I 

115TH CONGRESS 

1ST SESSION H. R. 4457 

To amend title 38, United States Code, to establish the Veterans Accountable 

Care Organization and to provide veterans access to private health insurance plans, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 21, 2017 

Mr. LAMBORN (for himself, Mr. MEADOWS, and Mr. FRANKS of Arizona) introduced the following bill; which was referred to the Committee on Veterans’ Affairs, and in addition to the Committees on Ways and Means, 

Oversight and Government Reform, Energy and Commerce, and Armed 

Services, for a period to be subsequently determined by the Speaker, in 

each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title 38, United States Code, to establish the 

Veterans Accountable Care Organization and to provide 

veterans access to private health insurance plans, and 

for other purposes. 

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; TABLE OF CONTENTS. 

4 This Act may be cited as the ‘‘Veterans Empower5 ment Act’’. 


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1 SEC. 2. ESTABLISHMENT OF VETERANS ACCOUNTABLE 

2 CARE ORGANIZATION. 

3 (a) ESTABLISHMENT.— 

4 (1) IN GENERAL.—Chapter 3 of title 38, United 

5 States Code, is amended by adding at the end the 

6 following new section: 

7 ‘‘§ 323. Veterans Accountable Care Organization 

8 ‘‘(a) ESTABLISHMENT.—(1) There is established the 

9 Veterans Accountable Care Organization (in this section 

10 referred to as the ‘Corporation’). 

11 ‘‘(2) The Corporation is a federally chartered cor12 poration. 

13 ‘‘(3) The Corporation shall be incorporated and domi14 ciled in the District of Columbia, or another nearby State, 

15 as determined by the board of directors of the Corpora16 tion. 

17 ‘‘(4) The Corporation shall be a charitable and non18 profit corporation. 

19 ‘‘(5) Except as otherwise provided, the Corporation 

20 shall have perpetual existence. 

21 ‘‘(b) PURPOSE.—The purpose of the Corporation is 

22 to furnish high-quality hospital care, medical services, and 

23 other health care (excluding nursing home care and domi24 ciliary care) to individuals eligible for such care and serv25 ices under laws administered by the Secretary. 


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1 ‘‘(c) BOARD OF DIRECTORS.—(1) The powers of the 

2 Corporation shall be vested in a Board of Directors that 

3 governs the Corporation. 

4 ‘‘(2) The Board of Directors shall be composed of the 

5 following members: 

6 ‘‘(A) The Secretary of Veterans Affairs. 

7 ‘‘(B) Two members appointed by the Speaker of 

8 the House of Representatives, at least one of whom 

9 shall be a veteran. 

10 ‘‘(C) Two members appointed by the Minority 

11 Leader of the House of Representatives, at least one 

12 of whom shall be a veteran. 

13 ‘‘(D) Two members appointed by the Majority 

14 Leader of the Senate, at least one of whom shall be 

15 a veteran. 

16 ‘‘(E) Two members appointed by the Minority 

17 Leader of the Senate, at least one of whom shall be 

18 a veteran. 

19 ‘‘(F) Two members appointed by the President, 

20 at least one of whom shall be veterans. 

21 ‘‘(3) The President shall designate a member of the 

22 Board of Directors to serve as Chairperson of the Board. 

23 The Board shall select a Vice Chairperson from among 

24 its members. 


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1 ‘‘(4)(A) A member of the Board of Directors shall 

2 serve for a term of five years, except that the members 

3 first appointed shall be appointed for staggered terms as 

4 the President considers appropriate to ensure that the 

5 terms of no more than three members expire in the same 

6 year. 

7 ‘‘(B) Any member appointed to fill a vacancy occur8 ring before the expiration of the term for which the mem9 ber’s predecessor was appointed shall be appointed only 

10 for the remainder of that term. A member may serve after 

11 the expiration of that member’s term until a successor has 

12 taken office. A vacancy on the Board shall not affect its 

13 powers, but shall be filled in the same manner in which 

14 the original appointment was made. 

15 ‘‘(C) The term of each member may be renewed for 

16 an additional term, except that in no case shall any mem17 ber serve more than two consecutive terms exceeding ten 

18 years. 

19 ‘‘(D) During the absence or disability of the Sec20 retary of Veterans Affairs or in the event of a vacancy 

21 in the office of Secretary, the Acting Secretary of Veterans 

22 Affairs shall serve as the member of the Board of Direc23 tors specified in paragraph (2)(A). 

24 ‘‘(d) DUTIES.—In carrying out subsection (b), the 

25 Corporation shall— 


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1 ‘‘(1) transfer personnel and assets of the De2 partment of Veterans Affairs to the Corporation 

3 pursuant to subsection (b) of section 2 of the Vet4 erans Empowerment Act; 

5 ‘‘(2) establish priorities, milestones, and time6 lines, in consultation with the Secretary of Veterans 

7 Affairs, for the termination of functions of the Vet8 erans Health Administration directly related to the 

9 furnishing of hospital care, medical services, and 

10 other health care (excluding nursing home care and 

11 domiciliary care) pursuant to subsection (c) of such 

12 section 2; 

13 ‘‘(3) with respect to centers of excellence relat14 ing to service-connected injuries and other medical 

15 issues— 

16 ‘‘(A) continue to administer such centers 

17 previously established by the Secretary; and 

18 ‘‘(B) establish and administer additional 

19 such centers as the Board of Directors deter20 mines appropriate. 

21 ‘‘(4) in consultation with the Secretary, carry 

22 out such other actions necessary to carry out this 

23 section. 

24 ‘‘(e) POWERS.—The Corporation shall— 

25 ‘‘(1) appoint employees; and 


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1 ‘‘(2) adopt a Constitution and bylaws consistent 

2 with the purpose set forth under subsection (b). 

