[House Report 115-872]
[From the U.S. Government Publishing Office]
115th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 115-872
======================================================================
VA HOSPITALS ESTABLISHING LEADERSHIP PERFORMANCE ACT
_______
July 24, 2018.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Roe of Tennessee, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 5864]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 5864) to direct the Secretary of Veterans
Affairs to establish qualifications for the human resources
positions within the Veterans Health Administration of the
Department of Veterans Affairs, and for other purposes, having
considered the same, report favorably thereon without amendment
and recommend that the bill do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Hearings......................................................... 3
Subcommittee Consideration....................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 4
New Budget Authority, Entitlement Authority, and Tax Expenditures 4
Earmarks and Tax and Tariff Benefits............................. 5
Committee Cost Estimate.......................................... 5
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 6
Advisory Committee Statement..................................... 6
Constitutional Authority Statement............................... 6
Applicability to Legislative Branch.............................. 6
Statement on Duplication of Federal Programs..................... 6
Disclosure of Directed Rulemaking................................ 6
Section-by-Section Analysis of the Legislation................... 6
Changes in Existing Law Made by the Bill as Reported............. 7
PURPOSE AND SUMMARY
H.R. 5864, the VA Hospitals Establishing Leadership
Performance (VA HELP) Act, would require the Department of
Veterans Affairs (VA) to establish qualification standards and
performance metrics for human resources (HR) professionals
working within the Veterans Health Administration (VHA).
Representative Mike Bost of Illinois introduced H.R. 5864 on
May 17, 2018.
BACKGROUND AND NEED FOR LEGISLATION
The vast majority--88 percent--of VA employees work for the
Veterans Health Administration (VHA), which manages and
oversees the VA healthcare system.\1\ VHA's effectiveness is
hampered by nationwide recruitment and retention issues that
are worsened by an aging workforce that is becoming
increasingly retirement-eligible.\2\
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\1\VA Fiscal Year 2019 Budget Submission, Volume II--Medical
Programs and Information Technology Programs, VHA-55.
\2\United States Cong. House Committee on Veterans' Affairs
Subcommittee on Health and Subcommittee on Economic Opportunity.
``Legislative Hearing.'' March 16, 2016. 114th Cong. 2nd sess.
Washington: GPO, 2016 (testimony of Max Stier, President and Chief
Executive Officer, Partnership for Public Service.)
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In recognition of this, Congress acted in section 301 of
the Veterans Access, Choice, and Accountability Act of 2014
(P.L. 113-146) to require the VA Inspector General (IG) to
identify and publish the five occupations of health care
providers with the largest staffing shortages across VHA and
authorize direct hiring authority to fill those shortages. The
resulting reports, which have been released annually since
2014, found a consistent need for physicians, nurses,
psychologists, physician assistants, medical technologists, and
physical therapists.\3\ Congress modified this reporting
requirement in section 201 of the VA Choice and Quality
Employment Act of 2017 (Public Law 115-46; 131 STAT. 958) to
require the IG to identify both clinical and non-clinical
occupations with the largest staffing shortages within each VA
medical center. This was intended to allow for the improved
identification of local staffing needs, which could vary
significantly, as well as the improved utilization of direct
hiring authority to address those needs. The modified report,
which was released for the first time in 2018, found that
physicians and nurses remained the top two most commonly cited
clinical shortage occupations and that HR professionals were
the most commonly cited non-clinical shortage occupation.\4\
The IG also found several challenges to improved recruitment
and retention across VHA, including a lack of qualified
applicants, non-competitive salaries, high turnover, and
geographic concerns such as urban areas with highly-competitive
labor markets and rural areas with serious labor market
shortages.\5\ These findings are substantively similar to
findings made in 2016 by the Commission on Care, which
concluded that:
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\3\VA Office of the Inspector General 18-01693-196, June 2018,
``OIG Determination of Veterans Health Administration's Occupational
Staffing Shortages,'' https://www.va.gov/oig/pubs/VAOIG-18-01693-
196.pdf.
\4\Ibid.
\5\Ibid.
VHA has staffing shortages and vacancies at every level
of the organization and across numerous critical
positions, including facility leadership, clinical
staff, supply chain personnel, and customer service
staff. VHA lacks competitive pay, must use inflexible
hiring processes, and continues to use a talent
management approach from the last century. A confusing
mix of personnel authorities and position standards
make staffing and management a struggle for both
supervisors and human resources personnel.\6\
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\6\Commission on Care, June 30, 2016, ``Commission on Care Final
Report,'' https://s3.amazonaws.com/sitesusa/wp-content/uploads/sites/
912/2016/07/Commission-on-Care_Final- Report_063016_FOR-WEB.pdf.
