President Barack Obama signed the Veterans Access, Choice and Accountability Act of 2014 (H.R. 3230) into public law on August 7. Chairmen of the Senate and House Veterans’ Affairs Committees Bernie Sanders (I-VT) and Jeff Miller (R-FL) as well as ranking members Senator Richard Burr (R-NC) and Representative Mike Michaud (D-ME) facilitated the passage of the legislation by reaching an agreement that resolved differences in the conflicting versions of the bill that had been introduced in the House and Senate. The Act aims to increase and improve veterans’ access to healthcare and will funnel funds towards subsidized care outside of the Veteran’s Administration (VA) healthcare system.
Please see the details below for highlights from the bill:
Care delivery and payment
- The bill requires that the VA provide authorization for qualifying veterans enrolled in the VA healthcare system who cannot be seen for an appointment within 30 days of seeking treatment at a VA medical facility to receive care outside of the VA system with a contracted outside hospital.
- Those authorized veterans will receive a Veterans Choice Card and the initiative will be funded with $10 billion from the “Veterans Choice Fund.”
- No later than 90 days after the bill is in enacted, the Secretary of the VA will contract with a private sector organization that will conduct independent assessments of the healthcare provided in VA medical facilities.
- The legislation requires that the VA enter into negotiations with the hospitals around rates, and that the rates not exceed the amount paid under the Medicare program (with the exception of care for eligible veterans who reside in a highly rural area). In addition, the entity that furnishes care or services may not be treated as a federal contractor or subcontractor.
- The entity that furnishes care or services may not be treated as a federal contractor or subcontractor
- The legislation requires prompt payment by the VA by developing an efficient system to process and pay claims. In addition, the legislation requires a report no later than a year after the date of enactment on the timeliness of payments for hospital care, medical services and other healthcare furnished by non-VA providers. The report shall include: the amount of time for payments, a comparison between these payment times and times for similar federal programs, and recommendations for legislative or administrative action as appropriate.
- Interim final regulations are required after 90 days of the date of enactment of the legislation.
Healthcare administrative matters
- Allocates $5 billion towards hiring additional medical staff and improving the system’s infrastructure.
- Requires an independent assessment of the VA system and management processes.
- Establishes a “Commission on Care” which will examine veterans’ access to healthcare from the VA and strategically examine how best to organize the VA, locate healthcare resources, and deliver care during the 20 year period following enactment of the legislation.
- Establishes improved performance metrics for healthcare provided by the VA.
- Requires the publication of wait times of each facility for primary care, specialty care and hospital care and medical services based on the general severity of the condition online 90 days after enactment of the legislation.
- Requires the development of a publically available database of patient safety, quality of care and outcomes measures no later than 180 after enactment. This information will appear on the Department of Health and Human Services (HHS) Hospital Compare website. The measures shall include:
- Timely and effective healthcare
- Readmissions, complications of death including with respect to 30-day mortality rates and 30-day readmission rates, surgical complication measures, and health care related infection measures
- Patients experience of care (HCAHPS or similar survey)
- Any other measures required or reported for hospital participation in Medicare
The Congressional Budget Office (CBO) current estimates put the cost of the bill at $11-$12 billion over 10 years.
- Highlights of the Veterans Access, Choice and Accountability Act of 2014