To establish a demonstration project to provide for Medicare reimbursement for health care services provided to certain Medicare-eligible veterans in selected facilities of the Department of Veterans Affairs.

May 17, 2001

Mr. SAXTON (for himself, Mr. MORAN of Kansas, Mr. ANDREWS, Mr. LOBIONDO, and Mr. KING) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committees on Veterans' Affairs and Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

To establish a demonstration project to provide for Medicare reimbursement for health care services provided to certain Medicare-eligible veterans in selected facilities of the Department of Veterans Affairs.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the `Veterans Medicare Reimbursement Demonstration Act of 2001'.

SEC. 2. FINDINGS.

The Congress makes the following findings:

(1) The health care system of the Department of Veterans Affairs enrolls veterans in 7 designated priority groups and provides health care services to veterans based upon these priority groups, with priority group 1 given the highest priority and priority group 7 given the lowest.

(2) Due to budgetary limitations in moneys appropriated to the Department of Veterans Affairs for veterans health care, certain veterans in lower priority groups could face limitations in access to health care from the Department of Veterans Affairs.

(3) Veterans participating in the health care system of the Department of Veterans Affairs and served under the lower priority groups 5, 6, and 7 are either low-income veterans whose annual income and net worth are below established thresholds, veterans whose incomes are above the thresholds and do not have service-connected disabilities that qualify them for priority care in that health care system, or other eligible veterans not already covered in groups 1-4.

(4) Allowing medicare-eligible veterans in these lower priority groups to utilize their medicare benefits in the health care system of the Department of Veterans Affairs provides veterans greater access to health care services and greater flexibility in choosing their health care providers.

(5) Allowing these veterans to utilize their medicare benefits in the health care system of the Department of Veterans Affairs also provides health care facilities of the Department of Veterans Affairs greater flexibility in serving veterans.

(6) All veterans should have access to necessary health care, and this Act takes the next step in demonstrating the value of medicare subvention, and demonstrates the commitment of Congress, to an improved Department of Veterans Affairs health care system for the Nation's veterans and to ensuring access to such health care by veterans.

(7) The Department of Veterans Affairs is not sufficiently funded to enable the entirety of the veteran population of 25,500,000 veterans to gain access to health care furnished by the Department.

(8) The Department of Veterans Affairs receives funding adequate to furnish health care only to those veterans who, in all likelihood, will be enrolled for such health care annually, based only on eligibility rules contained in chapter 17 of title 38, United States Code, and without regard to individual veterans who may have access to health care benefits through the medicare program or through other means.

SEC. 3. ESTABLISHMENT OF MEDICARE SUBVENTION DEMONSTRATION PROJECT FOR VETERANS.

Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by adding at the end the following:

`MEDICARE SUBVENTION DEMONSTRATION PROJECT FOR VETERANS

`SEC. 1897. (a) DEFINITIONS- In this section:

`(1) ADMINISTERING SECRETARIES- The term `administering Secretaries' means the Secretary and the Secretary of Veterans Affairs acting jointly.

`(2) DEMONSTRATION PROJECT- The term `demonstration project' means the demonstration project carried out under this section.

`(3) DEMONSTRATION SITE-

`(A) IN GENERAL- Subject to subparagraph (B), the term `demonstration site' means a Veterans Affairs medical facility that provides, alone or in conjunction with other facilities under the jurisdiction of the Secretary of Veterans Affairs and affiliated public or private entities--

`(i) in the case of a coordinated care health plan, the health care benefits prescribed in subsection (c)(3) to targeted medicare-eligible veterans residing within the service area; and

`(ii) in the case of health care benefits being provided on a fee-for-service basis, the health care benefits prescribed in subsection (d)(2) to targeted medicare-eligible veterans.

`(B) EXCLUSION- The term `demonstration site' shall not include the entire catchment area of a Veterans Integrated Services Network (VISN).

`(4) MEDICARE HEALTH CARE SERVICES- The term `medicare health care services' means items or services covered under part A or B of this title.

`(5) TARGETED MEDICARE-ELIGIBLE VETERAN- The term `targeted medicare-eligible veteran' means an individual who--

`(A) is a veteran (as defined in section 101 of title 38, United States Code) who is eligible for care and services under paragraph (5), (6), or (7) of section 1705(a) of title 38, United States Code;

`(B) has attained age 65;

`(C) is entitled to, or enrolled for, benefits under part A of this title; and

`(D) is enrolled for benefits under part B of this title.

