Rural Veterans Care Act of 2006 - Establishes the Assistant Secretary for Rural Affairs in the Department of Veterans Affairs to: (1) formulate and implement all Department policies and procedures that affect veterans living in rural areas; (2) carry out demonstration projects to examine alternatives for expanding veterans' care in rural areas; (3) reevaluate, and revise as necessary, Department guidance and procedures related to the use of fee basis care nationwide; and (4) establish and operate at least one and up to five centers of excellence for rural health research, education, and clinical activities.
Directs the Secretary to conduct a pilot program for improving the access of veterans who reside in highly rural or geographically remote areas to certain health care services.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 2433 Introduced in Senate (IS)]
109th CONGRESS
2d Session
S. 2433
To amend title 38, United States Code, to establish an Assistant
Secretary for Rural Veterans in the Department of Veterans Affairs, to
improve the care provided to veterans living in rural areas, and for
other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 16 (legislative day, March 15), 2006
Mr. Salazar (for himself, Mr. Thune, Mr. Akaka, Mr. Dorgan, Mr. Pryor,
Mr. Johnson, Mr. Burns, Ms. Murkowski, Mr. Thomas, Mr. Baucus, Mr.
Conrad, Mrs. Murray, Mrs. Lincoln, and Mr. Burr) introduced the
following bill; which was read twice and referred to the Committee on
Veterans' Affairs
_______________________________________________________________________
A BILL
To amend title 38, United States Code, to establish an Assistant
Secretary for Rural Veterans in the Department of Veterans Affairs, to
improve the care provided to veterans living in rural areas, 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 ``Rural Veterans Care Act of 2006''.
SEC. 2. ASSISTANT SECRETARY FOR RURAL VETERANS.
Section 308 of title 38, United States Code, is amended--
(1) in subsection (a)--
(A) by inserting ``(1)'' before ``There'';
(B) by striking ``six'' and inserting ``seven'';
and
(C) by striking ``Each'' and inserting the
following:
``(2) Each'';
(2) by redesignating subsection (c) as paragraph (3) and
inserting such paragraph at the end of subsection (a);
(3) by inserting after subsection (b) the following new
subsection:
``(c)(1) One of the Assistant Secretaries appointed under
subsection (a) shall be the Assistant Secretary for Rural Veterans,
who, under the direction of the Secretary, shall formulate and
implement all policies and procedures of the Department that affect
veterans living in rural areas.
``(2) The Assistant Secretary for Rural Veterans, under the
direction of the Secretary, shall perform the following functions:
``(A) Except as otherwise expressly provided in this title,
carry out the provisions of this title and administer all
Department programs for providing care to veterans living in
rural areas who are eligible for services authorized under this
title.
``(B) Oversee and coordinate personnel and policies of the
Veterans Health Administration, the Veterans Benefits
Administration, the National Cemetery Administration, and their
respective subagencies, including Veterans Integrated Service
Networks, to carry out Department programs to the extent such
programs affect veterans living in rural areas.
``(C) Oversee, coordinate, promote, and disseminate
research into issues affecting veterans living in rural areas
in cooperation with the medical, rehabilitation, health
services, and cooperative studies research programs, the Office
of Policy and the Office of Research and Development of the
Veterans Health Administration, and the centers established in
section 7329.
``(D) Ensure maximum effectiveness and efficiency in
providing services and assistance to eligible veterans under
the programs described in subparagraph (A), after consultation
with appropriate representatives of the Centers for Medicare
and Medicaid Services, the Indian Health Service, and the
Office of Rural Health Policy of the Department of Health and
Human Services, the Social Security Administration, the
Department of Labor, the Department of Agriculture (acting
through the Under Secretary for Rural Development), and other
Federal, State, and local government agencies.
``(E) Work with all personnel and resources of the
Department to develop, refine, and promulgate policies, best
practices, lessons learned, and innovative and successful
programs to improve care and services for rural veterans.
