IIA

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.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
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1 SECTION 1. SHORT TITLE; REFERENCES TO TITLE 38, UNIT2 ED STATES CODE.

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

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

5 (b) REFERENCES TO TITLE 38, UNITED STATES

6 CODE.—Except as otherwise expressly provided, whenever

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

8 of an amendment to, or repeal of, a section or other provi9 sion, the reference shall be considered to be made to a

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

11 SEC. 2. HOSPITAL CARE AND MEDICAL SERVICES.

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

13 amended by striking out paragraphs (1) and (2) and in14 serting the following:

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

16 amount provided in advance in appropriations Acts for

17 these purposes, provide hospital care and medical services,

18 and may provide nursing home care, which the Secretary

19 determines is needed to any veteran—

20 ‘‘(A) with a compensable service-connected dis21 ability;

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

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

24 disability that was incurred or aggravated in the line

25 of duty;
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1 ‘‘(C) who is in receipt of, or who, but for a sus2 pension pursuant to section 1151 of this title (or

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

4 would be entitled to disability compensation, but

5 only to the extent that such veteran’s continuing eli6 gibility for such care is provided for in the judgment

7 or settlement provided for in such section;

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

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

10 War I;

11 ‘‘(F) who was exposed to a toxic substance, ra12 diation, or environmental hazard, as provided in sub13 section (e); and

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

15 necessary care as determined under section 1722(a)

16 of this title.

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

18 in paragraph (1), the Secretary may, to the extent re19 sources and facilities are available and subject to the pro20 visions of subsection (f), furnish hospital care, medical

21 services, and nursing home care which the Secretary deter22 mines is needed.’’.

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

24 1710(e) is amended—
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1 (A) in paragraph (1), by striking out ‘‘hospital

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

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

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

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

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

7 and

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

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

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

11 (2) Chapter 17 is amended—

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

13 1710 as subsection (h); and

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

15 1712 to section 1710 so as to appear after sub16 section (f), redesignating such subsection as sub17 section (g), and amending such subsection by strik18 ing out ‘‘section 1710(a)(2) of this title’’ in para19 graph (1) and inserting in lieu thereof ‘‘subsection

20 (a)(2) of this section’’.

21 (3) Section 1712 is amended—

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

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

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

25 respectively.
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1 SEC. 3. PROSTHETICS.

2 (a) ELIGIBILITY FOR PROSTHETICS.—Section

3 1701(6)(A)(i) is amended—

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

5 otherwise receiving care or services under this chap6 ter)’’ and ‘‘(except under the conditions described in

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

8 (2) by inserting ‘‘(in the case of a person other9 wise receiving care or services under this chapter)’’

10 before ‘‘wheelchairs,’’; and

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

12 not furnish sensori-neural aids other than in accord13 ance with guidelines which the Secretary shall pre14 scribe,’’ after ‘‘reasonable and necessary,’’.

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

16 date of the enactment of this Act, the Secretary of Veter17 ans Affairs shall prescribe the guidelines required by the

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

19 copy of those guidelines to the Committees on Veterans’

20 Affairs of the Senate and House of Representatives.

21 SEC. 4. MANAGEMENT OF HEALTH CARE.

22 (a) IN GENERAL.—(1) Chapter 17 is amended by in23 serting after section 1704 the following new sections:
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1 ‘‘§ 1705. Management of health care: patient enroll2 ment system

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

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

5 Secretary, in accordance with regulations the Secretary

6 shall prescribe, shall establish and operate a system of an7 nual patient enrollment. The Secretary shall manage the

8 enrollment of veterans in accordance with the following

9 priorities, in the order listed:

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

11 rated 30 percent or greater.

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

13 and veterans with service-connected disabilities rated

14 10 percent or 20 percent.

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

16 pension based on a need of regular aid and attend17 ance or by reason of being permanently housebound

18 and other veterans who are catastrophically disabled.

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

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

21 of necessary care as determined under section

22 1722(a) of this title.

23 ‘‘(5) All other veterans eligible for hospital care,

24 medical services, and nursing home care under sec25 tion 1710(a)(1) of this title.
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1 ‘‘(b) In the design of an enrollment system under

2 subsection (a), the Secretary—

3 ‘‘(1) shall ensure that the system will be man4 aged in a manner to ensure that the provision of

5 care to enrollees is timely and acceptable in quality;

6 ‘‘(2) may establish additional priorities within

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

8 the Secretary determines necessary; and

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

10 priorities where dictated by compelling medical rea11 sons.

12 ‘‘§ 1706. Management of health care: other require13 ments

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

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

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

17 and manage health care programs in such a manner as

18 to promote cost-effective delivery of health care services

19 in the most clinically appropriate setting.

