[House Report 115-267]
[From the U.S. Government Publishing Office]
115th Congress } { REPORT
HOUSE OF REPRESENTATIVES
1st Session } { 115-267
======================================================================
GROW OUR OWN DIRECTIVE: PHYSICIAN ASSISTANT EMPLOYMENT AND EDUCATION
ACT OF 2017
_______
July 28, 2017.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Roe of Tennessee, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 3262]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 3262) to require the Secretary of Veterans
Affairs to carry out a pilot program to provide educational
assistance to certain former members of the Armed Forces for
education and training as physician assistants of the
Department of Veterans Affairs, to establish pay grades and
require competitive pay for physician assistants of the
Department, and for other purposes, having considered the same,
report favorably thereon with an amendment and recommend that
the bill as amended do pass.
CONTENTS
Page
Amendment........................................................ 2
Purpose and Summary.............................................. 6
Background and Need for Legislation.............................. 6
Hearings......................................................... 7
Subcommittee Consideration....................................... 7
Committee Consideration.......................................... 7
Committee Votes.................................................. 7
Committee Oversight Findings..................................... 7
Statement of General Performance Goals and Objectives............ 7
New Budget Authority, Entitlement Authority, and Tax Expenditures 8
Earmarks and Tax and Tariff Benefits............................. 8
Committee Cost Estimate.......................................... 8
Congressional Budget Office Estimate............................. 8
Federal Mandates Statement....................................... 11
Advisory Committee Statement..................................... 11
Constitutional Authority Statement............................... 11
Applicability to Legislative Branch.............................. 12
Statement on Duplication of Federal Programs..................... 12
Disclosure of Directed Rulemaking................................ 12
Section-by-Section Analysis of the Legislation................... 12
Changes in Existing Law Made by the Bill as Reported............. 16
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Grow Our Own Directive: Physician
Assistant Employment and Education Act of 2017''.
SEC. 2. PILOT PROGRAM TO PROVIDE EDUCATIONAL ASSISTANCE TO PHYSICIAN
ASSISTANTS TO BE EMPLOYED AT THE DEPARTMENT OF
VETERANS AFFAIRS.
(a) Pilot Program.--
(1) In general.--The Secretary of Veterans Affairs shall
carry out a pilot program to be known as the ``Grow Our Own
Directive'' or ``G.O.O.D.'' pilot program (in this section
referred to as the ``pilot program'') to provide educational
assistance to certain former members of the Armed Forces for
education and training as physician assistants of the
Department of Veterans Affairs.
(2) Information on pilot program.--The Secretary shall
provide information on the pilot program to eligible
individuals under subsection (b), including information on
application requirements and a list of entities with which the
Secretary has partnered under subsection (g).
(b) Eligible Individuals.--An individual is eligible to participate
in the pilot program if the individual--
(1) has medical or military health experience gained while
serving as a member of the Armed Forces;
(2) has received a certificate, associate degree,
baccalaureate degree, master's degree, or postbaccalaureate
training in a science relating to health care;
(3) is not eligible to participate in educational assistance
under chapter 30, 31, 32, 33, 34, or 35 of title 38, United
States Code, or chapter 1606 or 1607 of title 10, United States
Code;
(4) has participated in the delivery of health care services
or related medical services, including participation in
military training relating to the identification, evaluation,
treatment, and prevention of diseases and disorders; and
(5) does not have a degree of doctor of medicine, doctor of
osteopathy, or doctor of dentistry.
(c) Duration.--The pilot program shall be carried out during the
five-year period beginning on the date that is 180 days after the date
of the enactment of this Act.
(d) Selection.--
(1) In general.--The Secretary shall select not less than 250
eligible individuals under subsection (b) to participate in the
pilot program.
(2) Priority for selection.--In selecting individuals to
participate in the pilot program under paragraph (1), the
Secretary shall give priority to the following individuals:
(A) Individuals who participated in the Intermediate
Care Technician Pilot Program of the Department that
was carried out by the Secretary between January 2011
and February 2015.
(B) Individuals who agree to be employed as a
physician assistant for the Veterans Health
Administration at a medical facility of the Department
located in a community that--
(i) is designated as a medically underserved
population under section 330(b)(3)(A) of the
Public Health Service Act (42 U.S.C.
254b(b)(3)(A)); and
(ii) is in a State with a per capita
population of veterans of more than 9 percent
according to the National Center for Veterans
Analysis and Statistics and the United States
Census Bureau.
(e) Educational Assistance.--
(1) In general.--In carrying out the pilot program, the
Secretary shall provide educational assistance to individuals
participating in the pilot program, including through the use
of scholarships, to cover the costs to such individuals of
obtaining a master's degree in physician assistant studies or a
similar master's degree.
(2) Use of existing programs.--In providing educational
assistance under paragraph (1), the Secretary shall use the
Department of Veterans Affairs Health Professionals Educational
Assistance Program under chapter 76 of title 38, United States
Code, and such other educational assistance programs of the
Department as the Secretary considers appropriate.
(3) Use of scholarships.--The Secretary shall provide not
less than 35 scholarships under the pilot program to
individuals participating in the pilot program during each year
in which the pilot program is carried out.
(f) Period of Obligated Service.--
(1) In general.--The Secretary shall enter into an agreement
with each individual participating in the pilot program in
which such individual agrees to be employed as a physician
assistant for the Veterans Health Administration for a period
of obligated service specified in paragraph (2).
(2) Period specified.--With respect to each individual
participating in the pilot program, the period of obligated
service specified in this paragraph for the individual is--
(A) if the individual is participating in the pilot
program through a program described in subsection
(e)(2) that specifies a period of obligated service,
the period specified with respect to such program; or
(B) if the individual is participating in the pilot
program other than through a program described in such
subsection, or if such program does not specify a
period of obligated service, a period of three years or
such other period as the Secretary considers
appropriate for purposes of the pilot program.
(g) Breach.--
(1) Liability.--Except as provided in paragraph (2), an
individual who participates in the pilot program and fails to
satisfy the period of obligated service under subsection (f)
shall be liable to the United States, in lieu of such obligated
service, for the amount that has been paid or is payable to or
on behalf of the individual under the pilot program, reduced by
the proportion that the number of days served for completion of
the period of obligated service bears to the total number of
days in the period of obligated service of such individual.
(2) Exception.--If an individual is participating in the
pilot program through a program described in subsection (e)(2)
that specifies a period of obligated service, the liability of
the individual for failing to satisfy the period of obligated
service under subsection (f) shall be determined as specified
with respect to such program.
(h) Mentors.--The Secretary shall ensure that a physician assistant
mentor or mentors are available for individuals participating in the
pilot program at each facility of the Veterans Health Administration at
which a participant in the pilot program is employed.
(i) Partnerships.--In carrying out the pilot program, the Secretary
shall seek to partner with the following:
(1) Not less than 15 institutions of higher education that--
(A) offer a master's degree program in physician
assistant studies or a similar area of study that is
accredited by the Accreditation Review Commission on
Education for the Physician Assistant; and
(B) agree--
(i) to guarantee seats in such master's
degree program for individuals participating in
the pilot program who meet the entrance
requirements for such master's degree program;
and
(ii) to provide individuals participating in
the pilot program with information on
admissions criteria and the admissions process.
(2) Other institutions of higher education that offer
programs in physician assistant studies or other similar areas
of studies that are accredited by the Accreditation Review
Commission on Education for the Physician Assistant.
(3) The Transition Assistance Program of the Department of
Defense.
(4) The Veterans' Employment and Training Service of the
Department of Labor.
(5) Programs carried out under chapter 41 of title 38, United
States Code, for the purpose of marketing and advertising the
pilot program to veterans and members of the Armed Forces who
may be interested in the pilot program.
