Veterans Access, Choice, and Accountability
Act of 2014 (H.R. 3230; P.L. 113-146)
Sidath Viranga Panangala
Specialist in Veterans Policy
Maeve P. Carey
Analyst in Government Organization and Management
Cassandria Dortch
Analyst in Education Policy
Elayne J. Heisler
Specialist in Health Services
February 10, 2015
Congressional Research Service
7-5700
www.crs.gov
R43704
Veterans Access, Choice, and Accountability Act of 2014 (H.R. 3230; P.L. 113-146)
Summary
On August 7, 2014, the President signed the Veterans Access, Choice, and Accountability Act of
2014 (H.R. 3230; H.Rept. 113-564; P.L. 113-146). The Department of Veterans Affairs Expiring
Authorities Act of 2014 (H.R. 5404; P.L. 113-175), and the Consolidated and Further Continuing
Appropriations Act, 2015 (H.R. 83; P.L. 113-235), made minor amendments to some provisions
in P.L. 113-146. The act, as amended, makes a number of changes to programs and policies of the
Veterans Health Administration (VHA) within the Department of Veterans Affairs (VA) that aim
to increase access and lower wait times for veterans who seek care at VA facilities. Among other
things, the act establishes a new program (the Veterans Choice Program) that would allow the VA
to authorize care for veterans outside the VA health care system if they meet any of the following
requirements:
1. attempts, or has attempted, to schedule an appointment but is unable to schedule
an appointment within the current wait-time goals of the VHA for the furnishing
of care or services and chooses to receive care in a non-VA facility; or
2. resides more than 40 miles from the nearest VA medical facility including a
community-based outpatient clinic (CBOC); or
3. resides in a state without a VA medical facility that provides (a) hospital care; (b)
emergency medical services; and (c) surgical care, or more than 20 miles away
from such a VA medical facility; or
4. resides within 40 miles of a VA medical facility and is required to travel by air,
boat, or ferry to access such a facility; or who faces geographical challenges in
accessing that medical facility as determined by the VA.
This report offers an overview of the provisions in the law, which requires, among other things:
• increased collaboration between the VA and facilities operated by the Indian
Health Service or the Native Hawaiian Health Care System and requiring
increased funding for graduate medical education training at the VA;
• the extension of Project ARCH (Access Received Closer to Home) within
specified Veterans Integrated Service Networks (VISNs) for veterans in highly
rural areas who are enrolled in VA health care for an additional two years;
• several studies to examine a variety of issues pertaining to VA’s health care
delivery system, and to explore ideas on how best to reform the system;
• imposition of penalties on VA employees who knowingly falsify data on patient
wait times or health care quality measures or knowingly request other VA
employees to falsify such data; and
• limitations on VA employee bonuses and removal or transfer of VA senior
executives for performance or misconduct and expedited review of such actions.
According to the Congressional Budget Office (CBO), the Veterans Choice and Accountability
Act of 2014 (H.R. 3230; P.L. 113-146) will appropriate $15 billion to implement various
provisions of the act, and of this amount, $10 billion will be appropriated to increase access to
care through non-VA entities and providers. According to CBO, implementing the act will
increase the deficit by approximately $10 billion over a 10-year period. P.L. 113-146 provides
approximately $5 billion in spending offsets.
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Contents
Introduction ...................................................................................................................................... 1
Impact on Federal Spending ...................................................................................................... 1
Sec. 1. Short Title ...................................................................................................................... 3
Sec. 2. Definitions ..................................................................................................................... 3
Title I: Improvement of Access to Care from Non-Department of Veterans Affairs
Providers ....................................................................................................................................... 3
Sec. 101. Availability of Hospital Care and Medical Services through the Use of Non-
VA Entities .............................................................................................................................. 4
Eligibility ............................................................................................................................. 4
Choice of Provider .............................................................................................................. 5
Coordination of Care with Non-VA Entities ....................................................................... 5
Authorization of Care by the VA ......................................................................................... 6
Electronic Waiting List ........................................................................................................ 6
Care and Services Through Agreements ............................................................................. 6
Rates of Reimbursement ..................................................................................................... 6
VA as the Secondary Payer of Care ..................................................................................... 7
Veterans Choice Card .......................................................................................................... 7
Information on Availability of Care .................................................................................... 8
Follow-Up Care ................................................................................................................... 8
Credentials of Providers ...................................................................................................... 8
Copayments ......................................................................................................................... 8
Health Care Claims Processing ........................................................................................... 8
Medical Records .................................................................................................................. 8
Tracking Missed Appointments ........................................................................................... 9
Implementing Regulations .................................................................................................. 9
Office of the Inspector General (OIG) Report .................................................................... 9
End Date of the Expanded Authority for Non-VA Care ...................................................... 9
Reports to Congress ............................................................................................................ 9
Filling Prescription Medications ....................................................................................... 10
Wait-Time Goals of the VHA ............................................................................................ 10
Waiver of Certain Printing Requirements ......................................................................... 10
Sec. 102. Enhancement of Collaboration between the VA and Indian Health Service ............ 10
Sec. 103. Enhancement of Collaboration between the VA and the Native Hawaiian
Health Care System .............................................................................................................. 11
Sec. 104. Reauthorization and Modification of Project ARCH (Access Received
Closer to Home) ................................................................................................................... 11
Sec. 105. Prompt Payment ....................................................................................................... 12
Sec. 106. Reimbursement of Non-VA Providers Assigned to the Chief Business
Office (CBO) ........................................................................................................................ 12
Title II: Health Care Administrative Matters ................................................................................. 12
Sec. 201. Independent Assessment of the VA Health Care Delivery Systems and
Management Processes ......................................................................................................... 12
Sec. 202. Commission on Care ................................................................................................ 13
Sec. 203. Technology Task Force on Review of Scheduling System and Software of
the VA ................................................................................................................................... 13
Sec. 204. Improving Access to Mobile Vet Centers and Mobile Medical Centers .................. 14
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Sec. 205. Improved Performance Metrics for Health Care Provided by the VA ..................... 14
Sec. 206. Improved Transparency Concerning Health Care Provided by the VA ................... 14
Sec. 207. Information for Veterans on the Credentials of VA Physicians ................................ 15
Sec. 208. Information in Annual Budget of the President on Hospital Care and
Medical Services Furnished through the Expanded use of Contracts .................................. 15
Sec. 209. Prohibition on Falsification of Data Concerning Wait Times and Quality
Measures at the VA ............................................................................................................... 15
Title III: Health Care Staffing, Recruitment, and Training Matters ............................................... 16
Sec. 301. Treatment of Staffing Shortage and Biennial Report on Staffing of VA
Medical Facilities ................................................................................................................. 16
Sec. 302. Extension and Modification of Certain Programs within the VA’s Health
Professionals Educational Assistance Program .................................................................... 17
Sec. 303. Clinic Management Training for Employees at VA Medical Facilities ................... 17
Title IV: Health Care Related to Sexual Trauma ........................................................................... 17
Sec. 401. Expansion of Eligibility for Sexual Trauma Counseling and Treatment to
Veterans on Inactive Duty Training ...................................................................................... 18
Sec. 402. Provision of Counseling and Treatment for Sexual Trauma by the VA to
Members of the Armed Forces ............................................................................................. 18
Sec. 403. Reports on Military Sexual Trauma ......................................................................... 18
Title V: Other Health Care Matters ................................................................................................ 18
Sec. 501. Extension of Pilot Program on Assisted Living Services for Veterans with
Traumatic Brain Injury ......................................................................................................... 18
Title VI: Major Medical Facility Leases ........................................................................................ 19
Sec. 601. Authorization of Major Medical Facility Leases ..................................................... 19
Sec. 602. Budgetary Treatment of VA Major Medical Facilities Leases ................................. 19
Title VII: Other Veterans Matters .................................................................................................. 20
Sec. 701. Expansion of Marine Gunnery Sergeant John David Fry Scholarship .................... 20
Sec. 702. Approval of Courses of Education Provided by Public Institutions of Higher
Learning for Purposes of All-Volunteer Force Educational Assistance Program and
Post-9/11 Educational Assistance Conditional on In-State Tuition Rate for Veterans ......... 20
Secs. 703, 704, 705, and 706 ................................................................................................... 21
Sec. 707. Removal of Senior Executives of the VA for Performance or Misconduct ............. 21
Title VIII: Other Matters ................................................................................................................ 23
Sec. 801. Appropriation of Amounts ....................................................................................... 23
Sec. 802. Veterans Choice Fund .............................................................................................. 23
Sec. 803. Emergency Designations ......................................................................................... 23
Tables
Table A-1. Veterans Access, Choice, and Accountability Act of 2014 (P.L. 113-146 as
Amended by P.L. 113-175 and P.L. 113-235): Implementation and Reporting Deadlines ......... 24
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Appendixes
Appendix. Veterans Access, Choice, and Accountability Act of 2014: Implementation and
Reporting Deadlines ................................................................................................................... 24
Contacts
Author Contact Information........................................................................................................... 31
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Introduction
In an attempt to address delays in patient care provided by the Department of Veterans Affairs
(VA) health care system and to provide veterans with timely access to care, among other things,
the Senate and House introduced and passed several measures in May and June of 2014. Initially,
on June 9, 2014, the Veterans’ Access to Care through Choice, Accountability, and Transparency
Act of 2014 (S. 2450) was introduced in the Senate, and the Veteran Access to Care Act of 2014
(H.R. 4810) was introduced in the House. The House passed its measure on June 10, but the
Senate chose to act on its proposal by substituting the text of S. 2450 for that of H.R. 3230, a
measure previously received from the House.1 The House then amended the Senate substitute for
H.R. 3230 by substituting the text of H.R. 4810 and also that of the Department of Veterans
Affairs Management Accountability Act of 2014 (H.R. 4031), a measure it had previously passed
on May 21. This action enabled the two chambers to proceed to conference on their respective
versions of H.R. 3230. On July 28, the Co-Chairmen of the Conference Committee, Senator
Bernie Sanders and Representative Jeff Miller, announced that an agreement had been reached,
and reported the measure. The conferees voted on the conference report (H.Rept. 113-564) on the
same day.2 The full House passed the Veterans Access, Choice, and Accountability Act of 2014
(H.R. 3230; H.Rept. 113-564) on July 30, and the Senate passed the conference measure on July
31. The President signed the Veterans Access, Choice, and Accountability Act of 2014 into law
(P.L. 113-146) on August 7, 2014.3 On September 26, 2014, the Department of Veterans Affairs
Expiring Authorities Act of 2014 (H.R. 5404; P.L. 113-175) was signed into law. Sections 408
and 409 of P.L. 113-175 made minor amendments to Sections 101, 102, 104, 105, 204, 206, 207,
301,302, and 702 of the Veterans Access, Choice, and Accountability Act of 2014. On December
16, 2014, President Barack Obama signed into law the Consolidated and Further Continuing
Appropriations Act, 2015 (H.R. 83; P.L. 113-235). Division I of this act contained the Military
Construction and Veterans Affairs, and Related Agencies Appropriations Act, 2015. Section 242
of this act amended Section 101 of the Veterans Access, Choice, and Accountability Act of 2014.
