```

[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4011 Introduced in House (IH)]

<DOC>

114th CONGRESS
  1st Session
                                H. R. 4011

To increase the number of graduate medical education positions treating 
veterans, to improve the compensation of health care providers, medical 
directors, and directors of Veterans Integrated Service Networks of the 
        Department of Veterans Affairs, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           November 16, 2015

Mr. Gallego (for himself, Mrs. Kirkpatrick, Ms. Pingree, Mr. Honda, and 
  Ms. Esty) introduced the following bill; which was referred to the 
 Committee on Veterans' Affairs, and in addition to the Committees on 
Ways and Means and Energy and Commerce, for a period to be subsequently 
   determined by the Speaker, in each case for consideration of such 
 provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL

 
To increase the number of graduate medical education positions treating 
veterans, to improve the compensation of health care providers, medical 
directors, and directors of Veterans Integrated Service Networks of the 
        Department of Veterans Affairs, 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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Delivering 
Opportunities for Care and Services for Veterans Act of 2015'' or the 
``DOCs for Veterans Act of 2015''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
                TITLE I--MEDICAL EDUCATION AND TRAINING

Sec. 101. Disregard of resident slots that include VA training against 
                            the Medicare graduate medical education 
                            limitations.
Sec. 102. Extension of period for increase in graduate medical 
                            education residency positions at medical 
                            facilities of the Department of Veterans 
                            Affairs.
Sec. 103. Pilot program on graduate medical education residency 
                            programs in behavioral medicine in 
                            underserved areas.
Sec. 104. Inclusion of mental health professionals in education and 
                            training program for health personnel of 
                            the Department of Veterans Affairs.
Sec. 105. Expansion of qualifications for licensed mental health 
                            counselors of the Department of Veterans 
                            Affairs to include doctoral degrees.
 TITLE II--HEALTH CARE PROVIDERS OF THE DEPARTMENT OF VETERANS AFFAIRS

Sec. 201. Requirement that physician assistants employed by the 
                            Department of Veterans Affairs receive 
                            competitive pay.
Sec. 202. Modification of education debt reduction program of 
                            Department of Veterans Affairs to require a 
                            certain amount to be spent in rural and 
                            highly rural areas.
Sec. 203. Report on medical workforce of the Department of Veterans 
                            Affairs.
      TITLE III--LEADERSHIP OF THE VETERANS HEALTH ADMINISTRATION

Sec. 301. Establishment of positions of Directors of Veterans 
                            Integrated Service Networks in Office of 
                            Under Secretary for Health of Department of 
                            Veterans Affairs and modification of 
                            qualifications for Medical Directors.
Sec. 302. Pay for Medical Directors and Directors of Veterans 
                            Integrated Service Networks.
                  TITLE IV--OTHER HEALTH CARE MATTERS

Sec. 401. Pilot program on providing nurse advice line for veterans in 
                            rural and highly rural areas.

                TITLE I--MEDICAL EDUCATION AND TRAINING

SEC. 101. DISREGARD OF RESIDENT SLOTS THAT INCLUDE VA TRAINING AGAINST 
              THE MEDICARE GRADUATE MEDICAL EDUCATION LIMITATIONS.

    (a) Direct GME.--Section 1886(h)(4)(F) of the Social Security Act 
(42 U.S.C. 1395ww(h)(4)(F)) is amended by adding at the end the 
following new clause:
                            ``(iii) Disregard of certain resident slots 
                        that include va training.--For portions of cost 
                        reporting periods beginning on or after July 1, 
                        2017, in applying the limitations under clause 
                        (i) regarding the total number of full-time 
                        equivalent residents in the field of allopathic 
                        or osteopathic medicine in a hospital's 
                        approved medical residency training program, 
                        the Secretary shall not take into account any 
                        full-time equivalent resident within such 
                        program that is filling a graduate medical 
                        education residency position that counts 
                        towards meeting the obligation of the Secretary 
                        of Veterans Affairs authorized under section 
                        301(b)(2)(A) of the Veterans Access, Choice, 
                        and Accountability Act of 2014 (Public Law 113-
                        146; 38 U.S.C. 7302 note).''.
