II 

116TH CONGRESS 

1ST SESSION S. 629 

To require the Secretary of Veterans Affairs to review the processes and 

requirements of the Department of Veterans Affairs for scheduling appointments 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, and Mr. BROWN) 

introduced the following bill; which was read twice and referred to the 

Committee on Veterans’ Affairs 

A BILL 

To require the Secretary of Veterans Affairs to review the 

processes and requirements of the Department of Veterans Affairs for scheduling appointments for health care 

and conducting consultations under the laws administered by the Secretary, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Accountability in De5 partment of Veterans Affairs Scheduling and Consult 

6 Management Act’’. 


kjohnson on DSK79L0C42 with BILLS
2 

•S 629 IS

1 SEC. 2. PROCESSES AND REQUIREMENTS FOR SCHED2 ULING APPOINTMENTS FOR HEALTH CARE 

3 FROM DEPARTMENT OF VETERANS AFFAIRS. 

4 (a) PROCESSES AND REQUIREMENTS.— 

5 (1) IN GENERAL.—Not later than 60 days after 

6 the date of the enactment of this Act, the Secretary 

7 of Veterans Affairs shall submit to the Committee 

8 on Veterans’ Affairs of the Senate and the Com9 mittee on Veterans’ Affairs of the House of Rep10 resentatives a description of the processes and re11 quirements of the Department of Veterans Affairs 

12 for scheduling appointments for health care from the 

13 Department at the medical facility level. 

14 (2) PERIODIC REVISION.— 

15 (A) IN GENERAL.—The Secretary may re16 vise the processes and requirements required 

17 under paragraph (1) as the Secretary considers 

18 necessary. 

19 (B) SUBMITTAL TO CONGRESS.—Not later 

20 than 30 days before revising the processes and 

21 requirements under subparagraph (A), the Sec22 retary shall submit to the Committee on Vet23 erans’ Affairs of the Senate and the Committee 

24 on Veterans’ Affairs of the House of Represent25 ative a description of those revised processes 

26 and requirements, including a description of 


kjohnson on DSK79L0C42 with BILLS
3 

•S 629 IS

1 any modifications to the certification and train2 ing under subsection (b). 

3 (b) TRAINING ON PROCESSES AND REQUIRE4 MENTS.— 

5 (1) CERTIFICATION.—Not later than one year 

6 after the date of the enactment of this Act, the Sec7 retary shall require individuals involved in the sched8 uling of appointments for health care from the De9 partment to certify to the Secretary that the indi10 vidual understands the processes and requirements 

11 described in subsection (a), including the maximum 

12 number of days allowed to complete each step of the 

13 scheduling process. 

14 (2) NEW EMPLOYEES.—The Secretary shall re15 quire all employees hired by the Department after 

16 the date of the enactment of this Act who are to be 

17 involved in the scheduling of appointments for health 

18 care from the Department to undergo training on 

19 the processes and requirements described in sub20 section (a) as part of the onboarding process. 

21 (c) METHOD TO MONITOR COMPLIANCE.— 

22 (1) IN GENERAL.—Not later than 180 days 

23 after the date of the enactment of this Act, the Sec24 retary shall establish or maintain a method or tool 

25 to enable real-time monitoring of and ensure that 


kjohnson on DSK79L0C42 with BILLS
4 

•S 629 IS

1 each medical facility of the Department complies 

2 with the scheduling processes and requirements de3 scribed in subsection (a), including compliance with 

4 policies of the Department relating to the maximum 

5 number of days allowed to complete each step of the 

6 scheduling process. 

7 (2) USE THROUGHOUT DEPARTMENT.— 

8 (A) IN GENERAL.—The Secretary shall re9 quire each medical facility of the Department to 

10 use the method or tool described in paragraph 

11 (1). 

12 (B) CERTIFICATION.—Not later than one 

13 year after the date of the enactment of this Act, 

14 the Secretary shall require the director of each 

15 medical facility of the Department to certify to 

16 the Secretary that the director is using the 

17 method or tool described in paragraph (1). 

18 (d) COMPTROLLER GENERAL REPORT.—Not later 

19 than two years after the date of the enactment of this Act, 

20 the Comptroller General of the United States shall submit 

21 to the Committee on Veterans’ Affairs of the Senate and 

22 the Committee on Veterans’ Affairs of the House of Rep23 resentatives a report on the compliance of the Secretary 

24 with the requirements of this section. 


kjohnson on DSK79L0C42 with BILLS
5 

•S 629 IS

1 SEC. 3. AUDITS REGARDING SCHEDULING OF APPOINT2 MENTS AND MANAGEMENT OF CONSULTA3 TIONS FOR HEALTH CARE FROM DEPART4 MENT OF VETERANS AFFAIRS. 

