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H.R. 3118 (104th): Veterans’ Health Care Eligibility Reform Act of 1996

The text of the bill below is as of Jul 18, 1996 (Reported by House Committee).


HR 3118 RH

Union Calendar No. 358

104th CONGRESS

2d Session

H. R. 3118

[Report No. 104-690]

To amend title 38, United States Code, to reform eligibility for health care provided by the Department of Veterans Affairs.

IN THE HOUSE OF REPRESENTATIVES

March 20, 1996

Mr. STUMP (for himself, Mr. MONTGOMERY, Mr. HUTCHINSON, and Mr. EDWARDS) introduced the following bill; which was referred to the Committee on Veterans’ Affairs

July 18, 1996

Additional sponsors: Mr. SMITH of New Jersey, Mr. BILIRAKIS, Mr. ACKERMAN, Mr. GENE GREEN of Texas, Mr. CRAMER, Mr. FROST, Mr. MOAKLEY, Mr. SOLOMON, Mr. MASCARA, Mr. HALL of Texas, Mr. TEJEDA, Mr. FALEOMAVAEGA, Mr. MANTON, Mr. LINDER, Mr. WELLER, Mr. MCCRERY, Mr. GILMAN, Mr. FLAKE, Mr. DOYLE, Mr. WATTS of Oklahoma, Mr. EMERSON, Mr. EVERETT, Mr. BUYER, Mr. BACHUS, Mr. STEARNS, Mr. FOX of Pennsylvania, Mr. FLANAGAN, Mr. BARR of Georgia, Mr. COOLEY of Oregon, Mr. EVANS, Mr. KENNEDY of Massachusetts, Mr. CLEMENT, Mr. FILNER, Mr. BISHOP, Mr. BALDACCI, Mr. CAMP, Mr. BRYANT of Tennessee, Ms. KAPTUR, Mr. FAZIO of California, Mr. RAHALL, Mr. SCARBOROUGH, Mrs. LOWEY, Mr. SAXTON, Mr. QUINN, Mr. MCDERMOTT, Mrs. KELLY, Mr. WISE, Mr. JOHNSON of South Dakota, Mr. KENNEDY of Rhode Island, Mr. LIPINSKI, Mr. DOOLEY of California, Mr. SPRATT, Mr. ENGLISH of Pennsylvania, Ms. LOFGREN, Mr. TATE, Mr. SKAGGS, Mr. SANDERS, Mr. BARRETT of Nebraska, Mr. KILDEE, Mr. COYNE, Mr. BOUCHER, Mr. FARR of California

July 18, 1996

Committed to the Committee of the Whole House on the State of the Union and ordered to be printed


A BILL

To amend title 38, United States Code, to reform eligibility for health care provided by the Department of Veterans Affairs.

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

SECTION 1. SHORT TITLE; REFERENCES TO TITLE 38, UNITED STATES CODE.

    (a) SHORT TITLE- This Act may be cited as the ‘Veterans’ Health Care Eligibility Reform Act of 1996’.

    (b) REFERENCES TO TITLE 38, UNITED STATES CODE- Except as otherwise expressly provided, whenever in this Act an amendment or repeal is expressed in terms of an amendment to, or repeal of, a section or other provision, the reference shall be considered to be made to a section or other provision of title 38, United States Code.

SEC. 2. HOSPITAL CARE AND MEDICAL SERVICES.

    (a) ELIGIBILITY FOR CARE- Section 1710(a) is amended by striking out paragraphs (1) and (2) and inserting the following:

    ‘(a)(1) The Secretary shall, to the extent and in the amount provided in advance in appropriations Acts for these purposes, provide hospital care and medical services, and may provide nursing home care, which the Secretary determines is needed to any veteran--

      ‘(A) with a compensable service-connected disability;

      ‘(B) whose discharge or release from active military, naval, or air service was for a compensable disability that was incurred or aggravated in the line of duty;

      ‘(C) who is in receipt of, or who, but for a suspension pursuant to section 1151 of this title (or both a suspension and the receipt of retired pay), would be entitled to disability compensation, but only to the extent that such veteran’s continuing eligibility for such care is provided for in the judgment or settlement provided for in such section;

      ‘(D) who is a former prisoner of war;

      ‘(E) of the Mexican border period or of World War I;

      ‘(F) who was exposed to a toxic substance, radiation, or environmental hazard, as provided in subsection (e); and

      ‘(G) who is unable to defray the expenses of necessary care as determined under section 1722(a) of this title.

