[Congressional Record Volume 150, Number 132 (Wednesday, November 17, 2004)]
[House]
[Pages H9787-H9793]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE PERSONNEL ENHANCEMENT ACT OF 
                                  2004

  Mr. SIMMONS. Mr. Speaker, I move to suspend the rules and pass the 
Senate bill (S. 2484) 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.
  The Clerk read as follows:

                                S. 2484

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

[[Page H9788]]

     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.--(1) 
     Subsection (b) of section 7404 is amended--
       (A) by striking ``(1)'' after ``(b)'';
       (B) in the Physician and Dentist Schedule, by striking the 
     items relating to the grades and inserting the following:
       ``Physician grade.
       ``Dentist grade.''; and
       (C) by striking paragraph (2).
       (2) Subsection (a) of such section is amended by adding at 
     the end the following: ``The pay of physicians and dentists 
     serving in positions to which an Executive order applies 
     under the preceding sentence shall be determined under 
     subchapter III of this chapter instead of such Executive 
     order.''.
       (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) Performance pay as provided 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 dentiThe rate of base pay is 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 the amount 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) Each physician and dentist is eligible for market 
     pay.
       ``(2) Market pay shall consist of pay intended to reflect 
     the recruitment and retention needs for the specialty or 
     assignment (as defined by the Secretary) of a particular 
     physician or dentist in a facility of the Department of 
     Veterans Affairs.
       ``(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.
       ``(4)(A) In determining the amount of market pay for 
     physicians or dentists, the Secretary shall consult two or 
     more national surveys of pay for physicians or dentists, as 
     applicable, whether prepared by private, public, or quasi-
     public entities in order to make a general assessment of the 
     range of pays payable to physicians or dentists, as 
     applicable.
       ``(B)(i) In determining the amount of the market pay for a 
     particular physician or dentist under this subsection, and in 
     determining a tier (if any) to apply to a physician or 
     dentist under subsection (e)(1)(B), the Secretary shall 
     consult with and consider the recommendations of an 
     appropriate panel or board composed of physicians or dentists 
     (as applicable).
       ``(ii) A physician or dentist may not be a member of the 
     panel or board that makes recommendations under clause (i) 
     with respect to the market pay of such physician or dentist, 
     as the case may be.
       ``(iii) The Secretary should, to the extent practicable, 
     ensure that a panel or board consulted under this 
     subparagraph includes physicians or dentists (as applicable) 
     who are practicing clinicians and who do not hold management 
     positions in the medical facility of the Department at which 
     the physician or dentist subject to the consultation is 
     employed.
       ``(5) 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 assignment of the physician or dentist;
       ``(B) the need for the specialty or assignment of the 
     physician or dentist at the medical facility of the 
     Department concerned;
       ``(C) the health care labor market for the specialty or 
     assignment of the physician or dentist, which may cover any 
     geographic area the Secretary considers appropriate for the 
     specialty or assignment;
       ``(D) the board certifications, if any, of the physician or 
     dentist;
       ``(E) the prior experience, if any, of the physician or 
     dentist as an employee of the Veterans Health Administration; 
     and
       ``(F) such other considerations as the Secretary considers 
     appropriate.
       ``(6) 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 evaluated under this paragraph 
     shall receive written notice of the results of such 
     evaluation in accordance with procedures prescribed under 
     section 7433 of this title.
       ``(7) No adjustment of the amount of market pay of a 
     physician or dentist under paragraph (6) may result in a 
     reduction of the amount of market pay of the physician or 
     dentist while in the same position or assignment at the 
     medical facility of the Department concerned.
       ``(d) Performance Pay.--(1) One element of pay for 
     physicians and dentists shall be performance pay.
       ``(2) Performance pay shall be paid to a physician or 
     dentist on the basis of the physician's or dentist's 
     achievement of specific goals and performance objectives 
     prescribed by the Secretary.
       ``(3) The Secretary shall ensure that each physician and 
     dentist of the Department is advised of the specific goals or 
     objectives that are to be measured by the Secretary in 
     determining the eligibility of that physician or dentist for 
     performance pay.
       ``(4) The amount of the performance pay payable to a 
     physician or dentist may vary annually on the basis of 
     individual achievement or attainment of the goals or 
     objectives applicable to the physician or dentist under 
     paragraph (2).
       ``(5) The amount of performance pay payable to a physician 
     or dentist in a fiscal year shall be determined in accordance 
     with regulations prescribed by the Secretary, but may not 
     exceed the lower of--
       ``(A) $15,000; or
       ``(B) the amount equal to 7.5 percent of the sum of the 
     base pay and the market pay payable to such physician or 
     dentist in that fiscal year.
       ``(6) A failure to meet goals or objectives applicable to a 
     physician or dentist under paragraph (2) may not be the sole 
     basis for an adverse personnel action against that physician 
     or dentist.
       ``(e) Requirements and Limitations on Total Pay.--(1)(A) 
     Not less often than once every two years, the Secretary shall 
     prescribe for Department-wide applicability the minimum and 
     maximum amounts of annual pay that may be paid under this 
     section to physicians and the minimum and maximum amounts of 
     annual pay that may be paid under this section to dentists.
       ``(B) The Secretary may prescribe for Department-wide 
     applicability under this paragraph separate minimum and 
     maximum amounts of pay for a specialty or assignment. If the 
     Secretary prescribes separate minimum and maximum amounts for 
     a specialty or assignment, the Secretary may establish up to 
     four tiers of minimum and maximum amounts for such specialty 
     or assignment 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.
       ``(C) Amounts prescribed under this paragraph shall be 
     published in the Federal Register, and shall not take effect 
     until at least 60 days after the date of publication.
       ``(2) Except as provided in paragraph (3) and subject to 
     paragraph (4), the sum of the

