June 11, 2014

Legislative Notice: S. 2450 – Veterans Access to Care


Background: The Veterans’ Access to Care through Choice, Accountability, and Transparency Act of 2014, S. 2450, was placed on the calendar on June 10, 2014. It did not go through committee. The House unanimously passed the Veterans Access to Care Act, H.R. 4810. That bill would require VA to offer non-VA care to certain veterans who cannot get an appointment within the VA wait-time goals. The government would then reimburse the provider for that care at the rate set by the VA, Tricare, or Medicare, whichever is greatest. The House has also passed the Department of Veterans Affairs Management Accountability Act of 2014, H.R. 4031, by a vote of 390-33. This bill enhances the authority of the secretary to hold accountable VA Senior Executive Service staff if the secretary determines that is warranted.

Floor Situation: Majority Leader Reid has placed this bill directly on the calendar, thereby bypassing the committee process once again. Unanimous consent has been entered into providing for consideration of this bill. No amendments will be in order or considered. If a budget point of order is raised against the bill, the Senate will vote on the applicable motion to waive at 4PM today, followed by a vote on final passage.

Executive Summary: The bill’s main feature is to authorize a “choice card” for certain veterans so they can get health services outside the VA system if they can’t get an appointment in that system within the department’s wait-time goals. It also provides such an election to veterans residing more than 40 miles from a VA facility. The government is then to reimburse the non-VA health care provider for the services provided to the veteran. It also authorizes the secretary to hold accountable members of the Senior Executive Service if the secretary determines the performance of the individual warrants it. The bill authorizes and appropriates such sums as may be necessary to carry out this bill for fiscal years 2014 through 2016. No further appropriation will be necessary to make the funding available for these years. All of the spending for the bill is designated as an emergency requirement, and therefore the Budget Control Act caps are not implicated. There is no cost estimate for how much this bill adds to the deficit.

Overview of the Issue

Despite more than a 60 percent increase in veterans spending under the Obama administration, the national embarrassment of its management of the veterans health care system and its failure to our veterans has become apparent in the past few months.

For example, a recent VA audit found there are more than 57,000 veterans nationwide currently waiting to be scheduled for care. It further found another 64,000 “who over the past ten years have enrolled in [the VA] healthcare system and have not been seen for an appointment.”

A review of the Phoenix Health Care System found the facility manipulated its wait-time performance by not placing close to 1,700 veterans who were waiting for a primary care appointment on the official electronic waiting list. It found the effect of this is that “the Phoenix HCS leadership significantly understated the time new patients waited for their primary care appointment in their FY2013 performance appraisal accomplishments, which is one of the factors considered for awards and salary increases.” More generally, it further found “inappropriate scheduling practices are systemic” throughout the Veterans Health Administration.

This is a management and competence issue of the Obama administration VA, not a resource issue. The VA itself claimed in its fiscal year 2015 budget submission that “total VA funding has grown in 2015 by nearly 68% from 2009.”

Notable Bill Provisions

Sections 101 and 102 – Improvement of scheduling system for health care appointments

These sections together require an independent assessment of the scheduling procedures for health care appointments at VA medical facilities and a technology task force to review the scheduling system and software.

Sections 201 and 202 – Treatment of staffing shortage and clinic management

These sections are directed at identifying the health provider occupations with the largest staffing shortages, remedying that, and improving health care management through training.

Section 203 – Use of unobligated amounts

Authorizes the use of certain unobligated balances at the end of the next two fiscal years to hire additional health care providers for the Veterans Health Administration.

Section 301 – Expanded availability of medical services

Authorizes the issuance of a “choice card” to certain veterans for them to seek care from certain providers outside the VA system, namely from providers participating in the Medicare program, or funded by the Department of Defense or Indian Health Service. To be eligible, a veteran must be enrolled in the VA system and either have attempted to schedule an appointment within that system that cannot be provided within the Department’s wait-time goals or reside more than 40 miles from a VA facility or community-based outpatient clinic. The providers must maintain the same or similar credentials and licenses as those required for VA health care providers. This authorization shall terminate two years after the date the interim final regulations are published, which is to occur 90 days after enactment.

It further directs the secretary of the VA to enter into contracts to carry out this program, particularly as it pertains to the reimbursement rate, to be no more than rates paid out under the Medicare program. There is an exception, in that the secretary may negotiate a higher reimbursement rate if he determines there are no health care providers who will provide such care and services at the Medicare reimbursement rate within the current wait-time goals of the department within a 40-mile radius for eligible veterans.

The section also requires a variety of reports on this program, to include an assessment on the feasibility and advisability of continuing this program after its termination.

Section 305 – Sense of the Senate on payment

Expresses the sense of Congress that reimbursements to non-VA health care providers should comply with the “prompt payment rule.”

Section 404 – Improved performance metrics

Requires the secretary to ensure that scheduling and wait-time metrics are not used as factors in the determination of performance bonuses.

Section 405 – Improved transparency

Requires the publication of the department’s wait time goals and current wait times at its medical centers.

Section 409 – Removal of senior executives

Authorizes the secretary to remove or demote any individual from the Senior Executive Service if the secretary determines the performance of the individual warrants such removal. The secretary must then notify Congress within 30 days of removing or demoting an individual. The senior executive would be allowed an expedited review by the Merit Systems Protection Board. 

Section 502 – Treatment of sexual trauma

This section concerns the health care made available through the department to victims of sexual trauma.

Sections 601 and 602 – Medical facility leases

These sections authorize the department to carry out major medical facility leases specified in the bill. The VA is among the largest real property owners in the federal government. Current law requires congressional authorization for the VA to lease its space for use as a new medical facility if it expects an average annual rent of more than one million dollars.

Section 702 – Education benefits

Requires a public institution of higher learning to charge in-state tuition rates for people receiving certain veterans educational benefits if the person is living in the state and enrolls in a course of education there within three years of departure from military service.

Section 801 – Appropriation of emergency amounts

This section authorizes and appropriates such sums as may be necessary to carry out the act for fiscal years 2014, 2015 and 2016. No further appropriation will be necessary in order to make the funding available to the executive branch for these years.

Section 802 – Emergency designations

Designates this act as an emergency requirement under the Statutory Pay-As-You-Go Act of 2010 and under the fiscal year 2010 budget resolution. This has the effect of waiving the mandatory spending restrictions that would ordinarily be imposed by these measures.

Administration Position

The administration has not published a Statement of Administration Policy regarding the bill at this time.


There is no CBO score available for the bill at this time. CBO estimated the cost of H.R. 4810. It estimated the cost to be $61 million, $543 million, and $16 million, in fiscal years 2014 through 2016, respectively. It noted the secretary would be able to use available appropriations under the House bill. The House bill further directed OMB to estimate the budgetary impacts of the bill and what additional transfer authority or resources may be required to carry it out.


No amendments will be in order during the consideration of this bill.