[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 801 Reported in Senate (RS)]

                                                       Calendar No. 167
111th CONGRESS
  1st Session
                                 S. 801

                          [Report No. 111-80]

      To amend title 38, United States Code, to waive charges for 
  humanitarian care provided by the Department of Veterans Affairs to 
 family members accompanying veterans severely injured after September 
   11, 2001, as they receive medical care from the Department and to 
    provide assistance to family caregivers, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 2, 2009

     Mr. Akaka (for himself, Mr. Burr, Mr. Tester, Mr. Burris, Mr. 
 Rockefeller, Mr. Brown, Mr. Begich, Ms. Snowe, Mrs. Murray, Mr. Reed, 
 Mr. Specter, Ms. Murkowski, Mr. Johanns, Mrs. McCaskill, Mr. Merkley, 
Mr. Thune, Mr. Cardin, Mr. Johnson, Mrs. Hagan, Mr. Casey, Mr. Bennet, 
Mr. Udall of New Mexico, Mr. Durbin, Mrs. Hutchison, and Mr. Grassley) 
introduced the following bill; which was read twice and referred to the 
                     Committee on Veterans' Affairs

                           September 25, 2009

 Reported by Mr. Akaka, with an amendment and an amendment to the title
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL


 
      To amend title 38, United States Code, to waive charges for 
  humanitarian care provided by the Department of Veterans Affairs to 
 family members accompanying veterans severely injured after September 
   11, 2001, as they receive medical care from the Department and to 
    provide assistance to family caregivers, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``Caregiver and Veterans 
Health Services Act of 2009''.</DELETED>

<DELETED>SEC. 2. WAIVER OF CHARGES FOR HUMANITARIAN CARE PROVIDED TO 
              FAMILY MEMBERS ACCOMPANYING CERTAIN SEVERELY INJURED 
              VETERANS AS THEY RECEIVE MEDICAL CARE.</DELETED>

<DELETED>    The text of section 1784 of title 38, United States Code, 
is amended to read as follows:</DELETED>
<DELETED>    ``(a) In General.--The Secretary may furnish hospital care 
or medical services as a humanitarian service in emergency 
cases.</DELETED>
<DELETED>    ``(b) Reimbursement.--Except as provided in subsection 
(c), the Secretary shall charge for care and services provided under 
subsection (a) at rates prescribed by the Secretary.</DELETED>
<DELETED>    ``(c) Waiver of Charges.--(1) Except as provided in 
paragraph (2), the Secretary shall waive the charges required by 
subsection (b) for care or services provided under subsection (a) to an 
attendant of a covered veteran if such care or services are provided to 
such attendant for an emergency that occurs while such attendant is 
accompanying such veteran while such veteran is receiving approved 
inpatient or outpatient treatment at--</DELETED>
        <DELETED>    ``(A) a Department facility; or</DELETED>
        <DELETED>    ``(B) a non-Department facility--</DELETED>
                <DELETED>    ``(i) that is under contract with the 
                Department; or</DELETED>
                <DELETED>    ``(ii) at which the veteran is receiving 
                fee-basis care.</DELETED>
<DELETED>    ``(2) If an attendant is entitled to care or services 
under a health-plan contract (as that term is defined in section 
1725(f) of this title) or other contractual or legal recourse against a 
third party that would, in part, extinguish liability by charges 
described by subsection (b), the amount of such charges waived under 
paragraph (1) shall be the amount by which such charges exceed the 
amount of such charges covered by the health-plan contract or other 
contractual or legal recourse against the third party.</DELETED>
<DELETED>    ``(d) Definitions.--In this section:</DELETED>
        <DELETED>    ``(1) The term `attendant' includes, with respect 
        to a veteran, the following:</DELETED>
                <DELETED>    ``(A) A family member of the 
                veteran.</DELETED>
                <DELETED>    ``(B) An individual eligible to receive 
                ongoing family caregiver assistance under section 
                1717A(e)(1) of this title for the provision of personal 
                care services to the veteran.</DELETED>
                <DELETED>    ``(C) Any other individual whom the 
                Secretary determines--</DELETED>
                        <DELETED>    ``(i) has a relationship with the 
                        veteran sufficient to demonstrate a close 
                        affinity with the veteran; and</DELETED>
                        <DELETED>    ``(ii) provides a significant 
                        portion of the veteran's care.</DELETED>
        <DELETED>    ``(2) The term `covered veteran' means any veteran 
        with a severe injury incurred or aggravated in the line of duty 
        in the active military, naval, or air service on or after 
        September 11, 2001.</DELETED>
        <DELETED>    ``(3) The term `family member' with respect to a 
        veteran, includes the following:</DELETED>
                <DELETED>    ``(A) The spouse of the veteran.</DELETED>
                <DELETED>    ``(B) The child of the veteran.</DELETED>
                <DELETED>    ``(C) A parent of the veteran.</DELETED>
                <DELETED>    ``(D) A sibling of the veteran.</DELETED>
                <DELETED>    ``(E) A cousin of the veteran.</DELETED>
                <DELETED>    ``(F) An aunt of the veteran.</DELETED>
                <DELETED>    ``(G) An uncle of the veteran.</DELETED>
                <DELETED>    ``(H) A grandparent of the 
                veteran.</DELETED>
                <DELETED>    ``(I) A grandchild of the 
                veteran.</DELETED>
                <DELETED>    ``(J) A stepparent of the 
                veteran.</DELETED>
                <DELETED>    ``(K) A stepchild of the 
                veteran.</DELETED>
                <DELETED>    ``(L) A stepsibling of the 
                veteran.</DELETED>
                <DELETED>    ``(M) A parent-in-law of the 
                veteran.</DELETED>
                <DELETED>    ``(N) A sister-in-law of the 
                veteran.</DELETED>
                <DELETED>    ``(O) A brother-in-law of the 
                veteran.</DELETED>
                <DELETED>    ``(P) A cousin of the spouse of the 
                veteran.</DELETED>
                <DELETED>    ``(Q) An aunt of the spouse of the 
                veteran.</DELETED>
                <DELETED>    ``(R) An uncle of the spouse of the 
                veteran.</DELETED>
                <DELETED>    ``(S) A grandparent of the spouse of the 
                veteran.</DELETED>
                <DELETED>    ``(T) A grandchild of the spouse of the 
                veteran.</DELETED>
                <DELETED>    ``(U) A stepparent of the spouse of the 
                veteran.</DELETED>
                <DELETED>    ``(V) A stepsibling of the spouse of the 
                veteran.</DELETED>
                <DELETED>    ``(W) Such other individuals as the 
                Secretary shall specify in regulations for purposes of 
                this section.</DELETED>
        <DELETED>    ``(4) The term `severe injury' means, in the case 
        of a covered veteran, any injury as follows:</DELETED>
                <DELETED>    ``(A) A physiological condition of the 
                veteran if the condition is a permanent or temporary 
                severely disabling disorder that compromises the 
                ability of the veteran to carry out one or more 
                independent activities of daily living.</DELETED>
                <DELETED>    ``(B) A psychological condition of the 
                veteran if the condition is rated at 30 or less on the 
                Global Assessment of Functioning (GAF) scale, as set 
                forth in the Diagnostic and Statistical Manual of 
                Mental Disorders, Fourth Edition Text Revision (DSM-IV-
                TR), or the most recent edition if different than the 
                Fourth Edition Text Revision, of the American 
                Psychiatric Association.</DELETED>
                <DELETED>    ``(C) An injury for which the veteran 
                needs supervision or protection based on symptoms or 
                residuals of neurological or other 
                impairment.</DELETED>
                <DELETED>    ``(D) Any other injury of the veteran that 
                is determined to be a severe injury in accordance with 
                regulations prescribed by the Secretary for purposes of 
                this section.''.</DELETED>

