I

103D CONGRESS

2D SESSION H. R. 4124

To amend title 38, United States Code, to reform health care policy in

the Department of Veterans Affairs.

IN THE HOUSE OF REPRESENTATIVES

MARCH 24, 1994

Mr. MONTGOMERY (for himself and Mr. ROWLAND) introduced the following

bill; which was referred to the Committee on Veterans’ Affairs

A BILL

To amend title 38, United States Code, to reform health

care policy in 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. BENEFITS AND ELIGIBILITY THROUGH DE4 PARTMENT OF VETERANS AFFAIRS MEDICAL

5 SYSTEM.

6 (a) DVA AS A PARTICIPANT IN HEALTH CARE RE7 FORM.—

8 (1) IN GENERAL.—Title 38, United States

9 Code, is amended by inserting after chapter 17 the

10 following new chapter:
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1 ‘‘CHAPTER 18—ELIGIBILITY AND BENEFITS

2 UNDER HEALTH SECURITY ACT

‘‘SUBCHAPTER I—GENERAL

‘‘1801. Definitions.

‘‘SUBCHAPTER II—ENROLLMENT

‘‘1811. Enrollment: veterans.

‘‘1812. Enrollment: CHAMPVA eligibles.

‘‘1813. Enrollment: family members.

‘‘SUBCHAPTER III—BENEFITS

‘‘1821. Benefits for VA enrollees.

‘‘1822. Chapter 17 benefits.

‘‘1823. Supplemental benefits packages and policies.

‘‘1824. Limitation regarding veterans enrolled with health plans outside Department.

‘‘SUBCHAPTER IV—FINANCIAL MATTERS

‘‘1831. Premiums, copayments, etc.

‘‘1832. Medicare coverage and reimbursement.

‘‘1833. Recovery of cost of certain care and services.

‘‘1834. Health Plan Fund.

‘‘1835. Guaranteed funding of Government costs.

3 ‘‘SUBCHAPTER I—GENERAL

4 ‘‘§ 1801. Definitions

5 ‘‘For purposes of this chapter:

6 ‘‘(1) The term ‘health plan’ means an entity

7 that has been certified under the Health Security

8 Act as a health plan.

9 ‘‘(2) The term ‘VA health plan’ means a health

10 plan that is operated by the Secretary under section

11 7341 of this title.
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1 ‘‘(3) The term ‘VA enrollee’ means an individ2 ual enrolled under the Health Security Act and sub3 chapter II of this chapter in a VA health plan.

4 ‘‘(4) The term ‘comprehensive benefit package’

5 means the package of benefits required to be pro6 vided by a health plan under the Health Security

7 Act.

8 ‘‘(5) The term ‘Health Security Act’ means the

9 bill H.R. 3600 of the 103d Congress, as introduced

10 in the House of Representatives on November 20,

11 1993.

12 ‘‘SUBCHAPTER II—ENROLLMENT

13 ‘‘§ 1811. Enrollment: veterans

14 ‘‘Each veteran who is an eligible individual within the

15 meaning of section 1001 of the Health Security Act (in16 cluding a veteran who is a medicare-eligible individual as

17 defined in section 1902 of that Act) may enroll with a

18 VA health plan. A veteran who wants to receive the com19 prehensive benefit package through the Department shall

20 enroll with a VA health plan.

21 ‘‘§ 1812. Enrollment: CHAMPVA eligibles

22 ‘‘(a) An individual described in subsection (b) who

23 is eligible to enroll in a health plan pursuant to section

24 1001 of the Health Security Act may enroll under that

25 Act with a VA health plan.
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1 ‘‘(b) This section applies to—

2 ‘‘(1) the surviving spouse or child of a veteran

3 who (A) died as a result of a service-connected dis4 ability, or (B) at the time of death had a total dis5 ability permanent in nature, resulting from a serv6 ice-connected disability, and

7 ‘‘(2) the surviving spouse or child of a person

8 who died in the active military, naval, or air service

9 in the line of duty and not due to such person’s own

10 misconduct,

11 who are not otherwise eligible for medical care under chap12 ter 55 of title 10 (CHAMPUS).

