,i  #aacth ,,congress  #ast ,session    
,h4 ,r4 #biec  ,,in ,,the ,,house ,,of  
,,representatives  ,august #a1 #bjac    
,mr4 ,michaud introduced the following  
bill2 which was referred to the         
,committee on ,ways and ,means1 and in  
addition to the ,committees on ,energy  
and ,commerce and ,veterans' ,affairs1  
for a period to be subsequently         
determined by the ,speaker1 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      
conditions4  #a4 ,short title ,this ,act
 may be cited as the ,medicare ,,va     
,reimbursement ,act of #bjac4  #b4      
,establishment of ,medicare subvention  
for veterans  7a7 ,in general ,section  
#ahfb of the ,social ,security ,act 7#db
 ,u4,s4,c4 #aciey7 is amended by adding 

at the end the following new subsection3
  7p7 ,medicare subvention for veterans 
7#a7 ,establishment ,the ,secretary of  
,health and ,human ,services1 in        
cooperation with the ,secretary of      
,veterans ,affairs1 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 ,affairs1 from the        
,federal ,hospital ,insurance ,trust    
,fund established in section #ahag and  
the ,federal ,supplementary ,medical    
,insurance ,trust ,fund established in  
section #ahda1 for an item or service   
that--  7,a7 is furnished to a          
,medicare-eligible veteran by a         
,department of ,veterans ,affairs       
medical facility for the treatment of a 
non-service-connected condition2 and    
7,b7 is covered under this title or is  
determined to be medically necessary by 
the ,secretary of ,veterans ,affairs4   
7#b7 ,memorandum of understanding  7,a7 

,in general ,not later than #f months   
after the date of the enactment of this 
subsection1 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 program4   
7,b7 ,contract elements ,the memorandum 
of understanding under subparagraph 7,a7
 shall contain the following3  7i7      
,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 ,affairs4  7ii7 
,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 ,services4  7iii7    
,data sharing agreement ,an agreement on
 data sharing1 including--  7,i7        
identification of the data exchanges    

that each ,secretary will need to       
develop1 maintain1 or provide access to1
 for purposes of the ,medicare ,,va     
reimbursement program2 and  7,,ii7      
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 program4  7iv7 ,payment   
rate ,details of the payment rate to be 
used consistent with paragraph 7#c7 for 
reimbursements made under the ,medicare 
,,va reimbursement program4  7v7        
,performance measures ,an agreement on  
performance measures and performance    
targets to be used to demonstrate the   
impact of the ,medicare ,,va            
reimbursement program4  7vi7 ,additional
 terms ,any additional terms deemed     
necessary by the administering          

,secretaries4  7,c7 ,no maintenance of  
effort requirement ,for purposes of the 
,medicare ,,va reimbursement program1   
the ,secretary of ,veterans ,affairs    
shall not be required to meet 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 ,services4  7#c7     
,payments based on regular ,medicare    
payment rates  7,a7 ,amount ,subject to 
the succeeding provisions of this       
paragraph1 the ,secretary of ,health and
 ,human ,services shall reimburse the   
,secretary of ,veterans ,affairs--  7i7 
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 condition1 at a   
rate that is not less than #ajj percent 
of the amounts that otherwise would be  
payable under this title1 on a          

fee-for-service basis1 for such item or 
service if the ,department of ,veterans 
,affairs medical facility were a        
provider of services1 were participating
 in the ,medicare program1 and imposed  
charges for such item or service2 and   
7ii7 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 condition1 if the 
,secretary of ,veterans ,affairs        
determines that such item or service is 
medically necessary1 at a rate          
determined by the ,secretary of ,health 
and ,human ,services in consultation    
with the ,secretary of ,veterans        
,affairs4  7,b7 ,no arbitrary limitation
 on amount ,subject to the requirements 
of this subsection1 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        

program4  7,c7 ,exclusion of certain    
amounts ,in computing the amount of     
payment under subparagraph 7,a71 the    
following amounts shall be excluded3    
7i7 ,disproportionate share hospital    
adjustment ,any amount attributable to  
an adjustment under section             
#ahhf7;d77#e77;,f74  7ii7 ,direct       
graduate medical education payments ,any
 amount attributable to a payment under 
section #ahhf7;h74  7iii7 ,indirect     
medical education adjustment ,any amount
 attributable to the adjustment under   
section #ahhf7;d77#e77;,b74  7iv7       
,capital payments ,any amounts          
attributable to payments for            
capital-related costs under section     
#ahhf7;g74  7,d7 ,periodic payments from
 ,medicare trust funds ,reimbursements  
under this paragraph shall be made--    
7i7 on a periodic basis consistent with 
the periodicity of payments under this  
title2 and  7ii7 from the ,federal      
,hospital ,insurance ,trust ,fund       
established in section #ahag and the    

