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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 10 Introduced in Senate (IS)]

<DOC>

118th CONGRESS
  1st Session
                                 S. 10

To improve the workforce of the Department of Veterans Affairs, and for 
                            other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

             January 23 (legislative day, January 3), 2023

Mr. Tester (for himself and Mr. Boozman) introduced the following bill; 
which was read twice and referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL

 
To improve the workforce of the Department of Veterans Affairs, and for 
                            other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``VA Clinician 
Appreciation, Recruitment, Education, Expansion, and Retention Support 
(CAREERS) Act of 2023''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
 TITLE I--TRAINING, RECRUITMENT, AND RETENTION OF HEALTH CARE EMPLOYEES

Sec. 101. Payment of licensure exam costs for recipients of 
                            scholarships from Department of Veterans 
                            Affairs.
Sec. 102. Improvement of workforce training and team models to meet the 
                            needs of older veterans.
Sec. 103. Study on improving recruitment and retention at community 
                            living centers of Department of Veterans 
                            Affairs.
Sec. 104. Limitation on detail of directors of medical centers of 
                            Department of Veterans Affairs to different 
                            positions.
       TITLE II--ACCOUNTABILITY, OVERSIGHT, AND PERSONNEL MATTERS

                  Subtitle A--Matters Relating to Pay

Sec. 201. Modification of pay limitation for physicians, podiatrists, 
                            optometrists, and dentists of Department of 
                            Veterans Affairs.
Sec. 202. Increased pay cap for directors of medical centers and 
                            Veterans Integrated Service Networks of 
                            Department of Veterans Affairs.
Sec. 203. Waiver of pay limitation for employees of the Veterans Health 
                            Administration performing mission critical 
                            work.
Sec. 204. Increase of maximum amount of incentive pay for Department 
                            pharmacist executives.
Sec. 205. Modification of special pay authority for nurse executives.
           Subtitle B--Improvement of Recruitment and Hiring

Sec. 211. Oversight of direct hire authority and hiring flexibility of 
                            Department of Veterans Affairs.
Sec. 212. Waiver of certain licensure requirements.
                  Subtitle C--Other Personnel Matters

Sec. 221. Role of optometrists in Department of Veterans Affairs.
Sec. 222. Expansion of annual leave options for employees of Department 
                            of Veterans Affairs during public health 
                            emergency.
Sec. 223. Expansion of reimbursement of continuing professional 
                            education expenses.
Sec. 224. Inclusion of police officers of Department of Veterans 
                            Affairs as law enforcement officers.
Sec. 225. Department of Veterans Affairs personnel transparency.
Sec. 226. Comptroller General report assessing human resources 
                            modernization within Veterans Health 
                            Administration.

 TITLE I--TRAINING, RECRUITMENT, AND RETENTION OF HEALTH CARE EMPLOYEES

SEC. 101. PAYMENT OF LICENSURE EXAM COSTS FOR RECIPIENTS OF 
              SCHOLARSHIPS FROM DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--The Secretary of Veterans Affairs shall pay the 
costs of any licensing examinations and certifications required by the 
Secretary for any current recipient of a covered health professional 
scholarship from the Department of Veterans Affairs.
    (b) Licensing Examinations and Certifications.--Subsection (a) 
shall apply to the payment of costs for--
            (1) the United States Medical Licensing Examination Step 1, 
        Step 2, and Step 3;
            (2) the National Council Licensure Exam;
            (3) the National Board Dental Examination;
            (4) the National Board Dental Hygiene Examination;
            (5) the Dental Licensure Objective Structured Clinical 
        Examination and Integrated National Board Dental Examination;
            (6) the National Licensing Exams for Registered Nurses, 
        Nurse Practitioners, and Certified Registered Nurse 
        Anesthetists;
            (7) the American Podiatric Medical Licensing Exam;
            (8) the National Board of Examiners in Optometry Exam;
            (9) the Physician Assistant National Certification Exam;
            (10) the Examination for Professional Practice in 
        Psychology;
            (11) the Academy for Certification of Vision Rehabilitation 
        and Education Professionals certification examinations;
            (12) the Association of Social Workers Boards Exam; and
            (13) such other licensing examinations and certifications 
        as the Secretary considers appropriate.
    (c) Report to Congress.--Not later than one year after the date of 
the enactment of this Act, and not less frequently than annually 
thereafter, 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 this section 
that includes the following data for each State and territory of the 
United States for the one-year period preceding the date of the report:
            (1) Utilization by the Secretary of the requirement under 
        subsection (a) broken down by position and career type.
            (2) Number of times each examination or certification 
        described in subsection (b) was paid for by the Department and 
        total funds expended by the Department for each such 
        examination or certification.
    (d) Covered Health Professional Scholarship Defined.--In this 
section, the term ``covered health professional scholarship'' means--
            (1) the Department of Veterans Affairs Health Professional 
        Scholarship Program under subchapter II of chapter 76 of title 
        38, United States Code;
            (2) the Department of Veterans Affairs Employee Incentive 
        Scholarship Program under subchapter VI of such chapter, 
        including--
                    (A) the National Nursing Education Initiative; and
                    (B) the VA National Education for Employees 
                Program;
            (3) the Department of Veterans Affairs Readjustment 
        Counseling Service Scholarship Program under subchapter IX of 
        such chapter;
            (4) the Visual Impairment and Orientation and Mobility 
        Professionals Scholarship Program under chapter 75 of such 
        title;
            (5) the Veterans Healing Veterans Medical Access and 
        Scholarship Program under section 304 of the VA MISSION Act of 
        2018 (Public Law 115-182; 38 U.S.C. 7601 note);
            (6) the Physician Assistant Education and Training Pilot 
        Program for Former Members of The Armed Forces under section 
        246 of division J of the Consolidated Appropriations Act of 
        2018 (Public Law 115-141; 38 U.S.C. 7601 note); and
            (7) such other programs as the Secretary considers 
        appropriate.

