[Senate Hearing 117-559]
[From the U.S. Government Publishing Office]





                                                        S. Hrg. 117-559

     MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES 
                  APPROPRIATIONS FOR FISCAL YEAR 2022

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

                                HEARINGS

                                before a

                          SUBCOMMITTEE OF THE

            COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             FIRST SESSION

                                   on

                           H.R. 4355/S. 2604

  MAKING APPROPRIATIONS FOR MILITARY CONSTRUCTION, THE DEPARTMENT OF 
   VETERANS AFFAIRS, AND RELATED AGENCIES FOR THE FISCAL YEAR ENDING 
               SEPTEMBER 30, 2022, AND FOR OTHER PURPOSES

                               __________

                         Department of Defense
                     Department of Veterans Affairs

                               __________

         Printed for the use of the Committee on Appropriations


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       Available via the World Wide Web: https://www.govinfo.gov
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                      COMMITTEE ON APPROPRIATIONS

                  PATRICK J. LEAHY, Vermont, Chairman
PATTY MURRAY, Washington             RICHARD C. SHELBY, Alabama, Vice 
DIANNE FEINSTEIN, California             Chairman
RICHARD J. DURBIN, Illinois          MITCH McCONNELL, Kentucky
JACK REED, Rhode Island              SUSAN M. COLLINS, Maine
JON TESTER, Montana                  LISA MURKOWSKI, Alaska
JEANNE SHAHEEN, New Hampshire        LINDSEY GRAHAM, South Carolina
JEFF MERKLEY, Oregon                 ROY BLUNT, Missouri
CHRISTOPHER A. COONS, Delaware       JERRY MORAN, Kansas
BRIAN SCHATZ, Hawaii                 JOHN HOEVEN, North Dakota
TAMMY BALDWIN, Wisconsin             JOHN BOOZMAN, Arkansas
CHRISTOPHER MURPHY, Connecticut      SHELLEY MOORE CAPITO, West 
JOE MANCHIN, West Virginia               Virginia
CHRIS VAN HOLLEN, Maryland           JOHN KENNEDY, Louisiana
MARTIN HEINRICH, New Mexico          CINDY HYDE-SMITH, Mississippi
                                     MIKE BRAUN, Indiana
                                     BILL HAGERTY, Tennessee
                                     MARCO RUBIO, Florida

                   Charles E. Kieffer, Staff Director
           Shannon Hutcherson Hines, Minority Staff Director
                                 ------                                

 Subcommittee on Military Construction, Veterans Affairs, and Related 
                                Agencies

                 MARTIN HEINRICH, New Mexico, Chairman
BRIAN SCHATZ, Hawaii                 JOHN BOOZMAN, Arkansas, Ranking
JON TESTER, Montana                  MITCH McCONNELL, Kentucky
PATTY MURRAY, Washington             LISA MURKOWSKI, Alaska
JACK REED, Rhode Island              JOHN HOEVEN, North Dakota
TAMMY BALDWIN, Wisconsin             SUSAN M. COLLINS, Maine
CHRISTOPHER A. COONS, Delaware       SHELLEY MOORE CAPITO, West 
JOE MANCHIN, West Virginia               Virginia
                                     MARCO RUBIO, Florida
                                     BILL HAGERTY, Tennessee

                           Professional Staff

                           Michelle Dominguez
                              Joanne Hoff
                             Jason McMahon

                      Patrick Magnuson (Minority)
                       Jennifer Bastin (Minority)
                        Lucy Gardner (Minority)

                         Administrative Support

                               Drew Platt























                            C O N T E N T S

                              ----------                              

                                hearings

                        Wednesday, June 16, 2021

                                                                   Page



Department of Defense
Military Construction and Family Housing.........................     1

                        Wednesday, June 23, 2021

Department of Veterans Affairs...................................    53
                              ----------                              

                              back matter

List of Witnesses, Communications, and Prepared Statements.......    99

Subject Index:

    Department of Defense........................................   101

    Department of Veterans Affairs...............................   102 
 
     MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES 
                  APPROPRIATIONS FOR FISCAL YEAR 2022

                              ----------                              


                        WEDNESDAY, JUNE 16, 2021

                                       U.S. Senate,
           Subcommittee of the Committee on Appropriations,
                                                    Washington, DC.
    The subcommittee met at 10:01 a.m. in room SR-192, Dirksen 
Senate Office Building, Hon. Martin Heinrich (chairman) 
presiding.
    Present: Senators Heinrich, Tester, Boozman, Murkowski, 
Hoeven, Collins, and Hagerty.

                         DEPARTMENT OF DEFENSE

                Military Construction and Family Housing

STATEMENT OF PAUL CRAMER, PERFORMING THE DUTIES OF 
            ASSISTANT SECRETARY OF DEFENSE FOR 
            SUSTAINMENT


              opening statement of senator martin heinrich


    Senator Heinrich. Good morning, everyone. This hearing of 
the Military Construction Veteran's Affairs and Related 
Agencies Appropriation Subcommittee is now called to order.
    I would very much like to thank our witnesses for being 
here today. From OSD we have Mr. Paul Cramer performing the 
duties of assistant secretary of defense for sustainment. 
Representing each of the Services are: Lieutenant General Jason 
Evans, Deputy Chief of Staff, G-9 Installations; Vice Admiral 
Ricky Williamson, Deputy Chief of Naval Operations for Fleet 
Readiness and Logistics; Lieutenant General Charles Chiarotti, 
Deputy Commandant, Installations and Logistics; and Lieutenant 
General Warren Berry, Deputy Chief of Staff for Logistics, 
Engineering, and Force Protection.
    This year the Department has sent over a budget request of 
9.85 billion for the Military Construction and Family Housing 
accounts. That is a 20 percent increase over last year's 
request. I am encouraged to see DOD taking seriously the need 
to invest in its infrastructure, which is the foundation of 
military readiness.
    In addition to significant increases to most Service 
accounts, the request demonstrates a clear intent to prioritize 
quality of life projects for our Service members and their 
families. While the request rebounds from a significant 
decrease last year, it remains lower than fiscal years 2019 and 
2020, and still accounts for just over 1 percent of the total 
DOD budget.
    At the same time the need for recapitalization of existing 
facilities and new mission infrastructure continues to grow. 
Our subcommittee hearing last month highlighted the vulnerable 
state of many of our aging and outdated facilities. Broadly, 
this is a step in the right direction, but we need sustained 
and dedicated investment over more than just 2 years. The 
request, notably, does not include funding for overseas 
contingency operations, shifting those projects which are part 
of the European Deterrence Initiative into the base budget, 
which is a more appropriate place for them. This move is long 
overdue and I applaud it.
    I am encouraged by the Department's increased focus on 
energy resilience, specifically the Energy Resilience and 
Conservation Investment Program, or ERCIP, saw a 73 percent 
increase over last year's budget. This program which is a 
critical resource to improve energy resilience had been held 
flat in budget requests for the past decade, relying on 
congressional increases to address rising demand and more 
complex and expensive projects.
    Within this program there is also a $10 million request for 
planning and design funds associated with electric field--
vehicle infrastructure upgrades. I have been vocal about the 
need for the United States to embrace and accelerate 
electrification. And the Department needs to understand its 
capacity and plan for its requirements at an installation and 
at a community level.
    I look forward to hearing from the witnesses about what the 
funding request for ERCIP will achieve, and whether it is 
meeting the existing need. I am encouraged by the increase for 
ERCIP, but I would also note that there are 10 projects on the 
ERCIP unfunded priority list totaling some $162 million, which 
may not even account for the full need. So I look forward to 
hearing from our witnesses today about the need for these 
additional projects and the ability to execute them in fiscal 
year 2022 should additional funding be provided.
    While this request includes many positive stories, we also 
continue to see the negative impacts of the previous 
administration's decision to raid funding for military 
construction projects for border wall construction. There are 
16 projects that were defunded and that are included in the 
fiscal year 2022 request for Congress to appropriate funding to 
again. The cost of these projects is $221 million more than the 
level at which they were originally appropriated.
    I understand these projects were anticipating some 
unrelated cost increases prior to the diversion, but we lost 2 
years of trying to tackle those challenges because of the 
decision to pull funding and stop design, and taxpayers are 
paying for that now.
    For example, in my home state, the MQ-9 Formal Training 
Unit Operations Facility at Holloman Air Force Base originally 
funded 3 years ago, remains in a dilapidated state, and our 
airmen have been working in unsafe conditions for far too long.
    General Berry, I appreciated our conversation on the 
subject yesterday and look forward to working together to find 
a solution in the fiscal year.
    I would also call attention to the fact the Federal 
government will need to address critical safety concerns and 
undertake environmental remediation projects that are now 
necessary because of some of this construction. I understand 
that the Department of Defense will likely not be the lead 
agency for this effort, but I will remain engaged on this 
front.
    Lastly, I must note my disappointment that the budget 
documents do not include FY DPs. I understand the delays 
associated with the Presidential transition this year, and that 
it is not your decision to withhold this information, but these 
lists are truly critical to our ability to conduct oversight, 
understand the Department's planning and appropriately resource 
its military construction needs. I hope you will bring that 
message back with you after today.
    And with that, I will recognize the Ranking Member.


                   statement of senator john boozman


    Senator Boozman. Thank you, Mr. Chairman. And again, I also 
would like to extend a welcome to our witnesses here today, and 
we certainly appreciate your service to our country, and look 
forward to discussing the President's fiscal year 2022 Budget 
Request for military construction, family housing, and base 
realignment and closure for the Department of Defense.
    This year's budget request of $9.8 billion reflects a 22 
percent increase over the fiscal year 2021 enacted level of 8.1 
billion. While that appears to be a large increase it is worth 
noting that the fiscal year 2021 was such a low year for MILCON 
that even with an almost $2 billion increase this year's budget 
request is still one of the lowest MILCON request in recent 
years.
    Additionally, this year's request includes $329 million of 
European Deterrence Initiative projects that in the past would 
have been part of the OCO request, which has been shifted to 
the base. More than 1 billion of the budget is made up of 
increments on--for previously appropriated projects, and 661 
million is to restore deferred projects. This accounts for 
approximately 22 percent of the budget request, leaving less 
for new requirements.
    Further, large projects continue to take up a greater share 
of the budget, the increased complexity of facilities needed to 
support today's weapons systems combined with multi-billion 
dollar recapitalization initiatives to culminate in large and 
complex projects.
    Without a corresponding increase in top line, affordability 
will continue to decrease as the cost of construction projects 
continues to rise. This is a recurring theme and a familiar 
talking point. We have the same discussion year after year, and 
I am worried that MILCON requirements will continue to exceed 
the resources put towards it as the Department continues to 
take risk in infrastructure.
    The reality is, we will likely continue the same discussion 
with flatter declining top lines anticipated in the years 
ahead. We need to, therefore, make progress and realize 
efficiencies with the MILCON reform efforts being worked by the 
Department in Services. This is another frequent talking point, 
and it is something we point to year after year, but I am not 
sure that has yet translated to tangible improvements. We need 
to identify and implement best practices to lower cost, reduce 
schedule, and ultimately increase project delivery success.
    I would also like to highlight the disservice we do to 
ourselves when we do not adequately invest in the sustainment, 
restoration, and modernization of our existing facilities. 
While new mission requirements drive the need for new MILCON, 
replacing existing or failing facilities also drives up 
requirements. While buildings will eventually exceed their 
expected life, deferred maintenance and repairs can accelerate 
the need for major recapitalization in MILCON.
    More importantly, infrastructure in poor condition takes a 
toll on the Service members that work, train and live in these 
facilities. We need to improve our existing infrastructure, not 
just to possibly reduce future MILCON requirements, but we owe 
it to our Service members and their families to provide safe 
and secure facilities, from mission-critical facilities to 
dorms, barracks, and quality of life supporting infrastructure.
    Our infrastructure is a critical part of our national 
security and directly contributes to current and future force 
readiness. We must work smarter and find innovative solutions 
to deliver facility investments. And with a constrained 
environment, I look forward to working with the Department to 
achieve this goal.
    And, again, we appreciate your efforts that this is--as I 
said, this is not unique to this administration. This is 
something that we face year after year. MILCON has been, you 
know, and is significantly underfunded. So again, we look 
forward to working with you to figure out how we can do more 
with the dollars that we have.
    Thank you, Mr. Chairman.
    Senator Heinrich. Thank you, Senator Boozman. And we will 
now turn to the witnesses for their opening statements; your 
full written testimony will be included in the record and you 
will each be recognized for three minutes to summarize those 
remarks.
    And Mr. Cramer, you may start.


                  summary statement of mr. paul cramer


    Mr. Cramer. Senator, can you hear me?
    Senator Heinrich. I can.
    Mr. Cramer. Okay.
    Senator Heinrich. I think your mic is on.
    Mr. Cramer. Okay, good. Thank you. Chairman Heinrich, 
Ranking Member Boozman, and distinguished members of the 
subcommittee. On behalf of myself and my Service colleagues, 
thank you for the opportunity to present the President's fiscal 
year 2022 Budget Request for the Department's Energy, 
Installations, and Environment Program.
    While my written statement has been submitted for the 
record, I will highlight a few key areas. Our installations 
remain one of our primary weapon systems, while we have been 
able to operate from these bases that afforded us unprecedented 
power projection capabilities, today the stark reality is that 
the homeland is no longer a sanctuary. Therefore, we must 
ensure that our installations are not only postured to support 
the Joint Force, but they are resilient against the full range 
of man-made and natural threats.
    Our fiscal year 2022 budget request supports our efforts to 
address mission requirements, ensure Service members have a 
full, have a safe and resilient place to live and work, and 
also begins to address resilience challenges. We are requesting 
$26.1 billion for military construction and sustainment 
restoration and modernization funding to address critical-
mission requirements, and life, health, and safety concerns 
within our current fiscal environment.
    This funding will be used to replace, repair, and modernize 
facilities to enhance their resilience to climate events and 
promotes elimination of excess or obsolete facilities. A key 
focus of this year's budget request is addressing climate 
change. The changing climate will continue to amplify 
operational demands on the force. The great installations and 
infrastructure, increased health risks to the Service members, 
and require modifications to much of our existing and planned 
equipment.
    Extreme weather events are already costing billions of 
dollars, and those costs are likely to increase. In response to 
Executive Order 14008, tackling the climate crisis at home and 
abroad, the Department developed the DOD Climate Adaptation 
Plan, which will be finalized later this month.
    The plan identifies five key lines of effort. The first 
one, eliminate or develop a climate-informed decisionmaking 
process, train, test, and equip a climate-ready force, 
resilient, build, and natural infrastructure, supply chain 
resilience, and innovation, and enhanced adaptation and 
resilience through collaboration. We are also committed to 
protecting the quality of life for our personnel and families.
    Our primary focus here is ensuring access to safe, high 
quality, affordable family and unaccompanied housing. Our 
budget includes $1.4 billion to support our worldwide non-
privatized family housing inventory, which includes more than 
34,000 in government owned, and 5,800 lease units. This request 
also demonstrates our continued commitment to modernizing 
unaccompanied family housing was more than $477 million 
requested for eight construction projects.
    With regard to privatized housing, the Department continues 
to prioritize actions that improve the tenant experience and 
rebuild tenant trust. Our initial phase was predominantly 
focused on implementing the Military Housing Privatization 
Initiative (MHPI) Tenant Bill of Rights, and the NDAA 
requirements embedded in those rights. The Department has 
issued all policy guidance necessary to implement all rights at 
all MHPI projects to date. With few exceptions, all 18 tenant 
rights are now available.
    Finally, the Department depends on the resilient delivery 
of energy to prepare for peer competition where even the 
homeland is contested. The Department is addressing a range of 
technological, operational, and policy initiatives to enhance 
the use of energy and warfighting. To that end, we are 
requesting 4.3 billion in energy investments, including both 
installation energy, and operational energy. This includes 
approximately 287 million for the ERCIP, as previously 
discussed.
    A significant increase over last year's budget reflects our 
investment in energy systems. We appreciate Congress and this 
subcommittee's continued support as we work together to provide 
the best support possible for our soldiers, sailors, airmen, 
marines, guardians, and their families. I look forward to your 
questions.
    [The statement follows:]
                 Prepared Statement of Mr. Paul Cramer
                              introduction
    Chairman Heinrich, Ranking Member Boozman, and distinguished 
members of the Subcommittee: Thank you for the opportunity to discuss 
the Department of Defense's (DoD) posture as it relates to energy, 
installations, and environment in the President's Fiscal Year (FY) 2022 
budget request.
    Our installations remain one of our primary weapon systems. For 
nearly 80 years, we have been able to operate from our bases around the 
world with near-impunity, which has afforded us unprecedented power 
projection capabilities. However, the stark reality is that the 
homeland is no longer a sanctuary. Therefore, we must ensure that our 
installations are not only postured to support the Joint Force, but 
that they are resilient against the full range of man-made and natural 
threats. The FY 2022 President's Budget Request supports our efforts to 
address these resilience challenges, while also addressing mission 
requirements and ensuring Service members have a safe and resilient 
place to live and work.
                          key areas of concern
    Before I review the details of the budget request, I would like to 
provide updates on two key issues, specifically climate change and the 
Military Housing Privatization Initiative (MHPI).
                             climate change
    In the words of Secretary Austin, the Department faces a ``growing 
climate crisis that is impacting our missions, plans, and capabilities 
and must be met by ambitious, immediate action.'' Climate change will 
continue to amplify operational demands on the force, degrade 
installations and infrastructure, increase health risks to our service 
members, and require modifications to much of our existing and planned 
equipment. Extreme weather events are already costing the Department 
billions of dollars and those costs are likely to increase as climate 
change accelerates.
    As the Department's Chief Sustainability Officer, ASD (Sustainment) 
oversaw the development of the DoD Climate Adaptation Plan (CAP), that 
was developed per Executive Order (EO) 14008, Tackling the Climate 
Crisis at Home and Abroad, and will be finalized later this month. The 
CAP identifies five lines of effort: Climate-Informed Decision-Making; 
Train, Test, and Equip a Climate-Ready Force; Resilient Built and 
Natural Infrastructure; Supply Chain Resilience and Innovation; and 
Enhance Adaptation and Resilience Through Collaboration. The four 
cross-cutting enablers for these lines of effort are continuous 
monitoring and data analytics, innovation, climate literacy, and 
environmental justice.
    To enhance the oversight and execution of these initiatives, the 
Department recently established the Deputy Assistant Secretary of the 
Defense for Environment and Energy Resilience with OASD (Sustainment). 
Given the alignment between mission and climate priorities and the 
energy-related nature of climate initiatives, this integrated team is 
ideally positioned to review, prioritize, and oversee the Department's 
holistic climate and energy portfolio. The FY 2022 President's Budget 
request increases resources, staff, and expertise needed to achieve the 
goals of the Secretary of Defense and the President.
            military housing privatization initiative (mhpi)
    Under the overall direction of the Chief Housing Officer, the 
Department has made significant progress implementing actions to 
enhance the Military Housing Privatization Initiative (MHPI) program, 
consistent with our commitment to ensuring that MHPI projects provide 
safe, quality, well-maintained housing where our members and their 
families will want and choose to live.
    The Department continues to prioritize MHPI reform actions that 
will improve the tenant experience, rebuild tenant trust, and maintain 
MHPI housing project financial viability. This includes implementing 
MHPI reforms enacted as part of the National Defense Authorization Acts 
for Fiscal Year (FY) 2020 and FY 2021, including requirements for a 
Tenant Bill of Rights, a universal lease, a dispute resolution process, 
and other elements.
    Our initial phase has predominantly focused on implementing the 
MHPI Tenant Bill of Rights and the NDAA requirements imbedded in those 
rights, as a visible commitment to military members and their families. 
Based on our efforts to date, the Department has issued all policy 
guidance necessary to implement all rights at all MHPI housing 
projects.
    As Congress recognized in the FY 2020 NDAA, retroactive application 
of the requirements at existing projects requires voluntary agreement 
by the respective MHPI company; the Department cannot unilaterally 
change the deal terms of the complex, public-private partnerships that 
established the MHPI projects. Nearly all of the MHPI companies have 
agreed to implement all eighteen tenant rights at their existing 
projects; however, the final right--standard documentation (focused on 
a universal lease framework)--is available at more than 30 
installations with MHPI housing; with few exceptions, we expect all 
eighteen tenant rights to be fully available by the end of FY 2021.
    The Department issued housing policies to reinforce and expand the 
Department's programmatic oversight over MHPI housing projects, 
focusing on five key aspects that include: 1) senior leader engagement 
to collaborate internally and with MHPI companies on housing issues and 
necessary corrective actions; 2) rebuilding trust with military members 
and their families; 3) accountability at all levels within DoD and by 
MHPI companies to perform our oversight as originally intended at the 
outset of housing privatization; 4) transparency and more frequent 
communication with MHPI Tenants; and 5) ensuring the long-term 
financial viability of the MHPI projects and MHPI program. Further, the 
Department recently established a Deputy Assistant Secretary of Defense 
for Housing to enhance execution of the statutorily-defined Chief 
Housing Officer duties and responsibilities.
    Our priority going forward is to implement the remaining MHPI 
reform provisions that improve safety, quality, and maintenance of the 
privatized housing, and to ensure accountability at all levels within 
DoD and the MHPI companies to perform our oversight as originally 
intended at the outset of housing privatization.
    The Department of Defense understands that family is important and 
honors the sacrifice that military members and their families make to 
serve our nation. We recognize the environment where Service members 
(and their families) live impacts their quality of life, their ability 
to do their jobs, and the Department's ability to recruit and retain 
the force. We are committed to working closely with you and the 
committee staff to ensure the long-term success of the MHPI program, 
and will continue to remain diligent in our oversight to ensure 
delivery of quality housing for military members and their families 
over the life of the projects.
                military construction and family housing
    The President's FY 2022 budget requests $9.8 billion for the 
Military Construction (MilCon) and Family Housing appropriation. This 
represents a $2.0 billion or 26% increase from the FY 2021 budget 
request of $7.8 billion.
    The request reflects the Department's priorities in supporting the 
Administration's Interim National Security Strategy to address critical 
mission requirements and life, health, and safety concerns within the 
current fiscal environment. In addition to new construction needed to 
recapitalize the nuclear enterprise, this funding will be used to 
restore and modernize enduring facilities to enhance their resilience 
to climate events and promotes elimination of excess or obsolete 
facilities. The FY 2022 MilCon request includes projects that directly 
support operations, training, maintenance, production, and projects to 
take care of our people and their families, such as medical treatment 
facilities, unaccompanied personnel housing, and schools.
                         military construction
    We are requesting $8.4 billion in the budget for Military 
Construction across the Department, an increase of 30% from last year's 
request, primarily due to infrastructure requirements for the beddown 
of the B-21 aircraft, investments in KC-46A depot maintenance 
facilities, recruit dormitories, F-35A facilities in the United 
Kingdom, continued Guam relocation efforts, investments in the Shipyard 
Infrastructure Optimization Program, and the inclusion of previously 
deferred Section 2808 projects (16 projects totaling $661 million). 
Slightly more than half of this request provides readiness improvements 
in facilities to support operations, training, maintenance and 
production, and supply. Another $1.1 billion funds medical facilities, 
troop housing, and community support, and $206 million funds DoD's 
continued support to the NATO Security Investment Program.

    This request also includes $2 billion for the Defense-Wide 
Components, including

  --$192 million for dependent educational facilities

  --$110 million for fuel infrastructure;

  --$238 million for recapitalization of National Security Agency 
        facilities;

  --$304 million to address new capabilities/mission, force structure 
        growth, and infrastructure for Special Operations Forces;

  --$51 million for Washington Headquarters Services facilities; and

  --$247 million for the Energy Resilience and Conservation Investment 
        Program.

    In addition, the Defense-Wide request contains $508 million for 
medical facility recapitalization including $153 million for the fifth 
increment (of a $695 million project) for the Walter Reed Medical 
Center Addition/Alteration; $160 million for the fourth increment (of a 
$381 million) for a new hospital at Fort Leonard Wood, Missouri; $73 
million for three veterinary treatment facilities; and $122 million for 
four smaller medical treatment facilities. These projects are critical 
for our continued delivery of the quality health care that our service 
members and their families deserve.
              facilities sustainment and recapitalization
    Facilities sustainment represents the Department's largest category 
of facilities spending by providing for the regularly-scheduled 
maintenance and repair or replacement of facility components. These 
ongoing and predictable investments must be made throughout the service 
life of a facility to optimize its performance and support the safety, 
productivity, and quality of life of our personnel, while also reducing 
avoidable costs associated with premature deterioration.
    The Department's FY 2022 budget request includes $12.3 billion for 
the Military Services and the major Defense-wide organizations. This 
represents a sharp increase from the $11.3 billion in the FY 2021 
budget request but a slight decrease in the overall sustainment rate 
from 83 percent to 81 percent due to increased sustainment requirements 
resulting from a combination of higher sustainment costs, increased 
inventory, and the inclusion of costs for project design and 
standardized facility inspections.
    In addition to facilities sustainment funding, the Department 
relies upon its Restoration and Modernization (R&M) program funding to 
provide ongoing support to assigned missions by countering obsolescence 
and reversing degraded conditions of existing facilities. The 
Department's FY 2022 budget request includes $4.0 billion in Operations 
and Maintenance appropriations for facilities R&M, a slight decrease 
compared to our $4.3 billion FY 2021 budget request.
                    family and unaccompanied housing
    One of the Department's principal priorities is to support military 
personnel and their families and improve their quality of life by 
ensuring access to suitable, affordable housing. Service members are 
engaged in the front lines of protecting our national security and they 
deserve the best possible living and working conditions. Sustaining the 
quality of life of our people is crucial to recruitment, retention, 
readiness and morale.
    Our FY 2022 budget request includes $1.4 billion to fund 
construction, operation, and maintenance of government-owned and leased 
family housing worldwide; provide housing referral services to assist 
military members in renting or buying private sector housing; and 
oversight of privatized family housing. The FY 2022 request is $72 
million (5.3%) higher than the FY 2021 request, and $22 million (1.6%) 
higher than the FY 2021 enacted amount to sustain our increased focus 
on ensuring the delivery and maintenance of quality housing for 
military families. The FY 2022 request includes $293.2 million for 
construction and improvements to meet the Department's goal to maintain 
at least 90 percent of the world-wide Family Housing inventory at Good 
and Fair condition levels, to include $92.3 million for construction of 
130 Army housing units at Vicenza, Italy. The O&M budget request of 
$1.12 billion represents a $38.4 million (3.5%) increase compared to 
the FY 2021 request. This funding request supports more than 34,000 
government-owned family housing units, most of which are on enduring 
bases in overseas locations, and approximately 5,800 government-leased 
family housing units where government-owned or privatized housing is 
unavailable. The requested funding will ensure that U.S. military 
personnel and their families continue to have suitable housing choices.
    The Department's FY 2022 budget request demonstrates our continued 
commitment to modernize Unaccompanied Personnel Housing (UPH) to 
improve privacy and provide greater amenities. The FY 2022 budget 
request includes more than $477 million for eight construction projects 
that will improve living conditions for permanent party personnel. This 
includes $81 million for an Army barracks complex at Fort Meade, 
Maryland; $172 million for two Air Force dormitory projects at Joint 
Base San Antonio, Texas, and $43 million for a Navy barracks project in 
Joint Region Marianas, Guam.
                         environmental programs
    Installations are key platforms for our nation's defense. We must 
maintain our ability to conduct realistic training and flexible 
operations. The Department's environmental investments support this 
objective through activities ranging from managing critical habitat and 
avoiding training restrictions to addressing drinking water health 
advisories and making the best use of our cleanup dollars. The 
President's FY 2022 Budget requests $3.6 billion for environmental 
programs, keeping pace with our FY 2021 request.
               defense environmental restoration programs
    We are requesting $1.3 billion to continue cleanup efforts at the 
remaining Installation Restoration Program (IRP) sites and Military 
Munitions Response Program (MMRP) sites. The IRP is focused on cleanup 
of hazardous substances, pollutants, and contaminants, while the MMRP 
is focused on responding to unexploded ordnance and munition 
constituents at former military ranges. This includes $1.0 billion for 
``Environmental Restoration,'' which encompasses active installations 
and Formerly Used Defense Sites (FUDS--sites that DoD transferred to 
other Federal agencies, States, local governments, or private 
landowners before October 17, 1986). The remaining $264 million is for 
``BRAC Environmental.''

