[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 2009 Introduced in Senate (IS)]

113th CONGRESS
  2d Session
                                S. 2009

 To improve the provision of health care by the Department of Veterans 
  Affairs to veterans in rural and highly rural areas, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           February 10, 2014

  Mr. Udall of New Mexico (for himself and Mr. Heller) introduced the 
 following bill; which was read twice and referred to the Committee on 
                           Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
 To improve the provision of health care by the Department of Veterans 
  Affairs to veterans in rural and highly rural areas, and for other 
                               purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Rural Veterans Improvement Act of 
2014''.

SEC. 2. PROVISION OF MENTAL HEALTH CARE TO CERTAIN VETERANS IN RURAL 
              AND HIGHLY RURAL AREAS.

    (a) In General.--The Secretary of Veterans Affairs shall provide 
mental health care to eligible veterans described in subsection (c) for 
which a determination has been made under subsection (d).
    (b) Use of Other Providers.--
            (1) In general.--The Secretary may provide mental health 
        care under this section by contracting with or providing 
        payments to mental health care providers that are not otherwise 
        affiliated with the Department of Veterans Affairs and shall, 
        to the extent feasible, use health care resources pursuant to 
        existing arrangements, contracts, or agreements entered into 
        under section 8153 of title 38, United States Code.
            (2) Payments.--The Secretary may not provide payments 
        described in paragraph (1) that exceed the amount that the 
        Secretary would otherwise expend in providing similar mental 
        health care through the Department or under such existing 
        arrangements, contracts, or agreements.
    (c) Eligible Veterans.--An eligible veteran described in this 
subsection is a veteran that--
            (1) has a mental health issue resulting from post-traumatic 
        stress disorder, traumatic brain injury, or any other health 
        condition that was incurred or aggravated in line of duty in 
        the active military, naval, or air service; and
            (2) lives in a rural area or highly rural area.
    (d) Determination.--The Secretary shall provide the care required 
by subsection (a) to an eligible veteran if the Secretary determines 
any of the following:
            (1)(A) A mental health care provider affiliated with the 
        Department is not available to provide mental health care 
        services to the eligible veteran at the medical facility of the 
        Department that is nearest to the residence of the eligible 
        veteran; and
            (B)(i) in-person and telehealth mental health care services 
        from the Department are not available to the eligible veteran;
            (ii) the eligible veteran requests that a mental health 
        care provider affiliated with the Department provide mental 
        health care services to the eligible veteran in private and the 
        provider is unable or unwilling to do so; or
            (iii) travel by the eligible veteran to a regional medical 
        center of the Department is impractical or severely detrimental 
        to the health of the eligible veteran.
            (2) That--
                    (A)(i) a mental health care provider affiliated 
                with the Department has recommended that a 
                complementary and alternative therapy approved by the 
                Food and Drug Administration be administered to the 
                eligible veteran;
                    (ii) the eligible veteran is a member of an Indian 
                tribe or a Native Hawaiian and requests a healing 
                method that is a cultural tradition of the eligible 
                veteran; or
                    (iii) a mental health care provider has recommended 
                a treatment for the eligible veteran that, based on the 
                medical knowledge of the health care provider, is safe 
                and would assist the eligible veteran in coping with 
                post-traumatic stress disorder, traumatic brain injury, 
                or another mental health issue; and
                    (B)(i) the eligible veteran has not received the 
                therapy, healing method, or treatment described in 
                subparagraph (A) because of the inaccessibility or 
                unavailability of such treatment from a medical 
                facility of the Department; and
                    (ii) the eligible veteran, as a result of the 
                mental health condition of the eligible veteran--
                            (I) cannot work or maintain employment;
                            (II) is at increased risk of doing physical 
                        harm to the eligible veteran or others; or
                            (III) cannot adequately manage activities 
                        of daily life.
    (e) Indian Tribe Defined.--In this section, the term ``Indian 
tribe'' has the meaning given that term in section 4 of the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 450b).

SEC. 3. REPORT ON EFFECTIVENESS OF COMPLEMENTARY AND ALTERNATIVE 
              MEDICINE IN TREATING VETERANS WITH CERTAIN MENTAL 
              ILLNESSES.