(j) Administration of Pilot Program.--For purposes of carrying out
the pilot program, the Secretary shall appoint or select within the
Office of Physician Assistant Services of the Veterans Health
Administration the following:
(1) A Deputy Director for Education and Career Development of
Physician Assistants who--
(A) is a physician assistant, a veteran, and employed
by the Department as of the date of the enactment of
this Act;
(B) is responsible for--
(i) overseeing the pilot program;
(ii) recruiting candidates to participate in
the pilot program;
(iii) coordinating with individuals
participating in the pilot program and
assisting those individuals in applying and
being admitted to a master's degree program
under the pilot program; and
(iv) providing information to eligible
individuals under subsection (b) with respect
to the pilot program; and
(C) may be employed in the field at a medical center
of the Department.
(2) A Deputy Director of Recruitment and Retention who--
(A) is a physician assistant, a veteran, and employed
by the Department as of the date of the enactment of
this Act;
(B) is responsible for--
(i) identifying and coordinating the needs of
the pilot program and assist the Secretary in
providing mentors under subsection (h) to
participants in the pilot program; and
(ii) coordinating the staff of facilities of
the Veterans Health Administration with respect
to identifying employment positions and mentors
under subsection (h) for participants in the
pilot program; and
(C) may be employed in the field at a medical center
of the Department.
(3) A recruiter who--
(A) reports directly to the Deputy Director of
Recruitment and Retention; and
(B) works with the Workforce Management and
Consulting Office and the Healthcare Talent Management
Office of the Veterans Health Administration to develop
and implement national recruiting strategic plans for
the recruitment and retention of physician assistants
within the Department.
(4) An administrative assistant, compensated at a rate not
less than level GS-6 of the General Schedule, or equivalent,
who assists with administrative duties relating to the pilot
program in the Office of Physician Assistant Services and such
other duties as determined by the Secretary to ensure that the
Office runs effectively and efficiently.
(k) Report.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs,
in collaboration with the Secretary of Labor, the Secretary of
Defense, and the Secretary of Health and Human Services, shall
submit to Congress a report on the pilot program.
(2) Elements.--The report required by paragraph (1) shall
include the following:
(A) The extent to which the pilot program is
effective in improving the ability of eligible
individuals under subsection (b) to become physician
assistants;
(B) An examination of whether the pilot program is
achieving the goals of--
(i) enabling individuals to build on medical
skills gained as members of the Armed Forces by
entering into the physician assistant workforce
of the Department; and
(ii) helping to meet the shortage of
physician assistants employed by the
Department.
(C) An identification of such modifications to the
pilot program as the Secretary of Veterans Affairs, the
Secretary of Labor, the Secretary of Defense, and the
Secretary of Health and Human Services consider
necessary to meet the goals described in subparagraph
(B).
(D) An assessment of whether the pilot program could
serve as a model for other programs of the Department
to assist individuals in obtaining certification and
employment in other health care fields.
(l) Source of Amounts.--Not less than $8,000,000 of the amount
necessary to carry out the pilot program shall be derived from amounts
appropriated to the Department of Veterans Affairs before the date of
the enactment of this Act.
SEC. 3. ESTABLISHMENT OF STANDARDS FOR THE DEPARTMENT OF VETERANS
AFFAIRS FOR USING EDUCATIONAL ASSISTANCE PROGRAMS
TO EDUCATE AND HIRE PHYSICIAN ASSISTANTS.
(a) In General.--The Secretary of Veterans Affairs shall establish
standards described in subsection (b) to improve the use by the
Department of Veterans Affairs of the Department of Veterans Affairs
Health Professionals Educational Assistance Program under chapter 76 of
title 38, United States Code, and other educational assistance programs
of the Department, including the pilot program under section 2, to
educate and hire physician assistants of the Department.
(b) Standards.--The standards described in this subsection are the
following:
(1) Holding directors of medical centers of the Department
accountable for failure to use the educational assistance
programs described in subsection (a) and other incentives--
(A) to advance employees of the Department in their
education as physician assistants; and
(B) to improve recruitment and retention of physician
assistants.
(2) Ensuring that the Department of Veterans Affairs
Education Debt Reduction Program under subchapter VII of
chapter 76 of such title is available for participants in the
pilot program under section 2 to fill vacant physician
assistant positions at the Department, including by--
(A) including in all vacancy announcements for
physician assistant positions the availability of the
Education Debt Reduction Program; and
(B) informing applicants to physician assistant
positions of their eligibility for the Education Debt
Reduction Program.
(3) Monitoring compliance with the application process for
educational assistance programs described in subsection (a) to
ensure that such programs are being fully utilized to carry out
this section.
(4) Creating programs, including through the use of the
Department of Veterans Affairs Employee Incentive Scholarship
Program under subchapter VI of chapter 76 of such title, to
encourage employees of the Department to apply to accredited
physician assistant programs.
(c) Regulations.--The Secretary shall prescribe such regulations as
the Secretary considers appropriate to carry out this section.
SEC. 4. ESTABLISHMENT OF PAY GRADES FOR PHYSICIAN ASSISTANTS OF THE
DEPARTMENT OF VETERANS AFFAIRS AND REQUIREMENT TO
PROVIDE COMPETITIVE PAY.
(a) Establishment of Pay Grades.--Section 7404(b) of title 38, United
States Code, is amended by adding at the end the following:
``PHYSICIAN ASSISTANT SCHEDULE
``Physician Assistant IV.
``Physician Assistant III.
``Physician Assistant II.
``Physician Assistant I.''.
(b) Competitive Pay.--Section 7451(a)(2) of such title is amended--
(1) by redesignating subparagraph (B) as subparagraph (C);
(2) by inserting after subparagraph (A) the following new
subparagraph (B):
``(B) Physician assistant.''; and
(3) in subparagraph (C), as redesignated by paragraph (1), by
striking ``and registered nurse'' and inserting ``registered
nurse, and physician assistant''.
(c) National Strategic Plan.--
(1) In general.--The Secretary of Veterans Affairs shall
implement a national strategic plan for the retention and
recruitment of physician assistants of the Department of
Veterans Affairs that includes the establishment and adoption
of standards for the provision of competitive pay to physician
assistants of the Department in comparison to the pay of
physician assistants in the private sector.
(2) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee
on Veterans' Affairs of the House of Representatives a report
on the implementation of the national strategic plan under
paragraph (1).
SEC. 5. EXTENSION OF REQUIREMENT FOR COLLECTION OF FEES FOR HOUSING
LOANS GUARANTEED BY SECRETARY OF VETERANS AFFAIRS.
Section 3729(b)(2) of title 38, United States Code, is amended--
(1) in subparagraph (A)--
(A) in clause (iii), by striking ``September 30,
2024'' and inserting ``December 31, 2024''; and
(B) in clause (iv), by striking ``September 30,
2024'' and inserting ``December 31, 2024'';
(2) in subparagraph (B)--
(A) in clause (i), by striking ``September 30, 2024''
and inserting ``December 31, 2024''; and
(B) in clause (ii), by striking ``September 30,
2024'' and inserting ``December 31, 2024'';
(3) in subparagraph (C)--
(A) in clause (i), by striking ``September 30, 2024''
and inserting ``December 31, 2024''; and
(B) in clause (ii), by striking ``September 30,
2024'' and inserting ``December 31, 2024''; and
(4) in subparagraph (D)--
(A) in clause (i), by striking ``September 30, 2024''
and inserting ``December 31, 2024''; and
(B) in clause (ii), by striking ``September 30,
2024'' and inserting ``December 31, 2024''.
Purpose and Summary
H.R. 3262, the ``Grow Our Own Directive: Physician
Assistant Employment and Education Act of 2017,'' was
introduced by Representative Ann McLane Kuster of New Hampshire
on July 17, 2017. The bill, as amended, was ordered to be
favorably reported to the full House on July 19, 2017, by voice
vote.
H.R. 3262, as amended, would direct the Department of
Veterans Affairs (VA) to carry out the Grow Our Own Directive--
or, G.O.O.D.--pilot program to provide educational assistance
to certain former members of the Armed Forces for education and
training as VA physician assistants (PAs).
