I
105TH CONGRESS
2D SESSION
H. R. 3828
To amend title XVIII of the Social Security Act to improve access to health
care services for certain Medicare-eligible veterans.
IN THE HOUSE OF REPRESENTATIVES
MAY 12, 1998
Mr. THOMAS (for himself, Mr. STUMP, Mr. BILIRAKIS, Mr. SPENCE, Mr. RAN-
GEL, Mr. STEARNS, Mr. HOUGHTON, Mrs. JOHNSON of Connecticut, Mr.
SAM JOHNSON of Texas, Mr. MCCRERY, Mr. BARRETT of Nebraska, Mr.
BEREUTER, Mr. BOEHLERT, Mrs. CHENOWETH, Mr. CHRISTENSEN, Mr.
COLLINS, Mr. COMBEST, Mr. COOK, Mr. COOKSEY, Mr. CRANE, Mr.
CUNNINGHAM, Mr. DEAL of Georgia, Mr. DOYLE, Mr. EDWARDS, Mr.
EHRLICH, Mrs. EMERSON, Mr. ENGLISH of Pennsylvania, Mr. ENSIGN,
Mr. EVERETT, Mrs. FOWLER, Mr. FOX of Pennsylvania, Mr. FROST, Mr.
GONZALEZ, Mr. GOODLING, Ms. GRANGER, Mr. GREENWOOD, Mr. HALL
of Ohio, Mr. HALL of Texas, Mr. HAYWORTH, Mr. HEFNER, Mr.
HERGER, Mr. HOLDEN, Mr. HULSHOF, Mr. HUNTER, Mr. HUTCHINSON,
Mrs. KELLY, Mr. KUCINICH, Mr. LAHOOD, Mr. LAMPSON, Mr. LANTOS,
Mr. LIPINSKI, Mr. MANZULLO, Mr. METCALF, Mr. NETHERCUTT, Mr.
PORTMAN, Mr. REDMOND, Mrs. ROUKEMA, Mr. RUSH, Mr. SANDERS,
Mr. SANDLIN, Mr. SAXTON, Mr. SERRANO, Mr. SKEEN, Mr. SMITH of
New Jersey, Mr. SOLOMON, Mr. STUPAK, Mr. TANNER, Mrs. THURMAN,
Mr. TIAHRT, Mr. UPTON, Mr. WALSH, Mr. WATKINS, Mr. WATTS of
Oklahoma, Mr. WHITFIELD, and Ms. WOOLSEY) introduced the following
bill; which was referred to the Committee on Ways and Means, and in
addition to the Committees on Veterans’ Affairs, and Commerce, 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 com-
mittee concerned
A BILL
To amend title XVIII of the Social Security Act to improve
access to health care services for certain Medicare-eligible
veterans.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; PURPOSES.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Veterans Medicare Access Improvement Act of 1998’’.
(b) PURPOSES.—The purposes of this Act are—
(1) to establish a program that permits Medi-
care-eligible veterans who have a service-connected
disability or are financially needy and for whom ac-
cess to medical care of the Department of Veterans
Affairs has been historically deficient because of geo-
graphic remoteness or inaccessibility to receive their
Medicare benefits through a service network of pro-
viders established by the Department of Veterans
Affairs; and
(2) to establish a 3-year demonstration project
that permits other Medicare-eligible veterans to re-
ceive such benefits through the Department of Vet-
erans Affairs.
SEC. 2. IMPROVEMENT IN VETERANS’ ACCESS TO SERVICES
UNDER MEDICARE PROGRAM.
(a) IN GENERAL.—Title XVIII of the Social Security
Act, as amended by sections 4603, 4801, and 4015(a) of
the Balanced Budget Act of 1997, is amended by adding
at the end the following:
‘‘IMPROVING VETERANS’ ACCESS TO SERVICES
‘‘SEC. 1897. (a) DEFINITIONS.—In this section:
‘‘(1) ADMINISTERING SECRETARIES.—The term
‘administering Secretaries’ means the Secretary of
Health and Human Services and the Secretary of
Veterans Affairs acting jointly.
