102d CONGRESS
1st Session
H. R. 598
AMENDMENT
HR 598 EAS
In the Senate of the United States,
April 17 (legislative day, April 9), 1991.
Resolved, That the bill from the House of Representatives (H.R. 598)
entitled `An Act to amend title 38, United States Code, to improve the
capability of the Department of Veterans Affairs to recruit and retain
physicians and dentists through increases in special pay authorities, to
authorize collective bargaining over conditions of employment for health-care
employees of the Department of Veterans Affairs, and for other purposes',
do pass with the following
AMENDMENT:
Strike out all after the enacting clause and insert:

9ef98882c8e2990d20d25327ee3ff95d0e503443926139823e69e31827d8d7cd

(a) SHORT TITLE- This Act may be cited as the `Department of Veterans
Affairs Health-Care Personnel Act of 1991'.
(b) REFERENCES TO TITLE 38- 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.

fa3b9634da723dd940a86acccb80ffc28051612cfbdf85208ddf6db9bb2488bf

(a) RENAMING- The establishment in the Department of Veterans Affairs
known as the Veterans Health Services and Research Administration is hereby
redesignated as the Veterans Health Administration.
(b) REFERENCES- Any reference to the Veterans Health Services and Research
Administration (or to the Department of Medicine and Surgery of the Veterans'
Administration) in any Federal law, Executive order, regulation, delegation
of authority, or document of or pertaining to the Department of Veterans
Affairs shall be deemed to refer to the Veterans Health Administration.

e37de621af40a88d485be4b27e952ba8f6114c9c710629ce4ad2ed5b2d6cdcb5

This title may be cited as the `Department of Veterans Affairs Physician
and Dentist Recruitment and Retention Act of 1991'.

f157805203c433325f9f4fc64d75b8d96e0ae6d4c25768e46820d9fde0ca83d9

TITLE I

-SPECIAL PAY FOR PHYSICIANS AND DENTISTS

406448e9509a8b52014fd015e406285cdfecb10330f5dc5e3da20c5e52f34060

(a) IN GENERAL- Subchapter I of chapter 74 (as added by section 401(b)(2))
is amended by adding at the end the following sections:
`Sec. 7410. Additional pay authorities
`The Secretary may authorize the Chief Medical Director to pay advance
payments, recruitment or relocation bonuses, and retention allowances to
the personnel described in paragraph (1) of section 7401 of this title,
or interview expenses to candidates for appointment as such personnel, in
the same manner, and subject to the same limitations, as in the case of the
authority provided under sections 5524a, 5706b, 5753, and 5754 of title 5.
`Sec. 7411. Full-time board-certified physicians and dentists: reimbursement
of continuing professional education expenses
`The Secretary shall reimburse any full-time board-certified physician or
dentist appointed under section 7401(1) of this title for expenses incurred,
up to $1,000 per year, for continuing professional education.'.
(2) The table of sections at the beginning of chapter 74 (as amended by
section 401(b)(1)(A)) is amended by inserting after the item relating to
section 7409 the following:
`7410. Additional pay authorities.
`7411. Full-time board-certified physicians and dentists: reimbursement of
continuing professional education expenses.'.
(b) EFFECTIVE DATE- Section 7411 of title 38, United States Code, as
added by subsection (a), shall apply with respect to expenses incurred for
continuing professional education that is pursued after September 30, 1991.

e61290a5b8aa9df392dc0f752bbc074a7935c5096ab68884f6e142cd97259e80

(a) EFFECTIVE DATE- Subchapter III of chapter 74 of title 38, United States
Code, as added by section 102, shall take effect on the  first day of the
first pay period beginning after the earlier of--
(1) July 1, 1991; or
(2) the end of the 90-day period beginning on the date of the enactment
of this Act.
(b) TRANSITIONS PROVISIONS- (1) In the case of an agreement entered into
under section 4118 of title 38, United States Code, before the date of
the enactment of this Act that expires after the effective date specified
in subsection (a), the Secretary of Veterans Affairs and the physician
or dentist concerned may agree to terminate that agreement as of that
effective date in order to permit a new agreement under subchapter III
of chapter 74 of title 38, United States Code, as added by section 102,
to take effect as of that effective date.
(2) In the case of an agreement entered into under section 4118 of title
38, United States Code, before the date of the enactment of this Act that
expires during the period beginning on the date of the enactment of this Act
and ending on the effective date specified in subsection (a), an extension
or renewal of that agreement may not extend beyond that effective date.
(3) In the case of a physician or dentist who begins employment with the
Department of Veterans Affairs during the period beginning on the date
of the enactment of this Act and ending on the effective date specified
in subsection (a) who is eligible for an agreement under section 4118 of
title 38, United States Code, any such agreement may not extend beyond
that effective date.
(c) SAVINGS PROVISION- Except as provided in subsection (b)(1), any agreement
entered into under section 4118 of title 38, United States Code, before
the effective date specified in subsection (a) shall remain in effect in
accordance with its terms and shall be treated for all purposes in accordance
with such section as in effect on the day before such effective date.
(d) PROHIBITION OF RETROACTIVE AGREEMENTS- An agreement entered into under
subchapter III of chapter 74 of title 38, United States Code, as added by
section 102, may not provide special pay with respect to a period before
the effective date specified in subsection (a).

