S. 2484

One Hundred Eighth Congress

of the

United States of America

AT THE SECOND SESSION

Begun and held at the City of Washington on Tuesday,

the twentieth day of January, two thousand and four

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.

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 2004’’.

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. SIMPLIFICATION AND IMPROVEMENT OF GRADE AND PAY

PROVISIONS FOR PHYSICIANS AND DENTISTS.

(a) SIMPLIFICATION OF GRADES AND GRADE REQUIREMENTS.—

(1) Subsection (b) of section 7404 is amended—

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

(B) in the Physician and Dentist Schedule, by striking

the items relating to the grades and inserting the following:

‘‘Physician grade.

‘‘Dentist grade.’’; and

(C) by striking paragraph (2).

(2) Subsection (a) of such section is amended by adding at

the end the following: ‘‘The pay of physicians and dentists serving

in positions to which an Executive order applies under the preceding

sentence shall be determined under subchapter III of this chapter

instead of such Executive order.’’.

(b) SIMPLIFICATION AND IMPROVEMENT OF PAY AUTHORITIES.—

Subchapter III of chapter 74 is amended to read as follows:

‘‘SUBCHAPTER III—PAY FOR PHYSICIANS AND DENTISTS

‘‘§ 7431. Pay

‘‘(a) ELEMENTS OF PAY.—Pay of physicians and dentists in

the Veterans Health Administration shall consist of three elements

as follows:

‘‘(1) Base pay as provided for under subsection (b).

‘‘(2) Market pay as provided for under subsection (c).

‘‘(3) Performance pay as provided under subsection (d).
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‘‘(b) BASE PAY.—One element of pay for physicians and dentists

shall be base pay. Base pay shall meet the following requirements:

‘‘(1) Each physician and dentist is entitled to base pay

determined under the Physician and Dentist Base and Longevity Pay Schedule.

‘‘(2) The Physician and Dentist Base and Longevity Pay

Schedule is composed of 15 rates of base pay designated, from

the lowest rate of pay to the highest rate of pay, as base

pay steps 1 through 15.

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

is based on the total number of the years of the service of

the physician or dentist in the Veterans 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.

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

for a year under section 5303 of title 5, the Secretary shall

increase the amount of base pay payable under this subsection

for that year by a percentage equal to the percentage by which

rates of basic pay are increased under such section for that

year.

‘‘(c) MARKET PAY.—One element of pay for physicians and dentists shall be market pay. Market pay shall meet the following

requirements:

‘‘(1) Each physician and dentist is eligible for market pay.

‘‘(2) Market pay shall consist of pay intended to reflect

the recruitment and retention needs for the specialty or assignment (as defined by the Secretary) of a particular physician

or dentist in a facility of the Department of Veterans Affairs.

‘‘(3) The annual amount of the market pay payable to

a physician or dentist shall be determined by the Secretary

on a case-by-case basis.

‘‘(4)(A) In determining the amount of market pay for physicians or dentists, the Secretary shall consult two or more

national surveys of pay for physicians or dentists, as applicable,

whether prepared by private, public, or quasi-public entities

in order to make a general assessment of the range of pays

payable to physicians or dentists, as applicable.

‘‘(B)(i) In determining the amount of the market pay for

a particular physician or dentist under this subsection, and

in determining a tier (if any) to apply to a physician or dentist

under subsection (e)(1)(B), the Secretary shall consult with
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and consider the recommendations of an appropriate panel

or board composed of physicians or dentists (as applicable).

‘‘(ii) A physician or dentist may not be a member of the

panel or board that makes recommendations under clause (i)

with respect to the market pay of such physician or dentist,

as the case may be.

‘‘(iii) The Secretary should, to the extent practicable, ensure

that a panel or board consulted under this subparagraph

includes physicians or dentists (as applicable) who are practicing clinicians and who do not hold management positions

in the medical facility of the Department at which the physician

or dentist subject to the consultation is employed.

‘‘(5) The determination of the amount of market pay of

a physician or dentist shall take into account—

‘‘(A) the level of experience of the physician or dentist

in the specialty or assignment of the physician or dentist;

‘‘(B) the need for the specialty or assignment of the

physician or dentist at the medical facility of the Department concerned;

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

or assignment of the physician or dentist, which may cover

any geographic area the Secretary considers appropriate

for the specialty or assignment;

‘‘(D) the board certifications, if any, of the physician

or dentist;

‘‘(E) the prior experience, if any, of the physician or

dentist as an employee of the Veterans Health Administration; and

‘‘(F) such other considerations as the Secretary considers appropriate.

