On Wednesday, June 18, 2014, the House will consider H.Res. 628, which includes a Motion to Concur in the Senate Amendments with a Further Amendment and Motion to go to Conference on Senate Amendments to H.R. 3230. The House previously passed legislation to address the systemic mismanagement and lack of accountability across the Veterans Health Administration. On May 21, 2014, the House passed H.R. 4031, the Department of Veterans Affairs Management Accountability Act of 2014, by a vote of 390-33.On June 6, 2014, the House passed H.R. 4810, the Veteran Access to Care Act of 2014, by a vote of 426-0.
The Senate subsequently passed the Veterans’ Access to Care through Choice, Accountability, and Transparency Act of 2014 by making it an amendment to H.R. 3230, an unrelated appropriations measure previously passed by the House. The bill passed the Senate by a vote of 93-3. A summary is available here.
The House amendment to the Senate amendment to H.R. 3230 (the House’s proposed language for the conference reconciliation) combines the texts of H.R. 4810 and H.R. 4031.
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. An investigation by the House Committee on Veterans’ Affairs raised allegations of delayed care and preventable veteran deaths at the Phoenix Health Care System that prompted a review by the VA Office of the Inspector General (OIG). The review has since been broadened to as many as sixty-nine VA medical facilities and criminal investigations are now ongoing.
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.
 House Committee on Veterans’ Affairs.
 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).
 VA Office of Inspector General Interim Report 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.
There is no cost associated with a motion to go to conference. CBO estimates that implementing sections 2 and 3 of the House amendment to the Senate amendment to H.R. 3230 would cost roughly $500 million in 2014, $16 billion in 2015, and $28 billion in 2016. The estimate does not include the costs of providing additional services after 2016.
CBO estimates that provision would increase direct spending by $620 million over the 2014-2016 period. CBO estimates that, in order to cover some of the costs of the bill, “section 3 would allow the use of funds that have already been appropriated but would otherwise not be used.”
For questions or further information contact the GOP Conference at 5-5107.