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115th Congress   }                                   {   Rept. 115-149
                        HOUSE OF REPRESENTATIVES
 1st Session     }                                   {          Part 1

======================================================================



 
                    VA SCHEDULING ACCOUNTABILITY ACT

                                _______
                                

  May 23, 2017.--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. 467]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 467) to direct the Secretary of Veterans Affairs 
to ensure that each medical facility of the Department of 
Veterans Affairs complies with requirements relating to 
scheduling veterans for health care appointments, to improve 
the uniform application of directives of the Department, 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.........................................................     2
Subcommittee Consideration.......................................     3
Committee Consideration..........................................     3
Committee Votes..................................................     3
Committee Correspondence.........................................     4
Committee Oversight Findings.....................................     6
Statement of General Performance Goals and Objectives............     6
New Budget Authority, Entitlement Authority, and Tax Expenditures     6
Earmarks and Tax and Tariff Benefits.............................     6
Committee Cost Estimate..........................................     6
Congressional Budget Office Estimate.............................     6
Federal Mandates Statement.......................................     7
Advisory Committee Statement.....................................     7
Constitutional Authority Statement...............................     7
Applicability to Legislative Branch..............................     7
Statement on Duplication of Federal Programs.....................     7
Disclosure of Directed Rulemaking................................     8
Section-by-Section Analysis of the Legislation...................     8
Changes in Existing Law Made by the Bill as Reported.............     8

                          PURPOSE AND SUMMARY

    H.R. 467, the ``VA Scheduling Accountability Act,'' was 
introduced by Representative Jackie Walorski of Indiana on 
January 12, 2017.
    H.R. 467 would require that each director of a VA medical 
center annually certify compliance with VA's existing patient 
scheduling directive (or any successor directive that replaces 
it) and report to Congress.

                  BACKGROUND AND NEED FOR LEGISLATION

Section 2. Compliance with scheduling requirements

    Veterans Health Administration (VHA) Directive 2010-027, 
VHA Outpatient Scheduling Processes and Procedures, provides 
national policy for scheduling outpatient clinic appointments 
and for ensuring the competency of staff directly or indirectly 
involved in the scheduling process.\1\ This June 2010 directive 
requires annual certification of full compliance with the 
content of the directive. In May 2013, the then-VA Deputy Under 
Secretary for Health for Operations Management waived the 
requirement for facility directors to certify compliance with 
VHA Directive 2010-027. Subsequently, in April 2014, the 
Committee uncovered the use of unauthorized waiting lists at 
the Phoenix VA Health Care System in Phoenix, Arizona. This 
revelation--and the investigations that resulted from it--found 
that no less than 40 veterans died while on these waiting lists 
and led to a widespread, systemic access and accountability 
scandal. Though VA has since reinstated the certification 
requirement for VHA Directive 2010-027, non-compliance with 
VA's scheduling policies was a primary factor behind the 2014 
access crisis, the repercussions of which continue today.
---------------------------------------------------------------------------
    \1\VHA Directive 2010-027, VHA Outpatient Scheduling Processes and 
Procedure
---------------------------------------------------------------------------
    The Committee continues to be concerned about both the 
integrity of VA wait time data and individual medical 
facilities' compliance with VA scheduling policies. Section 2 
of the bill would require VA medical center directors to 
certify annually that their facility is in compliance with the 
scheduling directive (or any successor directive that replaces 
it), prohibit VA from waiving certification, and require VA to 
report to Congress on individual medical facilities' 
compliance. To ensure accountability for poor-performing 
facilities, section 2 of the bill would also prohibit VA 
medical center leaders from receiving awards or bonuses if 
their VA medical center fails to certify compliance with the 
scheduling directive (or any successor directive that replaces 
it).

                                HEARINGS

    There were no full Committee hearings held on H.R. 467.
    On March 29, 2017, the Subcommittee on Health conducted a 
legislative hearing on a number of bills including H.R. 467.
    The following witnesses testified:
          The Honorable David. P. Roe M.D. of Tennessee; The 
        Honorable Jackie Walorski of Indiana; The Honorable 
        Doug Collins of Georgia; The Honorable Mike Coffman of 
        Colorado; The Honorable Stephen Knight of California; 
        The Honorable Ann M. Kuster of New Hampshire; Jennifer 
        S. Lee, M.D., the Deputy Under Secretary for Health for 
        Policy and Services for the Veterans Health 
        Administration of the U.S. Department of Veterans 
        Affairs who was accompanied by Susan Blauert, the Chief 
        Counsel for the Health Care Law Group of the Office of 
        the General Counsel for the U.S. Department of Veterans 
        Affairs; Kayda Keleher, Legislative Associate for the 
        National Legislative Service of the Veterans of Foreign 
        Wars of the United States; Shurhonda Y. Love, the 
        Assistant National Legislative Director for the 
        Disabled American Veterans; and, Sarah S. Dean, the 
        Associate Legislative Director for the Paralyzed 
        Veterans of America.
    Statements for the record were submitted by:
          The Honorable Lee Zeldin of New York; The American 
        Legion; the National Association of State Veteran 
        Homes; Swords to Plowshares; and, the Wounded Warrior 
        Project.

