II 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Rural Veterans Care 

5 Act of 2006’’. 


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1 SEC. 2. ASSISTANT SECRETARY FOR RURAL VETERANS. 

2 Section 308 of title 38, United States Code, is 

3 amended— 

4 (1) in subsection (a)— 

5 (A) by inserting ‘‘(1)’’ before ‘‘There’’; 

6 (B) by striking ‘‘six’’ and inserting 

7 ‘‘seven’’; and 

8 (C) by striking ‘‘Each’’ and inserting the 

9 following: 

10 ‘‘(2) Each’’; 

11 (2) by redesignating subsection (c) as para12 graph (3) and inserting such paragraph at the end 

13 of subsection (a); 

14 (3) by inserting after subsection (b) the fol15 lowing new subsection: 

16 ‘‘(c)(1) One of the Assistant Secretaries appointed 

17 under subsection (a) shall be the Assistant Secretary for 

18 Rural Veterans, who, under the direction of the Secretary, 

19 shall formulate and implement all policies and procedures 

20 of the Department that affect veterans living in rural 

21 areas. 

22 ‘‘(2) The Assistant Secretary for Rural Veterans, 

23 under the direction of the Secretary, shall perform the fol24 lowing functions: 

25 ‘‘(A) Except as otherwise expressly provided in 

26 this title, carry out the provisions of this title and 


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1 administer all Department programs for providing 

2 care to veterans living in rural areas who are eligible 

3 for services authorized under this title. 

4 ‘‘(B) Oversee and coordinate personnel and 

5 policies of the Veterans Health Administration, the 

6 Veterans Benefits Administration, the National 

7 Cemetery Administration, and their respective sub8 agencies, including Veterans Integrated Service Net9 works, to carry out Department programs to the ex10 tent such programs affect veterans living in rural 

11 areas. 

12 ‘‘(C) Oversee, coordinate, promote, and dissemi13 nate research into issues affecting veterans living in 

14 rural areas in cooperation with the medical, rehabili15 tation, health services, and cooperative studies re16 search programs, the Office of Policy and the Office 

17 of Research and Development of the Veterans 

18 Health Administration, and the centers established 

19 in section 7329. 

20 ‘‘(D) Ensure maximum effectiveness and effi21 ciency in providing services and assistance to eligible 

22 veterans under the programs described in subpara23 graph (A), after consultation with appropriate rep24 resentatives of the Centers for Medicare and Med25 icaid Services, the Indian Health Service, and the 


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1 Office of Rural Health Policy of the Department of 

2 Health and Human Services, the Social Security Ad3 ministration, the Department of Labor, the Depart4 ment of Agriculture (acting through the Under Sec5 retary for Rural Development), and other Federal, 

6 State, and local government agencies. 

7 ‘‘(E) Work with all personnel and resources of 

8 the Department to develop, refine, and promulgate 

9 policies, best practices, lessons learned, and innova10 tive and successful programs to improve care and 

11 services for rural veterans. 

12 ‘‘(F) Perform such other functions and duties 

13 as the Secretary considers appropriate. 

14 ‘‘(3) The Secretary shall ensure that the Assistant 

15 Secretary for Rural Veterans has the budget, authority, 

16 and control necessary for the development, approval, im17 plementation, integration, and oversight of policies, proce18 dures, processes, activities, and systems of the Depart19 ment relating to the care of rural veterans. The Secretary 

20 shall identify a Rural Veterans Coordinator in each Vet21 erans Integrated Service Network, who shall report to the 

22 Assistant Secretary for Rural Veterans and coordinate the 

23 functions authorized under this subsection within such 

24 network. 


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1 ‘‘(4) The Assistant Secretary for Rural Veterans, 

2 under the direction of the Secretary, shall supervise the 

3 employees of the Department who are responsible for im4 plementing the policies and procedures described in para5 graph (1).’’; and 

6 (4) in subsection (d)— 

7 (A) in paragraph (1)— 

8 (i) by striking ‘‘18’’ and inserting 

9 ‘‘19’’; and 

10 (ii) by adding at the end the fol11 lowing: ‘‘One of the Deputy Assistant Sec12 retaries appointed under this paragraph 

13 shall be the Deputy Assistant Secretary for 

14 Rural Veterans, who shall perform such 

15 functions as the Assistant Secretary for 

16 Rural Veterans prescribes.’’; 

17 (B) in paragraph (2), by inserting ‘‘or, in 

18 the case of the Deputy Assistant Secretary for 

19 Rural Veterans, comparable service in a man20 agement position in the Armed Forces’’ after 

21 ‘‘Secretary’’. 

