I
104TH CONGRESS
2D SESSION
H. R. 3119
To amend title 38, United States Code, to revise and improve eligibility
for medical care and services under that title, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
MARCH 20, 1996
Mr. MONTGOMERY (by request) introduced the following bill; which was re-
ferred to the Committee on Veterans’ Affairs, and in addition to the
Committees on Ways and Means, and Commerce, for a period to be sub-
sequently determined by the Speaker, in each case for consideration of
such provisions as fall within the jurisdiction of the committee concerned
A BILL
To amend title 38, United States Code, to revise and improve
eligibility for medical care and services under that title,
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. ELIGIBILITY FOR CARE AND SERVICES OF
CATASTROPHICALLY DISABLED VETERANS.
(a) ELIGIBILITY.—Paragraph (1) of subsection (a) of
section 1710 of title 38, United States Code, is amended—
(1) by striking out ‘‘and’’ at the end of sub-
paragraph (H);
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(2) by striking out the period at the end of sub-
paragraph (I) and inserting in lieu thereof ‘‘; and’’;
and
(3) by adding at the end the following:
‘‘(J) to a veteran who is catastrophically dis-
abled, for any purpose that the Secretary determines
medically necessary.’’.
(b) DEFINITION.—Such subsection is further amend-
ed by adding at the end the following:
‘‘(4) For the purposes of this subsection, the term
‘veteran who is catastrophically disabled’ means any vet-
eran in any year in which the expenditures of the veteran
for hospital care and nursing home care exceeds the
amount equal to 7.5 percent of the gross adjusted income
of the veteran for Federal income tax purposes during the
preceding year.’’.
SEC. 2. ELIGIBILITY FOR OUTPATIENT SERVICES.
(a) ELIGIBILITY.—Subsection (a) of section 1712 of
title 38, United States Code, is amended—
(1) by striking out paragraphs (1) through (3)
and inserting in lieu thereof the following new para-
graphs (1) and (2):
‘‘(a)(1) The Secretary shall furnish on an ambulatory
or outpatient basis such medical services as the Secretary
determines are needed to any veteran described in sub-
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paragraph (A), (B), (C), (D), (E), (F), (H), (I), or (J)
of section 1710(a)(1) of this title for a disability described
in the subparagraph that relates to such veteran.
‘‘(2)(A)(i) Subject to subparagraphs (D) and (E) of
this paragraph, a veteran described in clause (ii) is eligible
for medical services on an ambulatory or outpatient basis
for any disability, notwithstanding that there is insuffi-
cient medical evidence to conclude that such disability may
be associated with the exposure of the veteran as described
in that clause.
‘‘(ii) Clause (i) applies to any veteran—
‘‘(I) who served on active duty in the Republic
of Vietnam during the Vietnam era; and
‘‘(II) who the Secretary finds may have been
exposed during such service to dioxin or was exposed
during such service to a toxic substance found in a
herbicide or defoliant used in connection with mili-
tary purposes during such era.
‘‘(B) Subject to subparagraphs (D) and (E) of this
paragraph, a veteran who the Secretary finds was exposed
while serving on active duty to ionizing radiation from the
detonation of a nuclear device in connection with such vet-
eran’s participation in the test of such a device or with
the American occupation of Hiroshima and Nagasaki,
Japan, during the period beginning on September 11,
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1945, and ending on July 1, 1946, is eligible for medical
services on an ambulatory or outpatient basis for any dis-
ability, notwithstanding that there is insufficient medical
evidence to conclude that such disability may be associated
with such exposure.
‘‘(C) Subject to subparagraphs (D) and (E) of this
paragraph, a veteran who the Secretary finds may have
been exposed while serving on active duty in the Southwest
Asia theater of operations during the Persian Gulf War
to a toxic substance or environmental hazard is eligible
for medical services on an ambulatory or outpatient basis
for any disability, notwithstanding that there is insuffi-
cient medical evidence to conclude that such disability may
be associated with such exposure.
