[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 1974 Introduced in Senate (IS)]

103d CONGRESS
  2d Session
                                S. 1974

    To authorize the Secretary of Veterans Affairs to conduct pilot 
 programs in order to evaluate the feasibility of the participation of 
  the Department of Veterans Affairs health care system in the health 
      care systems of States that have enacted health care reform.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

             March 24 (legislative day, February 22), 1994

Mr. Rockefeller (for himself, Mr. Murkowski, Mr. Graham, Mr. Akaka, Mr. 
   Daschle, Mr. Thurmond, Mr. Jeffords, Mr. Leahy, and Mrs. Murray) 
introduced the following bill; which was read twice and referred to the 
                     Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
    To authorize the Secretary of Veterans Affairs to conduct pilot 
 programs in order to evaluate the feasibility of the participation of 
  the Department of Veterans Affairs health care system in the health 
      care systems of States that have enacted health care reform.

    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 ``VA State Health Care Reform Pilot 
Program Act''.

SEC. 2. PURPOSE OF PILOT PROGRAMS.

    The purpose of this Act is to authorize the participation of the 
Department of Veterans Affairs health care system in the health care 
systems of States that have enacted health care reform in order to 
evaluate the most appropriate means of enabling the Department health 
care system to participate in such systems and in the National health 
care system contemplated under any plans for National health care 
reform.

SEC. 3. HEALTH CARE PILOT PROGRAMS.

