II 

108TH CONGRESS 

1ST SESSION S. 176

To amend title XVIII of the Social Security Act to establish a program 

to provide for medicare reimbursement for health care services provided 

to certain medicare-eligible veterans in facilities of the Department of 

Veterans Affairs. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 16, 2003

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

to the Committee on Finance 

A BILL

To amend title XVIII of the Social Security Act to establish 

a program to provide for medicare reimbursement for 

health care services provided to certain 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 Health Care 

5 Reimbursement Act of 2003’’. 
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1 SEC. 2. ESTABLISHMENT OF MEDICARE REIMBURSEMENT 

2 PROGRAM FOR VETERANS. 

3 (a) IN GENERAL.—Title XVIII of the Social Security 

4 Act (42 U.S.C. 1395 et seq.) is amended by adding at 

5 the end the following new section: 

6 ‘‘MEDICARE REIMBURSEMENT PROGRAM FOR VETERANS

7 ‘‘SEC. 1897. (a) DEFINITIONS.—In this section: 

8 ‘‘(1) ADMINISTERING SECRETARIES.—The term 

9 ‘administering Secretaries’ means the Secretary and 

10 the Secretary of Veterans Affairs acting jointly. 

11 ‘‘(2) MEDICARE HEALTH CARE SERVICES.—The 

12 term ‘medicare health care services’ means items or 

13 services covered under part A or part B. 

14 ‘‘(3) PROGRAM.—The term ‘program’ means 

15 the program carried out under this section. 

16 ‘‘(4) PROGRAM SITE.—The term ‘program site’ 

17 means a Veterans Affairs medical facility that pro18 vides, alone or in conjunction with other facilities 

19 under the jurisdiction of the Secretary of Veterans 

20 Affairs and affiliated public or private entities—

21 ‘‘(A) in the case of a coordinated care 

22 health plan, the health care benefits prescribed 

23 in subsection (c)(3) to targeted medicare-eligi24 ble veterans residing within the service area; 

25 and 
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1 ‘‘(B) in the case of health care benefits 

2 being provided on a fee-for-service basis, the 

3 health care benefits prescribed in subsection 

4 (d)(2) to targeted medicare-eligible veterans. 

5 ‘‘(5) TARGETED MEDICARE-ELIGIBLE VET6 ERAN.—The term ‘targeted medicare-eligible vet7 eran’ means an individual who—

8 ‘‘(A) is a veteran (as defined in section 

9 101 of title 38, United States Code) who is en10 rolled in the annual patient enrollment system 

11 under paragraph (4), (5), (6), or (7) of section 

12 1705(a) of title 38, United States Code; 

13 ‘‘(B) has attained age 65; 

14 ‘‘(C) is entitled to, or enrolled for, benefits 

15 under part A; and 

16 ‘‘(D) is enrolled for benefits under part B. 

17 ‘‘(6) TRUST FUNDS.—The term ‘trust funds’ 

18 means the Federal Hospital Insurance Trust Fund 

19 established in section 1817 and the Federal Supple20 mentary Medical Insurance Trust Fund established 

21 in section 1841. 

22 ‘‘(7) VETERANS AFFAIRS MEDICAL FACILITY.—

23 The term ‘Veterans Affairs medical facility’ means a 

24 medical facility as defined in section 8101 of title 

25 38, United States Code. 
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1 ‘‘(b) PROGRAM.—

2 ‘‘(1) IN GENERAL.—

3 ‘‘(A) ESTABLISHMENT.—The admin4 istering Secretaries shall establish a program 

5 (under agreements entered into by the admin6 istering Secretaries) under which the Secretary 

7 shall reimburse the Secretary of Veterans Af8 fairs, from the trust funds, for medicare health 

9 care services furnished to targeted medicare-eli10 gible veterans. 

