1.This Act may be cited as the
Rural Veterans Health Care Access and
Quality Act of 2009
.
2.Enhancement of
Department of Veterans Affairs Education Debt Reduction Program
(a)Enhanced
maximum annual amountParagraph (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
participationSection 7682 of such title is amended by adding at
the end the following new subsection:
(d)Notice to
potential employeesIn 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
offerSection 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).
.
3.Inclusion of
Department of Veterans Affairs facilities in list of facilities eligible for
assignment of participants in National Health Service Corps Scholarship
ProgramThe 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.
4.Office of Rural
Health five-year strategic plan
(a)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)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).
5.Enhancement of
Vet Centers to meet needs of veterans of Operation Iraqi Freedom and Operation
Enduring Freedom
(a)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)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.
.
6.Teleconsultation
and telemedicine
(a)Teleconsultation
and teleretinal imaging
(1)Subchapter I of chapter 17 of title 38, United States
Code, is amended by adding at the end the following new section:
1709.Teleconsultation
and teleretinal imaging
(a)(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)(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)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)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)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)
(1)Incentives for
provision of teleconsultation, teleretinal imaging, telemedicine, and
telehealth servicesThe 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 reportingThe Secretary shall
modify the Veterans Equitable Resource Allocation system to require the
inclusion of all telemedicine visits in the calculation of facility
workload.
(d)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.
7.Oversight of
contract and fee basis care
(a)Subchapter I of
chapter 17 of title 38, United States Code, is amended by inserting after
section 1703 the following new section:
1703A.Oversight of
contract and fee basis care
(a)Consolidation
of community based outpatient clinic contractingFor 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
coordinatorsThe 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)(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)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.
.
8.Travel benefits
for beneficiaries in remote locations
(a)Coverage of
cost of transportation by air
(1)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 pensionSubsection
(b)(1)(D)(i) of such section is amended by inserting who is not
traveling by air and
before whose annual
.
(3)Determination
of practicalitySubsection (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 airSubsection (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
.
9.Pilot program on
incentives for physicians who assume inpatient responsibilities at community
hospitals in health professional shortage areas
(a)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)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)The pilot program shall be carried out during the
three-year period beginning on the date of the commencement of the pilot
program.
(d)
(1)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 hospitalsA 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)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)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)
(1)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)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)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 ActIf 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)
(1)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)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
compensationThe 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 partiesIn 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 definedIn 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)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 definedIn 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)).