[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3455 Introduced in House (IH)]







110th CONGRESS
  1st Session
                                H. R. 3455

To amend title 38, United States Code, to provide for a more equitable 
   geographic allocation of funds appropriated to the Department of 
                   Veterans Affairs for medical care.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             August 4, 2007

 Mr. Larson of Connecticut (for himself and Mr. Murphy of Connecticut) 
 introduced the following bill; which was referred to the Committee on 
                           Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
To amend title 38, United States Code, to provide for a more equitable 
   geographic allocation of funds appropriated to the Department of 
                   Veterans Affairs for medical care.

    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 ``21st Century Veterans Equitable 
Treatment Act''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Veterans were promised by the Federal Government that 
        for their service to the country they would be provided a 
        lifetime of health care services, as well as their own health 
        care service network.
            (2) The current allocation system for appropriations made 
        to the Department of Veterans Affairs for medical care, known 
        as the Veterans Equitable Resource Allocation (VERA) formula 
        and established by the Secretary of Veterans Affairs pursuant 
        to section 429 of the Departments of Veterans Affairs and 
        Housing and Urban Development, and Independent Agencies 
        Appropriations Act, 1997 (Public Law 104-204; 110 Stat. 2929), 
        has proved to be an ineffective means of allocating such funds 
        fairly across the 23 national service regions, known as 
        Veterans Integrated Service Networks (VISNs), of the Department 
        of Veterans Affairs.
            (3) The VERA formula has resulted in a system in which 
        veterans in some regions of the country are forced to compete 
        with veterans in other regions for critical medical care funds, 
        whereas the system should be providing the funding necessary to 
        meet the health care needs of all veterans, regardless of where 
        they live, to ensure that all veterans have access to the level 
        and quality of care that they have all earned and deserved.
            (4) The Secretary of Veterans Affairs established a set of 
        performance goals in fiscal year 2000, which are referred to as 
        ``30-30-20'', representing the Secretary's goal to schedule 
        nonurgent primary care visits within 30 days, specialty care 
        visits within 30 days, and the maximum amount of time veterans 
        must wait once they arrive to be seen by a doctor as 20 
        minutes.
            (5) According to the Department's Fiscal Year 2006 
        Performance and Accountability Report, 89 percent of primary 
        care appointments were scheduled within 30 days of the desired 
        date and only 86 percent of specialty care appointments were 
        scheduled within 30 days of the desired date in 2002.
            (6) By 2006, the Department's Fiscal Year 2006 Performance 
        and Accountability Report states that 96 percent of primary 
        care appointments were scheduled within 30 days of the desired 
        date and 93 percent of specialty care appointments were 
        scheduled within 30 days of the desired date.
            (7) Although appointment performance has improved, the 
        increase primarily reflects the January 2003 ban on enrollment 
        of new Priority 8 veterans in the VA health care system.
            (8) According to the Veterans Health Administration (VHA) 
        Directive 2007-010, the VHA policy for national timeliness 
        standards for the processing of claims from non-Department of 
        Veterans Affairs providers is that 95 percent of all non-
        Department provider claims are processed within 30 days of 
        receipt.
            (9) Until the VERA formula is changed to ensure a more 
        equitable and adequate distribution of medical care funding 
        within the Department of Veterans Affairs system that includes 
        Priority 8 veterans, providing appropriate access to medical 
        care for the Nation's veterans must remain a national priority 
        with a method found to provide a safety net that will ensure 
        that veterans have access to the health care they need without 
        undermining the existing health care network of the Department 
        of Veterans Affairs.

SEC. 3. STANDARD FOR TIME FOR REFERRAL FOR SPECIALIST CARE.

    (a) Time for Specialist Appointments.--
            (1) Requirement.--The Secretary of Veterans Affairs shall 
        establish by regulation a maximum specialist referral period, 
        subject to such exceptions as the Secretary considers 
        necessary.
            (2) Specialist referral period defined.--For purposes of 
        paragraph (1), the term ``specialist referral period'' means 
        the period of time between (A) the date on which a veteran is 
        referred to a specialty clinic of the Department by the 
        veteran's primary care physician within the Department of 
        Veterans Affairs health care system, and (B) the date for which 
        the veteran is scheduled for an appointment with a Department 
        specialist pursuant to such referral.
            (3) Department policies.--In establishing a maximum 
        specialist referral period under paragraph (1), the Secretary 
        shall act in a manner consistent with the current treatment 
        policies of the Department based on clinical need and with the 
        established 30-30-20 performance goal of the Department for 
        such a referral period.
    (b) Standard for Transportation.--The Secretary shall take such 
steps as necessary to ensure that the Department of Veterans Affairs is 
able to provide appropriate transportation services for qualified 
veterans within a reasonable time period of a scheduled appointment.

SEC. 4. CONTRACT CARE TO BE PROVIDED WHEN DEPARTMENT OF VETERANS 
              AFFAIRS CARE NOT AVAILABLE IN ACCORDANCE WITH STANDARDS.

    (a) Contract Care.--In any case in which the Secretary of Veterans 
Affairs is not able to provide hospital care or medical services in 
accordance with the standard prescribed under section 3(a) or to 
provide transportation services in accordance with section 3(b), the 
Secretary shall promptly provide for such care or transportation from a 
private source. Hospital care or medical services so provided shall be 
those for which the veteran is otherwise eligible within the Department 
of Veterans Affairs medical care system.
    (b) Reimbursement Rate.--Whenever care or services are provided 
under subsection (a), the Secretary shall reimburse the provider of 
such care or services for the reasonable value of such care or 
services, as determined by the Secretary. Such reimbursement shall be 
provided in the same manner as applies to reimbursement for emergency 
treatment under section 1725 of title 38, United States Code, subject 
to such of the terms and conditions otherwise applicable to such 
reimbursements under such section as the Secretary determines to be 
appropriate for purposes of this section.
    (c) Expedited Reimbursement Procedures.--The Secretary shall take 
appropriate steps to expedite the reimbursement required by subsection 
(b) and consistent with the Veterans Health Administration policy that 
95 percent of all non-VA Contract Care claims are processed within 30 
days of receipt. Such steps may include steps to take advantage of 
modern technology, including so-called ``smart card'' technology that 
would allow claims for such reimbursement to be processed 
electronically. The Secretary shall, to the extent possible, also apply 
such steps for expediting reimbursement to claims for emergency 
services provided to veterans for which the Secretary provides 
reimbursement under provisions of law in effect before the date of the 
enactment of this Act.

SEC. 5. TERMINATION OF 24-MONTH RULE FOR REIMBURSEMENT FOR EMERGENCY 
              SERVICES.

    The provisions of subparagraph (B) of section 1725(b)(2) of title 
38, United States Code, shall not apply with respect to emergency 
treatment furnished on or after the date of the enactment of this Act.

SEC. 6. MEDICAL ADMINISTRATOR PERFORMANCE RATINGS.

    The Secretary of Veterans Affairs shall include in the standards of 
performance used for measuring performance of administrators in the 
Department of Veterans Affairs medical care system a standard of 
assessing improvements in appointment waiting times.

SEC. 7. REPORTS.

    The Secretary of Veterans Affairs shall submit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives a report 
at the end of each fiscal-year quarter on the waiting times for 
appointments in the Department of Veterans Affairs medical care system. 
The report shall describe any reductions in such waiting times and any 
experience with appointment delays.
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