[House Report 115-681]
[From the U.S. Government Publishing Office]
115th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 115-681
======================================================================
VA BILLING ACCOUNTABILITY ACT
_______
May 18, 2018.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Roe of Tennessee, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 1972]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 1972) to amend title 38, United States Code, to
authorize the Secretary of Veterans Affairs to waive the
requirement of certain veterans to make copayments for hospital
care and medical services in the case of an error by the
Department of Veterans Affairs, and for other purposes, having
considered the same, report favorably thereon with an amendment
and recommend that the bill as amended do pass.
CONTENTS
Page
Purpose and Summary.............................................. 5
Background and Need for Legislation.............................. 5
Hearings......................................................... 5
Subcommittee Consideration....................................... 6
Committee Consideration.......................................... 6
Committee Votes.................................................. 6
Committee Correspondence.........................................
Committee Oversight Findings..................................... 7
Statement of General Performance Goals and Objectives............ 7
New Budget Authority, Entitlement Authority, and Tax Expenditures 7
Earmarks and Tax and Tariff Benefits............................. 7
Committee Cost Estimate.......................................... 7
Congressional Budget Office Estimate............................. 7
Federal Mandates Statement....................................... 9
Advisory Committee Statement..................................... 9
Constitutional Authority Statement............................... 9
Applicability to Legislative Branch.............................. 9
Statement on Duplication of Federal Programs..................... 9
Disclosure of Directed Rulemaking................................ 9
Section-by-Section Analysis of the Legislation................... 10
Changes in Existing Law Made by the Bill as Reported............. 11
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``VA Billing Accountability Act''.
SEC. 2. AUTHORITY OF SECRETARY OF VETERANS AFFAIRS TO WAIVE REQUIREMENT
OF CERTAIN VETERANS TO MAKE COPAYMENTS FOR CARE AND
SERVICES IN THE CASE OF DEPARTMENT OF VETERANS
AFFAIRS ERROR.
(a) Hospital Care, Nursing Home Care, and Medical Services.--Section
1710(f)(3) of title 38, United States Code, is amended by adding at the
end the following new subparagraph:
``(G) The Secretary may waive the requirement of a veteran to make a
payment under this subsection or subsection (g) if--
``(i) an error committed by the Department or an employee of
the Department was the cause of delaying notification sent to
the veteran of the requirement to make the payment; and
``(ii) the veteran received such notification later than 180
days after the date on which the veteran received the care or
services for which the payment was required.''.
(b) Medications.--Section 1722A of such title is amended--
(1) by redesignating subsection (c) as subsection (d); and
(2) by inserting after subsection (b) the following new
subsection (c):
``(c) The Secretary may waive the requirement of a veteran to make a
payment under this section if--
``(1) an error committed by the Department or an employee of
the Department was the cause of delaying notification sent to
the veteran of the requirement to make the payment; and
``(2) the veteran received such notification later than 180
days after the date on which the veteran received the
medication for which the payment was required.''.
(c) Billing Procedures.--
(1) In general.--Subchapter I of chapter 17 of such title is
amended by adding at the end the following new section:
``Sec. 1709C. Procedures for copayments
``(a) Care at Department Facility.--(1) In requiring a veteran to
make a payment for care or services provided at a medical facility of
the Department pursuant to this chapter, including sections 1710 and
1722A, the Secretary shall provide to such veteran a notification of
such required payment by not later than 180 days after the date on
which the veteran receives the care or services for which payment is
required.
``(2) If the Secretary does not provide to a veteran a notification
of the required payment by the date required under paragraph (1), the
Secretary may not collect such payment, including through a third-party
entity, unless the Secretary provides the veteran the following:
``(A) Information regarding how to apply for a waiver
described in section 1710(f)(3)(G) or section 1722A(c) of this
title, as appropriate.
``(B) Information regarding how to establish a payment plan
with the Secretary.
``(C) Opportunity to make such a waiver or establish such a
payment plan.
``(b) Care at Non-Department Facility.--(1) In requiring a veteran to
make a payment for care or services provided at a non-Department
facility pursuant to this chapter or other provision of law, the
Secretary shall provide to such veteran a notification of such required
payment by not later than 18 months after the date on which the veteran
receives the care or services for which payment is required.
``(2) If the Secretary does not provide to a veteran a notification
of the required payment by the date required under paragraph (1), the
Secretary may not collect such payment, including through a third-party
entity, unless the Secretary provides the veteran the following:
``(A) Information regarding how to apply for a waiver
described in paragraph (3).
``(B) Information regarding how to establish a payment plan
with the Secretary.
``(C) Opportunity to make such a waiver or establish such a
payment plan.
``(3) The Secretary may waive the requirement of a veteran to make a
payment for care or services provided at a non-Department facility
pursuant to this chapter or other provision of law if--
``(A) an error committed by the Department, an employee of
the Department, or a non-Department facility was the cause of
delaying the notification sent to the veteran of the
requirement to make the payment; and
``(B) the veteran received such notification after the period
described in paragraph (1).''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 1709B the following new item:
``1709C. Procedures for copayments.''.
(d) Improvement of Procedures.--Not later than 180 days after the
date of the enactment of this Act, the Secretary of Veterans Affairs
shall--
(1) review the copayment billing internal controls and
notification procedures of the Department of Veterans Affairs;
and
(2) improve such controls and procedures, including pursuant
to the amendments made by this Act.
Amendment in the Nature of a Substitute to H.R. 1972 Offered by Mr.