    (b) Indirect GME.--Section 1886(d)(5)(B)(v) of the Social Security 
Act (42 U.S.C. 1395ww(d)(5)(B)(v)) is amended, in the second sentence, 
by striking ``subsection (h)(4)(F)(ii)'' and inserting ``clauses (ii) 
and (iii) of subsection (h)(4)(F)''.

SEC. 102. EXTENSION OF PERIOD FOR INCREASE IN GRADUATE MEDICAL 
              EDUCATION RESIDENCY POSITIONS AT MEDICAL FACILITIES OF 
              THE DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--Paragraph (2) of subsection (b) of section 301 of 
the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 
113-146; 38 U.S.C. 7302 note) is amended--
            (1) in the paragraph heading, by striking ``Five-year'' and 
        inserting ``Ten-Year''; and
            (2) in subparagraph (A), by striking ``5-year period'' and 
        inserting ``10-year period''.
    (b) Report.--Paragraph (3)(A) of such subsection is amended by 
striking ``until 2019'' and inserting ``until 2024''.

SEC. 103. PILOT PROGRAM ON GRADUATE MEDICAL EDUCATION RESIDENCY 
              PROGRAMS IN BEHAVIORAL MEDICINE IN UNDERSERVED AREAS.

    (a) Pilot Program.--Commencing not later than one year after the 
date of the enactment of this Act, the Secretary of Veterans Affairs 
and the Secretary of Health and Human Services shall jointly conduct a 
six-year pilot program to establish not less than three graduate 
medical education residency programs in behavioral medicine in 
underserved areas in the United States.
    (b) Elements.--Each graduate medical education residency program 
established under the pilot program shall--
            (1) provide residents participating in the graduate medical 
        education residency program with an opportunity to work with a 
        diverse patient population through a rotation between medical 
        facilities of the Department of Veterans Affairs, facilities of 
        the Indian Health Service, and facilities participating under 
        the Medicare program under title XVIII of the Social Security 
        Act (42 U.S.C. 1395 et seq.);
            (2) include graduate medical education in the field of 
        behavioral medicine;
            (3) be carried out in a manner consistent with graduate 
        medical education residency programs supported and funded by 
        the Department of Veterans Affairs and the Department of Health 
        and Human Services;
            (4) be located in a community that--
                    (A) is designated as a medically underserved area 
                under section 330(b)(3)(A) of the Public Health Service 
                Act (42 U.S.C. 254b(b)(3)(A));
                    (B) is in a State with a per capita population of 
                veterans of more than 9 percent according to the 
                National Center for Veterans Analysis and Statistics 
                and the United States Census Bureau; and
                    (C) is within 100 miles of a Reservation (as 
                defined in Section 3(d) of the Indian Financing Act of 
                1974 (25 U.S.C. 1452)).
    (c) Report.--
            (1) In general.--Not later than 180 days after the date of 
        the commencement of the pilot program and not less frequently 
        than once each year thereafter while the pilot program is being 
        carried out, the Secretary of Veterans Affairs and the 
        Secretary of Health and Human Services shall, in consultation 
        with representatives from facilities participating under the 
        Medicare program under title XVIII of the Social Security Act 
        (42 U.S.C. 1395 et seq.) that are participating in the pilot 
        program, jointly submit to Congress a report on the 
        implementation of the pilot program.
            (2) Elements.--Each report required by paragraph (1) shall 
        include the following:
                    (A) A description of the patient population served 
                by the residents participating in a graduate medical 
                education residency program under the pilot program.
                    (B) A description of the behavioral medicine 
                services provided under the pilot program, including 
                the extent to which those services were provided using 
                telemedicine services.
                    (C) The academic affiliation of each resident 
                participating in a graduate medical education residency 
                program under the pilot program.
