[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 963 Introduced in Senate (IS)]







109th CONGRESS
  1st Session
                                 S. 963

  To amend title 38, United States Code, to provide for a guaranteed 
  adequate level of funding for veterans' health care, to direct the 
  Secretary of Veterans Affairs to conduct a pilot program to improve 
   access to health care for rural veterans, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 28, 2005

   Mr. Thune introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
  To amend title 38, United States Code, to provide for a guaranteed 
  adequate level of funding for veterans' health care, to direct the 
  Secretary of Veterans Affairs to conduct a pilot program to improve 
   access to health care for rural veterans, 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 ``Veterans' Health Care and Equitable 
Access Act of 2005''.

SEC. 2. ASSURANCE OF ADEQUATE FUNDING FOR VETERANS' HEALTH CARE.

    (a) In General.--Chapter 3 of title 38, United States Code, is 
amended by adding at the end the following:
``Sec. 321. Assured funding for veterans' health care
    ``(a) For each fiscal year, the Secretary of the Treasury shall 
make available to the Secretary the amount determined under subsection 
(b) with respect to that fiscal year, which shall remain available, 
without fiscal year limitation, for the programs, functions, and 
activities of the Veterans Health Administration, as specified in 
subsection (c).
    ``(b)(1) The amount applicable to fiscal year 2007 under this 
subsection is $43,000,000,000.
    ``(2) The amount applicable to any fiscal year after fiscal year 
2007 under this subsection is the amount equal to the product of--
            ``(A) the sum of--
                    ``(i) the number of veterans enrolled in the 
                Department health care system under section 1705 of 
                this title as of July 1 preceding the beginning of such 
                fiscal year; and
                    ``(ii) the number of persons eligible for health 
                care under chapter 17 of this title who are not covered 
                by clause (i) and who were provided hospital care or 
                medical services under such chapter at any time during 
                the fiscal year preceding such fiscal year; and
            ``(B) the per capita baseline amount, as increased annually 
        pursuant to paragraph (3)(B).
    ``(3)(A) For purposes of paragraph (2)(B), the term `per capita 
baseline amount' means the amount equal to--
            ``(i) the amount specified in paragraph (1), divided by
            ``(ii) the number of veterans enrolled in the Department 
        health care system under section 1705 of this title as of 
        September 30, 2005.
    ``(B) With respect to any fiscal year, the Secretary shall provide 
a percentage increase (rounded to the nearest dollar) in the per capita 
baseline amount equal to the percentage by which--
            ``(i) the Consumer Price Index (All Urban Consumers, United 
        States city average, hospital and related services, seasonally 
        adjusted), published by the Bureau of Labor Statistics of the 
        Department of Labor for the 12-month period ending on June 30 
        preceding the beginning of the fiscal year for which the 
        increase is made; exceeds
            ``(ii) such Consumer Price Index for the 12-month period 
        preceding the 12-month period described in clause (i).
    ``(c)(1) Except as provided in paragraph (2), amounts made 
available pursuant to subsection (a) may be used for all programs, 
functions, and activities of the Veterans Health Administration.
    ``(2) Amounts made available pursuant to subsection (a) may not be 
used for--
            ``(A) construction, acquisition, or alteration of medical 
        facilities as provided in subchapter I of chapter 81 of this 
        title (except for such repairs as were provided for before the 
        date of enactment of this section through the medical care 
        appropriation for the Department); or
            ``(B) grants under subchapter III of chapter 81 of this 
        title.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 3 of title 38, United States Code, is amended by adding at the 
end the following:

``321. Assured funding for veterans' health care.''.

SEC. 3. PILOT PROGRAM ON IMPROVED ACCESS TO HEALTH CARE FOR VETERANS 
              WHO RESIDE IN HIGHLY RURAL AND GEOGRAPHICALLY REMOTE 
              AREAS.