Background and Need for Legislation
The PA profession started in the mid-1960s in response to a
nationwide shortage of primary care physicians. The first class
of PAs were primarily composed of Army medics and Navy corpsman
who had served in the Vietnam War. The significant number of
veterans working as PAs has continued since that time and is
illustrative of the unique relationship veterans and the VA
health care system have historically had with the PA
profession. According to testimony from the VA Physician
Assistants Association (VAPAA), VA is the largest single
federal employer of PAs, and a quarter of all primary care
patients in the VA health care system are seen by PAs.\1\
However, VA has experienced recent difficulties recruiting and
retaining PAs within the VA health care system, and as such,
PAs are a top 5 mission-critical occupation for VA, ranking
fourth according to a January 2015 VA Office of Inspector
General (OIG) report.\2\
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\1\May 15, 2015, Subcommittee on Health hearing, ``Overcoming
Barriers to More Efficient and Effective VA Staffing,'' http://
veterans.house.gov/hearing/overcoming-barriers-to-more-efficient-and-
effective-va-staffing.
\2\January 30, 2015, VA Inspector General report, ``Determination
of VHA Occupational Staffing Shortages,'' http://www.va.gov/oig/pubs/
VAOIG-15-00430-103.pdf.
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The Committee believes that PAs are critical to VA's
ability to provide access to timely, high-quality care to
veteran patients and encourages VA to prioritize recruitment
and retention of PAs within the VA health care system. As such,
the bill would require VA to carry out the G.O.O.D. pilot for
five years to assist certain veterans in obtaining education
and training as PAs. Individuals eligible to participate in the
G.O.O.D. pilot would include those with medical or military
health experience who have received a certificate, associate
degree, baccalaureate degree, master's degree, or post-
baccalaureate training in a science relating to health care and
that have participated in the delivery of health care services
or related medical services but do not have a doctor of
medicine, doctor of osteopathy, or doctor of dentistry degree.
VA would be required to select not less than 250 eligible
individuals to participate in the pilot and give priority to
those who participated in the VA Intermediate Care Technician
pilot program and who agree to work as a PA at VA medical
facilities in medically underserved communities or in states
with a per capita population of veterans of more than nine
percent. The bill would also require VA to provide educational
assistance--to include not less than 35 scholarships--to
individuals participating in the pilot program through the VA
Health Professionals Educational Assistance program, to enter
into an agreement for a period of obligated service with each
individual participating in the pilot program who agrees to
work as a VA PA, and to ensure PA mentors are available for
pilot program participants. Finally, the bill would require VA
to appoint a Deputy Director for PA Education and Career
Development and a Deputy Director for Recruitment and Retention
from within the VA Office of PAs and to submit a report to
Congress on the pilot program one year after enactment.
Hearings
There were no full Committee hearings held on H.R. 3262, as
amended.
There were no Subcommittee hearings held on H.R. 3262, as
amended.
Subcommittee Consideration
There were no Subcommittee markups involving H.R. 3262, as
amended.
Committee Consideration
On July 19, 2017, the full Committee met in open markup
session, a quorum being present, and ordered H.R. 3262, as
amended, reported favorably to the House of Representatives by
voice vote.
During consideration of the bill, the following amendment
in the nature of a substitute was considered and agreed to by
voice vote:
An Amendment in the Nature of a Substitute to H.R.,
3262 as amended, offered by Representative Ann McLane
Kuster of New Hampshire.
A motion by Representative Tim Walz of Minnesota to
favorably report H.R. 3262, as amended, to the House of
Representatives was agreed to by voice vote.
Committee Votes
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, there were no recorded votes
taken on amendments or in connection with ordering H.R. 3262,
as amended, reported to the House.
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are to ensure VA provides educational
assistance to certain former members of the Armed Forces for
education and training as VA physician assistants and increases
access to care for veteran patients through the increased
availability of VA physician assistants.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee adopts as its
own the estimate of new budget authority, entitlement
authority, or tax expenditures or revenues contained in the
cost estimate prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
Earmarks and Tax and Tariff Benefits
H.R. 3262, as amended, does not contain any Congressional
earmarks, limited tax benefits, or limited tariff benefits as
defined in clause 9 of rule XXI of the Rules of the House of
Representatives.
Committee Cost Estimate
The Committee adopts as its own the cost estimate on H.R.
3262, as amended, prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
Congressional Budget Office Cost Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
for H.R. 3262, as amended, provided by the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act
of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, July 24, 2017.
Hon. Phil Roe, M.D.,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 3262, the Grow Our
Own Directive: Physician Assistant Employment and Education Act
of 2027.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Ann E.
Futrell.
Sincerely,
Mark P. Hadley
(For Keith Hall, Director).
Enclosure.
H.R. 3262--Grow Our Own Directive: Physician Assistant Employment and
Education Act of 2017
Summary: H.R. 3262 would require the Department of Veterans
Affairs (VA) to modify compensation levels for physician
assistants (PAs) and to carry out a five-year pilot program to
provide educational assistance to veterans training to be PAs
at the department. CBO estimates that implementing the bill
would cost $120 million over the 2017-2022 period, assuming
appropriation of the necessary amounts.
The bill also would increase the fees charged to certain
veterans who obtain loans guaranteed by VA. CBO estimates that
enacting H.R. 3262 would decrease direct spending by $83
million over the 2017-2027 period. Because enacting the
legislation would affect direct spending, pay-as-you-go
procedures apply. Enacting the bill would not affect revenues.
CBO estimates that enacting H.R. 3262 would not increase
net direct spending or on-budget deficits in any of the four
consecutive 10-year periods beginning in 2028.
H.R. 3262 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would impose no costs on state, local, or tribal
governments.
Estimated cost to the Federal Government: The estimated
budgetary effect of H.R. 3262 is shown in the following table.
The costs of this legislation fall within budget function 700
(veterans benefits and services).
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
----------------------------------------------------------------------
2017 2018 2019 2020 2021 2022 2017-2022
----------------------------------------------------------------------------------------------------------------
INCREASES IN SPENDING SUBJECT TO APPROPRIATION
Competitive Pay for Physician Assistants:
Estimated Authorization Level........ 0 12 18 18 21 23 92
Estimated Outlays.................... 0 10 17 17 20 22 86
Pilot Program:
Estimated Authorization Level........ 0 2 7 10 11 6 36
Estimated Outlays.................... 0 2 6 9 11 6 34
Total Changes
Estimated Authorization Level.... 0 14 25 28 32 29 128
Estimated Outlays................ 0 12 23 26 31 28 120
----------------------------------------------------------------------------------------------------------------
Note: In addition to the costs shown above, enacting H.R. 3262 would decrease mandatory spending by $83 million
in 2025.
Basis of estimate: For this estimate, CBO assumes that H.R.
3262 will be enacted near the start of 2018, that the estimated
amounts will be appropriated each year, and that outlays will
follow historical spending patterns for affected programs.
Spending subject to appropriation
CBO estimates that implementing H.R. 3262 would increase
personnel and administrative costs at VA by a total of $120
million over the 2017-2022 period, subject to appropriation of
the necessary amounts.
Competitive Pay for Physician Assistants. Section 4 would
require VA to compensate PAs at rates that are competitive with
those paid by other health care providers. Currently, VA
employs about 2,200 physician assistants. Based on wages paid
in the private sector, CBO estimates that pay for those
employees would increase by 5 percent in 2018 (from $114,000 to
$120,000) if VA paid competitive rates. In addition, CBO
expects that the higher pay level would help ameliorate VA's
current difficulties in recruiting and retaining physicians
assistants and would thus increase the total number of PAs
employed by VA. Based on data from VA on hiring and retaining
nurses who are paid at competitive rates, CBO estimates that
under the bill VA would increase the number of PAs it employs
by about 4 percent above the current staffing level. On that
basis, CBO estimates that implementing the section would cost
$86 million over the 2017-2022 period.
Pilot Program. One of VA's largest staffing shortages is
for PAs. Section 2 would require VA to establish a five-year
pilot program to improve the recruitment and retention of PAs
by providing educational assistance to certain former members
of the Armed Forces. Participants in the pilot program must
agree to work as PAs for VA for at least three years. The pilot
program would offer scholarships to at least 250 candidates and
provide no less than 35 scholarships each year.
