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<PRE>[DOCID: f:s1188is.txt]






107th CONGRESS
  1st Session
                                S. 1188

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.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 17, 2001

Mr. Rockefeller (for himself and Mr. Cleland) introduced the following 
 bill; which was read twice and referred to the Committee on Veterans' 
                                Affairs

_______________________________________________________________________

                                 A BILL


 
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 maximu
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        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
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; 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 
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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''.
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