II 

110TH CONGRESS 

1ST SESSION S. 1146 

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

who live in rural areas, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 18, 2007 

Mr. SALAZAR (for himself, Mr. THUNE, Mr. TESTER, Mr. BURR, Mrs. MURRAY, Mr. GRASSLEY, Mr. WYDEN, Ms. COLLINS, Mr. PRYOR, Mr. ENZI, 

Mrs. LINCOLN, Ms. SNOWE, Mr. KERRY, Mr. BINGAMAN, Mr. SMITH, 

Mr. BAUCUS, and Mr. DORGAN) introduced the following bill; which was 

read twice and referred to the Committee on Veterans’ Affairs 

A BILL 

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

care for veterans who live 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 Improvement Act of 2007’’. 


pwalker on PROD1PC71 with BILLS
2 

•S 1146 IS

1 SEC. 2. TRAVEL REIMBURSEMENT FOR VETERANS RECEIV2 ING TREATMENT AT FACILITIES OF THE DE3 PARTMENT OF VETERANS AFFAIRS. 

4 Section 111 of title 38, United States Code, is 

5 amended— 

6 (1) in subsection (a)— 

7 (A) by striking ‘‘subsistence),’’ and insert8 ing ‘‘subsistence at a rate equivalent to the rate 

9 provided to Federal employees under section 

10 5702 of title 5),’’; and 

11 (B) by striking ‘‘traveled,’’ and inserting 

12 ‘‘(at a rate equivalent to the rate provided to 

13 Federal employees under section 5704 of title 

14 5),’’; 

15 (2) by striking subsection (g); and 

16 (3) by redesignating subsection (h) as sub17 section (g). 

18 SEC. 3. CENTERS FOR RURAL HEALTH RESEARCH, EDU19 CATION, AND CLINICAL ACTIVITIES. 

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

21 title 38, United States Code, is amended by adding at the 

22 end the following new section: 

23 ‘‘§ 7330A. Centers for rural health research, edu24 cation, and clinical activities 

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

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


pwalker on PROD1PC71 with BILLS
3 

•S 1146 IS

1 establish and operate not less than one and not more than 

2 five centers of excellence for rural health research, edu3 cation, and clinical activities, which shall— 

4 ‘‘(1) conduct research on the provision of health 

5 services in rural areas; 

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

7 Department in furnishing health services to veterans 

8 in rural areas; 

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

10 care professionals of the Department on the fur11 nishing of health services to veterans in rural areas; 

12 and 

13 ‘‘(4) develop and implement innovative clinical 

14 activities and systems of care for the Department 

15 for the furnishing of health services to veterans in 

16 rural areas. 

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

18 ensure that the centers authorized under this section are 

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

21 ‘‘(c) SELECTION CRITERIA.—The Secretary may not 

22 designate a health care facility as a location for a center 

23 under this section unless— 

24 ‘‘(1) the peer review panel established under 

25 subsection (d) determines that the proposal subVerDate Aug 31 2005 22:01 Apr 19, 2007 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1146.IS S1146

pwalker on PROD1PC71 with BILLS
4 

•S 1146 IS

1 mitted by such facility meets the highest competitive 

2 standards of scientific and clinical merit; and 

3 ‘‘(2) the Secretary determines that the facility 

4 has, or may reasonably be anticipated to develop, the 

5 following: 

6 ‘‘(A) An arrangement with an accredited 

7 medical school to provide residents with edu8 cation and training in health services for vet9 erans in rural areas. 

10 ‘‘(B) The ability to attract the participa11 tion of scientists who are capable of ingenuity 

12 and creativity in health care research efforts. 

13 ‘‘(C) A policymaking advisory committee, 

14 composed of appropriate health care and re15 search representatives of the facility and of the 

16 affiliated school or schools, to advise the direc17 tors of such facility and such center on policy 

18 matters pertaining to the activities of such cen19 ter during the period of the operation of such 

20 center. 

21 ‘‘(D) The capability to conduct effectively 

22 evaluations of the activities of such center. 

23 ‘‘(d) PANEL TO EVALUATE PROPOSALS.—(1) The 

24 Director of the Office of Rural Health shall establish a 

25 panel— 


pwalker on PROD1PC71 with BILLS
5 

•S 1146 IS

1 ‘‘(A) to evaluate the scientific and clinical merit 

2 of proposals submitted to establish centers under 

3 this section; and 

4 ‘‘(B) to provide advice to the Director regarding 

5 the implementation of this section. 

6 ‘‘(2) The panel shall review each proposal received 

7 from the Secretary and shall submit its views on the rel8 ative scientific and clinical merit of each such proposal to 

9 the Secretary. 

10 ‘‘(3) The panel established under paragraph (1) shall 

11 be comprised of experts in the fields of public health re12 search, education, and clinical care. 

13 ‘‘(4) Members of the panel shall serve as consultants 

14 to the Department for a period not to exceed two years. 

15 ‘‘(5) The panel shall not be subject to the Federal 

16 Advisory Committee Act (5 U.S.C. App.). 

17 ‘‘(e) FUNDING.—(1) There are authorized to be ap18 propriated to the Medical Care Account and the Medical 

19 and Prosthetics Research Account of the Department of 

20 Veterans Affairs such sums as may be necessary for the 

21 support of the research and education activities of the cen22 ters operated under this section. 

