[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5618 Introduced in House (IH)]

113th CONGRESS
  2d Session
                                H. R. 5618

      To establish a pilot program to improve the management and 
    accountability within the Veterans Health Administration of the 
 Department of Veterans Affairs, to provide oversight of the Veterans 
             Health Administration, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 18, 2014

 Mr. Kilmer (for himself, Mr. Cuellar, Mr. Carney, Mr. Barber, and Mr. 
   Gallego) introduced the following bill; which was referred to the 
Committee on Veterans' Affairs, and in addition to the Committee on the 
 Budget, for a period to be subsequently determined by the Speaker, in 
   each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
      To establish a pilot program to improve the management and 
    accountability within the Veterans Health Administration of the 
 Department of Veterans Affairs, to provide oversight of the Veterans 
             Health Administration, 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 ``Veterans Health Administration 
Management Improvement Act''.

SEC. 2. COMPTROLLER GENERAL MANAGEMENT REVIEW OF VETERANS HEALTH 
              ADMINISTRATION.

    (a) Management Review.--
            (1) In general.--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) Matters included.--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) Reports.--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.

SEC. 3. PILOT PROGRAM TO IMPROVE MANAGEMENT AND ACCOUNTABILITY OF 
              VETERANS HEALTH ADMINISTRATION.

    (a) Establishment.--The Secretary of Veterans Affairs shall 
establish a pilot program to improve the management and accountability 
within the Veterans Health Administration.
    (b) Goals of Pilot Program.--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 requirements.--During 
        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 requirements.--
        During 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 officer.--
        During 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) Evaluation Plan.--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 Program.--The 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) Briefings.--
            (1) Initial briefing.--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) Updates.--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) Duration.--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) Definitions.--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.

SEC. 4. MANAGEMENT AND ACCOUNTABILITY OMBUDSMAN.

    (a) In General.--Chapter 3 of title 38, United States Code, is 
amended by inserting after section 312A the following new section:
``Sec. 312B. Management and accountability ombudsman
    ``(a) In General.--(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) Responsibilities.--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 Investigations.--The 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) Coordination.--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) Annual Reports.--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) Risk Management Defined.--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) Clerical Amendment.--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 Reports.--The 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.

SEC. 5. VETERANS' BILL OF RIGHTS.

    (a) Display.--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 Employees.--The Secretary shall ensure 
that employees of the Department receive training on the Veterans' Bill 
of Rights described in subsection (e).
    (c) Outreach.--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) Implementation.--The Secretary shall ensure that the Veterans 
Health Administration honors the rights described in subsection (e).
    (e) Veterans' Bill of Rights.--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) Veterans' Bill of Rights.--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.
                                 <all>