‘‘(D) Medical services may not be provided under sub-
paragraph (A), (B), or (C) of this paragraph with respect
to a disability that is found, in accordance with guidelines
issued by the Under Secretary for Health, to have resulted
from a cause other than an exposure described in such
subparagraph (A), (B), or (C).
‘‘(E) Medical services may not be provided under or
by virtue of subparagraph (A), (B), or (C) of this para-
graph after December 31, 1996.’’;
(2) by redesignating paragraphs (4), (5), and
(6) as paragraphs (3), (4), and (5), respectively;
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(3) in paragraph (3), as so redesignated, by
striking out ‘‘paragraph (5)’’ and inserting in lieu
thereof ‘‘paragraph (4)’’;
(4) in subparagraph (A) of paragraph (4), as so
redesignated, by striking out ‘‘paragraph (4)’’ and
inserting in lieu thereof ‘‘paragraph (3)’’; and
(5) by striking out paragraph (7).
(b) REPEAL OF ORDER OF PRIORITY FOR SERV-
ICES.—Such section is further amended by striking out
subsection (i).
SEC. 3. ELIGIBILITY FOR NURSING HOME CARE, DOMI-
CILIARY CARE, AND LONG-TERM CARE.
(a) ELIGIBILITY.—Section 1710(a) of title 38, Unit-
ed States Code, as amended by section 1 of this Act, is
further amended by adding at the end the following:
‘‘(5) The Secretary shall furnish nursing home care,
domiciliary care, or long-term care to any veteran de-
scribed in paragraph (1) of this subsection if the Secretary
determines that the furnishing of such care to the veteran
is necessary for medical purposes or to obviate the need
for hospital care under this section.’’.
(b) DEFINITION
OF LONG-TERM CARE.—Section
1701 of such title is amended by adding at the end the
following:
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‘‘(10) The term ‘long-term care’ means home
care, home services, adult day health care, respite
care (as such term is defined in section 1720B(b) of
this title), and community residential care (including
care under the services authorized in section
1720C(a) of this title).’’.
SEC. 4. AUTHORITY TO PROVIDE HEALTH CARE SERVICES
TO ADULT DEPENDENTS OF VETERANS IN DE-
PARTMENT FACILITIES.
(a) AUTHORITY.—Subsection (a)(2) of section 1710
of title 38, United States Code, is amended—
(1) by inserting ‘‘(A)’’ after ‘‘(2)’’; and
(2) by adding at the end the following:
‘‘(B) The Secretary may, to the extent resources and
facilities are available, furnish hospital care and nursing
home care to any adult dependent of a veteran which the
Secretary determines is needed for a disability, subject to
the provisions of subsection (f) of this section.’’.
(b) PAYMENT FOR CARE.—Paragraph (1) of sub-
section (f) of such section is amended—
(1) by inserting ‘‘(A)’’ after ‘‘(f)(1)’’; and
(2) by adding at the end the following:
‘‘(B) The Secretary may not furnish hospital care or
nursing home care under this section to any adult depend-
ent of a veteran who is eligible for such care under sub-
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section (a)(2)(B) of this section unless the adult depend-
ent agrees to pay the United States the applicable amount
determined under paragraph (2) of this subsection. An
adult dependent shall be treated as a veteran for the pur-
poses of the application of such paragraph to the adult
dependent by reason of this subparagraph.’’.
(c) UTILIZATION OF PAYMENTS FOR CARE.—Para-
graph (4) of such subsection (f) is amended to read as
follows:
‘‘(4) Amounts collected or received by the United
States under this subsection shall be available to the Sec-
retary for payment of the costs of furnishing care and
services under this section. Such amounts shall be avail-
able without fiscal year limitation.’’.
SEC. 5. AUTHORITY TO PROVIDE PRIMARY HEALTH CARE
SERVICES.
(a) IN GENERAL.—Paragraph (6)(A)(i) of section
1701 of title 38, United States Code, is amended by in-
serting ‘‘primary health care services,’’ after ‘‘preventive
health services,’’.
