[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 1188 Reported in Senate (RS)]
Calendar No. 190
107th CONGRESS
1st Session
S. 1188
[Report No. 107-80]
To amend title 38, United States Code, to enhance the authority of the
Secretary of Veterans Affairs to recruit and retain qualified nurses
for the Veterans Health Administration, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 17, 2001
Mr. Rockefeller (for himself, Mr. Cleland, and Mr. Specter) introduced
the following bill; which was read twice and referred to the Committee
on Veterans' Affairs
October 10, 2001
Reported by Mr. Rockefeller, with an amendment and an amendment to the
title
[Strike out all after the enacting clause and insert the part printed
in italic]
_______________________________________________________________________
A BILL
To amend title 38, United States Code, to enhance the authority of the
Secretary of Veterans Affairs to recruit and retain qualified nurses
for the Veterans Health Administration, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
<DELETED>SECTION 1. SHORT TITLE; TABLE OF CONTENTS.</DELETED>
<DELETED> (a) Short Title.--This Act may be cited as the
``Department of Veterans Affairs Nurse Recruitment and Retention
Enhancement Act of 2001''.</DELETED>
<DELETED> (b) Table of Contents.--The table of contents for this Act
is as follows:</DELETED>
<DELETED>Sec. 1. Short title; table of contents.
<DELETED>Sec. 2. References to title 38, United States Code.
<DELETED>TITLE I--ENHANCEMENT OF RECRUITMENT AUTHORITIES
<DELETED>Sec. 101. Enhancement of employee incentive scholarship
program.
<DELETED>Sec. 102. Enhancement of education debt reduction program.
<DELETED>Sec. 103. Report on requests for waivers of pay reductions for
reemployed annuitants to fill nurse
positions.
<DELETED>TITLE II--ENHANCEMENT OF RETENTION AUTHORITIES
<DELETED>Sec. 201. Additional pay for Saturday tours of duty for
additional health care professional in the
Veterans Health Administration.
<DELETED>Sec. 202. Unused sick leave included in annuity computation of
registered nurses with the Veterans Health
Administration.
<DELETED>Sec. 203. Evaluation of Department of Veterans Affairs nurse
managed clinics.
<DELETED>Sec. 204. Staffing levels for operations of medical
facilities.
<DELETED>Sec. 205. Annual report on use of authorities to enhance
retention of experienced nurses.
<DELETED>Sec. 206. Report on mandatory overtime for nurses and nurse
assistants in Department of Veterans
Affairs facilities.
<DELETED>TITLE III--OTHER MATTERS
<DELETED>Sec. 301. Organizational responsibility of the Director of the
Nursing Service.
<DELETED>Sec. 302. Computation of annuity for part-time service
performed by certain health-care
professionals before April 7, 1986.
<DELETED>Sec. 303. Modification of nurse locality pay authorities.
<DELETED>Sec. 304. Technical amendments.
<DELETED>SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE.</DELETED>
<DELETED> 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.</DELETED>
<DELETED>TITLE I--ENHANCEMENT OF RECRUITMENT AUTHORITIES</DELETED>
<DELETED>SEC. 101. ENHANCEMENT OF EMPLOYEE INCENTIVE SCHOLARSHIP
PROGRAM.</DELETED>
<DELETED> (a) Permanent Authority.--(1) Section 7676 is
repealed.</DELETED>
<DELETED> (2) The table of sections at the beginning of chapter 76
is amended by striking the item relating to section 7676.</DELETED>
<DELETED> (b) Minimum Period of Department Employment for
Eligibility.--Section 7672(b) is amended by striking ``2 years'' and
inserting ``one year''.</DELETED>
<DELETED> (c) Scholarship Amount.--Subsection (b) of section 7673 is
amended--</DELETED>
<DELETED> (1) in paragraph (1), by striking ``for any one
year'' and inserting ``for the equivalent of one year of full-
time coursework''; and</DELETED>
<DELETED> (2) by striking paragraph (2) and inserting the
following new paragraph (2):</DELETED>
<DELETED> ``(2) in the case of a participant in the Program
who is a part-time student, shall bear the same ratio to the
amount that would be paid under paragraph (1) if the
participant were a full-time student in the course of education
or training being pursued by the participant as the coursework
carried by the student bears to full-time coursework in that
course of education or training.''.</DELETED>
<DELETED> (d) Limitation on Payment.--Subsection (c) of section 7673
is amended to read as follows:</DELETED>
<DELETED> ``(c) Limitations on Period of Payment.--(1) The maximum
number of school years for which a scholarship may be paid under
subsection (a) to a participant in the Program shall be six school
years.</DELETED>
<DELETED> ``(2) A participant in the Program may not receive a
scholarship under subsection (a) for more than the equivalent of three
years of full-time coursework.''.</DELETED>
<DELETED> (e) Full-Time Coursework.--Section 7673 is further amended
by adding at the end the following new subsection:</DELETED>
<DELETED> ``(e) Full-Time Coursework.--For purposes of this section,
full-time coursework shall consist of the following:</DELETED>
<DELETED> ``(1) In the case of undergraduate coursework, 30
semester hours per undergraduate school year.</DELETED>
<DELETED> ``(2) In the case of graduate coursework, 18
semester hours per graduate school year.''.</DELETED>
<DELETED> (f) Annual Adjustment of Maximum Scholarship Amount.--
Section 7631 is amended--</DELETED>
<DELETED> (1) in subsection (a)(1), by striking ``and the
maximum Selected Reserve member stipend amount'' and inserting
``the maximum Selected Reserve member stipend amount, the
maximum employee incentive scholarship amount,''; and</DELETED>
<DELETED> (2) in subsection (b)--</DELETED>
<DELETED> (A) by redesignating paragraph (4) as
paragraph (6); and</DELETED>
<DELETED> (B) by inserting after paragraph (3) the
following new paragraph (4):</DELETED>
<DELETED> ``(4) The term `maximum employee incentive
scholarship amount' means the maximum amount of the scholarship
payable to a participant in the Department of Veterans Affairs
Employee Incentive Scholarship Program under subchapter VI of
this chapter, as specified in section 7673(b)(1) of this title
and as previously adjusted (if at all) in accordance with this
section.''.</DELETED>
<DELETED>SEC. 102. ENHANCEMENT OF EDUCATION DEBT REDUCTION
PROGRAM.</DELETED>
<DELETED> (a) Permanent Authority.--(1) Section 7684 is
repealed.</DELETED>
<DELETED> (2) The table of sections at the beginning of chapter 76
