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<dc:title>115 HR 3874 IH: Accountability for Quality VA Healthcare Act</dc:title>
<dc:publisher>U.S. House of Representatives</dc:publisher>
<dc:date>2017-09-28</dc:date>
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<dc:language>EN</dc:language>
<dc:rights>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.</dc:rights>
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<distribution-code display="yes">I</distribution-code><congress display="yes">115th CONGRESS</congress><session display="yes">1st Session</session><legis-num display="yes">H. R. 3874</legis-num><current-chamber>IN THE HOUSE OF REPRESENTATIVES</current-chamber><action display="yes"><action-date date="20170928">September 28, 2017</action-date><action-desc><sponsor name-id="K000381">Mr. Kilmer</sponsor> (for himself, <cosponsor name-id="R000586">Mr. Renacci</cosponsor>, <cosponsor name-id="A000369">Mr. Amodei</cosponsor>, <cosponsor name-id="B001284">Mrs. Brooks of Indiana</cosponsor>, <cosponsor name-id="C001112">Mr. Carbajal</cosponsor>, <cosponsor name-id="J000295">Mr. Joyce of Ohio</cosponsor>, <cosponsor name-id="K000376">Mr. Kelly of Pennsylvania</cosponsor>, <cosponsor name-id="K000391">Mr. Krishnamoorthi</cosponsor>, <cosponsor name-id="M001196">Mr. Moulton</cosponsor>, <cosponsor name-id="N000188">Mr. Norcross</cosponsor>, <cosponsor name-id="P000608">Mr. Peters</cosponsor>, <cosponsor name-id="R000602">Miss Rice of New York</cosponsor>, <cosponsor name-id="S001190">Mr. Schneider</cosponsor>, <cosponsor name-id="N000189">Mr. Newhouse</cosponsor>, <cosponsor name-id="W000806">Mr. Webster of Florida</cosponsor>, <cosponsor name-id="M001202">Mrs. Murphy of Florida</cosponsor>, <cosponsor name-id="W000800">Mr. Welch</cosponsor>, <cosponsor name-id="B001269">Mr. Barletta</cosponsor>, <cosponsor name-id="R000609">Mr. Rutherford</cosponsor>, <cosponsor name-id="V000129">Mr. Valadao</cosponsor>, and <cosponsor name-id="B001282">Mr. Barr</cosponsor>) introduced the following bill; which was referred to the <committee-name committee-id="HVR00">Committee on Veterans' Affairs</committee-name></action-desc></action><legis-type>A BILL</legis-type><official-title display="yes">To direct the Secretary of Veterans Affairs to carry out a pilot program on physical security at
			 Department of Veterans Affairs medical facilities, to direct the Secretary
			 to make certain improvements relating to inspections of Department of
			 Veterans Affairs medical facilities and improving care for women, to
			 direct the Secretary to evaluate the organizational structure of the
			 Veterans Health Administration, and for other purposes.</official-title></form>
	<legis-body id="HAC6AF7B16C5146E6A8E2CEEE23F1CCBB" style="OLC">
 <section id="HFD88BE24351A4AFB88B70D475ECA53C8" section-type="section-one"><enum>1.</enum><header>Short title</header><text display-inline="no-display-inline">This Act may be cited as the <quote><short-title>Accountability for Quality VA Healthcare Act</short-title></quote>.</text> </section><section id="HBE816708752F4912AEAD67ACB9114A63" section-type="subsequent-section"><enum>2.</enum><header>Pilot program on physical security at Department of Veterans Affairs medical facilities</header> <subsection id="H965985295E434B419B039ADECE563904"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Beginning not later than 90 days after the date of the enactment of this Act the Secretary of Veterans Affairs shall carry out a pilot program to enhance the physical security of Department of Veterans Affairs medical facilities. At the medical facilities selected for the pilot program, the Secretary shall—</text>
 <paragraph id="H7AA424B1E42B483DACE7766116A22A3B"><enum>(1)</enum><text>ensure that alarm systems effectively notify relevant staff in the police command and control centers and the unit nursing stations of the facility; and</text>
 </paragraph><paragraph id="H32AA78E592FA4F7698D1B88B71CEB176"><enum>(2)</enum><text>require relevant medical center stakeholders to coordinate and consult on—</text> <subparagraph id="HC1BDAAF656C348008E14FA189841D14C"><enum>(A)</enum><text>plans for new and renovated units; and</text>
