H.R. 3230

Veterans’ Access to Care through Choice, Accountability, and Transparency Act of 2014

Date
July 30, 2014 (113th Congress, 2nd Session)

Staff Contact
Emily Leviner

Floor Situation

On Wednesday, July 30, 2014, the House will consider the Conference Report to Accompany H.R. 3230, the Veterans’ Access to Care through Choice, Accountability, and Transparency Act of 2014, under a suspension of the rules.  House and Senate conferees unanimously adopted the Conference Report, which was filed on July 28, 2014.[1]

On June 18, 2014, the House passed H.Res. 628, which included a Motion to go to Conference on the Senate Amendments to H.R. 3230 by a vote of 244-163.[2] The House’s proposed legislative text combined H.R. 4810 and H.R. 4031, both previously passed by the House.[3]

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[1] House Committee Report 113-564.
[2] Roll Call #315
[3] H.R. 4810 required the Secretary to provide non-VA care to veterans who had faced extensive wait times or live more than 40 miles from a VA medical facility. This authority terminated after 2 years. The bill required the Secretary to contract with private sector experts to conduct an assessment of the hospital care and medical services provided by the VA, and eliminated bonuses and performance awards for all VA employees for fiscal years 2014-2016.  H.R. 4031 generally gave the Secretary authority to remove an employee of the Senior Executive Service if the Secretary determined that the employee’s performance warrants removal.

Bill Summary

The Conference Report to Accompany H.R. 3230 contains the text agreed upon by House and Senate conferees.  The Joint Explanatory Statement of the Committee of the Conference explains the differences between the House language, the Senate language, and the language produced in the conference report.  The following summary of the Conference Report was provided by the House Veterans’ Affairs Committee:

To improve access to and quality of care for veterans, the bill would:

  • Require VA to offer an authorization to receive non-VA care to any veteran who is enrolled in the VA health care system as of August 1, 2014, or who is a newly discharged combat veteran if such veteran is unable to secure an appointment at a VA medical facility within 30 days (or a future published goal established by VA) or resides more than 40 miles from the nearest VA medical facility, with certain exceptions.
    • Require VA to provide a Veterans Choice Card to eligible veterans to facilitate care provided by non-VA providers.
    • Provide $10 billion for the newly-established “Veterans Choice Fund” to cover the costs of this increased access to non-VA care. Choice program authority would end when funds are exhausted or three years after enactment, whichever occurs first.
  • Require an independent assessment of VA medical care and establish a Congressional Commission on Care to evaluate access to care throughout the VA health care system.
  • Extend the ARCH (Access Received Closer to Home) pilot program for two years.
  • Extend for three years a pilot program to provide rehabilitation, quality of life, and community integration services to veterans with complex-mild to severe traumatic brain injury.
  • Improve the delivery of care to veterans who have experienced military sexual trauma as well as care for Native Hawaiian and Native American veterans.

To expand VA’s internal capacity to provide timely care to veterans, the bill would:

  • Provide $5 billion to VA to increase access to care through the hiring of physicians and other medical staff and by improving VA’s physical infrastructure.
  • Authorize 27 major medical facility leases in 18 states and Puerto Rico.

To provide real accountability for incompetent or corrupt senior managers, the bill would:

  • Authorize VA to fire or demote Senior Executive Service (SES) employees and Title 38 SES equivalent employees for poor performance or misconduct.
    • Provide an expedited and limited appeal process for employees disciplined under this authority. Appeals would go to a Merit Systems Protection Board administrative judge, who would have 21 days to decide on the appeal. If a decision is not reached within that 21-day period, then VA’s decision to remove or demote the executive is final.
    • Prohibit SES employees from receiving pay, bonuses and benefits during the appeal process.
  • Reduce funding for bonuses available to VA employees by $40 million each year through FY 2024.

To improve education benefits for veterans and dependents, the bill would:

  • Require public colleges to provide in-state tuition to veterans and eligible dependents in order for the school to remain eligible to receive G.I. Bill education payments.
  • Expand the Sgt. Fry Scholarship Program to provide full Post 9/11 G.I. Bill benefits to spouses of servicemembers who died in the line of duty after 9/11.