‘‘(2) PROGRAM.—The term ‘program’ means
the program established under this section with re-
spect to category A Medicare-eligible veterans.
‘‘(3) DEMONSTRATION
PROJECT; PROJECT.—
The terms ‘demonstration project’ and ‘project’
mean the demonstration project carried out under
this section with respect to category C Medicare-eli-
gible veterans.
‘‘(4) MEDICARE-ELIGIBLE VETERANS.—
‘‘(A) CATEGORY
A
MEDICARE-ELIGIBLE
VETERAN.—The term ‘category A Medicare-eli-
gible veteran’ means an individual—
‘‘(i) who is a veteran (as defined in
section 101(2) of title 38, United States
Code) and is described in paragraph (1) or
(2) of section 1710(a) of title 38, United
States Code;
‘‘(ii) who is entitled to hospital insur-
ance benefits under part A of the Medicare
program and is enrolled in the supple-
mentary medical insurance program under
part B of the Medicare program; and
‘‘(iii) for whom the medical center of
the Department of Veterans Affairs that is
closest to the individual’s place of resi-
dence is geographically remote or inacces-
sible from such place.
‘‘(B) CATEGORY
C
MEDICARE-ELIGIBLE
VETERAN.—The term ‘category C Medicare-eli-
gible veteran’ means an individual who—
‘‘(i) 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; and
‘‘(ii) is entitled to hospital insurance
benefits under part A of the Medicare pro-
gram and is enrolled in the supplementary
medical insurance program under part B
of the Medicare program.
‘‘(5) MEDICARE HEALTH CARE SERVICES.—The
term ‘Medicare health care services’ means items or
services covered under part A or B of this title.
‘‘(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.
‘‘(b) PROGRAM AND DEMONSTRATION PROJECT.—
‘‘(1) IN GENERAL.—
‘‘(A) ESTABLISHMENT.—The administer-
ing Secretaries are authorized to establish—
‘‘(i) a program (under an agreement
entered into by the administering Secretar-
ies) under which the Secretary of Health
and Human Services shall reimburse the
Secretary of Veterans Affairs, from the
trust funds, for Medicare health care serv-
ices furnished to category A Medicare-eligi-
ble veterans; and
‘‘(ii) a demonstration project (under
such an agreement) under which the Sec-
retary of Health and Human Services shall
reimburse the Secretary of Veterans Af-
fairs, from the trust funds, for Medicare
health care services furnished to category
C Medicare-eligible veterans.
‘‘(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 of the program
and the demonstration project established
under this section;
‘‘(ii) a description of the eligibility
rules for participation in the program and
demonstration project, including any cost
sharing requirements;
‘‘(iii) a description of the process for
enrolling veterans for participation in the
program, which process may, to the extent
practicable, be administered in the same or
similar manner to the registration process
established to implement section 1705 of
title 38, United States Code;
‘‘(iv) a description of how the pro-
gram and the demonstration project will
satisfy the requirements under this title;
‘‘(v) a description of the sites selected
under paragraph (2);
‘‘(vi) a description of how reimburse-
ment requirements under subsection (g)
and maintenance of effort requirements
under subsection (h) will be implemented
in the program and in the demonstration
project;
‘‘(vii) a statement that all data of the
Department of Veterans Affairs and of the
Department of Health and Human Serv-
ices that the administering Secretaries de-
termine is necessary to conduct independ-
ent estimates and audits of the mainte-
nance of effort requirement, the annual
reconciliation, and related matters required
under the program and the demonstration
project shall be available to the administer-
ing Secretaries;
‘‘(viii) a description of any require-
ment that the Secretary of Health and
Human Services waives pursuant to sub-
section (d);
‘‘(ix) a requirement that the Secretary
of Veterans Affairs undertake and main-
tain outreach and marketing activities,
consistent with capacity limits under the
program, for category A Medicare-eligible
veterans;
‘‘(x) a description of how the admin-
istering Secretaries shall conduct the data
matching program under subparagraph
(F), including the frequency of updates to
the comparisons performed under subpara-
graph (F)(ii); and
‘‘(xi) a statement by the Secretary of
Veterans Affairs that the type or amount
of health care services furnished under
chapter 17 of title 38, United States Code,
to veterans who are entitled to benefits
under part A or enrolled under part B, or
both, shall not be reduced by reason of the
program or project.