`(6) TRUST FUNDS- The term `trust funds' means the Federal Hospital Insurance Trust Fund established in section 1817 and the Federal Supplementary Medical Insurance Trust Fund established in section 1841.

`(7) VETERANS AFFAIRS MEDICAL FACILITY- The term `Veterans Affairs medical facility' means a medical facility as defined in section 8101 of title 38, United States Code.

`(b) DEMONSTRATION PROJECT-

`(1) IN GENERAL-

`(A) ESTABLISHMENT- The administering Secretaries are authorized to establish a demonstration project (under agreements entered into by the administering Secretaries) under which the Secretary shall reimburse the Secretary of Veterans Affairs, from the trust funds, for medicare health care services furnished to targeted medicare-eligible veterans.

`(B) AGREEMENT- Any agreement entered into under this paragraph shall include at a minimum--

`(i) a detailed description of the health care benefits to be provided to the participants of the demonstration project established under this section;

`(ii) a description of the eligibility rules for participation in the demonstration project, including any criteria established under subsection (e), any premiums established for a coordinated care health plan, and any cost-sharing arrangements;

`(iii) a description of how the demonstration project will satisfy the requirements under this title;

`(iv) a description of the demonstration sites selected under paragraph (2);

`(v) a description of how reimbursement requirements under subsection (k), maintenance of effort requirements under subsection (l), and the annual reconciliation under subsection (m) will be implemented in the demonstration project;

`(vi) a statement that the Secretary shall have access to all data of the Department of Veterans Affairs that the Secretary determines is necessary to conduct independent estimates and audits of the maintenance of effort requirement under subsection (l), the annual reconciliation under subsection (m), and related matters required under the demonstration project;

`(vii) a statement that the Comptroller General of the United States shall have access to all data of the Department of Veterans Affairs that the Comptroller General determines is necessary to carry out the reporting requirements under subsections (m) or (n).

`(viii) a description of any requirement that the Secretary waives pursuant to subsection (c)(4) or (d)(4); and

`(ix) a certification, provided after review by the administering Secretaries, that any facility or entity described in subsection (a)(3)(A) that is receiving payments by reason of the demonstration project has sufficient--

`(I) resources and expertise to provide, consistent with payment requirements under subsection (k), the health care benefits required to be provided to beneficiaries under the demonstration project (as established under subsections (c)(3) and (d)(2)); and

`(II) information and billing systems in place to ensure--

`(aa) accurate and timely submission of claims for health care benefits to the Secretary; and

`(bb) that providers of health care services that are not affiliated with the Department of Veterans Affairs are reimbursed by the Secretary of Veterans Affairs in a timely and accurate manner.

`(C) SEPARATE AGREEMENTS FOR COORDINATED CARE AND FEE-FOR-SERVICE- The administering Secretaries shall enter into separate agreements with regard to demonstration sites operating under a coordinated care health plan model and a fee-for-service model, and shall include in each agreement only such information that is applicable to that model.

`(2) NUMBER OF DEMONSTRATION SITES-

`(A) IN GENERAL- Subject to the succeeding provisions of this paragraph, the demonstration project established under this section shall be conducted in not more than 10 demonstration sites, designated jointly by the administering Secretaries.

`(B) EQUAL NUMBER OF COORDINATED CARE AND FEE-FOR-SERVICE SITES- The administrating Secretaries shall--

`(i) ensure that the number of demonstration sites operated under a coordinated care health plan model equals the number of demonstration sites operated under a fee-for-service model; and

`(ii) attempt to ensure that the volume of medicare health care services provided under the demonstration project at demonstration sites operated under a coordinated care health plan model is the same as the volume of such services provided at demonstration sites operated under a fee-for-service model.

`(C) RESTRICTION- A demonstration site may not operate under both a coordinated care health plan model and a fee-for-service model.

`(D) DEMONSTRATION SITES IN RURAL AREAS- At least 1 of each of the following demonstration sites shall be selected for inclusion in the demonstration project:

`(i) A demonstration site that is operated under a coordinated care health plan model and that serves a predominantly rural area.

