Text: S.2433 — 109th Congress (2005-2006)All Information (Except Text)

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Introduced in Senate (03/16/2006)


109th CONGRESS
2d Session
S. 2433


To amend title 38, United States Code, to establish an Assistant Secretary for Rural Veterans in the Department of Veterans Affairs, to improve the care provided to veterans living in rural areas, and for other purposes.


IN THE SENATE OF THE UNITED STATES

March 16 (legistlative day, March 15), 2006

Mr. Salazar (for himself, Mr. Thune, Mr. Akaka, Mr. Dorgan, Mr. Pryor, Mr. Johnson, Mr. Burns, Ms. Murkowski, Mr. Thomas, Mr. Baucus, Mr. Conrad, Mrs. Murray, Mrs. Lincoln, and Mr. Burr) introduced the following bill; which was read twice and referred to the Committee on Veterans' Affairs


A BILL

To amend title 38, United States Code, to establish an Assistant Secretary for Rural Veterans in the Department of Veterans Affairs, to improve the care provided to veterans living in 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 Care Act of 2006”.

SEC. 2. Assistant Secretary for Rural Veterans.

Section 308 of title 38, United States Code, is amended—

(1) in subsection (a)—

(A) by inserting “(1)” before “There”;

(B) by striking “six” and inserting “seven”; and

(C) by striking “Each” and inserting the following:

“(2) Each”;

(2) by redesignating subsection (c) as paragraph (3) and inserting such paragraph at the end of subsection (a);

(3) by inserting after subsection (b) the following new subsection:

“(c)(1) One of the Assistant Secretaries appointed under subsection (a) shall be the Assistant Secretary for Rural Veterans, who, under the direction of the Secretary, shall formulate and implement all policies and procedures of the Department that affect veterans living in rural areas.

“(2) The Assistant Secretary for Rural Veterans, under the direction of the Secretary, shall perform the following functions:

“(A) Except as otherwise expressly provided in this title, carry out the provisions of this title and administer all Department programs for providing care to veterans living in rural areas who are eligible for services authorized under this title.

“(B) Oversee and coordinate personnel and policies of the Veterans Health Administration, the Veterans Benefits Administration, the National Cemetery Administration, and their respective subagencies, including Veterans Integrated Service Networks, to carry out Department programs to the extent such programs affect veterans living in rural areas.

“(C) Oversee, coordinate, promote, and disseminate research into issues affecting veterans living in rural areas in cooperation with the medical, rehabilitation, health services, and cooperative studies research programs, the Office of Policy and the Office of Research and Development of the Veterans Health Administration, and the centers established in section 7329.

“(D) Ensure maximum effectiveness and efficiency in providing services and assistance to eligible veterans under the programs described in subparagraph (A), after consultation with appropriate representatives of the Centers for Medicare and Medicaid Services, the Indian Health Service, and the Office of Rural Health Policy of the Department of Health and Human Services, the Social Security Administration, the Department of Labor, the Department of Agriculture (acting through the Under Secretary for Rural Development), and other Federal, State, and local government agencies.

“(E) Work with all personnel and resources of the Department to develop, refine, and promulgate policies, best practices, lessons learned, and innovative and successful programs to improve care and services for rural veterans.

“(F) Perform such other functions and duties as the Secretary considers appropriate.

“(3) The Secretary shall ensure that the Assistant Secretary for Rural Veterans has the budget, authority, and control necessary for the development, approval, implementation, integration, and oversight of policies, procedures, processes, activities, and systems of the Department relating to the care of rural veterans. The Secretary shall identify a Rural Veterans Coordinator in each Veterans Integrated Service Network, who shall report to the Assistant Secretary for Rural Veterans and coordinate the functions authorized under this subsection within such network.

“(4) The Assistant Secretary for Rural Veterans, under the direction of the Secretary, shall supervise the employees of the Department who are responsible for implementing the policies and procedures described in paragraph (1).”; and

(4) in subsection (d)—

(A) in paragraph (1)—

(i) by striking “18” and inserting “19”; and

(ii) by adding at the end the following: “One of the Deputy Assistant Secretaries appointed under this paragraph shall be the Deputy Assistant Secretary for Rural Veterans, who shall perform such functions as the Assistant Secretary for Rural Veterans prescribes.”;

(B) in paragraph (2), by inserting “or, in the case of the Deputy Assistant Secretary for Rural Veterans, comparable service in a management position in the Armed Forces” after “Secretary”.

SEC. 3. Responsibilities of Assistant Secretary for Rural Veterans.

