US Codex
Pub. L.
Notes

Title IV — Health Care in Underserved Areas

115th Congress · Approved Jun 6, 2018 · 132 Stat. 1393 · Lineage

TITLE IV Health Care in Underserved Areas

SEC. 401. 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.

(a)
In General.— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall develop criteria to designate medical centers, ambulatory care facilities, and community based outpatient clinics of the Department of Veterans Affairs as underserved facilities.
(b)
Consideration.— Criteria developed under subsection (a) shall include consideration of the following with respect to a facility:
(1)
The ratio of veterans to health care providers of the Department of Veterans Affairs for a standardized geographic area surrounding the facility, including a separate ratio for general practitioners and specialists.
(2)
The range of clinical specialties covered by such providers in such area.
(3)
Whether the local community is medically underserved.
(4)
The type, number, and age of open consults.
(5)
Whether the facility is meeting the wait-time goals of the Department.
(6)
Such other criteria as the Secretary considers important in determining which facilities are not adequately serving area veterans.
(c)
Analysis of Facilities.— Not less frequently than annually, 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 (a).
(d)
Annual Plan To Address Underserved Facilities.—
(1)
Plan required.— Not later than 1 year after the date of the enactment of this Act and not less frequently than once each year, the Secretary shall submit to Congress a plan to address the problem of underserved facilities of the Department, as designated pursuant to criteria developed under subsection (a).
(2)
Contents.— Each plan submitted under paragraph (1) shall address the following:
(A)
Increasing personnel or temporary personnel assistance, including mobile deployment teams furnished under section 407 of this Act.
(B)
Providing special hiring incentives, including under the Education Debt Reduction Program under subchapter VII of chapter 76 of title 38, United States Code, and recruitment, relocation, and retention incentives.
(C)
Using direct hiring authority.
(D)
Improving training opportunities for staff.
(E)
Such other actions as the Secretary considers appropriate.

SEC. 402. Pilot Program to Furnish Mobile Deployment Teams to Underserved Facilities.

(a)
In General.— The Secretary of Veterans Affairs shall carry out a pilot program to furnish mobile deployment teams of medical personnel to underserved facilities.
(b)
Elements.— In furnishing mobile deployment teams under subsection (a), the Secretary shall consider the following elements:
(1)
The medical positions of greatest need at underserved facilities.
(2)
The size and composition of teams to be deployed.
(3)
Such other elements as the Secretary considers necessary for effective oversight of the program established under subsection (a).
(c)
Use of Annual Analysis.— The Secretary shall use the results of the annual analysis conducted under section 401(c) of this Act to form mobile deployment teams under subsection (a) that are composed of the most needed medical personnel for underserved facilities.
(d)
Reporting.—
(1)
Progress report.— Not later than 1 year after the date of the enactment of this Act, the Secretary shall submit a report to Congress on the implementation of the pilot program under this section.
(2)
Final report.— Not later than the termination of the pilot program under this section, the Secretary shall submit a final report to Congress that contains the recommendations of the Secretary regarding the feasibility and advisability of—
(A)
extending or expanding the pilot program; and
(B)
making the pilot program (or any aspect thereof) permanent.
(e)
Duration.— The pilot program under this section shall terminate 3 years after the date of the enactment of this Act.
(f)
Underserved Facility Defined.— In this section, the term “underserved facility” means a medical center, ambulatory care facility, or community based outpatient clinic of the Department of Veterans Affairs designated by the Secretary of Veterans Affairs as underserved pursuant to criteria developed under section 401 of this Act.

SEC. 403. Pilot Program on Graduate Medical Education and Residency.

