,i  #aaeth ,,congress  #ast ,session    
,h4 ,r4 #ddeg  ,,in ,,the ,,house ,,of  
,,representatives  ,november #ba1       
#bjag,mr4 ,lamborn 7for himself1 ,mr4   
,meadows1 and ,mr4 ,franks of ,arizona7 
introduced the following bill2 which was
 referred to the ,committee on          
,veterans' ,affairs1 and in addition to 
the ,committees on ,ways and ,means1    
,oversight and ,government ,reform1     
,energy and ,commerce1 and ,armed       
,services1 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 amend title #ch1 ,united 
,states ,code1 to establish the         
,veterans ,accountable ,care            
,organization and to provide veterans   
access to private health insurance      
plans1 and for other purposes4  #a4     
,short title2 table of contents  ,this  
,act may be cited as the ,veterans      
,empowerment ,act4  #b4 ,establishment  

of ,veterans ,accountable ,care         
,organization  7a7 ,establishment  7#a7 
,in general ,chapter #c of title #ch1   
,united ,states ,code1 is amended by    
adding at the end the following new     
section3  #cbc4 ,veterans ,accountable  
,care ,organization  7a7 ,establishment 
7#a7 ,there is established the ,veterans
 ,accountable ,care ,organization 7in   
this section referred to as the         
,corporation74  7#b7 ,the ,corporation  
is a federally chartered corporation4   
7#c7 ,the ,corporation shall be         
incorporated and domiciled in the       
,district of ,columbia1 or another      
nearby ,state1 as determined by the     
board of directors of the ,corporation4 
7#d7 ,the ,corporation shall be a       
charitable and nonprofit corporation4   
7#e7 ,except as otherwise provided1 the 
,corporation shall have perpetual       
existence4  7b7 ,purpose ,the purpose of
 the ,corporation is to furnish         
high-quality hospital care1 medical     
services1 and other health care         

7excluding nursing home care and        
domiciliary care7 to individuals        
eligible for such care and services     
under laws administered by the          
,secretary4  7c7 ,board of ,directors   
7#a7 ,the powers of the ,corporation    
shall be vested in a ,board of          
,directors that governs the             
,corporation4  7#b7 ,the ,board of      
,directors shall be composed of the     
following members3  7,a7 ,the ,secretary
 of ,veterans ,affairs4  7,b7 ,two      
members appointed by the ,speaker of the
 ,house of ,representatives1 at least   
one of whom shall be a veteran4  7,c7   
,two members appointed by the ,minority 
,leader of the ,house of                
,representatives1 at least one of whom  
shall be a veteran4  7,d7 ,two members  
appointed by the ,majority ,leader of   
the ,senate1 at least one of whom shall 
be a veteran4  7,e7 ,two members        
appointed by the ,minority ,leader of   
the ,senate1 at least one of whom shall 
be a veteran4  7,f7 ,two members        

appointed by the ,president1 at least   
one of whom shall be veterans4  7#c7    
,the ,president shall designate a member
 of the ,board of ,directors to serve as
 ,chairperson of the ,board4 ,the ,board
 shall select a ,vice ,chairperson from 
among its members4  7#d7  7,a7 ,a member
 of the ,board of ,directors shall serve
 for a term of five years1 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 year4  
7,b7 ,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
 term4 ,a member may serve after the    
expiration of that member's term until a
 successor has taken office4 ,a vacancy 
on the ,board shall not affect its      
powers1 but shall be filled in the same 
manner in which the original appointment

 was made4  7,c7 ,the term of each      
member may be renewed for an additional 
term1 except that in no case shall any  
member serve more than two consecutive  
terms exceeding ten years4  7,d7 ,during
 the absence or disability of the       
,secretary of ,veterans ,affairs or in  
the event of a vacancy in the office of 
,secretary1 the ,acting ,secretary of   
,veterans ,affairs shall serve as the   
member of the ,board of ,directors      
specified in paragraph 7#b77;,a74  7d7  
,duties ,in carrying out subsection 7b71
 the ,corporation shall-- 7#a7 transfer 
personnel and assets of the ,department 
of ,veterans ,affairs to the            
,corporation pursuant to subsection 7b7 
of section #b of the ,veterans          
,empowerment ,act2  7#b7 establish      
priorities1 milestones1 and timelines1  
in consultation with the ,secretary of  
,veterans ,affairs1 for the termination 
of functions of the ,veterans ,health   
,administration directly related to the 
furnishing of hospital care1 medical    

