II 

Calendar No. 713 

108TH CONGRESS 

2D SESSION S. 2484 

[Report No. 108–357] 

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 

SEPTEMBER 23, 2004 

Reported by Mr. SPECTER, with an amendment and an amendment to the title 

[Strike out all after the enacting clause and insert the part printed in italic] 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 
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•S 2484 RS 

1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Department of Vet3 erans Affairs Health Care Personnel Enhancement Act of 

4 2003’’. 

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

6 Except as otherwise expressly provided, whenever in 

7 this Act an amendment is expressed in terms of an amend8 ment to a section or other provision, the reference shall 

9 be considered to be made to a section or other provision 

10 of title 38, United States Code. 

11 SEC. 3. IMPROVEMENT AND SIMPLIFICATION OF PAY PRO12 VISIONS FOR PHYSICIANS AND DENTISTS. 

13 (a) Chapter 74 is amended— 

14 (1) In section 7404b— 

15 (A) by striking ‘‘(1)’’ after ‘‘(b)’’; 

16 (B) by striking the list of position grades 

17 under the caption, ‘‘PHYSICIAN AND DENTIST

18 SCHEDULE’’ and inserting in lieu thereof the 

19 following: 

20 ‘‘Physician grade. 

21 Dentist grade.’’; and 

22 (C) by striking paragraph (2) in its en23 tirety; 

24 (2) In section 7404(c) by striking ‘‘special’’; 

25 and 
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1 (3) By striking Subchapter III in its entirety 

2 and inserting in lieu thereof the following sections: 

3 ‘‘SUBCHAPTER III—PAY FOR PHYSICIANS AND 

4 DENTISTS 

5 ‘‘§ 7431. Pay authority 

6 ‘‘(a) In order to recruit and retain highly qualified 

7 physicians and dentists in the Veterans Health Adminis8 tration, the Secretary shall establish and periodically ad9 just the rates of pay for physicians and dentists based 

10 upon the factors specified in subsection (b). Total pay 

11 shall be benchmarked to representative salaries of non-De12 partment physicians, dentists, and health care clinician13 executives. 

14 ‘‘(b) Pay for physicians and dentists employed in the 

15 Veterans Health Administration shall have three compo16 nents: 

17 ‘‘(1) BASE PAY.—This shall be a uniform pay 

18 band applicable nationwide. The minimum rate shall 

19 be the maximum rate for Chief grade in the Vet20 erans Health Administration Physician and Dentist 

21 Pay Schedule in effect on the day before the date of 

22 enactment of this Act. The maximum rate may not 

23 exceed the rate of basic pay authorized by section 

24 5316 of title 5 for Level V of the Executive Sched25 ule. The Secretary shall adjust annually the min-
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1 imum rate by the same percentage as the adjust2 ment under section 5303 of title 5 in the rates of 

3 pay for the General Schedule, and the maximum 

4 rate in accordance with section 5318 of title 5. Ad5 ministration facilities, under regulations prescribed 

6 by the Secretary, may set individual base pay any7 where within the pay band. 

8 ‘‘(2) MARKET PAY.—This shall be a variable 

9 pay band based on geographic area, specialty, as10 signment, personal qualifications, and individual ex11 perience, and shall be established and adjusted lo12 cally in accordance with regulations prescribed under 

13 subsection (c). Administration facilities will set indi14 vidual market pay in accordance with regulations 

15 prescribed by the Secretary. The Under Secretary 

16 for Health shall periodically review and recommend 

17 to the Secretary adjustments to the market pay 

18 band based on published healthcare workforce em19 ployment and compensation data. The Secretary 

20 may adjust the market pay band periodically based 

21 on the recommendations of the Under Secretary and 

22 in response to changing health-care labor trends. 

23 ‘‘(3) PERFORMANCE PAY.— 

24 ‘‘(A) There shall be a variable pay band 

25 linked to the physician’s or dentist’s achieve-
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1 ment of specific corporate goals and individual 

2 performance objectives. Physicians and dentists 

3 other than those specified in subsection (f)(1) 

4 shall not be eligible for this component during 

5 the first year of appointment. The amount pay6 able to a physician or dentist for this compo7 nent may vary based on individual achievement. 

8 The performance component paid to any physi9 cian or dentist other than those specified in 

10 subsection (f)(1) will be in accordance with reg11 ulations prescribed by the Secretary and may 

12 not exceed $10,000 in a year. 

13 ‘‘(B) In accordance with regulations pre14 scribed by the Secretary, ten percent of the 

15 benchmark total pay for physicians and dentists 

16 specified in subsection (f)(1) shall be linked to 

17 the physician’s or dentist’s achievement of spe18 cific corporate goals and individual performance 

19 objectives as a performance component. Admin20 istration facilities may set the performance pay 

21 in accordance with regulations prescribed by the 

22 Secretary. 

23 ‘‘(c) Compensation paid under this subchapter shall 

24 be considered pay for all purposes, included but not lim25 ited to retirement benefits under chapters 83 and 84 of 
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1 title 5, United States Code, and other benefits. Notwith2 standing the preceding sentence, amounts paid for per3 formance pay under subsection (b)(3)(A) shall not be con4 sidered pay for retirement benefits under chapters 83 and 

5 84 of title 5, United States Code. 

6 ‘‘(d) Any decrease in pay that results from an adjust7 ment to the market or performance component of a physi8 cian’s or dentist’s total compensation does not constitute 

9 an adverse action. 

10 ‘‘(e) In no case may the total amount of compensa11 tion paid to a physician or dentist under this title in any 

12 one year exceed the amount of annual compensation (ex13 cluding expenses) specified in section 102 of title 3, United 

14 States Code. 

15 ‘‘(f) COVERED POSITIONS.— 

16 ‘‘(1) This subsection applies to physicians and 

17 dentists in the following positions: Chiefs of Staff or 

18 equivalent facility-level and Network-level clinical 

19 management positions (including Network Clinical 

20 Service Managers), facility and Network or Regional 

21 executive positions (including Network Service Line 

22 Coordinators and Medical Center/Health Care Sys23 tem Directors), Central Office executive positions, 

24 and such other positions under this title as the Sec-
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1 retary may determine in accordance with regulations 

2 prescribed in accordance with section 7434(a). 

