69–006 

115TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 115–267 

GROW OUR OWN DIRECTIVE: PHYSICIAN ASSISTANT 

EMPLOYMENT AND EDUCATION ACT OF 2017 

JULY 28, 2017.—Committed to the Committee of the Whole House on the State of 

the Union and ordered to be printed 

Mr. ROE of Tennessee, from the Committee on Veterans’ Affairs, 

submitted the following 

R E P O R T 

[To accompany H.R. 3262] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Veterans’ Affairs, to whom was referred the 

bill (H.R. 3262) to require the Secretary of Veterans Affairs to 

carry out a pilot program to provide educational assistance to certain former members of the Armed Forces for education and training as physician assistants of the Department of Veterans Affairs, 

to establish pay grades and require competitive pay for physician 

assistants of the Department, and for other purposes, having considered the same, report favorably thereon with an amendment and 

recommend that the bill as amended do pass. 

CONTENTS 

Page 

Amendment .............................................................................................................. 2 

Purpose and Summary ............................................................................................ 6 

Background and Need for Legislation .................................................................... 6 

Hearings ................................................................................................................... 7 

Subcommittee Consideration .................................................................................. 7 

Committee Consideration ........................................................................................ 7 

Committee Votes ...................................................................................................... 7 

Committee Oversight Findings ............................................................................... 7 

Statement of General Performance Goals and Objectives .................................... 7 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 8 

Earmarks and Tax and Tariff Benefits .................................................................. 8 

Committee Cost Estimate ....................................................................................... 8 

Congressional Budget Office Estimate ................................................................... 8 

Federal Mandates Statement ................................................................................. 11 

Advisory Committee Statement .............................................................................. 11 

Constitutional Authority Statement ...................................................................... 11 

Applicability to Legislative Branch ........................................................................ 12 

Statement on Duplication of Federal Programs .................................................... 12 

Disclosure of Directed Rulemaking ........................................................................ 12 

Section-by-Section Analysis of the Legislation ...................................................... 12 

Changes in Existing Law Made by the Bill as Reported ...................................... 16 

2 

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 ‘‘Grow Our Own Directive: Physician Assistant Employment and Education Act of 2017’’. 

SEC. 2. PILOT PROGRAM TO PROVIDE EDUCATIONAL ASSISTANCE TO PHYSICIAN ASSISTANTS 

TO BE EMPLOYED AT THE DEPARTMENT OF VETERANS AFFAIRS. 

(a) PILOT PROGRAM.— 

(1) IN GENERAL.—The Secretary of Veterans Affairs shall carry out a pilot program to be known as the ‘‘Grow Our Own Directive’’ or ‘‘G.O.O.D.’’ pilot program (in this section referred to as the ‘‘pilot program’’) to provide educational 

assistance to certain former members of the Armed Forces for education and 

training as physician assistants of the Department of Veterans Affairs. 

(2) INFORMATION ON PILOT PROGRAM.—The Secretary shall provide information on the pilot program to eligible individuals under subsection (b), including 

information on application requirements and a list of entities with which the 

Secretary has partnered under subsection (g). 

(b) ELIGIBLE INDIVIDUALS.—An individual is eligible to participate in the pilot program if the individual— 

(1) has medical or military health experience gained while serving as a member of the Armed Forces; 

(2) has received a certificate, associate degree, baccalaureate degree, master’s 

degree, or postbaccalaureate training in a science relating to health care; 

(3) is not eligible to participate in educational assistance under chapter 30, 

31, 32, 33, 34, or 35 of title 38, United States Code, or chapter 1606 or 1607 

of title 10, United States Code; 

(4) has participated in the delivery of health care services or related medical 

services, including participation in military training relating to the identification, evaluation, treatment, and prevention of diseases and disorders; and 

(5) does not have a degree of doctor of medicine, doctor of osteopathy, or doctor of dentistry. 

(c) DURATION.—The pilot program shall be carried out during the five-year period 

beginning on the date that is 180 days after the date of the enactment of this Act. 

(d) SELECTION.— 

(1) IN GENERAL.—The Secretary shall select not less than 250 eligible individuals under subsection (b) to participate in the pilot program. 

(2) PRIORITY FOR SELECTION.—In selecting individuals to participate in the 

pilot program under paragraph (1), the Secretary shall give priority to the following individuals: 

(A) Individuals who participated in the Intermediate Care Technician 

Pilot Program of the Department that was carried out by the Secretary between January 2011 and February 2015. 

(B) Individuals who agree to be employed as a physician assistant for the 

Veterans Health Administration at a medical facility of the Department located in a community that— 

(i) is designated as a medically underserved population under section 

330(b)(3)(A) of the Public Health Service Act (42 U.S.C. 254b(b)(3)(A)); 

and 

(ii) is in a State with a per capita population of veterans of more than 

9 percent according to the National Center for Veterans Analysis and 

Statistics and the United States Census Bureau. 

(e) EDUCATIONAL ASSISTANCE.— 

(1) IN GENERAL.—In carrying out the pilot program, the Secretary shall provide educational assistance to individuals participating in the pilot program, including through the use of scholarships, to cover the costs to such individuals 

of obtaining a master’s degree in physician assistant studies or a similar master’s degree. 

(2) USE OF EXISTING PROGRAMS.—In providing educational assistance under 

paragraph (1), the Secretary shall use the Department of Veterans Affairs 

Health Professionals Educational Assistance Program under chapter 76 of title 

38, United States Code, and such other educational assistance programs of the 

Department as the Secretary considers appropriate. 

(3) USE OF SCHOLARSHIPS.—The Secretary shall provide not less than 35 

scholarships under the pilot program to individuals participating in the pilot 

program during each year in which the pilot program is carried out. 

(f) PERIOD OF OBLIGATED SERVICE.— 

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(1) IN GENERAL.—The Secretary shall enter into an agreement with each individual participating in the pilot program in which such individual agrees to be 

employed as a physician assistant for the Veterans Health Administration for 

a period of obligated service specified in paragraph (2). 

(2) PERIOD SPECIFIED.—With respect to each individual participating in the 

pilot program, the period of obligated service specified in this paragraph for the 

individual is— 

(A) if the individual is participating in the pilot program through a program described in subsection (e)(2) that specifies a period of obligated service, the period specified with respect to such program; or 

(B) if the individual is participating in the pilot program other than 

through a program described in such subsection, or if such program does 

not specify a period of obligated service, a period of three years or such 

other period as the Secretary considers appropriate for purposes of the pilot 

program. 

(g) BREACH.— (1) LIABILITY.—Except as provided in paragraph (2), an individual who participates in the pilot program and fails to satisfy the period of obligated service 

under subsection (f) shall be liable to the United States, in lieu of such obligated 

service, for the amount that has been paid or is payable to or on behalf of the 

individual under the pilot program, reduced by the proportion that the number 

of days served for completion of the period of obligated service bears to the total 

number of days in the period of obligated service of such individual. 

(2) EXCEPTION.—If an individual is participating in the pilot program through 

a program described in subsection (e)(2) that specifies a period of obligated service, the liability of the individual for failing to satisfy the period of obligated 

service under subsection (f) shall be determined as specified with respect to 

such program. 

(h) MENTORS.—The Secretary shall ensure that a physician assistant mentor or 

mentors are available for individuals participating in the pilot program at each facility of the Veterans Health Administration at which a participant in the pilot program is employed. 

(i) PARTNERSHIPS.—In carrying out the pilot program, the Secretary shall seek to 

partner with the following: 

(1) Not less than 15 institutions of higher education that— 

(A) offer a master’s degree program in physician assistant studies or a 

similar area of study that is accredited by the Accreditation Review Commission on Education for the Physician Assistant; and 

(B) agree— 

(i) to guarantee seats in such master’s degree program for individuals 

participating in the pilot program who meet the entrance requirements 

for such master’s degree program; and 

(ii) to provide individuals participating in the pilot program with information on admissions criteria and the admissions process. 

(2) Other institutions of higher education that offer programs in physician assistant studies or other similar areas of studies that are accredited by the Accreditation Review Commission on Education for the Physician Assistant. 

(3) The Transition Assistance Program of the Department of Defense. 

(4) The Veterans’ Employment and Training Service of the Department of 

Labor. 

(5) Programs carried out under chapter 41 of title 38, United States Code, for 

the purpose of marketing and advertising the pilot program to veterans and 

members of the Armed Forces who may be interested in the pilot program. 

