II 

115TH CONGRESS 

2D SESSION S. 2357 

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 

JANUARY 30, 2018 

Mr. TESTER (for himself, Mrs. MURRAY, Mr. BLUMENTHAL, and Mr. 

MANCHIN) 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’’. 


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

3 FROM DEPARTMENT OF VETERANS AFFAIRS. 

4 (a) PROCESSES AND REQUIREMENTS.—Not later 

5 than 60 days after the date of the enactment of this Act, 

6 the Secretary of Veterans Affairs shall submit to the Com7 mittee on Veterans’ Affairs of the Senate and the Com8 mittee on Veterans’ Affairs of the House of Representa9 tives a description of the processes and requirements for 

10 scheduling appointments for health care from the Depart11 ment of Veterans Affairs at the medical facility level to 

12 be used by the Department. 

13 (b) TRAINING ON PROCESSES AND REQUIRE14 MENTS.— 

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

16 after the date of the enactment of this Act, the Sec17 retary shall require individuals involved in the sched18 uling of appointments for health care from the De19 partment to certify to the Secretary that the indi20 vidual understands the processes and requirements 

21 described in subsection (a). 

22 (2) NEW EMPLOYEES.—The Secretary shall re23 quire all employees hired by the Department after 

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

25 involved in the scheduling of appointments for health 

26 care from the Department to undergo training on 


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1 the processes and requirements described in sub2 section (a) as part of the onboarding process. 

3 (c) METHOD TO MONITOR COMPLIANCE.— 

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

5 after the date of the enactment of this Act, the Sec6 retary shall establish or maintain a method or tool 

7 to monitor and ensure that each medical facility of 

8 the Department complies with the processes and re9 quirements described in subsection (a). 

10 (2) USE THROUGHOUT DEPARTMENT.— 

11 (A) IN GENERAL.—The Secretary shall re12 quire each medical facility of the Department to 

13 use the method or tool described in paragraph 

14 (1). 

15 (B) CERTIFICATION.—Not later than one 

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

17 the Secretary shall require the director of each 

18 medical facility of the Department to certify to 

19 the Secretary that the director is using the 

20 method or tool described in paragraph (1). 

21 (3) AUDITS.— 

22 (A) IN GENERAL.—Not less frequently 

23 than twice each year, the Secretary shall pro24 vide for the conduct of facility-level audits of 

25 the scheduling of appointments, which shall inVerDate Sep 11 2014 03:35 Jan 31, 2018 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2357.IS S2357

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1 clude recommendations for corrective action, in2 cluding additional training, increased personnel, 

3 and such other resources as the Secretary con4 siders necessary. 

5 (B) TRANSMITTAL TO VHA.—Any audits 

6 conducted under subparagraph (A) shall be 

7 transmitted to the Under Secretary for Health 

8 of the Department so that the Under Secretary 

9 can— 

10 (i) strengthen oversight of those au11 dits; 

12 (ii) monitor national policy on the 

13 scheduling of appointments throughout the 

14 Department; 

15 (iii) determine if a mobile deployment 

16 team is warranted; and 

17 (iv) develop a remediation plan to ad18 dress issues uncovered by those audits. 

19 (4) REPORTING OF SCHEDULING ISSUES.—The 

20 Secretary shall require each director of a medical 

21 center of the Department— 

22 (A) to submit to the Under Secretary for 

23 Health, not less frequently than quarterly, a re24 port containing any scheduling issues that are 

25 uncovered at that medical center; 


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1 (B) to identify any corrective actions to be 

2 taken with respect to such issues, including in3 creased training or hiring; and 

4 (C) to certify to the Secretary that the di5 rector is in compliance with requirements of 

6 subparagraphs (A) and (B). 

7 SEC. 3. ADMINISTRATION OF NON-DEPARTMENT OF VET8 ERANS AFFAIRS HEALTH CARE. 

9 (a) CERTIFICATION OF PROPER ADMINISTRATION.— 

10 (1) REVIEW.— 

11 (A) IN GENERAL.—The Secretary of Vet12 erans Affairs shall conduct a review of the 

13 staffing, training, and other requirements nec14 essary to administer section 101 of the Vet15 erans Access, Choice, and Accountability Act of 

16 2014 (Public Law 113–146; 38 U.S.C. 1701 

17 note) and any other community care program of 

18 the Department of Veterans Affairs. 

19 (B) ELEMENTS.—The review conducted 

20 under paragraph (1) shall include, with respect 

21 to each medical facility of the Department, an 

22 assessment of the type of positions required to 

23 be staffed, the number of such positions at the 

24 medical facility, and the number filled at the 

25 medical facility. 


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

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

3 every 180 days thereafter, the Secretary of Veterans 

4 Affairs shall submit to the Committee on Veterans’ 

5 Affairs of the Senate and the Committee on Vet6 erans’ Affairs of the House of Representatives the 

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

8 including a certification that all staffing, training, 

9 and other requirements described in paragraph 

10 (1)(A) are fulfilled. 

