[Congressional Record Volume 155, Number 53 (Monday, March 30, 2009)]
[Senate]
[Pages S3988-S3991]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. AKAKA (for himself, Mr. Baucus, and Mr. Begich):
  S. 734. A bill to amend title 38, United States Code, to improve the 
capacity of the Department of Veterans Affairs to recruit and retain 
physicians in Health Professional Shortage Areas and to improve the 
provision of health care to veterans in rural areas, and for other 
purposes; to the Committee on Veterans' Affairs.
  Mr. AKAKA. Mr. President, I am today introducing legislation to make 
various improvements to VA rural health care. I am pleased to be joined 
in this effort by Senators Max Baucus and Mark Begich. The legislation 
is designed to bring more doctors into small communities; promote the 
use of volunteer counselors to help with mental health issues; expand 
telemedicine services; and create incentives for VA's community 
partners to provide high quality services to veterans.
  As the drawdown of forces in Iraq begins, VA must be prepared to meet 
the health care needs of veterans upon their return.
  Many veterans live in small towns and communities. This includes a 
large number of Guard members and Reservists who have served in such an 
integral role in Iraq and Afghanistan. Members of the Guard and Reserve 
face challenges that are different than those faced by their active 
duty counterparts, who return to military bases with the support of 
their unit and programs geared toward re-acclimating them to life 
outside of the combat zone. When members of the Guard or Reserves 
return home, they often are isolated from their units, leaving them to 
reintegrate back into their communities without a strong VA or DoD 
presence or support system.
  When health care is needed, a rural community may not have providers 
who offer mental health services, such as group counseling, and may not 
be familiar with treating combat-related disorders.
  I believe strongly that there is an obligation to care for all 
veterans in need, regardless of where they live. We must ensure that 
adequate resources are available to serve those who live in rural 
communities, and that VA works closely with local health care providers 
to help meet the need for care. It is critical that VA reach out to 
veterans living in rural communities so that they receive the care they 
need. Every resource must be united in the effort to care for wounded 
warriors, whether in a community hospital or VA clinic. When there is 
no VA presence in a community, VA may need to pay community providers 
for the reasonable costs of care.
  Last month, the Committee on Veterans' Affairs held a hearing on 
health care for veterans in rural areas. We heard from the chief 
executive officer of a community hospital, from a former director of a 
rural health clinic, and from outreach organizations who work to bridge 
the gap between VA and community health care systems. These witnesses 
testified about how hard it is for veterans who live in rural areas to 
find health care in the communities where they live, and about how 
difficult it is for community hospitals and clinics to provide quality 
services with the limited resources available to them.
  Committee on Veterans' Affairs staff also conducted an oversight 
visit to Hawaii and saw firsthand the needs of veterans living in rural 
communities on the neighbor islands. Many of those veterans find it 
hard to access VA health care because of travel restrictions and a 
shortage of services in their communities. Committee staff found that 
technology was not being used to bridge this gap; indeed, the use of 
telemedicine is actually declining in Hawaii.
  The legislation we are introducing today would help address the needs 
of veterans living in rural communities in a number of ways.
  First, the bill would bring more doctors to targeted communities by 
repaying their student loans while they work for VA. Currently, VA's 
loan repayment program is capped at an amount that is less than \1/3\ 
the average cost of medical school. This bill would remove the cap, 
allowing VA to offer full loan repayment so as to provide a much more 
effective recruitment tool.
  In addition, this bill would encourage VA and HHS to use the National 
Health Service Corps Scholarship Program to recruit physicians for VA 
facilities located in underserved areas. The National Health Service 
Corps pays for medical school up front in exchange for a doctor's 
agreement to work in an underserved area after graduation.
  To address the shortage of mental health providers in many 
communities, this legislation would also allow VA to shorten the 
credentialing and privileging process for licensed volunteer counselors 
who could provide mental health services to our veterans.
  The legislation would also create a pilot program to place VA doctors 
in community hospitals so as to enable them to provide more continuous 
care for veterans. Under this pilot, VA doctors working in communities 
without a VA hospital would be able to follow their patients when 
admitted to the local hospital. Participating VA doctors would earn 
additional compensation for assuming these responsibilities, thereby 
creating financial incentives for doctors to stay within VA. Since many 
non-VA hospitals do not have mental health providers or other providers 
experienced in the treatment of conditions such as post-traumatic 
stress disorder that disproportionately affect veterans, this would 
also bring needed expertise into other care communities.
  This bill would also allow VA to monitor the quality of care provided 
in non-VA facilities. Currently, there is no way for VA to do such 
quality assurance in a systematic way. This bill would encourage VA's 
community partners to participate in quality programs like peer review, 
or to seek accreditation by an outside organization.
  This bill also would bring new technologies to rural communities. By 
modifying VA's internal mechanism for distributing funds, the 
legislation would provide incentives for VA hospitals and clinics to 
use telehealth technologies. VA currently bases the distribution of 
funds to its facilities on workload and does not currently count all 
telehealth visits in a facility's workload. By requiring VA to give 
hospitals and clinics credit for telehealth

