[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2879 Introduced in House (IH)]
111th CONGRESS
1st Session
H. R. 2879
To amend title 38, United States Code, to improve health care for
veterans who live in rural areas, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 15, 2009
Mrs. Kirkpatrick of Arizona (for herself and Mr. Perriello) 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 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:
``Sec. 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:
``Sec. 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).
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