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) in-
troduced the following bill; which was referred to the Committee on Vet-
erans’ Affairs 
A BILL 
To amend title 38, United States Code, to improve health 
care for veterans in rural areas, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Rural Veterans Health 
Care Act of 2006’’. 
SEC. 2. OUTREACH PROGRAM TO VETERANS IN RURAL 
AREAS. 
(a) PROGRAM.—The Secretary of Veterans Affairs 
shall conduct an extensive outreach program to identify 
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and provide information to veterans who served in the the-
ater of operations for Operation Iraqi Freedom or Oper-
ation Enduring Freedom and who reside in rural commu-
nities in order to enroll those veterans in the health care 
system of the Department of Veterans Affairs during the 
period when they are eligible for such enrollment. 
(b) FEATURES OF PROGRAM.—In carrying out the 
program under subsection (a), the Secretary shall seek to 
work at the local level with employers, State agencies, 
community health centers located in rural areas, rural 
health clinics, and critical access hospitals located in rural 
areas, and units of the National Guard and other reserve 
components based in rural areas, in order to increase the 
awareness of veterans and their families of the availability 
of health care provided by the Secretary and the means 
by which those veterans can achieve access to the health 
care services provided by the Department of Veterans Af-
fairs. 
SEC. 3. ACCESS TO VET CENTERS IN RURAL AREAS. 
(a) EXPANSION OF ACCESS.—The Secretary of Vet-
erans Affairs shall expand access to Vet Centers in rural 
areas. In carrying out this section, the Secretary shall con-
duct a pilot program for the operation of at least two mo-
bile Vet Centers in rural areas for a period of five years. 
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(b) VET CENTER DEFINED.—In this section, the 
term ‘‘Vet Center’’ has the meaning given the term ‘‘cen-
ter’’ in section 1712A(i)(1) of title 38, United States 
Code. 
SEC. 4. QUALITY CARE IN RURAL AREAS. 
(a) REQUIREMENT.—The Secretary of Veterans Af-
fairs shall develop and implement a plan for improving the 
access of veterans to health care in rural areas. The plan 
shall be developed in consultation with the Advisory Com-
mittee on Rural Veterans established under section 546 
of title 38, United States Code, as added by section 6. 
(b) MATTERS TO BE INCLUDED.—The plan devel-
oped under subsection (a) shall include the following: 
(1) A review of progress in implementing the 
proposed 156 community-based outpatient clinics, 
and plans for further implementation of those pro-
posed clinics, that were included in the May 2004 
Secretary’s CARES Decision Document, announcing 
the implementation of the Department of Veterans 
Affairs health care planning process called Capital 
Asset Realignment for Enhanced Services (CARES), 
plans for establishment of additional community- 
based outpatient clinics, and plans for health-care 
outreach centers. 
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(2) Measures for meeting the long-term care 
needs of rural veterans through nursing homes of 
the Department of Veterans Affairs and State vet-
erans homes. 
(3) Expansion for rural veterans of the adult 
day-care and respite care programs of the Depart-
ment. 
(4) Expansion for rural veterans of the use of 
telemedicine to enhance care coordination and access 
to specialized care for such veterans. 
(5) Measures for meeting the needs of rural 
veterans for mental health care. 
(c) TIMETABLE.—The plan required by subsection 
(a) shall be submitted to Congress not later than nine 
months after the date of the enactment of this Act and 
shall be implemented not later than two years thereafter. 
SEC. 5. HEALTH INFORMATION TECHNOLOGY. 
The Secretary of Veterans Affairs shall establish a 
health information technology pilot program to ensure a 
continuum of quality of care for rural veterans who receive 
health care provided by the Secretary both directly 
through facilities of the Department of Veterans Affairs 
and as fee-basis care through non-Department providers 
and facilities, including, where appropriate, community 
health centers, rural health clinics, and critical access hos-
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pitals. The pilot program shall be conducted for a period 
of four years. 
SEC. 6. ADVISORY COMMITTEE ON RURAL VETERANS. 
