I 

109TH CONGRESS 

2D SESSION H. R. 5524 

To amend title 38, United States Code, to improve health care for veterans 

in rural areas, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 6, 2006 

Mr. MICHAUD (for himself, Mr. EVANS, Mr. FILNER, Mr. GUTIERREZ, Ms. 

CORRINE BROWN of Florida, Ms. HERSETH, Mr. STRICKLAND, Ms. 

HOOLEY, Mr. REYES, Mr. UDALL of New Mexico, and Mr. SALAZAR) introduced the following bill; which was referred to the Committee on Veterans’ Affairs 

A BILL 

To amend title 38, United States Code, to improve health 

care for veterans in rural areas, and for other purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Rural Veterans Health 

5 Care Act of 2006’’. 

6 SEC. 2. OUTREACH PROGRAM TO VETERANS IN RURAL 

7 AREAS. 

8 (a) PROGRAM.—The Secretary of Veterans Affairs 

9 shall conduct an extensive outreach program to identify 


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1 and provide information to veterans who served in the the2 ater of operations for Operation Iraqi Freedom or Oper3 ation Enduring Freedom and who reside in rural commu4 nities in order to enroll those veterans in the health care 

5 system of the Department of Veterans Affairs during the 

6 period when they are eligible for such enrollment. 

7 (b) FEATURES OF PROGRAM.—In carrying out the 

8 program under subsection (a), the Secretary shall seek to 

9 work at the local level with employers, State agencies, 

10 community health centers located in rural areas, rural 

11 health clinics, and critical access hospitals located in rural 

12 areas, and units of the National Guard and other reserve 

13 components based in rural areas, in order to increase the 

14 awareness of veterans and their families of the availability 

15 of health care provided by the Secretary and the means 

16 by which those veterans can achieve access to the health 

17 care services provided by the Department of Veterans Af18 fairs. 

19 SEC. 3. ACCESS TO VET CENTERS IN RURAL AREAS. 

20 (a) EXPANSION OF ACCESS.—The Secretary of Vet21 erans Affairs shall expand access to Vet Centers in rural 

22 areas. In carrying out this section, the Secretary shall con23 duct a pilot program for the operation of at least two mo24 bile Vet Centers in rural areas for a period of five years. 


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1 (b) VET CENTER DEFINED.—In this section, the 

2 term ‘‘Vet Center’’ has the meaning given the term ‘‘cen3 ter’’ in section 1712A(i)(1) of title 38, United States 

4 Code. 

5 SEC. 4. QUALITY CARE IN RURAL AREAS. 

6 (a) REQUIREMENT.—The Secretary of Veterans Af7 fairs shall develop and implement a plan for improving the 

8 access of veterans to health care in rural areas. The plan 

9 shall be developed in consultation with the Advisory Com10 mittee on Rural Veterans established under section 546 

11 of title 38, United States Code, as added by section 6. 

12 (b) MATTERS TO BE INCLUDED.—The plan devel13 oped under subsection (a) shall include the following: 

14 (1) A review of progress in implementing the 

15 proposed 156 community-based outpatient clinics, 

16 and plans for further implementation of those pro17 posed clinics, that were included in the May 2004 

18 Secretary’s CARES Decision Document, announcing 

19 the implementation of the Department of Veterans 

20 Affairs health care planning process called Capital 

21 Asset Realignment for Enhanced Services (CARES), 

22 plans for establishment of additional community23 based outpatient clinics, and plans for health-care 

24 outreach centers. 


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1 (2) Measures for meeting the long-term care 

2 needs of rural veterans through nursing homes of 

3 the Department of Veterans Affairs and State vet4 erans homes. 

5 (3) Expansion for rural veterans of the adult 

6 day-care and respite care programs of the Depart7 ment. 

8 (4) Expansion for rural veterans of the use of 

9 telemedicine to enhance care coordination and access 

10 to specialized care for such veterans. 

11 (5) Measures for meeting the needs of rural 

12 veterans for mental health care. 

13 (c) TIMETABLE.—The plan required by subsection 

14 (a) shall be submitted to Congress not later than nine 

15 months after the date of the enactment of this Act and 

16 shall be implemented not later than two years thereafter. 