Rutherford of Florida
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``VA Billing Accountability
Act''.
SEC. 2. AUTHORITY OF SECRETARY OF VETERANS AFFAIRS TO WAIVE REQUIREMENT
OF CERTAIN VETERANS TO MAKE COPAYMENTS FOR CARE AND
SERVICES IN THE CASE OF DEPARTMENT OF VETERANS
AFFAIRS ERROR.
(a) Hospital Care, Nursing Home Care, and Medical Services.--
Section 1710(f)(3) of title 38, United States Code, is amended
by adding at the end the following new subparagraph:
``(G) The Secretary may waive the requirement of a veteran to
make a payment under this subsection or subsection (g) if--
``(i) an error committed by the Department or an
employee of the Department was the cause of delaying
notification sent to the veteran of the requirement to
make the payment; and
``(ii) the veteran received such notification later
than 180 days after the date on which the veteran
received the care or services for which the payment was
required.''.
(b) Medications.--Section 1722A of such title is amended--
(1) by redesignating subsection (c) as subsection
(d); and
(2) by inserting after subsection (b) the following
new subsection (c):
``(c) The Secretary may waive the requirement of a veteran to
make a payment under this section if--
``(1) an error committed by the Department or an
employee of the Department was the cause of delaying
notification sent to the veteran of the requirement to
make the payment; and
``(2) the veteran received such notification later
than 180 days after the date on which the veteran
received the medication for which the payment was
required.''.
(c) Billing Procedures.--
(1) In general.--Subchapter I of chapter 17 of such
title is amended by adding at the end the following new
section:
``Sec. 1709C. Procedures for copayments
``(a) Care at Department Facility.--(1) In requiring a
veteran to make a payment for care or services provided at a
medical facility of the Department pursuant to this chapter,
including sections 1710 and 1722A, the Secretary shall provide
to such veteran a notification of such required payment by not
later than 180 days after the date on which the veteran
receives the care or services for which payment is required.
``(2) If the Secretary does not provide to a veteran a
notification of the required payment by the date required under
paragraph (1), the Secretary may not collect such payment,
including through a third-party entity, unless the Secretary
provides the veteran the following:
``(A) Information regarding how to apply for a waiver
described in section 1710(f)(3)(G) or section 1722A(c)
of this title, as appropriate.
``(B) Information regarding how to establish a
payment plan with the Secretary.
``(C) Opportunity to make such a waiver or establish
such a payment plan.
``(b) Care at Non-Department Facility.--(1) In requiring a
veteran to make a payment for care or services provided at a
non-Department facility pursuant to this chapter or other
provision of law, the Secretary shall provide to such veteran a
notification of such required payment by not later than 18
months after the date on which the veteran receives the care or
services for which payment is required.
``(2) If the Secretary does not provide to a veteran a
notification of the required payment by the date required under
paragraph (1), the Secretary may not collect such payment,
including through a third-party entity, unless the Secretary
provides the veteran the following:
``(A) Information regarding how to apply for a waiver
described in paragraph (3).
``(B) Information regarding how to establish a
payment plan with the Secretary.
``(C) Opportunity to make such a waiver or establish
such a payment plan.
``(3) The Secretary may waive the requirement of a veteran to
make a payment for care or services provided at a non-
Department facility pursuant to this chapter or other provision
of law if--
``(A) an error committed by the Department, an
employee of the Department, or a non-Department
facility was the cause of delaying the notification
sent to the veteran of the requirement to make the
payment; and
``(B) the veteran received such notification after
the period described in paragraph (1).''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by inserting after
the item relating to section 1709B the following new
item:
``1709C. Procedures for copayments.''.
(d) Improvement of Procedures.--Not later than 180 days after
the date of the enactment of this Act, the Secretary of
Veterans Affairs shall--
(1) review the copayment billing internal controls
and notification procedures of the Department of
Veterans Affairs; and
(2) improve such controls and procedures, including
pursuant to the amendments made by this Act.
Purpose and Summary
H.R. 1972, as amended, the ``VA Billing Accountability
Act'' would authorize the Department of Veterans Affairs (VA)
to waive copayment requirements for certain veterans under
certain conditions. Representative Lloyd Smucker of
Pennsylvania introduced H.R. 1972 on April 6, 2017.
Background and Need for Legislation
Section 1710(f) of title 38 United States Code (U.S.C.)
requires VA to assess copayments for health care services to
veterans whose income exceeds certain limits and to veterans
who choose not to complete a financial assessment upon
enrolling in the VA healthcare system.\1\
---------------------------------------------------------------------------
\1\Health Benefit Copays. U.S. Department of Veterans Affairs
Health Benefits. https://www.va.gov/healthbenefits/cost/copays.asp.
Accessed May 10, 2018.
---------------------------------------------------------------------------
On June 1, 2015, Members of the Wisconsin and Minnesota
Congressional delegation were notified that VA officials at the
Minneapolis VA Medical Center had initiated a review of past
processes on veteran inpatient copayments charges for the years
2011-2015.\2\ As part of the review, VA had uncovered more than
one thousand instances where veterans were not billed for
inpatient services VA provided to them and, as a result, VA
immediately began assessing thousands of dollars of copayments
for each of those veterans for care received during that
period.\3\ Initially, these charges were added to the veterans'
monthly billing statements. However, VA later suspended
accounts for the affected veterans and reached out via
telephone to explain their account status and provide them with
information about applying for waivers or repayment plans. VA
claimed to have 6 years to bring an action against a veteran
and no authority to waive copayment collections, according to
conversations that Committee staff had with VA regarding this
incident.
