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[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4013 Engrossed Amendment Senate (EAS)]

103d CONGRESS

  2d Session

                               H. R. 4013

_______________________________________________________________________

                               AMENDMENT
  
  
  
  
  
  
  
  
  
  

                  In the Senate of the United States,

                                June 8 (legislative day, June 7), 1994.
      Resolved, That the bill from the House of Representatives (H.R. 
4013) entitled ``An Act to amend title 38, United States Code, to 
provide the Secretary of Veterans Affairs with necessary flexibility in 
staffing the Veterans Health Administration'', do pass with the 
following

                               AMENDMENT:

            Strike out all after the enacting clause and insert:

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``VA State Health Care Reform Pilot 
Program Act''.

SEC. 2. PURPOSE OF PILOT PROGRAMS.

    The purpose of this Act is to authorize the participation of the 
Department of Veterans Affairs health care system in the health care 
systems of States that have enacted health care reform in order to 
evaluate the most appropriate means of enabling the Department health 
care system to participate in such systems and in the National health 
care system contemplated under any plans for National health care 
reform.

SEC. 3. HEALTH CARE PILOT PROGRAMS.

    (a) In General.--The Secretary may carry out pilot programs on the 
participation of the Department of Veterans Affairs health care system 
in the health care systems of States that have adopted comprehensive 
health benefit plans. The Secretary shall carry out any pilot program 
under this Act in accordance with the provisions of this Act.
    (b) States Eligible for Designation.--(1) The Secretary shall 
designate each of not more than five States as a location for a pilot 
program under this Act. The Secretary shall complete the designation of 
States as locations for pilot programs not later than 30 days after the 
date of the enactment of this Act.
    (2) The Secretary may designate a State as a location for a pilot 
program under this Act if the Secretary determines that--
            (A) the State has enacted, or will soon enact, a statute 
        establishing or providing for a comprehensive health benefit 
        plan; and
            (B) the participation of the health care system of the 
        Department under the plan is feasible and appropriate in light 
        of the purpose of this Act.
    (c) Department Participation in State Health Benefit Plans--(1) To 
the maximum extent practicable, the Secretary shall provide eligible 
persons under each pilot program under this Act with the comprehensive 
package of basic health care benefits that would otherwise be available 
to such persons under the comprehensive health benefit plan of the 
State in which the pilot program is carried out. The Secretary shall 
provide such benefits through the health care system of the Department 
in such State as if such system were a provider of such benefits under 
such plan.
    (2) Notwithstanding any other provision of law, a State may not 
prohibit the participation of the Department under the comprehensive 
health benefit plan of the State under a pilot program unless the chief 
executive officer of the State certifies to the Secretary that--
            (A) the benefits to be provided by the Department under the 
        pilot program do not meet requirements for quality of benefits 
        established by or provided under the plan; or
            (B) the location of Department facilities (including 
        facilities providing services by contract or agreement with the 
        Secretary) in the State is such that the proximity of eligible 
        persons to such facilities does not meet requirements so 
        established for such proximity.
    (3) Not later than 30 days after the designation of a State as a 
location for a pilot program under this Act, and at such other times as 
the Secretary may determine, the Secretary and the health system 
director for that State shall jointly determine the regulations under 
the authority of the Secretary the waiver or modification of which is 
necessary in order to facilitate the carrying out of the pilot program. 
Upon such determination, the Secretary shall waive or modify the 
application of such regulations to the pilot program.
    (4) The Secretary shall furnish any eligible person living in a 
State in which a pilot program is carried out (including any eligible 
person electing to receive benefits under the pilot program and any 
eligible person not electing to receive benefits under the pilot 
program) with the health care benefits for which such person is 
eligible under chapter 17 of title 38, United States Code, 
notwithstanding that the comprehensive package of basic health care 
benefits provided under the comprehensive health benefit plan of the 
State does not otherwise include such health care benefits. The 
Secretary shall furnish any health care benefits under this paragraph 
