Expresses the sense of Congress that the amount of funds appropriated for the Department of Veterans Affairs for medical care in any fiscal year beginning after the enactment of this Act should not be reduced because of the implementation of the Medicare Reimbursement Program for Veterans.
[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 2232 Introduced in Senate (IS)]
107th CONGRESS
2d Session
S. 2232
To amend title XVIII of the Social Security Act to establish a program
to provide for medicare reimbursement for health care services provided
to certain medicare-eligible veterans in facilities of the Department
of Veterans Affairs.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 23, 2002
Mr. Dayton introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to establish a program
to provide for medicare reimbursement for health care services provided
to certain medicare-eligible veterans in facilities of the Department
of Veterans Affairs.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Veterans Health Care Reimbursement
Act of 2002''.
SEC. 2. ESTABLISHMENT OF MEDICARE REIMBURSEMENT PROGRAM FOR VETERANS.
(a) In General.--Title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.) is amended by adding at the end the following new
section:
``medicare reimbursement program for veterans
``Sec. 1897. (a) Definitions.--In this section:
``(1) Administering secretaries.--The term `administering
Secretaries' means the Secretary and the Secretary of Veterans
Affairs acting jointly.
``(2) Medicare health care services.--The term `medicare
health care services' means items or services covered under
part A or part B.
``(3) Program.--The term `program' means the program
carried out under this section.
``(4) Program site.--The term `program site' means a
Veterans Affairs medical facility that provides, alone or in
conjunction with other facilities under the jurisdiction of the
Secretary of Veterans Affairs and affiliated public or private
entities--
``(A) in the case of a coordinated care health
plan, the health care benefits prescribed in subsection
(c)(3) to targeted medicare-eligible veterans residing
within the service area; and
``(B) in the case of health care benefits being
provided on a fee-for-service basis, the health care
benefits prescribed in subsection (d)(2) to targeted
medicare-eligible veterans.
``(5) Targeted medicare-eligible veteran.--The term
`targeted medicare-eligible veteran' means an individual who--
``(A) is a veteran (as defined in section 101 of
title 38, United States Code) who is enrolled in the
annual patient enrollment system under paragraph (4),
(5), (6), or (7) of section 1705(a) of title 38, United
States Code;
``(B) has attained age 65;
``(C) is entitled to, or enrolled for, benefits
under part A; and
``(D) is enrolled for benefits under part B.
``(6) Trust funds.--The term `trust funds' means the
Federal Hospital Insurance Trust Fund established in section
1817 and the Federal Supplementary Medical Insurance Trust Fund
established in section 1841.
``(7) Veterans affairs medical facility.--The term
`Veterans Affairs medical facility' means a medical facility as
defined in section 8101 of title 38, United States Code.
``(b) Program.--
``(1) In general.--
``(A) Establishment.--The administering Secretaries
shall establish a program (under agreements entered
into by the administering Secretaries) under which the
Secretary shall reimburse the Secretary of Veterans
Affairs, from the trust funds, for medicare health care
services furnished to targeted medicare-eligible
veterans.
``(B) Agreement.--Any agreement entered into under
this paragraph shall include at a minimum--
``(i) a detailed description of the health
care benefits to be provided to the
participants of the program;
``(ii) a description of the eligibility
rules for participation in the program, any
premiums established for a coordinated care
health plan, and any cost-sharing arrangements;
``(iii) a description of how the program
will satisfy the requirements under this title;
``(iv) a description of the sites selected
under paragraph (2) and which model such site
will operate under;
``(v) a description of how reimbursement
requirements under subsection (i), maintenance
of effort requirements under subsection (j),
and the annual reconciliation under subsection
(k) will be implemented in the program;
``(vi) a statement that the Secretary shall
have access to all data of the Department of
Veterans Affairs that the Secretary determines
is necessary to conduct independent estimates
and audits of the maintenance of effort
requirement under subsection (j), the annual
reconciliation under subsection (k), and
related matters required under the program;
``(vii) a statement that the Comptroller
General of the United States shall have access
to all data of the Department of Veterans
Affairs that the Comptroller General determines
is necessary to carry out the reporting
requirements under subsections (k) or (l);
``(viii) a description of any requirement
that the Secretary waives pursuant to
subsection (c)(4) or (d)(4); and
``(ix) a certification, provided after
review by the administering Secretaries, that
any facility or entity described in subsection
(a)(4) that is receiving payments by reason of
the program has sufficient--
``(I) resources and expertise to
provide, consistent with payment
requirements under subsection (i), the
health care benefits required to be
provided to beneficiaries under the
program (as established under
subsections (c)(3) and (d)(2)); and
``(II) information and billing
systems in place to ensure--
``(aa) accurate and timely
submission of claims for health
care benefits to the Secretary;
and
``(bb) that providers of
health care services that are
not affiliated with the
Department of Veterans Affairs
are reimbursed by the Secretary
of Veterans Affairs in a timely
and accurate manner.
