90TH CONGRESS HOUSE OF REPRESENTATIVES 2d Session REPORT No. 1835 PRESCRIBING HEALTH CARE COST-SHARING ARRANGEMENTS FOR CERTAIN SURVIVING DEPENDENTS AUGUST 1, 1968.-Committed to the Committee of the Whole House on the State of the Union and ordered to be printed Mr. HARDY, from the Committee on Armed Services, REPORT [To accompany H.R. 18673] The Committee on Armed Services, to whom was referred the bill (H.R. 18673) to amend title 10, United States Code, to prescribe health care cost-sharing arrangements for certain surviving dependents, and for other purposes, having considered the same, report favorably thereon without amendment and recommend that the bill do pass. PURPOSE OF THE BILL The purpose of the bill is to permit certain surviving dependents of members of the uniformed services who die while eligible for hostile-fire pay (or from illness or injury incurred while eligible for such pay) to continue for varying periods to receive benefits under the civilian health and medical program of the uniformed services in the same manner as though the members were still alive. In the case of regular health care the bill provides dependents shall, for a period of 1 year following the date of the member's death, pay for cost-sharing medical care benefits on the same basis prescribed for dependents of members of active duty personnel. For dependents who are receiving benefits under section 1079 (d) of title 10, United States Code, the bill provides they shall continue to be eligible for such benefits until their eligibility is otherwise terminated. Section 1079 (d) is a program that provides support for the care of mentally retarded or physically handicapped dependents of active duty military personnel. BACKGROUND Traditionally, families of deceased service personnel are provided medical care on the same basis as retirees and their dependents. Retirees and their dependents and dependents of deceased personnel are eligible for care in military facilities on a space-available basis. The law also provides for care of dependents of active duty personnel and retirees and their dependents and dependents of deceased personnel at civilian sources. But the law provides a higher level of charges for retirees and their dependents and dependents of deceased personnel than for dependents of active duty personnel for care from civilian sources. For care in civilian hospitals the dependents of active duty personnel pay the first $25 of charges, or $1.75 a day, whichever amount is the greater. Dependents of deceased personnel pay 25 percent of the charges for inpatient care from civilian hospitals. Similarly, for outpatient care from civilian sources, dependents of deceased personnel pay the first $50 of charges for all types of care authorized in each fiscal year plus 25 percent of all additional charges during the year; dependents of active duty personnel pay the first $50 each fiscal year plus 20 percent of remaining charges. There have come to the attention of the Committee on Armed Services, cases of service wives who were pregnant at the time their husbands died in Vietnam. Under present law, if they subsequently receive their maternity care at civilian hospitals they would be charged as a dependent of a deceased person. Instead of $25 or $1.75 a day, whichever is greater, the cost would be 25 percent of all charges. Thus, a dependent wife could find herself paying several times more than she expected to pay for maternity care because her husband was killed in combat. This is a result that was not envisioned at the time the law was enacted and the Committee on Armed Services does not believe that the dependents of a serviceman should be suddenly subject to higher hospital bills because the man gave his life in a hostile-fire area. The bill, therefore, while not otherwise changing the traditional treatment of deceased personnel, provides that for a 1-year period following the death of a serviceman while in receipt of hostile-fire pay, or from illness or injury incurred while eligible for such pay, charges for his dependents' medical care shall continue to be on the same basis as those prescribed for dependents of members of the uniformed services who are on active duty. This transitional period will take care of maternity cases such as those that have come to the committee's attention and similar cases where dependents are in the middle of a program of care. For example, when an active duty member is killed in Vietnam and his wife is pregnant she would typically be able, under the provisions of the bill, to obtain complete civilian medical care for the entire pregnancy, including hospitalization and delivery, at the same cost to her ($25) that would have applied had her husband not been killed. Under present law, she would be required to pay 25 percent of all the charges involved, which would typically result in a cost to her of approximately $150; in some cases her share of the costs could be as high as $250. Section 1079 (d) of title 10, United States Code, provides a program of assistance in the care of dependents of a member of the uniformed services who are moderately or severely mentally retarded or who has a serious physical handicap. Benefits include training, rehabilitation, special education, and institutional care. The program is limited to the dependents of active duty personnel. Therefore, retarded or handicapped dependents of personnel in Vietnam would, under the present workings of the law, lose their eligibility under the program when the service member dies. The bill, therefore, provides that when a service member dies while in receipt of hostile-fire pay, or from illness or injury incurred while eligible for such pay, his dependents would continue to be eligible for benefits under section 1079 (d) of title 10, United States Code, with the same cost-sharing arrangement, until eligibility is otherwise terminated. RETROACTIVE PROVISION The amendments to title 10, United States Code, made by the bill would be effective as of January 1, 1967, the date when the program for care of mentally retarded and physically handicapped dependents went into effect. COSTS While it is not possible to precisely determine the cost of the bill, the Department of Defense's best estimate is that the cost for a 12month period will not exceed $165,000. The cost can be absorbed within present appropriations. COMMITTEE POSITION The Committee on Armed Services, a quorum being present, unanimously endorsed the enactment of H.R. 18673. DEPARTMENTAL POSITION The Department of Defense supports the bill and the Bureau of the Budget interposes no objections as indicated in the following letter hereby made a part of this report: GENERAL COUNSEL OF THE DEPARTMENT OF DEFENSE, Hon. L. MENDEL RIVERS, Washington, D.C., July 30, 1968. Chairman, Committee on Armed Services, House of Representatives, Washington, D.C. DEAR MR. CHAIRMAN: Reference is made to your request for the views of the Department of Defense on H.R. 18673, 90th Congress, a bill to amend title 10, United States Code, to prescribe health care cost-sharing arrangements for certain surviving dependents, and for other purposes. The purpose of the bill is to permit certain surviving dependents of members of the uniformed services who die while eligible for hostilefire pay (or from illness or injury incurred while eligible for such pay) to continue for varying periods to receive benefits under the civilian health and medical program of the uniformed services (CHAMPUS) in the same manner as though the members were still alive. In the case of regular health care, the added benefits of the bill (in the form of |