                                         Progress Towards Cleanup Goals
 Goal: Achieve Response Complete at 90% and 95% of Active and BRAC IRP and MMRP sites, and FUDS IRP sites, by FY
                                         2018 and FY 2021, respectively
----------------------------------------------------------------------------------------------------------------
                                                                                               Projected status
                                                       Status as of the    Status as of the      atthe end of
                                                         endof FY2019        endof FY2020           FY2021
----------------------------------------------------------------------------------------------------------------
Army................................................                 91%                 91%                 92%
Navy................................................                 83%                 83%                 84%
Air Force...........................................                 88%                 85%                 86%
DLA.................................................                 84%                 84%                 85%
FUDS................................................                 87%                 88%                 89%
    Total...........................................                 88%                 87%                 88%
----------------------------------------------------------------------------------------------------------------

    By the end of FY 2020, the Department, in cooperation with State 
agencies and the Environmental Protection Agency, completed cleanup 
activities at 87 percent of Active and BRAC IRP and MMRP sites, and 
FUDS IRP sites, and is now monitoring the results. During FY 2020 
alone, the Department completed cleanup at 312 sites. Of the roughly 
40,000 restoration sites, more than 33,900 are now in monitoring status 
or have completed cleanup.
    Our focus remains on continuous improvement in the restoration 
program: minimizing overhead, adopting new technologies to reduce cost 
and accelerate cleanup, refining and standardizing our cost estimating, 
and improving our relationships with State regulators through increased 
dialogue. All of these initiatives help ensure that we make the best 
use of our available resources to complete cleanup.
    Per- and polyfluoroalkyl substances (PFAS) are a top priority and 
may cause the DoD to reopen previously-made decisions, which could 
cause delays in achieving our goals. Additionally, some sites have no 
feasible solution for cleanup and, as a result, the Department is 
making significant investments in environmental technology to identify 
new potential remediation methods.
                  per- and polyfluoroalkyl substances
    The presence of per- and polyfluoroalkyl substances (PFAS) in the 
environment is a national issue due to its wide-spread use in many 
industrial and consumer products. The Department recognizes the 
importance of this issue and is committed to addressing PFAS in a 
deliberative, holistic, and transparent manner, as we continue to 
pursue a PFAS-free fire-fighting alternative and address our PFAS 
releases.
The PFAS Task Force
    The Department established a PFAS Task Force in July 2019. This 
Task Force provides strategic leadership and direction to ensure a 
coordinated, aggressive, and holistic approach on DoD-wide efforts to 
address PFAS. The Task Force continues unchanged and is postured to be 
responsive to the direction of this Administration. The Task Force 
continues to focus on four main goals:

  --Mitigating and eliminating the use of the current aqueous film 
        forming foam (AFFF);

  --Fulfilling our cleanup responsibilities, and

  --Understanding the impacts of PFAS on human health

  --Public outreach
AFFF Replacement Research
    AFFF formulations in use by DoD today do not contain detectable 
amounts of PFOS or PFOA, but they still contain PFAS. We have an 
aggressive initiative to develop and demonstrate PFAS- free 
alternatives for AFFF. We have identified a number of commercially-
available and developmental PFAS-free alternative formulations that 
have acceptable fire extinguishment performance against jet fuel fires. 
Evaluation of the aging, materials compatibility, and toxicity of these 
formulations is underway. The Department is committed to finding an 
effective firefighting alternative that meets the life-saving 
performance standards of AFFF and does not have negative health or 
environmental effects.
PFAS Cleanup and Drinking Water Mitigation
    DoD follows the existing federal cleanup law (Comprehensive 
Environmental Response, Compensation and Liability Act (CERCLA)) and 
the long-standing EPA regulations for all chemicals in our cleanup 
program, including PFAS. The Defense Environmental Restoration Program 
statute provides authorities to DoD to perform and fund cleanup actions 
and requires they be carried out in accordance with CERCLA.
    As of March 31, 2021, the Department has identified 698 
installations where DoD used or potentially released PFAS. DoD has 
completed the initial assessment at 129 of these installations and of 
those, 63 were found to require no further action, while 66 are 
proceeding to the next step in the CERCLA process. During these initial 
assessments, DoD evaluates both groundwater and drinking water. If DoD 
identifies PFOS and/or PFOA from DoD activities in off-base drinking 
water above EPA's LHA, we quickly take action (i.e., a CERCLA removal 
action) to provide treatment or an alternative water source.
    In addition, as part of our normal operations, the Department has 
sampled over 500 on-base DoD drinking water systems worldwide. Of 
those, we identified 34 with PFOS and/or PFOA above EPA's LHA and took 
quick action to bring those systems below 70 ppt. As of today, no one 
is drinking water above EPA's lifetime HA of 70 ppt where DoD is the 
known source.
                        environmental technology
    The overall FY 2022 budget request for Environmental Technology is 
$131.9 million, centered on two key programs: the Strategic 
Environmental Research and Development Program (SERDP) and the 
Environmental Security Technology Certification Program (ESTCP). These 
Defense-wide environmental technology programs coordinate closely with 
the Military Services to ensure research, demonstration, test and 
evaluation are focused on the Departments most pressing environmental 
needs. Our request for SERDP, which is focused on basic and applied 
research, is $51.9 million. For ESTCP, which is focused on validating 
more mature technologies to transition them to widespread use, we are 
requesting $31.5 million for environmental technology demonstrations 
and $39.9 million for energy technology demonstrations.
    These programs have already achieved impactful results and have the 
potential to significantly reduce long-term costs by implementing new 
ways of treating sediment and groundwater contamination, to increase 
installation resilience by providing effective tools to planning staff 
to anticipate the impacts of climate change, and to reduce the life-
cycle costs of multiple weapons systems through development and 
demonstration of innovative coatings and materials that avoid 
increasingly unavailable hazardous elements.
    SERDP/ESTCP continue to invest in alternatives to incineration for 
disposal of AFFF-related per- and polyfluoroalkyl substances (PFAS) and 
development of analytical methods for PFAS in media other than drinking 
water in conjunction with the Environmental Protection Agency. In the 
critical area of installation energy, we are focused on proving 
technologies and solutions that cost-effectively incorporate energy 
storage into installation-level microgrids to improve the energy 
security and resiliency of our installations.
       the native american lands environmental mitigation program
    Our budget request includes $12 million for the Native American 
Lands Environmental Mitigation Program (NALEMP) to address 
environmental impacts to Indian lands, Alaska Native Claims Settlement 
Act (ANCSA)-conveyed properties, and tribal treaty rights attributable 
to past DoD activities. Impacts are typically associated with hazardous 
materials, munitions debris, underground fuel storage tanks, unsafe 
buildings, lead-based paint and asbestos, and abandoned equipment. Most 
Indian lands and ANCSA-conveyed properties are located in rural and 
remote areas with low population densities; thus, they might not 
qualify as high priority sites under DoD's traditional environmental 
restoration programs. The NALEMP seeks to bridge the gap between tribal 
needs and these traditional risk-based environmental restoration 
programs and incorporate tribal priorities to address potential impacts 
to Indian lands, ANCSA-conveyed properties, and tribal treaty rights. 
The goal of the NALEMP is to complete mitigation of sites by restoring 
health and human safety, protecting natural resources, protecting 
cultural resources, and returning tribal lands to optimal use.
    Under the NALEMP, the DoD fosters government-to-government 
relationships with tribes through a Memorandum of Agreement (MOA) and 
then enters into two-year Cooperative Agreements (CAs) with the tribal 
governments. Funding provided through CAs enables tribal governments to 
lead NALEMP projects, incorporate ``traditional ecological knowledge'' 
into design for cleanup, and build tribal capacity regarding 
environmental services and technical remediation skills. Tribal 
governments conduct the cleanup with technical assistance and 
mentorship from DoD and the U.S. Army Corps of Engineers.
    Eighty-eight sites in the lower 48 states and Alaska have been 
fully mitigated. Ninety percent of the 1,000+ potential tribal impacts 
reported to DoD have been assessed and 294 have been found eligible for 
NALEMP or are under review. In FY 2020, DoD executed a total of 13 
NALEMP CAs, of which nine CAs were with Alaska Native tribes and four 
with Pueblo Indian tribes in New Mexico. By the end of FY2021, DoD will 
execute an additional 16 CAs, of which 11 CAs will be with Alaska 
Native tribes and five Indian tribes in the lower 48 states.
         environmental conservation and compatible development
    The Department's lands and waters are vital to readiness. However, 
they also support a diverse array of fish and wildlife species, as well 
as significant historic sites and resources. DoD lands provided 
habitats for nearly 500 that are federally protected under the 
Endangered Species Act, over 130,000 recorded archaeological sites, and 
45 National Historic Landmarks. Our $577 million request for 
Conservation will allow us to protect these resources in compliance 
with applicable federal statues, and manage for healthy and resilient 
natural landscapes to reduce climate driven risks such as flooding and 
wildfire.
    Regulatory protections related to threatened and endangered species 
and their habitats continue to pose significant mission challenges by 
restricting use of our existing ranges and training areas, or limiting 
our development of new infrastructure. However, these investments in 
conservation are making significant progress towards alleviating these 
restrictions by promoting species recovery. In partnership with the 
Department of the Interior and US Fish and Wildlife Service, DoD has 
worked to identify priority species and conservation actions which has 
led to the proposed down-listing or de-listing of 10 species affecting 
20 military installations. Building on this success, we will continue 
to work with our federal, state and non-governmental partners to 
develop new and innovative regulatory approaches that streamline 
processes and provide greater mission flexibility.
    Additionally, developing and implementing climate adaptation and 
resilience into both the natural and cultural resource programs will be 
a priority moving forward. Using the data and information currently 
available through the Defense Climate Assessment Tool (DCAT) and 
emerging adaptation planning guidance related to natural and cultural 
resource management programs, the DoD will be evaluating the use of 
nature based solutions, and sustaining our natural infrastructure to 
address climate driven risks such as restoring salt marshes or wetlands 
to reduce flood risk, or altering forest management practices to reduce 
fire risks.
    Continued investments in conservation will maximize our flexibility 
to use our land, water, and airspace for military purposes and to 
address incompatible land uses beyond our fence lines, and will ensure 
that our military and civilian personnel have the access they need to 
conduct mission- essential activities. Strategies to address these 
conservation and climate adaptation priorities can be most effective 
through landscape-scale initiatives to better capitalize on both our 
on- installation conservation programs and our off-installation 
conservation partnerships through the Readiness and Environmental 
Protection Integration (REPI) Program.
The Readiness and Environmental Protection Integration (REPI) program
    Of the Department's $577 million budget for conservation, $150 
million is directed to the Readiness and Environmental Protection 
Integration (REPI) program. REPI uniquely supports DoD's ability to 
seamlessly operate across domains by stimulating innovative and diverse 
partnerships between local communities, federal and state agencies, and 
non-governmental organizations to limit incompatible development and 
promote climate resilience around our installations and ranges. Through 
FY 2020, DoD has leveraged $1.08 billion with over $975 million in non-
DoD partner contributions to protect over 757,000 acres of land across 
115 installations in 35 states and territories.
    The increased request for FY 2022 will allow the REPI program to 
build capacity and significantly expand projects that promote 
resilience to climate change. This includes opportunities that maintain 
and improve ``natural infrastructure,'' implementing solutions outside 
installation boundaries to enhance the benefits provided by natural 
systems. Natural infrastructure solutions encompass a wide range of 
possible actions that can help promote installation resilience, 
preserve access to critical installation and range assets and 
capabilities, and enhance DoD's core training, testing and operational 
missions.
    The FY 2022 funding will also enable increased investment in the 
Pacific region, preserving and enhancing key mission capabilities 
critical to deterring adversaries in the Pacific, including missile 
defense; intelligence, surveillance, and reconnaissance; and joint 
force capabilities. In the Pacific region alone, DoD and its partners 
have invested over $136 million at seven REPI projects across Hawaii, 
Alaska, and Guam.
    Finally, the increased funding will enable DoD to expand the 
interagency Sentinel Landscapes Partnership between DoD, the U.S. 
Department of Agriculture, and the U.S. Department of the Interior. The 
Partnership promotes shared land use priorities, and works to identify 
landscapes across the country where the missions of the federal 
agencies--strengthening national defense, promoting sustainable 
agriculture and forestry, and building community resilience to climate 
change--intersect. From FY 2012 to FY 2019, DoD has contributed $141 
million and leveraged $542 million in funds from federal, state, local, 
and private partners to advance the goals and shared land use 
priorities of the seven sentinel landscapes. In cooperation with our 
federal partners, DoD intends to designate additional Sentinel 
landscapes in FY 2022.
Military Aviation and Installation Assurance Siting Clearinghouse
    The Military Aviation and Installation Assurance Siting 
Clearinghouse continues to protect the Department's ability to train, 
test, and operate as the nation expands its renewable and other 
commercial energy and power transmission capacity. Commercial wind 
development typically poses the greatest compatibility challenge to DoD 
due to physical obstruction of low-level flight routes and 
electromagnetic interference with DoD radar systems. DoD resolved 
project concerns though collaboration among the Clearinghouse, the 
Military Departments, local communities, states, and energy developers, 
thereby maintaining the Department's ability to train, test, and 
operate while enabling development of alternative energy resources. DoD 
negotiated and signed 29 Mitigation Agreements with wind energy 
developers to minimize the impacts from proposed projects on DoD 
missions. Through our collaborative efforts, none of the proposed 
projects warranted a DoD objection to the Secretary of Transportation 
or Administrator of the FAA.
    The Department is actively implementing new approaches to protect 
DoD missions. The Clearinghouse intensified efforts to advocate for 
state-level legislation to protect military installations and 
operations from incompatible wind energy development. Indiana, Wyoming, 
and Alabama have passed protections for military missions in wind 
turbine permitting. Although DoD and developers have had success 
resolving issues related to incompatible energy development, state 
support is invaluable in the rare cases where developers choose not to 
voluntarily coordinate with DoD.
    The Department has developed active interactions with the Bureau of 
Ocean Energy Management (BOEM) to manage increasing plans for offshore 
energy development. The Clearinghouse, Department of Interior, and BOEM 
have updated and implemented offshore review practices to allow for DoD 
input at every stage of planning, permitting and development.
                 department of defense energy programs
    The FY 2022 President's Budget aligns with direction from the 
President and the Secretary of Defense to ensure installations and 
forces are resilient in the face of a wide range of challenges to 
include climate change, disruptions to energy or water supplies, and 
direct physical or cyber- attacks. The FY 2022 President's Budget 
includes approximately $4.4 billion in energy investments, including 
both installation energy (the energy used to power permanent 
installations and non-tactical fleet vehicles) and operational energy 
(the energy required for training, moving, and sustaining military 
forces and weapons platforms for military operations). Achieving Joint 
lethality, forward force maneuver and posture resilience, and resilient 
and agile logistics in support of military combat operations, each 
require the Department to reconsider the assured availability of fuel 
and power around the globe.
    In support of operational energy resilience, the Department is 
requesting $3.2 billion to upgrade and procure new vehicles and 
aircraft, increase the range and endurance of platforms, enhance energy 
resiliency at contingency bases, and plan and execute wargames to 
account for increasing risks to logistics and sustainment. As the 
Department prepares to operate in contested environments around the 
globe, these investments increase range, endurance, and lethality while 
decreasing risks to warfighters.
    In support of installation resilience, we are requesting $1.2 
billion for energy resilience and energy conservation initiatives, most 
of which are directed to existing buildings. This includes $595 million 
in the Services' operation & maintenance accounts for sustainment and 
recapitalization projects, which generally involve retrofits to install 
improved lighting, high- efficiency HVAC systems, double-pane windows, 
facility related control systems (FRCS), and new roofs. In addition, 
the Energy Resilience and Conservation Investment Program (ERCIP) 
provides $287 million in military construction funding, including 
planning and design, to enhance energy resilience through installing 
microgrids with renewable and clean energy generation and energy 
storage alternatives and projects that will improve energy efficiency 
at our installations. In particular, the FY 2022 request includes $10 
million in ERCIP design funds specifically to plan and design projects 
to enable the installation of electrical vehicle charging stations in 
support of the President's Executive Order 14008, Tackling the Climate 
Crisis at Home and Abroad, which requires the Department to electrify 
its non-tactical vehicle fleet.
                           threats to energy
    Energy is an essential enabler of military capability, and the 
Department depends on energy- resilient forces, weapon systems, and 
facilities to achieve its mission. At home and abroad, installations 
are reliant on commercial, municipal, and host nation power grids for 
day-to-day operations, including command and control systems, 
communications, lighting, heating, and cooling. Similarly, the 
Department relies on organic capabilities and commercial partners to 
provide refined petroleum products to globally deployed forces, and 
maximizes the use of local sources to minimize the time, resources, and 
effort associated with acquiring, moving, and delivering fuel to 
deployed forces.
    Adversaries recognize the strengths of U.S. power projection and 
sustainment, and possess long- range weapons, significant anti-access/
area-denial (A2/AD) systems, and substantial cyber capabilities able to 
degrade the ability of the Department to provide energy to forces and 
facilities. In response to these threats and in alignment with statute, 
the Department shall ``ensure readiness of the armed forces for their 
military missions by pursuing energy security and energy resilience'' 
(10 U.S.C. Sec. 2911) and ``ensure the types, availability, and use of 
operational energy promote the readiness of the armed forces'' (10 USC 
Sec. 2926).
    In addition, the Department's ability to provide energy to critical 
missions is affected by the climate. A climate-resilient supply chain 
is one in which the Department has ensured that key suppliers and 
industries can still operate though impacted by climate change, with 
special attention given to ``last-mile'' resilience.
                   enterprise-wide energy initiatives
    Facing the imperative to sustain critical operations in contested 
environments while also reducing our carbon footprint, the Department 
is implementing a series of initiatives to enhance the use of power or 
fuel and support informed decision-making with regard to investments 
and future force capabilities. In partnership with the Joint Staff, 
Defense Agencies, and the Services, the Department is pursuing the 
following initiatives to transform how the Department considers energy 
in planning and operations.
10 U.S.C. Sec. 2912 Energy Cost Savings
    With the passage of the FY 2020 and FY 2021 National Defense 
Authorization Acts, 10 U.S.C.Sec. 2912 now allows the Military 
Departments to retain amounts equal to installation and operational 
energy cost savings in order to fund additional energy resilience, 
energy efficiency, and installation quality of life projects. In FY2019 
and FY2020, the Military Departments piloted efforts to retain $115 
million in installation energy cost savings and $20 million in 
operational energy cost savings using the authority. Presently, OASD 
(Sustainment) is supporting pilot initiatives by Military Departments 
to implement this authority across both installation and operational 
energy activities, pursuant to the statute and DoD financial 
regulations.
Integrating Climate Mitigation Considerations into DoD Procurement
    While the Department has procured sustainable goods and services 
for many years, the Department now is preparing to consider greenhouse 
gas emissions in a broader set of energy procurement decisions. For 
instance, based on Executive Order 14008, the Department is evaluating 
how to procure carbon-free electricity for our installations. The 
Deputy Secretary of Defense also tasked OASD(Sustainment) to develop 
policy recommendations for the application of the social cost of carbon 
into DoD procurement. Finally, the FY 2022 President's Budget provided 
an additional $2.0 million to support additional testing and 
qualification of drop-in compatible alternative fuels already in 
commercial use to ensure the Department's ability to use any drop-in 
compatible fuels available in the global marketplace.
                     operational energy resilience
    In FY 2020, the Department consumed nearly 78 million barrels of 
fuel to power ships, aircraft, combat vehicles, and contingency bases 
at a total cost of $9.2 billion. To respond to the needs of a global 
force, the Department purchased 48% of this fuel outside of the U.S. 
Beyond liquid fuels, the Department also is relying on advanced energy 
storage to enable long-range, autonomous, directed energy, high-power 
sensors, and other warfighting capabilities across air, sea, and land 
domains.
    The Department depends on the resilient delivery of energy to 
forces, weapon systems, and facilities around the globe. To prepare for 
peer competition where even the homeland is contested, the Department 
is addressing a range of technological, operational, and policy 
initiatives to enhance the use of energy in warfighting.
Investments in Operational Energy
    FY 2022 President's Budget significantly enhances resources 
dedicated to reducing operational energy risks and applying energy 
technologies to improve warfighter capabilities. Relative to the FY 
2021 President's Budget, these operational energy enhancements include:

  --Operational Capability Improvement Fund (OECIF): +$74.3 million

  --Operational Energy Prototyping Fund (OEPF): +$23.2 million

  --Alternative Fuels Certification: +$2 million

  --Air Force/Navy Operations and Planning Tools: +$38.6 million

  --Air Force Large Aircraft Drag Reduction: +$14.1 million

  --Navy Platform and Propulsion Upgrades: +$19.5 million

  --Army Tactical Vehicle Electrification: +$5.2 million

    The Department also uses the budget certification authority in 10 
U.S.C. Sec. 2926 to quantify operational energy investments across the 
Military Departments and Defense Agencies and evaluate the alignment of 
the President's Budget with the operational energy strategy. ASD 
(Sustainment) judged the FY 2022 President's Budget as sufficient to 
meet the previous operational energy strategy and will provide this 
assessment to the Congress by the end of July 2021. As the Department 
develops a revised energy strategy that reflects the new guidance 
related to resilience and climate, the ASD(Sustainment) will use the 
budget certification authority to rigorously review the sufficiency and 
direction of investments in operational energy resilience.
Contested Logistics and Risks to Energy
    To ensure that energy considerations are included in Joint and 
Service capability development and planning, we are participating in 
the Joint Concept for Contested Logistics (JCCL) as part of the broader 
Joint Warfighting Concept (JWC). We also promote capabilities that 
identify solutions to overcome fuels distribution challenges in 
contested environments, and support the development of interoperable, 
mobile, and survivable operating concepts. These capabilities include, 
but are not limited to, the Joint Petroleum Over the Shore (JPOTS) 
system of systems and the Navy's Light Amphibious Warship (LAW). The 
JPOTS system of systems refreshes and advances the capability required 
to transfer bulk fuel from offshore to a land-based termination point 
during future contingency and crisis response operations.
Advanced Energy Storage
    Faced with increasing kinetic and non-kinetic threats, the 
Department is shifting toward more distributed, austere, and autonomous 
operational concepts carried out by platforms and installations with 
escalating power requirements. Advanced energy storage is emerging as a 
critical enabler of these new capabilities. Similar to the Nation as a 
whole, however, the Department lacks a strong domestic supply chain and 
depends on foreign sources.
    As part of this response, the ASD(Sustainment) joined four other 
inter-agency partners in September 2020 to establish the Federal 
Consortium for Advanced Batteries (FCAB) to accelerate the development 
of a robust secure domestic industrial base for advanced batteries. DoD 
was part of the inter-agency team that developed an inter-agency 
national strategy for lithium batteries designed to guide future 
investments in the domestic lithium battery manufacturing value chain; 
Department of Energy will release the strategy later this year. The 
Department also is supporting the implementation of Executive Order 
14017, America's Supply Chains, and ASD (Sustainment) will continue to 
provide a single voice regarding advanced energy storage requirements 
for national security applications.
                     installation energy resilience
    At over 500 worldwide military installations, the Department spent 
$3.5 billion in FY 2020 on energy to power over 500 installations and 
170,000 non-tactical vehicles.
Investments in Installation Energy
    The FY 2022 President's Budget includes $1.2 billion in investments 
in installation energy. Reflecting a strong track of record and 
alignment with Administration priorities, the FY2022 President's Budget 
included enhancements totaling over $181 million relative to the 
previous budget request. These enhancements include:

  --ERCIP for resilience and conservation: +$104.1 million

  --ERCIP Planning & Design for resilience and conservation: +$15.9 
        million

  --ERCIP Planning & Design for electric vehicle charging 
        infrastructure: +$10 million

