[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1004 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 1004

 To amend title 38, United States Code, to provide an enhanced funding 
process to ensure an adequate level of funding for veterans health care 
programs of the Department of Veterans Affairs, to establish standards 
of access to care for veterans seeking health care from the Department 
              of Veterans Affairs, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 11, 2009

   Mr. Smith of New Jersey introduced the following bill; which was 
             referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
 To amend title 38, United States Code, to provide an enhanced funding 
process to ensure an adequate level of funding for veterans health care 
programs of the Department of Veterans Affairs, to establish standards 
of access to care for veterans seeking health care from the Department 
              of Veterans Affairs, 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 Care Full Funding 
Act''.

SEC. 2. ENHANCED PROCESS FOR FUNDING VETERANS HEALTH CARE PROGRAMS.

    (a) In General.--(1) Chapter 3 of title 38, United States Code, is 
amended by adding at the end the following new section:
``Sec. 323. Enhanced funding process for veterans health care
    ``(a) In the President's budget for each fiscal year transmitted 
under section 1105 of title 31, amounts shall be requested for veterans 
health care programs in accordance with this section. Amounts 
appropriated for veterans health care programs shall be available for 
obligation for a period of two consecutive fiscal years.
    ``(b)(1) For each fiscal year (beginning with fiscal year 2010), 
the Veterans Health Care Funding Review Board shall determine the level 
of funding needed for veterans health care programs for that fiscal 
year and the next fiscal year. The Board shall make such determination, 
and shall publish such determination in the Federal Register, not later 
than November 1 of the year preceding the year in which the budget for 
such fiscal year is transmitted to Congress.
    ``(2) In making any such determination under paragraph (1), the 
Board shall take into consideration the most recent information 
relating to economic assumptions provided to the Board by the Director 
of the Office of Management and Budget pursuant to subsection 
(f)(4)(b).
    ``(c) The amount determined under subsection (b) for any two-
fiscal-year period is the amount needed to be appropriated to the 
Department for that two-fiscal-year period for veterans health care 
programs. The President shall include the full amount so determined in 
the budget transmitted to Congress under section 1105 of title 31 for 
the first fiscal year in such two-year period and shall include the 
amount of the second fiscal year as a budget forecast year.
    ``(d)(1) The Board shall make its determination of the level of 
funding needed for veterans health care programs for any two-fiscal-
year period under subsection (b) based upon an annual review of those 
programs and of veterans health care needs.
    ``(2) The Board shall ensure that its determination of the level of 
funding needed for veterans health care programs for any period is in 
an amount sufficient to provide for--
            ``(A) the health care needs of veterans estimated to be 
        enrolled in the Department health care system under section 
        1705(a) of this title (other than veterans described in 
        paragraph (8) of such section);
            ``(B) the health care needs of veterans with service-
        connected disabilities who are not required to enroll in such 
        health care system;
            ``(C) timely access to health care under standards for 
        access prescribed under section 1703(e)(1) of this title;
            ``(D) maintenance of capacities of Department nursing home 
        facilities as required by section 1710B(b) of this title and of 
        specialized programs as required by section 1706(b)(1) of this 
        title;
            ``(E) the health care needs of persons eligible for 
        benefits under chapter 17 of this title based upon subchapter 
        VIII of that chapter;
            ``(F) the necessary maintenance, improvement, upgrading, 
        expanding, repairing, and replacing of major and minor medical 
        facilities, capital equipment, and systems to ensure that 
        health care facilities of the Department are adequate for the 
        purposes of programs and benefits authorized for the care of 
        veterans under chapter 17 of this title; and
            ``(G) unanticipated requirements, including--
                    ``(i) changes in benefits;
                    ``(ii) changes in beneficiaries;
                    ``(iii) changes in economic conditions or 
                assumptions; and
                    ``(iv) such other factors as the Board considers 
                appropriate.
    ``(3) Each such review under paragraph (1) shall consider--
            ``(A) demographic information;
            ``(B) utilization and cost trends for veterans enrolled 
        under section 1705 of this title and other Department health-
        care beneficiaries;
            ``(C) requirements for support of other core missions of 
        the Department related to health care;
            ``(D) the degree of efficiency (or the lack of efficiency) 
        by which the Secretary actually delivers health care services 
        to veterans; and
            ``(E) such other factors as the Board considers 
        appropriate.
    ``(4)(A) The Board shall submit to Congress an annual report, not 
later than the date on which the President transmits the budget to 
Congress under section 1105 of title 31 each year, on its most recent 
determination under subsection (b) and its most recent review under 
paragraph (1).
    ``(B) The report shall include the following:
            ``(i) A statement of the amount determined for each of the 
        two fiscal years covered by such determination under subsection 
        (b).
            ``(ii) A description of the economic assumptions and other 
        assumptions made by the Board in making such determination and 
        how that determination was developed.
            ``(iii) Any recommendations to Congress or the Secretary 
        that the Board considers appropriate concerning the means and 
        methods for the Secretary to achieve optimal efficiencies or 
        savings in delivering health care to veterans.
    ``(5) Following the submission of the report under paragraph (4) 
each year, the Board shall review and reconsider the matters contained 
in the report and shall, during the five-day period ending on May 1 of 
that year, submit to Congress a report updating the matters in the 
report submitted under paragraph (4). The Board shall include in that 
report any revision it considers appropriate to its most recent 
determination under subsection (b), together with the reasons for any 
such revision.
    ``(e) For purposes of this section, the term `veterans health care 
programs' means programs, functions, and activities of the Veterans 
Health Administration other than--
            ``(1) medical and prosthetic research; and
            ``(2) grants under subchapter III of chapter 81 of this 
        title.
    ``(f)(1) There is established in the Department of Veterans Affairs 
a Veterans Health Care Funding Review Board. The Board shall consist of 
three members who shall be appointed by the Secretary. Persons 
appointed to the Board shall have professional backgrounds and 
experience in health care policy analysis, health care statistics, 
health care insurance, or health care economics or have similar 
qualifications considered suitable by the Secretary.
    ``(2)(A) Except as provided in subparagraph (B), the members of the 
Board shall serve for a term of 15 years, except that a member of the 
Board appointed to fill a vacancy occurring before the end of the term 
for which the member's predecessor was appointed shall only serve until 
the end of such term. A member may serve after the end of the term of 
the member until the successor of that member has taken office. A 
member of the Board may be removed by the Secretary for misconduct or 
failure to perform functions vested in the Board, and for no other 
reason.
    ``(B) Of the members of the Board who are first appointed under 
this paragraph, one each shall be appointed for terms ending 5, 10, and 
15 years, respectively, after the date of appointment, as designated by 
the Secretary at the time of appointment.
    ``(3) A member of the Board who is not otherwise an employee of the 
United States is entitled to receive pay at the daily equivalent of the 
annual rate of basic pay of the highest rate of basic pay under the 
General Schedule of subchapter III of chapter 53 of title 5, for each 
day the member is engaged in the performance of duties vested in the 
Board, and is entitled to travel expenses, including a per diem 
allowance, in accordance with section 5703 of title 5.
    ``(4)(A) The Secretary shall furnish the Board all papers, records, 
information, and other materials it requires in order to carry out its 
functions under this section.
    ``(B) The Director of the Office of Management and Budget shall 
furnish to the Board complete information on the economic assumptions 
(including assumptions as to inflation, unemployment, revenues and 
expenses, and energy costs) that inform or guide the President's 
overall budgetary presentation to Congress, including those assumptions 
that would be expected to particularly affect health care costs in the 
Department, or the cost of care to veterans.
    ``(5) Funds for the expenses of the Board for any fiscal year shall 
be provided from amounts available for that fiscal year for veterans 
health care programs. The Board shall include consideration of its own 
budget requirements in determinations under subsection (b).''.
    (2) The table of sections at the beginning of such chapter is 
amended by adding at the end the following new item:

``323. Enhanced funding process for veterans health care.''.
    (b) Effective Date.--Section 323 of title 38, United States Code, 
as added by subsection (a), shall take effect on January 1, 2008.
    (c) Repeal of Construction Authorization Requirement.--Effective 
October 1, 2008, subsections (a), (b), (c), and (d) of section 8104 of 
title 38, United States Code, are repealed.
    (d) Appointment of Initial Members of Board.--The initial 
appointment of the members of the Board established under subsection 
(f) of section 323 of title 38, United States Code, as added by 
subsection (a), shall be completed not later than 90 days after the 
date of the enactment of this Act.
    (e) Initial Funding for Board.--For fiscal year 2008, the Secretary 
of Veterans Affairs shall provide amounts needed for the operation of 
the Board established under subsection (f) of section 321 of title 38, 
United States Code, as added by subsection (a), in a total amount not 
to exceed $2,000,000, from amounts appropriated to the Department of 
Veterans Affairs for that fiscal year for Medical Care.

SEC. 3. ACCESS TO CARE STANDARDS.

    (a) Required Standard for Access to Care.--Section 1703 of title 
38, United States Code, is amended by adding at the end the following 
new subsection:
    ``(e)(1) The following are the standards for access to care for the 
Department:
            ``(A) For a veteran seeking primary care, the standard for 
        access is 30 days, determined from the date on which the 
        veteran contacts the Department seeking an appointment until 
        the date on which a visit with a primary care provider is 
        completed.
            ``(B) For a veteran seeking specialized care, the standard 
        for access is 30 days, determined from the date on which the 
        veteran is referred for specialty care by a primary care 
        provider until the date on which a visit with an appropriate 
        specialty primary care provider is completed.
    ``(2) The Secretary shall develop and disseminate an appropriate 
standard of waiting time, determined from the time at which the 
veteran's visit is scheduled until the veteran is seen by the provider. 
The Secretary shall periodically review performance of Department 
facilities compared to that standard. The Secretary shall annually 
report to the Committees on Veterans' Affairs of the Senate and House 
of Representatives an assessment of the Department's performance 
against that standard.
    ``(3) In a case in which the Secretary is unable to meet the 
standard for access to care, the Secretary shall use the authority of 
subsection (a) to furnish health care and services for that veteran in 
a non-Department facility.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the first day of the first month beginning more than six 
months after the date of the enactment of this Act.
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