services1 and other health care         
7excluding nursing home care and        
domiciliary care7 pursuant to subsection
 7c7 of such section #b2  7#c7 with     
respect to centers of excellence        
relating to service-connected injuries  
and other medical issues--  7,a7        
continue to administer such centers     
previously established by the           
,secretary2 and  7,b7 establish and     
administer additional such centers as   
the ,board of ,directors determines     
appropriate4  7#d7 in consultation with 
the ,secretary1 carry out such other    
actions necessary to carry out this     
section4  7e7 ,powers ,the ,corporation 
shall-- 7#a7 appoint employees2 and     
7#b7 adopt a ,constitution and bylaws   
consistent with the purpose set forth   
under subsection 7b74  7f7 ,duty ,to    
maintain corporate and tax-,exempt      
status  7#a7 ,the ,corporation shall    
maintain its status as a corporation    
incorporated under the laws of the      
,district of ,columbia or another nearby

 ,state1 as determined by the ,board of 
,directors4  7#b7 ,the ,corporation     
shall maintain its status as an         
organization exempt from the ,internal  
,revenue ,code of #aihf4  7g7 ,veterans 
,accountable ,care ,organization ,fund  
7#a7 ,there is in the ,treasury a fund  
to be known as the ,veterans            
,accountable ,care ,organization ,fund  
7in this subsection referred to as the  
,fund74  7#b7 ,amounts recovered or     
collected under chapter #bf of this     
title shall be deposited in the ,fund4  
7#c7 ,amounts in the ,fund shall be     
available1 without further appropriation
 and without fiscal year limitation1 to 
establish and administer centers of     
excellence described in subsection      
7d77#c7 and for health care or medical  
services furnished to a veteran at a    
facility operated by the ,corporation4  
4  7#b7 ,clerical amendment ,the table  
of sections at the beginning of chapter 
#c of such title is amended by inserting
 after the item relating to section #cbb

 the following new item3  #cbc4         
,veterans ,accountable ,care            
,organization4  4  7b7 ,transfer of     
personnel and assets  7#a7 ,transfer    
,all of the personnel1 property1        
records1 and unexpended balances of     
appropriations1 allocations1 and other  
funds employed1 used1 held1 available1  
or to be made available in connection   
with the direct furnishing of hospital  
care1 medical services1 and other health
 care 7excluding nursing home care and  
domiciliary care7 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 #cbc of title 
#ch1 ,united ,states ,code1 as added by 
subsection 7a74  7#b7 ,reduction in     
force ,the ,secretary may implement a   
reduction in force in carrying out      
paragraph 7#a74  7c7 ,termination of    
functions  7#a7 ,in general ,except as  

provided by paragraph 7#b71 all of the  
functions of the ,veterans ,health      
,administration directly relating to the
 furnishing of hospital care1 medical   
services1 and other health care         
7excluding nursing home care and        
domiciliary care7 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 
,act4  7#b7 ,extensions ,the ,secretary 
of ,veterans ,affairs may make not more 
than two #ij-;day extensions to the     
termination date specified in paragraph 
7#a7 if the ,secretary notifies         
,congress of such extensions4  7#c7     
,certification of termination date ,the 
,secretary shall certify to ,congress   
the date on which paragraph 7#a7 is     
carried out4  7d7 ,recommendations for  
statutory amendments ,not later than    
#ahj days after the date of the         
enactment of this ,act1 the ,secretary  
shall submit to ,congress a report that 

contains recommendations for technical  
and conforming amendments to ,federal   
statutes to carry out this ,act4  #c4   
,establishment of ,veterans ,health     
,insurance ,program  7a7 ,establishment 
,chapter #gc of title #ch1 ,united      
,states ,code1 is amended by adding at  
the end the following new section3      
#gcji;,a4 ,veterans ,health ,insurance  
,program  7a7 ,establishment ,there is  
established in the ,veterans ,health    
,administration the ,veterans ,health   
,insurance ,program 7in this section    
referred to as the ,program74  7b7      
,duties ,under the ,program1 the        
,secretary shall administer the         
provision of health insurance support to
 veterans under chapter #bf of this     
title4  4  7b7 ,clerical amendment ,the 
table of sections at the beginning of   
chapter #gc of such title is amended by 
inserting after the item relating to    
section #gcji the following new item3   
#gcji;,a4 ,veterans ,health ,insurance  
,program4  4  #d4 ,designation of       