(a) Demonstration projects.—

(1) IN GENERAL.—The Assistant Secretary for Rural Veterans, appointed under section 308 of title 38, United States Code, shall carry out demonstration projects to examine alternatives for expanding care in rural areas, including—

(A) establishing a partnership between the Department of Veterans Affairs and the Centers for Medicare and Medicaid Services of the Department of Health and Human Services to coordinate care for rural veterans conducted at critical access hospitals (as designated or certified under section 1820 of the Social Security Act (42 U.S.C. 1395i–4));

(B) establishing a partnership between the Department of Veterans Affairs and the Department of Health and Human Services to coordinate care for rural veterans conducted at community health centers;

(C) expanding the use of fee basis care through which private hospitals, health care facilities, and other third-party providers are reimbursed for providing care closer to the homes of veterans living in rural areas, as authorized under section 7405(a)(2); and

(D) expanding coordination between the Department of Veterans Affairs and the Indian Health Service to expand care for Native American veterans.

(2) GEOGRAPHIC DISTRIBUTION.—The Assistant Secretary for Rural Veterans shall ensure that the demonstration projects authorized under paragraph (1) are located at facilities that are geographically distributed throughout the United States.

(3) REPORT.—Not later than two years after the date of enactment of this Act, the Assistant Secretary for Rural Veterans shall submit a report on the results of the demonstration projects conducted under paragraph (1) to—

(A) the Committee on Veterans Affairs of the Senate;

(B) the Committee on Appropriations of the Senate;

(C) the Committee on Veterans Affairs of the House of Representatives; and

(D) the Committee on Appropriations of the House of Representatives.

(b) Policy revisions.—Not later than one year after the date of enactment of this Act, the Assistant Secretary for Rural Veterans shall—

(1) reevaluate directives 5005 and 5007 of the Department of Veterans Affairs and other guidance and procedures related to the use of fee basis care nationwide; and

(2) revise established policies to—

(A) provide stronger guidance to units of the Department of Veterans Affairs; and

(B) strengthen the use of fee basis care to extend health care services to rural and remote rural areas.

(c) Reports to Congress.—The Secretary of Veterans Affairs shall submit to Congress, in conjunction with the documents submitted in support of the President’s budget for each fiscal year, an assessment of the implementation during the most recently completed fiscal year of the provisions of this Act and the amendments made by this Act.

SEC. 4. Pilot program on enhanced access to health care for veterans in highly rural and geographically remote areas.

(a) Pilot Program.—

(1) IN GENERAL.—The Secretary of Veterans Affairs shall conduct a pilot program to evaluate the feasability and advisability of utilizing various means to improve the access of veterans who reside in highly rural or geographically remote areas to health care services referred to in subsection (d).

(2) PROVISION OF SERVICES UNDER PILOT PROGRAM.—In conducting the pilot program, the Secretary shall provide health care services referred to in subsection (d) to eligible veterans who reside in highly rural or geographically remote areas in the geographic service regions selected for purposes of the pilot program utilizing the contract authority of the Secretary under section 1703 of title 38, United States Code, and such other authorities available to the Secretary as the Secretary considers appropriate for purposes of the pilot program.

(b) Eligible Veterans.—A veteran is an eligible veteran for purposes of this section if the veteran—

(1) has a service-connected disability; or

(2) is enrolled in the veterans health care system under section 1705 of title 38, United States Code.

(c) Highly Rural or Geographically Remote Areas.—An eligible veteran resides in a highly rural or geographically remote area for purposes of this section if the veteran—

(1) resides in a location that is more than 60 miles driving distance from the nearest Department of Veterans Affairs health care facility; or

(2) in the case of an eligible veteran who resides in a location that is less than 60 miles driving distance from such a facility, experiences such hardship or other difficulties (as determined pursuant to regulations prescribed by the Secretary for purposes of this section) in travel to the nearest Department of Veterans Affairs health care facility that such travel is not in the best interests of the veteran.

(d) Health Care Services.—The health care services referred to in this section are—

(1) acute or chronic symptom management;

(2) nontherapeutic medical services; and

(3) any other medical services jointly determined appropriate for an eligible veteran for purposes of this section by the physician of the department responsible for primary care of such eligible veteran and the director of the Veterans Integrated Service Network concerned.

(e) Areas for Conduct of Pilot Program.—

(1) IN GENERAL.—The pilot program shall be conducted in 3 of the geographic service regions of the Veterans Health Administration (referred to as Veterans Integrated Service Networks) selected by the Secretary for purposes of the pilot program.

(2) SELECTION.—In selecting geographic service regions for the purposes of the pilot program, the Secretary, based on the recommendations of the Assistant Secretary for Rural Veterans, shall select from among the Veterans Integrated Service Networks that have a substantial population of veterans who reside in highly rural or geographically remote areas.

(f) Period of Pilot Program.—The pilot program shall be conducted during fiscal years 2007, 2008, and 2009.