                    (D) A description of any impediments faced in 
                carrying out the pilot program and actions taken by the 
                Secretary of Veterans Affairs and the Secretary of 
                Health and Human Services to address those impediments.

SEC. 104. INCLUSION OF MENTAL HEALTH PROFESSIONALS IN EDUCATION AND 
              TRAINING PROGRAM FOR HEALTH PERSONNEL OF THE DEPARTMENT 
              OF VETERANS AFFAIRS.

    (a) In General.--In carrying out the education and training program 
required under section 7302(a)(1) of title 38, United States Code, the 
Secretary of Veterans Affairs shall include education and training of 
marriage and family therapists and licensed professional mental health 
counselors.
    (b) Apportionment of Funding.--The Secretary shall apportion 
funding for the education and training program described in subsection 
(a) equally among the professions included in the program.

SEC. 105. EXPANSION OF QUALIFICATIONS FOR LICENSED MENTAL HEALTH 
              COUNSELORS OF THE DEPARTMENT OF VETERANS AFFAIRS TO 
              INCLUDE DOCTORAL DEGREES.

    Section 7402(b)(11)(A) of title 38, United States Code, is amended 
by inserting ``or doctoral degree'' after ``master's degree''.

 TITLE II--HEALTH CARE PROVIDERS OF THE DEPARTMENT OF VETERANS AFFAIRS

SEC. 201. REQUIREMENT THAT PHYSICIAN ASSISTANTS EMPLOYED BY THE 
              DEPARTMENT OF VETERANS AFFAIRS RECEIVE COMPETITIVE PAY.

    Section 7451(a)(2) of title 38, United States Code, is amended--
            (1) by redesignating subparagraph (B) as subparagraph (C);
            (2) by inserting after subparagraph (A) the following new 
        subparagraph (B):
            ``(B) Physician assistant.''; and
            (3) in subparagraph (C), as redesignated by paragraph (1), 
        by striking ``and registered nurse'' and inserting ``registered 
        nurse, and physician assistant''.

SEC. 202. MODIFICATION OF EDUCATION DEBT REDUCTION PROGRAM OF 
              DEPARTMENT OF VETERANS AFFAIRS TO REQUIRE A CERTAIN 
              AMOUNT TO BE SPENT IN RURAL AND HIGHLY RURAL AREAS.

    Section 7681 of title 38, United States Code, is amended by adding 
at the end the following new subsections:
    ``(c) Limitation on Amounts.--Not less than 30 percent of the 
amount of debt reduction payments paid under the Education Debt 
Reduction Program each year shall be paid to individuals who practice 
medicine in a rural area or highly rural area or demonstrate a 
commitment to practice medicine in such an area.
    ``(d) Definitions.--In this section:
            ``(1) The term `highly rural area' means an area located in 
        a county or similar community that has less than seven 
        individuals residing in that county or community per square 
        mile.
            ``(2) The term `rural area' means an area that is not an 
        urbanized area or a highly rural area.
            ``(3) The term `urbanized area' has the meaning given that 
        term by the Director of the Bureau of the Census.''.

SEC. 203. REPORT ON MEDICAL WORKFORCE OF THE DEPARTMENT OF VETERANS 
              AFFAIRS.

    (a) In General.--Not later than 120 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs 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 
medical workforce of the Department of Veterans Affairs.
    (b) Elements.--The report required by subsection (a) shall include 
the following:
            (1) With respect to licensed professional mental health 
        counselors and marriage and family therapists of the 
        Department--
                    (A) how many such counselors and therapists are 
                currently enrolled in the mental health professionals 
                trainee program of the Department;
                    (B) how many such counselors and therapists are 
                expected to enroll in the mental health professionals 
                trainee program of the Department during the 180-day 
                period beginning on the date of the submittal of the 
                report;
                    (C) a description of the eligibility criteria for 
                such counselors and therapists as compared to other 
                behavioral health professions in the Department;
                    (D) a description of the objectives, goals, and 
                timing of the Department with respect to increasing the 
                representation of such counselors and therapists in the 
                behavioral health workforce of the Department; and
                    (E) a description of the actions taken by the 
                Secretary, in consultation with the Director of the 
                Office of Personnel Management, to create an 
                occupational series for such counselors and therapists 
                and a timeline for the creation of such an occupational 
                series.