(b) DEFINITION.—Such section, as amended by sec-
tion 3(b) of this Act, is further amended by adding at the
end the following:
‘‘(11) The term ‘primary health care services’
includes—
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‘‘(A) initial diagnostic services (including
laboratory services, x-ray services, and phar-
macy services), treatment services, referral to
specialized care or services, and long-term fol-
low-up care or services with respect to chronic
conditions which services, referral, and care or
services are provided on an ambulatory basis by
physicians (including general and family practi-
tioners, pediatricians, obstetrician/gynecologists,
and internists) or by nurse practitioners or phy-
sician’s assistants under the supervision of phy-
sicians; and
‘‘(B) routine services with respect to dis-
abilities that are provided by physicians who
specialize in such disabilities.’’.
SEC. 6. CLARIFICATION OF AUTHORITY TO PROVIDE PRE-
VENTIVE HEALTH SERVICES.
Section 1701(6)(A)(i) of title 38, United States Code,
as amended by section 5, is further amended by striking
out ‘‘(in the case of a person otherwise receiving care or
services under this chapter)’’.
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SEC. 7. AUTHORITY TO CONTRACT FOR PRIMARY HEALTH
CARE SERVICES AND PREVENTIVE HEALTH
SERVICES IN NON-DEPARTMENT FACILITIES.
(a) REPEAL OF REPORTING REQUIREMENT.—Sec-
tion 1703 of title 38, United States Code, is amended by
striking out subsection (c).
(b) AUTHORITY TO CONTRACT.—Such section is fur-
ther amended—
(1) by redesignating subsection (b) as sub-
section (c); and
(2) by inserting after subsection (a) the follow-
ing new subsection (b):
‘‘(b)(1) Subject to paragraph (2), the Secretary may
furnish primary health care services or preventive health
services under section 1712 of this title to veterans who
reside in locations that are more than 50 miles or 1 hour
traveling time from a Department facility furnishing such
services by or through contract with non-Department fa-
cilities.
‘‘(2) The Secretary may contract with a non-Depart-
ment facility under paragraph (1) of this subsection only
if the Secretary determines through sound analysis that—
‘‘(A) the quality of the services to be provided
by the non-Department facility under the contract is
equal to or exceeds the quality of the services that
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would otherwise be provided by a Department facil-
ity in the absence of the contract; and
‘‘(B) the cost of furnishing the services by con-
tract through the non-Department facility will be
equal to or less than the cost of furnishing the serv-
ices through a Department facility.’’.
SEC. 8. REVISION OF AUTHORITY TO PROVIDE PROSTHETIC
APPLIANCES.
(a) DEFINITION
OF MEDICAL SERVICES.—Section
1701(6)(A)(i) of title 38, United States Code, as amended
by this Act, is further amended by striking out ‘‘and (ex-
cept under the conditions’’ and all that follows through
‘‘prosthetic appliances,’’ and inserting in lieu thereof
‘‘medical equipment and prosthetic appliances that are
prescribed by a physician based on specific medical
needs,’’.
(b) AUTHORITY TO PROVIDE.—(1) Section 1714 of
title 38, United States Code, is amended to read as fol-
lows:
‘‘§ 1714. Medical equipment and prosthetic appli-
ances; aids for the blind and the hearing
impaired
‘‘(a) The Secretary shall furnish medical equipment
or a prosthetic appliance to any veteran who is entitled
to such equipment or appliance.
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‘‘(b)(1) The Secretary shall furnish any veteran fur-
nished medical equipment or a prosthetic appliance under
subsection (a) with such fitting and training in the use
of the equipment or appliance as the Secretary determines
necessary.
‘‘(2) The Secretary may furnish training to a veteran
under this subsection in a Department facility or by con-
tract (including by contract with a training institution)
and may include in connection with such training travel
and incidental expenses (under the terms and conditions
set forth in section 111 of this title) to and from the home
of the veteran to the facility or institution at which the
training is furnished.
