or services under the Medicare
program under title XVIII of the Social Security Act.
(3) TRICARE payment rate.--The reimbursement rate for such
care or services furnished to a member of the Armed Forces
under chapter 55 of title 10, United States Code.
(b) Covered Veterans.--For purposes of this section, the term
``covered veteran'' means a veteran--
(1) who is enrolled in the patient enrollment system under
section 1705 of title 38, United States Code; and
(2) who--
(A) has waited longer than the wait-time goals of
the Veterans Health Administration (as of June 1, 2014)
for an appointment for hospital care or medical
services in a facility of the Department;
(B) has been notified by a facility of the
Department that an appointment for hospital care or
medical services is not available within such wait-time
goals after the date for which the veteran requests the
appointment; or
(C) who resides more than 40 miles from the medical
facility of the Department of Veterans Affairs,
including a community-based outpatient clinic, that is
closest to the residence of the veteran.
(c) Definitions.--For purposes of this section, the terms
``facilities of the Department'', ``non-Department facilities'',
``hospital care'', and ``medical services'' have the meanings given
such terms in section 1701 of title 38, United States Code.
(d) Implementation.--The Secretary shall begin implementing this
section on the date of the enactment of this Act.
(e) Construction.--Nothing in this section shall be construed to
authorize payment for care or services not otherwise covered under
chapter 17 of title 38, United States Code.
(f) Termination.--The authority of the Secretary under this section
shall terminate with respect to care or services furnished after the
date that is 2 years after the date of the enactment of this Act.
SEC. 4. INDEPENDENT ASSESSMENT OF VETERANS HEALTH ADMINISTRATION
PERFORMANCE.
(a) Independent Assessment Required.--Not later than 120 days after
the date of the enactment of this Act, the Secretary of Veterans
Affairs shall enter into a contract or contracts with a private sector
entity or entities with experience in the delivery systems of the
Veterans Health Administration and the private sector and in health
care management to conduct an independent assessment of hospital care
and medical services furnished in medical facilities of the Department
of Veterans Affairs. Such assessment shall address each of the
following:
(1) The current and projected demographics and unique care
needs of the patient population served by the Department of
Veterans Affairs.
(2) The current and projected health care capabilities and
resources of the Department, including hospital care and
medical services furnished by non-Department facilities under
contract with the Department, to provide timely and accessible
care to eligible veterans.
(3) The authorities and mechanisms under which the
Secretary may furnish hospital care and medical services at
non-Department facilities, including an assessment of whether
the Secretary should have the authority to furnish such care
and services at such facilities through the completion of
episodes of care.
(4) The appropriate system-wide access standard applicable
to hospital care and medical services furnished by and through
the Department of Veterans Affairs and recommendations relating
to access standards specific to individual specialties and
standards for post-care rehabilitation.
(5) The current organization, processes, and tools used to
support clinical staffing and documentation.
(6) The staffing levels and productivity standards,
including a comparison with industry performance percentiles.
(7) Information technology strategies of the Veterans
Health Administration, including an identification of
technology weaknesses and opportunities, especially as they
apply to clinical documentation of hospital care and medical
services provided in non-Department facilities.
(8) Business processes of the Veterans Health
Administration, including non-Department care, insurance
identification, third-party revenue collection, and vendor
reimbursement.
(b) Assessment Outcomes.--The assessment conducted pursuant to
subsection (a) shall include the following:
(1) An identification of improvement areas outlined both
qualitatively and quantitatively, taking into consideration
Department of Veterans Affairs directives and industry
benchmarks from outside the Federal Government.
(2) Recommendations for how to address the improvement
areas identified under paragraph (1) relating to structure,
accountability, process changes, technology, and other relevant
drivers of performance.
(3) The business case associated with making the
improvements and recommendations identified in paragraphs (1)
and (2).
(4) Findings and supporting analysis on how credible
conclusions were established.
(c) Program Integrator.--If the Secretary enters into contracts
with more than one private sector entity under subsection (a), the
Secretary shall designate one such entity as the program integrator.
The program integrator shall be responsible for coordinating the
outcomes of the assessments conducted by the private entities pursuant
to such contracts.
(d) Submittal of Reports to Congress.--
(1) Report on independent assessment.--Not later than 10
months after entering into the contract under subsection (a),
the Secretary shall submit to the Committees on Veterans'
Affairs of the Senate and House of Representatives the findings
and recommendations of the independent assessment required by
such subsection.
(2) Report on va action plan to implement recommendations
in assessment.--Not later than 120 days after the date of
submission of the report under paragraph (1), the Secretary
shall submit to such Committees on the Secretary's response to
the findings of the assessment and shall include an action
plan, including a timeline, for fully implementing the
recommendations of the assessment.
SEC. 5. LIMITATION ON AWARDS AND BONUSES TO EMPLOYEES OF DEPARTMENT OF
VETERANS AFFAIRS.
For each of fiscal years 2014 through 2016, the Secretary of
Veterans Affairs may not pay awards or bonuses under chapter 45 or 53
of title 5, United States Code, or any other awards or bonuses
authorized under such title.
SEC. 6. OMB ESTIMATE OF BUDGETARY EFFECTS AND NEEDED TRANSFER
AUTHORITY.
Not later than 30 days after the date of the enactment of this Act,
the Director of the Office of Management and Budget shall transmit to
the Committees on Appropriations, the Budget, and Veterans' Affairs of
the House of Representatives and of the Senate--
(1) an estimate of the budgetary effects of sections 2 and
3;
(2) any transfer authority needed to utilize the savings
from section 5 to satisfy such budgetary effects; and
(3) if necessary, a request for any additional budgetary
resources, or transfers or reprogramming of existing budgetary
resources, necessary to provide funding for sections 2 and 3.
SEC. 7. 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:
``Sec. 713. Senior Executive Service: removal based on performance
``(a) In General.--Notwithstanding any other provision of law, the
Secretary may remove any individual from the Senior Executive Service
if the Secretary determines the performance of the individual warrants
such removal. If the Secretary so removes such an individual, the
Secretary may--
``(1) remove the individual from Federal service; or
``(2) transfer 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 paragraph (1), the
Secretary shall submit to the Committees on Veterans' Affairs of the
Senate and 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.''.
SEC. 8. BUDGETARY EFFECTS OF ACT.
The budgetary effects of this Act, for the purpose of complying
with the Statutory Pay-As-You-Go Act of 2010, shall be determined by
reference to the latest statement titled ``Budgetary Effects of PAYGO
Legislation'' for this Act, submitted for printing in the Congressional
Record by the Chairman of the House Budget Committee, provided that
such statement has been submitted prior to the vote on passage.
Attest:
Clerk.
113th CONGRESS
2d Session
H.R. 3230
_______________________________________________________________________
HOUSE AMENDMENT TO SENATE AMENDMENT