To propose a substitute.

1. Replaces the bill's text with a full substitute

   Replaces the full textEverything after the enacting clause

   In S. 2484 · Reported to Senate

   Struck: "subchapter iii--pay for physicians and dentists

   Struck: "subchapter iv--pay for nurses and other health-care personnel

   SECTION 1. SHORT TITLE.

   This Act may be cited as the "Department of Veterans Affairs Health Care Personnel Enhancement Act of 2004".

   1 unchanged paragraphHide unchanged text

   SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE.

   Except as otherwise expressly provided, whenever in this Act an amendment is expressed in terms of an amendment to a section or other provision, the reference shall be considered to be made to a section or other provision of title 38, United States Code.

   SEC. 3. SIMPLIFICATION AND IMPROVEMENT OF GRADE AND PAY PROVISIONS FOR PHYSICIANS AND DENTISTS.

   (a) Simplification of Grades and Grade Requirements.--[struck: Section 7404][inserted: (1) Subsection ](b) [inserted: of section 7404 ]is amended--

   ([struck: 1][inserted: A]) by striking "(1)" after "(b)";

   ([struck: 2][inserted: B]) in the Physician and Dentist Schedule, by striking the items relating to the grades and inserting the following:[struck: "Physician grade. "Dentist grade."; and]

   Struck: (3) by striking paragraph (2).

   Inserted: "Physician grade.

   Inserted: "Dentist grade."; and

   Inserted: (C) by striking paragraph (2).

   Inserted: (2) Subsection (a) of such section is amended by adding at the end the following: "The pay of physicians and dentists serving in positions to which an Executive order applies under the preceding sentence shall be determined under subchapter III of this chapter instead of such Executive order.".

   (b) Simplification and Improvement of Pay Authorities.--Subchapter III of chapter 74 is amended to read as follows:

   "SUBCHAPTER III--PAY FOR PHYSICIANS AND DENTISTS

   2 unchanged paragraphsHide unchanged text

   "Sec. 7431. Pay

   "(a) Elements of Pay.--Pay of physicians and dentists in the Veterans Health Administration shall consist of three elements as follows:

   "(1) Base pay as provided for under subsection (b).

   "(2) Market pay as provided for under subsection (c).

   "(3) [struck: Incentive][inserted: Performance] pay as provided [struck: for ]under subsection (d).

   "(b) Base Pay.--One element of pay for physicians and dentists shall be base pay. Base pay shall meet the following requirements:

   "(1) Each physician and dentist is entitled to base pay determined under the Physician and Dentist Base and Longevity Pay Schedule.

   "(2) The Physician and Dentist Base and Longevity Pay Schedule is composed of 15 rates of base pay designated, from the lowest rate of pay to the highest rate of pay, as base pay steps 1 through 15.

   "(3) The rate of base pay payable to a physician or dentist is based on the total number of the years of the service of the physician or dentist in the Veterans Health Administration as follows:

   Inserted: "For a physician or dentiThe rate of base pay is the rate payable for:

   [struck: "For a physician or dentist The rate of base pay is with total service of: the rate payable for: ]two years or less.............................[struck: ][inserted: ..................]step 1 more than 2 years and not more than 4 years...[struck: ][inserted: ..................]step 2 more than 4 years and not more than 6 years...[struck: ][inserted: ..................]step 3 more than 6 years and not more than 8 years...[struck: ][inserted: ..................]step 4 more than 8 years and not more than 10 years..[struck: ][inserted: ..................]step 5 more than 10 years and not more than 12 years.[struck: ][inserted: ..................]step 6 more than 12 years and not more than 14 years.[struck: ][inserted: ..................]step 7 more than 14 years and not more than 16 years.[struck: ][inserted: ..................]step 8 more than 16 years and not more than 18 years.[struck: ][inserted: ..................]step 9 more than 18 years and not more than 20 years.[struck: ][inserted: .................]step 10 more than 20 years and not more than 22 years.[struck: ][inserted: .................]step 11 more than 22 years and not more than 24 years.[struck: ][inserted: .................]step 12 more than 24 years and not more than 26 years.[struck: ][inserted: .................]step 13 more than 26 years and not more than 28 years.[struck: ][inserted: .................]step 14 more than 28 years............................[struck: ][inserted: .................]step 15.

   "(4) At the same time as rates of basic pay are increased for a year under section 5303 of title 5, the Secretary shall increase [struck: each rate][inserted: the amount] of base pay payable under this subsection for that year by a percentage equal to the percentage by which rates of basic pay are increased under such section for that year.

   "(c) Market Pay.--One element of pay for physicians and dentists shall be market pay. Market pay shall meet the following requirements:

   "(1) [struck: Subject to paragraph (3), each ][inserted: Each ]physician and dentist is eligible for market pay.

   "(2) Market pay shall consist of pay intended to reflect the [struck: value to the Veterans Health Administration of the skills, experience, and availability ][inserted: recruitment and retention needs for the specialty or assignment (as defined by the Secretary) ]of a particular physician or dentist [struck: within][inserted: in] a [struck: particular health care labor market][inserted: facility of the Department of Veterans Affairs].

