II 

115TH CONGRESS 

2D SESSION S. 2356 

To require the Secretary of Veterans Affairs to address staffing and other 

issues at facilities, including underserved facilities, of the Department 

of Veterans Affairs, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 30, 2018 

Mr. TESTER (for himself, Mrs. MURRAY, Mr. SANDERS, and Mr. MANCHIN) 

introduced the following bill; which was read twice and referred to the 

Committee on Veterans’ Affairs 

A BILL 

To require the Secretary of Veterans Affairs to address staffing and other issues at facilities, including underserved 

facilities, of the Department of Veterans Affairs, and 

for other purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Stronger Medical 

5 Workforce for Veterans Act’’. 


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1 SEC. 2. DEVELOPMENT OF CRITERIA FOR DESIGNATION OF 

2 CERTAIN MEDICAL FACILITIES OF THE DE3 PARTMENT OF VETERANS AFFAIRS AS UN4 DERSERVED FACILITIES AND PLAN TO AD5 DRESS PROBLEM OF UNDERSERVED FACILI6 TIES. 

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

8 date of the enactment of this Act, the Secretary of Vet9 erans Affairs shall develop criteria to designate medical 

10 centers, ambulatory care facilities, and community based 

11 outpatient clinics of the Department of Veterans Affairs 

12 as underserved facilities. 

13 (b) CONSIDERATION.—Criteria developed under sub14 section (a) shall include consideration of the following with 

15 respect to a facility: 

16 (1) The ratio of veterans to health care pro17 viders of the Department of Veterans Affairs for a 

18 standardized geographic area surrounding the facil19 ity, including a separate ratio for general practi20 tioners and specialists. 

21 (2) The range of clinical specialties covered by 

22 such providers in such area. 

23 (3) Whether the local community is medically 

24 underserved. 

25 (4) The type, number, and age of open consults. 


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1 (5) Whether the facility is meeting the wait2 time goals of the Department. 

3 (6) Such other criteria as the Secretary con4 siders important in determining which facilities are 

5 not adequately serving area veterans. 

6 (c) ANALYSIS OF FACILITIES.—Not less frequently 

7 than annually, directors of Veterans Integrated Service 

8 Networks of the Department shall perform an analysis to 

9 determine which facilities within that Veterans Integrated 

10 Service Network qualify as underserved facilities pursuant 

11 to criteria developed under subsection (a). 

12 (d) ANNUAL PLAN TO ADDRESS UNDERSERVED FA13 CILITIES.— 

14 (1) PLAN REQUIRED.—Not later than one year 

15 after the date of the enactment of this Act, and not 

16 less frequently than once each year thereafter, the 

17 Secretary shall submit to Congress a plan to address 

18 the problem of underserved facilities of the Depart19 ment, as designated pursuant to criteria developed 

20 under subsection (a). 

21 (2) CONTENTS.—Each plan submitted under 

22 paragraph (1) shall address the following: 

23 (A) Increasing personnel or temporary per24 sonnel assistance, including mobile deployment 

25 teams. 


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1 (B) Providing special hiring incentives, in2 cluding under the Education Debt Reduction 

3 Program under subchapter VII of chapter 76 of 

4 title 38, United States Code, and recruitment, 

5 relocation, and retention incentives. 

6 (C) Using direct hiring authority. 

7 (D) Improving training opportunities for 

8 staff. 

9 (E) Such other actions as the Secretary 

10 considers appropriate. 

11 SEC. 3. PILOT PROGRAM ON TUITION REIMBURSEMENT 

12 AND LOAN REPAYMENT FOR HEALTH CARE 

13 PROVIDERS OF THE DEPARTMENT OF VET14 ERANS AFFAIRS AT UNDERSERVED FACILI15 TIES. 

16 (a) IN GENERAL.—Not later than 90 days after the 

17 date of the enactment of this Act, the Secretary of Vet18 erans Affairs shall commence a pilot program to assess 

19 the feasibility and advisability of providing incentives to 

20 individuals to work at underserved facilities of the Vet21 erans Health Administration by providing tuition reim22 bursement and loan repayment to medical students and 

23 health care providers who commit to serving in under24 served facilities selected under subsection (c). 


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1 (b) DURATION.—The Secretary shall carry out the 

2 pilot program during the six-year period beginning on the 

3 date of the commencement of the pilot program. 

4 (c) SELECTION OF LOCATIONS.— 

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

6 not fewer than three medical centers and seven am7 bulatory care facilities or community based out8 patient clinics of the Department to participate in 

9 the pilot program. 

10 (2) RURAL AND HIGHLY RURAL AREAS.—Not 

11 fewer than two of the medical centers and five of the 

12 ambulatory care facilities or community based out13 patient clinics selected under paragraph (1) shall be 

14 in States or United States territories that are among 

15 the ten States or United States territories with— 

16 (A) the highest percentage of land des17 ignated as highly rural pursuant to the rural18 urban commuting area codes set forth by the 

19 Department of Agriculture; or 

20 (B) the highest percentage of enrolled vet21 erans living in rural, highly rural, or insular is22 land areas. 

23 (3) STATES.—Facilities selected under para24 graph (1) shall be located in not fewer than eight 

25 different States. 


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1 (d) USE OF AMOUNTS.—Of the amounts used to pro2 vide tuition reimbursement or loan repayment under the 

3 pilot program— 

4 (1) one-half shall be used to provide tuition re5 imbursement or loan repayment for individuals prac6 ticing in a general practice position; and 

7 (2) one-half shall be used to provide tuition re8 imbursement or loan repayment for individuals prac9 ticing— 

10 (A) in a specialist position; or 

11 (B) in an occupation, other than a position 

12 described in paragraph (1), included in the 

13 most recent staffing shortage determination of 

14 the Department under section 7412 of title 38, 

15 United States Code. 

16 (e) TUITION REIMBURSEMENT.—Under the pilot pro17 gram, the Secretary may provide to an individual attend18 ing medical school and seeking a degree as a Doctor of 

19 Medicine or a Doctor of Osteopathic Medicine full tuition 

20 reimbursement in exchange for a five-year commitment to 

21 serve at an underserved facility selected under subsection 

22 (c). 

23 (f) STUDENT LOAN REPAYMENT.—Under the pilot 

24 program, in exchange for a three-year commitment to 


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1 serve at an underserved facility selected under subsection 

2 (c), the Secretary may provide— 

3 (1) to an individual currently serving as a 

4 health care provider at an underserved facility, an 

5 amount not to exceed $30,000 to apply to any re6 maining student loan debt of the individual; and 

7 (2) to an individual other than an individual de8 scribed in paragraph (1), an amount not to exceed 

9 $50,000 to apply to any remaining student loan debt 

10 of the individual. 

11 (g) BREACH.—An individual who participates in the 

12 pilot program and fails to satisfy a period of obligated 

13 service under subsection (e) or (f) shall be liable to the 

14 United States, in lieu of such obligated service, for the 

15 amount that has been paid or is payable to or on behalf 

16 of the individual under the pilot program, reduced by the 

17 proportion that the number of days served for completion 

18 of the period of obligated service bears to the total number 

19 of days in the period of obligated service of such indi20 vidual. 

21 (h) EXPEDITED HIRING.—The Secretary shall ensure 

22 that the hiring of individuals to serve in the Department 

23 under the pilot program is conducted in an expedited man24 ner. 


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1 (i) CONTINUATION IN PILOT PROGRAM.—An indi2 vidual participating in the pilot program in an occupation 

3 included in a staffing shortage determination of the De4 partment under section 7412 of title 38, United States 

5 Code, may continue participating in the pilot program not6 withstanding that the occupation is no longer included in 

7 such determination under such section. 

8 (j) ANNUAL REPORT.— 

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

10 after the date of the enactment of this Act, and not 

11 less frequently than once each year thereafter, the 

12 Secretary shall submit to Congress a report on the 

13 pilot program. 

14 (2) CONTENTS.—Each report submitted under 

15 paragraph (1) shall include the following: 

16 (A) The number of participants, including 

17 the number receiving tuition reimbursement 

18 and student loan repayment. 

19 (B) The number of facilities where partici20 pants are located. 

21 (C) The number of individuals who have 

22 applied to participate in the pilot program. 

23 (D) A list of the five most common occupa24 tions of the participants in the pilot program, 

25 other than general practice. 


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1 (k) DEFINITIONS.—In this section: 

2 (1) ENROLLED VETERAN.—The term ‘‘enrolled 

3 veteran’’ means a veteran who is enrolled in the sys4 tem of annual patient enrollment established and op5 erated under section 1705(a) of title 38, United 

6 States Code. 

7 (2) UNDERSERVED FACILITY.—The term ‘‘un8 derserved facility’’ means a medical center, ambula9 tory care facility, or community based outpatient 

10 clinic of the Department of Veterans Affairs des11 ignated by the Secretary of Veterans Affairs pursu12 ant to criteria developed under section 2. 

13 SEC. 4. REPORT ON WORKFORCE VACANCIES WITHIN THE 

14 VETERANS HEALTH ADMINISTRATION. 

15 (a) IN GENERAL.—Not later than 120 days after the 

16 date of the enactment of this Act, the Secretary of Vet17 erans Affairs shall submit to the Committee on Veterans’ 

18 Affairs of the Senate and the Committee on Veterans’ Af19 fairs of the House of Representatives a report on vacancies 

20 within the Veterans Health Administration. 

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

22 (a) shall include the following: 

23 (1) With respect to vacancies of personnel ap24 pointed under section 7401 of title 38, United States 

25 Code— 


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1 (A) the total number of such vacancies; 

2 (B) the number of such vacancies 

3 disaggregated by occupation, State, Veterans 

4 Integrated Service Network, medical facility, 

5 and the central office of the Department of Vet6 erans Affairs; and 

7 (C) a description of the plans of the Sec8 retary to fill such vacancies, including a 

9 timeline for filling such vacancies, and an as10 sessment of whether the Secretary requires ad11 ditional hiring authorities to expedite the hiring 

12 process. 

13 (2) With respect to vacancies of human re14 source specialists of the Veterans Health Adminis15 tration— 

16 (A) the total number of such vacancies; 

17 (B) the number of such vacancies 

18 disaggregated by State and medical facility; and 

19 (C) a description of the plans of the Sec20 retary to fill such vacancies, including a 

21 timeline for filling such vacancies, and an as22 sessment of whether the Secretary requires ad23 ditional hiring authorities to expedite the hiring 

24 process. 


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1 (3) A description of any impediments to filling 

2 the vacancies described in paragraphs (1) and (2) 

3 and any actions the Secretary intends to take to ad4 dress such impediments. 

5 (4) An update on the implementation by the 

6 Secretary of— 

7 (A) the Veterans Health Administration 

8 Workforce and Succession Strategic Plan for 

9 2016; 

10 (B) the recommendation by the Office of 

11 the Inspector General of the Department that 

12 the Under Secretary for Health develop staffing 

13 models for critical need occupations of the Vet14 erans Health Administration, as determined by 

15 the Secretary; and 

16 (C) the recommendation by the Office of 

17 the Inspector General that the Under Secretary 

18 for Health establish milestones and timetables 

19 for further development, piloting, and imple20 mentation of staffing models for critical need 

21 occupations of the Veterans Health Administra22 tion, as determined by the Secretary. 


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1 SEC. 5. ASSIGNMENT TO DEPARTMENT OF VETERANS AF2 FAIRS OF COMMISSIONED OFFICERS OF THE 

3 REGULAR CORPS OF THE PUBLIC HEALTH 

4 SERVICE. 

5 (a) ASSIGNMENT.— 

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

7 after the date of the enactment of this Act, the Sec8 retary of Veterans Affairs and the Surgeon General 

9 shall enter into a memorandum of understanding for 

10 the assignment of not fewer than 500 commissioned 

11 officers of the Regular Corps of the Public Health 

12 Service to the Department of Veterans Affairs. 

13 (2) MANNER OF ASSIGNMENT.—Assignments 

14 under paragraph (1) shall be made in the same 

15 manner in which assignments are made to other 

16 Federal agencies. 

17 (b) REIMBURSEMENT.—The Secretary shall reim18 burse the Surgeon General for such expenses as the Sur19 geon General may incur in assigning commissioned offi20 cers pursuant to a memorandum of understanding entered 

21 into under subsection (a). 

22 (c) REPORT.— 

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

24 after the date of the enactment of this Act, the Sec25 retary and the Surgeon General shall each submit to 

26 the Committee on Veterans’ Affairs of the Senate 


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1 and the Committee on Veterans’ Affairs of the 

2 House of Representatives a report on the memo3 randum of understanding entered into under sub4 section (a) and the commissioned officers assigned 

5 pursuant to such memorandum of understanding. 

6 (2) CONTENTS.—The report required by para7 graph (1) shall include the following: 

8 (A) The numbers, grades, and specialties 

9 of commissioned officers assigned pursuant to 

10 the memorandum of understanding entered into 

11 under subsection (a). 

12 (B) A description of any problems encoun13 tered in such assignment. 

14 SEC. 6. INCLUSION OF VET CENTER EMPLOYEES IN EDU15 CATION DEBT REDUCTION PROGRAM OF DE16 PARTMENT OF VETERANS AFFAIRS. 

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

18 shall ensure that clinical staff working at Vet Centers are 

19 eligible to participate in the education debt reduction pro20 gram of the Department of Veterans Affairs under sub21 chapter VII of chapter 76 of title 38, United States Code. 

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

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

24 to the Committee on Veterans’ Affairs of the Senate and 

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1 resentatives a report on the number of participants in the 

2 education debt reduction program of the Department 

3 under such subchapter who work at Vet Centers. 

4 (c) VET CENTER DEFINED.—In this section, the 

5 term ‘‘Vet Center’’ has the meaning given that term in 

6 section 1712A(h) of title 38, United States Code. 

Æ 


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