[House Report 119-263]
[From the U.S. Government Publishing Office]
119th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 119-263
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TERRITORIAL RESPONSE AND ACCESS TO
VETERANS' ESSENTIAL LIFECARE ACT
_______
September 10, 2025.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
_______
Mr. Bost, from the Committee on Veterans' Affairs, submitted the
following
R E P O R T
[To accompany H.R. 3400]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 3400) to amend title 38, United States Code, to
authorize the Secretary of Veterans Affairs to assign
physicians of the Department of Veterans Affairs to temporarily
serve as traveling physicians in the territories and
possessions of the United States, and for other purposes,
having considered the same, reports favorably thereon with an
amendment and recommends that the bill as amended do pass.
CONTENTS
Page
Amendment........................................................ 2
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 3
Hearings......................................................... 5
Committee Consideration.......................................... 6
Committee Votes.................................................. 7
Committee Oversight Findings..................................... 7
Statement of General Performance Goals and Objectives............ 7
Earmarks and Tax and Tariff Benefits............................. 7
Committee Cost Estimate.......................................... 7
Budget Authority and Congressional Budget Office Estimate........ 7
Federal Mandates Statement....................................... 11
Advisory Committee Statement..................................... 11
Applicability to Legislative Branch.............................. 11
Statement on Duplication of Federal Programs..................... 11
Section-by-Section Analysis of the Legislation................... 11
Changes in Existing Law Made by the Bill, as Reported............ 12
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 ``Territorial Response and Access to
Veterans' Essential Lifecare Act'' or the ``TRAVEL Act of 2025''.
SEC. 2. DEPARTMENT OF VETERANS ASSIGNMENT OF TRAVELING PHYSICIANS TO
SERVE TERRITORIES AND POSSESSIONS.
(a) In General.--Subchapter I of chapter 74 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 7415. Traveling physicians
``(a) In General.--(1) The Secretary may assign a physician appointed
under section 7401 or section 7431 of this title to serve as a
traveling physician for a period of not more than one year at a time. A
physician assigned to serve as a traveling physician under this section
may be assigned to provide health care to veterans residing in American
Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the
Commonwealth of Puerto Rico, the Virgin Islands of the United States,
or any other territory or possession of the United States at Department
facilities or other approved facilities located in such territory or
possession.
``(2) The Secretary may assign multiple physicians to serve as
traveling physicians under this section and may assign each such
physician to serve in a specific territory or possession.
``(b) Coordination of Care.--In providing care under this section,
traveling physicians shall coordinate with non-Department medical
providers to the extent practicable and necessary to ensure high
quality and coordinated care for veterans receiving hospital care and
medical services.
``(c) Pay.--In addition to pay under section 7431 of this title, the
Secretary shall provide a relocation or retention bonus to traveling
physicians under this section. Such relocation or retention bonus shall
be substantially similar to a relocation or retention bonus offered
under section 7410(a) of this title, as the Secretary considers
appropriate.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
7414 the following new item:
``7415. Traveling physicians.''.
(c) Technical and Conforming Amendments.--Title 38, United States
Code, is further amended as follows:
(1) In section 7410(a)(1), by--
(A) by striking ``retention allowances'' and
inserting ``retention bonuses''; and
(B) by striking the second comma after ``section
7401(1) of this title''; and
(2) In section 7431(e)(5)(B), by striking ``retention
allowances'' and inserting ``retention bonuses''.
SEC. 3. EXTENSION OF CERTAIN LIMITS ON PAYMENTS OF PENSION.
Section 5503(d)(7) of title 38, United States Code, is amended by
striking ``November 30, 2031'' and inserting ``December 31, 2032''.
Purpose and Summary
H.R. 3400, the ``Territorial Response and Access to
Veterans' Essential Lifecare Act,'' or the ``TRAVEL Act of
2025,'' was introduced by Delegate Kimberlyn King-Hinds of the
Commonwealth of the Northern Mariana Islands on May 14, 2025.
H.R. 3400, as amended, would authorize the Secretary of the
Department of Veterans Affairs (VA) to assign physicians to
temporarily serve as traveling physicians in the territories
and possessions of the United States.
Background and Need for Legislation
Section 1: Short title
This section would name the act ``the Territorial Response
and Access to Veterans' Essential Lifecare Act'' or the
``TRAVEL Act of 2025.''
Section 2: Department of Veterans assignment of traveling physicians to
serve territories and possessions
VA provides healthcare in the five U.S. territories\1\:
Commonwealth of Northern Mariana Islands (CNMI), Guam, and
American Samoa in the Pacific, and the Commonwealth of Puerto
Rico and the U.S. Virgin Islands in the Atlantic. In the
Pacific, the VA Pacific Islands Health Care System consists of
a VA medical center (VAMC) in Honolulu, Hawaii, and three
outpatient clinics in American Samoa, Guam, and CNMI. In the
Atlantic, the VA Caribbean Healthcare System consists of a VAMC
in San Juan, Puerto Rico, and 10 outpatient clinics across
Puerto Rico and the U.S. Virgin Islands.\2\ In fiscal year
2022, the VA Pacific Islands Health Care System coordinated
healthcare for an estimated 7,200 enrolled veterans, and the VA
Caribbean Healthcare System coordinated healthcare for an
estimated 61,000 enrolled veterans.\3\
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\1\GAO, Veterans Affairs: Actions Needed to Improve Access to Care
in the U.S. Territories and Freely Associated States (May 23, 2024),
https://www.gao.gov/products/gao-24-106364. The possessions of the U.S.
include the U.S. Minor Outlying Islands, which ``refers to certain
small islands that are U.S. Territories under U.S. jurisdiction in the
Caribbean Sea and Pacific Ocean: Baker Island, Howland Island, Jarvis
Island, Johnston Atoll, Kingman Reef, Midway Islands, Navassa Island,
Palmyra Atoll, and Wake Island. [. . .] they generally do not include
population year-round.'' U.S. Census Bureau, Glossary (last visited
August 20, 2025), https://www.census.gov/programs-surveys/geography/
about/glossary.html.
