II 

116TH CONGRESS 

1ST SESSION S. 1001 

To amend the Indian Health Care Improvement Act to allow the Indian 

Health Service to cover the cost of a copayment of an Indian or Alaska 

Native veteran receiving medical care or services from the Department 

of Veterans Affairs, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 3, 2019 

Mr. THUNE (for himself and Mr. ROUNDS) introduced the following bill; which 

was read twice and referred to the Committee on Indian Affairs 

A BILL 

To amend the Indian Health Care Improvement Act to allow 

the Indian Health Service to cover the cost of a copayment of an Indian or Alaska Native veteran receiving 

medical care or services from the Department of Veterans Affairs, 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 ‘‘Tribal Veterans Health 

5 Care Enhancement Act’’. 


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1 SEC. 2. LIABILITY FOR PAYMENT. 

2 Section 222 of the Indian Health Care Improvement 

3 Act (25 U.S.C. 1621u) is amended by adding at the end 

4 the following: 

5 ‘‘(d) VETERANS AFFAIRS COPAYMENTS.—The Serv6 ice may pay, in accordance with section 412, the cost of 

7 a copayment assessed by the Department of Veterans Af8 fairs to an eligible Indian veteran (as defined in section 

9 412) for covered medical care (as defined in such sec10 tion).’’. 

11 SEC. 3. COPAYMENTS FOR TRIBAL VETERANS RECEIVING 

12 CERTAIN MEDICAL SERVICES. 

13 Title IV of the Indian Health Care Improvement Act 

14 (25 U.S.C. 1641 et seq.) is amended by adding at the end 

15 the following: 

16 ‘‘SEC. 412. PAYMENTS FOR ELIGIBLE INDIAN VETERANS RE17 CEIVING COVERED MEDICAL CARE AT VA FA18 CILITIES. 

19 ‘‘(a) DEFINITIONS.—In this section: 

20 ‘‘(1) APPROPRIATE COMMITTEES OF CON21 GRESS.—The term ‘appropriate committees of Con22 gress’ means— 

23 ‘‘(A) in the Senate— 

24 ‘‘(i) the Committee on Veterans’ Af25 fairs; and 


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1 ‘‘(ii) the Committee on Indian Affairs; 

2 and 

3 ‘‘(B) in the House of Representatives— 

4 ‘‘(i) the Committee on Veterans’ Af5 fairs; and 

6 ‘‘(ii) the Committee on Natural Re7 sources. 

8 ‘‘(2) COVERED MEDICAL CARE.—The term ‘cov9 ered medical care’ means any medical care or service 

10 that is— 

11 ‘‘(A) authorized for an eligible Indian vet12 eran under the contract health service and re13 ferred by the Service; and 

14 ‘‘(B) administered at a facility of the De15 partment of Veterans Affairs, including any 

16 services rendered under a contract with a non17 Department of Veterans Affairs health care 

18 provider. 

19 ‘‘(3) ELIGIBLE INDIAN VETERAN.—The term 

20 ‘eligible Indian veteran’ means an Indian or Alaska 

21 Native veteran who is eligible for assistance from the 

22 Service. 

23 ‘‘(b) MEMORANDUM OF UNDERSTANDING.— 

24 ‘‘(1) IN GENERAL.—Notwithstanding any other 

25 provision of law, except as provided in paragraph 


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1 (3), the Secretary (or a designee, including the di2 rector of any area office of the Service), the Sec3 retary of Veterans Affairs (or a designee), and any 

4 tribal health program, as applicable, shall enter into 

5 a memorandum of understanding, in consultation 

6 with Indian tribes to be impacted by the memo7 randum of understanding (on a national or regional 

8 basis), that authorizes the Secretary or tribal health 

9 program, as applicable, to pay to the Secretary of 

10 Veterans Affairs any copayments owed to the De11 partment of Veterans Affairs by eligible Indian vet12 erans for covered medical care. 

13 ‘‘(2) FACTORS FOR CONSIDERATION.—In enter14 ing into a memorandum of understanding under 

15 paragraph (1), the Secretary, the Secretary of Vet16 erans Affairs, and any tribal health program, as ap17 plicable, shall take into consideration any findings 

18 contained in the report under subsection (e). 

19 ‘‘(3) EXCEPTION.—The Secretary, the Sec20 retary of Veterans Affairs, and any tribal health 

21 program, as applicable, shall not be required to 

22 enter into a memorandum of understanding under 

23 paragraph (1) if the Secretary, the Secretary of Vet24 erans Affairs, and any tribal health program, as ap25 plicable, jointly certify to the appropriate committees 


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1 of Congress that such a memorandum of under2 standing would— 

3 ‘‘(A) decrease the quality of health care 

4 provided to eligible Indian veterans; 

5 ‘‘(B) impede the access of those veterans 

6 to health care; or 

7 ‘‘(C) substantially decrease the quality of, 

8 or access to, health care by individuals receiving 

9 health care from the Department of Veterans 

10 Affairs or beneficiaries of the Service. 

11 ‘‘(c) PAYMENT BY SERVICE.—Notwithstanding any 

12 other provision of law and in accordance with the relevant 

13 memorandum of understanding described in subsection 

14 (b), the Service may cover the cost of any copayment as15 sessed by the Department of Veterans Affairs to an eligi16 ble Indian veteran receiving covered medical care. 

17 ‘‘(d) AUTHORIZATION TO ACCEPT FUNDS.—Notwith18 standing section 407(c), section 2901(b) of the Patient 

19 Protection and Affordable Care Act (25 U.S.C. 1623(b)), 

20 or any other provision of law, and in accordance with the 

21 relevant memorandum of understanding described in sub22 section (b), the Secretary of Veterans Affairs may accept 

23 a payment from the Service under subsection (c). 

24 ‘‘(e) REPORT.—Not later than 90 days after the date 

25 of enactment of this section, the Secretary and the SecVerDate Sep 11 2014 21:34 Apr 08, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1001.IS S1001

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1 retary of Veterans Affairs shall submit to the appropriate 

2 committees of Congress a report that describes— 

3 ‘‘(1) the number of veterans, disaggregated by 

4 State, who— 

5 ‘‘(A) are eligible for assistance from the 

6 Service; and 

7 ‘‘(B) have received health care at a medical 

8 facility of the Department of Veterans Affairs; 

9 ‘‘(2) the number of veterans, disaggregated by 

10 State and calendar year, who— 

11 ‘‘(A) are eligible for assistance from the 

12 Service; and 

13 ‘‘(B) were referred to a medical facility of 

14 the Department of Veterans Affairs from a fa15 cility of the Service during the period— 

16 ‘‘(i) beginning on January 1, 2013; 

17 and 

18 ‘‘(ii) ending on December 31, 2018; 

19 and 

20 ‘‘(3) an update regarding efforts of the Sec21 retary and the Secretary of Veterans Affairs to 

22 streamline health care for veterans who are eligible 

23 for assistance from the Service and have received 

24 health care at a medical facility of the Department 


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1 of Veterans Affairs and at a facility of the Service, 

2 including a description of— 

3 ‘‘(A) any changes to the provision of health 

4 care required under this Act; and 

5 ‘‘(B) any barriers to efficiently streamline 

6 the provision of health care to veterans who are 

7 eligible for assistance from the Service.’’. 

Æ 


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