II 113th CONGRESS 2d Session S. 2425 IN THE SENATE OF THE UNITED STATES June 4, 2014 Mr. Begich (for himself and Mr. Pryor ) introduced the following bill; which was read twice and referred to the Committee on Veterans' Affairs A BILL To require the Secretary of Veterans Affairs to carry out a pilot program to reduce the shortage of psychiatrists in the Veterans Health Administration of the Department of Veterans Affairs by repaying loans for certain psychiatrists, to carry out a pilot program to provide housing allowances to health care providers of the Veterans Health Administration who accept assignment at rural and highly rural clinics, and for other purposes.

1. Short title This Act may be cited as the Ensuring Veterans’ Resiliency Act . 2. Pilot program on repayment of educational loans for certain psychiatrists of Veterans Health Administration (a) In general The Secretary of Veterans Affairs shall carry out a pilot program to repay loans of individuals described in subsection (b) that— (1) were used by such individuals to finance the educational expenses of such individuals relating to psychiatric medicine, including education leading to— (A) an undergraduate degree; (B) a degree of doctor of medicine; or (C) a degree of doctor of osteopathy; and (2) were obtained from any of the following: (A) A governmental entity. (B) A private financial institution. (C) An institution of higher education. (D) Any other entity as specified the Secretary for purposes of the pilot program. (b) Eligible individuals (1) In general Subject to paragraph (2), an individual eligible for participation in the pilot program is an individual who— (A) either— (i) is licensed or eligible for licensure to practice psychiatric medicine in the Veterans Health Administration of the Department of Veterans Affairs; or (ii) is enrolled in the final year of a residency program leading to a specialty qualification in psychiatric medicine that is approved by the Accreditation Council for Graduate Medical Education; and (B) demonstrates a commitment to a long-term career as a psychiatrist in the Veterans Health Administration, as determined by the Secretary. (2) Prohibition on simultaneous eligibility An individual who is participating in any other program of the Federal Government that repays the educational loans of the individual is not eligible to participate in the pilot program. (c) Selection (1) In general The Secretary shall select not less than 10 individuals described in subsection (b) to participate in the pilot program for each year in which the Secretary carries out the pilot program. (2) Rural or highly rural areas Of the individuals selected under paragraph (1), not less than five shall be individuals who practice psychiatric medicine in a rural area or highly rural area or demonstrate a commitment to practice psychiatric medicine in such an area. (d) Period of obligated service The Secretary shall enter into an agreement with each individual selected under subsection (c) in which such individual agrees to serve a period of obligated service for the Veterans Health Administration in the field of psychiatric medicine, as determined by the Secretary for purposes of the pilot program, in exchange for the repayment of the loan or loans of such individual under the pilot program. (e) Loan Repayments (1) In general Subject to paragraph (2), a loan repayment under this section may consist of payment of the principal, interest, and related expenses of a loan obtained by an individual who is participating in the pilot program for all educational expenses (including tuition, fees, books, and laboratory expenses) of such individual relating to education described in subsection (a)(1). (2) Limit The amount paid by the Secretary under the pilot program for each year of obligated service agreed to by an individual under subsection (d) may not exceed $60,000. (f) Breach (1) Liability An individual who participates in the pilot program and fails to satisfy the period of obligated service under subsection (d) shall be liable to the United States, in lieu of such obligated service, for the amount that has been paid to or on behalf of the individual under the pilot program, reduced by the proportion that the number of days served for completion of the period of obligated service bears to the total number of days in the period of obligated service of such individual. (2) Repayment period Any amount of damages that the United States is entitled to recover under this subsection shall be paid to the United States not later than one year after the date of the breach of the agreement. (g) Report (1) In general Not later than 90 days after the date on which the pilot program terminates under subsection (i), 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 on the pilot program. (2) Elements The report required by paragraph (1) shall include the following: (A) An assessment of the overall effect of the pilot program on the psychiatric workforce shortage of the Veterans Health Administration. (B) A current assessment of the long-term stability of the psychiatric workforce of the Veterans Health Administration. (C) Strategies of the Veterans Health Administration to improve and increase the ability of the Administration to promote the physical and mental resiliency of all veterans. (h) Regulations The Secretary shall prescribe regulations to carry out this section, including standards for qualified loans and authorized payees and other terms and conditions for the making of loan repayments. (i) Termination The authority to carry out the pilot program shall expire on the date that is three years after the date on which the Secretary commences the pilot program. 3. Comptroller General of the United States study on pay disparities of psychiatrists of Veterans Health Administration (a) Study (1) In general Not later than one year after the date of the enactment of this Act, the Comptroller General of the United States shall conduct a study of pay disparities among psychiatrists of the Veterans Health Administration of the Department of Veterans Affairs. (2) Elements The study conducted under paragraph (1) shall include— (A) an examination of laws, regulations, practices, and policies, including salary flexibilities, that contribute to pay disparities described in paragraph (1); and (B) recommendations with respect to legislative or administrative actions to improve equity in pay among psychiatrists of the Veterans Health Administration. (b) Report Not later than one year after the date on which the Comptroller General completes the study under subsection (a), the Comptroller General shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the results of the study. 