3 ‘‘(f) DUTY TO MAINTAIN CORPORATE AND TAX-EX4 EMPT STATUS.—(1) The Corporation shall maintain its 

5 status as a corporation incorporated under the laws of the 

6 District of Columbia or another nearby State, as deter7 mined by the Board of Directors. 

8 ‘‘(2) The Corporation shall maintain its status as an 

9 organization exempt from the Internal Revenue Code of 

10 1986. 

11 ‘‘(g) VETERANS ACCOUNTABLE CARE ORGANIZATION

12 FUND.—(1) There is in the Treasury a fund to be known 

13 as the Veterans Accountable Care Organization Fund (in 

14 this subsection referred to as the ‘Fund’). 

15 ‘‘(2) Amounts recovered or collected under chapter 26 

16 of this title shall be deposited in the Fund. 

17 ‘‘(3) Amounts in the Fund shall be available, without 

18 further appropriation and without fiscal year limitation, 

19 to establish and administer centers of excellence described 

20 in subsection (d)(3) and for health care or medical services 

21 furnished to a veteran at a facility operated by the Cor22 poration.’’. 

23 (2) CLERICAL AMENDMENT.—The table of sec24 tions at the beginning of chapter 3 of such title is 


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1 amended by inserting after the item relating to sec2 tion 322 the following new item: 

‘‘323. Veterans Accountable Care Organization.’’. 

3 (b) TRANSFER OF PERSONNEL AND ASSETS.— 

4 (1) TRANSFER.—All of the personnel, property, 

5 records, and unexpended balances of appropriations, 

6 allocations, and other funds employed, used, held, 

7 available, or to be made available in connection with 

8 the direct furnishing of hospital care, medical serv9 ices, and other health care (excluding nursing home 

10 care and domiciliary care) to individuals eligible for 

11 such care and services under laws administered by 

12 the Secretary of Veterans Affairs are transferred to 

13 the Veterans Accountable Care Organization estab14 lished under section 323 of title 38, United States 

15 Code, as added by subsection (a). 

16 (2) REDUCTION IN FORCE.—The Secretary may 

17 implement a reduction in force in carrying out para18 graph (1). 

19 (c) TERMINATION OF FUNCTIONS.— 

20 (1) IN GENERAL.—Except as provided by para21 graph (2), all of the functions of the Veterans 

22 Health Administration directly relating to the fur23 nishing of hospital care, medical services, and other 

24 health care (excluding nursing home care and domi25 ciliary care) to individuals eligible for such care and 


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1 services under laws administered by the Secretary 

2 shall terminate one year after the date of the enact3 ment of this Act. 

4 (2) EXTENSIONS.—The Secretary of Veterans 

5 Affairs may make not more than two 90-day exten6 sions to the termination date specified in paragraph 

7 (1) if the Secretary notifies Congress of such exten8 sions. 

9 (3) CERTIFICATION OF TERMINATION DATE.— 

10 The Secretary shall certify to Congress the date on 

11 which paragraph (1) is carried out. 

12 (d) RECOMMENDATIONS FOR STATUTORY AMEND13 MENTS.—Not later than 180 days after the date of the 

14 enactment of this Act, the Secretary shall submit to Con15 gress a report that contains recommendations for tech16 nical and conforming amendments to Federal statutes to 

17 carry out this Act. 

18 SEC. 3. ESTABLISHMENT OF VETERANS HEALTH INSUR19 ANCE PROGRAM. 

20 (a) ESTABLISHMENT.—Chapter 73 of title 38, 

21 United States Code, is amended by adding at the end the 

22 following new section: 

23 ‘‘§ 7309A. Veterans Health Insurance Program 

24 ‘‘(a) ESTABLISHMENT.—There is established in the 

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1 surance Program (in this section referred to as the ‘Pro2 gram’). 

3 ‘‘(b) DUTIES.—Under the Program, the Secretary 

4 shall administer the provision of health insurance support 

5 to veterans under chapter 26 of this title.’’. 

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

7 at the beginning of chapter 73 of such title is amended 

8 by inserting after the item relating to section 7309 the 

9 following new item: 

‘‘7309A. Veterans Health Insurance Program.’’. 

10 SEC. 4. DESIGNATION OF EXISTING AUTHORITIES FOR HOS11 PITAL CARE, MEDICAL SERVICES, AND 

12 OTHER HEALTH CARE. 

13 (a) DESIGNATION.—Subchapter I of chapter 17 of 

14 title 38, United States Code, is amended by inserting after 

15 section 1701 the following new section: 

16 ‘‘§ 1701A. VetsCare Federal program: designation of 

17 authorities for hospital care, medical 

18 services, and other health care as pro19 gram 

20 ‘‘(a) IN GENERAL.—Effective as of the date de21 scribed in section 2(c)(3) of the Veterans Empowerment 

22 Act, the authorities for the provision of hospital care, med23 ical services, and other health care (other than nursing 

24 home care and domiciliary care) in subchapter II of this 

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1 retary may be referred to as the ‘VetsCare Federal pro2 gram’. 

3 ‘‘(b) DESIGNATION OF RECIPIENTS.—Effective as of 

4 the date described in section 2(c)(3) of the Veterans Em5 powerment Act, any eligible individual who receives hos6 pital care, medical services, and other health care (exclud7 ing nursing home care and domiciliary care) in accordance 

8 with the authorities referred to in subsection (a) after such 

9 date may be referred to in the receipt of such care or serv10 ices as participating in the ‘VetsCare Federal program’. 

