II 

109TH CONGRESS 

1ST SESSION S. 963 

To amend title 38, United States Code, to provide for a guaranteed adequate 

level of funding for veterans’ health care, to direct the Secretary of 

Veterans Affairs to conduct a pilot program to improve access to health 

care for rural veterans, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 28, 2005 

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

to the Committee on Finance 

A BILL 

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

guaranteed adequate level of funding for veterans’ health 

care, to direct the Secretary of Veterans Affairs to conduct a pilot program to improve access to health care 

for rural veterans, 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 and Equitable Access Act of 2005’’. 
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1 SEC. 2. ASSURANCE OF ADEQUATE FUNDING FOR VET2 ERANS’ HEALTH CARE. 

3 (a) IN GENERAL.—Chapter 3 of title 38, United 

4 States Code, is amended by adding at the end the fol5 lowing: 

6 ‘‘§ 321. Assured funding for veterans’ health care 

7 ‘‘(a) For each fiscal year, the Secretary of the Treas8 ury shall make available to the Secretary the amount de9 termined under subsection (b) with respect to that fiscal 

10 year, which shall remain available, without fiscal year limi11 tation, for the programs, functions, and activities of the 

12 Veterans Health Administration, as specified in subsection 

13 (c). 

14 ‘‘(b)(1) The amount applicable to fiscal year 2007 

15 under this subsection is $43,000,000,000. 

16 ‘‘(2) The amount applicable to any fiscal year after 

17 fiscal year 2007 under this subsection is the amount equal 

18 to the product of— 

19 ‘‘(A) the sum of— 

20 ‘‘(i) the number of veterans enrolled in the 

21 Department health care system under section 

22 1705 of this title as of July 1 preceding the be23 ginning of such fiscal year; and 

24 ‘‘(ii) the number of persons eligible for 

25 health care under chapter 17 of this title who 

26 are not covered by clause (i) and who were pro-
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1 vided hospital care or medical services under 

2 such chapter at any time during the fiscal year 

3 preceding such fiscal year; and 

4 ‘‘(B) the per capita baseline amount, as in5 creased annually pursuant to paragraph (3)(B). 

6 ‘‘(3)(A) For purposes of paragraph (2)(B), the term 

7 ‘per capita baseline amount’ means the amount equal to— 

8 ‘‘(i) the amount specified in paragraph (1), di9 vided by 

10 ‘‘(ii) the number of veterans enrolled in the De11 partment health care system under section 1705 of 

12 this title as of September 30, 2005. 

13 ‘‘(B) With respect to any fiscal year, the Secretary 

14 shall provide a percentage increase (rounded to the near15 est dollar) in the per capita baseline amount equal to the 

16 percentage by which— 

17 ‘‘(i) the Consumer Price Index (All Urban Con18 sumers, United States city average, hospital and re19 lated services, seasonally adjusted), published by the 

20 Bureau of Labor Statistics of the Department of 

21 Labor for the 12-month period ending on June 30 

22 preceding the beginning of the fiscal year for which 

23 the increase is made; exceeds 
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1 ‘‘(ii) such Consumer Price Index for the 12- 

2 month period preceding the 12-month period de3 scribed in clause (i). 

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

5 amounts made available pursuant to subsection (a) may 

6 be used for all programs, functions, and activities of the 

7 Veterans Health Administration. 

8 ‘‘(2) Amounts made available pursuant to subsection 

9 (a) may not be used for— 

10 ‘‘(A) construction, acquisition, or alteration of 

11 medical facilities as provided in subchapter I of 

12 chapter 81 of this title (except for such repairs as 

13 were provided for before the date of enactment of 

14 this section through the medical care appropriation 

15 for the Department); or 

16 ‘‘(B) grants under subchapter III of chapter 81 

17 of this title.’’. 

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

19 at the beginning of chapter 3 of title 38, United States 

20 Code, is amended by adding at the end the following: 

‘‘321. Assured funding for veterans’ health care.’’. 

