[Congressional Record Volume 144, Number 67 (Friday, May 22, 1998)]
[Senate]
[Pages S5441-S5445]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ROCKEFELLER (for himself and Ms. Mikulski):
  S. 2115. A bill to amend title 38, United States Code, to establish a 
scholarship program and an education loan debt reduction program to 
facilitate the employment of primary care and other health care 
professional by the Veterans Health Administration, and for other 
purposes; to the Committee on Veterans' Affairs.


department of veterans affairs primary care providers incentive act of 
                                  1998

 Mr. ROCKEFELLER. Mr. President, I am pleased today to 
introduce the following legislation, ``The Department of Veterans 
Affairs Primary Care Providers Incentive Act of 1998.'' This 
legislation is intended to revitalize the VA's Health Professionals 
Education Assistance Program, thereby reducing waste, targeting primary 
care professions and under-served areas, and making the VA more 
competitive with private employers for skilled personnel. I am pleased 
to be joined by my respected colleague from Maryland, Senator Mikulski, 
in this effort. I urge our colleagues to join us in supporting this 
legislation.
  The VA health care system is in the midst of a major reorganization 
that is simultaneously reducing the current workforce and creating the 
need for more primary care health professionals. This reorganization 
has dramatically changed the way the VA delivers health care, by 
shifting the emphasis to outpatient rather than inpatient care. As part 
of this process, the Department of Veterans Affairs has set a goal of 
doubling the number of primary care providers in the VA health care 
system, and we want to assist them. There are two good ways to hire and 
keep highly skilled professionals--offer incentives to current 
employees to get training in new areas of need by providing 
scholarships, and recruit new primary care providers by offering 
assistance in paying off student loans. This legislation, which 
includes both a scholarship program and an education debt reduction 
program, can help.
  The VA needs educational assistance programs such as these to 
effectively recruit and retain trained primary care health 
professionals. In the VA hospitals and clinics, some of the most 
difficult positions to fill are those of nurse practitioners, physical 
therapists, and occupational therapists. In my home state of West 
Virginia, for example, at one of the VA hospitals there has been a 
vacancy for an occupational therapist for over twelve years! Two of the 
VA hospitals have no physical therapists at all. This is simply 
unacceptable.
  The plain fact is that the VA cannot offer the same starting salaries 
as those available in private practice. The Education Debt Reduction 
Program included within the Primary Care Providers Incentive Act gives 
the VA a financial recruitment tool that will be

[[Page S5442]]

an enormous help in making the VAMCs more competitive for these much-
needed and highly skilled individuals. This program was first designed 
by Senator Mikulski in 1993 in recognition of this very problem. It was 
needed then, and it is still needed now.
  Recruitment is only half the problem in building a new workforce that 
is geared toward providing primary care. Retention of trained people, 
especially in the face of low morale due to budget cuts, is equally 
important. The scholarship program in this legislation is designed to 
answer this very need. Eligibility is limited to current VA employees, 
thus enabling VA to build staff morale. The scholarship program 
provides a means for vulnerable employees to protect themselves against 
future RIFs by acquiring training in the new areas of need. And, VA 
gets the workforce they need, composed of motivated and loyal 
employees.
  Professional associations representing primary care health workers, 
VAMC human resources personnel, and past recipients of VA scholarships 
are strongly in support of this legislation. Although this is a time of 
budget reductions in health care, these programs are a worthwhile 
investment, enhancing morale of the VA health care providers in the 
short term, while building a workforce that matches VA's needs and 
improves veterans' health care in the long run.
  Mr. President, I ask that the text of the bill be printed in the 
Record at this point.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2115

       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 ``Department of Veterans 
     Affairs Primary Care Providers Incentive Act of 1998''.

     SEC. 2. SCHOLARSHIP PROGRAM FOR DEPARTMENT OF VETERANS 
                   AFFAIRS EMPLOYEES RECEIVING EDUCATION OR 
                   TRAINING IN THE HEALTH PROFESSIONS.