in accordance with the provisions of that chapter.
    (d) Health System Director.--(1) The Secretary shall designate a 
health system director for each State in which a pilot program is 
carried out under this Act. To the maximum extent feasible, the 
Secretary shall delegate to the health system directors the 
responsibilities of the Secretary under this Act.
    (2)(A) Subject to subparagraph (B), the Secretary shall designate 
an individual as health system director for a State from among nominees 
for that position selected by a panel composed of individuals who are 
senior management personnel of the Department medical centers located 
in that State.
    (B) An individual selected for nomination to be a health system 
director of a State under subparagraph (A) shall be--
            (i) the director or chief of staff of a Department medical 
        center located in the State in which the pilot program is 
        carried out; or
            (ii) any other individual having experience with the 
        Department medical system that is equivalent to the experience 
        with that system of an individual in a position referred to in 
        clause (i).
    (e) Administrative Reorganization.--The Secretary may carry out any 
administrative reorganization of an office, facility, activity, or 
function of the health care system of the Department in a State in 
which a pilot program is carried out that the Secretary and the health 
system director jointly determine to be necessary in order to 
facilitate the carrying out of the pilot program. Section 510(b) of 
title 38, United States Code, shall not apply to any such 
administrative reorganization.
    (f) Provision of Benefits.--(1)(A) Except as provided in 
subparagraph (B), the Secretary shall provide health care benefits 
under a pilot program--
            (i) through the direct provision of such services by the 
        health care system of the Department in the State in which the 
        pilot program is carried out; or
            (ii) by contract or other agreement in accordance with 
        paragraph (2).
    (B) The Secretary may exclude facilities of the Department from 
participation in a pilot program. Any facilities so excluded shall 
continue to provide health care benefits to veterans and other persons 
eligible for such benefits in accordance with the provisions of laws 
administered by the Secretary.
    (2) The health system director of a pilot program may enter into 
contracts and agreements for the provision of health care services and 
contracts and agreements for other services with respect to the pilot 
program under paragraph (1)(A)(ii). Any such contract or agreement 
(including any lease) shall not be subject to the following provisions 
of law:
            (A) Section 8110(c) of title 38, United States Code, 
        relating to contracting of services at Department health-care 
        facilities.
            (B) Section 8122(a)(1) of such title, relating to the lease 
        of Department property.
            (C) Section 8125 of such title, relating to local contracts 
        for the procurement of health-care items.
            (D) Section 702 of title 5, United States Code, relating to 
        the right of review of agency wrongs by courts of the United 
        States.
            (E) Sections 1346(a)(2) and 1491 of title 28, United States 
        Code, relating to the jurisdiction of the district courts of 
        the United States and the United States Court of Federal 
        Claims, respectively, for the actions enumerated in such 
        sections.
            (F) Subchapter V of chapter 35 of title 31, United States 
        Code, relating to adjudication of protests of violations of 
        procurement statutes and regulations.
            (G) Sections 3526 and 3702 of such title, relating to the 
        settlement of accounts and claims, respectively, of the United 
        States.
            (H) Subsections (b)(7), (e), (f), (g), and (h) of section 8 
        of the Small Business Act (15 U.S.C. 637(b)(7), (e), (f), (g), 
        and (h)), relating to requirements with respect to small 
        businesses for contracts for property and services.
            (I) The provisions of law assembled for purposes of 
        codification of the United States Code as section 471 through 
        544 of title 40 that relate to the authority of the 
        Administrator of General Services over the lease and disposal 
        of Federal Government property.
            (J) The Office of Federal Procurement Policy Act (41 U.S.C. 
        401 et seq.), relating to the procurement of property and 
        services by the Federal Government.
            (K) Chapter 3 of the Federal Property and Administrative 
        Services Act of 1949 (41 U.S.C. 251 et seq.), relating to the 
        procurement of property and services by the Federal Government.
            (L) Office of Management and Budget Circular A-76.
    (3)(A) Notwithstanding any other provision of law, contracts and 
agreements for the provision of health care services under this 
