II 

115TH CONGRESS 

1ST SESSION S. 1449 

To authorize payment by the Department of Veterans Affairs for the costs 

associated with training and supervision of medical residents and interns 

at certain facilities that are not Department facilities, to require the 

Secretary of Veterans Affairs to carry out a pilot program to establish 

or affiliate with residency programs at facilities operated by Indian 

tribes, tribal organizations, and the Indian Health Service, and for other 

purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 27, 2017 

Mr. SULLIVAN (for himself and Mr. TESTER) introduced the following bill; 

which was read twice and referred to the Committee on Veterans’ Affairs 

A BILL 

To authorize payment by the Department of Veterans Affairs 

for the costs associated with training and supervision 

of medical residents and interns at certain facilities that 

are not Department facilities, to require the Secretary 

of Veterans Affairs to carry out a pilot program to 

establish or affiliate with residency programs at facilities 

operated by Indian tribes, tribal organizations, and the 

Indian Health Service, 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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Serving our Rural Vet3 erans Act of 2017’’. 

4 SEC. 2. SENSE OF CONGRESS. 

5 It is the sense of Congress that— 

6 (1) the Department of Veterans Affairs relies 

7 on agreements with the Indian Health Service and 

8 tribal health organizations to serve native and non9 native veteran populations in certain areas, espe10 cially rural areas of the United States, due to lim11 ited infrastructure or personnel of the Department 

12 in those areas; 

13 (2) the Department should support the practice 

14 of rural health care in the United States because 

15 such care is crucial to fulfilling the mission of the 

16 Department to provide the highest quality care for 

17 veterans; and 

18 (3) education regarding the unique health needs 

19 of veterans is necessary for all health care providers 

20 and is especially important for providers in rural 

21 health care delivery systems, including those affili22 ated with Indian tribes and tribal health organiza23 tions that care for a significant number of veterans. 


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1 SEC. 3. AUTHORIZATION OF PAYMENT BY DEPARTMENT OF 

2 VETERANS AFFAIRS FOR TRAINING AND SU3 PERVISION OF RESIDENTS OR INTERNS AT 

4 FACILITIES THAT ARE NOT DEPARTMENT FA5 CILITIES. 

6 (a) IN GENERAL.—Subsection (c) of section 7406 of 

7 title 38, United States Code, is amended by striking ‘‘De8 partment facility’’ each place it appears and inserting 

9 ‘‘covered facility’’. 

10 (b) COVERED FACILITY DEFINED.—Subsection 

11 (a)(2) of such section is amended by adding at the end 

12 the following new subparagraph: 

13 ‘‘(C) The term ‘covered facility’ means any of 

14 the following: 

15 ‘‘(i) A Department facility. 

16 ‘‘(ii) A facility operated by an Indian tribe 

17 or a tribal organization, as those terms are de18 fined in section 4 of the Indian Self-Determina19 tion and Education Assistance Act (25 U.S.C. 

20 5304). 

21 ‘‘(iii) A facility operated by the Indian 

22 Health Service. 

23 ‘‘(iv) A Federally-qualified health center, 

24 as defined in section 1905(l)(2)(B) of the Social 

25 Security Act (42 U.S.C. 1396d(l)(2)(B)). 

26 ‘‘(v) A community health center.’’. 


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1 SEC. 4. PILOT PROGRAM TO ESTABLISH OR AFFILIATE 

2 WITH GRADUATE MEDICAL RESIDENCY PRO3 GRAMS AT FACILITIES OPERATED BY INDIAN 

4 TRIBES, TRIBAL ORGANIZATIONS, AND THE 

5 INDIAN HEALTH SERVICE IN RURAL AREAS. 

6 (a) IN GENERAL.—The Secretary of Veterans Af7 fairs, in consultation with the Director of the Indian 

8 Health Service, shall carry out a pilot program— 

9 (1) to establish graduate medical education 

10 residency training programs at covered facilities; or 

11 (2) to affiliate with established programs de12 scribed in paragraph (1). 

13 (b) LOCATIONS.— 

14 (1) IN GENERAL.—The Secretary shall carry 

15 out the pilot program at not more than four covered 

16 facilities that have been selected by the Secretary for 

17 purposes of the pilot program. 

18 (2) CRITERIA.—The Secretary shall establish 

19 criteria for selecting covered facilities under para20 graph (1). 

21 (c) DURATION.—The Secretary shall implement the 

22 pilot program during the eight-year period beginning on 

23 the date that is 180 days after the date of the enactment 

24 of this Act. 

25 (d) REIMBURSEMENT OF COSTS.—The Secretary 

26 shall reimburse each covered facility participating in the 


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1 pilot program for the following costs associated with the 

2 pilot program: 

3 (1) Curriculum development. 

4 (2) Recruitment, training, supervision, and re5 tention of residents and faculty. 