11 ‘‘(c) SECONDARY PAYER.— 

12 ‘‘(1) IN GENERAL.—Notwithstanding any other 

13 provision of law, any health plan (including the 

14 Medicare program under title XVIII of the Social 

15 Security Act (42 U.S.C. 1395 et seq.) or a State 

16 plan under title XIX of such Act (42 U.S.C. 1396 

17 et seq.) and the TRICARE program under chapter 

18 55 of title 10) under which an eligible individual is 

19 covered shall be responsible for the payment of costs 

20 for any health care received by an eligible individual 

21 for a non-service connected disability up to the max22 imum amount allowable under such plan before the 

23 VetsCare Federal program is responsible for any 

24 such costs, if applicable. 


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1 ‘‘(2) NOTIFICATION.—The Secretary of Health 

2 and Human Services, the Secretary of Defense, or 

3 any other head of a relevant department or agency 

4 of the Federal Government shall notify the Secretary 

5 of Veterans Affairs of an eligible individual being 

6 covered under a health plan described in paragraph 

7 (1). 

8 ‘‘(d) TREATMENT OF EMPLOYER-SPONSORED

9 HEALTH PLANS.— 

10 ‘‘(1) IN GENERAL.—The provisions of section 

11 1862(b)(3)(C) of the Social Security Act (42 U.S.C. 

12 1395y(b)(3)(C)) shall apply with respect to financial 

13 or other incentives for an employee who is an eligible 

14 individual not to enroll (or to terminate enrollment) 

15 under a health plan that would (in the case of such 

16 enrollment) be responsible under subsection (c) for 

17 the payment of costs for hospital care, medical serv18 ices, or other health care received by the eligible in19 dividual for a non-service connected disability in the 

20 same manner as such section 1862(b)(3)(C) applies 

21 to financial or other incentives for an individual enti22 tled to benefits under title XVIII of the Social Secu23 rity Act (42 U.S.C. 1395 et seq.) not to enroll (or 

24 to terminate enrollment) under a group health plan 

25 or a large group health plan which would (in the 


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1 case of enrollment) be a primary plan (as defined in 

2 section 1862(b)(2)(A) of such Act). 

3 ‘‘(2) REGULATIONS.—The Secretary may by 

4 regulation adopt such additional exceptions to the 

5 prohibition described in paragraph (1) as the Sec6 retary considers appropriate and such paragraph 

7 shall be implemented taking into account the adop8 tion of such exceptions. 

9 ‘‘(3) AGREEMENTS.—The Veterans Accountable 

10 Care Organization and the Secretary of Health and 

11 Human Services may enter into agreements to carry 

12 out this subsection. Any such agreement shall pro13 vide that any expenses incurred by the Secretary of 

14 Health and Human Services pertaining to carrying 

15 out this subsection shall be reimbursed by the Vet16 erans Accountable Care Organization. 

17 ‘‘(4) GROUP HEALTH PLAN DEFINED.—In this 

18 subsection, the term ‘group health plan’ means a 

19 group health plan (as that term is defined in section 

20 5000(b)(1) of the Internal Revenue Code of 1986 

21 without regard to section 5000(d) of the Internal 

22 Revenue Code of 1986). 

23 ‘‘(e) ELIGIBLE INDIVIDUALS.—An individual is eligi24 ble to participate in the VetsCare Federal program if such 

25 individual was enrolled in the system of annual patient 


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1 enrollment established and operated by the Secretary 

2 under section 1705(a) of this title as of the date described 

3 in section 2(c)(3) of the Veterans Empowerment Act.’’. 

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

5 at the beginning of such chapter is amended by inserting 

6 after the item relating to section 1701 the following new 

7 item: 

‘‘1701A. VetsCare Federal program: designation of authorities for hospital care, 

medical services, and other health care as program.’’. 

8 SEC. 5. HEALTH INSURANCE SUPPORT FOR NEW VETERANS 

9 AND VETERANS ELECTING HEALTH INSUR10 ANCE SUPPORT IN LIEU OF ELIGIBILITY FOR 

11 HOSPITAL CARE, MEDICAL SERVICES, AND 

12 OTHER HEALTH CARE UNDER EXISTING AU13 THORITIES. 

14 (a) IN GENERAL.—Part II of title 38, United States 

15 Code, is amended by inserting after chapter 24 the fol16 lowing new chapter: 

17 ‘‘CHAPTER 26—VETERANS 

18 INDEPENDENCE IN HEALTH CARE 

‘‘SUBCHAPTER I—VETERANS GENERALLY

‘‘2601. VetsCare Choice program: designation of recipients. 

‘‘2602. Eligibility. 

‘‘2603. Qualifying health insurance. 

‘‘2604. Health insurance support. 

‘‘2605. Treatment of other health plans. 

‘‘2606. Receipt of health care through the Department. 

‘‘2607. Pharmacy benefits. 

‘‘SUBCHAPTER II—MEDICARE-ELIGIBLE VETERANS

‘‘2611. VetsCare Senior program: designation of recipients. 

‘‘2612. Medicare support. 


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1 ‘‘Subchapter I—Veterans Generally 

2 ‘‘§ 2601. VetsCare Choice program: designation of re3 cipients 

4 ‘‘(a) IN GENERAL.—The authorities for the provision 

5 of health insurance support under this subchapter may be 

6 referred to as the ‘VetsCare Choice program’. 

7 ‘‘(b) DESIGNATION OF RECIPIENTS.—Any veteran 

8 who receives health insurance support under this sub9 chapter may be referred to in the receipt of support as 

10 participating in the ‘VetsCare Choice program’. 

11 ‘‘(c) RELATIONSHIP TO CARE BY VETERANS AC12 COUNTABLE CARE ORGANIZATION.—Health insurance 

13 support under this subchapter is in addition to any health 

14 care or medical services furnished to a veteran at a facility 

15 operated by the Veterans Accountable Care Organization. 

