[Congressional Record Volume 162, Number 165 (Thursday, November 17, 2016)]
[Senate]
[Pages S6490-S6492]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 5110. Mr. ALEXANDER submitted an amendment intended to be proposed 
by him to the bill S. 2873, to require studies and reports examining 
the use of, and opportunities to use, technology-enabled collaborative 
learning and capacity building models to improve programs of the 
Department of Health and Human Services, and for other purposes; which 
was ordered to lie on the table; as follows:

       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Expanding Capacity for 
     Health Outcomes Act'' or the ``ECHO Act''.

     SEC. 2. DEFINITIONS.

       In this Act:
       (1) Health professional shortage area.--The term ``health 
     professional shortage area'' means a health professional 
     shortage area designated under section 332 of the Public 
     Health Service Act (42 U.S.C. 254e).
       (2) Indian tribe.--The term ``Indian tribe'' has the 
     meaning given the term in section 4

[[Page S6491]]

     of the Indian Self-Determination and Education Assistance Act 
     (25 U.S.C. 5304).
       (3) Medically underserved area.--The term ``medically 
     underserved area'' has the meaning given the term ``medically 
     underserved community'' in section 799B of the Public Health 
     Service Act (42 U.S.C. 295p).
       (4) Medically underserved population.--The term ``medically 
     underserved population'' has the meaning given the term in 
     section 330(b) of the Public Health Service Act (42 U.S.C. 
     254b(b)).
       (5) Native americans.--The term ``Native Americans'' has 
     the meaning given the term in section 736 of the Public 
     Health Service Act (42 U.S.C. 293) and includes Indian tribes 
     and tribal organizations.
       (6) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (7) Technology-enabled collaborative learning and capacity 
     building model.--The term ``technology-enabled collaborative 
     learning and capacity building model'' means a distance 
     health education model that connects specialists with 
     multiple other health care professionals through simultaneous 
     interactive videoconferencing for the purpose of facilitating 
     case-based learning, disseminating best practices, and 
     evaluating outcomes.
       (8) Tribal organization.--The term ``tribal organization'' 
     has the meaning given the term in section 4 of the Indian 
     Self-Determination and Education Assistance Act (25 U.S.C. 
     5304).

     SEC. 3. EXAMINATION AND REPORT ON TECHNOLOGY-ENABLED 
                   COLLABORATIVE LEARNING AND CAPACITY BUILDING 
                   MODELS.

       (a) Examination.--
       (1) In general.--The Secretary shall examine technology-
     enabled collaborative learning and capacity building models 
     and their impact on--
       (A) addressing mental and substance use disorders, chronic 
     diseases and conditions, prenatal and maternal health, 
     pediatric care, pain management, and palliative care;
       (B) addressing health care workforce issues, such as 
     specialty care shortages and primary care workforce 
     recruitment, retention, and support for lifelong learning;
       (C) the implementation of public health programs, including 
     those related to disease prevention, infectious disease 
     outbreaks, and public health surveillance;
       (D) the delivery of health care services in rural areas, 
     frontier areas, health professional shortage areas, and 
     medically underserved areas, and to medically underserved 
     populations and Native Americans; and
       (E) addressing other issues the Secretary determines 
     appropriate.
       (2) Consultation.--In the examination required under 
     paragraph (1), the Secretary shall consult public and private 
     stakeholders with expertise in using technology-enabled 
     collaborative learning and capacity building models in health 
     care settings.
       (b) Report.--
       (1) In general.--Not later than 2 years after the date of 
     enactment of this Act, the Secretary shall submit to the 
     Committee on Health, Education, Labor, and Pensions of the 
     Senate and the Committee on Energy and Commerce of the House 
     of Representatives, and post on the appropriate website of 
     the Department of Health and Human Services, a report based 
     on the examination under subsection (a).
       (2) Contents.--The report required under paragraph (1) 
     shall include findings from the examination under subsection 
     (a) and each of the following:
       (A) An analysis of--
       (i) the use and integration of technology-enabled 
     collaborative learning and capacity building models by health 
     care providers;
       (ii) the impact of such models on health care provider 
     retention, including in health professional shortage areas in 
     the States and communities in which such models have been 
     adopted;
       (iii) the impact of such models on the quality of, and 
     access to, care for patients in the States and communities in 
     which such models have been adopted;
       (iv) the barriers faced by health care providers, States, 
     and communities in adopting such models;
       (v) the impact of such models on the ability of local 
     health care providers and specialists to practice to the full 
     extent of their education, training, and licensure, including 
     the effects on patient wait times for specialty care; and
       (vi) efficient and effective practices used by States and 
     communities that have adopted such models, including 
     potential cost-effectiveness of such models.
       (B) A list of such models that have been funded by the 
     Secretary in the 5 years immediately preceding such report, 
     including the Federal programs that have provided funding for 
     such models.
       (C) Recommendations to reduce barriers for using and 
     integrating such models, and opportunities to improve 
     adoption of, and support for, such models as appropriate.
       (D) Opportunities for increased adoption of such models 
     into programs of the Department of Health and Human Services 
     that are in existence as of the report.
       (E) Recommendations regarding the role of such models in 
     continuing medical education and lifelong learning, including 
     the role of academic medical centers, provider organizations, 
     and community providers in such education and lifelong 
     learning.
                                 ______
                                 
  SA 5111. Mr. McCONNELL (for Mr. Moran (for himself and Mr. Tester)) 
proposed an amendment to the bill H.R. 3471, to amend title 38, United 
States Code, to make certain improvements in the provision of 
automobiles and adaptive equipment by the Department of Veterans 
Affairs; as follows:

       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Veterans Mobility Safety Act 
     of 2016''.