is amended by striking the item relating to section 7684.</DELETED>
<DELETED> (b) Eligible Individuals.--Subsection (a)(1) of section
7682 is amended--</DELETED>
<DELETED> (1) by striking ``under an appointment under
section 7402(b) of this title in a position'' and inserting
``in a position (as determined by the Secretary) providing
direct-patient care services or services incident to direct-
patient care services''; and</DELETED>
<DELETED> (2) by striking ``(as determined by the
Secretary)'' and inserting ``(as so determined)''.</DELETED>
<DELETED> (c) Maximum Debt Reduction Amount.--Section 7683(d)(1) is
amended--</DELETED>
<DELETED> (1) by striking ``for a year''; and</DELETED>
<DELETED> (2) by striking ``exceed--'' and all that follows
through the end of the paragraph and inserting ``exceed $44,000
over a total of five years of participation in the Program, of
which not more than $10,000 of such payments may be made in
each of the fourth and fifth years of participation in the
Program.''.</DELETED>
<DELETED> (d) Annual Adjustment of Maximum Debt Reduction Payments
Amount.--(1) Section 7631, as amended by section 101(f) of this Act, is
further amended--</DELETED>
<DELETED> (A) in subsection (a)(1), by inserting before the
period at the end of the first sentence the following: ``and
the maximum education debt reduction payments amount'';
and</DELETED>
<DELETED> (B) in subsection (b), by inserting after
paragraph (4) the following new paragraph (5):</DELETED>
<DELETED> ``(5) The term `maximum education debt reduction
payments amount' means the maximum amount of education debt
reduction payments payable to a participant in the Department
of Veterans Affairs Education Debt Reduction Program under
subchapter VII of this chapter, as specified in section
7683(d)(1) of this title and as previously adjusted (if at all)
in accordance with this section.''.</DELETED>
<DELETED> (2) Notwithstanding section 7631(a)(1) of title 38, United
States Code, as amended by paragraph (1), the Secretary of Veterans
Affairs shall not increase the maximum education debt reduction
payments amount under that section in calendar year 2002.</DELETED>
<DELETED> (e) Temporary Expansion of Individuals Eligible for
Participation in Program.--(1) Notwithstanding section 7682(c) of title
38, United States Code, the Secretary of Veterans Affairs may treat a
covered individual as being a recently appointed employee in the
Veterans Health Administration under section 7682(a) of that title for
purposes of eligibility in the Education Debt Reduction Program if the
Secretary determines that the participation of the individual in the
Program under this subsection would further the purposes of the
Program.</DELETED>
<DELETED> (2) For purposes of this subsection, a covered individual
is any individual otherwise described by section 7682(a) of title 38,
United States Code, as in effect on the day before the date of the
enactment of this Act, who--</DELETED>
<DELETED> (A) was appointed as an employee in a position
described in paragraph (1) of that section, as so in effect,
between January 1, 1999, and September 30, 2000; and</DELETED>
<DELETED> (B) is an employee in such position, or in another
position described in paragraph (1) of that section, as so in
effect, at the time of application for treatment as a covered
individual under this subsection.</DELETED>
<DELETED> (3) The Secretary shall make determinations regarding the
exercise of the authority in this subsection on a case-by-case
basis.</DELETED>
<DELETED> (4) The Secretary may not exercise the authority in this
subsection after December 31, 2001. The expiration of the authority in
this subsection shall not affect the treatment of an individual under
this subsection before that date as a covered individual for purposes
of eligibility in the Education Debt Reduction Program.</DELETED>
<DELETED> (5) In this subsection, the term ``Education Debt
Reduction Program'' means the Department of Veterans Affairs Education
Debt Reduction Program under subchapter VII of chapter 76 of title 38,
United States Code.</DELETED>
<DELETED>SEC. 103. REPORT ON REQUESTS FOR WAIVERS OF PAY REDUCTIONS FOR
REEMPLOYED ANNUITANTS TO FILL NURSE POSITIONS.</DELETED>
<DELETED> (a) Report.--Not later than November 30 of each of 2001
and 2002, the Secretary of Veterans Affairs shall submit to the
Committees on Veterans' Affairs of the Senate and the House of
Representatives a report describing each request of the Secretary,
during the fiscal year preceding such report, to the Director of the
Office of Personnel Management for the following:</DELETED>
<DELETED> (1) A waiver under subsection (i)(1)(A) of section
8344 of title 5, United States Code, of the provisions of such
section in order to meet requirements of the Department of
Veterans Affairs for appointments to nurse positions in the
Veterans Health Administration.</DELETED>
<DELETED> (2) A waiver under subsection (f)(1)(A) of section
8468 of title 5, United States Code, of the provisions of such
section in order to meet requirements of the Department for
appointments to such positions.</DELETED>
<DELETED> (3) A grant of authority under subsection
(i)(1)(B) of section 8344 of title 5, United States Code, for
the waiver of the provisions of such section in order to meet
requirements of the Department for appointments to such
positions.</DELETED>
<DELETED> (4) A grant of authority under subsection
(f)(1)(B) of section 8468 of title 5, United States Code, for
the waiver of the provisions of such section in order to meet
requirements of the Department for appointments to such
positions.</DELETED>
<DELETED> (b) Information on Responses to Requests.--The report
under subsection (a) shall specify for each request covered by the
report--</DELETED>
<DELETED> (1) the response of the Director to such request;
and</DELETED>
<DELETED> (2) if such request was granted, whether or not
the waiver or authority, as the case may be, assisted the
Secretary in meeting requirements of the Department for
appointments to nurse positions in the Veterans Health
Administration.</DELETED>
<DELETED>TITLE II--ENHANCEMENT OF RETENTION AUTHORITIES</DELETED>
<DELETED>SEC. 201. ADDITIONAL PAY FOR SATURDAY TOURS OF DUTY FOR
ADDITIONAL HEALTH CARE PROFESSIONAL IN THE VETERANS
HEALTH ADMINISTRATION.</DELETED>
<DELETED> (a) In General.--Section 7454(b) is amended--</DELETED>
