[House Report 113-475]
[From the U.S. Government Publishing Office]


113th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     113-475

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      PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 4870) MAKING 
APPROPRIATIONS FOR THE DEPARTMENT OF DEFENSE FOR THE FISCAL YEAR ENDING 
     SEPTEMBER 30, 2015, AND FOR OTHER PURPOSES, AND PROVIDING FOR 
 CONSIDERATION OF THE SENATE AMENDMENTS TO THE BILL (H.R. 3230) MAKING 
 CONTINUING APPROPRIATIONS DURING A GOVERNMENT SHUTDOWN TO PROVIDE PAY 
AND ALLOWANCES TO MEMBERS OF THE RESERVE COMPONENTS OF THE ARMED FORCES 
         WHO PERFORM INACTIVE-DUTY TRAINING DURING SUCH PERIOD

                                _______
                                

   June 17, 2014.--Referred to the House Calendar and ordered to be 
                                printed

                                _______
                                

               Mr. Nugent, from the Committee on Rules, 
                        submitted the following

                              R E P O R T

                       [To accompany H. Res. 628]

    The Committee on Rules, having had under consideration 
House Resolution 628, by a record vote of 9 to 3, report the 
same to the House with the recommendation that the resolution 
be adopted.

                SUMMARY OF PROVISIONS OF THE RESOLUTION

    The resolution provides for consideration of H.R. 4870, the 
Department of Defense Appropriations Act, 2015, under a 
modified-open rule. The resolution provides one hour of general 
debate equally divided and controlled by the chair and ranking 
minority member of the Committee on Appropriations. The 
resolution waives all points of order against consideration of 
the bill. The resolution waives points of order against 
provisions in the bill for failure to comply with clause 2 of 
rule XXI. The resolution provides that after general debate the 
bill shall be considered for amendment under the five-minute 
rule. During consideration of the bill for amendment: (1) 
amendments shall be debatable for 10 minutes equally divided 
and controlled by the proponent and an opponent and shall not 
be subject to amendment; and (2) no pro forma amendment shall 
be in order except that the chair and ranking minority member 
of the Committee on Appropriations or their respective 
designees may offer up to 10 pro forma amendments each at any 
point for the purpose of debate. Under the Rules of the House 
the bill shall be read for amendment by paragraph. The 
resolution authorizes the Chair to accord priority in 
recognition to Members who have pre-printed their amendments in 
the Congressional Record. The resolution provides one motion to 
recommit with or without instructions.
    Section 2 of the resolution provides for the consideration 
of the Senate amendments to H.R. 3230. The resolution makes in 
order a single motion offered by the chair of the Committee on 
Veterans' Affairs or his designee that the House concur in the 
Senate title amendment and concur in the Senate amendment to 
the text with the amendment printed in this report. The 
resolution waives all points of order against consideration of 
the motion; provides that the motion is not subject to a demand 
for division of the question; and provides that the motion is 
not subject to a question of consideration. The resolution 
provides that the Senate amendments and the motion shall be 
considered as read. The resolution provides one hour of debate 
on the motion equally divided and controlled by the chair and 
ranking minority member of the Committee on Veterans' Affairs. 
The resolution provides that if the motion is adopted, the 
chair of the Committee on Veterans' Affairs or his designee is 
then authorized to move that the House insist on its amendment 
to the Senate amendment to the text and request a conference 
with the Senate thereon.

                         EXPLANATION OF WAIVERS

    The waiver of all points of order against consideration of 
H.R. 4870 includes a waiver of clause 4(c) of rule XIII, which 
prohibits consideration of a general appropriations bill 
reported by the Committee on Appropriations from being 
considered in the House until the third calendar day on which 
printed hearings of the Committee on Appropriations thereon 
have been available to Members, and section 306 of the 
Congressional Budget Act, which prohibits consideration of 
legislation within the jurisdiction of the Committee on the 
Budget unless referred to or reported by the Budget Committee.
    The resolution includes a waiver of points of order against 
provisions in H.R. 4870 for failure to comply with clause 2 of 
rule XXI, which prohibits unauthorized appropriations or 
legislative provisions in an appropriations bill. The waiver is 
necessary because the bill contains unauthorized appropriations 
and legislative provisions included in the bill.
    Although the resolution waives all points of order against 
consideration of the motion to concur in the Senate title 
amendment and to concur in the Senate amendment to the text of 
H.R. 3230, with the amendment printed in this report, the 
Committee is not aware of any points of order. The waiver is 
prophylactic in nature.

                            COMMITTEE VOTES

    The results of each record vote on an amendment or motion 
to report, together with the names of those voting for and 
against, are printed below:

Rules Committee record vote No. 141

    Motion by Mr. Bishop of Utah to report the rule. Adopted: 
9-3.

