Sec. 211. Graduate medical education and residency
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The Secretary of Veterans Affairs shall increase the number of graduate medical education residency positions at covered facilities by up to 1,500 positions in the 10-year period beginning on the date of the enactment of this Act. For purposes of this section, a covered facility is any of the following: A facility of the Department of Veterans Affairs. A 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 ).
A facility operated by the Indian Health Service. 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) ). A community health center. A facility operated by the Department of Defense. Such other health care facility as the Secretary considers appropriate for purposes of this section. 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.
When determining characteristics of residency positions under paragraph (1), the Secretary shall consider the extent to which there is a clinical need for providers, as determined by the following: 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. Whether the local community is medically underserved. Whether the facility is located in a rural or remote area.
Such other criteria as the Secretary considers important in determining which facilities are not adequately serving area veterans. When determining the types of specialties to be included in residency positions under paragraph (1), the Secretary shall consider the following: The types of specialties that improve the quality and coverage of medical services provided to veterans. The range of clinical specialties covered by providers in standardized geographic areas surrounding facilities.
Whether the specialty is included in the most recent staffing shortage determination of the Department under section 7412 of title 38, United States Code. To participate as a resident in one of the positions increased under subsection (a)(1), an individual shall submit to the Secretary an application therefor together with an agreement described in subsection
(d)under which the participant agrees to serve a period of obligated service in the Veterans Health Administration as provided in the agreement in return for payment of stipend and benefit support as provided in the agreement. An individual becomes a participant in a residency program under this section upon the Secretary's approval of the individual's application under subsection
(b)and the Secretary's acceptance of the agreement under subsection
(d)(if required). Upon the Secretary's approval of an individual's participation in the program under paragraph (1), the Secretary shall promptly notify the individual of that approval. Such notice shall be in writing. An agreement between the Secretary and a resident in a position under subsection (a)(1) shall be in writing and shall be signed by the resident containing such terms as the Secretary may specify. The agreement must specify the terms of the service obligation resulting from participating as a resident under this section, including by requiring a service obligation equal to the number of years of stipend and benefit support. The Secretary may prescribe the conditions of employment of individuals appointed to positions under subsection (a)(1), including necessary training, and the customary amount and terms of pay for such positions during the period of such employment and training. Each individual appointed to a position under subsection (a)(1) shall provide service as a full-time employee of the Department for the period of obligated service provided in the agreement of the participant entered into under subsection (d). Such service shall be provided in the full-time clinical practice of such participant's profession or in another health care position in an assignment or location determined by the Secretary. Not later than 60 days before the date on which an individual commences serving in a position under subsection (a)(1), the Secretary shall notify the individual of such date. Such date shall be the first day of the individual's period of obligated service. An individual appointed under this section to a position under subsection (a)(1) (other than an individual who is liable under paragraph (2)) who fails to accept payment, or instructs the educational institution in which the individual is enrolled not to accept payment, in whole or in part, for a residency under the agreement entered into under subsection
(d)of this title shall be liable to the United States for liquidated damages in the amount of $1,500. Such liability is in addition to any period of obligated service or other obligation or liability under the agreement. An individual appointed to a position under subsection (a)(1) shall be liable to the United States for the amount which has been paid to or on behalf of the individual under the agreement if any of the following occurs: The individual is dismissed from the position for disciplinary reasons. The individual voluntarily terminates the residency before the completion of such course of training. The individual loses the individual's license, registration, or certification to practice the individual's health care profession in a State. Liability under this paragraph is in lieu of any service obligation arising under the individual's agreement under subsection (d). If an individual breaches the individuals's agreement under subsection
(d)by failing (for any reason) to complete such individual's period of obligated service, the United States shall be entitled to recover from the individual an amount equal to the product of— three; the sum of— the amounts paid under this section to or on behalf of the individual; and the interest on such amounts that would be payable if at the time the amounts were paid they were loans bearing interest at the maximum legal prevailing rate, as determined by the Treasurer of the United States; and the quotient of— the difference between— the total number of months in the individual's period of obligated service; and the number of months of such period served by the individual; and the total number of months in the individual's period of obligated service. Any amount which the United States is entitled to recover under this subsection shall be paid to the United States not later than the date that is one year after the date of the breach of the agreement. Not later than one year after the date of the enactment of this Act and not less frequently than once each year thereafter, the Secretary shall submit to the appropriate committees of Congress a report on the implementation of this section during the previous year. Each report submitted under paragraph
(1)shall include, for the period covered by the report, the following: The number of positions described in subsection
(a)that were filled. The location of each such position. The academic affiliate associated with each such position. A description of the challenges faced in filling the positions described in subsection
(a)and the actions the Secretary has taken to address such challenges. In this subsection, the term appropriate committees of Congress means— the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.
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