The summary of selected provisions of the Veterans Access, Choice, and Accountability Act of
2014 (P.L. 113-146) provided in this report incorporates these amendments made by P.L. 113-175
and P.L. 113-235.
Impact on Federal Spending
According to the Congressional Budget Office (CBO), H.R. 3230 (H.Rept. 113-564) would
appropriate $15 billion to implement various provisions of the act, and of this amount, $10 billion
would be appropriated to increase access to care through non-VA entities and providers.4
1 The Senate took this course of action because S. 2450 contained appropriations, which the House traditionally insists
must be enacted in a measure it has originated. H.R. 3230 was available for this purpose because Congress had acted in
other legislation on issues that H.R. 3230 originally addressed.
2 “Conference Report on H.R. 3230,” Congressional Record, daily edition, vol.160 (July 28, 2014), pp. H6953-H6974;
and U.S. Congress, Committee of Conference, Veterans Access, Choice, and Accountability Act of 2014, Report to
Accompany H.R. 3230, 113th Cong., 2nd sess., July 28, 2014, H.Rept. 113-564 (Washington: GPO, 2013), pp. 3-81.
3 While some provisions took effect on that same date, other provisions such as the new authority that would allow
veterans to seek care from non-VA health care providers will not take effect until implementing regulations are issued.
4 Congressional Budget Office, Letter to the Honorable Jeff Sessions regarding the conference agreement on H.R.
3230, as reported on July 28, 2014, July 31, 2014, http://cbo.gov/sites/default/files/cbofiles/attachments/
SessionsLtrVAconference.pdf.
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According to CBO, implementing the act would increase the deficit by approximately $10 billion
over a 10-year period.5 The conferees approved approximately $5 billion in spending offsets by
including several provisions in H.R. 3230 (H.Rept. 113-564). These include:
• Requiring the Secretary to disapprove a course at a public institution of higher
learning (IHL) if the IHL charges tuition and fees above the in-state rate for that
course to a qualifying Post-9/11 GI Bill or All-Volunteer Force Educational
Assistance Program (MGIB-AD)6 participant who is living in the state in which
the IHL is located.7 However, the public IHL may require the qualifying
participant to demonstrate intent to establish residency, by a means other than
physical presence, in order to qualify for in-state tuition8
• Extending the authorization period that requires the VA pension benefits for
veterans and survivors who are residing in Medicaid approved nursing homes to
be reduced to $90 per month.
• Extending the authorization period in which fees are charged from certain
veterans for obtaining home-loan guarantees from the VA.
• Limiting the amount of awards or bonuses paid to VA employees.
• Extending the authorization period in which the VA is required to obtain data
from the Internal Revenue Service (IRS) and the Social Security Administration
(SSA) to verify the income of VA pension applicants.
The rest of this report provides a summary of selected provisions in the Veterans Access, Choice,
and Accountability Act of 2014 (P.L. 113-146)—as amended by the Department of Veterans
Affairs Expiring Authorities Act of 2014 (H.R. 5404; P.L. 113-175), and the Consolidated and
Further Continuing Appropriations Act, 2015 (H.R. 83; P.L. 113-235)—by Title and section. It
does not attempt to analyze each of the provisions in the act in depth, but provides brief outlines
of the matters addressed. The Appendix provides a table showing the numerous implementing
and reporting deadlines required by P.L. 113-146 as amended by P.L. 113-175. Throughout this
report, unless otherwise stated, the “Secretary” means the Secretary of Veterans Affairs, and the
“VA” means the same. Additionally, “this section” refers to matters addressed under that specific
section of the act.
This report uses a number of acronyms, which are listed below.
CBO
Congressional Budget Office; also Chief Business Office of the Veterans Health Administration
CBOC
Community Based Outpatient Clinic
DOD
Department of Defense
FQHCs
Federally Qualified Health Centers
5 Congressional Budget Office, Letter to Honorable Bernie Sanders, on the budgetary effects of the conference
agreement on H.R. 3230, the Veterans Access, Choice, and Accountability Act of 2014, as reported on July 28, 2014;
July 29, 2014, http://cbo.gov/sites/default/files/cbofiles/attachments/hr3230Conference.pdf.
6 The Post-9/11 GI Bill and MGIB-AD provide educational assistance payments to eligible individuals enrolled in
approved programs. For more information on MGIB-AD, see CRS Report R42785, GI Bills Enacted Prior to 2008 and
Related Veterans’ Educational Assistance Programs: A Primer, by Cassandria Dortch.
7 The Secretary may waive this requirement.
8 As amended by the Department of Veterans Affairs Expiring Authorities Act of 2014 (P.L. 113-175).
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GAO
Government Accountability Office
HHS
Department of Health and Human Services
IHS
Indian Health Service
MST
Military Sexual Trauma
NVCC
Non-VA Care Coordination
Project ARCH
Access Received Closer to Home
U.S.C.
United States Code
VA
Department of Veterans Affairs
VAMC
VA Medical Center
VHA
Veterans Health Administration
VISNs
Veterans Integrated Service Networks
Sec. 1. Short Title
This section provides the title of the bill as the “Veterans Access, Choice, and Accountability Act
of 2014.’’
Sec. 2. Definitions
This section provides definitions of the terms used for the purposes of this act. These definitions
refer to current law definitions provided in Title 38 U.S.C. for the terms “facilities of the
Department,” “hospital care,” and “medical services.”9
Title I: Improvement of Access to Care from Non-
Department of Veterans Affairs Providers
At the core of this title is a new temporary program (the Veterans Choice Program) to provide
hospital care and medical services to certain eligible veterans in non-VA facilities or through non-
VA providers. The VA has 90 days from the date of enactment (i.e., November 5, 2014) to issue
interim final regulations to implement major provisions of Section 101.
9 38 U.S.C. §1701. Under current law, the term “facilities of the Department” means facilities over which the Secretary
has direct jurisdiction; other VA- contracted government facilities; and public or private facilities at which the
Secretary provides recreational activities for patients receiving VA care. The terms “hospital care” and “medical
services” have the meanings given such terms by 38 U.S.C. §1701(5) and §1701(6).
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Sec. 101. Availability of Hospital Care and Medical Services
through the Use of Non-VA Entities
Eligibility
This section requires the VA to authorize non-VA care to veterans who meet one of the following
two broad sets of criteria:
(A) a veteran enrolled in the VA health care system as of August 1, 2014, including a veteran
enrolled in the VA health care system who has not received hospital care or medical services
from the VA and has contacted the VA seeking an initial appointment for the receipt of such
care or services;
or
(B) a combat-theater veteran discharged or released from active duty during a five-year
period prior to enrollment;10
Once either of the above broad criteria is met, veterans are eligible for non-VA care authorization
if they meet one of the following four criteria:
(A) attempts, or has attempted to schedule an appointment for the receipt of hospital care or
medical services but is unable to schedule an appointment within the wait-time goals of the
VHA for the furnishing of care or services;
or
(B) resides more than 40 miles from the VA medical facility, including a CBOC, that is
closest to the residence of the veteran;
or
(C) resides in a State without a VA medical facility that provides (I) hospital care, and (II)
emergency medical services, and (III) surgical care rated by the Secretary as having a surgical
complexity standard; and more than 20 miles from a VA medical facility that provides
hospital care; and (II) emergency medical services; and (III) surgical care rated by the
10 38 U.S.C. §1710(e)(1)(D) states that a veteran who served on active duty in a theater of combat operations (as
determined by the Secretary of Veterans Affairs, in consultation with the Secretary of Defense) during a period of war
after the Persian Gulf War, or in combat against a hostile force during a period of hostilities after November 11, 1998,
is eligible for hospital care, medical services, and nursing home care for any illness, even if there is insufficient medical
evidence to conclude that such condition is attributable to such service. Combat veterans who were discharged or
released from active service on or after January 28, 2003, are eligible to enroll in the VA health care system within five
years from the most recent date of discharge or release. If a veteran has not enrolled prior to August 1, 2014, that
veteran could enroll if the veteran served in a combat theater of operations and was discharged or released on a date
that is five years or less prior to the date of enrollment, or within five years from the date of discharge or release after
August 1, 2014, to qualify for this new program.
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Secretary as having a surgical complexity standard.11
or
(D) resides in a location, (not including a location in Guam, American Samoa or the Republic
of the Philippines), that is 40 miles or less from a VA medical facility, including a CBOC;
and
(1) is required to travel by air, boat, or ferry to reach each VA medical facility, including a
CBOC, that is 40 miles or less from the veteran’s residence
or
(2) resides in a location, (not including a location in Guam, American Samoa, or the
Republic of the Philippines), that is 40 miles or less from a VA medical facility, including
a CBOC, and faces an unusual or excessive burden in accessing such a VA medical
facility due to geographical challenges as determined by the VA.
Choice of Provider
Eligible veterans authorized to receive care under this section could choose to receive care
through any of the following non-VA entities or providers: Medicare providers, including any
physician furnishing services under such program;12 FQHCs;13 DOD medical facilities; and IHS
facilities.
