ceding the date of the submission of the report, a measure-
ment of, for each such medical facility— 
‘‘(1) the period of time between— 
‘‘(A) the date on which a clinician em-
ployed by the Department determines that a 
veteran requires care, or a veteran presents to 
the Department requesting care, and the date 
on which the referral for care is sent to a non- 
Department health care provider; 
‘‘(B) the date on which such referral is 
sent to a non-Department health care provider 
and the date on which such non-Department 
health care provider accepts such referral; 
‘‘(C) the date on which such non-Depart-
ment health care provider accepts such referral 
and the date on which such referral is com-
pleted; 
‘‘(D) the date on which such referral is 
completed and the date on which an appoint-
ment with a non-Department health care pro-
vider is made; and 
‘‘(E) the date on which such an appoint-
ment is made and the date on which such ap-
pointment occurs; and
100 
‘‘(2) any other period of time that the Secretary 
determines necessary.’’. 
SEC. 141. ELIMINATION OF CERTAIN REQUIREMENTS FOR 
CERTAIN DEPARTMENT OF VETERANS AF-
FAIRS ASSISTANT UNDER SECRETARIES. 
Section 7306 of title 38, United States Code, is 
amended— 
(1) by striking subsection (b); 
(2) by redesignating subsections (c) through (g) 
as subsections (b) through (f), respectively; and 
(3) in subsection (c) (as so redesignated), by 
striking ‘‘subsection (e)’’ and inserting ‘‘subsection 
(f)’’. 
SEC. 142. MODIFICATION OF PAY LIMITATION FOR PHYSI-
CIANS, PODIATRISTS, OPTOMETRISTS, AND 
DENTISTS OF DEPARTMENT OF VETERANS 
AFFAIRS. 
(a) PAY.— 
(1) IN
GENERAL.—Section 7431 of title 38, 
United States Code, is amended— 
(A) by inserting ‘‘optometrists,’’ after ‘‘po-
diatrists,’’ each place it appears; 
(B) by inserting ‘‘optometrist’’ after ‘‘podi-
atrist,’’ each place it appears; 
(C) in subsection (c)—
101 
(i) in paragraph (5), by adding at the 
end the following new sentence: ‘‘Such a 
notice shall include a statement of whether 
the market pay will increase, decrease, or 
remain unchanged following such evalua-
tion.’’; and 
(ii) by adding at the end the following 
new paragraphs: 
‘‘(7) The Secretary shall ensure that each phy-
sician, podiatrist, optometrist, and dentist in the 
Veterans Health Administration is— 
‘‘(A) advised, on an annual basis, of the 
criteria described in subparagraph (F) of para-
graph (4); 
‘‘(B) evaluated in accordance with such 
criteria; and 
‘‘(C) compensated in accordance with— 
‘‘(i) applicable assignment and pay 
levels, subject to relevant pay limitations; 
and 
‘‘(ii) the extent to which such criteria 
is met. 
‘‘(8) Not later than 120 days after the end of 
each fiscal year, the Secretary shall submit to the 
Committees on Veterans’ Affairs of the Senate and
102 
the House of Representatives a report that includes 
the following: 
‘‘(A) A list of each facility and specialty 
that conducted an evaluation of pay during the 
period covered by the report. 
‘‘(B) For each evaluation described in sub-
paragraph (A)— 
‘‘(i) a list of occupations for which 
pay was evaluated, disaggregated by med-
ical specialty, number of authorized full- 
time employees, and onsite full-time em-
ployees as of the date of the evaluation; 
‘‘(ii) the date such evaluation was 
completed; 
‘‘(iii) whether a market pay adjust-
ment was made following the evaluation 
per each occupation and specialty evalu-
ated; 
‘‘(iv) whether applicable employees 
were notified of such evaluation; 
‘‘(v) whether local labor partners were 
notified of such evaluation; and 
‘‘(vi) in the case of an evaluation that 
resulted in an adjustment of pay— 
‘‘(I) the date such adjustment—
103 
‘‘(aa) was implemented; and 
‘‘(bb) became effective; and 
‘‘(II) the percentage of employees 
of each occupation and specialty for 
which pay was adjusted pursuant to 
such evaluation. 
‘‘(C) A list of facilities of the Department 
that have not conducted an evaluation of mar-
ket pay, pursuant to paragraph (5), during the 
18-month-period that precedes the date of the 
submission of such report.’’; 
(D) in subsection (e)— 
(i) in paragraph (1)(A), by inserting 
‘‘optometrists,’’ after ‘‘podiatrists,’’; and 
(ii) by adding at the end the following 
new paragraphs: 
‘‘(5) Notwithstanding any compensation or pay 
limitations under this title or title 5, the Secretary 
may authorize the Under Secretary for Health to 
pay physicians, podiatrists, optometrists and den-
tists— 
‘‘(A) awards authorized under this title; 
‘‘(B) advance payments, recruitment or re-
location bonuses, and retention allowances au-
104 
thorized under section 7410(a) of this title or 
as otherwise provided by law; 
‘‘(C) incentives or bonuses under section 
706 of this title or as otherwise provided by 
law; and 
‘‘(D) earnings from fee-basis appointments 
under section 7405(a)(2) of this title. 
