IIA
104TH CONGRESS
2D SESSION
H. R. 3118
IN THE SENATE OF THE UNITED STATES
JULY 31, 1996
Received; read twice and referred to the Committee on Veterans’ Affairs
AN ACT
To amend title 38, United States Code, to reform eligibility
for health care provided by 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,
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SECTION 1. SHORT TITLE; REFERENCES TO TITLE 38, UNIT-
ED STATES CODE.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Veterans’ Health Care Eligibility Reform Act of 1996’’.
(b) REFERENCES
TO TITLE 38, UNITED STATES
CODE.—Except as otherwise expressly provided, whenever
in this Act an amendment or repeal is expressed in terms
of an amendment to, or repeal of, a section or other provi-
sion, the reference shall be considered to be made to a
section or other provision of title 38, United States Code.
SEC. 2. HOSPITAL CARE AND MEDICAL SERVICES.
(a) ELIGIBILITY
FOR CARE.—Section 1710(a) is
amended by striking out paragraphs (1) and (2) and in-
serting the following:
‘‘(a)(1) The Secretary shall, to the extent and in the
amount provided in advance in appropriations Acts for
these purposes, provide hospital care and medical services,
and may provide nursing home care, which the Secretary
determines is needed to any veteran—
‘‘(A) with a compensable service-connected dis-
ability;
‘‘(B) whose discharge or release from active
military, naval, or air service was for a compensable
disability that was incurred or aggravated in the line
of duty;
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‘‘(C) who is in receipt of, or who, but for a sus-
pension pursuant to section 1151 of this title (or
both a suspension and the receipt of retired pay),
would be entitled to disability compensation, but
only to the extent that such veteran’s continuing eli-
gibility for such care is provided for in the judgment
or settlement provided for in such section;
‘‘(D) who is a former prisoner of war;
‘‘(E) of the Mexican border period or of World
War I;
‘‘(F) who was exposed to a toxic substance, ra-
diation, or environmental hazard, as provided in sub-
section (e); and
‘‘(G) who is unable to defray the expenses of
necessary care as determined under section 1722(a)
of this title.
‘‘(2) In the case of a veteran who is not described
in paragraph (1), the Secretary may, to the extent re-
sources and facilities are available and subject to the pro-
visions of subsection (f), furnish hospital care, medical
services, and nursing home care which the Secretary deter-
mines is needed.’’.
(b) 
CONFORMING
AMENDMENTS.—(1) 
Section
1710(e) is amended—
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(A) in paragraph (1), by striking out ‘‘hospital
care and nursing home care’’ in subparagraphs (A),
(B), and (C) and inserting in lieu thereof ‘‘hospital
care, medical services, and nursing home care’’;
(B) in paragraph (2), by inserting ‘‘and medical
services’’ after ‘‘Hospital and nursing home care’’;
and
(C) by striking out ‘‘subsection (a)(1)(G) of
this section’’ each place it appears and inserting in
lieu thereof ‘‘subsection (a)(1)(F)’’.
(2) Chapter 17 is amended—
(A) by redesignating subsection (g) of section
1710 as subsection (h); and
(B) by transferring subsection (f) of section
1712 to section 1710 so as to appear after sub-
section (f), redesignating such subsection as sub-
section (g), and amending such subsection by strik-
ing out ‘‘section 1710(a)(2) of this title’’ in para-
graph (1) and inserting in lieu thereof ‘‘subsection
(a)(2) of this section’’.
(3) Section 1712 is amended—
(A) by striking out subsections (a) and (i); and
(B) by redesignating subsections (b), (c), (d),
(h) and (j), as subsections (a), (b), (c), (d), and (e),
respectively.
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SEC. 3. PROSTHETICS.