‘‘(6) The amount of market pay of a physician or dentist

shall be evaluated by the Secretary not less often than once

every 24 months. The amount of market pay may be adjusted

as the result of an evaluation under this paragraph. A physician

or dentist whose market pay is evaluated under this paragraph

shall receive written notice of the results of such evaluation

in accordance with procedures prescribed under section 7433

of this title.

‘‘(7) No adjustment of the amount of market pay of a

physician or dentist under paragraph (6) may result in a reduction of the amount of market pay of the physician or dentist

while in the same position or assignment at the medical facility

of the Department concerned.

‘‘(d) PERFORMANCE PAY.—(1) One element of pay for physicians

and dentists shall be performance pay.

‘‘(2) Performance pay shall be paid to a physician or dentist

on the basis of the physician’s or dentist’s achievement of specific

goals and performance objectives prescribed by the Secretary.

‘‘(3) The Secretary shall ensure that each physician and dentist

of the Department is advised of the specific goals or objectives

that are to be measured by the Secretary in determining the eligibility of that physician or dentist for performance pay.

‘‘(4) The amount of the performance pay payable to a physician

or dentist may vary annually on the basis of individual achievement

or attainment of the goals or objectives applicable to the physician

or dentist under paragraph (2).
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‘‘(5) The amount of performance pay payable to a physician

or dentist in a fiscal year shall be determined in accordance with

regulations prescribed by the Secretary, but may not exceed the

lower of—

‘‘(A) $15,000; or

‘‘(B) the amount equal to 7.5 percent of the sum of the

base pay and the market pay payable to such physician or

dentist in that fiscal year.

‘‘(6) A failure to meet goals or objectives applicable to a physician or dentist under paragraph (2) may not be the sole basis

for an adverse personnel action against that physician or dentist.

‘‘(e) REQUIREMENTS AND LIMITATIONS ON TOTAL PAY.—(1)(A)

Not less often than once every two years, the Secretary shall prescribe for Department-wide applicability the minimum and maximum amounts of annual pay that may be paid under this section

to physicians and the minimum and maximum amounts of annual

pay that may be paid under this section to dentists.

‘‘(B) The Secretary may prescribe for Department-wide applicability under this paragraph separate minimum and maximum

amounts of pay for a specialty or assignment. If the Secretary

prescribes separate minimum and maximum amounts for a specialty

or assignment, the Secretary may establish up to four tiers of

minimum and maximum amounts for such specialty or assignment

and prescribe for each tier a minimum amount and a maximum

amount that the Secretary determines appropriate for the professional responsibilities, professional achievements, and administrative duties of the physicians or dentists (as the case may be)

whose pay is set within that tier. ‘‘(C) Amounts prescribed under this paragraph shall be published in the Federal Register, and shall not take effect until at

least 60 days after the date of publication. ‘‘(2) Except as provided in paragraph (3) and subject to paragraph (4), the sum of the total amount of the annual rate of

base pay payable to a physician or dentist under subsection (b)

and the market pay determined for the physician or dentist under

subsection (c) may not be less than the minimum amount, nor

more than the maximum amount, applicable to specialty or assignment of the physician or dentist under paragraph (1). ‘‘(3) The sum of the total amount of the annual rate of base

pay payable to a physician or dentist under subsection (b) and

the market pay determined for the physician or dentist under

subsection (c) may exceed the maximum amount applicable to the

specialty or assignment of the physician or dentist under paragraph

(1) as a result of an adjustment under paragraph (3) or (4) of

subsection (b). ‘‘(4) In no case may the total amount of compensation paid

to a physician or dentist under this title in any year exceed the

amount of annual compensation (excluding expenses) specified in

section 102 of title 3. ‘‘(f) TREATMENT OF PAY.—Pay under subsections (b) and (c)

of this section shall be considered pay for all purposes, including

retirement benefits under chapters 83 and 84 of title 5 and other

benefits. ‘‘(g) ANCILLARY EFFECTS OF DECREASES IN PAY.—(1) A decrease

in pay of a physician or dentist resulting from an adjustment

in the amount of market pay of the physician or dentist under

subsection (c) shall not be treated as an adverse action.
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‘‘(2) If the pay of a physician or dentist is reduced under

this subchapter as a result of an involuntary reassignment in

connection with a disciplinary action taken against the physician

or dentist, the involuntary reassignment shall be subject to appeal

under subchapter V of this chapter.

‘‘(h) DELEGATION OF RESPONSIBILITIES.—The Secretary may

delegate to an appropriate officer or employee of the Department

any responsibility of the Secretary under subsection (c), (d), or

(e) except for the responsibilities of the Secretary under subsection

(e)(1).

