II 

Calendar No. 190 

111TH CONGRESS 

1ST SESSION S. 1963 

To amend title 38, United States Code, to provide assistance to caregivers 

of veterans, to improve the provision of health care to veterans, and 

for other purposes. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 28, 2009 

Mr. AKAKA introduced the following bill; which was read the first time 

OCTOBER 29, 2009 

Read the second time and placed on the calendar 

A BILL 

To amend title 38, United States Code, to provide assistance 

to caregivers of veterans, to improve the provision of 

health care to veterans, 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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Caregivers and Veterans Omnibus Health Services Act 

6 of 2009’’. 


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1 (b) TABLE OF CONTENTS.—The table of contents for 

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. References to title 38, United States Code. 

TITLE I—CAREGIVER SUPPORT 

Sec. 101. Waiver of charges for humanitarian care provided to family members 

accompanying certain severely injured veterans as they receive 

medical care. 

Sec. 102. Family caregiver assistance. 

Sec. 103. Lodging and subsistence for attendants. 

Sec. 104. Survey of informal caregivers. 

TITLE II—WOMEN VETERANS HEALTH CARE MATTERS 

Sec. 201. Report on barriers to receipt of health care for women veterans. 

Sec. 202. Plan to improve provision of health care services to women veterans. 

Sec. 203. Independent study on health consequences of women veterans of military service in Operation Iraqi Freedom and Operation Enduring Freedom. 

Sec. 204. Training and certification for mental health care providers on care 

for veterans suffering from sexual trauma. 

Sec. 205. Pilot program on counseling in retreat settings for women veterans 

newly separated from service in the Armed Forces. 

Sec. 206. Report on full-time women veterans program managers at medical 

centers. 

Sec. 207. Service on certain advisory committees of women recently separated 

from service in the Armed Forces. 

Sec. 208. Pilot program on subsidies for child care for certain veterans receiving health care. 

Sec. 209. Care for newborn children of women veterans receiving maternity 

care. 

TITLE III—RURAL HEALTH IMPROVEMENTS 

Sec. 301. Enhancement of Department of Veterans Affairs Education Debt Reduction Program. 

Sec. 302. Visual impairment and orientation and mobility professionals education assistance program. 

Sec. 303. Inclusion of Department of Veterans Affairs facilities in list of facilities eligible for assignment of participants in National Health 

Service Corps Scholarship Program. 

Sec. 304. Teleconsultation and telemedicine. 

Sec. 305. Demonstration projects on alternatives for expanding care for veterans in rural areas. 

Sec. 306. Program on provision of readjustment and mental health care services to veterans who served in Operation Iraqi Freedom and 

Operation Enduring Freedom. 

Sec. 307. Improvement of care of American Indian veterans. 

Sec. 308. Travel reimbursement for veterans receiving treatment at facilities of 

the Department of Veterans Affairs. 

Sec. 309. Office of Rural Health five-year strategic plan. 

Sec. 310. Oversight of contract and fee-basis care. 


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Sec. 311. Enhancement of Vet Centers to meet needs of veterans of Operation 

Iraqi Freedom and Operation Enduring Freedom. 

Sec. 312. Centers of excellence for rural health research, education, and clinical 

activities. 

Sec. 313. Pilot program on incentives for physicians who assume inpatient responsibilities at community hospitals in health professional 

shortage areas. 

Sec. 314. Annual report on matters related to care for veterans who live in 

rural areas. 

Sec. 315. Transportation grants for rural veterans service organizations. 

Sec. 316. Modification of eligibility for participation in pilot program of enhanced contract care authority for health care needs of certain 

veterans. 

TITLE IV—MENTAL HEALTH CARE MATTERS 

Sec. 401. Eligibility of members of the Armed Forces who serve in Operation 

Iraqi Freedom or Operation Enduring Freedom for counseling 

and services through Readjustment Counseling Service. 

Sec. 402. Restoration of authority of Readjustment Counseling Service to provide referral and other assistance upon request to former members of the Armed Forces not authorized counseling. 

Sec. 403. Study on suicides among veterans. 

Sec. 404. Transfer of funds to Secretary of Health and Human Services for 

Graduate Psychology Education program. 

TITLE V—OTHER HEALTH CARE MATTERS 

Sec. 501. Repeal of certain annual reporting requirements. 

Sec. 502. Modifications to annual Gulf War research report. 

Sec. 503. Payment for care furnished to CHAMPVA beneficiaries. 

Sec. 504. Disclosures from certain medical records. 

Sec. 505. Disclosure to Secretary of health-plan contract information and social 

security number of certain veterans receiving care. 

Sec. 506. Enhancement of quality management. 

Sec. 507. Reports on improvements to Department health care quality management. 

Sec. 508. Pilot program on use of community-based organizations and local and 

State government entities to ensure that veterans receive care 

and benefits for which they are eligible. 

Sec. 509. Specialized residential care and rehabilitation for certain veterans. 

Sec. 510. Expanded study on the health impact of Project Shipboard Hazard 

and Defense. 

Sec. 511. Use of non-Department facilities for rehabilitation of individuals with 

traumatic brain injury. 

Sec. 512. Inclusion of federally recognized tribal organizations in certain programs for State veterans homes. 

Sec. 513. Pilot program on provision of dental insurance plans to veterans and 

survivors and dependents of veterans. 

Sec. 514. Expansion of veteran eligibility for reimbursement by Secretary of 

Veterans Affairs for emergency treatment furnished in a nonDepartment facility. 

Sec. 515. Prohibition on collection of copayments from veterans who are catastrophically disabled. 

TITLE VI—DEPARTMENT PERSONNEL MATTERS 


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Sec. 601. Enhancement of authorities for retention of medical professionals. 

Sec. 602. Limitations on overtime duty, weekend duty, and alternative work 

schedules for nurses. 

Sec. 603. Improvements to certain educational assistance programs. 

Sec. 604. Standards for appointment and practice of physicians in Department 

of Veterans Affairs medical facilities. 

TITLE VII—HOMELESS VETERANS MATTERS 

Sec. 701. Pilot program on financial support for entities that coordinate the 

provision of supportive services to formerly homeless veterans 

residing on certain military property. 

Sec. 702. Pilot program on financial support of entities that coordinate the provision of supportive services to formerly homeless veterans residing in permanent housing. 

Sec. 703. Pilot program on financial support of entities that provide outreach 

to inform certain veterans about pension benefits. 

Sec. 704. Assessment of pilot programs. 

TITLE VIII—NONPROFIT RESEARCH AND EDUCATION 

CORPORATIONS 

Sec. 801. General authorities on establishment of corporations. 

Sec. 802. Clarification of purposes of corporations. 

Sec. 803. Modification of requirements for boards of directors of corporations. 

Sec. 804. Clarification of powers of corporations. 

Sec. 805. Redesignation of section 7364A of title 38, United States Code. 

Sec. 806. Improved accountability and oversight of corporations. 

TITLE IX—CONSTRUCTION AND NAMING MATTERS 

Sec. 901. Authorization of medical facility projects. 

Sec. 902. Designation of Robley Rex Department of Veterans Affairs Medical 

Center. 

Sec. 903. Merril Lundman Department of Veterans Affairs Outpatient Clinic. 

Sec. 904. Modification on restriction of alienation of certain real property in 

Gulf Port, Mississippi. 

TITLE X—OTHER MATTERS 

Sec. 1001. Expansion of authority for Department of Veterans Affairs police 

officers. 

Sec. 1002. Uniform allowance for Department of Veterans Affairs police officers. 

1 SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE. 

2 Except as otherwise expressly provided, whenever in 

3 this Act an amendment or repeal is expressed in terms 

4 of an amendment to, or repeal of, a section or other provi5 sion, the reference shall be considered to be made to a 

6 section or other provision of title 38, United States Code. 


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1 TITLE I—CAREGIVER SUPPORT 

2 SEC. 101. WAIVER OF CHARGES FOR HUMANITARIAN CARE 

3 PROVIDED TO FAMILY MEMBERS ACCOM4 PANYING CERTAIN SEVERELY INJURED VET5 ERANS AS THEY RECEIVE MEDICAL CARE. 

6 The text of section 1784 is amended to read as fol7 lows: 

8 ‘‘(a) IN GENERAL.—The Secretary may furnish hos9 pital care or medical services as a humanitarian service 

10 in emergency cases. 

11 ‘‘(b) REIMBURSEMENT.—Except as provided in sub12 section (c), the Secretary shall charge for care and services 

13 provided under subsection (a) at rates prescribed by the 

14 Secretary. 

15 ‘‘(c) WAIVER OF CHARGES.—(1) Except as provided 

16 in paragraph (2), the Secretary shall waive the charges 

17 required by subsection (b) for care or services provided 

18 under subsection (a) to an attendant of a covered veteran 

19 if such care or services are provided to such attendant for 

20 an emergency that occurs while such attendant is accom21 panying such veteran while such veteran is receiving ap22 proved inpatient or outpatient treatment at— 

23 ‘‘(A) a Department facility; or 

24 ‘‘(B) a non-Department facility— 


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1 ‘‘(i) that is under contract with the De2 partment; or 

3 ‘‘(ii) at which the veteran is receiving fee4 basis care. 

5 ‘‘(2) If an attendant is entitled to care or services 

6 under a health-plan contract (as that term is defined in 

7 section 1725(f) of this title) or other contractual or legal 

8 recourse against a third party that would, in part, extin9 guish liability for charges described by subsection (b), the 

10 amount of such charges waived under paragraph (1) shall 

11 be the amount by which such charges exceed the amount 

12 of such charges covered by the health-plan contract or 

13 other contractual or legal recourse against the third party. 

14 ‘‘(d) DEFINITIONS.—In this section: 

15 ‘‘(1) The term ‘attendant’, with respect to a 

16 veteran, includes the following: 

17 ‘‘(A) A family member of the veteran. 

18 ‘‘(B) An individual eligible to receive ongo19 ing family caregiver assistance under section 

20 1717A(e)(1) of this title for the provision of 

21 personal care services to the veteran. 

22 ‘‘(C) Any other individual whom the Sec23 retary determines— 


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1 ‘‘(i) has a relationship with the vet2 eran sufficient to demonstrate a close af3 finity with the veteran; and 

4 ‘‘(ii) provides a significant portion of 

5 the veteran’s care. 

6 ‘‘(2) The term ‘covered veteran’ means any vet7 eran with a severe injury incurred or aggravated in 

8 the line of duty in the active military, naval, or air 

9 service on or after September 11, 2001. 

10 ‘‘(3) The term ‘family member’ shall have such 

11 meaning as the Secretary shall determine by policy 

12 or regulation. 

13 ‘‘(4) The term ‘severe injury’, in the case of a 

14 covered veteran, means any physiological, psycho15 logical, or neurological condition that renders a vet16 eran unable to live independently as determined by 

17 the Secretary.’’. 

18 SEC. 102. FAMILY CAREGIVER ASSISTANCE. 

19 (a) REQUIREMENT.— 

20 (1) IN GENERAL.—Subchapter II of chapter 17 

21 is amended by inserting after section 1717 the fol22 lowing new section: 

23 ‘‘§ 1717A. Family caregiver assistance 

24 ‘‘(a) IN GENERAL.—(1) As part of home health serv25 ices provided under section 1717 of this title, the SecVerDate Nov 24 2008 21:38 Oct 29, 2009 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1963.PCS S1963

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1 retary shall, upon the joint application of an eligible vet2 eran and a family member of such veteran (or other indi3 vidual designated by such veteran), furnish to such family 

4 member (or designee) family caregiver assistance in ac5 cordance with this section. The purpose of providing fam6 ily caregiver assistance under this section is— 

7 ‘‘(A) to reduce the number of veterans who are 

8 receiving institutional care, or who are in need of in9 stitutional care, whose personal care service needs 

10 could be substantially satisfied with the provision of 

11 such services by a family member (or designee); and 

12 ‘‘(B) to provide eligible veterans with additional 

13 options so that they can choose the setting for the 

14 receipt of personal care services that best suits their 

15 needs. 

16 ‘‘(2) The Secretary shall only furnish family caregiver 

17 assistance under this section to a family member of an 

18 eligible veteran (or other individual designated by such 

19 veteran) if the Secretary determines it is in the best inter20 est of the eligible veteran to do so. 

21 ‘‘(b) ELIGIBLE VETERANS.—For purposes of this 

22 section, an eligible veteran is a veteran (or member of the 

23 Armed Forces undergoing medical discharge from the 

24 Armed Forces)— 


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1 ‘‘(1) who has a serious injury (including trau2 matic brain injury, psychological trauma, or other 

3 mental disorder) incurred or aggravated in the line 

4 of duty in the active military, naval, or air service 

5 on or after September 11, 2001; and 

6 ‘‘(2) whom the Secretary determines, in con7 sultation with the Secretary of Defense as necessary, 

8 is in need of personal care services because of— 

9 ‘‘(A) an inability to perform one or more 

10 independent activities of daily living; 

11 ‘‘(B) a need for supervision or protection 

12 based on symptoms or residuals of neurological 

13 or other impairment or injury; or 

14 ‘‘(C) such other matters as the Secretary 

15 shall establish in consultation with the Sec16 retary of Defense as appropriate. 

17 ‘‘(c) EVALUATION OF ELIGIBLE VETERANS AND

18 FAMILY CAREGIVERS.—(1) The Secretary shall evaluate 

19 each eligible veteran who makes a joint application under 

20 subsection (a)(1)— 

21 ‘‘(A) to identify the personal care services re22 quired by such veteran; and 

23 ‘‘(B) to determine whether such requirements 

24 could be significantly or substantially satisfied with 

25 the provision of personal care services from a family 


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1 member (or other individual designated by the vet2 eran). 

3 ‘‘(2) The Secretary shall evaluate each family mem4 ber of an eligible veteran (or other individual designated 

5 by the veteran) who makes a joint application under sub6 section (a)(1) to determine— 

7 ‘‘(A) the basic amount of instruction, prepara8 tion, and training such family member (or designee) 

9 requires, if any, to provide the personal care services 

10 required by such veteran; and 

11 ‘‘(B) the amount of additional instruction, prep12 aration, and training such family member (or des13 ignee) requires, if any, to be the primary personal 

14 care attendant designated for such veteran under 

15 subsection (e). 

16 ‘‘(3) An evaluation carried out under paragraph (1) 

17 may be carried out— 

18 ‘‘(A) at a Department facility; 

19 ‘‘(B) at a non-Department facility determined 

20 appropriate by the Secretary for purposes of such 

21 evaluation; and 

22 ‘‘(C) at such other locations as the Secretary 

23 considers appropriate. 

24 ‘‘(d) TRAINING AND APPROVAL.—(1) Except as pro25 vided in subsection (a)(2), the Secretary shall provide each 


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1 family member of an eligible veteran (or other individual 

2 designated by the veteran) who makes a joint application 

3 under subsection (a)(1) the basic instruction, preparation, 

4 and training determined to be required by such family 

5 member (or designee) under subsection (c)(2)(A). 

6 ‘‘(2) The Secretary may provide to a family member 

7 of an eligible veteran (or other individual designated by 

8 the veteran) the additional instruction, preparation, and 

9 training determined to be required by such family member 

10 (or designee) under subsection (c)(2)(B) if such family 

11 member (or designee)— 

12 ‘‘(A) is approved as a personal care attendant 

13 for the veteran under paragraph (3); and 

14 ‘‘(B) requests, with concurrence of the veteran, 

15 such additional instruction, preparation, and train16 ing. 

17 ‘‘(3) Upon the successful completion by a family 

18 member of an eligible veteran (or other individual des19 ignated by the veteran) of basic instruction, preparation, 

20 and training provided under paragraph (1), the Secretary 

21 shall approve the family member as a personal care at22 tendant for the veteran. 

23 ‘‘(4) If the Secretary determines that a primary per24 sonal care attendant designated under subsection (e) re25 quires additional training to maintain such designation, 


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1 the Secretary shall make such training available to the pri2 mary personal care attendant. 

3 ‘‘(5) The Secretary shall, subject to regulations the 

4 Secretary shall prescribe, provide for necessary travel, 

5 lodging, and per diem expenses incurred by a family mem6 ber of an eligible veteran (or other individual designated 

7 by the veteran) in undergoing training under this sub8 section. 

9 ‘‘(6) If the participation of a family member of an 

10 eligible veteran (or other individual designated by the vet11 eran) in training under this subsection would interfere 

12 with the provision of personal care services to the veteran, 

13 the Secretary shall, subject to regulations as the Secretary 

14 shall prescribe and in consultation with the veteran, pro15 vide respite care to the veteran during the provision of 

16 such training to the family member so that such family 

17 caregiver (or designee) can participate in such training 

18 without interfering with the provision of such services. 

19 ‘‘(e) DESIGNATION OF PRIMARY PERSONAL CARE

20 ATTENDANT.—(1) For each eligible veteran with at least 

21 one family member (or other individual designated by the 

22 veteran) who is described by subparagraphs (A) through 

23 (E) of paragraph (2), the Secretary shall designate one 

24 family member of such veteran (or other individual des25 ignated by the veteran) as the primary personal care atVerDate Nov 24 2008 21:38 Oct 29, 2009 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S1963.PCS S1963

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1 tendant for such veteran to be the primary provider of 

2 personal care services for such veteran. 

3 ‘‘(2) A primary personal care attendant designated 

4 for an eligible veteran under paragraph (1) shall be se5 lected from among family members of such veteran (or 

6 other individuals designated by such veteran) who— 

7 ‘‘(A) are approved under subsection (d)(3) as a 

8 personal care attendant for such veteran; 

9 ‘‘(B) complete all additional instruction, prepa10 ration, and training, if any, provided under sub11 section (d)(2); 

12 ‘‘(C) elect to provide the personal care services 

13 to such veteran that the Secretary determines such 

14 veteran requires under subsection (c)(1); 

15 ‘‘(D) has the consent of such veteran to be the 

16 primary provider of such services for such veteran; 

17 and 

18 ‘‘(E) the Secretary considers competent to be 

19 the primary provider of such services for such vet20 eran. 

21 ‘‘(3)(A) An eligible veteran receiving personal care 

22 services from a family member (or other individual des23 ignated by the veteran) designated as the primary per24 sonal care attendant for the veteran under paragraph (1) 


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1 may revoke consent with respect to such family member 

2 (or designee) under paragraph (2)(D). 

3 ‘‘(B) An eligible veteran may revoke the designation 

4 of a primary personal care attendant under subparagraph 

5 (A) at any time, except that such revocation may not occur 

6 more frequently than once every six months unless the 

7 Secretary determines it is in the best interest of the eligi8 ble veteran to permit such revocation to occur more fre9 quently. 

10 ‘‘(4) If an individual designated as the primary per11 sonal care attendant of an eligible veteran under para12 graph (1) subsequently fails to meet the requirements set 

13 forth in paragraph (2), the Secretary— 

14 ‘‘(A) shall immediately revoke the individual’s 

15 designation under paragraph (1); and 

16 ‘‘(B) may designate, in consultation with the el17 igible veteran or the eligible veteran’s surrogate ap18 pointed under subsection (g), a new primary per19 sonal care attendant for the veteran under such 

20 paragraph. 

21 ‘‘(5) The Secretary shall take such actions as may 

22 be necessary to ensure that the revocation of a designation 

23 under paragraph (1) does not interfere with the provision 

24 of personal care services required by a veteran. 


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1 ‘‘(f) ONGOING FAMILY CAREGIVER ASSISTANCE.— 

2 (1) Except as provided in subsection (a)(2) and subject 

3 to the provisions of this subsection, the Secretary shall 

4 provide ongoing family caregiver assistance to family 

5 members of eligible veterans (or other individuals des6 ignated by such veterans) as follows: 

7 ‘‘(A) To each family member of an eligible vet8 eran (or designee) who is approved under subsection 

9 (d)(3) as a personal care attendant for the veteran 

10 the following: 

11 ‘‘(i) Direct technical support consisting of 

12 information and assistance to timely address 

13 routine, emergency, and specialized caregiving 

14 needs. 

15 ‘‘(ii) Counseling. 

16 ‘‘(iii) Access to an interactive Internet 

17 website on caregiver services that addresses all 

18 aspects of the provision of personal care serv19 ices under this section. 

20 ‘‘(B) To each family member of an eligible vet21 eran (or designee) who is designated as the primary 

22 personal care attendant for the veteran under sub23 section (e) the following: 

24 ‘‘(i) The ongoing family caregiver assist25 ance described in subparagraph (A). 


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1 ‘‘(ii) Mental health services. 

2 ‘‘(iii) Respite care of not less than 30 days 

3 annually, including 24-hour per day care of the 

4 veteran commensurate with the care provided 

5 by the family caregiver to permit extended res6 pite. 

7 ‘‘(iv) Medical care under section 1781 of 

8 this title if such family member (or designee) is 

9 not entitled to care or services under a health10 plan contract (as defined in section 1725(f) of 

11 this title). 

12 ‘‘(v) A monthly personal caregiver stipend. 

13 ‘‘(2)(A) The Secretary shall provide respite care 

14 under paragraph (1)(B)(iii), at the election of the Sec15 retary— 

16 ‘‘(i) through facilities of the Department that 

17 are appropriate for the veteran; or 

18 ‘‘(ii) through contracts under section 1720B(c) 

19 of this title. 

20 ‘‘(B) If the primary personal care attendant of an 

21 eligible veteran designated under subsection (e)(1) deter22 mines in consultation with the veteran or the veteran’s 

23 surrogate appointed under subsection (g), and the Sec24 retary concurs, that the needs of the veteran cannot be 

25 accommodated through the facilities and contracts deVerDate Nov 24 2008 21:38 Oct 29, 2009 Jkt 089200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S1963.PCS S1963

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1 scribed in subparagraph (A), the Secretary shall, in con2 sultation with the primary personal care attendant and the 

3 veteran (or the veteran’s surrogate), provide respite care 

4 through other facilities or arrangements that are medically 

5 and age appropriate. 

6 ‘‘(3) If the Secretary determines that the Department 

7 lacks the capacity to furnish medical care under clause 

8 (iv) of paragraph (1)(B), the Secretary may contract, in 

9 accordance with such regulations as the Secretary shall 

10 prescribe, for such insurance, medical services, or health 

11 plans as the Secretary considers appropriate to furnish 

12 such medical care. 

13 ‘‘(4)(A) The Secretary shall provide monthly personal 

14 caregiver stipends under paragraph (1)(B)(v) in accord15 ance with a schedule established by the Secretary that 

16 specifies stipends provided based upon the amount and de17 gree of personal care services provided. 

18 ‘‘(B) The Secretary shall ensure, to the extent prac19 ticable, that the schedule required by subparagraph (A) 

20 specifies that the amount of the personal caregiver stipend 

21 provided to a primary personal care attendant designated 

22 under subsection (e)(1) for the provision of personal care 

23 services to an eligible veteran is not less than the amount 

24 a commercial home health care entity would pay an indiVerDate Nov 24 2008 21:38 Oct 29, 2009 Jkt 089200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S1963.PCS S1963

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1 vidual in the geographic area of the veteran to provide 

2 equivalent personal care services to the veteran. 

3 ‘‘(C) If personal care services are not available from 

4 a commercial provider in the geographic area of an eligible 

5 veteran, the Secretary may establish the schedule required 

6 by subparagraph (A) with respect to the veteran by consid7 ering the costs of commercial providers of personal care 

8 services in geographic areas other than the geographic 

9 area of the veteran with similar costs of living. 

10 ‘‘(5) Provision of ongoing family caregiver assistance 

11 under this subsection for provision of personal care serv12 ices to an eligible veteran shall terminate if the veteran 

13 no longer requires the personal care services. 

14 ‘‘(g) SURROGATES.—If an eligible veteran lacks the 

15 capacity to submit an application, provide consent, make 

16 a request, or concur with a request under this section, the 

17 Secretary may, in accordance with regulations and policies 

18 of the Department regarding the appointment of guard19 ians or the use of powers of attorney, appoint a surrogate 

20 for the veteran who may submit applications, provide con21 sent, make requests, or concur with requests on behalf of 

22 the veteran under this section. 

23 ‘‘(h) OVERSIGHT.—(1) The Secretary shall enter into 

24 contracts with appropriate entities to provide oversight of 

25 the provision of personal care services under this section 


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1 by primary personal care attendants designated under 

2 subsection (e)(1). 

3 ‘‘(2) The Secretary shall ensure that each eligible vet4 eran receiving personal care services under this section 

5 from a primary personal care attendant designated under 

6 subsection (e)(1) is visited in the veteran’s home by an 

7 entity providing oversight under paragraph (1) at such 

8 frequency as the Secretary shall determine under para9 graph (3). 

10 ‘‘(3)(A) Except as provided in subparagraph (B), the 

11 Secretary shall determine the manner of oversight pro12 vided under paragraph (1) and the frequency of visits 

13 under paragraph (2) for an eligible veteran as the Sec14 retary considers commensurate with the needs of such vet15 eran. 

16 ‘‘(B) The frequency of visits under paragraph (2) for 

17 an eligible veteran shall be not less frequent than once 

18 every six months. 

19 ‘‘(4)(A) An entity visiting an eligible veteran under 

20 paragraph (2) shall submit to the Secretary the findings 

21 of the entity with respect to each visit, including whether 

22 the veteran is receiving the care the veteran requires. 

23 ‘‘(B) If an entity finds under subparagraph (A) that 

24 an eligible veteran is not receiving the care the veteran 

25 requires, the entity shall submit to the Secretary a recVerDate Nov 24 2008 21:38 Oct 29, 2009 Jkt 089200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\S1963.PCS S1963

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1 ommendation on the corrective actions that should be 

2 taken to ensure that the veteran receives the care the vet3 eran requires, including, if the entity considers appro4 priate, a recommendation for revocation of a caregiver’s 

5 approval under subsection (d)(3) or revocation of the des6 ignation of an individual under subsection (e)(1). 

7 ‘‘(5) After receiving findings and recommendations, 

8 if any, under paragraph (4) with respect to an eligible vet9 eran, the Secretary may take such actions as the Secretary 

10 considers appropriate to ensure that the veteran receives 

11 the care the veteran requires, including the following: 

12 ‘‘(A) Revocation of a caregiver’s approval under 

13 subsection (d)(3). 

14 ‘‘(B) Revocation of the designation of an indi15 vidual under subsection (e)(1). 

