[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 2009 Introduced in Senate (IS)]
113th CONGRESS
2d Session
S. 2009
To improve the provision of health care by the Department of Veterans
Affairs to veterans in rural and highly rural areas, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
February 10, 2014
Mr. Udall of New Mexico (for himself and Mr. Heller) introduced the
following bill; which was read twice and referred to the Committee on
Veterans' Affairs
_______________________________________________________________________
A BILL
To improve the provision of health care by the Department of Veterans
Affairs to veterans in rural and highly rural areas, and for other
purposes.
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 ``Rural Veterans Improvement Act of
2014''.
SEC. 2. PROVISION OF MENTAL HEALTH CARE TO CERTAIN VETERANS IN RURAL
AND HIGHLY RURAL AREAS.
(a) In General.--The Secretary of Veterans Affairs shall provide
mental health care to eligible veterans described in subsection (c) for
which a determination has been made under subsection (d).
(b) Use of Other Providers.--
(1) In general.--The Secretary may provide mental health
care under this section by contracting with or providing
payments to mental health care providers that are not otherwise
affiliated with the Department of Veterans Affairs and shall,
to the extent feasible, use health care resources pursuant to
existing arrangements, contracts, or agreements entered into
under section 8153 of title 38, United States Code.
(2) Payments.--The Secretary may not provide payments
described in paragraph (1) that exceed the amount that the
Secretary would otherwise expend in providing similar mental
health care through the Department or under such existing
arrangements, contracts, or agreements.
(c) Eligible Veterans.--An eligible veteran described in this
subsection is a veteran that--
(1) has a mental health issue resulting from post-traumatic
stress disorder, traumatic brain injury, or any other health
condition that was incurred or aggravated in line of duty in
the active military, naval, or air service; and
(2) lives in a rural area or highly rural area.
(d) Determination.--The Secretary shall provide the care required
by subsection (a) to an eligible veteran if the Secretary determines
any of the following:
(1)(A) A mental health care provider affiliated with the
Department is not available to provide mental health care
services to the eligible veteran at the medical facility of the
Department that is nearest to the residence of the eligible
veteran; and
(B)(i) in-person and telehealth mental health care services
from the Department are not available to the eligible veteran;
(ii) the eligible veteran requests that a mental health
care provider affiliated with the Department provide mental
health care services to the eligible veteran in private and the
provider is unable or unwilling to do so; or
(iii) travel by the eligible veteran to a regional medical
center of the Department is impractical or severely detrimental
to the health of the eligible veteran.
(2) That--
(A)(i) a mental health care provider affiliated
with the Department has recommended that a
complementary and alternative therapy approved by the
Food and Drug Administration be administered to the
eligible veteran;
(ii) the eligible veteran is a member of an Indian
tribe or a Native Hawaiian and requests a healing
method that is a cultural tradition of the eligible
veteran; or
(iii) a mental health care provider has recommended
a treatment for the eligible veteran that, based on the
medical knowledge of the health care provider, is safe
and would assist the eligible veteran in coping with
post-traumatic stress disorder, traumatic brain injury,
or another mental health issue; and
(B)(i) the eligible veteran has not received the
therapy, healing method, or treatment described in
subparagraph (A) because of the inaccessibility or
unavailability of such treatment from a medical
facility of the Department; and
(ii) the eligible veteran, as a result of the
mental health condition of the eligible veteran--
(I) cannot work or maintain employment;
(II) is at increased risk of doing physical
harm to the eligible veteran or others; or
(III) cannot adequately manage activities
of daily life.
(e) Indian Tribe Defined.--In this section, the term ``Indian
tribe'' has the meaning given that term in section 4 of the Indian
Self-Determination and Education Assistance Act (25 U.S.C. 450b).
SEC. 3. REPORT ON EFFECTIVENESS OF COMPLEMENTARY AND ALTERNATIVE
MEDICINE IN TREATING VETERANS WITH CERTAIN MENTAL
ILLNESSES.
