Veterans Empowerment Act
This bill restructures the delivery of Department of Veterans Affairs (VA) health care through private non-VA providers.
The Veterans Accountable Care Organization is established as a federally chartered corporation to permit veterans who are eligible for VA health care to choose to receive health care from private-sector providers. Veterans Health Administration (VHA) hospital care, medical services, and other health care functions and personnel (excluding nursing home care and domiciliary care) are transferred to the organization.
The bill establishes in the VHA the Veterans Health Insurance program to provide veterans with insurance coverage for both VA and private health care.
[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4457 Introduced in House (IH)]
<DOC>
115th CONGRESS
1st Session
H. R. 4457
To amend title 38, United States Code, to establish the Veterans
Accountable Care Organization and to provide veterans access to private
health insurance plans, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
November 21, 2017
Mr. Lamborn (for himself, Mr. Meadows, and Mr. Franks of Arizona)
introduced the following bill; which was referred to the Committee on
Veterans' Affairs, and in addition to the Committees on Ways and Means,
Oversight and Government Reform, Energy and Commerce, and Armed
Services, 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 amend title 38, United States Code, to establish the Veterans
Accountable Care Organization and to provide veterans access to private
health insurance plans, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
This Act may be cited as the ``Veterans Empowerment Act''.
SEC. 2. ESTABLISHMENT OF VETERANS ACCOUNTABLE CARE ORGANIZATION.
(a) Establishment.--
(1) In general.--Chapter 3 of title 38, United States Code,
is amended by adding at the end the following new section:
``Sec. 323. Veterans Accountable Care Organization
``(a) Establishment.--(1) There is established the Veterans
Accountable Care Organization (in this section referred to as the
`Corporation').
``(2) The Corporation is a federally chartered corporation.
``(3) The Corporation shall be incorporated and domiciled in the
District of Columbia, or another nearby State, as determined by the
board of directors of the Corporation.
``(4) The Corporation shall be a charitable and nonprofit
corporation.
``(5) Except as otherwise provided, the Corporation shall have
perpetual existence.
``(b) Purpose.--The purpose of the Corporation is to furnish high-
quality hospital care, medical services, and other health care
(excluding nursing home care and domiciliary care) to individuals
eligible for such care and services under laws administered by the
Secretary.
``(c) Board of Directors.--(1) The powers of the Corporation shall
be vested in a Board of Directors that governs the Corporation.
``(2) The Board of Directors shall be composed of the following
members:
``(A) The Secretary of Veterans Affairs.
``(B) Two members appointed by the Speaker of the House of
Representatives, at least one of whom shall be a veteran.
``(C) Two members appointed by the Minority Leader of the
House of Representatives, at least one of whom shall be a
veteran.
``(D) Two members appointed by the Majority Leader of the
Senate, at least one of whom shall be a veteran.
``(E) Two members appointed by the Minority Leader of the
Senate, at least one of whom shall be a veteran.
``(F) Two members appointed by the President, at least one
of whom shall be veterans.
``(3) The President shall designate a member of the Board of
Directors to serve as Chairperson of the Board. The Board shall select
a Vice Chairperson from among its members.
``(4)(A) A member of the Board of Directors shall serve for a term
of five years, except that the members first appointed shall be
appointed for staggered terms as the President considers appropriate to
ensure that the terms of no more than three members expire in the same
year.
``(B) Any member appointed to fill a vacancy occurring before the
expiration of the term for which the member's predecessor was appointed
shall be appointed only for the remainder of that term. A member may
serve after the expiration of that member's term until a successor has
taken office. A vacancy on the Board shall not affect its powers, but
shall be filled in the same manner in which the original appointment
was made.
``(C) The term of each member may be renewed for an additional
term, except that in no case shall any member serve more than two
consecutive terms exceeding ten years.
``(D) During the absence or disability of the Secretary of Veterans
Affairs or in the event of a vacancy in the office of Secretary, the
Acting Secretary of Veterans Affairs shall serve as the member of the
Board of Directors specified in paragraph (2)(A).
``(d) Duties.--In carrying out subsection (b), the Corporation
shall--
``(1) transfer personnel and assets of the Department of
Veterans Affairs to the Corporation pursuant to subsection (b)
of section 2 of the Veterans Empowerment Act;
``(2) establish priorities, milestones, and timelines, in
consultation with the Secretary of Veterans Affairs, for the
termination of functions of the Veterans Health Administration
directly related to the furnishing of hospital care, medical
services, and other health care (excluding nursing home care
and domiciliary care) pursuant to subsection (c) of such
section 2;
``(3) with respect to centers of excellence relating to
service-connected injuries and other medical issues--
``(A) continue to administer such centers
previously established by the Secretary; and
``(B) establish and administer additional such
centers as the Board of Directors determines
appropriate.
