H. R. 4546—131
Subtitle B—Reports
SEC. 711. CLAIMS INFORMATION.
(a) CORRESPONDENCE
TO
MEDICARE
CLAIMS
INFORMATION
REQUIREMENTS.—Section 1095c of title 10, United States Code,
is amended by adding at the end the following new subsection:
‘‘(d) CORRESPONDENCE
TO
MEDICARE
CLAIMS
INFORMATION
REQUIREMENTS.—The Secretary of Defense, in consultation with
the other administering Secretaries, shall limit the information
required in support of claims for payment for health care items
and services provided under the TRICARE program to that informa-
tion that is identical to the information that would be required
for claims for reimbursement for those items and services under
title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.)
except for that information, if any, that is uniquely required by
the TRICARE program. The Secretary of Defense shall report to
the Committee on Armed Services of the Senate and the Committee
on Armed Services of the House of Representatives any information
that is excepted under this provision, and the justification for that
exception.’’.
(b) APPLICABILITY.—The Secretary of Defense, in consultation
with the other administering Secretaries referred to in section
1072(3) of title 10, United States Code, shall apply the limitations
required under subsection (d) of section 1095c of such title (as
added by subsection (a)) with respect to contracts entered into
under the TRICARE program on or after October 1, 2002.
(c) COMPTROLLER GENERAL REPORT ON TRICARE CLAIMS PROC-
ESSING.—Not later than March 31, 2003, the Comptroller General
shall submit to Congress an evaluation of the continuing impedi-
ments to cost effective claims processing under the TRICARE pro-
gram. The evaluation shall include a discussion of the following:
(1) The extent of progress implementing improvements in
claims processing, particularly regarding the application of best
industry practices.
(2) The extent of progress in simplifying claims processing
procedures, including the elimination of, or reduction in, the
complexity of the Health Care Service Record requirements.
(3) The cost effectiveness of the data collection and fraud
prevention capabilities of existing claims processing practices.
(4) Recommendations for improving the claims processing
system that will reduce processing and administration costs,
create greater competition, and improve fraud-prevention activi-
ties.
SEC. 712. COMPTROLLER GENERAL REPORT ON PROVISION OF CARE
UNDER THE TRICARE PROGRAM.
Not later than March 31, 2003, the Comptroller General shall
submit to Congress an evaluation of the nature of, reasons for,
extent of, and trends regarding network provider instability under
the TRICARE program, and the effectiveness of efforts by the
Department of Defense and managed care support contractors to
measure and mitigate such instability. The evaluation shall include
a discussion of the following:
(1) The adequacy of measurement tools of TRICARE net-
work instability and their use by the Department of Defense
H. R. 4546—132
and managed care support contractors to assess network ade-
quacy and stability.
(2) Recommendations for improvements needed in measure-
ment tools or their application.
(3) The relationship of reimbursement rates and adminis-
tration requirements (including preauthorization requirements)
to TRICARE network instability.
(4) The extent of problems under the TRICARE program
and likely future trends with and without intervention using
existing authority.
(5) Use of existing authority by the Department of Defense
and TRICARE managed care support contractors to apply
higher reimbursement rates in specific geographic areas.
(6) Recommendations for specific fiscally prudent measures
that could mitigate negative trends or improve provider and
network stability.
SEC. 713. REPEAL OF REPORT REQUIREMENT.
Notwithstanding subsection (f)(2) of section 712 of the Floyd
D. Spence National Defense Authorization Act for Fiscal Year 2001
(as enacted into law by Public Law 106-398; 114 Stat. 1654A–
179), the amendment made by subsection (e) of such section shall
not take effect and the paragraph amended by such subsection
is repealed.
Subtitle C—Department of Defense-Depart-
ment of Veterans Affairs Health Re-
sources Sharing
SEC. 721. REVISED COORDINATION AND SHARING GUIDELINES.
(a) IN GENERAL.—(1) Section 8111 of title 38, United States
Code, is amended to read as follows:
‘‘§ 8111. Sharing of Department of Veterans Affairs and
Department of Defense health care resources
‘‘(a) REQUIRED COORDINATION AND SHARING OF HEALTH CARE
RESOURCES.—The Secretary of Veterans Affairs and the Secretary
of Defense shall enter into agreements and contracts for the mutu-
ally beneficial coordination, use, or exchange of use of the health
care resources of the Department of Veterans Affairs and the
Department of Defense with the goal of improving the access to,
and quality and cost effectiveness of, the health care provided
by the Veterans Health Administration and the Military Health
System to the beneficiaries of both Departments.
‘‘(b) JOINT REQUIREMENTS
FOR SECRETARIES
OF VETERANS
AFFAIRS
AND
DEFENSE.—To facilitate the mutually beneficial
coordination, use, or exchange of use of the health care resources
of the two Departments, the two Secretaries shall carry out the
following functions:
‘‘(1) Develop and publish a joint strategic vision statement
and a joint strategic plan to shape, focus, and prioritize the
coordination and sharing efforts among appropriate elements
H. R. 4546—133
of the two Departments and incorporate the goals and require-
ments of the joint sharing plan into the strategic and perform-
ance plan of each Department under the Government Perform-
ance and Results Act.
