,,ii  #aadth ,,congress  #ast ,session  
,s4 #afgf  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,june #bd1     
#bjae ,mr4 ,tester 7for himself and     
,mrs4 ,mc,caskill7 introduced the       
following bill2 which was read twice and
 referred to the ,committee on          
,veterans' ,affairs  ,a ,,bill  ,to     
increase the number of graduate medical 
education positions treating veterans1  
to improve the compensation of health   
care providers1 medical directors1 and  
directors of ,veterans ,integrated      
,service ,networks of the ,department of
 ,veterans ,affairs1 and for other      
purposes4  #a4 ,short title2 table of   
contents  7a7 ,short title  ,this ,act  
may be cited as the ,delivering         
,opportunities for ,care and ,services  
for ,veterans ,act of #bjae or the      
,d,o,cs for ,veterans ,act of #bjae4    
7b7 ,table of contents ,the table of    
contents for this ,act is as follows3   
,sec4 #a4 ,short title2 table of        
contents4 ,,title ,i--,medical          

,education and ,training ,sec4 #aja4    
,disregard of resident slots that       
include ,,va training against the       
,medicare graduate medical education    
limitations4 ,sec4 #ajb4 ,extension of  
period for increase in graduate medical 
education residency positions at medical
 facilities of the ,department of       
,veterans ,affairs4 ,sec4 #ajc4 ,pilot  
program on graduate medical education   
residency programs in behavioral        
medicine in underserved areas4 ,sec4    
#ajd4 ,inclusion of mental health       
professionals in education and training 
program for health personnel of the     
,department of ,veterans ,affairs4 ,sec4
 #aje4 ,expansion of qualifications for 
licensed mental health counselors of the
 ,department of ,veterans ,affairs to   
include doctoral degrees4 ,,title       
,,ii--,health ,care ,providers of the   
,department of ,veterans ,affairs ,sec4 
#bja4 ,requirement that physician       
assistants employed by the ,department  
of ,veterans ,affairs receive           

competitive pay4 ,sec4 #bjb4            
,modification of education debt         
reduction program of ,department of     
,veterans ,affairs to require a certain 
amount to be spent in rural and highly  
rural areas4 ,sec4 #bjc4 ,report on     
medical workforce of the ,department of 
,veterans ,affairs4 ,,title             
,,iii--,leadership of the ,veterans     
,health ,administration ,sec4 #cja4     
,establishment of positions of          
,directors of ,veterans ,integrated     
,service ,networks in ,office of ,under 
,secretary for ,health of ,department of
 ,veterans ,affairs and modification of 
qualifications for ,medical ,directors4 
,sec4 #cjb4 ,pay for ,medical ,directors
 and ,directors of ,veterans ,integrated
 ,service ,networks4 ,,title            
,,iv--,other ,health ,care ,matters     
,sec4 #dja4 ,pilot program on providing 
nurse advice line for veterans in rural 
and highly rural areas4  ,i ,medical    
,education and ,training  #aja4         
,disregard of resident slots that       

include ,,va training against the       
,medicare graduate medical education    
limitations  7a7 ,direct ,,gme ,section 
#ahhf7;h77#d77;,f7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#acieww7h77#d77;,f77 is amended by      
adding at the end the following new     
clause3  7iii7  ,disregard of certain   
resident slots that include ,,va        
training  ,for portions of cost         
reporting periods beginning on or after 
,july #a1 #bjaf1 in applying the        
limitations regarding the total number  
of full-time equivalent residents in the
 field of allopathic or osteopathic     
medicine under clause 7i7 in a          
hospital's approved medical residency   
training program1 the ,secretary shall  
not take into account any resident      
within such program that counts towards 
meeting the obligation of the ,secretary
 of ,veterans ,affairs under section    
#cja7;b77#b7 of the ,veterans ,access1  
,choice1 and ,accountability ,act of    
#bjad 7,public ,law #aac-adf2 #ch       