`(ii) A demonstration site that is operated under a fee-for-service model and that serves a predominantly rural area.

`(3) RESTRICTION ON NEW OR EXPANDED FACILITIES- No new Veterans Affairs medical facilities may be built or expanded with funds from the demonstration project.

`(4) DURATION-

`(A) COORDINATED CARE HEALTH PLAN MODEL- The authority of the administering Secretaries to conduct the demonstration

project under a coordinated care health plan model shall--

`(i) begin on January 1, 2003; and

`(ii) terminate on the earlier of--

`(I) the date which is 3 years after the date enrollment in a coordinated care health plan begins at any demonstration site using such a model; or

`(II) December 31, 2006.

`(B) FEE-FOR-SERVICE MODEL- The authority of the administering Secretaries to conduct the demonstration under a fee-for-service model shall--

`(i) begin on January 1, 2004; and

`(ii) terminate on the earlier of--

`(I) the date which is 3 years after the date that health care benefits begin to be provided at any demonstration site using such a model; or

`(II) December 31, 2007.

`(c) COORDINATED CARE HEALTH PLAN MODEL-

`(1) IN GENERAL- The Secretary of Veterans Affairs shall establish and operate coordinated care health plans in order to provide the health care benefits prescribed in paragraph (3) to targeted medicare-eligible veterans enrolled in the demonstration project consistent with part C of this title.

`(2) OPERATION BY OR THROUGH A DEMONSTRATION SITE- Any coordinated care health plan established in accordance with paragraph (1) shall be operated by or through a demonstration site.

`(3) HEALTH CARE BENEFITS-

`(A) IN GENERAL- Subject to subparagraph (B), the Secretary of Veterans Affairs shall prescribe the health care benefits to be provided to a targeted medicare-eligible veteran enrolled in a coordinated care health plan under the demonstration project.

`(B) MINIMUM BENEFITS- The benefits prescribed by the Secretary of Veterans Affairs pursuant to subparagraph (A) shall include at least all medicare health care services that are required to be provided by a Medicare+Choice organization under part C.

`(4) MEDICARE REQUIREMENTS-

`(A) IN GENERAL-

`(i) REQUIREMENTS- Except as provided under clause (ii), a coordinated care health plan operating under the demonstration project shall meet all requirements applicable to a Medicare+Choice plan under part C of this title and regulations pertaining thereto, and any other requirements for receiving payments under this title, except that the prohibition of payments to Federal providers of services under sections 1814(c) and 1835(d),

and paragraphs (2) and (3) of section 1862(a), shall not apply.

`(ii) WAIVER- Except with respect to any requirement described in subparagraph (B), the Secretary is authorized to waive any requirement described in clause (i), or approve equivalent or alternative ways of meeting such a requirement, but only if such waiver or approval--

`(I) reflects the unique status of the Department of Veterans Affairs as an agency of the Federal Government; and

`(II) is necessary to carry out, or improve the efficiency of, the demonstration project.

`(B) BENEFICIARY PROTECTIONS AND OTHER MATTERS- A coordinated care health plan shall comply with the requirements of part C of this title that relate to beneficiary protections and other related matters, including such requirements relating to the following areas:

`(i) Enrollment and disenrollment.

`(ii) Nondiscrimination.

`(iii) Information provided to beneficiaries.

`(iv) Cost-sharing limitations.

`(v) Appeal and grievance procedures.

`(vi) Provider participation.

`(vii) Access to services.

`(viii) Quality assurance and external review.

`(ix) Advance directives.

`(x) Other areas of beneficiary protections that the Secretary determines are applicable to a coordinated health care plan operating under the demonstration project.

`(d) FEE-FOR-SERVICE MODEL-

`(1) IN GENERAL- The Secretary of Veterans Affairs shall establish and operate a demonstration site in order to provide, on a fee-for-service basis, the medicare health care services prescribed in paragraph (2) to targeted medicare-eligible veterans under the demonstration project in a manner consistent with this title.

`(2) HEALTH CARE BENEFITS- The administering Secretaries shall prescribe the medicare health care services available to a targeted medicare-eligible veteran at a demonstration site operating under a fee-for-service model.

`(3) COST-SHARING- The Secretary of Veterans Affairs shall establish cost-sharing requirements for targeted medicare-eligible veterans that receive medicare health care services under a fee-for-service model at a demonstration site. Such cost-sharing requirements shall be the same as those required under this title.

