[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 2484 Reported in Senate (RS)]
Calendar No. 713
108th CONGRESS
2d Session
S. 2484
[Report No. 108-357]
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
September 23, 2004
Reported by Mr. Specter, 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 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,
<DELETED>SECTION 1. SHORT TITLE.</DELETED>
<DELETED> This Act may be cited as the ``Department of Veterans
Affairs Health Care Personnel Enhancement Act of 2003''.</DELETED>
<DELETED>SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE.</DELETED>
<DELETED> 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.</DELETED>
<DELETED>SEC. 3. IMPROVEMENT AND SIMPLIFICATION OF PAY PROVISIONS FOR
PHYSICIANS AND DENTISTS.</DELETED>
<DELETED> (a) Chapter 74 is amended--</DELETED>
<DELETED> (1) In section 7404b--</DELETED>
<DELETED> (A) by striking ``(1)'' after
``(b)'';</DELETED>
<DELETED> (B) by striking the list of position
grades under the caption, ``Physician and dentist
schedule'' and inserting in lieu thereof the
following:</DELETED>
<DELETED>``Physician grade.</DELETED>
<DELETED>Dentist grade.''; and</DELETED>
<DELETED> (C) by striking paragraph (2) in its
entirety;</DELETED>
<DELETED> (2) In section 7404(c) by striking ``special'';
and</DELETED>
<DELETED> (3) By striking Subchapter III in its entirety and
inserting in lieu thereof the following sections:</DELETED>
<DELETED>``SUBCHAPTER III--PAY FOR PHYSICIANS AND DENTISTS</DELETED>
<DELETED>``Sec. 7431. Pay authority</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(b) Pay for physicians and dentists employed in the
Veterans Health Administration shall have three components:</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(3) Performance pay.--</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(f) Covered Positions.--</DELETED>
<DELETED> ``(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).</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED>``Sec. 7432. Transition to new pay system</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED>``Sec. 7433. Pay for Under Secretary for Health</DELETED>
<DELETED> ``(a) Section 5314 of title 5 establishes the base pay for
the Under Secretary for Health at Level III of the Executive
Schedule.</DELETED>
<DELETED> ``(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).</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED>``Sec. 7434. Administrative provisions</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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:</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED> ``(2) the number of physicians and dentists who
left employment with the Veterans Health Administration during
the preceding year;</DELETED>
<DELETED> ``(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</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED>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.''.</DELETED>
<DELETED> (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:</DELETED>
``subchapter iii--pay for physicians and dentists
<DELETED>``Sec. 7431. Pay authority.
<DELETED>``Sec. 7432. Transition to new pay system.
<DELETED>``Sec. 7433. Pay for Under Secretary for Health.
<DELETED>``Sec. 7434. Administrative provisions.''.
<DELETED>SEC. 4. ALTERNATE WORK SCHEDULES.</DELETED>
<DELETED> (a) Chapter 74 is amended by adding a new section
7456a:</DELETED>
<DELETED>``Sec. 7456a. Alternate work schedules</DELETED>
<DELETED> ``(a) Coverage.--This section applies to registered nurses
appointed under this chapter.</DELETED>
<DELETED> ``(b) 36/40 Work Schedule.--</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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).</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(c) 7/7 Work Schedule.--</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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).</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(e) The Secretary shall prescribe regulations for the
implementation of this section.''.</DELETED>
<DELETED> (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:</DELETED>
``subchapter iv--pay for nurses and other health-care personnel
<DELETED>``Sec. 7451. Nurses and other health-care personnel:
competitive pay.
<DELETED>``Sec. 7452. Nurses and other health-care personnel:
administration of pay.
<DELETED>``Sec. 7453. Nurses: additional pay.
<DELETED>``Sec. 7454. Physician assistants and other health care
professionals: additional pay.
<DELETED>``Sec. 7455. Increases in rates of basic pay.
<DELETED>``Sec. 7456. Nurses: special rules for weekend duty.
<DELETED>``Sec. 7456a. Alternate work schedules.
<DELETED>``Sec. 7457. On-call pay.