  --Smart Grid pilot initiatives: +$48 million

  --Net Zero Installations: +$3 million
Installation Energy Resilience Policy and Governance
    The Department continues to be proactive in developing policy, 
guidance, and tools to advance installation energy and climate 
resilience.
    The Department is coordinating an updated policy with the Military 
Departments to implement energy resilience requirements (10 U.S.C. 
2920) that resulted from the Fiscal Year 2021 National Defense 
Authorization Act, and anticipates issuing the guidance this fiscal 
year. The policy memorandum sets forth energy availability standards 
for critical missions. In addition, it directs the military departments 
to promote the use of multiple and diverse sources of energy in their 
planning, prioritization of energy resources originating on the 
installation, encourages the use of micro grids, and favors the use of 
full-time, installed energy sources rather than emergency generation in 
their energy resilience solutions.
Black Start Exercises
    Black start exercises are a growing component of the Department's 
approach to risk assessment. In alignment with statute, the Department 
is conducting full-scale black start exercises to evaluate risks to the 
readiness of our military installations. These exercises have proven 
invaluable in identifying gaps in our installations' electrical 
infrastructure, such as previously- unknown interdependencies between 
various systems, so that we can best prioritize our resilience 
resources and planning.
    Last year, the Department issued the ``Framework for Planning and 
Executing Black Start Exercises'' that facilitates the planning and 
execution of future exercises. An ``Energy Resilience Tabletop Exercise 
Framework'' was also issued to promote continued modeling of black 
start exercises in times of restricted travel and social distancing. In 
FY 2021, the Department has executed an additional two exercises at 
Marine Corps Air Station Miramar and Joint Base McGuire-Dix-Lakehurst. 
In the remainder of FY 2021 and beyond, the Department will execute 
exercises at Eielson AFB, Wright-Patterson AFB and Springfield-Beckley 
Air National Guard Base, Robins AFB, JB Langley-Eustis, Fort Hood, Fort 
Leavenworth, Rock Island Arsenal, Naval Construction Battalion Center 
Gulfport and more.
Energy Resilience and Conservation Investment Program (ERCIP)
    Supported by black start exercises, installation energy plans 
provide the basis for prioritizing resources toward critical gaps. 
ERCIP is a critical element of DoD's strategy to improve the energy 
resilience, energy security, and energy conservation of its fixed 
installations.
    The Department increased the budget request for ERCIP to reflect 
the significance of risks to energy systems as well as the need to 
mitigate the causes of climate change. In FY 2022, DoD's combined ERCIP 
request is $286.75 million for ERCIP, including $243.64 million for 
energy/water resilience projects, $2.96 million for energy/water 
conservation projects, $30.15 million for associated planning and 
design efforts, and $10 million to plan and design EV utility 
infrastructure upgrades.
    The FY 2022 ERCIP request include two energy resilience projects, 
including a 10 megawatt (MW) Microgrid Project at Fort Bragg and a 
Landfill Gas (LFG) Power Meter Station at Marine Corps Air Station 
Miramar. Fort Bragg's ERCIP project consists of a 10 megawatt microgrid 
to increase energy resilience by providing continuous power for 
critical missions. Even during a commercial power outage, this 
microgrid technology will route continuous power to Joint Special 
Operations Command during contingency operations, increasing 
reliability of operations and mission assurance. Marine Corps Air 
Station Miramar is developing one of the nation's largest renewable 
energy microgrids to create a resilient and self-sustaining air 
station. The Landfill Gas Power Meter Station will enhance the 
microgrid controls as well as it will also incorporate and store 
renewable energy for use. The enhanced MCAS Miramar microgrid will 
result in improved energy resilience during grid outages in support of 
mission assurance.
    For FY 2022, the Department is taking a more proactive approach 
with an ERCIP program comprised of a variety of technologies such as 
renewable and clean energy power generation, energy storage systems, 
industrial control systems, microgrids, and improvements to 
distribution systems to enhance installation energy resilience, 
security, and control. Just as the Department ERCIP Construction 
request increased, our Planning and Design request increased from 
$14.25 million to $40.15 million to support increasingly complex 
microgrids, renewable and clean energy generation, and advanced energy 
storage. Included in this amount is $10 million specifically for 
planning and design of the charging infrastructure needed to 
accommodate the electrification of DoD's non-tactical vehicle fleet.
The Energy Resilience Assessment Tool
    The Department is enabling the identification of solutions beyond 
backup generators to meet critical energy requirements. To accomplish 
this, the Department continues to upgrade the Energy Resilience 
Assessment (ERA) Tool for use by the DoD Components. The ERA Tool 
allows users to evaluate and select energy resilience investments that 
best meet the cost and performance requirements of their critical 
missions. In addition to conducting continuous virtual training for 
installation energy personnel, recent upgrades include improved 
visualization of results and site-specific courses of action. Use of 
the ERA Tool to validate energy resilience enhancements is a 
requirement for all ERCIP project submissions throughout the 
Department.
Performance Contracting Authorities
    The Department continues to utilize performance contracting (i.e., 
ESPCs/UESCs) as a significant part of its efforts to enhance energy 
resilience through energy efficiency. Guided by the installation energy 
planning process, DoD will continue to use these contracts where they 
enhance DoD mission readiness, mission assurance, and ultimately DoD's 
warfighting capability.
    For example, through an ESPC at Marine Corps Recruitment Depot 
(MCRD) Parris Island the Marine Corps has enhanced readiness through 
the installation of a 3.5 megawatt combined heat and power plant 
(CHPP), 6.7 megawatts of solar photovoltaic panels with integrated 
energy storage, and a microgrid control system. Built above the flood 
zone, the CHPP is less susceptible to hurricanes, storms and sea level 
rise. Based in part to savings from the ESPC, MCRD Parris Island 
decreased its electricity purchased from the commercial grid by more 
than 50% in FY 2020 compared to FY 2019, which is contributing to 
greenhouse gas reductions.
    Additionally, Misawa Air Force Base awarded a $206 million-dollar 
ESPC that includes energy conservation and resilience measures such as 
a smart grid, solar arrays, and a cogeneration power plant capable of 
generating 6.2 MW of power and 83,000 lbs/hour of steam. The new 
generation plant will cut energy waste by an estimated 20% across 679 
buildings, generate 70% of the peak electrical demand, and reduce 60% 
of the annual electrical load.
Cyber Resilience
    To enable the projection, sustainment, and direct support to forces 
around the globe, DoD installations rely on a range of Facility-Related 
Control Systems (FRCS) to operate critical missions and facilities. 
FRCS in DoD are subject to a growing range of cyber threats as these 
systems have increasingly become more automated and connected. The 
attack surface for potential adversaries has increased exponentially as 
result of the integration of network-based building management systems, 
Internet of Things (IoT) devices, as well as the connection of legacy 
control systems into these networks.
    As cyber threats continue to expand, the Department has responded 
by integrating cybersecurity into the overall policy and governance for 
energy resilience. For example, DoD installations now include 
cybersecurity considerations in the development of installation energy 
plans, and cyber secure FRCS are now integral to utility privatization 
agreements, energy savings performance contracts (ESPCs), and utility 
energy service contracts (UESCs). The Department now requires the DoD 
Components to submit annual FRCS Cybersecurity Plans to capture their 
efforts to collect inventory, complete assessments, implement 
mitigations, and maintain sustainment for FRCS cybersecurity. These 
complement installation energy plans and are due by the end of June 
2021. The Department has also codified an FRCS Master List and 
associated security rankings to standardize the resourcing, training, 
education, and budgetary spend around a common definition of FRCS.
                           energy innovation
    OASD (Sustainment) oversees three Department-wide research, 
development, test, and evaluation programs that support resilient, 
efficient, and clean energy for use by installations and forces.
    The overall FY 2022 budget request for Operational Energy 
Technology is $97.5 million, centered on two key programs: the 
Operational Energy Capability Improvement (OECI) program and the 
Operational Energy Prototyping (OEP) program. These Defense-wide energy 
technology programs coordinate closely with the Military Services to 
ensure research, demonstration, test and evaluation are focused on the 
Departments most pressing operational energy needs. For OECI, which is 
focused on advanced technology demonstrations, we request $59.3 million 
for baseline efforts and $15.0 million for nuclear fuel efforts. Our 
request for OEP, which is focused on demonstration of operational 
energy technology and validation prototyping, is $23.2 million.
    To prepare for tomorrow's energy challenges and combat climate 
change, OECI/OEP invest in three lines of effort. Projects focused on 
Powering the Force support the deployment of more mobile and 
distributed operations with decreased and more agile logistics, 
especially through contested environments. Efforts in Electrifying the 
Battlespace enable the electrification of weapons, platforms, unmanned 
systems, and soldiers which drastically reduces fossil fuel resupply 
and enables new capabilities such as silent watch and exportable power. 
Finally, Commanding Energy efforts focus on capturing and understanding 
platform and weapon system energy profiles, including adversarial 
profiles, to transform the Joint Force from reactive to predictive with 
energy management and control.
    The FY 2022 budget request for Installation Energy Technology is 
$39.9 million, implemented through the Environmental Security 
Technology Certification Program's (ESTCP) Installation Energy and 
Water Program Area (EW). The ESTCP EW Program Area focuses on improving 
the resilience of DoD's energy and water systems and reducing carbon 
emissions from buildings and non-tactical vehicles. To achieve these 
outcomes, the Program identifies, demonstrates, and transitions 
innovative technologies that increase the energy and water efficiency 
of DoD buildings, improve the security and reliability of energy and 
water supply, reduce the life-cycle cost of DoD facilities, and reduce 
carbon emissions from on-site fuel consumption.
                               conclusion
    Thank you for the opportunity to present the President's FY 2022 
budget request for DoD programs supporting energy, installations, and 
environment. We appreciate Congress' continued support for our 
enterprise and look forward to working with you as you consider the 
budget request.

    Senator Heinrich. General Evans
STATEMENT OF LIEUTENANT GENERAL JASON EVANS, DEPUTY 
            CHIEF OF STAFF
    General Evans. Thank you, Chairman.
    Senator Heinrich. General. I apologize. Can you pull your 
mic a little bit closer? I think it is not quite picking up.
    General Evans. Thank you.
    [Technical issues.]
    [The statement follows:]
                Prepared Statement of LTG Jason T. Evans
    Chairman Heinrich, Ranking Member Boozman and members of the 
Subcommittee: on behalf of the Soldiers, Families, and Civilians of the 
United States Army, thank you for the opportunity to present the Army's 
Fiscal Year (FY) 2022 budget request for installation infrastructure.
    We would like to express our gratitude to members of this committee 
for your strong support of Army installations, Soldiers, and Families. 
Thank you for supporting our budget request and providing additional 
funding for key programs such as barracks, Family housing, and 
childcare facilities. This year, we are requesting $7.1 billion for 
Army's installation infrastructure-$1.7 billion for Military 
Construction, and $5.4 billion in Facilities Sustainment, Restoration, 
and Modernization (FSRM).
    The Army strategy provides a clear path to transform and achieve 
overmatch against its adversaries in great power competition. The Army 
priorities are People, readiness, and modernization. This 
reprioritization and recognition of the importance of alliances and 
partnerships, reflect the Army's success in rebuilding and sustaining 
tactical readiness over the past six years, establishing strategic 
readiness, investing in critical capabilities, and recognizing the 
fundamental role of our People and facilities in driving readiness and 
modernization. In support of the Army Strategy and priorities, the Army 
published additional supporting strategies, amongst them, the Army 
People Strategy, The Army Modernization Strategy and the Army 
Installations Strategy, all of which help to guide resource and 
programmatic allocations.
    The Chief of Staff of the Army has said, and the Secretary agrees, 
People are our number one priority, our greatest strength, our most 
valuable asset, and our most important weapon system. The Army People 
Strategy describes how we will more deliberately manage the talents of 
our Soldiers and Civilians. The Secretary has said she will prioritize 
the full range of People issues to ensure our Soldiers and civilians 
have the best quality of life possible and strive to continue improving 
Army housing, healthcare, childcare, and spouse employment. People 
drive our success in readiness, modernization, and reform.
    Our FY 2022 Budget and our Quality of Life initiatives are guided 
by the Army Installations Strategy in developing modern, resilient, 
sustainable installations; enhanced strategic readiness that can 
operate in a contested environment; and provide quality facilities, 
services, and support to our Soldiers, Families, and Civilians.
                    the army installations strategy
    Installations are platforms from which we sustain Army culture, 
care for our People, and project and sustain forces essential to 
strategic readiness and the Army's ability to deploy, fight, and win 
our nation's wars. With timely, adequate, predictable, and sustained 
funding, we will ensure that our People remain a priority and this will 
help us continue to recruit, train, and retain an Army of high quality 
Soldiers, supported by their Families and civilians, and prepared to 
win our Nation's wars.
    The Army's Installations Strategy published in December 2020, 
represents a pivot from Industrial-Age facility design concepts of 
single-function, single-tenant buildings and purpose-built 
specialization, to Information-Age infrastructure that is multi- 
functional, multi-tenant, and easier and less expensive to customize or 
reconfigure. A forthcoming Army Infrastructure Investment Strategy will 
tie planned Army investments to measurable effects.
                         taking care of people
    The Army wins through its People. Adaptable and tailorable quality 
of life programs for Soldiers, Civilians, and Families improve Army 
readiness and reduce uncertainty. Our People promote the Army as a 
great team to join, and installations as the best places to work and 
live. Facility conditions; modern services; Family programs; and 
Morale, Welfare, and Recreation functions are essential components for 
taking care of our People. Winning matters-the Army must be able to 
compete for and win the fight for talent-both for those who serve in 
uniform and those who seek to be part of our civilian workforce. What 
matters most to our People is not whether the Army owns or operates a 
facility but whether the services are delivered in a quality, safe 
facility, which are responsive, user friendly, and convenient.
                       quality of life priorities
    Recognizing the important role quality of life plays in 
recruitment, retention, and readiness, we are focused on improving 
military housing and barracks, ensuring the best health care, expanding 
access to child care, improving opportunities for spouses to gain 
meaningful employment and build their own careers, and reducing the 
turbulence of moving. Another priority is support and resilience where 
our focus is on increasing support and resources to some of our remote, 
isolated, and challenged installations. These focused efforts help 
strengthen the Army team.
                      family housing and barracks
    Our Soldiers and Families deserve high quality, safe housing. Our 
focus is on fixing the privatized housing issues were first brought to 
light in fall of 2018, while simultaneously working with the Military 
Housing Privatizing Initiative (MHPI) companies to strengthen the long-
term financial health of the Army's Residential Communities Initiatives 
(RCI) privatized housing portfolio. We are conducting 100 percent 
quality assurance inspections on change of occupancy and life, health, 
and safety maintenance work orders.
    The Army continues to prioritize privatized housing reform actions 
that will improve the tenant experience, rebuild tenant trust, and 
maintain RCI housing project financial viability. This includes 
implementing requirements for a Tenant Bill of Rights, a universal 
lease, a dispute resolution process, and other elements set out in the 
FY 2020 and FY 2021 NDAAs. Six of seven of the Army's RCI partners have 
agreed to implement the 18 tenant rights set out in the FY20 NDAA at 
their existing projects, and at least 17 of those rights are now 
available at nearly every Army installation with privatized housing. 
The final right--standard documentation (focused on a universal lease 
framework)--is available at 37 or 84% of Army's installations with RCI 
housing, and with few exceptions, we expect all 18 tenant rights to be 
fully available by the end of FY 2021.
    Our priority going forward is to continue implementing MHPI reforms 
that improve safety, quality, and maintenance of the privatized 
housing, continue engagement with residents, and ensure accountability 
at all levels within the Army and the MHPI companies to perform our 
oversight as originally intended at the outset of housing 
privatization. We continue to host weekly housing meetings with key 
stakeholders and RCI companies on a rotating basis to review physical 
and financial condition of privatized housing. We conduct quarterly 
Town Hall meetings with Commanders and residents; we have hired 
independent third-party experts to perform comprehensive financial and 
development reviews; we have established an enforceable incentive fee 
metric to reward improved work order response times, achieve better 
quality work, and increase resident satisfaction. We also have worked 
with our MHPI companies to accelerate investment in RCI home 
renovations and replacement. Our MHPI companies have obtained $1.5 
billion of additional private sector financing and are reinvesting 
another $1.3 billion from privatized project reinvestment accounts to 
perform significant improvements to the housing they own and operate on 
Army installations.
    Over the past three years, the Army has invested $1.73 billion in 
Army Family Housing, to include government-owned housing improvements 
and construction. In addition, the Army has also invested $2.1 billion 
in barracks for construction, operations & maintenance, and restoration 
& modernization over the last three years. The Army is focused on 
modernizing barracks standards that incorporate user feedback and the 
latest technology. We must continue to work to increase the overall 
quality of housing- Army-owned and privatized housing, and Army-owned 
barracks.
    Over the next 10 years, the Army has programmed over $11.5 billion 
to improve barracks. Our investment in military construction and repair 
and maintenance projects will help ensure that Army meets DoD's goal to 
maintain 90 percent of our unaccompanied housing in good or better 
condition. We also are requiring greater leadership presence in the 
barracks, as part of the Army Barracks Management Program. This program 
empowers leaders to exercise oversight and upkeep of barracks.
    The Army Maintenance Application (App) allows Soldiers to submit a 
maintenance claim quickly from their cell phone without having to wait 
for their chain of command or make an appointment. The app will 
eventually become the primary tool for maintenance inquiries for 
residents of Army-owned Family housing and barracks across the Army.
                        historic housing program
    The Army is faced with the extraordinary challenge of managing the 
largest inventory of historic housing in the federal government. The 
Army must provide quality of life for Soldiers and their Families; 
manage high renovation costs for historic housing; address hazards 
found in historic building materials such as lead-based paint and 
asbestos; and address the need for expanded living space and 
modernization of mechanical systems, all while preserving the historic 
and architectural character of its huge inventory of over 30,000 
historic homes. Issued in September 2020, the Program Comment for 
Department of the Army Inter-War Era Historic Housing, Associated 
Buildings and Structures, and Landscape Features (1919-1940) 
establishes a new paradigm for integration of National Historic 
Preservation Act requirements as part of the solution to the Army's 
most critical military Family housing concerns for over 3,200 Inter-War 
Era homes. The management actions addressed by the Program Comment 
directly improve the material living conditions and the quality of 
life, health, and safety for the thousands of Army Family members who 
live in Inter-War Era housing, while mitigation measures ensure the 
historic and architectural character of this housing is preserved.
                              health care
    Access to high-quality healthcare is an essential part of taking 
care of Soldiers and their Families. Attending to our beneficiaries' 
medical needs improves their quality of life, enabling Army readiness. 
Partnering with Defense Health Agency, Army Medicine will continue to 
deliver world-class care for our beneficiaries across our installations 
to maintain our Army Family's health. As the Military Health System 
reforms, our focus is readiness. This means that we will emphasize 
operationally oriented training, modernized capabilities, and 
innovative operational concepts. We are grateful to Congress for 
increases in Health Professional Officer special pay caps. This needed 
investment ensures we can sustain the recruiting and retention of the 
best quality healthcare professionals for the sustainability of the 
force.
                               child care
    Army Families do not always have the stability of an established 
neighborhood or the proximity of relatives to allow for a constant and 
reliable child care plan; thus Soldiers look to the Army to provide 
services that assist them in safely caring for their children so that 
they can focus on their mission and spouses on their careers.
    The Army is challenged by child care capacity, mainly for infants 
and toddlers. Additionally, availability of quality off-post care is 
limited in many communities, reducing options for Soldiers who cannot 
access on-post care. This drives longer wait times at some locations 
like Hawaii, the National Capital Region, and Joint Base Lewis- 
McChord. The Army is implementing mitigation strategies to maintain 
and, in some cases, increase access to care. This includes planning an 
additional 21 Child Development Centers over the next ten years, which 
will add up to 4,000 new spaces. Expanding Family Child Care, with 
aggressive marketing, recruitment and retention incentives, will 
increase the number of providers from 149 to 275 by the end of FY 2022. 
Finally, improving retention of staff through a comprehensive 
recruitment and retention strategy, including staff compensation 
adjustments in accordance with updated DoD guidance to remain 
competitive in local job markets.
                           spouse employment
    Spouses are the ``force behind the force,'' balancing professional 
careers, Family, health, and well-being, all in the context of the 
unique Army lifestyle that includes deployments, frequent moves, and 
mission requirements. They often sacrifice their personal career goals 
for the benefit of the Army. Supporting spouse employment and careers 
without excessive delay or extra expense reduces Permanent Change of 
Station (PCS) move stress, improves quality of life, and contributes to 
readiness and retention. The Army is grateful for the attention and 
support that Congress has provided in this area.
    The Army continues to make improvements in the spouse employment 
arena. We are improving policies for military spouse preference and 
non-competitive civil service appointments and conducting a pilot 
program for advanced application of Military Spouse Preference in 
certain foreign overseas locations. We are also assessing an initiative 
that better connects spouses to hiring officials prior to an overseas 
move. We reimburse up to $1,000 for qualified relicensing costs for 
fees or costs associated with getting the same or similar license in a 
new state after a move. We improved the portability of home-based 
businesses, streamlining the application and approval process to 
operate home-based businesses on our installations. We have 582 home-
based businesses on installations and 478 are operated by spouses. The 
Army Civilian Employment Assignment Tool allows certain non- 
appropriated fund employees to transfer between installations quickly. 
Since inception in August 2018, there have been 449 successful 
transfers; 259 were military spouses. We are adding an additional 31 
Employment Readiness Program Staff in the next 90 days. The Army 
continues to work with Office of the Secretary of Defense to promote 
workforce development scholarships, improve state license reciprocity 
and professional license compacts, and reduce barriers to overseas 
employment.
                permanent change of station (pcs) moves
    PCS moves are significant, and at times frustrating, events for 
Army Families. To ease the stress and reduce financial burdens, the 
Army is making great strides to improve the household goods and 
relocation experience. We continue to follow health protection 
protocols to ensure safety of everyone involved in the moving process. 
We are issuing orders earlier (120 days prior to report date) to help 
Soldiers and Families better plan moves. We are hiring additional 
quality assurance inspectors with approximately 365 inspectors on board 
to include 41 spouses or Family members to ensure moving companies 
comply with DoD standards. Finally, we have increased the Personally 
Procured Move monetary allowance from 95% to 100% of the estimated cost 
the government would have paid a moving company.
    Last year, we also launched a new interactive app, ``Army PCS 
Moves,'' which includes information on entitlements, move types, 
planning/scheduling moves, and claims procedures; with more than 13,000 
downloads.
                  strengthen readiness and resilience
Climate Change
    The Army recognizes climate change as a growing global security 
threat. In line with the President and the Secretary of Defense's 
direction, we are prioritizing climate change considerations in our 
threat picture, strategic plans, operations, and infrastructure design. 
We will include climate risk analyses in our war-gaming, modeling and 
simulation activities, and our daily operational missions. The Army is 
poised to build on past efforts with a focus on integrating climate 
security factors within assessments and planning, installation 
resilience, science and technology, operational energy, sustainable 
land management, and procurement. We are taking significant steps to 
address climate change and extreme weather impacts, which include the 
Army Directive 2020-08, U.S. Army Installation Policy to Address 
Threats Caused by Changing Climate and Extreme Weather, the Army 
Climate Assessment Tool, and the Army Climate Resilience Handbook. In 
March 2021, the Army established the Army Climate Change Working Group 
to synchronize and direct Army activities to address climate 
implications and policy, planning, and implementation across the force, 
and execute climate change objectives.
Energy and Water Resilience
    The Army is the largest consumer of installation energy in the 
Department of Defense, spending more than $1 billion per year on 
facility energy and water. Our installations rely, with few exceptions, 
on commercial energy and water sources to accomplish critical missions. 
The vulnerabilities in the interdependent electric grids, natural gas 
pipelines, and water resources supporting our installations jeopardize 
mission infrastructure, installation security, and the Army's ability 
to project power and sustain global operations.
    The Army Installation Energy and Water Strategic Plan sets a vision 
and establishes goals, strategic objectives, and measurable targets to 
shape efforts to achieve long-term infrastructure resilience, 
efficiency, and affordability. Building and measuring resilience 
enables Army readiness by improving the ability to prevent and recover 
from disruptions to vital energy and water utility services.
    We gain valuable insights into our existing infrastructure 
condition and capability gaps, resource access, and system operations 
and plans through planning and condition assessments. Installation 
Energy and Water Plans (IEWPs) outline critical mission needs, 
characterize energy and water baseline conditions, and propose 
prioritized approaches for projects and operational activities to 
increase energy and water resilience. The Army has 30 IEWPs at or near-
completion; all remaining installations are scheduled to be completed 
by the end of FY 2022. IEWP results will be incorporated into 
installation master plans. Black Start Exercises assess capabilities 
and reveal gaps, which are not always discoverable during table top 
exercises. They have also resulted in improved communications between 
the Army, local community, and utility companies that service an 
installation.
                         modernize and innovate
    The Army Modernization Strategy states installations must modernize 
``at pace'' with the rest of the Army to support a modernized Army by 
2035. To do this, installations must provide facilities, ranges, 
airfields, and support infrastructure that possess the appropriate 
physical characteristics required by new Army weapons systems.
    Army modernization requires that installations provide the 
facilities, systems, and connectivity to support the Army on its path 
toward full multi-domain operations readiness by 2035. Installation 
management practices must transform to accommodate new information-era 
technologies. Innovation efforts support the Army priority of Reform. 
We will prioritize those that create efficiencies, expand workforce 
productivity, and generate resilience.
    The Army will plan for upgrades to maintenance facilities, motor 
pools, ranges, network infrastructure, administrative facilities, 
housing, barracks, secure facilities, and utilities upgrades to keep 
pace with other modernization efforts. Force projection also requires 
assessment of roads and highways, bridges, ramps, marshaling yards, 
ammunition supply points, railways, and airfields. Real property master 
plan processes will expand in technical sophistication, using data-
informed analysis and modeling to accommodate new specifications for 
modern equipment and achieve better environmental analysis necessary to 
fulfill requirements of the National Environmental Policy Act.
    The Army is updating its facilities standards and standard designs 
to meet and support fielding of new weapon systems. The objective Army 
of 2035 will have systems that exceed the current facilities criteria. 
Examples of change include the tactical equipment maintenance facility 
at Fort Hood where the revised Army Standard will include minimum 
dimensions for bay space clearance and an additional 35-ton crane for 
overhead lift capability. The Supply Support Activity is a specialized 
facility from a general purpose warehouse with changes to include 
adding a second floor/mezzanine for automation and robotics 
capabilities and climate control for corrosion prevention.
    The Army Standard and Standard Design for permanent party barracks 
will also change to take care of our number one asset, the Soldier. 
We'll be improving resilience, readiness, and Quality of Life of our 
Soldiers by equalizing the have and have-nots and take care of HVAC as 
part of health/life/and safety issues and promote promising changes 
from research on behavioral and social health of barracks residents. 
Additional changes, like replacing communal laundries with built-in 
washer dryers and adding self- service food kiosks to common areas, 
will improve Quality of Life.
         fy 2022 budget request for installation infrastructure
    The Army's FY 2022 budget requests funding to take necessary near-
term actions to help make installations multi-domain ready and 
resilient.
                         military construction
    Army Military Construction. The Army's FY 2022 Military 
Construction request for $1.7 billion (appropriation and authorization 
of appropriations) will improve Installation readiness, Industrial Base 
readiness and Soldier Quality of Life. The Quality of Life investments 
consist of five new barracks projects for $262 million and one Family 
Housing project for $92 million. The total request includes $835 
million for the active component, $257 million for the National Guard, 
$65 million for the Army Reserve, $491 million for Army Family Housing 
(Construction and Operations), and $65 million in the Base Closure 
Account for environmental remediation, caretaker services, and program 
management costs at BRAC sites.
    Military Construction, Army (MCA). Inside the Active Army's request 
there is $399 million supporting installation readiness ($141 million 
Training, $95 million Command & Control and $51 million Maintenance, 
$96 million Industrial Base and $16 million in support of European 
Combatant Command) and $249 million for barracks. The Active Component 
also has $27 million for Host Nation Support.
    Pilot Program for Additional Child Development Center Construction. 
In the FY 2021 National Defense Authorization Act, section 2865, the 
Services were directed to conduct a pilot program under which the 
services may carry out military construction projects not otherwise 
specified in law. The Army plans to utilize the existing $27 million 
authorization provided in FY 2020 to accelerate a Child Development 
Center project at Fort Gordon.
    Military Construction, Army Reserve (MCAR). The FY 2022 MCAR budget 
request supports three major construction projects: Area Maintenance 
Support Activity facility in Southfield, Michigan, valued at $12 
million; Wright Patterson AFB Army Reserve Training Center, valued at 
$19 million; and Fort McCoy, Wisconsin transient training building, 
valued at $12.2 million.
    Military Construction, Army National Guard (MCNG). The National 
Guard's request supports readiness by funding $139 million for 
Readiness Centers and $43 million for Maintenance Facilities. It also 
provides $13 million for barracks.
    Minor Construction/Planning & Design. All three components have 
funds planned for Unspecified Minor Construction and Planning and 
Design.
    Army Family Housing (AFH). The Army's request for $92.3 million in 
construction funding supports one new/replacement project providing 130 
new homes (Vicenza, Italy) and necessary planning and design funds. The 
Army's request for $391.2 million in Family Housing Operations funding 
provides for Army Family Housing operations, maintenance and repair, 
utilities, leasing, and management of Residential Communities 
Initiative.
    Base Realignment and Closure (BRAC). The Army's request for $65.3 
million includes $7.1 million for continuing caretaker and program 
management requirements at remaining BRAC installations closed or 
realigned under the five previous BRAC rounds (BRAC (1988, 1991, 1993, 
1995, and 2005) and $58.2 million for environmental cleanup 
requirements. Additionally, the Army has included $21 million in prior 
year funds for Polyfluoroalkyl Substances (PFAS) cleanup requirements, 
a carryover from the $35 million PFAS funding provided to the Army in 
FY 2021. The Army continues to work with federal and state regulators 
to resolve complex environmental issues, including in regard to PFAS, 
that exist on Army's BRAC sites, to allow the property to be conveyed 
and used for a beneficial non-military purpose.
                operation and maintenance of facilities
    Facilities Sustainment, Restoration, and Modernization (FSRM). The 
Army is requesting $5.4 billion in FSRM to address our backlog of 
facilities maintenance and provide sustainment to slow degradation of 
facilities and demolish facilities ($90 million) no longer required.
    Army Sustainment. The Army's FY 2022 Facilities Sustainment request 
for $3,767 million (Active $2,832 million, USAR $255 million, ARNG $682 
million) will provide 80% of the Facility Sustainment Model 
requirements for all Components. It will allow maintenance work orders 
on all facilities and preventative maintenance orders on Quality of 
Life and mission readiness facilities. Army intends to ramp to the 
Office of the Secretary of Defense goal of 90% of FSM in future years.
    Restoration and Modernization (R&M), Active Army. The FY 2022 
request for the Active Army is $1,142 million and will primarily fund 
restoration projects for barracks and Child Development Centers across 
the Army and readiness facilities including vehicle maintenance 
facilities and transportation infrastructure at key installations.
    Restoration and Modernization (R&M), Army Reserve. The FY 2022 
request for the Army Reserve is $87 million and will primarily fund 
restoration projects for barracks, maintenance activities, and Reserve 
Centers.
    Restoration and Modernization (R&M), Army National Guard. The FY 
2022 request for the Army National Guard is $263 million and will 
primarily fund restoration projects for barracks and training 
facilities.
                           beyond the budget
    Leveraging Partnerships: The Army has a long history of leveraging 
public- public, public-private, and/or third party partnerships to 
optimize use of other than appropriated funds, improve Army readiness, 
and address underfunded requirements. These partnerships come in a 
variety of forms, but generally lead to increased investment on Army 
installations, enhanced provision of services, modernized 
infrastructure, and improved cooperation with other Services, 
communities, and organizations. The Army appreciates Congressional 
support for partnerships.
                               conclusion
    Army readiness begins on our installations. We need ready and 
resilient installations to ensure our Soldiers are properly trained and 
can be deployed anywhere in the world in order to fight and win our 
Nation's wars. Your continued advocacy helps to ensure we will remain 
an attractive option for current and future generations who want to 
serve their Nation and also retain the current force by meeting the 
expectations of an all-volunteer Army with capable, high-quality, and 
modernized installations.
    Thank you for the opportunity to present this testimony and for 
your continued support of our Soldiers, Civilians, and Families.

