[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3118 Reported in House (RH)]
Union Calendar No. 358
104th CONGRESS
2d Session
H. R. 3118
[Report No. 104-690]
_______________________________________________________________________
A BILL
To amend title 38, United States Code, to reform eligibility for health
care provided by the Department of Veterans Affairs.
_______________________________________________________________________
July 18, 1996
Committed to the Committee of the Whole House on the State of the Union
and ordered to be printed
Union Calendar No. 358
104th CONGRESS
2d Session
H. R. 3118
[Report No. 104-690]
To amend title 38, United States Code, to reform eligibility for health
care provided by the Department of Veterans Affairs.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 20, 1996
Mr. Stump (for himself, Mr. Montgomery, Mr. Hutchinson, and Mr.
Edwards) introduced the following bill; which was referred to the
Committee on Veterans' Affairs
July 18, 1996
Additional sponsors: Mr. Smith of New Jersey, Mr. Bilirakis, Mr.
Ackerman, Mr. Gene Green of Texas, Mr. Cramer, Mr. Frost, Mr. Moakley,
Mr. Solomon, Mr. Mascara, Mr. Hall of Texas, Mr. Tejeda, Mr.
Faleomavaega, Mr. Manton, Mr. Linder, Mr. Weller, Mr. McCrery, Mr.
Gilman, Mr. Flake, Mr. Doyle, Mr. Watts of Oklahoma, Mr. Emerson, Mr.
Everett, Mr. Buyer, Mr. Bachus, Mr. Stearns, Mr. Fox of Pennsylvania,
Mr. Flanagan, Mr. Barr of Georgia, Mr. Cooley of Oregon, Mr. Evans, Mr.
Kennedy of Massachusetts, Mr. Clement, Mr. Filner, Mr. Bishop, Mr.
Baldacci, Mr. Camp, Mr. Bryant of Tennessee, Ms. Kaptur, Mr. Fazio of
California, Mr. Rahall, Mr. Scarborough, Mrs. Lowey, Mr. Saxton, Mr.
Quinn, Mr. McDermott, Mrs. Kelly, Mr. Wise, Mr. Johnson of South
Dakota, Mr. Kennedy of Rhode Island, Mr. Lipinski, Mr. Dooley of
California, Mr. Spratt, Mr. English of Pennsylvania, Ms. Lofgren, Mr.
Tate, Mr. Skaggs, Mr. Sanders, Mr. Barrett of Nebraska, Mr. Kildee, Mr.
Coyne, Mr. Boucher, Mr. Farr of California
July 18, 1996
Committed to the Committee of the Whole House on the State of the Union
and ordered to be printed
_______________________________________________________________________
A BILL
To amend title 38, United States Code, to reform eligibility for health
care provided by 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; REFERENCES TO TITLE 38, UNITED STATES CODE.
(a) Short Title.--This Act may be cited as the ``Veterans' Health
Care Eligibility Reform Act of 1996''.
(b) References to Title 38, United States Code.--Except as
otherwise expressly provided, whenever in this Act an amendment or
repeal is expressed in terms of an amendment to, or repeal of, a
section or other provision, the reference shall be considered to be
made to a section or other provision of title 38, United States Code.
SEC. 2. HOSPITAL CARE AND MEDICAL SERVICES.
(a) Eligibility for Care.--Section 1710(a) is amended by striking
out paragraphs (1) and (2) and inserting the following:
``(a)(1) The Secretary shall, to the extent and in the amount
provided in advance in appropriations Acts for these purposes, provide
hospital care and medical services, and may provide nursing home care,
which the Secretary determines is needed to any veteran--
``(A) with a compensable service-connected disability;
``(B) 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;
``(C) who is in receipt of, or who, but for a suspension
pursuant to section 1151 of this title (or both a suspension
and the receipt of retired pay), would be entitled to
disability compensation, but only to the extent that such
veteran's continuing eligibility for such care is provided for
in the judgment or settlement provided for in such section;
``(D) who is a former prisoner of war;
``(E) of the Mexican border period or of World War I;
``(F) who was exposed to a toxic substance, radiation, or
environmental hazard, as provided in subsection (e); and
``(G) who is unable to defray the expenses of necessary
care as determined under section 1722(a) of this title.
