What This Bill Does
This bill improves how the Department of Veterans Affairs hires, trains and pays healthcare workers and other employees. It makes changes to pay rules for doctors and specialists, updates training programs for caring for older veterans, and increases oversight of hiring and staffing decisions.
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Who It Affects
* Healthcare professionals working at VA facilities (doctors, nurses, dentists, optometrists, podiatrists, psychologists, physician assistants)
* VA employees in administrative and support roles
* Veterans receiving care at VA medical centers and community living centers
* VA police officers
* The Department of Veterans Affairs and its sub-agencies
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Key Provisions
* The Secretary of Veterans Affairs shall pay the costs of licensing exams and certifications required for people who received healthcare scholarships from the VA (Sec. 101).
* The VA shall expand training programs for rural healthcare workers who care for older veterans and provide education on treating Alzheimer's disease and dementia (Sec. 102).
* The Secretary must notify Congress within 90 days when a medical center director is temporarily reassigned to a different position, and must appoint an acting director within 120 days (Sec. 104).
* Pay limits for VA physicians, podiatrists, optometrists and dentists change to allow "market pay" (pay based on current job market rates) instead of previous annual limits, and the Secretary can waive pay limits for recruiting or keeping critical healthcare workers (Sec. 201).
* A new pay system allows medical center directors and network directors to receive individually determined market-based pay considering their experience and job complexity (Sec. 202).
* The VA shall expand geriatric care team models and specialty services to every medical center where feasible and needed (Sec. 102).
* Annual leave restored to VA employees during the 2020-2022 public health emergency can be used until January 9, 2027, or employees can choose to receive a lump sum payment instead (Sec. 222).
* The Secretary shall reimburse full-time health professionals up to $1,000 per year for continuing education expenses (Sec. 223).
* VA police officers now qualify as law enforcement officers for retirement benefits purposes, with different rules for officers hired before and after this law takes effect (Sec. 224).
* The Secretary shall make publicly available on the VA website updated information about staffing, vacancies, and recruitment at VA facilities, broken down by location and occupation (Sec. 225).
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What Changes
The VA gains flexibility to pay competitive salaries to recruit and retain healthcare workers by removing previous caps on physician pay. Medical center directors gain clearer rules about temporary reassignments and protection for their permanent positions. VA employees receive clearer options for unused pandemic-era leave. VA police officers gain law enforcement retirement benefits. The public gains access to more detailed VA staffing and hiring information online.
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Important Definitions
* **Market pay**: Pay determined by the Secretary on a case-by-case basis that considers the current job market, the person's experience, and job complexity.
* **Covered health professional scholarship**: Includes VA scholarship programs for nurses, physicians, dentists, podiatrists, physician assistants, psychologists, social workers, and vision professionals.
* **Community living center**: A VA facility that provides residential care, typically for nursing care.
* **Geriatrics Patient Aligned Care Team model**: A team-based approach to providing coordinated care to older patients.
* **Mission critical work**: Not defined in bill text.
* **Law enforcement officer**: An employee of the VA who is a Department police officer under VA regulations, as determined by the Secretary.
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Effective Date
The amendments to physician pay take effect 30 days after enactment (Sec. 201). The amendments to medical center director notification requirements take effect upon enactment (Sec. 104). Provisions regarding police officer retirement benefits apply to individuals hired on or after enactment and to current police officers who make an election within five years of enactment (Sec. 224). Most other provisions take effect upon enactment unless otherwise specified.
II
118TH CONGRESS
1ST SESSION
S. 10
To improve the workforce of the Department of Veterans Affairs, and for
other purposes.
IN THE SENATE OF THE UNITED STATES
JANUARY 23 (legislative day, JANUARY 3), 2023
Mr. TESTER (for himself and Mr. BOOZMAN) introduced the following bill;
which was read twice and referred to the Committee on Veterans’ Affairs
A BILL
To improve the workforce of the Department of Veterans
Affairs, and for other purposes.
Be it enacted by the Senate and House of Representa-
1
tives of the United States of America in Congress assembled,
2
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
3
(a) SHORT TITLE.—This Act may be cited as the
4
‘‘VA Clinician Appreciation, Recruitment, Education, Ex-
5
pansion, and Retention Support (CAREERS) Act of
6
2023’’.