A master's degree program in physician assistant studies
takes two years to complete, with an average annual cost of
$40,000. CBO expects that VA would cover the full tuition of 35
people in 2018 and up to 145 people a year by 2021. After
accounting for anticipated inflation, CBO estimates that costs
for tuition would total $30 million over the 2017-2022 period.
Section 2 also would require VA to hire two senior
administrators to oversee and coordinate the pilot program. On
the basis of information from VA on salaries of senior
officials, CBO estimates that the salary and fringe benefits
would be roughly $150,000 (the equivalent of a GS-15 level) for
each person. In addition, CBO expects VA would need to hire a
recruiter, with annual costs of $70,000, and an administrative
assistant, with annual costs of $47,000. In total, CBO
estimates that the administrative costs of implementing the
pilot program would be $4 million over the 2017-2022 period.
Direct spending
Under its Home Loan program, VA guarantees mortgages made
to veterans; those guarantees enable veterans to get better
loan terms, such as lower interest rates or smaller down
payments. The loan guarantee provides a lender a payment of up
to 25 percent of the outstanding loan balances (subject to some
limitations on the original loan amounts) in the event that a
veteran defaults on a guaranteed loan. Section 3 would increase
some of the fees that VA charges veterans for providing those
guarantees. Those fees lower the subsidy cost of the guarantees
by partially offsetting the costs of subsequent defaults.\1\
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\1\Under the Federal Credit Reform Act of 1990, the subsidy cost of
a loan guarantee is the net present value of estimated payments by the
government to cover defaults and delinquencies, interest subsidies, or
other expenses, offset by any payments to the government, including
origination fees, other fees, penalties, and recoveries on defaulted
loans. Such subsidy costs are calculated by discounting those expected
cash flows using the rate on Treasury securities of comparable
maturity. The resulting estimated subsidy costs are recorded in the
budget when the loans are disbursed.
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Under current law, the up-front fee varies on the basis of
the size of the down payment and whether the veteran has
previously used the loan-guarantee benefit. Borrowers who are
members of the reserve component pay an additional fee of 0.25
percent of the loan amount. Veterans who receive compensation
for service-connected disabilities are exempt from paying the
fee. The current fees that would be affected by section 5 are:
2.15 percent of the loan amount for loans
with no down payment,
1.50 percent of the loan amount for loans
with a 5 percent down payment, and
0.75 percent of the loan amount for loans
with a 10 percent down payment.
Those fees are scheduled to decline on October 1, 2024, to
1.40 percent, 0.75 percent, and 0.50 percent, respectively.
Under section 5, that scheduled fee reduction would be
delayed by three months, until December 31, 2024. Continuing
the fees at their current level would increase collections by
VA, thereby lowering the subsidy cost of the loan guarantees.
Based on data from VA, CBO estimates that enacting section 5
would reduce direct spending by $83 million in 2025.
Pay-As-You-Go considerations: The Statutory Pay-As-You-Go
Act of 2010 establishes budget-reporting and enforcement
procedures for legislation affecting direct spending or
revenues. The net changes in outlays that are subject to those
pay-as-you-go procedures are shown in the following table.
CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR H.R. 3262, THE GROW OUR OWN DIRECTIVE: PHYSICIAN ASSISTANT EMPLOYMENT AND EDUCATION ACT OF 2017, AS ORDERED
REPORTED BY THE HOUSE COMMITTEE ON VETERANS' AFFAIRS ON JULY 19, 2017
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
---------------------------------------------------------------------------------------------------
2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2017-2022 2017-2027
--------------------------------------------------------------------------------------------------------------------------------------------------------
NET INCREASE OR DECREASE (-) IN THE [ON-BUDGET] DEFICIT
Statutory Pay-As-You-Go Impact 0 0 0 0 0 0 0 0 -83 0 0 0 -83
--------------------------------------------------------------------------------------------------------------------------------------------------------
Increase in long-term direct spending and deficits: CBO
estimates that enacting H.R. 3262 would not increase net direct
spending or on-budget deficits in any of the four consecutive
10-year periods beginning in 2028.
Intergovernmental and private-sector impact: H.R. 3262
contains no intergovernmental or private-sector mandates as
defined in UMRA and would impose no costs on state, local, or
tribal governments.
Estimate prepared by: Federal costs: Ann E. Futrell and
Dwayne M. Wright; Impact on state, local, and tribal
governments: Jon Sperl; Impact on the private sector: Paige
Piper/Bach.
Estimate approved by: H. Samuel Papenfuss, Deputy Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 3262, as amended, prepared by the
Director of the Congressional Budget Office pursuant to section
423 of the Unfunded Mandates Reform Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
3262, as amended.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 3262, as amended, is authorized by Congress'
power to ``provide for the common Defense and general Welfare
of the United States.''
Applicability to Legislative Branch
The Committee finds that H.R. 3262, as amended, does not
relate to the terms and conditions of employment or access to
public services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Statement on Duplication of Federal Programs
Pursuant to section 3(g) of H. Res. 5, 115th Cong. (2017),
the Committee finds that no provision of H.R. 3262, as amended,
establishes or reauthorizes a program of the Federal Government
known to be duplicative of another Federal program, a program
that was included in any report from the Government
Accountability Office to Congress pursuant to section 21 of
Public Law 111-139, or a program related to a program
identified in the most recent Catalog of Federal Domestic
Assistance.
Disclosure of Directed Rulemaking
Pursuant to section 3(i) of H. Res. 5, 115th Cong. (2017),
the Committee estimates that H.R. 3262, as amended, contains no
directed rule making that would require the Secretary to
prescribe regulations.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 of the bill would provide a short title of H.R.
3262, as amended, as the ''Grow Our Own Directive: Physician
Assistant Employment and Education Act of 2017''.
Section 2. Pilot program to provide educational assistance to be
employed at the Department of Veterans Affairs
Section 2(a) of the bill would require VA to carry out a
pilot program called the ``Grow Our Own Directive'' (or,
``G.O.O.D.'') to provide assistance to certain former members
of the Armed Forces for education and training as VA physician
assistants. Section 2(a) would also require VA to provide
relevant information--to include information regarding the
application process and a list of entities with which VA has
partnered--to individuals eligible for the G.O.O.D. pilot.
Section 2(b) of the bill would require that the eligibility
criteria for the G.O.O.D. pilot be defined as follows: (1)
possession of medical or military health experience gained
while serving as a member of the Armed Forces; (2) possession
of a certificate, associate degree, baccalaureate degree,
master's degree, or post baccalaureate training in a science
relating to health care; (3) is not eligible to participate in
education assistance under chapter 30, 31, 32, 33, 34, or 55 of
title 38, U.S.C., or chapter 1606 or 1607 of title 10, U.S.C.;
(4) participation in the delivery of health care services or
related medical services, including military training relating
to identification, evaluation, treatment, and prevention of
diseases and disorders; and, (5) is not a doctor of medicine,
doctor of osteopathy, or doctor of dentistry degree.
Section 2(c) of the bill would require that the G.O.O.D.
pilot be carried out for five years, beginning 180 days after
the date of enactment.
Section 2(d) of the bill would require VA to select at
least 250 eligible individuals to participate in the G.O.O.D.
pilot. This section would stipulate that in selecting eligible
individuals, VA must give priority to those who participated in
the Intermediate Care Technician pilot program and those who
agree to be employed as a physician assistant at a VA facility
in a community that is designated as serving a medically
underserved population in a state with a per capita veteran
population of more than nine percent.
Section 2(e) of the bill would require VA to provide
assistance, including through scholarships, to individuals
participating in the G.O.O.D. pilot to cover the costs of
obtaining a master's degree in physician assistant studies or a
similar master's degree. VA would also be required to use the
VA Health Professionals Education Assistance Program and such
other educational assistance programs as considered appropriate
to individuals participating in the G.O.O.D. pilot. VA would be
required to provide at least 35 scholarships to individuals
participating in the G.O.O.D. pilot during each year in which
the pilot is carried out.
