170
(1) to commit their respective Departments to
significantly improve mutually beneficial sharing and
coordination of health care resources and services
during peace and war;
(2) to build organizational cultures supportive
of improved sharing and coordination of health care
resources and services; and
(3) to establish and achieve measurable goals to
facilitate increased sharing and coordination of
health care resources and services.
(c) PURPOSE.—It is the purpose of this Act—
(1) to authorize a program to advance mutually
beneficial sharing and coordination of health care re-
sources between the two Departments consistent
with the longstanding intent of Congress; and
(2) to establish a basis for improved strategic
planning by the Department of Defense and Depart-
ment of Veterans Affairs health systems to ensure
that scarce health care resources are used more ef-
fectively and efficiently in order to enhance access to
high quality health care for their respective bene-
ficiaries.
171
SEC. 723. REVISED COORDINATION AND SHARING GUIDE-
LINES.
(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 mutually beneficial co-
ordination, use, or exchange of use of the health care re-
sources of the Department of Veterans Affairs and the De-
partment 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 De-
partments.
‘‘(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
172
among appropriate elements of the two Departments
and incorporate the goals and requirements of the
joint sharing plan into the strategic and perform-
ance plan of each Department under the Govern-
ment Performance 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 pro-
vide 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 Department of Veterans Affairs-Department
of Defense Health Executive Committee (hereinafter in
this section referred to as the ‘Committee’). The Com-
mittee is composed of—
‘‘(A) the Deputy Secretary of the Department
of Veterans Affairs and such other officers and em-
173
ployees of the Department of Veterans Affairs as the
Secretary of Veterans Affairs may designate; and
‘‘(B) the Under Secretary of Defense for Per-
sonnel and Readiness and such other officers and
employees of the Department of Defense as the Sec-
retary of Defense may designate.
‘‘(2)(A) During odd-numbered fiscal years, the Dep-
uty Secretary of Veterans Affairs shall chair the Com-
mittee. During even-numbered fiscal years, the Under Sec-
retary of Defense shall chair the Committee.
‘‘(B) The Deputy Secretary and the Under Secretary
shall determine 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 Committee’s cost of personnel and
administrative support and services. Support for such pur-
poses 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 ap-
propriate departmental staff and outside experts.
‘‘(3) The Committee shall recommend to the Secre-
taries strategic direction for the joint coordination and
sharing efforts between and within the two Departments
under this section and shall oversee implementation of
those efforts.
174
‘‘(4) The Committee shall submit to the two Secre-
taries and to Congress an annual report containing such
recommendations as the Committee considers appropriate.
The two Secretaries shall implement the Committee’s rec-
ommendations unless, with respect to any such rec-
ommendation, either Secretary formally determines that
the recommendation should not be implemented or should
be implemented in a modified form. Upon making such
a determination, the Secretary making the determination
shall submit to Congress notice of the Secretary’s deter-
mination and the Secretary’s rationale for the determina-
tion.
‘‘(5) In order to enable the Committee to make rec-
ommendations 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 Com-
mittee, would promote mutually beneficial coordina-
tion, use, or exchange of use of the health care re-
sources of the two Departments, with the goal of im-
proving the access to, and quality and cost effective-
ness of, the health care provided by the Veterans
175
Health Administration and the Military Health Sys-
tem to the beneficiaries of both Departments.
‘‘(C) Identify and assess further opportunities
for the coordination and sharing of health care re-
sources between the Departments that, in the judg-
ment of the Committee, would not adversely affect
the range of services, the quality of care, or the es-
tablished priorities for care provided by either De-
partment.
‘‘(D) Review the plans of both Departments for
the acquisition 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 coordina-
tion 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. To
assist in this effort, the Committee chairman, under
procedures jointly developed by the Secretaries of
both Departments, may task the Inspectors General
of either or both Departments.
‘‘(d) JOINT INCENTIVES PROGRAM.—(1) Pursuant to
subsection (b)(4), the two Secretaries shall carry out a
program to identify, provide incentives to, implement,
176
fund, and evaluate creative coordination and sharing ini-
tiatives at the facility, intraregional and nationwide levels.
