II

107TH CONGRESS

1ST SESSION S. 1188

To amend title 38, United States Code, to enhance the authority of the

Secretary of Veterans Affairs to recruit and retain qualified nurses

for the Veterans Health Administration, and for other purposes.

IN THE SENATE OF THE UNITED STATES

JULY 17, 2001

Mr. ROCKEFELLER (for himself and Mr. CLELAND) introduced the following

bill; which was read twice and referred to the Committee on Veterans’ Affairs

A BILL

To amend title 38, United States Code, to enhance the

authority of the Secretary of Veterans Affairs to recruit

and retain qualified nurses for the Veterans Health Administration, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Department of Veterans Affairs Nurse Recruitment and

6 Retention Enhancement Act of 2001’’.

7 (b) TABLE OF CONTENTS.—The table of contents for

8 this Act is as follows:
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Sec. 1. Short title; table of contents.

Sec. 2. References to title 38, United States Code.

TITLE I—ENHANCEMENT OF RECRUITMENT AUTHORITIES

Sec. 101. Enhancement of employee incentive scholarship program.

Sec. 102. Enhancement of education debt reduction program.

Sec. 103. Report on requests for waivers of pay reductions for reemployed annuitants to fill nurse positions.

TITLE II—ENHANCEMENT OF RETENTION AUTHORITIES

Sec. 201. Additional pay for Saturday tours of duty for additional health care

professional in the Veterans Health Administration.

Sec. 202. Unused sick leave included in annuity computation of registered

nurses with the Veterans Health Administration.

Sec. 203. Evaluation of Department of Veterans Affairs nurse managed clinics.

Sec. 204. Staffing levels for operations of medical facilities.

Sec. 205. Annual report on use of authorities to enhance retention of experienced nurses.

Sec. 206. Report on mandatory overtime for nurses and nurse assistants in Department of Veterans Affairs facilities.

TITLE III—OTHER MATTERS

Sec. 301. Organizational responsibility of the Director of the Nursing Service.

Sec. 302. Computation of annuity for part-time service performed by certain

health-care professionals before April 7, 1986.

Sec. 303. Modification of nurse locality pay authorities.

Sec. 304. Technical amendments.

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

2 Except as otherwise expressly provided, whenever in

3 this Act an amendment or repeal is expressed in terms

4 of an amendment to, or repeal of, a section or other provi5 sion, the reference shall be considered to be made to a

6 section or other provision of title 38, United States Code.

7 TITLE I—ENHANCEMENT OF

8 RECRUITMENT AUTHORITIES

9 SEC. 101. ENHANCEMENT OF EMPLOYEE INCENTIVE

10 SCHOLARSHIP PROGRAM.

11 (a) PERMANENT AUTHORITY.—(1) Section 7676 is

12 repealed.
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1 (2) The table of sections at the beginning of chapter

2 76 is amended by striking the item relating to section

3 7676.

4 (b) MINIMUM PERIOD OF DEPARTMENT EMPLOY5 MENT FOR ELIGIBILITY.—Section 7672(b) is amended by

6 striking ‘‘2 years’’ and inserting ‘‘one year’’.

7 (c) SCHOLARSHIP AMOUNT.—Subsection (b) of sec8 tion 7673 is amended—

9 (1) in paragraph (1), by striking ‘‘for any one

10 year’’ and inserting ‘‘for the equivalent of one year

11 of full-time coursework’’; and

12 (2) by striking paragraph (2) and inserting the

13 following new paragraph (2):

14 ‘‘(2) in the case of a participant in the Program

15 who is a part-time student, shall bear the same ratio

16 to the amount that would be paid under paragraph

17 (1) if the participant were a full-time student in the

18 course of education or training being pursued by the

19 participant as the coursework carried by the student

20 bears to full-time coursework in that course of edu21 cation or training.’’.

22 (d) LIMITATION ON PAYMENT.—Subsection (c) of

23 section 7673 is amended to read as follows:

24 ‘‘(c) LIMITATIONS ON PERIOD OF PAYMENT.—(1)

25 The maximum number of school years for which a scholar-
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1 ship may be paid under subsection (a) to a participant

2 in the Program shall be six school years.

