,i  #aacth ,,congress  #b;d ,session    
,h4 ,r4 #efah  ,,in ,,the ,,house ,,of  
,,representatives  ,september #ah1 #bjad
 ,mr4 ,kilmer 7for himself1 ,mr4        
,cuellar1 ,mr4 ,carney1 ,mr4 ,barber1   
and ,mr4 ,gallego7 introduced the       
following bill2 which was referred to   
the ,committee on ,veterans' ,affairs1  
and in addition to the ,committee on the
 ,budget1 for a period to be            
subsequently determined by the ,speaker1
 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 ,affairs1 to   
provide oversight of the ,veterans      
,health ,administration1 and for other  
purposes4  #a4 ,short title ,this ,act  
may be cited as the ,veterans ,health   
,administration ,management ,improvement
 ,act4  #b4 ,comptroller ,general       

management review of ,veterans ,health  
,administration  7a7 ,management review 
7#a7 ,in general ,during the five-year  
period beginning on the date of the     
enactment of this ,act1 the ,comptroller
 ,general of the ,united ,states shall  
conduct a management review of the      
,veterans ,health ,administration of the
 ,department of ,veterans ,affairs4     
7#b7 ,matters included ,the management  
review under paragraph 7#a7 shall       
include a review1 with respect to the   
,veterans ,health ,administration1 of   
the following3  7,a7 ,the management    
structure1 including the roles and      
responsibilities among the various      
organizational components 7local        
facilities1 regional networks1 and the  
central office74  7,b7 ,the oversight of
 core functions1 including the extent to
 which lines of accountability are      
clearly delineated4  7,c7 ,the          
evaluation plan1 operations1 and        
capacity to implement results-based     
strategic planning4  7,d7 ,the extent to

 which contractors are used and         
monitored to support core management    
functions4  7,e7 ,internal communication
 mechanisms1 including expectations for 
communications1 that support the        
mission4  7,f7 ,the setting of          
priorities and the monitoring of such   
priorities4  7,g7 ,budgeting and        
resource allocation processes4  7,h7    
,workforce planning4  7,i7 ,human       
capital processes1 including training   
activities1 to ensure timely hiring and 
effective retention of a qualified      
workforce4  7,j7 ,information technology
 to support core functions and          
activities4  7,k7 ,how each of the      
matters described in subparagraphs 7,a7 
through 7,j7 may differ for rural       
medical facilities of the ,department of
 ,veterans ,affairs4  7,l7 ,incentives1 
including any perverse incentives1      
affecting employee actions1 quality of  
care1 and the provision of services4    
7,m7 ,insights from employees and       
employee representatives about the work 

environment and the level of engagement 
of such employees as can be derived from
 the results of the annual ,federal     
employee survey and other internal      
surveys administered by the ,secretary  
of ,veterans ,affairs4  7,n7 ,insights  
on the findings of the ,comptroller     
,general from veteran service           
organizations1 organizations            
representing employees of the ,veterans 
,health ,administration1 other          
stakeholders1 and the ,management and   
,accountability ,ombudsman described in 
section #cab;,b of title #ch1 ,united   
,states ,code1 as added by section #d4  
7b7 ,reports ,not later than one year   
after the date of the enactment of this 
,act1 and annually thereafter for a     
four-year period1 the ,comptroller      
,general shall submit to ,congress one  
or more reports that include--  7#a7 the
 matters reviewed under subsection      
7a77#a72 and  7#b7 recommendations of   
the ,comptroller ,general based on such 
matters4  #c4 ,pilot program to improve 

management and accountability of        
,veterans ,health ,administration  7a7  
,establishment ,the ,secretary of       
,veterans ,affairs shall establish a    
pilot program to improve the management 
and accountability within the ,veterans 
,health ,administration4  7b7 ,goals of 
pilot program ,the ,secretary shall     
carry out the pilot program under       
subsection 7a7 in a manner that ensures 
that--  7#a7 the employees of the       
,veterans ,health ,administration have  
an opportunity to learn1 implement1 and 
identify successful means of advancing  
the management of the ,veterans ,health 
,administration and the delivery of care
 and services2 and  7#b7 the management 
and delivery of care and services at    
medical facilities of the ,department is
 improved by implementing the           
recommendations of the ,comptroller     
,general of the ,united ,states based on
 the management review conducted under  
section #b1 and any other appropriate   
recommendations1 with respect to the    

