[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2667 Introduced in House (IH)]







107th CONGRESS
  1st Session
                                H. R. 2667

To provide for a joint Department of Defense and Department of Veterans 
   Affairs demonstration project to identify benefits of integrated 
management of health care resources of those departments, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 27, 2001

 Mr. Smith of New Jersey (for himself, Mr. Bilirakis, Mr. Everett, Mr. 
Buyer, Mr. Gibbons, Mr. Simmons, Mr. Brown of South Carolina, Mr. Wamp, 
and Mr. Kirk) introduced the following bill; which was referred to the 
  Committee on Veterans' Affairs, and in addition to the Committee on 
   Armed Services, 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 provide for a joint Department of Defense and Department of Veterans 
   Affairs demonstration project to identify benefits of integrated 
management of health care resources of those departments, 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. SHORT TITLE.

    This Act may be cited as the ``Department of Defense-Department of 
Veterans Affairs Health Resources Access Improvement Act of 2001''.

SEC. 2. FINDINGS AND SENSE OF CONGRESS CONCERNING STATUS OF HEALTH 
              RESOURCES SHARING BETWEEN THE DEPARTMENT OF VETERANS 
              AFFAIRS AND THE DEPARTMENT OF DEFENSE.

    (a) Findings.--Congress makes the following findings:
            (1) Federal health resources provided by the people of the 
        United States through tax receipts are by their nature scarce 
        and thus should be effectively and efficiently used.
            (2) In 1982, Congress authorized health resources sharing 
        between Department of Defense medical treatment facilities and 
        Department of Veterans Affairs health care facilities in order 
        to allow more effective and efficient use of their health 
        resources.
            (3) Health care beneficiaries of the Departments of Defense 
        and Veterans Affairs, whether active servicemembers, veterans, 
        retirees, or family members of active or retired 
        servicemembers, should have full access to the health care and 
        services that Congress has authorized for them.
            (4) The Secretary of Defense and the Secretary of Veterans 
        Affairs, and the appropriate officials of each of those 
        departments with responsibilities related to health care, have 
        not taken full advantage of the opportunities provided by law 
        to make their respective health resources available to health 
        care beneficiaries of the other department in order to provide 
        improved health care for the whole number of beneficiaries.
            (5) After the many years of support and encouragement from 
        Congress, the departments have made little progress in health 
        resource sharing and the intended results of the sharing 
        authority have not been achieved.
    (b) Sense of Congress.--Congress urges the Secretary of Defense and 
the Secretary of Veterans Affairs to commit their respective 
departments to exploring new ways for significantly improving health 
resources sharing and to building organizational cultures supportive of 
health resources sharing.
    (c) Purpose.--It is the purpose of this Act--
            (1) to authorize a demonstration program to advance the 
        principles of health resources sharing consistent with the 
        expressed intent of Congress; and
            (2) to establish a basis for joint strategic planning of 
        Department of Defense and Department of Veterans Affairs health 
        systems to ensure that available funds are used more 
        effectively and efficiently in order to enhance access to high 
        quality health care for their beneficiaries.

SEC. 3. HEALTH CARE FACILITIES INTEGRATION DEMONSTRATION PROJECT.