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                Majority Members                      Vote               Minority Members               Vote
----------------------------------------------------------------------------------------------------------------
Ms. Foxx........................................          Yea   Ms. Slaughter.....................          Nay
Mr. Bishop of Utah..............................          Yea   Mr. McGovern......................          Nay
Mr. Cole........................................          Yea   Mr. Hastings of Florida...........          Nay
Mr. Woodall.....................................          Yea   Mr. Polis.........................  ............
Mr. Nugent......................................          Yea
Mr. Webster.....................................          Yea
Ms. Ros-Lehtinen................................          Yea
Mr. Burgess.....................................          Yea
Mr. Sessions, Chairman..........................          Yea
----------------------------------------------------------------------------------------------------------------

 SUMMARY OF THE HOUSE AMENDMENT TO THE SENATE AMENDMENT TO THE TEXT OF 
                               H.R. 3230

    Includes the text of H.R. 4810 and H.R. 4031, as passed by 
the House, with a modification.

TEXT OF THE HOUSE AMENDMENT TO THE SENATE AMENDMENT TO THE TEXT OF H.R. 
                                  3230

  In lieu of the matter proposed to be inserted by the 
amendment of the Senate to the text of the bill, insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Veteran Access to Care Act of 
2014''.

SEC. 2. PROVISION OF HOSPITAL CARE AND MEDICAL SERVICES AT NON-
                    DEPARTMENT OF VETERANS AFFAIRS FACILITIES FOR 
                    DEPARTMENT OF VETERANS AFFAIRS PATIENTS WITH 
                    EXTENDED WAITING TIMES FOR APPOINTMENTS AT 
                    DEPARTMENT FACILITIES.

  (a) In General.--As authorized by section 1710 of title 38, 
United States Code, the Secretary of Veterans Affairs (in this 
Act referred to as the ``Secretary'') shall enter into 
contracts with such non-Department facilities as may be 
necessary in order to furnish hospital care and medical 
services to covered veterans who are eligible for such care and 
services under chapter 17 of title 38, United States Code. To 
the greatest extent possible, the Secretary shall carry out 
this section using contracts entered into before the date of 
the enactment of this Act.
  (b) Covered Veterans.--For purposes of this section, the term 
``covered veteran'' means a veteran--
          (1) who is enrolled in the patient enrollment system 
        under section 1705 of title 38, United States Code;
          (2) who--
                  (A) has waited longer than the wait-time 
                goals of the Veterans Health Administration (as 
                of June 1, 2014) for an appointment for 
                hospital care or medical services in a facility 
                of the Department;
                  (B) has been notified by a facility of the 
                Department that an appointment for hospital 
                care or medical services is not available 
                within such wait-time goals; or
                  (C) resides more than 40 miles from the 
                medical facility of the Department of Veterans 
                Affairs, including a community-based outpatient 
                clinic, that is closest to the residence of the 
                veteran; and
          (3) who makes an election to receive such care or 
        services in a non-Department facility.
  (c) Follow-Up Care.--In carrying out this section, the 
Secretary shall ensure that, at the election of a covered 
veteran who receives hospital care or medical services at a 
non-Department facility in an episode of care under this 
section, the veteran receives such hospital care and medical 
services at such non-Department facility through the completion 
of the episode of care (but for a period not exceeding 60 
days), including all specialty and ancillary services deemed 
necessary as part of the treatment recommended in the course of 
such hospital care or medical services.
  (d) Report.--The Secretary shall submit to Congress a 
quarterly report on hospital care and medical services 
furnished pursuant to this section. Such report shall include 
information, for the quarter covered by the report, regarding--
          (1) the number of veterans who received care or 
        services at non-Department facilities pursuant to this 
        section;
          (2) the number of veterans who were eligible to 
        receive care or services pursuant to this section but 
        who elected to continue waiting for an appointment at a 
        Department facility;
          (3) the purchase methods used to provide the care and 
        services at non-Department facilities, including the 
        rate of payment for individual authorizations for such 
        care and services; and
          (4) any other matters the Secretary determines 
        appropriate.
  (e) Definitions.--For purposes of this section, the terms 
``facilities of the Department'', ``non-Department 
facilities'', ``hospital care'', and ``medical services'' have 
the meanings given such terms in section 1701 of title 38, 
United States Code.
  (f) Implementation.--The Secretary shall begin implementing 
this section on the date of the enactment of this Act.
  (g) Construction.--Nothing in this section shall be construed 
to authorize payment for care or services not otherwise covered 
under chapter 17 of title 38, United States Code.
  (h) Termination.--The authority of the Secretary under this 
section shall terminate with respect to any hospital care or 
medical services furnished after the end of the 2-year period 
beginning on the date of the enactment of this Act, except that 
in the case of an episode of care for which hospital care or 
medical services is furnished in a non-Department facility 
pursuant to this section before the end of such period, such 
termination shall not apply to such care and services furnished 
during the remainder of such episode of care but not to exceed 
a period of 60 days.

