,,ii  #aae? ,,congress  #a/ ,session    
,s4 #addi  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #bg1 #bjag,mr4   
,sullivan 7= himself & ,mr4 ,te/]7      
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,vet]ans' ,affairs  ,a ,,bill  ,to      
au?orize paym5t by ! ,dep>tm5t (        
,vet]ans ,affairs = ! co/s associat$ )  
tra9+ & sup]vision ( m$ical resid5ts &  
int]ns at c]ta9 facilities t are n      
,dep>tm5t facilities1 to require !      
,secret>y ( ,vet]ans ,affairs to c>ry   
out a pilot program to e/abli% or       
affiliate ) resid5cy programs at        
facilities op]at$ by ,indian tribes1    
tribal organizations1 & ! ,indian ,heal?
 ,s]vice1 & = o!r purposes4  #a4 ,%ort  
title ,?is ,act may be cit$ z ! ,s]v+   
our ,rural ,vet]ans ,act ( #bjag4  #b4  
,s5se ( ,congress ,x is ! s5se (        
,congress t-- 7#a7 ! ,dep>tm5t (        
,vet]ans ,affairs relies on agreem5ts ) 
! ,indian ,heal? ,s]vice & tribal heal? 
organizations to s]ve native &          

non-native vet]an populations 9 c]ta9   
areas1 especially rural areas ( ! ,unit$
 ,/ates1 due to limit$ infra/ructure or 
p]sonnel ( ! ,dep>tm5t 9 ^? areas2  7#b7
 ! ,dep>tm5t %\ld support ! practice (  
rural heal? c>e 9 ! ,unit$ ,/ates       
because su* c>e is crucial to fulfill+ !
 mission ( ! ,dep>tm5t to provide !     
highe/ quality c>e = vet]ans2 &  7#c7   
education reg>d+ ! unique heal? ne$s (  
vet]ans is necess>y = all heal? c>e     
provid]s & is especially important =    
provid]s 9 rural heal? c>e deliv]y      
sy/ems1 includ+ ^? affiliat$ ) ,indian  
tribes & tribal heal? organizations t   
c>e = a significant numb] ( vet]ans4    
#c4 ,au?orization ( paym5t by ,dep>tm5t 
( ,vet]ans ,affairs = tra9+ & sup]vision
 ( resid5ts or int]ns at facilities t   
are n ,dep>tm5t facilities  7a7 ,9 g5]al
 ,subsection 7c7 ( section #gdjf ( title
 #ch1 ,unit$ ,/ates ,code1 is am5d$ by  
/rik+ ,dep>tm5t facility ea* place x    
appe>s & ins]t+ cov]$ facility4  7b7    
,cov]$ facility def9$ ,subsection       

7a77#b7 ( su* section is am5d$ by add+  
at ! end ! foll[+ new subp>agraph3  7,c7
 ,! t]m cov]$ facility means any ( !    
foll[+3 7i7 ,a ,dep>tm5t facility4  7ii7
 ,a facility op]at$ by an ,indian tribe 
or a tribal organization1 z ^? t]ms are 
def9$ 9 section #d ( ! ,indian          
,self-,det]m9ation & ,education         
,assi/ance ,act 7#be ,u4,s4,c4 #ecjd74  
7iii7 ,a facility op]at$ by ! ,indian   
,heal? ,s]vice4  7iv7 ,a                
,f$]ally-qualifi$ heal? c5t]1 z def9$ 9 
section #aije7l77#b77;,b7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#acif;d7l77#b77;,b774  7v7 ,a community 
heal? c5t]4  4  #d4 ,pilot program to   
e/abli% or affiliate ) graduate m$ical  
resid5cy programs at facilities op]at$  
by ,indian tribes1 tribal organizations1
 & ! ,indian ,heal? ,s]vice 9 rural     
areas  7a7 ,9 g5]al ,! ,secret>y (      
,vet]ans ,affairs1 9 consultation ) !   
,director ( ! ,indian ,heal? ,s]vice1   
%all c>ry out a pilot program--  7#a7 to
 e/abli% graduate m$ical education      

resid5cy tra9+ programs at cov]$        
facilities2 or  7#b7 to affiliate )     
e/abli%$ programs describ$ 9 p>agraph   
7#a74  7b7 ,locations  7#a7 ,9 g5]al ,! 
,secret>y %all c>ry out ! pilot program 
at n m ?an f\r cov]$ facilities t h be5 
select$ by ! ,secret>y = purposes ( !   
pilot program4  7#b7 ,crit]ia ,!        
,secret>y %all e/abli% crit]ia = select+
 cov]$ facilities "u p>agraph 7#a74  7c7
 ,duration ,! ,secret>y %all implem5t ! 
pilot program dur+ ! eight-ye> p]iod    
beg9n+ on ! date t is #ahj days aft] !  
date ( ! enactm5t ( ?is ,act4  7d7      
,reimbursem5t ( co/s ,! ,secret>y %all  
reimburse ea* cov]$ facility p>ticipat+ 
9 ! pilot program = ! foll[+ co/s       
associat$ ) ! pilot program3  7#a7      
,curriculum developm5t4  7#b7           
,recruitm5t1 tra9+1 sup]vision1 &       
ret5tion ( resid5ts & faculty4  7#c7    
,accr$itation ( programs ( education "u 
! pilot program by ! ,accr$itation      
,c\ncil = ,graduate ,m$ical ,education  
7,,acgme7 or ! ,am]ican ,o/eopa?ic      

