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[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 2484 Introduced in Senate (IS)]

108th CONGRESS
  2d Session
                                S. 2484

  To amend title 38, United States Code, to simplify and improve pay 
  provisions for physicians and dentists, to authorize alternate work 
                schedules and executive pay for nurses.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                              June 1, 2004

Mr. Specter (by request) 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 simplify and improve pay 
  provisions for physicians and dentists, to authorize alternate work 
                schedules and executive pay for nurses.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Department of Veterans Affairs 
Health Care Personnel Enhancement Act of 2003''.

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

    Except as otherwise expressly provided, whenever in this Act an 
amendment is expressed in terms of an amendment to a section or other 
provision, the reference shall be considered to be made to a section or 
other provision of title 38, United States Code.

SEC. 3. IMPROVEMENT AND SIMPLIFICATION OF PAY PROVISIONS FOR PHYSICIANS 
              AND DENTISTS.

    (a) Chapter 74 is amended--
            (1) In section 7404b--
                    (A) by striking ``(1)'' after ``(b)'';
                    (B) by striking the list of position grades under 
                the caption, ``Physician and dentist schedule'' and 
                inserting in lieu thereof the following:
                ``Physician grade.
                Dentist grade.''; and
                    (C) by striking paragraph (2) in its entirety;
            (2) In section 7404(c) by striking ``special''; and
            (3) By striking Subchapter III in its entirety and 
        inserting in lieu thereof the following sections:

           ``SUBCHAPTER III--PAY FOR PHYSICIANS AND DENTISTS

``Sec. 7431. Pay authority
    ``(a) In order to recruit and retain highly qualified physicians 
and dentists in the Veterans Health Administration, the Secretary shall 
establish and periodically adjust the rates of pay for physicians and 
dentists based upon the factors specified in subsection (b). Total pay 
shall be benchmarked to representative salaries of non-Department 
physicians, dentists, and health care clinician-executives.
    ``(b) Pay for physicians and dentists employed in the Veterans 
Health Administration shall have three components:
            ``(1) Base pay.--This shall be a uniform pay band 
        applicable nationwide. The minimum rate shall be the maximum 
        rate for Chief grade in the Veterans Health Administration 
        Physician and Dentist Pay Schedule in effect on the day before 
the date of enactment of this Act. The maximum rate may not exceed the 
rate of basic pay authorized by section 5316 of title 5 for Level V of 
the Executive Schedule. The Secretary shall adjust annually the minimum 
rate by the same percentage as the adjustment under section 5303 of 
title 5 in the rates of pay for the General Schedule, and the maximum 
rate in accordance with section 5318 of title 5. Administration 
facilities, under regulations prescribed by the Secretary, may set 
individual base pay anywhere within the pay band.
            ``(2) Market pay.--This shall be a variable pay band based 
        on geographic area, specialty, assignment, personal 
        qualifications, and individual experience, and shall be 
        established and adjusted locally in accordance with regulations 
        prescribed under subsection (c). Administration facilities will 
        set individual market pay in accordance with regulations 
        prescribed by the Secretary. The Under Secretary for Health 
        shall periodically review and recommend to the Secretary 
        adjustments to the market pay band based on published 
        healthcare workforce employment and compensation data. The 
        Secretary may adjust the market pay band periodically based on 
        the recommendations of the Under Secretary and in response to 
        changing health-care labor trends.
            ``(3) Performance pay.--
                    ``(A) There shall be a variable pay band linked to 
                the physician's or dentist's achievement of specific 
                corporate goals and individual performance objectives. 
                Physicians and dentists other than those specified in 
                subsection (f)(1) shall not be eligible for this 
                component during the first year of appointment. The 
                amount payable to a physician or dentist for this 
                component may vary based on individual achievement. The 
                performance component paid to any physician or dentist 
                other than those specified in subsection (f)(1) will be 
                in accordance with regulations prescribed by the 
                Secretary and may not exceed $10,000 in a year.
                    ``(B) In accordance with regulations prescribed by 
                the Secretary, ten percent of the benchmark total pay 
                for physicians and dentists specified in subsection 
                (f)(1) shall be linked to the physician's or dentist's 
                achievement of specific corporate goals and individual 
                performance objectives as a performance component. 
                Administration facilities may set the performance pay 
                in accordance with regulations prescribed by the 
                Secretary.
    ``(c) Compensation paid under this subchapter shall be considered 
pay for all purposes, included but not limited to retirement benefits 
under chapters 83 and 84 of title 5, United States Code, and other 
benefits. Notwithstanding the preceding sentence, amounts paid for 
performance pay under subsection (b)(3)(A) shall not be considered pay 
for retirement benefits under chapters 83 and 84 of title 5, United 
States Code.
    ``(d) Any decrease in pay that results from an adjustment to the 
market or performance component of a physician's or dentist's total 
compensation does not constitute an adverse action.
    ``(e) In no case may the total amount of compensation paid to a 
physician or dentist under this title in any one year exceed the amount 
of annual compensation (excluding expenses) specified in section 102 of 
title 3, United States Code.
    ``(f) Covered Positions.--
            ``(1) This subsection applies to physicians and dentists in 
        the following positions: Chiefs of Staff or equivalent 
        facility-level and Network-level clinical management positions 
        (including Network Clinical Service Managers), facility and 
        Network or Regional executive positions (including Network 
        Service Line Coordinators and Medical Center/Health Care System 
        Directors), Central Office executive positions, and such other 
        positions under this title as the Secretary may determine in 
        accordance with regulations prescribed in accordance with 
        section 7434(a).
            ``(2) Notwithstanding the special relationships of the 
        Veterans Health Administration with affiliated institutions 
        under section 7302, physicians and dentists serving in covered 
        positions and receiving compensation under this subchapter may 
        not receive any compensation on or after the date specified in 
        regulations issued by the Secretary, through employment or 
        contract with, or negotiate or accept any offer of employment 
        from, any institution or other entity that is affiliated with 
        the VA medical center to which they are assigned, or affiliated 
        with a VA medical center which falls under their official 
        responsibilities. This limitation shall include receiving 
        compensation through or from practice groups or any other 
        entities associated with the affiliated institution(s), or from 
        entities under contract with the affiliated institution(s). 
        Compensation includes anything of monetary value, including but 
        not limited to honoraria, salary, and any fringe benefits such 
        as: tuition waiver, insurance protection, contributions to a 
        retirement fund, payment for books, below-market interest 
        loans, or employee discounts. Nothing in this section precludes 