22 SEC. 3. RESPONSIBILITIES OF ASSISTANT SECRETARY FOR 

23 RURAL VETERANS. 

24 (a) DEMONSTRATION PROJECTS.— 


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1 (1) IN GENERAL.—The Assistant Secretary for 

2 Rural Veterans, appointed under section 308 of title 

3 38, United States Code, shall carry out demonstra4 tion projects to examine alternatives for expanding 

5 care in rural areas, including— 

6 (A) establishing a partnership between the 

7 Department of Veterans Affairs and the Cen8 ters for Medicare and Medicaid Services of the 

9 Department of Health and Human Services to 

10 coordinate care for rural veterans conducted at 

11 critical access hospitals (as designated or cer12 tified under section 1820 of the Social Security 

13 Act (42 U.S.C. 1395i–4)); 

14 (B) establishing a partnership between the 

15 Department of Veterans Affairs and the De16 partment of Health and Human Services to co17 ordinate care for rural veterans conducted at 

18 community health centers; 

19 (C) expanding the use of fee basis care 

20 through which private hospitals, health care fa21 cilities, and other third-party providers are re22 imbursed for providing care closer to the homes 

23 of veterans living in rural areas, as authorized 

24 under section 7405(a)(2); and 


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1 (D) expanding coordination between the 

2 Department of Veterans Affairs and the Indian 

3 Health Service to expand care for Native Amer4 ican veterans. 

5 (2) GEOGRAPHIC DISTRIBUTION.—The Assist6 ant Secretary for Rural Veterans shall ensure that 

7 the demonstration projects authorized under para8 graph (1) are located at facilities that are geographi9 cally distributed throughout the United States. 

10 (3) REPORT.—Not later than two years after 

11 the date of enactment of this Act, the Assistant Sec12 retary for Rural Veterans shall submit a report on 

13 the results of the demonstration projects conducted 

14 under paragraph (1) to— 

15 (A) the Committee on Veterans Affairs of 

16 the Senate; 

17 (B) the Committee on Appropriations of 

18 the Senate; 

19 (C) the Committee on Veterans Affairs of 

20 the House of Representatives; and 

21 (D) the Committee on Appropriations of 

22 the House of Representatives. 

23 (b) POLICY REVISIONS.—Not later than one year 

24 after the date of enactment of this Act, the Assistant Sec25 retary for Rural Veterans shall— 


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1 (1) reevaluate directives 5005 and 5007 of the 

2 Department of Veterans Affairs and other guidance 

3 and procedures related to the use of fee basis care 

4 nationwide; and 

5 (2) revise established policies to— 

6 (A) provide stronger guidance to units of 

7 the Department of Veterans Affairs; and 

8 (B) strengthen the use of fee basis care to 

9 extend health care services to rural and remote 

10 rural areas. 

11 (c) REPORTS TO CONGRESS.—The Secretary of Vet12 erans Affairs shall submit to Congress, in conjunction with 

13 the documents submitted in support of the President’s 

14 budget for each fiscal year, an assessment of the imple15 mentation during the most recently completed fiscal year 

16 of the provisions of this Act and the amendments made 

17 by this Act. 

18 SEC. 4. PILOT PROGRAM ON ENHANCED ACCESS TO 

19 HEALTH CARE FOR VETERANS IN HIGHLY 

20 RURAL AND GEOGRAPHICALLY REMOTE 

21 AREAS. 

22 (a) PILOT PROGRAM.— 

23 (1) IN GENERAL.—The Secretary of Veterans 

24 Affairs shall conduct a pilot program to evaluate the 

25 feasability and advisability of utilizing various means 


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1 to improve the access of veterans who reside in high2 ly rural or geographically remote areas to health 

3 care services referred to in subsection (d). 

4 (2) PROVISION OF SERVICES UNDER PILOT

5 PROGRAM.—In conducting the pilot program, the 

6 Secretary shall provide health care services referred 

7 to in subsection (d) to eligible veterans who reside 

8 in highly rural or geographically remote areas in the 

9 geographic service regions selected for purposes of 

10 the pilot program utilizing the contract authority of 

11 the Secretary under section 1703 of title 38, United 

12 States Code, and such other authorities available to 

13 the Secretary as the Secretary considers appropriate 

14 for purposes of the pilot program. 