13 ‘‘(c) For purposes of this section, the term ‘child’ has

14 the meaning given that term in section 1011 of the Health

15 Security Act.

16 ‘‘§ 1813. Enrollment: family members

17 ‘‘(a) The Secretary shall authorize a VA health plan

18 to enroll members of the family of an enrollee under sec19 tion 1811 or 1812 of this title, subject to payment of pre20 miums, deductibles, copayments, and coinsurance as re21 quired under the Health Security Act. The enrollee shall

22 have the option of enrolling in the VA health plan as an

23 individual or with family members. If the enrollee chooses

24 to enroll in the VA health plan with family members, all

25 such family members must be so enrolled.
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1 ‘‘(b) An individual who is enrolled with a VA health

2 plan pursuant to subsection (a) as a member of the family

3 of a veteran enrolled under section 1811 of this title shall

4 not lose eligibility to be enrolled with VA health plans by

5 reason of the death of that veteran.

6 ‘‘(c) For purposes of subsection (a), the members of

7 the family of an enrollee are those individuals (other than

8 the enrollee) included within the term ‘family’ as defined

9 in section 1011(b) of the Health Security Act.

10 ‘‘SUBCHAPTER III—BENEFITS

11 ‘‘§ 1821. Benefits for VA enrollees

12 ‘‘The Secretary shall ensure that each VA health plan

13 provides to each individual enrolled with it the items and

14 services in the comprehensive benefit package under the

15 Health Security Act.

16 ‘‘§ 1822. Chapter 17 benefits

17 ‘‘(a)(1) In the case of care and services that may be

18 provided under chapter 17 of this title that are not in19 cluded in the comprehensive benefit package, the Sec20 retary shall provide to any veteran (whether not enrolled

21 with a health plan) the care and services authorized under

22 that chapter in accordance with the terms and conditions

23 applicable to that veteran and that care under that chap24 ter, notwithstanding that such care and services are not

25 included in the comprehensive benefit package.
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1 ‘‘(2) In the case of a veteran who is not an eligible

2 individual within the meaning of section 1001 of the

3 Health Security Act, the Secretary shall provide to the vet4 eran the care and services that may be provided under

5 chapter 17 of this title through any facility of the depart6 ment, whether or not the facility is operating as or within

7 a VA health plan.

8 ‘‘(b) In carrying out subsection (a), the Secretary

9 shall ensure that the Department maintains, within facili10 ties of the Department, the capacity to provide for the

11 specialized treatment and rehabilitative needs of disabled

12 veterans described in section 1710(a) of this title, includ13 ing veterans with spinal cord dysfunction, blindness, and

14 mental illness, in a manner that affords those veterans

15 reasonable access to such services.

16 ‘‘§ 1823. Supplemental benefits packages and policies

17 ‘‘A VA health plan may offer supplemental health

18 benefits policies for health care services not provided

19 under chapter 17 of this title and cost sharing policies con20 sistent with the requirements of part 2 of subtitle E of

21 title I of the Health Security Act.

22 ‘‘§ 1824. Limitation regarding veterans enrolled with

23 health plans outside Department

24 ‘‘(a) A veteran who is residing in a regional alliance

25 area in which the Department operates a health plan and
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1 who is enrolled in a health plan that is not operated by

2 the Department may be provided the items and services

3 in the comprehensive benefit package by a VA health plan

4 operating in that regional alliance area only if (except as

5 provided in subsection (b)) the plan is reimbursed for the

6 cost of the care provided in accordance with the Health

7 Security Act.

8 ‘‘(b) The Secretary may not impose on or collect from

9 a veteran described in subsection (a) a cost-share charge

10 of any kind in the case of treatment for a service-con11 nected disability requiring a specialized treatment capacity

12 that is not widely available in the community and for

13 which the Department has particular expertise.

14 ‘‘SUBCHAPTER IV—FINANCIAL MATTERS

15 ‘‘§ 1831. Premiums, copayments, etc.