Section 2(f) of the bill would require VA to enter into
agreements with each G.O.O.D. pilot participant stipulating
that the participant will be employed as a VA physician
assistant for a period of three years, unless a participating
individual is in a program described in subsection (e)(2) of
the bill and that program specified a period of time during
which that individual agreed to work for VA.
Section 2(g) of the bill would require that an individual
who participated in the G.O.O.D. pilot and who fails to satisfy
the period of obligated service described in subsection (f)(2)
of the bill is liable for the amount that has been paid or is
payable to or on behalf of the individual reduced by the number
of days served for completion of the period of obligated
service. If an individual is participating in the G.O.O.D.
pilot through a program described in subsection (e)(2) that
specifies a period of obligated service, the liability of the
individual for failing to satisfy the period of obligated
service under subsection (f)(1) would be determined as
specified with respect to such program.
Section 2(h) of the bill would require VA to ensure
physician assistant mentors are available for individuals
participating in the G.O.O.D. pilot at each VA facility at
which pilot participants are working.
Section 2(i) of the bill would require that, in carrying
out the G.O.O.D. pilot, VA seek to partner with: (1) at least
15 institutions of higher education that offer a master's
degree program in physician assistant studies or a similar area
of study that is accredited by the Accreditation Review
Commission on Education for the Physician Assistant and that
agree to guarantee seats in such programs for individuals
participating in the G.O.O.D. pilot who meet the entrance
requirements and to provide pilot participants with information
on admissions; (2) other institutions of higher education that
offer programs in physician assistant studies or other similar
areas of studies that are accredited by the Accreditation
Review Commission on Education for the Physician Assistant; (3)
the Department of Defense Transition Assistance Program; (4)
the Department of Labor Veterans' Employment and Training
Service; and (5) programs carried out under chapter 41 of title
38, U.S.C., for the purpose of marketing and advertising the
G.O.O.D. pilot to veterans and members of the Armed Forces who
may be interested.
Section 2(j) of the bill would require that, for the
purposes of carrying out the G.O.O.D. pilot, VA appoint from
within the Office of Physician Assistants, a Deputy Director
for Education and Career Development of Physician Assistants
who is a physician assistant, a veteran, and a VAemployee to be
responsible for the following: (1) overseeing the G.O.O.D. pilot; (2)
recruiting candidates to participate in the G.O.O.D. pilot; (3)
coordinating with individuals participating in the G.O.O.D. pilot; and
(4) assisting individuals participating in the G.O.O.D. pilot in
applying to master's programs. VA would also be required to select a
Deputy Director of Recruitment and Retention who is a physician
assistant employed by VA to be responsible for: (1) identifying and
coordinating the needs of the pilot program; (2) assisting VA in
providing mentors to G.O.O.D. pilot participants; and (3) coordinating
VA facility staff with respect to identifying employment positions and
mentors. This section would also require VA to select a recruiter to
report directly to the Deputy Director of Recruitment and Retention and
work with the Workforce Management and Consulting Office and the
Healthcare Talent Management Office to develop and implement national
recruiting strategic plans for the recruitment and retention of VA
physician assistants. Further, section 2(j) of the bill would require
VA to select an administrative assistant, compensated at a rate not
less than level GS-6 or equivalent, to assist with administrative
duties relating to the G.O.O.D. pilot in the Office of Physician
Assistant Services and such other duties as determined by the Secretary
to ensure that the Office runs effectively and efficiently.
Section 2(k) of the bill would require that, within one
year of enactment, VA submit to Congress a report on the pilot
program, in collaboration with the Department of Labor, the
Department of Defense, and the Department of Health and Human
Services. The report must include: (1) the extent to which the
G.O.O.D. pilot is effective in improving the ability of
participants to become physician assistants; (2) an examination
of whether the G.O.O.D. pilot is achieving the goal of enabling
individuals to build on medical skills gained as members of the
Armed Forces by entering into the VA physician assistant
workforce and helping to meet the shortage of physician
assistants employed by VA; (3) an identification of such
modifications to the pilot program as considered necessary; and
(4) an assessment of whether the G.O.O.D. pilot could serve as
a model for other VA programs.
Section 2(l) of the bill would require that no less than
$8,000,000 of the amount necessary to carry out the pilot
program be derived from amounts appropriated to VA before the
date of the enactment of this act.
Section 3. Establishment of standards for the Department of Veterans
Affairs for using educational assistance programs to educate
and hire physician assistants
Section 3(a) of the bill would require VA to establish
standards described in subsection (b) to improve VA's use of
the Department's Health Professionals Educational Assistance
Program under chapter 76 of title 38, U.S.C., and other VA
educational assistance programs, including the G.O.O.D. pilot,
to educate and hire physician assistants in VA.
Section 3(b) of the bill would require that the standards
described consist of the following: (1) holding directors of
medical centers of the Department accountable for failure to
use the educational assistance programs described in subsection
(a) and other incentives to advance employees of the Department
in their education as physician assistants and to improve
recruitment and retention of physician assistants; (2) ensuring
that the Department of Veterans Affairs Education Debt
Reduction Program under subchapter VII of chapter 76 of such
title is available for participants in the pilot program under
section 2 to fill vacant physician assistant positions at the
Department, including by including in all vacancy announcements
for physician assistant positions the availability of the
Education Debt Reduction Program, and informing applicants to
physician assistant positions of their eligibility for the
Education Debt Reduction Program; (3) Monitoring compliance
with the application process for educational assistance
programs described in subsection (a) to ensure that such
programs are being fully utilized to carry out this section;
and, Creating programs, including through the use of the
Department of Veterans Affairs Employee Incentive Scholarship
Program under subchapter VI of chapter 76 of such title, to
encourage employees of the Department to apply to accredited
physician assistant programs.
Section 3(c) of the bill would require that VA prescribe
such regulations as the Secretary considers appropriate to
carry out this section.
Section 4. Establishment of pay grades for physician assistants of the
Department of Veterans Affairs and requirement to provide
competitive pay
Section 4(a) of the bill would amend section 7404(b) of
title 38, U.S.C., by adding at the end, ``PHYSICIAN ASSISTANT
SCHEDULE,'' ``Physician Assistant IV,'' ``Physician Assistant
III,'' ``Physician Assistant II,'' and ``Physician Assistant
I.''
Section 4(b) of the bill would amend section 7451(a)(2) by
redesignating subparagraph (B) as subparagraph (C); by
inserting after subparagraph (A) the following new subparagraph
(B): `(B) Physician assistant.''; and, in subparagraph (C), as
redesignated by paragraph (1), by striking ``and registered
nurse'' and inserting ``registered nurse, and physician
assistant''.
Section 4(c) of the bill would require that VA implement a
national strategic plan for the retention and recruitment of VA
physician assistants that includes the establishment and
adoption of standards for the provision of competitive pay to
physician assistants of the Department in comparison to the pay
of physician assistants in the private sector. This section
would also require that no later than one year after the date
of the enactment of this act, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee
on Veterans' Affairs of the House of Representatives a report
on the implementation of the national strategic plan under
paragraph (1).
Section 5. Extension of requirement for collection of fees for housing
loans guaranteed by Secretary of Veterans Affairs
Section 3 of the bill would amend section 3729(b)(2) of
title 38, U.S.C. clause (iii) in subparagraph (A) by striking
``September 30, 2024'' and inserting ``September 30, 2025;''
clause (iv) in subparagraph (A) by striking ``September 30,
2024'' and inserting ``September 30, 2025;'' clause (i) in
subparagraph (B) by striking ``September 30, 2024'' and
inserting ``September 30, 2025;'' clause (ii) in subparagraph
(B) by striking ``September 30, 2024'' and inserting
``September 30, 2025;'' clause (i) in subparagraph (C) by
striking ``September 30, 2024'' and inserting ``September 30,
2025;'' clause (ii) in subparagraph (C) by striking ``September
30, 2024'' and inserting ``September 30, 2025;'' clause (i) in
subparagraph (D) by striking ``September 30, 2024'' and
inserting ``September 30, 2025;'' and, clause (ii) in
subparagraph (D) by striking ``September 30, 2024'' and
inserting ``September 30, 2025.''
