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Title II — Training and Hiring of Health Care Staff

S. 2422 · 113th Congress · Jun 3, 2014 · Lineage

II Training and Hiring of Health Care Staff

Sec. 201 Modification of liability for breach of period of obligated service under Health Professionals Educational Assistance Program for primary care physicians

Section 7617 of title 38, United States Code, is amended—
(1)
In subsection (c)(1), by striking “If a participant” and inserting “Except as provided in subsection (d), if a participant”; and
(2)
by adding at the end the following new subsection:

“(d) Liability shall not arise under subsection (c) in the case of a participant otherwise covered by that subsection who has pursued a course of education or training in primary care if—

“(1) the participant—

“(A) does not obtain, or fails to maintain, employment as a Department employee due to staffing changes approved by the Under Secretary for Health; or

“(B) does not obtain, or fails to maintain, employment in a position of primary care physician in the Veterans Health Administration due, as determined by the Secretary, to a number of primary care physicians in the Administration that is excess to the needs of the Administration; and

“(2) the participant agrees to accept and maintain employment as a primary care physician with another department or agency of the Federal Government (with such employment to be under such terms and conditions as are jointly agreed upon by the participant, the Secretary, and the head of such department or agency, including terms and conditions relating to a period of obligated service as a primary care physician with such department or agency) if such employment is offered to the participant by the Secretary and the head of such department or agency.”

Sec. 202 Program of education at Uniformed Services University of the Health Sciences with specialization in primary care

(a)
Program required under Health Professionals Educational Assistance Program—
(1)
In general— Chapter 76 of title 38, United States Code, is amended by adding after subchapter VII the following new subchapter:

“VIII Program of Education at Uniformed Services University of the Health Sciences With Specialization in Primary Care

“7691. Authority for program

“As part of the Educational Assistance Program, the Secretary shall, in collaboration with the Secretary of Defense, carry out a program to permit individuals to enroll in the Uniformed Services University of the Health Sciences under chapter 104 of title 10 to pursue a medical education with a specialization in primary care. The program shall be known as the Department of Veterans Affairs Primary Care Educational Assistance Program (in this chapter referred to as the “Primary Care Educational Assistance Program”).

“7692. Selection; agreement; ineligibility for certain other educational assistance

“(a) Selection

“(1) Medical students at the Uniformed Services University of the Health Sciences pursuant to the Primary Care Educational Assistance Program shall be selected by the Secretary, in consultation with the Secretary of Defense, in accordance with procedures established by the Secretaries for purposes of the Program.

“(2) The procedures referred to in paragraph (1) shall emphasize the basic requirement that students demonstrate a motivation and dedication to a medical career in primary care.

“(3) The number of medical students selected each year for first-year enrollment in the University pursuant to this subsection shall be jointly determined by the Secretary and the Secretary of Defense.

“(b) Agreement—An agreement between the Secretary and a participant in the Primary Care Educational Assistance Program shall (in addition to the requirements set forth in section 7604 of this title) include the following:

“(1) The Secretary's agreement to cover the costs of the participant's education and training at the Uniformed Services University of the Health Sciences under chapter 104 of title 10 as if the participant were a medical student enrolled in the University pursuant to section 2114 of title 10.

“(2) The participant's agreement to serve as a full-time employee in the Veterans Health Administration in a position as a primary care physician for a period of time (in this subchapter referred to as the “period of obligated service”) of one calendar year for each school year or part thereof for which the participant was a medical student at the Uniformed Services University of the Health Sciences pursuant to the Primary Care Educational Assistance Program, but for not less than one year.

“(c) Ineligibility for other educational assistance—An individual who receives education and training under the Primary Care Educational Assistance Program shall not be eligible for other assistance under this chapter in connection with such education and training.

“7693. Obligated service

“(a) In general—Each participant in the Primary Care Educational Assistance Program shall provide service as a full-time employee of the Department in the Veterans Health Administration in a primary care position for the period of obligated service provided in the agreement of the participant entered into for purposes of this subchapter. Such service shall be provided in a full-time primary care clinical practice in an assignment or location determined by the Secretary.

“(b) Service commencement date

“(1) Not later than 60 days before a participant's service commencement date, the Secretary shall notify the participant of that service commencement date. That date is the date for the beginning of the participant's period of obligated service.

