I
105TH CONGRESS
1ST SESSION
H. R. 1357
To require the Secretary of Defense and the Secretary of Health and Human
Services to carry out a demonstration project to provide the Department
of Defense with reimbursement from the Medicare Program for health
care services provided to Medicare-eligible beneficiaries under the
TRICARE program.
IN THE HOUSE OF REPRESENTATIVES
APRIL 16, 1997
Mr. WATTS of Oklahoma introduced the following bill; which was referred to
the Committee on Ways and Means, and in addition to the Committees
on Commerce, and National Security, for a period to be subsequently de-
termined by the Speaker, in each case for consideration of such provisions
as fall within the jurisdiction of the committee concerned
A BILL
To require the Secretary of Defense and the Secretary of
Health and Human Services to carry out a demonstra-
tion project to provide the Department of Defense with
reimbursement from the Medicare Program for health
care services provided to Medicare-eligible beneficiaries
under the TRICARE program.
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 ‘‘Medicare Subvention
Fairness Act’’.
SEC. 2. DEMONSTRATION PROJECT FOR MEDICARE REIM-
BURSEMENT OF DEPARTMENT OF DEFENSE
FOR HEALTH CARE PROVIDED TO MEDICARE-
ELIGIBLE BENEFICIARIES UNDER TRICARE.
(a) IN GENERAL.—Notwithstanding any other provi-
sion of law and subject to subsection (b), the Secretary
of Defense and the Secretary of Health and Human Serv-
ices shall enter into an agreement in order to carry out
a demonstration project under which the Secretary of
Health and Human Services reimburses the Secretary of
Defense, on a capitated basis, from the medicare program
under title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.) for certain health care services provided by
the Secretary of Defense to medicare-eligible military
beneficiaries through the TRICARE program.
(b) PROJECT REQUIREMENTS.—(1)(A) The Sec-
retary of Defense shall budget for and expend on health
care services in each region in which the demonstration
project is carried out an amount equal to the amount that
the Secretary would otherwise budget for and expend on
such services in the absence of the project.
(B) The Secretary may not be reimbursed under the
project for health care services provided to medicare-eligi-
ble military beneficiaries in a region until the amount ex-
pended by the Secretary to provide health care services
in that region exceeds the amount budgeted for health care
services in that region under subparagraph (A).
(2) The agreement between the Secretary of Defense
and the Secretary of Health and Human Services shall
provide that the cost to the medicare program of providing
services under the project does not exceed the cost that
the medicare program would otherwise incur in providing
such services in the absence of the project.
(3) The authority of the Secretary of Defense to
carry out the project shall expire three years after the date
of the commencement of the project.
(c) REPORTS.—Not later than 14 months after the
commencement of the demonstration project under sub-
section (a), and annually thereafter until the year follow-
ing the year in which the project is terminated, the Sec-
retary of Defense and the Secretary of Health and Human
Services shall jointly submit to Congress a report on the
demonstration project. The report shall include the follow-
ing:
(1) The number of medicare-eligible military
beneficiaries provided health care services under the
project during the previous year.
(2) An assessment of the benefits to such bene-
ficiaries of receiving health care services under the
project.
(3) A description of the cost-shifting, if any,
among medical care programs of the Department of
Defense that results from the project.
(4) A description of the cost shifting, if any,
from the Department to the medicare program that
results from the project.
(5) An analysis of the effect of the project on
the following:
(A) Access to the military medical treat-
ment system, including access to military medi-
cal treatment facilities.
(B) The availability of space and facilities
and the capabilities of medical staff to provide
fee-for-service medical care.
(C) Established priorities for treatment of
beneficiaries under chapter 55 of title 10, Unit-
ed States Code.
(D) The cost to the Department of provid-
ing prescription drugs to the beneficiaries de-
scribed in subparagraph (C).
(E) The quality of health care provided by
the Department.
(F) Health care providers and medicare-el-
igible military beneficiaries in the communities
in which the project is carried out.
(6) An assessment of the effects of continuing
the project on the overall budget of the Department
for health care and on the budget of each military
medical treatment facility.
(7) An assessment of the effects of continuing
the project on expenditures from the medicare trust
funds under title XVIII of the Social Security Act.
(8) An analysis of the lessons learned by the
Department as a result of the project.
(9) Any other information that the Secretary of
Defense and the Secretary of Health and Human
Services jointly consider appropriate.
(d) REVIEW BY COMPTROLLER GENERAL.—Not later
than December 31 each year in which the demonstration
project is carried out under this section, the Comptroller
General shall determine and submit to Congress a report
on the extent, if any, to which the costs of the Secretary
of Defense under the TRICARE program and the costs
of the Secretary of Health and Human Services under the
medicare program have increased as a result of the
project.
(e) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘medicare-eligible military bene-
ficiary’’ means a beneficiary under chapter 55 of
title 10, United States Code, who is entitled to bene-
fits under part A of title XVIII of the Social Secu-
rity Act.
(2) The term ‘‘TRICARE program’’ means the
managed health care program that is established by
the Secretary of Defense under the authority of
chapter 55 of title 10, United States Code, prin-
cipally section 1097 of that title, and includes the
competitive selection of contractors to financially un-
derwrite the delivery of health care services under
the Civilian Health and Medical Program of the
Uniformed Services.
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