[House Report 106-863]
[From the U.S. Government Publishing Office]
106th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 106-863
======================================================================
DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE PERSONNEL ACT OF 2000
_______
September 18, 2000.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
_______
Mr. Stump, from the Committee on Veterans' Affairs, submitted the
following
R E P O R T
[To accompany H.R. 5109]
The Committee on Veterans' Affairs, to whom was referred the
bill (H.R. 5109) to amend title 38, United States Code, to
improve the personnel system of the Veterans Health
Administration, and for other purposes, having considered the
same, reports favorably thereon with an amendment and
recommends that the bill as amended do pass.
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Department of
Veterans Affairs Health Care Personnel Act of 2000''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. References to title 38, United States Code.
TITLE I--PERSONNEL MATTERS
Sec. 101. Annual national pay comparability adjustment for nurses
employed by Department of Veterans Affairs.
Sec. 102. Special pay for dentists.
Sec. 103. Exemption for pharmacists from ceiling on special salary
rates.
Sec. 104. Physician assistant adviser to Under Secretary for Health.
Sec. 105. Temporary full-time appointments of certain medical
personnel.
Sec. 106. Qualifications of social workers.
Sec. 107. Extension of voluntary separation incentive payments.
TITLE II--CONSTRUCTION AUTHORIZATION
Sec. 201. Authorization of major medical facility projects.
Sec. 202. Authorization of appropriations.
TITLE III--MILITARY SERVICE ISSUES
Sec. 301. Military service history.
Sec. 302. Study of post-traumatic stress disorder in Vietnam veterans.
TITLE IV--MEDICAL ADMINISTRATION
Sec. 401. Pilot program for coordination of hospital benefits.
Sec. 402. Benefits for persons disabled by participation in compensated
work therapy program.
Sec. 403. Extension of authority to establish research and education
corporations.
Sec. 404. Department of Veterans Affairs Fisher Houses.
Sec. 405. Extension of annual report of Committee on Mentally Ill
Veterans.
Sec. 406. Exception to recapture rule.
Sec. 407. Change to enhanced use lease congressional notification
period.
Sec. 408. Technical and conforming changes.
Sec. 409. Release of reversionary interest of the United States in
certain real property previously conveyed to the State of Tennessee.
SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE.
Except as otherwise expressly provided, whenever in this Act an
amendment or repeal is expressed in terms of an amendment to, or repeal
of, a section or other provision, the reference shall be considered to
be made to a section or other provision of title 38, United States
Code.
TITLE I--PERSONNEL MATTERS
SEC. 101. ANNUAL NATIONAL PAY COMPARABILITY ADJUSTMENT FOR NURSES
EMPLOYED BY DEPARTMENT OF VETERANS AFFAIRS.
(a) Revised Pay Adjustment Procedures.--Section 7451 is amended--
(1) in subsection (d)--
(A) in paragraph (1)--
(i) by striking ``The rates'' and inserting
``Subject to subsection (e), the rates''; and
(ii) in subparagraph (A), by inserting ``and
to be by the same percentage'' after ``to have
the same effective date'';
(B) in paragraph (2), by striking ``Such'' in the
second sentence and inserting ``Except as provided in
paragraph (1)(A), such'';
(C) in paragraph (3)(B)--
(i) by inserting after the first sentence the
following new sentence: ``To the extent
practicable, the director shall use third-party
industry wage surveys to meet the requirements
of the preceding sentence.'';
(ii) by inserting before the penultimate
sentence the following new sentence: ``To the
extent practicable, all surveys conducted
pursuant to this subparagraph or subparagraph
(A) shall include the collection of salary
midpoints, actual salaries, lowest and highest
salaries, average salaries, bonuses, incentive
pays, differential pays, actual beginning rates
of pay and such other information needed to
meet the purpose of this section.''; and
(iii) in the penultimate sentence, by
inserting ``or published'' after ``completed'';
(D) by striking clause (iii) of paragraph (3)(C);
(2) by striking subsection (e) and inserting the following:
``(e)(1) An adjustment in a rate of basic pay under subsection (d)
may not reduce the rate of basic pay applicable to any grade of a
covered position.
``(2) The director of a Department health-care facility, in
determining whether to carry out a wage survey under subsection (d)(3)
with respect to rates of basic pay for a grade of a covered position,
may not consider as a factor in such determination the absence of a
current recruitment or retention problem for personnel in that grade of
that position. The director shall make such a determination based upon
whether, in accordance with criteria established by the Secretary,
there is a significant pay-related staffing problem at that facility in
any grade for a position. If the director determines that there is such
a problem, or that such a problem is likely to exist in the near
future, the Director shall provide for a wage survey in accordance with
paragraph (3) of subsection (d).
``(3) The Under Secretary for Health may, to the extent necessary to
carry out the purposes of subsection (d), modify any determination made
by the director of a Department health-care facility with respect to
adjusting the rates of basic pay applicable to covered positions. Upon
such action by the Under Secretary, any adjustment shall take effect on
the first day of the first pay period beginning after such action. The
Secretary shall ensure that the Under Secretary establishes a mechanism
for the exercise of the authority in the preceding sentence.
``(4) Each director of a Department health-care facility shall
provide to the Secretary, not later than July 31 each year, a report on
staffing for covered positions at that facility. The report shall
include the following:
``(A) Information on turnover rates and vacancy rates for
each grade in a covered position, including a comparison of
those rates with the rates for the preceding three years.
``(B) The director's findings concerning the review and
evaluation of the facility's staffing situation, including
whether there is, or is likely to be, in accordance with
criteria established by the Secretary, a significant pay-
related staffing problem at that facility for any grade of a
covered position and, if so, whether a wage survey was
conducted, or will be conducted with respect to that grade.
``(C) In any case in which the director conducts such a wage
survey during the period covered by the report, information
describing the survey and any actions taken or not taken based
on the survey, and the reasons for taking (or not taking) such
actions.
``(D) In any case in which the director, after finding that
there is, or is likely to be, in accordance with criteria
established by the Secretary, a significant pay-related
staffing problem at that facility for any grade of a covered
position, determines not to conduct a wage survey with respect
to that position, a statement of the reasons why the director
did not conduct such a survey.
``(5) Not later than September 30 of each year, the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate and House
of Representatives a report on staffing for covered positions at
Department healthcare facilities. Each such report shall include the
following:
``(A) A summary and analysis of the information contained in
the most recent reports submitted by facility directors under
paragraph (4).
``(B) The information for each such facility specified in
paragraph (4).'';
(3) in subsection (f)--
(A) by striking ``February 1 of 1991, 1992, and
1993'' and inserting ``March 1 of each year''; and
(B) by striking ``subsection (d)(1)(A)'' and
inserting ``subsection (d)''; and
(4) by striking subsection (g) and redesignating subsection
(h) as subsection (g).
(b) Required Consultations With Nurses.--(1) Subchapter II of chapter
73 is amended by adding at the end the following new section:
``Sec. 7323. Required consultations with nurses
``The Under Secretary for Health shall ensure that--
``(1) the director of a geographic service area, in
formulating policy relating to the provision of patient care,
shall consult regularly with a senior nurse executive or senior
nurse executives; and
``(2) the director of a medical center shall, to the extent
feasible, include a registered nurse as a member of any
committee used at that medical center to provide
recommendations or decisions on medical center operations or
policy affecting clinical services, clinical outcomes, budget,
or resources.''.
(2) The table of sections at the beginning of such chapter is amended
by inserting after the item relating to section 7322 the following new
item:
``7323. Required consultations with nurses.''.
SEC. 102. SPECIAL PAY FOR DENTISTS.
(a) Full-Time Status Pay.--Paragraph (1) of section 7435(b) is
amended by striking ``$3,500'' and inserting ``$9,000''.
(b) Special Pay for Post-Graduate Training.--Such section is amended
by adding at the end the following new paragraph:
``(8) For a dentist who has successfully completed a post-
graduate year of hospital-based training in a program
accredited by the American Dental Association, an annual rate
of $2,000 for each of the first two years of service after
successful completion of that training.''.
(c) Tenure Pay.--The table in paragraph (2)(A) of that section is
amended to read as follows:
------------------------------------------------------------------------
Rate
``Length of Service -------------------------
Minimum Maximum
------------------------------------------------------------------------
1 year but less than 2 years.................. $1,000 $2,000
2 years but less than 4 years................. 4,000 5,000
4 years but less than 8 years................. 5,000 8,000
8 years but less than 12 years................ 8,000 12,000
12 years but less than 20 years............... 12,000 15,000
20 years or more.............................. 15,000 18,000.''.
------------------------------------------------------------------------
(d) Scarce Specialty Pay.--Paragraph (3)(A) of that section is
amended by striking ``$20,000'' and inserting ``$30,000''.
(e) Geographic Pay.--Paragraph (6) of that section is amended by
striking ``$5,000'' and inserting ``$12,000''.
(f) Responsibility Pay.--(1) The table in paragraph (4)(A) of that
section is amended to read as follows:
------------------------------------------------------------------------
Rate
``Position -------------------------
Minimum Maximum
------------------------------------------------------------------------
Chief of Staff or in an Executive Grade....... $14,500 $25,000
Director Grade................................ 0 25,000
Service Chief (or in a comparable position as 4,500 15,000.''.
determined by the Secretary).................
------------------------------------------------------------------------
(2) The table in paragraph (4)(B) of that section is amended to read
as follows:
------------------------------------------------------------------------
``Position Rate
------------------------------------------------------------------------
Deputy Service Director.................................... $20,000
Service Director........................................... 25,000
Deputy Assistant Under Secretary for Health................ 27,500
Assistant Under Secretary for Health (or in a comparable 30,000.''.
position as determined by the Secretary)..................
------------------------------------------------------------------------
(g) Crediting of Increased Tenure Pay for Civil Service Retirement.--
Section 7438(b) is amended--
(1) by redesignating paragraph (5) as paragraph (6); and
(2) by inserting after paragraph (4) the following new
paragraph:
``(5) Notwithstanding paragraphs (1) and (2), a dentist employed as a
dentist in the Veterans Health Administration on the effective date of
section 102 of the Department of Veterans Affairs Health Care Personnel
Act of 2000 shall be entitled to have special pay paid to the dentist
under section 7435(b)(2)(A) of this title (referred to as `tenure pay')
considered basic pay for the purposes of chapter 83 or 84, as
appropriate, of title 5 only as follows:
``(A) In an amount equal to the amount that would have been
so considered under such section on the day before such
effective date based on the rates of special pay the dentist
was entitled to receive under that section on the day before
such effective date.
``(B) With respect to any amount of special pay received
under that section in excess of the amount such dentist was
entitled to receive under such section on the day before such
effective date, in an amount equal to 25 percent of such excess
amount for each two years that the physician or dentist has
completed as a physician or dentist in the Veterans Health
Administration after such effective date.''.
(h) Effective Date.--The amendments made by this section shall apply
with respect to agreements entered into by dentists under subchapter
III of chapter 74 of title 38, United States Code, on or after the
later of--
(1) the date of the enactment of this Act; and
(2) October 1, 2000.
(i) Transition.--(1) In the case of an agreement entered into by a
dentist under subchapter III of chapter 74 of title 38, United States
Code, before the date of the enactment of this Act that expires after
the effective date specified in subsection (h), the Secretary of
Veterans Affairs and the dentist concerned may agree to terminate that
agreement as of that effective date in order to permit a new agreement
in accordance with section 7435 of such title, as amended by this
section, to take effect as of that effective date.
(2) In the case of an agreement entered into under such subchapter
before the date of the enactment of this Act that expires during the
period beginning on the date of the enactment of this Act and ending on
the effective date specified in subsection (h)(2), an extension or
renewal of that agreement may not extend beyond that effective date.
(3) In the case of a dentist who begins employment with the
Department of Veterans Affairs during the period beginning on the date
of the enactment of this Act and ending on the effective date specified
in subsection (h)(2) who is eligible for an agreement under subchapter
III of chapter 74 of title 38, United States Code, any such agreement
may not extend beyond that effective date.
SEC. 103. EXEMPTION FOR PHARMACISTS FROM CEILING ON SPECIAL SALARY
RATES.
Section 7455(c)(1) is amended by inserting ``, pharmacists,'' after
``anesthetists''.
SEC. 104. PHYSICIAN ASSISTANT ADVISER TO UNDER SECRETARY FOR HEALTH.
Section 7306(f) is amended--
(1) by striking ``and'' at the end of paragraph (1);
(2) by striking the period at the end of paragraph (2) and
inserting ``; and''; and
(3) by adding at the end the following new paragraph:
``(3) a physician assistant with appropriate experience (who
may have a permanent duty station at a Department medical care
facility in reasonable proximity to Washington, DC) advises the
Under Secretary on all matters relating to the utilization and
employment of physician assistants in the Administration.''.
SEC. 105. TEMPORARY FULL-TIME APPOINTMENTS OF CERTAIN MEDICAL
PERSONNEL.
(a) Physician Assistants Awaiting Certification or Licensure.--
Paragraph (2) of section 7405(c) is amended to read as follows:
``(2) A temporary full-time appointment may not be made for a period
in excess of two years in the case of a person who--
``(A) has successfully completed--
``(i) a full course of nursing in a recognized school
of nursing, approved by the Secretary; or
``(ii) a full course of training for any category of
personnel described in paragraph (3) of section 7401 of
this title, or as a physician assistant, in a
recognized education or training institution approved
by the Secretary; and
``(B) is pending registration or licensure in a State or
certification by a national board recognized by the
Secretary.''.
(b) Medical Support Personnel.--That section is further amended--
(1) by redesignating paragraph (3) as paragraph (4); and
(2) by inserting after paragraph (2) the following new
paragraph (3):
``(3)(A) Temporary full-time appointments of persons in positions
referred to in subsection (a)(1)(D) shall not exceed three years.
``(B) Temporary full-time appointments under this paragraph may be
renewed for one or more additional periods not in excess of three years
each.''.
SEC. 106. QUALIFICATIONS OF SOCIAL WORKERS.