    (a) Establishment.--The Secretary of Veterans Affairs and the 
Secretary of Defense shall conduct a demonstration project to identify 
advantages of providing for integrated management of military treatment 
facilities and VA health care facilities that are located in the same 
geographic area.
    (b) Site Identification.--(1) The Secretaries shall jointly 
identify five qualifying sites at which to conduct the demonstration 
project under this section.
    (2) For purposes of this section, a qualifying site is an area in 
the United States in which--
            (A) one or more military treatment facilities and one or 
        more VA health care facilities are situated in relative 
        proximity to each other;
            (B) for which there could be in effect within one year 
        after the date of the enactment of this Act an integrated 
        budget and personnel system for those facilities; and
            (C) as determined by the Secretaries, both the candidate VA 
        facilities and the candidate military medical treatment 
        facilities have in place information systems to demonstrate the 
        validity of the activities of those facilities so that the 
        Secretaries are confident that they will be able to effectively 
        measure differences in activities at those facilities 
        (including cost, access, quality, patient satisfaction, and 
        other important performance indicators) before the 
        demonstration project, during the period of the demonstration 
        project, and after the end of the demonstration project.
    (c) Conduct of Demonstration Project.--At each site at which the 
demonstration project is conducted, the Secretaries shall provide for a 
unified management system for the military treatment facilities and VA 
health care facilities at that site. To the extent feasible, that 
unified management system shall include--
            (1) a unified budget and financial management system for 
        those facilities;
            (2) a unified staffing and assignment system for the 
        personnel employed at or assigned to those facilities; and
            (3) medical information and information technology systems 
        for those facilities that--
                    (A) are unified across those facilities;
                    (B) maintain interoperability with medical 
                information and information technology systems of the 
                respective departments of those facilities; and
                    (C) incorporate standards of information quality 
                that are at least equivalent to those adopted for the 
                departments at large.
    (d) Authority To Waive Certain Administrative Regulations and 
Policies.--(1) In order to carry out subsection (c), the Secretary of 
Defense may, in the Secretary's discretion, waive any regulation or 
administrative policy otherwise applicable to the Department of 
Defense, and the Secretary of Veterans Affairs may, in the Secretary's 
discretion, waive any regulation or administrative policy otherwise 
applicable to the Department of Veterans Affairs, as each Secretary 
determines necessary for the purposes of the demonstration project.
    (2) Not later than one year after the date of the enactment of this 
Act, the Secretary of Veterans Affairs and the Secretary of Defense 
shall jointly submit to the Committees on Veterans' Affairs and the 
Committees on Armed Services of the Senate and House of Representatives 
a report on the use of the authority provided by paragraph (1). The 
report shall include a statement of the numbers and types of requests 
for waivers of regulations and administrative policies that have been 
made to that date and the disposition of each.
    (e) Use of Title 38 Personnel Authorities.--(1) In order to carry 
out subsection (c), the Secretary of Defense may apply to civilian 
personnel of the Department of Defense assigned to or employed at a 
military treatment facility participating in the demonstration project 
any of the provisions of subchapters I, III, and IV of chapter 74 of 
title 38, United States Code, determined appropriate by the Secretary.
    (2) For such purposes, any reference in such chapter--
            (A) to the ``Secretary'' or the ``Under Secretary for 
        Health'' shall be treated as referring to the Secretary of 
        Defense; and
            (B) to the ``Veterans Health Administration'' shall be 
        treated as referring to the Department of Defense.
    (f) Facilities To Be Deemed Facilities of the Other Department.--A 
VA health care facility participating in the demonstration project 
shall be considered to be a military treatment facility for purposes of 
eligibility for care for beneficiaries of the Department of Defense, 
and a military treatment facility participating in the demonstration 
project shall be considered to be a VA health care facility for 
purposes of eligibility for care for beneficiaries of the Department of 
Veterans Affairs.
    (g) Benefits, Copayments, Etc., To Be Equalized.--In the case of 
facilities of the participating departments selected to participate in 
the demonstration project, the medical care for which a beneficiary of 
the Department of Defense or beneficiary of the Department of Veterans 
Affairs is eligible, and any required copayments or deductibles for 
such care applicable to the beneficiaries of either participating 
department, shall to the extent practicable be the same. Regulations to 
govern such benefits, copayments, and deductibles shall be prescribed 
by the Secretary of Defense and the Secretary of Veterans Affairs. 
However, in no case may the benefits for which any beneficiary is 
eligible be reduced or any copayment or deductible applicable to any 
beneficiary be increased.
    (h) Authorization of Appropriations.--There is authorized to be 
appropriated to each of the participating departments to carry out the 
demonstration project--
            (1) $10,000,000 for fiscal year 2002; and
            (2) $25,000,000 for each succeeding year during which the 
        demonstration project is in effect.
    (i) Definitions.--For purposes of this section:
            (1) The term ``military treatment facility'' means a 
        medical facility under the jurisdiction of the Secretary of a 
        military department.
            (2) The term ``VA health care facility'' means a facility 
        under the jurisdiction of the Veterans Health Administration of 
        the Department of Veterans Affairs.
            (3) The term ``participating departments'' means the 
        Department of Veterans Affairs and the Department of Defense.
    (j) Termination.--The demonstration project, and the authority 
provided by this section, shall terminate on September 30, 2006.

SEC. 4. JOINT PROSPECTUS FOR CONSTRUCTION OF NEW MEDICAL FACILITY.

