[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4457 Introduced in House (IH)]

<DOC>






115th CONGRESS
  1st Session
                                H. R. 4457

   To amend title 38, United States Code, to establish the Veterans 
Accountable Care Organization and to provide veterans access to private 
            health insurance plans, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 21, 2017

   Mr. Lamborn (for himself, Mr. Meadows, and Mr. Franks of Arizona) 
 introduced the following bill; which was referred to the Committee on 
Veterans' Affairs, and in addition to the Committees on Ways and Means, 
    Oversight and Government Reform, Energy and Commerce, and 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 amend title 38, United States Code, to establish the Veterans 
Accountable Care Organization and to provide veterans access to private 
            health insurance plans, 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; TABLE OF CONTENTS.

    This Act may be cited as the ``Veterans Empowerment Act''.

SEC. 2. ESTABLISHMENT OF VETERANS ACCOUNTABLE CARE ORGANIZATION.

    (a) Establishment.--
            (1) In general.--Chapter 3 of title 38, United States Code, 
        is amended by adding at the end the following new section:
``Sec. 323. Veterans Accountable Care Organization
    ``(a) Establishment.--(1) There is established the Veterans 
Accountable Care Organization (in this section referred to as the 
`Corporation').
    ``(2) The Corporation is a federally chartered corporation.
    ``(3) The Corporation shall be incorporated and domiciled in the 
District of Columbia, or another nearby State, as determined by the 
board of directors of the Corporation.
    ``(4) The Corporation shall be a charitable and nonprofit 
corporation.
    ``(5) Except as otherwise provided, the Corporation shall have 
perpetual existence.
    ``(b) Purpose.--The purpose of the Corporation is to furnish high-
quality hospital care, medical services, and other health care 
(excluding nursing home care and domiciliary care) to individuals 
eligible for such care and services under laws administered by the 
Secretary.
    ``(c) Board of Directors.--(1) The powers of the Corporation shall 
be vested in a Board of Directors that governs the Corporation.
    ``(2) The Board of Directors shall be composed of the following 
members:
            ``(A) The Secretary of Veterans Affairs.
            ``(B) Two members appointed by the Speaker of the House of 
        Representatives, at least one of whom shall be a veteran.
            ``(C) Two members appointed by the Minority Leader of the 
        House of Representatives, at least one of whom shall be a 
        veteran.
            ``(D) Two members appointed by the Majority Leader of the 
        Senate, at least one of whom shall be a veteran.
            ``(E) Two members appointed by the Minority Leader of the 
        Senate, at least one of whom shall be a veteran.
            ``(F) Two members appointed by the President, at least one 
        of whom shall be veterans.
    ``(3) The President shall designate a member of the Board of 
Directors to serve as Chairperson of the Board. The Board shall select 
a Vice Chairperson from among its members.
    ``(4)(A) A member of the Board of Directors shall serve for a term 
of five years, except that the members first appointed shall be 
appointed for staggered terms as the President considers appropriate to 
ensure that the terms of no more than three members expire in the same 
year.
    ``(B) Any member appointed to fill a vacancy occurring before the 
expiration of the term for which the member's predecessor was appointed 
shall be appointed only for the remainder of that term. A member may 
serve after the expiration of that member's term until a successor has 
taken office. A vacancy on the Board shall not affect its powers, but 
shall be filled in the same manner in which the original appointment 
was made.
    ``(C) The term of each member may be renewed for an additional 
term, except that in no case shall any member serve more than two 
consecutive terms exceeding ten years.
    ``(D) During the absence or disability of the Secretary of Veterans 
Affairs or in the event of a vacancy in the office of Secretary, the 
Acting Secretary of Veterans Affairs shall serve as the member of the 
Board of Directors specified in paragraph (2)(A).
    ``(d) Duties.--In carrying out subsection (b), the Corporation 
shall--
            ``(1) transfer personnel and assets of the Department of 
        Veterans Affairs to the Corporation pursuant to subsection (b) 
        of section 2 of the Veterans Empowerment Act;
            ``(2) establish priorities, milestones, and timelines, in 
        consultation with the Secretary of Veterans Affairs, for the 
        termination of functions of the Veterans Health Administration 
        directly related to the furnishing of hospital care, medical 
        services, and other health care (excluding nursing home care 
        and domiciliary care) pursuant to subsection (c) of such 
        section 2;
            ``(3) with respect to centers of excellence relating to 
        service-connected injuries and other medical issues--
                    ``(A) continue to administer such centers 
                previously established by the Secretary; and
                    ``(B) establish and administer additional such 
                centers as the Board of Directors determines 
                appropriate.
            ``(4) in consultation with the Secretary, carry out such 
        other actions necessary to carry out this section.
    ``(e) Powers.--The Corporation shall--
            ``(1) appoint employees; and
            ``(2) adopt a Constitution and bylaws consistent with the 
        purpose set forth under subsection (b).
    ``(f) Duty To Maintain Corporate and Tax-Exempt Status.--(1) The 
Corporation shall maintain its status as a corporation incorporated 
under the laws of the District of Columbia or another nearby State, as 
determined by the Board of Directors.
    ``(2) The Corporation shall maintain its status as an organization 
exempt from the Internal Revenue Code of 1986.
    ``(g) Veterans Accountable Care Organization Fund.--(1) There is in 
the Treasury a fund to be known as the Veterans Accountable Care 
Organization Fund (in this subsection referred to as the `Fund').
    ``(2) Amounts recovered or collected under chapter 26 of this title 
shall be deposited in the Fund.
    ``(3) Amounts in the Fund shall be available, without further 
appropriation and without fiscal year limitation, to establish and 
administer centers of excellence described in subsection (d)(3) and for 
health care or medical services furnished to a veteran at a facility 
operated by the Corporation.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of chapter 3 of such title is amended by inserting 
        after the item relating to section 322 the following new item:

``323. Veterans Accountable Care Organization.''.
    (b) Transfer of Personnel and Assets.--
            (1) Transfer.--All of the personnel, property, records, and 
        unexpended balances of appropriations, allocations, and other 
        funds employed, used, held, available, or to be made available 
        in connection with the direct furnishing of hospital care, 
        medical services, and other health care (excluding nursing home 
        care and domiciliary care) to individuals eligible for such 
        care and services under laws administered by the Secretary of 
        Veterans Affairs are transferred to the Veterans Accountable 
        Care Organization established under section 323 of title 38, 
        United States Code, as added by subsection (a).
            (2) Reduction in force.--The Secretary may implement a 
        reduction in force in carrying out paragraph (1).
    (c) Termination of Functions.--
            (1) In general.--Except as provided by paragraph (2), all 
        of the functions of the Veterans Health Administration directly 
        relating to the furnishing of hospital care, medical services, 
        and other health care (excluding nursing home care and 
        domiciliary care) to individuals eligible for such care and 
        services under laws administered by the Secretary shall 
        terminate one year after the date of the enactment of this Act.
            (2) Extensions.--The Secretary of Veterans Affairs may make 
        not more than two 90-day extensions to the termination date 
        specified in paragraph (1) if the Secretary notifies Congress 
        of such extensions.
            (3) Certification of termination date.--The Secretary shall 
        certify to Congress the date on which paragraph (1) is carried 
        out.
    (d) Recommendations for Statutory Amendments.--Not later than 180 
days after the date of the enactment of this Act, the Secretary shall 
submit to Congress a report that contains recommendations for technical 
and conforming amendments to Federal statutes to carry out this Act.

SEC. 3. ESTABLISHMENT OF VETERANS HEALTH INSURANCE PROGRAM.

    (a) Establishment.--Chapter 73 of title 38, United States Code, is 
amended by adding at the end the following new section:
``Sec. 7309A. Veterans Health Insurance Program
    ``(a) Establishment.--There is established in the Veterans Health 
Administration the Veterans Health Insurance Program (in this section 
referred to as the `Program').
    ``(b) Duties.--Under the Program, the Secretary shall administer 
the provision of health insurance support to veterans under chapter 26 
of this title.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 73 of such title is amended by inserting after the item 
relating to section 7309 the following new item:

``7309A. Veterans Health Insurance Program.''.

SEC. 4. DESIGNATION OF EXISTING AUTHORITIES FOR HOSPITAL CARE, MEDICAL 
              SERVICES, AND OTHER HEALTH CARE.