subsection may include contracts and other agreements with insurers, 
health care providers, or other individuals or entities that provide 
health care services.
    (B) Contracts and agreements under this paragraph may be entered 
into without prior review by the Central Office of the Department.
    (4)(A) Contracts and agreements under this subsection for services 
other than the services referred to in paragraph (3) (including 
contracts and agreements for procurement of equipment, maintenance and 
repair services, and other services related to the provision of health 
care services) shall not be subject to prior review by the Central 
Office if the amount of such contracts or agreements is less than 
$250,000.
    (B) Contracts and agreements for services under this paragraph 
shall be subject to prior review by the Central Office if the amount of 
such contracts or agreements is $250,000 or greater. If the Central 
Office fails to approve or reject a contract or agreement under this 
clause within 30 days of its submittal to the Central Office, such 
contract or agreement shall be deemed approved by the Central Office.
    (g) Department Personnel.--(1) Notwithstanding any other provision 
of law and to the extent necessary to carry out the purpose of a pilot 
program, the Secretary may--
            (A) appoint personnel to positions in the health care 
        system of the Department in the State in which the pilot 
        program is carried out in accordance with such standards for 
        such positions as the Secretary may establish; and
            (B) promote and advance personnel serving in such positions 
        in accordance with such standards as the Secretary may 
        establish.
    (2) Not later than 60 days after the designation of a State as a 
location for a pilot program under this Act, or at such other time as 
the Secretary may determine, the Secretary shall request authority from 
the Director of the Office of Management and Budget to permit the 
Secretary to employ a number of full time equivalent employees in the 
health care system of the Department in that State which exceeds the 
number of such employees that would otherwise be authorized for such 
employment by the Director.
    (3) Notwithstanding any other provision of law, employees of the 
Department at facilities of the Department under a pilot program shall 
not, during the carrying out of the pilot program, be subject to any 
reduction in the number of full time employees of the Department or as 
a result of a reduction in the number of full time employees of the 
Federal Government.
    (h) Eligible Persons.--(1) A person eligible for health care 
benefits under a pilot program is any person residing in a State in 
which a pilot program is carried out as follows:
            (A) Any veteran.
            (B) Any spouse or child of a veteran.
            (C) Any individual eligible for care under paragraph (2) or 
        (3) of section 1713(a) of title 38, United States Code.
    (2) Notwithstanding any other provision of law, a State may not 
require that any person other than a person referred to in paragraph 
(1) be eligible for health care benefits through the Department under a 
pilot program.
    (i) Copayments and Other Charges.--(1) Except as provided in 
paragraph (2), the Secretary may collect from or on behalf of any 
individual receiving health care benefits from the Secretary under a 
pilot program under this Act a premium, deductible, copayment, or other 
charge with respect to the provision of a benefit under the pilot 
program. The amount of the premium, deductible, copayment, or other 
charge collected with respect to a benefit provided under a pilot 
program may not exceed the maximum amount otherwise permitted for a 
premium, deductible, copayment, or other charge with respect to that 
benefit under the comprehensive health benefits plan of the State in 
which the pilot program is carried out.
    (2)(A) Except as provided in subparagraph (B), the Secretary shall 
not collect under the pilot programs premiums, deductibles, copayments, 
and other charges with respect to the benefits provided by the 
Department to the following:
            (i) Veterans with compensable service-connected 
        disabilities.
            (ii) Veterans whose discharge or release from active 
        military, naval, or air service was for a compensable 
        disability that was incurred or aggravated in the line of duty.
            (iii) Veterans who are in receipt of, or who, but for a 
        suspension pursuant to section 1151 of title 38, United States 
        Code (or both a suspension and the receipt of retired pay), 
        would be entitled to disability compensation, but only to the 
        extent that such veterans' continuing eligibility for such care 
        is provided for in the judgment or settlement provided for in 
        such section.
            (iv) Veterans who are former prisoners of war.
            (v) Veterans of the Mexican border period or of World War 
        I.
            (vi) Veterans who are unable to defray the expenses of 
        necessary care, as determined in accordance with section 
