II 

113TH CONGRESS 

2D SESSION S. 2009 

To improve the provision of health care by the Department of Veterans 

Affairs to veterans in rural and highly rural areas, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 10, 2014 

Mr. UDALL of New Mexico (for himself and Mr. HELLER) introduced the following bill; which was read twice and referred to the Committee on Veterans’ Affairs 

A BILL 

To improve the provision of health care by the Department 

of Veterans Affairs to veterans in rural and highly 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 Im5 provement Act of 2014’’. 


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1 SEC. 2. PROVISION OF MENTAL HEALTH CARE TO CERTAIN 

2 VETERANS IN RURAL AND HIGHLY RURAL 

3 AREAS. 

4 (a) IN GENERAL.—The Secretary of Veterans Affairs 

5 shall provide mental health care to eligible veterans de6 scribed in subsection (c) for which a determination has 

7 been made under subsection (d). 

8 (b) USE OF OTHER PROVIDERS.— 

9 (1) IN GENERAL.—The Secretary may provide 

10 mental health care under this section by contracting 

11 with or providing payments to mental health care 

12 providers that are not otherwise affiliated with the 

13 Department of Veterans Affairs and shall, to the ex14 tent feasible, use health care resources pursuant to 

15 existing arrangements, contracts, or agreements en16 tered into under section 8153 of title 38, United 

17 States Code. 

18 (2) PAYMENTS.—The Secretary may not pro19 vide payments described in paragraph (1) that ex20 ceed the amount that the Secretary would otherwise 

21 expend in providing similar mental health care 

22 through the Department or under such existing ar23 rangements, contracts, or agreements. 

24 (c) ELIGIBLE VETERANS.—An eligible veteran de25 scribed in this subsection is a veteran that— 


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1 (1) has a mental health issue resulting from 

2 post-traumatic stress disorder, traumatic brain in3 jury, or any other health condition that was incurred 

4 or aggravated in line of duty in the active military, 

5 naval, or air service; and 

6 (2) lives in a rural area or highly rural area. 

7 (d) DETERMINATION.—The Secretary shall provide 

8 the care required by subsection (a) to an eligible veteran 

9 if the Secretary determines any of the following: 

10 (1)(A) A mental health care provider affiliated 

11 with the Department is not available to provide men12 tal health care services to the eligible veteran at the 

13 medical facility of the Department that is nearest to 

14 the residence of the eligible veteran; and 

15 (B)(i) in-person and telehealth mental health 

16 care services from the Department are not available 

17 to the eligible veteran; 

18 (ii) the eligible veteran requests that a mental 

19 health care provider affiliated with the Department 

20 provide mental health care services to the eligible 

21 veteran in private and the provider is unable or un22 willing to do so; or 

23 (iii) travel by the eligible veteran to a regional 

24 medical center of the Department is impractical or 


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1 severely detrimental to the health of the eligible vet2 eran. 

3 (2) That— 

4 (A)(i) a mental health care provider affili5 ated with the Department has recommended 

6 that a complementary and alternative therapy 

7 approved by the Food and Drug Administration 

8 be administered to the eligible veteran; 

9 (ii) the eligible veteran is a member of an 

10 Indian tribe or a Native Hawaiian and requests 

11 a healing method that is a cultural tradition of 

12 the eligible veteran; or 

13 (iii) a mental health care provider has rec14 ommended a treatment for the eligible veteran 

15 that, based on the medical knowledge of the 

16 health care provider, is safe and would assist 

17 the eligible veteran in coping with post-trau18 matic stress disorder, traumatic brain injury, or 

19 another mental health issue; and 

20 (B)(i) the eligible veteran has not received 

21 the therapy, healing method, or treatment de22 scribed in subparagraph (A) because of the in23 accessibility or unavailability of such treatment 

24 from a medical facility of the Department; and 


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1 (ii) the eligible veteran, as a result of the 

2 mental health condition of the eligible veteran— 

3 (I) cannot work or maintain employ4 ment; 

5 (II) is at increased risk of doing phys6 ical harm to the eligible veteran or others; 

7 or 

8 (III) cannot adequately manage activi9 ties of daily life. 