    (a) In General.--The Secretary may carry out pilot programs on the 
participation of the Department of Veterans Affairs health care system 
in the health care systems of States that have adopted comprehensive 
health benefit plans. The Secretary shall carry out any pilot program 
under this Act in accordance with the provisions of this Act.
    (b) States Eligible for Designation.--(1) The Secretary shall 
designate each of not more than five States as a location for a pilot 
program under this Act. The Secretary shall complete the designation of 
States as locations for pilot programs not later than 30 days after the 
date of the enactment of this Act.
    (2) The Secretary may designate a State as a location for a pilot 
program under this Act if the Secretary determines that--
            (A) the State has enacted, or will soon enact, a statute 
        establishing or providing for a comprehensive health benefit 
        plan; and
            (B) the participation of the health care system of the 
        Department under the plan is feasible and appropriate in light 
        of the purpose of this Act.
    (c) Department Participation in State Health Benefit Plans.--(1) To 
the maximum extent practicable, the Secretary shall provide eligible 
persons under each pilot program under this Act with the comprehensive 
package of basic health care benefits that would otherwise be available 
to such persons under the comprehensive health benefit plan of the 
State in which the pilot program is carried out. The Secretary shall 
provide such benefits through the health care system of the Department 
in such State as if such system were a provider of such benefits under 
such plan.
    (2) Notwithstanding any other provision of law, a State may not 
prohibit the participation of the Department under the comprehensive 
health benefit plan of the State under a pilot program unless the chief 
executive officer of the State certifies to the Secretary that--
            (A) the benefits to be provided by the Department under the 
        pilot program do not meet requirements for quality of benefits 
        established by or provided under the plan; or
            (B) the location of Department facilities (including 
        facilities providing services by contract or agreement with the 
        Secretary) in the State is such that the proximity of eligible 
        persons to such facilities does not meet requirements so 
        established for such proximity.
    (3) To the maximum extent practicable, the Secretary shall provide 
health care benefits under a pilot program under this Act in accordance 
with the statutory requirements and regulatory requirements imposed 
with respect to the provision and availability of such benefits under 
the comprehensive health benefit plan of the State in which the pilot 
program is carried out.
    (4) Not later than 30 days after the designation of a State as a 
location for a pilot program under this Act, the Secretary and the 
health system director for that State shall jointly determine the 
Federal regulations the waiver or modification of which is necessary in 
order to facilitate the carrying out of the pilot program. Upon such 
determination, the Secretary shall waive or modify the application of 
such regulations to the pilot program.
    (5) The Secretary shall furnish any eligible person living in a 
State in which a pilot program is carried out (including any eligible 
person electing to receive benefits under the pilot program and any 
eligible person not electing to receive benefits under the pilot 
program) with the health care benefits for which such person is 
eligible under chapter 17 of title 38, United States Code, 
notwithstanding that the comprehensive package of basic health care 
benefits provided under the comprehensive health benefit plan of the 
State does not otherwise include such health care benefits. The 
Secretary shall furnish any health care benefits under this paragraph 
in accordance with the provisions of that chapter.
    (d) Health System Director.--The Secretary shall designate a health 
system director for each State in which a pilot program is carried out 
under this Act. The health system director of a State shall be the 
director or chief of staff of a Department medical center located in 
the State in which the pilot program is carried out. To the maximum 
extent practicable, the Secretary shall delegate to the health system 
directors the responsibilities of the Secretary under this Act.
    (e) Administrative Reorganization.--The Secretary may carry out any 
administrative reorganization of an office, facility, activity, or 
function of the health care system of the Department in a State in 
which a pilot program is carried out that the Secretary and the health 
system director jointly determine to be necessary in order to 
facilitate the carrying out of the pilot program. Section 510(b) of 
title 38, United States Code, shall not apply to any such 
administrative reorganization.
    (f) Provision of Benefits.--(1)(A) Except as provided in 
subparagraph (B), the Secretary shall provide health care benefits 
under a pilot program--
            (i) through the direct provision of such services by the 
        health care system of the Department in the State in which the 
        pilot program is carried out; or
            (ii) in the event that such services cannot be provided 
        directly by such system, by contract or other agreement in 
        accordance with paragraph (2).
    (B) The Secretary may exclude facilities of the Department from 
participation in a pilot program. Any facilities so excluded shall 
continue to provide health care benefits to veterans and other persons 
eligible for such benefits in accordance with the provisions of title 
38, United States Code.
    (2) The health system director of a pilot program may enter into 
contracts and agreements for the provision of health care services and 
contracts and agreements for other services with respect to the pilot 
program under paragraph (1)(A)(ii). Any such contract or agreement 
(including any lease) shall not be subject to the following provisions 
of law:
            (A) Section 8110(c) of title 38, United States Code, 
        relating to contracting of services at Department health-care 
        facilities.
