To amend title 38, United States Code, to enhance the authority of the Secretary of Veterans Affairs to recruit and retain qualified nurses for the Veterans Health Administration, and for other purposes.

October 3, 2001

Mr. UDALL of New Mexico (for himself, Mrs. MCCARTHY of New York, Mrs. KELLY, and Mr. DOYLE) introduced the following bill; which was referred to the Committee on Veterans' Affairs

To amend title 38, United States Code, to enhance the authority of the Secretary of Veterans Affairs to recruit and retain qualified nurses for the Veterans Health Administration, and for other purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) SHORT TITLE- This Act may be cited as the `Department of Veterans Affairs Nurse Recruitment and Retention Enhancement Act of 2001'.

(b) TABLE OF CONTENTS- The table of contents for this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. References to title 38, United States Code.

TITLE I--ENHANCEMENT OF RECRUITMENT AUTHORITIES

Sec. 101. Enhancement of employee incentive scholarship program.

Sec. 102. Enhancement of education debt reduction program.

Sec. 103. Report on requests for waivers of pay reductions for reemployed annuitants to fill nurse positions.

TITLE II--ENHANCEMENT OF RETENTION AUTHORITIES

Sec. 201. Additional pay for Saturday tours of duty for additional health care professional in the Veterans Health Administration.

Sec. 202. Unused sick leave included in annuity computation of registered nurses with the Veterans Health Administration.

Sec. 203. Evaluation of Department of Veterans Affairs nurse managed clinics.

Sec. 204. Staffing levels for operations of medical facilities.

Sec. 205. Annual report on use of authorities to enhance retention of experienced nurses.

Sec. 206. Report on mandatory overtime for nurses and nurse assistants in Department of Veterans Affairs facilities.

TITLE III--OTHER MATTERS

Sec. 301. Organizational responsibility of the Director of the Nursing Service.

Sec. 302. Computation of annuity for part-time service performed by certain health-care professionals before April 7, 1986.

Sec. 303. Modification of nurse locality pay authorities.

Sec. 304. Technical amendments.

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

Except as otherwise expressly provided, whenever in this Act an amendment or repeal is expressed in terms of an amendment to, or repeal of, a section or other provision, the reference shall be considered to be made to a section or other provision of title 38, United States Code.

TITLE I--ENHANCEMENT OF RECRUITMENT AUTHORITIES

SEC. 101. ENHANCEMENT OF EMPLOYEE INCENTIVE SCHOLARSHIP PROGRAM.

(a) PERMANENT AUTHORITY- (1) Section 7676 is repealed.

(2) The table of sections at the beginning of chapter 76 is amended by striking the item relating to section 7676.

(b) MINIMUM PERIOD OF DEPARTMENT EMPLOYMENT FOR ELIGIBILITY- Section 7672(b) is amended by striking `2 years' and inserting `one year'.

(c) SCHOLARSHIP AMOUNT- Subsection (b) of section 7673 is amended--

(1) in paragraph (1), by striking `for any one year' and inserting `for the equivalent of one year of full-time coursework'; and

(2) by striking paragraph (2) and inserting the following new paragraph (2):

`(2) in the case of a participant in the Program who is a part-time student, shall bear the same ratio to the amount that would be paid under paragraph (1) if the participant were a full-time student in the course of education or training being pursued by the participant as the coursework carried by the student

bears to full-time coursework in that course of education or training.'.

(d) LIMITATION ON PAYMENT- Subsection (c) of section 7673 is amended to read as follows:

`(c) LIMITATIONS ON PERIOD OF PAYMENT- (1) The maximum number of school years for which a scholarship may be paid under subsection (a) to a participant in the Program shall be six school years.

`(2) A participant in the Program may not receive a scholarship under subsection (a) for more than the equivalent of three years of full-time coursework.'.

(e) FULL-TIME COURSEWORK- Section 7673 is further amended by adding at the end the following new subsection:

`(e) FULL-TIME COURSEWORK- For purposes of this section, full-time coursework shall consist of the following:

`(1) In the case of undergraduate coursework, 30 semester hours per undergraduate school year.