<DELETED>``Sec. 7458. Recruitment and retention bonus pay.''.
<DELETED>SEC. 5. NURSE EXECUTIVE SPECIAL PAY.</DELETED>
<DELETED> (a) Section 7452 is amended by adding at the end
thereof:</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.''.</DELETED>
<DELETED>SEC. 6. EFFECTIVE DATE.</DELETED>
<DELETED> 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.</DELETED>
<DELETED>SEC. 7. ADMINISTRATIVE PROVISION.</DELETED>
<DELETED> (a) Chapter 74 is amended by adding a new section
7427:</DELETED>
<DELETED>``Sec. 7427. Functions</DELETED>
<DELETED> ``The functions assigned to the Secretary and other
officers of the Department of Veterans Affairs under this chapter are
vested in their discretion.''</DELETED>
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Department of Veterans Affairs
Health Care Personnel Enhancement Act of 2004''.
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. SIMPLIFICATION AND IMPROVEMENT OF GRADE AND PAY PROVISIONS FOR
PHYSICIANS AND DENTISTS.
(a) Simplification of Grades and Grade Requirements.--Section
7404(b) is amended--
(1) by striking ``(1)'' after ``(b)'';
(2) in the Physician and Dentist Schedule, by striking the
items relating to the grades and inserting the following:
``Physician grade.
``Dentist grade.''; and
(3) by striking paragraph (2).
(b) Simplification and Improvement of Pay Authorities.--Subchapter
III of chapter 74 is amended to read as follows:
``SUBCHAPTER III--PAY FOR PHYSICIANS AND DENTISTS
``Sec. 7431. Pay
``(a) Elements of Pay.--Pay of physicians and dentists in the
Veterans Health Administration shall consist of three elements as
follows:
``(1) Base pay as provided for under subsection (b).
``(2) Market pay as provided for under subsection (c).
``(3) Incentive pay as provided for under subsection (d).
``(b) Base Pay.--One element of pay for physicians and dentists
shall be base pay. Base pay shall meet the following requirements:
``(1) Each physician and dentist is entitled to base pay
determined under the Physician and Dentist Base and Longevity
Pay Schedule.
``(2) The Physician and Dentist Base and Longevity Pay
Schedule is composed of 15 rates of base pay designated, from
the lowest rate of pay to the highest rate of pay, as base pay
steps 1 through 15.
``(3) The rate of base pay payable to a physician or
dentist is based on the total number of the years of the
service of the physician or dentist in the Veterans Health
Administration as follows:
``For a physician or dentist The rate of base pay is
with total service of: the rate payable for:
two years or less............................. step 1
more than 2 years and not more than 4 years... step 2
more than 4 years and not more than 6 years... step 3
more than 6 years and not more than 8 years... step 4
more than 8 years and not more than 10 years.. step 5
more than 10 years and not more than 12 years. step 6
more than 12 years and not more than 14 years. step 7
more than 14 years and not more than 16 years. step 8
more than 16 years and not more than 18 years. step 9
more than 18 years and not more than 20 years. step 10
more than 20 years and not more than 22 years. step 11
more than 22 years and not more than 24 years. step 12
more than 24 years and not more than 26 years. step 13
more than 26 years and not more than 28 years. step 14
more than 28 years............................ step 15.
``(4) At the same time as rates of basic pay are increased
for a year under section 5303 of title 5, the Secretary shall
increase each rate of base pay payable under this subsection
for that year by a percentage equal to the percentage by which
rates of basic pay are increased under such section for that
year.
``(c) Market Pay.--One element of pay for physicians and dentists
shall be market pay. Market pay shall meet the following requirements:
``(1) Subject to paragraph (3), each physician and dentist
is eligible for market pay.
``(2) Market pay shall consist of pay intended to reflect
the value to the Veterans Health Administration of the skills,
experience, and availability of a particular physician or
dentist within a particular health care labor market.
``(3) The annual amount of the market pay payable to a
physician or dentist shall be determined by the Secretary on a
case-by-case basis, subject to paragraph (5). The sum of the
total amount of the market pay determined for a physician or
dentist under this subsection and the annual rate of base pay
payable to the physician or dentist under subsection (b) may
not be less than the minimum amount, nor more than the maximum
amount, applicable to the physician or dentist under paragraph
(4).