``(4) in consultation with the Secretary, carry out such
other actions necessary to carry out this section.
``(e) Powers.--The Corporation shall--
``(1) appoint employees; and
``(2) adopt a Constitution and bylaws consistent with the
purpose set forth under subsection (b).
``(f) Duty To Maintain Corporate and Tax-Exempt Status.--(1) The
Corporation shall maintain its status as a corporation incorporated
under the laws of the District of Columbia or another nearby State, as
determined by the Board of Directors.
``(2) The Corporation shall maintain its status as an organization
exempt from the Internal Revenue Code of 1986.
``(g) Veterans Accountable Care Organization Fund.--(1) There is in
the Treasury a fund to be known as the Veterans Accountable Care
Organization Fund (in this subsection referred to as the `Fund').
``(2) Amounts recovered or collected under chapter 26 of this title
shall be deposited in the Fund.
``(3) Amounts in the Fund shall be available, without further
appropriation and without fiscal year limitation, to establish and
administer centers of excellence described in subsection (d)(3) and for
health care or medical services furnished to a veteran at a facility
operated by the Corporation.''.
(2) Clerical amendment.--The table of sections at the
beginning of chapter 3 of such title is amended by inserting
after the item relating to section 322 the following new item:
``323. Veterans Accountable Care Organization.''.
(b) Transfer of Personnel and Assets.--
(1) Transfer.--All of the personnel, property, records, and
unexpended balances of appropriations, allocations, and other
funds employed, used, held, available, or to be made available
in connection with the direct furnishing of hospital care,
medical services, and other health care (excluding nursing home
care and domiciliary care) to individuals eligible for such
care and services under laws administered by the Secretary of
Veterans Affairs are transferred to the Veterans Accountable
Care Organization established under section 323 of title 38,
United States Code, as added by subsection (a).
(2) Reduction in force.--The Secretary may implement a
reduction in force in carrying out paragraph (1).
(c) Termination of Functions.--
(1) In general.--Except as provided by paragraph (2), all
of the functions of the Veterans Health Administration directly
relating to the furnishing of hospital care, medical services,
and other health care (excluding nursing home care and
domiciliary care) to individuals eligible for such care and
services under laws administered by the Secretary shall
terminate one year after the date of the enactment of this Act.
(2) Extensions.--The Secretary of Veterans Affairs may make
not more than two 90-day extensions to the termination date
specified in paragraph (1) if the Secretary notifies Congress
of such extensions.
(3) Certification of termination date.--The Secretary shall
certify to Congress the date on which paragraph (1) is carried
out.
(d) Recommendations for Statutory Amendments.--Not later than 180
days after the date of the enactment of this Act, the Secretary shall
submit to Congress a report that contains recommendations for technical
and conforming amendments to Federal statutes to carry out this Act.
SEC. 3. ESTABLISHMENT OF VETERANS HEALTH INSURANCE PROGRAM.
(a) Establishment.--Chapter 73 of title 38, United States Code, is
amended by adding at the end the following new section:
``Sec. 7309A. Veterans Health Insurance Program
``(a) Establishment.--There is established in the Veterans Health
Administration the Veterans Health Insurance Program (in this section
referred to as the `Program').
``(b) Duties.--Under the Program, the Secretary shall administer
the provision of health insurance support to veterans under chapter 26
of this title.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 73 of such title is amended by inserting after the item
relating to section 7309 the following new item:
``7309A. Veterans Health Insurance Program.''.
SEC. 4. DESIGNATION OF EXISTING AUTHORITIES FOR HOSPITAL CARE, MEDICAL
SERVICES, AND OTHER HEALTH CARE.
(a) Designation.--Subchapter I of chapter 17 of title 38, United
States Code, is amended by inserting after section 1701 the following
new section:
``Sec. 1701A. VetsCare Federal program: designation of authorities for
hospital care, medical services, and other health care as
program
``(a) In General.--Effective as of the date described in section
2(c)(3) of the Veterans Empowerment Act, the authorities for the
provision of hospital care, medical services, and other health care
(other than nursing home care and domiciliary care) in subchapter II of
this chapter and under any other law administered by the Secretary may
be referred to as the `VetsCare Federal program'.
