I

104TH CONGRESS

2D SESSION H. R. 3118

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

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
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1 of an amendment to, or repeal of, a section or other provi2 sion, the reference shall be considered to be made to a

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

4 SEC. 2. HOSPITAL CARE AND MEDICAL SERVICES.

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

6 amended by striking out paragraphs (1) and (2) and in7 serting the following:

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

9 amount provided in advance in appropriations Acts for

10 these purposes, provide hospital care and medical services,

11 and may provide nursing home care, which the Secretary

12 determines is needed to any veteran—

13 ‘‘(A) with a compensable service-connected dis14 ability;

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

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

17 disability that was incurred or aggravated in the line

18 of duty;

19 ‘‘(C) who is in receipt of, or who, but for a sus20 pension pursuant to section 1151 of this title (or

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

22 would be entitled to disability compensation, but

23 only to the extent that such veteran’s continuing eli24 gibility for such care is provided for in the judgment

25 or settlement provided for in such section;
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1 ‘‘(D) who is a former prisoner of war;

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

3 War I;

4 ‘‘(F) who was exposed to a toxic substance, ra5 diation, or environmental hazard, as provided in sub6 section (e); and

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

8 necessary care as determined under section 1722(a)

9 of this title.

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

11 in paragraph (1), the Secretary may, to the extent re12 sources and facilities are available and subject to the pro13 visions of subsection (f), furnish hospital care, medical

14 services, and nursing home care which the Secretary deter15 mines is needed.’’.

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

17 1710(e) is amended—

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

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

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

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

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

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

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

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

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

4 (2) Chapter 17 is amended—

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

6 1710 as subsection (h); and

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

8 1712 to section 1710 so as to appear after sub9 section (f), redesignating such subsection as sub10 section (g), and amending such subsection by strik11 ing out ‘‘section 1710(a)(2) of this title’’ in para12 graph (1) and inserting in lieu thereof ‘‘subsection

13 (a)(2) of this section’’.

14 (3) Section 1712 is amended—

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

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

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

18 respectively.

19 SEC. 3. PROSTHETICS.

20 (a) ELIGIBILITY FOR PROSTHETICS.—Section

21 1701(6)(A)(i) is amended—

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

23 otherwise receiving care or services under this chap24 ter)’’ and ‘‘(except under the conditions described in

25 section 1712(a)(5)(A) of this title),’’;
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1 (2) by inserting ‘‘(in the case of a person other2 wise receiving care or services under this chapter)’’

3 before ‘‘wheelchairs,’’; and

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

5 not furnish sensori-neural aids other than in accord6 ance with guidelines which the Secretary shall pre7 scribe,’’ after ‘‘reasonable and necessary,’’.

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

9 date of the enactment of this Act, the Secretary of Veter10 ans Affairs shall prescribe the guidelines required by the

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

12 copy of those guidelines to the Committees on Veterans’

13 Affairs of the Senate and House of Representatives.

14 SEC. 4. MANAGEMENT OF HEALTH CARE.

15 (a) IN GENERAL.—(1) Chapter 17 is amended by in16 serting after section 1704 the following new sections:

17 ‘‘§ 1705. Management of health care: patient enroll18 ment system

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

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

21 Secretary, in accordance with regulations the Secretary

22 shall prescribe, shall establish and operate a system of an23 nual patient enrollment. The Secretary shall manage the

24 enrollment of veterans in accordance with the following

25 priorities, in the order listed:
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1 ‘‘(1) Veterans with service-connected disabilities

2 rated 30 percent or greater.

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

4 and veterans with service connected disabilities rated

5 10 percent or 20 percent.

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

7 pension based on a need of regular aid and attend8 ance or by reason of being permanently housebound

9 and other veterans who are catastrophically disabled.

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

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

12 of necessary care as determined under section

13 1722(a) of this title.

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

15 medical services, and nursing home care under sec16 tion 1710(a)(1) of this title.

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

18 subsection (a), the Secretary—

19 ‘‘(1) shall ensure that the system will be man20 aged in a manner to ensure that the provision of

21 care to enrollees is timely and acceptable in quality;

22 ‘‘(2) may establish additional priorities within

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

24 the Secretary determines necessary; and
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1 ‘‘(3) may provide for exceptions to the specified

2 priorities where dictated by compelling medical rea3 sons.

4 ‘‘§ 1706. Management of health care: other require5 ments

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

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

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

9 and manage health care programs in such a manner as

10 to promote cost-effective delivery of health care services

11 in the most clinically appropriate setting.

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

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

14 Secretary—

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

16 services when Department facilities are not capable

17 of furnishing such care and services economically,

18 and

19 ‘‘(2) shall make such rules and regulations re20 garding acquisition procedures or policies as the Sec21 retary considers appropriate to provide such needed

22 care and services.

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

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

25 Secretary shall ensure that the Department maintains its
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1 capacity to provide for the specialized treatment and reha2 bilitative needs of disabled veterans described in section

3 1710(a) of this title (including veterans with spinal cord

4 dysfunction, blindness, amputations, and mental illness)

5 within distinct programs or facilities of the Department

6 that are dedicated to the specialized needs of those veter7 ans in a manner that (1) affords those veterans reasonable

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

9 (2) ensures that overall capacity of the Department to pro10 vide such services is not reduced below the capacity of the

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

12 the date of the enactment of this section.

