I 
114TH CONGRESS 
1ST SESSION H. R. 4011 
To increase the number of graduate medical education positions treating 
veterans, to improve the compensation of health care providers, medical 
directors, and directors of Veterans Integrated Service Networks of the 
Department of Veterans Affairs, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 16, 2015 
Mr. GALLEGO (for himself, Mrs. KIRKPATRICK, Ms. PINGREE, Mr. HONDA, 
and Ms. ESTY) introduced the following bill; which was referred to the 
Committee on Veterans’ Affairs, and in addition to the Committees on 
Ways and Means and Energy and Commerce, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To increase the number of graduate medical education posi-
tions treating veterans, to improve the compensation of 
health care providers, medical directors, and directors 
of Veterans Integrated Service Networks of the Depart-
ment of Veterans Affairs, 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; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Delivering Opportunities for Care and Services for Vet-
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erans Act of 2015’’ or the ‘‘DOCs for Veterans Act of 
2015’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—MEDICAL EDUCATION AND TRAINING 
Sec. 101. Disregard of resident slots that include VA training against the Medi-
care graduate medical education limitations. 
Sec. 102. Extension of period for increase in graduate medical education resi-
dency positions at medical facilities of the Department of Vet-
erans Affairs. 
Sec. 103. Pilot program on graduate medical education residency programs in 
behavioral medicine in underserved areas. 
Sec. 104. Inclusion of mental health professionals in education and training 
program for health personnel of the Department of Veterans 
Affairs. 
Sec. 105. Expansion of qualifications for licensed mental health counselors of 
the Department of Veterans Affairs to include doctoral de-
grees. 
TITLE II—HEALTH CARE PROVIDERS OF THE DEPARTMENT OF 
VETERANS AFFAIRS 
Sec. 201. Requirement that physician assistants employed by the Department 
of Veterans Affairs receive competitive pay. 
Sec. 202. Modification of education debt reduction program of Department of 
Veterans Affairs to require a certain amount to be spent in 
rural and highly rural areas. 
Sec. 203. Report on medical workforce of the Department of Veterans Affairs. 
TITLE III—LEADERSHIP OF THE VETERANS HEALTH 
ADMINISTRATION 
Sec. 301. Establishment of positions of Directors of Veterans Integrated Serv-
ice Networks in Office of Under Secretary for Health of De-
partment of Veterans Affairs and modification of qualifications 
for Medical Directors. 
Sec. 302. Pay for Medical Directors and Directors of Veterans Integrated Serv-
ice Networks. 
TITLE IV—OTHER HEALTH CARE MATTERS 
Sec. 401. Pilot program on providing nurse advice line for veterans in rural and 
highly rural areas. 
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TITLE I—MEDICAL EDUCATION 
AND TRAINING 
SEC. 101. DISREGARD OF RESIDENT SLOTS THAT INCLUDE 
VA TRAINING AGAINST THE MEDICARE GRAD-
UATE MEDICAL EDUCATION LIMITATIONS. 
(a) DIRECT GME.—Section 1886(h)(4)(F) of the So-
cial Security Act (42 U.S.C. 1395ww(h)(4)(F)) is amend-
ed by adding at the end the following new clause: 
‘‘(iii) DISREGARD OF CERTAIN RESI-
DENT
SLOTS
THAT
INCLUDE
VA
TRAIN-
ING.—For portions of cost reporting peri-
ods beginning on or after July 1, 2017, in 
applying the limitations under clause (i) 
regarding the total number of full-time 
equivalent 
residents 
in 
the 
field 
of 
allopathic or osteopathic medicine in a hos-
pital’s approved medical residency training 
program, the Secretary shall not take into 
account any full-time equivalent resident 
within such program that is filling a grad-
uate medical education residency position 
that counts towards meeting the obligation 
of the Secretary of Veterans Affairs au-
thorized under section 301(b)(2)(A) of the 
Veterans Access, Choice, and Account-
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ability Act of 2014 (Public Law 113–146; 
38 U.S.C. 7302 note).’’. 
(b) INDIRECT GME.—Section 1886(d)(5)(B)(v) of 
the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(v)) 
is amended, in the second sentence, by striking ‘‘sub-
section (h)(4)(F)(ii)’’ and inserting ‘‘clauses (ii) and (iii) 
of subsection (h)(4)(F)’’. 
SEC. 102. EXTENSION OF PERIOD FOR INCREASE IN GRAD-
UATE MEDICAL EDUCATION RESIDENCY PO-
SITIONS AT MEDICAL FACILITIES OF THE DE-
PARTMENT OF VETERANS AFFAIRS. 