existing authorities for hospital care1 
medical services1 and other health care 
7a7 ,designation ,subchapter ,i of      
chapter #ag of title #ch1 ,united       
,states ,code1 is amended by inserting  
after section #agja the following new   
section3  #agja;,a4 ,vets,care ,federal 
program3 designation of authorities for 
hospital care1 medical services1 and    
other health care as program  7a7 ,in   
general ,effective as of the date       
described in section #b7;c77#c7 of the  
,veterans ,empowerment ,act1 the        
authorities for the provision of        
hospital care1 medical services1 and    
other health care 7other than nursing   
home care and domiciliary care7 in      
subchapter ,,ii of this chapter and     
under any other law administered by the 
,secretary may be referred to as the    
,vets,care ,federal program4  7b7       
,designation of recipients ,effective as
 of the date described in section       
#b7;c77#c7 of the ,veterans ,empowerment
 ,act1 any eligible individual who      

receives hospital care1 medical         
services1 and other health care         
7excluding nursing home care and        
domiciliary care7 in accordance with the
 authorities referred to in subsection  
7a7 after such date may be referred to  
in the receipt of such care or services 
as participating in the ,vets,care      
,federal program4  7c7 ,secondary payer 
7#a7 ,in general ,notwithstanding any   
other provision of law1 any health plan 
7including the ,medicare program under  
title ,,xviii of the ,social ,security  
,act 7#db ,u4,s4,c4 #acie et seq47 or a 
,state plan under title ,,xix of such   
,act 7#db ,u4,s4,c4 #acif et seq47 and  
the ,,tricare program under chapter #ee 
of title #aj7 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    
,vets,care ,federal program is          

responsible for any such costs1 if      
applicable4  7#b7 ,notification ,the    
,secretary of ,health and ,human        
,services1 the ,secretary of ,defense1  
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 7#a74  7d7  
,treatment of employer-,sponsored health
 plans  7#a7 ,in general ,the provisions
 of section #ahfb7;b77#c77;,c7 of the   
,social ,security ,act 7#db ,u4,s4,c4   
#aciey7b77#c77;,c77 shall apply with    
respect to financial or other incentives
 for an employee who is an eligible     
individual not to enroll 7or to         
terminate enrollment7 under a health    
plan that would 7in the case of such    
enrollment7 be responsible under        
subsection 7c7 for the payment of costs 
for hospital care1 medical services1 or 
other health care received by the       
eligible individual for a non-service   

connected disability in the same manner 
as such section #ahfb7;b77#c77;,c7      
applies to financial or other incentives
 for an individual entitled to benefits 
under title ,,xviii of the ,social      
,security ,act 7#db ,u4,s4,c4 #acie et  
seq47 not to enroll 7or to terminate    
enrollment7 under a group health plan or
 a large group health plan which would  
7in the case of enrollment7 be a primary
 plan 7as defined in section            
#ahfb7;b77#b77;,a7 of such ,act74  7#b7 
,regulations ,the ,secretary may by     
regulation adopt such additional        
exceptions to the prohibition described 
in paragraph 7#a7 as the ,secretary     
considers appropriate and such paragraph
 shall be implemented taking into       
account the adoption of such exceptions4
  7#c7 ,agreements ,the ,veterans       
,accountable ,care ,organization and the
 ,secretary of ,health and ,human       
,services may enter into agreements to  
carry out this subsection4 ,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 ,organization4  7#d7 
,group health plan defined ,in this     
subsection1 the term group health plan  
means a group health plan 7as that term 
is defined in section #ejjj7;b77#a7 of  
the ,internal ,revenue ,code of #aihf   
without regard to section #ejjj7;d7 of  
the ,internal ,revenue ,code of #aihf74 
7e7 ,eligible individuals ,an individual
 is eligible to participate in the      
,vets,care ,federal program if such     
individual was enrolled in the system of
 annual patient enrollment established  
and operated by the ,secretary under    
section #agje7;a7 of this title as of   
the date described in section #b7;c77#c7
 of the ,veterans ,empowerment ,act4  4 
7b7 ,clerical amendment ,the table of   
sections at the beginning of such       
chapter is amended by inserting after   
the item relating to section #agja the  

following new item3  #agja;,a4          
,vets,care ,federal program3 designation
 of authorities for hospital care1      
medical services1 and other health care 
as program4  4  #e4 ,health insurance   
support for new veterans and veterans   
electing health insurance support in    
lieu of eligibility for hospital care1  
medical services1 and other health care 
under existing authorities  7a7 ,in     
general ,part ,,ii of title #ch1 ,united
 ,states ,code1 is amended by inserting 
after chapter #bd the following new     
chapter3  #bf ,veterans ,independence in
 ,health ,care  ,subchapter             
,i--,veterans ,generally #bfja4         
,vets,care ,choice program3 designation 
of recipients4 #bfjb4 ,eligibility4     
#bfjc4 ,qualifying health insurance4    
#bfjd4 ,health insurance support4 #bfje4
 ,treatment of other health plans4      
#bfjf4 ,receipt of health care through  
the ,department4 #bfjg4 ,pharmacy       
benefits4 ,subchapter                   
,,ii--,medicare-,eligible ,veterans     