`(2) In the case of graduate coursework, 18 semester hours per graduate school year.'.

(f) ANNUAL ADJUSTMENT OF MAXIMUM SCHOLARSHIP AMOUNT- Section 7631 is amended--

(1) in subsection (a)(1), by striking `and the maximum Selected Reserve member stipend amount' and inserting `the maximum Selected Reserve member stipend amount, the maximum employee incentive scholarship amount,'; and

(2) in subsection (b)--

(A) by redesignating paragraph (4) as paragraph (6); and

(B) by inserting after paragraph (3) the following new paragraph (4):

`(4) The term `maximum employee incentive scholarship amount' means the maximum amount of the scholarship payable to a participant in the Department of Veterans Affairs Employee Incentive Scholarship Program under subchapter VI of this chapter, as specified in section 7673(b)(1) of this title and as previously adjusted (if at all) in accordance with this section.'.

SEC. 102. ENHANCEMENT OF EDUCATION DEBT REDUCTION PROGRAM.

(a) PERMANENT AUTHORITY- (1) Section 7684 is repealed.

(2) The table of sections at the beginning of chapter 76 is amended by striking the item relating to section 7684.

(b) ELIGIBLE INDIVIDUALS- Subsection (a)(1) of section 7682 is amended--

(1) by striking `under an appointment under section 7402(b) of this title in a position' and inserting `in a position (as determined by the Secretary) providing direct-patient care services or services incident to direct-patient care services'; and

(2) by striking `(as determined by the Secretary)' and inserting `(as so determined)'.

(c) MAXIMUM DEBT REDUCTION AMOUNT- Section 7683(d)(1) is amended--

(1) by striking `for a year'; and

(2) by striking `exceed--' and all that follows through the end of the paragraph and inserting `exceed $44,000 over a total of five years of participation in the Program, of which not more than $10,000 of such payments may be made in each of the fourth and fifth years of participation in the Program.'.

(d) ANNUAL ADJUSTMENT OF MAXIMUM DEBT REDUCTION PAYMENTS AMOUNT- (1) Section 7631, as amended by section 101(f) of this Act, is further amended--

(A) in subsection (a)(1), by inserting before the period at the end of the first sentence the following: `and the maximum education debt reduction payments amount'; and

(B) in subsection (b), by inserting after paragraph (4) the following new paragraph (5):

`(5) The term `maximum education debt reduction payments amount' means the maximum amount of education debt reduction payments payable to a participant in the Department of Veterans Affairs Education Debt Reduction Program under subchapter VII of this chapter, as specified in section 7683(d)(1) of this title and as previously adjusted (if at all) in accordance with this section.'.

(2) Notwithstanding section 7631(a)(1) of title 38, United States Code, as amended by paragraph (1), the Secretary of Veterans Affairs shall not increase the maximum education debt reduction payments amount under that section in calendar year 2002.

(e) TEMPORARY EXPANSION OF INDIVIDUALS ELIGIBLE FOR PARTICIPATION IN PROGRAM- (1) Notwithstanding section 7682(c) of title 38, United States Code, the Secretary of Veterans Affairs may treat a covered individual as being a recently appointed employee in the Veterans Health Administration under section 7682(a) of that title for purposes of eligibility in the Education Debt Reduction Program if the Secretary determines that the participation of the individual in the Program under this subsection would further the purposes of the Program.

(2) For purposes of this subsection, a covered individual is any individual otherwise described by section 7682(a) of title 38, United States Code, as in effect on the day before the date of the enactment of this Act, who--

(A) was appointed as an employee in a position described in paragraph (1) of that section, as so in effect, between January 1, 1999, and September 30, 2000; and

(B) is an employee in such position, or in another position described in paragraph (1) of that section, as so in effect, at the time of application for treatment as a covered individual under this subsection.

(3) The Secretary shall make determinations regarding the exercise of the authority in this subsection on a case-by-case basis.

