[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5524 Introduced in House (IH)]








109th CONGRESS
  2d Session
                                H. R. 5524

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              June 6, 2006

  Mr. Michaud (for himself, Mr. Evans, Mr. Filner, Mr. Gutierrez, Ms. 
Corrine Brown of Florida, Ms. Herseth, Mr. Strickland, Ms. Hooley, Mr. 
    Reyes, Mr. Udall of New Mexico, and Mr. Salazar) introduced the 
   following bill; which was referred to the Committee on Veterans' 
                                Affairs

_______________________________________________________________________

                                 A BILL


 
   To amend title 38, United States Code, to improve health care for 
            veterans 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 Act of 
2006''.

SEC. 2. OUTREACH PROGRAM TO VETERANS IN RURAL AREAS.

    (a) Program.--The Secretary of Veterans Affairs shall conduct an 
extensive outreach program to identify and provide information to 
veterans who served in the theater of operations for Operation Iraqi 
Freedom or Operation Enduring Freedom and who reside in rural 
communities in order to enroll those veterans in the health care system 
of the Department of Veterans Affairs during the period when they are 
eligible for such enrollment.
    (b) Features of Program.--In carrying out the program under 
subsection (a), the Secretary shall seek to work at the local level 
with employers, State agencies, community health centers located in 
rural areas, rural health clinics, and critical access hospitals 
located in rural areas, and units of the National Guard and other 
reserve components based in rural areas, in order to increase the 
awareness of veterans and their families of the availability of health 
care provided by the Secretary and the means by which those veterans 
can achieve access to the health care services provided by the 
Department of Veterans Affairs.

SEC. 3. ACCESS TO VET CENTERS IN RURAL AREAS.

    (a) Expansion of Access.--The Secretary of Veterans Affairs shall 
expand access to Vet Centers in rural areas. In carrying out this 
section, the Secretary shall conduct a pilot program for the operation 
of at least two mobile Vet Centers in rural areas for a period of five 
years.
    (b) Vet Center Defined.--In this section, the term ``Vet Center'' 
has the meaning given the term ``center'' in section 1712A(i)(1) of 
title 38, United States Code.

SEC. 4. QUALITY CARE IN RURAL AREAS.

    (a) Requirement.--The Secretary of Veterans Affairs shall develop 
and implement a plan for improving the access of veterans to health 
care in rural areas. The plan shall be developed in consultation with 
the Advisory Committee on Rural Veterans established under section 546 
of title 38, United States Code, as added by section 6.
    (b) Matters to Be Included.--The plan developed under subsection 
(a) shall include the following:
            (1) A review of progress in implementing the proposed 156 
        community-based outpatient clinics, and plans for further 
        implementation of those proposed clinics, that were included in 
        the May 2004 Secretary's CARES Decision Document, announcing 
        the implementation of the Department of Veterans Affairs health 
        care planning process called Capital Asset Realignment for 
        Enhanced Services (CARES), plans for establishment of 
        additional community-based outpatient clinics, and plans for 
        health-care outreach centers.
            (2) Measures for meeting the long-term care needs of rural 
        veterans through nursing homes of the Department of Veterans 
        Affairs and State veterans homes.
            (3) Expansion for rural veterans of the adult day-care and 
        respite care programs of the Department.
            (4) Expansion for rural veterans of the use of telemedicine 
        to enhance care coordination and access to specialized care for 
        such veterans.
            (5) Measures for meeting the needs of rural veterans for 
        mental health care.
    (c) Timetable.--The plan required by subsection (a) shall be 
submitted to Congress not later than nine months after the date of the 
enactment of this Act and shall be implemented not later than two years 
thereafter.

SEC. 5. HEALTH INFORMATION TECHNOLOGY.

    The Secretary of Veterans Affairs shall establish a health 
information technology pilot program to ensure a continuum of quality 
of care for rural veterans who receive health care provided by the 
Secretary both directly through facilities of the Department of 
Veterans Affairs and as fee-basis care through non-Department providers 
and facilities, including, where appropriate, community health centers, 
rural health clinics, and critical access hospitals. The pilot program 
shall be conducted for a period of four years.

SEC. 6. ADVISORY COMMITTEE ON RURAL VETERANS.

