[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 734 Introduced in Senate (IS)]
111th CONGRESS
1st Session
S. 734
To amend title 38, United States Code, to improve the capacity of the
Department of Veterans Affairs to recruit and retain physicians in
Health Professional Shortage Areas and to improve the provision of
health care to veterans in rural areas, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 30, 2009
Mr. Akaka (for himself, Mr. Baucus, and Mr. Begich) introduced the
following bill; which was read twice and referred to
_______________________________________________________________________
A BILL
To amend title 38, United States Code, to improve the capacity of the
Department of Veterans Affairs to recruit and retain physicians in
Health Professional Shortage Areas and to improve the provision of
health care to veterans 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 Access
and Quality Act of 2009''.
SEC. 2. ENHANCEMENT OF DEPARTMENT OF VETERANS AFFAIRS EDUCATION DEBT
REDUCTION PROGRAM.
(a) Enhanced Maximum Annual Amount.--Paragraph (1) of section
7683(d) of title 38, United States Code, is amended by striking
``$44,000'' and all that follows through ``fifth years of participation
in the Program'' and inserting ``the total amount of principle and
interest owed by the participant on loans referred to in subsection
(a)''.
(b) Notice to Potential Employees of Eligibility and Selection for
Participation.--Section 7682 of such title is amended by adding at the
end the following new subsection:
``(d) Notice to Potential Employees.--In each offer of employment
made by the Secretary to an individual who, upon acceptance of such
offer would be treated as eligible to participate in the Education Debt
Reduction Program, the Secretary shall, to the maximum extent
practicable, include the following:
``(1) A notice that the individual will be treated as
eligible to participate in the Education Debt Reduction Program
upon the individual's acceptance of such offer.
``(2) A notice of the determination of the Secretary
whether or not the individual will be selected as a participant
in the Education Debt Reduction Program as of the individual's
acceptance of such offer.''.
(c) Selection of Employees Who Receive Notice of Selection With
Employment Offer.--Section 7683 of such title is further amended by
adding at the end the following new subsection:
``(e) Selection of Participants.--(1) The Secretary shall select
for participation in the Education Debt Reduction Program each
individual eligible for participation in the Education Debt Reduction
Program who--
``(A) the Secretary provided notice with an offer of
employment under section 7682(d) of this title that indicated
the individual would, upon the individual's acceptance of such
offer of employment, be--
``(i) eligible to participate in the Education Debt
Reduction Program; and
``(ii) selected to participate in the Education
Debt Reduction Program; and
``(B) accepts such offer of employment.
``(2) The Secretary may select for participation in the Education
Debt Reduction Program an individual eligible for participation in the
Education Debt Reduction Program who is not described by subparagraphs
(A) and (B) of paragraph (1).''.
SEC. 3. INCLUSION OF DEPARTMENT OF VETERANS AFFAIRS FACILITIES IN LIST
OF FACILITIES ELIGIBLE FOR ASSIGNMENT OF PARTICIPANTS IN
NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP PROGRAM.
The Secretary of Veterans Affairs shall transfer $20,000,000 from
accounts of the Veterans Health Administration to the Secretary of
Health and Human Services to include facilities of the Department of
Veterans Affairs in the list maintained by the Health Resources and
Services Administration of facilities eligible for assignment of
participants in the National Health Service Corps Scholarship Program.
SEC. 4. OFFICE OF RURAL HEALTH FIVE-YEAR STRATEGIC PLAN.
(a) Strategic Plan.--Not later than 180 days after the date of the
enactment of this Act, the Director of the Office of Rural Health of
the Department of Veterans Affairs shall develop a five-year strategic
plan for the Office of Rural Health.
(b) Contents.--The plan required by subsection (a) shall include
the following:
(1) Specific goals for the recruitment and retention of
health care personnel in rural areas, developed in conjunction
with the Director of the Health Care Retention and Recruitment
Office of the Department of Veterans Affairs.