‘‘§ 7432. Pay of Under Secretary for Health

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

shall be the annual rate of basic pay for positions at Level III

of the Executive Schedule under section 5314 of title 5.

‘‘(b) MARKET PAY.—(1) In the case of an Under Secretary for

Health who is also a physician or dentist, in addition to the base

pay specified in subsection (a) the Under Secretary for Health

may also be paid the market pay element of pay of physicians

and dentists under section 7431(c) of this title.

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

Health under this subsection shall be established by the Secretary.

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

Secretary for Health under this subsection, the Secretary shall

utilize an appropriate health care labor market selected by the

Secretary for purposes of this subsection.

‘‘(c) TREATMENT OF PAY.—Pay under this section shall be considered pay for all purposes, including retirement benefits under chapters 83 and 84 of title 5 and other benefits.

‘‘§ 7433. Administrative matters

‘‘(a) REGULATIONS.—(1) The Secretary shall prescribe regulations relating to the pay of physicians and dentists in the Veterans

Health Administration under this subchapter.

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

into account the recommendations of the Under Secretary for Health

on the administration of this subchapter. In formulating recommendations for the purpose of this paragraph, the Under Secretary shall request the views of representatives of labor organizations that are exclusive representatives of physicians and dentists

of the Department and the views of representatives of professional

organizations of physicians and dentists of the Department.

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

prescribes the regulations required by subsection (a), and annually

thereafter for the next 5 years, the Secretary shall submit to the

Committees on Veterans’ Affairs of the Senate and House of Representatives a report on the pay of physicians and dentists in

the Veterans Health Administration under this subchapter.

‘‘(2) Each report under this subsection shall include the following:

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

the current fiscal year with a comparison to the rates in effect

during the fiscal year preceding the current fiscal year, set

forth by facility and by specialty. ‘‘(B) The number of physicians and dentists who left the

Veterans Health Administration during the preceding fiscal

year.
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‘‘(C) The number of unfilled physician positions 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 an assessment of the reasons

that such positions remain unfilled.

‘‘(D) An assessment of the impact of implementation of

this subchapter on efforts to recruit and retain physicians and

dentists in the Veterans Health Administration.

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

also include a comparison of staffing levels, contract expenditures,

and average salaries of physicians and dentists in the Veterans

Health Administration for the current fiscal year and for the fiscal

year preceding the current fiscal year, set forth by facility and

by specialty.’’.

(c) INITIAL RATES OF BASE PAY FOR PHYSICIANS AND DENTISTS.—The initial rates of base pay established for the base pay

steps under the Physician and Dentist Base and Longevity Pay

Schedule provided in section 7431(b) of title 38, United States

Code (as added by subsection (b)), are 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 ....................................................................................................... $126,000

14 ....................................................................................................... $129,000

15 ....................................................................................................... $132,000.

(d) EFFECTIVE DATE.—(1) Notwithstanding the 60-day waiting

requirement in section 7431(e)(1)(C) of title 38, United States Code

(as amended by subsection (b)), pay provided for a physician or

dentist under subchapter III of chapter 74 of such title, as amended

by subsection (b), shall take effect on the first day of the first

pay period applicable to such physician or dentist that begins on

or after January 1, 2006.

(2) Pay provided for the Under Secretary for Health under

subchapter III of chapter 74 of title 38, United States Code, as

amended by this section shall take effect on the first day of the

first pay period applicable to the Under Secretary that begins

on or after January 1, 2006.

(e) TRANSITION PROVISIONS.—

(1) PHYSICIANS AND DENTISTS.—

(A) PAY.—(i) The amount of the pay payable on and

after the date of the enactment of this Act to a physician

or dentist in receipt of pay under section 7404 or 7405

of title 38, United States Code, as of the day before such

date shall continue to be determined under such section

(as in effect on the day before such date) until the effective

date that is applicable under subsection (d) to such physician or dentist, as the case may be.

(ii) A physician or dentist appointed or reassigned on

or after the date of the enactment of this Act, but before
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the effective date applicable under subsection (d) to such

physician or dentist, shall be compensated in accordance

with applicable provisions of section 7404 or 7405 of title

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

date of the enactment of this Act), until such effective

date.

(B) SPECIAL PAY.—(i) A special pay agreement entered

into by a physician or dentist under subchapter III of

chapter 74 of title 38, United States Code, before the date

of the enactment of this Act shall terminate on the date

of the enactment of this Act. However, a physician or

dentist in receipt of special pay pursuant to such an agreement on that date shall continue to receive special pay

under the terms of such agreement until the effective date

that is applicable under subsection (d) to such physician

or dentist.