16 ‘‘(a) In the case of a veteran described in subsection

17 (b) who is a VA enrollee, the Secretary may not impose

18 or collect from the veteran a cost-share charge of any kind

19 (whether a premium, copayment, deductible, coinsurance

20 charge, or other charge). The Secretary shall make such

21 arrangements as necessary with health alliances in order

22 to carry out this subsection.

23 ‘‘(b) The veterans referred to in subsection (a) are

24 the following:
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1 ‘‘(1) Any veteran with a service-connected dis2 ability.

3 ‘‘(2) Any veteran whose discharge or release

4 from the active military, naval or air service was for

5 a disability incurred or aggravated in the line of

6 duty.

7 ‘‘(3) Any veteran who is in receipt of, or who,

8 but for a suspension pursuant to section 1151 of

9 this title (or both such a suspension and the receipt

10 of retired pay), would be entitled to disability com11 pensation, but only to the extent that such a veter12 an’s continuing eligibility for such care is provided

13 for in the judgment or settlement provided for in

14 such section.

15 ‘‘(4) Any veteran who is a former prisoner of

16 war.

17 ‘‘(5) Any veteran of the Mexican border period

18 or World War I.

19 ‘‘(6) Any veteran who is unable to defray the

20 expenses of necessary care as determined under sec21 tion 1722(a) of this title.

22 ‘‘(c) In the case of a VA enrollee who is not described

23 in subsection (b), the Secretary shall charge premiums

24 and establish copayments, deductibles, and coinsurance

25 amounts. The premium rate, and the rates for deductibles
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1 and copayments, for each VA health plan shall be estab2 lished by that health plan based on rules established by

3 the health alliance under which it is operating.

4 ‘‘(d) In the case of a veteran with a service-connected

5 disability who is enrolled in a VA health plan and who

6 has net earnings from self-employment, the Secretary

7 shall, under regulations prescribed by the Secretary, pro8 vide for a reduction in any premium payment (or alliance

9 credit repayment) owed by the veteran under section 6126

10 or 6111 of the Health Security Act by virtue of the veter11 an’s net earnings from self-employment.

12 ‘‘§ 1832. Medicare coverage and reimbursement

13 ‘‘(a) For purposes of any program administered by

14 the Secretary of Health and Human Services under title

15 XVIII of the Social Security Act, a Department facility

16 shall be deemed to be a Medicare provider.

17 ‘‘(b)(1) A VA health plan shall be considered to be

18 a Medicare HMO.

19 ‘‘(2) For purposes of this section, the term ‘Medicare

20 HMO’ means an eligible organization under section 1876

21 of the Social Security Act.

22 ‘‘(c) In the case of care provided to a veteran other

23 than a veteran described in section 1831(b) of this title

24 who is eligible for benefits under the Medicare program

25 under title XVIII of the Social Security Act, the Secretary
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1 of Health and Human Services shall reimburse a VA

2 health plan or Department health-care facility providing

3 services as a Medicare provider or Medicare HMO in the

4 same amounts and under the same terms and conditions

5 as that Secretary reimburses other Medicare providers or

6 Medicare HMOs, respectively. The Secretary of Health

7 and Human Services shall include with each such reim8 bursement a Medicare explanation of benefits.

9 ‘‘(d) When the Secretary provides care to a veteran

10 for which the Secretary receives reimbursement under this

11 section, the Secretary shall require the veteran to pay to

12 the Department any applicable deductible or copayment

13 that is not covered by Medicare.

14 ‘‘§ 1833. Recovery of cost of certain care and services

15 ‘‘(a) In the case of an individual provided care or

16 services through a VA health plan who has coverage under

17 a supplemental health insurance policy pursuant to part

18 2 of subtitle E of title I of the Health Security Act or

19 under any other provision of law, or who has coverage

20 under a Medicare supplemental health insurance plan (as

21 defined in the Health Security Act) or under any other

22 provision of law, the Secretary has the right to recover

23 or collect charges for care or services (as determined by

24 the Secretary, but not including care or services for a serv25 ice-connected disability) from the party providing that cov-
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1 erage to the extent that the individual (or the provider

2 of the care or services) would be eligible to receive pay3 ment for such care or services from such party if the care

4 or services had not been furnished by a department or

5 agency of the United States.