            (B) Section 8122(a)(1) of such title, relating to the lease 
        of Department property.
            (C) Section 8125 of such title, relating to local contracts 
        for the procurement of health-care items.
            (D) Section 702 of title 5, United States Code, relating to 
        the right of review of agency wrongs by courts of the United 
        States.
            (E) Sections 1346(a)(2) and 1491 of title 28, United States 
        Code, relating to the jurisdiction of the district courts of 
        the United States and the United States Court of Federal 
        Claims, respectively, for the actions enumerated in such 
        sections.
            (F) Subchapter V of chapter 35 of title 31, United States 
        Code, relating to adjudication of protests of violations of 
        procurement statutes and regulations.
            (G) Sections 3526 and 3702 of such title, relating to the 
        settlement of accounts and claims, respectively, of the United 
        States.
            (H) Subsections (b)(7), (e), (f), (g), and (h) of section 8 
        of the Small Business Act (15 U.S.C. 637(b)(7), (e), (f), (g), 
        and (h)), relating to requirements with respect to small 
        businesses for contracts for property and services.
            (I) The provisions of law assembled for purposes of 
        codification of the United States Code as section 471 through 
        544 of title 40 that relate to the authority of the 
        Administrator of General Services over the lease and disposal 
        of Federal Government property.
            (J) The Office of Federal Procurement Policy Act (41 U.S.C. 
        401 et seq.), relating to the procurement of property and 
        services by the Federal Government.
            (K) Chapter 3 of the Federal Property and Administrative 
        Services Act of 1949 (41 U.S.C. 251 et seq.), relating to the 
        procurement of property and services by the Federal Government.
            (L) Office of Management and Budget Circular A-76.
    (3)(A) Notwithstanding any other provision of law, contracts and 
agreements for the provision of health care services under this 
subsection shall include contracts and other agreements with insurers, 
health care providers, or other individuals or entities that provide 
health care services in order to obtain health-care resources for 
eligible persons under a pilot program or to furnish health care 
benefits to such persons.
    (B) A health system director of a pilot program may enter into a 
contract or agreement under this paragraph only if the director 
determines that the contract or agreement is necessary in order to 
ensure the provision of health care services of an acceptable level and 
quality under the pilot program.
    (C) Contracts and agreements under this paragraph may be entered 
into without prior review by the Central Office of the Department.
    (4)(A) Contracts and agreements under this subsection for services 
other than the services referred to in paragraph (3) (including 
contracts and agreements for procurement of equipment, maintenance and 
repair services, and other services related to the provision of health 
care services) shall not be subject to review by the Central Office if 
the amount of such contracts or agreements is less than $250,000.
    (B) Contracts and agreements for services under this paragraph 
shall be subject to review by the Central Office if the amount of such 
contracts or agreements is $250,000 or greater. If the Central Office 
fails to approve or reject a contract or agreement under this clause 
within 30 days of its submittal to the Central Office, such contract or 
agreement shall be deemed approved by the Central Office.
    (g) Department Personnel.--(1) Notwithstanding any other provision 
of law and to the extent necessary to carry out the purpose of a pilot 
program, the Secretary may--
            (A) appoint health care personnel to positions in the 
        health care system of the Department in the State in which the 
        pilot program is carried out in accordance with such 
        qualifications for such positions as the Secretary may 
        establish; and
            (B) promote and advance personnel serving in such positions 
        in accordance with such qualifications as the Secretary may 
        establish.
    (2) Not later than 60 days after the designation of a State as a 
location for a pilot program under this Act, or at such other time as 
the Secretary may determine, the Secretary shall request authority from 
the Director of the Office of Management and Budget to permit the 
Secretary to employ a number of full time equivalent employees in the 
health care system of the Department in that State which exceeds the 
number of such employees that would otherwise be authorized for such 
employment by the Director.
    (3) Notwithstanding any other provision of law, employees of the 
Department at facilities of the Department under a pilot program shall 
not, during the carrying out of the pilot program, be subject to any 
reduction in the number of full time employees of the Department or as 
a result of a reduction in the number of full time employees of the 
Federal Government.
    (h) Eligible Persons.--(1) A person eligible for health care 
benefits under a pilot program is any person residing in a State in 
which a pilot program is carried out as follows:
            (A) Any veteran.
            (B) Any spouse or child of a veteran.
            (C) Any individual eligible for care under paragraph (2) or 
        (3) of section 1713(a) of title 38, United States Code.
    (2) Notwithstanding any other provision of law, a State may not 
require that any person other than a person referred to in paragraph 
(1) be eligible for health care benefits through the Department under a 
pilot program.
    (i) Copayments and Other Charges.--(1) Except as provided in 
paragraph (2), the Secretary may collect from or on behalf of any 
individual receiving health care benefits from the Secretary under a 
pilot program under this Act a premium, deductible, copayment, or other 
charge with respect to the provision of a benefit under the pilot 
program. The amount of the premium, deductible, copayment, or other 
charge collected with respect to a benefit provided under a pilot 