(a) NEW ADVISORY COMMITTEE.—Chapter 5 of title 
38, United States Code, is amended by adding at the end 
the following new section: 
‘‘§ 546. Advisory Committee on Rural Veterans 
‘‘(a)(1) The Secretary shall establish an advisory 
committee to be known as the Advisory Committee on 
Rural Veterans (hereinafter in this section referred to as 
‘the Committee’). 
‘‘(2)(A) The Committee shall consist of members ap-
pointed by the Secretary from the general public, includ-
ing— 
‘‘(i) representatives of rural veterans; 
‘‘(ii) individuals who are recognized authorities 
in fields pertinent to the needs of rural veterans, in-
cluding specific or unique health-care needs of rural 
veterans and access issues of rural veterans; 
‘‘(iii) individuals who have expertise in the de-
livery of mental health care in rural areas; 
‘‘(iv) individuals who have expertise in the deliv-
ery of long-term care in rural areas; 
‘‘(v) at least one veterans service organization 
representative from a rural State; and 
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‘‘(vi) representatives of rural veterans with 
service-connected disabilities. 
‘‘(B) The Committee shall include, as ex officio mem-
bers— 
‘‘(i) the Secretary of Health and Human Serv-
ices (or a representative of the Secretary of Health 
and Human Services designated by that Secretary); 
‘‘(ii) the Director of the Indian Health Service 
(or a representative of that Director); and 
‘‘(iii) the Under Secretary for Health and the 
Under Secretary for Benefits, or their designees. 
‘‘(C) The Secretary may invite representatives of 
other departments and agencies of the United States to 
participate in the meetings and other activities of the 
Committee. 
‘‘(3) The Secretary shall determine the number, 
terms of service, and pay and allowances of members of 
the Committee appointed by the Secretary, except that a 
term of service of any such member may not exceed three 
years. The Secretary may reappoint any such member for 
additional terms of service. 
‘‘(b) The Secretary shall, on a regular basis, consult 
with and seek the advice of the Committee with respect 
to the administration of benefits by the Department for 
rural veterans, reports and studies pertaining to rural vet-
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erans, and the needs of rural veterans with respect to pri-
mary care, mental health care, and long-term care needs 
of rural veterans. 
‘‘(c)(1) Not later than September 1 of each odd-num-
bered year through 2013, the Committee shall submit to 
the Secretary a report on the programs and activities of 
the Department that pertain to rural veterans. Each such 
report shall include— 
‘‘(A) an assessment of the needs of rural vet-
erans with respect to primary care, mental health 
care, and long-term care needs of rural veterans and 
other benefits and programs administered by the 
Department; 
‘‘(B) a review of the programs and activities of 
the Department designed to meet such needs; and 
‘‘(C) such recommendations (including rec-
ommendations for administrative and legislative ac-
tion) as the Committee considers appropriate. 
‘‘(2) The Secretary shall, within 60 days after receiv-
ing each report under paragraph (1), submit to the Con-
gress a copy of the report, together with any comments 
concerning the report that the Secretary considers appro-
priate. 
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‘‘(3) The Committee may also submit to the Sec-
retary such other reports and recommendations as the 
Committee considers appropriate. 
‘‘(4) The Secretary shall submit with each annual re-
port submitted to the Congress pursuant to section 529 
of this title a summary of all reports and recommendations 
of the Committee submitted to the Secretary since the pre-
vious annual report of the Secretary submitted pursuant 
to such section.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by adding 
at the end the following new item: 
‘‘546. Advisory Committee on Rural Veterans.’’. 
SEC. 7. RURAL HEALTH RESEARCH, EDUCATION, AND CLIN-
ICAL CARE CENTERS. 
(a) IN GENERAL.—(1) Subchapter II of chapter 73 
of title 38, United States Code, is amended by adding at 
the end the following new section: 
‘‘§ 7329. Rural health research, education, and clin-
ical care centers 
‘‘(a) The Secretary, upon the recommendation of the 
Under Secretary for Health and pursuant to the provi-
sions of this section, shall designate a minimum of four 
Department health care facilities as the locations for cen-
ters of rural health research, education, and clinical activi-
ties and (subject to the appropriation of sufficient funds 
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for such purpose) shall establish and operate such centers 
at such locations in accordance with this section. 