6 ‘‘(b) The provisions of subsections (b) through (f) of

7 section 1729 of this title shall apply with respect to claims

8 by the United States under subsection (a) in the same

9 manner as they apply to claims under subsection (a) of

10 that section.

11 ‘‘§ 1834. Health Plan Fund

12 ‘‘(a) There is hereby established in the Treasury a

13 revolving fund to be known as the ‘Department of Veter14 ans Affairs Health Plan Fund’.

15 ‘‘(b) Any amount received by the Department by rea16 son of the furnishing of health care by a VA health plan

17 to an individual other than a veteran described in section

18 1831(b) of this title or the enrollment of an individual

19 other than such a veteran with a VA health plan (includ20 ing amounts received as premiums, premium discount pay21 ments, copayments or coinsurance, and deductibles,

22 amounts received as third-party reimbursements, and

23 amounts received as reimbursements from another health

24 plan for care furnished to one of its enrollees) shall be

25 credited to the revolving fund.
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1 ‘‘(c) Amounts in the revolving fund are hereby made

2 available for the expenses of the delivery by a VA health

3 plan of the items and services in the comprehensive benefit

4 package and any supplemental benefits package or policy

5 offered by that health plan.

6 ‘‘§ 1835. Guaranteed funding of Government costs

7 ‘‘(a) The Secretary of the Treasury shall deposit into

8 the Department of Veterans Affairs Health Plan Fund on

9 the first day of each fiscal year quarter, from amounts

10 not otherwise appropriated, the amount certified to the

11 Secretary under subsection (b) with respect to the fiscal

12 year quarter beginning on that date. The first such deposit

13 shall be made with respect to the first fiscal year quarter

14 during which the Secretary operates a VA health plan

15 under the Health Security Act.

16 ‘‘(b) Not later than 30 days before the beginning of

17 each fiscal year quarter, the Secretary of Veterans Affairs

18 shall certify to the Secretary of the Treasury the amount

19 determined for that quarter under subsection (c).

20 ‘‘(c)(1) The amount to be certified to the Secretary

21 of the Treasury under subsection (b) for any fiscal year

22 quarter is the product of—

23 ‘‘(A) the projected number of VA enrollees de24 scribed in section 1831(b) of this title as of the be25 ginning of that fiscal year quarter, and
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1 ‘‘(B) the capitated enrollment amount for that

2 fiscal year determined under subsection (d).

3 ‘‘(2) The Secretary shall adjust future certifications

4 under this subsection to take account of differences be5 tween the actual number of veterans described in section

6 1831(b) of this title enrolled for a fiscal year quarter and

7 the projected number used in the certification for that

8 quarter pursuant to paragraph (1).

9 ‘‘(d)(1) The Secretary shall determine the capitated

10 enrollment amount for purposes of subsection (c). The ini11 tial capitated enrollment amount shall be determined as

12 the amount equal to—

13 ‘‘(A) the annual full cost (as defined in OMB

14 Circular A–25, issued on July 8, 1993) that has

15 been incurred by the Department in providing those

16 services that are specified to be included in the com17 prehensive benefit package, based upon the most re18 cent cost data available as of the time of the deter19 mination, adjusted for inflation to the date of the

20 determination based upon the medical care consumer

21 price index calculated by the Bureau of Labor Sta22 tistics, divided by

23 ‘‘(B) the total number of veterans described in

24 section 1831(b) of this title who received those

25 services.
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1 ‘‘(2) The Secretary shall include in the total annual

2 cost for purposes of paragraph (1)(A) the amount appro3 priated for fiscal year 1994 for the medical and prosthetic

4 research functions of the Veterans Health Administration.

5 ‘‘(3) The Secretary shall develop the methodology for

6 determining the initial capitated enrollment amount under

7 paragraph (1) in consultation with the Comptroller Gen8 eral of the United States. If the Comptroller General dis9 agrees with the methodology proposed to be used by the

10 Secretary, the Comptroller General shall promptly notify

11 the Committees on Veterans’ Affairs of the Senate and

12 House of Representatives. The determination of that

13 amount shall be made not later than June 1, 1995.

