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. 
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 Improvement Act of 2009’’. 
SEC. 2. TRAVEL REIMBURSEMENT FOR VETERANS RECEIV-
ING TREATMENT AT FACILITIES OF THE DE-
PARTMENT OF VETERANS AFFAIRS. 
(a) IN GENERAL.—Section 111 of title 38, United 
States Code, is amended— 
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(1) in subsection (a), by striking ‘‘traveled,’’ 
and inserting ‘‘(at a rate of 41.5 cents per mile),’’; 
(2) by striking subsection (g); and 
(3) by redesignating subsection (h) as sub-
section (g). 
(b) CLARIFICATION
OF
RELATION
TO
PUBLIC 
TRANSPORTATION IN VETERANS HEALTH ADMINISTRA-
TION HANDBOOK.—Not later than 30 days after the date 
of the enactment of this Act, the Secretary of Veterans 
Affairs shall revise the Veterans Health Administration 
Handbook to clarify that an allowance for travel based on 
mileage paid under section 111(a) of title 38, United 
States Code, may exceed the cost of such travel by public 
transportation regardless of medical necessity. 
SEC. 3. CENTERS OF EXCELLENCE FOR RURAL HEALTH RE-
SEARCH, EDUCATION, AND CLINICAL ACTIVI-
TIES. 
(a) IN GENERAL.—Subchapter II of chapter 73 of 
title 38, United States Code, is amended by adding at the 
end the following new section: 
‘‘§ 7330B. Centers of excellence for rural health re-
search, education, and clinical activities 
‘‘(a) ESTABLISHMENT OF CENTERS.—The Secretary, 
through the Director of the Office of Rural Health, shall 
establish and operate not less than one and not more than 
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five centers of excellence for rural health research, edu-
cation, and clinical activities, which shall— 
‘‘(1) conduct research on the provision of health 
services in rural areas; 
‘‘(2) develop specific models to be used by the 
Department in furnishing health services to veterans 
in rural areas; 
‘‘(3) provide education and training for health 
care professionals of the Department on the fur-
nishing of health services to veterans in rural areas; 
and 
‘‘(4) develop and implement innovative clinical 
activities and systems of care for the Department 
for the furnishing of health services to veterans in 
rural areas. 
‘‘(b) GEOGRAPHIC DISPERSION.—The Secretary shall 
ensure that the centers established under this section are 
located at health care facilities that are geographically dis-
persed throughout the United States. 
‘‘(c) SELECTION CRITERIA.—The Secretary may not 
designate a health care facility as a location for a center 
under this section unless— 
‘‘(1) the peer review panel established under 
subsection (d) determines that the proposal sub-
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mitted by such facility meets the highest competitive 
standards of scientific and clinical merit; and 
‘‘(2) the Secretary determines that such facility 
has, or may reasonably be anticipated to develop, the 
following: 
‘‘(A) An arrangement with an accredited 
medical school to provide residents with edu-
cation and training in health services for vet-
erans in rural areas. 
‘‘(B) The ability to attract the participa-
tion of scientists who are capable of ingenuity 
and creativity in health care research efforts. 
‘‘(C) A policymaking advisory committee, 
composed of appropriate health care and re-
search representatives of the facility and of the 
affiliated school or schools, to advise the direc-
tors of such facility and such center on policy 
matters pertaining to the activities of such cen-
ter during the period of the operation of such 
center. 
‘‘(D) The capability to conduct effectively 
evaluations of the activities of such center. 
‘‘(d) PANEL TO EVALUATE PROPOSALS.—(1) The 
Director of the Office of Rural Health shall establish a 
panel— 
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‘‘(A) to evaluate the scientific and clinical merit 
of proposals submitted to establish centers under 
this section; and 
‘‘(B) to provide advice to the Director regarding 
the implementation of this section. 
‘‘(2) The panel shall review each proposal received 
from the Secretary and shall submit its views on the rel-
ative scientific and clinical merit of each such proposal to 
the Secretary. 
‘‘(3) The panel established under paragraph (1) shall 
be comprised of experts in the fields of public health re-
search, education, and clinical care. 
‘‘(4) Members of the panel shall serve as consultants 
to the Department for a period not to exceed two years. 
‘‘(5) The panel shall not be subject to the Federal 
Advisory Committee Act (5 U.S.C. App.). 
‘‘(e) FUNDING.—(1) There are authorized to be ap-
propriated to the Medical Care Account and the Medical 
and Prosthetics Research Account of the Department of 
Veterans Affairs such sums as may be necessary for the 
support of the research and education activities of the cen-
ters operated under this section. 