        physicians and dentists in covered positions from holding 
        uncompensated appointments as other than officer, director, or 
        trustee with affiliated institutions in furtherance of section 
        7302.
            ``(3) Subject to any conditions the Secretary may be 
        regulation prescribe, the Secretary may, on a case-by-case 
        basis, suspend or waive the limitation in paragraph (2) to an 
        individual physician or dentist, when necessary and appropriate 
        to carry out the purposes of section 7302, to assist 
        communities or practice groups to meet medical needs which 
        otherwise would not be met, or where the Secretary determines 
        that suspension or waiver would be in the best interest of the 
        United States. The Secretary shall make any suspension or 
        wavier made pursuant to this paragraph in writing.
``Sec. 7432. Transition to new pay system
    ``(a) All current special pay agreements entered into under the 
provisions of this subchapter in effect on the day before the date of 
enactment of this Act shall terminate on the date of enactment of this 
Act. Any physician or dentist in receipt of special pay on that date 
shall continue to be compensated as if such agreement were still in 
effect until the date specified in regulations issued by the Secretary 
implementing this new subchapter.
    ``(b) Physicians and dentists appointed or reassigned on or after 
the date of enactment of this Act, but before implementation of this 
subchapter shall be compensated in accordance with sections 7404, 7405, 
7433, 7434, 7435, and 7436, as applicable, in effect on the day before 
the date of enactment of this Act. Any such physician or dentist shall 
continue to be compensated at the applicable rates until such date 
specified in regulations issued by the Secretary implementing the new 
pay system. No special pay agreement will be required of any physician 
or dentist receiving such pay.
    ``(c) During the period from the date of enactment of this Act 
through the date of implementation of this subchapter, physicians and 
dentists paid pursuant to this section shall be subject to paragraphs 
(1), (2), (4), (5), and (6) of subsection (b) of section 7438 in effect 
on the day before the date of enactment of this Act.
    ``(d) The amount of pay paid under this subchapter for a physician 
or dentist appointed before the effective date of regulations 
implementing this subchapter shall be not less than the amount of base 
pay and special pay such physician or dentist received under this title 
on the day before such effective date.
    ``(e) Special pay subject to the provisions of section 7438, as in 
effect before the date of enactment of this section, or subject to 
subsection (c), paid to Veterans Health Administration physicians and 
dentists appointed before the effective date of regulations 
implementing this subchapter and who separate after such effective 
date, shall be fully creditable for purposes of computing benefits 
under chapters 83 and 84 of title 5.
``Sec. 7433. Pay for Under Secretary for Health
    ``(a) Section 5314 of title 5 establishes the base pay for the 
Under Secretary for Health at Level III of the Executive Schedule.
    ``(b) In addition to base pay under section 5314 of title 5, the 
Under Secretary for Health shall be eligible for Market Pay under 
section 7431(b)(2).
    ``(c) Transition.--The current special pay agreement of the Under 
Secretary for Health entered into under the provisions of this 
subchapter in effect on the day before the date of enactment of this 
Act shall terminate on the date of enactment of this Act. The incumbent 
Under Secretary for Health on the date of enactment of this Act shall 
continue to receive special pay as if such agreement were still in 
effect until the date specified in regulations issued by the Secretary 
implementing this new subchapter. Any Under Secretary for Health 
appointed on or after the date of enactment of this Act, but before the 
date specified in regulations issued by the Secretary implementing this 
new subchapter, shall receive special pay in accordance with sections 
7432(d)(2), 7433, and 7437(a) in effect on the day before the date of 
enactment of this Act.
``Sec. 7434. Administrative provisions
    ``(a) After receiving the recommendations of the Under Secretary 
for Health, the Secretary, pursuant to the authority in section 
7421(a), shall prescribe regulations implementing the physician and 
dentist pay system established in this new subchapter. Such regulations 
shall include the method for computing the pay for all physicians and 
dentists in the Veterans Health Administration under this title.
    ``(b) Eighteen months after the Secretary issues regulations 
implementing this subchapter and annually thereafter for the next ten 
years, the Secretary shall provide to the Committees on Veterans' 
Affairs of the Senate and House of Representatives a report on the 
implementation of the authorities under this subchapter. Each report 
shall include:
            ``(1) a description of the rates of pay in effect during 
        the preceding fiscal year with a comparison to the rates in 
        effect during the previous fiscal year by facility and by 
        specialty;
            ``(2) the number of physicians and dentists who left 
        employment with the Veterans Health Administration during the 
        preceding year;
            ``(3) the number of unfilled physician and dentist 
        positions in each specialty in the Veterans Health 
        Administration, the average and maximum lengths of time that 
        such positions have been unfilled, and a summary of the reasons 
        that such positions remain unfilled; and
            ``(4) an assessment of the impact of implementation of this 
        subchapter on efforts to recruit and retain physicians and 
        dentists in the Veterans Health Administration.
In addition, the first two reports following implementation of this 
subchapter shall also include a comparison of staffing levels, contract 
expenditures, and average salary of physicians and dentists by facility 
and specialty for the preceding and previous fiscal years.''.
    (b) The title and list of sections for Subchapter III in the table 
of sections at the beginning of Chapter 74 is amended to read as 
follows:
           ``subchapter iii--pay for physicians and dentists
``Sec. 7431. Pay authority.
``Sec. 7432. Transition to new pay system.
``Sec. 7433. Pay for Under Secretary for Health.
``Sec. 7434. Administrative provisions.''.

