I 

113TH CONGRESS 

2D SESSION H. R. 5618 

To establish a pilot program to improve the management and accountability 

within the Veterans Health Administration of the Department of Veterans Affairs, to provide oversight of the Veterans Health Administration, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 18, 2014 

Mr. KILMER (for himself, Mr. CUELLAR, Mr. CARNEY, Mr. BARBER, and Mr. 

GALLEGO) introduced the following bill; which was referred to the Committee on Veterans’ Affairs, and in addition to the Committee on the 

Budget, for a period to be subsequently determined by the Speaker, in 

each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To establish a pilot program to improve the management 

and accountability within the Veterans Health Administration of the Department of Veterans Affairs, to provide 

oversight of the Veterans Health Administration, 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 ‘‘Veterans Health Ad5 ministration Management Improvement Act’’. 


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1 SEC. 2. COMPTROLLER GENERAL MANAGEMENT REVIEW 

2 OF VETERANS HEALTH ADMINISTRATION. 

3 (a) MANAGEMENT REVIEW.— 

4 (1) IN GENERAL.—During the five-year period 

5 beginning on the date of the enactment of this Act, 

6 the Comptroller General of the United States shall 

7 conduct a management review of the Veterans 

8 Health Administration of the Department of Vet9 erans Affairs. 

10 (2) MATTERS INCLUDED.—The management 

11 review under paragraph (1) shall include a review, 

12 with respect to the Veterans Health Administration, 

13 of the following: 

14 (A) The management structure, including 

15 the roles and responsibilities among the various 

16 organizational components (local facilities, re17 gional networks, and the central office). 

18 (B) The oversight of core functions, includ19 ing the extent to which lines of accountability 

20 are clearly delineated. 

21 (C) The evaluation plan, operations, and 

22 capacity to implement results-based strategic 

23 planning. 

24 (D) The extent to which contractors are 

25 used and monitored to support core manage26 ment functions. 


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1 (E) Internal communication mechanisms, 

2 including expectations for communications, that 

3 support the mission. 

4 (F) The setting of priorities and the moni5 toring of such priorities. 

6 (G) Budgeting and resource allocation 

7 processes. 

8 (H) Workforce planning. 

9 (I) Human capital processes, including 

10 training activities, to ensure timely hiring and 

11 effective retention of a qualified workforce. 

12 (J) Information technology to support core 

13 functions and activities. 

14 (K) How each of the matters described in 

15 subparagraphs (A) through (J) may differ for 

16 rural medical facilities of the Department of 

17 Veterans Affairs. 

18 (L) Incentives, including any perverse in19 centives, affecting employee actions, quality of 

20 care, and the provision of services. 

21 (M) Insights from employees and employee 

22 representatives about the work environment and 

23 the level of engagement of such employees as 

24 can be derived from the results of the annual 

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1 veys administered by the Secretary of Veterans 

2 Affairs. 

3 (N) Insights on the findings of the Comp4 troller General from veteran service organiza5 tions, organizations representing employees of 

6 the Veterans Health Administration, other 

7 stakeholders, and the Management and Ac8 countability Ombudsman described in section 

9 312B of title 38, United States Code, as added 

10 by section 4. 

11 (b) REPORTS.—Not later than one year after the date 

12 of the enactment of this Act, and annually thereafter for 

13 a four-year period, the Comptroller General shall submit 

14 to Congress one or more reports that include— 

15 (1) the matters reviewed under subsection 

16 (a)(1); and 

17 (2) recommendations of the Comptroller Gen18 eral based on such matters. 

19 SEC. 3. PILOT PROGRAM TO IMPROVE MANAGEMENT AND 

20 ACCOUNTABILITY OF VETERANS HEALTH AD21 MINISTRATION. 

22 (a) ESTABLISHMENT.—The Secretary of Veterans 

23 Affairs shall establish a pilot program to improve the man24 agement and accountability within the Veterans Health 

25 Administration. 


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1 (b) GOALS OF PILOT PROGRAM.—The Secretary shall 

2 carry out the pilot program under subsection (a) in a man3 ner that ensures that— 

4 (1) the employees of the Veterans Health Ad5 ministration have an opportunity to learn, imple6 ment, and identify successful means of advancing 

7 the management of the Veterans Health Administra8 tion and the delivery of care and services; and 

9 (2) the management and delivery of care and 

10 services at medical facilities of the Department is 

11 improved by implementing the recommendations of 

12 the Comptroller General of the United States based 

13 on the management review conducted under section 

14 2, and any other appropriate recommendations, with 

15 respect to the planning and evaluation capabilities of 

16 the Veteran Health Administration. 

