‘‘(vi) ADDITIONAL TERMS.—Any addi-
tional terms deemed necessary by the ad-
ministering Secretaries. 
‘‘(C) NO MAINTENANCE OF EFFORT RE-
QUIREMENT.—For purposes of the Medicare 
VA reimbursement program, the Secretary of 
Veterans Affairs shall not be required to meet 
a maintenance of effort requirement (a require-
ment that the Secretary of Veterans Affairs 
maintain a certain level of spending in order to 
receive reimbursement from the Secretary of 
Health and Human Services). 
‘‘(3) PAYMENTS BASED ON REGULAR MEDICARE 
PAYMENT RATES.— 
‘‘(A) AMOUNT.—Subject to the succeeding 
provisions of this paragraph, the Secretary of 
Health and Human Services shall reimburse the 
Secretary of Veterans Affairs— 
‘‘(i) for an item or service that is cov-
ered under this title and is provided to a 
Medicare-eligible veteran by a Department 
of Veterans Affairs medical facility for the 
treatment of a non-service-connected condi-
tion, at a rate that is not less than 100 
percent of the amounts that otherwise 
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would be payable under this title, on a fee- 
for-service basis, for such item or service if 
the Department of Veterans Affairs med-
ical facility were a provider of services, 
were participating in the Medicare pro-
gram, and imposed charges for such item 
or service; and 
‘‘(ii) for an item or service that is not 
covered under this title that is provided to 
a Medicare-eligible veteran by a Depart-
ment of Veterans Affairs medical facility 
for the treatment of a non-service-con-
nected condition, if the Secretary of Vet-
eran’s Affairs determines that such item or 
service is medically necessary, at a rate de-
termined by the Secretary of Health and 
Human Services in consultation with the 
Secretary of Veterans Affairs. 
‘‘(B) NO
ARBITRARY
LIMITATION
ON 
AMOUNT.—Subject to the requirements of this 
subsection, the Secretary of Health and Human 
Services may not impose an annual cap or other 
limit on the amount of reimbursement made 
under the Medicare VA reimbursement pro-
gram. 
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‘‘(C) EXCLUSION OF CERTAIN AMOUNTS.— 
In computing the amount of payment under 
subparagraph (A), the following amounts shall 
be excluded: 
‘‘(i) DISPROPORTIONATE SHARE HOS-
PITAL ADJUSTMENT.—Any amount attrib-
utable to an adjustment under section 
1886(d)(5)(F). 
‘‘(ii) DIRECT
GRADUATE
MEDICAL 
EDUCATION PAYMENTS.—Any amount at-
tributable to a payment under section 
1886(h). 
‘‘(iii) INDIRECT MEDICAL EDUCATION 
ADJUSTMENT.—Any amount attributable 
to 
the 
adjustment 
under 
section 
1886(d)(5)(B). 
‘‘(iv) 
CAPITAL
PAYMENTS.—Any 
amounts attributable to payments for cap-
ital-related costs under section 1886(g). 
‘‘(D) PERIODIC
PAYMENTS
FROM
MEDI-
CARE
TRUST
FUNDS.—Reimbursements under 
this paragraph shall be made— 
‘‘(i) on a periodic basis consistent 
with the periodicity of payments under this 
title; and 
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‘‘(ii) from the Federal Hospital Insur-
ance Trust Fund established in section 
1817 and the Federal Supplementary Med-
ical Insurance Trust Fund established in 
section 1841. 
‘‘(E) CREDITING
OF
PAYMENTS.—Any 
payment made to the Department of Veterans 
Affairs under this subsection shall be deposited 
in the Department of Veterans Affairs Medical 
Care Collections Fund established under section 
1729A of title 38, United States Code. 
‘‘(4) COST-SHARING REQUIREMENTS.—The Sec-
retary of Health and Human Services shall reduce 
the amount of reimbursement to the Secretary of 
Veterans Affairs for items and services under the 
Medicare VA reimbursement program by amounts 
attributable to applicable deductible, coinsurance, 
and cost-sharing requirements under this title. 
‘‘(5) WAIVER OF PROHIBITION ON PAYMENTS 
TO FEDERAL PROVIDERS OF SERVICES.—The prohi-
bition of payments to Federal providers of services 
under sections 1814(c) and 1835(d) shall not apply 
to items and services provided under this subsection. 