11 (b) SCHEDULING OF APPOINTMENTS.— 

12 (1) IN GENERAL.—The Secretary shall be re13 sponsible for ensuring that appointments for health 

14 care from non-Department health care providers 

15 under the laws administered by the Secretary are 

16 scheduled. 

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

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

19 Secretary shall establish timeliness goals for each 

20 step in scheduling an appointment for health care 

21 from a non-Department health care provider. 

22 (3) MEASUREMENT OF TIMELINESS FOR EACH

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

24 of the enactment of this Act, the Secretary shall 

25 measure, for each medical facility of the DepartVerDate Sep 11 2014 03:35 Jan 31, 2018 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S2357.IS S2357

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1 ment, the time it takes from the date that a clinician 

2 of the Department determines that a veteran re3 quires care from a non-Department health care pro4 vider to each of the following: 

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

6 sent to the non-Department health care pro7 vider. 

8 (B) The date that the non-Department 

9 health care provider accepts the referral. 

10 (C) The date that the appointment with 

11 the non-Department health care provider is 

12 made. 

13 (D) The date of the appointment with the 

14 non-Department health care provider. 

15 (E) Any other step that the Secretary de16 termines necessary to measure. 

17 (4) PUBLICATION OF DATA.— 

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

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

20 Secretary shall publish the data measured 

21 under paragraph (3), disaggregated by medical 

22 facility, on a publicly available Internet website 

23 of the Department. 


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1 (B) UPDATE.—Not less frequently than bi2 weekly, the Secretary shall update the data 

3 published under subparagraph (A). 

4 (c) COMPTROLLER GENERAL REPORT.— 

5 (1) IN GENERAL.—Beginning not later than 

6 one year after the date of the enactment of this Act, 

7 the Comptroller General of the United States shall 

8 review compliance by the Secretary with the require9 ments of this section, including a review of the ve10 racity of data published by the Secretary under sub11 section (b)(4). 

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

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

14 Comptroller General shall submit to the Committee 

15 on Veterans’ Affairs of the Senate and the Com16 mittee on Veterans’ Affairs of the House of Rep17 resentatives the results of the review conducted 

18 under paragraph (1). 

19 SEC. 4. ADMINISTRATION OF CONSULTATIONS FOR 

20 HEALTH CARE FROM DEPARTMENT OF VET21 ERANS AFFAIRS. 

22 (a) ADMINISTRATION OF OUTPATIENT CONSULTA23 TION REQUESTS.— 

24 (1) NATIONAL PROCESS.—Not later than 180 

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


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1 Secretary of Veterans Affairs shall establish a na2 tional process to track and process outpatient clin3 ical consultation requests. 

4 (2) TRAINING.—Not later than one year after 

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

6 shall ensure that all individuals involved in the proc7 ess of scheduling outpatient clinical consultations 

8 are properly trained. 

9 (3) CERTIFICATION.— 

10 (A) IN GENERAL.—The Secretary shall en11 sure that directors of medical centers and Vet12 erans Integrated Service Networks of the De13 partment of Veterans Affairs certify compli14 ance, on a quarterly basis, with the national 

15 process established under paragraph (1). 

16 (B) ELEMENTS.—The certification under 

17 subparagraph (A) shall include the following: 

18 (i) An assessment of whether con19 sultations were appropriately processed. 

20 (ii) Data with respect to consultations 

21 as follows: 

22 (I) Consultations that were 

23 scheduled within the request window. 

24 (II) Duplicate consultation re25 quests. 


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1 (III) Consultations that were dis2 continued. 

3 (IV) Delays in consultations. 

4 (V) Consultations that were not 

5 properly closed. 

6 (iii) For consultations that were im7 properly discontinued, a description of re8 mediation attempts. 

9 (4) REQUESTS FOR MOBILE DEPLOYMENT

10 TEAMS.— 

11 (A) IN GENERAL.—A director of a medical 

12 center of the Department shall request from the 

13 Secretary a mobile deployment team under the 

14 program established under section 6 if the re15 quirements of the national process established 

16 under paragraph (1) have not been met with re17 spect to a facility under the jurisdiction of the 

18 director. 

19 (B) REPORT.—Not less frequently than 

20 once every 180 days, the Secretary shall submit 

21 to the appropriate committees of Congress a re22 port setting forth each request under subpara23 graph (A) during the period covered by the re24 port, including an explanation of why a mobile 


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1 deployment team was or was not provided, as 

2 the case may be. 

3 (b) INITIAL REVIEW.— 

4 (1) IN GENERAL.—The Secretary shall review 

5 the processes and requirements of the Department 

6 with respect to consultations for health care under 

7 the laws administered by the Secretary. 

8 (2) REPORT.—Not later than 180 days after 

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

10 shall submit to the appropriate committees of Con11 gress a report on the results of the review conducted 

12 under paragraph (1). 

13 (c) BIANNUAL REVIEW.—Not later than 180 days 

14 after the date of the enactment of this Act, and every 180 

15 days thereafter, the Secretary shall conduct a review of 

16 consultations conducted at each medical facility of the De17 partment that includes the following: 

18 (1) A review of the accuracy of the type of serv19 ice, either administrative or clinical, that is inputted 

20 in the electronic health record. 