[[Page H9789]]

     total amount of the annual rate of base pay payable to a 
     physician or dentist under subsection (b) and the market pay 
     determined for the physician or dentist under subsection (c) 
     may not be less than the minimum amount, nor more than the 
     maximum amount, applicable to specialty or assignment of the 
     physician or dentist under paragraph (1).
       ``(3) The sum of the total amount of the annual rate of 
     base pay payable to a physician or dentist under subsection 
     (b) and the market pay determined for the physician or 
     dentist under subsection (c) may exceed the maximum amount 
     applicable to the specialty or assignment of the physician or 
     dentist under paragraph (1) as a result of an adjustment 
     under paragraph (3) or (4) of subsection (b).
       ``(4) In no case may the total amount of compensation paid 
     to a physician or dentist under this title in any year exceed 
     the amount of annual compensation (excluding expenses) 
     specified in section 102 of title 3.
       ``(f) Treatment of Pay.--Pay under subsections (b) and (c) 
     of this section shall be considered pay for all purposes, 
     including retirement benefits under chapters 83 and 84 of 
     title 5 and other benefits.
       ``(g) Ancillary Effects of Decreases in Pay.--(1) A 
     decrease in pay of a physician or dentist resulting from an 
     adjustment in the amount of market pay of the physician or 
     dentist under subsection (c) shall not be treated as an 
     adverse action.
       ``(2) If the pay of a physician or dentist is reduced under 
     this subchapter as a result of an involuntary reassignment in 
     connection with a disciplinary action taken against the 
     physician or dentist, the involuntary reassignment shall be 
     subject to appeal under subchapter V of this chapter.
       ``(h) Delegation of Responsibilities.--The Secretary may 
     delegate to an appropriate officer or employee of the 
     Department any responsibility of the Secretary under 
     subsection (c), (d), or (e) except for the responsibilities 
     of the Secretary under subsection (e)(1).