7
(b) TABLE OF CONTENTS.—The table of contents for
8
this Act is as follows:
9
Sec. 1. Short title; table of contents.
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TITLE I—TRAINING, RECRUITMENT, AND RETENTION OF
HEALTH CARE EMPLOYEES
Sec. 101. Payment of licensure exam costs for recipients of scholarships from
Department of Veterans Affairs.
Sec. 102. Improvement of workforce training and team models to meet the
needs of older veterans.
Sec. 103. Study on improving recruitment and retention at community living
centers of Department of Veterans Affairs.
Sec. 104. Limitation on detail of directors of medical centers of Department of
Veterans Affairs to different positions.
TITLE II—ACCOUNTABILITY, OVERSIGHT, AND PERSONNEL
MATTERS
Subtitle A—Matters Relating to Pay
Sec. 201. Modification of pay limitation for physicians, podiatrists, optom-
etrists, and dentists of Department of Veterans Affairs.
Sec. 202. Increased pay cap for directors of medical centers and Veterans Inte-
grated Service Networks of Department of Veterans Affairs.
Sec. 203. Waiver of pay limitation for employees of the Veterans Health Ad-
ministration performing mission critical work.
Sec. 204. Increase of maximum amount of incentive pay for Department phar-
macist executives.
Sec. 205. Modification of special pay authority for nurse executives.
Subtitle B—Improvement of Recruitment and Hiring
Sec. 211. Oversight of direct hire authority and hiring flexibility of Department
of Veterans Affairs.
Sec. 212. Waiver of certain licensure requirements.
Subtitle C—Other Personnel Matters
Sec. 221. Role of optometrists in Department of Veterans Affairs.
Sec. 222. Expansion of annual leave options for employees of Department of
Veterans Affairs during public health emergency.
Sec. 223. Expansion of reimbursement of continuing professional education ex-
penses.
Sec. 224. Inclusion of police officers of Department of Veterans Affairs as law
enforcement officers.
Sec. 225. Department of Veterans Affairs personnel transparency.
Sec. 226. Comptroller General report assessing human resources modernization
within Veterans Health Administration.
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TITLE
I—TRAINING,
RECRUIT-
1
MENT, AND RETENTION OF
2
HEALTH CARE EMPLOYEES
3
SEC. 101. PAYMENT OF LICENSURE EXAM COSTS FOR RE-
4
CIPIENTS OF SCHOLARSHIPS FROM DEPART-
5
MENT OF VETERANS AFFAIRS.
6
(a) IN GENERAL.—The Secretary of Veterans Affairs
7
shall pay the costs of any licensing examinations and cer-
8
tifications required by the Secretary for any current recipi-
9
ent of a covered health professional scholarship from the
10
Department of Veterans Affairs.
11
(b)
LICENSING
EXAMINATIONS
AND
CERTIFI-
12
CATIONS.—Subsection (a) shall apply to the payment of
13
costs for—
14
(1) the United States Medical Licensing Exam-
15
ination Step 1, Step 2, and Step 3;
16
(2) the National Council Licensure Exam;
17
(3) the National Board Dental Examination;
18
(4) the National Board Dental Hygiene Exam-
19
ination;
20
(5) the Dental Licensure Objective Structured
21
Clinical Examination and Integrated National Board
22
Dental Examination;
23
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(6) the National Licensing Exams for Reg-
1
istered Nurses, Nurse Practitioners, and Certified
2
Registered Nurse Anesthetists;
3
(7) the American Podiatric Medical Licensing
4
Exam;
5
(8) the National Board of Examiners in Optom-
6
etry Exam;
7
(9) the Physician Assistant National Certifi-
8
cation Exam;
9
(10) the Examination for Professional Practice
10
in Psychology;
11
(11) the Academy for Certification of Vision
12
Rehabilitation and Education Professionals certifi-
13
cation examinations;
14
(12) the Association of Social Workers Boards
15
Exam; and
16
(13) such other licensing examinations and cer-
17
tifications as the Secretary considers appropriate.
18
(c) REPORT TO CONGRESS.—Not later than one year
19
after the date of the enactment of this Act, and not less
20
frequently than annually thereafter, the Secretary shall
21
submit to the Committee on Veterans’ Affairs of the Sen-
22
ate and the Committee on Veterans’ Affairs of the House
23
of Representatives a report on the implementation of this
24
section that includes the following data for each State and
25
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territory of the United States for the one-year period pre-
1
ceding the date of the report:
2
(1) Utilization by the Secretary of the require-
3
ment under subsection (a) broken down by position
4
and career type.
