II Calendar No. 537 116TH CONGRESS 2D SESSION S. 629 To require the Secretary of Veterans Affairs to review the processes and requirements of the Department of Veterans Affairs for scheduling ap- pointments for health care and conducting consultations under the laws administered by the Secretary, and for other purposes. IN THE SENATE OF THE UNITED STATES FEBRUARY 28, 2019 Mr. TESTER (for himself, Mrs. MURRAY, Mr. BLUMENTHAL, Mr. BROWN, and Ms. DUCKWORTH) introduced the following bill; which was read twice and referred to the Committee on Veterans’ Affairs SEPTEMBER 15, 2020 Reported 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 Vet- erans Affairs for scheduling appointments for health care and conducting consultations under the laws adminis- tered by the Secretary, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 00:32 Sep 16, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S629.RS S629 kjohnson on DSK79L0C42PROD with BILLS 2 •S 629 RS SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Accountability in De- 2 partment of Veterans Affairs Scheduling and Consult 3 Management Act’’. 4 SEC. 2. PROCESSES AND REQUIREMENTS FOR SCHED- 5 ULING APPOINTMENTS FOR HEALTH CARE 6 FROM DEPARTMENT OF VETERANS AFFAIRS. 7 (a) PROCESSES AND REQUIREMENTS.— 8 (1) IN GENERAL.—Not later than 60 days after 9 the date of the enactment of this Act, the Secretary 10 of Veterans Affairs shall submit to the Committee 11 on Veterans’ Affairs of the Senate and the Com- 12 mittee on Veterans’ Affairs of the House of Rep- 13 resentatives a description of the processes and re- 14 quirements of the Department of Veterans Affairs 15 for scheduling appointments for health care from the 16 Department at the medical facility level. 17 (2) PERIODIC REVISION.— 18 (A) IN GENERAL.—The Secretary may re- 19 vise the processes and requirements required 20 under paragraph (1) as the Secretary considers 21 necessary. 22 (B) SUBMITTAL TO CONGRESS.—Not later 23 than 30 days before revising the processes and 24 requirements under subparagraph (A), the Sec- 25 retary shall submit to the Committee on Vet- 26 VerDate Sep 11 2014 00:32 Sep 16, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6401 E:\BILLS\S629.RS S629 kjohnson on DSK79L0C42PROD with BILLS 3 •S 629 RS erans’ Affairs of the Senate and the Committee 1 on Veterans’ Affairs of the House of Represent- 2 ative a description of those revised processes 3 and requirements, including a description of 4 any modifications to the certification and train- 5 ing under subsection (b). 6 (b) TRAINING ON PROCESSES AND REQUIRE- 7 MENTS.— 8 (1) CERTIFICATION.—Not later than one year 9 after the date of the enactment of this Act, the Sec- 10 retary shall require individuals involved in the sched- 11 uling of appointments for health care from the De- 12 partment to certify to the Secretary that the indi- 13 vidual understands the processes and requirements 14 described in subsection (a), including the maximum 15 number of days allowed to complete each step of the 16 scheduling process. 17 (2) NEW EMPLOYEES.—The Secretary shall re- 18 quire all employees hired by the Department after 19 the date of the enactment of this Act who are to be 20 involved in the scheduling of appointments for health 21 care from the Department to undergo training on 22 the processes and requirements described in sub- 23 section (a) as part of the onboarding process. 24 (c) METHOD TO MONITOR COMPLIANCE.— 25 VerDate Sep 11 2014 00:32 Sep 16, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6401 E:\BILLS\S629.RS S629 kjohnson on DSK79L0C42PROD with BILLS 4 •S 629 RS (1) IN GENERAL.—Not later than 180 days 1 after the date of the enactment of this Act, the Sec- 2 retary shall establish or maintain a method or tool 3 to enable real-time monitoring of and ensure that 4 each medical facility of the Department complies 5 with the scheduling processes and requirements de- 6 scribed in subsection (a), including compliance with 7 policies of the Department relating to the maximum 8 number of days allowed to complete each step of the 9 scheduling process. 10 (2) USE THROUGHOUT DEPARTMENT.— 11 (A) IN GENERAL.—The Secretary shall re- 12 quire each medical facility of the Department to 13 use the method or tool described in paragraph 14 (1). 15 (B) CERTIFICATION.—Not later than one 16 year after the date of the enactment of this Act, 17 the Secretary shall require the director of each 18 medical facility of the Department to certify to 19 the Secretary that the director is using the 20 method or tool described in paragraph (1). 21 (d) COMPTROLLER GENERAL REPORT.