[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1911 Introduced in House (IH)]
107th CONGRESS
1st Session
H. R. 1911
To establish a demonstration project to provide for Medicare
reimbursement for health care services provided to certain Medicare-
eligible veterans in selected facilities of the Department of Veterans
Affairs.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 17, 2001
Mr. Saxton (for himself, Mr. Moran of Kansas, Mr. Andrews, Mr.
LoBiondo, and Mr. King) introduced the following bill; which was
referred to the Committee on Ways and Means, and in addition to the
Committees on Veterans' Affairs and Energy and Commerce, 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 establish a demonstration project to provide for Medicare
reimbursement for health care services provided to certain Medicare-
eligible veterans in selected 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 Medicare Reimbursement
Demonstration Act of 2001''.
SEC. 2. FINDINGS.
The Congress makes the following findings:
(1) The health care system of the Department of Veterans
Affairs enrolls veterans in 7 designated priority groups and
provides health care services to veterans based upon these
priority groups, with priority group 1 given the highest
priority and priority group 7 given the lowest.
(2) Due to budgetary limitations in moneys appropriated to
the Department of Veterans Affairs for veterans health care,
certain veterans in lower priority groups could face
limitations in access to health care from the Department of
Veterans Affairs.
(3) Veterans participating in the health care system of the
Department of Veterans Affairs and served under the lower
priority groups 5, 6, and 7 are either low-income veterans
whose annual income and net worth are below established
thresholds, veterans whose incomes are above the thresholds and
do not have service-connected disabilities that qualify them
for priority care in that health care system, or other eligible
veterans not already covered in groups 1-4.
(4) Allowing medicare-eligible veterans in these lower
priority groups to utilize their medicare benefits in the
health care system of the Department of Veterans Affairs
provides veterans greater access to health care services and
greater flexibility in choosing their health care providers.
(5) Allowing these veterans to utilize their medicare
benefits in the health care system of the Department of
Veterans Affairs also provides health care facilities of the
Department of Veterans Affairs greater flexibility in serving
veterans.
(6) All veterans should have access to necessary health
care, and this Act takes the next step in demonstrating the
value of medicare subvention, and demonstrates the commitment
of Congress, to an improved Department of Veterans Affairs
health care system for the Nation's veterans and to ensuring
access to such health care by veterans.
(7) The Department of Veterans Affairs is not sufficiently
funded to enable the entirety of the veteran population of
25,500,000 veterans to gain access to health care furnished by
the Department.
(8) The Department of Veterans Affairs receives funding
adequate to furnish health care only to those veterans who, in
all likelihood, will be enrolled for such health care annually,
based only on eligibility rules contained in chapter 17 of
title 38, United States Code, and without regard to individual
veterans who may have access to health care benefits through
the medicare program or through other means.
SEC. 3. ESTABLISHMENT OF MEDICARE SUBVENTION DEMONSTRATION PROJECT FOR
VETERANS.
Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is
amended by adding at the end the following:
``medicare subvention demonstration project 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) Demonstration project.--The term `demonstration
project' means the demonstration project carried out under this
section.
``(3) Demonstration site.--
``(A) In general.--Subject to subparagraph (B), the
term `demonstration 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--
``(i) 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
``(ii) 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.
``(B) Exclusion.--The term `demonstration site'
shall not include the entire catchment area of a
Veterans Integrated Services Network (VISN).
``(4) Medicare health care services.--The term `medicare
health care services' means items or services covered under
part A or B of this title.
``(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 eligible for care
and services under paragraph (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 of this title; and
``(D) is enrolled for benefits under part B of this
title.
``(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) Demonstration Project.--
``(1) In general.--
``(A) Establishment.--The administering Secretaries
are authorized to establish a demonstration project
(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 demonstration project
established under this section;
``(ii) a description of the eligibility
rules for participation in the demonstration
project, including any criteria established
under subsection (e), any premiums established
for a coordinated care health plan, and any
cost-sharing arrangements;
``(iii) a description of how the
demonstration project will satisfy the
requirements under this title;
``(iv) a description of the demonstration
sites selected under paragraph (2);
``(v) a description of how reimbursement
requirements under subsection (k), maintenance
of effort requirements under subsection (l),
and the annual reconciliation under subsection
(m) will be implemented in the demonstration
project;
``(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 (l), the annual
reconciliation under subsection (m), and
related matters required under the
demonstration project;
``(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 (m) or (n).
