Sec. 102. Strategy regarding the High Performing Integrated Healthcare Network of the Department
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Subchapter III of chapter 17 is amended by inserting after section 1730A the following new section: Not later than one year after the date of the enactment of the Veterans Community Care and Access Act of 2017 and not less frequently than once every four years thereafter, the Secretary shall conduct a comprehensive examination (to be known as a quadrennial Veterans Health Administration review ) of programs and policies of the Department regarding the delivery of health care services and the need for health care services for veterans in future years.
The Secretary shall designate an individual in a Senior Executive Service position (as defined in section 3132(a) of title 5) or equivalent as the Director of the High-Performing Integrated Healthcare Network of the Department (in this section referred to as the Director ) who shall be responsible for carrying out this section and advising the Secretary and the Under Secretary for Health on matters pertaining to this section. Each quadrennial Veterans Health Administration review conducted under paragraph
(1)shall include a strategic plan to meet future requirements and demand for hospital care, medical services, and extended care services under the laws administered by the Secretary that includes a five-year budget forecast for meeting such requirements and demand based on the information contained in the market area assessments conducted under subsection
(c)and such other information as the Secretary considers appropriate. In preparing the quadrennial Veterans Health Administration review under paragraph (1), including the strategic plan under paragraph (3), the Secretary shall— consider the access and quality standards established under sections 1703B and 1703C of this title, respectively; consider the needs of the Department to furnish health care services to veterans based on— identified health care services that provide management of health conditions or disorders related to military service for which there is limited experience or access to such health care services from non-Department health care providers in the commercial market; the overall health of veterans throughout their lifespan; or such other services as the Secretary determines appropriate; consult with key stakeholders within the Department, the heads of other Federal agencies, and other relevant governmental and nongovernmental entities, including State, local, and tribal government officials, members of Congress, veterans service organizations, private sector representatives, academics, and other policy experts; identify emerging issues, trends, problems, and opportunities that could affect health care services furnished under the laws administered by the Secretary; develop recommendations regarding both short- and long-term priorities for health care services furnished under the laws administered by the Secretary; compare the Veterans Equitable Resource Allocation
(VERA)system to other resource allocation systems or models for the purpose of analyzing the effectiveness of such systems in allocating resources to furnish hospital care, medical services, and extended care services to veterans; and consider the work of the Center for Innovation for Care and Payment under section 1703F of this title with respect to research, development, and testing payment and service delivery models. The Director shall be responsible for the management, design, implementation, and assessment of the high-performing integrated healthcare network of the Department. In managing, designing, implementing, and assessing the high-performing integrated healthcare network of the Department under this subsection, the Director shall be responsible for the following: Overseeing the transformation and organizational change across the Department to achieve such high-performing integrated healthcare network. Developing and implementing the quadrennial Veterans Health Administration review and strategic plan under subsection (a). Overseeing the market area assessments performed under subsection (c). Developing the capital infrastructure planning and procurement processes, whether minor or major construction projects or leases, in coordination with other offices of the Department. Developing a multi-year budget process that is capable of forecasting future year budget requirements and projecting the cost of delivering health care services under a high-performing integrated healthcare network. To ensure that the Director is able to carry out the responsibilities under paragraph (2), the Secretary shall ensure that coordination and information sharing occurs with other relevant offices of the Department, including the following offices: The Office of Management. The Office of Acquisition, Logistics and Construction. The Office of Information and Technology. In carrying out this subsection, the Director shall confer with the Director of the Defense Health Agency and consider best practices and recommendations from non-Department entities, including entities carrying out market area assessments under subsection (c), that have developed plans, implemented systems, or advised other healthcare systems. Not less frequently than once every three months, the Secretary or the Director shall brief the appropriate committees of Congress on the activities conducted under this subsection. Each briefing conducted under subparagraph