Not later than one year after the date of the enactment of this
Act, the Secretary of Veterans Affairs shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a report on the effectiveness of
complementary and alternative medicine used by the Department of
Veterans Affairs in treating veterans with mental health conditions
resulting from post-traumatic stress disorder, traumatic brain injury,
or any other health condition that was incurred or aggravated in line
of duty in the active military, naval, or air service.
SEC. 4. GRANTS TO PROVIDE TRANSPORTATION TO COMMUNITY-BASED OUTPATIENT
CLINICS FOR VETERANS IN RURAL AND HIGHLY RURAL AREAS.
(a) Grants Authorized.--
(1) In general.--The Secretary of Veterans Affairs may
award grants to eligible entities to provide transportation to
veterans in rural and highly rural areas who would otherwise be
eligible for reimbursement for or payment of travel expenses by
the Department of Veterans Affairs pursuant to section 111 or
section 111A of title 38, United States Code.
(2) Maximum amount.--The Secretary may not award a grant
under this section in an amount that exceeds $100,000.
(3) No matching required.--The Secretary may not require
that an eligible entity provide a contribution of funds as a
condition of receiving the grant.
(b) Eligible Entities.--The Secretary may award grants under this
section to any of the following entities:
(1) State veterans agencies.
(2) Veterans service organizations.
(3) Tribal organizations.
(c) Use of Grants.--Eligible entities in receipt of a grant under
this section may use the grant amount as follows:
(1) To provide transportation to veterans in rural and
highly rural areas to and from medical centers of the
Department of Veterans Affairs, including transportation by air
or sea if necessary.
(2) To otherwise assist veterans in rural and highly rural
areas with transportation in connection with the provision of
medical care to those veterans, including transportation by air
or sea if necessary.
(d) Application.--
(1) In general.--Each eligible entity seeking a grant under
this section shall submit an application to the Secretary at
such time, in such manner, and accompanied by such information
as the Secretary may require.
(2) Contents.--Each application submitted pursuant to
paragraph (1) shall contain a proposal for the manner in which
the eligible entity seeks to provide the transportation
described in subsection (a).
(e) Priority.--The Secretary shall give priority in the awarding of
grants under this section to applications submitted under subsection
(d) that contain proposals that comply with section 504 of the
Rehabilitation Act of 1973 (29 U.S.C. 794) and regulations issued by
the Secretary of Transportation under such section 504.
(f) Definitions.--In this section:
(1) Tribal organization.--The term ``tribal organization''
has the meaning given that term in section 4 of the Indian
Self-Determination and Education Assistance Act (25 U.S.C.
450b).
(2) Veterans service organization.--The term ``veterans
service organization'' means an organization recognized by the
Secretary of Veterans Affairs for the representation of
veterans under section 5902 of title 38, United States Code.
SEC. 5. PILOT PROGRAM ON HOUSING ALLOWANCES FOR HEALTH CARE PROVIDERS
OF THE DEPARTMENT OF VETERANS AFFAIRS ACCEPTING
ASSIGNMENT AT RURAL AND HIGHLY RURAL COMMUNITY-BASED
OUTPATIENT CLINICS.
(a) Pilot Program Authorized.--The Secretary of Veterans Affairs
may carry out a pilot program to assess the feasibility and
advisability of providing a housing allowance to health care providers
of the Department of Veterans Affairs who accept assignment at rural or
highly rural community-based outpatient clinics as a means of
encouraging such health care providers to accept assignment to such
clinics.
(b) Eligibility.--An individual is eligible for participation in
the pilot program if the individual--
(1) is a health care provider;
(2) is, or agrees to become, an employee of the Veterans
Health Administration on a full-time basis in a health care
position designated by the Secretary for purposes of the pilot
program; and
(3) accepts an assignment in such position for a term of
not less than 36 months at a rural or highly rural community-
based outpatient clinic selected by the Secretary for purposes
of the pilot program.
