,i  #aac? ,,congress  #a/ ,session  ,h4 
,r4 #biec  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,augu/ #a1 #bjac ,mr4 
,mi*aud introduc$ ! foll[+ bill2 :i* 0  
ref]r$ to ! ,committee on ,ways &       
,means1 & 9 addition to ! ,committees on
 ,en]gy & ,comm]ce & ,vet]ans' ,affairs1
 = a p]iod to be subsequ5tly det]m9$ by 
! ,speak]1 9 ea* case = consid]ation (  
su* provisions z fall )9 ! jurisdiction 
( ! committee conc]n$  ,a ,,bill  ,to   
provide ,m$ic>e paym5ts to ,dep>tm5t (  
,vet]ans ,affairs m$ical facilities =   
items & s]vices provid$ to              
,m$ic>e-eligible vet]ans =              
non-s]vice-connect$ conditions4  #a4    
,%ort title ,?is ,act may be cit$ z !   
,m$ic>e ,,va ,reimbursem5t ,act ( #bjac4
  #b4 ,e/abli%m5t ( ,m$ic>e subv5tion = 
vet]ans  7a7 ,9 g5]al ,section #ahfb ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#aciey7 is am5d$ by add+ at ! end !     
foll[+ new subsection3  7p7 ,m$ic>e     
subv5tion = vet]ans  7#a7 ,e/abli%m5t ,!
 ,secret>y ( ,heal? & ,human ,s]vices1 9

 coop]ation ) ! ,secret>y ( ,vet]ans    
,affairs1 %all e/abli% a program to be  
kn[n z ! ,m$ic>e ,,va reimbursem5t      
program "u :i* ! ,secret>y ( ,heal? &   
,human ,s]vices %all reimburse !        
,secret>y ( ,vet]ans ,affairs1 f !      
,f$]al ,hospital ,insurance ,tru/ ,fund 
e/abli%$ 9 section #ahag & ! ,f$]al     
,supplem5t>y ,m$ical ,insurance ,tru/   
,fund e/abli%$ 9 section #ahda1 = an    
item or s]vice t--  7,a7 is furni%$ to a
 ,m$ic>e-eligible vet]an by a ,dep>tm5t 
( ,vet]ans ,affairs m$ical facility = ! 
treatm5t ( a non-s]vice-connect$        
condition2 &  7,b7 is cov]$ "u ?is title
 or is det]m9$ to be m$ically necess>y  
by ! ,secret>y ( ,vet]ans ,affairs4     
7#b7 ,memor&um ( und]/&+  7,a7 ,9 g5]al 
,n lat] ?an #f mon?s aft] ! date ( !    
enactm5t ( ?is subsection1 ! ,secret>y (
 ,heal? & ,human ,s]vices %all ent] a   
memor&um ( und]/&+ ) ! ,secret>y (      
,vet]ans ,affairs conc]n+ ! adm9i/ration
 ( ! ,m$ic>e ,,va reimbursem5t program4 
7,b7 ,contract elem5ts ,! memor&um (    

und]/&+ "u subp>agraph 7,a7 %all conta9 
! foll[+3  7i7 ,frequ5cy ( reimbursem5t 
,an agreem5t on h[ (t5 reimbursem5ts w  
be made by ! ,secret>y ( ,heal? & ,human
 ,s]vices to ! ,secret>y ( ,vet]ans     
,affairs4  7ii7 ,bill+ sy/em ,an        
agreem5t on ! details ( ! bill+ sy/em t 
w be us$ by ! ,secret>y ( ,vet]ans      
,affairs to make claims = reimbursem5t f
 ! ,secret>y ( ,heal? & ,human ,s]vices4
  7iii7 ,data %>+ agreem5t ,an agreem5t 
on data %>+1 includ+--  7,i7            
id5tification ( ! data ex*anges t ea*   
,secret>y w ne$ to develop1 ma9ta91 or  
provide access to1 = purposes ( !       
,m$ic>e ,,va reimbursem5t program2 &    
7,,ii7 v]ification ( data demon/rat+ t  
an item or s]vice 0 provid$ by a        
,dep>tm5t ( ,vet]ans ,affairs m$ical    
facility to a ,m$ic>e-eligible vet]an = 
a non-s]vice-connect$ condition be=e !  
,secret>y ( ,heal? & ,human ,s]vices    
provides = reimbursem5t = su* item or   
s]vice "u ! ,m$ic>e ,,va reimbursem5t   
program4  7iv7 ,paym5t rate ,details ( !