‘‘(6) RULES
OF
CONSTRUCTION.—Nothing in 
this subsection shall be construed— 
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‘‘(A) as prohibiting the Inspector General 
of the Department of Health and Human Serv-
ices from investigating any matters regarding 
the expenditure of funds under this subsection, 
including compliance with the provisions of this 
title and all other relevant laws; 
‘‘(B) as adding or requiring additional cri-
teria for eligibility for health care benefits fur-
nished to veterans by the Secretary of Veterans 
Affairs, as established under chapter 17 of title 
38, United States Code; or 
‘‘(C) subject to the requirements of title 
38, United States Code, as limiting a veteran’s 
ability to access such benefits, regardless of the 
veteran’s status as a Medicare-eligible veteran. 
‘‘(7) ANNUAL REPORTS.—Not later than one 
year after implementing the program under this sub-
section and annually thereafter, the administering 
Secretaries shall submit to the Congress a report 
containing the following: 
‘‘(A) The number of Medicare-eligible vet-
erans who opt to receive health care at a De-
partment of Veterans Affairs medical facility. 
‘‘(B) The total amount of reimbursements 
made from the Federal Hospital Insurance 
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Trust Fund established in section 1817 and the 
Federal 
Supplementary 
Medical 
Insurance 
Trust Fund established in section 1841 to the 
Department of Veterans Affairs Medical Care 
Collections Fund established under section 
1729A of title 38, United States Code. 
‘‘(C) The number and types of items and 
services provided to Medicare-eligible veterans 
by Department of Veterans Affairs medical fa-
cilities under this subsection. 
‘‘(D) An accounting of the manner in 
which the Department of Veterans Affairs ex-
pended funds received through reimbursements 
under this subsection. 
‘‘(E) A detailed description of any changes 
made to the memorandum of understanding 
under paragraph (2). 
‘‘(F) A comparison of the performance 
data with the performance targets under para-
graph (2)(B)(v). 
‘‘(G) Any other data on the Medicare VA 
reimbursement program that the administering 
Secretaries determine is appropriate. 
‘‘(8) DEFINITIONS.—For purposes of this sub-
section: 
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or in conjunction with other facilities under the 
jurisdiction of the Secretary of Veterans Af-
fairs.’’. 
(b) CONFORMING AMENDMENT.—Section 1729 of 
title 38, United States Code is amended by adding at the 
end the following new subsection: 
‘‘(j) In any case in which a Medicare-eligible veteran 
(as defined in section 1862(p)(8)(B) of the Social Security 
Act (42 U.S.C. 1395y(p)(8)(B))) is furnished care or serv-
ices under this chapter for a non-service-connected condi-
tion (as defined in section 1862(p)(8)(C) of such Act) the 
Secretary shall— 
‘‘(1) seek reimbursement from the Secretary of 
Health and Human Services for such care and serv-
ices under section 1862(p) of such Act; and 
‘‘(2) collect any applicable deductible, coinsur-
ance, or other cost-sharing amount required under 
title XVIII of the Social Security Act from the vet-
eran or from a third party to the extent that the vet-
eran (or the provider of the care or services) would 
be eligible to receive payment for such care or serv-
ices from such third party if the care or services had 
not been furnished by a department or agency of the 
United States.’’. 
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SEC. 3. GAO REPORT. 
(a) IN GENERAL.—Not later than the last day of the 
three-year period beginning on the date of the enactment 
of this Act and the last date of each subsequent three- 
year period, the Comptroller General of the United States 
shall submit to the Congress a report on the Medicare VA 
reimbursement program established under section 1862(p) 
of the Social Security Act, as added by section 2. 
(b) CONTENTS.—The report under subsection (a) 
shall contain an analysis of— 
(1) the impact of the Medicare VA reimburse-
ment program on the Federal Hospital Insurance 
Trust Fund established in section 1817 of the Social 
Security Act (42 U.S.C. 1395i) and the Federal 
Supplementary Medical Insurance Trust Fund es-
tablished in section 1841 of such Act (42 U.S.C. 
1395t); 
(2) whether Medicare-eligible veterans (as de-
fined in section 1862(p)(8)(B)) experience improved 
access to health care as a result of the program; 
(3) whether Medicare-eligible veterans experi-
ence a change in the quality of care that they receive 
as a result of this program; 
(4) the impact of the program on local health 
care providers and Medicare beneficiaries in the 
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communities surrounding Department of Veterans 
Affairs medical facilities; and 
(5) any additional issues deemed appropriate by 
the Comptroller General of the United States. 
SEC. 4. SENSE OF CONGRESS. 
It is the sense of the Congress that the amount of 
funds appropriated to the Department of Veterans Affairs 
for medical care in any fiscal year beginning on or after 
the date of the enactment of this Act should not be re-
duced as a result of the implementation of the Medicare 
VA reimbursement program under section 1862(p) of the 
Social Security Act, as added by section 2(a). 
Æ 
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