—Not later 22 than two years after the date of the enactment of this Act, 23 the Comptroller General of the United States shall submit 24 to the Committee on Veterans’ Affairs of the Senate and 25 VerDate Sep 11 2014 00:32 Sep 16, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6401 E:\BILLS\S629.RS S629 kjohnson on DSK79L0C42PROD with BILLS 5 •S 629 RS the Committee on Veterans’ Affairs of the House of Rep- 1 resentatives a report on the compliance of the Secretary 2 with the requirements of this section. 3 SEC. 3. AUDITS REGARDING SCHEDULING OF APPOINT- 4 MENTS AND MANAGEMENT OF CONSULTA- 5 TIONS FOR HEALTH CARE FROM DEPART- 6 MENT OF VETERANS AFFAIRS. 7 (a) IN GENERAL.—Not later than one year after the 8 date of the enactment of this Act, and not less frequently 9 than annually thereafter, the Secretary of Veterans Af- 10 fairs shall provide for the conduct of facility-level audits 11 of the scheduling of appointments and the management 12 of consultations for health care under the laws adminis- 13 tered by the Secretary. 14 (b) ELEMENTS.—Each audit conducted under sub- 15 section (a) shall include the following: 16 (1) With respect to each medical center of the 17 Department of Veterans Affairs, an assessment of 18 any scheduling or consultation management issues 19 at that medical center, including the following: 20 (A) An assessment of non-compliance with 21 policies of the Veterans Health Administration 22 relating to scheduling appointments and man- 23 aging consultations. 24 VerDate Sep 11 2014 00:32 Sep 16, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6401 E:\BILLS\S629.RS S629 kjohnson on DSK79L0C42PROD with BILLS 6 •S 629 RS (B) An assessment of the extent to which 1 appointments or consultations are not timely 2 processed. 3 (C) A description of any backlogs in ap- 4 pointments or consultations that are awaiting 5 action. 6 (D) An assessment of whether consulta- 7 tions are appropriately processed. 8 (E) Data with respect to consultations as 9 follows: 10 (i) Consultations that were scheduled 11 within the request window. 12 (ii) Duplicate consultation requests. 13 (iii) Consultations that were discon- 14 tinued. 15 (iv) Delays in consultations. 16 (v) Consultations that were not prop- 17 erly closed or discontinued, including a de- 18 scription of remediation attempts. 19 (F) A review for accuracy with respect to 20 consultation management as follows: 21 (i) A review of the accuracy of the 22 type of service, either administrative or 23 clinical, that is inputted in the electronic 24 health record. 25 VerDate Sep 11 2014 00:32 Sep 16, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6401 E:\BILLS\S629.RS S629 kjohnson on DSK79L0C42PROD with BILLS 7 •S 629 RS (ii) A review of the accuracy of the 1 type of consultation setting, either impa- 2 tient or outpatient, that is inputted in the 3 electronic health record. 4 (iii) A review of the appropriateness 5 of the level of urgency of the consultation 6 that is inputted in the electronic health 7 record. 8 (iv) A review of any delayed or unre- 9 solved consultations. 10 (2) An identification of such recommendations 11 for corrective action as the Secretary considers nec- 12 essary, including additional training, increased per- 13 sonnel, and other resources. 14 (3) A certification that the director of each 15 medical center of the Department is in compliance 16 with the processes and requirements described in 17 section 2(a) and such other requirements relating to 18 the scheduling of appointments and management of 19 consultations as the Secretary considers appropriate. 20 (4) With respect to referrals for health care be- 21 tween health care providers or facilities of the De- 22 partment, a measurement of, for each medical facil- 23 ity of the Department, the time it takes from the 24 date that a clinician of the Department determines 25 VerDate Sep 11 2014 00:32 Sep 16, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6401 E:\BILLS\S629.RS S629 kjohnson on DSK79L0C42PROD with BILLS 8 •S 629 RS that a veteran requires care from another health 1 care provider or facility to each of the following: 2 (A) The date that the referral for care is 3 sent to the other health care provider or facil- 4 ity. 5 (B) The date that the other health care 6 provider or facility accepts the referral. 7 (C) The date that the appointment with 8 the other health care provider or at the other 9 facility is made. 10 (D) The date of the appointment with the 11 other health care provider or at the other facil- 12 ity. 13 (E) Any other step that the Secretary de- 14 termines necessary to measure. 15 (c) CONDUCT OF AUDIT BY THIRD PARTY.—Each 16 audit conducted under subsection (a) with respect to a 17 medical facility of the Department shall be conducted by 18 an individual or entity that is not affiliated with the facil- 19 ity. 20 (d) TRANSMITTAL TO VHA.