    (a) Designation.--Subchapter I of chapter 17 of title 38, United 
States Code, is amended by inserting after section 1701 the following 
new section:
``Sec. 1701A. VetsCare Federal program: designation of authorities for 
              hospital care, medical services, and other health care as 
              program
    ``(a) In General.--Effective as of the date described in section 
2(c)(3) of the Veterans Empowerment Act, the authorities for the 
provision of hospital care, medical services, and other health care 
(other than nursing home care and domiciliary care) in subchapter II of 
this chapter and under any other law administered by the Secretary may 
be referred to as the `VetsCare Federal program'.
    ``(b) Designation of Recipients.--Effective as of the date 
described in section 2(c)(3) of the Veterans Empowerment Act, any 
eligible individual who receives hospital care, medical services, and 
other health care (excluding nursing home care and domiciliary care) in 
accordance with the authorities referred to in subsection (a) after 
such date may be referred to in the receipt of such care or services as 
participating in the `VetsCare Federal program'.
    ``(c) Secondary Payer.--
            ``(1) In general.--Notwithstanding any other provision of 
        law, any health plan (including the Medicare program under 
        title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) 
        or a State plan under title XIX of such Act (42 U.S.C. 1396 et 
        seq.) and the TRICARE program under chapter 55 of title 10) 
        under which an eligible individual is covered shall be 
        responsible for the payment of costs for any health care 
        received by an eligible individual for a non-service connected 
        disability up to the maximum amount allowable under such plan 
        before the VetsCare Federal program is responsible for any such 
        costs, if applicable.
            ``(2) Notification.--The Secretary of Health and Human 
        Services, the Secretary of Defense, or any other head of a 
        relevant department or agency of the Federal Government shall 
        notify the Secretary of Veterans Affairs of an eligible 
        individual being covered under a health plan described in 
        paragraph (1).
    ``(d) Treatment of Employer-Sponsored Health Plans.--
            ``(1) In general.--The provisions of section 1862(b)(3)(C) 
        of the Social Security Act (42 U.S.C. 1395y(b)(3)(C)) shall 
        apply with respect to financial or other incentives for an 
        employee who is an eligible individual not to enroll (or to 
        terminate enrollment) under a health plan that would (in the 
        case of such enrollment) be responsible under subsection (c) 
        for the payment of costs for hospital care, medical services, 
        or other health care received by the eligible individual for a 
        non-service connected disability in the same manner as such 
        section 1862(b)(3)(C) applies to financial or other incentives 
        for an individual entitled to benefits under title XVIII of the 
        Social Security Act (42 U.S.C. 1395 et seq.) not to enroll (or 
        to terminate enrollment) under a group health plan or a large 
        group health plan which would (in the case of enrollment) be a 
        primary plan (as defined in section 1862(b)(2)(A) of such Act).
            ``(2) Regulations.--The Secretary may by regulation adopt 
        such additional exceptions to the prohibition described in 
        paragraph (1) as the Secretary considers appropriate and such 
        paragraph shall be implemented taking into account the adoption 
        of such exceptions.
            ``(3) Agreements.--The Veterans Accountable Care 
        Organization and the Secretary of Health and Human Services may 
        enter into agreements to carry out this subsection. Any such 
        agreement shall provide that any expenses incurred by the 
        Secretary of Health and Human Services pertaining to carrying 
        out this subsection shall be reimbursed by the Veterans 
        Accountable Care Organization.
            ``(4) Group health plan defined.--In this subsection, the 
        term `group health plan' means a group health plan (as that 
        term is defined in section 5000(b)(1) of the Internal Revenue 
        Code of 1986 without regard to section 5000(d) of the Internal 
        Revenue Code of 1986).
    ``(e) Eligible Individuals.--An individual is eligible to 
participate in the VetsCare Federal program if such individual was 
enrolled in the system of annual patient enrollment established and 
operated by the Secretary under section 1705(a) of this title as of the 
date described in section 2(c)(3) of the Veterans Empowerment Act.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
1701 the following new item:

``1701A. VetsCare Federal program: designation of authorities for 
                            hospital care, medical services, and other 
                            health care as program.''.

SEC. 5. HEALTH INSURANCE SUPPORT FOR NEW VETERANS AND VETERANS ELECTING 
              HEALTH INSURANCE SUPPORT IN LIEU OF ELIGIBILITY FOR 
              HOSPITAL CARE, MEDICAL SERVICES, AND OTHER HEALTH CARE 
              UNDER EXISTING AUTHORITIES.

    (a) In General.--Part II of title 38, United States Code, is 
amended by inserting after chapter 24 the following new chapter:

           ``CHAPTER 26--VETERANS INDEPENDENCE IN HEALTH CARE

                   ``subchapter i--veterans generally

``2601. VetsCare Choice program: designation of recipients.
``2602. Eligibility.
``2603. Qualifying health insurance.
``2604. Health insurance support.
``2605. Treatment of other health plans.
``2606. Receipt of health care through the Department.
``2607. Pharmacy benefits.
               ``subchapter ii--medicare-eligible veterans

``2611. VetsCare Senior program: designation of recipients.
``2612. Medicare support.

