[House Report 104-226]
[From the U.S. Government Publishing Office]
104th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 104-226
_______________________________________________________________________
EXEMPTION OF CERTAIN FULL-TIME HEALTH CARE PROFESSIONALS OF THE
DEPARTMENT OF VETERANS AFFAIRS FROM RESTRICTIONS ON REMUNERATED OUTSIDE
PROFESSIONAL ACTIVITIES
_______________________________________________________________________
August 2, 1995.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Stump, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 1384]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred the
bill (H.R. 1384) to amend title 38, United States Code, to
exempt certain full-time health care professionals of the
Department of Veterans Affairs from restrictions on remunerated
outside professional activities, having considered the same,
reports favorably thereon with amendments and recommends that
the bill as amended do pass.
The amendments (stated in terms of the page and line numbers
of the introduced bill) are as follows:
Page 1, line 5, insert ``(a) Exemption of Certain Health-Care
Professionals From Restrictions on Remunerated Outside
Professional Activities.--'' before ``Section''.
Page 2, after line 22, insert the following:
(b) Cross Reference Amendments.--Subsection (d) of such
section, as redesignated by subsection (a)(2), is amended--
(1) in the matter preceding paragraph (1), by
striking out ``subsection (b)(6)'' and inserting in
lieu thereof ``subsection (b)(5)''; and
(2) in paragraph (2), by striking out ``paragraph
(1)(B)'' and inserting in lieu thereof ``section
7421(b) of this title''.
Introduction
The Subcommittee met on May 11, 1995 and recommended H.R.
1384 to the full Committee. The full Committee met on June 15,
1995 and ordered H.R. 1384 reported favorably to the House by
unanimous voice vote.
Summary of the Reported Bill
H.R. 1384 would:
1. Amend section 7423 of title 38, United States Code, to
exempt registered professional nurses, physician assistants,
and expanded-duty dental auxiliaries from restrictions
regarding outside professional activities for remuneration.
2. Continue the limitation on outside remuneration for
full-time title 38 health professionals such as physicians and
dentists except under circumstances to assist medically under-
served communities or to meet medical needs which would not
otherwise be available to communities or medical practice
groups. Waivers of periods up to 180 days may be granted by the
Under Secretary for Health.
Background and Discussion
In creating VA's Department of Medicine and Surgery in
1946, Congress established a personnel system under title 38 of
the United States Code for VA doctors, nurses, and dentists.
That personnel system, administered independently of the civil
service system, was intended to give VA exclusive control to
manage and operate its health care facilities. As part of that
statutory framework, Congress also established restrictions on
outside professional activities of those ``title 38'' health
care employees.
Those ``moonlighting'' restrictions were instituted to
ensure round-the-clock patient care coverage, and were a
response to a ``clock-punching'' work ethic often at odds with
actual patient care needs.
Much has changed in the VA health care system since the
establishment of restrictions on outside professional
activities. The role and working conditions of VA nurses, for
example, has changed markedly since 1946. In those years,
nurses often lived on station and were expected to be available
to meet patient care needs. Since that time the nursing
profession has undergone a major transformation from one of
physician handmaiden to independent practitioner with physician
collaboration. The change in professional status for nurses has
also impacted the work schedule for nurses and removed the
expectation of 24-hour availability. Most nurses today work a
prescribed schedule of hours, as do physician assistants and
expanded-duty dental auxiliaries.
Secondary employment, or ``moonlighting,'' becomes a
problem when it interferes with staffing needs. The problem is
most acute in connection with full-time VA physicians, who must
be on-call 24 hours a day, 7 days a week, to meet patient care
needs. However, registered nurses, physician assistants, and
expanded-duty dental auxiliaries to whom the ``moonlighting''
restrictions, as well as other aspects of the title 38
personnel system apply, do not have the same on-call demands as
physicians.
VA has other effective means to assure nursing coverage and
``moonlighting'' restrictions are, for all practical proposes,
irrelevant to maintaining that goal. The staffing needs that
prompted a comprehensive ``moonlighting'' ban in law have long
since changed. In the early 1970's, for example, basic annual
salary for a registered nurse, which had previously been based
on availability for duty 24 hours per day, 7 days per week, was
changed to provide for compensation at an hourly rate with
increased salary accruing for non-standard schedules worked.