    (a) New Advisory Committee.--Chapter 5 of title 38, United States 
Code, is amended by adding at the end the following new section:
``Sec. 546. Advisory Committee on Rural Veterans
    ``(a)(1) The Secretary shall establish an advisory committee to be 
known as the Advisory Committee on Rural Veterans (hereinafter in this 
section referred to as `the Committee').
    ``(2)(A) The Committee shall consist of members appointed by the 
Secretary from the general public, including--
            ``(i) representatives of rural veterans;
            ``(ii) individuals who are recognized authorities in fields 
        pertinent to the needs of rural veterans, including specific or 
        unique health-care needs of rural veterans and access issues of 
        rural veterans;
            ``(iii) individuals who have expertise in the delivery of 
        mental health care in rural areas;
            ``(iv) individuals who have expertise in the delivery of 
        long-term care in rural areas;
            ``(v) at least one veterans service organization 
        representative from a rural State; and
            ``(vi) representatives of rural veterans with service-
        connected disabilities.
    ``(B) The Committee shall include, as ex officio members--
            ``(i) the Secretary of Health and Human Services (or a 
        representative of the Secretary of Health and Human Services 
        designated by that Secretary);
            ``(ii) the Director of the Indian Health Service (or a 
        representative of that Director); and
            ``(iii) the Under Secretary for Health and the Under 
        Secretary for Benefits, or their designees.
    ``(C) The Secretary may invite representatives of other departments 
and agencies of the United States to participate in the meetings and 
other activities of the Committee.
    ``(3) The Secretary shall determine the number, terms of service, 
and pay and allowances of members of the Committee appointed by the 
Secretary, except that a term of service of any such member may not 
exceed three years. The Secretary may reappoint any such member for 
additional terms of service.
    ``(b) The Secretary shall, on a regular basis, consult with and 
seek the advice of the Committee with respect to the administration of 
benefits by the Department for rural veterans, reports and studies 
pertaining to rural veterans, and the needs of rural veterans with 
respect to primary care, mental health care, and long-term care needs 
of rural veterans.
    ``(c)(1) Not later than September 1 of each odd-numbered year 
through 2013, the Committee shall submit to the Secretary a report on 
the programs and activities of the Department that pertain to rural 
veterans. Each such report shall include--
            ``(A) an assessment of the needs of rural veterans with 
        respect to primary care, mental health care, and long-term care 
        needs of rural veterans and other benefits and programs 
        administered by the Department;
            ``(B) a review of the programs and activities of the 
        Department designed to meet such needs; and
            ``(C) such recommendations (including recommendations for 
        administrative and legislative action) as the Committee 
        considers appropriate.
    ``(2) The Secretary shall, within 60 days after receiving each 
report under paragraph (1), submit to the Congress a copy of the 
report, together with any comments concerning the report that the 
Secretary considers appropriate.
    ``(3) The Committee may also submit to the Secretary such other 
reports and recommendations as the Committee considers appropriate.
    ``(4) The Secretary shall submit with each annual report submitted 
to the Congress pursuant to section 529 of this title a summary of all 
reports and recommendations of the Committee submitted to the Secretary 
since the previous annual report of the Secretary submitted pursuant to 
such section.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by adding at the end the following new item:

``546. Advisory Committee on Rural Veterans.''.

SEC. 7. RURAL HEALTH RESEARCH, EDUCATION, AND CLINICAL CARE CENTERS.

