I 

113TH CONGRESS 

1ST SESSION H. R. 2953 

To provide Medicare payments to Department of Veterans Affairs medical 

facilities for items and services provided to Medicare-eligible veterans 

for non-service-connected conditions. 

IN THE HOUSE OF REPRESENTATIVES 

AUGUST 1, 2013 

Mr. MICHAUD introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committees on Energy 

and Commerce and Veterans’ Affairs, 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 provide Medicare payments to Department of Veterans 

Affairs medical facilities for items and services provided 

to Medicare-eligible veterans for non-service-connected 

conditions. 

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. 

4 This Act may be cited as the ‘‘Medicare VA Reim5 bursement Act of 2013’’. 

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1 SEC. 2. ESTABLISHMENT OF MEDICARE SUBVENTION FOR 

2 VETERANS. 

3 (a) IN GENERAL.—Section 1862 of the Social Secu4 rity Act (42 U.S.C. 1395y) is amended by adding at the 

5 end the following new subsection: 

6 ‘‘(p) MEDICARE SUBVENTION FOR VETERANS.— 

7 ‘‘(1) ESTABLISHMENT.—The Secretary of 

8 Health and Human Services, in cooperation with the 

9 Secretary of Veterans Affairs, shall establish a pro10 gram to be known as the ‘Medicare VA reimburse11 ment program’ under which the Secretary of Health 

12 and Human Services shall reimburse the Secretary 

13 of Veterans Affairs, from the Federal Hospital In14 surance Trust Fund established in section 1817 and 

15 the Federal Supplementary Medical Insurance Trust 

16 Fund established in section 1841, for an item or 

17 service that— 

18 ‘‘(A) is furnished to a Medicare-eligible 

19 veteran by a Department of Veterans Affairs 

20 medical facility for the treatment of a non-serv21 ice-connected condition; and 

22 ‘‘(B) is covered under this title or is deter23 mined to be medically necessary by the Sec24 retary of Veterans Affairs. 

25 ‘‘(2) MEMORANDUM OF UNDERSTANDING.— 

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1 ‘‘(A) IN GENERAL.—Not later than 6 

2 months after the date of the enactment of this 

3 subsection, the Secretary of Health and Human 

4 Services shall enter a memorandum of under5 standing with the Secretary of Veterans Affairs 

6 concerning the administration of the Medicare 

7 VA reimbursement program. 

8 ‘‘(B) CONTRACT ELEMENTS.—The memo9 randum of understanding under subparagraph 

10 (A) shall contain the following: 

11 ‘‘(i) FREQUENCY OF REIMBURSE12 MENT.—An agreement on how often reim13 bursements will be made by the Secretary 

14 of Health and Human Services to the Sec15 retary of Veterans Affairs. 

16 ‘‘(ii) BILLING SYSTEM.—An agree17 ment on the details of the billing system 

18 that will be used by the Secretary of Vet19 erans Affairs to make claims for reim20 bursement from the Secretary of Health 

21 and Human Services. 

22 ‘‘(iii) DATA SHARING AGREEMENT.— 

23 An agreement on data sharing, including— 

24 ‘‘(I) identification of the data ex25 changes that each Secretary will need 

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1 to develop, maintain, or provide access 

2 to, for purposes of the Medicare VA 

3 reimbursement program; and 

4 ‘‘(II) verification of data dem5 onstrating that an item or service was 

6 provided by a Department of Veterans 

7 Affairs medical facility to a Medicare8 eligible veteran for a non-service-con9 nected condition before the Secretary 

10 of Health and Human Services pro11 vides for reimbursement for such item 

12 or service under the Medicare VA re13 imbursement program. 

14 ‘‘(iv) PAYMENT RATE.—Details of the 

15 payment rate to be used consistent with 

16 paragraph (3) for reimbursements made 

17 under the Medicare VA reimbursement 

18 program. 

19 ‘‘(v) PERFORMANCE MEASURES.—An 

20 agreement on performance measures and 

21 performance targets to be used to dem22 onstrate the impact of the Medicare VA re23 imbursement program. 

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1 ‘‘(vi) ADDITIONAL TERMS.—Any addi2 tional terms deemed necessary by the ad3 ministering Secretaries. 

4 ‘‘(C) NO MAINTENANCE OF EFFORT RE5 QUIREMENT.—For purposes of the Medicare 

6 VA reimbursement program, the Secretary of 

7 Veterans Affairs shall not be required to meet 

8 a requirement that the Secretary of Veterans 

9 Affairs maintain a certain level of spending in 

10 order to receive reimbursement from the Sec11 retary of Health and Human Services. 