     SEC. 2. PERSONAL SELECTIONS OF AUTOMOBILES AND ADAPTIVE 
                   EQUIPMENT.

       Section 3903(b) of title 38, United States Code, is 
     amended--
       (1) by striking ``Except'' and inserting ``(1) Except''; 
     and
       (2) by adding at the end the following new paragraph:
       ``(2) The Secretary shall ensure that to the extent 
     practicable an eligible person who is provided an automobile 
     or other conveyance under this chapter is given the 
     opportunity to make personal selections relating to such 
     automobile or other conveyance.''.

     SEC. 3. COMPREHENSIVE POLICY FOR THE AUTOMOBILES ADAPTIVE 
                   EQUIPMENT PROGRAM.

       (a) Comprehensive Policy.--The Secretary of Veterans 
     Affairs shall develop a comprehensive policy regarding 
     quality standards for providers who provide modification 
     services to veterans under the automobile adaptive equipment 
     program.
       (b) Scope.--The policy developed under subsection (a) shall 
     cover each of the following:
       (1) The Department of Veterans Affairs-wide management of 
     the automobile adaptive equipment program.
       (2) The development of standards for safety and quality of 
     equipment and installation of equipment through the 
     automobile adaptive equipment program, including with respect 
     to the defined differentiations in levels of modification 
     complexity.
       (3) The consistent application of standards for safety and 
     quality of both equipment and installation throughout the 
     Department.
       (4) In accordance with subsection (c)(1), the certification 
     of a provider by a manufacturer if the Secretary designates 
     the quality standards of such manufacturer as meeting or 
     exceeding the standards developed under this section.
       (5) In accordance with subsection (c)(2), the certification 
     of a provider by a third party, nonprofit organization if the 
     Secretary designates the quality standards of such 
     organization as meeting or exceeding the standards developed 
     under this section.
       (6) The education and training of personnel of the 
     Department who administer the automobile adaptive equipment 
     program.
       (7) The compliance of the provider with the Americans with 
     Disabilities Act of 1990 (42 U.S.C. 12101 et seq.) when 
     furnishing automobile adaptive equipment at the facility of 
     the provider.
       (8) The allowance, where technically appropriate, for 
     veterans to receive modifications at their residence or 
     location of choice, including standards that ensure such 
     receipt and notification to veterans of the availability of 
     such receipt.
       (c) Certification of Manufacturers and Third Party, 
     Nonprofit Organizations.--
       (1) Certification of manufacturers.--The Secretary shall 
     approve a manufacturer as a certifying manufacturer for 
     purposes of subsection (b)(4), if the manufacturer 
     demonstrates that its certification standards meet or exceed 
     the quality standards developed under this section.
       (2) Certification of third party, nonprofit 
     organizations.--
       (A) In general.--The Secretary may approve two or more 
     private, nonprofit organizations as third party, nonprofit 
     certifying organizations for purposes of subsection (b)(5).
       (B) Limitation.--If at any time there is only one third 
     party, nonprofit certifying organization approved by the 
     Secretary for purposes of subsection (b)(5), such 
     organization shall not be permitted to provide certifications 
     under such subsection until such time as the Secretary 
     approves a second third party, nonprofit certifying 
     organization for purposes of such subsection.
       (d) Updates.--
       (1) Initial updates.--Not later than 1 year after the date 
     of the enactment of this Act, the Secretary shall update 
     Veterans Health Administration Handbook 1173.4, or any 
     successor handbook or directive, in accordance with the 
     policy developed under subsection (a).
       (2) Subsequent updates.--Not less frequently than once 
     every 6 years thereafter, the Secretary shall update such 
     handbook, or any successor handbook or directive.
       (e) Consultation.--The Secretary shall develop the policy 
     under subsection (a), and revise such policy under subsection 
     (d), in consultation with veterans service organizations, the 
     National Highway Transportation Administration, industry 
     representatives, manufacturers of automobile adaptive 
     equipment, and other entities with expertise in installing, 
     repairing, replacing, or manufacturing mobility equipment or 
     developing mobility accreditation standards for automobile 
     adaptive equipment.
       (f) Conflicts.--In developing and implementing the policy 
     under subsection (a), the Secretary shall--

[[Page S6492]]