                   ``Subchapter I--Veterans Generally

``Sec. 2601. VetsCare Choice program: designation of recipients
    ``(a) In General.--The authorities for the provision of health 
insurance support under this subchapter may be referred to as the 
`VetsCare Choice program'.
    ``(b) Designation of Recipients.--Any veteran who receives health 
insurance support under this subchapter may be referred to in the 
receipt of support as participating in the `VetsCare Choice program'.
    ``(c) Relationship to Care by Veterans Accountable Care 
Organization.--Health insurance support under this subchapter is in 
addition to any health care or medical services furnished to a veteran 
at a facility operated by the Veterans Accountable Care Organization.
``Sec. 2602. Eligibility
    ``(a) In General.--Except as provided in subsections (c) and (d), 
the following veterans shall be provided health insurance support under 
this subchapter:
            ``(1) Veterans who first enroll in the system of annual 
        patient enrollment established and operated by the Secretary 
        under section 1705(a) of this title on or after the date 
        described in section 2(c)(3) of the Veterans Empowerment Act.
            ``(2) Veterans enrolled in such system as of the date 
        described in section 2(c)(3) of the Veterans Empowerment Act 
        who elect health insurance support under this subchapter in 
        lieu of eligibility for hospital care, medical services, and 
        other health care (excluding nursing home care and domiciliary 
        care) under the VetsCare Federal program under chapter 17 of 
        this title or any other law administered by the Secretary.
    ``(b) Enrollment.--The Secretary shall administer--
            ``(1) an open enrollment period for the VetsCare Choice 
        program that corresponds to the open enrollment period for the 
        Federal Employees Health Benefits program described in section 
        8905(g); and
            ``(2) special enrollment periods based on qualifying life 
        events of veterans similar to such events under the Federal 
        Employees Health Benefits Program, except that the change of 
        priority group shall also be treated as a qualifying life 
        event.
    ``(c) Effect of Election.--While an election under subsection 
(a)(2) of a veteran described in that subsection is in effect, the 
veteran is not eligible for hospital care, medical services, and other 
health care (excluding nursing home care and domiciliary care) under 
chapter 17 of this title or any other law administered by the 
Secretary.
    ``(d) Exceptions.--The following veterans are not eligible for 
health insurance support under this subchapter:
            ``(1) Any veteran eligible for care under the Medicare 
        program under title XVIII of the Social Security Act (42 U.S.C. 
        1395 et seq.).
            ``(2) Any veteran who--
                    ``(A) first enrolls in the system of annual patient 
                enrollment established and operated by the Secretary 
                under section 1705(a) of this title on or after the 
                date described in section 2(c)(3) of the Veterans Act; 
                and
                    ``(B) is in priority group 7 or priority group 8.
    ``(e) Commencement of Availability of Support.--Health insurance 
support under this subchapter shall commence being available as 
follows:
            ``(1) With respect to veterans in priority group 1, 2, or 
        3, on the first day of the first month that begins on or after 
        the date described in section 2(c)(3) of the Veterans 
        Empowerment Act.
            ``(2) With respect to veterans in a priority group other 
        than 1, 2, or 3, on the first day of the first month that 
        begins on or after the date that is 180 days after the 
        commencement date under paragraph (1).
    ``(f) Priority Group Defined.--In this section, the term `priority 
group' means the priority groups established by the Secretary for 
purposes of the enrollment of veterans in the patient enrollment system 
under section 1705(a) of this title.
``Sec. 2603. Qualifying health insurance
    ``Health insurance support may be provided under this subchapter 
only for health plans that--
            ``(1) include the types of health care authorized under 
        section 1079 of title 10, United States Code; and
            ``(2) provide such additional elements of coverage as the 
        Secretary shall prescribe for purposes of this subchapter.
``Sec. 2604. Health insurance support
    ``(a) In General.--The Secretary shall provide health insurance 
support to veterans eligible for such support under this subchapter 
through premium support under subsections (b) and (c), cost-sharing 
support under subsection (d), and alternative support under subsection 
(e) by paying or reimbursing such veterans for the costs associated 
with such health insurance support. The Secretary shall make such 
payments or reimbursements in a manner similar to the manner in which 
the Centers for Medicare & Medicaid Services make similar payments and 
reimbursements.
    ``(b) Premium Support Generally.--The premium support provided by 
the Secretary under this subsection is as follows:
            ``(1) Tier 1.--To any veteran with a service-connected 
        disability rated as 100 percent disabling, health insurance 
        support sufficient to provide benefits to the veteran under a 
        health plan that are actuarially equivalent to 100 percent of 
        the full actuarial value of the benefits provided under the 
        health plan. A health plan under this paragraph may be referred 
        to as a `Tier 1 Plan'.
            ``(2) Tier 2.--To any veteran in priority group 1 not 
        covered by paragraph (1) and any veteran in priority group 2, 
        health insurance support sufficient to provide benefits to the 
        veteran under a health plan that are actuarially equivalent to 