(j) ADMINISTRATION OF PILOT PROGRAM.—For purposes of carrying out the pilot 

program, the Secretary shall appoint or select within the Office of Physician Assistant Services of the Veterans Health Administration the following: 

(1) A Deputy Director for Education and Career Development of Physician Assistants who— 

(A) is a physician assistant, a veteran, and employed by the Department 

as of the date of the enactment of this Act; 

(B) is responsible for— 

(i) overseeing the pilot program; 

(ii) recruiting candidates to participate in the pilot program; 

(iii) coordinating with individuals participating in the pilot program 

and assisting those individuals in applying and being admitted to a 

master’s degree program under the pilot program; and 

(iv) providing information to eligible individuals under subsection (b) 

with respect to the pilot program; and 

(C) may be employed in the field at a medical center of the Department. 

4 

(2) A Deputy Director of Recruitment and Retention who— 

(A) is a physician assistant, a veteran, and employed by the Department 

as of the date of the enactment of this Act; 

(B) is responsible for— 

(i) identifying and coordinating the needs of the pilot program and 

assist the Secretary in providing mentors under subsection (h) to participants in the pilot program; and 

(ii) coordinating the staff of facilities of the Veterans Health Administration with respect to identifying employment positions and mentors 

under subsection (h) for participants in the pilot program; and 

(C) may be employed in the field at a medical center of the Department. 

(3) A recruiter who— 

(A) reports directly to the Deputy Director of Recruitment and Retention; 

and 

(B) works with the Workforce Management and Consulting Office and the 

Healthcare Talent Management Office of the Veterans Health Administration to develop and implement national recruiting strategic plans for the recruitment and retention of physician assistants within the Department. 

(4) An administrative assistant, compensated at a rate not less than level 

GS–6 of the General Schedule, or equivalent, who assists with administrative 

duties relating to the pilot program in the Office of Physician Assistant Services 

and such other duties as determined by the Secretary to ensure that the Office 

runs effectively and efficiently. 

(k) REPORT.— 

(1) IN GENERAL.—Not later than one year after the date of the enactment of 

this Act, the Secretary of Veterans Affairs, in collaboration with the Secretary 

of Labor, the Secretary of Defense, and the Secretary of Health and Human 

Services, shall submit to Congress a report on the pilot program. 

(2) ELEMENTS.—The report required by paragraph (1) shall include the following: 

(A) The extent to which the pilot program is effective in improving the 

ability of eligible individuals under subsection (b) to become physician assistants; 

(B) An examination of whether the pilot program is achieving the goals 

of— 

(i) enabling individuals to build on medical skills gained as members 

of the Armed Forces by entering into the physician assistant workforce 

of the Department; and 

(ii) helping to meet the shortage of physician assistants employed by 

the Department. 

(C) An identification of such modifications to the pilot program as the 

Secretary of Veterans Affairs, the Secretary of Labor, the Secretary of Defense, and the Secretary of Health and Human Services consider necessary 

to meet the goals described in subparagraph (B). 

(D) An assessment of whether the pilot program could serve as a model 

for other programs of the Department to assist individuals in obtaining certification and employment in other health care fields. 

(l) SOURCE OF AMOUNTS.—Not less than $8,000,000 of the amount necessary to 

carry out the pilot program shall be derived from amounts appropriated to the Department of Veterans Affairs before the date of the enactment of this Act. 

SEC. 3. ESTABLISHMENT OF STANDARDS FOR THE DEPARTMENT OF VETERANS AFFAIRS FOR 

USING EDUCATIONAL ASSISTANCE PROGRAMS TO EDUCATE AND HIRE PHYSICIAN 

ASSISTANTS. 

(a) IN GENERAL.—The Secretary of Veterans Affairs shall establish standards described in subsection (b) to improve the use by the Department of Veterans Affairs 

of the Department of Veterans Affairs Health Professionals Educational Assistance 

Program under chapter 76 of title 38, United States Code, and other educational assistance programs of the Department, including the pilot program under section 2, 

to educate and hire physician assistants of the Department. 

(b) STANDARDS.—The standards described in this subsection are the following: 

(1) Holding directors of medical centers of the Department accountable for 

failure to use the educational assistance programs described in subsection (a) 

and other incentives— 

(A) to advance employees of the Department in their education as physician assistants; and 

(B) to improve recruitment and retention of physician assistants. 

(2) Ensuring that the Department of Veterans Affairs Education Debt Reduction Program under subchapter VII of chapter 76 of such title is available for 

5 

participants in the pilot program under section 2 to fill vacant physician assistant positions at the Department, including by— 

(A) including in all vacancy announcements for physician assistant positions the availability of the Education Debt Reduction Program; and 

(B) informing applicants to physician assistant positions of their eligibility for the Education Debt Reduction Program. 

(3) Monitoring compliance with the application process for educational assistance programs described in subsection (a) to ensure that such programs are 

being fully utilized to carry out this section. 

(4) Creating programs, including through the use of the Department of Veterans Affairs Employee Incentive Scholarship Program under subchapter VI of 

chapter 76 of such title, to encourage employees of the Department to apply to 

accredited physician assistant programs. 

(c) REGULATIONS.—The Secretary shall prescribe such regulations as the Secretary 

considers appropriate to carry out this section. 

SEC. 4. ESTABLISHMENT OF PAY GRADES FOR PHYSICIAN ASSISTANTS OF THE DEPARTMENT 

OF VETERANS AFFAIRS AND REQUIREMENT TO PROVIDE COMPETITIVE PAY. 

(a) ESTABLISHMENT OF PAY GRADES.—Section 7404(b) of title 38, United States 

Code, is amended by adding at the end the following: 

‘‘PHYSICIAN ASSISTANT SCHEDULE 

‘‘Physician Assistant IV. 

‘‘Physician Assistant III. 

‘‘Physician Assistant II. 

‘‘Physician Assistant I.’’. 

(b) COMPETITIVE PAY.—Section 7451(a)(2) of such title is amended— 

(1) by redesignating subparagraph (B) as subparagraph (C); 

(2) by inserting after subparagraph (A) the following new subparagraph (B): 

‘‘(B) Physician assistant.’’; and 

(3) in subparagraph (C), as redesignated by paragraph (1), by striking ‘‘and 

registered nurse’’ and inserting ‘‘registered nurse, and physician assistant’’. 

(c) NATIONAL STRATEGIC PLAN.— 

(1) IN GENERAL.—The Secretary of Veterans Affairs shall implement a national strategic plan for the retention and recruitment of physician assistants 

of the Department of Veterans Affairs that includes the establishment and 

adoption of standards for the provision of competitive pay to physician assistants of the Department in comparison to the pay of physician assistants in the 

private sector. 

(2) REPORT.—Not later than one year after the date of the enactment of this 

Act, the Secretary shall submit to the Committee on Veterans’ Affairs of the 

Senate and the Committee on Veterans’ Affairs of the House of Representatives 

a report on the implementation of the national strategic plan under paragraph 

(1). 

SEC. 5. EXTENSION OF REQUIREMENT FOR COLLECTION OF FEES FOR HOUSING LOANS 

GUARANTEED BY SECRETARY OF VETERANS AFFAIRS. 

Section 3729(b)(2) of title 38, United States Code, is amended— 

(1) in subparagraph (A)— 

(A) in clause (iii), by striking ‘‘September 30, 2024’’ and inserting ‘‘December 31, 2024’’; and 

(B) in clause (iv), by striking ‘‘September 30, 2024’’ and inserting ‘‘December 31, 2024’’; 

(2) in subparagraph (B)— 

(A) in clause (i), by striking ‘‘September 30, 2024’’ and inserting ‘‘December 31, 2024’’; and 

(B) in clause (ii), by striking ‘‘September 30, 2024’’ and inserting ‘‘December 31, 2024’’; 

(3) in subparagraph (C)— 

(A) in clause (i), by striking ‘‘September 30, 2024’’ and inserting ‘‘December 31, 2024’’; and 

(B) in clause (ii), by striking ‘‘September 30, 2024’’ and inserting ‘‘December 31, 2024’’; and 

(4) in subparagraph (D)— 

(A) in clause (i), by striking ‘‘September 30, 2024’’ and inserting ‘‘December 31, 2024’’; and 

(B) in clause (ii), by striking ‘‘September 30, 2024’’ and inserting ‘‘December 31, 2024’’. 