        1722(a) of such title.
    (B) The Secretary may collect premiums, deductibles, copayments, 
and other charges with respect to benefits provided under a pilot 
program to veterans referred to in subparagraph (A) from any third 
party obligated to provide, or to pay the expenses of, such benefits to 
or for such veterans under the comprehensive health benefits plan of 
the State in which the pilot program is carried out.
    (j) Funding.--(1) There is established in the Treasury a fund to be 
known as the Department of Veterans Affairs Health Care Reform Fund 
(hereafter referred to in this subsection as the ``Fund'').
    (2)(A) Notwithstanding any other provision of law, amounts shall be 
deposited in the Fund as follows:
            (i) Amounts collected under a pilot program in accordance 
        with subsection (i).
            (ii) Amounts made available to a pilot program based upon a 
        determination under paragraph (3).
            (iii) Amounts transferred to the Fund with respect to a 
        pilot program under paragraph (4).
            (iv) Such other amounts as the Secretary and the health 
        system directors of the pilot programs jointly determine to be 
        necessary in order to carry out the pilot programs.
            (v) Such other amounts as may be appropriated to the pilot 
        programs.
    (B) Amounts deposited in the Fund pursuant to clauses (ii) and (iv) 
shall be derived from amounts appropriated to the Department of 
Veterans Affairs for the Veterans Health Administration for medical 
care.
    (C) The Secretary shall establish and maintain a separate account 
under the Fund for each pilot program carried out under this Act. Any 
deposits and expenditures with respect to a pilot program shall be made 
to or from the account established and maintained with respect to that 
pilot program.
    (3)(A) For each year of the operation of a pilot program under this 
Act, the Secretary shall deposit in the account of the Fund for the 
pilot program an amount (as determined by the Secretary) equal to the 
amount that would otherwise be made available to the health care system 
of the Department in the State in which the pilot program is carried 
out for the payment of the cost of health care services by such system 
in that State in that year. The Secretary shall deposit such amount at 
the beginning of such year.
    (B) The costs referred to in subparagraph (A) shall not include 
costs relating to the provision by the Secretary of the following 
services:
            (i) Services relating to post-traumatic stress disorder.
            (ii) Services relating to spinal-cord dysfunction.
            (iii) Services relating to substance abuse.
            (iv) Services relating to the rehabilitation of blind 
        veterans.
            (v) Services relating to prosthetics.
    (4) Funds deposited in the Medical-Care Cost Recovery Fund 
established under section 1729(g) of title 38, United States Code, 
during any fiscal year in an amount in excess of the Congressional 
Budget Office baseline (as of the date of the enactment of this Act) 
for deposits in that fund for that fiscal year shall not be subject to 
paragraph (4) of section 1710(f), 1712(f), or 1729(g) (as the case may 
be) of that title, but shall be transferred to the fund established 
under this subsection. Such transfer for any fiscal year shall be made 
at any time that the total of amounts so received less amounts 
estimated to cover the expenses, payments, and costs described in 
paragraph (3) of section 1729(g) of that title is in excess of the 
applicable Congressional Budget Office baseline.
    (5)(A) Notwithstanding any other provision of law, amounts in the 
Fund shall be available for all expenses incurred by the Veterans 
Health Administration in carrying out the pilot programs. Subject to 
subparagraph (B), the health system director for a State in which a 
pilot program is carried out shall determine the expenses of the pilot 
program for that State for purposes of this paragraph.
    (B)(i) Except as provided in clause (ii), the costs of carrying out 
a pilot program under this paragraph shall include any costs of 
marketing and advertising under the program, costs of legal services 
provided to such pilot program by the General Counsel of the Department 
of Veterans Affairs, and costs relating to acquisition (including 
acquisition of land), construction, repair, or renovation of 
facilities.
    (ii) Costs under this subparagraph shall not include any costs 
relating to a major medical facility project or a major medical 
facility lease as such terms are defined in subparagraphs (A) and (B) 
of section 8104(a)(3) of title 38, United States Code, respectively.
    (C) The period of availability of amounts in an account established 
in the Fund for a pilot program shall end on the last day of the fiscal 
year in which the pilot program is carried out.
    (k) Termination.--A pilot program carried out under this Act shall 
terminate not later than 2 years after the date of the commencement of 
provision of benefits under the pilot program.

