1.This Act may be cited as the
Rural Veterans Health Care Improvement
Act of 2009
.
2.Travel reimbursement for veterans receiving
treatment at facilities of the Department of Veterans Affairs
(a)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
HandbookNot 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.
3.Centers of excellence 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:
7330B.Centers of excellence for rural health
research, education, and clinical activities
(a)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)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)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)(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)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.
.
4.Transportation grants for rural veterans
service organizations
(a)
(1)The Secretary of Veterans Affairs shall
establish a grant program to provide innovative transportation options to
veterans in highly rural areas.
(2)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)The amount of a grant
under this section may not exceed $50,000.
(4)The recipient of a grant under this section
shall not be required to provide matching funds as a condition for receiving
such grant.
(b)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
definitionIn 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
appropriationsThere are
authorized to be appropriated $3,000,000 for each of fiscal years 2009 through
2013 to carry out this section.
5.Demonstration projects on alternatives for
expanding care for veterans in rural areas
(a)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)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)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
appropriationsThere are authorized to be appropriated
$350,000,000 for each of fiscal years 2009 through 2011 to carry out this
section.
6.Program on provision
of readjustment and mental health care services to veterans who served in
Operation Iraqi Freedom and Operation Enduring Freedom
(a)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
servicesIn 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
servicesIn 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 servicesThe 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)
(1)Initial report
on plan for implementationNot 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)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.
7.Improvement of
care of American Indian veterans
(a)Indian Health
Coordinators
(1)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)(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)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)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)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 ServiceNot 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)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 installationIn 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 ServiceNot 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.
8.Annual report to Congress on matters
related to care for veterans who live in rural areas
(a)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
reportThe 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).