I 
111TH CONGRESS 
1ST SESSION H. R. 3365 
To provide Medicare payments to Department of Veterans Affairs medical 
facilities for items and services provided to Medicare-eligible veterans 
for non-service-connected conditions. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 28, 2009 
Mr. FILNER introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committees on Energy 
and Commerce and Veterans’ Affairs, for a period to be subsequently de-
termined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
A BILL 
To provide Medicare payments to Department of Veterans 
Affairs medical facilities for items and services provided 
to Medicare-eligible veterans for non-service-connected 
conditions. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare VA Reim-
bursement Act of 2009’’. 
VerDate Nov 24 2008 
06:17 Jul 30, 2009
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H3365.IH
H3365
jbell on DSKDVH8Z91PROD with BILLS
SEC. 2. ESTABLISHMENT OF MEDICARE SUBVENTION FOR 
VETERANS. 
(a) IN GENERAL.—Section 1862 of the Social Secu-
rity Act (42 U.S.C. 1395y) is amended by adding at the 
end the following new subsection: 
‘‘(n) MEDICARE SUBVENTION FOR VETERANS.— 
‘‘(1) 
ESTABLISHMENT.—The 
Secretary 
of 
Health and Human Services, in cooperation with the 
Secretary of Veterans Affairs, shall establish a pro-
gram to be known as the ‘Medicare VA reimburse-
ment program’ under which the Secretary of Health 
and Human Services shall reimburse the Secretary 
of Veterans Affairs, from the Federal Hospital In-
surance Trust Fund established in section 1817 and 
the Federal Supplementary Medical Insurance Trust 
Fund established in section 1841, for an item or 
service that— 
‘‘(A) is furnished to a Medicare-eligible 
veteran by a Department of Veterans Affairs 
medical facility for the treatment of a non-serv-
ice-connected condition; and 
‘‘(B) is covered under this title or is deter-
mined to be medically necessary by the Sec-
retary of Veterans Affairs. 
‘‘(2) MEMORANDUM OF UNDERSTANDING.— 
VerDate Nov 24 2008 
06:17 Jul 30, 2009
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H3365.IH
H3365
jbell on DSKDVH8Z91PROD with BILLS
‘‘(A) IN
GENERAL.—Not later than 6 
months after the date of the enactment of this 
Act, the Secretary of Health and Human Serv-
ices shall enter a memorandum of under-
standing with the Secretary of Veterans Affairs 
concerning the administration of the Medicare 
VA reimbursement program. 
‘‘(B) CONTRACT ELEMENTS.—The memo-
randum of understanding under subparagraph 
(A) shall contain the following: 
‘‘(i) FREQUENCY
OF
REIMBURSE-
MENT.—An agreement on how often reim-
bursements will be made by the Secretary 
of Health and Human Services to the Sec-
retary of Veterans Affairs. 
‘‘(ii) BILLING
SYSTEM.—An agree-
ment on the details of the billing system 
that will be used by the Secretary of Vet-
erans Affairs to make claims for reim-
bursement from the Secretary of Health 
and Human Services. 
‘‘(iii) DATA SHARING AGREEMENT.— 
An agreement on data sharing, including— 
‘‘(I) identification of the data ex-
changes that each Secretary will need 
VerDate Nov 24 2008 
06:17 Jul 30, 2009
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H3365.IH
H3365
jbell on DSKDVH8Z91PROD with BILLS
to develop, maintain, or provide access 
to, for purposes of the Medicare VA 
reimbursement program; and 
‘‘(II) verification of data dem-
onstrating that a item or service was 
provided by a Department of Veterans 
Affairs medical facility to a Medicare- 
eligible veteran for a non-service-con-
nected condition before the Secretary 
of Health and Human Services pro-
vides for reimbursement for such item 
or service under the Medicare VA re-
imbursement program. 
‘‘(iv) PAYMENT RATE.—Subject to the 
requirements of paragraph (3), details of 
the payment rate to be used for reimburse-
ments made under the Medicare VA reim-
bursement program. 
‘‘(v) PERFORMANCE
MEASURES.—An 
agreement on performance measures and 
performance targets to be used to dem-
onstrate the impact of the Medicare VA re-
imbursement program. 
VerDate Nov 24 2008 
06:17 Jul 30, 2009
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H3365.IH
H3365
jbell on DSKDVH8Z91PROD with BILLS
‘‘(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 
VerDate Nov 24 2008 
06:17 Jul 30, 2009
Jkt 079200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H3365.IH
H3365
jbell on DSKDVH8Z91PROD with BILLS
‘‘(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— 
VerDate Nov 24 2008 
06:17 Jul 30, 2009
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H3365.IH
H3365
jbell on DSKDVH8Z91PROD with BILLS
‘‘(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 
VerDate Nov 24 2008 
06:17 Jul 30, 2009
Jkt 079200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H3365.IH
H3365
jbell on DSKDVH8Z91PROD with BILLS
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: 
VerDate Nov 24 2008 
06:17 Jul 30, 2009
Jkt 079200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H3365.IH
H3365
jbell on DSKDVH8Z91PROD with BILLS
‘‘(A) ADMINISTERING SECRETARIES.—The 
term ‘administering Secretaries’ means the Sec-
retary of Health and Human Services and the 
Secretary of Veterans Affairs acting jointly. 
‘‘(B) MEDICARE-ELIGIBLE VETERAN.—The 
term ‘Medicare-eligible veteran’ means an indi-
vidual who is a veteran (as defined in section 
101(2) of title 38, United States Code) who is 
eligible for care and services under section 
1705(a) of title 38, United States Code and 
who— 
‘‘(i) is entitled to, or enrolled for, ben-
efits under part A of this title; or 
‘‘(ii) is enrolled for benefits under 
part B of this title. 
‘‘(C) NON-SERVICE
CONNECTED
CONDI-
TION.—The term ‘non-service-connected condi-
tion’ means a disease or condition that is ‘non- 
service-connected’ as such term is defined in 
section 101(17) of title 38, United States Code. 
‘‘(D) DEPARTMENT OF VETERANS AFFAIRS 
MEDICAL FACILITY.—The term ‘Department of 
Veterans Affairs medical facility’ means a ‘med-
ical facility’ as such term is defined in section 
8101(3) of title 38, United States Code, alone 
VerDate Nov 24 2008 
06:17 Jul 30, 2009
Jkt 079200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H3365.IH
H3365
jbell on DSKDVH8Z91PROD with BILLS
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(n)(8)(B) of the Social Security 
Act (42 U.S.C. 1395y(n)(8)(B))) is furnished care or serv-
ices under this chapter for a non-service-connected condi-
tion (as defined in section 1862(n)(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(n) 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.’’. 
VerDate Nov 24 2008 
06:17 Jul 30, 2009
Jkt 079200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H3365.IH
H3365
jbell on DSKDVH8Z91PROD with BILLS
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(n) 
of the Social Security Act, as added by section 2 of this 
Act. 
(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(n)(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 
VerDate Nov 24 2008 
06:17 Jul 30, 2009
Jkt 079200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H3365.IH
H3365
jbell on DSKDVH8Z91PROD with BILLS
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(n) of the 
Social Security Act, as added by section 2(a). 
Æ 
VerDate Nov 24 2008 
06:17 Jul 30, 2009
Jkt 079200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6301
E:\BILLS\H3365.IH
H3365
jbell on DSKDVH8Z91PROD with BILLS