Calendar No. 530

103D CONGRESS

2D SESSION S. 2309

A BILL

To amend title 38, United States Code, to provide

partment, and for other purposes.administration of health care benefits by the Deby the Department of Veterans Affairs and thefor reform of the health care benefits furnished

JULY 21 (legislative day, JULY 20), 1994

Placed on the calendar
II

Calendar No. 530

103D CONGRESS

2D SESSION S. 2309

To amend title 38, United States Code, to provide for reform of the health

care benefits furnished by the Department of Veterans Affairs and the

administration of health care benefits by the Department, and for other

purposes.

IN THE SENATE OF THE UNITED STATES

JULY 21 (legislative day, JULY 20), 1994

Mr. ROCKEFELLER, from the Committee on Veterans’ Affairs, reported the

following original bill; which was read twice and placed on the calendar

A BILL

To amend title 38, United States Code, to provide for reform

of the health care benefits furnished by the Department

of Veterans Affairs and the administration of health

care benefits by the Department, 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. SHORT TITLE.

4 This Act may be cited as the ‘‘Veterans Health Care

5 Reform Act of 1994’’.
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1 SEC. 2. BENEFITS AND ELIGIBILITY THROUGH DEPART2 MENT OF VETERANS AFFAIRS MEDICAL SYS3 TEM.

4 (a) DEPARTMENT OF VETERANS AFFAIRS AS A PAR5 TICIPANT IN HEALTH CARE REFORM.—

6 (1) IN GENERAL.—Title 38, United States

7 Code, is amended by inserting after chapter 17 the

8 following new chapter:

9 ‘‘CHAPTER 18—ELIGIBILITY AND BENEFITS

10 UNDER HEALTH SECURITY ACT

‘‘SUBCHAPTER I—GENERAL

‘‘1801. Definitions.

‘‘SUBCHAPTER II—ENROLLMENT

‘‘1811. Enrollment: veterans.

‘‘1812. Enrollment: CHAMPVA eligibles.

‘‘1813. Enrollment: family members.

‘‘SUBCHAPTER III—BENEFITS

‘‘1821. Benefits for VA enrollees.

‘‘1822. Chapter 17 benefits.

‘‘1823. Supplemental benefits packages and policies.

‘‘1824. Limitation regarding veterans enrolled with health plans outside Department.

‘‘SUBCHAPTER IV—FINANCIAL MATTERS

‘‘1831. Premiums, copayments, and other charges.

‘‘1832. Medicare coverage and reimbursement.

‘‘1833. Recovery of cost of certain care and services.

‘‘1834. Health Plan Fund.

11 ‘‘SUBCHAPTER I—GENERAL

12 ‘‘§ 1801. Definitions

13 ‘‘For purposes of this chapter:
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1 ‘‘(1) The term ‘health plan’ means an entity

2 that has been certified under the Health Security

3 Act as a health plan.

4 ‘‘(2) The term ‘VA health plan’ means a health

5 plan that is operated by the Secretary under section

6 7341 of this title.

7 ‘‘(3) The term ‘VA enrollee’ means an individ8 ual enrolled under the Health Security Act in a VA

9 health plan.

10 ‘‘(4) The term ‘comprehensive benefit package’

11 means the package of benefits required to be pro12 vided by a health plan under the Health Security

13 Act.

14 ‘‘SUBCHAPTER II—ENROLLMENT

15 ‘‘§ 1811. Enrollment: veterans

16 ‘‘Each veteran who is an eligible individual within the

17 meaning of section 1001 of the Health Security Act (in18 cluding a veteran who is a medicare-eligible individual as

19 defined in section 1902 of that Act) may enroll with a

20 VA health plan. A veteran who wants to receive the com21 prehensive benefit package through the Department shall

22 enroll with a VA health plan.

23 ‘‘§ 1812. Enrollment: CHAMPVA eligibles

24 ‘‘An individual who is eligible for benefits under sec25 tion 1713 of this title and who is eligible to enroll in a
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1 health plan pursuant to section 1001 of the Health Secu2 rity Act may enroll under that Act with a VA health plan

3 in the same manner as a veteran.