SEC. 102. IMPROVEMENT OF WORKFORCE TRAINING AND TEAM MODELS TO MEET THE 
              NEEDS OF OLDER VETERANS.

    (a) Rural Geriatrics Team Training.--The Secretary of Veterans 
Affairs shall expand the Rural Interdisciplinary Team Training program 
of the Department of Veterans Affairs to not fewer than one rural site 
in each Veterans Integrated Service Network of the Department and 
ensure access at such sites to learning opportunities through the 
Geriatric Scholars Program of the Department.
    (b) Training on Caring for Veterans With Memory Loss.--
            (1) In general.--The Secretary shall provide continuing 
        professional education for clinical staff of the Department who 
        provide care for veterans with Alzheimer's disease and 
        dementia.
            (2) Implementation.--The Secretary shall implement the 
        continuing professional education required under paragraph (1) 
        in consultation with the Office of Rural Health of the 
        Department of Veterans Affairs established under section 7308 
        of title 38, United States Code, in order to ensure equitable 
        access to learning opportunities for employees of the 
        Department in rural and highly rural areas.
    (c) Expansion of Geriatric Patient Aligned Care Team Model and 
Geriatric and Palliative Specialty Services.--
            (1) In general.--The Secretary shall expand the Geriatrics 
        Patient Aligned Care Team model and the geriatric and 
        palliative specialty services of the Department of Veterans 
        Affairs--
                    (A) to every medical center of the Department;
                    (B) to any community-based outpatient clinic at 
                which such expansion is determined by the Secretary to 
                be feasible and needed; and
                    (C) to provide access to all veterans that need 
                those services, including through implementing 
                Geriatric and Palliative Specialty Consultative 
                Clinical Resource Hubs to meet the needs of the aging 
                veteran population.
            (2) Waiver of expansion to medical centers.--The Secretary 
        may waive the application of the requirements under paragraph 
        (1)(A) with respect to a medical center if the Secretary 
        determines that the medical center does not have the capacity 
        or need to implement a Geriatrics Patient Aligned Care Team 
        model or to provide geriatric and palliative specialty 
        services, as the case may be.
            (3) Study.--The Secretary shall conduct a study on the 
        variations in the structure and model consistency of the 
        Geriatrics Patient Aligned Care Team model and delivery and 
        utilization of geriatric and palliative care throughout the 
        Department and how those variations impact quality of care and 
        patient outcomes.
    (d) Report to Congress.--
            (1) In general.--Not later than two years after the date of 
        the enactment of this Act, and not less frequently than 
        annually thereafter for the following five years, 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 this section.
            (2) Inclusion of information on waivers.--The Secretary 
        shall include in the report required by paragraph (1) an 
        identification of any medical center of the Department in 
        receipt of a waiver under subsection (c)(2) and the reason for 
        the waiver.
    (e) Definitions.--In this section, the terms ``rural'' and ``highly 
rural'' have the meanings given those terms under the Rural-Urban 
Commuting Areas (RUCA) coding system of the Department of Agriculture.

SEC. 103. STUDY ON IMPROVING RECRUITMENT AND RETENTION AT COMMUNITY 
              LIVING CENTERS OF DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--Not later than two years after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall complete 
a study on barriers to hiring and retaining staff at community living 
centers of the Department of Veterans Affairs and best practices for 
improving recruitment and retention of such staff, with an emphasis on 
nursing staff.
    (b) Report to Congress.--Not later than 180 days after completion 
of the study under subsection (a), 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--
            (1) summarizing key findings with respect to barriers to 
        hiring and retaining staff at community living centers of the 
        Department and best practices for improving recruitment and 
        retention of such staff, including any barriers or best 
        practices specific to rural areas; and
            (2) including recommendations for such administrative 
        action as the Secretary considers appropriate.

SEC. 104. LIMITATION ON DETAIL OF DIRECTORS OF MEDICAL CENTERS OF 
              DEPARTMENT OF VETERANS AFFAIRS TO DIFFERENT POSITIONS.

    (a) Notification.--
            (1) In general.--Not later than 90 days after detailing a 
        director of a medical center of the Department of Veterans 
        Affairs to a different position within the Department, the 
        Secretary of Veterans Affairs shall notify the Committee on 
        Veterans' Affairs of the Senate and the Committee on Veterans' 
        Affairs of the House of Representatives of such detail.
            (2) Matters to be included.--The notification required by 
        paragraph (1) shall include, with respect to a director of a 
        medical center who is detailed to a different position within 
        the Department, the following information:
                    (A) The location at which the director is detailed.
                    (B) The position title of the detail.
                    (C) The estimated time the director is expected to 
                be absent from their duties at the medical center.
                    (D) Such other information as the Secretary may 
                determine appropriate.
    (b) Appointment of Acting Director.--Not later than 120 days after 
detailing a director of a medical center of the Department to a 
different position within the Department, the Secretary shall appoint 
an individual as acting director of such medical center with all of the 
authority and responsibilities of the detailed director.
    (c) Update on Detail.--Not later than 120 days after detailing a 
director of a medical center of the Department to a different position 
within the Department, and not less frequently than every 30 days 
thereafter while the detail is in effect or while the director position 
at the medical center is vacant, the Secretary shall submit to the 
Committee on Veterans' Affairs of the Senate and the Committee on 
Veterans' Affairs of the House of Representatives an update regarding 
the status of the detail.
    (d) Return to Position or Reassignment.--
            (1) In general.--Except as provided in paragraph (2), not 
        later than 180 days after detailing a director of a medical 
        center of the Department to a different position within the 
        Department, for a reason other than an ongoing investigation or 
        administrative action with respect to the director, the 
        Secretary shall--
                    (A) return the individual to the position as 
                director of the medical center; or
                    (B) reassign the individual from the position as 
                director of the medical center and begin the process of 
                hiring a new director for such position.
            (2) Waiver.--
                    (A) In general.--The Secretary may waive the 
                requirement under paragraph (1) with respect to an 
                individual for successive 90-day increments for a total 
                period of not more than 540 days from the original date 
                the individual was detailed away from their position as 
                director of a medical center.
                    (B) Notification.--Not later than 30 days after 
                exercising a waiver under subparagraph (A), the 
                Secretary shall notify Congress of the waiver and 
                provide to Congress information as to why the waiver is 
                necessary.