SEC. 3. EXPANDED ACCESS TO HOSPITAL CARE AND MEDICAL SERVICES.

  (a) In General.--To the extent that appropriations are 
available for the Veterans Health Administration of the 
Department of Veterans Affairs for medical services, to the 
extent that the Secretary of Veterans Affairs is unable to 
provide access, within the wait-time goals of the Veterans 
Health Administration (as of June 1, 2014), to hospital care or 
medical services to a covered veteran who is eligible for such 
care or services under chapter 17 of title 38, United States 
Code, under contracts described in section 2, the Secretary 
shall reimburse any non-Department facility with which the 
Secretary has not entered into a contract to furnish hospital 
care or medical services for furnishing such hospital care or 
medical services to such veteran, if the veteran elects to 
receive such care or services from the non-Department facility. 
The Secretary shall reimburse the facility for the care or 
services furnished to the veteran at the greatest of the 
following rates:
          (1) VA payment rate.--The rate of reimbursement for 
        such care or services established by the Secretary of 
        Veterans Affairs.
          (2) Medicare payment rate.--The payment rate for such 
        care or services or comparable care or services under 
        the Medicare program under title XVIII of the Social 
        Security Act.
          (3) TRICARE payment rate.--The reimbursement rate for 
        such care or services furnished to a member of the 
        Armed Forces under chapter 55 of title 10, United 
        States Code.
  (b) Covered Veterans.--For purposes of this section, the term 
``covered veteran'' means a veteran--
          (1) who is enrolled in the patient enrollment system 
        under section 1705 of title 38, United States Code; and
          (2) who--
                  (A) has waited longer than the wait-time 
                goals of the Veterans Health Administration (as 
                of June 1, 2014) for an appointment for 
                hospital care or medical services in a facility 
                of the Department;
                  (B) has been notified by a facility of the 
                Department that an appointment for hospital 
                care or medical services is not available 
                within such wait-time goals after the date for 
                which the veteran requests the appointment; or
                  (C) who resides more than 40 miles from the 
                medical facility of the Department of Veterans 
                Affairs, including a community-based outpatient 
                clinic, that is closest to the residence of the 
                veteran.
  (c) Definitions.--For purposes of this section, the terms 
``facilities of the Department'', ``non-Department 
facilities'', ``hospital care'', and ``medical services'' have 
the meanings given such terms in section 1701 of title 38, 
United States Code.
  (d) Implementation.--The Secretary shall begin implementing 
this section on the date of the enactment of this Act.
  (e) Construction.--Nothing in this section shall be construed 
to authorize payment for care or services not otherwise covered 
under chapter 17 of title 38, United States Code.
  (f) Termination.--The authority of the Secretary under this 
section shall terminate with respect to care or services 
furnished after the date that is 2 years after the date of the 
enactment of this Act.

SEC. 4. INDEPENDENT ASSESSMENT OF VETERANS HEALTH ADMINISTRATION 
                    PERFORMANCE.

