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coverage may be provided the items and services in stand-
ard coverage through VA health coverage offered in that
area only if (except as provided in subsection (b)) the Sec-
retary is reimbursed for the cost of the care provided.
‘‘(b) EXCEPTION.—The Secretary may not impose on
or collect from a veteran described in subsection (a) a cost-
share charge of any kind in the case of treatment for a
service-connected disability that (as determined by the
Secretary) requires a specialized treatment capacity for
which the Department has particular expertise.
‘‘§ 1825. Limitation on use of funds for abortions
‘‘None of the funds appropriated to carry out this
title shall be expended for any abortion except when it is
made known to the Secretary that such procedure is nec-
essary to save the life of the mother or that the pregnancy
is the result of an act of rape or incest.
‘‘SUBCHAPTER IV—FINANCIAL MATTERS
‘‘§ 1831. Premiums, copayments, etc.
‘‘(a) EXEMPTION OF CERTAIN VETERANS.—Subject
to subsection (f), in the case of a veteran described in sub-
section (b) who is a VA enrollee, there may not be imposed
or collected from the veteran a cost-share charge of any
kind (whether a premium, copayment, deductible, coinsur-
ance charge, or other charge) for items and services in
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standard coverage that are provided to the veteran by the
Secretary within a VA plan provider network.
‘‘(b) VETERANS EXEMPT FROM CHARGES.—The vet-
erans referred to in subsection (a) are the following:
‘‘(1) Any veteran with a service-connected dis-
ability rated at 10 percent or greater.
‘‘(2) Any veteran whose discharge or release
from the active military, naval or air service was for
a disability incurred or aggravated in the line of
duty.
‘‘(3) Any veteran who is in receipt of, or who,
but for a suspension pursuant to section 1151 of
this title (or both such a suspension and the receipt
of retired pay), would be entitled to disability com-
pensation, but only to the extent that such a veter-
an’s continuing eligibility for such care is provided
for in the judgment or settlement provided for in
such section.
‘‘(4) Any veteran who is a former prisoner of
war.
‘‘(5) Any veteran of the Mexican border period
or World War I.
‘‘(6) Any veteran who is unable to defray the
expenses of necessary care as determined under sec-
tion 1722(a) of this title.
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‘‘(c) OTHER ENROLLEES.—(1) In the case of a VA
enrollee who is not described in subsection (b), the Sec-
retary shall (except as provided in paragraph (2)) charge
premiums and shall establish copayments, deductibles, and
coinsurance amounts.
‘‘(2) The Secretary may not collect from an enrollee
a premium in the case of—
‘‘(A) an individual with VA health coverage by
reason of eligibility under section 1812 of this title;
or
‘‘(B) an individual with VA health coverage by
reason of eligibility under section 1813 of this title
and who is described in paragraph (1) of section
1713(a) of this title.
‘‘(3) The Secretary may not charge a copayment, de-
ductible, or other coinsurance amount in the case of care
for any disease covered under section 1710(e)(1) of this
title.
‘‘(d) ESTABLISHMENT
OF RATES.—The premium
rate, and the rates for deductibles and copayments, appli-
cable under VA health coverage shall be established by the
Secretary based on rules applicable to all health coverage
offered in the geographic area in which such VA health
coverage is offered.
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‘‘(e) DUTIES OF EMPLOYERS.—The obligations (in-
cluding obligations with respect to payment of premiums)
under the Bipartisan Health Care Reform Act of 1994
of an employer with respect to employees with VA health
coverage, and with respect to such coverage, shall be the
same as those that apply with respect to other employees
and other health coverage.
‘‘(f) ACCEPTANCE OF PREMIUM CERTIFICATES.—In
the case of a veteran who has been issued a premium cer-
tificate or voucher under the Bipartisan Health Care Re-
form Act of 1994, the Secretary may require the veteran
to tender the certificate to the Secretary as a condition
of enrollment and the Secretary may accept the certificate.
‘‘§ 1832. Recovery of cost of certain care and services
‘‘(a) RECOVERY FROM THIRD PARTIES.—In the case
of an individual provided care or services through VA
health coverage who has coverage under any supplemental
health insurance policy, including a Medicare supple-
mental health insurance plan, the Secretary has the right
to recover or collect charges for care or services (as deter-
mined by the Secretary, but not including care or services
for a service-connected disability) from the party providing
that coverage to the extent that the individual (or the pro-
vider of the care or services) would be eligible to receive
payment for such care or services from such party if the
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care or services had not been furnished by a department
or agency of the United States.
‘‘(b) PROCEDURES.—The provisions of subsections
(b) through (f) of section 1729 of this title shall apply
with respect to claims by the United States under sub-
section (a) in the same manner as they apply to claims
under subsection (a) of that section.