(2) Specific goals for ensuring the timeliness and quality
of health care delivery in rural communities that are reliant
on contract and fee basis care, developed in conjunction with
the Director of the Office of Quality and Performance of the
Department.
(3) Specific goals for the expansion and implementation of
telemedicine services in rural areas, developed in conjunction
with the Director of the Office of Care Coordination Services
of the Department.
(4) Incremental milestones describing specific actions to
be taken for the purpose of achieving the goals specified under
paragraphs (1) through (3).
SEC. 5. ENHANCEMENT OF VET CENTERS TO MEET NEEDS OF VETERANS OF
OPERATION IRAQI FREEDOM AND OPERATION ENDURING FREEDOM.
(a) Volunteer Counselors.--Subsection (c) of section 1712A of title
38, United States Code, is amended--
(1) by striking ``The Under Secretary'' and inserting ``(1)
The Under Secretary'';
(2) in paragraph (1), as designated by paragraph (1), by
striking ``, and, in carrying'' and all that follows through
``screening activities''; and
(3) by adding at the end the following new paragraphs:
``(2) In carrying out this section, the Under Secretary may utilize
the services of the following:
``(A) Paraprofessionals, individuals who are volunteers
working without compensation, and individuals who are veteran-
students (as described in section 3485 of this title) in
initial intake and screening activities.
``(B) Eligible volunteer counselors in the provision of
counseling and related mental health services.
``(3) For purposes of this subsection, an eligible volunteer
counselor is an individual--
``(A) who--
``(i) provides counseling services without
compensation at a center;
``(ii) is a licensed psychologist or social worker;
``(iii) has never been named in a malpractice
action; and
``(iv) has never had, and has no pending,
disciplinary action taken with respect to any license
of the individual in any State; or
``(B) who is otherwise credentialed and privileged to
perform counseling services by the Secretary.
``(4) Not later than one year after the date of the enactment of
the Rural Veterans Health Care Access and Quality Act of 2009, the
Secretary shall establish expedited credentialing and privileging
procedures for eligible volunteer counselors for the provision of
counseling and related mental health services under this section.
``(5) For each application received by the Secretary for
credentialing and privileging of an eligible volunteer counselor under
this subsection, the Secretary shall complete the credentialing and
privileging process for such volunteer not later than 60 days after
receiving such application.''.
(b) Outreach.--Subsection (e) of such section is amended--
(1) by striking ``The Secretary'' and inserting ``(1) The
Secretary''; and
(2) by adding at the end the following new paragraph:
``(2) Each center shall develop an outreach plan to ensure that the
community served by the center is aware of the services offered by the
center.''.
SEC. 6. TELECONSULTATION AND TELEMEDICINE.
(a) Teleconsultation and Teleretinal Imaging.--
(1) In general.--Subchapter I of chapter 17 of title 38,
United States Code, is amended by adding at the end the
following new section:
``Sec. 1709. Teleconsultation and teleretinal imaging
``(a) Teleconsultation.--(1) The Secretary shall carry out a
program of teleconsultation for the provision of remote mental health
and traumatic brain injury assessments in facilities of the Department
that are not otherwise able to provide such assessments without
contracting with third party providers or reimbursing providers through
a fee basis system.
``(2) The Secretary shall, in consultation with appropriate
professional societies, promulgate technical and clinical care
standards for the use of teleconsultation services within facilities of
the Department.
``(b) Teleretinal Imaging.--(1) The Secretary shall carry out a
program of teleretinal imaging in each Veterans Integrated Services
Network (VISN).
``(2) In each fiscal year beginning with fiscal year 2010 and
ending with fiscal year 2015, the Secretary shall increase the number
of patients enrolled in each teleretinal imaging program under
paragraph (1) by not less than five percent from the number of patients
enrolled in each respective program in the previous fiscal year.
``(c) Definitions.--In this section:
``(1) The term `teleconsultation' means the use by a health
care specialist of telecommunications to assist another health
care provider in rendering a diagnosis or treatment.
