II

104TH CONGRESS

2D SESSION S. 1786

To require the Secretary of Veterans Affairs and the Secretary of Health

and Human Services to carry out a demonstration project to provide

the Department of Veterans Affairs with reimbursement from the Medicare program for health care services provided to certain Medicareeligible veterans.

IN THE SENATE OF THE UNITED STATES

MAY 21, 1996

Mr. WELLSTONE introduced the following bill; which was read twice and

referred to the Committee on Finance

A BILL

To require the Secretary of Veterans Affairs and the Secretary of Health and Human Services to carry out a

demonstration project to provide the Department of Veterans Affairs with reimbursement from the Medicare program for health care services provided to certain Medicare-eligible veterans.

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 VET3 ERANS AFFAIRS FOR HEALTH CARE PRO4 VIDED TO CERTAIN MEDICARE-ELIGIBLE

5 VETERANS.

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

8 of Veterans Affairs and the Secretary of Health and

9 Human Services shall enter into an agreement in order

10 to carry out a demonstration project under which the Sec11 retary of Health and Human Services reimburses the Sec12 retary of Veterans Affairs, on a capitated basis, from the

13 Medicare program under title XVIII of the Social Security

14 Act (42 U.S.C. 1395 et seq.) for health care services pro15 vided by the Secretary of Veterans Affairs to covered vet16 erans.

17 (b) PROJECT REQUIREMENTS.—(1)(A) The Sec18 retary of Veterans Affairs shall carry out the demonstra19 tion project in not less than two or more than four Veter20 ans Integrated Service Networks.

21 (B) For purposes of the demonstration project, the

22 health care facilities of the Department of Veterans Af23 fairs in each Veterans Integrated Service Network in

24 which the Secretary carries out the demonstration project

25 shall be deemed to meet such standards as are applicable
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1 to providers of services under the Medicare program under

2 title XVIII of the Social Security Act.

3 (2)(A) The Secretary of Veterans Affairs shall budget

4 for and expend on health care services in each Veterans

5 Integrated Service Network in which the demonstration

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

7 the Secretary would otherwise budget for and expend on

8 such services in the absence of the project.

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

10 project for health care services provided to covered veter11 ans in a Veterans Integrated Service Network until the

12 amount expended by the Secretary to provide health care

13 services in that network exceeds the amount budgeted for

14 health care services with respect to that network under

15 subparagraph (A).

16 (3) The agreement between the Secretary of Veterans

17 Affairs and the Secretary of Health and Human Services

18 shall provide that the cost to the Medicare program of pro19 viding services under the project does not exceed the cost

20 that the Medicare program would otherwise incur in pro21 viding such services.

22 (4) The authority of the Secretary of Veterans Af23 fairs to carry out the project shall expire 3 years after

24 the date of the commencement of the project.
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1 (c) REPORTS.—Not later than 14 months after the

2 commencement of the demonstration project under sub3 section (a), and annually thereafter until the year follow4 ing the year in which the project is terminated, the Sec5 retary of Veterans Affairs and the Secretary of Health and

6 Human Services shall jointly submit to Congress a report

7 on the demonstration project. The report shall include the

8 following:

9 (1) The number of covered veterans provided

10 health care services under the project during the

11 previous year.

12 (2) An assessment of the benefits to such veter13 ans of receiving health care services under the

14 project.

15 (3) A description of the cost shifting, if any,

16 among medical care programs of the Department of

17 Veterans Affairs that results from the project.

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

19 from the Department to the Medicare program that

20 results from the project.

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

22 the following:

23 (A) Access to the health care facilities of

24 the Department.
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1 (B) The availability of space and facilities

2 and the capabilities of medical staff to provide

3 fee-for-service medical care.

4 (C) Established priorities for treatment of

5 veterans under chapter 17 of title 38, United

6 States Code.

7 (D) The cost to the Department of provid8 ing prescription drugs to veterans.

9 (E) The quality of health care provided by

10 the Department.

11 (F) Health care providers and covered vet12 erans in the communities in which the project

13 is carried out.

14 (6) An assessment of the effects of continuing

15 the project on—

16 (A) the overall budget of the Department

17 for health care; and

18 (B) the budget of each Veterans Integrated

19 Service Network covered by the project.

20 (7) An assessment of the effects of continuing

21 the project on expenditures from the Medicare trust

22 funds under title XVIII of the Social Security Act.

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

24 Department as a result of the project.
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1 (9) Any other information that the Secretary of

2 Veterans Affairs and the Secretary of Health and

3 Human Services jointly consider appropriate.

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

5 than December 31 of each year in which the demonstra6 tion project is carried out under this section, the Comp7 troller General shall determine and submit to Congress a

8 report on the extent, if any, to which the costs of the Sec9 retary of Veterans Affairs under title 38, United States

10 Code, and the costs of the Secretary of Health and Human

11 Services under the Medicare program have increased as

12 a result of the project.

13 (e) DEFINITION.—In this section, the term ‘‘covered

14 veterans’’ means any veteran entitled to benefits under

15 part A of title XVIII of the Social Security Act who is

16 eligible for health care under chapter 17 of title 38, United

17 States Code, for a reason other than a service-connected

18 disability.

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