II

104TH CONGRESS

2D SESSION S. 1563

To amend title 38, United States Code, to revise and improve eligibility

for medical care and services under that title, and for other purposes.

IN THE SENATE OF THE UNITED STATES

FEBRUARY 7, 1996

Mr. SIMPSON (for himself and Mr. ROCKEFELLER) (by request) introduced the

following bill; which was read twice and referred to the Committee on

Veterans’ Affairs

A BILL

To amend title 38, United States Code, to revise and improve

eligibility for medical care and services under that title,

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. ELIGIBILITY FOR CARE AND SERVICES OF

4 CATASTROPHICALLY DISABLED VETERANS.

5 (a) ELIGIBILITY.—Paragraph (1) of subsection (a) of

6 section 1710 of title 38, United States Code, is amended—

7 (1) by striking out ‘‘and’’ at the end of sub8 paragraph (H);
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1 (2) by striking out the period at the end of sub2 paragraph (I) and inserting in lieu thereof ‘‘; and’’;

3 and

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

5 ‘‘(J) to a veteran who is catastrophically dis6 abled, for any purpose that the Secretary determines

7 medically necessary.’’.

8 (b) DEFINITION.—Such subsection is further amend9 ed by adding at the end the following:

10 ‘‘(4) For the purposes of this subsection, the term

11 ‘veteran who is catastrophically disabled’ means any vet12 eran in any year in which the expenditures of the veteran

13 for hospital care and nursing home care exceeds the

14 amount equal to 7.5 percent of the gross adjusted income

15 of the veteran for Federal income tax purposes during the

16 preceding year.’’.

17 SEC. 2. ELIGIBILITY FOR OUTPATIENT SERVICES.

18 (a) ELIGIBILITY.—Subsection (a) of section 1712 of

19 title 38, United States Code, is amended—

20 (1) by striking out paragraphs (1) through (3)

21 and inserting in lieu thereof the following new para22 graphs (1) and (2):

23 ‘‘(a)(1) The Secretary shall furnish on an ambulatory

24 or outpatient basis such medical services as the Secretary

25 determines are needed to any veteran described in sub-
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1 paragraph (A), (B), (C), (D), (E), (F), (H), (I), or (J)

2 of section 1710(a)(1) of this title for a disability described

3 in the subparagraph that relates to such veteran.

4 ‘‘(2)(A)(i) Subject to subparagraphs (D) and (E) of

5 this paragraph, a veteran described in clause (ii) is eligible

6 for medical services on an ambulatory or outpatient basis

7 for any disability, notwithstanding that there is insuffi8 cient medical evidence to conclude that such disability may

9 be associated with the exposure of the veteran as described

10 in that clause.

11 ‘‘(ii) Clause (i) applies to any veteran—

12 ‘‘(I) who served on active duty in the Republic

13 of Vietnam during the Vietnam era; and

14 ‘‘(II) who the Secretary finds may have been

15 exposed during such service to dioxin or was exposed

16 during such service to a toxic substance found in a

17 herbicide or defoliant used in connection with mili18 tary purposes during such era.

19 ‘‘(B) Subject to subparagraphs (D) and (E) of this

20 paragraph, a veteran who the Secretary finds was exposed

21 while serving on active duty to ionizing radiation from the

22 detonation of a nuclear device in connection with such vet23 eran’s participation in the test of such a device or with

24 the American occupation of Hiroshima and Nagasaki,

25 Japan, during the period beginning on September 11,
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1 1945, and ending on July 1, 1946, is eligible for medical

2 services on an ambulatory or outpatient basis for any dis3 ability, notwithstanding that there is insufficient medical

4 evidence to conclude that such disability may be associated

5 with such exposure.

6 ‘‘(C) Subject to subparagraphs (D) and (E) of this

7 paragraph, a veteran who the Secretary finds may have

8 been exposed while serving on active duty in the Southwest

9 Asia theater of operations during the Persian Gulf War

10 to a toxic substance or environmental hazard is eligible

11 for medical services on an ambulatory or outpatient basis

12 for any disability, notwithstanding that there is insuffi13 cient medical evidence to conclude that such disability may

14 be associated with such exposure.