     ``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.
       ``(c) Treatment of Pay.--Pay under this section shall be 
     considered pay for all purposes, including retirement 
     benefits under chapters 83 and 84 of title 5 and other 
     benefits.

     ``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. In 
     formulating recommendations for the purpose of this 
     paragraph, the Under Secretary shall request the views of 
     representatives of labor organizations that are exclusive 
     representatives of physicians and dentists of the Department 
     and the views of representatives of professional 
     organizations of physicians and dentists of the Department.
       ``(b) Reports.--(1) Not later than 18 months after the 
     Secretary prescribes the regulations required by subsection 
     (a), and annually thereafter for the next 5 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 current fiscal year with a comparison to the rates in 
     effect during the fiscal year preceding the current 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 current fiscal 
     year and for the fiscal year preceding the current 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.............................................................$126,000
14.............................................................$129,000
15.............................................................$132,000

       (d) Effective Date.--(1) Notwithstanding the 60-day waiting 
     requirement in section 7431(e)(1)(C) of title 38, United 
     States Code (as amended by subsection (b)), pay provided for 
     a physician or dentist under subchapter III of chapter 74 of 
     such title, as amended by subsection (b), shall take effect 
     on the first day of the first pay period applicable to such 
     physician or dentist that begins on or after January 1, 2006.
       (2) Pay provided for the Under Secretary for Health under 
     subchapter III of chapter 74 of title 38, United States Code, 
     as amended by this section shall take effect on the first day 
     of the first pay period applicable to the Under Secretary 
     that begins on or after January 1, 2006.
       (e) Transition Provisions.--
       (1) Physicians and dentists.--
       (A) Pay.--(i) The amount of the pay payable on and after 
     the date of the enactment of this Act to a physician or 
     dentist in receipt of pay under section 7404 or 7405 of title 
     38, United States Code, as of the day before such date shall 
     continue to be determined under such section (as in effect on 
     the day before such date) until the effective date that is 
     applicable under subsection (d) to such physician or dentist, 
     as the case may be.
       (ii) A physician or dentist appointed or reassigned on or 
     after the date of the enactment of this Act, but before the 
     effective date applicable under subsection (d) to such 
     physician or dentist, 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 such effective date.
       (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 that is applicable 
     under subsection (d) to such physician or dentist.
       (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 of the appointment or reassignment of such physician or 
     dentist, as the case may be, and ending on the effective date 
     applicable under subsection (d) to such physician or dentist. 
     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) to a physician or dentist during the period 
     beginning on the date of the enactment of this Act and ending 
     on the effective date applicable under subsection (d) to such 
     physician or dentist 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 to a physician or dentist under 
     section 7438 of title 38, United States Code (as in effect on 
     the day before the date of the enactment of this Act), 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 to a 
     physician or dentist after the effective date of this Act 
     shall not be less than the amount of pay paid to such 
     physician or dentist on the day before the effective date of 
     this Act while such physician or dentist remains in the same 
     position or assignment.
       (2) Under secretary for health.--
       (A) Special pay.--(i) The current special pay agreement 
     entered into by the Under Secretary for Health under 
     subchapters I and 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 that is applicable under subsection (d) to the 
     Under Secretary.
       (ii) An individual appointed as Under Secretary for Health 
     on or after the date of the

[[Page H9790]]

