distribution of their previous enrollment in
such plans and programs.
‘‘(vii) Any impact of the program or
project, respectively, on private health care
providers and beneficiaries under this title
that are not enrolled in the program or
project.
‘‘(viii) An assessment of the access to
care and quality of care for Medicare-eligi-
ble veterans under the program or project,
respectively.
‘‘(ix) An analysis of whether, and in
what manner, easier access to medical cen-
ters of the Department of Veterans Affairs
affects the number of category A Medicare-
eligible veterans or C Medicare-eligible vet-
erans, 
respectively, 
receiving 
Medicare
health care services.
‘‘(x) Any impact of the program or
project, respectively, on the access to care
for category A Medicare-eligible veterans or
C Medicare-eligible veterans, respectively,
who did not enroll in the program or
project and for other individuals entitled to
benefits under this title.
‘‘(xi) A description of the difficulties
(if any) experienced by the Department of
Veterans Affairs in managing the program
or project, respectively.
‘‘(xii) Any additional elements speci-
fied in the agreement entered into under
subsection (b).
‘‘(xiii) Any additional elements that
the Comptroller General of the United
States determines is appropriate to assess
regarding the program or project, respec-
tively.
‘‘(2) REPORTS
BY
SECRETARIES
ON
PROGRAM
AND
DEMONSTRATION
PROJECT
WITH
RESPECT
TO
MEDICARE-ELIGIBLE VETERANS.—
‘‘(A) DEMONSTRATION PROJECT.—Not later
than 6 months after the date of the submission
of the final report by the Comptroller General of
the United States on the demonstration project
under paragraph (1)(C), the administering Sec-
retaries shall submit to Congress a report con-
taining their recommendation as to—
‘‘(i) whether there is a cost to the
health care program under this title in con-
ducting the demonstration project;
‘‘(ii) whether to extend the demonstra-
tion project or make the project permanent;
and
‘‘(iii) whether the terms and conditions
of the project should otherwise be continued
(or modified) with respect to Medicare-eligi-
ble veterans.
‘‘(B) PROGRAM.—Not later than 6 months
after the date of the submission of the report by
the Comptroller General of the United States on
the third year of the operation of the program,
the administering Secretaries shall submit to
Congress a report containing their recommenda-
tion as to—
‘‘(i) whether there is a cost to the
health care program under this title in con-
ducting the program under this section;
‘‘(ii) whether to discontinue the pro-
gram with respect to category A Medicare-
eligible veterans; and
‘‘(iii) whether the terms and conditions
of the program should otherwise be contin-
ued (or modified) with respect to Medicare-
eligible veterans.’’.
(b) REPEAL OF PLAN REQUIREMENT.—Subsection (b)
of section 4015 of the Balanced Budget Act of 1997 (relating
to an implementation plan for Veterans subvention) is re-
pealed.
(c) EFFECTIVENESS CONTINGENT UPON ENACTMENT
OF OFFSETTING OUTLAY REDUCTIONS IN VA PROGRAMS
THROUGH RESTRICTION OF USE OF TOBACCO PRODUCTS
TO QUALIFY FOR SERVICE-CONNECTED ENTITLEMENT.—
(1) No payment may be made from the Federal Hospital
Insurance Trust Fund or from the Federal Supplementary
Medical Insurance Trust Fund for items or services fur-
nished under the program or demonstration project estab-
lished under section 1897 of Social Security Act, as added
by subsection (a), before the date that the Director of the
Office of Management and Budget determines that—
(A) legislation described in paragraph (2) has
been enacted; and
(B) the net amount of the reductions in expendi-
tures achieved by reason of such legislation during the
5-fiscal-year period beginning with fiscal year 1999,
that is available to offset the net aggregate increase in
outlays (if any) under the Medicare Program under
title XVIII of such Act, is not less than the estimate
of the amount of such net aggregate increase during
such period.
(2) For purposes of paragraph (1), the legislation de-
scribed in this paragraph is legislation that restricts entitle-
ment to service-connected compensation under title 38,
United States Code, for a disability that is the result of
a veteran’s use of tobacco products.
(3) The estimate described in paragraph (1)(B) shall
be the estimate made by the Congressional Budget Office
and contained in the report of the Committee on Ways and
Means of the House of Representatives to accompany H.
R. 3828 of the 105th Congress (the Veterans Medicare Access
Improvement Act of 1998)), except to the extent that the
Director of the Office of Management and Budget finds that
the estimate is materially inaccurate.
(d) REPORT TO CONGRESS ON A METHOD TO INCLUDE
THE COSTS OF VETERANS AFFAIRS AND MILITARY FACIL-
ITY SERVICES TO MEDICARE-ELIGIBLE BENEFICIARIES IN
THE
CALCULATION
OF
MEDICARE+CHOICE
PAYMENT
RATES.—The Secretary of Health and Human Services
shall report to the Congress by not later than January 1,
2001, on a method to phase-in the costs of military facility
services furnished by the Department of Veterans Affairs or
the Department of Defense to Medicare-eligible beneficiaries
in the calculation of an area’s Medicare+Choice capitation
payment. Such report shall include on a county-by-county
basis—
(1) the actual or estimated cost of such services
to Medicare-eligible beneficiaries;
(2) the change in Medicare+Choice capitation
payment rates if such costs are included in the cal-
culation of payment rates;
(3) one or more proposals for the implementation
of payment adjustments to Medicare+Choice plans in
counties where the payment rate has been affected due
to the failure to calculate the cost of such services to
Medicare-eligible beneficiaries; and
(4) 
a 
system 
to 
ensure 
that 
when 
a
Medicare+Choice enrollee receives covered services
through a facility of the Department of Veterans Af-
fairs or the Department of Defense there is an appro-
priate payment recovery to the Medicare Program.