5 (a) IN GENERAL.—Not later than one year after the 

6 date of the enactment of this Act, and not less frequently 

7 than annually thereafter, the Secretary of Veterans Af8 fairs shall provide for the conduct of facility-level audits 

9 of the scheduling of appointments and the management 

10 of consultations for health care under the laws adminis11 tered by the Secretary. 

12 (b) ELEMENTS.—Each audit conducted under sub13 section (a) shall include the following: 

14 (1) With respect to each medical center of the 

15 Department of Veterans Affairs, an assessment of 

16 any scheduling or consultation management issues 

17 at that medical center, including the following: 

18 (A) An assessment of non-compliance with 

19 policies of the Veterans Health Administration 

20 relating to scheduling appointments and man21 aging consultations. 

22 (B) An assessment of the extent to which 

23 appointments or consultations are not timely 

24 processed. 


kjohnson on DSK79L0C42 with BILLS
6 

•S 629 IS

1 (C) A description of any backlogs in ap2 pointments or consultations that are awaiting 

3 action. 

4 (D) An assessment of whether consulta5 tions are appropriately processed. 

6 (E) Data with respect to consultations as 

7 follows: 

8 (i) Consultations that were scheduled 

9 within the request window. 

10 (ii) Duplicate consultation requests. 

11 (iii) Consultations that were discon12 tinued. 

13 (iv) Delays in consultations. 

14 (v) Consultations that were not prop15 erly closed or discontinued, including a de16 scription of remediation attempts. 

17 (F) A review for accuracy with respect to 

18 consultation management as follows: 

19 (i) A review of the accuracy of the 

20 type of service, either administrative or 

21 clinical, that is inputted in the electronic 

22 health record. 

23 (ii) A review of the accuracy of the 

24 type of consultation setting, either impaVerDate Sep 11 2014 23:00 Mar 07, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S629.IS S629

kjohnson on DSK79L0C42 with BILLS
7 

•S 629 IS

1 tient or outpatient, that is inputted in the 

2 electronic health record. 

3 (iii) A review of the appropriateness 

4 of the level of urgency of the consultation 

5 that is inputted in the electronic health 

6 record. 

7 (iv) A review of any delayed or unre8 solved consultations. 

9 (2) An identification of such recommendations 

10 for corrective action as the Secretary considers nec11 essary, including additional training, increased per12 sonnel, and other resources. 

13 (3) A certification that the director of each 

14 medical center of the Department is in compliance 

15 with the processes and requirements described in 

16 section 2(a) and such other requirements relating to 

17 the scheduling of appointments and management of 

18 consultations as the Secretary considers appropriate. 

19 (4) With respect to referrals for health care be20 tween health care providers or facilities of the De21 partment, a measurement of, for each medical facil22 ity of the Department, the time it takes from the 

23 date that a clinician of the Department determines 

24 that a veteran requires care from another health 

25 care provider or facility to each of the following: 


kjohnson on DSK79L0C42 with BILLS
8 

•S 629 IS

1 (A) The date that the referral for care is 

2 sent to the other health care provider or facil3 ity. 

4 (B) The date that the other health care 

5 provider or facility accepts the referral. 

6 (C) The date that the appointment with 

7 the other health care provider or at the other 

8 facility is made. 

9 (D) The date of the appointment with the 

10 other health care provider or at the other facil11 ity. 

12 (E) Any other step that the Secretary de13 termines necessary to measure. 

14 (c) CONDUCT OF AUDIT BY THIRD PARTY.—Each 

15 audit conducted under subsection (a) with respect to a 

16 medical facility of the Department shall be conducted by 

17 an individual or entity that is not affiliated with the facil18 ity. 

19 (d) TRANSMITTAL TO VHA.—Each audit conducted 

20 under subsection (a) shall be transmitted to the Under 

21 Secretary for Health of the Department so that the Under 

22 Secretary can— 

23 (1) strengthen oversight of the scheduling of 

24 appointments and management of consultations 

25 throughout the Department; 


kjohnson on DSK79L0C42 with BILLS
9 

•S 629 IS

1 (2) monitor national policy on such scheduling 

2 and management; 

3 (3) determine if a mobile deployment team fur4 nished under the pilot program established under 

5 section 402 of the VA MISSION Act of 2018 (Pub6 lic Law 115–182) is warranted; and 

7 (4) develop a remediation plan to address issues 

8 uncovered by those audits. 

