[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 2357 Introduced in Senate (IS)]

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115th CONGRESS
  2d Session
                                S. 2357

 To require the Secretary of Veterans Affairs to review the processes 
 and requirements of the Department of Veterans Affairs for scheduling 
  appointments for health care and conducting consultations under the 
      laws administered by the Secretary, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            January 30, 2018

Mr. Tester (for himself, Mrs. Murray, Mr. Blumenthal, and Mr. Manchin) 
introduced the following bill; which was read twice and referred to the 
                     Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
 To require the Secretary of Veterans Affairs to review the processes 
 and requirements of the Department of Veterans Affairs for scheduling 
  appointments for health care and conducting consultations under the 
      laws administered by the Secretary, 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 ``Accountability in Department of 
Veterans Affairs Scheduling and Consult Management Act''.

SEC. 2. PROCESSES AND REQUIREMENTS FOR SCHEDULING APPOINTMENTS FOR 
              HEALTH CARE FROM DEPARTMENT OF VETERANS AFFAIRS.

    (a) Processes and Requirements.--Not later than 60 days after the 
date of the enactment of this Act, 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 
description of the processes and requirements for scheduling 
appointments for health care from the Department of Veterans Affairs at 
the medical facility level to be used by the Department.
    (b) Training on Processes and Requirements.--
            (1) Certification.--Not later than one year after the date 
        of the enactment of this Act, the Secretary shall require 
        individuals involved in the scheduling of appointments for 
        health care from the Department to certify to the Secretary 
        that the individual understands the processes and requirements 
        described in subsection (a).
            (2) New employees.--The Secretary shall require all 
        employees hired by the Department after the date of the 
        enactment of this Act who are to be involved in the scheduling 
        of appointments for health care from the Department to undergo 
        training on the processes and requirements described in 
        subsection (a) as part of the onboarding process.
    (c) Method To Monitor Compliance.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, the Secretary shall establish or 
        maintain a method or tool to monitor and ensure that each 
        medical facility of the Department complies with the processes 
        and requirements described in subsection (a).
            (2) Use throughout department.--
                    (A) In general.--The Secretary shall require each 
                medical facility of the Department to use the method or 
                tool described in paragraph (1).
                    (B) Certification.--Not later than one year after 
                the date of the enactment of this Act, the Secretary 
                shall require the director of each medical facility of 
                the Department to certify to the Secretary that the 
                director is using the method or tool described in 
                paragraph (1).
            (3) Audits.--
                    (A) In general.--Not less frequently than twice 
                each year, the Secretary shall provide for the conduct 
                of facility-level audits of the scheduling of 
                appointments, which shall include recommendations for 
                corrective action, including additional training, 
                increased personnel, and such other resources as the 
                Secretary considers necessary.
                    (B) Transmittal to vha.--Any audits conducted under 
                subparagraph (A) shall be transmitted to the Under 
                Secretary for Health of the Department so that the 
                Under Secretary can--
                            (i) strengthen oversight of those audits;
                            (ii) monitor national policy on the 
                        scheduling of appointments throughout the 
                        Department;
                            (iii) determine if a mobile deployment team 
                        is warranted; and
                            (iv) develop a remediation plan to address 
                        issues uncovered by those audits.
            (4) Reporting of scheduling issues.--The Secretary shall 
        require each director of a medical center of the Department--
                    (A) to submit to the Under Secretary for Health, 
                not less frequently than quarterly, a report containing 
                any scheduling issues that are uncovered at that 
                medical center;
                    (B) to identify any corrective actions to be taken 
                with respect to such issues, including increased 
                training or hiring; and
                    (C) to certify to the Secretary that the director 
                is in compliance with requirements of subparagraphs (A) 
                and (B).

SEC. 3. ADMINISTRATION OF NON-DEPARTMENT OF VETERANS AFFAIRS HEALTH 
              CARE.