<DELETED> (1) by inserting ``(1)'' after ``(b)'';
and</DELETED>
<DELETED> (2) by adding at the end the following new
paragraph:</DELETED>
<DELETED> ``(2) Health care professionals employed in positions
referred to in paragraph (1) shall be entitled to additional pay on the
same basis as provided for nurses in section 7453(c) of this
title.''.</DELETED>
<DELETED> (b) Applicability.--The amendments made by subsection (a)
shall take effect on the date of the enactment of this Act, and shall
apply with respect to pay periods beginning on or after that
date.</DELETED>
<DELETED>SEC. 202. UNUSED SICK LEAVE INCLUDED IN ANNUITY COMPUTATION OF
REGISTERED NURSES WITH THE VETERANS HEALTH
ADMINISTRATION.</DELETED>
<DELETED> (a) Annuity Computation.--Section 8415 of title 5, United
States Code, is amended by adding at the end the following:</DELETED>
<DELETED> ``(i) In computing an annuity under this subchapter, the
total service of an employee who retires from the position of a
registered nurse with the Veterans Health Administration on an
immediate annuity, or dies while employed in that position leaving any
survivor entitled to an annuity, includes the days of unused sick leave
to the credit of that employee under a formal leave system, except that
such days shall not be counted in determining average pay or annuity
eligibility under this subchapter.''.</DELETED>
<DELETED> (b) Deposit Not Required.--Section 8422(d) of title 5,
United States Code, is amended--</DELETED>
<DELETED> (1) by inserting ``(1)'' before ``Under such
regulations''; and</DELETED>
<DELETED> (2) by adding at the end the following:</DELETED>
<DELETED> ``(2) Deposit may not be required for days of unused sick
leave credited under section 8415(i).''.</DELETED>
<DELETED> (c) Effective Date.--The amendments made by this section
shall take effect 60 days after the date of the enactment of this Act,
and shall apply to individuals who separate from service on or after
that effective date.</DELETED>
<DELETED>SEC. 203. EVALUATION OF DEPARTMENT OF VETERANS AFFAIRS NURSE
MANAGED CLINICS.</DELETED>
<DELETED> (a) Evaluation.--The Secretary of Veterans Affairs shall
carry out an evaluation of the efficacy of the nurse managed health
care clinics of the Department of Veterans Affairs. The Secretary shall
complete the evaluation not later than 18 months after the date of the
enactment of this Act.</DELETED>
<DELETED> (b) Clinics To Be Evaluated.--(1) In carrying out the
evaluation under subsection (a), the Secretary consider nurse managed
health care clinics, including primary care clinics and geriatric care
clinics, located in three different Veterans Integrated Service
Networks (VISNs) of the Department.</DELETED>
<DELETED> (2) If there are not nurse managed health care clinics
located in three different Veterans Integrated Service Networks as of
the commencement of the evaluation, the Secretary shall--</DELETED>
<DELETED> (A) establish nurse managed health care clinics in
additional Veterans Integrated Services Networks such that
there are nurse managed health care clinics in three different
Veterans Integrated Service Networks for purposes of the
evaluation; and</DELETED>
<DELETED> (B) include such clinics, as so established, in
the evaluation.</DELETED>
<DELETED> (c) Matters To Be Evaluated.--In carrying out the
evaluation under subsection (a), the Secretary shall address the
following:</DELETED>
<DELETED> (1) Patient satisfaction.</DELETED>
<DELETED> (2) Provider experiences.</DELETED>
<DELETED> (3) Cost of care.</DELETED>
<DELETED> (4) Access to care, including waiting time for
care.</DELETED>
<DELETED> (5) The functional status of patients receiving
care.</DELETED>
<DELETED> (6) Any other matters the Secretary considers
appropriate.</DELETED>
<DELETED> (d) Report.--Not later than 18 months after the date of
the enactment of this Act, the Secretary shall submit to the Committees
on Veterans' Affairs of the Senate and the House of Representatives a
report on the evaluation carried out under subsection (a). The report
shall address the matters specified in subsection (c) and include any
other information, and any recommendations, that the Secretary
considers appropriate.</DELETED>
<DELETED>SEC. 204. STAFFING LEVELS FOR OPERATIONS OF MEDICAL
FACILITIES.</DELETED>
<DELETED> (a) In General.--Section 8110(a) is amended--</DELETED>
<DELETED> (1) in paragraph (1), by inserting after
``complete care of patients,'' in the fifth sentence the
following: ``and in a manner consistent with the policies of
the Secretary on overtime,''; and</DELETED>
<DELETED> (2) in paragraph (2)--</DELETED>
<DELETED> (A) by inserting ``, including the
staffing required to maintain such capacities,'' after
``all Department medical facilities'';</DELETED>
<DELETED> (B) by striking ``and to minimize'' and
inserting ``, to minimize''; and</DELETED>
<DELETED> (C) by inserting before the period the
following: ``, and to ensure that eligible veterans are
provided such care and services in an appropriate
manner''.</DELETED>
<DELETED> (b) Nationwide Policy on Staffing.--Paragraph (3) of that
section is amended--</DELETED>
<DELETED> (1) in subparagraph (A), by inserting ``the
adequacy of staff levels for compliance with the policy
established under subparagraph (C),'' after ``regarding'';
and</DELETED>
<DELETED> (2) by inserting after subparagraph (B) the
following new subparagraph:</DELETED>
<DELETED> ``(C) The Secretary shall, in consultation with the Under
Secretary for Health, establish a nationwide policy on the staffing of
Department medical facilities in order to ensure that such facilities
have adequate staff for the provision to veterans of appropriate, high-
quality care and services. The policy shall take into account the
staffing levels and mixture of staff skills required for the range of
care and services provided veterans in Department
facilities.''.</DELETED>
<DELETED>SEC. 205. ANNUAL REPORT ON USE OF AUTHORITIES TO ENHANCE
RETENTION OF EXPERIENCED NURSES.</DELETED>
<DELETED> (a) Annual Report.--(1) Subchapter II of chapter 73 is
amended by adding at the end the following new section:</DELETED>
<DELETED>``Sec. 7324. Annual report on use of authorities to enhance
retention of experienced nurses</DELETED>
<DELETED> ``(a) Annual Report.--Not later than January 31 each year,
the Secretary, acting through the Under Secretary for Health, shall
