US Codex
Pub. L.
Notes

Title III — Health Care Staffing, Recruitment, and Training Matters

113th Congress · Approved Aug 7, 2014 · 128 Stat. 1754

TITLE III Health Care Staffing, Recruitment, and Training Matters

SEC. 301. Treatment of Staffing Shortage and Biennial Report on Staffing of Medical Facilities of the Department of Veterans Affairs.

(a)
Staffing Shortages.—
(1)
In general.— Subchapter I of chapter 74 of title 38, United States Code, is amended by adding at the end the following new section:

Ҥ 7412. Annual determination of staffing shortages; recruitment and appointment for needed occupations

“(a) In General.—Not later than September 30 of each year, the Inspector General of the Department shall determine, and the Secretary shall publish in the Federal Register, the five occupations of personnel of this title of the Department covered under section 7401 of this title for which there are the largest staffing shortages throughout the Department as calculated over the five-year period preceding the determination.

“(b) Recruitment and Appointment.—Notwithstanding sections 3304 and 3309 through 3318 of title 5, the Secretary may, upon a determination by the Inspector General under paragraph (1) that there is a staffing shortage throughout the Department with respect to a particular occupation, recruit and directly appoint, during the fiscal year after the fiscal year during which such determination is made, qualified personnel to serve in that particular occupation for the Department.”

(2)
Clerical amendment.— The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 7411 the following new item:

“7412. Annual determination of staffing shortages; recruitment and appointment for needed occupations.”.

(3)
Deadline for first determination.— Notwithstanding the deadline under section 7412 of title 38, United States Code, as added by paragraph (1), for the annual determination of staffing shortages in the Veterans Health Administration, the Inspector General of the Department of Veterans Affairs shall make the first determination required under such section, and the Secretary of Veterans Affairs shall publish in the Federal Register such determination, by not later than the date that is 180 days after the date of the enactment of this Act.
(b)
Increase of Graduate Medical Education Residency Positions.—
(1)
In general.— Section 7302 of title 38, United States Code, is amended by adding at the end the following new subsection:

“(e)

(1) In carrying out this section, the Secretary shall establish medical residency programs, or ensure that already established medical residency programs have a sufficient number of residency positions, at any medical facility of the Department that the Secretary determines—

“(A) is experiencing a shortage of physicians; and

“(B) is located in a community that is designated as a health professional shortage area (as defined in section 332 of the Public Health Service Act (42 U.S.C. 254e)).

“(2) In carrying out paragraph (1), the Secretary shall—

“(A) allocate the residency positions under such paragraph among occupations included in the most current determination published in the Federal Register pursuant to section 7412(a) of this title; and

“(B) give priority to residency positions and programs in primary care, mental health, and any other specialty the Secretary determines appropriate.”

(2)
Five-year increase.—
(A)
In general.— In carrying out section 7302(e) of title 38, United States Code, as added by paragraph (1), during the 5-year period beginning on the day that is 1 year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall increase the number of graduate medical education residency positions at medical facilities of the Department by up to 1,500 positions.
(B)
Priority.— In increasing the number of graduate medical education residency positions at medical facilities of the Department under subparagraph (A), the Secretary shall give priority to medical facilities that—
(i)
as of the date of the enactment of this Act, do not have a medical residency program; and
(ii)
are located in a community that has a high concentration of veterans.
(3)
Report.—
(A)
In general.— Not later than 60 days after the date of the enactment of this Act, and not later than October 1 each year thereafter until 2019, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on graduate medical education residency positions at medical facilities of the Department.
(B)
Elements.— Each report required by subparagraph (A) shall include the following:
(i)
For the year preceding the submittal of the report, the number of graduate medical education residency positions at medical facilities of the Department as follows:
(I)
That were filled.
(II)
That were not filled.
(III)
That the Department anticipated filling.
(ii)
With respect to each graduate medical education residency position specified in clause (i)—
(I)
the geographic location of each such position; and
(II)
if such position was filled, the academic affiliation of the medical resident that filled such position.
(iii)
The policy at each medical facility of the Department with respect to the ratio of medical residents to staff supervising medical residents.
(iv)
During the 1-year period preceding the submittal of the report, the number of individuals who declined an offer from the Department to serve as a medical resident at a medical facility of the Department and the reason why each such individual declined such offer.
(v)
During the 1-year period preceding the submittal of the report, a description of—
(I)
challenges, if any, faced by the Department in filling graduate medical education residency positions at medical facilities of the Department; and
(II)
actions, if any, taken by the Department to address such challenges.
(vi)
A description of efforts of the Department, as of the date of the submittal of the report, to recruit and retain medical residents to work for the Veterans Health Administration as full-time employees.
(c)
Priority in Scholarship Program of Health Professionals Educational Assistance Program to Certain Providers.— Section 7612(b)(5) of title 38, United States Code, is amended—
(1)
in subparagraph (A), by striking “ and” at the end;
(2)
by redesignating subparagraph (B) as subparagraph (C); and
(3)
by inserting after subparagraph (A) the following new subparagraph (B):

“(B) shall give priority to applicants pursuing a course of education or training toward a career in an occupation for which the Inspector General of the Department has, in the most current determination published in the Federal Register pursuant to section 7412(a) of this title, determined that there is one of the largest staffing shortages throughout the Department with respect to such occupation; and”