    Not later than one year after the date of the enactment of this 
Act, the Secretary of Veterans Affairs 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 effectiveness of 
complementary and alternative medicine used by the Department of 
Veterans Affairs in treating veterans with mental health conditions 
resulting from post-traumatic stress disorder, traumatic brain injury, 
or any other health condition that was incurred or aggravated in line 
of duty in the active military, naval, or air service.

SEC. 4. GRANTS TO PROVIDE TRANSPORTATION TO COMMUNITY-BASED OUTPATIENT 
              CLINICS FOR VETERANS IN RURAL AND HIGHLY RURAL AREAS.

    (a) Grants Authorized.--
            (1) In general.--The Secretary of Veterans Affairs may 
        award grants to eligible entities to provide transportation to 
        veterans in rural and highly rural areas who would otherwise be 
        eligible for reimbursement for or payment of travel expenses by 
        the Department of Veterans Affairs pursuant to section 111 or 
        section 111A of title 38, United States Code.
            (2) Maximum amount.--The Secretary may not award a grant 
        under this section in an amount that exceeds $100,000.
            (3) No matching required.--The Secretary may not require 
        that an eligible entity provide a contribution of funds as a 
        condition of receiving the grant.
    (b) Eligible Entities.--The Secretary may award grants under this 
section to any of the following entities:
            (1) State veterans agencies.
            (2) Veterans service organizations.
            (3) Tribal organizations.
    (c) Use of Grants.--Eligible entities in receipt of a grant under 
this section may use the grant amount as follows:
            (1) To provide transportation to veterans in rural and 
        highly rural areas to and from medical centers of the 
        Department of Veterans Affairs, including transportation by air 
        or sea if necessary.
            (2) To otherwise assist veterans in rural and highly rural 
        areas with transportation in connection with the provision of 
        medical care to those veterans, including transportation by air 
        or sea if necessary.
    (d) Application.--
            (1) In general.--Each eligible entity seeking a grant under 
        this section shall submit an application to the Secretary at 
        such time, in such manner, and accompanied by such information 
        as the Secretary may require.
            (2) Contents.--Each application submitted pursuant to 
        paragraph (1) shall contain a proposal for the manner in which 
        the eligible entity seeks to provide the transportation 
        described in subsection (a).
    (e) Priority.--The Secretary shall give priority in the awarding of 
grants under this section to applications submitted under subsection 
(d) that contain proposals that comply with section 504 of the 
Rehabilitation Act of 1973 (29 U.S.C. 794) and regulations issued by 
the Secretary of Transportation under such section 504.
    (f) Definitions.--In this section:
            (1) Tribal organization.--The term ``tribal organization'' 
        has the meaning given that term in section 4 of the Indian 
        Self-Determination and Education Assistance Act (25 U.S.C. 
        450b).
            (2) Veterans service organization.--The term ``veterans 
        service organization'' means an organization recognized by the 
        Secretary of Veterans Affairs for the representation of 
        veterans under section 5902 of title 38, United States Code.

SEC. 5. PILOT PROGRAM ON HOUSING ALLOWANCES FOR HEALTH CARE PROVIDERS 
              OF THE DEPARTMENT OF VETERANS AFFAIRS ACCEPTING 
              ASSIGNMENT AT RURAL AND HIGHLY RURAL COMMUNITY-BASED 
              OUTPATIENT CLINICS.

