[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 2484 Introduced in Senate (IS)]
108th CONGRESS
2d Session
S. 2484
To amend title 38, United States Code, to simplify and improve pay
provisions for physicians and dentists, to authorize alternate work
schedules and executive pay for nurses.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 1, 2004
Mr. Specter (by request) introduced the following bill; which was read
twice and referred to the Committee on Veterans Affairs
_______________________________________________________________________
A BILL
To amend title 38, United States Code, to simplify and improve pay
provisions for physicians and dentists, to authorize alternate work
schedules and executive pay for nurses.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Department of Veterans Affairs
Health Care Personnel Enhancement Act of 2003''.
SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE.
Except as otherwise expressly provided, whenever in this Act an
amendment is expressed in terms of an amendment to 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.
SEC. 3. IMPROVEMENT AND SIMPLIFICATION OF PAY PROVISIONS FOR PHYSICIANS
AND DENTISTS.
(a) Chapter 74 is amended--
(1) In section 7404b--
(A) by striking ``(1)'' after ``(b)'';
(B) by striking the list of position grades under
the caption, ``Physician and dentist schedule'' and
inserting in lieu thereof the following:
``Physician grade.
Dentist grade.''; and
(C) by striking paragraph (2) in its entirety;
(2) In section 7404(c) by striking ``special''; and
(3) By striking Subchapter III in its entirety and
inserting in lieu thereof the following sections:
``SUBCHAPTER III--PAY FOR PHYSICIANS AND DENTISTS
``Sec. 7431. Pay authority
``(a) In order to recruit and retain highly qualified physicians
and dentists in the Veterans Health Administration, the Secretary shall
establish and periodically adjust the rates of pay for physicians and
dentists based upon the factors specified in subsection (b). Total pay
shall be benchmarked to representative salaries of non-Department
physicians, dentists, and health care clinician-executives.
``(b) Pay for physicians and dentists employed in the Veterans
Health Administration shall have three components:
``(1) Base pay.--This shall be a uniform pay band
applicable nationwide. The minimum rate shall be the maximum
rate for Chief grade in the Veterans Health Administration
Physician and Dentist Pay Schedule in effect on the day before
the date of enactment of this Act. The maximum rate may not exceed the
rate of basic pay authorized by section 5316 of title 5 for Level V of
the Executive Schedule. The Secretary shall adjust annually the minimum
rate by the same percentage as the adjustment under section 5303 of
title 5 in the rates of pay for the General Schedule, and the maximum
rate in accordance with section 5318 of title 5. Administration
facilities, under regulations prescribed by the Secretary, may set
individual base pay anywhere within the pay band.
``(2) Market pay.--This shall be a variable pay band based
on geographic area, specialty, assignment, personal
qualifications, and individual experience, and shall be
established and adjusted locally in accordance with regulations
prescribed under subsection (c). Administration facilities will
set individual market pay in accordance with regulations
prescribed by the Secretary. The Under Secretary for Health
shall periodically review and recommend to the Secretary
adjustments to the market pay band based on published
healthcare workforce employment and compensation data. The
Secretary may adjust the market pay band periodically based on
the recommendations of the Under Secretary and in response to
changing health-care labor trends.
``(3) Performance pay.--
``(A) There shall be a variable pay band linked to
the physician's or dentist's achievement of specific
corporate goals and individual performance objectives.
Physicians and dentists other than those specified in
subsection (f)(1) shall not be eligible for this
component during the first year of appointment. The
amount payable to a physician or dentist for this
component may vary based on individual achievement. The
performance component paid to any physician or dentist
other than those specified in subsection (f)(1) will be
in accordance with regulations prescribed by the
Secretary and may not exceed $10,000 in a year.
``(B) In accordance with regulations prescribed by
the Secretary, ten percent of the benchmark total pay
for physicians and dentists specified in subsection
(f)(1) shall be linked to the physician's or dentist's
achievement of specific corporate goals and individual
performance objectives as a performance component.
Administration facilities may set the performance pay
in accordance with regulations prescribed by the
Secretary.
``(c) Compensation paid under this subchapter shall be considered
pay for all purposes, included but not limited to retirement benefits
under chapters 83 and 84 of title 5, United States Code, and other
benefits. Notwithstanding the preceding sentence, amounts paid for
performance pay under subsection (b)(3)(A) shall not be considered pay
for retirement benefits under chapters 83 and 84 of title 5, United
States Code.
``(d) Any decrease in pay that results from an adjustment to the
market or performance component of a physician's or dentist's total
compensation does not constitute an adverse action.
