I

104TH CONGRESS

1ST SESSION H. R. 1385

To amend title 38, United States Code, to improve the delivery of health

care to veterans, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

APRIL 4, 1995

Mr. EDWARDS (for himself and Mr. MONTGOMERY) introduced the following

bill; which was referred to the Committee on Veterans’ Affairs

A BILL

To amend title 38, United States Code, to improve the

delivery of health care to veterans, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Veterans Health Care

5 Reform Act of 1995’’.

6 SEC. 2. HEALTH CARE REFORM PROGRAM.

7 (a) IN GENERAL.—Chapter 17 of title 38, United

8 States Code, is amended by inserting after section 1704

9 the following new section:
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1 ‘‘§ 1705. Delivery of health care through reformed

2 management of care

3 ‘‘(a) The Secretary shall conduct a program to reform

4 the way in which the Secretary manages delivery of health

5 care to veterans. The program shall be carried out in ac6 cordance with this section.

7 ‘‘(b)(1) In carrying out the program of reformed

8 health care under this section, the Secretary shall take ap9 propriate action to (A) expand the capacity of the Depart10 ment of Veterans Affairs to provide outpatient care to eli11 gible veterans, and (B) allocate resources to Department

12 facilities in such a manner as to enable such facilities in

13 carrying out the provisions of this section to provide to

14 veterans described in subsection (c) access to care which

15 is reasonably similar, without regard to the State in which

16 those veterans reside.

17 ‘‘(2) In carrying out paragraph (1), the Secretary

18 shall take appropriate steps, within service-delivery areas

19 established by the Secretary, to reduce duplication of serv20 ices and to realign services and programs.

21 ‘‘(c)(1) During the period through September 30,

22 1999, the Secretary shall, for purposes of the program of

23 reformed health care under this section, manage Depart24 ment health care facilities so as to provide needed hospital

25 care and outpatient medical treatment—
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1 ‘‘(A) to any veteran described in subsection (e)

2 without regard to otherwise applicable limitations in

3 this chapter (other than the limitations specified in

4 section 1712(b) of this title); and

5 ‘‘(B) to all other veterans, subject to the limita6 tions in this chapter.

7 ‘‘(2) The care and treatment described in paragraph

8 (1) includes the provision of preventive health services and

9 prosthetic appliances and may include home care services.

10 ‘‘(3) The Secretary shall, in carrying out the pro11 gram, ensure that any veteran with a service-connected

12 disability is provided all benefits to which that veteran is

13 entitled under this chapter.

14 ‘‘(d)(1) The Secretary, in order to manage the provi15 sion of care and services under this section, shall coordi16 nate care of veterans through facilities under the jurisdic17 tion of, or under contract to, the Secretary and through

18 referral to other appropriate providers in a veteran’s com19 munity.

20 ‘‘(2) The Secretary, to further the provision of care

21 and services under this section, may make such rules and

22 regulations regarding acquisition procedures or policies as

23 the Secretary considers appropriate to obtain needed care

24 and services under this section.
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1 ‘‘(3) The Secretary, in managing the provision of care

2 and services under this section, may—

3 ‘‘(A) use systems of patient prioritization, con4 sistent with the relative priorities described in sec5 tion 1712(i) of this title; and

6 ‘‘(B) establish a program of enrollment of eligi7 ble veterans.

8 ‘‘(4) The Secretary, in managing the provision of care

9 and services under this section, shall ensure that the De10 partment maintains its capacity to provide for the special11 ized treatment and rehabilitative needs of disabled veter12 ans described in section 1710(a) of this title (including

13 veterans with spinal cord dysfunction, blindness, and men14 tal illness) within distinct programs or facilities of the De15 partment that are dedicated to the specialized needs of

16 those veterans in a manner that (A) affords those veterans

17 reasonable access to care and services for those specialized

18 needs, and (B) ensures that overall capacity of the Depart19 ment to provide such services is not reduced below the ca20 pacity of the Department, nationwide, to provide those

21 services as of the date of the enactment of this section.