\2\GAO, Veterans Affairs: Actions Needed to Improve Access to Care
in the U.S. Territories and Freely Associated States (May 23, 2024),
https://www.gao.gov/products/gao-24-106364.
\3\GAO, Veterans Affairs: Actions Needed to Improve Access to Care
in the U.S. Territories and Freely Associated States (May 23, 2024),
https://www.gao.gov/products/gao-24-106364.
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The veterans in these systems expend significant resources
to obtain their earned healthcare through VA.
Mr. Randy Johnson, CNMI resident and veteran of the U.S.
Marine Corps, testified before the Health Subcommittee, ``When
veterans need more than basic care, we are often told to leave
the island, traveling thousands of miles, paying out of pocket,
and spending weeks away from our families.''\4\ Even basic
healthcare options are limited. According to Mr. Johnson,
``Veterans seeking care at home see one doctor, on Tuesdays and
Thursdays. [. . .] Her office has one VA Registered Nurse, a
veteran herself. But if she needs care, or takes a much-needed
vacation, there is no one left to keep pace.''\5\
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\4\Legislative Hearing on: H.R. 785, The Representing Our Seniors
at VA Act of 2025, H.R. 2068, The Veterans Patient Advocacy Act, H.R.
2605, The Service Dogs Assisting Veterans (SAVES) Act, H.R. 3400, The
Territorial Response and Access to Veterans' Essential Lifecare
(TRAVEL) Act of 2025, Discussion Draft: To amend title 38, United
States Code, to prohibit smoking on the premises of any facility of the
Veterans Health Administration, and for other purposes, Discussion
Draft: The VA Data Transparency and Trust Act, Discussion Draft: To
direct the Secretary of Veterans Affairs to conduct a study to
determine whether RNA sequencing can be used to effectively diagnose
PTSD in veterans, Discussion Draft: The Health Professionals
Scholarship Program Improvement Act of 2025, Discussion Draft: The
Fisher House Availability Act of 2025, H.R. 1404, The CHAMPVA
Children's Care Protection Act of 2025, H.R. 2148, The Veteran
Caregiver Reeducation, Reemployment, and Retirement Act, Discussion
Draft: The VA Mental Health Outreach and Engagement Act Before the
Subcommittee on Health of the Committee on Veterans' Affairs, 119th
Cong. (2025) (Statement of Randy T. Johnson).
\5\Legislative Hearing on: H.R. 785, The Representing Our Seniors
at VA Act of 2025, H.R. 2068, The Veterans Patient Advocacy Act, H.R.
2605, The Service Dogs Assisting Veterans (SAVES) Act, H.R. 3400, The
Territorial Response and Access to Veterans' Essential Lifecare
(TRAVEL) Act of 2025, Discussion Draft: To amend title 38, United
States Code, to prohibit smoking on the premises of any facility of the
Veterans Health Administration, and for other purposes, Discussion
Draft: The VA Data Transparency and Trust Act, Discussion Draft: To
direct the Secretary of Veterans Affairs to conduct a study to
determine whether RNA sequencing can be used to effectively diagnose
PTSD in veterans, Discussion Draft: The Health Professionals
Scholarship Program Improvement Act of 2025, Discussion Draft: The
Fisher House Availability Act of 2025, H.R. 1404, The CHAMPVA
Children's Care Protection Act of 2025, H.R. 2148, The Veteran
Caregiver Reeducation, Reemployment, and Retirement Act, Discussion
Draft: The VA Mental Health Outreach and Engagement Act Before the
Subcommittee on Health of the Committee on Veterans' Affairs, 119th
Cong. (2025) (Statement of Randy T. Johnson).
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A Guam veteran must travel almost 4,000 miles for care at
the Honolulu VAMC.\6\ An American Samoan veteran must travel
over 2,500 miles for care.\7\ A CNMI veteran must travel about
130 miles to Guam in order to travel to Hawaii.\8\ Another
subset of U.S. veterans, those who reside in the Freely
Associated States (FAS) and chose to serve in the U.S.
military, likewise have no locally available VA resources.\9\
Distances are shorter between the U.S. Virgin Islands and the
San Juan VAMC in Puerto Rico, but also require a veteran to
take a flight to obtain health care.
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\6\GAO, Veterans Affairs: Actions Needed to Improve Access to Care
in the U.S. Territories and Freely Associated States (May 23, 2024),
https://www.gao.gov/products/gao-24-106364.
\7\GAO, Veterans Affairs: Actions Needed to Improve Access to Care
in the U.S. Territories and Freely Associated States (May 23, 2024),
https://www.gao.gov/products/gao-24-106364.
\8\GAO, Veterans Affairs: Actions Needed to Improve Access to Care
in the U.S. Territories and Freely Associated States (May 23, 2024),
https://www.gao.gov/products/gao-24-106364.
\9\The Freely Associated States (FAS) include Palau, the Federated
States of Micronesia, and the Marshall Islands. These three nations are
signatories with the United States on the Compact of Free Association
(COFA), in which the United States provides for defense and social
services for citizens of the FAS. In return, many FAS citizens choose
to serve in the U.S. military.
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Even basic primary care is limited for some veterans. In
the Pacific, for instance, there is no community-based
outpatient clinic in CNMI, and as of September 2022, most of
the 88 Veterans Health Administration (VHA) employees worked in
Guam.\10\
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\10\GAO, Veterans Health Administration: Hiring Trends in the U.S.
Pacific Territories (Feb. 16, 2023), https://www.gao.gov/products/gao-
23-105953.
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To address the access to care issue, this section would
bring VA care to the dedicated veterans of the U.S.
territories, where residents enlist in the U.S. military at
high rates.\11\ This section would provide the Secretary the
authority to assign a physician to serve as a traveling
physician for a period of not more than one year at a time.
