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104th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES

 1st Session                                                    104-225


 August 2, 1995.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed


   Mr. Stump, from the Committee on Veterans' Affairs, submitted the 

                              R E P O R T

                        [To accompany H.R. 1536]

      [Including cost estimate of the Congressional Budget Office]
  The Committee on Veterans' Affairs, to whom was referred the 
bill (H.R. 1536) to amend title 38, United States Code, to 
extend for two years an expiring authority of the Secretary of 
Veterans Affairs with respect to determination of locality 
salaries for certain nurse anesthetist positions in the 
Department of Veterans Affairs, having considered the same, 
reports favorably thereon without amendment and recommends that 
the bill do pass.


    The Subcommittee met on May 11, 1995 and recommended H.R. 
1536 to the full Committee. The full Committee met on June 15, 
1995 and ordered H.R. 1536 reported favorably to the House by 
unanimous voice vote.

                      Summary of the Reported Bill

    H.R. 1536 would:
    1. Amend section 7451(d)(3)(C)(iii) of title 38, United 
States Code for a 2-year period by striking out ``April 1, 
1995'' and inserting in lieu thereof ``December 31, 1997''.
    2. The extension gives VA medical center directors the 
authority to use nurse anesthetist contract agency compensation 
data to ad- 
just locality-based nurse anesthetist pay rates where a VA 
locality survey provides insufficient data.

                       Background and Discussion

    With the Department of Veterans Affairs Nurse Pay Act, 
Public Law 101-366, Congress in 1990 established a ``locality 
pay'' system for setting rates of pay for registered nurses. 
The pay system vests the director of each VA hospital with 
authority to establish basic pay rates for nurses at levels to 
enable that facility to be competitive with other health care 
facilities in the same labor market in recruitment and 
retention of nurses. The sweeping changes introduced in P.L. 
101-366 and questions regarding VA's administration of the new 
law prompted extensive congressional oversight. This led 
Congress in 1992 to adopt amendments refining the 1990 Act.
    Among the problems brought to Congress' attention was a 
unique issue affecting the rates of pay of VA nurse 
anesthetists. Data indicated that the mechanism provided in 
P.L. 101-366 failed to provide an adequate means for 
determining the rates of pay for nurse anesthetists in the 
pertinent labor market. Under the Nurse Pay Act, VA officials 
were required to determine pay rates by reference to rates of 
pay for corresponding health care professionals employed in 
non-VA facilities. Prevailing practice for many hospitals, 
however, is to contract for such services. VA maintained that 
it could not under law consider the pay of such contractor 
employees in determining appropriate pay for VA nurse 
anesthetists, and was often unable to fairly compensate its 
nurse anesthetists. Accordingly, provisions of the Veterans 
Health Care Act of 1992, Public Law 102-585, authorized VA to 
use salary data from any employer of nurse anesthetists as a 
means of setting appropriate locality pay rates for these 
skilled practitioners. The authority to use salary data from 
sources other than a health care facility ran only through 
March 1995. The Secretary of Veterans Affairs by letter of 
March 3, 1995, transmitted to the Speaker of the House a draft 
bill which would have extended the authority through 1999. H.R. 
1536 would extend that authority through 1997.
    Because of nurse anesthetists' ability to command higher 
levels of compensation, it is important for VA medical centers 
to have the continued flexibility this extension would permit.

                           Oversight Findings

    No oversight findings have been submitted to the Committee 
by the Committee on Government Reform and Oversight.

               Congressional Budget Office Cost Estimate

    The following letter was received from the Congressional 
Budget Office concerning the cost of the reported bill:
                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, June 20, 1995.
Hon. Bob Stump,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: 
    The Congressional Budget Office has reviewed H.R. 1536, a 
bill to amend title 38, United States Code, to extend for two 
years an expiring authority of the Secretary of Veterans' 
Affairs with respect to determination of locality salaries for 
certain nurse anesthetist positions in the Department of 
Veterans Affairs, as ordered reported by the House Committee on 
Veterans' Affairs on June 15, 1995.
    The bill would have no significant cost to the federal 
government. H.R. 1536 would not affect the budgets of state or 
local governments, nor would it be subject to pay-as-you-go 
procedures under section 252 of the Balanced Budget and 
Emergency Deficit Control Act.
    If you wish further details on this estimate, we will be 
pleased to provide them.
                                           June E. O'Neill,

                     Inflationary Impact Statement

    The enactment of the reported bill would have no 
inflationary impact.
         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3 of rule XIII of the Rules of the 
House of Representatives, changes in existing law made by the 
bill, as reported, are shown as follows (existing law proposed 
to be omitted is enclosed in black brackets, new matter is 
printed in italics, existing law in which no change is proposed 
is shown in roman):


Sec. 7451. Nurses and other health-care personnel: competitive pay

  (a) * * *
          * * * * * * *
  (d)(1) * * *
          * * * * * * *
  (3)(A) * * *
          * * * * * * *
  (C)(i) * * *
          * * * * * * *
  (iii) The authority of the director to use such additional 
data under this subparagraph with respect to certified 
registered nurse anesthetists expires on [April 1, 1995] 
December 31, 1997.
          * * * * * * *