   Struck: "(3) The annual amount of the market pay payable to a physician or dentist shall be determined by the Secretary on a case-by-case basis, subject to paragraph (5). The sum of the total amount of the market pay determined for a physician or dentist under this subsection and the annual rate of base pay payable to the physician or dentist under subsection (b) may not be less than the minimum amount, nor more than the maximum amount, applicable to the physician or dentist under paragraph (4).

   Struck: "(4)(A) Not less often than once every two years, the Secretary shall prescribe for Departmentwide applicability the minimum and maximum amounts of annual pay (excluding incentive pay under subsection (d)) that may be paid under this section to physicians and the minimum and maximum amounts of annual pay (excluding incentive pay under subsection (d)) that may be paid under this section to dentists.

   Struck: "(B) The Secretary may prescribe for Departmentwide applicability under this paragraph separate minimum and maximum amounts of pay for a specialty or subspecialty. If the Secretary prescribes separate minimum and maximum amounts for a specialty or subspecialty, the Secretary may establish up to four tiers of minimum and maximum amounts for such specialty or subspecialty and prescribe for each tier a minimum amount and a maximum amount that the Secretary determines appropriate for the professional responsibilities, professional achievements, and administrative duties of the physicians or dentists (as the case may be) whose pay is set within that tier.

   Struck: "(5)(A) In determining the amount of the market pay for a physician or dentist and determining a tier (if any) to apply to a physician or dentist under paragraph (4)(B), the Secretary shall consult with and consider the recommendations of the Medical Professional Standards Board for the medical facility of the Department at which the physician or dentist is employed, except in the case of a physician or dentist whose market pay is determined under subparagraph (B).

   Show 2 more struck paragraphsShow less

   Struck: "(B) In the case of a physician or dentist who is a member of a Medical Professional Standards Board, the Secretary shall determine the amount of the market pay and the tier (if any) applicable to the physician or dentist under paragraph (4)(B) in accordance with such procedures and standards as the Secretary shall prescribe. Such procedures and standards shall, to the maximum extent practicable, be similar to the procedures and standards applicable to determinations of the amount of market pay and the tier applicable to physicians and dentists under paragraph (4)(B) who are not members of a board. Under such regulations, no member of a board may participate in or have a consultative role in determining the amount of market pay or tier of such member or any other member of such board.

   Struck: "(C) A Medical Professional Standards Board consulted under this subparagraph shall consist of at least three and not more than five persons, each of whom is either a physician or a dentist. Not less than a majority of the members of the board shall be practicing clinicians in their professions.

   "([struck: 6][inserted: 3]) [struck: Subject to paragraph (7), the determination ][inserted: The annual amount ]of the [struck: amount of ]market pay [struck: of ][inserted: payable to ]a physician or dentist shall [struck: take into account--][inserted: be determined by the Secretary on a case-by-case basis.]

   Struck: "(A) the level of experience of the physician or dentist in the specialty or subspecialty of the physician or dentist;

   Struck: "(B) the need for the specialty or subspecialty of the physician or dentist at the Department facility concerned;

   Struck: "(C) the health care labor market for the specialty or subspecialty of the physician or dentist, which may cover any geographic area the Secretary considers appropriate for the specialty or subspecialty;

   Struck: "(D) the professional reputation of the physician or dentist;

   Show 5 more struck paragraphsShow less

   Struck: "(E) the board certifications, if any, of the physician or dentist;

   Struck: "(F) the prior experience, if any, of the physician or dentist as an employee of the Veterans Health Administration; and

   Struck: "(G) such other considerations as the Secretary considers appropriate.

   Struck: "(7) The amount that any consideration specified in paragraph (6) may contribute to the amount of market pay may not exceed, or be less than, such amount as the Secretary may specify in regulations prescribed under section 7433 of this title, or in directives issued for purposes of this subsection.

   Struck: "(8) In determining amounts of market pay, the Secretary--

   "([inserted: 4)(]A) [inserted: In determining the amount of market pay for physicians or dentists, the Secretary ]shall consult two or more national surveys of pay for physicians or dentists, as applicable, whether prepared by [struck: public, private][inserted: private, public], or quasi-public entities[struck: ; and][inserted: in order to make a general assessment of the range of pays payable to physicians or dentists, as applicable.]

   Struck: "(B) may utilize the recommendations or assistance of one or more boards of physicians or dentists, as applicable, that are appointed by the Secretary for purposes of this subsection.

   Struck: "(9) The amount of market pay of a physician or dentist shall be adjusted at such times as the Secretary considers appropriate in order to ensure the retention of qualified physicians and dentists by the Veterans Health Administration.

   Struck: "(10) The amount of market pay of a physician or dentist shall be evaluated by the Secretary not less often than once every 24 months. The amount of market pay may be adjusted as the result of an evaluation under this paragraph. A physician or dentist whose market pay is increased by reason of an evaluation under this paragraph shall receive written notice of the increase in accordance with procedures prescribed under section 7433 of this title.

