H. R. 4546—135
and effects of those initiatives on improving access to care
by beneficiaries, improvements in the quality of care received
by those beneficiaries, and efficiencies gained in delivering serv-
ices to those beneficiaries.
‘‘(ii) Other matters of interest, including recommendations
from the Comptroller General for legislative improvements to
the program.
‘‘(4) The program under this subsection shall terminate on
September 30, 2007.
‘‘(e) GUIDELINES
AND
POLICIES
FOR
IMPLEMENTATION
OF
COORDINATION AND SHARING RECOMMENDATIONS, CONTRACTS, AND
AGREEMENTS.—(1) To implement 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 initiatives as they consider appropriate, the two Secretaries
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 responsibilities of
the Department of Veterans Affairs under this title and with
the health care responsibilities of the Department of Defense
under chapter 55 of title 10;
‘‘(B) will not adversely affect the range of services, the
quality of care, or the established priorities for care provided
by either Department; and
‘‘(C) will not reduce capacities in certain specialized pro-
grams of the Department of Veterans Affairs 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, uni-
form payment and reimbursement schedule for those services. Such
schedule shall be implemented no later than October 1, 2003, and
shall be revised periodically as necessary. The two Secretaries,
following implementation of the schedule, may on a case-by-case
basis waive elements of the schedule if they jointly agree that
such a waiver is in the best interests of both Departments.
‘‘(3)(A) The guidelines established under paragraph (1) shall
authorize the heads of individual Department of Defense and
Department of Veterans Affairs medical facilities and service
regions to enter into health care resources coordination and sharing
agreements.
‘‘(B) Under any such agreement, an individual who is a primary
beneficiary of one Department may be provided health care, as
provided in the agreement, at a facility 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 proce-
dures designed to ensure, that the availability of direct health
care to individuals who are not primary beneficiaries of the pro-
viding Department is (i) on a referral basis from the facility or
service region of the other Department, and (ii) does not (as deter-
mined 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 pro-
viding Department.
H. R. 4546—136
‘‘(E) Each such agreement shall provide that a providing
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).
‘‘(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 payment and
reimbursement schedule shall be credited to funds that have been
allotted to the facility of either Department 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 coordination 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) (and
any revision of such guidelines).
‘‘(B) The assessment of further opportunities identified
under subparagraph (C) of subsection (c)(5) for the sharing
of health-care resources between the two Departments.
‘‘(C) Any recommendation made under subsection (c)(4)
during such fiscal year.
‘‘(D) A review of the sharing agreements entered into under
subsection (e) and a summary of activities under such agree-
ments 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 provided by the Vet-
erans Health Administration and the Military Health System
to the beneficiaries of both Departments.
‘‘(E) A summary of other planning and activities involving
either Department in connection with promoting the coordina-
tion and sharing of Federal health-care resources during the
preceding fiscal year.
‘‘(F) Such recommendations for legislation as the two Secre-
taries 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 sub-
section an overall status report of the progress of health resources
sharing between the two Departments as a consequence of subtitle
C of title VII of the Bob Stump National Defense Authorization
Act for Fiscal Year 2003 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 during the period
covered by the report period with respect to sharing between
the two Departments.
‘‘(B) A description of progress made in new ventures or
particular areas of sharing and coordination that would be
H. R. 4546—137
of policy interest to Congress consistent with the intent of
such subtitle.
‘‘(C) A description of enhancements of access to care of
beneficiaries of both Departments that came about as a result
of new sharing approaches brought about by such subtitle.
‘‘(D) 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, including access improvements, savings,
and quality-of-care enhancements they brought about, and a
description of any additional use of funds made available under
subsection (d).
‘‘(4) In addition to the matters specified in paragraphs (2)
and (3), the two Secretaries shall include in the annual report
under this subsection for each year through 2008 the following:
‘‘(A) A description of the measures taken, or planned to
be taken, to implement the health resources sharing project
under section 722 of the Bob Stump National Defense
Authorization Act for Fiscal Year 2003 and any cost savings
anticipated, or cost sharing achieved, at facilities participating
in the project, including information on improvements in access
to care, quality, and timeliness, as well as impediments encoun-
tered and legislative recommendations to ameliorate such
impediments.
‘‘(B) A description of the use of the waiver authority pro-
vided by section 722(d)(1) of the Bob Stump National Defense
Authorization Act for Fiscal Year 2003, including—
‘‘(i) a statement of the numbers and types of requests
for waivers under that section of administrative policies
that have been made during the period covered by the
report and, for each such request, an explanation of the
content of each request, the intended purpose or result
of the requested waiver, and the disposition of each request;
and
‘‘(ii) descriptions of any new administrative policies
that enhance the success of the project.
‘‘(5) In addition to the matters specified in paragraphs (2),
(3), and (4), the two Secretaries shall include in the annual report
under this subsection for each year through 2009 a report on
the pilot program for graduate medical education under section
725 of the Bob Stump National Defense Authorization Act for
Fiscal Year 2003, including activities under the program during
the preceding year and each Secretary’s assessment of the efficacy
of providing education and training under that program.
‘‘(g) DEFINITIONS.—For the purposes of this section:
‘‘(1) The term ‘beneficiary’ means a person who is a primary
beneficiary of the Department of Veterans Affairs or of the
Department of Defense.
‘‘(2) The term ‘direct health care’ means health care pro-
vided to a beneficiary in a medical facility operated by the
Department of Veterans Affairs or the Department of Defense.
‘‘(3) The term ‘head of a medical facility’ (A) with respect
to a medical facility of the Department of Veterans Affairs,
means the director of the facility, and (B) with respect to
a medical facility of the Department of Defense, means the
medical or dental officer in charge or the contract surgeon
in charge.
H. R. 4546—138
‘‘(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 eligible under this
title (other than under section 1782, 1783, or 1784 or subsection
(d) of this section) or any other provision of law for care or
services 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 Depart-
ment of Veterans Affairs, in the case of care or services fur-
nished by a facility of the Department 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 geographic service
area of the Veterans Health Administration, in the case of
the Department of Veterans Affairs, and a service region, in
the case of the Department of Defense.’’.
(2) The item relating to that section in the table of sections
at the beginning of chapter 81 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.’’.
(b) CONFORMING AMENDMENT.—Section 1104(a) of title 10,
United States Code, is amended by striking ‘‘may’’ and inserting
‘‘shall’’.
(c) EFFECTIVE DATE.—The amendments made by this section
shall take effect on October 1, 2003.
SEC. 722. HEALTH CARE RESOURCES SHARING AND COORDINATION
PROJECT.
(a) ESTABLISHMENT.—(1) The Secretary of Veterans Affairs and
the Secretary of Defense shall conduct a health care resources
sharing project to serve as a test for evaluating the feasibility,
and the advantages and disadvantages, of measures and programs
designed to improve the sharing and coordination of health care
and health care resources between the Department of Veterans
Affairs and the Department of Defense. The project shall be carried
out, as a minimum, at the sites identified under subsection (b).
(2) Reimbursement between the two Departments with respect
to the project under this section shall be made in accordance with
the provisions of section 8111(e)(2) of title 38, United States Code,
as amended by section 721(a).
(b) SITE IDENTIFICATION.—(1) Not later than 90 days after
the date of the enactment of this Act, the Secretaries shall jointly
identify not less than three sites for the conduct of the project
under this section.
(2) For purposes of this section, a site at which the resource
sharing project shall be carried out is an area in the United States
in which—