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[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3118 Referred in Senate (RFS)]

104th CONGRESS
  2d Session
                                H. R. 3118

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             July 31, 1996

Received; read twice and referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 AN ACT

 
To amend title 38, United States Code, to reform eligibility for health 
          care provided by the Department of Veterans Affairs.

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

SECTION 1. SHORT TITLE; REFERENCES TO TITLE 38, UNITED STATES CODE.

    (a) Short Title.--This Act may be cited as the ``Veterans' Health 
Care Eligibility Reform Act of 1996''.
    (b) References to Title 38, United States Code.--Except as 
otherwise expressly provided, whenever in this Act an amendment or 
repeal is expressed in terms of an amendment to, or repeal of, a 
section or other provision, the reference shall be considered to be 
made to a section or other provision of title 38, United States Code.

SEC. 2. HOSPITAL CARE AND MEDICAL SERVICES.

    (a) Eligibility for Care.--Section 1710(a) is amended by striking 
out paragraphs (1) and (2) and inserting the following:
    ``(a)(1) The Secretary shall, to the extent and in the amount 
provided in advance in appropriations Acts for these purposes, provide 
hospital care and medical services, and may provide nursing home care, 
which the Secretary determines is needed to any veteran--
            ``(A) with a compensable service-connected disability;
            ``(B) whose discharge or release from active military, 
        naval, or air service was for a compensable disability that was 
        incurred or aggravated in the line of duty;
            ``(C) who is in receipt of, or who, but for a suspension 
        pursuant to section 1151 of this title (or both a suspension 
        and the receipt of retired pay), would be entitled to 
        disability compensation, but only to the extent that such 
        veteran's continuing eligibility for such care is provided for 
        in the judgment or settlement provided for in such section;
            ``(D) who is a former prisoner of war;
            ``(E) of the Mexican border period or of World War I;
            ``(F) who was exposed to a toxic substance, radiation, or 
        environmental hazard, as provided in subsection (e); and
            ``(G) who is unable to defray the expenses of necessary 
        care as determined under section 1722(a) of this title.
    ``(2) In the case of a veteran who is not described in paragraph 
(1), the Secretary may, to the extent resources and facilities are 
available and subject to the provisions of subsection (f), furnish 
hospital care, medical services, and nursing home care which the 
Secretary determines is needed.''.
    (b) Conforming Amendments.--(1) Section 1710(e) is amended--
            (A) in paragraph (1), by striking out ``hospital care and 
        nursing home care'' in subparagraphs (A), (B), and (C) and 
        inserting in lieu thereof ``hospital care, medical services, 
        and nursing home care'';
            (B) in paragraph (2), by inserting ``and medical services'' 
        after ``Hospital and nursing home care''; and
            (C) by striking out ``subsection (a)(1)(G) of this 
        section'' each place it appears and inserting in lieu thereof 
        ``subsection (a)(1)(F)''.
    (2) Chapter 17 is amended--
            (A) by redesignating subsection (g) of section 1710 as 
        subsection (h); and
            (B) by transferring subsection (f) of section 1712 to 
        section 1710 so as to appear after subsection (f), 
        redesignating such subsection as subsection (g), and amending 
        such subsection by striking out ``section 1710(a)(2) of this 
        title'' in paragraph (1) and inserting in lieu thereof 
        ``subsection (a)(2) of this section''.
    (3) Section 1712 is amended--
            (A) by striking out subsections (a) and (i); and
            (B) by redesignating subsections (b), (c), (d), (h) and 
        (j), as subsections (a), (b), (c), (d), and (e), respectively.

SEC. 3. PROSTHETICS.

    (a) Eligibility for Prosthetics.--Section 1701(6)(A)(i) is 
amended--
            (1) by striking out ``(in the case of a person otherwise 
        receiving care or services under this chapter)'' and ``(except 
        under the conditions described in section 1712(a)(5)(A) of this 
        title),'';
            (2) by inserting ``(in the case of a person otherwise 
        receiving care or services under this chapter)'' before 
        ``wheelchairs,''; and
            (3) by inserting ``except that the Secretary may not 
        furnish sensori-neural aids other than in accordance with 
        guidelines which the Secretary shall prescribe,'' after 
        ``reasonable and necessary,''.
    (b) Regulations.--Not later than 30 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall 
prescribe the guidelines required by the amendments made by subsection 
(a) and shall furnish a copy of those guidelines to the Committees on 
Veterans' Affairs of the Senate and House of Representatives.