54f1db4d72712576b60d02cf01bfe4a0a2d63548b59332f4b52d639d43d95e56

This title may be cited as the `Department of Veterans Affairs Labor
Relations Improvement Act of 1991'.

1b994faad63a0919294b8126528e2f64ba35c7d5a076b1ffd37e81fa68ce9fc2

TITLE II

-LABOR-MANAGEMENT RELATIONS

Chapter 74, as added by section 102, is amended by inserting before
subchapter III the following:
`SUBCHAPTER II--COLLECTIVE BARGAINING AND PERSONNEL ADMINISTRATION
`Sec. 7421. Personnel administration: in general
`(a) Notwithstanding any law, Executive order, or regulation, the Secretary
shall prescribe by regulation the hours and conditions of employment and
leaves of absence of employees appointed under any provision of this chapter
in positions in the Veterans Health Administration listed in subsection (b).
`(b) Subsection (a) refers to the following positions:
`(1) Physicians.
`(2) Dentists.
`(3) Podiatrists.
`(4) Optometrists.
`(5) Registered nurses.
`(6) Physician assistants.
`(7) Expanded-duty dental auxiliaries.
`Sec. 7422. Collective bargaining
`(a) Except as otherwise specifically provided in this title, the
authority of the Secretary to prescribe regulations under section 7421
of this title is subject to the right of Federal employees to engage in
collective bargaining with respect to conditions of employment through
representatives chosen by them in accordance with chapter 71 of title 5
(relating to labor-management relations).
`(b) Such collective bargaining (and any grievance procedures provided under
a collective bargaining agreement) in the case of employees described in
section 7421(b) of this title may not cover, or have any applicability to,
any matter or question concerning or arising out of (1) professional conduct
or competence, (2) peer review, or (3) the establishment, determination,
or adjustment of employee compensation under this title.
`(c) For purposes of this section, the term `professional conduct or
competence' means any of the following:
`(1) Direct patient care.
`(2) Clinical competence.
`(d) An issue of whether a matter or question concerns or arises out
of (1) professional conduct or competence, (2) peer review, or (3) the
establishment, determination, or adjustment of employee compensation under
this title shall be decided by the Secretary and is not itself subject to
collective bargaining and may not be reviewed by any other agency.
`(e) A petition for judicial review or petition for enforcement under section
7123 of title 5 in any case involving employees described in section 7421(b)
of this title or arising out of the applicability of chapter 71 of title 5
to employees in those positions, shall be taken only in the United States
Court of Appeals for the District of Columbia Circuit.
`Sec. 7423. Personnel administration: full-time employees
`(a) The hours of employment in carrying out responsibilities under this
title of any employee who is appointed in the Administration under any
provision of this chapter on a full-time basis in a position listed in
section 7421(b) of this title (other than an intern or resident appointed
pursuant to section 7406 of this title) and who accepts responsibilities
for carrying out professional services for remuneration other than those
assigned under this title shall consist of not less than 80 hours in a
biweekly pay period (as that term is used in section 5504 of title 5).
`(b) A person covered by subsection (a) may not do any of the following:
`(1) Assume responsibility for the medical care of any patient other than
a patient admitted for treatment at a Department facility, except in those
cases where the person, upon request and with the approval of the Chief
Medical Director, assumes such responsibilities to assist communities or
medical practice groups to meet medical needs which would not otherwise
be available for a period not to exceed 180 calendar days, which may be
extended by the Chief Medical Director for additional periods not to exceed
180 calendar days each.
`(2) Teach or provide consultative services at any affiliated institution
if such teaching or consultation will, because of its nature or duration,
conflict with such person's responsibilities under this title.
`(3) Accept payment under any insurance or assistance program established
under title XVIII or XIX of the Social Security Act or under chapter 55 of
title 10 for professional services rendered by such person while carrying
out such person's responsibilities under this title.
`(4) Accept from any source, with respect to any travel performed by such
person in the course of carrying out such person's responsibilities under
this title, any payment or per diem for such travel, other than as provided
for in section 4111 of title 5.
`(5) Request or permit any individual or organization to pay, on such
person's behalf for insurance insuring such person against malpractice
claims arising in the course of carrying out such person's responsibilities
under this title or for such person's dues or similar fees for membership
in medical or dental societies or related professional associations, except
where such payments constitute a part of such person's remuneration for the
performance of professional responsibilities permitted under this section,
other than those carried out under this title.
`(6) Perform, in the course of carrying out such person's responsibilities
under this title, professional services for the purpose of generating money
for any fund or account which is maintained by an affiliated institution
for the benefit of such institution, or for such person's personal benefit,
or both.
`(c) In the case of any fund or account described in subsection (b)(6)
that was established before September 1, 1973--
`(1) the affiliated institution shall submit semiannually an accounting
to the Secretary and to the Comptroller General of the United States with
respect to such fund or account and shall maintain such fund or account
subject to full public disclosure and audit by the Secretary and the
Comptroller General for a period of three years or for such longer period
as the Secretary shall prescribe, and
`(2) no person in a position specified in paragraph (1)(B) may receive any
cash from amounts deposited in such fund or account derived from services
performed before that date.
`(d) As used in this section:
`(1) The term `affiliated institution' means a medical school or other
institution of higher learning with which the Secretary has a contract or
agreement as referred to in section 7313 of this title for the training
or education of health personnel.
`(2) The term `remuneration' means the receipt of any amount of monetary
benefit from any non-Department source in payment for carrying out any
professional responsibilities.'.

