Veterans Health Administration Management Improvement Act - Directs the Comptroller General (GAO) to: (1) conduct a five-year management review of the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA); and (2) submit annual reports to Congress on the matters reviewed, including recommendations for improving the VHA's management.
Directs the Secretary of the VA to establish a five-year pilot program to improve the VHA's management and accountability that:
Requires the Secretary, during such pilot program, to: (1) establish an annual performance plan that uses logic modeling and risk assessment to coordinate the VA's operations with its goals; and (2) prepare an annual organization evaluation plan for the VHA that is informed by the GAO's recommendations.
Establishes an Office of the Management and Accountability Ombudsman within the VA to:
Directs the GAO to review each budget the President submits to Congress during 2015-2020 to evaluate the proposed budget for VA health care.
Establishes a Veterans' Bill of Rights regarding health care, which is to be prominently displayed in each VA medical facility and about which the Secretary shall conduct outreach to veterans and ensure that VA employees receive training.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5618 Introduced in House (IH)]
113th CONGRESS
2d Session
H. R. 5618
To establish a pilot program to improve the management and
accountability within the Veterans Health Administration of the
Department of Veterans Affairs, to provide oversight of the Veterans
Health Administration, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 18, 2014
Mr. Kilmer (for himself, Mr. Cuellar, Mr. Carney, Mr. Barber, and Mr.
Gallego) introduced the following bill; which was referred to the
Committee on Veterans' Affairs, and in addition to the Committee on the
Budget, for a period to be subsequently determined by the Speaker, in
each case for consideration of such provisions as fall within the
jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To establish a pilot program to improve the management and
accountability within the Veterans Health Administration of the
Department of Veterans Affairs, to provide oversight of the Veterans
Health Administration, and for other purposes.
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 ``Veterans Health Administration
Management Improvement Act''.
SEC. 2. COMPTROLLER GENERAL MANAGEMENT REVIEW OF VETERANS HEALTH
ADMINISTRATION.
(a) Management Review.--
(1) In general.--During the five-year period beginning on
the date of the enactment of this Act, the Comptroller General
of the United States shall conduct a management review of the
Veterans Health Administration of the Department of Veterans
Affairs.
(2) Matters included.--The management review under
paragraph (1) shall include a review, with respect to the
Veterans Health Administration, of the following:
(A) The management structure, including the roles
and responsibilities among the various organizational
components (local facilities, regional networks, and
the central office).
(B) The oversight of core functions, including the
extent to which lines of accountability are clearly
delineated.
(C) The evaluation plan, operations, and capacity
to implement results-based strategic planning.
(D) The extent to which contractors are used and
monitored to support core management functions.
(E) Internal communication mechanisms, including
expectations for communications, that support the
mission.
(F) The setting of priorities and the monitoring of
such priorities.
(G) Budgeting and resource allocation processes.
(H) Workforce planning.
(I) Human capital processes, including training
activities, to ensure timely hiring and effective
retention of a qualified workforce.
(J) Information technology to support core
functions and activities.
(K) How each of the matters described in
subparagraphs (A) through (J) may differ for rural
medical facilities of the Department of Veterans
Affairs.
(L) Incentives, including any perverse incentives,
affecting employee actions, quality of care, and the
provision of services.
(M) Insights from employees and employee
representatives about the work environment and the
level of engagement of such employees as can be derived
from the results of the annual Federal employee survey
and other internal surveys administered by the
Secretary of Veterans Affairs.
(N) Insights on the findings of the Comptroller
General from veteran service organizations,
organizations representing employees of the Veterans
Health Administration, other stakeholders, and the
Management and Accountability Ombudsman described in
section 312B of title 38, United States Code, as added
by section 4.
(b) Reports.--Not later than one year after the date of the
enactment of this Act, and annually thereafter for a four-year period,
the Comptroller General shall submit to Congress one or more reports
that include--
(1) the matters reviewed under subsection (a)(1); and
(2) recommendations of the Comptroller General based on
such matters.
SEC. 3. PILOT PROGRAM TO IMPROVE MANAGEMENT AND ACCOUNTABILITY OF
VETERANS HEALTH ADMINISTRATION.
(a) Establishment.--The Secretary of Veterans Affairs shall
establish a pilot program to improve the management and accountability
within the Veterans Health Administration.
(b) Goals of Pilot Program.--The Secretary shall carry out the
pilot program under subsection (a) in a manner that ensures that--
(1) the employees of the Veterans Health Administration
have an opportunity to learn, implement, and identify
successful means of advancing the management of the Veterans
Health Administration and the delivery of care and services;
and
(2) the management and delivery of care and services at
medical facilities of the Department is improved by
implementing the recommendations of the Comptroller General of
the United States based on the management review conducted
under section 2, and any other appropriate recommendations,
with respect to the planning and evaluation capabilities of the
Veteran Health Administration.