SEC. 4. MANAGEMENT OF HEALTH CARE.

    (a) In General.--(1) Chapter 17 is amended by inserting after 
section 1704 the following new sections:
``Sec. 1705. Management of health care: patient enrollment system
    ``(a) In managing the provision of hospital care and medical 
services under section 1710(a)(1) of this title, the Secretary, in 
accordance with regulations the Secretary shall prescribe, shall 
establish and operate a system of annual patient enrollment. The 
Secretary shall manage the enrollment of veterans in accordance with 
the following priorities, in the order listed:
            ``(1) Veterans with service-connected disabilities rated 30 
        percent or greater.
            ``(2) Veterans who are former prisoners of war and veterans 
        with service-connected disabilities rated 10 percent or 20 
        percent.
            ``(3) Veterans who are in receipt of increased pension 
        based on a need of regular aid and attendance or by reason of 
        being permanently housebound and other veterans who are 
        catastrophically disabled.
            ``(4) Veterans not covered by paragraphs (1) through (3) 
        who are unable to defray the expenses of necessary care as 
        determined under section 1722(a) of this title.
            ``(5) All other veterans eligible for hospital care, 
        medical services, and nursing home care under section 
        1710(a)(1) of this title.
    ``(b) In the design of an enrollment system under subsection (a), 
the Secretary--
            ``(1) shall ensure that the system will be managed in a 
        manner to ensure that the provision of care to enrollees is 
        timely and acceptable in quality;
            ``(2) may establish additional priorities within each 
        priority group specified in subsection (a), as the Secretary 
        determines necessary; and
            ``(3) may provide for exceptions to the specified 
        priorities where dictated by compelling medical reasons.
``Sec. 1706. Management of health care: other requirements
    ``(a) In managing the provision of hospital care and medical 
services under section 1710(a) of this title, the Secretary shall, to 
the extent feasible, design, establish and manage health care programs 
in such a manner as to promote cost-effective delivery of health care 
services in the most clinically appropriate setting.
    ``(b) In managing the provision of hospital care and medical 
services under section 1710(a) of this title, the Secretary--
            ``(1) may contract for hospital care and medical services 
        when Department facilities are not capable of furnishing such 
        care and services economically, and
            ``(2) shall make such rules and regulations regarding 
        acquisition procedures or policies as the Secretary considers 
        appropriate to provide such needed care and services.
    ``(c) In managing the provision of hospital care and medical 
services under section 1710(a) of this title, the Secretary shall 
ensure that the Department maintains its capacity to provide for the 
specialized treatment and rehabilitative needs of disabled veterans 
described in section 1710(a) of this title (including veterans with 
spinal cord dysfunction, blindness, amputations, and mental illness) 
within distinct programs or facilities of the Department that are 
dedicated to the specialized needs of those veterans in a manner that 
(1) affords those veterans reasonable access to care and services for 
those specialized needs, and (2) ensures that overall capacity of the 
Department to provide such services is not reduced below the capacity 
of the Department, nationwide, to provide those services, as of the 
date of the enactment of this section.
    ``(d) In managing the provision of hospital care and medical 
services under section 1710(a) of this title, the Secretary shall 
ensure that any veteran with a service-connected disability is provided 
all benefits under this chapter for which that veteran was eligible 
before the date of the enactment of this section.''.
    (2) The table of sections at the beginning of chapter 17 is amended 
by inserting after the item relating to section 1704 the following new 
items:

``1705. Management of health care: patient enrollment system.
``1706. Management of health care: other requirements.''.
    (b) Conforming Amendments to Section 1703.--(1) Section 1703 is 
amended--
            (A) by striking out subsections (a) and (b); and
            (B) in subsection (c) by--
                    (i) striking out ``(c)'', and
                    (ii) striking out ``this section, sections'' and 
                inserting in lieu thereof ``sections 1710,''.
    (2)(A) The heading of such section is amended to read as follows:
``Sec. 1703. Annual report on furnishing of care and services by 
              contract''.
    (B) The item relating to such section in the table of sections at 
the beginning of chapter 17 is amended to read as follows:

``1703. Annual report on furnishing of care and services by 
                            contract.''.

SEC. 5. IMPROVED EFFICIENCY IN HEALTH CARE RESOURCE MANAGEMENT.