[[Page S3989]]

visits, this bill will promote the natural expansion of these services 
to our veterans.
  Finally, for those veterans who must travel by air to obtain their 
health care--because of their health status, geography or other 
barriers--this bill would allow VA to pay beneficiary travel benefits 
for airfare to those veterans who cannot afford it. In recognition of 
the cost of airfare, a different income eligibility standard from that 
used for ground transportation would be used in connection with 
reimbursement of the costs of air travel.
  I urge our colleagues to work with me and the other members of the 
Veterans' Affairs Committee to improve access to health care for 
veterans who live in rural areas.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
placed in the Record, as follows:

                                 S. 734

       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 Health Care 
     Access and Quality Act of 2009''.

     SEC. 2. ENHANCEMENT OF DEPARTMENT OF VETERANS AFFAIRS 
                   EDUCATION DEBT REDUCTION PROGRAM.

       (a) Enhanced Maximum Annual Amount.--Paragraph (1) of 
     section 7683(d) of title 38, United States Code, is amended 
     by striking ``$44,000'' and all that follows through ``fifth 
     years of participation in the Program'' and inserting ``the 
     total amount of principle and interest owed by the 
     participant on loans referred to in subsection (a)''.
       (b) Notice to Potential Employees of Eligibility and 
     Selection for Participation.--Section 7682 of such title is 
     amended by adding at the end the following new subsection:
       ``(d) Notice to Potential Employees.--In each offer of 
     employment made by the Secretary to an individual who, upon 
     acceptance of such offer would be treated as eligible to 
     participate in the Education Debt Reduction Program, the 
     Secretary shall, to the maximum extent practicable, include 
     the following:
       ``(1) A notice that the individual will be treated as 
     eligible to participate in the Education Debt Reduction 
     Program upon the individual's acceptance of such offer.
       ``(2) A notice of the determination of the Secretary 
     whether or not the individual will be selected as a 
     participant in the Education Debt Reduction Program as of the 
     individual's acceptance of such offer.''.
       (c) Selection of Employees Who Receive Notice of Selection 
     With Employment Offer.--Section 7683 of such title is further 
     amended by adding at the end the following new subsection:
       ``(e) Selection of Participants.--(1) The Secretary shall 
     select for participation in the Education Debt Reduction 
     Program each individual eligible for participation in the 
     Education Debt Reduction Program who--
       ``(A) the Secretary provided notice with an offer of 
     employment under section 7682(d) of this title that indicated 
     the individual would, upon the individual's acceptance of 
     such offer of employment, be--
       ``(i) eligible to participate in the Education Debt 
     Reduction Program; and
       ``(ii) selected to participate in the Education Debt 
     Reduction Program; and
       ``(B) accepts such offer of employment.
       ``(2) The Secretary may select for participation in the 
     Education Debt Reduction Program an individual eligible for 
     participation in the Education Debt Reduction Program who is 
     not described by subparagraphs (A) and (B) of paragraph 
     (1).''.

     SEC. 3. INCLUSION OF DEPARTMENT OF VETERANS AFFAIRS 
                   FACILITIES IN LIST OF FACILITIES ELIGIBLE FOR 
                   ASSIGNMENT OF PARTICIPANTS IN NATIONAL HEALTH 
                   SERVICE CORPS SCHOLARSHIP PROGRAM.

       The Secretary of Veterans Affairs shall transfer 
     $20,000,000 from accounts of the Veterans Health 
     Administration to the Secretary of Health and Human Services 
     to include facilities of the Department of Veterans Affairs 
     in the list maintained by the Health Resources and Services 
     Administration of facilities eligible for assignment of 
     participants in the National Health Service Corps Scholarship 
     Program.

     SEC. 4. OFFICE OF RURAL HEALTH FIVE-YEAR STRATEGIC PLAN.

