Veterans Affairs from the current medical
care appropriation for the Department of
Veterans Affairs to the trust funds; and
‘‘(ii) under subparagraph (A)(ii) shall
include lowering the amount of payment
under the program or project under sub-
section (g)(1), and may include, in the case
of the demonstration project, suspending
or terminating the project (in whole or in
part).
‘‘(i) EVALUATION AND REPORTS.—
‘‘(1) INDEPENDENT EVALUATION BY GAO.—
‘‘(A) IN GENERAL.—The Comptroller Gen-
eral of the United States shall conduct an eval-
uation of the program and an evaluation of the
demonstration project, and shall submit annual
reports on the program and demonstration
project to the administering Secretaries and to
Congress.
‘‘(B) FIRST REPORT.—The first report for
the program or demonstration project under
subparagraph (A) shall be submitted not later
than 12 months after the date on which the
Secretary of Veterans Affairs first provides
services under the program or project, respec-
tively.
‘‘(C) FINAL REPORT ON DEMONSTRATION
PROJECT.—A final report shall be submitted
with respect to the demonstration project not
later than 31⁄2 years after the date of the first
report on the project under subparagraph (B).
‘‘(D) CONTENTS.—The evaluation and re-
ports under this paragraph for the program or
demonstration project shall include an assess-
ment, based on the agreement entered into
under subsection (b), of the following:
‘‘(i) Any savings or costs to the Medi-
care program under this title resulting
from the program or project.
‘‘(ii) The cost to the Department of
Veterans Affairs of providing care to cat-
egory A Medicare-eligible veterans under
the program or to category C Medicare-eli-
gible veterans under the demonstration
project, respectively.
‘‘(iii) An analysis of how such pro-
gram or project affects the overall acces-
sibility of medical care through the De-
partment of Veterans Affairs, and a de-
scription of the unintended effects (if any)
upon the patient enrollment system under
section 1705 of title 38, United States
Code.
‘‘(iv) Compliance by the Department
of Veterans Affairs with the requirements
under this title.
‘‘(v) The number of category A Medi-
care-eligible veterans or category C Medi-
care-eligible veterans, respectively, opting
to participate in the program or project in-
stead of receiving health benefits through
another health insurance plan (including
benefits under this title).
‘‘(vi) A list of the health insurance
plans and programs that were the primary
payers for Medicare-eligible veterans dur-
ing the year prior to their participation in
the program or project, respectively, and
the distribution of their previous enroll-
ment 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, respec-
tively, 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 sub-
mission of the final report by the Comptroller
General of the United States on the demonstra-
tion project under paragraph (1)(C), the admin-
istering Secretaries shall submit to Congress a
report containing their recommendation as to—
‘‘(i) whether there is a cost to the
health care program under this title in
conducting the demonstration project;
‘‘(ii) whether to extend the dem-
onstration project or make the project per-
manent; and
(c) EFFECTIVENESS CONTINGENT UPON ENACT-
MENT OF OFFSETTING OUTLAY REDUCTIONS IN VA PRO-
GRAMS THROUGH RESTRICTION OF USE OF TOBACCO
PRODUCTS TO QUALIFY FOR SERVICE-CONNECTED ENTI-
TLEMENT.—(1) No payment may be made from the Fed-
eral Hospital Insurance Trust Fund or from the Federal
Supplementary Medical Insurance Trust Fund for items
or services furnished under the program or demonstration
project established under section 1897 of the Social Secu-
rity Act, as added by subsection (a), before the date that
the Director of the Office of Management and Budget de-
termines that—
(A) legislation described in paragraph (2) has
been enacted; and
(B) the net amount of the reductions in expend-
itures 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 in-
crease in outlays (if any) under the Medicare pro-
gram under title XVIII of such Act, is not less than
the estimate of the amount of such net aggregate in-
crease during such period.
(2) For purposes of paragraph (1), the legislation de-
scribed in this paragraph is legislation that restricts enti-
tlement 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. ll 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.
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