11 ‘‘(B) AGREEMENT.—Any agreement en12 tered into under this paragraph shall include at 

13 a minimum—

14 ‘‘(i) a detailed description of the 

15 health care benefits to be provided to the 

16 participants of the program; 

17 ‘‘(ii) a description of the eligibility 

18 rules for participation in the program, any 

19 premiums established for a coordinated 

20 care health plan, and any cost-sharing ar21 rangements; 

22 ‘‘(iii) a description of how the pro23 gram will satisfy the requirements under 

24 this title; 
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1 ‘‘(iv) a description of the sites selected 

2 under paragraph (2) and which model such 

3 site will operate under; 

4 ‘‘(v) a description of how reimburse5 ment requirements under subsection (i), 

6 maintenance of effort requirements under 

7 subsection (j), and the annual reconcili8 ation under subsection (k) will be imple9 mented in the program; 

10 ‘‘(vi) a statement that the Secretary 

11 shall have access to all data of the Depart12 ment of Veterans Affairs that the Sec13 retary determines is necessary to conduct 

14 independent estimates and audits of the 

15 maintenance of effort requirement under 

16 subsection (j), the annual reconciliation 

17 under subsection (k), and related matters 

18 required under the program; 

19 ‘‘(vii) a statement that the Comp20 troller General of the United States shall 

21 have access to all data of the Department 

22 of Veterans Affairs that the Comptroller 

23 General determines is necessary to carry 

24 out the reporting requirements under sub25 sections (k) or (l);
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1 ‘‘(viii) a description of any require2 ment that the Secretary waives pursuant 

3 to subsection (c)(4) or (d)(4); and 

4 ‘‘(ix) a certification, provided after re5 view by the administering Secretaries, that 

6 any facility or entity described in sub7 section (a)(4) that is receiving payments 

8 by reason of the program has sufficient—

9 ‘‘(I) resources and expertise to 

10 provide, consistent with payment re11 quirements under subsection (i), the 

12 health care benefits required to be 

13 provided to beneficiaries under the 

14 program (as established under sub15 sections (c)(3) and (d)(2)); and 

16 ‘‘(II) information and billing sys17 tems in place to ensure—

18 ‘‘(aa) accurate and timely 

19 submission of claims for health 

20 care benefits to the Secretary; 

21 and 

22 ‘‘(bb) that providers of 

23 health care services that are not 

24 affiliated with the Department of 

25 Veterans Affairs are reimbursed 
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1 by the Secretary of Veterans Af2 fairs in a timely and accurate 

3 manner. 

4 ‘‘(C) SEPARATE AGREEMENTS FOR CO5 ORDINATED CARE AND FEE-FOR-SERVICE.—The 

6 administering Secretaries shall enter into sepa7 rate agreements with regard to program sites 

8 operating under a coordinated care health plan 

9 model and a fee-for-service model, and shall in10 clude in each agreement only such information 

11 that is applicable to that model. 

12 ‘‘(2) LOCATION OF PROGRAM SITES.—The pro13 gram shall be conducted at any program site that is 

14 designated by the Secretary of Veterans Affairs. 

15 ‘‘(3) RESTRICTIONS.—

16 ‘‘(A) ONLY 1 MODEL AT A SITE.—A pro17 gram site may not operate under both a coordi18 nated care health plan model and a fee-for-serv19 ice model. 

20 ‘‘(B) RESTRICTION ON NEW OR EXPANDED

21 FACILITIES.—No new Veterans Affairs medical 

22 facilities may be built or expanded with funds 

23 from the program. 

24 ‘‘(4) COMMENCEMENT OF PROJECT.—The ad25 ministering Secretaries shall commence the dem-
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1 onstration project not later than 6 months after the 

2 date of enactment of the Veterans Health Care Re3 imbursement Act of 2003. 

4 ‘‘(5) TERMINATION.—If determined appro5 priate, the Secretary of Veterans Affairs may termi6 nate the program. 

7 ‘‘(6) REPORT.—At least 30 days prior to the 

8 commencement of the program (for both the coordi9 nated care health plan model and the fee-for-service 

10 model), the administering Secretaries shall submit a 

11 copy of any agreement entered into under paragraph 

12 (1) to the committees of jurisdiction of Congress. 

