[House Report 110-642]
[From the U.S. Government Publishing Office]
110th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 110-642
======================================================================
DIRECTOR OF PHYSICIAN ASSISTANT SERVICES AT VETERANS HEALTH
ADMINISTRATION
_______
May 15, 2008.--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. 2790]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred the
bill (H.R. 2790) to amend title 38, United States Code, to
establish the position of Director of Physician Assistant
Services within the office of the Under Secretary of Veterans
Affairs for Health, having considered the same, report
favorably thereon with an amendment and recommend that the bill
as amended do pass.
CONTENTS
Page
Amendment........................................................ 2
Purpose and Summary.............................................. 2
Background and Discussion........................................ 2
Hearings......................................................... 3
Committee Consideration.......................................... 3
Committee Votes.................................................. 3
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 4
New Budget Authority, Entitlement Authority, and Tax Expenditures 4
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
Amendment
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. ESTABLISHMENT OF DIRECTOR OF PHYSICIAN ASSISTANT SERVICES AT
VETERANS HEALTH ADMINISTRATION OF DEPARTMENT OF
VETERANS AFFAIRS.
(a) In General.--Section 7306(a) of title 38, United States Code, is
amended by striking paragraph (9) and inserting the following:
``(9) The Director of Physician Assistant Services, who shall
be a qualified physician assistant who shall report to the
Under Secretary for Health on all matters relating to the
education and training, employment, appropriate utilization,
and optimal participation of physician assistants within the
programs and initiatives of the Administration. The Director of
Physician Assistant Services shall serve in a full-time
capacity at the Central Office of the Department.''.
(b) Deadline for Implementation.--The Secretary of Veterans Affairs
shall ensure that an individual is serving as the Director of Physician
Assistant Services under section 7306(a)(9) of title 38, United States
Code, as added by subsection (a), by not later than 120 days after the
date of the enactment of this Act.
Purpose and Summary
H.R. 2790 was introduced by Representative Phil Hare of
Illinois on June 20, 2007. The legislation would establish a
full-time Director of Physician Assistant Services within the
Veterans Health Administration in the Department of Veterans
Affairs (VA). This position would be located in the Department
of Veterans Affairs Central Office.
Background and Discussion
Physician Assistants (PAs) who choose to work for the
federal government are credentialed health professionals. As of
March 12, 1993, certification by the National Commission on
Certification of Physician Assistants is a requirement for
employment. PAs provide a comprehensive range of diagnostic and
therapeutic services including performing physical exams,
taking patient histories, ordering and interpreting laboratory
tests, diagnosing and treating illnesses, and writing
prescriptions. PAs practice medicine as delegated by, and under
the supervision of, a physician. Physicians may delegate to PAs
medical duties that are within the physician's scope of
practice, and the PA's training and experience, as allowed by
law. All states, the District of Columbia, and Guam authorize
physicians to delegate prescriptive privileges to the PAs they
supervise. According to the American Association of Physician
Assistants, approximately 245 million patient visits were made
and about 303 million medications were prescribed or
recommended by PAs.
The first physician assistants to graduate from PA academic
programs were former medical corpsmen who had served in Vietnam
and wanted to use their medical knowledge and experience in
civilian life. Dr. Eugene Stead of Duke University Medical
Center in North Carolina put together the first class of PAs in
1965, selecting Navy corpsmen that had considerable medical
training during their military experience. Today, there are 139
accredited PA programs across the United States.
Since the PA Advisor position was authorized by the
``Veterans Benefits and Health Care Improvement Act of 2000,''
Public Law 106-419, the number of PAs within the VA health care
system has increased 34 percent, from 1,195 to nearly 1,600
today. VA is the largest single employer of PAs in the United
States. PAs work in a wide variety of medical centers and
outpatient clinics throughout the VA health care system.
Although the institution of the part-time, field-based PA
Advisor has improved the utilization of PAs, there continues to
be inconsistencies in the way PAs are used across the system. A
full-time director, located in VA central office, would ensure
efficient utilization and full integration, when appropriate,
of VA's PA workforce in VA's patient care programs and
initiatives. The full-time PA Director would also work closely
with other offices within the Veterans Health Administration,
such as the Office of Rural Health, to ensure that veterans
living in medically underserved communities receive timely
access to medical care.
