I

104TH CONGRESS

1ST SESSION H. R. 861

To amend title 10, United States Code, and title XVIII of the Social Security

Act to permit the reimbursement of expenses incurred by a medical

facility of the uniformed services or the Department of Veterans Affairs

in providing health care to persons eligible for care under medicare.

IN THE HOUSE OF REPRESENTATIVES

FEBRUARY 8, 1995

Mr. CUNNINGHAM (for himself and Mr. HUNTER) introduced the following

bill, which was referred to the Committee on National Security and, in

addition, to the Committees on Commerce, and Ways and Means, 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 amend title 10, United States Code, and title XVIII

of the Social Security Act to permit the reimbursement

of expenses incurred by a medical facility of the uniformed services or the Department of Veterans Affairs

in providing health care to persons eligible for care under

medicare.

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. SHORT TITLE.

2 This Act may be cited as the ‘‘Military Retiree and

3 Veteran Health Care Act of 1995’’.

4 SEC. 2. DEFINITION OF MEDICARE SUBVENTION FUNDING.

5 Section 1072 of title 10, United States Code, is

6 amended by adding at the end the following new para7 graph:

8 ‘‘(7) The term ‘medicare subvention funding’

9 means funds or funding authority of any program

10 authorized under title XVIII of the Social Security

11 Act (42 U.S.C. 1395 et seq.), which is made avail12 able to a department or agency for the provision of

13 health care services, and wherein funds are provided

14 directly to a military treatment facility operated by

15 the Department of Defense or Department of Veter16 ans’ Affairs for the purpose of payment for care pro17 vided to authorized personnel treated in that par18 ticular facility; and further wherein the funds pro19 vided would otherwise be utilized for the same pur20 pose in a nonmilitary treatment facility.’’.

21 SEC. 3. MEDICAL AND DENTAL CARE FOR MEMBERS AND

22 CERTAIN FORMER MEMBERS.

23 Section 1074(b) of title 10, United States Code, is

24 amended—

25 (1) by inserting ‘‘(1)’’ after ‘‘(b)’’; and
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1 (2) by adding at the end the following new

2 paragraphs:

3 ‘‘(2) If a member or former member eligible for care

4 under paragraph (1) is also eligible for health insurance

5 payments under title XVIII of the Social Security Act (42

6 U.S.C. 1395 et seq.), the member or former member shall

7 be entitled to and given medical and dental care in any

8 medical facility of any uniformed service. The facility of

9 the uniformed service that provides such care will recover

10 the cost for the care provided from medicare subvention

11 funding by direct billing of the appropriate program ad12 ministering the health insurance program defined under

13 title XVIII of the Social Security Act (42 U.S.C. 1395

14 et seq.) and appropriate for the particular recipient of the

15 care. Medicare subvention funding payments to the provid16 ing military treatment facility will be at fixed rates ap17 proved by the President.

18 ‘‘(3) Payments received by a military treatment facil19 ity or Department of Veterans’ Affairs facility for medical

20 services provided, whether the funds originated as Depart21 ment of Defense appropriated funds or from medicare sub22 vention funding shall be deposited to the credit of the op23 erating and maintenance fund of the particular medical

24 facility that provided the service, and as direct reimburse25 ment for services rendered; without any requirement of
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1 equal or reciprocal reduction of the operating and mainte2 nance budget of the providing facility.’’.

3 SEC. 4. MEDICAL AND DENTAL CARE FOR DEPENDENTS.

4 Section 1076(a) of title 10, United States Code, is

5 amended by striking out paragraph (1) and inserting in

6 lieu thereof the following new paragraph:

7 ‘‘(1) A dependent described in paragraph (2) is enti8 tled, upon request, to the medical and dental care pre9 scribed by section 1077 of this title in facilities of the uni10 formed services. If the dependent is also entitled to hos11 pital insurance benefits under title XVIII of the Social Se12 curity Act (42 U.S.C. 1395 et seq.), then the facility of

13 the uniformed service will still provide authorized care, but

14 will recover the cost for providing the care from medicare

15 subvention funding by direct billing of the appropriate

16 program administering the health insurance program de17 fined under that Act, and appropriate for the particular

18 recipient of the care. Medicare subvention funding pay19 ments to the providing military treatment facility will be

20 at fixed rates approved by the President; and will be used,

21 deposited, and credited as specified in section 1074 of this

22 title.’’
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1 SEC. 5. CONFORMING AMENDMENT REGARDING MEDICARE

2 SUBVENTION FUNDING.

3 Section 1086(d) of title 10, United States Code, is

4 amended by adding at the end the following new para5 graph:

6 ‘‘(4) A covered beneficiary who is entitled to hospital

7 insurance benefits under title XVIII of the Social Security

8 Act (42 U.S.C. 1395 et seq.), and who elects to receive

9 care in a military treatment facility, as authorized by sec10 tion 1076 of this title, may do so. The insurance benefits

11 of the Social Security Act may then be utilized to reim12 burse the military treatment facility for the care given,

13 in the manner and rate as specified in sections 1074(b)

14 and 1076(a)(1) of this title.’’.

