Public Law 97–174

There are opportunities for greater sharing of the health-care resources of the Veterans’ Administration and the Department of Defense which would, if achieved, be beneficial to both veterans and members of the Armed Forces and could result in reduced costs to the Government by minimizing duplication and underuse of health-care resources.

Present incentives to encourage such sharing of health-care resources are inadequate.

Such sharing of health-care resources can be achieved without a detrimental effect on the primary health-care beneficiaries of the Veterans’ Administration and the Department of Defense.

During and immediately after a period of war or national emergency involving the use of the Armed Forces of the United States in armed conflict, the Department of Defense might not have adequate health-care resources to care for military personnel wounded in combat and other active-duty military personnel.

The Veterans’ Administration has an extensive, comprehensive health-care system that could be used to assist the Department of Defense in caring for such personnel in such a situation.

by inserting “(a)” before “The Administrator” the first place it appears;

by striking out “and material” and all that follows through “this title,” and inserting in lieu thereof “material, and other resources as may be needed to operate such facilities properly, except that the Administrator may not enter into an agreement that would result (1) in a permanent reduction in the total number of authorized Veterans’ Administration hospital beds and nursing home beds to a level below the minimum number of such beds required by section 5010(a)(1) of this

38 USC 5010.

title to be authorized, or (2) in a permanent reduction in the total number of such beds operated and maintained to a level below the minimum number of such beds required by such section to be operated and maintained”; and

by adding at the end the following new subsections:

“(b)“(b)

(1)(1)

In order to promote the sharing of health-care resources

Veterans’ Administration/Department of Defense Health-Care Resources Sharing Committee.

Establishment.

between the Veterans’ Administration and the Department of Defense (hereinafter in this section referred to as the ‘agencies’), there is established an interagency committee to be known as the Veterans’ Administration/Department of Defense Health-Care Resources Sharing Committee (hereinafter in this subsection referred to as the ‘Committee’).

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“(2)“(2)

The Committee shall be composed of—

“(A)“(A)

the Chief Medical Director and such other officers and employees of the Veterans’ Administration as the Chief Medical Director may designate; and

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“(B)“(B)

the Assistant Secretary of Defense for Health Affairs (hereinafter in this section referred to as the ‘Assistant Secretary’) and such other officers and employees of the Department of Defense as the Assistant Secretary may designate,

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except that the size of the Committee shall be mutually determined by the Chief Medical Director and the Assistant Secretary. During fiscal years 1982 and 1983, the Chief Medical Director shall be the chairman of the Committee. During fiscal year 1984, the Assistant Secretary shall be the chairman of the Committee. Thereafter, the chairmanship of the Committee shall alternate each fiscal year between the Chief Medical Director and the Assistant Secretary. The agencies shall provide administrative support services for the Committee at a level sufficient for the efficient operation of the Committee and shall share the responsibility for the provision of such services on an equitable basis.

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“(3)“(3)

In order to enable the Committee to make recommendations

Duties.

under paragraph (4) of this subsection, the Committee shall on a continuing basis—

“(A)“(A)

review existing policies, procedures, and practices relating to the sharing of health-care resources between the agencies;

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“(B)“(B)

identify and assess further opportunities for the sharing of health-care resources between the agencies that would not, in the judgment of the Committee, adversely affect the range of services, the quality of care, or the established priorities for care provided by either agency;

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“(C)“(C)

identify changes in policies, procedures, and practices that would, in the judgment of the Committee, promote such sharing of health-care resources between the agencies;

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“(D)“(D)

monitor plans of the agencies for the acquisition of additional health-care resources, including the location of new facilities and the acquisition of major equipment, in order to assess the potential impact of such plans on further opportunities for such sharing of health-care resources; and

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“(E)“(E)

monitor the implementation of activities designed to promote the sharing of health-care resources between the agencies.

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“(4)“(4)

Within nine months of the date of the enactment of this subsection

Recommendations to VA Administrator or DOD Secretary.

and at such times thereafter as the Committee considers appropriate, the Committee shall make recommendations to the Administrator or the Secretary of Defense, or both, with respect to (A) changes in policies, procedures, and practices that the Committee has identified under paragraph (3)(C) of this subsection pertain-ing to the sharing of health-care resources described in such paragraph, and (B) such other matters as the Committee considers appropriate in order to promote such sharing of health-care resources.

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“(c)“(c)

(1)(1)

After considering the recommendations made under subsection (b)(4) of this section, the Administrator and the Secretary of Defense shall jointly establish guidelines to promote the sharing of health-care resources between the agencies. Guidelines established under this subsection shall provide for such sharing consistent with the health-care responsibilities of the Veterans’ Administration under this title and with the health-care responsibilities of the

10 USC 1071 et seq.

Department of Defense under chapter 55 of title 10 and so as not to adversely affect the range of services, the quality of care, or the established priorities for care provided by either agency.