‘‘(2) There shall be allocated to the centers operated 
under this section, from amounts authorized to be appro-
priated to the Medical Care Account and the Medical and 
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Prosthetics Research Account by paragraph (1), such 
amounts as the Under Secretary of health considers ap-
propriate for such centers. Such amounts shall be allo-
cated through the Director of the Office of Rural Health. 
‘‘(3) Activities of clinical and scientific investigation 
at each center operated under this section— 
‘‘(A) shall be eligible to compete for the award 
of funding from funds appropriated for the Medical 
and Prosthetics Research Account; and 
‘‘(B) shall receive priority in the award of fund-
ing from such account to the extent that funds are 
awarded to projects for research in the care of rural 
veterans.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of chapter 73 of such title is amended 
by inserting after the item relating to section 7330A the 
following new item: 
‘‘7330B. Centers of excellence for rural health research, education, and clinical 
activities.’’. 
SEC. 4. TRANSPORTATION GRANTS FOR RURAL VETERANS 
SERVICE ORGANIZATIONS. 
(a) GRANTS AUTHORIZED.— 
(1) IN GENERAL.—The Secretary of Veterans 
Affairs shall establish a grant program to provide in-
novative transportation options to veterans in highly 
rural areas. 
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(2) USE
OF
FUNDS.—Grants awarded under 
this section may be used by State veterans’ service 
agencies and veterans service organizations to— 
(A) assist veterans in highly rural areas to 
travel to Department of Veterans Affairs med-
ical centers; and 
(B) otherwise assist in providing medical 
care to veterans in highly rural areas. 
(3) MAXIMUM
AMOUNT.—The amount of a 
grant under this section may not exceed $50,000. 
(4) NO MATCHING REQUIREMENT.—The recipi-
ent of a grant under this section shall not be re-
quired to provide matching funds as a condition for 
receiving such grant. 
(b) REGULATIONS.—The Secretary shall prescribe 
regulations for— 
(1) evaluating grant applications under this sec-
tion; and 
(2) otherwise administering the program estab-
lished by this section. 
(c) VETERANS
SERVICE
ORGANIZATION
DEFINI-
TION.—In this section, the term ‘‘veterans service organi-
zation’’ means any organization recognized by the Sec-
retary of Veterans Affairs for the representation of vet-
erans under section 5902 of title 38, United States Code. 
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(d) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated $3,000,000 for each of 
fiscal years 2009 through 2013 to carry out this section. 
SEC. 5. DEMONSTRATION PROJECTS ON ALTERNATIVES 
FOR EXPANDING CARE FOR VETERANS IN 
RURAL AREAS. 
(a) IN GENERAL.—The Secretary of Veterans Af-
fairs, through the Director of the Office of Rural Health, 
shall carry out demonstration projects to examine the fea-
sibility and advisability of alternatives for expanding care 
for veterans in rural areas, including the following: 
(1) Establishing a partnership between the De-
partment of Veterans Affairs and the Centers for 
Medicare and Medicaid Services of the Department 
of Health and Human Services to coordinate care 
for veterans in rural areas at critical access hospitals 
(as designated or certified under section 1820 of the 
Social Security Act (42 U.S.C. 1395i–4)). 
(2) Establishing a partnership between the De-
partment of Veterans Affairs and the Department of 
Health and Human Services to coordinate care for 
veterans in rural areas at community health centers. 
(3) Expanding coordination between the De-
partment of Veterans Affairs and the Indian Health 
Service to expand care for Indian veterans. 
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(b) GEOGRAPHIC DISTRIBUTION.—The Secretary of 
Veterans Affairs shall ensure that the demonstration 
projects carried out under subsection (a) are located at 
facilities that are geographically distributed throughout 
the United States. 
(c) REPORT.—Not later than two years after the date 
of the enactment of this Act, the Secretary of Veterans 
Affairs shall submit a report on the results of the dem-
onstration projects conducted under subsection (a) to— 
(1) the Committee on Veterans’ Affairs and the 
Committee on Appropriations of the Senate; and 
(2) the Committee on Veterans’ Affairs and the 
Committee on Appropriations of the House of Rep-
resentatives. 
(d) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated $350,000,000 for each 
of fiscal years 2009 through 2011 to carry out this sec-
tion. 
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SEC. 6. PROGRAM ON PROVISION OF READJUSTMENT AND 
MENTAL HEALTH CARE SERVICES TO VET-
ERANS WHO SERVED IN OPERATION IRAQI 
FREEDOM AND OPERATION ENDURING FREE-
DOM. 