14 ‘‘(4) The initial capitated enrollment amount, as ad15 justed annually for inflation based upon the medical care

16 consumer price index calculated by the Bureau of Labor

17 Statistics, shall apply for the first five fiscal years during

18 which the Secretary operates a VA health plan.

19 ‘‘(5)(A) Not later than the end of the third fiscal year

20 during which the Secretary operates a VA health plan, the

21 Secretary shall submit to the Committees on Veterans’ Af22 fairs of the Senate and House of Representatives a report

23 on what actions, if any, would be necessary in order for

24 the Department to change the annual capitated enrollment

25 amount by the end of the fifth such year from the initial
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1 amount determined under paragraph (1) to an amount de2 termined using the method described in subparagraph (B),

3 or to amounts determined using some other methodology,

4 without a reduction in quality of care.

5 ‘‘(B) The method for determining the annual

6 capitated enrollment amount for purposes of the study

7 under this paragraph is to determine the average premium

8 that would be payable under the Health Security Act for

9 individuals enrolled in health plans other than VA health

10 plans which have enrollment populations with dispro11 portionate numbers of persons with similar demographic

12 and patient-risk characteristics to the population of VA

13 enrollees.’’.

14 (2) The table of chapters at the beginning of

15 part II of title 38, United States Code, is amended

16 by inserting after the item relating to chapter 17 the

17 following new item:

‘‘18. Benefits and Eligibility Under Health Security Act ........................ 1801.’’.

18 (b) PRESERVATION OF EXISTING BENEFITS FOR FA19 CILITIES NOT OPERATING AS HEALTH PLANS.—(1)

20 Chapter 17 of title 38, United States Code, is amended

21 by inserting after section 1704 the following new section:
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1 ‘‘§ 1705. Facilities not operating within health plans;

2 veterans not eligible to enroll in health

3 plans

4 ‘‘The provisions of this chapter shall apply with re5 spect to the furnishing of care and services—

6 ‘‘(1) by any facility of the Department that is

7 not operating as or within a health plan certified as

8 a health plan under the Health Security Act; and

9 ‘‘(2) by any facility of the Department (whether

10 or not operating as or within a health plan certified

11 as a health plan under the Health Security Act) in

12 the case of a veteran who is not an eligible individ13 ual within the meaning of section 1001 of the

14 Health Security Act.’’.

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

16 chapter is amended by inserting after the item relating

17 to section 1704 the following new item:

‘‘1705. Facilities not operating within health plans; veterans not eligible to enroll in health plans.’’.

18 SEC. 2. ORGANIZATION OF DEPARTMENT OF VETERANS AF19 FAIRS FACILITIES AS HEALTH PLANS.

20 (a) IN GENERAL.—Chapter 73 of title 38, United

21 States Code, is amended—

22 (1) by redesignating subchapter IV as sub23 chapter V; and
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1 (2) by inserting after subchapter III the follow2 ing new subchapter:

3 ‘‘SUBCHAPTER IV—PARTICIPATION AS PART OF

4 NATIONAL HEALTH CARE REFORM

5 ‘‘§ 7341. Organization of health care facilities as

6 health plans

7 ‘‘(a) The Secretary shall organize health plans and

8 operate Department facilities as or within health plans

9 under the Health Security Act. The Secretary shall pre10 scribe regulations establishing standards for the operation

11 of Department health care facilities as or within health

12 plans under that Act. In prescribing those standards, the

13 Secretary shall assure that they conform, to the maximum

14 extent practicable, to the requirements for health plans

15 generally set forth in part 1 of subtitle E of title I of the

16 Health Security Act.

17 ‘‘(b) Within a geographic area or region, health care

18 facilities of the Department located within that area or

19 region may be organized to operate as a single health plan

20 encompassing all Department facilities within that area or

21 region or may be organized to operate as several health

22 plans.