16 ‘‘(6) If the Secretary terminates the provision of on17 going family caregiver assistance under subsection (f) to 

18 a family member of an eligible veteran (or other individual 

19 designated by the veteran) because of findings of an entity 

20 submitted to the Secretary under paragraph (4), the Sec21 retary may not provide compensation to such entity for 

22 the provision of personal care services to such veteran, un23 less the Secretary determines it would be in the best inter24 est of such veteran to provide compensation to such entity 

25 to provide such services. 


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1 ‘‘(i) OUTREACH.—The Secretary shall carry out a 

2 program of outreach to inform eligible veterans and their 

3 family members of the availability and nature of family 

4 caregiver assistance under this section. 

5 ‘‘(j) CONSTRUCTION.—(1) A decision by the Sec6 retary under this section affecting the furnishing of family 

7 caregiver assistance shall be considered a medical deter8 mination. 

9 ‘‘(2) Nothing in this section shall be construed to cre10 ate an employment relationship between the Secretary and 

11 an individual in receipt of family caregiver assistance 

12 under this section. 

13 ‘‘(3) Nothing in this section shall be construed to cre14 ate any entitlement to any services or stipends provided 

15 under this section. 

16 ‘‘(k) DEFINITIONS.—In this section: 

17 ‘‘(1) The term ‘family caregiver assistance’ in18 cludes the instruction, preparation, training, and ap19 proval provided under subsection (d) and the ongo20 ing family caregiver assistance provided under sub21 section (f). 

22 ‘‘(2) The term ‘family member’ shall have such 

23 meaning as the Secretary shall determine by policy 

24 or regulation. 


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1 ‘‘(3) The term ‘personal care services’, with re2 spect to a veteran, includes the following: 

3 ‘‘(A) Supervision of the veteran. 

4 ‘‘(B) Protection of the veteran. 

5 ‘‘(C) Services to assist the veteran with 

6 one or more independent activities of daily liv7 ing. 

8 ‘‘(D) Such other services as the Secretary 

9 considers appropriate.’’. 

10 (2) CLERICAL AMENDMENT.—The table of sec11 tions at the beginning of chapter 17 is amended by 

12 inserting after the item related to section 1717 the 

13 following new item: 

‘‘1717A. Family caregiver assistance.’’. 

14 (3) AUTHORIZATION FOR PROVISION OF

15 HEALTH CARE TO PERSONAL CARE ATTENDANTS.— 

16 Section 1781(a) is amended— 

17 (A) by redesignating paragraphs (2) and 

18 (3) as paragraphs (3) and (4), respectively; and 

19 (B) by inserting after paragraph (1) the 

20 following new paragraph (2): 

21 ‘‘(2) a family member of a veteran (or other in22 dividual designated by the veteran) designated as the 

23 primary personal care attendant for such veteran 

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1 tled to care or services under a health-plan contract 

2 (as defined in section 1725(f) of this title),’’. 

3 (4) CONSTRUCTION.—Any family caregiver as4 sistance furnished under section 1717A of title 38, 

5 United States Code, as added by paragraph (1), is 

6 in addition to any family caregiver assistance fur7 nished under other programs of the Department of 

8 Veterans Affairs as of the date of the enactment of 

9 this Act. 

10 (5) EFFECTIVE DATE.—The amendments made 

11 by this subsection shall take effect on the date that 

12 is 270 days after the date of the enactment of this 

13 Act. 

14 (b) IMPLEMENTATION PLAN AND REPORT.— 

15 (1) IN GENERAL.—Not later than 180 days 

16 after the date of the enactment of this Act, the Sec17 retary of Veterans Affairs shall— 

18 (A) develop a plan for the implementation 

19 of section 1717A of title 38, United States 

20 Code, as added by subsection (a)(1); and 

21 (B) submit to the Committee on Veterans’ 

22 Affairs of the Senate and the Committee on 

23 Veterans’ Affairs of the House of Representa24 tives a report on such plan. 


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1 (2) CONSULTATION.—In developing the plan re2 quired by paragraph (1)(A), the Secretary shall con3 sult with the following: 

4 (A) Veterans described in section 1717A(b) 

5 of title 38, United States Code, as added by 

6 subsection (a)(1). 

7 (B) Family members of veterans who pro8 vide personal care services to such veterans. 

9 (C) Veterans service organizations, as rec10 ognized by the Secretary of Veterans Affairs for 

11 the representation of veterans under section 

12 5902 of title 38, United States Code. 

13 (D) National organizations that specialize 

14 in the provision of assistance to individuals with 

15 the types of disabilities that personal care at16 tendants will encounter while providing personal 

17 care services under section 1717A of title 38, 

18 United States Code, as so added. 

19 (E) Such other organizations with an in20 terest in the provision of care to veterans as the 

21 Secretary considers appropriate. 

22 (F) The Secretary of Defense with respect 

23 to matters concerning personal care services for 

24 members of the Armed Forces undergoing med25 ical discharge from the Armed Forces who are 


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1 eligible to benefit from family caregiver assist2 ance furnished under section 1717A of title 38, 

3 United States Code, as so added. 

4 (3) REPORT CONTENTS.—The report required 

5 by paragraph (1)(B) shall contain the following: 

6 (A) The plan required by paragraph 

7 (1)(A). 

8 (B) A description of the veterans, care9 givers, and organizations consulted by the Sec10 retary under paragraph (2). 

11 (C) A description of such consultations. 

12 (D) The recommendations of such vet13 erans, caregivers, and organizations, if any, 

14 that were not incorporated into the plan re15 quired by paragraph (1)(A). 

16 (E) The reasons the Secretary did not in17 corporate such recommendations into such plan. 

18 (c) ANNUAL EVALUATION REPORT.— 

19 (1) IN GENERAL.—Not later than two years 

20 after the date described in subsection (a)(5) and an21 nually thereafter, the Secretary shall submit to the 

22 Committee on Veterans’ Affairs of the Senate and 

23 the Committee on Veterans’ Affairs of the House of 

24 Representatives a comprehensive report on the imVerDate Nov 24 2008 21:38 Oct 29, 2009 Jkt 089200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\S1963.PCS S1963

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1 plementation of section 1717A of title 38, United 

2 States Code, as added by subsection (a)(1). 

3 (2) CONTENTS.—The report required by para4 graph (1) shall include the following: 

5 (A) The number of family members (or 

6 other designated individuals) of veterans or 

7 members of the Armed Forces that received 

8 family caregiver assistance under such section 

9 1717A. 

10 (B) A description of the outreach activities 

11 carried out by the Secretary in accordance with 

12 subsection (i) of such section 1717A. 

13 (C) The resources expended by the Sec14 retary under such section 1717A. 

15 (D) An assessment of the manner in which 

16 resources are expended by the Secretary under 

17 such section 1717A, particularly with respect to 

18 the provision of monthly personal caregiver sti19 pends under subsection (f) of such section. 

20 (E) A description of the outcomes achieved 

21 by, and any measurable benefits of, carrying 

22 out the requirements of such section 1717A. 

23 (F) A justification of any determination 

24 made under subsection (b)(2) of such section 

25 1717A. 


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1 (G) An assessment of the effectiveness and 

2 the efficiency of the implementation of such sec3 tion 1717A. 

4 (H) An assessment of how the provision of 

5 family caregiver assistance fits into the con6 tinuum of home health care services and bene7 fits provided to veterans in need of such serv8 ices and benefits. 

9 (I) Such recommendations, including rec10 ommendations for legislative or administrative 

11 action, as the Secretary considers appropriate 

12 in light of carrying out the requirements of 

13 such section 1717A. 

14 (d) REPORT ON FEASIBILITY AND ADVISABILITY OF

15 EXPANDING CAREGIVER ASSISTANCE.— 

16 (1) IN GENERAL.—Not later than two years 

17 after the date of the enactment of the Caregivers 

18 and Veterans Omnibus Health Services Act of 2009, 

19 the Secretary shall submit to the Committee on Vet20 erans’ Affairs of the Senate and the Committee on 

21 Veterans’ Affairs of the House of Representatives a 

22 report on the feasibility and advisability of expand23 ing the provision of family caregiver assistance 

24 under section 1717A of title 38, United States Code, 

25 as added by subsection (a)(1), to family members of 


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1 veterans (or other individuals designated by such 

2 veterans) who— 

3 (A) have a serious injury described in sub4 section (b)(1) of such section 1717A incurred 

5 or aggravated before September 11, 2001; and 

6 (B) are described in paragraph (2) of such 

7 subsection. 

8 (2) RECOMMENDATIONS.—The report required 

9 by paragraph (1) shall include such recommenda10 tions as the Secretary considers appropriate with re11 spect to the expansion described in such paragraph. 

12 SEC. 103. LODGING AND SUBSISTENCE FOR ATTENDANTS. 

13 Section 111(e) is amended— 

14 (1) by striking ‘‘When any’’ and inserting ‘‘(1) 

15 When any’’; 

16 (2) in paragraph (1), as designated by para17 graph (1) of this subsection— 

18 (A) by inserting ‘‘(including lodging and 

19 subsistence)’’ after ‘‘expenses of travel’’; and 

20 (B) by inserting before the period at the 

21 end the following: ‘‘for the period consisting of 

22 travel to and from a treatment facility and the 

23 duration of the treatment episode at that facil24 ity’’; and 

25 (3) by adding at the end the following: 


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1 ‘‘(2) The Secretary may prescribe regulations to 

2 carry out this subsection. Such regulations may include 

3 provisions— 

4 ‘‘(A) to limit the number of individuals that 

5 may receive expenses of travel under paragraph (1) 

6 for a single treatment episode of a person; and 

7 ‘‘(B) to require attendants to use certain travel 

8 services. 

9 ‘‘(3) In this subsection: 

10 ‘‘(A) The term ‘attendant’ includes, with re11 spect to a person described in paragraph (1), the fol12 lowing: 

13 ‘‘(i) A family member of the person. 

14 ‘‘(ii) An individual approved as a personal 

15 care attendant under section 1717A(d)(3) of 

16 this title. 

17 ‘‘(iii) Any other individual whom the Sec18 retary determines— 

19 ‘‘(I) has a preexisting relationship 

20 with the person; and 

21 ‘‘(II) provides a significant portion of 

22 the person’s care. 

23 ‘‘(B) The term ‘family member’ shall have such 

24 meaning as the Secretary shall determine by policy 

25 or regulation.’’. 


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1 SEC. 104. SURVEY OF INFORMAL CAREGIVERS. 

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

3 shall, in collaboration with the Secretary of Defense, con4 duct a national survey of family caregivers of seriously dis5 abled veterans and members of the Armed Forces to better 

6 understand the size and characteristics of the population 

7 of such caregivers and the types of care they provide such 

8 veterans and members. 

9 (b) REPORT.—Not later than 540 days after the date 

10 of the enactment of this Act, the Secretary of Veterans 

11 Affairs shall, in collaboration with the Secretary of De12 fense, submit to Congress a report containing the findings 

13 of the Secretary with respect to the survey conducted 

14 under subsection (a). Results of the survey shall be 

15 disaggregated by the following: 

16 (1) Veterans and members of the Armed 

17 Forces. 

18 (2) Veterans and members of the Armed Forces 

19 who served in Operation Iraqi Freedom or Operation 

20 Enduring Freedom. 

21 (3) Veterans and members of the Armed Forces 

22 who live in rural areas. 


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1 TITLE II—WOMEN VETERANS 

2 HEALTH CARE MATTERS 

3 SEC. 201. REPORT ON BARRIERS TO RECEIPT OF HEALTH 

4 CARE FOR WOMEN VETERANS. 

5 (a) REPORT.—Not later than June 1, 2010, the Sec6 retary of Veterans Affairs shall submit to the Committee 

7 on Veterans’ Affairs of the Senate and the Committee on 

8 Veterans’ Affairs of the House of Representatives a report 

9 on the barriers to the receipt of comprehensive health care 

10 through the Department of Veterans Affairs that are en11 countered by women veterans, especially veterans of Oper12 ation Iraqi Freedom and Operation Enduring Freedom. 

13 (b) ELEMENTS.—The report required by subsection 

14 (a) shall include the following: 

15 (1) An identification and assessment of the fol16 lowing: 

17 (A) Any stigma perceived or associated 

18 with seeking mental health care services 

19 through the Department of Veterans Affairs. 

20 (B) The effect on access to care through 

21 the Department of driving distance or avail22 ability of other forms of transportation to the 

23 nearest appropriate facility of the Department. 

24 (C) The availability of child care. 


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1 (D) The receipt of health care through 

2 women’s health clinics, integrated primary care 

3 clinics, or both. 

4 (E) The extent of comprehension of eligi5 bility requirements for health care through the 

6 Department, and the scope of health care serv7 ices available through the Department. 

8 (F) The quality and nature of the recep9 tion of women veterans by Department health 

10 care providers and other staff. 

11 (G) The perception of personal safety and 

12 comfort of women veterans in inpatient, out13 patient, and behavioral health facilities of the 

14 Department. 

15 (H) The sensitivity of Department health 

16 care providers and other staff to issues that 

17 particularly affect women. 

18 (I) The effectiveness of outreach on health 

19 care services of the Department that are avail20 able to women veterans. 

21 (J) Such other matters as the Secretary 

22 identifies for purposes of the assessment. 

23 (2) Such recommendations for administrative 

24 and legislative action as the Secretary considers ap25 propriate in light of the report. 


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1 (c) FACILITY OF THE DEPARTMENT DEFINED.—In 

2 this section, the term ‘‘facility of the Department’’ has the 

3 meaning given that term in section 1701 of title 38, 

4 United States Code. 

5 SEC. 202. PLAN TO IMPROVE PROVISION OF HEALTH CARE 

6 SERVICES TO WOMEN VETERANS. 

7 (a) PLAN TO IMPROVE SERVICES.— 

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

9 Affairs shall develop a plan— 

10 (A) to improve the provision of health care 

11 services to women veterans; and 

12 (B) to plan appropriately for the future 

13 health care needs, including mental health care 

14 needs, of women serving on active duty in the 

15 Armed Forces in the combat theaters of Oper16 ation Iraqi Freedom and Operation Enduring 

17 Freedom. 

18 (2) REQUIRED ACTIONS.—In developing the 

19 plan required by this subsection, the Secretary of 

20 Veterans Affairs shall— 

21 (A) identify the types of health care serv22 ices to be available to women veterans at each 

23 Department of Veterans Affairs medical center; 

24 and 


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1 (B) identify the personnel and other re2 sources required to provide such services to 

3 women veterans under the plan at each such 

4 medical center. 

5 (b) SUBMITTAL OF PLAN TO CONGRESS.—Not later 

6 than 18 months after the date of the enactment of this 

7 Act, the Secretary of Veterans Affairs shall submit to the 

8 Committee on Veterans’ Affairs of the Senate and the 

9 Committee on Veterans’ Affairs of the House of Rep10 resentatives the plan required by this section, along with 

11 such recommendations for administrative and legislative 

12 action as the Secretary considers appropriate in light of 

13 the plan. 

14 SEC. 203. INDEPENDENT STUDY ON HEALTH CON15 SEQUENCES OF WOMEN VETERANS OF MILI16 TARY SERVICE IN OPERATION IRAQI FREE17 DOM AND OPERATION ENDURING FREEDOM. 

18 (a) STUDY REQUIRED.—The Secretary of Veterans 

19 Affairs shall enter into an agreement with a non-Depart20 ment of Veterans Affairs entity for the purpose of con21 ducting a study on health consequences for women vet22 erans of service on active duty in the Armed Forces in 

23 deployment in Operation Iraqi Freedom and Operation 

24 Enduring Freedom. 


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1 (b) SPECIFIC MATTERS STUDIED.—The study under 

2 subsection (a) shall include the following: 

3 (1) A determination of any association of envi4 ronmental and occupational exposures and combat in 

5 Operation Iraqi Freedom or Operation Enduring 

6 Freedom with the general health, mental health, or 

7 reproductive health of women who served on active 

8 duty in the Armed Forces in Operation Iraqi Free9 dom or Operation Enduring Freedom. 

10 (2) A review and analysis of published lit11 erature on environmental and occupational exposures 

12 of women while serving in the Armed Forces, includ13 ing combat trauma, military sexual trauma, and ex14 posure to potential teratogens associated with repro15 ductive problems and birth defects. 

16 (c) REPORT.— 

17 (1) IN GENERAL.—Not later than 18 months 

18 after entering into the agreement for the study 

19 under subsection (a), the entity described in sub20 section (a) shall submit to the Secretary of Veterans 

21 Affairs and to Congress a report on the study con22 taining such findings and determinations as the enti23 ty considers appropriate. 

24 (2) RESPONSIVE REPORT.—Not later than 90 

25 days after the receipt of the report under paragraph 


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1 (1), the Secretary shall submit to Congress a report 

2 setting forth the response of the Secretary to the 

3 findings and determinations of the entity described 

4 in subsection (a) in the report under paragraph (1). 

5 SEC. 204. TRAINING AND CERTIFICATION FOR MENTAL 

6 HEALTH CARE PROVIDERS ON CARE FOR 

7 VETERANS SUFFERING FROM SEXUAL TRAU8 MA. 

9 (a) PROGRAM REQUIRED.—Section 1720D is amend10 ed— 

11 (1) by redesignating subsection (d) as sub12 section (f); and 

13 (2) by inserting after subsection (c) the fol14 lowing new subsections: 

15 ‘‘(d)(1) The Secretary shall implement a program for 

16 education, training, certification, and continuing medical 

17 education for mental health professionals to specialize in 

18 the provision of counseling and care to veterans eligible 

19 for services under subsection (a). In carrying out the pro20 gram, the Secretary shall ensure that all such mental 

21 health professionals have been trained in a consistent 

22 manner and that such training includes principles of evi23 dence-based treatment and care for sexual trauma. 

24 ‘‘(2) The Secretary shall determine the minimum 

25 qualifications necessary for mental health professionals 


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1 certified by the program under paragraph (1) to provide 

2 evidence-based treatment and therapy to veterans eligible 

3 for services under subsection (a) in facilities of the De4 partment. 

5 ‘‘(e) The Secretary shall submit to Congress each 

6 year a report on the counseling, care, and services pro7 vided to veterans under this section. Each report shall in8 clude data for the preceding year with respect to the fol9 lowing: 

10 ‘‘(1) The number of mental health professionals 

11 and primary care providers who have been certified 

12 under the program under subsection (d), and the 

13 amount and nature of continuing medical education 

14 provided under such program to professionals and 

15 providers who have been so certified. 

16 ‘‘(2) The number of women veterans who re17 ceived counseling, care, and services under sub18 section (a) from professionals and providers who 

19 have been trained or certified under the program 

20 under subsection (d). 

21 ‘‘(3) The number of training, certification, and 

22 continuing medical education programs operating 

23 under subsection (d). 

24 ‘‘(4) The number of trained full-time equivalent 

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1 ment to meet the needs of veterans requiring treat2 ment and care for sexual trauma. 

3 ‘‘(5) Such other information as the Secretary 

4 considers appropriate.’’. 

5 (b) STANDARDS FOR PERSONNEL PROVIDING

6 TREATMENT FOR SEXUAL TRAUMA.—The Secretary of 

7 Veterans Affairs shall establish education, training, cer8 tification, and staffing standards for Department of Vet9 erans Affairs health-care facilities for full-time equivalent 

10 employees who are trained to provide treatment and care 

11 to veterans for sexual trauma. 

12 SEC. 205. PILOT PROGRAM ON COUNSELING IN RETREAT 

13 SETTINGS FOR WOMEN VETERANS NEWLY 

14 SEPARATED FROM SERVICE IN THE ARMED 

15 FORCES. 

16 (a) PILOT PROGRAM REQUIRED.— 

17 (1) IN GENERAL.—Commencing not later than 

18 180 days after the date of the enactment of this Act, 

19 the Secretary of Veterans Affairs shall carry out, 

20 through the Readjustment Counseling Service of the 

21 Veterans Health Administration, a pilot program to 

22 evaluate the feasibility and advisability of providing 

23 reintegration and readjustment services described in 

24 subsection (b) in group retreat settings to women 


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1 veterans who are recently separated from service in 

2 the Armed Forces after a prolonged deployment. 

3 (2) PARTICIPATION AT ELECTION OF VET4 ERAN.—The participation of a veteran in the pilot 

5 program under this section shall be at the election 

6 of the veteran. 

7 (b) COVERED SERVICES.—The services provided to a 

8 woman veteran under the pilot program shall include the 

9 following: 

10 (1) Information on reintegration into the vet11 eran’s family, employment, and community. 

12 (2) Financial counseling. 

13 (3) Occupational counseling. 

14 (4) Information and counseling on stress reduc15 tion. 

16 (5) Information and counseling on conflict reso17 lution. 

18 (6) Such other information and counseling as 

19 the Secretary considers appropriate to assist a 

20 woman veteran under the pilot program in reintegra21 tion into the veteran’s family and community. 

22 (c) LOCATIONS.—The Secretary shall carry out the 

23 pilot program at not fewer than five locations selected by 

24 the Secretary for purposes of the pilot program. 


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1 (d) DURATION.—The pilot program shall be carried 

2 out during the two-year period beginning on the date of 

3 the commencement of the pilot program. 

4 (e) REPORT.—Not later than 180 days after the com5 pletion of the pilot program, the Secretary shall submit 

6 to Congress a report on the pilot program. The report 

7 shall contain the findings and conclusions of the Secretary 

8 as a result of the pilot program, and shall include such 

9 recommendations for the continuation or expansion of the 

10 pilot program as the Secretary considers appropriate. 

11 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

12 are authorized to be appropriated to the Secretary of Vet13 erans Affairs for each of fiscal years 2010 and 2011, 

14 $2,000,000 to carry out the pilot program. 

15 SEC. 206. REPORT ON FULL-TIME WOMEN VETERANS PRO16 GRAM MANAGERS AT MEDICAL CENTERS. 

17 The Secretary shall, acting through the Under Sec18 retary for Health, submit to Congress a report on employ19 ment of full-time women veterans program managers at 

20 Department of Veterans Affairs medical centers to ensure 

21 that health care needs of women veterans are met. Such 

22 report should include an assessment of whether there is 

23 at least one full-time employee at each Department med24 ical center who is a full-time women veterans program 

25 manager. 


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1 SEC. 207. SERVICE ON CERTAIN ADVISORY COMMITTEES OF 

2 WOMEN RECENTLY SEPARATED FROM SERV3 ICE IN THE ARMED FORCES. 

4 (a) ADVISORY COMMITTEE ON WOMEN VETERANS.— 

5 Section 542(a)(2)(A) is amended— 

6 (1) in clause (ii), by striking ‘‘and’’ at the end; 

7 (2) in clause (iii), by striking the period at the 

8 end and inserting ‘‘; and’’; and 

9 (3) by inserting after clause (iii) the following 

10 new clause: 

11 ‘‘(iv) women veterans who are recently sepa12 rated from service in the Armed Forces.’’. 

13 (b) ADVISORY COMMITTEE ON MINORITY VET14 ERANS.—Section 544(a)(2)(A) is amended— 

15 (1) in clause (iii), by striking ‘‘and’’ at the end; 

16 (2) in clause (iv), by striking the period at the 

17 end and inserting ‘‘; and’’; and 

18 (3) by inserting after clause (iv) the following 

19 new clause: 

20 ‘‘(v) women veterans who are minority group 

21 members and are recently separated from service in 

22 the Armed Forces.’’. 

23 (c) EFFECTIVE DATE.—The amendments made by 

24 this section shall apply to appointments made on or after 

25 the date of the enactment of this Act. 


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1 SEC. 208. PILOT PROGRAM ON SUBSIDIES FOR CHILD CARE 

2 FOR CERTAIN VETERANS RECEIVING HEALTH 

3 CARE. 

4 (a) PILOT PROGRAM REQUIRED.—The Secretary of 

5 Veterans Affairs shall carry out a pilot program to assess 

6 the feasibility and advisability of providing, subject to sub7 section (b), subsidies to qualified veterans described in 

8 subsection (c) to obtain child care so that such veterans 

9 can receive health care services described in such sub10 section. 

11 (b) LIMITATION ON PERIOD OF PAYMENTS.—A sub12 sidy may only be provided to a qualified veteran under 

13 the pilot program for receipt of child care during the pe14 riod that the qualified veteran— 

15 (1) receives the types of health care services re16 ferred to in subsection (c) at a facility of the De17 partment; and 

18 (2) requires to travel to and return from such 

19 facility for the receipt of such health care services. 

20 (c) QUALIFIED VETERANS.—In this section, the term 

21 ‘‘qualified veteran’’ means a veteran who is the primary 

22 caretaker of a child or children and who is receiving from 

23 the Department one or more of the following health care 

24 services: 

25 (1) Regular mental health care services. 

26 (2) Intensive mental health care services. 


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1 (3) Such other intensive health care services 

2 that the Secretary determines that payment to the 

3 veteran for the provision of child care would improve 

4 access to those health care services by the veteran. 

5 (d) LOCATIONS.—The Secretary shall carry out the 

6 pilot program in no fewer than three Veterans Integrated 

7 Service Networks (VISNs) selected by the Secretary for 

8 purposes of the pilot program. 

9 (e) DURATION.—The pilot program shall be carried 

10 out during the two-year period beginning on the date of 

11 the commencement of the pilot program. 

12 (f) EXISTING MODEL.—To the extent practicable, the 

13 Secretary shall model the pilot program after the Depart14 ment of Veterans Affairs Child Care Subsidy Program 

15 that was established pursuant to section 630 of the Treas16 ury and General Government Appropriations Act, 2002 

17 (Public Law 107–67; 115 Stat. 552), using the same in18 come eligibility standards and payment structure. 

19 (g) REPORT.—Not later than six months after the 

20 completion of the pilot program, the Secretary shall sub21 mit to Congress a report on the pilot program. The report 

22 shall include the findings and conclusions of the Secretary 

23 as a result of the pilot program, and shall include such 

24 recommendations for the continuation or expansion of the 

25 pilot program as the Secretary considers appropriate. 


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1 (h) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to the Secretary of Vet3 erans Affairs for each of fiscal years 2010 and 2011, 

4 $1,500,000 to carry out the pilot program. 

5 SEC. 209. CARE FOR NEWBORN CHILDREN OF WOMEN VET6 ERANS RECEIVING MATERNITY CARE. 

7 (a) IN GENERAL.—Subchapter VIII of chapter 17 is 

8 amended by adding at the end the following new section: 

9 ‘‘SEC. 1786. CARE FOR NEWBORN CHILDREN OF WOMEN 

10 VETERANS RECEIVING MATERNITY CARE. 

11 ‘‘(a) IN GENERAL.—The Secretary may furnish 

12 health care services described in subsection (b) to a new13 born child of a woman veteran who is receiving maternity 

14 care furnished by the Department for not more than 7 

15 days after the birth of the child if the veteran delivered 

16 the child in— 

17 ‘‘(1) a facility of the Department; or 

18 ‘‘(2) another facility pursuant to a Department 

19 contract for services relating to such delivery. 