0bec84ce5691b7820b2e57cc3a1c61023790e25b7dad66fe3ce8888a985789c9

(a) REFORM OF DISCIPLINARY PROCEDURES FOR SECTION 7401(1) EMPLOYEES-
Chapter 74, as added by section 102 and amended by section 202, is further
amended by adding at the end the following:
`SUBCHAPTER V--DISCIPLINARY AND GRIEVANCE PROCEDURES
`Sec. 7461. Adverse actions: section 7401(1) employees
`(a) Whenever the Chief Medical Director (or an official designated by the
Chief Medical Director) brings charges based on conduct or performance
against a section 7401(1) employee and as a result of those charges an
adverse personnel action is taken against the employee, the employee shall
have the right to appeal the action.
`(b)(1) If the case involves or includes a question of professional conduct
or competence in which a major adverse action was taken, such an appeal shall
be made to a Disciplinary Appeals Board under section 7462 of this title.
`(2) In any other case, such an appeal shall be made--
`(A) through Department grievance procedures under section 7463 of this
title, in any case that involves or includes a question of professional
conduct or competence in which a major adverse action was not taken or
in any case of an employee who is not covered by a collective bargaining
agreement under chapter 71 of title 5; or
`(B) through grievance procedures provided through collective bargaining
under chapter 71 of title 5 or through Department grievance procedures
under section 7463 of this title, as the employee elects, in the case of
an employee covered by a collective bargaining agreement under chapter
71 of title 5 that does not involve or include a question of professional
conduct or competence.
`(c) For purposes of this subchapter--
`(1) Section 7401(1) employees are employees of the Department employed
on a full-time basis under a permanent appointment in a position listed in
section 7401(1) of this title (other than interns and residents appointed
pursuant to section 7406 of this title).
`(2) A major adverse action is an adverse action which includes any of
the following:
`(A) Suspension.
`(B) Transfer.
`(C) Reduction in grade.
`(D) Reduction in basic pay.
`(E) Discharge.
`(3) A question of professional conduct or competence is a question
involving any of the following:
`(A) Direct patient care.
`(B) Clinical competence.
`(d) An issue of whether a matter or question concerns, or arises out of,
professional conduct or competence is not itself subject to any grievance
procedure provided by law, regulation, or collective bargaining and may
not be reviewed by any other agency.
`(e) Whenever the Secretary proposes to prescribe regulations under this
subchapter, the Secretary shall publish the proposed regulations in the
Federal Register for notice-and-comment not less than 30 days before the
day on which they take effect.
`Sec. 7462. Major adverse actions involving professional conduct or competence
`(a)(1) Disciplinary Appeals Boards appointed under section 7464 of this
title shall have exclusive jurisdiction to review any case--
`(A) which arises out of (or which includes) a question of professional
conduct or competence of a section 7401(1) employee; and
`(B) in which a major adverse action was taken.
`(2) The board shall include in its record of decision in any mixed case
a statement of the board's exclusive jurisdiction under this subsection
and the basis for such exclusive jurisdiction.
`(3) For purposes of paragraph (2), a mixed case is a case that includes both
a major adverse action arising out of a question of professional conduct
or competence and an adverse action which is not a major adverse action or
which does not arise out of a question of professional conduct or competence.
`(b)(1) In any case in which charges are brought against a section 7401(1)
employee which arises out of, or includes, a question of professional
conduct or competence which could result in a major adverse action, the
employee is entitled to the following:
`(A) At least 30 days advance written notice from the Chief Medical Director
or other charging official specifically stating the basis for each charge,
the adverse actions that could be taken if the charges are sustained, and
a statement of any specific law, regulation, policy, procedure, practice,
or other specific instruction that has been violated with respect to
each charge, except that the requirement for notification in advance may
be waived if there is reasonable cause to believe that the employee has
committed a crime for which the employee may be imprisoned.
`(B) A reasonable time, but not less than seven days, to present an answer
orally and in writing to the Chief Medical Director or other deciding
official, who shall be an official higher in rank than the charging
official, and to submit affidavits and other documentary evidence in
support of the answer.
`(2) In any case described in paragraph (1), the employee is entitled to
be represented by an attorney or other representative of the employee's
choice at all stages of the case.
`(3)(A) If a proposed adverse action covered by this section is not
withdrawn, the deciding official shall render a decision in writing within
21 days of receipt by the deciding official of the employee's answer. The
decision shall include a statement of the specific reasons for the decision