program may not exceed the maximum amount otherwise permitted for a 
premium, deductible, copayment, or other charge with respect to that 
benefit under the comprehensive health benefits plan of the State in 
which the pilot program is carried out.
    (2)(A) Except as provided in subparagraph (B), the Secretary shall 
waive the collection under the pilot programs of premiums, deductibles, 
copayments, and other charges with respect to the benefits provided by 
the Department to the following:
            (i) Veterans with compensable service-connected 
        disabilities.
            (ii) Veterans whose discharge or release from active 
        military, naval, or air service was for a compensable 
        disability that was incurred or aggravated in the line of duty.
            (iii) Veterans who are in receipt of, or who, but for a 
        suspension pursuant to section 1151 of title 38, United States 
        Code (or both a suspension and the receipt of retired pay), 
        would be entitled to disability compensation, but only to the 
        extent that such veterans' continuing eligibility for such care 
        is provided for in the judgment or settlement provided for in 
        such section.
            (iv) Veterans who are a former prisoners of war.
            (v) Veterans of the Mexican border period or of World War 
        I.
            (vi) Veterans who are unable to defray the expenses of 
        necessary care, as determined in accordance with section 
        1722(a) of such title.
    (B) The Secretary may collect premiums, deductibles, copyaments, 
and other charges with respect to benefits provided under a pilot 
program to veterans referred to in subparagraph (A) from any third 
party obligated to provide, or to pay the expenses of, such benefits to 
or for such veterans under the comprehensive health benefits plan of 
the State in which the pilot program is carried out.
    (j) Funding.--(1) There is established in the Treasury a fund to be 
known as the Department of Veterans Affairs Health Care Reform Fund 
(hereafter referred to in this subsection as the ``Fund'').
    (2)(A) Notwithstanding any other provision of law, amounts shall be 
deposited in the Fund as follows:
            (i) Amounts made available to a pilot program based upon a 
        determination under paragraph (3).
            (ii) Amounts collected under a pilot program in accordance 
        with subsection (i).
            (iii) Amounts determined with respect to a pilot program 
        under paragraph (4).
            (iv) Such other amounts as the Secretary and the health 
        system directors of the pilot programs jointly determine to be 
        necessary in order to carry out the pilot programs.
            (v) Such other amounts as may be appropriated to the pilot 
        programs.
    (B) The Secretary shall make available amounts under clauses (i) 
and (iv) of subparagraph (A) from amounts appropriated to the 
Department of Veterans Affairs for the provision of health care 
services.
    (C) The Secretary shall establish and maintain a separate account 
under the Fund for each pilot program carried out under this Act. Any 
deposits and expenditures with respect to a pilot program shall be made 
to or from the account established and maintained with respect to that 
pilot program.
    (3)(A) For each year of the operation of a pilot program under this 
Act, the Secretary shall deposit in account of the Fund for the pilot 
program an amount (as determined by the Secretary) equal to the amount 
that would otherwise be made available to the health care system of the 
Department in the State in which the pilot program is carried out for 
the payment of the cost of health care services by such system in that 
State in that year. The Secretary shall deposit such amount at the 
beginning of such year.
    (B) The costs referred to in subparagraph (A) shall not include 
costs relating to the provision by the Secretary of the following 
services:
            (i) Services relating to post-traumatic stress disorder.
            (ii) Services relating to spinal-cord injuries.
            (iii) Services relating to substance abuse.
            (iv) Services relating to the rehabilitation of blind 
        veterans.
    (4)(A) In each year of the operation of a pilot program under this 
Act, the Secretary shall deposit into the account of the Fund for the 
pilot program an amount with respect to the pilot program that is equal 
to the portion of the amount referred to in subparagraph (B) that is 
allocable to the medical-care cost recovery activities of the 
Department under section 1729(g)(4) of title 38, United States Code, in 
the State in which the pilot program is carried out.
    (B) The amount referred to in subparagraph (A) is the amount by 
which the unobligated balance in the Department of Veterans Affairs 
Medical-Care Cost Recovery Fund for the year preceding the date of the 
deposit under this paragraph exceeds the estimated amount of such 
unobligated balance at the commencement of such preceding year.
    (C) The Secretary shall make deposits under this paragraph at the 
same time as the deposit under such section.
    (5)(A) Notwithstanding any other provision of law, the health 
system director for a State in which a pilot program is carried out 
shall determine the costs for which amounts in the Fund may be expended 
in carrying out the pilot program.
    (B)(i) Except as provided in clause (ii), the costs of carrying out 
a pilot program under this paragraph shall include any costs of 
marketing and advertising under the program and costs relating to 
acquisition (including acquisition of land), construction, repair, or 
renovation of facilities.
    (ii) Costs under this subparagraph shall not include any costs 
relating to a major medical facility project or a major medical 
facility lease as such terms are defined in subparagraphs (A) and (B) 
of section 8104(a)(3) of title 38, United States Code, respectively.
    (C) Amounts in the Fund for the payment of costs of a pilot program 
under this subsection shall be available for such purpose without 
fiscal year limitation.
    (k) Termination.--A pilot program carried out under this Act shall 
terminate not later than 2 years after the date of the commencement of 
provision of benefits under the pilot program.