     enactment of this Act and before the effective date 
     applicable under subsection (d) to the Under Secretary shall 
     be paid special pay in accordance with the provisions of 
     sections 7432(d)(2) and 7433 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 such effective date. 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) during the period beginning on the date of 
     the enactment of this Act and ending on the effective date 
     applicable under subsection (d) to the Under Secretary--
       (i) 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); and
       (ii) shall be fully creditable for purposes of computing 
     benefits under chapters 83 and 84 of title 5, United States 
     Code.
       (f) Conforming Amendments.--Section 7404 is amended--
       (1) in subsection (c), by striking ``special pay'' and 
     inserting ``pay''; and
       (2) in subsection (d), by striking ``pay may not be paid'' 
     and all that follows and inserting ``pay for positions for 
     which basic pay is paid under this section may not be paid at 
     a rate in excess of the rate of basic pay authorized by 
     section 5316 of title 5 for positions in Level V of the 
     Executive Schedule.''.
       (g) 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)(A) Subject to paragraph 
     (2), if the Secretary determines it to 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 work week shall be considered for all purposes 
     to have worked a full 40-hour basic work week.
       ``(B) A nurse who works under the authority in subparagraph 
     (A) shall be considered a 0.90 full-time equivalent employee 
     in computing full-time equivalent employees for the purposes 
     of determining compliance with personnel ceilings.
       ``(2)(A) Basic and additional pay for a nurse who is 
     considered under paragraph (1) to have worked a full 40-hour 
     basic work week 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 work week shall be 
     derived by dividing the nurse's annual rate of basic pay by 
     1,872.
       ``(C) The Secretary shall pay overtime pay to a nurse 
     covered by this paragraph who--
       ``(i) performs a period of service in excess of such 
     nurse's regularly scheduled 36-hour tour of duty within an 
     administrative work week;
       ``(ii) for officially ordered or approved service, performs 
     a period of service in excess of 8 hours on a day other than 
     a day on which such nurse's regularly scheduled 12-hour tour 
     of duty falls;
       ``(iii) performs a period of service in excess of 12 hours 
     for any day included in the regularly scheduled 36-hour tour 
     of duty work week; or
       ``(iv) performs a period of service in excess of 40 hours 
     during an administrative work week.
       ``(D) The Secretary may provide a nurse to whom this 
     subsection applies with additional pay under section 7453 of 
     this title 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.
       ``(c) Holiday Pay.--A nurse working a work schedule under 
     subsection (b) that includes a holiday designated by law or 
     Executive order shall be eligible for holiday pay under 
     section 7453(d) of this title for any service performed by 
     the nurse on such holiday under such section.
       ``(d) 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 full time for nine months with 3 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.
       ``(2) A nurse who works under the authority in paragraph 
     (1) shall be considered a 0.75 full-time equivalent employee 
     in computing full-time equivalent employees for the purposes 
     of determining compliance with personnel ceilings.
       ``(3) Work under this subsection shall be considered part-
     time 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 full-time employee for purposes of 
     chapter 89 of title 5.
       ``(e) Notification of Modification of Benefits.--The 
     Secretary shall provide each employee with respect to whom an 
     alternate work schedule under this section may apply written 
     notice of the effect, if any, that the alternate work 
     schedule will have on the employee'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 employee 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 Certain Work Hours.--(1) It is the sense 
     of Congress to encourage the Secretary of Veterans Affairs to 
     prevent work hours by nurses providing direct patient care in 
     excess of 12 consecutive hours or in excess of 60 hours in 
     any 7-day period, except in the case of nurses providing 
     emergency care.
       (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 hours by nurses providing direct patient care (other 
     than nurses providing emergency care) in excess of 12 
     consecutive hours or in excess of 60 hours in any 7-day 
     period.

     SEC. 5. 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 health care 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 health care facility concerned, the nature and number of 
     specialty care units at the health care facility concerned, 
     demonstrated difficulties in recruitment and retention of 
     nurse executives at the health care 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 of this 
     chapter.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Connecticut (Mr. Simmons) and the gentleman from Texas (Mr. Rodriguez) 
each will control 20 minutes.
  The Chair recognizes the gentleman from Connecticut (Mr. Simmons).
  Mr. SIMMONS. Mr. Speaker, I yield myself such time as I may consume.
  (Mr. SIMMONS asked and was given permission to revise and extend his 
remarks.)
  Mr. SIMMONS. Mr. Speaker, today the House considers S. 2484, the 
Department of Veterans Affairs Personnel Enhancement Act of 2004. This 
legislation is designed to improve VA's ability to recruit and retain 
physicians and nurses. The bill represents a compromise agreement 
between the two bodies and is supported by the administration.
  The Department of Veterans Affairs has almost 1,000 vacancies for 
full-time physicians, particularly specialists. Inadequate salaries are 
one of the biggest obstacles to filling these physician vacancies. 
Because VA is not able to hire the physician it needs, it will spend 
over a billion dollars this year for non-VA physicians to care for 
veterans under contractual agreements.
  Thirteen years have passed since Congress last made changes to the VA