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\11\``In 2022, the top five enlistment rates per capita for the 50
U.S. states and D.C., five U.S. territories, and FAS were, in order,
Guam, [the Commonwealth of the Northern Mariana Islands], [the U.S.
Virgin Islands], American Samoa, and the Republic of Palau.'' GAO,
Veterans Affairs: Actions Needed to Improve Access to Care in the U.S.
Territories and Freely Associated States (May 23, 2024), https://
www.gao.gov/products/gao-24-106364.
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The Committee believes, granting the Secretary the
authority to assign physicians to the U.S. territories under
this section would help to alleviate they burden on these
veterans in accessing their earned care through VA. An assigned
traveling physician would not necessarily provide care in each
and every possession or territory. But such a physician would
be able to see veterans traveling to the particular locale. For
instance, as the CNMI is comprised of several islands, the
Secretary could assign a physician to Saipan who would then see
patients from Tinian or Rota or even from the FAS. Further,
nothing in this legislation would prevent such a physician from
traveling within the CNMI island chain to see patients.
This section would also not dictate the type of physician
that should be assigned. The committee expects VA to decide
with the best clinical value in mind. In many cases, this may
mean a primary care physician. But given that diabetes and
heart disease are prevalent in some U.S. territories, it may be
of benefit to assign a cardiologist or endocrinologist or other
specialist to prevent veterans from needing to fly elsewhere
for specialty care. For instance, the Secretary could assign a
specialist to Guam who can treat veterans from the American
territories and the FAS, alleviating some of the need to fly to
Honolulu for specialty care.
This section would also require that the physicians
coordinate care with non-Departmental medical providers. This
would multiply resources and enhance the exchange of
information about healthcare needs among the veteran population
without necessarily requiring VA to establish a separate
physical presence in each of the territories.
The section would also require the Secretary to provide
retention or relocation bonuses. The Committee finds that these
bonuses would be necessary so that physicians are willing to
stay or travel to the territories. VHA officials have said when
discussing some of the territories covered by this bill that
hiring is ``very difficult,'' and ``using retention incentives
to maintain existing staff was ideal.''\12\ A relocation bonus
for traveling physicians would compensate the physicians for
the not unlikely scenario of leaving home for an extended
period of time in order to fulfill the responsibilities of the
assignment.
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\12\GAO, Veterans Health Administration: Hiring Trends in the U.S.
Pacific Territories (Feb. 16, 2023), https://www.gao.gov/products/gao-
23-105953.
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Section 3: Extension of certain limits of payments of pension
Under current law (38 U.S.C. Sec. 5503(d)), the amount of
VA pension paid to a veteran having no spouse nor child, a
veteran's surviving spouses having no child, or a veterans'
child who is admitted to a VA or Medicaid sponsored nursing
facility is capped at $90 a month. This section would cover the
costs of the other sections of this bill by extending this
pension limitation by thirteen months to December 31, 2032.
Because they receive government sponsored care in a nursing
home, these pension beneficiaries do not require the full
amount of pension to cover their cost of living. The Committee
believes this short-term extension of the current limit on
pension payments is a reasonable way to cover the costs
associated with the other sections of this bill.
Hearings
On June 12, 2025, the Subcommittee on Health held a
legislative hearing on H.R. 3400 and other bills pending before
the subcommittee. The following witnesses testified:
The Honorable Gregory F. Murphy, U.S. House of
Representatives, 3rd Congressional District, North
Carolina; The Honorable Morgan Luttrell, U.S. House of
Representatives, 8th Congressional District, Texas; The
Honorable Jennifer A. Kiggans, U.S. House of
Representatives, 2nd Congressional District, Virginia;
The Honorable Abraham J. Hamadeh, U.S. House of
Representatives, 8th Congressional District, Arizona;
The Honorable Kimberlyn King-Hinds, U.S. House of
Representatives, District At Large, Northern Mariana
Islands; The Honorable John J. McGuire, U.S. House of
Representatives, 5th Congressional District, Virginia;
The Honorable Joseph D. Morelle, U.S. House of
Representatives, 25th Congressional District, New York;
The Honorable Nikki Budzinski, U.S. House of
Representatives, 13th Congressional District, Illinois;
Dr. Antoinette V. Shappell, Deputy Assistant Under
Secretary for Health for Patient Care Services,
Veterans Health Administration, U.S. Department of
Veterans Affairs; Dr. Ilse Wiechers, Deputy Executive
Director, Office of Mental Health, Veterans Health
Administration, U.S. Department of Veterans Affairs;
Randy Johnson, Constituent, District At Large, Northern
Mariana Islands; Cole T. Lyle, Director, Veterans
Affairs & Rehabilitation Division, The American Legion;
David Coker, President, Fisher House Foundation; John
Schmitt, Chief Executive Officer, iXpressGenes, Inc.;
Caira Benson, Caregiver Fellow, Elizabeth Dole
Foundation.
The following individuals and organizations submitted
statements for the record:
K9s for Warriors, Quality of Life Foundation,
National Association of State Veterans Homes, Military
Officers Association of America, National Association
of Veterans' Research and Education Foundations,
iXpressGenes, Inc., Paralyzed Veterans of America, The
Honorable Joseph D. Morelle, Concerned Veterans for
America, USAA, Student Veterans of America, American
Academy of Physician Associates, Veterans of Foreign
Wars of the United States.
Subcommittee Consideration
On July 23, 2025, the Subcommittee on Health was discharged
from further consideration of this legislation.
Committee Consideration
On July 23, 2025, the full Committee met in open markup
session, a quorum being present, and ordered H.R. 3400, as
amended, be reported favorably to the House of Representatives
by voice vote. During consideration of the bill, the following
amendments were considered:
An amendment in the nature of a substitute offered by
Delegate Kimberlyn King-Hinds of the Commonwealth of
the Northern Mariana Islands would clarify the number
of traveling physicians the Secretary may assign. The
amendment in the nature of a substitute would also
change reference to pay authorities from Title 5 to
Title 38 for purposes of the relocation or retention
bonus the Secretary would provide. The amendment in the
nature of substitute, as amended, was agreed to by
voice vote.