<DELETED>SEC. 3. FAMILY CAREGIVER ASSISTANCE.</DELETED>

<DELETED>    (a) Requirement.--</DELETED>
        <DELETED>    (1) In general.--Subchapter II of chapter 17 of 
        title 38, United States Code, is amended by inserting after 
        section 1717 the following new section:</DELETED>
<DELETED>``Sec. 1717A. Family caregiver assistance</DELETED>
<DELETED>    ``(a) In General.--(1) As part of home health services 
provided under section 1717 of this title, the Secretary shall, upon 
the joint application of an eligible veteran and a family member of 
such veteran (or other individual designated by such veteran), furnish 
to such family member (or designee) family caregiver assistance in 
accordance with this section. The purpose of providing family caregiver 
assistance under this section is--</DELETED>
        <DELETED>    ``(A) to reduce the number of veterans who are 
        receiving institutional care, or who are in need of 
        institutional care, whose personal care service needs could be 
        substantially satisfied with the provision of such services by 
        a family member (or designee); and</DELETED>
        <DELETED>    ``(B) to provide eligible veterans with additional 
        options so that they can choose the setting for the receipt of 
        personal care services that best suits their needs.</DELETED>
<DELETED>    ``(2) The Secretary shall only furnish family caregiver 
assistance under this section to a family member of an eligible veteran 
(or other individual designated by such veteran) if the Secretary 
determines it is in the best interest of the eligible veteran to do 
so.</DELETED>
<DELETED>    ``(b) Eligible Veterans.--(1) For purposes of this 
section, an eligible veteran is a veteran (or member of the Armed 
Forces undergoing medical discharge from the Armed Forces)--</DELETED>
        <DELETED>    ``(A) who has a serious injury (including 
        traumatic brain injury, psychological trauma, or other mental 
        disorder) incurred or aggravated in line of duty in the active 
        military, naval, or air service on or after the date described 
        in paragraph (2); and</DELETED>
        <DELETED>    ``(B) whom the Secretary determines, in 
        consultation with the Secretary of Defense as necessary, is in 
        need of personal care services because of--</DELETED>
                <DELETED>    ``(i) an inability to perform one or more 
                independent activities of daily living;</DELETED>
                <DELETED>    ``(ii) a need for supervision or 
                protection based on symptoms or residuals of 
                neurological or other impairment or injury; 
                or</DELETED>
                <DELETED>    ``(iii) such other matters as the 
                Secretary shall establish in consultation with the 
                Secretary of Defense as appropriate.</DELETED>
<DELETED>    ``(2) The date described in this paragraph--</DELETED>
        <DELETED>    ``(A) during the period beginning on the date of 
        the enactment of the Caregiver and Veterans Health Services Act 
        of 2009 and ending two years after the date of the enactment of 
        that Act, is September 11, 2001; and</DELETED>
        <DELETED>    ``(B) beginning on the first day after the date 
        that is two years after the date of the enactment of the 
        Caregiver and Veterans Health Services Act of 2009, is the 
        earliest date the Secretary determines is appropriate to 
        include the largest number of veterans possible under this 
        section without reducing the quality of care provided to such 
        veterans.</DELETED>
<DELETED>    ``(c) Evaluation of Eligible Veterans and Family 
Caregivers.--(1) The Secretary shall evaluate each eligible veteran who 
makes a joint application under subsection (a)(1)--</DELETED>
        <DELETED>    ``(A) to identify the personal care services 
        required by such veteran; and</DELETED>
        <DELETED>    ``(B) to determine whether such requirements could 
        be significantly or substantially satisfied with the provision 
        of personal care services from a family member (or other 
        individual designated by the veteran).</DELETED>
<DELETED>    ``(2) The Secretary shall evaluate each family member of 
an eligible veteran (or other individual designated by the veteran) who 
makes a joint application under subsection (a)(1) to determine--
</DELETED>
        <DELETED>    ``(A) the basic amount of instruction, 
        preparation, and training such family member (or designee) 
        requires, if any, to provide the personal care services 
        required by such veteran; and</DELETED>
        <DELETED>    ``(B) the amount of additional instruction, 
        preparation, and training such family member (or designee) 
        requires, if any, to be the primary personal care attendant 
        designated for such veteran under subsection (e).</DELETED>
<DELETED>    ``(3) An evaluation carried out under paragraph (1) may be 
carried out--</DELETED>
        <DELETED>    ``(A) at a Department facility;</DELETED>
        <DELETED>    ``(B) at a non-Department facility determined 
        appropriate by the Secretary for purposes of such evaluation; 
        and</DELETED>
        <DELETED>    ``(C) such other locations as the Secretary 
        considers appropriate.</DELETED>
<DELETED>    ``(d) Training and Certification.--(1) Except as provided 
in subsection (a)(2), the Secretary shall provide each family member of 
an eligible veteran (or other individual designated by the veteran) who 
makes a joint application under subsection (a)(1) the basic 
instruction, preparation, and training determined to be required by 
such family member (or designee) under subsection (c)(2)(A).</DELETED>
<DELETED>    ``(2) The Secretary may provide to a family member of an 
eligible veteran (or other individual designated by the veteran) the 
additional instruction, preparation, and training determined to be 
required by such family member (or designee) under subsection (c)(2)(B) 
if such family member (or designee)--</DELETED>
        <DELETED>    ``(A) is certified as a personal care attendant 
        for the veteran under paragraph (3); and</DELETED>
        <DELETED>    ``(B) requests, with concurrence of the veteran, 
        such additional instruction, preparation, and 
        training.</DELETED>
<DELETED>    ``(3) Upon the successful completion by a family member of 
an eligible veteran (or other individual designated by the veteran) of 
basic instruction, preparation, and training provided under paragraph 
(1), the Secretary shall certify the family member as a personal care 
attendant for the veteran.</DELETED>
<DELETED>    ``(4) If the Secretary determines that a primary personal 
care attendant designated under subsection (e) requires additional 
training to maintain such designation, the Secretary shall make such 
training available to the primary personal care attendant.</DELETED>
<DELETED>    ``(5) The Secretary shall, subject to regulations the 
Secretary shall prescribe, provide for necessary travel, lodging, and 
per diem expenses incurred by a family member of an eligible veteran 
(or other individual designated by the veteran) in undergoing training 
under this subsection.</DELETED>
<DELETED>    ``(6) If the participation of a family member of an 
eligible veteran (or other individual designated by the veteran) in 
training under this subsection would interfere with the provision of 
personal care services to the veteran, the Secretary shall, subject to 
regulations as the Secretary shall prescribe and in consultation with 
the eligible veteran, provide respite care to the eligible veteran 
during the provision of such training to the family member so that such 
family caregiver (or designee) can participate in such training without 
interfering with the provision of such services.</DELETED>
<DELETED>    ``(e) Designation of Primary Personal Care Attendant.--(1) 
For each eligible veteran with at least one family member (or other 
individual designated by the veteran) who is described by subparagraphs 
(A) through (E) of paragraph (2), the Secretary shall designate one 
family member of such veteran (or other individual designated by the 
veteran) as the primary personal care attendant for such veteran to be 
the primary provider of personal care services for such 
veteran.</DELETED>
<DELETED>    ``(2) A primary personal care attendant designated for an 
eligible veteran under paragraph (1) shall be selected from among 
family members of such veteran (or other individuals designated by such 
veteran) who--</DELETED>
        <DELETED>    ``(A) are certified under subsection (d)(3) as a 
        personal care attendant for such veteran;</DELETED>
        <DELETED>    ``(B) complete all additional instruction, 
        preparation, and training, if any, provided under subsection 
        (d)(2);</DELETED>
        <DELETED>    ``(C) elect to provide the personal care services 
        to such veteran that the Secretary determines such veteran 
        requires under subsection (c)(1);</DELETED>
        <DELETED>    ``(D) has the consent of such veteran to be the 
        primary provider of such services for such veteran; 
        and</DELETED>
        <DELETED>    ``(E) the Secretary considers competent to be the 
        primary provider of such services for such veteran.</DELETED>
<DELETED>    ``(3) An eligible veteran receiving personal care services 
from a family member (or other individual designated by the veteran) 
designated as the primary personal care attendant for the veteran under 
paragraph (1) may revoke consent with respect to such family member (or 
designee) under paragraph (2)(D) at any time.</DELETED>
<DELETED>    ``(4) If an individual designated as the primary personal 
care attendant of an eligible veteran under paragraph (1) subsequently 
fails to meet the requirements set forth in paragraph (2), the 
Secretary--</DELETED>
        <DELETED>    ``(A) shall immediately revoke the individual's 
        designation under paragraph (1); and</DELETED>
        <DELETED>    ``(B) may designate, in consultation with the 
        eligible veteran or the eligible veteran's surrogate appointed 
        under subsection (g), a new primary personal care attendant for 
        the veteran under such paragraph.</DELETED>
<DELETED>    ``(5) The Secretary shall take such actions as may be 
necessary to ensure that the revocation of a designation under 
paragraph (1) does not interfere with the provision of personal care 
services required by a veteran.</DELETED>
<DELETED>    ``(f) Ongoing Family Caregiver Assistance.--(1) Except as 
provided in subsection (a)(2) and subject to the provisions of this 
subsection, the Secretary shall provide ongoing family caregiver 
assistance to family members of eligible veterans (or other individuals 
designated by such veterans) as follows:</DELETED>
        <DELETED>    ``(A) To each family member of an eligible veteran 
        (or designee) who is certified under subsection (d)(3) as a 
        personal care attendant for the veteran the 
        following:</DELETED>
                <DELETED>    ``(i) Direct technical support consisting 
                of information and assistance to timely address 
                routine, emergency, and specialized caregiving 
                needs.</DELETED>
                <DELETED>    ``(ii) Counseling.</DELETED>
                <DELETED>    ``(iii) Access to an interactive Internet 
                website on caregiver services that addresses all 
                aspects of the provision of personal care services 
                under this section.</DELETED>
        <DELETED>    ``(B) To each family member of an eligible veteran 
        (or designee) who is designated as the primary personal care 
        attendant for the veteran under subsection (e) the 
        following:</DELETED>
                <DELETED>    ``(i) The ongoing family caregiver 
                assistance described in subparagraph (A).</DELETED>
                <DELETED>    ``(ii) Mental health services.</DELETED>
                <DELETED>    ``(iii) Respite care of not less than 30 
                days annually, including 24-hour per day care of the 
                veteran commensurate with the care provided by the 
                family caregiver to permit extended respite.</DELETED>
                <DELETED>    ``(iv) Medical care under section 1781 of 
                this title.</DELETED>
                <DELETED>    ``(v) A monthly personal caregiver 
                stipend.</DELETED>
<DELETED>    ``(2)(A) The Secretary shall provide respite care under 
paragraph (1)(B)(iii), at the election of the Secretary--</DELETED>
        <DELETED>    ``(i) through facilities of the Department that 
        are appropriate for the veteran; or</DELETED>
        <DELETED>    ``(ii) through contracts under section 1720B(c) of 
        this title.</DELETED>
<DELETED>    ``(B) If the primary personal care attendant of an 
eligible veteran designated under subsection (e)(1) determines in 
consultation with the veteran or the veteran's surrogate appointed 
under subsection (g), and the Secretary concurs, that the needs of the 
veteran cannot be accommodated through the facilities and contracts 
described in subparagraph (A), the Secretary shall, in consultation 
with the primary personal care attendant and the veteran (or the 
veteran's surrogate), provide respite care through other facilities or 
arrangements that are medically and age appropriate.</DELETED>
<DELETED>    ``(3)(A) The Secretary shall provide monthly personal 
caregiver stipends under paragraph (1)(B)(v) in accordance with a 
schedule established by the Secretary that specifies stipends provided 
based upon the amount and degree of personal care services 
provided.</DELETED>
<DELETED>    ``(B) The Secretary shall ensure, to the extent 
practicable, that the schedule required by subparagraph (A) specifies 
that the amount of the personal caregiver stipend provided to a primary 
personal care attendant designated under subsection (e)(1) for the 
provision of personal care services to an eligible veteran is not less 
than the amount the Secretary would pay a commercial home health care 
entity in the geographic area of the veteran to provide equivalent 
personal care services to the veteran.</DELETED>
<DELETED>    ``(C) If personal care services are not available from a 
commercial provider in the geographic area of an eligible veteran, the 
Secretary may establish the schedule required by subparagraph (A) with 
respect to the veteran by considering the costs of commercial providers 
of personal care services in geographic areas other than the geographic 
area of the veteran with similar costs of living.</DELETED>
<DELETED>    ``(4) Provision of ongoing family caregiver assistance 
under this subsection for provision of personal care services to an 
eligible veteran shall terminate if the eligible veteran no longer 
requires the personal care services.</DELETED>
<DELETED>    ``(g) Surrogates.--If an eligible veteran lacks the 
capacity to submit an application, provide consent, make a request, or 
concur with a request under this section, the Secretary may, in 
accordance with regulations and policies of the Department regarding 
the appointment of guardians or the use of powers of attorney, appoint 
a surrogate for the veteran who may submit applications, provide 
consent, make requests, or concur with requests on behalf of the 
veteran under this section.</DELETED>
<DELETED>    ``(h) Oversight.--(1) The Secretary shall enter into 
contracts with appropriate entities to provide oversight of the 
provision of personal care services by primary personal care attendants 
designated under subsection (e)(1) under this section.</DELETED>
<DELETED>    ``(2) The Secretary shall ensure that each eligible 
veteran receiving personal care services under this section from a 
primary personal care attendant designated under subsection (e)(1) is 
visited in the veteran's home by an entity providing oversight under 
paragraph (1) at such frequency as the Secretary shall determine under 
paragraph (3) to determine if the care received by the veteran under 
this section meets the needs of the veteran.</DELETED>
<DELETED>    ``(3)(A) Except as provided in subparagraph (B), the 
Secretary shall determine the manner of oversight provided under 
paragraph (1) and the frequency of visits under paragraph (2) for an 
eligible veteran as the Secretary considers commensurate with the needs 
of such eligible veteran.</DELETED>
<DELETED>    ``(B) The frequency of visits under paragraph (2) for an 
eligible veteran shall be not less frequent than once every six 
months.</DELETED>
<DELETED>    ``(4)(A) An entity visiting an eligible veteran under 
paragraph (2) shall submit to the Secretary the findings of the entity 
with respect to each visit, including whether the eligible veteran is 
receiving the care the eligible veteran requires.</DELETED>
<DELETED>    ``(B) If an entity finds under subparagraph (A) that an 
eligible veteran is not receiving the care the eligible veteran 
requires, the entity shall submit to the Secretary a recommendation on 
the corrective actions that should be taken to ensure that the eligible 
veteran receives the care the eligible veteran requires, including, if 
the entity considers appropriate, a recommendation for revocation of a 
caregiver's certification under subsection (d)(3) or revocation of the 
designation of an individual under subsection (e)(1).</DELETED>
<DELETED>    ``(5) After receiving findings and recommendations, if 
any, under paragraph (4) with respect to an eligible veteran, the 
Secretary may take such actions as the Secretary considers appropriate 
to ensure that the eligible veteran receives the care the eligible 
veteran requires, including the following:</DELETED>
        <DELETED>    ``(A) Revocation of a caregiver's certification 
        under subsection (d)(3).</DELETED>
        <DELETED>    ``(B) Revocation of the designation of an 
        individual under subsection (e)(1).</DELETED>
<DELETED>    ``(6) If the Secretary terminates the provision of ongoing 
family caregiver assistance under subsection (f) to a family member of 
an eligible veteran (or other individual designated by the veteran) 
because of findings of an entity submitted to the Secretary under 
paragraph (4) of this subsection, the Secretary may not provide 
compensation to such entity for the provision of personal care services 
to such veteran, unless the Secretary determines it would be in the 
best interest of the eligible veteran to provide compensation to such 
entity to provide such services.</DELETED>
<DELETED>    ``(i) Outreach.--The Secretary shall carry out a program 
of outreach to inform eligible veterans and their family members of the 
availability and nature of family caregiver assistance.</DELETED>
<DELETED>    ``(j) Construction.--A decision by the Secretary under 
this section affecting the furnishing of family caregiver assistance 
shall be considered a medical determination.</DELETED>
<DELETED>    ``(k) Definitions.--In this section:</DELETED>
        <DELETED>    ``(1) The term `family caregiver assistance' 
        includes the instruction, preparation, training, and 
        certification provided under subsection (d) and the ongoing 
        family caregiver assistance provided under subsection 
        (f).</DELETED>
        <DELETED>    ``(2) The term `family member' includes, with 
        respect to a veteran, the following:</DELETED>
                <DELETED>    ``(A) The spouse of the veteran.</DELETED>
                <DELETED>    ``(B) The child of the veteran.</DELETED>
                <DELETED>    ``(C) A parent of the veteran.</DELETED>
                <DELETED>    ``(D) A sibling of the veteran.</DELETED>
                <DELETED>    ``(E) A cousin of the veteran.</DELETED>
                <DELETED>    ``(F) An aunt of the veteran.</DELETED>
                <DELETED>    ``(G) An uncle of the veteran.</DELETED>
                <DELETED>    ``(H) A grandparent of the 
                veteran.</DELETED>
                <DELETED>    ``(I) A grandchild of the 
                veteran.</DELETED>
                <DELETED>    ``(J) A stepparent of the 
                veteran.</DELETED>
                <DELETED>    ``(K) A stepchild of the 
                veteran.</DELETED>
                <DELETED>    ``(L) A stepsibling of the 
                veteran.</DELETED>
                <DELETED>    ``(M) A parent-in-law of the 
                veteran.</DELETED>
                <DELETED>    ``(N) A sister-in-law of the 
                veteran.</DELETED>
                <DELETED>    ``(O) A brother-in-law of the 
                veteran.</DELETED>
                <DELETED>    ``(P) A cousin of the spouse of the 
                veteran.</DELETED>
                <DELETED>    ``(Q) An aunt of the spouse of the 
                veteran.</DELETED>
                <DELETED>    ``(R) An uncle of the spouse of the 
                veteran.</DELETED>
                <DELETED>    ``(S) A grandparent of the spouse of the 
                veteran.</DELETED>
                <DELETED>    ``(T) A grandchild of the spouse of the 
                veteran.</DELETED>
                <DELETED>    ``(U) A stepparent of the spouse of the 
                veteran.</DELETED>
                <DELETED>    ``(V) A stepsibling of the spouse of the 
                veteran.</DELETED>
                <DELETED>    ``(W) Such other individuals as the 
                Secretary shall specify in regulations for purposes of 
                this section.</DELETED>
        <DELETED>    ``(3) The term `personal care services' includes 
        the following:</DELETED>
                <DELETED>    ``(A) Supervision.</DELETED>
                <DELETED>    ``(B) Protection.</DELETED>
                <DELETED>    ``(C) Services to assist a veteran with 
                one or more independent activities of daily 
                living.</DELETED>
                <DELETED>    ``(D) Such other services as the Secretary 
                considers appropriate.''.</DELETED>
        <DELETED>    (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 1717 the following 
        new item:</DELETED>