``(C) Separate agreements for coordinated care and
fee-for-service.--The administering Secretaries shall
enter into separate agreements with regard to program
sites operating under a coordinated care health plan
model and a fee-for-service model, and shall include in
each agreement only such information that is applicable
to that model.
``(2) Location of program sites.--The program shall be
conducted at any program site that is designated by the
Secretary of Veterans Affairs.
``(3) Restrictions.--
``(A) Only 1 model at a site.--A program site may
not operate under both a coordinated care health plan
model and a fee-for-service model.
``(B) Restriction on new or expanded facilities.--
No new Veterans Affairs medical facilities may be built
or expanded with funds from the program.
``(4) Commencement of project.--The administering
Secretaries shall commence the demonstration project not later
than 6 months after the date of enactment of the Veterans
Health Care Reimbursement Act of 2002.
``(5) Termination.--If determined appropriate, the
Secretary of Veterans Affairs may terminate the program.
``(6) Report.--At least 30 days prior to the commencement
of the program (for both the coordinated care health plan model
and the fee-for-service model), the administering Secretaries
shall submit a copy of any agreement entered into under
paragraph (1) to the committees of jurisdiction of Congress.
``(c) Coordinated Care Health Plan Model.--
``(1) In general.--The Secretary of Veterans Affairs shall
establish and operate coordinated care health plans in order to
provide the health care benefits prescribed in paragraph (3) to
targeted medicare-eligible veterans enrolled in the program
under this section consistent with the Medicare+Choice program
under part C.
``(2) Operation by or through a program site.--Any
coordinated care health plan established in accordance with
paragraph (1) shall be operated by or through a program site.
``(3) Health care benefits.--
``(A) In general.--Subject to subparagraph (B), the
Secretary of Veterans Affairs shall prescribe the
health care benefits to be provided to a targeted
medicare-eligible veteran enrolled in a coordinated
care health plan under the program.
``(B) Minimum benefits.--The benefits prescribed by
the Secretary of Veterans Affairs pursuant to
subparagraph (A) shall include at least all medicare
health care services that are required to be provided
by a Medicare+Choice organization under part C.
``(4) Medicare requirements.--
``(A) In general.--
``(i) Requirements.--Except as provided
under clause (ii), a coordinated care health
plan operating under the program shall meet all
requirements applicable to a Medicare+Choice
plan under part C and regulations pertaining
thereto, and any other requirements for
receiving payments under this title, except
that the prohibition of payments to Federal
providers of services under sections 1814(c)
and 1835(d), and paragraphs (2) and (3) of
section 1862(a), shall not apply.
``(ii) Waiver.--Except with respect to any
requirement described in subparagraph (B), the
Secretary is authorized to waive any
requirement described in clause (i), or approve
equivalent or alternative ways of meeting such
a requirement, but only if such waiver or
approval--
``(I) reflects the unique status of
the Department of Veterans Affairs as
an agency of the Federal Government;
and
``(II) is necessary to carry out,
or improve the efficiency of, the
program.
``(B) Beneficiary protections and other matters.--A
coordinated care health plan shall comply with the
requirements of the Medicare+Choice program under part
C that relate to beneficiary protections and other
related matters, including such requirements relating
to the following areas:
``(i) Enrollment and disenrollment.
``(ii) Nondiscrimination.
``(iii) Information provided to
beneficiaries.
``(iv) Cost-sharing limitations.
