To direct the Secretary of Veterans Affairs to enter into contracts for the 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, and for other purposes.
The Veteran Access to Care Act of 2014 (H.R. 4810) is a bill that would allow United States veterans to receive their healthcare from non-VA facilities under certain conditions.[1][2] The bill is a response to the Veterans Health Administration scandal of 2014, in which it was discovered that there was systematic lying about the wait times veterans experienced waiting to be seen by doctors.[3][4] By June 5, 2014, Veterans Affairs internal investigations had identified a total of 35 veterans who had died while waiting for care in the Phoenix VHA system.[5] Another audit determined that "more than 57,000 veterans waited at least 90 days to see a doctor, while another 63,000 over the last decade never received an initial appointment."[6]
CNN reported on April 30, 2014, that at least 40 United States Armed Forcesveterans died while waiting for care at the Phoenix, Arizona, Veterans Health Administration facilities. By June 5, 2014, Veterans Affairs internal investigations had identified a total of 35 veterans who had died while waiting for care in the Phoenix VHA system.[5] An investigation of delays in treatment throughout the Veterans Health Administration system is being conducted by the Veterans Affairs Office of the Inspector General,[3][4][7] and the House has passed legislation to fund a $1 million criminal investigation by the Justice Department.[8] On May 16, 2014, the Veterans Health Administration's top health official, Dr. Robert Petzel, retired early at the request of Secretary of Veterans AffairsEric Shinseki.[9][10] On May 30, 2014, Secretary Shinseki, himself, resigned from office amid the fallout from the controversy.[11][12] As of early June 2014, several other VA medical centers around the nation have been identified with the same problems as the Phoenix facility, and the investigations by the VA Inspector General, the Congress and others are widening.[3][12][13][14][15][16][17]
The Veteran Access to Care Act of 2014 would, in section 2, direct the Secretary of Veterans Affairs (VA) to enter into contracts with such non-VA facilities as may be necessary to furnish hospital care and medical services to veterans who:[1]
have waited longer than the wait-time goals of the Veterans Health Administration (VHA) (as of June 1, 2014) for an appointment for hospital care or medical services in a VA facility;
have been notified by a VA facility that an appointment for hospital care or medical services is not available within such wait-time goals; or
reside more than 40 miles from the VA medical facility, including a community-based outpatient clinic, that is closest to their residence.
The bill would allow eligible veterans who opt for hospital care or medical services in a non-VA facility to receive such care or services through the completion of the episode of care, but for no longer than 60 days.[1]
The bill would direct the Secretary to submit a quarterly report to Congress on the provision of such hospital care and medical services through contracts with non-VA facilities.[1]
The bill would terminate the Secretary's authority to contract with non-VA facilities for the provision of such care and services two years after this Act's enactment.[1]
Section 3 would direct the Secretary, to the extent that appropriations are available to the VHA for medical services, to reimburse non-VA facilities with which the VA does not have such a contract for providing hospital care and medical services to such veterans, if such care and services cannot be provided within the VHA's wait-time goals in a facility with which the VA has a contract. Sets the reimbursement rate for such care or services at the greatest of the VA, Medicare, or TRICARE (a Department of Defense [DOD] managed care program) payment rate for such care or services.[1]
The bill would terminate the Secretary's authority to reimburse non-VA facilities for the provision of such care and services two years after this Act's enactment.[1]
Section 4 would direct the Secretary, within 120 days of this Act's enactment, to enter into a contract or contracts with a private entity or entities with experience in VHA and private delivery systems and in health care management to conduct an independent assessment of the hospital care and medical services furnished in VA facilities.[1]
The bill would list the factors that must be addressed in assessing veterans access to, and the quality of, hospital care and medical services in VA facilities.[1]
The bill would direct the Secretary to submit reports to the congressional veterans committees regarding: (1) the findings and recommendations of the independent assessment; and (2) the Secretary's response to those findings, including an action plan for fully implementing such recommendations.[1]
Section 5 would prohibit the Secretary from paying awards and bonuses to VA employees for FY2014-FY2016.[1]
Section 6 would require the Director of the Office of Management and Budget (OMB), within 30 days of this Act's enactment, to transmit to Congress:[1]
an estimate of the budgetary effects of this Act's coverage of hospital care and medical services for veterans in non-VA facilities;
any transfer authority needed to utilize the savings from denying VA awards and bonuses to satisfy such budgetary effects; and
a request, if necessary, for additional funding, or the transfer or reprogramming of existing funding, for this Act's coverage of the hospital care and medical services provided to veterans in non-VA facilities.
H.R. 4810 would authorize the Department of Veterans Affairs (VA) to increase the provision of health care by contracting out to non-VA providers. For that purpose, the Secretary would be able to use available appropriations. Thus, the Congressional Budget Office (CBO) anticipates that this bill would make available some appropriated funds that would otherwise lapse - an estimated $620 million over the 2014-2016 period. In addition to those direct spending costs shown above, the bill would also substantially increase spending for veterans' health care, if sufficient appropriations were provided for that purpose. The CBO has not completed an estimate of the discretionary costs.[2]
Rep. Jeff Miller, who sponsored the bill, said that the wait times veterans were forced to face was "a national disgrace."[6]
Rep. Michael Michaud (D-ME) argued that the care veterans receive at the VA is not the problem, but the wait times were. Michaud stated that "we often hear that the care veterans receive at the VA facilities is second to none. That is, if you can get in... Tens of thousands of veterans are not getting in."[6]
Rep. Julia Brownley (D-CA) argued that the legislation should consider time as well as distance when it came to allowing veterans to visit non-VA medical centers. Brownley argued that "those of us who represent urban areas like Southern California we all know that 40 miles can take the better part of a day to traverse back and forth."[6]
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