,u4,s4,c4 #gcjb note74  4  7b7 ,indirect
 ,,gme ,section #ahhf7;d77#e77;,b77v7 of
 the ,social ,security ,act 7#db        
,u4,s4,c4 #acieww7d77#e77;,b77v77 is    
amended1 in the second sentence1 by     
striking subsection 7h77#d77;,f77ii7 and
 inserting clauses 7ii7 and 7iii7 of    
subsection 7h77#d77;,f74  #ajb4         
,extension of period for increase in    
graduate medical education residency    
positions at medical facilities of the  
,department of ,veterans ,affairs  7a7  
,in general ,paragraph 7#b7 of section  
#cja7;b7 of the ,veterans ,access1      
,choice1 and ,accountability ,act of    
#bjad 7,public ,law #aac-adf2 #ch       
,u4,s4,c4 #gcjb note7 is amended--  7#a7
 in the paragraph heading1 by striking  
,five-year and inserting ,ten-year2 and 
7#b7 in subparagraph 7,a71 by striking  
#e-year period and inserting #aj-year   
period4  7b7 ,report ,paragraph         
7#c77;,a7 of such section is amended by 
striking until #bjai and inserting until
 #bjbd4  #ajc4 ,pilot program on        

graduate medical education residency    
programs in behavioral medicine in      
underserved areas  7a7 ,pilot program   
,commencing not later than one year     
after the date of the enactment of this 
,act1 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 ,states4  7b7 ,elements 
,each graduate medical education        
residency program established under the 
pilot program shall-- 7#a7 provide      
residents participating in the graduate 
medical education residency program with
 an opportunity to work with a diverse  
patient population through a rotation   
between medical facilities of the       
,department of ,veterans ,affairs1      
facilities of the ,indian ,health       
,service1 and facilities participating  
under the ,medicare program under title 

,,xviii of the ,social ,security ,act   
7#db ,u4,s4,c4 #acie et seq472  7#b7    
include graduate medical education in   
the field of behavioral medicine2  7#c7 
be carried out in a manner consistent   
with graduate medical education         
residency programs supported and funded 
by the ,department of ,veterans ,affairs
 and the ,department of ,health and     
,human ,services2  7#d7 be located in a 
community that-- 7,a7 is designated as a
 medically underserved area under       
section #ccj7;b77#c77;,a7 of the ,public
 ,health ,service ,act 7#db ,u4,s4,c4   
#bed;b7b77#c77;,a772  7,b7 is in a      
,state with a per capita population of  
veterans of more than #i percent        
according to the ,national ,center for  
,veterans ,analysis and ,statistics and 
the ,united ,states ,census ,bureau2 and
  7,c7 is within #ajj miles of a        
,reservation 7as defined in ,section    
#c7;d7 of the ,indian ,financing ,act of
 #aigd 7#be ,u4,s4,c4 #adeb774  7c7     
,report  7#a7 ,in general ,not later    

than #ahj days after the date of the    
commencement of the pilot program and   
not less frequently than once each year 
thereafter while the pilot program is   
being carried out1 the ,secretary of    
,veterans ,affairs and the ,secretary of
 ,health and ,human ,services shall1 in 
consultation with representatives from  
facilities participating under the      
,medicare program under title ,,xviii of
 the ,social ,security ,act 7#db        
,u4,s4,c4 #acie et seq47 that are       
participating in the pilot program1     
jointly submit to ,congress a report on 
the implementation of the pilot program4
  7#b7 ,elements ,each report required  
by paragraph 7#a7 shall include the     
following3 7,a7 ,a description of the   
patient population served by the        
residents participating in a graduate   
medical education residency program     
under the pilot program4  7,b7 ,a       
description of the behavioral medicine  
services provided under the pilot       
program1 including the extent to which  