13 ‘‘(c) COORDINATED CARE HEALTH PLAN MODEL.—

14 ‘‘(1) IN GENERAL.—The Secretary of Veterans 

15 Affairs shall establish and operate coordinated care 

16 health plans in order to provide the health care ben17 efits prescribed in paragraph (3) to targeted medi18 care-eligible veterans enrolled in the program under 

19 this section consistent with the Medicare+Choice 

20 program under part C. 

21 ‘‘(2) OPERATION BY OR THROUGH A PROGRAM

22 SITE.—Any coordinated care health plan established 

23 in accordance with paragraph (1) shall be operated 

24 by or through a program site. 

25 ‘‘(3) HEALTH CARE BENEFITS.—
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1 ‘‘(A) IN GENERAL.—Subject to subpara2 graph (B), the Secretary of Veterans Affairs 

3 shall prescribe the health care benefits to be 

4 provided to a targeted medicare-eligible veteran 

5 enrolled in a coordinated care health plan under 

6 the program. 

7 ‘‘(B) MINIMUM BENEFITS.—The benefits 

8 prescribed by the Secretary of Veterans Affairs 

9 pursuant to subparagraph (A) shall include at 

10 least all medicare health care services that are 

11 required to be provided by a Medicare+Choice 

12 organization under part C. 

13 ‘‘(4) MEDICARE REQUIREMENTS.—

14 ‘‘(A) IN GENERAL.—

15 ‘‘(i) REQUIREMENTS.—Except as pro16 vided under clause (ii), a coordinated care 

17 health plan operating under the program 

18 shall meet all requirements applicable to a 

19 Medicare+Choice plan under part C and 

20 regulations pertaining thereto, and any 

21 other requirements for receiving payments 

22 under this title, except that the prohibition 

23 of payments to Federal providers of serv24 ices under sections 1814(c) and 1835(d),
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1 and paragraphs (2) and (3) of section 

2 1862(a), shall not apply. 

3 ‘‘(ii) WAIVER.—Except with respect to 

4 any requirement described in subparagraph 

5 (B), the Secretary is authorized to waive 

6 any requirement described in clause (i), or 

7 approve equivalent or alternative ways of 

8 meeting such a requirement, but only if 

9 such waiver or approval—

10 ‘‘(I) reflects the unique status of 

11 the Department of Veterans Affairs as 

12 an agency of the Federal Government; 

13 and 

14 ‘‘(II) is necessary to carry out, or 

15 improve the efficiency of, the pro16 gram. 

17 ‘‘(B) BENEFICIARY PROTECTIONS AND

18 OTHER MATTERS.—A coordinated care health 

19 plan shall comply with the requirements of the 

20 Medicare+Choice program under part C that 

21 relate to beneficiary protections and other re22 lated matters, including such requirements re23 lating to the following areas: 

24 ‘‘(i) Enrollment and disenrollment. 

25 ‘‘(ii) Nondiscrimination.
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1 ‘‘(iii) Information provided to bene2 ficiaries. 

3 ‘‘(iv) Cost-sharing limitations. 

4 ‘‘(v) Appeal and grievance procedures. 

5 ‘‘(vi) Provider participation. 

6 ‘‘(vii) Access to services. 

7 ‘‘(viii) Quality assurance and external 

8 review. 

9 ‘‘(ix) Advance directives. 

10 ‘‘(x) Other areas of beneficiary protec11 tions that the Secretary determines are ap12 plicable to a coordinated care health plan 

13 operating under the program under this 

14 section. 

15 ‘‘(d) FEE-FOR-SERVICE MODEL.—

16 ‘‘(1) IN GENERAL.—The Secretary of Veterans 

17 Affairs shall establish and operate a program site in 

18 order to provide, on a fee-for-service basis, the medi19 care health care services prescribed in paragraph (2) 

20 to targeted medicare-eligible veterans under the pro21 gram in a manner consistent with this title. 