``(4)(A) Not less often than once every two years, the
Secretary shall prescribe for Departmentwide applicability the
minimum and maximum amounts of annual pay (excluding incentive
pay under subsection (d)) that may be paid under this section
to physicians and the minimum and maximum amounts of annual pay
(excluding incentive pay under subsection (d)) that may be paid
under this section to dentists.
``(B) The Secretary may prescribe for Departmentwide
applicability under this paragraph separate minimum and maximum
amounts of pay for a specialty or subspecialty. If the
Secretary prescribes separate minimum and maximum amounts for a
specialty or subspecialty, the Secretary may establish up to
four tiers of minimum and maximum amounts for such specialty or
subspecialty and prescribe for each tier a minimum amount and a
maximum amount that the Secretary determines appropriate for
the professional responsibilities, professional achievements,
and administrative duties of the physicians or dentists (as the
case may be) whose pay is set within that tier.
``(5)(A) In determining the amount of the market pay for a
physician or dentist and determining a tier (if any) to apply
to a physician or dentist under paragraph (4)(B), the Secretary
shall consult with and consider the recommendations of the
Medical Professional Standards Board for the medical facility
of the Department at which the physician or dentist is
employed, except in the case of a physician or dentist whose
market pay is determined under subparagraph (B).
``(B) In the case of a physician or dentist who is a member
of a Medical Professional Standards Board, the Secretary shall
determine the amount of the market pay and the tier (if any)
applicable to the physician or dentist under paragraph (4)(B) in
accordance with such procedures and standards as the Secretary shall
prescribe. Such procedures and standards shall, to the maximum extent
practicable, be similar to the procedures and standards applicable to
determinations of the amount of market pay and the tier applicable to
physicians and dentists under paragraph (4)(B) who are not members of a
board. Under such regulations, no member of a board may participate in
or have a consultative role in determining the amount of market pay or
tier of such member or any other member of such board.
``(C) A Medical Professional Standards Board consulted
under this subparagraph shall consist of at least three and not
more than five persons, each of whom is either a physician or a
dentist. Not less than a majority of the members of the board
shall be practicing clinicians in their professions.
``(6) Subject to paragraph (7), the determination of the
amount of market pay of a physician or dentist shall take into
account--
``(A) the level of experience of the physician or
dentist in the specialty or subspecialty of the
physician or dentist;
``(B) the need for the specialty or subspecialty of
the physician or dentist at the Department facility
concerned;
``(C) the health care labor market for the
specialty or subspecialty of the physician or dentist,
which may cover any geographic area the Secretary
considers appropriate for the specialty or
subspecialty;
``(D) the professional reputation of the physician
or dentist;
``(E) the board certifications, if any, of the
physician or dentist;
``(F) the prior experience, if any, of the
physician or dentist as an employee of the Veterans
Health Administration; and
``(G) such other considerations as the Secretary
considers appropriate.
``(7) The amount that any consideration specified in
paragraph (6) may contribute to the amount of market pay may
not exceed, or be less than, such amount as the Secretary may
specify in regulations prescribed under section 7433 of this
title, or in directives issued for purposes of this subsection.
``(8) In determining amounts of market pay, the Secretary--
``(A) shall consult two or more national surveys of
pay for physicians or dentists, as applicable, whether
prepared by public, private, or quasi-public entities;
and
``(B) may utilize the recommendations or assistance
of one or more boards of physicians or dentists, as
applicable, that are appointed by the Secretary for
purposes of this subsection.
``(9) The amount of market pay of a physician or dentist
shall be adjusted at such times as the Secretary considers
appropriate in order to ensure the retention of qualified
physicians and dentists by the Veterans Health Administration.
``(10) The amount of market pay of a physician or dentist
shall be evaluated by the Secretary not less often than once
every 24 months. The amount of market pay may be adjusted as
the result of an evaluation under this paragraph. A physician
or dentist whose market pay is increased by reason of an
evaluation under this paragraph shall receive written notice of
the increase in accordance with procedures prescribed under
section 7433 of this title.