    (a) Certification of Proper Administration.--
            (1) Review.--
                    (A) In general.--The Secretary of Veterans Affairs 
                shall conduct a review of the staffing, training, and 
                other requirements necessary to administer section 101 
                of the Veterans Access, Choice, and Accountability Act 
                of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) and 
                any other community care program of the Department of 
                Veterans Affairs.
                    (B) Elements.--The review conducted under paragraph 
                (1) shall include, with respect to each medical 
                facility of the Department, an assessment of the type 
                of positions required to be staffed, the number of such 
                positions at the medical facility, and the number 
                filled at the medical facility.
            (2) Certification.--Not later than 180 days after the date 
        of the enactment of this Act, and every 180 days thereafter, 
        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 the results 
        of the review conducted under paragraph (1), including a 
        certification that all staffing, training, and other 
        requirements described in paragraph (1)(A) are fulfilled.
    (b) Scheduling of Appointments.--
            (1) In general.--The Secretary shall be responsible for 
        ensuring that appointments for health care from non-Department 
        health care providers under the laws administered by the 
        Secretary are scheduled.
            (2) Timeliness goals.--Not later than 30 days after the 
        date of the enactment of this Act, the Secretary shall 
        establish timeliness goals for each step in scheduling an 
        appointment for health care from a non-Department health care 
        provider.
            (3) Measurement of timeliness for each facility.--Not later 
        than 120 days after the date of the enactment of this Act, the 
        Secretary shall measure, for each medical facility of the 
        Department, the time it takes from the date that a clinician of 
        the Department determines that a veteran requires care from a 
        non-Department health care provider to each of the following:
                    (A) The date that the referral for care is sent to 
                the non-Department health care provider.
                    (B) The date that the non-Department health care 
                provider accepts the referral.
                    (C) The date that the appointment with the non-
                Department health care provider is made.
                    (D) The date of the appointment with the non-
                Department health care provider.
                    (E) Any other step that the Secretary determines 
                necessary to measure.
            (4) Publication of data.--
                    (A) In general.--Not later than one year after the 
                date of the enactment of this Act, the Secretary shall 
                publish the data measured under paragraph (3), 
                disaggregated by medical facility, on a publicly 
                available Internet website of the Department.
                    (B) Update.--Not less frequently than biweekly, the 
                Secretary shall update the data published under 
                subparagraph (A).
    (c) Comptroller General Report.--
            (1) In general.--Beginning not later than one year after 
        the date of the enactment of this Act, the Comptroller General 
        of the United States shall review compliance by the Secretary 
        with the requirements of this section, including a review of 
        the veracity of data published by the Secretary under 
        subsection (b)(4).
            (2) Completion.--Not later than three years after the date 
        of the enactment of this Act, the Comptroller General shall 
        submit to the Committee on Veterans' Affairs of the Senate and 
        the Committee on Veterans' Affairs of the House of 
        Representatives the results of the review conducted under 
        paragraph (1).

SEC. 4. ADMINISTRATION OF CONSULTATIONS FOR HEALTH CARE FROM DEPARTMENT 
              OF VETERANS AFFAIRS.

    (a) Administration of Outpatient Consultation Requests.--
            (1) National process.--Not later than 180 days after the 
        date of the enactment of this Act, the Secretary of Veterans 
        Affairs shall establish a national process to track and process 
        outpatient clinical consultation requests.
            (2) Training.--Not later than one year after the date of 
        the enactment of this Act, the Secretary shall ensure that all 
        individuals involved in the process of scheduling outpatient 
        clinical consultations are properly trained.
            (3) Certification.--
                    (A) In general.--The Secretary shall ensure that 
                directors of medical centers and Veterans Integrated 
                Service Networks of the Department of Veterans Affairs 
                certify compliance, on a quarterly basis, with the 
                national process established under paragraph (1).
                    (B) Elements.--The certification under subparagraph 
                (A) shall include the following:
                            (i) An assessment of whether consultations 
                        were appropriately processed.
                            (ii) Data with respect to consultations as 
                        follows:
                                    (I) Consultations that were 
                                scheduled within the request window.
                                    (II) Duplicate consultation 
                                requests.
                                    (III) Consultations that were 
                                discontinued.
                                    (IV) Delays in consultations.
                                    (V) Consultations that were not 
                                properly closed.
                            (iii) For consultations that were 
                        improperly discontinued, a description of 
                        remediation attempts.
            (4) Requests for mobile deployment teams.--
                    (A) In general.--A director of a medical center of 
                the Department shall request from the Secretary a 
                mobile deployment team under the program established 
                under section 6 if the requirements of the national 
                process established under paragraph (1) have not been 
                met with respect to a facility under the jurisdiction 
                of the director.
                    (B) Report.--Not less frequently than once every 
                180 days, the Secretary shall submit to the appropriate 
                committees of Congress a report setting forth each 
                request under subparagraph (A) during the period 
                covered by the report, including an explanation of why 
                a mobile deployment team was or was not provided, as 
                the case may be.
    (b) Initial Review.--
            (1) In general.--The Secretary shall review the processes 
        and requirements of the Department with respect to 
        consultations for health care under the laws administered by 
        the Secretary.
            (2) Report.--Not later than 180 days after the date of the 
        enactment of this Act, the Secretary shall submit to the 
        appropriate committees of Congress a report on the results of 
        the review conducted under paragraph (1).
    (c) Biannual Review.--Not later than 180 days after the date of the 
enactment of this Act, and every 180 days thereafter, the Secretary 
shall conduct a review of consultations conducted at each medical 
facility of the Department that includes the following:
            (1) A review of the accuracy of the type of service, either 
        administrative or clinical, that is inputted in the electronic 
        health record.
            (2) A review of the accuracy of the type of consultation 
        setting, either inpatient or outpatient, that is inputted in 
        the electronic health record.
            (3) A review of the appropriateness of the level of urgency 
        of the consultation that is inputted in the electronic health 
        record.
            (4) A review of any delayed or unresolved consultations.
            (5) A determination of the timeliness of consultations 
        based on guidance set forth by the Under Secretary for Health 
        of the Department.
    (d) Appropriate Committees of Congress Defined.--In this section, 
the term ``appropriate committees of Congress'' means--
            (1) the Committee on Veterans' Affairs and the Committee on 
        Appropriations of the Senate; and
            (2) the Committee on Veterans' Affairs and the Committee on 
        Appropriations of the House of Representatives.