21 SEC. 3. PILOT PROGRAM ON IMPROVED ACCESS TO 

22 HEALTH CARE FOR VETERANS WHO RESIDE 

23 IN HIGHLY RURAL AND GEOGRAPHICALLY 

24 REMOTE AREAS. 

25 (a) PILOT PROGRAM.— 
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1 (1) IN GENERAL.—The Secretary of Veterans 

2 Affairs shall conduct a pilot program to evaluate the 

3 feasability and advisability of utilizing various means 

4 to improve the access of veterans who reside in high5 ly rural or geographically remote areas to health 

6 care services referred to in subsection (d). 

7 (2) PROVISION OF SERVICES UNDER PILOT

8 PROGRAM.—In conducting the pilot program, the 

9 Secretary shall provide health care services referred 

10 to in subsection (d) to eligible veterans who reside 

11 in highly rural or geographically remote areas in the 

12 geographic service regions selected for purposes of 

13 the pilot program utilizing the contract authority of 

14 the Secretary under section 1703 of title 38, United 

15 States Code, and such other authorities available to 

16 the Secretary as the Secretary considers appropriate 

17 for purposes of the pilot program. 

18 (b) ELIGIBLE VETERANS.—A veteran is an eligible 

19 veteran for purposes of this section if the veteran— 

20 (1) has a service-connected disability; or 

21 (2) is enrolled in the veterans health care sys22 tem under section 1705 of title 38, United States 

23 Code. 

24 (c) HIGHLY RURAL OR GEOGRAPHICALLY REMOTE

25 AREAS.—An eligible veteran resides in a highly rural or 
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1 geographically remote area for purposes of this section if 

2 the veteran— 

3 (1) resides in a location that is more than 60 

4 miles driving distance from the nearest Department 

5 of Veterans Affairs health care facility; or 

6 (2) in the case of an eligible veteran who re7 sides in a location that is less than 60 miles driving 

8 distance from such a facility, experiences such hard9 ship or other difficulties (as determined pursuant to 

10 regulations prescribed by the Secretary for purposes 

11 of this section) in travel to the nearest Department 

12 of Veterans Affairs health care facility that such 

13 travel is not in the best interests of the veteran. 

14 (d) HEALTH CARE SERVICES.—The health care serv15 ices referred to in this subsection are— 

16 (1) acute or chronic symptom management; 

17 (2) nontherapeutic medical services; and 

18 (3) any other medical services jointly deter19 mined appropriate for an eligible veteran for pur20 poses of this section by the physician of the depart21 ment responsible for primary care of such eligible 

22 veteran and the director of the Veterans Integrated 

23 Service Network concerned. 

24 (e) AREAS FOR CONDUCT OF PILOT PROGRAM.— 
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1 (1) IN GENERAL.—The pilot program shall be 

2 conducted in 3 of the geographic service regions of 

3 the Veterans Health Administration (referred to as 

4 Veterans Integrated Service Networks) selected by 

5 the Secretary for purposes of the pilot program. 

6 (2) SELECTION.—In selecting geographic serv7 ice regions for purposes of the pilot program, the 

8 Secretary shall select— 

9 (A) Veterans Integrated Service Network 

10 number 23 as 1 of the regions for the conduct 

11 of the pilot program; and 

12 (B) the other 2 geographic service regions 

13 for the conduct of the pilot program from 

14 among the Veterans Integrated Service Net15 works that have a substantial population of vet16 erans who reside in highly rural or geographi17 cally remote areas. 

18 (f) PERIOD OF PILOT PROGRAM.—The pilot program 

19 shall be conducted during fiscal years 2006, 2007, and 

20 2008. 

21 (g) FUNDING FOR PILOT PROGRAM.— 

22 (1) IN GENERAL.—For each fiscal year during 

23 which the pilot program is conducted, the Secretary 

24 shall allocate for the pilot program an amount equal 
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1 to 0.9 percent of the total amount appropriated for 

2 such fiscal year for medical services. 

3 (2) TIMING OF ALLOCATION.—The allocation 

4 under paragraph (1) for a fiscal year shall be made 

5 before any other allocation of funds for medical care 

6 is made for such fiscal year, and any remaining allo7 cation of funds for medical care for such fiscal year 

8 shall be made without regard to the allocation under 

9 paragraph (1) in such fiscal year. 