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

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

22 Secretary—

23 ‘‘(1) may contract for hospital care and medical

24 services when Department facilities are not capable
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1 of furnishing such care and services economically,

2 and

3 ‘‘(2) shall make such rules and regulations re4 garding acquisition procedures or policies as the Sec5 retary considers appropriate to provide such needed

6 care and services.

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

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

9 Secretary shall ensure that the Department maintains its

10 capacity to provide for the specialized treatment and reha11 bilitative needs of disabled veterans described in section

12 1710(a) of this title (including veterans with spinal cord

13 dysfunction, blindness, amputations, and mental illness)

14 within distinct programs or facilities of the Department

15 that are dedicated to the specialized needs of those veter16 ans in a manner that (1) affords those veterans reasonable

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

18 (2) ensures that overall capacity of the Department to pro19 vide such services is not reduced below the capacity of the

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

21 the date of the enactment of this section.

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

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

24 Secretary shall ensure that any veteran with a service-con25 nected disability is provided all benefits under this chapter
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1 for which that veteran was eligible before the date of the

2 enactment of this section.’’.

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

4 17 is amended by inserting after the item relating to sec5 tion 1704 the following new items:

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

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

6 (b) CONFORMING AMENDMENTS TO SECTION

7 1703.—(1) Section 1703 is amended—

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

9 (B) in subsection (c) by—

10 (i) striking out ‘‘(c)’’, and

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

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

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

14 read as follows:

15 ‘‘§ 1703. Annual report on furnishing of care and

16 services by contract’’.

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

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

19 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.’’.

3 SEC. 8. AUTHORIZATION OF APPROPRIATIONS.

4 There is authorized to be appropriated for the De5 partment of Veterans Affairs for the Medical Care ac6 count, for the purposes specified for that account in Public

7 Law 103–327 (108 Stat. 2300), including the cost of pro8 viding hospital care and medical services under the amend9 ments made by section 2, not to exceed $17,250,000,000

10 for fiscal year 1997 and not to exceed $17,900,000,000

11 for fiscal year 1998.

12 SEC. 9. REPORT ON IMPLEMENTATION AND OPERATION.

13 (a) REPORT REQUIRED.—In carrying out sections 2,

14 3, and 4 (including the amendments made by those sec15 tions), the Secretary of Veterans Affairs shall establish in16 formation systems to assess, and, not later than March

17 1, 1998, shall submit to the Committees on Veterans’ Af18 fairs of the Senate and House of Representatives, a report

19 reflecting the experience of the Department during fiscal

20 year 1997 on—

21 (1) the effect of implementation of, and provi22 sion and management of care under, sections 2, 3,

23 and 4, on demand for health care services from the

24 Department of Veterans Affairs by veterans de-
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1 scribed in section 1710(a)(1), as amended by section

2 2;

3 (2) any differing patterns of demand on the

4 part of such veterans relating to such factors as rel5 ative distance from Department facilities and prior

6 experience, or lack of experience, as recipients of

7 care from the Department;

8 (3) the extent to which the Department has met

9 such demand for care; and

10 (4) changes in health-care delivery patterns in

11 Department facilities and the fiscal impact of such

12 changes.

13 (b) MATTERS TO BE INCLUDED.—The report under

14 subsection (a) shall include detailed information with re15 spect to fiscal year 1997 regarding the following:

16 (1) The number of veterans enrolled for care at

17 each Department medical facility and, of those veter18 ans, the number enrolled at each such facility who

19 had not received care from the Department during

20 the preceding three fiscal years.

21 (2) With respect to those veterans who had not

22 received care from the Department during the three

23 preceding fiscal years, the total cost of providing

24 care to those veterans, shown in total and separately

25 (A) by level of care, and (B) by reference to whether
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1 care is furnished in Department facilities or under

2 contract arrangements.

3 (3) With respect to the number of veterans de4 scribed in section 1710(a)(1), as amended by this

5 Act, who applied for health care from the Depart6 ment during fiscal year 1997—

7 (A) the number who applied for care

8 (shown in total and separately by facility);

9 (B) the number who were denied enroll10 ment (shown in total and separately by facility);

11 and

12 (C) the number who were denied care

13 which was considered to be medically necessary

14 but not of an emergency nature (shown in total

15 and separately by facility).

16 (4)(A) The numbers and characteristics of, and

17 the type and extent of health care furnished to, vet18 erans enrolled for care (shown in total and sepa19 rately by facility).

20 (B) The numbers and characteristics of, and

21 the type and extent of health care furnished to, vet22 erans not enrolled for care (shown separately by ref23 erence to each class of eligibility, both in total and

24 separately by facility).
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1 (5) The specific fiscal impact (shown in total

2 and by geographic health-care delivery areas) of

3 changes in delivery patterns instituted under the

4 amendments made by this Act.

Passed the House of Representatives July 30, 1996.

Attest: ROBIN H. CARLE,

Clerk.