submit to Congress a report on the use during the preceding year of
authorities for purposes of retaining experienced nurses in the
Veterans Health Administration, as follows:</DELETED>
<DELETED> ``(1) The authorities under chapter 76 of this
title.</DELETED>
<DELETED> ``(2) The authority under VA Directive 5102.1,
relating to the Department of Veterans Affairs nurse
qualification standard, dated November 10, 1999, or any
successor directive.</DELETED>
<DELETED> ``(3) Any other authorities available to the
Secretary for those purposes.</DELETED>
<DELETED> ``(b) Report Elements.--Each report under subsection (a)
shall specify for the period covered by such report, for each
Department medical facility and for each Veterans Integrated Service
Network, the following:</DELETED>
<DELETED> ``(1) The number of waivers requested under the
authority referred to in subsection (a)(2), and the number of
waivers granted under that authority, to promote to the Nurse
II grade or Nurse III grade under the Nurse Schedule under
section 7404(b)(1) of this title any nurse who has not
completed a bachelors of science in nursing in a recognized
school of nursing, set forth by age, race, and years of
experience of the individuals subject to such waiver requests
and waivers, as the case may be.</DELETED>
<DELETED> ``(2) The programs carried out to facilitate the
use of nursing education programs by experienced nurses,
including programs for flexible scheduling, scholarships,
salary replacement pay, and on-site classes.''.</DELETED>
<DELETED> (2) The table of sections at the beginning of chapter 73
is amended by inserting after the item relating to section 7323 the
following new item:</DELETED>
<DELETED>``7324. Annual report on use of authorities to enhance
retention of experienced nurses.''.
<DELETED> (b) Initial Report.--The initial report required under
section 7324 of title 38, United States Code, as added by subsection
(a), shall be submitted in 2002.</DELETED>
<DELETED>SEC. 206. REPORT ON MANDATORY OVERTIME FOR NURSES AND NURSE
ASSISTANTS IN DEPARTMENT OF VETERANS AFFAIRS
FACILITIES.</DELETED>
<DELETED> (a) Report.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit
to the Committees on Veterans' Affairs of the Senate and the House of
Representatives a report on the mandatory overtime required of licensed
nurses and nurse assistants providing direct patient care at Department
of Veterans Affairs medical facilities during 2001.</DELETED>
<DELETED> (b) Mandatory Overtime.--For purposes of the report under
subsection (a), mandatory overtime shall consist of any period in which
a nurse or nurse assistant is mandated or otherwise required, whether
directly or indirectly, to work or be in on-duty status in excess of--
</DELETED>
<DELETED> (1) a scheduled workshift or duty
period;</DELETED>
<DELETED> (2) 12 hours in any 24-hour period; or</DELETED>
<DELETED> (3) 80 hours in any period of 14 consecutive
days.</DELETED>
<DELETED> (c) Elements.--The report under subsection (a) shall
include the following:</DELETED>
<DELETED> (1) A description of the amount of mandatory
overtime described in that subsection at each Department
medical facility during the period covered by the
report.</DELETED>
<DELETED> (2) A description of the mechanisms employed by
the Secretary to monitor overtime of the nurses and nurse
assistants referred to in that subsection.</DELETED>
<DELETED> (3) An assessment of the effects of the mandatory
overtime of such nurses and nurse assistants on patient care,
including its contribution to medical errors.</DELETED>
<DELETED> (4) Recommendations regarding mechanisms for
preventing requirements for amounts of mandatory overtime in
other than emergency situations by such nurses and nurse
assistants.</DELETED>
<DELETED> (5) Any other matters that the Secretary considers
appropriate.</DELETED>
<DELETED>TITLE III--OTHER MATTERS</DELETED>
<DELETED>SEC. 301. ORGANIZATIONAL RESPONSIBILITY OF THE DIRECTOR OF THE
NURSING SERVICE.</DELETED>
<DELETED> Section 7306(a)(5) is amended by inserting ``, and report
directly to,'' after ``responsible to''.</DELETED>
<DELETED>SEC. 302. COMPUTATION OF ANNUITY FOR PART-TIME SERVICE
PERFORMED BY CERTAIN HEALTH-CARE PROFESSIONALS BEFORE
APRIL 7, 1986.</DELETED>
<DELETED> Section 7426 is amended--</DELETED>
<DELETED> (1) by redesignating subsection (c) as subsection
(d); and</DELETED>
<DELETED> (2) by inserting after subsection (b) the
following new subsection (c):</DELETED>
<DELETED> ``(c) The provisions of subsection (b) shall not apply to
the part-time service before April 7, 1986, of a registered nurse,
physician assistant, or expanded-function dental auxiliary. In
computing the annuity under the applicable provision of law specified
in that subsection of an individual covered by the preceding sentence,
the service described in that sentence shall be credited as full-time
service.''.</DELETED>
<DELETED>SEC. 303. MODIFICATION OF NURSE LOCALITY PAY
AUTHORITIES.</DELETED>
<DELETED> Section 7451 is amended--</DELETED>
<DELETED> (1) in subsection (d)(3)--</DELETED>
<DELETED> (A) in subparagraph (A), by striking
``beginning rates of'' each time it appears;</DELETED>
<DELETED> (B) in subparagraph (B), by striking
``beginning rates of''; and</DELETED>
<DELETED> (C) in subparagraph (C)(i), by striking
``beginning rates of'' each time it appears;</DELETED>
<DELETED> (2) in subsection (d)(4)--</DELETED>
<DELETED> (A) by striking ``or at any other time
that an adjustment in rates of pay is scheduled to take
place under this subsection'' in the first sentence;
and</DELETED>
<DELETED> (B) by striking the second sentence;
and</DELETED>
<DELETED> (3) in subsection (e)(4)--</DELETED>
<DELETED> (A) in subparagraph (A), by striking
``grade in a'';</DELETED>
<DELETED> (B) in subparagraph (B)--</DELETED>
<DELETED> (i) by striking ``grade of a'';
and</DELETED>
<DELETED> (ii) by striking ``that grade''
and inserting ``that position''; and</DELETED>
<DELETED> (C) in subparagraph (D), by striking
``grade of a''.</DELETED>
<DELETED>SEC. 304. TECHNICAL AMENDMENTS.</DELETED>
<DELETED> Section 7631(b) is amended by striking ``this subsection''
each place it appears and inserting ``this section''.</DELETED>
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Department of
Veterans Affairs Medical Programs Enhancement Act of 2001''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. References to title 38, United States Code.