    (a) Repeal of Sunset Provision.--Section 204 of the Veterans Health 
Care Act of 1992 (Public Law 102-585; 106 Stat. 4950) is repealed.
    (b) Cost Recovery.--Title II of such Act is further amended by 
adding at the end the following new section:

``SEC. 207. AUTHORITY TO BILL HEALTH-PLAN CONTRACTS.

    ``(a) Right To Recover.--In the case of a primary beneficiary (as 
described in section 201(2)(B)) who has coverage under a health-plan 
contract, as defined in section 1729(i)(1)(A) of title 38, United 
States Code, and who is furnished care or services by a Department 
medical facility pursuant to this title, the United States shall have 
the right to recover or collect charges for such care or services from 
such health-plan contract to the extent that the beneficiary (or the 
provider of the care or services) would be eligible to receive payment 
for such care or services from such health-plan contract if the care or 
services had not been furnished by a department or agency of the United 
States. Any funds received from such health-plan contract shall be 
credited to funds that have been allotted to the facility that 
furnished the care or services.
    ``(b) Enforcement.--The right of the United States to recover under 
such a beneficiary's health-plan contract shall be enforceable in the 
same manner as that provided by subsections (a)(3), (b), (c)(1), (d), 
(f), (h), and (i) of section 1729 of title 38, United States Code.''.

SEC. 6. SHARING AGREEMENTS FOR HEALTH CARE RESOURCES.

    (a) Repeal of Section 8151.--(1) Subchapter IV of chapter 81 is 
amended--
            (A) by striking out section 8151; and
            (B) by redesignating sections 8152, 8153, 8154, 8155, 8156, 
        8157, and 8158 as sections 8151, 8152, 8153, 8154, 8155, 8156, 
        and 8157, respectively.
    (2) The table of sections at the beginning of such chapter is 
amended--
            (A) by striking out the item relating to section 8151; and
            (B) by revising the items relating to sections 8152, 8153, 
        8154, 8155, 8156, 8157, and 8158 to reflect the redesignations 
        by paragraph (1)(B).
    (b) Revised Authority for Sharing Agreements.--Section 8152 (as 
redesignated by subsection (a)(1)(B)) is amended--
            (1) in subsection (a)(1)(A)--
                    (A) by striking out ``specialized medical 
                resources'' and inserting in lieu thereof ``health-care 
                resources''; and
                    (B) by striking out ``other'' and all that follows 
                through ``medical schools'' and inserting in lieu 
                thereof ``any medical school, health-care provider, 
                health-care plan, insurer, or other entity or 
                individual'';
            (2) in subsection (a)(2) by striking out ``only'' and all 
        that follows through ``are not'' and inserting in lieu thereof 
        ``if such resources are not, or would not be,'';
            (3) in subsection (b), by striking out ``reciprocal 
        reimbursement'' in the first sentence and all that follows 
        through the period at the end of that sentence and inserting in 
        lieu thereof ``payment to the Department in accordance with 
        procedures that provide appropriate flexibility to negotiate 
        payment which is in the best interest of the Government.'';
            (4) in subsection (d), by striking out ``preclude such 
        payment, in accordance with--'' and all that follows through 
        ``to such facility therefor'' and inserting in lieu thereof 
        ``preclude such payment to such facility for such care or 
        services'';
            (5) by redesignating subsection (e) as subsection (f); and
            (6) by inserting after subsection (d) the following new 
        subsection (e):
    ``(e) The Secretary may make an arrangement that authorizes the 
furnishing of services by the Secretary under this section to 
individuals who are not veterans only if the Secretary determines--
            ``(1) that such an arrangement will not result in the 
        denial of, or a delay in providing access to, care to any 
        veteran at that facility; and
            ``(2) that such an arrangement--
                    ``(A) is necessary to maintain an acceptable level 
                and quality of service to veterans at that facility; or
                    ``(B) will result in the improvement of services to 
                eligible veterans at that facility.''.
    (c) Cross-Reference Amendments.--(1) Section 8110(c)(3)(A) is 
amended by striking out ``8153'' and inserting in lieu thereof 
``8152''.
    (2) Subsection (b) of section 8154 (as redesignated by subsection 
(a)(1)(B)) is amended by striking out ``section 8154'' and inserting in 
lieu thereof ``section 8153''.
    (3) Section 8156 (as redesignated by subsection (a)(1)(B)) is 
amended--
            (A) in subsection (a), by striking out ``section 8153(a)'' 
        and inserting in lieu thereof ``section 8152(a)''; and
            (B) in subsection (b)(3), by striking out ``section 8153'' 
        and inserting in lieu thereof ``section 8152''.
    (4) Subsection (a) of section 8157 (as redesignated by subsection 
(a)(1)(B)) is amended--
            (A) in the matter preceding paragraph (1), by striking out 
        ``section 8157'' and ``section 8153(a)'' and inserting in lieu 
        thereof ``section 8156'' and ``section 8152(a)'', respectively; 
        and
            (B) in paragraph (1), by striking out ``section 
        8157(b)(4)'' and inserting in lieu thereof ``section 
        8156(b)(4)''.

