Union Calendar No. 358

104TH CONGRESS

2D SESSION H. R. 3118

[Report No. 104–690]

A BILL

To amend title 38, United States Code, to reform

ment of Veterans Affairs.eligibility for health care provided by the DepartJULY 18, 1996

Committed to the Committee of the Whole House on the

State of the Union and ordered to be printed
IB

Union Calendar No. 358

104TH CONGRESS

2D SESSION H. R. 3118

[Report No. 104–690]

To amend title 38, United States Code, to reform eligibility for health care

provided by the Department of Veterans Affairs.

IN THE HOUSE OF REPRESENTATIVES

MARCH 20, 1996

Mr. STUMP (for himself, Mr. MONTGOMERY, Mr. HUTCHINSON, and Mr. EDWARDS) introduced the following bill; which was referred to the Committee on Veterans’ Affairs

JULY 18, 1996

Additional sponsors: Mr. SMITH of New Jersey, Mr. BILIRAKIS, Mr. ACKERMAN, Mr. GENE GREEN of Texas, Mr. CRAMER, Mr. FROST, Mr. MOAKLEY, Mr. SOLOMON, Mr. MASCARA, Mr. HALL of Texas, Mr. TEJEDA,

Mr. FALEOMAVAEGA, Mr. MANTON, Mr. LINDER, Mr. WELLER, Mr.

MCCRERY, Mr. GILMAN, Mr. FLAKE, Mr. DOYLE, Mr. WATTS of Oklahoma, Mr. EMERSON, Mr. EVERETT, Mr. BUYER, Mr. BACHUS, Mr.

STEARNS, Mr. FOX of Pennsylvania, Mr. FLANAGAN, Mr. BARR of Georgia, Mr. COOLEY of Oregon, Mr. EVANS, Mr. KENNEDY of Massachusetts, Mr. CLEMENT, Mr. FILNER, Mr. BISHOP, Mr. BALDACCI, Mr.

CAMP, Mr. BRYANT of Tennessee, Ms. KAPTUR, Mr. FAZIO of California,

Mr. RAHALL, Mr. SCARBOROUGH, Mrs. LOWEY, Mr. SAXTON, Mr.

QUINN, Mr. MCDERMOTT, Mrs. KELLY, Mr. WISE, Mr. JOHNSON of

South Dakota, Mr. KENNEDY of Rhode Island, Mr. LIPINSKI, Mr.

DOOLEY of California, Mr. SPRATT, Mr. ENGLISH of Pennsylvania, Ms.

LOFGREN, Mr. TATE, Mr. SKAGGS, Mr. SANDERS, Mr. BARRETT of Nebraska, Mr. KILDEE, Mr. COYNE, Mr. BOUCHER, Mr. FARR of California

JULY 18, 1996

Committed to the Committee of the Whole House on the State of the Union

and ordered to be printed
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A BILL

To amend title 38, United States Code, to reform eligibility

for health care provided by the Department of Veterans

Affairs.

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; REFERENCES TO TITLE 38, UNIT4 ED STATES CODE.

5 (a) SHORT TITLE.—This Act may be cited as the

6 ‘‘Veterans’ Health Care Eligibility Reform Act of 1996’’.

7 (b) REFERENCES TO TITLE 38, UNITED STATES

8 CODE.—Except as otherwise expressly provided, whenever

9 in this Act an amendment or repeal is expressed in terms

10 of an amendment to, or repeal of, a section or other provi11 sion, the reference shall be considered to be made to a

12 section or other provision of title 38, United States Code.

13 SEC. 2. HOSPITAL CARE AND MEDICAL SERVICES.

14 (a) ELIGIBILITY FOR CARE.—Section 1710(a) is

15 amended by striking out paragraphs (1) and (2) and in16 serting the following:

17 ‘‘(a)(1) The Secretary shall, to the extent and in the

18 amount provided in advance in appropriations Acts for

19 these purposes, provide hospital care and medical services,

20 and may provide nursing home care, which the Secretary

21 determines is needed to any veteran—
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1 ‘‘(A) with a compensable service-connected dis2 ability;

3 ‘‘(B) whose discharge or release from active

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

5 disability that was incurred or aggravated in the line

6 of duty;

7 ‘‘(C) who is in receipt of, or who, but for a sus8 pension pursuant to section 1151 of this title (or

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

10 would be entitled to disability compensation, but

11 only to the extent that such veteran’s continuing eli12 gibility for such care is provided for in the judgment

13 or settlement provided for in such section;

14 ‘‘(D) who is a former prisoner of war;

15 ‘‘(E) of the Mexican border period or of World

16 War I;

17 ‘‘(F) who was exposed to a toxic substance, ra18 diation, or environmental hazard, as provided in sub19 section (e); and

20 ‘‘(G) who is unable to defray the expenses of

21 necessary care as determined under section 1722(a)

22 of this title.