21 (2) A review of the accuracy of the type of con22 sultation setting, either inpatient or outpatient, that 

23 is inputted in the electronic health record. 


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1 (3) A review of the appropriateness of the level 

2 of urgency of the consultation that is inputted in the 

3 electronic health record. 

4 (4) A review of any delayed or unresolved con5 sultations. 

6 (5) A determination of the timeliness of con7 sultations based on guidance set forth by the Under 

8 Secretary for Health of the Department. 

9 (d) APPROPRIATE COMMITTEES OF CONGRESS DE10 FINED.—In this section, the term ‘‘appropriate commit11 tees of Congress’’ means— 

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

13 Committee on Appropriations of the Senate; and 

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

15 Committee on Appropriations of the House of Rep16 resentatives. 

17 SEC. 5. MEASUREMENT OF TIMELINESS FOR REFERRALS 

18 FOR HEALTH CARE AMONG HEALTH CARE 

19 PROVIDERS OR FACILITIES OF DEPARTMENT 

20 OF VETERANS AFFAIRS. 

21 (a) IN GENERAL.—With respect to referrals for 

22 health care between health care providers or facilities of 

23 the Department of Veterans Affairs, not later than 120 

24 days after the date of the enactment of this Act, the Sec25 retary of Veterans Affairs shall measure, for each medical 


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1 facility of the Department, the time it takes from the date 

2 that a clinician of the Department determines that a vet3 eran requires care from another health care provider or 

4 facility to each of the following: 

5 (1) The date that the referral for care is sent 

6 to the other health care provider or facility. 

7 (2) The date that the other health care provider 

8 or facility accepts the referral. 

9 (3) The date that the appointment with the 

10 other health care provider or at the other facility is 

11 made. 

12 (4) The date of the appointment with the other 

13 health care provider or at the other facility. 

14 (5) Any other step that the Secretary deter15 mines necessary to measure. 

16 (b) PUBLICATION OF DATA.—Not later than one year 

17 after the date of the enactment of this Act, the Secretary 

18 shall publish the data measured under subsection (a), 

19 disaggregated by medical facility, on a publicly available 

20 Internet website of the Department. 

21 SEC. 6. EXAMINATION OF HEALTH CARE CONSULTATION 

22 AND SCHEDULING POSITIONS OF DEPART23 MENT OF VETERANS AFFAIRS. 

24 (a) PROPER GRADING OF CONSULTATION AND

25 SCHEDULING POSITIONS.— 


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

2 Affairs shall conduct an examination of health care 

3 positions of the Department of Veterans Affairs to 

4 determine whether health care positions involved in 

5 the consultation and scheduling processes are appro6 priately graded. 

7 (2) SUBMITTAL TO CONGRESS.—Not later than 

8 120 days after the date of the enactment of this Act, 

9 the Secretary shall submit to the appropriate com10 mittees of Congress the results of the examination 

11 conducted under paragraph (1). 

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

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

14 the Secretary shall submit to the appropriate committees 

15 of Congress— 

16 (1) a review of the onboarding process of indi17 viduals in health care positions described in sub18 section (a), including how long it takes to hire those 

19 individuals; and 

20 (2) a description of any changes that the Sec21 retary has made or plans to make to improve that 

22 process. 

23 (c) APPROPRIATE COMMITTEES OF CONGRESS DE24 FINED.—In this section, the term ‘‘appropriate commit25 tees of Congress’’ means— 


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

2 Committee on Appropriations of the Senate; and 

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

4 Committee on Appropriations of the House of Rep5 resentatives. 

6 SEC. 7. PROGRAM TO FURNISH MOBILE DEPLOYMENT 

7 TEAMS TO MEDICAL FACILITIES THAT RE8 QUIRE ASSISTANCE. 

9 (a) IN GENERAL.—The Secretary of Veterans Affairs 

10 shall establish a program to furnish mobile deployment 

11 teams of scheduling and medical personnel to medical fa12 cilities of the Department that require assistance. 

13 (b) ELEMENTS.—In furnishing a mobile deployment 

14 team to a medical facility under subsection (a), including 

15 the particular personnel to be included, the Secretary shall 

16 consider the following elements: 

17 (1) The scheduling needs of the facility. 

18 (2) The unfilled medical positions at the facil19 ity. 

20 (3) The number of open consultations at the fa21 cility. 

22 (4) The results of scheduler audits conducted 

23 under section 2(d)(3). 


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1 (5) Requests under section 4(a)(4) for mobile 

2 deployment teams due to a failure of the facility to 

3 meet consultation requirements. 

4 (6) Such other elements as the Secretary con5 siders necessary for effective oversight of the pro6 gram established under subsection (a). 

7 (c) COMPLETION OF DUTY.—In carrying out the pro8 gram under this section, the Secretary shall require each 

9 mobile deployment team furnished to a medical facility 

10 under subsection (a) to develop a remediation plan that, 

11 upon completion, terminates the deployment of the team 

12 to that facility. 

Æ 


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