On Tuesday, June 10, 2014, the House will consider H.R. 4810, the Veteran Access to Care Act of 2014, under suspension of the rules. H.R. 4810 was introduced on Monday, June 9, 2014 by Rep. Jeff Miller (R-FL) and was referred to the House Veterans’ Affairs Committee.
H.R. 4810 directs the Secretary of Veterans Affairs (Secretary) to enter contracts with non-VA facilities to provide care to veterans who 1) have waited longer than the wait-time goals of the Veterans Health Administration (VHA); 2) have been notified that an appointment will not be available within the VHA wait-time goals; or 3) live more than forty miles from a VA medical facility. If the Secretary is not able to contract with a non-VA facility for the necessary services, he must reimburse the non-VA facility that provides the services at a certain rate. The Secretary must ensure that the care extends through the completion of all services needed by the patient, including specialty and ancillary services, for a period not to exceed sixty days. H.R. 4810 requires the Secretary to begin utilizing this authority immediately following the bill’s enactment. The authority terminates after two years. H.R. 4810 requires the Secretary to submit to Congress a quarterly report on hospital care and medical services provided pursuant to this authority.
H.R. 4810 requires that the Secretary, within 120 days of the bill’s enactment, contract with independent private sector experts to conduct an assessment of the hospital care and medical services furnished by the VA. The assessment must identify improvement areas and include recommendations for addressing such areas. Within ten months of contracting for the assessment, the Secretary must submit to Congress the findings and recommendations. No more than 120 days later, the Secretary must submit a response to the assessment and an action plan for fully implementing the recommendations.
H.R. 4810 eliminates bonuses and performance awards for all VA employees for fiscal years 2014-2016.
Within 30 days of the enactment of H.R. 4810 the Director of the Office of Budget and Management (OMB) must submit to Congress an estimate of the budgetary effects of the bill’s authority; any transfer authority needed to utilize the savings from eliminating bonuses and awards to satisfy such budgetary effects; and if necessary, a request for additional budgetary resources, or transfers or reprogramming of existing budgetary resources, needed to provide funding for the bill’s authority.
 The Secretary must reimburse the facility for the care or services furnished at the greatest of the following rates: 1) the rate for such care or services established by the VA; 2) the rate for comparable care under Medicare; or 3) the rate for comparable care under TRICARE.
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. Allegations of delayed care and preventable veteran deaths at the Phoenix Health Care System prompted a review by the VA Office of the Inspector General (OIG). The review has since been broadened to at least forty-two VA medical facilities.
An interim report released by the VA OIG on May 28, 2014 “confirmed that inappropriate scheduling practices are systemic throughout the VHA.” 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. 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 fourteen days. This contrasts to the VA’s own assessment of these 226 veterans, which showed they waited an average of twenty-four days for their first primary care appointment.
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.” 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. Authority also exists to provide for reimbursement for emergency treatment at non-VA facilities. However, non-VA care options “have been the exception and not the rule . . . particularly for primary care services.” 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.” H.R. 4810 addresses the VA’s refusal to use such authority by directing the Secretary to provide non-VA care to veterans who experience long wait times or live more than forty miles from a VA medical facility.
 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.
 Id. at ii.
 Id. at iii.
 38 U.S.C. §1703(a).
 Erin Bagalman, CRS Insights: Getting Health Care Outside the VA (May 30, 2014).
 See 38 U.S.C. §1725.
 CRS Insights: Getting Health Care Outside the VA.
A CBO cost estimate is not available at this time.
For questions or further information contact the GOP Conference at 5-5107.