79–006 

115TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 115–872 

VA HOSPITALS ESTABLISHING LEADERSHIP 

PERFORMANCE ACT 

JULY 24, 2018.—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. 5864] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Veterans’ Affairs, to whom was referred the 

bill (H.R. 5864) to direct the Secretary of Veterans Affairs to establish qualifications for the human resources positions within the 

Veterans Health Administration 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 .................................................................. 5 

Committee Cost Estimate ....................................................................................... 5 

Congressional Budget Office Estimate ................................................................... 5 

Federal Mandates Statement ................................................................................. 6 

Advisory Committee Statement .............................................................................. 6 

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 

2 

1 VA Fiscal Year 2019 Budget Submission, Volume II—Medical Programs and Information 

Technology Programs, VHA–55. 2 United States Cong. House Committee on Veterans’ Affairs Subcommittee on Health and 

Subcommittee on Economic Opportunity. ‘‘Legislative Hearing.’’ March 16, 2016. 114th Cong. 

2nd sess. Washington: GPO, 2016 (testimony of Max Stier, President and Chief Executive Officer, Partnership for Public Service.) 3 VA Office of the Inspector General 18–01693–196, June 2018, ‘‘OIG Determination of Veterans Health Administration’s Occupational Staffing Shortages,’’ https://www.va.gov/oig/pubs/ 

VAOIG-18-01693-196.pdf. 4 Ibid. 

5 Ibid. 

PURPOSE AND SUMMARY

H.R. 5864, the VA Hospitals Establishing Leadership Performance (VA HELP) Act, would require the Department of Veterans 

Affairs (VA) to establish qualification standards and performance 

metrics for human resources (HR) professionals working within the 

Veterans Health Administration (VHA). Representative Mike Bost 

of Illinois introduced H.R. 5864 on May 17, 2018. 

BACKGROUND AND NEED FOR LEGISLATION

The vast majority—88 percent—of VA employees work for the 

Veterans Health Administration (VHA), which manages and oversees the VA healthcare system.1 VHA’s effectiveness is hampered 

by nationwide recruitment and retention issues that are worsened 

by an aging workforce that is becoming increasingly retirement-eligible.2

In recognition of this, Congress acted in section 301 of the Veterans Access, Choice, and Accountability Act of 2014 (P.L. 113–146) 

to require the VA Inspector General (IG) to identify and publish 

the five occupations of health care providers with the largest staffing shortages across VHA and authorize direct hiring authority to 

fill those shortages. The resulting reports, which have been released annually since 2014, found a consistent need for physicians, 

nurses, psychologists, physician assistants, medical technologists, 

and physical therapists.3 Congress modified this reporting requirement in section 201 of the VA Choice and Quality Employment Act 

of 2017 (Public Law 115–46; 131 STAT. 958) to require the IG to 

identify both clinical and non-clinical occupations with the largest 

staffing shortages within each VA medical center. This was intended to allow for the improved identification of local staffing 

needs, which could vary significantly, as well as the improved utilization of direct hiring authority to address those needs. The modified report, which was released for the first time in 2018, found 

that physicians and nurses remained the top two most commonly 

cited clinical shortage occupations and that HR professionals were 

the most commonly cited non-clinical shortage occupation.4 The IG 

also found several challenges to improved recruitment and retention across VHA, including a lack of qualified applicants, non-competitive salaries, high turnover, and geographic concerns such as 

urban areas with highly-competitive labor markets and rural areas 

with serious labor market shortages.5 These findings are substantively similar to findings made in 2016 by the Commission on 

Care, which concluded that: 

VHA has staffing shortages and vacancies at every level of 

the organization and across numerous critical positions, including facility leadership, clinical staff, supply chain perVerDate Sep 11 2014 02:56 Jul 30, 2018 Jkt 079006 PO 00000 Frm 00002 Fmt 6659 Sfmt 6602 E:\HR\OC\HR872.XXX HR872
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6 Commission on Care, June 30, 2016, ‘‘Commission on Care Final Report,’’ https:// 

s3.amazonaws.com/sitesusa/wp-content/uploads/sites/912/2016/07/Commission-on-Care_FinalReport_063016_FOR-WEB.pdf. 7 United States Cong. House Committee on Veterans’ Affairs Subcommittee on Health. ‘‘Legislative Hearing.’’ June 13, 2018. 115th Cong. 2nd sess. Washington: GPO, 2018 (testimony of Jeremy M. Villanueva, Associate National Legislative Director, Disabled American Veterans). 

sonnel, and customer service staff. VHA lacks competitive 

pay, must use inflexible hiring processes, and continues to 

use a talent management approach from the last century. 

A confusing mix of personnel authorities and position 

standards make staffing and management a struggle for 

both supervisors and human resources personnel.6

The Committee concurs with that assessment, as well as with 

the Disabled American Veterans’ comment in testimony regarding 

this bill that, ‘‘[while] VA acknowledges the need for reforming its 

human capital management system . . . leadership has not always 

provided strong guidance, oversight, or resource support to carry 

out such reforms.’’ 7 Given that, the Committee has become increasingly concerned in recent years that VHA HR professionals may 

not have the necessary qualifications to adequately fulfill their obligations. This concern has been compounded by several Committee 

investigations which found VHA HR professionals with substandard educational and professional backgrounds—including one 

HR Director at a VA medical center who lacked both a college degree and relevant work experience. Given the direct impact that 

staffing shortages have on VHA’s ability to ensure timely access to 

quality care for veteran patients, the Committee believes that improving VHA’s HR functions should be a priority for the Department. Accordingly, section 2 of the bill would require VA, within 

180 days of enactment, to establish qualification standards and 

standardized performance metrics for HR positions within VHA. To 

ensure transparency and to aid the Committee in ongoing oversight 

of VA hiring, section 2 of the bill would require VA to provide such 

standards and metrics to Congress once they have been established 

and also require the Government Accountability Office to assess 

their quality and implementation and report to Congress with their 

findings. 