``(11) No adjustment of the amount of market pay of a
physician or dentist under paragraph (9) or (10) may result in
a reduction of the amount of market pay of the physician or
dentist.
``(d) Incentive Pay.--One element of pay for physicians and
dentists shall be incentive pay. Incentive pay shall meet the following
requirements:
``(1) Each physician and dentist is eligible for incentive
pay.
``(2) Incentive pay shall consist of an amount intended to
recognize outstanding contributions by a physician or dentist
to--
``(A) the facility in which employed;
``(B) the furnishing of care to veterans; or
``(C) the practice of medicine or dentistry, as
applicable.
``(3) The amount of incentive pay shall be determined for a
physician or dentist by the Secretary.
``(4) The amount of incentive pay shall be determined for a
physician or dentist on a case-by-case basis.
``(5) The amount of incentive pay paid to a physician or
dentist in a calendar year may not exceed $10,000.
``(e) Delegation of Responsibilities.--The Secretary may delegate
to an appropriate officer or employee of the Department any
responsibility of the Secretary under subsection (c) or (d), except for
the responsibilities of the Secretary under subsection (c)(4).
``(f) Limitation on Total Compensation.--In no case may the total
amount of compensation paid to a physician or dentist under this
section in any year exceed the amount of annual compensation (excluding
expenses) specified in section 102 of title 3.
``(g) Treatment of Pay.--(1) Except as provided in paragraph (2),
pay under this subchapter shall be considered pay for all purposes,
including retirement benefits under chapters 83 and 84 of title 5 and
other benefits.
``(2) Incentive pay under subsection (d) shall not be considered
pay for purposes of retirement benefits under chapters 83 and 84 of
title 5.
``(h) Decreases in Certain Pay Not Treatable as Adverse Action.--A
decrease in pay of a physician or dentist resulting from an adjustment
in the amount of incentive pay of the physician or dentist under
subsection (d) shall not be treated as an adverse action.
``Sec. 7432. Pay of Under Secretary for Health
``(a) Base Pay.--The base pay of the Under Secretary for Health
shall be the annual rate of basic pay for positions at Level III of the
Executive Schedule under section 5314 of title 5.
``(b) Market Pay.--(1) In the case of an Under Secretary for Health
who is also a physician or dentist, in addition to the base pay
specified in subsection (a) the Under Secretary for Health may also be
paid the market pay element of pay of physicians and dentists under
section 7431(c) of this title.
``(2) The amount of market pay of the Under Secretary for Health
under this subsection shall be established by the Secretary.
``(3) In establishing the amount of market pay of the Under
Secretary for Health under this subsection, the Secretary shall utilize
an appropriate health care labor market selected by the Secretary for
purposes of this subsection.
``Sec. 7433. Administrative matters
``(a) Regulations.--(1) The Secretary shall prescribe regulations
relating to the pay of physicians and dentists in the Veterans Health
Administration under this subchapter.
``(2) In prescribing the regulations, the Secretary shall take into
account the recommendations of the Under Secretary for Health on the
administration of this subchapter.
``(b) Reports.--(1) Not later than 18 months after the Secretary
prescribes the regulations required by subsection (a), and annually
thereafter for the next 10 years, the Secretary shall submit to the
Committees on Veterans' Affairs of the Senate and House of
Representatives a report on the pay of physicians and dentists in the
Veterans Health Administration under this subchapter.
``(2) Each report under this subsection shall include the
following:
``(A) A description of the rates of pay in effect during
the preceding fiscal year with a comparison to the rates in
effect during the fiscal year preceding fiscal year, set forth
by facility and by specialty.
``(B) The number of physicians and dentists who left the
Veterans Health Administration during the preceding fiscal
year.
``(C) The number of unfilled physician positions 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 an assessment of the
reasons that such positions remain unfilled.
``(D) An assessment of the impact of implementation of this
subchapter on efforts to recruit and retain physicians and
dentists in the Veterans Health Administration.