       (a) Program Authority.--(1) Chapter 76 of title 38, United 
     States Code, is amended by adding at the end the following 
     new subchapter:

        ``SUBCHAPTER VI--EMPLOYEE INCENTIVE SCHOLARSHIP PROGRAM

     ``Sec. 7671. Authority for program

       ``As part of the Educational Assistance Program, the 
     Secretary shall carry out a scholarship program under this 
     subchapter. The program shall be known as the Department of 
     Veterans Affairs Employee Incentive Scholarship Program 
     (hereinafter in this subchapter referred to as the 
     `Program').

     ``Sec. 7672. Eligibility; agreement

       ``(a) Eligibility.--To be eligible to participate in the 
     Program, an individual--
       ``(1) must be an eligible Department employee who is 
     accepted for enrollment or enrolled (as described in section 
     7602 of this title) as a full-time or part-time student in a 
     field of education or training described in subsection (c); 
     and
       ``(2) must demonstrate financial need, as determined under 
     regulations prescribed by the Secretary.
       ``(b) Eligible Department Employees.--For purposes of 
     subsection (a), an eligible Department employee is any 
     employee of the Department who, as of the date on which the 
     employee submits an application for participation in the 
     Program, has been continuously employed by the Department for 
     not less than two years.
       ``(c) Qualifying Fields of Education or Training.--A 
     scholarship may be awarded under the Program only for 
     education and training in a field leading to appointment or 
     retention in a position under section 7401 of this title.
       ``(d) Preference in Award of Scholarships.--(1) 
     Notwithstanding section 7603(d) of this title and subject to 
     paragraph (2), in selecting participants in the Program, the 
     Secretary shall give preference to the following applicants, 
     in the order specified:
       ``(A) Applicants who are or will be pursuing a course of 
     education or training in a field relating to the provision of 
     primary care health services, as designated by the Secretary.
       ``(B) Applicants who are employed at Department health-care 
     facilities located in rural areas or at which there is an 
     inadequate supply of individuals qualified to hold a position 
     under section 7401 of this title, as so designated.
       ``(2) In the case of a pool of applicants covered by 
     subparagraph (A) or (B) of paragraph (1), the Secretary shall 
     give preference in the award of scholarships to the members 
     of the pool who have the greatest financial need.
       ``(3) The Secretary shall maintain, and update 
     periodically, a list setting forth--
       ``(A) the fields of education or training covered by 
     subparagraph (A) of paragraph (1); and
       ``(B) the facilities covered by subparagraph (B) of that 
     paragraph.
       ``(e) Agreement.--(1) An agreement between the Secretary 
     and a participant in the Program shall (in addition to the 
     requirements set forth in section 7604 of this title) include 
     the following:
       ``(A) The Secretary's agreement to provide the participant 
     with a scholarship under the Program for a specified number 
     (from one to three) of school years during which the 
     participant pursues a course of education or training 
     described in subsection (c) that meets the requirements set 
     forth in section 7602(a) of this title.
       ``(B) The participant's agreement to serve as a full-time 
     employee in the Veterans Health Administration for a period 
     of time (hereinafter in this subchapter referred to as the 
     `period of obligated service') of one calendar year for each 
     school year or part thereof for which the participant was 
     provided a scholarship under the Program, but for not less 
     than two years.
       ``(C) The participant's agreement to serve under 
     subparagraph (B) in a Department facility selected by the 
     Secretary.
       ``(2) In a case in which an extension is granted under 
     section 7673(c)(2) of this title, the number of years for 
     which a scholarship may be provided under the Program shall 
     be the number of school years provided for as a result of the 
     extension.
       ``(3) In the case of a participant who is a part-time 
     student--
       ``(A) the period of obligated service shall be reduced in 
     accordance with the proportion that the number of credit 
     hours carried by such participant in any such school year 
     bears to the number of credit hours required to be carried by 
     a full-time student in the course of training being pursued 
     by the participant, but in no event to less than one year; 
     and
       ``(B) the agreement shall include the participant's 
     agreement to maintain employment, while enrolled in such 
     course of education or training, as a Department employee 
     permanently assigned to a Department health-care facility.