TITLE I--ENHANCEMENT OF NURSE RECRUITMENT AND RETENTION AUTHORITIES
Sec. 101. Short title.
Subtitle A--Recruitment Authorities
Sec. 111. Enhancement of employee incentive scholarship program.
Sec. 112. Enhancement of education debt reduction program.
Sec. 113. Report on requests for waivers of pay reductions for
reemployed annuitants to fill nurse
positions.
Subtitle B--Retention Authorities
Sec. 121. Additional pay for Saturday tours of duty for additional
health care professional in the Veterans
Health Administration.
Sec. 122. Unused sick leave included in annuity computation of
registered nurses with the Veterans Health
Administration.
Sec. 123. Evaluation of Department of Veterans Affairs nurse managed
clinics.
Sec. 124. Staffing levels for operations of medical facilities.
Sec. 125. Annual report on use of authorities to enhance retention of
experienced nurses.
Sec. 126. Report on mandatory overtime for nurses and nurse assistants
in Department of Veterans Affairs
facilities.
Subtitle C--Other Authorities
Sec. 131. Organizational responsibility of the Director of the Nursing
Service.
Sec. 132. Computation of annuity for part-time service performed by
certain health-care professionals before
April 7, 1986.
Sec. 133. Modification of nurse locality pay authorities.
TITLE II--OTHER MATTERS
Sec. 201. Modification and enhancement of authority to provide dog-
guides and service dogs to veterans with
disabilities.
Sec. 202. Additional basis for establishment of inability to defray
expenses of necessary care.
Sec. 203. Funds for field offices of the Office of Research Compliance
and Assurance.
Sec. 204. Technical amendments.
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--ENHANCEMENT OF NURSE RECRUITMENT AND RETENTION AUTHORITIES
SEC. 101. SHORT TITLE.
This title may be cited as the ``Department of Veterans Affairs
Nurse Recruitment and Retention Enhancement Act of 2001''.
Subtitle A--Recruitment Authorities
SEC. 111. ENHANCEMENT OF EMPLOYEE INCENTIVE SCHOLARSHIP PROGRAM.
(a) Permanent Authority.--(1) Section 7676 is repealed.
(2) The table of sections at the beginning of chapter 76 is amended
by striking the item relating to section 7676.
(b) Minimum Period of Department Employment for Eligibility.--
Section 7672(b) is amended by striking ``2 years'' and inserting ``one
year''.
(c) Scholarship Amount.--Subsection (b) of section 7673 is
amended--
(1) in paragraph (1), by striking ``for any one year'' and
inserting ``for the equivalent of one year of full-time
coursework''; and
(2) by striking paragraph (2) and inserting the following
new paragraph (2):
``(2) in the case of a participant in the Program who is a
part-time student, shall bear the same ratio to the amount that
would be paid under paragraph (1) if the participant were a
full-time student in the course of education or training being
pursued by the participant as the coursework carried by the
student bears to full-time coursework in that course of
education or training.''.
(d) Limitation on Payment.--Subsection (c) of section 7673 is
amended to read as follows:
``(c) Limitations on Period of Payment.--(1) The maximum number of
school years for which a scholarship may be paid under subsection (a)
to a participant in the Program shall be six school years.
``(2) A participant in the Program may not receive a scholarship
under subsection (a) for more than the equivalent of three years of
full-time coursework.''.
(e) Full-Time Coursework.--Section 7673 is further amended by
adding at the end the following new subsection:
``(e) Full-Time Coursework.--For purposes of this section, full-
time coursework shall consist of the following:
``(1) In the case of undergraduate coursework, 30 semester
hours per undergraduate school year.
``(2) In the case of graduate coursework, 18 semester hours
per graduate school year.''.
(f) Annual Adjustment of Maximum Scholarship Amount.--Section 7631
is amended--
(1) in subsection (a)(1), by striking ``and the maximum
Selected Reserve member stipend amount'' and inserting ``the
maximum Selected Reserve member stipend amount, the maximum
employee incentive scholarship amount,''; and
(2) in subsection (b)--
(A) by redesignating paragraph (4) as paragraph
(6); and
(B) by inserting after paragraph (3) the following
new paragraph (4):
``(4) The term `maximum employee incentive scholarship
amount' means the maximum amount of the scholarship payable to
a participant in the Department of Veterans Affairs Employee
Incentive Scholarship Program under subchapter VI of this
chapter, as specified in section 7673(b)(1) of this title and
as previously adjusted (if at all) in accordance with this
section.''.
SEC. 112. ENHANCEMENT OF EDUCATION DEBT REDUCTION PROGRAM.
(a) Permanent Authority.--(1) Section 7684 is repealed.
(2) The table of sections at the beginning of chapter 76 is amended
by striking the item relating to section 7684.
(b) Eligible Individuals.--Subsection (a)(1) of section 7682 is
amended--
(1) by striking ``under an appointment under section
7402(b) of this title in a position'' and inserting ``in a
position (as determined by the Secretary) providing direct-
patient care services or services incident to direct-patient
care services''; and
(2) by striking ``(as determined by the Secretary)'' and
inserting ``(as so determined)''.