20 ‘‘(b) COVERED HEALTH CARE SERVICES.—Health 

21 care services described in this subsection are all post-deliv22 ery care services, including routine care services, that a 

23 newborn requires.’’. 

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

25 at the beginning of chapter 17 is amended by inserting 


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1 after the item relating to section 1785 the following new 

2 item: 

‘‘1786. Care for newborn children of women veterans receiving maternity care.’’. 

3 TITLE III—RURAL HEALTH 

4 IMPROVEMENTS 

5 SEC. 301. ENHANCEMENT OF DEPARTMENT OF VETERANS 

6 AFFAIRS EDUCATION DEBT REDUCTION PRO7 GRAM. 

8 (a) ENHANCED MAXIMUM ANNUAL AMOUNT.—Para9 graph (1) of section 7683(d) is amended by striking 

10 ‘‘$44,000’’ and all that follows through ‘‘fifth years of par11 ticipation in the Program’’ and inserting ‘‘the total 

12 amount of principle and interest owed by the participant 

13 on loans referred to in subsection (a)’’. 

14 (b) NOTICE TO POTENTIAL EMPLOYEES OF ELIGI15 BILITY AND SELECTION FOR PARTICIPATION.—Section 

16 7682 is amended by adding at the end the following new 

17 subsection: 

18 ‘‘(d) NOTICE TO POTENTIAL EMPLOYEES.—In each 

19 offer of employment made by the Secretary to an indi20 vidual who, upon acceptance of such offer would be treated 

21 as eligible to participate in the Education Debt Reduction 

22 Program, the Secretary shall, to the maximum extent 

23 practicable, include the following: 

24 ‘‘(1) A notice that the individual will be treated 

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1 duction Program upon the individual’s acceptance of 

2 such offer. 

3 ‘‘(2) A notice of the determination of the Sec4 retary whether or not the individual will be selected 

5 as a participant in the Education Debt Reduction 

6 Program as of the individual’s acceptance of such 

7 offer.’’. 

8 (c) SELECTION OF EMPLOYEES WHO RECEIVE NO9 TICE OF SELECTION WITH EMPLOYMENT OFFER.—Sec10 tion 7683 is further amended by adding at the end the 

11 following new subsection: 

12 ‘‘(e) SELECTION OF PARTICIPANTS.—(1) The Sec13 retary shall select for participation in the Education Debt 

14 Reduction Program each individual eligible for participa15 tion in the Education Debt Reduction Program who— 

16 ‘‘(A) the Secretary provided notice with an offer 

17 of employment under section 7682(d) of this title 

18 that indicated the individual would, upon the individ19 ual’s acceptance of such offer of employment, be— 

20 ‘‘(i) eligible to participate in the Education 

21 Debt Reduction Program; and 

22 ‘‘(ii) selected to participate in the Edu23 cation Debt Reduction Program; and 

24 ‘‘(B) accepts such offer of employment. 


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1 ‘‘(2) The Secretary may select for participation in the 

2 Education Debt Reduction Program an individual eligible 

3 for participation in the Education Debt Reduction Pro4 gram who is not described by subparagraphs (A) and (B) 

5 of paragraph (1).’’. 

6 SEC. 302. VISUAL IMPAIRMENT AND ORIENTATION AND MO7 BILITY PROFESSIONALS EDUCATION ASSIST8 ANCE PROGRAM. 

9 (a) ESTABLISHMENT OF PROGRAM.—Part V is 

10 amended by inserting after chapter 74 the following new 

11 chapter: 

12 ‘‘CHAPTER 75—VISUAL IMPAIRMENT AND 

13 ORIENTATION AND MOBILITY PROFES14 SIONALS EDUCATION ASSISTANCE 

15 PROGRAM 

‘‘Sec. 

‘‘7501. Establishment of scholarship program; purpose. 

‘‘7502. Application and acceptance. 

‘‘7503. Amount of assistance; duration. 

‘‘7504. Agreement. 

‘‘7505. Repayment for failure to satisfy requirements of agreement. 

16 ‘‘§ 7501. Establishment of scholarship program; pur17 pose 

18 ‘‘(a) ESTABLISHMENT.—Subject to the availability of 

19 appropriations, the Secretary shall establish and carry out 

20 a scholarship program to provide financial assistance in 

21 accordance with this chapter to an individual— 


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1 ‘‘(1) who is accepted for enrollment or currently 

2 enrolled in a program of study leading to a degree 

3 or certificate in visual impairment or orientation and 

4 mobility, or a dual degree or certification in both 

5 such areas, at an accredited (as determined by the 

6 Secretary) educational institution that is in a State; 

7 and 

8 ‘‘(2) who enters into an agreement with the 

9 Secretary as described in section 7504 of this chap10 ter. 

11 ‘‘(b) PURPOSE.—The purpose of the scholarship pro12 gram established under this chapter is to increase the sup13 ply of qualified blind rehabilitation specialists for the De14 partment and the Nation. 

15 ‘‘(c) OUTREACH.—The Secretary shall publicize the 

16 scholarship program established under this chapter to edu17 cational institutions throughout the United States, with 

18 an emphasis on disseminating information to such institu19 tions with high numbers of Hispanic students and to His20 torically Black Colleges and Universities. 

21 ‘‘§ 7502. Application and acceptance 

22 ‘‘(a) APPLICATION.—(1) To apply and participate in 

23 the scholarship program under this chapter, an individual 

24 shall submit to the Secretary an application for such par25 ticipation together with an agreement described in section 


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1 7504 of this chapter under which the participant agrees 

2 to serve a period of obligated service in the Department 

3 as provided in the agreement in return for payment of 

4 educational assistance as provided in the agreement. 

5 ‘‘(2) In distributing application forms and agreement 

6 forms to individuals desiring to participate in the scholar7 ship program, the Secretary shall include with such forms 

8 the following: 

9 ‘‘(A) A fair summary of the rights and liabil10 ities of an individual whose application is approved 

11 (and whose agreement is accepted) by the Secretary. 

12 ‘‘(B) A full description of the terms and condi13 tions that apply to participation in the scholarship 

14 program and service in the Department. 

15 ‘‘(b) APPROVAL.—(1) Upon the Secretary’s approval 

16 of an individual’s participation in the scholarship program, 

17 the Secretary shall, in writing, promptly notify the indi18 vidual of that acceptance. 

19 ‘‘(2) An individual becomes a participant in the schol20 arship program upon such approval by the Secretary. 

21 ‘‘§ 7503. Amount of assistance; duration 

22 ‘‘(a) AMOUNT OF ASSISTANCE.—The amount of the 

23 financial assistance provided for an individual under this 

24 chapter shall be the amount determined by the Secretary 

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1 vidual. In the case of an individual enrolled in a program 

2 of study leading to a dual degree or certification in both 

3 the areas of study described in section 7501(a)(1) of this 

4 chapter, the tuition and fees shall not exceed the amounts 

5 necessary for the minimum number of credit hours to 

6 achieve such dual certification or degree. 

7 ‘‘(b) RELATIONSHIP TO OTHER ASSISTANCE.—Fi8 nancial assistance may be provided to an individual under 

9 this chapter to supplement other educational assistance to 

10 the extent that the total amount of educational assistance 

11 received by the individual during an academic year does 

12 not exceed the total tuition and fees for such academic 

13 year. 

14 ‘‘(c) MAXIMUM AMOUNT OF ASSISTANCE.—(1) In no 

15 case may the total amount of assistance provided under 

16 this chapter for an academic year to an individual who 

17 is a full-time student exceed $15,000. 

18 ‘‘(2) In the case of an individual who is a part-time 

19 student, the total amount of assistance provided under 

20 this chapter shall bear the same ratio to the amount that 

21 would be paid under paragraph (1) if the participant were 

22 a full-time student in the program of study being pursued 

23 by the individual as the coursework carried by the indi24 vidual to full-time coursework in that program of study. 


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1 ‘‘(3) In no case may the total amount of assistance 

2 provided to an individual under this chapter exceed 

3 $45,000. 

4 ‘‘(d) MAXIMUM DURATION OF ASSISTANCE.—The 

5 Secretary may provide financial assistance to an individual 

6 under this chapter for not more than six years. 

7 ‘‘§ 7504. Agreement 

8 ‘‘An agreement between the Secretary and a partici9 pant in the scholarship program under this chapter shall 

10 be in writing, shall be signed by the participant, and shall 

11 include— 

12 ‘‘(1) the Secretary’s agreement to provide the 

13 participant with financial assistance as authorized 

14 under this chapter; 

15 ‘‘(2) the participant’s agreement— 

16 ‘‘(A) to accept such financial assistance; 

17 ‘‘(B) to maintain enrollment and attend18 ance in the program of study described in sec19 tion 7501(a)(1) of this chapter; 

20 ‘‘(C) while enrolled in such program, to 

21 maintain an acceptable level of academic stand22 ing (as determined by the educational institu23 tion offering such program under regulations 

24 prescribed by the Secretary); and 


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1 ‘‘(D) after completion of the program, to 

2 serve as a full-time employee in the Department 

3 for a period of three years, to be served within 

4 the first six years after the participant has com5 pleted such program and received a degree or 

6 certificate described in section 7501(a)(1) of 

7 this chapter; and 

8 ‘‘(3) any other terms and conditions that the 

9 Secretary determines appropriate for carrying out 

10 this chapter. 

11 ‘‘§ 7505. Repayment for failure to satisfy require12 ments of agreement 

13 ‘‘(a) IN GENERAL.—An individual who receives edu14 cational assistance under this chapter shall repay to the 

15 Secretary an amount equal to the unearned portion of 

16 such assistance if the individual fails to satisfy the require17 ments of the agreement entered into under section 7504 

18 of this chapter, except in circumstances authorized by the 

19 Secretary. 

20 ‘‘(b) AMOUNT OF REPAYMENT.—The Secretary shall 

21 establish, by regulations, procedures for determining the 

22 amount of the repayment required under this subsection 

23 and the circumstances under which an exception to the 

24 required repayment may be granted. 


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1 ‘‘(c) WAIVER OR SUSPENSION OF COMPLIANCE.— 

2 The Secretary shall prescribe regulations providing for the 

3 waiver or suspension of any obligation of an individual for 

4 service or payment under this chapter (or an agreement 

5 under this chapter) whenever noncompliance by the indi6 vidual is due to circumstances beyond the control of the 

7 individual or whenever the Secretary determines that the 

8 waiver or suspension of compliance is in the best interest 

9 of the United States. 

10 ‘‘(d) OBLIGATION AS DEBT TO UNITED STATES.— 

11 An obligation to repay the Secretary under this section 

12 is, for all purposes, a debt owed the United States. A dis13 charge in bankruptcy under title 11 does not discharge 

14 a person from such debt if the discharge order is entered 

15 less than five years after the date of the termination of 

16 the agreement or contract on which the debt is based.’’. 

17 (b) CLERICAL AMENDMENTS.—The tables of chap18 ters at the beginning of title 38, and of part V of title 

19 38, are each amended by inserting after the item relating 

20 to chapter 74 the following new item: 

‘‘75. Visual Impairment and Orientation and Mobility Professionals 

Education Assistance Program ..................................... 7501.’’. 

21 (c) EFFECTIVE DATE.—The Secretary of Veterans 

22 Affairs shall implement chapter 75 of title 38, United 

23 States Code, as added by subsection (a), not later than 

24 six months after the date of the enactment of this Act. 


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1 SEC. 303. INCLUSION OF DEPARTMENT OF VETERANS AF2 FAIRS FACILITIES IN LIST OF FACILITIES ELI3 GIBLE FOR ASSIGNMENT OF PARTICIPANTS 

4 IN NATIONAL HEALTH SERVICE CORPS 

5 SCHOLARSHIP PROGRAM. 

6 The Secretary of Veterans Affairs shall transfer 

7 $20,000,000 from accounts of the Veterans Health Ad8 ministration to the Secretary of Health and Human Serv9 ices to include facilities of the Department of Veterans Af10 fairs in the list maintained by the Health Resources and 

11 Services Administration of facilities eligible for assignment 

12 of participants in the National Health Service Corps 

13 Scholarship Program. 

14 SEC. 304. TELECONSULTATION AND TELEMEDICINE. 

15 (a) TELECONSULTATION AND TELERETINAL IMAG16 ING.— 

17 (1) IN GENERAL.—Subchapter I of chapter 17 

18 is amended by adding at the end the following new 

19 section: 

20 ‘‘§ 1709. Teleconsultation and teleretinal imaging 

21 ‘‘(a) TELECONSULTATION.—(1) The Secretary shall 

22 carry out a program of teleconsultation for the provision 

23 of remote mental health and traumatic brain injury as24 sessments in facilities of the Department that are not oth25 erwise able to provide such assessments without conVerDate Nov 24 2008 21:38 Oct 29, 2009 Jkt 089200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\S1963.PCS S1963

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1 tracting with third party providers or reimbursing pro2 viders through a fee-basis system. 

3 ‘‘(2) The Secretary shall, in consultation with appro4 priate professional societies, promulgate technical and 

5 clinical care standards for the use of teleconsultation serv6 ices within facilities of the Department. 

7 ‘‘(b) TELERETINAL IMAGING.—The Secretary shall 

8 carry out a program of teleretinal imaging in each Vet9 erans Integrated Services Network (VISN). 

10 ‘‘(c) ANNUAL REPORTS.—In each fiscal year begin11 ning with fiscal year 2010 and ending with fiscal year 

12 2015, the Secretary shall submit to Congress a report on 

13 the programs required by subsections (a) and (b). Such 

14 report shall include the following: 

15 ‘‘(1) A description of the efforts made by the 

16 Secretary to make teleconsultation available in rural 

17 areas and to utilize teleconsultation in rural areas. 

18 ‘‘(2) The rates of utilization of teleconsultation 

19 by Veterans Integrated Services Network 

20 disaggregated by each fiscal year for which a report 

21 is submitted under this subsection. 

22 ‘‘(d) DEFINITIONS.—In this section: 

23 ‘‘(1) The term ‘teleconsultation’ means the use 

24 by a health care specialist of telecommunications to 


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1 assist another health care provider in rendering a di2 agnosis or treatment. 

3 ‘‘(2) The term ‘teleretinal imaging’ means the 

4 use by a health care specialist of telecommuni5 cations, digital retinal imaging, and remote image 

6 interpretation to provide eye care.’’. 

7 (2) CLERICAL AMENDMENT.—The table of sec8 tions at the beginning of chapter 17 is amended by 

9 inserting after the item related to section 1708 the 

10 following new item: 

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

11 (b) TRAINING IN TELEMEDICINE.—The Secretary of 

12 Veterans Affairs shall require each Department of Vet13 erans Affairs facility that is involved in the training of 

14 medical residents to work with each university concerned 

15 to develop an elective rotation in telemedicine for such 

16 residents. 

17 (c) ENHANCEMENT OF VERA.— 

18 (1) INCENTIVES FOR PROVISION OF TELECON19 SULTATION, TELERETINAL IMAGING, TELEMEDICINE, 

20 AND TELEHEALTH SERVICES.—The Secretary of 

21 Veterans Affairs shall modify the Veterans Equitable 

22 Resource Allocation system to provide Veterans Inte23 grated Services Networks with incentives to utilize 

24 teleconsultation, teleretinal imaging, telemedicine, 

25 and telehealth coordination services. 


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1 (2) INCLUSION OF TELEMEDICINE VISITS IN

2 WORKLOAD REPORTING.—The Secretary shall mod3 ify the Veterans Equitable Resource Allocation sys4 tem to require the inclusion of all telemedicine visits 

5 in the calculation of facility workload. 

6 (d) DEFINITIONS.—In this section: 

7 (1) The terms ‘‘teleconsultation’’ and ‘‘teleret8 inal imaging’’ have the meanings given such terms 

9 in section 1709 of title 38, United States Code, as 

10 added by subsection (a). 

11 (2) The term ‘‘telemedicine’’ means the use by 

12 a health care provider of telecommunications to as13 sist in the diagnosis or treatment of a patient’s med14 ical condition. 

15 (3) The term ‘‘telehealth’’ means the use of 

16 telecommunications to collect patient data remotely 

17 and send data to a monitoring station for interpreta18 tion. 

19 SEC. 305. DEMONSTRATION PROJECTS ON ALTERNATIVES 

20 FOR EXPANDING CARE FOR VETERANS IN 

21 RURAL AREAS. 

22 (a) IN GENERAL.—The Secretary of Veterans Af23 fairs, through the Director of the Office of Rural Health, 

24 may carry out demonstration projects to examine the fea25 sibility and advisability of alternatives for expanding care 


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1 for veterans in rural areas, which may include the fol2 lowing: 

3 (1) Establishing a partnership between the De4 partment of Veterans Affairs and the Centers for 

5 Medicare and Medicaid Services of the Department 

6 of Health and Human Services to coordinate care 

7 for veterans in rural areas at critical access hospitals 

8 (as designated or certified under section 1820 of the 

9 Social Security Act (42 U.S.C. 1395i–4)). 

10 (2) Establishing a partnership between the De11 partment of Veterans Affairs and the Department of 

12 Health and Human Services to coordinate care for 

13 veterans in rural areas at community health centers. 

14 (3) Expanding coordination between the De15 partment of Veterans Affairs and the Indian Health 

16 Service to expand care for Indian veterans. 

17 (b) GEOGRAPHIC DISTRIBUTION.—The Secretary 

18 shall ensure that the demonstration projects carried out 

19 under subsection (a) are located at facilities that are geo20 graphically distributed throughout the United States. 

21 (c) REPORT.—Not later than two years after the date 

22 of the enactment of this Act, the Secretary shall submit 

23 a report on the results of the demonstration projects con24 ducted under subsection (a) to— 


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1 (1) the Committee on Veterans’ Affairs and the 

2 Committee on Appropriations of the Senate; and 

3 (2) the Committee on Veterans’ Affairs and the 

4 Committee on Appropriations of the House of Rep5 resentatives. 

6 (d) AUTHORIZATION OF APPROPRIATIONS.—There is 

7 authorized to be appropriated to carry out this section 

8 $5,000,000 for fiscal year 2010 and each fiscal year there9 after. 

10 SEC. 306. PROGRAM ON PROVISION OF READJUSTMENT 

11 AND MENTAL HEALTH CARE SERVICES TO 

12 VETERANS WHO SERVED IN OPERATION 

13 IRAQI FREEDOM AND OPERATION ENDURING 

14 FREEDOM. 

15 (a) PROGRAM REQUIRED.—Not later than 180 days 

16 after the date of the enactment of this Act, the Secretary 

17 of Veterans Affairs shall establish a program to provide— 

18 (1) to veterans of Operation Iraqi Freedom and 

19 Operation Enduring Freedom, particularly veterans 

20 who served in such operations while in the National 

21 Guard and the Reserves— 

22 (A) peer outreach services; 

23 (B) peer support services; 


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1 (C) readjustment counseling and services 

2 described in section 1712A of title 38, United 

3 States Code; and 

4 (D) mental health services; and 

5 (2) to members of the immediate family of such 

6 a veteran, during the three-year period beginning on 

7 the date of the return of such veteran from deploy8 ment in Operation Iraqi Freedom or Operation En9 during Freedom, education, support, counseling, and 

10 mental health services to assist in— 

11 (A) the readjustment of such veteran to ci12 vilian life; 

13 (B) in the case such veteran has an injury 

14 or illness incurred during such deployment, the 

15 recovery of such veteran; and 

16 (C) the readjustment of the family fol17 lowing the return of such veteran. 

18 (b) CONTRACTS WITH COMMUNITY MENTAL

19 HEALTH CENTERS AND QUALIFIED ENTITIES FOR PRO20 VISION OF SERVICES.—In carrying out the program re21 quired by subsection (a), the Secretary shall contract with 

22 community mental health centers and other qualified enti23 ties to provide the services required by such subsection 

24 only in areas the Secretary determines are not adequately 

25 served by other health care facilities or vet centers of the 


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1 Department of Veterans Affairs. Such contracts shall re2 quire each contracting community health center or enti3 ty— 

4 (1) to the extent practicable, to use telehealth 

5 services for the delivery of services required by sub6 section (a); 

7 (2) to the extent practicable, to employ veterans 

8 trained under subsection (c); 

9 (3) to participate in the training program con10 ducted in accordance with subsection (d); 

11 (4) to comply with applicable protocols of the 

12 Department before incurring any liability on behalf 

13 of the Department for the provision of the services 

14 required by subsection (a); 

15 (5) for each veteran for whom a community 

16 mental health center or other qualified entity pro17 vides mental health services under such contract, to 

18 provide the Department with such clinical summary 

19 information as the Secretary shall require; 

20 (6) to submit annual reports to the Secretary 

21 containing, with respect to the program required by 

22 subsection (a) and for the last full calendar year 

23 ending before the submission of such report— 

24 (A) the number of the veterans served, vet25 erans diagnosed, and courses of treatment proVerDate Nov 24 2008 21:38 Oct 29, 2009 Jkt 089200 PO 00000 Frm 00061 Fmt 6652 Sfmt 6201 E:\BILLS\S1963.PCS S1963

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1 vided to veterans as part of the program re2 quired by subsection (a); and 

3 (B) demographic information for such 

4 services, diagnoses, and courses of treatment; 

5 and 

6 (7) to meet such other requirements as the Sec7 retary shall require. 

8 (c) TRAINING OF VETERANS FOR THE PROVISION OF

9 PEER-OUTREACH AND PEER-SUPPORT SERVICES.—In 

10 carrying out the program required by subsection (a), the 

11 Secretary shall contract with a national not-for-profit 

12 mental health organization to carry out a national pro13 gram of training for veterans described in subsection (a) 

14 to provide the services described in subparagraphs (A) and 

15 (B) of paragraph (1) of such subsection. 

16 (d) TRAINING OF CLINICIANS FOR PROVISION OF

17 SERVICES.—The Secretary shall conduct a training pro18 gram for clinicians of community mental health centers 

19 or entities that have contracts with the Secretary under 

20 subsection (b) to ensure that such clinicians can provide 

21 the services required by subsection (a) in a manner that— 

22 (1) recognizes factors that are unique to the ex23 perience of veterans who served on active duty in 

24 Operation Iraqi Freedom or Operation Enduring 


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1 Freedom (including their combat and military train2 ing experiences); and 

3 (2) utilizes best practices and technologies. 

4 (e) REPORTS REQUIRED.— 

5 (1) INITIAL REPORT ON PLAN FOR IMPLEMEN6 TATION.—Not later than 45 days after the date of 

7 the enactment of this Act, the Secretary shall submit 

8 to the Committee on Veterans’ Affairs of the Senate 

9 and the Committee on Veterans’ Affairs of the 

10 House of Representatives a report containing the 

11 plans of the Secretary to implement the program re12 quired by subsection (a). 

13 (2) STATUS REPORT.—Not later than one year 

14 after the date of the enactment of this Act, the Sec15 retary shall submit to the Committee on Veterans’ 

16 Affairs of the Senate and the Committee on Vet17 erans’ Affairs of the House of Representatives a re18 port on the implementation of the program. Such re19 port shall include the following: 

20 (A) Information on the number of veterans 

21 who received services as part of the program 

22 and the type of services received during the last 

23 full calendar year completed before the submis24 sion of such report. 


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1 (B) An evaluation of the provision of serv2 ices under paragraph (2) of subsection (a) and 

3 a recommendation as to whether the period de4 scribed in such paragraph should be extended 

5 to a five-year period. 

6 SEC. 307. IMPROVEMENT OF CARE OF AMERICAN INDIAN 

7 VETERANS. 

8 (a) INDIAN HEALTH COORDINATORS.— 

9 (1) IN GENERAL.—Subchapter II of chapter 73 

10 is amended by adding at the end the following new 

11 section: 

12 ‘‘§ 7330B. Indian Veterans Health Care Coordinators 

13 ‘‘(a) IN GENERAL.—(1) The Secretary shall assign 

14 at each of the 10 Department Medical Centers that serve 

15 communities with the greatest number of Indian veterans 

16 per capita an official or employee of the Department to 

17 act as the coordinator of health care for Indian veterans 

18 at such Medical Center. The official or employee so as19 signed at a Department Medical Center shall be known 

20 as the ‘Indian Veterans Health Care Coordinator’ for the 

21 Medical Center. 

22 ‘‘(2) The Secretary shall, from time to time— 

23 ‘‘(A) survey the Department Medical Centers 

24 for purposes of identifying the 10 Department Med25 ical Centers that currently serve communities with 


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1 the greatest number of Indian veterans per capita; 

2 and 

3 ‘‘(B) utilizing the results of the most recent 

4 survey conducted under subparagraph (A), revise the 

5 assignment of Indian Veterans Health Care Coordi6 nators in order to assure the assignment of such co7 ordinators to appropriate Department Medical Cen8 ters as required by paragraph (1). 

9 ‘‘(b) DUTIES.—The duties of an Indian Veterans 

10 Health Care Coordinator shall include the following: 

11 ‘‘(1) Improving outreach to tribal communities. 

12 ‘‘(2) Coordinating the medical needs of Indian 

13 veterans on Indian reservations with the Veterans 

14 Health Administration and the Indian Health Serv15 ice. 

16 ‘‘(3) Expanding the access and participation of 

17 the Department of Veterans Affairs, the Indian 

18 Health Service, and tribal members in the Depart19 ment of Veterans Affairs Tribal Veterans Represent20 ative program. 

21 ‘‘(4) Acting as an ombudsman for Indian vet22 erans enrolled in the health care system of the Vet23 erans Health Administration. 

24 ‘‘(5) Advocating for the incorporation of tradi25 tional medicine and healing in Department treatVerDate Nov 24 2008 21:38 Oct 29, 2009 Jkt 089200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6201 E:\BILLS\S1963.PCS S1963

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1 ment plans for Indian veterans in need of care and 

2 services provided by the Department. 

3 ‘‘(c) INDIAN DEFINED.—In this section, the term ‘In4 dian’ has the meaning given the term in section 4 of the 

5 Indian Self-Determination and Education Assistance Act 

6 (25 U.S.C. 450b).’’. 