(c) Application of Certain Laws During Pilot Program.--
(1) Application of performance plan requirements.--During
the period in which the Secretary carries out the pilot program
under subsection (a), the Secretary shall carry out section
1115(b) of title 31, United States Code, as follows:
(A) In paragraph (2), by substituting ``, unless
authorized to be in an alternative form under
subsection (c), and situate each goal in the context of
its own logic modeling of how the operations and
activities of the agency, in coordination with any
significant operations and activities from external
entities, will contribute toward achieving the goals
and responsibilities of the agency;'' for ``unless
authorized to be in an alternative form under
subsection (c);''.
(B) By including in the agency performance plan
described in such section 1115(b), for each performance
goal covered by the plan, an identification and
assessment of the risks of creating new, or
perpetuating existing, perverse incentives, and
strategies for risk assessment, monitoring, and
mitigation, using a suitable risk management approach.
(2) Application of performance reporting requirements.--
During the period in which the Secretary carries out the pilot
program under subsection (a), the Secretary shall carry out
subsection (c) of section 1116 of title 31, United States Code,
by including in the update required by such subsection
statistical information regarding the Veterans Health
Administration that--
(A) is useful to multiple stakeholders for internal
management and external oversight; and
(B) provides insight into how programs are planned,
financed, and managed, regarding--
(i) the population of veterans, important
subgroups thereof, and the status of such
veterans;
(ii) the capacity of the operations of the
Veterans Health Administration under enacted
resource levels, listed by important
subcategories as appropriate; and
(iii) the workload of the Veterans Health
Administration, listed by important
subcategories as appropriate.
(3) Application of functions of chief operating officer.--
During the period in which the Secretary carries out the pilot
program under subsection (a), the Secretary shall carry out
section 1123(b)(1) of title 31, United States Code, by
substituting ``strategic and performance planning, measurement,
evaluation, analysis, regular assessment of progress, risk
management (including the risks of perverse incentives), and
use of performance information to improve the results
achieved'' for ``strategic and performance planning,
measurement, analysis, regular assessment of progress, and use
of performance information to improve the results achieved''.
(d) Evaluation Plan.--The Secretary shall prepare an annual
organization evaluation plan for the Veterans Health Administration
that is informed by the recommendations of the Comptroller General
based on the management review conducted under section 2.
(e) Assistance in Pilot Program.--The Management and Accountability
Ombudsman described in section 312B of title 38, United States Code, as
added by section 4(a), shall assist in the pilot program under
subsection (a) by--
(1) identifying areas in which employees of the Department
have problems implementing the pilot program, including
application of logic modeling, managing risk of perverse
incentives, and other issues that the Ombudsman determine
appropriate;
(2) to the extent practicable, proposing changes in the
administrative practices of the implementation of the pilot
program to mitigate problems identified under paragraph (1);
and
(3) reviewing, examining, and making recommendations
regarding logic modeling policies, strategies, and programs of
the Veterans Health Administration.
(f) Briefings.--
(1) Initial briefing.--Not later than 90 days before the
Secretary commences the pilot program under subsection (a), the
Secretary shall provide to the Committees on Veterans' Affairs
of the House of Representatives and the Senate and the
Comptroller General a briefing on--
(A) a logic model of how the features of the pilot
program will address the problems identified in the
management review conducted under section 2; and
(B) such other items as the Secretary determines
appropriate.
(2) Updates.--Not later than 240 days after the Secretary
commences the pilot program under subsection (a), and annually
thereafter during the period in which the Secretary carries out
the pilot program, the Secretary shall provide to the
Committees on Veterans' Affairs of the House of Representatives
and the Senate and the Comptroller General a briefing on--
(A) an evaluation of the implementation and
effectiveness of carrying out this section, including
any challenges encountered and lessons learned;
(B) planned actions to improve the success of the
pilot program, including a milestone plan for such
actions; and
(C) such other items as the Secretary determines
appropriate.
(g) Duration.--The Secretary shall--
(1) commence the pilot program under subsection (a) by not
later than 180 days after the date on which the Comptroller
General submits the report under section 2(b); and
(2) carry out the pilot program for a period of five years.
