113 HR 5618 IH: Veterans Health Administration Management Improvement Act
U.S. House of Representatives
2014-09-18
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.This Act may be cited as the Veterans Health Administration Management Improvement Act
.
2.Comptroller General management review of Veterans Health Administration
(a)
(1)During the five-year period beginning on the date of the enactment of this Act, the Comptroller
General of the United States shall conduct a management review of the
Veterans Health Administration of the Department of Veterans Affairs.
(2)The management review under paragraph (1) shall include a review, with respect to the Veterans
Health Administration, of the following:
(A)The management structure, including the roles and responsibilities among the various organizational
components (local facilities, regional networks, and the central office).
(B)The oversight of core functions, including the extent to which lines of accountability are clearly
delineated.
(C)The evaluation plan, operations, and capacity to implement results-based strategic planning.
(D)The extent to which contractors are used and monitored to support core management functions.
(E)Internal communication mechanisms, including expectations for communications, that support the
mission.
(F)The setting of priorities and the monitoring of such priorities.
(G)Budgeting and resource allocation processes.
(H)Workforce planning.
(I)Human capital processes, including training activities, to ensure timely hiring and effective
retention of a qualified workforce.
(J)Information technology to support core functions and activities.
(K)How each of the matters described in subparagraphs (A) through (J) may differ for rural medical
facilities of the Department of Veterans Affairs.
(L)Incentives, including any perverse incentives, affecting employee actions, quality of care, and the
provision of services.
(M)Insights from employees and employee representatives about the work environment and the level of
engagement of such employees as can be derived from the results of the
annual Federal employee survey and other internal surveys administered by
the Secretary of Veterans Affairs.
(N)Insights on the findings of the Comptroller General from veteran service organizations,
organizations representing employees of the Veterans Health
Administration, other stakeholders, and the Management and Accountability
Ombudsman described in section 312B of title 38, United States Code, as
added by section 4.
(b)Not later than one year after the date of the enactment of this Act, and annually thereafter for a
four-year period, the Comptroller General shall submit to Congress one or
more reports that include—
(1)the matters reviewed under subsection (a)(1); and
(2)recommendations of the Comptroller General based on such matters.
3.Pilot program to improve management and accountability of Veterans Health Administration
(a)The Secretary of Veterans Affairs shall establish a pilot program to improve the management and
accountability within the Veterans Health Administration.
(b)The Secretary shall carry out the pilot program under subsection (a) in a manner that ensures that—
(1)the employees of the Veterans Health Administration have an opportunity to learn, implement, and
identify successful means of advancing the management of the Veterans
Health Administration and the delivery of care and services; and
(2)the management and delivery of care and services at medical facilities of the Department is
improved by implementing the recommendations of the Comptroller General of
the United States based on the management review conducted under section
2, and any other appropriate recommendations, with respect to the planning
and evaluation capabilities of the Veteran Health Administration.
(c)Application of certain laws during pilot program
(1)Application of performance plan requirementsDuring the period in which the Secretary carries out the pilot program under subsection (a), the
Secretary shall carry out section 1115(b) of title 31, United States Code,
as follows:
(A)In paragraph (2), by substituting , unless authorized to be in an alternative form under subsection (c), and situate each goal in the
context of its own logic modeling of how the operations and activities of
the agency, in coordination with any significant operations and activities
from external entities, will contribute toward achieving the goals and
responsibilities of the agency;
for unless authorized to be in an alternative form under subsection (c);
.
(B)By including in the agency performance plan described in such section 1115(b), for each performance
goal covered by the plan, an identification and assessment of the risks of
creating new, or perpetuating existing, perverse incentives, and
strategies for risk assessment, monitoring, and mitigation, using a
suitable risk management approach.