Section 7402(b)(9) is amended by striking ``a person must'' and all
that follows and inserting ``a person must--
``(A) hold a master's degree in social work from a college or
university approved by the Secretary; and
``(B) be licensed or certified to independently practice
social work in a State, except that the Secretary may waive the
requirement of licensure or certification for an individual
social worker for a reasonable period of time recommended by
the Under Secretary for Health.''.
SEC. 107. EXTENSION OF VOLUNTARY SEPARATION INCENTIVE PAYMENTS.
The Department of Veterans Affairs Employment Reduction Assistance
Act of 1999 (title XI of Public Law 106-117; 5 U.S.C. 5597 note) is
amended as follows:
(1) Section 1102(c) is amended to read as follows:
``(c) Limitation.--The plan under subsection (a) shall be limited to
8,110 positions within the Department.''.
(2) Section 1105(a) is amended by striking ``26 percent'' and
inserting ``15 percent''.
(3) Section 1109(a) is amended by striking ``December 31,
2000'' and inserting ``December 31, 2002''.
TITLE II--CONSTRUCTION AUTHORIZATION
SEC. 201. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS.
(a) Fiscal Year 2001 Projects.--The Secretary of Veterans Affairs may
carry out the following major medical facility projects, with each
project to be carried out in the amount specified for that project:
(1) Construction of a psychogeriatric care building at the
Department of Veterans Affairs Medical Center, Palo Alto,
California, in an amount not to exceed $26,600,000.
(2) Construction of a utility plant and electrical vault at
the Department of Veterans Affairs Medical Center, Miami,
Florida, in an amount not to exceed $23,600,000.
(3) Seismic corrections, clinical consolidation, and other
improvements at the Department of Veterans Affairs Medical
Center, Long Beach, California, in an amount not to exceed
$51,700,000.
(b) Additional Fiscal Year 2000 Project.--The Secretary is authorized
to carry out a project for the renovation of psychiatric nursing units
at the Department of Veterans Affairs Medical Center, Murfreesboro,
Tennessee, in an amount not to exceed $14,000,000.
SEC. 202. AUTHORIZATION OF APPROPRIATIONS.
(a) In General.--There are authorized to be appropriated to the
Secretary of Veterans Affairs for fiscal years 2001 and 2002 for the
Construction, Major Projects, account, $101,900,000 for the projects
authorized in section 101(a).
(b) Limitation.--The projects authorized in section 101(a) may only
be carried out using--
(1) funds appropriated for fiscal year 2001 or 2002 pursuant
to the authorization of appropriations in subsection (a);
(2) funds appropriated for Construction, Major Projects for a
fiscal year before fiscal year 2001 that remain available for
obligation; and
(3) funds appropriated for Construction, Major Projects for
fiscal year 2001 or 2002 for a category of activity not
specific to a project.
TITLE III--MILITARY SERVICE ISSUES
SEC. 301. MILITARY SERVICE HISTORY.
(a) Military Histories.--The Secretary of Veterans Affairs, in
carrying out the responsibilities of the Secretary under chapter 17 of
title 38, United States Code, shall ensure that--
(1) during at least one clinical evaluation of a patient in a
facility of the Department, a protocol is used to identify
pertinent military experiences and exposures of the patient
that may contribute to the health status of the patient; and
(2) pertinent information relating to the military history of
the patient is included in the Department's medical records of
the patient.
(b) Report.--Not later than nine months after the date of the
enactment of this Act, the Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives a report
on the feasibility and desirability of using a computer-based system in
conducting clinical evaluations referred to in subsection (a)(1).
SEC. 302. STUDY OF POST-TRAUMATIC STRESS DISORDER IN VIETNAM VETERANS.
(a) Study on Post-Traumatic Stress Disorder.--Not later than 10
months after the date of the enactment of this Act, the Secretary of
Veterans Affairs shall enter into a contract with an appropriate entity
to carry out a study on post-traumatic stress disorder.
(b) Follow-Up Study.--The contract under subsection (a) shall provide
for a follow-up study to the study conducted in accordance with section
102 of the Veterans Health Care Amendments of 1983 (Public Law 98-160).
Such follow-up study shall use the data base and sample of the previous
study.
(c) Information To Be Included.--The study conducted pursuant to this
section shall be designed to yield information on--
(1) the long-term course of post-traumatic stress disorder;
(2) any long-term medical consequences of post-traumatic
stress disorder;
(3) whether particular subgroups of veterans are at greater
risk of chronic or more severe problems with such disorder; and
(4) the services used by veterans who have post-traumatic
stress disorder and the effect of those services on the course
of the disorder.
(d) Report.--The Secretary shall submit to the Committees of
Veterans' Affairs of the Senate and House of Representatives a report
on the results of the study under this section. The report shall be
submitted no later than October 1, 2004.
TITLE IV--MEDICAL ADMINISTRATION
SEC. 401. PILOT PROGRAM FOR COORDINATION OF HOSPITAL BENEFITS.
(a) In General.--Chapter 17 is amended by inserting after section
1725 the following new section:
``Sec. 1725A. Coordination of hospital benefits: pilot program
``(a) The Secretary may carry out a pilot program in not more than
four geographic areas of the United States to improve access to, and
coordination of, inpatient care of eligible veterans. Under the pilot
program, the Secretary, subject to subsection (b), may pay certain
costs described in subsection (b) for which an eligible veteran would
otherwise be personally liable. The authority to carry out the pilot
program shall expire on September 30, 2005.
``(b) In carrying out the program described in subsection (a), the
Secretary may pay the costs authorized under this section for hospital
care and medical services furnished on an inpatient basis in a non-
Department hospital to an eligible veteran participating in the
program. Such payment may cover the costs for applicable plan
deductibles and coinsurance and the reasonable costs of such inpatient
care and medical services not covered by any applicable health-care
plan of the veteran, but only to the extent such care and services are
of the kind authorized under this chapter. The Secretary shall limit
the care and services for which payment may be made under the program
to general medical and surgical services and shall require that such
services may be provided only upon preauthorization by the Secretary.
``(c)(1) A veteran described in paragraph (1) or (2) of section
1710(a) of this title is eligible to participate in the pilot program
if the veteran--
``(A) is enrolled to receive medical services from an
outpatient clinic operated by the Secretary which is (i) within
reasonable proximity to the principal residence of the veteran,
and (ii) located within the geographic area in which the
Secretary is carrying out the program described in subsection
(a);
``(B) has received care under this chapter within the 24-
month period preceding the veteran's application for enrollment
in the pilot program;
``(C) as determined by the Secretary before the
hospitalization of the veteran (i) requires such hospital care
and services for a non-service-connected condition, and (ii)
could not receive such services from a clinic operated by the
Secretary; and
``(D) elects to receive such care under a health-care plan
(other than under this title) under which the veteran is
entitled to receive such care.
``(2) Nothing in this section shall be construed to reduce the
authority of the Secretary to contract with non-Department facilities
for care of a service-connected disability of a veteran.
``(3) Notwithstanding subparagraph (D) of paragraph (1), the
Secretary shall ensure that not less than 15 percent of the veterans
participating in the program are veterans who do not have a health-care
plan.
``(d) As part of the program under this section, the Secretary shall,
through provision of case-management, coordinate the care being
furnished directly by the Secretary and care furnished under the
program in non-Department hospitals to veterans participating in the
program.
``(e)(1) In designating geographic areas in which to establish the
program under subsection (a), the Secretary shall ensure that--
``(A) the areas designated are geographically dispersed;
``(B) at least 70 percent of the veterans who reside in a
designated area reside at least two hours driving distance from
the closest medical center operated by the Secretary which
provides medical and surgical hospital care; and
``(C) the establishment of the program in any such area would
not result in jeopardizing the critical mass of patients needed
to maintain a Department medical center that serves that area.
``(2) Notwithstanding paragraph (1)(B), the Secretary may designate
for participation in the program at least one area which is in
proximity to a Department medical center which, as a result of a change
in mission of that center, does not provide hospital care.
``(f)(1) Not later than September 30, 2002, the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate and House
of Representatives a report on the experience in implementing the pilot
program under subsection (a).
``(2) Not later than September 30, 2004, the Secretary shall submit
to those committees a report on the experience in operating the pilot
program during the first two full fiscal years during which the pilot
program is conducted. That report shall include--
``(A) a comparison of the costs incurred by the Secretary
under the program and the cost experience for the calendar year
preceding establishment of the program at each site at which
the program is operated;
``(B) an assessment of the satisfaction of the participants
in the program; and
``(C) an analysis of the effect of the program on access and
quality of care for veterans.
``(g) The total amount expended for the pilot program in any fiscal
year (including amounts for administrative costs) may not exceed
$50,000,000.
``(h) For purposes of this section, the term `health-care plan' has
the meaning given that term in section 1725(f)(3) of this title.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
1725 the following new item:
``1725A. Coordination of hospital benefits: pilot program.''.
SEC. 402. BENEFITS FOR PERSONS DISABLED BY PARTICIPATION IN COMPENSATED
WORK THERAPY PROGRAM.
Section 1151(a)(2) is amended--
(1) by inserting ``(A)'' after ``proximately caused''; and
(2) by inserting before the period at the end the following:
``, or (B) by participation in a program (known as a
`compensated work therapy program') under section 1718 of this
title''.
SEC. 403. EXTENSION OF AUTHORITY TO ESTABLISH RESEARCH AND EDUCATION
CORPORATIONS.
Section 7368 is amended by striking ``December 31, 2000'' and
inserting ``December 31, 2005''.
SEC. 404. DEPARTMENT OF VETERANS AFFAIRS FISHER HOUSES.
(a) Authority.--Subchapter I of chapter 17 of title 38, United States
Code, is amended by adding at the end the following new section:
``Sec. 1708. Temporary lodging
``(a) The Secretary may furnish persons described in subsection (b)
with temporary lodging in a Fisher house or other appropriate facility
in connection with the examination, treatment, or care of a veteran
under this chapter or, as provided for under subsection (e)(5), in
connection with benefits administered under this title.
``(b) Persons to whom the Secretary may provide lodging under
subsection (a) are the following:
``(1) A veteran who must travel a significant distance to
receive care or services under this title.
``(2) A member of the family of a veteran and others who
accompany a veteran and provide the equivalent of familial
support for such veteran.
``(c) In this section, the term `Fisher house' means a housing
facility that--
``(1) is located at, or in proximity to, a Department medical
facility;
``(2) is available for residential use on a temporary basis
by patients of that facility and others described in subsection
(b)(2); and
``(3) is constructed by, and donated to the Secretary by, the
Zachary and Elizabeth M. Fisher Armed Services Foundation.
``(d) The Secretary may establish charges for providing lodging under
this section. The proceeds from such charges shall be credited to the
medical care account and shall be available until expended for the
purposes of providing such lodging.
``(e) The Secretary shall prescribe regulations to carry out this
section. Such regulations shall include provisions--
``(1) limiting the duration of such lodging;
``(2) establishing standards and criteria under which medical
facilities may set charges for such lodging;
``(3) establishing criteria for persons considered to be
accompanying a veteran;
``(4) establishing criteria for the use of such premises; and
``(5) any other limitations, conditions, and priorities that
the Secretary considers appropriate with respect to temporary
lodging under this section.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
1707 the following new item:
``1708. Temporary lodging.''.
SEC. 405. EXTENSION OF ANNUAL REPORT OF COMMITTEE ON MENTALLY ILL
VETERANS.
Section 7321(d)(2) is amended by striking ``three'' and inserting
``six''.
SEC. 406. EXCEPTION TO RECAPTURE RULE.
Section 8136 is amended--
(1) by inserting ``(a)'' at the beginning of the text of the
section; and
(2) by adding at the end the following new subsection:
``(b) The establishment and operation by the Secretary of an
outpatient clinic in facilities described in subsection (a) shall not
constitute grounds entitling the United States to any recovery under
that subsection.''.
SEC. 407. CHANGE TO ENHANCED USE LEASE CONGRESSIONAL NOTIFICATION
PERIOD.
Paragraph (2) of section 8163(c) is amended to read as follows:
``(2) The Secretary may not enter into an enhanced use lease until
the end of the 90-day period beginning on the date of the submission of
notice under paragraph (1).''.
SEC. 408. TECHNICAL AND CONFORMING CHANGES.
(a) Requirement To Provide Care.--Section 1710A(a) is amended by
inserting ``(subject to section 1710(a)(4) of this title)'' after
``Secretary'' the first place it appears.
(b) Conforming Amendment.--Section 1710(a)(4) is amended by striking
``requirement in'' and inserting ``requirements in section 1710A(a)
and''.
SEC. 409. RELEASE OF REVERSIONARY INTEREST OF THE UNITED STATES IN
CERTAIN REAL PROPERTY PREVIOUSLY CONVEYED TO THE
STATE OF TENNESSEE.
(a) Release of Interest.--The Secretary of Veterans Affairs shall
execute such legal instruments as necessary to release the reversionary
interest of the United States described in subsection (b) in a certain
parcel of real property conveyed to the State of Tennessee pursuant to
the Act entitled ``An Act authorizing the transfer of certain property
of the Veterans' Administration (in Johnson City, Tennessee) to the
State of Tennessee'', approved June 6, 1953 (67 Stat. 54).
(b) Specified Reversionary Interest.--Subsection (a) applies to the
reversionary interest of the United States required under section 2 of
the Act referred to in subsection (a), requiring use of the property
conveyed pursuant to that Act to be primarily for training of the
National Guard and for other military purposes.
(c) Conforming Amendment.--Section 2 of such Act is repealed.
Introduction
H.R. 5109 addresses a range of issues reviewed by the
Committee in hearings, meetings, and through other oversight
mechanisms over the course of this year.
On February 17, 2000, the Committee on Veterans' Affairs
held a hearing to receive information on the VA Medical Care
budget request for FY 2001. Those testifying at the hearing
included: the Honorable Togo D. West, Jr., Secretary of
Veterans Affairs; representatives of the Independent Budget,
Mr. Gordon H. Mansfield, Executive Director, Paralyzed Veterans
of America; Mr. David Gorman, Executive Director, Disabled
American Veterans; Mr. David E. Woodbury, National Executive
Director, AMVETS; Mr. Dennis M. Cullinan, National Legislative
Director, Veterans of Foreign Wars; Mr. Philip Wilkerson,
Deputy Director, National Veterans Affairs and Rehabilitation
Commission, The American Legion; Mr. Larry Rhea, Deputy
Director of Legislative Affairs, Non Commissioned Officers
Association; and Mr. Richard Weidman, Director of Government
Relations, Vietnam Veterans of America, on behalf of the
National Military Veterans Alliance.