9 (e) ANNUAL REPORT.— 

10 (1) IN GENERAL.—Not later than December 31 

11 of each year, the Secretary shall submit to the Com12 mittee on Veterans’ Affairs of the Senate and the 

13 Committee on Veterans’ Affairs of the House of 

14 Representatives a report on the audits conducted 

15 under subsection (a) during the year ending on that 

16 date. 

17 (2) ELEMENTS.—The Secretary shall include in 

18 each report required by paragraph (1)— 

19 (A) a description of the audits conducted 

20 under subsection (a) with respect to each facil21 ity of the Department; 

22 (B) an assessment of how the Department 

23 strengthened oversight of the scheduling of ap24 pointments and management of consultations at 

25 that facility as a result of those audits; 


kjohnson on DSK79L0C42 with BILLS
10 

•S 629 IS

1 (C) an assessment of how those audits in2 formed the national policy of the Department 

3 with respect to the scheduling of appointments 

4 and management of consultations; and 

5 (D) a description of any remediation plans 

6 to address issues raised by those audits that 

7 were completed. 

8 SEC. 4. ADMINISTRATION OF NON-DEPARTMENT OF VET9 ERANS AFFAIRS HEALTH CARE. 

10 (a) CERTIFICATION OF PROPER ADMINISTRATION.— 

11 (1) REVIEW.— 

12 (A) IN GENERAL.—The Secretary of Vet13 erans Affairs shall conduct a review of the 

14 staffing, training, and other requirements nec15 essary to administer section 101 of the Vet16 erans Access, Choice, and Accountability Act of 

17 2014 (Public Law 113–146; 38 U.S.C. 1701 

18 note), section 1703 of title 38, United States 

19 Code (as in effect on the date specified in sec20 tion 101(b) of the Caring for Our Veterans Act 

21 of 2018 (title I of Public Law 115–182)), and 

22 any other community care program of the De23 partment of Veterans Affairs. 


kjohnson on DSK79L0C42 with BILLS
11 

•S 629 IS

1 (B) ELEMENTS.—The review conducted 

2 under paragraph (1) shall include, with respect 

3 to each medical facility of the Department— 

4 (i) an assessment of the type of posi5 tions required to be staffed at the medical 

6 facility; 

7 (ii) the number of such positions au8 thorized; 

9 (iii) the number of such positions 

10 filled; and 

11 (iv) the number of additional such po12 sitions required to be authorized. 

13 (2) CERTIFICATION.—Not later than 180 days 

14 after the date of the enactment of this Act, and 

15 every 180 days thereafter, the Secretary of Veterans 

16 Affairs shall submit to the Committee on Veterans’ 

17 Affairs of the Senate and the Committee on Vet18 erans’ Affairs of the House of Representatives the 

19 results of the review conducted under paragraph (1), 

20 including a certification that all staffing, training, 

21 and other requirements described in paragraph 

22 (1)(A) are fulfilled. 

23 (b) SCHEDULING OF APPOINTMENTS.— 

24 (1) IN GENERAL.—The Secretary shall be re25 sponsible for ensuring that appointments for health 


kjohnson on DSK79L0C42 with BILLS
12 

•S 629 IS

1 care from non-Department health care providers 

2 under the laws administered by the Secretary are 

3 scheduled. 

4 (2) TIMELINESS GOALS.—Not later than 30 

5 days after the date of the enactment of this Act, the 

6 Secretary shall establish timeliness goals for each 

7 step in scheduling an appointment for health care 

8 from a non-Department health care provider set 

9 forth under subparagraphs (A) through (F) of para10 graph (3). 

11 (3) MEASUREMENT OF TIMELINESS FOR EACH

12 FACILITY.—Not later than 120 days after the date 

13 of the enactment of this Act, the Secretary shall 

14 measure, for each medical facility of the Depart15 ment, the time it takes from the date that a clinician 

16 of the Department determines that a veteran re17 quires care from a non-Department health care pro18 vider to each of the following: 

19 (A) The date that the referral for care is 

20 sent to the non-Department health care pro21 vider. 

22 (B) The date that the non-Department 

23 health care provider accepts the referral. 


kjohnson on DSK79L0C42 with BILLS
13 

•S 629 IS

1 (C) The date that the appointment with 

2 the non-Department health care provider is 

3 made. 

4 (D) The date that the appointment with 

5 the non-Department health care provider oc6 curs. 

7 (E) The date that the referral to the non8 Department health care provider is completed. 

9 (F) Any other step that the Secretary de10 termines necessary to measure. 

11 (4) PUBLICATION OF DATA.— 

12 (A) IN GENERAL.—Not later than one year 

13 after the date of the enactment of this Act, the 

14 Secretary shall publish the data measured 

15 under paragraph (3), disaggregated by medical 

16 facility, on a publicly available Internet website 

17 of the Department. 

