,,ii  #aacth ,,congress  #b;d ,session  
,s4 #bjji  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,february #aj1 
#bjad,mr4 ,udall of ,new ,mexico 7for   
himself and ,mr4 ,heller7 introduced the
 following bill2 which was read twice   
and referred to the ,committee on       
,veterans' ,affairs  ,a ,,bill  ,to     
improve the provision of health care by 
the ,department of ,veterans ,affairs to
 veterans in rural and highly rural     
areas1 and for other purposes4  #a4     
,short title ,this ,act may be cited as 
the ,rural ,veterans ,improvement ,act  
of #bjad4  #b4 ,provision of mental     
health care to certain veterans in rural
 and highly rural areas  7a7 ,in general
 ,the ,secretary of ,veterans ,affairs  
shall provide mental health care to     
eligible veterans described in          
subsection 7c7 for which a determination
 has been made under subsection 7d74    
7b7 ,use of other providers  7#a7 ,in   
general ,the ,secretary may provide     
mental health care under this section by

 contracting with or providing payments 
to mental health care providers that are
 not otherwise affiliated with the      
,department of ,veterans ,affairs and   
shall1 to the extent feasible1 use      
health care resources pursuant to       
existing arrangements1 contracts1 or    
agreements entered into under section   
#haec of title #ch1 ,united ,states     
,code4  7#b7 ,payments ,the ,secretary  
may not provide payments described in   
paragraph 7#a7 that exceed the amount   
that the ,secretary would otherwise     
expend in providing similar mental      
health care through the ,department or  
under such existing arrangements1       
contracts1 or agreements4  7c7 ,eligible
 veterans ,an eligible veteran described
 in this subsection is a veteran that-- 
7#a7 has a mental health issue resulting
 from post-traumatic stress disorder1   
traumatic brain injury1 or any other    
health condition that was incurred or   
aggravated in line of duty in the active
 military1 naval1 or air service2 and   

7#b7 lives in a rural area or highly    
rural area4  7d7 ,determination ,the    
,secretary shall provide the care       
required by subsection 7a7 to an        
eligible veteran if the ,secretary      
determines any of the following3 7#a7   
7,a7 ,a mental health care provider     
affiliated with the ,department is not  
available to provide mental health care 
services to the eligible veteran at the 
medical facility of the ,department that
 is nearest to the residence of the     
eligible veteran2 and  7,b7 7i7         
in-person and telehealth mental health  
care services from the ,department are  
not available to the eligible veteran2  
7ii7 the eligible veteran requests that 
a mental health care provider affiliated
 with the ,department provide mental    
health care services to the eligible    
veteran in private and the provider is  
unable or unwilling to do so2 or  7iii7 
travel by the eligible veteran to a     
regional medical center of the          
,department is impractical or severely  

detrimental to the health of the        
eligible veteran4  7#b7 ,that-- 7,a7 7i7
 a mental health care provider          
affiliated with the ,department has     
recommended that a complementary and    
alternative therapy approved by the     
,food and ,drug ,administration be      
administered to the eligible veteran2   
7ii7 the eligible veteran is a member of
 an ,indian tribe or a ,native ,hawaiian
 and requests a healing method that is a
 cultural tradition of the eligible     
veteran2 or  7iii7 a mental health care 
provider has recommended a treatment for
 the eligible veteran that1 based on the
 medical knowledge of the health care   
provider1 is safe and would assist the  
eligible veteran in coping with         
post-traumatic stress disorder1         
traumatic brain injury1 or another      
mental health issue2 and  7,b7 7i7 the  
eligible veteran has not received the   
therapy1 healing method1 or treatment   
described in subparagraph 7,a7 because  
of the inaccessibility or unavailability