On April 5, 2000, the Subcommittee on Health received
testimony on the issue of Veterans Health Administration
capital asset planning. Among those testifying at that hearing
were the Honorable Dave Weldon, Member of Congress from the
State of Florida; Mr. Stephen P. Backhus, Director, Veterans'
Affairs and Military Health Care Issues, Health, Education, and
Human Services Division, General Accounting Office, accompanied
by Mr. Paul Reynolds, Assistant Director, Veterans' Affairs and
Military Health Care Issues, Health, Education, and Human
Services Division, General Accounting Office; and Mr. Walter
Gembacz, Assistant Director, Veterans Affairs and Military
Health Care Issues, Health Education, and Human Services
Division, General Accounting Office; Dr. Frances M. Murphy,
Acting Deputy Under Secretary for Policy and Management,
Department of Veterans Affairs; accompanied by Dr. Terrence S.
Batliner, Director, VISN 19; Mr. Dennis Smith, Director, VA
Maryland Health Care System; Charles V. Yarbrough, Chief
Facilities Management Officer, Department of Veterans Affairs;
Mr. Gordon H. Mansfield, Executive Director, Paralyzed Veterans
of America; Mr. Dennis M. Cullinan, Director, National
Legislative Service, Veterans of Foreign Wars; and Mrs.
Jacqueline Garrick, Deputy Director, National Veterans Affairs
and Rehabilitation Commission, The American Legion.
On April 12, 2000, the Subcommittee on Health received
testimony on the issue of recruitment, retention, and
compensation of the VA health care workforce. Those testifying
at this hearing included: Mr. Kenneth J. Clark, Chief Network
Officer, Department of Veterans Affairs; accompanied by Mr.
Walter A. Hall, Assistant General Counsel, Mr. Thomas J. Hogan,
Director Management Support, Ms. Mari A. Horak, Management
Support; Ms. Margaret Kruckemeyer, President, Nursing
Organization for Veterans' Affairs (NOVA); Mr. Bobby Harnage,
National President, American Federation of Government
Employees; Dr. John F. Burton, National Association of VA
Physicians and Dentists, and Dr. Robert M. Anderton, American
Dental Association.
On May 17, 2000, the Subcommittee on Health received
testimony on the issue of Health Care Sharing programs of the
Departments of Veterans Affairs (VA) and Defense (DoD). Among
those testifying at this hearing included: Mr. Anthony J.
Principi, Chairman, Congressional Commission on Servicemembers
and Veterans Transition Assistance, Mr. Stephen P. Backhus,
Director, Veterans Affairs and Military Health Care Issues,
Health, Education, and Human Services Division, General
Accounting Office; the Honorable Thomas L. Garthwaite, Deputy
Under Secretary for Health, Department of Veterans Affairs;
Gwendolyn Brown, Deputy Assistant Secretary of Defense, Health
Budgets and Financial Policy, Department of Defense; and
Lieutenant General Paul K. Carlton, Jr., Surgeon General,
United States Air Force.
On the basis of its hearings and oversight on these
matters, the Subcommittee on Health met on September 7, 2000,
to mark up H.R. 5109, the Department of Veterans Affairs Health
Care Personnel Act of 2000. The bill was endorsed unanimously
by the Subcommittee and reported to the full Committee on
Veterans' Affairs. The full Committee met on September 13,
2000, and ordered the bill reported, as amended, favorably to
the House.
Summary of the Reported Bill
H.R. 5109 would:
TITLE I-PERSONNEL MATTERS
1. LAuthorize annual ``national'' comparability pay raise
for VA nurses on par with that of other federal employees.
2. LMake optional annual locality survey process for VA
nurse pay. Define ``triggers'' that indicate the need for
Directors to perform locality pay surveys for nurses such as
turnover, lag time, looming nurse shortage, to be defined in
criteria of Secretary; require communication to peer and senior
Veterans Health Administration (VHA) management of intent to
survey; report to Congress on decision to survey.
3. LEliminate the sole discretion vested in facility
directors to make pay decisions; clarify that the absence of a
nurse recruitment or retention problem not be a basis for
failure to provide a pay increase; prohibit ``negative pay
adjustments''; authorize the use of independent survey results;
and provide, to the extent practicable, for pay surveys to
collect actual salary and benefits data.
4. LProvide for nurse participation in policy and
decision-making at the network and medical center levels.
5. LRevise and increase the rates of special pay (in
addition to base pay) which is provided to dentists employed by
the Veterans Health Administration.
6. LAdd pharmacists to the occupations that are exempt
from a statutory cap on special salary rates that may be paid
to meet documented staffing problems.
7. LRequire that the Under Secretary for Health: (a)
designate a physician assistant (PA) to serve as a consultant
to the Under Secretary and (b) seek the advice of a PA
consultant on all matters relating to the employment and
utilization of PAs in the Veterans Health Administration.
8. LAuthorize temporary appointments of up to two years
for PAs who have successfully completed the full course of
training for that profession and are pending certification.
9. LAuthorize temporary extensions of term appointments for
medical support personnel in VA-funded research projects.
10. LAuthorize the Secretary to waive state licensure
requirements for VA social workers while they are completing
training.
11. LExtend and modify employee ``buyout'' legislation
through December 31, 2002.
TITLE II-CONSTRUCTION AUTHORIZATION
1. LAuthorize the Secretary to construct and authorize the
appropriation of $102 million in fiscal year 2001 or 2002 for
major construction projects (a psychogeriatric care building at
the Palo Alto, CA VA Medical Center; a utility plant at the
Miami, FL VA Medical Center; and seismic improvements at the
Long Beach, CA VA Medical Center).
2. LAuthorize previously appropriated but not authorized,
long-term care psychiatric facility at the Murfreesboro, TN VA
Medical Center.
TITLE III-MILITARY SERVICE ISSUES
1. LRequire that, in conducting an initial clinical
evaluation of a veteran, VA identify and document pertinent
military experiences and exposures, which may contribute to the
health status of the patient.
2. LRequire that VA enter into a contract with an
appropriate entity to carry out a study on post-traumatic
stress disorder in follow-up to the study on that disorder
conducted under section 102 of Public Law 98-160.
TITLE IV-MEDICAL ADMINISTRATION
1. LAuthorize VA to conduct a four site pilot program
involving coordination of VA and non-VA health care benefits;
(a) limit program to $50M/year total expenditure; (b) authorize
VA to include veterans without other health care benefits; (c)
set a delimiting date of September 30, 2005, for the
demonstration; (d) limit the ``scope of services'' to basic
medical-surgical care; and (e) require reports to the Veterans'
Affairs Committees.
2. LProvide compensation under section 1151 of title 38,
United States Code, (with consequent health care coverage under
chapter 17) to a veteran who is injured as a result of
participation in a VA compensated work therapy program.
3. LExtend through 2005, VA's authority to establish
nonprofit foundations to foster research, education, or both,
in VA medical centers.
4. LAuthorize VA to furnish veterans and others
accompanying veterans with temporary lodging (Fisher Houses) in
connection with treatment or other provision of services.
5. LExtend the requirement that VA maintain a special
committee relating to the care of the seriously chronically
mentally ill.
6. LFacilitate VA establishment of VA outpatient clinics
in State veterans' homes.
7. LModify the congressional reporting requirement for a
proposed enhanced use lease that requires VA to wait ``60
legislative days'' to ``90 calendar days.''
8. LRelease a reversionary interest of the United States
in certain property previously conveyed to the State of
Tennessee for use by the Army National Guard.
Background and Discussion
Nurse Pay
Congress in 1990 enacted a law (the Department of Veterans
Affairs Nurse Pay Act of 1990, Public Law 101-366) which
completely restructured the VA pay system for nurses to remedy
a serious recruitment and retention problem documented at that
time. The legislation was sparked by a nationwide shortage of
nurses which, under the constraints of then-applicable law,
left VA at a marked competitive disadvantage in hiring and
retaining registered nurses.
The 1990 nurse pay act established a flexible authority for
VA medical center directors to set pay rates for nurses, based
on the local labor market. (Pay adjustments were to be based on
data from the Bureau of Labor Statistics, or if unavailable, on
data from locally administered surveys). The act replaced a
system in which basic pay could only increase within a
specified pay range (for each of then eight nurse-pay grade
levels), and in accordance with annual government pay
increases. ``Special salary rates'' could be set to respond to
recruitment/retention problems but only through a cumbersome
headquarters-administered process. The new system allowed for
substantial pay increases tied to starting salaries for nurses
in the local community. The law also limited the extent of
locality pay adjustments to preclude VA from becoming a
community pay-leader (specifying that the minimum rate of basic
pay for any grade would not exceed the beginning rate of pay
for corresponding positions at non-VA facilities) and divorced
nurse pay from the pay system governing other VA employees.
Nurses' organizations supported this legislation, though it had
both positive and negative aspects. By linking pay to
compensation in the local private sector, the system offered
the potential for substantial pay increases. By severing that
system from the pay mechanisms of the General Schedule pay
system under which other medical care personnel are paid,
however, it left nurses without the assurance of annual pay
increases other employees received.
As an early result of this pay act, nurses in many
locations received very substantial pay increases which were
not given other health care personnel. In 1991, for example,
when the General Schedule increase was 4.1 percent, the minimum
pay rates for entry and intermediate level nurses at the
Washington, DC VA Medical Center jumped more than 59 and 35
percent, respectively. With the passage of years, however,
nurses in certain grades and in certain areas of the country
experienced substantially smaller pay increases than other VA
employees under the General Schedule system. In some instances,
nurses received no locality pay increases for two or more
years.
Overall, VA reports that nurse salaries have generally
tracked U.S. nurse salaries at large. But those salaries
reflect marked variability across the country. Current salaries
for beginning VA nurses at ``grade 1, step 1'' range from a
high of approximately $49,000 in San Francisco to salaries from
$25,000 to $30,000 in many locations; in many other major
metropolitan areas those salaries range from $35,000 to
$45,000. Those in the first step of ``grade 2'' range from
approximately $57,000 in northern California to salaries from
$35,000 to $40,000 in many locations. At the ``grade 3'' level,
VA nurse salaries begin above $60,000 in several locations (to
a high of about $63,000). The last three years have seen a
steady increase nationally in the percentage increase in
adjustments to nurse pay, with a national average increase of
2.2 percent, 3 percent, and 4.3 percent, in January of 1998,
1999, and 2000, respectively. The average increases for the
preceding two years were 1.2 percent and 1.3 percent,
respectively. General Schedule increases for these years,
however, outpaced nurses' average increases.
In light of concerns about administration of the locality-
pay system, in June 1998, VA entered into a contract for a
study to identify how well the locality pay system (LPS) is
working, and what could be done to improve the system.
Anticipating that study, Congress in November 1998, in Public
Law 105-368, directed VA to furnish its findings regarding the
locality pay system and provide recommendations to Congress by
February 1999 for administrative and legislative action. The
Secretary of Veterans Affairs ultimately submitted a report to
Congress in December 1999. That report, however, did not make
legislative recommendations. While acknowledging problems with
the manner in which the locality pay system had operated, in
testifying before the Subcommittee on Health, VA offered
neither a legislative nor an administrative remedy, nor any
timetable for presenting or implementing the contractor's
recommendations.
VA has generally agreed with the findings reported by its
contractor, that when first implemented, LPS helped VA efforts
to recruit and retain nurses. In subsequent years, however, a
reduction in nurse staffing in the non-Federal sector has
markedly changed the labor market. The contractor reported that
recruitment for nurses did not appear to be a major problem for
VA medical centers, and retention of VA nurses appeared to be
even less of a problem. The design, operation, and
administration of the LPS system were seen to represent
challenges, however. The report identified several problems
associated with conducting locality-pay surveys. For example,
approximately two-thirds of VA medical centers reportedly
experienced significant problems in obtaining pertinent salary
information from non-VA hospitals. The contractor identified as
a ``fundamental problem'' the fact that the LPS process focuses
on beginning rates of pay, which may not give a full or
completely accurate view of appropriate compensation levels.
Industry practice reportedly is to begin with midpoints for a
range and set the boundaries of the range at 20 percent or more
above and below the midpoints; thus, non-VA facilities may
never actually pay at the ``beginning'' rate of the range.
The report also addressed the question of how well the
compensation system was working, and found only one of five
indicators to be problematic, involving ``internal equity.'' It
identified several factors contributing to morale problems.
First, nurses may or may not receive an increase in a given
year, depending on the results of LPS and the judgments of VA
medical center directors, while their General Schedule-paid co-
workers receive annual pay increases and private sector nurses
generally receive cost-of-living or similar increases every
year. Second, many believe that budget constraints have a
direct and negative affect on pay increases. Because hospital
directors have exercised their discretion to provide pay raises
so variably across the system, nurses perceive their pay system
to be ``unfair.''
The study recommended that the LPS survey administration
reflect private industry practice. For example, the study
recommended use of independent, third-party surveys; acquiring
data on averages and ranges, as opposed to beginning pay only;
surveying hospitals on actual pay rather than published
minimums; and doing job analysis and detailed job matching on a
less than annual basis, using standard industry terms and
definitions.
In light of finding wide variability in VA medical center
directors' interpretations and implementations of the LPS law,
the study recommended that VA establish more checkpoints for
the validity, reasonableness, and fairness of the pay
adjustment decisionmaking process. It further recommended that
VA Headquarters communicate these checkpoints frequently to
directors. The study also made a ``longer-term'' recommendation
for the pay-setting process--to establish two separate
components for annual pay adjustment, a general across-the-
board pay adjustment for all VA nurses and a locality based
differential that reflects local market conditions or cost-of-
living differences. Insofar as the latter element is
characterized in the study as ``retain[ing] the key feature of
the current VA LPS that permits nurse pay at VA facilities to
be competitive with pay at local non-VA health care
facilities,'' the Committee believes that the recommendation is
worthy as an alternative to the current LPS.