                       SUBCOMMITTEE CONSIDERATION

    On April 6, 2017, the Subcommittee on Health met in an open 
markup session, a quorum being present, and ordered H.R. 467 to 
be reported favorably to the Full Committee by voice vote.

                        COMMITTEE CONSIDERATION

    On May 17, 2017, the Full Committee met in open markup 
session, a quorum being present, and ordered H.R. 467 to be 
reported favorably to the House of Representatives by voice 
vote. A motion by Representative Tim Walz of Minnesota, Ranking 
Member of the Committee on Veterans' Affairs, to report H.R. 
467 favorably to the House of Representatives was agreed to 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. 467 
reported to the House.

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                      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 ensure that VA medical facilities 
are in compliance with scheduling directives.

   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. 467 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. 
467 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. 467 provided by the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, May 19, 2017.
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. 467, the VA 
Scheduling Accountability 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,
                                                        Keith Hall.
    Enclosure.

H.R. 467--VA Scheduling Accountability Act

    H.R. 467 would require the Department of Veterans Affairs 
(VA) to ensure that the director of each medical facility of 
the department certify annually that the facility is in full 
compliance with the laws and regulations pertaining to 
scheduling medical appointments. That requirement would codify 
VA's current practice, as specified under Directive 2010-027. 
The bill also would prohibit VA from paying bonuses to senior 
staff in facilities that are not able to certify such 
compliance. CBO expects that few, if any, bonuses would be 
denied under this provision.
    In addition, the bill would require VA to ensure that 
directives and policies are being implemented in a uniform 
manner across the department. To accomplish that requirement, 
CBO expects VA would distribute regular guidance through 
electronic correspondence. On that basis, CBO estimates that 
implementing H.R. 467 would cost less than $500,000 over the 
2018-2022 period; any such spending would be subject to the 
availability of appropriated funds.
    Enacting H.R. 467 would not affect direct spending or 
revenues; therefore, pay-as-you-go procedures do not apply. CBO 
estimates that enacting H.R. 467 would not increase net direct 
spending or on-budget deficits in any of the four consecutive 
10-year periods beginning in 2028.
    H.R. 467 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act, and 
would not affect the budgets of state, local, or tribal 
governments.
    The CBO staff contact for this estimate is Ann E. Futrell. 
The estimate was approved by H. Samuel Papenfuss, Deputy 
Assistant Director for Budget Analysis.

                       FEDERAL MANDATES STATEMENT

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 467 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. 
467.

                 STATEMENT OF CONSTITUTIONAL AUTHORITY

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 467 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. 467 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 section 3(g) of H. Res. 5, 114th Cong. (2015), 
the Committee finds that no provision of H.R. 467 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, 114th Cong. (2015), 
the Committee estimates that H.R. 467 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 the short title to H.R. 
467 as the ``VA Scheduling Accountability Act.''

Section 2. Compliance with scheduling requirements

    Section 2(a)(1) of the bill would require that the 
Secretary ensure that the director of each center annually 
certifies that the medical facility is in full compliance with 
all provisions of law and regulations relating to scheduling 
medical appointments, including pursuant to VHA Directive 2010-
027 or any successor directive.
    Section 2(a)(2) of the bill would prohibit VA from waiving 
any provision of such laws or regulations.
    Section 2(b) of the bill would require that if a director 
of a facility fails to certify compliance pursuant to section 
4(a)(1) of the bill for any year, the director must submit to 
the Secretary a report containing an explanation of why the 
director cannot certify the facility and a description of 
actions taken to ensure compliance in the future.
    Section 2(c)(1) of the bill would prohibit ``covered 
officials'' from receiving any award or bonus the following 
year if the facility director cannot certify the facility.
    Section 2(c)(2) of the bill would define a ``covered 
official'' as an official who works in a VA facility that 
cannot be certified and holds one of the following positions: 
director; chief of staff; associate director; associate 
director for patient care; or, deputy chief of staff.
    Section 2(d) of the bill would require that the Secretary 
submit annually to the Committees on Veterans' Affairs of the 
U.S. House of Representatives and the U.S. Senate a report that 
includes a list of each medical facility for which a 
certification was made during the preceding year and a list of 
each medical facility for which a certification was not made 
during the preceding year, along with a copy of each report 
submitted to the Secretary under subsection (4)(b) of the bill 
for the preceding year.

         CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

    If enacted, this bill would make no changes in existing 
law.

                                  [all]