I 

109TH CONGRESS 

2D SESSION H. R. 4992 

To provide for Medicare reimbursement for health care services provided 

to Medicare-eligible veterans in facilities of the Department of Veterans 

Affairs. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 16, 2006 

Mrs. KELLY (for herself and Mr. BASS) 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 for Medicare reimbursement for health care services provided to Medicare-eligible veterans in facilities 

of the Department of Veterans Affairs. 

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 Medicare As5 sistance Act of 2006’’. 


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1 SEC. 2. ESTABLISHMENT OF MEDICARE SUBVENTION FOR 

2 VETERANS. 

3 Section 1862 of the Social Security Act (42 U.S.C. 

4 1395y) is amended by adding at the end the following new 

5 subsection: 

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

7 ‘‘(1) ESTABLISHMENT OF PROCEDURE FOR RE8 IMBURSEMENT.— 

9 ‘‘(A) IN GENERAL.—The administering 

10 Secretaries shall establish a procedure under 

11 which the Secretary shall reimburse the Sec12 retary of Veterans Affairs, from the trust 

13 funds, for medicare health care services fur14 nished to medicare-eligible veterans. 

15 ‘‘(B) REQUIREMENTS.—Under the proce16 dure established under subparagraph (A)— 

17 ‘‘(i) the administering Secretaries 

18 shall certify that any Department of Vet19 erans Affairs medical facility that fur20 nishes medicare health care services for 

21 which the Secretary of Veterans Affairs is 

22 reimbursed under this subsection has suffi23 cient— 

24 ‘‘(I) resources and expertise to 

25 provide the health care benefits re26 quired to be provided to individuals 


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1 entitled to benefits under part A or 

2 enrolled under part B; and 

3 ‘‘(II) information and billing sys4 tems in place to ensure accurate and 

5 timely submission of claims for health 

6 care benefits to the Secretary; 

7 ‘‘(ii) the Secretary shall have access to 

8 all data of the Department of Veterans Af9 fairs that the Secretary determines is nec10 essary to verify accuracy in billing and 

11 claims information; and 

12 ‘‘(iii) the Secretary shall waive re13 quirements for conditions of participation 

14 otherwise applicable to a provider of serv15 ices or a supplier under this title in the 

16 case of a Department of Veterans Affairs 

17 medical facility consistent with paragraph 

18 (3). 

19 ‘‘(C) RESTRICTION ON NEW OR EXPANDED

20 FACILITIES.—No new Veterans Affairs medical 

21 facilities may be built or expanded with funds 

22 received under this subsection. 

23 ‘‘(2) COST-SHARING.—The amount of reim24 bursement to the Secretary of Veterans Affairs for 

25 medicare health care services shall be reduced by 


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1 amounts attributable to applicable deductible, coin2 surance, and cost-sharing requirements under this 

3 title. 

4 ‘‘(3) MEDICARE REQUIREMENTS.— 

5 ‘‘(A) WAIVER.—The Secretary shall waive 

6 any requirements referred to in paragraph 

7 (1)(B)(iii) (relating to requirements for condi8 tions of participation) in the case of a Depart9 ment of Veterans Affairs medical facility, or ap10 prove equivalent or alternative ways of meeting 

11 such a requirement, but only if such waiver or 

12 approval— 

13 ‘‘(i) reflects the unique status of the 

14 Department of Veterans Affairs as an 

15 agency of the Federal Government; and 

16 ‘‘(ii) is necessary to provide (or to im17 prove the efficiency of providing) for reim18 bursement for medicare health care serv19 ices under this subsection. 

20 ‘‘(B) WAIVER OF PROHIBITION ON PAY21 MENTS TO FEDERAL PROVIDERS OF SERV22 ICES.—The prohibition of payments to Federal 

23 providers of services under sections 1814(c) and 

24 1835(d), and paragraphs (2) and (3) of sub25 section (a), shall not apply. 


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1 ‘‘(4) VERIFICATION OF ELIGIBILITY.— 

2 ‘‘(A) IN GENERAL.—The Secretary of Vet3 erans Affairs shall establish procedures for de4 termining whether an individual is a medicare5 eligible veteran. 

6 ‘‘(B) RESTRICTION.—No reimbursement 

7 shall be made under this subsection for any 

8 medicare health care service provided to an in9 dividual unless the individual has been deter10 mined to be a medicare-eligible veteran pursu11 ant to the procedures established under sub12 paragraph (A). 

13 ‘‘(5) DATA REQUIREMENTS.—Reimbursements 

14 for medicare health care services furnished to medi15 care-eligible veterans may not be made until such 

16 time as the administering Secretaries certify to Con17 gress that the— 

18 ‘‘(A) cost accounting and related trans19 action systems of the Veterans Health Adminis20 tration provide cost information and encounter 

21 data regarding health care delivered at each 

22 Department of Veterans Affairs medical facility 

23 on an inpatient and outpatient basis; and 


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1 ‘‘(B) cost information and encounter data 

2 provided by such systems is accurate, reliable, 

3 and consistent across all facilities. 

