[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4626 Referred in Senate (RFS)]

<DOC>
117th CONGRESS
  1st Session
                                H. R. 4626


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           November 17, 2021

Received; read twice and referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 AN ACT


 
   To amend title 38, United States Code, to require an independent 
assessment of health care delivery systems and management processes of 
 the Department of Veterans Affairs be conducted once every 10 years, 
                        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 ``VA Assessment by Independent 
Measures Act'' or the ``VA AIM Act''.

SEC. 2. REQUIREMENT FOR ONGOING INDEPENDENT ASSESSMENTS OF HEALTH CARE 
              DELIVERY SYSTEMS AND MANAGEMENT PROCESSES OF THE 
              DEPARTMENT OF VETERANS AFFAIRS.

    (a) Ongoing Assessments.--Chapter 17 of title 38, United States 
Code, is amended by inserting after section 1704 the following new 
section:
``Sec. 1704A. Independent assessments of health care delivery systems 
              and management processes
    ``(a) Independent Assessments.--Not less frequently than once every 
10 years, the Secretary of Veterans Affairs shall enter into one or 
more contracts with a private sector entity or entities described in 
subsection (d) to conduct an independent assessment of the hospital 
care, medical services, and other health care furnished by the 
Department of Veterans Affairs. Such assessment shall address each of 
the following:
            ``(1) Current and projected demographics and unique health 
        care needs of the patient population served by the Department.
            ``(2) The accuracy of models and forecasting methods used 
        by the Department to project health care demand, including with 
        respect to veteran demographics, rates of use of health care 
        furnished by the Department, the inflation of health care 
        costs, and such other factors as may be determined relevant by 
        the Secretary.
            ``(3) The reliability and accuracy of models and 
        forecasting methods used by the Department to project the 
        budgetary needs of the Veterans Health Administration and how 
        such models and forecasting methods inform budgetary trends.
            ``(4) The authorities and mechanisms under which the 
        Secretary may furnish hospital care, medical services, and 
        other health care at Department and non-Department facilities, 
        including through Federal and private sector partners and at 
        joint medical facilities, and the effect of such authorities 
        and mechanisms on eligibility and access to care.
            ``(5) The organization, workflow processes, and tools used 
        by the Department to support clinical staffing, access to care, 
        effective length-of-stay management and care transitions, 
        positive patient experience, accurate documentation, and 
        subsequent coding of inpatient services.
            ``(6) The efforts of the Department to recruit and retain 
        staff at levels necessary to carry out the functions of the 
        Veterans Health Administration and the process used by the 
        Department to determine staffing levels necessary for such 
        functions.
            ``(7) The staffing level at each medical facility of the 
        Department and the productivity of each health care provider at 
        the medical facility, compared with health care industry 
        performance metrics, which may include the following:
                    ``(A) An assessment of the case load of, and number 
                of patients treated by, each health care provider at 
                such medical facility during an average week.
                    ``(B) An assessment of the time spent by each such 
                health care provider on matters other than the case 
                load of the health care provider, including time spent 
                by the health care provider as follows:
                            ``(i) At a medical facility that is 
                        affiliated with the Department.
                            ``(ii) Conducting research.
                            ``(iii) Training or supervising other 
                        health care professionals of the Department.
            ``(8) The information technology strategies of the 
        Department with respect to furnishing and managing health care, 
        including an identification of any weaknesses or opportunities 
        with respect to the technology used by the Department, 
        especially those strategies with respect to clinical 
        documentation of hospital care, medical services, and other 
        health care, including any clinical images and associated 
        textual reports, furnished by the Department in Department or 
        non-Department facilities.
            ``(9) Business processes of the Veterans Health 
        Administration, including processes relating to furnishing non-
        Department health care, insurance identification, third-party 
        revenue collection, and vendor reimbursement, including an 
        identification of mechanisms as follows:
                    ``(A) To avoid the payment of penalties to vendors.
                    ``(B) To increase the collection of amounts owed to 
                the Department for hospital care, medical services, or 
                other health care provided by the Department, for which 
                reimbursement from a third party is authorized and to 
                ensure that such amounts collected are accurate.
                    ``(C) To increase the collection of any other 
                amounts owed to the Department with respect to hospital 
                care, medical services, or other health care and to 
                ensure that such amounts collected are accurate.
                    ``(D) To increase the accuracy and timeliness of 
                Department payments to vendors and providers.
                    ``(E) To reduce expenditures while improving the 
                quality of care furnished.
            ``(10) The purchase, distribution, and use of 
        pharmaceuticals, medical and surgical supplies, medical 
        devices, and health care-related services by the Department, 
        including the following:
                    ``(A) The prices paid for, standardization of, and 
                use by, the Department with respect to the following:
                            ``(i) Pharmaceuticals.
                            ``(ii) Medical and surgical supplies.
                            ``(iii) Medical devices.
                    ``(B) The use by the Department of group purchasing 
                arrangements to purchase pharmaceuticals, medical and 
                surgical supplies, medical devices, and health care-
                related services.
                    ``(C) The strategy and systems used by the 
                Department to distribute pharmaceuticals, medical and 
                surgical supplies, medical devices, and health care-
                related services to Veterans Integrated Service 
                Networks and medical facilities of the Department.
            ``(11) The process of the Department for carrying out 
        construction and maintenance projects at medical facilities of 
        the Department and the medical facility leasing program of the 
        Department.
            ``(12) The competency of Department leadership with respect 
        to culture, accountability, reform readiness, leadership 
        development, physician alignment, employee engagement, 
        succession planning, and performance management.
            ``(13) The effectiveness of the authorities and programs of 
        the Department to educate and train health personnel pursuant 
        to section 7302 of this title.
            ``(14) The conduct of medical and prosthetic research of 
        the Department.
            ``(15) The provision of Department assistance to Federal 
        agencies and personnel involved in responding to a disaster or 
        emergency.
            ``(16) Such additional matters as may be determined 
        relevant by the Secretary.
    ``(b) Timing.--The private sector entity or entities carrying out 
an assessment pursuant to subsection (a) shall complete such assessment 
not later than one year after entering into the contract described in 
such paragraph.
    ``(c) Data.--To the extent practicable, the private sector entity 
or entities carrying out an assessment pursuant to subsection (a) shall 
make use of existing data that has been compiled by the Department, 
including data that has been collected for--
            ``(1) the performance of quadrennial market assessments 
        under section 7330C of this title;
            ``(2) the quarterly publication of information on staffing 
        and vacancies with respect to the Veterans Health 
        Administration pursuant to section 505 of the VA MISSION Act of 
        2018 (Public Law 115-182; 38 U.S.C. 301 note); and
            ``(3) the conduct of annual audits pursuant to section 3102 
        of the Johnny Isakson and David P. Roe, M.D. Veterans Health 
        Care and Benefits Improvement Act of 2020 (Public Law 116-315; 
        38 U.S.C. 1701 note).
    ``(d) Private Sector Entities Described.--A private sector entity 
described in this subsection is a private entity that--
            ``(1) has experience and proven outcomes in optimizing the 
        performance of the health care delivery systems of the Veterans 
        Health Administration and the private sector and in health care 
        management; and
            ``(2) specializes in implementing large-scale 
        organizational and cultural transformations, especially with 
        respect to health care delivery systems.
    ``(e) Program Integrator.--(1) If the Secretary enters into 
contracts with more than one private sector entity under subsection (a) 
with respect to a single assessment under such subsection, the 
Secretary shall designate one such entity that is predominately a 
health care organization as the program integrator.
    ``(2) The program integrator designated pursuant to paragraph (1) 
shall be responsible for coordinating the outcomes of the assessments 
conducted by the private sector entities pursuant to such contracts.
    ``(f) Reports.--(1) Not later than 60 days after completing an 
assessment pursuant to subsection (a), the private sector entity or 
entities carrying out such assessment shall submit to the Secretary of 
Veterans Affairs and the Committees on Veterans' Affairs of the House 
of Representatives and the Senate a report on the findings and 
recommendations of the private sector entity or entities with respect 
to such assessment. Such report shall include an identification of the 
following:
            ``(A) Any changes with respect to the matters included in 
        such assessment since the date that is the later of the 
        following:
                    ``(i) The date on which the independent assessment 
                under section 201 of the Veterans Access, Choice, and 
                Accountability Act of 2014 (Public Law 113-146; 38 
                U.S.C. 1701 note) was completed.
                    ``(ii) The date on which the last assessment under 
                subsection (a) was completed.
            ``(B) Any recommendations regarding matters to be covered 
        by subsequent assessments under subsection (a), including any 
        additional matters to include for assessment or previously 
        assessed matters to exclude.
    ``(2) Not later than 30 days after receiving a report under 
paragraph (1), the Secretary shall publish such report in the Federal 
Register and on a publicly accessible internet website of the 
Department.
    ``(3) Not later than 90 days after receiving a report under 
paragraph (1), the Secretary shall submit to the Committees on 
Veterans' Affairs of the House of Representatives and the Senate a 
report outlining the feasibility, and advisability, of implementing the 
recommendations made by the private sector entity or entities in such 
report received, including an identification of the timeline, cost, and 
any legislative authorities necessary for such implementation.''.
    (b) Clerical Amendments.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
1704 the following new item:

``1704A. Independent assessments of health care delivery systems and 
                            management processes.''.
    (c) Deadline for Initial Assessment.--The initial assessment under 
section 1704A of title 38, United States Code, as added by subsection 
(a), shall be completed by not later than December 31, 2025.

            Passed the House of Representatives November 16, 2021.

            Attest:

                                             CHERYL L. JOHNSON,

                                                                 Clerk.