4 ‘‘§ 1813. Enrollment: family members

5 ‘‘(a) The Secretary may authorize a VA health plan

6 to enroll members of the family of an enrollee under sec7 tion 1811 or 1812 of this title, subject to payment of pre8 miums, deductibles, copayments, and coinsurance as re9 quired under the Health Security Act.

10 ‘‘(b) For purposes of subsection (a), an enrollee’s

11 family is those individuals (other than the enrollee) in12 cluded within the term ‘family’ as defined in section

13 1011(b) of the Health Security Act.

14 ‘‘SUBCHAPTER III—BENEFITS

15 ‘‘§ 1821. Benefits for VA enrollees

16 ‘‘The Secretary shall ensure that each VA health plan

17 provides to each individual enrolled with it the items and

18 services in the comprehensive benefit package under the

19 Health Security Act.

20 ‘‘§ 1822. Chapter 17 benefits

21 ‘‘The Secretary shall provide to a veteran the care

22 and services not included in the comprehensive benefits

23 package that are authorized to be provided under chapter

24 17 of this title in accordance with the terms and conditions
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1 applicable to that veteran and that care under such chap2 ter.

3 ‘‘§ 1823. Supplemental benefits packages and policies

4 ‘‘(a) As part of a VA health plan, the Secretary may

5 offer to veterans—

6 ‘‘(1) supplemental health benefits policies for

7 the care and services described in subsection (b);

8 and

9 ‘‘(2) cost-sharing policies consistent with the re10 quirements of part 2 of subtitle E of title I of the

11 Health Security Act.

12 ‘‘(b) The care and services referred to in subsection

13 (a) are care and services that—

14 ‘‘(1) are not available under the comprehensive

15 benefit package; and

16 ‘‘(2) can be provided by the Secretary at rea17 sonable cost.

18 ‘‘§ 1824. Limitation regarding veterans enrolled with

19 health plans outside Department

20 ‘‘A veteran who is residing in a regional alliance area

21 in which the Department operates a health plan and who

22 is enrolled in a health plan that is not operated by the

23 Department may be provided the items and services in the

24 comprehensive benefit package by a VA health plan only

25 if the plan is reimbursed for the care provided.
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1 ‘‘SUBCHAPTER IV—FINANCIAL MATTERS

2 ‘‘§ 1831. Premiums, copayments, and other charges

3 ‘‘(a)(1) Except as provided in paragraph (2), the Sec4 retary may not impose on or collect from a veteran de5 scribed in subsection (b) who is a VA enrollee a cost-share

6 charge of any kind (whether a premium, copayment, de7 ductible, coinsurance charge, or other charge) for items

8 and services in the comprehensive benefit package that a

9 VA health plan provides. The Secretary shall make such

10 arrangements as necessary with health alliances in order

11 to carry out this subsection.

12 ‘‘(2) The Secretary shall collect from a veteran re13 ferred to in paragraph (1) an appropriate cost-share

14 charge for any items and services that are available to the

15 veteran through the VA health plan but which the veteran

16 obtains from a health care provider other than a VA

17 health plan network provider.

18 ‘‘(b) The veterans referred to in subsection (a) are

19 the following:

20 ‘‘(1) Any veteran with a compensable service21 connected disability.

22 ‘‘(2) Any veteran whose discharge or release

23 from the active military, naval or air service was for

24 a disability incurred or aggravated in the line of

25 duty.
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1 ‘‘(3) Any veteran who is in receipt of, or who,

2 but for a suspension pursuant to section 1151 of

3 this title (or both such a suspension and the receipt

4 of retired pay), would be entitled to disability com5 pensation, but only to the extent that such a veter6 an’s continuing eligibility for such care is provided

7 for in the judgment or settlement provided for in

8 such section.

9 ‘‘(4) Any veteran who is a former prisoner of

10 war.

11 ‘‘(5) Any veteran of the Mexican border period

12 or World War I.

13 ‘‘(6) Any veteran who is unable to defray the

14 expenses of necessary care as determined under sec15 tion 1722(a) of this title.

16 ‘‘(7) Any veteran referred to in subparagraph

17 (A), (B), or (C) of section 1710(e) of this title.