‘‘(6)(A) The Secretary may waive any pay limi-
tation described in this section (including tier limita-
tions) that the Secretary determines necessary for 
the recruitment or retention of critical health care 
personnel whom the Secretary determines would pro-
vide direct patient care. 
‘‘(B) Priority for such waivers shall be given for 
positions, locations, and care provided through con-
tracts at a high cost to the Department. 
‘‘(C) The Chief Human Capital Officer of the 
Department, the Chief Financial Officer of the De-
partment, and the Office of the General Counsel of 
the Department shall review any waiver issued under 
subparagraph (A). 
‘‘(D) During the period the authority under 
subparagraph (A) is effective, the Secretary may not 
issue more than 300 waivers under such subpara-
graph.
105 
‘‘(E) The Secretary may prescribe require-
ments, limitations, and other considerations for 
waivers under such subparagraph. 
‘‘(F) Not later than 180 days after the date of 
the enactment of the Senator Elizabeth Dole 21st 
Century Veterans Healthcare and Benefits Improve-
ment Act, and annually thereafter, the Secretary 
shall submit to the Committees on Veterans’ Affairs 
of the Senate and the House of Representatives a 
report that includes— 
‘‘(i) any updates to the requirements, limi-
tations, and considerations prescribed under 
subparagraph (B) during the period covered by 
the report; 
‘‘(ii) a description of the findings of each 
review, if any, conducted pursuant to subpara-
graph (C); 
‘‘(iii) a description of each waiver under 
subparagraph (A) in effect as of the date of the 
submission of the report, including the— 
‘‘(I) duty location, position, specialty, 
market and performance considerations for 
the waiver; and
106 
‘‘(II) impact, if any, of the waiver on 
contracted care purchased by the Depart-
ment for the region; and 
‘‘(iv) a list of any separation actions dur-
ing the period covered by the report with re-
spect to a position for which a waiver under 
subparagraph (A) is in effect. 
‘‘(G) The authority of the Secretary under sub-
paragraph (A) shall terminate on the last day of the 
third full fiscal year following the date of the enact-
ment of the Senator Elizabeth Dole 21st Century 
Veterans Healthcare and Benefits Improvement 
Act.’’. 
(2) REPORT
ON
WAIVER
AUTHORITY.—Not 
later than 180 days after the date of the enactment 
of this Act, the Secretary of Veterans Affairs shall 
submit to the Committees on Veterans’ Affairs of 
the Senate and the House of Representatives a re-
port that includes a description of the requirements, 
limitations, and other considerations prescribed 
under section 7431(b)(6)(D) of title 38, United 
States Code, as added by paragraph (1). 
(3) CONFORMING AMENDMENTS.— 
(A) PAY
OF
UNDER
SECRETARY
FOR 
HEALTH.—Section 7432(b)(1) of such title is
107 
amended by inserting ‘‘, podiatrist, optom-
etrist,’’ after ‘‘physician’’. 
(B) ADMINISTRATIVE
MATTERS.—Section 
7433 of such title is amended by inserting ‘‘op-
tometrists,’’ after ‘‘physicians,’’ each place it 
appears. 
(C) 
COMPETITIVE
PAY.—Section 
7451(a)(2)(C) of such title is amended by in-
serting ‘‘optometrist,’’ after ‘‘physician,’’. 
(4) CLERICAL AMENDMENTS.— 
(A) SUBCHAPTER
HEADING.—Subchapter 
III of chapter 74 of such title is amended in the 
heading by inserting ‘‘Optometrists,’’ after 
‘‘PODIATRISTS,’’. 
(B) TABLE OF SECTIONS.—The table of 
sections for such chapter is amended by strik-
ing the item relating to subchapter III and in-
serting the following: 
‘‘SUBCHAPTER III—PAY FOR PHYSICIANS AND OTHER HEALTH-CARE 
PERSONNEL’’. 
(5) APPLICABILITY DATES.—The amendments 
made by this subsection shall apply to any pay pe-
riod of the Department of Veterans Affairs begin-
ning on or after the date that is 180 days after the 
date of the enactment of this Act.
108 
(b) MODIFICATION
AND CLARIFICATION
OF PAY 
GRADE FOR OPTOMETRISTS.—Section 7404 of title 38, 
United States Code, is amended— 
(1) in subsection (a)(2)(A), by striking ‘‘podia-
trists, and dentists’’ and inserting ‘‘podiatrists, op-
tometrists, and dentists’’; and 
(2) in subsection (b)— 
(A) by striking ‘‘podiatrist (dpm), and den-
tist’’ and inserting ‘‘podiatrist (dpm), optom-
etrist (od), and dentist’’; 
(B) by striking ‘‘clinical chiropractor and 
optometrist schedule,’’ and inserting ‘‘clinical 
chiropractor schedule’’; and 
(C) by inserting ‘‘optometrist grade’’ after 
‘‘Podiatrist grade’’. 
(c) RETROACTIVE
AUTHORITY
FOR
COMPENSA-
TION.— 
(1) IN GENERAL.—The Secretary of Veterans 
Affairs may pay retroactive compensation to a cov-
ered employee in an amount that equals the amount 
of compensation that was authorized to be paid to 
such covered employee during the period specified in 
paragraph (2), but was deferred and paid to such 
employee in the calendar year following the calender 
year in which such compensation was authorized be-