7 (2) CLERICAL AMENDMENT.—The table of sec8 tions at the beginning of chapter 73 is amended by 

9 inserting after the item relating to section 7330A 

10 the following new item: 

‘‘7330B. Indian Veterans Health Coordinators.’’. 

11 (b) INTEGRATION OF ELECTRONIC HEALTH

12 RECORDS WITH INDIAN HEALTH SERVICE.—Not later 

13 than one year after the date of the enactment of this Act, 

14 the Secretary of Veterans Affairs and the Secretary of 

15 Health and Human Services shall enter into a memo16 randum of understanding to ensure that the health 

17 records of Indian veterans may be transferred electroni18 cally between facilities of the Indian Health Service and 

19 the Department of Veterans Affairs. 

20 (c) TRANSFER OF MEDICAL EQUIPMENT TO THE IN21 DIAN HEALTH SERVICE.— 

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

23 Affairs may transfer to the Indian Health Service 

24 such surplus Department of Veterans Affairs med25 ical and information technology equipment as the 


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1 Secretary of Veterans Affairs and the Secretary of 

2 Health and Human Services jointly consider appro3 priate for purposes of the Indian Health Service. 

4 (2) TRANSPORTATION AND INSTALLATION.—In 

5 transferring medical or information technology 

6 equipment under this subsection, the Secretary of 

7 Veterans Affairs may transport and install such 

8 equipment in facilities of the Indian Health Service. 

9 (d) REPORT ON JOINT HEALTH CLINICS WITH IN10 DIAN HEALTH SERVICE.—Not later than one year after 

11 the date of the enactment of this Act, the Secretary of 

12 Veterans Affairs and the Secretary of Health and Human 

13 Services shall jointly submit to Congress a report on the 

14 feasability and advisability of the joint establishment and 

15 operation by the Veterans Health Administration and the 

16 Indian Health Service of health clinics on Indian reserva17 tions to serve the populations of such reservations, includ18 ing Indian veterans. 

19 SEC. 308. TRAVEL REIMBURSEMENT FOR VETERANS RE20 CEIVING TREATMENT AT FACILITIES OF THE 

21 DEPARTMENT OF VETERANS AFFAIRS. 

22 (a) ENHANCEMENT OF ALLOWANCE BASED UPON

23 MILEAGE TRAVELED.—Section 111 is amended— 


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1 (1) in subsection (a), by striking ‘‘traveled,’’ 

2 and inserting ‘‘(at a rate of 41.5 cents per mile),’’; 

3 and 

4 (2) by amending subsection (g) to read as fol5 lows: 

6 ‘‘(g)(1) Beginning one year after the date of the en7 actment of the Caregivers and Veterans Omnibus Health 

8 Services Act of 2009, the Secretary may adjust the mile9 age rate described in subsection (a) to be equal to the 

10 mileage reimbursement rate for the use of privately owned 

11 vehicles by Government employees on official business 

12 (when a Government vehicle is available), as prescribed by 

13 the Administrator of General Services under section 

14 5707(b) of title 5. 

15 ‘‘(2) If an adjustment in the mileage rate under para16 graph (1) results in a lower mileage rate than the mileage 

17 rate otherwise specified in subsection (a), the Secretary 

18 shall, not later than 60 days before the date of the imple19 mentation of the mileage rate as so adjusted, submit to 

20 Congress a written report setting forth the adjustment in 

21 the mileage rate under this subsection, together with a 

22 justification for the decision to make the adjustment in 

23 the mileage rate under this subsection.’’. 

24 (b) COVERAGE OF COST OF TRANSPORTATION BY

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1 section (a)(1), is further amended by inserting after the 

2 first sentence the following new sentence: ‘‘Actual nec3 essary expense of travel includes the reasonable costs of 

4 airfare if travel by air is the only practical way to reach 

5 a Department facility.’’. 

6 (c) ELIMINATION OF LIMITATION BASED ON MAX7 IMUM ANNUAL RATE OF PENSION.—Subsection 

8 (b)(1)(D)(i) of such section is amended by inserting ‘‘who 

9 is not traveling by air and’’ before ‘‘whose annual’’. 

10 (d) DETERMINATION OF PRACTICALITY.—Subsection 

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

12 following new paragraph: 

13 ‘‘(4) In determining for purposes of subsection (a) 

14 whether travel by air is the only practical way for a vet15 eran to reach a Department facility, the Secretary shall 

16 consider the medical condition of the veteran and any 

17 other impediments to the use of ground transportation by 

18 the veteran.’’. 

19 (e) NO EXPANSION OF ELIGIBILITY FOR BENE20 FICIARY TRAVEL.—The amendments made by subsections 

21 (b) and (d) of this section may not be construed as ex22 panding or otherwise modifying eligibility for payments or 

23 allowances for beneficiary travel under section 111 of title 

24 38, United States Code, as in effect on the day before 

25 the date of the enactment of this Act. 


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1 (f) CLARIFICATION OF RELATION TO PUBLIC TRANS2 PORTATION IN VETERANS HEALTH ADMINISTRATION

3 HANDBOOK.—Not later than 30 days after the date of the 

4 enactment of this Act, the Secretary of Veterans Affairs 

5 shall revise the Veterans Health Administration Handbook 

6 to clarify that an allowance for travel based on mileage 

7 paid under section 111(a) of title 38, United States Code, 

8 may exceed the cost of such travel by public transportation 

9 regardless of medical necessity. 

10 SEC. 309. OFFICE OF RURAL HEALTH FIVE-YEAR STRA11 TEGIC PLAN. 

12 (a) STRATEGIC PLAN.—Not later than 180 days after 

13 the date of the enactment of this Act, the Director of the 

14 Office of Rural Health of the Department of Veterans Af15 fairs shall develop a five-year strategic plan for the Office 

16 of Rural Health. 

17 (b) CONTENTS.—The plan required by subsection (a) 

18 shall include the following: 

19 (1) Specific goals for the recruitment and reten20 tion of health care personnel in rural areas, devel21 oped in conjunction with the Director of the Health 

22 Care Retention and Recruitment Office of the De23 partment of Veterans Affairs. 

24 (2) Specific goals for ensuring the timeliness 

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1 nities that are reliant on contract and fee-basis care, 

2 developed in conjunction with the Director of the Of3 fice of Quality and Performance of the Department. 

4 (3) Specific goals for the expansion and imple5 mentation of telemedicine services in rural areas, de6 veloped in conjunction with the Director of the Of7 fice of Care Coordination Services of the Depart8 ment. 

9 (4) Incremental milestones describing specific 

10 actions to be taken for the purpose of achieving the 

11 goals specified under paragraphs (1) through (3). 

12 SEC. 310. OVERSIGHT OF CONTRACT AND FEE-BASIS CARE. 

13 (a) IN GENERAL.—Subchapter I of chapter 17 is 

14 amended by inserting after section 1703 the following new 

15 section: 

16 ‘‘§ 1703A. Oversight of contract and fee-basis care 

17 ‘‘(a) RURAL OUTREACH COORDINATORS.—The Sec18 retary shall designate a rural outreach coordinator at each 

19 Department community based outpatient clinic at which 

20 not less than 50 percent of the veterans enrolled at such 

21 clinic reside in a highly rural area. The coordinator at a 

22 clinic shall be responsible for coordinating care and col23 laborating with community contract and fee-basis pro24 viders with respect to the clinic. 


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1 ‘‘(b) INCENTIVES TO OBTAIN ACCREDITATION OF

2 MEDICAL PRACTICE.—(1) The Secretary shall adjust the 

3 fee-basis compensation of providers of health care services 

4 under the Department to encourage such providers to ob5 tain accreditation of their medical practice from recog6 nized accrediting entities. 

7 ‘‘(2) In making adjustments under paragraph (1), the 

8 Secretary shall consider the increased overhead costs of 

9 accreditation described in paragraph (1) and the costs of 

10 achieving and maintaining such accreditation. 

11 ‘‘(c) INCENTIVES FOR PARTICIPATION IN PEER RE12 VIEW.—(1) The Secretary shall adjust the fee-basis com13 pensation of providers of health care services under the 

14 Department that do not provide such services as part of 

15 a medical practice accredited by a recognized accrediting 

16 entity to encourage such providers to participate in peer 

17 review under subsection (e). 

18 ‘‘(2) The Secretary shall provide incentives under 

19 paragraph (1) to a provider of health care services under 

20 the Department in an amount which may reasonably be 

21 expected (as determined by the Secretary) to encourage 

22 participation in the voluntary peer review under subsection 

23 (d). 

24 ‘‘(d) PEER REVIEW.—(1) The Secretary shall provide 

25 for the voluntary peer review of providers of health care 


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1 services under the Department who provide such services 

2 on a fee basis as part of a medical practice that is not 

3 accredited by a recognized accrediting entity. 

4 ‘‘(2) Each year, beginning with the first fiscal year 

5 beginning after the date of the enactment of this section, 

6 the Chief Quality and Performance Officer in each Vet7 erans Integrated Services Network (VISN) shall select a 

8 sample of patient records from each participating provider 

9 in the Officer’s Veterans Integrated Services Network to 

10 be peer reviewed by a facility designated under paragraph 

11 (3). 

12 ‘‘(3) The Chief Quality and Performance Officer in 

13 each Veterans Integrated Services Network shall designate 

14 Department facilities in such network for the peer review 

15 of patient records submitted under this subsection. 

16 ‘‘(4) Each year, beginning with the first fiscal year 

17 beginning after the date of the enactment of this section, 

18 each provider who elects to participate in the program 

19 shall submit the patient records selected under paragraph 

20 (2) to a facility selected under paragraph (3) to be peer 

21 reviewed by such facility. 

22 ‘‘(5) Each Department facility designated under 

23 paragraph (3) that receives patient records under para24 graph (4) shall— 


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1 ‘‘(A) peer review such records in accordance 

2 with policies and procedures established by the Sec3 retary; 

4 ‘‘(B) ensure that peer reviews are evaluated by 

5 the Peer Review Committee; and 

6 ‘‘(C) develop a mechanism for notifying the 

7 Under Secretary for Health of problems identified 

8 through such peer review. 

9 ‘‘(6) The Under Secretary for Health shall develop 

10 a mechanism by which the use of fee-basis providers of 

11 health care are terminated when quality of care concerns 

12 are identified with respect to such providers. 

13 ‘‘(7) The Chief Quality and Performance Officer in 

14 each Veterans Integrated Services Network shall be re15 sponsible for the oversight of the program of peer review 

16 under this subsection in that network.’’. 

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

18 at the beginning of chapter 17 is amended by inserting 

19 after the item related to section 1703 the following new 

20 item: 

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

21 SEC. 311. ENHANCEMENT OF VET CENTERS TO MEET 

22 NEEDS OF VETERANS OF OPERATION IRAQI 

23 FREEDOM AND OPERATION ENDURING FREE24 DOM. 

25 (a) VOLUNTEER COUNSELORS.— 


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1 (1) IN GENERAL.—Subsection (c) of section 

2 1712A is amended— 

3 (A) by striking ‘‘The Under Secretary’’ 

4 and inserting ‘‘(1) The Under Secretary’’; 

5 (B) in paragraph (1), as designated by 

6 paragraph (1), by striking ‘‘, and, in carrying’’ 

7 and all that follows through ‘‘screening activi8 ties’’; and 

9 (C) by adding at the end the following new 

10 paragraphs: 

11 ‘‘(2) In carrying out this section, the Under Secretary 

12 may utilize the services of the following: 

13 ‘‘(A) Paraprofessionals, individuals who are vol14 unteers working without compensation, and individ15 uals who are veteran-students (as described in sec16 tion 3485 of this title) in initial intake and screening 

17 activities. 

18 ‘‘(B) Eligible volunteer counselors in the provi19 sion of counseling and related mental health serv20 ices. 

21 ‘‘(3) For purposes of this subsection, an eligible vol22 unteer counselor is an individual— 

23 ‘‘(A) who— 

24 ‘‘(i) provides counseling services without 

25 compensation at a center; 


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1 ‘‘(ii) is a licensed psychologist or social 

2 worker; 

3 ‘‘(iii) has never been named in a tort claim 

4 arising from professional activities; and 

5 ‘‘(iv) has never had, and has no pending, 

6 disciplinary action taken with respect to any li7 cense or certification qualifying that individual 

8 to provide counseling services; or 

9 ‘‘(B) who is otherwise credentialed and privi10 leged to perform counseling services by the Sec11 retary. 

12 ‘‘(4) Eligible volunteer counselors shall be issued cre13 dentials and privileges for the provision of counseling and 

14 related mental health services under this section on an ex15 pedited basis in accordance with such procedures as the 

16 Secretary shall establish. Such procedures shall provide 

17 for the completion by the Secretary of the processing of 

18 an application for such credentials and privileges not later 

19 than 60 days after receipt of the application.’’. 

20 (2) PROCEDURES FOR ISSUING CREDENTIALS

21 AND PRIVILEGES TO VOLUNTEER COUNSELORS.— 

22 Not later than one year after the date of the enact23 ment of this Act, the Secretary of Veterans Affairs 

24 shall establish the procedures described in section 

25 1712A(c)(4), as added by paragraph (1). 


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1 (b) OUTREACH.—Subsection (e) of such section is 

2 amended— 

3 (1) by striking ‘‘The Secretary’’ and inserting 

4 ‘‘(1) The Secretary’’; and 

5 (2) by adding at the end the following new 

6 paragraph: 

7 ‘‘(2) Each center shall develop an outreach plan to 

8 ensure that the community served by the center is aware 

9 of the services offered by the center.’’. 

10 SEC. 312. CENTERS OF EXCELLENCE FOR RURAL HEALTH 

11 RESEARCH, EDUCATION, AND CLINICAL AC12 TIVITIES. 

13 (a) IN GENERAL.—Subchapter II of chapter 73, as 

14 amended by section 307 of this Act, is further amended 

15 by adding at the end the following new section: 

16 ‘‘§ 7330C. Centers of excellence for rural health re17 search, education, and clinical activities 

18 ‘‘(a) ESTABLISHMENT OF CENTERS.—The Secretary, 

19 through the Director of the Office of Rural Health, shall 

20 establish and operate at least one and not more than five 

21 centers of excellence for rural health research, education, 

22 and clinical activities, which shall— 

23 ‘‘(1) conduct research on the furnishing of 

24 health services in rural areas; 


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1 ‘‘(2) develop specific models to be used by the 

2 Department in furnishing health services to veterans 

3 in rural areas; 

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

5 care professionals of the Department on the fur6 nishing of health services to veterans in rural areas; 

7 and 

8 ‘‘(4) develop and implement innovative clinical 

9 activities and systems of care for the Department 

10 for the furnishing of health services to veterans in 

11 rural areas. 

12 ‘‘(b) USE OF RURAL HEALTH RESOURCE CEN13 TERS.—In selecting locations for the establishment of cen14 ters of excellence under subsection (a), the Secretary may 

15 select a rural health resource center that meets the re16 quirements of subsection (a). 

17 ‘‘(c) GEOGRAPHIC DISPERSION.—The Secretary shall 

18 ensure that the centers established under this section are 

19 located at health care facilities that are geographically dis20 persed throughout the United States. 

21 ‘‘(d) FUNDING.—(1) There are authorized to be ap22 propriated to the Medical Care Account and the Medical 

23 and Prosthetics Research Account of the Department of 

24 Veterans Affairs such sums as may be necessary for the 


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1 support of the research and education activities of the cen2 ters operated under this section. 

3 ‘‘(2) There shall be allocated to the centers operated 

4 under this section, from amounts authorized to be appro5 priated to the Medical Care Account and the Medical and 

6 Prosthetics Research Account by paragraph (1), such 

7 amounts as the Under Secretary of health considers ap8 propriate for such centers. Such amounts shall be allo9 cated through the Director of the Office of Rural Health. 

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

11 at each center operated under this section— 

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

13 of funding from funds appropriated for the Medical 

14 and Prosthetics Research Account; and 

15 ‘‘(B) shall receive priority in the award of fund16 ing from such account to the extent that funds are 

17 awarded to projects for research in the care of rural 

18 veterans.’’. 

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

20 at the beginning of chapter 73, as amended by section 307 

21 of this Act, is further amended by inserting after the item 

22 relating to section 7330B the following new item: 

‘‘7330C. Centers of excellence for rural health research, education, and clinical 

activities.’’. 


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1 SEC. 313. PILOT PROGRAM ON INCENTIVES FOR PHYSI2 CIANS WHO ASSUME INPATIENT RESPON3 SIBILITIES AT COMMUNITY HOSPITALS IN 

4 HEALTH PROFESSIONAL SHORTAGE AREAS. 

5 (a) PILOT PROGRAM REQUIRED.—The Secretary of 

6 Veterans Affairs shall carry out a pilot program to assess 

7 the feasability and advisability of each of the following: 

8 (1) The provision of financial incentives to eligi9 ble physicians who obtain and maintain inpatient 

10 privileges at community hospitals in health profes11 sional shortage areas in order to facilitate the provi12 sion by such physicians of primary care and mental 

13 health services to veterans at such hospitals. 

14 (2) The collection of payments from third-party 

15 providers for care provided by eligible physicians to 

16 nonveterans while discharging inpatient responsibil17 ities at community hospitals in the course of exer18 cising the privileges described in paragraph (1). 

19 (b) ELIGIBLE PHYSICIANS.—For purposes of this 

20 section, an eligible physician is a primary care or mental 

21 health physician employed by the Department of Veterans 

22 Affairs on a full-time basis. 

23 (c) DURATION OF PROGRAM.—The pilot program 

24 shall be carried out during the three-year period beginning 

25 on the date of the commencement of the pilot program. 

26 (d) LOCATIONS.— 


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

2 carried out at not less than five community hospitals 

3 in each of not less than two Veterans Integrated 

4 Services Networks (VISNs). The hospitals shall be 

5 selected by the Secretary utilizing the results of the 

6 survey required under subsection (e). 

7 (2) QUALIFYING COMMUNITY HOSPITALS.—A 

8 community hospital may be selected by the Secretary 

9 as a location for the pilot program if— 

10 (A) the hospital is located in a health pro11 fessional shortage area; and 

12 (B) the number of eligible physicians will13 ing to assume inpatient responsibilities at the 

14 hospital (as determined utilizing the result of 

15 the survey) is sufficient for purposes of the 

16 pilot program. 

17 (e) SURVEY OF PHYSICIAN INTEREST IN PARTICIPA18 TION.— 

19 (1) IN GENERAL.—Not later than 120 days 

20 after the date of the enactment of this Act, the Sec21 retary shall conduct a survey of eligible physicians to 

22 determine the extent of the interest of such physi23 cians in participating in the pilot program. 

24 (2) ELEMENTS.—The survey shall disclose the 

25 type, amount, and nature of the financial incentives 


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1 to be provided under subsection (h) to physicians 

2 participating in the pilot program. 

3 (f) PHYSICIAN PARTICIPATION.— 

4 (1) IN GENERAL.—The Secretary shall select 

5 physicians for participation in the pilot program 

6 from among eligible physicians who— 

7 (A) express interest in participating in the 

8 pilot program in the survey conducted under 

9 subsection (e); 

10 (B) are in good standing with the Depart11 ment; and 

12 (C) primarily have clinical responsibilities 

13 with the Department. 

14 (2) VOLUNTARY PARTICIPATION.—Participation 

15 in the pilot program shall be voluntary. Nothing in 

16 this section shall be construed to require a physician 

17 working for the Department to assume inpatient re18 sponsibilities at a community hospital unless other19 wise required as a term or condition of employment 

20 with the Department. 

21 (g) ASSUMPTION OF INPATIENT PHYSICIAN RESPON22 SIBILITIES.— 

23 (1) IN GENERAL.—Each eligible physician se24 lected for participation in the pilot program shall as25 sume and maintain inpatient responsibilities, includVerDate Nov 24 2008 21:38 Oct 29, 2009 Jkt 089200 PO 00000 Frm 00082 Fmt 6652 Sfmt 6201 E:\BILLS\S1963.PCS S1963

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1 ing inpatient responsibilities with respect to non2 veterans, at one or more community hospitals se3 lected by the Secretary for participation in the pilot 

4 program under subsection (d). 

5 (2) COVERAGE UNDER FEDERAL TORT CLAIMS

6 ACT.—If an eligible physician participating in the 

7 pilot program carries out on-call responsibilities at a 

8 community hospital where privileges to practice at 

9 such hospital are conditioned upon the provision of 

10 services to individuals who are not veterans while the 

11 physician is on call for such hospital, the provision 

12 of such services by the physician shall be considered 

13 an action within the scope of the physician’s office 

14 or employment for purposes of chapter 171 of title 

15 28, United States Code (commonly referred to as 

16 the ‘‘Federal Tort Claims Act’’). 

17 (h) COMPENSATION.— 

18 (1) IN GENERAL.—The Secretary shall provide 

19 each eligible physician participating in the pilot pro20 gram with such compensation (including pay and 

21 other appropriate compensation) as the Secretary 

22 considers appropriate to compensate such physician 

23 for the discharge of any inpatient responsibilities by 

24 such physician at a community hospital for which 

25 such physician would not otherwise be compensated 


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1 by the Department as a full-time employee of the 

2 Department. 

3 (2) WRITTEN AGREEMENT.—The amount of 

4 any compensation to be provided a physician under 

5 the pilot program shall be specified in a written 

6 agreement entered into by the Secretary and the 

7 physician for purposes of the pilot program. 

8 (3) TREATMENT OF COMPENSATION.—The Sec9 retary shall consult with the Director of the Office 

10 of Personnel Management on the inclusion of a pro11 vision in the written agreement required under para12 graph (2) that describes the treatment under Fed13 eral law of any compensation provided a physician 

14 under the pilot program, including treatment for 

15 purposes of retirement under the civil service laws. 

16 (i) COLLECTIONS FROM THIRD PARTIES.—In car17 rying out the pilot program for the purpose described in 

18 subsection (a)(2), the Secretary shall implement a variety 

19 and range of requirements and mechanisms for the collec20 tion from third-party payors of amounts to reimburse the 

21 Department for health care services provided to non22 veterans under the pilot program by eligible physicians 

23 discharging inpatient responsibilities under the pilot pro24 gram. 


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1 (j) INPATIENT RESPONSIBILITIES DEFINED.—In this 

2 section, the term ‘‘inpatient responsibilities’’ means on-call 

3 responsibilities customarily required of a physician by a 

4 community hospital as a condition of granting privileges 

5 to the physician to practice in the hospital. 

6 (k) REPORT.—Not later than one year after the date 

7 of the enactment of this Act and annually thereafter, the 

8 Secretary shall submit to Congress a report on the pilot 

9 program, including the following: 

10 (1) The findings of the Secretary with respect 

11 to the pilot program. 

12 (2) The number of veterans and nonveterans 

13 provided inpatient care by physicians participating 

14 in the pilot program. 

15 (3) The amounts collected and payable under 

16 subsection (i). 

17 (l) HEALTH PROFESSIONAL SHORTAGE AREA DE18 FINED.—In this section, the term ‘‘health professional 

19 shortage area’’ has the meaning given the term in section 

20 332(a) of the Public Health Service Act (42 U.S.C. 

21 254e(a)). 


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1 SEC. 314. ANNUAL REPORT ON MATTERS RELATED TO 

2 CARE FOR VETERANS WHO LIVE IN RURAL 

3 AREAS. 

4 (a) ANNUAL REPORT.—The Secretary of Veterans 

5 Affairs shall submit to Congress each year, together with 

6 documents submitted to Congress in support of the budget 

7 of the President for the fiscal year beginning in such year 

8 (as submitted pursuant to section 1105 of title 31, United 

9 States Code), an assessment, current as of the fiscal year 

10 ending in the year before such report is submitted, of the 

11 following: 

12 (1) The implementation of the provisions of sec13 tions 209 through 213, including the amendments 

14 made by such sections. 

15 (2) The establishment and functions of the Of16 fice of Rural Health under section 7308 of title 38, 

17 United States Code. 

18 (b) ADDITIONAL REQUIREMENTS FOR INITIAL RE19 PORT.—The first report submitted under subsection (a) 

20 shall also include the following: 

21 (1) The assessment of fee-basis health-care pro22 gram required by section 212(b) of the Veterans 

23 Benefits, Health Care, and Information Technology 

24 Act of 2006 (Public Law 109–461; 120 Stat. 3422). 


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1 (2) An assessment of the outreach program re2 quired by section 213 of such Act (120 Stat. 3422; 

3 38 U.S.C. 6303 note). 

4 SEC. 315. TRANSPORTATION GRANTS FOR RURAL VET5 ERANS SERVICE ORGANIZATIONS. 

6 (a) GRANTS AUTHORIZED.— 

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

8 Affairs shall establish a grant program to provide in9 novative transportation options to veterans in highly 

10 rural areas. 

11 (2) ELIGIBLE RECIPIENTS.—The following may 

12 be awarded a grant under this section: 

13 (A) State veterans service agencies. 

14 (B) Veterans service organizations. 

15 (3) USE OF FUNDS.—A State veterans service 

16 agency or veterans service organization awarded a 

17 grant under this section may use the grant amount 

18 to— 

19 (A) assist veterans in highly rural areas to 

20 travel to Department of Veterans Affairs med21 ical centers; and 

22 (B) otherwise assist in providing medical 

23 care to veterans in highly rural areas. 

24 (4) MAXIMUM AMOUNT.—The amount of a 

25 grant under this section may not exceed $50,000. 


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1 (5) NO MATCHING REQUIREMENT.—The recipi2 ent of a grant under this section shall not be re3 quired to provide matching funds as a condition for 

4 receiving such grant. 

5 (b) REGULATIONS.—The Secretary shall prescribe 

6 regulations for— 

7 (1) evaluating grant applications under this sec8 tion; and 

9 (2) otherwise administering the program estab10 lished by this section. 

11 (c) DEFINITIONS.—In this section: 

12 (1) HIGHLY RURAL.—The term ‘‘highly rural’’, 

13 in the case of an area, means that the area consists 

14 of a county or counties having a population of less 

15 than seven persons per square mile. 

16 (2) VETERANS SERVICE ORGANIZATION.—The 

17 term ‘‘veterans service organization’’ means any or18 ganization recognized by the Secretary of Veterans 

19 Affairs for the representation of veterans under sec20 tion 5902 of title 38, United States Code. 

21 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

22 are authorized to be appropriated $3,000,000 for each of 

23 fiscal years 2010 through 2014 to carry out this section. 