``(2) In the case of a veteran who is not described in paragraph
(1), the Secretary may, to the extent resources and facilities are
available and subject to the provisions of subsection (f), furnish
hospital care, medical services, and nursing home care which the
Secretary determines is needed.''.
(b) Conforming Amendments.--(1) Section 1710(e) is amended--
(A) in paragraph (1), by striking out ``hospital care and
nursing home care'' in subparagraphs (A), (B), and (C) and
inserting in lieu thereof ``hospital care, medical services,
and nursing home care'';
(B) in paragraph (2), by inserting ``and medical services''
after ``Hospital and nursing home care''; and
(C) by striking out ``subsection (a)(1)(G) of this
section'' each place it appears and inserting in lieu thereof
``subsection (a)(1)(F)''.
(2) Chapter 17 is amended--
(A) by redesignating subsection (g) of section 1710 as
subsection (h); and
(B) by transferring subsection (f) of section 1712 to
section 1710 so as to appear after subsection (f),
redesignating such subsection as subsection (g), and amending
such subsection by striking out ``section 1710(a)(2) of this
title'' in paragraph (1) and inserting in lieu thereof
``subsection (a)(2) of this section''.
(3) Section 1712 is amended--
(A) by striking out subsections (a) and (i); and
(B) by redesignating subsections (b), (c), (d), (h) and
(j), as subsections (a), (b), (c), (d), and (e), respectively.
SEC. 3. PROSTHETICS.
(a) Eligibility for Prosthetics.--Section 1701(6)(A)(i) is
amended--
(1) by striking out ``(in the case of a person otherwise
receiving care or services under this chapter)'' and ``(except
under the conditions described in section 1712(a)(5)(A) of this
title),'';
(2) by inserting ``(in the case of a person otherwise
receiving care or services under this chapter)'' before
``wheelchairs,''; and
(3) by inserting ``except that the Secretary may not
furnish sensori-neural aids other than in accordance with
guidelines which the Secretary shall prescribe,'' after
``reasonable and necessary,''.
(b) Regulations.--Not later than 30 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
prescribe the guidelines required by the amendments made by subsection
(a) and shall furnish a copy of those guidelines to the Committees on
Veterans' Affairs of the Senate and House of Representatives.
SEC. 4. MANAGEMENT OF HEALTH CARE.
(a) In General.--(1) Chapter 17 is amended by inserting after
section 1704 the following new sections:
``Sec. 1705. Management of health care: patient enrollment system
``(a) In managing the provision of hospital care and medical
services under section 1710(a)(1) of this title, the Secretary, in
accordance with regulations the Secretary shall prescribe, shall
establish and operate a system of annual patient enrollment. The
Secretary shall manage the enrollment of veterans in accordance with
the following priorities, in the order listed:
``(1) Veterans with service-connected disabilities rated 30
percent or greater.
``(2) Veterans who are former prisoners of war and veterans
with service-connected disabilities rated 10 percent or 20
percent.
``(3) Veterans who are in receipt of increased pension
based on a need of regular aid and attendance or by reason of
being permanently housebound and other veterans who are
catastrophically disabled.
``(4) Veterans not covered by paragraphs (1) through (3)
who are unable to defray the expenses of necessary care as
determined under section 1722(a) of this title.
``(5) All other veterans eligible for hospital care,
medical services, and nursing home care under section
1710(a)(1) of this title.
``(b) In the design of an enrollment system under subsection (a),
the Secretary--
``(1) shall ensure that the system will be managed in a
manner to ensure that the provision of care to enrollees is
timely and acceptable in quality;
``(2) may establish additional priorities within each
priority group specified in subsection (a), as the Secretary
determines necessary; and
``(3) may provide for exceptions to the specified
priorities where dictated by compelling medical reasons.