 of such treatment from a medical       
facility of the ,department2 and  7ii7  
the eligible veteran1 as a result of the
 mental health condition of the eligible
 veteran-- 7,i7 cannot work or maintain 
employment2  7,,ii7 is at increased risk
 of doing physical harm to the eligible 
veteran or others2 or  7,,iii7 cannot   
adequately manage activities of daily   
life4  7e7 ,indian tribe defined ,in    
this section1 the term ,indian tribe has
 the meaning given that term in section 
#d of the ,indian ,self-,determination  
and ,education ,assistance ,act 7#be    
,u4,s4,c4 #dej;b74  #c4 ,report on      
effectiveness of complementary and      
alternative medicine in treating        
veterans with certain mental illnesses  
,not later than one year after the date 
of the enactment of this ,act1 the      
,secretary of ,veterans ,affairs 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 effectiveness of complementary and  
alternative medicine used by the        
,department of ,veterans ,affairs in    
treating veterans with mental health    
conditions resulting from post-traumatic
 stress disorder1 traumatic brain       
injury1 or any other health condition   
that was incurred or aggravated in line 
of duty in the active military1 naval1  
or air service4  #d4 ,grants to provide 
transportation to community-based       
outpatient clinics for veterans in rural
 and highly rural areas  7a7 ,grants    
authorized  7#a7 ,in general ,the       
,secretary of ,veterans ,affairs may    
award grants to eligible entities to    
provide transportation to veterans in   
rural and highly rural areas who would  
otherwise be eligible for reimbursement 
for or payment of travel expenses by the
 ,department of ,veterans ,affairs      
pursuant to section #aaa or section     
#aaa;,a of title #ch1 ,united ,states   
,code4  7#b7 ,maximum amount ,the       
,secretary may not award a grant under  

this section in an amount that exceeds  
#ajj1jjj4  7#c7 ,no matching required   
,the ,secretary may not require that an 
eligible entity provide a contribution  
of funds as a condition of receiving the
 grant4  7b7 ,eligible entities ,the    
,secretary may award grants under this  
section to any of the following         
entities3 7#a7 ,state veterans agencies4
  7#b7 ,veterans service organizations4 
7#c7 ,tribal organizations4  7c7 ,use of
 grants ,eligible entities in receipt of
 a grant under this section may use the 
grant amount as follows3 7#a7 ,to       
provide transportation to veterans in   
rural and highly rural areas to and from
 medical centers of the ,department of  
,veterans ,affairs1 including           
transportation by air or sea if         
necessary4  7#b7 ,to otherwise assist   
veterans in rural and highly rural areas
 with transportation in connection with 
the provision of medical care to those  
veterans1 including transportation by   
air or sea if necessary4  7d7           

,application  7#a7 ,in general ,each    
eligible entity seeking a grant under   
this section shall submit an application
 to the ,secretary at such time1 in such
 manner1 and accompanied by such        
information as the ,secretary may       
require4  7#b7 ,contents ,each          
application submitted pursuant to       
paragraph 7#a7 shall contain a proposal 
for the manner in which the eligible    
entity seeks to provide the             
transportation described in subsection  
7a74  7e7 ,priority ,the ,secretary     
shall give priority in the awarding of  
grants under this section to            
applications submitted under subsection 
7d7 that contain proposals that comply  
with section #ejd of the ,rehabilitation
 ,act of #aigc 7#bi ,u4,s4,c4 #gid7 and 
regulations issued by the ,secretary of 
,transportation under such section #ejd4
  7f7 ,definitions ,in this section3    
7#a7 ,tribal organization ,the term     
tribal organization has the meaning     
given that term in section #d of the    