10 (e) INDIAN TRIBE DEFINED.—In this section, the 

11 term ‘‘Indian tribe’’ has the meaning given that term in 

12 section 4 of the Indian Self-Determination and Education 

13 Assistance Act (25 U.S.C. 450b). 

14 SEC. 3. REPORT ON EFFECTIVENESS OF COMPLEMENTARY 

15 AND ALTERNATIVE MEDICINE IN TREATING 

16 VETERANS WITH CERTAIN MENTAL ILL17 NESSES. 

18 Not later than one year after the date of the enact19 ment of this Act, the Secretary of Veterans Affairs shall 

20 submit to the Committee on Veterans’ Affairs of the Sen21 ate and the Committee on Veterans’ Affairs of the House 

22 of Representatives a report on the effectiveness of com23 plementary and alternative medicine used by the Depart24 ment of Veterans Affairs in treating veterans with mental 

25 health conditions resulting from post-traumatic stress disVerDate Mar 15 2010 21:06 Feb 11, 2014 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S2009.IS S2009

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1 order, traumatic brain injury, or any other health condi2 tion that was incurred or aggravated in line of duty in 

3 the active military, naval, or air service. 

4 SEC. 4. GRANTS TO PROVIDE TRANSPORTATION TO COM5 MUNITY-BASED OUTPATIENT CLINICS FOR 

6 VETERANS IN RURAL AND HIGHLY RURAL 

7 AREAS. 

8 (a) GRANTS AUTHORIZED.— 

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

10 Affairs may award grants to eligible entities to pro11 vide transportation to veterans in rural and highly 

12 rural areas who would otherwise be eligible for reim13 bursement for or payment of travel expenses by the 

14 Department of Veterans Affairs pursuant to section 

15 111 or section 111A of title 38, United States Code. 

16 (2) MAXIMUM AMOUNT.—The Secretary may 

17 not award a grant under this section in an amount 

18 that exceeds $100,000. 

19 (3) NO MATCHING REQUIRED.—The Secretary 

20 may not require that an eligible entity provide a con21 tribution of funds as a condition of receiving the 

22 grant. 

23 (b) ELIGIBLE ENTITIES.—The Secretary may award 

24 grants under this section to any of the following entities: 

25 (1) State veterans agencies. 


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1 (2) Veterans service organizations. 

2 (3) Tribal organizations. 

3 (c) USE OF GRANTS.—Eligible entities in receipt of 

4 a grant under this section may use the grant amount as 

5 follows: 

6 (1) To provide transportation to veterans in 

7 rural and highly rural areas to and from medical 

8 centers of the Department of Veterans Affairs, in9 cluding transportation by air or sea if necessary. 

10 (2) To otherwise assist veterans in rural and 

11 highly rural areas with transportation in connection 

12 with the provision of medical care to those veterans, 

13 including transportation by air or sea if necessary. 

14 (d) APPLICATION.— 

15 (1) IN GENERAL.—Each eligible entity seeking 

16 a grant under this section shall submit an applica17 tion to the Secretary at such time, in such manner, 

18 and accompanied by such information as the Sec19 retary may require. 

20 (2) CONTENTS.—Each application submitted 

21 pursuant to paragraph (1) shall contain a proposal 

22 for the manner in which the eligible entity seeks to 

23 provide the transportation described in subsection 

24 (a). 


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1 (e) PRIORITY.—The Secretary shall give priority in 

2 the awarding of grants under this section to applications 

3 submitted under subsection (d) that contain proposals 

4 that comply with section 504 of the Rehabilitation Act of 

5 1973 (29 U.S.C. 794) and regulations issued by the Sec6 retary of Transportation under such section 504. 

7 (f) DEFINITIONS.—In this section: 

8 (1) TRIBAL ORGANIZATION.—The term ‘‘tribal 

9 organization’’ has the meaning given that term in 

10 section 4 of the Indian Self-Determination and Edu11 cation Assistance Act (25 U.S.C. 450b). 

12 (2) VETERANS SERVICE ORGANIZATION.—The 

13 term ‘‘veterans service organization’’ means an orga14 nization recognized by the Secretary of Veterans Af15 fairs for the representation of veterans under section 

16 5902 of title 38, United States Code. 

