II

104TH CONGRESS

2D SESSION S. 1639

To require the Secretary of Defense and the Secretary of Health and Human

Services to carry out a demonstration project to provide the Department

of Defense with reimbursement from the Medicare Program for health

care services provided to Medicare-eligible beneficiaries under TRICARE.

IN THE SENATE OF THE UNITED STATES

MARCH 21, 1996

Mr. DOLE (for himself, Mr. THURMOND, Mr. WARNER, and Mr. GRAMM) introduced the following bill; which was read twice and referred to the Committee on Finance

A BILL

To require the Secretary of Defense and the Secretary of

Health and Human Services to carry out a demonstration project to provide the Department of Defense with

reimbursement from the Medicare Program for health

care services provided to Medicare-eligible beneficiaries

under TRICARE.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
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1 SECTION 1. DEMONSTRATION PROJECT FOR MEDICARE

2 REIMBURSEMENT OF DEPARTMENT OF DE3 FENSE FOR HEALTH CARE PROVIDED TO

4 Medicare-eligible BENEFICIARIES UNDER

5 TRICARE.

6 (a) IN GENERAL.—Notwithstanding any other provi7 sion of law and subject to subsection (b), the Secretary

8 of Defense and the Secretary of Health and Human Serv9 ices shall enter into an agreement in order to carry out

10 a demonstration project under which the Secretary of

11 Health and Human Services reimburses the Secretary of

12 Defense, on a capitated basis, from the Medicare Program

13 under title XVIII of the Social Security Act (42 U.S.C.

14 1395 et seq.) for certain health care services provided by

15 the Secretary of Defense to Medicare-eligible military

16 beneficiaries through the TRICARE Program.

17 (b) PROJECT REQUIREMENTS.—(1)(A) The Sec18 retary of Defense shall budget for and expend on health

19 care services in each region in which the demonstration

20 project is carried out an amount equal to the amount that

21 the Secretary would otherwise budget for and expend on

22 such services in the absence of the project.

23 (B) The Secretary may not be reimbursed under the

24 project for health care services provided to Medicare-eligi25 ble military beneficiaries in a region until the amount ex26 pended by the Secretary to provide health care services
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1 in that region exceeds the amount budgeted for health care

2 services in that region under subparagraph (A).

3 (2) The agreement between the Secretary of Defense

4 and the Secretary of Health and Human Services shall

5 provide that the cost to the Medicare Program of provid6 ing services under the project does not exceed the cost that

7 the Medicare Program would otherwise incur in providing

8 such services in the absence of the project.

9 (3) The authority of the Secretary of Defense to

10 carry out the project shall expire 3 years after the date

11 of the commencement of the project.

12 (c) REPORTS.—Not later than 14 months after the

13 commencement of the demonstration project under sub14 section (a), and annually thereafter until the year follow15 ing the year in which the project is terminated, the Sec16 retary of Defense and the Secretary of Health and Human

17 Services shall jointly submit to Congress a report on the

18 demonstration project. The report shall include the follow19 ing:

20 (1) The number of Medicare-eligible military

21 beneficiaries provided health care services under the

22 project during the previous year.

23 (2) An assessment of the benefits to such bene24 ficiaries of receiving health care services under the

25 project.
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1 (3) A description of the cost shifting, if any,

2 among medical care programs of the Department of

3 Defense that results from the project.

4 (4) A description of the cost shifting, if any,

5 from the Department to the Medicare Program that

6 results from the project.

7 (5) An analysis of the effect of the project on

8 the following:

9 (A) Access to the military medical treat10 ment system, including access to military medi11 cal treatment facilities.

12 (B) The availability of space and facilities

13 and the capabilities of medical staff to provide

14 fee-for-service medical care.

15 (C) Established priorities for treatment of

16 beneficiaries under chapter 55 of title 10, Unit17 ed States Code.

18 (D) The cost to the Department of provid19 ing prescription drugs to the beneficiaries de20 scribed in subparagraph (C).

21 (E) The quality of health care provided by

22 the Department.

23 (F) Health care providers and Medicare-el24 igible military beneficiaries in the communities

25 in which the project is carried out.
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1 (6) An assessment of the effects of continuing

2 the project on the overall budget of the Department

3 for health care and on the budget of each military

4 medical treatment facility.

5 (7) An assessment of the effects of continuing

6 the project on expenditures from the medicare trust

7 funds under title XVIII of the Social Security Act.

8 (8) An analysis of the lessons learned by the

9 Department as a result of the project.

10 (9) Any other information that the Secretary of

11 Defense and the Secretary of Health and Human

12 Services jointly consider appropriate.

13 (d) REVIEW BY COMPTROLLER GENERAL.—Not later

14 than December 31 of each year in which the demonstra15 tion project is carried out under this section, the Comp16 troller General shall determine and submit to Congress a

17 report on the extent, if any, to which the costs of the Sec18 retary of Defense under the TRICARE Program and the

19 costs of the Secretary of Health and Human Services

20 under the Medicare Program have increased as a result

21 of the project.

22 (e) DEFINITIONS.—For purposes of this section:

23 (1) The term ‘‘Medicare-eligible military bene24 ficiary’’ means a beneficiary under chapter 55 of

25 title 10, United States Code, who is entitled to bene-
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1 fits under part A of title XVIII of the Social Secu2 rity Act.

3 (2) The term ‘‘TRICARE Program’’ means the

4 managed health care program that is established by

5 the Secretary of Defense under the authority of

6 chapter 55 of title 10, United States Code, prin7 cipally section 1097 of that title, and includes the

8 competitive selection of contractors to financially un9 derwrite the delivery of health care services under

10 the Civilian Health and Medical Program of the

11 Uniformed Services.

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