Text: S.658 — 111th Congress (2009-2010)All Information (Except Text)

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Introduced in Senate (03/19/2009)


111th CONGRESS
1st Session
S. 658


To amend title 38, United States Code, to improve health care for veterans who live in rural areas, and for other purposes.


IN THE SENATE OF THE UNITED STATES

March 19, 2009

Mr. Tester 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 improve health care for veterans who live 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 Health Care Improvement Act of 2009”.

SEC. 2. Travel reimbursement for veterans receiving treatment at facilities of the Department of Veterans Affairs.

(a) In general.—Section 111 of title 38, United States Code, is amended—

(1) in subsection (a), by striking “traveled,” and inserting “(at a rate of 41.5 cents per mile),”;

(2) by striking subsection (g); and

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

(b) Clarification of relation to public transportation in Veterans Health Administration Handbook.—Not later than 30 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall revise the Veterans Health Administration Handbook to clarify that an allowance for travel based on mileage paid under section 111(a) of title 38, United States Code, may exceed the cost of such travel by public transportation regardless of medical necessity.

SEC. 3. Centers of excellence 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:

§ 7330B. Centers of excellence for rural health research, education, and clinical activities

“(a) Establishment of centers.—The Secretary, through the Director of the Office of Rural Health, 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 the provision of health services in rural areas;

“(2) develop specific models to be used by the Department in furnishing health services to veterans in rural areas;

“(3) provide education and training for health care professionals of the Department on the furnishing of health services to veterans in rural areas; and

“(4) develop and implement innovative clinical activities and systems of care for the Department for the furnishing of health services to veterans in rural areas.

“(b) Geographic dispersion.—The Secretary shall ensure that the centers established under this section are located at health care facilities that are geographically dispersed throughout the United States.

“(c) Selection criteria.—The Secretary 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 Secretary determines that such facility has, or may reasonably be anticipated to develop, the following:

“(A) An arrangement with an accredited medical school to provide residents with education and training in health services for veterans in rural areas.

“(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.

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

“(d) Panel To evaluate proposals.—(1) The Director of the Office of Rural Health shall establish a panel—

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

“(B) to provide advice to the Director regarding the implementation of this section.

“(2) The panel shall review each proposal received from the Secretary and shall submit its views on the relative scientific and clinical merit of each such proposal to the 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 (5 U.S.C. App.).

“(e) Funding.—(1) There are authorized to be appropriated to the Medical Care Account and the Medical and Prosthetics Research Account of the Department of Veterans Affairs such sums as may be necessary for the support of the research and education activities of the centers operated under this section.

“(2) There shall be allocated to the centers operated under this section, from amounts authorized to be appropriated to the Medical Care Account and the Medical and Prosthetics Research Account by paragraph (1), such amounts as the Under Secretary of health considers appropriate for such centers. Such amounts shall be allocated through the Director of the Office of Rural Health.

“(3) Activities of clinical and scientific investigation at each center operated under this section—

“(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 such title is amended by inserting after the item relating to section 7330A the following new item:


“7330B. Centers of excellence for rural health research, education, and clinical activities.”.

SEC. 4. Transportation grants for rural veterans service organizations.

(a) Grants authorized.—

(1) IN GENERAL.—The Secretary of Veterans Affairs shall establish a grant program to provide innovative transportation options to veterans in highly rural areas.

(2) USE OF FUNDS.—Grants awarded under this section may be used by State veterans’ service agencies and veterans service organizations to—

(A) assist veterans in highly rural areas to travel to Department of Veterans Affairs medical centers; and

(B) otherwise assist in providing medical care to veterans in highly rural areas.

(3) MAXIMUM AMOUNT.—The amount of a grant under this section may not exceed $50,000.

(4) NO MATCHING REQUIREMENT.—The recipient of a grant under this section shall not be required to provide matching funds as a condition for receiving such grant.

(b) Regulations.—The Secretary shall prescribe regulations for—

(1) evaluating grant applications under this section; and

(2) otherwise administering the program established by this section.

(c) Veterans service organization definition.—In this section, the term “veterans service organization” means any organization recognized by the Secretary of Veterans Affairs for the representation of veterans under section 5902 of title 38, United States Code.

(d) Authorization of appropriations.—There are authorized to be appropriated $3,000,000 for each of fiscal years 2009 through 2013 to carry out this section.

SEC. 5. Demonstration projects on alternatives for expanding care for veterans in rural areas.

