[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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