---------------------------------------------------------------------------
\2\United States Cong. House Committee on Veterans' Affairs
Subcommittee on Health. Legislative Hearing. November 17, 2015. 114th
Cong. 1st sess. Washington: GPO, 2015 (statement from the Honorable
John Kline, U.S. House of Representatives, 2nd Congressional District,
Minnesota).
\3\Ibid.
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Section 2 of the bill would authorize VA to waive the
requirement that a veteran make a copayment if an error
committed by VA was the cause of a delayed copayment
notification to the veteran and the veteran received such
notification later than 180 days (18 months in the case of a
community care facility) after the date on which the veteran
received the care or services. It would also prohibit VA from
collecting copayments from veterans if the veteran was not
notified of such copayment in a timely manner unless the
veteran is provided with both information about applying for a
waiver and establishing a payment plan and the opportunity to
make such a waiver or establish such a repayment plan. Finally,
it would require VA to review and improve copayment billing
internal controls and notification procedures.
Hearings
On September 26, 2017, the Subcommittee on Health conducted
a legislative hearing on a number of bills including H.R. 1972.
The following witnesses testified:
The Honorable Debbie Dingell, U.S. House of
Representatives, 12th District, Michigan; The Honorable
Beto O'Rourke, U.S. House of Representatives, 16th
Congressional District, Texas; The Honorable Derek
Kilmer, U.S. House of Representatives, 6th
Congressional District, Washington; The Honorable Steve
King, U.S. House of Representatives, 4th Congressional
District, Iowa; The Honorable Lloyd Smucker, U.S. House
of Representatives, 16th Congressional District,
Pennsylvania; The Honorable Mike Coffman, U.S. House of
Representatives, 6th Congressional District, Colorado;
The Honorable Steve Stivers, U.S. House of
Representatives, 15th Congressional District, Ohio; The
Honorable Ron DeSantis, U.S. House of Representatives,
6th Congressional District, Florida; The Honorable John
Rutherford, U.S. House of Representatives, 4th
Congressional District, Florida; Keronica Richardson,
Assistant Director of Women and Minority Veterans
Outreach for the National Security Division of The
American Legion; Amy Webb, National Legislative Policy
Advisor for AMVETS; and, Harold Kudler M.D., Acting
Assistant Deputy Under Secretary for Health for Patient
Care Services for the Veterans Health Administration of
the U.S. Department of Veterans Affairs, accompanied by
Catherine Biggs-Silvers, Executive Director for
Mission, Planning, and Analysis for the Human Resources
and Administration of the U.S. Department of Veterans
Affairs.
Statements for the record were submitted by:
Blinded Veterans Association, Veterans of Foreign
Wars of the United States, Disabled American Veterans,
Paralyzed Veterans of America, Justice for Vets, and,
Make a Difference America.
Subcommittee Consideration
There was no Subcommittee consideration of H.R. 1972.
Committee Consideration
On May 8, 2018, the full Committee met in open markup
session, a quorum being present, and ordered H.R. 1972, as
amended, to be reported favorably to the House of
Representatives by voice vote. During consideration of the
bill, the following amendment was considered and agreed to by
voice vote:
An amendment in the nature of a substitute offered by
Representative John Rutherford of Florida.
Committee Votes
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, there were no recorded votes
taken on amendments or in connection with ordering H.R. 1972,
as amended, reported to the House. A motion by Representative
Tim Walz of Minnesota, Ranking Member of the Committee on
Veterans' Affairs, to report H.R. 1972, as amended, favorably
to the House of Representatives was adopted by voice vote.
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are to improve VA's copayment billing
internal controls and notification procedures.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee adopts as its
own the estimate of new budget authority, entitlement
authority, or tax expenditures or revenues contained in the
cost estimate prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
Earmarks and Tax and Tariff Benefits
H.R. 1972, as amended, does not contain any Congressional
earmarks, limited tax benefits, or limited tariff benefits as
defined in clause 9 of rule XXI of the Rules of the House of
Representatives.
Committee Cost Estimate
The Committee adopts as its own the cost estimate on H.R.
1972, as amended, prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
Congressional Budget Office Cost Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
for H.R. 1972, as amended, provided by the Director of the
Congressional Budget Office pursuant to section 402 of the
Congressional Budget Act of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, May 16, 2018.
Hon. Phil Roe, M.D.,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 1972, the VA
Billing Accountability Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Ann E.
Futrell.
Sincerely,
Keith Hall,
Director.
Enclosure.
H.R. 1972--VA Billing Accountability Act
Summary: H.R. 1972 would allow the Department of Veterans
Affairs (VA) to waive the copayments charged for medical care
when veterans are not notified of the charges for a significant
period of time. CBO estimates that implementing the bill would
reduce collections by $141 million over the 2019-2023 period.
Assuming VA continued to provide the same level of health care,
additional funding totaling $141 million would have to be
appropriated, and spending would total $135 million.
Enacting the bill would not affect direct spending or
revenues; therefore, pay-as-you-go procedures do not apply.
CBO estimates that enacting H.R. 1972 would not increase
net direct spending or on-budget deficits in any of the four
consecutive 10-year periods beginning in 2029.
H.R. 1972 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
Estimated cost to the Federal Government: The estimated
budgetary effect of H.R. 1972 is shown in the following table.
The costs of the legislation fall within budget function 700
(veterans benefits and services).