3 ‘‘(2) A participant in the Program may not receive

4 a scholarship under subsection (a) for more than the

5 equivalent of three years of full-time coursework.’’.

6 (e) FULL-TIME COURSEWORK.—Section 7673 is fur7 ther amended by adding at the end the following new sub8 section:

9 ‘‘(e) FULL-TIME COURSEWORK.—For purposes of

10 this section, full-time coursework shall consist of the fol11 lowing:

12 ‘‘(1) In the case of undergraduate coursework,

13 30 semester hours per undergraduate school year.

14 ‘‘(2) In the case of graduate coursework, 18 se15 mester hours per graduate school year.’’.

16 (f) ANNUAL ADJUSTMENT OF MAXIMUM SCHOLAR17 SHIP AMOUNT.—Section 7631 is amended—

18 (1) in subsection (a)(1), by striking ‘‘and the

19 maximum Selected Reserve member stipend

20 amount’’ and inserting ‘‘the maximum Selected Re21 serve member stipend amount, the maximum em22 ployee incentive scholarship amount,’’; and

23 (2) in subsection (b)—

24 (A) by redesignating paragraph (4) as

25 paragraph (6); and
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1 (B) by inserting after paragraph (3) the

2 following new paragraph (4):

3 ‘‘(4) The term ‘maximum employee incentive

4 scholarship amount’ means the maximum amount of

5 the scholarship payable to a participant in the De6 partment of Veterans Affairs Employee Incentive

7 Scholarship Program under subchapter VI of this

8 chapter, as specified in section 7673(b)(1) of this

9 title and as previously adjusted (if at all) in accord10 ance with this section.’’.

11 SEC. 102. ENHANCEMENT OF EDUCATION DEBT REDUC12 TION PROGRAM.

13 (a) PERMANENT AUTHORITY.—(1) Section 7684 is

14 repealed.

15 (2) The table of sections at the beginning of chapter

16 76 is amended by striking the item relating to section

17 7684.

18 (b) ELIGIBLE INDIVIDUALS.—Subsection (a)(1) of

19 section 7682 is amended—

20 (1) by striking ‘‘under an appointment under

21 section 7402(b) of this title in a position’’ and in22 serting ‘‘in a position (as determined by the Sec23 retary) providing direct-patient care services or serv24 ices incident to direct-patient care services’’; and
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1 (2) by striking ‘‘(as determined by the Sec2 retary)’’ and inserting ‘‘(as so determined)’’.

3 (c) MAXIMUM DEBT REDUCTION AMOUNT.—Section

4 7683(d)(1) is amended—

5 (1) by striking ‘‘for a year’’; and

6 (2) by striking ‘‘exceed—’’ and all that follows

7 through the end of the paragraph and inserting ‘‘ex8 ceed $44,000 over a total of five years of participa9 tion in the Program, of which not more than

10 $10,000 of such payments may be made in each of

11 the fourth and fifth years of participation in the

12 Program.’’.

13 (d) ANNUAL ADJUSTMENT OF MAXIMUM DEBT RE14 DUCTION PAYMENTS AMOUNT.—(1) Section 7631, as

15 amended by section 101(f) of this Act, is further

16 amended—

17 (A) in subsection (a)(1), by inserting before the

18 period at the end of the first sentence the following:

19 ‘‘and the maximum education debt reduction pay20 ments amount’’; and

21 (B) in subsection (b), by inserting after para22 graph (4) the following new paragraph (5):

23 ‘‘(5) The term ‘maximum education debt reduc24 tion payments amount’ means the maximum amount

25 of education debt reduction payments payable to a
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1 participant in the Department of Veterans Affairs

2 Education Debt Reduction Program under sub3 chapter VII of this chapter, as specified in section

4 7683(d)(1) of this title and as previously adjusted

5 (if at all) in accordance with this section.’’.

6 (2) Notwithstanding section 7631(a)(1) of title 38,

7 United States Code, as amended by paragraph (1), the

8 Secretary of Veterans Affairs shall not increase the max9 imum education debt reduction payments amount under

10 that section in calendar year 2002.

