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[House Report 115-389]
[From the U.S. Government Publishing Office]

115th Congress }                                          { REPORT
                        HOUSE OF REPRESENTATIVES
 1st Session   }                                          { 115-389

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                  VA MANAGEMENT ALIGNMENT ACT OF 2017

                                _______
                                

November 6, 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. 1066]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 1066) to direct the Secretary of Veterans 
Affairs to submit to the Committees on Veterans' Affairs of the 
Senate and the House of Representatives a report regarding the 
organizational structure of the Department of Veterans Affairs, 
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.........................................................     3
Subcommittee Consideration.......................................     4
Committee Consideration..........................................     4
Committee Votes..................................................     4
Committee Oversight Findings.....................................     4
Statement of General Performance Goals and Objectives............     4
New Budget Authority, Entitlement Authority, and Tax Expenditures     4
Earmarks and Tax and Tariff Benefits.............................     4
Committee Cost Estimate..........................................     4
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     5
Advisory Committee Statement.....................................     5
Constitutional Authority Statement...............................     6
Applicability to Legislative Branch..............................     6
Statement on Duplication of Federal Programs.....................     6
Disclosure of Directed Rulemaking................................     6
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill as Reported.............     7

                          PURPOSE AND SUMMARY

    H.R. 1066, the ``VA Management Alignment Act of 2017,'' 
would require the Department of Veterans Affairs (VA) to submit 
a report to Congress on VA's organizational structure.

                  BACKGROUND AND NEED FOR LEGISLATION

Section 2. Report on the organizational structure of the Department of 
        Veterans Affairs

    In response to concerns about the quality of the care 
provided to veterans through the VA healthcare system, section 
201 of the Veterans Access, Choice and Accountability Act of 
2014 (VACAA) (Public Law 113-146; 128 Stat. 1755) required VA 
to contract with a private sector entity to conduct an 
independent assessment of the health care furnished in VA 
medical facilities. The resultant Independent Assessment of the 
Health Care Delivery Systems and Management Processes of VA 
(Independent Assessment) of the Veterans Health Administration 
(VHA), which manages the VA healthcare system, found the 
agency's organizational structure to be, ``intensely, 
unnecessarily complex'' and rampant with mistrust and risk 
aversion ``resulting in an inability to improve performance 
consistently and fully across the system.''\1\ The Independent 
Assessment also found VHA suffers from an expanding scope of 
activities, confusion around leadership priorities and 
strategic direction, limited role clarity, and fragmentation of 
authority.\2\ The Independent Assessment further noted VHA's 
workforce ``appears to be steadily losing its motivation'' 
while the attention of VHA's leadership is consumed by 
addressing past crises rather than preparing for future 
opportunities.\3\
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    \1\Independent Assessment of the Health Care Delivery Systems and 
Management Processes of the Department of Veterans Affairs. September 
1, 2015. https://www.va.gov/opa/choiceact/documents/assessments/
integrated_report.pdf.
    \2\Ibid.
    \3\Ibid.
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    Section 202 of VACAA also required VA to establish the 
Commission on Care to examine veterans' access to VA care and 
to strategically examine how best to organize the VA healthcare 
system, locate VA health care resources, and deliver health 
care to veterans through VA over the next 20 years. Like the 
Independent Assessment, the Commission on Care also found 
serious fault with the organization and management of VHA. For 
example, the final report of the Commission on Care found, 
``VHA currently lacks effective national policies, a rational 
organizational structure, and clear role definitions that would 
support effective leadership. . . .''\4\ The Commission on Care 
also noted VHA has one the lowest organizational health scores 
in all of government.\5\
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    \4\Commission on Care Final Report. June 30, 2016. https://
s3.amazonaws.com/sitesusa/wp-content/uploads/sites/912/2016/07/
Commission-on-Care_Final-Report_063016_FOR-WEB.pdf.
    \5\Ibid.
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    Findings similar to those made by the Independent 
Assessment and the Commission on Care regarding the 
organization and management of VHA and of other VA entities 
have been found in Government Accountability Office and VA 
Inspector General reports; have been voiced by veterans, 
veteran service organizations, and VA employees; and, have been 
common themes in the Committee's recent oversight hearings and 
site visits. Accordingly, the Committee believes it is 
imperative to improving performance and increasing 
accountability for VA to clarify the Department's 
organizational structure and the roles, responsibilities, and 
lines of authority for key leaders. Section 2 of the bill would 
require VA to create a report on the Department's 
organizational structure and submit it to the Committees on 
Veterans' Affairs of the U.S. House of Representatives and U.S. 
Senate. In preparing the report, VA would be required to use 
the findings and recommendations of the Independent Assessment, 
the Commission on Care, and other relevant studies or reports 
including an internal report dated February 28, 2015, entitled, 
``Task Force on Improving Effectiveness of VHA Governance: 
Report to the VHA Under Secretary for Health.'' VA would also 
be required to include in the report clearly delineated roles 
and responsibilities of each key leader of the Department and 
for each administration, staff office, staff organization or 
subordinate entity thereof as well as recommendations for 
legislation the Secretary considers appropriate. Section 2 of 
the bill defines a ``key leader'' as the Secretary, Deputy 
Secretary, Under Secretary, Assistant Secretary, Deputy 
Assistant Secretary, Chief Financial Officer, Chief Information 
Officer, General Counsel, Inspector General, Director of 
Construction and Facilities Management, Chief of Staff, 
Chairman of the Board of Veterans' Appeals, Vice Chairman of 
the Board of Veterans' Appeals, VISN Director, and medical 
facility Director.