(a) In general.—The Secretary of Veterans Affairs, through the Director of the Office of Rural Health, shall carry out demonstration projects to examine the feasibility and advisability of alternatives for expanding care for veterans in rural areas, including the following:

(1) 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 veterans in rural areas at critical access hospitals (as designated or certified under section 1820 of the Social Security Act (42 U.S.C. 1395i–4)).

(2) Establishing a partnership between the Department of Veterans Affairs and the Department of Health and Human Services to coordinate care for veterans in rural areas at community health centers.

(3) Expanding coordination between the Department of Veterans Affairs and the Indian Health Service to expand care for Indian veterans.

(b) Geographic distribution.—The Secretary of Veterans Affairs shall ensure that the demonstration projects carried out under subsection (a) are located at facilities that are geographically distributed throughout the United States.

(c) Report.—Not later than two years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit a report on the results of the demonstration projects conducted under subsection (a) to—

(1) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate; and

(2) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives.

(d) Authorization of appropriations.—There are authorized to be appropriated $350,000,000 for each of fiscal years 2009 through 2011 to carry out this section.

SEC. 6. Program on provision of readjustment and mental health care services to veterans who served in Operation Iraqi Freedom and Operation Enduring Freedom.

(a) Program required.—Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall establish a program to provide—

(1) to veterans of Operation Iraqi Freedom and Operation Enduring Freedom, particularly veterans who served in such operations while in the National Guard and the Reserves—

(A) peer outreach services;

(B) peer support services;

(C) readjustment counseling and services described in section 1712A of title 38, United States Code; and

(D) mental health services; and

(2) to members of the immediate family of such a veteran, during the three-year period beginning on the date of the return of such veteran from deployment in Operation Iraqi Freedom and Operation Enduring Freedom, education, support, counseling, and mental health services to assist in—

(A) the readjustment of such veteran to civilian life;

(B) in the case such veteran has an injury or illness incurred during such deployment, the recovery of such veteran; and

(C) the readjustment of the family following the return of such veteran.

(b) Contracts with community mental health centers and qualified entities for provision of services.—In carrying out the program required by subsection (a), the Secretary shall contract with community mental health centers and other qualified entities to provide the services required by such subsection only in areas the Secretary determines are not adequately served by other health care facilities of the Department of Veterans Affairs. Such contracts shall require each contracting community health center or entity—

(1) to the extent practicable, to employ veterans trained under subsection (c);

(2) to the extent practicable, to use telehealth services for the delivery of services required by subsection (a);

(3) to participate in the training program conducted in accordance with subsection (d);

(4) to comply with applicable protocols of the Department of Veterans Affairs before incurring any liability on behalf of the Department for the provision of the services required by subsection (a);

(5) to submit annual reports to the Secretary containing, with respect to the program required by subsection (a) and for the last full calendar year ending before the submission of such report—

(A) the number of the veterans served, veterans diagnosed, and courses of treatment provided to veterans as part of the program required by subsection (a); and

(B) demographic information for such services, diagnoses, and courses of treatment;

(6) for each veteran for whom a community mental health center or other qualified entity provides mental health services under such contract, to provide the Department of Veterans Affairs with such clinical summary information as the Secretary shall require; and

(7) to meet such other requirements as the Secretary shall require.

(c) Training of veterans for the provision of peer-outreach and peer-support services.—In carrying out the program required by subsection (a), the Secretary shall contract with a national not-for-profit mental health organization to carry out a national program of training for veterans described in subsection (a) to provide the services described in subparagraphs (A) and (B) of paragraph (1) of such subsection.

(d) Training of clinicians for provision of services.—The Secretary shall conduct a training program for clinicians of community mental health centers or entities that have contracts with the Secretary under subsection (b) to ensure that such clinicians can provide the services required by subsection (a) in a manner that—

(1) recognizes factors that are unique to the experience of veterans who served on active duty in Operation Iraqi Freedom or Operation Enduring Freedom (including their combat and military training experiences); and

(2) utilizes best practices and technologies.

(e) Reports required.—

(1) INITIAL REPORT ON PLAN FOR IMPLEMENTATION.—Not later than 45 days after the date of the enactment of this Act, 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 containing the plans of the Secretary to implement the program required by subsection (a).

(2) STATUS REPORT.—Not later than one year after the date of the enactment of this Act, 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 implementation of the program. Such report shall include the following:

(A) Information on the number of veterans who received services as part of the program and the type of services received during the last full calendar year completed before the submission of such report.