18 ‘‘(c)(1) Except as provided in paragraph (2), in the

19 case of a VA enrollee who is not described in subsection

20 (b), the Secretary shall charge premiums and establish

21 copayments, deductibles, and coinsurance amounts for

22 care and services provided under this chapter. The pre23 mium rate, and the rates for deductibles and copayments,

24 for each VA health plan shall be established by that health
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1 plan based on rules established by the health alliance

2 under which it is operating.

3 ‘‘(2) The Secretary may not charge a veteran referred

4 to in paragraph (1) a premium for any care or service

5 that the Secretary provides the veteran under a supple6 mental benefits policy offered under section 1823 of this

7 title if the Secretary is required to provide such care or

8 service under chapter 17 of this title.

9 ‘‘(d) In the case of a veteran with a compensable serv10 ice-connected disability who is enrolled in a VA health plan

11 and who has net earnings from self-employment, the Sec12 retary shall, under regulations prescribed by the Sec13 retary, provide for a reduction in any premium payment

14 (or alliance credit repayment) owed by the veteran under

15 section 6126 or 6111 of the Health Security Act by virtue

16 of the veteran’s net earnings from self-employment.

17 ‘‘§ 1832. Medicare coverage and reimbursement

18 ‘‘(a) For purposes of any program administered by

19 the Secretary of Health and Human Services under title

20 XVIII of the Social Security Act (42 U.S.C. 1395 et seq.),

21 a Department facility shall be deemed to be a Medicare

22 provider.

23 ‘‘(b)(1) A VA health plan shall be considered to be

24 a Medicare HMO.
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1 ‘‘(2) For purposes of this section, the term ‘Medicare

2 HMO’ means an eligible organization under section 1876

3 of the Social Security Act.

4 ‘‘(c) In the case of care provided under this chapter

5 to a veteran (other than a veteran described in section

6 1831(b) of this title), or to a family member of a veteran,

7 who is eligible for benefits under the Medicare program

8 under title XVIII of the Social Security Act, the Secretary

9 of Health and Human Services shall reimburse a VA

10 health plan or Department health-care facility providing

11 services as a Medicare provider or Medicare HMO in the

12 same amounts and under the same terms and conditions

13 as that Secretary reimburses other Medicare providers or

14 Medicare HMOs, respectively. The Secretary of Health

15 and Human Services shall include with each such reim16 bursement a Medicare explanation of benefits.

17 ‘‘(d) When the Secretary provides care to a veteran,

18 or a family member of a veteran, for which the Secretary

19 receives reimbursement under this section, the Secretary

20 shall require the veteran to pay to the Department any

21 applicable deductible or copayment that is not covered by

22 Medicare.

23 ‘‘§ 1833. Recovery of cost of certain care and services

24 ‘‘(a) In the case of an individual provided care or

25 services through a VA health plan who has coverage under
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1 a supplemental health insurance policy pursuant to part

2 2 of subtitle E of title I of the Health Security Act, a

3 Medicare supplemental health insurance plan (as defined

4 in the Health Security Act), or any other provision of law,

5 the Secretary has the right to recover or collect charges

6 for care or services (as determined by the Secretary, but

7 not including care or services for a service-connected dis8 ability) from the party providing that coverage to the ex9 tent that the individual (or the provider of the care or

10 services) would be eligible to receive payment for such care

11 or services from such party if the care or services had not

12 been furnished by a department or agency of the United

13 States.

14 ‘‘(b) In the case of a veteran referred to in section

15 1831(b) of this title who is enrolled in a health plan other

16 than a VA health plan and who is provided care or services

17 for a service-connected disability by a VA health plan, the

18 Secretary has the right to recover or collect charges for

19 such care and services from the party operating the health

20 plan to the extent that the veteran (or the provider of the

21 care or services) would be eligible to receive payment for

22 such care or services from such party if the care or serv23 ices had not been furnished by a department or agency

24 of the United States.
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1 ‘‘(c) The provisions of subsections (b) through (f) of

2 section 1729 of this title shall apply with respect to claims

3 by the United States under subsection (a) or (b) in the

4 same manner as they apply to claims under subsection (a)

5 of that section.

6 ‘‘§ 1834. Health Plan Fund

7 ‘‘(a) There is hereby established in the Treasury a

8 revolving fund to be known as the ‘Department of Veter9 ans Affairs Health Plan Fund’.