“(2) As soon as possible after a participant's service commencement date, the Secretary shall—

“(A) in the case of a participant who is not a full-time employee in the Veterans Health Administration, appoint the participant as such an employee; and

“(B) in the case of a participant who is an employee in the Veterans Health Administration but is not serving in a position for which the participant's course of education or training prepared the participant, assign the participant to such a position.

“(3) A participant's service commencement for purposes of this subsection date is the date upon which the participant becomes licensed to practice medicine in a State.

“(c) Commencement of obligated service—A participant in the Primary Care Educational Assistance Program shall be considered to have begun serving the participant's period of obligated service—

“(1) on the date on which the participant is appointed as a full-time employee in the Veterans Health Administration pursuant to subsection (b)(2)(A); or

“(2) if the participant is a full-time employee in the Veterans Health Administration and assigned to a position pursuant to subsection (b)(2)(B), on the date on which the participant is so assigned to such position.

“7694. Breach of agreement: liability

“(a) Liability during course of education or training

“(1) A participant in the Primary Care Educational Assistance Program shall be liable to the United States for the amount which has been paid on behalf of the participant under the agreement entered into for purposes of this subchapter if any of the following occurs:

“(A) The participant fails to maintain an acceptable level of academic standing in the Uniformed Services University of the Health Sciences.

“(B) The participant is dismissed from the Uniformed Services University of the Health Sciences for disciplinary reasons.

“(C) The participant voluntarily terminates the course of medical education and training in the Uniformed Services University of the Health Sciences before the completion of such course of education and training.

“(D) The participant fails to become licensed to practice medicine in a State during a period of time determined under regulations prescribed by the Secretary.

“(2) Liability under this subsection is in lieu of any service obligation arising under a participant's agreement for purposes of this subchapter.

“(b) Liability during period of obligated service

“(1) Except as provided in subsection (c) and subject to paragraph (2), if a participant in the Primary Care Educational Assistance Program breaches the agreement entered into for purposes of this subchapter by failing for any reason to complete the participant's period of obligated service, the United States shall be entitled to recover from the participant an amount equal to—

“(A) the total amount paid under this subchapter on behalf of the participant; multiplied by

“(B) a fraction—

“(i) the numerator of which is—

“(I) the total number of months in the participant's period of obligated service; minus

“(II) the number of months served by the participant pursuant to the agreement; and

“(ii) the denominator of which is the total number of months in the participant's period of obligated service.

“(2) Any period of internship or residency training of a participant shall not be treated as satisfying the participant's period of obligated service for purposes of this subsection.

“(c) Exceptions—Liability shall not arise under subsection (b) in the case of a participant otherwise covered by that subsection if—

“(1) the participant—

“(A) does not obtain, or fails to maintain, employment as a Department employee due to staffing changes approved by the Under Secretary for Health; or

“(B) does not obtain, or fails to maintain, employment in a position of primary care physician in the Veterans Health Administration due, as determined by the Secretary, to a number of primary care physicians in the Administration that is excess to the needs of the Administration; and

“(2) the participant agrees to accept and maintain employment as a primary care physician with another department or agency of the Federal Government (with such employment to be under such terms and conditions as are jointly agreed upon by the participant, the Secretary, and the head of such department or agency, including terms and conditions relating to a period of obligated service as a primary care physician with such department or agency) if such employment is offered to the participant by the Secretary and the head of such department or agency.

“7695. Funding

“(a) In general—Amounts for the Primary Care Educational Assistance Program shall be derived from amounts available to the Secretary for the Veterans Health Administration.

“(b) Transfer

“(1) The Secretary shall transfer to the Secretary of Defense amounts required by the Secretary of Defense to carry out the Primary Care Educational Assistance Program.

“(2) Amounts transferred to the Secretary of Defense pursuant to paragraph (1) shall be credited to the appropriation or account providing funding for the Uniformed Services University of the Health Sciences. Amounts so credited shall be merged with amounts in the appropriation or account to which credited and shall be available, subject to the terms and conditions applicable to such appropriation or account, for the Uniformed Services University of the Health Sciences.”

(2)
Clerical amendment— The table of sections at the beginning of chapter 76 of such title is amended by adding after the item relating to section 7684 the following:
(b)
Inclusion of program in Health Professionals Educational Assistance Program— Section 7601(a) of such title is amended—
(1)
in paragraph (4), by striking “; and” and inserting a semicolon;
(2)
in paragraph (5), by striking the period at the end and inserting “; and”; and
(3)
by adding at the end the following new paragraph:

“(6) the enrollment of individuals in the Uniformed Services University of the Health Sciences for specialization in primary care provided for in subchapter VIII of this chapter.”