23 ‘‘(2) In the case of a veteran who is not described

24 in paragraph (1), the Secretary may, to the extent re25 sources and facilities are available and subject to the pro-
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1 visions of subsection (f), furnish hospital care, medical

2 services, and nursing home care which the Secretary deter3 mines is needed.’’.

4 (b) CONFORMING AMENDMENTS.—(1) Section

5 1710(e) is amended—

6 (A) in paragraph (1), by striking out ‘‘hospital

7 care and nursing home care’’ in subparagraphs (A),

8 (B), and (C) and inserting in lieu thereof ‘‘hospital

9 care, medical services, and nursing home care’’;

10 (B) in paragraph (2), by inserting ‘‘and medical

11 services’’ after ‘‘Hospital and nursing home care’’;

12 and

13 (C) by striking out ‘‘subsection (a)(1)(G) of

14 this section’’ each place it appears and inserting in

15 lieu thereof ‘‘subsection (a)(1)(F)’’.

16 (2) Chapter 17 is amended—

17 (A) by redesignating subsection (g) of section

18 1710 as subsection (h); and

19 (B) by transferring subsection (f) of section

20 1712 to section 1710 so as to appear after sub21 section (f), redesignating such subsection as sub22 section (g), and amending such subsection by strik23 ing out ‘‘section 1710(a)(2) of this title’’ in para24 graph (1) and inserting in lieu thereof ‘‘subsection

25 (a)(2) of this section’’.
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1 (3) Section 1712 is amended—

2 (A) by striking out subsections (a) and (i); and

3 (B) by redesignating subsections (b), (c), (d),

4 (h) and (j), as subsections (a), (b), (c), (d), and (e),

5 respectively.

6 SEC. 3. PROSTHETICS.

7 (a) ELIGIBILITY FOR PROSTHETICS.—Section

8 1701(6)(A)(i) is amended—

9 (1) by striking out ‘‘(in the case of a person

10 otherwise receiving care or services under this chap11 ter)’’ and ‘‘(except under the conditions described in

12 section 1712(a)(5)(A) of this title),’’;

13 (2) by inserting ‘‘(in the case of a person other14 wise receiving care or services under this chapter)’’

15 before ‘‘wheelchairs,’’; and

16 (3) by inserting ‘‘except that the Secretary may

17 not furnish sensori-neural aids other than in accord18 ance with guidelines which the Secretary shall pre19 scribe,’’ after ‘‘reasonable and necessary,’’.

20 (b) REGULATIONS.—Not later than 30 days after the

21 date of the enactment of this Act, the Secretary of Veter22 ans Affairs shall prescribe the guidelines required by the

23 amendments made by subsection (a) and shall furnish a

24 copy of those guidelines to the Committees on Veterans’

25 Affairs of the Senate and House of Representatives.
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1 SEC. 4. MANAGEMENT OF HEALTH CARE.

2 (a) IN GENERAL.—(1) Chapter 17 is amended by in3 serting after section 1704 the following new sections:

4 ‘‘§ 1705. Management of health care: patient enroll5 ment system

6 ‘‘(a) In managing the provision of hospital care and

7 medical services under section 1710(a)(1) of this title, the

8 Secretary, in accordance with regulations the Secretary

9 shall prescribe, shall establish and operate a system of an10 nual patient enrollment. The Secretary shall manage the

11 enrollment of veterans in accordance with the following

12 priorities, in the order listed:

13 ‘‘(1) Veterans with service-connected disabilities

14 rated 30 percent or greater.

15 ‘‘(2) Veterans who are former prisoners of war

16 and veterans with service-connected disabilities rated

17 10 percent or 20 percent.

18 ‘‘(3) Veterans who are in receipt of increased

19 pension based on a need of regular aid and attend20 ance or by reason of being permanently housebound

21 and other veterans who are catastrophically disabled.

22 ‘‘(4) Veterans not covered by paragraphs (1)

23 through (3) who are unable to defray the expenses

24 of necessary care as determined under section

25 1722(a) of this title.
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1 ‘‘(5) All other veterans eligible for hospital care,

2 medical services, and nursing home care under sec3 tion 1710(a)(1) of this title.

4 ‘‘(b) In the design of an enrollment system under

5 subsection (a), the Secretary—

6 ‘‘(1) shall ensure that the system will be man7 aged in a manner to ensure that the provision of

8 care to enrollees is timely and acceptable in quality;

9 ‘‘(2) may establish additional priorities within

10 each priority group specified in subsection (a), as

11 the Secretary determines necessary; and

12 ‘‘(3) may provide for exceptions to the specified

13 priorities where dictated by compelling medical rea14 sons.