``(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)(3)(A) that is receiving payments by reason
of the demonstration project has sufficient--
``(I) resources and expertise to
provide, consistent with payment
requirements under subsection (k), the
health care benefits required to be
provided to beneficiaries under the
demonstration project (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
demonstration 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) Number of demonstration sites.--
``(A) In general.--Subject to the succeeding
provisions of this paragraph, the demonstration project
established under this section shall be conducted in
not more than 10 demonstration sites, designated
jointly by the administering Secretaries.
``(B) Equal number of coordinated care and fee-for-
service sites.--The administrating Secretaries shall--
``(i) ensure that the number of
demonstration sites operated under a
coordinated care health plan model equals the
number of demonstration sites operated under a
fee-for-service model; and
``(ii) attempt to ensure that the volume of
medicare health care services provided under
the demonstration project at demonstration
sites operated under a coordinated care health
plan model is the same as the volume of such
services provided at demonstration sites
operated under a fee-for-service model.
``(C) Restriction.--A demonstration site may not
operate under both a coordinated care health plan model
and a fee-for-service model.
``(D) Demonstration sites in rural areas.--At least
1 of each of the following demonstration sites shall be
selected for inclusion in the demonstration project:
``(i) A demonstration site that is operated
under a coordinated care health plan model and
that serves a predominantly rural area.
``(ii) A demonstration site that is
operated under a fee-for-service model and that
serves a predominantly rural area.
``(3) Restriction on new or expanded facilities.--No new
Veterans Affairs medical facilities may be built or expanded
with funds from the demonstration project.
``(4) Duration.--
``(A) Coordinated care health plan model.--The
authority of the administering Secretaries to conduct
the demonstration project under a coordinated care
health plan model shall--
``(i) begin on January 1, 2003; and
``(ii) terminate on the earlier of--
``(I) the date which is 3 years
after the date enrollment in a
coordinated care health plan begins at
any demonstration site using such a
model; or
``(II) December 31, 2006.
``(B) Fee-for-service model.--The authority of the
administering Secretaries to conduct the demonstration
under a fee-for-service model shall--
``(i) begin on January 1, 2004; and
``(ii) terminate on the earlier of--
``(I) the date which is 3 years
after the date that health care
benefits begin to be provided at any
demonstration site using such a model;
or
``(II) December 31, 2007.
``(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
demonstration project consistent with part C of this title.
``(2) Operation by or through a demonstration site.--Any
coordinated care health plan established in accordance with
paragraph (1) shall be operated by or through a demonstration
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 demonstration project.
``(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 demonstration project
shall meet all requirements applicable to a
Medicare+Choice plan under part C of this title
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
demonstration project.
``(B) Beneficiary protections and other matters.--A
coordinated care health plan shall comply with the
requirements of part C of this title 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 health care plan
operating under the demonstration project.
``(d) Fee-For-Service Model.--
``(1) In general.--The Secretary of Veterans Affairs shall
establish and operate a demonstration 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 demonstration project 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 demonstration 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 demonstration 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
demonstration project 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 demonstration
project.
``(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 demonstration project.
``(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 demonstration project unless the individual
has been determined to be eligible for the service
pursuant to the procedures established under
subparagraph (A).
``(e) Demonstration Site Requirements.--The Secretary of Veterans
Affairs may operate a coordinated care health plan at a demonstration
site, may provide medicare health care services using the fee-for-
service model at a demonstration site, and may authorize a
demonstration site to submit claims for payment under the demonstration
project only after the Secretary of Veterans Affairs submits to the
committees of jurisdiction of Congress a report setting forth a plan
for the establishment of such demonstration site and for the oversight
by the Secretary of Veterans Affairs of the demonstration project
conducted at such demonstration site. The administering Secretaries may
not implement the plan until the Secretary of Veterans Affairs has
received from the Inspector General of the Department of Health and
Human Services, and has forwarded to Congress, certification that--
``(1) the--
``(A) cost accounting and related transaction
systems of the Veterans Health Administration provide
cost information and encounter data regarding health
care delivered at each demonstration site (or delivered
by any entity or health care provider with which the
Secretary of Veterans Affairs has a contract or sharing
agreement) on an inpatient and outpatient basis; and
``(B) cost information and encounter data provided
by such systems is accurate, reliable, and consistent
across all the demonstration sites;
``(2) the Secretary of Veterans Affairs has minimized the
risk that any amount appropriated to the Department of Veterans
Affairs will be required to meet any obligation of the
demonstration sites under the demonstration project to a
targeted medicare-eligible veteran by developing a credible
plan--
``(A) based on market surveys, data from the
Decision Support System, actuarial analysis, and other
appropriate methods; and
``(B) taking into account the level of payment
under subsection (k) and the costs of health care
benefits provided at the demonstration sites with
regard to each demonstration site;
``(3) each demonstration site has the capacity to provide
to a sufficient number of targeted medicare-eligible veterans,
at a minimum--
``(A) under the coordinated care health plan model,
the health care benefits prescribed in subsection
(c)(3); or
``(B) under the fee-for-service model, the health
care benefits prescribed in subsection (d)(2); and
``(4) the Veterans Affairs medical facility administering
the demonstration site has sufficient systems and safeguards in
place to minimize any risk that instituting the coordinated
care health plan model or the fee-for-service model will result
in reducing--
``(A) the quality of care delivered to participants
in the demonstration project; or
``(B) the quality of, or the access to, care to
veterans not participating in the demonstration
project.