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
----------------------------------------------------------------------
2018 2019 2020 2021 2022 2023 2019-2023
----------------------------------------------------------------------------------------------------------------
INCREASES IN SPENDING SUBJECT TO APPROPRIATION
Estimated Authorization Level............ 0 29 28 28 28 28 141
Estimated Outlays........................ 0 25 27 27 28 28 135
----------------------------------------------------------------------------------------------------------------
Basis of estimate: For this estimate, CBO assumes that H.R.
1972 will be enacted near the beginning of fiscal year 2019 and
that the estimated amounts will be appropriated each year.
Estimated outlays are based on historical spending patterns for
the affected programs.
VA charges copayments to certain veterans for medical care
and services authorized by the department. H.R. 1972 would
allow VA to waive those copayments for veterans who are
notified of their liability more than 180 days after receiving
medical care or medication at a department facility or 18
months after an appointment at a non-VA facility. The
copayments are deposited in the Medical Care Collections Fund
and, subject to appropriation, are spent to provide medical
care for veterans. CBO expects that any reduction in
collections would require VA to request additional funding in
order to provide the same level of health care to veterans.
On the basis of information from VA about its billing
practices, CBO estimates that roughly 4 percent of the $660
million in copayments collected by the department each year
would be waived due to delayed notification. As a result of
those foregone collections, CBO estimates that implementing
this bill and continuing to provide the same level of health
care to veterans would cost $135 million over the 2019-2023
period, assuming appropriation of the necessary amounts.
Pay-As-You-Go Considerations: None.
Increase in long-term direct spending and deficits: CBO
estimates that enacting H.R. 1972 would not increase net direct
spending or on-budget deficits in any of the four consecutive
10-year periods beginning in 2029.
Mandates: H.R. 1972 contains no intergovernmental or
private-sector mandates as defined in UMRA.
Estimate prepared by: Federal costs: Ann E. Futrell;
Mandates: Andrew Laughlin.
Estimate reviewed by: Sarah Jennings, Chief, Defense,
International Affairs, and Veterans' Affairs Cost Estimates
Unit; Leo Lex, Deputy Assistant Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R 1972, as amended, prepared by the
Director of the Congressional Budget Office pursuant to section
423 of the Unfunded Mandates Reform Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
1972, as amended.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 1972, as amended, is authorized by Congress'
power to ``provide for the common Defense and general Welfare
of the United States.''
Applicability to Legislative Branch
The Committee finds that H.R. 1972, as amended, does not
relate to the terms and conditions of employment or access to
public services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Statement on Duplication of Federal Programs
Pursuant to clause 3(c)(5) of rule XIII of the Rules of the
House of Representatives, the Committee finds that no provision
of H.R. 1972, as amended, establishes or reauthorizes a program
of the Federal Government known to be duplicative of another
Federal program, a program that was included in any report from
the Government Accountability Office to Congress pursuant to
section 21 of Public Law 111-139, or a program related to a
program identified in the most recent Catalog of Federal
Domestic Assistance.
Disclosure of Directed Rulemaking
Pursuant to section 3(i) of H. Res. 5, 115th Cong. (2017),
the Committee estimates that H.R. 1972, as amended, contains no
directed rulemaking that would require the Secretary to
prescribe regulations.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 of the bill would establish a short title for
H.R. 1972, as amended, of the ``VA Billing Accountability
Act.''
Section 2. Authority of Secretary of Veterans Affairs to waive
requirement of certain veterans to make copayments for care and
services in the care of Department of Veterans Affairs
Section 2(a) of the bill would amend section 1710(f)(3) of
title 38 U.S.C. by adding at the end a new subparagraph
1710(f)(3)(G).
The new subparagraph 1710(f)(3)(G)(a) would authorize VA to
waive the requirement of a veteran to make a payment under this
section of section (g) if a VA error was the cause of a delayed
notification sent to the veteran of the requirement to make the
payment and the veteran received such notification later than
180 days after the date on which the veteran received the care
or services for which the payment was required.
Section 2(b) of the bill would amend section 1722A of title
38 U.S.C. by redesignating subsection (c) as subsection (d) and
by inserting after subsection (b) a new subsection (c).
The new subsection 1722(A)(c) would authorize VA to waive
the requirement of a veteran to make a copayment under this
section if an error committed by VA or a VA employee was the
cause of delaying notification sent to the veteran of the
requirement to make the payment and the veteran received such
notification later than 180 days after the date on which the
veteran received the medication for which the payment was
required.
Section 2(c) of the bill would amend subchapter I of
chapter 17 of title 38 U.S.C. by adding at the following new
section, ``1709C. Procedures for copayments.'' It would also
amend the table of sections at the beginning of chapter 17 of
title 38 U.S.C. by inserting after the item relating to section
1709B the following new item: ``1709C. Procedure for
copayments.''.
The new section 1709C(a) would require VA to provide a
veteran who is required to make a payment for care or services
provided at a VA medical facility pursuant to chapter 17 of
title 38 U.S.C. with a notification of such required payment by
not later than 180 days after the date on which the veteran
receives the care or services for which such payment is
required. In the event VA does not provide such veteran a
notification of the required payment by the date required, it
would also prohibit VA from collecting such payment, including
through a third party entity, unless VA provides the following:
information regarding how to apply for a waiver described in
section 1710(f)(3)(G) or section 1722A(c) of title 38 U.S.C.,
as appropriate; information regarding how to establish a
payment plan with VA; and the opportunity to make such a waiver
or establish such a payment plan.