22 ‘‘(2) HEALTH CARE BENEFITS.—The admin23 istering Secretaries shall prescribe the medicare 

24 health care services available to a targeted medicare-
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1 eligible veteran at a program site operating under a 

2 fee-for-service model. 

3 ‘‘(3) COST-SHARING.—The Secretary of Vet4 erans Affairs shall establish cost-sharing require5 ments for targeted medicare-eligible veterans that 

6 receive medicare health care services under a fee-for7 service model at a program site. Such cost-sharing 

8 requirements shall be the same as those required 

9 under this title. 

10 ‘‘(4) MEDICARE REQUIREMENTS.—

11 ‘‘(A) IN GENERAL.—Except as provided 

12 under subparagraph (B), any entity or health 

13 care provider that provides medicare health care 

14 services under the program on a fee-for-service 

15 basis shall meet all of the requirements under 

16 this title, except that the prohibition of pay17 ments to Federal providers of services under 

18 sections 1814(c) and 1835(d), and paragraphs 

19 (2) and (3) of section 1862(a), shall not apply. 

20 ‘‘(B) WAIVER.—The Secretary is author21 ized to waive any requirement described under 

22 subparagraph (A), or approve equivalent or al23 ternative ways of meeting such a requirement, 

24 but only if such waiver or approval—
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1 ‘‘(i) reflects the unique status of the 

2 Department of Veterans Affairs as an 

3 agency of the Federal Government; and 

4 ‘‘(ii) is necessary to carry out, or im5 prove the efficiency of, the program. 

6 ‘‘(5) VERIFICATION OF ELIGIBILITY.—

7 ‘‘(A) IN GENERAL.—The Secretary of Vet8 erans Affairs shall establish procedures for de9 termining whether an individual is eligible to re10 ceive medicare health care services on a fee-for11 service basis under the program. 

12 ‘‘(B) RESTRICTION.—No payments shall 

13 be made under this section for any medicare 

14 health care service provided to an individual on 

15 a fee-for-service basis under the program unless 

16 the individual has been determined to be eligible 

17 for the service pursuant to the procedures es18 tablished under subparagraph (A). 

19 ‘‘(e) VOLUNTARY PARTICIPATION.—Participation of 

20 a targeted medicare-eligible veteran in the program shall 

21 be voluntary, subject to the capacity of participating pro22 gram sites and any annual limitation on medicare pay23 ments specified by the administering Secretaries in sub24 section (i)(4), and shall be subject to such terms and con25 ditions as the administering Secretaries may establish.
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1 ‘‘(f) CREDITING OF PAYMENTS.—A payment received 

2 by the Secretary of Veterans Affairs under the program 

3 shall be credited to the appropriation of the Department 

4 of Veterans Affairs for Medical Care. Amounts credited 

5 to that appropriation for services furnished by a program 

6 site shall be credited to amounts in the appropriation that 

7 are available for the Veterans Integrated Services Network 

8 (VISN) in which the program site is located. Amounts so 

9 credited for a Veterans Integrated Services Network shall 

10 be available for the furnishing of health care and services 

11 by any Veterans Affairs medical facility in the Veterans 

12 Integrated Services Network. Amounts so credited shall 

13 be available in accordance with the preceding sentence 

14 without fiscal year limitation. 

15 ‘‘(g) WAIVER OF CERTAIN VA REQUIREMENTS.—

16 Notwithstanding any other provision of law, the Secretary 

17 of Veterans Affairs shall furnish medicare health care 

18 services to targeted medicare-eligible veterans pursuant to 

19 the program. 

20 ‘‘(h) INSPECTOR GENERAL.—Nothing in any agree21 ment entered into under subsection (b)(1) shall limit the 

22 Inspector General of the Department of Health and 

23 Human Services from investigating any matters regarding 

24 the expenditure of funds under this title for the program, 
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1 including compliance with the provisions of this title and 

2 all other relevant laws. 