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

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

15 Secretary shall ensure that any veteran with a service-con16 nected disability is provided all benefits under this chapter

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

18 enactment of this section.’’.

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

20 17 is amended by inserting after the item relating to sec21 tion 1704 the following new items:

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

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

22 (b) CONFORMING AMENDMENTS TO SECTION

23 1703.—(1) Section 1703 is amended—

24 (A) by striking out subsections (a) and (b); and
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1 (B) in subsection (c) by—

2 (i) striking out ‘‘(c)’’, and

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

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

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

6 read as follows:

7 ‘‘§ 1703. Annual report on furnishing of care and

8 services by contract’’.

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

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

11 as follows:

‘‘1703. Annual report on furnishing of care and services by contract.’’.

12 SEC. 5. IMPROVED EFFICIENCY IN HEALTH CARE RE13 SOURCE MANAGEMENT.

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

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

16 585; 106 Stat. 4950) is repealed.

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

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

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

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

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

22 coverage under a health-plan contract, as defined in sec23 tion 1729(i)(1)(A) of title 38, United States Code, and

24 who is furnished care or services by a Department medical

25 facility pursuant to this title, the United States shall have
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1 the right to recover or collect charges for such care or

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

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

4 would be eligible to receive payment for such care or serv5 ices from such health-plan contract if the care or services

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

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

8 contract shall be credited to funds that have been allotted

9 to the facility that furnished the care or services.

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

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

12 contract shall be enforceable in the same manner as that

13 provided by subsections (a)(3), (b), (c)(1), (d), (f), (h),

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

15 SEC. 6. SHARING AGREEMENTS FOR HEALTH CARE RE16 SOURCES.

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

18 of chapter 81 is amended—

19 (A) by striking out section 8151; and

20 (B) by redesignating sections 8152, 8153,

21 8154, 8155, 8156, 8157, and 8158 as sections 8151,

22 8152, 8153, 8154, 8155, 8156, and 8157, respec23 tively.

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

25 chapter is amended—
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1 (A) by striking out the item relating to section

2 8151; and

3 (B) by revising the items relating to sections

4 8152, 8153, 8154, 8155, 8156, 8157, and 8158 to

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

6 (b) REVISED AUTHORITY FOR SHARING AGREE7 MENTS.—Section 8152 (as redesignated by subsection

8 (a)(1)(B)) is amended—

9 (1) in subsection (a)(1)(A)—

10 (A) by striking out ‘‘specialized medical re11 sources’’ and inserting in lieu thereof ‘‘health12 care resources’’; and

13 (B) by striking out ‘‘other’’ and all that

14 follows through ‘‘medical schools’’ and inserting

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

16 provider, health-care plan, insurer, or other en17 tity or individual’’;

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

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

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

21 not be,’’;

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

23 reimbursement’’ in the first sentence and all that

24 follows through the period at the end of that sen25 tence and inserting in lieu thereof ‘‘payment to the
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1 Department in accordance with procedures that pro2 vide appropriate flexibility to negotiate payment

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

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

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

6 follows through ‘‘to such facility therefor’’ and in7 serting in lieu thereof ‘‘preclude such payment to

8 such facility for such care or services’’;

9 (5) by redesignating subsection (e) as sub10 section (f); and

11 (6) by inserting after subsection (d) the follow12 ing new subsection (e):

13 ‘‘(e) The Secretary may make an arrangement that

14 authorizes the furnishing of services by the Secretary

15 under this section to individuals who are not veterans only

16 if the Secretary determines—

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

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

19 care to any veteran at that facility; and

20 ‘‘(2) that such an arrangement—

21 ‘‘(A) is necessary to maintain an accept22 able level and quality of service to veterans at

23 that facility; or

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

25 services to eligible veterans at that facility.’’.
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1 (c) CROSS-REFERENCE AMENDMENTS.—(1) Section

2 8110(c)(3)(A) is amended by striking out ‘‘8153’’ and in3 serting in lieu thereof ‘‘8152’’.

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

5 by subsection (a)(1)(B)) is amended by striking out ‘‘sec6 tion 8154’’ and inserting in lieu thereof ‘‘section 8153’’.

7 (3) Section 8156 (as redesignated by subsection

8 (a)(1)(B)) is amended—

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

10 8153(a)’’ and inserting in lieu thereof ‘‘section

11 8152(a)’’; and

12 (B) in subsection (b)(3), by striking out ‘‘sec13 tion 8153’’ and inserting in lieu thereof ‘‘section

14 8152’’.

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

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

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

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

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

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

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

22 8157(b)(4)’’ and inserting in lieu thereof ‘‘section

23 8156(b)(4)’’.

24 SEC. 7. PERSONNEL FURNISHING SHARED RESOURCES.

25 Section 712(b)(2) is amended—
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1 (1) by striking out ‘‘the sum of—’’ and insert2 ing in lieu thereof ‘‘the sum of the following:’’;

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

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

5 (3) by striking out ‘‘; and’’ at the end of sub6 paragraph (A) and inserting in lieu thereof a period;

7 and

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

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

10 Department during that fiscal year held by per11 sons involved in providing health-care resources

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

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