Coordination of Care with Non-VA Entities
This section requires the VA to use the Non-VA Care Coordination (NVCC) program to
coordinate care of eligible veterans with non-VA providers. It also requires the VA to ensure that
appointments are scheduled within the wait-time goals of the VA.14
11 VA has assigned each of its medical centers an inpatient “surgical complexity” level—complex, intermediate or
standard. Hospitals assigned a “complex” rating require special facilities, equipment and staff for difficult operations,
such as cardiac surgery and craniotomies. Those with an “intermediate” rating may perform less complex surgeries,
such as partial colon removal and complete joint replacement. Those with a “standard” rating may perform inpatient
surgeries, such as hernia repair and ear, nose, and throat (ENT) surgeries. These measures were implemented May 7,
2010. If a VA hospital cannot provide a certain type of therapy or treatment to a patient, it will transfer the veteran to a
VA facility that has these programs.
12 Title XIII of the Social Security Act (“Medicare”) 42 U.S.C. §1395 et seq. Medicare providers include physicians
and psychologists, as well as patient care institutions such as hospitals, critical access hospitals, hospices, nursing
homes, and home health agencies. See, http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/
CertificationandComplianc/index.html.
13 These include FQHC Look-Alike facilities. For more details, see CRS Report R42433, Federal Health Centers, by
Elayne J. Heisler.
14 NVCC is an internal program to improve referral management practices. It was formerly known as ‘Fee Basis’,
‘Purchased Care’, or ‘Non-VA Care.’
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Authorization of Care by the VA
This section requires the VA to authorize care to eligible veterans. It also allows the veteran to
elect whether he or she wants to receive care from non-VA entities. If the veteran does not elect to
receive care from non-VA entities, the veteran could be provided with an appointment that
exceeds the wait-time goals of the VA,15 or the veteran will be placed on an electronic waiting
list—which may be viewed by the veteran—maintained by the VA for an appointment for hospital
care or medical services. If the veteran chooses to be seen by non-VA entities, the VA is required
to authorize such care or services to the eligible veteran for a period of time specified by the
Secretary; and notify the eligible veteran by electronic communication or in writing, describing
the care or services that the veteran is eligible to receive.
Electronic Waiting List
This section requires the VA to maintain an electronic waiting list and allow each eligible veteran
access to it either through the www.myhealth.va.gov or any successor website (or other digital
channel).16 The veteran could use the electronic waiting list to determine the average length of
time an individual spends on the waiting list at each specific VA medical facility. The veteran
could use this information to decide if they want to seek care from a non-VA entity.
Care and Services Through Agreements
This section requires the VA to enter into agreements for furnishing care and services to eligible
veterans with the following entities: Medicare providers, including any physician furnishing
services under such program;17 FQHCs;18 DOD medical facilities; and IHS facilities. This section
defines the term ‘‘agreement’’ to include contracts, intergovernmental agreements, and provider
agreements, as appropriate. Furthermore, this section stipulates that an agreement entered for
furnishing care and services to eligible veterans cannot be treated as a federal contract for the
acquisition of goods or services. This section also requires the Secretary to the maximum extent
practicable to furnish care and services to eligible veterans using existing contracts or other
processes available at VAMCs prior to entering into new agreements.19
Rates of Reimbursement
This section requires the Secretary to negotiate reimbursement rates for the furnishing of care and
services with non-VA entities. Furthermore, this section places a limit on the reimbursement rate
15 As amended by Department of Veterans Affairs Expiring Authorities Act of 2014 (P.L. 113-175). As required by
law, wait-time goals of the VA were published on October 17, 2014. See Department of Veterans Affairs, “Wait-Time
Goals of the Department for the Veterans Choice Program,” 79 Federal Register 62519-62520, October 17, 2014.
16 As amended by the Department of Veterans Affairs Expiring Authorities Act of 2014 (P.L. 113-175).
17 Title XIII of the Social Security Act (“Medicare”) 42 U.S.C. §1395 et seq. Medicare providers include physicians
and psychologists, as well as patient care institutions such as hospitals, critical access hospitals, hospices, nursing
homes, and home health agencies. See, http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/
CertificationandComplianc/index.html.
18 These include FQHC Look-Alike facilities. For more details, see CRS Report R42433, Federal Health Centers, by
Elayne J. Heisler.
19 As amended by the Department of Veterans Affairs Expiring Authorities Act of 2014 (P.L. 113-175).
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with several exceptions. In general, negotiated rates must be no more than the payment rate under
the Medicare program under Title XVIII of the Social Security Act, set by the Centers for
Medicare & Medicaid Services. However, the VA may negotiate a higher rate than the Medicare
reimbursement rate if the provider is furnishing care or services to an eligible veteran who resides
in a highly rural area (defined as an area located in a county that has fewer than seven individuals
residing in that county per square mile). Furthermore, in the State of Alaska, VA will be able to
reimburse providers under the VA Alaska Fee Schedule, and in states with an “All-Payer Model”
agreement, VA will calculate Medicare payments based on payment rates under such All-Payer
Model” agreements.20 This section also exempts Medicare and Medicaid providers—during the
period they are furnishing care to eligible veterans—from Federal Contract Compliance Programs
of the Department of Labor that apply to federal contractors and subcontractors. Furthermore, this
section stipulates that a non-VA health care entity may not collect an amount that is greater than
the rate that was negotiated with the VA for care to eligible veterans. It also requires that the
Secretary provide non-VA health care entities and providers with required information on policies
and procedures with regard to billing, claims submission, and care authorization, among other
things.
VA as the Secondary Payer of Care
This section of the act stipulates that the VA will generally be the secondary payer21 for eligible
veterans receiving care for nonservice-connected disabilities or conditions from specified non-VA
health care entities. It further stipulates that the VA will pay for care or services that are not
covered by the veteran’s health insurance plan at an amount not to exceed the Medicare rate or a
negotiated rate. Furthermore, before receiving hospital care or medical services, an eligible
veteran is required to provide the Secretary information on any insurance policy or contract that
the veteran has. For those veterans who are only enrolled in Medicare, Medicaid, or TRICARE,
the VA will be the primary payer for care and services for nonservice-connected disabilities or
conditions.22
Veterans Choice Card
This section stipulates that not later than 90 days after enactment the VA is required to provide
each enrolled veteran with a card known as a “Veterans Choice Card.” Among other things, as
specified, the following statement will be printed on the card: “This card is for qualifying medical
care outside the Department of Veterans Affairs. Please call the Department of Veterans Affairs
phone number specified on this card to ensure that treatment has been authorized.’’ Furthermore,
20 As amended by the Consolidated and Further Continuing Appropriations Act, 2015 (P.L. 113-235). Maryland
operates the nation’s only all-payer hospital rate regulation system. Under Section 1814(b) (3) of the Social Security
Act, the Centers for Medicare & Medicaid Services (“CMS”) has exempted certain hospitals in Maryland from
reimbursement under the national payment system and has allowed the state to set reimbursement rates payable by
Medicare for applicable services that otherwise would be reimbursed under Medicare’s Inpatient Prospective Payment
System (“IPPS”) and Outpatient Prospective Payment System (“OPPS”). On January 10, 2014, CMS and the State of
Maryland jointly announced a new initiative to modernize Maryland’s unique all-payer rate-setting system for hospital
services. In the state of Maryland, VA will follow this reimbursement system.
21 A secondary payer is an insurance carrier or program that is secondary to the primary insurance carrier or program.
22 VA will be a secondary payer in situations that the veteran has private coverage or other health care coverage that is
not Medicare, Medicaid or TRICARE.
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the act stipulates that the Secretary provide the eligible veteran with information clearly stating
the circumstances under which the veteran may be eligible for care or services.
Information on Availability of Care
This section requires the Secretary to provide information on non-VA care to veterans when they
enroll in the VA health care system, when the veteran attempts to schedule an appointment for the
receipt of hospital care or medical services from the VA but is unable to schedule an appointment
within the current wait-time goals of the VHA for the delivery of such care or services, and when
the veteran becomes eligible for hospital care or medical services under this act.
Follow-Up Care
This section requires non-VA care authorizations to include a complete episode of care (but for a
period not to exceed 60 days), including all specialty and ancillary services deemed necessary as
part of an episode of recommended treatment.
Credentials of Providers
This section of the act requires participating non-VA providers to maintain the same or similar
credentials and licenses as required of VA health care providers, and to submit verification at least
annually.
Copayments
This section of the act requires veterans who are authorized to receive non-VA care to pay
applicable copayment just as they would be assessed a copayment if treatment was provided in a
VA facility. The non-VA health care provider or entity that furnishes the care or service will be
required to collect the copayment directly from the eligible veteran.
Health Care Claims Processing
This section requires the Secretary to establish an efficient nationwide system for processing and
paying non-VA care bills or claims, and the Chief Business Office (CBO) of the VHA will
oversee the implementation and maintenance of the claims processing system. Regulations
implementing such a claims processing system are to be published no later than 90 days after
enactment of this act.
Medical Records
This section requires the VA to ensure that non-VA providers submit to the VA a copy of any
medical record information related to the care and services provided to an eligible veteran for
inclusion in the veteran’s Computerized Patient Record System (CPRS) maintained by the VA. It
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further stipulates that to the greatest extent possible the medical records submitted by non-VA
providers or entities should be in an electronic format.23
Tracking Missed Appointments
This section of the act requires the Secretary to implement a mechanism to track missed
appointments authorized under this section for eligible veterans to ensure that the VA does not
pay for such care or services that were not furnished to an eligible veteran.
Implementing Regulations
This section of the act requires the VA to prescribe and publish interim final regulations no later
than 90 days after the date of the enactment on the implementation of the new program to provide
eligible veterans with care in non-VA facilities.
Office of the Inspector General (OIG) Report
This section of the act requires the VA Inspector General to issue an audit of care report to the
Secretary on the expanded non-VA care authority. The report is required to be submitted no later
than 30 days after the Secretary determines that 75% of amounts deposited in the “Veterans
Choice Fund” (see section on “Sec. 802. Veterans Choice Fund” later in this report) have been
exhausted.
End Date of the Expanded Authority for Non-VA Care
This section stipulates that the authority for the new expanded non-VA care program will end on a
date when all the funds deposited in the “Veterans Choice Fund” (see section on “Sec. 802.
Veterans Choice Fund” later in this report) are exhausted or on a date that is three years after the
date of enactment, whichever comes first.
Reports to Congress
This section of the act requires the VA to submit reports to Congress on the expanded non-VA
care authority. The Secretary is required to submit an interim report to Congress, not later than 90
days after the publication of interim final regulations. The interim report must include
information on the number of eligible veterans and a description of the type of care and services
furnished to eligible veterans. A final report is required no later than 30 days after the date on
which the Secretary determines that 75% of the amounts deposited in the “Veterans Choice Fund”
are exhausted. The final report must include, among other things, an assessment and
recommendations regarding the continuation of non-VA care and services under the new
expanded authority.