3 ‘‘(2) Notwithstanding the special relationships 

4 of the Veterans Health Administration with affili5 ated institutions under section 7302, physicians and 

6 dentists serving in covered positions and receiving 

7 compensation under this subchapter may not receive 

8 any compensation on or after the date specified in 

9 regulations issued by the Secretary, through employ10 ment or contract with, or negotiate or accept any 

11 offer of employment from, any institution or other 

12 entity that is affiliated with the VA medical center 

13 to which they are assigned, or affiliated with a VA 

14 medical center which falls under their official re15 sponsibilities. This limitation shall include receiving 

16 compensation through or from practice groups or 

17 any other entities associated with the affiliated insti18 tution(s), or from entities under contract with the 

19 affiliated institution(s). Compensation includes any20 thing of monetary value, including but not limited to 

21 honoraria, salary, and any fringe benefits such as: 

22 tuition waiver, insurance protection, contributions to 

23 a retirement fund, payment for books, below-market 

24 interest loans, or employee discounts. Nothing in 

25 this section precludes physicians and dentists in cov-
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1 ered positions from holding uncompensated appoint2 ments as other than officer, director, or trustee with 

3 affiliated institutions in furtherance of section 7302. 

4 ‘‘(3) Subject to any conditions the Secretary 

5 may be regulation prescribe, the Secretary may, on 

6 a case-by-case basis, suspend or waive the limitation 

7 in paragraph (2) to an individual physician or den8 tist, when necessary and appropriate to carry out 

9 the purposes of section 7302, to assist communities 

10 or practice groups to meet medical needs which oth11 erwise would not be met, or where the Secretary de12 termines that suspension or waiver would be in the 

13 best interest of the United States. The Secretary 

14 shall make any suspension or wavier made pursuant 

15 to this paragraph in writing. 

16 ‘‘§ 7432. Transition to new pay system 

17 ‘‘(a) All current special pay agreements entered into 

18 under the provisions of this subchapter in effect on the 

19 day before the date of enactment of this Act shall termi20 nate on the date of enactment of this Act. Any physician 

21 or dentist in receipt of special pay on that date shall con22 tinue to be compensated as if such agreement were still 

23 in effect until the date specified in regulations issued by 

24 the Secretary implementing this new subchapter. 
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1 ‘‘(b) Physicians and dentists appointed or reassigned 

2 on or after the date of enactment of this Act, but before 

3 implementation of this subchapter shall be compensated 

4 in accordance with sections 7404, 7405, 7433, 7434, 

5 7435, and 7436, as applicable, in effect on the day before 

6 the date of enactment of this Act. Any such physician or 

7 dentist shall continue to be compensated at the applicable 

8 rates until such date specified in regulations issued by the 

9 Secretary implementing the new pay system. No special 

10 pay agreement will be required of any physician or dentist 

11 receiving such pay. 

12 ‘‘(c) During the period from the date of enactment 

13 of this Act through the date of implementation of this sub14 chapter, physicians and dentists paid pursuant to this sec15 tion shall be subject to paragraphs (1), (2), (4), (5), and 

16 (6) of subsection (b) of section 7438 in effect on the day 

17 before the date of enactment of this Act. 

18 ‘‘(d) The amount of pay paid under this subchapter 

19 for a physician or dentist appointed before the effective 

20 date of regulations implementing this subchapter shall be 

21 not less than the amount of base pay and special pay such 

22 physician or dentist received under this title on the day 

23 before such effective date. 

24 ‘‘(e) Special pay subject to the provisions of section 

25 7438, as in effect before the date of enactment of this 
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1 section, or subject to subsection (c), paid to Veterans 

2 Health Administration physicians and dentists appointed 

3 before the effective date of regulations implementing this 

4 subchapter and who separate after such effective date, 

5 shall be fully creditable for purposes of computing benefits 

6 under chapters 83 and 84 of title 5. 

7 ‘‘§ 7433. Pay for Under Secretary for Health 

8 ‘‘(a) Section 5314 of title 5 establishes the base pay 

9 for the Under Secretary for Health at Level III of the 

10 Executive Schedule. 

11 ‘‘(b) In addition to base pay under section 5314 of 

12 title 5, the Under Secretary for Health shall be eligible 

13 for Market Pay under section 7431(b)(2). 

14 ‘‘(c) TRANSITION.—The current special pay agree15 ment of the Under Secretary for Health entered into 

16 under the provisions of this subchapter in effect on the 

17 day before the date of enactment of this Act shall termi18 nate on the date of enactment of this Act. The incumbent 

19 Under Secretary for Health on the date of enactment of 

20 this Act shall continue to receive special pay as if such 

21 agreement were still in effect until the date specified in 

22 regulations issued by the Secretary implementing this new 

23 subchapter. Any Under Secretary for Health appointed on 

24 or after the date of enactment of this Act, but before the 

25 date specified in regulations issued by the Secretary imple-
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1 menting this new subchapter, shall receive special pay in 

2 accordance with sections 7432(d)(2), 7433, and 7437(a) 

3 in effect on the day before the date of enactment of this 

4 Act. 

5 ‘‘§ 7434. Administrative provisions 

6 ‘‘(a) After receiving the recommendations of the 

7 Under Secretary for Health, the Secretary, pursuant to 

8 the authority in section 7421(a), shall prescribe regula9 tions implementing the physician and dentist pay system 

10 established in this new subchapter. Such regulations shall 

11 include the method for computing the pay for all physi12 cians and dentists in the Veterans Health Administration 

13 under this title. 

14 ‘‘(b) Eighteen months after the Secretary issues reg15 ulations implementing this subchapter and annually there16 after for the next ten years, the Secretary shall provide 

17 to the Committees on Veterans’ Affairs of the Senate and 

18 House of Representatives a report on the implementation 

19 of the authorities under this subchapter. Each report shall 

20 include: 

21 ‘‘(1) a description of the rates of pay in effect 

22 during the preceding fiscal year with a comparison 

23 to the rates in effect during the previous fiscal year 

24 by facility and by specialty; 
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1 ‘‘(2) the number of physicians and dentists who 

2 left employment with the Veterans Health Adminis3 tration during the preceding year; 

4 ‘‘(3) the number of unfilled physician and den5 tist positions in each specialty in the Veterans 

6 Health Administration, the average and maximum 

7 lengths of time that such positions have been un8 filled, and a summary of the reasons that such posi9 tions remain unfilled; and 

10 ‘‘(4) an assessment of the impact of implemen11 tation of this subchapter on efforts to recruit and re12 tain physicians and dentists in the Veterans Health 

13 Administration. 

14 In addition, the first two reports following implementation 

15 of this subchapter shall also include a comparison of staff16 ing levels, contract expenditures, and average salary of 

17 physicians and dentists by facility and specialty for the 

18 preceding and previous fiscal years.’’. 

19 (b) The title and list of sections for Subchapter III 

20 in the table of sections at the beginning of Chapter 74 

21 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.’’. 
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1 SEC. 4. ALTERNATE WORK SCHEDULES. 