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, and existing law in which no
change is proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART III--READJUSTMENT AND RELATED BENEFITS
* * * * * * *
CHAPTER 37--HOUSING AND SMALL BUSINESS LOANS
* * * * * * *
Subchapter III--ADMINISTRATIVE PROVISIONS
* * * * * * *
Sec. 3729. Loan fee
(a) Requirement of Fee.--(1) Except as provided in subsection
(c), a fee shall be collected from each person obtaining a
housing loan guaranteed, insured, or made under this chapter,
and each person assuming a loan to which section 3714 of this
title applies. No such loan may be guaranteed, insured, made,
or assumed until the fee payable under this section has been
remitted to the Secretary.
(2) The fee may be included in the loan and paid from
the proceeds thereof.
(b) Determination of Fee.--(1) The amount of the fee shall be
determined from the loan fee table in paragraph (2). The fee is
expressed as a percentage of the total amount of the loan
guaranteed, insured, or made, or, in the case of a loan
assumption, the unpaid principal balance of the loan on the
date of the transfer of the property.
(2) The loan fee table referred to in paragraph (1) is as
follows:
LOAN FEE TABLE
------------------------------------------------------------------------
Active duty
Type of loan veteran Reservist Other obligor
------------------------------------------------------------------------
(A)(i) Initial 2.00 2.75 NA
loan
described in
section
3710(a) to
purchase or
construct a
dwelling with
0-down, or
any other
initial loan
described in
section
3710(a) other
than with 5-
down or 10-
down (closed
before
January 1,
2004)
(A)(ii) 2.20 2.40 NA
Initial loan
described in
section
3710(a) to
purchase or
construct a
dwelling with
0-down, or
any other
initial loan
described in
section
3710(a) other
than with 5-
down or 10-
down (closed
on or after
January 1,
2004, and
before
October 1,
2004)
(A)(iii) 2.15 2.40 NA
Initial loan
described in
section
3710(a) to
purchase or
construct a
dwelling with
0-down, or
any other
initial loan
described in
section
3710(a) other
than with 5-
down or 10-
down (closed
on or after
October 1,
2004, and
before
[September
30, 2024]
December 31,
2024 )
(A)(iv) 1.40 1.65 NA
Initial loan
described in
section
3710(a) to
purchase or
construct a
dwelling with
0-down, or
any other
initial loan
described in
section
3710(a) other
than with 5-
down or 10-
down (closed
on or after
[September
30, 2024]
December 31,
2024 )
(B)(i) 3.30 3.30 NA
Subsequent
loan
described in
section
3710(a) to
purchase or
construct a
dwelling with
0-down, or
any other
subsequent
loan
described in
section
3710(a)
(closed
before
[September
30, 2024]
December 31,
2024 )
(B)(ii) 1.25 1.25 NA
Subsequent
loan
described in
section
3710(a) to
purchase or
construct a
dwelling with
0-down, or
any other
subsequent
loan
described in
section
3710(a)
(closed on or
after
[September
30, 2024]
December 31,
2024 )
(C)(i) Loan 1.50 1.75 NA
described in
section
3710(a) to
purchase or
construct a
dwelling with
5-down
(closed
before
[September
30, 2024]
December 31,
2024 )
(C)(ii) Loan 0.75 1.00 NA
described in
section
3710(a) to
purchase or
construct a
dwelling with
5-down
(closed on or
after
[September
30, 2024]
December 31,
2024 )
(D)(i) Initial 1.25 1.50 NA
loan
described in
section
3710(a) to
purchase or
construct a
dwelling with
10-down
(closed
before
[September
30, 2024]
December 31,
2024 )
(D)(ii) 0.50 0.75 NA
Initial loan
described in
section
3710(a) to
purchase or
construct a
dwelling with
10-down
(closed on or
after
[September
30, 2024]
December 31,
2024 )
(E) Interest 0.50 0.50 NA
rate
reduction
refinancing
loan
(F) Direct 1.00 1.00 NA
loan under
section 3711
(G) 1.00 1.00 NA
Manufactured
home loan
under section
3712 (other
than an
interest rate
reduction
refinancing
loan)
(H) Loan to 1.25 1.25 NA
Native
American
veteran under
section 3762
(other than
an interest
rate
reduction
refinancing
loan)
(I) Loan 0.50 0.50 0.50
assumption
under section
3714
(J) Loan under 2.25 2.25 2.25
section
3733(a)
------------------------------------------------------------------------
(3) Any reference to a section in the ``Type of
loan'' column in the loan fee table in paragraph (2)
refers to a section of this title.
(4) For the purposes of paragraph (2):
(A) The term ``active duty veteran'' means
any veteran eligible for the benefits of this
chapter other than a Reservist.
(B) The term ``Reservist'' means a veteran
described in section 3701(b)(5)(A) of this
title who is eligible under section
3702(a)(2)(E) of this title.
(C) The term ``other obligor'' means a person
who is not a veteran, as defined in section 101
of this title or other provision of this
chapter.
(D) The term ``initial loan'' means a loan to
a veteran guaranteed under section 3710 or made
under section 3711 of this title if the veteran
has never obtained a loan guaranteed under
section 3710 or made under section 3711 of this
title.
(E) The term ``subsequent loan'' means a loan
to a veteran, other than an interest rate
reduction refinancing loan, guaranteed under
section 3710 or made under section 3711 of this
title if the veteran has previously obtained a
loan guaranteed under section 3710 or made
under section 3711 of this title.
(F) The term ``interest rate reduction
refinancing loan'' means a loan described in
section 3710(a)(8), 3710(a)(9)(B)(i),
3710(a)(11), 3712(a)(1)(F), or 3762(h) of this
title.
(G) The term ``0-down'' means a downpayment,
if any, of less than 5 percent of the total
purchase price or construction cost of the
dwelling.
(H) The term ``5-down'' means a downpayment
of at least 5 percent or more, but less than 10
percent, of the total purchase price or
construction cost of the dwelling.
(I) The term ``10-down'' means a downpayment
of 10 percent or more of the total purchase
price or construction cost of the dwelling.
(c) Waiver of Fee.--(1) A fee may not be collected under this
section from a veteran who is receiving compensation (or who,
but for the receipt of retirement pay or active service pay,
would be entitled to receive compensation) or from a surviving
spouse of any veteran (including a person who died in the
active military, naval, or air service) who died from a
service-connected disability.
(2)(A) A veteran described in subparagraph (B) shall
be treated as receiving compensation for purposes of
this subsection as of the date of the rating described
in such subparagraph without regard to whether an
effective date of the award of compensation is
established as of that date.
(B) A veteran described in this subparagraph
is a veteran who is rated eligible to receive
compensation--
(i) as the result of a pre-discharge
disability examination and rating; or
(ii) based on a pre-discharge review
of existing medical evidence (including
service medical and treatment records)
that results in the issuance of a
memorandum rating.
* * * * * * *
PART V--BOARDS, ADMINISTRATIONS, AND SERVICES
* * * * * * *
CHAPTER 74--VETERANS HEALTH ADMINISTRATION--PERSONNEL
* * * * * * *
SUBCHAPTER I--APPOINTMENTS
* * * * * * *
Sec. 7404. Grades and pay scales
(a)(1)(A) The annual rates or ranges of rates of basic pay
for positions provided in section? 7306 and 7401(4) of this
title shall be prescribed from time to time by Executive order
as authorized by chapter 53 of title 5 or as otherwise
authorized by law.
(B) Section 5377 of title 5 shall apply to a
position under section 7401(4) of this title as
if such position were included in the
definition of ``position'' in section 5377(a)
of title 5.
(2) The pay of physicians and dentists serving in
positions to which an Executive order applies under
paragraph (1) shall be determined under subchapter III
of this chapter instead of such Executive order.