those services were provided using      
telemedicine services4  7,c7 ,the       
academic affiliation of each resident   
participating in a graduate medical     
education residency program under the   
pilot program4  7,d7 ,a description of  
any impediments faced in carrying out   
the pilot program and actions taken by  
the ,secretary of ,veterans ,affairs and
 the ,secretary of ,health and ,human   
,services to address those impediments4 
#ajd4 ,inclusion of mental health       
professionals in education and training 
program for health personnel of the     
,department of ,veterans ,affairs  7a7  
,in general ,in carrying out the        
education and training program required 
under section #gcjb7;a77#a7 of title    
#ch1 ,united ,states ,code1 the         
,secretary of ,veterans ,affairs shall  
include education and training of       
marriage and family therapists and      
licensed professional mental health     
counselors4  7b7 ,apportionment of      
funding ,the ,secretary shall apportion 

funding for the education and training  
program described in subsection 7a7     
equally among the professions included  
in the program4  #aje4 ,expansion of    
qualifications for licensed mental      
health counselors of the ,department of 
,veterans ,affairs to include doctoral  
degrees ,section #gdjb7;b77#aa77;,a7 of 
title #ch1 ,united ,states ,code1 is    
amended by inserting or doctoral degree 
after master's degree4  ,,ii ,health    
,care ,providers of the ,department of  
,veterans ,affairs  #bja4 ,requirement  
that physician assistants employed by   
the ,department of ,veterans ,affairs   
receive competitive pay ,section        
#gdea7;a77#b7 of title #ch1 ,united     
,states ,code1 is amended--  7#a7 by    
redesignating subparagraph 7,b7 as      
subparagraph 7,c72  7#b7 by inserting   
after subparagraph 7,a7 the following   
new subparagraph 7,b73  7,b7 ,physician 
assistant4  2 and  7#c7 in subparagraph 
7,c71 as redesignated by paragraph 7#a71
 by striking and registered nurse and   

inserting registered nurse1 and         
physician assistant4  #bjb4             
,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 #gfha of title    
#ch1 ,united ,states ,code1 is amended  
by adding at the end the following new  
subsections3  7c7 ,limitation on amounts
 ,not less than #cj 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 commitment to practice    
medicine in such an area4  7d7          
,definitions ,in this section3 7#a7 ,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 mile4  7#b7 ,the term rural area
 means an area that is not an urbanized 

area or a highly rural area4  7#c7 ,the 
term urbanized area has the meaning     
given that term by the ,director of the 
,bureau of the ,census4  4  #bjc4       
,report on medical workforce of the     
,department of ,veterans ,affairs  7a7  
,in general ,not later than #abj days   
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 medical workforce of the        
,department of ,veterans ,affairs4  7b7 
,elements ,the report required by       
subsection 7a7 shall include the        
following3 7#a7 ,with respect to        
licensed professional mental health     
counselors and marriage and family      
therapists of the ,department--  7,a7   
how many such counselors and therapists 
are currently enrolled in the mental    
health professionals trainee program of 
the ,department2  7,b7 how many such    

counselors and therapists are expected  
to enroll in the mental health          
professionals trainee program of the    
,department during the #ahj-;day period 
beginning on the date of the submittal  
of the report2  7,c7 a description of   
the eligibility criteria for such       
counselors and therapists as compared to
 other behavioral health professions in 
the ,department2  7,d7 a description of 
the objectives1 goals1 and timing of the
 ,department with respect to increasing 
the representation of such counselors   
and therapists in the behavioral health 
workforce of the ,department2 and  7,e7 
a description of the actions taken by   
the ,secretary1 in consultation with the
 ,director of the ,office of ,personnel 
,management1 to create an occupational  
series for such counselors and          
therapists and a timeline for the       
creation of such an occupational series4
  7#b7 ,a breakdown of spending by the  
,department in connection with the      
education debt reduction program of the 