``(f) Voluntary Participation.--Participation of a targeted
medicare-eligible veteran in the demonstration project shall be
voluntary, subject to the capacity of participating demonstration sites
and the annual limitations on medicare payments specified in subsection
(k)(4), and shall be subject to such terms and conditions as the
administering Secretaries may establish.
``(g) Crediting of Payments.--A payment received by the Secretary
of Veterans Affairs under the demonstration project shall be credited
to the applicable Department of Veterans Affairs medical appropriation
unless the Secretary of Veterans Affairs has a compelling reason to do
otherwise. Any such payment received during a fiscal year for services
provided during a prior fiscal year may be obligated by the Secretary
of Veterans Affairs during the fiscal year during which the payment is
received.
``(h) 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 demonstration project.
``(i) Inspector General.--Nothing in any agreement entered into
under subsection (b) 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
demonstration project, including compliance with the provisions of this
title and all other relevant laws.
``(j) Report.--
``(1) In general.--At least 30 days prior to the
commencement of the demonstration project (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 subsection (b) to the
committees of jurisdiction of Congress.
``(2) Subsequent waiver of medicare requirements.--If the
Secretary waives any requirement under subsection (c)(4) or
(d)(4) that was not described in any agreement submitted to the
committees of jurisdiction of Congress under paragraph (1), the
Secretary shall submit a report to such committees describing
such waiver.
``(k) Payments Based on Regular Medicare Payment Rates.--
``(1) Amount.--Subject to the succeeding provisions of this
subsection and subsection (m), the Secretary shall reimburse
the Secretary of Veterans Affairs for health care benefits
provided under the demonstration project at the following
rates:
``(A) Coordinated care health plans.--In the case
of health care benefits provided under the
demonstration project 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 demonstration 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 demonstration site was not part of
this demonstration project, 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.--
``(A) Coordinated care health plan model.--Subject
to subparagraphs (C) and (D), the total amount paid to
the Department of Veterans Affairs under this
subsection for enrollees in coordinated care health
plans for any of the 3 consecutive 12-month periods
(the first of which begins on the date that enrollment
in such a plan begins at any demonstration site) shall
be equal to an amount determined appropriate by the
administering Secretaries.
``(B) Fee-for-service model.--Subject to
subparagraphs (C) and (D), the total amount paid to the
Department of Veterans Affairs under this subsection
for health care benefits provided on a fee-for-service
basis at a demonstration site for any of the 3
consecutive 12-month periods (the first of which begins
on the date that benefits begin to be provided at any
demonstration site using the fee-for-service model)
shall be equal to an amount determined appropriate by
the administering Secretaries.
``(C) No payments for benefits provided after
termination date.--No amounts shall be paid to the
Department of Veterans Affairs under this section for
health care benefits provided under the demonstration
project after the date that the project terminates
pursuant to subparagraph (A)(ii) or (B)(ii) of
subsection (b)(4).
``(D) Cap.--The sum of the amounts paid to the
Department of Veterans Affairs under this section
during each of the 12-month periods described in
subparagraph (A) shall not exceed $50,000,000.
``(l) 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 demonstration
project to targeted medicare-eligible veterans at a
demonstration site in a 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)(4)
(without regard to subparagraph (D) of such subsection) exceeds
such expenditures at the site for such services provided to
such individuals during a baseline period determined by the
administering Secretaries.
``(2) Rule of construction.--The criteria for eligiblity
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 eligiblity.
``(m) Annual Reconciliation To Assure No Increase in Costs to
Medicare Program.--
``(1) Monitoring effect of demonstration 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
demonstration site during the period of the
demonstration project compared to the expenditures that
would have been made for such veterans during that
period if the demonstration project had not been
conducted.
``(B) Annual reports by the comptroller general.--
``(i) Coordinated care health plan model.--
Not later than 6 months after the end of each
of the 3 consecutive 12-month periods referred
to in subsection (j)(4)(A), 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 demonstration site operating
under such a model increased as a result of the
demonstration project during the 12-month
period to which the report applies.