        90 percent of the full actuarial value of the benefits provided 
        under the health plan. A health plan under this paragraph may 
        be referred to as a `Tier 2 Plan'.
            ``(3) Tier 3.--To any veteran in priority group 3 or 
        priority group 4, health insurance support sufficient to 
        provide benefits to the veteran under a health plan that are 
        actuarially equivalent to 80 percent of the full actuarial 
        value of the benefits provided under the health plan. A health 
        plan under this paragraph may be referred to as a `Tier 3 
        Plan'.
            ``(4) Tier 4.--To any veteran in priority group 5 or 
        priority group 6, health insurance support sufficient to 
        provide benefits to the veteran under a health plan that are 
        actuarially equivalent to 70 percent of the full actuarial 
        value of the benefits provided under the health plan. A health 
        plan under this paragraph may be referred to as a `Tier 4 
        Plan'.
            ``(5) Tier 5.--To any veteran not in a priority group 
        covered by paragraphs (1) through (4) and not ineligible for 
        such support under section 2602(d)(2) of this title, health 
        insurance support sufficient to provide benefits to the veteran 
        under a health plan that are actuarially equivalent to 60 
        percent of the full actuarial value of the benefits provided 
        under the health plan. A health plan under this paragraph may 
        be referred to as a `Tier 5 Plan'.
    ``(c) Additional Premium Support Based on Need.--The premium 
support provided by the Secretary under this subsection is as follows:
            ``(1) To any veteran with an annual gross household income 
        that is less than 133 percent of the poverty line, health 
        insurance support sufficient to cover any costs of such monthly 
        premium that are more than 2 percent of the monthly gross 
        household income of the veteran.
            ``(2) To any veteran with an annual gross household income 
        that is between 133 percent and 150 percent of the poverty 
        line, health insurance support sufficient to cover any costs of 
        such monthly premium that are more than 3 percent of the 
        monthly gross household income of the veteran.
            ``(3) To any veteran with an annual gross household income 
        that is between 150 percent and 200 percent of the poverty 
        line, health insurance support sufficient to cover any costs of 
        such monthly premium that are more than 4 percent of the 
        monthly gross household income of the veteran.
            ``(4) To any veteran with an annual gross household income 
        that is between 200 percent and 250 percent of the poverty 
        line, health insurance support sufficient to cover any costs of 
        such monthly premium that are more than 6.3 percent of the 
        monthly gross household income of the veteran.
            ``(5) To any veteran with an annual gross household income 
        that is between 250 percent and 300 percent of the poverty 
        line, health insurance support sufficient to cover any costs of 
        such monthly premium that are more than 8.05 percent of the 
        monthly gross household income of the veteran.
            ``(6) To any veteran with an annual gross household income 
        that is between 300 percent and 400 percent of the poverty 
        line, health insurance support sufficient to cover any costs of 
        such monthly premium that are more than 9.5 percent of the 
        monthly gross household income of the veteran.
    ``(d) Cost-Sharing Support.--The cost-sharing support provided by 
the Secretary under this subsection is as follows:
            ``(1) To any veteran with an annual gross household income 
        that is less than 150 percent of the poverty line, health 
        insurance support sufficient to cover cost-sharing in order to 
        ensure that the effective minimum actuarial value of the 
        benefits provided under the health plan of the veteran is not 
        less than 94 percent.
            ``(2) To any veteran with an annual gross household income 
        that is between 150 percent and 200 percent of the poverty 
        line, health insurance support sufficient to cover cost-sharing 
        in order to ensure that the effective minimum actuarial value 
        of the benefits provided under the health plan of the veteran 
        is not less than 87 percent.
            ``(3) To any veteran with an annual gross household income 
        that is between 200 percent and 250 percent of the poverty 
        line, health insurance support sufficient to cover cost-sharing 
        in order to ensure that the effective minimum actuarial value 
        of the benefits provided under the health plan of the veteran 
        is not less than 73 percent.
    ``(e) Alternative Support for Veterans With Certain Health 
Insurance.--
            ``(1) In general.--Notwithstanding any other provision of 
        this section, upon the election of a veteran eligible for 
        health insurance support under this subchapter who obtains a 
        high deductible health plan that includes a health savings 
        account under section 223 of the Internal Revenue Code of 1986, 
        the Secretary shall contribute an amount calculated under 
        paragraph (2) into such health savings account on behalf of the 
        veteran.
            ``(2) Amount calculated.--The amount calculated under this 
        paragraph is an amount equal to the difference between--
                    ``(A) the amount of health insurance support the 
                veteran would otherwise have received under the 
                subsection of this section applicable to the veteran; 
                and
                    ``(B) the amount payable by the veteran in 
                connection with the high deductible health plan 