6 

1May 15, 2015, Subcommittee on Health hearing, ‘‘Overcoming Barriers to More Efficient and 

Effective VA Staffing,’’ http://veterans.house.gov/hearing/overcoming-barriers-to-more-efficientand-effective-va-staffing. 2 January 30, 2015, VA Inspector General report, ‘‘Determination of VHA Occupational Staffing Shortages,’’ http://www.va.gov/oig/pubs/VAOIG-15-00430-103.pdf. 

PURPOSE AND SUMMARY

H.R. 3262, the ‘‘Grow Our Own Directive: Physician Assistant 

Employment and Education Act of 2017,’’ was introduced by Representative Ann McLane Kuster of New Hampshire on July 17, 

2017. The bill, as amended, was ordered to be favorably reported 

to the full House on July 19, 2017, by voice vote. 

H.R. 3262, as amended, would direct the Department of Veterans 

Affairs (VA) to carry out the Grow Our Own Directive—or, 

G.O.O.D.—pilot program to provide educational assistance to certain former members of the Armed Forces for education and training as VA physician assistants (PAs). 

BACKGROUND AND NEED FOR LEGISLATION

The PA profession started in the mid-1960s in response to a nationwide shortage of primary care physicians. The first class of PAs 

were primarily composed of Army medics and Navy corpsman who 

had served in the Vietnam War. The significant number of veterans working as PAs has continued since that time and is illustrative of the unique relationship veterans and the VA health care 

system have historically had with the PA profession. According to 

testimony from the VA Physician Assistants Association (VAPAA), 

VA is the largest single federal employer of PAs, and a quarter of 

all primary care patients in the VA health care system are seen by 

PAs.1 However, VA has experienced recent difficulties recruiting 

and retaining PAs within the VA health care system, and as such, 

PAs are a top 5 mission-critical occupation for VA, ranking fourth 

according to a January 2015 VA Office of Inspector General (OIG) 

report.2

The Committee believes that PAs are critical to VA’s ability to 

provide access to timely, high-quality care to veteran patients and 

encourages VA to prioritize recruitment and retention of PAs within the VA health care system. As such, the bill would require VA 

to carry out the G.O.O.D. pilot for five years to assist certain veterans in obtaining education and training as PAs. Individuals eligible to participate in the G.O.O.D. pilot would include those with 

medical or military health experience who have received a certificate, associate degree, baccalaureate degree, master’s degree, or 

post-baccalaureate training in a science relating to health care and 

that have participated in the delivery of health care services or related medical services but do not have a doctor of medicine, doctor 

of osteopathy, or doctor of dentistry degree. VA would be required 

to select not less than 250 eligible individuals to participate in the 

pilot and give priority to those who participated in the VA Intermediate Care Technician pilot program and who agree to work as 

a PA at VA medical facilities in medically underserved communities or in states with a per capita population of veterans of more 

than nine percent. The bill would also require VA to provide educational assistance—to include not less than 35 scholarships—to individuals participating in the pilot program through the VA Health 

7 

Professionals Educational Assistance program, to enter into an 

agreement for a period of obligated service with each individual 

participating in the pilot program who agrees to work as a VA PA, 

and to ensure PA mentors are available for pilot program participants. Finally, the bill would require VA to appoint a Deputy Director for PA Education and Career Development and a Deputy Director for Recruitment and Retention from within the VA Office of 

PAs and to submit a report to Congress on the pilot program one 

year after enactment. 

HEARINGS

There were no full Committee hearings held on H.R. 3262, as 

amended. 

There were no Subcommittee hearings held on H.R. 3262, as 

amended. 

SUBCOMMITTEE CONSIDERATION

There were no Subcommittee markups involving H.R. 3262, as 

amended. 

COMMITTEE CONSIDERATION

On July 19, 2017, the full Committee met in open markup session, a quorum being present, and ordered H.R. 3262, as amended, 

reported favorably to the House of Representatives by voice vote. 

During consideration of the bill, the following amendment in the 

nature of a substitute was considered and agreed to by voice vote: 

An Amendment in the Nature of a Substitute to H.R., 3262 

as amended, offered by Representative Ann McLane 

Kuster of New Hampshire. 

A motion by Representative Tim Walz of Minnesota to favorably 

report H.R. 3262, as amended, 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, there were no recorded votes taken on 

amendments or in connection with ordering H.R. 3262, 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 are to ensure VA provides educational assistance to certain former members of the Armed Forces for education and training as VA physician assistants and increases access to care for vetVerDate Sep 11 2014 06:38 Jul 29, 2017 Jkt 069006 PO 00000 Frm 00007 Fmt 6659 Sfmt 6602 E:\HR\OC\HR267.XXX HR267
8 

eran patients through the increased availability of VA physician assistants. 

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

In compliance with clause 3(c)(2) of rule XIII of the Rules of the 

House of Representatives, the Committee adopts as its own the estimate of new budget authority, entitlement authority, or tax expenditures or revenues contained in the cost estimate prepared by 

the Director of the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974. 

EARMARKS AND TAX AND TARIFF BENEFITS

H.R. 3262, 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. 3262, 

as amended, prepared by the Director of the Congressional Budget 

Office pursuant to section 402 of the Congressional Budget Act of 

1974. 

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. 3262, 

as amended, provided by the Congressional Budget Office pursuant 

to section 402 of the Congressional Budget Act of 1974: 

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, Washington, DC, July 24, 2017. 

Hon. PHIL ROE, M.D., 

Chairman, Committee on Veterans’ Affairs, 

House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 3262, the Grow Our Own 

Directive: Physician Assistant Employment and Education Act of 

2027. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Ann E. Futrell. 

Sincerely, 

MARK P. HADLEY

(For Keith Hall, Director). 

Enclosure. 

H.R. 3262—Grow Our Own Directive: Physician Assistant Employment and Education Act of 2017 

Summary: H.R. 3262 would require the Department of Veterans 

Affairs (VA) to modify compensation levels for physician assistants 

(PAs) and to carry out a five-year pilot program to provide educational assistance to veterans training to be PAs at the department. CBO estimates that implementing the bill would cost $120 

9 

million over the 2017–2022 period, assuming appropriation of the 

necessary amounts. 

The bill also would increase the fees charged to certain veterans 

who obtain loans guaranteed by VA. CBO estimates that enacting 

H.R. 3262 would decrease direct spending by $83 million over the 

2017–2027 period. Because enacting the legislation would affect direct spending, pay-as-you-go procedures apply. Enacting the bill 

would not affect revenues. 

CBO estimates that enacting H.R. 3262 would not increase net 

direct spending or on-budget deficits in any of the four consecutive 

10-year periods beginning in 2028. 

H.R. 3262 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act (UMRA) 

and would impose no costs on state, local, or tribal governments. 

Estimated cost to the Federal Government: The estimated budgetary effect of H.R. 3262 is shown in the following table. The costs 

of this legislation fall within budget function 700 (veterans benefits 

and services). 

By fiscal year, in millions of dollars— 

2017 2018 2019 2020 2021 2022 2017– 

2022 

INCREASES IN SPENDING SUBJECT TO APPROPRIATION 

Competitive Pay for Physician Assistants: 

Estimated Authorization Level .............. 0 12 18 18 21 23 92 

Estimated Outlays ................................ 0 10 17 17 20 22 86 

Pilot Program: 

Estimated Authorization Level .............. 0 2 7 10 11 6 36 

Estimated Outlays ................................ 0 2 6 9 11 6 34 

Total Changes 

Estimated Authorization Level ..... 0 14 25 28 32 29 128 

Estimated Outlays ....................... 0 12 23 26 31 28 120 

Note: In addition to the costs shown above, enacting H.R. 3262 would decrease mandatory spending by $83 million in 2025. 

Basis of estimate: For this estimate, CBO assumes that H.R. 

3262 will be enacted near the start of 2018, that the estimated 

amounts will be appropriated each year, and that outlays will follow historical spending patterns for affected programs. 

Spending subject to appropriation 

CBO estimates that implementing H.R. 3262 would increase personnel and administrative costs at VA by a total of $120 million 

over the 2017–2022 period, subject to appropriation of the necessary amounts. 