Not only have the ``moonlighting'' restrictions diminished
in utility, they have also created problems of enforcement and
unwelcome adverse effects on recruitment and retention in
certain professions. For example, during the 1980's,
flexibility and economic considerations played a major part in
the decision of many full-time VA nurses to shift to part-time
schedules to escape the ban.
Given the need for many families to find new sources of
income under current economic conditions, a comprehensive ban
on outside employment appears unnecessarily sweeping and
counterproductive to recruitment and retention. It is for these
reasons that the Department and professional organizations
representing these groups strongly supported efforts to remove
the ban for registered professional nurses, physician
assistants, and expanded-duty dental auxiliaries.
Lifting the ban on outside employment for selected
professions could have real benefits for VA. The Department
could reap benefits such as increased staff creativity by
exposure to a variety of employment environments. It could also
serve as a vehicle to improve professional skills through
practice in private sector clinical areas that exceed or are
different from those available in the VA. The Department has
stated no objection to the bill.
Understanding the economic concerns of those groups
affected by H.R. 1384 and supportive of their position as
independent practitioners, the Chairman of the Subcommittee on
Hospitals and Health Care was joined in a bipartisan effort
with the Ranking Member of the Subcommittee to introduce this
bill. Efforts to align VA employment practices to those of the
private sector for registered professional nurses, physician
assistants, and expanded-duty dental auxiliaries should greatly
assist recruitment and retention efforts by procuring quality
health care providers for VA facilities.
Oversight Findings
No oversight findings have been submitted to the Committee
by the Committee on Government Reform and Oversight.
Congressional Budget Office Cost Estimate
The following letter was received from the Congressional
Budget Office concerning the cost of the reported bill:
U.S. Congress,
Congressional Budget Office,
Washington, DC, June 20, 1995.
Hon. Bob Stump,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
reviewed H.R. 1384, a bill to amend title 38, United States
Code, to exempt certain full-time health care professionals of
the Department of Veterans Affairs from restrictions on
remunerated outside activities as ordered reported by the House
Committee on Veterans' Affairs on June 15, 1995.
The bill would have no significant impact on the budgets of
federal, state, or local governments. H.R. 1384 would not be
subject to pay-as-you-go procedures under section 252 of the
Balanced Budget and Emergency Deficit Control Act.
If you wish further details on this estimate, we will be
pleased to provide them.
Sincerely,
June E. O'Neill,
Director.
Inflationary Impact Statement
The enactment of the reported bill would have no
inflationary impact.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3 of rule XIII of the Rules of the
House of Representatives, changes in existing law made by the
bill, as reported, are shown as follows (existing law proposed
to be omitted is enclosed in black brackets, new matter is
printed in italics, existing law in which no change is proposed
is shown in roman):
SECTION 7423 OF TITLE 38, UNITED STATES CODE
Sec. 7423. Personnel administration: full-time employees
(a) * * *
(b) A person covered by subsection (a) may not do any of the
following:
[(1) Assume responsibility for the medical care of
any patient other than a patient admitted for treatment
at a Department facility, except in those cases where
the person, upon request and with the approval of the
Under Secretary for Health, assumes such
responsibilities to assist communities or medical
practice groups to meet medical needs which would not
otherwise be available for a period not to exceed 180
calendar days, which may be extended by the Under
Secretary for Health for additional periods not to
exceed 180 calendar days each.]
[(2)] (1) Teach or provide consultative services at
any affiliated institution if such teaching or
consultation will, because of its nature or duration,
conflict with such person's responsibilities under this
title.
[(3)] (2) Accept payment under any insurance or
assistance program established under title XVIII or XIX
of the Social Security Act or under chapter 55 of title
10 for professional services rendered by such person
while carrying out such person's responsibilities under
this title.
[(4)] (3) Accept from any source, with respect to any
travel performed by such person in the course of
carrying out such person's responsibilities under this
title, any payment or per diem for such travel, other
than as provided for in section 4111 of title 5.