#bfaa4 ,vets,care ,senior program3      
designation of recipients4 #bfab4       
,medicare support4  ,i ,veterans        
,generally  #bfja4 ,vets,care ,choice   
program3 designation of recipients  7a7 
,in general ,the authorities for the    
provision of health insurance support   
under this subchapter may be referred to
 as the ,vets,care ,choice program4  7b7
 ,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 ,vets,care ,choice 
program4  7c7 ,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 ,organization4  #bfjb4            
,eligibility  7a7 ,in general ,except as
 provided in subsections 7c7 and 7d71   
the following veterans shall be provided

 health insurance support under this    
subchapter3  7#a7 ,veterans who first   
enroll in the system of annual patient  
enrollment established and operated by  
the ,secretary under section #agje7;a7  
of this title on or after the date      
described in section #b7;c77#c7 of the  
,veterans ,empowerment ,act4  7#b7      
,veterans enrolled in such system as of 
the date described in section #b7;c77#c7
 of the ,veterans ,empowerment ,act who 
elect health insurance support under    
this subchapter in lieu of eligibility  
for hospital care1 medical services1 and
 other health care 7excluding nursing   
home care and domiciliary care7 under   
the ,vets,care ,federal program under   
chapter #ag of this title or any other  
law administered by the ,secretary4  7b7
 ,enrollment ,the ,secretary shall      
administer-- 7#a7 an open enrollment    
period for the ,vets,care ,choice       
program that corresponds to the open    
enrollment period for the ,federal      
,employees ,health ,benefits program    

described in section #hije7;g72 and     
7#b7 special enrollment periods based on
 qualifying life events of veterans     
similar to such events under the        
,federal ,employees ,health ,benefits   
,program1 except that the change of     
priority group shall also be treated as 
a qualifying life event4  7c7 ,effect of
 election ,while an election under      
subsection 7a77#b7 of a veteran         
described in that subsection is in      
effect1 the veteran is not eligible for 
hospital care1 medical services1 and    
other health care 7excluding nursing    
home care and domiciliary care7 under   
chapter #ag of this title or any other  
law administered by the ,secretary4  7d7
 ,exceptions ,the following veterans are
 not eligible for health insurance      
support under this subchapter3 7#a7 ,any
 veteran eligible for care under the    
,medicare program under title ,,xviii of
 the ,social ,security ,act 7#db        
,u4,s4,c4 #acie et seq474  7#b7 ,any    
veteran who-- 7,a7 first enrolls in the 

system of annual patient enrollment     
established and operated by the         
,secretary under section #agje7;a7 of   
this title on or after the date         
described in section #b7;c77#c7 of the  
,veterans ,act2 and  7,b7 is in priority
 group #g or priority group #h4  7e7    
,commencement of availability of support
 ,health insurance support under this   
subchapter shall commence being         
available as follows3  7#a7 ,with       
respect to veterans in priority group   
#a1 #b1 or #c1 on the first day of the  
first month that begins on or after the 
date described in section #b7;c77#c7 of 
the ,veterans ,empowerment ,act4  7#b7  
,with respect to veterans in a priority 
group other than #a1 #b1 or #c1 on the  
first day of the first month that begins
 on or after the date that is #ahj days 
after the commencement date under       
paragraph 7#a74  7f7 ,priority group    
defined ,in this section1 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 #agje7;a7 of this title4  #bfjc4
 ,qualifying health insurance ,health   
insurance support may be provided under 
this subchapter only for health plans   
that-- 7#a7 include the types of health 
care authorized under section #ajgi of  
title #aj1 ,united ,states ,code2 and   
7#b7 provide such additional elements of
 coverage as the ,secretary shall       
prescribe for purposes of this          
subchapter4  #bfjd4 ,health insurance   
support  7a7 ,in general ,the ,secretary
 shall provide health insurance support 
to veterans eligible for such support   
under this subchapter through premium   
support under subsections 7b7 and 7c71  
cost-sharing support under subsection   
7d71 and alternative support under      
subsection 7e7 by paying or reimbursing 
such veterans for the costs associated  
with such health insurance support4 ,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 reimbursements4    
7b7 ,premium support generally ,the     
premium support provided by the         
,secretary under this subsection is as  
follows3 7#a7 ,tier #a ,to any veteran  
with a service-connected disability     
rated as #ajj percent disabling1 health 
insurance support sufficient to provide 
benefits to the veteran under a health  
plan that are actuarially equivalent to 
#ajj percent of the full actuarial value
 of the benefits provided under the     
health plan4 ,a health plan under this  
paragraph may be referred to as a ,tier 
#a ,plan4  7#b7 ,tier #b ,to any veteran
 in priority group #a not covered by    
paragraph 7#a7 and any veteran in       
priority group #b1 health insurance     
support sufficient to provide benefits  
to the veteran under a health plan that 
are actuarially equivalent to #ij       
percent of the full actuarial value of  
the benefits provided under the health  