‘‘§ 1833. Health Coverage Fund
‘‘(a) ESTABLISHMENT OF FUND.—There is hereby
established in the Treasury a revolving fund to be known
as the ‘Department of Veterans Affairs Health Coverage
Fund’.
‘‘(b) CREDITING
OF AMOUNTS
TO FUND.—There
shall be credited to the revolving fund any amount received
by the Department by reason of the furnishing of health
care under VA health coverage and any amount received
by the Department by reason of the enrollment of an indi-
vidual with VA health coverage (including amounts re-
ceived as premiums, premium certificates or vouchers,
copayments or coinsurance, and deductibles), any amount
received as a third-party reimbursement, and any amount
received as a reimbursement from other health coverage
for care furnished to one of its enrollees.
‘‘(c) CREDITING TO TREASURY.—Any amounts de-
posited to the revolving fund that are attributable to
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amounts received by the Department as a premium, in-
cluding a premium certificate or voucher, by reason of the
enrollment with VA health coverage of a veteran described
in section 1831(b) of this title shall be covered into the
General Fund of the Treasury.
‘‘(d) AMOUNTS
NOT
PERMITTED
TO
BE
RE-
TAINED.—Notwithstanding subsection (b), the Depart-
ment may not retain amounts received for care furnished
to a VA enrollee in a case in which the costs of such care
have been covered by appropriations. Such amounts shall
be deposited in the General Fund of the Treasury.
‘‘(e) AVAILABILITY OF FUNDS.—Amounts in the re-
volving fund are hereby made available for all expenses,
both direct and indirect, related to the delivery through
VA health coverage of the items and services in standard
coverage and any supplemental benefits package or policy
offered through such coverage.’’.
(b) PRESERVATION OF EXISTING BENEFITS FOR FA-
CILITIES NOT OFFERING SERVICES THROUGH QUALIFIED
HEALTH COVERAGE.—(1) Chapter 17 of title 38, United
States Code, is amended by inserting after section 1704
the following new section:
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‘‘§ 1705. Facilities not offering qualified health cov-
erage; veterans not eligible to enroll to
obtain coverage
‘‘The provisions of this chapter shall apply with re-
spect to the furnishing of care and services—
‘‘(1) by any facility of the Department that (A)
is not offering qualified health coverage under the
Bipartisan Health Care Reform Act of 1994, and
(B) is not located in a State (or portion of a State)
that is a single payer area; and
‘‘(2) by any facility of the Department (whether
or not offering qualified health coverage under the
Bipartisan Health Care Reform Act of 1994) in the
case of a veteran who is not eligible for enrollment
under chapter 18 of this title.’’.
(2) The table of sections at the beginning of such
chapter is amended by inserting after the item relating
to section 1704 the following new item:
‘‘1705. Facilities not offering qualified health coverage; veterans not eligible to
enroll to obtain coverage.’’.
SEC. 9002. ORGANIZATION OF DEPARTMENT OF VETERANS
AFFAIRS FACILITIES AS FACILITIES OFFER-
ING QUALIFIED HEALTH COVERAGE.
(a) IN GENERAL.—Chapter 73 of title 38, United
States Code, is amended—
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(1) by redesignating subchapter IV as sub-
chapter V; and
(2) by inserting after subchapter III the follow-
ing new subchapter:
‘‘SUBCHAPTER IV—PARTICIPATION AS PART OF
NATIONAL HEALTH CARE REFORM
‘‘§ 7341. Organization of health care facilities as fa-
cilities offering qualified health coverage
‘‘(a) Except as provided in section 7342 of this title,
the Secretary may, subject to the availability of appropria-
tions, organize Department plans and facilities as entities
and facilities offering qualified health coverage under the
Bipartisan Health Care Reform Act of 1994 subject to
adjustment under subsection (g). The Secretary shall pre-
scribe regulations establishing standards for the operation
of Department health care facilities as facilities offering
qualified health coverage under the Bipartisan Health
Care Reform Act of 1994. In prescribing those standards,
the Secretary shall assure that they conform, to the maxi-
mum extent practicable, to the requirements for qualified
health coverage generally set forth in the Bipartisan
Health Care Reform Act of 1994.
‘‘(b) Within a geographic area or region, health care
facilities of the Department located within that area or
region may be organized to operate as a single entity offer-
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ing qualified health coverage encompassing all Depart-
ment facilities within that area or region or may be orga-
nized to operate as several entities offering qualified
health coverage.
‘‘(c) A health plan purchasing organization operating
within one or more fair rating areas shall offer as an op-
tion to eligible individuals enrollment to obtain VA health
coverage that is offered in such area.