       TITLE II--ACCOUNTABILITY, OVERSIGHT, AND PERSONNEL MATTERS

                  Subtitle A--Matters Relating to Pay

SEC. 201. MODIFICATION OF PAY LIMITATION FOR PHYSICIANS, PODIATRISTS, 
              OPTOMETRISTS, AND DENTISTS OF DEPARTMENT OF VETERANS 
              AFFAIRS.

    (a) Market Pay.--
            (1) In general.--Section 7431 of title 38, United States 
        Code, is amended--
                    (A) by striking subsections (a), (b), and (d);
                    (B) by redesignating subsections (c), (e), (f), 
                (g), and (h) as subsections (a), (b), (c), (d), and 
                (e), respectively;
                    (C) by inserting ``optometrists,'' after 
                ``podiatrists,'' each place it appears;
                    (D) by inserting ``optometrist'' after 
                ``podiatrist,'' each place it appears;
                    (E) in subsection (a), as redesignated by 
                subparagraph (B), in the matter preceding paragraph 
                (1), by striking ``One element of pay for physicians, 
                podiatrists, and dentists shall be base pay. Base pay 
                shall meet the following requirements:'' and inserting 
                ``Pay of physicians, podiatrists, optometrists, and 
                dentists in the Veterans Health Administration shall 
                consist of base pay, which shall meet the following 
                requirements:'';
                    (F) in subsection (b), as so redesignated--
                            (i) in the subsection heading, by striking 
                        ``Total'' and inserting ``Market'';
                            (ii) in paragraph (1)(A)--
                                    (I) by striking ``annual'' each 
                                place it appears and inserting 
                                ``market''; and
                                    (II) by inserting ``, 
                                optometrists,'' after ``podiatrists'';
                            (iii) by striking paragraphs (2) and (3);
                            (iv) by redesignating paragraph (4) as 
                        paragraph (2);
                            (v) in paragraph (2), as redesignated by 
                        clause (iv), by striking ``Except as provided 
                        in sections 7404A(c) and 7410(a)(2) of this 
                        title, in no case may the total amount of 
                        compensation'' and inserting ``The total amount 
                        of market pay under subsection (a)'';
                            (vi) by inserting ``may not'' before 
                        ``exceed''; and
                            (vii) by adding at the end the following 
                        new paragraphs:
    ``(3) Notwithstanding any compensation or pay limitations under 
this title or title 5, the Secretary may authorize the Under Secretary 
for Health to pay physicians, podiatrists, and dentists--
            ``(A) awards authorized under this title;
            ``(B) advance payments, recruitment or relocation bonuses, 
        and retention allowances authorized under section 7410(a) of 
        this title or as otherwise provided by law;
            ``(C) incentives or bonuses under section 706 of this title 
        or as otherwise provided by law; and
            ``(D) earnings from fee-basis appointments under section 
        7405(a)(2) of this title.
    ``(4)(A) The Secretary may waive any pay limitation described in 
this section (to include tier limitations) if the Secretary determines 
it is necessary for the recruitment or retention of critical health 
care personnel, as determined by the Secretary.
    ``(B) The Secretary may prescribe requirements, limitations, and 
other considerations for waivers under subparagraph (A).'';
                    (G) in subsection (c), as so redesignated, by 
                striking ``subsections (b) and (c) of'';
                    (H) in subsection (d), as so redesignated--
                            (i) in paragraph (1), by striking 
                        ``subsection (c)'' and inserting ``subsection 
                        (a)''; and
                            (ii) by adding at the end the following new 
                        paragraph:
    ``(3) An individual receiving market pay under subsection (a) may 
not receive a non-foreign cost of living allowance under section 5941 
of title 5.''; and
                    (I) in subsection (e), as so redesignated, by 
                striking ``subsection (c), (d), or (e) except for the 
                responsibilities of the Secretary under subsection 
                (e)(1)'' and inserting ``subsections (a) or (b) except 
                for the responsibilities of the Secretary under 
                subsection (b)(1)''.
            (2) Conforming amendments.--
                    (A) Incentives for recruitment.--Section 706(d)(6) 
                of title 38, United States Code, is amended by striking 
                ``total amount of compensation under section 
                7431(e)(4)'' and inserting ``total amount of market pay 
                under section 7431''.
                    (B) Awards.--Section 7404A(c) of such title is 
                amended by striking ``the limitation under section 
                7431(e)(4)'' and inserting ``a limitation under section 
                7431''.
                    (C) Additional pay authorities.--Section 7410(a)(2) 
                of such title is amended by striking ``the limitation 
                under section 7431(e)(4)'' and inserting ``a limitation 
                under section 7431''.
                    (D) Pay of under secretary for health.--Section 
                7432(b)(1) of such title is amended--
                            (i) by inserting ``, podiatrist, 
                        optometrist,'' after ``physician''; and
                            (ii) by striking ``7431(c)'' and inserting 
                        ``7431''.
                    (E) Administrative matters.--Section 7433 of such 
                title is amended by inserting ``optometrists,'' after 
                ``physicians,'' each place it appears.
                    (F) Competitive pay.--Section 7451(a)(2)(C) of such 
                title is amended by inserting ``optometrist,'' after 
                ``physician,''.
                    (G) Compensation and professional standards for 
                certain medical officers.--Section 27(b) of the Central 
                Intelligence Agency Act of 1949 (50 U.S.C. 3528(b)) is 
                amended by striking ``section 7431(e)(1)(C)'' and 
                inserting ``section 7431(b)(1)(C)''.
            (3) Clerical amendments.--
                    (A) Section heading.--
                            (i) In general.--The heading for section 
                        7431 of title 38, United States Code is amended 
                        to read as follows:
``Sec. 7431. Market pay''.
                            (ii) Table of sections.--The table of 
                        sections at the beginning of subchapter III of 
                        chapter 74 of title 38, United States Code, is 
                        amended by striking the item relating to 
                        section 7431 and inserting the following new 
                        item:

``7431. Market pay.''.
                    (B) Subchapter heading.--
                            (i) In general.--The heading for subchapter 
                        III of chapter 74 of such title is amended to 
                        read as follows:

``Subchapter III--Pay for Physicians and Other Health-care Personnel''.