`(4) MEDICARE REQUIREMENTS-

`(A) IN GENERAL- Except as provided under subparagraph (B), any entity or health care provider that provides medicare health care services under the demonstration project on a fee-for-service basis shall meet all of the requirements under this title, except that the prohibition of payments to Federal providers of services under sections 1814(c) and 1835(d), and paragraphs (2) and (3) of section 1862(a), shall not apply.

`(B) WAIVER- The Secretary is authorized to waive any requirement described under subparagraph (A), or approve equivalent or alternative ways of meeting such a requirement, but only if such waiver or approval--

`(i) reflects the unique status of the Department of Veterans Affairs as an agency of the Federal Government; and

`(ii) is necessary to carry out, or improve the efficiency of, the demonstration project.

`(5) VERIFICATION OF ELIGIBILITY-

`(A) IN GENERAL- The Secretary of Veterans Affairs shall establish procedures for determining whether an individual is eligible to receive medicare health care services on a fee-for-service basis under the demonstration project.

`(B) RESTRICTION- No payments shall be made under this section for any medicare health care service provided to an individual on a fee-for-service basis under the demonstration project unless the individual has been determined to be eligible for the service pursuant to the procedures established under subparagraph (A).

`(e) DEMONSTRATION SITE REQUIREMENTS- The Secretary of Veterans Affairs may operate a coordinated care health plan at a demonstration site, may provide medicare health care services using the fee-for-service model at a demonstration site, and may authorize a demonstration site to submit claims for payment under the demonstration project only after the Secretary of Veterans Affairs submits to the committees of jurisdiction of Congress a report setting forth a plan for the establishment of such demonstration site and for the oversight by the Secretary of Veterans Affairs of the demonstration project conducted at such demonstration site. The administering Secretaries may not implement the plan until the Secretary of Veterans Affairs has received from the Inspector General of the Department of Health and Human Services, and has forwarded to Congress, certification that--

`(1) the--

`(A) cost accounting and related transaction systems of the Veterans Health Administration provide cost information and encounter data regarding health care delivered at each demonstration site (or delivered by any entity or health care provider with which the Secretary of Veterans Affairs has a contract or sharing agreement) on an inpatient and outpatient basis; and

`(B) cost information and encounter data provided by such systems is accurate, reliable, and consistent across all the demonstration sites;

`(2) the Secretary of Veterans Affairs has minimized the risk that any amount appropriated to the Department of Veterans Affairs will be required to meet any obligation of the demonstration sites under the demonstration project to a targeted medicare-eligible veteran by developing a credible plan--

`(A) based on market surveys, data from the Decision Support System, actuarial analysis, and other appropriate methods; and

`(B) taking into account the level of payment under subsection (k) and the costs of health care benefits provided at the demonstration sites with regard to each demonstration site;

`(3) each demonstration site has the capacity to provide to a sufficient number of targeted medicare-eligible veterans, at a minimum--

`(A) under the coordinated care health plan model, the health care benefits prescribed in subsection (c)(3); or

`(B) under the fee-for-service model, the health care benefits prescribed in subsection (d)(2); and

`(4) the Veterans Affairs medical facility administering the demonstration site has sufficient systems and safeguards in place to minimize any risk that instituting the coordinated care health plan model or the fee-for-service model will result in reducing--

`(A) the quality of care delivered to participants in the demonstration project; or

`(B) the quality of, or the access to, care to veterans not participating in the demonstration project.

`(f) VOLUNTARY PARTICIPATION- Participation of a targeted medicare-eligible veteran in the demonstration project shall be voluntary, subject to the capacity of participating demonstration sites and the annual limitations on medicare payments specified in subsection (k)(4), and shall be subject to such terms and conditions as the administering Secretaries may establish.

`(g) CREDITING OF PAYMENTS- A payment received by the Secretary of Veterans Affairs under the demonstration project shall be credited to the applicable Department of Veterans Affairs medical appropriation unless the Secretary of Veterans Affairs has a compelling reason to do otherwise. Any such payment received during a fiscal year for services provided during a prior fiscal year may be obligated by the Secretary of Veterans Affairs during the fiscal year during which the payment is received.

