[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4011 Introduced in House (IH)]
<DOC>
114th CONGRESS
1st Session
H. R. 4011
To increase the number of graduate medical education positions treating
veterans, to improve the compensation of health care providers, medical
directors, and directors of Veterans Integrated Service Networks of the
Department of Veterans Affairs, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
November 16, 2015
Mr. Gallego (for himself, Mrs. Kirkpatrick, Ms. Pingree, Mr. Honda, and
Ms. Esty) introduced the following bill; which was referred to the
Committee on Veterans' Affairs, and in addition to the Committees on
Ways and Means 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
_______________________________________________________________________
A BILL
To increase the number of graduate medical education positions treating
veterans, to improve the compensation of health care providers, medical
directors, and directors of Veterans Integrated Service Networks of the
Department of Veterans Affairs, 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; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Delivering
Opportunities for Care and Services for Veterans Act of 2015'' or the
``DOCs for Veterans Act of 2015''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--MEDICAL EDUCATION AND TRAINING
Sec. 101. Disregard of resident slots that include VA training against
the Medicare graduate medical education
limitations.
Sec. 102. Extension of period for increase in graduate medical
education residency positions at medical
facilities of the Department of Veterans
Affairs.
Sec. 103. Pilot program on graduate medical education residency
programs in behavioral medicine in
underserved areas.
Sec. 104. Inclusion of mental health professionals in education and
training program for health personnel of
the Department of Veterans Affairs.
Sec. 105. Expansion of qualifications for licensed mental health
counselors of the Department of Veterans
Affairs to include doctoral degrees.
TITLE II--HEALTH CARE PROVIDERS OF THE DEPARTMENT OF VETERANS AFFAIRS
Sec. 201. Requirement that physician assistants employed by the
Department of Veterans Affairs receive
competitive pay.
Sec. 202. Modification of education debt reduction program of
Department of Veterans Affairs to require a
certain amount to be spent in rural and
highly rural areas.
Sec. 203. Report on medical workforce of the Department of Veterans
Affairs.
TITLE III--LEADERSHIP OF THE VETERANS HEALTH ADMINISTRATION
Sec. 301. Establishment of positions of Directors of Veterans
Integrated Service Networks in Office of
Under Secretary for Health of Department of
Veterans Affairs and modification of
qualifications for Medical Directors.
Sec. 302. Pay for Medical Directors and Directors of Veterans
Integrated Service Networks.
TITLE IV--OTHER HEALTH CARE MATTERS
Sec. 401. Pilot program on providing nurse advice line for veterans in
rural and highly rural areas.
TITLE I--MEDICAL EDUCATION AND TRAINING
SEC. 101. DISREGARD OF RESIDENT SLOTS THAT INCLUDE VA TRAINING AGAINST
THE MEDICARE GRADUATE MEDICAL EDUCATION LIMITATIONS.
(a) Direct GME.--Section 1886(h)(4)(F) of the Social Security Act
(42 U.S.C. 1395ww(h)(4)(F)) is amended by adding at the end the
following new clause:
``(iii) Disregard of certain resident slots
that include va training.--For portions of cost
reporting periods beginning on or after July 1,
2017, in applying the limitations under clause
(i) regarding the total number of full-time
equivalent residents in the field of allopathic
or osteopathic medicine in a hospital's
approved medical residency training program,
the Secretary shall not take into account any
full-time equivalent resident within such
program that is filling a graduate medical
education residency position that counts
towards meeting the obligation of the Secretary
of Veterans Affairs authorized under section
301(b)(2)(A) of the Veterans Access, Choice,
and Accountability Act of 2014 (Public Law 113-
146; 38 U.S.C. 7302 note).''.
(b) Indirect GME.--Section 1886(d)(5)(B)(v) of the Social Security
Act (42 U.S.C. 1395ww(d)(5)(B)(v)) is amended, in the second sentence,
by striking ``subsection (h)(4)(F)(ii)'' and inserting ``clauses (ii)
and (iii) of subsection (h)(4)(F)''.
SEC. 102. EXTENSION OF PERIOD FOR INCREASE IN GRADUATE MEDICAL
EDUCATION RESIDENCY POSITIONS AT MEDICAL FACILITIES OF
THE DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Paragraph (2) of subsection (b) of section 301 of
the Veterans Access, Choice, and Accountability Act of 2014 (Public Law
113-146; 38 U.S.C. 7302 note) is amended--
(1) in the paragraph heading, by striking ``Five-year'' and
inserting ``Ten-Year''; and
(2) in subparagraph (A), by striking ``5-year period'' and
inserting ``10-year period''.