(c)
Application requirements—
(1)
In general— Subsection (a)(1) of section 7603 of such title is amended in the matter preceding subparagraph (A) by striking “, or VI” and inserting “, VI, or VIII”.
(2)
No priority for applications— Subsection (d) of such section is amended—
(A)
by striking “In selecting” and inserting “(1) Except as provided in paragraph (2), in selecting”; and
(B)
by adding at the end the following new paragraph:

“(2) Paragraph (1) shall not apply with respect to applicants for participation in the Program of Education at Uniformed Services University of the Health Sciences With Specialization in Primary Care pursuant to subchapter VIII of this chapter.”

(d)
Agreement requirements— Section 7604 of such title is amended by striking “, or VI” each place it appears and inserting “, VI, or VIII”.

Sec. 203 Treatment of staffing shortage and biannual report on staffing of medical facilities of the Department of Veterans Affairs

(a)
Staffing shortage—
(1)
In general— Not later than 180 days after the date of the enactment of this Act, and not later than September 30 each year thereafter, the Secretary of Veterans Affairs shall determine, and publish in the Federal Register, the five occupations of health care providers of the Department of Veterans Affairs for which there is the largest staffing shortage throughout the Department.
(2)
Recruitment and appointment— Notwithstanding sections 3304 and 3309 through 3318 of title 5, United States Code, the Secretary may, upon a determination by the Secretary under paragraph (1) or a modification to such determination under paragraph (2), that there is a staffing shortage throughout the Department with respect to a particular occupation of health care provider, recruit and directly appoint highly qualified health care providers to a position to serve as a health care provider in that particular occupation for the Department.
(3)
Priority in Health Professionals Educational Assistance Program to certain providers— Section 7612(b)(5) of title 38, United States Code, is amended—
(A)
in subparagraph (A), by striking “and” at the end;
(B)
by redesignating subparagraph (B) as subparagraph (C); and
(C)
by inserting after subparagraph (A) the following new subparagraph (B):

“(B) shall give priority to applicants pursuing a course of education or training towards a career in an occupation for which the Secretary has, in the most current determination published in the Federal Register pursuant to section 203(a)(1) of the Ensuring Veterans Access to Care Act of 2014, determined that there is one of the largest staffing shortage throughout the Department with respect to such occupation; and”

(b)
Reports—
(1)
In general— Not later than 180 days after the date of the enactment of this Act, and not later than December 31 of each even numbered year thereafter until 2024, 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 assessing the staffing of each medical facility of the Department of Veterans Affairs.
(2)
Elements— Each report submitted under paragraph (1) shall include the following:
(A)
The results of a system-wide assessment of all medical facilities of the Department to ensure the following:
(i)
Appropriate staffing levels for health care providers to meet the goals of the Secretary for timely access to care for veterans.
(ii)
Appropriate staffing levels for support personnel, including clerks.
(iii)
Appropriate sizes for clinical panels.
(iv)
Appropriate numbers of full-time staff, or full-time equivalent, dedicated to direct care of patients.
(v)
Appropriate physical plant space to meet the capacity needs of the Department in that area.
(vi)
Such other factors as the Secretary considers necessary.
(B)
A plan for addressing any issues identified in the assessment described in subparagraph (A), including a timeline for addressing such issues.
(C)
A list of the current wait times and workload levels for the following clinics in each medical facility:
(i)
Mental health.
(ii)
Primary care.
(iii)
Gastroenterology.
(iv)
Women’s health.
(v)
Such other clinics as the Secretary considers appropriate.
(D)
A description of the results of the determination of the Secretary under paragraph (1) of subsection (a) and a plan to use direct appointment authority under paragraph (2) of such subsection to fill staffing shortages, including recommendations for improving the speed at which the credentialing and privileging process can be conducted.
(E)
The current staffing models of the Department for the following clinics, including recommendations for changes to such models:
(i)
Mental health.
(ii)
Primary care.
(iii)
Gastroenterology.
(iv)
Women’s health.
(v)
Such other clinics as the Secretary considers appropriate.
(F)
A detailed analysis of succession planning at medical facilities of the Department, including the following:
(i)
The number of positions in medical facilities throughout the Department that are not filled by a permanent employee.
(ii)
The length of time each such position described in clause (i) remained vacant or filled by a temporary or acting employee.
(iii)
A description of any barriers to filling the positions described in clause (i).
(iv)
A plan for filling any positions that are vacant or filled by a temporary or acting employee for more than 180 days.
(v)
A plan for handling emergency circumstances, such administrative leave or sudden medical leave for senior officials.
(G)
The number of health care providers who have been removed from their position or have retired, by provider type, during the two-year period preceding the submittal of the report.
(H)
Of the health care providers specified in subparagraph (G) that have been removed from their position, the following:
(i)
The number of such health care providers who were reassigned to another position in the Department.
(ii)
The number of such health care providers who left the Department.

