[Congressional Record Volume 162, Number 175 (Tuesday, December 6, 2016)]
[House]
[Pages H7242-H7245]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              {time}  1515
                  FASTER CARE FOR VETERANS ACT OF 2016

  Mr. ROE of Tennessee. Mr. Speaker, I move to suspend the rules and 
pass the bill (H.R. 4352) to direct the Secretary of Veterans Affairs 
to carry out a pilot program establishing a patient self-scheduling 
appointment system, and for other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 4352

       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 ``Faster Care for Veterans Act 
     of 2016''.

     SEC. 2. PILOT PROGRAM ESTABLISHING A PATIENT SELF-SCHEDULING 
                   APPOINTMENT SYSTEM.

       (a) Pilot Program.--Not later than 120 days after the date 
     of the enactment of this Act, the Secretary of Veterans 
     Affairs shall commence a pilot program under which veterans 
     use an Internet website or mobile application to schedule and 
     confirm medical appointments at medical facilities of the 
     Department of Veterans Affairs.
       (b) Selection of Locations.--The Secretary shall select not 
     less than three Veterans Integrated Services Networks in 
     which to carry out the pilot program under subsection (a).
       (c) Contracts.--
       (1) Authority.--The Secretary shall seek to enter into a 
     contract using competitive procedures with one or more 
     contractors to provide the scheduling capability described in 
     subsection (a).
       (2) Notice of competition.--Not later than 60 days after 
     the date of the enactment of this Act, the Secretary shall 
     issue a request for proposals for the contract described in 
     paragraph (1). Such request shall be full and open to any 
     contractor that has an existing commercially available, off-
     the-shelf online patient self-scheduling system that includes 
     the capabilities specified in section 3(a).
       (3) Selection.--Not later than 120 days after the date of 
     the enactment of this Act, the Secretary shall award a 
     contract to one or more contractors pursuant to the request 
     for proposals under paragraph (2).
       (d) Duration of Pilot Program.--
       (1) In general.--Except as provided by paragraph (2), the 
     Secretary shall carry out the pilot program under subsection 
     (a) for an 18-month period.
       (2) Extension.--The Secretary may extend the duration of 
     the pilot program under subsection (a), and may expand the 
     selection of Veterans Integrated Services Networks under 
     subsection (b), if the Secretary determines that the pilot 
     program is reducing the wait times of veterans seeking 
     medical care and ensuring that more available appointment 
     times are filled.
       (e) Mobile Application Defined.--In this section, the term 
     ``mobile application'' means a software program that runs on 
     the operating system of a cellular telephone, tablet 
     computer, or similar portable computing device that transmits 
     data over a wireless connection.

[[Page H7243]]

  


     SEC. 3. CAPABILITIES OF PATIENT SELF-SCHEDULING APPOINTMENT 
                   SYSTEM.