                described in paragraph (1).
    ``(f) Determinations Based on Cost of Plans.--In making 
determinations under this section with respect to the amount of health 
insurance support to provide to a veteran, the Secretary shall make 
such determinations based on the costs associated with the second-
least-costly health plan available to the veteran in the area in which 
the veteran resides.
    ``(g) Definitions.--In this section:
            ``(1) The term `cost-sharing', in connection with the 
        receipt of health care and treatment under a health plan, means 
        any copayments, deductibles, or other charges imposed, 
        collected, or otherwise required by a health insurance provider 
        or health care provider in connection with the receipt of 
        health care and treatment under such health plan.
            ``(2) The term `poverty line' means the poverty line (as 
        defined in section 673(2) of the Community Services Block Grant 
        Act (42 U.S.C. 9902(2)) applicable to a family of the size 
        involved.
            ``(3) The term `high deductible health plan' has the 
        meaning given that term in section 223(c)(2) of the Internal 
        Revenue Code of 1986.
            ``(4) The term `priority group' means the priority groups 
        established by the Secretary for purposes of the enrollment of 
        veterans in the patient enrollment system under section 1705(a) 
        of this title.
``Sec. 2605. Treatment of other health plans
    ``(a) Secondary Payer.--
            ``(1) In general.--Notwithstanding any other provision of 
        law, any health plan (including a State plan under title XIX of 
        the Social Security Act (42 U.S.C. 1396 et seq.) and the 
        TRICARE program under chapter 55 of title 10) under which a 
        veteran is covered that is not a health plan for which health 
        insurance support is provided under this subchapter shall be 
        responsible for the payment of costs for any health care 
        received by an eligible individual for a non-service connected 
        disability up to the maximum amount allowable under such plan 
        before any health plan for which health insurance support is 
        provided under this subchapter is responsible for any such 
        costs, if applicable.
            ``(2) Notification.--The Secretary of Health and Human 
        Services, the Secretary of Defense, or any other head of a 
        relevant department or agency of the Federal Government shall 
        notify the Secretary of Veterans Affairs of an eligible 
        individual being covered under a health plan described in 
        paragraph (1).
    ``(b) Treatment of Employer-Sponsored Health Plans.--
            ``(1) In general.--The provisions of section 1862(b)(3)(C) 
        of the Social Security Act (42 U.S.C. 1395y(b)(3)(C)) shall 
        apply with respect to financial or other incentives for an 
        employee who is a veteran not to enroll (or to terminate 
        enrollment) under a health plan that is not a health plan for 
        which health insurance support is provided under this 
        subchapter and that would (in the case of such enrollment) be 
        responsible under subsection (a) for the payment of costs for 
        health care received by the veteran in the same manner as such 
        section 1862(b)(3)(C) applies to financial or other incentives 
        for an individual entitled to benefits under title XVIII of the 
        Social Security Act (42 U.S.C. 1395 et seq.) not to enroll (or 
        to terminate enrollment) under a group health plan or a large 
        group health plan which would (in the case of enrollment) be a 
        primary plan (as defined in section 1862(b)(2)(A) of such Act).
            ``(2) Regulations.--The Secretary may by regulation adopt 
        such additional exceptions to the prohibition described in 
        paragraph (1) as the Secretary considers appropriate and such 
        paragraph shall be implemented taking into account the adoption 
        of such exceptions.
            ``(3) Agreements.--The Secretary of Veterans Affairs and 
        the Secretary of Health and Human Services may enter into 
        agreements to carry out this subsection. Any such agreement 
        shall provide that any expenses incurred by the Secretary of 
        Health and Human Services pertaining to carrying out this 
        subsection shall be reimbursed by the Secretary of Veterans 
        Affairs.
            ``(4) Group health plan defined.--In this subsection, the 
        term `group health plan' means a group health plan (as that 
        term is defined in section 5000(b)(1) of the Internal Revenue 
        Code of 1986 without regard to section 5000(d) of the Internal 
        Revenue Code of 1986).
``Sec. 2606. Receipt of health care through the Department
    ``(a) Contracts.--Any health insurance provider that provides a 
health plan for which health insurance support may be provided under 
this subchapter or subchapter II may enter into a contract with the 
Veterans Accountable Care Organization under which the medical 
personnel and facilities of the Veterans Accountable Care Organization 
may be treated as a designated provider for purposes of such health 
plan.
    ``(b) Cost of Care.--The cost, including any copayments, of any 
health care or treatment provided to a veteran by the Veterans 
Accountable Care Organization under a contact under subsection (a) 
shall be determined by the Veterans Accountable Care Organization.
    ``(c) Mechanism.--The Board of Directors of the Veterans 
Accountable Care Organization shall establish a mechanism through which 
the Veterans Accountable Care Organization enters into contracts with 
health insurance providers under subsection (a).
``Sec. 2607. Pharmacy benefits
    ``A veteran who is enrolled in the VetsCare Choice program or the 
VetsCare Senior program may fill prescriptions at pharmacies of the 
Department.