            (2) A breakdown of spending by the Department in connection 
        with the education debt reduction program of the Department 
        under subchapter VII of chapter 76 of title 38, United States 
        Code, including--
                    (A) the amount spent by the Department in debt 
                reduction payments during the three-year period 
                preceding the submittal of the report disaggregated by 
                the medical profession of the individual receiving the 
                payments;
                    (B) a description of how the Department prioritizes 
                such spending by medical profession, including an 
                assessment of whether such priority reflects the five 
                occupations identified in the most recent determination 
                by the Inspector General of the Department of Veterans 
                Affairs as having the largest staffing shortages in the 
                Veterans Health Administration; and
                    (C) a description of the actions taken by the 
                Secretary to increase the effectiveness of such 
                spending for purposes of recruitment of health care 
                providers to the Department, including efforts to more 
                consistently include eligibility for the education debt 
                reduction program in vacancy announcements of positions 
                for health care providers at the Department.
            (3) A description of any impediments to the delivery by the 
        Department of telemedicine services to veterans and any actions 
        taken by the Department to address such impediments, including 
        with respect to--
                    (A) restrictions under Federal or State laws;
                    (B) licensing or credentialing issues for health 
                care providers, including non-Department health care 
                providers, practicing telemedicine with a veteran 
                located in a different State;
                    (C) the effect of limited broadband access or 
                limited information technology capabilities on the 
                delivery of health care;
                    (D) the distance a veteran is required to travel to 
                access a facility or clinic with telemedicine 
                capabilities;
                    (E) the effect on the provision of telemedicine 
                services to veterans of policies of and limited 
                liability protection for certain entities; and
                    (F) issues relating to reimbursement and travel 
                limitations for veterans that affect the participation 
                of non-Department health care providers in the 
                telemedicine program.
            (4) An update on the efforts of the Secretary to offer 
        training opportunities in telemedicine to medical residents in 
        medical facilities of the Department that use telemedicine, 
        consistent with medical residency program requirements 
        established by the Accreditation Council for Graduate Medical 
        Education, as required in section 108(b) of the Honoring 
        America's Veterans and Caring for Camp Lejeune Families Act of 
        2012 (Public Law 112-154; 38 U.S.C. 7406 note).
            (5) An assessment of the development and implementation by 
        the Secretary of succession planning policies to address the 
        prevalence of vacancies in positions in the Veterans Health 
        Administration of more than 180 days, including the development 
        of an enterprise position management system to more effectively 
        identify, track, and resolve such vacancies.
            (6) A description of the actions taken by the Secretary, in 
        consultation with the Director of the Office of Personnel 
        Management, to address any impediments to the timely 
        appointment and determination of qualifications for Directors 
        of Veterans Integrated Service Networks and Medical Directors 
        of the Department.

      TITLE III--LEADERSHIP OF THE VETERANS HEALTH ADMINISTRATION

SEC. 301. ESTABLISHMENT OF POSITIONS OF DIRECTORS OF VETERANS 
              INTEGRATED SERVICE NETWORKS IN OFFICE OF UNDER SECRETARY 
              FOR HEALTH OF DEPARTMENT OF VETERANS AFFAIRS AND 
              MODIFICATION OF QUALIFICATIONS FOR MEDICAL DIRECTORS.

    Section 7306(a)(4) of title 38, United States Code, is amended--
            (1) by inserting ``and Directors of Veterans Integrated 
        Service Networks'' after ``Such Medical Directors''; and
            (2) by striking ``, who shall be either a qualified doctor 
        of medicine or a qualified doctor of dental surgery or dental 
        medicine''.

SEC. 302. PAY FOR MEDICAL DIRECTORS AND DIRECTORS OF VETERANS 
              INTEGRATED SERVICE NETWORKS.