(c) Conditions on Payment of Housing Allowance.--Except as provided
in subsection (d)(3), an individual may be provided a housing allowance
under the pilot program only while--
(1) in good standing as a health care provider within the
Veterans Health Administration; and
(2) assigned as a health care provider at a rural or highly
rural community-based outpatient clinic.
(d) Amount of Housing Allowance.--
(1) Monthly amount during initial term.--During the first
36 months of participation in the pilot program, the housing
allowance provided a health care provider participating in the
pilot program shall be provided on a monthly basis at a rate
that is equivalent to the monthly rate of basic allowance for
housing (BAH) payable under section 403 of title 37, United
States Code, to members of the uniformed services whose grade,
dependency status, and geographic location most closely equals,
as determined by the Secretary, the grade of such provider
under section 7404 of title 38, United States Code, and the
dependency status and geographic location of such provider.
(2) Monthly amount for certain providers for additional
term.--If upon completion of the first 36 months in the pilot
program a health care provider accepts continuing participation
in the pilot program at a rural or highly rural community-based
outpatient clinic for a term of not less than 12 additional
months, the housing allowance provided the health care provider
under the pilot program shall be provided on a monthly basis
for such additional months at a rate determined in accordance
with paragraph (1).
(3) Bonus amount.--
(A) Completion of initial term.--Any health care
provider who successfully completes 36 months of
participation in the pilot program shall be paid upon
completion of participation in the pilot program an
amount equal to three months of the monthly rate of
housing allowance provided the health care provider
under paragraph (1) during the last month before the
provider's completion of participation in the pilot
program.
(B) Completion of additional one-year term.--Any
health care provider who successfully completes 48
months of participation in the pilot program shall be
paid upon completion of participation in the pilot
program an amount equal to 12 months of the monthly
rate of housing allowance provided the health care
provider under paragraph (2) during the last month
before the provider's completion of participation in
the pilot program.
(C) Completion of additional two-year term.--Any
health care provider who successfully completes 60
months of participation in the pilot program shall be
paid upon completion of participation in the pilot
program an amount equal to 13 months of the monthly
rate of housing allowance provided the health care
provider under paragraph (2) during the last month
before the provider's completion of participation in
the pilot program.
(D) No requirement to remain on assignment.--An
amount payable under this paragraph shall be paid
whether or not the health care provider concerned
remains in an assignment at a rural or highly rural
community-based outpatient clinic.
(e) Nature of Allowance.--
(1) Supplemental amount.--Any housing allowance provided
under the pilot program shall be in addition to any pay
(including basic pay, special pay, and retirement or other
bonus pay) payable to personnel of the Veterans Health
Administration personnel under chapter 74 of title 38, United
States Code, or any other provision of law.
(2) Exemption from taxation.--For purposes of the Internal
Revenue Code of 1986, any housing allowance provided under the
pilot program shall not be included in gross income.
(f) Annual Reports.--
(1) In general.--Not later than one year after the date of
the enactment of this Act and not less frequently than once
each year thereafter while the pilot program is in effect, the
Secretary shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the House
of Representatives a report on the pilot program.
(2) Elements.--Each report submitted under paragraph (1)
shall include the following:
(A) A current description of the pilot program,
including the current number of participants in the
pilot program and the amounts of housing allowance
being provided such participants.
(B) A current assessment of the value of the
housing allowance under the pilot program in
encouraging health care providers in accepting
assignment to rural and highly rural community-based
outpatient clinics.
(g) Funding.--Amounts for housing allowances under the pilot
program shall be derived from amounts available for the Veterans Health
Administration for Medical Services.
(h) Sunset.--
(1) In general.--No individual may commence participation
in the pilot program on or after the date that is five years
after the date of the enactment of this Act.