6 (3) Accreditation of programs of education 

7 under the pilot program by the Accreditation Coun8 cil for Graduate Medical Education (ACGME) or the 

9 American Osteopathic Association (AOA). 

10 (4) The portion of faculty salaries attributable 

11 to activities relating to carrying out the pilot pro12 gram. 

13 (5) Payment for expenses relating to providing 

14 medical education under the pilot program. 

15 (e) PERIOD OF OBLIGATED SERVICE.— 

16 (1) IN GENERAL.—The Secretary shall enter 

17 into an agreement with each individual who partici18 pates in the pilot program under which such indi19 vidual agrees to serve a period of one year of obli20 gated service at a covered facility or a facility of the 

21 Department of Veterans Affairs for each year in 

22 which the individual participates in the pilot pro23 gram under this section. 

24 (2) BREACH.—An individual who participates 

25 in the pilot program and fails to satisfy the period 


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1 of obligated service under paragraph (1) shall be lia2 ble to the United States, in lieu of such obligated 

3 service, for the amount that has been paid or is pay4 able to or on behalf of the individual under the pilot 

5 program, reduced by the proportion that the number 

6 of days served for completion of the period of obli7 gated service bears to the total number of days in 

8 the period of obligated service of such individual. 

9 (3) LOAN REPAYMENT.—During the period of 

10 obligated service of an individual under paragraph 

11 (1), the individual— 

12 (A) shall be deemed to be an eligible indi13 vidual under subsection (b) of section 108 of 

14 the Indian Health Care Improvement Act (25 

15 U.S.C. 1616a) for purposes of participation in 

16 the Indian Health Service Loan Repayment 

17 Program under such section during the portion 

18 of such period that the individual serves at a 

19 covered facility; and 

20 (B) shall be deemed to be an eligible indi21 vidual under section 7682(a) of title 38, United 

22 States Code, for purposes of participation in 

23 the Department of Veterans Affairs Education 

24 Debt Reduction Program under subchapter VII 

25 of chapter 76 of such title during the portion 


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1 of such period that the individual serves at a fa2 cility of the Department. 

3 (4) CONCURRENT SERVICE.—Any period of ob4 ligated service required of an individual under para5 graph (1) shall be served— 

6 (A) with respect to service at a covered fa7 cility, concurrently with any period of obligated 

8 service required of the individual by the Indian 

9 Health Service; and 

10 (B) with respect to service at a facility of 

11 the Department of Veterans Affairs, concur12 rently with any period of obligated service re13 quired of the individual by the Department. 

14 (f) REPORT.—Not later than three years before the 

15 termination of the pilot program under subsection (c), the 

16 Secretary of Veterans Affairs shall submit to the Com17 mittee on Veterans’ Affairs of the Senate and the Com18 mittee on Veterans’ Affairs of the House of Representa19 tives a report on the feasibility and advisability of— 

20 (1) expanding the pilot program to additional 

21 locations; and 

22 (2) making the pilot program or any aspect of 

23 the pilot program permanent. 

24 (g) AUTHORIZATION OF APPROPRIATIONS.— 


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1 (1) IN GENERAL.—There is authorized to be 

2 appropriated to the Secretary of Veterans Affairs 

3 $20,000,000 for each year in which the pilot pro4 gram is carried out. 

5 (2) LOAN REPAYMENTS.— 

6 (A) IN GENERAL.—There is authorized to 

7 be appropriated— 

8 (i) to the Secretary of Health and 

9 Human Services, acting through the Direc10 tor of the Indian Health Service, such 

11 sums as may be necessary to cover loan re12 payments paid under the Indian Health 

13 Service Loan Repayment Program to indi14 viduals participating in the pilot program; 

15 and 

16 (ii) to the Secretary of Veterans Af17 fairs such sums as may be necessary to 

18 cover loan repayments paid under the De19 partment of Veterans Affairs Education 

20 Debt Reduction Program to individuals 

21 participating in the pilot program. 

22 (B) SUPPLEMENT NOT SUPPLANT.— 

23 Amounts appropriated or otherwise made avail24 able for the Indian Health Service Loan Repay25 ment Program or the Department of Veterans 


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1 Affairs Education Debt Reduction Program 

2 pursuant to the authorization of appropriations 

3 under subparagraph (A) shall supplement, not 

4 supplant, amounts made available to such pro5 grams under other provisions of law. 

6 (h) COVERED FACILITY DEFINED.—In this section, 

7 the term ‘‘covered facility’’ means a facility— 

8 (1) operated by an Indian tribe or a tribal orga9 nization (as those terms are defined in section 4 of 

10 the Indian Self-Determination and Education Assist11 ance Act (25 U.S.C. 5304)), or the Indian Health 

12 Service, that has an existing reimbursement agree13 ment with the Department of Veterans Affairs under 

14 section 405(c) of the Indian Health Care Improve15 ment Act (25 U.S.C. 1645(c)); and 

16 (2) located in a rural or remote area, as deter17 mined by the Secretary. 

Æ 


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