An amendment to the amendment in the nature of a
substitute offered Chairman Mike Bost of Illinois would
offset the anticipated $70 million cost of the
legislation using the pension program under 38 U.S.C.
Sec. 5503. The amendment to the amendment in the nature
of a substitute was agreed to by voice vote.
A motion by Representative Mark Takano of California to
report H.R. 3400, as amended, favorably to the House of
Representatives was agreed to by voice vote.
Committee Votes
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, no recorded votes were taken on
amendments or in connection with ordering H.R. 3400, as
amended, reported to the House.
Committee Oversight Findings
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 descriptive portions of
this report.
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives of H.R. 3400, as amended, are to increase
healthcare access for veterans living in the U.S. territories
and possessions or living closer to the U.S. territories than
the nearest VA facility (e.g., those residing in the FAS) by
authorizing the Secretary to assign travel physicians to those
areas.
Earmarks and Tax and Tariff Benefits
H.R. 3400, as amended, 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.
Committee Cost Estimate
The Committee adopts as its own the cost estimate on H.R.
3400, as amended, prepared by the Director of the Congressional
Budget.
Budget Authority and Congressional Budget Office
Cost Estimate
Pursuant to clause (3)(c)(3) of rule XIII of the Rules of
the House of Representatives, the following is the cost
estimate for H.R. 3400, as amended, provided by the
Congressional Budget Office pursuant to section 402 of the
Congressional Budget Act of 1974:
The bill would:
Authorize the Department of Veterans Affairs
(VA) to assign traveling physicians to U.S. territories
Require VA to provide relocation or
retention bonuses to department physicians assigned to
U.S. territories
Extend the reduction of pensions that VA
pays to veterans and survivors residing in Medicaid
nursing homes
Estimated budgetary effects would mainly stem from:
Providing relocation and retention bonuses
to department physicians assigned to U.S. territories
Reducing pension payments
Bill summary: H.R. 3400 would authorize the Department of
Veterans Affairs (VA) to assign physicians to serve as
traveling doctors to veterans in U.S. territories. The bill
would require VA to provide relocation or retention bonuses to
those traveling physicians. Finally, the bill would extend a
temporary limitation on certain pension payments through
December 31, 2032.
Estimated Federal cost: The estimated budgetary effects of
H.R. 3400 are shown in Table 1. The costs of the legislation
fall within budget functions 550 (health) and 700 (veterans
benefits and services).
TABLE 1.--ESTIMATED BUDGETARY EFFECTS OF H.R. 3400
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By fiscal year, millions of dollars--
------------------------------------------------------------------------------------------------
2025- 2025-
2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2030 2035
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INCREASES OR DECREASES (-) IN DIRECT SPENDING
Estimated BudgetPAuthority............................. 0 * * 1 1 1 -39 -11 1 1 1 3 -44
Estimated Outlays...................................... 0 * * 1 1 1 -39 -11 1 1 1 3 -44
INCREASES IN SPENDING SUBJECT TO APPROPRIATION
Estimated Authorization................................ 0 2 2 2 2 2 2 2 2 2 2 10 20
Estimated Outlays...................................... 0 2 2 2 2 2 2 2 2 2 2 10 20
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* = between zero and $500,000.
Basis of estimate: For this estimate, CBO assumes that H.R.
3400 will be enacted near the beginning of fiscal year 2026 and
that outlays will follow historical spending patterns for
affected programs.
Provisions that affect spending subject to appropriation
and direct spending: Section 2 of H.R. 3400 would allow VA to
assign department physicians to serve as traveling doctors to
veterans in U.S. territories. Using information from studies on
the number of patients a physician can serve and the number of
veterans who live in U.S. territories, CBO estimates that about
50 doctors would be assigned to serve as traveling physicians.
Under the bill, VA would be required to provide relocation
or retention bonuses to physicians assigned under the program.
Under current law, VA is authorized to provide relocation and
retention bonuses of up to 25 percent of a physician's annual
salary. CBO estimates that the cost of providing bonuses of
that magnitude would average roughly $56,000 per physician per
year. In total, CBO estimates that implementing section 2 would
cost $28 million over the 2025-2035 period.
CBO expects that some of the costs of implementing the bill
would be paid from the Toxic Exposures Fund (TEF) established
by Public Law 117-168, the Honoring our PACT Act. The TEF is a
mandatory appropriation that VA uses to pay for health care,
disability claims processing, medical research, and IT
modernization that benefit veterans who were exposed to
environmental hazards.
Additional spending from the TEF would occur if legislation
increases the costs of similar activities that benefit veterans
with such exposure. Thus, in addition to increasing spending
subject to appropriation, enacting section 2 would increase
amounts paid from the TEF, which are classified as direct
spending. CBO projects that the proportion of costs paid by the
TEF will grow over time based on the amount of formerly
discretionary appropriations that CBO expects will be provided
through the mandatory appropriation as specified in the
Honoring our PACT Act.\1\
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\1\For additional information about estimated spending from the
TEF, see Congressional Budget Office, ``Toxic Exposures Fund--January
2025 Baseline'' (January 2025), https://tinyurl.com/465ytckb.
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CBO estimates that over the 2025-2035 period, implementing
section 2 would increase spending subject to appropriation by
$20 million and direct spending by $8 million.
Direct spending: In addition to expanding benefits that
would partly be covered by the TEF, enacting H.R.3400 would
affect direct spending by extending a statutory limitation on
VA pension payments. In total, enacting the bill would decrease
net direct spending by $44 million over the 2025-2035 period
(see Table 2).
Under current law, VA reduces pension payments to veterans
and survivors who reside in Medicaid nursing homes to $90 per
month. That required reduction expires November 30, 2031.