                            (ii) Table of sections.--The table of 
                        sections at the beginning of chapter 74 of such 
                        title is amended by striking the item relating 
                        to subchapter III and inserting the following 
                        new item:

       ``subchapter iii--pay for physicians and other health-care 
                              personnel''.

            (4) Application.--
                    (A) In general.--The amendments made by this 
                subsection shall apply to any pay period of the 
                Department of Veterans Affairs beginning on or after 
                the date that is 30 days after the date of the 
                enactment of this Act.
                    (B) Performance pay for year of enactment.--The 
                Secretary of Veterans Affairs may pay performance pay 
                under section 7431(d) of title 38, United States Code, 
                as in effect on the day before the date of the 
                enactment of this Act, for the calendar year in which 
                this Act is enacted.
    (b) Modification and Clarification of Pay Grade for Optometrists.--
Section 7404 of such title is amended--
            (1) in subsection (a)(2)(A), by striking ``podiatrists, and 
        dentists'' and inserting ``podiatrists, optometrists, and 
        dentists''; and
            (2) in the list in subsection (b)--
                    (A) by striking ``PODIATRIST (DPM), AND DENTIST'' 
                and inserting ``PODIATRIST (DPM), OPTOMETRIST (OD), AND 
                DENTIST''; and
                    (B) by striking ``CLINICAL CHIROPRACTOR AND 
                OPTOMETRIST SCHEDULE,'' and inserting ``CLINICAL 
                CHIROPRACTOR SCHEDULE''.
    (c) Retroactive Authority for Compensation.--
            (1) In general.--The Secretary of Veterans Affairs is 
        retroactively authorized to pay to a covered employee the 
        amount of compensation that was authorized to be paid to the 
        employee during the period specified in paragraph (2) but was 
        deferred and paid to the employee in the calendar year 
        following the calendar year in which it was authorized to be 
        paid because it exceeded $400,000 in a calendar year.
            (2) Period specified.--The period specified in this 
        paragraph is the period beginning on January 8, 2006, and 
        ending on December 31, 2017.
            (3) Additional period.--Compensation authorized under this 
        subsection shall not be included in the calculation of any 
        aggregate limit on compensation for a covered employee for the 
        year in which it is paid.
            (4) Charging of compensation.--Compensation authorized 
        under this subsection shall be charged to the appropriate 
        medical care appropriation account of the Department of 
        Veterans Affairs for the fiscal year in which the work was 
        performed except as follows:
                    (A) In the case of an account that has closed 
                pursuant to section 1552 of title 31, United States 
                Code, the compensation shall be charged to a current 
                appropriation account in accordance with section 1553 
                of such title.
                    (B) In the case of an expired account that has not 
                closed, if charging the compensation to the expired 
                account would cause such account to have a negative 
                unliquidated or unexpended balance, the compensation 
                may be charged to a current appropriation account 
                available for the same purpose.
            (5) Definitions.--In this subsection:
                    (A) Compensation.--The term ``compensation'' means 
                any pay, including salary, awards, and incentives.
                    (B) Covered employee.--The term ``covered 
                employee'' means a physician, podiatrist, optometrist, 
                or dentist subject to market pay under section 7431 of 
                title 38, United States Code, as amended by subsection 
                (a).