``(F) Perform such other functions and duties as the
Secretary considers appropriate.
``(3) The Secretary shall ensure that the Assistant Secretary for
Rural Veterans has the budget, authority, and control necessary for the
development, approval, implementation, integration, and oversight of
policies, procedures, processes, activities, and systems of the
Department relating to the care of rural veterans. The Secretary shall
identify a Rural Veterans Coordinator in each Veterans Integrated
Service Network, who shall report to the Assistant Secretary for Rural
Veterans and coordinate the functions authorized under this subsection
within such network.
``(4) The Assistant Secretary for Rural Veterans, under the
direction of the Secretary, shall supervise the employees of the
Department who are responsible for implementing the policies and
procedures described in paragraph (1).''; and
(4) in subsection (d)--
(A) in paragraph (1)--
(i) by striking ``18'' and inserting
``19''; and
(ii) by adding at the end the following:
``One of the Deputy Assistant Secretaries
appointed under this paragraph shall be the
Deputy Assistant Secretary for Rural Veterans,
who shall perform such functions as the
Assistant Secretary for Rural Veterans
prescribes.'';
(B) in paragraph (2), by inserting ``or, in the
case of the Deputy Assistant Secretary for Rural
Veterans, comparable service in a management position
in the Armed Forces'' after ``Secretary''.
SEC. 3. RESPONSIBILITIES OF ASSISTANT SECRETARY FOR RURAL VETERANS.
(a) Demonstration Projects.--
(1) In general.--The Assistant Secretary for Rural
Veterans, appointed under section 308 of title 38, United
States Code, shall carry out demonstration projects to examine
alternatives for expanding care in rural areas, including--
(A) establishing a partnership between the
Department of Veterans Affairs and the Centers for
Medicare and Medicaid Services of the Department of
Health and Human Services to coordinate care for rural
veterans conducted at critical access hospitals (as
designated or certified under section 1820 of the
Social Security Act (42 U.S.C. 1395i-4));
(B) establishing a partnership between the
Department of Veterans Affairs and the Department of
Health and Human Services to coordinate care for rural
veterans conducted at community health centers;
(C) expanding the use of fee basis care through
which private hospitals, health care facilities, and
other third-party providers are reimbursed for
providing care closer to the homes of veterans living
in rural areas, as authorized under section 7405(a)(2);
and
(D) expanding coordination between the Department
of Veterans Affairs and the Indian Health Service to
expand care for Native American veterans.
(2) Geographic distribution.--The Assistant Secretary for
Rural Veterans shall ensure that the demonstration projects
authorized under paragraph (1) are located at facilities that
are geographically distributed throughout the United States.
(3) Report.--Not later than two years after the date of
enactment of this Act, the Assistant Secretary for Rural
Veterans shall submit a report on the results of the
demonstration projects conducted under paragraph (1) to--
(A) the Committee on Veterans Affairs of the
Senate;
(B) the Committee on Appropriations of the Senate;
(C) the Committee on Veterans Affairs of the House
of Representatives; and
(D) the Committee on Appropriations of the House of
Representatives.
(b) Policy Revisions.--Not later than one year after the date of
enactment of this Act, the Assistant Secretary for Rural Veterans
shall--
(1) reevaluate directives 5005 and 5007 of the Department
of Veterans Affairs and other guidance and procedures related
to the use of fee basis care nationwide; and
(2) revise established policies to--
(A) provide stronger guidance to units of the
Department of Veterans Affairs; and
(B) strengthen the use of fee basis care to extend
health care services to rural and remote rural areas.
(c) Reports to Congress.--The Secretary of Veterans Affairs shall
submit to Congress, in conjunction with the documents submitted in
support of the President's budget for each fiscal year, an assessment
of the implementation during the most recently completed fiscal year of
the provisions of this Act and the amendments made by this Act.
SEC. 4. PILOT PROGRAM ON ENHANCED ACCESS TO HEALTH CARE FOR VETERANS IN
HIGHLY RURAL AND GEOGRAPHICALLY REMOTE AREAS.