   Inserted: "(B)(i) In determining the amount of the market pay for a particular physician or dentist under this subsection, and in determining a tier (if any) to apply to a physician or dentist under subsection (e)(1)(B), the Secretary shall consult with and consider the recommendations of an appropriate panel or board composed of physicians or dentists (as applicable).

   "([struck: 11][inserted: ii]) [struck: No adjustment of the amount of market pay ][inserted: A physician or dentist may not be a member ]of [struck: a physician][inserted: the panel] or [struck: dentist under paragraph (9) or ][inserted: board that makes recommendations under clause ]([struck: 10][inserted: i]) [struck: may result in a reduction of ][inserted: with respect to ]the [struck: amount of ]market pay of [struck: the][inserted: such] physician or dentist[inserted: , as the case may be].

   Struck: "(d) Incentive Pay.--One element of pay for physicians and dentists shall be incentive pay. Incentive pay shall meet the following requirements:

   Struck: "(1) Each physician and dentist is eligible for incentive pay.

   Struck: "(2) Incentive pay shall consist of an amount intended to recognize outstanding contributions by a physician or dentist to--

   Struck: "(A) the facility in which employed;

   Show 2 more struck paragraphsShow less

   Struck: "(B) the furnishing of care to veterans; or

   Struck: "(C) the practice of medicine or dentistry, as applicable.

   Inserted: "(iii) The Secretary should, to the extent practicable, ensure that a panel or board consulted under this subparagraph includes physicians or dentists (as applicable) who are practicing clinicians and who do not hold management positions in the medical facility of the Department at which the physician or dentist subject to the consultation is employed.

   "([struck: 3][inserted: 5]) The [struck: amount][inserted: determination] of [struck: incentive pay shall be determined for][inserted: the amount of market pay of] a physician or dentist [struck: by the Secretary.][inserted: shall take into account--]

   Struck: "(4) The amount of incentive pay shall be determined for a physician or dentist on a case-by-case basis.

   Struck: "(5) The amount of incentive pay paid to a physician or dentist in a calendar year may not exceed $10,000.

   Struck: "(e) Delegation of Responsibilities.--The Secretary may delegate to an appropriate officer or employee of the Department any responsibility of the Secretary under subsection (c) or (d), except for the responsibilities of the Secretary under subsection (c)(4).

   Struck: "(f) Limitation on Total Compensation.--In no case may the total amount of compensation paid to a physician or dentist under this section in any year exceed the amount of annual compensation (excluding expenses) specified in section 102 of title 3.

   Show 3 more struck paragraphsShow less

   Struck: "(g) Treatment of Pay.--(1) Except as provided in paragraph (2), pay under this subchapter shall be considered pay for all purposes, including retirement benefits under chapters 83 and 84 of title 5 and other benefits.

   Struck: "(2) Incentive pay under subsection (d) shall not be considered pay for purposes of retirement benefits under chapters 83 and 84 of title 5.

   Struck: "(h) Decreases in Certain Pay Not Treatable as Adverse Action.--A decrease in pay of a physician or dentist resulting from an adjustment in the amount of incentive pay of the physician or dentist under subsection (d) shall not be treated as an adverse action.

   Inserted: "(A) the level of experience of the physician or dentist in the specialty or assignment of the physician or dentist;

   Inserted: "(B) the need for the specialty or assignment of the physician or dentist at the medical facility of the Department concerned;

   Inserted: "(C) the health care labor market for the specialty or assignment of the physician or dentist, which may cover any geographic area the Secretary considers appropriate for the specialty or assignment;

   Inserted: "(D) the board certifications, if any, of the physician or dentist;

   Inserted: "(E) the prior experience, if any, of the physician or dentist as an employee of the Veterans Health Administration; and

   Inserted: "(F) such other considerations as the Secretary considers appropriate.

   Inserted: "(6) The amount of market pay of a physician or dentist shall be evaluated by the Secretary not less often than once every 24 months. The amount of market pay may be adjusted as the result of an evaluation under this paragraph. A physician or dentist whose market pay is evaluated under this paragraph shall receive written notice of the results of such evaluation in accordance with procedures prescribed under section 7433 of this title.

   Inserted: "(7) No adjustment of the amount of market pay of a physician or dentist under paragraph (6) may result in a reduction of the amount of market pay of the physician or dentist while in the same position or assignment at the medical facility of the Department concerned.

   Inserted: "(d) Performance Pay.--(1) One element of pay for physicians and dentists shall be performance pay.

   Inserted: "(2) Performance pay shall be paid to a physician or dentist on the basis of the physician's or dentist's achievement of specific goals and performance objectives prescribed by the Secretary.

   Inserted: "(3) The Secretary shall ensure that each physician and dentist of the Department is advised of the specific goals or objectives that are to be measured by the Secretary in determining the eligibility of that physician or dentist for performance pay.

   Inserted: "(4) The amount of the performance pay payable to a physician or dentist may vary annually on the basis of individual achievement or attainment of the goals or objectives applicable to the physician or dentist under paragraph (2).