5
(2) Number of times each examination or cer-
6
tification described in subsection (b) was paid for by
7
the Department and total funds expended by the
8
Department for each such examination or certifi-
9
cation.
10
(d) COVERED HEALTH PROFESSIONAL SCHOLARSHIP
11
DEFINED.—In this section, the term ‘‘covered health pro-
12
fessional scholarship’’ means—
13
(1) the Department of Veterans Affairs Health
14
Professional Scholarship Program under subchapter
15
II of chapter 76 of title 38, United States Code;
16
(2) the Department of Veterans Affairs Em-
17
ployee Incentive Scholarship Program under sub-
18
chapter VI of such chapter, including—
19
(A) the National Nursing Education Initia-
20
tive; and
21
(B) the VA National Education for Em-
22
ployees Program;
23
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(3) the Department of Veterans Affairs Read-
1
justment Counseling Service Scholarship Program
2
under subchapter IX of such chapter;
3
(4) the Visual Impairment and Orientation and
4
Mobility Professionals Scholarship Program under
5
chapter 75 of such title;
6
(5) the Veterans Healing Veterans Medical Ac-
7
cess and Scholarship Program under section 304 of
8
the VA MISSION Act of 2018 (Public Law 115–
9
182; 38 U.S.C. 7601 note);
10
(6) the Physician Assistant Education and
11
Training Pilot Program for Former Members of The
12
Armed Forces under section 246 of division J of the
13
Consolidated Appropriations Act of 2018 (Public
14
Law 115–141; 38 U.S.C. 7601 note); and
15
(7) such other programs as the Secretary con-
16
siders appropriate.
17
SEC. 102. IMPROVEMENT OF WORKFORCE TRAINING AND
18
TEAM MODELS TO MEET THE NEEDS OF
19
OLDER VETERANS.
20
(a) RURAL GERIATRICS TEAM TRAINING.—The Sec-
21
retary of Veterans Affairs shall expand the Rural Inter-
22
disciplinary Team Training program of the Department
23
of Veterans Affairs to not fewer than one rural site in
24
each Veterans Integrated Service Network of the Depart-
25
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ment and ensure access at such sites to learning opportu-
1
nities through the Geriatric Scholars Program of the De-
2
partment.
3
(b) TRAINING
ON CARING
FOR VETERANS WITH
4
MEMORY LOSS.—
5
(1) IN GENERAL.—The Secretary shall provide
6
continuing professional education for clinical staff of
7
the Department who provide care for veterans with
8
Alzheimer’s disease and dementia.
9
(2) IMPLEMENTATION.—The Secretary shall
10
implement the continuing professional education re-
11
quired under paragraph (1) in consultation with the
12
Office of Rural Health of the Department of Vet-
13
erans Affairs established under section 7308 of title
14
38, United States Code, in order to ensure equitable
15
access to learning opportunities for employees of the
16
Department in rural and highly rural areas.
17
(c) EXPANSION OF GERIATRIC PATIENT ALIGNED
18
CARE TEAM MODEL AND GERIATRIC AND PALLIATIVE
19
SPECIALTY SERVICES.—
20
(1) IN GENERAL.—The Secretary shall expand
21
the Geriatrics Patient Aligned Care Team model and
22
the geriatric and palliative specialty services of the
23
Department of Veterans Affairs—
24
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(A) to every medical center of the Depart-
1
ment;
2
(B) to any community-based outpatient
3
clinic at which such expansion is determined by
4
the Secretary to be feasible and needed; and
5
(C) to provide access to all veterans that
6
need those services, including through imple-
7
menting Geriatric and Palliative Specialty Con-
8
sultative Clinical Resource Hubs to meet the
9
needs of the aging veteran population.
10
(2) WAIVER OF EXPANSION TO MEDICAL CEN-
11
TERS.—The Secretary may waive the application of
12
the requirements under paragraph (1)(A) with re-
13
spect to a medical center if the Secretary determines
14
that the medical center does not have the capacity
15
or need to implement a Geriatrics Patient Aligned
16
Care Team model or to provide geriatric and pallia-
17
tive specialty services, as the case may be.