<DELETED>``1717A. Family caregiver assistance.''.
        <DELETED>    (3) Authorization for provision of health care to 
        personal care attendants.--Section 1781(a) of such title is 
        amended--</DELETED>
                <DELETED>    (A) by redesignating paragraphs (2) and 
                (3) as paragraphs (3) and (4), respectively; 
                and</DELETED>
                <DELETED>    (B) by inserting after paragraph (1) the 
                following new paragraph (2):</DELETED>
        <DELETED>    ``(2) a family member of a veteran (or other 
        individual designated by the veteran) designated as the primary 
        personal care attendant for such veteran under section 1717A(e) 
        of this title,''.</DELETED>
        <DELETED>    (4) Construction.--The furnishing of family 
        caregiver assistance under section 1717A of title 38, United 
        States Code, as added by paragraph (1), shall be construed to 
        supplement and not supplant the programs of the Department of 
        Veterans Affairs in existence on the date of the enactment of 
        this Act.</DELETED>
        <DELETED>    (5) Effective date.--The amendments made by this 
        subsection shall take effect on the date that is 270 days after 
        the date of the enactment of this Act.</DELETED>
<DELETED>    (b) Implementation Plan and Report.--</DELETED>
        <DELETED>    (1) In general.--Not later than 180 days after the 
        date of the enactment of this Act, the Secretary of Veterans 
        Affairs shall--</DELETED>
                <DELETED>    (A) develop a plan for the implementation 
                of section 1717A of title 38, United States Code, as 
                added by subsection (a)(1); and</DELETED>
                <DELETED>    (B) submit to the Committee on Veterans' 
                Affairs of the Senate and the Committee on Veterans' 
                Affairs of the House of Representatives a report on 
                such plan.</DELETED>
        <DELETED>    (2) Consultation.--In developing the plan required 
        by paragraph (1)(A), the Secretary shall consult with the 
        following:</DELETED>
                <DELETED>    (A) Veterans described in section 1717A(b) 
                of title 38, United States Code, as added by subsection 
                (a)(1).</DELETED>
                <DELETED>    (B) Family members of veterans who provide 
                personal care services to such veterans.</DELETED>
                <DELETED>    (C) Veterans service organizations, as 
                recognized by the Secretary of Veterans Affairs for the 
                representation of veterans under section 5902 of title 
                38, United States Code.</DELETED>
                <DELETED>    (D) Relevant national organizations that 
                specialize in the provision of assistance to 
                individuals with the types of disabilities that 
                personal care attendants will encounter while providing 
                personal care services under section 1717A of title 38, 
                United States Code, as so added.</DELETED>
                <DELETED>    (E) Such other organizations with an 
                interest in the provision of care to veterans as the 
                Secretary considers appropriate.</DELETED>
                <DELETED>    (F) The Secretary of Defense with respect 
                to matters concerning personal care services for 
                eligible veterans who are members of the Armed Forces 
                undergoing medical discharge from the Armed 
                Forces.</DELETED>
        <DELETED>    (3) Report contents.--The report required by 
        paragraph (1)(B) shall contain the following:</DELETED>
                <DELETED>    (A) The plan required by paragraph 
                (1)(A).</DELETED>
                <DELETED>    (B) A description of the veterans, 
                caregivers, and organizations consulted by the 
                Secretary under paragraph (2).</DELETED>
                <DELETED>    (C) A description of such 
                consultations.</DELETED>
                <DELETED>    (D) The recommendations of such veterans, 
                caregivers, and organizations, if any, that were not 
                incorporated into the plan required by paragraph 
                (1)(A).</DELETED>
                <DELETED>    (E) The reasons the Secretary did not 
                incorporate such recommendations into such 
                plan.</DELETED>
<DELETED>    (c) Annual Evaluation Report.--</DELETED>
        <DELETED>    (1) In general.--Not later than two years after 
        the date described in subsection (a)(4) and annually 
        thereafter, 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 comprehensive report 
        on the implementation of section 1717A of title 38, United 
        States Code, as added by subsection (a)(1).</DELETED>
        <DELETED>    (2) Contents.--The report required by paragraph 
        (1) shall include the following:</DELETED>
                <DELETED>    (A) The number of family members of 
                veterans (or other individuals designated by veterans) 
                that received family caregiver assistance under such 
                section 1717A.</DELETED>
                <DELETED>    (B) A description of the outreach 
                activities carried out by the Secretary in accordance 
                with subsection (i) of such section 1717A.</DELETED>
                <DELETED>    (C) The resources expended by the 
                Secretary under such section 1717A.</DELETED>
                <DELETED>    (D) An assessment of the manner in which 
                resources are expended by the Secretary under such 
                section 1717A, particularly with respect to the 
                provision of monthly personal caregiver stipends under 
                subsection (f) of such section.</DELETED>
                <DELETED>    (E) A description of the outcomes achieved 
                by, and any measurable benefits of, carrying out the 
                requirements of such section 1717A.</DELETED>
                <DELETED>    (F) A justification of any determination 
                made under subsection (b)(2) of such section 
                1717A.</DELETED>
                <DELETED>    (G) An assessment of the effectiveness and 
                the efficiency of the implementation of such section 
                1717A.</DELETED>
                <DELETED>    (H) An assessment of how the provision of 
                family caregiver assistance fits into the continuum of 
                home health care services and benefits provided to 
                veterans in need of such services and 
                benefits.</DELETED>
                <DELETED>    (I) Such recommendations, including 
                recommendations for legislative or administrative 
                action, as the Secretary considers appropriate in light 
                of carrying out the requirements of such section 
                1717A.</DELETED>