``(e) In no case may the total amount of compensation paid to a
physician or dentist under this title in any one year exceed the amount
of annual compensation (excluding expenses) specified in section 102 of
title 3, United States Code.
``(f) Covered Positions.--
``(1) This subsection applies to physicians and dentists in
the following positions: Chiefs of Staff or equivalent
facility-level and Network-level clinical management positions
(including Network Clinical Service Managers), facility and
Network or Regional executive positions (including Network
Service Line Coordinators and Medical Center/Health Care System
Directors), Central Office executive positions, and such other
positions under this title as the Secretary may determine in
accordance with regulations prescribed in accordance with
section 7434(a).
``(2) Notwithstanding the special relationships of the
Veterans Health Administration with affiliated institutions
under section 7302, physicians and dentists serving in covered
positions and receiving compensation under this subchapter may
not receive any compensation on or after the date specified in
regulations issued by the Secretary, through employment or
contract with, or negotiate or accept any offer of employment
from, any institution or other entity that is affiliated with
the VA medical center to which they are assigned, or affiliated
with a VA medical center which falls under their official
responsibilities. This limitation shall include receiving
compensation through or from practice groups or any other
entities associated with the affiliated institution(s), or from
entities under contract with the affiliated institution(s).
Compensation includes anything of monetary value, including but
not limited to honoraria, salary, and any fringe benefits such
as: tuition waiver, insurance protection, contributions to a
retirement fund, payment for books, below-market interest
loans, or employee discounts. Nothing in this section precludes
physicians and dentists in covered positions from holding
uncompensated appointments as other than officer, director, or
trustee with affiliated institutions in furtherance of section
7302.
``(3) Subject to any conditions the Secretary may be
regulation prescribe, the Secretary may, on a case-by-case
basis, suspend or waive the limitation in paragraph (2) to an
individual physician or dentist, when necessary and appropriate
to carry out the purposes of section 7302, to assist
communities or practice groups to meet medical needs which
otherwise would not be met, or where the Secretary determines
that suspension or waiver would be in the best interest of the
United States. The Secretary shall make any suspension or
wavier made pursuant to this paragraph in writing.
``Sec. 7432. Transition to new pay system
``(a) All current special pay agreements entered into under the
provisions of this subchapter in effect on the day before the date of
enactment of this Act shall terminate on the date of enactment of this
Act. Any physician or dentist in receipt of special pay on that date
shall continue to be compensated as if such agreement were still in
effect until the date specified in regulations issued by the Secretary
implementing this new subchapter.
``(b) Physicians and dentists appointed or reassigned on or after
the date of enactment of this Act, but before implementation of this
subchapter shall be compensated in accordance with sections 7404, 7405,
7433, 7434, 7435, and 7436, as applicable, in effect on the day before
the date of enactment of this Act. Any such physician or dentist shall
continue to be compensated at the applicable rates until such date
specified in regulations issued by the Secretary implementing the new
pay system. No special pay agreement will be required of any physician
or dentist receiving such pay.
``(c) During the period from the date of enactment of this Act
through the date of implementation of this subchapter, physicians and
dentists paid pursuant to this section shall be subject to paragraphs
(1), (2), (4), (5), and (6) of subsection (b) of section 7438 in effect
on the day before the date of enactment of this Act.
``(d) The amount of pay paid under this subchapter for a physician
or dentist appointed before the effective date of regulations
implementing this subchapter shall be not less than the amount of base
pay and special pay such physician or dentist received under this title
on the day before such effective date.
``(e) Special pay subject to the provisions of section 7438, as in
effect before the date of enactment of this section, or subject to
subsection (c), paid to Veterans Health Administration physicians and
dentists appointed before the effective date of regulations
implementing this subchapter and who separate after such effective
date, shall be fully creditable for purposes of computing benefits
under chapters 83 and 84 of title 5.
``Sec. 7433. Pay for Under Secretary for Health
``(a) Section 5314 of title 5 establishes the base pay for the
Under Secretary for Health at Level III of the Executive Schedule.
``(b) In addition to base pay under section 5314 of title 5, the
Under Secretary for Health shall be eligible for Market Pay under
section 7431(b)(2).
``(c) Transition.--The current special pay agreement of the Under
Secretary for Health entered into under the provisions of this
subchapter in effect on the day before the date of enactment of this
Act shall terminate on the date of enactment of this Act. The incumbent
Under Secretary for Health on the date of enactment of this Act shall
continue to receive special pay as if such agreement were still in
effect until the date specified in regulations issued by the Secretary
implementing this new subchapter. Any Under Secretary for Health
appointed on or after the date of enactment of this Act, but before the
date specified in regulations issued by the Secretary implementing this
new subchapter, shall receive special pay in accordance with sections
7432(d)(2), 7433, and 7437(a) in effect on the day before the date of
enactment of this Act.