``(b) Designation of Recipients.--Effective as of the date
described in section 2(c)(3) of the Veterans Empowerment Act, any
eligible individual who receives hospital care, medical services, and
other health care (excluding nursing home care and domiciliary care) in
accordance with the authorities referred to in subsection (a) after
such date may be referred to in the receipt of such care or services as
participating in the `VetsCare Federal program'.
``(c) Secondary Payer.--
``(1) In general.--Notwithstanding any other provision of
law, any health plan (including the Medicare program under
title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.)
or a State plan under title XIX of such Act (42 U.S.C. 1396 et
seq.) and the TRICARE program under chapter 55 of title 10)
under which an eligible individual is covered shall be
responsible for the payment of costs for any health care
received by an eligible individual for a non-service connected
disability up to the maximum amount allowable under such plan
before the VetsCare Federal program is responsible for any such
costs, if applicable.
``(2) Notification.--The Secretary of Health and Human
Services, the Secretary of Defense, or any other head of a
relevant department or agency of the Federal Government shall
notify the Secretary of Veterans Affairs of an eligible
individual being covered under a health plan described in
paragraph (1).
``(d) Treatment of Employer-Sponsored Health Plans.--
``(1) In general.--The provisions of section 1862(b)(3)(C)
of the Social Security Act (42 U.S.C. 1395y(b)(3)(C)) shall
apply with respect to financial or other incentives for an
employee who is an eligible individual not to enroll (or to
terminate enrollment) under a health plan that would (in the
case of such enrollment) be responsible under subsection (c)
for the payment of costs for hospital care, medical services,
or other health care received by the eligible individual for a
non-service connected disability in the same manner as such
section 1862(b)(3)(C) applies to financial or other incentives
for an individual entitled to benefits under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.) not to enroll (or
to terminate enrollment) under a group health plan or a large
group health plan which would (in the case of enrollment) be a
primary plan (as defined in section 1862(b)(2)(A) of such Act).
``(2) Regulations.--The Secretary may by regulation adopt
such additional exceptions to the prohibition described in
paragraph (1) as the Secretary considers appropriate and such
paragraph shall be implemented taking into account the adoption
of such exceptions.
``(3) Agreements.--The Veterans Accountable Care
Organization and the Secretary of Health and Human Services may
enter into agreements to carry out this subsection. Any such
agreement shall provide that any expenses incurred by the
Secretary of Health and Human Services pertaining to carrying
out this subsection shall be reimbursed by the Veterans
Accountable Care Organization.
``(4) Group health plan defined.--In this subsection, the
term `group health plan' means a group health plan (as that
term is defined in section 5000(b)(1) of the Internal Revenue
Code of 1986 without regard to section 5000(d) of the Internal
Revenue Code of 1986).
``(e) Eligible Individuals.--An individual is eligible to
participate in the VetsCare Federal program if such individual was
enrolled in the system of annual patient enrollment established and
operated by the Secretary under section 1705(a) of this title as of the
date described in section 2(c)(3) of the Veterans Empowerment Act.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
1701 the following new item:
``1701A. VetsCare Federal program: designation of authorities for
hospital care, medical services, and other
health care as program.''.
SEC. 5. HEALTH INSURANCE SUPPORT FOR NEW VETERANS AND VETERANS ELECTING
HEALTH INSURANCE SUPPORT IN LIEU OF ELIGIBILITY FOR
HOSPITAL CARE, MEDICAL SERVICES, AND OTHER HEALTH CARE
UNDER EXISTING AUTHORITIES.
(a) In General.--Part II of title 38, United States Code, is
amended by inserting after chapter 24 the following new chapter:
``CHAPTER 26--VETERANS INDEPENDENCE IN HEALTH CARE
``subchapter i--veterans generally
``2601. VetsCare Choice program: designation of recipients.
``2602. Eligibility.
``2603. Qualifying health insurance.
``2604. Health insurance support.
``2605. Treatment of other health plans.
``2606. Receipt of health care through the Department.
``2607. Pharmacy benefits.
``subchapter ii--medicare-eligible veterans
``2611. VetsCare Senior program: designation of recipients.
``2612. Medicare support.
``Subchapter I--Veterans Generally
``Sec. 2601. VetsCare Choice program: designation of recipients
``(a) In General.--The authorities for the provision of health
insurance support under this subchapter may be referred to as the
`VetsCare Choice program'.
``(b) Designation of Recipients.--Any veteran who receives health
insurance support under this subchapter may be referred to in the
receipt of support as participating in the `VetsCare Choice program'.