``(2) The term `teleretinal imaging' means the use by a
health care specialist of telecommunications, digital retinal
imaging, and remote image interpretation to provide eye
care.''.
(2) Clerical amendment.--The table of sections at the
beginning of chapter 17 of such title is amended by inserting
after the item related to section 1708 the following new item:
``1709. Teleconsultation and teleretinal imaging.''.
(b) Training in Telemedicine.--The Secretary of Veterans Affairs
shall require each Department of Veterans Affairs facility that is
involved in the training of medical residents to work with each
university concerned to develop an elective rotation in telemedicine
for such residents.
(c) Enhancement of VERA.--
(1) Incentives for provision of teleconsultation,
teleretinal imaging, telemedicine, and telehealth services.--
The Secretary of Veterans Affairs shall modify the Veterans
Equitable Resource Allocation system to provide incentives for
the utilization of teleconsultation, teleretinal imaging,
telemedicine, and telehealth coordination services.
(2) Inclusion of telemedicine visits in workload
reporting.--The Secretary shall modify the Veterans Equitable
Resource Allocation system to require the inclusion of all
telemedicine visits in the calculation of facility workload.
(d) Definitions.--In this section:
(1) The terms ``teleconsultation'' and ``teleretinal
imaging'' have the meanings given such terms in section 1720G
of title 38, United States Code, as added by subsection (a).
(2) The term ``telemedicine'' means the use by a health
care provider of telecommunications to assist in the diagnosis
or treatment of a patient's medical condition.
(3) The term ``telehealth'' means the use of
telecommunications to collect patient data remotely and send
data to a monitoring station for interpretation.
SEC. 7. OVERSIGHT OF CONTRACT AND FEE BASIS CARE.
(a) In General.--Subchapter I of chapter 17 of title 38, United
States Code, is amended by inserting after section 1703 the following
new section:
``Sec. 1703A. Oversight of contract and fee basis care
``(a) Consolidation of Community Based Outpatient Clinic
Contracting.--For each Veterans Integrated Services Network (VISN), the
Secretary shall, acting through the Under Secretary for Health and to
the maximum extent practicable, negotiate with each party that has
contracts to provide services at more than one community based
outpatient clinic in such Network to consolidate such contracts.
``(b) Rural Outreach Coordinators.--The Secretary shall designate a
rural outreach coordinator at each Department community based
outpatient clinic at which not less than 50 percent of the veterans
enrolled at such clinic reside in a highly rural area. The coordinator
at a clinic shall be responsible for coordinating care and
collaborating with community contract and fee basis providers with
respect to the clinic.
``(c) Incentives To Obtain Accreditation of Medical Practice.--(1)
The Secretary shall adjust the fee basis compensation of providers of
health care services under the Department to encourage such providers
to obtain accreditation of their medical practice from recognized
accrediting entities.
``(2) In making adjustments under paragraph (1), the Secretary
shall consider the increased overhead costs of accreditation described
in paragraph (1) and the costs of achieving and maintaining such
accreditation.
``(d) Incentives for Participation in Peer Review.--(1) The
Secretary shall adjust the fee basis compensation of providers of
health care services under the Department that do not provide such
services as part of a medical practice accredited by a recognized
accrediting entity to encourage such providers to participate in peer
review under subsection (e).
``(2) The Secretary shall provide incentives under paragraph (1) to
a provider of health care services under the Department in an amount
equal to the amount the Secretary would provide to such provider under
subsection (c) if such provider provided such services as part of a
medical practice accredited by a recognized accrediting entity.
``(e) Peer Review.--(1) The Secretary shall provide for the
voluntary peer review of providers of health care services under the
Department who provide such services on a fee basis as part of a
medical practice that is not accredited by a recognized accrediting
entity.
``(2) Each year, beginning with the first fiscal year beginning
after the date of the enactment of this section, the Chief Quality and
Performance Officer in each Veterans Integrated Services Network (VISN)
shall select a sample of patient records from each participating
provider in the Officer's Veterans Integrated Services Network to be
peer reviewed by a facility designated under paragraph (3).
