[House Report 111-489]
[From the U.S. Government Publishing Office]
111th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 111-489
======================================================================
ASSURING QUALITY CARE FOR VETERANS ACT
_______
May 20, 2010.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Filner, from the Committee on Veterans' Affairs, submitted the
following
R E P O R T
[To accompany H.R. 5145]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 5145) to amend title 38, United States Code, to
improve the continuing professional education reimbursement
provided to health professionals employed by the Department of
Veterans Affairs, having considered the same, report favorably
thereon without amendment and recommend that the bill do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Hearings......................................................... 2
Subcommittee Consideration....................................... 3
Committee Consideration.......................................... 3
Committee Votes.................................................. 3
Committee Oversight Findings..................................... 3
Statement of General Performance Goals and Objectives............ 3
New Budget Authority, Entitlement Authority, and Tax Expenditures 3
Earmarks and Tax and Tariff Benefits............................. 4
Committee Cost Estimate.......................................... 4
Congressional Budget Office Estimate............................. 4
Federal Mandates Statement....................................... 5
Advisory Committee Statement..................................... 5
Constitutional Authority Statement............................... 5
Applicability to Legislative Branch.............................. 5
Section-by-Section Analysis of the Legislation................... 6
Changes in Existing Law Made by the Bill as Reported............. 6
Purpose and Summary
H.R. 5145 was introduced by Representative Jerry McNerney
of California on April 27, 2010. This legislation would
increase the amount of reimbursement for continuing
professional education needed to maintain licensure beyond
doctors and dentists to other U.S. Department of Veterans
Affairs (VA) employed health care professionals.
Background and Need for Legislation
Section 103 of Public Law 102-40 (105 Stat. 187), the
Department of Veterans Affairs Health-Care Personnel Act of
1991, directed the Secretary to reimburse up to $1,000 per year
for continuing professional education expenses for any full-
time board-certified physician or dentist employed by the
Veterans Health Administration (VHA).
The Committee recognizes that the reimbursement for
continuing education has not been updated since 1991. As such,
H.R. 5145 increases the reimbursement to $1,600 to reflect the
effects of inflation. The Committee also recognizes that the
reimbursement for continuing education is an important tool in
the VA's recruitment and retention efforts for health care
professionals. In the 2009 Workforce Succession Strategic Plan,
VHA identified the top ten occupational priorities for
recruitment and retention. This list included key health care
professionals such as nurses, pharmacists, physical therapists,
and occupational therapists. Similar to physicians and
dentists, these health care professionals require continuing
professional education in order to maintain their licensure.
H.R. 5145 corrects this inequity by extending continuing
education expenses to health care professionals other than
physicians and dentists who need to maintain licensure. In
addition to making continuing professional education more
accessible for additional VA health professionals, this bill
also helps them update their knowledge and skills so that
veterans receive higher quality health care.
Finally, studies have shown that organizational efforts
that focus on improving access to opportunity, information, and
resources have the potential to empower staff and increase the
level of job satisfaction. H.R. 5145 provides the VA with a
tool to recruit, retain, and empower key health professionals.
Hearings
On March 25, 2010, the Subcommittee on Health held a
legislative hearing on a number of bills introduced during the
111th Congress including draft legislation on continuing
medical education reimbursements which was later introduced as
H.R. 5145. The following witnesses testified: The Honorable Bob
Filner of California; The Honorable Steve Scalise of Louisiana;
The Honorable Gabrielle Giffords of Arizona; The Honorable Ann
Kirkpatrick of Arizona; The Honorable Leonard L. Boswell of
Iowa; The Honorable Ginny Brown-Waite of Florida; Ms. Denise A.
Williams, Assistant Director, Veterans Affairs and
Rehabilitation Commission, The American Legion; Mr. Blake C.
Ortner, Senior Associate Legislative Director, Paralyzed
Veterans of America; Mr. Eric A. Hilleman, Director National
Veterans Service, Veterans of Foreign Wars of the United
States; Ms. Joy J. Ilem, Deputy National Legislative Director,
Disabled American Veterans; Gerald M. Cross, M.D., FAAFP,
Deputy Chief for Patient Care Services and Chief Consultant for
Primary Care, Veterans Health Administration, U.S. Department
of Veterans Affairs who was accompanied by Mr. Walter A. Hall,
Assistant General Counsel, Office of General Counsel, U.S.
Department of Veterans Affairs; Mr. Brian McVeigh, Chief
Consultant, Human Resources Management, Veterans Health
Administration, U.S. Department of Veterans Affairs; and,
Patricia Vandenberg, MHA, BS, Assistant Deputy Under Secretary
for Health for Policy and Planning, Veterans Health
Administration, U.S. Department of Veterans Affairs. Those
submitting for the record included: the American Federation of
Government Employees AFL-CIO; Mr. David J. Holway, National
President, National Association of Government Employees (SEIU-
NAGE); and, Mr. William R. Dougan, National President, National
Federation of Federal Employees.
