69–006 

110TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 110–642 

DIRECTOR OF PHYSICIAN ASSISTANT SERVICES AT 

VETERANS HEALTH ADMINISTRATION 

MAY 15, 2008.—Committed to the Committee of the Whole House on the State of 

the Union and ordered to be printed 

Mr. FILNER, from the Committee on Veterans’ Affairs, 

submitted the following 

R E P O R T 

[To accompany H.R. 2790] 

[Including cost estimate of the Congressional Budget Office] 

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

bill (H.R. 2790) to amend title 38, United States Code, to establish 

the position of Director of Physician Assistant Services within the 

office of the Under Secretary of Veterans Affairs for Health, 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 ............................................................................................ 2 

Background and Discussion .................................................................................... 2 

Hearings ................................................................................................................... 3 

Committee Consideration ........................................................................................ 3 

Committee Votes ...................................................................................................... 3 

Committee Oversight Findings ............................................................................... 4 

Statement of General Performance Goals and Objectives .................................... 4 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 4 

Earmarks and Tax and Tariff Benefits .................................................................. 4 

Committee Cost Estimate ....................................................................................... 4 

Congressional Budget Office Estimate ................................................................... 4 

Federal Mandates Statement ................................................................................. 5 

Advisory Committee Statement .............................................................................. 5 

Constitutional Authority Statement ...................................................................... 5 

Applicability to Legislative Branch ........................................................................ 5 

Section-by-Section Analysis of the Legislation ...................................................... 6 

Changes in Existing Law Made by the Bill as Reported ...................................... 6 


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AMENDMENT

The amendment is as follows: 

Strike all after the enacting clause and insert the following: 

SECTION 1. ESTABLISHMENT OF DIRECTOR OF PHYSICIAN ASSISTANT SERVICES AT VETERANS HEALTH ADMINISTRATION OF DEPARTMENT OF VETERANS AFFAIRS. 

(a) IN GENERAL.—Section 7306(a) of title 38, United States Code, is amended by 

striking paragraph (9) and inserting the following: ‘‘(9) The Director of Physician Assistant Services, who shall be a qualified 

physician assistant who shall report to the Under Secretary for Health on all 

matters relating to the education and training, employment, appropriate utilization, and optimal participation of physician assistants within the programs and 

initiatives of the Administration. The Director of Physician Assistant Services 

shall serve in a full-time capacity at the Central Office of the Department.’’. (b) DEADLINE FOR IMPLEMENTATION.—The Secretary of Veterans Affairs shall ensure that an individual is serving as the Director of Physician Assistant Services 

under section 7306(a)(9) of title 38, United States Code, as added by subsection (a), 

by not later than 120 days after the date of the enactment of this Act. 

PURPOSE AND SUMMARY

H.R. 2790 was introduced by Representative Phil Hare of Illinois 

on June 20, 2007. The legislation would establish a full-time Director of Physician Assistant Services within the Veterans Health Administration in the Department of Veterans Affairs (VA). This position would be located in the Department of Veterans Affairs Central Office. 

BACKGROUND AND DISCUSSION

Physician Assistants (PAs) who choose to work for the federal 

government are credentialed health professionals. As of March 12, 

1993, certification by the National Commission on Certification of 

Physician Assistants is a requirement for employment. PAs provide 

a comprehensive range of diagnostic and therapeutic services including performing physical exams, taking patient histories, ordering and interpreting laboratory tests, diagnosing and treating illnesses, and writing prescriptions. PAs practice medicine as delegated by, and under the supervision of, a physician. Physicians 

may delegate to PAs medical duties that are within the physician’s 

scope of practice, and the PA’s training and experience, as allowed 

by law. All states, the District of Columbia, and Guam authorize 

physicians to delegate prescriptive privileges to the PAs they supervise. According to the American Association of Physician Assistants, approximately 245 million patient visits were made and about 

303 million medications were prescribed or recommended by PAs. 

The first physician assistants to graduate from PA academic programs were former medical corpsmen who had served in Vietnam 

and wanted to use their medical knowledge and experience in civilian life. Dr. Eugene Stead of Duke University Medical Center in 

North Carolina put together the first class of PAs in 1965, selecting 

Navy corpsmen that had considerable medical training during their 

military experience. Today, there are 139 accredited PA programs 

across the United States. 

Since the PA Advisor position was authorized by the ‘‘Veterans 

Benefits and Health Care Improvement Act of 2000,’’ Public Law 

106–419, the number of PAs within the VA health care system has 

increased 34 percent, from 1,195 to nearly 1,600 today. VA is the 

largest single employer of PAs in the United States. PAs work in 


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a wide variety of medical centers and outpatient clinics throughout 

the VA health care system. 

Although the institution of the part-time, field-based PA Advisor 

has improved the utilization of PAs, there continues to be inconsistencies in the way PAs are used across the system. A full-time director, located in VA central office, would ensure efficient utilization and full integration, when appropriate, of VA’s PA workforce 

in VA’s patient care programs and initiatives. The full-time PA Director would also work closely with other offices within the Veterans Health Administration, such as the Office of Rural Health, 

to ensure that veterans living in medically underserved communities receive timely access to medical care. 

HEARINGS

On January 17, 2008, the Subcommittee on Health held a legislative hearing on a number of bills introduced in the 110th Congress, 

including H.R. 2790. The following witnesses testified: The Honorable Phil Hare of Illinois; The Honorable Stephanie Herseth 

Sandlin of South Dakota; The Honorable Zachary T. Space of Ohio; 

The Honorable Shelley Moore Capito of West Virginia; The Honorable Michael M. Honda of California; The Honorable Leonard L. 