plan4 ,a health plan under this         
paragraph may be referred to as a ,tier 
#b ,plan4  7#c7 ,tier #c ,to any veteran
 in priority group #c or priority group 
#d1 health insurance support sufficient 
to provide benefits to the veteran under
 a health plan that are actuarially     
equivalent to #hj percent of the full   
actuarial value of the benefits provided
 under the health plan4 ,a health plan  
under this paragraph may be referred to 
as a ,tier #c ,plan4  7#d7 ,tier #d ,to 
any veteran in priority group #e or     
priority group #f1 health insurance     
support sufficient to provide benefits  
to the veteran under a health plan that 
are actuarially equivalent to #gj       
percent of the full actuarial value of  
the benefits provided under the health  
plan4 ,a health plan under this         
paragraph may be referred to as a ,tier 
#d ,plan4  7#e7 ,tier #e ,to any veteran
 not in a priority group covered by     
paragraphs 7#a7 through 7#d7 and not    
ineligible for such support under       

section #bfjb7;d77#b7 of this title1    
health insurance support sufficient to  
provide benefits to the veteran under a 
health plan that are actuarially        
equivalent to #fj percent of the full   
actuarial value of the benefits provided
 under the health plan4 ,a health plan  
under this paragraph may be referred to 
as a ,tier #e ,plan4  7c7 ,additional   
premium support based on need ,the      
premium support provided by the         
,secretary under this subsection is as  
follows3 7#a7 ,to any veteran with an   
annual gross household income that is   
less than #acc percent of the poverty   
line1 health insurance support          
sufficient to cover any costs of such   
monthly premium that are more than #b   
percent of the monthly gross household  
income of the veteran4  7#b7 ,to any    
veteran with an annual gross household  
income that is between #acc percent and 
#aej percent of the poverty line1 health
 insurance support sufficient to cover  
any costs of such monthly premium that  

are more than #c percent of the monthly 
gross household income of the veteran4  
7#c7 ,to any veteran with an annual     
gross household income that is between  
#aej percent and #bjj percent of the    
poverty line1 health insurance support  
sufficient to cover any costs of such   
monthly premium that are more than #d   
percent of the monthly gross household  
income of the veteran4  7#d7 ,to any    
veteran with an annual gross household  
income that is between #bjj percent and 
#bej percent of the poverty line1 health
 insurance support sufficient to cover  
any costs of such monthly premium that  
are more than #f4c percent of the       
monthly gross household income of the   
veteran4  7#e7 ,to any veteran with an  
annual gross household income that is   
between #bej percent and #cjj percent of
 the poverty line1 health insurance     
support sufficient to cover any costs of
 such monthly premium that are more than
 #h4je percent of the monthly gross     
household income of the veteran4  7#f7  

,to any veteran with an annual gross    
household income that is between #cjj   
percent and #djj percent of the poverty 
line1 health insurance support          
sufficient to cover any costs of such   
monthly premium that are more than #i4e 
percent of the monthly gross household  
income of the veteran4  7d7             
,cost-,sharing support ,the cost-sharing
 support provided by the ,secretary     
under this subsection is as follows3    
7#a7 ,to any veteran with an annual     
gross household income that is less than
 #aej percent of the poverty line1      
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 #id percent4  7#b7 ,to any veteran 
with an annual gross household income   
that is between #aej percent and #bjj   
percent of the poverty line1 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 #hg
 percent4  7#c7 ,to any veteran with an 
annual gross household income that is   
between #bjj percent and #bej percent of
 the poverty line1 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 #gc percent4   
7e7 ,alternative support for veterans   
with certain health insurance  7#a7 ,in 
general ,notwithstanding any other      
provision of this section1 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 #bbc of   
the ,internal ,revenue ,code of #aihf1  
the ,secretary shall contribute an      
amount calculated under paragraph 7#b7  
into such health savings account on     