2 (a) Chapter 74 is amended by adding a new section 

3 7456a: 

4 ‘‘§ 7456a. Alternate work schedules 

5 ‘‘(a) COVERAGE.—This section applies to registered 

6 nurses appointed under this chapter. 

7 ‘‘(b) 36/40 WORK SCHEDULE.— 

8 ‘‘(1) Subject to paragraph (2), if the Secretary 

9 determines it be necessary in order to obtain or re10 tain the services of registered nurses at any Depart11 ment health-care facility, the Secretary may provide, 

12 in the case of nurses employed at such facility, that 

13 such nurses who work three regularly scheduled 12- 

14 hour tours of duty within a workweek shall be con15 sidered for all purposes (except computation of full16 time equivalent employees for the purposes of deter17 mining compliance with personnel ceilings) to have 

18 worked a full 40-hour basic workweek. 

19 ‘‘(2)(A) Basic and additional pay for a reg20 istered nurse who is considered under paragraph (1) 

21 to have worked a full 40-hour basic workweek shall 

22 be subject to subparagraphs (B) and (C). 

23 ‘‘(B) The hourly rate of basic pay for such a 

24 nurse for service performed as part of a regularly 

25 scheduled 36-hour tour of duty within the workweek 
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1 shall be derived by dividing the nurse’s annual rate 

2 of basic pay by 1,872. 

3 ‘‘(C)(i) Such a nurse who performs a period of 

4 service in excess of such nurse’s regularly scheduled 

5 36-hour tour of duty within a workweek is entitled 

6 to overtime pay under section 7453(e) of this title, 

7 or other applicable law, for officially ordered or ap8 proved service performed in excess of eight hours on 

9 a day other than a day on which such nurse’s regu10 larly scheduled three 12-hour tours fall, or in excess 

11 of 12 hours for any day included in the regularly 

12 scheduled 36-hour tour of duty, or in excess of 40 

13 hours during an administrative workweek. 

14 ‘‘(ii) Except as provided in subparagraph (i), a 

15 registered nurse to whom this subsection is applica16 ble is not entitled to additional pay under section 

17 7453 of this title, or other applicable law, for any 

18 period included in a regularly scheduled 12-hour 

19 tour of duty. 

20 ‘‘(3) A nurse who works a 36/40 work schedule 

21 described in this subsection who is absent on ap22 proved sick leave or annual leave during a regularly 

23 scheduled 12-hour tour of duty shall be charged for 

24 such leave at a rate of ten hours of leave for nine 

25 hours of absence. 
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1 ‘‘(c) 7/7 WORK SCHEDULE.— 

2 ‘‘(1) Subject to paragraph (2), if the Secretary 

3 determines it be necessary in order to obtain or re4 tain the services of registered nurses at any Depart5 ment health-care facility, the Secretary may provide, 

6 in the case of nurses employed at such facility, that 

7 such nurses who work seven regularly scheduled 10- 

8 hour tours of duty, with seven days off duty, within 

9 a two-week pay period, shall be considered for all 

10 purposes (except computation of full-time equivalent 

11 employees for the purposes of determining compli12 ance with personnel ceilings) to have worked a full 

13 80 hours for the pay period. 

14 ‘‘(2)(A) Basic and additional pay for a reg15 istered nurse who is considered under paragraph (1) 

16 to have worked a full 80-hour pay period shall be 

17 subject to subparagraphs (B) and (C). 

18 ‘‘(B) The hourly rate of basic pay for such a 

19 nurse for service performed as part of a regularly 

20 scheduled 70-hour tour of duty within the pay period 

21 shall be derived by dividing the nurse’s annual rate 

22 of basic pay by 1,820. 

23 ‘‘(C)(i) Such a nurse who performs a period of 

24 service in excess of such nurse’s regularly scheduled 

25 70-hour tour of duty within a pay period is entitled 
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1 to overtime pay under section 7453(e) of this title, 

2 or other applicable law, for officially ordered or ap3 proved service performed in excess of eight hours on 

4 a day other than a day on which such nurse’s regu5 larly scheduled seven 10-hour tours fall, or in excess 

6 of 10 hours for any day included in the regularly 

7 scheduled 70-hour tour of duty, or in excess of 80 

8 hours during a pay period. 

9 ‘‘(ii) Except as provided in subparagraph (i), a 

10 registered nurse to whom this subsection is applica11 ble is not entitled to additional pay under section 

12 7453 of this title, or other applicable law, for any 

13 period included in a regularly scheduled 10-hour 

14 tour of duty. 

15 ‘‘(3) A nurse who works a 7/7 work schedule 

16 described in this subsection who is absent on ap17 proved sick leave or annual leave during a regularly 

18 scheduled 12-hour tour of duty shall be charged for 

19 such leave at a rate of eight hours of leave for seven 

20 hours of absence. 

21 ‘‘(d) 9-MONTH WORK SCHEDULE.—The Secretary 

22 may authorize a registered nurse appointed under section 

23 7405, with the nurse’s written consent, to work full-time 

24 for nine months with three months off duty, within a fiscal 

25 year, and be paid at 75 percent of the full-time rate for 
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1 such nurse’s grade for each pay period of such fiscal year. 

2 Such employee shall be considered a .75 full-time equiva3 lent employee in computing full-time equivalent employees 

4 for the purposes of determining compliance with personnel 

5 ceilings. Service on this schedule shall be considered part6 time service for purposes of computing benefits under 

7 chapters 83 and 84 of title 5. 

8 ‘‘(e) The Secretary shall prescribe regulations for the 

9 implementation of this section.’’. 

10 (b) The title and list of sections for Subchapter IV 

11 in the table of sections at the beginning of Chapter 74 

12 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.’’. 

13 SEC. 5. NURSE EXECUTIVE SPECIAL PAY. 

14 (a) Section 7452 is amended by adding at the end 

15 thereof: 

16 ‘‘(g)(1) In order to recruit and retain highly qualified 

17 Department nurse executives, the Secretary, in accordance 

18 with regulations the Secretary shall prescribe, shall pay 

19 special pay to the nurse executive at each Department 

20 health-care facility or at Central Office. 
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1 ‘‘(2) Special pay paid under paragraph (1) shall be 

2 a minimum of $10,000 and a maximum of $25,000. The 

3 amount paid to each nurse executive shall be based on fac4 tors such as the grade of the nurse executive position, the 

5 scope and complexity of the nurse executive position, the 

6 nurse executive’s personal qualifications, the characteris7 tics of the health-care facility, e.g., tertiary, single site or 

8 multi-site, nature and number of specialty care units, dem9 onstrated recruitment and retention difficulties, and such 

10 other factors the Secretary deems appropriate. 