15 ‘‘(D) Medical services may not be provided under sub16 paragraph (A), (B), or (C) of this paragraph with respect

17 to a disability that is found, in accordance with guidelines

18 issued by the Under Secretary for Health, to have resulted

19 from a cause other than an exposure described in such

20 subparagraph (A), (B), or (C).

21 ‘‘(E) Medical services may not be provided under or

22 by virtue of subparagraph (A), (B), or (C) of this para23 graph after December 31, 1996.’’;

24 (2) by redesignating paragraphs (4), (5), and

25 (6) as paragraphs (3), (4), and (5), respectively;
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1 (3) in paragraph (3), as so redesignated, by

2 striking out ‘‘paragraph (5)’’ and inserting in lieu

3 thereof ‘‘paragraph (4)’’;

4 (4) in subparagraph (A) of paragraph (4), as so

5 redesignated, by striking out ‘‘paragraph (4)’’ and

6 inserting in lieu thereof ‘‘paragraph (3)’’; and

7 (5) by striking out paragraph (7).

8 (b) REPEAL OF ORDER OF PRIORITY FOR SERV9 ICES.—Such section is further amended by striking out

10 subsection (i).

11 SEC. 3. ELIGIBILITY FOR NURSING HOME CARE, DOMI12 CILIARY CARE, AND LONG-TERM CARE.

13 (a) ELIGIBILITY.—Section 1710(a) of title 38, Unit14 ed States Code, as amended by section 1 of this Act, is

15 further amended by adding at the end the following:

16 ‘‘(5) The Secretary shall furnish nursing home care,

17 domiciliary care, or long-term care to any veteran de18 scribed in paragraph (1) of this subsection if the Secretary

19 determines that the furnishing of such care to the veteran

20 is necessary for medical purposes or to obviate the need

21 for hospital care under this section.’’.

22 (b) DEFINITION OF LONG-TERM CARE.—Section

23 1701 of such title is amended by adding at the end the

24 following:
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1 ‘‘(10) The term ‘long-term care’ means home

2 care, home services, adult day health care, respite

3 care (as such term is defined in section 1720B(b) of

4 this title), and community residential care (including

5 care under the services authorized in section

6 1720C(a) of this title).’’.

7 SEC. 4. AUTHORITY TO PROVIDE HEALTH CARE SERVICES

8 TO ADULT DEPENDENTS OF VETERANS IN DE9 PARTMENT FACILITIES.

10 (a) AUTHORITY.—Subsection (a)(2) of section 1710

11 of title 38, United States Code, is amended—

12 (1) by inserting ‘‘(A)’’ after ‘‘(2)’’; and

13 (2) by adding at the end the following:

14 ‘‘(B) The Secretary may, to the extent resources and

15 facilities are available, furnish hospital care and nursing

16 home care to any adult dependent of a veteran which the

17 Secretary determines is needed for a disability, subject to

18 the provisions of subsection (f) of this section.’’.

19 (b) PAYMENT FOR CARE.—Paragraph (1) of sub20 section (f) of such section is amended—

21 (1) by inserting ‘‘(A)’’ after ‘‘(f)(1)’’; and

22 (2) by adding at the end the following:

23 ‘‘(B) The Secretary may not furnish hospital care or

24 nursing home care under this section to any adult depend25 ent of a veteran who is eligible for such care under sub-
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1 section (a)(2)(B) of this section unless the adult depend2 ent agrees to pay the United States the applicable amount

3 determined under paragraph (2) of this subsection. An

4 adult dependent shall be treated as a veteran for the pur5 poses of the application of such paragraph to the adult

6 dependent by reason of this subparagraph.’’.

7 (c) UTILIZATION OF PAYMENTS FOR CARE.—Para8 graph (4) of such subsection (f) is amended to read as

9 follows:

10 ‘‘(4) Amounts collected or received by the United

11 States under this subsection shall be available to the Sec12 retary for payment of the costs of furnishing care and

13 services under this section. Such amounts shall be avail14 able without fiscal year limitation.’’.

15 SEC. 5. AUTHORITY TO PROVIDE PRIMARY HEALTH CARE

16 SERVICES.

17 (a) IN GENERAL.—Paragraph (6)(A)(i) of section

18 1701 of title 38, United States Code, is amended by in19 serting ‘‘primary health care services,’’ after ‘‘preventive

20 health services,’’.