23 As amended by the Department of Veterans Affairs Expiring Authorities Act of 2014 (P.L. 113-175).
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Filling Prescription Medications
This section specifies that VA’s current practice of filling prescriptions of veterans at VA
pharmacies and/or Consolidated Mail Order Pharmacies (CMOPs), and the policies that allow the
VA to pay for prescribed drugs provided for certain eligible veterans, will continue without any
changes.
Wait-Time Goals of the VHA
This section of the act defines “wait time goals of the Veterans Health Administration” as an
appointment date that is not more than 30 days from the date that the veteran requested an
appointment for care. If the Secretary notifies Congress no later than 60 days after enactment that
the “wait-time goals of the Veterans Health Administration” are different than what is defined in
this section, then the new wait time goals of the VHA will be the ones defined by the Secretary.24
Waiver of Certain Printing Requirements
This section allows the Secretary to print material related to the Veterans Choice Program other
than through the Government Printing Office (GPO).25
Sec. 102. Enhancement of Collaboration between the VA and Indian
Health Service
This section requires the Secretary (in consultation with the IHS Director) to conduct outreach to
each medical facility operated by an Indian Tribe or Tribal Organization26 to make these facilities
aware that they can enter into agreements with the VA under which the VA will reimburse these
facilities for care provided to IHS beneficiaries who are also VA-enrolled veterans. This section
also requires the Secretary and the IHS director to jointly establish and implement performance
metrics that examine whether the existing MOU between the VA and IHS—“Memorandum of
Understanding” between the Department of Veterans Affairs (VA) and the Indian Health Service
(IHS)—is effective at, among other things, increasing access, improving quality and care
coordination, and determining whether health promotion and disease prevention services are
24 On October 17, 2014, the Department of Veterans Affairs published a notice in the Federal Register announcing
VA’s report on the wait-time goals for purposes of the Veterans Choice Program. The report provides that the goals of
the Veterans Health Administration are as follows: “Unless changed by further notice in the Federal Register, the term
‘wait-time goals of the Veterans Health Administration’ means not more than 30 days from either the date that an
appointment is deemed clinically appropriate by a VA health care provider, or if no such clinical determination has
been made, the date a Veteran prefers to be seen for hospital care or medical services. In the event a VA health care
provider identifies a time range when care must be provided (e.g., within the next 2 months), VA will use the last
clinically appropriate date for determining whether or not such care is timely. The Department anticipates that the
Under Secretary for Health periodically will consider changes to the wait-time goals of the Veterans Health
Administration as appropriate.” See Department of Veterans Affairs, “Wait-Time Goals of the Department for the
Veterans Choice Program,” 79 Federal Register 62519-62520, October 17, 2014.
25 As amended by the Department of Veterans Affairs Expiring Authorities Act of 2014 (P.L. 113-175). Section 501 of
Title 44 of the United States Code requires that all printing for the executive departments and independent offices and
establishments of the government be done through the Government Printing Office (GPO)
26 For more information about the Indian Health Service, see CRS Report R43330, The Indian Health Service (IHS): An
Overview, by Elayne J. Heisler.
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funded and available to beneficiaries under both health care systems. The section further requires
that the Secretary and the IHS Director submit a report to Congress on the (1) feasibility of
including Urban Indian Organizations in the current VA-IHS reimbursement agreement, (2)
feasibility of including the direct care costs of treating non-American Indian veterans in
agreements between the VA and IHS facilities or medical facilities operated by an Indian Tribe or
Tribal Organization, and (3) possible effects of an agreement between the IHS-VA agreement to
provide care to veterans at IHS facilities on access to services by IHS-beneficiaries. This report is
due no later than 180 days after enactment.27
Sec. 103. Enhancement of Collaboration between the VA and the
Native Hawaiian Health Care System
This section requires the VA, in consultation with Papa Ola Lokahi and such other organizations
involved in the delivery of health care to Native Hawaiians, to enter into contracts or agreements
with Native Hawaiian health care systems, receiving funds from the Secretary of Health and
Human Services (HHS), to reimburse such systems for direct care services provided to eligible
veterans (as specified in the particular contract or agreement).
Sec. 104. Reauthorization and Modification of Project ARCH
(Access Received Closer to Home)
This section reauthorizes and modifies the pilot program known as Project ARCH, which was
established under Section 403 of the Veterans’ Mental Health and Other Care Improvements Act
of 2008 (P.L. 110-387). The three-year pilot program was set to expire on August 29, 2014.28 This
section authorizes Project ARCH for two years from the date of enactment of the act. This section
stipulates in law the pilot sites as: VISN 1; VISN 6; VISN 15; VISN 18; and VISN 19.29 This
27 As amended by the Department of Veterans Affairs Expiring Authorities Act of 2014 (P.L. 113-175).
28 The Veterans’ Mental Health and Other Care Improvements Act of 2008 (P.L. 110-387) was signed into law on
October 10, 2008. Section 403 of this law required VA to conduct pilot programs during a three-year period to provide
non-VA health care services through contractual arrangements to eligible veterans. This pilot program had an
implementation date of 120 days after October 10, 2008. Soon after the law was enacted VA recognized that the pilot
program could not be commenced in the 120 days of the law’s enactment as required, and in March 2009, VA officials
briefed House and Senate VA Committees on these implementation issues. The first challenge that VA shared with
Congress was the statute’s definition of highly rural. The statute uses driving distances to define a highly rural veteran
whereas VA uses a Census Bureau definition and defines a highly rural veteran as a veteran who resides in a county
with fewer than seven civilians per square mile. VA has developed its data systems based on the Census Bureau
definition and uses these systems to identify highly rural veterans. The second challenge involved the term hardship
which VA needs to define through regulations. The Caregiver and Veterans Omnibus Health Services Act of 2010 (P.L.
111-163) signed into law in May 2010 made technical corrections regarding hardship exception and the mileage
standard. Those eligible to participate in Project ARCH include (1) veterans who are enrolled in the VA health care
system as of the date of the commencement of the pilot program and meet the statutory definition of “covered
Veterans”, or (2) eligible but not enrolled Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn
(OEF/OIF/OND) veterans who meet the statutory definition of “covered Veterans.” Covered veterans are defined as
those veterans residing in a Pilot VISN and are (1) more than 60 minutes away from the nearest VA health care facility
providing primary care services, or (2) more than 120 minutes away from the nearest VA health care facility providing
acute hospital care, or (3) more than 240 minutes away from the nearest VA health care facility providing tertiary care.
29 The VA’s health care system is organized into 21 geographically defined Veterans Integrated Service Networks
(VISNs). VISN offices oversee VA healthcare facilities community based outpatient clinics, nursing homes, and Vet
Centers throughout the country.
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section of the act further stipulates that the Secretary must ensure that medical appointments for
those veterans eligible to participate in Project ARCH are scheduled not later than 5 days after the
date on which the appointment is requested and occur no later than 30 days after such date. This
section allows the Secretary to use existing Project ARCH contracts or enter into new contracts.30
Sec. 105. Prompt Payment
This section states that it is the sense of Congress that the VA must comply with the Prompt
Payment rule,31 and requires VA to establish and implement a system to process and pay claims
from non-VA providers for hospital care, medical services, and other health care services
provided to eligible veterans. Furthermore, it requires the Government Accountability Office
(GAO) to submit a report, no later than one year after the date of enactment, to Congress on the
timeliness of payments by the VA to non-VA providers, among other things.32
Sec. 106. Reimbursement of Non-VA Providers Assigned to the
Chief Business Office (CBO)
This section of the act requires the Secretary to transfer payment authority for hospital care,
medical services, and other health care through non-VA providers, from the VISNs and VAMCs
to the Chief Business Office (CBO) of VHA. This transfer will be effective on October 1, 2014.
Furthermore, this section requires the VA, in each fiscal year that begins after the date of
enactment, to include in VHA’s CBO budget amounts to pay for hospital care, medical services,
and other health care provided through non-VA providers and to exclude these amounts from the
VISN and VAMC budgets.
Title II: Health Care Administrative Matters
The major emphasis of this title is the requirement of several studies to examine a variety of
issues pertaining to VA’s health care delivery system, and to explore ideas on how best to reform
the system.
Sec. 201. Independent Assessment of the VA Health Care Delivery
Systems and Management Processes
This section requires the Secretary, no later than 90 days after enactment of the act, to contract
with a private sector entity or entities to conduct an independent assessment of the hospital care,
and medical services furnished in VA medical facilities. Among other things, the assessment must
address current and projected demographics and unique health care needs of the patient
population served by the VA; the VA’s current and projected health care capabilities and
resources; the appropriate system-wide access standard applicable to hospital care, medical
services, and other health care furnished by and through the VA; the information technology
30 As amended by the Department of Veterans Affairs Expiring Authorities Act of 2014 (P.L. 113-175).
31 5 C.F.R. §1315. Also see, http://fms.treas.gov/prompt/regulations.html.
32 As amended by the Department of Veterans Affairs Expiring Authorities Act of 2014 (P.L. 113-175).
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strategies of the VA with respect to furnishing and managing health care; and the VA’s processes
for carrying out construction and maintenance projects at medical facilities and the medical
facility leasing program. The Secretary is required to submit this assessment report to Congress
and make it available to the public as well.
Sec. 202. Commission on Care
This section establishes a ‘‘Commission on Care’’ to undertake a comprehensive evaluation and
assessment of veterans access to VA health care and strategically examine how best to organize
the VHA. The ‘‘Commission on Care’’ will also examine how to locate health care resources and
deliver health care to veterans during the 20-year period beginning on the date of the enactment
of this act. The Commission will be composed of 15 voting members, and the appointment of
Commissioners will be made not later than one year after the date of the enactment of this act by
the Speaker of the House of Representatives, the Minority Leader of the House of
Representatives, the Majority Leader of the Senate, the Minority Leader of the Senate, and the
President of the United States. In appointing these Commissioners, at least one of the
Commissioners must represent a Veteran Service Organization (VSO) recognized by the
Secretary for the representation of veterans; have experience as senior manager for a private
integrated health care system with an annual gross revenue of more than $50,000,000; be familiar
with government health care systems, including those systems of the DOD, IHS, and FQHCs; be
familiar with the VHA but not be a current employee of the VHA; and be familiar with medical
facility construction and leasing projects carried out by government entities and have experience
in the building trades, including construction, engineering, and architecture. The “Commission on
Care’’ is required to submit to the President, through the Secretary, several reports on their
findings. The final report should be submitted within 180 days of the initial commission meeting.