   Show 14 more inserted paragraphsShow less

   Inserted: "(5) The amount of performance pay payable to a physician or dentist in a fiscal year shall be determined in accordance with regulations prescribed by the Secretary, but may not exceed the lower of--

   Inserted: "(A) $15,000; or

   Inserted: "(B) the amount equal to 7.5 percent of the sum of the base pay and the market pay payable to such physician or dentist in that fiscal year.

   Inserted: "(6) A failure to meet goals or objectives applicable to a physician or dentist under paragraph (2) may not be the sole basis for an adverse personnel action against that physician or dentist.

   Inserted: "(e) Requirements and Limitations on Total Pay.--(1)(A) Not less often than once every two years, the Secretary shall prescribe for Department-wide applicability the minimum and maximum amounts of annual pay that may be paid under this section to physicians and the minimum and maximum amounts of annual pay that may be paid under this section to dentists.

   Inserted: "(B) The Secretary may prescribe for Department-wide applicability under this paragraph separate minimum and maximum amounts of pay for a specialty or assignment. If the Secretary prescribes separate minimum and maximum amounts for a specialty or assignment, the Secretary may establish up to four tiers of minimum and maximum amounts for such specialty or assignment and prescribe for each tier a minimum amount and a maximum amount that the Secretary determines appropriate for the professional responsibilities, professional achievements, and administrative duties of the physicians or dentists (as the case may be) whose pay is set within that tier.

   Inserted: "(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.

   Inserted: "(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 or dentist under subsection (b) and the market pay determined for the physician or dentist under subsection (c) may not be less than the minimum amount, nor more than the maximum amount, applicable to specialty or assignment of the physician or dentist under paragraph (1).

   Inserted: "(3) The sum of the total amount of the annual rate of base pay payable to a physician or dentist under subsection (b) and the market pay determined for the physician or dentist under subsection (c) may exceed the maximum amount applicable to the specialty or assignment of the physician or dentist under paragraph (1) as a result of an adjustment under paragraph (3) or (4) of subsection (b).

   Inserted: "(4) In no case may the total amount of compensation paid to a physician or dentist under this title in any year exceed the amount of annual compensation (excluding expenses) specified in section 102 of title 3.

   Inserted: "(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.

   Inserted: "(g) Ancillary Effects of Decreases in Pay.--(1) A decrease in pay of a physician or dentist resulting from an adjustment in the amount of market pay of the physician or dentist under subsection (c) shall not be treated as an adverse action.

   Inserted: "(2) If the pay of a physician or dentist is reduced under this subchapter as a result of an involuntary reassignment in connection with a disciplinary action taken against the physician or dentist, the involuntary reassignment shall be subject to appeal under subchapter V of this chapter.

   Inserted: "(h) Delegation of Responsibilities.--The Secretary may delegate to an appropriate officer or employee of the Department any responsibility of the Secretary under subsection (c), (d), or (e) except for the responsibilities of the Secretary under subsection (e)(1).

   "Sec. 7432. Pay of Under Secretary for Health

   "(a) Base Pay.--The base pay of the Under Secretary for Health shall be the annual rate of basic pay for positions at Level III of the Executive Schedule under section 5314 of title 5.

   1 unchanged paragraphHide unchanged text

   "(b) Market Pay.--(1) In the case of an Under Secretary for Health who is also a physician or dentist, in addition to the base pay specified in subsection (a) the Under Secretary for Health may also be paid the market pay element of pay of physicians and dentists under section 7431(c) of this title.

   "(2) The amount of market pay of the Under Secretary for Health under this subsection shall be established by the Secretary.

   "(3) In establishing the amount of market pay of the Under Secretary for Health under this subsection, the Secretary shall utilize an appropriate health care labor market selected by the Secretary for purposes of this subsection.

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

   "Sec. 7433. Administrative matters

   "(a) Regulations.--(1) The Secretary shall prescribe regulations relating to the pay of physicians and dentists in the Veterans Health Administration under this subchapter.

   "(2) In prescribing the regulations, the Secretary shall take into account the recommendations of the Under Secretary for Health on the administration of this subchapter.[inserted: In formulating recommendations for the purpose of this paragraph, the Under Secretary shall request the views of representatives of labor organizations that are exclusive representatives of physicians and dentists of the Department and the views of representatives of professional organizations of physicians and dentists of the Department.]

   "(b) Reports.--(1) Not later than 18 months after the Secretary prescribes the regulations required by subsection (a), and annually thereafter for the next [struck: 10][inserted: 5] years, the Secretary shall submit to the Committees on Veterans' Affairs of the Senate and House of Representatives a report on the pay of physicians and dentists in the Veterans Health Administration under this subchapter.

   "(2) Each report under this subsection shall include the following:

   "(A) A description of the rates of pay in effect during the [struck: preceding][inserted: current] fiscal year with a comparison to the rates in effect during the fiscal year preceding [inserted: the current ]fiscal year, set forth by facility and by specialty.

   "(B) The number of physicians and dentists who left the Veterans Health Administration during the preceding fiscal year.

   "(C) The number of unfilled physician positions and dentist positions in each specialty in the Veterans Health Administration, the average and maximum lengths of time that such positions have been unfilled, and an assessment of the reasons that such positions remain unfilled.