17 SEC. 5. PILOT PROGRAM ON HOUSING ALLOWANCES FOR 

18 HEALTH CARE PROVIDERS OF THE DEPART19 MENT OF VETERANS AFFAIRS ACCEPTING AS20 SIGNMENT AT RURAL AND HIGHLY RURAL 

21 COMMUNITY-BASED OUTPATIENT CLINICS. 

22 (a) PILOT PROGRAM AUTHORIZED.—The Secretary 

23 of Veterans Affairs may carry out a pilot program to as24 sess the feasibility and advisability of providing a housing 

25 allowance to health care providers of the Department of 


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1 Veterans Affairs who accept assignment at rural or highly 

2 rural community-based outpatient clinics as a means of 

3 encouraging such health care providers to accept assign4 ment to such clinics. 

5 (b) ELIGIBILITY.—An individual is eligible for par6 ticipation in the pilot program if the individual— 

7 (1) is a health care provider; 

8 (2) is, or agrees to become, an employee of the 

9 Veterans Health Administration on a full-time basis 

10 in a health care position designated by the Secretary 

11 for purposes of the pilot program; and 

12 (3) accepts an assignment in such position for 

13 a term of not less than 36 months at a rural or 

14 highly rural community-based outpatient clinic se15 lected by the Secretary for purposes of the pilot pro16 gram. 

17 (c) CONDITIONS ON PAYMENT OF HOUSING ALLOW18 ANCE.—Except as provided in subsection (d)(3), an indi19 vidual may be provided a housing allowance under the 

20 pilot program only while— 

21 (1) in good standing as a health care provider 

22 within the Veterans Health Administration; and 

23 (2) assigned as a health care provider at a rural 

24 or highly rural community-based outpatient clinic. 

25 (d) AMOUNT OF HOUSING ALLOWANCE.— 


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1 (1) MONTHLY AMOUNT DURING INITIAL

2 TERM.—During the first 36 months of participation 

3 in the pilot program, the housing allowance provided 

4 a health care provider participating in the pilot pro5 gram shall be provided on a monthly basis at a rate 

6 that is equivalent to the monthly rate of basic allow7 ance for housing (BAH) payable under section 403 

8 of title 37, United States Code, to members of the 

9 uniformed services whose grade, dependency status, 

10 and geographic location most closely equals, as de11 termined by the Secretary, the grade of such pro12 vider under section 7404 of title 38, United States 

13 Code, and the dependency status and geographic lo14 cation of such provider. 

15 (2) MONTHLY AMOUNT FOR CERTAIN PRO16 VIDERS FOR ADDITIONAL TERM.—If upon comple17 tion of the first 36 months in the pilot program a 

18 health care provider accepts continuing participation 

19 in the pilot program at a rural or highly rural com20 munity-based outpatient clinic for a term of not less 

21 than 12 additional months, the housing allowance 

22 provided the health care provider under the pilot 

23 program shall be provided on a monthly basis for 

24 such additional months at a rate determined in ac25 cordance with paragraph (1). 


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1 (3) BONUS AMOUNT.— 

2 (A) COMPLETION OF INITIAL TERM.—Any 

3 health care provider who successfully completes 

4 36 months of participation in the pilot program 

5 shall be paid upon completion of participation 

6 in the pilot program an amount equal to three 

7 months of the monthly rate of housing allow8 ance provided the health care provider under 

9 paragraph (1) during the last month before the 

10 provider’s completion of participation in the 

11 pilot program. 

12 (B) COMPLETION OF ADDITIONAL ONE13 YEAR TERM.—Any health care provider who 

14 successfully completes 48 months of participa15 tion in the pilot program shall be paid upon 

16 completion of participation in the pilot program 

17 an amount equal to 12 months of the monthly 

18 rate of housing allowance provided the health 

19 care provider under paragraph (2) during the 

20 last month before the provider’s completion of 

21 participation in the pilot program. 