Competitive Pay for Physician Assistants. Section 4 would require VA to compensate PAs at rates that are competitive with 

those paid by other health care providers. Currently, VA employs 

about 2,200 physician assistants. Based on wages paid in the private sector, CBO estimates that pay for those employees would increase by 5 percent in 2018 (from $114,000 to $120,000) if VA paid 

competitive rates. In addition, CBO expects that the higher pay 

level would help ameliorate VA’s current difficulties in recruiting 

and retaining physicians assistants and would thus increase the 

total number of PAs employed by VA. Based on data from VA on 

hiring and retaining nurses who are paid at competitive rates, CBO 

estimates that under the bill VA would increase the number of PAs 

it employs by about 4 percent above the current staffing level. On 

10 

1 Under the Federal Credit Reform Act of 1990, the subsidy cost of a loan guarantee is the 

net present value of estimated payments by the government to cover defaults and delinquencies, 

interest subsidies, or other expenses, offset by any payments to the government, including origination fees, other fees, penalties, and recoveries on defaulted loans. Such subsidy costs are calculated by discounting those expected cash flows using the rate on Treasury securities of comparable maturity. The resulting estimated subsidy costs are recorded in the budget when the 

loans are disbursed. 

that basis, CBO estimates that implementing the section would 

cost $86 million over the 2017–2022 period. 

Pilot Program. One of VA’s largest staffing shortages is for PAs. 

Section 2 would require VA to establish a five-year pilot program 

to improve the recruitment and retention of PAs by providing educational assistance to certain former members of the Armed Forces. 

Participants in the pilot program must agree to work as PAs for 

VA for at least three years. The pilot program would offer scholarships to at least 250 candidates and provide no less than 35 scholarships each year. 

A master’s degree program in physician assistant studies takes two years to complete, with an average annual cost of $40,000. 

CBO expects that VA would cover the full tuition of 35 people in 

2018 and up to 145 people a year by 2021. After accounting for anticipated inflation, CBO estimates that costs for tuition would total 

$30 million over the 2017–2022 period. 

Section 2 also would require VA to hire two senior administrators to oversee and coordinate the pilot program. On the basis of 

information from VA on salaries of senior officials, CBO estimates 

that the salary and fringe benefits would be roughly $150,000 (the 

equivalent of a GS–15 level) for each person. In addition, CBO expects VA would need to hire a recruiter, with annual costs of 

$70,000, and an administrative assistant, with annual costs of 

$47,000. In total, CBO estimates that the administrative costs of 

implementing the pilot program would be $4 million over the 2017– 

2022 period. 

Direct spending 

Under its Home Loan program, VA guarantees mortgages made 

to veterans; those guarantees enable veterans to get better loan 

terms, such as lower interest rates or smaller down payments. The 

loan guarantee provides a lender a payment of up to 25 percent of 

the outstanding loan balances (subject to some limitations on the 

original loan amounts) in the event that a veteran defaults on a 

guaranteed loan. Section 3 would increase some of the fees that VA 

charges veterans for providing those guarantees. Those fees lower 

the subsidy cost of the guarantees by partially offsetting the costs 

of subsequent defaults.1

Under current law, the up-front fee varies on the basis of the size 

of the down payment and whether the veteran has previously used 

the loan-guarantee benefit. Borrowers who are members of the reserve component pay an additional fee of 0.25 percent of the loan 

amount. Veterans who receive compensation for service-connected 

disabilities are exempt from paying the fee. The current fees that 

would be affected by section 5 are: 

• 2.15 percent of the loan amount for loans with no down 

payment, 

• 1.50 percent of the loan amount for loans with a 5 percent 

down payment, and 

11 

• 0.75 percent of the loan amount for loans with a 10 percent down payment. 

Those fees are scheduled to decline on October 1, 2024, to 1.40 

percent, 0.75 percent, and 0.50 percent, respectively. 

Under section 5, that scheduled fee reduction would be delayed 

by three months, until December 31, 2024. Continuing the fees at 

their current level would increase collections by VA, thereby lowering the subsidy cost of the loan guarantees. Based on data from 

VA, CBO estimates that enacting section 5 would reduce direct 

spending by $83 million in 2025. 

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 the following table. 

CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR H.R. 3262, THE GROW OUR OWN DIRECTIVE: 

PHYSICIAN ASSISTANT EMPLOYMENT AND EDUCATION ACT OF 2017, AS ORDERED REPORTED 

BY THE HOUSE COMMITTEE ON VETERANS’ AFFAIRS ON JULY 19, 2017 

By fiscal year, in millions of dollars— 

2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2017– 

2022 

2017– 

2027 

NET INCREASE OR DECREASE (¥) IN THE [ON-BUDGET] DEFICIT 

Statutory Pay-As-You-Go Impact 0 0 0 0 0 0 0 0 ¥83 0 0 0 ¥83 

Increase in long-term direct spending and deficits: CBO estimates that enacting H.R. 3262 would not increase net direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2028. 

Intergovernmental and private-sector impact: H.R. 3262 contains 

no intergovernmental or private-sector mandates as defined in 

UMRA and would impose no costs on state, local, or tribal governments. 

Estimate prepared by: Federal costs: Ann E. Futrell and Dwayne 

M. Wright; Impact on state, local, and tribal governments: Jon 

Sperl; Impact on the private sector: Paige Piper/Bach. 

Estimate approved by: H. Samuel Papenfuss, Deputy Assistant 

Director for Budget Analysis. 

FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of Federal mandates regarding H.R. 3262, as amended, prepared by the Director 

of the Congressional Budget Office pursuant to section 423 of the 

Unfunded Mandates Reform Act. 

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. 3262, as 

amended. 

STATEMENT OF CONSTITUTIONAL AUTHORITY

Pursuant to Article I, section 8 of the United States Constitution, 

H.R. 3262, as amended, is authorized by Congress’ power to ‘‘proVerDate Sep 11 2014 06:49 Jul 29, 2017 Jkt 069006 PO 00000 Frm 00011 Fmt 6659 Sfmt 6602 E:\HR\OC\HR267.XXX HR267
12 

vide for the common Defense and general Welfare of the United 

States.’’ 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that H.R. 3262, 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 section 3(g) of H. Res. 5, 115th Cong. (2017), the 

Committee finds that no provision of H.R. 3262, 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. 

DISCLOSURE OF DIRECTED RULEMAKING

Pursuant to section 3(i) of H. Res. 5, 115th Cong. (2017), the 

Committee estimates that H.R. 3262, as amended, contains no directed rule making that would require the Secretary to prescribe 

regulations. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title 

Section 1 of the bill would provide a short title of H.R. 3262, as 

amended, as the ’’Grow Our Own Directive: Physician Assistant 

Employment and Education Act of 2017’’. 

Section 2. Pilot program to provide educational assistance to be employed at the Department of Veterans Affairs 

Section 2(a) of the bill would require VA to carry out a pilot program called the ‘‘Grow Our Own Directive’’ (or, ‘‘G.O.O.D.’’) to provide assistance to certain former members of the Armed Forces for 

education and training as VA physician assistants. Section 2(a) 

would also require VA to provide relevant information—to include 

information regarding the application process and a list of entities 

with which VA has partnered—to individuals eligible for the 

G.O.O.D. pilot. 

Section 2(b) of the bill would require that the eligibility criteria 

for the G.O.O.D. pilot be defined as follows: (1) possession of medical or military health experience gained while serving as a member of the Armed Forces; (2) possession of a certificate, associate 

degree, baccalaureate degree, master’s degree, or post baccalaureate training in a science relating to health care; (3) is not eligible to participate in education assistance under chapter 30, 31, 

32, 33, 34, or 55 of title 38, U.S.C., or chapter 1606 or 1607 of title 

10, U.S.C.; (4) participation in the delivery of health care services 

or related medical services, including military training relating to 

identification, evaluation, treatment, and prevention of diseases 

13 

and disorders; and, (5) is not a doctor of medicine, doctor of osteopathy, or doctor of dentistry degree. 

Section 2(c) of the bill would require that the G.O.O.D. pilot be 

carried out for five years, beginning 180 days after the date of enactment. 

Section 2(d) of the bill would require VA to select at least 250 

eligible individuals to participate in the G.O.O.D. pilot. This section 

would stipulate that in selecting eligible individuals, VA must give 

priority to those who participated in the Intermediate Care Technician pilot program and those who agree to be employed as a physician assistant at a VA facility in a community that is designated 

as serving a medically underserved population in a state with a per 

capita veteran population of more than nine percent. 

Section 2(e) of the bill would require VA to provide assistance, 

including through scholarships, to individuals participating in the 

G.O.O.D. pilot to cover the costs of obtaining a master’s degree in 

physician assistant studies or a similar master’s degree. VA would 

also be required to use the VA Health Professionals Education Assistance Program and such other educational assistance programs 

as considered appropriate to individuals participating in the 

G.O.O.D. pilot. VA would be required to provide at least 35 scholarships to individuals participating in the G.O.O.D. pilot during each 

year in which the pilot is carried out. 

