[Congressional Record Volume 150, Number 16 (Tuesday, February 10, 2004)]
[Senate]
[Pages S807-S809]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CONRAD (for himself, Mr. Graham of Florida, Mr. 
        Rockefeller, Mr. Akaka, and Mr. Johnson):
  S. 2063. A bill to require the Secretary of Veterans Affairs to carry 
out a demonstration projects on priorities in the scheduling of 
appointments of veterans for health care through the Department of 
Veterans Affairs, and for other purposes; to the Committee on Veterans' 
Affairs.
  Mr. CONRAD. Mr. President, as I visit with veterans in North Dakota 
and here in Washington, too often I hear that waiting periods for 
medical care, and particularly for specialty care, are too long. We owe 
an unbelievable debt to American's veterans, and it is just not right 
that they cannot get the medical care they need when they need it. The 
legislation I am introducing today begins to address this problem.
  Last month, as Ranking Member of the Senate Budget committee, I 
scheduled a field hearing in Bismarck, ND, to listen to the concerns of 
veterans regarding funding for the VA. Because more than fifty percent 
of veterans in North Dakota live in highly rural areas with limited 
access to VA medical facilities, I was particularly concerned about 
funding for VA medical care and the continuing reports from veterans 
regarding access to care and delays in the scheduling of appointments 
for medical care, especially speciality care.
  Last September, I expressed similar concerns in testimony to the VA 
CARES Commission during field hearings in Minneapolis. I emphasized to 
Commission members that many North Dakota veterans have to travel 
hundreds of miles to access health care from the Fargo VA Medical 
Center or another FA facility in VISN 23 and that the VA must do more 
to ensure timely access for appointments and other VA medical services.
  Reports in the national press make clear, however, that significant 
problems remain in the scheduling of appointments for medical care, 
particularly specialty care. Further complicating matters, there are 
many questions regarding the reliability of VA data on waiting list for 
appointments and the causes for the waiting periods according to 
reports in 2003 by the Department of Veterans Affairs Office of 
Inspector General and in 2000 by the General Accounting Office.
  In North Dakota, several veterans service officers have reported a 
number of veterans waiting months for eye care, orthopedics and one 
veteran waiting almost ten months for back surgery. Another veteran, 
from the Bismarck area, was required to travel to Iowa for cancer 
treatment.
  In view of these continuing concerns, I am today introducing 
legislation that would require the VA to undertake a two year pilot 
demonstration to study the implementation, cost and impact on VA 
services of several recent directives by the VA relating to the 
scheduling of medical appointments. The demonstration would be 
undertaken in three VISN networks, one highly rural, one rural, and one 
urban, that represent a cross-section of VA providers.
  Under the demonstration, the VA would offer participating veterans, 
both new enrollees and established patients, service-connected and non-
service connected, an appointment for primary care evaluation, 
hospitalization including specialty care or outpatient care within a 30 
day period. If the VA facility is unable to provide the medical care 
within the designated period, the Department would make arrangements 
for the care at another VA facility or non-VA facility. Every effort,

[[Page S808]]

