I
107TH CONGRESS
1ST SESSION
H. R. 2667
To provide for a joint Department of Defense and Department of Veterans
Affairs demonstration project to identify benefits of integrated manage-
ment of health care resources of those departments, and for other pur-
poses.
IN THE HOUSE OF REPRESENTATIVES
JULY 27, 2001
Mr. SMITH of New Jersey (for himself, Mr. BILIRAKIS, Mr. EVERETT, Mr.
BUYER, Mr. GIBBONS, Mr. SIMMONS, Mr. BROWN of South Carolina, Mr.
WAMP, and Mr. KIRK) introduced the following bill; which was referred
to the Committee on Veterans’ Affairs, and in addition to the Committee
on Armed Services, 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 committee concerned
A BILL
To provide for a joint Department of Defense and Depart-
ment of Veterans Affairs demonstration project to iden-
tify benefits of integrated management of health care
resources of those departments, 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. SHORT TITLE.
This Act may be cited as the ‘‘Department of De-
fense-Department of Veterans Affairs Health Resources
Access Improvement Act of 2001’’.
SEC. 2. FINDINGS AND SENSE OF CONGRESS CONCERNING
STATUS OF HEALTH RESOURCES SHARING
BETWEEN THE DEPARTMENT OF VETERANS
AFFAIRS AND THE DEPARTMENT OF DE-
FENSE.
(a) FINDINGS.—Congress makes the following find-
ings:
(1) Federal health resources provided by the
people of the United States through tax receipts are
by their nature scarce and thus should be effectively
and efficiently used.
(2) In 1982, Congress authorized health re-
sources sharing between Department of Defense
medical treatment facilities and Department of Vet-
erans Affairs health care facilities in order to allow
more effective and efficient use of their health re-
sources.
(3) Health care beneficiaries of the Depart-
ments of Defense and Veterans Affairs, whether ac-
tive servicemembers, veterans, retirees, or family
members of active or retired servicemembers, should
have full access to the health care and services that
Congress has authorized for them.
(4) The Secretary of Defense and the Secretary
of Veterans Affairs, and the appropriate officials of
each of those departments with responsibilities re-
lated to health care, have not taken full advantage
of the opportunities provided by law to make their
respective health resources available to health care
beneficiaries of the other department in order to
provide improved health care for the whole number
of beneficiaries.
(5) After the many years of support and en-
couragement from Congress, the departments have
made little progress in health resource sharing and
the intended results of the sharing authority have
not been achieved.
(b) SENSE OF CONGRESS.—Congress urges the Sec-
retary of Defense and the Secretary of Veterans Affairs
to commit their respective departments to exploring new
ways for significantly improving health resources sharing
and to building organizational cultures supportive of
health resources sharing.
(c) PURPOSE.—It is the purpose of this Act—
(1) to authorize a demonstration program to
advance the principles of health resources sharing
consistent with the expressed intent of Congress;
and
(2) to establish a basis for joint strategic plan-
ning of Department of Defense and Department of
Veterans Affairs health systems to ensure that avail-
able funds are used more effectively and efficiently
in order to enhance access to high quality health
care for their beneficiaries.
SEC. 3. HEALTH CARE FACILITIES INTEGRATION DEM-
ONSTRATION PROJECT.
(a) ESTABLISHMENT.—The Secretary of Veterans
Affairs and the Secretary of Defense shall conduct a dem-
onstration project to identify advantages of providing for
integrated management of military treatment facilities
and VA health care facilities that are located in the same
geographic area.
(b) SITE IDENTIFICATION.—(1) The Secretaries shall
jointly identify five qualifying sites at which to conduct
the demonstration project under this section.
(2) For purposes of this section, a qualifying site is
an area in the United States in which—
(A) one or more military treatment facilities
and one or more VA health care facilities are situ-
ated in relative proximity to each other;
(B) for which there could be in effect within
one year after the date of the enactment of this Act
an integrated budget and personnel system for those
facilities; and
(C) as determined by the Secretaries, both the
candidate VA facilities and the candidate military
medical treatment facilities have in place informa-
tion systems to demonstrate the validity of the ac-
tivities of those facilities so that the Secretaries are
confident that they will be able to effectively meas-
ure differences in activities at those facilities (includ-
ing cost, access, quality, patient satisfaction, and
other important performance indicators) before the
demonstration project, during the period of the dem-
onstration project, and after the end of the dem-
onstration project.