    (a) Pilot Program Authorized.--The Secretary of Veterans Affairs 
may carry out a pilot program to assess the feasibility and 
advisability of providing a housing allowance to health care providers 
of the Department of Veterans Affairs who accept assignment at rural or 
highly rural community-based outpatient clinics as a means of 
encouraging such health care providers to accept assignment to such 
clinics.
    (b) Eligibility.--An individual is eligible for participation in 
the pilot program if the individual--
            (1) is a health care provider;
            (2) is, or agrees to become, an employee of the Veterans 
        Health Administration on a full-time basis in a health care 
        position designated by the Secretary for purposes of the pilot 
        program; and
            (3) accepts an assignment in such position for a term of 
        not less than 36 months at a rural or highly rural community-
        based outpatient clinic selected by the Secretary for purposes 
        of the pilot program.
    (c) Conditions on Payment of Housing Allowance.--Except as provided 
in subsection (d)(3), an individual may be provided a housing allowance 
under the pilot program only while--
            (1) in good standing as a health care provider within the 
        Veterans Health Administration; and
            (2) assigned as a health care provider at a rural or highly 
        rural community-based outpatient clinic.
    (d) Amount of Housing Allowance.--
            (1) Monthly amount during initial term.--During the first 
        36 months of participation in the pilot program, the housing 
        allowance provided a health care provider participating in the 
        pilot program shall be provided on a monthly basis at a rate 
        that is equivalent to the monthly rate of basic allowance for 
        housing (BAH) payable under section 403 of title 37, United 
        States Code, to members of the uniformed services whose grade, 
        dependency status, and geographic location most closely equals, 
        as determined by the Secretary, the grade of such provider 
        under section 7404 of title 38, United States Code, and the 
        dependency status and geographic location of such provider.
            (2) Monthly amount for certain providers for additional 
        term.--If upon completion of the first 36 months in the pilot 
        program a health care provider accepts continuing participation 
        in the pilot program at a rural or highly rural community-based 
        outpatient clinic for a term of not less than 12 additional 
        months, the housing allowance provided the health care provider 
        under the pilot program shall be provided on a monthly basis 
        for such additional months at a rate determined in accordance 
        with paragraph (1).
            (3) Bonus amount.--
                    (A) Completion of initial term.--Any health care 
                provider who successfully completes 36 months of 
                participation in the pilot program shall be paid upon 
                completion of participation in the pilot program an 
                amount equal to three months of the monthly rate of 
                housing allowance provided the health care provider 
                under paragraph (1) during the last month before the 
                provider's completion of participation in the pilot 
                program.
                    (B) Completion of additional one-year term.--Any 
                health care provider who successfully completes 48 
                months of participation in the pilot program shall be 
                paid upon completion of participation in the pilot 
                program an amount equal to 12 months of the monthly 
                rate of housing allowance provided the health care 
                provider under paragraph (2) during the last month 
                before the provider's completion of participation in 
                the pilot program.
                    (C) Completion of additional two-year term.--Any 
                health care provider who successfully completes 60 
                months of participation in the pilot program shall be 
                paid upon completion of participation in the pilot 
                program an amount equal to 13 months of the monthly 
                rate of housing allowance provided the health care 
                provider under paragraph (2) during the last month 
                before the provider's completion of participation in 
                the pilot program.
                    (D) No requirement to remain on assignment.--An 
                amount payable under this paragraph shall be paid 
                whether or not the health care provider concerned 
                remains in an assignment at a rural or highly rural 
                community-based outpatient clinic.
    (e) Nature of Allowance.--
            (1) Supplemental amount.--Any housing allowance provided 
        under the pilot program shall be in addition to any pay 
        (including basic pay, special pay, and retirement or other 
        bonus pay) payable to personnel of the Veterans Health 
        Administration personnel under chapter 74 of title 38, United 
        States Code, or any other provision of law.
            (2) Exemption from taxation.--For purposes of the Internal 
        Revenue Code of 1986, any housing allowance provided under the 
        pilot program shall not be included in gross income.
    (f) Annual Reports.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act and not less frequently than once 
        each year thereafter while the pilot program is in effect, 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 pilot program.
            (2) Elements.--Each report submitted under paragraph (1) 
        shall include the following:
                    (A) A current description of the pilot program, 
                including the current number of participants in the 
                pilot program and the amounts of housing allowance 
                being provided such participants.
                    (B) A current assessment of the value of the 
                housing allowance under the pilot program in 
                encouraging health care providers in accepting 
                assignment to rural and highly rural community-based 
                outpatient clinics.
    (g) Funding.--Amounts for housing allowances under the pilot 
program shall be derived from amounts available for the Veterans Health 
Administration for Medical Services.
    (h) Sunset.--
            (1) In general.--No individual may commence participation 
        in the pilot program on or after the date that is five years 
        after the date of the enactment of this Act.
            (2) Continuation of on-going provision of allowance.--
        Nothing in paragraph (1) shall be construed to prohibit the 
        Secretary from providing housing allowances under the pilot 
        program to individuals who commence participation in the pilot 
        program before the date that is five years after the date of 
        the enactment of this Act.
    (i) Rural or Highly Rural Community-Based Outpatient Clinic 
Defined.--In this section, the term ``rural or highly rural community-
based outpatient clinic'' means a community-based outpatient clinic of 
the Veterans Health Administration that predominantly serves veterans 
who live in rural and highly rural areas.

