I
103D CONGRESS
2D SESSION
H. R. 4124
To amend title 38, United States Code, to reform health care policy in
the Department of Veterans Affairs.
IN THE HOUSE OF REPRESENTATIVES
MARCH 24, 1994
Mr. MONTGOMERY (for himself and Mr. ROWLAND) introduced the following
bill; which was referred to the Committee on Veterans’ Affairs
A BILL
To amend title 38, United States Code, to reform health
care policy in 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. BENEFITS AND ELIGIBILITY THROUGH DE-
PARTMENT OF VETERANS AFFAIRS MEDICAL
SYSTEM.
(a) DVA AS A PARTICIPANT IN HEALTH CARE RE-
FORM.—
(1) IN
GENERAL.—Title 38, United States
Code, is amended by inserting after chapter 17 the
following new chapter:
‘‘CHAPTER 18—ELIGIBILITY AND BENEFITS
UNDER HEALTH SECURITY ACT
‘‘SUBCHAPTER I—GENERAL
‘‘1801. Definitions.
‘‘SUBCHAPTER II—ENROLLMENT
‘‘1811. Enrollment: veterans.
‘‘1812. Enrollment: CHAMPVA eligibles.
‘‘1813. Enrollment: family members.
‘‘SUBCHAPTER III—BENEFITS
‘‘1821. Benefits for VA enrollees.
‘‘1822. Chapter 17 benefits.
‘‘1823. Supplemental benefits packages and policies.
‘‘1824. Limitation regarding veterans enrolled with health plans outside Depart-
ment.
‘‘SUBCHAPTER IV—FINANCIAL MATTERS
‘‘1831. Premiums, copayments, etc.
‘‘1832. Medicare coverage and reimbursement.
‘‘1833. Recovery of cost of certain care and services.
‘‘1834. Health Plan Fund.
‘‘1835. Guaranteed funding of Government costs.
‘‘SUBCHAPTER I—GENERAL
‘‘§ 1801. Definitions
‘‘For purposes of this chapter:
‘‘(1) The term ‘health plan’ means an entity
that has been certified under the Health Security
Act as a health plan.
‘‘(2) The term ‘VA health plan’ means a health
plan that is operated by the Secretary under section
7341 of this title.
‘‘(3) The term ‘VA enrollee’ means an individ-
ual enrolled under the Health Security Act and sub-
chapter II of this chapter in a VA health plan.
‘‘(4) The term ‘comprehensive benefit package’
means the package of benefits required to be pro-
vided by a health plan under the Health Security
Act.
‘‘(5) The term ‘Health Security Act’ means the
bill H.R. 3600 of the 103d Congress, as introduced
in the House of Representatives on November 20,
1993.
‘‘SUBCHAPTER II—ENROLLMENT
‘‘§ 1811. Enrollment: veterans
‘‘Each veteran who is an eligible individual within the
meaning of section 1001 of the Health Security Act (in-
cluding a veteran who is a medicare-eligible individual as
defined in section 1902 of that Act) may enroll with a
VA health plan. A veteran who wants to receive the com-
prehensive benefit package through the Department shall
enroll with a VA health plan.
‘‘§ 1812. Enrollment: CHAMPVA eligibles
‘‘(a) An individual described in subsection (b) who
is eligible to enroll in a health plan pursuant to section
1001 of the Health Security Act may enroll under that
Act with a VA health plan.
‘‘(b) This section applies to—
‘‘(1) the surviving spouse or child of a veteran
who (A) died as a result of a service-connected dis-
ability, or (B) at the time of death had a total dis-
ability permanent in nature, resulting from a serv-
ice-connected disability, and
‘‘(2) the surviving spouse or child of a person
who died in the active military, naval, or air service
in the line of duty and not due to such person’s own
misconduct,
who are not otherwise eligible for medical care under chap-
ter 55 of title 10 (CHAMPUS).
‘‘(c) For purposes of this section, the term ‘child’ has
the meaning given that term in section 1011 of the Health
Security Act.
‘‘§ 1813. Enrollment: family members
‘‘(a) The Secretary shall authorize a VA health plan
to enroll members of the family of an enrollee under sec-
tion 1811 or 1812 of this title, subject to payment of pre-
miums, deductibles, copayments, and coinsurance as re-
quired under the Health Security Act. The enrollee shall
have the option of enrolling in the VA health plan as an
individual or with family members. If the enrollee chooses
to enroll in the VA health plan with family members, all
such family members must be so enrolled.
‘‘(b) An individual who is enrolled with a VA health
plan pursuant to subsection (a) as a member of the family
of a veteran enrolled under section 1811 of this title shall
not lose eligibility to be enrolled with VA health plans by
reason of the death of that veteran.
‘‘(c) For purposes of subsection (a), the members of
the family of an enrollee are those individuals (other than
the enrollee) included within the term ‘family’ as defined
in section 1011(b) of the Health Security Act.
‘‘SUBCHAPTER III—BENEFITS
‘‘§ 1821. Benefits for VA enrollees
‘‘The Secretary shall ensure that each VA health plan
provides to each individual enrolled with it the items and
services in the comprehensive benefit package under the
Health Security Act.
‘‘§ 1822. Chapter 17 benefits
‘‘(a)(1) In the case of care and services that may be
provided under chapter 17 of this title that are not in-
cluded in the comprehensive benefit package, the Sec-
retary shall provide to any veteran (whether not enrolled
with a health plan) the care and services authorized under
that chapter in accordance with the terms and conditions
applicable to that veteran and that care under that chap-
ter, notwithstanding that such care and services are not
included in the comprehensive benefit package.