(c) CONDUCT
OF DEMONSTRATION PROJECT.—At
each site at which the demonstration project is conducted,
the Secretaries shall provide for a unified management
system for the military treatment facilities and VA health
care facilities at that site. To the extent feasible, that uni-
fied management system shall include—
(1) a unified budget and financial management
system for those facilities;
(2) a unified staffing and assignment system
for the personnel employed at or assigned to those
facilities; and
(3) medical information and information tech-
nology systems for those facilities that—
(A) are unified across those facilities;
(B) maintain interoperability with medical
information and information technology systems
of the respective departments of those facilities;
and
(C) incorporate standards of information
quality that are at least equivalent to those
adopted for the departments at large.
(d) AUTHORITY TO WAIVE CERTAIN ADMINISTRA-
TIVE REGULATIONS AND POLICIES.—(1) In order to carry
out subsection (c), the Secretary of Defense may, in the
Secretary’s discretion, waive any regulation or administra-
tive policy otherwise applicable to the Department of De-
fense, and the Secretary of Veterans Affairs may, in the
Secretary’s discretion, waive any regulation or administra-
tive policy otherwise applicable to the Department of Vet-
erans Affairs, as each Secretary determines necessary for
the purposes of the demonstration project.
(2) Not later than one year after the date of the en-
actment of this Act, the Secretary of Veterans Affairs and
the Secretary of Defense shall jointly submit to the Com-
mittees on Veterans’ Affairs and the Committees on
Armed Services of the Senate and House of Representa-
tives a report on the use of the authority provided by para-
graph (1). The report shall include a statement of the
numbers and types of requests for waivers of regulations
and administrative policies that have been made to that
date and the disposition of each.
(e) USE OF TITLE 38 PERSONNEL AUTHORITIES.—
(1) In order to carry out subsection (c), the Secretary of
Defense may apply to civilian personnel of the Department
of Defense assigned to or employed at a military treatment
facility participating in the demonstration project any of
the provisions of subchapters I, III, and IV of chapter 74
of title 38, United States Code, determined appropriate
by the Secretary.
(2) For such purposes, any reference in such
chapter—
(A) to the ‘‘Secretary’’ or the ‘‘Under Secretary
for Health’’ shall be treated as referring to the Sec-
retary of Defense; and
(B) to the ‘‘Veterans Health Administration’’
shall be treated as referring to the Department of
Defense.
(f) FACILITIES TO BE DEEMED FACILITIES OF THE
OTHER DEPARTMENT.—A VA health care facility partici-
pating in the demonstration project shall be considered to
be a military treatment facility for purposes of eligibility
for care for beneficiaries of the Department of Defense,
and a military treatment facility participating in the dem-
onstration project shall be considered to be a VA health
care facility for purposes of eligibility for care for bene-
ficiaries of the Department of Veterans Affairs.
(g) BENEFITS, COPAYMENTS, ETC., TO BE EQUAL-
IZED.—In the case of facilities of the participating depart-
ments selected to participate in the demonstration project,
the medical care for which a beneficiary of the Department
of Defense or beneficiary of the Department of Veterans
Affairs is eligible, and any required copayments or
deductibles for such care applicable to the beneficiaries of
either participating department, shall to the extent prac-
ticable be the same. Regulations to govern such benefits,
copayments, and deductibles shall be prescribed by the
Secretary of Defense and the Secretary of Veterans Af-
fairs. However, in no case may the benefits for which any
beneficiary is eligible be reduced or any copayment or de-
ductible applicable to any beneficiary be increased.
(h) AUTHORIZATION OF APPROPRIATIONS.—There is
authorized to be appropriated to each of the participating
departments to carry out the demonstration project—
(1) $10,000,000 for fiscal year 2002; and
(2) $25,000,000 for each succeeding year dur-
ing which the demonstration project is in effect.