SEC. 202. INCREASED PAY CAP FOR DIRECTORS OF MEDICAL CENTERS AND 
              VETERANS INTEGRATED SERVICE NETWORKS OF DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) Increased Pay Cap.--
            (1) In general.--Subchapter I of chapter 74 of title 38, 
        United States Code, is amended by adding at the end the 
        following new section:
``Sec. 7414. Pay for directors of medical centers and directors of 
              Veterans Integrated Service Networks
    ``(a) In General.--To reflect the recruitment and retention needs 
of the Department for the assignment of a particular director in a 
medical center or Veterans Integrated Service Network of the 
Department, the Secretary shall prescribe a system of pay for 
individuals appointed under section 7401(4) of this title.
    ``(b) Market Pay.--
            ``(1) In general.--The annual amount of the market rate of 
        pay of an individual appointed under section 7401(4) of this 
        title--
                    ``(A) shall be determined by the Secretary on a 
                case-by-case basis; and
                    ``(B) shall take into account--
                            ``(i) the level of experience of the 
                        individual in managing facilities or programs 
                        of the Department or other similar agencies or 
                        companies, whether governmental or 
                        nongovernmental;
                            ``(ii) the complexity of the assignment of 
                        the individual, whether assigned or to be 
                        assigned;
                            ``(iii) the labor market for individuals in 
                        similar positions, which may cover any 
                        geographic area the Secretary considers 
                        appropriate;
                            ``(iv) the experience of the individual in 
                        performing the assignment of the individual, 
                        whether assigned or to be assigned; and
                            ``(v) such other considerations as the 
                        Secretary considers appropriate.
            ``(2) Evaluation and adjustment.--
                    ``(A) In general.--The market rate of pay provided 
                under this subsection shall be evaluated by the 
                Secretary not less frequently than once every two 
                years.
                    ``(B) Adjustment.--The market rate of pay of an 
                individual may be adjusted as the result of an 
                evaluation under subparagraph (A).
                    ``(C) Notice of results.--An individual whose 
                market rate of pay is evaluated under subparagraph (A) 
                shall receive written notice of the results of such 
                evaluation.
    ``(c) Requirements and Limitations on Total Pay.--
            ``(1) Minimum and maximum amounts.--
                    ``(A) In general.--Not less frequently than once 
                every two years, the Secretary shall prescribe for 
                applicability throughout the Department the minimum and 
                maximum amounts for a market rate of pay that may be 
                paid under subsection (b).
                    ``(B) Publication and effective date of amounts.--
                Amounts prescribed under subparagraph (A) shall be 
                published in the Federal Register and shall take effect 
                not earlier than 60 days after the date of publication.
                    ``(C) Maximum.--
                            ``(i) In general.--Except as provided in 
                        clause (ii), in no case may the total market 
                        rate of pay provided under subsection (b) 
                        exceed the amount of annual compensation 
                        (excluding expenses) specified in section 102 
                        of title 3.
                            ``(ii) Waiver.--The Secretary may waive the 
                        limitation under clause (i) (to include tier 
                        limitations) if the Secretary determines it is 
                        necessary for the recruitment or retention of 
                        critical health care personnel, as determined 
                        by the Secretary.
            ``(2) Limitation on reduction.--No adjustment of the market 
        rate of pay under subsection (b)(2)(B) may result in a 
        reduction of the amount of the market rate of pay of an 
        individual while in the same position or assignment at the same 
        location.
    ``(d) Treatment of Pay.--
            ``(1) In general.--Pay under subsection (b) shall be 
        considered pay for all purposes, including retirement benefits 
        under chapters 83 and 84 of title 5 and other benefits.
            ``(2) Cost-of-living allowance.--An individual receiving 
        pay under subsection (b) may not receive a cost-of-living 
        allowance under section 5941 of title 5.
    ``(e) Annual Report.--Not later than one year after the date of the 
enactment of the VA Clinician Appreciation, Recruitment, Education, 
Expansion, and Retention Support (CAREERS) Act of 2023, and annually 
thereafter, 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 by the 
Secretary of the requirements under this section.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of such subchapter is amended by inserting after the 
        item relating to section 7413 the following new item:

``7414. Pay for directors of medical centers and directors of Veterans 
                            Integrated Service Networks.''.
    (b) Conforming Amendments.--Section 7404(a)(1) of title 38, United 
States Code, is amended--
            (1) in subparagraph (A)--
                    (A) by striking ``(A) The annual'' and inserting 
                ``The annual''; and
                    (B) by striking ``and 7401(4)''; and
            (2) by striking subparagraph (B).

SEC. 203. WAIVER OF PAY LIMITATION FOR EMPLOYEES OF THE VETERANS HEALTH 
              ADMINISTRATION PERFORMING MISSION CRITICAL WORK.

    (a) In General.--Subchapter I of chapter 74 of title 38, United 
States Code, as amended by section 202(a)(1), is further amended by 
adding at the end the following new section:
``Sec. 7415. Waiver of pay limitation for employees performing mission 
              critical work
    ``(a) In General.--Notwithstanding any other provision of law, the 
Secretary may waive any limitation on pay for an employee of the 
Veterans Health Administration who is performing mission critical work.
    ``(b) Authority.--The Secretary shall prescribe regulations for the 
administration of this section.
    ``(c) Employee of the Veterans Health Administration Defined.--In 
this section, the term ``employee of the Veterans Health 
Administration' includes any employee of the Veterans Health 
Administration, regardless of the authority under which the employee 
was hired.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such subchapter, as amended by section 202(a)(2), is further amended by 
inserting after the item relating to section 7414 the following new 
item:

``7415. Waiver of pay limitation for employees performing mission 
                            critical work.''.

SEC. 204. INCREASE OF MAXIMUM AMOUNT OF INCENTIVE PAY FOR DEPARTMENT 
              PHARMACIST EXECUTIVES.

    Section 7410(b)(1) of title 38, United States Code, is amended by 
striking ``$40,000'' and inserting ``$100,000''.

SEC. 205. MODIFICATION OF SPECIAL PAY AUTHORITY FOR NURSE EXECUTIVES.

    Section 7452(g) of title 38, United States Code, is amended--
            (1) in paragraph (1), by striking ``Department nurse 
        executives, the Secretary may, in accordance with'' and all 
        that follows through the period at the end and inserting 
        ``nurse executives for the Veterans Health Administration, the 
        Under Secretary for Health may pay special pay to personnel of 
        the Veterans Health Administration who are nurse executives.''; 
        and
            (2) by adding at the end the following new paragraph:
    ``(5) The Under Secretary for Health shall define through 
regulations which positions of the Veterans Health Administration 
qualify as nurse executives for purposes of special pay under paragraph 
(1).''.

           Subtitle B--Improvement of Recruitment and Hiring

SEC. 211. OVERSIGHT OF DIRECT HIRE AUTHORITY AND HIRING FLEXIBILITY OF 
              DEPARTMENT OF VETERANS AFFAIRS.

    Not later than three years after the date of the enactment of this 
Act, the Inspector General of the Department of Veterans Affairs shall 
conduct a study and publish a report on--
            (1) the use of direct hire authority by the Department;
            (2) the contributions made by the use of such authority to 
        filling vacancies within the Department; and
            (3) any vulnerabilities or inconsistencies with respect to 
        the use of such authority.

SEC. 212. WAIVER OF CERTAIN LICENSURE REQUIREMENTS.

    (a) Psychologists.--Paragraph (8)(C) of section 7402(b) of title 
38, United States Code, is amended--
            (1) by striking ``individual psychologist for a period'' 
        and inserting ``individual psychologist--
                    ``(i) for a period'';
            (2) by striking the period at the end and inserting ``; 
        or''; and
            (3) by adding at the end the following new clause:
                    ``(ii) for a reasonable period recommended by the 
                Under Secretary for Health, not to exceed four years, 
                during a public health emergency declared by the 
                President, the Secretary of Health and Human Services, 
                or such other authority as specified by the 
                Secretary.''.
    (b) Licensed Professional Mental Health Counselor.--Paragraph 
(11)(B) of such section is amended by striking the period at the end 
and inserting ``, except that the Secretary may waive the requirement 
of licensure or certification for an individual professional mental 
health counselor for a reasonable period of time recommended by the 
Under Secretary for Health.''.