`(h) WAIVER OF CERTAIN VA REQUIREMENTS- Notwithstanding any other provision of law, the Secretary of Veterans Affairs shall furnish medicare health care services to targeted medicare-eligible veterans pursuant to the demonstration project.

`(i) INSPECTOR GENERAL- Nothing in any agreement entered into under subsection (b) shall limit the Inspector General of the Department of Health and Human Services from investigating any matters regarding the expenditure of funds under this title for the demonstration project, including compliance with the provisions of this title and all other relevant laws.

`(j) REPORT-

`(1) IN GENERAL- At least 30 days prior to the commencement of the demonstration project (for both the coordinated care health plan model and the fee-for-service model), the administering Secretaries shall submit a copy of any agreement entered into under subsection (b) to the committees of jurisdiction of Congress.

`(2) SUBSEQUENT WAIVER OF MEDICARE REQUIREMENTS- If the Secretary waives any requirement under subsection (c)(4) or (d)(4) that was not described in any agreement submitted to the committees of jurisdiction of Congress under paragraph (1), the Secretary shall submit a report to such committees describing such waiver.

`(k) PAYMENTS BASED ON REGULAR MEDICARE PAYMENT RATES-

`(1) AMOUNT- Subject to the succeeding provisions of this subsection and subsection (m), the Secretary shall reimburse the Secretary of Veterans Affairs for health care benefits provided under the demonstration project at the following rates:

`(A) COORDINATED CARE HEALTH PLANS- In the case of health care benefits provided under the demonstration project to a targeted medicare-eligible veteran enrolled in a coordinated care health plan, at a rate equal to 95 percent of the amount paid to a Medicare+Choice organization under part C for an enrollee in a Medicare+Choice plan offered by such organization (as risk adjusted under section 1853(a)(1)(B)).

`(B) FEE-FOR-SERVICE MODEL- In the case of a medicare health care service prescribed in subsection (d)(2) that is provided at a demonstration site operating under a fee-for-service model, at a rate equal to 95 percent of the amounts that otherwise would be payable under this title on a noncapitated basis for such service if the demonstration site was not part of this demonstration project, was participating in the medicare program, and imposed charges for such service.

`(2) EXCLUSION OF CERTAIN AMOUNTS- In computing the amount of payment under paragraph (1), the following amounts shall be excluded:

`(A) DISPROPORTIONATE SHARE HOSPITAL ADJUSTMENT- Any amount attributable to an adjustment under section 1886(d)(5)(F).

`(B) DIRECT GRADUATE MEDICAL EDUCATION PAYMENTS- Any amount attributable to a payment under section 1886(h).

`(C) INDIRECT MEDICAL EDUCATION ADJUSTMENT- Any amount attributable to the adjustment under section 1886(d)(5)(B).

`(D) PERCENTAGE OF CAPITAL PAYMENTS- 67 percent of any amounts attributable to payments for capital-related costs under medicare payment policies under section 1886(g).

`(3) PERIODIC PAYMENTS FROM MEDICARE TRUST FUNDS- Payments under this subsection shall be made--

`(A) on a periodic basis consistent with the periodicity of payments under this title; and

`(B) in appropriate part, as determined by the Secretary, from the trust funds.

`(4) ANNUAL LIMIT ON MEDICARE PAYMENTS-

`(A) COORDINATED CARE HEALTH PLAN MODEL- Subject to subparagraphs (C) and (D), the total amount paid to the Department of Veterans Affairs under this subsection for enrollees in coordinated care health plans for any of the 3 consecutive 12-month periods (the first of which begins on the date that enrollment in such a plan begins at any demonstration site) shall be equal to an amount determined appropriate by the administering Secretaries.

`(B) FEE-FOR-SERVICE MODEL- Subject to subparagraphs (C) and (D), the total amount paid to the Department of Veterans Affairs under this subsection for health care benefits provided on a fee-for-service basis at a demonstration site for any of the 3 consecutive 12-month periods (the first of which begins on the date that benefits begin to be provided at any demonstration site using the fee-for-service model) shall be equal to an amount determined appropriate by the administering Secretaries.

`(C) NO PAYMENTS FOR BENEFITS PROVIDED AFTER TERMINATION DATE- No amounts shall be paid to the Department of Veterans Affairs under this section for health care benefits provided under the demonstration project after the date that the project terminates pursuant to subparagraph (A)(ii) or (B)(ii) of subsection (b)(4).