The new section 1709C(b) would require VA to provide to a
veteran who is required to make a payment for care or services
pursuant to chapter 17 of title 38 U.S.C. a notification of
such required payment. Such notification would be required by
not later than 18 months after the date on which the veteran
receives the care or services for which payment is required. In
the event that VA does not provide such a notification, it
would also prohibit VA from collecting such payment, including
through a third party entity, unless VA provides the following:
information regarding how to apply for a waiver as described
below; information regarding how to establish a payment plan
with VA; and the opportunity to make such a waiver or establish
such a payment plan. It would further prohibit the requirement
of a veteran to make a payment for care or services provided at
a community facility pursuant to chapter 17 of title 38 U.S.C.
or other provision of law if an error committed by VA, a VA
employee, or a community facility was the cause of delaying the
notification sent to the veteran of the requirement to make the
payment; and the veteran received such notification after the
required period.
Section 2(d) of the bill would require VA, not later than
180 days after the date of enactment of the Act, to review the
copayment billing internal controls and notification procedures
of VA and improve such controls and procedures, including
pursuant to the amendments made by this Act.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, and existing law in which no
change is proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
SUBCHAPTER I--GENERAL
Sec.
1701. Definitions.
* * * * * * *
1709C. Procedures for copayments.
* * * * * * *
SUBCHAPTER I--GENERAL
* * * * * * *
Sec. 1709C. Procedures for copayments
(a) Care at Department Facility.--(1) In requiring a veteran
to make a payment for care or services provided at a medical
facility of the Department pursuant to this chapter, including
sections 1710 and 1722A, the Secretary shall provide to such
veteran a notification of such required payment by not later
than 180 days after the date on which the veteran receives the
care or services for which payment is required.
(2) If the Secretary does not provide to a veteran a
notification of the required payment by the date required under
paragraph (1), the Secretary may not collect such payment,
including through a third-party entity, unless the Secretary
provides the veteran the following:
(A) Information regarding how to apply for a waiver
described in section 1710(f)(3)(G) or section 1722A(c)
of this title, as appropriate.
(B) Information regarding how to establish a payment
plan with the Secretary.
(C) Opportunity to make such a waiver or establish
such a payment plan.
(b) Care at Non-department Facility.--(1) In requiring a
veteran to make a payment for care or services provided at a
non-Department facility pursuant to this chapter or other
provision of law, the Secretary shall provide to such veteran a
notification of such required payment by not later than 18
months after the date on which the veteran receives the care or
services for which payment is required.
(2) If the Secretary does not provide to a veteran a
notification of the required payment by the date required under
paragraph (1), the Secretary may not collect such payment,
including through a third-party entity, unless the Secretary
provides the veteran the following:
(A) Information regarding how to apply for a waiver
described in paragraph (3).
(B) Information regarding how to establish a payment
plan with the Secretary.
(C) Opportunity to make such a waiver or establish
such a payment plan.
(3) The Secretary may waive the requirement of a veteran to
make a payment for care or services provided at a non-
Department facility pursuant to this chapter or other provision
of law if--
(A) an error committed by the Department, an employee
of the Department, or a non-Department facility was the
cause of delaying the notification sent to the veteran
of the requirement to make the payment; and
(B) the veteran received such notification after the
period described in paragraph (1).
SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT
Sec. 1710. Eligibility for hospital, nursing home, and domiciliary care
(a)(1) The Secretary (subject to paragraph (4)) shall furnish
hospital care and medical services which the Secretary
determines to be needed--
(A) to any veteran for a service-connected
disability; and
(B) to any veteran who has a service-connected
disability rated at 50 percent or more.
(2) The Secretary (subject to paragraph (4)) shall furnish
hospital care and medical services, and may furnish nursing
home care, which the Secretary determines to be needed to any
veteran--
(A) who has a compensable service-connected
disability rated less than 50 percent or, with respect
to nursing home care during any period during which the
provisions of section 1710A(a) of this title are in
effect, a compensable service-connected disability
rated less than 70 percent;
(B) whose discharge or release from active military,
naval, or air service was for a disability that was
incurred or aggravated in the line of duty;
(C) who is in receipt of, or who, but for a
suspension pursuant to section 1151 of this title (or
both a suspension and the receipt of retired pay),
would be entitled to disability compensation, but only
to the extent that such veteran's continuing
eligibility for such care is provided for in the
judgment or settlement provided for in such section;
(D) who is a former prisoner of war, who was awarded
the medal of honor under section 3741, 6241, or 8741 of
title 10 or section 491 of title 14, or who was awarded
the Purple Heart;
(E) who is a veteran of the Mexican border period or
of World War I;
(F) who was exposed to a toxic substance, radiation,
or other conditions, as provided in subsection (e); or
(G) who is unable to defray the expenses of necessary
care as determined under section 1722(a) of this title.
(3) In the case of a veteran who is not described in
paragraphs (1) and (2), the Secretary may, to the extent
resources and facilities are available and subject to the
provisions of subsections (f) and (g), furnish hospital care,
medical services, and nursing home care which the Secretary
determines to be needed.
(4) The requirement in paragraphs (1) and (2) that the
Secretary furnish hospital care and medical services, the
requirement in section 1710A(a) of this title that the
Secretary provide nursing home care, the requirement in section
1710B of this title that the Secretary provide a program of
extended care services, and the requirement in section 1745 of
this title to provide nursing home care and prescription
medicines to veterans with service-connected disabilities in
State homes shall be effective in any fiscal year only to the
extent and in the amount provided in advance in appropriations
Acts for such purposes.