3 ‘‘(i) PAYMENTS BASED ON REGULAR MEDICARE

4 PAYMENT RATES.—

5 ‘‘(1) AMOUNT.—Subject to the succeeding pro6 visions of this subsection and subsection (k), the 

7 Secretary shall reimburse the Secretary of Veterans 

8 Affairs for health care benefits provided under the 

9 program at the following rates: 

10 ‘‘(A) COORDINATED CARE HEALTH

11 PLANS.—In the case of health care benefits pro12 vided under the program to a targeted medi13 care-eligible veteran enrolled in a coordinated 

14 care health plan, at a rate equal to 95 percent 

15 of the amount paid to a Medicare+Choice orga16 nization under part C for an enrollee in a 

17 Medicare+Choice plan offered by such organi18 zation (as risk adjusted under section 

19 1853(a)(1)(B)). 

20 ‘‘(B) FEE-FOR-SERVICE MODEL.—In the 

21 case of a medicare health care service pre22 scribed in subsection (d)(2) that is provided at 

23 a program site operating under a fee-for-service 

24 model, at a rate equal to 95 percent of the 

25 amounts that otherwise would be payable under
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1 this title on a noncapitated basis for such serv2 ice if the program site was not part of the pro3 gram under this section, was participating in 

4 the medicare program, and imposed charges for 

5 such service. 

6 ‘‘(2) EXCLUSION OF CERTAIN AMOUNTS.—In 

7 computing the amount of payment under paragraph 

8 (1), the following amounts shall be excluded: 

9 ‘‘(A) DISPROPORTIONATE SHARE HOS10 PITAL ADJUSTMENT.—Any amount attributable 

11 to an adjustment under section 1886(d)(5)(F). 

12 ‘‘(B) DIRECT GRADUATE MEDICAL EDU13 CATION PAYMENTS.—Any amount attributable 

14 to a payment under section 1886(h). 

15 ‘‘(C) INDIRECT MEDICAL EDUCATION AD16 JUSTMENT.—Any amount attributable to the 

17 adjustment under section 1886(d)(5)(B). 

18 ‘‘(D) PERCENTAGE OF CAPITAL PAY19 MENTS.—67 percent of any amounts attrib20 utable to payments for capital-related costs 

21 under medicare payment policies under section 

22 1886(g). 

23 ‘‘(3) PERIODIC PAYMENTS FROM MEDICARE

24 TRUST FUNDS.—Payments under this subsection 

25 shall be made—
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1 ‘‘(A) on a periodic basis consistent with 

2 the periodicity of payments under this title; and 

3 ‘‘(B) in appropriate part, as determined by 

4 the Secretary, from the trust funds. 

5 ‘‘(4) ANNUAL LIMIT ON MEDICARE PAYMENTS

6 TO BE DETERMINED BY ADMINISTERING SECRE7 TARIES.—The aggregate amount that may be paid 

8 to the Department of Veterans Affairs under this 

9 subsection for enrollees in coordinated care health 

10 plans for a year and for health care benefits pro11 vided on a fee-for-service basis at a program site in 

12 that year shall be equal to an amount determined 

13 appropriate by the administering Secretaries. 

14 ‘‘(j) MAINTENANCE OF EFFORT.—

15 ‘‘(1) IN GENERAL.—The Secretary may not re16 imburse the Secretary of Veterans Affairs, from the 

17 trust funds, for medicare health care services fur18 nished under the program to targeted medicare-eligi19 ble veterans at a program site in a fiscal year until 

20 the expenditures during that year by the Depart21 ment of Veterans Affairs for such services provided 

22 at that site to individuals that meet the definition of 

23 a targeted medicare-eligible veteran under subsection 

24 (a)(5) (without regard to subparagraph (D) of such 

25 subsection) exceeds such expenditures at the site for 
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1 such services provided to applicable veterans during 

2 fiscal year 1998. 

3 ‘‘(2) APPLICABLE VETERAN DEFINED.—For 

4 purposes of paragraph (1), the term ‘applicable vet5 eran’ means an individual who—

6 ‘‘(A) is a veteran (as defined in section 

7 101 of title 38, United States Code) who is eli8 gible for care and services under section 

9 1710(a)(3) of title 38, United States Code; 

10 ‘‘(B) has attained age 65; and 

11 ‘‘(C) is entitled to, or enrolled for, benefits 

12 under part A. 