15 SEC. 6. COLLECTION FROM THIRD-PARTY PAYERS.

16 Section 1095 of title 10, United States Code, is

17 amended by striking out subsection (d) and inserting in

18 lieu thereof the following new subsection:

19 ‘‘(d) Collection may be made from any third-party

20 payer, including the appropriate program administering

21 the health insurance program defined under title XVIII

22 or XIX of the Social Security Act (42 U.S.C. 1395 et seq.)

23 pursuant to medicare subvention funding.’’.
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1 SEC. 7. DETERMINATION OF INABILITY TO PROVIDE MEDI2 CAL AND DENTAL SERVICES.

3 Section 1076 of title 10, United States Code, is

4 amended by striking out subsection (c) and inserting in

5 lieu thereof the following new subsection:

6 ‘‘(c) Medical or dental care may be denied to a person

7 who is otherwise eligible for such care at a military treat8 ment facility only if the senior officer-in-charge or com9 manding officer of the military treatment facility makes

10 a determination that the treatment facility, or subunit

11 thereof, cannot provide the particular care required. This

12 determination may be made, if, and only if, that particular

13 military treatment facility, or subunit thereof, does not,

14 at that particular time, have space or facilities available

15 to provide the treatment due solely to the then actual ex16 isting requirements to utilize all existing space or facilities

17 for active duty members; or does not, at that particular

18 time, and under any circumstances, provide the type of

19 care required. Authority to make such determination may

20 not be delegated. The administering Secretary will be ad21 vised immediately in all instances where a determination

22 to deny treatment, under this subsection, is made, with

23 a verifiable date as to when the restriction will be re24 moved.’’.
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1 SEC. 8. MEDICARE PROCEDURE FOR PAYMENT OF CLAIMS

2 OF PROVIDERS OF SERVICES.

3 (a) IN GENERAL.—Section 1835 of the Social Secu4 rity Act (42 U.S.C. 1395n) is amended by striking out

5 subsection (d) and inserting in lieu thereof the following:

6 ‘‘(d) PAYMENTS TO FEDERAL PROVIDER OF SERV7 ICES OR OTHER FEDERAL AGENCIES PROHIBITED.—Sub8 ject to sections 1880, 1890, and 1890A, no payment may

9 be made under this part (42 U.S.C. 1395j et seq.) to any

10 Federal provider of services or other Federal agency, ex11 cept a provider of services which the Secretary determines

12 is providing services to the public generally as a commu13 nity institution or agency; and no such payment may be

14 made to any provider of services or other person for any

15 item or service which such person or persons is obligated

16 by a law of, or a contract with, the United States to render

17 at public expense.’’.

18 (b) EXCEPTION FOR MILITARY AND VETERANS

19 TREATMENT FACILITIES.—Title XVIII of the Social Secu20 rity Act is amended by inserting after section 1888 the

21 following:

22 ‘‘SEC. 1890. MILITARY TREATMENT FACILITIES.

23 ‘‘(a) ELIGIBILITY FOR PAYMENTS; CONDITIONS AND

24 REQUIREMENTS.—A military treatment facility operated

25 by a uniformed service of the Department of Defense shall

26 be eligible for payments under this title notwithstanding
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1 sections 1814(c) and 1835(d) if and for so long as that

2 military treatment facility meets all of the conditions and

3 requirements for such payments which are applicable to

4 hospitals and skilled nursing facilities under this title.

5 ‘‘(b) DEFINITION.—Such payments under this sec6 tion shall be referred to as medicare subvention funding,

7 as that term is defined in section 1072(6) of title 10,

8 United States Code.

9 ‘‘SEC. 1890A. DEPARTMENTS OF VETERANS AFFAIRS MEDI10 CAL TREATMENT FACILITY.

11 ‘‘(a) ELIGIBILITY FOR PAYMENTS; CONDITIONS AND

12 REQUIREMENTS.—A medical treatment facility operated

13 by the Department of Veterans Affairs shall be eligible

14 for payments under this title notwithstanding sections

15 1814(c) and 1835(d) if and for so long as that medical

16 treatment facility meets all of the conditions and require17 ments for such payments which are applicable to hospitals

18 and skilled nursing facilities under this title.

19 ‘‘(b) DEFINITION.—Such payments under this sec20 tion shall be referred to as medicare subvention funding,

21 as that term is defined in section 1072(6) of title 10, Unit22 ed States Code.’’.

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