                                HEARINGS

    There were no full Committee hearings held on H.R. 1066.
    On September 26, 2017, the Subcommittee on Health conducted 
a legislative hearing on a number of bills including H.R. 1066.
    The following witnesses testified:
          The Honorable Debbie Dingell, U.S. House of 
        Representatives, 12th District, Michigan; The Honorable 
        Beto O'Rourke, U.S. House of Representatives, 16th 
        Congressional District, Texas; The Honorable Derek 
        Kilmer, U.S. House of Representatives, 6th 
        Congressional District, Washington; The Honorable Steve 
        King, U.S. House of Representatives, 4th Congressional 
        District, Iowa; The Honorable Lloyd Smucker, U.S. House 
        of Representatives, 16th Congressional District, 
        Pennsylvania; The Honorable Mike Coffman, U.S. House of 
        Representatives, 6th Congressional District, Colorado; 
        The Honorable Steve Stivers, U.S. House of 
        Representatives, 15th Congressional District, Ohio; The 
        Honorable Ron DeSantis, U.S. House of Representatives, 
        6th Congressional District, Florida; The Honorable John 
        Rutherford, U.S. House of Representatives, 4th 
        Congressional District, Florida; Keronica Richardson, 
        Assistant Director of Women and Minority Veterans 
        Outreach for the National Security Division of The 
        American Legion; Amy Webb, National Legislative Policy 
        Advisor for AMVETS; and, Harold Kudler M.D., Acting 
        Assistant Deputy Under Secretary for Health for Patient 
        Care Services for the Veterans Health Administration of 
        the U.S. Department of Veterans Affairs, accompanied by 
        Catherine Biggs-Silvers, Executive Director for 
        Mission, Planning, and Analysis for the Human Resources 
        and Administration of the U.S. Department of Veterans 
        Affairs.
    Statements for the record were submitted by:
          Blinded Veterans Association, Veterans of Foreign 
        Wars of the United States, Disabled American Veterans, 
        Paralyzed Veterans of America, Justice for Vets, and, 
        Make a Difference America.

                       SUBCOMMITTEE CONSIDERATION

    There was no Subcommittee consideration of H.R. 1066.