with respect to each charge. If a major adverse action is imposed, the
decision shall state whether any of the charges sustained arose out of a
question of professional conduct or competence. If any of the charges are
sustained, the notice of the decision to the employee shall include notice
of the employee's rights of appeal.
`(B) Notwithstanding the 21-day period specified in subparagraph (A), a
proposed adverse action may be held in abeyance if the employee requests,
and the deciding official agrees, that the employee shall seek counseling or
treatment for a condition covered under the Rehabilitation Act of 1973. Any
such abeyance of a proposed action may not extend for more than one year.
`(4)(A) The Secretary may require that any answer and submission under
paragraph (1)(B) be submitted so as to be received within 30 days of the
date of the written notice of the charges, except that the Secretary shall
allow the granting of extensions for good cause shown.
`(B) The Secretary shall require that any appeal to a Disciplinary Appeals
Board from a decision to impose a major adverse action shall be received
within 30 days after the date of service of the written decision on the
employee.
`(c)(1) When a Disciplinary Appeals Board convenes to consider an appeal
in a case under this section, the board, before proceeding to consider the
merits of the appeal, shall determine whether the case is properly before it.
`(2) Upon hearing such an appeal, the board shall, with respect to each
charge appealed to the board, sustain the charge, dismiss the charge, or
sustain the charge in part and dismiss the charge in part. If the deciding
official is sustained (in whole or in part) with respect to any such charge,
the board shall--
`(A) approve the action as imposed;
`(B) approve the action with modification, reduction, or exception; or
`(C) reverse the action.
`(3) A board shall afford an employee appealing an adverse action under
this section an opportunity for an oral hearing. If such a hearing is held,
the board shall provide the employee with a transcript of the hearing.
`(4) The board shall render a decision in any case within 45 days of
completion of the hearing, if there is a hearing, and in any event no
later than 120 days after the appeal commenced.
`(d)(1) After resolving any question as to whether a matter involves
professional conduct or competence, the Secretary shall cause to be executed
the decision of the Disciplinary Appeals Board in a timely manner and
in any event in not more than 90 days after the decision of the Board is
received by the Secretary. Pursuant to the board's decision, the Secretary
may order reinstatement, award back pay, and provide such other remedies
as the board found appropriate relating directly to the proposed action,
including expungement of records relating to the action.
`(2) If the Secretary finds a decision of the board to be clearly contrary
to the evidence or unlawful, the Secretary may--
`(A) reverse the decision of the board, or
`(B) vacate the decision of the board and remand the matter to the Board
for further consideration.
`(3) If the Secretary finds the decision of the board (while not clearly
contrary to the evidence or unlawful) to be not justified by the nature
of the charges, the Secretary may mitigate the adverse action imposed.
`(4) The Secretary's execution of a board's decision shall be the final
administrative action in the case.
`(e) The Secretary may designate an employee of the Department to represent
management in any case before a Disciplinary Appeals Board.
`(f)(1) A section 7401(1) employee adversely affected by a final order or
decision of a Disciplinary Appeals Board (as reviewed by the Secretary)
may obtain judicial review of the order or decision.
`(2) In any case in which judicial review is sought under this subsection,
the court shall review the record and hold unlawful and set aside any
agency action, finding, or conclusion found to be--
`(A) arbitrary, capricious, an abuse of discretion, or otherwise not in
accordance with law;
`(B) obtained without procedures required by law, rule, or regulation
having been followed; or
`(C) unsupported by substantial evidence.
`Sec. 7463. Other adverse actions
`(a) The Secretary shall prescribe by regulation procedures for the
consideration of grievances of section 7401(1) employees arising from
adverse personnel actions in which each action taken either--
`(1) is not a major adverse action; or
`(2) does not arise out of a question of professional conduct or competence.
Disciplinary Appeals Boards shall not have jurisdiction to review such
matters, other than as part of a mixed case (as defined in section 7462(a)(3)
of this title).
`(b) In the case of an employee who is a member of a collective bargaining
unit under chapter 71 of title 5, the employee may seek review of an
adverse action described in subsection (a) either under the grievance
procedures provided through regulations prescribed under subsection (a)
or through grievance procedures determined through collective bargaining,
but not under both. The employee shall elect which grievance procedure to
follow. Any such election may not be revoked.
`(c)(1) In any case in which charges are brought against a section 7401(1)
employee which could result in a major adverse action and which do not
involve professional conduct or competence, the employee is entitled to