``(v) Appeal and grievance procedures.
``(vi) Provider participation.
``(vii) Access to services.
``(viii) Quality assurance and external
review.
``(ix) Advance directives.
``(x) Other areas of beneficiary
protections that the Secretary determines are
applicable to a coordinated care health plan
operating under the program under this section.
``(d) Fee-For-Service Model.--
``(1) In general.--The Secretary of Veterans Affairs shall
establish and operate a program site in order to provide, on a
fee-for-service basis, the medicare health care services
prescribed in paragraph (2) to targeted medicare-eligible
veterans under the program in a manner consistent with this
title.
``(2) Health care benefits.--The administering Secretaries
shall prescribe the medicare health care services available to
a targeted medicare-eligible veteran at a program site
operating under a fee-for-service model.
``(3) Cost-sharing.--The Secretary of Veterans Affairs
shall establish cost-sharing requirements for targeted
medicare-eligible veterans that receive medicare health care
services under a fee-for-service model at a program site. Such
cost-sharing requirements shall be the same as those required
under this title.
``(4) Medicare requirements.--
``(A) In general.--Except as provided under
subparagraph (B), any entity or health care provider
that provides medicare health care services under the
program on a fee-for-service basis shall meet all of
the requirements under this title, except that the
prohibition of payments to Federal providers of
services under sections 1814(c) and 1835(d), and
paragraphs (2) and (3) of section 1862(a), shall not
apply.
``(B) Waiver.--The Secretary is authorized to waive
any requirement described under subparagraph (A), or
approve equivalent or alternative ways of meeting such
a requirement, but only if such waiver or approval--
``(i) reflects the unique status of the
Department of Veterans Affairs as an agency of
the Federal Government; and
``(ii) is necessary to carry out, or
improve the efficiency of, the program.
``(5) Verification of eligibility.--
``(A) In general.--The Secretary of Veterans
Affairs shall establish procedures for determining
whether an individual is eligible to receive medicare
health care services on a fee-for-service basis under
the program.
``(B) Restriction.--No payments shall be made under
this section for any medicare health care service
provided to an individual on a fee-for-service basis
under the program unless the individual has been
determined to be eligible for the service pursuant to
the procedures established under subparagraph (A).
``(e) Voluntary Participation.--Participation of a targeted
medicare-eligible veteran in the program shall be voluntary, subject to
the capacity of participating program sites and any annual limitation
on medicare payments specified by the administering Secretaries in
subsection (i)(4), and shall be subject to such terms and conditions as
the administering Secretaries may establish.
``(f) Crediting of Payments.--A payment received by the Secretary
of Veterans Affairs under the program shall be credited to the
appropriation of the Department of Veterans Affairs for Medical Care.
Amounts credited to that appropriation for services furnished by a
program site shall be credited to amounts in the appropriation that are
available for the Veterans Integrated Services Network (VISN) in which
the program site is located. Amounts so credited for a Veterans
Integrated Services Network shall be available for the furnishing of
health care and services by any Veterans Affairs medical facility in
the Veterans Integrated Services Network. Amounts so credited shall be
available in accordance with the preceding sentence without fiscal year
limitation.
``(g) Waiver of Certain VA Requirements.--Notwithstanding any other
provision of law, the Secretary of Veterans Affairs shall furnish
medicare health care services to targeted medicare-eligible veterans
pursuant to the program.
``(h) Inspector General.--Nothing in any agreement entered into
under subsection (b)(1) shall limit the Inspector General of the
Department of Health and Human Services from investigating any matters
regarding the expenditure of funds under this title for the program,
including compliance with the provisions of this title and all other
relevant laws.
``(i) Payments Based on Regular Medicare Payment Rates.--
``(1) Amount.--Subject to the succeeding provisions of this
subsection and subsection (k), the Secretary shall reimburse
the Secretary of Veterans Affairs for health care benefits
provided under the program at the following rates:
``(A) Coordinated care health plans.--In the case
of health care benefits provided under the program to a
targeted medicare-eligible veteran enrolled in a
coordinated care health plan, at a rate equal to 95
percent of the amount paid to a Medicare+Choice
organization under part C for an enrollee in a
Medicare+Choice plan offered by such organization (as
risk adjusted under section 1853(a)(1)(B)).