‘‘(c) The Secretary may furnish any veteran fur-
nished medical equipment or a prosthetic appliance under
subsection (a) with special clothing made necessary by the
wearing of the medical equipment or appliance.
‘‘(d) The Secretary may repair or replace any medical
equipment or prosthetic appliances reasonably necessary
to a veteran and belonging to the veteran which are dam-
aged or destroyed by a fall or other accident caused by
a service-connected disability for which the veteran is in
receipt of, or but for the receipt of retirement pay would
be entitled to, disability compensation.
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‘‘(e)(1) The Secretary may furnish veterans who are
entitled to disability compensation with the following:
‘‘(A) Seeing-eye or guide dogs trained for the
aid of the blind.
‘‘(B) Devices for aiding individuals in over-
coming the handicap of blindness.
‘‘(2) In furnishing a seeing-eye or guide dog to a vet-
eran under this subsection, the Secretary may furnish
training described in subsection (b)(2), including travel ex-
penses, to the veteran in the use of the dog.
‘‘(f) The Secretary may furnish devices for assisting
in overcoming the handicap of deafness, including
telecaptioning decoding devices for television receivers, to
veterans who are profoundly deaf and entitled to disability
compensation on account of hearing impairment.’’.
(2) The table of sections at the beginning of chapter
17 of such title is amended by striking out the item relat-
ing to section 1714 and inserting in lieu thereof the follow-
ing new item:
‘‘1714. Medical equipment and prosthetic appliances; aids for the blind and the
hearing impaired.’’.
(b) CONFORMING AMENDMENTS.—(1) Section 1717
of title 38, United States Code, is amended—
(A) by striking out subsections (b) and (c);
(B) by striking out ‘‘(a)(1)’’ and inserting in
lieu thereof ‘‘(a)’’;
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(C) by redesignating paragraphs (2) and (3) as
subsections (b) and (c), respectively; and
(D) in subsection (b), as so redesignated, by re-
designating subparagraphs (A) and (B) as para-
graphs (1) and (2), respectively.
(2)(A) Section 1719 of title 38, United States Code,
is repealed.
(B) The table of sections at the beginning of chapter
17 of such title is amended by striking out the item relat-
ing to section 1719.
SEC. 9. UTILIZATION OF MEDICAL CARE COST RECOVERY
FUND FOR PAYMENT OF COSTS OF FURNISH-
ING HEALTH CARE SERVICES.
(a) IN GENERAL.—Paragraph (4) of section 1729(g)
of title 38, United States Code, is amended to read as
follows:
‘‘(4)(A) Not later than January 1 of each year, there
shall be available to the Secretary for the purposes de-
scribed in subparagraph (C) an amount equal to the excess
of the amount of the unobligated balance remaining in the
Fund at the close of business on September 30 of the pre-
ceding year over the amount described in subparagraph
(B).
‘‘(B) The amount described in this subparagraph is
the amount equal to—
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‘‘(i) the amount of the unobligated balance re-
maining in the Fund at the close of business on Sep-
tember 30 of the preceding year that the Secretary
determines is necessary in order to enable to defray,
during the fiscal year in which the amount is avail-
able under this paragraph, expenses, payments, and
costs described in paragraph (3), plus
‘‘(ii) the amount of such balance that is equal
to the amount of the Congressional Budget Office
baseline for deposits in the Fund for such fiscal
year.
‘‘(C) Amounts available under subparagraph (A)
shall be available to the Secretary for payment of the costs
of furnishing hospital care and medical services under this
chapter, including the costs of salaries of personnel of the
Department who furnish such care and services. Such
amounts shall be available without fiscal year limitation.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall take effect on the date of the enact-
ment of this Act and apply to amounts in the Medical-
Care Cost Recovery Fund under section 1729(g) of title
38, United States Code, at the close of business on Sep-
tember 30, 1996.