    Not later than two years after the date of the enactment of this 
Act, the Secretary of Defense and the Secretary of Veterans Affairs 
shall submit to the appropriate committees of Congress a prospectus for 
construction of a new joint medical facility for their respective 
departments. The location for the new joint facility shall be selected 
jointly by the two Secretaries and shall be--
            (1) at a location where both a current Department of 
        Veterans Affairs medical center and a current Department of 
        Defense military treatment facility are in need of replacement 
        and the new facility can be a replacement for both; or
            (B) situated so as to provide improved access to eligible 
        veterans and eligible military beneficiaries in a location 
        where there is only one Department of Veterans Affairs medical 
        center or military medical treatment facility serving one of 
        those beneficiary populations.

SEC. 5. GRADUATE MEDICAL EDUCATION.

    (a) Findings.--Congress finds that integration or consolidation of 
graduate medical education programs of the Department of Defense and 
Department of Veterans Affairs would--
            (1) lead to increased efficiencies by eliminating 
        duplicative administrative processes and streamlining and 
        consolidating joint training programs;
            (2) allow increased clinical training sites in Department 
        of Defense and Department of Veterans Affairs accredited 
        programs; and
            (3) make Department of Veterans Affairs facilities 
        available to military reserve health care professionals 
        education programs.
    (b) Comprehensive Review.--The Secretary of Defense and the 
Secretary of Veterans Affairs shall enter into a joint contract for the 
conduct by an organization outside the Government of an independent, 
comprehensive review to identify opportunities for joint funding for an 
integrated graduate medical education program at facilities of their 
respective departments where such an integrated program is feasible.
    (c) Funding.--Funds for the contract under subsection (b) shall be 
provided in equal shares by the Department of Defense and the 
Department of Veterans Affairs.
    (d) Common Affiliation Agreement.--Based on the results of the 
review under subsection (b), the Secretary of Defense and the Secretary 
of Veterans Affairs shall develop and implement a common affiliation 
agreement or contract for graduate medical education purposes at 
locations where the demonstration project under section 3 is carried 
out.

SEC. 6. REQUIRED SHARING OF HEALTH CARE RESOURCES.

    (a) Required Sharing.--Section 8111(a) of title 38, United States 
Code, is amended by striking ``may enter into'' and inserting ``shall 
enter into''.
    (b) Conforming Amendment.--Section 1104 of title 10, United States 
Code, is amended by striking ``may'' and inserting ``shall''.
    (c) Repeal of VA Bed Limits.--(1) Section 8110(a)(1) of title 38, 
United States Code, is amended--
            (A) in the first sentence, by striking ``at not more than 
        125,000 and not less than 100,000'';
            (B) in the third sentence, by striking ``shall operate and 
        maintain a total of not less than 90,000 hospital beds and 
        nursing home beds and''; and
            (C) in the fourth sentence, by striking ``to enable the 
        Department to operate and maintain a total of not less than 
        90,000 hospital and nursing home beds in accordance with this 
        paragraph and''.
    (2) Section 8111(a) of such title is amended by striking ``, except 
that'' and all that follows through ``of the Government'' before the 
period at the end.

SEC. 7. REPORTS.

    (a) Interim Report.--Not later than February 1, 2003, the Secretary 
of Defense and Secretary of Veterans Affairs shall submit to the 
Committees on Veterans' Affairs and the Committees on Armed Services of 
the Senate and House of Representatives a joint interim report on the 
conduct of programs under this Act through the end of the preceding 
fiscal year. The Secretaries shall include in the report a description 
of the measures taken, or planned to be taken, to implement the 
demonstration project under section 3 and the other provisions of this 
Act and any cost savings anticipated at facilities participating in the 
demonstration project.
    (b) Final Report.--Not later than February 1, 2006, the Secretary 
of Defense and Secretary of Veterans Affairs shall submit to the 
committees of Congress specified in subsection (a) a joint report on 
the conduct of programs under this Act through the end of the preceding 
fiscal year. The Secretaries shall include in the report the following:
            (1) A description of activities under this Act.
            (2) Identification of cost savings, access improvements, 
        and other efficiencies realized under the demonstration project 
        carried out under section 3.
            (3) Analysis of measurable changes achieved by the 
        demonstration project, including the use of data sources and 
        performance indicators described in section 3(b)(2)(C).
            (4) Transmittal of the report resulting from the review 
        required by section 5(b), accompanied by appropriate 
        recommendations by the Under Secretary of Veterans Affairs for 
        Health and the Assistant Secretary of Defense for Health 
        Affairs.
            (5) Any recommendations of the two Secretaries for 
        expansion of the demonstration project to additional facilities 
        or for modification to any of the authorities for the 
        demonstration project provided in section 3.
                                 <all>