``Sec. 7434. Administrative provisions
``(a) After receiving the recommendations of the Under Secretary
for Health, the Secretary, pursuant to the authority in section
7421(a), shall prescribe regulations implementing the physician and
dentist pay system established in this new subchapter. Such regulations
shall include the method for computing the pay for all physicians and
dentists in the Veterans Health Administration under this title.
``(b) Eighteen months after the Secretary issues regulations
implementing this subchapter and annually thereafter for the next ten
years, the Secretary shall provide to the Committees on Veterans'
Affairs of the Senate and House of Representatives a report on the
implementation of the authorities under this subchapter. Each report
shall include:
``(1) a description of the rates of pay in effect during
the preceding fiscal year with a comparison to the rates in
effect during the previous fiscal year by facility and by
specialty;
``(2) the number of physicians and dentists who left
employment with the Veterans Health Administration during the
preceding year;
``(3) the number of unfilled physician and dentist
positions in each specialty in the Veterans Health
Administration, the average and maximum lengths of time that
such positions have been unfilled, and a summary of the reasons
that such positions remain unfilled; and
``(4) an assessment of the impact of implementation of this
subchapter on efforts to recruit and retain physicians and
dentists in the Veterans Health Administration.
In addition, the first two reports following implementation of this
subchapter shall also include a comparison of staffing levels, contract
expenditures, and average salary of physicians and dentists by facility
and specialty for the preceding and previous fiscal years.''.
(b) The title and list of sections for Subchapter III in the table
of sections at the beginning of Chapter 74 is amended to read as
follows:
``subchapter iii--pay for physicians and dentists
``Sec. 7431. Pay authority.
``Sec. 7432. Transition to new pay system.
``Sec. 7433. Pay for Under Secretary for Health.
``Sec. 7434. Administrative provisions.''.
SEC. 4. ALTERNATE WORK SCHEDULES.
(a) Chapter 74 is amended by adding a new section 7456a:
``Sec. 7456a. Alternate work schedules
``(a) Coverage.--This section applies to registered nurses
appointed under this chapter.
``(b) 36/40 Work Schedule.--
``(1) Subject to paragraph (2), if the Secretary determines
it be necessary in order to obtain or retain the services of
registered nurses at any Department health-care facility, the
Secretary may provide, in the case of nurses employed at such
facility, that such nurses who work three regularly scheduled
12-hour tours of duty within a workweek shall be considered for
all purposes (except computation of full-time equivalent
employees for the purposes of determining compliance with
personnel ceilings) to have worked a full 40-hour basic
workweek.
``(2)(A) Basic and additional pay for a registered nurse
who is considered under paragraph (1) to have worked a full 40-
hour basic workweek shall be subject to subparagraphs (B) and
(C).
``(B) The hourly rate of basic pay for such a nurse for
service performed as part of a regularly scheduled 36-hour tour
of duty within the workweek shall be derived by dividing the
nurse's annual rate of basic pay by 1,872.
``(C)(i) Such a nurse who performs a period of service in
excess of such nurse's regularly scheduled 36-hour tour of duty
within a workweek is entitled to overtime pay under section
7453(e) of this title, or other applicable law, for officially
ordered or approved service performed in excess of eight hours
on a day other than a day on which such nurse's regularly
scheduled three 12-hour tours fall, or in excess of 12 hours
for any day included in the regularly scheduled 36-hour tour of
duty, or in excess of 40 hours during an administrative
workweek.
``(ii) Except as provided in subparagraph (i), a registered
nurse to whom this subsection is applicable is not entitled to
additional pay under section 7453 of this title, or other
applicable law, for any period included in a regularly
scheduled 12-hour tour of duty.
``(3) A nurse who works a 36/40 work schedule described in
this subsection who is absent on approved sick leave or annual
leave during a regularly scheduled 12-hour tour of duty shall
be charged for such leave at a rate of ten hours of leave for
nine hours of absence.
``(c) 7/7 Work Schedule.--
``(1) Subject to paragraph (2), if the Secretary determines
it be necessary in order to obtain or retain the services of
registered nurses at any Department health-care facility, the
Secretary may provide, in the case of nurses employed at such
facility, that such nurses who work seven regularly scheduled
10-hour tours of duty, with seven days off duty, within a two-
week pay period, shall be considered for all purposes (except
computation of full-time equivalent employees for the purposes
of determining compliance with personnel ceilings) to have
worked a full 80 hours for the pay period.