(g) Funding for Pilot Program.—

(1) IN GENERAL.—For each fiscal year during which the pilot program is conducted, the Secretary shall allocate for the pilot program an amount equal to 0.9 percent of the total amount appropriated for such fiscal year for medical services.

(2) TIMING OF ALLOCATION.—The allocation under paragraph (1) for a fiscal year shall be made before any other allocation of funds for medical care is made for such fiscal year, and any remaining allocation of funds for medical care for such fiscal year shall be made without regard to the allocation under subsection (a) in such fiscal year.

(h) Report to Congress.—Not later than February 1, 2009, the Secretary shall submit to Congress a report on the pilot program. The Secretary shall include in the report such recommendations as the Secretary considers appropriate concerning extension of the pilot program or other means to improve the access of veterans who reside in highly rural or geographically remote areas to health care services referred to in subsection (d).

SEC. 5. Travel reimbursement for veterans receiving treatment at facilities of the Department of Veterans Affairs.

Section 111 of title 38, United States Code, is amended—

(1) in subsection (a)—

(A) by striking “subsistence),” and inserting “subsistence at a rate equivalent to the rate provided to Federal employees under section 5702 of title 5),”; and

(B) by striking “traveled,” and inserting “(at a rate equivalent to the rate provided to Federal employees under section 5704 of title 5),”;

(2) by striking subsection (g); and

(3) by redesignating subsection (h) as subsection (g).

SEC. 6. Centers for rural health research, education, and clinical activities.

(a) In general.—Subchapter II of chapter 73 of title 38, United States Code, is amended by adding at the end the following new section:

§ 7329. Centers for rural health research, education, and clinical activities

“(a) Establishment of centers.—The Assistant Secretary for Rural Veterans shall establish and operate not less than one and not more than five centers of excellence for rural health research, education, and clinical activities, which shall—

“(1) conduct research on rural health services;

“(2) allow the Department to use specific models for furnishing services to treat rural veterans;

“(3) provide education and training for health care professionals of the Department; and

“(4) develop and implement innovative clinical activities and systems of care for the Department.

“(b) Geographic dispersion.—The Assistant Secretary for Rural Veterans shall ensure that the centers authorized under paragraph (1) are located at health care facilities that are geographically dispersed throughout the United States.

“(c) Selection criteria.—The Assistant Secretary for Rural Veterans may not designate a health care facility as a location for a center under this section unless—

“(1) the peer review panel established under subsection (d) determines that the proposal submitted by such facility meets the highest competitive standards of scientific and clinical merit; and

“(2) the Assistant Secretary for Rural Veterans determines that the facility has, or may reasonably be anticipated to develop—

“(A) an arrangement with an accredited medical school to provide residents with education and training in care for rural veterans;

“(B) the ability to attract the participation of scientists who are capable of ingenuity and creativity in health care research efforts;

“(C) a policymaking advisory committee, composed of appropriate health care and research representatives of the facility and of the affiliated school or schools, to advise the directors of such facility and such center on policy matters pertaining to the activities of such center during the period of the operation of such center; and

“(D) the capability to effectively conduct evaluations of the activities of such center.

“(d) Panel To evaluate proposals.—(1) The Assistant Secretary for Rural Veterans shall establish a panel to—

“(A) evaluate the scientific and clinical merit of proposals submitted to establish centers under this section; and

“(B) provide advice to the Assistant Secretary for Rural Veterans regarding the implementation of this section.

“(2) The panel shall review each proposal received from the Assistant Secretary for Rural Veterans and shall submit its views on the relative scientific and clinical merit of each such proposal to the Assistant Secretary.

“(3) The panel established under paragraph (1) shall be comprised of experts in the fields of public health research, education, and clinical care.

“(4) Members of the panel shall serve as consultants to the Department for a period not to exceed two years.

“(5) The panel shall not be subject to the Federal Advisory Committee Act.

“(e) Funding.—(1) There are authorized to be appropriated such sums as may be necessary for the support of the research and education activities of the centers established pursuant to subsection (a).

“(2) The Assistant Secretary for Rural Veterans shall allocate such amounts as the Under Secretary for Health determines to be appropriate to the centers established pursuant to subsection (a) from funds appropriated for the Medical Care Account and the Medical and Prosthetics Research Account.

“(3) Activities of clinical and scientific investigation at each center established under subsection (a)—

“(A) shall be eligible to compete for the award of funding from funds appropriated for the Medical and Prosthetics Research Account; and

“(B) shall receive priority in the award of funding from such account to the extent that funds are awarded to projects for research in the care of rural veterans.”.

(b) Clerical amendment.—The table of sections at the beginning of chapter 73 of title 38, United States Code, is amended by inserting after the item relating to section 7328 the following new item:


“7329. Centers for rural health research, education, and clinical activities.”.