[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4992 Introduced in House (IH)]







109th CONGRESS
  2d Session
                                H. R. 4992

To provide for Medicare reimbursement for health care services provided 
   to Medicare-eligible veterans in facilities of the Department of 
                           Veterans Affairs.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 16, 2006

 Mrs. Kelly (for herself and Mr. Bass) introduced the following bill; 
which was referred to the Committee on Ways and Means, and in addition 
 to the Committees on Energy and Commerce and Veterans' Affairs, 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 Medicare reimbursement for health care services provided 
   to Medicare-eligible veterans in 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 Assistance Act of 
2006''.

SEC. 2. ESTABLISHMENT OF MEDICARE SUBVENTION FOR VETERANS.

    Section 1862 of the Social Security Act (42 U.S.C. 1395y) is 
amended by adding at the end the following new subsection:
    ``(n) Medicare Subvention for Veterans.--
            ``(1) Establishment of procedure for reimbursement.--
                    ``(A) In general.--The administering Secretaries 
                shall establish a procedure under which the Secretary 
                shall reimburse the Secretary of Veterans Affairs, from 
                the trust funds, for medicare health care services 
                furnished to medicare-eligible veterans.
                    ``(B) Requirements.--Under the procedure 
                established under subparagraph (A)--
                            ``(i) the administering Secretaries shall 
                        certify that any Department of Veterans Affairs 
                        medical facility that furnishes medicare health 
                        care services for which the Secretary of 
                        Veterans Affairs is reimbursed under this 
                        subsection has sufficient--
                                    ``(I) resources and expertise to 
                                provide the health care benefits 
                                required to be provided to individuals 
                                entitled to benefits under part A or 
                                enrolled under part B; and
                                    ``(II) information and billing 
                                systems in place to ensure accurate and 
                                timely submission of claims for health 
                                care benefits to the Secretary;
                            ``(ii) the Secretary shall have access to 
                        all data of the Department of Veterans Affairs 
                        that the Secretary determines is necessary to 
                        verify accuracy in billing and claims 
                        information; and
                            ``(iii) the Secretary shall waive 
                        requirements for conditions of participation 
                        otherwise applicable to a provider of services 
                        or a supplier under this title in the case of a 
                        Department of Veterans Affairs medical facility 
                        consistent with paragraph (3).
                    ``(C) Restriction on new or expanded facilities.--
                No new Veterans Affairs medical facilities may be built 
                or expanded with funds received under this subsection.
            ``(2) Cost-sharing.--The amount of reimbursement to the 
        Secretary of Veterans Affairs for medicare health care services 
        shall be reduced by amounts attributable to applicable 
        deductible, coinsurance, and cost-sharing requirements under 
        this title.
            ``(3) Medicare requirements.--
                    ``(A) Waiver.--The Secretary shall waive any 
                requirements referred to in paragraph (1)(B)(iii) 
                (relating to requirements for conditions of 
                participation) in the case of a Department of Veterans 
                Affairs medical facility, 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 provide (or to 
                        improve the efficiency of providing) for 
                        reimbursement for medicare health care services 
                        under this subsection.
                    ``(B) Waiver of prohibition on payments to federal 
                providers of services.--The prohibition of payments to 
                Federal providers of services under sections 1814(c) 
                and 1835(d), and paragraphs (2) and (3) of subsection 
                (a), shall not apply.
            ``(4) Verification of eligibility.--
                    ``(A) In general.--The Secretary of Veterans 
                Affairs shall establish procedures for determining 
                whether an individual is a medicare-eligible veteran.
                    ``(B) Restriction.--No reimbursement shall be made 
                under this subsection for any medicare health care 
                service provided to an individual unless the individual 
                has been determined to be a medicare-eligible veteran 
                pursuant to the procedures established under 
                subparagraph (A).
            ``(5) Data requirements.--Reimbursements for medicare 
        health care services furnished to medicare-eligible veterans 
        may not be made until such time as the administering 
        Secretaries certify to Congress that 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 Department of Veterans Affairs 
