[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 2433 Introduced in Senate (IS)]








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 (legislative 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:
``Sec. 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.''.
                                 <all>