                  Subtitle C--Other Personnel Matters

SEC. 221. ROLE OF OPTOMETRISTS IN DEPARTMENT OF VETERANS AFFAIRS.

    (a) Inclusion as Physician.--
            (1) In general.--Section 7413 of title 38, United States 
        Code, is amended--
                    (A) in the section heading, by inserting ``and 
                optometrists'' after ``podiatrists'';
                    (B) in subsection (a)--
                            (i) by striking ``a doctor of podiatric 
                        medicine who is appointed as a podiatrist under 
                        section 7401(1) of this title'' and inserting 
                        ``a covered individual''; and
                            (ii) by striking ``such section'' and 
                        inserting ``section 7401(1) of this title''; 
                        and
                    (C) by adding at the end the following new 
                subsection:
    ``(c) Covered Individual Defined.--In this section, the term 
`covered individual' means any of the following:
            ``(1) A doctor of podiatric medicine who is appointed as a 
        podiatrist under section 7401(1) of this title.
            ``(2) A doctor of optometry who is appointed as an 
        optometrist under section 7401(1) of this title.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of subchapter I of chapter 74 of such title is 
        amended by striking the item relating to section 7413 and 
        inserting the following new item

``7413. Treatment of podiatrists and optometrists; clinical oversight 
                            standards.''.
    (b) Clarification of Role.--Section 7306 of such title is amended--
            (1) in subsection (a)--
                    (A) in paragraph (6), by striking ``, a Director of 
                Dietetic Service, and a Director of Optometric 
                Service'' and inserting ``and a Director of Dietetic 
                Service'';
                    (B) by redesignating paragraph (12) as paragraph 
                (13); and
                    (C) by inserting after paragraph (11) the following 
                new paragraph (12):
            ``(12) An Executive Director of Optometric Service, who 
        shall be a qualified doctor of optometry and who shall be 
        responsible to the Under Secretary for Health for the operation 
        of the Optometric Service.'';
            (2) in subsection (b)(1), by inserting ``optometry,'' after 
        ``podiatric medicine,''; and
            (3) in subsection (c), by striking ``and (10)'' and 
        inserting ``(10), and (12)''.

SEC. 222. EXPANSION OF ANNUAL LEAVE OPTIONS FOR EMPLOYEES OF DEPARTMENT 
              OF VETERANS AFFAIRS DURING PUBLIC HEALTH EMERGENCY.

    (a) Account for Consolidation of Certain Annual Leave.--
            (1) In general.--Notwithstanding any other provision of 
        law, the Secretary of Veterans Affairs shall consolidate into 
        one restored annual leave account all annual leave restored 
        pursuant to section 6304(d)(1)(B) of title 5, United States 
        Code, during calendar years 2020, 2021, and 2022 for covered 
        employees who are employed by the Department of Veterans 
        Affairs on the date of the enactment of this Act.
            (2) Additional calendar years.--The Secretary may 
        consolidate into the annual leave account described in 
        paragraph (1) annual leave restored pursuant to section 
        6304(d)(1)(B) of such title during calendar years not described 
        in such paragraph with the approval of the Director of the 
        Office of Personnel Management.
    (b) Leave Expiration.--Annual leave consolidated into the annual 
leave account described in subsection (a)(1) shall be used before the 
later of--
            (1) January 9, 2027; and
            (2) the applicable deadline pursuant to section 630.309 of 
        title 5, Code of Federal Regulations, or successor regulation.
    (c) Program of Lump Sum Payments.--
            (1) In general.--Subject to the availability of 
        appropriations, the Secretary may establish a program under 
        which, during the period beginning on the date of the enactment 
        of this Act and ending on January 9, 2027, a covered employee 
        with annual leave described in subsection (a)(1) may elect to 
        receive a single lump sum payment lin lieu of using such leave.
            (2) Treatment of lump sum payments.--A lump sum payment 
        under a program established under paragraph (1) shall be 
        treated as separate and apart from any lump sum payment of 
        annual leave the covered employee may otherwise be entitled to 
        upon separation from employment with the Department.
    (d) Covered Employee Defined.--In this section, the term ``covered 
employee'' means an employee of the Department of Veterans Affairs 
who--
            (1) was appointed under chapter 73 or 74 of title 38, 
        United States Code, notwithstanding section 7421(a) of such 
        title, section 7425(b) of such title, or any other provision of 
        such chapter that impacts leave for such an employee;
            (2) was appointed under chapter 78 of such title; or
            (3) occupied any position under the jurisdiction of the 
        Secretary of Veterans Affairs that is subject to the leave 
        provisions of chapter 63 of title 5, United States Code.

SEC. 223. EXPANSION OF REIMBURSEMENT OF CONTINUING PROFESSIONAL 
              EDUCATION EXPENSES.

    (a) In General.--Section 7411 of title 38, United States Code, is 
amended to read as follows:
``Sec. 7411. Reimbursement of continuing professional education 
              expenses
    ``The Secretary shall reimburse certain full-time health care 
professionals of the Department for expenses incurred for continuing 
professional education in amounts as follows:
            ``(1) With respect to any physician, dentist, podiatrist, 
        chiropractor, optometrist, registered nurse, or physician 
        assistant appointed under section 7401(1) of this title, not 
        more than $1,000 per year for each such individual.
            ``(2) With respect to any licensed practical or vocational 
        nurse, medical technologist, pharmacist, pharmacy technician, 
        psychologist, diagnostic radiologic technologist, or social 
        worker appointed under section 7401(3) of this title, not more 
        than $1,000 per year for each such individual.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
subchapter I of chapter 74 of title 38, United States Code, is amended 
by striking the item relating to section 7411 and inserting the 
following new item:

``7411. Reimbursement of continuing professional education expenses.''.