the same notice and opportunity to answer with respect to those charges
as provided in subparagraphs (A) and (B) of section 7462(b)(1) of this title.
`(2) In any other case in which charges are brought against a section
7401(1) employee, the employee is entitled to--
`(A) an advance written notice stating the specific reason for the proposed
action, and
`(B) a reasonable time to answer orally and in writing and to furnish
affidavits and other documentary evidence in support of the answer.
`(d) Grievance procedures prescribed under subsection (a) shall include
the following:
`(1) A right to formal review by an impartial examiner within the Department
of Veterans Affairs, who, in the case of an adverse action arising from
a question of professional conduct or competence, shall be selected from
the panel designated under section 7464 of this title.
`(2) A right to a prompt report of the findings and recommendations by
the impartial examiner.
`(3) A right to a prompt review of the examiner's findings and
recommendations by an official of a higher level than the official who
decided upon the action. That official may accept, modify, or reject the
examiner's recommendations.
`(e) In any review of an adverse action under the grievance procedures
prescribed under subsection (a), the employee is entitled to be represented
by an attorney or other representative of the employee's choice at all
stages of the case.
`Sec. 7464. Disciplinary Appeals Boards
`(a) The Secretary shall from time to time appoint boards to hear appeals
of major adverse actions described in section 7462 of this title. Such
boards shall be known as Disciplinary Appeals Boards. Each board shall
consist of three employees of the Department, each of whom shall be of the
same grade as, or be senior in grade to, the employee who is appealing
an adverse action. At least two of the members of each board shall be
employed in the same category of position as the employee who is appealing
the adverse action. Members of a board shall be appointed from individuals
on the panel established under subsection (d).
`(b)(1) In appointing a board for any case, the Secretary shall designate
one of the members to be chairman and one of the members to be secretary
of the board, each of whom shall have authority to administer oaths.
`(2) Appointment of boards, and the proceedings of such boards, shall
be carried out under regulations prescribed by the Secretary. A verbatim
record shall be maintained of board hearings.
`(c)(1) Notwithstanding sections 5701 and 7332 of this title, the chairman
of a board, upon request of an employee whose case is under consideration by
the board (or a representative of that employee) may, in connection with the
considerations of the board, review records or information covered by those
sections and may authorize the disclosure of such records or information
to that employee (or representative) to the extent the board considers
appropriate for purposes of the proceedings of the board in that case.
`(2) In any such case the board chairman may direct that measures be taken to
protect the personal privacy of individuals whose records are involved. Any
person who uses or discloses a record or information covered by this
subsection for any purpose other than in connection with the proceedings
of the board shall be fined not more than $5,000 in the case of a first
offense and not more than $20,000 in the case of a subsequent offense.
`(d)(1) The Secretary shall provide for the periodic designation of
employees of the Department who are qualified to serve on Disciplinary
Appeals Boards. Those employees shall constitute the panel from which
board members in a case are appointed. The Secretary shall provide
(without charge) a list of the names of employees on the panel to any
person requesting such list.
`(2) The Secretary shall announce periodically, and not less often than
annually, that the roster of employees on the panel is available as described
in paragraph (1). Such announcement shall be made at Department medical
facilities and through publication in the Federal Register. Notice of a name
being on the list must be provided at least 30 days before the individual
selected may serve on a Board or as a grievance examiner. Employees,
employee organizations, and other interested parties may submit comments
to the Secretary concerning the suitability for service on the panel of
any employee whose name is on the list.
`(3) The Secretary shall provide training in the functions and duties of
Disciplinary Appeals Boards and grievance procedures under section 7463
of this title for employees selected to be on the panel.'.
(b) CLERICAL AMENDMENTS- The table of sections at the beginning of chapter
74, as added by section 102, is amended--
(1) by inserting before the item relating to subchapter III the following:
`SUBCHAPTER II--COLLECTIVE BARGAINING AND PERSONNEL ADMINISTRATION
`7421. Personnel administration: in general.
`7422. Collective bargaining.
`7423. Personnel administration: full-time employees.'; and
(2) by adding at the end the following:
`SUBCHAPTER V--DISCIPLINARY AND GRIEVANCE PROCEDURES
`7461. Adverse actions: section 7401(1) employees.
`7462. Major adverse actions involving professional conduct or competence.
`7463. Other adverse actions.
`7464. Disciplinary Appeals Boards.'.