``(B) Fee-for-service model.--In the case of a
medicare health care service prescribed in subsection
(d)(2) that is provided at a program site operating
under a fee-for-service model, at a rate equal to 95
percent of the amounts that otherwise would be payable
under this title on a noncapitated basis for such
service if the program site was not part of the program under this
section, was participating in the medicare program, and imposed charges
for such service.
``(2) Exclusion of certain amounts.--In computing the
amount of payment under paragraph (1), the following amounts
shall be excluded:
``(A) Disproportionate share hospital adjustment.--
Any amount attributable to an adjustment under section
1886(d)(5)(F).
``(B) Direct graduate medical education payments.--
Any amount attributable to a payment under section
1886(h).
``(C) Indirect medical education adjustment.--Any
amount attributable to the adjustment under section
1886(d)(5)(B).
``(D) Percentage of capital payments.--67 percent
of any amounts attributable to payments for capital-
related costs under medicare payment policies under
section 1886(g).
``(3) Periodic payments from medicare trust funds.--
Payments under this subsection shall be made--
``(A) on a periodic basis consistent with the
periodicity of payments under this title; and
``(B) in appropriate part, as determined by the
Secretary, from the trust funds.
``(4) Annual limit on medicare payments to be determined by
administering secretaries.--The aggregate amount that may be
paid to the Department of Veterans Affairs under this
subsection for enrollees in coordinated care health plans for a
year and for health care benefits provided on a fee-for-service
basis at a program site in that year shall be equal to an
amount determined appropriate by the administering Secretaries.
``(j) Maintenance of Effort.--
``(1) In general.--The Secretary may not reimburse the
Secretary of Veterans Affairs, from the trust funds, for
medicare health care services furnished under the program to
targeted medicare-eligible veterans at a program site in a
fiscal year until the expenditures during that year by the
Department of Veterans Affairs for such services provided at
that site to individuals that meet the definition of a targeted
medicare-eligible veteran under subsection (a)(5) (without
regard to subparagraph (D) of such subsection) exceeds such
expenditures at the site for such services provided to
applicable veterans during fiscal year 1998.
``(2) Applicable veteran defined.--For purposes of
paragraph (1), the term `applicable veteran' means an
individual who--
``(A) is a veteran (as defined in section 101 of
title 38, United States Code) who is eligible for care
and services under section 1710(a)(3) of title 38,
United States Code;
``(B) has attained age 65; and
``(C) is entitled to, or enrolled for, benefits
under part A.
``(3) Rule of construction.--The criteria for eligibility
for health care benefits furnished to veterans by the Secretary
of Veterans Affairs is established under chapter 17 of title
38, United States Code, and nothing in this section shall be
construed to add additional criteria for such eligibility.
``(k) Annual Reconciliation To Assure No Increase in Costs to
Medicare Program.--
``(1) Monitoring effect of program on costs to medicare
program.--
``(A) In general.--The administering Secretaries,
in consultation with the Comptroller General of the
United States, shall closely monitor the expenditures
made under the medicare program under this title for
targeted medicare-eligible veterans at each program
site during a fiscal year compared to the expenditures
that would have been made for such veterans during that
year if the program had not been conducted.
``(B) Annual reports by the comptroller general.--
Not later than 6 months after the end of each fiscal
year in which the program is operated, the Comptroller
General of the United States shall submit to the
administering Secretaries and the appropriate
committees of Congress a report on the extent, if any,
to which the costs of the Secretary under the medicare
program under this title for each program site
increased as a result of the program under this section
during the fiscal year to which the report applies.
``(2) Required response in case of increase in costs.--
``(A) In general.--If the administering Secretaries
find, based on paragraph (1), that the expenditures
under the medicare program under this title for each
program site increased (or are expected to increase)
during a fiscal year because of the program under this
section, the administering Secretaries shall take such
steps as may be needed--
``(i) to recoup for the medicare program
the amount of such increase in expenditures;
and
``(ii) to prevent any such increase in any
succeeding fiscal year.