 paym5t rate to be us$ consi/5t )       
p>agraph 7#c7 = reimbursem5ts made "u ! 
,m$ic>e ,,va reimbursem5t program4  7v7 
,p]=mance measures ,an agreem5t on      
p]=mance measures & p]=mance t>gets to  
be us$ to demon/rate ! impact ( !       
,m$ic>e ,,va reimbursem5t program4  7vi7
 ,additional t]ms ,any additional t]ms  
deem$ necess>y by ! adm9i/]+            
,secret>ies4  7,c7 ,no ma9t5ance ( ef=t 
requirem5t ,= purposes ( ! ,m$ic>e ,,va 
reimbursem5t program1 ! ,secret>y (     
,vet]ans ,affairs %all n be requir$ to  
meet a requirem5t t ! ,secret>y (       
,vet]ans ,affairs ma9ta9 a c]ta9 level (
 sp5d+ 9 ord] to receive reimbursem5t f 
! ,secret>y ( ,heal? & ,human ,s]vices4 
7#c7 ,paym5ts bas$ on regul> ,m$ic>e    
paym5t rates  7,a7 ,am\nt ,subject to ! 
succe$+ provisions ( ?is p>agraph1 !    
,secret>y ( ,heal? & ,human ,s]vices    
%all reimburse ! ,secret>y ( ,vet]ans   
,affairs--  7i7 = an item or s]vice t is
 cov]$ "u ?is title & is provid$ to a   
,m$ic>e-eligible vet]an by a ,dep>tm5t (

 ,vet]ans ,affairs m$ical facility = !  
treatm5t ( a non-s]vice-connect$        
condition1 at a rate t is n less ?an    
#ajj p]c5t ( ! am\nts t o!rwise w\ld be 
payable "u ?is title1 on a fee-=-s]vice 
basis1 = su* item or s]vice if !        
,dep>tm5t ( ,vet]ans ,affairs m$ical    
facility 7 a provid] ( s]vices1 7       
p>ticipat+ 9 ! ,m$ic>e program1 & impos$
 *>ges = su* item or s]vice2 &  7ii7 =  
an item or s]vice t is n cov]$ "u ?is   
title t is provid$ to a ,m$ic>e-eligible
 vet]an by a ,dep>tm5t ( ,vet]ans       
,affairs m$ical facility = ! treatm5t ( 
a non-s]vice-connect$ condition1 if !   
,secret>y ( ,vet]ans ,affairs det]m9es t
 su* item or s]vice is m$ically         
necess>y1 at a rate det]m9$ by !        
,secret>y ( ,heal? & ,human ,s]vices 9  
consultation ) ! ,secret>y ( ,vet]ans   
,affairs4  7,b7 ,no arbitr>y limitation 
on am\nt ,subject to ! requirem5ts ( ?is
 subsection1 ! ,secret>y ( ,heal? &     
,human ,s]vices may n impose an annual  
cap or o!r limit on ! am\nt (           

reimbursem5t made "u ! ,m$ic>e ,,va     
reimbursem5t program4  7,c7 ,exclusion (
 c]ta9 am\nts ,9 comput+ ! am\nt (      
paym5t "u subp>agraph 7,a71 ! foll[+    
am\nts %all be exclud$3  7i7            
,disproportionate %>e hospital adju/m5t 
,any am\nt attributable to an adju/m5t  
"u section #ahhf7;d77#e77;,f74  7ii7    
,direct graduate m$ical education       
paym5ts ,any am\nt attributable to a    
paym5t "u section #ahhf7;h74  7iii7     
,indirect m$ical education adju/m5t ,any
 am\nt attributable to ! adju/m5t "u    
section #ahhf7;d77#e77;,b74  7iv7       
,capital paym5ts ,any am\nts            
attributable to paym5ts = capital-relat$
 co/s "u section #ahhf7;g74  7,d7       
,p]iodic paym5ts f ,m$ic>e tru/ funds   
,reimbursem5ts "u ?is p>agraph %all be  
made--  7i7 on a p]iodic basis consi/5t 
) ! p]iodicity ( paym5ts "u ?is title2 &
  7ii7 f ! ,f$]al ,hospital ,insurance  
,tru/ ,fund e/abli%$ 9 section #ahag & !
 ,f$]al ,supplem5t>y ,m$ical ,insurance 
,tru/ ,fund e/abli%$ 9 section #ahda4   