(a) IN GENERAL.—Paragraph (2) of subsection (b) 
of section 301 of the Veterans Access, Choice, and Ac-
countability Act of 2014 (Public Law 113–146; 38 U.S.C. 
7302 note) is amended— 
(1) in the paragraph heading, by striking 
‘‘FIVE-YEAR’’ and inserting ‘‘TEN-YEAR’’; and 
(2) in subparagraph (A), by striking ‘‘5-year 
period’’ and inserting ‘‘10-year period’’. 
(b) REPORT.—Paragraph (3)(A) of such subsection 
is amended by striking ‘‘until 2019’’ and inserting ‘‘until 
2024’’. 
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SEC. 103. PILOT PROGRAM ON GRADUATE MEDICAL EDU-
CATION RESIDENCY PROGRAMS IN BEHAV-
IORAL MEDICINE IN UNDERSERVED AREAS. 
(a) PILOT PROGRAM.—Commencing not later than 
one year after the date of the enactment of this Act, the 
Secretary of Veterans Affairs and the Secretary of Health 
and Human Services shall jointly conduct a six-year pilot 
program to establish not less than three graduate medical 
education residency programs in behavioral medicine in 
underserved areas in the United States. 
(b) ELEMENTS.—Each graduate medical education 
residency program established under the pilot program 
shall— 
(1) provide residents participating in the grad-
uate medical education residency program with an 
opportunity to work with a diverse patient popu-
lation through a rotation between medical facilities 
of the Department of Veterans Affairs, facilities of 
the Indian Health Service, and facilities partici-
pating under the Medicare program under title 
XVIII of the Social Security Act (42 U.S.C. 1395 et 
seq.); 
(2) include graduate medical education in the 
field of behavioral medicine; 
(3) be carried out in a manner consistent with 
graduate medical education residency programs sup-
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ported and funded by the Department of Veterans 
Affairs and the Department of Health and Human 
Services; 
(4) be located in a community that— 
(A) is designated as a medically under-
served area under section 330(b)(3)(A) of the 
Public 
Health 
Service 
Act 
(42 
U.S.C. 
254b(b)(3)(A)); 
(B) is in a State with a per capita popu-
lation of veterans of more than 9 percent ac-
cording to the National Center for Veterans 
Analysis and Statistics and the United States 
Census Bureau; and 
(C) is within 100 miles of a Reservation 
(as defined in Section 3(d) of the Indian Fi-
nancing Act of 1974 (25 U.S.C. 1452)). 
(c) REPORT.— 
(1) IN
GENERAL.—Not later than 180 days 
after the date of the commencement of the pilot pro-
gram and not less frequently than once each year 
thereafter while the pilot program is being carried 
out, the Secretary of Veterans Affairs and the Sec-
retary of Health and Human Services shall, in con-
sultation with representatives from facilities partici-
pating under the Medicare program under title 
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XVIII of the Social Security Act (42 U.S.C. 1395 et 
seq.) that are participating in the pilot program, 
jointly submit to Congress a report on the imple-
mentation of the pilot program. 
(2) ELEMENTS.—Each report required by para-
graph (1) shall include the following: 
(A) A description of the patient population 
served by the residents participating in a grad-
uate medical education residency program 
under the pilot program. 
(B) A description of the behavioral medi-
cine services provided under the pilot program, 
including the extent to which those services 
were provided using telemedicine services. 
(C) The academic affiliation of each resi-
dent participating in a graduate medical edu-
cation residency program under the pilot pro-
gram. 
(D) A description of any impediments 
faced in carrying out the pilot program and ac-
tions taken by the Secretary of Veterans Affairs 
and the Secretary of Health and Human Serv-
ices to address those impediments. 
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SEC. 104. INCLUSION OF MENTAL HEALTH PROFESSIONALS 
IN EDUCATION AND TRAINING PROGRAM FOR 
HEALTH PERSONNEL OF THE DEPARTMENT 
OF VETERANS AFFAIRS. 
(a) IN GENERAL.—In carrying out the education and 
training program required under section 7302(a)(1) of 
title 38, United States Code, the Secretary of Veterans 
Affairs shall include education and training of marriage 
and family therapists and licensed professional mental 
health counselors. 
(b) APPORTIONMENT OF FUNDING.—The Secretary 
shall apportion funding for the education and training 
program described in subsection (a) equally among the 
professions included in the program. 
SEC. 105. EXPANSION OF QUALIFICATIONS FOR LICENSED 
MENTAL HEALTH COUNSELORS OF THE DE-
PARTMENT OF VETERANS AFFAIRS TO IN-
CLUDE DOCTORAL DEGREES. 
Section 7402(b)(11)(A) of title 38, United States 
Code, is amended by inserting ‘‘or doctoral degree’’ after 
‘‘master’s degree’’. 