For the past three years, at the urging of Congress, VA's
Under Secretary for Health has strongly encouraged facility
directors to grant pay increases to prevent pay-related
staffing problems. Even under that invigorated policy, however,
nurses' average pay increases over the past five years still
have lagged behind the General Schedule increases. In addition,
the VA has yet to make other administrative changes recommended
by the contractor.
To respond to these continuing problems, the Honorable
Steven C. LaTourette introduced H.R. 1216, the ``Department of
Veterans Affairs Nurses Appreciation Act of 1999.'' This bill
would require that VA provide the same General Schedule pay
raises for nurses and certain other health-care professionals
employed by the Department of Veterans Affairs as it provides
to other federal employees, and would revise the authority of
the Secretary of Veterans Affairs to make further locality pay
adjustments for those employees. Mr. LaTourette's advocacy in
the VA nurse pay issue, and particularly the introduction of
H.R. 1216, encouraged the Committee to require an annual
``national'' comparability pay increase for VA nurses. Also,
the Committee bill rescinds the mandatory annual locality
survey process governing VA nurse pay.
Instead of a mandated survey process, the bill requires
each VA health care facility to complete an annual report with
information on turnover and vacancy rates in nurse staffing,
including a comparison of these rates with those of the
preceding three years. If a director of a VA health-care
facility using objective criteria established by the Secretary
determines that no current recruitment or retention problems
exist, he or she may decide not to survey that year. This
decision, however, must be explained to the Under Secretary and
reported to Congress. The VA Under Secretary for Health,
however, may also question and override the decision of the
local director. Alternatively, if a director determines that
there is a current or pending problem with recruitment and
retention of VA nurses, the director may, after informing local
and regional directors, activate the wage survey process. The
VA Secretary will also report to Congress on these matters. The
Committee believes that providing a guaranteed annual
comparability pay increase and a means of providing competitive
wages in tight local labor markets for nurses, as well as
required oversight and reporting, will solve this longstanding
problem raised by VA nurses.
The reported bill requires VA network officials and VA
medical center directors to consult with VA nurses in matters
of allocation of resources, quality and other aspects of health
policy. It requires VA directors to appoint registered nurses
to local policy committees to ensure that the nursing
perspective is considered in formulating recommendations
affecting the delivery of health care in VA facilities.
Dental Pay
Section 7439 of title 38, United States Code, ensures that
Congress establish levels of total pay for physicians and
dentists of the Veterans Health Administration that are
reasonably comparable to levels of total pay for other federal
and non-federal physicians and dentists. That policy is
intended to ensure that VA recruits and retains a well-
qualified work force of physicians and dentists. To that end,
the law requires the Secretary of Veterans Affairs to report to
the President on a quadrennial basis on recruitment, retention,
and compensation of VA physicians and dentists, and to
recommend appropriate rates of special pay adjustments when
appropriate or necessary. The President is to include such
recommendations on rates of special pay changes in the budget.
The last substantial changes to physician and dental
special pay authorities were enacted in 1991 in the Department
of Veterans Affairs Physician and Dentist Recruitment and
Retention Act of 1991, Public Law 102-40. With that law,
Congress modified provisions established in 1975 when it first
provided for supplementing the pay of certain VA physicians and
dentists with ``special pay'' and ``incentive pay'' to improve
the hiring and retention of these clinicians. A rapid rise in
pay during the 1980s created new problems for VA in recruiting
and retaining certain physicians and dentists, particularly
specialists in these fields, and led to adoption of the 1991
Act.
The 1991 act authorized VA to pay physicians and dentists
supplementary amounts of pay (above base pay rates) in exchange
for their agreements to work for specified terms of years.
``Special'' pay could be paid (within specified pay ranges) for
any of the following: full-time status, tenure, supervisory or
executive responsibilities, exceptional qualifications, scarce
specialty status, and geographic location. This special pay
authority was intended to give the agency flexibility to
respond to local labor market conditions. At the time,
recruitment and retention of dentists did not pose as
significant a problem for VA as physicians did and,
accordingly, the Act provided lesser amounts of special pay in
most categories for VA dentists.
In its most recent (1999) quadrennial report to the
President, VA reported that pay for physicians is comparable to
physicians in other federal agencies and is reasonably
comparable to that of physicians in the uniformed services. In
light of the reported effectiveness of decentralized authority
on pay decisions, the ability to offer competitive compensation
packages, and ongoing restructuring of its professional work
force, VA found no need to propose changes in VA physician pay.
However, while concluding that ``the existing pay system is
working for physicians,'' the report acknowledged a dentist pay
problem.
VHA is starting to experience difficulty in
recruiting and retaining dentists. Most of this
difficulty is focused on VHA's inability to offer
adequate financial incentives due to the limitations of
dental special pay. During the five-year period
starting in 1995, VHA experienced a decline in full-
time dentists from 830 to about 677 while the annual
turnover rate has been running in excess of 11 percent.
There are also fewer ``highly qualified'' applicants to
fill vacant positions and most vacancies take several
months to fill. During this same period, income levels
for dentists in the private sector have increased to an
average of $130,000 per year, versus an average base
pay of $95,000 per year for VA dentists. In addition,
Congress recently passed legislation that provided
accession bonuses of $30,000 for newly appointed
military dentists while at the same time increasing
tenure pay to an amount up to $18,000 per annum.''
In that report, VA recommended an increase in ``full-time
pay'' for dentists (from $3,500 to $9,000) as ``a modest
response to a developing problem,'' and also proposed to
increase the pay ranges for dental executives to those of their
physician counterparts. As the report noted, lack of a
significant pay increase for dental executives ``has been a
financial disincentive to dentists assuming positions of added
responsibility, has hindered recruitment for these positions,
and has been cited as the reason for the resignation of several
dental service chiefs.''
There are relatively limited data to document the extent of
dentist recruitment and retention problems because many VA
medical center directors apparently have not attempted to fill
position vacancies. Nevertheless, in testifying before the
Subcommittee on Health on April 12, 2000, VA acknowledged that
almost seven in ten VA dentists will be eligible to retire by
2003. With VA dental specialists' salaries averaging $104,959
per year (as of September 30, 1999), including incentives, and
with pay of VA dentists in general practice averaging $102,063,
including incentives, the Committee concluded that VA dentist
pay is significantly below that of the uniformed services and
far below community levels. In capsule, VA's dentist pay
problem was summarized at the April 12 hearing as follows:
Mr. SIMPSON: ``. . . if 70 percent of the dentists in
the VA system are going to retire within the next three
years, or eligible for retirement within the next three
years, we're going to have serious problems in trying
to recruit dentists, even though you suggest that we
might not have that problem now. Over the next two
years, it is going to become a real problem, especially
when the rate of dental school graduates is decreasing,
and the environment in the private sector is so much
more advantageous for those people to enter into
private practice.
Although VA, in its report to the President, recommended
changes in two components of special pay, it is questionable
whether those changes alone would adequately address either the
recruitment or retention problems identified at the hearing.
Neither, for example, addresses the concern that VA no longer
attracts dentists with sufficient experience to work
effectively with VA's unique patient population. The reported
bill, accordingly, would provide special pay targeted to the
first two years of employment of dentists who have successfully
completed post-graduate hospital-based training. The reported
bill would also provide greater amounts of special pay in
recognition of the greater experience acquired over years of
service. VA policy as set under current law limits a dentist in
(what some might view as) the prime of his or her career to
tenure pay of only $3,500 and a maximum after 19 years service
of $4,000. The reported bill would significantly increase these
levels, as well as other key components of dental special pay,
to ensure that VA can meet its recruitment and retention goals.
Pharmacists' Pay
Under section 7455 of title 38, United States Code, VA has
authority to increase rates of basic pay--either nationally,
locally or on another geographic basis--when deemed necessary
for recruitment and retention of certain health care personnel.
The grant of special rates is based on documented staffing
problems, to include turnover, resignations based on pay, and
inability to fill vacancies.
With limited exceptions, the law limits such ``special
salary rates'' to a maximum, expressed as twice the difference
between the high and low basic pay levels for the particular
grade. (That maximum is the equivalent of the 28th pay step for
the particular grade.) It is noteworthy, however, that Congress
has exempted two categories of health care personnel from that
statutory ceiling: nurse anesthetists and physical therapists.
The Subcommittee on Health, in a recent survey and site
visits, has considered reports of severe difficulties in
recruitment and retention of pharmacists. The Committee
understands that significant competition to hire and retain
pharmacists is hampering VA's efforts to staff its pharmacies
adequately. Competition from retail pharmacies has already
prompted VA to increase salaries. As of April 30, 2000, VA
reported that 176 special salary authorizations for pharmacists
had been granted covering 3,762 individuals. Accordingly, 86
percent of the 4,384 pharmacists employed by VA as of that date
were being paid special salary rates. In the first four months
of this year alone, VA implemented 48 new or increased
pharmacist special rate authorizations. The number of special
rate authorizations at or within six percent of the step-28
limit increased by 12 in just over one month--from 73 as of
March 28, 2000 to 85 as of May 3, 2000.
Anticipating that, absent relief, these trends will
continue to plague VA's retention and recruitment of
pharmacists, the Committee has included language in this bill
that will add VA pharmacists to the two existing categories of
VA personnel exempted from statutory pay ceilings.
Physician Assistant Consultant
Physician assistants (PAs) have been employed in the VA
health care system since 1970. Physician assistants are
utilized in both inpatient and outpatient settings working in
virtually all medical specialties. VA is the largest American
employer of PAs with nearly 1,200 PAs employed throughout the
system. PAs are being utilized extensively as physician
extenders, and VA has acknowledged its need to employ still
more PAs to staff the growing number of VA outpatient clinics.
VHA is administered by an Under Secretary for Health who,
with chief consultants leading various strategic healthcare
groups, formulates VA health care policy. The VA Committee
envisions that a PA consultant would participate in these
policy discussions regarding personnel issues, recruitment and
staff development, education, clinical practice issues, and
health care strategic planning. Most recently, in December
1999, the VA Committee Chairman and Ranking Member wrote the
Deputy Under Secretary for Health urging VA to establish such a
position. VA's response in February 2000 stated that physician
assistants in VA are currently represented by the Chief
Consultant of Primary and Ambulatory Care, who coordinates with
a physician assistant field advisory group.
Despite employing PAs for nearly 30 years, the VA does not
employ a representative of the PA practice within VHA to advise
the administration on the optimal utilization of PAs. Without
this expertise, VHA has placed restrictions on the ability of
VA physicians to effectively use PAs. The Committee has
concluded that VHA is not fully utilizing a valuable resource
for providing cost-effective health care, especially primary
care as practiced in so many of the VA community-based
outpatient clinics.
The reported bill would create a PA consultant position
held by a VHA physician assistant who would serve as a
consultant to the Under Secretary for Health. The Committee
expects the Under Secretary to use this authority to address
many problems reported by VA PAs that would improve the
delivery of health care.
Temporary Appointments for Physician Assistants
Under current law (section 7405(c)(2) of title 38, United
States Code), VA has authority to provide temporary
appointments of up to two years to individuals in certain
professions (nursing, pharmacy, and respiratory, physical, and
occupational therapy) who have successfully completed a full
course of study and who are pending registration, licensure, or
certification. Upon obtaining the required credentials, these
professionals are converted to career appointments. The initial
temporary ``graduate technician'' experience can be credited
toward meeting grade level requirements for promotion within an
occupation. The temporary appointment authority provides VA a
means of recruiting health professionals while they are meeting
the technical qualification standards.
VA plans to double the number of PAs it employs within the
next several years. Nevertheless, VA has far less flexibility
in hiring physician assistants in training than it does nurses.
The only basis for employment of a physician assistant who is
waiting to take the certification examination is a one-year,
nonrenewable appointment. A one-year appointment limits VA's
efforts to recruit candidates. Moreover, since the physician
assistant national certification examination is only given
twice yearly, an individual often has only one opportunity to
take the examination during the course of his or her one-year
term appointment. Even highly qualified individuals are
reluctant to accept a VA position under these circumstances.
The reported bill would amend section 7405(c)(2) to enable
VA to provide temporary graduate technician appointments to
physician assistants who have completed approved training
programs on the same basis as for VA nurses and other
professionals. Graduate physician assistants would have up to
two years to seek and obtain professional certification. This
change should help VA's recruitment efforts for this important
occupation.
Social Worker Licensure
Public Law 102-86 requires a VA social worker to be
licensed, certified, or registered in the State in which he or
she works in a VA facility, within three years of initial
appointment in this capacity by VA. Certain states such as
California require challenging prerequisites to the licensure
examination that routinely require more than three years for
individuals to complete. Many states do not work reciprocally,
and thus will not grant a license unless a social worker takes
the state licensing examination. At present, VA social workers
are the only VA health care practitioners who cannot use their
state licenses to gain credentials in other states' VA medical
centers. As a consequence, in the State of California, for
example, 68 VA social workers face termination of employment or
significant position downgrades because of failure to meet this
three-year licensing requirement. VA social workers in
Louisiana are concerned as well, and this problem may occur in
additional states as yet unidentified. The Committee believes,
notwithstanding the fact that VA first proposed the three-year
licensure requirement, that VA should have additional
flexibility in managing its social workers. Therefore, the
reported bill would provide for the VA Secretary's waiver of
the licensure requirement to enable social workers to complete
their training preparatory to state licensure examinations.
Extension of Voluntary Separation Incentive Payments
The Veterans' Millennium Health Care and Benefits Act,
Public Law 106-117, authorized the Secretary of Veterans
Affairs to offer employees voluntary separation incentives
``buyouts'' of up to $25,000 each, in order to restructure
operations and functions identified in a plan designed to
improve operating efficiency and quality of care. The bill
continues to require a one-for-one exchange--in other words, VA
must hire one employee for every employee offered a buyout. VA
has sought replacement employees for 94 percent of the
positions for which it offered buyouts under its current
authority, which expires on December 31, 2000. VA made an
informal request late in this Congress for a three-year
extension of this authority.