,department under subchapter ,,vii of   
chapter #gf of title #ch1 ,united       
,states ,code1 including--  7,a7 the    
amount spent by the ,department in debt 
reduction payments during the three-year
 period preceding the submittal of the  
report disaggregated by the medical     
profession of the individual receiving  
the payments2  7,b7 a description of how
 the ,department prioritizes such       
spending by medical profession1         
including an assessment of whether such 
priority 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      
,administration2 and  7,c7 a description
 of the actions taken by the ,secretary 
to increase the effectiveness of such   
spending for purposes of recruitment of 
health care providers to the            
,department1 including efforts to more  
consistently include eligibility for the

 education debt reduction program in    
vacancy announcements of positions for  
health care providers at the            
,department4  7#c7 ,a description of any
 impediments to the delivery by the     
,department of telemedicine services to 
veterans and any actions taken by the   
,department to address such impediments1
 including with respect to--  7,a7      
restrictions under ,federal or ,state   
laws2  7,b7 licensing or credentialing  
issues for health care providers1       
including non-,department health care   
providers1 practicing telemedicine with 
a veteran located in a different ,state2
  7,c7 the effect of limited broadband  
access or limited information technology
 capabilities on the delivery of health 
care2  7,d7 the distance a veteran is   
required to travel to access a facility 
or clinic with telemedicine             
capabilities2  7,e7 the effect on the   
provision of telemedicine services to   
veterans of policies of and limited     
liability protection for certain        

entities2 and  7,f7 issues relating to  
reimbursement and travel limitations for
 veterans that affect the participation 
of non-,department health care providers
 in the telemedicine program4  7#d7 ,an 
update on the efforts of the ,secretary 
to offer training opportunities in      
telemedicine to medical residents in    
medical facilities of the ,department   
that use telemedicine1 consistent with  
medical residency program requirements  
established by the ,accreditation       
,council for ,graduate ,medical         
,education1 as required in section      
#ajh7;b7 of the ,honoring ,america's    
,veterans and ,caring for ,camp ,lejeune
 ,families ,act of #bjab 7,public ,law  
#aab-aed2 #ch ,u4,s4,c4 #gdjf note74    
7#e7 ,an assessment of the development  
and implementation by the ,secretary of 
succession planning policies to address 
the prevalence of vacancies in positions
 in the ,veterans ,health               
,administration of more than #ahj days1 
including the development of an         

enterprise position management system to
 more effectively identify1 track1 and  
resolve such vacancies4  7#f7 ,a        
description of the actions taken by the 
,secretary1 in consultation with the    
,director of the ,office of ,personnel  
,management1 to address any impediments 
to the timely appointment and           
determination of qualifications for     
,directors of ,veterans ,integrated     
,service ,networks and ,medical         
,directors of the ,department4  ,,iii   
,leadership of the ,veterans ,health    
,administration  #cja4 ,establishment of
 positions of ,directors of ,veterans   
,integrated ,service ,networks in       
,office of ,under ,secretary for ,health
 of ,department of ,veterans ,affairs   
and modification of qualifications for  
,medical ,directors ,section            
#gcjf7;a77#d7 of title #ch1 ,united     
,states ,code1 is amended-- 7#a7 by     
inserting and ,directors of ,veterans   
,integrated ,service ,networks after    
,such ,medical ,directors2 and  7#b7 by 

striking 1 who shall be either a        
qualified doctor of medicine or a       
qualified doctor of dental surgery or   
dental medicine4  #cjb4 ,pay for        
,medical ,directors and ,directors of   
,veterans ,integrated ,service ,networks
  7a7 ,in general ,chapter #gd of title 
#ch1 ,united ,states ,code1 is amended  
by adding at the end the following new  
subchapter3  ,,vii ,pay for ,medical    
,directors and ,directors of ,veterans  
,integrated ,service ,networks  #gdha4  
,pay for ,medical ,directors and        
,directors of ,veterans ,integrated     
,service ,networks  7a7 ,elements of pay
 ,pay for a ,medical ,director or       
,director of a ,veterans ,integrated    
,service ,network appointed under       
section #gcjf7;a77#d7 of this title 7in 
this section referred to as a ,director7
 shall consist of basic pay set forth   
under section #gdjd7;a7 of this title   
and market pay determined under         
subsection 7b74  7b7 ,market pay  7#a7  
,each ,director is eligible for market  

