[House Report 118-571]
[From the U.S. Government Publishing Office]


118th Congress }                                          { Report 
                        HOUSE OF REPRESENTATIVES
  2d Session   }                                          { 118-571

======================================================================
 
             IMPROVING ACCESS TO WORKERS' COMPENSATION FOR 
                     INJURED FEDERAL WORKERS ACT

                                _______
                                

  July 5, 2024.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Ms. Foxx, from the Committee on Education and the Workforce, submitted 
                             the following

                              R E P O R T

                        [To accompany H.R. 618]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Education and the Workforce, to whom was 
referred the bill (H.R. 618) to amend chapter 81 of title 5, 
United States Code, to cover, for purposes of workers' 
compensation under such chapter, services by physician 
assistants and nurse practitioners provided to injured Federal 
workers, and for other purposes, having considered the same, 
reports favorably thereon with an amendment and recommends that 
the bill as amended do pass.
    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Improving Access to Workers' 
Compensation for Injured Federal Workers Act''.

SEC. 2. INCLUSION OF PHYSICIAN ASSISTANTS AND NURSE PRACTITIONERS IN 
                    FEDERAL EMPLOYEES' COMPENSATION ACT.

  (a) Inclusion.--Section 8101 of title 5, United States Code, is 
amended--
          (1) in paragraph (3), by inserting ``, other eligible 
        providers,'' after ``osteopathic practitioners'';
          (2) by striking ``and'' at the end of paragraphs (18) and 
        (19);
          (3) by striking the period at the end of paragraph (20) and 
        inserting ``; and''; and
          (4) by adding at the end the following:
          ``(21) `other eligible provider' means a nurse practitioner 
        or physician assistant within the scope of their practice as 
        defined by State law.''.
  (b) Conforming Amendments.--Chapter 81 of title 5, United States 
Code, is amended--
          (1) in section 8103(a)--
                  (A) by inserting ``or other eligible provider'' after 
                ``physician'' each place it appears; and
                  (B) in paragraph (3), by inserting ``or other 
                eligible providers'' after ``physicians'';
          (2) in section 8121(6), by inserting ``or other eligible 
        provider'' after ``physician''; and
          (3) in section 8123(a)--
                  (A) by inserting ``or other eligible provider'' after 
                ``The employee may have a physician''; and
                  (B) by inserting ``or other eligible provider'' after 
                ``United States and the physician''.
  (c) Regulations.--Not later than 6 months after the date of enactment 
of this Act, the Secretary of Labor shall finalize rules to carry out 
the amendments made by this Act.

                                Purpose

    H.R. 618, the Improving Access to Workers' Compensation for 
Injured Federal Workers Act, expands the role of nurse 
practitioners (NPs) and physician assistants (PAs) in providing 
services to injured federal workers under the Federal 
Employees' Compensation Act (FECA) program within the scope of 
the practices of NPs and PAs as defined by state law.

                            Committee Action


                             117TH CONGRESS

    On November 30, 2021, Representative Joe Courtney (D-CT) 
introduced H.R. 6087, the Improving Access to Workers' 
Compensation for Injured Federal Workers Act, with 
Representative Tim Walberg (R-MI) as an original cosponsor. The 
bill was referred solely to the Committee on Education and 
Labor.

Hearing

    On December 2, 2021, the Subcommittee on Workforce 
Protections held a hearing entitled ``Strengthening the Safety 
Net for Injured Workers.'' The Subcommittee heard testimony on 
the difficulty injured federal workers face finding a physician 
willing to participate in the FECA program and the need for 
increased access to care for this population. The witnesses 
were Mr. Christopher J. Godfrey, Director, Office of Workers' 
Compensation Programs, U.S. Department of Labor, Washington, 
D.C., and Mr. Thomas M. Costa, Director of Education, 
Workforce, and Income Security, Government Accountability 
Office, Washington, D.C.

Legislative Action

    On March 16, 2022, the Committee considered H.R. 6087 in 
legislative session and reported it favorably, as amended, to 
the House of Representatives by voice vote. The Committee 
considered an Amendment in the Nature of a Substitute offered 
by Representative Courtney making technical changes. The 
amendment was adopted by voice vote.
    On June 7, 2022, the House agreed to a motion to suspend 
the rules and pass H.R. 6087, the Improving Access to Workers' 
Compensation for Injured Federal Workers Act, by a vote of 325-
83.

                             118TH CONGRESS

    On January 30, 2023, Representative Walberg introduced H.R. 
618, the Improving Access to Workers' Compensation for Injured 
Federal Workers Act, with Representative Courtney as an 
original cosponsor. The bill was referred solely to the 
Committee on Education and the Workforce.

Hearing

    On May 1, 2024, the Committee on Education and the 
Workforce held a hearing entitled ``Examining the Policies and 
Priorities of the Department of Labor'' to examine the 
Department of Labor's (DOL) Fiscal Year 2025 budget priorities 
and evaluate the effectiveness of its enforcement programs. The 
sole witness was the Honorable Julie A. Su, Acting Secretary of 
Labor, Washington, D.C. Representatives Walberg and Courtney 
questioned Ms. Su about DOL's position on H.R. 618.