   "(D) An assessment of the impact of implementation of this subchapter on efforts to recruit and retain physicians and dentists in the Veterans Health Administration.

   "(3) The first two annual reports under this subsection shall also include a comparison of staffing levels, contract expenditures, and average salaries of physicians and dentists in the Veterans Health Administration for the [inserted: current ]fiscal year [struck: preceding such report ]and for the fiscal year preceding [struck: such ][inserted: the current ]fiscal year, set forth by facility and by specialty.".

   (c) Initial Rates of Base Pay for Physicians and Dentists.--The initial rates of base pay established for the base pay steps under the Physician and Dentist Base and Longevity Pay Schedule provided in section 7431(b) of title 38, United States Code (as added by subsection (b)), are as follows:

   Inserted: Base Pay Step: Rate of Pay:

   [struck: Base Pay Step: Rate of Pay: ]1.............................................[struck: ][inserted: .................]$90,000 2.............................................[struck: ][inserted: .................]$93,000 3.............................................[struck: ][inserted: .................]$96,000 4.............................................[struck: ][inserted: .................]$99,000 5.............................................[struck: ][inserted: ................]$102,000 6.............................................[struck: ][inserted: ................]$105,000 7.............................................[struck: ][inserted: ................]$108,000 8.............................................[struck: ][inserted: ................]$111,000 9.............................................[struck: ][inserted: ................]$114,000 10............................................[struck: ][inserted: ................]$117,000 11............................................[struck: ][inserted: ................]$120,000 12............................................[struck: ][inserted: ................]$123,000 13............................................[struck: $127,000][inserted: ................$126,000] 14............................................[struck: $130,000][inserted: ................$129,000] 15............................................[struck: $133,000].[inserted: ...............$132,000.]

   Struck: (d) Transition Provisions.--

   Inserted: (d) Effective Date.--(1) Notwithstanding the 60-day waiting requirement in section 7431(e)(1)(C) of title 38, United States Code (as amended by subsection (b)), pay provided for a physician or dentist under subchapter III of chapter 74 of such title, as amended by subsection (b), shall take effect on the first day of the first pay period applicable to such physician or dentist that begins on or after January 1, 2006.

   Inserted: (2) Pay provided for the Under Secretary for Health under subchapter III of chapter 74 of title 38, United States Code, as amended by this section shall take effect on the first day of the first pay period applicable to the Under Secretary that begins on or after January 1, 2006.

   Inserted: (e) Transition Provisions.--

   (1) Physicians and dentists.--

   (A) Pay.--(i) [struck: A ][inserted: The amount of the pay payable on and after the date of the enactment of this Act to a ]physician or dentist in receipt of pay under section 7404 or 7405 of title 38, United States Code, as of the day before [struck: the][inserted: such] date [struck: of the enactment of this Act ]shall continue to [struck: receive pay][inserted: be determined] under such section (as in effect on the day before [struck: the][inserted: such] date[struck: of][inserted: ) until] the [struck: enactment of this Act) until the effective date of this Act under section 8 of this Act][inserted: effective date that is applicable under subsection (d) to such physician or dentist, as the case may be].

   (ii) A physician or dentist appointed or reassigned on or after the date of the enactment of this Act, but before the effective date [struck: of this Act][inserted: applicable under subsection (d) to such physician or dentist], shall be compensated in accordance with applicable provisions of section 7404 or 7405 of title 38, United States Code (as in effect on the day before date of the enactment of this Act), until [struck: the][inserted: such] effective date[struck: of this Act].

   (B) Special pay.--(i) A special pay agreement entered into by a physician or dentist under subchapter III of chapter 74 of title 38, United States Code, before the date of the enactment of this Act shall terminate on the date of the enactment of this Act. However, a physician or dentist in receipt of special pay pursuant to such an agreement on that date shall continue to receive special pay under the terms of such agreement until the effective date [struck: of this Act][inserted: that is applicable under subsection (d) to such physician or dentist].

   (ii) A physician or dentist described in subparagraph (A)(ii) may be paid special pay under applicable provisions of section 7433, 7434, 7435, or 7436 of title 38, United States Code (as in effect on the day before the date of the enactment of this Act), during the period beginning on the date [inserted: of the ]appointment or reassignment of such physician or dentist, as the case may be, and ending on the effective date [struck: of this Act][inserted: applicable under subsection (d) to such physician or dentist]. However, no special pay agreement shall be required for the payment of special pay under this clause.

   (C) Treatment of special pay.--(i) Special pay paid under subparagraph (B) [inserted: to a physician or dentist during the period beginning on the date of the enactment of this Act and ending on the effective date applicable under subsection (d) to such physician or dentist ]shall be subject to the provisions of paragraphs (1), (2), (4), (5), and (6) of section 7438(b) of title 38, United States Code (as in effect on the day before the date of the enactment of this Act).

   (ii) Special pay paid [inserted: to a physician or dentist ]under [struck: subparagraph ][inserted: section 7438 of title 38, United States Code ]([struck: B][inserted: as in effect on the day before the date of the enactment of this Act])[inserted: ,] shall be fully creditable for purposes of computing benefits under chapters 83 and 84 of title 5, United States Code.