23 ‘‘(c) In carrying out responsibilities under the Health

24 Security Act, a State (or a State-established entity)—
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1 ‘‘(1) may not impose any standard or require2 ment on a VA health plan that is inconsistent with

3 this section or any regulation prescribed under this

4 section or other Federal laws regarding the oper5 ation of this section; and

6 ‘‘(2) may not deny certification of a VA health

7 plan under the Health Security Act on the basis of

8 a conflict between a rule of a State or health alliance

9 and this section or regulations prescribed under this

10 section or other Federal laws regarding the oper11 ation of this section.

12 ‘‘§ 7342. Health care resource agreements

13 ‘‘(a) A VA health plan or the director of a Depart14 ment of Veterans Affairs’ health care facility that is oper15 ating as or within a VA health plan may, without regard

16 to section 1703 of this title or any other law or regulation

17 pertaining to competitive procedures, acquisition proce18 dures or policies (other than contract dispute settlement

19 procedures), or bid protests, enter into agreements with

20 health care plans, insurers, and health care providers, and

21 with any other entity or individual, to furnish or obtain

22 any health-care resource, as that term is defined in section

23 8152 of this title.

24 ‘‘(b) Any proceeds to the Government received from

25 an agreement under subsection (a) shall be credited to the
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1 Department of Veterans Affairs Health Plan Fund estab2 lished under section 1834 of this title and to funds that

3 have been allotted to the facility that furnished the re4 source involved.

5 ‘‘§ 7343. Administrative and personnel flexibility

6 ‘‘(a) In order to carry out this subchapter, the Sec7 retary may—

8 ‘‘(1) subject to section 1822(b) of this title,

9 carry out administrative reorganizations of the De10 partment without regard to those provisions of sec11 tion 510 of this title following subsection (a) of that

12 section; and

13 ‘‘(2) when the Secretary finds it is cost-effective

14 or necessary in order to provide health care services

15 in a timely manner—

16 ‘‘(A) enter into contracts for procurement

17 of any commercially available item at a cost of

18 under $100,000 without regard to any provision

19 of law or regulation (i) requiring competitive

20 procedures; (ii) mandating or giving priority to

21 any source of supply; or (iii) pertaining to pro22 tests; and

23 ‘‘(B) enter into contracts without regard to

24 section 8110(c) of this title for the performance
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1 of services previously performed by employees

2 of the Department.

3 ‘‘(b) The Secretary may establish alternative person4 nel systems or procedures for personnel at facilities oper5 ating as or with health plans under the Health Security

6 Act whenever the Secretary considers such action nec7 essary in order to carry out the terms of that Act, except

8 that the Secretary shall provide for preference eligibles (as

9 defined in section 2108 of title 5, United States Code)

10 in a manner comparable to the preference for such eligi11 bles under subchapter I of chapter 33, and subchapter I

12 of chapter 35, of such title.

13 ‘‘(c) Subject to the provisions of section 1404 of the

14 Health Security Act, the Secretary may carry out appro15 priate promotional, advertising, and marketing activities

16 to inform individuals of the availability of facilities of the

17 Department operating as or within health plans.

18 ‘‘§ 7344. Veterans Health Care Transition Fund

19 ‘‘(a) For each of fiscal years 1995, 1996, and 1997,

20 the Secretary of the Treasury shall, subject to subsection

21 (a), credit to a special fund (in this section referred to

22 as the ‘Fund’) of the Treasury an amount equal to—

23 ‘‘(1) $1,250,000,000 for fiscal year 1995;

24 ‘‘(2) $850,000,000 for fiscal year 1996; and

25 ‘‘(3) $1,950,000,000 for fiscal year 1997.
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1 ‘‘(b) Amounts in the Fund shall be available to the

2 Secretary only for the VA health plans authorized under

3 this chapter. Such amounts are available without fiscal

4 year limitation for costs of commencing operation of VA

5 health plans, including consulting services, procurement of

6 equipment, marketing, and other costs, minor construc7 tion, and (subject to section 8104 of this title) major con8 struction.

