,,ii  #aaeth ,,congress  #ast ,session  
,s4 #addi  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,june #bg1     
#bjag,mr4 ,sullivan 7for himself and    
,mr4 ,tester7 introduced the following  
bill2 which was read twice and referred 
to the ,committee on ,veterans' ,affairs
  ,a ,,bill  ,to authorize payment by   
the ,department of ,veterans ,affairs   
for the costs associated with training  
and supervision of medical residents and
 interns at certain facilities that are 
not ,department facilities1 to require  
the ,secretary of ,veterans ,affairs to 
carry out a pilot program to establish  
or affiliate with residency programs at 
facilities operated by ,indian tribes1  
tribal organizations1 and the ,indian   
,health ,service1 and for other         
purposes4  #a4 ,short title ,this ,act  
may be cited as the ,serving our ,rural 
,veterans ,act of #bjag4  #b4 ,sense of 
,congress ,it is the sense of ,congress 
that-- 7#a7 the ,department of ,veterans
 ,affairs relies on agreements with the 

,indian ,health ,service and tribal     
health organizations to serve native and
 non-native veteran populations in      
certain areas1 especially rural areas of
 the ,united ,states1 due to limited    
infrastructure or personnel of the      
,department in those areas2  7#b7 the   
,department should support the practice 
of rural health care in the ,united     
,states because such care is crucial to 
fulfilling the mission of the           
,department to provide the highest      
quality care for veterans2 and  7#c7    
education regarding the unique health   
needs of veterans is necessary for all  
health care providers and is especially 
important for providers in rural health 
care delivery systems1 including those  
affiliated with ,indian tribes and      
tribal health organizations that care   
for a significant number of veterans4   
#c4 ,authorization of payment by        
,department of ,veterans ,affairs for   
training and supervision of residents or
 interns at facilities that are not     

,department facilities  7a7 ,in general 
,subsection 7c7 of section #gdjf of     
title #ch1 ,united ,states ,code1 is    
amended by striking ,department facility
 each place it appears and inserting    
covered facility4  7b7 ,covered facility
 defined ,subsection 7a77#b7 of such    
section is amended by adding at the end 
the following new subparagraph3  7,c7   
,the term covered facility means any of 
the following3 7i7 ,a ,department       
facility4  7ii7 ,a facility operated by 
an ,indian tribe or a tribal            
organization1 as those terms are defined
 in section #d of the ,indian           
,self-,determination and ,education     
,assistance ,act 7#be ,u4,s4,c4 #ecjd74 
7iii7 ,a facility operated by the       
,indian ,health ,service4  7iv7 ,a      
,federally-qualified health center1 as  
defined in section #aije7l77#b77;,b7 of 
the ,social ,security ,act 7#db         
,u4,s4,c4 #acif;d7l77#b77;,b774  7v7 ,a 
community health center4  4  #d4 ,pilot 
program to establish or affiliate with  

graduate medical residency programs at  
facilities operated by ,indian tribes1  
tribal organizations1 and the ,indian   
,health ,service in rural areas  7a7 ,in
 general ,the ,secretary of ,veterans   
,affairs1 in consultation with the      
,director of the ,indian ,health        
,service1 shall carry out a pilot       
program--  7#a7 to establish graduate   
medical education residency training    
programs at covered facilities2 or  7#b7
 to affiliate with established programs 
described in paragraph 7#a74  7b7       
,locations  7#a7 ,in general ,the       
,secretary shall carry out the pilot    
program at not more than four covered   
facilities that have been selected by   
the ,secretary for purposes of the pilot
 program4  7#b7 ,criteria ,the          
,secretary shall establish criteria for 
selecting covered facilities under      
paragraph 7#a74  7c7 ,duration ,the     
,secretary shall implement the pilot    
program during the eight-year period    
beginning on the date that is #ahj days 

after the date of the enactment of this 
,act4  7d7 ,reimbursement of costs ,the 
,secretary shall reimburse each covered 
facility participating in the pilot     
program for the following costs         
associated with the pilot program3  7#a7
 ,curriculum development4  7#b7         
,recruitment1 training1 supervision1 and
 retention of residents and faculty4    
7#c7 ,accreditation of programs of      
education under the pilot program by the
 ,accreditation ,council for ,graduate  
,medical ,education 7,,acgme7 or the    
,american ,osteopathic ,association     
7,,aoa74  7#d7 ,the portion of faculty  
salaries attributable to activities     
relating to carrying out the pilot      
program4  7#e7 ,payment for expenses    
relating to providing medical education 
under the pilot program4  7e7 ,period of
 obligated service  7#a7 ,in general    
,the ,secretary shall enter into an     
agreement with each individual who      
participates in the pilot program under 
which such individual agrees to serve a 

