,,ii  #aaeth ,,congress  #b;d ,session  
,s4 #bcef  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,january #cj1  
#bjah ,mr4 ,tester 7for himself1 ,mrs4  
,murray1 ,mr4 ,sanders1 and ,mr4        
,manchin7 introduced the following bill2
 which was read twice and referred to   
the ,committee on ,veterans' ,affairs   
,a ,,bill  ,to require the ,secretary of
 ,veterans ,affairs to address staffing 
and other issues at facilities1         
including underserved facilities1 of the
 ,department of ,veterans ,affairs1 and 
for other purposes4  #a4 ,short title   
,this ,act may be cited as the ,stronger
 ,medical ,workforce for ,veterans ,act4
  #b4 ,development of criteria for      
designation of certain medical          
facilities of the ,department of        
,veterans ,affairs as underserved       
facilities and plan to address problem  
of underserved facilities  7a7 ,in      
general ,not later than #ahj days after 
the date of the enactment of this ,act1 
the ,secretary of ,veterans ,affairs    

shall develop criteria to designate     
medical centers1 ambulatory care        
facilities1 and community based         
outpatient clinics of the ,department of
 ,veterans ,affairs as underserved      
facilities4  7b7 ,consideration         
,criteria developed under subsection 7a7
 shall include consideration of the     
following with respect to a facility3   
7#a7 ,the ratio of veterans to health   
care providers of the ,department of    
,veterans ,affairs for a standardized   
geographic area surrounding the         
facility1 including a separate ratio for
 general practitioners and specialists4 
7#b7 ,the range of clinical specialties 
covered by such providers in such area4 
7#c7 ,whether the local community is    
medically underserved4  7#d7 ,the type1 
number1 and age of open consults4  7#e7 
,whether the facility is meeting the    
wait-time goals of the ,department4     
7#f7 ,such other criteria as the        
,secretary considers important in       
determining which facilities are not    

adequately serving area veterans4  7c7  
,analysis of facilities ,not less       
frequently than annually1 directors of  
,veterans ,integrated ,service ,networks
 of the ,department shall perform an    
analysis to determine which facilities  
within that ,veterans ,integrated       
,service ,network qualify as underserved
 facilities pursuant to criteria        
developed under subsection 7a74  7d7    
,annual plan ,to address underserved    
facilities  7#a7 ,plan required ,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 ,congress a plan to address the      
problem of underserved facilities of the
 ,department1 as designated pursuant to 
criteria developed under subsection 7a74
  7#b7 ,contents ,each plan submitted   
under paragraph 7#a7 shall address the  
following3 7,a7 ,increasing personnel or
 temporary personnel assistance1        
including mobile deployment teams4  7,b7

 ,providing special hiring incentives1  
including under the ,education ,debt    
,reduction ,program under subchapter    
,,vii of chapter #gf of title #ch1      
,united ,states ,code1 and recruitment1 
relocation1 and retention incentives4   
7,c7 ,using direct hiring authority4    
7,d7 ,improving training opportunities  
for staff4  7,e7 ,such other actions as 
the ,secretary considers appropriate4   
#c4 ,pilot program on tuition           
reimbursement and loan repayment for    
health care providers of the ,department
 of ,veterans ,affairs at underserved   
facilities  7a7 ,in general ,not later  
than #ij days after the date of the     
enactment of this ,act1 the ,secretary  
of ,veterans ,affairs shall commence a  
pilot program to assess the feasibility 
and advisability of providing incentives
 to individuals to work at underserved  
facilities of the ,veterans ,health     
,administration by providing tuition    
reimbursement and loan repayment to     
medical students and health care        

providers who commit to serving in      
underserved facilities selected under   
subsection 7c74  7b7 ,duration ,the     
,secretary shall carry out the pilot    
program during the six-year period      
beginning on the date of the            
commencement of the pilot program4  7c7 
,selection of locations  7#a7 ,in       
general ,the ,secretary shall select not
 fewer than three medical centers and   
seven ambulatory care facilities or     
community based outpatient clinics of   
the ,department to participate in the   
pilot program4  7#b7 ,rural and highly  
rural areas ,not fewer than two of the  
medical centers and five of the         
ambulatory care facilities or community 
based outpatient clinics selected under 
paragraph 7#a7 shall be in ,states or   
,united ,states territories that are    
among the ten ,states or ,united ,states
 territories with--  7,a7 the highest   
percentage of land designated as highly 
rural pursuant to the rural-urban       
commuting area codes set forth by the   

