I

103D CONGRESS

1ST SESSION H. R. 1778

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

APRIL 21, 1993

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

bill; which was referred jointly to the Committees on Armed Services,

Ways and Means, and Energy and Commerce

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,

3 SECTION 1. SHORT TITLE.

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

5 Veteran Health Care Act of 1993’’.
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1 SEC. 2. DEFINITION OF MEDICARE SUBVENTION FUNDING.

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

3 amended by adding at the end the following new para4 graph:

5 ‘‘(6) The term ‘medicare subvention funding’

6 means funds or funding authority of any program

7 authorized under title XVIII of the Social Security

8 Act (42 U.S.C. 1395 et seq.), which is made avail9 able to a department or agency for the provision of

10 health care services, and wherein funds are provided

11 directly to a military treatment facility operated by

12 the Department of Defense or Department of Veter13 ans’ Affairs for the purpose of payment for care pro14 vided to authorized personnel treated in that par15 ticular facility; and further wherein the funds pro16 vided would otherwise be utilized for the same pur17 pose in a nonmilitary treatment facility.’’.

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

19 CERTAIN FORMER MEMBERS.

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

21 amended—

22 (1) by inserting ‘‘(1)’’ after ‘‘(a)’’; and

23 (2) by adding at the end the following new

24 paragraphs:

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

26 under paragraph (1) is also eligible for health insurance
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1 payments under title XVIII of the Social Security Act (42

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

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

4 medical facility of any uniformed service. The facility of

5 the uniformed service that provides such care will recover

6 the cost for the care provided from medicare subvention

7 funding by direct billing of the appropriate program ad8 ministering the health insurance program defined under

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

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

11 care. Medicare subvention funding payments to the provid12 ing military treatment facility will be at fixed rates ap13 proved by the President.

14 ‘‘(3) Payments received by a military treatment facil15 ity or Department of Veterans’ Affairs facility for medical

16 services provided, whether the funds originated as Depart17 ment of Defense appropriated funds or from medicare sub18 vention funding shall be deposited to the credit of the op19 erating and maintenance fund of the particular medical

20 facility that provided the service, and as direct reimburse21 ment for services rendered; without any requirement of

22 equal or reciprocal reduction of the operating and mainte23 nance budget of the providing facility.’’.
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1 SEC. 4. MEDICAL AND DENTAL CARE FOR DEPENDENTS.

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

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

4 lieu thereof the following new paragraph:

5 ‘‘(1) A dependent described in paragraph (2) is enti6 tled, upon request, to the medical and dental care pre7 scribed by section 1077 of this title in facilities of the uni8 formed services. If the dependent is also entitled to hos9 pital insurance benefits under title XVIII of the Social Se10 curity Act (42 U.S.C. 1395 et seq.), then the facility of

11 the uniformed service will still provide authorized care, but

12 will recover the cost for providing the care from medicare

13 subvention funding by direct billing of the appropriate

14 program administering the health insurance program de15 fined under that Act, and appropriate for the particular

16 recipient of the care. Medicare subvention funding pay17 ments to the providing military treatment facility will be

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

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

20 title.’’

21 SEC. 5. CONFORMING AMENDMENT REGARDING MEDICARE

22 SUBVENTION FUNDING.

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

24 amended by adding at the end the following new para25 graph:
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1 ‘‘(4) A covered beneficiary who is entitled to hospital

2 insurance benefits under title XVIII of the Social Security

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

4 care in a military treatment facility, as authorized by sec5 tion 1076 of this title, may do so. The insurance benefits

6 of the Social Security Act may then be utilized to reim7 burse the military treatment facility for the care given,

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

9 and 1076(a)(1).’’.

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

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

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

13 lieu thereof the following new subsection:

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

15 payer, including the appropriate program administering

16 the health insurance program defined under title XVIII

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

18 pursuant to medicare subvention funding.’’.

19 SEC. 7. DETERMINATION OF INABILITY TO PROVIDE MEDI20 CAL AND DENTAL SERVICES.

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

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

23 lieu thereof the following new subsection:

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

25 who is otherwise eligible for such care at a military treat-
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1 ment facility only if the senior officer-in-charge or com2 manding officer of the military treatment facility makes

3 a determination that the treatment facility, or subunit

4 thereof, cannot provide the particular care required. This

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

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

7 at that particular time, have space or facilities available

8 to provide the treatment due solely to the then actual ex9 isting requirements to utilize all existing space or facilities

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

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

12 care required. Authority to make such determination may

13 not be delegated. The administering Secretary will be ad14 vised immediately in all instances where a determination

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

16 a verifiable date as to when the restriction will be re17 moved.’’.

18 SEC. 8. MEDICARE PROCEDURE FOR PAYMENT OF CLAIMS

19 OF PROVIDERS OF SERVICES.

20 (a) IN GENERAL.—Section 1835 of the Social Secu21 rity Act (42 U.S.C. 1395n) is amended by striking out

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

23 ‘‘(d) PAYMENTS TO FEDERAL PROVIDER OF SERV24 ICES OR OTHER FEDERAL AGENCIES PROHIBITED.—Sub25 ject to sections 1880, 1890, and 1890A, no payment may
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1 be made under this part (42 U.S.C. 1395j et seq.) to any

2 Federal provider of services or other Federal agency, ex3 cept a provider of services which the Secretary determines

4 is providing services to the public generally as a commu5 nity institution or agency; and no such payment may be

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

7 item or service which such person or persons is obligated

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

9 at public expense.’’.

10 (b) EXCEPTION FOR MILITARY AND VETERANS

11 TREATMENT FACILITIES.—Title XVIII of the Social Secu12 rity Act is amended by inserting after section 1889 the

13 following:

14 ‘‘SEC. 1890. MILITARY TREATMENT FACILITIES.

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

16 REQUIREMENTS.—A military treatment facility operated

17 by a uniformed service of the Department of Defense shall

18 be eligible for payments under this title notwithstanding

19 sections 1814(c) and 1835(d) if and for so long as that

20 military treatment facility meets all of the conditions and

21 requirements for such payments which are applicable to

22 hospitals and skilled nursing facilities under this title.

23 ‘‘(b) DEFINITION.—Such payments under this sec24 tion shall be referred to as medicare subvention funding,
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1 as that term is defined in section 1072(6) of title 10, Unit2 ed States Code.

3 ‘‘SEC. 1890A. DEPARTMENTS OF VETERANS AFFAIRS MEDI4 CAL TREATMENT FACILITY.

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

6 REQUIREMENTS.—A medical treatment facility operated

7 by the Department of Veterans Affairs shall be eligible

8 for payments under this title notwithstanding sections

9 1814(c) and 1835(d) if and for so long as that medical

10 treatment facility meets all of the conditions and require11 ments for such payments which are applicable to hospitals

12 and skilled nursing facilities under this title.

13 ‘‘(b) DEFINITION.—Such payments under this sec14 tion shall be referred to as medicare subvention funding,

15 as that term is defined in section 1072(6) of title 10, Unit16 ed States Code.’’.

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