Library of Congress Summary
The summary below was written by the Congressional Research Service, which is a nonpartisan division of the Library of Congress.
GI Bill of Health - Directs the Secretary of Veterans Affairs (Secretary, when not otherwise specified) to establish a process for the enrollment into Veterans Health Plans (VHPs) of:
(1) entitled and eligible veterans (as defined under this Act) and their dependents; and
(2) individuals who are eligible for benefits under the Civilian Health and Medical Program of the Uniformed Services. Requires the Secretary to provide for a continuous VHP open enrollment period of 18 months following the enactment of this Act, an annual enrollment period of at least 30 days, and special enrollment periods for veterans with changed circumstances.
Authorizes the Secretary to terminate VHP coverage for the nonpayment of premiums.
Includes as an "entitled" veteran any veteran:
(1) with a service-connected disability;
(2) whose discharge or release from active duty was for a disability incurred or aggravated in the line of duty;
(3) who is in receipt of veterans' disability compensation due to a disability received by treatment or vocational rehabilitation;
(4) who is a former prisoner of war;
(5) of the Mexican border period or World War I;
(6) who is unable to defray the expenses of necessary care;
(7) who served on active duty in the Republic of Vietnam during the Vietnam era and who the Secretary finds may have been exposed to a toxic substance during such service;
(8) who the Secretary finds was exposed to ionizing radiation during certain nuclear testing during World War II;
(9) who served on active duty in the Southwest Asia theater of operations during the Persian Gulf War and who the Secretary finds has an illness or disability which may be associated with exposure to a toxic substance or environmental hazard during such service;
(10) who, while on active duty, was exposed to mustard gas during certain testing during World War II;
(11) who suffers from a catastrophic illness or injury, payment for which would render such veteran destitute; or
(12) who is proven to be uninsurable in the private health insurance market.
Includes as an "eligible" veteran those veterans who do not otherwise qualify under this paragraph.
Requires entitled veterans to receive any medically necessary and appropriate care and services:
(1) associated with a service-connected disability; and
(2) for an established disability or illness determined to be proximately due to or the result of such disability or illness.
Provides special benefits for entitled veterans having a disability rating of 50 percent or more.
Provides for enrollment under a basic, comprehensive, or supplemental health benefits package for entitled veterans and their dependents, with benefits under each package depending upon degrees of disability and related factors.
Outlines services provided under each of the benefits packages.
Prohibits the Secretary from imposing any premium charges upon an entitled veteran for any medically necessary and appropriate care or services when such veteran has a service-connected disability rated at 50 percent or more.
Outlines premium payment requirements for:
(1) entitled veterans with disabilities rated at less than 50 percent;
(2) other veterans (and their dependents) enrolled in a VHP;
(3) veterans eligible for federally-administered health care programs;
(4) eligible veterans and veterans' dependents with Medicare Supplemental health insurance coverage; and
(5) fee-for-service benefits.
Establishes in the Treasury the Department of Veterans Affairs Health Plan Fund consisting of specified deposits, including premiums paid for VHP coverage.
Requires Fund proceeds to be used for the delivery of veterans' health care services.
Directs the Secretary of the Treasury to deposit quarterly into the Fund the amount certified to such Secretary as an amount representing (and determined according to a specified formula) the full Federal cost of veterans' health care delivery services for such quarter.
Directs such Secretary to allocate at least 75 percent of amounts deposited into the Fund to the VHP or Department facility that provided the care or services for which payment was made.
Requires the remaining 25 percent to be used to operate and maintain the veterans health system and to ensure that Department resources and health care services are allocated in a reasonable, efficient, and equitable manner throughout the United States. Requires the Secretary to:
(1) administer the veterans health system through the use of a medical practice model known as "managed care";
(2) organize veterans' hospitals and medical facilities and services into VHPs;
(3) establish standards for the operation of VHPs;
(4) ensure that payment schedules are uniform throughout the veterans health system (with exceptions permitted under the Secretary's discretion);
(5) establish procedures and guidance for VHPs with respect to agreements with non-Department entities for the furnishing of necessary and appropriate medical care to veterans and their dependents; and
(6) maintain full responsibility for treatment outcomes and quality of contracted care.
Authorizes the Secretary to enter into such contracts and agreements.
Authorizes the Secretary and VHP directors to contract with outside employers to provide health care services to their employees who are otherwise eligible for care through a VHP. Authorizes the Secretary to enter into agreements for the provision of administrative services to VHPs. Directs the Secretary to establish criteria and application procedures for veterans and dependents covered by this Act. Provides appropriate responsibilities of VHPs and their directors with respect to the enrollment of eligible individuals and their care and treatment.
States that a VHP shall be considered a qualified health care provider or carrier under any State health care reform plan, law, or regulation.
Supersedes and preempts conflicting State or local laws, but allows the Secretary to require VHPs to follow any State or local law or regulation that:
(1) is in the best interests of individuals enrolled in the VHP; or
(2) will assist the VHP in achieving or maintaining a competitive position with the State or locality.
Directs the Secretary to report annually to the Congress on costs incurred, premiums received, and payments made under this Act.