                medical facility on an inpatient and outpatient basis; 
                and
                    ``(B) cost information and encounter data provided 
                by such systems is accurate, reliable, and consistent 
                across all facilities.
            ``(6) Payments based on regular medicare payment rates.--
                    ``(A) Amount.--Subject to the succeeding provisions 
                of this paragraph, the Secretary shall reimburse the 
                Secretary of Veterans Affairs for health care benefits 
                provided to medicare-eligible veterans at a rate equal 
                to 100 percent of the amounts that otherwise would be 
                payable under this title on a noncapitated basis for 
                such service if the Department of Veterans Affairs 
                medical facility were a provider of services, were 
                participating in the medicare program, and imposed 
                charges for such service.
                    ``(B) Exclusion of certain amounts.--In computing 
                the amount of payment under subparagraph (A), the 
                following amounts shall be excluded:
                            ``(i) Disproportionate share hospital 
                        adjustment.--Any amount attributable to an 
                        adjustment under section 1886(d)(5)(F).
                            ``(ii) Direct graduate medical education 
                        payments.--Any amount attributable to a payment 
                        under section 1886(h).
                            ``(iii) Indirect medical education 
                        adjustment.--Any amount attributable to the 
                        adjustment under section 1886(d)(5)(B).
                            ``(iv) Percentage of capital payments.--67 
                        percent of any amounts attributable to payments 
                        for capital-related costs under medicare 
                        payment policies under section 1886(g).
                    ``(C) Periodic payments from medicare trust 
                funds.--Payments under this paragraph shall be made--
                            ``(i) on a periodic basis consistent with 
                        the periodicity of payments under this title; 
                        and
                            ``(ii) in appropriate part, as determined 
                        by the Secretary, from the trust funds.
            ``(7) Crediting of payments.--Any payment shall be 
        deposited in the Department of Veterans Affairs Medical Care 
        Collections Fund established under section 1729A of title 38, 
        United States Code.
            ``(8) Rules of construction.--Nothing in this subsection 
        shall be construed--
                    ``(A) as prohibiting the Inspector General of the 
                Department of Health and Human Services from 
                investigating any matters regarding the expenditure of 
                funds under this subsection, including compliance with 
                the provisions of this title and all other relevant 
                laws; or
                    ``(B) as adding or requiring additional criteria 
                for eligibility for health care benefits furnished to 
                veterans by the Secretary of Veterans Affairs, as 
                established under chapter 17 of title 38, United States 
                Code.
            ``(9) Evaluation and reports.--The administering 
        Secretaries shall conduct ongoing evaluations of the procedure 
        established under this subsection, and shall submit periodic 
        reports to Congress on--
                    ``(A) any savings or costs to the medicare program 
                by reason of this subsection; and
                    ``(B) effects of this subsection on access to care 
                by medicare-eligible veterans.
            ``(10) Definitions.--In this subsection:--
                    ``(A) Administering secretaries.--The term 
                `administering Secretaries' means the Secretary and the 
                Secretary of Veterans Affairs acting jointly.
                    ``(B) Medicare health care services.--The term 
                `medicare health care services' means items or services 
                covered under part A or B of this title.
                    ``(C) Medicare-eligible veteran.--The term 
                `medicare-eligible veteran' means an individual who--
                            ``(i) is a veteran (as defined in section 
                        101(2) of title 38, United States Code) who is 
                        eligible for care and services under section 
                        1705(a) of title 38, United States Code;
                            ``(ii) has attained age 65;
                            ``(iii) is entitled to, or enrolled for, 
                        benefits under part A of this title; and
                            ``(iv) is enrolled for benefits under part 
                        B of this title.
                    ``(D) 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.
                    ``(E) Department of veterans affairs medical 
                facility.--The term `Department of Veterans Affairs 
                medical facility' means a medical facility as defined 
                in section 8101(3) of title 38, United States Code 
                alone or in conjunction with other facilities under the 
                jurisdiction of the Secretary of Veterans Affairs.''.
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