(b) Report.--Paragraph (3)(A) of such subsection is amended by
striking ``until 2019'' and inserting ``until 2024''.
SEC. 103. PILOT PROGRAM ON GRADUATE MEDICAL EDUCATION RESIDENCY
PROGRAMS IN BEHAVIORAL MEDICINE IN UNDERSERVED AREAS.
(a) Pilot Program.--Commencing not later than one year after the
date of the enactment of this Act, the Secretary of Veterans Affairs
and the Secretary of Health and Human Services shall jointly conduct a
six-year pilot program to establish not less than three graduate
medical education residency programs in behavioral medicine in
underserved areas in the United States.
(b) Elements.--Each graduate medical education residency program
established under the pilot program shall--
(1) provide residents participating in the graduate medical
education residency program with an opportunity to work with a
diverse patient population through a rotation between medical
facilities of the Department of Veterans Affairs, facilities of
the Indian Health Service, and facilities participating under
the Medicare program under title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.);
(2) include graduate medical education in the field of
behavioral medicine;
(3) be carried out in a manner consistent with graduate
medical education residency programs supported and funded by
the Department of Veterans Affairs and the Department of Health
and Human Services;
(4) be located in a community that--
(A) is designated as a medically underserved area
under section 330(b)(3)(A) of the Public Health Service
Act (42 U.S.C. 254b(b)(3)(A));
(B) is in a State with a per capita population of
veterans of more than 9 percent according to the
National Center for Veterans Analysis and Statistics
and the United States Census Bureau; and
(C) is within 100 miles of a Reservation (as
defined in Section 3(d) of the Indian Financing Act of
1974 (25 U.S.C. 1452)).
(c) Report.--
(1) In general.--Not later than 180 days after the date of
the commencement of the pilot program and not less frequently
than once each year thereafter while the pilot program is being
carried out, the Secretary of Veterans Affairs and the
Secretary of Health and Human Services shall, in consultation
with representatives from facilities participating under the
Medicare program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.) that are participating in the pilot
program, jointly submit to Congress a report on the
implementation of the pilot program.
(2) Elements.--Each report required by paragraph (1) shall
include the following:
(A) A description of the patient population served
by the residents participating in a graduate medical
education residency program under the pilot program.
(B) A description of the behavioral medicine
services provided under the pilot program, including
the extent to which those services were provided using
telemedicine services.
(C) The academic affiliation of each resident
participating in a graduate medical education residency
program under the pilot program.
(D) A description of any impediments faced in
carrying out the pilot program and actions taken by the
Secretary of Veterans Affairs and the Secretary of
Health and Human Services to address those impediments.
SEC. 104. INCLUSION OF MENTAL HEALTH PROFESSIONALS IN EDUCATION AND
TRAINING PROGRAM FOR HEALTH PERSONNEL OF THE DEPARTMENT
OF VETERANS AFFAIRS.
(a) In General.--In carrying out the education and training program
required under section 7302(a)(1) of title 38, United States Code, the
Secretary of Veterans Affairs shall include education and training of
marriage and family therapists and licensed professional mental health
counselors.
(b) Apportionment of Funding.--The Secretary shall apportion
funding for the education and training program described in subsection
(a) equally among the professions included in the program.
SEC. 105. EXPANSION OF QUALIFICATIONS FOR LICENSED MENTAL HEALTH
COUNSELORS OF THE DEPARTMENT OF VETERANS AFFAIRS TO
INCLUDE DOCTORAL DEGREES.
Section 7402(b)(11)(A) of title 38, United States Code, is amended
by inserting ``or doctoral degree'' after ``master's degree''.
TITLE II--HEALTH CARE PROVIDERS OF THE DEPARTMENT OF VETERANS AFFAIRS
SEC. 201. REQUIREMENT THAT PHYSICIAN ASSISTANTS EMPLOYED BY THE
DEPARTMENT OF VETERANS AFFAIRS RECEIVE COMPETITIVE PAY.
