[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[S. 1563 Introduced in Senate (IS)]

  2d Session
                                S. 1563

     To amend title 38, United States Code, to revise and improve 
  eligibility for medical care and services under that title, and for 
                            other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            February 7, 1996

 Mr. Simpson (for himself and Mr. Rockefeller) (by request) introduced 
the following bill; which was read twice and referred to the Committee 
                          on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
     To amend title 38, United States Code, to revise and improve 
  eligibility for medical care and services under that title, and for 
                            other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. ELIGIBILITY FOR CARE AND SERVICES OF CATASTROPHICALLY 
              DISABLED VETERANS.

    (a) Eligibility.--Paragraph (1) of subsection (a) of section 1710 
of title 38, United States Code, is amended--
            (1) by striking out ``and'' at the end of subparagraph (H);
            (2) by striking out the period at the end of subparagraph 
        (I) and inserting in lieu thereof ``; and''; and
            (3) by adding at the end the following:
            ``(J) to a veteran who is catastrophically disabled, for 
        any purpose that the Secretary determines medically 
        necessary.''.
    (b) Definition.--Such subsection is further amended by adding at 
the end the following:
    ``(4) For the purposes of this subsection, the term `veteran who is 
catastrophically disabled' means any veteran in any year in which the 
expenditures of the veteran for hospital care and nursing home care 
exceeds the amount equal to 7.5 percent of the gross adjusted income of 
the veteran for Federal income tax purposes during the preceding 
year.''.

SEC. 2. ELIGIBILITY FOR OUTPATIENT SERVICES.

    (a) Eligibility.--Subsection (a) of section 1712 of title 38, 
United States Code, is amended--
            (1) by striking out paragraphs (1) through (3) and 
        inserting in lieu thereof the following new paragraphs (1) and 
        (2):
    ``(a)(1) The Secretary shall furnish on an ambulatory or outpatient 
basis such medical services as the Secretary determines are needed to 
any veteran described in subparagraph (A), (B), (C), (D), (E), (F), 
(H), (I), or (J) of section 1710(a)(1) of this title for a disability 
described in the subparagraph that relates to such veteran.
    ``(2)(A)(i) Subject to subparagraphs (D) and (E) of this paragraph, 
a veteran described in clause (ii) is eligible for medical services on 
an ambulatory or outpatient basis for any disability, notwithstanding 
that there is insufficient medical evidence to conclude that such 
disability may be associated with the exposure of the veteran as 
described in that clause.
    ``(ii) Clause (i) applies to any veteran--
            ``(I) who served on active duty in the Republic of Vietnam 
        during the Vietnam era; and
            ``(II) who the Secretary finds may have been exposed during 
        such service to dioxin or was exposed during such service to a 
        toxic substance found in a herbicide or defoliant used in 
        connection with military purposes during such era.
    ``(B) Subject to subparagraphs (D) and (E) of this paragraph, a 
veteran who the Secretary finds was exposed while serving on active 
duty to ionizing radiation from the detonation of a nuclear device in 
connection with such veteran's participation in the test of such a 
device or with the American occupation of Hiroshima and Nagasaki, 
Japan, during the period beginning on September 11, 1945, and ending on 
July 1, 1946, is eligible for medical services on an ambulatory or 
outpatient basis for any disability, notwithstanding that there is 
insufficient medical evidence to conclude that such disability may be 
associated with such exposure.
    ``(C) Subject to subparagraphs (D) and (E) of this paragraph, a 
veteran who the Secretary finds may have been exposed while serving on 
active duty in the Southwest Asia theater of operations during the 
Persian Gulf War to a toxic substance or environmental hazard is 
eligible for medical services on an ambulatory or outpatient basis for 
any disability, notwithstanding that there is insufficient medical 
evidence to conclude that such disability may be associated with such 
exposure.
    ``(D) Medical services may not be provided under subparagraph (A), 
(B), or (C) of this paragraph with respect to a disability that is 
found, in accordance with guidelines issued by the Under Secretary for 
Health, to have resulted from a cause other than an exposure described 
in such subparagraph (A), (B), or (C).
    ``(E) Medical services may not be provided under or by virtue of 
subparagraph (A), (B), or (C) of this paragraph after December 31, 
1996.'';
            (2) by redesignating paragraphs (4), (5), and (6) as 
        paragraphs (3), (4), and (5), respectively;
            (3) in paragraph (3), as so redesignated, by striking out 
        ``paragraph (5)'' and inserting in lieu thereof ``paragraph 
        (4)'';
            (4) in subparagraph (A) of paragraph (4), as so 
        redesignated, by striking out ``paragraph (4)'' and inserting 
        in lieu thereof ``paragraph (3)''; and
            (5) by striking out paragraph (7).
    (b) Repeal of Order of Priority for Services.--Such section is 
further amended by striking out subsection (i).