(2) Continuation of on-going provision of allowance.--
Nothing in paragraph (1) shall be construed to prohibit the
Secretary from providing housing allowances under the pilot
program to individuals who commence participation in the pilot
program before the date that is five years after the date of
the enactment of this Act.
(i) Rural or Highly Rural Community-Based Outpatient Clinic
Defined.--In this section, the term ``rural or highly rural community-
based outpatient clinic'' means a community-based outpatient clinic of
the Veterans Health Administration that predominantly serves veterans
who live in rural and highly rural areas.
SEC. 6. PROGRAM ON TRAINING HEALTH CARE PROFESSIONALS FOR ASSIGNMENT AT
COMMUNITY-BASED OUTPATIENT CLINICS THAT PREDOMINANTLY
SERVE VETERANS WHO LIVE IN RURAL AND HIGHLY RURAL AREAS.
(a) Program Required.--
(1) In general.--The Secretary of Veterans Affairs shall
establish a program to train health care professionals for
assignment at community-based outpatient clinics that
predominantly serve veterans who live in rural and highly rural
areas.
(2) Partnership with educational institutions.--
(A) In general.--In carrying out the program, the
Secretary may enter into partnerships with educational
institutions.
(B) Consultation.--If the Secretary enters into a
partnership with an educational institution to carry
out the program, the Secretary shall consult with the
head of such educational institution with respect to
the training and curriculum provided under the program
at such educational institution.
(b) Training.--The training provided to health care professionals
under the program shall include the following courses:
(1) Courses on general professional development of health
care professionals.
(2) Courses on providing health care to rural populations
and specifically to rural veterans.
(c) Curriculum.--The program shall include training with respect to
health issues that commonly afflict veterans as specified by the
Secretary.
(d) Hiring Preference.--
(1) In general.--Each health care professional that
completes the program and completes a three-year assignment at
a community-based outpatient clinic that predominantly serves
veterans who live in rural and highly rural areas shall receive
a preference in selection for employment in the Veterans Health
Administration at the end of such three-year assignment.
(2) Degree of preference.--
(A) In general.--The preference received under
paragraph (1) shall be less than the preference given a
veteran.
(B) Veterans.--A veteran that receives a preference
under paragraph (1) shall receive a greater preference
than an individual that receives a preference under
such paragraph who is not a veteran.
SEC. 7. ENCOURAGING AND FACILITATING TRANSITION OF MILITARY MEDICAL
PROFESSIONALS INTO EMPLOYMENT WITH VETERANS HEALTH
ADMINISTRATION.
(a) Encouraging Employment With Veterans Health Administration.--
The Secretary of Veterans Affairs and the Secretary of Defense shall
jointly establish a program to encourage an individual who serves in
the Armed Forces with a military occupational specialty relating to the
provision of health care to seek employment with the Veterans Health
Administration when the individual has been discharged or released from
service in the Armed Forces or is contemplating separating from such
service.
(b) Matching of Military Occupational Specialties.--The Secretary
of Veterans Affairs and the Secretary of Defense shall jointly identify
military occupational specialties relating to the provision of health
care and match such occupational specialties with occupations and
positions of employment within the Veterans Health Administration for
which experience in such military occupational specialty qualifies one
for employment in such occupation or position of employment.
(c) Facilitation of Transition to Employment With Veterans Health
Administration.--The Secretary of Veterans Affairs and the Secretary of
Defense shall prescribe such regulations and take such actions as may
be necessary to facilitate the transition of individuals with military
occupational specialties identified under subsection (b) into the
corresponding occupations and positions of employment with the Veterans
Health Administration under such subsection.
SEC. 8. ASSESSMENT OF COMMUNITY-BASED OUTPATIENT CLINICS IN RURAL AND
HIGHLY RURAL AREAS.
(a) Assessment.--
(1) In general.--The Secretary of Veterans Affairs shall
conduct a periodic assessment of community-based outpatient
clinics in rural and highly rural areas to determine whether
expansion and improvement of community-based outpatient clinics
in those areas is feasible or advisable.