    ‘(2) In the case of a veteran who is not described in paragraph (1), the Secretary may, to the extent resources and facilities are available and subject to the provisions of subsection (f), furnish hospital care, medical services, and nursing home care which the Secretary determines is needed.’.

    (b) CONFORMING AMENDMENTS- (1) Section 1710(e) is amended--

      (A) in paragraph (1), by striking out ‘hospital care and nursing home care’ in subparagraphs (A), (B), and (C) and inserting in lieu thereof ‘hospital care, medical services, and nursing home care’;

      (B) in paragraph (2), by inserting ‘and medical services’ after ‘Hospital and nursing home care’; and

      (C) by striking out ‘subsection (a)(1)(G) of this section’ each place it appears and inserting in lieu thereof ‘subsection (a)(1)(F)’.

    (2) Chapter 17 is amended--

      (A) by redesignating subsection (g) of section 1710 as subsection (h); and

      (B) by transferring subsection (f) of section 1712 to section 1710 so as to appear after subsection (f), redesignating such subsection as subsection (g), and amending such subsection by striking out ‘section 1710(a)(2) of this title’ in paragraph (1) and inserting in lieu thereof ‘subsection (a)(2) of this section’.

    (3) Section 1712 is amended--

      (A) by striking out subsections (a) and (i); and

      (B) by redesignating subsections (b), (c), (d), (h) and (j), as subsections (a), (b), (c), (d), and (e), respectively.

SEC. 3. PROSTHETICS.

    (a) ELIGIBILITY FOR PROSTHETICS- Section 1701(6)(A)(i) is amended--

      (1) by striking out ‘(in the case of a person otherwise receiving care or services under this chapter)’ and ‘(except under the conditions described in section 1712(a)(5)(A) of this title),’;

      (2) by inserting ‘(in the case of a person otherwise receiving care or services under this chapter)’ before ‘wheelchairs,’; and

      (3) by inserting ‘except that the Secretary may not furnish sensori-neural aids other than in accordance with guidelines which the Secretary shall prescribe,’ after ‘reasonable and necessary,’.

    (b) REGULATIONS- Not later than 30 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall prescribe the guidelines required by the amendments made by subsection (a) and shall furnish a copy of those guidelines to the Committees on Veterans’ Affairs of the Senate and House of Representatives.

SEC. 4. MANAGEMENT OF HEALTH CARE.

    (a) IN GENERAL- (1) Chapter 17 is amended by inserting after section 1704 the following new sections:

‘Sec. 1705. Management of health care: patient enrollment system

    ‘(a) In managing the provision of hospital care and medical services under section 1710(a)(1) of this title, the Secretary, in accordance with regulations the Secretary shall prescribe, shall establish and operate a system of annual patient enrollment. The Secretary shall manage the enrollment of veterans in accordance with the following priorities, in the order listed:

      ‘(1) Veterans with service-connected disabilities rated 30 percent or greater.

      ‘(2) Veterans who are former prisoners of war and veterans with service-connected disabilities rated 10 percent or 20 percent.

      ‘(3) Veterans who are in receipt of increased pension based on a need of regular aid and attendance or by reason of being permanently housebound and other veterans who are catastrophically disabled.

      ‘(4) Veterans not covered by paragraphs (1) through (3) who are unable to defray the expenses of necessary care as determined under section 1722(a) of this title.

      ‘(5) All other veterans eligible for hospital care, medical services, and nursing home care under section 1710(a)(1) of this title.

    ‘(b) In the design of an enrollment system under subsection (a), the Secretary--

      ‘(1) shall ensure that the system will be managed in a manner to ensure that the provision of care to enrollees is timely and acceptable in quality;

      ‘(2) may establish additional priorities within each priority group specified in subsection (a), as the Secretary determines necessary; and

      ‘(3) may provide for exceptions to the specified priorities where dictated by compelling medical reasons.