22 (C) COMPLETION OF ADDITIONAL TWO23 YEAR TERM.—Any health care provider who 

24 successfully completes 60 months of participa25 tion in the pilot program shall be paid upon 


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1 completion of participation in the pilot program 

2 an amount equal to 13 months of the monthly 

3 rate of housing allowance provided the health 

4 care provider under paragraph (2) during the 

5 last month before the provider’s completion of 

6 participation in the pilot program. 

7 (D) NO REQUIREMENT TO REMAIN ON AS8 SIGNMENT.—An amount payable under this 

9 paragraph shall be paid whether or not the 

10 health care provider concerned remains in an 

11 assignment at a rural or highly rural commu12 nity-based outpatient clinic. 

13 (e) NATURE OF ALLOWANCE.— 

14 (1) SUPPLEMENTAL AMOUNT.—Any housing al15 lowance provided under the pilot program shall be in 

16 addition to any pay (including basic pay, special pay, 

17 and retirement or other bonus pay) payable to per18 sonnel of the Veterans Health Administration per19 sonnel under chapter 74 of title 38, United States 

20 Code, or any other provision of law. 

21 (2) EXEMPTION FROM TAXATION.—For pur22 poses of the Internal Revenue Code of 1986, any 

23 housing allowance provided under the pilot program 

24 shall not be included in gross income. 

25 (f) ANNUAL REPORTS.— 


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1 (1) IN GENERAL.—Not later than one year 

2 after the date of the enactment of this Act and not 

3 less frequently than once each year thereafter while 

4 the pilot program is in effect, the Secretary shall 

5 submit to the Committee on Veterans’ Affairs of the 

6 Senate and the Committee on Veterans’ Affairs of 

7 the House of Representatives a report on the pilot 

8 program. 

9 (2) ELEMENTS.—Each report submitted under 

10 paragraph (1) shall include the following: 

11 (A) A current description of the pilot pro12 gram, including the current number of partici13 pants in the pilot program and the amounts of 

14 housing allowance being provided such partici15 pants. 

16 (B) A current assessment of the value of 

17 the housing allowance under the pilot program 

18 in encouraging health care providers in accept19 ing assignment to rural and highly rural com20 munity-based outpatient clinics. 

21 (g) FUNDING.—Amounts for housing allowances 

22 under the pilot program shall be derived from amounts 

23 available for the Veterans Health Administration for Med24 ical Services. 

25 (h) SUNSET.— 


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1 (1) IN GENERAL.—No individual may com2 mence participation in the pilot program on or after 

3 the date that is five years after the date of the en4 actment of this Act. 

5 (2) CONTINUATION OF ON-GOING PROVISION OF

6 ALLOWANCE.—Nothing in paragraph (1) shall be 

7 construed to prohibit the Secretary from providing 

8 housing allowances under the pilot program to indi9 viduals who commence participation in the pilot pro10 gram before the date that is five years after the date 

11 of the enactment of this Act. 

12 (i) RURAL OR HIGHLY RURAL COMMUNITY-BASED

13 OUTPATIENT CLINIC DEFINED.—In this section, the term 

14 ‘‘rural or highly rural community-based outpatient clinic’’ 

15 means a community-based outpatient clinic of the Vet16 erans Health Administration that predominantly serves 

17 veterans who live in rural and highly rural areas. 

18 SEC. 6. PROGRAM ON TRAINING HEALTH CARE PROFES19 SIONALS FOR ASSIGNMENT AT COMMUNITY20 BASED OUTPATIENT CLINICS THAT PREDOMI21 NANTLY SERVE VETERANS WHO LIVE IN 

22 RURAL AND HIGHLY RURAL AREAS. 

23 (a) PROGRAM REQUIRED.— 

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

25 Affairs shall establish a program to train health care 


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1 professionals for assignment at community-based 

2 outpatient clinics that predominantly serve veterans 

3 who live in rural and highly rural areas. 

4 (2) PARTNERSHIP WITH EDUCATIONAL INSTI5 TUTIONS.— 

6 (A) IN GENERAL.—In carrying out the 

7 program, the Secretary may enter into partner8 ships with educational institutions. 

9 (B) CONSULTATION.—If the Secretary en10 ters into a partnership with an educational in11 stitution to carry out the program, the Sec12 retary shall consult with the head of such edu13 cational institution with respect to the training 

14 and curriculum provided under the program at 

15 such educational institution. 

