Improving Confidence in Veterans’ Care Act

I 117TH CONGRESS 1ST SESSION H. R. 217 To amend title 38, United States Code, to direct the Secretary of Veterans Affairs to enforce the licensure requirement for medical providers of the Department of Veterans Affairs. IN THE HOUSE OF REPRESENTATIVES JANUARY 6, 2021 Mr. CLOUD (for himself, Mr. ALLEN, Mr. STEUBE, Mr. DAVIDSON, Mr. BERGMAN, Mr. PALMER, Mr. RUTHERFORD, and Mr. BAIRD) introduced the following bill; which was referred to the Committee on Veterans’ Af- fairs A BILL To amend title 38, United States Code, to direct the Sec- retary of Veterans Affairs to enforce the licensure re- quirement for medical providers of the Department of Veterans Affairs. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Improving Confidence 4 in Veterans’ Care Act’’. 5 VerDate Sep 11 2014 00:52 Feb 05, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H217.IH H217 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 217 IH SEC. 2. COMPLIANCE WITH REQUIREMENTS FOR EXAM- 1 INING QUALIFICATIONS AND CLINICAL ABILI- 2 TIES OF DEPARTMENT OF VETERANS AF- 3 FAIRS HEALTH CARE PROFESSIONALS. 4 (a) IN GENERAL.—Subchapter I of chapter 74 of title 5 38, United States Code, is amended by adding at the end 6 the following new section: 7 ‘‘§ 7414. Compliance with requirements for examining 8 qualifications and clinical abilities of 9 health care professionals 10 ‘‘(a) COMPLIANCE WITH CREDENTIALING REQUIRE- 11 MENTS.—The Secretary shall ensure that each medical 12 center of the Department, in a consistent manner— 13 ‘‘(1) compiles, verifies, and reviews documenta- 14 tion for each health care professional of the Depart- 15 ment at such medical center regarding, at a min- 16 imum— 17 ‘‘(A) the professional licensure, certifi- 18 cation, or registration of the health care profes- 19 sional; 20 ‘‘(B) whether the health care professional 21 holds a Drug Enforcement Administration reg- 22 istration; and 23 ‘‘(C) the education, training, experience, 24 malpractice history, and clinical competence of 25 the health care professional; and 26 VerDate Sep 11 2014 00:52 Feb 05, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H217.IH H217 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 217 IH ‘‘(2) continuously monitors any changes to the 1 matters under paragraph (1), including with respect 2 to suspensions, restrictions, limitations, probations, 3 denials, revocations, and other changes, relating to 4 the failure of a health care professional to meet gen- 5 erally accepted standards of clinical practice in a 6 manner that presents reasonable concern for the 7 safety of patients. 8 ‘‘(b) REGISTRATION REGARDING CONTROLLED SUB- 9 STANCES.—(1) Except as provided by paragraph (2), the 10 Secretary shall ensure that each covered health care pro- 11 fessional holds an active Drug Enforcement Administra- 12 tion registration. 13 ‘‘(2) The Secretary shall— 14 ‘‘(A) determine the circumstances in which a 15 medical center of the Department must obtain a 16 waiver under section 303 of the Controlled Sub- 17 stances Act (21 U.S.C. 823) with respect to covered 18 health care professionals; and 19 ‘‘(B) establish a process for medical centers to 20 request such waivers. 21 ‘‘(3) In carrying out paragraph (1), the Secretary 22 shall ensure that each medical center of the Department 23 monitors the Drug Enforcement Administration registra- 24 tions of covered health care professionals at such medical 25 VerDate Sep 11 2014 00:52 Feb 05, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H217.IH H217 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 217 IH center in a manner that ensures the medical center is 1 made aware of any change in status in the registration 2 by not later than 7 days after such change in status. 3 ‘‘(4) If a covered health care professional does not 4 hold an active Drug Enforcement Administration registra- 5 tion, the Secretary shall carry out any of the following ac- 6 tions, as the Secretary determines appropriate: 7 ‘‘(A) Obtain a waiver pursuant to paragraph 8 (2). 9 ‘‘(B) Transfer the health care professional to a 10 position that does not require prescribing, dis- 11 pensing, administering, or conducting research with 12 controlled substances. 