4 ‘‘(6) PAYMENTS BASED ON REGULAR MEDICARE

5 PAYMENT RATES.— 

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

7 provisions of this paragraph, the Secretary shall 

8 reimburse the Secretary of Veterans Affairs for 

9 health care benefits provided to medicare-eligi10 ble veterans at a rate equal to 100 percent of 

11 the amounts that otherwise would be payable 

12 under this title on a noncapitated basis for such 

13 service if the Department of Veterans Affairs 

14 medical facility were a provider of services, were 

15 participating in the medicare program, and im16 posed charges for such service. 

17 ‘‘(B) EXCLUSION OF CERTAIN AMOUNTS.— 

18 In computing the amount of payment under 

19 subparagraph (A), the following amounts shall 

20 be excluded: 

21 ‘‘(i) DISPROPORTIONATE SHARE HOS22 PITAL ADJUSTMENT.—Any amount attrib23 utable to an adjustment under section 

24 1886(d)(5)(F). 


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1 ‘‘(ii) DIRECT GRADUATE MEDICAL

2 EDUCATION PAYMENTS.—Any amount at3 tributable to a payment under section 

4 1886(h). 

5 ‘‘(iii) INDIRECT MEDICAL EDUCATION

6 ADJUSTMENT.—Any amount attributable 

7 to the adjustment under section 

8 1886(d)(5)(B). 

9 ‘‘(iv) PERCENTAGE OF CAPITAL PAY10 MENTS.—67 percent of any amounts at11 tributable to payments for capital-related 

12 costs under medicare payment policies 

13 under section 1886(g). 

14 ‘‘(C) PERIODIC PAYMENTS FROM MEDI15 CARE TRUST FUNDS.—Payments under this 

16 paragraph shall be made— 

17 ‘‘(i) on a periodic basis consistent 

18 with the periodicity of payments under this 

19 title; and 

20 ‘‘(ii) in appropriate part, as deter21 mined by the Secretary, from the trust 

22 funds. 

23 ‘‘(7) CREDITING OF PAYMENTS.—Any payment 

24 shall be deposited in the Department of Veterans AfVerDate Aug 31 2005 04:15 Mar 18, 2006 Jkt 049200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4992.IH H4992

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1 fairs Medical Care Collections Fund established 

2 under section 1729A of title 38, United States Code. 

3 ‘‘(8) RULES OF CONSTRUCTION.—Nothing in 

4 this subsection shall be construed— 

5 ‘‘(A) as prohibiting the Inspector General 

6 of the Department of Health and Human Serv7 ices from investigating any matters regarding 

8 the expenditure of funds under this subsection, 

9 including compliance with the provisions of this 

10 title and all other relevant laws; or 

11 ‘‘(B) as adding or requiring additional cri12 teria for eligibility for health care benefits fur13 nished to veterans by the Secretary of Veterans 

14 Affairs, as established under chapter 17 of title 

15 38, United States Code. 

16 ‘‘(9) EVALUATION AND REPORTS.—The admin17 istering Secretaries shall conduct ongoing evalua18 tions of the procedure established under this sub19 section, and shall submit periodic reports to Con20 gress on— 

21 ‘‘(A) any savings or costs to the medicare 

22 program by reason of this subsection; and 

23 ‘‘(B) effects of this subsection on access to 

24 care by medicare-eligible veterans. 

25 ‘‘(10) DEFINITIONS.—In this subsection:— 


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1 ‘‘(A) ADMINISTERING SECRETARIES.—The 

2 term ‘administering Secretaries’ means the Sec3 retary and the Secretary of Veterans Affairs 

4 acting jointly. 

5 ‘‘(B) MEDICARE HEALTH CARE SERV6 ICES.—The term ‘medicare health care services’ 

7 means items or services covered under part A 

8 or B of this title. 

9 ‘‘(C) MEDICARE-ELIGIBLE VETERAN.—The 

10 term ‘medicare-eligible veteran’ means an indi11 vidual who— 

12 ‘‘(i) is a veteran (as defined in section 

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

14 who is eligible for care and services under 

15 section 1705(a) of title 38, United States 

16 Code; 

17 ‘‘(ii) has attained age 65; 

18 ‘‘(iii) is entitled to, or enrolled for, 

19 benefits under part A of this title; and 

20 ‘‘(iv) is enrolled for benefits under 

21 part B of this title. 

22 ‘‘(D) TRUST FUNDS.—The term ‘trust 

23 funds’ means the Federal Hospital Insurance 

24 Trust Fund established in section 1817 and the 


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1 Federal Supplementary Medical Insurance 

2 Trust Fund established in section 1841. 

3 ‘‘(E) DEPARTMENT OF VETERANS AFFAIRS

4 MEDICAL FACILITY.—The term ‘Department of 

5 Veterans Affairs medical facility’ means a med6 ical facility as defined in section 8101(3) of title 

7 38, United States Code alone or in conjunction 

8 with other facilities under the jurisdiction of the 

9 Secretary of Veterans Affairs.’’. 

Æ 


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