I 

116TH CONGRESS 

1ST SESSION H. R. 2916 

To require the Secretary of Veterans Affairs to carry out a pilot program 

to provide hospital care and medical services to veterans in the Freely 

Associated States of the Republic of Palau, the Republic of the Marshall 

Islands, and the Federated States of Micronesia, and to conduct a 

study on the feasibility and advisability of establishing regional offices, 

suboffices, contact units, or other subordinate offices of the Department 

of Veterans Affairs in the Freely Associated States to provide such 

care and services, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 22, 2019 

Ms. GABBARD (for herself, Mrs. RADEWAGEN, Mr. CASE, Mr. SAN NICOLAS, 

and Mr. YOUNG) introduced the following bill; which was referred to the 

Committee on Veterans’ Affairs 

A BILL 

To require the Secretary of Veterans Affairs to carry out 

a pilot program to provide hospital care and medical 

services to veterans in the Freely Associated States of 

the Republic of Palau, the Republic of the Marshall 

Islands, and the Federated States of Micronesia, and 

to conduct a study on the feasibility and advisability 

of establishing regional offices, suboffices, contact units, 

or other subordinate offices of the Department of Veterans Affairs in the Freely Associated States to provide 

such care and services, and for other purposes. 


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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 ‘‘Compact of Free Asso5 ciation Veterans Review Act of 2019’’ or the ‘‘COFA Vet6 erans Review Act of 2019’’. 

7 SEC. 2. DEFINITIONS. 

8 In this Act: 

9 (1) APPROPRIATE COMMITTEES OF CON10 GRESS.—The term ‘‘appropriate committees of Con11 gress’’ means— 

12 (A) the Committee on Veterans’ Affairs 

13 and the Committee on Appropriations of the 

14 Senate; and 

15 (B) the Committee on Veterans’ Affairs 

16 and the Committee on Appropriations of the 

17 House of Representatives. 

18 (2) DEPARTMENT.—The term ‘‘Department’’ 

19 means the Department of Veterans Affairs. 

20 (3) FREELY ASSOCIATED STATES.—The term 

21 ‘‘Freely Associated States’’ means the Republic of 

22 Palau, the Republic of the Marshall Islands, and the 

23 Federated States of Micronesia, which have each en24 tered into a Compact of Free Association with the 

25 United States. 


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1 (4) HOSPITAL CARE; MEDICAL SERVICES.—The 

2 terms ‘‘hospital care’’ and ‘‘medical services’’ have 

3 the meanings given those terms in section 1701 of 

4 title 38, United States Code. 

5 (5) PATIENT ALIGNED CARE TEAM.—The term 

6 ‘‘patient aligned care team’’ means a team of health 

7 care professionals of the Department that provides 

8 comprehensive primary care in partnership with the 

9 patient and manages and coordinates comprehensive 

10 health care services consistent with agreed-upon 

11 goals of care. 

12 (6) PROJECT ECHO EDUCATION AND TRAIN13 ING.—The term ‘‘Project ECHO education and 

14 training’’ means education and training provided 

15 under the Project Extension for Community Health 

16 Outcomes. 

17 (7) SECRETARY.—The term ‘‘Secretary’’ means 

18 the Secretary of Veterans Affairs. 

19 (8) SERVICE-CONNECTED; NON-SERVICE-CON20 NECTED.—The terms ‘‘service-connected’’ and ‘‘non21 service-connected’’ have the meanings given those 

22 terms in section 101 of title 38, United States Code. 

23 (9) VETERANS SERVICE ORGANIZATION.—The 

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1 resentation of veterans under section 5902 of title 

2 38, United States Code. 

3 SEC. 3. PILOT PROGRAM ON PROVIDING HOSPITAL CARE 

4 AND MEDICAL SERVICES TO VETERANS RE5 SIDING IN THE FREELY ASSOCIATED STATES. 

6 (a) PILOT PROGRAM REQUIRED.—Commencing not 

7 later than January 1, 2020, the Secretary shall carry out 

8 a pilot program to provide hospital care, medical services, 

9 and other related services to veterans residing in the Free10 ly Associated States. 

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

12 pilot program required by subsection (a) during the three13 year period beginning on the date of the commencement 

14 of the pilot program. 

15 (c) SERVICES PROVIDED.—In carrying out the pilot 

16 program required by subsection (a), the Secretary shall 

17 ensure that the pilot program— 

18 (1) emphasizes the use of telehealth; 

19 (2) provides Project ECHO education and 

20 training to employees of the Department responsible 

21 for carrying out the pilot program; 

22 (3) includes the use of primary and specialty 

23 care provided by patient aligned care teams and spe24 cialty care providers; and 


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1 (4) includes the provision of compensation and 

2 pension medical examinations. 

3 (d) OUTREACH PROGRAM.—As part of the pilot pro4 gram required by subsection (a), the Secretary shall con5 duct a program of outreach to inform veterans in the 

6 Freely Associated States about the pilot program and the 

7 services available under the pilot program. 

8 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

9 are authorized to be appropriated to the Secretary such 

10 funds as may be necessary to carry out the pilot program. 