4e5172061827b4dee19bb8c1503df2af73d4869c99c82c74abb59d0e03b75f58

The Secretary of Veterans Affairs shall prescribe regulations under
subchapter V of chapter 74 of title 38, United States Code (as added by
section 203), not later than 180 days after the date of the enactment
of this Act. Such regulations shall be published in the Federal Register
for notice-and-comment not less than 30 days before the day on which they
take effect.

7346b160cf95c0f39161a5850cc2fc2a29903cc491460d088b49ce66664d021f

PENDING ACTIONS.
(a) EXISTING COLLECTIVE-BARGAINING ARRANGEMENTS- Any determination under
chapter 71 of title 5, United States Code, of a collective bargaining unit
within the Veterans Health Administration of the Department of Veterans
Affairs, and any recognition under that chapter of an employee labor
organization as the exclusive bargaining representative for employees
in a collective bargaining unit of the Department of Veterans Affairs,
that is in effect on the date of the enactment of this Act shall not be
affected by the amendments made by this Act and shall continue in effect
in accordance with the terms of such determination or regulation.
(b) PENDING CASES- With respect to cases pending on the date of the enactment
of this Act, or those cases which are brought before the establishment
of either an administrative grievance procedure pursuant to section 7463
of title 38, United States Code (as added by the amendments made by this
title), or a negotiated grievance procedure established under a collective
bargaining agreement, such cases shall proceed in the same manner as they
would have if this Act had not been enacted.

c92fb4e1c4d914289722bd20bcf715bfa9b58cd9acca660eb25003e0a58e2b38

AFFAIRS NURSE PAY ACT OF 1990.
(a) SAVINGS PROVISION- Physician assistants and expanded-function dental
auxiliaries shall continue to be paid after August 14, 1990, according to
the Nurse Schedule in section 4107(b) of title 38, United States Code, as in
effect on August 14, 1990, until the effective date of a determination by the
Secretary to convert those occupations to `covered positions' and pay them
pursuant to section 7451 of such title, as redesignated by section 401(c).
(b) CHIEF MEDICAL DIRECTOR AUTHORITY- Section 4141(d) is amended--
(1) in paragraph (1)(B), by inserting `or the Chief Medical Director, with
respect to covered Regional and Central Office employees in that grade,'
before `determines';
(2) in paragraph (3)--
(A) by redesignating subparagraph (C) as subparagraph (D) and by inserting
`or Chief Medical Director' in that subparagraph after `facility'; and
(B) by inserting after subparagraph (B) the following:
`(C) The Chief Medical Director 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.'; and
(3) in paragraph (4), by inserting `, or the Chief Medical Director with
respect to Regional and Central Office employees,' in the first sentence
after `facility' the first place it appears.
(c) INCLUSION OF CERTAIN TITLE 5 EMPLOYEES- Section 4141(a)(3) is amended
by inserting `or chapter 53 of title 5' before the period at the end.
(d) TECHNICAL AMENDMENT- Section 4142(a)(3) is amended by striking out
`appointed' and inserting in lieu thereof `paid'.
(e) EFFECTIVE DATE- Section 104(a)(2) of Public Law 101-366 is amended by
inserting `the first day of the first pay period beginning after' before
`April 1, 1991'.

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TITLE III

-MISCELLANEOUS

HEALTH CARE.
Section 19011(e)(1) of the Veterans' Health Care Amendments of 1986
(38 U.S.C. 610 note) is amended by striking out `each of' and all that
follows through `1989' and inserting in lieu thereof `each fiscal year
through fiscal year 1991'.