(A)shall include the following: An assessment of any remediation or improvement conducted by the Department with respect to a medical service line of the Department that the Secretary has determined does not meet an access standard or standard for quality established under section 1703B or 1703C of this title, respectively, in providing hospital care, a medical service, or an extended care service, including the following: An assessment of the factors that led the Secretary to make such determination. An assessment of the medical service line in relation to the market area assessment most recently performed under subsection (c), particularly with respect to how it relates to the demand for the medical service line in the area and by veterans using a medical facility of the Department for such medical service line. A plan with specific actions, and the time to complete them, to meet the access standards and standards for quality established under sections 1703B and 1703C of this title, respectively, which shall include consideration of— increasing personnel or temporary personnel assistance, including mobile deployment teams; special hiring incentives, including the Education Debt Reduction Program under subchapter VII of chapter 76 of this title and recruitment, relocation, and retention incentives; using direct hiring authority; providing improved training opportunities for staff; acquiring improved equipment; making structural modifications to the facility used by the medical service line; partnering with health care providers that have the capacity to meet the demand in the market area and meet access and quality standards established under sections 1703B and 1703C of this title; and such other actions as the Secretary considers appropriate. An assessment of the progress made by the Department with respect to the responsibilities of the Director under paragraph (2). Not less frequently than once every four years, the Secretary shall perform market area assessments regarding the health care services furnished under the laws administered by the Secretary. Each market area assessment performed under paragraph
(1)shall include the following: An assessment of the demand for hospital care, medical services, and extended care services from the Department, disaggregated by geographic market areas that are consistent with industry market areas or boundaries, including the number of requests for such care and services under the laws administered by the Secretary. An inventory of the health care capacity of the Department across the facilities of the Department. An assessment of the health care capacity to be provided through contracted community care providers and providers who entered into a provider agreement with the Department under section 1703A of this title, including the number of providers, the geographic location of the providers, and categories or types of health care services provided by the providers. An assessment obtained from other Federal direct delivery systems of their capacity to provide health care to veterans. An assessment of the health care capacity of non-contracted providers where there is insufficient network supply. An assessment of the health care capacity of academic affiliates and other collaborations of the Department as it relates to providing health care to veterans. An assessment of the effects on health care capacity by the access and quality standards established under sections 1703B and 1703C of this title, respectively. The number of appointments for health care services under the laws administered by the Secretary, disaggregated by— appointments at facilities of the Department; and appointments with non-Department health care providers. Analysis of information submitted from care coordination teams under section 1703(e)(2)(D) of this title from each Department medical facility that includes the following: An analysis of coordination and management best practices. Satisfaction survey data from the covered veterans from each care coordination team under section 1703(e) of this title. Findings and determinations related to the coordination of care under section 1703(e) of this title to assist the Director in the design, implementation, and assessment of the high-performing integrated healthcare network of the Department. A standardized climate survey developed jointly with the Centers for Medicare & Medicaid Services Alliance to Modernize Healthcare
(CAMH)for the employees of each medical facility of the Department that compiles data on culture, communication, teamwork, quality of worklife, rewards or recognition, leadership, and productivity. The Secretary shall submit to the appropriate committees of Congress each market area assessment performed under paragraph
(1)and the complete market area assessment being performed on the day before the date of the enactment of the Veterans Community Care and Access Act of 2017 in the same form as such assessments are delivered to the Secretary. The Secretary shall use the market area assessments performed under paragraph
(1)to inform the quadrennial Veterans Health Administration review and strategic plan under subsection
(a)and to determine the capacity of the Department and the capacity of the health care provider networks established under section 1703(d) of this title. The Secretary shall publish the capacity findings and results from the market area assessments performed under paragraph
(1)with respect to the Department and health care provider networks established under section 1703(d) of this title on a publicly accessible Internet website of the Department. The Secretary shall ensure that the budget request of the Department for any fiscal year (as submitted with the budget of the President under section 1105(a) of title 31) reflects the findings of the Secretary with respect to the most recent information described in subsection (b)(5) and is consistent with the quadrennial Veterans Health Administration review and strategic plan under subsection (a). In this section, the term appropriate committees of Congress means— the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives. . The table of sections at the beginning of chapter 17 is amended by inserting after the item relating to section 1730A the following new item: 1730B. Quadrennial Veterans Health Administration review, management of high-performing integrated healthcare network, and market area assessments. . Paragraph
(2)of section 1730B(c) of title 38, United States Code, as added by subsection (a), shall not apply to a market area assessment that was being performed by the Secretary of Veterans Affairs on the day before the date of the enactment of this Act.