Legislative Action

    On June 13, 2024, the Committee considered H.R. 618 in 
legislative session and reported it favorably, as amended, to 
the House of Representatives by a vote of 36-0. The Committee 
considered an Amendment in the Nature of a Substitute offered 
by Representative Walberg making technical changes. The 
amendment was adopted by voice vote.

                            Committee Views


                              INTRODUCTION

    H.R. 618 allows NPs and PAs to act as eligible providers 
under the FECA program within the scope of their practice 
according to state law.

                              CURRENT LAW

    Under FECA, which was enacted in 1916,\1\ only a physician 
can make the diagnosis, certify the injury and extent of the 
disability, and oversee the patient's treatment and care.\2\ 
``Physician'' includes surgeons, podiatrists, dentists, 
clinical psychologists, optometrists, chiropractors, and 
osteopathic practitioners within the scope of their practice as 
defined by state law.\3\ As such, under current law, NPs and 
PAs are unable to diagnose, certify an injury and extent of 
disability, or oversee the treatment and care of FECA 
beneficiaries.
---------------------------------------------------------------------------
    \1\Act of Sept. 7, 1916, Pub. L. No. 64-267, 39 Stat. 742 (1916).
    \2\5 U.S.C. Sec. 8101(2).
    \3\Id. 
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                          NURSE PRACTITIONERS

    NPs are advanced practice registered nurses who obtain 
graduate education at the master's, post-master's, or doctoral 
level and obtain national board certification. NPs are educated 
under the nursing model, where clinical training is integrated 
into their core curriculum. NP programs are competency-based, 
not time-based; as such, a student must demonstrate mastery of 
content before advancing.\4\ Daily NP responsibilities often 
include providing physical examinations, diagnosing and 
treating common acute and chronic problems, interpreting lab 
results and X-rays, prescribing and managing medications and 
therapies, and providing teaching and counseling to support 
healthy lifestyle behaviors.\5\
---------------------------------------------------------------------------
    \4\Memorandum from MaryAnne Sapio, Vice President of Fed. Gov't 
Aff., Am. Ass'n of Nurse Prac., to Kimberly Latimore, Leg. Assistant, 
Off. of Sen. Sherrod Brown, and Maria Olson, Leg. Assistant, Off. of 
Sen. Susan Collins (Jan. 8, 2024) (on file with Comm.).
    \5\Mayo Clinic C. of Med. & Science, Nurse Practitioner, 
college.mayo.edu/academics/
explore-health-care-careers/careers-a-z/nurse-practitioner/.
---------------------------------------------------------------------------

                          PHYSICIAN ASSISTANTS

    A physician assistant (PA) is a licensed medical 
professional who holds an advanced degree and can provide 
direct patient care. The specific duties of a PA are determined 
by their supervising physician and state law, but PAs provide 
many of the same services as a primary care physician.\6\ They 
practice in every state and in a wide variety of clinical 
settings and specialties.\7\ PA daily responsibilities include 
making rounds and performing patient exams, diagnosing 
illnesses, assisting in surgery, ordering and interpreting 
laboratory tests and X-rays, prescribing medications, 
developing and managing treatment plans, and advising patients 
on preventative care and optimal health practices.\8\
---------------------------------------------------------------------------
    \6\Mayo Clinic C. of Med. & Science, Physician Assistant, https://
college.mayo.edu/
academics/explore-health-care-careers/careers-a-z/physician-assistant/.
    \7\Letter from Lisa Gables, Chief Exec. Off., AAPA, to Reps. Joe 
Courtney & Tim Walberg (Mar. 15, 2022) (on file with Comm.).
    \8\Mayo Clinic C. of Med. & Science, Physician Assistant, supra 
note 6.
---------------------------------------------------------------------------

                         OTHER FEDERAL PROGRAMS

    The FECA program's prohibition on the utilization of NPs 
and PAs to treat beneficiaries distinguishes it from other 
federal programs. In Medicare, Medicaid, the Federal Employees 
Health Benefits Program, and TRICARE, NPs and PAs can provide 
and oversee care consistent with state scope-of-practice laws. 
This is also the case within the Veterans' Health 
Administration, the Department of Defense, the Indian Health 
Service, and the U.S. Coast Guard, among other federal 
agencies. Since 2017, the Social Security Administration has 
considered NPs and PAs, along with physicians, to serve as 
acceptable sources of information for documenting the existence 
of an impairment for purposes of determining a disability. 
Additionally, NPs and PAs are medical examiners listed on the 
National Registry of Certified Medical Examiners for the 
purpose of performing mandatory medical examinations for 
drivers of commercial motor vehicles.\9\
---------------------------------------------------------------------------
    \9\Memorandum from MaryAnne Sapio, Vice President of Fed. Gov't 
Aff., Am. Ass'n of Nurse Prac., to Kimberly Latimore, Leg. Assistant, 
Off. of Sen. Sherrod Brown, and Maria Olson, Leg. Assistant, Off. of 
Sen. Susan Collins (Jan. 8, 2024) (on file with Comm.).
---------------------------------------------------------------------------