17 SEC. 5. HEALTH INFORMATION TECHNOLOGY. 

18 The Secretary of Veterans Affairs shall establish a 

19 health information technology pilot program to ensure a 

20 continuum of quality of care for rural veterans who receive 

21 health care provided by the Secretary both directly 

22 through facilities of the Department of Veterans Affairs 

23 and as fee-basis care through non-Department providers 

24 and facilities, including, where appropriate, community 

25 health centers, rural health clinics, and critical access hosVerDate Aug 31 2005 23:54 Jun 08, 2006 Jkt 049196 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5524.IH H5524

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1 pitals. The pilot program shall be conducted for a period 

2 of four years. 

3 SEC. 6. ADVISORY COMMITTEE ON RURAL VETERANS. 

4 (a) NEW ADVISORY COMMITTEE.—Chapter 5 of title 

5 38, United States Code, is amended by adding at the end 

6 the following new section: 

7 ‘‘§ 546. Advisory Committee on Rural Veterans 

8 ‘‘(a)(1) The Secretary shall establish an advisory 

9 committee to be known as the Advisory Committee on 

10 Rural Veterans (hereinafter in this section referred to as 

11 ‘the Committee’). 

12 ‘‘(2)(A) The Committee shall consist of members ap13 pointed by the Secretary from the general public, includ14 ing— 

15 ‘‘(i) representatives of rural veterans; 

16 ‘‘(ii) individuals who are recognized authorities 

17 in fields pertinent to the needs of rural veterans, in18 cluding specific or unique health-care needs of rural 

19 veterans and access issues of rural veterans; 

20 ‘‘(iii) individuals who have expertise in the de21 livery of mental health care in rural areas; 

22 ‘‘(iv) individuals who have expertise in the deliv23 ery of long-term care in rural areas; 

24 ‘‘(v) at least one veterans service organization 

25 representative from a rural State; and 


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1 ‘‘(vi) representatives of rural veterans with 

2 service-connected disabilities. 

3 ‘‘(B) The Committee shall include, as ex officio mem4 bers— 

5 ‘‘(i) the Secretary of Health and Human Serv6 ices (or a representative of the Secretary of Health 

7 and Human Services designated by that Secretary); 

8 ‘‘(ii) the Director of the Indian Health Service 

9 (or a representative of that Director); and 

10 ‘‘(iii) the Under Secretary for Health and the 

11 Under Secretary for Benefits, or their designees. 

12 ‘‘(C) The Secretary may invite representatives of 

13 other departments and agencies of the United States to 

14 participate in the meetings and other activities of the 

15 Committee. 

16 ‘‘(3) The Secretary shall determine the number, 

17 terms of service, and pay and allowances of members of 

18 the Committee appointed by the Secretary, except that a 

19 term of service of any such member may not exceed three 

20 years. The Secretary may reappoint any such member for 

21 additional terms of service. 

22 ‘‘(b) The Secretary shall, on a regular basis, consult 

23 with and seek the advice of the Committee with respect 

24 to the administration of benefits by the Department for 

25 rural veterans, reports and studies pertaining to rural vetVerDate Aug 31 2005 23:54 Jun 08, 2006 Jkt 049196 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5524.IH H5524

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1 erans, and the needs of rural veterans with respect to pri2 mary care, mental health care, and long-term care needs 

3 of rural veterans. 

4 ‘‘(c)(1) Not later than September 1 of each odd-num5 bered year through 2013, the Committee shall submit to 

6 the Secretary a report on the programs and activities of 

7 the Department that pertain to rural veterans. Each such 

8 report shall include— 

9 ‘‘(A) an assessment of the needs of rural vet10 erans with respect to primary care, mental health 

11 care, and long-term care needs of rural veterans and 

12 other benefits and programs administered by the 

13 Department; 

14 ‘‘(B) a review of the programs and activities of 

15 the Department designed to meet such needs; and 

16 ‘‘(C) such recommendations (including rec17 ommendations for administrative and legislative ac18 tion) as the Committee considers appropriate. 

19 ‘‘(2) The Secretary shall, within 60 days after receiv20 ing each report under paragraph (1), submit to the Con21 gress a copy of the report, together with any comments 

22 concerning the report that the Secretary considers appro23 priate. 


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1 ‘‘(3) The Committee may also submit to the Sec2 retary such other reports and recommendations as the 

3 Committee considers appropriate. 

4 ‘‘(4) The Secretary shall submit with each annual re5 port submitted to the Congress pursuant to section 529 

6 of this title a summary of all reports and recommendations 

7 of the Committee submitted to the Secretary since the pre8 vious annual report of the Secretary submitted pursuant 

9 to such section.’’. 