Section 7451(a)(2) of title 38, United States Code, is amended--
(1) by redesignating subparagraph (B) as subparagraph (C);
(2) by inserting after subparagraph (A) the following new
subparagraph (B):
``(B) Physician assistant.''; and
(3) in subparagraph (C), as redesignated by paragraph (1),
by striking ``and registered nurse'' and inserting ``registered
nurse, and physician assistant''.
SEC. 202. MODIFICATION OF EDUCATION DEBT REDUCTION PROGRAM OF
DEPARTMENT OF VETERANS AFFAIRS TO REQUIRE A CERTAIN
AMOUNT TO BE SPENT IN RURAL AND HIGHLY RURAL AREAS.
Section 7681 of title 38, United States Code, is amended by adding
at the end the following new subsections:
``(c) Limitation on Amounts.--Not less than 30 percent of the
amount of debt reduction payments paid under the Education Debt
Reduction Program each year shall be paid to individuals who practice
medicine in a rural area or highly rural area or demonstrate a
commitment to practice medicine in such an area.
``(d) Definitions.--In this section:
``(1) The term `highly rural area' means an area located in
a county or similar community that has less than seven
individuals residing in that county or community per square
mile.
``(2) The term `rural area' means an area that is not an
urbanized area or a highly rural area.
``(3) The term `urbanized area' has the meaning given that
term by the Director of the Bureau of the Census.''.
SEC. 203. REPORT ON MEDICAL WORKFORCE OF THE DEPARTMENT OF VETERANS
AFFAIRS.
(a) In General.--Not later than 120 days 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
medical workforce of the Department of Veterans Affairs.
(b) Elements.--The report required by subsection (a) shall include
the following:
(1) With respect to licensed professional mental health
counselors and marriage and family therapists of the
Department--
(A) how many such counselors and therapists are
currently enrolled in the mental health professionals
trainee program of the Department;
(B) how many such counselors and therapists are
expected to enroll in the mental health professionals
trainee program of the Department during the 180-day
period beginning on the date of the submittal of the
report;
(C) a description of the eligibility criteria for
such counselors and therapists as compared to other
behavioral health professions in the Department;
(D) a description of the objectives, goals, and
timing of the Department with respect to increasing the
representation of such counselors and therapists in the
behavioral health workforce of the Department; and
(E) a description of the actions taken by the
Secretary, in consultation with the Director of the
Office of Personnel Management, to create an
occupational series for such counselors and therapists
and a timeline for the creation of such an occupational
series.
(2) A breakdown of spending by the Department in connection
with the education debt reduction program of the Department
under subchapter VII of chapter 76 of title 38, United States
Code, including--
(A) the amount spent by the Department in debt
reduction payments during the three-year period
preceding the submittal of the report disaggregated by
the medical profession of the individual receiving the
payments;
(B) a description of how the Department prioritizes
such spending by medical profession, including an
assessment of whether such priority reflects the five
occupations identified in the most recent determination
by the Inspector General of the Department of Veterans
Affairs as having the largest staffing shortages in the
Veterans Health Administration; and
(C) a description of the actions taken by the
Secretary to increase the effectiveness of such
spending for purposes of recruitment of health care
providers to the Department, including efforts to more
consistently include eligibility for the education debt
reduction program in vacancy announcements of positions
for health care providers at the Department.
(3) A description of any impediments to the delivery by the
Department of telemedicine services to veterans and any actions
taken by the Department to address such impediments, including
with respect to--
(A) restrictions under Federal or State laws;
(B) licensing or credentialing issues for health
care providers, including non-Department health care
providers, practicing telemedicine with a veteran
located in a different State;
(C) the effect of limited broadband access or
limited information technology capabilities on the
delivery of health care;
(D) the distance a veteran is required to travel to
access a facility or clinic with telemedicine
capabilities;
(E) the effect on the provision of telemedicine
services to veterans of policies of and limited
liability protection for certain entities; and
(F) issues relating to reimbursement and travel
limitations for veterans that affect the participation
of non-Department health care providers in the
telemedicine program.
(4) An update on the efforts of the Secretary to offer
training opportunities in telemedicine to medical residents in
medical facilities of the Department that use telemedicine,
consistent with medical residency program requirements
established by the Accreditation Council for Graduate Medical
Education, as required in section 108(b) of the Honoring
America's Veterans and Caring for Camp Lejeune Families Act of
2012 (Public Law 112-154; 38 U.S.C. 7406 note).