behalf of the veteran4  7#b7 ,amount    
calculated ,the amount calculated under 
this paragraph is an amount equal to the
 difference between-- 7,a7 the amount of
 health insurance support the veteran   
would otherwise have received under the 
subsection of this section applicable to
 the veteran2 and  7,b7 the amount      
payable by the veteran in connection    
with the high deductible health plan    
described in paragraph 7#a74  7f7       
,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
 veteran1 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 resides4  
7g7 ,definitions ,in this section3 7#a7 
,the term cost-sharing1 in connection   
with the receipt of health care and     
treatment under a health plan1 means any
 copayments1 deductibles1 or other      

charges imposed1 collected1 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 plan4  7#b7 
,the term poverty line means the poverty
 line 7as defined in section #fgc7b7 of 
the ,community ,services ,block ,grant  
,act 7#db ,u4,s4,c4 #iijb7b77 applicable
 to a family of the size involved4  7#c7
 ,the term high deductible health plan  
has the meaning given that term in      
section #bbc7;c77#b7 of the ,internal   
,revenue ,code of #aihf4  7#d7 ,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 #agje7;a7 of this title4  #bfje4
 ,treatment of other health plans  7a7  
,secondary payer  7#a7 ,in general      
,notwithstanding any other provision of 
law1 any health plan 7including a ,state
 plan under title ,,xix of the ,social  
,security ,act 7#db ,u4,s4,c4 #acif et  

seq47 and the ,,tricare program under   
chapter #ee of title #aj7 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 
costs1 if applicable4  7#b7             
,notification ,the ,secretary of ,health
 and ,human ,services1 the ,secretary of
 ,defense1 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    
7#a74  7b7 ,treatment of                
employer-,sponsored health plans  7#a7  
,in general ,the provisions of section  

#ahfb7;b77#c77;,c7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#aciey7b77#c77;,c77 shall apply with    
respect to financial or other incentives
 for an employee who is a veteran not to
 enroll 7or to terminate enrollment7    
under a health plan that is not a health
 plan for which health insurance support
 is provided under this subchapter and  
that would 7in the case of such         
enrollment7 be responsible under        
subsection 7a7 for the payment of costs 
for health care received by the veteran 
in the same manner as such section      
#ahfb7;b77#c77;,c7 applies to financial 
or other incentives for an individual   
entitled to benefits under title ,,xviii
 of the ,social ,security ,act 7#db     
,u4,s4,c4 #acie et seq47 not to enroll  
7or to terminate enrollment7 under a    
group health plan or a large group      
health plan which would 7in the case of 
enrollment7 be a primary plan 7as       
defined in section #ahfb7;b77#b77;,a7 of
 such ,act74  7#b7 ,regulations ,the    

,secretary may by regulation adopt such 
additional exceptions to the prohibition
 described in paragraph 7#a7 as the     
,secretary considers appropriate and    
such paragraph shall be implemented     
taking into account the adoption of such
 exceptions4  7#c7 ,agreements ,the     
,secretary of ,veterans ,affairs and the
 ,secretary of ,health and ,human       
,services may enter into agreements to  
carry out this subsection4 ,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 ,affairs4  7#d7 ,group health 
plan defined ,in this subsection1 the   
term group health plan means a group    
health plan 7as that term is defined in 
section #ejjj7;b77#a7 of the ,internal  
,revenue ,code of #aihf without regard  
to section #ejjj7;d7 of the ,internal   
,revenue ,code of #aihf74  #bfjf4       
,receipt of health care through the     

,department  7a7 ,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 plan4  7b7 ,cost of care    
,the cost1 including any copayments1 of 
any health care or treatment provided to
 a veteran by the ,veterans ,accountable
 ,care ,organization under a contact    
under subsection 7a7 shall be determined
 by the ,veterans ,accountable ,care    
,organization4  7c7 ,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 7a74  #bfjg4 ,pharmacy       
benefits ,a veteran who is enrolled in  
the ,vets,care ,choice program or the   
,vets,care ,senior program may fill     
prescriptions at pharmacies of the      
,department4  ,,ii ,medicare-,eligible  
,veterans  #bfaa4 ,vets,care ,senior    
program3 designation of recipients  7a7 
,in general ,the authorities for the    
provision of health insurance support   
under this subchapter may be referred to
 as the ,vets,care ,senior program4  7b7
 ,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 ,vets,care ,senior 
program4  7c7 ,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 ,organization4  #bfab4 ,medicare  