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

11 at the beginning of such chapter is amended by adding 

12 at the end the following new item: 

‘‘546. Advisory Committee on Rural Veterans.’’. 

13 SEC. 7. RURAL HEALTH RESEARCH, EDUCATION, AND CLIN14 ICAL CARE CENTERS. 

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

16 of title 38, United States Code, is amended by adding at 

17 the end the following new section: 

18 ‘‘§ 7329. Rural health research, education, and clin19 ical care centers 

20 ‘‘(a) The Secretary, upon the recommendation of the 

21 Under Secretary for Health and pursuant to the provi22 sions of this section, shall designate a minimum of four 

23 Department health care facilities as the locations for cen24 ters of rural health research, education, and clinical activi25 ties and (subject to the appropriation of sufficient funds 


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1 for such purpose) shall establish and operate such centers 

2 at such locations in accordance with this section. 

3 ‘‘(b) The centers established under this section 

4 shall— 

5 ‘‘(1) conduct research on rural health services; 

6 ‘‘(2) allow the Department to use specific mod7 els for furnishing services to treat rural veterans; 

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

9 care professionals of the Department; and 

10 ‘‘(4) develop and implement innovative clinical 

11 activities and systems of care for the Department. 

12 ‘‘(c) In designating locations for centers under sub13 section (a), the Secretary, upon the recommendation of the 

14 Under Secretary for Health, shall— 

15 ‘‘(1) assure appropriate geographic distribution 

16 of such centers; 

17 ‘‘(2) assure that one of the centers shall focus 

18 on mental health, including substance abuse treat19 ment; 

20 ‘‘(3) assure that one of the centers shall focus 

21 on case management of chronic diseases; 

22 ‘‘(4) assure that one of the centers shall focus 

23 on telemedicine; and 

24 ‘‘(5) assure that at least one of the centers 

25 shall be located to collaborate with a Rural Health 


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1 Research Center of the Department of Health and 

2 Human Services in a geographic service area of the 

3 Department of Veterans Affairs that includes several 

4 rural States. 

5 ‘‘(d) The Secretary may not designate a health care 

6 facility as a location for a center under subsection (a) un7 less the peer review panel established under subsection (e) 

8 has determined under that subsection that the proposal 

9 submitted by such facility as a location for a new center 

10 under subsection (a) is among those proposals that have 

11 met the highest competitive standards of scientific and 

12 clinical merit and the Secretary (upon the recommenda13 tion of the Under Secretary for Health) determines that 

14 the facility has (or may reasonably be anticipated to de15 velop) each of the following: 

16 ‘‘(1) An arrangement under which medical, 

17 nursing, or allied health personnel receive training 

18 and education in the unique aspects of rural care 

19 through regular rotation through rurally located fa20 cilities and community based outpatient clinics. 

21 ‘‘(2) The ability to attract the participation of 

22 scientists and clinicians who are capable of ingenuity 

23 and creativity in health care research efforts. 

24 ‘‘(3) A policymaking advisory committee com25 posed of appropriate health care and research repVerDate Aug 31 2005 23:54 Jun 08, 2006 Jkt 049196 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H5524.IH H5524

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1 resentatives of the facility and of the affiliated 

2 school or schools to advise the directors of such fa3 cility and such center on policy matters pertaining to 

4 the activities of such center during the period of the 

5 operation of such center. 

6 ‘‘(4) The capability to coordinate, as part of an 

7 integrated national system, education, clinical, and 

8 research activities within all facilities with such cen9 ters. 

10 ‘‘(5) The capability to jointly develop a consor11 tium of providers with interest in improving quality 

12 care in rural areas. 

13 ‘‘(6) The capability to develop a national reposi14 tory for the collection of best practices and evidenced 

15 based care to rural veterans. 

16 ‘‘(7) The capability to effectively conduct eval17 uations of the activities of such center. 

18 ‘‘(e)(1) In order to provide advice to assist the Sec19 retary and the Under Secretary for Health in carrying out 

20 their responsibilities under this section, the Assistant 

21 Under Secretary for Health shall establish a panel to as22 sess the scientific and clinical merit of proposals that are 

23 submitted to the Secretary for the establishment of new 

24 centers under this section. 


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1 ‘‘(2) The membership of the panel shall consist of ex2 perts in the fields pertinent to the needs of rural veterans, 

3 including mental health care and long-term care. Members 

4 of the panel shall serve as consultants to the Department 

5 for a period of no longer than six months. 