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TITLE II—HEALTH CARE PRO-
VIDERS 
OF 
THE 
DEPART-
MENT OF VETERANS AFFAIRS 
SEC. 201. REQUIREMENT THAT PHYSICIAN ASSISTANTS EM-
PLOYED BY THE DEPARTMENT OF VETERANS 
AFFAIRS RECEIVE COMPETITIVE PAY. 
Section 7451(a)(2) of title 38, United States Code, 
is amended— 
(1) by redesignating subparagraph (B) as sub-
paragraph (C); 
(2) by inserting after subparagraph (A) the fol-
lowing new subparagraph (B): 
‘‘(B) Physician assistant.’’; and 
(3) in subparagraph (C), as redesignated by 
paragraph (1), by striking ‘‘and registered nurse’’ 
and inserting ‘‘registered nurse, and physician as-
sistant’’. 
SEC. 202. MODIFICATION OF EDUCATION DEBT REDUCTION 
PROGRAM OF DEPARTMENT OF VETERANS 
AFFAIRS TO REQUIRE A CERTAIN AMOUNT 
TO BE SPENT IN RURAL AND HIGHLY RURAL 
AREAS. 
Section 7681 of title 38, United States Code, is 
amended by adding at the end the following new sub-
sections: 
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‘‘(c) LIMITATION ON AMOUNTS.—Not less than 30 
percent of the amount of debt reduction payments paid 
under the Education Debt Reduction Program each year 
shall be paid to individuals who practice medicine in a 
rural area or highly rural area or demonstrate a commit-
ment to practice medicine in such an area. 
‘‘(d) DEFINITIONS.—In this section: 
‘‘(1) The term ‘highly rural area’ means an 
area located in a county or similar community that 
has less than seven individuals residing in that coun-
ty or community per square mile. 
‘‘(2) The term ‘rural area’ means an area that 
is not an urbanized area or a highly rural area. 
‘‘(3) The term ‘urbanized area’ has the mean-
ing given that term by the Director of the Bureau 
of the Census.’’. 
SEC. 203. REPORT ON MEDICAL WORKFORCE OF THE DE-
PARTMENT OF VETERANS AFFAIRS. 
(a) IN GENERAL.—Not later than 120 days after the 
date of the enactment of this Act, the Secretary of Vet-
erans Affairs shall submit to the Committee on Veterans 
Affairs of the Senate and the Committee on Veterans Af-
fairs of the House of Representatives a report on the med-
ical workforce of the Department of Veterans Affairs. 
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(b) ELEMENTS.—The report required by subsection 
(a) shall include the following: 
(1) With respect to licensed professional mental 
health counselors and marriage and family thera-
pists of the Department— 
(A) how many such counselors and thera-
pists are currently enrolled in the mental health 
professionals trainee program of the Depart-
ment; 
(B) how many such counselors and thera-
pists are expected to enroll in the mental health 
professionals trainee program of the Depart-
ment during the 180-day period beginning on 
the date of the submittal of the report; 
(C) a description of the eligibility criteria 
for such counselors and therapists as compared 
to other behavioral health professions in the 
Department; 
(D) a description of the objectives, goals, 
and timing of the Department with respect to 
increasing the representation of such counselors 
and therapists in the behavioral health work-
force of the Department; and 
(E) a description of the actions taken by 
the Secretary, in consultation with the Director 
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of the Office of Personnel Management, to cre-
ate an occupational series for such counselors 
and therapists and a timeline for the creation 
of such an occupational series. 
(2) A breakdown of spending by the Depart-
ment in connection with the education debt reduc-
tion program of the Department under subchapter 
VII of chapter 76 of title 38, United States Code, 
including— 
(A) the amount spent by the Department 
in debt reduction payments during the three- 
year period preceding the submittal of the re-
port disaggregated by the medical profession of 
the individual receiving the payments; 
(B) a description of how the Department 
prioritizes such spending by medical profession, 
including an assessment of whether such pri-
ority reflects the five occupations identified in 
the most recent determination by the Inspector 
General of the Department of Veterans Affairs 
as having the largest staffing shortages in the 
Veterans Health Administration; and 
(C) a description of the actions taken by 
the Secretary to increase the effectiveness of 
such spending for purposes of recruitment of 
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health care providers to the Department, in-
cluding efforts to more consistently include eli-
gibility for the education debt reduction pro-
gram in vacancy announcements of positions for 
health care providers at the Department. 