18
(3) STUDY.—The Secretary shall conduct a
19
study on the variations in the structure and model
20
consistency of the Geriatrics Patient Aligned Care
21
Team model and delivery and utilization of geriatric
22
and palliative care throughout the Department and
23
how those variations impact quality of care and pa-
24
tient outcomes.
25
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(d) REPORT TO CONGRESS.—
1
(1) IN
GENERAL.—Not later than two years
2
after the date of the enactment of this Act, and not
3
less frequently than annually thereafter for the fol-
4
lowing five years, the Secretary shall submit to the
5
Committee on Veterans’ Affairs of the Senate and
6
the Committee on Veterans’ Affairs of the House of
7
Representatives a report on the implementation of
8
this section.
9
(2) INCLUSION
OF
INFORMATION
ON
WAIV-
10
ERS.—The Secretary shall include in the report re-
11
quired by paragraph (1) an identification of any
12
medical center of the Department in receipt of a
13
waiver under subsection (c)(2) and the reason for
14
the waiver.
15
(e) DEFINITIONS.—In this section, the terms ‘‘rural’’
16
and ‘‘highly rural’’ have the meanings given those terms
17
under the Rural-Urban Commuting Areas (RUCA) coding
18
system of the Department of Agriculture.
19
SEC. 103. STUDY ON IMPROVING RECRUITMENT AND RE-
20
TENTION AT COMMUNITY LIVING CENTERS
21
OF DEPARTMENT OF VETERANS AFFAIRS.
22
(a) IN GENERAL.—Not later than two years after the
23
date of the enactment of this Act, the Secretary of Vet-
24
erans Affairs shall complete a study on barriers to hiring
25
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and retaining staff at community living centers of the De-
1
partment of Veterans Affairs and best practices for im-
2
proving recruitment and retention of such staff, with an
3
emphasis on nursing staff.
4
(b) REPORT TO CONGRESS.—Not later than 180 days
5
after completion of the study under subsection (a), the
6
Secretary shall submit to the Committee on Veterans’ Af-
7
fairs of the Senate and the Committee on Veterans’ Af-
8
fairs of the House of Representatives a report—
9
(1) summarizing key findings with respect to
10
barriers to hiring and retaining staff at community
11
living centers of the Department and best practices
12
for improving recruitment and retention of such
13
staff, including any barriers or best practices specific
14
to rural areas; and
15
(2) including recommendations for such admin-
16
istrative action as the Secretary considers appro-
17
priate.
18
SEC. 104. LIMITATION ON DETAIL OF DIRECTORS OF MED-
19
ICAL CENTERS OF DEPARTMENT OF VET-
20
ERANS AFFAIRS TO DIFFERENT POSITIONS.
21
(a) NOTIFICATION.—
22
(1) IN GENERAL.—Not later than 90 days after
23
detailing a director of a medical center of the De-
24
partment of Veterans Affairs to a different position
25
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within the Department, the Secretary of Veterans
1
Affairs shall notify the Committee on Veterans’ Af-
2
fairs of the Senate and the Committee on Veterans’
3
Affairs of the House of Representatives of such de-
4
tail.
5
(2) MATTERS TO BE INCLUDED.—The notifica-
6
tion required by paragraph (1) shall include, with re-
7
spect to a director of a medical center who is de-
8
tailed to a different position within the Department,
9
the following information:
10
(A) The location at which the director is
11
detailed.
12
(B) The position title of the detail.
13
(C) The estimated time the director is ex-
14
pected to be absent from their duties at the
15
medical center.
16
(D) Such other information as the Sec-
17
retary may determine appropriate.
18
(b) APPOINTMENT OF ACTING DIRECTOR.—Not later
19
than 120 days after detailing a director of a medical cen-
20
ter of the Department to a different position within the
21
Department, the Secretary shall appoint an individual as
22
acting director of such medical center with all of the au-
23
thority and responsibilities of the detailed director.
24
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(c) UPDATE ON DETAIL.—Not later than 120 days
1
after detailing a director of a medical center of the De-
2
partment to a different position within the Department,
3
and not less frequently than every 30 days thereafter while
4
the de
[Text truncated for display. Full text available on Congress.gov.]