[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). 
-A-n-y -s-u-c-h -f-u-n-d-s -s-o -r-e-c-e-i-v-e-d -s-h-a-l-l -b-e 
-d-e-p-o-s-i-t-e-d -t-o -t-h-e -r-e-v-o-l-v-i-n-g -f-u-n-d-.
    -(-2-) -A-n-y -s-u-c-h -f-u-n-d-s -s-o -r-e-c-e-i-v-e-d -a-n-d 
-d-e-p-o-s-i-t-e-d-, -t-h-e -r-e-c-o-v-e-r-y -o-r -c-o-l-l-e-c-t-i-o-n 
-o-f -w-h-i-c-h -i-s -a-u-t-h-o-r-i-z-e-d -i-n -s-e-c-t-i-o-n 
-1-7-2-9-(-a-) -o-f -t-i-t-l-e -3-8-, -U-n-i-t-e-d -S-t-a-t-e-s 
-C-o-d-e-, -a-s -i-n -e-f-f-e-c-t -o-n -F-e-b-r-u-a-r-y -1-, -1-9-9-4-, 
-s-h-a-l-l -b-e -a-d-m-i-n-i-s-t-e-r-e-d -i-n -a-c-c-o-r-d-a-n-c-e 
-w-i-t-h -p-a-r-a-g-r-a-p-h -(-3-)-.
    -(-3-) -F-u-n-d-s -r-e-c-o-v-e-r-e-d -o-r -c-o-l-l-e-c-t-e-d -b-y 
-t-h-e -D-e-p-a-r-t-m-e-n-t -p-u-r-s-u-a-n-t -t-o -s-e-c-t-i-o-n 
-1-7-2-9-(-a-) -o-f -t-i-t-l-e -3-8-, -U-n-i-t-e-d -S-t-a-t-e-s 
-C-o-d-e-, -d-u-r-i-n-g -a-n-y -f-i-s-c-a-l -y-e-a-r -i-n -a-n 
-a-m-o-u-n-t -i-n -e-x-c-e-s-s -o-f -t-h-e -c-u-r-r-e-n-t 
-C-o-n-g-r-e-s-s-i-o-n-a-l -B-u-d-g-e-t -O-f-f-i-c-e -b-a-s-e-l-i-n-e 
-f-o-r -r-e-c-e-i-p-t-s -u-n-d-e-r -t-h-a-t -s-e-c-t-i-o-n -f-o-r 
-t-h-a-t -f-i-s-c-a-l -y-e-a-r -s-h-a-l-l -n-o-t -b-e -s-u-b-j-e-c-t 
-t-o -s-e-c-t-i-o-n -1-7-2-9-(-g-)-(-2-) -o-f -s-u-c-h -t-i-t-l-e-, 
-t-o -t-h-e -e-x-t-e-n-t -t-h-o-s-e -f-u-n-d-s -a-r-e 
-a-t-t-r-i-b-u-t-a-b-l-e -t-o -t-h-e -o-p-e-r-a-t-i-o-n -o-f -a 
-p-i-l-o-t -p-r-o-g-r-a-m -u-n-d-e-r -t-h-i-s -t-i-t-l-e-.
    (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.

                                 <all>

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