                        COMMITTEE CONSIDERATION

    On October 12, 2017, the full Committee met in open markup 
session, a quorum being present, and ordered H.R. 1066 to be 
reported favorably to the House of Representatives 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. 1066 
reported to the House. A motion by Representative Tim Walz of 
Minnesota, Ranking Member of the Committee on Veterans' 
Affairs, to report H.R. 1066 favorably to the House of 
Representatives was agreed to by voice vote.

                      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 require VA to report on the 
different organizational elements of the Department and the 
roles and responsibilities of key VA leaders.

   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. 1066 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. 
1066 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. 1066 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, October 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. 1066, the VA 
Management Alignment Act of 2017.
    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. 1066--VA Management Alignment Act of 2017

    H.R. 1066 would require the Department of Veterans Affairs 
(VA), within 180 days of enactment, to submit a report to the 
Congress on the organizational structure of the department. The 
bill would direct the report to include the results from 
existing studies to assess the roles, responsibilities, and 
accountability of employees and offices within the department 
and to include recommendations for legislation. Based on an 
analysis of information from VA about the necessary resources 
to produce such a report, CBO estimates that implementing the 
bill 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. 1066 would not affect direct spending or 
revenues; therefore, pay-as-you-go procedures do not apply.
    CBO estimates that enacting H.R. 1066 would not increase 
net direct spending or on-budget deficits in any of the four 
consecutive 10-year periods beginning in 2028.
    H.R. 1066 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act.
    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. 1066 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. 
1066.

                 STATEMENT OF CONSTITUTIONAL AUTHORITY

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 1066 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. 1066 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, 115th Cong. (2017), 
the Committee finds that no provision of H.R. 1066 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. 1066 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 for 
H.R. 1066, as the ``VA Management Alignment Act of 2017.''

Section 2. Report on the organizational structure of the Department of 
        Veterans Affairs

    Section 2(a) of the bill would require the Secretary of 
Veterans Affairs to submit a report not later than 180 days 
after the date of enactment to the Committees on Veterans' 
Affairs of the Senate and House of Representatives regarding 
the roles, responsibility, and accountability of elements and 
individuals of the Department of Veterans Affairs and include 
recommendations for legislation the Secretary considers 
appropriate.
    Section 2(b) of the bill would require the Secretary, in 
creating the report that would be required under section 2(a) 
of the bill, to utilize the following: the results of the 
Independent Assessment of the Health Care Delivery Systems and 
Management Process of the Department of Veterans Affairs 
established by section 201 of the Veterans Access, Choice, and 
Accountability Act of 2014 (Public Law 113-146); any study or 
report by the Commission on Care established by section 202 of 
the Veterans Access, Choice and Accountability Act of 2014 
(Public Law 113-146); and, other studies or reports including a 
report entitled ``Task Force on Improving Effectiveness of VHA 
Governance: Report to the VHA Under Secretary for Health'' 
dated February 28, 2015. Section 2(b) of the bill would also 
require the Secretary, in creating the report that would be 
required under section 2(a) of the bill, to specify clearly 
delineated roles and responsibilities to optimize the 
organizational effectiveness and accountability of each: 
Administration, staff office, or staff organization; 
subordinate organization of each Administration, staff office, 
or staff organization; and, key leader of the Department in 
relation to any Administration, staff office, staff 
organization, Veterans Integrated Service Network, or medical 
facility.
    Section 2(c) of the bill would define the term ``key leader 
of the Department'' to include: the Secretary, the Deputy 
Secretary, each Under Secretary, each Assistant Secretary, each 
Deputy Assistant Secretary, the Chief Financial Officer, the 
Chief Information Officer, the General Counsel, the Inspector 
General, the Director of Construction and Facilities 
Management, the Chief of Staff, the Chairman of the Board of 
Veterans' Appeals, the Vice Chairman of the Board of Veterans' 
Appeals, the Director of each Veterans Integrated Service 
Network, and the Director of each medical facility.

         CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

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

                                  [all]
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