SEC. 4. REPORTS ON PILOT PROGRAMS.

    (a) Collection of Information.--(1) The Secretary shall collect 
such information with respect to the provision of health care benefits 
under each pilot program as is necessary to permit the Secretary to 
evaluate the pilot program in light of the purpose of the pilot program 
under this Act.
    (2) The information collected by the Secretary under paragraph (1) 
shall include aggregated data on the following:
            (A) The number of persons participating in each pilot 
        program, including the age, sex, health status, disability 
        ratings (if any), employment status, and incomes of such 
        persons.
            (B) The nature of benefits sought by such persons under 
        each pilot program.
            (C) The nature and quantity of benefits provided to such 
        persons under each pilot program.
            (D) The cost to the Department of providing such benefits 
        under each pilot program.
    (b) Reports.--(1) Not later than 14 months after the date of the 
completion of the designation of States as locations for pilot programs 
under this Act, the Secretary shall submit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives a report 
on the progress of the Secretary in carrying out the pilot programs. 
Such report shall include the information referred to in subsection 
(a)(2) on the date of the report.
    (2) Not later than November 30 of the year of the termination of 
the final pilot program under this Act, the Secretary shall submit to 
the committees referred to in paragraph (1) a report on the pilot 
programs carried out under this Act. The report shall include the 
following:
            (A) The information referred to in subsection (a)(2), 
        together with the comments and conclusions of the Secretary 
        with respect to such information.
            (B) An assessment by the Secretary of the utility of each 
        pilot program for carrying out the purpose of this Act.
            (C) An assessment by the Secretary of appropriate means of 
        integrating the health care system of the Department into the 
        health care systems of States that have enacted health care 
        reform and into the National health care system contemplated 
        under any plans for National health care reform.
            (D) Such other information, assessments, and conclusions as 
        the Secretary considers appropriate.
    (3) Not later than 30 days after the end of any fiscal year in 
which a pilot program is carried out under section 3, the Secretary 
shall submit to the appropriate committees of Congress a report 
describing the amounts expended from the Department of Veterans Affairs 
Health Care Reform Fund established under section 3(j)(1) during that 
fiscal year for each pilot program so carried out.

SEC. 5. DEFINITIONS.

    For the purposes of this Act--
            (1) The terms ``Secretary'', ``Department'', ``veteran'', 
        ``child'' and ``spouse'' have the meanings given such terms in 
        paragraphs (1), (2), (4), and (31) of section 101 of title 38, 
        United States Code, respectively.
            (2) The term ``comprehensive health benefit plan'', in the 
        case of a State, means a plan or system established under the 
        law of the State that--
                    (A) attempts to ensure the access of residents of 
                the State to a comprehensive package of basic health 
                care benefits; and
                    (B) ensures such access by providing that such 
                benefits shall be provided directly or by contract by 
                public and private entities.
            (3) The term ``comprehensive package of basic health care 
        benefits'' means the health care benefits provided for by a 
        State under the comprehensive health benefit plan of the State.
            (4) The term ``health care system of the Department'', in 
        the case of a State designated as a location for a pilot 
        program, means the facilities and personnel of the Department 
        located in that State that provide health care services under 
        chapter 17 of title 38, United States Code.

            Attest:

                                                             Secretary.

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