       (a) Minimum Capabilities.--The Secretary of Veterans 
     Affairs shall ensure that the patient self-scheduling 
     appointment system used in the pilot program under section 2, 
     and any other patient self-scheduling appointment system 
     developed or used by the Department of Veterans Affairs, 
     includes, at a minimum, the following capabilities:
       (1) Capability to schedule, modify, and cancel appointments 
     for primary care, specialty care, and mental health.
       (2) Capability to support appointments for the provision of 
     health care regardless of whether such care is provided in 
     person or through telehealth services.
       (3) Capability to view appointment availability in real 
     time.
       (4) Capability to make available, in real time, 
     appointments that were previously filled but later cancelled 
     by other patients.
       (5) Capability to provide prompts or reminders to veterans 
     to schedule follow-up appointments.
       (6) Capability to be used 24 hours per day, seven days per 
     week.
       (7) Capability to integrate with the Veterans Health 
     Information Systems and Technology Architecture of the 
     Department, or such successor information technology system.
       (b) Independent Validation and Verification.--
       (1) Independent entity.--
       (A) The Secretary shall seek to enter into an agreement 
     with an appropriate non-governmental, not-for-profit entity 
     with expertise in health information technology to 
     independently validate and verify that the patient self-
     scheduling appointment system used in the pilot program under 
     section 2, and any other patient self-scheduling appointment 
     system developed or used by the Department of Veterans 
     Affairs, includes the capabilities specified in subsection 
     (a).
       (B) Each independent validation and verification conducted 
     under subparagraph (A) shall be completed as follows:
       (i) With respect to the validation and verification of the 
     patient self-scheduling appointment system used in the pilot 
     program under section 2, by not later than 60 days after the 
     date on which such pilot program commences.
       (ii) With respect to any other patient self-scheduling 
     appointment system developed or used by the Department of 
     Veterans Affairs, by not later than 60 days after the date on 
     which such system is deployed, regardless of whether such 
     deployment is on a limited basis, but not including any 
     deployments for testing purposes.
       (2) GAO evaluation.--
       (A) The Comptroller General of the United States shall 
     evaluate each validation and verification conducted under 
     paragraph (1).
       (B) Not later than 30 days after the date on which the 
     Comptroller General completes an evaluation under paragraph 
     (1), the Comptroller General shall submit to the appropriate 
     congressional committees a report on such evaluation.
       (C) In this paragraph, the term ``appropriate congressional 
     committees'' means--
       (i) the Committees on Veterans' Affairs of the House of 
     Representatives and the Senate; and
       (ii) the Committees on Appropriations of the House of 
     Representatives and the Senate.
       (c) Certification.--
       (1) Capabilities included.--Not later than December 31, 
     2017, the Secretary shall certify to the Committees on 
     Veterans' Affairs of the House of Representatives and the 
     Senate that the patient self-scheduling appointment system 
     used in the pilot program under section 2, and any other 
     patient self-scheduling appointment system developed or used 
     by the Department of Veterans Affairs as of the date of the 
     certification, includes the capabilities specified in 
     subsection (a).
       (2) New systems.--If the Secretary develops or begins using 
     a new patient self-scheduling appointment system that is not 
     covered by a certification made under paragraph (1), the 
     Secretary shall certify to such committees that such new 
     system includes the capabilities specified in subsection (a) 
     by not later than 30 days after the date on which the 
     Secretary determines to replace the previous patient self-
     scheduling appointment system.
       (3) Effect of capabilities not included.--If the Secretary 
     does not make a timely certification under paragraph (1) or 
     paragraph (2), the Secretary shall replace any patient self-
     scheduling appointment system developed by the Secretary that 
     is in use with a commercially available, off-the-shelf online 
     patient self-scheduling system that includes the capabilities 
     specified in subsection (a).

     SEC. 4. PROHIBITION ON NEW APPROPRIATIONS.

       No additional funds are authorized to carry out the 
     requirements of this Act. Such requirements shall be carried 
     out using amounts otherwise authorized.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Tennessee (Mr. Roe) and the gentleman from California (Mr. Takano) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Tennessee.