   (D) Preservation of pay.--The amount of pay paid [struck: under subchapter III of chapter 74 of title 38, United States Code (as amended by subsection (a)), ]to a physician or dentist [struck: appointed or reassigned before ][inserted: after ]the effective date of this Act [struck: may be ][inserted: shall ]not [inserted: be ]less than the [struck: aggregate ]amount of pay [struck: and special pay ]paid to [struck: the][inserted: such] physician or dentist [struck: under chapter 74 of title 38, United States Code (as in effect ]on the day before the [inserted: effective ]date of [struck: the enactment of ]this Act[struck: ), as of the day before the effective date of this Act][inserted: while such physician or dentist remains in the same position or assignment].

   (2) Under secretary for health.--

   (A) Special pay.--(i) The current special pay agreement entered into by the Under Secretary for Health under [struck: subchapter ][inserted: subchapters I and ]III of chapter 74 of title 38, United States Code, before the date of the enactment of this Act shall terminate on the date of the enactment of this Act. However, the Under Secretary shall continue to receive special pay under the terms of such agreement until the effective date [struck: of this Act][inserted: that is applicable under subsection (d) to the Under Secretary].

   (ii) An individual appointed as Under Secretary for Health on or after the date of the enactment of this Act and before the effective date [struck: of this Act ][inserted: applicable under subsection (d) to the Under Secretary ]shall be paid special pay in accordance with the provisions of [struck: section][inserted: sections] 7432(d)(2)[struck: , 7433, ][inserted: ]and [struck: 7437(a)][inserted: 7433] of title 38, United States Code (as in effect on the day before the date of the enactment of this Act), during the period beginning on the date of appointment and ending on [struck: the][inserted: such] effective date[struck: of this Act]. However, no special pay agreement shall be required for the payment of special pay under this clause.

   Struck: (B) Treatment of special pay.--Special pay paid under subparagraph (A) shall be fully creditable for purposes of computing benefits under chapters 83 and 84 of title 5, United States Code.

   Struck: (e) Conforming Amendment.--Section 7404(c) is amended by striking "special pay" and inserting "pay".

   Struck: (f) Clerical Amendment.--The table of sections at the beginning of chapter 74 is amended by striking the items relating to subchapter III and inserting the following new items:

   Inserted: (B) Treatment of special pay.--Special pay paid under subparagraph (A) during the period beginning on the date of the enactment of this Act and ending on the effective date applicable under subsection (d) to the Under Secretary--

   Inserted: (i) shall be subject to the provisions of paragraphs (1), (2), (4), (5), and (6) of section 7438(b) of title 38, United States Code (as in effect on the day before the date of the enactment of this Act); and

   Inserted: (ii) shall be fully creditable for purposes of computing benefits under chapters 83 and 84 of title 5, United States Code.

   Inserted: (f) Conforming Amendments.--Section 7404 is amended--

   Inserted: (1) in subsection (c), by striking "special pay" and inserting "pay"; and

   Inserted: (2) in subsection (d), by striking "pay may not be paid" and all that follows and inserting "pay for positions for which basic pay is paid under this section may not be paid at a rate in excess of the rate of basic pay authorized by section 5316 of title 5 for positions in Level V of the Executive Schedule.".

   Inserted: (g) Clerical Amendment.--The table of sections at the beginning of chapter 74 is amended by striking the items relating to subchapter III and inserting the following new items:

   "SUBCHAPTER III--PAY FOR PHYSICIANS AND DENTISTS

   "Sec. 7431. Pay.

   4 unchanged paragraphsHide unchanged text

   "Sec. 7432. Pay of Under Secretary for Health.

   "Sec. 7433. Administrative matters.".

   SEC. 4. ALTERNATE WORK SCHEDULES FOR REGISTERED NURSES.

   (a) In General.--(1) Chapter 74 is amended by inserting after section 7456 the following new section:

   "Sec. 7456A. Nurses: alternate work schedules

   "(a) Applicability.--This section applies to registered nurses appointed under this chapter.

   "(b) 36/40 Work Schedule.--(1)[inserted: (A)] Subject to paragraph (2), if the Secretary determines it [inserted: to ]be necessary in order to obtain or retain the services of registered nurses at any Department health-care facility, the Secretary may provide, in the case of nurses employed at such facility, that such nurses who work three regularly scheduled 12-hour tours of duty within a [struck: workweek ][inserted: work week ]shall be considered for all purposes [struck: (except computation of full-time equivalent employees for the purposes of determining compliance with personnel ceilings) ]to have worked a full 40-hour basic [struck: workweek][inserted: work week].

   Inserted: "(B) A nurse who works under the authority in subparagraph (A) shall be considered a 0.90 full-time equivalent employee in computing full-time equivalent employees for the purposes of determining compliance with personnel ceilings.

   "(2)(A) Basic and additional pay for a nurse who is considered under paragraph (1) to have worked a full 40-hour basic [struck: workweek ][inserted: work week ]shall be subject to subparagraphs (B) and (C).

