```

[House Report 114-710]
[From the U.S. Government Publishing Office]

114th Congress   }                                    {         Report
                        HOUSE OF REPRESENTATIVES
 2d Session      }                                    {        114-710

======================================================================

 
 GROW OUR OWN DIRECTIVE: PHYSICIAN ASSISTANT EMPLOYMENT AND EDUCATION 
                              ACT OF 2016

                                _______
                                

 September 6, 2016.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

    Mr. Miller of Florida, from the Committee on Veterans' Affairs, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 3974]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 3974) 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 amendment and recommend that the 
bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     2
Purpose and Summary..............................................     4
Background and Need for Legislation..............................     5
Hearings.........................................................     6
Subcommittee Consideration.......................................     6
Committee Consideration..........................................     6
Committee Votes..................................................     7
Committee Oversight Findings.....................................     7
Statement of General Performance Goals and Objectives............     7
New Budget Authority, Entitlement Authority, and Tax Expenditures     7
Earmarks and Tax and Tariff Benefits.............................     7
Committee Cost Estimate..........................................     7
Congressional Budget Office Estimate.............................     7
Federal Mandates Statement.......................................     9
Advisory Committee Statement.....................................     9
Constitutional Authority Statement...............................     9
Applicability to Legislative Branch..............................    10
Statement on Duplication of Federal Programs.....................    10
Disclosure of Directed Rulemaking................................    10
Section-by-Section Analysis of the Legislation...................    10
Changes in Existing Law Made by the Bill as Reported.............    13

                               AMENDMENT

    The amendments are 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 2016''.

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) 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
          (4) 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.--
          (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.
          (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.

    Amend the title so as to read:
    A bill 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.

                          PURPOSE AND SUMMARY

    H.R. 3974, the ``Grow Our Own Directive: Physician 
Assistant Employment and Education Act of 2015,'' was 
introduced by Representative Ann McLane Kuster of New Hampshire 
on November 5, 2015. The bill, as amended, was ordered to be 
favorably reported to the full House on May 18, 2016, by voice 
vote. H.R. 3974, 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\
---------------------------------------------------------------------------
    \1\May 15, 2015, Subcommittee on Health hearing, ``Overcoming 
Barriers to More Efficient and Effective VA Staffing,'' http://
veterans.house.gov/hearing/overcoming-barriers-to-more-efficient-and-
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.
---------------------------------------------------------------------------
    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 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. 3974, as 
amended.
    On April 20, 2016, the Subcommittee on Health held a 
legislative hearing on various bills introduced in the 114th 
Congress, including H.R. 3974. The following witnesses 
testified:

          The Honorable Lee Zeldin, U.S House of 
        Representatives, 1st Congressional District, New York; 
        The Honorable Mike Bost, U.S. House of Representatives, 
        12th Congressional District, Illinois; The Honorable 
        Ann McLane Kuster; U.S. House of Representatives, 2nd 
        Congressional District, New Hampshire; The Honorable 
        Elise Stefanik, U.S. House of Representatives, 21st 
        Congressional District, New York; The Honorable Jackie 
        Walorski, U.S. House of Representatives, 2nd 
        Congressional District, Indiana; Diane M. Zumatto, 
        National Legislative Director, AMVETS; Shurhonda Y. 
        Love, Assistant National Legislative Director, Disabled 
        American Veterans; Fred S. Sganga, Legislative Officer, 
        National Association of State Veteran Homes; Maureen 
        McCarthy M.D., Assistant Deputy Under Secretary for 
        Health for Patient Care Services, Veterans Health 
        Administration, U.S. Department of Veterans Affairs; 
        Accompanied by: Susan Blauert, Chief Counsel, Health 
        Care Law Group, Office of General Counsel, U.S. 
        Department of Veterans Affairs.

    Statements for the record were submitted by:

          The American Legion, American Psychiatric 
        Association, Easter Seals, National Association of 
        Mental Illness, Veterans Affairs Physician Assistant 
        Association, Veterans of Foreign Wars of the United 
        States.

                       SUBCOMMITTEE CONSIDERATION

    On April 29, 2016, the Subcommittee on Health met in open 
markup session, a quorum being present, and ordered H.R. 3974, 
as amended, favorably forwarded to the full Committee 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. 
        3974 offered by Representative Ann McLane Kuster of New 
        Hampshire.

                        COMMITTEE CONSIDERATION

    On May 18, 2016, the full Committee met in open markup 
session, a quorum being present, and ordered H.R. 3974, 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. 
        3974, as amended, offered by Representative Ann McLane 
        Kuster of New Hampshire.