                             General Leave

  Mr. ROE of Tennessee. Mr. Speaker, I ask unanimous consent that all 
Members have 5 legislative days in which to revise and extend their 
remarks and to add extraneous material.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Tennessee?
  There was no objection.
  Mr. ROE of Tennessee. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I rise today in support of H.R. 4352, as amended, the 
Faster Care for Veterans Act of 2016.
  The wait time scandals that continue to plague the Department of 
Veterans Affairs have highlighted the need for veterans to be able to 
schedule their own medical appointments. Everyone agrees that the 
veterans who want this capability should have it.
  A self-scheduling option would reduce the workload on overburdened 
schedulers, allow the VA to use taxpayer resources more efficiently, 
and grant veterans who would prefer to schedule their own appointments 
the ability and flexibility to do so. It would also encourage 
accountability by giving veterans verifiable records of their own 
appointment bookings.
  VA has been considering self-scheduling since at least 2013. However, 
projects start and stop, priorities shift, and nothing usable has so 
far emerged from those considerations. Unfortunately, this seems to be 
the result of a tug of war between some VA officials who favor a 
commercial off-the-shelf system and others who favor a government-
developed system.
  VA has been developing a self-scheduling mobile application based on 
its VISTA management system and plans to roll it out in January 2017. I 
have high hopes for that effort, but VA's IT development record is 
mixed--to put it mildly--and past experience shows that meeting high 
standards and firm deadlines are crucial to success.
  The time has come to settle this issue once and for all. H.R. 4352, 
as amended, establishes capability standards reflecting the state of 
the art that apply to any commercial or government self-scheduling 
system in VA. It also directs VA to pilot the best available commercial 
software in three locations. The bill tasks an independent expert to 
verify whether that commercial system and the government system meet 
those standards, and by the end of 2017, VA must certify whether or not 
they do.
  The concept is, in other words, a bake-off to create the most 
successful possible software for our veterans. Ideally, both systems 
will meet the standards, but if the government system cannot make the 
grade, VA will have a commercial alternative thoroughly piloted and 
ready to go to work for VA patients.
  H.R. 4352, as amended, is sponsored by Congressman Seth Moulton from 
Massachusetts and Congresswoman Cathy McMorris Rodgers from Washington. 
I thank them both for their leadership on this issue.
  This broadly bipartisan legislation is an efficient, timely solution 
to a longstanding problem, and I encourage all of my colleagues to join 
me in supporting it.
  Mr. Speaker, I reserve the balance of my time.
  Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise today in support of H.R. 4352, as amended, 
sponsored by my friend, the gentleman from Massachusetts and a veteran 
himself, Representative Moulton.
  This important legislation authorizes the VA to administer a pilot 
program where veterans use an Internet Web site to schedule and confirm 
medical appointments at medical facilities of the Department of 
Veterans Affairs. The VA has been working to bring the power of 
scheduling to veterans since the wait time scandal at the Phoenix VA 
Medical Center in 2014.
  The Department of Veterans Affairs had developed and is rolling out 
the Veterans Appointment Request, otherwise known as VAR, for primary 
care. This is a mobile application, and the approach will allow 
veterans to directly schedule or request primary care appointments and 
request mental health appointments at facilities where they are already 
receiving care. With the app, veterans can also view appointment 
details, track the status of requests, send messages about the 
requested appointments, get notifications about appointments, and 
cancel most appointments.
  The VA has also implemented the Audiology and Optometry Direct

[[Page H7244]]

Scheduling Initiative. This program began as a successful pilot at 
three sites in 2015 and is now being expanded to all VA medical 
centers.
  Veterans can schedule a routine appointment for audiology or 
optometry directly by calling the scheduling department or by speaking 
directly with audiology or optometry staff. The covered services 
include hearing tests, eye exams, vision prescriptions, eyeglass 
fittings, and other routine appointments.
  This important legislation will allow veterans to better control 
their VA experience no matter what services they need. Ensuring 
veterans are comfortable with the scheduling platform ultimately used 
is a critical factor. Whether that is a smartphone, Internet Web site 
or calling directly to make that appointment, the primary consideration 
is the ease of use by the veteran.
  The only way to make sure it works is to test it. This legislation 
will ensure that the technology fits the veteran and also fits the VA.
  For those reasons, I support this legislation and urge my colleagues 
to do the same.
  Mr. Speaker, I reserve the balance of my time.
  Mr. ROE of Tennessee. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, this is long overdue. One of the problems we have in VA 
is that we know the scandal at Phoenix where there were secret waiting 
lists for appointments for honorably discharged veterans to see a 
doctor.