ecdfa601bd14cba14fd59d0d0381d6e1c323c178069568a05128da9867877fe5

Section 210(b)(2) is amended--
(1) in subparagraph (A), by striking out the second and third sentences
and inserting in lieu thereof the following: `No action to carry out such
reorganization may be taken after the submission of such report until the
end of a 90-day period of continuous session of Congress following the date
of the submission of the report. For purposes of the preceding sentence,
continuity of a session of Congress is broken only by an adjournment sine
die, and there shall be excluded from the computation of such 90-day period
any day during which either House of Congress is not in session during an
adjournment of more than three days to a day certain.';
(2) by striking out subparagraph (B) and inserting in lieu thereof the
following:
`(B) An administrative reorganization described in this subparagraph is an
administrative reorganization of a covered field office or facility that
involves a reduction during any fiscal year in the number of full-time
equivalent employees with permanent duty stations at such office or
facility--
`(i) by 15 percent or more; or
`(ii) by a percent which, when added to the percent reduction made in the
number of such employees with permanent duty stations at such office or
facility during the preceding fiscal year, is 25 percent or more.';
(3) in subparagraph (C)--
(A) by inserting `administrative' before `reorganization' the first place
it appears;
(B) by striking out `the reorganization' after `applies to' and inserting
in lieu thereof `an administrative reorganization';
(C) by striking out `more than 25 but less than 100 employees' and inserting
in lieu thereof `30 or more employees'; and
(D) by striking out `in such unit--' and all that follows and inserting
in lieu thereof `in such unit by 50 percent or more.'; and
(4) in subparagraph (D)--
(A) by adding at the end of clause (i) the following new sentence: `Such term
does not include a consolidation or redistribution of functions at a covered
field office or facility, or between components of the Veterans Benefits
Administration and the Veterans Health Administration at a Department medical
and regional office center, if after the consolidation or redistribution
the same number of full-time equivalent employees continues to perform
the affected functions at that field office, facility, or center.';
(B) by striking out clause (ii); and
(C) by redesignating clauses (iii) and (iv) as clauses (ii) and (iii),
respectively.

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IN NURSING HOMES.
(a) EXCLUSION OF STATE HOMES- Section 3203(f)(1)(B) is amended by inserting
before the period at the end the following: `, other than a facility that
is a State home with respect to which the Secretary makes per diem payments
for nursing home care pursuant to section 641(a) of this title'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply as
if included in the amendment made by section 8003(a) of the Omnibus Budget
Reconciliation Act of 1990 (Public Law 101-508; 104 Stat. 1388-874).

3dd7656c4ce3914c26b8448b75db994cfcff4eeb74e312060e01c4e41fb32f16

(a) SECTION 3202- Section 3202(d) is amended by striking out `an inmate'
and inserting in lieu thereof `a patient'.
(b) SUBCHAPTER HEADING- (1) The heading of subchapter II of chapter 85 is
amended by striking out `INMATE' and inserting in lieu thereof `PATIENT'.
(2) The item relating to such subchapter heading in the table of sections
at the beginning of such chapter is amended by striking out `INMATE'
and inserting in lieu thereof `PATIENT'.

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b38f8b3d213323d01f63bed5a6a87b084e9d24c94be2cc87282d2be35cbb11dd

TITLE IV

-REORGANIZATION AND REDESIGNATION OF PARTS IV, V, AND VI OF TITLE 38

(a) TRANSFER OF CHAPTER 75- Chapter 75 is transferred to the end of part
V and is redesignated as chapter 78.
(b) REDESIGNATION OF SECTIONS TO CONFORM TO CHAPTER NUMBERS- (1) Each
section contained in any of chapters 51, 53, 55, 57, 59, 61, 71, 72, 76,
78 (as redesignated by subsection (a)), 81, 83, and 85 is redesignated so
that the first two digits of the section number of that section are the
same as the chapter number of the chapter containing that section.
(2) Chapter 82 is amended--
(A) by redesignating section 5070 as section 8201;
(B) by redesignating sections 5071, 5072, 5073, and 5074 as sections 8211,
8212, 8213, and 8214, respectively;
(C) by redesignating sections 5081, 5082, and 5083 as sections 8221, 8222,
and 8223, respectively;
(D) by redesignating sections 5091, 5092, and 5093 as sections 8231, 8232,
and 8233, respectively; and
(E) by redesignating section 5096 as section 8241.
(c) TABLES OF SECTIONS AND CHAPTERS- (1) The tables of sections at the
beginning of the chapters referred to in subsection (b) are revised so as
to conform the section references in those tables to the redesignations
made by that subsection.
(2) The table of chapters before part I and the tables of chapters at the
beginning of parts IV, V, and VI are revised so as to conform the section
references in those tables to the redesignations made by subsection (b).
(d) CROSS-REFERENCES- (1) Each provision of title 38, United States Code,
that contains a reference to a section redesignated by section 401(a)(4)
or by subsection (b) is amended so that the reference refers to the section
as redesignated.
(2) Any reference in a provision of law other than title 38, United States
Code, to a section redesignated by subsection (b) shall be deemed to refer
to the section as so redesignated.

