Union Calendar No. 464
105TH CONGRESS
2D SESSION
H. R. 3828
[Report No. 105–793, Part I]
A BILL
To amend title XVIII of the Social Security Act to
improve access to health care services for certain
Medicare-eligible veterans.
OCTOBER 20, 1998
Committees on Veterans’ Affairs and Commerce dis-
charged; committed to the Committee of the Whole
House on the State of the Union and ordered to be
printed
IB
Union Calendar No. 464
105TH CONGRESS
2D SESSION
H. R. 3828
[Report No. 105–793, Part I]
To amend title XVIII of the Social Security Act to improve access to health
care services for certain Medicare-eligible veterans.
IN THE HOUSE OF REPRESENTATIVES
MAY 12, 1998
Mr. THOMAS (for himself, Mr. STUMP, Mr. BILIRAKIS, Mr. SPENCE, Mr. RAN-
GEL, Mr. STEARNS, Mr. HOUGHTON, Mrs. JOHNSON of Connecticut, Mr.
SAM JOHNSON of Texas, Mr. MCCRERY, Mr. BARRETT of Nebraska, Mr.
BEREUTER, Mr. BOEHLERT, Mrs. CHENOWETH, Mr. CHRISTENSEN, Mr.
COLLINS, Mr. COMBEST, Mr. COOK, Mr. COOKSEY, Mr. CRANE, Mr.
CUNNINGHAM, Mr. DEAL of Georgia, Mr. DOYLE, Mr. EDWARDS, Mr.
EHRLICH, Mrs. EMERSON, Mr. ENGLISH of Pennsylvania, Mr. ENSIGN,
Mr. EVERETT, Mrs. FOWLER, Mr. FOX of Pennsylvania, Mr. FROST, Mr.
GONZALEZ, Mr. GOODLING, Ms. GRANGER, Mr. GREENWOOD, Mr. HALL
of Ohio, Mr. HALL of Texas, Mr. HAYWORTH, Mr. HEFNER, Mr.
HERGER, Mr. HOLDEN, Mr. HULSHOF, Mr. HUNTER, Mr. HUTCHINSON,
Mrs. KELLY, Mr. KUCINICH, Mr. LAHOOD, Mr. LAMPSON, Mr. LANTOS,
Mr. LIPINSKI, Mr. MANZULLO, Mr. METCALF, Mr. NETHERCUTT, Mr.
PORTMAN, Mr. REDMOND, Mrs. ROUKEMA, Mr. RUSH, Mr. SANDERS,
Mr. SANDLIN, Mr. SAXTON, Mr. SERRANO, Mr. SKEEN, Mr. SMITH of
New Jersey, Mr. SOLOMON, Mr. STUPAK, Mr. TANNER, Mrs. THURMAN,
Mr. TIAHRT, Mr. UPTON, Mr. WALSH, Mr. WATKINS, Mr. WATTS of
Oklahoma, Mr. WHITFIELD, and Ms. WOOLSEY) introduced the following
bill; which was referred to the Committee on Ways and Means, and in
addition to the Committees on Veterans’ Affairs, and Commerce, 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 com-
mittee concerned
OCTOBER 7, 1998
Reported from the Committee on Ways and Means with an amendment
[Strike out all after the enacting clause and insert the part printed in italic]
OCTOBER 7, 1998
Referral to the Committees on Veterans’ Affairs and Commerce extended for
a period ending not later than October 9, 1998
OCTOBER 9, 1998
Referral to the Committees on Veterans’ Affairs and Commerce extended for
a period ending not later than October 16, 1998
OCTOBER 16, 1998
Referral to the Committees on Veterans’ Affairs and Commerce extended for
a period ending not later than October 20, 1998
OCTOBER 20, 1998
Additional sponsors: Mr. NUSSLE, Mr. WELLER, Mr. RAMSTAD, Mr. PETER-
SON of Pennsylvania, Mr. BUNNING, Mr. GUTKNECHT, Mr. BOUCHER,
Mr. DOOLEY of California, Mrs. BONO, Mr. PICKERING, Mr. DAVIS of Il-
linois, Mr. ALLEN, Ms. SLAUGHTER, Mr. THOMPSON, Mr. NORWOOD,
Mrs. WILSON, Mr. STENHOLM, and Mr. CONDIT
OCTOBER 20, 1998
Committees on Veterans’ Affairs and Commerce discharged; committed to the
Committee of the Whole House on the State of the Union and ordered
to be printed
[For text of introduced bill, see copy of bill as introduced on May 12, 1998]
A BILL
To amend title XVIII of the Social Security Act to improve
access to health care services for certain Medicare-eligible
veterans.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; PURPOSES.
(a) SHORT TITLE.—This Act may be cited as the ‘‘Vet-
erans Medicare Access Improvement Act of 1998’’.
(b) PURPOSES.—The purposes of this Act are—
(1) to establish a program that permits Medi-
care-eligible veterans who have a service-connected
disability or are financially needy and for whom ac-
cess to medical care of the Department of Veterans Af-
fairs has been historically deficient because of geo-
graphic remoteness or inaccessibility to receive their
Medicare benefits through a service network of provid-
ers established by the Department of Veterans Affairs;
and
(2) to establish a 3-year demonstration project
that permits other Medicare-eligible veterans to re-
ceive such benefits through the Department of Veter-
ans Affairs.
SEC. 2. IMPROVEMENT IN VETERANS’ ACCESS TO SERVICES
UNDER MEDICARE PROGRAM.
(a) IN GENERAL.—Title XVIII of the Social Security
Act, as amended by sections 4603, 4801, and 4015(a) of
the Balanced Budget Act of 1997, is amended by adding
at the end the following:
‘‘IMPROVING VETERANS’ ACCESS TO SERVICES
‘‘SEC. 1897. (a) DEFINITIONS.—In this section:
‘‘(1) ADMINISTERING SECRETARIES.—The term
‘administering Secretaries’ means the Secretary of
Health and Human Services and the Secretary of
Veterans Affairs acting jointly.
