1.This Act may be cited as the
Rural Veterans Care Act of
2006
.
2.Assistant
Secretary for Rural VeteransSection 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
.
3.Responsibilities
of Assistant Secretary for Rural Veterans
(a)
(1)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)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)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)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)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.
4.Pilot program on
enhanced access to health care for veterans in highly rural and geographically
remote areas
(a)
(1)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 programIn 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)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 AreasAn 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)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)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)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)The pilot program
shall be conducted during fiscal years 2007, 2008, and 2009.
(g)Funding for
Pilot Program
(1)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)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)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).
5.Travel
reimbursement for veterans receiving treatment at facilities of the Department
of Veterans AffairsSection
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).
6.Centers for
rural health research, education, and clinical activities
(a)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)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)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)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)(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)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.
.