[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 814 Introduced in House (IH)]

112th CONGRESS
  1st Session
                                H. R. 814

To provide Medicare payments to Department of Veterans Affairs medical 
    facilities for items and services provided to Medicare-eligible 
             veterans for non-service-connected conditions.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 18, 2011

  Mr. Filner 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 Medicare payments to Department of Veterans Affairs medical 
    facilities for items and services provided to Medicare-eligible 
             veterans for non-service-connected conditions.

    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 ``Medicare VA Reimbursement Act of 
2011''.

SEC. 2. 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 new subsection:
    ``(p) Medicare Subvention for Veterans.--
            ``(1) Establishment.--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) In general.--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) Contract elements.--The memorandum of 
                understanding under subparagraph (A) shall contain the 
                following:
                            ``(i) Frequency of reimbursement.--An 
                        agreement on how often reimbursements will be 
                        made by the Secretary of Health and Human 
                        Services to the Secretary of Veterans Affairs.
                            ``(ii) Billing system.--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) Data sharing agreement.--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 an 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) Payment rate.--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) Performance measures.--An agreement 
                        on performance measures and performance targets 
                        to be used to demonstrate the impact of the 
                        Medicare VA reimbursement program.
                            ``(vi) Additional terms.--Any additional 
                        terms deemed necessary by the administering 
                        Secretaries.
                    ``(C) No maintenance of effort requirement.--For 
                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) Amount.--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 amount.--Subject 
                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 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) Capital payments.--Any amounts 
                        attributable to payments for capital-related 
                        costs under section 1886(g).
                    ``(D) Periodic payments from medicare trust 
                funds.--Reimbursements 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) Crediting of payments.--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 requirements.--The 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 services.--The 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) 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;
                    ``(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) Annual reports.--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) Definitions.--For purposes of this subsection:
                    ``(A) Administering secretaries.--The term 
                `administering Secretaries' means the Secretary of 
                Health and Human Services and the Secretary of Veterans 
                Affairs acting jointly.
                    ``(B) Medicare-eligible veteran.--The 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 condition.--The 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 
                facility.--The 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) Conforming Amendment.--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(p)(8)(B) of the Social Security Act (42 U.S.C. 
1395y(p)(8)(B))) is furnished care or services under this chapter for a 
non-service-connected condition (as defined in section 1862(p)(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(p) 
        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.''.

SEC. 3. GAO REPORT.

    (a) In General.--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(p) of the 
Social Security Act, as added by section 2.
    (b) Contents.--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(p)(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.

SEC. 4. SENSE OF CONGRESS.

    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(p) of the Social 
Security Act, as added by section 2(a).
                                 <all>