‘‘(C) COST-SHARING UNDER DEMONSTRA-
TION PROJECT.—Notwithstanding any provision
of title 38, United States Code, in order—
‘‘(i) to maintain and broaden access
to services,
‘‘(ii) to encourage appropriate use of
services, and
‘‘(iii) to control costs,
the Secretary of Veterans Affairs may establish
enrollment fees and copayment requirements
under the demonstration project under this sec-
tion consistent with subsection (d)(1). Such fees
and requirements may vary based on income.
‘‘(D) HEALTH CARE BENEFITS.—The ad-
ministering Secretaries shall prescribe the mini-
mum health care benefits to be provided under
the program and demonstration project to
Medicare-eligible veterans enrolled in the pro-
gram or project. Those benefits shall include at
least all Medicare health care services covered
under this title.
‘‘(E) ESTABLISHMENT OF SERVICE NET-
WORKS.—
‘‘(i) USE
OF
VA
OUTPATIENT
CLIN-
ICS.—The Secretary of Veterans Affairs, to
the extent practicable, shall use outpatient
clinics of the Department of Veterans Af-
fairs in providing services under the pro-
gram.
‘‘(ii) AUTHORITY TO CONTRACT FOR
SERVICES.—The Secretary of Veterans Af-
fairs may enter into contracts and arrange-
ments with entities (such as private practi-
tioners, providers of services, preferred
provider organizations, and health care
plans) for the provision of services for
which the Secretary of Health and Human
Services is responsible under the program
or project under this section and shall take
into account the existence of qualified
practitioners and providers in the areas in
which the program or project is being con-
ducted. Under such contracts and arrange-
ments, such Secretary of Health and
Human Services may require the entities
to furnish such information as such Sec-
retary may require to carry out this sec-
tion.
‘‘(F) DATA MATCH.—
‘‘(i) 
ESTABLISHMENT
OF
DATA
MATCHING
PROGRAM.—The administering
Secretaries shall establish a data matching
program under which there is an exchange
of information of the Department of Veter-
ans Affairs and of the Department of
Health and Human Services as is nec-
essary to identify veterans who are entitled
to benefits under part A or enrolled under
part B, or both, in order to carry out this
section. The provisions of section 552a of
title 5, United States Code, shall apply
with respect to such matching program
only to the extent the administering Sec-
retaries find it feasible and appropriate in
carrying out this section in a timely and
efficient manner.
‘‘(ii) 
PERFORMANCE
OF
DATA
MATCH.—The administering Secretaries,
using the data matching program estab-
lished under clause (i), shall perform a
comparison in order to identify veterans
who are entitled to benefits under part A
or enrolled under part B, or both. To the
extent such Secretaries deem appropriate
to carry out this section, the comparison
and identification may distinguish among
such veterans by category of veterans, by
entitlement to benefits under this title, or
by other characteristics.
‘‘(iii) DEADLINE
FOR
FIRST
DATA
MATCH.—The 
administering 
Secretaries
shall first perform a comparison under
clause (ii) by not later than October 31,
1998.
‘‘(iv) CERTIFICATION
BY
INSPECTOR
GENERAL.—
‘‘(I) IN GENERAL.—The admin-
istering Secretaries may not conduct
the program unless the Inspector Gen-
eral of the Department of Health and
Human Services certifies to Congress
that the administering Secretaries
have established the data matching
program under clause (i) and have
performed a comparison under clause
(ii).