  (a) Independent Assessment Required.--Not later than 120 days 
after the date of the enactment of this Act, the Secretary of 
Veterans Affairs shall enter into a contract or contracts with 
a private sector entity or entities with experience in the 
delivery systems of the Veterans Health Administration and the 
private sector and in health care management to conduct an 
independent assessment of hospital care and medical services 
furnished in medical facilities of the Department of Veterans 
Affairs. Such assessment shall address each of the following:
          (1) The current and projected demographics and unique 
        care needs of the patient population served by the 
        Department of Veterans Affairs.
          (2) The current and projected health care 
        capabilities and resources of the Department, including 
        hospital care and medical services furnished by non-
        Department facilities under contract with the 
        Department, to provide timely and accessible care to 
        eligible veterans.
          (3) The authorities and mechanisms under which the 
        Secretary may furnish hospital care and medical 
        services at non-Department facilities, including an 
        assessment of whether the Secretary should have the 
        authority to furnish such care and services at such 
        facilities through the completion of episodes of care.
          (4) The appropriate system-wide access standard 
        applicable to hospital care and medical services 
        furnished by and through the Department of Veterans 
        Affairs and recommendations relating to access 
        standards specific to individual specialties and 
        standards for post-care rehabilitation.
          (5) The current organization, processes, and tools 
        used to support clinical staffing and documentation.
          (6) The staffing levels and productivity standards, 
        including a comparison with industry performance 
        percentiles.
          (7) Information technology strategies of the Veterans 
        Health Administration, including an identification of 
        technology weaknesses and opportunities, especially as 
        they apply to clinical documentation of hospital care 
        and medical services provided in non-Department 
        facilities.
          (8) Business processes of the Veterans Health 
        Administration, including non-Department care, 
        insurance identification, third-party revenue 
        collection, and vendor reimbursement.
  (b) Assessment Outcomes.--The assessment conducted pursuant 
to subsection (a) shall include the following:
          (1) An identification of improvement areas outlined 
        both qualitatively and quantitatively, taking into 
        consideration Department of Veterans Affairs directives 
        and industry benchmarks from outside the Federal 
        Government.
          (2) Recommendations for how to address the 
        improvement areas identified under paragraph (1) 
        relating to structure, accountability, process changes, 
        technology, and other relevant drivers of performance.
          (3) The business case associated with making the 
        improvements and recommendations identified in 
        paragraphs (1) and (2).
          (4) Findings and supporting analysis on how credible 
        conclusions were established.
  (c) Program Integrator.--If the Secretary enters into 
contracts with more than one private sector entity under 
subsection (a), the Secretary shall designate one such entity 
as the program integrator. The program integrator shall be 
responsible for coordinating the outcomes of the assessments 
conducted by the private entities pursuant to such contracts.
  (d) Submittal of Reports to Congress.--
          (1) Report on independent assessment.--Not later than 
        10 months after entering into the contract under 
        subsection (a), the Secretary shall submit to the 
        Committees on Veterans' Affairs of the Senate and House 
        of Representatives the findings and recommendations of 
        the independent assessment required by such subsection.
          (2) Report on va action plan to implement 
        recommendations in assessment.--Not later than 120 days 
        after the date of submission of the report under 
        paragraph (1), the Secretary shall submit to such 
        Committees on the Secretary's response to the findings 
        of the assessment and shall include an action plan, 
        including a timeline, for fully implementing the 
        recommendations of the assessment.

SEC. 5. LIMITATION ON AWARDS AND BONUSES TO EMPLOYEES OF DEPARTMENT OF 
                    VETERANS AFFAIRS.

  For each of fiscal years 2014 through 2016, the Secretary of 
Veterans Affairs may not pay awards or bonuses under chapter 45 
or 53 of title 5, United States Code, or any other awards or 
bonuses authorized under such title.

SEC. 6. OMB ESTIMATE OF BUDGETARY EFFECTS AND NEEDED TRANSFER 
                    AUTHORITY.

  Not later than 30 days after the date of the enactment of 
this Act, the Director of the Office of Management and Budget 
shall transmit to the Committees on Appropriations, the Budget, 
and Veterans' Affairs of the House of Representatives and of 
the Senate--
          (1) an estimate of the budgetary effects of sections 
        2 and 3;
          (2) any transfer authority needed to utilize the 
        savings from section 5 to satisfy such budgetary 
        effects; and
          (3) if necessary, a request for any additional 
        budgetary resources, or transfers or reprogramming of 
        existing budgetary resources, necessary to provide 
        funding for sections 2 and 3.

SEC. 7. REMOVAL OF SENIOR EXECUTIVE SERVICE EMPLOYEES OF THE DEPARTMENT 
                    OF VETERANS AFFAIRS FOR PERFORMANCE.

  (a) In General.--Chapter 7 of title 38, United States Code, 
is amended by adding at the end the following new section:

``Sec. 713. Senior Executive Service: removal based on performance

  ``(a) In General.--Notwithstanding any other provision of 
law, the Secretary may remove any individual from the Senior 
Executive Service if the Secretary determines the performance 
of the individual warrants such removal. If the Secretary so 
removes such an individual, the Secretary may--
          ``(1) remove the individual from Federal service; or
          ``(2) transfer the individual to a General Schedule 
        position at any grade of the General Schedule the 
        Secretary determines appropriate.
  ``(b) Notice to Congress.--Not later than 30 days after 
removing an individual from the Senior Executive Service under 
paragraph (1), the Secretary shall submit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives 
notice in writing of such removal and the reason for such 
removal.
  ``(c) Manner of Removal.--A removal under this section shall 
be done in the same manner as the removal of a professional 
staff member employed by a Member of Congress.''.
  (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. Senior Executive Service: removal based on performance.''.

SEC. 8. BUDGETARY EFFECTS OF ACT.

  The budgetary effects of this Act, for the purpose of 
complying with the Statutory Pay-As-You-Go-Act of 2010, shall 
be determined by reference to the latest statement titled 
``Budgetary Effects of PAYGO Legislation'' for this Act, 
submitted for printing in the Congressional Record by the 
Chairman of the House Budget Committee, provided that such 
statement has been submitted prior to the vote on passage.

                                  
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