    (a) In General.--Chapter 74 of title 38, United States Code, is 
amended by adding at the end the following new subchapter:

 ``Subchapter VII--Pay for Medical Directors and Directors of Veterans 
                      Integrated Service Networks

``Sec. 7481. Pay for Medical Directors and Directors of Veterans 
              Integrated Service Networks
    ``(a) Elements of Pay.--Pay for a Medical Director or Director of a 
Veterans Integrated Service Network appointed under section 7306(a)(4) 
of this title (in this section referred to as a `Director') shall 
consist of basic pay set forth under section 7404(a) of this title and 
market pay determined under subsection (b).
    ``(b) Market Pay.--(1) Each Director is eligible for market pay 
determined under this subsection.
    ``(2) The amount of market pay payable to a Director under this 
section shall be determined by the Secretary on a case-by-case basis 
and shall consist of pay intended to reflect needs of the Department 
with respect to the recruitment and retention (as determined by the 
Secretary) of such Director.
    ``(3) In determining the amount of market pay payable to a Director 
under this section, the Secretary shall--
            ``(A) consult not less than two national surveys on pay for 
        hospital directors, medical facility directors, or other 
        similar positions, whether prepared by private, public, or 
        quasi-public entities, to make a general assessment of the 
        range of potential pay for the Director; and
            ``(B) take into account--
                    ``(i) the experience of the Director in managing 
                facilities or program offices of the Department, 
                including the complexity of such facilities or offices;
                    ``(ii) the complexity of the facility or facilities 
                to be managed by the Director;
                    ``(iii) the labor market, in such geographic area 
                as the Secretary considers relevant, for hospital 
                directors, medical facility directors, and other 
                similar positions;
                    ``(iv) the experience of the Director in managing 
                medical facilities for other Federal agencies, private 
                entities, or non-profit entities; and
                    ``(v) such other considerations as the Secretary 
                considers appropriate.
    ``(4)(A) The Secretary shall evaluate the amount of market pay 
payable to a Director under this section not less frequently than once 
every two years and may adjust the market pay payable to such Director 
as a result of such evaluation.
    ``(B) A Director whose market pay is evaluated under subparagraph 
(A) shall receive written notice of the results of such evaluation.
    ``(c) Requirements and Limitations on Total Pay.--(1) Not less 
frequently than once every two years, the Secretary shall set forth a 
Department-wide minimum and maximum amount for total annual pay under 
subsection (a) that may be paid to a Director and shall publish each 
such amount in the Federal Register.
    ``(2) The minimum and maximum amounts set forth under paragraph (1) 
shall take effect not earlier than the date that is 60 days after the 
publication of such amounts under such paragraph.
    ``(3) The sum of the basic pay set forth under section 7404(a) of 
this title and market pay determined under subsection (b) for a 
Director for a calendar year--
            ``(A) may not be less than the most recent minimum amount 
        set forth under paragraph (1) before the beginning of such 
        calendar year; and
            ``(B) may not be more than the most recent maximum amount 
        set forth under such paragraph before the beginning of such 
        calendar year.
    ``(4) The total amount of compensation paid to a Director under 
this title in any calendar year may not exceed the amount of annual 
compensation (excluding expenses) of the President under section 102 of 
title 3.
    ``(5) The Secretary may not delegate to an officer or employee of 
the Department the requirement of the Secretary to set forth a 
Department-wide minimum and maximum amount under paragraph (1).
    ``(d) Treatment of Pay.--Pay under this section shall be considered 
pay for all purposes, including retirement benefits under chapters 83 
and 84 of title 5 and other benefits.
    ``(e) Ancillary Effects of Decreases in Pay.--(1) A decrease in pay 
of a Director resulting from an adjustment in the amount of market pay 
of the Director under subsection (b) shall not be treated as an adverse 
action.