16 ‘‘§ 2602. Eligibility 

17 ‘‘(a) IN GENERAL.—Except as provided in sub18 sections (c) and (d), the following veterans shall be pro19 vided health insurance support under this subchapter: 

20 ‘‘(1) Veterans who first enroll in the system of 

21 annual patient enrollment established and operated 

22 by the Secretary under section 1705(a) of this title 

23 on or after the date described in section 2(c)(3) of 

24 the Veterans Empowerment Act. 


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1 ‘‘(2) Veterans enrolled in such system as of the 

2 date described in section 2(c)(3) of the Veterans 

3 Empowerment Act who elect health insurance sup4 port under this subchapter in lieu of eligibility for 

5 hospital care, medical services, and other health care 

6 (excluding nursing home care and domiciliary care) 

7 under the VetsCare Federal program under chapter 

8 17 of this title or any other law administered by the 

9 Secretary. 

10 ‘‘(b) ENROLLMENT.—The Secretary shall admin11 ister— 

12 ‘‘(1) an open enrollment period for the 

13 VetsCare Choice program that corresponds to the 

14 open enrollment period for the Federal Employees 

15 Health Benefits program described in section 

16 8905(g); and 

17 ‘‘(2) special enrollment periods based on quali18 fying life events of veterans similar to such events 

19 under the Federal Employees Health Benefits Pro20 gram, except that the change of priority group shall 

21 also be treated as a qualifying life event. 

22 ‘‘(c) EFFECT OF ELECTION.—While an election 

23 under subsection (a)(2) of a veteran described in that sub24 section is in effect, the veteran is not eligible for hospital 

25 care, medical services, and other health care (excluding 


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1 nursing home care and domiciliary care) under chapter 17 

2 of this title or any other law administered by the Sec3 retary. 

4 ‘‘(d) EXCEPTIONS.—The following veterans are not 

5 eligible for health insurance support under this sub6 chapter: 

7 ‘‘(1) Any veteran eligible for care under the 

8 Medicare program under title XVIII of the Social 

9 Security Act (42 U.S.C. 1395 et seq.). 

10 ‘‘(2) Any veteran who— 

11 ‘‘(A) first enrolls in the system of annual 

12 patient enrollment established and operated by 

13 the Secretary under section 1705(a) of this title 

14 on or after the date described in section 2(c)(3) 

15 of the Veterans Act; and 

16 ‘‘(B) is in priority group 7 or priority 

17 group 8. 

18 ‘‘(e) COMMENCEMENT OF AVAILABILITY OF SUP19 PORT.—Health insurance support under this subchapter 

20 shall commence being available as follows: 

21 ‘‘(1) With respect to veterans in priority group 

22 1, 2, or 3, on the first day of the first month that 

23 begins on or after the date described in section 

24 2(c)(3) of the Veterans Empowerment Act. 


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1 ‘‘(2) With respect to veterans in a priority 

2 group other than 1, 2, or 3, on the first day of the 

3 first month that begins on or after the date that is 

4 180 days after the commencement date under para5 graph (1). 

6 ‘‘(f) PRIORITY GROUP DEFINED.—In this section, 

7 the term ‘priority group’ means the priority groups estab8 lished by the Secretary for purposes of the enrollment of 

9 veterans in the patient enrollment system under section 

10 1705(a) of this title. 

11 ‘‘§ 2603. Qualifying health insurance 

12 ‘‘Health insurance support may be provided under 

13 this subchapter only for health plans that— 

14 ‘‘(1) include the types of health care authorized 

15 under section 1079 of title 10, United States Code; 

16 and 

17 ‘‘(2) provide such additional elements of cov18 erage as the Secretary shall prescribe for purposes 

19 of this subchapter. 

20 ‘‘§ 2604. Health insurance support 

21 ‘‘(a) IN GENERAL.—The Secretary shall provide 

22 health insurance support to veterans eligible for such sup23 port under this subchapter through premium support 

24 under subsections (b) and (c), cost-sharing support under 

25 subsection (d), and alternative support under subsection 


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1 (e) by paying or reimbursing such veterans for the costs 

2 associated with such health insurance support. The Sec3 retary shall make such payments or reimbursements in a 

4 manner similar to the manner in which the Centers for 

5 Medicare & Medicaid Services make similar payments and 

6 reimbursements. 

7 ‘‘(b) PREMIUM SUPPORT GENERALLY.—The pre8 mium support provided by the Secretary under this sub9 section is as follows: 

10 ‘‘(1) TIER 1.—To any veteran with a service11 connected disability rated as 100 percent disabling, 

12 health insurance support sufficient to provide bene13 fits to the veteran under a health plan that are actu14 arially equivalent to 100 percent of the full actuarial 

15 value of the benefits provided under the health plan. 

16 A health plan under this paragraph may be referred 

17 to as a ‘Tier 1 Plan’. 

18 ‘‘(2) TIER 2.—To any veteran in priority group 

19 1 not covered by paragraph (1) and any veteran in 

20 priority group 2, health insurance support sufficient 

21 to provide benefits to the veteran under a health 

22 plan that are actuarially equivalent to 90 percent of 

23 the full actuarial value of the benefits provided 

24 under the health plan. A health plan under this 

25 paragraph may be referred to as a ‘Tier 2 Plan’. 