(c) Maximum Debt Reduction Amount.--Section 7683(d)(1) is amended--
(1) by striking ``for a year''; and
(2) by striking ``exceed--'' and all that follows through
the end of the paragraph and inserting ``exceed $44,000 over a
total of five years of participation in the Program, of which
not more than $10,000 of such payments may be made in each of
the fourth and fifth years of participation in the Program.''.
(d) Annual Adjustment of Maximum Debt Reduction Payments Amount.--
(1) Section 7631, as amended by section 101(f) of this Act, is further
amended--
(A) in subsection (a)(1), by inserting before the period at
the end of the first sentence the following: ``and the maximum
education debt reduction payments amount''; and
(B) in subsection (b), by inserting after paragraph (4) the
following new paragraph (5):
``(5) The term `maximum education debt reduction payments
amount' means the maximum amount of education debt reduction
payments payable to a participant in the Department of Veterans
Affairs Education Debt Reduction Program under subchapter VII
of this chapter, as specified in section 7683(d)(1) of this
title and as previously adjusted (if at all) in accordance with
this section.''.
(2) Notwithstanding section 7631(a)(1) of title 38, United States
Code, as amended by paragraph (1), the Secretary of Veterans Affairs
shall not increase the maximum education debt reduction payments amount
under that section in calendar year 2002.
(e) Temporary Expansion of Individuals Eligible for Participation
in Program.--(1) Notwithstanding section 7682(c) of title 38, United
States Code, the Secretary of Veterans Affairs may treat a covered
individual as being a recently appointed employee in the Veterans
Health Administration under section 7682(a) of that title for purposes
of eligibility in the Education Debt Reduction Program if the Secretary
determines that the participation of the individual in the Program
under this subsection would further the purposes of the Program.
(2) For purposes of this subsection, a covered individual is any
individual otherwise described by section 7682(a) of title 38, United
States Code, as in effect on the day before the date of the enactment
of this Act, who--
(A) was appointed as an employee in a position described in
paragraph (1) of that section, as so in effect, between January
1, 1999, and September 30, 2000; and
(B) is an employee in such position, or in another position
described in paragraph (1) of that section, as so in effect, at
the time of application for treatment as a covered individual
under this subsection.
(3) The Secretary shall make determinations regarding the exercise
of the authority in this subsection on a case-by-case basis.
(4) The Secretary may not exercise the authority in this subsection
after December 31, 2001. The expiration of the authority in this
subsection shall not affect the treatment of an individual under this
subsection before that date as a covered individual for purposes of
eligibility in the Education Debt Reduction Program.
(5) In this subsection, the term ``Education Debt Reduction
Program'' means the Department of Veterans Affairs Education Debt
Reduction Program under subchapter VII of chapter 76 of title 38,
United States Code.
SEC. 113. REPORT ON REQUESTS FOR WAIVERS OF PAY REDUCTIONS FOR
REEMPLOYED ANNUITANTS TO FILL NURSE POSITIONS.
(a) Report.--Not later than November 30 of each of 2001 and 2002,
the Secretary of Veterans Affairs shall submit to the Committees on
Veterans' Affairs of the Senate and the House of Representatives a
report describing each request of the Secretary, during the fiscal year
preceding such report, to the Director of the Office of Personnel
Management for the following:
(1) A waiver under subsection (i)(1)(A) of section 8344 of
title 5, United States Code, of the provisions of such section
in order to meet requirements of the Department of Veterans
Affairs for appointments to nurse positions in the Veterans
Health Administration.
(2) A waiver under subsection (f)(1)(A) of section 8468 of
title 5, United States Code, of the provisions of such section
in order to meet requirements of the Department for
appointments to such positions.
(3) A grant of authority under subsection (i)(1)(B) of
section 8344 of title 5, United States Code, for the waiver of
the provisions of such section in order to meet requirements of
the Department for appointments to such positions.
(4) A grant of authority under subsection (f)(1)(B) of
section 8468 of title 5, United States Code, for the waiver of
the provisions of such section in order to meet requirements of
the Department for appointments to such positions.
(b) Information on Responses to Requests.--The report under
subsection (a) shall specify for each request covered by the report--
(1) the response of the Director to such request; and
(2) if such request was granted, whether or not the waiver
or authority, as the case may be, assisted the Secretary in
meeting requirements of the Department for appointments to
nurse positions in the Veterans Health Administration.
Subtitle B--Retention Authorities
SEC. 121. ADDITIONAL PAY FOR SATURDAY TOURS OF DUTY FOR ADDITIONAL
HEALTH CARE PROFESSIONAL IN THE VETERANS HEALTH
ADMINISTRATION.
(a) In General.--Section 7454(b) is amended--
(1) by inserting ``(1)'' after ``(b)''; and
(2) by adding at the end the following new paragraph:
``(2) Health care professionals employed in positions referred to
in paragraph (1) shall be entitled to additional pay on the same basis
as provided for nurses in section 7453(c) of this title.''.
(b) Applicability.--The amendments made by subsection (a) shall
take effect on the date of the enactment of this Act, and shall apply
with respect to pay periods beginning on or after that date.
SEC. 122. UNUSED SICK LEAVE INCLUDED IN ANNUITY COMPUTATION OF
REGISTERED NURSES WITH THE VETERANS HEALTH
ADMINISTRATION.
(a) Annuity Computation.--Section 8415 of title 5, United States
Code, is amended by adding at the end the following:
``(i) In computing an annuity under this subchapter, the total
service of an employee who retires from the position of a registered
nurse with the Veterans Health Administration on an immediate annuity,
or dies while employed in that position leaving any survivor entitled
to an annuity, includes the days of unused sick leave to the credit of
that employee under a formal leave system, except that such days shall
not be counted in determining average pay or annuity eligibility under
this subchapter.''.
(b) Deposit Not Required.--Section 8422(d) of title 5, United
States Code, is amended--
(1) by inserting ``(1)'' before ``Under such regulations'';
and
(2) by adding at the end the following:
``(2) Deposit may not be required for days of unused sick leave
credited under section 8415(i).''.