planning and evaluation capabilities of 
the ,veteran ,health ,administration4   
7c7 ,application of certain laws during 
pilot program  7#a7 ,application of     
performance plan requirements ,during   
the period in which the ,secretary      
carries out the pilot program under     
subsection 7a71 the ,secretary shall    
carry out section #aaae7;b7 of title    
#ca1 ,united ,states ,code1 as follows3 
7,a7 ,in paragraph 7#b71 by substituting
 1 unless authorized to be in an        
alternative form under subsection 7c71  
and situate each goal in the context of 
its own logic modeling of how the       
operations and activities of the agency1
 in coordination with any significant   
operations and activities from external 
entities1 will contribute toward        
achieving the goals and responsibilities
 of the agency2 for unless authorized to
 be in an alternative form under        
subsection 7c724  7,b7 ,by including in 
the agency performance plan described in
 such section #aaae7;b71 for each       

performance goal covered by the plan1 an
 identification and assessment of the   
risks of creating new1 or perpetuating  
existing1 perverse incentives1 and      
strategies for risk assessment1         
monitoring1 and mitigation1 using a     
suitable risk management approach4  7#b7
 ,application of performance reporting  
requirements ,during the period in which
 the ,secretary carries out the pilot   
program under subsection 7a71 the       
,secretary shall carry out subsection   
7c7 of section #aaaf of title #ca1      
,united ,states ,code1 by including in  
the update required by such subsection  
statistical information regarding the   
,veterans ,health ,administration that--
  7,a7 is useful to multiple            
stakeholders for internal management and
 external oversight2 and  7,b7 provides 
insight into how programs are planned1  
financed1 and managed1 regarding--  7i7 
the population of veterans1 important   
subgroups thereof1 and the status of    
such veterans2  7ii7 the capacity of the

 operations of the ,veterans ,health    
,administration under enacted resource  
levels1 listed by important             
subcategories as appropriate2 and  7iii7
 the workload of the ,veterans ,health  
,administration1 listed by important    
subcategories as appropriate4  7#c7     
,application of functions of chief      
operating officer ,during the period in 
which the ,secretary carries out the    
pilot program under subsection 7a71 the 
,secretary shall carry out section      
#aabc7;b77#a7 of title #ca1 ,united     
,states ,code1 by substituting strategic
 and performance planning1 measurement1 
evaluation1 analysis1 regular assessment
 of progress1 risk management 7including
 the risks of perverse incentives71 and 
use of performance information to       
improve the results achieved for        
strategic and performance planning1     
measurement1 analysis1 regular          
assessment of progress1 and use of      
performance information to improve the  
results achieved4  7d7 ,evaluation plan 

,the ,secretary shall prepare an annual 
organization evaluation plan for the    
,veterans ,health ,administration that  
is informed by the recommendations of   
the ,comptroller ,general based on the  
management review conducted under       
section #b4  7e7 ,assistance in pilot   
program ,the ,management and            
,accountability ,ombudsman described in 
section #cab;,b of title #ch1 ,united   
,states ,code1 as added by section      
#d7;a71 shall assist in the pilot       
program under subsection 7a7 by--  7#a7 
identifying areas in which employees of 
the ,department have problems           
implementing the pilot program1         
including application of logic modeling1
 managing risk of perverse incentives1  
and other issues that the ,ombudsman    
determine appropriate2  7#b7 to the     
extent practicable1 proposing changes in
 the administrative practices of the    
implementation of the pilot program to  
mitigate problems identified under      
paragraph 7#a72 and  7#c7 reviewing1    

examining1 and making recommendations   
regarding logic modeling policies1      
strategies1 and programs of the         
,veterans ,health ,administration4  7f7 
,briefings  7#a7 ,initial briefing ,not 
later than #ij days before the          
,secretary commences the pilot program  
under subsection 7a71 the ,secretary    
shall provide to the ,committees on     
,veterans' ,affairs of the ,house of    
,representatives and the ,senate and the
 ,comptroller ,general a briefing on--  
7,a7 a logic model of how the features  
of the pilot program will address the   
problems identified in the management   
review conducted under section #b2 and  
7,b7 such other items as the ,secretary 
determines appropriate4  7#b7 ,updates  
,not later than #bdj days after the     
,secretary commences the pilot program  
under subsection 7a71 and annually      
thereafter during the period in which   
the ,secretary carries out the pilot    
program1 the ,secretary shall provide to
 the ,committees on ,veterans' ,affairs 