however, would be made to provide the medical care for the veteran 
through the VA healthcare network.
  Finally, because of concerns regarding the accuracy of VA data on 
appointment periods, the bill requires the VA to report to Congress by 
FY 2007 on waiting periods for health care appointments, primary care 
and speciality care services. The VA would be required to report on the 
waiting periods for appointments by VA facility and VISN, include a 
breakdown of waiting periods by speciality, and submit recommendations 
to Congress for addressing the shortages of medical personnel. Finally, 
the legislation requests the Secretary, on the basis of the two year 
demonstration, to report to Congress by FY 2007 on the costs associated 
with implementation of the VA directive in the three VISNs and to 
report on the estimated cost to fully implement the directive 
throughout the VA system.
  I am very pleased that my distinguished colleagues, Ranking Member of 
the Senate Committee on Veterans Affairs, Senator Bob Graham and 
Senators Jay Rockefeller, Tim Johnson and Daniel Akaka are joining me 
in sponsoring this legislation. I am also honored to have the strong 
support of the Disabled American Veterans and the AMVETS for this 
legislative proposal. I want to express my appreciation to Dave Gorman, 
DAV Executive Director; Joseph Violante, DAV National Legislative 
Director; Mike Dobmeier, former National Commander of the DAV and Rick 
Jones, AMVETS, National Legislative Director for their support.
  It is critical that Congress and the Administration address the 
concerns of our veterans on the issue of waiting periods for medical 
care before adjourning of the 108th Congress. Veterans returning from 
Iraq, Afghanistan and from other peacekeeping deployments around the 
globe should not have to wait months for needed medical care. The needs 
of injured military personnel are great and the VA system will play a 
key role in their recovery. I encourage the Senate Committee on 
Veterans Affairs to review this legislation carefully and to act 
favorably on the measure before Congressional adjournment this fall.
  I ask unanimous consent that the text of this legislation along with 
the letters of endorsement from the Disabled American Veterans and the 
AMVETS be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 2063

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. DEMONSTRATION PROJECT ON PRIORITIES IN SCHEDULING 
                   OF APPOINTMENTS OF VETERANS FOR HEALTH CARE 
                   THROUGH THE DEPARTMENT OF VETERANS AFFAIRS.

       (a) Project Required.--The Secretary of Veterans Affairs 
     shall carry out a demonstration project to assess the 
     feasibility and advisability of providing for priorities in 
     the scheduling of appointments of veterans for health care 
     through the Department of Veterans Affairs in accordance with 
     the following:
       (1) The Department of Veterans Affairs Waiting Time for 
     Appointments goals (30-30-20) of 2000.
       (2) The provisions of the Veterans Health Administration 
     directive entitled ``Priority For Outpatient Medical Services 
     and Inpatient Hospital Care'' (VHA Directive 2002-059).
       (3) The provisions of the Veterans Health Administration 
     directive entitled ``Priority Scheduling for Outpatient 
     Medical Services and Inpatient Hospital Care for Service 
     Connected Veterans'' (VHA Directive 2003-062), dated October 
     23, 2003.
       (b) Period of Project.--The Secretary shall carry out the 
     demonstration project during the two-year period beginning on 
     October 1, 2004.
       (c) Locations of Project.--(1) The Secretary shall carry 
     out the demonstration project throughout each of three 
     Veterans Integrated Service Networks (VISNs) selected by the 
     Secretary for purposes of the project.
       (2) In selecting Veterans Integrated Service Networks under 
     paragraph (1), the Secretary shall ensure that the project is 
     carried out in urban, rural, and highly rural areas.
       (d) Project Requirements and Authorities.--(1) Except as 
     provided in paragraphs (2) and (3), in carrying out the 
     demonstration project the Secretary shall schedule 
     appointments for veterans for outpatient medical services and 
     inpatient hospital care through the Department in accordance 
     with the goals and directives referred to in subsection (a).
       (2) The veterans covered by the demonstration project shall 
     include any veterans residing in a Veterans Integrated 
     Service Network covered by the project, whether new or 
     current enrollees with the Department and including veterans 
     with service-connected disabilities and veterans with non-
     service-connected disabilities.
       (3) The Secretary shall schedule each appointment under the 
     demonstration project in a Department facility unless, as 
     determined by the Secretary--
       (A) the cost of scheduling the appointment in a Department 
     facility exceeds the cost of scheduling the appointment in a 
     non-Department facility to an unreasonable degree; or
       (B) the scheduling of the appointment in a non-Department 
     facility is required for medical or other reasons.
       (4) In carrying out the demonstration project, the 
     Secretary may utilize the Preferred Pricing Program (PPP) of 
     the Department, or similar programs or authorities, in the 
     locations covered by the project.
       (5) In this subsection, the terms ``Department facility'' 
     and ``non-Department facility'' have the meaning given such 
     terms in section 1701 of title 38, United States Code.
       (e) Annual Reports on Waiting Times for Appointments for 
     Care and Services.--(1) Not later than January 31 each year, 
     the Secretary shall submit to the Committees on Veterans' 
     Affairs of the Senate and the House of Representatives a 
     report on the waiting times of veterans for appointments for 
     health care and services from the Department during the 
     preceding year.
       (2) Each report under paragraph (1) shall specify, for the 
     year covered by the report, the following:
       (A) A tabulation of the waiting time of veterans for 
     appointments with the Department for each category of primary 
     or specialty care or services furnished by the Department, 
     broken out by particular Department facility and by Veterans 
     Integrated Service Network.
       (B) An identification of the categories of specialty care 
     or services for which there are lengthy delays for 
     appointments at particular Department facilities or 
     throughout particular Veterans Integrated Service Networks, 
     and, for each category so identified, recommendations for the 
     reallocation of personnel, financial, and other resources to 
     address such delays.
       (f) Report on Project.--The report under subsection (e) in 
     2007 shall also include information on the demonstration 
     project under this section. That information shall include--
       (1) a description of the project, including the Veterans 
     Integrated Service Networks selected for the project, the 
     number of veterans covered by the project, the number and 
     timeliness of appointments scheduled under the project, and 
     the costs of carrying out the project;
       (2) an assessment of the feasibility and advisability of 
     implementing the project nationwide; and
       (3) such other information with respect to the project as 
     the Secretary considers appropriate.
                                  ____