``(c) Relationship to Care by Veterans Accountable Care
Organization.--Health insurance support under this subchapter is in
addition to any health care or medical services furnished to a veteran
at a facility operated by the Veterans Accountable Care Organization.
``Sec. 2602. Eligibility
``(a) In General.--Except as provided in subsections (c) and (d),
the following veterans shall be provided health insurance support under
this subchapter:
``(1) Veterans who first enroll in the system of annual
patient enrollment established and operated by the Secretary
under section 1705(a) of this title on or after the date
described in section 2(c)(3) of the Veterans Empowerment Act.
``(2) Veterans enrolled in such system as of the date
described in section 2(c)(3) of the Veterans Empowerment Act
who elect health insurance support under this subchapter in
lieu of eligibility for hospital care, medical services, and
other health care (excluding nursing home care and domiciliary
care) under the VetsCare Federal program under chapter 17 of
this title or any other law administered by the Secretary.
``(b) Enrollment.--The Secretary shall administer--
``(1) an open enrollment period for the VetsCare Choice
program that corresponds to the open enrollment period for the
Federal Employees Health Benefits program described in section
8905(g); and
``(2) special enrollment periods based on qualifying life
events of veterans similar to such events under the Federal
Employees Health Benefits Program, except that the change of
priority group shall also be treated as a qualifying life
event.
``(c) Effect of Election.--While an election under subsection
(a)(2) of a veteran described in that subsection is in effect, the
veteran is not eligible for hospital care, medical services, and other
health care (excluding nursing home care and domiciliary care) under
chapter 17 of this title or any other law administered by the
Secretary.
``(d) Exceptions.--The following veterans are not eligible for
health insurance support under this subchapter:
``(1) Any veteran eligible for care under the Medicare
program under title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.).
``(2) Any veteran who--
``(A) first enrolls in the system of annual patient
enrollment established and operated by the Secretary
under section 1705(a) of this title on or after the
date described in section 2(c)(3) of the Veterans Act;
and
``(B) is in priority group 7 or priority group 8.
``(e) Commencement of Availability of Support.--Health insurance
support under this subchapter shall commence being available as
follows:
``(1) With respect to veterans in priority group 1, 2, or
3, on the first day of the first month that begins on or after
the date described in section 2(c)(3) of the Veterans
Empowerment Act.
``(2) With respect to veterans in a priority group other
than 1, 2, or 3, on the first day of the first month that
begins on or after the date that is 180 days after the
commencement date under paragraph (1).
``(f) Priority Group Defined.--In this section, the term `priority
group' means the priority groups established by the Secretary for
purposes of the enrollment of veterans in the patient enrollment system
under section 1705(a) of this title.
``Sec. 2603. Qualifying health insurance
``Health insurance support may be provided under this subchapter
only for health plans that--
``(1) include the types of health care authorized under
section 1079 of title 10, United States Code; and
``(2) provide such additional elements of coverage as the
Secretary shall prescribe for purposes of this subchapter.
``Sec. 2604. Health insurance support
``(a) In General.--The Secretary shall provide health insurance
support to veterans eligible for such support under this subchapter
through premium support under subsections (b) and (c), cost-sharing
support under subsection (d), and alternative support under subsection
(e) by paying or reimbursing such veterans for the costs associated
with such health insurance support. The Secretary shall make such
payments or reimbursements in a manner similar to the manner in which
the Centers for Medicare & Medicaid Services make similar payments and
reimbursements.
``(b) Premium Support Generally.--The premium support provided by
the Secretary under this subsection is as follows:
``(1) Tier 1.--To any veteran with a service-connected
disability rated as 100 percent disabling, health insurance
support sufficient to provide benefits to the veteran under a
health plan that are actuarially equivalent to 100 percent of
the full actuarial value of the benefits provided under the
health plan. A health plan under this paragraph may be referred
to as a `Tier 1 Plan'.
``(2) Tier 2.--To any veteran in priority group 1 not
covered by paragraph (1) and any veteran in priority group 2,
health insurance support sufficient to provide benefits to the
veteran under a health plan that are actuarially equivalent to
90 percent of the full actuarial value of the benefits provided
under the health plan. A health plan under this paragraph may
be referred to as a `Tier 2 Plan'.
``(3) Tier 3.--To any veteran in priority group 3 or
priority group 4, health insurance support sufficient to
provide benefits to the veteran under a health plan that are
actuarially equivalent to 80 percent of the full actuarial
value of the benefits provided under the health plan. A health
plan under this paragraph may be referred to as a `Tier 3
Plan'.