17 (c) APPLICATION OF CERTAIN LAWS DURING PILOT

18 PROGRAM.— 

19 (1) APPLICATION OF PERFORMANCE PLAN RE20 QUIREMENTS.—During the period in which the Sec21 retary carries out the pilot program under sub22 section (a), the Secretary shall carry out section 

23 1115(b) of title 31, United States Code, as follows: 

24 (A) In paragraph (2), by substituting ‘‘, 

25 unless authorized to be in an alternative form 


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1 under subsection (c), and situate each goal in 

2 the context of its own logic modeling of how the 

3 operations and activities of the agency, in co4 ordination with any significant operations and 

5 activities from external entities, will contribute 

6 toward achieving the goals and responsibilities 

7 of the agency;’’ for ‘‘unless authorized to be in 

8 an alternative form under subsection (c);’’. 

9 (B) By including in the agency perform10 ance plan described in such section 1115(b), for 

11 each performance goal covered by the plan, an 

12 identification and assessment of the risks of 

13 creating new, or perpetuating existing, perverse 

14 incentives, and strategies for risk assessment, 

15 monitoring, and mitigation, using a suitable 

16 risk management approach. 

17 (2) APPLICATION OF PERFORMANCE REPORT18 ING REQUIREMENTS.—During the period in which 

19 the Secretary carries out the pilot program under 

20 subsection (a), the Secretary shall carry out sub21 section (c) of section 1116 of title 31, United States 

22 Code, by including in the update required by such 

23 subsection statistical information regarding the Vet24 erans Health Administration that— 


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1 (A) is useful to multiple stakeholders for 

2 internal management and external oversight; 

3 and 

4 (B) provides insight into how programs are 

5 planned, financed, and managed, regarding— 

6 (i) the population of veterans, impor7 tant subgroups thereof, and the status of 

8 such veterans; 

9 (ii) the capacity of the operations of 

10 the Veterans Health Administration under 

11 enacted resource levels, listed by important 

12 subcategories as appropriate; and 

13 (iii) the workload of the Veterans 

14 Health Administration, listed by important 

15 subcategories as appropriate. 

16 (3) APPLICATION OF FUNCTIONS OF CHIEF OP17 ERATING OFFICER.—During the period in which the 

18 Secretary carries out the pilot program under sub19 section (a), the Secretary shall carry out section 

20 1123(b)(1) of title 31, United States Code, by sub21 stituting ‘‘strategic and performance planning, 

22 measurement, evaluation, analysis, regular assess23 ment of progress, risk management (including the 

24 risks of perverse incentives), and use of performance 

25 information to improve the results achieved’’ for 


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1 ‘‘strategic and performance planning, measurement, 

2 analysis, regular assessment of progress, and use of 

3 performance information to improve the results 

4 achieved’’. 

5 (d) EVALUATION PLAN.—The Secretary shall pre6 pare an annual organization evaluation plan for the Vet7 erans Health Administration that is informed by the rec8 ommendations of the Comptroller General based on the 

9 management review conducted under section 2. 

10 (e) ASSISTANCE IN PILOT PROGRAM.—The Manage11 ment and Accountability Ombudsman described in section 

12 312B of title 38, United States Code, as added by section 

13 4(a), shall assist in the pilot program under subsection 

14 (a) by— 

15 (1) identifying areas in which employees of the 

16 Department have problems implementing the pilot 

17 program, including application of logic modeling, 

18 managing risk of perverse incentives, and other 

19 issues that the Ombudsman determine appropriate; 

20 (2) to the extent practicable, proposing changes 

21 in the administrative practices of the implementation 

22 of the pilot program to mitigate problems identified 

23 under paragraph (1); and 

24 (3) reviewing, examining, and making rec25 ommendations regarding logic modeling policies, 


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1 strategies, and programs of the Veterans Health Ad2 ministration. 