‘‘(2) PROGRAM.—The term ‘program’ means the
program established under this section with respect to
category A Medicare-eligible veterans.
‘‘(3) DEMONSTRATION PROJECT; PROJECT.—The
terms ‘demonstration project’ and ‘project’ mean the
demonstration project carried out under this section
with respect to category C Medicare-eligible veterans.
‘‘(4) MEDICARE-ELIGIBLE VETERANS.—
‘‘(A) CATEGORY A MEDICARE-ELIGIBLE VET-
ERAN.—The term ‘category A Medicare-eligible
veteran’ means an individual—
‘‘(i) who is a veteran (as defined in
section 101(2) of title 38, United States
Code) and is described in paragraph (1) or
(2) of section 1710(a) of title 38, United
States Code;
‘‘(ii) who is entitled to hospital insur-
ance benefits under part A of the Medicare
Program and is enrolled in the supple-
mentary medical insurance program under
part B of the Medicare Program; and
‘‘(iii) for whom the medical center of
the Department of Veterans Affairs that is
closest to the individual’s place of residence
is geographically remote or inaccessible
from such place.
‘‘(B) CATEGORY C MEDICARE-ELIGIBLE VET-
ERAN.—The term ‘category C Medicare-eligible
veteran’ means an individual who—
‘‘(i) is a veteran (as defined in section
101(2) of title 38, United States Code) and
is described in section 1710(a)(3) of title 38,
United States Code; and
‘‘(ii) is entitled to hospital insurance
benefits under part A of the Medicare Pro-
gram and is enrolled in the supplementary
medical insurance program under part B of
the Medicare Program.
‘‘(5) MEDICARE HEALTH CARE SERVICES.—The
term ‘Medicare health care services’ means items or
services covered under part A or B of this title.
‘‘(6) TRUST
FUNDS.—The term ‘trust funds’
means the Federal Hospital Insurance Trust Fund es-
tablished in section 1817 and the Federal Supple-
mentary Medical Insurance Trust Fund established in
section 1841.
‘‘(b) PROGRAM AND DEMONSTRATION PROJECT.—
‘‘(1) IN GENERAL.—
‘‘(A) ESTABLISHMENT.—The administering
Secretaries are authorized to establish—
‘‘(i) a program (under an agreement
entered into by the administering Secretar-
ies) under which the Secretary of Health
and Human Services shall reimburse the
Secretary of Veterans Affairs, from the trust
funds, for Medicare health care services fur-
nished to category A Medicare-eligible veter-
ans; and
‘‘(ii) a demonstration project (under
such an agreement) under which the Sec-
retary of Health and Human Services shall
reimburse the Secretary of Veterans Affairs,
from the trust funds, for Medicare health
care services furnished to category C Medi-
care-eligible veterans.
‘‘(B) AGREEMENT.—The agreement entered
into under subparagraph (A) shall include at a
minimum—
‘‘(i) a description of the benefits to be
provided to the participants of the program
and the demonstration project established
under this section;
‘‘(ii) a description of the eligibility
rules for participation in the program and
demonstration project, including any cost
sharing requirements;
‘‘(iii) a description of the process for
enrolling veterans for participation in the
program, which process may, to the extent
practicable, be administered in the same or
similar manner to the registration process
established to implement section 1705 of
title 38, United States Code;
‘‘(iv) a description of how the program
and the demonstration project will satisfy
the requirements under this title;
‘‘(v) a description of the sites selected
under paragraph (2);
‘‘(vi) a description of how reimburse-
ment requirements under subsection (g) and
maintenance of effort requirements under
subsection (h) will be implemented in the
program and in the demonstration project;
‘‘(vii) a statement that all data of the
Department of Veterans Affairs and of the
Department of Health and Human Services
that the administering Secretaries deter-
mine is necessary to conduct independent
estimates and audits of the maintenance of
effort requirement, the annual reconcili-
ation, and related matters required under
the program and the demonstration project
shall be available to the administering Sec-
retaries;
‘‘(viii) a description of any require-
ment that the Secretary of Health and
Human Services waives pursuant to sub-
section (d);
‘‘(ix) a requirement that the Secretary
of Veterans Affairs undertake and maintain
outreach and marketing activities, consist-
ent with capacity limits under the program,
for category A Medicare-eligible veterans;
‘‘(x) a description of how the admin-
istering Secretaries shall conduct the data
matching program under subparagraph (F),
including the frequency of updates to the
comparisons performed under subparagraph
(F)(ii); and
‘‘(xi) a statement by the Secretary of
Veterans Affairs that the type or amount of
health care services furnished under chapter
17 of title 38, United States Code, to veter-
ans who are entitled to benefits under part
A or enrolled under part B, or both, shall
not be reduced by reason of the program or
project.
‘‘(C) COST-SHARING
UNDER
DEMONSTRA-
TION PROJECT.—Notwithstanding any provision
of title 38, United States Code, in order—
‘‘(i) to maintain and broaden access to
services,
‘‘(ii) to encourage appropriate use of
services, and
‘‘(iii) to control costs,
the Secretary of Veterans Affairs may establish
enrollment fees and copayment requirements
under the demonstration project under this sec-
tion consistent with subsection (d)(1). Such fees
and requirements may vary based on income.
‘‘(D) HEALTH
CARE
BENEFITS.—The ad-
ministering Secretaries shall prescribe the mini-
mum health care benefits to be provided under
the program and demonstration project to Medi-
care-eligible veterans enrolled in the program or
project. Those benefits shall include at least all