``Sec. 1706. Management of health care: other requirements
``(a) In managing the provision of hospital care and medical
services under section 1710(a) of this title, the Secretary shall, to
the extent feasible, design, establish and manage health care programs
in such a manner as to promote cost-effective delivery of health care
services in the most clinically appropriate setting.
``(b) In managing the provision of hospital care and medical
services under section 1710(a) of this title, the Secretary--
``(1) may contract for hospital care and medical services
when Department facilities are not capable of furnishing such
care and services economically, and
``(2) shall make such rules and regulations regarding
acquisition procedures or policies as the Secretary considers
appropriate to provide such needed care and services.
``(c) In managing the provision of hospital care and medical
services under section 1710(a) of this title, the Secretary shall
ensure that the Department maintains its capacity to provide for the
specialized treatment and rehabilitative needs of disabled veterans
described in section 1710(a) of this title (including veterans with
spinal cord dysfunction, blindness, amputations, and mental illness)
within distinct programs or facilities of the Department that are
dedicated to the specialized needs of those veterans in a manner that
(1) affords those veterans reasonable access to care and services for
those specialized needs, and (2) ensures that overall capacity of the
Department to provide such services is not reduced below the capacity
of the Department, nationwide, to provide those services, as of the
date of the enactment of this section.
``(d) In managing the provision of hospital care and medical
services under section 1710(a) of this title, the Secretary shall
ensure that any veteran with a service-connected disability is provided
all benefits under this chapter for which that veteran was eligible
before the date of the enactment of this section.''.
(2) The table of sections at the beginning of chapter 17 is amended
by inserting after the item relating to section 1704 the following new
items:
``1705. Management of health care: patient enrollment system.
``1706. Management of health care: other requirements.''.
(b) Conforming Amendments to Section 1703.--(1) Section 1703 is
amended--
(A) by striking out subsections (a) and (b); and
(B) in subsection (c) by--
(i) striking out ``(c)'', and
(ii) striking out ``this section, sections'' and
inserting in lieu thereof ``sections 1710,''.
(2)(A) The heading of such section is amended to read as follows:
``Sec. 1703. Annual report on furnishing of care and services by
contract''.
(B) The item relating to such section in the table of sections at
the beginning of chapter 17 is amended to read as follows:
``1703. Annual report on furnishing of care and services by
contract.''.
SEC. 5. IMPROVED EFFICIENCY IN HEALTH CARE RESOURCE MANAGEMENT.
(a) Repeal of Sunset Provision.--Section 204 of the Veterans Health
Care Act of 1992 (Public Law 102-585; 106 Stat. 4950) is repealed.
(b) Cost Recovery.--Title II of such Act is further amended by
adding at the end the following new section:
``SEC. 207. AUTHORITY TO BILL HEALTH-PLAN CONTRACTS.
``(a) Right To Recover.--In the case of a primary beneficiary (as
described in section 201(2)(B)) who has coverage under a health-plan
contract, as defined in section 1729(i)(1)(A) of title 38, United
States Code, and who is furnished care or services by a Department
medical facility pursuant to this title, the United States shall have
the right to recover or collect charges for such care or services from
such health-plan contract to the extent that the beneficiary (or the
provider of the care or services) would be eligible to receive payment
for such care or services from such health-plan contract if the care or
services had not been furnished by a department or agency of the United
States. Any funds received from such health-plan contract shall be
credited to funds that have been allotted to the facility that
furnished the care or services.
``(b) Enforcement.--The right of the United States to recover under
such a beneficiary's health-plan contract shall be enforceable in the
same manner as that provided by subsections (a)(3), (b), (c)(1), (d),
(f), (h), and (i) of section 1729 of title 38, United States Code.''.
SEC. 6. SHARING AGREEMENTS FOR HEALTH CARE RESOURCES.