(c) Effective Date.--The amendments made by this section shall take
effect 60 days after the date of the enactment of this Act, and shall
apply to individuals who separate from service on or after that
effective date.
SEC. 123. EVALUATION OF DEPARTMENT OF VETERANS AFFAIRS NURSE MANAGED
CLINICS.
(a) Evaluation.--The Secretary of Veterans Affairs shall carry out
an evaluation of the efficacy of the nurse managed health care clinics
of the Department of Veterans Affairs. The Secretary shall complete the
evaluation not later than 18 months after the date of the enactment of
this Act.
(b) Clinics To Be Evaluated.--(1) In carrying out the evaluation
under subsection (a), the Secretary consider nurse managed health care
clinics, including primary care clinics and geriatric care clinics,
located in three different Veterans Integrated Service Networks (VISNs)
of the Department.
(2) If there are not nurse managed health care clinics located in
three different Veterans Integrated Service Networks as of the
commencement of the evaluation, the Secretary shall--
(A) establish nurse managed health care clinics in
additional Veterans Integrated Services Networks such that
there are nurse managed health care clinics in three different
Veterans Integrated Service Networks for purposes of the
evaluation; and
(B) include such clinics, as so established, in the
evaluation.
(c) Matters To Be Evaluated.--In carrying out the evaluation under
subsection (a), the Secretary shall address the following:
(1) Patient satisfaction.
(2) Provider experiences.
(3) Cost of care.
(4) Access to care, including waiting time for care.
(5) The functional status of patients receiving care.
(6) Any other matters the Secretary considers appropriate.
(d) Report.--Not later than 18 months after the date of the
enactment of this Act, the Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and the House of Representatives a
report on the evaluation carried out under subsection (a). The report
shall address the matters specified in subsection (c) and include any
other information, and any recommendations, that the Secretary
considers appropriate.
SEC. 124. STAFFING LEVELS FOR OPERATIONS OF MEDICAL FACILITIES.
(a) In General.--Section 8110(a) is amended--
(1) in paragraph (1), by inserting after ``complete care of
patients,'' in the fifth sentence the following: ``and in a
manner consistent with the policies of the Secretary on
overtime,''; and
(2) in paragraph (2)--
(A) by inserting ``, including the staffing
required to maintain such capacities,'' after ``all
Department medical facilities'';
(B) by striking ``and to minimize'' and inserting
``, to minimize''; and
(C) by inserting before the period the following:
``, and to ensure that eligible veterans are provided
such care and services in an appropriate manner''.
(b) Nationwide Policy on Staffing.--Paragraph (3) of that section
is amended--
(1) in subparagraph (A), by inserting ``the adequacy of
staff levels for compliance with the policy established under
subparagraph (C),'' after ``regarding''; and
(2) by inserting after subparagraph (B) the following new
subparagraph:
``(C) The Secretary shall, in consultation with the Under Secretary
for Health, establish a nationwide policy on the staffing of Department
medical facilities in order to ensure that such facilities have
adequate staff for the provision to veterans of appropriate, high-
quality care and services. The policy shall take into account the
staffing levels and mixture of staff skills required for the range of
care and services provided veterans in Department facilities.''.
SEC. 125. ANNUAL REPORT ON USE OF AUTHORITIES TO ENHANCE RETENTION OF
EXPERIENCED NURSES.
(a) Annual Report.--(1) Subchapter II of chapter 73 is amended by
adding at the end the following new section:
``Sec. 7324. Annual report on use of authorities to enhance retention
of experienced nurses
``(a) Annual Report.--Not later than January 31 each year, the
Secretary, acting through the Under Secretary for Health, shall submit
to Congress a report on the use during the preceding year of
authorities for purposes of retaining experienced nurses in the
Veterans Health Administration, as follows:
``(1) The authorities under chapter 76 of this title.
``(2) The authority under VA Directive 5102.1, relating to
the Department of Veterans Affairs nurse qualification
standard, dated November 10, 1999, or any successor directive.
``(3) Any other authorities available to the Secretary for
those purposes.
``(b) Report Elements.--Each report under subsection (a) shall
specify for the period covered by such report, for each Department
medical facility and for each Veterans Integrated Service Network, the
following:
``(1) The number of waivers requested under the authority
referred to in subsection (a)(2), and the number of waivers
granted under that authority, to promote to the Nurse II grade
or Nurse III grade under the Nurse Schedule under section
7404(b)(1) of this title any nurse who has not completed a
bachelors of science in nursing in a recognized school of
nursing, set forth by age, race, and years of experience of the
individuals subject to such waiver requests and waivers, as the
case may be.
``(2) The programs carried out to facilitate the use of
nursing education programs by experienced nurses, including
programs for flexible scheduling, scholarships, salary
replacement pay, and on-site classes.''.
(2) The table of sections at the beginning of chapter 73 is amended
by inserting after the item relating to section 7323 the following new
item:
``7324. Annual report on use of authorities to enhance retention of
experienced nurses.''.
(b) Initial Report.--The initial report required under section 7324
of title 38, United States Code, as added by subsection (a), shall be
submitted in 2002.
SEC. 126. REPORT ON MANDATORY OVERTIME FOR NURSES AND NURSE ASSISTANTS
IN DEPARTMENT OF VETERANS AFFAIRS FACILITIES.
(a) Report.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit
to the Committees on Veterans' Affairs of the Senate and the House of
Representatives a report on the mandatory overtime required of licensed
nurses and nurse assistants providing direct patient care at Department
of Veterans Affairs medical facilities during 2001.
(b) Mandatory Overtime.--For purposes of the report under
subsection (a), mandatory overtime shall consist of any period in which
a nurse or nurse assistant is mandated or otherwise required, whether
directly or indirectly, to work or be in on-duty status in excess of--
(1) a scheduled workshift or duty period;
(2) 12 hours in any 24-hour period; or
(3) 80 hours in any period of 14 consecutive days.
(c) Elements.--The report under subsection (a) shall include the
following:
(1) A description of the amount of mandatory overtime
described in that subsection at each Department medical
facility during the period covered by the report.
(2) A description of the mechanisms employed by the
Secretary to monitor overtime of the nurses and nurse
assistants referred to in that subsection.