SEC. 7. PERSONNEL FURNISHING SHARED RESOURCES.

    Section 712(b)(2) is amended--
            (1) by striking out ``the sum of--'' and inserting in lieu 
        thereof ``the sum of the following:'';
            (2) by capitalizing the first letter of the first word of 
        each of subparagraphs (A) and (B);
            (3) by striking out ``; and'' at the end of subparagraph 
        (A) and inserting in lieu thereof a period; and
            (4) by adding at the end the following:
                    ``(C) The number of such positions in the 
                Department during that fiscal year held by persons 
                involved in providing health-care resources under 
                section 8111 or 8152 of this title.''.

SEC. 8. AUTHORIZATION OF APPROPRIATIONS.

    There is authorized to be appropriated for the Department of 
Veterans Affairs for the Medical Care account, for the purposes 
specified for that account in Public Law 103-327 (108 Stat. 2300), 
including the cost of providing hospital care and medical services 
under the amendments made by section 2, not to exceed $17,250,000,000 
for fiscal year 1997 and not to exceed $17,900,000,000 for fiscal year 
1998.

SEC. 9. REPORT ON IMPLEMENTATION AND OPERATION.

    (a) Report Required.--In carrying out sections 2, 3, and 4 
(including the amendments made by those sections), the Secretary of 
Veterans Affairs shall establish information systems to assess, and, 
not later than March 1, 1998, shall submit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives, a report 
reflecting the experience of the Department during fiscal year 1997 
on--
            (1) the effect of implementation of, and provision and 
        management of care under, sections 2, 3, and 4, on demand for 
        health care services from the Department of Veterans Affairs by 
        veterans described in section 1710(a)(1), as amended by section 
        2;
            (2) any differing patterns of demand on the part of such 
        veterans relating to such factors as relative distance from 
        Department facilities and prior experience, or lack of 
        experience, as recipients of care from the Department;
            (3) the extent to which the Department has met such demand 
        for care; and
            (4) changes in health-care delivery patterns in Department 
        facilities and the fiscal impact of such changes.
    (b) Matters To Be Included.--The report under subsection (a) shall 
include detailed information with respect to fiscal year 1997 regarding 
the following:
            (1) The number of veterans enrolled for care at each 
        Department medical facility and, of those veterans, the number 
        enrolled at each such facility who had not received care from 
        the Department during the preceding three fiscal years.
            (2) With respect to those veterans who had not received 
        care from the Department during the three preceding fiscal 
        years, the total cost of providing care to those veterans, 
        shown in total and separately (A) by level of care, and (B) by 
        reference to whether care is furnished in Department facilities 
        or under contract arrangements.
            (3) With respect to the number of veterans described in 
        section 1710(a)(1), as amended by this Act, who applied for 
        health care from the Department during fiscal year 1997--
                    (A) the number who applied for care (shown in total 
                and separately by facility);
                    (B) the number who were denied enrollment (shown in 
                total and separately by facility); and
                    (C) the number who were denied care which was 
                considered to be medically necessary but not of an 
                emergency nature (shown in total and separately by 
                facility).
            (4)(A) The numbers and characteristics of, and the type and 
        extent of health care furnished to, veterans enrolled for care 
        (shown in total and separately by facility).
            (B) The numbers and characteristics of, and the type and 
        extent of health care furnished to, veterans not enrolled for 
        care (shown separately by reference to each class of 
        eligibility, both in total and separately by facility).
            (5) The specific fiscal impact (shown in total and by 
        geographic health-care delivery areas) of changes in delivery 
        patterns instituted under the amendments made by this Act.

            Passed the House of Representatives July 30, 1996.

            Attest:

                                                ROBIN H. CARLE,

                                                                 Clerk.
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