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111th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     111-489

======================================================================



 
                 ASSURING QUALITY CARE FOR VETERANS ACT

                                _______
                                

  May 20, 2010.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

  Mr. Filner, from the Committee on Veterans' Affairs, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 5145]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 5145) to amend title 38, United States Code, to 
improve the continuing professional education reimbursement 
provided to health professionals employed by the Department of 
Veterans Affairs, having considered the same, report favorably 
thereon without amendment and recommend that the bill do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Hearings.........................................................     2
Subcommittee Consideration.......................................     3
Committee Consideration..........................................     3
Committee Votes..................................................     3
Committee Oversight Findings.....................................     3
Statement of General Performance Goals and Objectives............     3
New Budget Authority, Entitlement Authority, and Tax Expenditures     3
Earmarks and Tax and Tariff Benefits.............................     4
Committee Cost Estimate..........................................     4
Congressional Budget Office Estimate.............................     4
Federal Mandates Statement.......................................     5
Advisory Committee Statement.....................................     5
Constitutional Authority Statement...............................     5
Applicability to Legislative Branch..............................     5
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill as Reported.............     6

                          Purpose and Summary

    H.R. 5145 was introduced by Representative Jerry McNerney 
of California on April 27, 2010. This legislation would 
increase the amount of reimbursement for continuing 
professional education needed to maintain licensure beyond 
doctors and dentists to other U.S. Department of Veterans 
Affairs (VA) employed health care professionals.

                  Background and Need for Legislation

    Section 103 of Public Law 102-40 (105 Stat. 187), the 
Department of Veterans Affairs Health-Care Personnel Act of 
1991, directed the Secretary to reimburse up to $1,000 per year 
for continuing professional education expenses for any full-
time board-certified physician or dentist employed by the 
Veterans Health Administration (VHA).
    The Committee recognizes that the reimbursement for 
continuing education has not been updated since 1991. As such, 
H.R. 5145 increases the reimbursement to $1,600 to reflect the 
effects of inflation. The Committee also recognizes that the 
reimbursement for continuing education is an important tool in 
the VA's recruitment and retention efforts for health care 
professionals. In the 2009 Workforce Succession Strategic Plan, 
VHA identified the top ten occupational priorities for 
recruitment and retention. This list included key health care 
professionals such as nurses, pharmacists, physical therapists, 
and occupational therapists. Similar to physicians and 
dentists, these health care professionals require continuing 
professional education in order to maintain their licensure. 
H.R. 5145 corrects this inequity by extending continuing 
education expenses to health care professionals other than 
physicians and dentists who need to maintain licensure. In 
addition to making continuing professional education more 
accessible for additional VA health professionals, this bill 
also helps them update their knowledge and skills so that 
veterans receive higher quality health care.
    Finally, studies have shown that organizational efforts 
that focus on improving access to opportunity, information, and 
resources have the potential to empower staff and increase the 
level of job satisfaction. H.R. 5145 provides the VA with a 
tool to recruit, retain, and empower key health professionals.

                                Hearings

    On March 25, 2010, the Subcommittee on Health held a 
legislative hearing on a number of bills introduced during the 
111th Congress including draft legislation on continuing 
medical education reimbursements which was later introduced as 
H.R. 5145. The following witnesses testified: The Honorable Bob 
Filner of California; The Honorable Steve Scalise of Louisiana; 
The Honorable Gabrielle Giffords of Arizona; The Honorable Ann 
Kirkpatrick of Arizona; The Honorable Leonard L. Boswell of 
Iowa; The Honorable Ginny Brown-Waite of Florida; Ms. Denise A. 
Williams, Assistant Director, Veterans Affairs and 
Rehabilitation Commission, The American Legion; Mr. Blake C. 
Ortner, Senior Associate Legislative Director, Paralyzed 
Veterans of America; Mr. Eric A. Hilleman, Director National 
Veterans Service, Veterans of Foreign Wars of the United 
States; Ms. Joy J. Ilem, Deputy National Legislative Director, 
Disabled American Veterans; Gerald M. Cross, M.D., FAAFP, 
Deputy Chief for Patient Care Services and Chief Consultant for 
Primary Care, Veterans Health Administration, U.S. Department 
of Veterans Affairs who was accompanied by Mr. Walter A. Hall, 
Assistant General Counsel, Office of General Counsel, U.S. 
Department of Veterans Affairs; Mr. Brian McVeigh, Chief 
Consultant, Human Resources Management, Veterans Health 
Administration, U.S. Department of Veterans Affairs; and, 
Patricia Vandenberg, MHA, BS, Assistant Deputy Under Secretary 
for Health for Policy and Planning, Veterans Health 
Administration, U.S. Department of Veterans Affairs. Those 
submitting for the record included: the American Federation of 
Government Employees AFL-CIO; Mr. David J. Holway, National 
President, National Association of Government Employees (SEIU-
NAGE); and, Mr. William R. Dougan, National President, National 
Federation of Federal Employees.

                       Subcommittee Consideration

    On April 29, 2010, the Subcommittee on Health met in open 
markup session and ordered favorably forwarded to the full 
Committee H.R. 5145.

                        Committee Consideration

    On May 12, 2010, the full Committee met in an open markup 
session, a quorum being present, and ordered H.R. 5145 reported 
favorably to the House of Representatives, by voice vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report the legislation and amendments thereto. 
There were no record votes taken on amendments or in connection 
with ordering H.R. 5145 reported to the House. A motion by Mr. 
Stearns of Florida to order H.R. 5145 reported favorably to the 
House of Representatives was agreed to by voice vote.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII and clause 
2(b)(1) of rule X of the Rules of the House of Representatives, 
the Committee's oversight findings and recommendations are 
reflected in the descriptive portions of this report.