   "(B) The hourly rate of basic pay for a nurse covered by this paragraph for service performed as part of a regularly scheduled [struck: 36- hour ][inserted: 36-hour ]tour of duty within the [struck: workweek ][inserted: work week ]shall be derived by dividing the nurse's annual rate of basic pay by 1,872.

   "(C)[struck: (i) A nurse covered by this paragraph is entitled to ][inserted: The Secretary shall pay ]overtime pay [struck: for work performed in such periods as the Secretary shall prescribe.][inserted: to a nurse covered by this paragraph who--]

   Struck: "(ii) Except as otherwise provided in clause (i), a nurse covered by this paragraph is not entitled to additional pay under section 7453 of this title, or other applicable law, for any period included in a regularly scheduled 12-hour tour of duty.

   Inserted: "(i) performs a period of service in excess of such nurse's regularly scheduled 36-hour tour of duty within an administrative work week;

   Inserted: "(ii) for officially ordered or approved service, performs a period of service in excess of 8 hours on a day other than a day on which such nurse's regularly scheduled 12-hour tour of duty falls;

   Inserted: "(iii) performs a period of service in excess of 12 hours for any day included in the regularly scheduled 36-hour tour of duty work week; or

   Inserted: "(iv) performs a period of service in excess of 40 hours during an administrative work week.

   Inserted: "(D) The Secretary may provide a nurse to whom this subsection applies with additional pay under section 7453 of this title for any period included in a regularly scheduled 12-hour tour of duty.

   "(3) A nurse who works a work schedule described in this subsection who is absent on approved sick leave or annual leave during a regularly scheduled 12-hour tour of duty shall be charged for such leave at a rate of ten hours of leave for every nine hours of absence.

   "([struck: 4][inserted: c]) [inserted: Holiday Pay.--]A nurse working a work schedule under [struck: this ]subsection [inserted: (b) that includes a holiday designated by law or Executive order ]shall be eligible for holiday pay under section 7453(d) of this title for any service performed by the nurse on [struck: a designated holiday under ]such [struck: section, regardless of whether such ]holiday [struck: occurs during or outside the nurse's regularly scheduled tour of duty ]under such [struck: work schedule][inserted: section].

   "([struck: c][inserted: d]) 9-Month Work Schedule for Certain Nurses.--(1) The Secretary may authorize a registered nurse appointed under section 7405 of this title, with the nurse's written consent, to work [struck: fulltime ][inserted: full time ]for nine months with 3 months off duty, within a fiscal year, and be paid at 75 percent of the [struck: fulltime][inserted: full-time] rate for such nurse's grade for each pay period of such fiscal year.

   "(2) A nurse who works under the authority in paragraph (1) shall be considered a 0.75 [struck: fulltime][inserted: full-time] equivalent employee in computing [struck: fulltime][inserted: full-time] equivalent employees for the purposes of determining compliance with personnel ceilings.

   "(3) Work under this subsection shall be considered [struck: parttime][inserted: part-time] service for purposes of computing benefits under chapters 83 and 84 of title 5.

   "(4) A nurse who works under the authority in paragraph (1) shall be considered a [struck: fulltime][inserted: full-time] employee for purposes of chapter 89 of title 5.

   Struck: "(d) Treatment as Full-Time Employee.--(1) A nurse working a work schedule under subsection (b) or (c) who is a full-time employee in non-probationary status at the commencement of work under such work schedule shall remain a full-time employee in non-probationary status while working under such work schedule.

   Struck: "(2)(A) A nurse under a part-time appointment under section 7405(d) of this title who, while working a work schedule under subsection (b) or (c), performs hours of service (as determined in accordance with such subsection) equivalent to two years of service shall be treated as a full-time employee and no longer in probationary status.

   Struck: "(B) In determining the hours of service performed by a nurse for purposes of subparagraph (A), any hours of service not performed under a work schedule under subsection (b) or (c) shall not be included.

   "(e) Notification of Modification of Benefits.--The Secretary shall provide each [struck: nurse][inserted: employee] with respect to whom an alternate work schedule under this section may apply written notice of the effect, if any, [inserted: that ]the alternate work schedule will have on the [struck: nurse's][inserted: employee's] health care premium, retirement, life insurance premium, probationary status, or other benefit or condition of employment. The notice shall be provided not later than 14 days before the [struck: nurse][inserted: employee] consents to the alternate work schedule.

   "(f) Regulations.--The Secretary shall prescribe regulations to carry out this section.".

   (2) The table of sections at the beginning of chapter 74 is amended by inserting after the item relating to section 7456 the following new item:

   "Sec. 7456A. Nurses: alternate work schedules.".

   (b) Policy Against [inserted: Certain ]Work [struck: Shifts in Excess of 12 ]Hours.--(1) It is the sense of Congress to encourage the Secretary of Veterans Affairs to prevent work [struck: shifts][inserted: hours] by nurses providing direct patient care in excess of 12 [inserted: consecutive ]hours [inserted: or ]in [struck: any 24 hour ][inserted: excess of 60 hours in any 7-day ]period[inserted: , except in the case of nurses providing emergency care].

