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[House Report 115-872]
[From the U.S. Government Publishing Office]

115th Congress     }                                {          Report
                        HOUSE OF REPRESENTATIVES
 2d Session        }                                {          115-872

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          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

                          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\
---------------------------------------------------------------------------
    \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.)
---------------------------------------------------------------------------
    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:
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    \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.

        VHA has staffing shortages and vacancies at every level 
        of the organization and across numerous critical 
        positions, including facility leadership, clinical 
        staff, supply chain personnel, 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\
---------------------------------------------------------------------------
    \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_Final- Report_063016_FOR-WEB.pdf.

    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.
---------------------------------------------------------------------------
    \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).
---------------------------------------------------------------------------

                                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 Gonzalez-Colon, 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 
        Legion; 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.

                  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.

                       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 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.

                                  [all]
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