This section requires the President to require the Secretary of Veterans Affairs and other heads of
relevant executive departments and agencies to implement each recommendation included in the
final report of the ‘‘Commission on Care,’’ as specified.
Sec. 203. Technology Task Force on Review of Scheduling System
and Software of the VA
This section requires the Secretary to conduct a review of the needs of the VA’s scheduling
system and scheduling software that is used to schedule appointments for veterans for hospital
care, medical services, and other health care. The Secretary is required to use the free services of
a technology task force for this purpose. Not later than 45 days after the date of the enactment of
this act, the technology task force is required to submit to the Secretary and Congress a report
setting forth the findings and recommendations of the technology task force regarding the needs
of the VA with respect to the scheduling system and scheduling software. Furthermore, this
section requires the Secretary to make the report public no later than 30 days after the receipt of
the report, and implement the recommendations in the report that the Secretary considers feasible,
advisable, and cost effective.
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Sec. 204. Improving Access to Mobile Vet Centers and Mobile
Medical Centers
This section of the act requires the VA to provide standardized requirements to improve access of
veterans to telemedicine services, other health care services, and readjustment counseling services
provided by mobile Vet Centers and mobile medical centers. The standardized requirements
include the number of days each mobile vet center and mobile medical center is expected to travel
per year; the number of locations and events each center is expected to visit per year; the number
of appointments and outreach contacts each center is expected to conduct per year; and the
method and timing of notifications given by each center to individuals in the area to which the
center is traveling, including notifications informing veterans of the availability to schedule
appointments at the center. This section also requires the Secretary, one year after enactment, to
submit an annual report (no later than September 30 of each year) to Congress outlining the
recommended improvements for access to telemedicine, health care services, and readjustment
counseling services through mobile Vet Centers and mobile medical centers, as well as data on
the use of mobile Vet Centers and mobile medical centers.33
Sec. 205. Improved Performance Metrics for Health Care Provided
by the VA
This section of the act requires the Secretary to ensure that scheduling and wait-time metrics or
goals are not used as factors in evaluating employee performance for purposes of determining
whether to pay performance awards to the following categories of employees: directors, associate
directors, assistant directors, deputy directors, chiefs of staff, and clinical leads of VA medical
centers; and directors, assistant directors, and quality management officers of VISNs.
Furthermore, no later than 30 days after enactment, the Secretary is required to modify the
performance plans of the directors of the VA medical centers and the directors of the VISNs to
ensure that performance plans are based on the quality of care received by the veterans, as
specified. This section further stipulates that the Secretary must not include performance goals in
the performance plans of VISN and medical center Directors that might provide incentives for not
authorizing non-VA care furnished through non-VA entities.
Sec. 206. Improved Transparency Concerning Health Care Provided
by the VA
This section requires the VA, no later than 90 days after the date of enactment, to publish in the
Federal Register, and on a publicly accessible Internet website of each VA medical center, the
wait-times for the scheduling of an appointment in that facility by a veteran for the receipt of
primary care, specialty care, and hospital care and medical services based on the general severity
of the condition of the veteran. Furthermore, whenever the wait-times for the scheduling of such
an appointment changes, the Secretary is required to publish the revised wait-times on a publicly
accessible Internet website of each VA medical center no later than 30 days after such a change;
and in the Federal Register no later than 90 days after such change. This section also requires the
Secretary to develop and make available to the public a comprehensive, machine-readable data
33 As amended by the Department of Veterans Affairs Expiring Authorities Act of 2014 (P.L. 113-175).
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set containing all applicable patient safety, quality of care, and outcome measures for health care
provided by VA and tracked by the VA. Furthermore, at least once a year the VA is required to
update the data. This section further stipulates that the Secretary must enter into an agreement
with the Secretary of Health and Human Services (HHS) to provide VA hospital data on patient
quality and outcomes as specified in order for it to be made available through the Hospital
Compare Internet website of the Department of Health and Human Services (HHS). This section
also requires the Government Accountability Office (GAO) to conduct a review, no later than
three years after enactment of this act, of publicly available safety and quality metrics.34
Sec. 207. Information for Veterans on the Credentials of VA
Physicians
This section requires the VA to improve the information available to veterans regarding residency
training in the “Our Doctors” data set located on each VAMCs website. This section requires the
VA to publish on its website the following information: name of the facility at which each VA
physician underwent residency training, and identifying whether a physician is a physician in
residency. Furthermore, this section stipulates that for those veterans undergoing surgical
procedures, the VA is to provide them information on the education and training of the surgeon as
well as the licensure, registration, and certification of the surgeon. This section of the act also
requires the GAO to report to Congress on VA’s Patient Centered Community Care program
(PCCC) and requires the Secretary to submit a plan to Congress and to GAO in response to
GAO’s findings and recommendations, and to implement such recommendation no later than 90
days after submitting the report.35
Sec. 208. Information in Annual Budget of the President on
Hospital Care and Medical Services Furnished through the
Expanded use of Contracts
This section requires that VA’s annual congressional budget submissions include information
pertaining to the number of veterans who received hospital care and medical services under the
new expanded authority under Section 101 of P.L. 113-146; the amount expended by the VA on
furnishing care and services under Section 101; the amount requested for the costs of furnishing
care and services under Section 101; the number of veterans that the VA estimates will receive
hospital care and medical services under Section 101during the fiscal year of the budget request;
and the number of VA employees on paid administrative leave at any point during the fiscal year
preceding the fiscal year in which such budget request is submitted.
Sec. 209. Prohibition on Falsification of Data Concerning Wait
Times and Quality Measures at the VA
This section of the act requires the Secretary to establish, no later than 60 days after enactment,
policies that will impose penalties on VA employees who knowingly falsify data on patient wait-
34 As amended by the Department of Veterans Affairs Expiring Authorities Act of 2014 (P.L. 113-175).
35 As amended by the Department of Veterans Affairs Expiring Authorities Act of 2014 (P.L. 113-175).
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times or health care quality measures or knowingly request other VA employees to falsify such
data.
Title III: Health Care Staffing, Recruitment, and
Training Matters
The provisions of this title together aim to address the clinical workforce shortages in the VA
health care system, and bolster recruitment and retention programs of the VA.
Sec. 301. Treatment of Staffing Shortage and Biennial Report on
Staffing of VA Medical Facilities
This section requires the Inspector General (IG) to determine, and the Secretary to publish in the
Federal Register, not later than September 30 annually, a list of the five VHA occupations,
among the health professions listed in 38 U.S.C. §7401, that have the largest staffing shortages as
calculated over the five year period that precedes the determination.36 The section also specifies
that the first determination be made and published not later than 180 days after enactment. The
section also authorizes the Secretary to use the IG’s determination to recruit and directly appoint
qualified personnel in one of the identified occupations in the fiscal year that follows the report.
The section requires the Secretary to establish medical residency programs or to ensure that
currently operating medical residency programs have sufficient positions at any VA facility that
has a shortage or is located in a health professional shortage area as designated by the Department
of Health and Human Services.37 The subsection further requires that the Secretary allocate the
residency positions among the occupations that the IG determined to be in shortage in the most
recent report and must also give priority to residency positions in primary care, mental health, and
any other specialty that the Secretary deems appropriate. The section also specifies that during the
five-year period beginning on the day that is one year after enactment, the Secretary is required to
increase the number of medical residency positions at VA facilities by up to 1,500 positions
giving priority to medical facilities that do not, at the time of enactment, have a medical residency
program and are located in a community that has a high concentration of veterans. Finally, the
section requires that, on October 1 beginning in 2015 and continuing through 2019, the Secretary
submit a report to the Committees on Veterans’ Affairs in the House and Senate on VA graduate
medical education that includes certain specified elements.
The section amends the priority of the VA’s Scholarship Program of Health Professionals
Educational Assistance Program to Certain Providers to give priority to individuals who are in
the final year of education or training in an occupation that the IG identified in its most recent
determination as having a large staffing shortage.
The section also requires, not later than 180 days after enactment and not later than December 31
of each even-numbered year thereafter until 2024, that the Secretary submit to the Committees on
36 The act adds a new §7412 to Subchapter 1 of Chapter 74 of title 38 U.S.C.
37 The act adds a new §7302(e) to title 38 U.S.C. For more information about health professional shortage areas, see
http://www.hrsa.gov/shortage/index.html.
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Veterans’ Affairs in the House and Senate a report that assesses staffing at each VHA facility. The
report will also include assessments of the appropriateness of certain specified elements related to
VA staffing, including but not limited to staffing levels, patient panel size,38 workloads, and wait
times in certain fields; staffing models used in these specified fields; succession planning at the
VA, and the number of health providers who have left the VA during the two years that precede
the report’s submission, including the reason they have left the VA, among other things.39
Sec. 302. Extension and Modification of Certain Programs within
the VA’s Health Professionals Educational Assistance Program
This section extends authorization of the VA scholarship program until December 31, 2019. It
also modifies the Education Debt Reduction program to increase the amount that the VA could
pay in total to a participant, over a five-year period, from $60,000 to $120,000. It also increases
the amount that could be paid in the fourth and fifth years from $12,000 to $24,000 per year.
Finally, the section eliminates the requirement that VA education debt reduction payments may
not exceed the amount of principal and interest that a participant owes during a single year.40
Sec. 303. Clinic Management Training for Employees at VA
Medical Facilities
This section of the act requires the Secretary to commence a clinic management training program,
no later than 180 days after the date of enactment of this act, to provide in-person, standardized
education on systems and processes for health care practice management and scheduling to all
appropriate employees at VA medical facilities. Among other things, the training must include
how to manage the schedules of VA health care providers; training on the appropriate number of
appointments that a health care provider should conduct on a daily basis, based on specialty;
training on how to determine whether there are enough available appointment slots to manage
demand for different appointment types and mechanisms for alerting management of insufficient
slots; training on how to properly use the VA appointment scheduling system including any new
scheduling system; training on how to optimize the use of technology; and training on how to
properly use VA’s physical plant space to ensure efficient flow and privacy for patients and staff.