Section 3 of H.R. 3400 would extend that reduction for 13
months, through December 31, 2032. CBO estimates that extending
that requirement would reduce VA benefits by $10 million per
month. As a result of that reduction in beneficiaries' income,
Medicaid would pay more of the cost of their care, increasing
spending for that program by $6 million per month. Thus,
enacting section 3 would reduce net direct spending by $52
million over the 2025-2035 period.
TABLE 2.--ESTIMATED CHANGES IN DIRECT SPENDING UNDER H.R. 3400
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By fiscal year, millions of dollars--
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2025- 2025-
2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2030 2035
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Traveling Physicians:
Estimated Budget Authority......................... 0 * * 1 1 1 1 1 1 1 1 3 8
Estimated Outlays.................................. 0 * * 1 1 1 1 1 1 1 1 3 8
Pensions and Medicaid:
Estimated Budget Authority......................... 0 0 0 0 0 0 -40 -12 0 0 0 0 -52
Estimated Outlays.................................. 0 0 0 0 0 0 -40 -12 0 0 0 0 -52
Total Changes:
Estimated Budget Authority......................... 0 * * 1 1 1 -39 -11 1 1 1 3 -44
Estimated Outlays.................................. 0 * * 1 1 1 -39 -11 1 1 1 3 -44
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* = between zero and $500,000.
Spending subject to appropriation: The discussion above in
``Provisions that Affect Spending Subject to Appropriation and
Direct Spending'' describes the costs of providing relocation
or retention bonuses to department physicians assigned to U.S.
territories. Providing those bonuses would increase spending
subject to appropriation by $20 million over the 2025-2035
period, CBO estimates.
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. The net changes in outlays that are subject to those
pay-as-you-go procedures are shown in Table 1.
Increase in long-term net direct spending and deficits: CBO
estimates that enacting H.R. 3400 would not increase net direct
spending by more than $2.5 billion in any of the four
consecutive 10-year periods beginning in 2036.
CBO estimates that enacting H.R. 3400 would not increase
on-budget deficits by more than $5 billion in any of the four
consecutive 10-year periods beginning in 2036.
Mandates: The bill contains no intergovernmental or
private-sector mandates as defined in the Unfunded Mandates
Reform Act.
Estimate prepared by: Federal costs: Noah Callahan (for
veterans' health care), Logan Smith (for pensions and
Medicaid); Mandates: Brandon Lever.
Estimate reviewed by: David Newman, Chief, Defense,
International Affairs, and Veterans' Affairs Cost Estimates
Unit; Kathleen FitzGerald, Chief, Public and Private Mandates
Unit; Christina Hawley Anthony, Deputy Director of Budget
Analysis.
Estimate approved by: Phillip L. Swagel, Director,
Congressional Budget Office.
Federal Mandates Statement
With respect to the requirements of Section 423 of the
Congressional Budget and Impoundment Control Act (as amended by
Section 101(a)(2) of the Unfunded Mandate Reform Act, P.L. 104-
4), the Committee has requested but not received from the
Director of the Congressional Budget Office a statement as to
whether the provisions of the reported bill include unfunded
mandates.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
3400, as amended.
Applicability to Legislative Branch
The Committee finds that H.R. 3400, as amended, does not
relate to the terms and conditions of employment or access to
public services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Statement on Duplication of Federal Programs
Pursuant to clause 3(c)(5) of rule XIII of the Rules of the
House of Representatives, the Committee finds that no provision
of H.R. 3400, as amended, 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.
Section-by-Section Analysis of the Legislation
Section 1: Short title
This section would establish the title of the bill as the
``Territorial Response and Access to Veterans' Essential
Lifecare Act,'' or the ``TRAVEL Act of 2025.''
Section 2: Department of Veterans assignment of traveling physicians to
serve territories and possessions
This section would create a new section at 38 U.S.C.
Sec. 7415, ``Traveling physicians.'' It would give the
Secretary additional appointment authority under sections 7401
and 7431 to assign a traveling physician or multiple traveling
physicians--for a period of not more than one year at a time--
to provide health care to veterans in the U.S. territories and
possessions of American Samoa, Guam, the Commonwealth of the
Northern Mariana Islands, the Commonwealth of Puerto Rico, the
U.S. Virgin Islands, or any other U.S. territory or possession.
The traveling physician would provide health care at
Department facilities or other approved facilities located in
the given territory or possession. In providing care, the
traveling physician would coordinate with non-Department
medical providers to ensure high quality and coordinated care
for veterans receiving hospital care and medical services.
Under this section, the Secretary would provide a
relocation or retention bonus to the traveling physician. The
bonus would have to be substantially similar to the relocation
or retention bonus offered under section 7410(a). The Secretary
would have the authority to decide the exact parameters of the
relocation or retention bonus beyond the substantial similarity
to section 7410(a).
The section would make clerical, technical, and conforming
amendments. Among other amendments, the section would use the
phrase ``retention bonuses'' instead of ``retention
allowances'' in sections 7410(a)(1) and 7431(e)(5)(B).
Section 3: Extension of certain limits of payments of pension
This section would extend the termination date of
limitations on VA pension payments to institutionalized
beneficiaries by amending 38 U.S.C. Sec. 5503(d)(7), changing
the expiration from November 30, 2031, to December 31, 2032.
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, existing law in which no change
is proposed is shown in roman):
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 38, UNITED STATES CODE
* * * * * * *
PART IV--GENERAL ADMINISTRATIVE PROVISIONS
* * * * * * *
CHAPTER 55--MINORS, INCOMPETENTS, AND OTHER WARDS
* * * * * * *
Sec. 5503. Hospitalized veterans and estates of incompetent
institutionalized veterans
(a)(1)(A) Where any veteran having neither spouse nor child
is being furnished domiciliary care by the Department, no
pension in excess of $90 per month shall be paid to or for the
veteran for any period after the end of the third full calendar
month following the month of admission for such care.