11 (e) TEMPORARY EXPANSION OF INDIVIDUALS ELIGI12 BLE FOR PARTICIPATION IN PROGRAM.—(1) Notwith13 standing section 7682(c) of title 38, United States Code,

14 the Secretary of Veterans Affairs may treat a covered indi15 vidual as being a recently appointed employee in the Vet16 erans Health Administration under section 7682(a) of

17 that title for purposes of eligibility in the Education Debt

18 Reduction Program if the Secretary determines that the

19 participation of the individual in the Program under this

20 subsection would further the purposes of the Program.

21 (2) For purposes of this subsection, a covered indi22 vidual is any individual otherwise described by section

23 7682(a) of title 38, United States Code, as in effect on

24 the day before the date of the enactment of this Act,

25 who—
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1 (A) was appointed as an employee in a position

2 described in paragraph (1) of that section, as so in

3 effect, between January 1, 1999, and September 30,

4 2000; and

5 (B) is an employee in such position, or in an6 other position described in paragraph (1) of that

7 section, as so in effect, at the time of application for

8 treatment as a covered individual under this sub9 section.

10 (3) The Secretary shall make determinations regard11 ing the exercise of the authority in this subsection on a

12 case-by-case basis.

13 (4) The Secretary may not exercise the authority in

14 this subsection after December 31, 2001. The expiration

15 of the authority in this subsection shall not affect the

16 treatment of an individual under this subsection before

17 that date as a covered individual for purposes of eligibility

18 in the Education Debt Reduction Program.

19 (5) In this subsection, the term ‘‘Education Debt Re20 duction Program’’ means the Department of Veterans Af21 fairs Education Debt Reduction Program under sub22 chapter VII of chapter 76 of title 38, United States Code.
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1 SEC. 103. REPORT ON REQUESTS FOR WAIVERS OF PAY RE2 DUCTIONS FOR REEMPLOYED ANNUITANTS

3 TO FILL NURSE POSITIONS.

4 (a) REPORT.—Not later than November 30 of each

5 of 2001 and 2002, the Secretary of Veterans Affairs shall

6 submit to the Committees on Veterans’ Affairs of the Sen7 ate and the House of Representatives a report describing

8 each request of the Secretary, during the fiscal year pre9 ceding such report, to the Director of the Office of Per10 sonnel Management for the following:

11 (1) A waiver under subsection (i)(1)(A) of sec12 tion 8344 of title 5, United States Code, of the pro13 visions of such section in order to meet requirements

14 of the Department of Veterans Affairs for appoint15 ments to nurse positions in the Veterans Health Ad16 ministration.

17 (2) A waiver under subsection (f)(1)(A) of sec18 tion 8468 of title 5, United States Code, of the pro19 visions of such section in order to meet requirements

20 of the Department for appointments to such posi21 tions.

22 (3) A grant of authority under subsection

23 (i)(1)(B) of section 8344 of title 5, United States

24 Code, for the waiver of the provisions of such section

25 in order to meet requirements of the Department for

26 appointments to such positions.
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1 (4) A grant of authority under subsection

2 (f)(1)(B) of section 8468 of title 5, United States

3 Code, for the waiver of the provisions of such section

4 in order to meet requirements of the Department for

5 appointments to such positions.

6 (b) INFORMATION ON RESPONSES TO REQUESTS.—

7 The report under subsection (a) shall specify for each re8 quest covered by the report—

9 (1) the response of the Director to such re10 quest; and

11 (2) if such request was granted, whether or not

12 the waiver or authority, as the case may be, assisted

13 the Secretary in meeting requirements of the De14 partment for appointments to nurse positions in the

15 Veterans Health Administration.

16 TITLE II—ENHANCEMENT OF

17 RETENTION AUTHORITIES

18 SEC. 201. ADDITIONAL PAY FOR SATURDAY TOURS OF DUTY

19 FOR ADDITIONAL HEALTH CARE PROFES20 SIONAL IN THE VETERANS HEALTH ADMINIS21 TRATION.

22 (a) IN GENERAL.—Section 7454(b) is amended—

23 (1) by inserting ‘‘(1)’’ after ‘‘(b)’’; and

24 (2) by adding at the end the following new

25 paragraph:
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1 ‘‘(2) Health care professionals employed in positions

2 referred to in paragraph (1) shall be entitled to additional

3 pay on the same basis as provided for nurses in section

4 7453(c) of this title.’’.

