,,ii  #aaith ,,congress  #ast ,session  
,s4 #cjcc  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,october #bb   
7legislative day1 ,october #ba71 #bjbe  
,ms4 ,duckworth 7for herself and ,mrs4  
,blackburn7 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 establish      
partnerships between medical facilities 
of the ,department of ,veterans ,affairs
 and medical facilities in rural areas1 
and for other purposes4  #a4  ,short    
title  ,this ,act may be cited as the   
,improving ,access to ,care for ,rural  
,veterans ,act4  #b4  ,partnerships     
between medical facilities of           
,department of ,veterans ,affairs and   
rural medical facilities  7a7           
,partnerships  7#a7  ,in general  ,the  
,secretary of ,veterans ,affairs shall  
require that each medical facility of   
the ,department of ,veterans ,affairs   
enter into a partnership with a medical 

facility in a rural area4  7#b7         
,agreements  ,each partnership entered  
into under paragraph 7#a7 may include an
 agreement for provision of telehealth1 
co-location or leasing of space or      
equipment1 training1 care coordination1 
emergency services 7including           
transportation71 or other services as   
determined appropriate4  7#c7  ,purpose 
of partnership  ,the purpose of any     
partnership entered into under paragraph
 7#a7 shall be to provide greater access
 to care for veterans in rural areas and
 to reduce costs to all entities within 
the partnership4  7b7  ,waiver  7#a7    
,in general  ,the ,secretary may waive  
the requirement under subsection 7a77#a7
 with respect to a medical facility for 
a period not to exceed five years1      
subject to such requirements as the     
,secretary may establish1 if the        
,secretary notifies ,congress of the    
waiver not later than #dh hours before  
the waiver takes effect4  7#b7  ,renewal
  ,the ,secretary may renew a waiver    

under paragraph 7#a7 with respect to a  
medical facility only if the ,secretary1
 in consultation with the head of the   
medical facility1 evaluates the need for
 the waiver and determines that the     
waiver is necessary4  7c7  ,briefing    
,not later than #ahj days after the date
 of the enactment of this ,act1 the     
,secretary shall provide to the         
appropriate committees of ,congress a   
briefing on the plans of the ,secretary 
for the implementation of the           
requirement under subsection 7a77#a71   
including--  7#a7 a timeline for        
implementation of such requirement2     
7#b7 an identification of an official of
 the ,department responsible for        
oversight and implementation of such    
requirement2  7#c7 an update on the     
establishment of any office1 task force1
 or personnel assignments to support the
 implementation of such requirement2    
7#d7 a description of the plan of the   
,department for oversight of such       
requirement2  7#e7 a standardized form  

or forms to be used for waivers under   
subsection 7b7 and an explanation of the
 criteria for eligibility for such a    
waiver2 and  7#f7 such other information
 as the ,secretary considers to be of   
interest to the appropriate committees  
of ,congress4  7d7  ,report  ,not later 
than two years after the date of the    
enactment of this ,act1 and biennially  
thereafter1 the ,secretary shall submit 
to the appropriate committees of        
,congress a report on the operation and 
performance of partnerships entered into
 under subsection 7a71 including--  7#a7
 new partnerships created1 in the case  
of the initial report1 since the date of
 the enactment of this ,act1 and1 in the
 case of any subsequent report1 during  
the period following the previous       
report2  7#b7 existing partnerships     
between medical facilities of the       
,department and medical facilities in   
rural areas2 and  7#c7 as assessment of 
the success of all partnerships         
described in paragraphs 7#a7 and 7#b7 in

 delivering services to veterans in     
rural areas1 including--  7,a7 the      
number of veterans enrolled in the      
system of annual patient enrollment of  
the ,department under section #agje7;a7 
of title #ch1 ,united ,states ,code1 in 
the region in which the partnered       
medical facilities are located compared 
to the previous five-year period2  7,b7 
an evaluation of accessibility to       
services as compared to the services    
available to those veterans prior to the
 implementation of such partnerships2   
7,c7 an overview of new best practices  
developed for such partnerships and the 
,department more broadly2 and  7,d7 the 
number of veterans receiving            
compensation from the ,department for a 
service-connected disability in the     
region in which the partnered medical   
facilities are located compared to the  
previous five-year period4  7e7         
,timeline  7#a7  ,existing facilities   
,except as provided in paragraph 7#b71  
by not later than three years after the 

date of the enactment of this ,act1 the 
,secretary shall ensure that all medical
 facilities of the ,department that are 
seeing patients are compliant with the  
requirement under subsection 7a77#a7 or 
have received a waiver under subsection 
7b74  7#b7  ,new facilities  ,the       
,secretary shall ensure that any medical
 facility of the ,department established
 after the date of the enactment of this
 ,act is compliant with the requirement 
under subsection 7a77#a7 or has received
 a waiver under subsection 7b7 by not   
later than three years after the date on
 which patients are first seen at the   
medical facility4  7f7  ,relationship to
 existing law  ,the requirements and    
authorities under this section are in   
addition to1 and separate from1 the     
authority under section #haec of title  
#ch1 ,united ,states ,code4  7g7        
,definitions  ,in this section3 7#a7    
,appropriate committees of ,congress    
,the term appropriate committees of     
,congress means--  7,a7 the ,committee  

on ,veterans' ,affairs and the          
,committee on ,appropriations of the    
,senate2 and  7,b7 the ,committee on    
,veterans' ,affairs and the ,committee  
on ,appropriations of the ,house of     
,representatives4  7#b7  ,partnership   
,the term partnership includes a leasing
 or co-location agreement1 a memorandum 
of understanding1 a partnership         
agreement1 an employment contract1 an   
independent contractor agreement1 a     
service agreement1 or any other similar 
agreement4  7#c7  ,rural  ,the term     
rural has the meaning given that term   
under the ,rural-,urban ,commuting      
,areas 7,,ruca7 coding system of the    
,department of ,agriculture4  7#d7      
,service-connected  ,the term           
service-connected has the meaning given 
that term in section #aja7af7 of title  
#ch1 ,united ,states ,code4