VA State Health-Care Reform Pilot Programs Act

Summary: VA State Health-Care Reform Pilot Programs Act - Authorizes the Secretary of Veterans Affairs to conduct pilot programs in up to five States that have reformed health-care systems (a statutorily established system to assure residents access to health-care services) under which the Department of Veterans Affairs may provide, directly or by contract, health-care services on the same or a similar basis as the State plan mandates for residents.  Makes eligible for such services veterans, survivors and dependents of disabled veterans or veterans who died in active service, and members of the family of any veteran participating in the pilot program.  Outlines pilot program conditions, including a 30-day waiting period after notifying specified congressional committees of the intention to establish the program. Requires the payment of all applicable premiums, copayments, deductibles, and coinsurance payments by program participants.  Terminates the authority to conduct the pilot programs as of December 31, 1990. 
Establishes a revolving fund and authorizes appropriations to the fund for FY 1995 through 1997 for pilot program purposes.  Provides for the collection of funds from program participants. Allows any required administrative reorganization necessary to carry out a pilot program without the required congressional notification and waiting period.  Provides for:  (1) marketing activities to promote the pilot programs; and (2) required reports.

SECTION 1. SHORT TITLE.

    This Act shall be cited as the ``VA State Health-Care Reform Pilot 
Programs Act''.

SEC. 2. DEFINITIONS.

    For purposes of this Act--
            (1) The term ``Department'' means the Department of 
        Veterans Affairs.
            (2) The term ``family'' means the spouse of a veteran or a 
        child of a veteran as those terms are defined in section 101 of 
        title 38, United States Code.
            (3) The term ``pilot program'' means a program authorized 
        by section 5(a) of this Act.
            (4) The term ``reformed health-care system'' means a State 
        program which is statutorily established by a State that the 
        Secretary determines was established to assure that residents 
        of the State have access to health-care services.
            (5) The term ``Secretary'' means the Secretary of Veterans 
        Affairs.
            (6) The term ``veteran'' has meaning given such term in 
        section 101(2) of title 38, United States Code.

SEC. 3. PILOT PROGRAMS AUTHORITY.

    (a) Authority To Conduct Programs.--In up to five States that have 
reformed health-care systems, the Secretary may conduct pilot programs 
under which the Department may provide health care services, directly 
or by contract, to persons identified in subsection (b) on the same or 
similar basis as the State plan mandates for residents in the State.
    (b) Persons Eligible for Services Under Programs.--Persons eligible 
to receive services under a pilot program are any residents of the 
State in which the pilot program is being conducted who are--
            (1) veterans;
            (2) individuals eligible for benefits under section 1713 of 
        title 38, United States Code; or
            (3) members of the family of any veteran who participates 
        in a pilot program.
    (c) Authority To Comply With State Health Plan Requirements.--In 
conducting pilot programs, the Secretary may comply with such 
requirements of State law applicable to the establishment and operation 
of a health plan under a State reform plan, or to functioning as a 
participant in, member of, or contractor to, such a health plan, as the 
Secretary considers appropriate for application to a department or 
agency of the Federal Government.
    (d) Catchment Areas.--In conducting pilot programs in a State, the 
Secretary may--
            (1) conduct the programs in some or all health care 
        facilities of the Department located in the State; and
            (2) establish such catchment areas within the State as the 
        Secretary determines appropriate.

SEC. 4. CONDITIONS OF PARTICIPATION.