Sec. 204 Clinic management training program of the Department of Veterans Affairs

(a)
In general— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall implement a clinic management training program to provide in-person, standardized education on health care management to all managers of, and health care providers at, medical facilities of the Department of Veterans Affairs.
(b)
Elements— The clinic management training program required by subsection (a) shall include the following:
(1)
Training on how to manage the schedules of health care providers of the Department, including the following:
(A)
Maintaining such schedules in a manner that allows appointments to be booked at least eight weeks in advance.
(B)
Proper planning procedures for vacation, leave, and graduate medical education training schedules.
(2)
Training on the appropriate number of appointments that a health care provider should conduct on a daily basis, based on specialty.
(3)
Training on how to determine whether there are enough available appointment slots to manage demand for different appointment types and mechanisms for alerting management of insufficient slots.
(4)
Training on how to properly use the data produced by the scheduling dashboard required by section 101(b)(11) of this Act to meet demand for health care, including the following:
(A)
Training on determining the next available appointment for each health care provider at the medical facility.
(B)
Training on determining the number of health care providers needed to meet demand for health care at the medical facility.
(C)
Training on determining the number of exam rooms needed to meet demand for such health care in an efficient manner.
(5)
Training on how to properly use the appointment scheduling system of the Department, including any new scheduling system implemented by the Department.
(6)
Training on how to optimize the use of technology, including the following:
(A)
Telemedicine.
(B)
Electronic mail.
(C)
Text messaging.
(D)
Such other technologies as specified by the Secretary.
(7)
Training on how to properly use physical plant space at medical facilities of the Department to ensure efficient flow and privacy for patients and staff.

Sec. 205 Inclusion of Department of Veterans Affairs facilities in National Health Service Corps Scholarship and loan repayment programs

(a)
In general— The Secretary of Health and Human Services shall use the funds transferred under subsection (e) to award scholarship and loan repayment contracts under sections 338A and 338B of the Public Health Service Act (42 U.S.C. 254l, 254l–1) to eligible individuals who agree to a period of obligated service under section 338A(f)(1) or 338B(f)(1) of such Act, as applicable, at a health facility of the Department of Veterans Affairs.
(b)
Health professional shortage areas— For purposes of selecting individuals eligible for the scholarships and loan repayment contracts under subsection (a), all health facilities of the Department of Veterans Affairs shall be deemed health professional shortage areas, as defined in section 332 of the Public Health Service Act (42 U.S.C. 254e).
(c)
Requirement— The Secretary of Health and Human Services shall ensure that a minimum of 5 scholarships or loan repayment contracts are awarded to individuals who agree to a period of obligated service at Veterans Affairs facilities in each State.
(d)
Applicability of NHSC program requirements— Except as otherwise provided in this section, the terms of the National Health Service Corps Scholarship Program and the National Health Service Corps Loan Repayment Program shall apply to participants awarded a grant or loan repayment contract under subsection (a) in the same manner that such terms apply to participants awarded a grant or loan repayment contract under section 338A or 338B of the Public Health Service Act.
(e)
Inclusion of geriatricians— For purposes of awarding scholarships and loan repayments contracts to eligible individuals who agree to a period of obligated service at a health facility of the Department of Veterans Affairs pursuant to this section, in sections 338A and 338B of the Public Health Service Act (42 U.S.C. 254l, 254l–1), the term primary health services shall include geriatrics.
(f)
Funding— The Secretary of Veterans Affairs shall transfer $20,000,000 for fiscal year 2014, and such sums as may be necessary for each fiscal year thereafter, from accounts of the Veterans Health Administration to the Secretary of Health and Human Services to award scholarships and loan repayment contracts, as described in subsection (a). All funds so transferred shall be used exclusively for the purposes described in such subsection.

Sec. 206 Authorization of emergency appropriations

There is authorized to be appropriated for the Department of Veterans Affairs such sums as may be necessary to carry out this title.