The training program must end on the date that is two years after the date on which the clinic
management training program commences. After the termination of the program the Secretary is
required to provide training materials and update them regularly.
Title IV: Health Care Related to Sexual Trauma
This title liberalizes eligibility for VA sexual trauma counseling, care, and services to certain
veterans and servicemembers.
38 Generally the number of patients for a full-time physician provider.
39 As amended by the Department of Veterans Affairs Expiring Authorities Act of 2014 (P.L. 113-175).
40 §408 of P.L. 113-175 further amends the Education Debt Reduction Program to permit the VA to directly make
payments to the entities that hold the eligible individual’s loans. As amended by the Department of Veterans Affairs
Expiring Authorities Act of 2014 (P.L. 113-175).
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Sec. 401. Expansion of Eligibility for Sexual Trauma Counseling
and Treatment to Veterans on Inactive Duty Training
This section provides VA with the authority to provide counseling, care, and services to veterans,
and certain other servicemembers who may not have veteran status, who experienced sexual
trauma while serving on active duty for training or inactive duty for training.41
Sec. 402. Provision of Counseling and Treatment for Sexual Trauma
by the VA to Members of the Armed Forces
This section amends Section 1720D of title 38, U.S.C., and allows the Secretary in consultation
with the Secretary of Defense to provide counseling and treatment for sexual trauma victims in
the Armed Forces (including members of the National Guard and Reserve components on active
duty) without an initial consultation and referral from DOD.
Sec. 403. Reports on Military Sexual Trauma
This section requires the Secretary to submit various reports to Congress on Military Sexual
Trauma.
Title V: Other Health Care Matters
This title extends the Assisted Living Pilot Program for Veterans with Traumatic Brain Injury
until October 6, 2017.
Sec. 501. Extension of Pilot Program on Assisted Living Services for
Veterans with Traumatic Brain Injury
This section extends the pilot program established by Section 1705 of the National Defense
Authorization Act (NDAA) for Fiscal Year 2008 (P.L. 110-181) through October 6, 2017. Section
1705 required the Secretary, in collaboration with DOD’s Defense and Veterans Brain Injury
Center (DVBIC), to carry out a five-year pilot program to assess the effectiveness of providing
assisted living (AL) services to eligible veterans with traumatic brain injury (TBI). The AL-TBI
pilot program was established for implementation between April 2008 and June 2013 and was
administered through contracts with residential living programs designed to accommodate the
needs of patients with TBI.
41 The act amends §1720D of title 38, U.S.C.
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Title VI: Major Medical Facility Leases
This title authorizes the VA to carry out specified major medical facility leases and requires the
VA to comply with current laws and policies governing obligations for major medical facility
leases.
Sec. 601. Authorization of Major Medical Facility Leases
This section of the act authorizes medical facility leases (requested by the VA in its FY2014
congressional budget submission) at the following locations: (1) Albuquerque, NM, for an
amount of $9,560,000; (2) Brink, NJ, for an amount of $7,280,000; (3) Charleston, SC, for an
amount of $7,070,250; (4) Cobb County, GA, for an amount of $6,409,000; (5) Honolulu, HI, for
an amount of $15,887,370; (6) Johnson County, KS, for an amount of $2,263,000; (7) Lafayette,
LA, for an amount of $2,996,000; (8) Lake Charles, LA, for an amount of $2,626,000; (9) New
Port Richey, FL, for an amount of $11,927,000; (10) Ponce, PR, for an amount of $11,535,000;
(11) San Antonio, TX, for an amount of $19,426,000; (12) San Diego, CA, for an amount of
$11,946,100; (13) Tyler, TX, for an amount of $4,327,000; (14) West Haven, CT, for an amount
of $4,883,000; (15) Worcester, MA, for an amount of $4,855,000; (16) Cape Girardeau, MO, for
an amount of $4,232,060; (17) Chattanooga, TN, for an amount of $7,069,000; (18) Chico, CA,
for an amount of $4,534,000; (19) Chula Vista, CA, for an amount of $3,714,000; (20) Hines, IL,
for an amount of $22,032,000; (21) Houston, TX, for an amount of $6,142,000; (22) Lincoln, NE,
for an amount of $7,178,400; (23) Lubbock, TX, for an amount of $8,554,000; (24) Myrtle
Beach, SC, for an amount of $8,022,000; (25) Phoenix, AZ, for an amount of $20,757,000; (26)
Redding, CA, for an amount of $8,154,000; and (27) Tulsa, OK, for an amount of $13,269,200.42
This section also stipulates specific lease requirements for the leased clinic located in Tulsa,
OK.43
Sec. 602. Budgetary Treatment of VA Major Medical
Facilities Leases
This section requires the Secretary to record the full cost of the contractual obligation at the time
a contract is executed either in an amount equal to total payments required under the full term of
the lease; or equal to an amount sufficient to cover the first-year lease payments and any specified
cancellation costs in the event that the lease is terminated before its full term. Furthermore, this
section requires the VA to provide a detailed analysis of how such lease is expected to comply
with Office of Management and Budget (OMB) Circular A–11 and Section 1341 of title 31,
U.S.C. in a prospectus for a proposed lease, and requires the VA to submit to Congress the
following information: (1) notice of the intent to enter into a lease; (2) a copy of the proposed
lease; (3) an explanation of any difference between the prospectus and the lease submitted under
this subsection; and (4) a scoring analysis demonstrating compliance with OMB Circular A–11.
42 38, U.S.C. §8104 requires that VA major medical facility leases, defined as “a lease for space for use as a new
medical facility at an average annual rent of more than $1 million,” be specifically authorized by law.
43 These facilities are community based outpatient clinics (CBOCs). A VHA CBOC is a health care site that is
geographically distinct and separate from a parent medical facility and may be a site that is VA-operated and/or
contracted.
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Veterans Access, Choice, and Accountability Act of 2014 (H.R. 3230; P.L. 113-146)
This information must be submitted to Congress not less than 30 days before entering into a
major medical facility lease.
Title VII: Other Veterans Matters
This section broadly address several areas including veterans education benefits, spending offsets,
and provides authority for the removal or transfer of Senior Executive Service (SES) employees
of the VA for performance or misconduct and requires expedited review of such actions.
Sec. 701. Expansion of Marine Gunnery Sergeant John David Fry
Scholarship
This section expands eligibility for the Marine Gunnery Sergeant John David Fry Scholarship
program to the spouse of an individual who, on or after September 11, 2001, dies in the line of
duty while serving on active duty as a member of the Armed Forces.44 Under this section a spouse
would be entitled to the scholarship until the earlier of 15 years following the servicemember’s
death or remarriage. A similarly circumstanced spouse is currently eligible for educational
assistance under the Survivors’ and Dependents’ Educational Assistance program (DEA). This
section requires the spouse to make an irrevocable election to receive benefits under either the
scholarship or DEA. The amendment is effective for terms beginning after December 31, 2014.45
Sec. 702. Approval of Courses of Education Provided by Public
Institutions of Higher Learning for Purposes of All-Volunteer Force
Educational Assistance Program and Post-9/11 Educational
Assistance Conditional on In-State Tuition Rate for Veterans
This section requires the Secretary to disapprove a course at a public institution of higher learning
(IHL) if the IHL charges tuition and fees above the in-state rate for that course to a qualifying
Post-9/11 GI Bill or All-Volunteer Force Educational Assistance Program (MGIB-AD)46
participant who is living in the state in which the IHL is located.47 However, the public IHL may
require the qualifying participant to demonstrate intent to establish residency, by a means other
than physical presence, in order to qualify for in-state tuition. The course disapproval only applies
to the Post-9/11 GI Bill and MGIB-AD. Qualifying Post-9/11 GI Bill and MGIB-AD participants
44 The Post-9/11 GI Bill provides educational assistance payments to eligible individuals enrolled in approved
programs. Prior to the enactment of P.L. 113-146 the Marine Gunnery Sergeant John David Fry Scholarship program
provided eligibility for the Post-9/11 GI Bill for the children of individuals who, on or after September 11, 2001, died
in the line of duty while serving on active duty as a member of the Armed Forces.
45 For more information on the Post-9/11 GI Bill, see CRS Report R42755, The Post-9/11 Veterans Educational
Assistance Act of 2008 (Post-9/11 GI Bill): Primer and Issues, by Cassandria Dortch. For more information on DEA,
see CRS Report R42785, GI Bills Enacted Prior to 2008 and Related Veterans’ Educational Assistance Programs: A
Primer, by Cassandria Dortch.
46 The Post-9/11 GI Bill and MGIB-AD provide educational assistance payments to eligible individuals enrolled in
approved programs. For more information on MGIB-AD, see CRS Report R42785, GI Bills Enacted Prior to 2008 and
Related Veterans’ Educational Assistance Programs: A Primer, by Cassandria Dortch.
47 The Secretary may waive this requirement.
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Veterans Access, Choice, and Accountability Act of 2014 (H.R. 3230; P.L. 113-146)
are those who were discharged or released from a period of not fewer than 90 days of service in
the active military, naval, or air service less than three years before the date of enrollment in said
course and to their Post-9/11 GI Bill-eligible dependents and survivors.48 If a course is
disapproved, the qualifying participant cannot be approved for subsequent courses at the same
IHL if continuously enrolled. This section is effective for terms beginning after July 1, 2015.49
Secs. 703, 704, 705, and 706
These sections of the act, respectively: extend the authorization period that requires the VA
pension benefits for veterans and survivors who are residing in Medicaid-approved nursing
homes to be reduced to $90 per month; extend the authorization period in which fees are charged
from certain veterans for obtaining home-loan guarantees from the VA; limits the amount of
awards or bonuses paid to VA employees; and extend the authorization period in which VA is
required to obtain data from the Internal Revenue Service (IRS) and the Social Security
Administration (SSA) to verify the income of VA pension applicants.