                               STATE LAWS

    In the majority of state workers' compensation programs 
that oversee private sector employees, NPs and PAs can provide 
services. NPs can make a diagnosis and oversee and coordinate 
care in 28 states.\10\ PAs are included as covered providers in 
36 states, while four states defer to the insurance carrier and 
another four do not permit PAs to file under their own National 
Provider Identifier number.\11\
---------------------------------------------------------------------------
    \10\Am. Ass'n of Nurse Prac. (AANP), AANP Workers' Compensation 
State List (on file with Comm.).
    \11\Am. Academy of Physician Assistants, Workers' Comp Chart 2020 
(on file with Comm.).
---------------------------------------------------------------------------

                             ACCESS TO CARE

    According to the Medicare Payment Advisory Commission, NPs 
and PAs account for one third of all primary care clinicians 
treating Medicare beneficiaries nationwide. In rural 
communities, their presence is closer to half of the primary 
care clinicians.\12\ During a 2021 Workforce Protections 
Subcommittee hearing titled ``Strengthening the Safety Net for 
Injured Workers,'' Christopher Godfrey, the director of the 
Office of Workers' Compensation Programs, testified on the 
challenges of accessing care in rural communities. He said 
there is often no doctor in town, and an NP or PA may be the 
only clinician who can provide the immediate treatment or 
ongoing care needed following a workplace injury. He also 
stated that utilizing NPs and PAs will make it much easier for 
FECA beneficiaries to access the care they need.\13\
---------------------------------------------------------------------------
    \12\Medicare Payment Advisory Comm'n, Medicare and the Health Care 
Delivery System 27 (June 2022) https://www.medpac.gov/wp-content/
uploads/2022/06/Jun22_MedPAC_
Report_to_Congress_SEC.pdf.
    \13\Strengthening the Safety Net for Injured Workers: Hearing 
Before the Subcomm. on Workforce Protections of the H. Comm. on Educ. & 
Lab., 117th Cong. 57-58 (2021).
---------------------------------------------------------------------------

                               CONCLUSION

    More must be done to increase access to care for injured 
federal workers, especially those in rural communities where 
the closest physician may be several hours away. H.R. 618 takes 
an important step to authorize NPs and PAs to act as eligible 
providers under the FECA program within the scope of their 
practice according to state law, as NPs and PAs are often the 
only clinician within many communities. This legislation will 
increase health care access for FECA beneficiaries at a time 
when many areas of the country are grappling with provider 
shortages.

                                Summary


                  H.R. 618 SECTION-BY-SECTION SUMMARY

Section 1. Short title

    Section 1 provides that the short title is ``Improving 
Access to Workers' Compensation for Injured Federal Workers 
Act.''

Section 2. Inclusion of physician assistants and nurse practitioners in 
        Federal Employees' Compensation Act

    Section 2 allows nurse practitioners and physician 
assistants acting within the scope of their practice under 
state law to (1) prescribe or recommend treatment for injured 
federal workers; (2) certify the nature of an injury and 
probable extent of disability; (3) provide prescribed treatment 
for injured federal workers; and (4) participate, with a 
physician designated by DOL, in a mandatory workers' 
compensation examination of an injured worker. Section 2 also 
directs DOL to finalize rules to carry out Section 2 within six 
months of enactment.

                       Explanation of Amendments

    The amendments, including the amendment in the nature of a 
substitute, are explained in the body of this report.

              Application of Law to the Legislative Branch

    Section 102(b)(3) of Public Law 104-1 requires a 
description of the application of this bill to the legislative 
branch. H.R. 618 expands the role of nurse practitioners and 
physician assistants to be eligible providers to injured 
federal workers. H.R. 618 is applicable to the federal workers' 
compensation program, and therefore does not apply to the 
Legislative Branch.

                       Unfunded Mandate Statement

    Pursuant to Section 423 of the Congressional Budget and 
Impoundment Control Act of 1974, Pub. L. No. 93-344 (as amended 
by Section 101(a)(2) of the Unfunded Mandates Reform Act of 
1995, Pub. L. No. 104-4), the Committee traditionally adopts as 
its own the cost estimate prepared by the Director of the 
Congressional Budget Office (CBO) pursuant to section 402 of 
the Congressional Budget and Impoundment Control Act of 1974.

                           Earmark Statement

    H.R. 618 does not contain any congressional earmarks, 
limited tax benefits, or limited tariff benefits as defined in 
clause 9 of rule XXI of the Rules of the House of 
Representatives.

                            Roll Call Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee Report to include for 
each record vote on a motion to report the measure or matter 
and on any amendments offered to the measure or matter the 
total number of votes for and against and the names of the 
Members voting for and against.


         Statement of General Performance Goals and Objectives

    In accordance with clause (3)(c) of House rule XIII, the 
goal of H.R. 618, the Improving Access to Workers' Compensation 
for Injured Federal Workers Act, is to increase access to care 
for FECA beneficiaries.

                    Duplication of Federal Programs

    No provision of H.R. 618 establishes or reauthorizes a 
program of the Federal Government known to be duplicative of 
another Federal program, a program that was included in any 
report from the Government Accountability Office to Congress 
pursuant to section 21 of Public Law 111-139, or a program 
related to a program identified in the most recent Catalog of 
Federal Domestic Assistance.