The program shall be administered by the Committee es-
tablished in subsection (c), under procedures jointly pre-
scribed by the two Secretaries.
‘‘(2) To facilitate the incentive program, there is es-
tablished in the Treasury, effective on October 1, 2003,
a DOD–VA Health Care Sharing Incentive Fund. Each
Secretary shall annually contribute to the fund a minimum
of $15,000,000 from the funds appropriated to that Sec-
retary’s Department. Such funds shall remain available
until expended.
‘‘(3)(A) The implementation and effectiveness of the
program under this subsection shall be reviewed annually
by the joint Department of Defense-Department of Vet-
erans Affairs Inspector General review team established
in section 724(i) of the Department of Defense-Depart-
ment of Veterans Affairs Health Resources Sharing and
Performance Improvement Act of 2002. On completion of
the annual review, the review team shall submit a report
to the two Secretaries on the results of the review. Such
report shall be submitted through the Committee to the
Secretaries not later than December 31 of each calendar
year. The Secretaries shall forward each report, without
change, to the Committees on Armed Services and Vet-
177
erans’ Affairs of the Senate and House of Representatives
not later than February 28 of the following year.
‘‘(B) Each such report shall describe activities carried
out under the program under this subsection during the
preceding fiscal year. 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 ini-
tiatives, from the Health Care Sharing Incentive
Fund, including the purposes and effects of those
initiatives on improving access to care by bene-
ficiaries, improvements in the quality of care re-
ceived by those beneficiaries, and efficiencies gained
in delivering services to those beneficiaries.
‘‘(ii) Other matters of interest, including rec-
ommendations from the review team to make legisla-
tive improvements to the program.
‘‘(4) The program under this subsection shall termi-
nate on September 30, 2007.
‘‘(e) GUIDELINES AND POLICIES FOR IMPLEMENTA-
TION OF COORDINATION AND SHARING RECOMMENDA-
TIONS, CONTRACTS, AND AGREEMENTS.—(1) To imple-
ment the recommendations made by the Committee under
subsection (c)(2), as well as to carry out other health care
contracts and agreements for coordination and sharing
178
initiatives as they consider appropriate, the two Secre-
taries shall jointly issue guidelines and policy directives.
Such guidelines and policies shall provide for coordination
and sharing that—
‘‘(A) is consistent with the health care respon-
sibilities of the Department of Veterans Affairs
under this title and with the health care responsibil-
ities of the Department of Defense under chapter 55
of title 10;
‘‘(B) will not adversely affect the range of serv-
ices, the quality of care, or the established priorities
for care provided by either Department; and
‘‘(C) will not reduce capacities in certain spe-
cialized programs of the Department of Veterans Af-
fairs that the Secretary is required to maintain in
accordance with section 1706(b) of this title.
‘‘(2) To facilitate the sharing and coordination of
health care services between the two Departments, the two
Secretaries shall jointly develop and implement guidelines
for a standardized, uniform payment and reimbursement
schedule for those services. Such schedule shall be imple-
mented no later than the beginning of fiscal year 2004
and shall be revised periodically as necessary.
‘‘(3)(A) The guidelines established under paragraph
(1) shall authorize the heads of individual Department of
179
Defense and Department of Veterans Affairs medical fa-
cilities and service regions to enter into health care re-
sources coordination and sharing agreements.
‘‘(B) Under any such agreement, an individual who
is a primary beneficiary of one Department may be pro-
vided health care, as provided in the agreement, at a facil-
ity or in the service region of the other Department that
is a party to the sharing agreement.
‘‘(C) Each such agreement shall identify the health
care resources to be shared.
‘‘(D) Each such agreement shall provide, and shall
specify procedures designed to ensure, that the availability
of direct health care to individuals who are not primary
beneficiaries of the providing Department is (i) on a refer-
ral basis from the facility or service region of the other
Department, and (ii) does not (as determined by the head
of the providing facility or region) adversely affect the
range of services, the quality of care, or the established
priorities for care provided to the primary beneficiaries of
the providing Department.
‘‘(E) Each such agreement shall provide that a pro-
viding Department or service region shall be reimbursed
for the cost of the health care resources provided under
the agreement and that the rate of such reimbursement
shall be as determined in accordance with paragraph (2).
