,,ii #aad? ,,congress #a/ ,session ,s4 #afgf ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,june #bd1 #bjae ,mr4 ,te/] 7= himself & ,mrs4 ,mc,caskill7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,vet]ans' ,affairs ,a ,,bill ,to increase ! numb] ( graduate m$ical education positions treat+ vet]ans1 to improve ! comp5sation ( heal? c>e provid]s1 m$ical directors1 & directors ( ,vet]ans ,integrat$ ,s]vice ,networks ( ! ,dep>tm5t ( ,vet]ans ,affairs1 & = o!r purposes4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,deliv]+ ,opportunities = ,c>e & ,s]vices = ,vet]ans ,act ( #bjae or ! ,d,o,cs = ,vet]ans ,act ( #bjae4 7b7 ,table ( cont5ts ,! table ( cont5ts = ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4 ,,title ,i--,m$ical ,education & ,tra9+ ,sec4 #aja4 ,disreg>d ( resid5t slots t include ,,va tra9+ aga9/ ! ,m$ic>e graduate m$ical education limitations4 ,sec4 #ajb4 ,ext5sion ( p]iod = increase 9 graduate m$ical education resid5cy positions at m$ical facilities ( ! ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #ajc4 ,pilot program on graduate m$ical education resid5cy programs 9 behavioral m$ic9e 9 und]s]v$ areas4 ,sec4 #ajd4 ,inclusion ( m5tal heal? pr(essionals 9 education & tra9+ program = heal? p]sonnel ( ! ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #aje4 ,expansion ( qualifications = lic5s$ m5tal heal? c\nselors ( ! ,dep>tm5t ( ,vet]ans ,affairs to include doctoral degrees4 ,,title ,,ii--,heal? ,c>e ,provid]s ( ! ,dep>tm5t ( ,vet]ans ,affairs ,sec4 #bja4 ,requirem5t t physician assi/ants employ$ by ! ,dep>tm5t ( ,vet]ans ,affairs receive competitive pay4 ,sec4 #bjb4 ,modification ( education debt r$uction program ( ,dep>tm5t ( ,vet]ans ,affairs to require a c]ta9 am\nt to be sp5t 9 rural & highly rural areas4 ,sec4 #bjc4 ,report on m$ical work=ce ( ! ,dep>tm5t ( ,vet]ans ,affairs4 ,,title ,,iii--,lead]%ip ( ! ,vet]ans ,heal? ,adm9i/ration ,sec4 #cja4 ,e/abli%m5t ( positions ( ,directors ( ,vet]ans ,integrat$ ,s]vice ,networks 9 ,(fice ( ,"u ,secret>y = ,heal? ( ,dep>tm5t ( ,vet]ans ,affairs & modification ( qualifications = ,m$ical ,directors4 ,sec4 #cjb4 ,pay = ,m$ical ,directors & ,directors ( ,vet]ans ,integrat$ ,s]vice ,networks4 ,,title ,,iv--,o!r ,heal? ,c>e ,matt]s ,sec4 #dja4 ,pilot program on provid+ nurse advice l9e = vet]ans 9 rural & highly rural areas4 ,i ,m$ical ,education & ,tra9+ #aja4 ,disreg>d ( resid5t slots t include ,,va tra9+ aga9/ ! ,m$ic>e graduate m$ical education limitations 7a7 ,direct ,,gme ,section #ahhf7;h77#d77;,f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77#d77;,f77 is am5d$ by add+ at ! end ! foll[+ new clause3 7iii7 ,disreg>d ( c]ta9 resid5t slots t include ,,va tra9+ ,= portions ( co/ report+ p]iods beg9n+ on or aft] ,july #a1 #bjaf1 9 apply+ ! limitations reg>d+ ! total numb] ( full-"t equival5t resid5ts 9 ! field ( allopa?ic or o/eopa?ic m$ic9e "u clause 7i7 9 a hospital's approv$ m$ical resid5cy tra9+ program1 ! ,secret>y %all n take into acc\nt any resid5t )9 