    (a) Condition on Establishment of Programs.--The Secretary may 
establish and operate a pilot program in a State only after 
determining, based on such factors as the Secretary considers relevant 
(including the factors referred to in subsection (b)), that, in the 
absence of an enrollment option through a Department plan in that 
State, the projected workload in one or more Department health care 
facilities in the State would decline to a level that--
            (1) would threaten to impair the capability of such 
        facilities to meet one or more assigned mission of such 
        facilities; or
            (2) would result in a deterioration in the quality of the 
        service delivered by such facilities to an extent that it would 
        not be reasonable to continue to provide needed services in 
        such facilities and satisfactory alternative arrangements could 
        not feasibly be provided.
    (b) Factors.--In making a determination under subsection (a), the 
Secretary shall consider the following:
            (1) The relative universality of coverage provided to State 
        residents under the State reform plan.
            (2) The scope of benefits offered under the plan.
            (3) The extent of financing supporting the plan.
            (4) The extent to which the State may serve as a model for 
        the Department in determining how to compete with other health 
        care providers in other States when Congress enacts National 
        health care reform.
            (5) Such other matters as the Secretary determines 
        appropriate.
    (c) Notice and Wait Requirement.--(1) The Secretary may establish 
and operate a pilot program in a State not earlier than 30 days after 
submitting to the Committees on Veterans' Affairs of the Senate and the 
House of Representatives a report on the pilot program.
    (2) Each report submitted under paragraph (1) shall include the 
following:
            (A) The rationale for proposed participation in the State 
        reform plan.
            (B) A description of the extent to which applicable 
        provisions of State law specifically accommodate and facilitate 
        participation of the Department in the State reform plan.
            (C) A detailed business plan for the participation of the 
        Department under the State reform plan.
            (D) A description of the actions the Secretary has taken to 
        consult with veterans on the proposed participation of the 
        Department in the State reform plan.
    (d) Requirement for Regulations.--The Secretary may operate a pilot 
program in a State only after prescribing implementing regulations.
    (e) Copayments.--(1) Except as provided in paragraph (2), the 
Secretary shall require persons receiving health care services under a 
pilot program to pay all premiums, copayments, deductibles, and 
coinsurance amounts required by State law in the State where the pilot 
program is undertaken.
    (2) The Secretary may not collect premiums, copayments, 
deductibles, and coinsurance amounts under this subsection from the 
following individuals:
            (A) Any veteran with a service-connected disability.
            (B) any veteran whose discharge or release from the active 
        military, naval or air service was for a disability incurred or 
        aggravated in the line of duty.
            (C) Any veteran who is in receipt of, or who, but for a 
        suspension pursuant to section 1151 of title 38, United States 
        Code (or both such a suspension and the receipt of retired 
        pay), would be entitled to disability compensation, but only to 
        the extent that such a veteran's continuing eligibility for 
        such care is provided for in the judgment or settlement 
        provided for in such section.
            (D) Any veteran who is a former prisoner of war.
            (E) Any veteran of the Mexican border period or World War 
        I.
            (F) Any veteran who is unable to defray the expenses of 
        necessary care as determined under section 1722(a) of title 38, 
        United States Code.

SEC. 5. EXPIRATION OF AUTHORITY.

    The authority to conduct pilot programs under this Act shall expire 
on December 31, 1997.

SEC. 6. FUNDING.

    (a) Revolving Fund.--There is established in the Treasury of the 
United States a revolving fund for conducting pilot programs authorized 
by section 3(a).
    (b) Authorization of Appropriations.--There is authorized to be 
appropriated to the revolving fund for fiscal years 1995, 1996, and 
1997 such sums as may be necessary to carry out the purposes of this 
Act.
    (c) Availability of Funds.--(1) Amounts in the revolving fund 
established under subsection (a) shall be available without fiscal year 
limitation for payment of all expenses necessary to carry out the pilot 
programs, including--
            (A) expenses of furnishing medical care and services;
            (B) expenses of consumer surveys;
            (C) expenses of printing, marketing, and advertising 
        services (including contracts for such services); and
            (D) expenses for the acquisition, construction, repair, or 
        renovation of facilities (including the land on which 
        facilities are located or to be constructed).
    (2) Funds in the revolving fund shall not be available for a major 
medical facility project, or a major medical facility lease, under 
section 8104(a)(3) of title 38, United States Code, unless specifically 
authorized by law.
    (d) Collection of Funds.--(1) The Secretary may recover or collect 
funds which result from participation by the Department in a pilot 
program authorized under section 3(a) for care provided to veterans or 
their dependents. The Secretary may recover or collect such funds 
(including amounts received as premiums, copayments, deductibles or 
third-party reimbursements) from an individual, another agency or 
department of the Federal Government, an agency of State or local 
government, or a health-care provider, health care plan, insurer, or 
other entity.
    (2) The Secretary shall, in consultation with the Director of the 
Office of Management and Budget, estimate the collection of funds to be 
received for services to be provided to veterans by each Department 
facility participating in a State pilot program during each fiscal 
year. Such estimates shall be based upon and consistent with the higher 
of--
            (A) the fiscal year baseline for third-party recoveries, 
        copayments, and other medical collections for the fiscal year 
        included in the budget submitted to Congress by the President; 
        or
            (B) the fiscal year baseline for such collections for the 
        fiscal year as reestimated by the Congressional Budget Office.
    (3)(A) Amounts collected for services provided to dependents shall 
be deposited in the revolving fund established in subsection (a).
    (B) Amounts collected for services provided to veterans in excess 
of the estimate determined under paragraph (2) shall be deposited in 
the revolving fund established under subsection (a).
    (C) An amount up to the estimate determined under paragraph (2) 
shall be deposited in the Medical-Care Cost Recovery Fund established 
under section 1729(g) of title 38, United States Code.