(4) The Secretary may not exercise the authority in this subsection after December 31, 2001. The expiration of the authority in this subsection shall not affect the treatment of an individual under this subsection before that date as a covered individual for purposes of eligibility in the Education Debt Reduction Program.

(5) In this subsection, the term `Education Debt Reduction Program' means the Department of Veterans Affairs Education Debt Reduction Program under subchapter VII of chapter 76 of title 38, United States Code.

SEC. 103. REPORT ON REQUESTS FOR WAIVERS OF PAY REDUCTIONS FOR REEMPLOYED ANNUITANTS TO FILL NURSE POSITIONS.

(a) REPORT- Not later than November 30 of each of 2001 and 2002, the Secretary of Veterans Affairs shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a report describing each request of the Secretary, during the fiscal year preceding such report, to the Director of the Office of Personnel Management for the following:

(1) A waiver under subsection (i)(1)(A) of section 8344 of title 5, United States Code, of the provisions of such section in order to meet requirements of the Department of Veterans Affairs for appointments to nurse positions in the Veterans Health Administration.

(2) A waiver under subsection (f)(1)(A) of section 8468 of title 5, United States Code, of the provisions of such section in order to meet requirements of the Department for appointments to such positions.

(3) A grant of authority under subsection (i)(1)(B) of section 8344 of title 5, United States Code, for the waiver of the provisions of such section in order to meet requirements of the Department for appointments to such positions.

(4) A grant of authority under subsection (f)(1)(B) of section 8468 of title 5, United States Code, for the waiver of the provisions of such section in order to meet requirements of the Department for appointments to such positions.

(b) INFORMATION ON RESPONSES TO REQUESTS- The report under subsection (a) shall specify for each request covered by the report--

(1) the response of the Director to such request; and

(2) if such request was granted, whether or not the waiver or authority, as the case may be, assisted the Secretary in meeting requirements of the Department for appointments to nurse positions in the Veterans Health Administration.

TITLE II--ENHANCEMENT OF RETENTION AUTHORITIES

SEC. 201. ADDITIONAL PAY FOR SATURDAY TOURS OF DUTY FOR ADDITIONAL HEALTH CARE PROFESSIONAL IN THE VETERANS HEALTH ADMINISTRATION.

(a) IN GENERAL- Section 7454(b) is amended--

(1) by inserting `(1)' after `(b)'; and

(2) by adding at the end the following new paragraph:

`(2) Health care professionals employed in positions referred to in paragraph (1) shall be entitled to additional pay on the same basis as provided for nurses in section 7453(c) of this title.'.

(b) APPLICABILITY- The amendments made by subsection (a) shall take effect on the date of the enactment of this Act, and shall apply with respect to pay periods beginning on or after that date.

SEC. 202. UNUSED SICK LEAVE INCLUDED IN ANNUITY COMPUTATION OF REGISTERED NURSES WITH THE VETERANS HEALTH ADMINISTRATION.

(a) ANNUITY COMPUTATION- Section 8415 of title 5, United States Code, is amended by adding at the end the following:

`(i) In computing an annuity under this subchapter, the total service of an employee who retires from the position of a registered nurse with the Veterans Health Administration on an immediate annuity, or dies while employed in that position leaving any survivor entitled to an annuity, includes the days of unused sick leave to the credit of that employee under a formal leave system, except

that such days shall not be counted in determining average pay or annuity eligibility under this subchapter.'.

(b) DEPOSIT NOT REQUIRED- Section 8422(d) of title 5, United States Code, is amended--

(1) by inserting `(1)' before `Under such regulations'; and

(2) by adding at the end the following:

`(2) Deposit may not be required for days of unused sick leave credited under section 8415(i).'.

(c) EFFECTIVE DATE- The amendments made by this section shall take effect 60 days after the date of the enactment of this Act, and shall apply to individuals who separate from service on or after that effective date.

SEC. 203. EVALUATION OF DEPARTMENT OF VETERANS AFFAIRS NURSE MANAGED CLINICS.