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“(2)“(2)

Guidelines established under paragraph (1) of this subsection shall authorize the heads of individual medical facilities of the agencies to enter into health-care resources sharing agreements in accordance with subsection (d) of this section and shall include guidelines for such agreements.

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“(d)“(d)

(1)(1)

The head of each medical facility of either agency is authorized to enter into sharing agreements with the heads of medical facilities of the other agency in accordance with guidelines established under subsection (c) of this section. Under any such agreement, an individual who is a primary beneficiary of one agency may be provided health care at a facility of the other agency that is a party to the sharing agreement.

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“(2)“(2)

Each such agreement shall identify the health-care resources to be shared.

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“(3)“(3)

Each such agreement shall provide, and shall specify procedures designed to ensure, that the availability of direct health care to individuals who are not primary beneficiaries of the providing agency (A) is on a referral basis from the facility of the other agency, and (B) does not (as determined by the head of the facility of the providing agency) adversely affect the range of services, the quality of care, or the established priorities for care provided to the primary beneficiaries of the providing agency.

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“(4)“(4)

Each such agreement shall provide that a providing agency shall be reimbursed for the cost of the health-care resources provided under the agreement and that the rate for such reimbursement shall be determined in accordance with the methodology agreed to pursuant to subsection (e) of this section.

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“(5)“(5)

Each proposal for an agreement under paragraph (1) of this subsection shall be submitted to the Chief Medical Director and the Assistant Secretary and shall be effective as an agreement in accordance with its terms (A) on the forty-sixth day after the receipt of such proposal by both such officials, unless earlier disapproved by either such official, or (B) if earlier approved by both such officials, on the date of such approval.

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“(e)“(e)

Reimbursement under any sharing agreement entered into under subsection (d) of this section shall be based upon a methodology that is agreed upon by the Chief Medical Director and the Assistant Secretary and that provides appropriate flexibility to the heads of the facilities concerned to take into account local conditions and needs and the actual costs to the providing agency’s facility of the health-care resources provided. Any funds received through such a reimbursement shall be credited to funds that have been allotted to the facility that provided the care or services.

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“(f)“(f)

At the time the President’s Budget is transmitted to Congress

Report to Congress.

in any year pursuant to section 201(a) of the Budget and Accounting Act, 1921 (31 U.S.C. 11(a)), the Administrator and the Secretary of Defense shall submit a joint report to Congress on the implementation of this section during the fiscal year that ended during the previous calendar year. Each such report shall include—

“(1)“(1)

the guidelines prescribed under subsection (c) of this section (and any revision of such guidelines);

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“(2)“(2)

the assessment of further opportunities identified under clause (B) of subsection (b)(3) of this section for sharing of health-care resources between the agencies;

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“(3)“(3)

any recommendation made under subsection (b)(4) of this section during such fiscal year;

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“(4)“(4)

a review of the sharing agreements entered into under subsection (d) of this section and a summary of activities under such agreements during such fiscal year;

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“(5)“(5)

a summary of other planning and activities involving either agency in connection with promoting the coordination and sharing of Federal health-care resources during the preceding fiscal year; and

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“(6)“(6)

such recommendations for legislation as the Administrator and the Secretary consider appropriate to facilitate the sharing of health-care resources between the agencies.

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“(g)“(g)

For the purposes of this section:

Definitions.

“(1)“(1)

The term ‘beneficiary’ means a person who is a primary beneficiary of the Veterans’ Administration or of the Department of Defense.

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“(2)“(2)

The term ‘direct health care’ means health care provided to a beneficiary in a medical facility operated by the Veterans’ Administration or the Department of Defense.

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“(3)“(3)

The term ‘head of a medical facility’ (A) with respect to a medical facility of the Veterans’ Administration, means the director of the facility, and (B) with respect to a medical facility of the Department of Defense, means the medical or dental officer in charge or the contract surgeon in charge.

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“(4)“(4)

The term ‘health-care resource’ includes hospital care, medical services, and rehabilitative services, as those terms are defined in paragraphs (5), (6), and (8), respectively, of section 601 of this title, any other health-care service, and any health-care support or administrative resource.

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“(5)“(5)

The term ‘primary beneficiary’ (A) with respect to the Veterans’ Administration means a person who is eligible under this title (other than under section 611(b) or 613 or subsection

38 USC 611, 613.

(d) of this section) or any other provision of law for care or services in Veterans’ Administration medical facilities, and (B) with respect to the Department of Defense, means a member or former member of the Armed Forces who is eligible for care under section 1074 of title 10.

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“(6)“(6)

The term ‘providing agency’ means the Veterans’ Administration, in the case of care or services furnished by a facility of the Veterans’ Administration, and the Department of Defense, in the case of care or services furnished by a facility of the Department of Defense.”.

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The heading of such section is amended to read as follows:

38 USC 5011.

“§ 5011. Sharing of Veterans’ Administration and Department of Defense health-care resources”.

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The item relating to such section in the table of sections at the beginning of chapter 81 of such title is amended to read as follows: