II 

117TH CONGRESS 

1ST SESSION S. 3163 

To improve access to medical examinations required by veterans to obtain 

disability compensation or pension under laws administered by the Secretary of Veterans Affairs, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

NOVEMBER 4, 2021 

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

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

A BILL 

To improve access to medical examinations required by veterans to obtain disability compensation or pension under 

laws administered by the Secretary 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 ‘‘Reform and Update 

5 Rural Access to Local Exams Act of 2021’’ or the 

6 ‘‘RURAL Exams Act of 2021’’. 

7 SEC. 2. DEFINITIONS. 

8 In this Act: 


kjohnson on DSK79L0C42PROD with BILLS
2 

•S 3163 IS

1 (1) COVERED MEDICAL DISABILITY EXAMINA2 TION.—The term ‘‘covered medical disability exam3 ination’’ means a medical examination that the Sec4 retary of Veterans Affairs determines necessary for 

5 the purposes of adjudicating a benefit under chapter 

6 11 or 15 of title 38, United States Code, regardless 

7 of whether conducted by an employee or a contractor 

8 of the Department of Veterans Affairs. 

9 (2) HOUSEBOUND.—The term ‘‘housebound’’, 

10 with respect to a veteran, means— 

11 (A) the veteran meets the requirement of 

12 ‘‘permanently housebound’’ as described in sec13 tion 1114(s) of title 38, United States Code; 

14 (B) the veteran meets the requirement of 

15 ‘‘permanently housebound’’ as described in sec16 tion 1502(c) of such title; or 

17 (C) the Secretary has determined that the 

18 veteran faces significant difficulty in traveling 

19 to obtain a covered medical disability examina20 tion. 

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

22 means any non-urban area, within the meaning of 

23 the Rural-Urban Commuting Area Codes system of 

24 the Department of Agriculture and the Department 

25 of Health and Human Services, or successor system. 


kjohnson on DSK79L0C42PROD with BILLS
3 

•S 3163 IS

1 (4) RURAL VETERAN.—The term ‘‘rural vet2 eran’’ means a veteran who resides in a rural area. 

3 SEC. 3. IMPROVING DATA COLLECTION BY DEPARTMENT 

4 OF VETERANS AFFAIRS ON COVERED MED5 ICAL DISABILITY EXAMINATIONS. 

6 (a) DATA COLLECTION REQUIRED.—Not later than 

7 180 days after the date of the enactment of this Act, the 

8 Secretary of Veterans Affairs shall begin collecting data 

9 to improve access of veterans to covered medical disability 

10 examinations. 

11 (b) ELEMENTS.—Data collected under subsection (a) 

12 shall include data regarding the following: 

13 (1) Timeliness, quality, and veteran satisfaction 

14 measurements of covered medical disability examina15 tions. 

16 (2) Proportion of completed covered medical 

17 disability examinations determined to be inadequate 

18 for the adjudication of a claim for compensation or 

19 pension under chapter 11 or 15 of title 38, United 

20 States Code. 

21 (3) Every performance standard required for 

22 eligibility for financial incentives or disincentives in 

23 a contract between the Department of Veterans Af24 fairs and any contractor for the provision of a cov25 ered medical disability examination. 


kjohnson on DSK79L0C42PROD with BILLS
4 

•S 3163 IS

1 (c) DISAGGREGATION OF DATA.—The Secretary shall 

2 disaggregate data collected under subsection (a) by— 

3 (1) State; 

4 (2) county; and 

5 (3) as the case may be— 

6 (A) individual contractor with a Depart7 ment of Veterans Affairs contract for the provi8 sion of a covered medical disability examination; 

9 or 

10 (B) individual Veterans Health Adminis11 tration facility conducting a covered medical 

12 disability examination. 

13 (d) PUBLICATION.—Not later than one year after the 

14 date of the enactment of this Act, the Secretary shall 

15 make publicly available on an internet website, and up16 dated not less frequently than quarterly, all data collected 

17 under subsection (a). 

18 SEC. 4. STUDY ON IMPROVEMENTS TO DEPARTMENT OF 

19 VETERANS AFFAIRS COVERED MEDICAL DIS20 ABILITY EXAMINATIONS IN RURAL AREAS. 

21 (a) STUDY REQUIRED.—Not later than one year 

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

23 of Veterans Affairs shall complete a study on access by 

24 rural veterans to covered medical disability examinations. 

25 (b) ELEMENTS.— 


kjohnson on DSK79L0C42PROD with BILLS
5 

•S 3163 IS

1 (1) IN GENERAL.—The study conducted under 

2 subsection (a) shall include the following: 

3 (A) A comparison of the average number 

4 of days to complete covered medical disability 

5 examinations for rural veterans compared to 

6 the national non-rural average time to complete 

7 covered medical disability examinations, by ei8 ther contractors or employees of the Depart9 ment. 

10 (B) A root cause analysis of differences 

11 identified pursuant to subparagraph (A). 

12 (C) The plan of the Secretary for the fol13 lowing year to improve access described in sub14 section (a), which shall include a plan for the 

15 pursuit of a commercial or industry-standard 

16 solution or technology that could enable rural 

17 or housebound veterans to receive examinations 

18 without traveling long distances. 

19 (2) NATIONAL NON-RURAL AVERAGE DE20 FINED.—For purposes of paragraph (1)(A), the 

21 term ‘‘national non-rural average’’ means the na22 tional average of all periods in the previous calendar 

23 year— 

24 (A) beginning on the date on which a con25 tractor received a request from the Secretary to 


kjohnson on DSK79L0C42PROD with BILLS
6 

•S 3163 IS

1 conduct a covered medical disability examina2 tion for a veteran who is not a rural veteran; 

3 and 

4 (B) ending on the date on which the exam5 ination was completed. 

