Title VIII, SEC. 8101. BENEFITS AND ELIGIBILITY THROUGH DEPARTMENT OF VETERANS AFFAIRS MEDICAL SYSTEM. (a) DVA As a Participant in Health Care Reform. (1) In general. Title 38, United States Code, is amended by inserting after chapter 17 the following new chapter: ``CHAPTER 18 ELIGIBILITY AND BENEFITS UNDER HEALTH SECURITY ACT ``SUBCHAPTER I GENERAL ``1801. Definitions. ``SUBCHAPTER II ENROLLMENT ``1811. Enrollment: veterans. ``1812. Enrollment: CHAMPVA eligibles. ``1813. Enrollment: family members. ``SUBCHAPTER III BENEFITS ``1821. Benefits for VA enrollees. ``1822. Chapter 17 benefits described. ``1823. Entitlement to chapter 17 benefits for certain veterans. ``1824. Supplemental benefits packages and policies. ``1825. Limitation regarding veterans enrolled with health plans outside Department. ``SUBCHAPTER IV FINANCIAL MATTERS ``1831. Premiums, copayments, etc.. ``1832. Medicare coverage and reimbursement. ``1833. Recovery of cost of certain care and services. ``1834. Health Plan Funds. ``SUBCHAPTER I GENERAL `` 1801. Definitions ``For purposes of this chapter: ``(1) The term `health plan' means an entity that has been certified under the Health Security Act as a health plan. ``(2) The term `VA health plan' means a health plan that is operated by the Secretary under section 7341 of this title. ``(3) The term `VA enrollee' means an individual enrolled under the Health Security Act in a VA health plan. ``SUBCHAPTER II ENROLLMENT `` 1811. Enrollment: veterans ``Each veteran who is an eligible individual within the meaning of section 1001 of the Health Security Act may enroll with a VA health plan. A veteran who wants to receive the comprehensive benefit package through the Department shall enroll with a VA health plan. `` 1812. Enrollment: CHAMPVA eligibles ``An individual who is eligible for benefits under section 1713 of this title and who is eligible to enroll in a health plan pursuant to section 1001 of the Health Security Act may enroll under that Act with a VA health plan in the same manner as a veteran. `` 1813. Enrollment: family members ``(a) The Secretary may authorize a VA health plan to enroll members of the family of an enrollee under section 1811 or 1812 of this title, subject to payment of premiums, deductibles, copayments, and coinsurance as required under the Health Security Act. ``(b) For purposes of subsection (a), an enrollee's family is those individuals (other than the enrollee) included within the term `family' as defined in section 1011(b) of the Health Security Act. ``SUBCHAPTER III BENEFITS `` 1821. Benefits for VA enrollees ``The Secretary shall ensure that each VA health plan provides to each individual enrolled with it the items and services in the comprehensive benefit package under the Health Security Act. `` 1822. Chapter 17 benefits described ``The Secretary shall provide to each veteran described in section 1823(a) of this title the care and services that are authorized to be provided under chapter 17 of this title in accordance with the terms and conditions applicable to that care under such chapter, notwithstanding that such care and services are not included in the comprehensive benefit package. `` 1823. Entitlement to chapter 17 benefits for certain veterans ``(a) The following veterans are eligible for additional care and services as described in section 1822 of this title: ``(1) Any veteran with a service-connected disability. ``(2) Any veteran whose discharge or release from the active military, naval or air service was for a disability incurred or aggravated in the line of duty. ``(3) Any veteran who is in receipt of, or who, but for a suspension pursuant to section 1151 of this title (or both such a suspension and the receipt of retired pay), would be entitled to disability compensation, but only to the extent that such a veteran's continuing eligibility for such care is provided for in the judgment or settlement provided for in such section. ``(4) Any veteran who is a former prisoner of war. ``(5) Any veteran of the Mexican border period or World War I. ``(6) Any veteran who is unable to defray the expenses of necessary care as determined under section 1722(a) of this title. ``(b) In the case of a veteran who is eligible to receive care or services under section 1710(a)(1)(G) of this title for a disability which may be associated with exposure to a toxic substance, radiation, or environmental hazard, the Secretary shall furnish such care or services to that veteran. ``(c) A veteran covered by subsection (a) or (b) ``(1) is eligible for care and services described in that subsection whether or not such veteran is a VA enrollee; and ``(2) shall not be subject to any charge or any other cost for such care and services. `` 1824. Supplemental benefits packages and policies ``(a)(1) In order to meet the special needs of veterans, the Secretary may offer to veterans supplemental health benefits packages for health care services not included in the comprehensive benefit package. A veteran eligible under section 1823 of this title to receive the health care services described in section 1822 of this title may not be offered a supplemental health benefits package under this subsection. The supplemental health benefits packages offered under this subsection may consist of any or all of the benefits that the Secretary may provide under chapter 17 of this title that are not included in the comprehensive benefit package. ``(2) The Secretary shall charge a premium for a supplemental health benefits package under this subsection. The amount of such premium shall be established so as to cover the actual and full costs of such care. ``(b) A VA health plan may offer supplemental health benefits policies for health care services not provided under chapter 17 of this title and cost sharing policies consistent with the requirements of part 2 of subtitle E of title I of the Health Security Act. `` 1825. Limitation regarding veterans enrolled with health plans outside Department ``A veteran who is residing in a regional alliance area in