The Committee concurs with that assessment, as well as with
the Disabled American Veterans' comment in testimony regarding
this bill that, ``[while] VA acknowledges the need for
reforming its human capital management system . . . leadership
has not always provided strong guidance, oversight, or resource
support to carry out such reforms.''\7\ Given that, the
Committee has become increasingly concerned in recent years
that VHA HR professionals may not have the necessary
qualifications to adequately fulfill their obligations. This
concern has been compounded by several Committee investigations
which found VHA HR professionals with substandard educational
and professional backgrounds--including one HR Director at a VA
medical center who lacked both a college degree and relevant
work experience. Given the direct impact that staffing
shortages have on VHA's ability to ensure timely access to
quality care for veteran patients, the Committee believes that
improving VHA's HR functions should be a priority for the
Department. Accordingly, section 2 of the bill would require
VA, within 180 days of enactment, to establish qualification
standards and standardized performance metrics for HR positions
within VHA. To ensure transparency and to aid the Committee in
ongoing oversight of VA hiring, section 2 of the bill would
require VA to provide such standards and metrics to Congress
once they have been established and also require the Government
Accountability Office to assess their quality and
implementation and report to Congress with their findings.
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\7\United States Cong. House Committee on Veterans' Affairs
Subcommittee on Health. ``Legislative Hearing.'' June 13, 2018. 115th
Cong. 2nd sess. Washington: GPO, 2018 (testimony of Jeremy M.
Villanueva, Associate National Legislative Director, Disabled American
Veterans).
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HEARINGS
On June 13, 2018, the Subcommittee on Health conducted a
legislative hearing on a number of bills including H.R. 5864.
The following witnesses testified:
The Honorable Vicky Hartzler, U.S. House of
Representatives, 4th District, Missouri; The Honorable
Marcy Kaptur, U.S. House of Representatives, 9th
District, Ohio; The Honorable Matt Cartwright, U.S.
House of Representatives,17th District, Pennsylvania;
The Honorable Clay Higgins, U.S. House of
Representatives, 3rd District, Louisiana; The Honorable
Mike Bost, U.S. House of Representatives, 12th
District, Illinois; The Honorable Jeff Denham, U.S.
House of Representatives, 10th District, California;
The Honorable Jenniffer Gonzalez-Colon, U.S. House of
Representatives, Puerto Rico; The Honorable Brad
Wenstrup, U.S. House of Representatives, 2nd District,
Ohio; Roscoe Butler, Deputy Director for Health Care,
Veterans Affairs and Rehabilitation, The American
Legion; Jeremy Villanueva, Associate National
Legislative Director, Disabled American Veterans; Kayda
Keleher, Associate Director, National Legislative
Service, Veterans of Foreign Wars of the United States;
and Jessica Bonjorni MBA, PMP, SPHR, Acting Assistant
Deputy Under Secretary for Health for Workforce
Services, Veterans Health Administration, U.S.
Department of Veterans Affairs, who was accompanied by
Dayna Cooper MSN, RN, Director, Home and Community-
Based Programs, Veterans Health Administration, U.S.
Department of Veterans Affairs.
Statements for the record were submitted by:
American Orthotic and Prosthetic Association,
Paralyzed Veterans of America, and Military Officers
Association of America.
SUBCOMMITTEE CONSIDERATION
On June 27, 2018, the Subcommittee on Health met in open
markup session, a quorum being present, and favorably forwarded
H.R. 5864 to the full Committee.
COMMITTEE CONSIDERATION
On July 12, 2018, the full Committee met in open markup
session, a quorum being present, and ordered H.R. 5864 to be
reported favorably to the House of Representatives by voice
vote.
COMMITTEE VOTES
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, there were no recorded votes
taken on amendments or in connection with ordering H.R. 5864
reported to the House. A motion by Representative Tim Walz of
Minnesota--the Ranking Member of the Committee on Veterans'
Affairs--to report H.R. 5864 favorably to the House of
Representatives was adopted by voice vote.
COMMITTEE OVERSIGHT FINDINGS
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are to improve the HR functioning across
the VA healthcare system.
NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX EXPENDITURES
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee adopts as its
own the estimate of new budget authority, entitlement
authority, or tax expenditures or revenues contained in the
cost estimate prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
EARMARKS AND TAX AND TARIFF BENEFITS
H.R. 5864 does not contain any Congressional earmarks,
limited tax benefits, or limited tariff benefits as defined in
clause 9 of rule XXI of the Rules of the House of
Representatives.
COMMITTEE COST ESTIMATE
The Committee adopts as its own the cost estimate on H.R.
5864 prepared by the Director of the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act
of 1974.
CONGRESSIONAL BUDGET OFFICE COST ESTIMATE
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
for H.R. 5864 provided by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, July 18, 2018.
Hon. Phil Roe, M.D.,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 5864, the VA
Hospitals Establishing Leadership Performance Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Ann E.
Futrell.
Sincerely,
Mark P. Hadley
(For Keith Hall, Director).
Enclosure.
H.R. 5864--VA Hospitals Establishing Leadership Performance Act
Within 180 days of enactment, H.R. 5864 would require the
Department of Veterans Affairs (VA) to establish qualifications
and performance metrics for each human resource position with
the Veterans Health Administration. Within one year of
enactment, the bill also would require VA and the Government
Accountability Office to report to the Congress on the
qualifications and standardized performance metrics for those
positions. Based on the resources needed to address similar
requirements, CBO estimates that implementing this bill would
cost less than $500,000 over the 2019-2023 period; such
spending would be subject to the availability of appropriated
funds.
Enacting H.R. 5864 would not affect direct spending or
revenues; therefore, pay-as-you-go procedures do not apply.
CBO estimates that enacting H.R. 5864 would not increase
net direct spending or on-budget deficits in any of the four
consecutive 10-year periods beginning in 2029.
H.R. 5864 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act.
The CBO staff contact for this estimate is Ann E. Futrell.
The estimate was reviewed by Leo Lex, Deputy Assistant Director
for Budget Analysis.
FEDERAL MANDATES STATEMENT
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 5864 prepared by the Director of the
Congressional Budget Office pursuant to section 423 of the
Unfunded Mandates Reform Act.
ADVISORY COMMITTEE STATEMENT
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
5864.
STATEMENT OF CONSTITUTIONAL AUTHORITY
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 5864 is authorized by Congress' power to
``provide for the common Defense and general Welfare of the
United States.''
APPLICABILITY TO LEGISLATIVE BRANCH
The Committee finds that H.R. 5864 does not relate to the
terms and conditions of employment or access to public services
or accommodations within the meaning of section 102(b)(3) of
the Congressional Accountability Act.
STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS
Pursuant to clause 3(c)(5) of rule XIII of the Rules of the
House of Representatives, the Committee finds that no provision
of H.R. 5864 establishes or reauthorizes a program of the
Federal Government known to be duplicative of another Federal
program, a program that was included in any report from the
Government Accountability Office to Congress pursuant to
section 21 of Public Law 111-139, or a program related to a
program identified in the most recent Catalog of Federal
Domestic Assistance.
DISCLOSURE OF DIRECTED RULEMAKING
Pursuant to section 3(i) of H. Res. 5, 115th Cong. (2017),
the Committee estimates that H.R. 5864 contains no directed
rulemaking that would require the Secretary to prescribe
regulations.
SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION
Section 1. Short title
Section 1 of the bill would provide a short title of the
bill as the ``VA Hospitals Establishing Leadership Performance
(VA HELP) Act''.
Section 2. Qualifications for human resources positions within the
Veterans Health Administration of the Department of Veterans
Affairs
Section 2(a) of the bill would require VA, not later than
180 days after the date of enactment of this Act, to: establish
qualifications for each human resources position within the
Veterans Health Administration; establish standardized
performance metrics for each such position; and to submit to
Congress a report containing such qualifications and
standardized metrics.
Section 2(b) of the bill would require the Comptroller
General of the United States, not later than 180 days after the
establishment of the qualifications and performance metrics
under subsection (a), to submit to the Committee on Veterans'
Affairs of the House of Representatives and the Committee on
Veterans' Affairs of the Senate a report containing a
description of the implementation of such qualifications and
performance metrics and an assessment of the quality of such
qualifications and performance metrics.
CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED
If enacted, this bill would make no changes in existing
law.
[all]