       (1) minimize the possibility of conflicts of interest, to 
     the extent practicable; and
       (2) establish procedures that ensure against the use of a 
     certifying organization referred to in subsection (b)(5) that 
     has a financial conflict of interest regarding the 
     certification of an eligible provider.
       (g) Biennial Report.--
       (1) In general.--Not later than 1 year after the date on 
     which the Secretary updates Veterans Health Administration 
     Handbook 1173.4, or any successor handbook or directive, 
     under subsection (d), and not less frequently than once every 
     other year thereafter through 2022, 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 implementation and facility 
     compliance with the policy developed under subsection (a).
       (2) Contents.--The report required by paragraph (1) shall 
     include the following:
       (A) A description of the implementation plan for the policy 
     developed under subsection (a) and any revisions to such 
     policy under subsection (d).
       (B) A description of the performance measures used to 
     determine the effectiveness of such policy in ensuring the 
     safety of veterans enrolled in the automobile adaptive 
     equipment program.
       (C) An assessment of safety issues due to improper 
     installations based on a survey of recipients of adaptive 
     equipment from the Department.
       (D) An assessment of the adequacy of the adaptive equipment 
     services of the Department based on a survey of recipients of 
     adaptive equipment from the Department.
       (E) An assessment of the training provided to the personnel 
     of the Department with respect to administering the program.
       (F) An assessment of the certified providers of the 
     Department of adaptive equipment with respect to meeting the 
     minimum standards developed under subsection (b)(2).
       (h) Definitions.--In this section:
       (1) Automobile adaptive equipment program.--The term 
     ``automobile adaptive equipment program'' means the program 
     administered by the Secretary of Veterans Affairs pursuant to 
     chapter 39 of title 38, United States Code.
       (2) Veterans service organization.--The term ``veterans 
     service organization'' means any organization recognized by 
     the Secretary for the representation of veterans under 
     section 5902 of title 38, United States Code.

     SEC. 4. APPOINTMENT OF LICENSED HEARING AID SPECIALISTS IN 
                   VETERANS HEALTH ADMINISTRATION.

       (a) Licensed Hearing Aid Specialists.--
       (1) Appointment.--Section 7401(3) of title 38, United 
     States Code, is amended by inserting ``licensed hearing aid 
     specialists,'' after ``Audiologists,''.
       (2) Qualifications.--Section 7402(b)(14) of such title is 
     amended by inserting ``, hearing aid specialist'' after 
     ``dental technologist''.
       (b) Requirements.--With respect to appointing hearing aid 
     specialists under sections 7401 and 7402 of title 38, United 
     States Code, as amended by subsection (a), and providing 
     services furnished by such specialists, the Secretary shall 
     ensure that--
       (1) a hearing aid specialist may only perform hearing 
     services consistent with the hearing aid specialist's State 
     license related to the practice of fitting and dispensing 
     hearing aids without excluding other qualified professionals, 
     including audiologists, from rendering services in 
     overlapping practice areas;
       (2) services provided to veterans by hearing aid 
     specialists shall be provided as part of the non-medical 
     treatment plan developed by an audiologist; and
       (3) the medical facilities of the Department of Veterans 
     Affairs provide to veterans access to the full range of 
     professional services provided by an audiologist.
       (c) Consultation.--In determining the qualifications 
     required for hearing aid specialists and in carrying out 
     subsection (b), the Secretary shall consult with veterans 
     service organizations, audiologists, otolaryngologists, 
     hearing aid specialists, and other stakeholder and industry 
     groups as the Secretary determines appropriate.
       (d) Annual Report.--
       (1) In general.--Not later than 1 year after the date of 
     the enactment of this Act, and annually thereafter during the 
     5-year period beginning on the date of the enactment of this 
     Act, the Secretary of Veterans Affairs shall submit to 
     Congress a report on the following:
       (A) Timely access of veterans to hearing health services 
     through the Department of Veterans Affairs.
       (B) Contracting policies of the Department with respect to 
     providing hearing health services to veterans in facilities 
     that are not facilities of the Department.
       (2) Timely access to services.--Each report shall, with 
     respect to the matter specified in paragraph (1)(A) for the 
     1-year period preceding the submittal of such report, include 
     the following:
       (A) The staffing levels of audiologists, hearing aid 
     specialists, and health technicians in audiology in the 
     Veterans Health Administration.
       (B) A description of the metrics used by the Secretary in 
     measuring performance with respect to appointments and care 
     relating to hearing health.
       (C) The average time that a veteran waits to receive an 
     appointment, beginning on the date on which the veteran makes 
     the request, for the following:
       (i) A disability rating evaluation for a hearing-related 
     disability.
       (ii) A hearing aid evaluation.
       (iii) Dispensing of hearing aids.
       (iv) Any follow-up hearing health appointment.
       (D) The percentage of veterans whose total wait time for 
     appointments described in subparagraph (C), including an 
     initial and follow-up appointment, if applicable, is more 
     than 30 days.
       (3) Contracting policies.--Each report shall, with respect 
     to the matter specified in paragraph (1)(B) for the 1-year 
     period preceding the submittal of such report, include the 
     following:
       (A) The number of veterans that the Secretary refers to 
     non-Department audiologists for hearing health care 
     appointments.
       (B) The number of veterans that the Secretary refers to 
     non-Department hearing aid specialists for follow-up 
     appointments for a hearing aid evaluation, the dispensing of 
     hearing aids, or any other purpose relating to hearing 
     health.

                          ____________________