<DELETED>SEC. 4. LODGING AND SUBSISTENCE FOR ATTENDANTS.</DELETED>

<DELETED>    Section 111(e) of title 38, United States Code, is 
amended--</DELETED>
        <DELETED>    (1) by striking ``When any'' and inserting ``(1) 
        When any'';</DELETED>
        <DELETED>    (2) in paragraph (1), as designated by paragraph 
        (1) of this subsection--</DELETED>
                <DELETED>    (A) by inserting ``(including lodging and 
                subsistence)'' after ``expenses of travel''; 
                and</DELETED>
                <DELETED>    (B) by inserting before the period at the 
                end the following: ``for the period consisting of 
                travel to and from a treatment facility and the 
                duration of the treatment episode''; and</DELETED>
        <DELETED>    (3) by adding at the end the following:</DELETED>
<DELETED>    ``(2) The Secretary may prescribe regulations to carry out 
this subsection. Such regulations may include provisions--</DELETED>
        <DELETED>    ``(A) to limit the number of individuals that may 
        receive expenses of travel under paragraph (1) for a single 
        treatment episode of a person; and</DELETED>
        <DELETED>    ``(B) to require attendants to use certain travel 
        services.</DELETED>
<DELETED>    ``(3) In this subsection:</DELETED>
        <DELETED>    ``(A) The term `attendant' includes, with respect 
        to a person described in paragraph (1), the 
        following:</DELETED>
                <DELETED>    ``(i) A family member of the 
                person.</DELETED>
                <DELETED>    ``(ii) An individual certified as a 
                personal care attendant under section 1717A(d)(3) of 
                this title.</DELETED>
                <DELETED>    ``(iii) Any other individual whom the 
                Secretary determines--</DELETED>
                        <DELETED>    ``(I) has a preexisting 
                        relationship with the person; and</DELETED>
                        <DELETED>    ``(II) provides a significant 
                        portion of the person's care.</DELETED>
        <DELETED>    ``(B) The term `family member' includes, with 
        respect to a person described in paragraph (1), the 
        following:</DELETED>
                <DELETED>    ``(i) The spouse of the person.</DELETED>
                <DELETED>    ``(ii) The child of the person.</DELETED>
                <DELETED>    ``(iii) A parent of the person.</DELETED>
                <DELETED>    ``(iv) A sibling of the person.</DELETED>
                <DELETED>    ``(v) A cousin of the person.</DELETED>
                <DELETED>    ``(vi) An aunt of the person.</DELETED>
                <DELETED>    ``(vii) An uncle of the person.</DELETED>
                <DELETED>    ``(viii) A grandparent of the 
                person.</DELETED>
                <DELETED>    ``(ix) A grandchild of the 
                person.</DELETED>
                <DELETED>    ``(x) A stepparent of the 
                person.</DELETED>
                <DELETED>    ``(xi) A stepchild of the 
                person.</DELETED>
                <DELETED>    ``(xii) A stepsibling of the 
                person.</DELETED>
                <DELETED>    ``(xiii) A parent-in-law of the 
                person.</DELETED>
                <DELETED>    ``(xiv) A sister-in-law of the 
                person.</DELETED>
                <DELETED>    ``(xv) A brother-in-law of the 
                person.</DELETED>
                <DELETED>    ``(xvi) A cousin of the spouse of the 
                person.</DELETED>
                <DELETED>    ``(xvii) An aunt of the spouse of the 
                person.</DELETED>
                <DELETED>    ``(xviii) An uncle of the spouse of the 
                person.</DELETED>
                <DELETED>    ``(xix) A grandparent of the spouse of the 
                person.</DELETED>
                <DELETED>    ``(xx) A grandchild of the spouse of the 
                person.</DELETED>
                <DELETED>    ``(xxi) A stepparent of the spouse of the 
                person.</DELETED>
                <DELETED>    ``(xxii) A stepsibling of the spouse of 
                the person.</DELETED>
                <DELETED>    ``(xxiii) Such other individuals as the 
                Secretary shall specify in regulations for purposes of 
                this subsection.''.</DELETED>

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Caregiver and 
Veterans Health Services Act of 2009''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. References to title 38, United States Code.

                       TITLE I--CAREGIVER SUPPORT

Sec. 101. Waiver of charges for humanitarian care provided to family 
                            members accompanying certain severely 
                            injured veterans as they receive medical 
                            care.
Sec. 102. Family caregiver assistance.
Sec. 103. Lodging and subsistence for attendants.
Sec. 104. Survey of informal caregivers.

                  TITLE II--RURAL HEALTH IMPROVEMENTS

Sec. 201. Enhancement of Department of Veterans Affairs Education Debt 
                            Reduction Program.
Sec. 202. Visual impairment and orientation and mobility professionals 
                            education assistance program.
Sec. 203. Inclusion of Department of Veterans Affairs facilities in 
                            list of facilities eligible for assignment 
                            of participants in National Health Service 
                            Corps Scholarship Program.
Sec. 204. Teleconsultation and telemedicine.
Sec. 205. Demonstration projects on alternatives for expanding care for 
                            veterans in rural areas.
Sec. 206. Program on provision of readjustment and mental health care 
                            services to veterans who served in 
                            Operation Iraqi Freedom and Operation 
                            Enduring Freedom.
Sec. 207. Improvement of care of American Indian veterans.
Sec. 208. Travel reimbursement for veterans receiving treatment at 
                            facilities of the Department of Veterans 
                            Affairs.
Sec. 209. Office of Rural Health five-year strategic plan.
Sec. 210. Oversight of contract and fee-basis care.
Sec. 211. Enhancement of Vet Centers to meet needs of veterans of 
                            Operation Iraqi Freedom and Operation 
                            Enduring Freedom.
Sec. 212. Centers of excellence for rural health research, education, 
                            and clinical activities.
Sec. 213. Pilot program on incentives for physicians who assume 
                            inpatient responsibilities at community 
                            hospitals in health professional shortage 
                            areas.
Sec. 214. Annual report on matters related to care for veterans who 
                            live in rural areas.
Sec. 215. Transportation grants for rural veterans service 
                            organizations.

                  TITLE III--OTHER HEALTH CARE MATTERS

Sec. 301. Expansion of veteran eligibility for reimbursement by 
                            Secretary of Veterans Affairs for emergency 
                            treatment furnished in a non-Department 
                            facility.
Sec. 302. Prohibition on collection of copayments from veterans who are 
                            catastrophically disabled.

               TITLE IV--CONSTRUCTION AND NAMING MATTERS

Sec. 401. Major medical facility project Department of Veterans Affairs 
                            Medical Center, Walla Walla, Washington.
Sec. 402. Merril Lundman Department of Veterans Affairs Outpatient 
                            Clinic.

SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE.

    Except as otherwise expressly provided, whenever in this Act an 
amendment or repeal is expressed in terms of an amendment to, or repeal 
of, a section or other provision, the reference shall be considered to 
be made to a section or other provision of title 38, United States 
Code.

                       TITLE I--CAREGIVER SUPPORT

SEC. 101. WAIVER OF CHARGES FOR HUMANITARIAN CARE PROVIDED TO FAMILY 
              MEMBERS ACCOMPANYING CERTAIN SEVERELY INJURED VETERANS AS 
              THEY RECEIVE MEDICAL CARE.

    The text of section 1784 is amended to read as follows:
    ``(a) In General.--The Secretary may furnish hospital care or 
medical services as a humanitarian service in emergency cases.
    ``(b) Reimbursement.--Except as provided in subsection (c), the 
Secretary shall charge for care and services provided under subsection 
(a) at rates prescribed by the Secretary.
    ``(c) Waiver of Charges.--(1) Except as provided in paragraph (2), 
the Secretary shall waive the charges required by subsection (b) for 
care or services provided under subsection (a) to an attendant of a 
covered veteran if such care or services are provided to such attendant 
for an emergency that occurs while such attendant is accompanying such 
veteran while such veteran is receiving approved inpatient or 
outpatient treatment at--
            ``(A) a Department facility; or
            ``(B) a non-Department facility--
                    ``(i) that is under contract with the Department; 
                or
                    ``(ii) at which the veteran is receiving fee-basis 
                care.
    ``(2) If an attendant is entitled to care or services under a 
health-plan contract (as that term is defined in section 1725(f) of 
this title) or other contractual or legal recourse against a third 
party that would, in part, extinguish liability for charges described 
by subsection (b), the amount of such charges waived under paragraph 
(1) shall be the amount by which such charges exceed the amount of such 
charges covered by the health-plan contract or other contractual or 
legal recourse against the third party.
    ``(d) Definitions.--In this section:
            ``(1) The term `attendant', with respect to a veteran, 
        includes the following:
                    ``(A) A family member of the veteran.
                    ``(B) An individual eligible to receive ongoing 
                family caregiver assistance under section 1717A(e)(1) 
                of this title for the provision of personal care 
                services to the veteran.
                    ``(C) Any other individual whom the Secretary 
                determines--
                            ``(i) has a relationship with the veteran 
                        sufficient to demonstrate a close affinity with 
                        the veteran; and
                            ``(ii) provides a significant portion of 
                        the veteran's care.
            ``(2) The term `covered veteran' means any veteran with a 
        severe injury incurred or aggravated in the line of duty in the 
        active military, naval, or air service on or after September 
        11, 2001.
            ``(3) The term `family member' shall have such meaning as 
        the Secretary shall determine by policy or regulation.
            ``(4) The term `severe injury', in the case of a covered 
        veteran, means any physiological, psychological, or 
        neurological condition that renders a veteran unable to live 
        independently as determined by the Secretary.''.

SEC. 102. FAMILY CAREGIVER ASSISTANCE.