12 ‘‘(3) PAYMENTS BASED ON REGULAR MEDICARE

13 PAYMENT RATES.— 

14 ‘‘(A) AMOUNT.—Subject to the succeeding 

15 provisions of this paragraph, the Secretary of 

16 Health and Human Services shall reimburse the 

17 Secretary of Veterans Affairs— 

18 ‘‘(i) for an item or service that is cov19 ered under this title and is provided to a 

20 Medicare-eligible veteran by a Department 

21 of Veterans Affairs medical facility for the 

22 treatment of a non-service-connected condi23 tion, at a rate that is not less than 100 

24 percent of the amounts that otherwise 

25 would be payable under this title, on a feemstockstill on DSK4VPTVN1PROD with BILLS

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1 for-service basis, for such item or service if 

2 the Department of Veterans Affairs med3 ical facility were a provider of services, 

4 were participating in the Medicare pro5 gram, and imposed charges for such item 

6 or service; and 

7 ‘‘(ii) for an item or service that is not 

8 covered under this title that is provided to 

9 a Medicare-eligible veteran by a Depart10 ment of Veterans Affairs medical facility 

11 for the treatment of a non-service-con12 nected condition, if the Secretary of Vet13 erans Affairs determines that such item or 

14 service is medically necessary, at a rate de15 termined by the Secretary of Health and 

16 Human Services in consultation with the 

17 Secretary of Veterans Affairs. 

18 ‘‘(B) NO ARBITRARY LIMITATION ON

19 AMOUNT.—Subject to the requirements of this 

20 subsection, the Secretary of Health and Human 

21 Services may not impose an annual cap or other 

22 limit on the amount of reimbursement made 

23 under the Medicare VA reimbursement pro24 gram. 

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1 ‘‘(C) EXCLUSION OF CERTAIN AMOUNTS.— 

2 In computing the amount of payment under 

3 subparagraph (A), the following amounts shall 

4 be excluded: 

5 ‘‘(i) DISPROPORTIONATE SHARE HOS6 PITAL ADJUSTMENT.—Any amount attrib7 utable to an adjustment under section 

8 1886(d)(5)(F). 

9 ‘‘(ii) DIRECT GRADUATE MEDICAL

10 EDUCATION PAYMENTS.—Any amount at11 tributable to a payment under section 

12 1886(h). 

13 ‘‘(iii) INDIRECT MEDICAL EDUCATION

14 ADJUSTMENT.—Any amount attributable 

15 to the adjustment under section 

16 1886(d)(5)(B). 

17 ‘‘(iv) CAPITAL PAYMENTS.—Any 

18 amounts attributable to payments for cap19 ital-related costs under section 1886(g). 

20 ‘‘(D) PERIODIC PAYMENTS FROM MEDI21 CARE TRUST FUNDS.—Reimbursements under 

22 this paragraph shall be made— 

23 ‘‘(i) on a periodic basis consistent 

24 with the periodicity of payments under this 

25 title; and 

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1 ‘‘(ii) from the Federal Hospital Insur2 ance Trust Fund established in section 

3 1817 and the Federal Supplementary Med4 ical Insurance Trust Fund established in 

5 section 1841. 

6 ‘‘(E) CREDITING OF PAYMENTS.—Any 

7 payment made to the Department of Veterans 

8 Affairs under this subsection shall be deposited 

9 in the Department of Veterans Affairs Medical 

10 Care Collections Fund established under section 

11 1729A of title 38, United States Code. 

12 ‘‘(4) COST-SHARING REQUIREMENTS.—The Sec13 retary of Health and Human Services shall reduce 

14 the amount of reimbursement to the Secretary of 

15 Veterans Affairs for items and services under the 

16 Medicare VA reimbursement program by amounts 

17 attributable to applicable deductible, coinsurance, 

18 and cost-sharing requirements under this title. 

19 ‘‘(5) WAIVER OF PROHIBITION ON PAYMENTS

20 TO FEDERAL PROVIDERS OF SERVICES.—The prohi21 bition of payments to Federal providers of services 

22 under sections 1814(c), 1835(d), and 1862(a)(3) 

23 shall not apply to items and services provided under 

24 this subsection. 

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1 ‘‘(6) RULES OF CONSTRUCTION.—Nothing in 

2 this subsection shall be construed— 

3 ‘‘(A) as prohibiting the Inspector General 

4 of the Department of Health and Human Serv5 ices from investigating any matters regarding 

6 the expenditure of funds under this subsection, 

7 including compliance with the provisions of this 

8 title and all other relevant laws; 

9 ‘‘(B) as adding or requiring additional cri10 teria for eligibility for health care benefits fur11 nished to veterans by the Secretary of Veterans 

12 Affairs, as established under chapter 17 of title 

13 38, United States Code; or 

14 ‘‘(C) subject to the requirements of title 

15 38, United States Code, as limiting a veteran’s 

16 ability to access such benefits, regardless of the 

17 veteran’s status as a Medicare-eligible veteran. 

18 ‘‘(7) ANNUAL REPORTS.—Not later than one 

19 year after the date of implementing the Medicare 

20 VA reimbursement program and annually thereafter, 

21 the administering Secretaries shall submit to the 

22 Congress a report containing the following: 

23 ‘‘(A) The number of Medicare-eligible vet24 erans who elect to receive health care at a De25 partment of Veterans Affairs medical facility. 