    Senator Heinrich. Admiral Williamson.
STATEMENT OF VICE ADMIRAL RICKY WILLIAMSON, DEPUTY 
            CHIEF OF NAVAL OPERATIONS FOR FLEET 
            READINESS AND LOGISTICS
    Admiral Williamson. Chairman Heinrich, Ranking Member 
Boozman, and distinguished members of the subcommittee. In 
conjunction with the other members of the panel, I appreciate 
the opportunity to provide an overview of the Navy's fiscal 
year 2022 Military Construction Budget Request. On behalf of 
our sailors and their families, thank you for your continued 
support to the Navy's and its military construction program in 
our 70 installations around the world, which enable us to 
strengthen readiness, to support and deliver new and more 
lethal platforms.
    The Navy's fiscal year 2022 MILCON budget request of 
approximately 1.3 billion with 14 projects, which optimize Navy 
installations to enable global logistics and warfighter 
development, generation and employment from the shore, the 
proposed investments are deliberately targeted to slow further 
degradation of our facilities, and to address the existing 
backlog of facilities' maintenance and repair.
    Our facilities, sustainment, restoration and modernization 
request of 3 billion will help to improve sustainment of our 
most critical facilities in support of overall mission 
readiness.
    The additional request of 4.8 billion in base operating 
support allows ongoing focus on critical shore investments to 
include targeted climate resilience projects. This budget 
request will help to reduce the backlog, but it will take 
several years of consistent resourcing to achieve full 
recovery.
    Finally, in support of our sailors and family, the Navy is 
committed to improving our privatized housing program through 
regaining the trust, and reinforcing oversight, and exercising 
active leadership. Over the past year, we have made significant 
progress on near-term efforts to better advocate for Service 
members and their families, increase awareness of problem 
resolution process, and increase involvement of Navy government 
housing team. We are committed to continuing these improvements 
moving forward.
    It is a privilege to testify before the committee today, we 
are committed to being good stewards of taxpayers' dollars, and 
we will invest smartly to drive efficiency, and ensure best 
return of investment for the Nation, our sailors and civilians. 
I will look forward to your questions.
    Thank you, Senator.
    [The statement follows:]
            Prepared Statement of VADM Ricky Lee Williamson
    Chairman Heinrich, Ranking Member Boozman, and distinguished 
members of the Committee, it is an honor to appear before you 
representing the thousands of Navy Sailors and civilians at our seventy 
installations worldwide. Thank you for the opportunity to testify about 
the importance of our infrastructure, its resiliency, and all of the 
base operating support required to meet the Navy's critical missions.
    One innovative way that we look at installation resilience is by 
viewing our installations as military platforms with assigned missions. 
We then assess the ability of the installation platforms around the 
world to accomplish their missions despite deliberate actions by 
adversaries or natural events that may deny, disrupt, exploit, or 
destroy the ability of the installation platform to carry out those 
assigned missions. The operation and maintenance of these platforms, as 
well as their future development and ability to support missions, 
require long-term planning, careful investment, and timely program 
execution.
    Energy and climate resiliency are critical, as they are integral to 
the long term ability of our Navy to support ongoing operations, and 
ensure our Sailors are equipped to meet adversity. Energy resilience 
and climate resilience focus on consideration of environmental 
vulnerabilities in installation master planning, management of natural 
resources, design and construction standards, utility systems, and 
emergency management operations. Moving forward, the Navy will continue 
to prioritize all facets of resilience in installation decisions to 
ensure the ongoing, highest level of mission capabilities.
    The Navy must deliver affordable, sustainable, environmentally 
compliant and safe shore platforms through improved processes. The 
Navy's FY 22 Military Construction (MILCON) program optimizes Navy 
installations to enable global logistics and force development, 
generation and employment from the shore. Targeted sustainment of 
existing assets and prioritized modernization of our infrastructure 
will ensure readiness at the lowest overall lifecycle cost. Investments 
in increased resilience of Navy installations to extreme weather events 
and sea-level rise will result in long term cost avoidance. Continued 
use of standard design criteria, increased use of expeditionary 
standards, and mandated use of standard designs for new construction 
will reduce delivery costs and increase buying capacity. Finally, in 
order to optimize the shore footprint and maximize resources, the Navy 
must consolidate and divest infrastructure that does not contribute 
directly to Fleet readiness and lethality.
                            milcon execution
    The Navy's Fiscal Year 2022 Military Construction request includes 
a total of $1,307 million for fifteen projects, which includes $258 
million for Planning and Design, and $41 million for Unspecified Minor 
Construction projects. These fifteen projects include five that are 
overseas totaling $295 million to enhance global reach and persistent 
presence of forward- deployed naval forces, and $485 million in funding 
associated with follow on increments of previously approved projects.
               infrastructure sustainment and restoration
    When viewed as platforms, Navy installations missions enable fleet 
operations, equipment reconstitution, material sustainment, Total Force 
training, unit recovery, Sailor administrative support, and quality of 
life programs. Facility Sustainment, Restoration, and Modernization 
(FSRM) investment is necessary to ensure these missions can be carried 
out. The FSRM program maintains the working order of our facilities 
inventory and prevents premature condition degradation of mission 
critical facilities. We are prioritizing investments in our critical 
readiness infrastructure. Our public shipyards, dry docks, maintenance 
facilities, and aviation depots are vital national assets. The Shipyard 
Infrastructure Optimization Plan (SIOP) will deliver efficient and 
modernized shipyards through upgrading existing dry docks and building 
new ones, reimagining the physical layout of the shipyards, and 
replacing antiquated capital equipment with modern machines. 
Additionally, we are investing in our fleet support infrastructure, the 
global network of bases and stations, that generates naval power from 
the shore. Navy Shore leadership is preparing a long-term strategic 
investment plan that focuses our resources on the locations that best 
support our future force.
    Base Operating Support (BOS) comprises Fleet Operations, Safety and 
Security, Facility Support, Navy Quality of Life, and Mission Support 
and Management programs provided to seventy Navy Installations. BOS 
funding remains essentially flat, creating challenges as new priorities 
arise each year. BOS funding is prioritized to support increased Fleet 
operational and installation security requirements.
    Additionally, the Navy will address climate change and resiliency 
within the FSRM program. These projects enhance the Navy's waterfront 
resiliency against environmental and other vulnerabilities and improve 
utility infrastructure, increasing the Navy installations' energy and 
water resiliency, efficiency, and security.
                            military housing
    The Navy is committed to providing quality and safe housing for all 
of our Sailors and their families. Our family housing Fiscal Year 
budget request supports renovation of Navy Family Housing units as well 
as continued support of our Public Private partnerships. Over the past 
two years, all levels of leadership across the Navy have been laser-
focused on improving the privatized housing experience for our service 
members and their families. Installation Commanding Officers are 
personally involved in resolving privatized housing issues and 
advocating for military families. Finally, we have made significant 
progress on near-term efforts to better advocate, increase awareness of 
the problem resolution process, and increase involvement of the Navy 
government housing team.
                               conclusion
    Thank you for the opportunity to testify before you today. We look 
forward to working with you to continue enhancing and enabling 
warfighting capability and readiness through optimization and increased 
resiliency of our installation platforms to support Navy critical 
missions across the spectrum of competition.

    Senator Heinrich. General Chiarotti.
STATEMENT OF LIEUTENANT GENERAL CHARLES CHIAROTTI, 
            DEPUTY COMMANDANT, INSTALLATIONS & 
            LOGISTICS
    General Chiarotti. Chairman Heinrich, Ranking Member 
Boozman, and distinguished members of the subcommittee, I 
appreciate the opportunity to discuss this year's Marine Corps 
Installations and Family Housing Budget. Our installations are 
critical to the ability to train our forces and maintain 
readiness. And thanks to the strong support we have received 
from Congress, the Marine Corps continues to improve the 
quality and resiliency of its installation's infrastructure.
    I would like to start by expressing my gratitude for the 
support provided to rebuild the infrastructure damaged by 
Hurricane Florence in 2018. The effects of that storm 
highlighted the need to modernize our infrastructure so that it 
was more resilient to the effects of extreme weather. We 
sincerely appreciate your rapid support in providing the 
resources to restore our facilities on the East Coast.
    The Marine Corps' fiscal year 2022 MILCON budget request is 
for $1.1 billion for 15 projects, eight projects totaling about 
500 million to support the Defense Program Review Initiative, 
as well as modernization and recapitalization projects. The 
Marine Corps operates installations and support infrastructure 
worldwide valued at more than $110 billion. These assets must 
be properly maintained to prevent degradation of our ability to 
train and generate readiness for global employment to support 
our mission essential tasks.
    Our installations must be resilient to the wide variety of 
threats, this resiliency rest in the ability to maintain 
reliable access to critical functions, such as an effective 
power grid, clean water distribution, and communications 
capabilities.
    The Marine Corps has undertaken several initiatives to 
retain this access. For example, at Marine Corps Logistics Base 
Albany, the Marine Corps' first net-zero installation, and at 
Marine Corps Recruit Depot Parris Island, and Marine Corps Air 
Station Miramar, we also are conducting black start exercises 
earlier this year, which shows our independence from the 
commercial grid, and our ability to operate an extended period 
of time off of the grid.
    The Marine Corps is undergoing a significant transition in 
how it is organized, trained, and equipped to meet the current 
and evolving threats from our peer adversaries. The future 
force will have new capabilities whose installations 
requirements are difficult to fully determine at present. The 
Marine Corps has continued to evaluate the facilities' 
requirement of this force, as the Service's experimentation 
efforts continues, these new requirements for support and 
protection will come into greater focus.
    Finally, the quality of life of our marines, and sailors, 
and their families is integral to the effectiveness of the 
force. The overall goal of Military Family Housing 
Privatization Program is to provide safe, quality, and 
affordable housing to our Military and Marine Corps, and the 
Marine Corps views its role in providing these homes as a top 
priority.
    In conclusion, the Marine Corps' installations must prove 
resilient against a variety of threats we face, and must 
modernize our installations to protect our ability to generate 
combat power in support of our Title X responsibilities. Our 
operational capabilities are adapting to meet these threat 
changes, and we need to invest in the next generation of 
installation infrastructure to sustain the force of the future.
    Thank you for the opportunity to testify before you today, 
your oversight input and support as we determine the 
infrastructure requirements that will best position the Marine 
Corps for mission accomplishment. I look forward to working 
with you to sustain our war-fighting capabilities and the 
readiness of our power projection platforms. Thank you, sir.
    [The statement follows:]
          Prepared Statement of Lt. Gen. Charles G. Chiarotti
    Chairman Heinrich, Ranking Member Boozman, and distinguished 
Members of the Committee, I appreciate the opportunity to discuss this 
year's Marine Corps installations budget. Our installations are 
critical to our ability to train forces and maintain readiness, and 
thanks to the strong supportwe have received from Congress, the Marine 
Corps continues to improve the quality and resiliency of its 
installations infrastructure.
    First, I'd like to express my sincere gratitude for the swift 
response and support that was provided to rebuild the infrastructure 
that was damaged when Hurricane Florence made landfall in North 
Carolina in the fall of 2018. The effects of that storm highlighted the 
need to modernize and our infrastructure and make it more resilient so 
it can withstand the effects of extreme weather, with minimal 
interruption to training and operations. We appreciate your rapid 
support in providing the resources to restore II Marine Expeditionary 
Force's ability to train and generate combat readiness.
    The Marine Corps operates installations and support infrastructure 
worldwide valued at more than $110 billion that are used to train, 
house, and provide quality of life support for our Marines, Sailors, 
and their families. This infrastructure must be properly maintained to 
prevent degradation of our capability to train and generate readiness 
for global employment to support our mission-essential tasks. 
Protecting our installations, supporting new warfighting and training 
capabilities, and sustaining infrastructure are top priorities for the 
Marine Corps.
    The Marine Corps' Fiscal Year 2022 Military Construction request is 
$1.133 billion for 15 projects, which includes $112 million for 
planning and design, $18 million for unspecified minor construction 
projects, and $136 million associated with follow-on increments of 
previously approved projects. These 15 projects include 8 projects 
totaling $498 million to support the relocation of forces to Guam 
enhancing force posture in the Pacific.
          installations resiliency and resiliency initiatives
    We define installation resilience as the ability of our 
installations around the world to achieve mission accomplishment in the 
face of threats, both kinetic and non-kinetic, that may deny, disrupt, 
exploit, or destroy critical infrastructure elements which would 
inhibit our ability to generate combat readiness. Our installations 
must be resilient to a wide variety of threats--from asymmetric 
attacks, to the effects of climate change and extreme weather. 
Additionally, installation resiliency must be continually assessed in 
response to the rapid technological changes that define this 
increasingly complex security environment. We must maintain the 
flexibility to adapt and evolve our infrastructure protection measures 
to be resilient not only to today's threats, but also to provide 
protection against the threats of the future. Effective operations and 
maintenance of installations as well as thoughtful future development 
and employment requires long-term planning, careful investment, and 
timely program execution.
    Installation resiliency rests in the ability to maintain reliable 
access to critical functions, such as an effective power grid, clean 
water distribution, and communications capabilities. The Marine Corps 
has undertaken several initiatives to retain this access. For example, 
Marine Corps Logistics Base Albany is the first United States Marine 
Corps Net Zero Installation: the base produces as much electricity from 
renewable ``green'' energy sources as it consumes from the utility 
providers in the surrounding community. The transition to Net Zero has 
improved the resiliency of the base while reducing reliance on 
traditional energy sources and cutting back on greenhouse gas 
emissions.
    The Marine Corps has also installed two smart grids at Marine Corps 
Recruit Depot Parris Island and Marine Corps Air Station Miramar, which 
enable continuity of critical installation functions in the event of a 
power outage. MCAS Miramar was the first Marine Corps installation to 
conduct a Black Start exercise earlier this year, which provided 
critical lessons learned to understanding how to improve installation 
resilience in the face of power outages and other utility failures. 
Continuing to invest in projects such as Net Zero initiatives and smart 
grids will place the Marine Corps on a trajectory to meet future 
requirements while withstanding disruptive weather events.
                     force design and installations
    The Marine Corps is currently undergoing a significant transition 
in how it is organized, trained, and equipped, to meet current and 
evolving threats from our peer adversaries. In addition to developing 
new operating concepts, increasing integration with the Navy, and 
modernizing the equipment we employ, the Marine Corps' installations 
infrastructure must also evolve. Our installations are more than a 
collection of buildings, ranges, and airfields. They are global 
warfighting platforms that support execution of our Title X 
responsibilities and provide a home for our Marines, Sailors, and their 
families.
    In this effort, sound infrastructure is a critical capability. The 
readiness of our infrastructure cannot just be measured in terms of the 
physical condition of our buildings but must also consider the optimal 
posture of the force around the globe and our resilience against the 
impacts of climate change and extreme weather events.
    The Future Force will have new capabilities whose installation 
requirements are difficult to fully determine at present. Further, due 
to the rise of peer and near peer threats, several of our bases and 
stations must persist inside the Weapons Engagement Zone of our 
adversaries which presents unique challenges for installation 
resilience. The Marine Corps is continuing to evaluate the facilities 
requirements of the force. As the service's experimentation effort 
continues, these new requirements for support and protection will come 
into greater focus.
                              ppv housing
    The quality of life of our Marines, Sailors, and their families, is 
integral to the effectiveness of our force, and the overall goal of the 
Military Family Housing Privatization program is to provide safe, 
quality, and affordable housing to our military families comparable to 
what is available on the local economy. Our Public Private Venture 
(PPV) partners are responsible for providing the day-to-day operations 
and the management of the PPV portfolio, and the Marine Corps is 
responsible for providing the required oversight of the homes to ensure 
that they are habitable, that any identified health concerns are 
properly addressed, and that residents are being charged fairly for 
services received.
    The Marine Corps, along with our partners and sister services, 
continues to implement the requirements of the FY20 and FY21 NDAAs and 
the Tenant Bill of Rights. The Marine Corps views its role in providing 
homes to our Marines, Sailors, and their families as a top priority and 
we are committed to providing the necessary tools and resources to our 
installation commanders and other senior installation leadership.
               budget uncertainty and the milcon process
    With Congress' strong support, the Marine Corps has made 
significant progress over the last decade in replacing aging and 
underperforming infrastructure, and we are extremely grateful for the 
rapid infusion of financial support in response to Hurricane Florence. 
However, the possibility of future budget uncertainty has the potential 
to erode readiness and negatively impacts the service's ability to make 
the long-term decisions required for maintaining healthy installations. 
Predictable budgets over a sustained period are critical for 
installation readiness, and enable the Marine Corps to effectively 
respond to both operational and climate-related threats using a 
deliberate MILCON process.
                               conclusion
    The Marine Corps' installations must prove resilient against the 
myriad threats we face. We must modernize our installations to protect 
our forces. Our operational capabilities are adapting to meet threat 
changes, and we need to invest in the next generation installation 
infrastructure to match the Marine Corps' evolving capabilities. Thank 
you for the opportunity to testify before you today, and for your 
oversight, input, and support as we determine the infrastructure 
requirements that will best position the Marine Corps for mission 
accomplishment. I look forward to working with you to sustain our 
warfighting capability and the readiness of our power projection 
platforms.