11 ‘‘(3) Special pay paid under paragraph (1) shall be 

12 in addition to any other pay (including basic pay) and al13 lowances to which the nurse executive is entitled, and shall 

14 be considered pay for all purposes, including but not lim15 ited to retirement benefits under chapters 83 and 84 of 

16 title 5, United States Code, and other benefits, but shall 

17 not be considered basic pay for purposes of adverse actions 

18 under subchapter V.’’. 

19 SEC. 6. EFFECTIVE DATE. 

20 The amendments to title 38, United States Code, 

21 contained herein shall take effect on the first day of the 

22 first pay period on or after the later of April 1, 2004, 

23 or six months after the date of enactment. 
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1 SEC. 7. ADMINISTRATIVE PROVISION. 

2 (a) Chapter 74 is amended by adding a new section 

3 7427: 

4 ‘‘§ 7427. Functions 

5 ‘‘The functions assigned to the Secretary and other 

6 officers of the Department of Veterans Affairs under this 

7 chapter are vested in their discretion.’’ 

8 SECTION 1. SHORT TITLE. 

9 This Act may be cited as the ‘‘Department of Veterans 

10 Affairs Health Care Personnel Enhancement Act of 2004’’. 

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

12 Except as otherwise expressly provided, whenever in 

13 this Act an amendment is expressed in terms of an amend14 ment to a section or other provision, the reference shall be 

15 considered to be made to a section or other provision of title 

16 38, United States Code. 

17 SEC. 3. SIMPLIFICATION AND IMPROVEMENT OF GRADE 

18 AND PAY PROVISIONS FOR PHYSICIANS AND 

19 DENTISTS. 

20 (a) SIMPLIFICATION OF GRADES AND GRADE RE21 QUIREMENTS.—Section 7404(b) is amended— 

22 (1) by striking ‘‘(1)’’ after ‘‘(b)’’; 

23 (2) in the Physician and Dentist Schedule, by 

24 striking the items relating to the grades and inserting 

25 the following: 

26 ‘‘Physician grade. 
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1 ‘‘Dentist grade.’’; and 

2 (3) by striking paragraph (2). 

3 (b) SIMPLIFICATION AND IMPROVEMENT OF PAY AU4 THORITIES.—Subchapter III of chapter 74 is amended to 

5 read as follows: 

6 ‘‘SUBCHAPTER III—PAY FOR PHYSICIANS AND 

7 DENTISTS 

8 ‘‘§ 7431. Pay 

9 ‘‘(a) ELEMENTS OF PAY.—Pay of physicians and den10 tists in the Veterans Health Administration shall consist 

11 of three elements as follows: 

12 ‘‘(1) Base pay as provided for under subsection 

13 (b). 

14 ‘‘(2) Market pay as provided for under sub15 section (c). 

16 ‘‘(3) Incentive pay as provided for under sub17 section (d). 

18 ‘‘(b) BASE PAY.—One element of pay for physicians 

19 and dentists shall be base pay. Base pay shall meet the fol20 lowing requirements: 

21 ‘‘(1) Each physician and dentist is entitled to 

22 base pay determined under the Physician and Dentist 

23 Base and Longevity Pay Schedule. 

24 ‘‘(2) The Physician and Dentist Base and Lon25 gevity Pay Schedule is composed of 15 rates of base 
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1 pay designated, from the lowest rate of pay to the 

2 highest rate of pay, as base pay steps 1 through 15. 

3 ‘‘(3) The rate of base pay payable to a physician 

4 or dentist is based on the total number of the years 

5 of the service of the physician or dentist in the Vet6 erans Health Administration as follows: 

‘‘For a physician or dentist The rate of base pay is 

with total service of: the rate payable for: 

two years or less ............................................................................. step 1

more than 2 years and not more than 4 years ........................... step 2

more than 4 years and not more than 6 years ........................... step 3

more than 6 years and not more than 8 years ........................... step 4

more than 8 years and not more than 10 years ......................... step 5

more than 10 years and not more than 12 years ....................... step 6

more than 12 years and not more than 14 years ....................... step 7

more than 14 years and not more than 16 years ....................... step 8

more than 16 years and not more than 18 years ....................... step 9

more than 18 years and not more than 20 years ....................... step 10

more than 20 years and not more than 22 years ....................... step 11

more than 22 years and not more than 24 years ....................... step 12

more than 24 years and not more than 26 years ....................... step 13

more than 26 years and not more than 28 years ....................... step 14

more than 28 years ........................................................................ step 15. 

7 ‘‘(4) At the same time as rates of basic pay are 

8 increased for a year under section 5303 of title 5, the 

9 Secretary shall increase each rate of base pay payable 

10 under this subsection for that year by a percentage 

11 equal to the percentage by which rates of basic pay 

12 are increased under such section for that year. 

13 ‘‘(c) MARKET PAY.—One element of pay for physicians 

14 and dentists shall be market pay. Market pay shall meet 

15 the following requirements: 

16 ‘‘(1) Subject to paragraph (3), each physician 

17 and dentist is eligible for market pay. 
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1 ‘‘(2) Market pay shall consist of pay intended to 

2 reflect the value to the Veterans Health Administra3 tion of the skills, experience, and availability of a 

4 particular physician or dentist within a particular 

5 health care labor market. 

6 ‘‘(3) The annual amount of the market pay pay7 able to a physician or dentist shall be determined by 

8 the Secretary on a case-by-case basis, subject to para9 graph (5). The sum of the total amount of the market 

10 pay determined for a physician or dentist under this 

11 subsection and the annual rate of base pay payable 

12 to the physician or dentist under subsection (b) may 

13 not be less than the minimum amount, nor more than 

14 the maximum amount, applicable to the physician or 

15 dentist under paragraph (4). 

16 ‘‘(4)(A) Not less often than once every two years, 

17 the Secretary shall prescribe for Departmentwide ap18 plicability the minimum and maximum amounts of 

19 annual pay (excluding incentive pay under subsection 

20 (d)) that may be paid under this section to physi21 cians and the minimum and maximum amounts of 

22 annual pay (excluding incentive pay under subsection 

23 (d)) that may be paid under this section to dentists. 

24 ‘‘(B) The Secretary may prescribe for Depart25 mentwide applicability under this paragraph sepa-
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1 rate minimum and maximum amounts of pay for a 

2 specialty or subspecialty. If the Secretary prescribes 

3 separate minimum and maximum amounts for a spe4 cialty or subspecialty, the Secretary may establish up 

5 to four tiers of minimum and maximum amounts for 

6 such specialty or subspecialty and prescribe for each 

7 tier a minimum amount and a maximum amount 

8 that the Secretary determines appropriate for the pro9 fessional responsibilities, professional achievements, 

10 and administrative duties of the physicians or den11 tists (as the case may be) whose pay is set within that 

12 tier. 