``(4) Tier 4.--To any veteran in priority group 5 or
priority group 6, health insurance support sufficient to
provide benefits to the veteran under a health plan that are
actuarially equivalent to 70 percent of the full actuarial
value of the benefits provided under the health plan. A health
plan under this paragraph may be referred to as a `Tier 4
Plan'.
``(5) Tier 5.--To any veteran not in a priority group
covered by paragraphs (1) through (4) and not ineligible for
such support under section 2602(d)(2) of this title, health
insurance support sufficient to provide benefits to the veteran
under a health plan that are actuarially equivalent to 60
percent of the full actuarial value of the benefits provided
under the health plan. A health plan under this paragraph may
be referred to as a `Tier 5 Plan'.
``(c) Additional Premium Support Based on Need.--The premium
support provided by the Secretary under this subsection is as follows:
``(1) To any veteran with an annual gross household income
that is less than 133 percent of the poverty line, health
insurance support sufficient to cover any costs of such monthly
premium that are more than 2 percent of the monthly gross
household income of the veteran.
``(2) To any veteran with an annual gross household income
that is between 133 percent and 150 percent of the poverty
line, health insurance support sufficient to cover any costs of
such monthly premium that are more than 3 percent of the
monthly gross household income of the veteran.
``(3) To any veteran with an annual gross household income
that is between 150 percent and 200 percent of the poverty
line, health insurance support sufficient to cover any costs of
such monthly premium that are more than 4 percent of the
monthly gross household income of the veteran.
``(4) To any veteran with an annual gross household income
that is between 200 percent and 250 percent of the poverty
line, health insurance support sufficient to cover any costs of
such monthly premium that are more than 6.3 percent of the
monthly gross household income of the veteran.
``(5) To any veteran with an annual gross household income
that is between 250 percent and 300 percent of the poverty
line, health insurance support sufficient to cover any costs of
such monthly premium that are more than 8.05 percent of the
monthly gross household income of the veteran.
``(6) To any veteran with an annual gross household income
that is between 300 percent and 400 percent of the poverty
line, health insurance support sufficient to cover any costs of
such monthly premium that are more than 9.5 percent of the
monthly gross household income of the veteran.
``(d) Cost-Sharing Support.--The cost-sharing support provided by
the Secretary under this subsection is as follows:
``(1) To any veteran with an annual gross household income
that is less than 150 percent of the poverty line, health
insurance support sufficient to cover cost-sharing in order to
ensure that the effective minimum actuarial value of the
benefits provided under the health plan of the veteran is not
less than 94 percent.
``(2) To any veteran with an annual gross household income
that is between 150 percent and 200 percent of the poverty
line, health insurance support sufficient to cover cost-sharing
in order to ensure that the effective minimum actuarial value
of the benefits provided under the health plan of the veteran
is not less than 87 percent.
``(3) To any veteran with an annual gross household income
that is between 200 percent and 250 percent of the poverty
line, health insurance support sufficient to cover cost-sharing
in order to ensure that the effective minimum actuarial value
of the benefits provided under the health plan of the veteran
is not less than 73 percent.
``(e) Alternative Support for Veterans With Certain Health
Insurance.--
``(1) In general.--Notwithstanding any other provision of
this section, upon the election of a veteran eligible for
health insurance support under this subchapter who obtains a
high deductible health plan that includes a health savings
account under section 223 of the Internal Revenue Code of 1986,
the Secretary shall contribute an amount calculated under
paragraph (2) into such health savings account on behalf of the
veteran.
``(2) Amount calculated.--The amount calculated under this
paragraph is an amount equal to the difference between--
``(A) the amount of health insurance support the
veteran would otherwise have received under the
subsection of this section applicable to the veteran;
and
``(B) the amount payable by the veteran in
connection with the high deductible health plan
described in paragraph (1).
``(f) Determinations Based on Cost of Plans.--In making
determinations under this section with respect to the amount of health
insurance support to provide to a veteran, the Secretary shall make
such determinations based on the costs associated with the second-
least-costly health plan available to the veteran in the area in which
the veteran resides.
``(g) Definitions.--In this section:
``(1) The term `cost-sharing', in connection with the
receipt of health care and treatment under a health plan, means
any copayments, deductibles, or other charges imposed,
collected, or otherwise required by a health insurance provider
or health care provider in connection with the receipt of
health care and treatment under such health plan.
``(2) The term `poverty line' means the poverty line (as
defined in section 673(2) of the Community Services Block Grant
Act (42 U.S.C. 9902(2)) applicable to a family of the size
involved.