(3) An assessment of the effects of the mandatory overtime
of such nurses and nurse assistants on patient care, including
its contribution to medical errors.
(4) Recommendations regarding mechanisms for preventing
mandatory overtime in other than emergency situations by such
nurses and nurse assistants.
(5) Any other matters that the Secretary considers
appropriate.
Subtitle C--Other Authorities
SEC. 131. ORGANIZATIONAL RESPONSIBILITY OF THE DIRECTOR OF THE NURSING
SERVICE.
Section 7306(a)(5) is amended by inserting ``, and report directly
to,'' after ``responsible to''.
SEC. 132. COMPUTATION OF ANNUITY FOR PART-TIME SERVICE PERFORMED BY
CERTAIN HEALTH-CARE PROFESSIONALS BEFORE APRIL 7, 1986.
Section 7426 is amended by adding at the end the following new
subsection:
``(c) The provisions of subsection (b) shall not apply to the part-
time service before April 7, 1986, of a registered nurse, physician
assistant, or expanded-function dental auxiliary. In computing the
annuity under the applicable provision of law specified in that
subsection of an individual covered by the preceding sentence, the
service described in that sentence shall be credited as full-time
service.''.
SEC. 133. MODIFICATION OF NURSE LOCALITY PAY AUTHORITIES.
Section 7451 is amended--
(1) in subsection (d)(3)--
(A) in subparagraph (A), by striking ``beginning
rates of'' each place it appears;
(B) in subparagraph (B), by striking ``beginning
rates of'' the first place it appears; and
(C) in subparagraph (C)(i), by striking ``beginning
rates of'' each place it appears;
(2) in subsection (d)(4)--
(A) by striking ``or at any other time that an
adjustment in rates of pay is scheduled to take place
under this subsection'' in the first sentence; and
(B) by striking the second sentence; and
(3) in subsection (e)(4)--
(A) in subparagraph (A), by striking ``grade in
a'';
(B) in subparagraph (B)--
(i) by striking ``grade of a''; and
(ii) by striking ``that grade'' and
inserting ``that position''; and
(C) in subparagraph (D), by striking ``grade of
a''.
TITLE II--OTHER MATTERS
SEC. 201. MODIFICATION AND ENHANCEMENT OF AUTHORITY TO PROVIDE DOG-
GUIDES AND SERVICE DOGS TO VETERANS WITH DISABILITIES.
(a) Enhancement of Authority.--Subsection (b) of section 1714 is
amended to read as follows:
``(b)(1) The Secretary may provide any blind veteran who is
entitled to disability compensation with--
``(A) a dog-guide trained for the aid of the blind; and
``(B) mechanical or electronic equipment for aid in
overcoming the disability of blindness.
``(2) The Secretary may provide a service dog to the following:
``(A) Any hearing-impaired veteran who is entitled to
disability compensation.
``(B) Any veteran with a spinal cord injury or dysfunction
who is entitled to disability compensation.
``(C) Any veteran entitled to disability compensation who
has any other chronic physical or mental impairment that
substantially limits mobility, hearing, or activities of daily
living in order to assist such veteran in overcoming such
physical or mental impairment.
``(3) In providing a dog-guide or service dog to a veteran under
this subsection, the Secretary may pay travel and incidental expenses
(under the terms and conditions set forth in section 111 of this title)
of the veteran to and from the veteran's home and incurred in becoming
adjusted to the dog-guide or service dog, as the case may be.''.
(b) Conforming and Clerical Amendments.--(1) The section heading of
that section is amended to read as follows:
``Sec. 1714. Fitting and training in use of prosthetic appliances; dog-
guides and service dogs''
(2) The table of section at the beginning of chapter 17 is amended
by striking the item relating to section 1714 and inserting the
following new item:
``1714. Fitting and training in use of prosthetic appliances; dog-
guides and service dogs.''.
SEC. 202. ADDITIONAL BASIS FOR ESTABLISHMENT OF INABILITY TO DEFRAY
EXPENSES OF NECESSARY CARE.
(a) Additional Basis.--Section 1722(a) is amended--
(1) in paragraph (2), by striking ``or'' at the end;
(2) in paragraph (3), by striking the period at the end and
inserting ``; or''; and
(3) by adding at the end the following new paragraph:
``(4) the veteran (including any applicable part of the
veteran's family) is eligible for treatment as a low-income
family under section 3 of the United States Housing Act of 1937
(42 U.S.C. 1437a) for the area in which the veteran resides.''.
(b) Applicability.--The amendments made by subsection (a) shall
take effect on January 1, 2002, and shall apply with respect to years
beginning after December 31, 2001.
SEC. 203. FUNDS FOR FIELD OFFICES OF THE OFFICE OF RESEARCH COMPLIANCE
AND ASSURANCE.
(a) In General.--Amounts for the activities of the field offices of
the Office of Research Compliance and Assurance of the Department of
Veterans Affairs shall be derived from amounts appropriated for the
Department of Veterans Affairs for the Veterans Health Administration
for Medical Care, rather than from amounts appropriated for the
Veterans Health Administration for Medical and Prosthetic Research.
(b) Applicability.--Subsection (a) shall apply with respect to
fiscal years after fiscal year 2001.
SEC. 204. TECHNICAL AMENDMENTS.
Section 7631(b) is amended by striking ``this subsection'' each
place it appears and inserting ``this section''.
Amend the title to read: ``A Bill to amend title 38, United States
Code, to enhance the authority of the Secretary of Veterans Affairs to
recruit and retain qualified nurses for the Veterans Health
Administration, to provide an additional basis for establishing the
inability of veterans to defray expenses of necessary medical care, to
modify other authorities relating to health care for veterans, and for
other purposes.''.
Calendar No. 190
107th CONGRESS
1st Session
S. 1188
[Report No. 107-80]
_______________________________________________________________________
A BILL
To amend title 38, United States Code, to enhance the authority of the
Secretary of Veterans Affairs to recruit and retain qualified nurses
for the Veterans Health Administration, and for other purposes.
_______________________________________________________________________
October 10, 2001
Reported with an amendment and an amendment to the title