[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 2356 Introduced in Senate (IS)]

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115th CONGRESS
  2d Session
                                S. 2356

 To require the Secretary of Veterans Affairs to address staffing and 
 other issues at facilities, including underserved facilities, of the 
        Department of Veterans Affairs, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            January 30, 2018

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

_______________________________________________________________________

                                 A BILL


 
 To require the Secretary of Veterans Affairs to address staffing and 
 other issues at facilities, including underserved facilities, of the 
        Department of Veterans Affairs, 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 ``Stronger Medical Workforce for 
Veterans Act''.

SEC. 2. DEVELOPMENT OF CRITERIA FOR DESIGNATION OF CERTAIN MEDICAL 
              FACILITIES OF THE DEPARTMENT OF VETERANS AFFAIRS AS 
              UNDERSERVED FACILITIES AND PLAN TO ADDRESS PROBLEM OF 
              UNDERSERVED FACILITIES.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall develop 
criteria to designate medical centers, ambulatory care facilities, and 
community based outpatient clinics of the Department of Veterans 
Affairs as underserved facilities.
    (b) Consideration.--Criteria developed under subsection (a) shall 
include consideration of the following with respect to a facility:
            (1) The ratio of veterans to health care providers of the 
        Department of Veterans Affairs for a standardized geographic 
        area surrounding the facility, including a separate ratio for 
        general practitioners and specialists.
            (2) The range of clinical specialties covered by such 
        providers in such area.
            (3) Whether the local community is medically underserved.
            (4) The type, number, and age of open consults.
            (5) Whether the facility is meeting the wait-time goals of 
        the Department.
            (6) Such other criteria as the Secretary considers 
        important in determining which facilities are not adequately 
        serving area veterans.
    (c) Analysis of Facilities.--Not less frequently than annually, 
directors of Veterans Integrated Service Networks of the Department 
shall perform an analysis to determine which facilities within that 
Veterans Integrated Service Network qualify as underserved facilities 
pursuant to criteria developed under subsection (a).
    (d) Annual Plan To Address Underserved Facilities.--
            (1) Plan required.--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 Congress a 
        plan to address the problem of underserved facilities of the 
        Department, as designated pursuant to criteria developed under 
        subsection (a).
            (2) Contents.--Each plan submitted under paragraph (1) 
        shall address the following:
                    (A) Increasing personnel or temporary personnel 
                assistance, including mobile deployment teams.
                    (B) Providing special hiring incentives, including 
                under the Education Debt Reduction Program under 
                subchapter VII of chapter 76 of title 38, United States 
                Code, and recruitment, relocation, and retention 
                incentives.
                    (C) Using direct hiring authority.
                    (D) Improving training opportunities for staff.
                    (E) Such other actions as the Secretary considers 
                appropriate.

SEC. 3. PILOT PROGRAM ON TUITION REIMBURSEMENT AND LOAN REPAYMENT FOR 
              HEALTH CARE PROVIDERS OF THE DEPARTMENT OF VETERANS 
              AFFAIRS AT UNDERSERVED FACILITIES.

    (a) In General.--Not later than 90 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall commence 
a pilot program to assess the feasibility and advisability of providing 
incentives to individuals to work at underserved facilities of the 
Veterans Health Administration by providing tuition reimbursement and 
loan repayment to medical students and health care providers who commit 
to serving in underserved facilities selected under subsection (c).
    (b) Duration.--The Secretary shall carry out the pilot program 
during the six-year period beginning on the date of the commencement of 
the pilot program.
    (c) Selection of Locations.--
            (1) In general.--The Secretary shall select not fewer than 
        three medical centers and seven ambulatory care facilities or 
        community based outpatient clinics of the Department to 
        participate in the pilot program.
            (2) Rural and highly rural areas.--Not fewer than two of 
        the medical centers and five of the ambulatory care facilities 
        or community based outpatient clinics selected under paragraph 
        (1) shall be in States or United States territories that are 
        among the ten States or United States territories with--
                    (A) the highest percentage of land designated as 
                highly rural pursuant to the rural-urban commuting area 
                codes set forth by the Department of Agriculture; or
                    (B) the highest percentage of enrolled veterans 
                living in rural, highly rural, or insular island areas.
            (3) States.--Facilities selected under paragraph (1) shall 
        be located in not fewer than eight different States.
    (d) Use of Amounts.--Of the amounts used to provide tuition 
reimbursement or loan repayment under the pilot program--
            (1) one-half shall be used to provide tuition reimbursement 
        or loan repayment for individuals practicing in a general 
        practice position; and
            (2) one-half shall be used to provide tuition reimbursement 
        or loan repayment for individuals practicing--
                    (A) in a specialist position; or
                    (B) in an occupation, other than a position 
                described in paragraph (1), included in the most recent 
                staffing shortage determination of the Department under 
                section 7412 of title 38, United States Code.
    (e) Tuition Reimbursement.--Under the pilot program, the Secretary 
may provide to an individual attending medical school and seeking a 
degree as a Doctor of Medicine or a Doctor of Osteopathic Medicine full 
tuition reimbursement in exchange for a five-year commitment to serve 
at an underserved facility selected under subsection (c).
    (f) Student Loan Repayment.--Under the pilot program, in exchange 
for a three-year commitment to serve at an underserved facility 
selected under subsection (c), the Secretary may provide--
            (1) to an individual currently serving as a health care 
        provider at an underserved facility, an amount not to exceed 
        $30,000 to apply to any remaining student loan debt of the 
        individual; and
            (2) to an individual other than an individual described in 
        paragraph (1), an amount not to exceed $50,000 to apply to any 
        remaining student loan debt of the individual.
    (g) Breach.--An individual who participates in the pilot program 
and fails to satisfy a period of obligated service under subsection (e) 
or (f) 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.
    (h) Expedited Hiring.--The Secretary shall ensure that the hiring 
of individuals to serve in the Department under the pilot program is 
conducted in an expedited manner.
    (i) Continuation in Pilot Program.--An individual participating in 
the pilot program in an occupation included in a staffing shortage 
determination of the Department under section 7412 of title 38, United 
States Code, may continue participating in the pilot program 
notwithstanding that the occupation is no longer included in such 
determination under such section.
    (j) Annual Report.--
            (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, the Secretary shall submit to Congress a 
        report on the pilot program.
            (2) Contents.--Each report submitted under paragraph (1) 
        shall include the following:
                    (A) The number of participants, including the 
                number receiving tuition reimbursement and student loan 
                repayment.
                    (B) The number of facilities where participants are 
                located.
                    (C) The number of individuals who have applied to 
                participate in the pilot program.
                    (D) A list of the five most common occupations of 
                the participants in the pilot program, other than 
                general practice.
    (k) Definitions.--In this section:
            (1) Enrolled veteran.--The term ``enrolled veteran'' means 
        a veteran who is enrolled in the system of annual patient 
        enrollment established and operated under section 1705(a) of 
        title 38, United States Code.
            (2) Underserved facility.--The term ``underserved 
        facility'' means a medical center, ambulatory care facility, or 
        community based outpatient clinic of the Department of Veterans 
        Affairs designated by the Secretary of Veterans Affairs 
        pursuant to criteria developed under section 2.