,department of ,agriculture2 or  7,b7   
the highest percentage of enrolled      
veterans living in rural1 highly rural1 
or insular island areas4  7#c7 ,states  
,facilities selected under paragraph    
7#a7 shall be located in not fewer than 
eight different ,states4  7d7 ,use of   
amounts ,of the amounts used to provide 
tuition reimbursement or loan repayment 
under the pilot program-- 7#a7 one-half 
shall be used to provide tuition        
reimbursement or loan repayment for     
individuals practicing in a general     
practice position2 and  7#b7 one-half   
shall be used to provide tuition        
reimbursement or loan repayment for     
individuals practicing--  7,a7 in a     
specialist position2 or  7,b7 in an     
occupation1 other than a position       
described in paragraph 7#a71 included in
 the most recent staffing shortage      
determination of the ,department under  
section #gdab of title #ch1 ,united     
,states ,code4  7e7 ,tuition            
reimbursement ,under the pilot program1 

the ,secretary may provide to an        
individual attending medical school and 
seeking a degree as a ,doctor of        
,medicine or a ,doctor of ,osteopathic  
,medicine full tuition reimbursement in 
exchange for a five-year commitment to  
serve at an underserved facility        
selected under subsection 7c74  7f7     
,student loan repayment ,under the pilot
 program1 in exchange for a three-year  
commitment to serve at an underserved   
facility selected under subsection 7c71 
the ,secretary may provide--  7#a7 to an
 individual currently serving as a      
health care provider at an underserved  
facility1 an amount not to exceed       
#cj1jjj to apply to any remaining       
student loan debt of the individual2 and
  7#b7 to an individual other than an   
individual described in paragraph 7#a71 
an amount not to exceed #ej1jjj to apply
 to any remaining student loan debt of  
the individual4  7g7 ,breach ,an        
individual who participates in the pilot
 program and fails to satisfy a period  

of obligated service under subsection   
7e7 or 7f7 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  7h7 ,expedited     
hiring ,the ,secretary shall ensure that
 the hiring of individuals to serve in  
the ,department under the pilot program 
is conducted in an expedited manner4    
7i7 ,continuation in pilot program ,an  
individual participating in the pilot   
program in an occupation included in a  
staffing shortage determination of the  
,department under section #gdab of title
 #ch1 ,united ,states ,code1 may        
continue participating in the pilot     
program notwithstanding that the        
occupation is no longer included in such

 determination under such section4  7j7 
,annual report  7#a7 ,in general ,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 ,congress a report on the pilot      
program4  7#b7 ,contents ,each report   
submitted under paragraph 7#a7 shall    
include the following3 7,a7 ,the number 
of participants1 including the number   
receiving tuition reimbursement and     
student loan repayment4  7,b7 ,the      
number of facilities where participants 
are located4  7,c7 ,the number of       
individuals who have applied to         
participate in the pilot program4  7,d7 
,a list of the five most common         
occupations of the participants in the  
pilot program1 other than general       
practice4  7k7 ,definitions ,in this    
section3 7#a7 ,enrolled veteran ,the    
term enrolled veteran means a veteran   
who is enrolled in the system of annual 
patient enrollment established and      

operated under section #agje7;a7 of     
title #ch1 ,united ,states ,code4  7#b7 
,underserved facility ,the term         
underserved facility means a medical    
center1 ambulatory care facility1 or    
community based outpatient clinic of the
 ,department of ,veterans ,affairs      
designated by the ,secretary of         
,veterans ,affairs pursuant to criteria 
developed under section #b4  #d4 ,report
 on workforce vacancies within the      
,veterans ,health ,administration  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 vacancies  
within the ,veterans ,health            
,administration4  7b7 ,elements ,the    
report required by subsection 7a7 shall 
include the following3 7#a7 ,with       
respect to vacancies of personnel       