10 (h) REPORT TO CONGRESS.—Not later than Feb11 ruary 1, 2009, the Secretary shall submit to Congress a 

12 report on the pilot program. The Secretary shall include 

13 in the report such recommendations as the Secretary con14 siders appropriate concerning extension of the pilot pro15 gram or other means to improve the access of veterans 

16 who reside in highly rural or geographically remote areas 

17 to health care services referred to in subsection (d). 

18 SEC. 4. TRAVEL REIMBURSEMENT FOR VETERANS RECEIV19 ING TREATMENT AT VETERANS FACILITIES. 

20 Section 111 of title 38, United States Code, is 

21 amended— 

22 (1) in subsection (a), by striking ‘‘), or in lieu 

23 thereof an allowance based upon mileage traveled’’ 

24 and insert ‘‘at a rate equivalent to the rate provided 

25 to Federal employees under section 5702 of title 5), 
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1 or in lieu thereof an allowance based upon mileage 

2 traveled (at a rate equivalent to the rate provided to 

3 Federal employees under section 5704 of title 5)’’; 

4 (2) by striking subsection (g); and 

5 (3) by redesignating subsection (h) as sub6 section (g). 

7 SEC. 5. DISABILITY RATING FOR VETERANS WHO LOSE USE 

8 OF A LIMB AS A RESULT OF A SERVICE-CON9 NECTED INJURY. 

10 Any veteran who lost the use of an arm or a leg as 

11 a result of a service-connected injury shall have a disability 

12 rating of not less than 50 percent disabled. 

13 SEC. 6. ESTABLISHMENT OF MEDICARE SUBVENTION FOR 

14 VETERANS. 

15 (a) IN GENERAL.—Section 1862 of the Social Secu16 rity Act (42 U.S.C. 1395y) is amended by adding at the 

17 end the following: 

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

19 ‘‘(1) ESTABLISHMENT OF PROCEDURE FOR RE20 IMBURSEMENT.— 

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

22 Secretaries shall establish a procedure under 

23 which the Secretary shall reimburse the Sec24 retary of Veterans Affairs, from the trust 
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1 funds, for medicare health care services fur2 nished to medicare-eligible veterans. 

3 ‘‘(B) REQUIREMENTS.—Under the proce4 dure— 

5 ‘‘(i) the administering Secretaries 

6 shall certify that any Department of Vet7 erans Affairs medical facility that fur8 nishes medicare health care services for 

9 which the Secretary of Veterans Affairs is 

10 reimbursed under this subsection has suffi11 cient— 

12 ‘‘(I) resources and expertise to 

13 provide the health care benefits re14 quired to be provided to beneficiaries; 

15 and 

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

18 timely submission of claims for health 

19 care benefits to the Secretary; 

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

21 all data of the Department of Veterans Af22 fairs that the Secretary determines is nec23 essary to verify accuracy in billing and 

24 claims information; and 
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1 ‘‘(iii) the Secretary shall waive re2 quirements for conditions of participation 

3 otherwise applicable to a provider of serv4 ices, physician, practitioner, supplier, or 

5 facility under this title in the case of a De6 partment of Veterans Affairs medical facil7 ity consistent with paragraph (3). 

8 ‘‘(C) RESTRICTION ON NEW OR EXPANDED

9 FACILITIES.—No new Department of Veterans 

10 Affairs medical facilities may be built or ex11 panded with funds received under this sub12 section. 

13 ‘‘(2) COST-SHARING.—The amount of reim14 bursement for medicare health care services to the 

15 Secretary of Veterans Affairs for medicare health 

16 care services shall be reduced by amounts attrib17 utable to applicable deductible, coinsurance, and 

18 cost-sharing requirements under this title. 