10 ‘‘(b)(1) Subject to paragraphs (2) and (3), amounts

11 collected or recovered by the Department under this sub12 chapter by reason of the furnishing of care and services

13 to an individual by a VA health plan or the enrollment

14 of an individual with a VA health plan (including amounts

15 received as premiums, premium discount payments,

16 copayments or coinsurance, and deductibles, amounts re17 ceived as third-party reimbursements, and amounts re18 ceived as reimbursements from another health plan for

19 care furnished to one of its enrollees) shall be credited to

20 the revolving fund.

21 ‘‘(2) Premiums collected by the Department under

22 this subchapter during fiscal year 1996 or 1997 by reason

23 of the furnishing of care and services under a VA health

24 plan to a veteran referred to in section 1831(b) of this

25 title shall be credited to the revolving fund established
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1 under subsection (a) only if the amount of funds appro2 priated to the Veterans Health Care Investment Fund es3 tablished under subsection (a)(1) of section 7346 of this

4 title for the fiscal year concerned is less than the amount

5 specified to be credited to that fund for that fiscal year

6 under subsection (c) of such section 7346.

7 ‘‘(3) Premiums received by the Department under

8 this subchapter in any fiscal year after fiscal year 1997

9 by reason of the furnishing of care and services under a

10 VA health plan to a veteran referred to in paragraph (2)

11 shall be credited to the revolving fund established under

12 subsection (a) only if the cost of providing such care and

13 services is not covered by appropriations. The amount so

14 credited shall be the amount of such premiums received

15 that is necessary to cover the difference between the cost

16 of such care and services and such appropriations.

17 ‘‘(c) The Secretary shall establish in the revolving

18 fund a separate account for each VA health plan. The Sec19 retary shall credit any amount received under subsection

20 (b) by reason of the furnishing of care and services in or

21 through a VA health plan or the enrollment of an individ22 ual with a VA health plan.

23 ‘‘(d) Amounts credited to the account of the revolving

24 fund for a VA health plan under subsection (b) are hereby

25 made available to the VA health plan for the expenses of
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1 the delivery by the VA health plan of the items and serv2 ices in the comprehensive benefit package and any supple3 mental benefits package or policy offered by the VA health

4 plan.’’.

5 (2) The table of chapters at the beginning of

6 title 38, United States Code, and at the beginning

7 of part II of such title, is amended by inserting after

8 the item relating to chapter 17 the following new

9 item:

‘‘18. Benefits and Eligibility Under Health Security Act ........................ 1801.’’.

10 (b) PRESERVATION OF EXISTING BENEFITS FOR FA11 CILITIES NOT OPERATING AS HEALTH PLANS.—(1)

12 Chapter 17 of title 38, United States Code, is amended

13 by inserting after section 1704 the following new section:

14 ‘‘§ 1705. Facilities not operating within health plans;

15 veterans not eligible to enroll in health

16 plans

17 ‘‘The provisions of this chapter shall apply with re18 spect to the furnishing of care and services—

19 ‘‘(1) by any facility of the Department when it

20 is not operating as or within a health plan certified

21 as a health plan under the Health Security Act; and

22 ‘‘(2) by any facility of the Department (whether

23 or not operating as or within a health plan certified

24 as a health plan under the Health Security Act) in

25 the case of a veteran who is not an eligible individ-
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1 ual with the meaning of section 1001 of the Health

2 Security Act.’’.

3 (2) The table of sections at the beginning of such

4 chapter is amended by inserting after the item relating

5 to section 1704 the following new item:

‘‘1705. Facilities not operating within health plans; veterans not eligible to enroll in health plans.’’.

6 SEC. 3. ORGANIZATION OF DEPARTMENT OF VETERANS AF7 FAIRS FACILITIES AS HEALTH PLANS.

8 (a) IN GENERAL.—Chapter 73 of title 38, United

9 States Code, is amended—

10 (1) by redesignating subchapter IV as sub11 chapter V; and

12 (2) by inserting after subchapter III the follow13 ing new subchapter IV:

14 ‘‘SUBCHAPTER IV—PARTICIPATION AS PART OF

15 NATIONAL HEALTH CARE REFORM

16 ‘‘§ 7341. Organization of health care facilities as

17 health plans

18 ‘‘(a)(1) The Secretary shall organize health plans and

19 operate Department facilities as or within health plans

20 under the Health Security Act.