(5) During any period during which the provisions of section
1710A(a) of this title are not in effect, the Secretary may
furnish nursing home care which the Secretary determines is
needed to any veteran described in paragraph (1), with the
priority for such care on the same basis as if provided under
that paragraph.
(b)(1) The Secretary may furnish to a veteran described in
paragraph (2) of this subsection such domiciliary care as the
Secretary determines is needed for the purpose of the
furnishing of medical services to the veteran.
(2) This subsection applies in the case of the following
veterans:
(A) Any veteran whose annual income (as determined
under section 1503 of this title) does not exceed the
maximum annual rate of pension that would be applicable
to the veteran if the veteran were eligible for pension
under section 1521(d) of this title.
(B) Any veteran who the Secretary determines has no
adequate means of support.
(c) While any veteran is receiving hospital care or nursing
home care in any Department facility, the Secretary may, within
the limits of Department facilities, furnish medical services
to correct or treat any non-service-connected disability of
such veteran, in addition to treatment incident to the
disability for which such veteran is hospitalized, if the
veteran is willing, and the Secretary finds such services to be
reasonably necessary to protect the health of such veteran. The
Secretary may furnish dental services and treatment, and
related dental appliances, under this subsection for a non-
service-connected dental condition or disability of a veteran
only (1) to the extent that the Secretary determines that the
dental facilities of the Department to be used to furnish such
services, treatment, or appliances are not needed to furnish
services, treatment, or appliances for dental conditions or
disabilities described in section 1712(a) of this title, or (2)
if (A) such non-service-connected dental condition or
disability is associated with or aggravating a disability for
which such veteran is receiving hospital care, or (B) a
compelling medical reason or a dental emergency requires
furnishing dental services, treatment, or appliances (excluding
the furnishing of such services, treatment, or appliances of a
routine nature) to such veteran during the period of
hospitalization under this section.
(d) In no case may nursing home care be furnished in a
hospital not under the direct jurisdiction of the Secretary
except as provided in section 1720 of this title.
(e)(1)(A) A Vietnam-era herbicide-exposed veteran is eligible
(subject to paragraph (2)) for hospital care, medical services,
and nursing home care under subsection (a)(2)(F) for any
disability, notwithstanding that there is insufficient medical
evidence to conclude that such disability may be associated
with such exposure.
(B) A radiation-exposed veteran is eligible for hospital
care, medical services, and nursing home care under subsection
(a)(2)(F) for any disease suffered by the veteran that is--
(i) a disease listed in section 1112(c)(2) of this
title; or
(ii) any other disease for which the Secretary, based
on the advice of the Advisory Committee on
Environmental Hazards, determines that there is
credible evidence of a positive association between
occurrence of the disease in humans and exposure to
ionizing radiation.
(C) Subject to paragraph (2) of this subsection, a veteran
who served on active duty between August 2, 1990, and November
11, 1998, in the Southwest Asia theater of operations during
the Persian Gulf War is eligible for hospital care, medical
services, and nursing home care under subsection (a)(2)(F) for
any disability, notwithstanding that there is insufficient
medical evidence to conclude that such disability may be
associated with such service.
(D) Subject to paragraphs (2) and (3), a veteran who served
on active duty in a theater of combat operations (as determined
by the Secretary in consultation with the Secretary of Defense)
during a period of war after the Persian Gulf War, or in combat
against a hostile force during a period of hostilities after
November 11, 1998, is eligible for hospital care, medical
services, and nursing home care under subsection (a)(2)(F) for
any illness, notwithstanding that there is insufficient medical
evidence to conclude that such condition is attributable to
such service.
(E) Subject to paragraph (2), a veteran who participated in a
test conducted by the Department of Defense Deseret Test Center
as part of a program for chemical and biological warfare
testing from 1962 through 1973 (including the program
designated as ``Project Shipboard Hazard and Defense (SHAD)''
and related land-based tests) is eligible for hospital care,
medical services, and nursing home care under subsection
(a)(2)(F) for any illness, notwithstanding that there is
insufficient medical evidence to conclude that such illness is
attributable to such testing.
(F) Subject to paragraph (2), a veteran who served on active
duty in the Armed Forces at Camp Lejeune, North Carolina, for
not fewer than 30 days during the period beginning on August 1,
1953, and ending on December 31, 1987, is eligible for hospital
care and medical services under subsection (a)(2)(F) for any of
the following illnesses or conditions, notwithstanding that
there is insufficient medical evidence to conclude that such
illnesses or conditions are attributable to such service:
(i) Esophageal cancer.
(ii) Lung cancer.
(iii) Breast cancer.
(iv) Bladder cancer.
(v) Kidney cancer.
(vi) Leukemia.
(vii) Multiple myeloma.
(viii) Myelodysplastic syndromes.
(ix) Renal toxicity.
(x) Hepatic steatosis.
(xi) Female infertility.
(xii) Miscarriage.
(xiii) Scleroderma.
(xiv) Neurobehavioral effects.
(xv) Non-Hodgkin's lymphoma.