6 (c) REPORT ON STUDY.—Not later than one year 

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

8 shall submit to the Committee on Veterans’ Affairs of the 

9 Senate and the Committee on Veterans’ Affairs of the 

10 House of Representatives a report on the findings of the 

11 Secretary with respect to the study completed under sub12 section (a). 

13 (d) ANNUAL REPORT ON PLANS.—Not later than two 

14 years after the date of the enactment of this Act and not 

15 less frequently than once each year thereafter, the Sec16 retary shall submit to the Committee on Veterans’ Affairs 

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

18 the House of Representatives a report evaluating the con19 duct of the plans of the Secretary to improve access de20 scribed in subsection (a) and a new or revised plan for 

21 such improvement in the following year. 


kjohnson on DSK79L0C42PROD with BILLS
7 

•S 3163 IS

1 SEC. 5. DEPARTMENT OF VETERANS AFFAIRS TIMELINESS 

2 REQUIREMENTS FOR PROVISION OF COV3 ERED MEDICAL DISABILITY EXAMINATIONS 

4 BY CONTRACTORS TO RURAL AND HOUSE5 BOUND VETERANS. 

6 In each contract entered into by the Secretary of Vet7 erans Affairs after the date of the enactment of this Act 

8 for the provision by a contractor of a covered medical dis9 ability examination, the Secretary shall include the fol10 lowing: 

11 (1) Such financial incentives as the Secretary 

12 considers appropriate to encourage a contractor to 

13 provide a covered medical disability examination to 

14 a rural veteran or a housebound veteran in a timely 

15 manner. 

16 (2) Such financial disincentives as the Secretary 

17 considers appropriate to discourage a contractor 

18 from failing to provide a covered medical disability 

19 examination to a rural veteran or a housebound vet20 eran in a timely manner. 

21 (3) A requirement that the contractor cooperate 

22 with inspections conducted under the program re23 quired by section 6(a). 


kjohnson on DSK79L0C42PROD with BILLS
8 

•S 3163 IS

1 SEC. 6. ANNUAL INSPECTIONS BY DEPARTMENT OF VET2 ERANS AFFAIRS OF FACILITIES USED BY 

3 CONTRACTORS FOR PROVISION OF COVERED 

4 MEDICAL DISABILITY EXAMINATIONS. 

5 (a) PROGRAM REQUIRED.—Not later than one year 

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

7 of Veterans Affairs shall establish a program of periodic 

8 inspections of sites, locations, and facilities where covered 

9 medical disability examinations are provided by contrac10 tors of the Department of Veterans Affairs. 

11 (b) NUMBER AND PERIODICITY.— 

12 (1) IN GENERAL.—Under the program required 

13 by subsection (a), the Secretary shall, each year, in14 spect not fewer than three percent of all sites, loca15 tions, and facilities used by a contractor of the De16 partment to provide a covered medical disability ex17 amination during the previous one-year period. 

18 (2) INITIAL INSPECTIONS.—Paragraph (1) shall 

19 apply with respect to the first one-year period begin20 ning after the date of the establishment of the pro21 gram pursuant to subsection (a) and each year 

22 thereafter. 

23 (c) SELECTION OF SITES, LOCATIONS, AND FACILI24 TIES FOR INSPECTION.—Under the program required by 

25 subsection (a), the Secretary shall— 


kjohnson on DSK79L0C42PROD with BILLS
9 

•S 3163 IS

1 (1) use both random and targeted methods of 

2 selecting sites, locations, and facilities for inspection; 

3 and 

4 (2) ensure that the number of inspections of 

5 sites, locations, and facilities in rural areas bears the 

6 same ratio to the total number of inspections as the 

7 number of covered medical disability examinations 

8 provided by contractors of the Department to rural 

9 veterans bears to the total number of covered med10 ical disability examinations provided by contractors 

11 of the Department to all veterans. 

12 (d) NOTICE AND TIMING.—Each inspection under 

13 the program required by subsection (a) shall be conducted 

14 during such business hours as the Secretary considers rea15 sonable and the Secretary shall provide no more notice 

16 than the Secretary considers necessary to ensure the in17 spected facility is available for such inspection. 

18 (e) ELEMENTS.—Each inspection conducted under 

19 the program required by subsection (a) shall include in20 spection of a site, location, or facility for the following: 

21 (1) Compliance with the terms of any applicable 

22 contract. 

23 (2) Compliance with the Americans with Dis24 abilities Act of 1990 (42 U.S.C. 12101 et seq.). 

25 (3) Cleanliness. 


kjohnson on DSK79L0C42PROD with BILLS
10 

•S 3163 IS

1 (4) General fitness for a covered medical dis2 ability examination. 

3 (5) Such other elements as the Secretary con4 siders necessary to ensure that covered medical dis5 ability examinations provided on behalf of the De6 partment are safe, clean, accessible, and dignified. 

7 (f) ANNUAL REPORTS.—Not later than one year after 

8 the date of the establishment of the program required by 

9 subsection (a), the Secretary shall submit to the Com10 mittee on Veterans’ Affairs of the Senate and the Com11 mittee on Veterans’ Affairs of the House of Representa12 tives a report on the findings of the Secretary with respect 

13 to the inspections conducted under the program during the 

14 one-year period ending on the date of the submittal of the 

15 report. 

Æ 


kjohnson on DSK79L0C42PROD with BILLS