  This is one of the ways in which we can put veterans back in charge. 
One of the things I want to do is put veterans and doctors--healthcare 
providers--in charge of the health care and not bureaucrats, 
schedulers, and so forth. This puts the power back in front of the 
veterans.
  We are at the Christmas season. Many of us order packages on Amazon 
or wherever. Guess what we can do? We can track that through our own 
personal device anywhere that package is so that it reaches our 
doorstep. Veterans should have that command so they can have an 
appointment when they want it; they can make it. The technology is 
available. I can't think of a better thing to do than to have a private 
and public competition to see which is the most effective for the 
veteran. I think in a year we are going to know. It will be simple to 
implement. Almost everyone has a smart device now that we can use for 
this process.
  Mr. Speaker, I reserve the balance of my time.
  Mr. TAKANO. Mr. Speaker, I yield 5 minutes to the gentleman from 
Massachusetts (Mr. Moulton).
  Mr. MOULTON. Mr. Speaker, I rise today in support of H.R. 4352, the 
Faster Care for Veterans Act, which I introduced with Congresswoman 
Cathy McMorris Rodgers.
  The idea behind the bill is simple. Our Nation's veterans deserve the 
same technological innovations and level of service at VA healthcare 
facilities as patients in the private market. One such innovation is 
patient self-scheduling technology. Patients can log on to an app on 
their phone or on a Web site, indicate the type of appointment they 
need, select their location, and schedule their own appointments at a 
time convenient for them--no middle men, no obnoxious hold music, and 
no unending carousel of options on an automated phone menu; just a 
quick and easy medical appointment that works for your schedule.
  This technology is not just beneficial for patients, it is good for 
medical providers as well. In the private market, the introduction of 
patient self-scheduling has dramatically decreased wait times, saving 
time and money. The VA ought to chase these same innovations so our 
veterans receive the best health care and user experience in the world.
  As a Member of Congress, I declined congressional health care and 
pledged to receive my care at the VA. I receive excellent service from 
terrific doctors and nurses at my home VA facility in Bedford, 
Massachusetts. However, scheduling an appointment here in D.C. or at 
home in Bedford has never been easy.
  Dennis Magnasco, my veterans' liaison in my office in Salem, 
Massachusetts, learned this the hard way. Shortly after I introduced 
the Faster Care for Veterans Act, Dennis called our local VA hospital 
to make an appointment himself. He listened to the options on the 
automated menu and pressed one to schedule an appointment. After 
several more pushed buttons, rather than connecting him to the talented 
schedulers who work in the Bedford VA, the automated menu started over 
again. It went into an endless cycle. He hung up, and after multiple 
unsuccessful further attempts, he recorded himself doing this in a 
video.
  I put this video on my Facebook page, and the response was 
astonishing. Four million people saw the video, 35,000 people shared 
the video, and 2,000 people commented. People from all over the country 
shared their experience trying to schedule their own appointments at 
the VA. The frustration is nationwide.
  A veteran from Walcott, Arkansas, said: I can tell you this is for 
real. It happens every time I call. I usually give up and drive to the 
clinic 18 or 20 miles away so I can talk to a person face to face.
  A veteran from El Paso, Texas, said: This is exactly what happens 
every time you try to call for an appointment or even get general 
information about an existing appointment. This is exactly why lots of 
us vets end up giving up on the system.
  A veteran from Philadelphia, Pennsylvania, said: The longest I have 
been on hold with the VA was an hour and 45 minutes before I gave up.
  This is not an issue of quality of care, it is an issue of access to 
care. The Faster Care for Veterans Act is a solution.
  First, this bill directs the VA to conduct a pilot program to test 
commercial off-the-shelf self-scheduling technology at three locations 
across the country while allowing the VA to continue developing its 
inhouse solution.
  Second, the bill requires both the pilot program and the VA's 
solution to meet several capabilities currently available in the 
private market. These requirements will ensure our veterans get the 
same level of service as every other American.
  Third, the bill provides for an independent assessment to verify if 
the pilot program or the VA's solution meets the minimum capabilities.
  Lastly, the bill requires the VA to replace any system used by the VA 
that does not meet those minimum requirements with a commercially 
available off-the-shelf technology that does meet those capabilities.
  The bill is supported by the Iraq and Afghanistan Veterans of 
America, the American College of Neurosurgeons, and the American 
Osteopathic Association; and this bill is cosponsored by more than half 
of the House of Representatives. Our veterans are demanding a 21st 
century VA healthcare system. This bill is one step in that direction.
  Mr. Speaker, I urge my colleagues to support this legislation.
  Mr. ROE of Tennessee. Mr. Speaker, I yield such time as she may 
consume to the gentlewoman from Washington (Mrs. McMorris Rodgers), who 
is our conference chair. Cathy McMorris Rodgers is a very passionate 
supporter of veterans' issues.
  Mrs. McMORRIS RODGERS. Mr. Speaker, I rise today, more than 2 years 
after we were all shocked by the news that Phoenix veterans had died 
waiting for appointments at their local VA. Yet, after all this time, 
little has changed.
  Every week veterans contact my office seeking help to get the care 
that they need, like the veteran who couldn't access urgent care and 
was afraid he would be billed if he went to the hospital for help, or 
the veteran who got cancer from atomic testing but had to jump through 
all kinds of hoops to prove it.
  Is this how a grateful nation should treat its veterans? Absolutely 
not.
  The best way we show our gratitude to those who have served is to get 
them the care that they have earned. When a veteran contacts the VA, 
they should have the red carpet rolled out for them, period; but, 
instead, these stories are repeated over and over and over in 
communities all across the country: The VA won't listen; the VA doesn't 
return calls; we can't see a doctor.
  There is a disconnect between the service of our military and the 
service they receive when they return home.
  Mr. Moulton of Massachusetts and I introduced the Faster Care for 
Veterans Act to leverage technology to cut