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1 SEC. 316. MODIFICATION OF ELIGIBILITY FOR PARTICIPA2 TION IN PILOT PROGRAM OF ENHANCED 

3 CONTRACT CARE AUTHORITY FOR HEALTH 

4 CARE NEEDS OF CERTAIN VETERANS. 

5 Section 403(b) of the Veterans’ Mental Health and 

6 other Care Improvements Act of 2008 (Public Law 110– 

7 387; 122 Stat. 4125; 38 U.S.C. 1703 note) is amended 

8 to read as follows: 

9 ‘‘(b) COVERED VETERANS.—For purposes of the 

10 pilot program under this section, a covered veteran is any 

11 veteran who— 

12 ‘‘(1) is— 

13 ‘‘(A) enrolled in the system of patient en14 rollment established under section 1705(a) of 

15 title 38, United States Code, as of the date of 

16 the commencement of the pilot program under 

17 subsection (a)(2); or 

18 ‘‘(B) eligible for health care under section 

19 1710(e)(3)(C) of title 38, United States Code; 

20 and 

21 ‘‘(2) resides in a location that is— 

22 ‘‘(A) more than 60 minutes driving dis23 tance from the nearest Department health care 

24 facility providing primary care services, if the 

25 veteran is seeking such services; 


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1 ‘‘(B) more than 120 minutes driving dis2 tance from the nearest Department health care 

3 facility providing acute hospital care, if the vet4 eran is seeking such care; or 

5 ‘‘(C) more than 240 minutes driving dis6 tance from the nearest Department health care 

7 facility providing tertiary care, if the veteran is 

8 seeking such care.’’. 

9 TITLE IV—MENTAL HEALTH 

10 CARE MATTERS 

11 SEC. 401. ELIGIBILITY OF MEMBERS OF THE ARMED 

12 FORCES WHO SERVE IN OPERATION IRAQI 

13 FREEDOM OR OPERATION ENDURING FREE14 DOM FOR COUNSELING AND SERVICES 

15 THROUGH READJUSTMENT COUNSELING 

16 SERVICE. 

17 (a) IN GENERAL.—Any member of the Armed 

18 Forces, including a member of the National Guard or Re19 serve, who serves on active duty in the Armed Forces in 

20 Operation Iraqi Freedom or Operation Enduring Freedom 

21 is eligible for readjustment counseling and related mental 

22 health services under section 1712A of title 38, United 

23 States Code, through the Readjustment Counseling Serv24 ice of the Veterans Health Administration. 


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1 (b) NO REQUIREMENT FOR CURRENT ACTIVE DUTY

2 SERVICE.—A member of the Armed Forces who meets the 

3 requirements for eligibility for counseling and services 

4 under subsection (a) is entitled to counseling and services 

5 under that subsection regardless of whether or not the 

6 member is currently on active duty in the Armed Forces 

7 at the time of receipt of counseling and services under that 

8 subsection. 

9 (c) REGULATIONS.—The eligibility of members of the 

10 Armed Forces for counseling and services under sub11 section (a) shall be subject to such regulations as the Sec12 retary of Defense and the Secretary of Veterans Affairs 

13 shall jointly prescribe for purposes of this section. 

14 (d) SUBJECT TO AVAILABILITY OF APPROPRIA15 TIONS.—The provision of counseling and services under 

16 subsection (a) shall be subject to the availability of appro17 priations for such purpose. 

18 SEC. 402. RESTORATION OF AUTHORITY OF READJUST19 MENT COUNSELING SERVICE TO PROVIDE 

20 REFERRAL AND OTHER ASSISTANCE UPON 

21 REQUEST TO FORMER MEMBERS OF THE 

22 ARMED FORCES NOT AUTHORIZED COUN23 SELING. 

24 Section 1712A is amended— 


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1 (1) by redesignating subsections (c) through (f) 

2 as subsections (d) through (g), respectively; and 

3 (2) by inserting after subsection (b) the fol4 lowing new subsection (c): 

5 ‘‘(c) Upon receipt of a request for counseling under 

6 this section from any individual who has been discharged 

7 or released from active military, naval, or air service but 

8 who is not otherwise eligible for such counseling, the Sec9 retary shall— 

10 ‘‘(1) provide referral services to assist such in11 dividual, to the maximum extent practicable, in ob12 taining mental health care and services from sources 

13 outside the Department; and 

14 ‘‘(2) if pertinent, advise such individual of such 

15 individual’s rights to apply to the appropriate mili16 tary, naval, or air service, and to the Department, 

17 for review of such individual’s discharge or release 

18 from such service.’’. 

19 SEC. 403. STUDY ON SUICIDES AMONG VETERANS. 

20 (a) STUDY REQUIRED.—The Secretary of Veterans 

21 Affairs shall conduct a study to determine the number of 

22 veterans who died by suicide between January 1, 1999, 

23 and the date of the enactment of this Act. 


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1 (b) COORDINATION.—In carrying out the study under 

2 subsection (a) the Secretary of Veterans Affairs shall co3 ordinate with— 

4 (1) the Secretary of Defense; 

5 (2) Veterans Service Organizations; 

6 (3) the Centers for Disease Control and Preven7 tion; and 

8 (4) State public health offices and veterans 

9 agencies. 

10 (c) REPORT TO CONGRESS.—The Secretary of Vet11 erans Affairs shall submit to the Committee on Veterans’ 

12 Affairs of the Senate and the Committee on Veterans’ Af13 fairs of the House of Representatives a report on the study 

14 required under subsection (a) and the findings of the Sec15 retary. 

16 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

17 are authorized to be appropriated such sums as may be 

18 necessary to carry out this section. 

19 SEC. 404. TRANSFER OF FUNDS TO SECRETARY OF HEALTH 

20 AND HUMAN SERVICES FOR GRADUATE PSY21 CHOLOGY EDUCATION PROGRAM. 

22 (a) TRANSFER OF FUNDS.—Not later than Sep23 tember 30, 2010, the Secretary of Veterans Affairs shall 

24 transfer $5,000,000 from accounts of the Veterans Health 

25 Administration to the Secretary of Health and Human 


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1 Services for the Graduate Psychology Education program 

2 established under section 755(b)(1)(J) of the Public 

3 Health Service Act (42 U.S.C. 294e(b)(1)(J)). 

4 (b) USE OF FUNDS TRANSFERRED.—Funds trans5 ferred under subsection (a) shall be used to award grants 

6 to support the training of psychologists in the treatment 

7 of veterans with post traumatic stress disorder, traumatic 

8 brain injury, and other combat-related disorders. 

9 (c) PREFERENCE FOR DEPARTMENT OF VETERANS

10 AFFAIRS HEALTH CARE FACILITIES.—In the awarding of 

11 grants under subsection (b), the Graduate Psychology 

12 Education program shall give preference to health care fa13 cilities of the Department of Veterans Affairs and grad14 uate programs of education that are affiliated with such 

15 facilities. 

16 TITLE V—OTHER HEALTH CARE 

17 MATTERS 

18 SEC. 501. REPEAL OF CERTAIN ANNUAL REPORTING RE19 QUIREMENTS. 

20 (a) NURSE PAY REPORT.—Section 7451 is amend21 ed— 

22 (1) by striking subsection (f); and 

23 (2) by redesignating subsection (g) as sub24 section (f). 

25 (b) LONG-TERM PLANNING REPORT.— 


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1 (1) IN GENERAL.—Section 8107 is repealed. 

2 (2) CONFORMING AMENDMENT.—The table of 

3 sections at the beginning of chapter 81 is amended 

4 by striking the item relating to section 8107. 

5 SEC. 502. MODIFICATIONS TO ANNUAL GULF WAR RE6 SEARCH REPORT. 

7 Section 707(c)(1) of the Persian Gulf War Veterans’ 

8 Health Status Act (title VII of Public Law 102–585; 38 

9 U.S.C. 527 note) is amended by striking ‘‘Not later than 

10 March 1 of each year’’ and inserting ‘‘Not later than July 

11 1, 2010, and July 1 of each of the five following years’’. 

12 SEC. 503. PAYMENT FOR CARE FURNISHED TO CHAMPVA 

13 BENEFICIARIES. 

14 Section 1781 is amended at the end by adding the 

15 following new subsection: 

16 ‘‘(e) Payment by the Secretary under this section on 

17 behalf of a covered beneficiary for medical care shall con18 stitute payment in full and extinguish any liability on the 

19 part of the beneficiary for that care.’’. 

20 SEC. 504. DISCLOSURES FROM CERTAIN MEDICAL 

21 RECORDS. 

22 Section 7332(b)(2) is amended by adding at the end 

23 the following new subparagraph: 

24 ‘‘(F)(i) To a representative of a patient who 

25 lacks decision-making capacity, when a practitioner 


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1 deems the content of the given record necessary for 

2 that representative to make an informed decision re3 garding the patient’s treatment. 

4 ‘‘(ii) In this subparagraph, the term ‘represent5 ative’ means an individual, organization, or other 

6 body authorized under section 7331 of this title and 

7 its implementing regulations to give informed con8 sent on behalf of a patient who lacks decision-mak9 ing capacity.’’. 

10 SEC. 505. DISCLOSURE TO SECRETARY OF HEALTH-PLAN 

11 CONTRACT INFORMATION AND SOCIAL SECU12 RITY NUMBER OF CERTAIN VETERANS RE13 CEIVING CARE. 

14 (a) IN GENERAL.—Subchapter I of chapter 17 is 

15 amended by adding at the end the following new section: 

16 ‘‘§ 1709. Disclosure to Secretary of health-plan con17 tract information and social security 

18 number of certain veterans receiving 

19 care 

20 ‘‘(a) REQUIRED DISCLOSURE OF HEALTH-PLAN

21 CONTRACTS.—(1) Any individual who applies for or is in 

22 receipt of care described in paragraph (2) shall, at the 

23 time of such application, or otherwise when requested by 

24 the Secretary, submit to the Secretary such current infor25 mation as the Secretary may require to identify any 


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1 health-plan contract (as defined in section 1729(i) of this 

2 title) under which such individual is covered, to include, 

3 as applicable— 

4 ‘‘(A) the name, address, and telephone number 

5 of such health-plan contract; 

6 ‘‘(B) the name of the individual’s spouse, if the 

7 individual’s coverage is under the spouse’s health8 plan contract; 

9 ‘‘(C) the plan number; and 

10 ‘‘(D) the plan’s group code. 

11 ‘‘(2) The care described in this paragraph is— 

12 ‘‘(A) hospital, nursing home, or domiciliary 

13 care; 

14 ‘‘(B) medical, rehabilitative, or preventive 

15 health services; or 

16 ‘‘(C) other medical care under laws adminis17 tered by the Secretary. 

18 ‘‘(b) REQUIRED DISCLOSURE OF SOCIAL SECURITY

19 NUMBER.—(1) Any individual who applies for or is in re20 ceipt of care described in paragraph (2) shall, at the time 

21 of such application, or otherwise when requested by the 

22 Secretary, submit to the Secretary— 

23 ‘‘(A) the individual’s social security number; 

24 and 


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1 ‘‘(B) the social security number of any depend2 ent or Department beneficiary on whose behalf, or 

3 based upon whom, such individual applies for or is 

4 in receipt of such care. 

5 ‘‘(2) The care described in this paragraph is— 

6 ‘‘(A) hospital, nursing home, or domiciliary 

7 care; 

8 ‘‘(B) medical, rehabilitative, or preventive 

9 health services; or 

10 ‘‘(C) other medical care under laws adminis11 tered by the Secretary. 

12 ‘‘(3) This subsection does not require an individual 

13 to furnish the Secretary with a social security number for 

14 any individual to whom a social security number has not 

15 been assigned. 

16 ‘‘(c) FAILURE TO DISCLOSE SOCIAL SECURITY NUM17 BER.—(1) The Secretary shall deny an individual’s appli18 cation for, or may terminate an individual’s enrollment in, 

19 the system of patient enrollment established by the Sec20 retary under section 1705 of this title, if such individual 

21 does not provide the social security number required or 

22 requested to be submitted pursuant to subsection (b). 

23 ‘‘(2) Following a denial or termination under para24 graph (1) with respect to an individual, the Secretary may, 

25 upon receipt of the information required or requested 


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1 under subsection (b), approve such individual’s application 

2 or reinstate such individual’s enrollment (if otherwise in 

3 order), for such medical care and services provided on and 

4 after the date of such receipt of information. 

5 ‘‘(d) CONSTRUCTION.—Nothing in this section shall 

6 be construed as authority to deny medical care and treat7 ment to an individual in a medical emergency.’’. 

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

9 at the beginning of such chapter 17 is amended by insert10 ing after the item relating to section 1708 the following 

11 new item: 

‘‘1709. Disclosure to Secretary of health-plan contract information and social security number of certain veterans receiving care.’’. 

12 SEC. 506. ENHANCEMENT OF QUALITY MANAGEMENT. 

13 (a) ENHANCEMENT OF QUALITY MANAGEMENT

14 THROUGH QUALITY MANAGEMENT OFFICERS.— 

15 (1) IN GENERAL.—Subchapter II of chapter 73 

16 is amended by inserting after section 7311 the fol17 lowing new section: 

18 ‘‘§ 7311A. Quality management officers 

19 ‘‘(a) NATIONAL QUALITY MANAGEMENT OFFICER.— 

20 (1) The Under Secretary for Health shall designate an of21 ficial of the Veterans Health Administration to act as the 

22 principal quality management officer for the quality-assur23 ance program required by section 7311 of this title. The 

24 official so designated may be known as the ‘National QualVerDate Nov 24 2008 21:38 Oct 29, 2009 Jkt 089200 PO 00000 Frm 00099 Fmt 6652 Sfmt 6201 E:\BILLS\S1963.PCS S1963

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1 ity Management Officer of the Veterans Health Adminis2 tration’ (in this section referred to as the ‘National Qual3 ity Management Officer’). 

4 ‘‘(2) The National Quality Management Officer shall 

5 report directly to the Under Secretary for Health in the 

6 discharge of responsibilities and duties of the Officer 

7 under this section. 

8 ‘‘(3) The National Quality Management Officer shall 

9 be the official within the Veterans Health Administration 

10 who is principally responsible for the quality-assurance 

11 program referred to in paragraph (1). In carrying out that 

12 responsibility, the Officer shall be responsible for the fol13 lowing: 

14 ‘‘(A) Establishing and enforcing the require15 ments of the program referred to in paragraph (1). 

16 ‘‘(B) Developing an aggregate quality metric 

17 from existing data sources, such as the Inpatient 

18 Evaluation Center of the Department, the National 

19 Surgical Quality Improvement Program, and the Ex20 ternal Peer Review Program of the Veterans Health 

21 Administration, that could be used to assess reliably 

22 the quality of care provided at individual Depart23 ment medical centers and associated community 

24 based outpatient clinics. 


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1 ‘‘(C) Ensuring that existing measures of qual2 ity, including measures from the Inpatient Evalua3 tion Center, the National Surgical Quality Improve4 ment Program, System-Wide Ongoing Assessment 

5 and Review reports of the Department, and Com6 bined Assessment Program reviews of the Office of 

7 Inspector General of the Department, are monitored 

8 routinely and analyzed in a manner that ensures the 

9 timely detection of quality of care issues. 

10 ‘‘(D) Encouraging research and development in 

11 the area of quality metrics for the purposes of im12 proving how the Department measures quality in in13 dividual facilities. 

14 ‘‘(E) Carrying out such other responsibilities 

15 and duties relating to quality management in the 

16 Veterans Health Administration as the Under Sec17 retary for Health shall specify. 

18 ‘‘(4) The requirements under paragraph (3) shall in19 clude requirements regarding the following: 

20 ‘‘(A) A confidential system for the submittal of 

21 reports by Veterans Health Administration per22 sonnel regarding quality management at Department 

23 facilities. 


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1 ‘‘(B) Mechanisms for the peer review of the ac2 tions of individuals appointed in the Veterans Health 

3 Administration in the position of physician. 

4 ‘‘(b) QUALITY MANAGEMENT OFFICERS FOR

5 VISNS.—(1) The Regional Director of each Veterans In6 tegrated Services Network (VISN) shall appoint an official 

7 of the Network to act as the quality management officer 

8 of the Network. 

9 ‘‘(2) The quality management officer for a Veterans 

10 Integrated Services Network shall report to the Regional 

11 Director of the Veterans Integrated Services Network, and 

12 to the National Quality Management Officer, regarding 

13 the discharge of the responsibilities and duties of the offi14 cer under this section. 

15 ‘‘(3) The quality management officer for a Veterans 

16 Integrated Services Network shall— 

17 ‘‘(A) direct the quality management office in 

18 the Network; and 

19 ‘‘(B) coordinate, monitor, and oversee the qual20 ity management programs and activities of the Ad21 ministration medical facilities in the Network in 

22 order to ensure the thorough and uniform discharge 

23 of quality management requirements under such 

24 programs and activities throughout such facilities. 


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1 ‘‘(c) QUALITY MANAGEMENT OFFICERS FOR MED2 ICAL FACILITIES.—(1) The director of each Veterans 

3 Health Administration medical facility shall appoint a 

4 quality management officer for that facility. 

5 ‘‘(2) The quality management officer for a facility 

6 shall report directly to the director of the facility, and to 

7 the quality management officer of the Veterans Integrated 

8 Services Network in which the facility is located, regarding 

9 the discharge of the responsibilities and duties of the qual10 ity management officer under this section. 

11 ‘‘(3) The quality management officer for a facility 

12 shall be responsible for designing, disseminating, and im13 plementing quality management programs and activities 

14 for the facility that meet the requirements established by 

15 the National Quality Management Officer under sub16 section (a). 

17 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—(1) Ex18 cept as provided in paragraph (2), there are authorized 

19 to be appropriated such sums as may be necessary to carry 

20 out this section. 

21 ‘‘(2) There are authorized to be appropriated to carry 

22 out the provisions of subparagraphs (B), (C), and (D) of 

23 subsection (a)(3), $25,000,000 for the two-year period of 

24 fiscal years beginning after the date of the enactment of 

25 this section.’’. 


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1 (2) CLERICAL AMENDMENT.—The table of sec2 tions at the beginning of chapter 73 is amended by 

3 inserting after the item relating to section 7311 the 

4 following new item: 

‘‘7311A. Quality management officers.’’. 

5 (b) REPORTS ON QUALITY CONCERNS UNDER QUAL6 ITY-ASSURANCE PROGRAM.—Section 7311(b) is amended 

7 by adding at the end the following new paragraph: 

8 ‘‘(4) As part of the quality-assurance program, the 

9 Under Secretary for Health shall establish mechanisms 

10 through which employees of Veterans Health Administra11 tion facilities may submit reports, on a confidential basis, 

12 on matters relating to quality of care in Veterans Health 

13 Administration facilities to the quality management offi14 cers of such facilities under section 7311A(b) of this title. 

15 The mechanisms shall provide for the prompt and thor16 ough review of any reports so submitted by the receiving 

17 officials.’’. 

18 (c) REVIEW OF CURRENT HEALTH CARE QUALITY

19 SAFEGUARDS.— 

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

21 Affairs shall conduct a comprehensive review of all 

22 current policies and protocols of the Department of 

23 Veterans Affairs for maintaining health care quality 

24 and patient safety at Department medical facilities. 

25 The review shall include a review and assessment of 


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1 the National Surgical Quality Improvement Program 

2 (NSQIP), including an assessment of— 

3 (A) the efficacy of the quality indicators 

4 under the program; 

5 (B) the efficacy of the data collection 

6 methods under the program; 

7 (C) the efficacy of the frequency with 

8 which regular data analyses are performed 

9 under the program; and 

10 (D) the extent to which the resources allo11 cated to the program are adequate to fulfill the 

12 stated function of the program. 

13 (2) REPORT.—Not later than 60 days after the 

14 date of the enactment of this Act, the Secretary 

15 shall submit to Congress a report on the review con16 ducted under paragraph (1), including the findings 

17 of the Secretary as a result of the review and such 

18 recommendations as the Secretary considers appro19 priate in light of the review. 

20 SEC. 507. REPORTS ON IMPROVEMENTS TO DEPARTMENT 

21 HEALTH CARE QUALITY MANAGEMENT. 

22 (a) REPORT.—Not later than December 15, 2010, 

23 and each year thereafter through 2012, the Secretary of 

24 Veterans Affairs shall submit to the congressional vet25 erans affairs committees a report on the implementation 


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1 of sections 604 and 506 of this Act and the amendments 

2 made by such sections during the preceding fiscal year. 

3 Each report shall include, for the fiscal year covered by 

4 such report, the following: 

5 (1) A comprehensive description of the imple6 mentation of sections 604 and 506 of this Act and 

7 the amendments made by such sections. 

8 (2) Such recommendations as the Secretary 

9 considers appropriate for legislative or administra10 tive action to improve the authorities and require11 ments in such sections and the amendments made 

12 by such sections or to otherwise improve the quality 

13 of health care and the quality of the physicians in 

14 the Veterans Health Administration. 

15 (b) CONGRESSIONAL VETERANS AFFAIRS COMMIT16 TEES DEFINED.—In this section, the term ‘‘congressional 

17 veterans affairs committees’’ means— 

18 (1) the Committees on Veterans’ Affairs and 

19 Appropriations of the Senate; and 

20 (2) the Committees on Veterans’ Affairs and 

21 Appropriations of the House of Representatives. 


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1 SEC. 508. PILOT PROGRAM ON USE OF COMMUNITY-BASED 

2 ORGANIZATIONS AND LOCAL AND STATE 

3 GOVERNMENT ENTITIES TO ENSURE THAT 

4 VETERANS RECEIVE CARE AND BENEFITS 

5 FOR WHICH THEY ARE ELIGIBLE. 

6 (a) PILOT PROGRAM REQUIRED.—The Secretary of 

7 Veterans Affairs shall carry out a pilot program to assess 

8 the feasibility and advisability of using community-based 

9 organizations and local and State government entities— 

10 (1) to increase the coordination of community, 

11 local, State, and Federal providers of health care 

12 and benefits for veterans to assist veterans who are 

13 transitioning from military service to civilian life in 

14 such transition; 

15 (2) to increase the availability of high quality 

16 medical and mental health services to veterans 

17 transitioning from military service to civilian life; 

18 (3) to provide assistance to families of veterans 

19 who are transitioning from military service to civil20 ian life to help such families adjust to such transi21 tion; and 

22 (4) to provide outreach to veterans and their 

23 families to inform them about the availability of ben24 efits and connect them with appropriate care and 

25 benefit programs. 


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1 (b) DURATION OF PROGRAM.—The pilot program 

2 shall be carried out during the two-year period beginning 

3 on the date of the enactment of this Act. 

4 (c) PROGRAM LOCATIONS.— 

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

6 carried out at five locations selected by the Secretary 

7 for purposes of the pilot program. 

8 (2) CONSIDERATIONS.—In selecting locations 

9 for the pilot program, the Secretary shall consider 

10 the advisability of selecting locations in— 

11 (A) rural areas; 

12 (B) areas with populations that have a 

13 high proportion of minority group representa14 tion; 

15 (C) areas with populations that have a 

16 high proportion of individuals who have limited 

17 access to health care; and 

18 (D) areas that are not in close proximity 

19 to an active duty military installation. 

20 (d) GRANTS.—The Secretary shall carry out the pilot 

21 program through the award of grants to community-based 

22 organizations and local and State government entities. 

23 (e) SELECTION OF GRANT RECIPIENTS.— 

24 (1) IN GENERAL.—A community-based organi25 zation or local or State government entity seeking a 


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1 grant under the pilot program shall submit to the 

2 Secretary of Veterans Affairs an application therefor 

3 in such form and in such manner as the Secretary 

4 considers appropriate. 

5 (2) ELEMENTS.—Each application submitted 

6 under paragraph (1) shall include the following: 

7 (A) A description of how the proposal was 

8 developed in consultation with the Department 

9 of Veterans Affairs. 

10 (B) A plan to coordinate activities under 

11 the pilot program, to the greatest extent pos12 sible, with the local, State, and Federal pro13 viders of services for veterans to reduce duplica14 tion of services and to increase the effect of 

15 such services. 

16 (f) USE OF GRANT FUNDS.—The Secretary shall pre17 scribe appropriate uses of grant funds received under the 

18 pilot program. 

19 (g) REPORT ON PROGRAM.— 

20 (1) IN GENERAL.—Not later than 180 days 

21 after the completion of the pilot program, the Sec22 retary shall submit to Congress a report on the pilot 

23 program. 

24 (2) ELEMENTS.—The report required by para25 graph (1) shall include the following: 


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1 (A) The findings and conclusions of the 

2 Secretary with respect to the pilot program. 

3 (B) An assessment of the benefits to vet4 erans of the pilot program. 

5 (C) The recommendations of the Secretary 

6 as to the advisability of continuing the pilot 

7 program. 

8 SEC. 509. SPECIALIZED RESIDENTIAL CARE AND REHABILI9 TATION FOR CERTAIN VETERANS. 

10 Section 1720 is amended by adding at the end the 

11 following new subsection: 

12 ‘‘(g) The Secretary may contract with appropriate en13 tities to provide specialized residential care and rehabilita14 tion services to a veteran of Operation Enduring Freedom 

15 or Operation Iraqi Freedom who the Secretary determines 

16 suffers from a traumatic brain injury, has an accumula17 tion of deficits in activities of daily living and instrumental 

18 activities of daily living, and because of these deficits, 

19 would otherwise require admission to a nursing home even 

20 though such care would generally exceed the veteran’s 

21 nursing needs.’’. 


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1 SEC. 510. EXPANDED STUDY ON THE HEALTH IMPACT OF 

2 PROJECT SHIPBOARD HAZARD AND DE3 FENSE. 

4 (a) IN GENERAL.—Not later than 90 days after the 

5 date of the enactment of this Act, the Secretary of Vet6 erans Affairs shall enter into a contract with the Institute 

7 of Medicine of the National Academies to conduct an ex8 panded study on the health impact of Project Shipboard 

9 Hazard and Defense (Project SHAD). 

10 (b) COVERED VETERANS.—The study required by 

11 subsection (a) shall include, to the extent practicable, all 

12 veterans who participated in Project Shipboard Hazard 

13 and Defense. 