``(3) The first two annual reports under this subsection shall also
include a comparison of staffing levels, contract expenditures, and
average salaries of physicians and dentists in the Veterans Health
Administration for the fiscal year preceding such report and for the
fiscal year preceding such fiscal year, set forth by facility and by
specialty.''.
(c) Initial Rates of Base Pay for Physicians and Dentists.--The
initial rates of base pay established for the base pay steps under the
Physician and Dentist Base and Longevity Pay Schedule provided in
section 7431(b) of title 38, United States Code (as added by subsection
(b)), are as follows:
Base Pay Step: Rate of Pay:
1............................................. $90,000
2............................................. $93,000
3............................................. $96,000
4............................................. $99,000
5............................................. $102,000
6............................................. $105,000
7............................................. $108,000
8............................................. $111,000
9............................................. $114,000
10............................................ $117,000
11............................................ $120,000
12............................................ $123,000
13............................................ $127,000
14............................................ $130,000
15............................................ $133,000.
(d) Transition Provisions.--
(1) Physicians and dentists.--
(A) Pay.--(i) A physician or dentist in receipt of
pay under section 7404 or 7405 of title 38, United
States Code, as of the day before the date of the
enactment of this Act shall continue to receive pay
under such section (as in effect on the day before the
date of the enactment of this Act) until the effective
date of this Act under section 8 of this Act.
(ii) A physician or dentist appointed or reassigned
on or after the date of the enactment of this Act, but
before the effective date of this Act, shall be
compensated in accordance with applicable provisions of
section 7404 or 7405 of title 38, United States Code
(as in effect on the day before date of the enactment
of this Act), until the effective date of this Act.
(B) Special pay.--(i) A special pay agreement
entered into by a physician or dentist under subchapter
III of chapter 74 of title 38, United States Code,
before the date of the enactment of this Act shall
terminate on the date of the enactment of this Act.
However, a physician or dentist in receipt of special
pay pursuant to such an agreement on that date shall
continue to receive special pay under the terms of such
agreement until the effective date of this Act.
(ii) A physician or dentist described in
subparagraph (A)(ii) may be paid special pay under
applicable provisions of section 7433, 7434, 7435, or
7436 of title 38, United States Code (as in effect on
the day before the date of the enactment of this Act),
during the period beginning on the date appointment or
reassignment of such physician or dentist, as the case
may be, and ending on the effective date of this Act.
However, no special pay agreement shall be required for
the payment of special pay under this clause.
(C) Treatment of special pay.--(i) Special pay paid
under subparagraph (B) shall be subject to the
provisions of paragraphs (1), (2), (4), (5), and (6) of
section 7438(b) of title 38, United States Code (as in
effect on the day before the date of the enactment of
this Act).
(ii) Special pay paid under subparagraph (B) shall
be fully creditable for purposes of computing benefits
under chapters 83 and 84 of title 5, United States
Code.
(D) Preservation of pay.--The amount of pay paid
under subchapter III of chapter 74 of title 38, United
States Code (as amended by subsection (a)), to a
physician or dentist appointed or reassigned before the
effective date of this Act may be not less than the
aggregate amount of pay and special pay paid to the
physician or dentist under chapter 74 of title
38, United States Code (as in effect on the day before the date of the
enactment of this Act), as of the day before the effective date of this
Act.
(2) Under secretary for health.--
(A) Special pay.--(i) The current special pay
agreement entered into by the Under Secretary for
Health under subchapter III of chapter 74 of title 38,
United States Code, before the date of the enactment of
this Act shall terminate on the date of the enactment
of this Act. However, the Under Secretary shall
continue to receive special pay under the terms of such
agreement until the effective date of this Act.
(ii) An individual appointed as Under Secretary for
Health on or after the date of the enactment of this
Act and before the effective date of this Act shall be
paid special pay in accordance with the provisions of
section 7432(d)(2), 7433, and 7437(a) of title 38,
United States Code (as in effect on the day before the
date of the enactment of this Act), during the period
beginning on the date of appointment and ending on the
effective date of this Act. However, no special pay
agreement shall be required for the payment of special
pay under this clause.