(a) Pilot Program.--
(1) In general.--The Secretary of Veterans Affairs shall
conduct a pilot program to evaluate the feasability and
advisability of utilizing various means to improve the access
of veterans who reside in highly rural or geographically remote
areas to health care services referred to in subsection (d).
(2) Provision of services under pilot program.--In
conducting the pilot program, the Secretary shall provide
health care services referred to in subsection (d) to eligible
veterans who reside in highly rural or geographically remote
areas in the geographic service regions selected for purposes
of the pilot program utilizing the contract authority of the
Secretary under section 1703 of title 38, United States Code,
and such other authorities available to the Secretary as the
Secretary considers appropriate for purposes of the pilot
program.
(b) Eligible Veterans.--A veteran is an eligible veteran for
purposes of this section if the veteran--
(1) has a service-connected disability; or
(2) is enrolled in the veterans health care system under
section 1705 of title 38, United States Code.
(c) Highly Rural or Geographically Remote Areas.--An eligible
veteran resides in a highly rural or geographically remote area for
purposes of this section if the veteran--
(1) resides in a location that is more than 60 miles
driving distance from the nearest Department of Veterans
Affairs health care facility; or
(2) in the case of an eligible veteran who resides in a
location that is less than 60 miles driving distance from such
a facility, experiences such hardship or other difficulties (as
determined pursuant to regulations prescribed by the Secretary
for purposes of this section) in travel to the nearest
Department of Veterans Affairs health care facility that such
travel is not in the best interests of the veteran.
(d) Health Care Services.--The health care services referred to in
this section are--
(1) acute or chronic symptom management;
(2) nontherapeutic medical services; and
(3) any other medical services jointly determined
appropriate for an eligible veteran for purposes of this
section by the physician of the department responsible for
primary care of such eligible veteran and the director of the
Veterans Integrated Service Network concerned.
(e) Areas for Conduct of Pilot Program.--
(1) In general.--The pilot program shall be conducted in 3
of the geographic service regions of the Veterans Health
Administration (referred to as Veterans Integrated Service
Networks) selected by the Secretary for purposes of the pilot
program.
(2) Selection.--In selecting geographic service regions for
the purposes of the pilot program, the Secretary, based on the
recommendations of the Assistant Secretary for Rural Veterans,
shall select from among the Veterans Integrated Service
Networks that have a substantial population of veterans who
reside in highly rural or geographically remote areas.
(f) Period of Pilot Program.--The pilot program shall be conducted
during fiscal years 2007, 2008, and 2009.
(g) Funding for Pilot Program.--
(1) In general.--For each fiscal year during which the
pilot program is conducted, the Secretary shall allocate for
the pilot program an amount equal to 0.9 percent of the total
amount appropriated for such fiscal year for medical services.
(2) Timing of allocation.--The allocation under paragraph
(1) for a fiscal year shall be made before any other allocation
of funds for medical care is made for such fiscal year, and any
remaining allocation of funds for medical care for such fiscal
year shall be made without regard to the allocation under
subsection (a) in such fiscal year.
(h) Report to Congress.--Not later than February 1, 2009, the
Secretary shall submit to Congress a report on the pilot program. The
Secretary shall include in the report such recommendations as the
Secretary considers appropriate concerning extension of the pilot
program or other means to improve the access of veterans who reside in
highly rural or geographically remote areas to health care services
referred to in subsection (d).
SEC. 5. TRAVEL REIMBURSEMENT FOR VETERANS RECEIVING TREATMENT AT
FACILITIES OF THE DEPARTMENT OF VETERANS AFFAIRS.