    Senator Heinrich. General Berry.
STATEMENT OF LIEUTENANT GENERAL WARREN BERRY, DEPUTY 
            CHIEF OF STAFF FOR LOGISTICS, ENGINEERING, 
            AND FORCE PROTECTION
    General Berry. Good morning, Chairman Heinrich, Ranking 
Member Boozman, and distinguished members of the subcommittee. 
I am honored to appear before you today to discuss Air Force, 
Military Construction and Family Housing.
    I am pleased to tell the subcommittee that the Department's 
investment in this portfolio returned to historic norms in 
fiscal year 2022 request. Throughout the last year we have made 
great strides at improving our processes to build a more mature 
and stable MILCON program, ultimately increasing the likelihood 
of successful award and execution.
    We anchored on 35 percent design criteria, created a two-
year program lock to further stabilize the program, and 
optimize planning and design expenditures, and enforced 
admissibility criteria with requirement owners to ensure only 
the most ready projects were included in the budget proposal.
    As a result, our fiscal year 2022 MILCON request of $2.38 
billion is a significant step up from fiscal year 2021. As you 
know, our installations are not only power projection platforms 
for our many weapons systems and missions; they are also home 
for many of our airmen, guardians, and their families. And 
those that don't live on base often rely on the many services 
those installations provide.
    Throughout this portfolio, we strive to strike that balance 
between mission and people, so we can continue to provide safe, 
secure, and resilient bases for both. In that vein, our fiscal 
year 2022 request includes $637 million for efforts which 
directly support Service members and their families, including 
housing, construction, housing, operations, and maintenance, 
privatized housing oversight, as well as new construction of 
dorms and a child development center.
    For information, our MILCON program focuses on three key 
areas: nine projects worth $431 million supporting 
modernization of the nuclear triad, specifically ground-based 
strategic deterrent and the B-21 Raider, 20 projects worth $793 
million to support combatant commanders, particularly in Europe 
and the Pacific, and $229 million for planning and design to 
ensure continued MILCON execution success going forward.
    While not part of the fiscal year 2022 request, our 
enterprise remains heavily invested in natural disaster 
recovery efforts. The Air Force is extremely thankful to this 
subcommittee for the support of these efforts. With the $3.6 
billion provided in fiscal years 2019 and 2020, the Air Force 
is rebuilding Tyndall and Offutt Air Force Bases, in a more 
efficient and resilient way.
    The first MILCON project at Tyndall, a child development 
center, was awarded in September. Design efforts are underway 
for the rest of the program, and I expect to start seeing 
additional construction contract awards this summer, with 
approximately two-thirds of the remaining requirements on 
contract by the end of the fiscal year.
    And finally, I would like to quickly mention our efforts to 
support the standup of the United States Space Force. Though 
details are still being worked out, the Space Force will 
continue to leverage current Air Force installation support 
processes.
    In fiscal year 2022, the Department transferred facility 
restoration, modernization, and sustainment, along with 
unaccompanied housing and facilities operations funds to the 
Space Force for execution. We then expect MILCON funds to be 
transferred by fiscal year 2024.
    For the fiscal year 2022 program bill, Space Force MILCON 
priorities were considered in our existing Department of the 
Air Force, MILCON prioritization process. This portfolio is 
essential to the health of our vast infrastructure, 
infrastructure that is not only critical to mission success, 
but also to the wellbeing of our airmen, guardians, and their 
families.
    We thank the subcommittee for your interest and support. 
And I thank you for the opportunity to testify today. I look 
forward to answering your questions.
    [The statement follows:]
             Prepared Statement of Lt. Gen. Warren D. Berry
                              introduction
    Every Department of the Air Force (DAF) mission begins and ends on 
an installation. They are the foundations from which we project power, 
generate readiness, test new platforms, and support Joint operations. 
Our installations also provide safe and healthy communities for more 
than 330,000 Airmen, Guardians, and their families. In order to ensure 
Joint Force mission success in the future fight, we require an 
integrated network of ready and resilient Air and Space Force 
installations that are postured to deliver critical warfighting 
capabilities around the world and withstand any threat our adversaries 
may present.
    Our nation's military faces several challenges, including the rise 
of great power competition with China and Russia, increasing complexity 
of simultaneous multi-domain threats, ever-present fiscal pressures, 
and rapidly evolving technologies. Climate change and severe weather 
events also pose a significant threat to our installations that must be 
accounted for in our infrastructure investments. The Fiscal Year 2022 
(FY22) President's Budget Request supports the Interim National 
Security Strategic Guidance and lays out a plan to modernize our 
military capabilities in order to successfully overcome these 
challenges. The Military Construction (MILCON) budget prioritizes 
nuclear enterprise modernization and Combatant Command (CCMD) 
infrastructure support to deter our adversaries in the European and 
Pacific theaters. The budget request also provides important quality of 
life investments in housing, dorms, and community support facilities. 
The result is a budget request that supports installations' capacity to 
fulfill mission requirements and ensures we meet the needs of our 
Airmen, Guardians, and their families.
                               challenges
    Within the installation investment portfolio, the DAF also faces a 
variety of challenges that influence our investment decisions and 
budget execution. We remain committed to addressing these challenges 
and appreciate the continued support from Congress to overcome them and 
ensure the Air and Space Forces may continue to successfully defend the 
Nation and her allies.
    Seeking to balance readiness, modernization, and recapitalization 
has forced the DAF to accept risk in installation investment as limited 
resources are prioritized to the Joint Force's most critical needs. 
Over time, deferral of facility and infrastructure requirements has 
resulted in a maintenance and repair backlog of more than $30 billion. 
If left unchecked, the declining condition of infrastructure will 
impact the Department's ability to safely and effectively execute our 
mission. Additionally, atrophied facilities and infrastructure are more 
susceptible to impact from routine and severe weather events. The 
damage caused by Hurricane Michael at Tyndall Air Force Base (AFB) 
serves as an example of this, where recently constructed facilities 
using updated building codes weathered the storm better than degraded 
or older facilities which were constructed under outdated building 
codes and subjected to longer term deferred maintenance. We also 
observed the impact of deferred infrastructure investments during 
damage assessments from recent severe winter storms across the United 
States. In many instances, degraded facility systems and components 
failed, causing water and fire suppression liquids to freeze, expand, 
and eventually burst the pipes.
    The DAF has also struggled to award MILCON projects in the year of 
appropriation. Sub- optimal design maturity, as a result of 
insufficient budgeting for Planning and Design (P&D), significantly 
contributed to cost overruns and drove the need to request additional 
funds or reprogramming. Design maturity issues also led to the need to 
finish or re-design projects after funding was appropriated leading to 
additional cost increases and construction award delays. These delays 
have also left MILCON funds susceptible to rescission or reallocation.
                         overcoming challenges
    The DAF is working to overcome these challenges through continued 
implementation of our Infrastructure Investment Strategy (I2S) and 
reforms within our MILCON program. First introduced in 2019, the I2S is 
the Department's long-term strategy to cost-effectively modernize and 
restore infrastructure readiness, improve the resiliency of mission-
critical nodes, and drive innovation in installation management 
practices. This strategy informs efforts to optimize facility and 
infrastructure investment decisions and project prioritization within 
the MILCON and Facilities Restoration, Sustainment, and Modernization 
(FSRM) programs. The I2S also focuses on the recapitalization of 
facilities and infrastructure by identifying opportunities to reduce 
costly infrastructure in poor condition which no longer sufficiently 
meets mission requirements.
    In an effort to leverage advanced infrastructure risk analytics, 
the DAF continues to develop predictive models, which use current 
building condition information, to drive project prioritization and 
funding decisions. As a result, the DAF developed our first five-year 
Integrated Priority List (IPL) for FSRM projects for the FY21-25 
program and continues it this year. This is a key step in our 
intentional shifting from a ``worst-first'' prioritization approach to 
investing at the optimal time of the lifecycle for a facility, 
otherwise known as ``sweet spot'' investing.
    In building the FY 22 program, the DAF took great strides to build 
a mature, stable MILCON program to address award timeline issues and 
cost overruns. We anchored on 35% design criteria to ensure project 
documentation was consistent for every project, created a two- year 
program lock to stabilize the program and optimize P&D expenditures, 
and enforced admissibility criteria with requirement owners across the 
enterprise to ensure only ready projects were included in the budget 
proposal. The FY 22 program includes only two projects (Royal Air Force 
Lakenheath Weapons Load Training Facility and Munitions Inspection 
Facility) that did not meet the Financial Management Regulation 35% 
design milestone by August 31st, 2020, but these projects reached 35% 
design on January 29th, 2021, and are on track to award in the year of 
appropriation. Additionally, all projects exceeding $40 million include 
Design/Construction Agent cost assessments to further build confidence 
in our program and estimates. We were also able to address under-
designed projects over the last year. We used a portion of our FY 21 
appropriation to provide funding to bring all previously authorized and 
appropriated projects to full design.
    The I2S also recommends programming annual Maintenance and Repair 
(M&R) funding at a minimum investment level of 2% of Plant Replacement 
Value (PRV), with an ultimate goal of 2.3% of PRV, to reduce the 
growing backlog of deferred maintenance and restore our facilities and 
infrastructure. M&R consists of our FSRM portfolio as well as the 
portion of the MILCON program that recapitalizes existing 
infrastructure. The baseline funding level request for FY 22 
demonstrates our deliberate efforts to align our budget request to the 
I2S.
                         special interest items
COVID-19
    The COVID-19 pandemic has challenged the DAF to adapt to sustain 
our global operations. In particular, travel restrictions and social 
distancing measures affected personnel access at some installations, 
material production and delivery, and construction design reviews. 
Access and material production and delivery issues were alleviated as 
the world came to grips with the pandemic and markets and processes 
adapted to the new normal. The DAF adapted to design review challenges 
by utilizing virtual platforms to complete remote design reviews and 
charrettes, which typically require group gatherings, to prevent design 
delays and maintain quality reviews. Should any delays arise in the 
future, the DAF is prepared to work with our Design/Construction Agents 
and base level contracting professionals to address any Requests for 
Equitable Adjustments. While no significant requests for delay-driven 
compensation have arisen yet, contractors may quantify COVID-related 
costs in the future.
    Additionally, the DAF is gathering data on potential footprint 
reductions resulting from implementation of long-term telework business 
models. We are looking at operational impacts and more subtle effects 
like DAF culture. The outcome of this analysis may inform future policy 
changes.
Tackling the Climate Crisis
    Secretary of Defense Austin recently released his top three 
priorities for the Department of Defense (DoD): Defend the Nation, Take 
Care of our People, and Succeed through Teamwork. He identified 
tackling the climate crisis as one of the lines of effort under the 
priority to defend the nation, elevating climate consideration as a 
national security priority for the DoD. Changing climate and severe 
weather events are a continual threat to our installations. Over the 
past several years, the DAF has directly witnessed the impacts climate 
and severe weather can have on our installations. We are leveraging 
these lessons learned through our rebuild efforts at Tyndall AFB, 
Florida, following the devastation caused by Hurricane Michael in 2018 
and Offutt AFB, Nebraska, following historic flooding in 2019. We are 
also recovering from recent winter storms that brought extreme cold to 
much of the United States, impacting dozens of DAF installations.
    In recent years, Congress has passed several legislative 
initiatives to enhance installation resilience efforts across the DoD. 
The DAF, in conjunction with the Office of the Secretary of Defense 
(OSD), works to implement these provisions at our installations. We are 
incorporating climate and energy resiliency considerations in our 
Installation Development Plans (IDPs). Last year, we published a Severe 
Weather and Climate Hazard Screening and Risk Assessment Playbook, 
which gives installation-level planners a consistent and systematic 
framework to screen for severe weather and climate hazards and assess 
current and future risks. We have completed initial assessments at all 
major installations and will be incorporating results into an addendum 
to our IDPs with a focus on installation resilience over the next 
several years. Additionally, we have completed twenty four Installation 
Energy Plans (IEPs) to identify risks and track and adjust requirements 
to advance energy and water resilience goals. We expect to complete an 
additional twenty IEPs this year.
    The DAF is incorporating resiliency planning directly into MILCON 
projects as well. All projects are assessed to determine if the planned 
facility could be impacted by current or future mean sea level 
fluctuations or if it is located in a 100 year floodplain. We implement 
mitigation actions to raise the elevation when required by the mission. 
One mitigation action example from Offutt AFB, addresses future flood 
concerns. As part of the rebuild of three critical campuses, we are 
importing approximately 600,000 cubic yards of fill material, or about 
40,000 dump trucks, to raise the elevation of the entire site at least 
three feet above the 100 year floodplain. Additionally, the DAF 
provides inputs to drive changes to the Unified Facilities Criteria 
(UFCs) and then applies those evolving building codes to all MILCON 
projects. Many of these UFCs have been updated recently to specifically 
incorporate resilience considerations such as sea level rise scenario 
planning and updated structural engineering criteria to address wind, 
seismic, and flood threats.
Natural Disaster Recovery Efforts
    In 2019 and 2020, Congress appropriated $3.6 billion for the 
recovery and rebuild of Tyndall AFB, Florida, from the devastation 
caused by Hurricane Michael and Offutt AFB, Nebraska, from the effects 
of historic flooding. The funding also enables construction at Joint 
Base Langley-Eustis, Virginia, to support the relocation of the F-22 
Raptor training mission from Tyndall AFB. To date, the DAF has awarded 
five construction projects for a total of $72 million, and design 
efforts continue for the rest of the program. The DAF expects to award 
an additional $2.25 billion of construction contracts by the end of 
2021.
    Through the Natural Disaster Recovery program, the DAF will rebuild 
these installations more efficiently and resiliently. Facilities are 
being designed and constructed using the latest Department of Defense 
building codes, or UFCs. Additionally, given the extensive damage at 
Tyndall AFB, the DAF made a policy decision to design beyond the 
minimum UFC criteria for civil and structural engineering. The minimum 
design wind speed being used for all new facilities is 165 miles per 
hour, exceeding the highest wind speed captured during Hurricane 
Michael, and incorporates best practices from the Florida Building 
Code's High Velocity Hurricane Zone for Miami-Dade, Broward, and 
coastal Palm Beach Counties. Facilities are also being designed 14 to 
19 feet above today's mean sea level, which incorporates a 7-foot 
projected sea level rise scenario through the year 2100. Additionally, 
coastal resiliency is one of the most important aspects to the plan at 
Tyndall. This partnered approach includes cost-shared investments which 
combine with DAF FSRM and MILCON investments to attenuate storm energy 
through natural infrastructure before it reaches built infrastructure. 
Key partners such as the Defense Advanced Research Projects Agency, 
Fish and Wildlife Service, Bay County, the Florida Department of 
Environmental Protection, and the University of Florida are working 
together as part of OSD's Readiness and Environmental Protection 
Integration Program on key initiatives. We are exploring several low 
life-cycle cost Engineering with Nature initiatives to include sand 
fencing, submerged shoreline stabilization, living shorelines, oyster 
reefs, and marsh and seagrass enhancements. At Offutt AFB, we are 
consolidating facilities to higher ground out of the 100-year 
floodplain. Where relocation is not possible due to mission 
requirements, we are raising the finished floor elevation above the 
floodplain and building in a way to minimize clean- up should flooding 
occur again.
Winter Storms of 2021
    Recent extreme winter storms throughout much of the Midwest and 
southern United States had a considerable impact on DAF installations. 
Initial assessments indicate some degree of damage at 28 installations. 
The DAF continues to assess the damage and will restore facilities to 
full mission capability.
    A majority of the damage was the result of burst water and fire 
suppression lines due to freezing. Our personnel prepared our 
installations admirably, but numerous factors, including sustained 
periods of extreme cold, degraded facilities and infrastructure, and 
off-base power and water supply issues, led to damage and temporary 
interruptions. Several installations experienced limited power or water 
interruptions consistent with interruptions experienced by the local 
communities. Back-up energy sources and contingency plans, as well as 
effective coordination with commercial power and water suppliers, were 
generally effective in minimizing the length and impact of utility 
interruptions. In some cases, such as at Offutt AFB, installations were 
able to use on-base power plants and generators to supply their own 
power. These efforts were instrumental in helping the utility provider 
stabilize the power grid and minimize rolling blackouts in the 
community.
Taking Care of Airmen
    In December 2020, the Chief of Staff of the Air Force, General 
Charles Q. Brown, released a series of action orders providing guidance 
to implement his strategic approach, ``Accelerate Change or Lose.'' The 
first action order focuses on Airmen. If the Service is to ensure it 
has a quality future force where Airmen see continued service as an 
attractive career choice, we must consider the environments we provide 
for these Airmen and their families at DAF installations. Taking care 
of Airmen, and now Guardians, and their families is not just about 
quality of life, it is also about readiness. It is at the forefront of 
ensuring the DAF can continue to provide critical warfighting 
capabilities to the nation. Two programs with direct ties to quality of 
life are Child Development Centers (CDC) and dormitories.
    In early 2020, the DAF established a cross-functional Child Care 
Capacity Initiative Working Group to address unmet child care needs. 
This team has prioritized child development and school age care 
facility projects based on unmet childcare demand, staffing, and 
building conditions. We issued a Strategic Enterprise Executive 
Decision memo directing installations to initiate planning actions for 
14 projects identified on the prioritized list. The DAF is using the 
$11 million in MILCON P&D funds provided in FY 20 to initiate designs 
and posture these projects for future execution. Five of our top 
priority CDCs--Sheppard AFB-Texas (TX), Joint Base San Antonio (JBSA)--
Lackland-TX, JBSA--Fort Sam Houston-TX, Wright Patterson AFB-Ohio, and 
Royal Air Force (RAF) Lakenheath, in the United Kingdom--will be ready 
for execution in FY 22. The Sheppard AFB CDC is included in the FY 22 
budget request. The fifth CDC at Royal Air Force Lakenheath in the 
United Kingdom is required due to the new F-35A mission bed down. CDCs 
historically have not completed well against other mission-related 
priorities in the MILCON program. We are addressing childcare facility 
concerns with FSRM and MILCON in FY 2022. Additionally, we are 
posturing MILCON projects for future execution. Eleven FSRM projects, 
valued at $44 million, are in development and will be ready for award 
in FY 22. As previously stated, the DAF will construct a new child 
development center at Sheppard Air Force Base, Texas for $20 million.
    The DAF is also committed to ensuring unaccompanied service members 
are provided quality housing on our dormitory campuses. The Department 
has re-emphasized the roles and responsibilities of commanders in 
protecting the health and safety of unaccompanied Airmen and Guardians. 
Commanders are responsible for enforcing inspection criteria to 
identify and report conditions requiring immediate and future 
maintenance, as well as sustaining an adequately resourced maintenance 
and repair program to effectively address requirements. Funded from the 
DAF FSRM account, the investment strategy for dormitories focuses on 
restoration and modernization of these facilities in their existing 
configurations. This strategy will ensure the Service continues to meet 
the DoD goal whereby 90% of dormitory rooms are in good or better 
condition, based on the Facility Condition Index score, for permanent 
party unaccompanied Airmen and Guardians and will reduce the 
requirement for replacement construction. We are focused on ensuring 
the Air Force continues to invest in maintenance and repair work as 
required to keep these facilities functioning as originally intended. 
This enables the DAF to focus MILCON funds on modern, formal training 
facilities for newly recruited Airmen, such as the Airman Training 
Center at Joint Base San Antonio--Lackland, Texas, included in the FY 
22 budget request.
Space Force
    The FY20 National Defense Authorization Act NDAA established the 
United States Space Force (USSF) as the sixth branch of the armed 
forces. In accordance with DoD direction that the Space Force be 
established as a lean, agile, mission-focused military Service, the 
Space Force will rely on the Air Force for infrastructure, logistics, 
security, medical services, and a host of other support functions. 
Formal agreements and implementation plans are being finalized to 
codify all stakeholder roles and responsibilities. From an installation 
engineering perspective, Air Force civil engineer squadrons will 
continue to support Space Force installations as they did prior to 
establishment of the Space Force. Air Force Materiel Command's Air 
Force Installation and Mission Support Center will continue to provide 
enterprise level support for all installation and mission support 
programs and processes. In FY 22, the DAF will transfer FSRM, 
unaccompanied housing, and facilities operations funds to the Space 
Force for execution. MILCON authorization is expected to be transferred 
to the Space Force by FY 24. The Space Force is in the process of 
developing a separate governance process, leveraging current Air Force 
processes, to ensure strategic alignment of investments to Space Force 
priorities.
                          fy22 milcon program
    In FY 21, the DAF focused on MILCON program stability to ensure we 
are postured to award projects in the year of appropriation. Having 
improved policy to correct these measures in FY 21, the FY 22 program 
returns to a level similar to funding requests from previous years. In 
FY 22, the DAF MILCON request is $2.38 billion, approximately double 
the FY 21 enacted amount. This return to previous funding levels will 
support the DAF's commitment to fulfilling National Defense Strategy 
requirements and posturing for the future high-end fight.
    The FY 22 MILCON program supports Combatant Commanders with a focus 
on the Pacific and European theaters and modernizing the nuclear 
enterprise. Our request also focuses on P&D to reinforce the 
Department's MILCON program stability and consistency. Additionally, 
the MILCON program continues efforts to beddown new weapons systems and 
seeks to recapitalize facilities that have outlived their useable life 
or no longer meet mission requirements.
Combatant Commander Infrastructure
    The FY 22 MILCON program prioritizes Combatant Commander 
requirements with a particular emphasis on the Pacific and European 
theaters. Support to Indo-Pacific Command will enhance the United 
States defensive posture in the region, reassure allies and partners, 
and increase readiness capabilities. The request includes $571 million 
for projects in Alaska, Guam, Japan, and Australia to recapitalize key 
facilities, disperse resources, and construct operational facilities as 
well as Pacific focused P&D. The request includes the construction of 
three warehouses to store pre-positioned Airfield Damage Repair 
equipment and materials in Guam and Japan, aircraft operations and 
maintenance facilities in Australia and Japan, munitions storage 
structures in Guam and Japan, and a runway extension to increase 
airfield capacity in Alaska.
    The DAF remains committed to European Defense Initiative (EDI) 
efforts to reassure North Atlantic Treaty Organization allies and other 
European partners of United States commitment to collective security 
and territorial integrity. In FY 22, the DAF requests $162.4 million 
for EDI and other European theater projects to include support for the 
prepositioning of equipment in the United Kingdom, and airfield 
upgrades in Hungary and Spain. These projects will further improve 
deterrence efforts in the theater and enable Joint and coalition forces 
to quickly respond to aggressive regional actors. The DAF request also 
includes support to CCMDs within the United States to include a 
continued focus on Weapons Generation Facilities and Joint Air Defense 
Operations which directly supports Strategic Command and Northern 
Command, respectively.
New Mission Beddowns
    The FY 22 budget request also supports the beddown of new weapons 
systems and missions, with a heavy focus on modernizing the nuclear 
enterprise. The request includes six projects at Ellsworth AFB, South 
Dakota, to bed down the first B-21 Raiders and three projects at Hill 
AFB, Utah, and Vandenberg AFB, California to support the transition 
from the Minuteman III intercontinental ballistic missile weapon system 
to the Ground Based Strategic Deterrent (GBSD). The NDS directs the 
Department of Defense to build a more lethal force by modernizing key 
capabilities, the first of which are nuclear forces. Once on-line, 
these weapons systems will ensure the DAF can effectively supply two 
thirds of the nation's nuclear triad well into the future.
    The DAF is appreciative of the legislative authorities which 
posture the Ground Based Strategic Deterrent (GBSD) program for 
success. The FY 21 NDAA provided significant flexibility for the Launch 
Facility/Launch Center conversion under MILCON authorization, enabled 
all GBSD construction to be carried out under direction and supervision 
by the Secretary of the Air Force, and allowed a single prime 
contractor to plan, design, and construct all GBSD projects. 
Furthermore, it established authorization expiration in 15 years or 
until GBSD fielding is complete (whichever is earlier). The DAF will 
continue to inform Congress on the Department's progress during design, 
construction, and commissioning of GBSD facilities.
    The FY 22 President's Budget also requests funding for two projects 
at Royal Air Force Lakenheath to construct operational facilities for 
the F-35A bed down. Additionally, the request re-integrates two F-35A 
projects at Luke AFB, Arizona, to provide flight training and planning 
space and additional maintenance capacity. The Air Force cancelled 
these projects in 2019 due to a strategic basing decision which 
promoted the efficient use of existing facilities, training airspace, 
and command and control at Eglin AFB, Florida. FY 22 is the optimal 
time to re-integrate these projects, as they are critical to receive 
new F-35A aircraft at Luke AFB. Lastly, the budget request includes a 
three-bay depot maintenance hangar at Tinker AFB, Oklahoma to directly 
support reliable and responsive infrastructure for the KC-46A weapons 
system.
Existing Mission Recapitalization
    The FY 22 budget request also seeks $447.4 million to recapitalize 
facilities that have outlived their useable life or no longer meet 
mission requirements. This request includes additional funding for our 
Basic Military Trainee Recruit Dormitory modernization, to include 
reinserting Dormitory 7 back into the program at Joint Base San 
Antonio--Lackland, Texas. The Air Force previously cancelled Dormitory 
7 to cover funding disconnects with the other dormitories in the 
program, but in FY 22, the time is right to bring this requirement back 
into the budget to construct the final dormitory required for bringing 
new Airmen and Guardians into the Department. Other recapitalization 
projects include the Nuclear Command Control and Communications 
Acquisitions Management Facility at Hanscom AFB, Massachusetts, which 
provides a critical facility for the Air Force Nuclear Weapons Center, 
a crash fire rescue station at Joint Base Andrews, Maryland, and a gate 
project at Davis-Monthan AFB, Arizona.
    Additionally, the request includes a CDC at Sheppard AFB, Texas, 
which is the DAF's top priority to address child care capacity 
shortfalls.
Planning and Design
    P&D remains a central focus of the DAF MILCON program to reinforce 
program stability and consistency. Sufficient P&D enables projects to 
progress rapidly through design and meet maturity criteria for 
admissibility into the program, provides more accurate cost estimates, 
and maximizes opportunity to award projects in the year of 
appropriation. Without sufficient P&D, the DAF must award designs by 
design phase, which adds risk associated with costs and timely delivery 
of design. With the FY 22 P&D request of $253.5 million, the DAF 
intends to complete remaining design requirements for our FY 22 
program, fully fund designs for our planned FY 23 and FY 24 projects, 
and initiate design for FY 25. Our two year budget lock policy outcome 
is a stable MILCON program allowing us to efficiently use P&D for 
future projects.
     facilities sustainment, restoration, and modernization (fsrm)
    The FSRM and MILCON programs are interdependent. Together, these 
two funding streams are the foundation of DAF installations. FSRM 
provides a non-MILCON pathway to repair facilities and infrastructure 
maximizing their lifespan. The FY 22 budget request of $3.9 billion in 
FSRM funding is an 18% increase from FY 21 enacted levels. The increase 
shows our deliberate focus on ramping funding toward the I2S 
recommended floor of 1.9% of PRV to address degrading infrastructure.
    Our I2S drove changes in how we execute the FSRM program by 
prioritizing projects based on mission risk and timing investments at 
the optimal point in the asset lifecycle. The centralized FSRM scoring 
model targets investments at an asset's ``sweet spot'' in its life 
cycle rather than at end-of-life failure, which is significantly more 
expensive. FSRM funding distributed directly to installations 
(considered decentralized FSRM), empowers Commanders to make the right 
local investment decisions, including day-to-day maintenance and 
smaller scale repair and sustainment projects, based on mission 
requirements and I2S guidance.
           housing construction and operation and maintenance
    The DAF prioritizes providing safe and healthy homes to our 
families. The FY 22 budget request seeks $441 million for housing 
construction, P&D, and operation and maintenance. These funds will 
support a continued focus on eliminating inadequate housing from the 
DAF inventory. The military family housing construction request of $116 
million will fund planning studies and design for future construction 
projects, the renovation of existing homes, and supports the 
restructures of two privatized housing projects that are under 
currently under negotiation with the privatized housing project 
companies.
    The high cost of construction in the Pacific, specifically at 
Okinawa, Japan, continues to present challenges where the DAF is the 
executive agent for more than 7,800 family housing units. The increased 
cost of construction requires solutions within the DAF family housing 
construction program to include cancelling projects that are no longer 
necessary due to European theatre posture changes and using existing 
resources to achieve full scope on multiple projects. The DAF continues 
to focus investment in the Okinawa housing inventory to provide 
adequate housing for all service members and their families residing on 
the island.
    Our military family housing operation and maintenance request of 
$325 million will fund efforts to sustain, improve, and modernize our 
Government-owned inventory of approximately 15,200 family housing units 
and provide and sustain enhanced oversight of more than 55,000 
privatized homes. The additional $20 million in Family Housing Support 
and Management funding provided in FY 21 will ensure continued support 
for the housing needs of Airmen, Guardians, their families, and our 
Army, Navy and Marine Corps teammates housed in government-owned and 
privatized inventory.
                           privatized housing
    The DAF, with the support of Congress, has taken substantive 
actions to address the concerns and make meaningful, enduring changes 
to our privatized military housing program. Over the past two years, 
DAF leadership at all levels has been focused on improving the living 
experience for service members and their families living in privatized 
housing while we implement housing reforms set out in the FY 20 and FY 
21 NDAAs. Nearly all of Air Force's MHPI companies have agreed to 
implement all eighteen tenant rights at their existing projects, and 
with few exceptions, we expect these rights to be fully available at 
Air Force installations with privatized housing by the end of FY 2021. 
In addition, the Air Force has taken action to increase oversight and 
increase accountability to ensure identified hazards have been 
corrected and, if not, contractors are held accountable.
    Some highlights regarding the improvements the DAF implemented last 
year include increased program and project oversight. The DAF added and 
filled 218 manpower authorizations, and has filled them all, to improve 
oversight, quality assurance, and advocacy at all installations. The 
DAF also added 147 manpower authorizations to increase installation-
level oversight. These additional personnel are receiving training to 
conduct change of occupancy inspections consistent with national 
industry standards. Additionally, the DAF added 60 manpower 
authorizations to provide Resident Advocates to directly support 
residents ensuring they have multiple avenues to raise and resolve 
issues. Resident Advocates report directly to the wing leadership to 
increase commander awareness of concerns raised by residents. The DAF 
has also added 11 manpower authorizations for Headquarters DAF, Air 
Force Civil Engineer Center and our legal staff. Finally, the 
Department instituted a revised governance structure to review 
programmatic and systemic issues, best practices, and financial health 
of the program. The revised governance structure culminates with a 
council that includes the uniform chain of command and is advised by 
military housing office professionals.
    The DAF also approved a revised performance incentive fee (PIF) 
framework to increase both the commander and resident voice in 
assessing earned PIFs. The new performance incentive fees will improve 
tracking and reporting of maintenance operations at each project. The 
DAF is in the process of re-negotiating the PIF framework with project 
owners, reaching agreement with two of the nine project owners that 
have a PIF as part of their agreements. As part of the DAF's plan to 
increase transparency and accountability, all the project owners 
implemented automated work order systems, allowing residents to submit 
electronic work orders, schedule repairs, and provide satisfaction 
feedback. Lastly, the DAF centrally contracted for the annual tenant 
satisfaction survey, coordinating with the Army and Navy to ensure a 
consistent survey DoD-wide as well as issuing the survey to collect 
resident input from both privatized and government owned housing.
    In spite of these successes, the DAF is working with our MHPI 
project companies, in coordination with the Office of the Secretary of 
Defense and the Office of Management and Budget, on restructures for 
two financially challenged projects in order to address health and life 
safety, sustainment, and reinvestment needs. There is still more work 
to accomplish to ensure quality and safe homes for our Airmen, 
Guardians and their families. Our priority going forward is to remain 
focused on improved oversight, long-term project health, and 
sustainment of the housing inventory to provide military families 
access to safe, quality, affordable, and well- maintained housing 
communities where they choose to live, and to ensure accountability at 
all levels within DAF and the MHPI companies to perform our oversight 
as originally intended at the outset of housing privatization. Our FY 
22 request provides funding to ensure our DAF has the staffing and 
resources they need to ensure that housing privatization projects 
provide safe, quality, well-maintained housing, and address resident 
concerns in a timely, transparent, and responsive manner.
                  base realignment and closure (brac)
    Through the BRAC process the DAF has closed 40 installations and 
sites and transferred more than 98% of the property back to communities 
for beneficial use, producing $2.9 billion in annual savings. Property 
transfer is complete for 34 former installations, and we expect to 
complete transfer of fewer than 2,000 acres at the remaining six former 
installations by 2027.
    Our BRAC cleanup program focuses on protecting human health and the 
environment, projects that transfer acreage and achieve beneficial 
reuse of property, and investigations and response actions associated 
with PFAS.
                               conclusion
    The DAF's FY 22 budget request supports President Biden's Interim 
National Security Strategic Guidance and lays out a plan to modernize 
our military capabilities while taking care of our Airmen, Guardians, 
and families. It keeps us on the path toward a successful future 
posture. The I2S continues to guide MILCON and FSRM budget decisions 
and business practices as we endeavor to deliver ready, resilient 
installations as cost effectively as possible. The MILCON portion of 
the FY 22 request prioritizes nuclear enterprise modernization and 
supports Combatant Commanders, with particular focus on the European 
and Pacific theaters. The housing request provides the resources needed 
to sustain and improve the DAF's inventory of government-owned homes 
and provide oversight of privatized housing project owners. The 
Department remains committed to overcoming challenges affecting this 
portfolio and delivering effective, efficient installation engineering 
services. The FY 22 President's Budget request ensures that our Airmen, 
Guardians, and installations are ready to defend American interests now 
and in the future.