(3) A description of any impediments to the de-
livery by the Department of telemedicine services to 
veterans and any actions taken by the Department 
to address such impediments, including with respect 
to— 
(A) restrictions under Federal or State 
laws; 
(B) licensing or credentialing issues for 
health care providers, including non-Depart-
ment health care providers, practicing telemedi-
cine with a veteran located in a different State; 
(C) the effect of limited broadband access 
or limited information technology capabilities on 
the delivery of health care; 
(D) the distance a veteran is required to 
travel to access a facility or clinic with telemedi-
cine capabilities; 
(E) the effect on the provision of telemedi-
cine services to veterans of policies of and lim-
ited liability protection for certain entities; and 
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(F) issues relating to reimbursement and 
travel limitations for veterans that affect the 
participation of non-Department health care 
providers in the telemedicine program. 
(4) An update on the efforts of the Secretary 
to offer training opportunities in telemedicine to 
medical residents in medical facilities of the Depart-
ment that use telemedicine, consistent with medical 
residency program requirements established by the 
Accreditation Council for Graduate Medical Edu-
cation, as required in section 108(b) of the Honoring 
America’s Veterans and Caring for Camp Lejeune 
Families Act of 2012 (Public Law 112–154; 38 
U.S.C. 7406 note). 
(5) An assessment of the development and im-
plementation by the Secretary of succession planning 
policies to address the prevalence of vacancies in po-
sitions in the Veterans Health Administration of 
more than 180 days, including the development of 
an enterprise position management system to more 
effectively identify, track, and resolve such vacan-
cies. 
(6) A description of the actions taken by the 
Secretary, in consultation with the Director of the 
Office of Personnel Management, to address any im-
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pediments to the timely appointment and determina-
tion of qualifications for Directors of Veterans Inte-
grated Service Networks and Medical Directors of 
the Department. 
TITLE III—LEADERSHIP OF THE 
VETERANS HEALTH ADMINIS-
TRATION 
SEC. 301. ESTABLISHMENT OF POSITIONS OF DIRECTORS 
OF VETERANS INTEGRATED SERVICE NET-
WORKS IN OFFICE OF UNDER SECRETARY 
FOR HEALTH OF DEPARTMENT OF VETERANS 
AFFAIRS AND MODIFICATION OF QUALIFICA-
TIONS FOR MEDICAL DIRECTORS. 
Section 7306(a)(4) of title 38, United States Code, 
is amended— 
(1) by inserting ‘‘and Directors of Veterans In-
tegrated Service Networks’’ after ‘‘Such Medical Di-
rectors’’; and 
(2) by striking ‘‘, who shall be either a qualified 
doctor of medicine or a qualified doctor of dental 
surgery or dental medicine’’. 
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SEC. 302. PAY FOR MEDICAL DIRECTORS AND DIRECTORS 
OF VETERANS INTEGRATED SERVICE NET-
WORKS. 
(a) IN GENERAL.—Chapter 74 of title 38, United 
States Code, is amended by adding at the end the fol-
lowing new subchapter: 
‘‘Subchapter VII—Pay for Medical Directors 
and Directors of Veterans Integrated 
Service Networks 
‘‘§ 7481. Pay for Medical Directors and Directors of 
Veterans Integrated Service Networks 
‘‘(a) ELEMENTS OF PAY.—Pay for a Medical Direc-
tor or Director of a Veterans Integrated Service Network 
appointed under section 7306(a)(4) of this title (in this 
section referred to as a ‘Director’) shall consist of basic 
pay set forth under section 7404(a) of this title and mar-
ket pay determined under subsection (b). 
‘‘(b) MARKET PAY.—(1) Each Director is eligible for 
market pay determined under this subsection. 
‘‘(2) The amount of market pay payable to a Director 
under this section shall be determined by the Secretary 
on a case-by-case basis and shall consist of pay intended 
to reflect needs of the Department with respect to the re-
cruitment and retention (as determined by the Secretary) 
of such Director. 
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‘‘(3) In determining the amount of market pay pay-
able to a Director under this section, the Secretary shall— 
‘‘(A) consult not less than two national surveys 
on pay for hospital directors, medical facility direc-
tors, or other similar positions, whether prepared by 
private, public, or quasi-public entities, to make a 
general assessment of the range of potential pay for 
the Director; and 
‘‘(B) take into account— 
‘‘(i) the experience of the Director in man-
aging facilities or program offices of the De-
partment, including the complexity of such fa-
cilities or offices; 
‘‘(ii) the complexity of the facility or facili-
ties to be managed by the Director; 
‘‘(iii) the labor market, in such geographic 
area as the Secretary considers relevant, for 
hospital directors, medical facility directors, and 
other similar positions; 
‘‘(iv) the experience of the Director in 
managing medical facilities for other Federal 
agencies, private entities, or non-profit entities; 
and 
‘‘(v) such other considerations as the Sec-
retary considers appropriate. 
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