SEC. 3. ELIGIBILITY FOR NURSING HOME CARE, DOMICILIARY CARE, AND LONG-
              TERM CARE.

    (a) Eligibility.--Section 1710(a) of title 38, United States Code, 
as amended by section 1 of this Act, is further amended by adding at 
the end the following:
    ``(5) The Secretary shall furnish nursing home care, domiciliary 
care, or long-term care to any veteran described in paragraph (1) of 
this subsection if the Secretary determines that the furnishing of such 
care to the veteran is necessary for medical purposes or to obviate the 
need for hospital care under this section.''.
    (b) Definition of Long-Term Care.--Section 1701 of such title is 
amended by adding at the end the following:
            ``(10) The term `long-term care' means home care, home 
        services, adult day health care, respite care (as such term is 
        defined in section 1720B(b) of this title), and community 
        residential care (including care under the services authorized 
        in section 1720C(a) of this title).''.

SEC. 4. AUTHORITY TO PROVIDE HEALTH CARE SERVICES TO ADULT DEPENDENTS 
              OF VETERANS IN DEPARTMENT FACILITIES.

    (a) Authority.--Subsection (a)(2) of section 1710 of title 38, 
United States Code, is amended--
            (1) by inserting ``(A)'' after ``(2)''; and
            (2) by adding at the end the following:
    ``(B) The Secretary may, to the extent resources and facilities are 
available, furnish hospital care and nursing home care to any adult 
dependent of a veteran which the Secretary determines is needed for a 
disability, subject to the provisions of subsection (f) of this 
section.''.
    (b) Payment for Care.--Paragraph (1) of subsection (f) of such 
section is amended--
            (1) by inserting ``(A)'' after ``(f)(1)''; and
            (2) by adding at the end the following:
    ``(B) The Secretary may not furnish hospital care or nursing home 
care under this section to any adult dependent of a veteran who is 
eligible for such care under subsection (a)(2)(B) of this section 
unless the adult dependent agrees to pay the United States the 
applicable amount determined under paragraph (2) of this subsection. An 
adult dependent shall be treated as a veteran for the purposes of the 
application of such paragraph to the adult dependent by reason of this 
subparagraph.''.
    (c) Utilization of Payments for Care.--Paragraph (4) of such 
subsection (f) is amended to read as follows:
    ``(4) Amounts collected or received by the United States under this 
subsection shall be available to the Secretary for payment of the costs 
of furnishing care and services under this section. Such amounts shall 
be available without fiscal year limitation.''.

SEC. 5. AUTHORITY TO PROVIDE PRIMARY HEALTH CARE SERVICES.

    (a) In General.--Paragraph (6)(A)(i) of section 1701 of title 38, 
United States Code, is amended by inserting ``primary health care 
services,'' after ``preventive health services,''.
    (b) Definition.--Such section, as amended by section 3(b) of this 
Act, is further amended by adding at the end the following:
            ``(11) The term `primary health care services' includes--
                    ``(A) initial diagnostic services (including 
                laboratory services, x-ray services, and pharmacy 
                services), treatment services, referral to specialized 
                care or services, and long-term follow-up care or 
                services with respect to chronic conditions which 
                services, referral, and care or services are provided 
                on an ambulatory basis by physicians (including general 
                and family practitioners, pediatricians, obstetrician/
                gynecologists, and internists) or by nurse 
                practitioners or physician's assistants under the 
                supervision of physicians; and
                    ``(B) routine services with respect to disabilities 
                that are provided by physicians who specialize in such 
                disabilities.''.

SEC. 6. CLARIFICATION OF AUTHORITY TO PROVIDE PREVENTIVE HEALTH 
              SERVICES.

    Section 1701(6)(A)(i) of title 38, United States Code, as amended 
by section 5, is further amended by striking out ``(in the case of a 
person otherwise receiving care or services under this chapter)''.

SEC. 7. AUTHORITY TO CONTRACT FOR PRIMARY HEALTH CARE SERVICES AND 
              PREVENTIVE HEALTH SERVICES IN NON-DEPARTMENT FACILITIES.