5 (b) APPLICABILITY.—The amendments made by sub6 section (a) shall take effect on the date of the enactment

7 of this Act, and shall apply with respect to pay periods

8 beginning on or after that date.

9 SEC. 202. UNUSED SICK LEAVE INCLUDED IN ANNUITY

10 COMPUTATION OF REGISTERED NURSES

11 WITH THE VETERANS HEALTH ADMINISTRA12 TION.

13 (a) ANNUITY COMPUTATION.—Section 8415 of title

14 5, United States Code, is amended by adding at the end

15 the following:

16 ‘‘(i) In computing an annuity under this subchapter,

17 the total service of an employee who retires from the posi18 tion of a registered nurse with the Veterans Health Ad19 ministration on an immediate annuity, or dies while em20 ployed in that position leaving any survivor entitled to an

21 annuity, includes the days of unused sick leave to the cred22 it of that employee under a formal leave system, except

23 that such days shall not be counted in determining average

24 pay or annuity eligibility under this subchapter.’’.
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1 (b) DEPOSIT NOT REQUIRED.—Section 8422(d) of

2 title 5, United States Code, is amended—

3 (1) by inserting ‘‘(1)’’ before ‘‘Under such regu4 lations’’; and

5 (2) by adding at the end the following:

6 ‘‘(2) Deposit may not be required for days of unused

7 sick leave credited under section 8415(i).’’.

8 (c) EFFECTIVE DATE.—The amendments made by

9 this section shall take effect 60 days after the date of the

10 enactment of this Act, and shall apply to individuals who

11 separate from service on or after that effective date.

12 SEC. 203. EVALUATION OF DEPARTMENT OF VETERANS AF13 FAIRS NURSE MANAGED CLINICS.

14 (a) EVALUATION.—The Secretary of Veterans Affairs

15 shall carry out an evaluation of the efficacy of the nurse

16 managed health care clinics of the Department of Vet17 erans Affairs. The Secretary shall complete the evaluation

18 not later than 18 months after the date of the enactment

19 of this Act.

20 (b) CLINICS TO BE EVALUATED.—(1) In carrying

21 out the evaluation under subsection (a), the Secretary con22 sider nurse managed health care clinics, including primary

23 care clinics and geriatric care clinics, located in three dif24 ferent Veterans Integrated Service Networks (VISNs) of

25 the Department.
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1 (2) If there are not nurse managed health care clinics

2 located in three different Veterans Integrated Service Net3 works as of the commencement of the evaluation, the Sec4 retary shall—

5 (A) establish nurse managed health care clinics

6 in additional Veterans Integrated Services Networks

7 such that there are nurse managed health care clin8 ics in three different Veterans Integrated Service

9 Networks for purposes of the evaluation; and

10 (B) include such clinics, as so established, in

11 the evaluation.

12 (c) MATTERS TO BE EVALUATED.—In carrying out

13 the evaluation under subsection (a), the Secretary shall

14 address the following:

15 (1) Patient satisfaction.

16 (2) Provider experiences.

17 (3) Cost of care.

18 (4) Access to care, including waiting time for

19 care.

20 (5) The functional status of patients receiving

21 care.

22 (6) Any other matters the Secretary considers

23 appropriate.