``(3) The term `high deductible health plan' has the
meaning given that term in section 223(c)(2) of the Internal
Revenue Code of 1986.
``(4) The term `priority group' means the priority groups
established by the Secretary for purposes of the enrollment of
veterans in the patient enrollment system under section 1705(a)
of this title.
``Sec. 2605. Treatment of other health plans
``(a) Secondary Payer.--
``(1) In general.--Notwithstanding any other provision of
law, any health plan (including a State plan under title XIX of
the Social Security Act (42 U.S.C. 1396 et seq.) and the
TRICARE program under chapter 55 of title 10) under which a
veteran is covered that is not a health plan for which health
insurance support is provided under this subchapter shall be
responsible for the payment of costs for any health care
received by an eligible individual for a non-service connected
disability up to the maximum amount allowable under such plan
before any health plan for which health insurance support is
provided under this subchapter is responsible for any such
costs, if applicable.
``(2) Notification.--The Secretary of Health and Human
Services, the Secretary of Defense, or any other head of a
relevant department or agency of the Federal Government shall
notify the Secretary of Veterans Affairs of an eligible
individual being covered under a health plan described in
paragraph (1).
``(b) Treatment of Employer-Sponsored Health Plans.--
``(1) In general.--The provisions of section 1862(b)(3)(C)
of the Social Security Act (42 U.S.C. 1395y(b)(3)(C)) shall
apply with respect to financial or other incentives for an
employee who is a veteran not to enroll (or to terminate
enrollment) under a health plan that is not a health plan for
which health insurance support is provided under this
subchapter and that would (in the case of such enrollment) be
responsible under subsection (a) for the payment of costs for
health care received by the veteran in the same manner as such
section 1862(b)(3)(C) applies to financial or other incentives
for an individual entitled to benefits under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.) not to enroll (or
to terminate enrollment) under a group health plan or a large
group health plan which would (in the case of enrollment) be a
primary plan (as defined in section 1862(b)(2)(A) of such Act).
``(2) Regulations.--The Secretary may by regulation adopt
such additional exceptions to the prohibition described in
paragraph (1) as the Secretary considers appropriate and such
paragraph shall be implemented taking into account the adoption
of such exceptions.
``(3) Agreements.--The Secretary of Veterans Affairs and
the Secretary of Health and Human Services may enter into
agreements to carry out this subsection. Any such agreement
shall provide that any expenses incurred by the Secretary of
Health and Human Services pertaining to carrying out this
subsection shall be reimbursed by the Secretary of Veterans
Affairs.
``(4) Group health plan defined.--In this subsection, the
term `group health plan' means a group health plan (as that
term is defined in section 5000(b)(1) of the Internal Revenue
Code of 1986 without regard to section 5000(d) of the Internal
Revenue Code of 1986).
``Sec. 2606. Receipt of health care through the Department
``(a) Contracts.--Any health insurance provider that provides a
health plan for which health insurance support may be provided under
this subchapter or subchapter II may enter into a contract with the
Veterans Accountable Care Organization under which the medical
personnel and facilities of the Veterans Accountable Care Organization
may be treated as a designated provider for purposes of such health
plan.
``(b) Cost of Care.--The cost, including any copayments, of any
health care or treatment provided to a veteran by the Veterans
Accountable Care Organization under a contact under subsection (a)
shall be determined by the Veterans Accountable Care Organization.
``(c) Mechanism.--The Board of Directors of the Veterans
Accountable Care Organization shall establish a mechanism through which
the Veterans Accountable Care Organization enters into contracts with
health insurance providers under subsection (a).
``Sec. 2607. Pharmacy benefits
``A veteran who is enrolled in the VetsCare Choice program or the
VetsCare Senior program may fill prescriptions at pharmacies of the
Department.
``SUBCHAPTER II--MEDICARE-ELIGIBLE VETERANS
``Sec. 2611. VetsCare Senior program: designation of recipients
``(a) In General.--The authorities for the provision of health
insurance support under this subchapter may be referred to as the
`VetsCare Senior program'.
``(b) Designation of Recipients.--Any veteran who receives health
insurance support under this subchapter may be referred to in the
receipt of support as participating in the `VetsCare Senior program'.
``(c) Relationship to Care by Veterans Accountable Care
Organization.--Health insurance support under this subchapter is in
addition to any health care or medical services furnished to a veteran
at a facility operated by the Veterans Accountable Care Organization.
``Sec. 2612. Medicare support
``(a) In General.--The Secretary shall provide health insurance
support to each covered veteran equal to the costs incurred by such
veteran for Medicare premiums and cost-sharing under parts A, B, C, and
D of title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.)
and for premiums and cost-sharing for Medicare supplemental policies
under section 1882 of such Act (42 U.S.C. 1395ss).