[[Page H9791]]

physician and dentist compensation system. Last year, VA submitted a 
legislative proposal to allow VA to be more competitive in physician 
recruitment. After receiving that proposal, we worked with our Senate 
counterparts, the VA and interested organizations to craft the 
compromise legislation before the House today.
  The largest component of physician compensation for most physicians 
would be fixed in statute and adjusted annually. A second component, 
market pay, would be determined through an open three-step process. 
VA's Under Secretary for Health in formulating recommendations on pay 
to the Secretary would solicit the views of concerned employee 
representatives and professional organizations. The Secretary would 
then provide notice in the Federal Register with a 60-day waiting 
period before adjustments to pay bans would be finalized.
  Further, the compromise agreement would require VA to provide each 
physician and dentist written notice of any decisions made by the VA 
concerning their pay.
  This compromise agreement would also provide a third component of 
compensation that addresses the issue of performance pay for physicians 
and dentists. Any award of performance pay would be made on the basis 
of an individual physician's or dentist's achievement of specific goals 
agreed upon in advance. This provision is very important because it 
would ensure that performance payments serve as incentives for good 
performance rather than as penalties for lack of performance.
  The compromise we are considering today is supported by the VA 
employee representatives and professional organizations and is a very 
much needed change that should enhance health care for our veterans. 
The compromise agreement also includes provisions that would ensure 
proper retirement credits to physicians and dentists during the 
transition from the current pay system to the new system. It provides a 
total VA compensation paid to a physician or dentist in a given year 
would not exceed the salary of the President, and the compromise 
agreement would also make the new compensation system effective the 
first pay period following January 1, 2006.
  Our compromise agreement includes several provisions from H.R. 4231, 
which was a bill I introduced earlier this year, to authorize 
alternative tours of duty for VA registered nurses. This bill passed 
the House on September 30, 2004, and the provisions are intended to 
make VA's scheduling of nurse duty hours more flexible and more family-
friendly while enabling VA nurses to pursue their careers in VA health 
care.
  Mr. Speaker, this is a good bill that ought to pass.
  Mr. Speaker, I reserve the balance of my time.
  Mr. RODRIGUEZ. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I rise in support of S. 2484, the Department of Veterans 
Affairs Health Care Personnel Enhancement Act of 2004. I am pleased 
that this bill is the result of the collaboration of the House and 
Senate Committee on Veterans' Affairs' staff working with the 
representatives from the VA, the National Association of VA Physicians 
and Dentists, and the American Federation of Government Employees.
  This legislation has been a long time coming and provides much needed 
updated improvements in how the VA physicians and dentists are 
compensated. The VA's current system of pay for physicians and dentists 
has not been modified since 1991 and has not kept up with the 
compensation for doctors in the private and academic sectors. According 
to the testimony from the VA in June of this year, the effects of the 
noncompetitive pay and benefits are reflected in the dramatic increases 
in the VA's reliance on expensive, scarce medical specialist contracts 
and fee-based care.
  This bill establishes two components that make up the physician's 
total salary and also incorporates additional performance pay.