13 ‘‘(5)(A) In determining the amount of the market 

14 pay for a physician or dentist and determining a tier 

15 (if any) to apply to a physician or dentist under 

16 paragraph (4)(B), the Secretary shall consult with 

17 and consider the recommendations of the Medical Pro18 fessional Standards Board for the medical facility of 

19 the Department at which the physician or dentist is 

20 employed, except in the case of a physician or dentist 

21 whose market pay is determined under subparagraph 

22 (B). 

23 ‘‘(B) In the case of a physician or dentist who 

24 is a member of a Medical Professional Standards 

25 Board, the Secretary shall determine the amount of 
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1 the market pay and the tier (if any) applicable to the 

2 physician or dentist under paragraph (4)(B) in ac3 cordance with such procedures and standards as the 

4 Secretary shall prescribe. Such procedures and stand5 ards shall, to the maximum extent practicable, be simi6 lar to the procedures and standards applicable to de7 terminations of the amount of market pay and the tier 

8 applicable to physicians and dentists under paragraph 

9 (4)(B) who are not members of a board. Under such 

10 regulations, no member of a board may participate in 

11 or have a consultative role in determining the amount 

12 of market pay or tier of such member or any other 

13 member of such board. 

14 ‘‘(C) A Medical Professional Standards Board 

15 consulted under this subparagraph shall consist of at 

16 least three and not more than five persons, each of 

17 whom is either a physician or a dentist. Not less than 

18 a majority of the members of the board shall be prac19 ticing clinicians in their professions. 

20 ‘‘(6) Subject to paragraph (7), the determination 

21 of the amount of market pay of a physician or dentist 

22 shall take into account— 

23 ‘‘(A) the level of experience of the physician 

24 or dentist in the specialty or subspecialty of the 

25 physician or dentist; 
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1 ‘‘(B) the need for the specialty or sub2 specialty of the physician or dentist at the De3 partment facility concerned; 

4 ‘‘(C) the health care labor market for the 

5 specialty or subspecialty of the physician or den6 tist, which may cover any geographic area the 

7 Secretary considers appropriate for the specialty 

8 or subspecialty; 

9 ‘‘(D) the professional reputation of the phy10 sician or dentist; 

11 ‘‘(E) the board certifications, if any, of the 

12 physician or dentist; 

13 ‘‘(F) the prior experience, if any, of the 

14 physician or dentist as an employee of the Vet15 erans Health Administration; and 

16 ‘‘(G) such other considerations as the Sec17 retary considers appropriate. 

18 ‘‘(7) The amount that any consideration speci19 fied in paragraph (6) may contribute to the amount 

20 of market pay may not exceed, or be less than, such 

21 amount as the Secretary may specify in regulations 

22 prescribed under section 7433 of this title, or in direc23 tives issued for purposes of this subsection. 

24 ‘‘(8) In determining amounts of market pay, the 

25 Secretary— 
26 

•S 2484 RS 

1 ‘‘(A) shall consult two or more national sur2 veys of pay for physicians or dentists, as appli3 cable, whether prepared by public, private, or 

4 quasi-public entities; and 

5 ‘‘(B) may utilize the recommendations or 

6 assistance of one or more boards of physicians or 

7 dentists, as applicable, that are appointed by the 

8 Secretary for purposes of this subsection. 

9 ‘‘(9) The amount of market pay of a physician 

10 or dentist shall be adjusted at such times as the Sec11 retary considers appropriate in order to ensure the 

12 retention of qualified physicians and dentists by the 

13 Veterans Health Administration. 

14 ‘‘(10) The amount of market pay of a physician 

15 or dentist shall be evaluated by the Secretary not less 

16 often than once every 24 months. The amount of mar17 ket pay may be adjusted as the result of an evalua18 tion under this paragraph. A physician or dentist 

19 whose market pay is increased by reason of an eval20 uation under this paragraph shall receive written no21 tice of the increase in accordance with procedures pre22 scribed under section 7433 of this title. 

23 ‘‘(11) No adjustment of the amount of market 

24 pay of a physician or dentist under paragraph (9) or 
27 

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1 (10) may result in a reduction of the amount of mar2 ket pay of the physician or dentist. 

3 ‘‘(d) INCENTIVE PAY.—One element of pay for physi4 cians and dentists shall be incentive pay. Incentive pay 

5 shall meet the following requirements: 

6 ‘‘(1) Each physician and dentist is eligible for 

7 incentive pay. 

8 ‘‘(2) Incentive pay shall consist of an amount 

9 intended to recognize outstanding contributions by a 

10 physician or dentist to— 

11 ‘‘(A) the facility in which employed; 

12 ‘‘(B) the furnishing of care to veterans; or 

13 ‘‘(C) the practice of medicine or dentistry, 

14 as applicable. 

15 ‘‘(3) The amount of incentive pay shall be deter16 mined for a physician or dentist by the Secretary. 

17 ‘‘(4) The amount of incentive pay shall be deter18 mined for a physician or dentist on a case-by-case 

19 basis. 

20 ‘‘(5) The amount of incentive pay paid to a phy21 sician or dentist in a calendar year may not exceed 

22 $10,000. 

23 ‘‘(e) DELEGATION OF RESPONSIBILITIES.—The Sec24 retary may delegate to an appropriate officer or employee 

25 of the Department any responsibility of the Secretary under 
28 

•S 2484 RS 

1 subsection (c) or (d), except for the responsibilities of the 

2 Secretary under subsection (c)(4). 

3 ‘‘(f) LIMITATION ON TOTAL COMPENSATION.—In no 

4 case may the total amount of compensation paid to a physi5 cian or dentist under this section in any year exceed the 

6 amount of annual compensation (excluding expenses) speci7 fied in section 102 of title 3. 

8 ‘‘(g) TREATMENT OF PAY.—(1) Except as provided in 

9 paragraph (2), pay under this subchapter shall be consid10 ered pay for all purposes, including retirement benefits 

11 under chapters 83 and 84 of title 5 and other benefits. 

12 ‘‘(2) Incentive pay under subsection (d) shall not be 

13 considered pay for purposes of retirement benefits under 

14 chapters 83 and 84 of title 5. 

15 ‘‘(h) DECREASES IN CERTAIN PAY NOT TREATABLE AS

16 ADVERSE ACTION.—A decrease in pay of a physician or 

17 dentist resulting from an adjustment in the amount of in18 centive pay of the physician or dentist under subsection (d) 

19 shall not be treated as an adverse action. 

