,i  #aac? ,,congress  #a/ ,session  ,h4 
,r4 #fce  ,,9 ,,! ,,h\se ,,(            
,,repres5tatives  ,febru>y #ac1 #bjac   
,mr4 ,pe>ce 7= himself1 ,mr4 ,tipton1   
,mr4 ,"y ( ,alaska1 ,mr4 ,=bes1 ,mr4    
,h>ris1 ,mr4 ,hall1 ,mr4 ,m>*ant1 ,mr4  
,wilson ( ,s\? ,c>ol9a1 ,mr4 ,flores1   
,mr4 ,gohm]t1 ,mr4 ,we/morel&1 ,mr4     
,conaway1 ,mr4 ,rahall1 ,mr4 ,jones1    
,mr4 ,gos>1 & ,mr4 ,posey7 introduc$ !  
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ,vet]ans' ,affairs  ,a    
,,bill  ,to am5d title #ch1 ,unit$      
,/ates ,code1 to require ! ,secret>y (  
,vet]ans ,affairs to ent] into contracts
 ) community heal? c>e provid]s to      
improve access to heal? c>e = vet]ans 9 
highly rural areas1 & = o!r purposes4   
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,help ,e/abli% ,access to ,local      
,timely ,heal?c>e = ,y\r ,vets ,act (   
#bjac or ! ,,heal?y ,vets ,act ( #bjac4 
#b4 ,enhanc$ contract c>e au?ority =    
heal? c>e ne$s ( vet]ans 9 highly rural 
areas  7a7 ,rural ,vet]ans ,section     

#agjc ( title #ch1 ,unit$ ,/ates ,code1 
is am5d$ by add+ at ! end ! foll[+ new  
subsection3  7e7 7#a7 ,9 ! case ( a     
vet]an = :om ,dep>tm5t facilities are   
geographically inaccessible 7z provid$ 9
 p>agraph 7#b771 ! ,secret>y %all use ! 
contract au?ority provid$ 9 subsection  
7a7 = ! foll[+ c>e3  7,a7 ,prim>y c>e4  
7,b7 ,acute or *ronic symptom managem5t4
  7,c7 ,non!rapeutic m$ical s]vices4    
7,d7 ,o!r m$ical s]vices z det]m9$      
appropriate by ! director ( !           
appropriate geographic s]vice region ( !
 ,dep>tm5t1 aft] consultation ) !       
,dep>tm5t physician responsible = prim>y
 c>e ( ! vet]an4  7#b7 ,dep>tm5t        
facilities %all be deem$ to be          
geographically inaccessible = purposes (
 p>agraph 7#a7 9 ! case ( a vet]an ^:   
resid5ce meets any ( ! foll[+ crit]ia3  
7,a7 ,! resid5ce is 9 a c\nty ) a       
population d5sity ( less ?an #g4j p p]  
squ>e mile & is m ?an #ge miles f !     
ne>e/ ,dep>tm5t heal? c>e facility4     
7,b7 ,! resid5ce is 9 a c\nty ) a       

population d5sity ( m ?an #g4j & less   
?an #h4j p p] squ>e mile & is m ?an #ajj
 miles f ! ne>e/ ,dep>tm5t heal? c>e    
facility4  7,c7 ,! resid5ce is 9 a c\nty
 ) a population d5sity ( m ?an #h4j &   
less ?an #i4j p p] squ>e mile & is m ?an
 #abe miles f ! ne>e/ ,dep>tm5t heal?   
c>e facility4  7,d7 ,! resid5ce is m ?an
 #aej miles f ! ne>e/ ,dep>tm5t heal?   
c>e facility4  7#c7 ,! ,secret>y may    
waive ! requirem5t 9 p>agraph 7#a7 9 !  
case ( a p>ticul> vet]an if ! ,secret>y 
demon/rates on an individual basis ?r\gh
 a co/-b5efit analysis t ! co/s to !    
,dep>tm5t ( provid+ c>e to t vet]an     
pursuant to p>agraph 7#a7 significantly 
outweigh ! b5efits ( localiz$ heal? c>e 
= ! individual vet]an4  7#d7 ,= purposes
 ( p>agraph 7#b71 a di/ance 9 miles %all
 be det]m9$ on ! basis ( ! mo/ conv5i5t 
highway r\te t is available to ! vet]an1
 z det]m9$ by ! ,secret>y4  4  7b7      
,effective ,date ,subsection 7e7 (      
section #agjc ( title #ch1 ,unit$ ,/ates
 ,code1 z add$ by subsection 7a71 %all  

take effect on ! date t is #abj days    
aft] ! date ( ! enactm5t ( ?is ,act4