    Senator Heinrich. Thank you, General Berry. We will proceed 
with questions and use the standard five-minute rounds. 
Senators will be recognized in the order that they arrived, and 
I will start by recognizing myself for five minutes.
    To either General Evans or General Berry; I mentioned in my 
opening statement that I am encouraged by the increased request 
for ERCIP; however, it is my understanding that the demand for 
funding still exceeds the request. So, for example, there are 
microgrid projects ready to go at installations across the 
country, including Kirtland Air Force Base in White Sands 
Missile Range. Could you talk about the interest in ERCIP from 
installations and the regions? And if there was additional 
funding, what would the ability to execute be?
    General Evans. Sir, thank you for the question. We are 
budgeting $104 million this year for ERCIP, which is an 
increase from last year, and we are also in the out years 
increasing the use of ERCIP. I can get you those numbers. ERCIP 
is an important program to us, as well as the other third-party 
contracts that address climate control and environment. But I 
can get you the numbers for the out years. We are increasing 
our years, sir.
    General Berry. Yes, sir. As far as the Air Force, so for 
resilience, you know, we look at it through several different 
lenses, through energy, through cyber, infrastructure, response 
when something happens, of course, due to climate. From a 
resilience perspective, I don't have the exact numbers for the 
ERCIP, unfortunately for the Air Force. I can certainly take 
that for the record to get back to you for particular projects 
that we had in the budget for the 2022 request.
    But as you know, and I think as both you and Senator 
Boozman mentioned, the challenges that we have, right, are the 
many demands on the portfolio. And so the many things that we 
try to fit into the top line and the obligation authority that 
we do have in the Department can't satisfy all the demands that 
are there.
    But it is important to us, we are committed to resilience. 
We have, as I mentioned in my opening comments with Tyndall and 
Offutt, many of the projects there in terms of building those 
facilities and bases back to what we need, not just what was 
there before, by incorporating resilience, and incorporating 
all those resilience standards into our design standards, 
moving forward, for future MILCON, restoration of modernization 
is very, very important to us.
    Senator Heinrich. Admiral Williamson or General Chiarotti; 
the fiscal year 2022 ERCIP unfunded requirements list does not 
include any Navy or Marine Corps projects. Do the four Navy and 
single Marine Corps projects in the budget request reflect the 
entirety of ERCIP demand in those services?
    Admiral Williamson. Sir, fiscal year 2022 included $109 
million for nine ERCIP projects. To give you an example of 
those, one is Great Lakes Illinois, our single training 
facility, and the other is at Atsugi.
    Additionally, one of those projects we took advantage of, 
not only the resilience that my counterparts talked about but 
on San Clemente Island, which is very important to our 
training. We are able to get wind turbines up there, which 
allowed us to get away from using, diesel generators. It is a 
very important part of our base master plans, and we validate 
that through our mission assurance program, by going out 
looking at the infrastructure of the base, ensuring that it can 
respond to, you know, any loss of power, and also that we were 
producing, the most efficient use of the power.
    Senator Heinrich. General Chiarotti, do you want to add to 
that?
    General Chiarotti. Sure. Thank you. So from the Marine 
Corps perspective we have--across our installations we have 
undertaken an assessment analysis of where we stand with our 
ability to maintain the resiliency that is needed to operate 
our core functions. And as I mentioned in my opening statement, 
some of our installations now are at net-zero, and we are able 
to generate that utility that is required in order to sustain 
the functions, and in some cases also sell back utilities. So 
we find great value across the board. We continue to make those 
investments, but we are moving at a very deliberate and 
informed pace through our analysis that is being provided 
there.
    You will see in San Diego, MCRD San Diego where we are 
pairing up with commercial utilities provider for a long-term 
power sustainment, independence in that regard. So from the 
Marine Corps perspective, yes, sir, we were taking max 
advantage of that. Thank you.
    Senator Heinrich. It is been interesting as we have worked 
through some of these projects in New Mexico, where we have a 
microgrid project at Kirtland Air Force Base. You know, we 
started to realize that we have heavily relied on things like 
diesel generators which, you know, one out of three times, you 
try to get them started and they just don't start. And, 
replacing those with on-grid storage has made quite a 
difference. So look forward to hearing more.
    And, with that, I will recognize our Ranking Member.
    Senator Boozman. Thank you. Thank you, Mr. Chairman.
    Mr. Cramer, the past couple of years, your office has been 
working on military construction reform, looking for ways to 
reduce cost and improve timeliness of delivery by looking at 
specific key areas of the MILCON process. I did not see any 
mention of that effort in your written statement. Again, we had 
a really good visit in the office and talked about these 
things. So can you just reaffirm what MILCON is thinking about 
in regard to initiatives that are focusing on producing real 
change and results for the MILCON program in that regard? Can 
you share any specific examples of process improvements you 
have identified and you are working towards from an enterprise-
wide approach?
    Mr. Cramer. Thank you, Senator. Yes, so one of the measures 
we talked about yesterday, as part of our MILCON reform, an 
effort we started a couple of years ago, we kind of got 
sidetracked with other more urgent needs, and while we've 
talked about MILCON reform, and more staff to actually to 
execute the MILCON reform so as part of the 2021 NDAA we split 
back the what was combined into the Assistant Secretary of 
Defense for Sustainment pulled apart what was usually called 
ASD for Installation Energy and Environments, and also 
Environment, Installation and Energy, so that stood up.
    And with that, now I have a dedicated deputy assistant 
secretary to do construction oversight. And so one of those, 
Mike McAndrew, a long-serving SES and knows exactly what needs 
to be done in MILCON reform. He was doing housing and MILCON 
reform up until earlier this year. So now he is back and 
dedicated, so he's now, in fact, today meeting with 
representatives from our Design Construction Agents in the Air 
Force's current facilities, the Civil Engineering Command. And 
so that is the body of folks that actually then have oversight 
of the Department's MILCON processes, and it is too long.
    And if you look at the frontend in comparison, and if we do 
it right before we seek budget, and the 35 percent design is 
kind of the number we settled in on, and to say that is a 
design sufficiency. But what we really want to go after is the 
design risk. And then if we're--at the 35 percent there is some 
risk involved in that design for the unknown, and the 
installations will go through with the project.
    So we want to add into the program amount, a sufficient 
dollar to overcome those risks, so that we are not coming back 
and doing reprogramming actions which will take a while to get 
the process to get it up to you guys to approve.
    So we want, in order to get the program amount on those 
projects to about what we need to overcome the things that we 
know to be risk at the time of the request. Things like the 
pandemic and global construction, we can't foresee those, but 
we can look into, you know, past practices to get better at 
what is our design risk--so that we are not always seeking 
reprogramming so that [inaudible].
    Senator Boozman. Right.
    Mr. Cramer. So I am trying to avoid that at the frontend of 
the projects, and really get more design sufficiency and 
project definition before we get to the [inaudible].
    Senator Boozman. All right. Thank you. For one of our 
Service witnesses, if you will just jump in, this applies to 
all of you--very quickly. There has been a lot of attention in 
recent years to the condition, not just housing, but also 
barracks and dormitories. We have seen multiple stories of 
barracks and dorms in poor condition, sometimes against the 
backdrop of low morale, poor command climates, and troubling 
stories. Most of you addressed this in your written and oral 
statements, but I would like to address it here.
    How are you prioritizing funding for barracks and dorms 
within the MILCON budget, as well as against other quality of 
life projects such as child development centers? Yes, sir?
    General Evans. I will go first. Can you hear me, sir?
    Senator Boozman. Yes, sir.
    General Evans. All right. Sir, under the G-9 we lead a 
Quality of Life Task Force for the Army. We have been leading 
that since about November 2019, and there is six lines of 
efforts, it is really six priorities that were really based on 
the Chief of Staff of the Army's Transition Task Force, where 
they canvassed the Army, talked to privates, all the way up to 
generals, talk to civilians, talk to family members. And what 
came out of that is the number one priority for people, which 
is our number one priority, is housing. And included to that is 
barracks.
    And I think our budget request reflects that, you will see 
five barracks projects they are wanting--and also includes a 
reserve component. With your support the Chief of Staff's 
fiscal year 2022 UFR list, there is about 13 barracks projects 
in there. And then the third priority in that was child 
development center. And you will see four child development 
center projects in the UFR list, two CDC MILCON projects, and 
two R&M projects, and you will see the same in our request.
    And so that is how we look at it. Our priorities are 
people, modernization, and readiness, and I think that our 
budget request and our UFR request reflects that.
    Senator Boozman. Good. Thank you, General. Thank you, Mr. 
Chairman.
    Senator Heinrich. Senator Collins.
    Senator Collins. Thank you, Mr. Chairman.
    Admiral Williamson, as you may know, the acting secretary 
of the Navy recently visited the Portsmouth Naval Shipyard in 
Kittery, Maine. He was clearly very impressed with what he saw 
there, the outstanding, talented, highly-skilled employed, we 
have an excellent captain commanding the shipyard, and the 
entire Maine delegation, and New Hampshire delegation are 
strongly supportive of the shipyard.
    The Navy's budget requests 250 million for the second 
increment of the Multi-Mission Dry Dock No. 1 extension project 
at the Portsmouth Naval Shipyard. The Navy has included as its 
number one MILCON unfunded priority an additional 225 million 
that is needed to keep this essential project on schedule. It 
is vitally important. Beginning of 2024 scheduled Virginia 
Class maintenance availabilities at the shipyard will exceed 
its capacity, and failure to complete this project on time will 
result in 20 deferred availabilities through 2040.
    In other words, we need this project completed in time, or 
we risk our submarines and our sailors being unable to 
accomplish their mission. Could you discuss the importance of 
the additional funding to the success of the project? And with 
this additional funding, number one on your unfunded priority 
list? Would the Navy be able to eliminate the 20 deferred 
availabilities so that we can return our submarines and our 
sailors to the fleet on scheduled so they can perform their 
important mission?
    Admiral Williamson. Yes, ma'am. First, yesterday the CNO 
testified, this is a once-in-a-century opportunity. The 
shipyards play a very vital role. I am familiar with Portsmouth 
Naval Shipyard, as you know, as a Commander of Navy Region Mid-
Atlantic. The shipyards, our dry docks are over 100 years old, 
the infrastructure that supports is greater than 61 years old. 
It is vital to support Columbia, and Virginia Class Submarines, 
particularly for COCOM requirements.
    We did have a project that came in over what we expected. I 
think it was a tremendous opportunity for us to learn, because 
we have not done a mega project this size in a very long time. 
Our leadership has absolutely, with a sense of urgency said, we 
need to learn quicker, and we will. The raw materials: for 
example, the impact, the volatility due to COVID driving that 
up, balancing the maintenance of building a new shipyard while 
you are doing maintenance to a very complex platform, ensuring 
that those maintenance availabilities are predictable and on 
time allows you to maintain that superior workforce that is in 
Portsmouth.
    We are committed to learning from that. We have taken 
several actions, you know, obviously taking on a task of this 
size requires great expertise. So we are bringing on cost 
engineers, and economists, experts to help us. We are also 
bringing in third-party risk consultants to get better 
accuracy, and reduce the risk as we move forward. In addition 
to that, you know, it kind of ties into the resilience 
conversation we had earlier. You know, the first element of 
this is a digital twin. We are currently looking at all four of 
our shipyards. Hawaii is completed. We hope to have the digital 
twins completed by the end of this year for all of our 
shipyards, and what that will allow us to do is do an area 
development plan.
    Senator Collins. But just to clarify. You stand by the 
statement that is in the budget materials, that the additional 
money would eliminate the 20 deferred maintenances?
    Admiral Williamson. Yes, ma'am.
    Senator Heinrich. Admiral, I was just going to say: Can 
everyone, please, make sure your mics are on, and pull them in 
nice and tight so that the folks who are watching on the 
website can hear you.
    Admiral Williamson. Apologize, sir.
    Senator Heinrich. Yes.
    Senator Collins. Thank you.
    General Evans. I was pleased to see that the Army's budget 
request includes 21 million for a new Joint Vehicle Maintenance 
Shop for the Maine National Guard at its Saco location. The 
existing undersized facility was constructed more than 80 years 
ago, and it has a host of problems, including insufficient 
lighting, poor ventilation, fire mitigation and electrical 
wiring that is not up to code, asbestos in the structure, and 
there are also force protection issues with the current 
building. What would be the impact of a delay in replacing this 
facility on readiness?
    General Evans. Well, ma'am, all the reasons you stated. An 
antiquated facility, it does not have the room----
    Senator Heinrich. Can you make sure your mic is all the way 
in because----
    General Evans. Sorry, sir.
    Senator Heinrich. There you go.
    General Evans. All those reasons you stated, along with 
that being the only vehicle maintenance facility in Bloomington 
of its kind, it is also a shared facility with the Air National 
Guard as well as the Army National Guard will have a tremendous 
impact on the readiness of maintenance on combat and tactical 
vehicles.
    Senator Collins. Thank you. Thank you, Mr. Chairman.
    Senator Heinrich. Thank you. I think we are going to start 
a second round and I believe Senator Tester may be on his way 
as well.
    So I want to ask you Mr. Cramer. This is the first year 
that DOD has requested funding for electric vehicle 
infrastructure planning and design, it is critical that the 
Department commit resources to understand its energy demand 
needs, and electrical grid capacity, and to build out its 
electric infrastructure where necessary. Could you discuss how 
the Department is approaching electrification at installations, 
in particular to support both the non-tactical and the tactical 
vehicle fleet?
    Mr. Cramer. Senator, I would start that with--it goes back 
to--I didn't want to be accused of a spring [inaudible] to the 
question you answered--or asked earlier about ERCIP, and really 
the plan starts with our installation energy plans. And so if 
we have a holistic plan of energy needs on an installation, a 
subset of that would be the grid. Resilience of the grid, 
electrification of the grid in order to provide electricity to 
the point of need, regardless of what that point is; electric 
vehicles, you know, command facilities.
    And then also what we want to do, as part of our 
installation energy plan, is build in efficiency into those 
facilities so that we could reduce the demand which then 
increases the O&M dollars to spread out. And so specifically 
for electric vehicles and electrification to support, and 
focused on the non-tactical. We are years away from 
electrification of a tactical vehicle.
    So non-tactical vehicles on an installation, we really have 
to look at the point of need, and the sufficiency of the grid, 
so we don't throw, you know, our whole electric system off 
balance. So we really have to then hire some folks that are 
experts in the field, which quite frankly, we don't have that 
muscle memory within our organizations just yet. We may build 
that, that capacity, but right now we are really gonna rely on 
some consultants to come back and do an installation. And say: 
All right, so here is what the grid looks like today. Here is 
kind of the direction we are going to go. And we are going to 
make sure that it fits into our overall installation energy 
plan, and then we use the tools in the toolkit in order to 
address a lot of that, ERCIP being one of those.
    And I think what you will find is, is that while the FY DP 
for an ERCIP does not look that deep today, as we fill out the 
installation energy plans across the entire Department of 
Defense, then that--you know, one to N list does get fairly 
robust, because the need is there to support resilience on our 
installations. That is what we are really looking for. How do 
we continue to operate regardless of the events that take 
place, and eliminate those single points of failure that exists 
today in our grid?
    Senator Heinrich. I forgot that. I am following my own 
advice here. Is the Department integrating electrification 
requirements into upfront facility design? For example, are you 
updating the unified facilities' criteria to think about these 
things so that we are not, down the road, retrofitting 
expensive land? You know, a lot of what you talked about in 
your testimony just now, it is not really rocket science. I 
have been doing this for--I built my first electric vehicle in 
the early '90s, and I have been driving electric for a few 
years now. And oftentimes it is cheaper if you plan for it. It 
is not cheaper if you retrofit.
    So, for example, if you have a new office building, or if 
you have a new housing, and you put in the smallest service 
panel available when you build that, if you add additional 
demand you are going to have to make an expensive upgrade. 
Whereas, if you put a service panel in that has additional 
slots in it, it is not a big deal. So are you making the shift 
to thinking about this into the future, and planning so you are 
avoiding, you know, expensive upgrades down the road?
    Mr. Cramer. Yes, Senator. We have updated our Unified 
Facilities Criteria, our version of design codes, and our 
facilities guides that we give out to--or that our design 
construction agents use to give out to their architects and 
engineers. So those guide specs and facility criteria codes 
have been updated, and then so we are not in the habit of doing 
is retrofitting buildings for retrofit sake.
    You know, we are going to go into a facility that has a 
need for more than just one single item to correct. We will do 
that restoration and modernization, and we will put in, you 
know, all of the latest and greatest at that time of contract. 
But we have got hundreds of thousands of facilities we have got 
to get to. And so we are--we are really then, you know, 
focusing on the retrofit as we go down. And I will let my 
Service colleagues add on if they want.
    Admiral Williamson. Sir, to address the question 
specifically. As Mr. Cramer mentioned, as part of our 
installation development plans, and part of our mission 
assurance reviews of our bases, it is twofold. UFC standard as 
we move to look at resiliency moving forward, and this being 
part of our master plan, we specifically look at the bases with 
grids, for example, to ensure that when we build back, we build 
back better.
    And that is built with two things in mind. One, of the 
efficiency of the base, which is a multiplier for us, and two, 
allows us resilience. I had the great fortune of being the CEO 
of Naval Base San Diego, had a great partnership with San Diego 
Gas & Electric, and obviously huge demand signals in that area. 
But when you have the partnerships with the local energy 
providers, it is a tremendous opportunity and leverage for us 
to learn.
    So certain times a year in San Diego, Naval Base San Diego 
is home to 50 more ships, huge energy consumption, we come on 
to ship's power to allow San Diego the same opportunity they 
allow us to operate. And so through those partnerships, I think 
it is tremendous learning, and it is also an operational 
advantage for us.
    Senator Heinrich. All right. Thank you.
    Senator Hagerty.
    Senator Hagerty. Thank you, Mr. Chairman. I appreciate the 
opportunity to be here with such distinguished witnesses today, 
and in particular, a very good friend, General ``Chuck'' 
Chiarotti. It is wonderful to see you again, Chuck.
    And Chuck, I am going to I am going to direct some 
questioning to you, if you don't mind. I want to go back and 
talk about the 2018 National Defense Strategy, and quote from 
that. ``China wants to shape a world consistent with its 
authoritarian model, gaining veto authority over other nations' 
economic, diplomatic, and security decisions.'' In pursuit of 
that objective, each day China continues to strengthen its 
posture in the Indo-Pacific region. It continues to maintain a 
very real threat to the United States and to our allies. And 
that is why the U.S. Military posture in the Indo-Pacific 
region is more important than ever.
    As Ambassador to Japan, it was my great honor to work 
alongside you, General Chiarotti, and such a competent team of 
United States Military professionals in that region. And we 
continued to focus our posture to be as effective as we could 
be every day. So I would like to get your perspective, if you 
could describe the strategic environment and the Indo-Pacific 
today, as it stands today, and whether China is continuing to 
tilt the balance of power in its favor?
    General Chiarotti. Senator Hagerty, it is good to see you, 
sir. Sir, I will stay within my lane, and that is within the 
area of logistics and facilities, and also of the United States 
Marine Corps. Our commandant has put the Marine Corps on a 
footing to address the threat that China is. In that regard he 
has directed a force design, which really seeks to address the 
growing risks that China has placed on the United States, and 
as defined by the National Defense Strategy.
    To that end, we are, as we always do when faced with a 
threat, reevaluating our posture to ensure that we are able to 
provide the Indo-Pacific Commander and the Nation, the 
responsiveness that the United States Marine Corps is expected 
to deliver, sir.
    Senator Hagerty. Well, I want to thank you and the many 
Marines that serve in that region. In my experience with China 
the past couple of decades, they have increased their military 
expenditure some eight-fold, and recently they just surpassed 
the number of ships in their fleet, greater than the U.S. 
Military's fleet.
    Now, of course, our ships are far more capable, and a real 
force in that region, but as you continue to think about our 
posture there, do you think of us moving in a more dispersed 
fashion? Do you think of us hardening our position? How do you 
see, from a facility standpoint that evolved in, given the 
breadth of the challenge in that region?
    General Chiarotti. As you will know, sir, our installations 
in the Indo-Pacific AOR are located within the first island 
chain, the majority of those, and so we continually look at the 
vulnerabilities that are--that we face both from environmental, 
as well as kinetic threats from our potential adversaries. To 
that end, the United States Marine Corps is an expeditionary 
force, and so we see ourselves operating in a very dispersed 
manner within that first island chain providing that 
competition deterrent, and the ability to quickly transition 
from competition to the blunt force, as directed within the 
National Defense Strategy, sir.
    Senator Hagerty. Well, I want to thank you for everything 
that you have done in your career and service, Chuck, and I 
want to let you know that, were it not for the strength that 
you provide, our diplomacy would not be as effective as it is. 
So thank you. And thanks to all of our witnesses today.
    Mr. Chairman, I yield back. Thank you.
    Senator Heinrich. Thank you.
    Senator Tester.
    Senator Tester. Thank you, Mr. Chairman, Ranking Member 
Boozman, for having this hearing. I want to thank all the 
witnesses for being here.
    And Senator Hagerty, I look forward to working with you. 
You laid out the challenges very, very well, both from a 
military perspective, and an infrastructure perspective in this 
country. So thank you for those statements.
    Okay. Last year, the National Guard has been called to 
respond to COVID-19, domestic unrest, and even to secure where 
we are at right here today. One of the only major MILCON 
accounts that saw a significant decrease in the budget request 
was the Army National Guard MILCON account. We are relying on 
our National Guard more than ever, and I am concerned that we 
are going to reward them by asking them to do more with less.
    So, General Evans, can you tell us about what kind of risks 
that we are taking by funding the Army National Guard MILCON at 
the level that is requested?
    General Evans. Sir, thank you for the question. The MILCON 
budget, to include the Army National Guard, is based on the 
Army priorities, people, and readiness, and modernization. I 
think what you see in Army National Guard MILCON account budget 
request is addressing those items: barracks, vehicle 
maintenance, as well as readiness center. You also see a number 
of projects, with your support, in the Chief of Staff UFR lists 
for the same barracks, readiness centers, and maintenance, to 
address exactly what you are talking about, sir, the readiness 
of the Army National Guard.
    Senator Tester. So, just to follow up very quickly, General 
Evans, you don't think we are taking any risk by having the 
National Guard MILCON, funded at this level. Do you think it is 
adequate?
    General Evans. So I think the Army senior leaders, as they 
prioritize the MILCON list, considered the risk across all 
compo, sir. And I think what you have is it addresses the 
people in readiness and modernization for all compos to include 
Army National Guard, sir.
    Senator Tester. So this is adequate?
    General Evans. So I would say, with your support, with the 
chief of staff, the Army's UFR list I think we will continue to 
make ground on that. As you know, the Army does have an 
infrastructure backlog, and I think the UFR list, along with 
what we are doing now, addresses that, and we will continue to 
address that based on the Army priority, sir.
    Senator Tester. Okay.
    General, General Berry, we have got Malmstrom Air Force 
Base in my backyard, we have got a potential weapons storage 
facility to be built there as long as well as one in Senator 
Hoeven's state, in Wyoming. I believe they started on the one 
in Wyoming. They are supposed to start on the one in Montana 
soon, I think. It is well funded, but there has been somewhat 
of a history of kicking the can down the road a bit, and I want 
to make sure it does not get kicked down the road on the 
weapons storage facility.
    So, to cut to the chase, can you give me a timeframe about 
when you think, because it is somewhat dependent on Wyoming, 
when you think they will break ground on the Montana Weapons 
Storage Facility?
    General Berry. Senator, thanks for the question. So, as you 
said, you know, as we do the construction, F.E. Warren, we are 
learning lessons as we go along. There have been some design 
changes from those lessons we learned at F.E. Warren that we 
are now incorporating into the Weapons Generation Facility at 
Malmstrom. We are proceeding with the 95 percent design on the 
Malmstrom Weapons Generation Facility. Right now, talking to 
our design and construction agent, we believe that we will be 
ready for a contract award in the spring of 2022.
    So once we do contract award, then you can start doing the 
mobilization, and you can start doing the actual construction 
at that site. So for now we have the $120 million first 
increment for that structure, and that is a very, very 
complicated facility. We think that is enough money for now to 
carry us through fiscal year 2022 to get to the more robust 
design and get us through contract award, sir.
    Senator Tester. So a year from now--actually a little 
before that--because we are in June now. So spring is, at least 
in Montana, we are in summer, even though the calendar doesn't 
state it.
    General Berry. Yes, sir.
    Senator Tester. The contract award will be given?
    General Berry. That at is the current schedule that we are 
marching to. Yes, sir.
    Senator Tester. And what point in time after that contract 
award does dirt start being moved?
    General Berry. I can get back to you on the exact 
timeframe.
    Senator Tester. Typically, how long does it take?
    General Berry. It is months later.
    Senator Tester. Months?
    General Berry. By the time you mobilize the contractor and 
get them onsite, yes, sir.
    Senator Tester. I appreciate that. And I will probably hold 
it to it too. So thank you. On privatized--oh, I am out of 
time. I will submit a question for the record, Mr. Chairman. I 
just wanted to express my appreciation to all of you for the 
work you do. Thank you.
    Senator Heinrich. Thank you, Senator Tester.
    Senator Hoeven.
    Senator Hoeven. Thank you, Mr. Chairman. I am going to pick 
up right where Senator Tester left off, no surprise to him. We 
have common interest, both in the Weapons Generation Facility, 
and also the MH-139 Facility. And we have worked very hard on 
those--both of those, including the helicopter, getting the new 
helicopter out to the ICBM bases. And so he mentioned 
Malmstrom, and I am going to bring up the Minot Air Force Base.
    General Berry, can you update me as to the status for well, 
let's start with the MH-139 Facility. We appropriated, let's 
see, $66 million in 2019, an additional $5.5 million in 2020 to 
house that facility. I have been expecting that you all would 
have had a groundbreaking by now. So can you update me on the 
status of constructing that facility?
    General Berry. Yes, sir. So it is a similar story to the 
last question Senator Tester asked. As we put the bids out, the 
bids came in higher than anticipated, and so our construction 
agent right now is evaluating those bids to try to see if we 
can get it more in line with what we expected that project to 
cost. Since it is, right now, in solicitation, I am hesitant to 
say anything publicly. I think we would be more than happy to 
come talk to you privately about some of the challenges that we 
are seeing on that MH-139 facility.
    We do know that once the Corps of Engineers does award the 
contract, it will be about a two-year period of performance to 
actually get the facility completed. But until we can get 
through the bids, I cannot give you a firm answer on when that 
construction will actually start.
    Senator Hoeven. Well, then I would ask that you come talk 
to me privately, so to just know when that is going to be. All 
right?
    General Berry. Yes.
    Senator Hoeven. Thank you. But then also I want to ask 
about the Weapons Generation Facility, unlike F.E. Warren, or 
Malmstrom, we have both the ICBM Ground-Based Nuclear 
Deterrent, but also the B-52s with their nuclear weapons. So we 
have been told that we have not been started on the new Weapons 
Generation Facility because we have--you have to handle both 
aircraft and missiles, and the others are just the missiles. I 
understand that. I still want to know where we are at in 
getting that done. I mean, this is the only dual nuclear base 
in the country operating with an older facility. So it seems to 
me it is of great importance. Can you tell me on the timeline 
there?
    General Berry. Yes. So, Senator, I unfortunately cannot 
commit to a specific date of when we will get to that Weapons 
Generation Facility. I think as you alluded to, right, it is 
very, very complicated, that WGFs themselves are complicated 
and complex facilities, when you design in all the safety and 
security standards that come with that weapon system. We are 
learning lessons at F.E. Warren, we will learn some lessons 
when we get to Malmstrom. This fiscal year 2022 budget 
increment one, for the Barksdale Weapons Generation Facilities 
in there; that is the first bomber WGF that we will design and 
build as well.
    So all of those are giving us an opportunity to learn the 
lessons that will then come to play at Minot, whereas, you 
mentioned, we are putting both of these missions together into 
one facility that makes it even more complex than the other 
ones. So we think by doing that, we will get a better design, 
we will get a better cost estimate, and we have a better chance 
of meeting cost and schedule when we do it that way. But, but 
right now we have not started the detailed design on that 
structure.
    Senator Hoeven. But you are also building Weapons 
Generation Facilities for the new B-21 at Ellsworth and Dyess, 
I think, and somewhere else. So I keep getting told this, we 
are going to learn a lot of lessons, but I am quite anxious to 
understand when we are going to get going on this facility. So 
maybe that is something we could talk about as well.
    General Berry. Absolutely, sir. We have a plan for the 
Weapons Generation Facilities as they come online based on 
mission need for the missions that are going to the various 
bases. So we will be happy to come talk to you in more detail 
about the Minot Project.
    Senator Hoeven. This is the only base in the Nation with a 
dual nuclear mission, performing at a high level strategically 
important base for ICBMs, and a B-52 deployment that is very, 
very high for both the Korean Peninsula and the Middle East. 
High ops tempo, these soldiers are doing--these airmen and 
women are doing a whale of a job out of that facility, and it 
really does deserve the attention.
    General Berry. Sir, we agree with you, with the importance 
of the mission, and we are committed to replace the weapons 
storage area with a WGF.
    Senator Hoeven. Thank you. I guess on a positive front, I 
would tell you from a funding standpoint, it looks to me like 
we are keeping the new GBSD, Ground-Based Strategic Deterrent, 
as well as the LRSO on schedule, which has been no small effort 
on the part of this appropriating committee. So just any 
thoughts you have there, are incredibly important as far as 
part of the nuclear triad. We are committed to it. We are 
working very hard to do that. And I know our chairman here is 
very committed to the nuclear lab piece, since he has part of 
that in his state; any thoughts as far as staying on schedule 
with those?
    General Berry. So the GBSD, I know that we have been very, 
very grateful to the Congress for giving us some authorizations 
there that will help us do the very, very complicated, when we 
are talking about WGFs being complicated, GBSD, where you are 
essentially going to replace a silo and wait for 8 years, is 
going to be a very complicated endeavor as well.
    So we are very grateful to the authorities we have gotten 
from Congress. And I think those authorities that we have 
received at least set us on the path to realizing the goal of 
staying on cost and on budget for the GBSD transition.
    Senator Hoeven. Thank you, General. Thank you, not only for 
what you do, as in, to all of you here, gathered. Thank you. We 
truly appreciate you very much. And thank you for all that you 
do for us.
    Senator Heinrich. Senator Murkowski?
    Senator Murkowski. Thank you, Mr. Chairman. Gentlemen, 
thank you for being here this morning, for your leadership. I 
want to talk about housing today.
    I had an opportunity just this morning to meet the new 
incoming, Commander General Eifler. He is going to be taking 
over for General Andrysiak, who has been doing a great job for 
us in Alaska. And one of the issues that he and I have shared, 
just a great deal, quite honestly, of anxiety and stress over 
is--as what we have seen in the increasing rate of suicide in 
Alaska, particularly within the Army.
    Just really very, very disturbing, and as General Andrysiak 
has used the term, it is heartbreaking. So we are trying to 
address these issues, and you are trying to look to what are 
the contributing factors, what is happening out there? Is it 
deployments? What is it? And it seems that so much of it comes 
back to some of the quality of life issues, and in how we are 
able to support our soldiers, our airmen, our marines, how we 
are there for them. And housing is kind of a basic thing.
    So we want to make sure that we are doing right in all of 
these spaces. We are really quite pleased that in Alaska we are 
seeing a plus-up in terms of the military personnel that is 
coming specifically to Eielson, but also at Fort Wainwright, 
this is up in the interior of the state, owing to the F-35 bed-
down, Eielson is expected to receive 54 jets, an additional 
1,300 military personnel, plus their families, by December of 
2021. By 2023, Eielson will receive four more KC-135s, and more 
than 200 active-duty Air Force personnel, plus their families
    We are really excited about it. The Alaska delegation 
certainly is, but also the communities up north. Those in the 
Fairbanks North Star Borough where Eielson is located, have 
been enthusiastic in every sense of the word, but they have 
also been a little bit concerned about: How do we make sure 
that we truly are that golden heart community where we not only 
welcome all of our military and their families, but how do we 
make sure that they are well cared for?
    And so we have a housing issue in the region just more 
largely, but on-base housing availability at both Eielson Fort 
Wainwright are about 95 percent capacity that is right now. And 
to my knowledge, there is no ongoing construction, planned 
construction, or funding request for the creation of on-base 
housing. And I think it is important to say, this is what 
everyone had agreed to.
    I am not laying the onus on anybody here, but it was going 
to be necessary for the community to know that they were not 
going to make that investment on the private side, build 
things, and then have Air Force come in, and build housing that 
would put the investments on the private side at risk. We have 
been down that road before, and the community was not at all 
interested in doing that.
    So what we are trying to do is make this work for everyone. 
Nearly all of these incoming personnel are going to live in the 
community. And, and again, right now we have got housing issues 
within the community at large, in addition to the number of 
units, there has been a recent housing assessment that found 
that 36 percent of households are cost-burdened, meaning more 
that they--meaning that they spend more than 30 percent of 
their income on housing. And this is due to a number of 
factors.
    It is called climate, it is aging homes, it is more 
expensive. So that is a long question. I spent five minutes 
outlining this which I shouldn't have, because I need your 
input here.
    And Mr. Cramer, this is probably for you. But General 
Berry, General Evans I would certainly welcome your input on 
this. What is happening within DOD, notably, the Air Force and 
the Army to partner with the community, to identify, and 
implement solutions, to make sure that we are getting airmen 
and their families into these homes and at an affordable rate? 
So that is a very broad question to you, but know that we are 
very, very concerned that the timing on all this matches the 
incoming number of personnel.
    So Mr. Cramer, it looks like you are ready to go.
    Mr. Cramer. Yes, Senator. I will start it off, yes. So 
having served in the Army as a deputy assistant secretary for a 
number of years, I am very familiar with the housing program in 
the North Star Borough, both at Eielson and at Fort Wainwright. 
Capacity issue is definitely a challenge, especially in the 
larger homes where we see a lot of the military families have 
more kids. And so in the two-bedroom, three-bedroom, there is a 
good inventory; but four or five bedrooms, there is not.
    Senator Murkowski. Right.
    Mr. Cramer. And so with the Army, has kept online Birchwood 
family housing, even though it was--it far exceeded both in-
leased and the out-leased for that project, so we have kept it 
online just because it had the larger homes. And have partnered 
with the community to try to, you know, entice development of 
housing off-post, because in the Department of Defense, our 
priority is still community first, housing, and not on-base 
housing.
    So to the extent we give assurances to the local 
construction housing developers we are willing to do that, so 
that they can spur some construction on. And, Senator I am 
concerned about the 30 percent--36 percent house burden number 
that you cited, because that, if it is military folks, you 
know, we can do better in our base allowance for housing 
surveys that we do annually to set the rates.
    Because what we don't want to do is burden our soldiers and 
airmen in having to spend more on a house, because then it 
comes directly out of the rest of their household budget, you 
know, and we are very concerned about. Because that leads to 
what you started this conversation on.
    And I will turn it over to General Berry and General Evans.
    General Berry. Senator, I think Mr. Cramer hit, hit all the 
points that I would have hit. I know that we are tracking the 
concern. We are talking to the local leadership there so we can 
really understand the details behind it. So then we know how we 
can come in and help them, as required. But we are tracking it. 
We continue to work with the local community to try and find 
some creative solutions.
    Senator Murkowski. Know that we appreciate that. We will 
look forward to partnering very closely with you as the months, 
proceed here. I will share just one, one factor that I picked 
up at a roundtable that I did with military spouses a couple of 
years ago, when we were talking about based-housing allowance, 
and a recognition that Fairbanks, in the area you have many 
homes that are not on city water.
    So there is an additional fee to have your septic pump. 
There is an additional fee for water delivery. And those are 
not at least at the time--were not incorporated as part of that 
allowance. So things like that, that we can look to, 
creatively, I think help with these financial stressors.
    Thank you, Mr. Chairman.
    Senator Boozman. Thank you. Senator Heinrich is like the 
rest of us, we have all got three, three of these going on that 
are so important with such really important witnesses like 
yourself, talking about some really important topics that are 
going on. But I would like to just ask a real quick question, 
because I think it is important. A follow-up on Senator 
Hagerty, and maybe a couple of the other Service witnesses can 
jump in.
    The request that we have does not include investments in 
Pacific deterrents and issues that we were expecting to see. 
While the President's budget includes 5.1 billion in funding to 
support the effort, none of it is for MILCON. What is your role 
in the PDI funding process? Does the PDI tagged MILCON go 
through traditional MILCON decisionmaking processes? Or are we 
treating it differently somehow? We will end on an easy 
question.
    Mr. Cramer. I will, Senator.
    Senator Boozman. But it is a very important question.
    Mr. Cramer. It is a very important question, and so it goes 
back to our earlier discussion about project development of 
MILCON projects. And so we have sat through some classified 
briefings to understand, you know, where we intend to go with 
PDI? And I will just tell you that I think we are still early 
to need on developing those projects within a budget year. And 
what we don't want to do is get so far ahead of our headlights 
that we identify projects in a specific country that we don't 
have necessarily an agreement with to do any construction, and 
then it languishes for a number of years. We have learned that 
lesson in the not so recent past in, in Europe.
    So we want to get all those stars aligned, get the project 
defined, get the host nation agreements, and then go forward 
with those projects, but it is in the works.
    Senator Boozman. No, we appreciate that, and that is very 
reassuring. Again, thank you all for being here today. We 
appreciate you for taking the time to, again, talk about this 
very important subject.
    Also for the senators participating in today's hearing, I 
look forward to working closely with you to address the 
Military construction and family housing needs facing us. And I 
say that on behalf of the entire committee.
    Finally, we will keep the hearing open for a week. 
Committee members who would like to submit written questions 
for the record should do so by 5:00 p.m., Wednesday, June the 
23rd. We appreciate the Department responding to them in a 
reasonable period of time.

