1.This Act may be cited as the
Medicare VA Reimbursement Act of
2009
.
2.Establishment of
Medicare subvention for veterans
(a)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)The Secretary of Health and Human Services,
in cooperation with the Secretary of Veterans Affairs, shall establish a
program to be known as the Medicare VA reimbursement program
under which the Secretary of Health and Human Services shall reimburse the
Secretary of Veterans Affairs, from the Federal Hospital Insurance Trust Fund
established in section 1817 and the Federal Supplementary Medical Insurance
Trust Fund established in section 1841, for an item or service that—
(A)is furnished to a
Medicare-eligible veteran by a Department of Veterans Affairs medical facility
for the treatment of a non-service-connected condition; and
(B)is covered under
this title or is determined to be medically necessary by the Secretary of
Veterans Affairs.
(2)Memorandum of
understanding
(A)Not later than 6
months after the date of the enactment of this Act, the Secretary of Health and
Human Services shall enter a memorandum of understanding with the Secretary of
Veterans Affairs concerning the administration of the Medicare VA reimbursement
program.
(B)The memorandum of understanding under subparagraph (A)
shall contain the following:
(i)Frequency of
reimbursementAn agreement on
how often reimbursements will be made by the Secretary of Health and Human
Services to the Secretary of Veterans Affairs.
(ii)An agreement on the details of the billing system that
will be used by the Secretary of Veterans Affairs to make claims for
reimbursement from the Secretary of Health and Human Services.
(iii)An agreement on data sharing, including—
(I)identification of
the data exchanges that each Secretary will need to develop, maintain, or
provide access to, for purposes of the Medicare VA reimbursement program;
and
(II)verification of data demonstrating that a
item or service was provided by a Department of Veterans Affairs medical
facility to a Medicare-eligible veteran for a non-service-connected condition
before the Secretary of Health and Human Services provides for reimbursement
for such item or service under the Medicare VA reimbursement program.
(iv)Subject to the requirements of
paragraph (3), details of the payment rate
to be used for reimbursements made under the Medicare VA reimbursement
program.
(v)An agreement on
performance measures and performance targets to be used to demonstrate the
impact of the Medicare VA reimbursement program.
(vi)Any additional terms
deemed necessary by the administering Secretaries.
(C)No maintenance
of effort requirementFor purposes of the Medicare VA
reimbursement program, the Secretary of Veterans Affairs shall not be required
to meet a maintenance of effort requirement (a requirement that the Secretary
of Veterans Affairs maintain a certain level of spending in order to receive
reimbursement from the Secretary of Health and Human Services).
(3)Payments based
on regular Medicare payment rates
(A)Subject
to the succeeding provisions of this paragraph, the Secretary of Health and
Human Services shall reimburse the Secretary of Veterans Affairs—
(i)for an item or
service that is covered under this title and is provided to a Medicare-eligible
veteran by a Department of Veterans Affairs medical facility for the treatment
of a non-service-connected condition, at a rate that is not less than 100
percent of the amounts that otherwise would be payable under this title, on a
fee-for-service basis, for such item or 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 item or service; and
(ii)for an item or service that is not covered
under this title that is provided to a Medicare-eligible veteran by a
Department of Veterans Affairs medical facility for the treatment of a
non-service-connected condition, if the Secretary of Veteran’s Affairs
determines that such item or service is medically necessary, at a rate
determined by the Secretary of Health and Human Services in consultation with
the Secretary of Veterans Affairs.
(B)No arbitrary
limitation on amountSubject to the requirements of this
subsection, the Secretary of Health and Human Services may not impose an annual
cap or other limit on the amount of reimbursement made under the Medicare VA
reimbursement program.
(C)Exclusion of
certain amountsIn computing the amount of payment under
subparagraph (A), the following amounts shall be excluded:
(i)Disproportionate
share hospital adjustmentAny amount attributable to an
adjustment under section 1886(d)(5)(F).
(ii)Direct graduate
medical education paymentsAny amount attributable to a payment
under section 1886(h).
(iii)Indirect
medical education adjustmentAny amount attributable to the
adjustment under section 1886(d)(5)(B).
(iv)Any amounts attributable to payments for capital-related
costs under section 1886(g).
(D)Periodic
payments from Medicare trust fundsReimbursements under this
paragraph shall be made—
(i)on a periodic
basis consistent with the periodicity of payments under this title; and
(ii)from the Federal Hospital Insurance Trust
Fund established in section 1817 and the Federal Supplementary Medical
Insurance Trust Fund established in section 1841.
(E)Any payment made to
the Department of Veterans Affairs under this subsection shall be deposited in
the Department of Veterans Affairs Medical Care Collections Fund established
under section 1729A of title 38, United States Code.