 </subparagraph><subparagraph id="H5A6E63788C1D436F9AAA19A8C5EA7753"><enum>(B)</enum><text>any changes to physical security features, including closed-circuit television cameras.</text> </subparagraph></paragraph></subsection><subsection id="HF4A2FDA72609415BA90BF16B127BD948"><enum>(b)</enum><header>Locations</header><text>The Secretary shall select five medical facilities of the Department to participate in the pilot program.</text>
 </subsection><subsection id="HDB5BE5433DE64054B44043BC9D29887E"><enum>(c)</enum><header>Termination</header><text display-inline="yes-display-inline">The pilot program shall terminate on the date that is two years after the date on which the pilot program commences.</text>
 </subsection><subsection id="H1F3AA8BB57ED4C56ACC9BE2999D1A939"><enum>(d)</enum><header>Report</header><text>Not later than 30 days after the termination of the pilot program under subsection (c), the Secretary shall submit to Congress a report on the pilot program.</text>
			</subsection></section><section id="H9B34047115AE48FD924BEC12BC99B6D1" section-type="subsequent-section"><enum>3.</enum><header>Report on Department of Veterans Affairs improvement of facility alignment</header>
 <subsection id="HC132D593608843AAACB89C66E1B6DC0F"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to Congress a report on the findings and recommendations of the report of the Government Accountability Office entitled <quote>VA Real Property: VA Should Improve Its Efforts to Align Facilities with Veterans’ Needs</quote>. The report submitted by the Secretary shall include the plan of the Secretary, including a time frame for completion, to specifically address the following recommendations:</text>
 <paragraph id="HB919ACC08A724B45BC67E8E905C0246E"><enum>(1)</enum><text display-inline="yes-display-inline">To address identified limitations to the strategic capital investment planning process, including limitations to scoring and approval and access to information.</text>
 </paragraph><paragraph id="H8AFFD9C3B3184FB7A364ADCB3B8493CB"><enum>(2)</enum><text>To assess the value of the Department of Veterans Affairs Integrated Planning facility master plans as a facility-planning tool, and based on conclusions contained in the Government Accountability Office report, either discontinue the development of such master plans or address the limitations of such master plans.</text>
 </paragraph><paragraph id="H5FA59F89C1C5440C903B1622A8F10983"><enum>(3)</enum><text>To develop and distribute guidance for Veterans Integrated Service Networks and facilities using best practices on how to effectively communicate with stakeholders about alignment change.</text>
 </paragraph><paragraph id="H0D67D77420CD42668D56320AA6147C3D"><enum>(4)</enum><text>To develop and implement a mechanism to evaluate Veterans Integrated Service Network and facility communication efforts with stakeholders to ensure that such communication efforts are working as intended and align with guidance and best practices.</text>
 </paragraph></subsection><subsection id="H0AD875D348DC48009B4506D0BB4B73E3"><enum>(b)</enum><header>Public availability</header><text>Upon submittal of the report under subsection (a), the Secretary shall make the report publicly available on an internet website of the Department.</text>
 </subsection></section><section id="H714E3EEC83124D04ACE8C69AD68C99A2" section-type="subsequent-section"><enum>4.</enum><header>Update of handbook to improve leasing projects</header><text display-inline="no-display-inline">Not later than 180 days after the date of the enactment of this Act, and not less than once every five-year period thereafter, the Secretary of Veterans Affairs shall update the handbook of the Department of Veterans Affairs titled <quote>Planning and Activating Community Based Outpatient Clinics</quote>, or a successor handbook, to reflect current policies, best practices, and clarify the roles and responsibilities of the personnel of the Department involved in the leasing projects of the Department.</text>
