I

104TH CONGRESS

2D SESSION H. R. 3117

To amend title 38, United States Code, to enable the Secretary of Veterans

Affairs to improve service-delivery of health care to veterans, and for

other purposes.

IN THE HOUSE OF REPRESENTATIVES

MARCH 20, 1996

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

on Veterans’ Affairs, and in addition to the Committee on Commerce,

and Ways and Means, for a period to be subsequently determined by the

Speaker, in each case for consideration of such provisions as fall within

the jurisdiction of the committee concerned

A BILL

To amend title 38, United States Code, to enable the Secretary of Veterans Affairs to improve service-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. AUTHORITY TO ESTABLISH AND OPERATE MAN4 AGED HEALTH-CARE PLANS.

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

6 States Code, is amended by inserting after section 1704

7 the following new section:
2

•HR 3117 IH

1 ‘‘§ 1705. Establishment of managed health-care plans

2 ‘‘(a) In carrying out responsibilities under this title

3 with respect to the delivery of health care, the Secretary

4 may establish and operate managed health-care plans. Any

5 such plan shall be operated by or through a Department

6 health-care facility or group of facilities and may include

7 the provision of health services through other public or

8 private entities under arrangements made between that

9 Department facility or group of facilities and the other

10 public or private entity concerned. Any such managed

11 health care plan under this section shall be established and

12 operated in conformance with standards prescribed by the

13 Secretary after consultation with the Secretary of Health

14 and Human Services.

15 ‘‘(b) The Secretary, as part of the standards pre16 scribed under subsection (a), shall prescribe the minimum

17 health care benefits to be provided under the plan to veter18 ans enrolled in the plan. Those benefits shall include at

19 least those health benefits covered under parts A and B

20 of the Medicare program under title XVIII of the Social

21 Security Act.

22 ‘‘(c) The Secretary may establish an enrollment sys23 tem to enroll veterans (other than veterans described in

24 section 1710(a)(1) of this title) in any plan established

25 under subsection (a).
3

•HR 3117 IH

1 ‘‘(d) The Secretary, notwithstanding sections 1710(f)

2 and 1712(f) of this title, may establish such cost-sharing

3 requirements for veterans enrolled in a plan under this

4 section as the Secretary considers appropriate to cover

5 costs of providing benefits under the plan that are not

6 paid by the Medicare program under title XVIII of the

7 Social Security Act. Such cost-sharing requirements may

8 include an enrollment premium, copayment charges, and

9 deductibles.

10 ‘‘(e) Payments received under subsection (d) and

11 under section 1729A of this title with respect to care or

12 services provided to a veteran enrolled in a health-care

13 plan under this section shall be credited to the applicable

14 Department medical appropriation and shall be used to

15 pay for the costs of furnishing care and services under

16 subsection (a).

17 ‘‘(f) The Secretary may not in any fiscal year operate

18 a plan under subsection (a) at a Department facility un19 less the director of that facility has certified to the Under

20 Secretary for Health that sufficient medical care funds

21 have been allotted to that facility for that fiscal year to

22 enable the director to provide needed hospital care and

23 medical services authorized under this chapter to veterans

24 described in section 1710(a)(1) of this title in the number

25 that, in the judgment of the director, are likely to require
4

•HR 3117 IH

1 that care and services from that facility during that fiscal

2 year.’’.

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. Establishment of managed health-care plans.’’.

7 SEC. 2. REQUIREMENT FOR PAYMENT FOR CERTAIN SERV8 ICES PROVIDED BY DEPARTMENT FACILI9 TIES.

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

11 States Code, is amended by inserting after section 1729

12 the following new section:

13 ‘‘§ 1729A. Medicare payment for certain veterans

14 ‘‘(a) Notwithstanding any other provision of law, the

15 Secretary of Health and Human Services shall make pay16 ments during a year to a Department managed health care

17 plan on behalf of veterans (other than veterans described

18 in section 1710(a)(1) of this title) who are Medicare-eligi19 ble individuals and are enrolled in such plan during the

20 year under similar terms as the Secretary makes payments

21 under title XVIII of the Social Security Act to other eligi22 ble managed care health plans.

23 ‘‘(b)(1) For purposes of subsection (a), a managed

24 health care plan organized and operated under section

25 1705 of this title—
5

•HR 3117 IH

1 ‘‘(A) which provides care to Medicare-eligible

2 veterans (other than veterans described in section

3 1710(a)(1) of this title); and

4 ‘‘(B) for which there is a certification in effect

5 under paragraph (2),

6 shall be deemed to be a certified Medicare Choice organi7 zation under section 1857 of the Social Security Act.

8 ‘‘(2) The Secretary shall certify to the Secretary of

9 Health and Human Services each year a list of all Depart10 ment managed health care plans established under section

11 1705 of this title which the Secretary finds conform to

12 the standards prescribed under such section.

13 ‘‘(c) For purposes of this section—

14 ‘‘(1) the term ‘Medicare program’ means the

15 health insurance program under title XVIII of the

16 Social Security Act;

17 ‘‘(2) the term ‘Medicare-eligible veteran’ means

18 a veteran who is entitled to benefits under the Medi19 care program; and

20 ‘‘(3) the term ‘Medicare Choice organization’

21 means a managed health care organization under

22 part C of title XVIII of the Social Security Act.’’.

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

24 at the beginning of such chapter is amended by inserting
6

•HR 3117 IH

1 after the item relating to section 1729 the following new

2 item:

‘‘1729A. Medicare payment for certain veterans.’’.

3 (c) EFFECTIVE DATE.—Section 1729A of title 38,

4 United States Code, as added by subsection (b), shall

5 apply with respect to care provided after the date of the

6 enactment of this Act.

Æ