    (a) Repeal of Reporting Requirement.--Section 1703 of title 38, 
United States Code, is amended by striking out subsection (c).
    (b) Authority To Contract.--Such section is further amended--
            (1) by redesignating subsection (b) as subsection (c); and
            (2) by inserting after subsection (a) the following new 
        subsection (b):
    ``(b)(1) Subject to paragraph (2), the Secretary may furnish 
primary health care services or preventive health services under 
section 1712 of this title to veterans who reside in locations that are 
more than 50 miles or 1 hour traveling time from a Department facility 
furnishing such services by or through contract with non-Department 
facilities.
    ``(2) The Secretary may contract with a non-Department facility 
under paragraph (1) of this subsection only if the Secretary determines 
through sound analysis that--
            ``(A) the quality of the services to be provided by the 
        non-Department facility under the contract is equal to or 
        exceeds the quality of the services that would otherwise be 
        provided by a Department facility in the absence of the 
        contract; and
            ``(B) the cost of furnishing the services by contract 
        through the non-Department facility will be equal to or less 
        than the cost of furnishing the services through a Department 
        facility.''.

SEC. 8. REVISION OF AUTHORITY TO PROVIDE PROSTHETIC APPLIANCES.

    (a) Definition of Medical Services.--Section 1701(6)(A)(i) of title 
38, United States Code, as amended by this Act, is further amended by 
striking out ``and (except under the conditions'' and all that follows 
through ``prosthetic appliances,'' and inserting in lieu thereof 
``medical equipment and prosthetic appliances that are prescribed by a 
physician based on specific medical needs,''.
    (b) Authority To Provide.--(1) Section 1714 of title 38, United 
States Code, is amended to read as follows:
``Sec. 1714. Medical equipment and prosthetic appliances; aids for the 
              blind and the hearing impaired
    ``(a) The Secretary shall furnish medical equipment or a prosthetic 
appliance to any veteran who is entitled to such equipment or 
appliance.
    ``(b)(1) The Secretary shall furnish any veteran furnished medical 
equipment or a prosthetic appliance under subsection (a) with such 
fitting and training in the use of the equipment or appliance as the 
Secretary determines necessary.
    ``(2) The Secretary may furnish training to a veteran under this 
subsection in a Department facility or by contract (including by 
contract with a training institution) and may include in connection 
with such training travel and incidental expenses (under the terms and 
conditions set forth in section 111 of this title) to and from the home 
of the veteran to the facility or institution at which the training is 
furnished.
    ``(c) The Secretary may furnish any veteran furnished medical 
equipment or a prosthetic appliance under subsection (a) with special 
clothing made necessary by the wearing of the medical equipment or 
appliance.
    ``(d) The Secretary may repair or replace any medical equipment or 
prosthetic appliances reasonably necessary to a veteran and belonging 
to the veteran which are damaged or destroyed by a fall or other 
accident caused by a service-connected disability for which the veteran 
is in receipt of, or but for the receipt of retirement pay would be 
entitled to, disability compensation.
    ``(e)(1) The Secretary may furnish veterans who are entitled to 
disability compensation with the following:
            ``(A) Seeing-eye or guide dogs trained for the aid of the 
        blind.
            ``(B) Devices for aiding individuals in overcoming the 
        handicap of blindness.
    ``(2) In furnishing a seeing-eye or guide dog to a veteran under 
this subsection, the Secretary may furnish training described in 
subsection (b)(2), including travel expenses, to the veteran in the use 
of the dog.
    ``(f) The Secretary may furnish devices for assisting in overcoming 
the handicap of deafness, including telecaptioning decoding devices for 
television receivers, to veterans who are profoundly deaf and entitled 
to disability compensation on account of hearing impairment.''.
    (2) The table of sections at the beginning of chapter 17 of such 
title is amended by striking out the item relating to section 1714 and 
inserting in lieu thereof the following new item:

``1714. Medical equipment and prosthetic appliances; aids for the blind 
                            and the hearing impaired.''.
    (b) Conforming Amendments.--(1) Section 1717 of title 38, United 
States Code, is amended--
            (A) by striking out subsections (b) and (c);
            (B) by striking out ``(a)(1)'' and inserting in lieu 
        thereof ``(a)'';
            (C) by redesignating paragraphs (2) and (3) as subsections 
        (b) and (c), respectively; and
            (D) in subsection (b), as so redesignated, by redesignating 
        subparagraphs (A) and (B) as paragraphs (1) and (2), 
        respectively.
    (2)(A) Section 1719 of title 38, United States Code, is repealed.
    (B) The table of sections at the beginning of chapter 17 of such 
title is amended by striking out the item relating to section 1719.

SEC. 9. UTILIZATION OF MEDICAL CARE COST RECOVERY FUND FOR PAYMENT OF 
              COSTS OF FURNISHING HEALTH CARE SERVICES.