14 (c) UTILIZATION OF EXISTING STUDIES.—The study 

15 required by subsection (a) may use results from the study 

16 covered in the report entitled ‘‘Long-Term Health Effects 

17 of Participation in Project SHAD’’ of the Institute of 

18 Medicine of the National Academies. 

19 SEC. 511. USE OF NON-DEPARTMENT FACILITIES FOR RE20 HABILITATION OF INDIVIDUALS WITH TRAU21 MATIC BRAIN INJURY. 

22 Section 1710E is amended— 

23 (1) by redesignating subsection (b) as sub24 section (c); 

25 (2) by inserting after subsection (a) the fol26 lowing new subsection (b): 


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1 ‘‘(b) COVERED INDIVIDUALS.—The care and services 

2 provided under subsection (a) shall be made available to 

3 an individual— 

4 ‘‘(1) who is described in section 1710C(a) of 

5 this title; and 

6 ‘‘(2)(A) to whom the Secretary is unable to pro7 vide such treatment or services at the frequency or 

8 for the duration prescribed in such plan; or 

9 ‘‘(B) for whom the Secretary determines that it 

10 is optimal with respect to the recovery and rehabili11 tation for such individual.’’; and 

12 (3) by adding at the end the following new sub13 section: 

14 ‘‘(d) STANDARDS.—The Secretary may not provide 

15 treatment or services as described in subsection (a) at a 

16 non-Department facility under such subsection unless 

17 such facility maintains standards for the provision of such 

18 treatment or services established by an independent, peer19 reviewed organization that accredits specialized rehabilita20 tion programs for adults with traumatic brain injury.’’. 


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1 SEC. 512. INCLUSION OF FEDERALLY RECOGNIZED TRIBAL 

2 ORGANIZATIONS IN CERTAIN PROGRAMS FOR 

3 STATE VETERANS HOMES. 

4 (a) TREATMENT OF TRIBAL ORGANIZATION HEALTH

5 FACILITIES AS STATE HOMES.—Section 8138 is amend6 ed— 

7 (1) by redesignating subsection (e) as sub8 section (f); and 

9 (2) by inserting after subsection (d) the fol10 lowing new subsection (e): 

11 ‘‘(e)(1) A health facility (or certain beds in a health 

12 facility) of a tribal organization is treatable as a State 

13 home under subsection (a) in accordance with the provi14 sions of that subsection. 

15 ‘‘(2) Except as provided in paragraph (3), the provi16 sions of this section shall apply to a health facility (or cer17 tain beds in such facility) treated as a State home under 

18 subsection (a) by reason of this subsection to the same 

19 extent as health facilities (or beds) treated as a State 

20 home under subsection (a). 

21 ‘‘(3) Subsection (f) shall not apply to the treatment 

22 of health facilities (or certain beds in such facilities) of 

23 tribal organizations as a State home under subsection 

24 (a).’’. 

25 (b) STATE HOME FACILITIES FOR DOMICILIARY, 

26 NURSING, AND OTHER CARE.— 


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1 (1) IN GENERAL.—Chapter 81 is further 

2 amended— 

3 (A) in section 8131, by adding at the end 

4 the following new paragraph: 

5 ‘‘(5) The term ‘tribal organization’ has the 

6 meaning given such term in section 3765 of this 

7 title.’’; 

8 (B) in section 8132, by inserting ‘‘and 

9 tribal organizations’’ after ‘‘the several States’’; 

10 and 

11 (C) by inserting after section 8133 the fol12 lowing new section: 

13 ‘‘§ 8133A. Tribal organizations 

14 ‘‘(a) AUTHORITY TO AWARD GRANTS.—The Sec15 retary may award a grant to a tribal organization under 

16 this subchapter in order to carry out the purposes of this 

17 subchapter. 

18 ‘‘(b) MANNER AND CONDITION OF GRANT

19 AWARDS.—(1) Grants to tribal organizations under this 

20 section shall be awarded in the same manner, and under 

21 the same conditions, as grants awarded to the several 

22 States under the provisions of this subchapter, subject to 

23 such exceptions as the Secretary shall prescribe for pur24 poses of this subchapter to take into account the unique 

25 circumstances of tribal organizations. 


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1 ‘‘(2) For purposes of according priority under sub2 section (c)(2) of section 8135 of this title to an application 

3 submitted under subsection (a) of such section, an applica4 tion submitted under such subsection (a) by a tribal orga5 nization of a State that has previously applied for award 

6 of a grant under this subchapter for construction or acqui7 sition of a State nursing home shall be considered under 

8 subparagraph (C) of such subsection (c)(2) an application 

9 from a tribal organization that has previously applied for 

10 such a grant.’’. 

11 (2) CLERICAL AMENDMENT.—The table of sec12 tions at the beginning of chapter 81 is amended by 

13 inserting after the item relating to section 8133 the 

14 following new item: 

‘‘8133A. Tribal organizations.’’. 

15 SEC. 513. PILOT PROGRAM ON PROVISION OF DENTAL IN16 SURANCE PLANS TO VETERANS AND SUR17 VIVORS AND DEPENDENTS OF VETERANS. 

18 (a) PILOT PROGRAM REQUIRED.—The Secretary of 

19 Veterans Affairs shall carry out a pilot program to assess 

20 the feasibility and advisability of providing a dental insur21 ance plan to veterans and survivors and dependents of vet22 erans described in subsection (b). 

23 (b) COVERED VETERANS AND SURVIVORS AND DE24 PENDENTS.—The veterans and survivors and dependents 

25 of veterans described in this subsection are as follows: 


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1 (1) Any veteran who is enrolled in the system 

2 of annual patient enrollment under section 1705 of 

3 this title. 

4 (2) Any survivor or dependent of a veteran who 

5 is eligible for medical care under section 1781 of 

6 this title. 

7 (c) DURATION OF PROGRAM.—The pilot program 

8 shall be carried out during the three-year period beginning 

9 on the date of the enactment of this Act. 

10 (d) PILOT PROGRAM LOCATIONS.—The pilot pro11 gram shall be carried out in not less than two and not 

12 more than four Veterans Integrated Services Networks 

13 (VISNs) selected by the Secretary of Veterans Affairs for 

14 purposes of the pilot program. 

15 (e) ADMINISTRATION.—The Secretary of Veterans 

16 Affairs shall contract with a dental insurer to administer 

17 the dental plan provided under the pilot program. 

18 (f) BENEFITS.—The dental insurance plan under the 

19 pilot program shall provide such benefits for dental care 

20 and treatment as the Secretary considers appropriate for 

21 the dental insurance plan, including diagnostic services, 

22 preventative services, endodontics and other restorative 

23 services, surgical services, and emergency services. 

24 (g) ENROLLMENT.— 


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1 (1) VOLUNTARY.—Enrollment in the dental in2 surance plan under this section shall be voluntary. 

3 (2) MINIMUM PERIOD.—Enrollment in the den4 tal insurance plan shall be for such minimum period 

5 as the Secretary shall prescribe for purposes of this 

6 section. 

7 (h) PREMIUMS.— 

8 (1) IN GENERAL.—Premiums for coverage 

9 under the dental insurance plan under the pilot pro10 gram shall be in such amount or amounts as the 

11 Secretary of Veterans Affairs shall prescribe to cover 

12 all costs associated with the pilot program. 

13 (2) ANNUAL ADJUSTMENT.—The Secretary 

14 shall adjust the premiums payable under the pilot 

15 program for coverage under the dental insurance 

16 plan on an annual basis. Each individual covered by 

17 the dental insurance plan at the time of such an ad18 justment shall be notified of the amount and effec19 tive date of such adjustment. 

20 (3) RESPONSIBILITY FOR PAYMENT.—Each in21 dividual covered by the dental insurance plan shall 

22 pay the entire premium for coverage under the den23 tal insurance plan, in addition to the full cost of any 

24 copayments. 

25 (i) VOLUNTARY DISENROLLMENT.— 


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1 (1) IN GENERAL.—With respect to enrollment 

2 in the dental insurance plan under the pilot pro3 gram, the Secretary shall— 

4 (A) permit the voluntary disenrollment of 

5 an individual in the dental insurance plan if the 

6 disenrollment occurs during the 30-day period 

7 beginning on the date of the enrollment of the 

8 individual in the dental insurance plan; and 

9 (B) permit the voluntary disenrollment of 

10 an individual in the dental insurance plan for 

11 such circumstances as the Secretary shall pre12 scribe for purposes of this subsection, but only 

13 to the extent such disenrollment does not jeop14 ardize the fiscal integrity of the dental insur15 ance plan. 

16 (2) ALLOWABLE CIRCUMSTANCES.—The cir17 cumstances prescribed under paragraph (1)(B) shall 

18 include the following: 

19 (A) If an individual enrolled in the dental 

20 insurance plan relocates to a location outside 

21 the jurisdiction of the dental insurance plan 

22 that prevents utilization of the benefits under 

23 the dental insurance plan. 

24 (B) If an individual enrolled in the dental 

25 insurance plan is prevented by a serious medVerDate Nov 24 2008 21:38 Oct 29, 2009 Jkt 089200 PO 00000 Frm 00118 Fmt 6652 Sfmt 6201 E:\BILLS\S1963.PCS S1963

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1 ical condition from being able to obtain benefits 

2 under the dental insurance plan. 

3 (C) Such other circumstances as the Sec4 retary shall prescribe for purposes of this sub5 section. 

6 (3) ESTABLISHMENT OF PROCEDURES.—The 

7 Secretary shall establish procedures for determina8 tions on the permissibility of voluntary 

9 disenrollments under paragraph (1)(B). Such proce10 dures shall ensure timely determinations on the per11 missibility of such disenrollments. 

12 (j) RELATIONSHIP TO DENTAL CARE PROVIDED BY

13 SECRETARY.—Nothing in this section shall affect the re14 sponsibility of the Secretary to provide dental care under 

15 section 1712 of title 38, United States Code, and the par16 ticipation of an individual in the dental insurance plan 

17 under the pilot program shall not affect the individual’s 

18 entitlement to outpatient dental services and treatment, 

19 and related dental appliances, under that section. 

20 (k) REGULATIONS.—The dental insurance plan under 

21 the pilot program shall be administered under such regula22 tions as the Secretary shall prescribe. 


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1 SEC. 514. EXPANSION OF VETERAN ELIGIBILITY FOR REIM2 BURSEMENT BY SECRETARY OF VETERANS 

3 AFFAIRS FOR EMERGENCY TREATMENT FUR4 NISHED IN A NON-DEPARTMENT FACILITY. 

5 (a) EXPANSION OF ELIGIBILITY.—Subsection 

6 (b)(3)(C) of section 1725 is amended by striking ‘‘, in 

7 whole or in part,’’. 

8 (b) LIMITATIONS ON REIMBURSEMENT.—Section 

9 1725 is further amended— 

10 (1) in subsection (c), by adding at the end the 

11 following new paragraph: 

12 ‘‘(4)(A) If the veteran has contractual or legal re13 course against a third party that would, in part, extin14 guish the veteran’s liability to the provider of the emer15 gency treatment and payment for the treatment may be 

16 made both under subsection (a) and by the third party, 

17 the amount payable for such treatment under such sub18 section shall be the amount by which the costs for the 

19 emergency treatment exceed the amount payable or paid 

20 by the third party, except that the amount payable may 

21 not exceed the maximum amount payable established 

22 under paragraph (1)(A). 

23 ‘‘(B) In any case in which a third party is financially 

24 responsible for part of the veteran’s emergency treatment 

25 expenses, the Secretary shall be the secondary payer. 


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1 ‘‘(C) A payment in the amount payable under sub2 paragraph (A) shall be considered payment in full and 

3 shall extinguish the veteran’s liability to the provider. 

4 ‘‘(D) The Secretary may not reimburse a veteran 

5 under this section for any copayment or similar payment 

6 that the veteran owes the third party or for which the vet7 eran is responsible under a health-plan contract.’’; and 

8 (2) in subsection (f)(3)— 

9 (A) in subparagraph (A), by inserting be10 fore the period at the end the following: ‘‘, in11 cluding the Secretary of Health and Human 

12 Services with respect to the Medicare program 

13 under title XVIII of the Social Security Act (42 

14 U.S.C. 1395 et seq.) and the Medicaid program 

15 under title XIX of such Act (42 U.S.C. 1396 et 

16 seq.)’’; and 

17 (B) in subparagraph (B), by inserting be18 fore the period at the end the following: ‘‘, in19 cluding a State Medicaid agency with respect to 

20 payments made under a State plan for medical 

21 assistance approved under title XIX of such Act 

22 (42 U.S.C. 1396 et seq.)’’. 

23 (c) EFFECTIVE DATE.— 

24 (1) IN GENERAL.—The amendments made by 

25 subsections (a) and (b) shall take effect on the date 


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1 of the enactment of this Act, and shall apply with 

2 respect to emergency treatment furnished on or 

3 after that date. 

4 (2) REIMBURSEMENT FOR TREATMENT BEFORE

5 EFFECTIVE DATE.—The Secretary of Veterans Af6 fairs may provide reimbursement under section 1725 

7 of title 38, United States Code, as amended by this 

8 subsection, for emergency treatment furnished be9 fore the date of the enactment of this Act if the Sec10 retary determines that, under the circumstances ap11 plicable with respect to the veteran, it is appropriate 

12 to do so. 

13 SEC. 515. PROHIBITION ON COLLECTION OF COPAYMENTS 

14 FROM VETERANS WHO ARE CATASTROPH15 ICALLY DISABLED. 

16 (a) IN GENERAL.—Subchapter III of chapter 17 is 

17 amended by adding at the end the following new section: 

18 ‘‘§ 1730A. Prohibition on collection of copayments 

19 from catastrophically disabled veterans 

20 ‘‘Notwithstanding subsections (f) and (g) of section 

21 1710 and section 1722A(a) of this title or any other provi22 sion of law, the Secretary may not require a veteran who 

23 is catastrophically disabled to make any copayment for the 

24 receipt of hospital care or medical services under the laws 

25 administered by the Secretary.’’. 


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

2 at the beginning of such chapter is amended by inserting 

3 after the item relating to section 1730 the following new 

4 item: 

‘‘1730A. Prohibition on collection of copayments from catastrophically disabled 

veterans.’’. 

5 TITLE VI—DEPARTMENT 

6 PERSONNEL MATTERS 

7 SEC. 601. ENHANCEMENT OF AUTHORITIES FOR RETEN8 TION OF MEDICAL PROFESSIONALS. 

9 (a) SECRETARIAL AUTHORITY TO EXTEND TITLE 38 

10 STATUS TO ADDITIONAL POSITIONS.— 

11 (1) IN GENERAL.—Paragraph (3) of section 

12 7401 is amended by striking ‘‘and blind rehabilita13 tion outpatient specialists.’’ and inserting the fol14 lowing: ‘‘blind rehabilitation outpatient specialists, 

15 and such other classes of health care occupations as 

16 the Secretary considers necessary for the recruit17 ment and retention needs of the Department subject 

18 to the following requirements: 

19 ‘‘(A) Such other classes of health care oc20 cupations— 

21 ‘‘(i) are not occupations relating to 

22 administrative, clerical, or physical plant 

23 maintenance and protective services; 


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1 ‘‘(ii) that would otherwise receive 

2 basic pay in accordance with the General 

3 Schedule under section 5332 of title 5; 

4 ‘‘(iii) provide, as determined by the 

5 Secretary, direct patient care services or 

6 services incident to direct patient services; 

7 and 

8 ‘‘(iv) would not otherwise be available 

9 to provide medical care or treatment for 

10 veterans. 

11 ‘‘(B) Not later than 45 days before the 

12 Secretary appoints any personnel for a class of 

13 health care occupations that is not specifically 

14 listed in this paragraph, the Secretary shall 

15 submit to the Committee on Veterans’ Affairs 

16 of the Senate, the Committee on Veterans’ Af17 fairs of the House of Representatives, and the 

18 Office of Management and Budget notice of 

19 such appointment. 

20 ‘‘(C) Before submitting notice under sub21 paragraph (B), the Secretary shall solicit com22 ments from any labor organization representing 

23 employees in such class and include such com24 ments in such notice.’’. 


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1 (2) APPOINTMENT OF NURSE ASSISTANTS.— 

2 Such paragraph is further amended by inserting 

3 ‘‘nurse assistants,’’ after ‘‘licensed practical or voca4 tional nurses,’’. 

5 (b) PROBATIONARY PERIODS FOR REGISTERED

6 NURSES.—Section 7403(b) is amended— 

7 (1) in paragraph (1), by striking ‘‘Appoint8 ments’’ and inserting ‘‘Except as otherwise provided 

9 in this subsection, appointments’’; 

10 (2) by redesignating paragraph (2) as para11 graph (4); and 

12 (3) by inserting after paragraph (1) the fol13 lowing new paragraphs: 

14 ‘‘(2) With respect to the appointment of a registered 

15 nurse under this chapter, paragraph (1) shall apply with 

16 respect to such appointment regardless of whether such 

17 appointment is on a full-time basis or a part-time basis. 

18 ‘‘(3) An appointment described in subsection (a) on 

19 a part-time basis of a person who has previously served 

20 on a full-time basis for the probationary period for the 

21 position concerned shall be without a probationary pe22 riod.’’. 

23 (c) PROHIBITION ON TEMPORARY PART-TIME REG24 ISTERED NURSE APPOINTMENTS IN EXCESS OF TWO


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1 YEARS.—Section 7405 is amended by adding at the end 

2 the following new subsection: 

3 ‘‘(g)(1) Except as provided in paragraph (3), employ4 ment of a registered nurse on a temporary part-time basis 

5 under subsection (a)(1) shall be for a probationary period 

6 of two years. 

7 ‘‘(2) Except as provided in paragraph (3), upon com8 pletion by a registered nurse of the probationary period 

9 described in paragraph (1)— 

10 ‘‘(A) the employment of such nurse shall— 

11 ‘‘(i) no longer be considered temporary; 

12 and 

13 ‘‘(ii) be considered an appointment de14 scribed in section 7403(a) of this title; and 

15 ‘‘(B) the nurse shall be considered to have 

16 served the probationary period required by section 

17 7403(b). 

18 ‘‘(3) This subsection shall not apply to appointments 

19 made on a term limited basis of less than or equal to three 

20 years of— 

21 ‘‘(A) nurses with a part-time appointment re22 sulting from an academic affiliation or teaching posi23 tion in a nursing academy of the Department; 

24 ‘‘(B) nurses appointed as a result of a specific 

25 research proposal or grant; or 


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1 ‘‘(C) nurses who are not citizens of the United 

2 States and appointed under section 7407(a) of this 

3 title.’’. 

4 (d) WAIVER OF OFFSET FROM PAY FOR CERTAIN

5 REEMPLOYED ANNUITANTS.— 

6 (1) IN GENERAL.—Section 7405, as amended 

7 by subsection (c), is further amended by adding at 

8 the end the following new subsection: 

9 ‘‘(h)(1) The Secretary may waive the application of 

10 sections 8344 and 8468 of title 5 (relating to annuities 

11 and pay on reemployment) or any other similar provision 

12 of law under a Government retirement system on a case13 by-case basis for an annuitant reemployed on a temporary 

14 basis under the authority of subsection (a) in a position 

15 described under paragraph (1) of that subsection. 

16 ‘‘(2) An annuitant to whom a waiver under para17 graph (1) is in effect shall not be considered an employee 

18 for purposes of any Government retirement system. 

19 ‘‘(3) An annuitant to whom a waiver under para20 graph (1) is in effect shall be subject to the provisions 

21 of chapter 71 of title 5 (including all labor authority and 

22 labor representative collective bargaining agreements) ap23 plicable to the position to which appointed. 

24 ‘‘(4) In this subsection: 


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1 ‘‘(A) The term ‘annuitant’ means an annuitant 

2 under a Government retirement system. 

3 ‘‘(B) The term ‘employee’ has the meaning 

4 under section 2105 of title 5. 

5 ‘‘(C) The term ‘Government retirement system’ 

6 means a retirement system established by law for 

7 employees of the Government of the United States.’’. 

8 (2) EFFECTIVE DATE.—The amendment made 

9 by paragraph (1) shall take effect on the date that 

10 is 180 days after the date of the enactment of this 

11 Act, and shall apply to pay periods beginning on or 

12 after such effective date. 

13 (e) RATE OF BASIC PAY FOR APPOINTEES TO THE

14 OFFICE OF THE UNDER SECRETARY FOR HEALTH SET

15 TO RATE OF BASIC PAY FOR SENIOR EXECUTIVE SERV16 ICE POSITIONS.— 

17 (1) IN GENERAL.—Section 7404(a) is amend18 ed— 

19 (A) by striking ‘‘The annual’’ and insert20 ing ‘‘(1) The annual’’; 

21 (B) by striking ‘‘The pay’’ and inserting 

22 the following: 

23 ‘‘(2) The pay’’; 


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1 (C) by striking ‘‘under the preceding sen2 tence’’ and inserting ‘‘under paragraph (1)’’; 

3 and 

4 (D) by adding at the end the following new 

5 paragraph: 

6 ‘‘(3)(A) The rate of basic pay for a position to which 

7 an Executive order applies under paragraph (1) and is not 

8 described by paragraph (2) shall be set in accordance with 

9 section 5382 of title 5 as if such position were a Senior 

10 Executive Service position (as such term is defined in sec11 tion 3132(a) of title 5). 

12 ‘‘(B) A rate of basic pay for a position may not be 

13 set under subparagraph (A) in excess of— 

14 ‘‘(i) in the case the position is not described in 

15 clause (ii), the rate of basic pay payable for level III 

16 of the Executive Schedule; or 

17 ‘‘(ii) in the case that the position is covered by 

18 a performance appraisal system that meets the cer19 tification criteria established by regulation under 

20 section 5307(d) of title 5, the rate of basic pay pay21 able for level II of the Executive Schedule. 

22 ‘‘(C) Notwithstanding the provisions of subsection (d) 

23 of section 5307 of title 5, the Secretary may make any 

24 certification under that subsection instead of the Office 


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1 of Personnel Management and without concurrence of the 

2 Office of Management and Budget.’’. 

3 (2) EFFECTIVE DATE.—The amendments made 

4 by paragraph (1) shall take effect on the first day 

5 of the first pay period beginning after the day that 

6 is 180 days after the date of the enactment of this 

7 Act. 

8 (f) SPECIAL INCENTIVE PAY FOR DEPARTMENT

9 PHARMACIST EXECUTIVES.—Section 7410 is amended— 

10 (1) by striking ‘‘The Secretary may’’ and in11 serting the following: 

12 ‘‘(a) IN GENERAL.—The Secretary may’’; and 

13 (2) by adding at the end the following new sub14 section: 

15 ‘‘(b) SPECIAL INCENTIVE PAY FOR DEPARTMENT

16 PHARMACIST EXECUTIVES.—(1) In order to recruit and 

17 retain highly qualified Department pharmacist executives, 

18 the Secretary may authorize the Under Secretary for 

19 Health to pay special incentive pay of not more than 

20 $40,000 per year to an individual of the Veterans Health 

21 Administration who is a pharmacist executive. 

22 ‘‘(2) In determining whether and how much special 

23 pay to provide to such individual, the Under Secretary 

24 shall consider the following: 


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1 ‘‘(A) The grade and step of the position of the 

2 individual. 

3 ‘‘(B) The scope and complexity of the position 

4 of the individual. 

5 ‘‘(C) The personal qualifications of the indi6 vidual. 

7 ‘‘(D) The characteristics of the labor market 

8 concerned. 

9 ‘‘(E) Such other factors as the Secretary con10 siders appropriate. 

11 ‘‘(3) Special incentive pay under paragraph (1) for 

12 an individual is in addition to all other pay (including 

13 basic pay) and allowances to which the individual is enti14 tled. 

15 ‘‘(4) Except as provided in paragraph (5), special in16 centive pay under paragraph (1) for an individual shall 

17 be considered basic pay for all purposes, including retire18 ment benefits under chapters 83 and 84 of title 5, and 

19 other benefits. 

20 ‘‘(5) Special incentive pay under paragraph (1) for 

21 an individual shall not be considered basic pay for pur22 poses of adverse actions under subchapter V of this chap23 ter. 

24 ‘‘(6) Special incentive pay under paragraph (1) may 

25 not be awarded to an individual in an amount that would 


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1 result in an aggregate amount of pay (including bonuses 

2 and awards) received by such individual in a year under 

3 this title that is greater than the annual pay of the Presi4 dent.’’. 

5 (g) PAY FOR PHYSICIANS AND DENTISTS.— 

6 (1) NON-FOREIGN COST OF LIVING ADJUST7 MENT ALLOWANCE.—Section 7431(b) is amended by 

8 adding at the end the following new paragraph: 

9 ‘‘(5) The non-foreign cost of living adjustment 

10 allowance authorized under section 5941 of title 5 

11 for physicians and dentists whose pay is set under 

12 this section shall be determined as a percentage of 

13 base pay only.’’. 

14 (2) MARKET PAY DETERMINATIONS FOR PHYSI15 CIANS AND DENTISTS IN ADMINISTRATIVE OR EXEC16 UTIVE LEADERSHIP POSITIONS.—Section 

17 7431(c)(4)(B)(i) is amended by adding at the end 

18 the following: ‘‘The Secretary may exempt physi19 cians and dentists occupying administrative or exec20 utive leadership positions from the requirements of 

21 the previous sentence.’’. 

22 (3) EXCEPTION TO PROHIBITION ON REDUC23 TION OF MARKET PAY.—Section 7431(c)(7) is 

24 amended by striking ‘‘concerned.’’ and inserting 


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1 ‘‘concerned, unless there is a change in board certifi2 cation or reduction of privileges.’’. 

3 (h) ADJUSTMENT OF PAY CAP FOR NURSES.—Sec4 tion 7451(c)(2) is amended by striking ‘‘level V’’ and in5 serting ‘‘level IV’’. 

6 (i) EXEMPTION FOR CERTIFIED REGISTERED NURSE

7 ANESTHETISTS FROM LIMITATION ON AUTHORIZED COM8 PETITIVE PAY.—Section 7451(c)(2) is further amended 

9 by adding at the end the following new sentence: ‘‘The 

10 maximum rate of basic pay for a grade for the position 

11 of certified registered nurse anesthetist pursuant to an ad12 justment under subsection (d) may exceed the maximum 

13 rate otherwise provided in the preceding sentence.’’. 

14 (j) INCREASED LIMITATION ON SPECIAL PAY FOR

15 NURSE EXECUTIVES.—Section 7452(g)(2) is amended by 

16 striking ‘‘$25,000’’ and inserting ‘‘$100,000’’. 

17 (k) LOCALITY PAY SCALE COMPUTATIONS.— 

18 (1) EDUCATION, TRAINING, AND SUPPORT FOR

19 FACILITY DIRECTORS IN WAGE SURVEYS.—Section 

20 7451(d)(3) is amended by adding at the end the fol21 lowing new subparagraph: 

22 ‘‘(F) The Under Secretary for Health shall provide 

23 appropriate education, training, and support to directors 

24 of Department health care facilities in the conduct and 


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1 use of surveys, including the use of third-party surveys, 

2 under this paragraph.’’. 

