I
112th CONGRESS
1st Session
H. R. 814
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.
Short title
This Act may be cited as the
Medicare VA Reimbursement Act of
2011
.
Establishment of Medicare subvention for veterans
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:
Medicare subvention for veterans
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—
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
is covered under this title or is determined to be medically necessary by the Secretary of Veterans Affairs.
Memorandum of understanding
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.
Contract elements
The memorandum of understanding under subparagraph (A) shall contain the following:
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.
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.
Data sharing agreement
An agreement on data sharing, including—
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
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.
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.
Performance measures
An agreement on performance measures and performance targets to be used to demonstrate the impact of the Medicare VA reimbursement program.
Additional terms
Any additional terms deemed necessary by the administering Secretaries.
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).
Payments based on regular Medicare payment rates
Amount
Subject to the succeeding provisions of this paragraph, the Secretary of Health and Human Services shall reimburse the Secretary of Veterans Affairs—
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
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.
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.
Exclusion of certain amounts
In computing the amount of payment under subparagraph (A), the following amounts shall be excluded:
Disproportionate share hospital adjustment
Any amount attributable to an adjustment under section 1886(d)(5)(F).
Direct graduate medical education payments
Any amount attributable to a payment under section 1886(h).
Indirect medical education adjustment
Any amount attributable to the adjustment under section 1886(d)(5)(B).
Capital payments
Any amounts attributable to payments for capital-related costs under section 1886(g).
Periodic payments from Medicare trust funds
Reimbursements under this paragraph shall be made—
on a periodic basis consistent with the periodicity of payments under this title; and
from the Federal Hospital Insurance Trust Fund established in section 1817 and the Federal Supplementary Medical Insurance Trust Fund established in section 1841.
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.
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.
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.
Rules of construction
Nothing in this subsection shall be construed—
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;
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
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.
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:
The number of Medicare-eligible veterans who opt to receive health care at a Department of Veterans Affairs medical facility.
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.
The number and types of items and services provided to Medicare-eligible veterans by Department of Veterans Affairs medical facilities under this subsection.
An accounting of the manner in which the Department of Veterans Affairs expended funds received through reimbursements under this subsection.
A detailed description of any changes made to the memorandum of understanding under paragraph (2).
A comparison of the performance data with the performance targets under paragraph (2)(B)(v).
Any other data on the Medicare VA reimbursement program that the administering Secretaries determine is appropriate.
Definitions
For purposes of this subsection:
Administering Secretaries
The term administering Secretaries means the Secretary of Health and Human Services and the Secretary of Veterans Affairs acting jointly.
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—
is entitled to, or enrolled for, benefits under part A of this title; or
is enrolled for benefits under part B of this title.
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.
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.
.
Conforming amendment
Section 1729 of title 38, United States Code is amended by adding at the end the following new subsection:
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—
seek reimbursement from the Secretary of Health and Human Services for such care and services under section 1862(p) of such Act; and
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.
.
GAO report
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.
Contents
The report under subsection (a) shall contain an analysis of—
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);
whether Medicare-eligible veterans (as defined in section 1862(p)(8)(B)) experience improved access to health care as a result of the program;
whether Medicare-eligible veterans experience a change in the quality of care that they receive as a result of this program;
the impact of the program on local health care providers and Medicare beneficiaries in the communities surrounding Department of Veterans Affairs medical facilities; and
any additional issues deemed appropriate by the Comptroller General of the United States.
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).