In considering VA's request, the Committee notes that VA
stands alone among agencies in being required to make to the
federal civil service retirement fund a contribution of 26
percent of an employee's average highest three-year salary as a
type of premium paid to the fund to cover its added costs
incurred from these particular retirements. However, a
Committee inquiry to the Office of Personnel Management yielded
information leading the Committee to conclude that this rate
represents an overpayment by VA. The OPM actuarial forecast
that was used previously to derive the 26 percent payment was
based on an ``early out'' analysis, not a buyout basis. The
Committee observes and VA has documented that most VA employees
who have participated in the voluntary separation program to
date were either already eligible for voluntary retirement on
the basis of length of service, or shortly would have been so
eligible. Other agencies participating in the buyout program
contribute at the 15 percent level for the ``high-three''
average salary years. Based on all the efforts of Congress in
the 1998-99 period to restore VA medical care funding, and
given that most of the buyouts to date emanated from the
Veterans Health Administration, the Committee believes that
there is no basis for requiring VA to make a higher payment
than other agencies to the retirement fund.
The reported bill would provide an extension of VA's buyout
authority until December 31, 2002, a two-year extension rather
than the three years requested informally by VA. The Committee
will closely monitor VA's use of buyout authority to ensure
that the qualitative base for delivering health care to
veterans is not eroded by VA's use of this authority.
Military Service History
The Committee recognizes and applauds the leadership of the
Veterans Health Administration for initiating efforts to
incorporate a military history into the scope of a
comprehensive medical examination. Left unidentified and
untreated, conditions which have their origins in military
service not only portend severe consequences for a patient's
health, but represent the very essence of what a veterans'
health care system was intended to detect and rehabilitate.
Ascertaining that a veteran was a prisoner of war, participated
in combat, or was exposed to sustained subfreezing conditions,
toxic substances, or environmental hazards or nuclear ionizing
radiation, for example, are of critical diagnostic and
treatment relevance. The Committee views the taking of a
thorough history, to include a military medical history, to be
so central to VA's mission that it has included this
requirement in the reported bill. While VA has stated its
support of this effort, progress in implementing it has been
slow. This Committee has historically respected, and repeatedly
declined invitations to direct, clinicians' practice of their
professions. Yet there is both value and importance in
recognizing and affirming the wisdom of ensuring that a
military medical history be a mandatory component of every
veteran's VA care. The reported bill would provide assurance
that such a policy becomes a matter not only of administrative
policy but also everyday clinical practice in VA.
Post-Traumatic Stress Disorder Study
In 1984, the VA began a large-scale survey on the
prevalence and incidence of post-traumatic stress disorder and
other psychological problems among Vietnam veterans. That
study, directed by Congress in Public Law 98-160, involved a
representative sample of all Vietnam theater and era veterans
who served between August 1964 and May 1975. The study found
that at the time some 15 percent of male and 8.5 percent of
female Vietnam theater veterans suffered from post-traumatic
stress disorder (PTSD). Among those exposed to high levels of
war zone stress the rates were dramatically higher--fourfold
for men (a rate of almost 35.8 percent) and sevenfold for women
(a rate of 17.5 percent)--than rates for those with low to
moderate stress exposure. Some 31 percent of males and 27
percent of female Vietnam theater veterans were found to have
suffered from PTSD at some point after their military service.
The VA study was recognized as a landmark investigation
that provided definitive and unique information on the
prevalence and etiology of PTSD. The study results led VA to
develop specialized programs to treat those veterans suffering
from this condition. Because of the high rates of PTSD and
strong evidence of its persistence, experts have cited the
importance of initiating a follow-up study involving those who
participated in the original work.
Recent studies have documented that PTSD is an important
determinant of continued disability and need for care. PTSD has
been shown to be strongly associated with a range of other
mental health diagnoses, social and adjustment problems,
including substance use disorders, and with high consumption of
VA health care resources. Given its chronicity and association
with long-term disability, the proportion of VA resources
required to meet the needs of veterans with PTSD may increase
over the coming years. To help VA prepare to meet such a need,
it must have a better understanding of whether PTSD is a risk
factor for later health problems which may yet emerge in this
still comparatively young population. A follow-up study of the
National Vietnam Veterans Readjustment Study would provide a
valuable, cost-efficient mechanism to answer important
questions such as:
(1) LWhat is the impact of PTSD on subsequent medical
morbidity? There is suspicion, for example, that PTSD could be
a risk factor for cardiovascular disease. A follow-up of
findings from the original study coupled with physical
examinations and more extensive data collection on physical
health problems would permit VA to collect valuable information
that could help plan for veterans' future needs for medical
services.
(2) LWhat is the long-range course of PTSD? Follow-up
interviews would allow an estimate of remission and relapse
rates, and identification of risk factors that affect the
course of the syndrome.
(3) LWhat are the psychological and psychiatric
consequences of PTSD?
(4) LWhat subgroups of veterans are least likely to recover
from PTSD and most likely to suffer effects of PTSD in other
aspects of their health and functioning?
(5) LWhat VA health care services do veterans with PTSD use
and what impact has such use had on the course of the disorder?
Scientists who have conceived such a follow-up study
envision that it would involve re-interviewing the
approximately 2,350 theater and era veterans who participated
in the original study, and that a portion of the study
population would undergo a standardized physical examination,
psychiatric assessment, as well as a review of their medical
and treatment records. It is anticipated that the cost of this
study would be a fraction of the original, longer $10 million
study. The Committee believes that VA, with the close
involvement of its National Center for Post-Traumatic Stress
Disorder, should design this project. Based on the earlier
understanding that the study's subjects not be identifiable by
the government, the study should be conducted by an independent
contractor.
Enhanced Use Lease Program
Congress, in the Veterans' Millennium Health Care Act,
Public Law 106-117, eased limits in law on leasing underused VA
property based on a finding that long-term leasing could be
used more extensively to enhance health care delivery to
veterans. In an April 5, 2000, hearing before the Subcommittee
on Health on VA capital asset planning and management, the
General Accounting Office reiterated its earlier-expressed view
that VA could improve veterans' health care if it reduced the
level of resources spent on underused, inefficient, or obsolete
buildings and reinvested those savings in providing health care
more efficiently in modern facilities at existing or new
locations closer to where veterans live. A survey of VA
facilities conducted by the Subcommittee earlier this year
revealed that many facilities have unneeded buildings or land
with potential for long-term leasing and commercial
development. The years-long approval process was frequently
cited as a significant disincentive for potential private
sector lessees.
The Committee has written to the Secretary of Veterans
Affairs to encourage the Department to streamline its approval
process. The Secretary has as yet failed to act on the
Committee's initiative. Statutory requirements, however, to
include a requirement for public hearing and Congressional
notice also delay development and execution of such leases. The
Committee's review of those statutory requirements suggests
that, with the maturing and demonstrated success of this
program, it is appropriate to consider relaxing safeguards
which were imposed at its inception, but which now may no
longer be necessary. Therefore, in this bill, the Committee has
included language reducing the waiting period after VA notifies
Congress of the intent to execute an enhanced use lease from 60
``legislative days'' to 90 ``days.''
Temporary Lodging at VA Health Care Facilities
Fundamental changes in VA health care delivery over the
past 20 years have dramatically increased the number of medical
procedures being performed on an outpatient basis at VA medical
centers. Because of the lengthy travel required to undergo
needed tests and procedures, VA's patients occasionally need
overnight lodging. For example, patients, who may live hours
from a VA medical center, often must be at that center early in
the morning to undergo a procedure and to be sent home later
the same day. Transportation problems may require a patient,
often accompanied by a family member, to arrive the night
before a procedure. It is also common for a patient to require
a series of outpatient visits over a short period of time, none
necessitating a hospital admission. Thus, for example, a
patient might have surgery on an outpatient basis and be
required to return to the clinic for follow-up care the next
day. Such situations can present great difficulties for often
elderly patients with limited financial means who must travel
long distances to obtain outpatient care, but who lack the
means to procure local accommodations. While VA's establishment
of hundreds of new community-based outpatient clinics has
helped ameliorate the problem, many patients must still travel
significant distances for diagnostic testing, specialty care,
or surgery. In an effort to meet patients' needs, VA medical
centers have for some years made efforts to assist patients and
family members accompanying them in finding overnight
accommodations. Similar efforts are made by many non-VA medical
facilities that serve a geographically-dispersed patient
population.
The Committee is aware that VA has tried to meet the needs
of veterans for accommodations in various ways. One alternative
has been the establishment of facilities known as ``Fisher
Houses,'' built with funds donated by the Zachary and Elizabeth
M. Fisher Foundation. Four such facilities are now being
operated in conjunction with VA medical centers. The Committee
is also aware that many VA medical centers over the years have
converted unused wards and other available space to establish
temporary lodging facilities for use by patients. In fact, VA
has encouraged medical centers to establish such facilities as
an alternative to hospitalizing patients when outpatient
treatment is more appropriate. In 1996, the Under Secretary for
Health issued VHA Information Letter 10-96-028 to provide
guidance on the requirements for operating these facilities,
which the Under Secretary named as ``hoptels.'' The guidance
provided that VA facilities could provide lodging without
charge to outpatients and family members accompanying the
veteran when medically necessary. The guidance also sanctioned
the use of a revocable license for family members under which
the individual would be required to pay VA a fee equal to the
fair market value of the services being furnished.
It is the Committee's understanding that most VA medical
centers now offer patients in need help with some form of
hoptel or lodging facility. Indeed, VA has informally advised
the Committee that more than 115 facilities offer lodging of
some kind on VA grounds, and that services are available in
non-VA facilities at a number of other locations. It is not at
all clear, however, that these facilities are operated in
strict compliance with the guidance provided in the 1996
Information Letter.
The reported bill would provide clear authority for VA to
provide such temporary overnight accommodations in Fisher
Houses and other similar facilities located at or near a VA
facility, when it is appropriate to do so. These accommodations
would be available to veterans who have business at a VA
medical facility and must travel a significant distance to
receive Department services, and to other individuals
accompanying veterans. The bill would also give VA clear
authority to charge for overnight accommodations and apply the
fees collected to help support these services. The bill
contemplates that VA will promulgate regulations to address
such matters such as the appropriate limitations on the use of
the facilities and the length of time individuals may stay in
the facilities.
Pilot Program on Coordination of Benefits
The VA health care system has undergone a profound
transformation in recent years. Among the changes in VA health
care is a marked improvement in veterans' access to care. In
contrast to the hospital-centered system of years ago, many
veterans no longer rely exclusively on VA hospitals for routine
health care delivery, but increasingly have access to VA
community-based clinics that provide primary care and sometimes
additional services within reasonable distances of their homes.
The proliferation of such clinics, however, has not necessarily
eased access to hospital care when hospitalization is required.
The remarkable success of a pilot program in east central
Florida has sparked development of a model which could improve
veterans' access to needed inpatient care. In appropriating
funds for VA medical care for fiscal year 1998, Congress
earmarked $5 million for this pilot program. (The earmarking
followed Congressional rejection of a VA proposal to construct
a new VA hospital in that area, and appropriation of funds
instead to construct a community-based VA clinic.) The pilot
program was designed to explore the cost effectiveness of
meeting veterans' needs for hospital care in their own
communities. It also provides an alternative to veterans
traveling considerable distances to receive VA hospital care.
In June 1997, an interim primary care clinic was opened in
Palm Bay (Brevard County), FL, pending completion of the new
Brevard County clinic in Viera, FL, which opened in July 1999.
The east central Florida pilot program outlined above (ECF
pilot) was initiated in June 1998. Under the pilot, veterans
residing in Brevard County who were enrolled and referred for
services in the Palm Bay clinic and who did not have specialty
needs were given a choice of receiving any needed hospital care
at VA expense at the Tampa or Palm Beach VA medical centers or
in a private sector hospital. The pilot program operated from
July 1, 1998 to June 30, 1999.
An independent study of the pilot program, discussed at the
Subcommittee's hearing on April 5, 2000, found that the
veterans who participated in the ECF pilot were generally
comparable in age and illness experience to Brevard County and
non-Brevard County veterans who were not eligible for the pilot
and were hospitalized at VA facilities in Tampa and Palm Beach.
These patients were enrolled in a primary care clinic which
indicated that they did not have conditions that required
ongoing treatment by specialists. This eliminated many veterans
with chronic disabilities and ensured that most of the care
these veterans received was for acute conditions. Patient
satisfaction among participants was generally high. Pilot
participants who were hospitalized in contract facilities had a
much shorter length of stay than that of veterans hospitalized
in VA facilities. The study indicates that overall inpatient
costs for the ECF pilot were about 28 percent less than the VA
hospitalized groups. According to the report, ``[t]here is
reason to believe that private sector contracting might be the
most cost-effective approach to veteran care in areas where
there is no VA hospital presence and many underutilized private
sector hospitals.'' The report estimated that the cost of
extending the pilot program for an additional five years would
increase from $5 million to more than $35 million annually.
While the ECF pilot has demonstrated success, further
extending or expanding a contract program is not the only way
to apply ``lessons learned'' from this experience. The
Committee takes note, for example, that many veterans who
obtain care from VA have other health plan coverage. The ECF
pilot demonstrates that in areas of the country in which VA
does not operate a hospital, a VA clinic can coordinate
veterans' care. There is no precedent, however, for VA's
coordinating payments among external plans and payers.
The reported bill would authorize a pilot program involving
coordination of hospital benefits which could operate in up to
four locations. Under such a program, veterans with Medicare or
other health plan coverage who rely on a nearby VA clinic for
care but reside far from the nearest VA medical facility could
make a choice when VA finds that they need hospital care.
Veterans who are reluctant to travel hundreds of miles to a VA
facility could elect to receive care at a community hospital as
a Medicare or other health plan beneficiary. The VA clinic
would still coordinate the care. To ensure that the patient
does not incur additional out-of-pocket costs, the reported
bill provides that VA would cover copayments required by an
individual veteran's health plan. The experience of the Florida
pilot program strongly suggests that veterans would welcome
such an option. It would represent a step beyond simply
contracting for care and instead provide for coordination of
health care benefits. The anticipated result would be that
veterans who now often must choose between two or more health
plans would get better, VA-coordinated, and less costly care.