  Statement of Oversight Findings and Recommendations of the Committee

    In compliance with clause 3(c)(1) of rule XIII and clause 
2(b)(1) of rule X of the Rules of the House of Representatives, 
the committee's oversight findings and recommendations are 
reflected in the body of this report.

                       Required Committee Hearing

    In compliance with clause 3(c)(6) of rule XIII the 
following hearing held during the 118th Congress was used to 
develop or consider H.R. 618: On May 1, 2024, the Committee on 
Education and the Workforce held a hearing on ``Examining the 
Policies and Priorities of the Department of Labor.''

               New Budget Authority and CBO Cost Estimate

    With respect to the requirements of clause 3(c)(2) of rule 
XIII of the Rules of the House of Representatives and section 
308(a) of the Congressional Budget Act of 1974 and with respect 
to requirements of clause 3(c)(3) of rule XIII of the Rules of 
the House of Representatives and section 402 of the 
Congressional Budget Act of 1974, the Committee adopts as its 
own the cost estimate prepared by the Director of the 
Congressional Budget Office.




    Legislation summary: On June 13, 2024, the House Committee 
on Education and the Workforce ordered to be reported eight 
bills and one joint resolution. This document provides 
estimates for seven of those bills and the resolution.
    Generally, the legislation would:
           Repeal a rule submitted by the Department of 
        Education relating to ``Nondiscrimination on the Basis 
        of Sex in Education Programs or Activities Receiving 
        Federal Financial Assistance;''
           Allow nurse practitioners and physician 
        assistants to diagnose, treat, and certify an injury 
        and extent of disability for the purposes of federal 
        workers' compensation;
           Require elementary and secondary schools and 
        institutions of higher education to meet new 
        requirements in order to maintain eligibility for 
        funding from the Department of Education;
           Prevent student athletes from being 
        considered the employees of an institution of higher 
        education; and
           Authorize appropriations for the educational 
        activities of the United States Holocaust Memorial 
        Museum.
    Estimated Federal cost: The estimated costs of the 
legislation fall within budget function 500 (education, 
training, employment, and social services).
    Basis of Estimate: For this estimate, CBO assumes that the 
legislation will be enacted near the end of fiscal year 2024. 
The estimated costs do not include any interaction effects 
among the pieces of legislation. If all seven bills and the 
resolution were combined and enacted as a single piece of 
legislation, the estimated costs could be different than the 
sum of the separate estimates, although CBO expects that any 
difference would be small.
    CBO estimates that implementing H.R. 8606 would cost $8 
million over the 2024-2029 period. Implementing the remaining 
bills and the joint resolution would each cost less than 
$500,000 over the same period. Any related spending would be 
subject to the availability of appropriated funds.
    H.J. Res. 165, a joint resolution providing for 
Congressional disapproval under chapter 8 of title 5, United 
States Code, of the rule submitted by the Department of 
Education relating to ``Nondiscrimination on the Basis of Sex 
in Education Programs or Activities Receiving Federal Financial 
Assistance'': H.J. Res 165 would disapprove the rule submitted 
by the Department of Education relating to ``Nondiscrimination 
on the Basis of Sex in Education Programs or Activities 
Receiving Federal Financial Assistance,'' as published in the 
Federal Register on April 29, 2024.
    The rule amends title IX of the Education Amendments of 
1972 (title IX), which prohibits discrimination on the basis of 
sex in any education program or activity receiving federal 
financial assistance. The rule clarifies definitions related to 
sex-based discrimination and harassment and specifies the 
requirements for grievance procedures, and requirements for 
preventing sexual discrimination and remedying its effects.
    Institutions that fail to comply with title IX, as amended 
by the rule, could lose federal funding. However, CBO expects 
that institutions will comply with the regulations to avoid 
doing so. On that basis, CBO estimates that disapproving the 
rule would not affect institutions' eligibility for federal 
student aid.
    Based on the costs of similar activities, CBO estimates 
that implementing the resolution would cost less than $500,000 
over the 2024-2029 period. Any related spending would be 
subject to the availability of appropriated funds.
    H.R. 618, Improving Access to Workers' Compensation for 
Injured Federal Workers Act: H.R. 618 would allow nurse 
practitioners and physician assistants to diagnose, prescribe 
treatment, and certify an injury and the extent of disability 
for the purpose of compensating federal workers under the 
Federal Employees' Compensation Act (FECA). Using information 
from the Department of Labor, CBO expects that nonphysician 
providers would be compensated at the same rate as physicians 
and that total benefits provided to injured federal workers 
would not significantly change. Some people may receive 
treatment more quickly under the bill, which could increase 
costs over the 10-year period because some payments to medical 
providers that would have occurred in 2035 under current law 
could be paid in 2034. On the other hand, if injured workers 
receive treatment faster, some may return to work more quickly, 
which could reduce costs. CBO has no basis to estimate which 
effect would predominate, but we expect that those effects 
would roughly offset each other. Thus, CBO estimates that 
enacting H.R. 618 would affect net direct spending by an 
insignificant amount.
    The FECA payments are mandatory. The costs of those 
payments are charged to a claimant's employing agency, which 
reimburses the Department of Labor out of its salaries and 
expense accounts. Any effect on discretionary spending would be 
subject to future appropriation actions.
    H.R. 5567, CLASS Act: H.R. 5567 would require public 
elementary and secondary schools that receive funding from the 
Department of Education to disclose to the department funds 
received or contracts signed with foreign sources that are more 
than $10,000.
    CBO expects schools would comply with the new requirements; 
thus, enacting the bill would not affect their eligibility to 
receive federal funds. Based on the costs of similar 
activities, CBO estimates that implementing the bill would cost 
the Department of Education less than $500,000 over the 2024-
2029 period. Any related spending would be subject to the 
availability of appropriated funds.
    H.R. 6816, PROTECT Our Kids Act: H.R. 6816 would prohibit 