(h) Definitions.--In this section:
(1) The term ``logic modeling'' means an approach, also
referred to as program theory, program modeling, or theory of
change, that articulates the assumptions of the strategy or
tactics of a program or activity and how such strategy or
tactics relate to the benefits that the program or activity is
expected to contribute toward in order to achieve certain
goals, objectives or responsibilities, and may include--
(A) the mapping of direct and indirect
relationships among relevant resources, activities,
milestones, outputs, intermediate outcomes, and end
outcomes; and
(B) if significant coordination or cooperation with
entities external to a program or activity may
contribute to achieving the relevant goals, objectives,
or responsibilities, the mapping of the roles of
entities external to the program or activity.
(2) The term ``risk management'' means the processes that
are used to identify, assess, monitor, mitigate, and report on
risks to achieving the missions, goals, and objectives of a
department, agency, or program using resources and processes
appropriate to the nature of risks and resources available.
SEC. 4. MANAGEMENT AND ACCOUNTABILITY OMBUDSMAN.
(a) In General.--Chapter 3 of title 38, United States Code, is
amended by inserting after section 312A the following new section:
``Sec. 312B. Management and accountability ombudsman
``(a) In General.--(1) There is in the Department an Office of the
Management and Accountability Ombudsman (in this section referred to as
the `Office'). There is at the head of the Office an Ombudsman, who
shall be appointed by the President from among individuals with a
background in enterprise risk management.
``(2) The Ombudsman shall report directly to the Secretary but the
Secretary may not prevent or prohibit the Ombudsman from initiating,
carrying out, or completing any responsibility of the Ombudsman.
``(3) The Secretary shall determine the appropriate level of
staffing and distribution of responsibility to ensure the success of
the Office.
``(4) The President shall include in the budget transmitted to the
Congress for each fiscal year pursuant to section 1105 of title 31 an
estimate of the amount for the Office that is sufficient to provide for
a number of full-time positions in the Office.
``(b) Responsibilities.--The Ombudsman shall--
``(1) receive and address reports from employees and
employee representatives of the Veterans Health Administration
Affairs and assist in resolving problems with the management,
administration, and delivery of care of the Veterans Health
Agency;
``(2) communicate to the Secretary the observations and
findings received pursuant to paragraph (1);
``(3) conduct inspections of medical facilities of the
Veterans Health Administration, including non-Department
facilities that provide care pursuant to a contract entered
into under chapter 17 of this title as necessary;
``(4) establish a program under which the Ombudsman and the
Secretary shall--
``(A) provide incentives to employees of the
Veterans Health Administration who suggest methods to
improve the management and operations of the Veterans
Health Administration;
``(B) carry out in a pilot program the suggestions
that are likely to be successful; and
``(C) if such a pilot program demonstrates that a
suggestion causes a marked improvement in such
management and operations--
``(i) reward the employee who made such
suggestion; and
``(ii) carry out such suggestion throughout
the Veterans Health Administration; and
``(5) not less frequently than once each calendar quarter,
provide to the Secretary a summary and relevant statistics
concerning the activities and findings of the Ombudsman,
including a summary of the suggestions made and carried out
pursuant to paragraph (4).
``(c) Request for Investigations.--The Ombudsman may request the
Inspector General of the Department to conduct an inspection,
investigation, or audit. Upon such a request, the Inspector General
shall respond to the Ombudsman explaining the plan of the Inspector
General to comply with such request or the rationale of the Inspector
General for denying such request.
``(d) Coordination.--The Secretary shall ensure that each element
of the Department has procedures to provide the Ombudsman with formal
responses to any recommendation submitted by the Ombudsman to the head
of such element.
``(e) Annual Reports.--Not later than June 30 of each year, the
Ombudsman shall submit to the Committees on Veterans' Affairs of the
Senate and the House of Representatives a report on the objectives of
the Ombudsman for the fiscal year beginning in such calendar year. Each
report shall--
``(1) contain a full and substantive analysis, in addition
to statistical information; and
``(2) set forth any recommendations the Ombudsman has made
on improving the management and accountability of the employees
of the Department and any responses received under subsection
(d) with respect to the estimates described in section 117(b)
of this title.
``(f) Risk Management Defined.--In this section, the term `risk
management' means the processes that are used to identify, assess,
monitor, mitigate, and report on risks to achieving a the mission,
goals, and objectives of a department, agency, or program using
resources and processes appropriate to the nature of risks and
resources available.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
312A the following new item:
``312B. Management and Accountability Ombudsman.''.
(c) Comptroller General Reports.--The Comptroller General of the
United States shall review each budget of the President submitted to
Congress under section 1105 of title 31 during 2015 through 2020 to
evaluate the proposed budget for health care provided by the Secretary
of Veterans Affairs. The Comptroller General shall submit to the
Committees on Veterans' Affairs of the Senate and the House of
Representatives a report containing the results of each such review, at
such times and with such additional matters as the Comptroller General
determines appropriate in consultation with such committees.
