,,ii  #aacth ,,congress  #ast ,session  
,s4 #afjd  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,october #bi1  
#bjac,mr4 ,sanders introduced the       
following bill2 which was read twice and
 referred to the ,committee on          
,veterans' ,affairs  ,a ,,bill  ,to     
amend title #ch1 ,united ,states ,code1 
to expand and enhance eligibility for   
health care and services through the    
,department of ,veterans ,affairs1 and  
for other purposes4  #a4 ,short title   
,this ,act may be cited as the ,veterans
 ,health ,care ,eligibility ,expansion  
and ,enhancement ,act of #bjac4  #b4    
,enhancement of nature of eligibility   
for care of certain veterans ,section   
#agaj7;a77#c7 of title #ch1 ,united     
,states ,code1 is amended by striking   
may1 to the extent resources and        
facilities are available and and        
inserting shall14  #c4 ,requirement for 
enrollment in patient enrollment system 
of ,department of ,veterans ,affairs of 
certain veterans eligible for enrollment

 by law but not currently permitted to  
enroll  7a7 ,requirement for enrollment 
,section #agje of title #ch1 ,united    
,states ,code1 is amended by adding at  
the end the following new subsection3   
7d7 7#a7 ,the ,secretary shall provide  
for the enrollment in the patient       
enrollment system of veterans specified 
in paragraph 7#b7 by not later than     
,december #ca1 #bjad4  7#b7 ,veterans   
specified in this paragraph are as      
follows3 7,a7 ,veterans with            
noncompensable service-connected        
disabilities rated as zero percent      
disabling who-- 7i7 are not otherwise   
permitted to enroll in the system as of 
the date of the enactment of the        
,veterans ,health ,care ,eligibility    
,expansion and ,enhancement ,act of     
#bjac2 and  7ii7 as of the date of      
enrollment under this section1 do not   
have access to health insurance except  
through a health exchange established   
pursuant to section #acaa of the        
,patient ,protection and ,affordable    

,care ,act 7#db ,u4,s4,c4 #ahjca74  7,b7
 ,veterans without service-connected    
disability who-- 7i7 are not otherwise  
permitted to enroll in the system as of 
the date of the enactment of the        
,veterans ,health ,care ,eligibility    
,expansion and ,enhancement ,act of     
#bjac2 and  7ii7 as of the date of      
enrollment under this section1 do not   
have access to health insurance except  
through a health exchange established   
pursuant to section #acaa of the        
,patient ,protection and ,affordable    
,care ,act4  7#c7 ,the ,secretary shall 
determine whether a veteran does not    
have access to health insurance except  
through a health exchange for purposes  
of paragraph 7#b7 using information     
obtained by the ,secretary of ,health   
and ,human ,services and the ,secretary 
of the ,treasury for purposes of        
determining whether the veteran         
maintains minimum essential coverage as 
required by section #ejjj;,a of the     
,internal ,revenue ,code of #aihf and   

reported as required by section #fjee of
 the ,internal ,revenue ,code of #aihf4 
7#d7 ,a veteran who1 after enrolling in 
the patient enrollment system pursuant  
to this subsection1 obtains access to   
health insurance other than through a   
health exchange shall remain enrolled in
 the patient enrollment system          
notwithstanding obtaining access to such
 health insurance4  7#e7 ,a veteran     
enrolled in the patient enrollment      
system pursuant to this subsection shall
 maintain the priority for care of the  
veteran at the time of enrollment unless
 and until a change in circumstances of 
the veteran results in a higher priority
 for care of the veteran under          
subsection 7a74  4  7b7 ,public notice  
of commencement of enrollment ,the      
,secretary of ,veterans ,affairs shall  
publish in the ,federal ,register1 and  
shall make available to the public on an
 ,internet website of the ,department of
 ,veterans ,affairs1 a notice regarding 
the date on which veterans covered by   

subsection 7d7 of section #agje of title
 #ch1 ,united ,states ,code 7as added by
 subsection 7a7 of this section71 may   
commence enrollment in the patient      
enrollment system required by that      
section4  #d4 ,further extension of     
period of eligibility for health care   
for veterans of combat service during   
certain periods of hostilities and war  
,section #agaj7;e77#c7 of title #ch1    
,united ,states ,code1 is amended-- 7#a7
 in subparagraph 7,a71 by striking the  
date that is five years before the date 
of the enactment of the ,national       
,defense ,authorization ,act for ,fiscal
 ,year #bjjh1 after a period of five    
years and inserting ,january #bg1 #bjjc1
 after a period of #aj years2 and  7#b7 
in subparagraph 7,b71 by striking more  
than five years and all that follows and
 inserting before ,january #bh1 #bjjc1  
and who did not enroll in the patient   
enrollment system under section #agje of
 this title before ,january #bh1 #bjjh1 
after ,january #bg1 #bjah44  #e4        

