,,ii  #aadth ,,congress  #ast ,session  
,s4 #bdag  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,december #ag1 
#bjae ,mr4 ,thune 7for himself and ,mr4 
,rounds7 introduced the following bill2 
which was read twice and referred to the
 ,committee on ,indian ,affairs  ,a     
,,bill  ,to amend the ,indian ,health   
,care ,improvement ,act to allow the    
,indian ,health ,service to cover the   
cost of a copayment of an ,indian or    
,alaska ,native veteran receiving       
medical care or services from the       
,department of ,veterans ,affairs1 and  
for other purposes4  #a4 ,short title   
,this ,act may be cited as the ,tribal  
,veterans ,health ,care ,enhancement    
,act4  #b4 ,copayments for ,indian      
veterans receiving certain medical      
services  7a7 ,liability for payment    
,section #bbb7;a7 of the ,indian ,health
 ,care ,improvement ,act 7#be ,u4,s4,c4 
#afbau7a77 is amended--  7#a7 by        
striking ,a patient who and inserting   
the following3  7#a7 ,in general        

,subject to paragraph 7#b71 a patient   
who  2 and  7#b7 by adding at the end   
the following3  7#b7 ,veterans ,affairs 
copayments ,the ,service may pay1 in    
accordance with section #dje7;d71 the   
cost of a copayment assessed by the     
,department of ,veterans ,affairs to an 
eligible ,indian veteran 7as defined in 
section #dje7;d77#a774  4  7b7 ,sharing 
arrangements with ,federal agencies     
,section #dje of the ,indian ,health    
,care ,improvement ,act 7#be ,u4,s4,c4  
#afde7 is amended-- 7#a7 by             
redesignating subsection 7d7 as         
subsection 7e72 and  7#b7 by inserting  
after subsection 7c7 the following3  7d7
 ,payments for eligible ,indian veterans
 receiving medical services at ,,va     
facilities  7#a7 ,definition of eligible
 ,indian veteran ,in this subsection1   
the term eligible ,indian veteran means 
an ,indian or ,alaska ,native veteran   
who receives any medical care or service
 that is--  7,a7 authorized on referral 
by the ,service2 and  7,b7 administered 

at a facility of the ,department of     
,veterans ,affairs4  7#b7 ,payment by   
,service ,notwithstanding any other     
provision of law1 the ,service may cover
 the cost of any copayment assessed by  
the ,department of ,veterans ,affairs to
 an eligible ,indian veteran receiving  
services authorized under the           
,purchased_/,referred ,care program4    
7#c7 ,authorization to accept funds     
,notwithstanding section #djg7;c7 of    
this ,act1 section #bija7;b7 of the     
,patient ,protection and ,affordable    
,care ,act 7#be ,u4,s4,c4 #afbc7;b771 or
 any other provision of law1 the        
,secretary of ,veterans ,affairs may    
accept a payment from the ,service under
 paragraph 7#b74  4  7c7 ,memorandum of 
understanding2 report  7#a7 ,definitions
 ,in this subsection3 7,a7 ,appropriate 
committees of ,congress ,the term       
appropriate committees of ,congress     
means--  7i7 in the ,senate-- 7,i7 the  
,committee on ,veterans' ,affairs2 and  
7,,ii7 the ,committee on ,indian        

,affairs2 and  7ii7 in the ,house of    
,representatives--  7,i7 the ,committee 
on ,veterans' ,affairs2 and  7,,ii7 the 
,committee on ,natural ,resources4  7,b7
 ,beneficiary of the ,service ,the term 
beneficiary of the ,service means an    
individual who is eligible for          
assistance from the ,service4  7,c7     
,director ,the term ,director means the 
,director of the ,service4  7,d7 ,indian
 tribe ,the term ,indian tribe has the  
meaning given that term in section #d of
 the ,indian ,self-,determination and   
,education ,assistance ,act 7#be        
,u4,s4,c4 #dej;b74  7,e7 ,secretary ,the
 term ,secretary means the ,secretary of
 ,veterans ,affairs4  7,f7 ,service ,the
 term ,service means the ,indian ,health
 ,service4  7#b7 ,memorandum of         
understanding  7,a7 ,in general         
,notwithstanding any other provision of 
law1 except as provided in subparagraph 
7,c71 the ,secretary and the ,director  
shall enter into a memorandum of        
understanding1 in consultation with     

,indian tribes to be impacted by the    
memorandum of understanding 7on a       
national or regional basis71 that       
authorizes the ,director to pay to the  
,secretary any copayments owed to the   
,department of ,veterans ,affairs by    
veterans who are beneficiaries of the   
,service for services rendered by the   
,department of ,veterans ,affairs       
7including any services rendered under a
 contract with a non-,department health 
care provider7 to those veterans        
pursuant to a referral from a facility  
of the ,service under the               
,purchased_/,referred ,care program of  
the ,service4  7,b7 ,factors for        
consideration ,in entering into a       
memorandum of understanding under       
subparagraph 7,a71 the ,secretary and   
the ,director shall take into           
consideration any findings contained in 
the report under paragraph 7#c74  7,c7  
,exception ,the ,secretary and the      
,director shall not be required to enter
 into a memorandum of understanding     

under subparagraph 7,a7 if the          
,secretary and the ,director jointly    
certify to the appropriate committees of
 ,congress that such a memorandum of    
understanding would--  7i7 decrease the 
quality of health care provided to      
veterans who are beneficiaries of the   
,service2  7ii7 impede the access of    
those veterans to health care2 or  7iii7
 substantially decrease the quality of1 
or access to1 health care by individuals
 receiving health care from the         
,department of ,veterans ,affairs or    
beneficiaries of the ,service4  7#c7    
,report ,not later than #de days after  
the date of enactment of this ,act1 the 
,secretary and the ,director shall      
submit to the appropriate committees of 
,congress a report that describes--     
7,a7 the number of veterans1            
disaggregated by ,state1 who-- 7i7 are  
beneficiaries of the ,service2 and  7ii7
 have received health care at a medical 
facility of the ,department of ,veterans
 ,affairs2  7,b7 the number of veterans1

 disaggregated by ,state and calendar   
year1 who--  7i7 are beneficiaries of   
the ,service2 and  7ii7 were referred to
 a medical facility of the ,department  
of ,veterans ,affairs from a facility of
 the ,service during the period--  7,i7 
beginning on ,january #a1 #bjaj2 and    
7,,ii7 ending on ,december #ca1 #bjae2  
and  7,c7 an update regarding efforts of
 the ,secretary and the ,director to    
streamline health care for veterans who 
are beneficiaries of the ,service and   
have received health care at a medical  
facility of the ,department of ,veterans
 ,affairs and at a facility of the      
,service1 including a description of--  
7i7 any changes to the provision of     
health care required under the ,indian  
,health ,care ,improvement ,act 7#be    
,u4,s4,c4 #afja et seq472 and  7ii7 any 
barriers to efficiently streamline the  
provision of health care to veterans who
 are beneficiaries of the ,service4