19 ‘‘(3) MEDICARE REQUIREMENTS.— 

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

21 any requirements referred to in paragraph 

22 (1)(B)(iii) (relating to requirements for condi23 tions of participation) in the case of a Depart24 ment of Veterans Affairs medical facility, or ap25 prove equivalent or alternative ways of meeting 
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1 such a requirement, but only if such waiver or 

2 approval— 

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

4 Department of Veterans Affairs as an 

5 agency of the Federal Government; and 

6 ‘‘(ii) is necessary to carry out, or im7 prove the efficiency of, this subsection. 

8 ‘‘(B) WAIVER OF PROHIBITION ON PAY9 MENTS TO FEDERAL PROVIDERS OF SERV10 ICES.—The prohibition of payments to Federal 

11 providers of services under sections 1814(c) and 

12 1835(d), and paragraphs (2) and (3) of sub13 section (a), shall not apply. 

14 ‘‘(4) VERIFICATION OF ELIGIBILITY.— 

15 ‘‘(A) IN GENERAL.—The Secretary of Vet16 erans Affairs shall establish procedures for de17 termining whether an individual is a medicare18 eligible veteran. 

19 ‘‘(B) RESTRICTION.—No reimbursement 

20 shall be made under this subsection for any 

21 medicare health care service provided to an in22 dividual unless the individual has been deter23 mined to be a medicare-eligible veteran pursu24 ant to the procedures established under sub25 paragraph (A). 
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1 ‘‘(5) DATA REQUIREMENTS.—Reimbursements 

2 for medicare health care services furnished to medi3 care-eligible veterans may not be made until such 

4 time as the administering Secretaries certify to Con5 gress that the— 

6 ‘‘(A) cost accounting and related trans7 action systems of the Veterans Health Adminis8 tration provide cost information and encounter 

9 data regarding health care delivered at each 

10 Department of Veterans Affairs medical facility 

11 on an inpatient and outpatient basis; and 

12 ‘‘(B) cost information and encounter data 

13 provided by such systems is accurate, reliable, 

14 and consistent across all facilities. 

15 ‘‘(6) PAYMENTS BASED ON REGULAR MEDICARE

16 PAYMENT RATES.— 

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

18 provisions of this paragraph, the Secretary shall 

19 reimburse the Secretary of Veterans Affairs for 

20 health care benefits provided to medicare-eligi21 ble veterans at a rate equal to 100 percent of 

22 the amounts that otherwise would be payable 

23 under this title on a noncapitated basis for such 

24 service if the Department of Veterans Affairs 

25 medical facility were a provider of services, were 
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1 participating in the medicare program, and im2 posed charges for such service. 

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

4 In computing the amount of payment under 

5 subparagraph (A), the following amounts shall 

6 be excluded: 

7 ‘‘(i) DISPROPORTIONATE SHARE HOS8 PITAL ADJUSTMENT.—Any amount attrib9 utable to an adjustment under section 

10 1886(d)(5)(F). 

11 ‘‘(ii) DIRECT GRADUATE MEDICAL

12 EDUCATION PAYMENTS.—Any amount at13 tributable to a payment under section 

14 1886(h). 

15 ‘‘(iii) INDIRECT MEDICAL EDUCATION

16 ADJUSTMENT.—Any amount attributable 

17 to the adjustment under section 

18 1886(d)(5)(B). 

19 ‘‘(iv) PERCENTAGE OF CAPITAL PAY20 MENTS.—Sixty-seven percent of any 

21 amounts attributable to payments for cap22 ital-related costs under medicare payment 

23 policies under section 1886(g). 
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1 ‘‘(C) PERIODIC PAYMENTS FROM MEDI2 CARE TRUST FUNDS.—Payments under this 

3 paragraph shall be made— 

4 ‘‘(i) on a periodic basis consistent 

5 with the periodicity of payments under this 

6 title; and 

7 ‘‘(ii) in appropriate part, as deter8 mined by the Secretary, from the trust 

9 funds. 

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

11 shall be deposited in the Department of Veterans Af12 fairs Medical Care Collections Fund established 

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

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

15 this subsection shall be construed— 

16 ‘‘(A) as prohibiting the Inspector General 

17 of the Department of Health and Human Serv18 ices from investigating any matters regarding 

19 the expenditure of funds under this subsection, 

20 including compliance with the provisions of this 

21 title and all other relevant laws; or 

22 ‘‘(B) as adding or requiring additional cri23 teria for eligibility for health care benefits fur24 nished to veterans by the Secretary of Veterans 
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1 Affairs, as established under chapter 17 of title 

2 38, United States Code. 