                              {time}  1530

  Under this new system, base pay for doctors is comprised of 15 steps.
  Physicians automatically move up one step every 2 years, so a 
doctor's base pay is based on the number of years he or she has worked 
in the VA health care system. Step increases in base pay are another 
way of rewarding the VA doctors for their long-term commitment to 
caring for our veterans.
  The second component of this particular bill is market pay as set by 
the Secretary of Veterans Affairs and will be determined according to 
geographic areas, specialty or assignment, board certifications, and 
experience.
  The VA will rely on national surveys to establish market pay 
comparable bands, which are then to be published in the Federal 
Register. Market pay helps the VA achieve comparability with the 
private sector.
  Performance pay makes up the final tier of this new system and is a 
result of the VA physicians' annual performance reviews measuring 
achievement as well as attainment of VA ``corporate'' goals. This 
bipartisan bill also contains special pay for the VA nurse executives, 
a bonus of between $10,000 and $25,000, which is based on several 
descriptive factors.
  This will also help further the VA's ability to recruit and retain 
highly qualified nurse executives and adds incentive for those nurses 
to move into managerial positions within the VA health care system.
  Since one of the major causes of dissatisfaction in the nursing 
workforce is inflexible work schedules, a more flexible work schedule 
for VA nurses is also provided in this piece of legislation.
  This new system of pay for VA physicians and dentists and the 
provisions for the nurses greatly improves the VA's ability not only to 
recruit, but also to retain top-quality doctors and nurses to care for 
our veterans.
  I ask my colleagues to join me in supporting this piece of 
legislation.
  I also want to take this opportunity to thank the gentleman from 
Connecticut (Mr. Simmons) for his leadership in this area and also 
personally thank him for his kind words. It has been rewarding working 
with him on this particular piece of legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. SIMMONS. Mr. Speaker, I yield such time as he may wish to consume 
to the gentleman from New Jersey (Mr. Smith), my friend and colleague 
and the distinguished chairman of the Committee on Veterans' Affairs.
  Mr. SMITH of New Jersey. Mr. Speaker, I thank the gentleman for 
yielding me this time.
  Mr. Speaker, after 22 years on the House Committee on Veterans' 
Affairs, Pat Ryan, our chief counsel and staff director, is retiring 
from government service. I want to take this opportunity to pay tribute 
to his extraordinary career and his many, many accomplishments.
  For over 2 decades, Pat Ryan has made tremendous contributions to 
many of the most important new veterans laws that have been approved by 
Congress. He worked on numerous bills to expand services for aging 
veterans and those in need of long-term health care.
  He was instrumental in helping to establish domiciliaries for 
homeless veterans and was the principal drafter of legislation to 
authorize VA's transitional housing guarantee program to benefit 
homeless veterans. Pat played an essential role in helping to establish 
the Department of Veterans Affairs and in creating the Court of Appeals 
for Veterans Claims.
  Pat has been deeply involved in numerous successful committee 
initiatives that expanded and strengthened programs to assist surviving 
spouses and children of servicemembers killed in action or who later 
died of service-related causes. Over the past 20 years, Pat has helped 
to increase the Montgomery GI Bill benefit for qualified veterans from 
$300 per month when he joined the committee to over $1,000 per month 
today.
  Using his budget expertise gained from 10 years working for the VA 
early in his career, Pat has been an extraordinarily valuable person in 
helping the Congress to ensure that the VA's budget has been both 
appropriate and responsive and that all funds are well spent. His 
extensive knowledge of the law and the inner workings of the VA greatly 
aided our committee in its work to create exemplary oversight of 
veterans programs.
  From managing the committee's professional staff, to drafting 
legislation, to overseeing VA's programs and services, Patrick Ryan is 
the consummate