21 (b) DEFINITION.—Such section, as amended by sec22 tion 3(b) of this Act, is further amended by adding at the

23 end the following:

24 ‘‘(11) The term ‘primary health care services’

25 includes—
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1 ‘‘(A) initial diagnostic services (including

2 laboratory services, x-ray services, and phar3 macy services), treatment services, referral to

4 specialized care or services, and long-term fol5 low-up care or services with respect to chronic

6 conditions which services, referral, and care or

7 services are provided on an ambulatory basis by

8 physicians (including general and family practi9 tioners, pediatricians, obstetrician/gynecologists,

10 and internists) or by nurse practitioners or phy11 sician’s assistants under the supervision of phy12 sicians; and

13 ‘‘(B) routine services with respect to dis14 abilities that are provided by physicians who

15 specialize in such disabilities.’’.

16 SEC. 6. CLARIFICATION OF AUTHORITY TO PROVIDE PRE17 VENTIVE HEALTH SERVICES.

18 Section 1701(6)(A)(i) of title 38, United States Code,

19 as amended by section 5, is further amended by striking

20 out ‘‘(in the case of a person otherwise receiving care or

21 services under this chapter)’’.
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1 SEC. 7. AUTHORITY TO CONTRACT FOR PRIMARY HEALTH

2 CARE SERVICES AND PREVENTIVE HEALTH

3 SERVICES IN NON-DEPARTMENT FACILITIES.

4 (a) REPEAL OF REPORTING REQUIREMENT.—Sec5 tion 1703 of title 38, United States Code, is amended by

6 striking out subsection (c).

7 (b) AUTHORITY TO CONTRACT.—Such section is fur8 ther amended—

9 (1) by redesignating subsection (b) as sub10 section (c); and

11 (2) by inserting after subsection (a) the follow12 ing new subsection (b):

13 ‘‘(b)(1) Subject to paragraph (2), the Secretary may

14 furnish primary health care services or preventive health

15 services under section 1712 of this title to veterans who

16 reside in locations that are more than 50 miles or 1 hour

17 traveling time from a Department facility furnishing such

18 services by or through contract with non-Department fa19 cilities.

20 ‘‘(2) The Secretary may contract with a non-Depart21 ment facility under paragraph (1) of this subsection only

22 if the Secretary determines through sound analysis that—

23 ‘‘(A) the quality of the services to be provided

24 by the non-Department facility under the contract is

25 equal to or exceeds the quality of the services that
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1 would otherwise be provided by a Department facil2 ity in the absence of the contract; and

3 ‘‘(B) the cost of furnishing the services by con4 tract through the non-Department facility will be

5 equal to or less than the cost of furnishing the serv6 ices through a Department facility.’’.

7 SEC. 8. REVISION OF AUTHORITY TO PROVIDE PROSTHETIC

8 APPLIANCES.

9 (a) DEFINITION OF MEDICAL SERVICES.—Section

10 1701(6)(A)(i) of title 38, United States Code, as amended

11 by this Act, is further amended by striking out ‘‘and (ex12 cept under the conditions’’ and all that follows through

13 ‘‘prosthetic appliances,’’ and inserting in lieu thereof

14 ‘‘medical equipment and prosthetic appliances that are

15 prescribed by a physician based on specific medical

16 needs,’’.

17 (b) AUTHORITY TO PROVIDE.—(1) Section 1714 of

18 title 38, United States Code, is amended to read as fol19 lows:

20 ‘‘§ 1714. Medical equipment and prosthetic appli21 ances; aids for the blind and the hearing

22 impaired

23 ‘‘(a) The Secretary shall furnish medical equipment

24 or a prosthetic appliance to any veteran who is entitled

25 to such equipment or appliance.
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1 ‘‘(b)(1) The Secretary shall furnish any veteran fur2 nished medical equipment or a prosthetic appliance under

3 subsection (a) with such fitting and training in the use

4 of the equipment or appliance as the Secretary determines

5 necessary.

6 ‘‘(2) The Secretary may furnish training to a veteran

7 under this subsection in a Department facility or by con8 tract (including by contract with a training institution)

9 and may include in connection with such training travel

10 and incidental expenses (under the terms and conditions

11 set forth in section 111 of this title) to and from the home

12 of the veteran to the facility or institution at which the

13 training is furnished.