‘‘(II) DEADLINE
FOR
CERTIFI-
CATION.—Not later than December
15, 1998, the Inspector General of the
Department of Health and Human
Services shall submit a report to Con-
gress 
containing 
the 
certification
under subclause (I) or the denial of
such certification.
‘‘(2) NUMBER
OF
SITES.—The program and
demonstration project shall be conducted in geo-
graphic service areas of the Department of Veterans
Affairs, designated jointly by the administering Sec-
retaries after review of all such areas, as follows:
‘‘(A) PROGRAM SITES.—
‘‘(i) IN
GENERAL.—Except as pro-
vided in clause (ii), the program shall be
conducted in not more than 3 such areas
with respect to category A Medicare-eligi-
ble veterans.
‘‘(ii) ADDITIONAL PROGRAM SITES.—
Subject to the certification required under
subsection (h)(1)(B)(iii), for a year begin-
ning on or after January 1, 2003, the pro-
gram shall be conducted in such areas as
are designated jointly by the administering
Secretaries after review of all such areas.
‘‘(B) PROJECT SITES.—
‘‘(i) IN
GENERAL.—The demonstra-
tion project shall be conducted in not more
than 3 such areas with respect to category
C Medicare-eligible veterans.
‘‘(ii) MANDATORY SITE.—At least one
of the areas designated under clause (i)
shall encompass the catchment area of a
military medical facility which was closed
pursuant to either the Defense Base Clo-
sure and Realignment Act of 1990 (part A
of title XXIX of Public Law 101–510; 10
U.S.C. 2687 note) or title II of the De-
fense Authorization Amendments and Base
Closure and Realignment Act (Public Law
100–526; 10 U.S.C. 2687 note).
‘‘(3) RESTRICTION.—Funds from the program
or demonstration project shall not be used for—
‘‘(A) the construction of any treatment fa-
cility of the Department of Veterans Affairs; or
‘‘(B) the renovation, expansion, or other
construction at such a facility.
‘‘(4) DURATION.—The administering Secretar-
ies shall conduct and implement the program and
the demonstration project as follows:
‘‘(A) PROGRAM.—
‘‘(i) IN GENERAL.—The program shall
begin on January 1, 2000, in the sites des-
ignated under paragraph (2)(A)(i) and,
subject to subsection (h)(1)(B)(iii)(II), for
a year beginning on or after January 1,
2003, the program may be conducted in
such additional sites designated under
paragraph (2)(A)(ii).
‘‘(ii) If for a year beginning on or
after January 1, 2003, the program is con-
ducted only in the sites designated under
paragraph (2)(A)(i), Medicare health care
services may not be provided under the
program to a number of category-A Medi-
care-eligible veterans that exceeds the ag-
gregate number of such veterans covered
under the program as of December 31,
2002.
‘‘(B) 
PROJECT.—The 
demonstration
project shall begin on January 1, 1999, and
end on December 31, 2001.
‘‘(C) IMPLEMENTATION.—The administer-
ing Secretaries may implement the program
and demonstration project through the publica-
tion of regulations that take effect on an in-
terim basis, after notice and pending oppor-
tunity for public comment.
‘‘(5) REPORTS.—
‘‘(A) PROGRAM.—By not later than Sep-
tember 1, 1999, the administering Secretaries
shall submit a copy of the agreement entered
into under paragraph (1) with respect to the
program to Congress.
‘‘(B) PROJECT.—By not later than Sep-
tember 1, 1998, the administering Secretaries
shall submit a copy of the agreement entered
into under paragraph (1) with respect to the
project to Congress.