    A motion by Representative Corrine Brown of Florida to 
favorably report H.R. 3974, 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. 3974, 
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 veteran 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. 3974, 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. 
3974, 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. 3974, 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, June 28, 2016.
Hon. Jeff Miller
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. 3974, the Grow Our 
Own Directive: Physician Assistant Employment and Education Act 
of 2016.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Ann E. 
Futrell.
            Sincerely,
                                                        Keith Hall.
    Enclosure.

H.R. 3974--Grow Our Own Directive: Physician Assistant Employment and 
        Education Act of 2016

    Summary: H.R. 3974 would require the Department of Veterans 
Affairs (VA) to carry out a five-year pilot program that would 
provide educational assistance to veterans training to be 
physician assistants (PAs) for the department. CBO estimates 
that implementing the bill would cost $36 million over the 
2017-2021 period, subject to appropriation of the necessary 
amounts.
    Pay-as-you-go procedures do not apply because enacting the 
legislation would not affect direct spending or revenues. CBO 
estimates that enacting H.R. 3974 would not increase net direct 
spending or on-budget deficits in any of the four consecutive 
10-year periods beginning in 2027.
    H.R. 3974 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. 3974 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  2017-2021
----------------------------------------------------------------------------------------------------------------
                                  INCREASE IN SPENDING SUBJECT TO APPROPRIATION
 
Estimated Authorization Level.....................................      3      7     10     11      6       37
Estimated Outlays.................................................      2      7     10     11      6       36
----------------------------------------------------------------------------------------------------------------

    Basis of estimate: For this estimate, CBO assumes that H.R. 
3974 will be enacted near the start of fiscal year 2017, that 
the necessary amounts will be provided, and that outlays will 
follow historical spending patterns for affected programs.
    Within 180 days of enactment, the bill would require VA to 
establish a five-year pilot program that would pay for certain 
veterans to obtain master's degrees in physician assistant 
studies. Participants in the pilot program would be required to 
work as PAs for VA for at least three years. The bill would 
require VA to offer educational assistance to at least 250 
candidates and to provide no fewer than 35 scholarships each 
year.
    A master's degree program in physician assistant studies 
takes two years to complete. Based on a review of various 
graduate programs for PA studies, CBO estimates that the 
average annual cost for tuition was $36,000 in 2015 and, after 
accounting for projected inflation, would average about $44,000 
over the 2017-2021 period. Based on the assistance provided by 
VA under the existing Health Professional Educational 
Assistance Program, CBO expects that VA would cover the full 
costs of tuition and provide an annual stipend that would 
average $22,000. CBO expects that those benefits would be 
provided to 35 people in 2017 and a total of 250 people through 
2021. On that basis, CBO estimates that providing benefits 
under this program would cost $32 million over the 2017-2021 
period.
    To administer the pilot program, H.R. 3974 would require VA 
to establish two new deputy director positions and two 
supporting positions. On the basis of information from VA on 
compensation for deputy directors, we estimate that the salary 
and other benefits for that position would amount to roughly 
$190,000 a year. Including the costs of compensation for a 
recruiter, an administrative assistant, and the necessary 
office space, CBO estimates that administering the program 
would cost $4 million over the 2017-2021 period.
    In total, CBO estimates that implementing the pilot program 
would cost $36 million over the 2017-2021 period, assuming 
appropriation of the necessary amounts.
    Pay-As-You-Go considerations: None.
    Increase in long-term direct spending and deficits: CBO 
estimates that enacting H.R. 3974 would not increase net direct 
spending or on-budget deficits in any of the four consecutive 
10-year periods beginning in 2027.
    Intergovernmental and private-sector impact: H.R. 3974 
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; 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. 3974, 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. 
3974, as amended.

                 STATEMENT OF CONSTITUTIONAL AUTHORITY

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 3974, as amended, is authorized by Congress' 
power to ``provide for the common Defense and general Welfare 
of the United States.''

                  APPLICABILITY TO LEGISLATIVE BRANCH

    The Committee finds that H.R. 3974, 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, 114th Cong. (2015), 
the Committee finds that no provision of H.R. 3974, 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, 114th Cong. (2015), 
the Committee estimates that H.R. 3974, 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 the short title of the 
``Grow Our Own Directive: Physician Assistant Employment and 
Education Act of 2016.''

Section 2. Pilot program to provide educational assistance to physician 
        assistants 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 veterans 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) participation in the delivery of 
health care services or related medical services, including 
military training relating to identification, evaluation, 
treatment, and prevention of diseases and disorders; and, (4) 
lack of 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. In selecting eligible individuals, VA would 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. 
Additionally, 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 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 require 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.

         CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

    If enacted, this bill would make no changes in existing 
law.

                                  [all]
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