7,e7 ,cr$it+ ( paym5ts ,any paym5t made 
to ! ,dep>tm5t ( ,vet]ans ,affairs "u   
?is subsection %all be deposit$ 9 !     
,dep>tm5t ( ,vet]ans ,affairs ,m$ical   
,c>e ,collections ,fund e/abli%$ "u     
section #agbi;,a ( title #ch1 ,unit$    
,/ates ,code4  7#d7 ,co/-%>+ requirem5ts
 ,! ,secret>y ( ,heal? & ,human ,s]vices
 %all r$uce ! am\nt ( reimbursem5t to ! 
,secret>y ( ,vet]ans ,affairs = items & 
s]vices "u ! ,m$ic>e ,,va reimbursem5t  
program by am\nts attributable to       
applicable d$uctible1 co9surance1 &     
co/-%>+ requirem5ts "u ?is title4  7#e7 
,waiv] ( prohibition on paym5ts to      
,f$]al provid]s ( s]vices ,! prohibition
 ( paym5ts to ,f$]al provid]s ( s]vices 
"u sections #ahad7;c71 #ahce7;d71 &     
#ahfb7;a77#c7 %all n apply to items &   
s]vices provid$ "u ?is subsection4  7#f7
 ,rules ( con/ruction ,no?+ 9 ?is       
subsection %all be con/ru$--  7,a7 z    
prohibit+ ! ,inspector ,g5]al ( !       
,dep>tm5t ( ,heal? & ,human ,s]vices f  
inve/igat+ any matt]s reg>d+ !          

exp5diture ( funds "u ?is subsection1   
includ+ compliance ) ! provisions ( ?is 
title & all o!r relevant laws2  7,b7 z  
add+ or requir+ additional crit]ia =    
eligibility = heal? c>e b5efits furni%$ 
to vet]ans by ! ,secret>y ( ,vet]ans    
,affairs1 z e/abli%$ "u *apt] #ag (     
title #ch1 ,unit$ ,/ates ,code2 or  7,c7
 subject to ! requirem5ts ( title #ch1  
,unit$ ,/ates ,code1 z limit+ a vet]an's
 ability to access su* b5efits1         
reg>dless ( ! vet]an's /atus z a        
,m$ic>e-eligible vet]an4  7#g7 ,annual  
reports ,n lat] ?an "o ye> aft] ! date (
 implem5t+ ! ,m$ic>e ,,va reimbursem5t  
program & annually !reaft]1 ! adm9i/]+  
,secret>ies %all submit to ! ,congress a
 report conta9+ ! foll[+3  7,a7 ,! numb]
 ( ,m$ic>e-eligible vet]ans :o elect to 
receive heal? c>e at a ,dep>tm5t (      
,vet]ans ,affairs m$ical facility4  7,b7
 ,! total am\nt ( reimbursem5ts made "u 
! program f ! ,f$]al ,hospital          
,insurance ,tru/ ,fund e/abli%$ 9       
section #ahag & ! ,f$]al ,supplem5t>y   

,m$ical ,insurance ,tru/ ,fund e/abli%$ 
9 section #ahda to ! ,dep>tm5t (        
,vet]ans ,affairs ,m$ical ,c>e          
,collections ,fund e/abli%$ "u section  
#agbi;,a ( title #ch1 ,unit$ ,/ates     
,code4  7,c7 ,! numb] & types ( items & 
s]vices provid$ to ,m$ic>e-eligible     
vet]ans by ,dep>tm5t ( ,vet]ans ,affairs
 m$ical facilities "u ! program4  7,d7  
,an acc\nt+ ( ! mann] 9 :i* ! ,dep>tm5t 
( ,vet]ans ,affairs exp5d$ funds receiv$
 ?r\gh reimbursem5ts "u ! program4  7,e7
 ,a detail$ description ( any *anges    
made to ! memor&um ( und]/&+ "u p>agraph
 7#b74  7,f7 ,a comp>ison ( ! p]=mance  
data ) ! p]=mance t>gets "u p>agraph    
7#b77;,b77v74  7,g7 ,any o!r data on !  
program t ! adm9i/]+ ,secret>ies det]m9e
 are appropriate4  7#h7 ,def9itions ,=  
purposes ( ?is subsection3  7,a7        
,adm9i/]+ ,secret>ies ,! t]m adm9i/]+   
,secret>ies means ! ,secret>y ( ,heal? &
 ,human ,s]vices & ! ,secret>y (        
,vet]ans ,affairs act+ jo9tly4  7,b7    
,m$ic>e-eligible vet]an ,! t]m          