``(2)(A) Basic and additional pay for a registered nurse
who is considered under paragraph (1) to have worked a full 80-
hour pay period shall be subject to subparagraphs (B) and (C).
``(B) The hourly rate of basic pay for such a nurse for
service performed as part of a regularly scheduled 70-hour tour
of duty within the pay period shall be derived by dividing the
nurse's annual rate of basic pay by 1,820.
``(C)(i) Such a nurse who performs a period of service in
excess of such nurse's regularly scheduled 70-hour tour of duty
within a pay period is entitled to overtime pay under section
7453(e) of this title, or other applicable law, for officially
ordered or approved service performed in excess of eight hours
on a day other than a day on which such nurse's regularly
scheduled seven 10-hour tours fall, or in excess of 10 hours
for any day included in the regularly scheduled 70-hour tour of
duty, or in excess of 80 hours during a pay period.
``(ii) Except as provided in subparagraph (i), a registered
nurse to whom this subsection is applicable is not entitled to
additional pay under section 7453 of this title, or other
applicable law, for any period included in a regularly
scheduled 10-hour tour of duty.
``(3) A nurse who works a 7/7 work schedule described in
this subsection who is absent on approved sick leave or annual
leave during a regularly scheduled 12-hour tour of duty shall
be charged for such leave at a rate of eight hours of leave for
seven hours of absence.
``(d) 9-Month Work Schedule.--The Secretary may authorize a
registered nurse appointed under section 7405, with the nurse's written
consent, to work full-time for nine months with three months off duty,
within a fiscal year, and be paid at 75 percent of the full-time rate
for such nurse's grade for each pay period of such fiscal year. Such
employee shall be considered a .75 full-time equivalent employee in
computing full-time equivalent employees for the purposes of
determining compliance with personnel ceilings. Service on this
schedule shall be considered part-time service for purposes of
computing benefits under chapters 83 and 84 of title 5.
``(e) The Secretary shall prescribe regulations for the
implementation of this section.''.
(b) The title and list of sections for Subchapter IV in the table
of sections at the beginning of Chapter 74 is amended to read as
follows:
``subchapter iv--pay for nurses and other health-care personnel
``Sec. 7451. Nurses and other health-care personnel: competitive pay.
``Sec. 7452. Nurses and other health-care personnel: administration of
pay.
``Sec. 7453. Nurses: additional pay.
``Sec. 7454. Physician assistants and other health care professionals:
additional pay.
``Sec. 7455. Increases in rates of basic pay.
``Sec. 7456. Nurses: special rules for weekend duty.
``Sec. 7456a. Alternate work schedules.
``Sec. 7457. On-call pay.
``Sec. 7458. Recruitment and retention bonus pay.''.
SEC. 5. NURSE EXECUTIVE SPECIAL PAY.
(a) Section 7452 is amended by adding at the end thereof:
``(g)(1) In order to recruit and retain highly qualified Department
nurse executives, the Secretary, in accordance with regulations the
Secretary shall prescribe, shall pay special pay to the nurse executive
at each Department health-care facility or at Central Office.
``(2) Special pay paid under paragraph (1) shall be a minimum of
$10,000 and a maximum of $25,000. The amount paid to each nurse
executive shall be based on factors such as the grade of the nurse
executive position, the scope and complexity of the nurse executive
position, the nurse executive's personal qualifications, the
characteristics of the health-care facility, e.g., tertiary, single
site or multi-site, nature and number of specialty care units,
demonstrated recruitment and retention difficulties, and such other
factors the Secretary deems appropriate.
``(3) Special pay paid under paragraph (1) shall be in addition to
any other pay (including basic pay) and allowances to which the nurse
executive is entitled, and shall be considered pay for all purposes,
including but not limited to retirement benefits under chapters 83 and
84 of title 5, United States Code, and other benefits, but shall not be
considered basic pay for purposes of adverse actions under subchapter
V.''.
SEC. 6. EFFECTIVE DATE.
The amendments to title 38, United States Code, contained herein
shall take effect on the first day of the first pay period on or after
the later of April 1, 2004, or six months after the date of enactment.
SEC. 7. ADMINISTRATIVE PROVISION.
(a) Chapter 74 is amended by adding a new section 7427:
``Sec. 7427. Functions
``The functions assigned to the Secretary and other officers of the
Department of Veterans Affairs under this chapter are vested in their
discretion.''
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