(2)Application of performance reporting requirementsDuring the period in which the Secretary carries out the pilot program under subsection (a), the
Secretary shall carry out subsection (c) of section 1116 of title 31,
United States Code, by including in the update required by such subsection
statistical information regarding the Veterans Health Administration that—
(A)is useful to multiple stakeholders for internal management and external oversight; and
(B)provides insight into how programs are planned, financed, and managed, regarding—
(i)the population of veterans, important subgroups thereof, and the status of such veterans;
(ii)the capacity of the operations of the Veterans Health Administration under enacted resource levels,
listed by important subcategories as appropriate; and
(iii)the workload of the Veterans Health Administration, listed by important subcategories as
appropriate.
(3)Application of functions of chief operating officerDuring the period in which the Secretary carries out the pilot program under subsection (a), the
Secretary shall carry out section 1123(b)(1) of title 31, United States
Code, by substituting strategic and performance planning, measurement, evaluation, analysis, regular assessment of
progress, risk management (including the risks of perverse incentives),
and use of performance information to improve the results achieved
for strategic and performance planning, measurement, analysis, regular assessment of progress, and use
of performance information to improve the results achieved
.
(d)The Secretary shall prepare an annual organization evaluation plan for the Veterans Health
Administration that is informed by the recommendations of the Comptroller
General based on the management review conducted under section 2.
(e)Assistance in pilot programThe Management and Accountability Ombudsman described in section 312B of title 38, United States
Code, as added by section 4(a), shall assist in the pilot program under
subsection (a) by—
(1)identifying areas in which employees of the Department have problems implementing the pilot
program, including application of logic modeling, managing risk of
perverse incentives, and other issues that the Ombudsman determine
appropriate;
(2)to the extent practicable, proposing changes in the administrative practices of the implementation
of the pilot program to mitigate problems identified under paragraph (1);
and
(3)reviewing, examining, and making recommendations regarding logic modeling policies, strategies, and
programs of the Veterans Health Administration.
(f)
(1)Not later than 90 days before the Secretary commences the pilot program under subsection (a), the
Secretary shall provide to the Committees on Veterans’ Affairs of the
House of Representatives and the Senate and the Comptroller General a
briefing on—
(A)a logic model of how the features of the pilot program will address the problems identified in the
management review conducted under section 2; and
(B)such other items as the Secretary determines appropriate.
(2)Not later than 240 days after the Secretary commences the pilot program under subsection (a), and
annually thereafter during the period in which the Secretary carries out
the pilot program, the Secretary shall provide to the Committees on
Veterans’ Affairs of the House of Representatives and the Senate and the
Comptroller General a briefing on—
(A)an evaluation of the implementation and effectiveness of carrying out this section, including any
challenges encountered and lessons learned;
(B)planned actions to improve the success of the pilot program, including a milestone plan for such
actions; and
(C)such other items as the Secretary determines appropriate.
(g)The Secretary shall—
(1)commence the pilot program under subsection (a) by not later than 180 days after the date on which
the Comptroller General submits the report under section 2(b); and
(2)carry out the pilot program for a period of five years.
(h)In this section:
(1)The term logic modeling means an approach, also referred to as program theory, program modeling, or theory of change, that
articulates the assumptions of the strategy or tactics of a program or
activity and how such strategy or tactics relate to the benefits that the
program or activity is expected to contribute toward in order to achieve
certain goals, objectives or responsibilities, and may include—
(A)the mapping of direct and indirect relationships among relevant resources, activities, milestones,
outputs, intermediate outcomes, and end outcomes; and
(B)if significant coordination or cooperation with entities external to a program or activity may
contribute to achieving the relevant goals, objectives, or
responsibilities, the mapping of the roles of entities external to the
program or activity.
(2)The term risk management means the processes that are used to identify, assess, monitor, mitigate, and report on risks to
achieving the missions, goals, and objectives of a department, agency, or
program using resources and processes appropriate to the nature of risks
and resources available.