15 (b) ELIGIBLE VETERANS.—A veteran is an eligible 

16 veteran for purposes of this section if the veteran— 

17 (1) has a service-connected disability; or 

18 (2) is enrolled in the veterans health care sys19 tem under section 1705 of title 38, United States 

20 Code. 

21 (c) HIGHLY RURAL OR GEOGRAPHICALLY REMOTE

22 AREAS.—An eligible veteran resides in a highly rural or 

23 geographically remote area for purposes of this section if 

24 the veteran— 


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1 (1) resides in a location that is more than 60 

2 miles driving distance from the nearest Department 

3 of Veterans Affairs health care facility; or 

4 (2) in the case of an eligible veteran who re5 sides in a location that is less than 60 miles driving 

6 distance from such a facility, experiences such hard7 ship or other difficulties (as determined pursuant to 

8 regulations prescribed by the Secretary for purposes 

9 of this section) in travel to the nearest Department 

10 of Veterans Affairs health care facility that such 

11 travel is not in the best interests of the veteran. 

12 (d) HEALTH CARE SERVICES.—The health care serv13 ices referred to in this section are— 

14 (1) acute or chronic symptom management; 

15 (2) nontherapeutic medical services; and 

16 (3) any other medical services jointly deter17 mined appropriate for an eligible veteran for pur18 poses of this section by the physician of the depart19 ment responsible for primary care of such eligible 

20 veteran and the director of the Veterans Integrated 

21 Service Network concerned. 

22 (e) AREAS FOR CONDUCT OF PILOT PROGRAM.— 

23 (1) IN GENERAL.—The pilot program shall be 

24 conducted in 3 of the geographic service regions of 

25 the Veterans Health Administration (referred to as 


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1 Veterans Integrated Service Networks) selected by 

2 the Secretary for purposes of the pilot program. 

3 (2) SELECTION.—In selecting geographic serv4 ice regions for the purposes of the pilot program, the 

5 Secretary, based on the recommendations of the As6 sistant Secretary for Rural Veterans, shall select 

7 from among the Veterans Integrated Service Net8 works that have a substantial population of veterans 

9 who reside in highly rural or geographically remote 

10 areas. 

11 (f) PERIOD OF PILOT PROGRAM.—The pilot program 

12 shall be conducted during fiscal years 2007, 2008, and 

13 2009. 

14 (g) FUNDING FOR PILOT PROGRAM.— 

15 (1) IN GENERAL.—For each fiscal year during 

16 which the pilot program is conducted, the Secretary 

17 shall allocate for the pilot program an amount equal 

18 to 0.9 percent of the total amount appropriated for 

19 such fiscal year for medical services. 

20 (2) TIMING OF ALLOCATION.—The allocation 

21 under paragraph (1) for a fiscal year shall be made 

22 before any other allocation of funds for medical care 

23 is made for such fiscal year, and any remaining allo24 cation of funds for medical care for such fiscal year 


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1 shall be made without regard to the allocation under 

2 subsection (a) in such fiscal year. 

3 (h) REPORT TO CONGRESS.—Not later than Feb4 ruary 1, 2009, the Secretary shall submit to Congress a 

5 report on the pilot program. The Secretary shall include 

6 in the report such recommendations as the Secretary con7 siders appropriate concerning extension of the pilot pro8 gram or other means to improve the access of veterans 

9 who reside in highly rural or geographically remote areas 

10 to health care services referred to in subsection (d). 

11 SEC. 5. TRAVEL REIMBURSEMENT FOR VETERANS RECEIV12 ING TREATMENT AT FACILITIES OF THE DE13 PARTMENT OF VETERANS AFFAIRS. 

14 Section 111 of title 38, United States Code, is 

15 amended— 

16 (1) in subsection (a)— 

17 (A) by striking ‘‘subsistence),’’ and insert18 ing ‘‘subsistence at a rate equivalent to the rate 

19 provided to Federal employees under section 

20 5702 of title 5),’’; and 

21 (B) by striking ‘‘traveled,’’ and inserting 

22 ‘‘(at a rate equivalent to the rate provided to 

23 Federal employees under section 5704 of title 

24 5),’’; 

25 (2) by striking subsection (g); and 


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1 (3) by redesignating subsection (h) as sub2 section (g). 

