[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4013 Reported in House (RH)]
Union Calendar No. 268
103d CONGRESS
2d Session
H. R. 4013
[Report No. 103-477]
_______________________________________________________________________
A BILL
To amend title 38, United States Code, to provide the Secretary of
Veterans Affairs with necessary flexibility in staffing the Veterans
Health Administration, to authorize the Secretary to establish pilot
programs for health care delivery, and for other purposes.
_______________________________________________________________________
April 14, 1994
Reported with amendments, committed to the Committee of the Whole House
on the State of the Union, and ordered to be printed
Union Calendar No. 268
103d CONGRESS
2d Session
H. R. 4013
[Report No. 103-477]
To amend title 38, United States Code, to provide the Secretary of
Veterans Affairs with necessary flexibility in staffing the Veterans
Health Administration, to authorize the Secretary to establish pilot
programs for health care delivery, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 11, 1994
Mr. Rowland (for himself, Mr. Montgomery, Mr. Stump, and Mr. Smith of
New Jersey) introduced the following bill; which was referred to the
Committee on Veterans' Affairs
April 14, 1994
Additional sponsors: Mr. Bishop, Mr. Kreidler, Mr. Williams, Ms. Brown
of Florida, Mr. Sanders, Mr. Sangmeister, Mr. Stearns, Mr. Hutchinson,
Mr. Bilirakis, Mr. Everett, Mr. Quinn, Mr. Hefner, Mr. Richardson, Mr.
Stenholm, Mr. Payne of Virginia, and Mr. Parker
April 14, 1994
Reported with amendments, committed to the Committee of the Whole House
on the State of the Union, and ordered to be printed
[Omit the part struck through and insert the part printed in italic]
_______________________________________________________________________
A BILL
To amend title 38, United States Code, to provide the Secretary of
Veterans Affairs with necessary flexibility in staffing the Veterans
Health Administration, to authorize the Secretary to establish pilot
programs for health care delivery, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Veterans Health Programs Improvement
Act of 1994''.
TITLE I--VETERANS HEALTH ADMINISTRATION STAFFING LEVELS
SEC. 101. FINDINGS.
The Congress makes the following findings:
(1) Under proposals for national health care reform, the
Department of Veterans Affairs would be required to establish
an enrollment system for veterans and to provide health care on
a competitive basis with other, private health care providers.
(2) In order to be able to implement changes contemplated
by proposals for national health care reform, the Secretary of
Veterans Affairs must have flexibility to restructure and
reform the Veterans Health Administration as necessary without
externally imposed constraints on full-time equivalent employee
(FTEE) positions levels.
(3) The Office of Management and Budget, as part of an
announced plan to require a reduction over five years of
252,000 FTEE positions in the executive branch, proposes to
require reductions of FTEE positions totaling 25,493 in
personnel of the Veterans Health Administration, a reduction in
personnel which would severely impede the ability of the
Department of Veterans Affairs to implement national health
care reform and to meet the responsibilities of the Department
under existing law.
SEC. 102. EMPLOYMENT LEVEL IN VETERANS HEALTH ADMINISTRATION.
(a) In General.--Chapter 7 of title 38, United States Code, is
amended by adding at the end the following new section:
``Sec. 713. Full-time equivalent employees: limitation on reduction
``(a) During the five-year period beginning on October 1, 1994, no
reduction may be made in the number of full-time equivalent employees
in the Veterans Health Administration other than as specifically
required by a law directing reductions in personnel or positions of the
Veterans Health Administration or by the availability of funds. During
that period, the personnel of the Veterans Health Administration shall
be managed on the basis of the needs of eligible veterans and the
availability of funds.
``(b) During the period specified in subsection (a), no law
imposing a restriction on hiring by executive agencies for the purpose
of achieving workforce reductions shall apply to the Veterans Health
Administration.
``(c) No law may be construed as suspending or modifying this
section unless such law specifically refers to or amends this
section.''.
(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. Full-time equivalent employees: limitation on reduction.''.
SEC. 103. REPORT ON STREAMLINING.