(a)
Establishment.—
(1)
In general.— Subject to paragraph (5), the Secretary of Veterans Affairs shall establish a pilot program to establish medical residency positions authorized under section 301(b)(2) of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 7302 note) at covered facilities.
(2)
Covered facilities.— For purposes of this section, a covered facility is any of the following:
(A)
A health care facility of the Department of Veterans Affairs.
(B)
A health care facility operated by an Indian tribe or a tribal organization, as those terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304).
(C)
A health care facility operated by the Indian Health Service.
(D)
A Federally-qualified health center, as defined in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1396d(l)(2)(B)).
(E)
A health care facility operated by the Department of Defense.
(F)
Such other health care facility as the Secretary considers appropriate for purposes of this section.
(3)
Agreements.— To carry out the pilot program under this section, the Secretary may enter into agreements with entities that operate covered facilities in which the Secretary places residents under paragraph (1).
(4)
Parameters for location, affiliate sponsor, and duration.— When determining in which covered facilities to place residents under paragraph (1), the Secretary shall consider the extent to which there is a clinical need for providers in an area, as determined by the following:
(A)
The ratio of veterans to health care providers of the Department for a standardized geographic area surrounding a facility, including a separate ratio for general practitioners and specialists.
(B)
The range of clinical specialties of providers in standardized geographic areas surrounding a facility.
(C)
Whether the specialty of a provider is included in the most recent staffing shortage determination of the Department under section 7412 of title 38, United States Code.
(D)
Whether the local community is designated by the Secretary of Veterans Affairs as underserved pursuant to criteria developed under section 401 of this Act.
(E)
Whether the facility is located in a community that is designated by the Secretary of Health and Human Services as a health professional shortage area under section 332 of the Public Health Service Act (42 U.S.C. 254e).
(F)
Whether the facility is located in a rural or remote area.
(G)
Such other criteria as the Secretary considers important in determining which facilities are not adequately serving area veterans.
(5)
Priority in placements.— During the pilot program under this section, the Secretary shall place no fewer than 100 residents in covered facilities—
(A)
operated by the Indian Health Service;
(B)
operated by an Indian tribe;
(C)
operated by a tribal organization; or
(D)
located in communities designated by the Secretary as underserved pursuant to criteria developed under section 401 of this Act.
(6)
Stipends and benefits.— The Secretary may pay stipends and provide benefits for residents in positions under paragraph (1), regardless of whether they have been assigned in a Department facility.
(b)
Reimbursement.— If a covered facility establishes a new residency program in which the Secretary places a resident under the pilot program, the Secretary shall reimburse that covered facility for costs of the following:
(1)
Curriculum development.
(2)
Recruitment and retention of faculty.
(3)
Accreditation of the program by the Accreditation Council for Graduate Medical Education.
(4)
The portion of faculty salaries attributable to duties under an agreement subsection (a)(3).
(5)
Expenses relating to educating a resident under the pilot program.
(c)
Reporting.—
(1)
In general.— Not later than 1 year after the date of the enactment of this Act and not less frequently than once each year thereafter until the termination of the pilot program, the Secretary shall submit to Congress a report on the implementation of the pilot program.
(2)
Elements.— Each report submitted under paragraph (1) shall include the following with regard to the immediately preceding year, and in comparison to the year immediately preceding that year:
(A)
The number of veterans who received care from residents under the pilot program.
(B)
The number of veterans who received care from each resident per position described in subsection (a)(1) under the pilot program.
(C)
The number of veterans who received care from residents under the pilot program expressed as a percentage of all individuals who received care from such residents.
(D)
The number of clinical appointments for veterans conducted by each resident under the pilot program.
(E)
The number of clinical appointments for veterans conducted by residents per position described in subsection (a)(1) under the pilot program.
(F)
The number of clinical appointments for veterans expressed as a percentage of all clinical appointments conducted by residents under the pilot program.
(G)
The number of positions described in subsection (a)(1) at each covered facility under the pilot program.
(H)
For each position described in subsection (a)(1) in a residency program affiliated with a health care facility of the Department, the time a resident under the pilot program spent training at that facility of the Department, expressed as a percentage of the total training time for that resident position.
(I)
For each residency program affiliated with a health care facility of the Department, the time all residents under the pilot program spent training at that facility of the Department, expressed as a percentage of the total training time for those residents.
(J)
The time that all residents under the pilot program who are assigned to programs affiliated with health care facilities of the Department spent training at facilities of the Department, expressed as a percentage of the total training time for those residents.
(K)
The cost to the Department of Veterans Affairs under the pilot program in the year immediately preceding the report and since the beginning of the pilot program.
(L)
The cost to the Department of Veterans Affairs per resident placed under the pilot program at each covered facility.
(M)
The number of residents under the pilot program hired by the Secretary to work in the Veterans Health Administration after completion of residency in the year immediately preceding the report and since the beginning of the pilot program.
(N)
The medical specialties pursued by residents under the pilot program.
(d)
Duration.— The pilot program under this section shall terminate on August 7, 2024.