Section 2(f) of the bill would require VA to enter into agreements 

with each G.O.O.D. pilot participant stipulating that the participant will be employed as a VA physician assistant for a period of 

three years, unless a participating individual is in a program described in subsection (e)(2) of the bill and that program specified 

a period of time during which that individual agreed to work for 

VA. 

Section 2(g) of the bill would require that an individual who participated in the G.O.O.D. pilot and who fails to satisfy the period 

of obligated service described in subsection (f)(2) of the bill is liable 

for the amount that has been paid or is payable to or on behalf of 

the individual reduced by the number of days served for completion 

of the period of obligated service. If an individual is participating 

in the G.O.O.D. pilot through a program described in subsection 

(e)(2) that specifies a period of obligated service, the liability of the 

individual for failing to satisfy the period of obligated service under 

subsection (f)(1) would be determined as specified with respect to 

such program. 

Section 2(h) of the bill would require VA to ensure physician assistant mentors are available for individuals participating in the 

G.O.O.D. pilot at each VA facility at which pilot participants are 

working. 

Section 2(i) of the bill would require that, in carrying out the 

G.O.O.D. pilot, VA seek to partner with: (1) at least 15 institutions 

of higher education that offer a master’s degree program in physician assistant studies or a similar area of study that is accredited 

by the Accreditation Review Commission on Education for the Physician Assistant and that agree to guarantee seats in such programs for individuals participating in the G.O.O.D. pilot who meet 

the entrance requirements and to provide pilot participants with 

information on admissions; (2) other institutions of higher education that offer programs in physician assistant studies or other 

14 

similar areas of studies that are accredited by the Accreditation Review Commission on Education for the Physician Assistant; (3) the 

Department of Defense Transition Assistance Program; (4) the Department of Labor Veterans’ Employment and Training Service; 

and (5) programs carried out under chapter 41 of title 38, U.S.C., 

for the purpose of marketing and advertising the G.O.O.D. pilot to 

veterans and members of the Armed Forces who may be interested. 

Section 2(j) of the bill would require that, for the purposes of carrying out the G.O.O.D. pilot, VA appoint from within the Office of 

Physician Assistants, a Deputy Director for Education and Career 

Development of Physician Assistants who is a physician assistant, 

a veteran, and a VA employee to be responsible for the following: 

(1) overseeing the G.O.O.D. pilot; (2) recruiting candidates to participate in the G.O.O.D. pilot; (3) coordinating with individuals participating in the G.O.O.D. pilot; and (4) assisting individuals participating in the G.O.O.D. pilot in applying to master’s programs. 

VA would also be required to select a Deputy Director of Recruitment and Retention who is a physician assistant employed by VA 

to be responsible for: (1) identifying and coordinating the needs of 

the pilot program; (2) assisting VA in providing mentors to 

G.O.O.D. pilot participants; and (3) coordinating VA facility staff 

with respect to identifying employment positions and mentors. This 

section would also require VA to select a recruiter to report directly 

to the Deputy Director of Recruitment and Retention and work 

with the Workforce Management and Consulting Office and the 

Healthcare Talent Management Office to develop and implement 

national recruiting strategic plans for the recruitment and retention of VA physician assistants. Further, section 2(j) of the bill 

would require VA to select an administrative assistant, compensated at a rate not less than level GS–6 or equivalent, to assist 

with administrative duties relating to the G.O.O.D. pilot in the Office of Physician Assistant Services and such other duties as determined by the Secretary to ensure that the Office runs effectively 

and efficiently. 

Section 2(k) of the bill would require that, within one year of enactment, VA submit to Congress a report on the pilot program, in 

collaboration with the Department of Labor, the Department of Defense, and the Department of Health and Human Services. The report must include: (1) the extent to which the G.O.O.D. pilot is effective in improving the ability of participants to become physician 

assistants; (2) an examination of whether the G.O.O.D. pilot is 

achieving the goal of enabling individuals to build on medical skills 

gained as members of the Armed Forces by entering into the VA 

physician assistant workforce and helping to meet the shortage of 

physician assistants employed by VA; (3) an identification of such 

modifications to the pilot program as considered necessary; and (4) 

an assessment of whether the G.O.O.D. pilot could serve as a 

model for other VA programs. 

Section 2(l) of the bill would require that no less than $8,000,000 

of the amount necessary to carry out the pilot program be derived 

from amounts appropriated to VA before the date of the enactment 

of this act. 

15 

Section 3. Establishment of standards for the Department of Veterans Affairs for using educational assistance programs to educate and hire physician assistants 

Section 3(a) of the bill would require VA to establish standards 

described in subsection (b) to improve VA’s use of the Department’s 

Health Professionals Educational Assistance Program under chapter 76 of title 38, U.S.C., and other VA educational assistance programs, including the G.O.O.D. pilot, to educate and hire physician 

assistants in VA. 

Section 3(b) of the bill would require that the standards described consist of the following: (1) holding directors of medical centers of the Department accountable for failure to use the educational assistance programs described in subsection (a) and other 

incentives to advance employees of the Department in their education as physician assistants and to improve recruitment and retention of physician assistants; (2) ensuring that the Department 

of Veterans Affairs Education Debt Reduction Program under subchapter VII of chapter 76 of such title is available for participants 

in the pilot program under section 2 to fill vacant physician assistant positions at the Department, including by including in all vacancy announcements for physician assistant positions the availability of the Education Debt Reduction Program, and informing 

applicants to physician assistant positions of their eligibility for the 

Education Debt Reduction Program; (3) Monitoring compliance 

with the application process for educational assistance programs 

described in subsection (a) to ensure that such programs are being 

fully utilized to carry out this section; and, Creating programs, including through the use of the Department of Veterans Affairs Employee Incentive Scholarship Program under subchapter VI of chapter 76 of such title, to encourage employees of the Department to 

apply to accredited physician assistant programs. 

Section 3(c) of the bill would require that VA prescribe such regulations as the Secretary considers appropriate to carry out this 

section. 

Section 4. Establishment of pay grades for physician assistants of 

the Department of Veterans Affairs and requirement to provide 

competitive pay 

Section 4(a) of the bill would amend section 7404(b) of title 38, 

U.S.C., by adding at the end, ‘‘PHYSICIAN ASSISTANT SCHEDULE,’’ ‘‘Physician Assistant IV,’’ ‘‘Physician Assistant III,’’ ‘‘Physician Assistant II,’’ and ‘‘Physician Assistant I.’’ 

Section 4(b) of the bill would amend section 7451(a)(2) by redesignating subparagraph (B) as subparagraph (C); by inserting after 

subparagraph (A) the following new subparagraph (B): ‘(B) Physician assistant.’’; and, in subparagraph (C), as redesignated by paragraph (1), by striking ‘‘and registered nurse’’ and inserting ‘‘registered nurse, and physician assistant’’. 

Section 4(c) of the bill would require that VA implement a national strategic plan for the retention and recruitment of VA physician assistants that includes the establishment and adoption of 

standards for the provision of competitive pay to physician assistants of the Department in comparison to the pay of physician assistants in the private sector. This section would also require that 

no later than one year after the date of the enactment of this act, 

16 

the Secretary shall submit to the Committee on Veterans’ Affairs 

of the Senate and the Committee on Veterans’ Affairs of the House 

of Representatives a report on the implementation of the national 

strategic plan under paragraph (1). 

Section 5. Extension of requirement for collection of fees for housing 

loans guaranteed by Secretary of Veterans Affairs 

Section 3 of the bill would amend section 3729(b)(2) of title 38, 

U.S.C. clause (iii) in subparagraph (A) by striking ‘‘September 30, 

2024’’ and inserting ‘‘September 30, 2025;’’ clause (iv) in subparagraph (A) by striking ‘‘September 30, 2024’’ and inserting ‘‘September 30, 2025;’’ clause (i) in subparagraph (B) by striking ‘‘September 30, 2024’’ and inserting ‘‘September 30, 2025;’’ clause (ii) in 

subparagraph (B) by striking ‘‘September 30, 2024’’ and inserting 

‘‘September 30, 2025;’’ clause (i) in subparagraph (C) by striking 

‘‘September 30, 2024’’ and inserting ‘‘September 30, 2025;’’ clause 

(ii) in subparagraph (C) by striking ‘‘September 30, 2024’’ and inserting ‘‘September 30, 2025;’’ clause (i) in subparagraph (D) by 

striking ‘‘September 30, 2024’’ and inserting ‘‘September 30, 2025;’’ 

and, clause (ii) in subparagraph (D) by striking ‘‘September 30, 

2024’’ and inserting ‘‘September 30, 2025.’’ 