[(5)] (4) Request or permit any individual or
organization to pay, on such person's behalf for
insurance insuring such person against malpractice
claims arising in the course of carrying out such
person's responsibilities under this title or for such
person's dues or similar fees for membership in medical
or dental societies or related professional
associations, except where such payments constitute a
part of such person's remuneration for the performance
of professional responsibilities permitted under this
section, other than those carried out under this title.
[(6)] (5) Perform, in the course of carrying out such
person's responsibilities under this title,
professional services for the purpose of generating
money for any fund or account which is maintained by an
affiliated institution for the benefit of such
institution, or for such person's personal benefit, or
both.
(c)(1) An employee of the Veterans Health Administration who
is covered by subsection (a) (other than a registered nurse, a
physician's assistant, or an expanded-duty dental auxiliary)
may not assume responsibility for the medical care of any
patient other than a patient admitted for treatment at a
Department facility.
(2) The limitation in paragraph (1) shall not apply in a case
in which the employee, upon request and with the approval of
the Under Secretary for Health, assumes such responsibilities
to assist communities or medical practice groups to meet
medical needs which would not otherwise be available. The
approval of the Under Secretary may not be for a period in
excess of 180 days, which may be extended by the Under
Secretary for additional periods of not to exceed 180 days.
[(c)] (d) In the case of any fund or account described in
[subsection (b)(6)] subsection (b)(5) that was established
before September 1, 1973--
(1) the affiliated institution shall submit
semiannually an accounting to the Secretary and to the
Comptroller General of the United States with respect
to such fund or account and shall maintain such fund or
account subject to full public disclosure and audit by
the Secretary and the Comptroller General for a period
of three years or for such longer period as the
Secretary shall prescribe, and
(2) no person in a position specified in [paragraph
(1)(B)] section 7421(b) of this title may receive any
cash from amounts deposited in such fund or account
derived from services performed before that date.
[(d)] (e) As used in this section:
(1) The term ``affiliated institution'' means a
medical school or other institution of higher learning
with which the Secretary has a contract or agreement as
referred to in section 7313 of this title for the
training or education of health personnel.
(2) The term ``remuneration'' means the receipt of
any amount of monetary benefit from any non-Department
source in payment for carrying out any professional
responsibilities.
[(e)] (f)(1) The Secretary shall establish a leave transfer
program for the benefit of health-care professionals in
positions listed in section 7401(1) of this title. The
Secretary may also establish a leave bank program for the
benefit of such health-care professionals.
(2) To the maximum extent feasible--
(A) the leave transfer program shall provide the same
or similar requirements and conditions as are provided
for the program established by the Director of the
Office of Personnel Management under subchapter III of
chapter 63 of title 5; and
(B) any leave bank program established pursuant to
paragraph (1) shall be consistent with the requirements
and conditions provided for agency leave bank programs
in subchapter IV of such chapter.
(3) Participation by a health-care professional in the leave
transfer program established pursuant to paragraph (1), and in
any leave bank program established pursuant to such paragraph,
shall be voluntary. The Secretary may not require any health-
care professional to participate in such a program.
(4)(A) The Secretary and the Director of the Office of
Personnel Management may enter into an agreement that permits
health-care professionals referred to in paragraph (1) to
participate in the leave transfer program established by the
Director of the Office of Personnel Management under subchapter
III of chapter 63 of title 5 or in any leave bank program
established for other employees of the Department pursuant to
subchapter IV of chapter 63 of title 5, or both.
(B) Participation of such health-care professionals in a
leave transfer program or a leave bank program pursuant to an
agreement entered into under subparagraph (A) shall be subject
to such requirements and conditions as may be prescribed in
such agreement.
(5) The Secretary is not required to establish a leave
transfer program for any personnel permitted to participate in
a leave transfer program pursuant to an agreement referred to
in paragraph (4).
[(f)] (g) The Secretary may purchase promotional items of
nominal value for use in the recruitment of individuals for
employment under this chapter. The Secretary shall prescribe
guidelines for the administration of the preceding sentence.
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