elementary and secondary schools that receive direct or 
indirect support from the government of the People's Republic 
of China (including Confucius Institutes), from receiving funds 
from the Department of Education.
    The 2018 National Defense Authorization Act prohibited 
institutions of higher education from using federal funding for 
Chinese language programs at Confucius Institutes. As a result, 
nearly all Confucius Institutes at postsecondary institutions 
have closed, according to a Government Accountability Office 
report released in 2023.\1\ On that basis, CBO expects schools 
would comply with the new requirements; thus, enacting the bill 
would not affect their eligibility to receive federal funds.
---------------------------------------------------------------------------
    \1\Government Accountability Office, China: With Nearly All U.S. 
Confucius Institutes Closed, Some Schools Sought Alternative Language 
Support, GAO-20-105981 (October 2023), www.gao.gov/products/gao-24-
105981.
---------------------------------------------------------------------------
    Based on the costs of similar activities, CBO estimates 
that implementing the bill would cost the Department of 
Education less than $500,000 over the 2024-2029 period. Any 
related spending would be subject to the availability of 
appropriated funds.
    H.R. 8534, Protecting Student Athletes' Economic Freedom 
Act: The bill would prohibit student athletes from being 
considered an employee of an institution based on the athletes' 
participation in a varsity intercollegiate athletic program or 
competition. Based on the costs of similar activities, CBO 
estimates that implementing the bill would cost the Department 
of Education less than $500,000 over the 2024-2029 period. Any 
related spending would be subject to the availability of 
appropriated funds.
    H.R. 8606, Never Again Education Reauthorization and Study 
Act of 2024: H.R. 8606 would authorize the appropriation of $2 
million each year from 2026 through 2030 for the Director of 
the United States Holocaust Memorial Museum to support 
education and training related to the lessons of the Holocaust. 
Under current law, the authorization of appropriations for 
those activities expires at the end of 2025. The bill also 
would require the Director to conduct a study on the 
educational activities being carried out at the state and local 
level. Assuming appropriation of the authorized amounts and 
using historical spending patterns for those activities, CBO 
estimates that implementing H.R. 8606 would cost $8 million 
over the 2024-2029 period and $2 million after 2029.
    H.R 8648, Civil Rights Protection Act of 2024: H.R. 8648 
would require any institution of higher education that receives 
federal student aid to make publicly available its process for 
addressing violations of title VI of the Civil Rights Act and 
any complaints received regarding alleged violations. The bill 
also would require the Assistant Secretary for Civil Rights at 
the Department of Education to give monthly briefings on 
violations specific to race, color, or national origin, and 
report the findings of institutional complaints.
    CBO expects institutions would comply with the new 
requirements; thus, enacting the bill would not affect their 
eligibility for federal student aid. Based on the costs of 
similar activities, CBO estimates that implementing the bill 
would cost the Department of Education less than $500,000 over 
the 2024-2029 period. Any related spending would be subject to 
the availability of appropriated funds.
    H.R. 8649, Transparency in Reporting Adversarial 
Contributions to Education Act: The bill would require 
elementary and secondary schools that receive funding from the 
Department of Education to disclose to parents and the public 
any contributions received from foreign countries and the terms 
or conditions of such contributions.
    CBO expects schools would comply with the new requirements; 
thus, enacting the bill would not affect their eligibility to 
receive federal funds. Based on the costs of similar 
activities, CBO estimates that implementing the bill would cost 
the Department of Education less than $500,000 over the 2024-
2029 period. Any related spending would be subject to the 
availability of appropriated funds.
    Pay-As-You-Go considerations: The Statutory Pay-As-You-Go 
Act of 2010 establishes budget-reporting and enforcement 
procedures for legislation affecting direct spending or 
revenues. CBO estimates that enacting H.R. 618 would affect net 
direct spending by less than $500,000 over the 2024-2034 
period.
    Increase in long-term net direct spending and deficits: CBO 
estimates that enacting the joint resolution or any of the 
seven bills in this estimate would not increase net direct 
spending or deficits in any of the four consecutive 10-year 
periods beginning in 2035.
    Mandates: H.R. 8534 would impose an intergovernmental 
mandate as defined in the Unfunded Mandates Reform Act (UMRA) 
by prohibiting states from designating varsity athletes of a 
school, conference, or association as employees of that entity. 
CBO estimates that the net costs of the direct effects of the 
legislation would not result in additional expenditures or 
losses in revenue; therefore, the cost of the preemption would 
not exceed the threshold established in UMRA for 
intergovernmental mandates ($100 million in 2024, adjusted 
annually for inflation).
    The bill would not impose a private-sector mandate as 
defined in UMRA.
    Enacting the legislation may result in other secondary 
effects on private entities by denying employment-related 
benefits to varsity athletes that they may otherwise have 
qualified for as an employee. However, CBO's estimate of those 
effects is subject to uncertainty because the question of 
whether athletes affected by the bill should be recategorized 
as employees of their institutions remains unsettled as court 
rulings, administrative decisions, and changes in policies of 
the National Collegiate Athletics Association are announced. 
What effect, if any, the bill would have on private entities 
would depend on the final adjudication of the matter.
    None of the remaining pieces of legislation contained in 
this estimate would impose intergovernmental or private-sector 
mandates as defined in UMRA.
    Estimate prepared by: Federal costs: Meredith Decker 
(Department of Labor); Leah Koestner (Department of Education); 
Susanne Mehlman (United States Holocaust Memorial Museum); 
Garrett Quenneville (Department of Education). Mandates: Erich 
Dvorak, Brandon Lever, and Grace Watson.
    Estimate reviewed by: Elizabeth Cove Delisle, Chief, Income 
Security Cost Estimates Unit; Justin Humphrey, Chief, Finance, 
Housing, and Education Cost Estimates Unit; Kathleen 
FitzGerald, Chief, Public and Private Mandates Unit; H. Samuel 
Papenfuss, Deputy Director of Budget Analysis.
    Estimate approved by: Phillip L. Swagel, Director, 
Congressional Budget Office.