18 (B) UPDATE.—Not less frequently than bi19 weekly, the Secretary shall update the data 

20 published under subparagraph (A). 

21 (c) COMPTROLLER GENERAL REPORT.— 

22 (1) REVIEW.—Beginning not later than one 

23 year after the date of the enactment of this Act, the 

24 Comptroller General of the United States shall re25 view compliance by the Secretary with the requireVerDate Sep 11 2014 23:00 Mar 07, 2019 Jkt 089200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S629.IS S629

kjohnson on DSK79L0C42 with BILLS
14 

•S 629 IS

1 ments of this section, including a review of the valid2 ity and reliability of data published by the Secretary 

3 under subsection (b)(4). 

4 (2) COMPLETION.—Not later than three years 

5 after the date of the enactment of this Act, the 

6 Comptroller General shall submit to the Committee 

7 on Veterans’ Affairs of the Senate and the Com8 mittee on Veterans’ Affairs of the House of Rep9 resentatives the results of the review conducted 

10 under paragraph (1). 

11 SEC. 5. REQUESTS FOR MOBILE DEPLOYMENT TEAMS BY 

12 DIRECTORS OF MEDICAL CENTERS OF DE13 PARTMENT OF VETERANS AFFAIRS. 

14 (a) IN GENERAL.—A director of a medical center of 

15 the Department of Veterans Affairs shall request from the 

16 Secretary of Veterans Affairs a mobile deployment team 

17 under the pilot program established under section 402 of 

18 the VA MISSION Act of 2018 (Public Law 115–182) if 

19 requirements of the Department under sections 2 and 4 

20 have not been met with respect to a facility under the ju21 risdiction of the director. 

22 (b) REPORT.—Not less frequently than once every 

23 180 days, the Secretary shall submit to the appropriate 

24 committees of Congress a report setting forth each request 

25 under subsection (a) during the period covered by the reVerDate Sep 11 2014 23:00 Mar 07, 2019 Jkt 089200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S629.IS S629

kjohnson on DSK79L0C42 with BILLS
15 

•S 629 IS

1 port, including an explanation of why a mobile deployment 

2 team was or was not provided, as the case may be. 

3 (c) APPROPRIATE COMMITTEES OF CONGRESS DE4 FINED.—In this section, the term ‘‘appropriate commit5 tees of Congress’’ means— 

6 (1) the Committee on Veterans’ Affairs and the 

7 Committee on Appropriations of the Senate; and 

8 (2) the Committee on Veterans’ Affairs and the 

9 Committee on Appropriations of the House of Rep10 resentatives. 

11 SEC. 6. EXAMINATION OF HEALTH CARE CONSULTATION 

12 AND SCHEDULING POSITIONS OF DEPART13 MENT OF VETERANS AFFAIRS. 

14 (a) PROPER GRADING OF CONSULTATION AND

15 SCHEDULING POSITIONS.— 

16 (1) IN GENERAL.—The Secretary of Veterans 

17 Affairs shall conduct an examination of health care 

18 positions of the Department of Veterans Affairs to 

19 determine whether health care positions involved in 

20 the consultation and scheduling processes are appro21 priately graded. 

22 (2) CONSULTATION.—In conducting the exam23 ination under paragraph (1), the Secretary shall 

24 consult with health care staffing experts in the Fed25 eral Government and the private sector. 


kjohnson on DSK79L0C42 with BILLS
16 

•S 629 IS

1 (3) SUBMITTAL TO CONGRESS.—Not later than 

2 120 days after the date of the enactment of this Act, 

3 the Secretary shall submit to the appropriate com4 mittees of Congress the results of the examination 

5 conducted under paragraph (1). 

6 (b) REVIEW OF ONBOARDING PROCESS.—Not later 

7 than 180 days after the date of the enactment of this Act, 

8 the Secretary shall submit to the appropriate committees 

9 of Congress— 

10 (1) a review of the onboarding process of indi11 viduals in health care positions described in sub12 section (a), including how long it takes to hire those 

13 individuals; and 

14 (2) a description of any changes that the Sec15 retary has made or plans to make to improve that 

16 process. 

17 (c) APPROPRIATE COMMITTEES OF CONGRESS DE18 FINED.—In this section, the term ‘‘appropriate commit19 tees of Congress’’ means— 

20 (1) the Committee on Veterans’ Affairs and the 

21 Committee on Appropriations of the Senate; and 

22 (2) the Committee on Veterans’ Affairs and the 

23 Committee on Appropriations of the House of Rep24 resentatives. 

Æ 


kjohnson on DSK79L0C42 with BILLS