[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 1449 Introduced in Senate (IS)]

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115th CONGRESS
  1st Session
                                S. 1449

  To authorize payment by the Department of Veterans Affairs for the 
costs associated with training and supervision of medical residents and 
 interns at certain facilities that are not Department facilities, to 
require the Secretary of Veterans Affairs to carry out a pilot program 
    to establish or affiliate with residency programs at facilities 
operated by Indian tribes, tribal organizations, and the Indian Health 
                    Service, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 27, 2017

  Mr. Sullivan (for himself and Mr. Tester) introduced the following 
 bill; which was read twice and referred to the Committee on Veterans' 
                                Affairs

_______________________________________________________________________

                                 A BILL


 
  To authorize payment by the Department of Veterans Affairs for the 
costs associated with training and supervision of medical residents and 
 interns at certain facilities that are not Department facilities, to 
require the Secretary of Veterans Affairs to carry out a pilot program 
    to establish or affiliate with residency programs at facilities 
operated by Indian tribes, tribal organizations, and the Indian Health 
                    Service, 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 ``Serving our Rural Veterans Act of 
2017''.

SEC. 2. SENSE OF CONGRESS.

    It is the sense of Congress that--
            (1) the Department of Veterans Affairs relies on agreements 
        with the Indian Health Service and tribal health organizations 
        to serve native and non-native veteran populations in certain 
        areas, especially rural areas of the United States, due to 
        limited infrastructure or personnel of the Department in those 
        areas;
            (2) the Department should support the practice of rural 
        health care in the United States because such care is crucial 
        to fulfilling the mission of the Department to provide the 
        highest quality care for veterans; and
            (3) education regarding the unique health needs of veterans 
        is necessary for all health care providers and is especially 
        important for providers in rural health care delivery systems, 
        including those affiliated with Indian tribes and tribal health 
        organizations that care for a significant number of veterans.

SEC. 3. AUTHORIZATION OF PAYMENT BY DEPARTMENT OF VETERANS AFFAIRS FOR 
              TRAINING AND SUPERVISION OF RESIDENTS OR INTERNS AT 
              FACILITIES THAT ARE NOT DEPARTMENT FACILITIES.

    (a) In General.--Subsection (c) of section 7406 of title 38, United 
States Code, is amended by striking ``Department facility'' each place 
it appears and inserting ``covered facility''.
    (b) Covered Facility Defined.--Subsection (a)(2) of such section is 
amended by adding at the end the following new subparagraph:
            ``(C) The term `covered facility' means any of the 
        following:
                    ``(i) A Department facility.
                    ``(ii) A facility operated by an Indian tribe or a 
                tribal organization, as those terms are defined in 
                section 4 of the Indian Self-Determination and 
                Education Assistance Act (25 U.S.C. 5304).
                    ``(iii) A facility operated by the Indian Health 
                Service.
                    ``(iv) A Federally-qualified health center, as 
                defined in section 1905(l)(2)(B) of the Social Security 
                Act (42 U.S.C. 1396d(l)(2)(B)).
                    ``(v) A community health center.''.

SEC. 4. PILOT PROGRAM TO ESTABLISH OR AFFILIATE WITH GRADUATE MEDICAL 
              RESIDENCY PROGRAMS AT FACILITIES OPERATED BY INDIAN 
              TRIBES, TRIBAL ORGANIZATIONS, AND THE INDIAN HEALTH 
              SERVICE IN RURAL AREAS.