pay determined under this subsection4   
7#b7 ,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         
recruitment and retention 7as determined
 by the ,secretary7 of such ,director4  
7#c7 ,in determining the amount of      
market pay payable to a ,director under 
this section1 the ,secretary shall--    
7,a7 consult not less than two national 
surveys on pay for hospital directors1  
medical facility directors1 or other    
similar positions1 whether prepared by  
private1 public1 or quasi-public        
entities1 to make a general assessment  
of the range of potential pay for the   
,director2 and  7,b7 take into account--
 7i7 the experience of the ,director in 
managing facilities or program offices  
of the ,department1 including the       
complexity of such facilities or        
offices2  7ii7 the complexity of the    

facility or facilities to be managed by 
the ,director2  7iii7 the labor market1 
in such geographic area as the          
,secretary considers relevant1 for      
hospital directors1 medical facility    
directors1 and other similar positions2 
7iv7 the experience of the ,director in 
managing medical facilities for other   
,federal agencies1 private entities1 or 
non-profit entities2 and  7v7 such other
 considerations as the ,secretary       
considers appropriate4  7#d7 7,a7 ,the  
,secretary shall evaluate the amount of 
market pay payable to a ,director under 
this section not less frequently than   
once every two years and may adjust the 
market pay payable to such ,director as 
a result of such evaluation4  7,b7 ,a   
,director whose market pay is evaluated 
under subparagraph 7,a7 shall receive   
written notice of the results of such   
evaluation4  7c7 ,requirements and      
limitations on total pay  7#a7 ,not less
 frequently than once every two years1  
the ,secretary shall set forth a        

,department-wide minimum and maximum    
amount for total annual pay under       
subsection 7a7 that may be paid to a    
,director and shall publish each such   
amount in the ,federal ,register4  7#b7 
,the minimum and maximum amounts set    
forth under paragraph 7#a7 shall take   
effect not earlier than the date that is
 #fj days after the publication of such 
amounts under such paragraph4  7#c7 ,the
 sum of the basic pay set forth under   
section #gdjd7;a7 of this title and     
market pay determined under subsection  
7b7 for a ,director for a calendar      
year--  7,a7 may not be less than the   
most recent minimum amount set forth    
under paragraph 7#a7 before the         
beginning of such calendar year2 and    
7,b7 may not be more than the most      
recent maximum amount set forth under   
such paragraph before the beginning of  
such calendar year4  7#d7 ,the total    
amount of compensation paid to a        
,director under this title in any       
calendar year may not exceed the amount 

of annual compensation 7excluding       
expenses7 of the ,president under       
section #ajb of title #c4  7#e7 ,the    
,secretary may not delegate to an       
officer or employee of the ,department  
the requirement of the ,secretary to set
 forth a ,department-wide minimum and   
maximum amount under paragraph 7#a74    
7d7 ,treatment of pay ,pay under this   
section shall be considered pay for all 
purposes1 including retirement benefits 
under chapters #hc and #hd of title #e  
and other benefits4  7e7 ,ancillary     
effects of decreases in pay  7#a7 ,a    
decrease in pay of a ,director resulting
 from an adjustment in the amount of    
market pay of the ,director under       
subsection 7b7 shall not be treated as  
an adverse action4  7#b7 ,a decrease in 
the amount of pay of a ,director        
resulting from an involuntary           
reassignment in connection with a       
disciplinary action taken against the   
,director is not subject to appeal or   
judicial review4  4  7b7 ,clerical      