SEC. 6. PROGRAM ON TRAINING HEALTH CARE PROFESSIONALS FOR ASSIGNMENT AT 
              COMMUNITY-BASED OUTPATIENT CLINICS THAT PREDOMINANTLY 
              SERVE VETERANS WHO LIVE IN RURAL AND HIGHLY RURAL AREAS.

    (a) Program Required.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        establish a program to train health care professionals for 
        assignment at community-based outpatient clinics that 
        predominantly serve veterans who live in rural and highly rural 
        areas.
            (2) Partnership with educational institutions.--
                    (A) In general.--In carrying out the program, the 
                Secretary may enter into partnerships with educational 
                institutions.
                    (B) Consultation.--If the Secretary enters into a 
                partnership with an educational institution to carry 
                out the program, the Secretary shall consult with the 
                head of such educational institution with respect to 
                the training and curriculum provided under the program 
                at such educational institution.
    (b) Training.--The training provided to health care professionals 
under the program shall include the following courses:
            (1) Courses on general professional development of health 
        care professionals.
            (2) Courses on providing health care to rural populations 
        and specifically to rural veterans.
    (c) Curriculum.--The program shall include training with respect to 
health issues that commonly afflict veterans as specified by the 
Secretary.
    (d) Hiring Preference.--
            (1) In general.--Each health care professional that 
        completes the program and completes a three-year assignment at 
        a community-based outpatient clinic that predominantly serves 
        veterans who live in rural and highly rural areas shall receive 
        a preference in selection for employment in the Veterans Health 
        Administration at the end of such three-year assignment.
            (2) Degree of preference.--
                    (A) In general.--The preference received under 
                paragraph (1) shall be less than the preference given a 
                veteran.
                    (B) Veterans.--A veteran that receives a preference 
                under paragraph (1) shall receive a greater preference 
                than an individual that receives a preference under 
                such paragraph who is not a veteran.

SEC. 7. ENCOURAGING AND FACILITATING TRANSITION OF MILITARY MEDICAL 
              PROFESSIONALS INTO EMPLOYMENT WITH VETERANS HEALTH 
              ADMINISTRATION.

    (a) Encouraging Employment With Veterans Health Administration.--
The Secretary of Veterans Affairs and the Secretary of Defense shall 
jointly establish a program to encourage an individual who serves in 
the Armed Forces with a military occupational specialty relating to the 
provision of health care to seek employment with the Veterans Health 
Administration when the individual has been discharged or released from 
service in the Armed Forces or is contemplating separating from such 
service.
    (b) Matching of Military Occupational Specialties.--The Secretary 
of Veterans Affairs and the Secretary of Defense shall jointly identify 
military occupational specialties relating to the provision of health 
care and match such occupational specialties with occupations and 
positions of employment within the Veterans Health Administration for 
which experience in such military occupational specialty qualifies one 
for employment in such occupation or position of employment.
    (c) Facilitation of Transition to Employment With Veterans Health 
Administration.--The Secretary of Veterans Affairs and the Secretary of 
Defense shall prescribe such regulations and take such actions as may 
be necessary to facilitate the transition of individuals with military 
occupational specialties identified under subsection (b) into the 
corresponding occupations and positions of employment with the Veterans 
Health Administration under such subsection.

SEC. 8. ASSESSMENT OF COMMUNITY-BASED OUTPATIENT CLINICS IN RURAL AND 
              HIGHLY RURAL AREAS.