VA's Deputy Under Secretary for Health cited the importance
of developing mechanisms for coordinating benefits at the
Subcommittee's May 17 hearing:
Providing incentives in health care is a difficult
proposition. Having said that, I think we can make
significant progress in clarifying benefits for
military veterans and retirees. Many are eligible for
VA benefits and retiree benefits and many are eligible
for Medicare, and there is a significant amount of
shopping of benefits between the systems that results
in wasting of resources and it results in poor
coordination of care.
The reported bill offers a limited model for testing
coordination of hospital benefits in a manner that promises to
improve access and veteran satisfaction without diminishing the
quality of patient care.
In providing for siting the program in up to four
geographic areas, the intent is that such geographic areas
would be relatively circumscribed and would not encompass the
area of an entire ``VISN'' (one of the 22 veterans' integrated
service networks). The Committee anticipates, for example, that
the catchment area of the Brevard, FL outpatient clinic in east
central Florida would be one of the areas designated for this
program. The Committee intends further that VA, in considering
potential areas for siting this program, avoid any situation
where the establishment of such a program would have the likely
effect of so diminishing the number of veterans receiving care
at a VA medical center so as to reduce the patient base to the
point at which that facility would have to consider eliminating
services.
The Committee also seeks to avoid a situation in which
either program costs markedly exceed initial projections or the
impact on a VA medical center is more profound than
anticipated, with the result that continued expansion of the
program would likely impair the efficient operation of that
facility. In addition, the program is specifically designed to
address a coordinated benefit. This means that VA must pre-
approve any care-intentionally limited to acute medical and
general services-that program enrollees receive in community
hospitals. This will allow VA to remain responsible for
delivering the specialized care it delivers best, including its
special emphasis programs, mental health programs, and
inpatient long-term care services. In order to ensure that VA
not erode its current services, the Committee has introduced a
$50 million annual limitation on expenditures, including
administrative expenses, that the program would allow. This
limit does not apply to expenditures for emergency care which
VA is now authorized to pay in limited circumstances under
authority granted in Public Law 106-117. The Committee has also
addressed concerns that the program serves only ``wealthier''
veterans. This proposal strongly recommends that VA sites
enroll up to 15 percent of its participants who lack any
insurance. VA will sponsor the full costs of these individuals'
care in the community.
The Committee envisions that VA will select sites that best
meet the criteria outlined in the bill. Once sites are
selected, VA directors should request proposals from providers
within the designated project area and select providers based
upon such factors as reimbursement rates, accreditation by
appropriate agencies (such as the Joint Commission on
Accreditation of Healthcare Organizations), other indicators of
quality, the availability of services, and the provider's
ability and willingness to ensure adequate exchange of patient
information with VA to enhance veterans' continuity of care and
provide for effective utilization review. VA may select as many
local providers as meet these criteria to ensure adequate
coverage for the pilot program area. In addition, the Committee
intends that patients who volunteer to participate in this
pilot program be limited to those who, in general, require
short duration, general medical and surgical inpatient care as
those terms are defined in title 38, United States Code. The
Committee imposed this limitation out of concern that VA's
specialized medical programs--unique national VA resources for
the care of severely disabled veterans--not be eroded or
otherwise affected negatively by this pilot program. To
reiterate, it is the Committee's intent that this pilot program
be directed to promote veterans' access to care and convenience
in communities where a VA community based clinic operates
distant from its host VA medical center, and in instances in
which patients under its care need short periods of general
hospital care that can be obtained from community hospitals.
Compensated Work Therapy Program
The Compensated Work Therapy Program (CWT) is a therapeutic
program authorized by section 1718 of title 38, United States
Code, which VA employs in the rehabilitation of veteran-
patients. Veterans are paid for work performed on contracts
with governmental and industrial entities. This work-based
model helps veterans re-enter the work force while enabling
them to increase self confidence and improve their ability to
adjust appropriately to the work setting. VA data indicate that
some 85 percent admitted to the program have substance abuse
problems; 66 percent are homeless; and 44 percent have been
diagnosed with major mental health disorders. The program has
enjoyed success in assisting these often-challenging patients
in making the transition from medical settings into the
community by developing the capacity for work and increasing
their self-worth.
Nearly 15,000 veterans were treated in 101 different CWT
programs throughout the country in fiscal year 1999. These
veterans earned over $43.8 million for work performed on more
than 3,600 contracts. The traditional CWT setting was in the
nature of a sheltered workshop environment at the VA medical
center. Work might range from simple collating tasks to
fabrication of elaborate electromechanical subassemblies or
machine shop operations using technologically sophisticated
equipment. VA also employs a second model, in the nature of a
``transitional work experience,'' in which participants work at
industry sites (including VA medical centers and other Federal
agency settings). The latter mode, broadly supported in the
field of rehabilitation, has proven effective in helping
veterans transition to full employment. The rate of placement
into employment from CWT is 43 percent, with another seven
percent of participating veterans entering various training
programs.
The Committee has become aware that as the ``transitional
work experience'' component of the program has grown, more
program participants are placed at risk of work-related injury
for which they can receive no compensation. The risk of injury
is real with transitional therapeutic work opportunities being
provided at sites such as manufacturing settings and
construction sites. In the event of work-related injury while
participating in a CWT program, participants are not entitled
to any worker compensation benefits. Veterans are not
considered ``employees'' of either the United States, or of the
private entity where they may work. Rather, their status is as
patients, and the work they perform is undertaken in the
context of medical rehabilitative treatment, prescribed by a VA
physician and monitored by VA clinical staff.
In the past, CWT jobs have been relatively safe, with few
adverse consequences, and the Committee understands that in
instances when CWT participants have incurred injuries in the
course of such participation, VA has typically awarded the
veteran benefits under section 1151 of title 38, United States
Code. In that instance, VA has considered a work-related injury
as if it were service-incurred. With amendments to section 1151
in section 422 of Public Law 104-204 (adding a requirement that
the injury or death have been due to negligence or fault, or
have been unforeseeable), the VA Office of General Counsel has
advised CWT program staff that in a routine case a veteran now
has little actual recourse under section 1151. The situation
raises concern about the viability of continuing the
transitional work experience model. To ensure that these
participants in the work therapy program are protected
financially in the event of work-related injury, the reported
bill would make them eligible for compensation benefits under
section 1151 without regard to whether the injury was the
result of negligence.
In proposing to provide CWT participants with such
financial protection in the event of injury, the Committee is
proposing the same remedy Congress employed three years ago in
an analogous situation. In that instance, it provided such
protection to participants in VA's vocational rehabilitation
program. Under that program, as under the CWT program,
participants work in community settings where they are at risk
for injury. In 1996, Congress provided that veterans injured
while working in the vocational rehabilitation program could
receive compensation benefits under section 1151 without regard
to whether the injury was the result of negligence. The
reported bill would provide the same coverage to CWT program
participants.
Oversight Findings
No oversight findings have been submitted to the committee
by the Committee on Government Reform.
Administration Views
At the Subcommittee on Health Hearing on VA Capital Asset
Planning, April 5, 2000, Frances Murphy, M.D., Acting Deputy
Under Secretary for Policy and Management, gave the following
written testimony concerning changes in VA health care:
VA was a hospital-based, disease-oriented, impersonal
organization of medical centers. The ``New VA'' is an
integrated health system that provides a continuum of
accessible, coordinated, patient-centered care. We have
seen demonstrable improvements in our capacity to
achieve consistently reliable, accessible, satisfying,
high-quality care. We continue to face challenges of
reducing medical errors in our health care; of meeting
the needs of an aging population; of incorporating the
rapid growth of scientific knowledge into daily
practice; of incorporating expensive new medical and
information technologies; and of realigning our
infrastructure to more effectively support current
health care needs.
* * * * *
The transformation that is occurring in how health
care is provided has outpaced our ability to make
infrastructure changes. VA's infrastructure was built
largely at a time when bed based care was the standard
mode of providing health care. As described above, over
the past 5 years VA has significantly shifted care from
inpatient to ambulatory care delivery. We have also
significantly moved care closer to the patient by
establishing Community Based Clinics and home care. We
currently face the challenge of realigning our
infrastructure to optimally support how health care is
being delivered today and will be delivered in the
future.
At the April 12, 2000, Subcommittee on Health hearing on
Status of Recruitment, Retention, and Compensation of the VA
Health Care Work Force, Kenneth J. Clark, Chief Network
Officer, VHA, submitted testimony on VA professional personnel
to include the following:
At the present time, health care staffing in the VA
health care system is relatively stable and we are not
currently experiencing any widespread or critical
staffing shortage for our health care occupations.
However, there are some specific problem areas--
individual locations that are experiencing some
difficulties for some occupations and non-VA pay trends
for dentists and pharmacists are beginning to create
difficulties.
* * * * *
We believe that the Department needs the flexibility
to consider salary information beyond and in addition
to the BLS results if we are to retain the ability to
adjust pay rates when justified and necessary to
maintain a competitive stance with the community,
whether it be to set rates for remote locations, for
specialized groups of nurses, or for pay comparability,
should the BLS survey data not be adequate to VA's
staffing needs. Thus, VA favors retention of its
current authority to conduct local surveys where BLS
data are inadequate, not yet validated, for too large
an area, or offer insufficient detail on specialties.
* * * * *
When the amounts of special pay for dentists were
established in P.L. 102-40, the Department was not
experiencing significant turnover or retention
difficulties for dentists. For that reason, special pay
increases at the level of those for physicians were not
put in place.
Although VA does not currently have a widespread
recruitment and retention problem for dentists, there
are some areas where problems exist. Almost 70 percent
of VA full-time dentists will be eligible for regular
or early retirement in the next three years. Therefore,
we are concerned that as VA dentists retire, it will be
difficult to attract the best qualified dentists to
work in the VA, given the gap that exists between VA
and non-VA compensation packages. VA is currently
reviewing legislative options that would mitigate these
potential problems.
* * * * *
One occupation for which VA is currently experiencing
increased recruitment and retention difficulties is
pharmacist. Currently, VA pharmacists are not leaving
their jobs to pursue private sector opportunities (most
losses are due to retirements); rather VA is
experiencing some increased difficulty recruiting new
pharmacists.
There is a significant increase in the number of
special salary rate authorizations for pharmacists. The
Department is receiving requests for new or increased
special rates on almost a daily basis. VA will continue
to monitor the ceiling on special rates contained in 38
U.S.C. 7455(c) to ensure that restrictions in salary
adjustments do not become problematic.
Congressional Budget Office Cost Estimate
At the time of filing this report, the Congressional Budget
Office had not provided the Committee with a cost estimate.
Applicability to Legislative Branch
The reported bill would not be applicable to the
legislative branch under the Congressional Accountability Act,
Public Law 104-1, because the bill would only affect certain
Department of Veterans Affairs programs and benefits
recipients.
Statement of Federal Mandates
The reported bill would not establish a federal mandate
under the Unfunded Mandates Reform Act, Public Law 104-4.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, the reported bill is authorized by Congress'
power to ``provide for the common Defense and general Welfare
of the United States.''
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, existing law in which no change
is proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
SUBCHAPTER VI--GENERAL COMPENSATION PROVISIONS
Sec. 1151. Benefits for persons disabled by treatment or vocational
rehabilitation
(a) Compensation under this chapter and dependency and
indemnity compensation under chapter 13 of this title shall be
awarded for a qualifying additional disability or a qualifying
death of a veteran in the same manner as if such additional
disability or death were service-connected. For purposes of
this section, a disability or death is a qualifying additional
disability or qualifying death if the disability or death was
not the result of the veteran's willful misconduct and--
(1) * * *
(2) the disability or death was proximately caused
(A) by the provision of training and rehabilitation
services by the Secretary (including by a service-
provider used by the Secretary for such purpose under
section 3115 of this title) as part of an approved
rehabilitation program under chapter 31 of this title,
or (B) by participation in a program (known as a
``compensated work therapy program'') under section
1718 of this title.
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
subchapter i--general
Sec.
1701. Definitions.
* * * * * * *
1708. Temporary lodging.
* * * * * * *
subchapter iii--miscellaneous provisions relating to hospital and
nursing home care and medical treatment of veterans
1721. Power to make rules and regulations.
* * * * * * *
1725A. Coordination of hospital benefits: pilot program.
* * * * * * *
SUBCHAPTER I--GENERAL
* * * * * * *
Sec. 1708. Temporary lodging
(a) The Secretary may furnish persons described in subsection
(b) with temporary lodging in a Fisher house or other
appropriate facility in connection with the examination,
treatment, or care of a veteran under this chapter or, as
provided for under subsection (e)(5), in connection with
benefits administered under this title.
(b) Person to whom the Secretary may provide lodging under
subsection (a) are the following:
(1) A veteran who must travel a significant distance
to receive care or services under this title.
(2) A member of the family of a veteran and others
who accompany a veteran and provide the equivalent of
familial support for such veteran.
(c) In this section, the term ``Fisher house'' means a
housing facility that--
(1) is located at, or in proximity to, a Department
medical facility;
(2) is available for residential use on a temporary
basis by patients of that facility and others described
in subsection (b)(2); and
(3) is constructed by, and donated to the Secretary
by, the Zachary and Elizabeth M. Fisher Armed Services
Foundation.
(d) The Secretary may establish charges for providing lodging
under this section. The proceeds from such charges shall be
credited to the medical care account and shall be available
until expended for the purposes of providing such lodging.
(e) The Secretary shall prescribe regulations to carry out
this section. Such regulations shall include provisions--
(1) limiting the duration of such lodging;
(2) establishing standards and criteria under which
medical facilities may set charges for such lodging;
(3) establishing criteria for persons considered to
be accompanying a veteran;
(4) establishing criteria for the use of such
premises; and
(5) any other limitations, conditions, and priorities
that the Secretary considers appropriate with respect
to temporary lodging under this section.
SUBCHAPTER II--HOSPITAL, NURSING HOME OR DOMICILIARY CARE AND MEDICAL
TREATMENT
Sec. 1710. Eligibility for hospital, nursing home, and domiciliary care
(a)(1) * * *
* * * * * * *
(4) The requirement in paragraphs (1) and (2) that the
Secretary furnish hospital care and medical services, and the
[requirement in] requirements in section 1710A(a) and section
1710B of this title that the Secretary provide a program of
extended care services, shall be effective in any fiscal year
only to the extent and in the amount provided in advance in
appropriations Acts for such purposes.