amendment ,the table of sections at the 
beginning of chapter #gd of such title  
is amended by adding at the end the     
following3  ,subchapter ,,vii4 ,pay for 
,medical ,directors and ,directors of   
,veterans ,integrated ,service ,networks
 #gdha4 ,pay for ,medical ,directors and
 ,directors of ,veterans ,integrated    
,service ,networks4  4  ,,iv ,other     
,health ,care ,matters  #dja4 ,pilot    
program on providing nurse advice line  
for veterans in rural and highly rural  
areas  7a7 ,in general ,commencing not  
later than one year after the date of   
the enactment of this ,act1 the         
,secretary of ,veterans ,affairs shall  
conduct a two-year pilot program to     
assess the feasibility and advisability 
of implementing in rural areas and      
highly rural areas with a large         
percentage of veterans a nurse advice   
line to furnish to veterans medical     
advice1 appointment and cancellation    
services1 and information on the        
availability of benefits from the       

,department of ,veterans ,affairs4  7b7 
,nurse advice line ,in carrying out the 
pilot program under subsection 7a7 the  
,secretary shall establish a nurse      
advice line that--  7#a7 operates free  
of charge2  7#b7 is based on1 and       
improves upon1 the nurse advice line    
implemented by the ,department of       
,defense for beneficiaries under the    
,,tricare program 7as defined in section
 #ajgb7e7 of title #aj1 ,united ,states 
,code72  7#c7 complies with call center 
requirements set forth by ,,urac2  7#d7 
operates in close consultation with the 
,secretary to--  7,a7 establish a       
process through which the eligibility of
 a caller for the nurse advice line can 
be validated2  7,b7 allow eligibility   
and benefit information in possession of
 the ,department of ,veterans ,affairs  
to be shared with the nurse advice line2
 and  7,c7 allow the nurse advice line  
to connect with appropriate technology  
and personnel of the ,department for    
purposes of scheduling appointments for 

the receipt of health care from the     
,department2 and  7#e7 maintains quality
 controls to ensure that calls are      
answered by a customer service          
representative within #cj seconds and   
with an abandonment rate of less than #e
 percent4  7c7 ,services provided ,the  
nurse advice line established under the 
pilot program shall provide an array of 
services to veterans1 including the     
following3  7#a7 ,medical advice from   
licensed registered nurses who assess   
the symptoms of the caller using a      
proprietary clinical algorithm that--   
7,a7 has been shown in peer-reviewed    
medical journals to most closely emulate
 the clinical decisionmaking processes  
of physicians2 and  7,b7 triages the    
caller to the appropriate venue at which
 the caller may receive the health care 
that they need4  7#b7 ,information to   
address basic questions regarding the   
eligibility of the caller for benefits  
from the ,department of ,veterans       
,affairs and the availability of those  

benefits4  7#c7 ,use of an appointment  
clerk to facilitate the scheduling1     
rescheduling1 and cancellation of       
appointments for health care from the   
,department4  7d7 ,report  7#a7 ,in     
general ,not later than #abj days after 
the date of the completion of the pilot 
program1 the ,secretary of ,veterans    
,affairs shall submit to ,congress a    
report on the findings of the ,secretary
 with respect to the pilot program4     
7#b7 ,elements ,the report required by  
paragraph 7#a7 shall include the        
following3 7,a7 ,a description of the   
veterans who have benefitted from advice
 through the nurse advice line under the
 pilot program1 including the locations 
of the veterans served4  7,b7 ,a        
description of any impediments to the   
,secretary in carrying out the pilot    
program4  7,c7 ,a description of any    
impediments encountered by individuals  
in seeking advice or services through   
the nurse advice line under the pilot   
program4  7,d7 ,an assessment of the    

feasibility and advisability of         
expanding the pilot program to include  
more veterans4  7e7 ,definitions ,in    
this section3 7#a7 ,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 mile4  7#b7 ,rural 
area ,the term rural area means an area 
that is not an urbanized area or a      
highly rural area4  7#c7 ,urbanized area
 ,the term urbanized area has the       
meaning given that term by the ,director
 of the ,bureau of the ,census4