    (a) Assessment.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        conduct a periodic assessment of community-based outpatient 
        clinics in rural and highly rural areas to determine whether 
        expansion and improvement of community-based outpatient clinics 
        in those areas is feasible or advisable.
            (2) Elements.--Each periodic assessment required by 
        subsection (a) shall include the following with respect to each 
        community-based outpatient clinic assessed:
                    (A) An assessment of whether the facility--
                            (i) meets applicable building code 
                        requirements;
                            (ii) meets applicable health care 
                        requirements related to privacy;
                            (iii) has the capacity to handle the number 
                        of patients that seek care at the facility;
                            (iv) has sufficient parking for patients 
                        that seek care at the facility;
                            (v) has adequate access to broadband 
                        technology to allow the use or expansion of 
                        telehealth services at the facility; and
                            (vi) has the capacity to properly store and 
                        dispose of medical and other hazardous waste.
                    (B) A survey of health care providers who practice 
                at the facility with respect to--
                            (i) strengths of the facility;
                            (ii) weaknesses of the facility; and
                            (iii) areas in which the facility may be 
                        improved.
    (b) Report.--Not later than one year after the date of the 
enactment of this Act, and not less frequently than once each year 
thereafter, the Secretary shall submit to the Committee on Veterans' 
Affairs and the Committee on Appropriations of the Senate and the 
Committee on Veterans' Affairs and the Committee on Appropriations of 
the House of Representatives a report on the findings of the Secretary 
with respect to the most recently completed assessment conducted under 
subsection (a), including such recommendations as the Secretary may 
have for the expansion or improvement of community-based outpatient 
clinics in rural and highly rural areas.

SEC. 9. REPORT ON ESTABLISHMENT OF POLYTRAUMA REHABILITATION CENTERS OR 
              POLYTRAUMA NETWORK SITES OF THE DEPARTMENT OF VETERANS 
              AFFAIRS IN RURAL AREAS.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall submit 
to Congress a report on the feasibility and advisability of 
establishing a Polytrauma Rehabilitation Center or Polytrauma Network 
Site in each area in which the nearest Polytrauma Rehabilitation Center 
or Polytrauma Network Site is more than 300 miles away.
    (b) Requirements.--
            (1) In general.--The report required by this section shall 
        include the following:
                    (A) An assessment of the adequacy of existing 
                Polytrauma Rehabilitation Centers and Polytrauma 
                Network Sites in providing care to veterans that live 
                more than 300 miles from such facilities.
                    (B) An assessment of the adequacy of existing 
                Polytrauma Rehabilitation Centers and Polytrauma 
                Network Sites in providing rehabilitation services 
                pursuant to section 1710C of title 38, United States 
                Code.
                    (C) An assessment of the feasibility and 
                advisability of establishing a Polytrauma 
                Rehabilitation Center or Polytrauma Network Site in 
                each State in which there is a medical center of the 
                Department of Veterans Affairs.
                    (D) An assessment of whether establishing new 
                Polytrauma Rehabilitation Centers and Polytrauma 
                Network Sites would be beneficial--
                            (i) to the veteran population in general;
                            (ii) to veterans who live--
                                    (I) more than 300 miles from the 
                                nearest Polytrauma Rehabilitation 
                                Center or Polytrauma Network Site; or
                                    (II) in a State in which there is 
                                not a Polytrauma Rehabilitation Center 
                                or Polytrauma Network Site; and
                            (iii) to veterans who served in the active 
                        military, naval, or air service on or after 
                        September 11, 2001.
            (2) Budget for additional facilities.--If the Secretary 
        determines that establishing additional Polytrauma 
        Rehabilitation Centers and Polytrauma Network Sites is feasible 
        and advisable, the Secretary shall include with the report 
        required by subsection (a) a budget and plan for the 
        establishment of those additional facilities.

SEC. 10. DEFINITIONS.

    In this Act:
            (1) Active military, naval, or air service.--The term 
        ``active military, naval, or air service'' has the meaning 
        given that term in section 101 of title 38, United States Code.
            (2) Highly rural area.--The term ``highly rural area'' 
        means an area located in a county that has less than seven 
        individuals residing in that county per square mile.
            (3) Rural area.--The term ``rural area'' means any area 
        that is not an urbanized area or a highly rural area.
            (4) Urbanized area.--The term ``urbanized area'' has the 
        meaning given that term by the Director of the Bureau of the 
        Census.
                                 <all>