SEC. 5. MEASUREMENT OF TIMELINESS FOR REFERRALS FOR HEALTH CARE AMONG 
              HEALTH CARE PROVIDERS OR FACILITIES OF DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) In General.--With respect to referrals for health care between 
health care providers or facilities of the Department of Veterans 
Affairs, not later than 120 days after the date of the enactment of 
this Act, the Secretary of Veterans Affairs shall measure, for each 
medical facility of the Department, the time it takes from the date 
that a clinician of the Department determines that a veteran requires 
care from another health care provider or facility to each of the 
following:
            (1) The date that the referral for care is sent to the 
        other health care provider or facility.
            (2) The date that the other health care provider or 
        facility accepts the referral.
            (3) The date that the appointment with the other health 
        care provider or at the other facility is made.
            (4) The date of the appointment with the other health care 
        provider or at the other facility.
            (5) Any other step that the Secretary determines necessary 
        to measure.
    (b) Publication of Data.--Not later than one year after the date of 
the enactment of this Act, the Secretary shall publish the data 
measured under subsection (a), disaggregated by medical facility, on a 
publicly available Internet website of the Department.

SEC. 6. EXAMINATION OF HEALTH CARE CONSULTATION AND SCHEDULING 
              POSITIONS OF DEPARTMENT OF VETERANS AFFAIRS.

    (a) Proper Grading of Consultation and Scheduling Positions.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        conduct an examination of health care positions of the 
        Department of Veterans Affairs to determine whether health care 
        positions involved in the consultation and scheduling processes 
        are appropriately graded.
            (2) Submittal to congress.--Not later than 120 days after 
        the date of the enactment of this Act, the Secretary shall 
        submit to the appropriate committees of Congress the results of 
        the examination conducted under paragraph (1).
    (b) Review of Onboarding Process.--Not later than 180 days after 
the date of the enactment of this Act, the Secretary shall submit to 
the appropriate committees of Congress--
            (1) a review of the onboarding process of individuals in 
        health care positions described in subsection (a), including 
        how long it takes to hire those individuals; and
            (2) a description of any changes that the Secretary has 
        made or plans to make to improve that process.
    (c) Appropriate Committees of Congress Defined.--In this section, 
the term ``appropriate committees of Congress'' means--
            (1) the Committee on Veterans' Affairs and the Committee on 
        Appropriations of the Senate; and
            (2) the Committee on Veterans' Affairs and the Committee on 
        Appropriations of the House of Representatives.

SEC. 7. PROGRAM TO FURNISH MOBILE DEPLOYMENT TEAMS TO MEDICAL 
              FACILITIES THAT REQUIRE ASSISTANCE.

    (a) In General.--The Secretary of Veterans Affairs shall establish 
a program to furnish mobile deployment teams of scheduling and medical 
personnel to medical facilities of the Department that require 
assistance.
    (b) Elements.--In furnishing a mobile deployment team to a medical 
facility under subsection (a), including the particular personnel to be 
included, the Secretary shall consider the following elements:
            (1) The scheduling needs of the facility.
            (2) The unfilled medical positions at the facility.
            (3) The number of open consultations at the facility.
            (4) The results of scheduler audits conducted under section 
        2(d)(3).
            (5) Requests under section 4(a)(4) for mobile deployment 
        teams due to a failure of the facility to meet consultation 
        requirements.
            (6) Such other elements as the Secretary considers 
        necessary for effective oversight of the program established 
        under subsection (a).
    (c) Completion of Duty.--In carrying out the program under this 
section, the Secretary shall require each mobile deployment team 
furnished to a medical facility under subsection (a) to develop a 
remediation plan that, upon completion, terminates the deployment of 
the team to that facility.
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