3 ‘‘(9) EVALUATION AND REPORTS.—The admin4 istering Secretaries shall conduct ongoing evalua5 tions of the procedure established under this sub6 section, and shall submit periodic reports to Con7 gress on— 

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

9 program by reason of this subsection; and 

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

11 care by medicare-eligible veterans. 

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

13 ‘‘(A) ADMINISTERING SECRETARIES.—The 

14 term ‘administering Secretaries’ means the Sec15 retary and the Secretary of Veterans Affairs, 

16 acting jointly. 

17 ‘‘(B) MEDICARE HEALTH CARE SERV18 ICES.—The term ‘medicare health care services’ 

19 means items or services covered under part A 

20 or part B of this title. 

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

22 term ‘medicare-eligible veteran’ means an indi23 vidual who— 

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

25 101 of title 38, United States Code) who 
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1 is eligible for care and services under sec2 tion 1705(a) of title 38, United States 

3 Code; 

4 ‘‘(ii) has attained age 65; 

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

6 benefits under part A of this title; and 

7 ‘‘(iv) is enrolled for benefits under 

8 part B of this title. 

9 ‘‘(D) TRUST FUNDS.—The term ‘trust 

10 funds’ means the Federal Hospital Insurance 

11 Trust Fund established in section 1817 and the 

12 Federal Supplementary Medical Insurance 

13 Trust Fund established in section 1841. 

14 ‘‘(E) DEPARTMENT OF VETERANS AFFAIRS

15 MEDICAL FACILITY.—The term ‘Department of 

16 Veterans Affairs medical facility’ means a med17 ical facility as defined in section 8101(3) of title 

18 38, United States Code, alone or in conjunction 

19 with other facilities under the jurisdiction of the 

20 Secretary of Veterans Affairs.’’. 

21 SEC. 7. MEDICAL REIMBURSEMENT STUDY AND REPORT. 

22 (a) STUDY.— 

23 (1) IN GENERAL.—The Secretary of Veterans 

24 Affairs, in consultation with the Secretary of De25 fense, shall conduct a study of the reimbursements 
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1 received by the Department of Veterans Affairs and 

2 the Department of Defense from insurance compa3 nies and other responsible parties for services per4 formed and medication dispensed at the medical fa5 cilities of such departments. 

6 (2) ISSUES TO BE STUDIED.—The study con7 ducted under this subsection shall determine, for the 

8 fiscal year ending within 1 year before the date of 

9 enactment of this Act— 

10 (A) the value of the services and medica11 tion provided by the Department of Veterans 

12 Affairs or the Department of Defense for which 

13 another party is financially responsible; 

14 (B) the value of such services and medica15 tion that were billed to such financially respon16 sible parties; and 

17 (C) the amount of reimbursement paid by 

18 such financially responsible parties to the De19 partment of Veterans Affairs or the Depart20 ment of Defense. 

21 (b) REPORT.—Not later than 1 year after the date 

22 of enactment of this Act, the Secretary of Veterans Affairs 

23 shall submit a report to Congress on the results of the 

24 study conducted under subsection (a). 
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1 SEC. 8. EXTENSION OF CHILD CARE ELIGIBILITY FOR CHIL2 DREN OF SOLDIERS WHO DIE IN THE LINE OF 

3 DUTY. 

4 Section 1799 of title 10, United States Code, is 

5 amended by adding at the end the following: 

6 ‘‘(d) CHILDREN WHOSE MILITARY PARENT DIED IN

7 THE LINE OF DUTY.—If a member of the Armed Forces, 

8 National Guard, or Reserve dies while on active service 

9 or active status, any child of such individual who is en10 rolled in any Federal child care program shall be eligible 

11 to continue receiving such child care services for a period 

12 of 24 months following such death.’’. 

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