Not later than January 15, 1995, the Secretary of Veterans Affairs
shall submit to the Committees on Veterans' Affairs of the Senate and
House of Representatives a report on streamlining activities in the
Veterans Health Administration. The report shall include a description
of--
(1) opportunities to improve the efficiency and
effectiveness of delivery of health care services in the
Veterans Health Administration through consolidation,
reorganization, or other means;
(2) plans and actions taken to realize such efficiencies;
and
(3) impediments to implementing particular plans.
TITLE II--PILOT PROGRAMS
SEC. 201. SHORT TITLE.
This title may be cited as the ``Veterans Health-Care Pilot Program
Act of 1994''.
SEC. 202. PILOT PROGRAM AUTHORITY.
(a) In General.--Subject to section 203, the Secretary of Veterans
Affairs may establish and operate a pilot program under this Act in up
to five States which have established a State reform plan.
(b) State Reform Plans.--For purposes of this Act, a State reform
plan shall be considered to have been established in a State if the
Secretary determines that the State has enacted legislation that is
intended, at least in part, to provide residents of that State who
lack, or have inadequate, health insurance coverage access to health
care services.
(c) Authority of Secretary Under Pilot Program.--Notwithstanding
any other law, the Secretary, in carrying out a pilot program in a
State under this title, may do the following:
(1) Provide health-care services on the same or similar
basis as the State reform plan mandates to veterans, members of
the family of a veteran who participates in the pilot program,
and individuals described in section 1713(a) of title 38,
United States Code, including the establishment of one or more
health plans in that State through Department of Veterans
Affairs health care facilities in the State and the
implementation of an enrollment option for eligible
beneficiaries.
(2) Comply with such requirements of State law applicable
to the establishment and operation of a health plan under a
State reform plan, or to functioning as a participant in,
member of, or contractor to, such a health plan, as the
Secretary considers appropriate for application to a Federal
department.
(3) Conduct the pilot program in some or all Department of
Veterans Affairs health-care facilities located in the State.
(4) Establish such catchment areas for enrollment in the
pilot programs as the Secretary determines appropriate.
SEC. 203. CONDITIONS OF PARTICIPATION.
(a) In General.--The Secretary may establish and operate a pilot
program in a State under section 202 only if--
(1) the Secretary has determined, based on such factors as
the Secretary considers relevant (which shall include the
factors specified in subsection (b)) that, in the absence of an
enrollment option through a Department of Veterans Affairs plan
in that State, the projected workload in one or more Department
of Veterans Affairs health care facilities in the State would
decline to a level that--
(A) would threaten to impair the capability of
those facilities to meet one or more assigned mission
of those facilities; or
(B) would result in a deterioration in the quality
of service-delivery to a degree that it would not be
reasonable to continue to provide a needed service or
services in such facility or facilities and
satisfactory alternative arrangements could not
feasibly be provided;
(2) the Secretary has taken action to ensure that in
designing and establishing a health plan under the pilot
program, provisions are made, to the extent feasible, for the
applicability and compatibility of the components of the plan
with other Department health care facilities that are not
participants in the pilot program in that State; -a-n-d
(3) the Secretary has provided for an evaluation of the
pilot program to assess (A) appropriate measures of (i) access
to service, (ii) cost of care, (iii) quality of service to
patients, and (iv) quality of care, (B) the ability of such
plans to attract enrollees, and (C) such other matters as the
Secretary determines appropriate-.; and
(4) the Secretary has required the director of each medical
center that is to participate in the pilot program to
establish, and to consult regularly with, a committee, which
shall include veteran and other patient representatives,
regarding the delivery of services and conduct of the pilot
program.
(b) Factors To Be Considered.--Factors considered by the Secretary
for purposes of subsection (a)(1) shall include--
(1) the relative universality of coverage afforded State
residents under the State reform plan;
(2) the scope of benefits offered under such plan; and
(3) the extent of financing supporting such plan.
(c) Submission of Plan to Congress.--The Secretary may implement a
pilot program under section 202 only after--
(1) the Secretary has submitted a report to the Committees
on Veterans' Affairs of the Senate and House of Representatives
on the proposed plan, as specified in subsection (d); and
(2) a period of 30 days during which Congress has been in
continuous session has elapsed since submission of the report
under paragraph (1).
For purposes of paragraph (2), continuity of a session of Congress is
broken only by adjournment sine die, and there shall be excluded from
the computation of such 30-day period any day during which either House
of Congress is not in session during an adjournment of more than three
days to a day certain.