``(3) The Chief Quality and Performance Officer in each Veterans
Integrated Services Network shall designate Department facilities in
such network for the peer review of patient records submitted under
this subsection.
``(4) Each year, beginning with the first fiscal year beginning
after the date of the enactment of this section, each provider who
elects to participate in the program shall submit the patient records
selected under paragraph (2) to a facility selected under paragraph (3)
to be peer reviewed by such facility.
``(5) Each Department facility designated under paragraph (3) that
receives patient records under paragraph (4) shall--
``(A) peer review such records in accordance with policies
and procedures established by the Secretary;
``(B) ensure that peer reviews are evaluated by the Peer
Review Committee; and
``(C) develop a mechanism for notifying the Under Secretary
for Health of problems identified through such peer review.
``(6) The Under Secretary for Health shall develop a mechanism by
which the use of fee basis providers of health care are terminated when
quality of care concerns are identified.
``(7) The Chief Quality and Performance Officer in each Veterans
Integrated Services Network shall be responsible for the oversight of
the program in that network.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 17 of such title is amended by inserting after the item related
to section 1703 the following new item:
``1703A. Oversight of contract and fee basis care.''.
SEC. 8. TRAVEL BENEFITS FOR BENEFICIARIES IN REMOTE LOCATIONS.
(a) Coverage of Cost of Transportation by Air.--
(1) In general.--Subsection (a) of section 111 of title 38,
United States Code, is amended by inserting after the first
sentence the following new sentence: ``Actual necessary expense
of travel includes the reasonable costs of airfare if travel by
air is the only practical way to reach a Department
facility.''.
(2) Elimination of limitation based on maximum annual rate
of pension.--Subsection (b)(1)(D)(i) of such section is amended
by inserting ``who is not traveling by air and'' before ``whose
annual''.
(3) Determination of practicality.--Subsection (b) of such
section is amended by adding at the end the following new
paragraph:
``(4) In determining for purposes of subsection (a) whether travel
by air is the only practical way for a veteran to reach a Department
facility, the Secretary shall consider the medical condition of the
veteran and any other impediments to the use of ground transportation
by the veteran.''.
(b) Mileage Reimbursement Rate for Travel by Air.--Subsection
(g)(1) of such section is amended by inserting after ``is available)''
the following: ``or the mileage reimbursement rate for airplanes if
travel by airplane is the only practical method of travel''.
SEC. 9. PILOT PROGRAM ON INCENTIVES FOR PHYSICIANS WHO ASSUME INPATIENT
RESPONSIBILITIES AT COMMUNITY HOSPITALS IN HEALTH
PROFESSIONAL SHORTAGE AREAS.
(a) Pilot Program Required.--The Secretary of Veterans Affairs
shall carry out a pilot program to assess the feasability and
advisability of each of the following:
(1) The provision of financial incentives to eligible
physicians who obtain and maintain inpatient privileges at
community hospitals in health professional shortage areas in
order to facilitate the provision by such physicians of primary
care and mental health services to veterans at such hospitals.
(2) The collection of payments from third-party providers
for care provided by eligible physicians to non-veterans while
discharging inpatient responsibilities at community hospitals
in the course of exercising the privileges described in
paragraph (1).
(b) Eligible Physicians.--For purposes of this section, an eligible
physician is a primary care or mental health physician employed by the
Department of Veterans Affairs on a full-time basis.
(c) Duration of Program.--The pilot program shall be carried out
during the three-year period beginning on the date of the commencement
of the pilot program.
(d) Locations.--
(1) In general.--The pilot program shall be carried out at
not less than five community hospitals in each of not less than
two Veterans Integrated Services Networks (VISNs). The
hospitals shall be selected by the Secretary utilizing the
results of the survey required under subsection (e).