(i) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘military treatment facility’’
means a medical facility under the jurisdiction of the
Secretary of a military department.
(2) The term ‘‘VA health care facility’’ means
a facility under the jurisdiction of the Veterans
Health Administration of the Department of Vet-
erans Affairs.
(3) The term ‘‘participating departments’’
means the Department of Veterans Affairs and the
Department of Defense.
(j) TERMINATION.—The demonstration project, and
the authority provided by this section, shall terminate on
September 30, 2006.
SEC. 4. JOINT PROSPECTUS FOR CONSTRUCTION OF NEW
MEDICAL FACILITY.
Not later than two years after the date of the enact-
ment of this Act, the Secretary of Defense and the Sec-
retary of Veterans Affairs shall submit to the appropriate
committees of Congress a prospectus for construction of
a new joint medical facility for their respective depart-
ments. The location for the new joint facility shall be se-
lected jointly by the two Secretaries and shall be—
(1) at a location where both a current Depart-
ment of Veterans Affairs medical center and a cur-
rent Department of Defense military treatment facil-
ity are in need of replacement and the new facility
can be a replacement for both; or
(B) situated so as to provide improved access to
eligible veterans and eligible military beneficiaries in
a location where there is only one Department of
Veterans Affairs medical center or military medical
treatment facility serving one of those beneficiary
populations.
SEC. 5. GRADUATE MEDICAL EDUCATION.
(a) FINDINGS.—Congress finds that integration or
consolidation of graduate medical education programs of
the Department of Defense and Department of Veterans
Affairs would—
(1) lead to increased efficiencies by eliminating
duplicative administrative processes and stream-
lining and consolidating joint training programs;
(2) allow increased clinical training sites in De-
partment of Defense and Department of Veterans
Affairs accredited programs; and
(3) make Department of Veterans Affairs facili-
ties available to military reserve health care profes-
sionals education programs.
(b) COMPREHENSIVE REVIEW.—The Secretary of
Defense and the Secretary of Veterans Affairs shall enter
into a joint contract for the conduct by an organization
outside the Government of an independent, comprehensive
review to identify opportunities for joint funding for an
integrated graduate medical education program at facili-
ties of their respective departments where such an inte-
grated program is feasible.
(c) FUNDING.—Funds for the contract under sub-
section (b) shall be provided in equal shares by the De-
partment of Defense and the Department of Veterans Af-
fairs.
(d) COMMON AFFILIATION AGREEMENT.—Based on
the results of the review under subsection (b), the Sec-
retary of Defense and the Secretary of Veterans Affairs
shall develop and implement a common affiliation agree-
ment or contract for graduate medical education purposes
at locations where the demonstration project under section
3 is carried out.
SEC. 6. REQUIRED SHARING OF HEALTH CARE RESOURCES.
(a) REQUIRED SHARING.—Section 8111(a) of title
38, United States Code, is amended by striking ‘‘may
enter into’’ and inserting ‘‘shall enter into’’.
(b) CONFORMING AMENDMENT.—Section 1104 of
title 10, United States Code, is amended by striking
‘‘may’’ and inserting ‘‘shall’’.
(c) REPEAL
OF
VA BED
LIMITS.—(1) Section
8110(a)(1) of title 38, United States Code, is amended—
(A) in the first sentence, by striking ‘‘at not
more than 125,000 and not less than 100,000’’;
(B) in the third sentence, by striking ‘‘shall op-
erate and maintain a total of not less than 90,000
hospital beds and nursing home beds and’’; and
(C) in the fourth sentence, by striking ‘‘to en-
able the Department to operate and maintain a total
of not less than 90,000 hospital and nursing home
beds in accordance with this paragraph and’’.
(2) Section 8111(a) of such title is amended by strik-
ing ‘‘, except that’’ and all that follows through ‘‘of the
Government’’ before the period at the end.
SEC. 7. REPORTS.
(a) INTERIM REPORT.—Not later than February 1,
2003, the Secretary of Defense and Secretary of Veterans
Affairs shall submit to the Committees on Veterans’ Af-
fairs and the Committees on Armed Services of the Senate