         Statement of General Performance Goals and Objectives

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's performance 
goals and objectives are reflected in the descriptive portions 
of this report.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee adopts as its 
own the estimate of new budget authority, entitlement 
authority, or tax expenditures or revenues contained in the 
cost estimate prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

                  Earmarks and Tax and Tariff Benefits

    H.R. 5145 does not contain any congressional earmarks, 
limited tax benefits, or limited tariff benefits as defined in 
clause 9 of rule XXI of the Rules of the House of 
Representatives.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate on H.R. 
5145 prepared by the Director of the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974.

               Congressional Budget Office Cost Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 5145 provided by the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, May 18, 2010.
Hon. Bob Filner,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 5145, the Assuring 
Quality Care for Veterans Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Sunita 
D'Monte.
            Sincerely,
                                      Douglas W. Elmendorf,
                                                          Director.
    Enclosure.

H.R. 5145--Assuring Quality Care for Veterans Act

    H.R. 5145 would expand an existing program at the Veterans 
Health Administration (VHA) to reimburse employees for the 
expenses of continuing professional education. CBO estimates 
that implementing the bill would cost $41 million over the 
2011-2015 period, assuming appropriation of the necessary 
amounts. Enacting this legislation would not affect direct 
spending or revenues; therefore, pay-as-you-go procedures would 
not apply.
    H.R. 5145 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act.
    The estimated budgetary impact of H.R. 5145 is shown in the 
following table. The costs of this legislation fall within 
budget function 700 (veterans benefits and services).

----------------------------------------------------------------------------------------------------------------
                                                               By fiscal year, in millions of dollars--
                                                    ------------------------------------------------------------
                                                       2011      2012      2013      2014      2015    2011-2015
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Estimated Authorization Level......................         4         9         9        10        10         42
Estimated Outlays..................................         4         8         9        10        10         41
----------------------------------------------------------------------------------------------------------------

    Under current law, VHA is required to reimburse board-
certified dentists and physicians, up to $1,000 a year, for the 
expenses they incur in taking courses to maintain their 
professional credentials. According to VHA, there are over 
9,500 employees eligible for the program but few request 
reimbursements because many such educational opportunities are 
provided free at VHA facilities.
    The bill would expand the pool of eligible employees to 
include several other occupations and would increase the 
maximum reimbursement to $1,600 a year. It also would give VHA 
discretion in deciding whether to reimburse employees. Based on 
information from VHA, CBO estimates that almost 94,000 
employees would be eligible under the bill but that, on 
average, VHA would reimburse $1,000 each to about 9,300 
employees a year. Assuming appropriation of the necessary 
amounts, a two-year phase-in period, and annual adjustments for 
inflation, CBO estimates that implementing the bill would cost 
$4 million in 2011, growing to $10 million a year by 2014.
    The CBO staff contact for this estimate is Sunita D'Monte. 
The estimate was approved by Theresa Gullo, Deputy Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 5145 prepared by the Director of the 
Congressional Budget Office pursuant to section 423 of the 
Unfunded Mandates Reform Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
5145.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for H.R. 5145 is provided by Article 
I, section 8 of the Constitution of the United States.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    This section provides the short title of H.R. 5145 as the 
``Assuring Quality Care for Veterans Act.''

Section 2. Improvement of continuing professional education 
        reimbursement for health professionals employed by the 
        Department of Veterans Affairs

    This section requires the Department of Veterans Affairs to 
increase the reimbursement for continuing professional 
education from $1,000 to $1,600 to reflect inflationary 
adjustments since 1991. This section also expands VA's 
authority to offer continuing professional education 
reimbursements beyond physicians and dentists to other health 
care professionals employed by the VA who need such education 
in order to maintain their licensure. Finally, this section 
ensures that VA health professionals may not be reimbursed for 
the same continuing education expenses provided by a VA medical 
center.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) 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 italic, existing law in which no change is 
proposed is shown in roman):

TITLE 38, UNITED STATES CODE

           *       *       *       *       *       *       *



PART V--BOARDS, ADMINISTRATIONS, AND SERVICES

           *       *       *       *       *       *       *


         CHAPTER 74--VETERANS HEALTH ADMINISTRATION - PERSONNEL


                       SUBCHAPTER I--APPOINTMENTS

Sec.
7401. Appointments in Veterans Health Administration.
     * * * * * * *
[7411. Full-time board-certified physicians and dentists: reimbursement 
          of continuing professional education expenses.]
7411. Full-time health professionals: reimbursement of continuing 
          professional education expenses.

           *       *       *       *       *       *       *


SUBCHAPTER I--APPOINTMENTS

           *       *       *       *       *       *       *


Sec. 7411. [Full-time board-certified physicians and dentists: 
                    reimbursement of continuing professional education 
                    expenses] Full-time health professionals: 
                    reimbursement of continuing professional education 
                    expenses

  The Secretary [shall] may reimburse any full-time [board-
certified physician or dentist appointed under section 7401(1) 
of this title] health professional appointed under paragraph 
(1) or (3) of section 7401 of this title for expenses incurred, 
up to [$1,000] $1,600 per year, for continuing professional 
education required to maintain licensure. No such health 
professional may receive reimbursement under this section and 
reimbursement for the same expenses incurred for continuing 
professional education provided by a Department medical center.

           *       *       *       *       *       *       *