(2) Qualifying community hospitals.--A community hospital
may be selected by the Secretary as a location for the pilot
program if--
(A) the hospital is located in a health
professional shortage area; and
(B) the number of eligible physicians willing to
assume inpatient responsibilities at the hospital (as
determined utilizing the result of the survey) is
sufficient for purposes of the pilot program.
(e) Survey of Physician Interest in Participation.--
(1) In general.--Not later than 120 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall conduct a survey of eligible physicians to determine the
extent of the interest of such physicians in participating in
the pilot program.
(2) Elements.--The survey shall disclose the type, amount,
and nature of the financial incentives to be provided under
subsection (h) to physicians participating in the pilot
program.
(f) Physician Participation.--
(1) In general.--The Secretary shall select physicians for
participation in the pilot program from among eligible
physicians who--
(A) express interest in participating in the pilot
program in the survey conducted under subsection (e);
(B) are in good standing with the Department; and
(C) primarily have clinical responsibilities with
the Department.
(2) Voluntary participation.--Participation in the pilot
program shall be voluntary. Nothing in this section shall be
construed to require a physician working for the Department to
assume inpatient responsibilities at a community hospital
unless otherwise required as a term or condition of employment
with the Department.
(g) Assumption of Inpatient Physician Responsibilities.--
(1) In general.--Each eligible physician selected for
participation in the pilot program shall assume and maintain
inpatient responsibilities, including inpatient
responsibilities with respect to non-veterans, at one or more
community hospitals selected by the Secretary for participation
in the pilot program under subsection (d).
(2) Coverage under federal tort claims act.--If an eligible
physician participating in the pilot program carries out on-
call responsibilities at a community hospital where privileges
to practice at such hospital are conditioned upon the provision
of services to individuals who are not veterans while the
physician is on call for such hospital, the provision of such
services by the physician shall be considered an action within
the scope fo the physician's office or employment for purposes
of chapter 171 of title 28, United States Code (commonly
referred to as the ``Federal Tort Claims Act'').
(h) Compensation.--
(1) In general.--The Secretary shall provide each eligible
physician participating in the pilot program with such
compensation (including pay and other appropriate compensation)
as the Secretary considers appropriate to compensate such
physician for the discharge of any inpatient responsibilities
by such physician at a community hospital for which such
physician would not otherwise be compensated by the Department
as a full-time employee of the Department.
(2) Written agreement.--The amount of any compensation to
be provided a physician under the pilot program shall be
specified in a written agreement entered into by the Secretary
and the physician for purposes of the pilot program.
(3) Treatment of compensation.--The Secretary shall consult
with the Director of the Office of Personnel Management on the
inclusion of a provision in the written agreement required
under paragraph (2) that describes the treatment under Federal
law of any compensation provided a physician under the pilot
program, including treatment for purposes of retirement under
the civil service laws.
(i) Collections From Third Parties.--In carrying out the pilot
program for the purpose described in subsection (a)(2), the Secretary
shall implement a variety and range of requirements and mechanisms for
the collection from third-party payors of amounts to reimburse the
Department for health care services provided to non-veterans under the
pilot program by eligible physicians discharging inpatient
responsibilities under the pilot program.
(j) Inpatient Responsibilities Defined.--In this section, the term
``inpatient responsibilities'' means on-call responsibilities
customarily required of a physician by community hospital as a
condition of granting privileges to the physician to practice in the
hospital.
(k) Report.--Not later than one year after the date of the
enactment of this Act and annually thereafter, the Secretary shall
submit to Congress a report on the pilot program, including the
following:
(1) The findings of the Secretary with respect to the pilot
program.
(2) The number of veterans and non-veterans provided
inpatient care by physicians participating in the pilot
program.
(3) The amounts collected and payable under subsection (i).
(l) Health Professional Shortage Area Defined.--In this section,
the term ``health professional shortage area'' has the meaning given
the term in section 332(a) of the Public Health Service Act (42 U.S.C.
254e(a)).
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