                                   Disabled American Veterans,

                                 Washington, DC, February 4, 2004.
     Hon. Kent Conrad,
     U.S. Senate, Hart Senate Office Building, Washington, DC.
       Dear Senator Conrad: On behalf of the more than one million 
     members of the Disabled American Veterans (DAV), we are 
     pleased to support your proposed legislation to assess the 
     feasibility and advisability of providing priorities in the 
     scheduling of appointments through the Department of Veterans 
     Affairs (VA) in accordance with VA's own access directives 
     and goals.
       The highest priority for VA health care must always be the 
     core group of veterans the system was designed to treat: 
     service-connected disabled veterans, the medically indigent, 
     and those with special needs and catastrophic disabilities. 
     As you are aware, in the past year, the Secretary of Veterans 
     Affairs has issued two directives relating to priority care 
     and the scheduling of appointments for service-connected 
     veterans. In addition, VA has set access standards for 
     patient appointments and struggled with improving its access 
     goals of 30-30-20 for primary and specialty care 
     appointments; specifically, access to non-urgent primary care 
     appointments within 30 days, non-urgent appointments with a 
     specialist within 30 days of the date of referral, and being 
     seen by a provider at VA health care facilities within 20 
     minutes of a patient's scheduled appointment. Despite VA's 
     efforts, we continue to hear reports from veterans of lengthy 
     delays in getting appointments for both primary and specialty 
     health care and services.
       Through a pilot project in three Veterans Integrated 
     Service Networks representing urban, rural, and highly rural 
     areas, your bill seeks to improve access for veterans seeking 
     VA health care and to evaluate the personnel, cost, and other 
     resources necessary for VA to meet its own access goals. The 
     annual reporting requirements about delay times for primary 
     and specialty care appointments nationwide, and 
     recommendations for the allocation of personnel, financial, 
     and other resources needed to address such delays are 
     essential and will help Congress and VA better understand the 
     actual resources necessary to meet veterans health care needs 
     in a timely manner.
       It has been abundantly clear for some time that our 
     government needs to develop long-term solutions to the 
     funding problems facing the veterans health care system. This

[[Page S809]]

     proposed measure will help begin to address this issue. The 
     DAV and the other major veterans groups are united in our 
     support for legislation that would guarantee an adequate 
     level of funding for the VA medical system as the key to 
     ensuring timely access to quality health care for our 
     nation's veterans. The Congress and the Administration must 
     make the commitment to provide the necessary resources to 
     fulfill the obligation to care for America's sick and 
     disabled vetrans--now and in the future.
       Thank you for your continued interest in this issue, and 
     for sponsoring this important legislation. We greatly 
     appreciate your efforts on behalf of our nation's sick and 
     disabled veterans.
           Sincerely,
                                                   Alan W. Bowers,
     National Commander.
                                  ____