(B) Except as provided in subparagraph (D) of this
paragraph, where any veteran having neither spouse nor child is
being furnished nursing home care by the Department, no pension
in excess of $90 per month shall be paid to or for the veteran
for any period after the end of the third full calendar month
following the month of admission for such care. Any amount in
excess of $90 per month to which the veteran would be entitled
but for the application of the preceding sentence shall be
deposited in a revolving fund at the Department medical
facility which furnished the veteran nursing care, and such
amount shall be available for obligation without fiscal year
limitation to help defray operating expenses of that facility.
(C) No pension in excess of $90 per month shall be paid to
or for a veteran having neither spouse nor child for any period
after the month in which such veteran is readmitted for care
described in subparagraph (A) or (B) of this paragraph and
furnished by the Department if such veteran is readmitted
within six months of a period of care in connection with which
pension was reduced pursuant to subparagraph (A) or (B) of this
paragraph.
(D) In the case of a veteran being furnished nursing home
care by the Department and with respect to whom subparagraph
(B) of this paragraph requires a reduction in pension, such
reduction shall not be made for a period of up to three
additional calendar months after the last day of the third
month referred to in such subparagraph if the Secretary
determines that the primary purpose for the furnishing of such
care during such additional period is for the Department to
provide such veteran with a prescribed program of
rehabilitation services, under chapter 17 of this title,
designed to restore such veteran's ability to function within
such veteran's family and community. If the Secretary
determines that it is necessary, after such period, for the
veteran to continue such program of rehabilitation services in
order to achieve the purposes of such program and that the
primary purpose of furnishing nursing home care to the veteran
continues to be the provision of such program to the veteran,
the reduction in pension required by subparagraph (B) of this
paragraph shall not be made for the number of calendar months
that the Secretary determines is necessary for the veteran to
achieve the purposes of such program.
(2) The provisions of paragraph (1) shall also apply to a
veteran being furnished such care who has a spouse but whose
pension is payable under section 1521(b) of this title. In such
a case, the Secretary may apportion and pay to the spouse, upon
an affirmative showing of hardship, all or any part of the
amounts in excess of the amount payable to the veteran while
being furnished such care which would be payable to the veteran
if pension were payable under section 1521(c) of this title.
(b) Notwithstanding any other provision of this section or
any other provision of law, no reduction shall be made in the
pension of any veteran for any part of the period during which
the veteran is furnished hospital treatment, or institutional
or domiciliary care, for Hansen's disease, by the United States
or any political subdivision thereof.
(c) Where any veteran in receipt of an aid and attendance
allowance described in subsection (r) or (t) of section 1114 of
this title is hospitalized at Government expense, such
allowance shall be discontinued from the first day of the
second calendar month which begins after the date of the
veteran's admission for such hospitalization for so long as
such hospitalization continues. Any discontinuance required by
administrative regulation, during hospitalization of a veteran
by the Department, of increased pension based on need of
regular aid and attendance or additional compensation based on
need of regular aid and attendance as described in subsection
(l) or (m) of section 1114 of this title, shall not be
effective earlier than the first day of the second calendar
month which begins after the date of the veteran's admission
for hospitalization. In case a veteran affected by this
subsection leaves a hospital against medical advice and is
thereafter admitted to hospitalization within six months from
the date of such departure, such allowance, increased pension,
or additional compensation, as the case may be, shall be
discontinued from the date of such readmission for so long as
such hospitalization continues.
(d)(1) For the purposes of this subsection--
(A) the term ``Medicaid plan'' means a State plan
for medical assistance referred to in section 1902(a)
of the Social Security Act (42 U.S.C. 1396a(a)); and
(B) the term ``nursing facility'' means a nursing
facility described in section 1919 of such Act (42
U.S.C. 1396r), other than a facility that is a State
home with respect to which the Secretary makes per diem
payments for nursing home care pursuant to section
1741(a) of this title.
(2) If a veteran having neither spouse nor child is covered
by a Medicaid plan for services furnished such veteran by a
nursing facility, no pension in excess of $90 per month shall
be paid to or for the veteran for any period after the month of
admission to such nursing facility.
(3) Notwithstanding any provision of title XIX of the
Social Security Act, the amount of the payment paid a nursing
facility pursuant to a Medicaid plan for services furnished a
veteran may not be reduced by any amount of pension permitted
to be paid such veteran under paragraph (2) of this subsection.
(4) A veteran is not liable to the United States for any
payment of pension in excess of the amount permitted under this
subsection that is paid to or for the veteran by reason of the
inability or failure of the Secretary to reduce the veteran's
pension under this subsection unless such inability or failure
is the result of a willful concealment by the veteran of
information necessary to make a reduction in pension under this
subsection.
(5)(A) The provisions of this subsection shall apply with
respect to a surviving spouse having no child in the same
manner as they apply to a veteran having neither spouse nor
child.
(B) The provisions of this subsection shall apply with
respect to a child entitled to pension under section 1542 of
this title in the same manner as they apply to a veteran having
neither spouse nor child.
(6) The costs of administering this subsection shall be
paid for from amounts available to the Department of Veterans
Affairs for the payment of compensation and pension.
(7) This subsection expires on [November 30, 2031] December
31, 2032.
* * * * * * *
PART V--BOARDS, ADMINISTRATIONS, AND SERVICES
* * * * * * *
CHAPTER 74--VETERANS HEALTH ADMINISTRATION--PERSONNEL
SUBCHAPTER I--APPOINTMENTS
Sec.
* * * * * * *
7415. Traveling physicians.
* * * * * * *
SUBCHAPTER I--APPOINTMENTS
* * * * * * *
Sec. 7410. Additional pay authorities
(a) In General.--(1) The Secretary may authorize the Under
Secretary for Health to pay advance payments, recruitment or
relocation bonuses, and [retention allowances] retention
bonuses to personnel appointed under section 7306 of this title
or section 7401(4) of this title, or personnel described in
section 7401(1) of this title,[,] or interview expenses to
candidates for appointment as such personnel, in a manner
consistent with the authority provided under sections 5524a,
5706b, 5753, and 5754 of title 5.