(2)(A) In the case of a veteran described in paragraph
(1)(A), hospital care, medical services, and nursing home care
may not be provided under subsection (a)(2)(F) with respect
to--
(i) a disability that is found, in accordance with
guidelines issued by the Under Secretary for Health, to
have resulted from a cause other than an exposure
described in paragraph (4)(A)(ii); or
(ii) a disease for which the National Academy of
Sciences, in a report issued in accordance with section
3 of the Agent Orange Act of 1991, has determined that
there is limited or suggestive evidence of the lack of
a positive association between occurrence of the
disease in humans and exposure to a herbicide agent.
(B) In the case of a veteran described in subparagraph (C),
(D), (E), or (F) of paragraph (1), hospital care, medical
services, and nursing home care may not be provided under
subsection (a)(2)(F) with respect to a disability that is
found, in accordance with guidelines issued by the Under
Secretary for Health, to have resulted from a cause other than
the service or testing described in such subparagraph.
(3) In the case of care for a veteran described in paragraph
(1)(D), hospital care, medical services, and nursing home care
may be provided under or by virtue of subsection (a)(2)(F) only
during the following periods:
(A) Except as provided by subparagraph (B), with
respect to a veteran described in paragraph (1)(D) who
is discharged or released from the active military,
naval, or air service after January 27, 2003, the five-
year period beginning on the date of such discharge or
release.
(B) With respect to a veteran described in paragraph
(1)(D) who is discharged or released from the active
military, naval, or air service after January 1, 2009,
and before January 1, 2011, but did not enroll to
receive such hospital care, medical services, or
nursing home care pursuant to such paragraph during the
five-year period described in subparagraph (A), the
one-year period beginning on the date of the enactment
of the Clay Hunt Suicide Prevention for American
Veterans Act.
(C) With respect to a veteran described in paragraph
(1)(D) who is discharged or released from the active
military, naval, or air service on or before January
27, 2003, and did not enroll in the patient enrollment
system under section 1705 of this title on or before
such date, the three-year period beginning on January
27, 2008.
(4) For purposes of this subsection--
(A) The term ``Vietnam-era herbicide-exposed
veteran'' means a veteran (i) who served on active duty
in the Republic of Vietnam during the during the period
beginning on January 9, 1962, and ending on May 7,
1975, and (ii) who the Secretary finds may have been
exposed during such service to dioxin or was exposed
during such service to a toxic substance found in a
herbicide or defoliant used for military purposes
during such period.
(B) The term ``radiation-exposed veteran'' has the
meaning given that term in section 1112(c)(3) of this
title.
(5) When the Secretary first provides care for veterans using
the authority provided in paragraph (1)(D), the Secretary shall
establish a system for collection and analysis of information
on the general health status and health care utilization
patterns of veterans receiving care under that paragraph. Not
later than 18 months after first providing care under such
authority, the Secretary shall submit to Congress a report on
the experience under that authority. The Secretary shall
include in the report any recommendations of the Secretary for
extension of that authority.
(f)(1) The Secretary may not furnish hospital care or nursing
home care (except if such care constitutes hospice care) under
this section to a veteran who is eligible for such care under
subsection (a)(3) of this section unless the veteran agrees to
pay to the United States the applicable amount determined under
paragraph (2) or (4) of this subsection.
(2) A veteran who is furnished hospital care or nursing home
care under this section and who is required under paragraph (1)
of this subsection to agree to pay an amount to the United
States in order to be furnished such care shall be liable to
the United States for an amount equal to--
(A) the lesser of--
(i) the cost of furnishing such care, as
determined by the Secretary; or
(ii) the amount determined under paragraph
(3) of this subsection; and
(B) before September 30, 2019, an amount equal to $10
for every day the veteran receives hospital care and $5
for every day the veteran receives nursing home care.
(3)(A) In the case of hospital care furnished during any 365-
day period, the amount referred to in paragraph (2)(A)(ii) of
this subsection is--
(i) the amount of the inpatient Medicare deductible,
plus (ii) one-half of such amount for each 90 days of
care (or fraction thereof) after the first 90 days of
such care during such 365-day period.
(B) In the case of nursing home care furnished during any
365-day period, the amount referred to in paragraph (2)(A)(ii)
of this subsection is the amount of the inpatient Medicare
deductible for each 90 days of such care (or fraction thereof)
during such 365-day period.
(C)(i) Except as provided in clause (ii) of this
subparagraph, in the case of a veteran who is admitted for
nursing home care under this section after being furnished,
during the preceding 365-day period, hospital care for which
the veteran has paid the amount of the inpatient Medicare
deductible under this subsection and who has not been furnished
90 days of hospital care in connection with such payment, the
veteran shall not incur any liability under paragraph (2) of
this subsection with respect to such nursing home care until--
(I) the veteran has been furnished, beginning with
the first day of such hospital care furnished in
connection with such payment, a total of 90 days of
hospital care and nursing home care; or
(II) the end of the 365-day period applicable to the
hospital care for which payment was made,
whichever occurs first.
(ii) In the case of a veteran who is admitted for nursing
home care under this section after being furnished, during any
365-day period, hospital care for which the veteran has paid an
amount under subparagraph (A)(ii) of this paragraph and who has
not been furnished 90 days of hospital care in connection with
such payment, the amount of the liability of the veteran under
paragraph (2) of this subsection with respect to the number of
days of such nursing home care which, when added to the number
of days of such hospital care, is 90 or less, is the difference
between the inpatient Medicare deductible and the amount paid
under such subparagraph until--
(I) the veteran has been furnished, beginning with
the first day of such hospital care furnished in
connection with such payment, a total of 90 days of
hospital care and nursing home care; or
(II) the end of the 365-day period applicable to the
hospital care for which payment was made,
whichever occurs first.