Background

Recent media reports have highlighted severe mismanagement and a lack of accountability across the VA.  Reports of preventable veteran deaths, “secret” waiting lists intended to conceal the lengthy wait times for patients, and an increased claims backlog have corresponded with bonuses and positive performance reviews for VA management.  According to recent findings, “the [VA] paid more than $380,000 in case bonuses to top executives at 38 hospitals that are under investigation for falsifying wait times . . . or where there have been long delays.”[4]  An investigation by the House Committee on Veterans’ Affairs raised allegations of delayed care and preventable veteran deaths at the Phoenix Health Care System, prompting a review by the VA Office of the Inspector General (OIG).[5]  The review has since been broadened to as many as over one hundred VA medical facilities,[6] and criminal investigations are now ongoing.[7]

An interim report released by the VA OIG on May 28, 2014 “confirmed that inappropriate scheduling practices are systemic throughout the VHA.”[8]  At the Phoenix facility, the OIG identified 1,400 veterans who did not have a primary care appointment but were included on the electronic waiting list; however, an additional 1,700 who were waiting for an appointment were left off the list.[9]  In reviewing new patient wait times for primary care, the OIG found that the 226 veterans reviewed waited an average of 115 days for their first primary care appointment, with approximately 84% waiting more than 14 days.[10]  This contrasts to the VA’s own assessment of these 226 veterans, which showed they waited an average of 24 days for their first primary care appointment.[11]

The U.S. Office of Special Counsel (OSC) recently “reported that [although] the [VA] often admits to serious deficiencies,” it denies that veterans’ health was negatively impacted.[12]  In a letter to the VA, the OSC cited numerous instances in which the VA’s conduct unquestionably harmed veterans.  In one example, a “veteran with significant and chronic mental health issues did not receive his first comprehensive psychiatric evaluation until 2011, more than eight years after he was admitted.”[13]  In another case, a doctor at a VA facility in Alabama “copied prior provider notes in over 1,200 patient records, likely resulting in inaccurate health information being recorded.”[14]  VA cases represent more than one-fourth of the matters government-wide that have been referred to OSC for investigation.[15]

The Secretary presently has statutory authority to provide non-VA care “[w]hen Department facilities are not capable of furnishing economical hospital care or medical services because of geographical inaccessibility or are not capable of furnishing the care or services required.”[16]  Legislation enacted in 2008 directed the VA to establish Project Access Received Closer to Home (ARCH), a pilot program to provide enhanced access to non-VA care for veterans in highly rural areas.  In addition, the VA recently initiated the Patient-Centered Community Care (PC3) program by contracting with two private companies that will develop provider networks in six regions spanning the country.[17]  Authority also exists to provide for reimbursement for emergency treatment at non-VA facilities.[18]  However, non-VA care options “have been the exception and not the rule . . . particularly for primary care services.”[19]  In congressional testimony in September 2012, a VA official explained that the “VA views primary care as being its primary responsibility . . . and do[es] not think that this is an appropriate thing to be contracting for in the main.”[20]

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[4] House Veterans’ Affairs Committee: Miller Bill Would Give VA Secretary Complete Authority to Recoup Employee Bonuses (July 14, 2014).
[5] VA Office of the Inspector General, Veterans Health Administration – Interim Report: Review of Patient Wait Times, Scheduling Practices, and Alleged Patient Deaths at Phoenix Health Care System (May 28, 2014) at i.
[6] House Committee on Veterans’ Affairs.
[7] Testimony by the Honorable James B. Comey, Director of the Federal Bureau of Investigation, House Judiciary Committee Hearing: Oversight of the FBI (June 11, 2014).
[8] VA Office of Inspector General Interim Report at iii.
[9] Id.
[10] Id.
[11] Id.
[12] OSC Cites Deficiencies in VA Health Care Reports, U.S. Office of Special Counsel (June 23, 2014).
[13] Id.
[14] Id.
[15] Id.
[16] 38 U.S.C. §1703(a).
[17] Erin Bagalman, CRS Insights: Getting Health Care Outside the VA (May 30, 2014).
[18] See 38 U.S.C. §1725.
[19] CRS Insights: Getting Health Care Outside the VA.
[20] Id.

Cost

According to preliminary CBO estimates, implementing the bill would increase net mandatory spending by approximately $11-12 billion over a ten year period.

The total offsets in the Conference Report total roughly $5 billion, pending final CBO analysis.  A fact sheet prepared by the House Veterans’ Affairs Committee explaining the offsets is available here.

Additional Information

For questions or further information contact the GOP Conference at 5-5107.