(a) PROGRAM REQUIRED.—Not later than 180 days 
after the date of the enactment of this Act, the Secretary 
of Veterans Affairs shall establish a program to provide— 
(1) to veterans of Operation Iraqi Freedom and 
Operation Enduring Freedom, particularly veterans 
who served in such operations while in the National 
Guard and the Reserves— 
(A) peer outreach services; 
(B) peer support services; 
(C) readjustment counseling and services 
described in section 1712A of title 38, United 
States Code; and 
(D) mental health services; and 
(2) to members of the immediate family of such 
a veteran, during the three-year period beginning on 
the date of the return of such veteran from deploy-
ment in Operation Iraqi Freedom and Operation 
Enduring Freedom, education, support, counseling, 
and mental health services to assist in— 
(A) the readjustment of such veteran to ci-
vilian life; 
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(B) in the case such veteran has an injury 
or illness incurred during such deployment, the 
recovery of such veteran; and 
(C) the readjustment of the family fol-
lowing the return of such veteran. 
(b) 
CONTRACTS
WITH
COMMUNITY
MENTAL 
HEALTH CENTERS AND QUALIFIED ENTITIES FOR PRO-
VISION OF SERVICES.—In carrying out the program re-
quired by subsection (a), the Secretary shall contract with 
community mental health centers and other qualified enti-
ties to provide the services required by such subsection 
only in areas the Secretary determines are not adequately 
served by other health care facilities of the Department 
of Veterans Affairs. Such contracts shall require each con-
tracting community health center or entity— 
(1) to the extent practicable, to employ veterans 
trained under subsection (c); 
(2) to the extent practicable, to use telehealth 
services for the delivery of services required by sub-
section (a); 
(3) to participate in the training program con-
ducted in accordance with subsection (d); 
(4) to comply with applicable protocols of the 
Department of Veterans Affairs before incurring any 
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liability on behalf of the Department for the provi-
sion of the services required by subsection (a); 
(5) to submit annual reports to the Secretary 
containing, with respect to the program required by 
subsection (a) and for the last full calendar year 
ending before the submission of such report— 
(A) the number of the veterans served, vet-
erans diagnosed, and courses of treatment pro-
vided to veterans as part of the program re-
quired by subsection (a); and 
(B) demographic information for such 
services, diagnoses, and courses of treatment; 
(6) for each veteran for whom a community 
mental health center or other qualified entity pro-
vides mental health services under such contract, to 
provide the Department of Veterans Affairs with 
such clinical summary information as the Secretary 
shall require; and 
(7) to meet such other requirements as the Sec-
retary shall require. 
(c) TRAINING OF VETERANS FOR THE PROVISION OF 
PEER-OUTREACH
AND PEER-SUPPORT SERVICES.—In 
carrying out the program required by subsection (a), the 
Secretary shall contract with a national not-for-profit 
mental health organization to carry out a national pro-
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gram of training for veterans described in subsection (a) 
to provide the services described in subparagraphs (A) and 
(B) of paragraph (1) of such subsection. 
(d) TRAINING OF CLINICIANS FOR PROVISION OF 
SERVICES.—The Secretary shall conduct a training pro-
gram for clinicians of community mental health centers 
or entities that have contracts with the Secretary under 
subsection (b) to ensure that such clinicians can provide 
the services required by subsection (a) in a manner that— 
(1) recognizes factors that are unique to the ex-
perience of veterans who served on active duty in 
Operation Iraqi Freedom or Operation Enduring 
Freedom (including their combat and military train-
ing experiences); and 
(2) utilizes best practices and technologies. 
(e) REPORTS REQUIRED.— 
(1) INITIAL REPORT ON PLAN FOR IMPLEMEN-
TATION.—Not later than 45 days after the date of 
the enactment of this Act, the Secretary shall submit 
to the Committee on Veterans’ Affairs of the Senate 
and the Committee on Veterans’ Affairs of the 
House of Representatives a report containing the 
plans of the Secretary to implement the program re-
quired by subsection (a). 
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(2) STATUS REPORT.—Not later than one year 
after the date of the enactment of this Act, the Sec-
retary shall submit to the Committee on Veterans’ 
Affairs of the Senate and the Committee on Vet-
erans’ Affairs of the House of Representatives a re-
port on the implementation of the program. Such re-
port shall include the following: 
(A) Information on the number of veterans 
who received services as part of the program 
and the type of services received during the last 
full calendar year completed before the submis-
sion of such report. 