22 ‘‘(e) A veteran referred to in subsection (c)(1)(A) is

23 any veteran—

24 ‘‘(1) with a compensable service-connected dis25 ability;
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1 ‘‘(2) whose discharge or release from active

2 military, naval, or air service was for a compensable

3 disability that was incurred or aggravated in the line

4 of duty;

5 ‘‘(3) who is in receipt of, or who, but for a sus6 pension pursuant to section 1151 of this title (or

7 both a suspension and the receipt of retired pay),

8 would be entitled to disability compensation, but

9 only to the extent that such veteran’s continuing eli10 gibility for such care is provided for in the judgment

11 or settlement provided for in such section;

12 ‘‘(4) who is a former prisoner of war;

13 ‘‘(5) of the Mexican border period or of World

14 War I; or

15 ‘‘(6) who is unable to defray the expenses of

16 necessary care, as determined in accordance with

17 section 1722(a) of this title.

18 ‘‘(f) Not later than February 1, 1999, the Secretary

19 shall submit to the Committees on Veterans’ Affairs of

20 the Senate and the House of Representatives a report on

21 the experience of the Department in establishing and ad22 ministering the program required by this section. The re23 port shall include any recommendations of the Secretary

24 for legislation to expand access of eligible veterans to

25 health care services furnished by the Department.
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1 ‘‘(g) This section shall expire at the close of Septem2 ber 30, 1999.’’.

3 (b) CLERICAL AMENDMENT.—The table of sections

4 at the beginning of such chapter is amended by inserting

5 after the item relating to section 1704 the following new

6 item:

‘‘1705. Delivery of health care through reformed managment of care.’’.

7 (c) DEADLINE FOR IMPLEMENTATION.—The Sec8 retary shall implement the program under section 1705

9 of title 38, United States Code, as added by subsection

10 (a), not later than October 1, 1996.

11 SEC. 3. FUNDS RECOVERED FROM THIRD PARTIES.

12 (a) AUTHORIZED USES.—Section 1729 of title 38,

13 United States Code, is amended by adding at the end of

14 paragraph (3) of subsection (g) the following new subpara15 graph:

16 ‘‘(C) Expenses of (i) establishing new out17 patient clinics, (ii) altering or remodeling medical fa18 cilities to provide additional space for provision of

19 outpatient care, and (iii) other measures as deter20 mined necessary by the Secretary to increase the

21 number of outpatient visits provided eligible veterans

22 through facilities of the Department or under con23 tract arrangements.’’.
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1 (b) AVAILABILITY OF FUNDS.—Subsection (g) of

2 such section is further amended by striking out paragraph

3 (4) and inserting the following:

4 ‘‘(4)(A) There shall be within the Fund a reserve to

5 be available for the purposes specified in paragraph

6 (3)(C). Not later than December 1 of each year, there

7 shall be set aside for the reserve amounts as provided in

8 this paragraph. If the amount to be set aside for the re9 serve for any year is less than zero, the amount added

10 to the reserve for that year shall be zero. Funds may be

11 obligated under paragraph (3)(C) only to the extent of the

12 availability of unobligated amounts in the reserve.

13 Amounts in the reserve shall remain available for obliga14 tion until expended.

15 ‘‘(B) On December 1, 1995, the amount set aside for

16 the reserve under subparagraph (A) shall be the amount

17 by which—

18 ‘‘(i) the unobligated balance remaining in the

19 Fund at the close of business on September 30,

20 1995, minus any part of such balance that the Sec21 retary determines is necessary to defray the ex22 penses, payments, and costs described in paragraph

23 (3), exceeds

24 ‘‘(ii) $579,282,000.
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1 ‘‘(C) On December 1, 1996, the amount set aside for

2 the reserve under subparagraph (A) shall be the amount

3 by which—

4 ‘‘(i) the unobligated balance remaining in the

5 Fund at the close of business on September 30,

6 1996, minus any part of such balance that the Sec7 retary determines is necessary to defray the ex8 penses, payments, and costs described in paragraph

9 (3), exceeds

10 ‘‘(ii) $640,918,000.

