I 

111TH CONGRESS 

1ST SESSION H. R. 2879 

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

who live in rural areas, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 15, 2009 

Mrs. KIRKPATRICK of Arizona (for herself and Mr. PERRIELLO) 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 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 2009’’. 

6 SEC. 2. TRAVEL REIMBURSEMENT FOR VETERANS RECEIV7 ING TREATMENT AT FACILITIES OF THE DE8 PARTMENT OF VETERANS AFFAIRS. 

9 (a) IN GENERAL.—Section 111 of title 38, United 

10 States Code, is amended— 


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1 (1) in subsection (a), by striking ‘‘traveled,’’ 

2 and inserting ‘‘(at a rate of 41.5 cents per mile),’’; 

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

4 (3) by redesignating subsection (h) as sub5 section (g). 

6 (b) CLARIFICATION OF RELATION TO PUBLIC

7 TRANSPORTATION IN VETERANS HEALTH ADMINISTRA8 TION HANDBOOK.—Not later than 30 days after the date 

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

10 Affairs shall revise the Veterans Health Administration 

11 Handbook to clarify that an allowance for travel based on 

12 mileage paid under section 111(a) of title 38, United 

13 States Code, may exceed the cost of such travel by public 

14 transportation regardless of medical necessity. 

15 SEC. 3. CENTERS OF EXCELLENCE FOR RURAL HEALTH RE16 SEARCH, EDUCATION, AND CLINICAL ACTIVI17 TIES. 

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

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

20 end the following new section: 

21 ‘‘§ 7330B. Centers of excellence for rural health re22 search, education, and clinical activities 

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

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

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


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1 five centers of excellence for rural health research, edu2 cation, and clinical activities, which shall— 

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

4 services in rural areas; 

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

6 Department in furnishing health services to veterans 

7 in rural areas; 

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

9 care professionals of the Department on the fur10 nishing of health services to veterans in rural areas; 

11 and 

12 ‘‘(4) develop and implement innovative clinical 

13 activities and systems of care for the Department 

14 for the furnishing of health services to veterans in 

15 rural areas. 

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

17 ensure that the centers established under this section are 

18 located at health care facilities that are geographically dis19 persed throughout the United States. 

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

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

22 under this section unless— 

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

24 subsection (d) determines that the proposal subVerDate Nov 24 2008 03:58 Jun 16, 2009 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2879.IH H2879

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1 mitted by such facility meets the highest competitive 

2 standards of scientific and clinical merit; and 

3 ‘‘(2) the Secretary determines that such 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— 


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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 


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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 7330A the 

17 following new item: 

‘‘7330B. Centers of excellence 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 highly 

24 rural areas. 


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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 highly 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 highly 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. 


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1 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

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

3 fiscal years 2009 through 2013 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 the fea10 sibility and advisability of alternatives for expanding care 

11 for veterans in rural areas, including 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 

25 Service to expand care for Indian veterans. 


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1 (b) GEOGRAPHIC DISTRIBUTION.—The Secretary of 

2 Veterans Affairs shall ensure that the demonstration 

3 projects carried out under subsection (a) are located at 

4 facilities that are geographically distributed throughout 

5 the United States. 

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

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

8 Affairs shall submit a report on the results of the dem9 onstration projects conducted under subsection (a) to— 

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

11 Committee on Appropriations of the Senate; and 

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

13 Committee on Appropriations of the House of Rep14 resentatives. 

15 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

16 are authorized to be appropriated $350,000,000 for each 

17 of fiscal years 2009 through 2011 to carry out this sec18 tion. 


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1 SEC. 6. PROGRAM ON PROVISION OF READJUSTMENT AND 

2 MENTAL HEALTH CARE SERVICES TO VET3 ERANS WHO SERVED IN OPERATION IRAQI 

4 FREEDOM AND OPERATION ENDURING FREE5 DOM. 

6 (a) PROGRAM REQUIRED.—Not later than 180 days 

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

8 of Veterans Affairs shall establish a program to provide— 

9 (1) to veterans of Operation Iraqi Freedom and 

10 Operation Enduring Freedom, particularly veterans 

11 who served in such operations while in the National 

12 Guard and the Reserves— 

13 (A) peer outreach services; 

14 (B) peer support services; 

15 (C) readjustment counseling and services 

16 described in section 1712A of title 38, United 

17 States Code; and 

18 (D) mental health services; and 

19 (2) to members of the immediate family of such 

20 a veteran, during the three-year period beginning on 

21 the date of the return of such veteran from deploy22 ment in Operation Iraqi Freedom and Operation 

23 Enduring Freedom, education, support, counseling, 

24 and mental health services to assist in— 

25 (A) the readjustment of such veteran to ci26 vilian life; 


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1 (B) in the case such veteran has an injury 

2 or illness incurred during such deployment, the 

3 recovery of such veteran; and 

4 (C) the readjustment of the family fol5 lowing the return of such veteran. 

