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105TH CONGRESS

2D SESSION S. 2009

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

to carry out joint reviews relating to interdepartmental cooperation in

the delivery of medical care by the departments.

IN THE SENATE OF THE UNITED STATES

APRIL 30, 1998

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

to the Committee on Armed Services

A BILL

To require the Secretary of Defense and the Secretary of

Veterans Affairs to carry out joint reviews relating to

interdepartmental cooperation in the delivery of medical

care by the departments.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. FINDINGS.

4 Congress makes the following findings:

5 (1) The military health care system of the De6 partment of Defense and the Veterans Health Ad7 ministration of the Department of Veterans Affairs

8 are national institutions that collectively manage
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1 more than 1,500 hospitals, clinics, and health care

2 facilities worldwide to provide services to more than

3 11,000,000 beneficiaries.

4 (2) In the post-Cold War era, these institutions

5 are in a profound transition that involves challeng6 ing opportunities.

7 (3) During the period from 1988 to 1998, the

8 number of military medical personnel has declined

9 by 15 percent and the number of military hospitals

10 has been reduced by one-third.

11 (4) During the two years since 1996, the De12 partment of Veterans Affairs has revitalized its

13 structure by decentralizing authority into 22 Veter14 ans Integrated Service Networks.

15 (5) In the face of increasing costs of medical

16 care, increased demands for health care services, and

17 increasing budgetary constraints, the Department of

18 Defense and the Department of Veterans Affairs

19 have embarked on a variety of dynamic and innova20 tive cooperative programs ranging from shared serv21 ices to joint venture operations of medical facilities.

22 (6) In 1984, there was a combined total of 102

23 Department of Veterans Affairs and Department of

24 Defense facilities with sharing agreements. By 1997,

25 that number had grown to 420. During the six years
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1 from fiscal year 1992 through fiscal year 1997,

2 shared services increased from slightly over 3,000

3 services to more than 6,000 services ranging from

4 major medical and surgical services, laundry, blood,

5 and laboratory services to unusual speciality care

6 services.

7 (7) The Department of Defense and the De8 partment of Veterans Affairs are conducting four

9 health care joint ventures in New Mexico, Nevada,

10 Texas, Oklahoma, and are planning to conduct four

11 more such ventures in Alaska, Florida, Hawaii, and

12 California.

13 SEC. 2. SENSE OF CONGRESS.

14 It is the sense of Congress that—

15 (1) the Department of Defense and the Depart16 ment of Veterans Affairs are to be commended for

17 the cooperation between the two departments in the

18 delivery of medical care, of which the cooperation in19 volved in the establishment and operation of the De20 partment of Defense and the Department of Veter21 ans Affairs Executive Council is a praiseworthy ex22 ample;

23 (2) the two departments are encouraged to con24 tinue to explore new opportunities to enhance the

25 availability and delivery of medical care to bene-
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1 ficiaries by further enhancing the cooperative efforts

2 of the departments; and

3 (3) enhanced cooperation is encouraged for—

4 (A) the general areas of access to quality

5 medical care, identification and elimination of

6 impediments to enhanced cooperation, and joint

7 research and program development; and

8 (B) the specific areas in which there is sig9 nificant potential to achieve progress in co10 operation in a short term, including comput11 erization of patient records systems, participa12 tion of the Department of Veterans Affairs in

13 the TRICARE program, pharmaceutical pro14 grams, and joint physical examinations.

15 SEC. 3. JOINT SURVEY ON POPULATIONS SERVED.

16 (a) SURVEY REQUIRED.—The Secretary of Defense

17 and the Secretary of Veterans Affairs shall jointly conduct

18 a survey of their respective medical care beneficiary popu19 lations to identify, by category of beneficiary (defined as

20 the Secretaries consider appropriate), the expectations of,

21 requirements for, and behavior patterns of the bene22 ficiaries with respect to medical care. The two Secretaries

23 shall develop the protocol for the survey jointly, but shall

24 obtain the services of an entity independent of the Depart-
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1 ment of Defense and the Department of Veterans Affairs

2 for carrying out the survey.

3 (b) MATTERS TO BE SURVEYED.—The survey shall

4 include the following:

5 (1) Demographic characteristics, economic char6 acteristics, and geographic location of beneficiary

7 populations with regard to catchment or service

8 areas.

9 (2) The types and frequency of care required by

10 veterans, retirees, and dependents within catchment

11 or service areas of Department of Defense and Vet12 erans Affairs medical facilities and outside those

13 areas.

14 (3) The numbers of, characteristics of, and

15 types of medical care needed by the veterans, retir16 ees, and dependents who, though eligible for medical

17 care in Department of Defense or Department of

18 Veterans Affairs treatment facilities or other feder19 ally funded medical programs, choose not to seek

20 medical care from those facilities or under those pro21 grams, and the reasons for that choice.

22 (4) The obstacles or disincentives for seeking

23 medical care from such facilities or under such pro24 grams that veterans, retirees, and dependents per25 ceive.
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1 (5) Any other matters that the Secretary of De2 fense and the Secretary of Veterans Affairs consider

3 appropriate for the survey.