(a) EVALUATION- The Secretary of Veterans Affairs shall carry out an evaluation of the efficacy of the nurse managed health care clinics of the Department of Veterans Affairs. The Secretary shall complete the evaluation not later than 18 months after the date of the enactment of this Act.

(b) CLINICS TO BE EVALUATED- (1) In carrying out the evaluation under subsection (a), the Secretary consider nurse managed health care clinics, including primary care clinics and geriatric care clinics, located in three different Veterans Integrated Service Networks (VISNs) of the Department.

(2) If there are not nurse managed health care clinics located in three different Veterans Integrated Service Networks as of the commencement of the evaluation, the Secretary shall--

(A) establish nurse managed health care clinics in additional Veterans Integrated Services Networks such that there are nurse managed health care clinics in three different Veterans Integrated Service Networks for purposes of the evaluation; and

(B) include such clinics, as so established, in the evaluation.

(c) MATTERS TO BE EVALUATED- In carrying out the evaluation under subsection (a), the Secretary shall address the following:

(1) Patient satisfaction.

(2) Provider experiences.

(3) Cost of care.

(4) Access to care, including waiting time for care.

(5) The functional status of patients receiving care.

(6) Any other matters the Secretary considers appropriate.

(d) REPORT- Not later than 18 months after the date of the enactment of this Act, the Secretary shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a report on the evaluation carried out under subsection (a). The report shall address the matters specified in subsection (c) and include any other information, and any recommendations, that the Secretary considers appropriate.

SEC. 204. STAFFING LEVELS FOR OPERATIONS OF MEDICAL FACILITIES.

(a) IN GENERAL- Section 8110(a) is amended--

(1) in paragraph (1), by inserting after `complete care of patients,' in the fifth sentence the following: `and in a manner consistent with the policies of the Secretary on overtime,'; and

(2) in paragraph (2)--

(A) by inserting `, including the staffing required to maintain such capacities,' after `all Department medical facilities';

(B) by striking `and to minimize' and inserting `, to minimize'; and

(C) by inserting before the period the following: `, and to ensure that eligible veterans are provided such care and services in an appropriate manner'.

(b) NATIONWIDE POLICY ON STAFFING- Paragraph (3) of that section is amended--

(1) in subparagraph (A), by inserting `the adequacy of staff levels for compliance with the policy established under subparagraph (C),' after `regarding'; and

(2) by inserting after subparagraph (B) the following new subparagraph:

`(C) The Secretary shall, in consultation with the Under Secretary for Health, establish a nationwide policy on the staffing of Department medical facilities in order to ensure that such facilities have adequate staff for the provision to veterans of appropriate, high-quality care and services. The policy shall take into account the staffing levels and mixture of staff skills required for the range of care and services provided veterans in Department facilities.'.

SEC. 205. ANNUAL REPORT ON USE OF AUTHORITIES TO ENHANCE RETENTION OF EXPERIENCED NURSES.

(a) ANNUAL REPORT- (1) Subchapter II of chapter 73 is amended by adding at the end the following new section:

`Sec. 7324. Annual report on use of authorities to enhance retention of experienced nurses

`(a) ANNUAL REPORT- Not later than January 31 each year, the Secretary, acting through the Under Secretary for Health, shall submit to Congress a report on the use during the preceding year of authorities for purposes of retaining experienced nurses in the Veterans Health Administration, as follows:

`(1) The authorities under chapter 76 of this title.

`(2) The authority under VA Directive 5102.1, relating to the Department of Veterans Affairs nurse qualification standard, dated November 10, 1999, or any successor directive.

`(3) Any other authorities available to the Secretary for those purposes.

`(b) REPORT ELEMENTS- Each report under subsection (a) shall specify for the period covered by such report, for each Department medical facility and for each Veterans Integrated Service Network, the following:

`(1) The number of waivers requested under the authority referred to in subsection (a)(2), and the number of waivers granted under that authority, to promote to the Nurse II grade or Nurse III grade under the Nurse Schedule under section 7404(b)(1) of this title any nurse who has not completed a

bachelors of science in nursing in a recognized school of nursing, set forth by age, race, and years of experience of the individuals subject to such waiver requests and waivers, as the case may be.