     ``Sec. 7673. Scholarship

       ``(a) Scholarship.--A scholarship provided to a participant 
     in the Program for a school year shall consist of payment of 
     the tuition of the participant for that school year and 
     payment of other reasonable educational expenses (including 
     fees, books, and laboratory expenses) for that school year.
       ``(b) Amounts.--The total amount of the scholarship payable 
     under subsection (a)--
       ``(1) in the case of a participant in the Program who is a 
     full-time student, may not exceed $10,000 for any one year; 
     and
       ``(2) in the case of a participant in the Program who is a 
     part-time student, shall be the amount specified in paragraph 
     (1) reduced in accordance with the proportion that the number 
     of credit hours carried by the participant in that school 
     year bears to the number of credit hours required to be 
     carried by a full-time student in the course of education or 
     training being pursued by the participant.
       ``(c) Limitation on Years of Payment.--(1) Subject to 
     paragraph (2), a participant in the Program may not receive a 
     scholarship under subsection (a) for more than three school 
     years.
       ``(2) The Secretary may extend the number of school years 
     for which a scholarship may be awarded to a participant in 
     the Program who is a part-time student to a maximum of six 
     school years if the Secretary determines that the extension 
     would be in the best interest of the United States.
       ``(d) Payment of Educational Expenses by Educational 
     Institutions.--The Secretary may arrange with an educational 
     institution in which a participant in the Program is enrolled 
     for the payment of the educational expenses described in 
     subsection (a). Such payments may be made without regard to 
     subsections (a) and (b) of section 3324 of title 31.

     ``Sec. 7674. Status of certain participants

       ``(a) Status.--A participant in the Program described in 
     subsection (b) shall not, by reason of such participation--
       ``(1) be considered an employee of the Federal Government; 
     or
       ``(2) be counted against any personnel ceiling affecting 
     the Veterans Health Administration.
       ``(b) Covered Participants.--Subsection (a) applies in the 
     case of any participant in the Program who is a student on a 
     full-time basis and is not performing service for the 
     Department.

     ``Sec. 7675. Obligated service

       ``(a) In General.--Each participant in the Program shall 
     provide service as a full-time employee of the Department for 
     the period of obligated service provided in the agreement of 
     the participant entered into under section 7603 of this 
     title. Such service shall be provided in the full-time 
     clinical practice of such participant's profession or in 
     another health-care position in an assignment or location 
     determined by the Secretary.
       ``(b) Determination of Service Commencement Date.--(1) Not 
     later than 60 days before a participant's service 
     commencement date, the Secretary shall notify the participant 
     of that service commencement date. That date is the date for 
     the beginning of the participant's period of obligated 
     service.
       ``(2) As soon as possible after a participant's service 
     commencement date, the Secretary shall--
       ``(A) in the case of a participant who is not a full-time 
     employee in the Veterans Health

[[Page S5443]]

     Administration, appoint the participant as such an employee; 
     and
       ``(B) in the case of a participant who is an employee in 
     the Veterans Health Administration but is not serving in a 
     position for which the participant's course of education or 
     training prepared the participant, assign the participant to 
     such a position.
       ``(3)(A) In the case of a participant receiving a degree 
     from a school of medicine, osteopathy, dentistry, optometry, 
     or podiatry, the participant's service commencement date is 
     the date upon which the participant becomes licensed to 
     practice medicine, osteopathy, dentistry, optometry, or 
     podiatry, as the case may be, in a State.
       ``(B) In the case of a participant receiving a degree from 
     a school of nursing, the participant's service commencement 
     date is the later of--
       ``(i) the participant's course completion date; or
       ``(ii) the date upon which the participant becomes licensed 
     as a registered nurse in a State.
       ``(C) In the case of a participant not covered by 
     subparagraph (A) or (B), the participant's service 
     commencement date is the later of--
       ``(i) the participant's course completion date; or
       ``(ii) the date the participant meets any applicable 
     licensure or certification requirements.
       ``(4) The Secretary shall by regulation prescribe the 
     service commencement date for participants who were part-time 
     students. Such regulations shall prescribe terms as similar 
     as practicable to the terms set forth in paragraph (3).
       ``(c) Commencement of Obligated Service.--(1) Except as 
     provided in paragraph (2), a participant in the Program shall 
     be considered to have begun serving the participant's period 
     of obligated service--
       ``(A) on the date, after the participant's course 
     completion date, on which the participant (in accordance with 
     subsection (b)) is appointed as a full-time employee in the 
     Veterans Health Administration; or
       ``(B) if the participant is a full-time employee in the 
     Veterans Health Administration on such course completion 
     date, on the date thereafter on which the participant is 
     assigned to a position for which the participant's course of 
     training prepared the participant.
       ``(2) A participant in the Program who on the participant's 
     course completion date is a full-time employee in the 
     Veterans Health Administration serving in a capacity for 
     which the participant's course of training prepared the 
     participant shall be considered to have begun serving the 
     participant's period of obligated service on such course 
     completion date.
       ``(d) Course Completion Date Defined.--In this section, the 
     term `course completion date' means the date on which a 
     participant in the Program completes the participant's course 
     of education or training under the Program.