,relocation and restatement of          
limitation on requirements to furnish   
certain care and services contingent on 
the availability of appropriations  7a7 
,relocation and restatement ,section    
#agjg of title #ch1 ,united ,states     
,code1 is amended by adding at the end  
the following new subsection3  7c7 7#a7 
,the requirements specified in paragraph
 7#b7 shall be effective in any fiscal  
year only to the extent and in the      
amount provided in advance in           
appropriations ,acts for such purposes4 
7#b7 ,the requirements specified in this
 paragraph are as follows3 7,a7 ,the    
requirement in paragraphs 7#a71 7#b71   
and 7#c7 of section #agaj7;a7 of this   
title that the ,secretary provide       
hospital care and medical services4     
7,b7 ,the requirement in section        
#agaj;,a7a7 of this title that the      
,secretary provide nursing home care4   
7,c7 ,the requirement in section        
#agaj;,b of this title that the         
,secretary provide a program of extended

 care services4  7,d7 ,the requirement  
in section #agde of this title that the 
,secretary provide nursing home care and
 prescription medicines to veterans with
 service-connected disabilities in      
,state homes4  4  7b7 ,conforming repeal
 of superseded limitation ,section      
#agaj7;a7 of such title is amended--    
7#a7 by striking paragraph 7#d72 and    
7#b7 by redesignating paragraph 7#e7 as 
paragraph 7#d74  #f4 ,modification of   
determination of eligibility of veterans
 for treatment as a low-income family   
for purposes of enrollment in the       
patient enrollment system of the        
,department of ,veterans ,affairs  7a7  
,areas of residence ,the ,secretary of  
,veterans ,affairs shall modify the     
areas in which veterans reside as       
specified for purposes of determining   
whether veterans qualify for treatment  
as low-income families for enrollment in
 the patient enrollment system of the   
,department of ,veterans ,affairs under 
section #agje7;a77#g7 of title #ch1     

,united ,states ,code1 to meet the      
requirements as follows3 7#a7 ,any area 
so specified shall be within only one   
,state4  7#b7 ,any area so specified    
shall be co-extensive with one or more  
counties 7or similar political          
subdivisions7 in the ,state concerned4  
7b7 ,variable income thresholds ,the    
,secretary shall modify the thresholds  
for income as specified for purposes of 
determining whether veterans qualify for
 treatment as low-income families for   
enrollment in the patient enrollment    
system referred to in subsection 7a7 to 
meet the requirements as follows3 7#a7  
,there shall be one income threshold for
 each ,state1 equal to the highest      
income threshold among the counties     
within such ,state4  7#b7 ,the          
calculation of the highest income       
threshold of a county shall be          
consistent with the calculation used for
 purposes of section #c7;b7 of the      
,united ,states ,housing ,act of #aicg  
7#db ,u4,s4,c4 #adcg;a7b774  7#c7 ,the  

timing and methodology for implementing 
any modifications in geographic income  
thresholds pursuant to paragraph 7#a7   
shall be determined by the ,secretary in
 such a manner as to permit the         
,department to build capacity for       
enrolling such additional veterans in   
the patient enrollment system of the    
,department as become eligible for      
enrollment as a result of such          
modifications1 except that all required 
modifications shall be completed not    
later than five years after date of the 
enactment of this ,act4  #g4            
,contracting for health care  7a7 ,use  
of capitation-,based resource allocation
 in entry into contracts ,in entering   
into contracts for the furnishing of    
health care services under the laws     
administered by the ,secretary of       
,veterans ,affairs 7including under this
 ,act and the amendments made by this   
,act71 the ,secretary shall use the     
capitation-based resource allocation    
model of the ,department of ,veterans   

,affairs4  7b7 ,priority for contracts  
with certain entities ,in entering into 
contracts for the furnishing of health  
care services under the laws            
administered by the ,secretary1 the     
,secretary shall afford a priority for  
entry into contracts for ,federally     
,qualified ,health ,centers 7,f,q,h,cs7 
and ,community ,health ,centers         
7,c,h,cs71 whenever appropriate4  7c7   
,best practices ,the ,secretary shall   
modify the guidance of the ,department  
of ,veterans ,affairs on contracts for  
health care services in order to provide
 for the incorporation into such        
contracts of standardized requirements  
for such best practices under such      
contracts1 including the following3 7#a7
 ,requirements that contracts provide   
the ,department on a regular basis      
information on scheduling and appearance
 for appointments for health care on a  
per-patient basis4  7#b7 ,such other    
best practices requirements as the      
,secretary considers appropriate4