180
‘‘(F) Each proposal for an agreement under this
paragraph shall be effective (i) on the 46th day after the
receipt of such proposal by the Committee, unless earlier
disapproved, or (ii) if earlier approved by the Committee,
on the date of such approval.
‘‘(G) Any funds received through such a uniform pay-
ment and reimbursement schedule shall be credited to
funds that have been allotted to the facility of either De-
partment that provided the care or services, or is due the
funds from, any such agreement.
‘‘(f) ANNUAL JOINT REPORT.—(1) At the time the
President’s budget is transmitted to Congress in any year
pursuant to section 1105 of title 31, the two Secretaries
shall submit to Congress a joint report on health care co-
ordination and sharing activities under this section during
the fiscal year that ended during the previous calendar
year.
‘‘(2) Each report under this section shall include the
following:
‘‘(A) The guidelines prescribed under subsection
(e) of this section (and any revision of such guide-
lines).
‘‘(B) The assessment of further opportunities
identified under subparagraph (C) of subsection
181
(c)(5) for the sharing of health-care resources be-
tween the two Departments.
‘‘(C) Any recommendation made under sub-
section (c)(4) of this section during such fiscal year.
‘‘(D) A review of the sharing agreements en-
tered into under subsection (e) of this section and a
summary of activities under such agreements during
such fiscal year and a description of the results of
such agreements in improving access to, and the
quality and cost effectiveness of, the health care pro-
vided by the Veterans Health Administration and
the Military Health System to the beneficiaries of
both Departments.
‘‘(E) A summary of other planning and activi-
ties involving either Department in connection with
promoting the coordination and sharing of Federal
health-care resources during the preceding fiscal
year.
‘‘(F) Such recommendations for legislation as
the two Secretaries consider appropriate to facilitate
the sharing of health-care resources between the two
Departments.
‘‘(3) In addition to the matters specified in paragraph
(2), the two Secretaries shall include in the annual report
under this subsection an overall status report of the
182
progress of health resources sharing between the two De-
partments as a consequence of the Department of De-
fense-Department of Veterans Affairs Health Resources
Sharing and Performance Improvement Act of 2002 and
of other sharing initiatives taken during the period covered
by the report. Such status report shall indicate the status
of such sharing and shall include appropriate data as well
as analyses of that data. The annual report shall include
the following:
‘‘(A) Enumerations and explanations of major
policy decisions reached by the two Secretaries dur-
ing the period covered by the report period with re-
spect to sharing between the two Departments.
‘‘(B) A description of any purposes of Depart-
ment of Defense-Department of Veterans Affairs
Health Resources Sharing and Performance Im-
provement Act of 2002 that presented barriers that
could not be overcome by the two Secretaries and
their status at the time of the report.
‘‘(C) A description of progress made in new
ventures or particular areas of sharing and coordina-
tion that would be of policy interest to Congress con-
sistent with the intent of such Act.
‘‘(D) A description of enhancements of access
to care of beneficiaries of both Departments that
183
came about as a result of new sharing approaches
brought about by such Act.
‘‘(E) A description of proposals for which funds
are provided through the joint incentives program
under subsection (d), together with a description of
their results or status at the time of the report, in-
cluding access improvements, savings, and quality-
of-care enhancements they brought about, and a de-
scription of any additional use of funds made avail-
able under subsection (d).
‘‘(g) DEFINITIONS.—For the purposes of this section:
‘‘(1) The term ‘beneficiary’ means a person who
is a primary beneficiary of the Department of Vet-
erans Affairs or of the Department of Defense.
‘‘(2) The term ‘direct health care’ means health
care provided to a beneficiary in a medical facility
operated by the Department or the Department of
Defense.
‘‘(3) The term ‘head of a medical facility’ (A)
with respect to a medical facility of the Department,
means the director of the facility, and (B) with re-
spect to a medical facility of the Department of De-
fense, means the medical or dental officer in charge
or the contract surgeon in charge.
184
‘‘(4) The term ‘health-care resource’ includes
hospital care, medical services, and rehabilitative
services, as those terms are defined in paragraphs
(5), (6), and (8), respectively, of section 1701 of this
title, services under sections 1782 and 1783 of this
title, any other health-care service, and any health-
care support or administrative resource.