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 italic, 

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 italic, 

and existing law in which no change is proposed is shown in 

roman): 

TITLE 38, UNITED STATES CODE 

* * * * * * * 

PART III—READJUSTMENT AND RELATED 

BENEFITS 

* * * * * * * 

CHAPTER 37—HOUSING AND SMALL BUSINESS LOANS 

* * * * * * * 

Subchapter III—ADMINISTRATIVE PROVISIONS 

* * * * * * * 

17 

§ 3729. Loan fee 

(a) REQUIREMENT OF FEE.—(1) Except as provided in subsection 

(c), a fee shall be collected from each person obtaining a housing 

loan guaranteed, insured, or made under this chapter, and each 

person assuming a loan to which section 3714 of this title applies. 

No such loan may be guaranteed, insured, made, or assumed until 

the fee payable under this section has been remitted to the Secretary. 

(2) The fee may be included in the loan and paid from the 

proceeds thereof. 

(b) DETERMINATION OF FEE.—(1) The amount of the fee shall be 

determined from the loan fee table in paragraph (2). The fee is expressed as a percentage of the total amount of the loan guaranteed, 

insured, or made, or, in the case of a loan assumption, the unpaid 

principal balance of the loan on the date of the transfer of the property. 

(2) The loan fee table referred to in paragraph (1) is as follows: 

LOAN FEE TABLE 

Type of loan Active duty veteran Reservist Other obligor 

(A)(i) Initial loan described 

in section 3710(a) to 

purchase or construct a 

dwelling with 0-down, or 

any other initial loan described in section 

3710(a) other than with 

5-down or 10-down 

(closed before January 1, 

2004) 

2.00 2.75 NA 

(A)(ii) Initial loan described 

in section 3710(a) to 

purchase or construct a 

dwelling with 0-down, or 

any other initial loan described in section 

3710(a) other than with 

5-down or 10-down 

(closed on or after January 1, 2004, and before 

October 1, 2004) 

2.20 2.40 NA 

(A)(iii) Initial loan described 

in section 3710(a) to 

purchase or construct a 

dwelling with 0-down, or 

any other initial loan described in section 

3710(a) other than with 

5-down or 10-down 

(closed on or after October 1, 2004, and before 

øSeptember 30, 2024¿ 

December 31, 

2024 ) 

2.15 2.40 NA 

18 

LOAN FEE TABLE—Continued 

Type of loan Active duty veteran Reservist Other obligor 

(A)(iv) Initial loan described 

in section 3710(a) to 

purchase or construct a 

dwelling with 0-down, or 

any other initial loan described in section 

3710(a) other than with 

5-down or 10-down 

(closed on or after øSeptember 30, 2024¿ December 31, 2024 ) 

1.40 1.65 NA 

(B)(i) Subsequent loan described in section 

3710(a) to purchase or 

construct a dwelling with 

0-down, or any other 

subsequent loan described in section 

3710(a) (closed before 

øSeptember 30, 2024¿ 

December 31, 

2024 ) 

3.30 3.30 NA 

(B)(ii) Subsequent loan described in section 

3710(a) to purchase or 

construct a dwelling with 

0-down, or any other 

subsequent loan described in section 

3710(a) (closed on or 

after øSeptember 30, 

2024¿ December 

31, 2024 ) 

1.25 1.25 NA 

(C)(i) Loan described in 

section 3710(a) to purchase or construct a 

dwelling with 5-down 

(closed before øSeptember 30, 2024¿ December 31, 2024 ) 

1.50 1.75 NA 

(C)(ii) Loan described in 

section 3710(a) to purchase or construct a 

dwelling with 5-down 

(closed on or after øSeptember 30, 2024¿ December 31, 2024 ) 

0.75 1.00 NA 

(D)(i) Initial loan described 

in section 3710(a) to 

purchase or construct a 

dwelling with 10-down 

(closed before øSeptember 30, 2024¿ December 31, 2024 ) 

1.25 1.50 NA 

(D)(ii) Initial loan described 

in section 3710(a) to 

purchase or construct a 

dwelling with 10-down 

(closed on or after øSeptember 30, 2024¿ December 31, 2024 ) 

0.50 0.75 NA 

(E) Interest rate reduction 

refinancing loan 

0.50 0.50 NA 

(F) Direct loan under section 3711 1.00 1.00 NA 

19 

LOAN FEE TABLE—Continued 

Type of loan Active duty veteran Reservist Other obligor 

(G) Manufactured home 

loan under section 3712 

(other than an interest 

rate reduction refinancing loan) 

1.00 1.00 NA 

(H) Loan to Native American veteran under section 3762 (other than an 

interest rate reduction 

refinancing loan) 

1.25 1.25 NA 

(I) Loan assumption under 

section 3714 

0.50 0.50 0.50 

(J) Loan under section 

3733(a) 

2.25 2.25 2.25 

(3) Any reference to a section in the ‘‘Type of loan’’ column 

in the loan fee table in paragraph (2) refers to a section of this 

title. 

(4) For the purposes of paragraph (2): 

(A) The term ‘‘active duty veteran’’ means any veteran 

eligible for the benefits of this chapter other than a Reservist. 

(B) The term ‘‘Reservist’’ means a veteran described in 

section 3701(b)(5)(A) of this title who is eligible under section 3702(a)(2)(E) of this title. 

(C) The term ‘‘other obligor’’ means a person who is not 

a veteran, as defined in section 101 of this title or other 

provision of this chapter. 

(D) The term ‘‘initial loan’’ means a loan to a veteran 

guaranteed under section 3710 or made under section 3711 

of this title if the veteran has never obtained a loan guaranteed under section 3710 or made under section 3711 of 

this title. 

(E) The term ‘‘subsequent loan’’ means a loan to a veteran, other than an interest rate reduction refinancing 

loan, guaranteed under section 3710 or made under section 

3711 of this title if the veteran has previously obtained a 

loan guaranteed under section 3710 or made under section 

3711 of this title. 

(F) The term ‘‘interest rate reduction refinancing loan’’ 

means a loan described in section 3710(a)(8), 

3710(a)(9)(B)(i), 3710(a)(11), 3712(a)(1)(F), or 3762(h) of 

this title. 

(G) The term ‘‘0-down’’ means a downpayment, if any, of 

less than 5 percent of the total purchase price or construction cost of the dwelling. 

(H) The term ‘‘5-down’’ means a downpayment of at least 

5 percent or more, but less than 10 percent, of the total 

purchase price or construction cost of the dwelling. 

(I) The term ‘‘10-down’’ means a downpayment of 10 percent or more of the total purchase price or construction 

cost of the dwelling. 

(c) WAIVER OF FEE.—(1) A fee may not be collected under this 

section from a veteran who is receiving compensation (or who, but 

for the receipt of retirement pay or active service pay, would be enVerDate Sep 11 2014 06:38 Jul 29, 2017 Jkt 069006 PO 00000 Frm 00019 Fmt 6659 Sfmt 6602 E:\HR\OC\HR267.XXX HR267
20 

titled to receive compensation) or from a surviving spouse of any 

veteran (including a person who died in the active military, naval, 

or air service) who died from a service-connected disability. 

(2)(A) A veteran described in subparagraph (B) shall be 

treated as receiving compensation for purposes of this subsection as of the date of the rating described in such subparagraph without regard to whether an effective date of the award 

of compensation is established as of that date. 

(B) A veteran described in this subparagraph is a veteran who is rated eligible to receive compensation— 

(i) as the result of a pre-discharge disability examination and rating; or 

(ii) based on a pre-discharge review of existing medical evidence (including service medical and treatment 

records) that results in the issuance of a memorandum 

rating. 

* * * * * * * 

PART V—BOARDS, ADMINISTRATIONS, AND 

SERVICES 

* * * * * * * 

CHAPTER 74—VETERANS HEALTH ADMINISTRATION— 

PERSONNEL 

* * * * * * * 

SUBCHAPTER I—APPOINTMENTS 

* * * * * * * 

§ 7404. Grades and pay scales 

(a)(1)(A) The annual rates or ranges of rates of basic pay for positions provided in section? 7306 and 7401(4) of this title shall be 

prescribed from time to time by Executive order as authorized by 

chapter 53 of title 5 or as otherwise authorized by law. 