SEC. 4. ALTERNATE WORK SCHEDULES.

    (a) Chapter 74 is amended by adding a new section 7456a:
``Sec. 7456a. Alternate work schedules
    ``(a) Coverage.--This section applies to registered nurses 
appointed under this chapter.
    ``(b) 36/40 Work Schedule.--
            ``(1) Subject to paragraph (2), if the Secretary determines 
        it be necessary in order to obtain or retain the services of 
        registered nurses at any Department health-care facility, the 
        Secretary may provide, in the case of nurses employed at such 
        facility, that such nurses who work three regularly scheduled 
        12-hour tours of duty within a workweek shall be considered for 
        all purposes (except computation of full-time equivalent 
        employees for the purposes of determining compliance with 
        personnel ceilings) to have worked a full 40-hour basic 
        workweek.
            ``(2)(A) Basic and additional pay for a registered nurse 
        who is considered under paragraph (1) to have worked a full 40-
        hour basic workweek shall be subject to subparagraphs (B) and 
        (C).
            ``(B) The hourly rate of basic pay for such a nurse for 
        service performed as part of a regularly scheduled 36-hour tour 
        of duty within the workweek shall be derived by dividing the 
        nurse's annual rate of basic pay by 1,872.
            ``(C)(i) Such a nurse who performs a period of service in 
        excess of such nurse's regularly scheduled 36-hour tour of duty 
        within a workweek is entitled to overtime pay under section 
        7453(e) of this title, or other applicable law, for officially 
        ordered or approved service performed in excess of eight hours 
        on a day other than a day on which such nurse's regularly 
        scheduled three 12-hour tours fall, or in excess of 12 hours 
        for any day included in the regularly scheduled 36-hour tour of 
        duty, or in excess of 40 hours during an administrative 
        workweek.
            ``(ii) Except as provided in subparagraph (i), a registered 
        nurse to whom this subsection is applicable is not entitled to 
        additional pay under section 7453 of this title, or other 
        applicable law, for any period included in a regularly 
        scheduled 12-hour tour of duty.
            ``(3) A nurse who works a 36/40 work schedule described in 
        this subsection who is absent on approved sick leave or annual 
        leave during a regularly scheduled 12-hour tour of duty shall 
        be charged for such leave at a rate of ten hours of leave for 
        nine hours of absence.
    ``(c) 7/7 Work Schedule.--
            ``(1) Subject to paragraph (2), if the Secretary determines 
        it be necessary in order to obtain or retain the services of 
        registered nurses at any Department health-care facility, the 
        Secretary may provide, in the case of nurses employed at such 
        facility, that such nurses who work seven regularly scheduled 
        10-hour tours of duty, with seven days off duty, within a two-
        week pay period, shall be considered for all purposes (except 
        computation of full-time equivalent employees for the purposes 
        of determining compliance with personnel ceilings) to have 
        worked a full 80 hours for the pay period.
            ``(2)(A) Basic and additional pay for a registered nurse 
        who is considered under paragraph (1) to have worked a full 80-
        hour pay period shall be subject to subparagraphs (B) and (C).
            ``(B) The hourly rate of basic pay for such a nurse for 
        service performed as part of a regularly scheduled 70-hour tour 
        of duty within the pay period shall be derived by dividing the 
        nurse's annual rate of basic pay by 1,820.
            ``(C)(i) Such a nurse who performs a period of service in 
        excess of such nurse's regularly scheduled 70-hour tour of duty 
        within a pay period is entitled to overtime pay under section 
        7453(e) of this title, or other applicable law, for officially 
        ordered or approved service performed in excess of eight hours 
        on a day other than a day on which such nurse's regularly 
        scheduled seven 10-hour tours fall, or in excess of 10 hours 
        for any day included in the regularly scheduled 70-hour tour of 
        duty, or in excess of 80 hours during a pay period.
            ``(ii) Except as provided in subparagraph (i), a registered 
        nurse to whom this subsection is applicable is not entitled to 
        additional pay under section 7453 of this title, or other 
        applicable law, for any period included in a regularly 
        scheduled 10-hour tour of duty.
            ``(3) A nurse who works a 7/7 work schedule described in 
        this subsection who is absent on approved sick leave or annual 
        leave during a regularly scheduled 12-hour tour of duty shall 
        be charged for such leave at a rate of eight hours of leave for 
        seven hours of absence.
    ``(d) 9-Month Work Schedule.--The Secretary may authorize a 
registered nurse appointed under section 7405, with the nurse's written 
consent, to work full-time for nine months with three months off duty, 
within a fiscal year, and be paid at 75 percent of the full-time rate 
for such nurse's grade for each pay period of such fiscal year. Such 
employee shall be considered a .75 full-time equivalent employee in 
computing full-time equivalent employees for the purposes of 
determining compliance with personnel ceilings. Service on this 
schedule shall be considered part-time service for purposes of 
computing benefits under chapters 83 and 84 of title 5.
    ``(e) The Secretary shall prescribe regulations for the 
implementation of this section.''.
    (b) The title and list of sections for Subchapter IV in the table 
of sections at the beginning of Chapter 74 is amended to read as 
follows:
    ``subchapter iv--pay for nurses and other health-care personnel
``Sec. 7451. Nurses and other health-care personnel: competitive pay.
``Sec. 7452. Nurses and other health-care personnel: administration of 
                            pay.
``Sec. 7453. Nurses: additional pay.
``Sec. 7454. Physician assistants and other health care professionals: 
                            additional pay.
``Sec. 7455. Increases in rates of basic pay.
``Sec. 7456. Nurses: special rules for weekend duty.
``Sec. 7456a. Alternate work schedules.
``Sec. 7457. On-call pay.
``Sec. 7458. Recruitment and retention bonus pay.''.