3 (f) BRIEFINGS.— 

4 (1) INITIAL BRIEFING.—Not later than 90 days 

5 before the Secretary commences the pilot program 

6 under subsection (a), the Secretary shall provide to 

7 the Committees on Veterans’ Affairs of the House of 

8 Representatives and the Senate and the Comptroller 

9 General a briefing on— 

10 (A) a logic model of how the features of 

11 the pilot program will address the problems 

12 identified in the management review conducted 

13 under section 2; and 

14 (B) such other items as the Secretary de15 termines appropriate. 

16 (2) UPDATES.—Not later than 240 days after 

17 the Secretary commences the pilot program under 

18 subsection (a), and annually thereafter during the 

19 period in which the Secretary carries out the pilot 

20 program, the Secretary shall provide to the Commit21 tees on Veterans’ Affairs of the House of Represent22 atives and the Senate and the Comptroller General 

23 a briefing on— 

24 (A) an evaluation of the implementation 

25 and effectiveness of carrying out this section, 


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1 including any challenges encountered and les2 sons learned; 

3 (B) planned actions to improve the success 

4 of the pilot program, including a milestone plan 

5 for such actions; and 

6 (C) such other items as the Secretary de7 termines appropriate. 

8 (g) DURATION.—The Secretary shall— 

9 (1) commence the pilot program under sub10 section (a) by not later than 180 days after the date 

11 on which the Comptroller General submits the report 

12 under section 2(b); and 

13 (2) carry out the pilot program for a period of 

14 five years. 

15 (h) DEFINITIONS.—In this section: 

16 (1) The term ‘‘logic modeling’’ means an ap17 proach, also referred to as program theory, program 

18 modeling, or theory of change, that articulates the 

19 assumptions of the strategy or tactics of a program 

20 or activity and how such strategy or tactics relate to 

21 the benefits that the program or activity is expected 

22 to contribute toward in order to achieve certain 

23 goals, objectives or responsibilities, and may in24 clude— 


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1 (A) the mapping of direct and indirect re2 lationships among relevant resources, activities, 

3 milestones, outputs, intermediate outcomes, and 

4 end outcomes; and 

5 (B) if significant coordination or coopera6 tion with entities external to a program or ac7 tivity may contribute to achieving the relevant 

8 goals, objectives, or responsibilities, the map9 ping of the roles of entities external to the pro10 gram or activity. 

11 (2) The term ‘‘risk management’’ means the 

12 processes that are used to identify, assess, monitor, 

13 mitigate, and report on risks to achieving the mis14 sions, goals, and objectives of a department, agency, 

15 or program using resources and processes appro16 priate to the nature of risks and resources available. 

17 SEC. 4. MANAGEMENT AND ACCOUNTABILITY OMBUDSMAN. 

18 (a) IN GENERAL.—Chapter 3 of title 38, United 

19 States Code, is amended by inserting after section 312A 

20 the following new section: 

21 ‘‘§ 312B. Management and accountability ombudsman 

22 ‘‘(a) IN GENERAL.—(1) There is in the Department 

23 an Office of the Management and Accountability Ombuds24 man (in this section referred to as the ‘Office’). There is 

25 at the head of the Office an Ombudsman, who shall be 


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1 appointed by the President from among individuals with 

2 a background in enterprise risk management. 

3 ‘‘(2) The Ombudsman shall report directly to the Sec4 retary but the Secretary may not prevent or prohibit the 

5 Ombudsman from initiating, carrying out, or completing 

6 any responsibility of the Ombudsman. 

7 ‘‘(3) The Secretary shall determine the appropriate 

8 level of staffing and distribution of responsibility to ensure 

9 the success of the Office. 

10 ‘‘(4) The President shall include in the budget trans11 mitted to the Congress for each fiscal year pursuant to 

12 section 1105 of title 31 an estimate of the amount for 

13 the Office that is sufficient to provide for a number of 

14 full-time positions in the Office. 

15 ‘‘(b) RESPONSIBILITIES.—The Ombudsman shall— 

16 ‘‘(1) receive and address reports from employ17 ees and employee representatives of the Veterans 

18 Health Administration Affairs and assist in resolv19 ing problems with the management, administration, 

20 and delivery of care of the Veterans Health Agency; 

21 ‘‘(2) communicate to the Secretary the observa22 tions and findings received pursuant to paragraph 

23 (1); 

24 ‘‘(3) conduct inspections of medical facilities of 

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1 Department facilities that provide care pursuant to 

2 a contract entered into under chapter 17 of this title 

3 as necessary; 