‘Sec. 1706. Management of health care: other requirements

    ‘(a) In managing the provision of hospital care and medical services under section 1710(a) of this title, the Secretary shall, to the extent feasible, design, establish and manage health care programs in such a manner as to promote cost-effective delivery of health care services in the most clinically appropriate setting.

    ‘(b) In managing the provision of hospital care and medical services under section 1710(a) of this title, the Secretary--

      ‘(1) may contract for hospital care and medical services when Department facilities are not capable of furnishing such care and services economically, and

      ‘(2) shall make such rules and regulations regarding acquisition procedures or policies as the Secretary considers appropriate to provide such needed care and services.

    ‘(c) In managing the provision of hospital care and medical services under section 1710(a) of this title, the Secretary shall ensure that the Department maintains its capacity to provide for the specialized treatment and rehabilitative needs of disabled veterans described in section 1710(a) of this title (including veterans with spinal cord dysfunction, blindness, amputations, and mental illness) within distinct programs or facilities of the Department that are dedicated to the specialized needs of those veterans in a manner that (1) affords those veterans reasonable access to care and services for those specialized needs, and (2) ensures that overall capacity of the Department to provide such services is not reduced below the capacity of the Department, nationwide, to provide those services, as of the date of the enactment of this section.

    ‘(d) In managing the provision of hospital care and medical services under section 1710(a) of this title, the Secretary shall ensure that any veteran with a service-connected disability is provided all benefits under this chapter for which that veteran was eligible before the date of the enactment of this section.’.

    (2) The table of sections at the beginning of chapter 17 is amended by inserting after the item relating to section 1704 the following new items:

      ‘1705. Management of health care: patient enrollment system.

      ‘1706. Management of health care: other requirements.’.

    (b) CONFORMING AMENDMENTS TO SECTION 1703- (1) Section 1703 is amended--

      (A) by striking out subsections (a) and (b); and

      (B) in subsection (c) by--

        (i) striking out ‘(c)’, and

        (ii) striking out ‘this section, sections’ and inserting in lieu thereof ‘sections 1710,’.

    (2)(A) The heading of such section is amended to read as follows:

‘Sec. 1703. Annual report on furnishing of care and services by contract’.

    (B) The item relating to such section in the table of sections at the beginning of chapter 17 is amended to read as follows:

      ‘1703. Annual report on furnishing of care and services by contract.’.

SEC. 5. IMPROVED EFFICIENCY IN HEALTH CARE RESOURCE MANAGEMENT.

    (a) REPEAL OF SUNSET PROVISION- Section 204 of the Veterans Health Care Act of 1992 (Public Law 102-585; 106 Stat. 4950) is repealed.

    (b) COST RECOVERY- Title II of such Act is further amended by adding at the end the following new section:

‘SEC. 207. AUTHORITY TO BILL HEALTH-PLAN CONTRACTS.

    ‘(a) RIGHT TO RECOVER- In the case of a primary beneficiary (as described in section 201(2)(B)) who has coverage under a health-plan contract, as defined in section 1729(i)(1)(A) of title 38, United States Code, and who is furnished care or services by a Department medical facility pursuant to this title, the United States shall have the right to recover or collect charges for such care or services from such health-plan contract to the extent that the beneficiary (or the provider of the care or services) would be eligible to receive payment for such care or services from such health-plan contract if the care or services had not been furnished by a department or agency of the United States. Any funds received from such health-plan contract shall be credited to funds that have been allotted to the facility that furnished the care or services.

    ‘(b) ENFORCEMENT- The right of the United States to recover under such a beneficiary’s health-plan contract shall be enforceable in the same manner as that provided by subsections (a)(3), (b), (c)(1), (d), (f), (h), and (i) of section 1729 of title 38, United States Code.’.

SEC. 6. SHARING AGREEMENTS FOR HEALTH CARE RESOURCES.