Subcommittee Consideration
On April 29, 2010, the Subcommittee on Health met in open
markup session and ordered favorably forwarded to the full
Committee H.R. 5145.
Committee Consideration
On May 12, 2010, the full Committee met in an open markup
session, a quorum being present, and ordered H.R. 5145 reported
favorably to the House of Representatives, by voice vote.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report the legislation and amendments thereto.
There were no record votes taken on amendments or in connection
with ordering H.R. 5145 reported to the House. A motion by Mr.
Stearns of Florida to order H.R. 5145 reported favorably to the
House of Representatives was agreed to by voice vote.
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 reflected in the descriptive portions
of this report.
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. 5145 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.
5145 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. 5145 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, May 18, 2010.
Hon. Bob Filner,
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. 5145, the Assuring
Quality Care for Veterans Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sunita
D'Monte.
Sincerely,
Douglas W. Elmendorf,
Director.
Enclosure.
H.R. 5145--Assuring Quality Care for Veterans Act
H.R. 5145 would expand an existing program at the Veterans
Health Administration (VHA) to reimburse employees for the
expenses of continuing professional education. CBO estimates
that implementing the bill would cost $41 million over the
2011-2015 period, assuming appropriation of the necessary
amounts. Enacting this legislation would not affect direct
spending or revenues; therefore, pay-as-you-go procedures would
not apply.
H.R. 5145 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act.
The estimated budgetary impact of H.R. 5145 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--
------------------------------------------------------------
2011 2012 2013 2014 2015 2011-2015
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CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Estimated Authorization Level...................... 4 9 9 10 10 42
Estimated Outlays.................................. 4 8 9 10 10 41
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Under current law, VHA is required to reimburse board-
certified dentists and physicians, up to $1,000 a year, for the
expenses they incur in taking courses to maintain their
professional credentials. According to VHA, there are over
9,500 employees eligible for the program but few request
reimbursements because many such educational opportunities are
provided free at VHA facilities.
The bill would expand the pool of eligible employees to
include several other occupations and would increase the
maximum reimbursement to $1,600 a year. It also would give VHA
discretion in deciding whether to reimburse employees. Based on
information from VHA, CBO estimates that almost 94,000
employees would be eligible under the bill but that, on
average, VHA would reimburse $1,000 each to about 9,300
employees a year. Assuming appropriation of the necessary
amounts, a two-year phase-in period, and annual adjustments for
inflation, CBO estimates that implementing the bill would cost
$4 million in 2011, growing to $10 million a year by 2014.
The CBO staff contact for this estimate is Sunita D'Monte.
The estimate was approved by Theresa Gullo, Deputy Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 5145 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.
5145.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds that the
Constitutional authority for H.R. 5145 is provided by Article
I, section 8 of the Constitution of the United States.
Applicability to Legislative Branch
The Committee finds that the legislation 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.
Section-by-Section Analysis of the Legislation
Section 1. Short title
This section provides the short title of H.R. 5145 as the
``Assuring Quality Care for Veterans Act.''
Section 2. Improvement of continuing professional education
reimbursement for health professionals employed by the
Department of Veterans Affairs
This section requires the Department of Veterans Affairs to
increase the reimbursement for continuing professional
education from $1,000 to $1,600 to reflect inflationary
adjustments since 1991. This section also expands VA's
authority to offer continuing professional education
reimbursements beyond physicians and dentists to other health
care professionals employed by the VA who need such education
in order to maintain their licensure. Finally, this section
ensures that VA health professionals may not be reimbursed for
the same continuing education expenses provided by a VA medical
center.
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):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART V--BOARDS, ADMINISTRATIONS, AND SERVICES
* * * * * * *
CHAPTER 74--VETERANS HEALTH ADMINISTRATION - PERSONNEL
SUBCHAPTER I--APPOINTMENTS
Sec.
7401. Appointments in Veterans Health Administration.
* * * * * * *
[7411. Full-time board-certified physicians and dentists: reimbursement
of continuing professional education expenses.]
7411. Full-time health professionals: reimbursement of continuing
professional education expenses.
* * * * * * *
SUBCHAPTER I--APPOINTMENTS
* * * * * * *
Sec. 7411. [Full-time board-certified physicians and dentists:
reimbursement of continuing professional education
expenses] Full-time health professionals:
reimbursement of continuing professional education
expenses
The Secretary [shall] may reimburse any full-time [board-
certified physician or dentist appointed under section 7401(1)
of this title] health professional appointed under paragraph
(1) or (3) of section 7401 of this title for expenses incurred,
up to [$1,000] $1,600 per year, for continuing professional
education required to maintain licensure. No such health
professional may receive reimbursement under this section and
reimbursement for the same expenses incurred for continuing
professional education provided by a Department medical center.
* * * * * * *