    (a) Requirement.--
            (1) In general.--Subchapter II of chapter 17 is amended by 
        inserting after section 1717 the following new section:
``Sec. 1717A. Family caregiver assistance
    ``(a) In General.--(1) As part of home health services provided 
under section 1717 of this title, the Secretary shall, upon the joint 
application of an eligible veteran and a family member of such veteran 
(or other individual designated by such veteran), furnish to such 
family member (or designee) family caregiver assistance in accordance 
with this section. The purpose of providing family caregiver assistance 
under this section is--
            ``(A) to reduce the number of veterans who are receiving 
        institutional care, or who are in need of institutional care, 
        whose personal care service needs could be substantially 
        satisfied with the provision of such services by a family 
        member (or designee); and
            ``(B) to provide eligible veterans with additional options 
        so that they can choose the setting for the receipt of personal 
        care services that best suits their needs.
    ``(2) The Secretary shall only furnish family caregiver assistance 
under this section to a family member of an eligible veteran (or other 
individual designated by such veteran) if the Secretary determines it 
is in the best interest of the eligible veteran to do so.
    ``(b) Eligible Veterans.--(1) For purposes of this section, an 
eligible veteran is a veteran (or member of the Armed Forces undergoing 
medical discharge from the Armed Forces)--
            ``(A) who has a serious injury (including traumatic brain 
        injury, psychological trauma, or other mental disorder) 
        incurred or aggravated in the line of duty in the active 
        military, naval, or air service on or after the date described 
        in paragraph (2); and
            ``(B) whom the Secretary determines, in consultation with 
        the Secretary of Defense as necessary, is in need of personal 
        care services because of--
                    ``(i) an inability to perform one or more 
                independent activities of daily living;
                    ``(ii) a need for supervision or protection based 
                on symptoms or residuals of neurological or other 
                impairment or injury; or
                    ``(iii) such other matters as the Secretary shall 
                establish in consultation with the Secretary of Defense 
                as appropriate.
    ``(2) The date described in this paragraph--
            ``(A) during the period beginning on the date of the 
        enactment of the Caregiver and Veterans Health Services Act of 
        2009 and ending two years after the date of the enactment of 
        that Act, is September 11, 2001; and
            ``(B) beginning on the first day after the date that is two 
        years after the date of the enactment of the Caregiver and 
        Veterans Health Services Act of 2009, is the earliest date the 
        Secretary determines is appropriate to include the largest 
        number of veterans (and members of the Armed Forces) possible 
        under this section without reducing the quality of care 
        provided to such veterans (and members).
    ``(c) Evaluation of Eligible Veterans and Family Caregivers.--(1) 
The Secretary shall evaluate each eligible veteran who makes a joint 
application under subsection (a)(1)--
            ``(A) to identify the personal care services required by 
        such veteran; and
            ``(B) to determine whether such requirements could be 
        significantly or substantially satisfied with the provision of 
        personal care services from a family member (or other 
        individual designated by the veteran).
    ``(2) The Secretary shall evaluate each family member of an 
eligible veteran (or other individual designated by the veteran) who 
makes a joint application under subsection (a)(1) to determine--
            ``(A) the basic amount of instruction, preparation, and 
        training such family member (or designee) requires, if any, to 
        provide the personal care services required by such veteran; 
        and
            ``(B) the amount of additional instruction, preparation, 
        and training such family member (or designee) requires, if any, 
        to be the primary personal care attendant designated for such 
        veteran under subsection (e).
    ``(3) An evaluation carried out under paragraph (1) may be carried 
out--
            ``(A) at a Department facility;
            ``(B) at a non-Department facility determined appropriate 
        by the Secretary for purposes of such evaluation; and
            ``(C) at such other locations as the Secretary considers 
        appropriate.
    ``(d) Training and Approval.--(1) Except as provided in subsection 
(a)(2), the Secretary shall provide each family member of an eligible 
veteran (or other individual designated by the veteran) who makes a 
joint application under subsection (a)(1) the basic instruction, 
preparation, and training determined to be required by such family 
member (or designee) under subsection (c)(2)(A).
    ``(2) The Secretary may provide to a family member of an eligible 
veteran (or other individual designated by the veteran) the additional 
instruction, preparation, and training determined to be required by 
such family member (or designee) under subsection (c)(2)(B) if such 
family member (or designee)--
            ``(A) is approved as a personal care attendant for the 
        veteran under paragraph (3); and
            ``(B) requests, with concurrence of the veteran, such 
        additional instruction, preparation, and training.
    ``(3) Upon the successful completion by a family member of an 
eligible veteran (or other individual designated by the veteran) of 
basic instruction, preparation, and training provided under paragraph 
(1), the Secretary shall approve the family member as a personal care 
attendant for the veteran.
    ``(4) If the Secretary determines that a primary personal care 
attendant designated under subsection (e) requires additional training 
to maintain such designation, the Secretary shall make such training 
available to the primary personal care attendant.
    ``(5) The Secretary shall, subject to regulations the Secretary 
shall prescribe, provide for necessary travel, lodging, and per diem 
expenses incurred by a family member of an eligible veteran (or other 
individual designated by the veteran) in undergoing training under this 
subsection.
    ``(6) If the participation of a family member of an eligible 
veteran (or other individual designated by the veteran) in training 
under this subsection would interfere with the provision of personal 
care services to the veteran, the Secretary shall, subject to 
regulations as the Secretary shall prescribe and in consultation with 
the veteran, provide respite care to the veteran during the provision 
of such training to the family member so that such family caregiver (or 
designee) can participate in such training without interfering with the 
provision of such services.
    ``(e) Designation of Primary Personal Care Attendant.--(1) For each 
eligible veteran with at least one family member (or other individual 
designated by the veteran) who is described by subparagraphs (A) 
through (E) of paragraph (2), the Secretary shall designate one family 
member of such veteran (or other individual designated by the veteran) 
as the primary personal care attendant for such veteran to be the 
primary provider of personal care services for such veteran.
    ``(2) A primary personal care attendant designated for an eligible 
veteran under paragraph (1) shall be selected from among family members 
of such veteran (or other individuals designated by such veteran) who--
            ``(A) are approved under subsection (d)(3) as a personal 
        care attendant for such veteran;
            ``(B) complete all additional instruction, preparation, and 
        training, if any, provided under subsection (d)(2);
            ``(C) elect to provide the personal care services to such 
        veteran that the Secretary determines such veteran requires 
        under subsection (c)(1);
            ``(D) has the consent of such veteran to be the primary 
        provider of such services for such veteran; and
            ``(E) the Secretary considers competent to be the primary 
        provider of such services for such veteran.
    ``(3) An eligible veteran receiving personal care services from a 
family member (or other individual designated by the veteran) 
designated as the primary personal care attendant for the veteran under 
paragraph (1) may revoke consent with respect to such family member (or 
designee) under paragraph (2)(D) at any time.
    ``(4) If an individual designated as the primary personal care 
attendant of an eligible veteran under paragraph (1) subsequently fails 
to meet the requirements set forth in paragraph (2), the Secretary--
            ``(A) shall immediately revoke the individual's designation 
        under paragraph (1); and
            ``(B) may designate, in consultation with the eligible 
        veteran or the eligible veteran's surrogate appointed under 
        subsection (g), a new primary personal care attendant for the 
        veteran under such paragraph.
    ``(5) The Secretary shall take such actions as may be necessary to 
ensure that the revocation of a designation under paragraph (1) does 
not interfere with the provision of personal care services required by 
a veteran.
    ``(f) Ongoing Family Caregiver Assistance.--(1) Except as provided 
in subsection (a)(2) and subject to the provisions of this subsection, 
the Secretary shall provide ongoing family caregiver assistance to 
family members of eligible veterans (or other individuals designated by 
such veterans) as follows:
            ``(A) To each family member of an eligible veteran (or 
        designee) who is approved under subsection (d)(3) as a personal 
        care attendant for the veteran the following:
                    ``(i) Direct technical support consisting of 
                information and assistance to timely address routine, 
                emergency, and specialized caregiving needs.
                    ``(ii) Counseling.
                    ``(iii) Access to an interactive Internet website 
                on caregiver services that addresses all aspects of the 
                provision of personal care services under this section.
            ``(B) To each family member of an eligible veteran (or 
        designee) who is designated as the primary personal care 
        attendant for the veteran under subsection (e) the following:
                    ``(i) The ongoing family caregiver assistance 
                described in subparagraph (A).
                    ``(ii) Mental health services.
                    ``(iii) Respite care of not less than 30 days 
                annually, including 24-hour per day care of the veteran 
                commensurate with the care provided by the family 
                caregiver to permit extended respite.
                    ``(iv) Medical care under section 1781 of this 
                title if such family member (or designee) is not 
                entitled to care or services under a health-plan 
                contract (as defined in section 1725(f) of this title).
                    ``(v) A monthly personal caregiver stipend.
    ``(2)(A) The Secretary shall provide respite care under paragraph 
(1)(B)(iii), at the election of the Secretary--
            ``(i) through facilities of the Department that are 
        appropriate for the veteran; or
            ``(ii) through contracts under section 1720B(c) of this 
        title.
    ``(B) If the primary personal care attendant of an eligible veteran 
designated under subsection (e)(1) determines in consultation with the 
veteran or the veteran's surrogate appointed under subsection (g), and 
the Secretary concurs, that the needs of the veteran cannot be 
accommodated through the facilities and contracts described in 
subparagraph (A), the Secretary shall, in consultation with the primary 
personal care attendant and the veteran (or the veteran's surrogate), 
provide respite care through other facilities or arrangements that are 
medically and age appropriate.
    ``(3) If the Secretary determines that the Department lacks the 
capacity to furnish medical care under clause (iv) of paragraph (1)(B), 
the Secretary may contract, in accordance with such regulations as the 
Secretary shall prescribe, for such insurance, medical services, or 
health plans as the Secretary considers appropriate to furnish such 
medical care.
    ``(4)(A) The Secretary shall provide monthly personal caregiver 
stipends under paragraph (1)(B)(v) in accordance with a schedule 
established by the Secretary that specifies stipends provided based 
upon the amount and degree of personal care services provided.
    ``(B) The Secretary shall ensure, to the extent practicable, that 
the schedule required by subparagraph (A) specifies that the amount of 
the personal caregiver stipend provided to a primary personal care 
attendant designated under subsection (e)(1) for the provision of 
personal care services to an eligible veteran is not less than the 
amount a commercial home health care entity would pay an individual in 
the geographic area of the veteran to provide equivalent personal care 
services to the veteran.
    ``(C) If personal care services are not available from a commercial 
provider in the geographic area of an eligible veteran, the Secretary 
may establish the schedule required by subparagraph (A) with respect to 
the veteran by considering the costs of commercial providers of 
personal care services in geographic areas other than the geographic 
area of the veteran with similar costs of living.
    ``(5) Provision of ongoing family caregiver assistance under this 
subsection for provision of personal care services to an eligible 
veteran shall terminate if the veteran no longer requires the personal 
care services.
    ``(g) Surrogates.--If an eligible veteran lacks the capacity to 
submit an application, provide consent, make a request, or concur with 
a request under this section, the Secretary may, in accordance with 
regulations and policies of the Department regarding the appointment of 
guardians or the use of powers of attorney, appoint a surrogate for the 
veteran who may submit applications, provide consent, make requests, or 
concur with requests on behalf of the veteran under this section.
    ``(h) Oversight.--(1) The Secretary shall enter into contracts with 
appropriate entities to provide oversight of the provision of personal 
care services under this section by primary personal care attendants 
designated under subsection (e)(1).
    ``(2) The Secretary shall ensure that each eligible veteran 
receiving personal care services under this section from a primary 
personal care attendant designated under subsection (e)(1) is visited 
in the veteran's home by an entity providing oversight under paragraph 
(1) at such frequency as the Secretary shall determine under paragraph 
(3).
    ``(3)(A) Except as provided in subparagraph (B), the Secretary 
shall determine the manner of oversight provided under paragraph (1) 
and the frequency of visits under paragraph (2) for an eligible veteran 
as the Secretary considers commensurate with the needs of such veteran.
    ``(B) The frequency of visits under paragraph (2) for an eligible 
veteran shall be not less frequent than once every six months.
    ``(4)(A) An entity visiting an eligible veteran under paragraph (2) 
shall submit to the Secretary the findings of the entity with respect 
to each visit, including whether the veteran is receiving the care the 
veteran requires.
    ``(B) If an entity finds under subparagraph (A) that an eligible 
veteran is not receiving the care the veteran requires, the entity 
shall submit to the Secretary a recommendation on the corrective 
actions that should be taken to ensure that the veteran receives the 
care the veteran requires, including, if the entity considers 
appropriate, a recommendation for revocation of a caregiver's approval 
under subsection (d)(3) or revocation of the designation of an 
individual under subsection (e)(1).
    ``(5) After receiving findings and recommendations, if any, under 
paragraph (4) with respect to an eligible veteran, the Secretary may 
take such actions as the Secretary considers appropriate to ensure that 
the veteran receives the care the veteran requires, including the 
following:
            ``(A) Revocation of a caregiver's approval under subsection 
        (d)(3).
            ``(B) Revocation of the designation of an individual under 
        subsection (e)(1).
    ``(6) If the Secretary terminates the provision of ongoing family 
caregiver assistance under subsection (f) to a family member of an 
eligible veteran (or other individual designated by the veteran) 
because of findings of an entity submitted to the Secretary under 
paragraph (4), the Secretary may not provide compensation to such 
entity for the provision of personal care services to such veteran, 
unless the Secretary determines it would be in the best interest of 
such veteran to provide compensation to such entity to provide such 
services.
    ``(i) Outreach.--The Secretary shall carry out a program of 
outreach to inform eligible veterans and their family members of the 
availability and nature of family caregiver assistance under this 
section.
    ``(j) Construction.--(1) A decision by the Secretary under this 
section affecting the furnishing of family caregiver assistance shall 
be considered a medical determination.
    ``(2) Nothing in this section shall be construed to create an 
employment relationship between the Secretary and an individual in 
receipt of family caregiver assistance under this section.
    ``(3) Nothing in this section shall be construed to create any 
entitlement to any services or stipends provided under this section.
    ``(k) Definitions.--In this section:
            ``(1) The term `family caregiver assistance' includes the 
        instruction, preparation, training, and approval provided under 
        subsection (d) and the ongoing family caregiver assistance 
        provided under subsection (f).
            ``(2) The term `family member' shall have such meaning as 
        the Secretary shall determine by policy or regulation.
            ``(3) The term `personal care services', with respect to a 
        veteran, includes the following:
                    ``(A) Supervision of the veteran.
                    ``(B) Protection of the veteran.
                    ``(C) Services to assist the veteran with one or 
                more independent activities of daily living.
                    ``(D) Such other services as the Secretary 
                considers appropriate.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of chapter 17 is amended by inserting after the item 
        related to section 1717 the following new item:

``1717A. Family caregiver assistance.''.
            (3) Authorization for provision of health care to personal 
        care attendants.--Section 1781(a) is amended--
                    (A) by redesignating paragraphs (2) and (3) as 
                paragraphs (3) and (4), respectively; and
                    (B) by inserting after paragraph (1) the following 
                new paragraph (2):
            ``(2) a family member of a veteran (or other individual 
        designated by the veteran) designated as the primary personal 
        care attendant for such veteran under section 1717A(e) of this 
        title who is not entitled to care or services under a health-
        plan contract (as defined in section 1725(f) of this title),''.
            (4) Construction.--Any family caregiver assistance 
        furnished under section 1717A of title 38, United States Code, 
        as added by paragraph (1), is in addition to any family 
        caregiver assistance furnished under other programs of the 
        Department of Veterans Affairs as of the date of the enactment 
        of this Act.
            (5) Effective date.--The amendments made by this subsection 
        shall take effect on the date that is 270 days after the date 
        of the enactment of this Act.
    (b) Implementation Plan and Report.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall--
                    (A) develop a plan for the implementation of 
                section 1717A of title 38, United States Code, as added 
                by subsection (a)(1); and
                    (B) submit to the Committee on Veterans' Affairs of 
                the Senate and the Committee on Veterans' Affairs of 
                the House of Representatives a report on such plan.
            (2) Consultation.--In developing the plan required by 
        paragraph (1)(A), the Secretary shall consult with the 
        following:
                    (A) Veterans described in section 1717A(b) of title 
                38, United States Code, as added by subsection (a)(1).
                    (B) Family members of veterans who provide personal 
                care services to such veterans.
                    (C) Veterans service organizations, as recognized 
                by the Secretary of Veterans Affairs for the 
                representation of veterans under section 5902 of title 
                38, United States Code.
                    (D) National organizations that specialize in the 
                provision of assistance to individuals with the types 
                of disabilities that personal care attendants will 
                encounter while providing personal care services under 
                section 1717A of title 38, United States Code, as so 
                added.
                    (E) Such other organizations with an interest in 
                the provision of care to veterans as the Secretary 
                considers appropriate.
                    (F) The Secretary of Defense with respect to 
                matters concerning personal care services for members 
                of the Armed Forces undergoing medical discharge from 
                the Armed Forces who are eligible to benefit from 
                family caregiver assistance furnished under section 
                1717A of title 38, United States Code, as so added.
            (3) Report contents.--The report required by paragraph 
        (1)(B) shall contain the following:
                    (A) The plan required by paragraph (1)(A).
                    (B) A description of the veterans, caregivers, and 
                organizations consulted by the Secretary under 
                paragraph (2).
                    (C) A description of such consultations.
                    (D) The recommendations of such veterans, 
                caregivers, and organizations, if any, that were not 
                incorporated into the plan required by paragraph 
                (1)(A).
                    (E) The reasons the Secretary did not incorporate 
                such recommendations into such plan.
    (c) Annual Evaluation Report.--
            (1) In general.--Not later than two years after the date 
        described in subsection (a)(5) and annually thereafter, 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 comprehensive report on the implementation 
        of section 1717A of title 38, United States Code, as added by 
        subsection (a)(1).
            (2) Contents.--The report required by paragraph (1) shall 
        include the following:
                    (A) The number of family members (or other 
                designated individuals) of veterans or members of the 
                Armed Forces that received family caregiver assistance 
                under such section 1717A.
                    (B) A description of the outreach activities 
                carried out by the Secretary in accordance with 
                subsection (i) of such section 1717A.
                    (C) The resources expended by the Secretary under 
                such section 1717A.
                    (D) An assessment of the manner in which resources 
                are expended by the Secretary under such section 1717A, 
                particularly with respect to the provision of monthly 
                personal caregiver stipends under subsection (f) of 
                such section.
                    (E) A description of the outcomes achieved by, and 
                any measurable benefits of, carrying out the 
                requirements of such section 1717A.
                    (F) A justification of any determination made under 
                subsection (b)(2) of such section 1717A.
                    (G) An assessment of the effectiveness and the 
                efficiency of the implementation of such section 1717A.
                    (H) An assessment of how the provision of family 
                caregiver assistance fits into the continuum of home 
                health care services and benefits provided to veterans 
                in need of such services and benefits.
                    (I) Such recommendations, including recommendations 
                for legislative or administrative action, as the 
                Secretary considers appropriate in light of carrying 
                out the requirements of such section 1717A.

SEC. 103. LODGING AND SUBSISTENCE FOR ATTENDANTS.

    Section 111(e) is amended--
            (1) by striking ``When any'' and inserting ``(1) When 
        any'';
            (2) in paragraph (1), as designated by paragraph (1) of 
        this subsection--
                    (A) by inserting ``(including lodging and 
                subsistence)'' after ``expenses of travel''; and
                    (B) by inserting before the period at the end the 
                following: ``for the period consisting of travel to and 
                from a treatment facility and the duration of the 
                treatment episode at that facility''; and
            (3) by adding at the end the following:
    ``(2) The Secretary may prescribe regulations to carry out this 
subsection. Such regulations may include provisions--
            ``(A) to limit the number of individuals that may receive 
        expenses of travel under paragraph (1) for a single treatment 
        episode of a person; and
            ``(B) to require attendants to use certain travel services.
    ``(3) In this subsection:
            ``(A) The term `attendant' includes, with respect to a 
        person described in paragraph (1), the following:
                    ``(i) A family member of the person.
                    ``(ii) An individual approved as a personal care 
                attendant under section 1717A(d)(3) of this title.
                    ``(iii) Any other individual whom the Secretary 
                determines--
                            ``(I) has a preexisting relationship with 
                        the person; and
                            ``(II) provides a significant portion of 
                        the person's care.
            ``(B) The term `family member' shall have such meaning as 
        the Secretary shall determine by policy or regulation.''.

SEC. 104. SURVEY OF INFORMAL CAREGIVERS.

    (a) In General.--The Secretary of Veterans Affairs shall, in 
collaboration with the Secretary of Defense, conduct a national survey 
of family caregivers of seriously disabled veterans and members of the 
Armed Forces to better understand the size and characteristics of the 
population of such caregivers and the types of care they provide such 
veterans and members.
    (b) Report.--Not later than 540 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall, in 
collaboration with the Secretary of Defense, submit to Congress a 
report containing the findings of the Secretary with respect to the 
survey conducted under subsection (a). Results of the survey shall be 
disaggregated by the following:
            (1) Veterans and members of the Armed Forces.
            (2) Veterans and members of the Armed Forces who served in 
        Operation Iraqi Freedom or Operation Enduring Freedom.
            (3) Veterans and members of the Armed Forces who live in 
        rural areas.