[[Page H9792]]

professional. I consider him to be a great friend and a great partner 
in all that this committee has accomplished during our time together, 
and it has been an honor to work side by side with him.
  On a personal level, Pat Ryan has lived his life in a way that has 
truly made a difference and has walked to the beat of our Lord's 
drummer when He said whatever you do to the least of my brethren, you 
do likewise to me. For Pat, that means always looking out for the 
little guy. I have such respect and admiration for that character 
trait, and it is very strong in Patrick Ryan. What motivates him more 
than anything else, and it is first and foremost in his life, is his 
love for his wife, Kathy, and their three children: Kerry, Dan, and 
Julia. For Pat Ryan, family always comes first.
  Pat is ever proud of his father who has passed, William Everest Ryan, 
who was a proud Marine and who saw combat during World War II in the 
South Pacific where he was wounded and won the Purple Heart award. He 
later joined the Justice Department while continuing in the Marine 
reserves as an officer in the JAG, retiring with the rank of colonel in 
1964. Pat Ryan has spent his entire career in Congress, defending the 
same values his father defended on the battlefield and in the 
courtroom.
  Mr. Speaker, on behalf of his colleagues in the House and members of 
the Committee on Veterans' Affairs who know and admire him so much, and 
other Members who have known and worked with him, and on behalf of 
millions of veterans who have benefited from his work, but have never 
known his name, I want to thank Pat Ryan for a distinguished career of 
faithful public service. It has been an honor to work with him.
  Mr. RODRIGUEZ. Mr. Speaker, I yield 2 minutes to the gentleman from 
Illinois (Mr. Evans), our ranking member.
  Mr. EVANS. Mr. Speaker, I rise in support of S. 2484, the Department 
of Veterans Affairs Health Care Personnel Enhancement Act of 2004.
  There are now over 14,000 physicians and dentists who work in the VA 
health care system. Unfortunately, the pay system that the VA uses to 
pay our doctors has not been updated since 1991, and it is not helping 
the VA's efforts to recruit and retain high-quality providers for our 
veterans.
  The current system is very complex and does not offer the flexibility 
needed to respond to the changes of competitive markets, especially for 
the highest paid subspecialties.
  This legislation offers the VA the opportunity to award its 
physicians and dentists for tenure within the VA health care system, 
and even adds a performance pay section which acts as a bonus for those 
doctors who achieved specific goals and performance objectives outlined 
by the Secretary of Veterans Affairs.
  Thanks to the efforts of the Senate and House Committee on Veterans' 
Affairs, we will have legislation that will greatly enhance the VA's 
ability to recruit and retain high-quality physicians and dentists.
  I support this legislation, and I ask my colleagues to do the same.
  Mr. SIMMONS. Mr. Speaker, I yield myself such time as I may consume.
  I want to thank Chairman Specter and Ranking Member Graham of the 
Senate Committee on Veterans' Affairs for their diligence on this 
important piece of legislation. Again, I thank our very distinguished 
chairman, the gentleman from New Jersey (Mr. Smith); our committee 
ranking member, the gentleman from Illinois (Mr. Evans); and my 
colleague and ranking member on the Subcommittee on Health Care, the 
gentleman from Texas (Mr. Rodriguez), for all of their hard work on 
bringing this legislation to fruition.
  I would also like to recognize the Senate Committee on Veterans' 
Affairs Staff Director Bill Tuerk and Bill Cahill, health counsel to 
the Senate committee, without whose hard work this compromise simply 
would not have been possible. Finally, I want to acknowledge the 
excellent staff work conducted by our own committee staff, Pat Ryan, 
our committee chief counsel; staff director Kingston Smith, Jeannie 
McNally, John Bradley, and Dolores Dunn of the committee staff.
  Finally, I would like to associate myself with the remarks made by 
the chairman on Pat Ryan. I had the honor a number of years ago to 
serve as staff director of a committee, regrettably on the Senate side; 
but what I learned from those 4 years was how difficult it is sometimes 
to accommodate the differing views of Members, all of whom argue in 
good faith for their points of view; and observing Pat over the 4 years 
that I have served on this committee, I think he has done an excellent 
job. He has been very professional. He has kept his cool under some 
difficult circumstances. I wish him all the best in his future 
endeavors.
