#aacth ,,congress  #b;d ,session  ,in   
the ,house of ,representatives1 ,u4 ,s41
  ,june #ah1 #bjad  ,,house ,,amendment 
,,to ,,senate ,,amendment  ,that the    
,house agree to the amendment of the    
,senate to the title of the bill 7,h4,r4
 #cbcj7 entitled ,an ,act making        
continuing appropriations during a      
,government shutdown to provide pay and 
allowances to members of the reserve    
components of the ,armed ,forces who    
perform inactive-duty training during   
such period4 and be it further  ,that   
the ,house agree to the amendment of the
 ,senate to the text of the             
aforementioned bill1 with the following 
,in lieu of the matter proposed to be   
inserted by the amendment of the ,senate
 to the text of the bill1 insert the    
following3  #a4 ,short title ,this ,act 
may be cited as the ,veteran ,access to 
,care ,act of #bjad4  #b4 ,provision of 
hospital care and medical services at   
non-,department of ,veterans ,affairs   
facilities for ,department of ,veterans 

,affairs patients with extended waiting 
times for appointments at ,department   
facilities  7a7 ,in general ,as         
authorized by section #agaj of title    
#ch1 ,united ,states ,code1 the         
,secretary of ,veterans ,affairs 7in    
this ,act referred to as the ,secretary7
 shall enter into contracts with such   
non-,department facilities as may be    
necessary in order to furnish hospital  
care and medical services to covered    
veterans who are eligible for such care 
and services under chapter #ag of title 
#ch1 ,united ,states ,code4 ,to the     
greatest extent possible1 the ,secretary
 shall carry out this section using     
contracts entered into before the date  
of the enactment of this ,act4  7b7     
,covered veterans ,for purposes of this 
section1 the term covered veteran means 
a veteran--  7#a7 who is enrolled in the
 patient enrollment system under section
 #agje of title #ch1 ,united ,states    
,code2  7#b7 who--  7,a7 has waited     
longer than the wait-time goals of the  

,veterans ,health ,administration 7as of
 ,june #a1 #bjad7 for an appointment for
 hospital care or medical services in a 
facility of the ,department2  7,b7 has  
been notified by a facility of the      
,department that an appointment for     
hospital care or medical services is not
 available within such wait-time goals2 
or  7,c7 resides more than #dj miles    
from the medical facility of the        
,department of ,veterans ,affairs1      
including a community-based outpatient  
clinic1 that is closest to the residence
 of the veteran2 and  7#c7 who makes an 
election to receive such care or        
services in a non-,department facility4 
7c7 ,follow-,up care ,in carrying out   
this section1 the ,secretary shall      
ensure that1 at the election of a       
covered veteran who receives hospital   
care or medical services at a           
non-,department facility in an episode  
of care under this section1 the veteran 
receives such hospital care and medical 
services at such non-,department        

facility through the completion of the  
episode of care 7but for a period not   
exceeding #fj days71 including all      
specialty and ancillary services deemed 
necessary as part of the treatment      
recommended in the course of such       
hospital care or medical services4  7d7 
,report ,the ,secretary shall submit to 
,congress a quarterly report on hospital
 care and medical services furnished    
pursuant to this section4 ,such report  
shall include information1 for the      
quarter covered by the report1          
regarding--  7#a7 the number of veterans
 who received care or services at       
non-,department facilities pursuant to  
this section2  7#b7 the number of       
veterans who were eligible to receive   
care or services pursuant to this       
section but who elected to continue     
waiting for an appointment at a         
,department facility2  7#c7 the purchase
 methods used to provide the care and   
services at non-,department facilities1 
including the rate of payment for       

individual authorizations for such care 
and services2 and  7#d7 any other       
matters the ,secretary determines       
appropriate4  7e7 ,definitions ,for     
purposes of this section1 the terms     
facilities of the ,department1          
non-,department facilities1 hospital    
care1 and medical services have the     
meanings given such terms in section    
#agja of title #ch1 ,united ,states     
,code4  7f7 ,implementation ,the        
,secretary shall begin implementing this
 section on the date of the enactment of
 this ,act4  7g7 ,construction ,nothing 
in this section shall be construed to   
authorize payment for care or services  
not otherwise covered under chapter #ag 
of title #ch1 ,united ,states ,code4    
7h7 ,termination ,the authority of the  
,secretary under this section shall     
terminate with respect to any hospital  
care or medical services furnished after
 the end of the #b-year period beginning
 on the date of the enactment of this   
,act1 except that in the case of an     