		</section><section id="H45B816E9E1094F0E9F656BF510D189F9" section-type="subsequent-section"><enum>5.</enum><header>Improvement of inspections of Department of Veterans Affairs medical facilities and improvement of
			 care for women provided by Department of Veterans Affairs</header>
 <subsection id="H0195521FC05B41C2BCA51CF813E98C78"><enum>(a)</enum><header>Findings</header><text display-inline="yes-display-inline">Congress makes the following findings:</text> <paragraph id="H71EFAD701F974C378A3F66D64D1C79A7"><enum>(1)</enum><text display-inline="yes-display-inline">The Department of Veterans Affairs has policies in place to help ensure the privacy, safety, and dignity of women veterans when they receive care at its medical facilities.</text>
 </paragraph><paragraph id="HCA8195064C6D498A9F7B3E316EC625E5"><enum>(2)</enum><text>A Government Accountability Office report found many instances of noncompliance with such policies.</text> </paragraph><paragraph id="H7049EB5D101A4302874312713192F807"><enum>(3)</enum><text>Women veterans are the fastest growing cohort within the veteran community.</text>
 </paragraph><paragraph id="H3F369788027D48509765CB7F0934E687"><enum>(4)</enum><text>Women serve in every branch of the Armed Forces and represent nearly 15 percent of the members of the Armed Forces currently serving on active duty and 18 percent of members of the National Guard and reserve components.</text>
 </paragraph><paragraph id="H3F0760AF5FB54F1AA1A94A6C19AE47FD"><enum>(5)</enum><text>The number of women veterans using the medical care provided by the Department of Veterans Affairs is expected to increase dramatically.</text>
 </paragraph></subsection><subsection id="H72FED2A1054C481B8FAE9EC2E625C995"><enum>(b)</enum><header>Sense of Congress</header><text display-inline="yes-display-inline">It is the sense of Congress that—</text> <paragraph id="H054C8CBA827A4A379173498FDF99A338"><enum>(1)</enum><text>female veterans are put at risk by a system that is currently designed for men; and</text>
 </paragraph><paragraph id="H6B00A31B22E646AEA310411B238B6991"><enum>(2)</enum><text>the Department of Veterans Affairs should follow through with commitments to ensure female veterans can access services tailored to their needs.</text>
				</paragraph></subsection><subsection id="H386286FEF7BD44C78FF37943A0A63871"><enum>(c)</enum><header>Improvement of inspections of Department of Veterans Affairs medical facilities and improvement of
			 care for women provided by Department of Veterans Affairs</header>
 <paragraph id="H00B5D4E9D0D7401885F853FEAEEBD38B"><enum>(1)</enum><header>Improvement of inspections process</header><text display-inline="yes-display-inline">The Secretary of Veterans Affairs shall strengthen the environment of care inspections process and oversight of such process by—</text>
 <subparagraph id="HFB41A6C1341140948C24A2F72BEC2D7C"><enum>(A)</enum><text display-inline="yes-display-inline">expanding the list of requirements that facility staff inspect for compliance to align with the policy of the Veterans Health Administration;</text>
 </subparagraph><subparagraph id="HD65CACEC6A2F440783538271F03D7184"><enum>(B)</enum><text>ensuring that all patient care areas of Department medical facilities are inspected as required;</text> </subparagraph><subparagraph id="HE2AE8E846AC74A99AD2D69ABD3437C16"><enum>(C)</enum><text>clarifying the roles and responsibilities of Department medical facility staff responsible for identifying and addressing compliance; and</text>
 </subparagraph><subparagraph id="H3927B1F0E8DE4044B1C99C7811EAE8CA"><enum>(D)</enum><text>establishing a process to verify that noncompliance information reported by facilities to the Veterans Health Administration central office is accurate and complete.</text>
					</subparagraph></paragraph><paragraph id="HB4F95E9D19C24FDEB4652B9AD13A3CCE"><enum>(2)</enum><header>Improvement of care for women</header>