Sec. 707. Removal of Senior Executives of the VA for Performance
or Misconduct
This section of the act provides the VA Secretary with new authority to remove senior executives
from the department. The new authority and procedures created under this section apply to
members of the Senior Executive Service (SES) in the VA, as well as individuals in certain
leadership positions specific to the VA and commonly referred to as “Title 38 employees.”50 The
new authority will be added to Title 38 of the U.S.C., which currently contains a set of adverse
action procedures for employees appointed under that title, and is in addition to the authority the
Secretary currently has to remove members of the SES under Title 5 of the U.S.C.51
If the Secretary determines that the performance of a senior executive warrants removal or that
the individual has engaged in misconduct that warrants removal, he can invoke the authority
provided in this section and remove a senior executive in one of two ways. First, the Secretary
48 The term “active military, naval, or air service,” as defined in 38 U.S.C. §101(24), includes active duty. The term
“active duty,” as defined in 38 U.S.C. §101(21), is not equivalent to that defined in 38 U.S.C. §3301(1) or 38 U.S.C.
§3002.
49 As amended by the Department of Veterans Affairs Expiring Authorities Act of 2014 (P.L. 113-175).
50 Title 38 U.S.C. employees covered by the act include “any individual who occupies an administrative or executive
position and who was appointed under section 7306(a) or section 7401(1) of this title.” Section 7306(a) of Title 38
establishes positions for administrative officials in the office of the under secretary for health, including several
assistant undersecretaries for health, a director of physical assistant services, a director of nursing services, and several
other administrative directors whose appointments are considered necessary to suit the needs of the department. Section
7401(1) includes “physicians, dentists, podiatrists, chiropractors, optometrists, registered nurses, physician assistants,
and expanded-function dental auxiliaries.”
51 The act retains the Secretary’s current authority for removing a member of the SES or a Title 38 employee. Under his
current authority, the Secretary could instigate a removal for a member of the SES under 5 U.S.C. §3592, which allows
him to remove a senior executive for unsatisfactory performance. In other circumstances, the Secretary could remove a
member of the SES using adverse action procedures under 5 U.S.C. §7543 “for reasons of misconduct, neglect of duty,
malfeasance, or failure to accept a directed reassignment or to accompany a position in a transfer of function.” For
individuals in the VA-specific positions created under Title 38, another set of adverse action procedures is available to
the Secretary under that title (38 U.S.C. §§7461 et seq.).
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Veterans Access, Choice, and Accountability Act of 2014 (H.R. 3230; P.L. 113-146)
may remove the executive from the civil service entirely (i.e., from federal service). Second, the
Secretary may transfer the executive into a position at any grade on the General Schedule (GS)
“for which the individual is qualified and that the Secretary determines appropriate.”52 Under the
second scenario, the individual would be compensated at the established rate for that position.53
If the Secretary chooses to remove an individual using this new authority, the Secretary must
submit notice to the Senate and House Veterans’ Affairs Committees within 30 days of the
removal or transfer. The notice must contain the reasons for removal or transfer.
A removal or transfer made under this section would also be subject to a new set of expedited
appeal procedures if the senior executive chose to appeal the Secretary’s decision. First, the
individual would have up to seven days to appeal the Secretary’s decision to the Merit Systems
Protection Board (MSPB). While the appeal is ongoing, the individual is not eligible for
compensation, including pay, awards, bonuses, and other benefits.
Once the MSPB receives the appeal, the agency is to refer it to an administrative judge for
review, and the judge has up to 21 days following the date of the appeal to issue a decision. To
assist the MSPB in accomplishing the expedited review, the act instructs the Secretary to provide
to the MSPB and the reviewing administrative judge “such information and assistance as may be
necessary to ensure an appeal under this subsection is expedited.” The administrative judge’s
decision is final and may not be subject to further appeal.
If the judge cannot issue a decision in the case within the required 21-day period, the Secretary’s
decision to remove or transfer the senior executive would become final. If such an instance were
to occur, the MSPB must submit a report to the Senate and House Veterans’ Affairs Committees
explaining why the decision was not issued within 21 days.
This section also requires MSPB to establish a process to conduct these expedited reviews within
14 days of enactment of the act. The MSPB issued an interim final rule to comply with this
requirement on August 19, 2014.54 The rule is effective as of the date of issuance. Also within 14
days of enactment, the MSPB is required to report to the Committees on Veterans’ Affairs in the
Senate and House on their planned actions for expedited reviews. This report is to provide a
description of the resources the MSPB expects will be necessary to conduct the reviews,
including a description of any additional resources that may be necessary for the agency to fulfill
its new responsibilities.
52 The General Schedule is the pay scale on which many white-collar employees in the civil service are compensated.
53 Under current law, if an individual is removed from the SES for performance reasons, he or she is generally
guaranteed placement into a GS-15 position and may be eligible to receive pay that is higher than what would
otherwise have been allotted for that position. See 5 U.S.C. §3594(c)(1)(B).
54 Merit Systems Protection Board, “Practices and Procedures; Appeal of Removal or Transfer of Senior Executive
Service Employees of the Department of Veterans Affairs,” 79 Federal Register 48941-48946, August 19, 2014; and
Merit Systems Protection Board, “Practices and Procedures,” 79 Federal Register 63031-63032, October 22, 2014.
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Veterans Access, Choice, and Accountability Act of 2014 (H.R. 3230; P.L. 113-146)
Title VIII: Other Matters
Sec. 801. Appropriation of Amounts
This section, among other things, authorizes and appropriates $5 billion for the VA to hire
primary care and specialty care physicians and to hire other medical staff, including the
following: physicians; nurses; social workers; mental health professionals; and other health care
professionals as the Secretary considers appropriate. This funding will also be available for the
maintenance and operation of VHA facilities including leases and minor construction.
Sec. 802. Veterans Choice Fund
This section establishes in the Treasury a new fund known as the “Veterans Choice Fund” and the
Secretary will administer this fund. This section authorizes and appropriates $10 billion to be
deposited in the Veterans Choice Fund, and this amount will be available until expended to
implement only the provisions in Section 101. This section also stipulates that no more than $300
million of this amount shall be used for administrative expenses to implement Section 101.
Sec. 803. Emergency Designations
This section designates this act as an emergency requirement, and exempts it from budget
enforcement rules.55
55 Congress may exempt the budgetary effects of a provision in legislation from certain enforcement procedures by
designating such provision as an emergency requirement. Under the existing budget enforcement rules, if a provision is
so designated, the spending and revenue effects projected to result from that provision are not counted for purposes of
enforcing the budget procedures. For more information see, CRS Report R41564, Emergency Designation: Current
Budget Rules and Procedures, by Bill Heniff Jr.
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Appendix. Veterans Access, Choice, and Accountability Act of 2014:
Implementation and Reporting Deadlines
Table A-1. Veterans Access, Choice, and Accountability Act of 2014 (P.L. 113-146 as Amended by P.L. 113-175 and P.L. 113-235):
Implementation and Reporting Deadlines
Section of
P.L. 113-146 as amended
by P.L. 113-175 and P.L. 113-235
Brief Description
Implementation and/or Reporting Deadlinea
Section 101(k)
The Secretary is required to implement an efficient
The Secretary is required to prescribe regulations for
nationwide system for processing and paying bills or
the implementation of a claims processing system no
claims for authorized care and services under the
later than November 5, 2014.
Veterans Choice Program.
The Secretary is required to submit to the House and
Reports are due to the Committees no later than 20
Senate Committees on Veterans’ Affairs a quarterly
days after the end of a quarter.
report on the accuracy claims processing system.
Section 101(n)
The Secretary is required to prescribe and publish
The Secretary is required to publish regulations in the
interim final regulations on the implementation of
Federal Register for the implementation of Veterans
Veterans Choice Program.
Choice Program no later than November 5, 2014.
Section 101(o)
The Inspector General of the VA is required to submit
The Inspector General’s report is due no later than 30
audit report to the Secretary.
days after the Secretary determines that 75% of the
funds in the Veterans Choice Fund have been
exhausted.
Section 101(p)
The authority to provide care and services under the
The authority for the Veterans Choice Program expires
Veterans Choice Program.
on August 7, 2017, or when funds in the Veterans
Choice Fund have been exhausted—whichever occurs
first.
The Secretary is required to publish in the Federal
Register and on the VA website a notice indicating
expiration of the Veterans Choice Program. The
Secretary is required to publish this notice 30 days
before the funds are exhausted or no later than July 8,
2017.
CRS-24
Section of
P.L. 113-146 as amended
by P.L. 113-175 and P.L. 113-235
Brief Description
Implementation and/or Reporting Deadlinea
Section 101(q)
The Secretary is required to submit to the House and
The initial report is due no later than February 3, 2015,
Senate Committees on Veterans’ Affairs a report on
and the final report is due no later than 30 days after
the furnishing of care and services under the Veterans
the Secretary determines that 75% of the funds in the
Choice Program.
Veterans Choice Fund have been exhausted.
Section 101(s)
The Secretary is required to publish a report stating the The Secretary is required to publish in the Federal
actual wait-time goals of the VHA.
Register and on a website a report stating the actual
wait-time goals of the Veterans Health Administration
no later than October 6, 2014.
Section 102(c)
The Secretary and the Director of the Indian Health
The report is due to Congress no later than February
Service are jointly required to submit a report to
3, 2015.
Congress regarding the enhancement of col aboration
between the VA and Indian Health Service.
Section 105(c)
The Government Accountability Office (GAO) is
The report is due to Congress no later than August 7,
required to submit a report to Congress on the
2015.
timeliness of payments by the VA for hospital care,
medical services, and other health care furnished by
non-VA health care providers.
Section 201(a)
The Secretary is required to enter into one or more
Contracts are required to be entered into no later than
contracts with a private sector entity or entities to
November 5, 2014.
conduct an independent assessment of the hospital
care, medical services, and other health care furnished
in VA medical facilities.
The assessment needs to be completed no later than
July 3, 2015.
Section 201(d)
The program integrator is required to report the
The program integrator is required to report the
results of the independent assessment to the Secretary,
results within 60 days of the assessment’s conclusion.
the House and Senate Committees on Veterans' Affairs,
and the Commission on Care.
The Secretary is required to publish the results of the
independent assessment in the Federal Register and the
VA website no later than 30 days after receiving the
report.
CRS-25
Section of
P.L. 113-146 as amended
by P.L. 113-175 and P.L. 113-235
Brief Description
Implementation and/or Reporting Deadlinea
Section 202(a)
Certain Members of the Congress holding leadership
The Ful Commission on Care needs to be established
positions and the President are required to appoint a
no later than August 7, 2015.