of the ,house of ,representatives and   
the ,senate and the ,comptroller        
,general a briefing on--  7,a7 an       
evaluation of the implementation and    
effectiveness of carrying out this      
section1 including any challenges       
encountered and lessons learned2  7,b7  
planned actions to improve the success  
of the pilot program1 including a       
milestone plan for such actions2 and    
7,c7 such other items as the ,secretary 
determines appropriate4  7g7 ,duration  
,the ,secretary shall--  7#a7 commence  
the pilot program under subsection 7a7  
by not later than #ahj days after the   
date on which the ,comptroller ,general 
submits the report under section #b7;b72
 and  7#b7 carry out the pilot program  
for a period of five years4  7h7        
,definitions ,in this section3  7#a7    
,the term logic modeling means an       
approach1 also referred to as program   
theory1 program modeling1 or theory of  
change1 that articulates the assumptions
 of the strategy or tactics of a program

 or activity and how such strategy or   
tactics relate to the benefits that the 
program or activity is expected to      
contribute toward in order to achieve   
certain goals1 objectives or            
responsibilities1 and may include--     
7,a7 the mapping of direct and indirect 
relationships among relevant resources1 
activities1 milestones1 outputs1        
intermediate outcomes1 and end outcomes2
 and  7,b7 if significant coordination  
or cooperation with entities external to
 a program or activity may contribute to
 achieving the relevant goals1          
objectives1 or responsibilities1 the    
mapping of the roles of entities        
external to the program or activity4    
7#b7 ,the term risk management means the
 processes that are used to identify1   
assess1 monitor1 mitigate1 and report on
 risks to achieving the missions1 goals1
 and objectives of a department1 agency1
 or program using resources and         
processes appropriate to the nature of  
risks and resources available4  #d4     

,management and accountability ombudsman
  7a7 ,in general ,chapter #c of title  
#ch1 ,united ,states ,code1 is amended  
by inserting after section #cab;,a the  
following new section3  #cab;,b4        
,management and accountability ombudsman
  7a7 ,in general  7#a7 ,there is in the
 ,department an ,office of the          
,management and ,accountability         
,ombudsman 7in this section referred to 
as the ,office74 ,there is at the head  
of the ,office an ,ombudsman1 who shall 
be appointed by the ,president from     
among individuals with a background in  
enterprise risk management4  7#b7 ,the  
,ombudsman shall report directly to the 
,secretary but the ,secretary may not   
prevent or prohibit the ,ombudsman from 
initiating1 carrying out1 or completing 
any responsibility of the ,ombudsman4   
7#c7 ,the ,secretary shall determine the
 appropriate level of staffing and      
distribution of responsibility to ensure
 the success of the ,office4  7#d7 ,the 
,president shall include in the budget  

transmitted to the ,congress for each   
fiscal year pursuant to section #aaje of
 title #ca an estimate of the amount for
 the ,office that is sufficient to      
provide for a number of full-time       
positions in the ,office4  7b7          
,responsibilities ,the ,ombudsman       
shall--  7#a7 receive and address       
reports from employees and employee     
representatives of the ,veterans ,health
 ,administration ,affairs and assist in 
resolving problems with the management1 
administration1 and delivery of care of 
the ,veterans ,health ,agency2  7#b7    
communicate to the ,secretary the       
observations and findings received      
pursuant to paragraph 7#a72  7#c7       
conduct inspections of medical          
facilities of the ,veterans ,health     
,administration1 including              
non-,department facilities that provide 
care pursuant to a contract entered into
 under chapter #ag of this title as     
necessary2  7#d7 establish a program    
under which the ,ombudsman and the      