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1 ‘‘(3) TIER 3.—To any veteran in priority group 

2 3 or priority group 4, health insurance support suffi3 cient to provide benefits to the veteran under a 

4 health plan that are actuarially equivalent to 80 per5 cent of the full actuarial value of the benefits pro6 vided under the health plan. A health plan under 

7 this paragraph may be referred to as a ‘Tier 3 

8 Plan’. 

9 ‘‘(4) TIER 4.—To any veteran in priority group 

10 5 or priority group 6, health insurance support suffi11 cient to provide benefits to the veteran under a 

12 health plan that are actuarially equivalent to 70 per13 cent of the full actuarial value of the benefits pro14 vided under the health plan. A health plan under 

15 this paragraph may be referred to as a ‘Tier 4 

16 Plan’. 

17 ‘‘(5) TIER 5.—To any veteran not in a priority 

18 group covered by paragraphs (1) through (4) and 

19 not ineligible for such support under section 

20 2602(d)(2) of this title, health insurance support 

21 sufficient to provide benefits to the veteran under a 

22 health plan that are actuarially equivalent to 60 per23 cent of the full actuarial value of the benefits pro24 vided under the health plan. A health plan under 


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1 this paragraph may be referred to as a ‘Tier 5 

2 Plan’. 

3 ‘‘(c) ADDITIONAL PREMIUM SUPPORT BASED ON

4 NEED.—The premium support provided by the Secretary 

5 under this subsection is as follows: 

6 ‘‘(1) To any veteran with an annual gross 

7 household income that is less than 133 percent of 

8 the poverty line, health insurance support sufficient 

9 to cover any costs of such monthly premium that are 

10 more than 2 percent of the monthly gross household 

11 income of the veteran. 

12 ‘‘(2) To any veteran with an annual gross 

13 household income that is between 133 percent and 

14 150 percent of the poverty line, health insurance 

15 support sufficient to cover any costs of such monthly 

16 premium that are more than 3 percent of the 

17 monthly gross household income of the veteran. 

18 ‘‘(3) To any veteran with an annual gross 

19 household income that is between 150 percent and 

20 200 percent of the poverty line, health insurance 

21 support sufficient to cover any costs of such monthly 

22 premium that are more than 4 percent of the 

23 monthly gross household income of the veteran. 

24 ‘‘(4) To any veteran with an annual gross 

25 household income that is between 200 percent and 


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1 250 percent of the poverty line, health insurance 

2 support sufficient to cover any costs of such monthly 

3 premium that are more than 6.3 percent of the 

4 monthly gross household income of the veteran. 

5 ‘‘(5) To any veteran with an annual gross 

6 household income that is between 250 percent and 

7 300 percent of the poverty line, health insurance 

8 support sufficient to cover any costs of such monthly 

9 premium that are more than 8.05 percent of the 

10 monthly gross household income of the veteran. 

11 ‘‘(6) To any veteran with an annual gross 

12 household income that is between 300 percent and 

13 400 percent of the poverty line, health insurance 

14 support sufficient to cover any costs of such monthly 

15 premium that are more than 9.5 percent of the 

16 monthly gross household income of the veteran. 

17 ‘‘(d) COST-SHARING SUPPORT.—The cost-sharing 

18 support provided by the Secretary under this subsection 

19 is as follows: 

20 ‘‘(1) To any veteran with an annual gross 

21 household income that is less than 150 percent of 

22 the poverty line, health insurance support sufficient 

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1 vided under the health plan of the veteran is not less 

2 than 94 percent. 

3 ‘‘(2) To any veteran with an annual gross 

4 household income that is between 150 percent and 

5 200 percent of the poverty line, health insurance 

6 support sufficient to cover cost-sharing in order to 

7 ensure that the effective minimum actuarial value of 

8 the benefits provided under the health plan of the 

9 veteran is not less than 87 percent. 

10 ‘‘(3) To any veteran with an annual gross 

11 household income that is between 200 percent and 

12 250 percent of the poverty line, health insurance 

13 support sufficient to cover cost-sharing in order to 

14 ensure that the effective minimum actuarial value of 

15 the benefits provided under the health plan of the 

16 veteran is not less than 73 percent. 

17 ‘‘(e) ALTERNATIVE SUPPORT FOR VETERANS WITH

18 CERTAIN HEALTH INSURANCE.— 

19 ‘‘(1) IN GENERAL.—Notwithstanding any other 

20 provision of this section, upon the election of a vet21 eran eligible for health insurance support under this 

22 subchapter who obtains a high deductible health 

23 plan that includes a health savings account under 

24 section 223 of the Internal Revenue Code of 1986, 

25 the Secretary shall contribute an amount calculated 


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1 under paragraph (2) into such health savings ac2 count on behalf of the veteran. 

3 ‘‘(2) AMOUNT CALCULATED.—The amount cal4 culated under this paragraph is an amount equal to 

5 the difference between— 

6 ‘‘(A) the amount of health insurance sup7 port the veteran would otherwise have received 

8 under the subsection of this section applicable 

9 to the veteran; and 

10 ‘‘(B) the amount payable by the veteran in 

11 connection with the high deductible health plan 

12 described in paragraph (1). 

13 ‘‘(f) DETERMINATIONS BASED ON COST OF

14 PLANS.—In making determinations under this section 

15 with respect to the amount of health insurance support 

16 to provide to a veteran, the Secretary shall make such de17 terminations based on the costs associated with the sec18 ond-least-costly health plan available to the veteran in the 

19 area in which the veteran resides. 

20 ‘‘(g) DEFINITIONS.—In this section: 

21 ‘‘(1) The term ‘cost-sharing’, in connection with 

22 the receipt of health care and treatment under a 

23 health plan, means any copayments, deductibles, or 

24 other charges imposed, collected, or otherwise re25 quired by a health insurance provider or health care 


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1 provider in connection with the receipt of health care 

2 and treatment under such health plan. 

3 ‘‘(2) The term ‘poverty line’ means the poverty 

4 line (as defined in section 673(2) of the Community 

5 Services Block Grant Act (42 U.S.C. 9902(2)) appli6 cable to a family of the size involved. 

7 ‘‘(3) The term ‘high deductible health plan’ has 

8 the meaning given that term in section 223(c)(2) of 

9 the Internal Revenue Code of 1986. 

