I
107TH CONGRESS
1ST SESSION
H. R. 1911
To establish a demonstration project to provide for Medicare reimbursement
for health care services provided to certain Medicare-eligible veterans
in selected facilities of the Department of Veterans Affairs.
IN THE HOUSE OF REPRESENTATIVES
MAY 17, 2001
Mr. SAXTON (for himself, Mr. MORAN of Kansas, Mr. ANDREWS, Mr.
LOBIONDO, and Mr. KING) introduced the following bill; which was re-
ferred to the Committee on Ways and Means, and in addition to the
Committees on Veterans’ Affairs and Energy and Commerce, for a period
to be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee
concerned
A BILL
To establish a demonstration project to provide for Medicare
reimbursement for health care services provided to cer-
tain Medicare-eligible veterans in selected facilities of
the Department of Veterans Affairs.
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 ‘‘Veterans Medicare Re-
imbursement Demonstration Act of 2001’’.
SEC. 2. FINDINGS.
The Congress makes the following findings:
(1) The health care system of the Department
of Veterans Affairs enrolls veterans in 7 designated
priority groups and provides health care services to
veterans based upon these priority groups, with pri-
ority group 1 given the highest priority and priority
group 7 given the lowest.
(2) Due to budgetary limitations in moneys ap-
propriated to the Department of Veterans Affairs
for veterans health care, certain veterans in lower
priority groups could face limitations in access to
health care from the Department of Veterans Af-
fairs.
(3) Veterans participating in the health care
system of the Department of Veterans Affairs and
served under the lower priority groups 5, 6, and 7
are either low-income veterans whose annual income
and net worth are below established thresholds, vet-
erans whose incomes are above the thresholds and
do not have service-connected disabilities that qualify
them for priority care in that health care system, or
other eligible veterans not already covered in groups
1–4.
(4) Allowing medicare-eligible veterans in these
lower priority groups to utilize their medicare bene-
fits in the health care system of the Department of
Veterans Affairs provides veterans greater access to
health care services and greater flexibility in choos-
ing their health care providers.
(5) Allowing these veterans to utilize their
medicare benefits in the health care system of the
Department of Veterans Affairs also provides health
care facilities of the Department of Veterans Affairs
greater flexibility in serving veterans.
(6) All veterans should have access to necessary
health care, and this Act takes the next step in dem-
onstrating the value of medicare subvention, and
demonstrates the commitment of Congress, to an
improved Department of Veterans Affairs health
care system for the Nation’s veterans and to ensur-
ing access to such health care by veterans.
(7) The Department of Veterans Affairs is not
sufficiently funded to enable the entirety of the vet-
eran population of 25,500,000 veterans to gain ac-
cess to health care furnished by the Department.
(8) The Department of Veterans Affairs re-
ceives funding adequate to furnish health care only
to those veterans who, in all likelihood, will be en-
rolled for such health care annually, based only on
eligibility rules contained in chapter 17 of title 38,
United States Code, and without regard to indi-
vidual veterans who may have access to health care
benefits through the medicare program or through
other means.
SEC. 3. ESTABLISHMENT OF MEDICARE SUBVENTION DEM-
ONSTRATION PROJECT FOR VETERANS.
Title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.) is amended by adding at the end the fol-
lowing:
‘‘MEDICARE SUBVENTION DEMONSTRATION PROJECT FOR
VETERANS
‘‘SEC. 1897. (a) DEFINITIONS.—In this section:
‘‘(1) ADMINISTERING SECRETARIES.—The term
‘administering Secretaries’ means the Secretary and
the Secretary of Veterans Affairs acting jointly.
‘‘(2) DEMONSTRATION
PROJECT.—The term
‘demonstration project’ means the demonstration
project carried out under this section.
‘‘(3) DEMONSTRATION SITE.—
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the term ‘demonstration site’ means
a Veterans Affairs medical facility that pro-
vides, alone or in conjunction with other facili-
ties under the jurisdiction of the Secretary of
Veterans Affairs and affiliated public or private
entities—
‘‘(i) in the case of a coordinated care
health plan, the health care benefits pre-
scribed in subsection (c)(3) to targeted
medicare-eligible veterans residing within
the service area; and
‘‘(ii) in the case of health care bene-
fits being provided on a fee-for-service
basis, the health care benefits prescribed in
subsection (d)(2) to targeted medicare-eli-
gible veterans.
‘‘(B) EXCLUSION.—The term ‘demonstra-
tion site’ shall not include the entire catchment
area of a Veterans Integrated Services Network
(VISN).
‘‘(4) MEDICARE HEALTH CARE SERVICES.—The
term ‘medicare health care services’ means items or
services covered under part A or B of this title.
‘‘(5) 
TARGETED
MEDICARE-ELIGIBLE
VET-
ERAN.—The term ‘targeted medicare-eligible vet-
eran’ means an individual who—
‘‘(A) is a veteran (as defined in section
101 of title 38, United States Code) who is eli-
gible for care and services under paragraph (5),
(6), or (7) of section 1705(a) of title 38, United
States Code;
‘‘(B) has attained age 65;
‘‘(C) is entitled to, or enrolled for, benefits
under part A of this title; and
‘‘(D) is enrolled for benefits under part B
of this title.
‘‘(6) TRUST FUNDS.—The term ‘trust funds’
means the Federal Hospital Insurance Trust Fund
established in section 1817 and the Federal Supple-
mentary Medical Insurance Trust Fund established
in section 1841.
‘‘(7) VETERANS AFFAIRS MEDICAL FACILITY.—
The term ‘Veterans Affairs medical facility’ means a
medical facility as defined in section 8101 of title
38, United States Code.
‘‘(b) DEMONSTRATION PROJECT.—
‘‘(1) IN GENERAL.—
‘‘(A) 
ESTABLISHMENT.—The 
admin-
istering Secretaries are authorized to establish
a demonstration project (under agreements en-
tered into by the administering Secretaries)
under which the Secretary shall reimburse the
Secretary of Veterans Affairs, from the trust
funds, for medicare health care services fur-
nished to targeted medicare-eligible veterans.
‘‘(B) AGREEMENT.—Any agreement en-
tered into under this paragraph shall include at
a minimum—
‘‘(i) a detailed description of the
health care benefits to be provided to the
participants of the demonstration project
established under this section;
‘‘(ii) a description of the eligibility
rules for participation in the demonstration
project, including any criteria established
under subsection (e), any premiums estab-
lished for a coordinated care health plan,
and any cost-sharing arrangements;
‘‘(iii) a description of how the dem-
onstration project will satisfy the require-
ments under this title;
‘‘(iv) a description of the demonstra-
tion sites selected under paragraph (2);
‘‘(v) a description of how reimburse-
ment requirements under subsection (k),
maintenance of effort requirements under
subsection (l), and the annual reconcili-
ation under subsection (m) will be imple-
mented in the demonstration project;