(B) Treatment of special pay.--Special pay paid
under subparagraph (A) shall be fully creditable for
purposes of computing benefits under chapters 83 and 84
of title 5, United States Code.
(e) Conforming Amendment.--Section 7404(c) is amended by striking
``special pay'' and inserting ``pay''.
(f) Clerical Amendment.--The table of sections at the beginning of
chapter 74 is amended by striking the items relating to subchapter III
and inserting the following new items:
``SUBCHAPTER III--PAY FOR PHYSICIANS AND
DENTISTS
``Sec. 7431. Pay.
``Sec. 7432. Pay of Under Secretary for Health.
``Sec. 7433. Administrative matters.''.
SEC. 4. ALTERNATE WORK SCHEDULES FOR REGISTERED NURSES.
(a) In General.--(1) Chapter 74 is amended by inserting after
section 7456 the following new section:
``Sec. 7456A. Nurses: alternate work schedules
``(a) Applicability.--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 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 a nurse covered by this
paragraph 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) A nurse covered by this paragraph is entitled to overtime
pay for work performed in such periods as the Secretary shall
prescribe.
``(ii) Except as otherwise provided in clause (i), a nurse covered
by this paragraph 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 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 every nine hours of absence.
``(4) A nurse working a work schedule under this subsection shall
be eligible for holiday pay under section 7453(d) of this title for any
service performed by the nurse on a designated holiday under such
section, regardless of whether such holiday occurs during or outside
the nurse's regularly scheduled tour of duty under such work schedule.
``(c) 9-Month Work Schedule for Certain Nurses.--(1) The Secretary
may authorize a registered nurse appointed under section 7405 of this
title, with the nurse's written consent, to work fulltime for nine
months with 3 months off duty, within a fiscal year, and be paid at 75
percent of the fulltime rate for such nurse's grade for each pay period
of such fiscal year.
``(2) A nurse who works under the authority in paragraph (1) shall
be considered a 0.75 fulltime equivalent employee in computing fulltime
equivalent employees for the purposes of determining compliance with
personnel ceilings.
``(3) Work under this subsection shall be considered parttime
service for purposes of computing benefits under chapters 83 and 84 of
title 5.
``(4) A nurse who works under the authority in paragraph (1) shall
be considered a fulltime employee for purposes of chapter 89 of title
5.
``(d) Treatment as Full-Time Employee.--(1) A nurse working a work
schedule under subsection (b) or (c) who is a full-time employee in
non-probationary status at the commencement of work under such work
schedule shall remain a full-time employee in non-probationary status
while working under such work schedule.
``(2)(A) A nurse under a part-time appointment under section
7405(d) of this title who, while working a work schedule under
subsection (b) or (c), performs hours of service (as determined in
accordance with such subsection) equivalent to two years of service
shall be treated as a full-time employee and no longer in probationary
status.
``(B) In determining the hours of service performed by a nurse for
purposes of subparagraph (A), any hours of service not performed under
a work schedule under subsection (b) or (c) shall not be included.
``(e) Notification of Modification of Benefits.--The Secretary
shall provide each nurse with respect to whom an alternate work
schedule under this section may apply written notice of the effect, if
any, the alternate work schedule will have on the nurse's health care
premium, retirement, life insurance premium, probationary status,
or other benefit or condition of employment. The notice shall be
provided not later than 14 days before the nurse consents to the
alternate work schedule.
``(f) Regulations.--The Secretary shall prescribe regulations to
carry out this section.''.
(2) The table of sections at the beginning of chapter 74 is amended
by inserting after the item relating to section 7456 the following new
item:
``Sec. 7456A. Nurses: alternate work schedules.''.
(b) Policy Against Work Shifts in Excess of 12 Hours.--(1) It is
the sense of Congress to encourage the Secretary of Veterans Affairs to
prevent work shifts by nurses providing direct patient care in excess
of 12 hours in any 24 hour period.
(2) Not later than one year after the date of the enactment of this
Act and every year thereafter for the next two years, the Secretary
shall certify to Congress whether or not each Veterans Health
Administration facility has in place, as of the date of such
certification, a policy designed to prevent work shifts by nurses
providing direct patient care in excess of 12 hours in any 24 hour
period.