                          SUBCOMMITTEE RECESS

    Senator Boozman. And with that, we stand adjourned.
    [Whereupon, at 11:16 a.m., Wednesday, June 16, the 
subcommittee was recessed, to reconvene at a time subject to 
the call of the Chair.]



     MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES 
                  APPROPRIATIONS FOR FISCAL YEAR 2022

                              ----------                              


                        WEDNESDAY, JUNE 23, 2021

                                       U.S. Senate,
           Subcommittee of the Committee on Appropriations,
                                                    Washington, DC.
    The subcommittee met at 10:00 a.m. in room SD-138, Dirksen 
Senate Office Building, Hon. Martin Heinrich, chairman of the 
subcommittee, presiding.
    Present: Senators Heinrich, Schatz, Tester, Baldwin, 
Boozman, and Hoeven.

                     DEPARTMENT OF VETERANS AFFAIRS

STATEMENT OF HON. DENIS R. MCDONOUGH, SECRETARY OF 
            VETERANS AFFAIRS

              OPENING STATEMENT OF SENATOR MARTIN HEINRICH

    Senator Heinrich. This hearing of the Military 
Construction, Veterans Affairs, and Related Agencies 
Appropriation Subcommittee is now called order.
    Today, we are going to be discussing the Department of 
Veterans Affairs' fiscal year 2022 Budget and fiscal year 2023 
Advanced Appropriations Requests. Veterans deserve more than 
just words of gratitude for their sacrifice when they return 
home. They deserve the quality care and benefits that they have 
earned. This budget strives to do that and requests a mandatory 
appropriation of $153 billion, and a discretionary 
appropriation of $113 billion. That is an 8.2 percent increase 
over fiscal year 2021.
    It also requests 156 billion mandatory advanced 
appropriation, as well as 111 billion discretionary advanced 
appropriation just to support its medical programs in fiscal 
year 2023. The cost of medical care continues to grow, and 
there are a lot of issues that we want to discuss this morning.
    We understand that VA's budget request is a bit complicated 
this year. The Department's request reflects the direct and 
indirect costs of the pandemic, including addressing the 
increases in the disability claims backlog, as well as the 
provision of deferred care, and increased mental health 
services. Funding provided in the Families First Act, the CARES 
Act, and the American Rescue Plan demonstrate congressional 
support for veterans during this challenging time, and much of 
the funding remains available for use in fiscal year 2022.
    In addition, this is the first year VA is allowed to use 
flexibility provided by Congress in the Recurring Expenses 
Transformational Fund, and VA plans to use $820 million of 
expired funds to support information technology and minor 
construction projects. While this is a robust request, 
especially considering all of the additional funding recently 
provided to the Department, VA must have what is necessary to 
respond to veteran demand.
    VA's requests for fiscal year 2023 shows a decrease in this 
program without supplemental funding. I hope that the need has 
subsided by then, but VA must plan effectively to avoid service 
cliffs relative to demand in these programs.
    This budget was developed prior to your undertaking a 
strategic review of the Electronic Health Record Modernization 
Program. We look forward to receiving more information on the 
results of the review, how the findings will affect the 
remainder of VA's ten-year plan, and how VHA's infrastructure 
costs will be incorporated into the total cost of the effort. 
The budget reflects VA's need to invest in physical 
infrastructure. As veterans come back to receive care at the 
VA, they deserve to be treated in facilities that are up to 
date and modernized. This year VA is planning to invest in its 
infrastructure through base funding, the Transformational Fund, 
and the American Rescue Plan funding.
    I look forward to working together to provide veterans with 
the services and the benefits that they have earned and 
deserve.
    And with that, I would recognize the Ranking Member for his 
opening statements.

                   STATEMENT OF SENATOR JOHN BOOZMAN

    Senator Boozman. Thank you, Mr. Chairman. And thank you, 
Mr. Secretary, for being here to discuss the Veteran's Affairs 
fiscal year 2022 and 2023 budget request. The budget request of 
$271 billion in fiscal year 2022 for the Department of Veterans 
Affairs, including medical care, collections, and the new 
Transformation Fund, represents a 10.4 percent increase over 
fiscal year 2021 enacted levels.
    This includes $118 billion in discretionary funds, a 10.4 
billion or 9.7 percent increase over fiscal year 2021. The 
budget also requests a total of $272 billion in advanced 
appropriations for fiscal year 2023. The large fiscal year 2022 
increase highlights the continued importance of programs for 
veterans. It also reflects the continued growth and popularity 
of the Veterans Community Care Program, which consolidated 
multiple community care programs through the MISSION Act.
    In fact, in this request the only dollars requested as part 
of the second bite to supplement last year's advance 
appropriations are for community care. Members of the 
subcommittee remain committed to providing VA with the 
resources needed to care for our veterans. However, continued 
growth of 8, 9 and 10 percent gets really difficult, and 
probably is unsustainable.
    Mr. Secretary, we need to work together to make certain we 
are prioritizing resources where they need to go, and to make 
sure Congress does not mandate costly initiatives without 
thoroughly considering the associated cost implications. Over 
the last year VA received roughly $37 billion in emergency 
funding to address COVID.
    I have to say that, overall, VA performed admirably 
throughout the crisis, and deserves praise and recognition for 
that. There is no doubt that most of these funds were 
absolutely necessary, and the obligation reports for the CARES 
Act funding demonstrates this. I had the opportunity to be in a 
number of facilities during that time, and again, the 
Department, all of those on the frontlines, and just all of the 
different areas really do deserve a big pat on the back.
    I hope to hear more about the future needs of the VA, 
especially after this large influx of emergency dollars; we 
don't want to find ourselves in a situation where CARES and the 
American Rescue Plan have reset the baseline for VA spending.
    The budget requests $2.6 billion for electronic health 
modernization, and many of us on this committee have long 
advocated for single, joint medical record that will follow a 
service member throughout their careers in the military and 
into their time as a veteran. We understand that this strategic 
review is nearing completion and we look forward to hearing the 
new path forward for the program. In particular, we look 
forward to receiving a revised deployment schedule as directed 
in last year's Omnibus.
    In addition to updates on those programs, we look forward 
to hearing details about the Department's request for mental 
health services, including efforts to combat opioid use 
disorder, and prevent veteran suicide. These initiatives to 
prevent veterans' homelessness also are very, very important, 
and efforts to improve care for our rural veterans, including 
through the greatly expanded telehealth program which, again, 
we can be so proud that the VA has been a leader.
    We look forward to discussing these and other issues this 
morning. And with that, I yield back, Mr. Chairman.
    Senator Heinrich. Well, I want to thank our witnesses for 
participating today. We have Secretary of Veterans Affairs 
Denis McDonough; and Assistant Secretary for Management and 
Chief Financial Officer, Jon Rychalski.
    Did I get that right, sir?
    Mr. Rychalski. That is correct.
    Senator Heinrich. Great, fantastic. We are going to start 
with questions, and I will recognize myself for five minutes 
first and then head to the--I apologize.
    With that, we will go to each of you for your opening 
statement.

               SUMMARY STATEMENT OF HON. DENIS MCDONOUGH

    Secretary McDonough. Thank you, Mr. Chairman, very much.
    Let me start by just offering my deep condolences to the 
family of Senator Warner, who will be laid to rest today, a 
Navy and Marine Corps vet of World War II and Korea, Secretary 
of the Navy for 30 years, and an outstanding senator. He was a 
true patriot, an iconic statesman, who always did what he felt 
was right for his constituents and for America. We will, 
obviously, all miss him.
    Chairman Heinrich, Ranking Member Boozman, Senators Schatz 
and Tester, thank you for the opportunity to testify today in 
support of the President's fiscal year 2022 and fiscal year 
2023 Budget Request, and for your steadfast support for 
veterans; I am accompanied today, as the chairman just said, by 
our assistant Secretary for Management and Chief Financial 
Officer, and proud Montanan, Jon Rychalski. Let me also 
acknowledge the Veteran Service Organizations, and our union 
partners, all of whom make us a stronger agency.
    Some good news: First, we have taken steps to reduce the 
backlog log of claims caused by the pandemic. We ramped up 
scanning efforts to digitize Federal records for claims 
processing, and temporarily assigned VA personnel to the 
National Personnel Records Center to pull records for claims 
processing. Now most of VA's requests for records are answered 
in two to three days. The number of pending VA-related record 
requests has dropped by 90 percent to pre-pandemic levels.
    Second, VBA rated our one-millionth veteran disability 
claim two weeks ago, hitting this important milestone faster 
than in all but 1 year in VA history, notwithstanding the 
challenge posed by COVID.
    Third, VA has now vaccinated 3.4 million people with at 
least one dose, including veterans, family members, caregivers, 
employees, and members of other Federal agencies.
    Last, and most importantly, on May 24th, just a month ago, 
there were no, that is to say no COVID-related deaths in any VA 
facility for the first time in 448 days, since March 18, 2020.
    These positive outcomes are a direct result of two factors: 
resources, which you have been critical in providing, and 
caring, compassionate people. Let me tell you about one such 
outcome. At the height of the pandemic Marine Veteran, Michael 
Novielli, developed fatigue, aches, and a fever. He never, 
``Felt this sick in his whole life,'' and his diagnosis was 
exactly what he feared. Like millions of other Americans, he 
had contracted COVID-19.
    After four days at Northport VA Medical Center, Michael was 
well enough to be discharged, but we placed him on our VA 
telehealth program to monitor his symptoms. That decision 
likely saved his life. He shared his temperature, oxygen 
levels, and heart rate every day for two weeks via telehealth. 
Then his VA nurse, Marjorie Rogers, noticed something unusual 
in his heart rate. She called him and told him to go to the 
emergency room immediately, where he was diagnosed with 
pneumonia, admitted--and admitted for another two weeks.
    ''Marjorie saved my life.'' he said. ``If I wasn't on 
telehealth, I would have stayed home with pneumonia.'' And 
Michael would be the first to tell you that that would have 
been, or could have been disastrous. Now that is the kind of 
experience every single veteran deserves at VA. VA people are 
the ones who cared for Michael, they are the ones who risked 
their lives to serve veterans during the pandemic, and they are 
the ones who made zero COVID deaths on May 24th possible.
    But VA employees will also tell you that their life-saving 
work is not possible without the resources they need; that is 
why this budget request is critical. The fiscal year 2022 
budget request will ensure VA can provide care and services to 
veterans, their families, caregivers, and survivors, and to 
other Americans such as the 488 non-veterans treated at VA 
facilities as pandemic-related humanitarian missions, including 
citizens from Arkansas, Arizona, and Texas, among others.
    These resources will be put to good use, empowering our 
Department to fulfill President Biden's charter for me to fight 
like hell for our vets. The budget ensures we can continue the 
growth and success of our Caregiver Support Program by fully 
integrating families and caregivers into the care plans of the 
veterans they love, continuing to implement MISSION Act 
expansion of our Program of Comprehensive Assistance to all 
generations of eligible veterans, and supporting the power--the 
training of over 1,900 field-based staff.
    The budget provides needed funding for women veterans. The 
number of women using VA health care has more than tripled 
since 2001. And this budget funds recruiting and hiring for 
women's health care providers, improving access to reproductive 
health services, and emergency services. The budget allows us 
to continue our success in reducing veteran's homelessness, 
building on the success of the last decade during which we 
decreased veteran homelessness by 50 percent. And this budget 
allows us to provide strong, sustainable, high quality direct 
care to our veterans at a time when they need it most.
    Community care, as Senator Boozman said, and direct care 
are both important, and care in both contexts is rising 
dramatically as the pandemic ebbs, and veterans returned to VA 
for care. And while both are growing, care in the community is 
rising at a faster rate than direct care. Veterans need deserve 
a thriving direct care system for generations to come, because 
it provides high quality, evidence-based, integrated care 
tailored to their unique needs.
    Beyond that, our Nation depends on the research, 
innovation, and medical education components of VA direct care. 
As well as an effective backstop to our country's health care 
system, VA's Fourth Mission has been critically important 
during this pandemic, as well as multiple other national 
disasters.
    That is not all these budget resources will do: they will 
fund mental health and suicide prevention initiatives, address 
major deficits in construction, physical information technology 
infrastructure, continue our electronic health record 
modernization, address issues of veterans environmental 
exposures, and continue to ensure VA is always a place where 
diversity is--diversity, equity, and inclusion are valued and 
sought.
    In short, this proposed budget allows us to deliver high-
quality whole health care and benefits to our veterans, and it 
does so, in large part, by enabling the work of great people, 
like those who cared for Michael Novielli. I commit to using 
these appropriated resources responsibly and transparently in 
close consultation with you, and getting greatest value out of 
every dollar.
    Mr. Chairman, Ranking Member Boozman, other members of the 
committee, I thank you for the opportunity to appear before you 
today. And I look forward to your questions.
    [The statement follows:]
               Prepared Statement of Hon. Denis McDonough
    Chairman Heinrich, Senator Boozman, and distinguished Members of 
the Subcommittee. Thank you for the opportunity to testify today in 
support of the President's Fiscal Year 2022 Budget and Fiscal Year 2023 
Advance Appropriations Request for the Department of Veterans Affairs 
(VA), and for your longstanding support of Veterans and their families. 
I am accompanied by Mr. Jon Rychalski, Assistant Secretary for 
Management and Chief Financial Officer.
    President Biden defined our country's most sacred obligation as 
preparing and equipping the troops we send into harm's way and then 
caring for them and their families when they return. It is the honor of 
my lifetime to join the dedicated, highly skilled professionals who 
constitute the VA workforce-many of them Veterans themselves. VA 
employees are committed to serving Veterans, their families, caregivers 
and survivors. The President's FY 2022 Budget Request reflects this 
commitment. This budget request will ensure VA is moving swiftly and 
smartly into the future, with much- needed monetary investments in our 
most successful and vital programs. This Budget ensures all Veterans, 
including women Veterans, Veterans of color, and LGBTQ+ Veterans, 
receive the care and benefits they have earned and prioritizes Veteran 
homelessness, suicide prevention outreach and caregiver support.
    VA faces critical challenges, many of them made even more complex 
by the COVID-19 pandemic. Getting our Veterans through this pandemic 
continues to be one of our department's highest priorities. As our 
country re-opens after 14 months of closures and necessary restrictions 
on some activities, all of us at VA remain focused on the robust 
clinical response to COVID-19. Our efforts include expanding COVID-19 
vaccinations; ensuring Veterans stay connected to longitudinal care 
through telehealth and in person care where necessary; keeping 
employees safe; and, planning how to address the pandemic's future 
impacts on Veterans and our workforce in the health care, benefits and 
cemetery systems. VA has demonstrated resiliency through this crisis by 
providing continuous services in line with national policy, and we 
continue to update our safety guidelines in accordance with Centers for 
Disease Control and Prevention (CDC) guidance. We encourage every 
Veteran to be vaccinated as soon as possible. That is why we thank 
Congress for providing additional authorities and we have expanded our 
efforts to include vaccinations for all Veterans, regardless of whether 
they are enrolled or eligible to enroll in VA health care, for 
Veterans' spouses, and for Veterans' caregivers, and, most recently, 
for some 12- to 17-year-olds, including those serving as Veteran 
caregivers and those who qualify as beneficiaries under VA's Civilian 
Health and Medical Program.
    As of June 11, VA has fully vaccinated more than 3 million 
Veterans, family members, caregivers, employees, and federal partners. 
We are seeing the positive results of those efforts. I am honored and 
delighted to report that VA recorded zero deaths from COVID-19 in our 
facilities on May 24 for the first time in more than a year. That is a 
critically important indicator of significant progress in fighting this 
pandemic. As we prepared for Memorial Day, a time of special 
significance for us and our Veteran communities, we followed CDC 
guidance and relaxed restrictions at our National Cemeteries which 
allowed us to remember our fallen heroes in person again this year.
    We are seeking input from VA employees about how we can safely and 
confidently bring our teams back to work in a manner consistent with 
CDC guidance and data- driven facts. We look forward to our continued 
return to normal operations, while recognizing that this pandemic has 
had an impact on every aspect of daily life for Veterans, their 
families, and all Americans.
        fiscal year 2022 budget and 2023 advance appropriations
    The President's FY 2022 Budget Request includes $269.9 billion 
(with medical collections), a 10.0% increase above 2021. This includes 
a discretionary budget request of $117.2 billion (with medical 
collections). The request includes $101.5 billion (with collections) 
for VA medical care, $8.7 billion or 9.4% above the 2021 enacted level. 
The 2022 mandatory funding request totals $152.7 billion, an increase 
of $14.9 billion or 10.8% above 2021. This funding is in addition to 
the substantial resources provided in the American Rescue Plan Act of 
2021.
    The 2023 Medical Care Advance Appropriations Request includes a 
discretionary funding request of $115.5 billion (with medical care 
collections). The 2023 mandatory Advance Appropriations request is 
$156.6 billion for Veterans benefits programs (Compensation and 
Pensions, Readjustment Benefits, and Veterans Insurance and 
Indemnities).
                            strategic focus
    To fulfill our country's most sacred obligation, every decision I 
make will be determined by whether it increases Veterans' access to 
care and benefits and improves outcomes for them. I will work 
tirelessly to rebuild trust and restore VA as the premier agency for 
ensuring the well-being of America's Veterans through a persistent 
focus on the three core responsibilities of the Department:

1. Providing our Veterans with timely world-class health care;

2. Ensuring our Veterans and their families have timely access to their 
    benefits; and

3. Honoring our Veterans with their final resting place and lasting 
    tributes to their service.

    Under my leadership, the Department will make it a priority to 
implement management reforms to improve accountability and ensure 
Veterans receive the care and benefits they have earned. In addition to 
the funding for medical care, this Budget includes $3.4 billion for the 
General Operating Expenses--Veterans Benefits Administration (VBA) 
account, including funds to hire 429 new disability compensation claims 
processors, and $394 million for the National Cemetery Administration 
(NCA). The Budget fully funds operation of the largest integrated 
health care system in the United States, with over 9.2 million enrolled 
Veterans, provides disability compensation benefits to nearly 6 million 
Veterans and their survivors and administers pension benefits for over 
350,000 Veterans and their survivors.
    In addition to focusing on these three core responsibilities, 
President Biden also tasked me with:

1. Getting our Veterans through this COVID-19 pandemic;

2. Helping our Veterans build civilian lives of opportunity with the 
    education and jobs worthy of their skills and talents;

3. Ensuring VA welcomes all our Veterans, including women Veterans, 
    Veterans of color, and LGBTQ+ Veterans; and Diversity, Equity and 
    Inclusion are woven into the fabric of the Department;

4. Working to eliminate Veteran homelessness and prevent suicide; and

5. Keeping faith with our families and caregivers.


Key Challenges:

    As VA addresses the numerous challenges brought on or exacerbated 
by the COVID-19 pandemic, we also will need to tackle other 
longstanding issues that are essential to the Department's ability to 
sustainably and effectively execute its mission, including (1) 
establishing the right balance of direct care and purchased care, (2) 
delivering timely access to high-quality mental health care, including 
substance use disorder care, and preventing Veteran suicide, (3) 
increasing support to families and caregivers, (4) increasing support 
for the growing number of women Veterans who utilize VA services, (5) 
providing a whole of government solution to drive progress to eliminate 
Veteran homelessness, (6) improving support for transitioning 
servicemembers through improvements to the Transition Assistance 
Program (TAP), education and job training programs, and (7) addressing 
an aging medical infrastructure.
        establishing the right balance of va and community care
    Providing Veterans with timely access to high quality health care 
is essential. VA remains committed to a strong, thriving direct VA 
health care system, augmented by a robust and high-quality community 
care network. We will continue to expand access, innovate, and leverage 
our research and education missions to push the boundaries of what is 
possible in serving our Nation's Veterans. In short, we will lead--
empowering each Veteran with the confidence that their trusted system 
will lead with sustained excellence on their behalf and on behalf of 
future generations of Veterans. For the Veterans listening today: VA is 
here as a welcoming, steady force ready to help you grow your health 
and well-being with the excellence you expect from us.
             access to mental health and suicide prevention
    VA has made suicide prevention a top clinical priority and is 
implementing a comprehensive public health approach to reach all 
Veterans. The 2022 Budget Request includes $598 million, nearly $287 
million above the 2021 enacted level, for existing programs dedicated 
to suicide prevention outreach and related activities, including 
funding to increase the capacity of the Veterans Crisis Line. Funding 
for mental health in total grows to $13.5 billion in 2022, up from 
$12.0 billion in 2021. Our commitment to a proactive, Veteran-centered 
Whole Health approach is integral to our mental health care efforts and 
includes online and telehealth access strategies. Whole Health can help 
Veterans reconnect with their mission and purpose in life as part of 
our comprehensive approach to reducing risk. Suicide is a complex issue 
with no single cause. Maintaining the integrity of VA's mental health 
care system is vitally important, but it is not enough. We know some 
Veterans may not receive any health care services from VA, which 
highlights VA alone cannot end Veteran suicide. This requires a 
nationwide effort.
    VA developed the National Strategy for Preventing Veteran Suicide 
(2018),\1\ which laid the foundation for VA's approach to suicide. This 
national vision for preventing Veteran suicide is grounded in three 
major tenets in which we firmly believe: (1) suicide is preventable, 
(2) suicide requires a public health approach, combining community-
based and clinical approaches and (3) everyone has a role to play in 
suicide prevention. While the development of the National Strategy was 
groundbreaking in defining the vision of reaching and serving Veterans 
within and outside Veterans Health Administration (VHA) clinical care, 
VA moved to translate the vision of the 10-year National Strategy into 
operational plans of actions in: Suicide Prevention 2.0 (SP 2.0) 
combined with the Suicide Prevention Now initiative.
---------------------------------------------------------------------------
    \1\ Department of Veterans Affairs (2018). National Strategy for 
Preventing Veteran Suicide. Washington, DC. Available at https://
www.mentalhealth.va.gov/suicide_prevention/docs/Office-of-Mental-
Health-and-Suicide-Prevention-National-Strategy-for-Preventing-
Veterans-Suicide.pdf.
---------------------------------------------------------------------------
    My promise to Veterans remains the same: (1) to promote, preserve 
and restore Veterans' health and well-being, (2) to empower and equip 
them to achieve their life goals using a whole health approach and (3) 
to provide state-of-the-art clinical treatments. We will continue to 
invest and share resources with community organizations in the fight 
against Veteran suicide. We understand Veterans possess unique 
characteristics and experiences related to their military service that 
may increase their risk of suicide. Additionally, Veterans also tend to 
possess skills and protective factors, like resilience and a strong 
sense of belonging to a group.
                         supporting caregivers
    The 2022 request includes $1.4 billion, an increase of $350 million 
above 2021, in funding dedicated to the Caregiver Support Program 
(CSP). The CSP empowers caregivers to provide care and support to 
Veterans with a wide range of resources through the Program of General 
Caregiver Support Services (PGCSS) and the Program of Comprehensive 
Assistance for Family Caregivers (PCAFC). As a result of the John S. 
McCain III, Daniel Akaka, and Samuel R. Johnson VA Maintaining Internal 
Systems and Strengthening Integrated Outside Networks Act of 2018, or 
the VA MISSION Act of 2018, VA began a major expansion of PCAFC.
    PCAFC expansion rolls out in two phases. The first phase, which 
began on October 1, 2020, expands PCAFC eligibility to include eligible 
Veterans who incurred or aggravated a serious injury in the line of 
duty on or before May 7, 1975. Effective October 1, 2022, the second 
phase will expand PCAFC eligibility to include eligible Veterans who 
incurred or aggravated a serious injury in the line of duty between May 
7, 1975, and September 11, 2001.
    Expansion of this Program was contingent upon the implementation 
and certification of the new IT system, Caregiver Record Management 
Application (CARMA). CARMA automates manual processes and integrates 
with other VA systems, increasing efficiencies and effectiveness, and 
allowing for more effective monitoring and management of the program 
for caregivers and VA staff.
    CARMA supports consistency through systematic calculations of 
monthly stipend payments and provides a mechanism for CARMA users to 
identify upcoming reassessments of PCAFC participants, among other key 
functions. A new digital version of VA FORM 10-10CG allows online PCAFC 
applications.
    VA also expedited the hiring of key staff with clinical 
qualifications and organizational skills to support program needs, 
provide a strong infrastructure and standardize application processing 
and adjudication, ensuring consistent eligibility decision-making. The 
expansion funded by this request will support providing training and 
education to over 1,900 field-based staff dedicated to the caregiver 
program. CSP has already expanded to approximately 1,800 staff. These 
changes will help ensure Veterans and caregivers receive timely, 
accurate assessments and eligibility determinations, as well as an 
improved customer experience.
                  improving support for women veterans
    As the number of women Veterans enrolling in VA health care 
continues to increase, VA must be prepared to meet their needs. Women 
make up 16.5% of today's Active Duty military forces and 19% of 
National Guard and Reserves. Based on the trend, the expected number of 
women Veterans using VA health care will rise rapidly. More women are 
choosing VA for their health care than ever before, with women 
accounting for over 30% of the increase in Veterans enrolled over the 
past 5 years. The number of women Veterans using VA health care 
services has more than tripled since 2001, growing from 159,810 to more 
than 550,000 today. To support the growing number of women Veterans, VA 
will increase total planned obligations from all funding sources for 
gender-specific care from $630 million in 2021 to $706 million in 2022, 
an increase of $76 million, or 12%.
    To address the needs of the growing number of women Veterans who 
are eligible for VA health care, VA is strategically enhancing services 
and access for women Veterans by hiring women's health personnel 
nationally to fill any gaps in capacity to provide gender specific 
care--this includes hiring primary care providers, gynecologists, 
mental health care providers and care coordinators across all VISNS so 
that VA is able to fulfill the mission of caring for those we serve. 
Funds also are available for programs such as pelvic floor physical 
therapy or lactation support. These efforts will be sustained by the 
2022 request, which includes $105 million for the Office of Women's 
Health.
    Each of the 171 VA medical centers across the United States now has 
a full-time Women Veterans Program Manager tasked with advocating for 
the health care needs of women Veterans. Mini residencies in women's 
health with didactic and practicum components have been implemented to 
enhance clinician proficiency. Since 2008, more than 7,600 health care 
providers and nurses have been trained in the local and national mini-
residency programs and even more have participated in monthly webinars 
and Talent Management System (TMS) trainings, not only developing 
women's health experts, but also enhancing competency of all clinicians 
across the system.
    Under a new collaboration with the Office of Rural Health, we 
established a pathway for accelerating access to women's health 
training for rural primary care providers. VHA actively recruits 
providers with experience in women's health care to join its care team. 
VHA has launched numerous initiatives to improve access to state-of-
the- art reproductive health services, mental health services and 
emergency services for women Veterans, as well as focusing on enhancing 
care coordination through technological innovations such as registries 
and mobile applications.
    To provide the highest quality of care to women Veterans, VA offers 
women Veterans trained and experienced designated Women's Health 
Primary Care Providers (WH-PCP). National VA satisfaction and quality 
data indicate women who are assigned to WH-PCPs have higher 
satisfaction and higher quality of gender specific care than those 
assigned to other providers. Importantly, we also find women assigned 
to WH- PCPs are twice as likely to choose to stay in VA health care 
over time. Designated WH- PCPs are available across all VA Health Care 
Systems, and VA is actively recruiting additional new providers with 
even more enhanced proficiency in women's health care. VA provides full 
services to meet specific needs of women Veterans, such as gynecology, 
maternity care, infertility services, reproductive mental health 
services and military sexual trauma assistance.
                    eliminating veteran homelessness
    VA remains committed to ending Veteran homelessness. The 2022 
Budget Request includes $2.2 billion for Veteran homelessness programs, 
an increase of 8.4% over the 2021 enacted level (base funding only). In 
addition, VA will obligate $486 million in ARP funding in 2022, for a 
total of $2.6 billion dedicated to reducing Veteran homelessness in 
2022. The goal is to ensure every Veteran has permanent, sustainable 
housing with access to high-quality health care and other supportive 
services to prevent Veteran homelessness. VA has partnered closely with 
other Federal agencies and with State and local programs across the 
country to:

  --Identify all Veterans experiencing homelessness;

  --Provide shelter immediately to any Veteran experiencing unsheltered 
        homelessness;

  --Provide service-intensive transitional housing to Veterans who 
        prefer and choose such a program;

  --Move Veterans swiftly into permanent housing; and

  --Have resources, plans, partnerships and system capacity in place 
        should any Veteran become homeless or be at risk of 
        homelessness.

