A bill to require the Secretary of Defense and the Secretary of Veterans Affairs to carry out joint reviews relating to interdepartmental cooperation in the delivery of medical care by the departments.

SECTION 1. FINDINGS.

    Congress makes the following findings:
            (1) The military health care system of the Department of 
        Defense and the Veterans Health Administration of the 
        Department of Veterans Affairs are national institutions that 
        collectively manage more than 1,500 hospitals, clinics, and 
        health care facilities worldwide to provide services to more 
        than 11,000,000 beneficiaries.
            (2) In the post-Cold War era, these institutions are in a 
        profound transition that involves challenging opportunities.
            (3) During the period from 1988 to 1998, the number of 
        military medical personnel has declined by 15 percent and the 
        number of military hospitals has been reduced by one-third.
            (4) During the two years since 1996, the Department of 
        Veterans Affairs has revitalized its structure by 
        decentralizing authority into 22 Veterans Integrated Service 
        Networks.
            (5) In the face of increasing costs of medical care, 
        increased demands for health care services, and increasing 
        budgetary constraints, the Department of Defense and the 
        Department of Veterans Affairs have embarked on a variety of 
        dynamic and innovative cooperative programs ranging from shared 
        services to joint venture operations of medical facilities.
            (6) In 1984, there was a combined total of 102 Department 
        of Veterans Affairs and Department of Defense facilities with 
        sharing agreements. By 1997, that number had grown to 420. 
        During the six years from fiscal year 1992 through fiscal year 
        1997, shared services increased from slightly over 3,000 
        services to more than 6,000 services ranging from major medical 
        and surgical services, laundry, blood, and laboratory services 
        to unusual speciality care services.
            (7) The Department of Defense and the Department of 
        Veterans Affairs are conducting four health care joint ventures 
        in New Mexico, Nevada, Texas, Oklahoma, and are planning to 
        conduct four more such ventures in Alaska, Florida, Hawaii, and 
        California.

SEC. 2. SENSE OF CONGRESS.

    It is the sense of Congress that--
            (1) the Department of Defense and the Department of 
        Veterans Affairs are to be commended for the cooperation 
        between the two departments in the delivery of medical care, of 
        which the cooperation involved in the establishment and 
        operation of the Department of Defense and the Department of 
        Veterans Affairs Executive Council is a praiseworthy example;
            (2) the two departments are encouraged to continue to 
        explore new opportunities to enhance the availability and 
        delivery of medical care to beneficiaries by further enhancing 
        the cooperative efforts of the departments; and
            (3) enhanced cooperation is encouraged for--
                    (A) the general areas of access to quality medical 
                care, identification and elimination of impediments to 
                enhanced cooperation, and joint research and program 
                development; and
                    (B) the specific areas in which there is 
                significant potential to achieve progress in 
                cooperation in a short term, including computerization 
                of patient records systems, participation of the 
                Department of Veterans Affairs in the TRICARE program, 
                pharmaceutical programs, and joint physical 
                examinations.

SEC. 3. JOINT SURVEY ON POPULATIONS SERVED.

    (a) Survey Required.--The Secretary of Defense and the Secretary of 
Veterans Affairs shall jointly conduct a survey of their respective 
medical care beneficiary populations to identify, by category of 
beneficiary (defined as the Secretaries consider appropriate), the 
expectations of, requirements for, and behavior patterns of the 
beneficiaries with respect to medical care. The two Secretaries shall 
develop the protocol for the survey jointly, but shall obtain the 
services of an entity independent of the Department of Defense and the 
Department of Veterans Affairs for carrying out the survey.
    (b) Matters To Be Surveyed.--The survey shall include the 
following:
            (1) Demographic characteristics, economic characteristics, 
        and geographic location of beneficiary populations with regard 
        to catchment or service areas.
            (2) The types and frequency of care required by veterans, 
        retirees, and dependents within catchment or service areas of 
        Department of Defense and Veterans Affairs medical facilities 
        and outside those areas.
            (3) The numbers of, characteristics of, and types of 
        medical care needed by the veterans, retirees, and dependents 
        who, though eligible for medical care in Department of Defense 
        or Department of Veterans Affairs treatment facilities or other 
        federally funded medical programs, choose not to seek medical 
        care from those facilities or under those programs, and the 
        reasons for that choice.
            (4) The obstacles or disincentives for seeking medical care 
        from such facilities or under such programs that veterans, 
        retirees, and dependents perceive.
            (5) Any other matters that the Secretary of Defense and the 
        Secretary of Veterans Affairs consider appropriate for the 
        survey.
    (c) Report.--The Secretary of Defense and the Secretary of Veterans 
Affairs shall submit a report on the results of the survey to the 
appropriate committees of Congress. The report shall contain the 
matters described in subsection (b) and any proposals for legislation 
that the Secretaries recommend for enhancing Department of Defense and 
Department of Veterans Affairs cooperative efforts with respect to the 
delivery of medical care.

SEC. 4. REVIEW OF IMPEDIMENTS TO COOPERATION.