(d) Matters To Be Included in Report.--Each report under subsection
(c) shall include the following:
(1) A detailed description of the rationale (as it relates
to the determinations described in subsections (a)(1) and (g)
of this section) for proposed participation in the State reform
plan which shall specifically address the determinations under
such provisions.
(2) A description of the extent to which applicable
provisions of State law specifically accommodate and facilitate
participation by the Department in the State reform plan.
(3) A detailed business plan for the Department's
participation under the State reform plan.
(4) A description of the actions the Secretary has taken to
consult with veterans on the Department's proposed
participation in such State reform plan.
(e) Exemption of High-Priority Veterans From Premiums, Etc.--A
veteran described in section 1710(a)(1) of title 38, United States
Code, who receives health care services from the Secretary under a
pilot program under this title incurs no liability to pay a premium,
deductible, copayment, or other charge in connection with (1) receiving
the hospital care services the veteran is eligible for under section
1710(a)(1) of such title, and (2) medical services to persons described
in section 1710(a)(1) of such title, subject to the limitations in
section 1710(e) of such title.
(f) Retention of Specialized Capacities.--In carrying out the pilot
programs, the Secretary shall ensure that the Department maintains its
capacity to provide for the specialized treatment and rehabilitative
needs of disabled veterans described in section 1710(a) of title 38,
United States Code, including veterans with spinal cord dysfunction,
blindness, and mental illness.
(g) Requirement for Consideration of Use of Expanded -S-h-a-r-i-n-g
Authority.--The Secretary may not make a determination under subsection
(a)(1) unless the Secretary has fully considered the feasibility of
using authority under title -I-I III of this Act.
SEC. 204. FUNDING.
(a) Establishment of Revolving Fund.--There is established in the
Treasury of the United States a revolving fund for conduct of the pilot
programs under this title. -A-m-o-u-n-t-s Subject to subsection (e),
amounts in the revolving fund are available without fiscal year
limitation for all expenses necessary to carry out the purposes of the
pilot program.
(b) Authorization of Appropriations.--There is authorized to be
appropriated to the revolving fund such sums as may be necessary for
each of fiscal years 1995 through 2000 for conduct and evaluation of
the pilot programs.
(c) Authorization To Transfer Certain Funds.--(1) In addition to
funds appropriated pursuant to subsection (a), the Secretary may
transfer to the revolving fund authorized by subsection (a) funds from
the Medical Care Appropriation Account and the Construction
Appropriation Accounts of the Department for any fiscal year when the
Secretary determines such transfer is necessary to carry out the
purposes of the pilot program.
(2) The authority in paragraph (1) shall apply only with respect to
amounts appropriated after the date of the enactment of this Act.
(d) Authorized Disbursements.--(1) Notwithstanding any other
provision of law, the Secretary, subject to paragraph (2) and to
subsection (e), may make disbursements from the revolving fund
established under subsection (a) as the Secretary considers necessary
to carry out the purposes of the pilot programs and their evaluation.
Such disbursements may be made to furnish medical care and services, or
for the acquisition, construction, repair, or renovation of facilities
(including the land on which facilities are located or to be
constructed) necessary to carry out the pilot program, and for
conducting consumer surveys, printing, marketing, and advertising
(including contracts for such services).
(2) Funds in the revolving fund shall not be available for a major
medical facility project, or a major medical facility lease, as defined
in section 8104(a)(3) of title 38, United States Code, unless funds for
such project or lease have been specifically authorized by law.
(e) Receipt of Funds.--(1) Notwithstanding any other provision of
law, the Secretary may recover or collect funds by reason of the
furnishing of health care under a pilot program authorized under
section 202 in the same manner as any other health-care provider or
plan operating in the State, whether such funds are received from an
individual, another agency or department of the United States, an
agency of State or local government, a health-care provider, health
care plan, insurer, or other entity (including amounts received as
premiums, copayments, deductibles, or third-party reimbursements).
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(2) Any such funds received under paragraph (1), other than funds
for which recovery could have been accomplished under section 1710(f),
1712(f), 1722A, or 1729(a) of title 38, United States Code, shall be
deposited in the revolving fund. Funds for which recovery could have
been accomplished under any of those sections shall be deposited in the
Medical-Care Cost Recovery Fund established under section 1729(g) of
that title.