4 ‘‘(4) establish a program under which the Om5 budsman and the Secretary shall— 

6 ‘‘(A) provide incentives to employees of the 

7 Veterans Health Administration who suggest 

8 methods to improve the management and oper9 ations of the Veterans Health Administration; 

10 ‘‘(B) carry out in a pilot program the sug11 gestions that are likely to be successful; and 

12 ‘‘(C) if such a pilot program demonstrates 

13 that a suggestion causes a marked improvement 

14 in such management and operations— 

15 ‘‘(i) reward the employee who made 

16 such suggestion; and 

17 ‘‘(ii) carry out such suggestion 

18 throughout the Veterans Health Adminis19 tration; and 

20 ‘‘(5) not less frequently than once each calendar 

21 quarter, provide to the Secretary a summary and 

22 relevant statistics concerning the activities and find23 ings of the Ombudsman, including a summary of the 

24 suggestions made and carried out pursuant to para25 graph (4). 


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1 ‘‘(c) REQUEST FOR INVESTIGATIONS.—The Ombuds2 man may request the Inspector General of the Department 

3 to conduct an inspection, investigation, or audit. Upon 

4 such a request, the Inspector General shall respond to the 

5 Ombudsman explaining the plan of the Inspector General 

6 to comply with such request or the rationale of the Inspec7 tor General for denying such request. 

8 ‘‘(d) COORDINATION.—The Secretary shall ensure 

9 that each element of the Department has procedures to 

10 provide the Ombudsman with formal responses to any rec11 ommendation submitted by the Ombudsman to the head 

12 of such element. 

13 ‘‘(e) ANNUAL REPORTS.—Not later than June 30 of 

14 each year, the Ombudsman shall submit to the Commit15 tees on Veterans’ Affairs of the Senate and the House of 

16 Representatives a report on the objectives of the Ombuds17 man for the fiscal year beginning in such calendar year. 

18 Each report shall— 

19 ‘‘(1) contain a full and substantive analysis, in 

20 addition to statistical information; and 

21 ‘‘(2) set forth any recommendations the Om22 budsman has made on improving the management 

23 and accountability of the employees of the Depart24 ment and any responses received under subsection 


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1 (d) with respect to the estimates described in section 

2 117(b) of this title. 

3 ‘‘(f) RISK MANAGEMENT DEFINED.—In this section, 

4 the term ‘risk management’ means the processes that are 

5 used to identify, assess, monitor, mitigate, and report on 

6 risks to achieving a the mission, goals, and objectives of 

7 a department, agency, or program using resources and 

8 processes appropriate to the nature of risks and resources 

9 available.’’. 

10 (b) CLERICAL AMENDMENT.—The table of sections 

11 at the beginning of such chapter is amended by inserting 

12 after the item relating to section 312A the following new 

13 item: 

‘‘312B. Management and Accountability Ombudsman.’’. 

14 (c) COMPTROLLER GENERAL REPORTS.—The Comp15 troller General of the United States shall review each 

16 budget of the President submitted to Congress under sec17 tion 1105 of title 31 during 2015 through 2020 to evalu18 ate the proposed budget for health care provided by the 

19 Secretary of Veterans Affairs. The Comptroller General 

20 shall submit to the Committees on Veterans’ Affairs of 

21 the Senate and the House of Representatives a report con22 taining the results of each such review, at such times and 

23 with such additional matters as the Comptroller General 

24 determines appropriate in consultation with such commit25 tees. 


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1 SEC. 5. VETERANS’ BILL OF RIGHTS. 

2 (a) DISPLAY.—The Secretary of Veterans Affairs 

3 shall ensure that the Veterans’ Bill of Rights described 

4 in subsection (e) is printed on signage in accessible for5 mats and displayed prominently and conspicuously in each 

6 medical facility of the Department of Veterans Affairs in 

7 accordance with subsection (c). 

8 (b) EDUCATION OF DEPARTMENT EMPLOYEES.— 

9 The Secretary shall ensure that employees of the Depart10 ment receive training on the Veterans’ Bill of Rights de11 scribed in subsection (e). 