                                                       AMVETS,

                                    Lantham, MD, February 9, 2004.
     Hon. Kent Conrad,
     Hart Senate Office Building, U.S. Senate, Washington, DC.
       Dear Senator Conrad: It is our understanding that you plan 
     to offer legislation that would help reduce the time veterans 
     must wait for a VA doctor's appointment. AMVETS, a nationwide 
     veterans service organization, is pleased to support your 
     proposal.
       The need for reducing the time veterans wait for medical 
     exams is well documented. A report issued last year by the 
     President's task force on improving veterans health care 
     delivery said there were nearly 300,000 veterans waiting for 
     medical services at the start of 2003.
       While progress is being made to gain more timely care for 
     veterans, the Secretary's decision to halt enrollment of 
     certain veterans for the remainder of the year and into the 
     next fiscal year is another clear indicator that VA cannot 
     meet its own standard for scheduling and appointment within 
     30 days.
       Your proposal would establish a two-year pilot program in 
     three Veterans Integrated Service Networks--a highly rural 
     VISN, a rural VISN, and an urban VISN--to improve access for 
     veterans seeking care and determine how much such standards 
     would cost in terms of resources and impact on other VA 
     medical services.
       In effect, the bill provides a valuable tool to use for 
     reducing waiting times and responding to the healthcare needs 
     of veterans. Moreover, it would provide vital information on 
     the actual resource needs necessary to ensure veterans earned 
     benefits are provided in a timely manner.
       We are grateful for your leadership in proposing this 
     legislation, and we thank you for supporting the men and 
     women who have served America's Armed Forces.
           Sincerely,
                                                 Richard A. Jones,
                                    National Legislative Director.

   Mr. GRAHAM. Mr. President, I rise today with my friend, Senator 
Conrad, in support of legislation to ensure that the Department of 
Veterans Affairs meets appropriate health care access standards.
   With more than 60,000 veterans nationwide still on waiting lists to 
see a doctor--in some cases for more than a year--we must take measures 
to combat this problem. Right now, at the Gainesville VA Hospital in my 
home State of Florida, there are 1,085 veterans that have been waiting 
6 months or longer to see a primary care doctor. And at the Fort Myers 
Outpatient Clinic, almost 600 veterans must wait at least a year to see 
an eye doctor. While VA has made improvements over the past year, I 
remain skeptical of their ability to rectify the problem. My concerns 
were exacerbated by a May 2003 Inspector General report which concluded 
that VA needed to improve their accuracy in tracking patients on 
waiting lists.
   The legislation Senator Conrad and I are introducing today would 
establish three pilot programs that seek to improve the timeliness of 
veterans' access to VA health care services. The programs would first 
require VA to meet the access standards they set for themselves at 30 
days for a primary care appointment and 30 days for a specialty care 
appointment. If VA cannot schedule an appointment for a patient within 
this timeline, then they must provide for the service elsewhere, such 
as through contracts with local private health care facilities.
   This initiative would merely put VA's already existing access 
standards into law, reinforcing VA's own targets and sending a message 
that we are willing to work with VA to help combat this problem. It has 
been over a year now that the Department has dealt with waiting lists 
and has yet to eliminate them. We cannot continue to sit back and 
criticize--we have provided the funding VA needs, and now we must also 
try to assist them in other ways.
   Most importantly, the pilot program would be cost-neutral because it 
grants the Secretary discretion to defer from the access requirements 
if the cost of outside care exceeds that of VA's. Therefore, there will 
be no detriment to the VA system for providing timely access to needed 
health care services. I know my colleagues agree that our Nation's 
veterans deserve quality health care within a reasonable time frame, 
and I urge them to support this legislation.

                          ____________________