15 ‘‘§ 1706. Management of health care: other require16 ments

17 ‘‘(a) In managing the provision of hospital care and

18 medical services under section 1710(a) of this title, the

19 Secretary shall, to the extent feasible, design, establish

20 and manage health care programs in such a manner as

21 to promote cost-effective delivery of health care services

22 in the most clinically appropriate setting.

23 ‘‘(b) In managing the provision of hospital care and

24 medical services under section 1710(a) of this title, the

25 Secretary—
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1 ‘‘(1) may contract for hospital care and medical

2 services when Department facilities are not capable

3 of furnishing such care and services economically,

4 and

5 ‘‘(2) shall make such rules and regulations re6 garding acquisition procedures or policies as the Sec7 retary considers appropriate to provide such needed

8 care and services.

9 ‘‘(c) In managing the provision of hospital care and

10 medical services under section 1710(a) of this title, the

11 Secretary shall ensure that the Department maintains its

12 capacity to provide for the specialized treatment and reha13 bilitative needs of disabled veterans described in section

14 1710(a) of this title (including veterans with spinal cord

15 dysfunction, blindness, amputations, and mental illness)

16 within distinct programs or facilities of the Department

17 that are dedicated to the specialized needs of those veter18 ans in a manner that (1) affords those veterans reasonable

19 access to care and services for those specialized needs, and

20 (2) ensures that overall capacity of the Department to pro21 vide such services is not reduced below the capacity of the

22 Department, nationwide, to provide those services, as of

23 the date of the enactment of this section.

24 ‘‘(d) In managing the provision of hospital care and

25 medical services under section 1710(a) of this title, the
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1 Secretary shall ensure that any veteran with a service-con2 nected disability is provided all benefits under this chapter

3 for which that veteran was eligible before the date of the

4 enactment of this section.’’.

5 (2) The table of sections at the beginning of chapter

6 17 is amended by inserting after the item relating to sec7 tion 1704 the following new items:

‘‘1705. Management of health care: patient enrollment system.

‘‘1706. Management of health care: other requirements.’’.

8 (b) CONFORMING AMENDMENTS TO SECTION

9 1703.—(1) Section 1703 is amended—

10 (A) by striking out subsections (a) and (b); and

11 (B) in subsection (c) by—

12 (i) striking out ‘‘(c)’’, and

13 (ii) striking out ‘‘this section, sections’’

14 and inserting in lieu thereof ‘‘sections 1710,’’.

15 (2)(A) The heading of such section is amended to

16 read as follows:

17 ‘‘§ 1703. Annual report on furnishing of care and

18 services by contract’’.

19 (B) The item relating to such section in the table of

20 sections at the beginning of chapter 17 is amended to read

21 as follows:

‘‘1703. Annual report on furnishing of care and services by contract.’’.
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1 SEC. 5. IMPROVED EFFICIENCY IN HEALTH CARE RE2 SOURCE MANAGEMENT.

3 (a) REPEAL OF SUNSET PROVISION.—Section 204 of

4 the Veterans Health Care Act of 1992 (Public Law 102–

5 585; 106 Stat. 4950) is repealed.

6 (b) COST RECOVERY.—Title II of such Act is further

7 amended by adding at the end the following new section:

8 ‘‘SEC. 207. AUTHORITY TO BILL HEALTH-PLAN CONTRACTS.

9 ‘‘(a) RIGHT TO RECOVER.—In the case of a primary

10 beneficiary (as described in section 201(2)(B)) who has

11 coverage under a health-plan contract, as defined in sec12 tion 1729(i)(1)(A) of title 38, United States Code, and

13 who is furnished care or services by a Department medical

14 facility pursuant to this title, the United States shall have

15 the right to recover or collect charges for such care or

16 services from such health-plan contract to the extent that

17 the beneficiary (or the provider of the care or services)

18 would be eligible to receive payment for such care or serv19 ices from such health-plan contract if the care or services

20 had not been furnished by a department or agency of the

21 United States. Any funds received from such health-plan

22 contract shall be credited to funds that have been allotted

23 to the facility that furnished the care or services.

24 ‘‘(b) ENFORCEMENT.—The right of the United

25 States to recover under such a beneficiary’s health-plan

26 contract shall be enforceable in the same manner as that
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1 provided by subsections (a)(3), (b), (c)(1), (d), (f), (h),

2 and (i) of section 1729 of title 38, United States Code.’’.

3 SEC. 6. SHARING AGREEMENTS FOR HEALTH CARE RE4 SOURCES.

5 (a) REPEAL OF SECTION 8151.—(1) Subchapter IV

6 of chapter 81 is amended—

7 (A) by striking out section 8151; and

8 (B) by redesignating sections 8152, 8153,

9 8154, 8155, 8156, 8157, and 8158 as sections 8151,

10 8152, 8153, 8154, 8155, 8156, and 8157, respec11 tively.