21 ‘‘(2)(A) The Secretary shall prescribe regulations es22 tablishing standards for the operation of Department

23 health care facilities as or within health plans under that

24 Act. In prescribing such standards, the Secretary shall en-
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1 sure that they conform, to the maximum extent prac2 ticable, to the requirements for health plans generally set

3 forth in part 1 of subtitle E of title I of the Health Secu4 rity Act.

5 ‘‘(B) Not later than 30 days after prescribing such

6 standards, the Secretary shall submit to the Committees

7 on Veterans’ Affairs of the Senate and the House of Rep8 resentatives a report describing the differences, if any, be9 tween such standards and the requirements for health

10 plans generally referred to in subparagraph (A).

11 ‘‘(b) Health care facilities of the Department located

12 within an area or region may be organized to operate as

13 a single health plan encompassing all Department facili14 ties within that area or region or may be organized to op15 erate as several health plans.

16 ‘‘(c) In carrying out responsibilities under the Health

17 Security Act, a State (or a State-established entity)—

18 ‘‘(1) may not impose any standard or require19 ment on a VA health plan that is inconsistent with

20 this chapter or any regulation prescribed under this

21 chapter or other Federal laws regarding the oper22 ation of this chapter; and

23 ‘‘(2) may not deny certification of a VA health

24 plan under the Health Security Act on the basis of

25 a conflict between a rule of a State or health alliance
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1 and this chapter or regulations prescribed under this

2 chapter or other Federal laws regarding the oper3 ation of this chapter.

4 ‘‘§ 7342. Contract authority for facilities operating as

5 or within health plans

6 ‘‘(a) The Secretary shall designate a health plan di7 rector for each VA health plan organized and operated

8 under this subchapter.

9 ‘‘(b) The health plan director of a VA health plan

10 may enter into contracts and agreements for the provision

11 of care and services to be provided under the VA health

12 plan and contracts and agreements for other services (in13 cluding procurement of equipment, maintenance and re14 pair services, and other services related to the provision

15 of health care services) that are necessary for the provision

16 of care and services under the VA health plan.

17 ‘‘(c) Contracts and agreements (including leases)

18 under subsection (a) shall not be subject to the following

19 provisions of law:

20 ‘‘(1) Section 8110(c) of this title, relating to

21 the contracting of services at Department health22 care facilities.

23 ‘‘(2) Section 8122(a)(1) of this title, relating to

24 the lease of Department property.
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1 ‘‘(3) Section 8125 of this title, relating to local

2 contracts for the procurement of health-care items.

3 ‘‘(4) Section 702 of title 5, relating to the right

4 of review of agency wrongs by courts of the United

5 States.

6 ‘‘(5) Sections 1346(a)(2) and 1491 of title 28,

7 relating to the jurisdiction of the district courts of

8 the United States and the United States Court of

9 Federal Claims, respectively, for the actions enumer10 ated in such sections.

11 ‘‘(6) Subchapter V of chapter 35 of title 31, re12 lating to adjudication of protests of violations of pro13 curement statutes and regulations.

14 ‘‘(7) Sections 3526 and 3702 of such title, re15 lating to the settlement of accounts and claims, re16 spectively, of the United States.

17 ‘‘(8) Subsections (b)(7), (e), (f), (g), and (h) of

18 section 8 of the Small Business Act (15 U.S.C.

19 637(b)(7), (e), (f), (g), and (h)), relating to require20 ments with respect to small businesses for contracts

21 for property and services.

22 ‘‘(9) The provisions of law assembled for pur23 poses of codification of the United States Code as

24 section 471 through 544 of title 40 that relate to the

25 authority of the Administrator of General Services
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1 over the lease and disposal of Federal Government

2 property.

3 ‘‘(10) The provisions of the Office of Federal

4 Procurement Policy Act (41 U.S.C. 401 et seq.), re5 lating to the procurement of property and services

6 by the Federal Government.