(B) An evaluation of the provision of services under paragraph (2) of subsection (a) and a recommendation as to whether the period described in such paragraph should be extended to a five-year period.

SEC. 7. Improvement of care of American Indian veterans.

(a) Indian Health Coordinators.—

(1) IN GENERAL.—Subchapter II of chapter 73 of title 38, United States Code, as amended by section 3, is further amended by adding at the end the following new section:

§ 7330C. Indian Veterans Health Care Coordinators

“(a) In general.—(1) The Secretary shall assign at each of the 10 Department Medical Centers that serve communities with the greatest number of Indian veterans per capita an official or employee of the Department to act as the coordinator of health care for Indian veterans at such Medical Center. The official or employee so assigned at a Department Medical Center shall be known as the ‘Indian Veterans Health Care Coordinator’ for the Medical Center.

“(2) The Secretary shall, from time to time—

“(A) survey the Department Medical Centers for purposes of identifying the 10 Department Medical Centers that currently serve communities with the greatest number of Indian veterans per capita; and

“(B) utilizing the results of the most recent survey conducted under subparagraph (A), revise the assignment of Indian Veterans Health Care Coordinators in order to assure the assignment of such coordinators to appropriate Department Medical Centers as required by paragraph (1).

“(b) Duties.—The duties of a Indian Veterans Health Care Coordinator shall include the following:

“(1) Improving outreach to tribal communities.

“(2) Coordinating the medical needs of Indian veterans on Indian reservations with the Veterans Health Administration and the Indian Health Service.

“(3) Expanding the access and participation of Department of Veterans Affairs, Indian Health Service, and tribal members in the Department of Veterans Affairs Tribal Veterans Representative program.

“(4) Acting as an ombudsman for Indian veterans enrolled in the health care system of the Veterans Health Administration.

“(5) Advocating for the incorporation of traditional medicine and healing in Department treatment plans for Indian veterans in need of care and services provided by the Department.

“(c) Native American defined.—In this section, the term ‘Indian’ has the meaning given the term in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b).”.

(2) CLERICAL AMENDMENT.—The table of sections at the beginning of chapter 73 of such title, as amended by section 3, is further amended by inserting after the item relating to section 7330B the following new item:


“7330C. Indian Veterans Health Coordinators.”.

(b) Integration of electronic health records with Indian Health Service.—Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs and Secretary of the Interior shall enter into a memorandum of understanding to ensure that the health records of Indian veterans may be transferred electronically between facilities of the Indian Health Service and the Department of Veterans Affairs.

(c) Transfer of medical equipment to the Indian Health Service.—

(1) IN GENERAL.—The Secretary of Veterans Affairs may transfer to the Indian Health Service such surplus Department of Veterans Affairs medical and information technology equipment as the Secretary of Veterans Affairs and the Secretary of Health and Human Services jointly consider appropriate for purposes of the Indian Health Service.

(2) TRANSPORTATION AND INSTALLATION.—In transferring medical or information technology equipment under this subsection, the Secretary of Veterans Affairs may transport and install such equipment in facilities of the Indian Health Service.

(d) Report on Joint Health Clinics With Indian Health Service.—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 submit to Congress a report on the feasability and advisability of the joint establishment and operation by the Veterans Health Administration and the Indian Health Service of health clinics on Indian reservations to serve the populations of such reservations, including Indian veterans.

SEC. 8. Annual report to Congress on matters related to care for veterans who live in rural areas.

(a) Annual report.—The Secretary of Veterans Affairs shall submit to Congress each year, together with documents submitted to Congress in support of the budget of the President for the fiscal year beginning in such year (as submitted pursuant to section 1105 of title 31, United States Code), an assessment, current as of the fiscal year ending in the year before such report is submitted, of the following:

(1) The implementation of the provisions of this Act, including the amendments made by this Act.

(2) The establishment and function of the Office of Rural Health under section 7308 of title 38, United States Code.

(b) Additional requirements for initial report.—The first report submitted under subsection (a) shall also include the following:

(1) The assessment of fee-basis health-care program required by section 212(b) of the Veterans Benefits, Health Care, and Information Technology Act of 2006 (Public Law 109–461; 120 Stat. 3422).

(2) An assessment of the outreach program required by section 213 of such Act (120 Stat. 3422; 38 U.S.C. 6303 note).