 <subparagraph id="HFF568F28D1584F7196215642369E714A"><enum>(A)</enum><header>Monitoring of gender-specific care services</header><text display-inline="yes-display-inline">To improve care for women veterans, the Secretary of Veterans Affairs shall monitor women veterans’ access to gender-specific care services under current and future community care contracts or agreements. Such monitoring shall include an examination of appointment scheduling and completion times, driving times to appointments, and reasons appointments could not be scheduled with community providers.</text>
 </subparagraph><subparagraph id="H6BA943F0077247AEA2962E50CC8C493C"><enum>(B)</enum><header>Definitions</header><text>In this subparagraph:</text> <clause id="H3B560A982FF440429D3C3F078B40116A"><enum>(i)</enum><text>The term <term>gender-specific care services</term> means mammography, maternity care, and gynecology.</text>
 </clause><clause id="HAC26E3AAD2C34060B832F3986655CEC3"><enum>(ii)</enum><text display-inline="yes-display-inline">The term <term>community care contract or agreement</term> means an agreement described in section 101(d) of the Veterans Access, Choice, and Accountability Act of 2014 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>), or other contract or agreement under which the Secretary furnishes hospital care and medical treatment to veterans at non-Department of Veterans Affairs health care facilities.</text>
						</clause></subparagraph></paragraph></subsection></section><section id="HB8F92E9F59AC4B61B7D841BAF3E0FFB3" section-type="subsequent-section"><enum>6.</enum><header>Improvement of delivery of care at Department of Veterans Affairs medical facilities</header>
 <subsection id="H4754DBEFDB294EF6A7B37A49E93AD647"><enum>(a)</enum><header>Wait times</header><text display-inline="yes-display-inline">The Secretary of Veterans Affairs shall clearly identify measures for wait times for medical appointments in Department of Veterans Affairs medical facilities in a manner that reduces the likelihood of an individual misinterpreting such measures.</text>
 </subsection><subsection id="H054B22428EA742EA91418886C82A7380"><enum>(b)</enum><header>Scheduling</header><text>The Secretary shall ensure that the term <term>patient indicated date</term> is clearly defined for purposes of the scheduling policy of the Veterans Health Administration and in related training documents. The Secretary shall take such steps as may be necessary to ensure such term is correctly implemented by employees who perform scheduling functions.</text>
			</subsection><subsection id="H8C9D6F8E43754850847F7CC78A1E843E"><enum>(c)</enum><header>Staff availability</header>
 <paragraph id="HEB54687E33D040E99319FBC56A3990C0"><enum>(1)</enum><header>Allocation; scheduling</header><text>The Secretary shall develop a policy requiring Department of Veterans Affairs medical facilities to routinely assess the scheduling needs and resources required to ensure that employees of such facilities are allocated in such a manner as to adequately respond to the demand for scheduling medical appointments.</text>
 </paragraph><paragraph id="H7EF7B78A66A14152BBD77CA0634DB6B7"><enum>(2)</enum><header>Recruitment and retention</header><text>The Secretary shall develop a strategy to improve recruitment and retention of Department of Veterans Affairs medical providers and employees who perform scheduling functions for Department medical facilities. Such strategy shall be designed to ensure adequate staffing of Department medical facilities and shall emphasize recruitment and retention in facilities located in rural areas.</text>
 </paragraph></subsection><subsection id="H337C455A35EC49DDA81DC782ED5EE298"><enum>(d)</enum><header>Telephone access</header><text>The Secretary shall—</text> <paragraph id="H7913208C2C6C4A3C8B5433CB75638285"><enum>(1)</enum><text display-inline="yes-display-inline">ensure that all Department medical facilities provide oversight of telephone access and implement the best practices outlined in the Department 2015 Telephone Access and Contact Management Improvement Guide, or a successor guide; and</text>