7 ‘‘(11) Chapter 3 of the Federal Property and

8 Administrative Services Act of 1949 (41 U.S.C. 251

9 et seq.), relating to the procurement of property and

10 services by the Federal Government.

11 ‘‘(12) Office of Management and Budget Cir12 cular A–76.

13 ‘‘(d)(1) Contracts and agreements for the provision

14 of care and services under subsection (a) may include any

15 contract or other agreement that the health plan director

16 of a VA health plan determines appropriate in order to

17 provide care and services under the VA health plan.

18 ‘‘(2) Contracts and agreements under this subsection

19 may be entered into without prior review by the Central

20 Office of the Department.

21 ‘‘(e)(1) The entry into a contract or agreement under

22 this section for services other than the services referred

23 to in subsection (c) (including contracts and agreements

24 for procurement of equipment, maintenance and repair

25 services, and other services related to the provision of
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1 health care services) shall not be subject to prior review

2 by the Central Office if the amount of the contract or

3 agreement is less than $250,000.

4 ‘‘(2)(A) The Central Office may conduct a prior re5 view of a contract or agreement referred to in paragraph

6 (1) if the amount of the contract or agreement is

7 $250,000 or greater.

8 ‘‘(B) If the Central Office fails to approve or reject

9 a contract or agreement referred to under subparagraph

10 (A) within 30 days of its submittal to the Central Office,

11 such contract or agreement shall be deemed approved by

12 the Central Office.

13 ‘‘§ 7343. Resource sharing authority

14 ‘‘(a) The Secretary may enter into agreements under

15 section 8153 of this title with other health care plans, with

16 health care providers, and with other health industry orga17 nizations, and with individuals, for the sharing of re18 sources of the Department under a VA health plan.

19 ‘‘(b) The Secretary may enter into agreements with

20 other departments and agencies of the Federal Govern21 ment for the sharing of resources of the Department and

22 such departments and agencies in order to provide care

23 and services under a VA health plan.
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1 ‘‘§ 7344. Administrative and personnel flexibility

2 ‘‘(a) Notwithstanding any other provision of law, the

3 Secretary may—

4 ‘‘(1) appoint health care personnel to positions

5 in any facility of the Department operating as or

6 within a VA health plan in accordance with such

7 qualifications for such positions as the Secretary

8 may establish; and

9 ‘‘(2) promote and advance personnel serving in

10 such positions in accordance with such qualifications

11 as the Secretary may establish.

12 ‘‘(b) Subject to the provisions of section 1404 of the

13 Health Security Act, the Secretary may carry out appro14 priate promotional, advertising, and marketing activities

15 to inform individuals of the availability of VA health plans.

16 ‘‘§ 7345. Expenditure authority

17 ‘‘(a)(1) Except as provided in subsection (b) and not18 withstanding any other provision of law, the director of

19 a VA health plan may expend funds available to a VA

20 health plan (including funds available under section

21 1834(c) of this title, funds available under section

22 7346(d)(2)(B) of this title, and funds otherwise made

23 available to the VA health plan by the Secretary) for any

24 purpose, and in any amount, that the director determines

25 appropriate in order to ensure that the VA health plan

26 meets the requirements and the requirements of furnish-
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1 ing care and services to veterans under chapter 17 of this

2 title.

3 ‘‘(2) Funds may be expended under this subsection

4 in order to cover the following costs:

5 ‘‘(A) The costs of marketing and advertising

6 under a VA health plan.

7 ‘‘(B) The costs of legal services provided to a

8 VA health plan by the General Counsel of the De9 partment.

10 ‘‘(C) The costs of acquisition (including acquisi11 tion of land), construction, repair, or renovation of

12 facilities.

13 ‘‘(3) The exercise by a health plan director of the au14 thority provided in paragraph (1) shall not be subject to

15 prior review by the Central Office of the Department.

16 ‘‘(b) Subsection (a) shall not apply to expenditures

17 of funds provided to a facility by the Central Office of

18 the Department exclusively for the purpose of the provi19 sion of the following services:

20 ‘‘(1) Services relating to post-traumatic stress

21 disorder.

22 ‘‘(2) Services relating to spinal-cord injuries.

23 ‘‘(3) Services relating to substance abuse.