    ``(2) A decrease in the amount of pay of a Director resulting from 
an involuntary reassignment in connection with a disciplinary action 
taken against the Director is not subject to appeal or judicial 
review.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 74 of such title is amended by adding at the end the following:

 ``subchapter vii. pay for medical directors and directors of veterans 
                      integrated service networks

``7481. Pay for Medical Directors and Directors of Veterans Integrated 
                            Service Networks.''.

                  TITLE IV--OTHER HEALTH CARE MATTERS

SEC. 401. PILOT PROGRAM ON PROVIDING NURSE ADVICE LINE FOR VETERANS IN 
              RURAL AND HIGHLY RURAL AREAS.

    (a) In General.--Commencing not later than one year after the date 
of the enactment of this Act, the Secretary of Veterans Affairs shall 
conduct a two-year pilot program to assess the feasibility and 
advisability of implementing in rural areas and highly rural areas with 
a large percentage of veterans a nurse advice line to furnish to 
veterans medical advice, appointment and cancellation services, and 
information on the availability of benefits from the Department of 
Veterans Affairs.
    (b) Nurse Advice Line.--In carrying out the pilot program under 
subsection (a) the Secretary shall establish a nurse advice line that--
            (1) operates free of charge;
            (2) is based on, and improves upon, the nurse advice line 
        implemented by the Department of Defense for beneficiaries 
        under the TRICARE program (as defined in section 1072(5) of 
        title 10, United States Code);
            (3) complies with call center requirements set forth by 
        URAC;
            (4) operates in close consultation with the Secretary to--
                    (A) establish a process through which the 
                eligibility of a caller for the nurse advice line can 
                be validated;
                    (B) allow eligibility and benefit information in 
                possession of the Department of Veterans Affairs to be 
                shared with the nurse advice line; and
                    (C) allow the nurse advice line to connect with 
                appropriate technology and personnel of the Department 
                for purposes of scheduling appointments for the receipt 
                of health care from the Department; and
            (5) maintains quality controls to ensure that calls are 
        answered by a customer service representative within 30 seconds 
        and with an abandonment rate of less than 5 percent.
    (c) Services Provided.--The nurse advice line established under the 
pilot program shall provide an array of services to veterans, including 
the following:
            (1) Medical advice from licensed registered nurses who 
        assess the symptoms of the caller using a proprietary clinical 
        algorithm that--
                    (A) has been shown in peer-reviewed medical 
                journals to most closely emulate the clinical 
                decisionmaking processes of physicians; and
                    (B) triages the caller to the appropriate venue at 
                which the caller may receive the health care that they 
                need.
            (2) Information to address basic questions regarding the 
        eligibility of the caller for benefits from the Department of 
        Veterans Affairs and the availability of those benefits.
            (3) Use of an appointment clerk to facilitate the 
        scheduling, rescheduling, and cancellation of appointments for 
        health care from the Department.
    (d) Report.--
            (1) In general.--Not later than 120 days after the date of 
        the completion of the pilot program, the Secretary of Veterans 
        Affairs shall submit to Congress a report on the findings of 
        the Secretary with respect to the pilot program.
            (2) Elements.--The report required by paragraph (1) shall 
        include the following:
                    (A) A description of the veterans who have 
                benefitted from advice through the nurse advice line 
                under the pilot program, including the locations of the 
                veterans served.
                    (B) A description of any impediments to the 
                Secretary in carrying out the pilot program.
                    (C) A description of any impediments encountered by 
                individuals in seeking advice or services through the 
                nurse advice line under the pilot program.
                    (D) An assessment of the feasibility and 
                advisability of expanding the pilot program to include 
                more veterans.
    (e) Definitions.--In this section:
            (1) Highly rural area.--The term ``highly rural area'' 
        means an area located in a county or similar community that has 
        less than seven individuals residing in that county or 
        community per square mile.
            (2) Rural area.--The term ``rural area'' means an area that 
        is not an urbanized area or a highly rural area.
            (3) Urbanized area.--The term ``urbanized area'' has the 
        meaning given that term by the Director of the Bureau of the 
        Census.
                                 <all>
```