(3)(A) The rate of basic pay for a position to which
an Executive order applies under paragraph (1) and is
not described by paragraph (2) shall be set in
accordance with section 5382 of title 5 as if such
position were a Senior Executive Service position (as
such term is defined in section 3132(a) of title 5).
(B) A rate of basic pay for a position may
not be set under subparagraph (A) in excess
of--
(i) in the case the position is not
described in clause (ii), the rate of
basic pay payable for level III of the
Executive Schedule; or
(ii) in the case that the position is
covered by a performance appraisal
system that meets the certification
criteria established by regulation
under section 5307(d) of title 5, the
rate of basic pay payable for level II
of the Executive Schedule.
(C) Notwithstanding the provisions of
subsection (d) of section 5307 of title 5, the
Secretary may make any certification under that
subsection instead of the Office of Personnel
Management and without concurrence of the
Office of Management and Budget.
(b) The grades for positions provided for in paragraph (1) of
section 7401 of this title shall be as follows. The annual
ranges of rates of basic pay for those grades shall be
prescribed from time to time by Executive order as authorized
by chapter 53 of title 5 or as otherwise authorized by law:
PHYSICIAN AND DENTIST SCHEDULE
Physician grade.
Dentist grade.
NURSE SCHEDULE
Nurse V.
Nurse IV.
Nurse III.
Nurse II.
Nurse I.
CLINICAL PODIATRIST, CHIROPRACTOR, AND OPTOMETRIST SCHEDULE
Chief grade.
Senior grade.
Intermediate grade.
Full grade.
Associate grade.
PHYSICIAN ASSISTANT SCHEDULE
Physician Assistant IV.
Physician Assistant III.
Physician Assistant II.
Physician Assistant I.
(c) Notwithstanding the provisions of section 7425(a) of this
title, a person appointed under section 7306 of this title who
is not eligible for pay under subchapter III shall be deemed to
be a career appointee for the purposes of sections 4507 and
5384 of title 5.
(d) Except as provided under subsection (e), subchapter III,
and section 7457 of this title, 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.
(e) The position of Chief Nursing Officer, Office of Nursing
Services, shall be exempt from the provisions of section 7451
of this title and shall be paid at a rate determined by the
Secretary, not to exceed the maximum rate established for the
Senior Executive Service under section 5382 of title 5.
* * * * * * *
SUBCHAPTER IV--PAY FOR NURSES AND OTHER HEALTH-CARE PERSONNEL
Sec. 7451. Nurses and other health-care personnel: competitive pay
(a)(1) It is the purpose of this section to ensure, by a
means providing increased responsibility and authority to
directors of Department health-care facilities, that the rates
of basic pay for health-care personnel positions described in
paragraph (2) in each Department health-care facility
(including the rates of basic pay of personnel employed in such
positions on a part-time basis) are sufficient for that
facility to be competitive, on the basis of pay and other
employee benefits, with non-Department health-care facilities
in the same labor-market area in the recruitment and retention
of qualified personnel for those positions.
(2) The health-care personnel positions referred to
in paragraph (1) (hereinafter in this section referred
to as ``covered positions'') are the following:
(A) Registered nurse.
(B) Physician assistant.
[(B)] (C) Such positions referred to in
paragraphs (1) and (3) of section 7401 of this
title (other than the positions of physician,
dentist, [and registered nurse] registered
nurse, and physician assistant) as the
Secretary may determine upon the recommendation
of the Under Secretary for Health.
(3)(A) Except as provided in subparagraph (B), the
rates of basic pay for covered positions in the
Department shall be established and adjusted in
accordance with this section instead of subsection
(b)(1) of section 7404 of this title or chapter 53 of
title 5.
(B) Under such regulations as the Secretary
shall prescribe, the Secretary shall establish
and adjust the rates of basic pay for covered
positions at the following health-care
facilities in order to provide rates of basic
pay that enable the Secretary to recruit and
retain sufficient numbers of health-care
personnel in such positions at those
facilities:
(i) The Veterans Memorial Medical
Center in the Republic of the
Philippines.
(ii) Department of Veterans Affairs
health-care facilities located outside
the contiguous States, Alaska, and
Hawaii.
(4) The Secretary, after receiving the recommendation
of the Under Secretary for Health, shall prescribe
regulations setting forth criteria and procedures to
carry out this section and section 7452 of this title.
Requirements in such regulations for directors to
provide and maintain documentation of actions taken
under this section shall require no more documentation
than the minimum essential for responsible
administration.
(b) The Secretary shall maintain the five grade levels for
nurses employed by the Department under section 7401(1) of this
title as specified in the Nurse Schedule in section 7404(b) of
this title. The Secretary shall, pursuant to regulations
prescribed to carry out this subchapter, establish grades for
other covered positions as the Secretary considers appropriate.
(c)(1) For each grade in a covered position, there shall be a
range of basic pay. The maximum rate of basic pay for a grade
shall be 133 percent of the minimum rate of basic pay for the
grade, except that, if the Secretary determines that a higher
maximum rate is necessary with respect to any such grade in
order to recruit and retain a sufficient number of high-quality
health-care personnel, the Secretary may raise the maximum rate
of basic pay for that grade to a rate not in excess of 175
percent of the minimum rate of basic pay for the grade.
Whenever the Secretary exercises the authority under the
preceding sentence to establish the maximum rate of basic pay
at a rate in excess of 133 percent of the minimum rate for that
grade, the Secretary shall, in the next annual report required
by subsection (g), provide justification for doing so to the
Committees on Veterans' Affairs of the Senate and House of
Representatives.
(2) The maximum rate of basic pay for any grade for a
covered position may not exceed the maximum rate of
basic pay established for positions in level IV of the
Executive Schedule under section 5316 of title 5. The
maximum rate of basic pay for a grade for the position
of certified registered nurse anesthetist pursuant to
an adjustment under subsection (d) may exceed the
maximum rate otherwise provided in the preceding
sentence.
(3) The range of basic pay for each such grade shall
be divided into equal increments, known as ``steps''.
The Secretary shall prescribe the number of steps. Each
grade in a covered position shall have the same number
of steps. Rates of pay within a grade may not be
established at rates other than whole steps. Any
increase (other than an adjustment under subsection
(d)) within a grade in the rate of basic pay payable to
an employee in a covered position shall be by one or
more of such step increments.
(d)(1) Subject to subsection (e), the rates of basic pay for
each grade in a covered position shall be adjusted periodically
in accordance with this subsection in order to achieve the
purposes of this section. Such adjustments shall be made--
(A) whenever there is an adjustment under
section 5303 of title 5 in the rates of pay
under the General Schedule, with the adjustment
under this subsection to have the same
effective date and to be by the same percentage
as the adjustment in the rates of basic pay
under the General Schedule; and
(B) at such additional times as the director
of a Department health-care facility, with
respect to employees in that grade at that
facility, or the Under Secretary for Health,
with respect to covered Regional and Central
Office employees in that grade, determines.
(2) An adjustment in rates of basic pay under this
subsection for a grade shall be carried out by
adjusting the amount of the minimum rate of basic pay
for that grade in accordance with paragraph (3) and
then adjusting the other rates for that grade to
conform to the requirements of subsection (c). Except
as provided in paragraph (1)(A), such an adjustment in
the minimum rate of basic pay for a grade shall be made
by the director of a Department health-care facility so
as to achieve consistency with the beginning rate of
compensation for corresponding health-care
professionals in the Bureau of Labor Statistics (BLS)
labor-market area of that facility.
(3)(A) In the case of a Department health-care
facility located in an area for which there is current
information, based upon an industry-wage survey by the
Bureau of Labor Statistics for that labor market, on
compensation for corresponding health-care
professionals for the BLS labor-market area of that
facility, the director of the facility concerned shall
use that information as the basis for making
adjustments in rates of pay under this subsection.