(d)
Reports.—
(1)
In general.— Not later than 180 days after the date of the enactment of this Act, and not later than December 31 of each even-numbered year thereafter until 2024, the Secretary of Veterans Affairs shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives a report assessing the staffing of each medical facility of the Department.
(2)
Elements.— Each report submitted under paragraph (1) shall include the following:
(A)
The results of a system-wide assessment of all medical facilities of the Department to ensure the following:
(i)
Appropriate staffing levels for health care professionals to meet the goals of the Secretary for timely access to care for veterans.
(ii)
Appropriate staffing levels for support personnel, including clerks.
(iii)
Appropriate sizes for clinical panels.
(iv)
Appropriate numbers of full-time staff, or full-time equivalents, dedicated to direct care of patients.
(v)
Appropriate physical plant space to meet the capacity needs of the Department in that area.
(vi)
Such other factors as the Secretary considers necessary.
(B)
A plan for addressing any issues identified in the assessment described in subparagraph (A), including a timeline for addressing such issues.
(C)
A list of the current wait times and workload levels for the following clinics in each medical facility:
(i)
Mental health.
(ii)
Primary care.
(iii)
Gastroenterology.
(iv)
Women’s health.
(v)
Such other clinics as the Secretary considers appropriate.
(D)
A description of the results of the most current determination of the Inspector General under subsection (a) of section 7412 of title 38, United States Code, as added by subsection (a)(1) of this section, and a plan to use direct appointment authority under subsection (b) of such section 7412 to fill staffing shortages, including recommendations for improving the speed at which the credentialing and privileging process can be conducted.
(E)
The current staffing models of the Department for the following clinics, including recommendations for changes to such models:
(i)
Mental health.
(ii)
Primary care.
(iii)
Gastroenterology.
(iv)
Women’s health.
(v)
Such other clinics as the Secretary considers appropriate.
(F)
A detailed analysis of succession planning at medical facilities of the Department, including the following:
(i)
The number of positions in medical facilities throughout the Department that are not filled by a permanent employee.
(ii)
The length of time each position described in clause (i) remained vacant or filled by a temporary or acting employee.
(iii)
A description of any barriers to filling the positions described in clause (i).
(iv)
A plan for filling any positions that are vacant or filled by a temporary or acting employee for more than 180 days.
(v)
A plan for handling emergency circumstances, such as administrative leave or sudden medical leave for senior officials.
(G)
The number of health care providers of the Department who have been removed from their positions, have retired, or have left their positions for another reason, disaggregated by provider type, during the 2-year period preceding the submittal of the report.
(H)
Of the health care providers specified in subparagraph (G) who have been removed from their positions, the following:
(i)
The number of such health care providers who were reassigned to other positions in the Department.
(ii)
The number of such health care providers who left the Department.
(iii)
The number of such health care providers who left the Department and were subsequently rehired by the Department.

SEC. 302. Extension and Modification of Certain Programs Within the Department of Veterans Affairs Health Professionals Educational Assistance Program.

(a)
Extension of Scholarship Program.— Section 7619 of title 38, United States Code, is amended by striking “ December 31, 2014” and inserting “ December 31, 2019”.
(b)
Modification of Education Debt Reduction Program.—
(1)
Modification of amount and duration of eligibility.— Paragraph (1) of section 7683(d) of such title is amended—
(A)
by striking “ $60,000” and inserting “ $120,000”; and
(B)
by striking “ $12,000 of such payments” and all that follows through the period at the end and inserting “ $24,000 of such payments may be made in each year of participation in the Program”.
(2)
Elimination of limitation.—
(A)
In general.— Such section is further amended—
(i)
by striking paragraph (2);
(ii)
by redesignating paragraph (3) as paragraph (2); and
(iii)
in paragraph (2), as redesignated by clause (ii), by striking “ paragraphs (1) and (2)” and inserting “ paragraph (1)”.
(B)
Conforming amendment.— Paragraph (1) of such section, as amended by paragraph (1), is further amended by striking “ Subject to paragraph (2), the amount” and inserting “ The amount”.

SEC. 303. Clinic Management Training for Employees at Medical Facilities of the Department of Veterans Affairs.

(a)
Clinic Management Training Program.—
(1)
In general.— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall commence a role-specific clinic management training program to provide in-person, standardized education on systems and processes for health care practice management and scheduling to all appropriate employees, as determined by the Secretary, at medical facilities of the Department.
(2)
Elements.—
(A)
In general.— The clinic management training program required by paragraph (1) shall include the following:
(i)
Training on how to manage the schedules of health care providers of the Department, including the following:
(I)
Maintaining such schedules in a manner that allows appointments to be booked at least eight weeks in advance.
(II)
Proper planning procedures for vacation, leave, and graduate medical education training schedules.
(ii)
Training on the appropriate number of appointments that a health care provider should conduct on a daily basis, based on specialty.
(iii)
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 slots.
(iv)
Training on how to properly use the appointment scheduling system of the Department, including any new scheduling system implemented by the Department.
(v)
Training on how to optimize the use of technology, including the following:
(I)
Telemedicine.
(II)
Electronic mail.
(III)
Text messaging.
(IV)
Such other technologies as specified by the Secretary.
(vi)
Training on how to properly use physical plant space at medical facilities of the Department to ensure efficient flow and privacy for patients and staff.
(B)
Role-specific.— The Secretary shall ensure that each employee of the Department included in the clinic management training program required by paragraph (1) receives education under such program that is relevant to the responsibilities of such employee.
(3)
Sunset.— The clinic management training program required by paragraph (1) shall terminate on the date that is 2 years after the date on which the Secretary commences such program.
(b)
Training Materials.—
(1)
In general.— After the termination of the clinic management training program required by subsection (a), the Secretary shall provide training materials on health care management to each of the following employees of the Department that are relevant to the position and responsibilities of such employee upon the commencement of employment of such employee:
(A)
Any manager of a medical facility of the Department.
(B)
Any health care provider at a medical facility of the Department.
(C)
Such other employees of the Department as the Secretary considers appropriate.
(2)
Update.— The Secretary shall regularly update the training materials required under paragraph (1).