       (a) Strategic Plan.--Not later than 180 days after the date 
     of the enactment of this Act, the Director of the Office of 
     Rural Health of the Department of Veterans Affairs shall 
     develop a five-year strategic plan for the Office of Rural 
     Health.
       (b) Contents.--The plan required by subsection (a) shall 
     include the following:
       (1) Specific goals for the recruitment and retention of 
     health care personnel in rural areas, developed in 
     conjunction with the Director of the Health Care Retention 
     and Recruitment Office of the Department of Veterans Affairs.
       (2) Specific goals for ensuring the timeliness and quality 
     of health care delivery in rural communities that are reliant 
     on contract and fee basis care, developed in conjunction with 
     the Director of the Office of Quality and Performance of the 
     Department.
       (3) Specific goals for the expansion and implementation of 
     telemedicine services in rural areas, developed in 
     conjunction with the Director of the Office of Care 
     Coordination Services of the Department.
       (4) Incremental milestones describing specific actions to 
     be taken for the purpose of achieving the goals specified 
     under paragraphs (1) through (3).

     SEC. 5. ENHANCEMENT OF VET CENTERS TO MEET NEEDS OF VETERANS 
                   OF OPERATION IRAQI FREEDOM AND OPERATION 
                   ENDURING FREEDOM.

       (a) Volunteer Counselors.--Subsection (c) of section 1712A 
     of title 38, United States Code, is amended--
       (1) by striking ``The Under Secretary'' and inserting ``(1) 
     The Under Secretary'';
       (2) in paragraph (1), as designated by paragraph (1), by 
     striking ``, and, in carrying'' and all that follows through 
     ``screening activities''; and
       (3) by adding at the end the following new paragraphs:
       ``(2) In carrying out this section, the Under Secretary may 
     utilize the services of the following:
       ``(A) Paraprofessionals, individuals who are volunteers 
     working without compensation, and individuals who are 
     veteran-students (as described in section 3485 of this title) 
     in initial intake and screening activities.
       ``(B) Eligible volunteer counselors in the provision of 
     counseling and related mental health services.
       ``(3) For purposes of this subsection, an eligible 
     volunteer counselor is an individual--
       ``(A) who--
       ``(i) provides counseling services without compensation at 
     a center;
       ``(ii) is a licensed psychologist or social worker;
       ``(iii) has never been named in a malpractice action; and
       ``(iv) has never had, and has no pending, disciplinary 
     action taken with respect to any license of the individual in 
     any State; or
       ``(B) who is otherwise credentialed and privileged to 
     perform counseling services by the Secretary.
       ``(4) Not later than one year after the date of the 
     enactment of the Rural Veterans Health Care Access and 
     Quality Act of 2009, the Secretary shall establish expedited 
     credentialing and privileging procedures for eligible 
     volunteer counselors for the provision of counseling and 
     related mental health services under this section.
       ``(5) For each application received by the Secretary for 
     credentialing and privileging of an eligible volunteer 
     counselor under this subsection, the Secretary shall complete 
     the credentialing and privileging process for such volunteer 
     not later than 60 days after receiving such application.''.
       (b) Outreach.--Subsection (e) of such section is amended--
       (1) by striking ``The Secretary'' and inserting ``(1) The 
     Secretary''; and
       (2) by adding at the end the following new paragraph:
       ``(2) Each center shall develop an outreach plan to ensure 
     that the community served by the center is aware of the 
     services offered by the center.''.

     SEC. 6. TELECONSULTATION AND TELEMEDICINE.

       (a) Teleconsultation and Teleretinal Imaging.--
       (1) In general.--Subchapter I of chapter 17 of title 38, 
     United States Code, is amended by adding at the end the 
     following new section:

     ``Sec. 1709. Teleconsultation and teleretinal imaging

       ``(a) Teleconsultation.--(1) The Secretary shall carry out 
     a program of teleconsultation for the provision of remote 
     mental health and traumatic brain injury assessments in 
     facilities of the Department that are not otherwise able to 
     provide such assessments without contracting with third party 
     providers or reimbursing providers through a fee basis 
     system.
       ``(2) The Secretary shall, in consultation with appropriate 
     professional societies, promulgate technical and clinical 
     care standards for the use of teleconsultation services 
     within facilities of the Department.
       ``(b) Teleretinal Imaging.--(1) The Secretary shall carry 
     out a program of teleretinal imaging in each Veterans 
     Integrated Services Network (VISN).
       ``(2) In each fiscal year beginning with fiscal year 2010 
     and ending with fiscal year 2015, the Secretary shall 
     increase the number of patients enrolled in each teleretinal 
     imaging program under paragraph (1) by not less than five 
     percent from the number of patients enrolled in each 
     respective program in the previous fiscal year.
       ``(c) Definitions.--In this section:
       ``(1) The term `teleconsultation' means the use by a health 
     care specialist of telecommunications to assist another 
     health care provider in rendering a diagnosis or treatment.
       ``(2) The term `teleretinal imaging' means the use by a 
     health care specialist of telecommunications, digital retinal 
     imaging, and remote image interpretation to provide eye 
     care.''.
       (2) Clerical amendment.--The table of sections at the 
     beginning of chapter 17 of such title is amended by inserting 
     after the item related to section 1708 the following new 
     item:

``1709. Teleconsultation and teleretinal imaging.''.

       (b) Training in Telemedicine.--The Secretary of Veterans 
     Affairs shall require each

[[Page S3990]]

     Department of Veterans Affairs facility that is involved in 
     the training of medical residents to work with each 
     university concerned to develop an elective rotation in 
     telemedicine for such residents.
       (c) Enhancement of VERA.--
       (1) Incentives for provision of teleconsultation, 
     teleretinal imaging, telemedicine, and telehealth services.--
     The Secretary of Veterans Affairs shall modify the Veterans 
     Equitable Resource Allocation system to provide incentives 
     for the utilization of teleconsultation, teleretinal imaging, 
     telemedicine, and telehealth coordination services.
       (2) Inclusion of telemedicine visits in workload 
     reporting.--The Secretary shall modify the Veterans Equitable 
     Resource Allocation system to require the inclusion of all 
     telemedicine visits in the calculation of facility workload.
       (d) Definitions.--In this section:
       (1) The terms ``teleconsultation'' and ``teleretinal 
     imaging'' have the meanings given such terms in section 1720G 
     of title 38, United States Code, as added by subsection (a).
       (2) The term ``telemedicine'' means the use by a health 
     care provider of telecommunications to assist in the 
     diagnosis or treatment of a patient's medical condition.
       (3) The term ``telehealth'' means the use of 
     telecommunications to collect patient data remotely and send 
     data to a monitoring station for interpretation.

     SEC. 7. OVERSIGHT OF CONTRACT AND FEE BASIS CARE.

       (a) In General.--Subchapter I of chapter 17 of title 38, 
     United States Code, is amended by inserting after section 
     1703 the following new section:

     ``Sec. 1703A. Oversight of contract and fee basis care

       ``(a) Consolidation of Community Based Outpatient Clinic 
     Contracting.--For each Veterans Integrated Services Network 
     (VISN), the Secretary shall, acting through the Under 
     Secretary for Health and to the maximum extent practicable, 
     negotiate with each party that has contracts to provide 
     services at more than one community based outpatient clinic 
     in such Network to consolidate such contracts.
       ``(b) Rural Outreach Coordinators.--The Secretary shall 
     designate a rural outreach coordinator at each Department 
     community based outpatient clinic at which not less than 50 
     percent of the veterans enrolled at such clinic reside in a 
     highly rural area. The coordinator at a clinic shall be 
     responsible for coordinating care and collaborating with 
     community contract and fee basis providers with respect to 
     the clinic.
       ``(c) Incentives to Obtain Accreditation of Medical 
     Practice.--(1) The Secretary shall adjust the fee basis 
     compensation of providers of health care services under the 
     Department to encourage such providers to obtain 
     accreditation of their medical practice from recognized 
     accrediting entities.
       ``(2) In making adjustments under paragraph (1), the 
     Secretary shall consider the increased overhead costs of 
     accreditation described in paragraph (1) and the costs of 
     achieving and maintaining such accreditation.
       ``(d) Incentives for Participation in Peer Review.--(1) The 
     Secretary shall adjust the fee basis compensation of 
     providers of health care services under the Department that 
     do not provide such services as part of a medical practice 
     accredited by a recognized accrediting entity to encourage 
     such providers to participate in peer review under subsection 
     (e).
       ``(2) The Secretary shall provide incentives under 
     paragraph (1) to a provider of health care services under the 
     Department in an amount equal to the amount the Secretary 
     would provide to such provider under subsection (c) if such 
     provider provided such services as part of a medical practice 
     accredited by a recognized accrediting entity.
       ``(e) Peer Review.--(1) The Secretary shall provide for the 
     voluntary peer review of providers of health care services 
     under the Department who provide such services on a fee basis 
     as part of a medical practice that is not accredited by a 
     recognized accrediting entity.
       ``(2) Each year, beginning with the first fiscal year 
     beginning after the date of the enactment of this section, 
     the Chief Quality and Performance Officer in each Veterans 
     Integrated Services Network (VISN) shall select a sample of 
     patient records from each participating provider in the 
     Officer's Veterans Integrated Services Network to be peer 
     reviewed by a facility designated under paragraph (3).
       ``(3) The Chief Quality and Performance Officer in each 
     Veterans Integrated Services Network shall designate 
     Department facilities in such network for the peer review of 
     patient records submitted under this subsection.
       ``(4) Each year, beginning with the first fiscal year 
     beginning after the date of the enactment of this section, 
     each provider who elects to participate in the program shall 
     submit the patient records selected under paragraph (2) to a 
     facility selected under paragraph (3) to be peer reviewed by 
     such facility.
       ``(5) Each Department facility designated under paragraph 
     (3) that receives patient records under paragraph (4) shall--
       ``(A) peer review such records in accordance with policies 
     and procedures established by the Secretary;
       ``(B) ensure that peer reviews are evaluated by the Peer 
     Review Committee; and
       ``(C) develop a mechanism for notifying the Under Secretary 
     for Health of problems identified through such peer review.
       ``(6) The Under Secretary for Health shall develop a 
     mechanism by which the use of fee basis providers of health 
     care are terminated when quality of care concerns are 
     identified.
       ``(7) The Chief Quality and Performance Officer in each 
     Veterans Integrated Services Network shall be responsible for 
     the oversight of the program in that network.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of chapter 17 of such title is amended by inserting 
     after the item related to section 1703 the following new 
     item:

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

     SEC. 8. TRAVEL BENEFITS FOR BENEFICIARIES IN REMOTE 
                   LOCATIONS.

       (a) Coverage of Cost of Transportation by Air.--
       (1) In general.--Subsection (a) of section 111 of title 38, 
     United States Code, is amended by inserting after the first 
     sentence the following new sentence: ``Actual necessary 
     expense of travel includes the reasonable costs of airfare if 
     travel by air is the only practical way to reach a Department 
     facility.''.
       (2) Elimination of limitation based on maximum annual rate 
     of pension.--Subsection (b)(1)(D)(i) of such section is 
     amended by inserting ``who is not traveling by air and'' 
     before ``whose annual''.
       (3) Determination of practicality.--Subsection (b) of such 
     section is amended by adding at the end the following new 
     paragraph:
       ``(4) In determining for purposes of subsection (a) whether 
     travel by air is the only practical way for a veteran to 
     reach a Department facility, the Secretary shall consider the 
     medical condition of the veteran and any other impediments to 
     the use of ground transportation by the veteran.''.
       (b) Mileage Reimbursement Rate for Travel by Air.--
     Subsection (g)(1) of such section is amended by inserting 
     after ``is available)'' the following: ``or the mileage 
     reimbursement rate for airplanes if travel by airplane is the 
     only practical method of travel''.

     SEC. 9. PILOT PROGRAM ON INCENTIVES FOR PHYSICIANS WHO ASSUME 
                   INPATIENT RESPONSIBILITIES AT COMMUNITY 
                   HOSPITALS IN HEALTH PROFESSIONAL SHORTAGE 
                   AREAS.