Hearings
On January 17, 2008, the Subcommittee on Health held a
legislative hearing on a number of bills introduced in the
110th Congress, including H.R. 2790. The following witnesses
testified: The Honorable Phil Hare of Illinois; The Honorable
Stephanie Herseth Sandlin of South Dakota; The Honorable
Zachary T. Space of Ohio; The Honorable Shelley Moore Capito of
West Virginia; The Honorable Michael M. Honda of California;
The Honorable Leonard L. Boswell of Iowa; The Honorable Steve
Kagen of Wisconsin; Mr. Joseph L. Wilson, Deputy Director,
Veterans Affairs and Rehabilitation Commission, The American
Legion; Ms. Joy J. Ilem, Assistant National Legislative
Director, Disabled American Veterans; Mr. Christopher Needham,
Senior Legislative Associate, Veterans of Foreign Wars of the
United States; Mr. Richard F. Weidman, Executive Director for
Policy and Government Affairs, Vietnam Veterans of America;
Gerald M. Cross, M.D., FAAFP, Principal Deputy Under Secretary
for Health, Veterans Health Administration, U.S. Department of
Veterans Affairs, accompanied by Mr. Walter A. Hall, Assistant
General Counsel, U.S. Department of Veterans Affairs. Those
submitting statements for the record included: American Academy
of Physician Assistants; The Honorable Shelley Berkley of
Nevada; Mental Health America; and the Paralyzed Veterans of
America.
Committee Consideration
On April 23, 2008, the Subcommittee on Health met in open
markup session and favorably forwarded H.R. 2790, as amended,
to the full Committee for consideration by voice vote.
An amendment by Mr. Hare of Illinois to establish the
position 120 days after the date of enactment.
On April 30, 2008, the full Committee met in open markup
session, a quorum being present, and ordered H.R. 2790, as
amended, favorably reported to the House of Representatives, by
a 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. 2790 reported to the House. A motion by Mr.
Buyer of Indiana to order H.R. 2790, as amended, 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. 2790 does not contain any congressional earmarks,
limited tax benefits, or limited tariff benefits as defined in
clause 9(d), 9(e), or 9(f) 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.
2790 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. 2790 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 12, 2008.
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. 2790, a bill to
amend title 38, United States Code, to establish the position
of Director of Physician Assistant Services within the office
of the Under Secretary of Veterans Affairs for Health.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sunita
D'Monte.
Sincerely,
Robert A. Sunshine
(For Peter R. Orszag, Director).
Enclosure.
H.R. 2790--A bill to amend title 38, United States Code, to establish
the position of Director of Physician Assistant Services within
the office of the Under Secretary of Veterans Affairs for
Health
H.R. 2790 would require the Department of Veterans Affairs
(VA) to establish the position of Director of Physician
Assistant Services within the office of the Under Secretary of
Veterans Affairs for Health. As required under current law, VA
has an Advisor on Physician Assistants who reports to the Under
Secretary. VA indicated that the current advisor works part
time. CBO expects that to meet the bill's requirements, VA
would make the position full time and require small additional
appropriations for salaries, expenses, and travel. CBO
estimates that implementing the bill would cost less than
$500,000 over the 2009-2013 period, assuming availability of
the estimated amounts. Enacting the bill would have no effect
on direct spending or revenues.
H.R. 2790 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act and
would not affect the budgets of state, local, or tribal
governments.
The CBO staff contact for this estimate is Sunita D'Monte.
This 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. 2790 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.
2790.
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. 2790 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. Establishment of a Director of Physician Assistant Services
at the Veterans Health Administration of the Department of
Veterans Affairs
This section amends section 7306(a) of title 38, United
States Code, to make the Advisor of Physician Assistant
Services a Director of Physician Assistant Services, and also
mandates that the position be a full-time position, based in
the Central Office of the Department of Veterans Affairs.
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):
SECTION 7306 OF TITLE 38, UNITED STATES CODE
Sec. 7306. Office of the Under Secretary for Health
(a) The Office of the Under Secretary for Health shall
consist of the following:
(1) * * *
* * * * * * *
[(9) The Advisor on Physician Assistants, who shall be a
physician assistant with appropriate experience and who shall
advise the Under Secretary for Health on all matters relating
to the utilization and employment of physician assistants in
the Administration.]
(9) The Director of Physician Assistant Services, who shall
be a qualified physician assistant who shall report to the
Under Secretary for Health on all matters relating to the
education and training, employment, appropriate utilization,
and optimal participation of physician assistants within the
programs and initiatives of the Administration. The Director of
Physician Assistant Services shall serve in a full-time
capacity at the Central Office of the Department.
* * * * * * *