    (a) In General.--The Secretary of Veterans Affairs, in consultation 
with the Director of the Indian Health Service, shall carry out a pilot 
program--
            (1) to establish graduate medical education residency 
        training programs at covered facilities; or
            (2) to affiliate with established programs described in 
        paragraph (1).
    (b) Locations.--
            (1) In general.--The Secretary shall carry out the pilot 
        program at not more than four covered facilities that have been 
        selected by the Secretary for purposes of the pilot program.
            (2) Criteria.--The Secretary shall establish criteria for 
        selecting covered facilities under paragraph (1).
    (c) Duration.--The Secretary shall implement the pilot program 
during the eight-year period beginning on the date that is 180 days 
after the date of the enactment of this Act.
    (d) Reimbursement of Costs.--The Secretary shall reimburse each 
covered facility participating in the pilot program for the following 
costs associated with the pilot program:
            (1) Curriculum development.
            (2) Recruitment, training, supervision, and retention of 
        residents and faculty.
            (3) Accreditation of programs of education under the pilot 
        program by the Accreditation Council for Graduate Medical 
        Education (ACGME) or the American Osteopathic Association 
        (AOA).
            (4) The portion of faculty salaries attributable to 
        activities relating to carrying out the pilot program.
            (5) Payment for expenses relating to providing medical 
        education under the pilot program.
    (e) Period of Obligated Service.--
            (1) In general.--The Secretary shall enter into an 
        agreement with each individual who participates in the pilot 
        program under which such individual agrees to serve a period of 
        one year of obligated service at a covered facility or a 
        facility of the Department of Veterans Affairs for each year in 
        which the individual participates in the pilot program under 
        this section.
            (2) Breach.--An individual who participates in the pilot 
        program and fails to satisfy the period of obligated service 
        under paragraph (1) shall be liable to the United States, in 
        lieu of such obligated service, for the amount that has been 
        paid or is payable to or on behalf of the individual under the 
        pilot program, reduced by the proportion that the number of 
        days served for completion of the period of obligated service 
        bears to the total number of days in the period of obligated 
        service of such individual.
            (3) Loan repayment.--During the period of obligated service 
        of an individual under paragraph (1), the individual--
                    (A) shall be deemed to be an eligible individual 
                under subsection (b) of section 108 of the Indian 
                Health Care Improvement Act (25 U.S.C. 1616a) for 
                purposes of participation in the Indian Health Service 
                Loan Repayment Program under such section during the 
                portion of such period that the individual serves at a 
                covered facility; and
                    (B) shall be deemed to be an eligible individual 
                under section 7682(a) of title 38, United States Code, 
                for purposes of participation in the Department of 
                Veterans Affairs Education Debt Reduction Program under 
                subchapter VII of chapter 76 of such title during the 
                portion of such period that the individual serves at a 
                facility of the Department.
            (4) Concurrent service.--Any period of obligated service 
        required of an individual under paragraph (1) shall be served--
                    (A) with respect to service at a covered facility, 
                concurrently with any period of obligated service 
                required of the individual by the Indian Health 
                Service; and
                    (B) with respect to service at a facility of the 
                Department of Veterans Affairs, concurrently with any 
                period of obligated service required of the individual 
                by the Department.
    (f) Report.--Not later than three years before the termination of 
the pilot program under subsection (c), 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 feasibility and advisability of--
            (1) expanding the pilot program to additional locations; 
        and
            (2) making the pilot program or any aspect of the pilot 
        program permanent.
    (g) Authorization of Appropriations.--
            (1) In general.--There is authorized to be appropriated to 
        the Secretary of Veterans Affairs $20,000,000 for each year in 
        which the pilot program is carried out.
            (2) Loan repayments.--
                    (A) In general.--There is authorized to be 
                appropriated--
                            (i) to the Secretary of Health and Human 
                        Services, acting through the Director of the 
                        Indian Health Service, such sums as may be 
                        necessary to cover loan repayments paid under 
                        the Indian Health Service Loan Repayment 
                        Program to individuals participating in the 
                        pilot program; and
                            (ii) to the Secretary of Veterans Affairs 
                        such sums as may be necessary to cover loan 
                        repayments paid under the Department of 
                        Veterans Affairs Education Debt Reduction 
                        Program to individuals participating in the 
                        pilot program.
                    (B) Supplement not supplant.--Amounts appropriated 
                or otherwise made available for the Indian Health 
                Service Loan Repayment Program or the Department of 
                Veterans Affairs Education Debt Reduction Program 
                pursuant to the authorization of appropriations under 
                subparagraph (A) shall supplement, not supplant, 
                amounts made available to such programs under other 
                provisions of law.
    (h) Covered Facility Defined.--In this section, the term ``covered 
facility'' means a facility--
            (1) operated by an Indian tribe or a tribal organization 
        (as those terms are defined in section 4 of the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 5304)), 
        or the Indian Health Service, that has an existing 
        reimbursement agreement with the Department of Veterans Affairs 
        under section 405(c) of the Indian Health Care Improvement Act 
        (25 U.S.C. 1645(c)); and
            (2) located in a rural or remote area, as determined by the 
        Secretary.
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