(5) An assessment of the development and implementation by
the Secretary of succession planning policies to address the
prevalence of vacancies in positions in the Veterans Health
Administration of more than 180 days, including the development
of an enterprise position management system to more effectively
identify, track, and resolve such vacancies.
(6) A description of the actions taken by the Secretary, in
consultation with the Director of the Office of Personnel
Management, to address any impediments to the timely
appointment and determination of qualifications for Directors
of Veterans Integrated Service Networks and Medical Directors
of the Department.
TITLE III--LEADERSHIP OF THE VETERANS HEALTH ADMINISTRATION
SEC. 301. ESTABLISHMENT OF POSITIONS OF DIRECTORS OF VETERANS
INTEGRATED SERVICE NETWORKS IN OFFICE OF UNDER SECRETARY
FOR HEALTH OF DEPARTMENT OF VETERANS AFFAIRS AND
MODIFICATION OF QUALIFICATIONS FOR MEDICAL DIRECTORS.
Section 7306(a)(4) of title 38, United States Code, is amended--
(1) by inserting ``and Directors of Veterans Integrated
Service Networks'' after ``Such Medical Directors''; and
(2) by striking ``, who shall be either a qualified doctor
of medicine or a qualified doctor of dental surgery or dental
medicine''.
SEC. 302. PAY FOR MEDICAL DIRECTORS AND DIRECTORS OF VETERANS
INTEGRATED SERVICE NETWORKS.
(a) In General.--Chapter 74 of title 38, United States Code, is
amended by adding at the end the following new subchapter:
``Subchapter VII--Pay for Medical Directors and Directors of Veterans
Integrated Service Networks
``Sec. 7481. Pay for Medical Directors and Directors of Veterans
Integrated Service Networks
``(a) Elements of Pay.--Pay for a Medical Director or Director of a
Veterans Integrated Service Network appointed under section 7306(a)(4)
of this title (in this section referred to as a `Director') shall
consist of basic pay set forth under section 7404(a) of this title and
market pay determined under subsection (b).
``(b) Market Pay.--(1) Each Director is eligible for market pay
determined under this subsection.
``(2) The amount of market pay payable to a Director under this
section shall be determined by the Secretary on a case-by-case basis
and shall consist of pay intended to reflect needs of the Department
with respect to the recruitment and retention (as determined by the
Secretary) of such Director.
``(3) In determining the amount of market pay payable to a Director
under this section, the Secretary shall--
``(A) consult not less than two national surveys on pay for
hospital directors, medical facility directors, or other
similar positions, whether prepared by private, public, or
quasi-public entities, to make a general assessment of the
range of potential pay for the Director; and
``(B) take into account--
``(i) the experience of the Director in managing
facilities or program offices of the Department,
including the complexity of such facilities or offices;
``(ii) the complexity of the facility or facilities
to be managed by the Director;
``(iii) the labor market, in such geographic area
as the Secretary considers relevant, for hospital
directors, medical facility directors, and other
similar positions;
``(iv) the experience of the Director in managing
medical facilities for other Federal agencies, private
entities, or non-profit entities; and
``(v) such other considerations as the Secretary
considers appropriate.
``(4)(A) The Secretary shall evaluate the amount of market pay
payable to a Director under this section not less frequently than once
every two years and may adjust the market pay payable to such Director
as a result of such evaluation.
``(B) A Director whose market pay is evaluated under subparagraph
(A) shall receive written notice of the results of such evaluation.
``(c) Requirements and Limitations on Total Pay.--(1) Not less
frequently than once every two years, the Secretary shall set forth a
Department-wide minimum and maximum amount for total annual pay under
subsection (a) that may be paid to a Director and shall publish each
such amount in the Federal Register.
``(2) The minimum and maximum amounts set forth under paragraph (1)
shall take effect not earlier than the date that is 60 days after the
publication of such amounts under such paragraph.
``(3) The sum of the basic pay set forth under section 7404(a) of
this title and market pay determined under subsection (b) for a
Director for a calendar year--
``(A) may not be less than the most recent minimum amount
set forth under paragraph (1) before the beginning of such
calendar year; and
``(B) may not be more than the most recent maximum amount
set forth under such paragraph before the beginning of such
calendar year.