   (2) Not later than one year after the date of the enactment of this Act and every year thereafter for the next two years, the Secretary shall certify to Congress whether or not each Veterans Health Administration facility has in place, as of the date of such certification, a policy designed to prevent work [struck: shifts][inserted: hours] by nurses providing direct patient care [inserted: (other than nurses providing emergency care) ]in excess of 12 [inserted: consecutive ]hours [inserted: or ]in [struck: any 24 hour ][inserted: excess of 60 hours in any 7-day ]period.

   Struck: (c) Report on Overtime for Certain Nurses.--(1) Not later than one year after the effective date of this Act, the Secretary of Veterans Affairs shall submit to Congress a report on the overtime, if any, worked by nurses covered by work schedules described by subsections (b) and (c) of section 7456A of title 38, United States Code (as added by subsection (a)), during the one-year period ending on the date of such report.

   Struck: (2) The report shall set forth--

   Struck: (A) the aggregate number of hours of overtime worked by nurses under each such work schedule during the one-year period ending on the date of the report; and

   Struck: (B) the aggregate amount of overtime pay paid to nurses working under each such work schedule during such period.

   Show 8 more struck paragraphsShow less

   Struck: SEC. 5. RATE OF PAY FOR DIRECTOR OF NURSING SERVICE.

   Struck: (a) Senior Executive Service ES-6 Rate.--(1) Subchapter IV of chapter 74 is amended by adding at the end the following new section:

   Struck: "Sec. 7459. Director of Nursing Service: rate of pay

   Struck: "(a) Senior Executive Service ES-6 Rate.--The rate of pay for the Director of Nursing Service shall be equal to the sum of the maximum rate of basic pay established for the Senior Executive Service under section 5382 of title 5 and the amount of the locality-based comparability payment provided under section 5304 of such title for the Director's locality.

   Struck: "(b) Inapplicability of Nurse Pay Provision.--Section 7451 of this title does not apply to the Director of Nursing Service.".

   Struck: (2) The table of sections at the beginning of chapter 74 is amended by inserting after the item relating to section 7458 the following new item:

   Struck: "Sec. 7459. Director of Nursing Service: rate of pay.".

   Struck: (b) Conforming Amendment.--Section 7404(d) is amended by striking "section 7457" and inserting "sections 7457 and 7459".

   SEC. [struck: 6][inserted: 5]. NURSE EXECUTIVE SPECIAL PAY.

   Section 7452 is amended by adding at the end the following new subsection:

   "(g)(1) In order to recruit and retain highly qualified Department nurse executives, the Secretary may, in accordance with regulations prescribed by the Secretary, pay special pay to the nurse executive at each location as follows:

   "(A) Each Department [struck: healthcare ][inserted: health care ]facility.

   "(B) The Central Office.

   "(2) The amount of special pay paid to a nurse executive under paragraph (1) shall be not less than $10,000 or more than $25,000.

   "(3) The amount of special pay paid to a nurse executive under paragraph (1) shall be based on factors such as the grade of the nurse executive position, the scope and complexity of the nurse executive position, the personal qualifications of the nurse executive, the characteristics of the [struck: healthcare ][inserted: health care ]facility concerned, the nature and number of specialty care units at the [struck: healthcare ][inserted: health care ]facility concerned, demonstrated difficulties in recruitment and retention of nurse executives at the [struck: healthcare ][inserted: health care ]facility concerned, and such other factors as the Secretary considers appropriate.

   "(4) Special pay paid to a nurse executive under paragraph (1) shall be in addition to any other pay (including basic pay) and allowances to which the nurse executive is entitled, and shall be considered pay for all purposes, including retirement benefits under chapters 83 and 84 of title 5, and other benefits, but shall not be considered basic pay for purposes of adverse actions under subchapter V[inserted: of this chapter].".

   Struck: SEC. 7. CLARIFICATION OF DISCRETIONARY NATURE OF VETERANS HEALTH ADMINISTRATION PERSONNEL ADMINISTRATION AUTHORITIES.

   Struck: (a) In General.--Chapter 74 is amended by inserting after section 7426 the following new section:

   Struck: "Sec. 7427. Discretionary nature of functions "Any authority assigned to the Secretary or another officer of the Department under this chapter shall be carried out at the discretion of the Secretary or other officer, as the case may be.".

   Struck: (b) Clerical Amendment.--The table of sections at the beginning of chapter 74 is amended by inserting after the item relating to section 7426 the following new item:

   Show 3 more struck paragraphsShow less

   Struck: "7427. Discretionary nature of functions.".

   Struck: SEC. 8. EFFECTIVE DATE.

   Struck: The amendments to title 38, United States Code, made by this Act shall take effect one year after the date of the enactment of this Act. Amend the title so as to read: "An Act to amend title 38, United States Code, to simplify and improve pay provisions for physicians and dentists and to authorize alternate work schedules and executive pay for nurses, and for other purposes.".

   Original wording

   Strike all after the enacting clause and insert the following:

Read automatically from the Congressional Record. Check the original before relying on it.

As printed