Medicare VA Reimbursement Act of 2009 - Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services (HHS), in cooperation with the Secretary of Veterans Affairs (VA), to establish a Medicare VA reimbursement program under which the HHS Secretary shall reimburse the VA Secretary, from the Medicare trust funds, for any item or service: (1) furnished to a Medicare-eligible veteran by a VA medical facility for the treatment of a non-service-connected condition; and (2) covered by Medicare or determined to be medically necessary by the VA Secretary.
Requires the HHS Secretary to enter a memorandum of understanding with the VA Secretary concerning administration of the program. Specifies required conditions in the memorandum.
Directs the Comptroller General to report to Congress on the program every three years.
Declares the sense of Congress that the amount of funds appropriated to the VA for medical care in any fiscal year should not be reduced as a result of the implementation of the Medicare VA reimbursement program.
[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3365 Introduced in House (IH)]
111th CONGRESS
1st Session
H. R. 3365
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.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 28, 2009
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.
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 ``Medicare VA Reimbursement Act of
2009''.
SEC. 2. ESTABLISHMENT OF MEDICARE SUBVENTION FOR VETERANS.
(a) 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:
``(n) Medicare Subvention for Veterans.--
``(1) 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--
``(A) 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
``(B) is covered under this title or is determined
to be medically necessary by the Secretary of Veterans
Affairs.
``(2) Memorandum of understanding.--
``(A) 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.
``(B) Contract elements.--The memorandum of
understanding under subparagraph (A) shall contain the
following:
``(i) 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.
``(ii) 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.
``(iii) Data sharing agreement.--An
agreement on data sharing, including--
``(I) 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
``(II) verification of data
demonstrating that a 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.
``(iv) 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.
``(v) Performance measures.--An agreement
on performance measures and performance targets
to be used to demonstrate the impact of the
Medicare VA reimbursement program.
``(vi) Additional terms.--Any additional
terms deemed necessary by the administering
Secretaries.
``(C) 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).
``(3) Payments based on regular medicare payment rates.--
``(A) Amount.--Subject to the succeeding provisions
of this paragraph, the Secretary of Health and Human
Services shall reimburse the Secretary of Veterans
Affairs--
``(i) 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
``(ii) 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.
``(B) 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.
``(C) 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) Capital payments.--Any amounts
attributable to payments for capital-related
costs under section 1886(g).
``(D) Periodic payments from medicare trust
funds.--Reimbursements under this paragraph shall be
made--
``(i) on a periodic basis consistent with
the periodicity of payments under this title;
and
``(ii) from the Federal Hospital Insurance
Trust Fund established in section 1817 and the
Federal Supplementary Medical Insurance Trust
Fund established in section 1841.
``(E) 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.
``(4) 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.
``(5) 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.
``(6) 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;
``(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; or
``(C) 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.
``(7) 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:
``(A) The number of Medicare-eligible veterans who
opt to receive health care at a Department of Veterans
Affairs medical facility.
``(B) 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.
``(C) The number and types of items and services
provided to Medicare-eligible veterans by Department of
Veterans Affairs medical facilities under this
subsection.
``(D) An accounting of the manner in which the
Department of Veterans Affairs expended funds received
through reimbursements under this subsection.
``(E) A detailed description of any changes made to
the memorandum of understanding under paragraph (2).
``(F) A comparison of the performance data with the
performance targets under paragraph (2)(B)(v).
``(G) Any other data on the Medicare VA
reimbursement program that the administering
Secretaries determine is appropriate.
``(8) Definitions.--For purposes of this subsection:
``(A) Administering secretaries.--The term
`administering Secretaries' means the Secretary of
Health and Human Services and the Secretary of Veterans
Affairs acting jointly.
``(B) 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--
``(i) is entitled to, or enrolled for,
benefits under part A of this title; or
``(ii) is enrolled for benefits under part
B of this title.
``(C) 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.
``(D) 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.''.
(b) Conforming Amendment.--Section 1729 of title 38, United States
Code is amended by adding at the end the following new subsection:
``(j) In any case in which a Medicare-eligible veteran (as defined
in section 1862(n)(8)(B) of the Social Security Act (42 U.S.C.
1395y(n)(8)(B))) is furnished care or services under this chapter for a
non-service-connected condition (as defined in section 1862(n)(8)(C) of
such Act) the Secretary shall--
``(1) seek reimbursement from the Secretary of Health and
Human Services for such care and services under section 1862(n)
of such Act; and
``(2) 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.''.
SEC. 3. GAO REPORT.
(a) 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(n) of the
Social Security Act, as added by section 2 of this Act.
(b) Contents.--The report under subsection (a) shall contain an
analysis of--
(1) 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);
(2) whether Medicare-eligible veterans (as defined in
section 1862(n)(8)(B)) experience improved access to health
care as a result of the program;
(3) whether Medicare-eligible veterans experience a change
in the quality of care that they receive as a result of this
program;
(4) the impact of the program on local health care
providers and Medicare beneficiaries in the communities
surrounding Department of Veterans Affairs medical facilities;
and
(5) any additional issues deemed appropriate by the
Comptroller General of the United States.
SEC. 4. 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(n) of the Social
Security Act, as added by section 2(a).
<all>
Introduced in House
Introduced in House
Referred to House Ways and Means
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 House Energy and Commerce
Referred to House Veterans' Affairs
Referred to the Subcommittee on Health.
Sponsor introductory remarks on measure. (CR E2122)
Referred to the Subcommittee on Health.
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