(2) Payments under paragraph (1) shall not be considered in
calculating the limitation under section 7431(e)(4) of this
title.
(b) Special Incentive Pay for Department Pharmacist
Executives.--(1) In order to recruit and retain highly
qualified Department pharmacist executives, the Secretary may
authorize the Under Secretary for Health to pay special
incentive pay of not more than $40,000 per year to an
individual of the Veterans Health Administration who is a
pharmacist executive.
(2) In determining whether and how much special pay to
provide to such individual, the Under Secretary shall consider
the following:
(A) The grade and step of the position of the
individual.
(B) The scope and complexity of the position of the
individual.
(C) The personal qualifications of the individual.
(D) The characteristics of the labor market
concerned.
(E) Such other factors as the Secretary considers
appropriate.
(3) Special incentive pay under paragraph (1) for an
individual is in addition to all other pay (including basic
pay) and allowances to which the individual is entitled.
(4) Except as provided in paragraph (5), special incentive
pay under paragraph (1) for an individual shall be considered
basic pay for all purposes, including retirement benefits under
chapters 83 and 84 of title 5, and other benefits.
(5) Special incentive pay under paragraph (1) for an
individual shall not be considered basic pay for purposes of
adverse actions under subchapter V of this chapter.
(6) Special incentive pay under paragraph (1) may not be
awarded to an individual in an amount that would result in an
aggregate amount of pay (including bonuses and awards) received
by such individual in a year under this title that is greater
than the annual pay of the President.
* * * * * * *
Sec. 7415. Traveling physicians
(a) In General.--(1) The Secretary may assign a physician
appointed under section 7401 or section 7431 of this title to
serve as a traveling physician for a period of not more than
one year at a time. A physician assigned to serve as a
traveling physician under this section may be assigned to
provide health care to veterans residing in American Samoa,
Guam, the Commonwealth of the Northern Mariana Islands, the
Commonwealth of Puerto Rico, the Virgin Islands of the United
States, or any other territory or possession of the United
States at Department facilities or other approved facilities
located in such territory or possession.
(2) The Secretary may assign multiple physicians to serve
as traveling physicians under this section and may assign each
such physician to serve in a specific territory or possession.
(b) Coordination of Care.--In providing care under this
section, traveling physicians shall coordinate with non-
Department medical providers to the extent practicable and
necessary to ensure high quality and coordinated care for
veterans receiving hospital care and medical services.
(c) Pay.--In addition to pay under section 7431 of this
title, the Secretary shall provide a relocation or retention
bonus to traveling physicians under this section. Such
relocation or retention bonus shall be substantially similar to
a relocation or retention bonus offered under section 7410(a)
of this title, as the Secretary considers appropriate.
* * * * * * *
SUBCHAPTER III--PAY FOR PHYSICIANS, PODIATRISTS, OPTOMETRISTS, AND
DENTISTS
Sec. 7431. Pay
(a) Elements of Pay.--Pay of physicians, podiatrists,
optometrists, 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,
podiatrists, optometrists, and dentists shall be base pay. Base
pay shall meet the following requirements:
(1) Each physician, podiatrist, optometrist and
dentist is entitled to base pay determined under the
Physician, Podiatrist, and Dentist Base and Longevity
Pay Schedule.
(2) The Physician, Podiatrist, 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,
podiatrist, optometrist or dentist is based on the
total number of the years of the service of the
physician, podiatrist, optometrist or dentist in the
Veterans Health Administration as follows:
(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.
(5) The non-foreign cost of living adjustment
allowance authorized under section 5941 of title 5 for
physicians, podiatrists, optometrists, and dentists
whose pay is set under this section shall be determined
as a percentage of base pay only.
(c) Market Pay.--One element of pay for physicians,
podiatrists, optometrists, and dentists shall be market pay.
Market pay shall meet the following requirements:
(1) Each physician, podiatrist, optometrist 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, podiatrist, optometrist or
dentist in a facility of the Department of Veterans
Affairs.
(3) The annual amount of the market pay payable to
a physician, podiatrist, optometrist or dentist shall
be determined by the Secretary on a case-by-case basis.
(4) The determination of the amount of market pay
of a physician, podiatrist, optometrist or dentist
shall take into account--
(A) the level of experience of the
physician, podiatrist, optometrist or dentist
in the specialty or assignment of the
physician, podiatrist, optometrist or dentist;
(B) the need for the specialty or
assignment of the physician, podiatrist,
optometrist or dentist at the medical facility
of the Department concerned;
(C) the health care labor market for the
specialty or assignment of the physician,
podiatrist, optometrist 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, podiatrist, optometrist or
dentist;
(E) the prior experience, if any, of the
physician, podiatrist, optometrist or dentist
as an employee of the Veterans Health
Administration; and
(F) such other considerations as the
Secretary considers appropriate.
(5) The amount of market pay of a physician,
podiatrist, optometrist 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, podiatrist, optometrist 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. Such a notice shall
include a statement of whether the market pay will
increase, decrease, or remain unchanged following such
evaluation.
(6) No adjustment of the amount of market pay of a
physician, podiatrist, optometrist or dentist under
paragraph (5) may result in a reduction of the amount
of market pay of the physician, podiatrist, optometrist
or dentist while in the same position or assignment at
the medical facility of the Department concerned,
unless there is a change in board certification or
reduction of privileges.
(7) The Secretary shall ensure that each physician,
podiatrist, optometrist, and dentist in the Veterans
Health Administration is--
(A) advised, on an annual basis, of the
criteria described in subparagraph (F) of
paragraph (4);
(B) evaluated in accordance with such
criteria; and
(C) compensated in accordance with--
(i) applicable assignment and pay
levels, subject to relevant pay
limitations; and
(ii) the extent to which such
criteria are met.