,indian ,self-,determination and        
,education ,assistance ,act 7#be        
,u4,s4,c4 #dej;b74  7#b7 ,veterans      
service organization ,the term veterans 
service organization means an           
organization recognized by the          
,secretary of ,veterans ,affairs for the
 representation of veterans under       
section #eijb of title #ch1 ,united     
,states ,code4  #e4 ,pilot program on   
housing allowances for health care      
providers of the ,department of         
,veterans ,affairs accepting assignment 
at rural and highly rural               
community-based outpatient clinics  7a7 
,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 ,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  
clinics4  7b7 ,eligibility ,an          
individual is eligible for participation
 in the pilot program if the            
individual-- 7#a7 is a health care      
provider2  7#b7 is1 or agrees to become1
 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   
program2 and  7#c7 accepts an assignment
 in such position for a term of not less
 than #cf months at a rural or highly   
rural community-based outpatient clinic 
selected by the ,secretary for purposes 
of the pilot program4  7c7 ,conditions  
on payment of housing allowance ,except 
as provided in subsection 7d77#c71 an   
individual may be provided a housing    
allowance under the pilot program only  
while-- 7#a7 in good standing as a      
health care provider within the         
,veterans ,health ,administration2 and  
7#b7 assigned as a health care provider 
at a rural or highly rural              

community-based outpatient clinic4  7d7 
,amount of housing allowance  7#a7      
,monthly amount during initial term     
,during the first #cf months of         
participation in the pilot program1 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 7,,bah7 payable under section   
#djc of title #cg1 ,united ,states      
,code1 to members of the uniformed      
services whose grade1 dependency status1
 and geographic location most closely   
equals1 as determined by the ,secretary1
 the grade of such provider under       
section #gdjd of title #ch1 ,united     
,states ,code1 and the dependency status
 and geographic location of such        
provider4  7#b7 ,monthly amount for     
certain providers for additional term   
,if upon completion of the first #cf    
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 #ab additional months1 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 7#a74  7#c7
 ,bonus amount  7,a7 ,completion of     
initial term ,any health care provider  
who successfully completes #cf 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 7#a7 during the last month    
before the provider's completion of     
participation in the pilot program4     
7,b7 ,completion of additional one-year 
term ,any health care provider who      
successfully completes #dh months of    
participation in the pilot program shall

 be paid upon completion of             
participation in the pilot program an   
amount equal to #ab months of the       
monthly rate of housing allowance       
provided the health care provider under 
paragraph 7#b7 during the last month    
before the provider's completion of     
participation in the pilot program4     
7,c7 ,completion of additional two-year 
term ,any health care provider who      
successfully completes #fj months of    
participation in the pilot program shall
 be paid upon completion of             
participation in the pilot program an   
amount equal to #ac months of the       
monthly rate of housing allowance       
provided the health care provider under 
paragraph 7#b7 during the last month    
before the provider's completion of     
participation in the pilot program4     
7,d7 ,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 
clinic4  7e7 ,nature of allowance  7#a7 
,supplemental amount ,any housing       
allowance provided under the pilot      
program shall be in addition to any pay 
7including basic pay1 special pay1 and  
retirement or other bonus pay7 payable  
to personnel of the ,veterans ,health   
,administration personnel under chapter 
#gd of title #ch1 ,united ,states ,code1
 or any other provision of law4  7#b7   
,exemption from taxation ,for purposes  
of the ,internal ,revenue ,code of      
#aihf1 any housing allowance provided   
under the pilot program shall not be    
included in gross income4  7f7 ,annual  
reports  7#a7 ,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
 effect1 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  
program4  7#b7 ,elements ,each report   
submitted under paragraph 7#a7 shall    
include the following3 7,a7 ,a current  
description of the pilot program1       
including the current number of         
participants in the pilot program and   
the amounts of housing allowance being  
provided such participants4  7,b7 ,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 clinics4  7g7 ,funding       
,amounts for housing allowances under   
the pilot program shall be derived from 
amounts available for the ,veterans     
,health ,administration for ,medical    
,services4  7h7 ,sunset  7#a7 ,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 ,act4
  7#b7 ,continuation of on-going        

provision of allowance ,nothing in      
paragraph 7#a7 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 ,act4
  7i7 ,rural or highly rural            
community-,based outpatient clinic      
defined ,in this section1 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 and highly rural areas4  #f4   
,program on training health care        
professionals for assignment at         
community-based outpatient clinics that 
predominantly serve veterans who live in
 rural and highly rural areas  7a7      
,program required  7#a7 ,in general ,the
 ,secretary of ,veterans ,affairs shall 
establish a program to train health care