6 (b) CONTRACTS WITH COMMUNITY MENTAL

7 HEALTH CENTERS AND QUALIFIED ENTITIES FOR PRO8 VISION OF SERVICES.—In carrying out the program re9 quired by subsection (a), the Secretary shall contract with 

10 community mental health centers and other qualified enti11 ties to provide the services required by such subsection 

12 only in areas the Secretary determines are not adequately 

13 served by other health care facilities of the Department 

14 of Veterans Affairs. Such contracts shall require each con15 tracting community health center or entity— 

16 (1) to the extent practicable, to employ veterans 

17 trained under subsection (c); 

18 (2) to the extent practicable, to use telehealth 

19 services for the delivery of services required by sub20 section (a); 

21 (3) to participate in the training program con22 ducted in accordance with subsection (d); 

23 (4) to comply with applicable protocols of the 

24 Department of Veterans Affairs before incurring any 


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1 liability on behalf of the Department for the provi2 sion of the services required by subsection (a); 

3 (5) to submit annual reports to the Secretary 

4 containing, with respect to the program required by 

5 subsection (a) and for the last full calendar year 

6 ending before the submission of such report— 

7 (A) the number of the veterans served, vet8 erans diagnosed, and courses of treatment pro9 vided to veterans as part of the program re10 quired by subsection (a); and 

11 (B) demographic information for such 

12 services, diagnoses, and courses of treatment; 

13 (6) for each veteran for whom a community 

14 mental health center or other qualified entity pro15 vides mental health services under such contract, to 

16 provide the Department of Veterans Affairs with 

17 such clinical summary information as the Secretary 

18 shall require; and 

19 (7) to meet such other requirements as the Sec20 retary shall require. 

21 (c) TRAINING OF VETERANS FOR THE PROVISION OF

22 PEER-OUTREACH AND PEER-SUPPORT SERVICES.—In 

23 carrying out the program required by subsection (a), the 

24 Secretary shall contract with a national not-for-profit 

25 mental health organization to carry out a national proVerDate Nov 24 2008 03:58 Jun 16, 2009 Jkt 079200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H2879.IH H2879

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1 gram of training for veterans described in subsection (a) 

2 to provide the services described in subparagraphs (A) and 

3 (B) of paragraph (1) of such subsection. 

4 (d) TRAINING OF CLINICIANS FOR PROVISION OF

5 SERVICES.—The Secretary shall conduct a training pro6 gram for clinicians of community mental health centers 

7 or entities that have contracts with the Secretary under 

8 subsection (b) to ensure that such clinicians can provide 

9 the services required by subsection (a) in a manner that— 

10 (1) recognizes factors that are unique to the ex11 perience of veterans who served on active duty in 

12 Operation Iraqi Freedom or Operation Enduring 

13 Freedom (including their combat and military train14 ing experiences); and 

15 (2) utilizes best practices and technologies. 

16 (e) REPORTS REQUIRED.— 

17 (1) INITIAL REPORT ON PLAN FOR IMPLEMEN18 TATION.—Not later than 45 days after the date of 

19 the enactment of this Act, the Secretary shall submit 

20 to the Committee on Veterans’ Affairs of the Senate 

21 and the Committee on Veterans’ Affairs of the 

22 House of Representatives a report containing the 

23 plans of the Secretary to implement the program re24 quired by subsection (a). 


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1 (2) STATUS REPORT.—Not later than one year 

2 after the date of the enactment of this Act, the Sec3 retary shall submit to the Committee on Veterans’ 

4 Affairs of the Senate and the Committee on Vet5 erans’ Affairs of the House of Representatives a re6 port on the implementation of the program. Such re7 port shall include the following: 

8 (A) Information on the number of veterans 

9 who received services as part of the program 

10 and the type of services received during the last 

11 full calendar year completed before the submis12 sion of such report. 

13 (B) An evaluation of the provision of serv14 ices under paragraph (2) of subsection (a) and 

15 a recommendation as to whether the period de16 scribed in such paragraph should be extended 

17 to a five-year period. 

18 SEC. 7. IMPROVEMENT OF CARE OF AMERICAN INDIAN 

19 VETERANS. 

20 (a) INDIAN HEALTH COORDINATORS.— 

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

22 of title 38, United States Code, as amended by sec23 tion 3, is further amended by adding at the end the 

24 following new section: 


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1 ‘‘§ 7330C. Indian Veterans Health Care Coordinators 

2 ‘‘(a) IN GENERAL.—(1) The Secretary shall assign 

3 at each of the 10 Department Medical Centers that serve 

4 communities with the greatest number of Indian veterans 

5 per capita an official or employee of the Department to 

6 act as the coordinator of health care for Indian veterans 

7 at such Medical Center. The official or employee so as8 signed at a Department Medical Center shall be known 

9 as the ‘Indian Veterans Health Care Coordinator’ for the 

10 Medical Center. 

11 ‘‘(2) The Secretary shall, from time to time— 

12 ‘‘(A) survey the Department Medical Centers 

13 for purposes of identifying the 10 Department Med14 ical Centers that currently serve communities with 

15 the greatest number of Indian veterans per capita; 

16 and 

17 ‘‘(B) utilizing the results of the most recent 

18 survey conducted under subparagraph (A), revise the 

19 assignment of Indian Veterans Health Care Coordi20 nators in order to assure the assignment of such co21 ordinators to appropriate Department Medical Cen22 ters as required by paragraph (1). 