3 (2) INFORMATION ON METHODOLOGY USED IN

4 WAGE SURVEYS.—Section 7451(e)(4) is amended— 

5 (A) by redesignating subparagraph (D) as 

6 subparagraph (E); and 

7 (B) by inserting after subparagraph (C) 

8 the following new subparagraph (D): 

9 ‘‘(D) In any case in which the director conducts 

10 such a wage survey during the period covered by the 

11 report and makes adjustment in rates of basic pay 

12 applicable to one or more covered positions at the fa13 cility, information on the methodology used in mak14 ing such adjustment or adjustments.’’. 

15 (3) DISCLOSURE OF INFORMATION TO PERSONS

16 IN COVERED POSITIONS.—Section 7451(e), as 

17 amended by paragraph (2) of this subsection, is fur18 ther amended by adding at the end the following 

19 new paragraph: 

20 ‘‘(6)(A) Upon the request of an individual described 

21 in subparagraph (B) for a report provided under para22 graph (4) with respect to a Department health-care facil23 ity, the Under Secretary for Health or the director of such 

24 facility shall provide to the individual the most current re25 port for such facility provided under such paragraph. 


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1 ‘‘(B) An individual described in this subparagraph 

2 is— 

3 ‘‘(i) an individual in a covered position at a De4 partment health-care facility; or 

5 ‘‘(ii) a representative of the labor organization 

6 representing that individual who is designated by 

7 that individual to make the request.’’. 

8 (l) ELIGIBILITY OF PART-TIME NURSES FOR ADDI9 TIONAL NURSE PAY.— 

10 (1) IN GENERAL.—Section 7453 is amended— 

11 (A) in subsection (a), by striking ‘‘a 

12 nurse’’ and inserting ‘‘a full-time nurse or part13 time nurse’’; 

14 (B) in subsection (b)— 

15 (i) in the first sentence— 

16 (I) by striking ‘‘on a tour of 

17 duty’’; 

18 (II) by striking ‘‘service on such 

19 tour’’ and inserting ‘‘such service’’; 

20 and 

21 (III) by striking ‘‘of such tour’’ 

22 and inserting ‘‘of such service’’; and 

23 (ii) in the second sentence, by striking 

24 ‘‘of such tour’’ and inserting ‘‘of such serv25 ice’’; 


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1 (C) in subsection (c)— 

2 (i) by striking ‘‘on a tour of duty’’; 

3 and 

4 (ii) by striking ‘‘service on such tour’’ 

5 and inserting ‘‘such service’’; and 

6 (D) in subsection (e)— 

7 (i) in paragraph (1), by striking 

8 ‘‘eight hours in a day’’ and inserting 

9 ‘‘eight consecutive hours’’; and 

10 (ii) in paragraph (5)(A), by striking 

11 ‘‘tour of duty’’ and inserting ‘‘period of 

12 service’’. 

13 (2) EXCLUSION OF APPLICATION OF ADDI14 TIONAL NURSE PAY PROVISIONS TO CERTAIN ADDI15 TIONAL EMPLOYEES.—Paragraph (3) of section 

16 7454(b) is amended to read as follows: 

17 ‘‘(3) Employees appointed under section 7408 of this 

18 title performing service on a tour of duty, any part of 

19 which is within the period commencing at midnight Friday 

20 and ending at midnight Sunday, shall receive additional 

21 pay in addition to the rate of basic pay provided such em22 ployees for each hour of service on such tour at a rate 

23 equal to 25 percent of such employee’s hourly rate of basic 

24 pay.’’. 


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1 (m) ENHANCED AUTHORITY TO INCREASE RATES OF

2 BASIC PAY TO OBTAIN OR RETAIN SERVICES OF CERTAIN

3 PERSONS.—Section 7455(c) is amended to read as fol4 lows: 

5 ‘‘(c)(1) Subject to paragraph (2), the amount of any 

6 increase under subsection (a) in the minimum rate for any 

7 grade may not (except in the case of nurse anesthetists, 

8 licensed practical nurses, licensed vocational nurses, nurs9 ing positions otherwise covered by title 5, pharmacists, 

10 and licensed physical therapists) exceed the maximum rate 

11 of basic pay (excluding any locality-based comparability 

12 payment under section 5304 of title 5 or similar provision 

13 of law) for the grade or level by more than 30 percent. 

14 ‘‘(2) No rate may be established under this section 

15 in excess of the rate of basic pay payable for level IV of 

16 the Executive Schedule.’’. 

17 SEC. 602. LIMITATIONS ON OVERTIME DUTY, WEEKEND 

18 DUTY, AND ALTERNATIVE WORK SCHEDULES 

19 FOR NURSES. 

20 (a) OVERTIME DUTY.— 

21 (1) IN GENERAL.—Subchapter IV of chapter 74 

22 is amended by adding at the end the following new 

23 section: 


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1 ‘‘§ 7459. Nursing staff: special rules for overtime duty 

2 ‘‘(a) LIMITATION.—Except as provided in subsection 

3 (c), the Secretary may not require nursing staff to work 

4 more than 40 hours (or 24 hours if such staff is covered 

5 under section 7456 of this title) in an administrative work 

6 week or more than eight consecutive hours (or 12 hours 

7 if such staff is covered under section 7456 or 7456A of 

8 this title). 

9 ‘‘(b) VOLUNTARY OVERTIME.—(1) Nursing staff may 

10 on a voluntary basis elect to work hours otherwise prohib11 ited by subsection (a). 

12 ‘‘(2) The refusal of nursing staff to work hours pro13 hibited by subsection (a) shall not be grounds to discrimi14 nate (within the meaning of section 704(a) of the Civil 

15 Rights Act of 1964 (42 U.S.C. 2000e–3(a))) against the 

16 staff, dismissal or discharge of the staff, or any other ad17 verse personnel action against the staff. 

18 ‘‘(c) OVERTIME UNDER EMERGENCY CIR19 CUMSTANCES.—(1) Subject to paragraph (2), the Sec20 retary may require nursing staff to work hours otherwise 

21 prohibited by subsection (a) if— 

22 ‘‘(A) the work is a consequence of an emer23 gency that could not have been reasonably antici24 pated; 

25 ‘‘(B) the emergency is non-recurring and is not 

26 caused by or aggravated by the inattention of the 


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1 Secretary or lack of reasonable contingency planning 

2 by the Secretary; 

3 ‘‘(C) the Secretary has exhausted all good faith, 

4 reasonable attempts to obtain voluntary workers; 

5 ‘‘(D) the nurse staff have critical skills and ex6 pertise that are required for the work; and 

7 ‘‘(E) the work involves work for which the 

8 standard of care for a patient assignment requires 

9 continuity of care through completion of a case, 

10 treatment, or procedure. 

11 ‘‘(2) Nursing staff may not be required to work hours 

12 under this subsection after the requirement for a direct 

13 role by the staff in responding to medical needs resulting 

14 from the emergency ends. 

15 ‘‘(d) NURSING STAFF DEFINED.—In this section, the 

16 term ‘nursing staff’ includes the following; 

17 ‘‘(1) A registered nurse. 

18 ‘‘(2) A licensed practical or vocational nurse. 

19 ‘‘(3) A nurse assistant appointed under this 

20 chapter or title 5. 

21 ‘‘(4) Any other nurse position designated by the 

22 Secretary for purposes of this section.’’. 

23 (2) CLERICAL AMENDMENT.—The table of sec24 tions at the beginning of chapter 74 is amended by 


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1 inserting after the item relating to section 7458 the 

2 following new item: 

‘‘7459. Nursing staff: special rules for overtime duty.’’. 

3 (b) WEEKEND DUTY.—Section 7456 is amended— 

4 (1) by striking subsection (c); and 

5 (2) by redesignating subsection (d) as sub6 section (c). 

7 (c) ALTERNATE WORK SCHEDULES.— 

8 (1) IN GENERAL.—Section 7456A(b)(1)(A) is 

9 amended by striking ‘‘three regularly scheduled’’ and 

10 all that follows through the period at the end and 

11 inserting ‘‘six regularly scheduled 12-hour tours of 

12 duty within a 14-day period shall be considered for 

13 all purposes to have worked a full 80-hour pay pe14 riod.’’. 

15 (2) CONFORMING AMENDMENTS.—Section 

16 7456A(b) is amended— 

17 (A) in the subsection heading, by striking 

18 ‘‘36/40’’ and inserting ‘‘72/80’’; 

19 (B) in paragraph (2)— 

20 (i) in subparagraph (A), by striking 

21 ‘‘40-hour basic work week’’ and inserting 

22 ‘‘80-hour pay period’’; 

23 (ii) in subparagraph (B), by striking 

24 ‘‘regularly scheduled 36-hour tour of duty 

25 within the work week’’ and inserting 


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1 ‘‘scheduled 72-hour tour of duty within the 

2 bi-weekly pay period’’; 

3 (iii) in subparagraph (C)— 

4 (I) in clause (i), by striking ‘‘reg5 ularly scheduled 36-hour tour of duty 

6 within an administrative work week’’ 

7 and inserting ‘‘scheduled 72-hour tour 

8 of duty within an administrative pay 

9 period’’; 

10 (II) in clause (ii), by striking 

11 ‘‘regularly’’; and 

12 (III) in clause (iii), by striking 

13 ‘‘regularly scheduled 36-hour tour of 

14 duty work week’’ and inserting 

15 ‘‘scheduled 72-hour tour of duty pay 

16 period’’; and 

17 (iv) in subparagraph (D), by striking 

18 ‘‘regularly’’; and 

19 (C) in paragraph (3), by striking ‘‘regu20 larly’’. 

21 SEC. 603. IMPROVEMENTS TO CERTAIN EDUCATIONAL AS22 SISTANCE PROGRAMS. 

23 (a) REINSTATEMENT OF HEALTH PROFESSIONALS

24 EDUCATIONAL ASSISTANCE SCHOLARSHIP PROGRAM.— 


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1 (1) IN GENERAL.—Section 7618 is amended by 

2 striking ‘‘December 31, 1998’’ and inserting ‘‘De3 cember 31, 2014’’. 

4 (2) EXPANSION OF ELIGIBILITY REQUIRE5 MENTS.—Section 7612(b)(2) is amended by striking 

6 ‘‘(under section’’ and all that follows through ‘‘or vo7 cational nurse.’’ and inserting the following: ‘‘as an 

8 appointee under paragraph (1) or (3) of section 

9 7401 of this title.’’. 

10 (b) IMPROVEMENTS TO EDUCATION DEBT REDUC11 TION PROGRAM.— 

12 (1) INCLUSION OF EMPLOYEE RETENTION AS

13 PURPOSE OF PROGRAM.—Section 7681(a)(2) is 

14 amended by inserting ‘‘and retention’’ after ‘‘recruit15 ment’’ the first time it appears. 

16 (2) ELIGIBILITY.—Section 7682 is amended— 

17 (A) in subsection (a)(1), by striking ‘‘a re18 cently appointed’’ and inserting ‘‘an’’; and 

19 (B) by striking subsection (c). 

20 (c) LOAN REPAYMENT PROGRAM FOR CLINICAL RE21 SEARCHERS FROM DISADVANTAGED BACKGROUNDS.— 

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

23 Affairs may, in consultation with the Secretary of 

24 Health and Human Services, utilize the authorities 

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1 ice Act (42 U.S.C. 288–5) for the repayment of the 

2 principal and interest of educational loans of appro3 priately qualified health professionals who are from 

4 disadvantaged backgrounds in order to secure clin5 ical research by such professionals for the Veterans 

6 Health Administration. 

7 (2) LIMITATIONS.—The exercise by the Sec8 retary of Veterans Affairs of the authorities referred 

9 to in paragraph (1) shall be subject to the conditions 

10 and limitations specified in paragraphs (2) and (3) 

11 of section 487E(a) of the Public Health Service Act 

12 (42 U.S.C. 288–5(a)(2) and (3)). 

13 (3) FUNDING.—Amounts for the repayment of 

14 principal and interest of educational loans under this 

15 subsection shall be derived from amounts available 

16 to the Secretary of Veterans Affairs for the Veterans 

17 Health Administration for Medical Services. 

18 SEC. 604. STANDARDS FOR APPOINTMENT AND PRACTICE 

19 OF PHYSICIANS IN DEPARTMENT OF VET20 ERANS AFFAIRS MEDICAL FACILITIES. 

21 (a) STANDARDS.— 

22 (1) IN GENERAL.—Subchapter I of chapter 74 

23 is amended by inserting after section 7402 the fol24 lowing new section: 


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1 ‘‘§ 7402A. Appointment and practice of physicians: 

2 standards 

3 ‘‘(a) IN GENERAL.—The Secretary shall, acting 

4 through the Under Secretary for Health, prescribe stand5 ards to be met by individuals in order to qualify for ap6 pointment in the Veterans Health Administration in the 

7 position of physician and to practice as a physician in 

8 medical facilities of the Administration. The standards 

9 shall incorporate the requirements of this section. 

10 ‘‘(b) DISCLOSURE OF CERTAIN INFORMATION BE11 FORE APPOINTMENT.—Each individual seeking appoint12 ment in the Veterans Health Administration in the posi13 tion of physician shall do the following: 

14 ‘‘(1) Provide the Secretary a full and complete 

15 explanation of the following: 

16 ‘‘(A) Each lawsuit, civil action, or other 

17 claim (whether open or closed) brought against 

18 the individual for medical malpractice or neg19 ligence. 

20 ‘‘(B) Each payment made by or on behalf 

21 of the individual to settle any lawsuit, action, or 

22 claim covered by subparagraph (A). 

23 ‘‘(C) Each investigation or disciplinary ac24 tion taken against the individual relating to the 

25 individual’s performance as a physician. 


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1 ‘‘(2) Provide the Secretary a written authoriza2 tion that permits the State licensing board of each 

3 State in which the individual holds or has held a li4 cense to practice medicine to disclose to the Sec5 retary any information in the records of such State 

6 on the following: 

7 ‘‘(A) Each lawsuit, civil action, or other 

8 claim brought against the individual for medical 

9 malpractice or negligence covered by paragraph 

10 (1)(A) that occurred in such State. 

11 ‘‘(B) Each payment made by or on behalf 

12 of the individual to settle any lawsuit, action, or 

13 claim covered by subparagraph (A). 

14 ‘‘(C) Each medical malpractice judgment 

15 against the individual by the courts or adminis16 trative agencies or bodies of such State. 

17 ‘‘(D) Each disciplinary action taken or 

18 under consideration against the individual by 

19 an administrative agency or body of such State. 

20 ‘‘(E) Any change in the status of the li21 cense to practice medicine issued the individual 

22 by such State, including any voluntary or non23 disciplinary surrendering of such license by the 

24 individual. 


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1 ‘‘(F) Any open investigation of the indi2 vidual by an administrative agency or body of 

3 such State, or any outstanding allegation 

4 against the individual before such an adminis5 trative agency or body. 

6 ‘‘(G) Any written notification by the State 

7 to the individual of potential termination of a li8 cense for cause or otherwise. 

9 ‘‘(c) DISCLOSURE OF CERTAIN INFORMATION FOL10 LOWING APPOINTMENT.—(1) Each individual appointed 

11 in the Veterans Health Administration in the position of 

12 physician after the date of the enactment of this section 

13 shall, as a condition of service under the appointment, dis14 close to the Secretary, not later than 30 days after the 

15 occurrence of such event, the following: 

16 ‘‘(A) A judgment against the individual for 

17 medical malpractice or negligence. 

18 ‘‘(B) A payment made by or on behalf of the 

19 individual to settle any lawsuit, action, or claim dis20 closed under paragraph (1) or (2) of subsection (b). 

21 ‘‘(C) Any disposition of or material change in a 

22 matter disclosed under paragraph (1) or (2) of sub23 section (b). 


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1 ‘‘(D) Any lawsuit, disciplinary action, or claim 

2 filed or undertaken after the date of the disclosures 

3 under subsection (b). 

4 ‘‘(2) Each individual appointed in the Veterans 

5 Health Administration in the position of physician as of 

6 the date of the enactment of this section shall do the fol7 lowing: 

8 ‘‘(A) Not later than the end of the 60-day pe9 riod beginning on the date of the enactment of this 

10 section and as a condition of service under the ap11 pointment after the end of that period, submit the 

12 request and authorization described in subsection 

13 (b)(2). 

14 ‘‘(B) Agree, as a condition of service under the 

15 appointment, to disclose to the Secretary, not later 

16 than 30 days after the occurrence of such event, the 

17 following: 

18 ‘‘(i) A judgment against the individual for 

19 medical malpractice or negligence. 

20 ‘‘(ii) A payment made by or on behalf of 

21 the individual to settle any lawsuit, action, or 

22 claim disclosed pursuant to subparagraph (A) 

23 or under this subparagraph. 


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1 ‘‘(iii) Any disposition of or material change 

2 in a matter disclosed pursuant to subparagraph 

3 (A) or under this subparagraph. 

4 ‘‘(3) Each individual appointed in the Veterans 

5 Health Administration in the position of physician shall, 

6 as part of the biennial review of the performance of the 

7 physician under the appointment, submit the request and 

8 authorization described in subsection (b)(2). The require9 ment of this paragraph is in addition to the requirements 

10 of paragraph (1) or (2), as applicable. 

11 ‘‘(d) INVESTIGATION OF DISCLOSED MATTERS.—(1) 

12 The Director of the Veterans Integrated Services Network 

13 (VISN) in which an individual is seeking appointment in 

14 the Veterans Health Administration in the position of phy15 sician shall perform an investigation (in such manner as 

16 the standards required by this section shall specify) of 

17 each matter disclosed under subsection (b) with respect 

18 to the individual. 

19 ‘‘(2) The Director of the Veterans Integrated Serv20 ices Network in which an individual is appointed in the 

21 Veterans Health Administration in the position of physi22 cian shall perform an investigation (in a manner so speci23 fied) of each matter disclosed under subsection (c) with 

24 respect to the individual. 


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1 ‘‘(3) The results of each investigation performed 

2 under this subsection shall be fully documented. 

3 ‘‘(e) APPROVAL OF APPOINTMENTS BY DIRECTORS

4 OF VISNS.—(1) An individual may not be appointed in 

5 the Veterans Health Administration in the position of phy6 sician without the approval of the Director of the Veterans 

7 Integrated Services Network in which the individual will 

8 first serve under the appointment, unless the medical cen9 ter director and credentialing and privileging manager of 

10 the facility hiring the physician certify in writing that— 

11 ‘‘(A) a full investigation was carried out in com12 pliance with section 104 of this title; and 

13 ‘‘(B) an investigation did not disclose any ac14 tions described in subsections (b), (c), and (d) of 

15 such section. 

16 ‘‘(2) In approving the appointment under this sub17 section of an individual for whom any matters have been 

18 disclosed under subsection (b), a Director shall— 

19 ‘‘(A) certify in writing the completion of the 

20 performance of the investigation under subsection 

21 (d)(1) of each such matter, including the results of 

22 such investigation; and 

23 ‘‘(B) provide a written justification why any 

24 matters raised in the course of such investigation do 

25 not disqualify the individual from appointment. 


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1 ‘‘(f) ENROLLMENT OF PHYSICIANS WITH PRACTICE

2 PRIVILEGES IN PROACTIVE DISCLOSURE SERVICE.—Each 

3 medical facility of the Department at which physicians are 

4 extended the privileges of practice shall enroll each physi5 cian extended such privileges in the Proactive Disclosure 

6 Service of the National Practitioner Data Bank. 

7 ‘‘(g) ENCOURAGING HIRING OF PHYSICIANS WITH

8 BOARD CERTIFICATION.—(1) The Secretary shall, for 

9 each performance contract with a Director of a Veterans 

10 Integrated Services Network (VISN), include in such con11 tract a provision that encourages such director to hire 

12 physicians who are board eligible or board certified in the 

13 specialty in which the physicians will practice. 

14 ‘‘(2) The Secretary may determine the nature and 

15 manner of the provision described in paragraph (1).’’. 

16 (2) CLERICAL AMENDMENT.—The table of sec17 tions at the beginning of chapter 74 is amended by 

18 inserting after the item relating to section 7402 the 

19 following new item: 

‘‘7402A. Appointment and practice of physicians: standards.’’. 

20 (b) EFFECTIVE DATE AND APPLICABILITY.— 

21 (1) EFFECTIVE DATE.—Except as provided in 

22 paragraphs (2) and (3), the amendments made by 

23 subsection (a) shall take effect on the date of the en24 actment of this Act. 


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1 (2) APPLICABILITY OF CERTAIN REQUIRE2 MENTS TO PHYSICIANS PRACTICING ON EFFECTIVE

3 DATE.—In the case of an individual appointed to the 

4 Veterans Health Administration in the position of 

5 physician as of the date of the enactment of this 

6 Act, the requirements of section 7402A(f) of title 

7 38, United States Code, as added by subsection (a) 

8 of this section, shall take effect on the date that is 

9 60 days after the date of the enactment of this Act. 

10 (3) APPLICABILITY OF REQUIREMENTS RE11 LATED TO HIRING OF PHYSICIANS WITH BOARD CER12 TIFICATION.—The requirement of section 7402A(g) 

13 of such title, as added by subsection (a), shall begin 

14 with the first cycle of performance contracts for di15 rectors of Veterans Integrated Services Networks be16 ginning after the date of the enactment of this Act. 

17 TITLE VII—HOMELESS 

18 VETERANS MATTERS 

19 SEC. 701. PILOT PROGRAM ON FINANCIAL SUPPORT FOR 

20 ENTITIES THAT COORDINATE THE PROVI21 SION OF SUPPORTIVE SERVICES TO FOR22 MERLY HOMELESS VETERANS RESIDING ON 

23 CERTAIN MILITARY PROPERTY. 

24 (a) ESTABLISHMENT.— 


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1 (1) IN GENERAL.—Subject to the availability of 

2 appropriations for such purpose, the Secretary of 

3 Veterans Affairs may carry out a pilot program to 

4 make grants to public and nonprofit organizations 

5 (including faith-based and community organizations) 

6 to coordinate the provision of supportive services 

7 available in the local community to very low income, 

8 formerly homeless veterans residing in permanent 

9 housing that is located on qualifying property de10 scribed in subsection (b). 

11 (2) NUMBER OF GRANTS.—The Secretary may 

12 make grants at up to 10 qualifying properties under 

13 the pilot program. 

14 (b) QUALIFYING PROPERTY.—Qualifying property 

15 under the pilot program is property that— 

16 (1) was part of a military installation that was 

17 closed in accordance with— 

18 (A) decisions made as part of the 2005 

19 round of defense base closure and realignment 

20 under the Defense Base Closure and Realign21 ment Act of 1990 (part A of title XXIX of 

22 Public Law 101–510; 10 U.S.C. 2687 note); 

23 and 

24 (B) subchapter III of chapter 5 of title 40, 

25 United States Code; and 


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1 (2) the Secretary of Defense determines, after 

2 considering any redevelopment plans of any local re3 development authority relating to such property, 

4 may be used to assist the homeless in accordance 

5 with such redevelopment plan. 

6 (c) CRITERIA FOR GRANTS.—The Secretary shall 

7 prescribe criteria and requirements for grants under this 

8 section and shall publish such criteria and requirements 

9 in the Federal Register. 

10 (d) DURATION OF PROGRAM.—The authority of the 

11 Secretary to provide grants under a pilot program under 

12 this section shall cease on the date that is five years after 

13 the date of the commencement of the pilot program. 

14 (e) VERY LOW INCOME DEFINED.—In this section, 

15 the term ‘‘very low income’’ has the meaning given that 

16 term in the Resident Characteristics Report issued annu17 ally by the Department of Housing and Urban Develop18 ment. 

19 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

20 authorized to be appropriated from amounts made avail21 able under the heading ‘‘General Operating Expenses’’, 

22 not more than $3,000,000 in each of fiscal years 2010 

23 through 2014 to carry out the purposes of this section. 


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1 SEC. 702. PILOT PROGRAM ON FINANCIAL SUPPORT OF EN2 TITIES THAT COORDINATE THE PROVISION 

3 OF SUPPORTIVE SERVICES TO FORMERLY 

4 HOMELESS VETERANS RESIDING IN PERMA5 NENT HOUSING. 

6 (a) ESTABLISHMENT OF PILOT PROGRAM.— 

7 (1) IN GENERAL.—Subject to the availability of 

8 appropriations for such purpose, the Secretary of 

9 Veterans Affairs may carry out a pilot program to 

10 make grants to public and nonprofit organizations 

11 (including faith-based and community organizations) 

12 to coordinate the provision of supportive services 

13 available in the local community to very low income, 

14 formerly homeless veterans residing in permanent 

15 housing. 

16 (2) NUMBER OF GRANTS.—The Secretary may 

17 make grants at up to 10 qualifying properties under 

18 the pilot program. 

19 (b) QUALIFYING PROPERTY.—Qualifying property 

20 under the pilot program is any property in the United 

21 States on which permanent housing is provided or af22 forded to formerly homeless veterans, as determined by 

23 the Secretary. 

24 (c) CRITERIA FOR GRANTS.—The Secretary shall 

25 prescribe criteria and requirements for grants under this 


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1 section and shall publish such criteria and requirements 

2 in the Federal Register. 

3 (d) DURATION OF PILOT PROGRAM.—The authority 

4 of the Secretary to provide grants under a pilot program 

5 under this section shall cease on the date that is five years 

6 after the date of the commencement of the pilot program. 

7 (e) VERY LOW INCOME DEFINED.—In this section, 

8 the term ‘‘very low income’’ has the meaning given that 

9 term in the Resident Characteristics Report issued annu10 ally by the Department of Housing and Urban Develop11 ment. 

12 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

13 authorized to be appropriated from amounts made avail14 able under the heading ‘‘General Operating Expenses’’, 

15 not more than $3,000,000 in each of fiscal years 2010 

16 through 2014 to carry out the purposes of this section. 

17 SEC. 703. PILOT PROGRAM ON FINANCIAL SUPPORT OF EN18 TITIES THAT PROVIDE OUTREACH TO IN19 FORM CERTAIN VETERANS ABOUT PENSION 

20 BENEFITS. 

21 (a) AUTHORITY TO MAKE GRANTS.—In addition to 

22 the outreach authority provided to the Secretary of Vet23 erans Affairs by section 6303 of title 38, United States 

24 Code, the Secretary may carry out a pilot program to 

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1 ing faith-based and community organizations) for services 

2 to provide outreach to inform low-income and elderly vet3 erans and their spouses who reside in rural areas of bene4 fits for which they may be eligible under chapter 15 of 

5 such title. 