(2) Elements.--Each periodic assessment required by
subsection (a) shall include the following with respect to each
community-based outpatient clinic assessed:
(A) An assessment of whether the facility--
(i) meets applicable building code
requirements;
(ii) meets applicable health care
requirements related to privacy;
(iii) has the capacity to handle the number
of patients that seek care at the facility;
(iv) has sufficient parking for patients
that seek care at the facility;
(v) has adequate access to broadband
technology to allow the use or expansion of
telehealth services at the facility; and
(vi) has the capacity to properly store and
dispose of medical and other hazardous waste.
(B) A survey of health care providers who practice
at the facility with respect to--
(i) strengths of the facility;
(ii) weaknesses of the facility; and
(iii) areas in which the facility may be
improved.
(b) Report.--Not later than one year after the date of the
enactment of this Act, and not less frequently than once each year
thereafter, the Secretary shall submit to the Committee on Veterans'
Affairs and the Committee on Appropriations of the Senate and the
Committee on Veterans' Affairs and the Committee on Appropriations of
the House of Representatives a report on the findings of the Secretary
with respect to the most recently completed assessment conducted under
subsection (a), including such recommendations as the Secretary may
have for the expansion or improvement of community-based outpatient
clinics in rural and highly rural areas.
SEC. 9. REPORT ON ESTABLISHMENT OF POLYTRAUMA REHABILITATION CENTERS OR
POLYTRAUMA NETWORK SITES OF THE DEPARTMENT OF VETERANS
AFFAIRS IN RURAL AREAS.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit
to Congress a report on the feasibility and advisability of
establishing a Polytrauma Rehabilitation Center or Polytrauma Network
Site in each area in which the nearest Polytrauma Rehabilitation Center
or Polytrauma Network Site is more than 300 miles away.
(b) Requirements.--
(1) In general.--The report required by this section shall
include the following:
(A) An assessment of the adequacy of existing
Polytrauma Rehabilitation Centers and Polytrauma
Network Sites in providing care to veterans that live
more than 300 miles from such facilities.
(B) An assessment of the adequacy of existing
Polytrauma Rehabilitation Centers and Polytrauma
Network Sites in providing rehabilitation services
pursuant to section 1710C of title 38, United States
Code.
(C) An assessment of the feasibility and
advisability of establishing a Polytrauma
Rehabilitation Center or Polytrauma Network Site in
each State in which there is a medical center of the
Department of Veterans Affairs.
(D) An assessment of whether establishing new
Polytrauma Rehabilitation Centers and Polytrauma
Network Sites would be beneficial--
(i) to the veteran population in general;
(ii) to veterans who live--
(I) more than 300 miles from the
nearest Polytrauma Rehabilitation
Center or Polytrauma Network Site; or
(II) in a State in which there is
not a Polytrauma Rehabilitation Center
or Polytrauma Network Site; and
(iii) to veterans who served in the active
military, naval, or air service on or after
September 11, 2001.
(2) Budget for additional facilities.--If the Secretary
determines that establishing additional Polytrauma
Rehabilitation Centers and Polytrauma Network Sites is feasible
and advisable, the Secretary shall include with the report
required by subsection (a) a budget and plan for the
establishment of those additional facilities.
SEC. 10. DEFINITIONS.
In this Act:
(1) Active military, naval, or air service.--The term
``active military, naval, or air service'' has the meaning
given that term in section 101 of title 38, United States Code.
(2) Highly rural area.--The term ``highly rural area''
means an area located in a county that has less than seven
individuals residing in that county per square mile.
(3) Rural area.--The term ``rural area'' means any area
that is not an urbanized area or a highly rural area.
(4) Urbanized area.--The term ``urbanized area'' has the
meaning given that term by the Director of the Bureau of the
Census.
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