 professionals for assignment at        
community-based outpatient clinics that 
predominantly serve veterans who live in
 rural and highly rural areas4  7#b7    
,partnership with educational           
institutions  7,a7 ,in general ,in      
carrying out the program1 the ,secretary
 may enter into partnerships with       
educational institutions4  7,b7         
,consultation ,if the ,secretary enters 
into a partnership with an educational  
institution to carry out the program1   
the ,secretary shall consult with the   
head of such educational institution    
with respect to the training and        
curriculum provided under the program at
 such educational institution4  7b7     
,training ,the training provided to     
health care professionals under the     
program shall include the following     
courses3 7#a7 ,courses on general       
professional development of health care 
professionals4  7#b7 ,courses on        
providing health care to rural          
populations and specifically to rural   

veterans4  7c7 ,curriculum ,the program 
shall include training with respect to  
health issues that commonly afflict     
veterans as specified by the ,secretary4
  7d7 ,hiring preference  7#a7 ,in      
general ,each health care professional  
that completes the program and completes
 a three-year assignment at a           
community-based outpatient clinic that  
predominantly serves veterans who live  
in rural and highly rural areas shall   
receive a preference in selection for   
employment in the ,veterans ,health     
,administration at the end of such      
three-year assignment4  7#b7 ,degree of 
preference  7,a7 ,in general ,the       
preference received under paragraph 7#a7
 shall be less than the preference given
 a veteran4  7,b7 ,veterans ,a veteran  
that receives a preference under        
paragraph 7#a7 shall receive a greater  
preference than an individual that      
receives a preference under such        
paragraph who is not a veteran4  #g4    
,encouraging and facilitating transition

 of military medical professionals into 
employment with ,veterans ,health       
,administration  7a7 ,encouraging       
employment with ,veterans ,health       
,administration ,the ,secretary of      
,veterans ,affairs and the ,secretary of
 ,defense shall jointly establish a     
program to encourage an individual who  
serves in the ,armed ,forces with a     
military occupational specialty relating
 to the provision of health care to seek
 employment with the ,veterans ,health  
,administration when the individual has 
been discharged or released from service
 in the ,armed ,forces or is            
contemplating separating from such      
service4  7b7 ,matching of military     
occupational specialties ,the ,secretary
 of ,veterans ,affairs and the          
,secretary of ,defense shall jointly    
identify military occupational          
specialties relating to the provision of
 health care and match such occupational
 specialties with occupations and       
positions of employment within the      

,veterans ,health ,administration for   
which experience in such military       
occupational specialty qualifies one for
 employment in such occupation or       
position of employment4  7c7            
,facilitation of transition to          
employment with ,veterans ,health       
,administration ,the ,secretary of      
,veterans ,affairs and the ,secretary of
 ,defense shall prescribe such          
regulations and take such actions as may
 be necessary to facilitate the         
transition of individuals with military 
occupational specialties identified     
under subsection 7b7 into the           
corresponding occupations and positions 
of employment with the ,veterans ,health
 ,administration under such subsection4 
#h4 ,assessment of community-based      
outpatient clinics in rural and highly  
rural areas  7a7 ,assessment  7#a7 ,in  
general ,the ,secretary of ,veterans    
,affairs shall conduct a periodic       
assessment of community-based outpatient
 clinics in rural and highly rural areas

 to determine whether expansion and     
improvement of community-based          
outpatient clinics in those areas is    
feasible or advisable4  7#b7 ,elements  
,each periodic assessment required by   
subsection 7a7 shall include the        
following with respect to each          
community-based outpatient clinic       
assessed3 7,a7 ,an assessment of whether
 the facility-- 7i7 meets applicable    
building code requirements2  7ii7 meets 
applicable health care requirements     
related to privacy2  7iii7 has the      
capacity to handle the number of        
patients that seek care at the facility2
  7iv7 has sufficient parking for       
patients that seek care at the facility2
  7v7 has adequate access to broadband  
technology to allow the use or expansion
 of telehealth services at the facility2
 and  7vi7 has the capacity to properly 
store and dispose of medical and other  
hazardous waste4  7,b7 ,a survey of     
health care providers who practice at   
the facility with respect to-- 7i7      