`(D) CAP- The sum of the amounts paid to the Department of Veterans Affairs under this section during each of the 12-month periods described in subparagraph (A) shall not exceed $50,000,000.

`(l) MAINTENANCE OF EFFORT-

`(1) IN GENERAL- The Secretary may not reimburse the Secretary of Veterans Affairs, from the trust funds, for medicare health care services furnished under the demonstration project to targeted medicare-eligible veterans at a demonstration site in a year until the expenditures during that year by the Department of Veterans Affairs for such services provided at that site to individuals that meet the definition of a targeted medicare-eligible veteran under subsection (a)(4) (without regard to subparagraph (D) of such subsection) exceeds such expenditures at the site for such services provided to such individuals during a baseline period determined by the administering Secretaries.

`(2) RULE OF CONSTRUCTION- The criteria for eligiblity for health care benefits furnished to veterans by the Secretary of Veterans Affairs is established under chapter 17 of title 38, United States Code, and nothing in this section shall be construed to add additional criteria for such eligiblity.

`(m) ANNUAL RECONCILIATION TO ASSURE NO INCREASE IN COSTS TO MEDICARE PROGRAM-

`(1) MONITORING EFFECT OF DEMONSTRATION PROGRAM ON COSTS TO MEDICARE PROGRAM-

`(A) IN GENERAL- The administering Secretaries, in consultation with the Comptroller General of the United States, shall closely monitor the expenditures made under the medicare program under this title for targeted medicare-eligible veterans at each demonstration site during the period of the demonstration project compared to the expenditures that would have been made for such veterans during that period if the demonstration project had not been conducted.

`(B) ANNUAL REPORTS BY THE COMPTROLLER GENERAL-

`(i) COORDINATED CARE HEALTH PLAN MODEL- Not later than 6 months after the end of each of the 3 consecutive 12-month periods referred to in subsection (j)(4)(A), the Comptroller General of the United States shall submit to the administering Secretaries and the appropriate committees of Congress a report on the extent, if any, to which the costs of the Secretary under the medicare program under this title for each demonstration site operating under such a model increased as a result of the demonstration project during the 12-month period to which the report applies.

`(ii) FEE-FOR-SERVICE MODEL- Not later than 6 months after the end of each of the 3 consecutive 12-month periods referred to in subsection (j)(4)(B), the Comptroller General of the United States shall submit to the administering Secretaries and the appropriate committees of jurisdiction of Congress a report described in clause (i) with respect to such a model.

`(2) REQUIRED RESPONSE IN CASE OF INCREASE IN COSTS-

`(A) IN GENERAL- If the administering Secretaries find, based on paragraph (1), that the expenditures under the medicare program under this title for each demonstration site increased (or are expected to increase) during a fiscal year because of the demonstration project, the administering Secretaries shall take such steps as may be needed--

`(i) to recoup for the medicare program the amount of such increase in expenditures; and

`(ii) to prevent any such increase in any succeeding fiscal year.

`(B) STEPS- Such steps--

`(i) under subparagraph (A)(i), shall include payment of an amount equal to the amount of such increased expenditures by the Secretary of Veterans Affairs from the current medical care appropriation of the Department of Veterans Affairs to the trust funds; and

`(ii) under subparagraph (A)(ii), shall include suspending or terminating the demonstration project (in whole or in part) or reducing the amount of payment under subsection (k).

`(n) EVALUATION AND REPORTS-

`(1) INDEPENDENT EVALUATION-

`(A) IN GENERAL- The Comptroller General of the United States shall conduct an evaluation of the demonstration project, including--

`(i) an evaluation of demonstration sites operating under a coordinated care health plan model and under a fee-for-service model; and

`(ii) where appropriate, a comparison of such models.

`(B) CONTENTS- Any evaluation conducted under subparagraph (A) shall include an assessment, based on the agreement entered into under subsection (b), of the following:

`(i) Any savings or costs to the medicare program under this title resulting from the demonstration project.

`(ii) Compliance of participating demonstration sites with applicable measures of quality of care, compared to such compliance by other entities that participate in the medicare program and are not Veterans Affairs medical facilities.