(c) Report on Overtime for Certain Nurses.--(1) Not later than one
year after the effective date of this Act, the Secretary of Veterans
Affairs shall submit to Congress a report on the overtime, if any,
worked by nurses covered by work schedules described by subsections (b)
and (c) of section 7456A of title 38, United States Code (as added by
subsection (a)), during the one-year period ending on the date of such
report.
(2) The report shall set forth--
(A) the aggregate number of hours of overtime worked by
nurses under each such work schedule during the one-year period
ending on the date of the report; and
(B) the aggregate amount of overtime pay paid to nurses
working under each such work schedule during such period.
SEC. 5. RATE OF PAY FOR DIRECTOR OF NURSING SERVICE.
(a) Senior Executive Service ES-6 Rate.--(1) Subchapter IV of
chapter 74 is amended by adding at the end the following new section:
``Sec. 7459. Director of Nursing Service: rate of pay
``(a) Senior Executive Service ES-6 Rate.--The rate of pay for the
Director of Nursing Service shall be equal to the sum of the maximum
rate of basic pay established for the Senior Executive Service under
section 5382 of title 5 and the amount of the locality-based
comparability payment provided under section 5304 of such title for the
Director's locality.
``(b) Inapplicability of Nurse Pay Provision.--Section 7451 of this
title does not apply to the Director of Nursing Service.''.
(2) The table of sections at the beginning of chapter 74 is amended
by inserting after the item relating to section 7458 the following new
item:
``Sec. 7459. Director of Nursing Service: rate of pay.''.
(b) Conforming Amendment.--Section 7404(d) is amended by striking
``section 7457'' and inserting ``sections 7457 and 7459''.
SEC. 6. NURSE EXECUTIVE SPECIAL PAY.
Section 7452 is amended by adding at the end the following new
subsection:
``(g)(1) In order to recruit and retain highly qualified Department
nurse executives, the Secretary may, in accordance with regulations
prescribed by the Secretary, pay special pay to the nurse executive at
each location as follows:
``(A) Each Department healthcare facility.
``(B) The Central Office.
``(2) The amount of special pay paid to a nurse executive under
paragraph (1) shall be not less than $10,000 or more than $25,000.
``(3) The amount of special pay paid to a nurse executive under
paragraph (1) shall be based on factors such as the grade of the nurse
executive position, the scope and complexity of the nurse executive
position, the personal qualifications of the nurse executive, the
characteristics of the healthcare facility concerned, the nature and
number of specialty care units at the healthcare facility concerned,
demonstrated difficulties in recruitment and retention of nurse
executives at the healthcare facility concerned, and such other factors
as the Secretary considers appropriate.
``(4) Special pay paid to a nurse executive 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 retirement benefits under
chapters 83 and 84 of title 5, and other benefits, but shall not be
considered basic pay for purposes of adverse actions under subchapter
V.''.
SEC. 7. CLARIFICATION OF DISCRETIONARY NATURE OF VETERANS HEALTH
ADMINISTRATION PERSONNEL ADMINISTRATION AUTHORITIES.
(a) In General.--Chapter 74 is amended by inserting after section
7426 the following new section:
``Sec. 7427. Discretionary nature of functions
``Any authority assigned to the Secretary or another officer of the
Department under this chapter shall be carried out at the discretion of
the Secretary or other officer, as the case may be.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 74 is amended by inserting after the item relating to section
7426 the following new item:
``7427. Discretionary nature of functions.''.
SEC. 8. EFFECTIVE DATE.
The amendments to title 38, United States Code, made by this Act
shall take effect one year after the date of the enactment of this Act.
Amend the title so as to read: ``An Act to amend title 38,
United States Code, to simplify and improve pay provisions for
physicians and dentists and to authorize alternate work
schedules and executive pay for nurses, and for other
purposes.''.
Calendar No. 713
108th CONGRESS
2d Session
S. 2484
[Report No. 108-357]
_______________________________________________________________________
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.
_______________________________________________________________________
September 23, 2004
Reported with an amendment and an amendment to the title