``(b) Relationship With VetsCare Federal.--Notwithstanding any
other provision of law, if a covered veteran is enrolled in the
VetsCare Federal program under section 1701A of this title, the
Medicare program under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) (or a Medicare supplemental policy under section
1882 of such Act (42 U.S.C. 1395ss)) shall be responsible for the
payment of costs for any health care received by an eligible individual
for a non-service connected disability up to the maximum amount
allowable under such program (or supplemental policy) for such health
care before the VetsCare Federal program is responsible for any such
costs, if applicable.
``(c) Availability of Payment or Reimbursement.--
``(1) Commencement.--Health insurance support under this
subchapter shall commence being available as follows:
``(A) With respect to covered veterans in priority
group 1, 2, or 3, on the first day of the first month
that begins on or after the date described in section
2(c)(3) of the Veterans Empowerment Act.
``(B) With respect to covered veterans in a
priority group other than 1, 2, or 3, on the first day
of the first month that begins on or after the date
that is 180 days after the commencement date under
paragraph (1).
``(2) Exclusion of certain veterans.--A covered veteran is
not eligible for health insurance support under this section if
such veteran--
``(A) first enrolls in the system of annual patient
enrollment established and operated by the Secretary
under section 1705(a) of this title on or after the
date of the enactment of this Act; and
``(B) is in priority group 7 or 8.
``(d) Definitions.--In this section:
``(1) The term `cost-sharing', in connection with the
receipt of health care and treatment under the Medicare program
under title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) or Medicare supplemental policies under section 1882 of
such Act (42 U.S.C. 1395ss), means any copayments, deductibles,
or other charges imposed, collected, or otherwise required by a
health insurance provider or health care provider in connection
with receipt of health care and treatment under such program or
supplemental policies.
``(2) The term `covered veteran' means a veteran receiving
benefits under the Medicare program under title XVIII of the
Social Security Act.
``(3) The term `priority group' means the priority groups
established by the Secretary for purposes of the enrollment of
veterans in the patient enrollment system under section 1705(a)
of this title.''.
(b) Clerical Amendment.--The table of chapters at the beginning
title 38, United States Code, is amended by inserting after the item
relating to chapter 24 the following new item:
``Chapter 26. Veterans Independence in Health Care.......... 2601''.
(c) Conforming Amendments.--
(1) Minimum essential coverage.--Section 5000A(f)(1)(A)(v)
of the Internal Revenue Code of 1986 is amended by striking
``or 18'' and inserting ``, 18, or 26''.
(2) Medicare part b.--
(A) Non-application of late enrollment penalty.--
Section 1839(b) of the Social Security Act (42 U.S.C.
1395r(b)) is amended, in the second sentence, by
inserting ``or months for which the individual can
demonstrate that the individual was enrolled in the
VetsCare Senior program under subchapter II of chapter
26 of title 38, United States Code'' after ``an
individual described in section 1837(k)(3)''.
(B) Special enrollment period.--Section 1837 of the
Social Security Act (42 U.S.C. 1395p) is amended by
adding at the end the following new subsection:
``(m)(1) In the case of any individual who is enrolled in the
VetsCare Senior program under subchapter II of chapter 26 of title 38,
United States Code at the time the individual is entitled to part A
under section 226 or section 226A and who is eligible to enroll but who
has elected not to enroll (or to be deemed enrolled) during the
individual's initial enrollment period, there shall be a special
enrollment period as specified by the Secretary.
``(2) In the case of an individual who enrolls during the special
enrollment period provided under paragraph (1), the coverage period
under this part shall begin on such date specified by the Secretary.
``(3) An individual may only enroll during the special enrollment
period provided under paragraph (1) one time during the individual's
lifetime.
``(4) The Secretary of Veterans Affairs shall collaborate with the
Secretary of Health and Human Services and the Commissioner of Social
Security to provide for the accurate identification of individuals
described in paragraph (1). The Secretary of Veterans Affairs shall
provide such individuals with notification with respect to this
subsection. The Secretary of Veterans Affairs shall collaborate with
the Secretary of Health and Human Services and the Commissioner of
Social Security to ensure appropriate follow up pursuant to any
notification provided under the preceding sentence.''.
SEC. 6. COORDINATION BETWEEN VETSCARE CHOICE PROGRAM AND ELIGIBILITY TO
MAKE CONTRIBUTIONS TO HEALTH SAVINGS ACCOUNTS.