     ``Sec. 7676. Breach of agreement: liability

       ``(a) Liquidated Damages.--A participant in the Program 
     (other than a participant described in subsection (b)) who 
     fails to accept payment, or instructs the educational 
     institution in which the participant is enrolled not to 
     accept payment, in whole or in part, of a scholarship under 
     the agreement entered into under section 7603 of this title 
     shall be liable to the United States for liquidated damages 
     in the amount of $1,500. Such liability is in addition to any 
     period of obligated service or other obligation or liability 
     under the agreement.
       ``(b) Liability During Course of Education or Training.--
     (1) Except as provided in subsection (d), a participant in 
     the Program shall be liable to the United States for the 
     amount which has been paid to or on behalf of the participant 
     under the agreement if any of the following occurs:
       ``(A) The participant fails to maintain an acceptable level 
     of academic standing in the educational institution in which 
     the participant is enrolled (as determined by the educational 
     institution under regulations prescribed by the Secretary).
       ``(B) The participant is dismissed from such educational 
     institution for disciplinary reasons.
       ``(C) The participant voluntarily terminates the course of 
     education or training in such educational institution before 
     the completion of such course of education or training.
       ``(D) The participant fails to become licensed to practice 
     medicine, osteopathy, dentistry, podiatry, or optometry in a 
     State, fails to become licensed as a registered nurse in a 
     State, or fails to meet any applicable licensure requirement 
     in the case of any other health-care personnel who provide 
     either direct patient-care services or services incident to 
     direct patient-care services, during a period of time 
     determined under regulations prescribed by the Secretary.
       ``(E) In the case of a participant who is a part-time 
     student, the participant fails to maintain employment, while 
     enrolled in the course of training being pursued by the 
     participant, as a Department employee.
       ``(2) Liability under this subsection is in lieu of any 
     service obligation arising under a participant's agreement.
       ``(c) Liability During Period of Obligated Service.--(1) 
     Except as provided in subsection (d), if a participant in the 
     Program breaches the agreement by failing for any reason to 
     complete such participant's period of obligated service, the 
     United States shall be entitled to recover from the 
     participant an amount determined in accordance with the 
     following formula:

 
                                              t-s
         A=3F                 (       -------------------        )
                                               t
------------------------------------------------------------------------
 

       ``(2) In such formula:
       ``(A) `A' is the amount the United States is entitled to 
     recover.
       ``(B) `F' is the sum of--
       ``(i) the amounts paid under this subchapter to or on 
     behalf of the participant; and
       ``(ii) the interest on such amounts which would be payable 
     if at the time the amounts were paid they were loans bearing 
     interest at the maximum legal prevailing rate, as determined 
     by the Treasurer of the United States.
       ``(C) `t' is the total number of months in the 
     participant's period of obligated service, including any 
     additional period of obligated service in accordance with 
     section 7673(c)(2) of this title.
       ``(D) `s' is the number of months of such period served by 
     the participant in accordance with section 7673 of this 
     title.
       ``(d) Limitation on Liability for Reductions-in-Force.--
     Liability shall not arise under subsection (b)(1)(E) or (c) 
     in the case of a participant otherwise covered by the 
     subsection concerned if the participant fails to maintain 
     employment as a Department employee due to a reduction-in-
     force.
       ``(e) Period for Payment of Damages.--Any amount of damages 
     which the United States is entitled to recover under this 
     section shall be paid to the United States within the one-
     year period beginning on the date of the breach of the 
     agreement.