‘‘(b) The centers established under this section 
shall— 
‘‘(1) conduct research on rural health services; 
‘‘(2) allow the Department to use specific mod-
els for furnishing services to treat rural veterans; 
‘‘(3) provide education and training for health 
care professionals of the Department; and 
‘‘(4) develop and implement innovative clinical 
activities and systems of care for the Department. 
‘‘(c) In designating locations for centers under sub-
section (a), the Secretary, upon the recommendation of the 
Under Secretary for Health, shall— 
‘‘(1) assure appropriate geographic distribution 
of such centers; 
‘‘(2) assure that one of the centers shall focus 
on mental health, including substance abuse treat-
ment; 
‘‘(3) assure that one of the centers shall focus 
on case management of chronic diseases; 
‘‘(4) assure that one of the centers shall focus 
on telemedicine; and 
‘‘(5) assure that at least one of the centers 
shall be located to collaborate with a Rural Health 
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Research Center of the Department of Health and 
Human Services in a geographic service area of the 
Department of Veterans Affairs that includes several 
rural States. 
‘‘(d) The Secretary may not designate a health care 
facility as a location for a center under subsection (a) un-
less the peer review panel established under subsection (e) 
has determined under that subsection that the proposal 
submitted by such facility as a location for a new center 
under subsection (a) is among those proposals that have 
met the highest competitive standards of scientific and 
clinical merit and the Secretary (upon the recommenda-
tion of the Under Secretary for Health) determines that 
the facility has (or may reasonably be anticipated to de-
velop) each of the following: 
‘‘(1) An arrangement under which medical, 
nursing, or allied health personnel receive training 
and education in the unique aspects of rural care 
through regular rotation through rurally located fa-
cilities and community based outpatient clinics. 
‘‘(2) The ability to attract the participation of 
scientists and clinicians who are capable of ingenuity 
and creativity in health care research efforts. 
‘‘(3) A policymaking advisory committee com-
posed of appropriate health care and research rep-
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resentatives of the facility and of the affiliated 
school or schools to advise the directors of such fa-
cility and such center on policy matters pertaining to 
the activities of such center during the period of the 
operation of such center. 
‘‘(4) The capability to coordinate, as part of an 
integrated national system, education, clinical, and 
research activities within all facilities with such cen-
ters. 
‘‘(5) The capability to jointly develop a consor-
tium of providers with interest in improving quality 
care in rural areas. 
‘‘(6) The capability to develop a national reposi-
tory for the collection of best practices and evidenced 
based care to rural veterans. 
‘‘(7) The capability to effectively conduct eval-
uations of the activities of such center. 
‘‘(e)(1) In order to provide advice to assist the Sec-
retary and the Under Secretary for Health in carrying out 
their responsibilities under this section, the Assistant 
Under Secretary for Health shall establish a panel to as-
sess the scientific and clinical merit of proposals that are 
submitted to the Secretary for the establishment of new 
centers under this section. 
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‘‘(2) The membership of the panel shall consist of ex-
perts in the fields pertinent to the needs of rural veterans, 
including mental health care and long-term care. Members 
of the panel shall serve as consultants to the Department 
for a period of no longer than six months. 
‘‘(3) The panel shall review each proposal submitted 
to the panel by the Assistant Under Secretary and shall 
submit its views on the relative scientific and clinical merit 
of each such proposal to the Assistant Under Secretary. 
‘‘(4) The panel shall not be subject to the Federal 
Advisory Committee Act. 
‘‘(f) Before providing funds for the operation of any 
such center at a health care facility other than a health 
care facility designated under subsection (c)(1), the Sec-
retary shall assure that the center at each facility des-
ignated under such subsection is receiving adequate fund-
ing to enable such center to function effectively in the 
areas of rural health care research, education, and clinical 
activities. 
‘‘(g) There are authorized to be appropriated such 
sums as may be necessary for the support of the research 
and education activities of the centers established pursu-
ant to subsection (a). The Under Secretary for Health 
shall allocate to such centers from other funds appro-
priated generally for the Department medical care account 
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