---
kind: "range"
citation: "38 C.F.R. §§ 17.244–17.248"
title: "38"
from: "17.244"
to: "17.248"
count: 5
url: "https://uscodex.org/cfr/38/17.244..17.248"
---

# §17.244. Definitions.


For purposes of [§§ 17.243 through 17.248](/cfr/38/17.243..17.248.md):

Benefit means a benefit provided by VA to a resident that has monetary value in addition to a resident's stipend, which may include but not be limited to health insurance, life insurance, worker's compensation, disability insurance, Federal Insurance Contributions Act taxes, and retirement contributions.

Covered facility means any facility identified in [§ 17.245](/cfr/38/17.245.md).

Educational activities mean all activities in which residents participate to meet educational goals or curriculum requirements of a residency program, to include but not be limited to: clinical duties; research; attendance in didactic sessions; attendance at facility committee meetings; scholarly activities that are part of an accredited training program; and approved educational details.

Resident means physician trainees engaged in post-graduate specialty or subspecialty training programs that are either accredited by the Accreditation Council for Graduate Medical Education or in the application process for such accreditation. A resident may include an individual in their first post-graduate year (PGY-1) of training (often referred to as an intern), and an individual who has completed training in their primary specialty and continues training in a subspecialty graduate medical education program (generally referred to a fellow).

Stipend means the annual salary paid by VA for a resident.

VA health care facility means any VA-owned or VA-operated location where VA physicians provide care to veterans, to include but not be limited to a VA medical center, independent outpatient clinic, domiciliary, nursing home (community living center), residential treatment program, and community-based clinic.


# §17.245. Covered facilities.


A covered facility is any of the following:

- (a) A VA health care facility;
- (b) A health care facility operated by an Indian tribe or tribal organization, as those terms are defined in [25 U.S.C. 5304](/usc/25/5304.md) and at [25 CFR 273.106](/cfr/25/273.106.md);
- (c) A health care facility operated by the Indian Health Service;
- (d) A federally-qualified health center as defined in [42 U.S.C. 1396d(l)(2)(B)](/usc/42/1396d.md?p=l-2-B);
- (e) A health care facility operated by the Department of Defense; or
- (f) **Other health care facilities deemed appropriate by VA.**

# §17.246. Consideration factors for placement of residents.

- (a) **General.** When determining in which covered facilities residents will be placed, VA shall consider the clinical need for health care providers in an area, as determined by VA's evaluation of the following factors:
  - (1) The ratio of veterans to VA providers for a standardized geographic area surrounding a covered facility, including a separate ratio for general practitioners and specialists.
    - (i) For purposes of paragraphs [(a)(1)](#a-1) and [(2)](#a-2) of this section, standardized geographic area means the county in which the covered facility is located.
    - (ii) VA may consider either or both of the ratio(s) for general practitioners and specialists, where a higher ratio of veterans to VA providers indicates a higher need for health care providers in an area.
  - (2) The range of clinical specialties of VA and non-VA providers for a standardized geographic area surrounding a covered facility, where the presence of fewer clinical specialties indicates a higher need for health care providers in an area.
  - (3) Whether the specialty of a provider is included in the most recent staffing shortage determination by VA under [38 U.S.C. 7412](/usc/38/7412.md).
  - (4) Whether the covered facility is in the local community of a VA facility that has been designated by VA as an underserved facility pursuant to criteria developed under section 401 of Public Law 115-182.
  - (5) Whether the covered facility is located in a community that is designated by the Secretary of Health and Human Services as a health professional shortage area under [42 U.S.C. 254e](/usc/42/254e.md).
  - (6) **Whether the covered facility is in a rural or remote area, where—**
    - (i) A rural area means an area identified by the U.S. Census Bureau as rural; and
    - (ii) A remote area means an area within a zip-code designated as a frontier and remote area (FAR) code by the Economic Research Service within the United States Department of Agriculture, based on the most recent decennial census and to include all identified FAR code levels.
  - (7) Such other criteria as VA considers important in determining those covered facilities that are not adequately serving area veterans. These factors may include but are not limited to:
    - (i) Proximity of a non-VA covered facility to a VA health care facility, such that residents placed in non-VA covered facilities may also receive training in VA health care facilities.
    - (ii) Programmatic considerations related to establishing or maintaining a sustainable residency program, such as: whether the stated objectives of a residency program align with VA's workforce needs; the likely or known available educational infrastructure of a new residency program or existing residency program (including the ability to attract and retain qualified teaching faculty); and the ability of the residency program to remain financially sustainable after the cessation of funding that VA may furnish under [§ 17.248](/cfr/38/17.248.md).
- (b) **Priority in placements.** For the duration in which the PPGMER is administered, no fewer than 100 residents will be placed in covered facilities operated by either the Indian Health Service, an Indian tribe, a tribal organization, or covered facilities located in the same areas as VA facilities designated by VA as underserved pursuant to criteria developed under section 401 of Public Law 115-182.