       (a) Pilot Program Required.--The Secretary of Veterans 
     Affairs shall carry out a pilot program to assess the 
     feasability and advisability of each of the following:
       (1) The provision of financial incentives to eligible 
     physicians who obtain and maintain inpatient privileges at 
     community hospitals in health professional shortage areas in 
     order to facilitate the provision by such physicians of 
     primary care and mental health services to veterans at such 
     hospitals.
       (2) The collection of payments from third-party providers 
     for care provided by eligible physicians to non-veterans 
     while discharging inpatient responsibilities at community 
     hospitals in the course of exercising the privileges 
     described in paragraph (1).
       (b) Eligible Physicians.--For purposes of this section, an 
     eligible physician is a primary care or mental health 
     physician employed by the Department of Veterans Affairs on a 
     full-time basis.
       (c) Duration of Program.--The pilot program shall be 
     carried out during the three-year period beginning on the 
     date of the commencement of the pilot program.
       (d) Locations.--
       (1) In general.--The pilot program shall be carried out at 
     not less than five community hospitals in each of not less 
     than two Veterans Integrated Services Networks (VISNs). The 
     hospitals shall be selected by the Secretary utilizing the 
     results of the survey required under subsection (e).
       (2) Qualifying community hospitals.--A community hospital 
     may be selected by the Secretary as a location for the pilot 
     program if--
       (A) the hospital is located in a health professional 
     shortage area; and
       (B) the number of eligible physicians willing to assume 
     inpatient responsibilities at the hospital (as determined 
     utilizing the result of the survey) is sufficient for 
     purposes of the pilot program.
       (e) Survey of Physician Interest in Participation.--
       (1) In general.--Not later than 120 days after the date of 
     the enactment of this Act, the Secretary of Veterans Affairs 
     shall conduct a survey of eligible physicians to determine 
     the extent of the interest of such physicians in 
     participating in the pilot program.
       (2) Elements.--The survey shall disclose the type, amount, 
     and nature of the financial incentives to be provided under 
     subsection (h) to physicians participating in the pilot 
     program.
       (f) Physician Participation.--
       (1) In general.--The Secretary shall select physicians for 
     participation in the pilot program from among eligible 
     physicians who--
       (A) express interest in participating in the pilot program 
     in the survey conducted under subsection (e);
       (B) are in good standing with the Department; and
       (C) primarily have clinical responsibilities with the 
     Department.
       (2) Voluntary participation.--Participation in the pilot 
     program shall be voluntary. Nothing in this section shall be 
     construed to

[[Page S3991]]

     require a physician working for the Department to assume 
     inpatient responsibilities at a community hospital unless 
     otherwise required as a term or condition of employment with 
     the Department.
       (g) Assumption of Inpatient Physician Responsibilities.--
       (1) In general.--Each eligible physician selected for 
     participation in the pilot program shall assume and maintain 
     inpatient responsibilities, including inpatient 
     responsibilities with respect to non-veterans, at one or more 
     community hospitals selected by the Secretary for 
     participation in the pilot program under subsection (d).
       (2) Coverage under federal tort claims act.--If an eligible 
     physician participating in the pilot program carries out on-
     call responsibilities at a community hospital where 
     privileges to practice at such hospital are conditioned upon 
     the provision of services to individuals who are not veterans 
     while the physician is on call for such hospital, the 
     provision of such services by the physician shall be 
     considered an action within the scope fo the physician's 
     office or employment for purposes of chapter 171 of title 28, 
     United States Code (commonly referred to as the ``Federal 
     Tort Claims Act'').
       (h) Compensation.--
       (1) In general.--The Secretary shall provide each eligible 
     physician participating in the pilot program with such 
     compensation (including pay and other appropriate 
     compensation) as the Secretary considers appropriate to 
     compensate such physician for the discharge of any inpatient 
     responsibilities by such physician at a community hospital 
     for which such physician would not otherwise be compensated 
     by the Department as a full-time employee of the Department.
       (2) Written agreement.--The amount of any compensation to 
     be provided a physician under the pilot program shall be 
     specified in a written agreement entered into by the 
     Secretary and the physician for purposes of the pilot 
     program.
       (3) Treatment of compensation.--The Secretary shall consult 
     with the Director of the Office of Personnel Management on 
     the inclusion of a provision in the written agreement 
     required under paragraph (2) that describes the treatment 
     under Federal law of any compensation provided a physician 
     under the pilot program, including treatment for purposes of 
     retirement under the civil service laws.
       (i) Collections From Third Parties.--In carrying out the 
     pilot program for the purpose described in subsection (a)(2), 
     the Secretary shall implement a variety and range of 
     requirements and mechanisms for the collection from third-
     party payors of amounts to reimburse the Department for 
     health care services provided to non-veterans under the pilot 
     program by eligible physicians discharging inpatient 
     responsibilities under the pilot program.
       (j) Inpatient Responsibilities Defined.--In this section, 
     the term ``inpatient responsibilities'' means on-call 
     responsibilities customarily required of a physician by 
     community hospital as a condition of granting privileges to 
     the physician to practice in the hospital.
       (k) Report.--Not later than one year after the date of the 
     enactment of this Act and annually thereafter, the Secretary 
     shall submit to Congress a report on the pilot program, 
     including the following:
       (1) The findings of the Secretary with respect to the pilot 
     program.
       (2) The number of veterans and non-veterans provided 
     inpatient care by physicians participating in the pilot 
     program.
       (3) The amounts collected and payable under subsection (i).
       (l) Health Professional Shortage Area Defined.--In this 
     section, the term ``health professional shortage area'' has 
     the meaning given the term in section 332(a) of the Public 
     Health Service Act (42 U.S.C. 254e(a)).
                                 ______