20 ‘‘§ 7432. Pay of Under Secretary for Health 

21 ‘‘(a) BASE PAY.—The base pay of the Under Secretary 

22 for Health shall be the annual rate of basic pay for posi23 tions at Level III of the Executive Schedule under section 

24 5314 of title 5. 
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•S 2484 RS 

1 ‘‘(b) MARKET PAY.—(1) In the case of an Under Sec2 retary for Health who is also a physician or dentist, in 

3 addition to the base pay specified in subsection (a) the 

4 Under Secretary for Health may also be paid the market 

5 pay element of pay of physicians and dentists under section 

6 7431(c) of this title. 

7 ‘‘(2) The amount of market pay of the Under Secretary 

8 for Health under this subsection shall be established by the 

9 Secretary. 

10 ‘‘(3) In establishing the amount of market pay of the 

11 Under Secretary for Health under this subsection, the Sec12 retary shall utilize an appropriate health care labor market 

13 selected by the Secretary for purposes of this subsection. 

14 ‘‘§ 7433. Administrative matters 

15 ‘‘(a) REGULATIONS.—(1) The Secretary shall prescribe 

16 regulations relating to the pay of physicians and dentists 

17 in the Veterans Health Administration under this sub18 chapter. 

19 ‘‘(2) In prescribing the regulations, the Secretary shall 

20 take into account the recommendations of the Under Sec21 retary for Health on the administration of this subchapter. 

22 ‘‘(b) REPORTS.—(1) Not later than 18 months after 

23 the Secretary prescribes the regulations required by sub24 section (a), and annually thereafter for the next 10 years, 

25 the Secretary shall submit to the Committees on Veterans’ 
30 

•S 2484 RS 

1 Affairs of the Senate and House of Representatives a report 

2 on the pay of physicians and dentists in the Veterans 

3 Health Administration under this subchapter. 

4 ‘‘(2) Each report under this subsection shall include 

5 the following: 

6 ‘‘(A) A description of the rates of pay in effect 

7 during the preceding fiscal year with a comparison to 

8 the rates in effect during the fiscal year preceding fis9 cal year, set forth by facility and by specialty. 

10 ‘‘(B) The number of physicians and dentists who 

11 left the Veterans Health Administration during the 

12 preceding fiscal year. 

13 ‘‘(C) The number of unfilled physician positions 

14 and dentist positions in each specialty in the Vet15 erans Health Administration, the average and max16 imum lengths of time that such positions have been 

17 unfilled, and an assessment of the reasons that such 

18 positions remain unfilled. 

19 ‘‘(D) An assessment of the impact of implemen20 tation of this subchapter on efforts to recruit and re21 tain physicians and dentists in the Veterans Health 

22 Administration. 

23 ‘‘(3) The first two annual reports under this subsection 

24 shall also include a comparison of staffing levels, contract 

25 expenditures, and average salaries of physicians and den-
31 

•S 2484 RS 

1 tists in the Veterans Health Administration for the fiscal 

2 year preceding such report and for the fiscal year preceding 

3 such fiscal year, set forth by facility and by specialty.’’. 

4 (c) INITIAL RATES OF BASE PAY FOR PHYSICIANS AND

5 DENTISTS.—The initial rates of base pay established for the 

6 base pay steps under the Physician and Dentist Base and 

7 Longevity Pay Schedule provided in section 7431(b) of title 

8 38, United States Code (as added by subsection (b)), are 

9 as follows: 

Base Pay Step: Rate of Pay: 

1 ...................................................................................................... $90,000

2 ...................................................................................................... $93,000

3 ...................................................................................................... $96,000

4 ...................................................................................................... $99,000

5 ...................................................................................................... $102,000

6 ...................................................................................................... $105,000

7 ...................................................................................................... $108,000

8 ...................................................................................................... $111,000

9 ...................................................................................................... $114,000

10 .................................................................................................... $117,000

11 .................................................................................................... $120,000

12 .................................................................................................... $123,000

13 .................................................................................................... $127,000

14 .................................................................................................... $130,000

15 .................................................................................................... $133,000. 

10 (d) TRANSITION PROVISIONS.— 

11 (1) PHYSICIANS AND DENTISTS.— 

12 (A) PAY.—(i) A physician or dentist in re13 ceipt of pay under section 7404 or 7405 of title 

14 38, United States Code, as of the day before the 

15 date of the enactment of this Act shall continue 

16 to receive pay under such section (as in effect on 

17 the day before the date of the enactment of this 
32 

•S 2484 RS 

1 Act) until the effective date of this Act under sec2 tion 8 of this Act. 

3 (ii) A physician or dentist appointed or re4 assigned on or after the date of the enactment of 

5 this Act, but before the effective date of this Act, 

6 shall be compensated in accordance with appli7 cable provisions of section 7404 or 7405 of title 

8 38, United States Code (as in effect on the day 

9 before date of the enactment of this Act), until 

10 the effective date of this Act. 

11 (B) SPECIAL PAY.—(i) A special pay agree12 ment entered into by a physician or dentist 

13 under subchapter III of chapter 74 of title 38, 

14 United States Code, before the date of the enact15 ment of this Act shall terminate on the date of 

16 the enactment of this Act. However, a physician 

17 or dentist in receipt of special pay pursuant to 

18 such an agreement on that date shall continue to 

19 receive special pay under the terms of such 

20 agreement until the effective date of this Act. 

21 (ii) A physician or dentist described in sub22 paragraph (A)(ii) may be paid special pay 

23 under applicable provisions of section 7433, 

24 7434, 7435, or 7436 of title 38, United States 

25 Code (as in effect on the day before the date of 
33 

•S 2484 RS 

1 the enactment of this Act), during the period be2 ginning on the date appointment or reassign3 ment of such physician or dentist, as the case 

4 may be, and ending on the effective date of this 

5 Act. However, no special pay agreement shall be 

6 required for the payment of special pay under 

7 this clause. 

8 (C) TREATMENT OF SPECIAL PAY.—(i) Spe9 cial pay paid under subparagraph (B) shall be 

10 subject to the provisions of paragraphs (1), (2), 

11 (4), (5), and (6) of section 7438(b) of title 38, 

12 United States Code (as in effect on the day before 

13 the date of the enactment of this Act). 

14 (ii) Special pay paid under subparagraph 

15 (B) shall be fully creditable for purposes of com16 puting benefits under chapters 83 and 84 of title 

17 5, United States Code. 

18 (D) PRESERVATION OF PAY.—The amount 

19 of pay paid under subchapter III of chapter 74 

20 of title 38, United States Code (as amended by 

21 subsection (a)), to a physician or dentist ap22 pointed or reassigned before the effective date of 

23 this Act may be not less than the aggregate 

24 amount of pay and special pay paid to the phy25 sician or dentist under chapter 74 of title 38, 
34 

•S 2484 RS 

1 United States Code (as in effect on the day before 

2 the date of the enactment of this Act), as of the 

3 day before the effective date of this Act. 