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1 ‘‘(B) The total amount of reimbursements 

2 made under the program from the Federal Hos3 pital Insurance Trust Fund established in sec4 tion 1817 and the Federal Supplementary Med5 ical Insurance Trust Fund established in sec6 tion 1841 to the Department of Veterans Af7 fairs Medical Care Collections Fund established 

8 under section 1729A of title 38, United States 

9 Code. 

10 ‘‘(C) The number and types of items and 

11 services provided to Medicare-eligible veterans 

12 by Department of Veterans Affairs medical fa13 cilities under the program. 

14 ‘‘(D) An accounting of the manner in 

15 which the Department of Veterans Affairs ex16 pended funds received through reimbursements 

17 under the program. 

18 ‘‘(E) A detailed description of any changes 

19 made to the memorandum of understanding 

20 under paragraph (2). 

21 ‘‘(F) A comparison of the performance 

22 data with the performance targets under para23 graph (2)(B)(v). 

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1 ‘‘(G) Any other data on the program that 

2 the administering Secretaries determine are ap3 propriate. 

4 ‘‘(8) DEFINITIONS.—For purposes of this sub5 section: 

6 ‘‘(A) ADMINISTERING SECRETARIES.—The 

7 term ‘administering Secretaries’ means the Sec8 retary of Health and Human Services and the 

9 Secretary of Veterans Affairs acting jointly. 

10 ‘‘(B) MEDICARE-ELIGIBLE VETERAN.—The 

11 term ‘Medicare-eligible veteran’ means an indi12 vidual who is a veteran (as defined in section 

13 101(2) of title 38, United States Code) who is 

14 eligible for care and services under section 

15 1705(a) of title 38, United States Code and 

16 who— 

17 ‘‘(i) is entitled to, or enrolled for, ben18 efits under part A; or 

19 ‘‘(ii) is enrolled for benefits under 

20 part B. 

21 ‘‘(C) NON-SERVICE CONNECTED CONDI22 TION.—The term ‘non-service-connected condi23 tion’ means a disease or condition that is non24 service-connected (as defined in section 101(17) 

25 of title 38, United States Code). 

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1 ‘‘(D) DEPARTMENT OF VETERANS AFFAIRS

2 MEDICAL FACILITY.—The term ‘Department of 

3 Veterans Affairs medical facility’ means a med4 ical facility (as defined in section 8101(3) of 

5 title 38, United States Code), alone or in con6 junction with other facilities under the jurisdic7 tion of the Secretary of Veterans Affairs.’’. 

8 (b) CONFORMING AMENDMENT.—Section 1729 of 

9 title 38, United States Code, is amended by adding at the 

10 end the following new subsection: 

11 ‘‘(j) In any case in which a Medicare-eligible veteran 

12 (as defined in section 1862(p)(8)(B) of the Social Security 

13 Act (42 U.S.C. 1395y(p)(8)(B))) is furnished care or serv14 ices under this chapter for a non-service-connected condi15 tion (as defined in section 1862(p)(8)(C) of such Act) the 

16 Secretary shall— 

17 ‘‘(1) seek reimbursement from the Secretary of 

18 Health and Human Services for such care and serv19 ices under section 1862(p) of such Act; and 

20 ‘‘(2) collect any applicable deductible, coinsur21 ance, or other cost-sharing amount required under 

22 title XVIII of the Social Security Act from the vet23 eran or from a third party to the extent that the vet24 eran (or the provider of the care or services) would 

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1 ices from such third party if the care or services had 

2 not been furnished by a department or agency of the 

3 United States.’’. 

4 SEC. 3. GAO REPORT. 

5 (a) IN GENERAL.—Not later than the last day of the 

6 three-year period beginning on the date of the enactment 

7 of this Act and the last date of each subsequent three8 year period, the Comptroller General of the United States 

9 shall submit to the Congress a report on the Medicare VA 

10 reimbursement program established under section 1862(p) 

11 of the Social Security Act, as added by section 2. 

12 (b) CONTENTS.—The report under subsection (a) 

13 shall contain an analysis of— 

14 (1) the impact of the Medicare VA reimburse15 ment program on the Federal Hospital Insurance 

16 Trust Fund established in section 1817 of the Social 

17 Security Act (42 U.S.C. 1395i) and the Federal 

18 Supplementary Medical Insurance Trust Fund es19 tablished in section 1841 of such Act (42 U.S.C. 

20 1395t); 

21 (2) whether Medicare-eligible veterans (as de22 fined in section 1862(p)(8)(B) of such Act) experi23 ence improved access to health care as a result of 

24 the program; 

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1 (3) whether Medicare-eligible veterans experi2 ence a change in the quality of care that they receive 

3 as a result of this program; 

4 (4) the impact of the program on local health 

5 care providers and Medicare beneficiaries in the 

6 communities surrounding Department of Veterans 

7 Affairs medical facilities; and 

8 (5) any additional issues deemed appropriate by 

9 the Comptroller General of the United States. 

10 SEC. 4. SENSE OF CONGRESS. 

11 It is the sense of the Congress that the amount of 

12 funds appropriated to the Department of Veterans Affairs 

13 for medical care in any fiscal year beginning on or after 

14 the date of the enactment of this Act should not be re15 duced as a result of the implementation of the Medicare 

16 VA reimbursement program under section 1862(p) of the 

17 Social Security Act, as added by section 2(a). 

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