``(B) Steps.--Such steps--
``(i) under subparagraph (A)(i), shall
include payment of an amount equal to the
amount of such increased expenditures by the
Secretary of Veterans Affairs from the current
appropriation for Medical Care of the
Department of Veterans Affairs to the trust
funds; and
``(ii) under subparagraph (A)(ii), shall
include suspending or terminating the program
(in whole or in part) or reducing the amount of
payment under subsection (i).
``(l) GAO Evaluation and Additional Reports.--
``(1) Evaluation.--
``(A) In general.--The Comptroller General of the
United States shall conduct an evaluation of the
program, including--
``(i) an evaluation of program sites
operating under a coordinated care health plan
model and under a fee-for-service model; and
``(ii) where appropriate, a comparison of
such models.
``(B) Contents.--Any evaluation conducted under
subparagraph (A) shall include an assessment, based on
the agreements entered into under subsection (b)(1), of
the following:
``(i) Any savings or costs to the medicare
program under this title resulting from the
program.
``(ii) Compliance of participating program
sites with applicable measures of quality of
care, compared to such compliance by other
entities that participate in the medicare
program and are not Veterans Affairs medical
facilities.
``(iii) Compliance by the Department of
Veterans Affairs with the requirements under
this title.
``(iv) The number of targeted medicare-
eligible veterans opting to receive health care
benefits under the program instead of receiving
such benefits through another health insurance
plan (including health care benefits under this
title).
``(v) A comparison of the costs of
participation of the program sites in the
program with the reimbursements for health care
services provided by such sites.
``(vi) Any impact the program has on the
access to health care services, or the quality
of such services, for--
``(I) targeted medicare-eligible
veterans receiving health care benefits
under the program; and
``(II) veterans (including targeted
medicare-eligible veterans) that are
not receiving health care benefits
under the program.
``(vii) Any impact the program has on
private health care providers and on
beneficiaries under this title that are not
receiving health care benefits under the
program.
``(viii) Any effect that the program has on
the enrollment in Medicare+Choice plans offered
by Medicare+Choice organizations under part C
in the established program site areas.
``(ix) Any impact that the exclusion of the
amounts described in subsection (i)(2) from the
reimbursement amounts under the program has on
the Department of Veterans Affairs or on
targeted medicare-eligible veterans.
``(x) A description of the difficulties (if
any) experienced by--
``(I) the Department of Veterans
Affairs in managing the program; or
``(II) the Department of Health and
Human Services in overseeing the
program.
``(xi) Any additional elements specified in
the agreements entered into under subsection
(b)(1).
``(xii) Any additional elements that the
Comptroller General of the United States
determines are appropriate to assess regarding
the program.
``(2) Biannual reports.--Not later than the date that is
the 2-year anniversary of the commencement of the program and
biannually thereafter (for as long as the program is being
conducted), the Comptroller General of the United States shall
submit reports on the evaluation conducted under subparagraph
(A) to the administering Secretaries and to the committees of
jurisdiction of Congress.
``(m) Reports by Administering Secretaries on Program Operation and
Changes.--
``(1) Annual report.--The administering Secretaries shall
submit to the committees of jurisdiction of Congress an annual
report on the program and its impact on costs and the provision
of health services under this title and title 38, United States
Code.
``(2) Report before making certain program changes.--
``(A) In general.--The administering Secretaries
shall submit to the committees of jurisdiction of
Congress a report at least 60 days before--
``(i) adding or changing the designation of
a site under subsection (b)(2);
``(ii) waiving any requirement under
subsection (c)(4) or (d)(4) that was not
described in any agreement under subsection
(b)(1) or previous report under this
subsection;
``(iii) making other significant changes in
the operation of the program; or
``(iv) terminating the agreement under
subsection (b)(5).
``(B) Explanation.--Each report under subparagraph
(A) shall include justifications for the changes or
termination to which the report refers.''.
(b) Sense of Congress.--It is the sense of Congress that the amount
of funds appropriated for the Department of Veterans Affairs for
Medical Care in any fiscal year beginning after the date of enactment
of this Act should not be reduced because of the implementation of the
Medicare Reimbursement Program for Veterans under section 1897 of the
Social Security Act (as added by subsection (a)).
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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