(B) Section 5377 of title 5 shall apply to a position under 

section 7401(4) of this title as if such position were included in the definition of ‘‘position’’ in section 5377(a) of 

title 5. 

(2) The pay of physicians and dentists serving in positions to 

which an Executive order applies under paragraph (1) shall be 

determined under subchapter III of this chapter instead of 

such Executive order. 

(3)(A) The rate of basic pay for a position to which an Executive order applies under paragraph (1) and is not described by 

paragraph (2) shall be set in accordance with section 5382 of 

title 5 as if such position were a Senior Executive Service position (as such term is defined in section 3132(a) of title 5). 

(B) A rate of basic pay for a position may not be set 

under subparagraph (A) in excess of— 

(i) in the case the position is not described in clause 

(ii), the rate of basic pay payable for level III of the 

Executive Schedule; or 

21 

(ii) in the case that the position is covered by a performance appraisal system that meets the certification 

criteria established by regulation under section 

5307(d) of title 5, the rate of basic pay payable for 

level II of the Executive Schedule. 

(C) Notwithstanding the provisions of subsection (d) of 

section 5307 of title 5, the Secretary may make any certification under that subsection instead of the Office of Personnel Management and without concurrence of the Office 

of Management and Budget. 

(b) The grades for positions provided for in paragraph (1) of section 7401 of this title shall be as follows. The annual ranges of 

rates of basic pay for those grades shall be prescribed from time 

to time by Executive order as authorized by chapter 53 of title 5 

or as otherwise authorized by law: 

PHYSICIAN AND DENTIST SCHEDULE 

Physician grade. 

Dentist grade. 

NURSE SCHEDULE 

Nurse V. 

Nurse IV. 

Nurse III. 

Nurse II. 

Nurse I. 

CLINICAL PODIATRIST, CHIROPRACTOR, AND OPTOMETRIST SCHEDULE 

Chief grade. 

Senior grade. 

Intermediate grade. 

Full grade. 

Associate grade. 

PHYSICIAN ASSISTANT SCHEDULE 

Physician Assistant IV. 

Physician Assistant III. 

Physician Assistant II. 

Physician Assistant I. 

(c) Notwithstanding the provisions of section 7425(a) of this title, 

a person appointed under section 7306 of this title who is not eligible for pay under subchapter III shall be deemed to be a career appointee for the purposes of sections 4507 and 5384 of title 5. 

(d) Except as provided under subsection (e), subchapter III, and 

section 7457 of this title, 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. 

(e) The position of Chief Nursing Officer, Office of Nursing Services, shall be exempt from the provisions of section 7451 of this 

title and shall be paid at a rate determined by the Secretary, not 

to exceed the maximum rate established for the Senior Executive 

Service under section 5382 of title 5. 

* * * * * * * 

22 

SUBCHAPTER IV—PAY FOR NURSES AND OTHER HEALTHCARE PERSONNEL 

§ 7451. Nurses and other health-care personnel: competitive 

pay 

(a)(1) It is the purpose of this section to ensure, by a means providing increased responsibility and authority to directors of Department health-care facilities, that the rates of basic pay for healthcare personnel positions described in paragraph (2) in each Department health-care facility (including the rates of basic pay of personnel employed in such positions on a part-time basis) are sufficient for that facility to be competitive, on the basis of pay and 

other employee benefits, with non-Department health-care facilities 

in the same labor-market area in the recruitment and retention of 

qualified personnel for those positions. 

(2) The health-care personnel positions referred to in paragraph (1) (hereinafter in this section referred to as ‘‘covered positions’’) are the following: 

(A) Registered nurse. 

(B) Physician assistant. 

ø(B)¿ (C) Such positions referred to in paragraphs (1) 

and (3) of section 7401 of this title (other than the positions of physician, dentist, øand registered nurse¿ registered nurse, and physician assistant) as the Secretary 

may determine upon the recommendation of the Under 

Secretary for Health. 

(3)(A) Except as provided in subparagraph (B), the rates of 

basic pay for covered positions in the Department shall be established and adjusted in accordance with this section instead 

of subsection (b)(1) of section 7404 of this title or chapter 53 

of title 5. 

(B) Under such regulations as the Secretary shall prescribe, the Secretary shall establish and adjust the rates 

of basic pay for covered positions at the following healthcare facilities in order to provide rates of basic pay that 

enable the Secretary to recruit and retain sufficient numbers of health-care personnel in such positions at those facilities: 

(i) The Veterans Memorial Medical Center in the 

Republic of the Philippines. 

(ii) Department of Veterans Affairs health-care facilities located outside the contiguous States, Alaska, 

and Hawaii. 

(4) The Secretary, after receiving the recommendation of the 

Under Secretary for Health, shall prescribe regulations setting 

forth criteria and procedures to carry out this section and section 7452 of this title. Requirements in such regulations for directors to provide and maintain documentation of actions taken 

under this section shall require no more documentation than 

the minimum essential for responsible administration. 

(b) The Secretary shall maintain the five grade levels for nurses 

employed by the Department under section 7401(1) of this title as 

specified in the Nurse Schedule in section 7404(b) of this title. The 

Secretary shall, pursuant to regulations prescribed to carry out this 

23 

subchapter, establish grades for other covered positions as the Secretary considers appropriate. 

(c)(1) For each grade in a covered position, there shall be a range 

of basic pay. The maximum rate of basic pay for a grade shall be 

133 percent of the minimum rate of basic pay for the grade, except 

that, if the Secretary determines that a higher maximum rate is 

necessary with respect to any such grade in order to recruit and 

retain a sufficient number of high-quality health-care personnel, 

the Secretary may raise the maximum rate of basic pay for that 

grade to a rate not in excess of 175 percent of the minimum rate 

of basic pay for the grade. Whenever the Secretary exercises the 

authority under the preceding sentence to establish the maximum 

rate of basic pay at a rate in excess of 133 percent of the minimum 

rate for that grade, the Secretary shall, in the next annual report 

required by subsection (g), provide justification for doing so to the 

Committees on Veterans’ Affairs of the Senate and House of Representatives. 

(2) The maximum rate of basic pay for any grade for a covered position may not exceed the maximum rate of basic pay 

established for positions in level IV of the Executive Schedule 

under section 5316 of title 5. The maximum rate of basic pay 

for a grade for the position of certified registered nurse anesthetist pursuant to an adjustment under subsection (d) may exceed the maximum rate otherwise provided in the preceding 

sentence. 

(3) The range of basic pay for each such grade shall be divided into equal increments, known as ‘‘steps’’. The Secretary 

shall prescribe the number of steps. Each grade in a covered 

position shall have the same number of steps. Rates of pay 

within a grade may not be established at rates other than 

whole steps. Any increase (other than an adjustment under 

subsection (d)) within a grade in the rate of basic pay payable 

to an employee in a covered position shall be by one or more 

of such step increments. 

(d)(1) Subject to subsection (e), the rates of basic pay for each 

grade in a covered position shall be adjusted periodically in accordance with this subsection in order to achieve the purposes of this 

section. Such adjustments shall be made— 

(A) whenever there is an adjustment under section 5303 

of title 5 in the rates of pay under the General Schedule, 

with the adjustment under this subsection to have the 

same effective date and to be by the same percentage as 

the adjustment in the rates of basic pay under the General 

Schedule; and 

(B) at such additional times as the director of a Department health-care facility, with respect to employees in that 

grade at that facility, or the Under Secretary for Health, 

with respect to covered Regional and Central Office employees in that grade, determines. 

(2) An adjustment in rates of basic pay under this subsection 

for a grade shall be carried out by adjusting the amount of the 

minimum rate of basic pay for that grade in accordance with 

paragraph (3) and then adjusting the other rates for that grade 

to conform to the requirements of subsection (c). Except as provided in paragraph (1)(A), such an adjustment in the minimum 

24 

rate of basic pay for a grade shall be made by the director of 

a Department health-care facility so as to achieve consistency 

with the beginning rate of compensation for corresponding 

health-care professionals in the Bureau of Labor Statistics 

(BLS) labor-market area of that facility. 