12 (2) The table of sections at the beginning of such

13 chapter is amended—

14 (A) by striking out the item relating to section

15 8151; and

16 (B) by revising the items relating to sections

17 8152, 8153, 8154, 8155, 8156, 8157, and 8158 to

18 reflect the redesignations by paragraph (1)(B).

19 (b) REVISED AUTHORITY FOR SHARING AGREE20 MENTS.—Section 8152 (as redesignated by subsection

21 (a)(1)(B)) is amended—

22 (1) in subsection (a)(1)(A)—

23 (A) by striking out ‘‘specialized medical re24 sources’’ and inserting in lieu thereof ‘‘health25 care resources’’; and
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1 (B) by striking out ‘‘other’’ and all that

2 follows through ‘‘medical schools’’ and inserting

3 in lieu thereof ‘‘any medical school, health-care

4 provider, health-care plan, insurer, or other en5 tity or individual’’;

6 (2) in subsection (a)(2) by striking out ‘‘only’’

7 and all that follows through ‘‘are not’’ and inserting

8 in lieu thereof ‘‘if such resources are not, or would

9 not be,’’;

10 (3) in subsection (b), by striking out ‘‘reciprocal

11 reimbursement’’ in the first sentence and all that

12 follows through the period at the end of that sen13 tence and inserting in lieu thereof ‘‘payment to the

14 Department in accordance with procedures that pro15 vide appropriate flexibility to negotiate payment

16 which is in the best interest of the Government.’’;

17 (4) in subsection (d), by striking out ‘‘preclude

18 such payment, in accordance with—’’ and all that

19 follows through ‘‘to such facility therefor’’ and in20 serting in lieu thereof ‘‘preclude such payment to

21 such facility for such care or services’’;

22 (5) by redesignating subsection (e) as sub23 section (f); and

24 (6) by inserting after subsection (d) the follow25 ing new subsection (e):
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1 ‘‘(e) The Secretary may make an arrangement that

2 authorizes the furnishing of services by the Secretary

3 under this section to individuals who are not veterans only

4 if the Secretary determines—

5 ‘‘(1) that such an arrangement will not result

6 in the denial of, or a delay in providing access to,

7 care to any veteran at that facility; and

8 ‘‘(2) that such an arrangement—

9 ‘‘(A) is necessary to maintain an accept10 able level and quality of service to veterans at

11 that facility; or

12 ‘‘(B) will result in the improvement of

13 services to eligible veterans at that facility.’’.

14 (c) CROSS-REFERENCE AMENDMENTS.—(1) Section

15 8110(c)(3)(A) is amended by striking out ‘‘8153’’ and in16 serting in lieu thereof ‘‘8152’’.

17 (2) Subsection (b) of section 8154 (as redesignated

18 by subsection (a)(1)(B)) is amended by striking out ‘‘sec19 tion 8154’’ and inserting in lieu thereof ‘‘section 8153’’.

20 (3) Section 8156 (as redesignated by subsection

21 (a)(1)(B)) is amended—

22 (A) in subsection (a), by striking out ‘‘section

23 8153(a)’’ and inserting in lieu thereof ‘‘section

24 8152(a)’’; and
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1 (B) in subsection (b)(3), by striking out ‘‘sec2 tion 8153’’ and inserting in lieu thereof ‘‘section

3 8152’’.

4 (4) Subsection (a) of section 8157 (as redesignated

5 by subsection (a)(1)(B)) is amended—

6 (A) in the matter preceding paragraph (1), by

7 striking out ‘‘section 8157’’ and ‘‘section 8153(a)’’

8 and inserting in lieu thereof ‘‘section 8156’’ and

9 ‘‘section 8152(a)’’, respectively; and

10 (B) in paragraph (1), by striking out ‘‘section

11 8157(b)(4)’’ and inserting in lieu thereof ‘‘section

12 8156(b)(4)’’.

13 SEC. 7. PERSONNEL FURNISHING SHARED RESOURCES.

14 Section 712(b)(2) is amended—

15 (1) by striking out ‘‘the sum of—’’ and insert16 ing in lieu thereof ‘‘the sum of the following:’’;

17 (2) by capitalizing the first letter of the first

18 word of each of subparagraphs (A) and (B);

19 (3) by striking out ‘‘; and’’ at the end of sub20 paragraph (A) and inserting in lieu thereof a period;

21 and

22 (4) by adding at the end the following:

23 ‘‘(C) The number of such positions in the

24 Department during that fiscal year held by per-
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1 sons involved in providing health-care resources

2 under section 8111 or 8152 of this title.’’.