``(ii) Fee-for-service model.--Not later
than 6 months after the end of each of the 3
consecutive 12-month periods referred to in
subsection (j)(4)(B), the Comptroller General
of the United States shall submit to the
administering Secretaries and the appropriate
committees of jurisdiction of Congress a report
described in clause (i) with respect to such a
model.
``(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
demonstration site increased (or are expected to
increase) during a fiscal year because of the
demonstration project, 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
medical care appropriation of the Department of
Veterans Affairs to the trust funds; and
``(ii) under subparagraph (A)(ii), shall
include suspending or terminating the
demonstration project (in whole or in part) or
reducing the amount of payment under subsection
(k).
``(n) Evaluation and Reports.--
``(1) Independent evaluation.--
``(A) In general.--The Comptroller General of the
United States shall conduct an evaluation of the
demonstration project, including--
``(i) an evaluation of demonstration 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 agreement entered into under subsection (b), of the
following:
``(i) Any savings or costs to the medicare
program under this title resulting from the
demonstration project.
``(ii) Compliance of participating
demonstration 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 demonstration project
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 demonstration sites in the
program with the reimbursements for health care
services provided by such sites.
``(vi) Any impact the demonstration project
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 demonstration project; and
``(II) veterans (including targeted
medicare-eligible veterans) that are
not receiving health care benefits
under the demonstration project.
``(vii) Any impact the demonstration
project has on private health care providers
and on beneficiaries under this title that are
not receiving health care benefits under the
demonstration project.
``(viii) Any effect that the demonstration
project has on the enrollment in
Medicare+Choice plans offered by
Medicare+Choice organizations under part C of
this title in the established demonstration
site areas.
``(ix) Any impact that the exclusion of the
amounts described in subsection (k)(2) from the
reimbursement amounts under the demonstration
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 demonstration
project; or
``(II) the Department of Health and
Human Services in overseeing the
demonstration project.
``(xi) Any additional elements specified in
the agreement entered into under subsection
(b).
``(xii) Any additional elements that the
Comptroller General of the United States
determines are appropriate to assess regarding
the demonstration project.
``(C) Periodic reports.--
``(i) Coordinated care health plan model.--
With respect to the portion of the
demonstration project that is operating under a
coordinated care health plan model, 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 as follows:
``(I) Initial report.--An initial
report shall be submitted not later
than 12 months after the date that
enrollment in a coordinated care health
plan begins at any demonstration site.
``(II) Second report.--A second
report shall be submitted not later
than 30 months after such date.
``(III) Final report.--A final
report shall be submitted not later
than 42 months after such date.
``(ii) Fee-for-service model.--With respect
to the portion of the demonstration project
that is operating under a fee-for-service
model, 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 as follows:
``(I) Initial report.--An initial
report shall be submitted not later
than 12 months after the date that
medicare health care services begin to
be provided at any demonstration site
using such a model.
``(II) Second report.--A second
report shall be submitted not later
than 30 months after such date.
``(III) Final report.--A final
report shall be submitted not later
than 42 months after such date.
``(2) Reports on extension and expansion of the
demonstration project.--
``(A) Coordinated care health plan model.--With
respect to the demonstration project that is operating
under a coordinated care health plan model, not later
than 3 months after the date of the submission of the
final report by the Comptroller General of the United
States under paragraph (1)(C)(i)(III), the
administering Secretaries shall submit to the
committees of jurisdiction of Congress a report
containing the final recommendations of such
Secretaries as to--
``(i) whether expenditures for targeted
medicare-eligible veterans under the
demonstration project exceed the expenditures
that would have been incurred under the
medicare program under this title with regard
to such veterans had this section not been
enacted;
``(ii) whether the demonstration project
could be expanded or extended without
increasing the cost to the medicare program
under this title or to the Federal Government;
``(iii) whether to extend the duration of
the demonstration project;
``(iv) whether to increase the number of
demonstration sites operating under such a
model;
``(v) whether to increase the maximum
amount of reimbursement under the demonstration
project in any year; and
``(vi) whether the terms and conditions of
the demonstration project should be altered if
the project is extended or expanded.
``(B) Fee-for-service model.--With respect to the
demonstration project that is operating under a fee-
for-service model, not later than 3 months after the
date of the submission of the final report by the
Comptroller General of the United States under
paragraph (1)(C)(ii)(III), the administering
Secretaries shall submit to the committees of
jurisdiction of Congress a report described in
subparagraph (A) with respect to such model.''.
<all>