(a) 
ELIGIBILITY
FOR
PROSTHETICS.—Section
1701(6)(A)(i) is amended—
(1) by striking out ‘‘(in the case of a person
otherwise receiving care or services under this chap-
ter)’’ and ‘‘(except under the conditions described in
section 1712(a)(5)(A) of this title),’’;
(2) by inserting ‘‘(in the case of a person other-
wise receiving care or services under this chapter)’’
before ‘‘wheelchairs,’’; and
(3) by inserting ‘‘except that the Secretary may
not furnish sensori-neural aids other than in accord-
ance with guidelines which the Secretary shall pre-
scribe,’’ after ‘‘reasonable and necessary,’’.
(b) REGULATIONS.—Not later than 30 days after the
date of the enactment of this Act, the Secretary of Veter-
ans Affairs shall prescribe the guidelines required by the
amendments made by subsection (a) and shall furnish a
copy of those guidelines to the Committees on Veterans’
Affairs of the Senate and House of Representatives.
SEC. 4. MANAGEMENT OF HEALTH CARE.
(a) IN GENERAL.—(1) Chapter 17 is amended by in-
serting after section 1704 the following new sections:
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of furnishing such care and services economically,
and
‘‘(2) shall make such rules and regulations re-
garding acquisition procedures or policies as the Sec-
retary considers appropriate to provide such needed
care and services.
‘‘(c) In managing the provision of hospital care and
medical services under section 1710(a) of this title, the
Secretary shall ensure that the Department maintains its
capacity to provide for the specialized treatment and reha-
bilitative needs of disabled veterans described in section
1710(a) of this title (including veterans with spinal cord
dysfunction, blindness, amputations, and mental illness)
within distinct programs or facilities of the Department
that are dedicated to the specialized needs of those veter-
ans in a manner that (1) affords those veterans reasonable
access to care and services for those specialized needs, and
(2) ensures that overall capacity of the Department to pro-
vide such services is not reduced below the capacity of the
Department, nationwide, to provide those services, as of
the date of the enactment of this section.
‘‘(d) In managing the provision of hospital care and
medical services under section 1710(a) of this title, the
Secretary shall ensure that any veteran with a service-con-
nected disability is provided all benefits under this chapter
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for which that veteran was eligible before the date of the
enactment of this section.’’.
(2) The table of sections at the beginning of chapter
17 is amended by inserting after the item relating to sec-
tion 1704 the following new items:
‘‘1705. Management of health care: patient enrollment system.
‘‘1706. Management of health care: other requirements.’’.
(b) 
CONFORMING
AMENDMENTS
TO
SECTION
1703.—(1) Section 1703 is amended—
(A) by striking out subsections (a) and (b); and
(B) in subsection (c) by—
(i) striking out ‘‘(c)’’, and
(ii) striking out ‘‘this section, sections’’
and inserting in lieu thereof ‘‘sections 1710,’’.
(2)(A) The heading of such section is amended to
read as follows:
‘‘§ 1703. Annual report on furnishing of care and
services by contract’’.
(B) The item relating to such section in the table of
sections at the beginning of chapter 17 is amended to read
as follows:
‘‘1703. Annual report on furnishing of care and services by contract.’’.
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SEC. 5. IMPROVED EFFICIENCY IN HEALTH CARE RE-
SOURCE MANAGEMENT.
(a) REPEAL OF SUNSET PROVISION.—Section 204 of
the Veterans Health Care Act of 1992 (Public Law 102–
585; 106 Stat. 4950) is repealed.
(b) COST RECOVERY.—Title II of such Act is further
amended by adding at the end the following new section:
‘‘SEC. 207. AUTHORITY TO BILL HEALTH-PLAN CONTRACTS.
‘‘(a) RIGHT TO RECOVER.—In the case of a primary
beneficiary (as described in section 201(2)(B)) who has
coverage under a health-plan contract, as defined in sec-
tion 1729(i)(1)(A) of title 38, United States Code, and
who is furnished care or services by a Department medical
facility pursuant to this title, the United States shall have
the right to recover or collect charges for such care or
services from such health-plan contract to the extent that
the beneficiary (or the provider of the care or services)
would be eligible to receive payment for such care or serv-
ices from such health-plan contract if the care or services
had not been furnished by a department or agency of the
United States. Any funds received from such health-plan
contract shall be credited to funds that have been allotted
to the facility that furnished the care or services.