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SEC. 10. AUTHORITY FOR REIMBURSEMENT BY MEDICARE
OF CERTAIN HEALTH CARE SERVICES PRO-
VIDED BY DEPARTMENT FACILITIES.
(a) AUTHORITY.—(1) Subchapter III of chapter 17
of title 38, United States Code, is amended by inserting
after section 1729 the following new section:
‘‘§ 1729A. Medicare coverage and reimbursement
‘‘(a) A Department facility shall be eligible to partici-
pate under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) as a provider of services and shall
be eligible for payments under such title if such facility
files an agreement with the Secretary of Health and Hu-
mans Services under section 1866 of the Social Security
Act (42 U.S.C. 1395cc).
‘‘(b)(1) In the case of care or services provided under
this chapter to an individual described in paragraph
(2)(A) by a Department facility, the Secretary of Health
and Human Services shall reimburse the Department fa-
cility in the same amounts and under the same terms and
conditions as that Secretary reimburses other providers of
such care and services under title XVIII of such Act with
respect to such individual.
‘‘(2)(A) Paragraph (1) applies to any veteran or adult
dependent of a veteran who is described in section
1710(a)(2) of this title and who is medicare eligible.
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‘‘(B) For purposes of this paragraph, an individual
is medicare eligible if the individual is—
‘‘(i) entitled to benefits under part A of title
XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.); or
‘‘(ii) enrolled under part B of such title (42
U.S.C. 1395j et seq.).
‘‘(c) When the Secretary provides care or services to
an individual for which the Secretary receives reimburse-
ment under this section, the Secretary shall require the
individual to pay to the Department any applicable de-
ductible or copayment that is not reimbursed by the medi-
care program under title XVIII of the Social Security Act.
‘‘(d) The Secretary shall utilize amounts received by
the Secretary under this section for payment of the costs
of furnishing care and services under this chapter.’’.
(2) The table of sections at the beginning of chapter
17 of such title is amended by inserting after the item
relating to section 1729 the following:
‘‘1729A. Medicare coverage and reimbursement.’’.
(b) PAYMENTS UNDER PART A OF MEDICARE.—Sec-
tion 1814(h) of the Social Security Act (42 U.S.C.
1395f(c)) is amended to read as follows:
‘‘Payment for Certain Services Provided in Depart-
ment of Veterans Affairs Facilities
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‘‘(h) Subject to the provisions of section 1729A of
title 38, United States Code, subsection (c) shall not apply
to care and services furnished under chapter 17 of such
title.’’.
(c) PAYMENTS UNDER PART B OF MEDICARE.—Sec-
tion 1835(d) of the Social Security Act (42 U.S.C.
1395n(d)) is amended—
(1) by striking ‘‘(d)’’ and inserting ‘‘(d)(1)’’;
and
(2) by adding at the end the following new
paragraph:
‘‘(2) Subject to the provisions of section 1729A of
title 38, United States Code, paragraph (1) shall not apply
to care and services furnished under chapter 17 of such
title.’’.
SEC. 11. MAINTENANCE OF CAPACITY OF DEPARTMENT OF
VETERANS AFFAIRS TO PROVIDE SPECIAL-
IZED SERVICES TO VETERANS.
In managing the provision of medical care and serv-
ices by the Department of Veterans Affairs, the Secretary
of Veterans Affairs shall ensure that the Department
maintains its capacity to provide for the specialized treat-
ment and rehabilitative needs of disabled veterans de-
scribed in section 1710(a) of title 38, United States Code,
including veterans with spinal cord dysfunction, blindness,
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and mental illness, within distinct programs or facilities
of the Department that are dedicated to the specialized
needs of those veterans in a manner that—
(1) affords those veterans reasonable access to
care and services for those specialized needs; and
(2) ensures that overall capacity of the Depart-
ment to provide such services is not reduced below
the capacity of the Department, nationwide, to pro-
vide those services as of the date of the enactment
of this Act.
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