3 SEC. 6. CENTERS FOR RURAL HEALTH RESEARCH, EDU4 CATION, AND CLINICAL ACTIVITIES. 

5 (a) IN GENERAL.—Subchapter II of chapter 73 of 

6 title 38, United States Code, is amended by adding at the 

7 end the following new section: 

8 ‘‘§ 7329. Centers for rural health research, education, 

9 and clinical activities 

10 ‘‘(a) ESTABLISHMENT OF CENTERS.—The Assistant 

11 Secretary for Rural Veterans shall establish and operate 

12 not less than one and not more than five centers of excel13 lence for rural health research, education, and clinical ac14 tivities, which shall— 

15 ‘‘(1) conduct research on rural health services; 

16 ‘‘(2) allow the Department to use specific mod17 els for furnishing services to treat rural veterans; 

18 ‘‘(3) provide education and training for health 

19 care professionals of the Department; and 

20 ‘‘(4) develop and implement innovative clinical 

21 activities and systems of care for the Department. 

22 ‘‘(b) GEOGRAPHIC DISPERSION.—The Assistant Sec23 retary for Rural Veterans shall ensure that the centers 

24 authorized under paragraph (1) are located at health care 


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1 facilities that are geographically dispersed throughout the 

2 United States. 

3 ‘‘(c) SELECTION CRITERIA.—The Assistant Secretary 

4 for Rural Veterans may not designate a health care facility 

5 as a location for a center under this section unless— 

6 ‘‘(1) the peer review panel established under 

7 subsection (d) determines that the proposal sub8 mitted by such facility meets the highest competitive 

9 standards of scientific and clinical merit; and 

10 ‘‘(2) the Assistant Secretary for Rural Veterans 

11 determines that the facility has, or may reasonably 

12 be anticipated to develop— 

13 ‘‘(A) an arrangement with an accredited 

14 medical school to provide residents with edu15 cation and training in care for rural veterans; 

16 ‘‘(B) the ability to attract the participation 

17 of scientists who are capable of ingenuity and 

18 creativity in health care research efforts; 

19 ‘‘(C) a policymaking advisory committee, 

20 composed of appropriate health care and re21 search representatives of the facility and of the 

22 affiliated school or schools, to advise the direc23 tors of such facility and such center on policy 

24 matters pertaining to the activities of such cenVerDate Aug 31 2005 02:14 Mar 18, 2006 Jkt 049196 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S2433.IS S2433

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1 ter during the period of the operation of such 

2 center; and 

3 ‘‘(D) the capability to effectively conduct 

4 evaluations of the activities of such center. 

5 ‘‘(d) PANEL TO EVALUATE PROPOSALS.—(1) The 

6 Assistant Secretary for Rural Veterans shall establish a 

7 panel to— 

8 ‘‘(A) evaluate the scientific and clinical merit of 

9 proposals submitted to establish centers under this 

10 section; and 

11 ‘‘(B) provide advice to the Assistant Secretary 

12 for Rural Veterans regarding the implementation of 

13 this section. 

14 ‘‘(2) The panel shall review each proposal received 

15 from the Assistant Secretary for Rural Veterans and shall 

16 submit its views on the relative scientific and clinical merit 

17 of each such proposal to the Assistant Secretary. 

18 ‘‘(3) The panel established under paragraph (1) shall 

19 be comprised of experts in the fields of public health re20 search, education, and clinical care. 

21 ‘‘(4) Members of the panel shall serve as consultants 

22 to the Department for a period not to exceed two years. 

23 ‘‘(5) The panel shall not be subject to the Federal 

24 Advisory Committee Act. 


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1 ‘‘(e) FUNDING.—(1) There are authorized to be ap2 propriated such sums as may be necessary for the support 

3 of the research and education activities of the centers es4 tablished pursuant to subsection (a). 

5 ‘‘(2) The Assistant Secretary for Rural Veterans shall 

6 allocate such amounts as the Under Secretary for Health 

7 determines to be appropriate to the centers established 

8 pursuant to subsection (a) from funds appropriated for 

9 the Medical Care Account and the Medical and Prosthetics 

10 Research Account. 

11 ‘‘(3) Activities of clinical and scientific investigation 

12 at each center established under subsection (a)— 

13 ‘‘(A) shall be eligible to compete for the award 

14 of funding from funds appropriated for the Medical 

15 and Prosthetics Research Account; and 

16 ‘‘(B) shall receive priority in the award of fund17 ing from such account to the extent that funds are 

18 awarded to projects for research in the care of rural 

19 veterans.’’. 

20 (b) CLERICAL AMENDMENT.—The table of sections 

21 at the beginning of chapter 73 of title 38, United States 

22 Code, is amended by inserting after the item relating to 

23 section 7328 the following new item: 

‘‘7329. Centers for rural health research, education, and clinical activities.’’. 

Æ 


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