13 ‘‘(C) Take adverse actions under subchapter V 14 of this chapter, with respect to an employee of the 15 Department, or terminate the services of a con- 16 tractor, with respect to a contractor of the Depart- 17 ment. 18 ‘‘(c) REVIEWS OF CONCERNS RELATING TO QUALITY 19 OF CLINICAL CARE.—(1) The Secretary shall ensure that 20 each medical center of the Department, in a consistent 21 manner, carries out— 22 ‘‘(A) ongoing, retrospective, and comprehensive moni- 23 toring of the performance and quality of the health care 24 delivered by each health care professional of the Depart- 25 VerDate Sep 11 2014 00:52 Feb 05, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H217.IH H217 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 217 IH ment located at the medical center, including with respect 1 to the safety of such care; and 2 ‘‘(B) timely and documented reviews of such care if 3 an individual notifies the Secretary of any potential con- 4 cerns relating to a failure of the health care professional 5 to meet generally accepted standards of clinical practice 6 in a manner that presents reasonable concern for the safe- 7 ty of patients. 8 ‘‘(2) The Secretary shall establish a policy to carry 9 out paragraph (1), including with respect to— 10 ‘‘(A) determining the period by which a medical 11 center of the Department must initiate the review of 12 a concern described in subparagraph (B) of such 13 paragraph following the date on which the concern 14 is received; and 15 ‘‘(B) ensuring the compliance of each medical 16 center with such policy. 17 ‘‘(d) COMPLIANCE WITH REQUIREMENTS FOR RE- 18 PORTING QUALITY OF CARE CONCERNS.—When the Sec- 19 retary substantiates a concern relating to the clinical com- 20 petency of, or quality of care delivered by, a health care 21 professional of the Department (including a former such 22 health care professional), the Secretary shall ensure that 23 the appropriate medical center of the Department timely 24 VerDate Sep 11 2014 00:52 Feb 05, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H217.IH H217 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 217 IH notifies the following entities of such concern, as appro- 1 priate: 2 ‘‘(1) The appropriate licensing, registration, or 3 certification body in each State in which the health 4 care professional is licensed, registered, or certified. 5 ‘‘(2) The Drug Enforcement Administration. 6 ‘‘(3) The National Practitioner Data Bank es- 7 tablished pursuant to the Health Care Quality Im- 8 provement Act of 1986 (42 U.S.C. 11101 et seq.). 9 ‘‘(4) Any other relevant entity. 10 ‘‘(e) PROHIBITION ON CERTAIN SETTLEMENT 11 AGREEMENT TERMS.—(1) Except as provided by para- 12 graph (2), the Secretary may not enter into a settlement 13 agreement relating to an adverse action against a health 14 care professional of the Department if such agreement in- 15 cludes terms that require the Secretary to conceal from 16 the personnel file of the employee a serious medical error 17 or lapse in clinical practice that constitutes a substantial 18 failure to meet generally accepted standards of clinical 19 practice as to raise reasonable concern for the safety of 20 patients. 21 ‘‘(2) Paragraph (1) does not apply to adverse actions 22 that the Special Counsel under section 1211 of title 5 de- 23 termines constitutes a prohibited personnel practice. 24 VerDate Sep 11 2014 00:52 Feb 05, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H217.IH H217 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 217 IH ‘‘(f) TRAINING.—Not less frequently than biannually, 1 the Secretary shall provide mandatory training to employ- 2 ees of each medical center of the Department who are re- 3 sponsible for any of the following activities: 4 ‘‘(1) Compiling, validating, or reviewing the cre- 5 dentials of health care professionals of the Depart- 6 ment. 7 ‘‘(2) Reviewing the quality of clinical care deliv- 8 ered by health care professionals of the Department. 9 ‘‘(3) Taking adverse privileging actions or mak- 10 ing determinations relating to other disciplinary ac- 11 tions or employment actions against health care pro- 12 fessionals of the Department for reasons relating to 13 the failure of a health care professional to meet gen- 14 erally accepted standards of clinical practice in a 15 manner that presents reasonable concern for the 16 safety of patients. 