(a) Repeal of Section 8151.--(1) Subchapter IV of chapter 81 is
amended--
(A) by striking out section 8151; and
(B) by redesignating sections 8152, 8153, 8154, 8155, 8156,
8157, and 8158 as sections 8151, 8152, 8153, 8154, 8155, 8156,
and 8157, respectively.
(2) The table of sections at the beginning of such chapter is
amended--
(A) by striking out the item relating to section 8151; and
(B) by revising the items relating to sections 8152, 8153,
8154, 8155, 8156, 8157, and 8158 to reflect the redesignations
by paragraph (1)(B).
(b) Revised Authority for Sharing Agreements.--Section 8152 (as
redesignated by subsection (a)(1)(B)) is amended--
(1) in subsection (a)(1)(A)--
(A) by striking out ``specialized medical
resources'' and inserting in lieu thereof ``health-care
resources''; and
(B) by striking out ``other'' and all that follows
through ``medical schools'' and inserting in lieu
thereof ``any medical school, health-care provider,
health-care plan, insurer, or other entity or
individual'';
(2) in subsection (a)(2) by striking out ``only'' and all
that follows through ``are not'' and inserting in lieu thereof
``if such resources are not, or would not be,'';
(3) in subsection (b), by striking out ``reciprocal
reimbursement'' in the first sentence and all that follows
through the period at the end of that sentence and inserting in
lieu thereof ``payment to the Department in accordance with
procedures that provide appropriate flexibility to negotiate
payment which is in the best interest of the Government.'';
(4) in subsection (d), by striking out ``preclude such
payment, in accordance with--'' and all that follows through
``to such facility therefor'' and inserting in lieu thereof
``preclude such payment to such facility for such care or
services'';
(5) by redesignating subsection (e) as subsection (f); and
(6) by inserting after subsection (d) the following new
subsection (e):
``(e) The Secretary may make an arrangement that authorizes the
furnishing of services by the Secretary under this section to
individuals who are not veterans only if the Secretary determines--
``(1) that such an arrangement will not result in the
denial of, or a delay in providing access to, care to any
veteran at that facility; and
``(2) that such an arrangement--
``(A) is necessary to maintain an acceptable level
and quality of service to veterans at that facility; or
``(B) will result in the improvement of services to
eligible veterans at that facility.''.
(c) Cross-Reference Amendments.--(1) Section 8110(c)(3)(A) is
amended by striking out ``8153'' and inserting in lieu thereof
``8152''.
(2) Subsection (b) of section 8154 (as redesignated by subsection
(a)(1)(B)) is amended by striking out ``section 8154'' and inserting in
lieu thereof ``section 8153''.
(3) Section 8156 (as redesignated by subsection (a)(1)(B)) is
amended--
(A) in subsection (a), by striking out ``section 8153(a)''
and inserting in lieu thereof ``section 8152(a)''; and
(B) in subsection (b)(3), by striking out ``section 8153''
and inserting in lieu thereof ``section 8152''.
(4) Subsection (a) of section 8157 (as redesignated by subsection
(a)(1)(B)) is amended--
(A) in the matter preceding paragraph (1), by striking out
``section 8157'' and ``section 8153(a)'' and inserting in lieu
thereof ``section 8156'' and ``section 8152(a)'', respectively;
and
(B) in paragraph (1), by striking out ``section
8157(b)(4)'' and inserting in lieu thereof ``section
8156(b)(4)''.
SEC. 7. PERSONNEL FURNISHING SHARED RESOURCES.
Section 712(b)(2) is amended--
(1) by striking out ``the sum of--'' and inserting in lieu
thereof ``the sum of the following:'';
(2) by capitalizing the first letter of the first word of
each of subparagraphs (A) and (B);
(3) by striking out ``; and'' at the end of subparagraph
(A) and inserting in lieu thereof a period; and
(4) by adding at the end the following:
``(C) The number of such positions in the
Department during that fiscal year held by persons
involved in providing health-care resources under
section 8111 or 8152 of this title.''.