,association 7,,aoa74  7#d7 ,! portion (
 faculty sal>ies attributable to        
activities relat+ to c>ry+ out ! pilot  
program4  7#e7 ,paym5t = exp5ses relat+ 
to provid+ m$ical education "u ! pilot  
program4  7e7 ,p]iod ( obligat$ s]vice  
7#a7 ,9 g5]al ,! ,secret>y %all ent]    
into an agreem5t ) ea* individual :o    
p>ticipates 9 ! pilot program "u :i* su*
 individual agrees to s]ve a p]iod ( "o 
ye> ( obligat$ s]vice at a cov]$        
facility or a facility ( ! ,dep>tm5t (  
,vet]ans ,affairs = ea* ye> 9 :i* !     
individual p>ticipates 9 ! pilot program
 "u ?is section4  7#b7 ,brea* ,an       
individual :o p>ticipates 9 ! pilot     
program & fails to satisfy ! p]iod (    
obligat$ s]vice "u p>agraph 7#a7 %all be
 liable to ! ,unit$ ,/ates1 9 lieu ( su*
 obligat$ s]vice1 = ! am\nt t has be5   
paid or is payable to or on behalf ( !  
individual "u ! pilot program1 r$uc$ by 
! proportion t ! numb] ( days s]v$ =    
completion ( ! p]iod ( obligat$ s]vice  
be>s to ! total numb] ( days 9 ! p]iod (

 obligat$ s]vice ( su* individual4  7#c7
 ,loan repaym5t ,dur+ ! p]iod ( obligat$
 s]vice ( an individual "u p>agraph     
7#a71 ! individual-- 7,a7 %all be deem$ 
to be an eligible individual "u         
subsection 7b7 ( section #ajh ( !       
,indian ,heal? ,c>e ,improvem5t ,act    
7#be ,u4,s4,c4 #afaf;a7 = purposes (    
p>ticipation 9 ! ,indian ,heal? ,s]vice 
,loan ,repaym5t ,program "u su* section 
dur+ ! portion ( su* p]iod t !          
individual s]ves at a cov]$ facility2 & 
7,b7 %all be deem$ to be an eligible    
individual "u section #gfhb7;a7 ( title 
#ch1 ,unit$ ,/ates ,code1 = purposes (  
p>ticipation 9 ! ,dep>tm5t ( ,vet]ans   
,affairs ,education ,debt ,r$uction     
,program "u sub*apt] ,,vii ( *apt] #gf (
 su* title dur+ ! portion ( su* p]iod t 
! individual s]ves at a facility ( !    
,dep>tm5t4  7#d7 ,concurr5t s]vice ,any 
p]iod ( obligat$ s]vice requir$ ( an    
individual "u p>agraph 7#a7 %all be     
s]v$-- 7,a7 ) respect to s]vice at a    
cov]$ facility1 concurr5tly ) any p]iod 

( obligat$ s]vice requir$ ( ! individual
 by ! ,indian ,heal? ,s]vice2 &  7,b7 ) 
respect to s]vice at a facility ( !     
,dep>tm5t ( ,vet]ans ,affairs1          
concurr5tly ) any p]iod ( obligat$      
s]vice requir$ ( ! individual by !      
,dep>tm5t4  7f7 ,report ,n lat] ?an ?ree
 ye>s be=e ! t]m9ation ( ! pilot program
 "u subsection 7c71 ! ,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 ! feasibility & advisability  
(--  7#a7 exp&+ ! pilot program to      
additional locations2 &  7#b7 mak+ !    
pilot program or any aspect ( ! pilot   
program p]man5t4  7g7 ,au?orization (   
appropriations  7#a7 ,9 g5]al ,!re is   
au?oriz$ to be appropriat$ to !         
,secret>y ( ,vet]ans ,affairs           
#bj1jjj1jjj = ea* ye> 9 :i* ! pilot     
program is c>ri$ out4  7#b7 ,loan       
repaym5ts  7,a7 ,9 g5]al ,!re is        
au?oriz$ to be appropriat$-- 7i7 to !   

,secret>y ( ,heal? & ,human ,s]vices1   
act+ ?r\gh ! ,director ( ! ,indian      
,heal? ,s]vice1 su* sums z may be       
necess>y to cov] loan repaym5ts paid "u 
! ,indian ,heal? ,s]vice ,loan ,repaym5t
 ,program to individuals p>ticipat+ 9 ! 
pilot program2 &  7ii7 to ! ,secret>y ( 
,vet]ans ,affairs su* sums z may be     
necess>y to cov] loan repaym5ts paid "u 
! ,dep>tm5t ( ,vet]ans ,affairs         
,education ,debt ,r$uction ,program to  
individuals p>ticipat+ 9 ! pilot        
program4  7,b7 ,supplem5t n supplant    
,am\nts appropriat$ or o!rwise made     
available = ! ,indian ,heal? ,s]vice    
,loan ,repaym5t ,program or ! ,dep>tm5t 
( ,vet]ans ,affairs ,education ,debt    
,r$uction ,program pursuant to !        
au?orization ( appropriations "u        
subp>agraph 7,a7 %all supplem5t1 n      
supplant1 am\nts made available to su*  
programs "u o!r provisions ( law4  7h7  
,cov]$ facility def9$ ,9 ?is section1 ! 
t]m cov]$ facility means a facility--   
7#a7 op]at$ by an ,indian tribe or a    

tribal organization 7z ^? t]ms are def9$
 9 section #d ( ! ,indian               
,self-,det]m9ation & ,education         
,assi/ance ,act 7#be ,u4,s4,c4 #ecjd771 
or ! ,indian ,heal? ,s]vice1 t has an   
exi/+ reimbursem5t agreem5t ) !         
,dep>tm5t ( ,vet]ans ,affairs "u section
 #dje7;c7 ( ! ,indian ,heal? ,c>e       
,improvem5t ,act 7#be ,u4,s4,c4         
#afde7;c772 &  7#b7 locat$ 9 a rural or 
remote area1 z det]m9$ by ! ,secret>y4