SEC. 7. ADMINISTRATIVE FLEXIBILITY.

    (a) Applicability of Notice and Wait Requirement.--The Secretary 
may carry out any reorganization necessary to carry out a pilot program 
authorized by section 3(a) without regard to the provisions of section 
510(b) of title 38, United States Code.
    (b) Applicability of Other Provisions of Law.--The Director of a 
Department health care facility participating in a pilot project 
authorized by section 3(a) may enter into agreements with health care 
plans, insurers, health care providers, or with any other entity or 
individual to furnish or obtain any health care resource, as that term 
is defined in section 8152 of title 38, United States Code, without 
regard to the following:
            (1) Chapter 7 of the Office of Federal Procurement Policy 
        Act (41 U.S.C. 410 et. seq.).
            (2) Chapter 4 of the Federal Property and Administrative 
        Services Act of 1949 (41 U.S.C. 251 et seq.).
            (3) Subsections (b)(7), (e), (f), (g), and (h) of section 8 
        of the Small Business Act (15 U.S.C. 637), relating to 
        certificate of competency, notice, and sole sourcing.
            (4) Office of Management and Budget Circular A-76.
            (5) Section 8110(c) of title 38, United States Code, 
        relating to contracting out at Department medical facilities.
            (6) Subchapter V of chapter 35 of title 31, United States 
        Code, relating to Government Accounting Office protests.
            (7) Sections 3526 and 3702 of title 31, United States Code, 
        relating to jurisdiction over Government Accounting Office 
        protests.
            (8) Section 1491 of title 28, United States Code, relating 
        to protests to the United States Court of Federal Claims.
            (9) Section 702 of title 5, United States Code, and section 
        1346(2) of title 28, United States Code, relating to protests 
        to United States district courts.
            (10) Section 8125 of title 38, United States Code, relating 
        to local contracts for health care items.
            (11) The provisions of law appearing as sections 471 
        through 544 of title 40, United States Code, for purposes of 
        the proposal of the Law Revision Counsel of a codification of 
        Federal law, relating to the authority of the General Services 
        Administration over leasing and disposal of property.
            (12) Section 8122(a)(1) of title 38, United States Code, 
        relating to out-leasing by the Department.

SEC. 8. MARKETING.

    The Secretary may carry out such promotional, advertising, and 
marketing activities as the Secretary considers necessary to 
effectively establish and operate a health plan pilot program.

SEC. 9. REPORTS.

    Not later than November 30 of each of 1995 through 1998, the 
Secretary shall submit to the Committees on Veterans' Affairs of the 
Senate and the House of Representatives a report on the pilot programs 
carried out by the Secretary under this Act.

SEC. 10. SAVINGS PROVISIONS.

    (a) Benefits.--The Secretary shall provide the persons referred to 
in section 3(b) with all benefits authorized to be provided to such 
persons under title 38, United States Code, in accordance with the 
terms and conditions applicable to such persons and such benefits, 
notwithstanding that such benefits are not provided under the pilot 
program.
    (b) Utilization of Other Department Facilities.--Department 
facilities not participating in pilot programs shall continue to 
furnish health care benefits in accordance with the provisions of title 
38, United States Code.