 </paragraph><paragraph id="H5815769FAB254EB7859B2B253D7753BB"><enum>(2)</enum><text>identify medical facilities that are using outdated telephone technology and replace such technology with new systems designed to improve telephone service and access to health care.</text>
				</paragraph></subsection></section><section display-inline="no-display-inline" id="HDCF5888C993947D185E877F64C9F2B54" section-type="subsequent-section"><enum>7.</enum><header>Evaluations of organizational structure of Veterans Health Administration and realignment of
			 Veterans Integrated Service Networks</header>
			<subsection id="H3652900D9D294D13A947F40C5A8E5389"><enum>(a)</enum><header>Organizational Structure</header>
 <paragraph id="H44596A3D969343439D2D699B2B345485"><enum>(1)</enum><header>Process</header><text>The Secretary of Veterans Affairs, acting through the Under Secretary for Health, shall implement a process to consistently evaluate reviews described in paragraph (3).</text>
 </paragraph><paragraph id="HD75B5746FCFB44EB9AA1832AA23D4F26"><enum>(2)</enum><header>Matters included</header><text>The process under paragraph (1) shall include the following:</text> <subparagraph id="H462C51A7866F4B3FB70646BA54CB5EE1"><enum>(A)</enum><text display-inline="yes-display-inline">Identification of the officials and the offices of the Department of Veterans Affairs responsible for evaluating and approving, and ensuring the implementation of, recommendations made by reviews described in paragraph (3), including—</text>
 <clause id="H01B2D519F89E442AB254E7977BC0DDD1"><enum>(i)</enum><text>the roles of each such official and office; and</text> </clause><clause id="H374F7841469F4E7780AD5D494B8BDA02"><enum>(ii)</enum><text>a description of how decisions are made and documented to approve such implementation.</text>
 </clause></subparagraph><subparagraph id="HCA0CF12B3CB14913A44A38F88598A268"><enum>(B)</enum><text display-inline="yes-display-inline">A description of how recommendations made by reviews described in paragraph (3) should be evaluated.</text>
 </subparagraph><subparagraph id="H7261F2F820D946819918312CE3566D87"><enum>(C)</enum><text>A description of how timelines should be established to ensure recommendations are evaluated and implemented in a timely manner and metrics to assess the progress made with respect to such implementation.</text>
 </subparagraph></paragraph><paragraph id="H74DFE0A1DA9A4C55BCAF459E87C776E6"><enum>(3)</enum><header>Reviews described</header><text display-inline="yes-display-inline">The reviews described in this paragraph are reviews of the organizational structure of the Veterans Health Administration conducted by the Secretary, the Inspector General of the Department of Veterans Affairs, the Comptroller General of the United States, the Commission on Care established by section 202 of the Veterans Access, Choice, and Accountability Act of 2014 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>; 128 Stat. 1773), or by an independent entity, as determined appropriate by the Secretary.</text>
 </paragraph><paragraph id="H5C8B3D46FE034253880296C50BE97BA5"><enum>(4)</enum><header>First use</header><text display-inline="yes-display-inline">The Under Secretary shall use the process under paragraph (1) to evaluate the results of the evaluation conducted under subsection (b)(1). The Under Secretary shall make any required improvements to such process based on the lessons learned by the Under Secretary resulting from such use.</text>
				</paragraph></subsection><subsection id="H392A2F5E340F4240BC266B0901AB0B43"><enum>(b)</enum><header>Veterans Integrated Service Networks</header>
 <paragraph id="H95F210EA1B614D488AD3E9545D425639"><enum>(1)</enum><header>Evaluation</header><text display-inline="yes-display-inline">Consistent with the report of the Comptroller General of the United States titled <quote>VA Health Care: Processes to Evaluate, Implement, and Monitor Organizational Structure Changes Needed</quote> (GAO–16–803), the Secretary, acting through the Under Secretary for Health, shall conduct an evaluation of all the Veterans Integrated Service Networks, including with respect to—</text>