  Again, Mr. Speaker, I urge my colleagues to support this reform.
  Mr. RODRIGUEZ. Mr. Speaker, I yield myself such time as I may 
consume.
  Let me take this opportunity also just to thank the gentleman from 
New Jersey (Chairman Smith) for his leadership and the bipartisan 
manner in which we have conducted this piece of legislation and during 
the last 8 years. I want to personally thank the gentleman from New 
Jersey (Chairman Smith) for his hard work and for reaching out on 
behalf of all veterans in this country. I also wanted to take this 
opportunity to thank the gentleman from Connecticut (Mr. Simmons), whom 
I have enjoyed working with, and I want to personally thank him also 
for all his hard work and for coming down to San Antonio also.
  In the same light, I also want to thank Pat Ryan. I know that a lot 
of times the Members get all the credit and the staff does all the 
work. And I do want to thank the staff from both sides of the aisle and 
thank them for their hard work in a bipartisan manner.
  Mr. Speaker, I also want to take this opportunity to thank our 
ranking member, the gentleman from Illinois (Mr. Evans). From the very 
beginning when I first got elected, he came forth to my district in San 
Antonio and was there with my veterans, one of the first times; and he 
has helped to educate me on a lot of the issues in my district. So I 
want to personally thank the gentleman from Illinois (Mr. Evans) for 
the opportunity of working with him, and thank him, as well as all the 
other veterans here for their service to our country.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I rise today as a strong 
supporter of S. 2484 the Department of Veterans Affairs Health Care 
Personnel Enhancement Act of 2004 which received unanimous approval in 
the Senate and is now before this body for passage. The Veterans 
Affairs Health Care Personnel Enhancement Act would set forth important 
new pay provisions for physicians and dentists employed by the Veterans 
Health Administration.
  These physicians and dentists represent the lifeblood of the services 
provided by the Veterans Health Administration. There are over 
26,550,000 veterans in the United States, the great majority of whom 
rely upon these services to maintain a healthy standard of living. In 
the 18th Congressional District alone there are more than 38,000 
veterans and they make up almost ten percent of the district's civilian 
population over the age of 18. These veterans rely upon the great 
services offered at the Michael E. DeBakey VA Medical Center in 
Houston. Of course any great medical facility is only as good as its 
health care personnel, which is why this legislation is so necessary to 
correct any pay inequities.
  The Veterans Affairs Health Care Personnel Enhancement Act includes 
three different components. The first calls for base pay that is 
uniform nationwide; which will ensure that entry level personnel will 
not be taken advantage and paid lower wages than their counterparts in 
other facilities. The second component institutes market pay that 
varies based on geographic area, specialty, assignment, personal 
qualifications, and individual experience. This component will allow 
for varying pay grades based on each individuals experience and 
circumstance as opposed to fixed pay rates that do not properly reflect 
each individual's contribution to the Veterans Health Administration. 
The final component calls for performance pay linked to the achievement 
of specific corporate goals and individual performance objectives. 
Again, this component will allow individual health care personnel to be 
rewarded based on their level of service and it will encourage others 
to raise their level of performance in order to collect performance 
bonuses. These three components as a whole will provide a more 
equitable and just pay scale physicians and dentists employed by the 
Veterans Health Administration. As a Member in this body I have always 
insisted on our brave veterans receiving the best of care in the finest 
health care facilities that we can provide. The Veterans Affairs Health 
Care Personnel Enhancement Act will allow those who provide these

[[Page H9793]]

vital health care services to be properly compensated and motivated to 
stay within the Veterans Health Administration.
  Mr. RODRIGUEZ. Mr. Speaker, I yield back the balance of my time.
  Mr. SIMMONS. Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Terry). The question is on the motion 
offered by the gentleman from Connecticut (Mr. Simmons) that the House 
suspend the rules and pass the Senate bill, S. 2484.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the Senate bill was passed.
  A motion to reconsider was laid on the table.

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