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

24 under this section, from amounts authorized to be appro25 priated to the Medical Care Account and the Medical and 


pwalker on PROD1PC71 with BILLS
6 

•S 1146 IS

1 Prosthetics Research Account by paragraph (1), such 

2 amounts as the Under Secretary of health considers ap3 propriate for such centers. Such amounts shall be allo4 cated through the Director of the Office of Rural Health. 

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

6 at each center operated under this section— 

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

8 of funding from funds appropriated for the Medical 

9 and Prosthetics Research Account; and 

10 ‘‘(B) shall receive priority in the award of fund11 ing from such account to the extent that funds are 

12 awarded to projects for research in the care of rural 

13 veterans.’’. 

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

15 at the beginning of chapter 73 of such title is amended 

16 by inserting after the item relating to section 7330 the 

17 following new item: 

‘‘7330A. Centers for rural health research, education, and clinical activities.’’. 

18 SEC. 4. TRANSPORTATION GRANTS FOR RURAL VETERANS 

19 SERVICE ORGANIZATIONS. 

20 (a) GRANTS AUTHORIZED.— 

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

22 Affairs shall establish a grant program to provide in23 novative transportation options to veterans in remote 

24 rural areas. 


pwalker on PROD1PC71 with BILLS
7 

•S 1146 IS

1 (2) USE OF FUNDS.—Grants awarded under 

2 this section may be used by State veterans’ service 

3 agencies and veterans service organizations to— 

4 (A) assist veterans in remote rural areas to 

5 travel to Department of Veterans Affairs med6 ical centers; and 

7 (B) otherwise assist in providing medical 

8 care to veterans in remote rural areas. 

9 (3) MAXIMUM AMOUNT.—The amount of a 

10 grant under this section may not exceed $50,000. 

11 (4) NO MATCHING REQUIREMENT.—The recipi12 ent of a grant under this section shall not be re13 quired to provide matching funds as a condition for 

14 receiving such grant. 

15 (b) REGULATIONS.—The Secretary shall prescribe 

16 regulations for— 

17 (1) evaluating grant applications under this sec18 tion; and 

19 (2) otherwise administering the program estab20 lished by this section. 

21 (c) VETERANS SERVICE ORGANIZATION DEFINI22 TION.—In this section, the term ‘‘veterans service organi23 zation’’ means any organization recognized by the Sec24 retary of Veterans Affairs for the representation of vet25 erans under section 5902 of title 38, United States Code. 


pwalker on PROD1PC71 with BILLS
8 

•S 1146 IS

1 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated $3,000,000 for each of 

3 fiscal years 2008 through 2012 to carry out this section. 

4 SEC. 5. DEMONSTRATION PROJECTS ON ALTERNATIVES 

5 FOR EXPANDING CARE FOR VETERANS IN 

6 RURAL AREAS. 

7 (a) IN GENERAL.—The Secretary of Veterans Af8 fairs, through the Director of the Office of Rural Health, 

9 shall carry out demonstration projects to examine alter10 natives for expanding care for veterans in rural areas, in11 cluding the following: 

12 (1) Establishing a partnership between the De13 partment of Veterans Affairs and the Centers for 

14 Medicare and Medicaid Services of the Department 

15 of Health and Human Services to coordinate care 

16 for veterans in rural areas at critical access hospitals 

17 (as designated or certified under section 1820 of the 

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

19 (2) Establishing a partnership between the De20 partment of Veterans Affairs and the Department of 

21 Health and Human Services to coordinate care for 

22 veterans in rural areas at community health centers. 

23 (3) Expanding coordination between the De24 partment of Veterans Affairs and the Indian Health 


pwalker on PROD1PC71 with BILLS
9 

•S 1146 IS

1 Service to expand care for Native American vet2 erans. 

3 (b) GEOGRAPHIC DISTRIBUTION.—The Secretary of 

4 Veterans Affairs shall ensure that the demonstration 

5 projects authorized under subsection (a) are located at fa6 cilities that are geographically distributed throughout the 

7 United States. 

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

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

10 Affairs shall submit a report on the results of the dem11 onstration projects conducted under subsection (a) to— 

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

13 Committee on Appropriations of the Senate; and 

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

15 Committee on Appropriations of the House of Rep16 resentatives. 

17 SEC. 6. REPORT TO CONGRESS ON MATTERS RELATED TO 

18 CARE FOR VETERANS WHO LIVE IN RURAL 

19 AREAS. 

20 (a) ANNUAL REPORT.—The Secretary of Veterans 

21 Affairs shall submit to Congress each year, together with 

22 documents submitted to Congress in support of the budget 

23 of the President for the fiscal year beginning in such year 

24 (as submitted pursuant to section 1105 of title 31, United 

25 States Code), an assessment, current as of the fiscal year 


pwalker on PROD1PC71 with BILLS
10 

•S 1146 IS

1 ending in the year before such report is submitted, of the 

2 following: 

3 (1) The implementation of the provisions of this 

4 Act, including the amendments made by this Act. 

5 (2) The establishment and function of the Of6 fice of Rural Health under section 7308 of title 38, 

7 United States Code. 

8 (b) ADDITIONAL REQUIREMENTS FOR INITIAL RE9 PORT.—The Secretary of Veterans Affairs shall submit to 

10 Congress, together with the first report submitted under 

11 subsection (a), an assessment of the following: 

12 (1) The fee-basis health-care program required 

13 by subsection (b) of section 212 of the Veterans 

14 Benefits, Health Care, and Information Technology 

15 Act of 2006 (Public Law 109–461; 120 Stat. 3422). 

16 (2) The outreach program required by section 

17 213 of such Act. 

Æ 


pwalker on PROD1PC71 with BILLS