6 ‘‘(3) The panel shall review each proposal submitted 

7 to the panel by the Assistant Under Secretary and shall 

8 submit its views on the relative scientific and clinical merit 

9 of each such proposal to the Assistant Under Secretary. 

10 ‘‘(4) The panel shall not be subject to the Federal 

11 Advisory Committee Act. 

12 ‘‘(f) Before providing funds for the operation of any 

13 such center at a health care facility other than a health 

14 care facility designated under subsection (c)(1), the Sec15 retary shall assure that the center at each facility des16 ignated under such subsection is receiving adequate fund17 ing to enable such center to function effectively in the 

18 areas of rural health care research, education, and clinical 

19 activities. 

20 ‘‘(g) There are authorized to be appropriated such 

21 sums as may be necessary for the support of the research 

22 and education activities of the centers established pursu23 ant to subsection (a). The Under Secretary for Health 

24 shall allocate to such centers from other funds appro25 priated generally for the Department medical care account 


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1 and medical and prosthetics research account, as appro2 priate, such amounts as the Under Secretary for Health 

3 determines appropriate. 

4 ‘‘(h) Activities of clinical and scientific investigation 

5 at each center established under subsection (a) shall be 

6 eligible to compete for the award of funding from funds 

7 appropriated for the Department medical and prosthetics 

8 research account and shall receive priority in the award 

9 of funding from such account insofar as funds are award10 ed to projects for research in rural health care.’’. 

11 (2) The table of sections at the beginning of such 

12 chapter is amended by inserting after the item relating 

13 to section 7328 the following new item: 

‘‘7329. Rural health research, education, and clinical care centers.’’. 

14 (b) DESIGNATION OF CENTERS.—The Secretary of 

15 Veterans Affairs shall designate the centers for rural 

16 health research, education, and clinical activities required 

17 by section 7329 of title 38, United States Code (as added 

18 by subsection (a)), not later than one year after the date 

19 of the enactment of this Act. 

20 (c) ANNUAL REPORTS.— 

21 (1) ANNUAL REPORT.—Not later than 18 

22 months after the date of the designation of centers 

23 for rural health research, education, and clinical ac24 tivities required by section 7329 of title 38, United 

25 States Code (as so added), and annually thereafter 


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1 for the next three years, the Secretary shall submit 

2 to the Committees on Veterans’ Affairs of the Sen3 ate and House of Representatives a report on the 

4 status and activities of such centers during the one5 year period beginning on the date of such designa6 tion, for the first such report, and for successive 

7 one-year periods, for subsequent reports. 

8 (2) MATTER TO BE INCLUDED.—Each such re9 port shall include, for the period covered by the re10 port, the following: 

11 (A) A description of the activities carried 

12 out at each center and the funding provided for 

13 such activities. 

14 (B) A description of any advances made in 

15 the participating programs of each center in re16 search, education, training, and clinical activi17 ties related to rural health. 

18 SEC. 8. HOMELESS RURAL VETERANS. 

19 Section 2061(b) of title 38, United States Code, is 

20 amended— 

21 (1) by striking ‘‘or’’ at the end of paragraph 

22 (3); 

23 (2) by striking the period at the end of para24 graph (4) and inserting ‘‘; and’’; and 


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1 (3) by adding at the end the following new 

2 paragraph: 

3 ‘‘(5) rural.’’. 

4 SEC. 9. RURAL EDUCATION AND TRAINING OF HEALTH 

5 PROFESSIONALS. 

6 The Secretary of Veterans Affairs shall carry out ac7 tivities to enhance the education, training, retention, and 

8 recruitment of health professionals in rural areas. As part 

9 of such activities, the Secretary shall— 

10 (1) establish additional rotations for medical 

11 residents in rural areas; 

12 (2) establish programs to enhance the edu13 cation, training, recruitment, and retention of nurses 

14 in rural areas; and 

15 (3) establish programs to enhance the edu16 cation, training, recruitment, and retention of allied 

17 health professionals in rural areas. 

18 SEC. 10. NATIVE AMERICANS. 

19 The Secretary of Veterans Affairs shall expand the 

20 health care presence of the Department of Veterans Af21 fairs in Native American, Native Hawaiian, and Native 

22 Alaskan rural communities in order to improve access to 

23 Department of Veterans Affairs health care services for 

24 veterans in those communities. 

Æ 


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