(ii) A physician or dentist described in subparagraph

(A)(ii) may be paid special pay under applicable provisions

of section 7433, 7434, 7435, or 7436 of title 38, United

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

the enactment of this Act), during the period beginning

on the date of the appointment or reassignment of such

physician or dentist, as the case may be, and ending on

the effective date applicable under subsection (d) to such

physician or dentist. However, no special pay agreement

shall be required for the payment of special pay under

this clause.

(C) TREATMENT OF SPECIAL PAY.—(i) Special pay paid

under subparagraph (B) to a physician or dentist during

the period beginning on the date of the enactment of this

Act and ending on the effective date applicable under subsection (d) to such physician or dentist shall be subject

to the provisions of paragraphs (1), (2), (4), (5), and (6)

of section 7438(b) of title 38, United States Code (as in

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

Act).

(ii) Special pay paid to a physician or dentist under

section 7438 of title 38, United States Code (as in effect

on the day before the date of the enactment of this Act),

shall be fully creditable for purposes of computing benefits

under chapters 83 and 84 of title 5, United States Code.

(D) PRESERVATION OF PAY.—The amount of pay paid

to a physician or dentist after the effective date of this

Act shall not be less than the amount of pay paid to

such physician or dentist on the day before the effective

date of this Act while such physician or dentist remains

in the same position or assignment.

(2) UNDER SECRETARY FOR HEALTH.— (A) SPECIAL PAY.—(i) The current special pay agreement entered into by the Under Secretary for Health under

subchapters I and III of chapter 74 of title 38, United

States Code, before the date of the enactment of this Act

shall terminate on the date of the enactment of this Act.

However, the Under Secretary shall continue to receive

special pay under the terms of such agreement until the

effective date that is applicable under subsection (d) to

the Under Secretary.
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(ii) An individual appointed as Under Secretary for

Health on or after the date of the enactment of this Act

and before the effective date applicable under subsection

(d) to the Under Secretary shall be paid special pay in

accordance with the provisions of sections 7432(d)(2) and

7433 of title 38, United States Code (as in effect on the

day before the date of the enactment of this Act), during

the period beginning on the date of appointment and ending

on such effective date. However, no special pay agreement

shall be required for the payment of special pay under

this clause.

(B) TREATMENT OF SPECIAL PAY.—Special pay paid

under subparagraph (A) during the period beginning on

the date of the enactment of this Act and ending on the

effective date applicable under subsection (d) to the Under

Secretary—

(i) shall be subject to the provisions of paragraphs

(1), (2), (4), (5), and (6) of section 7438(b) of title

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

the date of the enactment of this Act); and

(ii) shall be fully creditable for purposes of computing benefits under chapters 83 and 84 of title 5,

United States Code.

(f) CONFORMING AMENDMENTS.—Section 7404 is amended—

(1) in subsection (c), by striking ‘‘special pay’’ and inserting

‘‘pay’’; and

(2) in subsection (d), by striking ‘‘pay may not be paid’’

and all that follows and inserting ‘‘pay for positions for which

basic pay is paid under this section may not be paid at a

rate in excess of the rate of basic pay authorized by section

5316 of title 5 for positions in Level V of the Executive

Schedule.’’.

(g) CLERICAL AMENDMENT.—The table of sections at the beginning of chapter 74 is amended by striking the items relating to

subchapter III and inserting the following new items:

‘‘SUBCHAPTER III—PAY FOR PHYSICIANS AND DENTISTS

‘‘Sec. 7431. Pay.

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

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

SEC. 4. ALTERNATE WORK SCHEDULES FOR REGISTERED NURSES.

(a) IN GENERAL.—(1) Chapter 74 is amended by inserting after

section 7456 the following new section:

‘‘§ 7456A. Nurses: alternate work schedules

‘‘(a) APPLICABILITY.—This section applies to registered nurses

appointed under this chapter.

‘‘(b) 36/40 WORK SCHEDULE.—(1)(A) Subject to paragraph (2),

if the Secretary determines it to 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 work week shall be considered for all purposes to have worked a full 40-hour basic work

week.

‘‘(B) A nurse who works under the authority in subparagraph

(A) shall be considered a 0.90 full-time equivalent employee in
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computing full-time equivalent employees for the purposes of determining compliance with personnel ceilings.

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

under paragraph (1) to have worked a full 40-hour basic work

week shall be subject to subparagraphs (B) and (C).