11 ‘‘(D) On December 1, 1997, the amount set aside for

12 the reserve under subparagraph (A) shall be the amount

13 by which—

14 ‘‘(i) the unobligated balance remaining in the

15 Fund at the close of business on September 30,

16 1997, minus any part of such balance that the Sec17 retary determines is necessary to defray the ex18 penses, payments, and costs described in paragraph

19 (3), exceeds

20 ‘‘(ii) $731,334,000.

21 ‘‘(E) On December 1, 1998, the amount set aside for

22 the reserve under subparagraph (A) shall be the amount

23 by which—

24 ‘‘(i) the unobligated balance remaining in the

25 Fund at the close of business on September 30,
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1 1998, minus any part of such balance that the Sec2 retary determines is necessary to defray the ex3 penses, payments, and costs described in paragraph

4 (3), exceeds

5 ‘‘(ii) $758,321,000.

6 ‘‘(F) On December 1, 1999, the amount set aside for

7 the reserve under subparagraph (A) shall be the amount

8 by which—

9 ‘‘(i) the unobligated balance remaining in the

10 Fund at the close of business on September 30,

11 1999, minus any part of such balance that the Sec12 retary determines is necessary to defray the ex13 penses, payments, and costs described in paragraph

14 (3), exceeds

15 ‘‘(ii) $372,435,000.

16 ‘‘(5) Not later than January 1 of each year, there

17 shall be deposited into the Treasury as miscellaneous re18 ceipts an amount equal to the amount of the unobligated

19 balance remaining in the Fund at the close of business

20 on September 30 of the preceding year minus (A) any part

21 of such balance that the Secretary determines is necessary

22 in order to enable the Secretary to defray, during the fiscal

23 year in which the deposit is made, the expenses, payments,

24 and costs described in paragraph (3), and (B) the amount

25 in the reserve described in paragraph (4).
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1 ‘‘(6) The Secretary shall prescribe regulations for the

2 allocation of amounts in the reserve under paragraph (4)

3 for the purposes stated in paragraph (3)(C). Those regula4 tions shall be designed to provide incentives to increase

5 the recoveries and collections under this section. Such reg6 ulations may provide that up to 25 percent of those

7 amounts be made available each year directly to the medi8 cal centers, or networks of medical centers, at which such

9 recoveries have been at above average levels. The remain10 der of those funds shall be allocated by the Secretary,

11 based on the plan developed pursuant to paragraph (7),

12 in a manner such that funds are targeted to areas deter13 mined to have the greatest unmet need for outpatient care.

14 ‘‘(7) In order to promote effective planning for or15 derly development of needed capacity for providing out16 patient care to eligible veterans, the Under Secretary for

17 Health shall conduct an annual study to evaluate the rel18 ative need within service-delivery areas of the Department

19 for expanding that capacity (directly or through contract

20 arrangements).’’.

21 (c) ANNUAL REPORT ON MEDICAL CARE COST RE22 COVERY.—Such section is further amended by adding at

23 the end the following new subsection:

24 ‘‘(j) Not later than February 1 each year, the Sec25 retary shall submit to the Committees on Veterans’ Affairs
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1 of the Senate and House of Representatives a report on

2 medical care cost recovery under this section. The report

3 shall include (1) the plan described in subsection (g)(7),

4 (2) the regulations promulgated under subsection (g)(6),

5 (3) the specific allocations made pursuant to such regula6 tions, and (4) the actions taken by the Secretary to carry

7 out section 2(d)(4) of the Veterans Health Care Reform

8 Act of 1995 during the preceding fiscal year.’’.

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