11 SEC. 4. STUDY ON PROVIDING HOSPITAL CARE AND MED12 ICAL SERVICES TO VETERANS RESIDING IN 

13 THE FREELY ASSOCIATED STATES. 

14 (a) STUDY REQUIRED.— 

15 (1) IN GENERAL.—The Secretary shall conduct 

16 a study on the feasibility and advisability of estab17 lishing one or more regional offices, suboffices, con18 tact units, or other subordinate offices of the De19 partment in the remote Pacific islands, including the 

20 Freely Associated States, to provide hospital care 

21 and medical services to veterans residing in the re22 mote Pacific islands, including the Freely Associated 

23 States. 


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1 (2) CONSIDERATIONS AND ANALYSIS.—In con2 ducting the study required by paragraph (1), the 

3 Secretary shall consider and analyze the following: 

4 (A) The results of the pilot program re5 quired by section 3(a). 

6 (B) The ability of the Department to pro7 vide hospital care and medical services to vet8 erans residing or traveling outside the United 

9 States, including veterans residing in the Freely 

10 Associated States. 

11 (C) The feasibility, efficacy, and advis12 ability of building clinics or leasing space on 

13 embassy compounds or in consulate facilities of 

14 the United States in the Freely Associated 

15 States or insular areas for the purposes of pro16 viding hospital care and medical services to vet17 erans residing or traveling outside the United 

18 States, including veterans residing in the Freely 

19 Associated States. 

20 (D) The feasibility and advisability of pro21 viding services, such as telehealth, Project 

22 ECHO education and training, primary and 

23 specialty care provided by patient aligned care 

24 teams and specialty care providers, and com25 pensation and pension medical examinations, to 


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1 veterans residing in the Freely Associated 

2 States. 

3 (E) Updates to census data of the Depart4 ment on the number of veterans residing in the 

5 Freely Associated States to determine whether 

6 such data supports the establishment of a per7 manent patient aligned care team of the De8 partment based in the Freely Associated States. 

9 (F) With respect to the United States and 

10 the Freely Associated States, the data stand11 ards for— 

12 (i) patient medical record information; 

13 and 

14 (ii) the electronic interchange of such 

15 information. 

16 (G) The feasibility and advisability of pro17 viding hospital care and medical services to vet18 erans residing in the Freely Associated States 

19 for non-service-connected disabilities. 

20 (H) The feasibility and advisability of pro21 viding continuity of care to veterans for service22 connected disabilities that cannot be treated by 

23 the Department within a regional office, sub24 office, contact unit, or other subordinate office 


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1 of the Department in the remote Pacific is2 lands, including the Freely Associated States. 

3 (I) Such other matters as the Secretary 

4 considers appropriate. 

5 (3) COOPERATION AND CONSULTATION.—The 

6 Secretary shall conduct the study required by para7 graph (1)— 

8 (A) in cooperation with— 

9 (i) the Secretary of Defense; 

10 (ii) the Secretary of Health and 

11 Human Services; 

12 (iii) the Secretary of the Interior; 

13 (iv) the Secretary of State; and 

14 (v) such other heads of Federal agen15 cies as may be interested in the study; and 

16 (B) in consultation with— 

17 (i) such representatives of State and 

18 local governments as the Secretary deter19 mines may be interested in the study; 

20 (ii) each government of the Freely As21 sociated States; 

22 (iii) veterans service organizations; 

23 (iv) such nongovernmental organiza24 tions as the Secretary considers appro25 priate; and 


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1 (v) the public. 

2 (b) REPORT REQUIRED.— 

3 (1) IN GENERAL.—Not later than 270 days 

4 after the date on which the pilot program required 

5 by section 3(a) terminates, the Secretary shall sub6 mit to the appropriate committees of Congress a re7 port on the findings of the Secretary with respect to 

8 the study required by subsection (a)(1). 

9 (2) CONTENTS.—The report submitted under 

10 paragraph (1) shall include the following: 

11 (A) A description of the processes required 

12 for the Secretary to establish one or more re13 gional offices, suboffices, contact units, or other 

14 subordinate offices in the Freely Associated 

15 States. 

16 (B) The number of veterans expected to 

17 receive hospital care and medical services pro18 vided under laws administered by the Secretary 

19 in the Freely Associated States. 

20 (C) A resource management plan for the 

21 Department to provide hospital care and med22 ical services in the Freely Associated States, in23 cluding an assessment of the effect that such 

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1 erans Affairs Pacific Islands Health Care Sys2 tem. 

3 (D) An explanation of the guidelines that 

4 the Department will use to provide hospital care 

5 and medical services under laws administered 

6 by the Secretary in the Freely Associated 

7 States, including an explanation of benefits for 

8 service-connected and non-service-connected dis9 abilities. 

10 (E) An explanation of how the Department 

11 expects to provide continuity of care to veterans 

12 for service-connected disabilities that cannot be 

13 treated within a regional office, suboffice, con14 tact unit, or other subordinate office in the 

15 Freely Associated States, including how the De16 partment plans to communicate with such vet17 erans regarding their continuity of care. 

18 (F) An assessment of the budgetary re19 sources required to establish and provide hos20 pital care and medical services to veterans in 

21 the Freely Associated States during the 10-year 

22 period beginning on the date of the submittal of 

23 the report. 

Æ 


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