Boswell of Iowa; The Honorable Steve Kagen of Wisconsin; Mr. Joseph L. Wilson, Deputy Director, Veterans Affairs and Rehabilitation Commission, The American Legion; Ms. Joy J. Ilem, Assistant 

National Legislative Director, Disabled American Veterans; Mr. 

Christopher Needham, Senior Legislative Associate, Veterans of 

Foreign Wars of the United States; Mr. Richard F. Weidman, Executive Director for Policy and Government Affairs, Vietnam Veterans of America; Gerald M. Cross, M.D., FAAFP, Principal Deputy 

Under Secretary for Health, Veterans Health Administration, U.S. 

Department of Veterans Affairs, accompanied by Mr. Walter A. 

Hall, Assistant General Counsel, U.S. Department of Veterans Affairs. Those submitting statements for the record included: American Academy of Physician Assistants; The Honorable Shelley 

Berkley of Nevada; Mental Health America; and the Paralyzed Veterans of America. 

COMMITTEE CONSIDERATION

On April 23, 2008, the Subcommittee on Health met in open 

markup session and favorably forwarded H.R. 2790, as amended, 

to the full Committee for consideration by voice vote. 

An amendment by Mr. Hare of Illinois to establish the position 

120 days after the date of enactment. 

On April 30, 2008, the full Committee met in open markup session, a quorum being present, and ordered H.R. 2790, as amended, 

favorably reported to the House of Representatives, by a voice vote. 

COMMITTEE VOTES

Clause 3(b) of rule XIII of the Rules of the House of Representatives requires the Committee to list the record votes on the motion 

to report the legislation and amendments thereto. There were no 

record votes taken on amendments or in connection with ordering 

H.R. 2790 reported to the House. A motion by Mr. Buyer of Indiana 


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to order H.R. 2790, as amended, reported favorably to the House 

of Representatives was agreed to by voice vote. 

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 reflected in the descriptive portions of this report. 

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. 2790 does not contain any congressional earmarks, limited 

tax benefits, or limited tariff benefits as defined in clause 9(d), 9(e), 

or 9(f) 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. 2790 

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. 2790 

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, May 12, 2008. 

Hon. BOB FILNER, 

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. 2790, a bill to amend title 

38, United States Code, to establish the position of Director of Physician Assistant Services within the office of the Under Secretary 

of Veterans Affairs for Health. 


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

to provide them. The CBO staff contact is Sunita D’Monte. 

Sincerely, 

ROBERT A. SUNSHINE

(For Peter R. Orszag, Director). 

Enclosure. 

H.R. 2790—A bill to amend title 38, United States Code, to establish the position of Director of Physician Assistant Services 

within the office of the Under Secretary of Veterans Affairs for 

Health 

H.R. 2790 would require the Department of Veterans Affairs 

(VA) to establish the position of Director of Physician Assistant 

Services within the office of the Under Secretary of Veterans Affairs for Health. As required under current law, VA has an Advisor 

on Physician Assistants who reports to the Under Secretary. VA indicated that the current advisor works part time. CBO expects that 

to meet the bill’s requirements, VA would make the position full 

time and require small additional appropriations for salaries, expenses, and travel. CBO estimates that implementing the bill 

would cost less than $500,000 over the 2009–2013 period, assuming 

availability of the estimated amounts. Enacting the bill would have 

no effect on direct spending or revenues. 

H.R. 2790 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act and would 

not affect the budgets of state, local, or tribal governments. 

The CBO staff contact for this estimate is Sunita D’Monte. This 

estimate was approved by Theresa Gullo, Deputy Assistant Director for Budget Analysis. 

FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of Federal mandates regarding H.R. 2790 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. 2790. 

CONSTITUTIONAL AUTHORITY STATEMENT

Pursuant to clause 3(d)(1) of rule XIII of the Rules of the House 

of Representatives, the Committee finds that the Constitutional authority for H.R. 2790 is provided by Article I, section 8, of the Constitution of the United States. 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that the legislation 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. 


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SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Establishment of a Director of Physician Assistant Services at the Veterans Health Administration of the Department 

of Veterans Affairs 

This section amends section 7306(a) of title 38, United States 

Code, to make the Advisor of Physician Assistant Services a Director of Physician Assistant Services, and also mandates that the position be a full-time position, based in the Central Office of the Department of Veterans Affairs. 

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): 

SECTION 7306 OF TITLE 38, UNITED STATES CODE 

§ 7306. Office of the Under Secretary for Health 

(a) The Office of the Under Secretary for Health shall consist of 

the following: 

(1) * * * 

* * * * * * * 

ø(9) The Advisor on Physician Assistants, who shall be a physician 

assistant with appropriate experience and who shall advise the 

Under Secretary for Health on all matters relating to the utilization and employment of physician assistants in the Administration.¿ 

(9) The Director of Physician Assistant Services, who shall be a 

qualified physician assistant who shall report to the Under Secretary for Health on all matters relating to the education and training, employment, appropriate utilization, and optimal participation 

of physician assistants within the programs and initiatives of the 

Administration. The Director of Physician Assistant Services shall 

serve in a full-time capacity at the Central Office of the Department. 

* * * * * * * 

Æ 


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