I

104TH CONGRESS

2D SESSION H. R. 3151

To require the Secretary of Defense and the Secretary of Health and Human

Services to carry out a demonstration project to provide the Department

of Defense with reimbursement from the Medicare program for health

care services provided to Medicare-eligible beneficiaries under TRICARE.

IN THE HOUSE OF REPRESENTATIVES

MARCH 21, 1996

Mr. WATTS of Oklahoma introduced the following bill; which was referred to

the Committee on Ways and Means, and in addition to the Committees

on Commerce, and National Security, 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 require the Secretary of Defense and the Secretary of

Health and Human Services to carry out a demonstration project to provide the Department of Defense with

reimbursement from the Medicare program for health

care services provided to Medicare-eligible beneficiaries

under TRICARE.

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 ‘‘Medicare Subvention

5 Fairness Act’’.
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1 SEC. 2. DEMONSTRATION PROJECT FOR MEDICARE REIM2 BURSEMENT OF DEPARTMENT OF DEFENSE

3 FOR HEALTH CARE PROVIDED TO MEDICARE4 ELIGIBLE BENEFICIARIES UNDER TRICARE.

5 (a) IN GENERAL.—Notwithstanding any other provi6 sion of law and subject to subsection (b), the Secretary

7 of Defense and the Secretary of Health and Human Serv8 ices shall enter into an agreement in order to carry out

9 a demonstration project under which the Secretary of

10 Health and Human Services reimburses the Secretary of

11 Defense, on a capitated basis, from the medicare program

12 under title XVIII of the Social Security Act (42 U.S.C.

13 1395 et seq.) for certain health care services provided by

14 the Secretary of Defense to medicare-eligible military

15 beneficiaries through the TRICARE program.

16 (b) PROJECT REQUIREMENTS.—(1)(A) The Sec17 retary of Defense shall budget for and expend on health

18 care services in each region in which the demonstration

19 project is carried out an amount equal to the amount that

20 the Secretary would otherwise budget for and expend on

21 such services in the absence of the project.

22 (B) The Secretary may not be reimbursed under the

23 project for health care services provided to medicare-eligi24 ble military beneficiaries in a region until the amount ex25 pended by the Secretary to provide health care services
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1 in that region exceeds the amount budgeted for health care

2 services in that region under subparagraph (A).

3 (2) The agreement between the Secretary of Defense

4 and the Secretary of Health and Human Services shall

5 provide that the cost to the medicare program of providing

6 services under the project does not exceed the cost that

7 the medicare program would otherwise incur in providing

8 such services in the absence of the project.

9 (3) The authority of the Secretary of Defense to

10 carry out the project shall expire 3 years after the date

11 of the commencement of the project.

12 (c) REPORTS.—Not later than 14 months after the

13 commencement of the demonstration project under sub14 section (a), and annually thereafter until the year follow15 ing the year in which the project is terminated, the Sec16 retary of Defense and the Secretary of Health and Human

17 Services shall jointly submit to Congress a report on the

18 demonstration project. The report shall include the follow19 ing:

20 (1) The number of medicare-eligible military

21 beneficiaries provided health care services under the

22 project during the previous year.

23 (2) An assessment of the benefits to such bene24 ficiaries of receiving health care services under the

25 project.
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1 (3) A description of the cost-shifting, if any,

2 among medical care programs of the Department of

3 Defense that results from the project.

4 (4) A description of the cost shifting, if any,

5 from the Department to the medicare program that

6 results from the project.

7 (5) An analysis of the effect of the project on

8 the following:

9 (A) Access to the military medical treat10 ment system, including access to military medi11 cal treatment facilities.

12 (B) The availability of space and facilities

13 and the capabilities of medical staff to provide

14 fee-for-service medical care.

15 (C) Established priorities for treatment of

16 beneficiaries under chapter 55 of title 10, Unit17 ed States Code.

18 (D) The cost to the Department of provid19 ing prescription drugs to the beneficiaries de20 scribed in subparagraph (C).

21 (E) The quality of health care provided by

22 the Department.

23 (F) Health care providers and medicare-el24 igible military beneficiaries in the communities

25 in which the project is carried out.
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1 (6) An assessment of the effects of continuing

2 the project on the overall budget of the Department

3 for health care and on the budget of each military

4 medical treatment facility.

5 (7) An assessment of the effects of continuing

6 the project on expenditures from the medicare trust

7 funds under title XVIII of the Social Security Act.

8 (8) An analysis of the lessons learned by the

9 Department as a result of the project.

10 (9) Any other information that the Secretary of

11 Defense and the Secretary of Health and Human

12 Services jointly consider appropriate.

13 (d) REVIEW BY COMPTROLLER GENERAL.—Not later

14 than December 31 each year in which the demonstration

15 project is carried out under this section, the Comptroller

16 General shall determine and submit to Congress a report

17 on the extent, if any, to which the costs of the Secretary

18 of Defense under the TRICARE program and the costs

19 of the Secretary of Health and Human Services under the

20 medicare program have increased as a result of the

21 project.

22 (e) DEFINITIONS.—For purposes of this section:

23 (1) The term ‘‘medicare-eligible military bene24 ficiary’’ means a beneficiary under chapter 55 of

25 title 10, United States Code, who is entitled to bene-
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1 fits under part A of title XVIII of the Social Secu2 rity Act.

3 (2) The term ‘‘TRICARE program’’ means the

4 managed health care program that is established by

5 the Secretary of Defense under the authority of

6 chapter 55 of title 10, United States Code, prin7 cipally section 1097 of that title, and includes the

8 competitive selection of contractors to financially un9 derwrite the delivery of health care services under

10 the Civilian Health and Medical Program of the

11 Uniformed Services.

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