14 ‘‘(c) The Secretary may furnish any veteran fur15 nished medical equipment or a prosthetic appliance under

16 subsection (a) with special clothing made necessary by the

17 wearing of the medical equipment or appliance.

18 ‘‘(d) The Secretary may repair or replace any medical

19 equipment or prosthetic appliances reasonably necessary

20 to a veteran and belonging to the veteran which are dam21 aged or destroyed by a fall or other accident caused by

22 a service-connected disability for which the veteran is in

23 receipt of, or but for the receipt of retirement pay would

24 be entitled to, disability compensation.
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1 ‘‘(e)(1) The Secretary may furnish veterans who are

2 entitled to disability compensation with the following:

3 ‘‘(A) Seeing-eye or guide dogs trained for the

4 aid of the blind.

5 ‘‘(B) Devices for aiding individuals in over6 coming the handicap of blindness.

7 ‘‘(2) In furnishing a seeing-eye or guide dog to a vet8 eran under this subsection, the Secretary may furnish

9 training described in subsection (b)(2), including travel ex10 penses, to the veteran in the use of the dog.

11 ‘‘(f) The Secretary may furnish devices for assisting

12 in overcoming the handicap of deafness, including

13 telecaptioning decoding devices for television receivers, to

14 veterans who are profoundly deaf and entitled to disability

15 compensation on account of hearing impairment.’’.

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

17 17 of such title is amended by striking out the item relat18 ing to section 1714 and inserting in lieu thereof the follow19 ing new item:

‘‘1714. Medical equipment and prosthetic appliances; aids for the blind and the

hearing impaired.’’.

20 (b) CONFORMING AMENDMENTS.—(1) Section 1717

21 of title 38, United States Code, is amended—

22 (A) by striking out subsections (b) and (c);

23 (B) by striking out ‘‘(a)(1)’’ and inserting in

24 lieu thereof ‘‘(a)’’;
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1 (C) by redesignating paragraphs (2) and (3) as

2 subsections (b) and (c), respectively; and

3 (D) in subsection (b), as so redesignated, by re4 designating subparagraphs (A) and (B) as para5 graphs (1) and (2), respectively.

6 (2)(A) Section 1719 of title 38, United States Code,

7 is repealed.

8 (B) The table of sections at the beginning of chapter

9 17 of such title is amended by striking out the item relat10 ing to section 1719.

11 SEC. 9. UTILIZATION OF MEDICAL CARE COST RECOVERY

12 FUND FOR PAYMENT OF COSTS OF FURNISH13 ING HEALTH CARE SERVICES.

14 (a) IN GENERAL.—Paragraph (4) of section 1729(g)

15 of title 38, United States Code, is amended to read as

16 follows:

17 ‘‘(4)(A) Not later than January 1 of each year, there

18 shall be available to the Secretary for the purposes de19 scribed in subparagraph (C) an amount equal to the excess

20 of the amount of the unobligated balance remaining in the

21 Fund at the close of business on September 30 of the pre22 ceding year over the amount described in subparagraph

23 (B).

24 ‘‘(B) The amount described in this subparagraph is

25 the amount equal to—
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1 ‘‘(i) the amount of the unobligated balance re2 maining in the Fund at the close of business on Sep3 tember 30 of the preceding year that the Secretary

4 determines is necessary in order to enable to defray,

5 during the fiscal year in which the amount is avail6 able under this paragraph, expenses, payments, and

7 costs described in paragraph (3), plus

8 ‘‘(ii) the amount of such balance that is equal

9 to the amount of the Congressional Budget Office

10 baseline for deposits in the Fund for such fiscal

11 year.

12 ‘‘(C) Amounts available under subparagraph (A)

13 shall be available to the Secretary for payment of the costs

14 of furnishing hospital care and medical services under this

15 chapter, including the costs of salaries of personnel of the

16 Department who furnish such care and services. Such

17 amounts shall be available without fiscal year limitation.’’.