* * * * * * *
Sec. 1710A. Required nursing home care
(a) The Secretary (subject to section 1710(a)(4) of this
title) shall provide nursing home care which the Secretary
determines is needed (1) to any veteran in need of such care
for a service-connected disability, and (2) to any veteran who
is in need of such care and who has a service-connected
disability rated at 70 percent or more.
* * * * * * *
SUBCHAPTER III--MISCELLANEOUS PROVISIONS RELATING TO HOSPITAL AND
NURSING HOME CARE AND MEDICAL TREATMENT OF VETERANS
* * * * * * *
Sec. 1725A. Coordination of hospital benefits: pilot program
(a) The Secretary may carry out a pilot program in not more
than four geographic areas of the United States to improve
access to, and coordination of, inpatient care of eligible
veterans. Under the pilot program, the Secretary, subject to
subsection (b), may pay certain costs described in subsection
(b) for which an eligible veteran would otherwise be personally
liable. The authority to carry out the pilot program shall
expire on September 30, 2005.
(b) In carrying out the program described in subsection (a),
the Secretary may pay the costs authorized under this section
for hospital care and medical services furnished on an
inpatient basis in a non-Department hospital to an eligible
veteran participating in the program. Such payment may cover
the costs for applicable plan deductibles and coinsurance and
the reasonable costs of such inpatient care and medical
services not covered by any applicable health-care plan of the
veteran, but only to the extent such care and services are of
the kind authorized under this chapter. The Secretary shall
limit the care and services for which payment may be made under
the program to general medical and surgical services and shall
require that such services may be provided only upon
preauthorization by the Secretary.
(c)(1) A veteran described in paragraph (1) or (2) of section
1710(a) of this title is eligible to participate in the pilot
program if the veteran--
(A) is enrolled to receive medical services from an
outpatient clinic operated by the Secretary which is
(i) within reasonable proximity to the principal
residence of the veteran, and (ii) located within the
geographic area in which the Secretary is carrying out
the program described in subsection (a);
(B) has received care under this chapter within the
24-month period preceding the veteran's application for
enrollment in the pilot program;
(C) as determined by the Secretary before the
hospitalization of the veteran (i) requires such
hospital care and services for a non-service-connected
condition, and (ii) could not receive such services
from a clinic operated by the Secretary; and
(D) elects to receive such care under a health-care
plan (other than under this title) under which the
veteran is entitled to receive such care.
(2) Nothing in this section shall be construed to reduce the
authority of the Secretary to contract with non-Department
facilities for care of a service-connected disability of a
veteran.
(3) Notwithstanding subparagraph (D) of paragraph (1), the
Secretary shall ensure that not less than 15 percent of the
veterans participating in the program are veterans who do not
have a health-care plan.
(d) As part of the program under this section, the Secretary
shall, through provision of case-management, coordinate the
care being furnished directly by the Secretary and care
furnished under the program in non-Department hospitals to
veterans participating in the program.
(e)(1) In designating geographic areas in which to establish
the program under subsection (a), the Secretary shall ensure
that--
(A) the areas designated are geographically
dispersed;
(B) at least 70 percent of the veterans who reside in
a designated area reside at least two hours driving
distance from the closest medical center operated by
the Secretary which provides medical and surgical
hospital care; and
(C) the establishment of the program in any such area
would not result in jeopardizing the critical mass of
patients needed to maintain a Department medical center
that serves that area.
(2) Notwithstanding paragraph (1)(B), the Secretary may
designate for participation in the program at least one area
which is in proximity to a Department medical center which, as
a result of a change in mission of that center, does not
provide hospital care.
(f)(1) Not later than September 30, 2002, the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate and
House of Representatives a report on the experience in
implementing the pilot program under subsection (a).
(2) Not later than September 30, 2004, the Secretary shall
submit to those committees a report on the experience in
operating the pilot program during the first two full fiscal
years during which the pilot program is conducted. That report
shall include--
(A) a comparison of the costs incurred by the
Secretary under the program and the cost experience for
the calendar year preceding establishment of the
program at each site at which the program is operated;
(B) an assessment of the satisfaction of the
participants in the program; and
(C) an analysis of the effect of the program on
access and quality of care for veterans.
(g) The total amount expended for the pilot program in any
fiscal year (including amounts for administrative costs) may
not exceed $50,000,000.
(h) For purposes of this section, the term ``health-care
plan'' has the meaning given that term in section 1725(f)(3) of
this title.
* * * * * * *
PART V--BOARDS, ADMINISTRATIONS, AND SERVICES
* * * * * * *
CHAPTER 73--VETERANS HEALTH ADMINISTRATION--ORGANIZATION AND FUNCTIONS
subchapter i--organization
Sec.
7301. Functions of Veterans Health Administration: in general.
* * * * * * *
subchapter ii--general authority and administration
7311. Quality assurance.
* * * * * * *
7323. Required consultations with nurses.
* * * * * * *
SUBCHAPTER I--ORGANIZATION
* * * * * * *
Sec. 7306. Office of the Under Secretary for Health
(a) * * *
* * * * * * *
(f) In organizing the Office and appointing persons to
positions in the Office, the Under Secretary shall ensure
that--
(1) the Office is staffed so as to provide the Under
Secretary, through a designated clinician in the
appropriate discipline in each instance, with expertise
and direct policy guidance on--
(A) * * *
(B) the programs established under section
1712A of this title; [and]
(2) with respect to the programs established under
section 1712A of this title, a clinician with
appropriate expertise in those programs is responsible
to the Under Secretary for the management of those
programs[.]; and
(3) a physician assistant with appropriate experience
(who may have a permanent duty station at a Department
medical care facility in reasonable proximity to
Washington, DC) advises the Under Secretary on all
matters relating to the utilization and employment of
physician assistants in the Administration.
* * * * * * *
SUBCHAPTER II--GENERAL AUTHORITY AND ADMINISTRATION
Sec. 7321. Committee on Care of Severely Chronically Mentally Ill
Veterans
(a) * * *
* * * * * * *
(d)(1) * * *
(2) Not later than February 1, 1998, and February 1 of each
of the [three] six following years, the Secretary shall submit
to the Committees on Veterans' Affairs of the Senate and House
of Representatives a report containing information updating the
reports submitted under this subsection before the submission
of such report.
* * * * * * *
Sec. 7323. Required consultations with nurses
The Under Secretary for Health shall ensure that--
(1) the director of a geographic service area, in
formulating policy relating to the provision of patient
care, shall consult regularly with a senior nurse
executive or senior nurse executives; and
(2) the director of a medical center shall, to the
extent feasible, include a registered nurse as a member
of any committee used at that medical center to provide
recommendations or decisions on medical center
operations or policy affecting clinical services,
clinical outcomes, budget, or resources.
* * * * * * *
SUBCHAPTER IV--RESEARCH CORPORATIONS
* * * * * * *
Sec. 7368. Expiration of authority
No corporation may be established under this subchapter after
December 31, [2000] 2005.
* * * * * * *
CHAPTER 74--VETERANS HEALTH ADMINISTRATION--
PERSONNEL
* * * * * * *
SUBCHAPTER I--APPOINTMENTS
* * * * * * *
Sec. 7402. Qualifications of appointees
(a) * * *
(b)(1) * * *
* * * * * * *
(9) Social Worker.--To be eligible to be appointed to a
social worker position, [a person must hold a master's degree
in social work from a college or university approved by the
Secretary and satisfy the social worker licensure,
certification, or registration requirements, if any, of the
State in which the social worker is to be employed, except that
the Secretary may waive the licensure, certification, or
registration requirement of this paragraph for an individual
social worker for a reasonable period, not to exceed 3 years,
in order for the social worker to take any actions necessary to
satisfy the licensure, certification, or registration
requirements of such State.] a person must--
(A) hold a master's degree in social work from a
college or university approved by the Secretary; and
(B) be licensed or certified to independently
practice social work in a State, except that the
Secretary may waive the requirement of licensure or
certification for an individual social worker for a
reasonable period of time recommended by the Under
Secretary for Health.
* * * * * * *
Sec. 7405. Temporary full-time appointments, part-time appointments,
and without-compensation appointments
(a) * * *
* * * * * * *
(c)(1) * * *
[(2) Temporary full-time appointments of persons who have
successfully completed a full course of nursing in a recognized
school of nursing, approved by the Secretary, or who have
successfully completed a full course of training for any
category of personnel described in paragraph (3) of section
7401 of this title in a recognized education or training
institution approved by the Secretary, and who are pending
registration or licensure in a State, or certification by a
national board recognized by the Secretary, shall not exceed
two years.]
(2) A temporary full-time appointment may not be made for a
period in excess of two years in the case of a person who--
(A) has successfully completed--
(i) a full course of nursing in a recognized
school of nursing, approved by the Secretary;
or
(ii) a full course of training for any
category of personnel described in paragraph
(3) of section 7401 of this title, or as a
physician assistant, in a recognized education
or training institution approved by the
Secretary; and
(B) is pending registration or licensure in a State
or certification by a national board recognized by the
Secretary.
(3)(A) Temporary full-time appointments of persons in
positions referred to in subsection (a)(1)(D) shall not exceed
three years.
(B) Temporary full-time appointments under this paragraph may
be renewed for one or more additional periods not in excess of
three years each.
[(3)] (4) Temporary full-time appointments of other personnel
may not be for a period in excess of one year except as
authorized in subsection (f).
* * * * * * *
SUBCHAPTER III--SPECIAL PAY FOR PHYSICIANS AND DENTISTS
* * * * * * *
Sec. 7435. Special pay: full-time dentists
(a) * * *
(b) The special pay factors, and the annual rates, applicable
to full-time dentists are as follows:
(1) For full-time status, [$3,500] $9,000.
(2)(A) For length of service as a dentist within the
Veterans Health Administration--
------------------------------------------------------------------------
Rate
[Length of Service ---------------------
Minimum Maximum
------------------------------------------------------------------------
2 years but less than 4 years................... $1,000 $2,000
4 years but less than 8 years................... 2,000 3,000
8 years but less than 12 years.................. 3,000 3,500
12 years or more................................ 3,000 4,000]
------------------------------------------------------------------------
------------------------------------------------------------------------
Rate
Length of Service -------------------------
Minimum Maximum
------------------------------------------------------------------------
1 year but less than 2 years.................. $1,000 $2,000
2 years but less than 4 years................. 4,000 5,000
4 years but less than 8 years................. 5,000 8,000
8 years but less than 12 years................ 8,000 12,000
12 years but less than 20 years............... 12,000 15,000
20 years or more.............................. 15,000 18,000.
------------------------------------------------------------------------
(3)(A) For service in a dental specialty with respect
to which there are extraordinary difficulties (on a
nationwide basis or on the basis of the needs of a
specific medical facility) in the recruitment or
retention of qualified dentists, an annual rate of not
more than [$20,000] $30,000.
* * * * * * *
(4)(A) For service in any of the following executive
positions, an annual rate not to exceed the rate
applicable to that position as follows:
------------------------------------------------------------------------
Rate
[Position ---------------------
Minimum Maximum
------------------------------------------------------------------------
Service Director................................ $1,000 $9,000
Deputy Service Director......................... 1,000 8,000
Chief of Staff or in an Executive Grade......... 1,000 8,000
Director Grade.................................. 0 8,000
Service Chief (or in a comparable position as 1,000 5,000]
determined by the Secretary)...................
------------------------------------------------------------------------
------------------------------------------------------------------------
Rate
Position -------------------------
Minimum Maximum
------------------------------------------------------------------------
Chief of Staff or in an Executive Grade....... $14,500 $25,000
Director Grade................................ 0 25,000
Service Chief (or in a comparable position as 4,500 15,000.
determined by the Secretary).................
------------------------------------------------------------------------
(B) For service in any of the following executive
positions, the annual rate applicable to that position
as follows:
[Position Rate
Assistant Under Secretary for Health (or in a comparable
position as determined by the Secretary)................ $10,000
Deputy Assistant Under Secretary for Health............... 10,000]
------------------------------------------------------------------------
Position Rate
------------------------------------------------------------------------
Deputy Service Director.................................... $20,000
Service Director........................................... 25,000
Deputy Assistant Under Secretary for Health................ 27,500
Assistant Under Secretary for Health (or in a comparable 30,000.
position as determined by the Secretary)..................
------------------------------------------------------------------------
* * * * * * *
(6) For service in a specific geographic location
with respect to which there are extraordinary
difficulties in the recruitment or retention of
qualified dentists in a specific category of dentists,
an annual rate not more than [$5,000] $12,000.
* * * * * * *
(8) For a dentist who has successfully completed a
post-graduate year of hospital-based training in a
program accredited by the American Dental Association,
an annual rate of $2,000 for each of the first two
years of service after successful completion of that
training.
Sec. 7438. Special pay: coordination with other benefits laws
(a) * * *
(b)(1) * * *
* * * * * * *
(5) Notwithstanding paragraphs (1) and (2), a dentist
employed as a dentist in the Veterans Health Administration on
the effective date of section 102 of the Department of Veterans
Affairs Health Care Personnel Act of 2000 shall be entitled to
have special pay paid to the dentist under section
7435(b)(2)(A) of this title (referred to as ``tenure pay'')
considered basic pay for the purposes of chapter 83 or 84, as
appropriate, of title 5 only as follows:
(A) In an amount equal to the amount that would have
been so considered under such section on the day before
such effective date based on the rates of special pay
the dentist was entitled to receive under that section
on the day before such effective date.
(B) With respect to any amount of special pay
received under that section in excess of the amount
such dentist was entitled to receive under such section
on the day before such effective date, in an amount
equal to 25 percent of such excess amount for each two
years that the physician or dentist has completed as a
physician or dentist in the Veterans Health
Administration after such effective date.