SEC. 224. INCLUSION OF POLICE OFFICERS OF DEPARTMENT OF VETERANS 
              AFFAIRS AS LAW ENFORCEMENT OFFICERS.

    (a) Definitions.--In this section--
            (1) the term ``Director'' means the Director of the Office 
        of Personnel Management;
            (2) the term ``Fund'' means the Civil Service Retirement 
        and Disability Fund;
            (3) the term ``incumbent'' means an individual who--
                    (A) was appointed as a law enforcement officer 
                before the date of enactment of this Act; and
                    (B) is serving as a law enforcement officer on the 
                date of enactment of this Act;
            (4) the term ``law enforcement officer'' means an 
        individual who satisfies the requirements of section 8331(20) 
        or 8401(17) of title 5, United States Code, by virtue of the 
        amendments made by this section;
            (5) the term ``prior service'' means, with respect to an 
        incumbent who makes an election under subsection (c)(2), 
        service performed by the incumbent before the date on which 
        appropriate retirement deductions begin to be made under the 
        election; and
            (6) the term ``service'' means service performed by an 
        individual as a law enforcement officer.
    (b) Civil Service Retirement System.--
            (1) In general.--Title 5, United States Code, is amended--
                    (A) in section 8331(20), in the matter preceding 
                subparagraph (A)--
                            (i) by inserting ``(or who is described in 
                        section 8401(17)(E))'' after ``criminal laws of 
                        the United States''; and
                            (ii) by inserting ``(or who is so 
                        described)'' after ``engaged in this 
                        activity''; and
                    (B) in section 8401(17)--
                            (i) in subparagraph (C)--
                                    (I) by striking ``subparagraph (A) 
                                and (B)'' and inserting ``subparagraph 
                                (A), (B), or (E)''; and
                                    (II) by striking ``and'' at the 
                                end;
                            (ii) in the flush text following 
                        subparagraph (D)(iii), by adding ``and'' after 
                        the semicolon at the end; and
                            (iii) by adding at the end the following:
                    ``(E) an employee of the Department of Veterans 
                Affairs who is a Department police officer under 
                section 902 of title 38, as determined by the Secretary 
                of Veterans Affairs;''.
            (2) Application.--The amendments made by this subsection 
        shall apply to any--
                    (A) individual who is appointed as a law 
                enforcement officer--
                            (i) as defined in section 8331(20) or 
                        8401(17) of title 5, United States Code, as 
                        amended by this subsection; and
                            (ii) on or after the date of enactment of 
                        this Act; and
                    (B) incumbent, consistent with the requirements of 
                this section.
    (c) Treatment of Service Performed by Incumbents.--
            (1) Service on or after date of enactment.--Service 
        performed by an incumbent on or after the date of enactment of 
        this Act shall be treated as service performed as a law 
        enforcement officer.
            (2) Service before date of enactment.--Service performed by 
        an incumbent before the date of enactment of this Act shall, 
        for purposes of subchapter III of chapter 83 and chapter 84 of 
        title 5, United States Code, be treated as service performed as 
        a law enforcement officer only if the incumbent submits a 
        written election to the Director by the earlier of--
                    (A) the date that is 5 years after the date of 
                enactment of this Act; or
                    (B) the day before the date on which the incumbent 
                separates from the service.
    (d) Individual Contributions for Prior Service.--
            (1) In general.--An incumbent who makes an election under 
        subsection (c)(2) may, with respect to prior service performed 
        by the incumbent, pay a deposit into the Fund equal to the sum 
        of--
                    (A) the difference between--
                            (i) the amount that would have been 
                        deducted during the period of prior service 
                        under section 8334 or 8422 of title 5, United 
                        States Code, from the pay of the incumbent if 
                        the amendments made by this section had been in 
                        effect during the prior service; and
                            (ii) the amount that was deducted during 
                        the period of prior service under section 8334 
                        or 8422 of title 5, United States Code; and
                    (B) interest on the amount described in 
                subparagraph (A)(i), as computed under--
                            (i) paragraphs (2) and (3) of section 
                        8334(e) of title 5, United States Code; and
                            (ii) regulations promulgated by the 
                        Director.
            (2) Effect of not contributing.--If an incumbent does not 
        pay the full amount of the deposit described in paragraph (1)--
                    (A) all prior service of the incumbent shall remain 
                fully creditable as a law enforcement officer; and
                    (B) the resulting annuity shall be reduced--
                            (i) in a manner similar to that described 
                        in section 8334(d)(2) of title 5, United States 
                        Code; and
                            (ii) to the extent necessary to make up the 
                        amount unpaid.
    (e) Government Contributions for Prior Service.--
            (1) In general.--If an incumbent makes an election under 
        subsection (c)(2), an agency that employed the incumbent during 
        any prior service of the incumbent shall remit to the Director, 
        for deposit in the Fund, an amount equal to the sum of--
                    (A) the difference between--
                            (i) the total amount of Government 
                        contributions that would have been paid under 
                        section 8334 or 8423 of title 5, United States 
                        Code, if the amendments made by this section 
                        had been in effect during the prior service; 
                        and
                            (ii) the total amount of Government 
                        contributions paid under section 8334 or 8423 
                        of title 5, United States Code; and
                    (B) interest on the amount described in 
                subparagraph (A)(i), as computed in accordance with--
                            (i) paragraphs (2) and (3) of section 
                        8334(e) of title 5, United States Code; and
                            (ii) regulations promulgated by the 
                        Director.
            (2) Contributions to be made ratably.--Government 
        contributions under this subsection on behalf of an incumbent 
        shall be made by the agency ratably (not less frequently than 
        annually) over the 10-year period beginning on the date 
        described in subsection (a)(5).
    (f) Exemption From Mandatory Separation.--Notwithstanding sections 
8335(b) and 8425(b) of title 5, United States Code, a law enforcement 
officer shall not be subject to mandatory separation during the 3-year 
period beginning on the date of enactment of this Act.
    (g) Regulations.--The Director shall prescribe regulations to carry 
out this section, and the amendments made by this section, including 
regulations for the application of this section (and those amendments) 
in the case of any individual entitled to a survivor annuity (based on 
the service of an incumbent who dies before making an election under 
subsection (c)(2)), to the extent that any rights that would have been 
available to the decedent if still living.
    (h) Rule of Construction.--Nothing in this section, or an amendment 
made by this section, shall be considered to apply in the case of a 
reemployed annuitant.

