[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5007 Introduced in House (IH)]

113th CONGRESS
  2d Session
                                H. R. 5007

To assess staffing shortages at medical facilities of the Department of 
               Veterans Affairs, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 26, 2014

   Mr. Ruiz introduced the following bill; which was referred to the 
                     Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
To assess staffing shortages at medical facilities of the Department of 
               Veterans Affairs, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Restoring Accountability in Veterans 
Access to Health Care Act''.

SEC. 2. TREATMENT OF STAFFING SHORTAGE AND REPORT ON STAFFING OF 
              MEDICAL FACILITIES OF THE DEPARTMENT OF VETERANS AFFAIRS.

    (a) Staffing Shortage.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, and annually thereafter, the 
        Inspector General of the Department of Veterans Affairs shall 
        determine, and publish in the Federal Register, the five 
        occupations of health care providers of the Department of 
        Veterans Affairs for which there is the largest staffing 
        shortage throughout the Department.
            (2) Recruitment and appointment.--Notwithstanding sections 
        3304 and 3309 through 3318 of title 5, United States Code, the 
        Secretary of Veterans Affairs, based upon a determination by 
        the Inspector General under paragraph (1) that there is a 
        staffing shortage throughout the Department with respect to a 
        particular occupation of health care provider, may recruit and 
        directly appoint highly qualified health care providers to a 
        position to serve as a health care provider in that particular 
        occupation for the Department.
    (b) Reports.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, and not later than December 31 of 
        each even numbered year thereafter until 2024, the Secretary of 
        Veterans Affairs shall submit to the Committee on Veterans' 
        Affairs of the Senate and the Committee on Veterans' Affairs of 
        the House of Representatives a report assessing the staffing of 
        each medical facility of the Department of Veterans Affairs.
            (2) Elements.--Each report submitted under paragraph (1) 
        shall include the following:
                    (A) The results of a system-wide assessment of all 
                medical facilities of the Department to ensure the 
                following:
                            (i) Appropriate staffing levels for health 
                        care providers to meet the goals of the 
                        Secretary for timely access to care for 
                        veterans.
                            (ii) Appropriate staffing levels for 
                        support personnel, including clerks.
                            (iii) Appropriate sizes for clinical 
                        panels.
                            (iv) Appropriate numbers of full-time 
                        staff, or full-time equivalent, dedicated to 
                        direct care of patients.
                            (v) The appropriate physician to patient 
                        ratio (including for both primary and specialty 
                        care), as compared to such ratio as it exists 
                        on the date of the report.
                            (vi) Appropriate physical plant space to 
                        meet the capacity needs of the Department in 
                        that area.
                            (vii) Such other factors as the Secretary 
                        considers necessary.
                    (B) An explanation of the measurable productivity 
                standards used to establish the levels in the 
                assessment described in subparagraph (A).
                    (C) A plan for addressing any issues identified in 
                the assessment described in subparagraph (A), including 
                a timeline for addressing such issues.
                    (D) A list of the current wait times and workload 
                levels for the following clinics in each medical 
                facility:
                            (i) Mental health.
                            (ii) Primary care.
                            (iii) Gastroenterology.
                            (iv) Women's health.
                            (v) Specialty care.
                            (vi) Ophthalmology.
                            (vii) Such other clinics as the Secretary 
                        considers appropriate.
                    (E) A description of the results of the 
                determination of the Secretary under paragraph (1) of 
                subsection (a) and a plan to use direct appointment 
                authority under paragraph (2) of such subsection to 
                fill staffing shortages, including recommendations for 
                improving the speed at which the credentialing and 
                privileging process can be conducted.
                    (F) The current staffing models of the Department 
                for the following clinics, including recommendations 
                for changes to such models:
                            (i) Mental health.
                            (ii) Primary care.
                            (iii) Gastroenterology.
                            (iv) Women's health.
                            (v) Specialty care.
                            (vi) Ophthalmology.
                            (vii) Such other clinics as the Secretary 
                        considers appropriate.
                    (G) A detailed analysis of succession planning at 
                medical facilities of the Department, including the 
                following:
                            (i) The number of positions in medical 
                        facilities throughout the Department that are 
                        not filled by a permanent employee.
                            (ii) The length of time each such position 
                        described in clause (i) remained vacant or 
                        filled by a temporary or acting employee.
                            (iii) A description of any barriers to 
                        filling the positions described in clause (i).
                            (iv) A plan for filling any positions that 
                        are vacant or filled by a temporary or acting 
                        employee for more than 180 days.
                            (v) A plan for handling emergency 
                        circumstances, such administrative leave or 
                        sudden medical leave for senior officials.
                    (H) The number of health care providers who have 
                been removed from their position or have retired, by 
                provider type, during the two-year period preceding the 
                submittal of the report.
                    (I) Of the health care providers specified in 
                subparagraph (G) that have been removed from their 
                position, the following:
                            (i) The number of such health care 
                        providers who were reassigned to another 
                        position in the Department.
                            (ii) The number of such health care 
                        providers who left the Department.

SEC. 3. CLINIC MANAGEMENT TRAINING PROGRAM OF THE DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall 
implement a clinic management training program to provide in-person, 
standardized education on health care management to all managers of, 
and health care providers at, medical facilities of the Department of 
Veterans Affairs.
    (b) Elements.--The clinic management training program required by 
subsection (a) shall include the following:
            (1) Training on how to manage the schedules of health care 
        providers of the Department and training on customer service 
        and veteran-centered care, including proper planning procedures 
        for vacation, leave, and graduate medical education training 
        schedules.
            (2) Training on the appropriate number of appointments that 
        a health care provider should conduct on a daily basis, based 
        on specialty.
            (3) Training on how to determine whether there are enough 
        available appointment slots to manage demand for different 
        appointment types and mechanisms for alerting management of 
        insufficient slots.
            (4) Training on how scheduling systems will be monitored 
        and how schedulers will be held accountable for accurate data.
            (5) Training on how to properly use data to meet the demand 
        for health care, including the following:
                    (A) Training on determining the next available 
                appointment for each health care provider at the 
                medical facility.
                    (B) Training on determining the number of health 
                care providers needed to meet demand for health care at 
                the medical facility.
                    (C) Training on determining the number of exam 
                rooms needed to meet demand for such health care in an 
                efficient manner.
            (6) Training on how to properly use the appointment 
        scheduling system of the Department, including any new 
        scheduling system implemented by the Department.
            (7) Training on how to optimize the use of technology, 
        including the following:
                    (A) Telemedicine.
                    (B) Electronic mail.
                    (C) Text messaging.
                    (D) Such other technologies as specified by the 
                Secretary.
            (8) Training on how to properly use physical plant space at 
        medical facilities of the Department to ensure efficient flow 
        and privacy for patients and staff.
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