23 ‘‘(b) DUTIES.—The duties of a Indian Veterans 

24 Health Care Coordinator shall include the following: 

25 ‘‘(1) Improving outreach to tribal communities. 


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1 ‘‘(2) Coordinating the medical needs of Indian 

2 veterans on Indian reservations with the Veterans 

3 Health Administration and the Indian Health Serv4 ice. 

5 ‘‘(3) Expanding the access and participation of 

6 Department of Veterans Affairs, Indian Health 

7 Service, and tribal members in the Department of 

8 Veterans Affairs Tribal Veterans Representative pro9 gram. 

10 ‘‘(4) Acting as an ombudsman for Indian vet11 erans enrolled in the health care system of the Vet12 erans Health Administration. 

13 ‘‘(5) Advocating for the incorporation of tradi14 tional medicine and healing in Department treat15 ment plans for Indian veterans in need of care and 

16 services provided by the Department. 

17 ‘‘(c) NATIVE AMERICAN DEFINED.—In this section, 

18 the term ‘Indian’ has the meaning given the term in sec19 tion 4 of the Indian Self-Determination and Education As20 sistance Act (25 U.S.C. 450b).’’. 

21 (2) CLERICAL AMENDMENT.—The table of sec22 tions at the beginning of chapter 73 of such title, as 

23 amended by section 3, is further amended by insert24 ing after the item relating to section 7330B the fol25 lowing new item: 

‘‘7330C. Indian Veterans Health Coordinators.’’. 


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1 (b) INTEGRATION OF ELECTRONIC HEALTH

2 RECORDS WITH INDIAN HEALTH SERVICE.—Not later 

3 than one year after the date of the enactment of this Act, 

4 the Secretary of Veterans Affairs and Secretary of the In5 terior shall enter into a memorandum of understanding 

6 to ensure that the health records of Indian veterans may 

7 be transferred electronically between facilities of the In8 dian Health Service and the Department of Veterans Af9 fairs. 

10 (c) TRANSFER OF MEDICAL EQUIPMENT TO THE IN11 DIAN HEALTH SERVICE.— 

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

13 Affairs may transfer to the Indian Health Service 

14 such surplus Department of Veterans Affairs med15 ical and information technology equipment as the 

16 Secretary of Veterans Affairs and the Secretary of 

17 Health and Human Services jointly consider appro18 priate for purposes of the Indian Health Service. 

19 (2) TRANSPORTATION AND INSTALLATION.—In 

20 transferring medical or information technology 

21 equipment under this subsection, the Secretary of 

22 Veterans Affairs may transport and install such 

23 equipment in facilities of the Indian Health Service. 

24 (d) REPORT ON JOINT HEALTH CLINICS WITH IN25 DIAN HEALTH SERVICE.—Not later than one year after 


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1 the date of the enactment of this Act, the Secretary of 

2 Veterans Affairs and the Secretary of Health and Human 

3 Services shall jointly submit to Congress a report on the 

4 feasability and advisability of the joint establishment and 

5 operation by the Veterans Health Administration and the 

6 Indian Health Service of health clinics on Indian reserva7 tions to serve the populations of such reservations, includ8 ing Indian veterans. 

9 SEC. 8. ANNUAL REPORT TO CONGRESS ON MATTERS RE10 LATED TO CARE FOR VETERANS WHO LIVE IN 

11 RURAL AREAS. 

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

13 Affairs shall submit to Congress each year, together with 

14 documents submitted to Congress in support of the budget 

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

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

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

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

19 following: 

20 (1) The implementation of the provisions of this 

21 Act, including the amendments made by this Act. 

22 (2) The establishment and function of the Of23 fice of Rural Health under section 7308 of title 38, 

24 United States Code. 


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1 (b) ADDITIONAL REQUIREMENTS FOR INITIAL RE2 PORT.—The first report submitted under subsection (a) 

3 shall also include the following: 

4 (1) The assessment of fee-basis health-care pro5 gram required by section 212(b) of the Veterans 

6 Benefits, Health Care, and Information Technology 

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

8 (2) An assessment of the outreach program re9 quired by section 213 of such Act (120 Stat. 3422; 

10 38 U.S.C. 6303 note). 

Æ 


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