—Each audit conducted 21 under subsection (a) shall be transmitted to the Under 22 Secretary for Health of the Department so that the Under 23 Secretary can— 24 VerDate Sep 11 2014 00:32 Sep 16, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6401 E:\BILLS\S629.RS S629 kjohnson on DSK79L0C42PROD with BILLS 9 •S 629 RS (1) strengthen oversight of the scheduling of 1 appointments and management of consultations 2 throughout the Department; 3 (2) monitor national policy on such scheduling 4 and management; 5 (3) determine if a mobile deployment team fur- 6 nished under the pilot program established under 7 section 402 of the VA MISSION Act of 2018 (Pub- 8 lic Law 115–182) is warranted; and 9 (4) develop a remediation plan to address issues 10 uncovered by those audits. 11 (e) ANNUAL REPORT.— 12 (1) IN GENERAL.—Not later than December 31 13 of each year, the Secretary shall submit to the Com- 14 mittee on Veterans’ Affairs of the Senate and the 15 Committee on Veterans’ Affairs of the House of 16 Representatives a report on the audits conducted 17 under subsection (a) during the year ending on that 18 date. 19 (2) ELEMENTS.—The Secretary shall include in 20 each report required by paragraph (1)— 21 (A) a description of the audits conducted 22 under subsection (a) with respect to each facil- 23 ity of the Department; 24 VerDate Sep 11 2014 00:32 Sep 16, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6401 E:\BILLS\S629.RS S629 kjohnson on DSK79L0C42PROD with BILLS 10 •S 629 RS (B) an assessment of how the Department 1 strengthened oversight of the scheduling of ap- 2 pointments and management of consultations at 3 that facility as a result of those audits; 4 (C) an assessment of how those audits in- 5 formed the national policy of the Department 6 with respect to the scheduling of appointments 7 and management of consultations; and 8 (D) a description of any remediation plans 9 to address issues raised by those audits that 10 were completed. 11 SEC. 4. ADMINISTRATION OF NON-DEPARTMENT OF VET- 12 ERANS AFFAIRS HEALTH CARE. 13 (a) CERTIFICATION OF PROPER ADMINISTRATION.— 14 (1) REVIEW.— 15 (A) IN GENERAL.—The Secretary of Vet- 16 erans Affairs shall conduct a review of the 17 staffing, training, and other requirements nec- 18 essary to administer section 101 of the Vet- 19 erans Access, Choice, and Accountability Act of 20 2014 (Public Law 113–146; 38 U.S.C. 1701 21 note), section 1703 of title 38, United States 22 Code (as in effect on the date specified in sec- 23 tion 101(b) of the Caring for Our Veterans Act 24 of 2018 (title I of Public Law 115–182)), and 25 VerDate Sep 11 2014 00:32 Sep 16, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6401 E:\BILLS\S629.RS S629 kjohnson on DSK79L0C42PROD with BILLS 11 •S 629 RS any other community care program of the De- 1 partment of Veterans Affairs. 2 (B) ELEMENTS.—The review conducted 3 under paragraph (1) shall include, with respect 4 to each medical facility of the Department— 5 (i) an assessment of the type of posi- 6 tions required to be staffed at the medical 7 facility; 8 (ii) the number of such positions au- 9 thorized; 10 (iii) the number of such positions 11 filled; and 12 (iv) the number of additional such po- 13 sitions required to be authorized. 14 (2) CERTIFICATION.—Not later than 180 days 15 after the date of the enactment of this Act, and 16 every 180 days thereafter, the Secretary of Veterans 17 Affairs shall submit to the Committee on Veterans’ 18 Affairs of the Senate and the Committee on Vet- 19 erans’ Affairs of the House of Representatives the 20 results of the review conducted under paragraph (1), 21 including a certification that all staffing, training, 22 and other requirements described in paragraph 23 (1)(A) are fulfilled. 24 (b) SCHEDULING OF APPOINTMENTS.— 25 VerDate Sep 11 2014 00:32 Sep 16, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6401 E:\BILLS\S629.RS S629 kjohnson on DSK79L0C42PROD with BILLS 12 •S 629 RS (1) IN GENERAL.—The Secretary shall be re- 1 sponsible for ensuring that appointments for health 2 care from non-Department health care providers 3 under the laws administered by the Secretary are 4 scheduled. 5 (2) TIMELINESS GOALS.—Not later than 30 6 days after the date of the enactment of this Act, the 7 Secretary shall establish timeliness goals for each 8 step in scheduling an appointment for health care 9 from a non-Department health care provider set 10 forth under subparagraphs (A) through (F) of para- 11 graph (3). 12 (3) MEASUREMENT OF TIMELINESS FOR EACH 13 FACILITY.—Not later than 120 days after the date 14 of the enactment of this Act, the Secretary shall 15 measure, for each medical facility of the Depart- 16 ment, the time it takes from the date that a clinician 17 of the Department determines that a veteran re- 18 quires care from a non-Department health care pro- 19 vider to each of the following: 20 (A) The date that the referral for care is 21 sent to the non-D [Text truncated for display. 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