10 ‘‘(4) The term ‘priority group’ means the pri11 ority groups established by the Secretary for pur12 poses of the enrollment of veterans in the patient en13 rollment system under section 1705(a) of this title. 

14 ‘‘§ 2605. Treatment of other health plans 

15 ‘‘(a) SECONDARY PAYER.— 

16 ‘‘(1) IN GENERAL.—Notwithstanding any other 

17 provision of law, any health plan (including a State 

18 plan under title XIX of the Social Security Act (42 

19 U.S.C. 1396 et seq.) and the TRICARE program 

20 under chapter 55 of title 10) under which a veteran 

21 is covered that is not a health plan for which health 

22 insurance support is provided under this subchapter 

23 shall be responsible for the payment of costs for any 

24 health care received by an eligible individual for a 

25 non-service connected disability up to the maximum 


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1 amount allowable under such plan before any health 

2 plan for which health insurance support is provided 

3 under this subchapter is responsible for any such 

4 costs, if applicable. 

5 ‘‘(2) NOTIFICATION.—The Secretary of Health 

6 and Human Services, the Secretary of Defense, or 

7 any other head of a relevant department or agency 

8 of the Federal Government shall notify the Secretary 

9 of Veterans Affairs of an eligible individual being 

10 covered under a health plan described in paragraph 

11 (1). 

12 ‘‘(b) TREATMENT OF EMPLOYER-SPONSORED

13 HEALTH PLANS.— 

14 ‘‘(1) IN GENERAL.—The provisions of section 

15 1862(b)(3)(C) of the Social Security Act (42 U.S.C. 

16 1395y(b)(3)(C)) shall apply with respect to financial 

17 or other incentives for an employee who is a veteran 

18 not to enroll (or to terminate enrollment) under a 

19 health plan that is not a health plan for which 

20 health insurance support is provided under this sub21 chapter and that would (in the case of such enroll22 ment) be responsible under subsection (a) for the 

23 payment of costs for health care received by the vet24 eran in the same manner as such section 

25 1862(b)(3)(C) applies to financial or other incentives 


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1 for an individual entitled to benefits under title 

2 XVIII of the Social Security Act (42 U.S.C. 1395 et 

3 seq.) not to enroll (or to terminate enrollment) 

4 under a group health plan or a large group health 

5 plan which would (in the case of enrollment) be a 

6 primary plan (as defined in section 1862(b)(2)(A) of 

7 such Act). 

8 ‘‘(2) REGULATIONS.—The Secretary may by 

9 regulation adopt such additional exceptions to the 

10 prohibition described in paragraph (1) as the Sec11 retary considers appropriate and such paragraph 

12 shall be implemented taking into account the adop13 tion of such exceptions. 

14 ‘‘(3) AGREEMENTS.—The Secretary of Veterans 

15 Affairs and the Secretary of Health and Human 

16 Services may enter into agreements to carry out this 

17 subsection. Any such agreement shall provide that 

18 any expenses incurred by the Secretary of Health 

19 and Human Services pertaining to carrying out this 

20 subsection shall be reimbursed by the Secretary of 

21 Veterans Affairs. 

22 ‘‘(4) GROUP HEALTH PLAN DEFINED.—In this 

23 subsection, the term ‘group health plan’ means a 

24 group health plan (as that term is defined in section 

25 5000(b)(1) of the Internal Revenue Code of 1986 


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1 without regard to section 5000(d) of the Internal 

2 Revenue Code of 1986). 

3 ‘‘§ 2606. Receipt of health care through the Depart4 ment 

5 ‘‘(a) CONTRACTS.—Any health insurance provider 

6 that provides a health plan for which health insurance 

7 support may be provided under this subchapter or sub8 chapter II may enter into a contract with the Veterans 

9 Accountable Care Organization under which the medical 

10 personnel and facilities of the Veterans Accountable Care 

11 Organization may be treated as a designated provider for 

12 purposes of such health plan. 

13 ‘‘(b) COST OF CARE.—The cost, including any copay14 ments, of any health care or treatment provided to a vet15 eran by the Veterans Accountable Care Organization 

16 under a contact under subsection (a) shall be determined 

17 by the Veterans Accountable Care Organization. 

18 ‘‘(c) MECHANISM.—The Board of Directors of the 

19 Veterans Accountable Care Organization shall establish a 

20 mechanism through which the Veterans Accountable Care 

21 Organization enters into contracts with health insurance 

22 providers under subsection (a). 


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1 ‘‘§ 2607. Pharmacy benefits 

2 ‘‘A veteran who is enrolled in the VetsCare Choice 

3 program or the VetsCare Senior program may fill pre4 scriptions at pharmacies of the Department. 

5 ‘‘SUBCHAPTER II—MEDICARE-ELIGIBLE 

6 VETERANS 

7 ‘‘§ 2611. VetsCare Senior program: designation of re8 cipients 

9 ‘‘(a) IN GENERAL.—The authorities for the provision 

10 of health insurance support under this subchapter may be 

11 referred to as the ‘VetsCare Senior program’. 

12 ‘‘(b) DESIGNATION OF RECIPIENTS.—Any veteran 

13 who receives health insurance support under this sub14 chapter may be referred to in the receipt of support as 

15 participating in the ‘VetsCare Senior program’. 

16 ‘‘(c) RELATIONSHIP TO CARE BY VETERANS AC17 COUNTABLE CARE ORGANIZATION.—Health insurance 

18 support under this subchapter is in addition to any health 

19 care or medical services furnished to a veteran at a facility 

20 operated by the Veterans Accountable Care Organization. 