``(4) The total amount of compensation paid to a Director under
this title in any calendar year may not exceed the amount of annual
compensation (excluding expenses) of the President under section 102 of
title 3.
``(5) The Secretary may not delegate to an officer or employee of
the Department the requirement of the Secretary to set forth a
Department-wide minimum and maximum amount under paragraph (1).
``(d) Treatment of Pay.--Pay under this section shall be considered
pay for all purposes, including retirement benefits under chapters 83
and 84 of title 5 and other benefits.
``(e) Ancillary Effects of Decreases in Pay.--(1) A decrease in pay
of a Director resulting from an adjustment in the amount of market pay
of the Director under subsection (b) shall not be treated as an adverse
action.
``(2) A decrease in the amount of pay of a Director resulting from
an involuntary reassignment in connection with a disciplinary action
taken against the Director is not subject to appeal or judicial
review.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 74 of such title is amended by adding at the end the following:
``subchapter vii. pay for medical directors and directors of veterans
integrated service networks
``7481. Pay for Medical Directors and Directors of Veterans Integrated
Service Networks.''.
TITLE IV--OTHER HEALTH CARE MATTERS
SEC. 401. PILOT PROGRAM ON PROVIDING NURSE ADVICE LINE FOR VETERANS IN
RURAL AND HIGHLY RURAL AREAS.
(a) In General.--Commencing not later than one year after the date
of the enactment of this Act, the Secretary of Veterans Affairs shall
conduct a two-year pilot program to assess the feasibility and
advisability of implementing in rural areas and highly rural areas with
a large percentage of veterans a nurse advice line to furnish to
veterans medical advice, appointment and cancellation services, and
information on the availability of benefits from the Department of
Veterans Affairs.
(b) Nurse Advice Line.--In carrying out the pilot program under
subsection (a) the Secretary shall establish a nurse advice line that--
(1) operates free of charge;
(2) is based on, and improves upon, the nurse advice line
implemented by the Department of Defense for beneficiaries
under the TRICARE program (as defined in section 1072(5) of
title 10, United States Code);
(3) complies with call center requirements set forth by
URAC;
(4) operates in close consultation with the Secretary to--
(A) establish a process through which the
eligibility of a caller for the nurse advice line can
be validated;
(B) allow eligibility and benefit information in
possession of the Department of Veterans Affairs to be
shared with the nurse advice line; and
(C) allow the nurse advice line to connect with
appropriate technology and personnel of the Department
for purposes of scheduling appointments for the receipt
of health care from the Department; and
(5) maintains quality controls to ensure that calls are
answered by a customer service representative within 30 seconds
and with an abandonment rate of less than 5 percent.
(c) Services Provided.--The nurse advice line established under the
pilot program shall provide an array of services to veterans, including
the following:
(1) Medical advice from licensed registered nurses who
assess the symptoms of the caller using a proprietary clinical
algorithm that--
(A) has been shown in peer-reviewed medical
journals to most closely emulate the clinical
decisionmaking processes of physicians; and
(B) triages the caller to the appropriate venue at
which the caller may receive the health care that they
need.
(2) Information to address basic questions regarding the
eligibility of the caller for benefits from the Department of
Veterans Affairs and the availability of those benefits.
(3) Use of an appointment clerk to facilitate the
scheduling, rescheduling, and cancellation of appointments for
health care from the Department.
(d) Report.--
(1) In general.--Not later than 120 days after the date of
the completion of the pilot program, the Secretary of Veterans
Affairs shall submit to Congress a report on the findings of
the Secretary with respect to the pilot program.
(2) Elements.--The report required by paragraph (1) shall
include the following:
(A) A description of the veterans who have
benefitted from advice through the nurse advice line
under the pilot program, including the locations of the
veterans served.
(B) A description of any impediments to the
Secretary in carrying out the pilot program.
(C) A description of any impediments encountered by
individuals in seeking advice or services through the
nurse advice line under the pilot program.
(D) An assessment of the feasibility and
advisability of expanding the pilot program to include
more veterans.
(e) Definitions.--In this section:
(1) Highly rural area.--The term ``highly rural area''
means an area located in a county or similar community that has
less than seven individuals residing in that county or
community per square mile.
(2) Rural area.--The term ``rural area'' means an area that
is not an urbanized area or a highly rural area.
(3) 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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