[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 629 Introduced in Senate (IS)]

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116th CONGRESS
  1st Session
                                 S. 629

 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

                           February 28, 2019

 Mr. Tester (for himself, Mrs. Murray, Mr. Blumenthal, and Mr. Brown) 
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.--
            (1) In general.--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 
        of the Department of Veterans Affairs for scheduling 
        appointments for health care from the Department at the medical 
        facility level.
            (2) Periodic revision.--
                    (A) In general.--The Secretary may revise the 
                processes and requirements required under paragraph (1) 
                as the Secretary considers necessary.
                    (B) Submittal to congress.--Not later than 30 days 
                before revising the processes and requirements under 
                subparagraph (A), the Secretary shall submit to the 
                Committee on Veterans' Affairs of the Senate and the 
                Committee on Veterans' Affairs of the House of 
                Representative a description of those revised processes 
                and requirements, including a description of any 
                modifications to the certification and training under 
                subsection (b).
    (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), including the maximum number of 
        days allowed to complete each step of the scheduling process.
            (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 enable real-time monitoring of and 
        ensure that each medical facility of the Department complies 
        with the scheduling processes and requirements described in 
        subsection (a), including compliance with policies of the 
        Department relating to the maximum number of days allowed to 
        complete each step of the scheduling process.
            (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).
    (d) Comptroller General Report.--Not later than two years after the 
date of the enactment of this Act, the Comptroller General of the 
United States shall submit to the Committee on Veterans' Affairs of the 
Senate and the Committee on Veterans' Affairs of the House of 
Representatives a report on the compliance of the Secretary with the 
requirements of this section.

SEC. 3. AUDITS REGARDING SCHEDULING OF APPOINTMENTS AND MANAGEMENT OF 
              CONSULTATIONS FOR HEALTH CARE FROM DEPARTMENT OF VETERANS 
              AFFAIRS.

    (a) In General.--Not later than one year after the date of the 
enactment of this Act, and not less frequently than annually 
thereafter, the Secretary of Veterans Affairs shall provide for the 
conduct of facility-level audits of the scheduling of appointments and 
the management of consultations for health care under the laws 
administered by the Secretary.
    (b) Elements.--Each audit conducted under subsection (a) shall 
include the following:
            (1) With respect to each medical center of the Department 
        of Veterans Affairs, an assessment of any scheduling or 
        consultation management issues at that medical center, 
        including the following:
                    (A) An assessment of non-compliance with policies 
                of the Veterans Health Administration relating to 
                scheduling appointments and managing consultations.
                    (B) An assessment of the extent to which 
                appointments or consultations are not timely processed.
                    (C) A description of any backlogs in appointments 
                or consultations that are awaiting action.
                    (D) An assessment of whether consultations are 
                appropriately processed.
                    (E) 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 or discontinued, including a description 
                        of remediation attempts.
                    (F) A review for accuracy with respect to 
                consultation management as follows:
                            (i) A review of the accuracy of the type of 
                        service, either administrative or clinical, 
                        that is inputted in the electronic health 
                        record.
                            (ii) A review of the accuracy of the type 
                        of consultation setting, either impatient or 
                        outpatient, that is inputted in the electronic 
                        health record.
                            (iii) A review of the appropriateness of 
                        the level of urgency of the consultation that 
                        is inputted in the electronic health record.
                            (iv) A review of any delayed or unresolved 
                        consultations.
            (2) An identification of such recommendations for 
        corrective action as the Secretary considers necessary, 
        including additional training, increased personnel, and other 
        resources.
            (3) A certification that the director of each medical 
        center of the Department is in compliance with the processes 
        and requirements described in section 2(a) and such other 
        requirements relating to the scheduling of appointments and 
        management of consultations as the Secretary considers 
        appropriate.
            (4) With respect to referrals for health care between 
        health care providers or facilities of the Department, a 
        measurement of, 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:
                    (A) The date that the referral for care is sent to 
                the other health care provider or facility.
                    (B) The date that the other health care provider or 
                facility accepts the referral.
                    (C) The date that the appointment with the other 
                health care provider or at the other facility is made.
                    (D) The date of the appointment with the other 
                health care provider or at the other facility.
                    (E) Any other step that the Secretary determines 
                necessary to measure.
    (c) Conduct of Audit by Third Party.--Each audit conducted under 
subsection (a) with respect to a medical facility of the Department 
shall be conducted by an individual or entity that is not affiliated 
with the facility.
    (d) Transmittal to VHA.--Each audit conducted under subsection (a) 
shall be transmitted to the Under Secretary for Health of the 
Department so that the Under Secretary can--
            (1) strengthen oversight of the scheduling of appointments 
        and management of consultations throughout the Department;
            (2) monitor national policy on such scheduling and 
        management;
            (3) determine if a mobile deployment team furnished under 
        the pilot program established under section 402 of the VA 
        MISSION Act of 2018 (Public Law 115-182) is warranted; and
            (4) develop a remediation plan to address issues uncovered 
        by those audits.
    (e) Annual Report.--
            (1) In general.--Not later than December 31 of each year, 
        the Secretary shall submit to the Committee on Veterans' 
        Affairs of the Senate and the Committee on Veterans' Affairs of 
        the House of Representatives a report on the audits conducted 
        under subsection (a) during the year ending on that date.
            (2) Elements.--The Secretary shall include in each report 
        required by paragraph (1)--
                    (A) a description of the audits conducted under 
                subsection (a) with respect to each facility of the 
                Department;
                    (B) an assessment of how the Department 
                strengthened oversight of the scheduling of 
                appointments and management of consultations at that 
                facility as a result of those audits;
                    (C) an assessment of how those audits informed the 
                national policy of the Department with respect to the 
                scheduling of appointments and management of 
                consultations; and
                    (D) a description of any remediation plans to 
                address issues raised by those audits that were 
                completed.

SEC. 4. 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), 
                section 1703 of title 38, United States Code (as in 
                effect on the date specified in section 101(b) of the 
                Caring for Our Veterans Act of 2018 (title I of Public 
                Law 115-182)), 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--
                            (i) an assessment of the type of positions 
                        required to be staffed at the medical facility;
                            (ii) the number of such positions 
                        authorized;
                            (iii) the number of such positions filled; 
                        and
                            (iv) the number of additional such 
                        positions required to be authorized.
            (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 set forth under subparagraphs (A) through (F) of 
        paragraph (3).
            (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 that the appointment with the non-
                Department health care provider occurs.
                    (E) The date that the referral to the non-
                Department health care provider is completed.
                    (F) 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) Review.--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 
        validity and reliability 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. 5. REQUESTS FOR MOBILE DEPLOYMENT TEAMS BY DIRECTORS OF MEDICAL 
              CENTERS OF DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--A director of a medical center of the Department 
of Veterans Affairs shall request from the Secretary of Veterans 
Affairs a mobile deployment team under the pilot program established 
under section 402 of the VA MISSION Act of 2018 (Public Law 115-182) if 
requirements of the Department under sections 2 and 4 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 subsection (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.
    (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. 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) Consultation.--In conducting the examination under 
        paragraph (1), the Secretary shall consult with health care 
        staffing experts in the Federal Government and the private 
        sector.
            (3) 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.
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