,m$ic>e-eligible vet]an means an        
individual :o is a vet]an 7z def9$ 9    
section #aja7b7 ( title #ch1 ,unit$     
,/ates ,code7 :o is eligible = c>e &    
s]vices "u section #agje7;a7 ( title    
#ch1 ,unit$ ,/ates ,code & :o--  7i7 is 
entitl$ to1 or enroll$ =1 b5efits "u "p 
,a2 or  7ii7 is enroll$ = b5efits "u "p 
,b4  7,c7 ,non-s]vice connect$ condition
 ,! t]m non-s]vice-connect$ condition   
means a disease or condition t is       
non-s]vice-connect$ 7z def9$ 9 section  
#aja7ag7 ( title #ch1 ,unit$ ,/ates     
,code74  7,d7 ,dep>tm5t ( ,vet]ans      
,affairs m$ical facility ,! t]m         
,dep>tm5t ( ,vet]ans ,affairs m$ical    
facility means a m$ical facility 7z     
def9$ 9 section #haja7c7 ( title #ch1   
,unit$ ,/ates ,code71 alone or 9        
conjunction ) o!r facilities "u !       
jurisdiction ( ! ,secret>y ( ,vet]ans   
,affairs4  4  7b7 ,con=m+ am5dm5t       
,section #agbi ( title #ch1 ,unit$      
,/ates ,code1 is am5d$ by add+ at ! end 
! foll[+ new subsection3  7j7 ,9 any    

case 9 :i* a ,m$ic>e-eligible vet]an 7z 
def9$ 9 section #ahfb7p77#h77;,b7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciey7p77#h77;,b777 is furni%$ c>e or  
s]vices "u ?is *apt] = a                
non-s]vice-connect$ condition 7z def9$ 9
 section #ahfb7p77#h77;,c7 ( su* ,act7 !
 ,secret>y %all--  7#a7 seek            
reimbursem5t f ! ,secret>y ( ,heal? &   
,human ,s]vices = su* c>e & s]vices "u  
section #ahfb7p7 ( su* ,act2 &  7#b7    
collect any applicable d$uctible1       
co9surance1 or o!r co/-%>+ am\nt requir$
 "u title ,,xviii ( ! ,social ,security 
,act f ! vet]an or f a ?ird p>ty to !   
ext5t t ! vet]an 7or ! provid] ( ! c>e  
or s]vices7 w\ld be eligible to receive 
paym5t = su* c>e or s]vices f su* ?ird  
p>ty if ! c>e or s]vices _h n be5       
furni%$ by a dep>tm5t or ag5cy ( !      
,unit$ ,/ates4  4  #c4 ,,gao report  7a7
 ,9 g5]al ,n lat] ?an ! la/ day ( !     
?ree-ye> p]iod beg9n+ on ! date ( !     
enactm5t ( ?is ,act & ! la/ date ( ea*  
subsequ5t ?ree-ye> p]iod1 ! ,comptroll] 

,g5]al ( ! ,unit$ ,/ates %all submit to 
! ,congress a report on ! ,m$ic>e ,,va  
reimbursem5t program e/abli%$ "u section
 #ahfb7p7 ( ! ,social ,security ,act1 z 
add$ by section #b4  7b7 ,cont5ts ,!    
report "u subsection 7a7 %all conta9 an 
analysis (--  7#a7 ! impact ( ! ,m$ic>e 
,,va reimbursem5t program on ! ,f$]al   
,hospital ,insurance ,tru/ ,fund        
e/abli%$ 9 section #ahag ( ! ,social    
,security ,act 7#db ,u4,s4,c4 #acie;i7 &
 ! ,f$]al ,supplem5t>y ,m$ical          
,insurance ,tru/ ,fund e/abli%$ 9       
section #ahda ( su* ,act 7#db ,u4,s4,c4 
#aciet72  7#b7 :e!r ,m$ic>e-eligible    
vet]ans 7z def9$ 9 section              
#ahfb7p77#h77;,b7 ( su* ,act7 exp]i5ce  
improv$ access to heal? c>e z a result (
 ! program2  7#c7 :e!r ,m$ic>e-eligible 
vet]ans exp]i5ce a *ange 9 ! quality (  
c>e t !y receive z a result ( ?is       
program2  7#d7 ! impact ( ! program on  
local heal? c>e provid]s & ,m$ic>e      
b5efici>ies 9 ! communities surr\nd+    
,dep>tm5t ( ,vet]ans ,affairs m$ical    

facilities2 &  7#e7 any additional      
issues deem$ appropriate by !           
,comptroll] ,g5]al ( ! ,unit$ ,/ates4   
#d4 ,s5se ( ,congress ,x is ! s5se ( !  
,congress t ! am\nt ( funds appropriat$ 
to ! ,dep>tm5t ( ,vet]ans ,affairs =    
m$ical c>e 9 any fiscal ye> beg9n+ on or
 aft] ! date ( ! enactm5t ( ?is ,act    
%\ld n be r$uc$ z a result ( !          
implem5tation ( ! ,m$ic>e ,,va          
reimbursem5t program "u section #ahfb7p7
 ( ! ,social ,security ,act1 z add$ by  
section #b7;a74