[Congressional Record Volume 167, Number 199 (Tuesday, November 16, 2021)]
[House]
[Pages H6281-H6283]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              {time}  1245
               VA ASSESSMENT BY INDEPENDENT MEASURES ACT

  Mr. TAKANO. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 4626) 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, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 4626

       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:

[[Page H6282]]

       ``(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.

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


                             General Leave

  Mr. TAKANO. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
to insert extraneous material on H.R. 4626, as amended.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise today in support of H.R. 4626, as amended, the VA 
Assessment by Independent Measures Act, or VA AIM Act.
  This bill would require the Department of Veterans Affairs to 
contract with one or more private-sector entities to conduct 
independent assessments of its healthcare delivery systems and 
management processes once every 10 years.
  This bill would make permanent an independent assessment process that 
is nearly identical to the one that was mandated by the Veterans 
Access, Choice, and Accountability Act of 2014.
  Among other things, the review would examine VA patient demographics 
and healthcare needs now and in the future; the accuracy and 
reliability of the models used to project VA's healthcare budget; 
veterans' access to healthcare through community providers and other 
Federal facilities; VA's healthcare appointment scheduling processes; 
and VA's process for determining its staffing needs and recruiting and 
retaining clinical staff.
  I am pleased that Ranking Member Bost and Representative Bergman were 
open to incorporating my feedback when this bill was considered by our 
committee this summer. We added a provision to the bill that requires 
VA to submit to Congress a report outlining the feasibility and 
advisability of implementing any recommendations made through these 
independent assessments. This will help us hold the Department 
accountable for improving its delivery of the healthcare benefits our 
Nation's veterans have earned.

[[Page H6283]]

  Mr. Speaker, I urge my colleagues to join me in supporting H.R. 4626, 
as amended, the VA AIM Act, and I reserve the balance of my time.
  Mr. BOST. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise today in support of H.R. 4626, as amended, the VA 
Assessment by Independent Measures Act, or AIM Act.
  The AIM Act is sponsored by my friend and fellow Marine Corps 
veteran, General Jack Bergman. General Bergman is the ranking member of 
the Subcommittee on Health, and I thank him for his dedication to 
ensuring that the VA is providing good care for each one of our 
Nation's veterans.
  The AIM Act would require an independent assessment of the VA 
healthcare system once every decade, starting in the year 2025.
  When the VA was in the midst of a nationwide access and 
accountability crisis in 2014, Congress passed the Choice Act to help 
right the ship. The Choice Act included a provision requiring an 
independent assessment of the VA healthcare system. That led to many of 
the reforms that are occurring across the VA system today. Establishing 
a mechanism for regular independent assessments will ensure that the VA 
continues to improve in the decades ahead.
  I appreciate Chairman Takano and his staff for working with me and 
General Bergman while the AIM Act was pending in committee. I hope that 
this bill will have the same level of bipartisan support today.
  Mr. Speaker, I reserve the balance of my time.
  Mr. TAKANO. Mr. Speaker, I have no further speakers. I am prepared to 
close, and I reserve the balance of my time.
  Mr. BOST. Mr. Speaker, I yield 3 minutes to the gentleman from 
Michigan (Mr. Bergman).
  Mr. BERGMAN. Mr. Speaker, I am proud to rise today in support of my 
bill, H.R. 4626, as amended, the Department of Veterans Affairs 
Assessment by Independent Measures Act, or AIM Act.
  When it comes to bureaucracies, I have never believed that 
maintaining the status quo is an acceptable path forward. In fact, it 
is an impossible path forward.
  The world is constantly in a state of change. The way American men 
and women defend freedom around the world, and the way those same men 
and women seek care when they come home, is constantly changing as 
well. The VA healthcare system must change, too, or it will never 
fulfill its obligations to all of our veterans.
  That is where the AIM Act comes in. The AIM Act would require an 
independent assessment of the operations and management of the VA 
healthcare system once every decade, beginning in 2025.
  The independent assessment framework in the AIM Act is modeled after 
the independent assessment that was required in the Choice Act, which 
was signed into law in 2014 following the nationwide VA access and 
accountability crisis that saw some veterans literally dying on VA 
facilities' waiting lists.
  That independent assessment was completed in 2015, and the findings 
and recommendations it contained directly underpinned many of the 
necessary improvements that have occurred in the VA healthcare system 
since then.
  The AIM Act would ensure that this successful model is not a one-and-
done but instead regularly recurs to ensure that the VA keeps improving 
for veterans long into the future.
  I am grateful for the support the AIM Act has received from veterans 
service organizations, particularly the Veterans of Foreign Wars, the 
Wounded Warrior Project, and the Minority Veterans of America.
  I am also grateful for the bipartisan support the AIM Act received in 
the Veterans' Affairs Committee. I thank all of my colleagues for that. 
I hope that there will be a similar show of bipartisan support for the 
bill today. My fellow veterans have earned it.
  Mr. TAKANO. Mr. Speaker, I am prepared to close, and I reserve the 
balance of my time.
  Mr. BOST. Mr. Speaker, I encourage all of my colleagues to support 
this bill, and I yield back the balance of my time.
  Mr. TAKANO. Mr. Speaker, I ask all of my colleagues to join me in 
passing this important piece of legislation, H.R. 4626, as amended, and 
I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from California (Mr. Takano) that the House suspend the rules 
and pass the bill, H.R. 4626, 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.

                          ____________________