[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 658 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                 S. 658

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 19, 2009

  Mr. Tester 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 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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