     ``Sec. 7677. Expiration of program

       ``The Secretary may not furnish scholarships to individuals 
     who commence participation in the Program after December 31, 
     2001.''.
       (2) The table of sections at the beginning of chapter 76 of 
     title 38, United States Code, is amended by adding at the end 
     the following:

        ``SUBCHAPTER VI--EMPLOYEE INCENTIVE SCHOLARSHIP PROGRAM

``7671. Authority for program.
``7672. Eligibility; agreement.
``7673. Scholarship.
``7674. Status of certain participants.
``7675. Obligated service.
``7676. Breach of agreement: liability.
``7677. Expiration of program.''.
       (b) Regulations.--The Secretary of Veterans Affairs may 
     treat regulations prescribed subchapter II of chapter 76 of 
     title 38, United States Code, as regulations required under 
     subchapter VI of that chapter, as added by subsection (a), 
     but only to the extent that the regulations prescribed under 
     such subchapter II are not inconsistent with the provisions 
     of such subchapter VI.

     SEC. 3. EDUCATION DEBT REDUCTION PROGRAM FOR VETERANS HEALTH 
                   ADMINISTRATION HEALTH PROFESSIONALS.

       (a) Program Authority.--Chapter 76 of title 38, United 
     States Code (as amended by section 2), is further amended by 
     adding after subchapter VI the following new subchapter:

           ``SUBCHAPTER VII--EDUCATION DEBT REDUCTION PROGRAM

     ``Sec. 7681. Authority for program

       ``(a) In General.--(1) As part of the Educational 
     Assistance Program, the Secretary may carry out an education 
     debt reduction program under this subchapter. The program 
     shall be known as the Department of Veterans Affairs Primary 
     Care Workers Education Debt Reduction Program (hereinafter in 
     this subchapter referred to as the `Education Debt Reduction 
     Program').
       ``(2) The purpose of the Education Debt Reduction Program 
     is to assist personnel serving in health-care positions in 
     the Veterans Health Administration in reducing the amount of 
     debt incurred by such personnel in completing programs of 
     education or training that qualified such personnel for such 
     service.
       ``(b) Relationship to Educational Assistance Program.--
     Education debt reduction payments under the Education Debt 
     Reduction Program shall be in addition to other assistance 
     available to individuals under the Educational Assistance 
     Program.

     ``Sec. 7682. Eligibility

       ``(a) Eligibility.--An individual eligible to participate 
     in the Education Debt Reduction Program is any individual 
     who--
       ``(1) is serving in a position in the Veterans Health 
     Administration under an appointment under section 7402(b) of 
     this title; and
       ``(2) owes any amount of principal or interest under a loan 
     the proceeds of which were used by or on behalf of the 
     individual to pay costs relating to a course of education or 
     training which led to a degree that qualified the individual 
     for a position referred to in paragraph (1).
       ``(b) Covered Costs.--For purposes of subsection (a)(2), 
     costs relating to a course of education or training include--
       ``(1) tuition expenses;
       ``(2) all other reasonable educational expenses, including 
     expenses for fees, books, and laboratory expenses; and
       ``(3) reasonable living expenses.

     ``Sec. 7683. Preference

       ``(a) Preference.--Notwithstanding section 7603(d) of this 
     title, in selecting individuals for education debt reduction 
     payments

[[Page S5444]]

     under the Education Debt Reduction Program, the Secretary 
     shall give preference to the following (in the order 
     specified):
       ``(1) Individuals recently appointed by the Secretary to 
     positions under section 7401 of this title in fields relating 
     to primary care health services, as designated by the 
     Secretary.
       ``(2) Individuals recently appointed by the Secretary to 
     positions under such section in areas in which the 
     recruitment or retention of an adequate supply of qualified 
     health-care personnel is difficult, as so designated.
       ``(3) Any other individuals serving in appointments to 
     positions described in paragraphs (1) and (2).
       ``(b) Recently Appointed Individuals.--An individual shall 
     be treated as recently appointed to a position for purposes 
     of subsection (a) if the individual was appointed to the 
     position not more than 6 months before the date of treatment 
     for such purposes.