support  7a7 ,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 ,a1 ,b1 ,c1 and ,d of title 
,,xviii of the ,social ,security ,act   
7#db ,u4,s4,c4 #acie et seq47 and for   
premiums and cost-sharing for ,medicare 
supplemental policies under section     
#ahhb of such ,act 7#db ,u4,s4,c4       
#aciess74  7b7 ,relationship with       
,vets,care ,federal ,notwithstanding any
 other provision of law1 if a covered   
veteran is enrolled in the ,vets,care   
,federal program under section #agja;,a 
of this title1 the ,medicare program    
under title ,,xviii of the ,social      
,security ,act 7#db ,u4,s4,c4 #acie et  
seq47 7or a ,medicare supplemental      
policy under section #ahhb of such ,act 
7#db ,u4,s4,c4 #aciess77 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 7or        
supplemental policy7 for such health    
care before the ,vets,care ,federal     
program is responsible for any such     
costs1 if applicable4  7c7 ,availability
 of payment or reimbursement  7#a7      
,commencement ,health insurance support 
under this subchapter shall commence    
being available as follows3 7,a7 ,with  
respect to covered veterans in priority 
group #a1 #b1 or #c1 on the first day of
 the first month that begins on or after
 the date described in section          
#b7;c77#c7 of the ,veterans ,empowerment
 ,act4  7,b7 ,with respect to covered   
veterans in a priority group other than 
#a1 #b1 or #c1 on the first day of the  
first month that begins on or after the 
date that is #ahj days after the        
commencement date under paragraph 7#a74 
7#b7 ,exclusion of certain veterans ,a  
covered veteran is not eligible for     
health insurance support under this     
section if such veteran-- 7,a7 first    

enrolls in the system of annual patient 
enrollment established and operated by  
the ,secretary under section #agje7;a7  
of this title on or after the date of   
the enactment of this ,act2 and  7,b7 is
 in priority group #g or #h4  7d7       
,definitions ,in this section3  7#a7    
,the term cost-sharing1 in connection   
with the receipt of health care and     
treatment under the ,medicare program   
under title ,,xviii of the ,social      
,security ,act 7#db ,u4,s4,c4 #acie et  
seq47 or ,medicare supplemental policies
 under section #ahhb of such ,act 7#db  
,u4,s4,c4 #aciess71 means any           
copayments1 deductibles1 or other       
charges imposed1 collected1 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 policies4  7#b7 ,the term  
covered veteran means a veteran         
receiving benefits under the ,medicare  
program under title ,,xviii of the      

,social ,security ,act4  7#c7 ,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 #agje7;a7 of this title4  4  7b7
 ,clerical amendment ,the table of      
chapters at the beginning title #ch1    
,united ,states ,code1 is amended by    
inserting after the item relating to    
chapter #bd the following new item3     
,chapter #bf4,veterans ,independence in 
,health ,care#bfja  4  7c7 ,conforming  
amendments  7#a7 ,minimum essential     
coverage ,section                       
#ejjj;,a7f77#a77;,a77v7 of the ,internal
 ,revenue ,code of #aihf is amended by  
striking or #ah and inserting 1 #ah1 or 
#bf4  7#b7 ,medicare part ,b  7,a7      
,non-application of late enrollment     
penalty ,section #ahci7;b7 of the       
,social ,security ,act 7#db ,u4,s4,c4   
#acier7b77 is amended1 in the second    
sentence1 by inserting or months for    
which the individual can demonstrate    

that the individual was enrolled in the 
,vets,care ,senior program under        
subchapter ,,ii of chapter #bf of title 
#ch1 ,united ,states ,code after an     
individual described in section         
#ahcg7k77#c74  7,b7 ,special enrollment 
period ,section #ahcg of the ,social    
,security ,act 7#db ,u4,s4,c4 #aciep7 is
 amended by adding at the end the       
following new subsection3  7m7  7#a7 ,in
 the case of any individual who is      
enrolled in the ,vets,care ,senior      
program under subchapter ,,ii of chapter
 #bf of title #ch1 ,united ,states ,code
 at the time the individual is entitled 
to part ,a under section #bbf or section
 #bbf;,a and who is eligible to enroll  
but who has elected not to enroll 7or to
 be deemed enrolled7 during the         
individual's initial enrollment period1 
there shall be a special enrollment     
period as specified by the ,secretary4  
7#b7 ,in the case of an individual who  
enrolls during the special enrollment   
period provided under paragraph 7#a71   