`(2) The programs carried out to facilitate the use of nursing education programs by experienced nurses, including programs for flexible scheduling, scholarships, salary replacement pay, and on-site classes.'.

(2) The table of sections at the beginning of chapter 73 is amended by inserting after the item relating to section 7323 the following new item:

`7324. Annual report on use of authorities to enhance retention of experienced nurses.'.

(b) INITIAL REPORT- The initial report required under section 7324 of title 38, United States Code, as added by subsection (a), shall be submitted in 2002.

SEC. 206. REPORT ON MANDATORY OVERTIME FOR NURSES AND NURSE ASSISTANTS IN DEPARTMENT OF VETERANS AFFAIRS FACILITIES.

(a) REPORT- Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a report on the mandatory overtime required of licensed nurses and nurse assistants providing direct patient care at Department of Veterans Affairs medical facilities during 2001.

(b) MANDATORY OVERTIME- For purposes of the report under subsection (a), mandatory overtime shall consist of any period in which a nurse or nurse assistant is mandated or otherwise required, whether directly or indirectly, to work or be in on-duty status in excess of--

(1) a scheduled workshift or duty period;

(2) 12 hours in any 24-hour period; or

(3) 80 hours in any period of 14 consecutive days.

(c) ELEMENTS- The report under subsection (a) shall include the following:

(1) A description of the amount of mandatory overtime described in that subsection at each Department medical facility during the period covered by the report.

(2) A description of the mechanisms employed by the Secretary to monitor overtime of the nurses and nurse assistants referred to in that subsection.

(3) An assessment of the effects of the mandatory overtime of such nurses and nurse assistants on patient care, including its contribution to medical errors.

(4) Recommendations regarding mechanisms for preventing requirements for amounts of mandatory overtime in other than emergency situations by such nurses and nurse assistants.

(5) Any other matters that the Secretary considers appropriate.

TITLE III--OTHER MATTERS

SEC. 301. ORGANIZATIONAL RESPONSIBILITY OF THE DIRECTOR OF THE NURSING SERVICE.

Section 7306(a)(5) is amended by inserting `, and report directly to,' after `responsible to'.

SEC. 302. COMPUTATION OF ANNUITY FOR PART-TIME SERVICE PERFORMED BY CERTAIN HEALTH-CARE PROFESSIONALS BEFORE APRIL 7, 1986.

Section 7426 is amended--

(1) by redesignating subsection (c) as subsection (d); and

(2) by inserting after subsection (b) the following new subsection (c):

`(c) The provisions of subsection (b) shall not apply to the part-time service before April 7, 1986, of a registered nurse, physician assistant, or expanded-function dental auxiliary. In computing the annuity under the applicable provision of law specified in that subsection of an individual covered by the preceding sentence, the service described in that sentence shall be credited as full-time service.'.

SEC. 303. MODIFICATION OF NURSE LOCALITY PAY AUTHORITIES.

Section 7451 is amended--

(1) in subsection (d)(3)--

(A) in subparagraph (A), by striking `beginning rates of' each time it appears;

(B) in subparagraph (B), by striking `beginning rates of'; and

(C) in subparagraph (C)(i), by striking `beginning rates of' each time it appears;

(2) in subsection (d)(4)--

(A) by striking `or at any other time that an adjustment in rates of pay is scheduled to take place under this subsection' in the first sentence; and

(B) by striking the second sentence; and

(3) in subsection (e)(4)--

(A) in subparagraph (A), by striking `grade in a';

(B) in subparagraph (B)--

(i) by striking `grade of a'; and

(ii) by striking `that grade' and inserting `that position'; and

(C) in subparagraph (D), by striking `grade of a'.

SEC. 304. TECHNICAL AMENDMENTS.

Section 7631(b) is amended by striking `this subsection' each place it appears and inserting `this section'.

END