# §17.247. Determination process for placement of residents.


Section 403 of Public Law 115-182 does not authorize a grant program or cooperative agreement program through which covered facilities or any other entity may apply for residents to be placed in covered facilities or to apply for VA to pay or reimburse costs under [§ 17.248](/cfr/38/17.248.md). VA therefore will not conduct a public solicitation to determine those covered facilities in which residents may be placed or to determine costs that may be paid or reimbursed under [§ 17.248](/cfr/38/17.248.md). VA will instead determine those covered facilities in which residents may be placed and determine any costs to be paid or reimbursed under [§ 17.248](/cfr/38/17.248.md) in accordance with the following parameters:

- (a) VA Central Office will issue a request for proposal (RFP) to announce opportunities for residents to be placed in covered facilities and to have costs paid or reimbursed under [§ 17.248](/cfr/38/17.248.md). This RFP will describe, at a minimum:
  - (1) Consideration factors to include the criteria in [§ 17.246](/cfr/38/17.246.md), that will be used to evaluate any responses to the RFP, as well as the relative importance of such consideration factors;
  - (2) Information required to be in any responses to the RFP; and
  - (3) **The process to submit a response to the RFP.**
- (b) Covered facilities will submit responses to the RFP to VA Central Office.
- (c) Consistent with [paragraph (a)](#a) of this section, VA Central Office will evaluate responses to the RFP and will determine those covered facilities where residents may be placed and costs under [§ 17.248](/cfr/38/17.248.md) are paid or reimbursed.

# §17.248. Costs of placing residents and new residency programs.


Once VA determines in which covered facilities residents will be placed in accordance with [§§ 17.246 through 17.247](/cfr/38/17.246..17.247.md), payment or reimbursement is authorized for the following costs:

- (a) **Resident stipends and benefits.** For residents placed in covered facilities, VA may pay only the proportionate cost of resident stipends and benefits that are associated with residents participating in educational activities directly related to the PPGMER, in accordance with any contract, agreement, or other arrangement VA has legal authority to form.
- (b) **Costs associated with new residency programs.**
  - (1) If a covered facility establishes a new residency program in which a resident is placed, VA will reimburse the following costs in accordance with any contract, agreement, or other arrangement VA has legal authority to form.
    - (i) Curriculum development costs, to include but not be limited to costs associated with needs analysis, didactic activities, materials, equipment, consultant fees, and instructional design.
    - (ii) Recruitment and retention of faculty costs, to include but not be limited to costs associated with advertising available faculty positions, and monetary incentives to fill such positions such as relocation costs and educational loan repayment.
    - (iii) Accreditation costs, to include but not be limited to the administrative fees incurred by a covered facility in association with applying for only initial accreditation of the program by the Accreditation Council for Graduate Medical Education (ACGME).
    - (iv) Faculty salary costs, to include only the proportionate cost of faculty performing duties directly related to the PPGMER.
    - (v) Resident education expense costs, to include but not be limited to costs associated with the required purchase of medical equipment and required training, national resident match program participation fees, and residency program management software fees.
  - (2) VA considers new residency programs as only those residency programs that have initial ACGME accreditation or have continued ACGME accreditation without outcomes, and have not graduated an inaugural class, at the time VA has determined those covered facilities where residents will be placed under [§ 17.247(c)](/cfr/38/17.247.md?p=c).