                        Committee Cost Estimate

    Clause 3(d)(1) of rule XIII of the Rules of the House of 
Representatives requires an estimate and a comparison of the 
costs that would be incurred in carrying out H.R. 618. However, 
clause 3(d)(2)(B) of that Rule provides that this requirement 
does not apply when, as with the present report, the Committee 
adopts as its own the cost estimate for the bill prepared by 
the Director of the Congressional Budget Office.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) 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, and existing law in which no 
change is proposed is shown in roman):

                      TITLE 5, UNITED STATES CODE



           *       *       *       *       *       *       *
PART III--EMPLOYEES

           *       *       *       *       *       *       *


SUBPART G--INSURANCE AND ANNUITIES

           *       *       *       *       *       *       *


CHAPTER 81--COMPENSATION FOR WORK INJURIES

           *       *       *       *       *       *       *


                        SUBCHAPTER I--GENERALLY

Sec. 8101. Definitions

  For the purpose of this subchapter--
          (1) ``employee'' means--
                  (A) a civil officer or employee in any branch 
                of the Government of the United States, 
                including an officer or employee of an 
                instrumentality wholly owned by the United 
                States;
                  (B) an individual rendering personal service 
                to the United States similar to the service of 
                a civil officer or employee of the United 
                States, without pay or for nominal pay, when a 
                statute authorizes the acceptance or use of the 
                service, or authorizes payment of travel or 
                other expenses of the individual;
                  (C) an individual, other than an independent 
                contractor or an individual employed by an 
                independent contractor, employed on the 
                Menominee Indian Reservation in Wisconsin in 
                operations conducted under a statute relating 
                to tribal timber and logging operations on that 
                reservation;
                  (D) an individual employed by the government 
                of the District of Columbia;
                  (E) an individual appointed to a position on 
                the office staff of a former President under 
                section 1(b) of the Act of August 25, 1958 (72 
                Stat. 838);
                  (F) an individual selected pursuant to 
                chapter 121 of title 28, and serving as a petit 
                or grand juror; and
                  (G) an individual who is a System member of 
                the National Urban Search and Rescue Response 
                System during a period of appointment into 
                Federal service pursuant to section 327 of the 
                Robert T. Stafford Disaster Relief and 
                Emergency Assistance Act;
        but does not include--
                  
                  (i) a commissioned officer of the Regular 
                Corps of the Public Health Service;
                  
                  (ii) a commissioned officer of the Reserve 
                Corps of the Public Health Service on active 
                duty;
                  
                  (iii) a commissioned officer of the 
                Environmental Science Services Administration; 
                or
                  