‘‘(5) The term ‘primary beneficiary’ (A) with
respect to the Department means a person who is el-
igible under this title (other than under section
1782, 1783, or 1784 or subsection (d) of this sec-
tion) or any other provision of law for care or serv-
ices in Department medical facilities, and (B) with
respect to the Department of Defense, means a
member or former member of the Armed Forces who
is eligible for care under section 1074 of title 10.
‘‘(6) The term ‘providing Department’ means
the Department of Veterans Affairs, in the case of
care or services furnished by a facility of the Depart-
ment of Veterans Affairs, and the Department of
Defense, in the case of care or services furnished by
a facility of the Department of Defense.
‘‘(7) The term ‘service region’ means a geo-
graphic service area of the Veterans Health Admin-
istration, in the case of the Department of Veterans
228
(c) REPEAL OF SUPERCEDED PROVISIONS.—(1) Sec-
tions 4835 and 9835 of title 10, United States Code, are
repealed.
(2)(A) The table of sections at the beginning of chap-
ter 453 of such title is amended by striking the item relat-
ing to section 4835.
(B) The table of sections at the beginning of chapter
953 of such title is amended by striking the item relating
to section 9835.
SEC. 1004. ACCOUNTABLE OFFICIALS IN THE DEPARTMENT
OF DEFENSE.
(a) ACCOUNTABLE OFFICIALS WITHIN THE DEPART-
MENT OF DEFENSE.—Chapter 165 of title 10, United
States Code, is amended by inserting after section 2773
the following new section:
‘‘§ 2773a. Departmental accountable officials
‘‘(a) DESIGNATION.—(1) The Secretary of Defense
may designate as a ‘departmental accountable official’ any
civilian employee of the Department of Defense or member
of the armed forces under the Secretary’s jurisdiction who
is described in paragraph (2). Any such designation shall
be in writing.
‘‘(2) An employee or member of the armed forces de-
scribed in this paragraph is an employee or member who
is responsible in the performance of the employee’s or
375
in such amounts as are provided in appropriations Acts,
to pay for—
(1) the cost of a survey described in subsection
(f) with respect to the property;
(2) the cost of carrying out any environmental
assessment, study, or analysis, and any remediation,
that may be required under Federal law, or is con-
sidered appropriate by the Secretary, in connection
with the property or the conveyance of the property;
and
(3) any other costs incurred by the Secretary in
conveying the property.
(f) DESCRIPTION OF PROPERTY.—The exact acreage
and legal description of any real property to be conveyed
under subsection (a) shall be determined by a survey satis-
factory to the Secretary.
(g) ADDITIONAL TERMS
AND CONDITIONS.—The
Secretary may require such additional terms and condi-
tions in connection with a conveyance of real property
under this section as the Secretary considers appropriate
to protect the interests of the United States.
SEC. 2822. LAND CONVEYANCE, FORT CAMPBELL, KEN-
TUCKY.
(a) CONVEYANCE AUTHORIZED.—The Secretary of
the Army may convey, without consideration, to the City
382
as military family housing, design and construct
such military family housing units and supporting
facilities as the Secretary considers appropriate.
(2) The total combined value of the real property and
military family housing conveyed by the Corporation under
this subsection shall be at least equal to the fair market
value of the real property conveyed to the Secretary under
subsection (a), including any severance costs arising from
any diminution of the value or utility of other property
at Marine Corps Air Station Miramar attributable to the
prospective future use of the property conveyed under sub-
section (a).
(3) The Secretary shall determine the fair market
value of the real property to be conveyed under subsection
(a) and the fair market value of the consideration to be
provided under this subsection. Such determinations shall
be final.
(c) REVERSIONARY INTEREST.—(1) Subject to para-
graph (2), if the Secretary determines at any time that
the property conveyed under subsection (a) is not being
used in accordance with the purpose of the conveyance
specified in such subsection, all right, title, and interest
in and to the property, including any improvements there-
on, shall revert, at the option of the Secretary, to the
United States, and the United States shall have the right