period of one year of obligated service 
at a covered facility or a facility of  
the ,department of ,veterans ,affairs   
for each year in which the individual   
participates in the pilot program under 
this section4  7#b7 ,breach ,an         
individual who participates in the pilot
 program and fails to satisfy the period
 of obligated service under paragraph   
7#a7 shall be liable to the ,united     
,states1 in lieu of such obligated      
service1 for the amount that has been   
paid or is payable to or on behalf of   
the individual under the pilot program1 
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 individual4
  7#c7 ,loan repayment ,during the      
period of obligated service of an       
individual under paragraph 7#a71 the    
individual-- 7,a7 shall be deemed to be 
an eligible individual under subsection 
7b7 of section #ajh of the ,indian      

,health ,care ,improvement ,act 7#be    
,u4,s4,c4 #afaf;a7 for purposes of      
participation in the ,indian ,health    
,service ,loan ,repayment ,program under
 such section during the portion of such
 period that the individual serves at a 
covered facility2 and  7,b7 shall be    
deemed to be an eligible individual     
under section #gfhb7;a7 of title #ch1   
,united ,states ,code1 for purposes of  
participation in the ,department of     
,veterans ,affairs ,education ,debt     
,reduction ,program under subchapter    
,,vii of chapter #gf of such title      
during the portion of such period that  
the individual serves at a facility of  
the ,department4  7#d7 ,concurrent      
service ,any period of obligated service
 required of an individual under        
paragraph 7#a7 shall be served-- 7,a7   
with respect to service at a covered    
facility1 concurrently with any period  
of obligated service required of the    
individual by the ,indian ,health       
,service2 and  7,b7 with respect to     

service at a facility of the ,department
 of ,veterans ,affairs1 concurrently    
with any period of obligated service    
required of the individual by the       
,department4  7f7 ,report ,not later    
than three years before the termination 
of the pilot program under subsection   
7c71 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        
feasibility and advisability of--  7#a7 
expanding the pilot program to          
additional locations2 and  7#b7 making  
the pilot program or any aspect of the  
pilot program permanent4  7g7           
,authorization of appropriations  7#a7  
,in general ,there is authorized to be  
appropriated to the ,secretary of       
,veterans ,affairs #bj1jjj1jjj for each 
year in which the pilot program is      
carried out4  7#b7 ,loan repayments     
7,a7 ,in general ,there is authorized to

 be appropriated-- 7i7 to the ,secretary
 of ,health and ,human ,services1 acting
 through the ,director of the ,indian   
,health ,service1 such sums as may be   
necessary to cover loan repayments paid 
under the ,indian ,health ,service ,loan
 ,repayment ,program to individuals     
participating in the pilot program2 and 
7ii7 to the ,secretary of ,veterans     
,affairs such sums as may be necessary  
to cover loan repayments paid under the 
,department of ,veterans ,affairs       
,education ,debt ,reduction ,program to 
individuals participating in the pilot  
program4  7,b7 ,supplement not supplant 
,amounts appropriated or otherwise made 
available for the ,indian ,health       
,service ,loan ,repayment ,program or   
the ,department of ,veterans ,affairs   
,education ,debt ,reduction ,program    
pursuant to the authorization of        
appropriations under subparagraph 7,a7  
shall supplement1 not supplant1 amounts 
made available to such programs under   
other provisions of law4  7h7 ,covered  

facility defined ,in this section1 the  
term covered facility means a facility--
 7#a7 operated by an ,indian tribe or a 
tribal organization 7as those terms are 
defined in section #d of the ,indian    
,self-,determination and ,education     
,assistance ,act 7#be ,u4,s4,c4 #ecjd771
 or the ,indian ,health ,service1 that  
has an existing reimbursement agreement 
with the ,department of ,veterans       
,affairs under section #dje7;c7 of the  
,indian ,health ,care ,improvement ,act 
7#be ,u4,s4,c4 #afde7;c772 and  7#b7    
located in a rural or remote area1 as   
determined by the ,secretary4