                  (iv) a member of the Metropolitan Police or 
                the Fire Department of the District of Columbia 
                who is pensioned or pensionable under sections 
                521-535 of title 4, District of Columbia Code; 
                and
          (2) ``physician'' includes surgeons, podiatrists, 
        dentists, clinical psychologists, optometrists, 
        chiropractors, and osteopathic practitioners within the 
        scope of their practice as defined by State law. The 
        term ``physician'' includes chiropractors only to the 
        extent that their reimbursable services are limited to 
        treatment consisting of manual manipulation of the 
        spine to correct a subluxation as demonstrated by X-ray 
        to exist, and subject to regulation by the Secretary;
          (3) ``medical, surgical, and hospital services and 
        supplies'' includes services and supplies by 
        podiatrists, dentists, clinical psychologists, 
        optometrists, chiropractors, osteopathic practitioners, 
        other eligible providers, and hospitals within the 
        scope of their practice as defined by State law. 
        Reimbursable chiropractic services are limited to 
        treatment consisting of manual manipulation of the 
        spine to correct a subluxation as demonstrated by X-ray 
        to exist, and subject to regulation by the Secretary;
          (4) ``monthly pay'' means the monthly pay at the time 
        of injury, or the monthly pay at the time disability 
        begins, or the monthly pay at the time compensable 
        disability recurs, if the recurrence begins more than 6 
        months after the injured employee resumes regular full-
        time employment with the United States, whichever is 
        greater, except when otherwise determined under section 
        8113 of this title with respect to any period;
          (5) ``injury'' includes, in addition to injury by 
        accident, a disease proximately caused by the 
        employment, and damage to or destruction of medical 
        braces, artificial limbs, and other prosthetic devices 
        which shall be replaced or repaired, and such time lost 
        while such device or appliance is being replaced or 
        repaired; except that eyeglasses and hearing aids would 
        not be replaced, repaired, or otherwise compensated 
        for, unless the damages or destruction is incident to a 
        personal injury requiring medical services;
          (6) ``widow'' means the wife living with or dependent 
        for support on the decedent at the time of his death, 
        or living apart for reasonable cause or because of his 
        desertion;
          (7) ``parent'' includes stepparents and parents by 
        adoption;
          (8) ``brother'' and ``sister'' mean one who at the 
        time of the death of the employee is under 18 years of 
        age or over that age and incapable of self-support, and 
        include stepbrothers and stepsisters, half brothers and 
        half sisters, and brothers and sisters by adoption, but 
        do not include married brothers or married sisters;
          (9) ``child'' means one who at the time of the death 
        of the employee is under 18 years of age or over that 
        age and incapable of self-support, and includes 
        stepchildren, adopted children, and posthumous 
        children, but does not include married children;
          (10) ``grandchild'' means one who at the time of the 
        death of the employee is under 18 years of age or over 
        that age and incapable of self-support;
          (11) ``widower'' means the husband living with or 
        dependent for support on the decedent at the time of 
        her death, or living apart for reasonable cause or 
        because of her desertion;
          (12) ``compensation'' includes the money allowance 
        payable to an employee or his dependents and any other 
        benefits paid for from the Employees' Compensation 
        Fund, but this does not in any way reduce the amount of 
        the monthly compensation payable for disability or 
        death;
          (13) ``war-risk hazard'' means a hazard arising 
        during a war in which the United States is engaged; 
        during an armed conflict in which the United States is 
        engaged, whether or not war has been declared; or 
        during a war or armed conflict between military forces 
        of any origin, occurring in the country in which an 
        individual to whom this subchapter applies is serving; 
        from--
                  (A) the discharge of a missile, including 
                liquids and gas, or the use of a weapon, 
                explosive, or other noxious thing by a hostile 
                force or individual or in combating an attack 
                or an imagined attack by a hostile force or 
                individual;
                  (B) action of a hostile force or individual, 
                including rebellion or insurrection against the 
                United States or any of its allies;
                  (C) the discharge or explosion of munitions 
                intended for use in connection with a war or 
                armed conflict with a hostile force or 
                individual;
                  (D) the collision of vessels on convoy or the 
                operation of vessels or aircraft without 
                running lights or without other customary 
                peacetime aids to navigation; or
                  (E) the operation of vessels or aircraft in a 
                zone of hostilities or engaged in war 
                activities;
          (14) ``hostile force or individual'' means a nation, 
        a subject of a foreign nation, or an individual serving 
        a foreign nation--
                  (A) engaged in a war against the United 
                States or any of its allies;
                  (B) engaged in armed conflict, whether or not 
                war has been declared, against the United 
                States or any of its allies; or
                  (C) engaged in a war or armed conflict 
                between military forces of any origin in a 
                country in which an individual to whom this 
                subchapter applies is serving;
          (15) ``allies'' means any nation with which the 
        United States is engaged in a common military effort or 
        with which the United States has entered into a common 
        defensive military alliance;
          (16) ``war activities'' includes activities directly 
        relating to military operations;
          (17) ``student'' means an individual under 23 years 
        of age who has not completed 4 years of education 
        beyond the high school level and who is regularly 
        pursuing a full-time course of study or training at an 
        institution which is--
                  (A) a school or college or university 
                operated or directly supported by the United 
                States, or by a State or local government or 
                political subdivision thereof;
                  (B) a school or college or university which 
                has been accredited by a State or by a State-
                recognized or nationally recognized accrediting 
                agency or body;
                  (C) a school or college or university not so 
                accredited but whose credits are accepted, on 
                transfer, by at least three institutions which 
                are so accredited, for credit on the same basis 
                as if transferred from an institution so 
                accredited; or
                  (D) an additional type of educational or 
                training institution as defined by the 
                Secretary of Labor.
        Such an individual is deemed not to have ceased to be a 
        student during an interim between school years if the 
        interim is not more than 4 months and if he shows to 
        the satisfaction of the Secretary that he has a bona 
        fide intention of continuing to pursue a full-time 
        course of study or training during the semester or 
        other enrollment period immediately after the interim 
        or during periods of reasonable duration during which, 
        in the judgment of the Secretary, he is prevented by 
        factors beyond his control from pursuing his education. 
        A student whose 23rd birthday occurs during a semester 
        or other enrollment period is deemed a student until 
        the end of the semester or other enrollment period;
          (18) ``price index'' means the Consumer Price Index 
        (all items--United States city average) published 
        monthly by the Bureau of Labor Statistics; [and]
          (19) ``organ'' means a part of the body that performs 
        a special function, and for purposes of this subchapter 
        excludes the brain, heart, and back; [and]
          (20) ``United States medical officers and hospitals'' 
        includes medical officers and hospitals of the Army, 
        Navy, Air Force, Department of Veterans Affairs, and 
        United States Public Health Service, and any other 
        medical officer or hospital designated as a United 
        States medical officer or hospital by the Secretary of 
        Labor[.]; and
          (21) ``other eligible provider'' means a nurse 
        practitioner or physician assistant within the scope of 
        their practice as defined by State law.