(D) In the case of a veteran who is admitted for hospital
care under this section after having been furnished, during the
preceding 365-day period, nursing home care for which the
veteran has paid the amount of the inpatient Medicare
deductible under this subsection and who has not been furnished
90 days of nursing home care in connection with such payment,
the veteran shall not incur any liability under paragraph (2)
of this subsection with respect to such hospital care until--
(i) the veteran has been furnished, beginning with
the first day of such nursing home care furnished in
connection with such payment, a total of 90 days of
nursing home care and hospital care; or
(ii) the end of the 365-day period applicable to the
nursing home care for which payment was made,
whichever occurs first.
(E) A veteran may not be required to make a payment under
this subsection for hospital care or nursing home care
furnished under this section during any 90-day period in which
the veteran is furnished medical services under paragraph (3)
of subsection (a) to the extent that such payment would cause
the total amount paid by the veteran under this subsection for
hospital care and nursing home care furnished during that
period and under subsection (g) for medical services furnished
during that period to exceed the amount of the inpatient
Medicare deductible in effect on the first day of such period.
(F) A veteran may not be required to make a payment under
this subsection or subsection (g) for any days of care in
excess of 360 days of care during any 365-calendar-day period.
(G) The Secretary may waive the requirement of a veteran to
make a payment under this subsection or subsection (g) if--
(i) an error committed by the Department or an
employee of the Department was the cause of delaying
notification sent to the veteran of the requirement to
make the payment; and
(ii) the veteran received such notification later
than 180 days after the date on which the veteran
received the care or services for which the payment was
required.
(4) In the case of a veteran covered by this subsection who
is also described by section 1705(a)(7) of this title, the
amount for which the veteran shall be liable to the United
States for hospital care under this subsection shall be an
amount equal to 20 percent of the total amount for which the
veteran would otherwise be liable for such care under
subparagraphs (2)(B) and (3)(A) but for this paragraph.
(5) For the purposes of this subsection, the term ``inpatient
Medicare deductible'' means the amount of the inpatient
hospital deductible in effect under section 1813(b) of the
Social Security Act (42 U.S.C. 1395e(b)) on the first day of
the 365-day period applicable under paragraph (3) of this
subsection.
(g)(1) The Secretary may not furnish medical services (except
if such care constitutes hospice care) under subsection (a) of
this section (including home health services under section 1717
of this title) to a veteran who is eligible for hospital care
under this chapter by reason of subsection (a)(3) of this
section unless the veteran agrees to pay to the United States
in the case of each outpatient visit the applicable amount or
amounts established by the Secretary by regulation.
(2) A veteran who is furnished medical services under
subsection (a) of this section and who is required under
paragraph (1) of this subsection to agree to pay an amount to
the United States in order to be furnished such services shall
be liable to the United States, in the case of each visit in
which such services are furnished to the veteran, for an amount
which the Secretary shall establish by regulation.
(3) This subsection does not apply with respect to the
following:
(A) Home health services under section 1717 of this
title to the extent that such services are for
improvements and structural alterations.
(B) Education on the use of opioid antagonists to
reverse the effects of overdoses of specific
medications or substances.
(h) Nothing in this section requires the Secretary to furnish
care to a veteran to whom another agency of Federal, State, or
local government has a duty under law to provide care in an
institution of such government.
* * * * * * *
SUBCHAPTER III--MISCELLANEOUS PROVISIONS RELATING TO HOSPITAL AND
NURSING HOME CARE AND MEDICAL TREATMENT OF VETERANS
* * * * * * *
Sec. 1722A. Copayment for medications
(a)(1) Subject to paragraph (2), the Secretary shall require
a veteran to pay the United States $2 for each 30-day supply of
medication furnished such veteran under this chapter on an
outpatient basis for the treatment of a non-service-connected
disability or condition. If the amount supplied is less than a
30-day supply, the amount of the charge may not be reduced.
(2) The Secretary may not require a veteran to pay an amount
in excess of the cost to the Secretary for medication described
in paragraph (1).
(3) Paragraph (1) does not apply--
(A) to a veteran with a service-connected disability
rated 50 percent or more;
(B) to a veteran who is a former prisoner of war;
(C) to a veteran whose annual income (as determined
under section 1503 of this title) does not exceed the
maximum annual rate of pension which would be payable
to such veteran if such veteran were eligible for
pension under section 1521 of this title; or
(D) to a veteran who was awarded the medal of honor
under section 3741, 6241, or 8741 of title 10 or
section 491 of title 14.
(4) Paragraph (1) does not apply to opioid antagonists
furnished under this chapter to a veteran who is at high risk
for overdose of a specific medication or substance in order to
reverse the effect of such an overdose.
(b) The Secretary, pursuant to regulations which the
Secretary shall prescribe, may--
(1) increase the copayment amount in effect under
subsection (a); and
(2) establish a maximum monthly and a maximum annual
pharmaceutical copayment amount under subsection (a)
for veterans who have multiple outpatient
prescriptions.
(c) The Secretary may waive the requirement of a veteran to
make a payment under this section if--
(1) an error committed by the Department or an
employee of the Department was the cause of delaying
notification sent to the veteran of the requirement to
make the payment; and
(2) the veteran received such notification later than
180 days after the date on which the veteran received
the medication for which the payment was required.
[(c)] (d) Amounts collected under this section shall be
deposited in the Department of Veterans Affairs Medical Care
Collections Fund.
* * * * * * *
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