‘‘(2) Jointly fund the interagency committee provided for
under subsection (c).
‘‘(3) Continue to facilitate and improve sharing between
individual Department of Veterans Affairs and Department
of Defense health care facilities, but giving priority of effort
to initiatives (A) that improve sharing and coordination of
health resources at the intraregional and nationwide levels,
and (B) that improve the ability of both Departments to provide
coordinated health care.
‘‘(4) Establish a joint incentive program under subsection
(d).
‘‘(c) DOD–VA HEALTH EXECUTIVE COMMITTEE.—(1) There is
established an interagency committee to be known as the Depart-
ment of Veterans Affairs-Department of Defense Health Executive
Committee (hereinafter in this section referred to as the ‘Com-
mittee’). The Committee is composed of—
‘‘(A) the Deputy Secretary of Veterans Affairs and such
other officers and employees of the Department of Veterans
Affairs as the Secretary of Veterans Affairs may designate;
and
‘‘(B) the Under Secretary of Defense for Personnel and
Readiness and such other officers and employees of the Depart-
ment of Defense as the Secretary of Defense may designate.
‘‘(2)(A) During odd-numbered fiscal years, the Deputy Secretary
of Veterans Affairs shall chair the Committee. During even-num-
bered fiscal years, the Under Secretary of Defense shall chair the
Committee.
‘‘(B) The Deputy Secretary and the Under Secretary shall deter-
mine the size and structure of the Committee, as well as the
administrative and procedural guidelines for the operation of the
Committee. The two Departments shall share equally the Commit-
tee’s cost of personnel and administrative support and services.
Support for such purposes shall be provided at a level sufficient
for the efficient operation of the Committee, including a permanent
staff and, as required, other temporary working groups of appro-
priate departmental staff and outside experts.
‘‘(3) The Committee shall recommend to the Secretaries stra-
tegic direction for the joint coordination and sharing efforts between
and within the two Departments under this section and shall over-
see implementation of those efforts.
‘‘(4) The Committee shall submit to the two Secretaries and
to Congress an annual report containing such recommendations
as the Committee considers appropriate.
‘‘(5) In order to enable the Committee to make recommendations
in its annual report under paragraph (4), the Committee shall
do the following:
‘‘(A) Review existing policies, procedures, and practices
relating to the coordination and sharing of health care resources
between the two Departments.
‘‘(B) Identify changes in policies, procedures, and practices
that, in the judgment of the Committee, would promote mutu-
ally beneficial coordination, use, or exchange of use of the
health care resources of the two Departments, with the goal
H. R. 4546—134
of improving the access to, and quality and cost effectiveness
of, the health care provided by the Veterans Health Administra-
tion and the Military Health System to the beneficiaries of
both Departments.
‘‘(C) Identify and assess further opportunities for the
coordination and sharing of health care resources between the
Departments that, in the judgment of the Committee, would
not adversely affect the range of services, the quality of care,
or the established priorities for care provided by either Depart-
ment.
‘‘(D) Review the plans of both Departments for the acquisi-
tion of additional health care resources, especially new facilities
and major equipment and technology, in order to assess the
potential effect of such plans on further opportunities for the
coordination and sharing of health care resources.
‘‘(E) Review the implementation of activities designed to
promote the coordination and sharing of health care resources
between the Departments.
‘‘(6) The Committee chairman, under procedures jointly devel-
oped by the two Secretaries, may require the Inspector General
of either or both Departments to assist in activities under paragraph
(5)(E).
‘‘(d) JOINT INCENTIVES PROGRAM.—(1) Pursuant to subsection
(b)(4), the two Secretaries shall carry out a program to identify,
provide incentives to, implement, fund, and evaluate creative
coordination and sharing initiatives at the facility, intraregional,
and nationwide levels. The program shall be administered by the
Committee established in subsection (c), under procedures jointly
prescribed by the two Secretaries.
‘‘(2) To facilitate the incentive program, effective October 1,
2003, there is established in the Treasury a fund to be known
as the ‘DOD–VA Health Care Sharing Incentive Fund’. Each Sec-
retary shall annually contribute to the fund a minimum of
$15,000,000 from the funds appropriated to that Secretary’s Depart-
ment. Such funds shall remain available until expended.
‘‘(3)(A) For each fiscal year during which the program under
this subsection is in effect, the Comptroller General shall conduct
a review of the implementation and effectiveness of the incentives
program under this subsection. Upon completion of each such
annual review, the Comptroller General shall submit to the Commit-
tees on Armed Services and Veterans’ Affairs of the Senate and
House of Representatives a report on the results of that review.
Each such report shall be submitted not later than February 28
of the year following the fiscal year covered by the report. In
addition, the Comptroller General shall conduct such a review
during the first five months of fiscal year 2004 and, not later
than February 28, 2004, shall submit to those committees a report
on the implementation and effectiveness of the incentives program
under this subsection to that date.
‘‘(B) Each report under this paragraph shall describe activities
carried out under the program under this subsection during the
preceding fiscal year (or, in the case of the first such report, to
the date of the submission of the report). Each report shall include
at least the following:
‘‘(i) An analysis of the initiatives funded by the Committee,
and the funds so expended by such initiatives, from the DOD-
VA Health Care Sharing Incentive Fund, including the purposes