su* program t c\nts t[>ds meet+ ! obligation ( ! ,secret>y ( ,vet]ans ,affairs "u section #cja7;b77#b7 ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #gcjb note74 4 7b7 ,indirect ,,gme ,section #ahhf7;d77#e77;,b77v7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77v77 is am5d$1 9 ! second s5t5ce1 by /rik+ subsection 7h77#d77;,f77ii7 & ins]t+ clauses 7ii7 & 7iii7 ( subsection 7h77#d77;,f74 #ajb4 ,ext5sion ( p]iod = increase 9 graduate m$ical education resid5cy positions at m$ical facilities ( ! ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,9 g5]al ,p>agraph 7#b7 ( section #cja7;b7 ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #gcjb note7 is am5d$-- 7#a7 9 ! p>agraph head+1 by /rik+ ,five-ye> & ins]t+ ,t5-ye>2 & 7#b7 9 subp>agraph 7,a71 by /rik+ #e-ye> p]iod & ins]t+ #aj-ye> p]iod4 7b7 ,report ,p>agraph 7#c77;,a7 ( su* section is am5d$ by /rik+ until #bjai & ins]t+ until #bjbd4 #ajc4 ,pilot program on graduate m$ical education resid5cy programs 9 behavioral m$ic9e 9 und]s]v$ areas 7a7 ,pilot program ,comm5c+ n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs & ! ,secret>y ( ,heal? & ,human ,s]vices %all jo9tly conduct a six-ye> pilot program to e/abli% n less ?an ?ree graduate m$ical education resid5cy programs 9 behavioral m$ic9e 9 und]s]v$ areas 9 ! ,unit$ ,/ates4 7b7 ,elem5ts ,ea* graduate m$ical education resid5cy program e/abli%$ "u ! pilot program %all-- 7#a7 provide resid5ts p>ticipat+ 9 ! graduate m$ical education resid5cy program ) an opportunity to "w ) a div]se pati5t population ?r\gh a rotation betwe5 m$ical facilities ( ! ,dep>tm5t ( ,vet]ans ,affairs1 facilities ( ! ,indian ,heal? ,s]vice1 & facilities p>ticipat+ "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq472 7#b7 include graduate m$ical education 9 ! field ( behavioral m$ic9e2 7#c7 be c>ri$ out 9 a mann] consi/5t ) graduate m$ical education resid5cy programs support$ & fund$ by ! ,dep>tm5t ( ,vet]ans ,affairs & ! ,dep>tm5t ( ,heal? & ,human ,s]vices2 7#d7 be locat$ 9 a community t-- 7,a7 is designat$ z a m$ically und]s]v$ area "u section #ccj7;b77#c77;,a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;b7b77#c77;,a772 7,b7 is 9 a ,/ate ) a p] capita population ( vet]ans ( m ?an #i p]c5t accord+ to ! ,national ,c5t] = ,vet]ans ,analysis & ,/ati/ics & ! ,unit$ ,/ates ,c5sus ,bureau2 & 7,c7 is )9 #ajj miles ( a ,res]vation 7z def9$ 9 ,section #c7;d7 ( ! ,indian ,f9anc+ ,act ( #aigd 7#be ,u4,s4,c4 #adeb774 7c7 ,report 7#a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! date ( ! comm5cem5t ( ! pilot program & n less frequ5tly ?an once ea* ye> !reaft] :ile ! pilot program is be+ c>ri$ out1 ! ,secret>y ( ,vet]ans ,affairs & ! ,secret>y ( ,heal? & ,human ,s]vices %all1 9 consultation ) repres5tatives f facilities p>ticipat+ "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 t are p>ticipat+ 9 ! pilot program1 jo9tly submit to ,congress a report on ! implem5tation ( ! pilot program4 7#b7 ,elem5ts ,ea* report requir$ by p>agraph 7#a7 %all include ! foll[+3 7,a7 ,a description ( ! pati5t population s]v$ by ! resid5ts p>ticipat+ 9 a graduate m$ical education resid5cy program "u ! pilot program4 7,b7 ,a description ( ! behavioral m$ic9e s]vices provid$ "u ! pilot program1 includ+ ! ext5t to :i* ^? s]vices 7 provid$ us+ telem$ic9e s]vices4 7,c7 ,! academic affiliation ( ea* resid5t p>ticipat+ 9 a graduate m$ical education resid5cy program "u ! pilot program4 7,d7 ,a description ( any imp$im5ts fac$ 9 c>ry+ out ! pilot program & actions tak5 by ! ,secret>y ( ,vet]ans ,affairs & ! ,secret>y ( ,heal? & ,human ,s]vices to address ^? imp$im5ts4 #ajd4 ,inclusion ( m5tal heal? pr(essionals 9 education & tra9+ program = heal? p]sonnel ( ! ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,9 g5]al ,9 c>ry+ out ! education & tra9+ program requir$ "u section #gcjb7;a77#a7 ( title #ch1 ,unit$ ,/ates ,code1 ! ,secret>y ( ,vet]ans ,affairs %all include education & tra9+ ( m>riage & family !rapi/s & lic5s$ pr(essional m5tal heal? c\nselors4 7b7 ,apportionm5t ( fund+ ,! ,secret>y %all apportion fund+ = ! education & tra9+ program describ$ 9 subsection 7a7 equally among ! pr(essions includ$ 9 ! program4 #aje4 ,expansion ( qualifications = lic5s$ m5tal heal? c\nselors ( ! ,dep>tm5t ( ,vet]ans ,affairs to include doctoral degrees ,section #gdjb7;b77#aa77;,a7 ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by ins]t+ or doctoral degree aft] ma/]'s degree4 ,,ii ,heal? ,c>e ,provid]s ( ! ,dep>tm5t ( ,vet]ans ,affairs #bja4 ,requirem5t t physician assi/ants employ$ by ! ,dep>tm5t ( ,vet]ans ,affairs receive competitive pay ,section #gdea7;a77#b7 ( title #ch1 ,unit$ ,/ates ,code1 is am5d$-- 7#a7 by r$esignat+ subp>agraph 7,b7 z subp>agraph 7,c72 7#b7 by ins]t+ aft] subp>agraph 7,a7 ! foll[+ new subp>agraph 7,b73 7,b7 ,physician assi/ant4 2 & 7#c7 9 subp>agraph 7,c71 z r$esignat$ by p>agraph 7#a71 by /rik+ & regi/]$ nurse & ins]t+ regi/]$ nurse1 & physician assi/ant4 #bjb4 ,modification ( education debt r$uction program ( ,dep>tm5t ( ,vet]ans ,affairs to require a c]ta9 am\nt to be sp5t 9 rural & highly rural areas ,section #gfha ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+ new subsections3 7c7 ,limitation on am\nts ,n less ?an #cj p]c5t ( ! am\nt ( debt r$uction paym5ts paid "u ! ,education ,debt ,r$uction ,program ea* ye> %all be paid to individuals :o practice m$ic9e 9 a rural area or highly rural area or demon/rate a commitm5t to practice m$ic9e 9 su* an area4 7d7 ,def9itions ,9 ?is section3 7#a7 ,! t]m highly rural area means an area locat$ 9 a c\nty or simil> community t has less ?an sev5 individuals resid+ 9 t c\nty or community p] squ>e mile4 7#b7 ,! t]m rural area means an area t is n an urbaniz$ area or a highly rural area4 7#c7 ,! t]m urbaniz$ area has ! mean+ giv5 t t]m by ! ,director ( ! ,bureau ( ! ,c5sus4 4 #bjc4 ,report on m$ical work=ce ( ! ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,9 g5]al ,n lat] ?an #abj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all submit to ! ,committee on ,vet]ans ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans ,affairs ( ! ,h\se ( ,repres5tatives a report on ! m$ical work=ce ( ! ,dep>tm5t ( ,vet]ans ,affairs4 7b7 ,elem5ts ,! report requir$ by subsection 7a7 %all include ! foll[+3 7#a7 ,) respect to lic5s$ pr(essional m5tal heal? c\nselors & m>riage & family !rapi/s ( ! ,dep>tm5t-- 7,a7 h[ _m su* c\nselors & !rapi/s are curr5tly enroll$ 9 ! m5tal heal? pr(essionals tra9ee program ( ! ,dep>tm5t2 7,b7 h[ _m su* c\nselors & !rapi/s are expect$ to enroll 9 ! m5tal heal? pr(essionals tra9ee program ( ! ,dep>tm5t dur+ ! #ahj-;day p]iod beg9n+ on ! date ( ! submittal ( ! report2 7,c7 a description ( ! eligibility crit]ia = su* c\nselors & !rapi/s z comp>$ to o!r behavioral heal? pr(essions 9 ! ,dep>tm5t2 7,d7 a description ( ! objectives1 goals1 & tim+ ( ! ,dep>tm5t ) respect to increas+ ! repres5tation ( su* c\nselors & !rapi/s 9 ! behavioral heal? work=ce ( ! ,dep>tm5t2 & 7,e7 a description ( ! actions tak5 by ! ,secret>y1 9 consultation ) ! ,director ( ! ,(fice ( ,p]sonnel ,managem5t1 to create an occupational s]ies = su* c\nselors & !rapi/s & a timel9e = ! creation ( su* an occupational s]ies4 7#b7 ,a breakd[n ( sp5d+ by ! ,dep>tm5t 9 connection ) ! education debt r$uction program ( ! ,dep>tm5t "u sub*apt] ,,vii ( *apt] #gf ( title #ch1 ,unit$ ,/ates ,code1 includ+-- 7,a7 ! am\nt sp5t by ! ,dep>tm5t 9 debt r$uction paym5ts dur+ ! ?ree-ye> p]iod prec$+ ! submittal ( ! report disaggregat$ by ! m$ical pr(ession ( ! individual receiv+ ! paym5ts2 7,b7 a description ( h[ ! ,dep>tm5t prioritizes su* sp5d+ by m$ical pr(ession1 includ+ an assessm5t ( :e!r su* priority reflects ! five occupations id5tifi$ 9 ! mo/ rec5t det]m9ation by ! ,inspector ,g5]al ( ! ,dep>tm5t ( ,vet]ans ,affairs z hav+ ! l>ge/ /aff+ %ortages 9 ! ,vet]ans ,heal? ,adm9i/ration2 & 7,c7 a description ( ! actions tak5 by ! ,secret>y to increase ! effectiv5ess ( su* sp5d+ = purposes ( recruitm5t ( heal? c>e provid]s to ! ,dep>tm5t1 includ+ ef=ts to m consi/5tly include eligibility = ! education debt r$uction program 9 vacancy ann\ncem5ts ( positions = heal? c>e provid]s at ! ,dep>tm5t4 7#c7 ,a description ( any imp$im5ts to ! deliv]y by ! ,dep>tm5t ( telem$ic9e s]vices to vet]ans & any actions tak5 by ! ,dep>tm5t to address su* imp$im5ts1 includ+ ) respect to-- 7,a7 re/rictions "u ,f$]al or ,/ate laws2 7,b7 lic5s+ or cr$5tial+ issues = heal? c>e provid]s1 includ+ non-,dep>tm5t heal? c>e provid]s1 practic+ telem$ic9e ) a vet]an locat$ 9 a diff]5t ,/ate2 7,c7 ! effect ( limit$ broadb& access or limit$ in=mation te*nology capabilities on ! deliv]y ( heal? c>e2 7,d7 ! di/ance a vet]an is requir$ to travel to access a facility or cl9ic ) telem$ic9e capabilities2 7,e7 ! effect on ! provision ( telem$ic9e s]vices to vet]ans ( policies ( & limit$ liability protection = c]ta9 entities2 & 7,f7 issues relat+ to reimbursem5t & travel limitations = vet]ans t affect ! p>ticipation ( non-,dep>tm5t heal? c>e provid]s 9 ! telem$ic9e program4 7#d7 ,an update on ! ef=ts ( ! ,secret>y to (f] tra9+ opportunities 9 telem$ic9e to m$ical resid5ts 9 m$ical facilities ( ! ,dep>tm5t t use telem$ic9e1 consi/5t ) m$ical resid5cy program requirem5ts e/abli%$ by ! ,accr$itation ,c\ncil = ,graduate ,m$ical ,education1 z requir$ 9 section #ajh7;b7 ( ! ,honor+ ,am]ica's ,vet]ans & ,c>+ = ,camp ,lejeune ,families ,act ( #bjab 7,public ,law #aab-aed2 #ch ,u4,s4,c4 #gdjf note74 7#e7 ,an assessm5t ( ! developm5t & implem5tation by ! ,secret>y ( succession plann+ policies to address ! preval5ce ( vacancies 9 positions 9 ! ,vet]ans ,heal? ,adm9i/ration ( m ?an #ahj days1 includ+ ! developm5t ( an ent]prise position managem5t sy/em to m effectively id5tify1 track1 & resolve su* vacancies4 7#f7 ,a description ( ! actions tak5 by ! ,secret>y1 9 consultation ) ! ,director ( ! ,(fice ( ,p]sonnel ,managem5t1 to address any imp$im5ts to ! timely appo9tm5t & det]m9ation ( qualifications = ,directors ( ,vet]ans ,integrat$ ,s]vice ,networks & ,m$ical ,directors ( ! ,dep>tm5t4 ,,iii ,lead]%ip ( ! ,vet]ans ,heal? ,adm9i/ration #cja4 ,e/abli%m5t ( positions ( ,directors ( ,vet]ans ,integrat$ ,s]vice ,networks 9 ,(fice ( ,"u ,secret>y = ,heal? ( ,dep>tm5t ( ,vet]ans ,affairs & modification ( qualifications = ,m$ical ,directors ,section #gcjf7;a77#d7 ( title #ch1 ,unit$ ,/ates ,code1 is am5d$-- 7#a7 by ins]t+ & ,directors ( ,vet]ans ,integrat$ ,s]vice ,networks aft] ,su* ,m$ical ,directors2 & 7#b7 by /rik+ 1 :o %all be ei!r a qualifi$ doctor ( m$ic9e or a qualifi$ doctor ( d5tal surg]y or d5tal m$ic9e4 #cjb4 ,pay = ,m$ical ,directors & ,directors ( ,vet]ans ,integrat$ ,s]vice ,networks 7a7 ,9 g5]al ,*apt] #gd ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+ new sub*apt]3 ,,vii ,pay = ,m$ical ,directors & ,directors ( ,vet]ans ,integrat$ ,s]vice ,networks #gdha4 ,pay = ,m$ical ,directors & ,directors ( ,vet]ans ,integrat$ ,s]vice ,networks 7a7 ,elem5ts ( pay ,pay = a ,m$ical ,director or ,director ( a ,vet]ans ,integrat$ ,s]vice ,network appo9t$ "u section #gcjf7;a77#d7 ( ?is title 79 ?is section ref]r$ to z a ,director7 %all consi/ ( basic pay set =? "u section #gdjd7;a7 ( ?is title & m>ket pay det]m9$ "u subsection 7b74 7b7 ,m>ket pay 7#a7 ,ea* ,director is eligible = m>ket pay det]m9$ "u ?is subsection4 7#b7 ,! am\nt ( m>ket pay payable to a ,director "u ?is section %all be det]m9$ by ! ,secret>y on a case-by-case basis & %all consi/ ( pay int5d$ to reflect ne$s ( ! ,dep>tm5t ) respect to ! recruitm5t & ret5tion 7z det]m9$ by ! ,secret>y7 ( su* ,director4 7#c7 ,9 det]m9+ ! am\nt ( m>ket pay payable to a ,director "u ?is section1 ! ,secret>y %all-- 7,a7 consult n less ?an two national surveys on pay = hospital directors1 m$ical facility directors1 or o!r simil> positions1 :e!r prep>$ by private1 public1 or quasi-public entities1 to make a g5]al assessm5t ( ! range ( pot5tial pay = ! ,director2 & 7,b7 take into acc\nt-- 7i7 ! exp]i5ce ( ! ,director 9 manag+ facilities or program (fices ( ! ,dep>tm5t1 includ+ ! complexity ( su* facilities or (fices2 7ii7 ! complexity ( ! facility or facilities to be manag$ by ! ,director2 7iii7 ! labor m>ket1 9 su* geographic area z ! ,secret>y consid]s relevant1 = hospital directors1 m$ical facility directors1 & o!r simil> positions2 7iv7 ! exp]i5ce ( ! ,director 9 manag+ m$ical facilities = o!r ,f$]al ag5cies1 private entities1 or non-pr(it entities2 & 7v7 su* o!r consid]ations z ! ,secret>y consid]s appropriate4 7#d7 7,a7 ,! ,secret>y %all evaluate ! am\nt ( m>ket pay payable to a ,director "u ?is section n less frequ5tly ?an once e two ye>s & may adju/ ! m>ket pay payable to su* ,director z a result ( su* evaluation4 7,b7 ,a ,director ^: m>ket pay is evaluat$ "u subp>agraph 7,a7 %all receive writt5 notice ( ! results ( su* evaluation4 7c7 ,requirem5ts & limitations on total pay 7#a7 ,n less frequ5tly ?an once e two ye>s1 ! ,secret>y %all set =? a ,dep>tm5t-wide m9imum & maximum am\nt = total annual pay "u subsection 7a7 t may be paid to a ,director & %all publi% ea* su* am\nt 9 ! ,f$]al ,regi/]4 7#b7 ,! m9imum & maximum am\nts set =? "u p>agraph 7#a7 %all take effect n e>li] ?an ! date t is #fj days aft] ! publication ( su* am\nts "u su* p>agraph4 7#c7 ,! sum ( ! basic pay set =? "u section #gdjd7;a7 ( ?is title & m>ket pay det]m9$ "u subsection 7b7 = a ,director = a cal5d> ye>-- 7,a7 may n be less ?an ! mo/ rec5t m9imum am\nt set =? "u p>agraph 7#a7 be=e ! beg9n+ ( su* cal5d> ye>2 & 7,b7 may n be m ?an ! mo/ rec5t maximum am\nt set =? "u su* p>agraph be=e ! beg9n+ ( su* cal5d> ye>4 7#d7 ,! total am\nt ( comp5sation paid to a ,director "u ?is title 9 any cal5d> ye> may n exce$ ! am\nt ( annual comp5sation 7exclud+ exp5ses7 ( ! ,presid5t "u section #ajb ( title #c4 7#e7 ,! ,secret>y may n delegate to an (fic] or employee ( ! ,dep>tm5t ! requirem5t ( ! ,secret>y to set =? a ,dep>tm5t-wide m9imum & maximum am\nt "u p>agraph 7#a74 7d7 ,treatm5t ( pay ,pay "u ?is section %all be consid]$ pay = all purposes1 includ+ retirem5t b5efits "u *apt]s #hc & #hd ( title #e & o!r b5efits4 7e7 ,ancill>y effects ( decreases 9 pay 7#a7 ,a decrease 9 pay ( a ,director result+ f an adju/m5t 9 ! am\nt ( m>ket pay ( ! ,director "u subsection 7b7 %all n be treat$ z an adv]se action4 7#b7 ,a decrease 9 ! am\nt ( pay ( a ,director result+ f an involunt>y reassignm5t 9 connection ) a discipl9>y action tak5 aga9/ ! ,director is n subject to appeal or judicial review4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #gd ( su* title is am5d$ by add+ at ! end ! foll[+3 ,sub*apt] ,,vii4 ,pay = ,m$ical ,directors & ,directors ( ,vet]ans ,integrat$ ,s]vice ,networks #gdha4 ,pay = ,m$ical ,directors & ,directors ( ,vet]ans ,integrat$ ,s]vice ,networks4 4 ,,iv ,o!r ,heal? ,c>e ,matt]s #dja4 ,pilot program on provid+ nurse advice l9e = vet]ans 9 rural & highly rural areas 7a7 ,9 g5]al ,comm5c+ n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all conduct a two-ye> pilot program to assess ! feasibility & advisability ( implem5t+ 9 rural areas & highly rural areas ) a l>ge