‘‘(b) ENFORCEMENT.—The right of the United
States to recover under such a beneficiary’s health-plan
contract shall be enforceable in the same manner as that
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provided by subsections (a)(3), (b), (c)(1), (d), (f), (h),
and (i) of section 1729 of title 38, United States Code.’’.
SEC. 6. SHARING AGREEMENTS FOR HEALTH CARE RE-
SOURCES.
(a) REPEAL OF SECTION 8151.—(1) Subchapter IV
of chapter 81 is amended—
(A) by striking out section 8151; and
(B) by redesignating sections 8152, 8153,
8154, 8155, 8156, 8157, and 8158 as sections 8151,
8152, 8153, 8154, 8155, 8156, and 8157, respec-
tively.
(2) The table of sections at the beginning of such
chapter is amended—
(A) by striking out the item relating to section
8151; and
(B) by revising the items relating to sections
8152, 8153, 8154, 8155, 8156, 8157, and 8158 to
reflect the redesignations by paragraph (1)(B).
(b) REVISED AUTHORITY
FOR SHARING AGREE-
MENTS.—Section 8152 (as redesignated by subsection
(a)(1)(B)) is amended—
(1) in subsection (a)(1)(A)—
(A) by striking out ‘‘specialized medical re-
sources’’ and inserting in lieu thereof ‘‘health-
care resources’’; and
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(B) by striking out ‘‘other’’ and all that
follows through ‘‘medical schools’’ and inserting
in lieu thereof ‘‘any medical school, health-care
provider, health-care plan, insurer, or other en-
tity or individual’’;
(2) in subsection (a)(2) by striking out ‘‘only’’
and all that follows through ‘‘are not’’ and inserting
in lieu thereof ‘‘if such resources are not, or would
not be,’’;
(3) in subsection (b), by striking out ‘‘reciprocal
reimbursement’’ in the first sentence and all that
follows through the period at the end of that sen-
tence and inserting in lieu thereof ‘‘payment to the
Department in accordance with procedures that pro-
vide appropriate flexibility to negotiate payment
which is in the best interest of the Government.’’;
(4) in subsection (d), by striking out ‘‘preclude
such payment, in accordance with—’’ and all that
follows through ‘‘to such facility therefor’’ and in-
serting in lieu thereof ‘‘preclude such payment to
such facility for such care or services’’;
(5) by redesignating subsection (e) as sub-
section (f); and
(6) by inserting after subsection (d) the follow-
ing new subsection (e):
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‘‘(e) The Secretary may make an arrangement that
authorizes the furnishing of services by the Secretary
under this section to individuals who are not veterans only
if the Secretary determines—
‘‘(1) that such an arrangement will not result
in the denial of, or a delay in providing access to,
care to any veteran at that facility; and
‘‘(2) that such an arrangement—
‘‘(A) is necessary to maintain an accept-
able level and quality of service to veterans at
that facility; or
‘‘(B) will result in the improvement of
services to eligible veterans at that facility.’’.
(c) CROSS-REFERENCE AMENDMENTS.—(1) Section
8110(c)(3)(A) is amended by striking out ‘‘8153’’ and in-
serting in lieu thereof ‘‘8152’’.
(2) Subsection (b) of section 8154 (as redesignated
by subsection (a)(1)(B)) is amended by striking out ‘‘sec-
tion 8154’’ and inserting in lieu thereof ‘‘section 8153’’.
(3) Section 8156 (as redesignated by subsection
(a)(1)(B)) is amended—
(A) in subsection (a), by striking out ‘‘section
8153(a)’’ and inserting in lieu thereof ‘‘section
8152(a)’’; and
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(B) in subsection (b)(3), by striking out ‘‘sec-
tion 8153’’ and inserting in lieu thereof ‘‘section
8152’’.