which the Department operates a health plan and who is enrolled in a health plan that is not operated by the Department may be provided the items and services in the comprehensive benefit package by a VA health plan only if the plan is reimbursed for the actual and full cost of the care provided. ``SUBCHAPTER IV FINANCIAL MATTERS `` 1831. Premiums, copayments, etc. ``(a) In the case of a veteran described in section 1823(a) of this title who is a VA enrollee, the Secretary may not impose or collect from the veteran a cost-share charge of any kind (whether a premium, copayment, deductible, coinsurance charge, or other charge). The Secretary shall make such arrangements as necessary with health alliances in order to carry out this subsection. ``(b) For other VA enrollees, the Secretary shall charge premiums and establish copayments, deductibles, and coinsurance amounts. The premium rate, and the rates for deductibles and copayments, for each VA health plan shall be established by that health plan based on rules established by the health alliance under which it is operating. `` 1832. Medicare coverage and reimbursement ``(a) For purposes of any program administered by the Secretary of Health and Human Services under title XVIII of the Social Security Act, a VA health plan or Department facility shall be deemed to be a Medicare provider. ``(b)(1) The Secretary of Health and Human Services shall enter into an agreement with a VA health plan or Department health-care facility to treat such plan or facility as a Medicare HMO in any case in which that health plan or facility seeks to enter into such an agreement. ``(2) For purposes of this section, the term `Medicare HMO' means an eligible organization under section 1876 of the Social Security Act. ``(c) In the case of care provided to a veteran other than a veteran described in section 1823(a) of this title who is eligible for benefits under the Medicare program under title XVIII of the Social Security Act, the Secretary of Health and Human Services shall reimburse a VA health plan or Department health-care facility providing services as a Medicare provider or Medicare HMO on the same basis as that Secretary reimburses other Medicare providers or Medicare HMOs, respectively. The Secretary of Health and Human Services shall include with each such reimbursement a Medicare explanation of benefits. ``(d) When the Secretary provides care to a veteran for which the Secretary receives reimbursement under this section, the Secretary shall require the veteran to pay to the Department any applicable deductible or copayment that is not covered by Medicare. `` 1833. Recovery of cost of certain care and services ``(a) In the case of an individual provided care or services through a VA health plan who has coverage under a supplemental health insurance policy pursuant to part 2 of subtitle E of title I of the Health Security Act or under any other provision of law, or who has coverage under a Medicare supplemental health insurance plan (as defined in the Health Security Act) or under any other provision of law, the Secretary has the right to recover or collect charges for care or services (as determined by the Secretary, but not including care or services for a service-connected disability) from the party providing that coverage to the extent that the individual (or the provider of the care or services) would be eligible to receive payment for such care or services from such party if the care or services had not been furnished by a department or agency of the United States. ``(b) The provisions of subsections (b) through (f) of section 1729 of this title shall apply with respect to claims by the United States under subsection (a) in the same manner as they apply to claims under subsection (a) of that section. `` 1834. Health Plan Funds ``(a) The Secretary shall establish for each VA health plan a separate revolving fund. ``(b) Any amount received by the Department by reason of the furnishing of health care by a VA health plan or the enrollment of an individual with a VA health plan (including amounts received as premiums, premium discount payments, copayments or coinsurance, and deductibles, amounts received as third-party reimbursements, and amounts received as reimbursements from another health plan for care furnished to one of its enrollees) shall be credited to the revolving fund of that health plan. ``(c) Notwithstanding subsection (b), a VA health plan may not retain amounts received for care furnished to a VA enrollee in a case in which the costs of such care have been covered by appropriations. Such amounts shall be deposited in the General Fund of the Treasury. ``(d) Each revolving fund for a health plan shall be managed by that health plan. ``(e) Amounts in a revolving fund for a health plan are hereby made available for the expenses of the delivery of the items and services in the comprehensive benefit package by the health plan.''. (2) The table of chapters at the beginning of part II of title 38, United States Code, is amended by inserting after the item relating to chapter 17 the following new item: I60``18. Benefits and Eligibility Under Health Security Act I521801.''. (b) Preservation of Existing Benefits for Facilities Not Operating as health plans. (1) Chapter 17 of title 38, United States Code, is amended by inserting after section 1704 the following new section: `` 1705. Facilities not operating within health plans; veterans not eligible to enroll in health plans ``The provisions of this chapter shall apply with respect to the furnishing of care and services ``(1) by any facility of the Department that is not operating as or within a health plan certified as a health plan under the Health Security Act; and ``(2) to any veteran who is an eligible individual with the meaning of section 1001 of the Health Security Act.''. (2) The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1704 the following new item: ``1705. Facilities not operating within health plans; veterans not eligible to enroll in health plans.''.