(B) An evaluation of the provision of serv-
ices under paragraph (2) of subsection (a) and 
a recommendation as to whether the period de-
scribed in such paragraph should be extended 
to a five-year period. 
SEC. 7. IMPROVEMENT OF CARE OF AMERICAN INDIAN 
VETERANS. 
(a) INDIAN HEALTH COORDINATORS.— 
(1) IN GENERAL.—Subchapter II of chapter 73 
of title 38, United States Code, as amended by sec-
tion 3, is further amended by adding at the end the 
following new section: 
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‘‘§ 7330C. Indian Veterans Health Care Coordinators 
‘‘(a) IN GENERAL.—(1) The Secretary shall assign 
at each of the 10 Department Medical Centers that serve 
communities with the greatest number of Indian veterans 
per capita an official or employee of the Department to 
act as the coordinator of health care for Indian veterans 
at such Medical Center. The official or employee so as-
signed at a Department Medical Center shall be known 
as the ‘Indian Veterans Health Care Coordinator’ for the 
Medical Center. 
‘‘(2) The Secretary shall, from time to time— 
‘‘(A) survey the Department Medical Centers 
for purposes of identifying the 10 Department Med-
ical Centers that currently serve communities with 
the greatest number of Indian veterans per capita; 
and 
‘‘(B) utilizing the results of the most recent 
survey conducted under subparagraph (A), revise the 
assignment of Indian Veterans Health Care Coordi-
nators in order to assure the assignment of such co-
ordinators to appropriate Department Medical Cen-
ters as required by paragraph (1). 
‘‘(b) DUTIES.—The duties of a Indian Veterans 
Health Care Coordinator shall include the following: 
‘‘(1) Improving outreach to tribal communities. 
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‘‘(2) Coordinating the medical needs of Indian 
veterans on Indian reservations with the Veterans 
Health Administration and the Indian Health Serv-
ice. 
‘‘(3) Expanding the access and participation of 
Department of Veterans Affairs, Indian Health 
Service, and tribal members in the Department of 
Veterans Affairs Tribal Veterans Representative pro-
gram. 
‘‘(4) Acting as an ombudsman for Indian vet-
erans enrolled in the health care system of the Vet-
erans Health Administration. 
‘‘(5) Advocating for the incorporation of tradi-
tional medicine and healing in Department treat-
ment plans for Indian veterans in need of care and 
services provided by the Department. 
‘‘(c) NATIVE AMERICAN DEFINED.—In this section, 
the term ‘Indian’ has the meaning given the term in sec-
tion 4 of the Indian Self-Determination and Education As-
sistance Act (25 U.S.C. 450b).’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of chapter 73 of such title, as 
amended by section 3, is further amended by insert-
ing after the item relating to section 7330B the fol-
lowing new item: 
‘‘7330C. Indian Veterans Health Coordinators.’’. 
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the date of the enactment of this Act, the Secretary of 
Veterans Affairs and the Secretary of Health and Human 
Services shall jointly submit to Congress a report on the 
feasability and advisability of the joint establishment and 
operation by the Veterans Health Administration and the 
Indian Health Service of health clinics on Indian reserva-
tions to serve the populations of such reservations, includ-
ing Indian veterans. 
SEC. 8. ANNUAL REPORT TO CONGRESS ON MATTERS RE-
LATED TO CARE FOR VETERANS WHO LIVE IN 
RURAL AREAS. 
(a) ANNUAL REPORT.—The Secretary of Veterans 
Affairs shall submit to Congress each year, together with 
documents submitted to Congress in support of the budget 
of the President for the fiscal year beginning in such year 
(as submitted pursuant to section 1105 of title 31, United 
States Code), an assessment, current as of the fiscal year 
ending in the year before such report is submitted, of the 
following: 
(1) The implementation of the provisions of this 
Act, including the amendments made by this Act. 
(2) The establishment and function of the Of-
fice of Rural Health under section 7308 of title 38, 
United States Code. 
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(b) ADDITIONAL REQUIREMENTS FOR INITIAL RE-
PORT.—The first report submitted under subsection (a) 
shall also include the following: 
(1) The assessment of fee-basis health-care pro-
gram required by section 212(b) of the Veterans 
Benefits, Health Care, and Information Technology 
Act of 2006 (Public Law 109–461; 120 Stat. 3422). 
(2) An assessment of the outreach program re-
quired by section 213 of such Act (120 Stat. 3422; 
38 U.S.C. 6303 note). 
Æ 
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