HEARINGS

On June 13, 2018, the Subcommittee on Health conducted a legislative hearing on a number of bills including H.R. 5864. 

The following witnesses testified: 

The Honorable Vicky Hartzler, U.S. House of Representatives, 4th District, Missouri; The Honorable Marcy Kaptur, 

U.S. House of Representatives, 9th District, Ohio; The Honorable Matt Cartwright, U.S. House of Representatives,17th District, Pennsylvania; The Honorable Clay Higgins, U.S. House 

of Representatives, 3rd District, Louisiana; The Honorable 

Mike Bost, U.S. House of Representatives, 12th District, Illinois; The Honorable Jeff Denham, U.S. House of Representatives, 10th District, California; The Honorable Jenniffer 

Gonza ́lez-Colo ́n, U.S. House of Representatives, Puerto Rico; 

The Honorable Brad Wenstrup, U.S. House of Representatives, 

2nd District, Ohio; Roscoe Butler, Deputy Director for Health 

Care, Veterans Affairs and Rehabilitation, The American LeVerDate Sep 11 2014 02:56 Jul 30, 2018 Jkt 079006 PO 00000 Frm 00003 Fmt 6659 Sfmt 6602 E:\HR\OC\HR872.XXX HR872
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gion; Jeremy Villanueva, Associate National Legislative Director, Disabled American Veterans; Kayda Keleher, Associate Director, National Legislative Service, Veterans of Foreign Wars 

of the United States; and Jessica Bonjorni MBA, PMP, SPHR, 

Acting Assistant Deputy Under Secretary for Health for Workforce Services, Veterans Health Administration, U.S. Department of Veterans Affairs, who was accompanied by Dayna Cooper MSN, RN, Director, Home and Community-Based Programs, Veterans Health Administration, U.S. Department of 

Veterans Affairs. 

Statements for the record were submitted by: 

American Orthotic and Prosthetic Association, Paralyzed 

Veterans of America, and Military Officers Association of 

America. 

SUBCOMMITTEE CONSIDERATION

On June 27, 2018, the Subcommittee on Health met in open 

markup session, a quorum being present, and favorably forwarded 

H.R. 5864 to the full Committee. 

COMMITTEE CONSIDERATION

On July 12, 2018, the full Committee met in open markup session, a quorum being present, and ordered H.R. 5864 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. 5864 reported to 

the House. A motion by Representative Tim Walz of Minnesota— 

the Ranking Member of the Committee on Veterans’ Affairs—to report H.R. 5864 favorably to the House of Representatives was 

adopted 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 improve the HR functioning across the VA 

healthcare system. 

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. 

5 

EARMARKS AND TAX AND TARIFF BENEFITS

H.R. 5864 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. 5864 

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. 5864 

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

U.S. CONGRESS, CONGRESSIONAL BUDGET OFFICE, Washington, DC, July 18, 2018. 

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. 5864, the VA Hospitals 

Establishing Leadership Performance 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, 

MARK P. HADLEY

(For Keith Hall, Director). 

Enclosure. 

H.R. 5864—VA Hospitals Establishing Leadership Performance Act 

Within 180 days of enactment, H.R. 5864 would require the Department of Veterans Affairs (VA) to establish qualifications and 

performance metrics for each human resource position with the 

Veterans Health Administration. Within one year of enactment, the 

bill also would require VA and the Government Accountability Office to report to the Congress on the qualifications and standardized performance metrics for those positions. Based on the resources needed to address similar requirements, CBO estimates 

that implementing this bill would cost less than $500,000 over the 

2019–2023 period; such spending would be subject to the availability of appropriated funds. 

Enacting H.R. 5864 would not affect direct spending or revenues; 

therefore, pay-as-you-go procedures do not apply. 

CBO estimates that enacting H.R. 5864 would not increase net 

direct spending or on-budget deficits in any of the four consecutive 

10-year periods beginning in 2029. 

H.R. 5864 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 reviewed by Leo Lex, Deputy Assistant Director for 

Budget Analysis. 

6 

FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of Federal mandates regarding H.R. 5864 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. 5864. 

STATEMENT OF CONSTITUTIONAL AUTHORITY

Pursuant to Article I, section 8 of the United States Constitution, 

H.R. 5864 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. 5864 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 clause 3(c)(5) of rule XIII of the Rules of the House 

of Representatives, the Committee finds that no provision of H.R. 

5864 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, 115th Cong. (2017), the 

Committee estimates that H.R. 5864 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 a short title of the bill as the 

‘‘VA Hospitals Establishing Leadership Performance (VA HELP) 

Act’’. 

Section 2. Qualifications for human resources positions within the 

Veterans Health Administration of the Department of Veterans 

Affairs 

Section 2(a) of the bill would require VA, not later than 180 days 

after the date of enactment of this Act, to: establish qualifications 

for each human resources position within the Veterans Health Administration; establish standardized performance metrics for each 

such position; and to submit to Congress a report containing such 

qualifications and standardized metrics. 

Section 2(b) of the bill would require the Comptroller General of 

the United States, not later than 180 days after the establishment 

7 

of the qualifications and performance metrics under subsection (a), 

to submit to the Committee on Veterans’ Affairs of the House of 

Representatives and the Committee on Veterans’ Affairs of the 

Senate a report containing a description of the implementation of 

such qualifications and performance metrics and an assessment of 

the quality of such qualifications and performance metrics. 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

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

Æ