p]c5tage ( vet]ans a nurse advice l9e to furni% to vet]ans m$ical advice1 appo9tm5t & cancellation s]vices1 & in=mation on ! availability ( b5efits f ! ,dep>tm5t ( ,vet]ans ,affairs4 7b7 ,nurse advice l9e ,9 c>ry+ out ! pilot program "u subsection 7a7 ! ,secret>y %all e/abli% a nurse advice l9e t-- 7#a7 op]ates free ( *>ge2 7#b7 is bas$ on1 & improves ^u1 ! nurse advice l9e implem5t$ by ! ,dep>tm5t ( ,def5se = b5efici>ies "u ! ,,tric>e program 7z def9$ 9 section #ajgb7e7 ( title #aj1 ,unit$ ,/ates ,code72 7#c7 complies ) call c5t] requirem5ts set =? by ,,urac2 7#d7 op]ates 9 close consultation ) ! ,secret>y to-- 7,a7 e/abli% a process ?r\gh :i* ! eligibility ( a call] = ! nurse advice l9e c be validat$2 7,b7 all[ eligibility & b5efit in=mation 9 possession ( ! ,dep>tm5t ( ,vet]ans ,affairs to be %>$ ) ! nurse advice l9e2 & 7,c7 all[ ! nurse advice l9e to connect ) appropriate te*nology & p]sonnel ( ! ,dep>tm5t = purposes ( s*$ul+ appo9tm5ts = ! receipt ( heal? c>e f ! ,dep>tm5t2 & 7#e7 ma9ta9s quality controls to ensure t calls are answ]$ by a cu/om] s]vice repres5tative )9 #cj seconds & ) an ab&onm5t rate ( less ?an #e p]c5t4 7c7 ,s]vices provid$ ,! nurse advice l9e e/abli%$ "u ! pilot program %all provide an array ( s]vices to vet]ans1 includ+ ! foll[+3 7#a7 ,m$ical advice f lic5s$ regi/]$ nurses :o assess ! symptoms ( ! call] us+ a propriet>y cl9ical algori?m t-- 7,a7 has be5 %[n 9 pe]-review$ m$ical j\rnals to mo/ closely emulate ! cl9ical decisionmak+ processes ( physicians2 & 7,b7 triages ! call] to ! appropriate v5ue at :i* ! call] may receive ! heal? c>e t !y ne$4 7#b7 ,in=mation to address basic que/ions reg>d+ ! eligibility ( ! call] = b5efits f ! ,dep>tm5t ( ,vet]ans ,affairs & ! availability ( ^? b5efits4 7#c7 ,use ( an appo9tm5t cl]k to facilitate ! s*$ul+1 res*$ul+1 & cancellation ( appo9tm5ts = heal? c>e f ! ,dep>tm5t4 7d7 ,report 7#a7 ,9 g5]al ,n lat] ?an #abj days aft] ! date ( ! completion ( ! pilot program1 ! ,secret>y ( ,vet]ans ,affairs %all submit to ,congress a report on ! f9d+s ( ! ,secret>y ) respect to ! pilot program4 7#b7 ,elem5ts ,! report requir$ by p>agraph 7#a7 %all include ! foll[+3 7,a7 ,a description ( ! vet]ans :o h b5efitt$ f advice ?r\gh ! nurse advice l9e "u ! pilot program1 includ+ ! locations ( ! vet]ans s]v$4 7,b7 ,a description ( any imp$im5ts to ! ,secret>y 9 c>ry+ out ! pilot program4 7,c7 ,a description ( any imp$im5ts enc\nt]$ by individuals 9 seek+ advice or s]vices ?r\gh ! nurse advice l9e "u ! pilot program4 7,d7 ,an assessm5t ( ! feasibility & advisability ( exp&+ ! pilot program to include m vet]ans4 7e7 ,def9itions ,9 ?is section3 7#a7 ,highly rural area ,! t]m highly rural area means an area locat$ 9 a c\nty or simil> community t has less ?an sev5 individuals resid+ 9 t c\nty or community p] squ>e mile4 7#b7 ,rural area ,! t]m rural area means an area t is n an urbaniz$ area or a highly rural area4 7#c7 ,urbaniz$ area ,! t]m urbaniz$ area has ! mean+ giv5 t t]m by ! ,director ( ! ,bureau ( ! ,c5sus4