SEC. 225. DEPARTMENT OF VETERANS AFFAIRS PERSONNEL TRANSPARENCY.

    (a) In General.--Section 505 of the John S. McCain III, Daniel K. 
Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and 
Strengthening Integrated Outside Networks Act of 2018 (Public Law 115-
182; 38 U.S.C. 301 note) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1)--
                            (i) in the matter before subparagraph (A), 
                        by striking ``information,'' and all that 
                        follows through ``facility:'' and inserting 
                        ``information:'';
                            (ii) in subparagraph (B)--
                                    (I) by inserting ``(i)'' before 
                                ``The number''; and
                                    (II) by adding at the end the 
                                following new clause:
                    ``(ii) Information made available under this 
                subparagraph shall be updated not less frequently than 
                once each quarter to account for delays in data 
                processing and shall reflect the most recently 
                available data.'';
                            (iii) in subparagraph (C), by striking 
                        ``vacancies, by occupation.'' and inserting 
                        ``positions currently undergoing a recruitment 
                        action, disaggregated by occupation and by 
                        stage of recruitment, including pre-posting, 
                        posting processing stage, recruitment stage, 
                        onboarding stage, and waiting to start stage, 
                        or successor stages if modified.''; and
                            (iv) by adding at the end the following new 
                        subparagraph:
                    ``(F) The number of positions vacated that the 
                Secretary as decided not to backfill, disaggregated by 
                occupation.'';
                    (B) by redesignating paragraph (5) as paragraph 
                (6);
                    (C) by inserting after paragraph (4) the following 
                new paragraph (5):
            ``(5) Display of information.--The display of information 
        made publicly available on an Internet website of the 
        Department pursuant to paragraph (1), subject to subparagraph 
        (D) of such paragraph, shall be disaggregated--
                    ``(A) by departmental component;
                    ``(B) in the case of information relating to 
                Veterans Health Administration positions, by medical 
                facility; and
                    ``(C) in the case of information relating to 
                Veterans Benefits Administration positions, by regional 
                office.''; and
                    (D) in paragraph (6), as redesignated by 
                subparagraph (B), by striking ``shall'' and all that 
                follows and inserting ``shall--
                    ``(A) review the administration of the website 
                required under paragraph (1);
                    ``(B) develop recommendations relating to the 
                improvement of such administration; and
                    ``(C) submit to the Committee on Veterans' Affairs 
                of the Senate and the Committee on Veterans' Affairs of 
                the House of Representatives a report containing--
                            ``(i) the findings of the Inspector General 
                        with respect to the most recent review 
                        conducted under subparagraph (A); and
                            ``(ii) the recommendations most recently 
                        developed under subparagraph (B).''; and
            (2) by amending subsection (b) to read as follows:
    ``(b) Annual Report.--Each year, the Secretary shall submit to 
Congress an annual report that includes the following:
            ``(1) A description of the steps the Department is taking 
        to achieve full staffing capacity.
            ``(2) A description of the actions the Department is taking 
        to improve the onboard timeline for facilities of the 
        Department, including--
                    ``(A) in the case of facilities of the Veterans 
                Health Administration, for facilities for which the 
                duration of the onboarding process exceeds the metrics 
                laid out in the Time to Hire Model of the Veterans 
                Health Administration, or successor model; and
                    ``(B) in the case of Veterans Benefits 
                Administration, for regional offices that exceed the 
                time-to-hire target of the Office of Personnel 
                Management.
            ``(3) The amount of additional funds necessary to enable 
        the Department to reach full staffing capacity.
            ``(4) Such recommendations for legislative or 
        administrative action as the Secretary may have in order to 
        achieve full staffing capacity at the Department.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on the date of the enactment of this Act and shall apply 
with respect to the first update under section 505(a)(3) of such Act 
beginning after the date of the enactment of this Act and each update 
thereafter.

SEC. 226. COMPTROLLER GENERAL REPORT ASSESSING HUMAN RESOURCES 
              MODERNIZATION WITHIN VETERANS HEALTH ADMINISTRATION.

    (a) In General.--Not later than 18 months after the date of the 
enactment of this Act, the Comptroller General of the United States 
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 human resources modernization conducted by the Veterans 
Health Administration (in this section referred to as the 
``Administration'').
    (b) Elements.--The report required by subsection (a) shall include 
an assessment of the following:
            (1) The Human Resources Modernization Program of the 
        Administration, including an assessment of the activities 
        carried out under the Program, the results of those activities, 
        and how the Administration measures the performance of those 
        activities.
            (2) The human resources information technology systems of 
        the Administration, including the performance, accuracy, 
        efficiency, and user-ability of those systems for human 
        resources professionals, managers with hiring authority, and 
        other employees of the Administration who use those systems.
            (3) Metrics and timelines used to report hiring and vacancy 
        data within the Administration, including recruitment and 
        retention data.
            (4) Trends in hiring, recruitment, retention, and vacancies 
        among employees of the Administration.
            (5) The use by the Administration of authorities and 
        waivers for hiring flexibility, including an assessment of the 
        standardization of use of such authorities and waivers within 
        each Veterans Integrated Service Network.
            (6) Training, development, and workload of human resources 
        professionals of the Administration.
            (7) Such other matters as the Comptroller General considers 
        relevant.
                                 <all>
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