SEC. 5. NURSE EXECUTIVE SPECIAL PAY.

    (a) Section 7452 is amended by adding at the end thereof:
    ``(g)(1) In order to recruit and retain highly qualified Department 
nurse executives, the Secretary, in accordance with regulations the 
Secretary shall prescribe, shall pay special pay to the nurse executive 
at each Department health-care facility or at Central Office.
    ``(2) Special pay paid under paragraph (1) shall be a minimum of 
$10,000 and a maximum of $25,000. The amount paid to each nurse 
executive shall be based on factors such as the grade of the nurse 
executive position, the scope and complexity of the nurse executive 
position, the nurse executive's personal qualifications, the 
characteristics of the health-care facility, e.g., tertiary, single 
site or multi-site, nature and number of specialty care units, 
demonstrated recruitment and retention difficulties, and such other 
factors the Secretary deems appropriate.
    ``(3) Special pay paid under paragraph (1) shall be in addition to 
any other pay (including basic pay) and allowances to which the nurse 
executive is entitled, and shall be considered pay for all purposes, 
including but not limited to retirement benefits under chapters 83 and 
84 of title 5, United States Code, and other benefits, but shall not be 
considered basic pay for purposes of adverse actions under subchapter 
V.''.

SEC. 6. EFFECTIVE DATE.

    The amendments to title 38, United States Code, contained herein 
shall take effect on the first day of the first pay period on or after 
the later of April 1, 2004, or six months after the date of enactment.

SEC. 7. ADMINISTRATIVE PROVISION.

    (a) Chapter 74 is amended by adding a new section 7427:
``Sec. 7427. Functions
    ``The functions assigned to the Secretary and other officers of the 
Department of Veterans Affairs under this chapter are vested in their 
discretion.''
                                 <all>
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