‘‘(d) Any health insurance program that is provided
for Federal employees shall include enrollment to obtain
VA health coverage as enrollment options for eligible indi-
viduals. Premiums shall be paid for VA health coverage
under any such insurance program based upon enrollment
with that program in the same manner as to any other
health coverage.
‘‘(e)(1) In establishing and operating standard health
coverage, the Secretary, in consultation with the Comp-
troller General, shall take appropriate steps to ensure the
financial solvency and stability of the VA health coverage
and of contractors and subcontractors providing services
pursuant to section 7343 of this title.
‘‘(2) In carrying out paragraph (1), the Secretary
may purchase from commercial sources insurance to in-
sure the Department against the financial risks involved
in the offering of VA health coverage.
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‘‘(3) Notwithstanding any other provision of law,
there shall be no requirements applicable to the offering
of VA health coverage with respect to the maintenance of
a reserve fund, requirements to reinsure, or payments into
any other financial integrity fund other than as estab-
lished pursuant to paragraph (1).
‘‘(f) In carrying out responsibilities under the Bipar-
tisan Health Care Reform Act of 1994, a State (or a
State-established entity)—
‘‘(1) may not impose any standard or require-
ment on VA health coverage that is inconsistent with
this section or any regulation prescribed under this
section or other Federal laws regarding the oper-
ation of this section; and
‘‘(2) may not deny certification of VA health
coverage under the Bipartisan Health Care Reform
Act of 1994 on the basis of a conflict between a rule
of a State (or State-established entity) and this sec-
tion or regulations prescribed under this section or
other Federal laws regarding the operation of this
section.
‘‘(g) Notwithstanding any provision of the Bipartisan
Health Care Reform Act of 1994 or this subchapter, any
reference in this subchapter to ‘qualified health coverage’
under such Act shall, subject to section 1821(b) of this
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title, be considered a reference to coverage of a standard-
ized package of benefits established by the Secretary with
an actuarial value not less than the actuarial value of
qualified health coverage under such Act.
‘‘§ 7342. Operation of health care facilities within
States operating as single payer areas
‘‘(a) In a State (or portion of a State) that operates
as a single payer system, Department health care facilities
in that State (or portion of a State) shall serve as provid-
ers to individuals residing in that State (or portion of a
State) who would be eligible to enroll under chapter 18
of this title to obtain VA health coverage if they were re-
siding in an area where qualified health coverage was of-
fered under the Bipartisan Health Care Reform Act of
1994. Such facilities may provide those individuals any
covered service in standard coverage.
‘‘(b) A Department facility providing care to resi-
dents of a single payer area pursuant to subsection (a)
shall be reimbursed for that care on the same basis as
any other provider furnishing the same services in that
area.
‘‘(c) A veteran described in section 1831(b) of this
title shall be exempt from any otherwise applicable charges
for such care. Any other individual provided care pursuant
to subsection (a) shall be subject to all applicable require-
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ments respecting copayments, deductibles, and coinsur-
ance. Notwithstanding the preceding sentence, section
1831(c)(3) of this title shall apply to any such charge.
‘‘§ 7343. Health care resource agreements
‘‘(a)(1) In accordance with policies established under
subsection (b), an official specified in paragraph (2) may,
without regard to any law or regulation specified in para-
graph (3), enter into agreements with health care plans,
with insurers, and with health care providers, and with
any other entity or individual, to furnish or obtain any
health-care resource.
‘‘(2) An official specified in this paragraph is any of
the following:
‘‘(A) The head official offering VA health cov-
erage.
‘‘(B) The director of a Department health care
facility that is providing service through VA health
coverage.
‘‘(C) The director of a Department health care
facility that is operating in a State (or portion of a
State) that is operating under a single payer system.
‘‘(3) A law or regulation specified in this paragraph
is any of the following:
‘‘(A) Section 1703 of this title.
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‘‘(B) Any other law or regulation pertaining
to—
‘‘(i) competitive procedures;
‘‘(ii) acquisition procedures or policies
(other than contract dispute settlement proce-
dures); or
‘‘(iii) bid protests.
‘‘(4) For purposes of this subsection, the term
‘health-care resource’ has the meaning given that term in
section 8152 of this title.
‘‘(b) Policies established by the Secretary under sub-
section (a) shall include appropriate provisions to ensure
that procurements under that subsection are carried out
in a manner consistent with (1) Federal acquisition poli-
cies regarding nondiscrimination, equal opportunity, busi-
ness integrity, and safeguarding against fraud and abuse,
and (2) the goal of a streamlined process for the acquisi-
tion of health-care resources.
‘‘(c) Any proceeds to the Government received from
an agreement under subsection (a) shall be credited to the
Department of Veterans Affairs Health Coverage Fund
established under section 1834 of this title and to funds
that have been allotted to the facility that furnished the
resource involved.