              ``SUBCHAPTER II--MEDICARE-ELIGIBLE VETERANS

``Sec. 2611. VetsCare Senior program: designation of recipients
    ``(a) In General.--The authorities for the provision of health 
insurance support under this subchapter may be referred to as the 
`VetsCare Senior program'.
    ``(b) Designation of Recipients.--Any veteran who receives health 
insurance support under this subchapter may be referred to in the 
receipt of support as participating in the `VetsCare Senior program'.
    ``(c) Relationship to Care by Veterans Accountable Care 
Organization.--Health insurance support under this subchapter is in 
addition to any health care or medical services furnished to a veteran 
at a facility operated by the Veterans Accountable Care Organization.
``Sec. 2612. Medicare support
    ``(a) In General.--The Secretary shall provide health insurance 
support to each covered veteran equal to the costs incurred by such 
veteran for Medicare premiums and cost-sharing under parts A, B, C, and 
D of title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) 
and for premiums and cost-sharing for Medicare supplemental policies 
under section 1882 of such Act (42 U.S.C. 1395ss).
    ``(b) Relationship With VetsCare Federal.--Notwithstanding any 
other provision of law, if a covered veteran is enrolled in the 
VetsCare Federal program under section 1701A of this title, the 
Medicare program under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.) (or a Medicare supplemental policy under section 
1882 of such Act (42 U.S.C. 1395ss)) shall be responsible for the 
payment of costs for any health care received by an eligible individual 
for a non-service connected disability up to the maximum amount 
allowable under such program (or supplemental policy) for such health 
care before the VetsCare Federal program is responsible for any such 
costs, if applicable.
    ``(c) Availability of Payment or Reimbursement.--
            ``(1) Commencement.--Health insurance support under this 
        subchapter shall commence being available as follows:
                    ``(A) With respect to covered veterans in priority 
                group 1, 2, or 3, on the first day of the first month 
                that begins on or after the date described in section 
                2(c)(3) of the Veterans Empowerment Act.
                    ``(B) With respect to covered veterans in a 
                priority group other than 1, 2, or 3, on the first day 
                of the first month that begins on or after the date 
                that is 180 days after the commencement date under 
                paragraph (1).
            ``(2) Exclusion of certain veterans.--A covered veteran is 
        not eligible for health insurance support under this section if 
        such veteran--
                    ``(A) first enrolls in the system of annual patient 
                enrollment established and operated by the Secretary 
                under section 1705(a) of this title on or after the 
                date of the enactment of this Act; and
                    ``(B) is in priority group 7 or 8.
    ``(d) Definitions.--In this section:
            ``(1) The term `cost-sharing', in connection with the 
        receipt of health care and treatment under the Medicare program 
        under title XVIII of the Social Security Act (42 U.S.C. 1395 et 
        seq.) or Medicare supplemental policies under section 1882 of 
        such Act (42 U.S.C. 1395ss), means any copayments, deductibles, 
        or other charges imposed, collected, or otherwise required by a 
        health insurance provider or health care provider in connection 
        with receipt of health care and treatment under such program or 
        supplemental policies.
            ``(2) The term `covered veteran' means a veteran receiving 
        benefits under the Medicare program under title XVIII of the 
        Social Security Act.
            ``(3) The term `priority group' means the priority groups 
        established by the Secretary for purposes of the enrollment of 
        veterans in the patient enrollment system under section 1705(a) 
        of this title.''.
    (b) Clerical Amendment.--The table of chapters at the beginning 
title 38, United States Code, is amended by inserting after the item 
relating to chapter 24 the following new item:

``Chapter 26. Veterans Independence in Health Care..........    2601''.
    (c) Conforming Amendments.--
            (1) Minimum essential coverage.--Section 5000A(f)(1)(A)(v) 
        of the Internal Revenue Code of 1986 is amended by striking 
        ``or 18'' and inserting ``, 18, or 26''.
            (2) Medicare part b.--
                    (A) Non-application of late enrollment penalty.--
                Section 1839(b) of the Social Security Act (42 U.S.C. 
                1395r(b)) is amended, in the second sentence, by 
                inserting ``or months for which the individual can 
                demonstrate that the individual was enrolled in the 
                VetsCare Senior program under subchapter II of chapter 
                26 of title 38, United States Code'' after ``an 
                individual described in section 1837(k)(3)''.
                    (B) Special enrollment period.--Section 1837 of the 
                Social Security Act (42 U.S.C. 1395p) is amended by 
                adding at the end the following new subsection:
    ``(m)(1) In the case of any individual who is enrolled in the 
VetsCare Senior program under subchapter II of chapter 26 of title 38, 
United States Code at the time the individual is entitled to part A 
under section 226 or section 226A and who is eligible to enroll but who 
has elected not to enroll (or to be deemed enrolled) during the 
individual's initial enrollment period, there shall be a special 
enrollment period as specified by the Secretary.
    ``(2) In the case of an individual who enrolls during the special 
enrollment period provided under paragraph (1), the coverage period 
under this part shall begin on such date specified by the Secretary.
    ``(3) An individual may only enroll during the special enrollment 
period provided under paragraph (1) one time during the individual's 
lifetime.
    ``(4) The Secretary of Veterans Affairs shall collaborate with the 
Secretary of Health and Human Services and the Commissioner of Social 
Security to provide for the accurate identification of individuals 
described in paragraph (1). The Secretary of Veterans Affairs shall 
provide such individuals with notification with respect to this 
subsection. The Secretary of Veterans Affairs shall collaborate with 
the Secretary of Health and Human Services and the Commissioner of 
Social Security to ensure appropriate follow up pursuant to any 
notification provided under the preceding sentence.''.

