[Congressional Record Volume 150, Number 31 (Thursday, March 11, 2004)]
[Senate]
[Pages S2720-S2721]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CAMPBELL ( for himself, Ms. Collins, and Ms. Snowe):
  S. 2196. A bill to amend title 38, United States Code, to clarify 
that per diem payments by the Department of Veterans Affairs for the 
care of Veterans in State homes shall not be used to offset payments 
that are made under the medicaid program for the purpose of assisting 
veterans; to the Committee on Finance.
  Mr. CAMPBELL. Mr. President, today I am pleased to be joined by my 
colleagues Senators Collins and Snowe to introduce legislation which 
will rectify a very serious problem affecting veterans in my State and 
around the Nation. The bill I am introducing will clarify the treatment 
of the per diem payments made by the Department of Veterans Affairs, 
VA, to

[[Page S2721]]

support State Veterans Homes across the country.
  For several decades, Federal law has required that the VA pay a per 
diem amount to States to support quality care provided to eligible 
veterans at qualified State Veterans Homes. This VA per diem, currently 
about $56 per day for nursing home care and $27 per day for domiciliary 
care, is intended to assist States in providing the best possible care 
to those who served in our armed forces.
  In Colorado and a number of other States, the availability of the VA 
per diem is threatened by interpretations of Medicaid rules by the 
Centers for Medicare and Medicaid Services, CMS. CMS would treat the VA 
per diem payments as third-party payments, requiring that the entire 
amount be offset against Medicaid payments. This interpretation would 
deny residents of State Veterans Homes who receive Medicaid in these 
states any benefit whatsoever of the VA per diem payments.
  I believe this runs contrary to the intent of Congress in 
establishing the VA per diem payment system. State Veterans Homes are 
required to meet stringent and costly VA standards for care as a 
condition for receiving these per diem payments. These standards of 
care exceed those required by Medicaid, and the VA per diem makes it 
possible for State Veterans Homes to meet the higher VA standards. Most 
importantly, this per diem allows our veterans to receive high quality 
nursing care.
  An insistence by CMS on its interpretation would jeopardize the 
funding balance for many Medicaid-certified State Veterans Homes across 
the country. The result of the CMS interpretation would be to force 
State Veterans Homes that do not currently offset the VA per diem 
payments against Medicaid funding to reduce their standard of care, 
defer construction of needed new facilities, and possibly close certain 
State Veterans Homes.
  The legislation we are introducing today would simply clarify that 
the VA per diem payments cannot not be considered to be a third-party 
liability under Medicaid. It would build on other precedents where 
Congress wanted to make sure that benefits were received by their 
intentional recipients, not transferred to the Medicaid program. For 
example, federal law already includes exceptions for similar payments, 
such as those made under the Indian Health program.
  Our legislation recognizes that the States fund their State Veterans 
Homes in a variety of different manners. It preserves their flexibility 
to do so in a way that best serves their veterans, and ensures that no 
state is forced to lose the benefit of the VA per diem.
  I urge my colleagues to support this legislation and move forward 
with a plan that will enable our State Veterans Nursing Homes to 
provide the high quality care that our veterans deserve.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to printed in the 
Record, as follows:

                                S. 2196

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. TREATMENT UNDER MEDICAID PROGRAM OF DEPARTMENT OF 
                   VETERANS AFFAIRS PER DIEM PAYMENTS TO STATE 
                   HOMES FOR VETERANS.

       Section 1741 of title 38, United States Code, is amended by 
     adding at the end the following new subsection:
       ``(e) Payments to States pursuant to this section shall not 
     be considered a liability of a third party for any purpose 
     under section 1902(a)(25) of the Social Security Act (42 
     U.S.C. 1396a(25)).''.
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