18 (b) EFFECTIVE DATE.—The amendment made by

19 subsection (a) shall take effect on the date of the enact20 ment of this Act and apply to amounts in the Medical21 Care Cost Recovery Fund under section 1729(g) of title

22 38, United States Code, at the close of business on Sep23 tember 30, 1996.
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1 SEC. 10. AUTHORITY FOR REIMBURSEMENT BY MEDICARE

2 OF CERTAIN HEALTH CARE SERVICES PRO3 VIDED BY DEPARTMENT FACILITIES.

4 (a) AUTHORITY.—(1) Subchapter III of chapter 17

5 of title 38, United States Code, is amended by inserting

6 after section 1729 the following new section:

7 ‘‘§ 1729A. Medicare coverage and reimbursement

8 ‘‘(a) A Department facility shall be eligible to partici9 pate under title XVIII of the Social Security Act (42

10 U.S.C. 1395 et seq.) as a provider of services and shall

11 be eligible for payments under such title if such facility

12 files an agreement with the Secretary of Health and Hu13 mans Services under section 1866 of the Social Security

14 Act (42 U.S.C. 1395cc).

15 ‘‘(b)(1) In the case of care or services provided under

16 this chapter to an individual described in paragraph

17 (2)(A) by a Department facility, the Secretary of Health

18 and Human Services shall reimburse the Department fa19 cility in the same amounts and under the same terms and

20 conditions as that Secretary reimburses other providers of

21 such care and services under title XVIII of such Act with

22 respect to such individual.

23 ‘‘(2)(A) Paragraph (1) applies to any veteran or adult

24 dependent of a veteran who is described in section

25 1710(a)(2) of this title and who is medicare eligible.
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1 ‘‘(B) For purposes of this paragraph, an individual

2 is medicare eligible if the individual is—

3 ‘‘(i) entitled to benefits under part A of title

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

5 seq.); or

6 ‘‘(ii) enrolled under part B of such title (42

7 U.S.C. 1395j et seq.).

8 ‘‘(c) When the Secretary provides care or services to

9 an individual for which the Secretary receives reimburse10 ment under this section, the Secretary shall require the

11 individual to pay to the Department any applicable de12 ductible or copayment that is not reimbursed by the medi13 care program under title XVIII of the Social Security Act.

14 ‘‘(d) The Secretary shall utilize amounts received by

15 the Secretary under this section for payment of the costs

16 of furnishing care and services under this chapter.’’.

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

18 17 of such title is amended by inserting after the item

19 relating to section 1729 the following:

‘‘1729A. Medicare coverage and reimbursement.’’.

20 (b) PAYMENTS UNDER PART A OF MEDICARE.—Sec21 tion 1814(h) of the Social Security Act (42 U.S.C.

22 1395f(c)) is amended to read as follows:

23 ‘‘Payment for Certain Services Provided in Depart24 ment of Veterans Affairs Facilities
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1 ‘‘(h) Subject to the provisions of section 1729A of

2 title 38, United States Code, subsection (c) shall not apply

3 to care and services furnished under chapter 17 of such

4 title.’’.

5 (c) PAYMENTS UNDER PART B OF MEDICARE.—Sec6 tion 1835(d) of the Social Security Act (42 U.S.C.

7 1395n(d)) is amended—

8 (1) by striking ‘‘(d)’’ and inserting ‘‘(d)(1)’’;

9 and

10 (2) by adding at the end the following new

11 paragraph:

12 ‘‘(2) Subject to the provisions of section 1729A of

13 title 38, United States Code, paragraph (1) shall not apply

14 to care and services furnished under chapter 17 of such

15 title.’’.

16 SEC. 11. MAINTENANCE OF CAPACITY OF DEPARTMENT OF

17 VETERANS AFFAIRS TO PROVIDE SPECIAL18 IZED SERVICES TO VETERANS.

19 In managing the provision of medical care and serv20 ices by the Department of Veterans Affairs, the Secretary

21 of Veterans Affairs shall ensure that the Department

22 maintains its capacity to provide for the specialized treat23 ment and rehabilitative needs of disabled veterans de24 scribed in section 1710(a) of title 38, United States Code,

25 including veterans with spinal cord dysfunction, blindness,
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1 and mental illness, within distinct programs or facilities

2 of the Department that are dedicated to the specialized

3 needs of those veterans in a manner that—

4 (1) affords those veterans reasonable access to

5 care and services for those specialized needs; and

6 (2) ensures that overall capacity of the Depart7 ment to provide such services is not reduced below

8 the capacity of the Department, nationwide, to pro9 vide those services as of the date of the enactment

10 of this Act.

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