,i  #aacth ,,congress  #b;d ,session    
,h4 ,r4 #ejjg  ,,in ,,the ,,house ,,of  
,,representatives  ,june #bf1 #bjad ,mr4
 ,ruiz introduced the following bill2   
which was referred to the ,committee on 
,veterans' ,affairs  ,a ,,bill  ,to     
assess staffing shortages at medical    
facilities of the ,department of        
,veterans ,affairs1 and for other       
purposes4  #a4 ,short title ,this ,act  
may be cited as the ,restoring          
,accountability in ,veterans ,access to 
,health ,care ,act4  #b4 ,treatment of  
staffing shortage and report on staffing
 of medical facilities of the           
,department of ,veterans ,affairs  7a7  
,staffing shortage  7#a7 ,in general    
,not later than #ahj days after the date
 of the enactment of this ,act1 and     
annually thereafter1 the ,inspector     
,general of the ,department of ,veterans
 ,affairs shall determine1 and publish  
in the ,federal ,register1 the five     
occupations of health care providers of 
the ,department of ,veterans ,affairs   

for which there is the largest staffing 
shortage throughout the ,department4    
7#b7 ,recruitment and appointment       
,notwithstanding sections #ccjd and     
#ccji through #ccah of title #e1 ,united
 ,states ,code1 the ,secretary of       
,veterans ,affairs1 based upon a        
determination by the ,inspector ,general
 under paragraph 7#a7 that there is a   
staffing shortage throughout the        
,department with respect to a particular
 occupation of health care provider1 may
 recruit and directly appoint highly    
qualified health care providers to a    
position to serve as a health care      
provider in that particular occupation  
for the ,department4  7b7 ,reports  7#a7
 ,in general ,not later than #ahj days  
after the date of the enactment of this 
,act1 and not later than ,december #ca  
of each even numbered year thereafter   
until #bjbd1 the ,secretary of ,veterans
 ,affairs shall submit to the ,committee
 on ,veterans' ,affairs of the ,senate  
and the ,committee on ,veterans'        

,affairs of the ,house of               
,representatives a report assessing the 
staffing of each medical facility of the
 ,department of ,veterans ,affairs4     
7#b7 ,elements ,each report submitted   
under paragraph 7#a7 shall include the  
following3  7,a7 ,the results of a      
system-wide assessment of all medical   
facilities of the ,department to ensure 
the following3  7i7 ,appropriate        
staffing levels for health care         
providers to meet the goals of the      
,secretary for timely access to care for
 veterans4  7ii7 ,appropriate staffing  
levels for support personnel1 including 
clerks4  7iii7 ,appropriate sizes for   
clinical panels4  7iv7 ,appropriate     
numbers of full-time staff1 or full-time
 equivalent1 dedicated to direct care of
 patients4  7v7 ,the appropriate        
physician to patient ratio 7including   
for both primary and specialty care71 as
 compared to such ratio as it exists on 
the date of the report4  7vi7           
,appropriate physical plant space to    

meet the capacity needs of the          
,department in that area4  7vii7 ,such  
other factors as the ,secretary         
considers necessary4  7,b7 ,an          
explanation of the measurable           
productivity standards used to establish
 the levels in the assessment described 
in subparagraph 7,a74  7,c7 ,a plan for 
addressing any issues identified in the 
assessment described in subparagraph    
7,a71 including a timeline for          
addressing such issues4  7,d7 ,a list of
 the current wait times and workload    
levels for the following clinics in each
 medical facility3  7i7 ,mental health4 
7ii7 ,primary care4  7iii7              
,gastroenterology4  7iv7 ,women's       
health4  7v7 ,specialty care4  7vi7     
,ophthalmology4  7vii7 ,such other      
clinics as the ,secretary considers     
appropriate4  7,e7 ,a description of the
 results of the determination of the    
,secretary under paragraph 7#a7 of      
subsection 7a7 and a plan to use direct 
appointment authority under paragraph   

7#b7 of such subsection to fill staffing
 shortages1 including recommendations   
for improving the speed at which the    
credentialing and privileging process   
can be conducted4  7,f7 ,the current    
staffing models of the ,department for  
the following clinics1 including        
recommendations for changes to such     
models3  7i7 ,mental health4  7ii7      
,primary care4  7iii7 ,gastroenterology4
  7iv7 ,women's health4  7v7 ,specialty 
care4  7vi7 ,ophthalmology4  7vii7 ,such
 other clinics as the ,secretary        
considers appropriate4  7,g7 ,a detailed
 analysis of succession planning at     
medical facilities of the ,department1  
including the following3  7i7 ,the      
number of positions in medical          
facilities throughout the ,department   
that are not filled by a permanent      
employee4  7ii7 ,the length of time each
 such position described in clause 7i7  
remained vacant or filled by a temporary
 or acting employee4  7iii7 ,a          
description of any barriers to filling  

the positions described in clause 7i74  
7iv7 ,a plan for filling any positions  
that are vacant or filled by a temporary
 or acting employee for more than #ahj  
days4  7v7 ,a plan for handling         
emergency circumstances1 such           
administrative leave or sudden medical  
leave for senior officials4  7,h7 ,the  
number of health care providers who have
 been removed from their position or    
have retired1 by provider type1 during  
the two-year period preceding the       
submittal of the report4  7,i7 ,of the  
health care providers specified in      
subparagraph 7,g7 that have been removed
 from their position1 the following3    
7i7 ,the number of such health care     
providers who were reassigned to another
 position in the ,department4  7ii7 ,the
 number of such health care providers   
who left the ,department4  #c4 ,clinic  
management training program of the      
,department of ,veterans ,affairs  7a7  
,in general ,not later than #ahj days   
after the date of the enactment of this 

,act1 the ,secretary of ,veterans       
,affairs shall implement a clinic       
management training program to provide  
in-person1 standardized education on    
health care management to all managers  
of1 and health care providers at1       
medical facilities of the ,department of
 ,veterans ,affairs4  7b7 ,elements ,the
 clinic management training program     
required by subsection 7a7 shall include
 the following3  7#a7 ,training on how  
to manage the schedules of health care  
providers of the ,department and        
training on customer service and        
veteran-centered care1 including proper 
planning procedures for vacation1 leave1
 and graduate medical education training
 schedules4  7#b7 ,training on the      
appropriate number of appointments that 
a health care provider should conduct on
 a daily basis1 based on specialty4     
7#c7 ,training on how to determine      
whether there are enough available      
appointment slots to manage demand for  
different appointment types and         

mechanisms for alerting management of   
insufficient slots4  7#d7 ,training on  
how scheduling systems will be monitored
 and how schedulers will be held        
accountable for accurate data4  7#e7    
,training on how to properly use data to
 meet the demand for health care1       
including the following3  7,a7 ,training
 on determining the next available      
appointment for each health care        
provider at the medical facility4  7,b7 
,training on determining the number of  
health care providers needed to meet    
demand for health care at the medical   
facility4  7,c7 ,training on determining
 the number of exam rooms needed to meet
 demand for such health care in an      
efficient manner4  7#f7 ,training on how
 to properly use the appointment        
scheduling system of the ,department1   
including any new scheduling system     
implemented by the ,department4  7#g7   
,training on how to optimize the use of 
technology1 including the following3    
7,a7 ,telemedicine4  7,b7 ,electronic   

mail4  7,c7 ,text messaging4  7,d7 ,such
 other technologies as specified by the 
,secretary4  7#h7 ,training on how to   
properly use physical plant space at    
medical facilities of the ,department to
 ensure efficient flow and privacy for  
patients and staff4