the coverage period under this part     
shall begin on such date specified by   
the ,secretary4  7#c7 ,an individual may
 only enroll during the special         
enrollment period provided under        
paragraph 7#a7 one time during the      
individual's lifetime4  7#d7 ,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   
7#a74 ,the ,secretary of ,veterans      
,affairs shall provide such individuals 
with notification with respect to this  
subsection4 ,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 sentence4  
4  #f4 ,coordination between ,vets,care 
,choice program and eligibility to make 

contributions to health savings accounts
  7a7 ,in general ,section              
#bbc7;c77#a77;,b7 of the ,internal      
,revenue ,code of #aihf is amended by   
striking and at the end of clause 7ii71 
by striking the period at the end of    
clause 7iii7 and inserting 1 and1 and by
 adding at the end the following new    
clause3  7iv7 coverage for health       
insurance support under the ,vets,care  
,choice program under subchapter ,i of  
chapter #bf of title #ch1 ,united       
,states ,code4  4  7b7 ,denial of       
deduction for amounts not includible in 
gross income ,subsection 7b7 of section 
#bbc of the ,internal ,revenue ,code of 
#aihf is amended by adding at the end   
the following new paragraph3  7#i7      
,amounts not includible in gross income 
,no amount paid to a health savings     
account of an individual shall be taken 
into account under subsection 7a7 if    
7without regard to this section7 such   
amount1 when paid to or on behalf of    
such individual1 is excluded from gross 

income of the individual or exempt from 
taxation under any provision of ,federal
 law4  4  7c7 ,effective date ,the      
amendments made by this section shall   
apply to amounts paid to a health       
savings account 7as defined in section  
#bbc7;d7 of the ,internal ,revenue ,code
 of #aihf7 after the date of the        
enactment of this ,act4  #g4            
,publication of health care information 
7a7 ,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 ,administration4  7b7 ,elements 
,the information published under        
subsection 7a7 shall include information
 about the operations of the ,veterans  
,health ,administration1 including      

metrics regarding quality1 safety1      
patient experience1 timeliness1 and     
cost-effectiveness4  #h4 ,veterans'     
eligibility for long-term care insurance
  7a7 ,in general ,section #ijja of     
title #e1 ,united ,states ,code1 is     
amended-- 7#a7 by redesignating         
paragraphs 7#e7 through 7#aj7 as 7#f7   
through 7#aa71 respectively2  7#b7 by   
inserting after paragraph 7#d7 the      
following3  7#e7 ,veteran ,the term     
veteran has the same meaning given the  
term in section #aja7b7 of title #ch1   
,united ,states ,code4  2  7#c7 in      
paragraph 7#f71 as so redesignated--    
7,a7 in subparagraph 7,a71 by striking  
or 7#d74 and inserting 7#d71 or 7#e742  
7,b7 in subparagraph 7,b71 by striking  
7#a7 or 7#c74 and inserting 7#a71 7#c71 
or 7#e742  7,c7 in subparagraph 7,c71 by
 striking or 7#d7 and inserting 7#d71 or
 7#e72 and  7,d7 in subparagraph 7,d71  
by striking or 7#d7 and inserting 7#d71 
or 7#e72  7#d7 in paragraph 7#g71 as so 
redesignated1 by striking or 7#e74 and  

inserting 7#e71 or 7#f742 and  7#e7 in  
paragraph 7#aa71 as so redesignated--   
7,a7 in subparagraph 7,c71 by striking  
,commerce2 and and inserting ,commerce22
  7,b7 in subparagraph 7,d71 by striking
 ,services4 and inserting ,services2    
and2 and  7,c7 by inserting after       
subparagraph 7,d73  7,e7 with respect to
 a veteran1 the ,secretary of ,veterans 
,affairs4  4  7b7 ,technical and        
conforming amendments ,title #e1 ,united
 ,states ,code1 is amended as follows3  
7#a7 ,section #ijjb is amended-- 7,a7 in
 subsection 7a71 by striking or 7#e7 and
 inserting 7#e71 or 7#f72 and  7,b7 in  
subsection 7e7-- 7i7 in paragraph 7#b71 
by striking or 7#d7 and inserting 7#d71 
or 7#e72 and  7ii7 in paragraph 7#d71 by
 striking section #ijja7i7 and inserting
 section #ijja7aj74  7#b7 ,section      
#ijjd7;d7 is amended by inserting after 
withheld under subsection 7b7 the       
following3 1 who is an enrollee by      
virtue of being a veteran described in  
section #ijja7e7 of this title14  7#c7  

,section #ijjh7;c7 is amended by        
striking 7#c7 or 7#d7 and inserting     
7#c71 7#d71 or 7#e74