I 113th CONGRESS 1st Session H. R. 2953 IN THE HOUSE OF REPRESENTATIVES August 1, 2013 Mr. Michaud introduced the following bill; which was referred to the Committee on Ways and Means , and in addition to the Committees on Energy and Commerce and Veterans’ Affairs , for a period to be subsequently determined 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.

1. Short title This Act may be cited as the Medicare VA Reimbursement Act of 2013 . 2. Establishment of Medicare subvention for veterans (a) In general Section 1862 of the Social Security Act ( 42 U.S.C. 1395y ) is amended by adding at the end the following new subsection: (p) Medicare subvention for veterans (1) Establishment The Secretary of Health and Human Services, in cooperation with the Secretary of Veterans Affairs, shall establish a program to be known as the Medicare VA reimbursement program under which the Secretary of Health and Human Services shall reimburse the Secretary of Veterans Affairs, from the Federal Hospital Insurance 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-service-connected condition; and (B) is covered under this title or is determined to be medically necessary by the Secretary of Veterans Affairs. (2) Memorandum of understanding (A) In general Not later than 6 months after the date of the enactment of this subsection, the Secretary of Health and Human Services shall enter a memorandum of understanding with the Secretary of Veterans Affairs concerning the administration of the Medicare VA reimbursement program. (B) Contract elements The memorandum of understanding under subparagraph (A) shall contain the following: (i) Frequency of reimbursement An agreement on how often reimbursements will be made by the Secretary of Health and Human Services to the Secretary of Veterans Affairs. (ii) Billing system An agreement on the details of the billing system that will be used by the Secretary of Veterans Affairs to make claims for reimbursement from the Secretary of Health and Human Services. (iii) Data sharing agreement An agreement on data sharing, including— (I) identification of the data exchanges that each Secretary will need to develop, maintain, or provide access to, for purposes of the Medicare VA reimbursement program; and (II) verification of data demonstrating that an item or service was provided by a Department of Veterans Affairs medical facility to a Medicare-eligible veteran for a non-service-connected condition before the Secretary of Health and Human Services provides for reimbursement for such item or service under the Medicare VA reimbursement program. (iv) Payment rate Details of the payment rate to be used consistent with paragraph (3) for reimbursements made under the Medicare VA reimbursement program. (v) Performance measures An agreement on performance measures and performance targets to be used to demonstrate the impact of the Medicare VA reimbursement program. (vi) Additional terms Any additional terms deemed necessary by the administering Secretaries. (C) No maintenance of effort requirement For purposes of the Medicare VA reimbursement program, the Secretary of Veterans Affairs shall not be required to meet a requirement 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 covered 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 condition, at a rate that is not less than 100 percent of the amounts that otherwise would be payable under this title, on a fee-for-service basis, for such item or service if the Department of Veterans Affairs medical facility were a provider of services, were participating in the Medicare program, 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 Department of Veterans Affairs medical facility for the treatment of a non-service-connected condition, if the Secretary of Veterans Affairs determines that such item or service is medically necessary, at a rate determined 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 program. (C) Exclusion of certain amounts In computing the amount of payment under subparagraph (A), the following amounts shall be excluded: (i) Disproportionate share hospital adjustment Any amount attributable to an adjustment under section 1886(d)(5)(F). (ii) Direct graduate medical education payments Any amount attributable 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 capital-related costs under section 1886(g). (D) Periodic payments from Medicare trust funds Reimbursements under this paragraph shall be made— (i) on a periodic basis consistent with the periodicity of payments under this title; and (ii) from the Federal Hospital Insurance Trust Fund established in section 1817 and the Federal Supplementary Medical 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 Secretary 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 prohibition of payments to Federal providers of services under sections 1814(c), 1835(d), and 1862(a)(3) shall not apply to items and services provided under this subsection. (6) Rules of construction Nothing in this subsection shall be construed— (A) as prohibiting the Inspector General of the Department of Health and Human Services 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 criteria for eligibility for health care benefits furnished 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 the date of implementing the Medicare VA reimbursement program and annually thereafter, the administering Secretaries shall submit to the Congress a report containing the following: (A) The number of Medicare-eligible veterans who elect to receive health care at a Department of Veterans Affairs medical facility. (B) The total amount of reimbursements made under the program from the Federal Hospital Insurance 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 facilities under the program. (D) An accounting of the manner in which the Department of Veterans Affairs expended funds received through reimbursements under the program. (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 paragraph (2)(B)(v). (G) Any other data on the program that the administering Secretaries determine are appropriate. (8) Definitions For purposes of this subsection: (A) Administering Secretaries The term administering Secretaries means the Secretary of Health and Human Services and the Secretary of Veterans Affairs acting jointly. (B) Medicare-eligible veteran The term Medicare-eligible veteran means an individual 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, benefits under part A; or (ii) is enrolled for benefits under part B. (C) Non-service connected condition The term non-service-connected condition means a disease or condition that is non-service-connected (as 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 medical facility (as defined in section 8101(3) of title 38, United States Code), alone or in conjunction with other facilities under the jurisdiction of the Secretary of Veterans Affairs. . (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 services under this chapter for a non-service-connected condition (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 services under section 1862(p) of such Act; and (2) collect any applicable deductible, coinsurance, or other cost-sharing amount required under title XVIII of the Social Security Act from the veteran or from a third party to the extent that the veteran (or the provider of the care or services) would be eligible to receive payment for such care or services from such third party if the care or services had not been furnished by a department or agency of the United States. . 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 reimbursement 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 established in section 1841 of such Act (42 U.S.C. 1395t); (2) whether Medicare-eligible veterans (as defined in section 1862(p)(8)(B) of such Act) experience improved access to health care as a result of the program; (3) whether Medicare-eligible veterans experience 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 communities surrounding Department of Veterans Affairs medical facilities; and (5) any additional issues deemed appropriate by the Comptroller General of the United States. 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 reduced 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).