‘‘(6) REPORT ON MAINTENANCE OF LEVEL OF
HEALTH CARE SERVICES.—
‘‘(A) IN GENERAL.—The Secretary of Vet-
erans Affairs may not implement the program
at a site designated under paragraph (2)(A) un-
less, by not later than 90 days before the date
of the implementation, the Secretary of Veter-
ans Affairs submits to Congress and to the
Comptroller General of the United States a re-
port that contains the information described in
subparagraph (B). The Secretary of Veterans
Affairs shall periodically update the report
under this paragraph as appropriate.
‘‘(B) INFORMATION DESCRIBED.—For pur-
poses of subparagraph (A), the information de-
scribed in this subparagraph is a description of
the operation of the program at the site and of
the steps to be taken by the Secretary of Veter-
ans Affairs to prevent the reduction of the type
or amount of health care services furnished
under chapter 17 of title 38, United States
Code, to veterans who are entitled to benefits
under part A or enrolled under part B, or both,
within the geographic service area of the De-
partment of Veterans Affairs in which the site
is located by reason of the program or project.
‘‘(c) CREDITING OF PAYMENTS.—A payment received
by the Secretary of Veterans Affairs under the program
or demonstration project shall be credited to the applicable
Department of Veterans Affairs medical care appropria-
tion (and within that appropriation). Any such payment
received during a fiscal year for services provided during
a prior fiscal year may be obligated by the Secretary of
Veterans Affairs during the fiscal year during which the
payment is received.
‘‘(d) APPLICATION
OF CERTAIN MEDICARE RE-
QUIREMENTS.—
‘‘(1) AUTHORITY.—
‘‘(A) IN
GENERAL.—Except as provided
under subparagraph (B), the program and the
demonstration project shall meet all require-
ments of Medicare+Choice plans under part C
and regulations pertaining thereto, and other
requirements for receiving Medicare payments,
except that the prohibition of payments to Fed-
eral providers of services under sections 1814(c)
and 1835(d), and paragraphs (2) and (3) of
section 1862(a) shall not apply.
‘‘(B) WAIVER.—Except as provided in
paragraph (2), the Secretary of Health and
Human Services is authorized to waive any re-
quirement described under subparagraph (A),
or approve equivalent or alternative ways of
meeting such a requirement, but only if such
waiver or approval—
‘‘(i) reflects the unique status of the
Department of Veterans Affairs as an
agency of the Federal Government; and
‘‘(ii) is necessary to carry out the pro-
gram or demonstration project.
‘‘(2) BENEFICIARY PROTECTIONS AND OTHER
MATTERS.—The program and the demonstration
project shall comply with the requirements of part C
of this title that relate to beneficiary protections and
other matters, including such requirements relating
to the following areas, to the extent not inconsistent
with subsection (b)(1)(B)(iii):
‘‘(A) Enrollment and disenrollment.
‘‘(B) Nondiscrimination.
‘‘(C) Information provided to beneficiaries.
‘‘(D) Cost-sharing limitations.
‘‘(E) Appeal and grievance procedures.
‘‘(F) Provider participation.
‘‘(G) Access to services.
‘‘(H) Quality assurance and external re-
view.
‘‘(I) Advance directives.
‘‘(J) Other areas of beneficiary protections
that the administering Secretaries determine
are applicable to such program or project.
‘‘(e) INSPECTOR GENERAL.—Nothing in the agree-
ment entered into under subsection (b) shall limit the In-
spector General of the Department of Health and Human
Services from investigating any matters regarding the ex-
penditure of funds under this title for the program and
demonstration project, including compliance with the pro-
visions of this title and all other relevant laws.
‘‘(f) VOLUNTARY PARTICIPATION.—Participation of a
category A Medicare-eligible veteran in the program or
category C Medicare-eligible veteran in the demonstration
project shall be voluntary.