    (a) In General.--Paragraph (4) of section 1729(g) of title 38, 
United States Code, is amended to read as follows:
    ``(4)(A) Not later than January 1 of each year, there shall be 
available to the Secretary for the purposes described in subparagraph 
(C) an amount equal to the excess of the amount of the unobligated 
balance remaining in the Fund at the close of business on September 30 
of the preceding year over the amount described in subparagraph (B).
    ``(B) The amount described in this subparagraph is the amount equal 
to--
            ``(i) the amount of the unobligated balance remaining in 
        the Fund at the close of business on September 30 of the 
        preceding year that the Secretary determines is necessary in 
        order to enable to defray, during the fiscal year in which the 
        amount is available under this paragraph, expenses, payments, 
        and costs described in paragraph (3), plus
            ``(ii) the amount of such balance that is equal to the 
        amount of the Congressional Budget Office baseline for deposits 
        in the Fund for such fiscal year.
    ``(C) Amounts available under subparagraph (A) shall be available 
to the Secretary for payment of the costs of furnishing hospital care 
and medical services under this chapter, including the costs of 
salaries of personnel of the Department who furnish such care and 
services. Such amounts shall be available without fiscal year 
limitation.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date of the enactment of this Act and apply to 
amounts in the Medical-Care Cost Recovery Fund under section 1729(g) of 
title 38, United States Code, at the close of business on September 30, 
1996.

SEC. 10. AUTHORITY FOR REIMBURSEMENT BY MEDICARE OF CERTAIN HEALTH CARE 
              SERVICES PROVIDED BY DEPARTMENT FACILITIES.

    (a) Authority.--(1) Subchapter III of chapter 17 of title 38, 
United States Code, is amended by inserting after section 1729 the 
following new section:
``Sec. 1729A. Medicare coverage and reimbursement
    ``(a) A Department facility shall be eligible to participate under 
title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) as a 
provider of services and shall be eligible for payments under such 
title if such facility files an agreement with the Secretary of Health 
and Humans Services under section 1866 of the Social Security Act (42 
U.S.C. 1395cc).
    ``(b)(1) In the case of care or services provided under this 
chapter to an individual described in paragraph (2)(A) by a Department 
facility, the Secretary of Health and Human Services shall reimburse 
the Department facility in the same amounts and under the same terms 
and conditions as that Secretary reimburses other providers of such 
care and services under title XVIII of such Act with respect to such 
individual.
    ``(2)(A) Paragraph (1) applies to any veteran or adult dependent of 
a veteran who is described in section 1710(a)(2) of this title and who 
is medicare eligible.
    ``(B) For purposes of this paragraph, an individual is medicare 
eligible if the individual is--
            ``(i) entitled to benefits under part A of title XVIII of 
        the Social Security Act (42 U.S.C. 1395 et seq.); or
            ``(ii) enrolled under part B of such title (42 U.S.C. 1395j 
        et seq.).
    ``(c) When the Secretary provides care or services to an individual 
for which the Secretary receives reimbursement under this section, the 
Secretary shall require the individual to pay to the Department any 
applicable deductible or copayment that is not reimbursed by the 
medicare program under title XVIII of the Social Security Act.
    ``(d) The Secretary shall utilize amounts received by the Secretary 
under this section for payment of the costs of furnishing care and 
services under this chapter.''.
    (2) The table of sections at the beginning of chapter 17 of such 
title is amended by inserting after the item relating to section 1729 
the following:

``1729A. Medicare coverage and reimbursement.''.
    (b) Payments Under Part A of Medicare.--Section 1814(h) of the 
Social Security Act (42 U.S.C. 1395f(c)) is amended to read as follows:
    ``Payment for Certain Services Provided in Department of Veterans 
Affairs Facilities
    ``(h) Subject to the provisions of section 1729A of title 38, 
United States Code, subsection (c) shall not apply to care and services 
furnished under chapter 17 of such title.''.
    (c) Payments Under Part B of Medicare.--Section 1835(d) of the 
Social Security Act (42 U.S.C. 1395n(d)) is amended--
            (1) by striking ``(d)'' and inserting ``(d)(1)''; and
            (2) by adding at the end the following new paragraph:
    ``(2) Subject to the provisions of section 1729A of title 38, 
United States Code, paragraph (1) shall not apply to care and services 
furnished under chapter 17 of such title.''.

SEC. 11. MAINTENANCE OF CAPACITY OF DEPARTMENT OF VETERANS AFFAIRS TO 
              PROVIDE SPECIALIZED SERVICES TO VETERANS.

    In managing the provision of medical care and services by the 
Department of Veterans Affairs, the Secretary of Veterans Affairs 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 title 38, United States Code, including 
veterans with spinal cord dysfunction, blindness, 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 Act.
                                 <all>
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