    (a) Review Required.--The Secretary of Defense and the Secretary of 
Veterans Affairs shall jointly conduct a review to identify impediments 
to cooperation between the Department of Defense and the Department of 
Veterans Affairs regarding the delivery of medical care. The matters 
reviewed shall include the following:
            (1) All laws, policies, and regulations, and any attitudes 
        of beneficiaries of the health care systems of the two 
        departments, that have the effect of preventing the 
        establishment, or limiting the effectiveness, of cooperative 
        health care programs of the departments.
            (2) The requirements and practices involved in the 
        credentialling and licensure of health care providers.
            (3) The perceptions of beneficiaries in a variety of 
        categories (defined as the Secretaries consider appropriate) 
        regarding the various Federal health care systems available for 
        their use.
    (b) Report.--The Secretaries shall jointly submit a report on the 
results of the review to the appropriate committees of Congress. The 
report shall include any proposals for legislation that the Secretaries 
recommend for eliminating or reducing impediments to interdepartmental 
cooperation that are identified during the review.

SEC. 5. PARTICIPATION OF DEPARTMENT OF VETERANS AFFAIRS IN TRICARE.

    (a) Review Required.--The Secretary of Defense shall review the 
TRICARE program to identify opportunities for increased participation 
by the Department of Veterans Affairs in that program. The ongoing 
collaboration between Department of Defense officials and Department of 
Veterans Affairs officials regarding increasing the participation shall 
be included among the matters reviewed.
    (b) Semiannual Report.--The Secretary of Defense and the Secretary 
of Veterans Affairs shall jointly submit to the appropriate committees 
of Congress a semiannual report on the status of the review and on 
efforts to increase the participation of the Department of Veterans 
Affairs in the TRICARE program. No report is required under this 
subsection after the submission of a semiannual report in which the 
Secretaries declare that the Department of Veterans Affairs is 
participating in the TRICARE program to the extent that can reasonably 
be expected to be attained.

SEC. 6. PHARMACEUTICAL BENEFITS AND PROGRAMS.

    (a) Examination Required.--(1) The Federal Pharmaceutical Steering 
Committee shall--
            (A) undertake a comprehensive examination of existing 
        pharmaceutical benefits and programs for beneficiaries of 
        Federal medical care programs, including matters relating to 
        the purchasing, distribution, and dispensing of pharmaceuticals 
        and the management of mail order pharmaceuticals programs; and
            (B) review the existing methods for contracting for and 
        distributing medical supplies and services.
    (2) The committee shall submit a report on the results of the 
examination to the appropriate committees of Congress.
    (b) Report.--The committee shall submit a report on the results of 
the examination to the appropriate committees of Congress.

SEC. 7. STANDARDIZATION OF PHYSICAL EXAMINATIONS FOR DISABILITIES.

    The Secretary of Defense and the Secretary of Veterans Affairs 
shall submit to the appropriate committees of Congress a report on the 
status of the efforts of the Department of Defense and the Department 
of Veterans Affairs to standardize physical examinations administered 
by the two departments for the purpose of determining or rating 
disabilities.

SEC. 8. APPROPRIATE COMMITTEES OF CONGRESS DEFINED.

    For the purposes of this Act, the appropriate committees of 
Congress are as follows:
            (1) The Committee on Armed Services and the Committee on 
        Veterans' Affairs of the Senate.
            (2) The Committee on National Security and the Committee on 
        Veterans' Affairs of the House of Representatives.

SEC. 9. DEADLINES FOR SUBMISSION OF REPORTS.

    (a) Report on Joint Survey of Populations Served.--The report 
required by section 3(c) shall be submitted not later than January 1, 
2000.
    (b) Report on Review of Impediments to Cooperation.--The report 
required by section 4(b) shall be submitted not later than May 1, 1999.
    (c) Semiannual Report on Participation of Department of Veterans 
Affairs in TRICARE.--The semiannual report required by section 5(b) 
shall be submitted not later than January 1 and June 1 of each year.
    (d) Report on Examination of Pharmaceutical Benefits and 
Programs.--The report on the examination required under section 6 shall 
be submitted not later than 60 days after the completion of the 
examination.
    (e) Report on Standardization of Physical Examinations for 
Disabilities.--The report required by section 7 shall be submitted not 
later than June 1, 1999.

Summary: Expresses the sense of the Congress that:  (1) the Department of Defense (DOD) and the Department of Veterans Affairs (VA) should be commended for their cooperative efforts in the delivery of medical care; (2) DOD and VA should continue to explore new opportunities to enhance the availability and delivery of medical care to beneficiaries by further enhancing such cooperative efforts; and (3) such enhanced cooperation is encouraged for the general areas of access to quality medical care, identification and elimination of impediments to cooperation, and joint research and program development and for the specific areas in which there is significant potential to achieve progress in cooperation in a short term, including computerization of patient records systems, VA participation in TRICARE, pharmaceutical programs, and joint physical examinations. 
Directs the DOD and VA Secretaries to jointly conduct:  (1) a survey of their respective medical care beneficiary populations to identify the expectations of, requirements for, and behavior patterns of such beneficiaries with respect to medical care; and (2) a review of impediments to cooperation in the delivery of medical care.  Requires reports to the congressional defense and veterans' affairs committees (the committees). 
Requires the Secretary of Defense to review and report semiannually to the committees on opportunities for increased VA participation in TRICARE. 
Directs the Federal Pharmaceutical Steering Committee to:  (1) undertake a comprehensive examination of existing pharmaceutical benefits and programs for beneficiaries of Federal medical care programs; (2) review the existing methods for contracting for and distributing medical supplies and services; and (3) report examination results to the committees. 
Directs the Secretaries to submit to the committees a report on the status of DOD and VA efforts to standardize physical examinations administered to determine or rate disabilities. 
Provides deadlines for required reports.