24 (d) REPORT.—Not later than 18 months after the

25 date of the enactment of this Act, the Secretary shall sub-
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1 mit to the Committees on Veterans’ Affairs of the Senate

2 and the House of Representatives a report on the evalua3 tion carried out under subsection (a). The report shall ad4 dress the matters specified in subsection (c) and include

5 any other information, and any recommendations, that the

6 Secretary considers appropriate.

7 SEC. 204. STAFFING LEVELS FOR OPERATIONS OF MEDICAL

8 FACILITIES.

9 (a) IN GENERAL.—Section 8110(a) is amended—

10 (1) in paragraph (1), by inserting after ‘‘com11 plete care of patients,’’ in the fifth sentence the fol12 lowing: ‘‘and in a manner consistent with the poli13 cies of the Secretary on overtime,’’; and

14 (2) in paragraph (2)—

15 (A) by inserting ‘‘, including the staffing

16 required to maintain such capacities,’’ after ‘‘all

17 Department medical facilities’’;

18 (B) by striking ‘‘and to minimize’’ and in19 serting ‘‘, to minimize’’; and

20 (C) by inserting before the period the fol21 lowing: ‘‘, and to ensure that eligible veterans

22 are provided such care and services in an ap23 propriate manner’’.

24 (b) NATIONWIDE POLICY ON STAFFING.—Paragraph

25 (3) of that section is amended—
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1 (1) in subparagraph (A), by inserting ‘‘the ade2 quacy of staff levels for compliance with the policy

3 established under subparagraph (C),’’ after ‘‘regard4 ing’’; and

5 (2) by inserting after subparagraph (B) the fol6 lowing new subparagraph:

7 ‘‘(C) The Secretary shall, in consultation with the

8 Under Secretary for Health, establish a nationwide policy

9 on the staffing of Department medical facilities in order

10 to ensure that such facilities have adequate staff for the

11 provision to veterans of appropriate, high-quality care and

12 services. The policy shall take into account the staffing

13 levels and mixture of staff skills required for the range

14 of care and services provided veterans in Department fa15 cilities.’’.

16 SEC. 205. ANNUAL REPORT ON USE OF AUTHORITIES TO

17 ENHANCE RETENTION OF EXPERIENCED

18 NURSES.

19 (a) ANNUAL REPORT.—(1) Subchapter II of chapter

20 73 is amended by adding at the end the following new

21 section:

22 ‘‘§ 7324. Annual report on use of authorities to en23 hance retention of experienced nurses

24 ‘‘(a) ANNUAL REPORT.—Not later than January 31

25 each year, the Secretary, acting through the Under Sec-
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1 retary for Health, shall submit to Congress a report on

2 the use during the preceding year of authorities for pur3 poses of retaining experienced nurses in the Veterans

4 Health Administration, as follows:

5 ‘‘(1) The authorities under chapter 76 of this

6 title.

7 ‘‘(2) The authority under VA Directive 5102.1,

8 relating to the Department of Veterans Affairs

9 nurse qualification standard, dated November 10,

10 1999, or any successor directive.

11 ‘‘(3) Any other authorities available to the Sec12 retary for those purposes.

13 ‘‘(b) REPORT ELEMENTS.—Each report under sub14 section (a) shall specify for the period covered by such re15 port, for each Department medical facility and for each

16 Veterans Integrated Service Network, the following:

17 ‘‘(1) The number of waivers requested under

18 the authority referred to in subsection (a)(2), and

19 the number of waivers granted under that authority,

20 to promote to the Nurse II grade or Nurse III grade

21 under the Nurse Schedule under section 7404(b)(1)

22 of this title any nurse who has not completed a

23 bachelors of science in nursing in a recognized

24 school of nursing, set forth by age, race, and years
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1 of experience of the individuals subject to such waiv2 er requests and waivers, as the case may be.

3 ‘‘(2) The programs carried out to facilitate the

4 use of nursing education programs by experienced

5 nurses, including programs for flexible scheduling,

6 scholarships, salary replacement pay, and on-site

7 classes.’’.

8 (2) The table of sections at the beginning of chapter

9 73 is amended by inserting after the item relating to sec10 tion 7323 the following new item:

‘‘7324. Annual report on use of authorities to enhance retention of experienced

nurses.’’.

11 (b) INITIAL REPORT.—The initial report required

12 under section 7324 of title 38, United States Code, as

13 added by subsection (a), shall be submitted in 2002.

