Veterans Medicare Reimbursement Act of 2003 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to require the Secretaries of Health and Human Services (HHS) and of Veterans Affairs (VA) to establish a Medicare subvention project under which the HHS Secretary shall reimburse the VA Secretary for Medicare health care services furnished to Medicare-eligible veterans in VA facilities.
[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2664 Introduced in House (IH)]
108th CONGRESS
1st Session
H. R. 2664
To provide for Medicare reimbursement for health care services provided
to Medicare-eligible veterans in facilities of the Department of
Veterans Affairs.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 8, 2003
Mrs. Kelly 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 for Medicare reimbursement for health care services provided
to Medicare-eligible veterans in facilities of 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.
This Act may be cited as the ``Veterans Medicare Reimbursement Act
of 2003''.
SEC. 2. ESTABLISHMENT OF MEDICARE SUBVENTION FOR VETERANS.
Section 1862 of the Social Security Act (42 U.S.C. 1395y) is
amended by inserting after subsection (c) the following new subsection:
``(d) Medicare Subvention for Veterans.--
``(1) Establishment of procedure for reimbursement.--
``(A) In general.--The administering Secretaries
shall establish a procedure under which the Secretary
shall reimburse the Secretary of Veterans Affairs, from
the trust funds, for medicare health care services
furnished to medicare-eligible veterans.
``(B) Requirements.--Under the procedure--
``(i) the administering Secretaries shall
certify, that any Department of Veterans
Affairs medical facility that furnishes
medicare health care services for which the
Secretary of Veterans Affairs is reimbursed
under this subsection has sufficient--
``(I) resources and expertise to
provide the health care benefits
required to be provided to
beneficiaries; and
``(II) information and billing
systems in place to ensure accurate and
timely submission of claims for health
care benefits to the Secretary;
``(ii) the Secretary shall have access to
all data of the Department of Veterans Affairs
that the Secretary determines is necessary to
verify accuracy in billing and claims
information; and
``(iii) the Secretary shall waive
requirements for conditions of participation
otherwise applicable to a provider of services,
physician, practitioner, supplier, or facility
under this title in the case of a Department of
Veterans Affairs medical facility consistent
with paragraph (3).
``(C) Restriction on new or expanded facilities.--
No new Veterans Affairs medical facilities may be built
or expanded with funds received under this subsection.
``(2) Cost-sharing.--The amount of reimbursement for
medicare health care services to the Secretary of Veterans
Affairs for medicare health care services shall be reduced by
amounts attributable to applicable deductible, coinsurance, and
cost-sharing requirements under this title.
``(3) Medicare requirements.--
``(A) Waiver.--The Secretary shall waive any
requirements referred to in paragraph (1)(B)(iii)
(relating to requirements for conditions of
participation) in the case of a Department of Veterans
Affairs medical facility, or approve equivalent or
alternative ways of meeting such a requirement, but
only if such waiver or approval--
``(i) reflects the unique status of the
Department of Veterans Affairs as an agency of
the Federal Government; and
``(ii) is necessary to carry out, or
improve the efficiency of, to provide for
reimbursement for medicare health care services
under this subsection.
``(B) 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), and paragraphs (2) and (3) of subsection
(a), shall not apply.
``(4) Verification of eligibility.--
``(A) In general.--The Secretary of Veterans
Affairs shall establish procedures for determining
whether an individual is a medicare-eligible veteran.
``(B) Restriction.--No reimbursement shall be made
under this subsection for any medicare health care
service provided to an individual unless the individual
has been determined to be a medicare-eligible veteran
pursuant to the procedures established under
subparagraph (A).
``(5) Data requirements.--Reimbursements for medicare
health care services furnished to medicare-eligible veterans
may not be made until such time as the administering
Secretaries certify to Congress that the--
``(A) cost accounting and related transaction
systems of the Veterans Health Administration provide
cost information and encounter data regarding health
care delivered at each Department of Veterans Affairs
medical facility on an inpatient and outpatient basis;
and
``(B) cost information and encounter data provided
by such systems is accurate, reliable, and consistent
across all facilities.
``(6) Payments based on regular medicare payment rates.--
``(A) Amount.--Subject to the succeeding provisions
of this paragraph, the Secretary shall reimburse the
Secretary of Veterans Affairs for health care benefits
provided to medicare-eligible veterans at a rate equal
to 100 percent of the amounts that otherwise would be
payable under this title on a noncapitated basis for
such 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 service.
``(B) Exclusion of certain amounts.--In computing
the amount of payment under subparagraph (A), the
following amounts shall be excluded:
``(i) Disproportionate share hospital
adjustment.--Any amount attributable to an
adjustment under section 1886(d)(5)(F).
``(ii) Direct graduate medical education
payments.--Any amount attributable to a payment
under section 1886(h).
``(iii) Indirect medical education
adjustment.--Any amount attributable to the
adjustment under section 1886(d)(5)(B).
``(iv) Percentage of capital payments.--67
percent of any amounts attributable to payments
for capital-related costs under medicare
payment policies under section 1886(g).
``(C) Periodic payments from medicare trust
funds.--Payments under this paragraph shall be made--
``(i) on a periodic basis consistent with
the periodicity of payments under this title;
and
``(ii) in appropriate part, as determined
by the Secretary, from the trust funds.
``(7) Crediting of payments.--Any payment shall be
deposited in the Department of Veterans Affairs Medical Care
Collections Fund established under section 1729A of title 38,
United States Code.
``(8) Rules of construction.--Nothing in this subsection
shall be construed--
``(A) 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; or
``(B) 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.
``(9) Evaluation and reports.--The administering
Secretaries shall conduct ongoing evaluations of the procedure
established under this subsection, and shall submit periodic
reports to Congress on--
``(A) any savings or costs to the medicare program
by reason of this subsection; and
``(B) effects of this subsection on access to care
by medicare-eligible veterans.
``(10) Definitions.--In this subsection:
``(A) Administering secretaries.--The term
`administering Secretaries' means the Secretary and the
Secretary of Veterans Affairs acting jointly.
``(B) Medicare health care services.--The term
`medicare health care services' means items or services
covered under part A or B of this title.
``(C) Medicare-eligible veteran.--The term
`medicare-eligible veteran' means an individual who--
``(i) is a veteran (as defined in section
101 of title 38, United States Code) who is
eligible for care and services under section
1705(a) of title 38, United States Code;
``(ii) has attained age 65;
``(iii) is entitled to, or enrolled for,
benefits under part A of this title; and
``(iv) is enrolled for benefits under part
B of this title.
``(D) Trust funds.--The term `trust funds' means
the Federal Hospital Insurance Trust Fund established
in section 1817 and the Federal Supplementary Medical
Insurance Trust Fund established in section 1841.
``(E) Department of veterans affairs medical
facility.--The term `Department of Veterans Affairs
medical facility' means a medical facility as 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.''.
<all>
Introduced in House
Introduced in House
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.
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.
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.
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.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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