(4)Cost-sharing
requirementsThe Secretary of
Health and Human Services shall reduce the amount of reimbursement to the
Secretary of Veterans Affairs for items and services under the Medicare VA
reimbursement program by amounts attributable to applicable deductible,
coinsurance, and cost-sharing requirements under this title.
(5)Waiver of
prohibition on payments to Federal providers of servicesThe
prohibition of payments to Federal providers of services under sections 1814(c)
and 1835(d) shall not apply to items and services provided under this
subsection.
(6)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;
(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; or
(C)subject to the
requirements of title 38, United States Code, as limiting a veteran’s ability
to access such benefits, regardless of the veteran’s status as a
Medicare-eligible veteran.
(7)Not later than one year after implementing the program
under this subsection and annually thereafter, the administering Secretaries
shall submit to the Congress a report containing the following:
(A)The number of
Medicare-eligible veterans who opt to receive health care at a Department of
Veterans Affairs medical facility.
(B)The total amount of reimbursements made
from the Federal Hospital Insurance Trust Fund established in section 1817 and
the Federal Supplementary Medical Insurance Trust Fund established in section
1841 to the Department of Veterans Affairs Medical Care Collections Fund
established under section 1729A of title 38, United States Code.
(C)The number and
types of items and services provided to Medicare-eligible veterans by
Department of Veterans Affairs medical facilities under this subsection.
(D)An accounting of
the manner in which the Department of Veterans Affairs expended funds received
through reimbursements under this subsection.
(E)A detailed
description of any changes made to the memorandum of understanding under
paragraph (2).
(F)A comparison of
the performance data with the performance targets under paragraph
(2)(B)(v).
(G)Any other data on
the Medicare VA reimbursement program that the administering Secretaries
determine is appropriate.
(8)For purposes of this subsection:
(A)Administering
SecretariesThe term administering Secretaries means
the Secretary of Health and Human Services and the Secretary of Veterans
Affairs acting jointly.
(B)Medicare-eligible
veteranThe term Medicare-eligible veteran means an
individual who 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 and who—
(i)is entitled to, or
enrolled for, benefits under part A of this title; or
(ii)is enrolled for
benefits under part B of this title.
(C)Non-service
connected conditionThe term non-service-connected
condition means a disease or condition that is
non-service-connected
as such term is defined in section 101(17)
of title 38, United States Code.
(D)Department of
Veterans Affairs medical facilityThe term Department of
Veterans Affairs medical facility means a medical
facility
as such term is 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.
.
(b)Section 1729 of title 38, United States Code is amended
by adding at the end the following new subsection:
(j)In any case in which a Medicare-eligible
veteran (as defined in section 1862(n)(8)(B) of the Social Security Act (42
U.S.C. 1395y(n)(8)(B))) is furnished care or services under this chapter for a
non-service-connected condition (as defined in section 1862(n)(8)(C) of such
Act) the Secretary shall—
(1)seek reimbursement
from the Secretary of Health and Human Services for such care and services
under section 1862(n) of such Act; and
(2)collect any applicable deductible,
coinsurance, or other cost-sharing amount required under title XVIII of the
Social Security Act from the veteran or from a third party to the extent that
the veteran (or the provider of the care or services) would be eligible to
receive payment for such care or services from such third party if the care or
services had not been furnished by a department or agency of the United
States.
.
3.
(a)Not later than the
last day of the three-year period beginning on the date of the enactment of
this Act and the last date of each subsequent three-year period, the
Comptroller General of the United States shall submit to the Congress a report
on the Medicare VA reimbursement program established under section 1862(n) of
the Social Security Act, as added by section 2 of this Act.
(b)The report under subsection (a) shall
contain an analysis of—
(1)the impact of the Medicare VA reimbursement
program on the Federal Hospital Insurance Trust Fund established in section
1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary
Medical Insurance Trust Fund established in section 1841 of such Act (42 U.S.C.
1395t);
(2)whether
Medicare-eligible veterans (as defined in section 1862(n)(8)(B)) experience
improved access to health care as a result of the program;
(3)whether
Medicare-eligible veterans experience a change in the quality of care that they
receive as a result of this program;
(4)the impact of the
program on local health care providers and Medicare beneficiaries in the
communities surrounding Department of Veterans Affairs medical facilities;
and
(5)any additional
issues deemed appropriate by the Comptroller General of the United
States.
4.It is the sense of
the Congress that the amount of funds appropriated to the Department of
Veterans Affairs for medical care in any fiscal year beginning on or after the
date of the enactment of this Act should not be reduced as a result of the
implementation of the Medicare VA reimbursement program under section 1862(n)
of the Social Security Act, as added by section 2(a).