II 

114TH CONGRESS 

2D SESSION S. 3403 

To authorize payment by the Department of Veterans Affairs for the costs 

associated with service by medical residents and interns at facilities 

operated by Indian tribes, tribal organizations, and the Indian Health 

Service, to require the Secretary of Veterans Affairs to carry out a 

pilot program to expand medical residencies and internships at such 

facilities, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 27, 2016 

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

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

A BILL 

To authorize payment by the Department of Veterans Affairs 

for the costs associated with service by medical residents 

and interns at facilities operated by Indian tribes, tribal 

organizations, and the Indian Health Service, to require 

the Secretary of Veterans Affairs to carry out a pilot 

program to expand medical residencies and internships 

at such facilities, 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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Serving our Rural Vet3 erans Act of 2016’’. 

4 SEC. 2. AUTHORIZATION OF PAYMENT BY DEPARTMENT OF 

5 VETERANS AFFAIRS FOR SERVICE BY RESI6 DENTS OR INTERNS AT FACILITIES OPER7 ATED BY INDIAN TRIBES, TRIBAL ORGANIZA8 TIONS, AND THE INDIAN HEALTH SERVICE. 

9 (a) IN GENERAL.—Subsection (c) of section 7406 of 

10 title 38, United States Code, is amended by striking ‘‘De11 partment facility’’ each place it appears and inserting 

12 ‘‘covered facility’’. 

13 (b) COVERED FACILITY DEFINED.—Such section is 

14 amended by adding at the end the following new sub15 section: 

16 ‘‘(d) In this section, the term ‘covered facility’ 

17 means— 

18 ‘‘(1) a Department facility; 

19 ‘‘(2) a facility operated by an Indian tribe or a 

20 tribal organization, as those terms are defined in 

21 section 4 of the Indian Self-Determination and Edu22 cation Assistance Act (25 U.S.C. 5304); or 

23 ‘‘(3) a facility operated by the Indian Health 

24 Service.’’. 


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1 SEC. 3. PILOT PROGRAM TO CREATE OR EXPAND GRAD2 UATE MEDICAL RESIDENCIES AT FACILITIES 

3 OPERATED BY INDIAN TRIBES, TRIBAL ORGA4 NIZATIONS, AND THE INDIAN HEALTH SERV5 ICE IN RURAL AREAS. 

6 (a) IN GENERAL.—The Secretary of Veterans Af7 fairs, in consultation with the Director of the Indian 

8 Health Service, shall carry out a pilot program to establish 

9 graduate medical education residency training programs 

10 at covered facilities. 

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

12 pilot program at not more than one covered facility in each 

13 of Alaska and Montana that has been selected by the Sec14 retary for purposes of the pilot program. 

15 (c) DURATION.—The Secretary shall implement the 

16 pilot program during the eight-year period beginning on 

17 the date that is 180 days after the date of the enactment 

18 of this Act. 

19 (d) REIMBURSEMENT OF COSTS.—The Secretary 

20 shall reimburse each covered facility participating in the 

21 pilot program for the following costs associated with the 

22 pilot program: 

23 (1) Curriculum development. 

24 (2) Recruitment, training, and retention of resi25 dents and faculty. 


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1 (3) Accreditation of programs of education 

2 under the pilot program by the Accreditation Coun3 cil for Graduate Medical Education (ACGME) or the 

4 American Osteopathic Association (AOA). 

5 (4) The portion of faculty salaries attributable 

6 to activities relating to carrying out the pilot pro7 gram. 

8 (5) Payment for expenses relating to providing 

9 medical education under the pilot program in an 

10 amount not to exceed— 

11 (A) the amount determined under section 

12 340H of the Public Health Service Act (42 

13 U.S.C. 256h) that would be paid to a covered 

14 facility for such expenses if the covered facility 

15 were a qualified teaching health center under 

16 such section, plus 

17 (B) an additional amount to account for 

18 the increased costs to the covered facility of 

19 providing health care and medical education 

20 under the pilot program in rural and remote 

21 areas. 

22 (e) PERIOD OF OBLIGATED SERVICE.— 

23 (1) IN GENERAL.—The Secretary shall enter 

24 into an agreement with each medical resident who 

25 participates in the pilot program under which such 


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1 medical resident agrees to serve a period of two 

2 years of obligated service at a covered facility or a 

3 facility of the Department of Veterans Affairs for 

4 each year in which the medical resident participates 

5 in the pilot program under this section. 

6 (2) BREACH.—A medical resident who partici7 pates in the pilot program and fails to satisfy the 

8 period of obligated service under paragraph (1) shall 

9 be liable to the United States, in lieu of such obli10 gated service, for the amount that has been paid or 

11 is payable to or on behalf of the medical resident 

12 under the pilot program, reduced by the proportion 

13 that the number of days served for completion of the 

14 period of obligated service bears to the total number 

15 of days in the period of obligated service of such 

16 medical resident. 

17 (f) LOAN REPAYMENT.— 

18 (1) IN GENERAL.—A medical resident who par19 ticipates in the pilot program shall be eligible for 

20 participation in the Indian Health Service Loan Re21 payment Program under section 108 of the Indian 

22 Health Care Improvement Act (25 U.S.C. 1616a). 

23 (2) AUTHORIZATION OF APPROPRIATIONS.— 

24 (A) IN GENERAL.—There is authorized to 

25 be appropriated to the Secretary of Health and 


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1 Human Services, acting through the Indian 

2 Health Service, such sums as may be necessary 

3 to cover loan repayments paid under the Indian 

4 Health Service Loan Repayment Program to 

5 medical residents participating in the pilot pro6 gram. 

7 (B) SUPPLEMENT NOT SUPPLANT.— 

8 Amounts appropriated or otherwise made avail9 able for the Indian Health Service Loan Repay10 ment Program pursuant to the authorization of 

11 appropriations under subparagraph (A) shall 

12 supplement, not supplant, amounts made avail13 able to such program under other provisions of 

14 law. 

15 (g) REPORT.—Not later than two years before the 

16 termination of the pilot program under subsection (c), the 

17 Secretary shall submit to the Committee on Veterans’ Af18 fairs of the Senate and the Committee on Veterans’ Af19 fairs of the House of Representatives a report on the feasi20 bility and advisability of— 

21 (1) expanding the pilot program to additional 

22 locations; and 

23 (2) making the pilot program or any aspect of 

24 the pilot program permanent. 


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1 (h) COVERED FACILITY DEFINED.—In this section, 

2 the term ‘‘covered facility’’ means a facility— 

3 (1) operated by an Indian tribe or a tribal orga4 nization (as those terms are defined in section 4 of 

5 the Indian Self-Determination and Education Assist6 ance Act (25 U.S.C. 5304)), or the Indian Health 

7 Service, that has an existing reimbursement agree8 ment with the Department of Veterans Affairs under 

9 section 405(c) of the Indian Health Care Improve10 ment Act (25 U.S.C. 1645(c)); and 

11 (2) located in a rural or remote area, as deter12 mined by the Secretary. 

13 (i) AUTHORIZATION OF APPROPRIATIONS.—There is 

14 authorized to be appropriated to the Secretary of Veterans 

15 Affairs $20,000,000 for each year in which the pilot pro16 gram is carried out. 

Æ 


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