,federal ,supplementary ,medical        
,insurance ,trust ,fund established in  
section #ahda4  7,e7 ,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 #agbi;,a of   
title #ch1 ,united ,states ,code4  7#d7 
,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 deductible1  
coinsurance1 and cost-sharing           
requirements under this title4  7#e7    
,waiver of prohibition on payments to   
,federal providers of services ,the     
prohibition of payments to ,federal     
providers of services under sections    
#ahad7;c71 #ahce7;d71 and #ahfb7;a77#c7 

shall not apply to items and services   
provided under this subsection4  7#f7   
,rules of construction ,nothing in this 
subsection shall be construed--  7,a7 as
 prohibiting the ,inspector ,general of 
the ,department of ,health and ,human   
,services from investigating any matters
 regarding the expenditure of funds     
under this subsection1 including        
compliance with the provisions of this  
title and all other relevant laws2  7,b7
 as adding or requiring additional      
criteria for eligibility for health care
 benefits furnished to veterans by the  
,secretary of ,veterans ,affairs1 as    
established under chapter #ag of title  
#ch1 ,united ,states ,code2 or  7,c7    
subject to the requirements of title    
#ch1 ,united ,states ,code1 as limiting 
a veteran's ability to access such      
benefits1 regardless of the veteran's   
status as a ,medicare-eligible veteran4 
7#g7 ,annual reports ,not later than one
 year after the date of implementing the
 ,medicare ,,va reimbursement program   

and annually thereafter1 the            
administering ,secretaries shall submit 
to the ,congress a report containing the
 following3  7,a7 ,the number of        
,medicare-eligible veterans who elect to
 receive health care at a ,department of
 ,veterans ,affairs medical facility4   
7,b7 ,the total amount of reimbursements
 made under the program from the        
,federal ,hospital ,insurance ,trust    
,fund established in section #ahag and  
the ,federal ,supplementary ,medical    
,insurance ,trust ,fund established in  
section #ahda to the ,department of     
,veterans ,affairs ,medical ,care       
,collections ,fund established under    
section #agbi;,a of title #ch1 ,united  
,states ,code4  7,c7 ,the number and    
types of items and services provided to 
,medicare-eligible veterans by          
,department of ,veterans ,affairs       
medical facilities under the program4   
7,d7 ,an accounting of the manner in    
which the ,department of ,veterans      
,affairs expended funds received through

 reimbursements under the program4  7,e7
 ,a detailed description of any changes 
made to the memorandum of understanding 
under paragraph 7#b74  7,f7 ,a          
comparison of the performance data with 
the performance targets under paragraph 
7#b77;,b77v74  7,g7 ,any other data on  
the program that the administering      
,secretaries determine are appropriate4 
7#h7 ,definitions ,for purposes of this 
subsection3  7,a7 ,administering        
,secretaries ,the term administering    
,secretaries means the ,secretary of    
,health and ,human ,services and the    
,secretary of ,veterans ,affairs acting 
jointly4  7,b7 ,medicare-eligible       
veteran ,the term ,medicare-eligible    
veteran means an individual who is a    
veteran 7as defined in section #aja7b7  
of title #ch1 ,united ,states ,code7 who
 is eligible for care and services under
 section #agje7;a7 of title #ch1 ,united
 ,states ,code and who--  7i7 is        
entitled to1 or enrolled for1 benefits  
under part ,a2 or  7ii7 is enrolled for 

benefits under part ,b4  7,c7           
,non-service connected condition ,the   
term non-service-connected condition    
means a disease or condition that is    
non-service-connected 7as defined in    
section #aja7ag7 of title #ch1 ,united  
,states ,code74  7,d7 ,department of    
,veterans ,affairs medical facility ,the
 term ,department of ,veterans ,affairs 
medical facility means a medical        
facility 7as defined in section #haja7c7
 of title #ch1 ,united ,states ,code71  
alone or in conjunction with other      
facilities under the jurisdiction of the
 ,secretary of ,veterans ,affairs4  4   
7b7 ,conforming amendment ,section #agbi
 of title #ch1 ,united ,states ,code1 is
 amended by adding at the end the       
following new subsection3  7j7 ,in any  
case in which a ,medicare-eligible      
veteran 7as defined in section          
#ahfb7p77#h77;,b7 of the ,social        
,security ,act 7#db ,u4,s4,c4           
#aciey7p77#h77;,b777 is furnished care  
or services under this chapter for a    

non-service-connected condition 7as     
defined in section #ahfb7p77#h77;,c7 of 
such ,act7 the ,secretary shall--  7#a7 
seek reimbursement from the ,secretary  
of ,health and ,human ,services for such
 care and services under section        
#ahfb7p7 of such ,act2 and  7#b7 collect
 any applicable deductible1 coinsurance1
 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 7or the provider of the care or 
services7 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 ,states4  4    
#c4 ,,gao report  7a7 ,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 
period1 the ,comptroller ,general of the
 ,united ,states shall submit to the    

,congress a report on the ,medicare ,,va
 reimbursement program established under
 section #ahfb7p7 of the ,social        
,security ,act1 as added by section #b4 
7b7 ,contents ,the report under         
subsection 7a7 shall contain an analysis
 of--  7#a7 the impact of the ,medicare 
,,va reimbursement program on the       
,federal ,hospital ,insurance ,trust    
,fund established in section #ahag of   
the ,social ,security ,act 7#db         
,u4,s4,c4 #acie;i7 and the ,federal     
,supplementary ,medical ,insurance      
,trust ,fund established in section     
#ahda of such ,act 7#db ,u4,s4,c4       
#aciet72  7#b7 whether                  
,medicare-eligible veterans 7as defined 
in section #ahfb7p77#h77;,b7 of such    
,act7 experience improved access to     
health care as a result of the program2 
7#c7 whether ,medicare-eligible veterans
 experience a change in the quality of  
care that they receive as a result of   
this program2  7#d7 the impact of the   
program on local health care providers  

and ,medicare beneficiaries in the      
communities surrounding ,department of  
,veterans ,affairs medical facilities2  
and  7#e7 any additional issues deemed  
appropriate by the ,comptroller ,general
 of the ,united ,states4  #d4 ,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     
#ahfb7p7 of the ,social ,security ,act1 
as added by section #b7;a74