The Department of Veterans Affairs is getting an extensive list of changes to how it delivers health care and benefits, now that Congress passed sweeping year-end legislation.

The House passed the Sen. Elizabeth Dole 21st Century Veterans Health Care and Benefits Improvement Act in a 382-12 vote Monday evening. The bill now heads to President Joe Biden’s desk.

Among its provisions, the Dole Act would expand pay flexibilities for some VA health care workers, and would allow the VA to provide backpay to health care workers who exceed pay caps between January 2006 and December 2017.

The bill would also require the VA to develop a plan to expand same-day scheduling for medical appointments.

The omnibus legislation pulls together several bills that lawmakers introduced this session of Congress.

House VA Committee Chairman Mike Bost (R-Ill.) said that among the bill’s provisions, it expands veterans’ homelessness programs and employment programs. He also said that the bill will also put “veterans’ health care back in the hands of the veteran and hold VA officials accountable.”

“The Dole Act is not only a common-sense bill, but one that would save lives and push the VA forward and not backward,” Bost said on the House floor Monday evening.

The Senate approved the bill last week. The House originally passed the Dole Act last month, but lawmakers voted on a final version Monday that includes technical changes made in the Senate.

Committee Ranking Member Mark Takano (D-Calif.) said the final version of the bill makes “no substantive changes” to the version the House passed in November.

“It has been a quite long and winding journey for this bill, which was unfortunate. But I’m glad we can at least pass some significant veterans legislation this Congress, even if it comes at the last possible moment,” Takano said.

More than 40 veterans service organizations support the Dole Act. The Elizabeth Dole Foundation, an advocacy group for military families, celebrated the bill’s final passage.

“The resources, reforms, and improvements contained in this legislation are precisely the types of advancements that only Congress can provide, and I applaud the members and their staff who never wavered in their determination to get this bill to the president’s desk,” former Sen. Elizabeth Dole (R-N.C.)  said in a statement.

The Dole Act requires each VA physician, podiatrist, optometrist and dentist to receive an annual pay evaluation, and would give the VA more flexibility to offer pay awards, as well as recruitment, retention and relocation bonuses to these health care workers.

The VA would have to give Congress an annual report on the outcome of these pay evaluations, and all resulting market pay adjustments.

The Dole Act would also give the VA the authority to pay retroactive compensation to health care employees who exceeded annual pay caps between Jan. 8, 2006, and Dec. 31, 2017.

The bill would allow the VA to waive pay limitations for up to 300 personnel, “if deemed necessary for the recruitment or retention of critical health care personnel.”

The Dole Act would also require the VA to develop staffing models for its Office of Integrated Veteran Care, Veterans Integrated Services Networks (VISNs), and VA medical centers that will allow the department to “ensure timely access to care and to effectively oversee the provision of care.”

The VA would also have to submit annual reports to Congress and the Government Accountability Office on its efforts to meet these staffing targets.

The VA says it’s delivering more health care and benefits to more veterans than ever before, breaking previous records.

The department is seeing this record workload under the 2022 PACT Act, which expands health care and benefits for veterans exposed to toxic substances during their military service.

The Dole Act would require the VA to incorporate performance metrics and accountability measures within performance appraisals for VA employees responsible for providing timely access to care.

The bill requires the VA to develop a strategic plan to implement “value-based care” that focuses on quality, provider performance and patient experience. That plan would include an assessment of the VA’s IT infrastructure and workforce challenges.

Following the report’s release, the department would launch a three-year pilot of value-based care across its primary care, mental health and substance abuse services.

The Dole Act would require all new VA employees to receive training from the VA’s inspector general’s office on reporting wrongdoing.

Rep. Morgan Lutrell (R-Texas), chairman of the disability assistance and memorial affairs subcommittee, said the Dole Act includes his bill, the Modernization Department of Veterans Affairs Disability Benefit Questionnaires Act.

Lutrell said VA contractors who perform disability exams are not required to submit disability benefit questionnaires (DBQs) in a format that can easily be processed by the VA’s claims automation software.

“This leads to the backlogs and delays that could be avoided by submitting the DBQs based on a standard that computers can read,” he said.

The bill would require these DBQs to be readable by an automated program.

“Computerizing the data is the key to helping VA process and adjudicate veterans’ claims faster,” Lutrell said. “As the VA moves forward with automation, standardizing the DBQ data will be crucial to timely and accurate claims processing.”

Rep. Juan Ciscomani (R-Ariz.), who led the Dole Act in the House, applauded provisions of the bill that reauthorize and fund the VA’s VET-TEC program through September 2027, and would allow up to 4,000 veterans to enroll in the program each year.

The VET-TEC program places veterans into training to learn IT skills, or to start or advance tech careers. The VET-TEC program started a five-year pilot.

The VA stopped accepting new applications in April 2024. The program has an 84% graduation rate for the 12,000 veterans who have already completed training.

The Dole Act directs the Interior Department to launch its own pilot program to hire veterans in conservation and resource management positions.

“I look forward to taking this final step to send this bill to the President’s desk and give our veterans the VA reforms they demand and that they deserve,” Ciscomani said.

The final version of the bill no longer includes the RESET Act, a bipartisan bill that would have kept the VA from rolling out a new Electronic Health Record at more of its facilities, until the six VA sites already using the new system meet certain performance standards.

The VA paused all future deployments of the Oracle-Cerner EHR in April 2023 to address persistent problems reported by VA employees at facilities already using the new system.

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