`(iii) Compliance by the Department of Veterans Affairs with the requirements under this title.

`(iv) The number of targeted medicare-eligible veterans opting to receive health care benefits under the demonstration project instead of receiving such benefits through another health insurance plan (including health care benefits under this title).

`(v) A comparison of the costs of participation of the demonstration sites in the program with the reimbursements for health care services provided by such sites.

`(vi) Any impact the demonstration project has on the access to health care services, or the quality of such services, for--

`(I) targeted medicare-eligible veterans receiving health care benefits under the demonstration project; and

`(II) veterans (including targeted medicare-eligible veterans) that are not receiving health care benefits under the demonstration project.

`(vii) Any impact the demonstration project has on private health care providers and on beneficiaries under this title that are not receiving health care benefits under the demonstration project.

`(viii) Any effect that the demonstration project has on the enrollment in Medicare+Choice plans offered by Medicare+Choice organizations under part C of this title in the established demonstration site areas.

`(ix) Any impact that the exclusion of the amounts described in subsection (k)(2) from the reimbursement amounts under the demonstration has on the Department of Veterans Affairs or on targeted medicare-eligible veterans.

`(x) A description of the difficulties (if any) experienced by--

`(I) the Department of Veterans Affairs in managing the demonstration project; or

`(II) the Department of Health and Human Services in overseeing the demonstration project.

`(xi) Any additional elements specified in the agreement entered into under subsection (b).

`(xii) Any additional elements that the Comptroller General of the United States determines are appropriate to assess regarding the demonstration project.

`(C) PERIODIC REPORTS-

`(i) COORDINATED CARE HEALTH PLAN MODEL- With respect to the portion of the demonstration project that is operating under a coordinated care health plan model, the Comptroller General of the United States shall submit reports on the evaluation conducted under subparagraph (A) to the administering Secretaries and to the committees of jurisdiction of Congress as follows:

`(I) INITIAL REPORT- An initial report shall be submitted not later than 12 months after the date that enrollment in a coordinated care health plan begins at any demonstration site.

`(II) SECOND REPORT- A second report shall be submitted not later than 30 months after such date.

`(III) FINAL REPORT- A final report shall be submitted not later than 42 months after such date.

`(ii) FEE-FOR-SERVICE MODEL- With respect to the portion of the demonstration project that is operating under a fee-for-service model, the Comptroller General of the United States shall submit reports on the evaluation conducted under subparagraph (A) to the administering Secretaries and to the committees of jurisdiction of Congress as follows:

`(I) INITIAL REPORT- An initial report shall be submitted not later than 12 months after the date that medicare health care services begin to be provided at any demonstration site using such a model.

`(II) SECOND REPORT- A second report shall be submitted not later than 30 months after such date.

`(III) FINAL REPORT- A final report shall be submitted not later than 42 months after such date.

`(2) REPORTS ON EXTENSION AND EXPANSION OF THE DEMONSTRATION PROJECT-

`(A) COORDINATED CARE HEALTH PLAN MODEL- With respect to the demonstration project that is operating under a coordinated care health plan model, not later than 3 months after the date of the submission of the final report by the Comptroller General of the United States under paragraph (1)(C)(i)(III), the administering Secretaries shall submit to the committees of jurisdiction of Congress a report containing the final recommendations of such Secretaries as to--

`(i) whether expenditures for targeted medicare-eligible veterans under the demonstration project exceed the expenditures that would have been incurred under the medicare program under this title with regard to such veterans had this section not been enacted;

`(ii) whether the demonstration project could be expanded or extended without increasing the cost to the medicare program under this title or to the Federal Government;

`(iii) whether to extend the duration of the demonstration project;

`(iv) whether to increase the number of demonstration sites operating under such a model;

`(v) whether to increase the maximum amount of reimbursement under the demonstration project in any year; and

`(vi) whether the terms and conditions of the demonstration project should be altered if the project is extended or expanded.

`(B) FEE-FOR-SERVICE MODEL- With respect to the demonstration project that is operating under a fee-for-service model, not later than 3 months after the date of the submission of the final report by the Comptroller General of the United States under paragraph (1)(C)(ii)(III), the administering Secretaries shall submit to the committees of jurisdiction of Congress a report described in subparagraph (A) with respect to such model.'.

END