I
106TH CONGRESS
1ST SESSION
H. R. 1347
To provide for a Medicare subvention demonstration project for veterans,
to improve the Department of Defense TRICARE program, and for
other purposes.
IN THE HOUSE OF REPRESENTATIVES
MARCH 25, 1999
Mr. PICKERING (for himself and Mr. MORAN of Kansas) introduced the fol-
lowing bill; which was referred to the Committee on Ways and Means,
and in addition to the Committees on Commerce, Armed Services, and
Veterans’ Affairs, 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 provide for a Medicare subvention demonstration project
for veterans, to improve the Department of Defense
TRICARE program, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Veterans Health Care
Improvement Act of 1999’’.
SEC. 
2. 
MEDICARE 
SUBVENTION 
DEMONSTRATION
PROJECT FOR VETERANS.
Title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.) is amended by adding at the end the fol-
lowing new section:
‘‘MEDICARE SUBVENTION DEMONSTRATION PROJECT FOR
VETERANS
‘‘SEC. 1897. (a) DEFINITIONS.—In this section:
‘‘(1) ADMINISTERING SECRETARIES.—The term
‘administering Secretaries’ means the Secretary and
the Secretary of Veterans Affairs acting jointly.
‘‘(2) DEMONSTRATION
PROJECT; PROJECT.—
The terms ‘demonstration project’ and ‘project’
mean the demonstration project carried out under
this section.
‘‘(3) DEMONSTRATION SITE.—The term ‘dem-
onstration site’ means a Veterans Affairs medical fa-
cility, including a group of Veterans Affairs medical
facilities that provide hospital care or medical serv-
ices as part of a service network or similar organiza-
tion.
‘‘(4) MILITARY RETIREE.—The term ‘military
retiree’ means a member or former member of the
Armed Forces who is entitled to retired pay.
‘‘(5) 
TARGETED
MEDICARE-ELIGIBLE
VET-
ERAN.—The term ‘targeted medicare-eligible vet-
eran’ means an individual who—
‘‘(A) is a veteran (as defined in section
101(2) of title 38, United States Code) and is
described in section 1710(a)(3) of title 38,
United States Code;
‘‘(B) has attained age 65;
‘‘(C) is entitled to benefits under part A of
this title; and
‘‘(D)(i) is enrolled for benefits under part
B of this title; and
‘‘(ii) if such individual attained age 65 be-
fore the date of enactment of the Veterans’
Equal Access to Medicare Act, was so enrolled
on such date.
‘‘(6) TRUST FUNDS.—The term ‘trust funds’
means the Federal Hospital Insurance Trust Fund
established in section 1817 and the Federal Supple-
mentary Medical Insurance Trust Fund established
in section 1841.
‘‘(7) VETERANS AFFAIRS MEDICAL FACILITY.—
The term ‘Veterans Affairs medical facility’ means a
medical facility as defined in section 8101 of title
38, United States Code.
‘‘(b) DEMONSTRATION PROJECT.—
‘‘(1) IN GENERAL.—
‘‘(A) 
ESTABLISHMENT.—The 
admin-
istering Secretaries are authorized to establish
a demonstration project (under an agreement
entered into by the administering Secretaries)
under which the Secretary shall reimburse the
Secretary of Veterans Affairs, from the trust
funds, for medicare health care services fur-
nished to certain targeted medicare-eligible vet-
erans at a demonstration site.
‘‘(B) AGREEMENT.—The agreement en-
tered into under subparagraph (A) shall include
at a minimum—
‘‘(i) a description of the benefits to be
provided to the participants in the dem-
onstration project established under this
section;
‘‘(ii) a description of the eligibility
rules for participation in the demonstration
project, including any terms and conditions
established under subparagraph (C) and
any cost-sharing required under subpara-
graph (D);
‘‘(iii) a description of how the dem-
onstration project will satisfy the require-
ments under this title (including bene-
ficiary protections and quality assurance
mechanisms);
‘‘(iv) a description of the demonstra-
tion sites selected under paragraph (2);
‘‘(v) a description of how reimburse-
ment and maintenance of effort require-
ments under subsection (h) will be imple-
mented in the demonstration project;
‘‘(vi) a statement that the Secretary
shall have access to all data of the Depart-
ment of Veterans Affairs that the Sec-
retary determines is necessary to conduct
independent estimates and audits of the
maintenance of effort requirement, the an-
nual reconciliation, and related matters re-
quired under the demonstration project;
‘‘(vii) a description of any require-
ment that the Secretary waives pursuant
to subsection (d); and
‘‘(viii) a certification, provided after
review by the administering Secretaries,
that any entity that is receiving payments
by reason of the demonstration project has
sufficient—
‘‘(I) resources and expertise to
provide, consistent with payments
under subsection (h), the full range of
benefits required to be provided to
beneficiaries under the project; and
‘‘(II) information and billing sys-
tems in place to ensure the accurate
and timely submission of claims for
benefits and to ensure that providers
of services, physicians, and other
health care professionals are reim-
bursed by the entity in a timely and
accurate manner.
‘‘(C) VOLUNTARY
PARTICIPATION.—Par-
ticipation of targeted medicare-eligible veterans
in the demonstration project shall be voluntary,
subject to the capacity of participating dem-
onstration sites and the funding limitations
specified in subsection (h), and shall be subject
to such terms and conditions as the admin-
istering Secretaries may establish. In the case
of a demonstration site described in paragraph
(2)(C)(i), targeted medicare-eligible veterans
services in a simplified and expedited manner. To the max-
imum extent practicable, such practices shall include elec-
tronic processing of claims.
‘‘(d) REIMBURSEMENT
OF HEALTH CARE PRO-
VIDERS.—(1) Subject to paragraph (2), the Secretary of
Defense may increase the reimbursement provided to
health care providers under the TRICARE program above
the reimbursement otherwise authorized such providers
under that program if the Secretary determines that such
increase is necessary in order to ensure the availability of
an adequate number of qualified health care providers
under that program.
‘‘(2) The amount of reimbursement provided under
paragraph (1) with respect to a health care service may
not exceed the lesser of—
‘‘(A) the amount equal to the local usual and
customary charge for the service in the service area
(as determined by the Secretary) in which the serv-
ice is provided; or
‘‘(B) the amount equal to 115 per cent of the
CHAMPUS maximum allowable charge for the serv-
ice.
‘‘(e) AUTHORITY FOR CERTAIN THIRD-PARTY COL-
LECTIONS.—(1) A medical treatment facility of the uni-
formed services under the TRICARE program may collect