4 (2) UNDER SECRETARY FOR HEALTH.— 

5 (A) SPECIAL PAY.—(i) The current special 

6 pay agreement entered into by the Under Sec7 retary for Health under subchapter III of chap8 ter 74 of title 38, United States Code, before the 

9 date of the enactment of this Act shall terminate 

10 on the date of the enactment of this Act. How11 ever, the Under Secretary shall continue to re12 ceive special pay under the terms of such agree13 ment until the effective date of this Act. 

14 (ii) An individual appointed as Under Sec15 retary for Health on or after the date of the en16 actment of this Act and before the effective date 

17 of this Act shall be paid special pay in accord18 ance with the provisions of section 7432(d)(2), 

19 7433, and 7437(a) of title 38, United States 

20 Code (as in effect on the day before the date of 

21 the enactment of this Act), during the period be22 ginning on the date of appointment and ending 

23 on the effective date of this Act. However, no spe24 cial pay agreement shall be required for the pay25 ment of special pay under this clause. 
35 

•S 2484 RS 

1 (B) TREATMENT OF SPECIAL PAY.—Special 

2 pay paid under subparagraph (A) shall be fully 

3 creditable for purposes of computing benefits 

4 under chapters 83 and 84 of title 5, United 

5 States Code. 

6 (e) CONFORMING AMENDMENT.—Section 7404(c) is 

7 amended by striking ‘‘special pay’’ and inserting ‘‘pay’’. 

8 (f) CLERICAL AMENDMENT.—The table of sections at 

9 the beginning of chapter 74 is amended by striking the 

10 items relating to subchapter III and inserting the following 

11 new items: 

‘‘SUBCHAPTER III—PAY FOR PHYSICIANS AND DENTISTS 

‘‘Sec. 7431. Pay. 

‘‘Sec. 7432. Pay of Under Secretary for Health. 

‘‘Sec. 7433. Administrative matters.’’. 

12 SEC. 4. ALTERNATE WORK SCHEDULES FOR REGISTERED 

13 NURSES. 

14 (a) IN GENERAL.—(1) Chapter 74 is amended by in15 serting after section 7456 the following new section: 

16 ‘‘§ 7456A. Nurses: alternate work schedules 

17 ‘‘(a) APPLICABILITY.—This section applies to reg18 istered nurses appointed under this chapter. 

19 ‘‘(b) 36/40 WORK SCHEDULE.—(1) Subject to para20 graph (2), if the Secretary determines it be necessary in 

21 order to obtain or retain the services of registered nurses 

22 at any Department health-care facility, the Secretary may 

23 provide, in the case of nurses employed at such facility, that 
36 

•S 2484 RS 

1 such nurses who work three regularly scheduled 12-hour 

2 tours of duty within a workweek shall be considered for all 

3 purposes (except computation of full-time equivalent em4 ployees for the purposes of determining compliance with 

5 personnel ceilings) to have worked a full 40-hour basic 

6 workweek. 

7 ‘‘(2)(A) Basic and additional pay for a nurse who is 

8 considered under paragraph (1) to have worked a full 40- 

9 hour basic workweek shall be subject to subparagraphs (B) 

10 and (C). 

11 ‘‘(B) The hourly rate of basic pay for a nurse covered 

12 by this paragraph for service performed as part of a regu13 larly scheduled 36-hour tour of duty within the workweek 

14 shall be derived by dividing the nurse’s annual rate of basic 

15 pay by 1,872. 

16 ‘‘(C)(i) A nurse covered by this paragraph is entitled 

17 to overtime pay for work performed in such periods as the 

18 Secretary shall prescribe. 

19 ‘‘(ii) Except as otherwise provided in clause (i), a 

20 nurse covered by this paragraph is not entitled to addi21 tional pay under section 7453 of this title, or other applica22 ble law, for any period included in a regularly scheduled 

23 12-hour tour of duty. 

24 ‘‘(3) A nurse who works a work schedule described in 

25 this subsection who is absent on approved sick leave or an-
37 

•S 2484 RS 

1 nual leave during a regularly scheduled 12-hour tour of 

2 duty shall be charged for such leave at a rate of ten hours 

3 of leave for every nine hours of absence. 

4 ‘‘(4) A nurse working a work schedule under this sub5 section shall be eligible for holiday pay under section 

6 7453(d) of this title for any service performed by the nurse 

7 on a designated holiday under such section, regardless of 

8 whether such holiday occurs during or outside the nurse’s 

9 regularly scheduled tour of duty under such work schedule. 

10 ‘‘(c) 9-MONTH WORK SCHEDULE FOR CERTAIN

11 NURSES.—(1) The Secretary may authorize a registered 

12 nurse appointed under section 7405 of this title, with the 

13 nurse’s written consent, to work fulltime for nine months 

14 with 3 months off duty, within a fiscal year, and be paid 

15 at 75 percent of the fulltime rate for such nurse’s grade for 

16 each pay period of such fiscal year. 

17 ‘‘(2) A nurse who works under the authority in para18 graph (1) shall be considered a 0.75 fulltime equivalent em19 ployee in computing fulltime equivalent employees for the 

20 purposes of determining compliance with personnel ceilings. 

21 ‘‘(3) Work under this subsection shall be considered 

22 parttime service for purposes of computing benefits under 

23 chapters 83 and 84 of title 5. 
38 

•S 2484 RS 

1 ‘‘(4) A nurse who works under the authority in para2 graph (1) shall be considered a fulltime employee for pur3 poses of chapter 89 of title 5. 

4 ‘‘(d) TREATMENT AS FULL-TIME EMPLOYEE.—(1) A 

5 nurse working a work schedule under subsection (b) or (c) 

6 who is a full-time employee in non-probationary status at 

7 the commencement of work under such work schedule shall 

8 remain a full-time employee in non-probationary status 

9 while working under such work schedule. 

10 ‘‘(2)(A) A nurse under a part-time appointment under 

11 section 7405(d) of this title who, while working a work 

12 schedule under subsection (b) or (c), performs hours of serv13 ice (as determined in accordance with such subsection) 

14 equivalent to two years of service shall be treated as a full15 time employee and no longer in probationary status. 

16 ‘‘(B) In determining the hours of service performed by 

17 a nurse for purposes of subparagraph (A), any hours of 

18 service not performed under a work schedule under sub19 section (b) or (c) shall not be included. 