(4) Subsection (a) of section 8157 (as redesignated
by subsection (a)(1)(B)) is amended—
(A) in the matter preceding paragraph (1), by
striking out ‘‘section 8157’’ and ‘‘section 8153(a)’’
and inserting in lieu thereof ‘‘section 8156’’ and
‘‘section 8152(a)’’, respectively; and
(B) in paragraph (1), by striking out ‘‘section
8157(b)(4)’’ and inserting in lieu thereof ‘‘section
8156(b)(4)’’.
SEC. 7. PERSONNEL FURNISHING SHARED RESOURCES.
Section 712(b)(2) is amended—
(1) by striking out ‘‘the sum of—’’ and insert-
ing in lieu thereof ‘‘the sum of the following:’’;
(2) by capitalizing the first letter of the first
word of each of subparagraphs (A) and (B);
(3) by striking out ‘‘; and’’ at the end of sub-
paragraph (A) and inserting in lieu thereof a period;
and
(4) by adding at the end the following:
‘‘(C) The number of such positions in the
Department during that fiscal year held by per-
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sons involved in providing health-care resources
under section 8111 or 8152 of this title.’’.
SEC. 8. AUTHORIZATION OF APPROPRIATIONS.
There is authorized to be appropriated for the De-
partment of Veterans Affairs for the Medical Care ac-
count, for the purposes specified for that account in Public
Law 103–327 (108 Stat. 2300), including the cost of pro-
viding hospital care and medical services under the amend-
ments made by section 2, not to exceed $17,250,000,000
for fiscal year 1997 and not to exceed $17,900,000,000
for fiscal year 1998.
SEC. 9. REPORT ON IMPLEMENTATION AND OPERATION.
(a) REPORT REQUIRED.—In carrying out sections 2,
3, and 4 (including the amendments made by those sec-
tions), the Secretary of Veterans Affairs shall establish in-
formation systems to assess, and, not later than March
1, 1998, shall submit to the Committees on Veterans’ Af-
fairs of the Senate and House of Representatives, a report
reflecting the experience of the Department during fiscal
year 1997 on—
(1) the effect of implementation of, and provi-
sion and management of care under, sections 2, 3,
and 4, on demand for health care services from the
Department of Veterans Affairs by veterans de-
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scribed in section 1710(a)(1), as amended by section
2;
(2) any differing patterns of demand on the
part of such veterans relating to such factors as rel-
ative distance from Department facilities and prior
experience, or lack of experience, as recipients of
care from the Department;
(3) the extent to which the Department has met
such demand for care; and
(4) changes in health-care delivery patterns in
Department facilities and the fiscal impact of such
changes.
(b) MATTERS TO BE INCLUDED.—The report under
subsection (a) shall include detailed information with re-
spect to fiscal year 1997 regarding the following:
(1) The number of veterans enrolled for care at
each Department medical facility and, of those veter-
ans, the number enrolled at each such facility who
had not received care from the Department during
the preceding three fiscal years.
(2) With respect to those veterans who had not
received care from the Department during the three
preceding fiscal years, the total cost of providing
care to those veterans, shown in total and separately
(A) by level of care, and (B) by reference to whether
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care is furnished in Department facilities or under
contract arrangements.
(3) With respect to the number of veterans de-
scribed in section 1710(a)(1), as amended by this
Act, who applied for health care from the Depart-
ment during fiscal year 1997—
(A) the number who applied for care
(shown in total and separately by facility);
(B) the number who were denied enroll-
ment (shown in total and separately by facility);
and
(C) the number who were denied care
which was considered to be medically necessary
but not of an emergency nature (shown in total
and separately by facility).
(4)(A) The numbers and characteristics of, and
the type and extent of health care furnished to, vet-
erans enrolled for care (shown in total and sepa-
rately by facility).
(B) The numbers and characteristics of, and
the type and extent of health care furnished to, vet-
erans not enrolled for care (shown separately by ref-
erence to each class of eligibility, both in total and
separately by facility).