,,ii  #aafth ,,congress  #ast ,session  
,s4 #ajja  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,april #c1     
#bjai,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 ,liability for payment       
,section #bbb of the ,indian ,health    
,care ,improvement ,act 7#be ,u4,s4,c4  
#afbau7 is amended by adding at the end 
the following3  7d7 ,veterans ,affairs  
copayments ,the ,service may pay1 in    
accordance with section #dab1 the cost  
of a copayment assessed by the          

,department of ,veterans ,affairs to an 
eligible ,indian veteran 7as defined in 
section #dab7 for covered medical care  
7as defined in such section74  4  #c4   
,copayments for tribal veterans         
receiving certain medical services      
,title ,,iv of the ,indian ,health ,care
 ,improvement ,act 7#be ,u4,s4,c4 #afda 
et seq47 is amended by adding at the end
 the following3  #dab4 ,payments for    
eligible ,indian veterans receiving     
covered medical care at ,,va facilities 
7a7 ,definitions ,in this section3 7#a7 
,appropriate committees of ,congress    
,the term appropriate committees of     
,congress means-- 7,a7 in the ,senate-- 
7i7 the ,committee on ,veterans'        
,affairs2 and  7ii7 the ,committee on   
,indian ,affairs2 and  7,b7 in the      
,house of ,representatives-- 7i7 the    
,committee on ,veterans' ,affairs2 and  
7ii7 the ,committee on ,natural         
,resources4  7#b7 ,covered medical care 
,the term covered medical care means any
 medical care or service that is-- 7,a7 

authorized for an eligible ,indian      
veteran under the contract health       
service and referred by the ,service2   
and  7,b7 administered at a facility of 
the ,department of ,veterans ,affairs1  
including any services rendered under a 
contract with a non-,department of      
,veterans ,affairs health care provider4
  7#c7 ,eligible ,indian veteran ,the   
term eligible ,indian veteran means an  
,indian or ,alaska ,native veteran who  
is eligible for assistance from the     
,service4  7b7 ,memorandum of           
understanding  7#a7 ,in general         
,notwithstanding any other provision of 
law1 except as provided in paragraph    
7#c71 the ,secretary 7or a designee1    
including the director of any area      
office of the ,service71 the ,secretary 
of ,veterans ,affairs 7or a designee71  
and any tribal health program1 as       
applicable1 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 ,secretary 
or tribal health program1 as applicable1
 to pay to the ,secretary of ,veterans  
,affairs any copayments owed to the     
,department of ,veterans ,affairs by    
eligible ,indian veterans for covered   
medical care4  7#b7 ,factors for        
consideration ,in entering into a       
memorandum of understanding under       
paragraph 7#a71 the ,secretary1 the     
,secretary of ,veterans ,affairs1 and   
any tribal health program1 as           
applicable1 shall take into             
consideration any findings contained in 
the report under subsection 7e74  7#c7  
,exception ,the ,secretary1 the         
,secretary of ,veterans ,affairs1 and   
any tribal health program1 as           
applicable1 shall not be required to    
enter into a memorandum of understanding
 under paragraph 7#a7 if the ,secretary1
 the ,secretary of ,veterans ,affairs1  
and any tribal health program1 as       
applicable1 jointly certify to the      

appropriate committees of ,congress that
 such a memorandum of understanding     
would-- 7,a7 decrease the quality of    
health care provided to eligible ,indian
 veterans2  7,b7 impede the access of   
those veterans to health care2 or  7,c7 
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  7c7     
,payment by ,service ,notwithstanding   
any other provision of law and in       
accordance with the relevant memorandum 
of understanding described in subsection
 7b71 the ,service may cover the cost of
 any copayment assessed by the          
,department of ,veterans ,affairs to an 
eligible ,indian veteran receiving      
covered medical care4  7d7              
,authorization ,to accept funds         
,notwithstanding section #djg7;c71      
section #bija7;b7 of the ,patient       
,protection and ,affordable ,care ,act  
7#be ,u4,s4,c4 #afbc7;b771 or any other 

provision of law1 and in accordance with
 the relevant memorandum of             
understanding described in subsection   
7b71 the ,secretary of ,veterans        
,affairs may accept a payment from the  
,service under subsection 7c74  7e7     
,report ,not later than #ij days after  
the date of enactment of this section1  
the ,secretary and the ,secretary of    
,veterans ,affairs shall submit to the  
appropriate committees of ,congress a   
report that describes-- 7#a7 the number 
of veterans1 disaggregated by ,state1   
who-- 7,a7 are eligible for assistance  
from the ,service2 and  7,b7 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-- 7,a7 are eligible for       
assistance from the ,service2 and  7,b7 
were referred to a medical facility of  
the ,department of ,veterans ,affairs   
from a facility of the ,service during  
the period-- 7i7 beginning on ,january  

#a1 #bjac2 and  7ii7 ending on ,december
 #ca1 #bjah2 and  7#c7 an update        
regarding efforts of the ,secretary and 
the ,secretary of ,veterans ,affairs to 
streamline health care for veterans who 
are eligible for assistance from 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-- 7,a7 any changes to the
 provision of health care required under
 this ,act2 and  7,b7 any barriers to   
efficiently streamline the provision of 
health care to veterans who are eligible
 for assistance from the ,service4  4