‘‘(g) PAYMENTS BASED
ON REGULAR MEDICARE
PAYMENT RATES.—
‘‘(1) IN GENERAL.—Subject to the succeeding
provisions of this subsection, the Secretary of Health
and Human Services shall reimburse the Secretary
of Veterans Affairs for services provided under the
program or demonstration project at a rate equal to
percent 
of 
the 
amount 
paid 
to 
a
Medicare+Choice organization under part C of this
title with respect to such an enrollee. In cases in
which a payment amount may not otherwise be read-
ily computed, the Secretary of Health and Human
Services shall establish rules for computing equiva-
lent or comparable payment amounts.
‘‘(2) EXCLUSION
OF
CERTAIN
AMOUNTS.—In
computing the amount of payment under paragraph
(1), the following shall be excluded:
‘‘(A) SPECIAL
PAYMENTS.—Any amount
attributable to an adjustment under subpara-
graphs (B) and (F) of section 1886(d)(5) and
subsection (h) of such section.
‘‘(B) PERCENTAGE
OF
CAPITAL
PAY-
MENTS.—An amount determined by the admin-
istering Secretaries for amounts attributable to
payments for capital-related costs under sub-
section (g) of such section.
‘‘(3) PERIODIC
PAYMENTS
FROM MEDICARE
TRUST
FUNDS.—Payments under this subsection
shall be made—
‘‘(A) on a periodic basis consistent with
the periodicity of payments under this title; and
amount shall not exceed a total of $50,000,000
for each of calendar years 1999 through 2001.
‘‘(h) MAINTENANCE OF EFFORT.—
‘‘(1) MONITORING EFFECT OF PROGRAM AND
DEMONSTRATION PROJECT ON COSTS TO MEDICARE
PROGRAM.—
‘‘(A) IN
GENERAL.—The administering
Secretaries, in consultation with the Comptrol-
ler General of the United States, shall closely
monitor the expenditures made under this title
for category A and C Medicare-eligible veterans
compared to the expenditures that would have
been made for such veterans if the program and
demonstration project had not been conducted.
The agreement entered into by the administer-
ing Secretaries under subsection (b) shall re-
quire the Department of Veterans Affairs to
maintain overall the level of effort for services
covered under this title to such categories of
veterans by reference to a base year as deter-
mined by the administering Secretaries.
‘‘(B) DETERMINATION
OF
MEASURE
OF
COSTS
OF MEDICARE
HEALTH
CARE
SERV-
ICES.—
‘‘(i) IMPROVEMENT OF INFORMATION
MANAGEMENT
SYSTEM.—Not later than
October 1, 2001, the Secretary of Veterans
Affairs shall improve its information man-
agement system such that, for a year be-
ginning on or after January 1, 2002, the
Secretary of Veterans Affairs is able to
identify costs incurred by the Department
of Veterans Affairs in providing Medicare
health care services to Medicare-eligible
veterans for purposes of meeting the re-
quirements with respect to maintenance of
effort under an agreement under sub-
section (b)(1)(A).
‘‘(ii) IDENTIFICATION OF MEDICARE
HEALTH CARE SERVICES.—The Secretary
of Health and Human Services shall pro-
vide such assistance as is necessary for the
Secretary of Veterans Affairs to determine
which health care services furnished by the
Secretary of Veterans Affairs qualify as
Medicare health care services.
‘‘(iii) CERTIFICATION BY HHS INSPEC-
TOR GENERAL.—
‘‘(I) REQUEST
FOR
CERTIFI-
CATION.—The Secretary of Veterans
Affairs may request the Inspector
General of the Department of Health
and Human Services to make a cer-
tification to Congress that the Sec-
retary of Veterans Affairs has im-
proved its management system under
clause (i) such that the Secretary of
Veterans Affairs is able to identify the
costs described in such clause in a
reasonably reliable and accurate man-
ner.
‘‘(II) REQUIREMENT FOR EXPAN-
SION
OF
PROGRAM.—The program
may be conducted in the additional
sites under paragraph (2)(A)(ii) and
cover such additional category A
Medicare eligible veterans in such ad-
ditional sites only if the Inspector
General of the Department of Health
and Human Services has made the
certification described in subclause
(I).