episode of care for which hospital care 
or medical services is furnished in a   
non-,department facility pursuant to    
this section before the end of such     
period1 such termination shall not apply
 to such care and services furnished    
during the remainder of such episode of 
care but not to exceed a period of #fj  
days4  #c4 ,expanded access to hospital 
care and medical services  7a7 ,in      
general ,to the extent that             
appropriations are available for the    
,veterans ,health ,administration of the
 ,department of ,veterans ,affairs for  
medical services1 to the extent that the
 ,secretary of ,veterans ,affairs is    
unable to provide access1 within the    
wait-time goals of the ,veterans ,health
 ,administration 7as of ,june #a1       
#bjad71 to hospital care or medical     
services to a covered veteran who is    
eligible for such care or services under
 chapter #ag of title #ch1 ,united      
,states ,code1 under contracts described
 in section #b1 the ,secretary shall    

reimburse any non-,department facility  
with which the ,secretary has not       
entered into a contract to furnish      
hospital care or medical services for   
furnishing such hospital care or medical
 services to such veteran1 if the       
veteran elects to receive such care or  
services from the non-,department       
facility4 ,the ,secretary shall         
reimburse the facility for the care or  
services furnished to the veteran at the
 greatest of the following rates3  7#a7 
,,va payment rate ,the rate of          
reimbursement for such care or services 
established by the ,secretary of        
,veterans ,affairs4  7#b7 ,medicare     
payment rate ,the payment rate for such 
care or services or comparable care or  
services under the ,medicare program    
under title ,,xviii of the ,social      
,security ,act4  7#c7 ,,tricare payment 
rate ,the reimbursement rate for such   
care or services furnished to a member  
of the ,armed ,forces under chapter #ee 
of title #aj1 ,united ,states ,code4    

7b7 ,covered veterans ,for purposes of  
this section1 the term covered veteran  
means a veteran--  7#a7 who is enrolled 
in the patient enrollment system under  
section #agje of title #ch1 ,united     
,states ,code2 and  7#b7 who--  7,a7 has
 waited longer than the wait-time goals 
of the ,veterans ,health ,administration
 7as of ,june #a1 #bjad7 for an         
appointment for hospital care or medical
 services in a facility of the          
,department2  7,b7 has been notified by 
a facility of the ,department that an   
appointment for hospital care or medical
 services is not available within such  
wait-time goals after the date for which
 the veteran requests the appointment2  
or  7,c7 who resides more than #dj miles
 from the medical facility of the       
,department of ,veterans ,affairs1      
including a community-based outpatient  
clinic1 that is closest to the residence
 of the veteran4  7c7 ,definitions ,for 
purposes of this section1 the terms     
facilities of the ,department1          

non-,department facilities1 hospital    
care1 and medical services have the     
meanings given such terms in section    
#agja of title #ch1 ,united ,states     
,code4  7d7 ,implementation ,the        
,secretary shall begin implementing this
 section on the date of the enactment of
 this ,act4  7e7 ,construction ,nothing 
in this section shall be construed to   
authorize payment for care or services  
not otherwise covered under chapter #ag 
of title #ch1 ,united ,states ,code4    
7f7 ,termination ,the authority of the  
,secretary under this section shall     
terminate with respect to care or       
services furnished after the date that  
is #b years after the date of the       
enactment of this ,act4  #d4            
,independent assessment of ,veterans    
,health ,administration performance  7a7
 ,independent assessment required ,not  
later than #abj days after the date of  
the enactment of this ,act1 the         
,secretary of ,veterans ,affairs shall  
enter into a contract or contracts with 

a private sector entity or entities with
 experience in the delivery systems of  
the ,veterans ,health ,administration   
and the private sector and in health    
care management to conduct an           
independent assessment of hospital care 
and medical services furnished in       
medical facilities of the ,department of
 ,veterans ,affairs4 ,such assessment   
shall address each of the following3    
7#a7 ,the current and projected         
demographics and unique care needs of   
the patient population served by the    
,department of ,veterans ,affairs4  7#b7
 ,the current and projected health care 
capabilities and resources of the       
,department1 including hospital care and
 medical services furnished by          
non-,department facilities under        
contract with the ,department1 to       
provide timely and accessible care to   
eligible veterans4  7#c7 ,the           
authorities and mechanisms under which  
the ,secretary may furnish hospital care
 and medical services at non-,department

 facilities1 including an assessment of 
whether the ,secretary should have the  
authority to furnish such care and      
services at such facilities through the 
completion of episodes of care4  7#d7   
,the appropriate system-wide access     
standard applicable to hospital care and
 medical services furnished by and      
through the ,department of ,veterans    
,affairs and recommendations relating to
 access standards specific to individual
 specialties and standards for post-care
 rehabilitation4  7#e7 ,the current     
organization1 processes1 and tools used 
to support clinical staffing and        
documentation4  7#f7 ,the staffing      
levels and productivity standards1      
including a comparison with industry    
performance percentiles4  7#g7          
,information technology strategies of   
the ,veterans ,health ,administration1  
including an identification of          
technology weaknesses and opportunities1
 especially as they apply to clinical   
documentation of hospital care and      

medical services provided in            
non-,department facilities4  7#h7       
,business processes of the ,veterans    
,health ,administration1 including      
non-,department care1 insurance         
identification1 third-party revenue     
collection1 and vendor reimbursement4   
7b7 ,assessment outcomes ,the assessment
 conducted pursuant to subsection 7a7   
shall include the following3  7#a7 ,an  
identification of improvement areas     
outlined both qualitatively and         
quantitatively1 taking into             
consideration ,department of ,veterans  
,affairs directives and industry        
benchmarks from outside the ,federal    
,government4  7#b7 ,recommendations for 
how to address the improvement areas    
identified under paragraph 7#a7 relating
 to structure1 accountability1 process  
changes1 technology1 and other relevant 
drivers of performance4  7#c7 ,the      
business case associated with making the
 improvements and recommendations       
identified in paragraphs 7#a7 and 7#b74 

