S 734 ISCommentsClose CommentsPermalink

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.CommentsClose CommentsPermalink

March 30, 2009CommentsClose CommentsPermalink

Mr. AKAKA (for himself, Mr. BAUCUS, and Mr. BEGICH) introduced the following bill; which was read twice and referred toCommentsClose CommentsPermalink

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.CommentsClose CommentsPermalink

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,CommentsClose CommentsPermalink

SECTION 1. SHORT TITLE.

This Act may be cited as the ‘Rural Veterans Health Care Access and Quality Act of 2009’.CommentsClose CommentsPermalink

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)’.CommentsClose CommentsPermalink





(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:CommentsClose CommentsPermalink





‘(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:CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink





(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:CommentsClose CommentsPermalink





‘(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--CommentsClose CommentsPermalink





‘(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--CommentsClose CommentsPermalink





‘(i) eligible to participate in the Education Debt Reduction Program; andCommentsClose CommentsPermalink





‘(ii) selected to participate in the Education Debt Reduction Program; andCommentsClose CommentsPermalink





‘(B) accepts such offer of employment.CommentsClose CommentsPermalink





‘(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).’.CommentsClose CommentsPermalink

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.CommentsClose CommentsPermalink

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.CommentsClose CommentsPermalink





(b) Contents- The plan required by subsection (a) shall include the following:CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(4) Incremental milestones describing specific actions to be taken for the purpose of achieving the goals specified under paragraphs (1) through (3).CommentsClose CommentsPermalink

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--CommentsClose CommentsPermalink





(1) by striking ‘The Under Secretary’ and inserting ‘(1) The Under Secretary’;CommentsClose CommentsPermalink





(2) in paragraph (1), as designated by paragraph (1), by striking ‘, and, in carrying’ and all that follows through ‘screening activities’; andCommentsClose CommentsPermalink





(3) by adding at the end the following new paragraphs:CommentsClose CommentsPermalink





‘(2) In carrying out this section, the Under Secretary may utilize the services of the following:CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(B) Eligible volunteer counselors in the provision of counseling and related mental health services.CommentsClose CommentsPermalink





‘(3) For purposes of this subsection, an eligible volunteer counselor is an individual--CommentsClose CommentsPermalink





‘(A) who--CommentsClose CommentsPermalink





‘(i) provides counseling services without compensation at a center;CommentsClose CommentsPermalink





‘(ii) is a licensed psychologist or social worker;CommentsClose CommentsPermalink





‘(iii) has never been named in a malpractice action; andCommentsClose CommentsPermalink





‘(iv) has never had, and has no pending, disciplinary action taken with respect to any license of the individual in any State; orCommentsClose CommentsPermalink





‘(B) who is otherwise credentialed and privileged to perform counseling services by the Secretary.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink





(b) Outreach- Subsection (e) of such section is amended--CommentsClose CommentsPermalink





(1) by striking ‘The Secretary’ and inserting ‘(1) The Secretary’; andCommentsClose CommentsPermalink





(2) by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink

SEC. 6. TELECONSULTATION AND TELEMEDICINE.

(a) Teleconsultation and Teleretinal Imaging-CommentsClose CommentsPermalink





(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:CommentsClose CommentsPermalink

‘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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(b) Teleretinal Imaging- (1) The Secretary shall carry out a program of teleretinal imaging in each Veterans Integrated Services Network (VISN).CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(c) Definitions- In this section:CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink





(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:CommentsClose CommentsPermalink





‘1709. Teleconsultation and teleretinal imaging.’.CommentsClose CommentsPermalink





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





(c) Enhancement of VERA-CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(d) Definitions- In this section:CommentsClose CommentsPermalink





(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).CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(3) The term ‘telehealth’ means the use of telecommunications to collect patient data remotely and send data to a monitoring station for interpretation.CommentsClose CommentsPermalink

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:CommentsClose CommentsPermalink

‘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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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).CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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).CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(5) Each Department facility designated under paragraph (3) that receives patient records under paragraph (4) shall--CommentsClose CommentsPermalink





‘(A) peer review such records in accordance with policies and procedures established by the Secretary;CommentsClose CommentsPermalink





‘(B) ensure that peer reviews are evaluated by the Peer Review Committee; andCommentsClose CommentsPermalink





‘(C) develop a mechanism for notifying the Under Secretary for Health of problems identified through such peer review.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink





(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:CommentsClose CommentsPermalink





‘1703A. Oversight of contract and fee basis care.’.CommentsClose CommentsPermalink

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

(a) Coverage of Cost of Transportation by Air-CommentsClose CommentsPermalink





(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.’.CommentsClose CommentsPermalink





(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’.CommentsClose CommentsPermalink





(3) DETERMINATION OF PRACTICALITY- Subsection (b) of such section is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink





(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’.CommentsClose CommentsPermalink

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:CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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).CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(d) Locations-CommentsClose CommentsPermalink





(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).CommentsClose CommentsPermalink





(2) QUALIFYING COMMUNITY HOSPITALS- A community hospital may be selected by the Secretary as a location for the pilot program if--CommentsClose CommentsPermalink





(A) the hospital is located in a health professional shortage area; andCommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(e) Survey of Physician Interest in Participation-CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(f) Physician Participation-CommentsClose CommentsPermalink





(1) IN GENERAL- The Secretary shall select physicians for participation in the pilot program from among eligible physicians who--CommentsClose CommentsPermalink





(A) express interest in participating in the pilot program in the survey conducted under subsection (e);CommentsClose CommentsPermalink





(B) are in good standing with the Department; andCommentsClose CommentsPermalink





(C) primarily have clinical responsibilities with the Department.CommentsClose CommentsPermalink





(2) VOLUNTARY PARTICIPATION- Participation in the pilot program shall be voluntary. Nothing in this section shall be construed to 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.CommentsClose CommentsPermalink





(g) Assumption of Inpatient Physician Responsibilities-CommentsClose CommentsPermalink





(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).CommentsClose CommentsPermalink





(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’).CommentsClose CommentsPermalink





(h) Compensation-CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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:CommentsClose CommentsPermalink





(1) The findings of the Secretary with respect to the pilot program.CommentsClose CommentsPermalink





(2) The number of veterans and non-veterans provided inpatient care by physicians participating in the pilot program.CommentsClose CommentsPermalink





(3) The amounts collected and payable under subsection (i).CommentsClose CommentsPermalink





(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)).CommentsClose CommentsPermalink