[(5)] (6) For purposes of this subsection:
(A) * * *
* * * * * * *
SUBCHAPTER IV--PAY FOR NURSES AND OTHER HEALTH-CARE PERSONNEL
Sec. 7451. Nurses and other health-care personnel: competitive pay
(a) * * *
* * * * * * *
(d)(1) [The rates] Subject to subsection (e), the rates of
basic pay for each grade in a covered position shall be
adjusted periodically in accordance with this subsection in
order to achieve the purposes of this section. Such adjustments
shall be made--
(A) whenever there is an adjustment under section
5305 of title 5 in the rates of pay under the General
Schedule, with the adjustment under this subsection to
have the same effective date and to be by the same
percentage as the adjustment in the rates of basic pay
under the General Schedule; and
(2) An adjustment in rates of basic pay under this subsection
for a grade shall be carried out by adjusting the amount of
minimum rate of basic pay for that grade in accordance with
paragraph (3) and then adjusting the other rates for that grade
to conform to the requirements of subsection (c). [Such] Except
as provided in paragraph (1)(A), such an adjustment in the
minimum rate of basic pay for a grade shall be made by the
director of a Department health-care facility so as to achieve
consistency with the beginning rate of compensation for
corresponding health-care professionals in the Bureau of Labor
Statistics (BLS) labor-market area of that facility.
(3)(A) * * *
(B) In the case of a Department health-care facility located
in an area for which the Bureau of Labor Statistic does not
have current information on beginning rates of compensation for
corresponding health-care professional for the labor-market
area of that facility for any covered position, the director of
that facility shall conduct a survey in accordance with this
subparagraph and shall adjust the amount of the minimum rate of
basic pay for grades in that covered position at that facility
based upon that survey. To the extent practicable, the director
shall use third-party industry wage surveys to meet the
requirements of the preceding sentence. Any such survey shall
be conducted in accordance with regulations prescribed by the
Secretary. Those regulations shall be developed in consultation
with the Secretary of Labor in order to ensure that the
director of a facility collects information that is valid and
reliable and is consistent with standards of the Bureau. The
survey should be conducted using methodology comparable to that
used by the Bureau in making industry-wage surveys except to
the extent determined infeasible by the Secretary. To the
extent practicable, all surveys conducted pursuant to this
subparagraph or subparagraph (A) shall include the collection
of salary midpoints, actual salaries, lowest and highest
salaries, average salaries, bonuses, incentive pays,
differential pays, actual beginning rates of pay and such other
information needed to meet the purpose of this section. Upon
conducting a survey under this subparagraph the director
concerned shall determine, not later than 30 days after the
date on which the collection of information through the survey
is completed or published, whether an adjustment in rates of
pay for employees at that facility for any covered position is
necessary in order to meet the purposes of this section. If the
director determines that such an adjustment is necessary, the
adjustment, based upon the information determined in the
survey, shall take effect on the first day of the first pay
period beginning after that determination.
(C)(i) * * *
* * * * * * *
[(iii) The authority of the director to use such additional
data under this subparagraph with respect to certified
registered nurse anesthetists expires on January 1, 1998.]
* * * * * * *
[(e) Adjustments in rates of basic pay under subsection (d)
may increase or reduce the rates of basic pay applicable to any
grade of a covered position. In the case of such an adjustment
that reduces the rates of pay for a grade, an employee serving
at a Department health-care facility on the day before the
effective date of that adjustment in a position affected by the
adjustment may not (by reason of that adjustment) incur a
reduction in the rate of basic pay applicable to that employee
so long as the employee continues to serve in that covered
position at that facility. If such an employee is subsequently
promoted to a higher grade, or advanced to a higher step within
the employee's grade, for which the rate of pay as so adjusted
is lower than the employee's rate of basic pay on the day
before the effective date of the promotion, the employee shall
continue to be paid at a rate of basic pay not less than the
rate of basic pay applicable to the employee before the
promotion so long as the employee continues to serve in that
covered position at that facility.]
(e)(1) An adjustment in a rate of basic pay under subsection
(d) may not reduce the rate of basic pay applicable to any
grade of a covered position.
(2) The director of a Department health-care facility, in
determining whether to carry out a wage survey under subsection
(d)(3) with respect to rates of basic pay for a grade of a
covered position, may not consider as a factor in such
determination the absence of a current recruitment or retention
problem for personnel in that grade of that position. The
director shall make such a determination based upon whether, in
accordance with criteria established by the Secretary, there is
a significant pay-related staffing problem at that facility in
any grade for a position. If the director determines that there
is such a problem, or that such a problem is likely to exist in
the near future, the Director shall provide for a wage survey
in accordance with paragraph (3) of subsection (d).
(3) The Under Secretary for Health may, to the extent
necessary to carry out the purposes of subsection (d), modify
any determination made by the director of a Department health-
care facility with respect to adjusting the rates of basic pay
applicable to covered positions. Upon such action by the Under
Secretary, any adjustment shall take effect on the first day of
the first pay period beginning after such action. The Secretary
shall ensure that the Under Secretary establishes a mechanism
for the exercise of the authority in the preceding sentence.
(4) Each director of a Department health-care facility shall
provide to the Secretary, not later than July 31 each year, a
report on staffing for covered positions at that facility. The
report shall include the following:
(A) Information on turnover rates and vacancy rates
for each grade in a covered position, including a
comparison of those rates with the rates for the
preceding three years.
(B) The director's findings concerning the review and
evaluation of the facility's staffing situation,
including whether there is, or is likely to be, in
accordance with criteria established by the Secretary,
a significant pay-related staffing problem at that
facility for any grade of a covered position and, if
so, whether a wage survey was conducted, or will be
conducted with respect to that grade.
(C) In any case in which the director conducts such a
wage survey during the period covered by the report,
information describing the survey and any actions taken
or not taken based on the survey, and the reasons for
taking (or not taking) such actions.
(D) In any case in which the director, after finding
that there is, or is likely to be, in accordance with
criteria established by the Secretary, a significant
pay-related staffing problem at that facility for any
grade of a covered position, determines not to conduct
a wage survey with respect to that position, a
statement of the reasons why the director did not
conduct such a survey.
(5) Not later than September 30 of each year, the Secretary
shall submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a report on staffing for
covered positions at Department healthcare facilities. Each
such report shall include the following:
(A) A summary and analysis of the information
contained in the most recent reports submitted by
facility directors under paragraph (4).
(B) The information for each such facility specified
in paragraph (4).
(f) Not later than [February 1 of 1991, 1992, and 1993] March
1 of each year, the Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives a
report regarding any pay adjustments under the authority of
subsection [(d)(1)(A)] (d) effective during the 12 months
preceding the submission of the report. Each such report shall
set forth, by health-care facility, the percentage of such
increases and, in any case in which no increase was made, the
basis for not providing an increase.
[(g) Not later than December 1 of 1991, 1992, and 1993, the
Secretary shall submit to the Committees on Veterans' Affairs
of the Senate and House of Representatives a report regarding
the exercise of the authorities provided in this section for
the preceding fiscal year. Each such report shall include the
following:
[(1) A review of the use of the authorities provided
in this section (including the Secretary's and Under
Secretary for Health's actions, findings,
recommendations, and other activities under this
section) during the preceding fiscal year, including an
assessment of the effects of the exercise of such
authorities on the ability of the Department to recruit
and retain qualified health-care professionals for
covered positions.
[(2) The plans for the use of the authorities
provided in this subchapter for the next fiscal year.
[(3) A description of the rates of basic pay in
effect during the preceding fiscal year, with a
comparison to the rates in effect during the previous
fiscal year, shown by facility and by covered position.
[(4) The numbers of employees in covered positions
(shown separately for registered nurses and for each
other covered positions who during the preceding fiscal
year (A) left employment with the Department, (B) left
employment at one Department medical facility for
employment at another Department medical facility, or
(C) changed from full-time status to part-time status
(and from part-time status to full-time status), and a
summary of the reasons therefor.
[(5) The number of vacancies in covered positions in
the Administration and a summary of the reasons that
those positions are vacant.
[(6) The number of employees who during the preceding
fiscal year left employment at a health-care facility
in one Bureau of Labor Statistics labor-market area for
employment at a health-care facility in another such
labor-market area, without changing residence.
[(7) Justification for setting the maximum rate of
basic pay for any grade at a rate in excess of 133
percent of the minimum rate of basic pay for that
grade.
[(8) The discussion required by section 7452(b)(2) of
this title.
[(9) The justification required by section 7452(e) of
this title.
[(10) The number of nurses, shown by facility and by
grade, who are on pay retention or in the top step of
any grade and, with respect to those employees,
comprehensive information (by facility) as to whether
an extension of the pay grades was sought for these
positions, and with respect to each such request for
extension, whether such request was granted or denied.]
[(h)] (g) For the purposes of this section, the term
``health-care facility'' means a medical center, an independent
outpatient clinic, or an independent domiciliary facility.
* * * * * * *
Sec. 7455. Increases in rates of basic pay
(a) * * *
* * * * * * *
(c)(1) The amount of any increase under subsection (a) in the
maximum rate for any grade may not (except in the case of nurse
anesthetists, pharmacists, and licensed physical therapists)
exceed by two times the amount by which the maximum for such
grade (under applicable provisions of law other than this
subsection) exceeds the minimum for such grade (under
applicable provisions of law other than this subsection), and
the maximum rate as so increased may not exceed the rate paid
for individuals serving as Assistant Under Secretary for
Health.
* * * * * * *
PART VI--ACQUISITION AND DISPOSITION OF PROPERTY
* * * * * * *
CHAPTER 81--ACQUISITION AND OPERATION OF HOSPITAL AND DOMICILIARY
FACILITIES; PROCUREMENT AND SUPPLY; ENHANCED-USE LEASES OF REAL
PROPERTY
* * * * * * *
SUBCHAPTER III--STATE HOME FACILITIES FOR FURNISHING DOMICILIARY,
NURSING HOME, AND HOSPITAL CARE
* * * * * * *
Sec. 8136. Recapture provisions
(a) If, within the 20-year period beginning on the date of
the approval by the Secretary of the final architectural and
engineering inspection of any project with respect to which a
grant has been made under this subchapter (except that the
Secretary, pursuant to regulations which the Secretary shall
prescribe, may at the time of such grant provide for a shorter
period than 20, but not less than seven years, based on the
magnitude of the project and the grant amount involved, in the
case of the acquisition, expansion, remodeling, or alteration
of existing facilities), the facilities covered by the project
cease to be operated by a State, a State home, or an agency or
instrumentality of a State principally for furnishing
domiciliary, nursing home, or hospital care to veterans, the
United States shall be entitled to recover from the State which
was the recipient of the grant under this subchapter, or from
the then owner of such facilities, 65 percent of the then value
of such project (but in no event an amount greater than the
amount of assistance provided under this subchapter), as
determined by agreement of the parties or by action brought in
the district court of the United States for the district in
which such facilities are situated.
(b) The establishment and operation by the Secretary of an
outpatient clinic in facilities described in subsection (a)
shall not constitute grounds entitling the United States to any
recovery under that subsection.
* * * * * * *
SUBCHAPTER V--ENHANCED-USE LEASES OF REAL PROPERTY
* * * * * * *
Sec. 8163. Designation of property to be leased
(a) * * *
* * * * * * *
(c)(1) * * *
[(2) The Secretary may not enter into an enhanced-use lease
until the end of a 60-day period of continuous session of
Congress following the date of the submission of notice under
paragraph (1). For purposes of the preceding sentence,
continuity of a session of Congress is broken only by an
adjournment sine die, and there shall be excluded from the
computation of such 60-day period any day during which either
House of Congress is not in session during an adjournment of
more than three days to a day certain.]
(2) The Secretary may not enter into an enhanced use lease
until the end of the 90-day period beginning on the date of the
submission of notice under paragraph (1).
* * * * * * *
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DEPARTMENT OF VETERANS AFFAIRS EMPLOYMENT REDUCTION ASSISTANCE ACT OF
1999
* * * * * * *
TITLE XI--VOLUNTARY SEPARATION INCENTIVE PROGRAM
SEC. 1101. SHORT TITLE.
This title may be cited as the ``Department of Veterans
Affairs Employment Reduction Assistance Act of 1999''.
SEC. 1102. PLAN FOR PAYMENT OF VOLUNTARY SEPARATION INCENTIVE PAYMENTS.
(a) * * *
* * * * * * *
[(c) Limitation on Elements and Personnel.--The plan under
subsection (a) shall be limited to the elements of the
Department, and the number of positions within such elements,
as follows:
[(1) The Veterans Health Administration, 4,400
positions.
[(2) The Veterans Benefits Administration, 240
positions.
[(3) Department of Veterans Affairs Staff Offices, 45
positions.
[(4) The National Cemetery Administration, 15
positions.]
(c) Limitation.--The plan under subsection (a) shall be
limited to 8,110 positions within the Department.
* * * * * * *
SEC. 1105. ADDITIONAL AGENCY CONTRIBUTIONS TO CIVIL SERVICE RETIREMENT
AND DISABILITY FUND.
(a) Requirement.--In addition to any other payments which it
is required to make under subchapter III of chapter 83 or
chapter 84 of title 5, United States Code, the Secretary shall
remit to the Office of Personnel Management for deposit in the
Treasury of the United States to the credit of the Civil
Service Retirement and Disability Fund an amount equal to [26]
15 percent of the final basic pay of each employee of the
Department who is covered under subchapter III of chapter 83 or
chapter 84 of title 5, United States Code, to whom a voluntary
separation incentive is paid under this title.
* * * * * * *
SEC. 1109. LIMITATION; SAVINGS CLAUSE.
(a) Limitation.--No voluntary separation incentive payment
may be paid under this title based on the separation of an
employee after December 31, [2000] 2002.
* * * * * * *
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SECTION 2 OF THE ACT OF JUNE 6, 1953
AN ACT Authorizing the transfer of certain property to the Veterans'
Administration (in Johnson City, Tennessee) to the State of Tennessee.
[Sec. 2. Such conveyance shall contain a provision that said
property shall be used primarily for training of the National
Guard and for other military purposes, and that if the State of
Tennessee shall cease to use the property so conveyed for the
purposes intended, then title thereto shall immediately revert
to the United States, and in addition, all improvements made by
the State of Tennessee during its occupancy shall vest in the
United States without payment of compensation therefor.]