SEC. 4. REPORTS ON PILOT PROGRAMS.

    (a) Collection of Information.--(1) The Secretary shall collect 
such information with respect to the provision of health care benefits 
under each pilot program as is necessary to permit the Secretary to 
evaluate the pilot program in light of the purpose of the pilot program 
under this Act.
    (2) The information collected by the Secretary under paragraph (1) 
shall include aggregated data on the following:
            (A) The number of persons participating in each pilot 
        program, including the age, sex, health status, disability 
        ratings (if any), employment status, and incomes of such 
        persons.
            (B) The nature of benefits sought by such persons under 
        each pilot program.
            (C) The nature and quantity of benefits provided to such 
        persons under each pilot program.
            (D) The cost to the Department of providing such benefits 
        under each pilot program.
    (b) Reports.--(1) Not later than 14 months after the date of the 
completion of the designation of States as locations for pilot programs 
under this Act, the Secretary shall submit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives a report 
on the progress of the Secretary in carrying out the pilot programs. 
Such report shall include the information referred to in subsection 
(a)(2) on the date of the report.
    (2) Not later than November 30 of the year of the termination of 
the final pilot program under this Act, the Secretary shall submit to 
the committees referred to in paragraph (1) a report on the pilot 
programs carried out under this Act. The report shall include the 
following:
            (A) The information referred to in subsection (a)(2), 
        together with the comments and conclusions of the Secretary 
        with respect to such information.
            (B) An assessment by the Secretary of the utility of each 
        pilot program for carrying out the purpose of this Act.
            (C) An assessment by the Secretary of appropriate means of 
        integrating the health care system of the Department into the 
        health care systems of States that have enacted health care 
        reform and into the National health care system contemplated 
        under any plans for National health care reform.
            (D) Such other information, assessments, and conclusions as 
        the Secretary considers appropriate.

SEC. 5. DEFINITIONS.

    For the purposes of this Act--
            (1) The terms ``Secretary'', ``Department'', ``veteran'', 
        ``child'' and ``spouse'' have the meanings given such terms in 
        paragraphs (1), (2), (4), and (31) of section 101 of title 38, 
        United States Code, respectively.
            (2) The term ``comprehensive health benefit plan'', in the 
        case of a State, means a plan or system established under the 
        law of the State that--
                    (A) ensures the access of all residents of the 
                State to a comprehensive package of basic health care 
                benefits; and
                    (B) ensures such access by providing that such 
                benefits shall be provided directly or by contract by 
                public and private entities.
            (3) The term ``comprehensive package of basic health care 
        benefits'' means the health care benefits provided for by a 
        State under the comprehensive health benefit plan of the State.
            (4) The term ``health care system of the Department'', in 
        the case of a State designated as a location for a pilot 
        program, means the facilities and personnel of the Department 
        located in that State that provide health care services under 
        chapter 17 of title 38, United States Code.

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