16 (b) TRAINING.—The training provided to health care 

17 professionals under the program shall include the fol18 lowing courses: 

19 (1) Courses on general professional development 

20 of health care professionals. 

21 (2) Courses on providing health care to rural 

22 populations and specifically to rural veterans. 

23 (c) CURRICULUM.—The program shall include train24 ing with respect to health issues that commonly afflict vet25 erans as specified by the Secretary. 


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1 (d) HIRING PREFERENCE.— 

2 (1) IN GENERAL.—Each health care profes3 sional that completes the program and completes a 

4 three-year assignment at a community-based out5 patient clinic that predominantly serves veterans 

6 who live in rural and highly rural areas shall receive 

7 a preference in selection for employment in the Vet8 erans Health Administration at the end of such 

9 three-year assignment. 

10 (2) DEGREE OF PREFERENCE.— 

11 (A) IN GENERAL.—The preference received 

12 under paragraph (1) shall be less than the pref13 erence given a veteran. 

14 (B) VETERANS.—A veteran that receives a 

15 preference under paragraph (1) shall receive a 

16 greater preference than an individual that re17 ceives a preference under such paragraph who 

18 is not a veteran. 

19 SEC. 7. ENCOURAGING AND FACILITATING TRANSITION OF 

20 MILITARY MEDICAL PROFESSIONALS INTO 

21 EMPLOYMENT WITH VETERANS HEALTH AD22 MINISTRATION. 

23 (a) ENCOURAGING EMPLOYMENT WITH VETERANS

24 HEALTH ADMINISTRATION.—The Secretary of Veterans 

25 Affairs and the Secretary of Defense shall jointly establish 


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1 a program to encourage an individual who serves in the 

2 Armed Forces with a military occupational specialty relat3 ing to the provision of health care to seek employment 

4 with the Veterans Health Administration when the indi5 vidual has been discharged or released from service in the 

6 Armed Forces or is contemplating separating from such 

7 service. 

8 (b) MATCHING OF MILITARY OCCUPATIONAL SPE9 CIALTIES.—The Secretary of Veterans Affairs and the 

10 Secretary of Defense shall jointly identify military occupa11 tional specialties relating to the provision of health care 

12 and match such occupational specialties with occupations 

13 and positions of employment within the Veterans Health 

14 Administration for which experience in such military occu15 pational specialty qualifies one for employment in such oc16 cupation or position of employment. 

17 (c) FACILITATION OF TRANSITION TO EMPLOYMENT

18 WITH VETERANS HEALTH ADMINISTRATION.—The Sec19 retary of Veterans Affairs and the Secretary of Defense 

20 shall prescribe such regulations and take such actions as 

21 may be necessary to facilitate the transition of individuals 

22 with military occupational specialties identified under sub23 section (b) into the corresponding occupations and posi24 tions of employment with the Veterans Health Administra25 tion under such subsection. 


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1 SEC. 8. ASSESSMENT OF COMMUNITY-BASED OUTPATIENT 

2 CLINICS IN RURAL AND HIGHLY RURAL 

3 AREAS. 

4 (a) ASSESSMENT.— 

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

6 Affairs shall conduct a periodic assessment of com7 munity-based outpatient clinics in rural and highly 

8 rural areas to determine whether expansion and im9 provement of community-based outpatient clinics in 

10 those areas is feasible or advisable. 

11 (2) ELEMENTS.—Each periodic assessment re12 quired by subsection (a) shall include the following 

13 with respect to each community-based outpatient 

14 clinic assessed: 

15 (A) An assessment of whether the facil16 ity— 

17 (i) meets applicable building code re18 quirements; 

19 (ii) meets applicable health care re20 quirements related to privacy; 

21 (iii) has the capacity to handle the 

22 number of patients that seek care at the 

23 facility; 

24 (iv) has sufficient parking for patients 

25 that seek care at the facility; 


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1 (v) has adequate access to broadband 

2 technology to allow the use or expansion of 

3 telehealth services at the facility; and 

4 (vi) has the capacity to properly store 

5 and dispose of medical and other haz6 ardous waste. 