4.Management and accountability ombudsman
(a)Chapter 3 of title 38, United States Code, is amended by inserting after section 312A the following
new section:
312B.Management and accountability ombudsman
(a)
(1)There is in the Department an Office of the Management and Accountability Ombudsman (in this
section referred to as the Office
). There is at the head of the Office an Ombudsman, who shall be appointed by the President from
among individuals with a background in enterprise risk management.
(2)The Ombudsman shall report directly to the Secretary but the Secretary may not prevent or prohibit
the Ombudsman from initiating, carrying out, or completing any
responsibility of the Ombudsman.
(3)The Secretary shall determine the appropriate level of staffing and distribution of responsibility
to ensure the success of the Office.
(4)The President shall include in the budget transmitted to the Congress for each fiscal year pursuant
to section 1105 of title 31 an estimate of the amount for the Office that
is sufficient to provide for a number of full-time positions in the
Office.
(b)The Ombudsman shall—
(1)receive and address reports from employees and employee representatives of the Veterans Health
Administration Affairs and assist in resolving problems with the
management, administration, and delivery of care of the Veterans Health
Agency;
(2)communicate to the Secretary the observations and findings received pursuant to paragraph (1);
(3)conduct inspections of medical facilities of the Veterans Health Administration, including
non-Department facilities that provide care pursuant to a contract entered
into under chapter 17 of this title as necessary;
(4)establish a program under which the Ombudsman and the Secretary shall—
(A)provide incentives to employees of the Veterans Health Administration who suggest methods to
improve the management and operations of the Veterans Health
Administration;
(B)carry out in a pilot program the suggestions that are likely to be successful; and
(C)if such a pilot program demonstrates that a suggestion causes a marked improvement in such
management and operations—
(i)reward the employee who made such suggestion; and
(ii)carry out such suggestion throughout the Veterans Health Administration; and
(5)not less frequently than once each calendar quarter, provide to the Secretary a summary and
relevant statistics concerning the activities and findings of the
Ombudsman, including a summary of the suggestions made and carried out
pursuant to paragraph (4).
(c)Request for investigationsThe Ombudsman may request the Inspector General of the Department to conduct an inspection,
investigation, or audit. Upon such a request, the Inspector General shall
respond to the Ombudsman explaining the plan of the Inspector General to
comply with such request or the rationale of the Inspector General for
denying such request.
(d)The Secretary shall ensure that each element of the Department has procedures to provide the
Ombudsman with formal responses to any recommendation submitted by the
Ombudsman to the head of such element.
(e)Not later than June 30 of each year, the Ombudsman shall submit to the Committees on Veterans’
Affairs of the Senate and the House of Representatives a report on the
objectives of the Ombudsman for the fiscal year beginning in such calendar
year. Each report shall—
(1)contain a full and substantive analysis, in addition to statistical information; and
(2)set forth any recommendations the Ombudsman has made on improving the management and accountability
of the employees of the Department and any responses received under
subsection (d) with respect to the estimates described in section 117(b)
of this title.
(f)In this section, the term risk management means the processes that are used to identify, assess, monitor, mitigate, and report on risks to
achieving a the mission, goals, and objectives of a department, agency, or
program using resources and processes appropriate to the nature of risks
and resources available.
.
(b)The table of sections at the beginning of such chapter is amended by inserting after the item
relating to section 312A the following new item:
312B. Management and Accountability Ombudsman..
(c)Comptroller General reportsThe Comptroller General of the United States shall review each budget of the President submitted to
Congress under section 1105 of title 31 during 2015 through 2020 to
evaluate the proposed budget for health care provided by the Secretary of
Veterans Affairs. The Comptroller General shall submit to the Committees
on Veterans’ Affairs of the Senate and the House of Representatives a
report containing the results of each such review, at such times and with
such additional matters as the Comptroller General determines appropriate
in consultation with such committees.
5.
(a)The Secretary of Veterans Affairs shall ensure that the Veterans’ Bill of Rights described in
subsection (e) is printed on signage in accessible formats and displayed
prominently and conspicuously in each medical facility of the Department
of Veterans Affairs in accordance with subsection (c).