Section 111 of title 38, United States Code, is amended--
(1) in subsection (a)--
(A) by striking ``subsistence),'' and inserting
``subsistence at a rate equivalent to the rate provided
to Federal employees under section 5702 of title 5),'';
and
(B) by striking ``traveled,'' and inserting ``(at a
rate equivalent to the rate provided to Federal
employees under section 5704 of title 5),'';
(2) by striking subsection (g); and
(3) by redesignating subsection (h) as subsection (g).
SEC. 6. CENTERS FOR RURAL HEALTH RESEARCH, EDUCATION, AND CLINICAL
ACTIVITIES.
(a) In General.--Subchapter II of chapter 73 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 7329. Centers for rural health research, education, and clinical
activities
``(a) Establishment of Centers.--The Assistant Secretary for Rural
Veterans shall establish and operate not less than one and not more
than five centers of excellence for rural health research, education,
and clinical activities, which shall--
``(1) conduct research on rural health services;
``(2) allow the Department to use specific models for
furnishing services to treat rural veterans;
``(3) provide education and training for health care
professionals of the Department; and
``(4) develop and implement innovative clinical activities
and systems of care for the Department.
``(b) Geographic Dispersion.--The Assistant Secretary for Rural
Veterans shall ensure that the centers authorized under paragraph (1)
are located at health care facilities that are geographically dispersed
throughout the United States.
``(c) Selection Criteria.--The Assistant Secretary for Rural
Veterans may not designate a health care facility as a location for a
center under this section unless--
``(1) the peer review panel established under subsection
(d) determines that the proposal submitted by such facility
meets the highest competitive standards of scientific and
clinical merit; and
``(2) the Assistant Secretary for Rural Veterans determines
that the facility has, or may reasonably be anticipated to
develop--
``(A) an arrangement with an accredited medical
school to provide residents with education and training
in care for rural veterans;
``(B) the ability to attract the participation of
scientists who are capable of ingenuity and creativity
in health care research efforts;
``(C) a policymaking advisory committee, composed
of appropriate health care and research representatives
of the facility and of the affiliated school or
schools, to advise the directors of such facility and
such center on policy matters pertaining to the
activities of such center during the period of the
operation of such center; and
``(D) the capability to effectively conduct
evaluations of the activities of such center.
``(d) Panel To Evaluate Proposals.--(1) The Assistant Secretary for
Rural Veterans shall establish a panel to--
``(A) evaluate the scientific and clinical merit of
proposals submitted to establish centers under this section;
and
``(B) provide advice to the Assistant Secretary for Rural
Veterans regarding the implementation of this section.
``(2) The panel shall review each proposal received from the
Assistant Secretary for Rural Veterans and shall submit its views on
the relative scientific and clinical merit of each such proposal to the
Assistant Secretary.
``(3) The panel established under paragraph (1) shall be comprised
of experts in the fields of public health research, education, and
clinical care.
``(4) Members of the panel shall serve as consultants to the
Department for a period not to exceed two years.
``(5) The panel shall not be subject to the Federal Advisory
Committee Act.
``(e) Funding.--(1) There are authorized to be appropriated such
sums as may be necessary for the support of the research and education
activities of the centers established pursuant to subsection (a).
``(2) The Assistant Secretary for Rural Veterans shall allocate
such amounts as the Under Secretary for Health determines to be
appropriate to the centers established pursuant to subsection (a) from
funds appropriated for the Medical Care Account and the Medical and
Prosthetics Research Account.
``(3) Activities of clinical and scientific investigation at each
center established under subsection (a)--
``(A) shall be eligible to compete for the award of funding
from funds appropriated for the Medical and Prosthetics
Research Account; and
``(B) shall receive priority in the award of funding from
such account to the extent that funds are awarded to projects
for research in the care of rural veterans.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 73 of title 38, United States Code, is amended by inserting
after the item relating to section 7328 the following new item:
``7329. Centers for rural health research, education, and clinical
activities.''.
<all>
Introduced in Senate
Read twice and referred to the Committee on Veterans' Affairs. (text of measure as introduced: CR S2324-2326)
Committee on Veterans' Affairs. Hearings held.
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