     ``Sec. 7684. Education debt reduction

       ``(a) In General.--Education debt reduction payments under 
     the Education Debt Reduction Program shall consist of 
     payments to individuals selected to participate in the 
     program of amounts to reimburse such individuals for payments 
     by such individuals of principal and interest on loans 
     described in section 7682(a)(2) of this title.
       ``(b) Frequency of Payment.--(1) The Secretary may make 
     education debt reduction payments to any given participant in 
     the Education Debt Reduction Program on a monthly or annual 
     basis, at the election of the Secretary.
       ``(2) The Secretary shall make such payments at the end of 
     the period elected by the Secretary under paragraph (1).
       ``(c) Performance Requirement.--The Secretary may make 
     education debt reduction payments to a participant in the 
     Education Debt Reduction Program for a period only if the 
     Secretary determines that the individual maintained an 
     acceptable level of performance in the position or positions 
     served by the participant during the period.
       ``(d) Maximum Annual Amount.--(1) Subject to paragraph (2), 
     the total amount of education debt reduction payments made to 
     a participant for a year under the Education Debt Reduction 
     Program shall be--
       ``(A) $6,000 for the first year of the participant's 
     participation in such Program;
       ``(B) $8,000 for the second year of the participant's 
     participation in such Program; and
       ``(C) $10,000 for the third year of the participant's 
     participation in such Program.
       ``(2) The total amount payable to a participant in such 
     Program for any year may not exceed the amount of the 
     principle and interest on loans referred to in subsection (a) 
     that is paid by the individual during such year.

     ``Sec. 7685. Expiration of program

       ``The Secretary may not make education debt reduction 
     payments to individuals who commence participation in the 
     Education Debt Reduction Program after December 31, 2001.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of chapter 76 of title 38, United States Code (as 
     amended by section 2(b)), is further amended by adding at the 
     end the following:

           ``SUBCHAPTER VII--EDUCATION DEBT REDUCTION PROGRAM

``7681. Authority for program.
``7682. Eligibility.
``7683. Preference.
``7684. Education debt reduction.
``7685. Expiration of program.''.

     SEC. 4. REPEAL OF PROHIBITION ON PAYMENT OF TUITION LOANS.

       Section 523(b) of the Veterans Health Care Act of 1992 
     (Public Law 102-585; 106 Stat. 4959; 38 U.S.C. 7601 note) is 
     repealed.

     SEC. 5. OUTREACH.

       The Secretary of Veterans Affairs shall take appropriate 
     actions to notify employees of the Department of Veterans 
     Affairs of the benefits available under the Department of 
     Veterans Affairs Employee Incentive Scholarship Program under 
     subchapter VI of chapter 76 of title 38, United States Code 
     (as added by section 2), and under the Department of Veterans 
     Affairs Primary Care Workers Education Debt Reduction Program 
     under subchapter VII of that chapter (as added by section 3).

     SEC. 6. CONFORMING AMENDMENTS.

       Chapter 76 of title 38, United States Code (as amended by 
     this Act), is further amended as follows:
       (1) In section 7601(a)--
       (A) by striking out ``and'' at the end of paragraph (2);
       (B) by striking out the period at the end of paragraph (3) 
     and inserting in lieu thereof a semicolon; and
       (C) by adding at the end the following:
       ``(4) the employee incentive scholarship program provided 
     for in subchapter VI of this chapter; and''; and
       ``(5) the education debt reduction program provided for in 
     subchapter VII of this chapter.''.
       (2) In section 7602--
       (A) in subsection (a)(1)--
       (i) by striking out ``subchapter I or II'' and inserting in 
     lieu thereof ``subchapter II, III, or VI'';
       (ii) by striking out ``or for which'' and inserting in lieu 
     thereof ``, for which''; and
       (iii) by inserting before the period at the end the 
     following: ``, or for which a scholarship may be awarded 
     under subchapter VI of this chapter, as the case may be''; 
     and
       (B) in subsection (b), by striking out ``subchapter I or 
     II'' and inserting in lieu thereof ``subchapter II, III, or 
     VI''.
       (3) In section 7603--
       (A) in subsection (a)--
       (i) by striking out ``To apply to participate in the 
     Educational Assistance Program,'' and inserting in lieu 
     thereof ``(1) To apply to participate in the Educational 
     Assistance Program under subsection II, III, V, or VI of this 
     chapter,''; and
       (ii) by adding at the end the following:
       ``(2) To apply to participate in the Educational Assistance 
     Program under subchapter VII of this chapter, an individual 
     shall submit to the Secretary an application for such 
     participation.''; and
       (B) in subsection (b)(1), by inserting ``(if required)'' 
     before the period at the end.
       (4) In section 7604, by striking out ``subchapter II, III, 
     or V'' each place it appears in paragraphs (1)(A), (2)(D), 
     and (5) and inserting in lieu thereof ``subchapter II, III, 
     V, or VI''.
       (5) In section 7632--
       (A) in paragraph (1)--
       (i) by striking out ``and the Tuition Reimbursement 
     Program'' and inserting in lieu thereof ``, the Tuition 
     Reimbursement Program, the Employee Incentive Scholarship 
     Program, and the Education Debt Reduction Program''; and
       (ii) by inserting ``(if any)'' after ``number of 
     students'';
       (B) in paragraph (2), by inserting ``(if any)'' after 
     ``education institutions''; and
       (C) in paragraph (4)--
       (i) by striking ``and per participant'' and inserting in 
     lieu thereof ``, per participant''; and
       (ii) by inserting ``, per participant in the Employee 
     Incentive Scholarship Program, and per participant in the 
     Education Debt Reduction Program'' before the period at the 
     end.
       (6) In section 7636, by striking ``or a stipend'' and 
     inserting ``a stipend, or education debt reduction''.