(3)(A) In the case of a Department health-care facility located in an area for which there is current information, based 

upon an industry-wage survey by the Bureau of Labor Statistics for that labor market, on compensation for corresponding 

health-care professionals for the BLS labor-market area of that 

facility, the director of the facility concerned shall use that information as the basis for making adjustments in rates of pay 

under this subsection. Whenever the Bureau of Labor Statistics releases the results of a new industry-wage survey for that 

labor market that includes information on compensation for 

corresponding health-care professionals, the director of that facility shall determine, not later than 30 days after the results 

of the survey are released, whether an adjustment in rates of 

pay for employees at that facility for any covered position is 

necessary in order to meet the purposes of this section. If the 

director determines that such an adjustment is necessary, the 

adjustment, based upon the information determined in the survey, shall take effect on the first day of the first pay period beginning after that determination. 

(B) In the case of a Department health-care facility located in an area for which the Bureau of Labor Statistics 

does not have current information on compensation for corresponding health-care professionals for the labor-market 

area of that facility for any covered position, the director 

of that facility shall conduct a survey in accordance with 

this subparagraph and shall adjust the amount of the minimum rate of basic pay for grades in that covered position 

at that facility based upon that survey. To the extent practicable, the director shall use third-party industry wage 

surveys to meet the requirements of the preceding sentence. Any such survey shall be conducted in accordance 

with regulations prescribed by the Secretary. Those regulations shall be developed in consultation with the Secretary of Labor in order to ensure that the director of a facility collects information that is valid and reliable and is 

consistent with standards of the Bureau. The survey 

should be conducted using methodology comparable to that 

used by the Bureau in making industry-wage surveys except to the extent determined infeasible by the Secretary. 

To the extent practicable, all surveys conducted pursuant 

to this subparagraph or subparagraph (A) shall include the 

collection of salary midpoints, actual salaries, lowest and 

highest salaries, average salaries, bonuses, incentive pays, 

differential pays, actual beginning rates of pay, and such 

other information needed to meet the purpose of this section. Upon conducting a survey under this subparagraph, 

the director concerned shall determine, not later than 30 

days after the date on which the collection of information 

through the survey is completed or published, whether an 

adjustment in rates of pay for employees at that facility for 

25 

any covered position is necessary in order to meet the purposes of this section. If the director determines that such 

an adjustment is necessary, the adjustment, based upon 

the information determined in the survey, shall take effect 

on the first day of the first pay period beginning after that 

determination. 

(C)(i) A director of a Department health-care facility 

may use data on the compensation paid to certified registered nurse anesthetists who are employed on a salary 

basis by entities that provide anesthesia services through 

certified registered nurse anesthetists in the labor-market 

area only if the director— 

(I) has conducted a survey of compensation for 

certified registered nurse anesthetists in the local 

labor-market area of the facility under subparagraph (B); 

(II) has used all available administrative authority with regard to collection of survey data; 

and 

(III) makes a determination (under regulations 

prescribed by the Secretary) that such survey 

methods are insufficient to permit the adjustments referred to in subparagraph (B) for such 

nurse anesthetists employed by the facility. 

(ii) For the purposes of this subparagraph, certified 

registered nurse anesthetists who are so employed by 

such entities shall be deemed to be corresponding 

health-care professionals to the certified registered 

nurse anesthetists employed by the facility. 

(D) The Under Secretary for Health shall prescribe regulations providing for the adjustment of the rates of basic 

pay for Regional and Central Office employees in covered 

positions in order to assure that those rates are sufficient 

and competitive. 

(E) The director of a facility or Under Secretary for 

Health may not adjust rates of basic pay under this subsection for any pay grade so that the minimum rate of 

basic pay for that grade is greater than the beginning 

rates of compensation for corresponding positions at nonDepartment health-care facilities. 

(F) The Under Secretary for Health shall provide appropriate education, training, and support to directors of Department health care facilities in the conduct and use of 

surveys, including the use of third-party surveys, under 

this paragraph. 

(4) If the director of a Department health-care facility, or the 

Under Secretary for Health with respect to Regional and Central Office employees, determines, after any survey under paragraph (3)(B) that it is not necessary to adjust the rates of basic 

pay for employees in a grade of a covered position at that facility in order to carry out the purpose of this section, such an 

adjustment for employees at that facility in that grade shall 

not be made. 

26 

(5) Information collected by the Department in surveys conducted under this subsection is not subject to disclosure under 

section 552 of title 5. 

(6) In this subsection— 

(A) The term ‘‘beginning rate of compensation’’, with respect to health-care personnel positions in non-Department 

health-care facilities corresponding to a grade of a covered 

position, means the sum of— 

(i) the minimum rate of pay established for personnel in such positions who have education, training, 

and experience equivalent or similar to the education, 

training, and experience required for health-care personnel employed in the same category of Department 

covered positions; and 

(ii) other employee benefits for those positions to the 

extent that those benefits are reasonably quantifiable. 

(B) The term ‘‘corresponding’’, with respect to healthcare personnel positions in non-Department health-care facilities, means those positions for which the education, 

training, and experience requirements are equivalent or 

similar to the education, training, and experience requirements for health-care personnel positions in Department 

health-care facilities. 

(e)(1) An adjustment in a rate of basic pay under subsection (d) 

may not reduce the rate of basic pay applicable to any grade of a 

covered position. 

(2) The director of a Department health-care facility, in determining whether to carry out a wage survey under subsection (d)(3) with respect to rates of basic pay for a grade of 

a covered position, may not consider as a factor in such determination the absence of a current recruitment or retention 

problem for personnel in that grade of that position. The director shall make such a determination based upon whether, in 

accordance with criteria established by the Secretary, there is 

a significant pay-related staffing problem at that facility in any 

grade for a position. If the director determines that there is 

such a problem, or that such a problem is likely to exist in the 

near future, the Director shall provide for a wage survey in accordance with subsection (d)(3). 

(3) The Under Secretary for Health may, to the extent necessary to carry out the purposes of subsection (d), modify any 

determination made by the director of a Department healthcare facility with respect to adjusting the rates of basic pay applicable to covered positions. If the determination of the director would result in an adjustment in rates of basic pay applicable to covered positions, any action by the Under Secretary 

under the preceding sentence shall be made before the effective 

date of such pay adjustment. Upon such action by the Under 

Secretary, any adjustment shall take effect on the first day of 

the first pay period beginning after such action. The Secretary 

shall ensure that the Under Secretary establishes a mechanism for the timely exercise of the authority in this paragraph. 

(4) Each director of a Department health-care facility shall 

provide to the Secretary, not later than July 31 each year, a 

27 

report on staffing for covered positions at that facility. The report shall include the following: 

(A) Information on turnover rates and vacancy rates for 

each covered position, including a comparison of those 

rates with the rates for the preceding three years. 

(B) The director’s findings concerning the review and 

evaluation of the facility’s staffing situation, including 

whether there is, or is likely to be, in accordance with criteria established by the Secretary, a significant pay-related 

staffing problem at that facility for any covered position 

and, if so, whether a wage survey was conducted, or will 

be conducted with respect to that position. 

(C) In any case in which the director conducts such a 

wage survey during the period covered by the report, information describing the survey and any actions taken or not 

taken based on the survey, and the reasons for taking (or 

not taking) such actions. 

(D) In any case in which the director conducts such a 

wage survey during the period covered by the report and 

makes adjustment in rates of basic pay applicable to one 

or more covered positions at the facility, information on 

the methodology used in making such adjustment or adjustments. 

(E) In any case in which the director, after finding that 

there is, or is likely to be, in accordance with criteria established by the Secretary, a significant pay-related staffing problem at that facility for any covered position, determines not to conduct a wage survey with respect to that 

position, a statement of the reasons why the director did 

not conduct such a survey. 

(5) Not later than September 30 of each year, the Secretary 

shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives a report on staffing for covered positions at Department health care facilities. Each such 

report shall include the following: 

(A) A summary and analysis of the information contained in the most recent reports submitted by facility directors under paragraph (4). 

(B) The information for each such facility specified in 

paragraph (4). 

(6)(A) Upon the request of an individual described in subparagraph (B) for a report provided under paragraph (4) with 

respect to a Department health-care facility, the Under Secretary for Health or the director of such facility shall provide 

to the individual the most current report for such facility provided under such paragraph. 

(B) An individual described in this subparagraph is— 

(i) an individual in a covered position at a Department health-care facility; or 

(ii) a representative of the labor organization representing that individual who is designated by that individual to make the request. 

28 

(f) For the purposes of this section, the term ‘‘health-care facility’’ 

means a medical center, an independent outpatient clinic, or an 

independent domiciliary facility. 

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