[[Page H7245]]

back on wait times. Our veterans should have the same options that 
people have in doctors' offices across the country. They should be able 
to use an app, go online to schedule; or if they want to call, they can 
do that, too.

                              {time}  1530

  The point is the technology to make it easier to self-schedule 
already exists. Why not provide it to our veterans?
  With this bill, we are demonstrating to the VA that innovative 
technology can work. It can get our veterans the care that they have 
earned more quickly without all the red tape.
  But wait times are just the tip of this bureaucratic iceberg. The 
terrible stories this past week of HIV exposure and a veteran dying 
with maggots in his wounds are graphic reminders to all of us that the 
VA has lost sight of its sole mission: serving veterans.
  Veterans should be in control of all aspects of their health care. 
That is not what is happening right now. After all the years, all the 
money, no more excuses. It is time for a deeper look into rethinking 
this outdated government bureaucracy.
  Mr. Speaker, I never again want to hear a war hero cry because of how 
the VA has treated him. I urge my colleagues to join us in supporting 
the Faster Care for Veterans Act.
  Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.
  I have no further speakers. Before I close, I would like to say that 
I fully appreciate the work of my friend and colleague, the gentleman 
from Massachusetts (Mr. Moulton), for the work he has done on this bill 
and for the way in which he is able to reach out to veterans and those 
who care for veterans across the country.
  I am especially pleased that included in this legislation is a 
specific way to independently assess the off-the-shelf technology as 
compared to the technology that is being developed in-house at the VA. 
I think these provisions will ensure that the taxpayer is protected in 
terms of cost, efficiency, and effectiveness. And, of course, bottom 
line, this means effectiveness for our veterans. We want to make sure 
that the best technology is put forward, whether it is in-house or 
whether it is the off-the-shelf choice, that we have a way to 
independently verify which is best.
  I want to encourage all of my colleagues to support this important 
legislation and join me in passing H.R. 4352.
  I yield back the balance of my time.
  Mr. ROE of Tennessee. Mr. Speaker, I yield myself such time as I may 
consume.
  I want to thank Mr. Moulton and one of our leaders, Cathy McMorris 
Rodgers, for bringing this very important piece of legislation to the 
floor. One of the reasons is that it shows when you bring someone with 
real-world experiences who uses the VA how they can then take that and 
convert that into meaningful legislation that will actually help 
veterans around the country.
  I encourage all Members to support this legislation.
  I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Hultgren). The question is on the motion 
offered by the gentleman from Tennessee (Mr. Roe) that the House 
suspend the rules and pass the bill, H.R. 4352, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

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