12 (c) OUTREACH.—The Secretary shall conduct out13 reach to inform veterans about the Veterans’ Bill of 

14 Rights described in subsection (e) by— 

15 (1) ensuring that such Bill of Rights is avail16 able on the Internet website of the Department and 

17 prominently displayed (using posters printed in a 

18 large type that allows for individuals with 20/20 vi19 sion to read the print from 10 feet away) in public 

20 spaces, lobbies, visitor centers, clinic waiting rooms, 

21 and patient sitting rooms of the Department; 

22 (2) briefing patients about such Bill of Rights 

23 when the patient enrolls in the system of patient en24 rollment system under section 1705 of title 38, 

25 United States Code; and 


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1 (3) conducting other types of outreach targeted 

2 at specific groups of veterans, which may include, at 

3 a minimum, outreach conducted on other Internet 

4 websites or through veterans service organizations, 

5 health fairs, and the Veterans Health Administra6 tion Veterans Center outreach program. 

7 (d) IMPLEMENTATION.—The Secretary shall ensure 

8 that the Veterans Health Administration honors the rights 

9 described in subsection (e). 

10 (e) VETERANS’ BILL OF RIGHTS.—The Veterans’ 

11 Bill of Rights described in this subsection is a statement 

12 that veterans should have, at a minimum and in addition 

13 to the rights covered by section 17.33 of title 38, Code 

14 of Federal Regulations, the following rights: 

15 (1) The right to access the highest quality care, 

16 including the right to the most appropriate tech17 nology and qualified practitioners. 

18 (2) The right to continuity of care in the transi19 tion from the health program of the Department of 

20 Defense to the health care system of the Depart21 ment of Veterans Affairs. 

22 (3) The right to receive assistance in under23 standing the available benefits and services to which 

24 the veteran is entitled. 


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1 (4) The right to receive a careful explanation of 

2 a proposed diagnostic or therapeutic procedure or 

3 course of treatment by the appropriate medical prac4 titioner, including with respect to the risks, com5 plications, alternatives, and results. 

6 (5) The right to ask questions concerning 

7 health treatment. 

8 (f) VETERANS’ BILL OF RIGHTS.—The Veterans’ Bill 

9 of Rights described in this subsection is a statement that 

10 veterans who receive health care provided under the laws 

11 administered by the Secretary of Veterans Affairs should 

12 have, at a minimum, the following rights (to the extent 

13 of the eligibility and enrollment of the veteran for such 

14 health care): 

15 (1) The right to access the highest quality care, 

16 including the right to the most appropriate tech17 nology and qualified practitioners. 

18 (2) The right to know what rules and regula19 tions apply to patients. 

20 (3) The right to continuity of care in the transi21 tion from the health program of the Department of 

22 Defense to the health care system of the Depart23 ment of Veterans Affairs. 

24 (4) The right to receive careful explanation of 

25 proposed diagnostic or therapeutic procedures or 


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1 courses of treatment by the responsible medical per2 sonnel, including with respect to risks, complica3 tions, alternative health practices, results, informa4 tion and reasoning for prescribed pain management 

5 plans, and a daily review of the medical chart of the 

6 patient. 

7 (5) The right for the patient to ask questions 

8 and be involved in all decisions regarding the care 

9 received by the patient. 

10 (6) The right to a second opinion or change of 

11 provider, if available. 

12 (7) The right to know the reason for any 

13 change in medical practitioners responsible for the 

14 care of the patient. 

15 (8) The right to know the identity and profes16 sional status of individuals providing service and to 

17 know who is primarily responsible for the care of the 

18 patient. 

19 (9) The right to not be transferred to another 

20 facility, organization, or department unless the pa21 tient receives a complete explanation for the need, 

22 was notified of alternatives, and the receiving orga23 nization, facility, or department is ready to accept 

24 the transfer. 


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1 (10) The right to receive considerate, respectful 

2 care at all times and under all circumstances with 

3 recognition of personal dignity, diversity, and reli4 gious, or other spiritual and cultural preferences. 

5 (11) The right, in accordance with relevant pro6 visions of law, to personal and informational con7 fidentiality and privacy in the discussion of the care 

8 and management of records of patients. 

9 (12) The right to visitors within the policies of 

10 the facility and to be informed of the visitation 

11 rights, including any clinically necessary restrictions. 

12 (13) The right to be free from all forms of 

13 abuse or harassment. 

14 (14) The right to access protective and advo15 cacy services, when available, and file grievances. 

16 (15) The right to remain free of chemical and 

17 physical restraints unless safety requires otherwise. 

18 (16) The right to care provided in a safe and 

19 clean setting, free from excessive noise and with suf20 ficient lighting for comfort and safety. 

Æ 


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