20 ‘‘(e) NOTIFICATION OF MODIFICATION OF BENEFITS.— 

21 The Secretary shall provide each nurse with respect to 

22 whom an alternate work schedule under this section may 

23 apply written notice of the effect, if any, the alternate work 

24 schedule will have on the nurse’s health care premium, re25 tirement, life insurance premium, probationary status, or 
39 

•S 2484 RS 

1 other benefit or condition of employment. The notice shall 

2 be provided not later than 14 days before the nurse consents 

3 to the alternate work schedule. 

4 ‘‘(f) REGULATIONS.—The Secretary shall prescribe reg5 ulations to carry out this section.’’. 

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

7 74 is amended by inserting after the item relating to section 

8 7456 the following new item: 

‘‘Sec. 7456A. Nurses: alternate work schedules.’’. 

9 (b) POLICY AGAINST WORK SHIFTS IN EXCESS OF 12 

10 HOURS.—(1) It is the sense of Congress to encourage the 

11 Secretary of Veterans Affairs to prevent work shifts by 

12 nurses providing direct patient care in excess of 12 hours 

13 in any 24 hour period. 

14 (2) Not later than one year after the date of the enact15 ment of this Act and every year thereafter for the next two 

16 years, the Secretary shall certify to Congress whether or not 

17 each Veterans Health Administration facility has in place, 

18 as of the date of such certification, a policy designed to pre19 vent work shifts by nurses providing direct patient care in 

20 excess of 12 hours in any 24 hour period. 

21 (c) REPORT ON OVERTIME FOR CERTAIN NURSES.— 

22 (1) Not later than one year after the effective date of this 

23 Act, the Secretary of Veterans Affairs shall submit to Con24 gress a report on the overtime, if any, worked by nurses 

25 covered by work schedules described by subsections (b) and 
40 

•S 2484 RS 

1 (c) of section 7456A of title 38, United States Code (as 

2 added by subsection (a)), during the one-year period ending 

3 on the date of such report. 

4 (2) The report shall set forth— 

5 (A) the aggregate number of hours of overtime 

6 worked by nurses under each such work schedule dur7 ing the one-year period ending on the date of the re8 port; and 

9 (B) the aggregate amount of overtime pay paid 

10 to nurses working under each such work schedule dur11 ing such period. 

12 SEC. 5. RATE OF PAY FOR DIRECTOR OF NURSING SERVICE. 

13 (a) SENIOR EXECUTIVE SERVICE ES–6 RATE.—(1) 

14 Subchapter IV of chapter 74 is amended by adding at the 

15 end the following new section: 

16 ‘‘§ 7459. Director of Nursing Service: rate of pay 

17 ‘‘(a) SENIOR EXECUTIVE SERVICE ES–6 RATE.—The 

18 rate of pay for the Director of Nursing Service shall be equal 

19 to the sum of the maximum rate of basic pay established 

20 for the Senior Executive Service under section 5382 of title 

21 5 and the amount of the locality-based comparability pay22 ment provided under section 5304 of such title for the Direc23 tor’s locality. 
41 

•S 2484 RS 

1 ‘‘(b) INAPPLICABILITY OF NURSE PAY PROVISION.— 

2 Section 7451 of this title does not apply to the Director 

3 of Nursing Service.’’. 

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

5 74 is amended by inserting after the item relating to section 

6 7458 the following new item: 

‘‘Sec. 7459. Director of Nursing Service: rate of pay.’’. 

7 (b) CONFORMING AMENDMENT.—Section 7404(d) is 

8 amended by striking ‘‘section 7457’’ and inserting ‘‘sections 

9 7457 and 7459’’. 

10 SEC. 6. NURSE EXECUTIVE SPECIAL PAY. 

11 Section 7452 is amended by adding at the end the fol12 lowing new subsection: 

13 ‘‘(g)(1) In order to recruit and retain highly qualified 

14 Department nurse executives, the Secretary may, in accord15 ance with regulations prescribed by the Secretary, pay spe16 cial pay to the nurse executive at each location as follows: 

17 ‘‘(A) Each Department healthcare facility. 

18 ‘‘(B) The Central Office. 

19 ‘‘(2) The amount of special pay paid to a nurse execu20 tive under paragraph (1) shall be not less than $10,000 or 

21 more than $25,000. 

22 ‘‘(3) The amount of special pay paid to a nurse execu23 tive under paragraph (1) shall be based on factors such as 

24 the grade of the nurse executive position, the scope and com25 plexity of the nurse executive position, the personal quali-
42 

•S 2484 RS 

1 fications of the nurse executive, the characteristics of the 

2 healthcare facility concerned, the nature and number of spe3 cialty care units at the healthcare facility concerned, dem4 onstrated difficulties in recruitment and retention of nurse 

5 executives at the healthcare facility concerned, and such 

6 other factors as the Secretary considers appropriate. 

7 ‘‘(4) Special pay paid to a nurse executive under para8 graph (1) shall be in addition to any other pay (including 

9 basic pay) and allowances to which the nurse executive is 

10 entitled, and shall be considered pay for all purposes, in11 cluding retirement benefits under chapters 83 and 84 of title 

12 5, and other benefits, but shall not be considered basic pay 

13 for purposes of adverse actions under subchapter V.’’. 

14 SEC. 7. CLARIFICATION OF DISCRETIONARY NATURE OF 

15 VETERANS HEALTH ADMINISTRATION PER16 SONNEL ADMINISTRATION AUTHORITIES. 

17 (a) IN GENERAL.—Chapter 74 is amended by insert18 ing after section 7426 the following new section: 

19 ‘‘§ 7427. Discretionary nature of functions 

20 ‘‘Any authority assigned to the Secretary or another 

21 officer of the Department under this chapter shall be carried 

22 out at the discretion of the Secretary or other officer, as 

23 the case may be.’’. 
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•S 2484 RS 

1 (b) CLERICAL AMENDMENT.—The table of sections at 

2 the beginning of chapter 74 is amended by inserting after 

3 the item relating to section 7426 the following new item: 

‘‘7427. Discretionary nature of functions.’’. 

4 SEC. 8. EFFECTIVE DATE. 

5 The amendments to title 38, United States Code, made 

6 by this Act shall take effect one year after the date of the 

7 enactment of this Act. 

Amend the title so as to read: ‘‘An Act to amend 

title 38, United States Code, to simplify and improve pay 

provisions for physicians and dentists and to authorize alternate work schedules and executive pay for nurses, and 

for other purposes.’’. 
Calendar No. 713 

108TH CONGRESS 

2D SESSION S. 2484 

[Report No. 108–357] 

A BILL 

To amend title 38, United States Code, to simplify 

and executive pay for nurses. dentists, to authorize alternate work schedules and improve pay provisions for physicians and 

SEPTEMBER 23, 2004 

Reported with an amendment and an amendment to the 

title