 <subparagraph id="H289A3537412F48A6B6AB54C1BAD524D9"><enum>(A)</enum><text>the implementation by the Secretary of realignments to such Networks; and</text> </subparagraph><subparagraph id="H256C416F390A4577ADC8B582D52B4A7D"><enum>(B)</enum><text>identifying deficiencies to such Networks that require corrective action.</text>
 </subparagraph></paragraph><paragraph id="HEF6582DEDE234CEDA3D4A8F64090DDCA"><enum>(2)</enum><header>Assessment and implementation</header><text display-inline="yes-display-inline">In accordance with subsection (a)(4), the Under Secretary shall use the process implemented under subsection (a) to assess the results of the evaluation conducted under paragraph (1) and to implement changes and other actions to improve the Veterans Integrated Service Networks.</text>
 </paragraph></subsection><subsection id="HE87F765EBCF849D58206337854B9344A"><enum>(c)</enum><header>Report</header><text>Not later than 90 days after the date of the enactment of this Act, the Under Secretary shall submit to Congress a report that includes a description of—</text>
 <paragraph id="H0F9D762149FA4C85AC7B8F71A84EC1B3"><enum>(1)</enum><text>the process implemented under subsection (a)(1);</text> </paragraph><paragraph id="H3C240E26F550485DBEA4297379893863"><enum>(2)</enum><text>the deficiencies identified under paragraph (1) of subsection (b); and</text>
 </paragraph><paragraph id="H6F9960C77D1A4251BA9C0ECB3D640A60"><enum>(3)</enum><text>how the Under Secretary will carry out paragraph (2) of such subsection.</text> </paragraph></subsection><subsection id="HE75D306C927A4AADBB84D5D9B56FDEEA"><enum>(d)</enum><header>Prohibition on new appropriations</header><text display-inline="yes-display-inline">No additional funds are authorized to be appropriated to carry out this section, and this section shall be carried out using amounts otherwise made available for such purposes.</text>
			</subsection></section><section id="HA7860C2D9313462AB2677EC7C133A0FD" section-type="subsequent-section"><enum>8.</enum><header>Annual report regarding the recruitment, hiring, and retention of nurses for the Veterans Health
			 Administration</header>
 <subsection id="H6A995A757C354F708EFB4F9AC0F10444"><enum>(a)</enum><header>Report required</header><text display-inline="yes-display-inline">Not later than one year after the date of the enactment of this Act and annually thereafter, the Secretary of Veterans Affairs shall publish and submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report regarding efforts to recruit, hire, and retain nurses for the Veterans Health Administration.</text>
 </subsection><subsection id="H9E8C4493A9174BD5918CA22734BCB49D"><enum>(b)</enum><header>Elements</header><text display-inline="yes-display-inline">The report under subsection (a) shall include details relating to—</text> <paragraph id="HF928AA97A62D4FCA8EBBDA399291DD38"><enum>(1)</enum><text display-inline="yes-display-inline">efforts to recruit, hire, and retain nurses at each medical facility of the Department;</text>
 </paragraph><paragraph id="H03BA969E71B141E38E7D3B3C72AA519D"><enum>(2)</enum><text display-inline="yes-display-inline">resources provided by the Secretary to recruit, hire, and retain nurses for the Veterans Health Administration; and</text>
 </paragraph><paragraph id="H43CAEADC66DC4D95961D8489F7EA2A97"><enum>(3)</enum><text display-inline="yes-display-inline">recommendations for legislation the Secretary considers appropriate.</text> </paragraph></subsection></section><section id="H6C13210442A240C5A70CBA8FD6DC7E37"><enum>9.</enum><header>Reinstatement of reporting requirement regarding the Department of Veterans Affairs Health Professionals Educational Assistance Program</header><text display-inline="no-display-inline">Section 3003(a)(1) of the Federal Reports Elimination and Sunset Act of 1995 (<external-xref legal-doc="public-law" parsable-cite="pl/104/66">Public Law 104–66</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/31/1113">31 U.S.C. 1113</external-xref> note) shall not apply to the report required under section 7632 of title 38, United States Code.</text>
		</section></legis-body></bill>