 Ms. MIKULSKI. Mr. President, today I am cosponsoring with 
Senator Rockefeller, the DVA Primary Care Incentive Act of 1998.
  Mr. President, I believe that this bill will ultimately benefit our 
veterans. It will help the Department of Veterans Affairs in its effort 
to provide the highest quality of care that our veterans deserve.
  Mr. President, this bill will create a new Education Debt Reduction 
program, and an Employee Incentive Scholarship Program. The Debt 
Reduction Program will aid the VA in its efforts to increase its number 
of primary care professionals. Preference will be given to those 
choosing to serve at rural or under-served sites, and to those 
professionals in hard to fill specialties. The bill provides the 
Secretary of the VA with the discretion to determine priority needs 
with respect to profession, and locations with the greatest need. Debt 
Reduction program recipients will have to serve a term with the VA 
equivalent to the length of the repayments. A key component of the Debt 
Reduction Program is that each years repayments won't begin until a 
person has completed a corresponding year of service to the VA. This 
requirement is critical to ensuring that our veterans get the service 
they deserve, and that taxpayers get a return on their tax dollars 
invested.
  Mr. President, I introduced a debt reduction bill in 1992 because I 
recognized the need to provide the VA with adequate resources to 
recruit the professionals it needs. And I realized that some who may 
want to get the training to help our veterans may not have all of the 
necessary means to do so. I applaud Senator Rockefeller for including 
an updated debt reduction component to this bill.
  The second component of the bill is the Employee Incentive 
Scholarship Program. This is designed to help meet the VA's need for 
more primary care professionals and to help retain and retrain some of 
the VA's current employees. Like the Debt Reduction program, priority 
would be given to those willing to serve in under-served areas and in 
hard to fill specialties. Recipients would also have to serve at a VA 
clinical site for a term equivalent to the scholarship term. The 
difference is that the Scholarship program would be open only to 
current VA employees with a minimum of two years of service. We want to 
ensure that those benefiting from the Scholarship program have 
demonstrated a commitment to the VA. We also want to provide the 
opportunity structure for those employees who want to expand their 
skills and move into new fields.
  In 1996, Veterans Health Administration Under Secretary for Health, 
Dr. Kenneth Kizer, published a work called ``Prescription for Change''. 
In it, he noted the VA's goal to increase the

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number of VA non-physician primary care providers by 200 percent by 
1998. While the VA has made progress, it has not met its goal. This 
bill seeks to provide another tool in the VA's tool belt that will 
allow it to meet its goal.
  Mr. President, I have been an advocate for our nation's veterans for 
years. I firmly believe that promises made to our nations veterans must 
be promises kept. Our veterans risked their lives for our freedom and 
the protection of democracy. I believe that we as a nation are 
committed to providing the services that our veterans need.
  As the VA continues its move to more outpatient primary care, we must 
make sure that the VA can attract and retain the type of professionals 
who can give our veterans the medical care and treatment they deserve.
  I urge my colleagues' support.
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