S 629 — Accountability in Department of Veterans Affairs Scheduling and Consult Management Act

629 IntroducedReported in Senate (IS)](RS)] <DOC> 116thCalendar CONGRESSNo. 1st Session S.

537 116th CONGRESS 2d Session S.

Blumenthal, and Mr.

Brown)Brown, introducedand theMs. following bill;

whichDuckworth) wasintroduced read twice and referred to the Committeefollowing onbill; 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.

Bewhich itwas enactedread bytwice the Senate and Housereferred ofto Representatives of the UnitedCommittee Stateson ofVeterans' AmericaAffairs inSeptember Congress15, assembled,2020 SECTIONReported 1.by Mr.

Moran, with an amendment [Strike out all after the enacting clause and insert the part printed in italic] _______________________________________________________________________ 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, <DELETED>SECTION 1.

SHORT TITLE.</DELETED> <DELETED> This Act may be cited as the ``Accountability in Department of Veterans Affairs Scheduling and Consult Management Act''.</DELETED> <DELETED>SEC.

2.

PROCESSES AND REQUIREMENTS FOR SCHEDULING APPOINTMENTS FOR HEALTH CARE FROM DEPARTMENT OF VETERANS AFFAIRS.</DELETED> <DELETED> (a) Processes and Requirements.--</DELETED> <DELETED> (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.</DELETED> <DELETED> (2) Periodic revision.--</DELETED> <DELETED> (A) In general.--The Secretary may revise the processes and requirements required under paragraph (1) as the Secretary considers necessary.</DELETED> <DELETED> (B) Submittal to congress.--Not later than 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).</DELETED> <DELETED> (b) Training on Processes and Requirements.--</DELETED> <DELETED> (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.</DELETED> <DELETED> (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.</DELETED> <DELETED> (c) Method To Monitor Compliance.--</DELETED> <DELETED> (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.</DELETED> <DELETED> (2) Use throughout department.--</DELETED> <DELETED> (A) In general.--The Secretary shall require each medical facility of the Department to use the method or tool described in paragraph (1).</DELETED> <DELETED> (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).</DELETED> <DELETED> (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.</DELETED> <DELETED>SEC.

3.

AUDITS REGARDING SCHEDULING OF APPOINTMENTS AND MANAGEMENT OF CONSULTATIONS FOR HEALTH CARE FROM DEPARTMENT OF VETERANS AFFAIRS.</DELETED> <DELETED> (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.</DELETED> <DELETED> (b) Elements.--Each audit conducted under subsection (a) shall include the following:</DELETED> <DELETED> (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:</DELETED> <DELETED> (A) An assessment of non-compliance with policies of the Veterans Health Administration relating to scheduling appointments and managing consultations.</DELETED> <DELETED> (B) An assessment of the extent to which appointments or consultations are not timely processed.</DELETED> <DELETED> (C) A description of any backlogs in appointments or consultations that are awaiting action.</DELETED> <DELETED> (D) An assessment of whether consultations are appropriately processed.</DELETED> <DELETED> (E) Data with respect to consultations as follows:</DELETED> <DELETED> (i) Consultations that were scheduled within the request window.</DELETED> <DELETED> (ii) Duplicate consultation requests.</DELETED> <DELETED> (iii) Consultations that were discontinued.</DELETED> <DELETED> (iv) Delays in consultations.</DELETED> <DELETED> (v) Consultations that were not properly closed or discontinued, including a description of remediation attempts.</DELETED> <DELETED> (F) A review for accuracy with respect to consultation management as follows:</DELETED> <DELETED> (i) A review of the accuracy of the type of service, either administrative or clinical, that is inputted in the electronic health record.</DELETED> <DELETED> (ii) A review of the accuracy of the type of consultation setting, either impatient or outpatient, that is inputted in the electronic health record.</DELETED> <DELETED> (iii) A review of the appropriateness of the level of urgency of the consultation that is inputted in the electronic health record.</DELETED> <DELETED> (iv) A review of any delayed or unresolved consultations.</DELETED> <DELETED> (2) An identification of such recommendations for corrective action as the Secretary considers necessary, including additional training, increased personnel, and other resources.</DELETED> <DELETED> (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.</DELETED> <DELETED> (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:</DELETED> <DELETED> (A) The date that the referral for care is sent to the other health care provider or facility.</DELETED> <DELETED> (B) The date that the other health care provider or facility accepts the referral.</DELETED> <DELETED> (C) The date that the appointment with the other health care provider or at the other facility is made.</DELETED> <DELETED> (D) The date of the appointment with the other health care provider or at the other facility.</DELETED> <DELETED> (E) Any other step that the Secretary determines necessary to measure.</DELETED> <DELETED> (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.</DELETED> <DELETED> (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--</DELETED> <DELETED> (1) strengthen oversight of the scheduling of appointments and management of consultations throughout the Department;</DELETED> <DELETED> (2) monitor national policy on such scheduling and management;</DELETED> <DELETED> (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</DELETED> <DELETED> (4) develop a remediation plan to address issues uncovered by those audits.</DELETED> <DELETED> (e) Annual Report.--</DELETED> <DELETED> (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.</DELETED> <DELETED> (2) Elements.--The Secretary shall include in each report required by paragraph (1)--</DELETED> <DELETED> (A) a description of the audits conducted under subsection (a) with respect to each facility of the Department;</DELETED> <DELETED> (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;</DELETED> <DELETED> (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</DELETED> <DELETED> (D) a description of any remediation plans to address issues raised by those audits that were completed.</DELETED> <DELETED>SEC.

