I
105TH CONGRESS
1ST SESSION
H. R. 192
To establish a demonstration project to evaluate the cost-effectiveness of
using the medicare trust funds to reimburse the Department of Defense
for certain health care services provided to medicare-eligible covered
military beneficiaries.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 7, 1997
Mr. HEFLEY (for himself, Mr. WATTS of Oklahoma, Mr. NORWOOD, Mr. TAY-
LOR of Mississippi, Mr. FILNER, Mr. ENSIGN, Mr. BONILLA, Mr. BART-
LETT of Maryland, Mr. ABERCROMBIE, Mr. GONZALEZ, Mr. RAMSTAD,
Mr. CONDIT, Mr. GOODLATTE, Mr. LEWIS of Kentucky, Mr. BALLENGER,
Mr. BEREUTER, Mr. CUNNINGHAM, Mr. CLEMENT, and Mr. HERGER) in-
troduced the following bill; which was referred to the Committee on Ways
and Means, and in addition to the Committees on Commerce and Na-
tional Security, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction of the committee concerned
A BILL
To establish a demonstration project to evaluate the cost-
effectiveness of using the medicare trust funds to reim-
burse the Department of Defense for certain health care
services provided to medicare-eligible covered military
beneficiaries.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Uniformed Services Medicare Subvention Demonstration
Project Act’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
Sec. 3. Establishment of demonstration project.
Sec. 4. Determination of reimbursement amounts.
Sec. 5. Reporting requirements.
SEC. 2. DEFINITIONS.
For purposes of this Act:
(1) MEDICARE-ELIGIBLE
COVERED
MILITARY
BENEFICIARY.—The term ‘‘medicare-eligible covered
military beneficiary’’ means a beneficiary under
chapter 55 of title 10, United States Code, who—
(A) is entitled to hospital insurance bene-
fits under part A of title XVIII of the Social
Security Act (42 U.S.C. 1395c et seq.);
(B) is enrolled in the supplementary medi-
cal insurance program under part B of such
title (42 U.S.C. 1395j et seq.); and
(C) resides within a geographic area des-
ignated under section 3(b) as a location for the
demonstration project.
(2) 
TRICARE 
PROGRAM.—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, principally section 1097 of
such title, and includes the competitive selection of
contractors to financially underwrite the delivery of
health care services under the Civilian Health and
Medical Program of the Uniformed Services.
(3) DEMONSTRATION
PROJECT.—The term
‘‘demonstration project’’ means the uniformed serv-
ices medicare subvention demonstration project es-
tablished under section 3.
(4) SECRETARIES.—The term ‘‘Secretaries’’
means the Secretary of Defense and the Secretary of
Health and Human Services acting jointly, except
that in section 6, the term means the Secretary of
Veterans Affairs and the Secretary of Health and
Human Services acting jointly.
SEC. 3. ESTABLISHMENT OF DEMONSTRATION PROJECT.
(a) ESTABLISHMENT REQUIRED.—The Secretary of
Defense and the Secretary of Health and Human Services
shall jointly establish a demonstration project to provide
the Department of Defense with reimbursement, in ac-
cordance with section 4, from the medicare program under
title XVIII of the Social Security Act (42 U.S.C. 1395
under the medicare program have increased as a result
of the project.
(f) DEMONSTRATION PROJECT ADJUSTMENTS FOL-
LOWING REVIEW.—Based on the review prepared under
subsection (e), the Secretaries shall modify the demonstra-
tion project at the end of each year as provided in sub-
section (d)(2) to correct for any discrepancy between cost
targets and actual spending under the demonstration
project. The Secretaries shall provide for an annual rec-
onciliation of payments to ensure that actual costs in-
curred by the Secretary of Defense to provide health care
services to medicare-eligible covered military beneficiaries,
exclusive of payments from the Secretary of Health and
Human Services under subsection (a), met the mainte-
nance of effort requirements under subsection (b).
SEC. 5. REPORTING REQUIREMENTS.
Not later than 15 months after the establishment of
the demonstration project, and then not later than 90 days
after the end of the demonstration project, the Secretaries
shall submit to Congress a report containing the following:
(1) The number of medicare-eligible covered
military beneficiaries enrolling in the demonstration
project instead of receiving health benefits through
another health insurance plan (including through the
medicare program).
(2) An analysis of whether, and in what man-
ner, easier access to the military treatment system
affects the number of medicare-eligible covered mili-
tary beneficiaries receiving health benefits under the
medicare program.
(3) A list of the health insurance plans and pro-
grams that were the primary payers for medicare-eli-
gible covered military beneficiaries during the year
prior to their enrollment in the demonstration
project and the distribution of their previous enroll-
ment in such plans and programs.
(4) An identification of cost-shifting (if any)
among medical care programs as a result of the
demonstration project and a description of the na-
ture of any such cost-shifting.
(5) An analysis of how the demonstration
project affects the overall accessibility of the military
treatment system and the amount of space available
for point-of-service care and a description of the un-
intended effects (if any) upon the normal treatment
priority system.
(6) A description of the difficulties (if any) ex-
perienced by the Department of Defense in manag-
ing the demonstration project.
(7) A description of the effects of the dem-
onstration project on military treatment facility
readiness and training and the probable effects of
the project on overall Department of Defense medi-
cal readiness and training.
(8) A description of the effects that the dem-
onstration project, if permanent, would be expected
to have on the overall budget of the military health
care system and the budgets of individual military
treatment facilities.
(9) An analysis of whether the demonstration
project affects the cost to the Department of De-
fense of prescription drugs or the accessibility, avail-
ability, and cost of such drugs to program bene-
ficiaries.
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