                  TITLE II--RURAL HEALTH IMPROVEMENTS

SEC. 201. ENHANCEMENT OF DEPARTMENT OF VETERANS AFFAIRS EDUCATION DEBT 
              REDUCTION PROGRAM.

    (a) Enhanced Maximum Annual Amount.--Paragraph (1) of section 
7683(d) 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 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 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. 202. VISUAL IMPAIRMENT AND ORIENTATION AND MOBILITY PROFESSIONALS 
              EDUCATION ASSISTANCE PROGRAM.

    (a) Establishment of Program.--Part V is amended by inserting after 
chapter 74 the following new chapter:

     ``CHAPTER 75--VISUAL IMPAIRMENT AND ORIENTATION AND MOBILITY 
               PROFESSIONALS EDUCATION ASSISTANCE PROGRAM

``Sec.
``7501. Establishment of scholarship program; purpose.
``7502. Application and acceptance.
``7503. Amount of assistance; duration.
``7504. Agreement.
``7505. Repayment for failure to satisfy requirements of agreement.
``Sec. 7501. Establishment of scholarship program; purpose
    ``(a) Establishment.--Subject to the availability of 
appropriations, the Secretary shall establish and carry out a 
scholarship program to provide financial assistance in accordance with 
this chapter to an individual--
            ``(1) who is accepted for enrollment or currently enrolled 
        in a program of study leading to a degree or certificate in 
        visual impairment or orientation and mobility, or a dual degree 
        or certification in both such areas, at an accredited (as 
        determined by the Secretary) educational institution that is in 
        a State; and
            ``(2) who enters into an agreement with the Secretary as 
        described in section 7504 of this chapter.
    ``(b) Purpose.--The purpose of the scholarship program established 
under this chapter is to increase the supply of qualified blind 
rehabilitation specialists for the Department and the Nation.
    ``(c) Outreach.--The Secretary shall publicize the scholarship 
program established under this chapter to educational institutions 
throughout the United States, with an emphasis on disseminating 
information to such institutions with high numbers of Hispanic students 
and to Historically Black Colleges and Universities.
``Sec. 7502. Application and acceptance
    ``(a) Application.--(1) To apply and participate in the scholarship 
program under this chapter, an individual shall submit to the Secretary 
an application for such participation together with an agreement 
described in section 7504 of this chapter under which the participant 
agrees to serve a period of obligated service in the Department as 
provided in the agreement in return for payment of educational 
assistance as provided in the agreement.
    ``(2) In distributing application forms and agreement forms to 
individuals desiring to participate in the scholarship program, the 
Secretary shall include with such forms the following:
            ``(A) A fair summary of the rights and liabilities of an 
        individual whose application is approved (and whose agreement 
        is accepted) by the Secretary.
            ``(B) A full description of the terms and conditions that 
        apply to participation in the scholarship program and service 
        in the Department.
    ``(b) Approval.--(1) Upon the Secretary's approval of an 
individual's participation in the scholarship program, the Secretary 
shall, in writing, promptly notify the individual of that acceptance.
    ``(2) An individual becomes a participant in the scholarship 
program upon such approval by the Secretary.
``Sec. 7503. Amount of assistance; duration
    ``(a) Amount of Assistance.--The amount of the financial assistance 
provided for an individual under this chapter shall be the amount 
determined by the Secretary as being necessary to pay the tuition and 
fees of the individual. In the case of an individual enrolled in a 
program of study leading to a dual degree or certification in both the 
areas of study described in section 7501(a)(1) of this chapter, the 
tuition and fees shall not exceed the amounts necessary for the minimum 
number of credit hours to achieve such dual certification or degree.
    ``(b) Relationship to Other Assistance.--Financial assistance may 
be provided to an individual under this chapter to supplement other 
educational assistance to the extent that the total amount of 
educational assistance received by the individual during an academic 
year does not exceed the total tuition and fees for such academic year.
    ``(c) Maximum Amount of Assistance.--(1) In no case may the total 
amount of assistance provided under this chapter for an academic year 
to an individual who is a full-time student exceed $15,000.
    ``(2) In the case of an individual who is a part-time student, the 
total amount of assistance provided under this chapter shall bear the 
same ratio to the amount that would be paid under paragraph (1) if the 
participant were a full-time student in the program of study being 
pursued by the individual as the coursework carried by the individual 
to full-time coursework in that program of study.
    ``(3) In no case may the total amount of assistance provided to an 
individual under this chapter exceed $45,000.
    ``(d) Maximum Duration of Assistance.--The Secretary may provide 
financial assistance to an individual under this chapter for not more 
than six years.
``Sec. 7504. Agreement
    ``An agreement between the Secretary and a participant in the 
scholarship program under this chapter shall be in writing, shall be 
signed by the participant, and shall include--
            ``(1) the Secretary's agreement to provide the participant 
        with financial assistance as authorized under this chapter;
            ``(2) the participant's agreement--
                    ``(A) to accept such financial assistance;
                    ``(B) to maintain enrollment and attendance in the 
                program of study described in section 7501(a)(1) of 
                this chapter;
                    ``(C) while enrolled in such program, to maintain 
                an acceptable level of academic standing (as determined 
                by the educational institution offering such program 
                under regulations prescribed by the Secretary); and
                    ``(D) after completion of the program, to serve as 
                a full-time employee in the Department for a period of 
                three years, to be served within the first six years 
                after the participant has completed such program and 
                received a degree or certificate described in section 
                7501(a)(1) of this chapter; and
            ``(3) any other terms and conditions that the Secretary 
        determines appropriate for carrying out this chapter.
``Sec. 7505. Repayment for failure to satisfy requirements of agreement
    ``(a) In General.--An individual who receives educational 
assistance under this chapter shall repay to the Secretary an amount 
equal to the unearned portion of such assistance if the individual 
fails to satisfy the requirements of the agreement entered into under 
section 7504 of this chapter, except in circumstances authorized by the 
Secretary.
    ``(b) Amount of Repayment.--The Secretary shall establish, by 
regulations, procedures for determining the amount of the repayment 
required under this subsection and the circumstances under which an 
exception to the required repayment may be granted.
    ``(c) Waiver or Suspension of Compliance.--The Secretary shall 
prescribe regulations providing for the waiver or suspension of any 
obligation of an individual for service or payment under this chapter 
(or an agreement under this chapter) whenever noncompliance by the 
individual is due to circumstances beyond the control of the individual 
or whenever the Secretary determines that the waiver or suspension of 
compliance is in the best interest of the United States.
    ``(d) Obligation as Debt to United States.--An obligation to repay 
the Secretary under this section is, for all purposes, a debt owed the 
United States. A discharge in bankruptcy under title 11 does not 
discharge a person from such debt if the discharge order is entered 
less than five years after the date of the termination of the agreement 
or contract on which the debt is based.''.
    (b) Clerical Amendments.--The tables of chapters at the beginning 
of title 38, and of part V of title 38, are each amended by inserting 
after the item relating to chapter 74 the following new item:

``75. Visual Impairment and Orientation and Mobility           7501.''.
                            Professionals Education 
                            Assistance Program.
    (c) Effective Date.--The Secretary of Veterans Affairs shall 
implement chapter 75 of title 38, United States Code, as added by 
subsection (a), not later than six months after the date of the 
enactment of this Act.

SEC. 203. 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. 204. TELECONSULTATION AND TELEMEDICINE.

    (a) Teleconsultation and Teleretinal Imaging.--
            (1) In general.--Subchapter I of chapter 17 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.--The Secretary shall carry out a program 
of teleretinal imaging in each Veterans Integrated Services Network 
(VISN).
    ``(c) Annual Reports.--In each fiscal year beginning with fiscal 
year 2010 and ending with fiscal year 2015, the Secretary shall submit 
to Congress a report on the programs required by subsections (a) and 
(b). Such report shall include the following:
            ``(1) A description of the efforts made by the Secretary to 
        make teleconsultation available in rural areas and to utilize 
        teleconsultation in rural areas.
            ``(2) The rates of utilization of teleconsultation by 
        Veterans Integrated Services Network disaggregated by each 
        fiscal year for which a report is submitted under this 
        subsection.
    ``(d) 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 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 Veterans 
        Integrated Services Networks with incentives to utilize 
        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 1709 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. 205. 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, may carry out demonstration 
projects to examine the feasibility and advisability of alternatives 
for expanding care for veterans in rural areas, which may include 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 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 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.

SEC. 206. 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 or 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 or 
vet centers of the Department of Veterans Affairs. Such contracts shall 
require each contracting community health center or entity--
            (1) to the extent practicable, to use telehealth services 
        for the delivery of services required by subsection (a);
            (2) to the extent practicable, to employ veterans trained 
        under subsection (c);
            (3) to participate in the training program conducted in 
        accordance with subsection (d);
            (4) to comply with applicable protocols of the Department 
        before incurring any liability on behalf of the Department for 
        the provision of the services required by subsection (a);
            (5) 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 with 
        such clinical summary information as the Secretary shall 
        require;
            (6) 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; 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. 207. IMPROVEMENT OF CARE OF AMERICAN INDIAN VETERANS.

    (a) Indian Health Coordinators.--
            (1) In general.--Subchapter II of chapter 73 is amended by 
        adding at the end the following new section:
``Sec. 7330B. 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 an 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 the 
        Department of Veterans Affairs, the 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) Indian 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 is amended by inserting after the item 
        relating to section 7330A the following new item:

``7330B. 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 the Secretary of Health 
and Human Services 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. 208. TRAVEL REIMBURSEMENT FOR VETERANS RECEIVING TREATMENT AT 
              FACILITIES OF THE DEPARTMENT OF VETERANS AFFAIRS.