7 (B) A survey of health care providers who 

8 practice at the facility with respect to— 

9 (i) strengths of the facility; 

10 (ii) weaknesses of the facility; and 

11 (iii) areas in which the facility may be 

12 improved. 

13 (b) REPORT.—Not later than one year after the date 

14 of the enactment of this Act, and not less frequently than 

15 once each year thereafter, the Secretary shall submit to 

16 the Committee on Veterans’ Affairs and the Committee 

17 on Appropriations of the Senate and the Committee on 

18 Veterans’ Affairs and the Committee on Appropriations 

19 of the House of Representatives a report on the findings 

20 of the Secretary with respect to the most recently com21 pleted assessment conducted under subsection (a), includ22 ing such recommendations as the Secretary may have for 

23 the expansion or improvement of community-based out24 patient clinics in rural and highly rural areas. 


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1 SEC. 9. REPORT ON ESTABLISHMENT OF POLYTRAUMA RE2 HABILITATION CENTERS OR POLYTRAUMA 

3 NETWORK SITES OF THE DEPARTMENT OF 

4 VETERANS AFFAIRS IN RURAL AREAS. 

5 (a) IN GENERAL.—Not later than 180 days after the 

6 date of the enactment of this Act, the Secretary of Vet7 erans Affairs shall submit to Congress a report on the fea8 sibility and advisability of establishing a Polytrauma Re9 habilitation Center or Polytrauma Network Site in each 

10 area in which the nearest Polytrauma Rehabilitation Cen11 ter or Polytrauma Network Site is more than 300 miles 

12 away. 

13 (b) REQUIREMENTS.— 

14 (1) IN GENERAL.—The report required by this 

15 section shall include the following: 

16 (A) An assessment of the adequacy of ex17 isting Polytrauma Rehabilitation Centers and 

18 Polytrauma Network Sites in providing care to 

19 veterans that live more than 300 miles from 

20 such facilities. 

21 (B) An assessment of the adequacy of ex22 isting Polytrauma Rehabilitation Centers and 

23 Polytrauma Network Sites in providing rehabili24 tation services pursuant to section 1710C of 

25 title 38, United States Code. 


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1 (C) An assessment of the feasibility and 

2 advisability of establishing a Polytrauma Reha3 bilitation Center or Polytrauma Network Site in 

4 each State in which there is a medical center of 

5 the Department of Veterans Affairs. 

6 (D) An assessment of whether establishing 

7 new Polytrauma Rehabilitation Centers and 

8 Polytrauma Network Sites would be bene9 ficial— 

10 (i) to the veteran population in gen11 eral; 

12 (ii) to veterans who live— 

13 (I) more than 300 miles from the 

14 nearest Polytrauma Rehabilitation 

15 Center or Polytrauma Network Site; 

16 or 

17 (II) in a State in which there is 

18 not a Polytrauma Rehabilitation Cen19 ter or Polytrauma Network Site; and 

20 (iii) to veterans who served in the ac21 tive military, naval, or air service on or 

22 after September 11, 2001. 

23 (2) BUDGET FOR ADDITIONAL FACILITIES.—If 

24 the Secretary determines that establishing additional 

25 Polytrauma Rehabilitation Centers and Polytrauma 


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1 Network Sites is feasible and advisable, the Sec2 retary shall include with the report required by sub3 section (a) a budget and plan for the establishment 

4 of those additional facilities. 

5 SEC. 10. DEFINITIONS. 

6 In this Act: 

7 (1) ACTIVE MILITARY, NAVAL, OR AIR SERV8 ICE.—The term ‘‘active military, naval, or air serv9 ice’’ has the meaning given that term in section 101 

10 of title 38, United States Code. 

11 (2) HIGHLY RURAL AREA.—The term ‘‘highly 

12 rural area’’ means an area located in a county that 

13 has less than seven individuals residing in that coun14 ty per square mile. 

15 (3) RURAL AREA.—The term ‘‘rural area’’ 

16 means any area that is not an urbanized area or a 

17 highly rural area. 

18 (4) URBANIZED AREA.—The term ‘‘urbanized 

19 area’’ has the meaning given that term by the Direc20 tor of the Bureau of the Census. 

Æ 


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