7#d7 ,findings and supporting analysis  
on how credible conclusions were        
established4  7c7 ,program integrator   
,if the ,secretary enters into contracts
 with more than one private sector      
entity under subsection 7a71 the        
,secretary shall designate one such     
entity as the program integrator4 ,the  
program integrator shall be responsible 
for coordinating the outcomes of the    
assessments conducted by the private    
entities pursuant to such contracts4    
7d7 ,submittal of reports to ,congress  
7#a7 ,report on independent assessment  
,not later than #aj months after        
entering into the contract under        
subsection 7a71 the ,secretary shall    
submit to the ,committees on ,veterans' 
,affairs of the ,senate and ,house of   
,representatives the findings and       
recommendations of the independent      
assessment required by such subsection4 
7#b7 ,report on ,,va action plan to     
implement recommendations in assessment 
,not later than #abj days after the date

 of submission of the report under      
paragraph 7#a71 the ,secretary shall    
submit to such ,committees on the       
,secretary's response to the findings of
 the assessment and shall include an    
action plan1 including a timeline1 for  
fully implementing the recommendations  
of the assessment4  #e4 ,limitation on  
awards and bonuses to employees of      
,department of ,veterans ,affairs ,for  
each of fiscal years #bjad through      
#bjaf1 the ,secretary of ,veterans      
,affairs may not pay awards or bonuses  
under chapter #de or #ec of title #e1   
,united ,states ,code1 or any other     
awards or bonuses authorized under such 
title4  #f4 ,,omb estimate of budgetary 
effects and needed transfer authority   
,not later than #cj days after the date 
of the enactment of this ,act1 the      
,director of the ,office of ,management 
and ,budget shall transmit to the       
,committees on ,appropriations1 the     
,budget1 and ,veterans' ,affairs of the 
,house of ,representatives and of the   

,senate--  7#a7 an estimate of the      
budgetary effects of sections #b and #c2
  7#b7 any transfer authority needed to 
utilize the savings from section #e to  
satisfy such budgetary effects2 and     
7#c7 if necessary1 a request for any    
additional budgetary resources1 or      
transfers or reprogramming of existing  
budgetary resources1 necessary to       
provide funding for sections #b and #c4 
#g4 ,removal of ,senior ,executive      
,service employees of the ,department of
 ,veterans ,affairs for performance  7a7
 ,in general ,chapter #g of title #ch1  
,united ,states ,code1 is amended by    
adding at the end the following new     
section3  #gac4 ,senior ,executive      
,service3 removal based on performance  
7a7 ,in general ,notwithstanding any    
other provision of law1 the ,secretary  
may remove any individual from the      
,senior ,executive ,service if the      
,secretary determines the performance of
 the individual warrants such removal4  
,if the ,secretary so removes such an   

individual1 the ,secretary may--  7#a7  
remove the individual from ,federal     
service2 or  7#b7 transfer the          
individual to a ,general ,schedule      
position at any grade of the ,general   
,schedule the ,secretary determines     
appropriate4  7b7 ,notice to ,congress  
,not later than #cj days after removing 
an individual from the ,senior          
,executive ,service under paragraph     
7#a71 the ,secretary shall submit to the
 ,committees on ,veterans' ,affairs of  
the ,senate and ,house of               
,representatives notice in writing of   
such removal and the reason for such    
removal4  7c7 ,manner of removal ,a     
removal under this section shall be done
 in the same manner as the removal of a 
professional staff member employed by a 
,member of ,congress4  4  7b7 ,clerical 
amendment ,the table of sections at the 
beginning of such chapter is amended by 
adding at the end the following new     
item3  #gac4 ,senior ,executive         
,service3 removal based on performance4 

4  #h4 ,budgetary effects of ,act ,the  
budgetary effects of this ,act1 for the 
purpose of complying with the ,statutory
 ,pay-,as-,you-,go ,act of #bjaj1 shall 
be determined by reference to the latest
 statement titled ,budgetary ,effects of
 ,,paygo ,legislation for this ,act1    
submitted for printing in the           
,congressional ,record by the ,chairman 
of the ,house ,budget ,committee1       
provided that such statement has been   
submitted prior to the vote on passage4 
,clerk4