(8) Not later than 120 days after the end of each
fiscal year, the Secretary shall submit to the
Committees on Veterans' Affairs of the Senate and the
House of Representatives a report that includes the
following:
(A) A list of each facility and specialty
that conducted an evaluation of pay during the
period covered by the report.
(B) For each evaluation described in
subparagraph (A)--
(i) a list of occupations for which
pay was evaluated, disaggregated by
medical specialty, number of authorized
full-time employees, and onsite full-
time employees as of the date of the
evaluation;
(ii) the date such evaluation was
completed;
(iii) whether a market pay
adjustment was made following the
evaluation per each occupation and
specialty evaluated;
(iv) whether applicable employees
were notified of such evaluation;
(v) whether local labor partners
were notified of such evaluation; and
(vi) in the case of an evaluation
that resulted in an adjustment of pay--
(I) the date such
adjustment--
(aa) was
implemented; and
(bb) became
effective; and
(II) the percentage of
employees of each occupation
and specialty for which pay was
adjusted pursuant to such
evaluation.
(C) A list of facilities of the Department
that have not conducted an evaluation of market
pay, pursuant to paragraph (5), during the 18-
month-period that precedes the date of the
submission of such report.
(d) Performance Pay.--(1) One element of pay for
physicians, podiatrists, optometrists, and dentists shall be
performance pay.
(2) Performance pay shall be paid to a physician,
podiatrist, optometrist 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,
podiatrist, optometrist 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, podiatrist, optometrist or dentist for
performance pay.
(4) The amount of the performance pay payable to a
physician, podiatrist, optometrist or dentist may vary annually
on the basis of individual achievement or attainment of the
goals or objectives applicable to the physician, podiatrist,
optometrist or dentist under paragraph (2).
(5) The amount of performance pay payable to a physician,
podiatrist, optometrist 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, podiatrist, optometrist or dentist in that
fiscal year.
(6) A failure to meet goals or objectives applicable to a
physician, podiatrist, optometrist or dentist under paragraph
(2) may not be the sole basis for an adverse personnel action
against that physician, podiatrist, optometrist 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 podiatrists
and 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, podiatrists,
optometrists, 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 total amount of the annual rate
of base pay payable to a physician, podiatrist, optometrist or
dentist under subsection (b) and the market pay determined for
the physician, podiatrist, optometrist 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, podiatrist, optometrist or dentist
under paragraph (1).
(3) The sum of the total amount of the annual rate of base
pay payable to a physician, podiatrist, optometrist or dentist
under subsection (b) and the market pay determined for the
physician, podiatrist, optometrist or dentist under subsection
(c) may exceed the maximum amount applicable to the specialty
or assignment of the physician, podiatrist, optometrist or
dentist under paragraph (1) as a result of an adjustment under
paragraph (3) or (4) of subsection (b).
(4) Except as provided in sections 7404A(c) and 7410(a)(2)
of this title, in no case may the total amount of compensation
paid to a physician, podiatrist, optometrist or dentist under
this title in any year exceed the amount of annual compensation
(excluding expenses) specified in section 102 of title 3.
(5) Notwithstanding any compensation or pay limitations
under this title or title 5, the Secretary may authorize the
Under Secretary for Health to pay physicians, podiatrists,
optometrists, and dentists--
(A) awards authorized under this title;
(B) advance payments, recruitment or relocation
bonuses, and [retention allowances] retention bonuses
authorized under section 7410(a) of this title or as
otherwise provided by law;
(C) incentives or bonuses under section 706 of this
title or as otherwise provided by law; and
(D) earnings from fee-basis appointments under
section 7405(a)(2) of this title.
(6)(A) The Secretary may waive any pay limitation described
in this section (including tier limitations) that the Secretary
determines necessary for the recruitment or retention of
critical health care personnel whom the Secretary determines
would provide direct patient care.
(B) Priority for such waivers shall be given for positions,
locations, and care provided through agreements that are costly
to the Department.
(C) The Chief Human Capital Officer of the Department, the
Chief Financial Officer of the Department, and the Office of
the General Counsel of the Department shall review any waiver
issued under subparagraph (A).
(D) During the period the authority under subparagraph (A)
is effective, the Secretary may not issue more than 300 waivers
under such subparagraph.
(E) The Secretary may prescribe requirements, limitations,
and other considerations for waivers under such subparagraph.
(F) Not later than 180 days after the date of the enactment
of the Senator Elizabeth Dole 21st Century Veterans Healthcare
and Benefits Improvement Act, and annually thereafter, the
Secretary shall submit to the Committees on Veterans' Affairs
of the Senate and the House of Representatives a report that
includes--
(i) any updates to the requirements, limitations,
and considerations prescribed under subparagraph (B)
during the period covered by the report;
(ii) a description of the findings of each review,
if any, conducted pursuant to subparagraph (C);
(iii) a description of each waiver under
subparagraph (A) in effect as of the date of the
submission of the report, including the--
(I) duty location, position, specialty,
market and performance considerations for the
waiver; and
(II) impact, if any, of the waiver on care
furnished by the Department pursuant to an
agreement regarding the geographic area; and
(iv) a list of any separation actions during the
period covered by the report with respect to a position
for which a waiver under subparagraph (A) is in effect.
(G) The authority of the Secretary under subparagraph (A)
shall terminate on the last day of the third full fiscal year
following the date of the enactment of the Senator Elizabeth
Dole 21st Century Veterans Healthcare and Benefits Improvement
Act.
(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, podiatrist, optometrist or dentist
resulting from an adjustment in the amount of market pay of the
physician, podiatrist, optometrist or dentist under subsection
(c) shall not be treated as an adverse action.
(2) If the pay of a physician, podiatrist, optometrist or
dentist is reduced under this subchapter as a result of an
involuntary reassignment in connection with a disciplinary
action taken against the physician, podiatrist, optometrist 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).
* * * * * * *
[all]