9 ‘‘(c) The Secretary shall submit to Congress, no later

10 than March 1, 1997, a report concerning the operation

11 of the Department of Veterans Affairs health care system

12 in preparing for, and operating under, national health care

13 reform under the Health Security Act during fiscal years

14 1995 and 1996. The report shall include a discussion of—

15 ‘‘(1) the adequacy of amounts in the Fund for

16 the operation of VA health plans;

17 ‘‘(2) the quality of care provided by such plans;

18 ‘‘(3) the ability of such plans to attract pa19 tients; and

20 ‘‘(4) the need (if any) for additional funds for

21 the Fund in fiscal years after fiscal year 1997.

22 ‘‘§ 7345. Funding provisions: grants and other sources

23 of assistance

24 ‘‘The Secretary may apply for and accept, if awarded,

25 any grant or other source of funding that is intended to
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1 meet the needs of special populations and that but for this

2 section is unavailable to facilities of the Department or

3 to health plans operated by the Government if funds ob4 tained through the grant or other source of funding will

5 be used through a facility of the Department operating

6 as or within a health plan.’’.

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

8 at the beginning of chapter 73 is amended by striking out

9 the item relating to the heading for subchapter IV and

10 inserting in lieu thereof the following:

‘‘SUBCHAPTER IV—PARTICIPATION AS PART OF NATIONAL HEALTH CARE

REFORM

‘‘7341. Organization of health care facilities as health plans.

‘‘7342. Health care resource agreements.

‘‘7343. Administrative and personnel flexibility.

‘‘7344. Veterans Health Care Transition Fund.

‘‘7345. Funding provisions: grants and other sources of assistance.

‘‘SUBCHAPTER V—RESEARCH CORPORATIONS’’.

11 SEC. 3. ELIGIBILITY FOR CHAPTER 17 CARE.

12 (a) NURSING HOME CARE.—Section 1710(a)(1) of

13 title 38, United States Code, is amended by inserting ‘‘(or,

14 in the case of a veteran described in subparagraph (A)

15 or (D) below, shall furnish nursing home care)’’ after

16 ‘‘may furnish nursing home care’’.

17 (b) OUTPATIENT CARE FOR ENROLLED VETER18 ANS.—Paragraph (1) of section 1712(a) of such title is

19 amended—
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1 (1) by striking out ‘‘and’’ at the end of sub2 paragraph (B);

3 (2) by striking out the period at the end of sub4 paragraph (C) and inserting in lieu thereof ‘‘; and’’;

5 and

6 (3) by adding at the end the following:

7 ‘‘(D) to any veteran described in section

8 1831(b) of this title who is enrolled under section

9 1811 of this title and the Health Security Act with

10 a VA health plan (as defined in section 1801 of this

11 title), for any disability for which care and treatment

12 is not included within the comprehensive benefit

13 package (as defined in section 1801 of this title).’’.

14 (c) OBVIATE-THE-NEED OUTPATIENT CARE.—(1)

15 Paragraph (2) of such section is amended by striking out

16 ‘‘The Secretary’’ and all the follows through ‘‘this sub17 section—’’ and inserting in lieu thereof ‘‘Except as pro18 vided in subsection (b) of this section, the Secretary shall

19 furnish on an ambulatory or outpatient basis such medical

20 services as the Secretary determines are needed—’’.

21 (2) Paragraph (4) of such section is amended by

22 striking out ‘‘medical services for a purpose described in

23 paragraph (5) of this subsection’’ and inserting in lieu

24 thereof ‘‘, to the extent that facilities are available, such

25 medical services as the Secretary determines are needed’’.
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1 (3) Such section is further amended by striking out

2 paragraph (5) and redesignating paragraph (6) as para3 graph (5).

4 SEC. 4. EFFECTIVE DATE OF COVERAGE FOR HIGH-PRIOR5 ITY VETERANS.

6 Notwithstanding any other provision of this Act, the

7 provisions of the amendments made by sections 1, 2, and

8 3 shall take effect with respect to veterans described in

9 section 1831(b) of title 38, United States Code, as added

10 by section 1, on October 1, 1995. The Secretary of Veter11 ans Affairs shall take such steps as necessary to imple12 ment those provisions with respect to those veterans by

13 that date.

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