21 ‘‘§ 2612. Medicare support 

22 ‘‘(a) IN GENERAL.—The Secretary shall provide 

23 health insurance support to each covered veteran equal to 

24 the costs incurred by such veteran for Medicare premiums 

25 and cost-sharing under parts A, B, C, and D of title XVIII 

26 of the Social Security Act (42 U.S.C. 1395 et seq.) and 


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1 for premiums and cost-sharing for Medicare supplemental 

2 policies under section 1882 of such Act (42 U.S.C. 

3 1395ss). 

4 ‘‘(b) RELATIONSHIP WITH VETSCARE FEDERAL.— 

5 Notwithstanding any other provision of law, if a covered 

6 veteran is enrolled in the VetsCare Federal program under 

7 section 1701A of this title, the Medicare program under 

8 title XVIII of the Social Security Act (42 U.S.C. 1395 

9 et seq.) (or a Medicare supplemental policy under section 

10 1882 of such Act (42 U.S.C. 1395ss)) shall be responsible 

11 for the payment of costs for any health care received by 

12 an eligible individual for a non-service connected disability 

13 up to the maximum amount allowable under such program 

14 (or supplemental policy) for such health care before the 

15 VetsCare Federal program is responsible for any such 

16 costs, if applicable. 

17 ‘‘(c) AVAILABILITY OF PAYMENT OR REIMBURSE18 MENT.— 

19 ‘‘(1) COMMENCEMENT.—Health insurance sup20 port under this subchapter shall commence being 

21 available as follows: 

22 ‘‘(A) With respect to covered veterans in 

23 priority group 1, 2, or 3, on the first day of the 

24 first month that begins on or after the date deVerDate Sep 11 2014 01:07 Nov 25, 2017 Jkt 079200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\H4457.IH H4457

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1 scribed in section 2(c)(3) of the Veterans Em2 powerment Act. 

3 ‘‘(B) With respect to covered veterans in a 

4 priority group other than 1, 2, or 3, on the first 

5 day of the first month that begins on or after 

6 the date that is 180 days after the commence7 ment date under paragraph (1). 

8 ‘‘(2) EXCLUSION OF CERTAIN VETERANS.—A 

9 covered veteran is not eligible for health insurance 

10 support under this section if such veteran— 

11 ‘‘(A) first enrolls in the system of annual 

12 patient enrollment established and operated by 

13 the Secretary under section 1705(a) of this title 

14 on or after the date of the enactment of this 

15 Act; and 

16 ‘‘(B) is in priority group 7 or 8. 

17 ‘‘(d) DEFINITIONS.—In this section: 

18 ‘‘(1) The term ‘cost-sharing’, in connection with 

19 the receipt of health care and treatment under the 

20 Medicare program under title XVIII of the Social 

21 Security Act (42 U.S.C. 1395 et seq.) or Medicare 

22 supplemental policies under section 1882 of such Act 

23 (42 U.S.C. 1395ss), means any copayments, 

24 deductibles, or other charges imposed, collected, or 

25 otherwise required by a health insurance provider or 


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1 health care provider in connection with receipt of 

2 health care and treatment under such program or 

3 supplemental policies. 

4 ‘‘(2) The term ‘covered veteran’ means a vet5 eran receiving benefits under the Medicare program 

6 under title XVIII of the Social Security Act. 

7 ‘‘(3) The term ‘priority group’ means the pri8 ority groups established by the Secretary for pur9 poses of the enrollment of veterans in the patient en10 rollment system under section 1705(a) of this title.’’. 

11 (b) CLERICAL AMENDMENT.—The table of chapters 

12 at the beginning title 38, United States Code, is amended 

13 by inserting after the item relating to chapter 24 the fol14 lowing new item: 

‘‘Chapter 26. Veterans Independence in Health Care ............................. 2601’’. 

15 (c) CONFORMING AMENDMENTS.— 

16 (1) MINIMUM ESSENTIAL COVERAGE.—Section 

17 5000A(f)(1)(A)(v) of the Internal Revenue Code of 

18 1986 is amended by striking ‘‘or 18’’ and inserting 

19 ‘‘, 18, or 26’’. 

20 (2) MEDICARE PART B.— 

21 (A) NON-APPLICATION OF LATE ENROLL22 MENT PENALTY.—Section 1839(b) of the Social 

23 Security Act (42 U.S.C. 1395r(b)) is amended, 

24 in the second sentence, by inserting ‘‘or months 

25 for which the individual can demonstrate that 


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1 the individual was enrolled in the VetsCare Sen2 ior program under subchapter II of chapter 26 

3 of title 38, United States Code’’ after ‘‘an indi4 vidual described in section 1837(k)(3)’’. 

5 (B) SPECIAL ENROLLMENT PERIOD.—Sec6 tion 1837 of the Social Security Act (42 U.S.C. 

7 1395p) is amended by adding at the end the 

8 following new subsection: 

9 ‘‘(m)(1) In the case of any individual who is enrolled 

10 in the VetsCare Senior program under subchapter II of 

11 chapter 26 of title 38, United States Code at the time 

12 the individual is entitled to part A under section 226 or 

13 section 226A and who is eligible to enroll but who has 

14 elected not to enroll (or to be deemed enrolled) during the 

15 individual’s initial enrollment period, there shall be a spe16 cial enrollment period as specified by the Secretary. 

17 ‘‘(2) In the case of an individual who enrolls during 

18 the special enrollment period provided under paragraph 

19 (1), the coverage period under this part shall begin on 

20 such date specified by the Secretary. 

21 ‘‘(3) An individual may only enroll during the special 

22 enrollment period provided under paragraph (1) one time 

23 during the individual’s lifetime. 