13 ‘‘(3) RULE OF CONSTRUCTION.—The criteria 

14 for eligibility for health care benefits furnished to 

15 veterans by the Secretary of Veterans Affairs is es16 tablished under chapter 17 of title 38, United States 

17 Code, and nothing in this section shall be construed 

18 to add additional criteria for such eligibility. 

19 ‘‘(k) ANNUAL RECONCILIATION TO ASSURE NO IN20 CREASE IN COSTS TO MEDICARE PROGRAM.—

21 ‘‘(1) MONITORING EFFECT OF PROGRAM ON

22 COSTS TO MEDICARE PROGRAM.—

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

24 Secretaries, in consultation with the Comp25 troller General of the United States, shall close-
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1 ly monitor the expenditures made under the 

2 medicare program under this title for targeted 

3 medicare-eligible veterans at each program site 

4 during a fiscal year compared to the expendi5 tures that would have been made for such vet6 erans during that year if the program had not 

7 been conducted. 

8 ‘‘(B) ANNUAL REPORTS BY THE COMP9 TROLLER GENERAL.—Not later than 6 months 

10 after the end of each fiscal year in which the 

11 program is operated, the Comptroller General 

12 of the United States shall submit to the admin13 istering Secretaries and the appropriate com14 mittees of Congress a report on the extent, if 

15 any, to which the costs of the Secretary under 

16 the medicare program under this title for each 

17 program site increased as a result of the pro18 gram under this section during the fiscal year 

19 to which the report applies. 

20 ‘‘(2) REQUIRED RESPONSE IN CASE OF IN21 CREASE IN COSTS.—

22 ‘‘(A) IN GENERAL.—If the administering 

23 Secretaries find, based on paragraph (1), that 

24 the expenditures under the medicare program 

25 under this title for each program site increased 
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1 (or are expected to increase) during a fiscal 

2 year because of the program under this section, 

3 the administering Secretaries shall take such 

4 steps as may be needed—

5 ‘‘(i) to recoup for the medicare pro6 gram the amount of such increase in ex7 penditures; and 

8 ‘‘(ii) to prevent any such increase in 

9 any succeeding fiscal year. 

10 ‘‘(B) STEPS.—Such steps—

11 ‘‘(i) under subparagraph (A)(i), shall 

12 include payment of an amount equal to the 

13 amount of such increased expenditures by 

14 the Secretary of Veterans Affairs from the 

15 current appropriation for Medical Care of 

16 the Department of Veterans Affairs to the 

17 trust funds; and 

18 ‘‘(ii) under subparagraph (A)(ii), shall 

19 include suspending or terminating the pro20 gram (in whole or in part) or reducing the 

21 amount of payment under subsection (i). 

22 ‘‘(l) GAO EVALUATION AND ADDITIONAL RE23 PORTS.—

24 ‘‘(1) EVALUATION.—
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1 ‘‘(A) IN GENERAL.—The Comptroller Gen2 eral of the United States shall conduct an eval3 uation of the program, including—

4 ‘‘(i) an evaluation of program sites 

5 operating under a coordinated care health 

6 plan model and under a fee-for-service 

7 model; and 

8 ‘‘(ii) where appropriate, a comparison 

9 of such models. 

10 ‘‘(B) CONTENTS.—Any evaluation con11 ducted under subparagraph (A) shall include an 

12 assessment, based on the agreements entered 

13 into under subsection (b)(1), of the following: 

14 ‘‘(i) Any savings or costs to the medi15 care program under this title resulting 

16 from the program. 

17 ‘‘(ii) Compliance of participating pro18 gram sites with applicable measures of 

19 quality of care, compared to such compli20 ance by other entities that participate in 

21 the medicare program and are not Vet22 erans Affairs medical facilities. 