‘‘(III) DEADLINE
FOR
CERTIFI-
CATION.—Not later than the date that
is the earlier of the date that is 60
days after the Secretary of Veterans
Affairs requests a certification under
subclause (I) or June 1, 2002, the In-
spector General of the Department of
Health and Human Services shall sub-
mit a report to Congress containing
the certification under subclause (I)
or the denial of such certification.
‘‘(C) MAINTENANCE
OF
LEVEL
OF
EF-
FORT.—
‘‘(i) REPORT BY SECRETARY OF VET-
ERANS AFFAIRS ON BASIS FOR CALCULA-
TION.—Not later than the date that is 60
days after the date on which the admin-
istering Secretaries enter into an agree-
ment under subsection (b)(1)(A), the Sec-
retary of Veterans Affairs shall submit a
report to Congress and the Comptroller
General of the United States explaining
the methodology used and basis for cal-
culating the level of effort of the Depart-
ment of Veterans Affairs under the pro-
gram and project.
‘‘(ii) REPORT BY COMPTROLLER GEN-
ERAL.—Not later than the date that is 180
days after the date described in clause (i),
the Comptroller General of the United
States shall submit to Congress and the
administering Secretaries a report setting
forth the Comptroller General’s findings,
conclusion, and recommendations with re-
spect to the report submitted by the Sec-
retary of Veterans Affairs under clause (i).
‘‘(iii) RESPONSE
BY
SECRETARY
OF
VETERANS
AFFAIRS.—The Secretary of
Veterans Affairs shall submit to Congress
not later than 60 days after the date de-
scribed in clause (ii) a report setting forth
such Secretary’s response to the report
submitted by the Comptroller General
under clause (ii).
‘‘(D) ANNUAL REPORT BY THE COMPTROL-
LER GENERAL.—Not later than December 31 of
each year during which the program and dem-
onstration project is conducted, the Comptroller
General of the United States shall submit to
the administering Secretaries and to Congress a
report on the extent, if any, to which the costs
of the Secretary of Health and Human Services
under the Medicare program under this title in-
creased during the preceding fiscal year as a re-
sult of the program or demonstration project.
‘‘(2) REQUIRED
RESPONSE
IN
CASE
OF
IN-
CREASE IN COSTS.—
‘‘(A) IN GENERAL.—If the administering
Secretaries find, based on paragraph (1), that
the expenditures under the Medicare program
under this title increased (or are expected to in-
crease) during a fiscal year because of the pro-
gram or demonstration project, the administer-
ing Secretaries shall take such steps as may be
needed—
‘‘(i) to recoup for the Medicare pro-
gram the amount of such increase in ex-
penditures; and
‘‘(ii) to prevent any such increase in
the future.
‘‘(B) STEPS.—Such steps—
‘‘(i) under subparagraph (A)(i) shall
include payment of the amount of such in-
creased expenditures by the Secretary of
‘‘(iii) whether the terms and condi-
tions of the project should otherwise be
continued (or modified) with respect to
Medicare-eligible veterans.
‘‘(B) PROGRAM.—Not later than 6 months
after the date of the submission of the report
by the Comptroller General of the United
States on the third year of the operation of the
program, the administering Secretaries shall
submit to Congress a report containing their
recommendation as to—
‘‘(i) whether there is a cost to the
health care program under this title in
conducting the program under this section;
‘‘(ii) whether to discontinue the pro-
gram with respect to category A Medicare-
eligible veterans; and
‘‘(iii) whether the terms and condi-
tions of the program should otherwise be
continued (or modified) with respect to
Medicare-eligible veterans.’’.
(b) REPEAL OF PLAN REQUIREMENT.—Subsection
(b) of section 4015 of the Balanced Budget Act of 1997
(relating to an implementation plan for Veterans sub-
vention) is repealed.