24 ‘‘(4) Services relating to the rehabilitation of

25 blind veterans.
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1 ‘‘§ 7346. Veterans Health Care Investment Fund

2 ‘‘(a)(1) There is hereby established in the Treasury

3 of the United States a fund to be known as the Veterans

4 Health Care Investment Fund (in this section referred to

5 as the ‘Fund’).

6 ‘‘(2) The Fund shall be added to the list of accounts

7 that are considered mandatory for the purposes of scoring

8 appropriations bills.

9 ‘‘(b) There is hereby authorized to be appropriated

10 to the Department, in addition to amounts otherwise au11 thorized to be appropriated to the Department for VA

12 health plans, such amounts as are necessary for the Sec13 retary of the Treasury to fulfill the requirement of sub14 section (c).

15 ‘‘(c) For each of fiscal years 1995, 1996, and 1997,

16 the Secretary of the Treasury shall, subject to the avail17 ability of appropriated funds, credit to the Fund an

18 amount in that fiscal year as follows:

19 ‘‘(1) For fiscal year 1995, $1,225,000,000.

20 ‘‘(2) For fiscal year 1996, $600,000,000.

21 ‘‘(3) For fiscal year 1997, $1,700,000,000.

22 ‘‘(d)(1) Subject to paragraph (2), amounts in the

23 Fund shall be available to the Secretary only for the VA

24 health plans organized and operated under this sub25 chapter.
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1 ‘‘(2)(A) For each of fiscal years 1996 and 1997, the

2 Secretary shall estimate the total amount to be collected

3 or recovered under sections 1831, 1832, and 1833 of this

4 title by reason of the provision of care and services

5 through VA health plans under chapter 18 of this title

6 or the enrollment of individuals in such plans under that

7 chapter. The Secretary shall estimate the amount to be

8 so collected or recovered with respect to each VA health

9 plan and with respect to all VA health plans.

10 ‘‘(B) For each such fiscal year, the Secretary shall

11 make available to each VA health plan an amount that

12 bears the same relationship to the total amount available

13 in the Fund for the fiscal year as the amount estimated

14 to be collected or recovered by the VA health plan during

15 the fiscal year bears to the total amount estimated to be

16 collected or recovered by all VA health plans during that

17 fiscal year.

18 ‘‘(e) Not later than March 1, 1997, the Secretary

19 shall submit to Congress a report concerning the operation

20 of the Department of Veterans Affairs health care system

21 in preparing for, and operating under, national health care

22 reform under the Health Security Act during fiscal years

23 1995 and 1996. The report shall include a discussion of—

24 ‘‘(1) the adequacy of amounts in the Fund for

25 the operation of VA health plans;
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1 ‘‘(2) the quality of care provided by such plans;

2 ‘‘(3) the ability of such plans to attract pa3 tients; and

4 ‘‘(4) the need (if any) for additional funds for

5 the Fund in fiscal years after fiscal year 1997.

6 ‘‘§ 7347. Funding provisions: grants and other sources

7 of assistance

8 ‘‘The Secretary may apply for and accept, if awarded,

9 any grant or other source of funding that is intended to

10 meet the needs of special populations and that but for this

11 section is unavailable to facilities of the Department or

12 to health plans operated by the Government if funds ob13 tained through the grant or other source of funding will

14 be used through a facility of the Department operating

15 as or within a health plan.’’.

16 (b) CLERICAL AMENDMENT.—The table of sections

17 at the beginning of chapter 73 is amended by striking out

18 the item relating to the heading for subchapter IV and

19 inserting in lieu thereof the following:

‘‘SUBCHAPTER IV—PARTICIPATION AS PART OF NATIONAL HEALTH CARE

REFORM

‘‘7341. Organization of health care facilities as health plans.

‘‘7342. Contract authority for facilities operating as or within health plans.

‘‘7343. Resource sharing authority.

‘‘7344. Administrative and personnel flexibility.

‘‘7345. Expenditure authority.

‘‘7346. Veterans Health Care Investment Fund.

‘‘7347. Funding provisions: grants and other sources of assistance.

‘‘SUBCHAPTER V—RESEARCH CORPORATIONS’’.

S 2309 PCS——2
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•S 2309 PCS

S 2309 PCS——3