23 ‘‘(iii) Compliance by the Department 

24 of Veterans Affairs with the requirements 

25 under this title. 
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1 ‘‘(iv) The number of targeted medi2 care-eligible veterans opting to receive 

3 health care benefits under the program in4 stead of receiving such benefits through 

5 another health insurance plan (including 

6 health care benefits under this title). 

7 ‘‘(v) A comparison of the costs of par8 ticipation of the program sites in the pro9 gram with the reimbursements for health 

10 care services provided by such sites. 

11 ‘‘(vi) Any impact the program has on 

12 the access to health care services, or the 

13 quality of such services, for—

14 ‘‘(I) targeted medicare-eligible 

15 veterans receiving health care benefits 

16 under the program; and 

17 ‘‘(II) veterans (including targeted 

18 medicare-eligible veterans) that are 

19 not receiving health care benefits 

20 under the program.

21 ‘‘(vii) Any impact the program has on 

22 private health care providers and on bene23 ficiaries under this title that are not receiv24 ing health care benefits under the pro25 gram. 
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1 ‘‘(viii) Any effect that the program 

2 has on the enrollment in Medicare+Choice 

3 plans offered by Medicare+Choice organi4 zations under part C in the established 

5 program site areas. 

6 ‘‘(ix) Any impact that the exclusion of 

7 the amounts described in subsection (i)(2) 

8 from the reimbursement amounts under 

9 the program has on the Department of 

10 Veterans Affairs or on targeted medicare11 eligible veterans. 

12 ‘‘(x) A description of the difficulties 

13 (if any) experienced by—

14 ‘‘(I) the Department of Veterans 

15 Affairs in managing the program; or 

16 ‘‘(II) the Department of Health 

17 and Human Services in overseeing the 

18 program. 

19 ‘‘(xi) Any additional elements speci20 fied in the agreements entered into under 

21 subsection (b)(1). 

22 ‘‘(xii) Any additional elements that 

23 the Comptroller General of the United 

24 States determines are appropriate to as25 sess regarding the program. 
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1 ‘‘(2) BIANNUAL REPORTS.—Not later than the 

2 date that is the 2-year anniversary of the commence3 ment of the program and biannually thereafter (for 

4 as long as the program is being conducted), the 

5 Comptroller General of the United States shall sub6 mit reports on the evaluation conducted under sub7 paragraph (A) to the administering Secretaries and 

8 to the committees of jurisdiction of Congress. 

9 ‘‘(m) REPORTS BY ADMINISTERING SECRETARIES ON

10 PROGRAM OPERATION AND CHANGES.—

11 ‘‘(1) ANNUAL REPORT.—The administering 

12 Secretaries shall submit to the committees of juris13 diction of Congress an annual report on the program 

14 and its impact on costs and the provision of health 

15 services under this title and title 38, United States 

16 Code. 

17 ‘‘(2) REPORT BEFORE MAKING CERTAIN PRO18 GRAM CHANGES.—

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

20 Secretaries shall submit to the committees of 

21 jurisdiction of Congress a report at least 60 

22 days before—

23 ‘‘(i) adding or changing the designa24 tion of a site under subsection (b)(2); 
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1 ‘‘(ii) waiving any requirement under 

2 subsection (c)(4) or (d)(4) that was not de3 scribed in any agreement under subsection 

4 (b)(1) or previous report under this sub5 section; 

6 ‘‘(iii) making other significant 

7 changes in the operation of the program; 

8 or 

9 ‘‘(iv) terminating the agreement under 

10 subsection (b)(5). 

11 ‘‘(B) EXPLANATION.—Each report under 

12 subparagraph (A) shall include justifications for 

13 the changes or termination to which the report 

14 refers.’’. 

15 (b) SENSE OF CONGRESS.—It is the sense of Con16 gress that the amount of funds appropriated for the De17 partment of Veterans Affairs for Medical Care in any fis18 cal year beginning after the date of enactment of this Act 

19 should not be reduced because of the implementation of 

20 the Medicare Reimbursement Program for Veterans under 

21 section 1897 of the Social Security Act (as added by sub22 section (a)).

Æ