,secretary shall--  7,a7 provide        
incentives to employees of the ,veterans
 ,health ,administration who suggest    
methods to improve the management and   
operations of the ,veterans ,health     
,administration2  7,b7 carry out in a   
pilot program the suggestions that are  
likely to be successful2 and  7,c7 if   
such a pilot program demonstrates that a
 suggestion causes a marked improvement 
in such management and operations--  7i7
 reward the employee who made such      
suggestion2 and  7ii7 carry out such    
suggestion throughout the ,veterans     
,health ,administration2 and  7#e7 not  
less frequently than once each calendar 
quarter1 provide to the ,secretary a    
summary and relevant statistics         
concerning the activities and findings  
of the ,ombudsman1 including a summary  
of the suggestions made and carried out 
pursuant to paragraph 7#d74  7c7        
,request for investigations ,the        
,ombudsman may request the ,inspector   
,general of the ,department to conduct  

an inspection1 investigation1 or audit4 
,upon such a request1 the ,inspector    
,general shall respond to the ,ombudsman
 explaining the plan of the ,inspector  
,general to comply with such request or 
the rationale of the ,inspector ,general
 for denying such request4  7d7         
,coordination ,the ,secretary shall     
ensure that each element of the         
,department has procedures to provide   
the ,ombudsman with formal responses to 
any recommendation submitted by the     
,ombudsman to the head of such element4 
7e7 ,annual reports ,not later than     
,june #cj of each year1 the ,ombudsman  
shall submit to the ,committees on      
,veterans' ,affairs of the ,senate and  
the ,house of ,representatives a report 
on the objectives of the ,ombudsman for 
the fiscal year beginning in such       
calendar year4 ,each report shall--     
7#a7 contain a full and substantive     
analysis1 in addition to statistical    
information2 and  7#b7 set forth any    
recommendations the ,ombudsman has made 

on improving the management and         
accountability of the employees of the  
,department and any responses received  
under subsection 7d7 with respect to the
 estimates described in section #aag7;b7
 of this title4  7f7 ,risk management   
defined ,in this section1 the term risk 
management means the processes that are 
used to identify1 assess1 monitor1      
mitigate1 and report on risks to        
achieving a the mission1 goals1 and     
objectives of a department1 agency1 or  
program using resources and processes   
appropriate to the nature of risks and  
resources available4  4  7b7 ,clerical  
amendment ,the table of sections at the 
beginning of such chapter is amended by 
inserting after the item relating to    
section #cab;,a the following new item3 
#cab;,b4 ,management and ,accountability
 ,ombudsman4  4  7c7 ,comptroller       
,general reports ,the ,comptroller      
,general of the ,united ,states shall   
review each budget of the ,president    
submitted to ,congress under section    

#aaje of title #ca during #bjae through 
#bjbj to evaluate the proposed budget   
for health care provided by the         
,secretary of ,veterans ,affairs4 ,the  
,comptroller ,general shall submit to   
the ,committees on ,veterans' ,affairs  
of the ,senate and the ,house of        
,representatives a report containing the
 results of each such review1 at such   
times and with such additional matters  
as the ,comptroller ,general determines 
appropriate in consultation with such   
committees4  #e4 ,veterans' ,bill of    
,rights  7a7 ,display ,the ,secretary of
 ,veterans ,affairs shall ensure that   
the ,veterans' ,bill of ,rights         
described in subsection 7e7 is printed  
on signage in accessible formats and    
displayed prominently and conspicuously 
in each medical facility of the         
,department of ,veterans ,affairs in    
accordance with subsection 7c74  7b7    
,education of ,department employees ,the
 ,secretary shall ensure that employees 
of the ,department receive training on  

the ,veterans' ,bill of ,rights         
described in subsection 7e74  7c7       
,outreach ,the ,secretary shall conduct 
outreach to inform veterans about the   
,veterans' ,bill of ,rights described in
 subsection 7e7 by--  7#a7 ensuring that
 such ,bill of ,rights is available on  
the ,internet website of the ,department
 and prominently displayed 7using       
posters printed in a large type that    
allows for individuals with #bj_/bj     
vision to read the print from #aj feet  
away7 in public spaces1 lobbies1 visitor
 centers1 clinic waiting rooms1 and     
patient sitting rooms of the            
,department2  7#b7 briefing patients    
about such ,bill of ,rights when the    
patient enrolls in the system of patient
 enrollment system under section #agje  
of title #ch1 ,united ,states ,code2 and
  7#c7 conducting other types of        
outreach targeted at specific groups of 
veterans1 which may include1 at a       
minimum1 outreach conducted on other    
,internet websites or through veterans  