14 SEC. 206. REPORT ON MANDATORY OVERTIME FOR NURSES

15 AND NURSE ASSISTANTS IN DEPARTMENT OF

16 VETERANS AFFAIRS FACILITIES.

17 (a) REPORT.—Not later than 180 days after the date

18 of the enactment of this Act, the Secretary of Veterans

19 Affairs shall submit to the Committees on Veterans’ Af20 fairs of the Senate and the House of Representatives a

21 report on the mandatory overtime required of licensed

22 nurses and nurse assistants providing direct patient care

23 at Department of Veterans Affairs medical facilities dur24 ing 2001.
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1 (b) MANDATORY OVERTIME.—For purposes of the

2 report under subsection (a), mandatory overtime shall con3 sist of any period in which a nurse or nurse assistant is

4 mandated or otherwise required, whether directly or indi5 rectly, to work or be in on-duty status in excess of—

6 (1) a scheduled workshift or duty period;

7 (2) 12 hours in any 24-hour period; or

8 (3) 80 hours in any period of 14 consecutive

9 days.

10 (c) ELEMENTS.—The report under subsection (a)

11 shall include the following:

12 (1) A description of the amount of mandatory

13 overtime described in that subsection at each De14 partment medical facility during the period covered

15 by the report.

16 (2) A description of the mechanisms employed

17 by the Secretary to monitor overtime of the nurses

18 and nurse assistants referred to in that subsection.

19 (3) An assessment of the effects of the manda20 tory overtime of such nurses and nurse assistants on

21 patient care, including its contribution to medical er22 rors.

23 (4) Recommendations regarding mechanisms

24 for preventing requirements for amounts of manda-
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1 tory overtime in other than emergency situations by

2 such nurses and nurse assistants.

3 (5) Any other matters that the Secretary con4 siders appropriate.

5 TITLE III—OTHER MATTERS

6 SEC. 301. ORGANIZATIONAL RESPONSIBILITY OF THE DI7 RECTOR OF THE NURSING SERVICE.

8 Section 7306(a)(5) is amended by inserting ‘‘, and

9 report directly to,’’ after ‘‘responsible to’’.

10 SEC. 302. COMPUTATION OF ANNUITY FOR PART-TIME

11 SERVICE PERFORMED BY CERTAIN HEALTH12 CARE PROFESSIONALS BEFORE APRIL 7, 1986.

13 Section 7426 is amended—

14 (1) by redesignating subsection (c) as sub15 section (d); and

16 (2) by inserting after subsection (b) the fol17 lowing new subsection (c):

18 ‘‘(c) The provisions of subsection (b) shall not apply

19 to the part-time service before April 7, 1986, of a reg20 istered nurse, physician assistant, or expanded-function

21 dental auxiliary. In computing the annuity under the ap22 plicable provision of law specified in that subsection of an

23 individual covered by the preceding sentence, the service

24 described in that sentence shall be credited as full-time

25 service.’’.
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1 SEC. 303. MODIFICATION OF NURSE LOCALITY PAY AU2 THORITIES.

3 Section 7451 is amended—

4 (1) in subsection (d)(3)—

5 (A) in subparagraph (A), by striking ‘‘be6 ginning rates of’’ each time it appears;

7 (B) in subparagraph (B), by striking ‘‘be8 ginning rates of’’; and

9 (C) in subparagraph (C)(i), by striking

10 ‘‘beginning rates of’’ each time it appears;

11 (2) in subsection (d)(4)—

12 (A) by striking ‘‘or at any other time that

13 an adjustment in rates of pay is scheduled to

14 take place under this subsection’’ in the first

15 sentence; and

16 (B) by striking the second sentence; and

17 (3) in subsection (e)(4)—

18 (A) in subparagraph (A), by striking

19 ‘‘grade in a’’;

20 (B) in subparagraph (B)—

21 (i) by striking ‘‘grade of a’’; and

22 (ii) by striking ‘‘that grade’’ and in23 serting ‘‘that position’’; and

24 (C) in subparagraph (D), by striking

25 ‘‘grade of a’’.
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1 SEC. 304. TECHNICAL AMENDMENTS.

2 Section 7631(b) is amended by striking ‘‘this sub3 section’’ each place it appears and inserting ‘‘this section’’.

Æ