SEC. 6. COORDINATION BETWEEN VETSCARE CHOICE PROGRAM AND ELIGIBILITY TO 
              MAKE CONTRIBUTIONS TO HEALTH SAVINGS ACCOUNTS.

    (a) In General.--Section 223(c)(1)(B) of the Internal Revenue Code 
of 1986 is amended by striking ``and'' at the end of clause (ii), by 
striking the period at the end of clause (iii) and inserting ``, and'', 
and by adding at the end the following new clause:
                            ``(iv) coverage for health insurance 
                        support under the VetsCare Choice program under 
                        subchapter I of chapter 26 of title 38, United 
                        States Code.''.
    (b) Denial of Deduction for Amounts Not Includible in Gross 
Income.--Subsection (b) of section 223 of the Internal Revenue Code of 
1986 is amended by adding at the end the following new paragraph:
            ``(9) Amounts not includible in gross income.--No amount 
        paid to a health savings account of an individual shall be 
        taken into account under subsection (a) if (without regard to 
        this section) such amount, when paid to or on behalf of such 
        individual, is excluded from gross income of the individual or 
        exempt from taxation under any provision of Federal law.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to amounts paid to a health savings account (as defined in 
section 223(d) of the Internal Revenue Code of 1986) after the date of 
the enactment of this Act.

SEC. 7. PUBLICATION OF HEALTH CARE INFORMATION.

    (a) In General.--The Secretary of Veterans Affairs shall make 
available to the public on an ongoing basis information about the 
operations of the Veterans Health Administration in a manner similar to 
publication of information under the Medicare Accountable Care 
Organization program to better monitor and support continuous 
improvement in the Veterans Health Administration.
    (b) Elements.--The information published under subsection (a) shall 
include information about the operations of the Veterans Health 
Administration, including metrics regarding quality, safety, patient 
experience, timeliness, and cost-effectiveness.

SEC. 8. VETERANS' ELIGIBILITY FOR LONG-TERM CARE INSURANCE.

    (a) In General.--Section 9001 of title 5, United States Code, is 
amended--
            (1) by redesignating paragraphs (5) through (10) as (6) 
        through (11), respectively;
            (2) by inserting after paragraph (4) the following:
            ``(5) Veteran.--The term `veteran' has the same meaning 
        given the term in section 101(2) of title 38, United States 
        Code.'';
            (3) in paragraph (6), as so redesignated--
                    (A) in subparagraph (A), by striking ``or (4).'' 
                and inserting ``(4), or (5).'';
                    (B) in subparagraph (B), by striking ``(1) or 
                (3).'' and inserting ``(1), (3), or (5).'';
                    (C) in subparagraph (C), by striking ``or (4)'' and 
                inserting ``(4), or (5)''; and
                    (D) in subparagraph (D), by striking ``or (4)'' and 
                inserting ``(4), or (5)'';
            (4) in paragraph (7), as so redesignated, by striking ``or 
        (5).'' and inserting ``(5), or (6).''; and
            (5) in paragraph (11), as so redesignated--
                    (A) in subparagraph (C), by striking ``Commerce; 
                and'' and inserting ``Commerce;'';
                    (B) in subparagraph (D), by striking ``Services.'' 
                and inserting ``Services; and''; and
                    (C) by inserting after subparagraph (D):
                    ``(E) with respect to a veteran, the Secretary of 
                Veterans Affairs.''.
    (b) Technical and Conforming Amendments.--Title 5, United States 
Code, is amended as follows:
            (1) Section 9002 is amended--
                    (A) in subsection (a), by striking ``or (5)'' and 
                inserting ``(5), or (6)''; and
                    (B) in subsection (e)--
                            (i) in paragraph (2), by striking ``or 
                        (4)'' and inserting ``(4), or (5)''; and
                            (ii) in paragraph (4), by striking 
                        ``section 9001(9)'' and inserting ``section 
                        9001(10)''.
            (2) Section 9004(d) is amended by inserting after 
        ``withheld under subsection (b)'' the following: ``, who is an 
        enrollee by virtue of being a veteran described in section 
        9001(5) of this title,''.
            (3) Section 9008(c) is amended by striking ``(3) or (4)'' 
        and inserting ``(3), (4), or (5)''.
                                 <all>