II

104TH CONGRESS

1ST SESSION S. 69

To amend section 1086 of title 10, United States Code, to provide for

payment under CHAMPUS of certain health care expenses incurred

by certain members and former members of the uniformed services and

their dependents to the extent that such expenses are not payable under

medicare, and for other purposes.

IN THE SENATE OF THE UNITED STATES

JANUARY 4, 1995

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

to the Committee on Armed Services

A BILL

To amend section 1086 of title 10, United States Code,

to provide for payment under CHAMPUS of certain

health care expenses incurred by certain members and

former members of the uniformed services and their dependents to the extent that such expenses are not payable under medicare, 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,
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1 SECTION 1. EXPANSION OF MEDICARE EXCEPTION TO THE

2 PROHIBITION OF CHAMPUS COVERAGE FOR

3 CARE COVERED BY ANOTHER HEALTH CARE

4 PLAN.

5 (a) AMENDMENT AND REORGANIZATION OF EXCEP6 TIONS.—Subsection (d) of section 1086 of title 10, United

7 States Code, is amended to read as follows:

8 ‘‘(d)(1) Section 1079(j) of this title shall apply to a

9 plan contracted for under this section except as follows:

10 ‘‘(A) Subject to paragraph (2), a benefit may

11 be paid under such plan in the case of a person re12 ferred to in subsection (c) for items and services for

13 which payment is made under title XVIII of the So14 cial Security Act.

15 ‘‘(B) No person eligible for health benefits

16 under this section may be denied benefits under this

17 section with respect to care or treatment for any

18 service-connected disability which is compensable

19 under chapter 11 of title 38 solely on the basis that

20 such person is entitled to care or treatment for such

21 disability in facilities of the Department of Veterans

22 Affairs.

23 ‘‘(2) If a person described in paragraph (1)(A) re24 ceives medical or dental care for which payment may be

25 made under both title XVIII of the Social Security Act

26 (42 U.S.C. 1395 et seq.) and a plan contracted for under
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1 subsection (a), the amount payable for that care under

2 the plan may not exceed the difference between—

3 ‘‘(A) the sum of any deductibles, coinsurance,

4 and balance billing charges that would be imposed

5 on the person if payment for that care were made

6 solely under that title; and

7 ‘‘(B) the sum of any deductibles, coinsurance,

8 and balance billing charges that would be imposed

9 on the person if payment for that care were made

10 solely under the plan.

11 ‘‘(3) A plan contracted for under this section shall

12 not be considered a group health plan for the purposes

13 of paragraph (2) or (3) of section 1862(b) of the Social

14 Security Act (42 U.S.C. 1395y(b)).

15 ‘‘(4) A person who, by reason of the application of

16 paragraph (1), receives a benefit for items or services

17 under a plan contracted for under this section shall pro18 vide the Secretary of Defense with any information relat19 ing to amounts charged and paid for the items and serv20 ices that, after consulting with the other administering

21 Secretaries, the Secretary requires. A certification of such

22 person regarding such amounts may be accepted for the

23 purposes of determining the benefit payable under this

24 section.’’.
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•S 69 IS

1 (b) REPEAL OF SUPERSEDED PROVISION.—Such sec2 tion is amended—

3 (1) by striking out subsection (g); and

4 (2) by redesignating subsection (h) as sub5 section (g).

6 SEC. 2. CONFORMING AMENDMENT.

7 Section 1713(d) of title 38, United States Code, is

8 amended by striking out ‘‘section 1086(d)(1) of title 10

9 or’’.

10 SEC. 3. EFFECTIVE DATE.

11 The amendments made by this Act shall take effect

12 with respect to health care items or services provided on

13 and after the date of enactment of this Act.

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