appointed under section #gdja of title  
#ch1 ,united ,states ,code--  7,a7 the  
total number of such vacancies2  7,b7   
the number of such vacancies            
disaggregated by occupation1 ,state1    
,veterans ,integrated ,service ,network1
 medical facility1 and the central      
office of the ,department of ,veterans  
,affairs2 and  7,c7 a description of the
 plans of the ,secretary to fill such   
vacancies1 including a timeline for     
filling such vacancies1 and an          
assessment of whether the ,secretary    
requires additional hiring authorities  
to expedite the hiring process4  7#b7   
,with respect to vacancies of human     
resource specialists of the ,veterans   
,health ,administration-- 7,a7 the total
 number of such vacancies2  7,b7 the    
number of such vacancies disaggregated  
by ,state and medical facility2 and     
7,c7 a description of the plans of the  
,secretary to fill such vacancies1      
including a timeline for filling such   
vacancies1 and an assessment of whether 

the ,secretary requires additional      
hiring authorities to expedite the      
hiring process4  7#c7 ,a description of 
any impediments to filling the vacancies
 described in paragraphs 7#a7 and 7#b7  
and any actions the ,secretary intends  
to take to address such impediments4    
7#d7 ,an update on the implementation by
 the ,secretary of-- 7,a7 the ,veterans 
,health ,administration ,workforce and  
,succession ,strategic ,plan for #bjaf2 
7,b7 the recommendation by the ,office  
of the ,inspector ,general of the       
,department that the ,under ,secretary  
for ,health develop staffing models for 
critical need occupations of the        
,veterans ,health ,administration1 as   
determined by the ,secretary2 and  7,c7 
the recommendation by the ,office of the
 ,inspector ,general that the ,under    
,secretary for ,health establish        
milestones and timetables for further   
development1 piloting1 and              
implementation of staffing models for   
critical need occupations of the        

,veterans ,health ,administration1 as   
determined by the ,secretary4  #e4      
,assignment to ,department of ,veterans 
,affairs of commissioned officers of the
 ,regular ,corps of the ,public ,health 
,service  7a7 ,assignment  7#a7 ,in     
general ,not later than #ahj days after 
the date of the enactment of this ,act1 
the ,secretary of ,veterans ,affairs and
 the ,surgeon ,general shall enter into 
a memorandum of understanding for the   
assignment of not fewer than #ejj       
commissioned officers of the ,regular   
,corps of the ,public ,health ,service  
to the ,department of ,veterans         
,affairs4  7#b7 ,manner of assignment   
,assignments under paragraph 7#a7 shall 
be made in the same manner in which     
assignments are made to other ,federal  
agencies4  7b7 ,reimbursement ,the      
,secretary shall reimburse the ,surgeon 
,general for such expenses as the       
,surgeon ,general may incur in assigning
 commissioned officers pursuant to a    
memorandum of understanding entered into

 under subsection 7a74  7c7 ,report     
7#a7 ,in general ,not later than one    
year after the date of the enactment of 
this ,act1 the ,secretary and the       
,surgeon ,general shall each 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        
memorandum of understanding entered into
 under subsection 7a7 and the           
commissioned officers assigned pursuant 
to such memorandum of understanding4    
7#b7 ,contents ,the report required by  
paragraph 7#a7 shall include the        
following3 7,a7 ,the numbers1 grades1   
and specialties of commissioned officers
 assigned pursuant to the memorandum of 
understanding entered into under        
subsection 7a74  7,b7 ,a description of 
any problems encountered in such        
assignment4  #f4 ,inclusion of ,vet     
,center employees in education debt     
reduction program of ,department of     
,veterans ,affairs  7a7 ,in general ,the

 ,secretary of ,veterans ,affairs shall 
ensure that clinical staff working at   
,vet ,centers are eligible to           
participate in the education debt       
reduction program of the ,department of 
,veterans ,affairs under subchapter     
,,vii of chapter #gf of title #ch1      
,united ,states ,code4  7b7 ,report ,not
 later than one year after the date of  
the enactment of this ,act1 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 number 
of participants in the education debt   
reduction program of the ,department    
under such subchapter who work at ,vet  
,centers4  7c7 ,vet ,center defined ,in 
this section1 the term ,vet ,center has 
the meaning given that term in section  
#agab;,a7h7 of title #ch1 ,united       
,states ,code4