4. Pilot program on housing allowances for health care providers of Veterans Health Administration accepting assignment at rural and highly rural community-based outpatient clinics (a) Pilot program authorized The Secretary of Veterans Affairs may carry out a pilot program to assess the feasibility and advisability of providing a housing allowance to health care providers of the Veterans Health Administration of the Department of Veterans Affairs who accept assignment at rural or highly rural community-based outpatient clinics as a means of encouraging such health care providers to accept assignment to such clinics. (b) Eligibility An individual is eligible for participation in the pilot program if the individual— (1) is a health care provider; (2) is, or agrees to become, an employee of the Veterans Health Administration on a full-time basis in a health care position designated by the Secretary for purposes of the pilot program; and (3) accepts an assignment in such position for a term of not less than 36 months at a rural or highly rural community-based outpatient clinic selected by the Secretary for purposes of the pilot program. (c) Conditions on payment of housing allowance Except as provided in subsection (d)(3), an individual may be provided a housing allowance under the pilot program only while— (1) in good standing as a health care provider within the Veterans Health Administration; and (2) assigned as a health care provider at a rural or highly rural community-based outpatient clinic. (d) Amount of housing allowance (1) Monthly amount during initial term During the first 36 months of participation in the pilot program, the housing allowance provided a health care provider participating in the pilot program shall be provided on a monthly basis at a rate that is equivalent to the monthly rate of basic allowance for housing (BAH) payable under section 403 of title 37, United States Code, to members of the uniformed services whose grade, dependency status, and geographic location most closely equals, as determined by the Secretary, the grade of such provider under section 7404 of title 38, United States Code, and the dependency status and geographic location of such provider. (2) Monthly amount for certain providers for additional term If upon completion of the first 36 months in the pilot program a health care provider accepts continuing participation in the pilot program at a rural or highly rural community-based outpatient clinic for a term of not less than 12 additional months, the housing allowance provided the health care provider under the pilot program shall be provided on a monthly basis for such additional months at a rate determined in accordance with paragraph (1). (3) Bonus amount (A) Completion of initial term Any health care provider who successfully completes 36 months of participation in the pilot program shall be paid upon completion of participation in the pilot program an amount equal to three months of the monthly rate of housing allowance provided the health care provider under paragraph (1) during the last month before the provider's completion of participation in the pilot program. (B) Completion of additional one-year term Any health care provider who successfully completes 48 months of participation in the pilot program shall be paid upon completion of participation in the pilot program an amount equal to 12 months of the monthly rate of housing allowance provided the health care provider under paragraph (2) during the last month before the provider's completion of participation in the pilot program. (C) Completion of additional two-year term Any health care provider who successfully completes 60 months of participation in the pilot program shall be paid upon completion of participation in the pilot program an amount equal to 13 months of the monthly rate of housing allowance provided the health care provider under paragraph (2) during the last month before the provider's completion of participation in the pilot program. (D) No requirement to remain on assignment An amount payable under this paragraph shall be paid whether or not the health care provider concerned remains in an assignment at a rural or highly rural community-based outpatient clinic. (e) Supplemental nature of allowance Any housing allowance provided under the pilot program shall be in addition to any pay (including basic pay, special pay, and retirement or other bonus pay) payable to personnel of the Veterans Health Administration personnel under chapter 74 of title 38, United States Code, or any other provision of law. (f) Annual reports (1) In general Not later than one year after the date of the enactment of this Act and not less frequently than once each year thereafter while the pilot program is in effect, 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 on the pilot program. (2) Elements Each report submitted under paragraph (1) shall include the following: (A) A current description of the pilot program, including the current number of participants in the pilot program and the amounts of housing allowance being provided such participants. (B) A current assessment of the value of the housing allowance under the pilot program in encouraging health care providers in accepting assignment to rural and highly rural community-based outpatient clinics. (g) Funding Amounts for housing allowances under the pilot program shall be derived from amounts available for the Veterans Health Administration for Medical Services. (h) Sunset (1) In general No individual may commence participation in the pilot program on or after the date that is five years after the date of the enactment of this Act. (2) Continuation of on-going provision of allowance Nothing in paragraph (1) shall be construed to prohibit the Secretary from providing housing allowances under the pilot program to individuals who commence participation in the pilot program before the date that is five years after the date of the enactment of this Act. (i) Rural or highly rural community-Based outpatient clinic defined In this section, the term rural or highly rural community-based outpatient clinic means a community-based outpatient clinic of the Veterans Health Administration that predominantly serves veterans who live in rural areas and highly rural areas. 5. Definitions In this Act: (1) Highly rural area The term highly rural area means an area located in a county or similar community that has less than seven individuals residing in that county or community per square mile. (2) Rural area The term rural area means an area that is not an urbanized area or a highly rural area. (3) Urbanized area The term urbanized area has the meaning given that term by the Director of the Bureau of the Census.