6 (b) CRITERIA FOR GRANTS.—The Secretary shall 

7 prescribe criteria and requirements for grants under this 

8 section and shall publish such criteria and requirements 

9 in the Federal Register. 

10 (c) DURATION OF PILOT PROGRAM.—The authority 

11 of the Secretary to provide grants under a pilot program 

12 under this section shall cease on the date that is five years 

13 after the date of the commencement of the pilot program. 

14 (d) AUTHORIZATION OF APPROPRIATIONS.—There is 

15 authorized to be appropriated from amounts made avail16 able under the heading ‘‘General Operating Expenses’’, 

17 not more than $1,275,000 in each of fiscal years 2010 

18 through 2014 to carry out the purposes of this section. 

19 SEC. 704. ASSESSMENT OF PILOT PROGRAMS. 

20 (a) PROGRESS REPORTS.—Not less than one year be21 fore the expiration of the authority to carry out a pilot 

22 program authorized by sections 501 through 503, the Sec23 retary of Veterans Affairs shall submit to Congress a 

24 progress report on such pilot program. 


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1 (b) CONTENTS.—Each progress report submitted for 

2 a pilot program under subsection (a) shall include the fol3 lowing: 

4 (1) The lessons learned by the Secretary of Vet5 erans Affairs with respect to such pilot program that 

6 can be applied to other programs with similar pur7 poses. 

8 (2) The recommendations of the Secretary on 

9 whether to continue such pilot program. 

10 (3) The number of veterans and dependents 

11 served by such pilot program. 

12 (4) An assessment of the quality of service pro13 vided to veterans and dependents under such pilot 

14 program. 

15 (5) The amount of funds provided to grant re16 cipients under such pilot program. 

17 (6) The names of organizations that have re18 ceived grants under such pilot program. 

19 TITLE VIII—NONPROFIT RE20 SEARCH AND EDUCATION 

21 CORPORATIONS 

22 SEC. 801. GENERAL AUTHORITIES ON ESTABLISHMENT OF 

23 CORPORATIONS. 

24 (a) AUTHORIZATION OF MULTI-MEDICAL CENTER

25 RESEARCH CORPORATIONS.— 


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1 (1) IN GENERAL.—Section 7361 is amended— 

2 (A) by redesignating subsection (b) as sub3 section (e); and 

4 (B) by inserting after subsection (a) the 

5 following new subsection (b): 

6 ‘‘(b)(1) Subject to paragraph (2), a corporation es7 tablished under this subchapter may facilitate the conduct 

8 of research, education, or both at more than one medical 

9 center. Such a corporation shall be known as a ‘multi-med10 ical center research corporation’. 

11 ‘‘(2) The board of directors of a multi-medical center 

12 research corporation under this subsection shall include 

13 the official at each Department medical center concerned 

14 who is, or who carries out the responsibilities of, the med15 ical center director of such center as specified in section 

16 7363(a)(1)(A)(i) of this title. 

17 ‘‘(3) In facilitating the conduct of research, edu18 cation, or both at more than one Department medical cen19 ter under this subchapter, a multi-medical center research 

20 corporation may administer receipts and expenditures re21 lating to such research, education, or both, as applicable, 

22 performed at the Department medical centers concerned.’’. 

23 (2) EXPANSION OF EXISTING CORPORATIONS TO

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1 TIONS.—Such section is further amended by adding 

2 at the end the following new subsection: 

3 ‘‘(f) A corporation established under this subchapter 

4 may act as a multi-medical center research corporation 

5 under this subchapter in accordance with subsection (b) 

6 if— 

7 ‘‘(1) the board of directors of the corporation 

8 approves a resolution permitting facilitation by the 

9 corporation of the conduct of research, education, or 

10 both at the other Department medical center or 

11 medical centers concerned; and 

12 ‘‘(2) the Secretary approves the resolution of 

13 the corporation under paragraph (1).’’. 

14 (b) RESTATEMENT AND MODIFICATION OF AUTHORI15 TIES ON APPLICABILITY OF STATE LAW.— 

16 (1) IN GENERAL.—Section 7361, as amended 

17 by subsection (a) of this section, is further amended 

18 by inserting after subsection (b) the following new 

19 subsection (c): 

20 ‘‘(c) Any corporation established under this sub21 chapter shall be established in accordance with the non22 profit corporation laws of the State in which the applicable 

23 Department medical center is located and shall, to the ex24 tent not inconsistent with any Federal law, be subject to 

25 the laws of such State. In the case of any multi-medical 


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1 center research corporation that facilitates the conduct of 

2 research, education, or both at Department medical cen3 ters located in different States, the corporation shall be 

4 established in accordance with the nonprofit corporation 

5 laws of the State in which one of such Department medical 

6 centers is located.’’. 

7 (2) CONFORMING AMENDMENT.—Section 7365 

8 is repealed. 

9 (c) CLARIFICATION OF STATUS OF CORPORATIONS.— 

10 Section 7361, as amended by this section, is further 

11 amended— 

12 (1) in subsection (a), by striking the second 

13 sentence; and 

14 (2) by inserting after subsection (c) the fol15 lowing new subsection (d): 

16 ‘‘(d)(1) Except as otherwise provided in this sub17 chapter or under regulations prescribed by the Secretary, 

18 any corporation established under this subchapter, and its 

19 officers, directors, and employees, shall be required to 

20 comply only with those Federal laws, regulations, and ex21 ecutive orders and directives that apply generally to pri22 vate nonprofit corporations. 

23 ‘‘(2) A corporation under this subchapter is not— 

24 ‘‘(A) owned or controlled by the United States; 

25 or 


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1 ‘‘(B) an agency or instrumentality of the 

2 United States.’’. 

3 (d) REINSTATEMENT OF REQUIREMENT FOR

4 501(C)(3) STATUS OF CORPORATIONS.—Subsection (e) of 

5 section 7361, as redesignated by subsection (a)(1) of this 

6 section, is further amended by inserting ‘‘section 

7 501(c)(3) of’’ after ‘‘exempt from taxation under’’. 

8 SEC. 802. CLARIFICATION OF PURPOSES OF CORPORA9 TIONS. 

10 (a) CLARIFICATION OF PURPOSES.—Subsection (a) 

11 of section 7362 is amended— 

12 (1) in the first sentence— 

13 (A) by striking ‘‘Any corporation’’ and all 

14 that follows through ‘‘facilitate’’ and inserting 

15 ‘‘A corporation established under this sub16 chapter shall be established to provide a flexible 

17 funding mechanism for the conduct of approved 

18 research and education at one or more Depart19 ment medical centers and to facilitate functions 

20 related to the conduct of’’; and 

21 (B) by inserting before the period at the 

22 end the following: ‘‘or centers’’; and 

23 (2) in the second sentence, by inserting ‘‘or cen24 ters’’ after ‘‘at the medical center’’. 


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1 (b) MODIFICATION OF DEFINED TERM RELATING TO

2 EDUCATION AND TRAINING.—Subsection (b) of such sec3 tion is amended in the matter preceding paragraph (1) 

4 by striking ‘‘the term ‘education and training’ ’’ and in5 serting ‘‘the term ‘education’ includes education and train6 ing and’’. 

7 (c) REPEAL OF ROLE OF CORPORATIONS WITH RE8 SPECT TO FELLOWSHIPS.—Paragraph (1) of subsection 

9 (b) of such section is amended by striking the flush matter 

10 following subparagraph (C). 

11 (d) AVAILABILITY OF EDUCATION FOR FAMILIES OF

12 VETERAN PATIENTS.—Paragraph (2) of subsection (b) of 

13 such section is amended by striking ‘‘to patients and to 

14 the families’’ and inserting ‘‘and includes education and 

15 training for patients and families’’. 

16 SEC. 803. MODIFICATION OF REQUIREMENTS FOR BOARDS 

17 OF DIRECTORS OF CORPORATIONS. 

18 (a) REQUIREMENTS FOR DEPARTMENT BOARD MEM19 BERS.—Paragraph (1) of section 7363(a) is amended to 

20 read as follows: 

21 ‘‘(1) with respect to the Department medical 

22 center— 

23 ‘‘(A)(i) the director (or directors of each 

24 Department medical center, in the case of a 

25 multi-medical center research corporation); 


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1 ‘‘(ii) the chief of staff; and 

2 ‘‘(iii) as appropriate for the activities of 

3 such corporation, the associate chief of staff for 

4 research and the associate chief of staff for 

5 education; or 

6 ‘‘(B) in the case of a Department medical 

7 center at which one or more of the positions re8 ferred to in subparagraph (A) do not exist, the 

9 official or officials who are responsible for car10 rying out the responsibilities of such position or 

11 positions at the Department medical center; 

12 and’’. 

13 (b) REQUIREMENTS FOR NON-DEPARTMENT BOARD

14 MEMBERS.—Paragraph (2) of such section is amended— 

15 (1) by inserting ‘‘not less than two’’ before 

16 ‘‘members’’; and 

17 (2) by striking ‘‘and who’’ and all that follows 

18 through the period at the end and inserting ‘‘and 

19 who have backgrounds, or business, legal, financial, 

20 medical, or scientific expertise, of benefit to the op21 erations of the corporation.’’. 

22 (c) CONFLICTS OF INTEREST.—Subsection (c) of sec23 tion 7363 is amended by striking ‘‘, employed by, or have 

24 any other financial relationship with’’ and inserting ‘‘or 

25 employed by’’. 


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1 SEC. 804. CLARIFICATION OF POWERS OF CORPORATIONS. 

2 (a) IN GENERAL.—Section 7364 is amended to read 

3 as follows: 

4 ‘‘§ 7364. General powers 

5 ‘‘(a) IN GENERAL.—(1) A corporation established 

6 under this subchapter may, solely to carry out the pur7 poses of this subchapter— 

8 ‘‘(A) accept, administer, retain, and spend 

9 funds derived from gifts, contributions, grants, fees, 

10 reimbursements, and bequests from individuals and 

11 public and private entities; 

12 ‘‘(B) enter into contracts and agreements with 

13 individuals and public and private entities; 

14 ‘‘(C) subject to paragraph (2), set fees for edu15 cation and training facilitated under section 7362 of 

16 this title, and receive, retain, administer, and spend 

17 funds in furtherance of such education and training; 

18 ‘‘(D) reimburse amounts to the applicable ap19 propriation account of the Department for the Office 

20 of General Counsel for any expenses of that Office 

21 in providing legal services attributable to research 

22 and education agreements under this subchapter; 

23 and 

24 ‘‘(E) employ such employees as the corporation 

25 considers necessary for such purposes and fix the 

26 compensation of such employees. 


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1 ‘‘(2) Fees charged under paragraph (1)(C) for edu2 cation and training described in that paragraph to individ3 uals who are officers or employees of the Department may 

4 not be paid for by any funds appropriated to the Depart5 ment. 

6 ‘‘(3) Amounts reimbursed to the Office of General 

7 Counsel under paragraph (1)(D) shall be available for use 

8 by the Office of the General Counsel only for staff and 

9 training, and related travel, for the provision of legal serv10 ices described in that paragraph and shall remain available 

11 for such use without fiscal year limitation. 

12 ‘‘(b) TRANSFER AND ADMINISTRATION OF FUNDS.— 

13 (1) Except as provided in paragraph (2), any funds re14 ceived by the Secretary for the conduct of research or edu15 cation at a Department medical center or centers, other 

16 than funds appropriated to the Department, may be trans17 ferred to and administered by a corporation established 

18 under this subchapter for such purposes. 

19 ‘‘(2) A Department medical center may reimburse the 

20 corporation for all or a portion of the pay, benefits, or 

21 both of an employee of the corporation who is assigned 

22 to the Department medical center if the assignment is car23 ried out pursuant to subchapter VI of chapter 33 of title 

24 5. 


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1 ‘‘(3) A Department medical center may retain and 

2 use funds provided to it by a corporation established under 

3 this subchapter. Such funds shall be credited to the appli4 cable appropriation account of the Department and shall 

5 be available, without fiscal year limitation, for the pur6 poses of that account. 

7 ‘‘(c) RESEARCH PROJECTS.—Except for reasonable 

8 and usual preliminary costs for project planning before its 

9 approval, a corporation established under this subchapter 

10 may not spend funds for a research project unless the 

11 project is approved in accordance with procedures pre12 scribed by the Under Secretary for Health for research 

13 carried out with Department funds. Such procedures shall 

14 include a scientific review process. 

15 ‘‘(d) EDUCATION ACTIVITIES.—Except for reason16 able and usual preliminary costs for activity planning be17 fore its approval, a corporation established under this sub18 chapter may not spend funds for an education activity un19 less the activity is approved in accordance with procedures 

20 prescribed by the Under Secretary for Health. 

21 ‘‘(e) POLICIES AND PROCEDURES.—The Under Sec22 retary for Health may prescribe policies and procedures 

23 to guide the spending of funds by corporations established 

24 under this subchapter that are consistent with the purpose 

25 of such corporations as flexible funding mechanisms and 


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1 with Federal and State laws and regulations, and execu2 tive orders, circulars, and directives that apply generally 

3 to the receipt and expenditure of funds by nonprofit orga4 nizations exempt from taxation under section 501(c)(3) of 

5 the Internal Revenue Code of 1986.’’. 

6 (b) CONFORMING AMENDMENT.—Section 7362(a), as 

7 amended by section 802(a)(1) of this Act, is further 

8 amended by striking the last sentence. 

9 SEC. 805. REDESIGNATION OF SECTION 7364A OF TITLE 38, 

10 UNITED STATES CODE. 

11 (a) REDESIGNATION.—Section 7364A is redesignated 

12 as section 7365. 

13 (b) CLERICAL AMENDMENTS.—The table of sections 

14 at the beginning of chapter 73 is amended— 

15 (1) by striking the item relating to section 

16 7364A; and 

17 (2) by striking the item relating to section 7365 

18 and inserting the following new item: 

‘‘7365. Coverage of employees under certain Federal tort claims laws.’’. 

19 SEC. 806. IMPROVED ACCOUNTABILITY AND OVERSIGHT OF 

20 CORPORATIONS. 

21 (a) ADDITIONAL INFORMATION IN ANNUAL RE22 PORTS.—Subsection (b) of section 7366 is amended to 

23 read as follows: 

24 ‘‘(b)(1) Each corporation shall submit to the Sec25 retary each year a report providing a detailed statement 


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1 of the operations, activities, and accomplishments of the 

2 corporation during that year. 

3 ‘‘(2)(A) A corporation with revenues in excess of 

4 $300,000 for any year shall obtain an audit of the cor5 poration for that year. 

6 ‘‘(B) A corporation with annual revenues between 

7 $10,000 and $300,000 shall obtain an audit of the cor8 poration at least once every three years. 

9 ‘‘(C) Any audit under this paragraph shall be per10 formed by an independent auditor. 

11 ‘‘(3) The corporation shall include in each report to 

12 the Secretary under paragraph (1) the following: 

13 ‘‘(A) The most recent audit of the corporation 

14 under paragraph (2). 

15 ‘‘(B) The most recent Internal Revenue Service 

16 Form 990 ‘Return of Organization Exempt from In17 come Tax’ or equivalent and the applicable schedules 

18 under such form.’’. 

19 (b) CONFIRMATION OF APPLICATION OF CONFLICT

20 OF INTEREST REGULATIONS TO APPROPRIATE CORPORA21 TION POSITIONS.—Subsection (c) of such section is 

22 amended— 

23 (1) by striking ‘‘laws and’’ each place it ap24 pears; 

25 (2) in paragraph (1)— 


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1 (A) by inserting ‘‘each officer and’’ after 

2 ‘‘under this subchapter,’’; and 

3 (B) by striking ‘‘, and each employee of 

4 the Department’’ and all that follows through 

5 ‘‘during any year’’; and 

6 (3) in paragraph (2)— 

7 (A) by inserting ‘‘, officer,’’ after 

8 ‘‘verifying that each director’’; and 

9 (B) by striking ‘‘in the same manner’’ and 

10 all that follows before the period at the end. 

11 (c) ESTABLISHMENT OF APPROPRIATE PAYEE RE12 PORTING THRESHOLD.—Subsection (d)(3)(C) of such sec13 tion is amended by striking ‘‘$35,000’’ and inserting 

14 ‘‘$50,000’’. 

15 TITLE IX—CONSTRUCTION AND 

16 NAMING MATTERS 

17 SEC. 901. AUTHORIZATION OF MEDICAL FACILITY 

18 PROJECTS. 

19 (a) AUTHORIZATION OF FISCAL YEAR 2010 MAJOR

20 MEDICAL FACILITY PROJECTS.—The Secretary of Vet21 erans Affairs may carry out the following major medical 

22 facility projects in fiscal year 2010, with each project to 

23 be carried out in the amount specified for each project: 

24 (1) Construction (including acquisition of land) 

25 for the realignment of services and closure projects 


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1 at the Department of Veterans Affairs Medical Cen2 ter in Livermore, California, in an amount not to ex3 ceed $55,430,000. 

4 (2) Construction of a Multi-Specialty Care Fa5 cility in Walla Walla, Washington, in an amount not 

6 to exceed $71,400,000. 

7 (3) Construction (including acquisition of land) 

8 for a new medical facility at the Department of Vet9 erans Affairs Medical Center in Louisville, Ken10 tucky, in an amount not to exceed $75,000,000. 

11 (4) Construction (including acquisition of land) 

12 for a clinical expansion for a Mental Health Facility 

13 at the Department of Veterans Affairs Medical Cen14 ter in Dallas, Texas, in an amount not to exceed 

15 $15,640,000. 

16 (5) Construction (including acquisition of land) 

17 for a replacement bed tower and clinical expansion 

18 at the Department of Veterans Affairs Medical Cen19 ter in St. Louis, Missouri, in an amount not to ex20 ceed $43,340,000. 

21 (b) EXTENSION OF AUTHORIZATION FOR MAJOR

22 MEDICAL FACILITY CONSTRUCTION PROJECTS PRE23 VIOUSLY AUTHORIZED.—The Secretary of Veterans Af24 fairs may carry out the following major medical facility 


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1 projects in fiscal year 2010, as follows with each project 

2 to be carried out in the amount specified for that project: 

3 (1) Replacement of the existing Department of 

4 Veterans Affairs Medical Center in Denver, Colo5 rado, in an amount not to exceed $800,000,000. 

6 (2) Construction of Outpatient and Inpatient 

7 Improvements in Bay Pines, Florida, in an amount 

8 not to exceed $194,400,000. 

9 (c) AUTHORIZATION OF APPROPRIATIONS.— 

10 (1) AUTHORIZATION OF APPROPRIATIONS FOR

11 CONSTRUCTION.—There is authorized to be appro12 priated to the Secretary of Veterans Affairs for fis13 cal year 2010, or the year in which funds are appro14 priated, for the Construction, Major Projects ac15 count— 

16 (A) $260,810,000 for the projects author17 ized in subsection (a); and 

18 (B) $994,400,000 for the projects author19 ized in subsection (b). 

20 (2) LIMITATION.—The projects authorized in 

21 subsections (a) and (b) may only be carried out 

22 using— 

23 (A) funds appropriated for fiscal year 2010 

24 pursuant to the authorization of appropriations 

25 in paragraph (1) of this section; 


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1 (B) funds available for Construction, 

2 Major Projects for a fiscal year before fiscal 

3 year 2010 that remain available for obligation; 

4 (C) funds available for Construction, Major 

5 Projects for a fiscal year after fiscal year 2010 

6 that remain available for obligation; 

7 (D) funds appropriated for Construction, 

8 Major Projects for fiscal year 2010 for a cat9 egory of activity not specific to a project; 

10 (E) funds appropriated for Construction, 

11 Major Projects for a fiscal year before 2010 for 

12 a category of activity not specific to a project; 

13 and 

14 (F) funds appropriated for Construction, 

15 Major Projects for a fiscal year after 2010 for 

16 a category of activity not specific to a project. 

17 SEC. 902. DESIGNATION OF ROBLEY REX DEPARTMENT OF 

18 VETERANS AFFAIRS MEDICAL CENTER. 

19 (a) DESIGNATION.—The Department of Veterans Af20 fairs Medical Center in Louisville, Kentucky, and any suc21 cessor to such medical center, shall after the date of the 

22 enactment of this Act be known and designated as the 

23 ‘‘Robley Rex Department of Veterans Affairs Medical 

24 Center’’. 


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1 (b) REFERENCES.—Any reference in any law, regula2 tion, map, document, record, or other paper of the United 

3 States to the medical center referred to in subsection (a) 

4 shall be considered to be a reference to the Robley Rex 

5 Department of Veterans Affairs Medical Center. 

6 SEC. 903. MERRIL LUNDMAN DEPARTMENT OF VETERANS 

7 AFFAIRS OUTPATIENT CLINIC. 

8 (a) IN GENERAL.—The Department of Veterans Af9 fairs outpatient clinic in Havre, Montana, shall after the 

10 date of the enactment of this Act be known and designated 

11 as the ‘‘Merril Lundman Department of Veterans Affairs 

12 Outpatient Clinic’’. 

13 (b) REFERENCES.—Any reference in any law, regula14 tion, map, document, record, or other paper of the United 

15 States to the outpatient clinic referred to in subsection 

16 (a) shall be considered to be a reference to the Merril 

17 Lundman Department of Veterans Affairs Outpatient 

18 Clinic. 

19 SEC. 904. MODIFICATION ON RESTRICTION OF ALIENATION 

20 OF CERTAIN REAL PROPERTY IN GULF PORT, 

21 MISSISSIPPI. 

22 (a) IN GENERAL.—Section 2703(b) of the Emer23 gency Supplemental Appropriations Act for Defense, the 

24 Global War on Terror, and Hurricane Recovery, 2006 

25 (Public Law 109–234; 120 Stat. 469), as amended by secVerDate Nov 24 2008 21:38 Oct 29, 2009 Jkt 089200 PO 00000 Frm 00173 Fmt 6652 Sfmt 6201 E:\BILLS\S1963.PCS S1963

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1 tion 231 of the Military Construction and Veterans Affairs 

2 and Related Agencies Appropriations Act, 2009 (division 

3 E of Public Law 110–329; 122 Stat. 3713), is further 

4 amended by inserting after ‘‘the City of Gulfport’’ the fol5 lowing: ‘‘, or its urban renewal agency,’’. 

6 (b) MEMORIALIZATION OF MODIFICATION.—The Sec7 retary of Veterans Affairs shall take appropriate actions 

8 to modify the quitclaim deeds executed to effectuate the 

9 conveyance authorized by section 2703 of the Emergency 

10 Supplemental Appropriations Act for Defense, the Global 

11 War on Terror, and Hurricane Recovery, 2006 (Public 

12 Law 109–234) in order to accurately reflect and memori13 alize the amendment made by subsection (a). 

14 TITLE X—OTHER MATTERS 

15 SEC. 1001. EXPANSION OF AUTHORITY FOR DEPARTMENT 

16 OF VETERANS AFFAIRS POLICE OFFICERS. 

17 Section 902 is amended— 

18 (1) in subsection (a)— 

19 (A) by amending paragraph (1) to read as 

20 follows: 

21 ‘‘(1) Employees of the Department who are De22 partment police officers shall, with respect to acts 

23 occurring on Department property— 

24 ‘‘(A) enforce Federal laws; 


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1 ‘‘(B) enforce the rules prescribed under 

2 section 901 of this title; 

3 ‘‘(C) enforce traffic and motor vehicle laws 

4 of a State or local government (by issuance of 

5 a citation for violation of such laws) within the 

6 jurisdiction of which such Department property 

7 is located as authorized by an express grant of 

8 authority under applicable State or local law; 

9 ‘‘(D) carry the appropriate Department10 issued weapons, including firearms, while off 

11 Department property in an official capacity or 

12 while in an official travel status; 

13 ‘‘(E) conduct investigations, on and off 

14 Department property, of offenses that may have 

15 been committed on property under the original 

16 jurisdiction of Department, consistent with 

17 agreements or other consultation with affected 

18 local, State, or Federal law enforcement agen19 cies; and 

20 ‘‘(F) carry out, as needed and appropriate, 

21 the duties described in subparagraphs (A) 

22 through (E) of this paragraph when engaged in 

23 duties authorized by other Federal statutes.’’; 

24 (B) by striking paragraph (2) and redesig25 nating paragraph (3) as paragraph (2); and 


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1 (C) in paragraph (2), as redesignated by 

2 subparagraph (B) of this paragraph, by insert3 ing ‘‘, and on any arrest warrant issued by 

4 competent judicial authority’’ before the period; 

5 and 

6 (2) by amending subsection (c) to read as fol7 lows: 

8 ‘‘(c) The powers granted to Department police offi9 cers designated under this section shall be exercised in ac10 cordance with guidelines approved by the Secretary and 

11 the Attorney General.’’. 

12 SEC. 1002. UNIFORM ALLOWANCE FOR DEPARTMENT OF 

13 VETERANS AFFAIRS POLICE OFFICERS. 

14 Section 903 is amended— 

15 (1) by amending subsection (b) to read as fol16 lows: 

17 ‘‘(b)(1) The amount of the allowance that the Sec18 retary may pay under this section is the lesser of— 

19 ‘‘(A) the amount currently allowed as pre20 scribed by the Office of Personnel Management; or 

21 ‘‘(B) estimated costs or actual costs as deter22 mined by periodic surveys conducted by the Depart23 ment. 

24 ‘‘(2) During any fiscal year no officer shall receive 

25 more for the purchase of a uniform described in subsection 


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1 (a) than the amount established under this subsection.’’; 

2 and 

3 (2) by striking subsection (c) and inserting the 

4 following new subsection (c): 

5 ‘‘(c) The allowance established under subsection (b) 

6 shall be paid at the beginning of a Department police offi7 cer’s employment for those appointed on or after October 

8 1, 2008. In the case of any other Department police offi9 cer, an allowance in the amount established under sub10 section (b) shall be paid upon the request of the officer.’’. 


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Calendar No. 190 

111TH CONGRESS 

1ST SESSION S. 1963 

A BILL 

To amend title 38, United States Code, to provide 

other purposes. the provision of health care to veterans, and for assistance to caregivers of veterans, to improve 

OCTOBER 29, 2009 

Read the second time and placed on the calendar 


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