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Sec. 8103. Medical services and initial medical and other benefits

  (a) The United States shall furnish to an employee who is 
injured while in the performance of duty, the services, 
appliances, and supplies prescribed or recommended by a 
qualified physician or other eligible provider, which the 
Secretary of Labor considers likely to cure, give relief, 
reduce the degree or the period of disability, or aid in 
lessening the amount of the monthly compensation. These 
services, appliances, and supplies shall be furnished--
          (1) whether or not disability has arisen;
          (2) notwithstanding that the employee has accepted or 
        is entitled to receive benefits under subchapter III of 
        chapter 83 of this title or another retirement system 
        for employees of the Government; and
          (3) by or on the order of United States medical 
        officers and hospitals, or, at the employee's option, 
        by or on the order of physicians or other eligible 
        providers and hospitals designated or approved by the 
        Secretary.
The employee may initially select a physician or other eligible 
provider to provide medical services, appliances, and supplies, 
in accordance with such regulations and instructions as the 
Secretary considers necessary, and may be furnished necessary 
and reasonable transportation and expenses incident to the 
securing of such services, appliances, and supplies. These 
expenses, when authorized or approved by the Secretary, shall 
be paid from the Employees' Compensation Fund.
  (b) The Secretary, under such limitations or conditions as he 
considers necessary, may authorize the employing agencies to 
provide for the initial furnishing of medical and other 
benefits under this section. The Secretary may certify vouchers 
for these expenses out of the Employees' Compensation Fund when 
the immediate superior of the employee certifies that the 
expense was incurred in respect to an injury which was accepted 
by the employing agency as probably compensable under this 
subchapter. The Secretary shall prescribe the form and content 
of the certificate.

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Sec. 8121. Claim

  Compensation under this subchapter may be allowed only if an 
individual or someone on his behalf makes claim therefor. The 
claim shall--
          (1) be made in writing within the time specified by 
        section 8122 of this title;
          (2) be delivered to the office of the Secretary of 
        Labor or to an individual whom the Secretary may 
        designate by regulation, or deposited in the mail 
        properly stamped and addressed to the Secretary or his 
        designee;
          (3) be on a form approved by the Secretary;
          (4) contain all information required by the 
        Secretary;
          (5) be sworn to by the individual entitled to 
        compensation or someone on his behalf; and
          (6) except in case of death, be accompanied by a 
        certificate of the physician or other eligible provider 
        of the employee stating the nature of the injury and 
        the nature and probable extent of the disability.
The Secretary may waive paragraphs (3)-(6) of this section for 
reasonable cause shown.

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Sec. 8123. Physical examinations

  (a) An employee shall submit to examination by a medical 
officer of the United States, or by a physician designated or 
approved by the Secretary of Labor, after the injury and as 
frequently and at the times and places as may be reasonably 
required. The employee may have a physician or other eligible 
provider designated and paid by him present to participate in 
the examination. If there is disagreement between the physician 
making the examination for the United States and the physician 
or other eligible provider of the employee, the Secretary shall 
appoint a third physician who shall make an examination.
  (b) An employee is entitled to be paid expenses incident to 
an examination required by the Secretary which in the opinion 
of the Secretary are necessary and reasonable, including 
transportation and loss of wages incurred in order to be 
examined. The expenses, when authorized or approved by the 
Secretary, are paid from the Employees' Compensation Fund.
  (c) The Secretary shall fix the fees for examinations held 
under this section by physicians not employed by or under 
contract to the United States to furnish medical services to 
employees. The fees, when authorized or approved by the 
Secretary, are paid from the Employees' Compensation Fund.
  (d) If an employee refuses to submit to or obstructs an 
examination, his right to compensation under this subchapter is 
suspended until the refusal or obstruction stops. Compensation 
is not payable while a refusal or obstruction continues, and 
the period of the refusal or obstruction is deducted from the 
period for which compensation is payable to the employee.

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