SEC. 4. REPORT ON WORKFORCE VACANCIES WITHIN THE VETERANS HEALTH 
              ADMINISTRATION.

    (a) In General.--Not later than 120 days 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 
vacancies within the Veterans Health Administration.
    (b) Elements.--The report required by subsection (a) shall include 
the following:
            (1) With respect to vacancies of personnel appointed under 
        section 7401 of title 38, United States Code--
                    (A) the total number of such vacancies;
                    (B) the number of such vacancies disaggregated by 
                occupation, State, Veterans Integrated Service Network, 
                medical facility, and the central office of the 
                Department of Veterans Affairs; and
                    (C) a description of the plans of the Secretary to 
                fill such vacancies, including a timeline for filling 
                such vacancies, and an assessment of whether the 
                Secretary requires additional hiring authorities to 
                expedite the hiring process.
            (2) With respect to vacancies of human resource specialists 
        of the Veterans Health Administration--
                    (A) the total number of such vacancies;
                    (B) the number of such vacancies disaggregated by 
                State and medical facility; and
                    (C) a description of the plans of the Secretary to 
                fill such vacancies, including a timeline for filling 
                such vacancies, and an assessment of whether the 
                Secretary requires additional hiring authorities to 
                expedite the hiring process.
            (3) A description of any impediments to filling the 
        vacancies described in paragraphs (1) and (2) and any actions 
        the Secretary intends to take to address such impediments.
            (4) An update on the implementation by the Secretary of--
                    (A) the Veterans Health Administration Workforce 
                and Succession Strategic Plan for 2016;
                    (B) the recommendation by the Office of the 
                Inspector General of the Department that the Under 
                Secretary for Health develop staffing models for 
                critical need occupations of the Veterans Health 
                Administration, as determined by the Secretary; and
                    (C) the recommendation by the Office of the 
                Inspector General that the Under Secretary for Health 
                establish milestones and timetables for further 
                development, piloting, and implementation of staffing 
                models for critical need occupations of the Veterans 
                Health Administration, as determined by the Secretary.

SEC. 5. ASSIGNMENT TO DEPARTMENT OF VETERANS AFFAIRS OF COMMISSIONED 
              OFFICERS OF THE REGULAR CORPS OF THE PUBLIC HEALTH 
              SERVICE.

    (a) Assignment.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        and the Surgeon General shall enter into a memorandum of 
        understanding for the assignment of not fewer than 500 
        commissioned officers of the Regular Corps of the Public Health 
        Service to the Department of Veterans Affairs.
            (2) Manner of assignment.--Assignments under paragraph (1) 
        shall be made in the same manner in which assignments are made 
        to other Federal agencies.
    (b) Reimbursement.--The Secretary shall reimburse the Surgeon 
General for such expenses as the Surgeon General may incur in assigning 
commissioned officers pursuant to a memorandum of understanding entered 
into under subsection (a).
    (c) Report.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Secretary and the Surgeon 
        General shall each 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 memorandum of 
        understanding entered into under subsection (a) and the 
        commissioned officers assigned pursuant to such memorandum of 
        understanding.
            (2) Contents.--The report required by paragraph (1) shall 
        include the following:
                    (A) The numbers, grades, and specialties of 
                commissioned officers assigned pursuant to the 
                memorandum of understanding entered into under 
                subsection (a).
                    (B) A description of any problems encountered in 
                such assignment.

SEC. 6. INCLUSION OF VET CENTER EMPLOYEES IN EDUCATION DEBT REDUCTION 
              PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--The Secretary of Veterans Affairs shall ensure 
that clinical staff working at Vet Centers are eligible to participate 
in the education debt reduction program of the Department of Veterans 
Affairs under subchapter VII of chapter 76 of title 38, United States 
Code.
    (b) 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 number of participants 
in the education debt reduction program of the Department under such 
subchapter who work at Vet Centers.
    (c) Vet Center Defined.--In this section, the term ``Vet Center'' 
has the meaning given that term in section 1712A(h) of title 38, United 
States Code.
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