    (a) In General.--(1) Subchapter II of chapter 73 of title 38, 
United States Code, is amended by adding at the end the following new 
section:
``Sec. 7329. Rural health research, education, and clinical care 
              centers
    ``(a) The Secretary, upon the recommendation of the Under Secretary 
for Health and pursuant to the provisions of this section, shall 
designate a minimum of four Department health care facilities as the 
locations for centers of rural health research, education, and clinical 
activities and (subject to the appropriation of sufficient funds for 
such purpose) shall establish and operate such centers at such 
locations in accordance with this section.
    ``(b) The centers established under this section 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.
    ``(c) In designating locations for centers under subsection (a), 
the Secretary, upon the recommendation of the Under Secretary for 
Health, shall--
            ``(1) assure appropriate geographic distribution of such 
        centers;
            ``(2) assure that one of the centers shall focus on mental 
        health, including substance abuse treatment;
            ``(3) assure that one of the centers shall focus on case 
        management of chronic diseases;
            ``(4) assure that one of the centers shall focus on 
        telemedicine; and
            ``(5) assure that at least one of the centers shall be 
        located to collaborate with a Rural Health Research Center of 
        the Department of Health and Human Services in a geographic 
        service area of the Department of Veterans Affairs that 
        includes several rural States.
    ``(d) The Secretary may not designate a health care facility as a 
location for a center under subsection (a) unless the peer review panel 
established under subsection (e) has determined under that subsection 
that the proposal submitted by such facility as a location for a new 
center under subsection (a) is among those proposals that have met the 
highest competitive standards of scientific and clinical merit and the 
Secretary (upon the recommendation of the Under Secretary for Health) 
determines that the facility has (or may reasonably be anticipated to 
develop) each of the following:
            ``(1) An arrangement under which medical, nursing, or 
        allied health personnel receive training and education in the 
        unique aspects of rural care through regular rotation through 
        rurally located facilities and community based outpatient 
        clinics.
            ``(2) The ability to attract the participation of 
        scientists and clinicians who are capable of ingenuity and 
        creativity in health care research efforts.
            ``(3) 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.
            ``(4) The capability to coordinate, as part of an 
        integrated national system, education, clinical, and research 
        activities within all facilities with such centers.
            ``(5) The capability to jointly develop a consortium of 
        providers with interest in improving quality care in rural 
        areas.
            ``(6) The capability to develop a national repository for 
        the collection of best practices and evidenced based care to 
        rural veterans.
            ``(7) The capability to effectively conduct evaluations of 
        the activities of such center.
    ``(e)(1) In order to provide advice to assist the Secretary and the 
Under Secretary for Health in carrying out their responsibilities under 
this section, the Assistant Under Secretary for Health shall establish 
a panel to assess the scientific and clinical merit of proposals that 
are submitted to the Secretary for the establishment of new centers 
under this section.
    ``(2) The membership of the panel shall consist of experts in the 
fields pertinent to the needs of rural veterans, including mental 
health care and long-term care. Members of the panel shall serve as 
consultants to the Department for a period of no longer than six 
months.
    ``(3) The panel shall review each proposal submitted to the panel 
by the Assistant Under Secretary and shall submit its views on the 
relative scientific and clinical merit of each such proposal to the 
Assistant Under Secretary.
    ``(4) The panel shall not be subject to the Federal Advisory 
Committee Act.
    ``(f) Before providing funds for the operation of any such center 
at a health care facility other than a health care facility designated 
under subsection (c)(1), the Secretary shall assure that the center at 
each facility designated under such subsection is receiving adequate 
funding to enable such center to function effectively in the areas of 
rural health care research, education, and clinical activities.
    ``(g) 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). The Under Secretary 
for Health shall allocate to such centers from other funds appropriated 
generally for the Department medical care account and medical and 
prosthetics research account, as appropriate, such amounts as the Under 
Secretary for Health determines appropriate.
    ``(h) Activities of clinical and scientific investigation at each 
center established under subsection (a) shall be eligible to compete 
for the award of funding from funds appropriated for the Department 
medical and prosthetics research account and shall receive priority in 
the award of funding from such account insofar as funds are awarded to 
projects for research in rural health care.''.
    (2) The table of sections at the beginning of such chapter is 
amended by inserting after the item relating to section 7328 the 
following new item:

``7329. Rural health research, education, and clinical care centers.''.
    (b) Designation of Centers.--The Secretary of Veterans Affairs 
shall designate the centers for rural health research, education, and 
clinical activities required by section 7329 of title 38, United States 
Code (as added by subsection (a)), not later than one year after the 
date of the enactment of this Act.
    (c) Annual Reports.--
            (1) Annual report.--Not later than 18 months after the date 
        of the designation of centers for rural health research, 
        education, and clinical activities required by section 7329 of 
        title 38, United States Code (as so added), and annually 
        thereafter for the next three years, the Secretary shall submit 
        to the Committees on Veterans' Affairs of the Senate and House 
        of Representatives a report on the status and activities of 
        such centers during the one-year period beginning on the date 
        of such designation, for the first such report, and for 
        successive one-year periods, for subsequent reports.
            (2) Matter to be included.--Each such report shall include, 
        for the period covered by the report, the following:
                    (A) A description of the activities carried out at 
                each center and the funding provided for such 
                activities.
                    (B) A description of any advances made in the 
                participating programs of each center in research, 
                education, training, and clinical activities related to 
                rural health.

SEC. 8. HOMELESS RURAL VETERANS.

    Section 2061(b) of title 38, United States Code, is amended--
            (1) by striking ``or'' at the end of paragraph (3);
            (2) by striking the period at the end of paragraph (4) and 
        inserting ``; and''; and
            (3) by adding at the end the following new paragraph:
            ``(5) rural.''.

SEC. 9. RURAL EDUCATION AND TRAINING OF HEALTH PROFESSIONALS.

    The Secretary of Veterans Affairs shall carry out activities to 
enhance the education, training, retention, and recruitment of health 
professionals in rural areas. As part of such activities, the Secretary 
shall--
            (1) establish additional rotations for medical residents in 
        rural areas;
            (2) establish programs to enhance the education, training, 
        recruitment, and retention of nurses in rural areas; and
            (3) establish programs to enhance the education, training, 
        recruitment, and retention of allied health professionals in 
        rural areas.

SEC. 10. NATIVE AMERICANS.

    The Secretary of Veterans Affairs shall expand the health care 
presence of the Department of Veterans Affairs in Native American, 
Native Hawaiian, and Native Alaskan rural communities in order to 
improve access to Department of Veterans Affairs health care services 
for veterans in those communities.
                                 <all>