4.

ADMINISTRATION OF NON-DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE.</DELETED> <DELETED> (a) Certification of Proper Administration.--</DELETED> <DELETED> (1) Review.--</DELETED> <DELETED> (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 (title I of Public Law 115-182)), and any other community care program of the Department of Veterans Affairs.</DELETED> <DELETED> (B) Elements.--The review conducted under paragraph (1) shall include, with respect to each medical facility of the Department--</DELETED> <DELETED> (i) an assessment of the type of positions required to be staffed at the medical facility;</DELETED> <DELETED> (ii) the number of such positions authorized;</DELETED> <DELETED> (iii) the number of such positions filled;

and</DELETED> <DELETED> (iv) the number of additional such positions required to be authorized.</DELETED> <DELETED> (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.</DELETED> <DELETED> (b) Scheduling of Appointments.--</DELETED> <DELETED> (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.</DELETED> <DELETED> (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).</DELETED> <DELETED> (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:</DELETED> <DELETED> (A) The date that the referral for care is sent to the non-Department health care provider.</DELETED> <DELETED> (B) The date that the non-Department health care provider accepts the referral.</DELETED> <DELETED> (C) The date that the appointment with the non-Department health care provider is made.</DELETED> <DELETED> (D) The date that the appointment with the non-Department health care provider occurs.</DELETED> <DELETED> (E) The date that the referral to the non- Department health care provider is completed.</DELETED> <DELETED> (F) Any other step that the Secretary determines necessary to measure.</DELETED> <DELETED> (4) Publication of data.--</DELETED> <DELETED> (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.</DELETED> <DELETED> (B) Update.--Not less frequently than biweekly, the Secretary shall update the data published under subparagraph (A).</DELETED> <DELETED> (c) Comptroller General Report.--</DELETED> <DELETED> (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).</DELETED> <DELETED> (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).</DELETED> <DELETED>SEC.

5.

REQUESTS FOR MOBILE DEPLOYMENT TEAMS BY DIRECTORS OF MEDICAL CENTERS OF DEPARTMENT OF VETERANS AFFAIRS.</DELETED> <DELETED> (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.</DELETED> <DELETED> (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.</DELETED> <DELETED> (c) Appropriate Committees of Congress Defined.--In this section, the term ``appropriate committees of Congress'' means-- </DELETED> <DELETED> (1) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate;

and</DELETED> <DELETED> (2) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives.</DELETED> <DELETED>SEC.

6.