Whenever the Bureau of Labor Statistics releases the
results of a new industry-wage survey for that labor
market that includes information on compensation for
corresponding health-care professionals, the director
of that facility shall determine, not later than 30
days after the results of the survey are released,
whether an adjustment in rates of pay for employees at
that facility for any covered position is necessary in
order to meet the purposes of this section. If the
director determines that such an adjustment is
necessary, the adjustment, based upon the information
determined in the survey, shall take effect on the
first day of the first pay period beginning after that
determination.
(B) In the case of a Department health-care
facility located in an area for which the
Bureau of Labor Statistics does not have
current information on compensation for
corresponding health-care professionals for the
labor-market area of that facility for any
covered position, the director of that facility
shall conduct a survey in accordance with this
subparagraph and shall adjust the amount of the
minimum rate of basic pay for grades in that
covered position at that facility based upon
that survey. To the extent practicable, the
director shall use third-party industry wage
surveys to meet the requirements of the
preceding sentence. Any such survey shall be
conducted in accordance with regulations
prescribed by the Secretary. Those regulations
shall be developed in consultation with the
Secretary of Labor in order to ensure that the
director of a facility collects information
that is valid and reliable and is consistent
with standards of the Bureau. The survey should
be conducted using methodology comparable to
that used by the Bureau in making industry-wage
surveys except to the extent determined
infeasible by the Secretary. To the extent
practicable, all surveys conducted pursuant to
this subparagraph or subparagraph (A) shall
include the collection of salary midpoints,
actual salaries, lowest and highest salaries,
average salaries, bonuses, incentive pays,
differential pays, actual beginning rates of
pay, and such other information needed to meet
the purpose of this section. Upon conducting a
survey under this subparagraph, the director
concerned shall determine, not later than 30
days after the date on which the collection of
information through the survey is completed or
published, whether an adjustment in rates of
pay for employees at that facility for any
covered position is necessary in order to meet
the purposes of this section. If the director
determines that such an adjustment is
necessary, the adjustment, based upon the
information determined in the survey, shall
take effect on the first day of the first pay
period beginning after that determination.
(C)(i) A director of a Department health-care
facility may use data on the compensation paid
to certified registered nurse anesthetists who
are employed on a salary basis by entities that
provide anesthesia services through certified
registered nurse anesthetists in the labor-
market area only if the director--
(I) has conducted a survey of
compensation for certified
registered nurse anesthetists
in the local labor-market area
of the facility under
subparagraph (B);
(II) has used all available
administrative authority with
regard to collection of survey
data; and
(III) makes a determination
(under regulations prescribed
by the Secretary) that such
survey methods are insufficient
to permit the adjustments
referred to in subparagraph (B)
for such nurse anesthetists
employed by the facility.
(ii) For the purposes of this
subparagraph, certified registered
nurse anesthetists who are so employed
by such entities shall be deemed to be
corresponding health-care professionals
to the certified registered nurse
anesthetists employed by the facility.
(D) The Under Secretary for Health shall
prescribe regulations providing for the
adjustment of the rates of basic pay for
Regional and Central Office employees in
covered positions in order to assure that those
rates are sufficient and competitive.
(E) The director of a facility or Under
Secretary for Health may not adjust rates of
basic pay under this subsection for any pay
grade so that the minimum rate of basic pay for
that grade is greater than the beginning rates
of compensation for corresponding positions at
non-Department health-care facilities.
(F) The Under Secretary for Health shall
provide appropriate education, training, and
support to directors of Department health care
facilities in the conduct and use of surveys,
including the use of third-party surveys, under
this paragraph.
(4) If the director of a Department health-care
facility, or the Under Secretary for Health with
respect to Regional and Central Office employees,
determines, after any survey under paragraph (3)(B)
that it is not necessary to adjust the rates of basic
pay for employees in a grade of a covered position at
that facility in order to carry out the purpose of this
section, such an adjustment for employees at that
facility in that grade shall not be made.
(5) Information collected by the Department in
surveys conducted under this subsection is not subject
to disclosure under section 552 of title 5.
(6) In this subsection--
(A) The term ``beginning rate of
compensation'', with respect to health-care
personnel positions in non-Department health-
care facilities corresponding to a grade of a
covered position, means the sum of--
(i) the minimum rate of pay
established for personnel in such
positions who have education, training,
and experience equivalent or similar to
the education, training, and experience
required for health-care personnel
employed in the same category of
Department covered positions; and
(ii) other employee benefits for
those positions to the extent that
those benefits are reasonably
quantifiable.
(B) The term ``corresponding'', with respect
to health-care personnel positions in non-
Department health-care facilities, means those
positions for which the education, training,
and experience requirements are equivalent or
similar to the education, training, and
experience requirements for health-care
personnel positions in Department health-care
facilities.
(e)(1) An adjustment in a rate of basic pay under subsection
(d) may not reduce the rate of basic pay applicable to any
grade of a covered position.
(2) The director of a Department health-care
facility, in determining whether to carry out a wage
survey under subsection (d)(3) with respect to rates of
basic pay for a grade of a covered position, may not
consider as a factor in such determination the absence
of a current recruitment or retention problem for
personnel in that grade of that position. The director
shall make such a determination based upon whether, in
accordance with criteria established by the Secretary,
there is a significant pay-related staffing problem at
that facility in any grade for a position. If the
director determines that there is such a problem, or
that such a problem is likely to exist in the near
future, the Director shall provide for a wage survey in
accordance with subsection (d)(3).
(3) The Under Secretary for Health may, to the extent
necessary to carry out the purposes of subsection (d),
modify any determination made by the director of a
Department health-care facility with respect to
adjusting the rates of basic pay applicable to covered
positions. If the determination of the director would
result in an adjustment in rates of basic pay
applicable to covered positions, any action by the
Under Secretary under the preceding sentence shall be
made before the effective date of such pay adjustment.
Upon such action by the Under Secretary, any adjustment
shall take effect on the first day of the first pay
period beginning after such action. The Secretary shall
ensure that the Under Secretary establishes a mechanism
for the timely exercise of the authority in this
paragraph.
(4) Each director of a Department health-care
facility shall provide to the Secretary, not later than
July 31 each year, a report on staffing for covered
positions at that facility. The report shall include
the following:
(A) Information on turnover rates and vacancy
rates for each covered position, including a
comparison of those rates with the rates for
the preceding three years.
(B) The director's findings concerning the
review and evaluation of the facility's
staffing situation, including whether there is,
or is likely to be, in accordance with criteria
established by the Secretary, a significant
pay-related staffing problem at that facility
for any covered position and, if so, whether a
wage survey was conducted, or will be conducted
with respect to that position.
(C) In any case in which the director
conducts such a wage survey during the period
covered by the report, information describing
the survey and any actions taken or not taken
based on the survey, and the reasons for taking
(or not taking) such actions.
(D) In any case in which the director
conducts such a wage survey during the period
covered by the report and makes adjustment in
rates of basic pay applicable to one or more
covered positions at the facility, information
on the methodology used in making such
adjustment or adjustments.
(E) In any case in which the director, after
finding that there is, or is likely to be, in
accordance with criteria established by the
Secretary, a significant pay-related staffing
problem at that facility for any covered
position, determines not to conduct a wage
survey with respect to that position, a
statement of the reasons why the director did
not conduct such a survey.
(5) Not later than September 30 of each year, the
Secretary shall submit to the Committees on Veterans'
Affairs of the Senate and House of Representatives a
report on staffing for covered positions at Department
health care facilities. Each such report shall include
the following:
(A) A summary and analysis of the information
contained in the most recent reports submitted
by facility directors under paragraph (4).
(B) The information for each such facility
specified in paragraph (4).
(6)(A) Upon the request of an individual described in
subparagraph (B) for a report provided under paragraph
(4) with respect to a Department health-care facility,
the Under Secretary for Health or the director of such
facility shall provide to the individual the most
current report for such facility provided under such
paragraph.
(B) An individual described in this
subparagraph is--
(i) an individual in a covered
position at a Department health-care
facility; or
(ii) a representative of the labor
organization representing that
individual who is designated by that
individual to make the request.
(f) For the purposes of this section, the term ``health-care
facility'' means a medical center, an independent outpatient
clinic, or an independent domiciliary facility.
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