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

paragraph for service performed as part of a regularly scheduled

36-hour tour of duty within the work week shall be derived by

dividing the nurse’s annual rate of basic pay by 1,872.

‘‘(C) The Secretary shall pay overtime pay to a nurse covered

by this paragraph who—

‘‘(i) performs a period of service in excess of such nurse’s

regularly scheduled 36-hour tour of duty within an administrative work week;

‘‘(ii) for officially ordered or approved service, performs

a period of service in excess of 8 hours on a day other than

a day on which such nurse’s regularly scheduled 12-hour tour

of duty falls;

‘‘(iii) performs a period of service in excess of 12 hours

for any day included in the regularly scheduled 36-hour tour

of duty work week; or

‘‘(iv) performs a period of service in excess of 40 hours

during an administrative work week.

‘‘(D) The Secretary may provide a nurse to whom this subsection

applies with additional pay under section 7453 of this title for

any period included in a regularly scheduled 12-hour tour of duty.

‘‘(3) A nurse who works a 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 every nine

hours of absence.

‘‘(c) HOLIDAY PAY.—A nurse working a work schedule under

subsection (b) that includes a holiday designated by law or Executive order shall be eligible for holiday pay under section 7453(d)

of this title for any service performed by the nurse on such holiday

under such section.

‘‘(d) 9-MONTH WORK SCHEDULE FOR CERTAIN NURSES.—(1) The

Secretary may authorize a registered nurse appointed under section

7405 of this title, with the nurse’s written consent, to work full

time for nine months with 3 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.

‘‘(2) A nurse who works under the authority in paragraph

(1) shall be considered a 0.75 full-time equivalent employee in

computing full-time equivalent employees for the purposes of determining compliance with personnel ceilings.

‘‘(3) Work under this subsection shall be considered part-time

service for purposes of computing benefits under chapters 83 and

84 of title 5.

‘‘(4) A nurse who works under the authority in paragraph

(1) shall be considered a full-time employee for purposes of chapter

89 of title 5.

‘‘(e) NOTIFICATION OF MODIFICATION OF BENEFITS.—The Secretary shall provide each employee with respect to whom an alternate work schedule under this section may apply written notice

of the effect, if any, that the alternate work schedule will have

on the employee’s health care premium, retirement, life insurance
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premium, probationary status, or other benefit or condition of

employment. The notice shall be provided not later than 14 days

before the employee consents to the alternate work schedule.

‘‘(f) REGULATIONS.—The Secretary shall prescribe regulations

to carry out this section.’’.

(2) The table of sections at the beginning of chapter 74 is

amended by inserting after the item relating to section 7456 the

following new item:

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

(b) POLICY AGAINST CERTAIN WORK HOURS.—(1) It is the sense

of Congress to encourage the Secretary of Veterans Affairs to prevent work hours by nurses providing direct patient care in excess

of 12 consecutive hours or in excess of 60 hours in any 7-day

period, except in the case of nurses providing emergency care.

(2) Not later than one year after the date of the enactment

of this Act and every year thereafter for the next two years, the

Secretary shall certify to Congress whether or not each Veterans

Health Administration facility has in place, as of the date of such

certification, a policy designed to prevent work hours by nurses

providing direct patient care (other than nurses providing emergency care) in excess of 12 consecutive hours or in excess of 60

hours in any 7-day period.

SEC. 5. NURSE EXECUTIVE SPECIAL PAY.

Section 7452 is amended by adding at the end the following

new subsection:

‘‘(g)(1) In order to recruit and retain highly qualified Department nurse executives, the Secretary may, in accordance with regulations prescribed by the Secretary, pay special pay to the nurse

executive at each location as follows:

‘‘(A) Each Department health care facility.

‘‘(B) The Central Office.

‘‘(2) The amount of special pay paid to a nurse executive under

paragraph (1) shall be not less than $10,000 or more than $25,000.

‘‘(3) The amount of special pay paid to a nurse executive under

paragraph (1) shall be based on factors such as the grade of the

nurse executive position, the scope and complexity of the nurse

executive position, the personal qualifications of the nurse executive,

the characteristics of the health care facility concerned, the nature

and number of specialty care units at the health care facility concerned, demonstrated difficulties in recruitment and retention of

nurse executives at the health care facility concerned, and such

other factors as the Secretary considers appropriate.

‘‘(4) Special pay paid to a nurse executive 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 retirement benefits

under chapters 83 and 84 of title 5, and other benefits, but shall
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not be considered basic pay for purposes of adverse actions under

subchapter V of this chapter.’’.

Speaker of the House of Representatives.

Vice President of the United States and

President of the Senate.