(a) In General.--Section 223(c)(1)(B) of the Internal Revenue Code
of 1986 is amended by striking ``and'' at the end of clause (ii), by
striking the period at the end of clause (iii) and inserting ``, and'',
and by adding at the end the following new clause:
``(iv) coverage for health insurance
support under the VetsCare Choice program under
subchapter I of chapter 26 of title 38, United
States Code.''.
(b) Denial of Deduction for Amounts Not Includible in Gross
Income.--Subsection (b) of section 223 of the Internal Revenue Code of
1986 is amended by adding at the end the following new paragraph:
``(9) Amounts not includible in gross income.--No amount
paid to a health savings account of an individual shall be
taken into account under subsection (a) if (without regard to
this section) such amount, when paid to or on behalf of such
individual, is excluded from gross income of the individual or
exempt from taxation under any provision of Federal law.''.
(c) Effective Date.--The amendments made by this section shall
apply to amounts paid to a health savings account (as defined in
section 223(d) of the Internal Revenue Code of 1986) after the date of
the enactment of this Act.
SEC. 7. PUBLICATION OF HEALTH CARE INFORMATION.
(a) In General.--The Secretary of Veterans Affairs shall make
available to the public on an ongoing basis information about the
operations of the Veterans Health Administration in a manner similar to
publication of information under the Medicare Accountable Care
Organization program to better monitor and support continuous
improvement in the Veterans Health Administration.
(b) Elements.--The information published under subsection (a) shall
include information about the operations of the Veterans Health
Administration, including metrics regarding quality, safety, patient
experience, timeliness, and cost-effectiveness.
SEC. 8. VETERANS' ELIGIBILITY FOR LONG-TERM CARE INSURANCE.
(a) In General.--Section 9001 of title 5, United States Code, is
amended--
(1) by redesignating paragraphs (5) through (10) as (6)
through (11), respectively;
(2) by inserting after paragraph (4) the following:
``(5) Veteran.--The term `veteran' has the same meaning
given the term in section 101(2) of title 38, United States
Code.'';
(3) in paragraph (6), as so redesignated--
(A) in subparagraph (A), by striking ``or (4).''
and inserting ``(4), or (5).'';
(B) in subparagraph (B), by striking ``(1) or
(3).'' and inserting ``(1), (3), or (5).'';
(C) in subparagraph (C), by striking ``or (4)'' and
inserting ``(4), or (5)''; and
(D) in subparagraph (D), by striking ``or (4)'' and
inserting ``(4), or (5)'';
(4) in paragraph (7), as so redesignated, by striking ``or
(5).'' and inserting ``(5), or (6).''; and
(5) in paragraph (11), as so redesignated--
(A) in subparagraph (C), by striking ``Commerce;
and'' and inserting ``Commerce;'';
(B) in subparagraph (D), by striking ``Services.''
and inserting ``Services; and''; and
(C) by inserting after subparagraph (D):
``(E) with respect to a veteran, the Secretary of
Veterans Affairs.''.
(b) Technical and Conforming Amendments.--Title 5, United States
Code, is amended as follows:
(1) Section 9002 is amended--
(A) in subsection (a), by striking ``or (5)'' and
inserting ``(5), or (6)''; and
(B) in subsection (e)--
(i) in paragraph (2), by striking ``or
(4)'' and inserting ``(4), or (5)''; and
(ii) in paragraph (4), by striking
``section 9001(9)'' and inserting ``section
9001(10)''.
(2) Section 9004(d) is amended by inserting after
``withheld under subsection (b)'' the following: ``, who is an
enrollee by virtue of being a veteran described in section
9001(5) of this title,''.
(3) Section 9008(c) is amended by striking ``(3) or (4)''
and inserting ``(3), (4), or (5)''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Veterans' Affairs, and in addition to the Committees on Ways and Means, Oversight and Government Reform, Energy and Commerce, and Armed Services, 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 Veterans' Affairs, and in addition to the Committees on Ways and Means, Oversight and Government Reform, Energy and Commerce, and Armed Services, 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 Veterans' Affairs, and in addition to the Committees on Ways and Means, Oversight and Government Reform, Energy and Commerce, and Armed Services, 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 Veterans' Affairs, and in addition to the Committees on Ways and Means, Oversight and Government Reform, Energy and Commerce, and Armed Services, 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 Veterans' Affairs, and in addition to the Committees on Ways and Means, Oversight and Government Reform, Energy and Commerce, and Armed Services, 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.
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Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Military Personnel.