    (a) Pilot Program.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        conduct a pilot program to evaluate the feasability and 
        advisability of utilizing various means to improve the access 
        of veterans who reside in highly rural or geographically remote 
        areas to health care services referred to in subsection (d).
            (2) Provision of services under pilot program.--In 
        conducting the pilot program, the Secretary shall provide 
        health care services referred to in subsection (d) to eligible 
        veterans who reside in highly rural or geographically remote 
        areas in the geographic service regions selected for purposes 
        of the pilot program utilizing the contract authority of the 
        Secretary under section 1703 of title 38, United States Code, 
        and such other authorities available to the Secretary as the 
        Secretary considers appropriate for purposes of the pilot 
        program.
    (b) Eligible Veterans.--A veteran is an eligible veteran for 
purposes of this section if the veteran--
            (1) has a service-connected disability; or
            (2) is enrolled in the veterans health care system under 
        section 1705 of title 38, United States Code.
    (c) Highly Rural or Geographically Remote Areas.--An eligible 
veteran resides in a highly rural or geographically remote area for 
purposes of this section if the veteran--
            (1) resides in a location that is more than 60 miles 
        driving distance from the nearest Department of Veterans 
        Affairs health care facility; or
            (2) in the case of an eligible veteran who resides in a 
        location that is less than 60 miles driving distance from such 
        a facility, experiences such hardship or other difficulties (as 
        determined pursuant to regulations prescribed by the Secretary 
        for purposes of this section) in travel to the nearest 
        Department of Veterans Affairs health care facility that such 
        travel is not in the best interests of the veteran.
    (d) Health Care Services.--The health care services referred to in 
this subsection are--
            (1) acute or chronic symptom management;
            (2) nontherapeutic medical services; and
            (3) any other medical services jointly determined 
        appropriate for an eligible veteran for purposes of this 
        section by the physician of the department responsible for 
        primary care of such eligible veteran and the director of the 
        Veterans Integrated Service Network concerned.
    (e) Areas for Conduct of Pilot Program.--
            (1) In general.--The pilot program shall be conducted in 3 
        of the geographic service regions of the Veterans Health 
        Administration (referred to as Veterans Integrated Service 
        Networks) selected by the Secretary for purposes of the pilot 
        program.
            (2) Selection.--In selecting geographic service regions for 
        purposes of the pilot program, the Secretary shall select--
                    (A) Veterans Integrated Service Network number 23 
                as 1 of the regions for the conduct of the pilot 
                program; and
                    (B) the other 2 geographic service regions for the 
                conduct of the pilot program from among the Veterans 
                Integrated Service Networks that have a substantial 
                population of veterans who reside in highly rural or 
                geographically remote areas.
    (f) Period of Pilot Program.--The pilot program shall be conducted 
during fiscal years 2006, 2007, and 2008.
    (g) Funding for Pilot Program.--
            (1) In general.--For each fiscal year during which the 
        pilot program is conducted, the Secretary shall allocate for 
        the pilot program an amount equal to 0.9 percent of the total 
        amount appropriated for such fiscal year for medical services.
            (2) Timing of allocation.--The allocation under paragraph 
        (1) for a fiscal year shall be made before any other allocation 
        of funds for medical care is made for such fiscal year, and any 
        remaining allocation of funds for medical care for such fiscal 
        year shall be made without regard to the allocation under 
        paragraph (1) in such fiscal year.
    (h) Report to Congress.--Not later than February 1, 2009, the 
Secretary shall submit to Congress a report on the pilot program. The 
Secretary shall include in the report such recommendations as the 
Secretary considers appropriate concerning extension of the pilot 
program or other means to improve the access of veterans who reside in 
highly rural or geographically remote areas to health care services 
referred to in subsection (d).

SEC. 4. TRAVEL REIMBURSEMENT FOR VETERANS RECEIVING TREATMENT AT 
              VETERANS FACILITIES.

    Section 111 of title 38, United States Code, is amended--
            (1) in subsection (a), by striking ``), or in lieu thereof 
        an allowance based upon mileage traveled'' and insert ``at a 
        rate equivalent to the rate provided to Federal employees under 
        section 5702 of title 5), or in lieu thereof an allowance based 
        upon mileage traveled (at a rate equivalent to the rate 
        provided to Federal employees under section 5704 of title 5)'';
            (2) by striking subsection (g); and
            (3) by redesignating subsection (h) as subsection (g).

SEC. 5. DISABILITY RATING FOR VETERANS WHO LOSE USE OF A LIMB AS A 
              RESULT OF A SERVICE-CONNECTED INJURY.

    Any veteran who lost the use of an arm or a leg as a result of a 
service-connected injury shall have a disability rating of not less 
than 50 percent disabled.

SEC. 6. ESTABLISHMENT OF MEDICARE SUBVENTION FOR VETERANS.

    (a) In General.--Section 1862 of the Social Security Act (42 U.S.C. 
1395y) is amended by adding at the end the following:
    ``(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--
                            ``(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 
                                beneficiaries; 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, 
                        physician, practitioner, supplier, or facility 
                        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 Department of Veterans Affairs medical 
                facilities may be built or expanded with funds received 
                under this subsection.
            ``(2) Cost-sharing.--The amount of reimbursement for 
        medicare health care services 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 carry out, or 
                        improve the efficiency of, 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.--
                        Sixty-seven 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 part 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 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.''.

SEC. 7. MEDICAL REIMBURSEMENT STUDY AND REPORT.

    (a) Study.--
            (1) In general.--The Secretary of Veterans Affairs, in 
        consultation with the Secretary of Defense, shall conduct a 
        study of the reimbursements received by the Department of 
        Veterans Affairs and the Department of Defense from insurance 
        companies and other responsible parties for services performed 
        and medication dispensed at the medical facilities of such 
        departments.
            (2) Issues to be studied.--The study conducted under this 
        subsection shall determine, for the fiscal year ending within 1 
        year before the date of enactment of this Act--
                    (A) the value of the services and medication 
                provided by the Department of Veterans Affairs or the 
                Department of Defense for which another party is 
                financially responsible;
                    (B) the value of such services and medication that 
                were billed to such financially responsible parties; 
                and
                    (C) the amount of reimbursement paid by such 
                financially responsible parties to the Department of 
                Veterans Affairs or the Department of Defense.
    (b) Report.--Not later than 1 year after the date of enactment of 
this Act, the Secretary of Veterans Affairs shall submit a report to 
Congress on the results of the study conducted under subsection (a).

SEC. 8. EXTENSION OF CHILD CARE ELIGIBILITY FOR CHILDREN OF SOLDIERS 
              WHO DIE IN THE LINE OF DUTY.

    Section 1799 of title 10, United States Code, is amended by adding 
at the end the following:
    ``(d) Children Whose Military Parent Died in the Line of Duty.--If 
a member of the Armed Forces, National Guard, or Reserve dies while on 
active service or active status, any child of such individual who is 
enrolled in any Federal child care program shall be eligible to 
continue receiving such child care services for a period of 24 months 
following such death.''.
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