service organizations1 health fairs1 and
 the ,veterans ,health ,administration  
,veterans ,center outreach program4  7d7
 ,implementation ,the ,secretary shall  
ensure that the ,veterans ,health       
,administration honors the rights       
described in subsection 7e74  7e7       
,veterans' ,bill of ,rights ,the        
,veterans' ,bill of ,rights described in
 this subsection is a statement that    
veterans should have1 at a minimum and  
in addition to the rights covered by    
section #ag4cc of title #ch1 ,code of   
,federal ,regulations1 the following    
rights3  7#a7 ,the right to access the  
highest quality care1 including the     
right to the most appropriate technology
 and qualified practitioners4  7#b7 ,the
 right to continuity of care in the     
transition from the health program of   
the ,department of ,defense to the      
health care system of the ,department of
 ,veterans ,affairs4  7#c7 ,the right to
 receive assistance in understanding the
 available benefits and services to     

which the veteran is entitled4  7#d7    
,the right to receive a careful         
explanation of a proposed diagnostic or 
therapeutic procedure or course of      
treatment by the appropriate medical    
practitioner1 including with respect to 
the risks1 complications1 alternatives1 
and results4  7#e7 ,the right to ask    
questions concerning health treatment4  
7f7 ,veterans' bill of rights ,the      
,veterans' ,bill of ,rights described in
 this subsection is a statement that    
veterans who receive health care        
provided under the laws administered by 
the ,secretary of ,veterans ,affairs    
should have1 at a minimum1 the following
 rights 7to the extent of the           
eligibility and enrollment of the       
veteran for such health care73  7#a7    
,the right to access the highest quality
 care1 including the right to the most  
appropriate technology and qualified    
practitioners4  7#b7 ,the right to know 
what rules and regulations apply to     
patients4  7#c7 ,the right to continuity

 of care in the transition from the     
health program of the ,department of    
,defense to the health care system of   
the ,department of ,veterans ,affairs4  
7#d7 ,the right to receive careful      
explanation of proposed diagnostic or   
therapeutic procedures or courses of    
treatment by the responsible medical    
personnel1 including with respect to    
risks1 complications1 alternative health
 practices1 results1 information and    
reasoning for prescribed pain management
 plans1 and a daily review of the       
medical chart of the patient4  7#e7 ,the
 right for the patient to ask questions 
and be involved in all decisions        
regarding the care received by the      
patient4  7#f7 ,the right to a second   
opinion or change of provider1 if       
available4  7#g7 ,the right to know the 
reason for any change in medical        
practitioners responsible for the care  
of the patient4  7#h7 ,the right to know
 the identity and professional status of
 individuals providing service and to   

know who is primarily responsible for   
the care of the patient4  7#i7 ,the     
right to not be transferred to another  
facility1 organization1 or department   
unless the patient receives a complete  
explanation for the need1 was notified  
of alternatives1 and the receiving      
organization1 facility1 or department is
 ready to accept the transfer4  7#aj7   
,the right to receive considerate1      
respectful care at all times and under  
all circumstances with recognition of   
personal dignity1 diversity1 and        
religious1 or other spiritual and       
cultural preferences4  7#aa7 ,the right1
 in accordance with relevant provisions 
of law1 to personal and informational   
confidentiality and privacy in the      
discussion of the care and management of
 records of patients4  7#ab7 ,the right 
to visitors within the policies of the  
facility and to be informed of the      
visitation rights1 including any        
clinically necessary restrictions4      
7#ac7 ,the right to be free from all    

forms of abuse or harassment4  7#ad7    
,the right to access protective and     
advocacy services1 when available1 and  
file grievances4  7#ae7 ,the right to   
remain free of chemical and physical    
restraints unless safety requires       
otherwise4  7#af7 ,the right to care    
provided in a safe and clean setting1   
free from excessive noise and with      
sufficient lighting for comfort and     
safety4