17 ‘‘(4) Making notifications under subsection (d). 18 ‘‘(g) DEFINITIONS.—In this section: 19 ‘‘(1) The term ‘controlled substance’ has the 20 meaning given that term in section 102 of the Con- 21 trolled Substances Act (21 U.S.C. 802). 22 ‘‘(2) The term ‘covered health care professional’ 23 means a person employed in a position as a health 24 care professional of the Department, or a contractor 25 VerDate Sep 11 2014 00:52 Feb 05, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H217.IH H217 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 217 IH of the Department, that requires the person to be 1 authorized to prescribe, dispense, administer, or con- 2 duct research with, controlled substances. 3 ‘‘(3) The term ‘Drug Enforcement Administra- 4 tion registration’ means registration with the Drug 5 Enforcement Administration under section 303 of 6 the Controlled Substances Act (21 U.S.C. 823) by 7 health care practitioners authorized to dispense, pre- 8 scribe, administer, or conduct research with, con- 9 trolled substances. 10 ‘‘(4) The term ‘health care professional of the 11 Department’ means the professionals described in 12 section 1730C(b) of this title, and includes a con- 13 tractor of the Department serving as such a profes- 14 sional.’’. 15 (b) CLERICAL AMENDMENT.—The table of sections 16 at the beginning of such chapter is amended by inserting 17 after the item relating to section 7413 the following new 18 item: 19 ‘‘7414. Compliance with requirements for examining qualifications and clinical abilities of health care professionals.’’. (c) DEADLINE FOR IMPLEMENTATION.—The Sec- 20 retary of Veterans Affairs shall commence the implemen- 21 tation of section 7414 of title 38, United States Code, as 22 added by subsection (a), by the following dates: 23 VerDate Sep 11 2014 00:52 Feb 05, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H217.IH H217 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 217 IH (1) With respect to subsections (a), (c)(2), (d), 1 and (f), not later than 180 days after the date of the 2 enactment of this Act. 3 (2) With respect to subsection (c)(1), not later 4 than 1 year after the date of the enactment of this 5 Act. 6 (3) With respect to subsection (b)(2), not later 7 than 18 months after the date of the enactment of 8 this Act. 9 (d) AUDITS AND REPORTS.— 10 (1) AUDITS.—The Secretary of Veterans Af- 11 fairs shall carry out annual audits of the compliance 12 of medical centers of the Department of Veterans 13 Affairs with the matters required by section 7414 of 14 title 38, United States Code, as added by subsection 15 (a). In carrying out such audits, the Secretary— 16 (A) may not authorize the medical center 17 being audited to conduct the audit; and 18 (B) may enter into an agreement with an- 19 other department or agency of the Federal Gov- 20 ernment or a nongovernmental entity to con- 21 duct such audits. 22 (2) REPORTS.—Not later than 1 year after the 23 date of the enactment of this Act, and annually 24 thereafter for 5 years, the Secretary of Veterans Af- 25 VerDate Sep 11 2014 00:52 Feb 05, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H217.IH H217 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 217 IH fairs shall submit to the Committees on Veterans’ 1 Affairs of the House of Representatives and the Sen- 2 ate a report on the audits conducted under para- 3 graph (1). Each such report shall include a sum- 4 mary of the compliance by each medical center with 5 the matters required by such section 7414. 6 (3) INITIAL REPORT.—The Secretary shall in- 7 clude in the first report submitted under paragraph 8 (2) the following: 9 (A) A description of the progress made by 10 the Secretary in implementing such section 11 7414, including any matters under such section 12 that the Secretary has not fully implemented. 13 (B) An analysis of the feasibility, advis- 14 ability, and cost of requiring credentialing em- 15 ployees of the Department to be trained by an 16 outside entity and to maintain a credentialing 17 certification. 18 Æ VerDate Sep 11 2014 00:52 Feb 05, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\H217.IH H217 kjohnson on DSK79L0C42PROD with BILLS