24 ‘‘(4) The Secretary of Veterans Affairs shall collabo25 rate with the Secretary of Health and Human Services 


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1 and the Commissioner of Social Security to provide for 

2 the accurate identification of individuals described in para3 graph (1). The Secretary of Veterans Affairs shall provide 

4 such individuals with notification with respect to this sub5 section. The Secretary of Veterans Affairs shall collabo6 rate with the Secretary of Health and Human Services 

7 and the Commissioner of Social Security to ensure appro8 priate follow up pursuant to any notification provided 

9 under the preceding sentence.’’. 

10 SEC. 6. COORDINATION BETWEEN VETSCARE CHOICE PRO11 GRAM AND ELIGIBILITY TO MAKE CONTRIBU12 TIONS TO HEALTH SAVINGS ACCOUNTS. 

13 (a) IN GENERAL.—Section 223(c)(1)(B) of the Inter14 nal Revenue Code of 1986 is amended by striking ‘‘and’’ 

15 at the end of clause (ii), by striking the period at the end 

16 of clause (iii) and inserting ‘‘, and’’, and by adding at the 

17 end the following new clause: 

18 ‘‘(iv) coverage for health insurance 

19 support under the VetsCare Choice pro20 gram under subchapter I of chapter 26 of 

21 title 38, United States Code.’’. 

22 (b) DENIAL OF DEDUCTION FOR AMOUNTS NOT IN23 CLUDIBLE IN GROSS INCOME.—Subsection (b) of section 

24 223 of the Internal Revenue Code of 1986 is amended by 

25 adding at the end the following new paragraph: 


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1 ‘‘(9) AMOUNTS NOT INCLUDIBLE IN GROSS IN2 COME.—No amount paid to a health savings account 

3 of an individual shall be taken into account under 

4 subsection (a) if (without regard to this section) 

5 such amount, when paid to or on behalf of such indi6 vidual, is excluded from gross income of the indi7 vidual or exempt from taxation under any provision 

8 of Federal law.’’. 

9 (c) EFFECTIVE DATE.—The amendments made by 

10 this section shall apply to amounts paid to a health sav11 ings account (as defined in section 223(d) of the Internal 

12 Revenue Code of 1986) after the date of the enactment 

13 of this Act. 

14 SEC. 7. PUBLICATION OF HEALTH CARE INFORMATION. 

15 (a) IN GENERAL.—The Secretary of Veterans Affairs 

16 shall make available to the public on an ongoing basis in17 formation about the operations of the Veterans Health Ad18 ministration in a manner similar to publication of infor19 mation under the Medicare Accountable Care Organiza20 tion program to better monitor and support continuous 

21 improvement in the Veterans Health Administration. 

22 (b) ELEMENTS.—The information published under 

23 subsection (a) shall include information about the oper24 ations of the Veterans Health Administration, including 


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1 metrics regarding quality, safety, patient experience, time2 liness, and cost-effectiveness. 

3 SEC. 8. VETERANS’ ELIGIBILITY FOR LONG-TERM CARE IN4 SURANCE. 

5 (a) IN GENERAL.—Section 9001 of title 5, United 

6 States Code, is amended— 

7 (1) by redesignating paragraphs (5) through 

8 (10) as (6) through (11), respectively; 

9 (2) by inserting after paragraph (4) the fol10 lowing: 

11 ‘‘(5) VETERAN.—The term ‘veteran’ has the 

12 same meaning given the term in section 101(2) of 

13 title 38, United States Code.’’; 

14 (3) in paragraph (6), as so redesignated— 

15 (A) in subparagraph (A), by striking ‘‘or 

16 (4).’’ and inserting ‘‘(4), or (5).’’; 

17 (B) in subparagraph (B), by striking ‘‘(1) 

18 or (3).’’ and inserting ‘‘(1), (3), or (5).’’; 

19 (C) in subparagraph (C), by striking ‘‘or 

20 (4)’’ and inserting ‘‘(4), or (5)’’; and 

21 (D) in subparagraph (D), by striking ‘‘or 

22 (4)’’ and inserting ‘‘(4), or (5)’’; 

23 (4) in paragraph (7), as so redesignated, by 

24 striking ‘‘or (5).’’ and inserting ‘‘(5), or (6).’’; and 

25 (5) in paragraph (11), as so redesignated— 


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1 (A) in subparagraph (C), by striking 

2 ‘‘Commerce; and’’ and inserting ‘‘Commerce;’’; 

3 (B) in subparagraph (D), by striking 

4 ‘‘Services.’’ and inserting ‘‘Services; and’’; and 

5 (C) by inserting after subparagraph (D): 

6 ‘‘(E) with respect to a veteran, the Sec7 retary of Veterans Affairs.’’. 

8 (b) TECHNICAL AND CONFORMING AMENDMENTS.— 

9 Title 5, United States Code, is amended as follows: 

10 (1) Section 9002 is amended— 

11 (A) in subsection (a), by striking ‘‘or (5)’’ 

12 and inserting ‘‘(5), or (6)’’; and 

13 (B) in subsection (e)— 

14 (i) in paragraph (2), by striking ‘‘or 

15 (4)’’ and inserting ‘‘(4), or (5)’’; and 

16 (ii) in paragraph (4), by striking ‘‘sec17 tion 9001(9)’’ and inserting ‘‘section 

18 9001(10)’’. 

19 (2) Section 9004(d) is amended by inserting 

20 after ‘‘withheld under subsection (b)’’ the following: 

21 ‘‘, who is an enrollee by virtue of being a veteran de22 scribed in section 9001(5) of this title,’’. 

23 (3) Section 9008(c) is amended by striking ‘‘(3) 

24 or (4)’’ and inserting ‘‘(3), (4), or (5)’’. 

Æ 


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