EXAMINATION OF HEALTH CARE CONSULTATION AND SCHEDULING POSITIONS OF DEPARTMENT OF VETERANS AFFAIRS.</DELETED> <DELETED> (a) Proper Grading of Consultation and Scheduling Positions.--</DELETED> <DELETED> (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.</DELETED> <DELETED> (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.</DELETED> <DELETED> (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).</DELETED> <DELETED> (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--</DELETED> <DELETED> (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</DELETED> <DELETED> (2) a description of any changes that the Secretary has made or plans to make to improve that process.</DELETED> <DELETED> (c) Appropriate Committees of Congress Defined.--In this section, the term ``appropriate committees of Congress'' means-- </DELETED> <DELETED> (1) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate;

and</DELETED> <DELETED> (2) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives.</DELETED> SECTION 1.

PROCESSESPROCESS AND REQUIREMENTS FOR SCHEDULING APPOINTMENTS FOR HEALTH CARE FROM DEPARTMENT OF VETERANS AFFAIRS.

(a) ProcessesProcess and Requirements.-- (1) In general.--Not later than 60 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shallshall-- submit(A) toestablish the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a descriptionprocess of the processes and requirements of the Department of Veterans Affairs for scheduling appointments for health care from the Department atof theVeterans medicalAffairs; facility level.

(2)and Periodic(B) revision.--submit (A)to Inthe general.--TheCommittee Secretaryon mayVeterans' reviseAffairs of the processesSenate and requirementsthe requiredCommittee underon paragraphVeterans' (1)Affairs asof the SecretaryHouse considersof necessary.Representatives a description of such process and requirements.

(B)(2) SubmittalElements toof congress.--Notdescription.--The laterdescription thanof 30 days before revising the processesprocess and requirements underfor subparagraphscheduling (A),appointments thefor Secretaryhealth shallcare submitfrom to the CommitteeDepartment onrequired Veterans'to Affairsbe ofsubmitted theunder Senateparagraph and(1)(B) theshall Committeeinclude-- on(A) Veterans'information Affairson ofhow thesuch Houseprocess ofand Representativerequirements atake descriptioninto ofaccount thosethe revisedaccess processesstandards andestablished requirements,under includingsection a1703B description of anytitle modifications38, toUnited theStates certificationCode; and training under subsection (b).

(b) Training on Processes and Requirements.--(B) (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 thesuch scheduling process.

(2)(3) NewPeriodic employees.--Therevision.-- Secretary(A) shallIn requiregeneral.--The allSecretary employeesmay hiredrevise by the Departmentprocess 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 describedrequired inunder subsectionparagraph (a)(1) as part of the onboardingSecretary process.considers necessary.

(c)(B) MethodSubmittal Toto Monitorcongress.--Not Compliance.-- (1) In general.--Not later than 18030 days afterbefore revising the dateprocess ofand therequirements enactmentunder ofsubparagraph this(A), Act, the Secretary shall establishsubmit orto maintainthe aCommittee methodon orVeterans' toolAffairs toof enablethe real-timeSenate monitoring of and ensurethe thatCommittee eachon medicalVeterans' facilityAffairs of the DepartmentHouse compliesof withRepresentatives thea schedulingdescription processesof andsuch requirementsrevised describedprocess inand subsectionrequirements, (a), including compliancea withdescription policies of theany Departmentmodifications relating to the maximumcertification numberand oftraining daysunder allowedsubsection to(b). complete each step of the scheduling process.

(b) Certification and Training on Process 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, including schedulers, clinical coordinators, and supervisors, to certify to the Secretary that the individual understands the process and requirements established under subsection (a), including the maximum number of days allowed to complete each step of such process.

(2) New employees.--The Secretary shall require all employees hired by the Department on or 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-- (A) to undergo training on the process and requirements established under subsection (a) as part of training for the position for which they have been hired;

and (B) to make the certification to the Secretary required under paragraph (1).

(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-- (A) to enable monitoring of the compliance of the Department with the process and requirements established under subsection (a), including compliance with policies of the Department relating to the maximum number of days allowed to complete each step of such process;

and (B) to ensure that each medical facility of the Department complies with such process and requirements.

(B) Certification.--NotReport.--Not later than one year after the date of the enactment of this Act, the Secretary shall requiresubmit to the directorCommittee on Veterans' Affairs of eachthe medicalSenate facilityand the Committee on Veterans' Affairs of the DepartmentHouse toof certifyRepresentatives toa thereport Secretaryindicating thatwhether each medical facility of the directorDepartment is using the method or tool described in paragraph (1).