SEC. 5. VETERANS' BILL OF RIGHTS.
(a) Display.--The Secretary of Veterans Affairs shall ensure that
the Veterans' Bill of Rights described in subsection (e) is printed on
signage in accessible formats and displayed prominently and
conspicuously in each medical facility of the Department of Veterans
Affairs in accordance with subsection (c).
(b) Education of Department Employees.--The Secretary shall ensure
that employees of the Department receive training on the Veterans' Bill
of Rights described in subsection (e).
(c) Outreach.--The Secretary shall conduct outreach to inform
veterans about the Veterans' Bill of Rights described in subsection (e)
by--
(1) ensuring that such Bill of Rights is available on the
Internet website of the Department and prominently displayed
(using posters printed in a large type that allows for
individuals with 20/20 vision to read the print from 10 feet
away) in public spaces, lobbies, visitor centers, clinic
waiting rooms, and patient sitting rooms of the Department;
(2) briefing patients about such Bill of Rights when the
patient enrolls in the system of patient enrollment system
under section 1705 of title 38, United States Code; and
(3) conducting other types of outreach targeted at specific
groups of veterans, which may include, at a minimum, outreach
conducted on other Internet websites or through veterans
service organizations, health fairs, and the Veterans Health
Administration Veterans Center outreach program.
(d) Implementation.--The Secretary shall ensure that the Veterans
Health Administration honors the rights described in subsection (e).
(e) Veterans' Bill of Rights.--The Veterans' Bill of Rights
described in this subsection is a statement that veterans should have,
at a minimum and in addition to the rights covered by section 17.33 of
title 38, Code of Federal Regulations, the following rights:
(1) The right to access the highest quality care, including
the right to the most appropriate technology and qualified
practitioners.
(2) The right to continuity of care in the transition from
the health program of the Department of Defense to the health
care system of the Department of Veterans Affairs.
(3) The right to receive assistance in understanding the
available benefits and services to which the veteran is
entitled.
(4) The right to receive a careful explanation of a
proposed diagnostic or therapeutic procedure or course of
treatment by the appropriate medical practitioner, including
with respect to the risks, complications, alternatives, and
results.
(5) The right to ask questions concerning health treatment.
(f) Veterans' Bill of Rights.--The Veterans' Bill of Rights
described in this subsection is a statement that veterans who receive
health care provided under the laws administered by the Secretary of
Veterans Affairs should have, at a minimum, the following rights (to
the extent of the eligibility and enrollment of the veteran for such
health care):
(1) The right to access the highest quality care, including
the right to the most appropriate technology and qualified
practitioners.
(2) The right to know what rules and regulations apply to
patients.
(3) The right to continuity of care in the transition from
the health program of the Department of Defense to the health
care system of the Department of Veterans Affairs.
(4) The right to receive careful explanation of proposed
diagnostic or therapeutic procedures or courses of treatment by
the responsible medical personnel, including with respect to
risks, complications, alternative health practices, results,
information and reasoning for prescribed pain management plans,
and a daily review of the medical chart of the patient.
(5) The right for the patient to ask questions and be
involved in all decisions regarding the care received by the
patient.
(6) The right to a second opinion or change of provider, if
available.
(7) The right to know the reason for any change in medical
practitioners responsible for the care of the patient.
(8) The right to know the identity and professional status
of individuals providing service and to know who is primarily
responsible for the care of the patient.
(9) The right to not be transferred to another facility,
organization, or department unless the patient receives a
complete explanation for the need, was notified of
alternatives, and the receiving organization, facility, or
department is ready to accept the transfer.
(10) The right to receive considerate, respectful care at
all times and under all circumstances with recognition of
personal dignity, diversity, and religious, or other spiritual
and cultural preferences.
(11) The right, in accordance with relevant provisions of
law, to personal and informational confidentiality and privacy
in the discussion of the care and management of records of
patients.
(12) The right to visitors within the policies of the
facility and to be informed of the visitation rights, including
any clinically necessary restrictions.
(13) The right to be free from all forms of abuse or
harassment.
(14) The right to access protective and advocacy services,
when available, and file grievances.
(15) The right to remain free of chemical and physical
restraints unless safety requires otherwise.
(16) The right to care provided in a safe and clean
setting, free from excessive noise and with sufficient lighting
for comfort and safety.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Veterans' Affairs, and in addition to the Committee on the Budget, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Veterans' Affairs, and in addition to the Committee on the Budget, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
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