(b)Education of Department employeesThe Secretary shall ensure that employees of the Department receive training on the Veterans’ Bill
of Rights described in subsection (e).
(c)The Secretary shall conduct outreach to inform veterans about the Veterans’ Bill of Rights
described in subsection (e) by—
(1)ensuring that such Bill of Rights is available on the Internet website of the Department and
prominently displayed (using posters printed in a large type that allows
for individuals with 20/20 vision to read the print from 10 feet away) in
public spaces, lobbies, visitor centers, clinic waiting rooms, and patient
sitting rooms of the Department;
(2)briefing patients about such Bill of Rights when the patient enrolls in the system of patient
enrollment system under section 1705 of title 38, United States Code; and
(3)conducting other types of outreach targeted at specific groups of veterans, which may include, at a
minimum, outreach conducted on other Internet websites or through veterans
service organizations, health fairs, and the Veterans Health
Administration Veterans Center outreach program.
(d)The Secretary shall ensure that the Veterans Health Administration honors the rights described in
subsection (e).
(e)The Veterans’ Bill of Rights described in this subsection is a statement that veterans should have,
at a minimum and in addition to the rights covered by section 17.33 of
title 38, Code of Federal Regulations, the following rights:
(1)The right to access the highest quality care, including the right to the most appropriate
technology and qualified practitioners.
(2)The right to continuity of care in the transition from the health program of the Department of
Defense to the health care system of the Department of Veterans Affairs.
(3)The right to receive assistance in understanding the available benefits and services to which the
veteran is entitled.
(4)The right to receive a careful explanation of a proposed diagnostic or therapeutic procedure or
course of treatment by the appropriate medical practitioner, including
with respect to the risks, complications, alternatives, and results.
(5)The right to ask questions concerning health treatment.
(f)The Veterans’ Bill of Rights described in this subsection is a statement that veterans who receive
health care provided under the laws administered by the Secretary of
Veterans Affairs should have, at a minimum, the following rights (to the
extent of the eligibility and enrollment of the veteran for such health
care):
(1)The right to access the highest quality care, including the right to the most appropriate
technology and qualified practitioners.
(2)The right to know what rules and regulations apply to patients.
(3)The right to continuity of care in the transition from the health program of the Department of
Defense to the health care system of the Department of Veterans Affairs.
(4)The right to receive careful explanation of proposed diagnostic or therapeutic procedures or
courses of treatment by the responsible medical personnel, including with
respect to risks, complications, alternative health practices, results,
information and reasoning for prescribed pain management plans, and a
daily review of the medical chart of the patient.
(5)The right for the patient to ask questions and be involved in all decisions regarding the care
received by the patient.
(6)The right to a second opinion or change of provider, if available.
(7)The right to know the reason for any change in medical practitioners responsible for the care of
the patient.
(8)The right to know the identity and professional status of individuals providing service and to know
who is primarily responsible for the care of the patient.
(9)The right to not be transferred to another facility, organization, or department unless the patient
receives a complete explanation for the need, was notified of
alternatives, and the receiving organization, facility, or department is
ready to accept the transfer.
(10)The right to receive considerate, respectful care at all times and under all circumstances with
recognition of personal dignity, diversity, and religious, or other
spiritual and cultural preferences.
(11)The right, in accordance with relevant provisions of law, to personal and informational
confidentiality and privacy in the discussion of the care and management
of records of patients.
(12)The right to visitors within the policies of the facility and to be informed of the visitation
rights, including any clinically necessary restrictions.
(13)The right to be free from all forms of abuse or harassment.
(14)The right to access protective and advocacy services, when available, and file grievances.
(15)The right to remain free of chemical and physical restraints unless safety requires otherwise.
(16)The right to care provided in a safe and clean setting, free from excessive noise and with
sufficient lighting for comfort and safety.