(3) Funds deposited in the Medical-Care Cost Recovery Fund during
any fiscal year in an amount in excess of the Congressional Budget
Office baseline (as of the date of the enactment of this Act) for
deposits in that fund for that fiscal year shall not be subject to
paragraph (4) of section 1710(f), 1712(f), or 1729(g) (as the case may
be) of that title, but shall be transferred to the revolving fund. Such
transfer for any fiscal year shall be made at any time that the total
of amounts so received less amounts estimated to cover the expenses,
payments, and costs described in paragraph (3) of section 1729(g) of
that title is in excess of the applicable Congressional Budget Office
baseline.
(f) Checking Accounts.--The Secretary may establish and maintain
checking and savings accounts in any -F-e-d-e-r-a-l -R-e-s-e-r-v-e
-B-a-n-k-, -a-n-y -d-e-p-o-s-i-t-o-r-y -f-o-r -p-u-b-l-i-c -f-u-n-d-s-,
depository for public funds or in such other places and in such manner
as the Secretary determines appropriate in connection with the
revolving fund established under subsection (a). -T-h-e Subject to
subsection (e), the Secretary may disburse funds from any such account
in such manner as the Secretary considers necessary to carry out the
purposes of the pilot programs associated with those funds.
(g) Transfer of Excess Funds to Treasury.--If the Secretary
determines that moneys in the revolving fund established under
subsection (a) are in excess of the needs of the pilot program, the
Secretary shall transfer the excess funds to the Medical Care
Appropriation account of the Department.
SEC. 205. ADMINISTRATIVE FLEXIBILITY.
The Secretary, when the Secretary considers it necessary to carry
out a pilot program authorized under section 202, may--
(1) carry out administrative reorganizations, subject to
section 203(f) of this title, without regard to section 510(b)
of title 38, United States Code;
(2) when the Secretary finds it is cost-effective or
necessary in order to provide health care services in a timely
manner, enter into contracts--
(A) for procurement of any commercially available
item at a cost of under $100,000 without regard to any
provision of law or regulation (i) requiring
competitive procedures; (ii) mandating or giving
priority to any source of supply; or (iii) pertaining
to protests; and
(B) without regard to the provisions of section
8110(c) of title 38, United States Code;
(3) carry out consumer-survey, promotional, advertising,
and marketing activities related to establishing and operating
a health plan; and
(4) exercise the authority established in title III.
SEC. 206. ANNUAL REPORTS TO CONGRESS.
Not later than November 30 of each year from 1995 through 2000, the
Secretary shall submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a report on the Department's
experience in carrying out the provisions of this title and the
findings or interim findings of evaluations carried out under section
203(a)(3). Each such report shall include information regarding the
effect on Department health care delivery and operations in each State
in which a State reform plan has been implemented and shall
specifically identify each transfer of funds under section 204(c) and
account specifically for the use of such funds.
SEC. 207. EXPIRATION OF AUTHORITY.
The authority to conduct pilot programs under this title shall
expire on September 30, 2000.
TITLE III--HEALTH CARE RESOURCE AGREEMENTS
SEC. 301. AUTHORITY IN STATES WITH STATE REFORM PLANS.
(a) In General.--The director of a Department of Veterans Affairs'
health care facility serving veterans who reside in a State that has
established a State reform plan may, without regard to section 1703 of
title 38, United States Code, or any other law or regulation pertaining
to competitive procedures, acquisition procedures or policies (other
than contract dispute settlement procedures), or bid protests, enter
into agreements with health care plans, insurers, and health care
providers, and with any other entity or individual, to furnish or
obtain any health-care resource, as that term is defined in section
8152 of title 38, United States Code.
(b) Limitation.--A director may enter into an agreement under
subsection (a) only if the director has determined that the agreement
to furnish services is necessary to maintain an acceptable level and
quality of service to veterans at that facility.
SEC. 302. REIMBURSEMENT METHODOLOGY.
An agreement under section 301 shall provide for reimbursement to
the Department based on a methodology that provides appropriate
flexibility to establish an appropriate reimbursement rate. Any
proceeds to the Government received from the agreement shall be
credited to the applicable Department medical appropriation and to
funds that have been allotted to the facility that furnished the
resource involved.
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