    (a) Enhancement of Allowance Based Upon Mileage Traveled.--Section 
111 is amended--
            (1) in subsection (a), by striking ``traveled,'' and 
        inserting ``(at a rate of 41.5 cents per mile),''; and
            (2) by amending subsection (g) to read as follows:
    ``(g)(1) Beginning one year after the date of the enactment of the 
Caregiver and Veterans Health Services Act of 2009, the Secretary may 
adjust the mileage rate described in subsection (a) to be equal to the 
mileage reimbursement rate for the use of privately owned vehicles by 
Government employees on official business (when a Government vehicle is 
available), as prescribed by the Administrator of General Services 
under section 5707(b) of title 5.
    ``(2) If an adjustment in the mileage rate under paragraph (1) 
results in a lower mileage rate than the mileage rate otherwise 
specified in subsection (a), the Secretary shall, not later than 60 
days before the date of the implementation of the mileage rate as so 
adjusted, submit to Congress a written report setting forth the 
adjustment in the mileage rate under this subsection, together with a 
justification for the decision to make the adjustment in the mileage 
rate under this subsection.''.
    (b) Coverage of Cost of Transportation by Air.--Subsection (a) of 
section 111, as amended by subsection (a)(1), is further 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.''.
    (c) 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''.
    (d) 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.''.
    (e) No Expansion of Eligibility for Beneficiary Travel.--The 
amendments made by subsections (b) and (d) of this section may not be 
construed as expanding or otherwise modifying eligibility for payments 
or allowances for beneficiary travel under section 111 of title 38, 
United States Code, as in effect on the day before the date of the 
enactment of this Act.
    (f) 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. 209. 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. 210. OVERSIGHT OF CONTRACT AND FEE-BASIS CARE.

    (a) In General.--Subchapter I of chapter 17 is amended by inserting 
after section 1703 the following new section:
``Sec. 1703A. Oversight of contract and fee-basis care
    ``(a) 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.
    ``(b) 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.
    ``(c) 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 
which may reasonably be expected (as determined by the Secretary) to 
encourage participation in the voluntary peer review under subsection 
(d).
    ``(d) 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 with respect to such providers.
    ``(7) The Chief Quality and Performance Officer in each Veterans 
Integrated Services Network shall be responsible for the oversight of 
the program of peer review under this subsection in that network.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 is amended by inserting after the item related to section 
1703 the following new item:

``1703A. Oversight of contract and fee-basis care.''.

SEC. 211. ENHANCEMENT OF VET CENTERS TO MEET NEEDS OF VETERANS OF 
              OPERATION IRAQI FREEDOM AND OPERATION ENDURING FREEDOM.

    (a) Volunteer Counselors.--
            (1) In general.--Subsection (c) of section 1712A is 
        amended--
                    (A) by striking ``The Under Secretary'' and 
                inserting ``(1) The Under Secretary'';
                    (B) in paragraph (1), as designated by paragraph 
                (1), by striking ``, and, in carrying'' and all that 
                follows through ``screening activities''; and
                    (C) 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 tort claim 
                arising from professional activities; and
                    ``(iv) has never had, and has no pending, 
                disciplinary action taken with respect to any license 
                or certification qualifying that individual to provide 
                counseling services; or
            ``(B) who is otherwise credentialed and privileged to 
        perform counseling services by the Secretary.
    ``(4) Eligible volunteer counselors shall be issued credentials and 
privileges for the provision of counseling and related mental health 
services under this section on an expedited basis in accordance with 
such procedures as the Secretary shall establish. Such procedures shall 
provide for the completion by the Secretary of the processing of an 
application for such credentials and privileges not later than 60 days 
after receipt of the application.''.
            (2) Procedures for issuing credentials and privileges to 
        volunteer counselors.--Not later than one year after the date 
        of the enactment of this Act, the Secretary of Veterans Affairs 
        shall establish the procedures described in section 
        1712A(c)(4), as added by paragraph (1).
    (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. 212. CENTERS OF EXCELLENCE FOR RURAL HEALTH RESEARCH, EDUCATION, 
              AND CLINICAL ACTIVITIES.

    (a) In General.--Subchapter II of chapter 73, as amended by section 
214 of this Act, is further amended by adding at the end the following 
new section:
``Sec. 7330C. 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 at 
least one and not more than five centers of excellence for rural health 
research, education, and clinical activities, which shall--
            ``(1) conduct research on the furnishing 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) Use of Rural Health Resource Centers.--In selecting locations 
for the establishment of centers of excellence under subsection (a), 
the Secretary may select a rural health resource center that meets the 
requirements of subsection (a).
    ``(c) 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.
    ``(d) 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, as amended by section 214 of this Act, is further amended 
by inserting after the item relating to section 7330B the following new 
item:

``7330C. Centers of excellence for rural health research, education, 
                            and clinical activities.''.

SEC. 213. 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 nonveterans 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 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 nonveterans, 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 of 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 nonveterans 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 a 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 nonveterans 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)).

SEC. 214. ANNUAL REPORT 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 sections 209 
        through 213, including the amendments made by such sections.
            (2) The establishment and functions 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).

SEC. 215. 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) Eligible recipients.--The following may be awarded a 
        grant under this section:
                    (A) State veterans service agencies.
                    (B) Veterans service organizations.
            (3) Use of funds.--A State veterans service agency or 
        veterans service organization awarded a grant under this 
        section may use the grant amount 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.
            (4) Maximum amount.--The amount of a grant under this 
        section may not exceed $50,000.
            (5) 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) Definitions.--In this section:
            (1) Highly rural.--The term ``highly rural'', in the case 
        of an area, means that the area consists of a county or 
        counties having a population of less than seven persons per 
        square mile.
            (2) Veterans service organization.--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 2010 through 2014 to 
carry out this section.

                  TITLE III--OTHER HEALTH CARE MATTERS

SEC. 301. EXPANSION OF VETERAN ELIGIBILITY FOR REIMBURSEMENT BY 
              SECRETARY OF VETERANS AFFAIRS FOR EMERGENCY TREATMENT 
              FURNISHED IN A NON-DEPARTMENT FACILITY.

    (a) Expansion of Eligibility.--Subsection (b)(3)(C) of section 1725 
is amended by striking ``, in whole or in part,''.
    (b) Limitations on Reimbursement.--Section 1725 is further 
amended--
            (1) in subsection (c), by adding at the end the following 
        new paragraph:
    ``(4)(A) If the veteran has contractual or legal recourse against a 
third party that would, in part, extinguish the veteran's liability to 
the provider of the emergency treatment and payment for the treatment 
may be made both under subsection (a) and by the third party, the 
amount payable for such treatment under such subsection shall be the 
amount by which the costs for the emergency treatment exceed the amount 
payable or paid by the third party, except that the amount payable may 
not exceed the maximum amount payable established under paragraph 
(1)(A).
    ``(B) In any case in which a third party is financially responsible 
for part of the veteran's emergency treatment expenses, the Secretary 
shall be the secondary payer.
    ``(C) A payment in the amount payable under subparagraph (A) shall 
be considered payment in full and shall extinguish the veteran's 
liability to the provider.
    ``(D) The Secretary may not reimburse a veteran under this section 
for any copayment or similar payment that the veteran owes the third 
party or for which the veteran is responsible under a health-plan 
contract.''; and
            (2) in subsection (f)(3)--
                    (A) in subparagraph (A), by inserting before the 
                period at the end the following: ``, including the 
                Secretary of Health and Human Services with respect to 
                the Medicare program under title XVIII of the Social 
                Security Act (42 U.S.C. 1395 et seq.) and the Medicaid 
                program under title XIX of such Act (42 U.S.C. 1396 et 
                seq.)''; and
                    (B) in subparagraph (B), by inserting before the 
                period at the end the following: ``, including a State 
                Medicaid agency with respect to payments made under a 
                State plan for medical assistance approved under title 
                XIX of such Act (42 U.S.C. 1396 et seq.)''.
    (c) Effective Date.--
            (1) In general.--The amendments made by subsections (a) and 
        (b) shall take effect on the date of the enactment of this Act, 
        and shall apply with respect to emergency treatment furnished 
        on or after that date.
            (2) Reimbursement for treatment before effective date.--The 
        Secretary of Veterans Affairs may provide reimbursement under 
        section 1725 of title 38, United States Code, as amended by 
        this subsection, for emergency treatment furnished before the 
        date of the enactment of this Act if the Secretary determines 
        that, under the circumstances applicable with respect to the 
        veteran, it is appropriate to do so.

SEC. 302. PROHIBITION ON COLLECTION OF COPAYMENTS FROM VETERANS WHO ARE 
              CATASTROPHICALLY DISABLED.

    (a) In General.--Subchapter III of chapter 17 is amended by adding 
at the end the following new section:
``Sec. 1730A. Prohibition on collection of copayments from 
              catastrophically disabled veterans
    ``Notwithstanding subsections (f) and (g) of section 1710 and 
section 1722A(a) of this title or any other provision of law, the 
Secretary may not require a veteran who is catastrophically disabled to 
make any copayment for the receipt of hospital care or medical services 
under the laws administered by the Secretary.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
1730 the following new item:

``1730A. Prohibition on collection of copayments from catastrophically 
                            disabled veterans.''.

               TITLE IV--CONSTRUCTION AND NAMING MATTERS

SEC. 401. MAJOR MEDICAL FACILITY PROJECT DEPARTMENT OF VETERANS AFFAIRS 
              MEDICAL CENTER, WALLA WALLA, WASHINGTON.

    (a) Authorization for Major Medical Facility Project.--The 
Secretary of Veterans Affairs may carry out a major medical facility 
project for the construction of a new multiple specialty outpatient 
facility, campus renovation and upgrades, and additional parking at the 
Department of Veterans Affairs Medical Center, Walla Walla, Washington, 
with the project to be carried out in an amount not to exceed 
$71,400,000.
    (b) Authorization of Appropriations.--There is authorized to be 
appropriated to the Secretary of Veterans Affairs for fiscal year 2010 
for the Construction, Major Projects account, $71,400,000 for the 
project authorized in subsection (a).

SEC. 402. MERRIL LUNDMAN DEPARTMENT OF VETERANS AFFAIRS OUTPATIENT 
              CLINIC.

    (a) In General.--The Department of Veterans Affairs outpatient 
clinic in Havre, Montana, shall after the date of the enactment of this 
Act be known and designated as the ``Merril Lundman Department of 
Veterans Affairs Outpatient Clinic''.
    (b) References.--Any reference in any law, regulation, map, 
document, record, or other paper of the United States to the outpatient 
clinic referred to in subsection (a) shall be considered to be a 
reference to the Merril Lundman Department of Veterans Affairs 
Outpatient Clinic.
            Amend the title so as to read: ``A Bill to amend title 38, 
        United States Code, to provide assistance to caregivers of 
        veterans, to improve the provision of health care to veterans 
        in rural areas, and for other purposes.''.
                                                       Calendar No. 167

111th CONGRESS

  1st Session

                                 S. 801

                          [Report No. 111-80]

_______________________________________________________________________

                                 A BILL

      To amend title 38, United States Code, to waive charges for 
  humanitarian care provided by the Department of Veterans Affairs to 
 family members accompanying veterans severely injured after September 
   11, 2001, as they receive medical care from the Department and to 
    provide assistance to family caregivers, and for other purposes.

_______________________________________________________________________

                           September 25, 2009

        Reported with an amendment and an amendment to the title