4 (c) REPORT.—The Secretary of Defense and the Sec5 retary of Veterans Affairs shall submit a report on the

6 results of the survey to the appropriate committees of

7 Congress. The report shall contain the matters described

8 in subsection (b) and any proposals for legislation that the

9 Secretaries recommend for enhancing Department of De10 fense and Department of Veterans Affairs cooperative ef11 forts with respect to the delivery of medical care.

12 SEC. 4. REVIEW OF IMPEDIMENTS TO COOPERATION.

13 (a) REVIEW REQUIRED.—The Secretary of Defense

14 and the Secretary of Veterans Affairs shall jointly conduct

15 a review to identify impediments to cooperation between

16 the Department of Defense and the Department of Veter17 ans Affairs regarding the delivery of medical care. The

18 matters reviewed shall include the following:

19 (1) All laws, policies, and regulations, and any

20 attitudes of beneficiaries of the health care systems

21 of the two departments, that have the effect of pre22 venting the establishment, or limiting the effective23 ness, of cooperative health care programs of the de24 partments.
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1 (2) The requirements and practices involved in

2 the credentialling and licensure of health care pro3 viders.

4 (3) The perceptions of beneficiaries in a variety

5 of categories (defined as the Secretaries consider ap6 propriate) regarding the various Federal health care

7 systems available for their use.

8 (b) REPORT.—The Secretaries shall jointly submit a

9 report on the results of the review to the appropriate com10 mittees of Congress. The report shall include any propos11 als for legislation that the Secretaries recommend for

12 eliminating or reducing impediments to interdepartmental

13 cooperation that are identified during the review.

14 SEC. 5. PARTICIPATION OF DEPARTMENT OF VETERANS

15 AFFAIRS IN TRICARE.

16 (a) REVIEW REQUIRED.—The Secretary of Defense

17 shall review the TRICARE program to identify opportuni18 ties for increased participation by the Department of Vet19 erans Affairs in that program. The ongoing collaboration

20 between Department of Defense officials and Department

21 of Veterans Affairs officials regarding increasing the par22 ticipation shall be included among the matters reviewed.

23 (b) SEMIANNUAL REPORT.—The Secretary of De24 fense and the Secretary of Veterans Affairs shall jointly

25 submit to the appropriate committees of Congress a semi-
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1 annual report on the status of the review and on efforts

2 to increase the participation of the Department of Veter3 ans Affairs in the TRICARE program. No report is re4 quired under this subsection after the submission of a

5 semiannual report in which the Secretaries declare that

6 the Department of Veterans Affairs is participating in the

7 TRICARE program to the extent that can reasonably be

8 expected to be attained.

9 SEC. 6. PHARMACEUTICAL BENEFITS AND PROGRAMS.

10 (a) EXAMINATION REQUIRED.—(1) The Federal

11 Pharmaceutical Steering Committee shall—

12 (A) undertake a comprehensive examination of

13 existing pharmaceutical benefits and programs for

14 beneficiaries of Federal medical care programs, in15 cluding matters relating to the purchasing, distribu16 tion, and dispensing of pharmaceuticals and the

17 management of mail order pharmaceuticals pro18 grams; and

19 (B) review the existing methods for contracting

20 for and distributing medical supplies and services.

21 (2) The committee shall submit a report on the re22 sults of the examination to the appropriate committees of

23 Congress.
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1 (b) REPORT.—The committee shall submit a report

2 on the results of the examination to the appropriate com3 mittees of Congress.

4 SEC. 7. STANDARDIZATION OF PHYSICAL EXAMINATIONS

5 FOR DISABILITIES.

6 The Secretary of Defense and the Secretary of Veter7 ans Affairs shall submit to the appropriate committees of

8 Congress a report on the status of the efforts of the De9 partment of Defense and the Department of Veterans Af10 fairs to standardize physical examinations administered by

11 the two departments for the purpose of determining or

12 rating disabilities.

13 SEC. 8. APPROPRIATE COMMITTEES OF CONGRESS DE14 FINED.

15 For the purposes of this Act, the appropriate commit16 tees of Congress are as follows:

17 (1) The Committee on Armed Services and the

18 Committee on Veterans’ Affairs of the Senate.

19 (2) The Committee on National Security and

20 the Committee on Veterans’ Affairs of the House of

21 Representatives.

22 SEC. 9. DEADLINES FOR SUBMISSION OF REPORTS.

23 (a) REPORT ON JOINT SURVEY OF POPULATIONS

24 SERVED.—The report required by section 3(c) shall be

25 submitted not later than January 1, 2000.
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1 (b) REPORT ON REVIEW OF IMPEDIMENTS TO CO2 OPERATION.—The report required by section 4(b) shall be

3 submitted not later than May 1, 1999.

4 (c) SEMIANNUAL REPORT ON PARTICIPATION OF DE5 PARTMENT OF VETERANS AFFAIRS IN TRICARE.—The

6 semiannual report required by section 5(b) shall be sub7 mitted not later than January 1 and June 1 of each year.

8 (d) REPORT ON EXAMINATION OF PHARMACEUTICAL

9 BENEFITS AND PROGRAMS.—The report on the examina10 tion required under section 6 shall be submitted not later

11 than 60 days after the completion of the examination.

12 (e) REPORT ON STANDARDIZATION OF PHYSICAL EX13 AMINATIONS FOR DISABILITIES.—The report required by

14 section 7 shall be submitted not later than June 1, 1999.

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