6fa32b6c04e883dc75b8750296cba56cd2d5d8be5a3996e8c7c9026d5720d157

(a) SUBCHAPTERS OF CHAPTER 73- Subchapter III and subchapter IV (as
redesignated by section 401(a)(2)) of chapter 73 are amended--
(1) by striking out `Administrator' and `Administrator's' each place
they appear and inserting in lieu thereof `Secretary' and `Secretary's',
respectively; and
(2) by striking out `Veterans' Administration' each place it appears and
inserting in lieu thereof `Department';
(3) by striking out `section 4101(c)(1)' in section 7362 and inserting in
lieu thereof `section 7303(a)';
(4) by striking out `of this section' and `of this subsection' each place
they appear (other than in subsections (d), (e), and (g) of section 7332
and in section 7333(b)); and
(5) by striking out `of this paragraph' in section 7332(f)(2)(B).
(b) REFERENCES TO CHAPTER 73 PROVISIONS-
(1) Section 1904(a) is amended by striking out `section 4101' and inserting
in lieu thereof `section 7303'.
(2) Section 5705(a) (as redesignated by section 402(b)) is amended by
striking out `section 4152(b)' and inserting in lieu thereof `section
7311(g)'.
(3) Section 7604(1)(B) (as redesignated by section 402(b)) is amended by
striking out `section 4105' and inserting in lieu thereof `section 7402'.
(4) Section 7612(b) (as redesignated by section 402(b)) is amended--
(A) in paragraph (2)--
(i) by striking out `section 4104' in the matter preceding subparagraph
(A) and inserting in lieu thereof `section 7401'; and
(ii) by striking out `section 4104(3)' in subparagraph (B) and inserting
in lieu thereof `section 7401(3)'; and
(B) in paragraph (3), by striking out `section 4107(g)(1)(B) of this title'
and inserting in lieu thereof `subsection (a)(1) of section 7455 of this
title for personnel described in subsection (a)(2)(B) of such section'.
(5) Section 7616(b)(4) (as redesignated by section 402(b)) is amended by
striking out `section 4108(c)(1)' and inserting in lieu thereof `section
7423(d)(1)'.
(6) Section 8201(f) (as redesignated by section 402(b)) is amended by
striking out `section 4101(b)' and inserting in lieu thereof `section 7302'.
(7) Section 8241 (as redesignated by section 402(b)) is amended by striking
out `section 4101(b)' and inserting in lieu thereof `section 7302'.
(c) REFERENCES IN TITLE 5, UNITED STATES CODE- Title 5, United States Code,
is amended as follows:
(1) Section 5102(c) is amended--
(A) in paragraph (14), by striking out `section 4202 of title 38' and
inserting in lieu thereof `section 7802 of title 38'; and
(B) in paragraph (16), by striking out `section 4114' and inserting in
lieu thereof `sections 7405 and 7406'.
(2) Section 6123 is amended--
(A) in subsection (a)(1), by striking out `section 4107(e)(5)' and inserting
in lieu thereof `section 7453(e)'; and
(B) in subsection (c)(2)--
(i) by striking out `section 4107(e)(2)' in the matter preceding subparagraph
(A) and inserting in lieu thereof `section 7453(b)'; and
(ii) by striking out `subsection (e)(2) of such section 4107' in subparagraph
(B) and inserting in lieu thereof `subsection (b) of such section 7453'.
(3) Section 6128(a) is amended by striking out `section 4107(e)(5)' and
inserting in lieu thereof `section 7453(e)'.
(e) PART V HEADING-
(1) The heading of part V is amended to read as follows:
`PART V--BOARDS, ADMINISTRATIONS, AND SERVICES'.
(2) The item relating to part V in the table of parts before part I is
amended to read as follows:
7101'.
(f) TABLES OF CHAPTERS-
(1) The table of chapters before part I is amended--
(A) by striking out the heading for part V and inserting in lieu thereof
the following:
`PART V--BOARDS, ADMINISTRATIONS, AND SERVICES';
(B) by striking out the items relating to chapters 73 and 75 and inserting
in lieu thereof the following:
7301
7401';
and
(C) by inserting after the item relating to chapter 76 the following
new item:
7801'.
(2) The table of chapters at the beginning of part V is amended--
(A) by striking out the items relating to chapters 73 and 75 and inserting
in lieu thereof the following:
7301
7401';
and
(B) by adding at the end the following new item:
7801'.
Attest:
Secretary.
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cd66046dfcd74dc8b2525003b258f780b75cfcc1c062bfd979fa2f4ab61687df

Department of Veterans Affairs Health-Care Personnel Act of 1991

Other Sections

TITLE I

TITLE II

TITLE III

TITLE IV

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