    (a) REPEAL OF SECTION 8151- (1) Subchapter IV of chapter 81 is amended--

      (A) by striking out section 8151; and

      (B) by redesignating sections 8152, 8153, 8154, 8155, 8156, 8157, and 8158 as sections 8151, 8152, 8153, 8154, 8155, 8156, and 8157, respectively.

    (2) The table of sections at the beginning of such chapter is amended--

      (A) by striking out the item relating to section 8151; and

      (B) by revising the items relating to sections 8152, 8153, 8154, 8155, 8156, 8157, and 8158 to reflect the redesignations by paragraph (1)(B).

    (b) REVISED AUTHORITY FOR SHARING AGREEMENTS- Section 8152 (as redesignated by subsection (a)(1)(B)) is amended--

      (1) in subsection (a)(1)(A)--

        (A) by striking out ‘specialized medical resources’ and inserting in lieu thereof ‘health-care resources’; and

        (B) by striking out ‘other’ and all that follows through ‘medical schools’ and inserting in lieu thereof ‘any medical school, health-care provider, health-care plan, insurer, or other entity or individual’;

      (2) in subsection (a)(2) by striking out ‘only’ and all that follows through ‘are not’ and inserting in lieu thereof ‘if such resources are not, or would not be,’;

      (3) in subsection (b), by striking out ‘reciprocal reimbursement’ in the first sentence and all that follows through the period at the end of that sentence and inserting in lieu thereof ‘payment to the Department in accordance with procedures that provide appropriate flexibility to negotiate payment which is in the best interest of the Government.’;

      (4) in subsection (d), by striking out ‘preclude such payment, in accordance with--’ and all that follows through ‘to such facility therefor’ and inserting in lieu thereof ‘preclude such payment to such facility for such care or services’;

      (5) by redesignating subsection (e) as subsection (f); and

      (6) by inserting after subsection (d) the following new subsection (e):

    ‘(e) The Secretary may make an arrangement that authorizes the furnishing of services by the Secretary under this section to individuals who are not veterans only if the Secretary determines--

      ‘(1) that such an arrangement will not result in the denial of, or a delay in providing access to, care to any veteran at that facility; and

      ‘(2) that such an arrangement--

        ‘(A) is necessary to maintain an acceptable level and quality of service to veterans at that facility; or

        ‘(B) will result in the improvement of services to eligible veterans at that facility.’.

    (c) CROSS-REFERENCE AMENDMENTS- (1) Section 8110(c)(3)(A) is amended by striking out ‘8153’ and inserting in lieu thereof ‘8152’.

    (2) Subsection (b) of section 8154 (as redesignated by subsection (a)(1)(B)) is amended by striking out ‘section 8154’ and inserting in lieu thereof ‘section 8153’.

    (3) Section 8156 (as redesignated by subsection (a)(1)(B)) is amended--

      (A) in subsection (a), by striking out ‘section 8153(a)’ and inserting in lieu thereof ‘section 8152(a)’; and

      (B) in subsection (b)(3), by striking out ‘section 8153’ and inserting in lieu thereof ‘section 8152’.

    (4) Subsection (a) of section 8157 (as redesignated by subsection (a)(1)(B)) is amended--

      (A) in the matter preceding paragraph (1), by striking out ‘section 8157’ and ‘section 8153(a)’ and inserting in lieu thereof ‘section 8156’ and ‘section 8152(a)’, respectively; and

      (B) in paragraph (1), by striking out ‘section 8157(b)(4)’ and inserting in lieu thereof ‘section 8156(b)(4)’.

SEC. 7. PERSONNEL FURNISHING SHARED RESOURCES.

    Section 712(b)(2) is amended--

      (1) by striking out ‘the sum of--’ and inserting in lieu thereof ‘the sum of the following:’;

      (2) by capitalizing the first letter of the first word of each of subparagraphs (A) and (B);

      (3) by striking out ‘; and’ at the end of subparagraph (A) and inserting in lieu thereof a period; and

      (4) by adding at the end the following:

        ‘(C) The number of such positions in the Department during that fiscal year held by persons involved in providing health-care resources under section 8111 or 8152 of this title.’.