strengths of the facility2  7ii7        
weaknesses of the facility2 and  7iii7  
areas in which the facility may be      
improved4  7b7 ,report ,not later than  
one year after the date of the enactment
 of this ,act1 and not less frequently  
than once each year thereafter1 the     
,secretary shall submit to the          
,committee on ,veterans' ,affairs and   
the ,committee on ,appropriations of the
 ,senate and the ,committee on          
,veterans' ,affairs and the ,committee  
on ,appropriations of the ,house of     
,representatives a report on the        
findings of the ,secretary with respect 
to the most recently completed          
assessment conducted under subsection   
7a71 including such recommendations as  
the ,secretary may have for the         
expansion or improvement of             
community-based outpatient clinics in   
rural and highly rural areas4  #i4      
,report on establishment of ,polytrauma 
,rehabilitation ,centers or ,polytrauma 
,network ,sites of the ,department of   

,veterans ,affairs in rural areas  7a7  
,in general ,not later than #ahj days   
after the date of the enactment of this 
,act1 the ,secretary of ,veterans       
,affairs shall submit to ,congress a    
report on the feasibility and           
advisability of establishing a          
,polytrauma ,rehabilitation ,center or  
,polytrauma ,network ,site in each area 
in which the nearest ,polytrauma        
,rehabilitation ,center or ,polytrauma  
,network ,site is more than #cjj miles  
away4  7b7 ,requirements  7#a7 ,in      
general ,the report required by this    
section shall include the following3    
7,a7 ,an assessment of the adequacy of  
existing ,polytrauma ,rehabilitation    
,centers and ,polytrauma ,network ,sites
 in providing care to veterans that live
 more than #cjj miles from such         
facilities4  7,b7 ,an assessment of the 
adequacy of existing ,polytrauma        
,rehabilitation ,centers and ,polytrauma
 ,network ,sites in providing           
rehabilitation services pursuant to     

section #agaj;,c of title #ch1 ,united  
,states ,code4  7,c7 ,an assessment of  
the feasibility and advisability of     
establishing a ,polytrauma              
,rehabilitation ,center or ,polytrauma  
,network ,site in each ,state in which  
there is a medical center of the        
,department of ,veterans ,affairs4  7,d7
 ,an assessment of whether establishing 
new ,polytrauma ,rehabilitation ,centers
 and ,polytrauma ,network ,sites would  
be beneficial-- 7i7 to the veteran      
population in general2  7ii7 to veterans
 who live-- 7,i7 more than #cjj miles   
from the nearest ,polytrauma            
,rehabilitation ,center or ,polytrauma  
,network ,site2 or  7,,ii7 in a ,state  
in which there is not a ,polytrauma     
,rehabilitation ,center or ,polytrauma  
,network ,site2 and  7iii7 to veterans  
who served in the active military1      
naval1 or air service on or after       
,september #aa1 #bjja4  7#b7 ,budget for
 additional facilities ,if the          
,secretary determines that establishing 

additional ,polytrauma ,rehabilitation  
,centers and ,polytrauma ,network ,sites
 is feasible and advisable1 the         
,secretary shall include with the report
 required by subsection 7a7 a budget and
 plan for the establishment of those    
additional facilities4  #aj4            
,definitions ,in this ,act3 7#a7 ,active
 military1 naval1 or air service ,the   
term active military1 naval1 or air     
service has the meaning given that term 
in section #aja of title #ch1 ,united   
,states ,code4  7#b7 ,highly rural area 
,the term highly rural area means an    
area located in a county that has less  
than seven individuals residing in that 
county per square mile4  7#c7 ,rural    
area ,the term rural area means any area
 that is not an urbanized area or a     
highly rural area4  7#d7 ,urbanized area
 ,the term urbanized area has the       
meaning given that term by the ,director
 of the ,bureau of the ,census4