“Commission on Care”
Majority of voting members of the “Commission on
A majority of the members of the Commission on Care
Care” appointed.
must be appointed by February 18, 2015.
Section 202(b)
The Commission on Care is required to submit an
The Interim report is due no later than 90 days after
interim and final report to the President, through the
the date of the initial meeting of the Commission on
Secretary.
Care, and a final report not later than 180 days after
the date of the initial meeting.
Section 202(g)
The President is required to submit a report to the
The report to the committees is due no later than 60
House and Senate Committees on Veterans’ Affairs and days after the President receives a report from the
other appropriate committees on the
Commission on Care.
recommendations contained in the Commission on
Care report.
Section 203(a)
The Secretary is required to use a technology task
No specific deadline.
force to conduct a review of the VA’s patient
scheduling system.
Section 203(b)
The technology task force is required to submit a
The technology task force report is required no later
report to the Secretary, the House and Senate
than September 21, 2014.
Committees on Veterans' Affairs, regarding the needs
of the VA with respect to the scheduling system and
scheduling software.
The Secretary is required to publish the technology
task force report in the Federal Register and on the VA
website no later than 30 days after receipt of the
report.
Section 203(c)
The Secretary is required to implement the
The Secretary is required to implement the
recommendations of technology task force report that
recommendations no later than one year after receipt
the Secretary considers are feasible, advisable, and cost
of the report.
effective.
CRS-26
Section of
P.L. 113-146 as amended
by P.L. 113-175 and P.L. 113-235
Brief Description
Implementation and/or Reporting Deadlinea
Section 204(b)
The Secretary is required to submit a report to the
The Secretary is required to submit the report no later
House and Senate Committees on Veterans' Affairs on
than August 7, 2015, and no later than September 30 of
access to care through VA mobile vet centers and
each year thereafter.
mobile medical centers.
Section 205(b)
The Secretary is required to modify the performance
The Secretary is required to modify the performance
plans of the directors of the VAMCs and VISNs.
plans no later than September 06, 2014.
Section 206(a)
The Secretary is required to publish the wait-times for
The Secretary is required to publish this information in
the scheduling of an appointment at each VAMC for the the Federal Register and on a publicly accessible website
receipt of primary care, specialty care, and hospital care no later than November 05, 2014. Whenever the wait-
and medical services based on the general severity of
times for scheduling an appointment changes, the
the condition of the veteran.
Secretary is required to publish the revised wait-times
not later than 30 days after such change; and in the
Federal Register by not later than 90 days after such
change.
Section 206(b)
The Secretary is required to develop and make available The Secretary is required to establish this database no
to the public a comprehensive database containing
later than February 3, 2015.
patient safety, quality of care, and outcome measures
for health care provided by the VA.
Section 206(c)
The Secretary is required to enter into an agreement
The Secretary is required to enter into an agreement
with the Secretary of Health and Human Services for
no later than February 3, 2015.
the provision of information to be available on the
Hospital Compare Internet website.
Section 206(d)
The Government Accountability Office (GAO) is
The GAO is required to conduct the review no later
required to conduct a review of the safety and quality
than August 7, 2017.
metrics made publicly available by the VA.
Section 207(c)
The Government Accountability Office (GAO) is
The GAO report is required no later than August 7,
required to submit a report to the House and Senate
2016.
Committees on Veterans’ Affairs on the oversight of
the credentialing of physicians under the Patient-
Centered Community Care initiative as well the
Veterans Choice Program.
CRS-27
Section of
P.L. 113-146 as amended
by P.L. 113-175 and P.L. 113-235
Brief Description
Implementation and/or Reporting Deadlinea
The Secretary is required to submit a report to GAO
The plan is required no later than 30 days after the
and to the House and Senate Committees on Veterans’
submittal of the GAO report.
Affairs, a plan to address any findings and
recommendations of the GAO report.
Secretary is required to implement the plan no later
than 90 days after the submittal of the GAO report.
Section 209
The Secretary is required to establish policies that
Secretary is required to implement these policies and
would impose penalties including termination of
penalties no later than October 6, 2014.
employees who knowingly submits false data concerning
wait times for health care or quality measures or
requires others to do so.
Section 301(a)
The VA Inspector General is required to determine,
The Secretary is required to publish in the Federal
and the Secretary is required to publish the five medical
Register the VA Inspector General’s determination, no
occupations for which there are the largest staffing
later than February 3, 2015, and by September 30 each
shortages throughout the VA.
year thereafter.
Section 301(b)
The Secretary is required to submit a report to the
The Secretary is required to submit this report on
House and Senate Committees on Veterans’ Affairs on
October 1 each year beginning 2015 and ending 2019.
graduate medical education residency positions at VA
medical facilities.
Section 301(d)
The Secretary is required to submit a report to the
The Secretary is required to submit this report no later
House and Senate Committees on Veterans’ Affairs
than February 3, 2015, and no later than December 31
assessing the staffing needs of each VA medical facility.
of each even-numbered year thereafter until 2024.
Section 303(a)
The Secretary is required to implement a clinic
The Secretary is required to implement this clinic
management training program to provide in-person,
management training program no later than February 3,
standardized education on systems and processes for
2015.
health care practice management and scheduling to all
appropriate employees.
Section 401
The act provides eligibility for sexual trauma counseling
Veterans on inactive duty training could receive
and treatment to veterans on inactive duty training.
services beginning August 7, 2014.
CRS-28
Section of
P.L. 113-146 as amended
by P.L. 113-175 and P.L. 113-235
Brief Description
Implementation and/or Reporting Deadlinea
Section 402
The Secretary may, in consultation with the Secretary
Members of the Armed Forces (including members of
of Defense, provide sexual trauma counseling and
the National Guard and Reserves) on active duty may
treatment to members of the Armed Forces (including
receive services beginning August 7, 2015.
members of the National Guard and Reserves) on
active duty.
Section 403(a)
The Secretary is required to submit a report to the
The report on the treatment and services available
House and Senate Committees on Veterans’ Affairs on
from the VA for military sexual trauma is required to
VA services available for military sexual trauma.
be submitted no later than April 28, 2016.
Section 403(b)
The Department of Veterans Affairs-Department of
The report on the transition of military sexual trauma
Defense Joint Executive Committee is required to
treatment from DOD to VA must be submitted no
submit a report to the House and Senate Committees
later than April 28, 2016, and annually thereafter until
on Veterans’ Affairs on the transition of military sexual
September 30, 2021.
trauma treatment from DOD to VA.
Section 501
Extension of Pilot Program on Assisted Living Services
The Assisted Living-Traumatic Brain Injury pilot will
for Veterans with Traumatic Brain Injury.
provided services to eligible veterans through contracts
with private sector community-based and transitional
rehabilitation programs from September 30, 2014, until
October 6, 2017.
Section 601(b)
The Secretary is required to determine the most cost
If the Secretary determines the most cost effective
effective option over a 30-year life cycle for a CBOC in
option is to construct a new CBOC the Secretary may
Tulsa, Oklahoma.
request authority for a major medical facility project in
Tulsa, Oklahoma, from Congress, and submit a detailed
cost-benefit analysis no later than 90 days after making
such a determination.
Section 602
The Secretary is required to submit reports to the
The Secretary is required to submit a report no less
House and Senate Committees on Veterans’ Affairs on
than 30 days before entering into a major medical
the budgetary treatment of VA major medical facilities
facility lease and no more than 30 days after entering
leases.
into a major medical facility lease.
Section 701
The act expands eligibility for the Marine Gunnery
This is effective for terms beginning after December 31,
Sergeant John David Fry Scholarship program to the
2014.
spouse of an individual who, on or after September 11,
2001, dies in the line of duty while serving on active
duty as a member of the Armed Forces.
CRS-29
Section of
P.L. 113-146 as amended
by P.L. 113-175 and P.L. 113-235
Brief Description
Implementation and/or Reporting Deadlinea
Section 702
The act requires the Secretary to disapprove a course
This is effective for terms beginning after July 1, 2015.
at a public institution of higher learning (IHL) if the IHL
charges tuition and fees above the in-state rate for that
course to a qualifying Post-9/11 GI Bill or Al -Volunteer
Force Educational Assistance Program (MGIB-AD)
participant who is living in the state in which the IHL is
located.
Section 707
The act creates a new statute, 38 U.S.C. 713, which
The act requires the Merit Systems Protection Board to
sets forth new rules for the removal or transfer of
develop and to put into effect expedited procedures for
Senior Executive Service employees of the Department
processing appeals filed pursuant to 38 U.S.C. 713 no
of Veterans Affairs (covered SES employees) for
later than August 21, 2014.
performance or misconduct and requires expedited
review of such actions by the Merit Systems Protection
Board.
Section 801(d)
The Secretary is required submit a report to the House The Secretary is required to submit the report no later
and Senate Veterans’ Affairs Committees and
than August 7, 2015.
Appropriations Committees, on how the VA has
obligated the $5 billion that was authorized and
appropriated to increase veterans access to care
through the hiring of physicians and other medical staff
and by improving VA’s physical infrastructure.
Section 802(c)
The Secretary is required to submit a report to the
No specific deadline.
House and Senate Veterans’ Affairs and Appropriations
Committees if the Secretary plans to use more than
$300 million from the Veterans Choice Fund for
administrative purposes to implement the Veterans
Choice Program.
Source: Table prepared by the Congressional Research Service (CRS).
a. Certain dates were calculated based on the number of days prescribed in P.L. 113-146 as amended by P.L. 113-175 and P.L. 113-235. Where the number of days is
dependent upon certain preceding actions, only the number of days as indicated in the statute is presented. For example, if a report is due 90 days after an initial
meeting, then only “90 days” is indicated.
CRS-30
Veterans Access, Choice, and Accountability Act of 2014 (H.R. 3230; P.L. 113-146)
Author Contact Information
Sidath Viranga Panangala
Cassandria Dortch
Specialist in Veterans Policy
Analyst in Education Policy
spanangala@crs.loc.gov, 7-0623
cdortch@crs.loc.gov, 7-0376
Maeve P. Carey
Elayne J. Heisler
Analyst in Government Organization and
Specialist in Health Services
Management
eheisler@crs.loc.gov, 7-4453
mcarey@crs.loc.gov, 7-7775
Congressional Research Service
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