    VA has made significant progress to prevent and end Veteran 
homelessness. The number of Veterans experiencing homelessness in the 
United States has declined by nearly half since 2010. On any given 
night in January 2020, an estimated 37,252 Veterans were experiencing 
homelessness. Since 2010, over 850,000 Veterans and their family 
members have been permanently housed or prevented from becoming 
homeless. Efforts to end Veteran homelessness have resulted in an 
expansion of services available to permanently house homeless Veterans 
and the implementation of new programs aimed at prevention, including 
low-threshold care/engagement strategies and monitoring homeless 
outcomes. VA offers a wide array of interventions designed to find 
Veterans experiencing homelessness, engage them in services, find 
pathways to permanent housing and prevent homelessness from 
reoccurring.
                          economic opportunity
    As an overall group, Veterans fare better economically than the 
average American. However, Veterans and their spouses still face 
economic challenges. Helping Veterans build civilian lives of 
opportunity with the education and jobs worthy of their skills and 
talents is a critical priority. The budget request supports this 
commitment by making key investments in VBA, including an increase of 
$81.5 million to support the Digital GI Bill Modernization effort, as 
well as an increase of $5 million for the Veterans' Clean Energy Job 
Training program in conjunction with the Department of Labor, and $3.6 
million for the VA Disability Employment Pilot Project to assist 
Veterans with service-connected disabilities seeking employment 
opportunities.
    VA military-to-civilian transition programs are designed to give 
transitioning Service members the best possible start to their post-
military lives. The VA Benefits and Services course, as part of the 
interagency Transition Assistance Program (TAP), helps Service members 
and their spouses understand how to access the VA benefits and services 
they have earned. VA TAP provides resources and tools Service members 
need to achieve emotional and physical health, attain economic 
stability in civilian life and become career ready. Although TAP has 
evolved significantly over the years, we continue to assess its 
effectiveness and evolve where appropriate to promote meaningful and 
economically enriching lives for Veterans and their families.
                   addressing an aging infrastructure
    The 2022 request includes $2.2 billion, a 26.8% increase over 2021, 
for Major and Minor Construction. The Major Construction request 
includes funding for 12 medical facility and two cemetery expansion 
projects. Additionally, the President requests $18 billion in mandatory 
funding in the American Jobs Plan (AJP) to modernize VA health care 
facilities with $3 billion to address immediate infrastructure needs 
within VA health care facilities and the remaining $15 billion to fully 
modernize or replace outdated medical centers with state-of-the-art 
facilities. We look forward to working with Congress to achieve our 
shared goal of addressing VA's aging infrastructure.
    VA operates the largest integrated health care, member benefits and 
cemetery system in the Nation, with more than 1,700 hospitals, clinics 
and other health care facilities; a variety of benefits and service 
locations; and national cemeteries. The VA infrastructure portfolio 
consists of approximately 184 million owned and leased square feet-one 
of the largest in the Federal Government. The median age of U.S. 
private sector hospitals is 11 years; however, the median age of VA's 
portfolio is 58 years, with 69% of VA hospitals over the age of 50. 
With aging infrastructure comes operational disruption, risk and cost. 
VA estimates that between $49 and $59 billion in short- and medium-term 
investments will be needed to maintain our infrastructure using our 
annual Strategic Capital Investment Planning process. However, any 
effort to fully address the aging infrastructure portfolio needs would 
likely far exceed those estimates and occur over a significant 
timeline.
    VA's market assessments have been on-going for nearly two years, 
allowing VA to gain significant insights into trends and needs in the 
VA health care delivery system--with enhancing Veteran access and 
outcomes at the core. The VA MISSION Act requires VA to continue 
construction, leasing, budgeting, and long-range capital planning 
activities while the market assessment and Asset and Infrastructure 
Review (AIR) Commission activities are occurring. The additional AJP 
investment would enable planning to start sooner to address facilities 
we know are not conducive to future health care delivery, while still 
being informed by outcomes of the AIR process.
    Health care innovation is occurring at an exponential pace and the 
comparative age between VA facilities and private sector facilities is 
informed by these trends. The architects who designed and constructed 
many VA facilities in the decades following World War II could not have 
anticipated the requirements of today's medical technology and the key 
role infrastructure-and technological infrastructure-now plays in 
delivering safe and high-quality health care. As a result, many of VA's 
facilities were not designed with these technology and infrastructure 
requirements, which limits our agility and ability to meet the evolving 
health care needs of Veterans.
    The experience of responding to the COVID-19 pandemic brought 
critical lessons. Uncertainty regarding the timing and location of the 
next surge or surges in cases across the country underscored the 
importance of portable capabilities (e.g., 24- bed Intensive Care Unit 
that can be transported) for VA health care's Fourth Mission role in 
future public health emergencies.
    Transforming VA health care to achieve a safer, sustainable, 
greener, person- centered national health care model requires VA to 
leverage innovations in medical technology and clinical procedures. As 
technology-enabled trends in U.S. medicine bring health care closer to 
individuals and communities, there is less demand for prodigious, 
sprawling campuses and more demand for emphasis on ambulatory 
facilities and virtual care. Many surgical, medical and diagnostic 
procedures that once required a hospital stay now are performed safely 
in the outpatient setting, and telehealth and tele-service delivery 
bring expertise to a patient's own home.
    This evolving landscape requires VA to rebalance and recapitalize 
its infrastructure to optimize the mix of traditional inpatient 
hospitals with outpatient hospitals, multi-specialty Community Based 
Outpatient Clinics, single specialty Community Based Outpatient Clinics 
and virtual care.
   leveraging technology to support service and medical care delivery
    VA is undergoing one of the most comprehensive information 
technology (IT) infrastructure modernizations in the Federal 
government, which will support seamless transition of health care 
information throughout an individual's journey from military service to 
Veteran status. The 2022 Budget Request includes $4.8 billion in 
appropriations for the Office of Information and Technology to pilot 
application transformation efforts, support cloud modernization, 
deliver efficient IT services and enhance customer service experience. 
Our three main transformative projects are the implementation of the 
Electronic Health Record Modernization (EHRM); the replacement of VA's 
multiple, aging systems to manage its inventory and assets with the 
enterprise-wide inventory management system used by the Department of 
Defense (DoD)-the Defense Medical Logistics Standard Support (DMLSS); 
and the adoption of a new financial and acquisition management system-
our Financial Management Business Transformation (FMBT).
                                  ehrm
    In October 2020, VA deployed a new electronic health record (EHR) 
system at the Mann-Grandstaff VA Medical Center in Spokane, Washington. 
This effort is one of the most complex and transformational enterprise-
wide endeavors in the Department's history. The Budget includes $2.7 
billion in FY 2022, which maintains a significant level of investment 
in FY 2022 and in future years and ensures necessary infrastructure 
upgrades are in place. This EHRM appropriation is in addition to the 
request for the central IT appropriation. The vision for the new EHR 
system is to empower Veterans, Service members and care teams with 
longitudinal health care information to enable the achievement of 
health and life goals from Service in the military to Veteran status. 
The new EHR system also presents the opportunity to achieve 
unprecedented interoperability with the DoD and functions as a catalyst 
for advancing VA's leadership of health care in the United States.
    In my first weeks in VA, I directed a 12-week strategic review of 
the EHRM program, which consists of a full assessment of ongoing 
activities in order to ensure the success of future EHR deployments. 
Based on opportunities identified at the first ``go- live'' site in 
Mann-Grandstaff, the strategic review is focused on ensuring patient 
safety, identifying areas for additional productivity and clinical 
workflow optimization, change management and team-based training; and 
driving enhanced rigor into VA's management of cost, schedule, and 
performance. Additionally, we are conducting a human-centered design 
initiative to optimize the patient portal experience. We intend not 
only to get this right but to drive the industry forward alongside DoD. 
Furthermore, establishing strong, effective management of the EHRM 
program sets the tone for our other key efforts: modernizing supply 
chain management and enhancing financial and business transactions.
                     va logistics redesign (valor)
    VA's response to COVID-19 highlighted the shortcomings of the 
software and business practices supporting VA procurement, logistics 
and infrastructure operations, including a 50-year-old inventory 
system, separate procurement system and multiple stand-alone systems to 
manage property accountability, distribution and transportation. VA 
also uses multiple, stand-alone systems for health care technology and 
facility management, which limit enterprise visibility of assets and 
their respective readiness conditions. VA is requesting $299 million in 
FY 2022, an increase of $103 million (53%) from FY 2021, to continue 
its efforts in replacing these systems.
    VHA is adopting DoD's proven software platform implementing the 
Defense Medical Logistics Standard Support (DMLSS) information 
technology system to modernize and standardize our supply chain, 
property, health care technology and facility management business 
lines. This improvement will allow us to manage the VHA supply chain 
and support functions and operate like other integrated medical 
systems. In doing so, we will ensure clinicians have the supplies and 
equipment where and when needed to provide safe and high-quality care 
to our Veterans. VA completed the first DMLSS deployment at the James 
A. Lovell Federal Health Care Center in Chicago, Illinois, on September 
21, 2020, and is continuing deployment on an accelerated schedule. We 
are grateful for the ARP funds that will help facilitate the continued 
modernization of VA's badly antiquated supply chain system.
    By implementing DMLSS and standardizing our business practices, 
leaders at every level will be able to leverage new capabilities and 
capitalize on enterprise data to drive insights into operations and 
enable evidence-based decision-making. This implementation, too, offers 
significant opportunity for cost avoidance.
              financial management business transformation
    In support of VA fiscal stewardship, the Financial Management 
Business Transformation (FMBT) program is increasing the transparency, 
accuracy, timeliness and reliability of financial and acquisition 
activities across the Department. The 2022 Budget includes $357 million 
for FMBT, a program that is improving fiscal accountability to 
taxpayers and enhancing mission outcomes for those who serve Veterans. 
Our recent roll-out of the new Integrated Financial and Acquisition 
Management System (iFAMS) at NCA and VBA has not been without 
challenges and has exposed the incredible complexities inherent in a 
financial and acquisition system implementation of this magnitude. We 
are learning from these early deployments and adjusting our strategy 
accordingly. Nonetheless, these implementations bring us one step 
closer to providing a modern, standardized and secure integrated 
solution that enables VA to meet its objectives and fully comply with 
financial management and acquisition legislation and directives. The 
next system rollout is Enterprise Acquisition for NCA, which is 
scheduled for April 2022. System rollouts will then continue across the 
remaining Administrations and Staff Offices until enterprise-wide 
implementation is complete.
     an evolving landscape will influence how va cares for veterans
    As VA addresses challenges and longstanding issues, several long-
term demographic and fiscal trends will shape VA's ability to serve 
Veterans in the future. Although the U.S. Veteran population is aging 
and shrinking and simultaneously becoming more diverse, demand for VA 
services continues to increase. As the Veteran population continues to 
evolve, it also continues to use VA more-most likely the result of 
nearly 20 years of sustained conflict, longer average terms of service 
for military personnel and rising health care and educational costs 
that will incentivize more Veterans to use the VA benefits they have 
earned. U.S. health care is changing, too, from a hospital-centric 
model of care to dispersed (and even virtual) care that can be 
delivered through networks of direct and purchased-care providers.
                         congressional support
    Over the past several years, Congress has generously supported VA's 
budget requests, which have enabled the Department to address new and 
growing challenges. More recently, Congress passed the ARP, which will, 
among other things:

    1. Help ensure health care access for the 9.2 million enrolled 
Veterans who may have delayed care or have more complex health care 
needs because of the COVID-19 pandemic;

    2. Forgive Veteran health care copayments and other cost shares and 
reimburse copays and other cost shares for care and prescriptions from 
April 6, 2020 through September 30, 2021;

    3. Fund construction grants and payments to State Veterans Homes to 
greatly improve the living conditions of our most vulnerable Veterans;

    4. Provide up to 12 months of training and employment assistance 
for unemployed Veterans to enter high demand occupations; and

    5. Help reduce the backlog of disability compensation and pension 
claims, which has grown from 73,000 in March 2020 to 188,000 in May 
2021.

    The Department is grateful for the ARP, which not only will enhance 
VA's ability to deliver world class services to Veterans and their 
families, but also will ease thousands of Veterans' worries by 
forgiving some debt, speed up VA disability compensation claims 
adjudication and provide much needed funding to retrain Veterans in 
high-demand occupations. We will work diligently to ensure these funds 
are effectively and efficiently used.
                       new statutory authorities
    Over the past 3 years, Congress has passed into law numerous, far-
reaching pieces of legislation, including the John S. McCain III, 
Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems 
and Strengthening Integrated Outside Networks Act of 2018 (VA MISSION 
Act of 2018), the Commander John Scott Hannon Veterans Mental Health 
Care Improvement Act of 2019, the Veterans Comprehensive Prevention, 
Access to Care, and Treatment Act of 2020 (Veterans COMPACT Act of 
2020), the Johnny Isakson and David P. Roe, M.D. Veterans Health Care 
and Benefits Improvement Act of 2020 and the National Defense 
Authorization Act (NDAA) for Fiscal Year 2021.
    The 2022 Budget Request includes over $500 million within VA's 
Medical Care accounts to begin implementing new and recently expanded 
health care programs for Veterans, including a new grant program for 
suicide prevention outreach, increased eligibility for emergency 
suicide prevention treatment, new investments in women's health 
programs, expansion of homeless programs, and military sexual trauma 
services. The funding also will further support the Department's 
efforts to address substance use disorders.
                        environmental exposures
    For some medical conditions that develop after military service, 
the information needed to connect these conditions to military service 
may be incomplete. Information may be needed about specific in-service 
exposures or there may be incomplete scientific or medical evidence as 
to whether an exposure causes a particular condition. These issues loom 
large for all Veterans, represented currently by post-9/11 Veterans, 
whose exposures to airborne and other environmental hazards may result 
in unknown long-term health impacts. I am committed to a full review of 
how VA provides health care and benefits to Veterans exposed to 
environmental hazards to be responsive to the Veterans we serve. I 
believe it is possible to strike a balance between the needs of 
Veterans and the need for an evidentiary scientific basis for action.
    In 2019, Congress passed legislation expanding benefits to tens of 
thousands of Blue Water Navy (BWN) Vietnam Veterans. As of May 1, 2021, 
VA has completed more than 54,000 BWN claims and paid out nearly 900 
million in retroactive benefits. More recently, VA added three new 
diseases to the Agent Orange presumptive conditions list in the FY 2021 
NDAA. VA will begin implementing these provisions so that Vietnam 
Veterans will no longer wait for these earned benefits. As the 
Department harnesses its resources to execute these new requirements 
and ensure Veterans receive the benefits they have earned, I have also 
recommended initiation of rulemaking to establish a presumption of 
service connection for respiratory conditions related to exposure to 
particulate matter and other airborne hazards, which may conclude such 
conditions as asthma, rhinitis, and sinusitis for Gulf War Veterans. 
This decision was based on the first iteration of a newly formed 
internal VA process to review scientific evidence relating to 
exposures. VA will conduct broad outreach efforts to reach impacted 
Veterans and encourages them to participate in the rulemaking process.
                                research
    The Budget includes $882 million, the largest year-over-year 
increase in recent history, for medical and prosthetic research. This 
historic investment will advance the Department's understanding of the 
impact of traumatic brain injury (TBI) and toxic exposure on long-term 
health outcomes while continuing to prioritize research focused on the 
needs of Veterans to include Mental Health and Suicide, Rare Cancers 
and Prosthetics as well as other disease areas.
    Increased TBI investment will enhance cutting-edge diagnostics and 
treatments such as investigating the role genomics plays in resilience 
and recovery from blast exposure, validating blast models, and studying 
the link between TBI and suicide. Further investment in environmental 
exposure includes the VA Military Exposures Research Program (MERP), 
capacity building with Federal partners, and expanding the workforce in 
military exposures research and training.
    VA will also invest additional resources, including from the 
American Rescue Plan, to advance the Department's understanding of 
coronavirus related research and impacts. To remain on the cutting edge 
of technology, VA will focus on software-as-a- service, cloud 
computing, and data security, and will continue to partner with the 
Department of Energy (DOE) to capitalize on DOE's computing power and 
technical expertise to put Veteran data to work.
                    diversity, equity and inclusion
    Diversity, equity, and inclusiveness are standards fundamental to 
everything we do. We will welcome all Veterans, including women 
Veterans, Veterans of color, and LGBTQ+ Veterans. Every person entering 
a VA facility must feel safe, free of harassment and discrimination, 
and we will never accept discrimination, harassment or assault at any 
VA facility. We will provide a safe, inclusive environment for Veterans 
and VA employees.
    Diversity is a strength, never a weakness, among Veterans, VA 
employees and all of America. Leveraging diversity, equity and 
inclusiveness will produce the excellence in all our interactions with 
Veterans. I recently instructed my team to establish a 120-day task 
force on diversity, equity and inclusion. The task force's goal is to 
offer concrete, actionable recommendations while building solidarity 
across the VA system on diversity, equity and inclusion. To support the 
Department's commitment to strengthening VA's diversity program and 
preventing and resolving discrimination at the early stages, the Office 
of Human Resources and Administration created the new Office of 
Resolution Management, Diversity, and Inclusion (ORMDI) by 
consolidating the Office of Diversity and Inclusion and with the Office 
of Resolution Management. The budget for this combined office will 
increase by $12.9 million and 74 FTE. These resources will also provide 
a robust harassment prevention program and counseling services while 
advancing equity for all who have been historically underserved.
    The Budget Request also furthers the commitment of the VHA Office 
of Health Equity to help eliminate health disparities based on race, 
gender, age, religion, socio- economic status or disability by 
improving health outcomes for underserved Veteran populations.
            empowering leaders to implement positive change
    I am mindful VA's capabilities have not always risen to the needs 
of our Veterans. Consistent throughout many of these past shortcomings 
has been a theme of leadership inconsistency and cultural challenges. 
To rebuild trust and restore VA as the premier agency for ensuring the 
well-being of America's Veterans, I am focusing on building a diverse 
team of professional, experienced leaders who bring a great breadth and 
depth of knowledge in government and Veterans issues. To that end, we 
recently stood up a commission to identify candidates to lead and 
manage VHA.
    At the same time, I also am working to retain the talented and 
hard-working leaders we currently have by empowering them to make 
decisions in a structure that allows them to do what's right for 
Veterans. As an initial step in support of that effort, I recently 
signed a memo for VA employees emphasizing my intent to lead with VA's 
ICARE Core Values-Integrity, Commitment, Advocacy, Respect and 
Excellence--and have been seeking opportunities to engage with leaders 
across the system to drive this point home. VA's success as a team-our 
ability to deliver world-class care for our Veterans-also depends on 
how employees treat one another and Veterans. Our respect for our 
fellow VA employees and the Veterans we serve is critical to everything 
we do.
    Essential to ensuring a healthy and accountable culture at VA is 
the Office of Inspector General's oversight. The 2022 Budget includes 
the OIG's request of $239 million for 1,100 FTE to support its programs 
and operations through independent audits, inspections, reviews, and 
investigations. The OIG's efforts have a significant impact on the 
services and benefits provided to Veterans. This funding level is 
prudent to safeguard the significant investments in VA and to help 
improve services and benefits for Veterans and their families.
    I take full responsibility to ensure VA employees have everything 
they need to carry out the important work before us and we operate in a 
culture that celebrates and draws strength from our country's great 
diversity. To ensure a welcoming environment for Veterans, we must 
foster fair and inclusive VA workplaces where the experiences and 
perspectives of our diverse employees are valued. The success of our 
mission depends on everyone being able to contribute their expertise, 
experience, talents, ideas and perspectives. I commit to advancing 
equity in VA and providing all employees with opportunities to reach 
their full potential. I commit to these principles and will make sure 
my senior leadership team reflects and embeds them in everything we do.
    At this moment when our country must come together, caring for our 
country's Veterans and their families is a mission that can unite us 
all, and I look forward to working with this Committee, Congress as a 
whole and our many other partners to embrace our collective 
responsibility to serve Veterans.
    Mr. Chairman, Ranking Member Boozman, I look forward to working 
with you and this Committee. Thank you for the opportunity to appear 
before you today to discuss my priorities for the Department and how 
the President's FY 2022 and FY 2023 Advance Appropriations Request will 
serve our Nation's Veterans.

    Senator Heinrich. Well, I want to thank you both. And, the 
fiscal year 2022 request and the fiscal year 2023 advanced 
appropriations request, Mr. Secretary, are record levels coming 
on top of a record fiscal year 2021 appropriation, and 
significant supplemental funding. The pandemic provided unique 
challenges to projecting where veterans will demand those 
services.
    For instance, through transfers, and the second bite, VA is 
significantly increasing resources to meet community care 
demand in fiscal year 2022, yet, this budget assumes a decrease 
in demand in fiscal year 2023. So, what is VA's vision for the 
right balance between in-house and community care going into 
the future; and is the medical community care request in 2023 
the right number?
    Secretary McDonough. Thank you very much. Thank you very 
much, chairman. We have been talking with all of you and with 
your teams, as well as within the agency about the right 
balance. We are driven first and foremost by the requirement in 
statute that we make decisions based on best outcome for 
veterans. That is also the commitment I have made to the Senate 
in the context of my confirmation, which is, every decision I 
make will be based on increasing access and improving outcomes 
for veterans.
    So first and foremost, we will make a determination based 
on what is medically best for our veterans. Second, I happen to 
believe, and I think the data shows, that veterans in our care 
do better than veterans not in our care. So, I think it is very 
important that we maintain a sustainably funded, whole health 
care system in VA, with the full range of specialties that our 
vets have demanded over time, and with care provided by 
providers who have particular understanding of the challenges 
facing vets.
    The fact is, however, that--and particularly in highly 
rural areas--our vets will continue to be dependent on the 
community as well. And this is something I have talked at 
length with many members of this body about, and traveled to 
see the impacts of our partnership with the community.
    And so, we will be working over the course of this year and 
next, as we manage this bow wave of care, our next year's 
appropriation, advanced appropriation request, recognizes that 
the expansion of provision of care is not as I think Senator 
Boozman fears it may be, or asked for clarity, that it not be a 
resetting of the baseline. But it is rather an ability to 
manage this bow wave of care now, and then over time as we get 
to post-pandemic, we will be in a position to right-size that 
care in the system and find where we need to augment that care 
in the community.
    Senator Heinrich. Mr. Secretary, I know the AIR Commission 
work is ongoing, but one of the concerns I have is that, to do 
a market assessment during a pandemic raises a lot of questions 
about the data that will go into those final decisions. We had 
enormous market distortions. We saw that in impacts to your 
budget, we saw it in the private sector. Will you provide that 
data to the committee, but also, do you have concerns about the 
quality of that data?
    Secretary McDonough. So, our teams have been looking at 
these market assessments now going back a couple of years. I 
have not dug into that data aggressively myself. I do have a 
belief. I do believe that it makes sense for us to relook that 
data in light of the pandemic, also in light of the fact that 
the U.S. Government has just gone through the decennial Census, 
for example. So, there may be data there, too, for us to 
prosecute as we do these market assessments.
    So, we will be augmenting the review that we have had to 
date. We are also committed, I have made this commitment in 
other public hearings, and I reiterate it here, to provide you 
that information for you to make your own decisions about this. 
I think it is only right that we make decisions like this with 
such import for the national interest in the light of public 
day--in public light. And that is what we intend to do. So, I 
would be more than happy to make sure that we get the committee 
information.
    Senator Heinrich. Great. I look forward to taking a look at 
that, and I have concerns given what a unique year it is to 
make very long-term impactful decisions based on data, in what 
may be a year that is a complete anomaly. With that, we will go 
to the Ranking Member for his questions.
    Senator Boozman. Thank you, Mr. Chairman. The CARES Act and 
the American Rescue Plan provided VA with $37 billion to 
respond to the pandemic. One of the conditions in the CARES Act 
was that any personnel hired using this money can only be 
temporary employees, so as to avoid building a ``budget tail'' 
in years to come. And you discussed a little bit about this in 
your previous question, but I want to follow up. The fiscal 
year 2023 medical care advance appropriations requests $111.3 
billion is an increase of $13.8 billion over fiscal year 2022 
revised request.
    So, I guess the question is, what is driving the 14 percent 
increase? Is the budget proposing to make the temporary hires 
permanent? Has the sudden influx of COVID-related funding reset 
the VA baseline significantly higher than it was before the 
pandemic?
    Secretary McDonough. Yeah, we don't--I will ask Jon to pile 
in with some additional specifics on this, Senator Boozman, but 
we don't seek to reset the baseline. We are seeking to manage 
both a strong pandemic response, which the CARES Act allows us 
to do, and then ARP really allows us to sustain that response, 
which is going to need to be sustained through this year, 
because of this bow wave of care, and supports recovery.
    But really what is happening, as we see care for our 
veterans, is a series of fairly substantial, big-moving pieces 
that include the fact that vets are living longer, that the 
pandemic has increased the complexity of care that our vets are 
facing. By the way, I think we have a better handle on that 
than anybody. We are doing--if you look in--you can't open a 
newspaper any morning now without seeing a story about VA-based 
research on Long COVID, and to be honest with you, no other 
system is doing that. We are doing that, thanks to your 
support.
    We have a particularly soft economy right now, and 
historically what we know in soft economies is that vets who 
were reliant on employer-provided care, until now, are relying 
on their care for us. Lastly, all those things contribute to a 
trend line towards complexity of care for our vets. That means 
that any incident of care is more complex and therefore more 
costly.
    That is coming at a time when, for example, the MISSION Act 
has increased what we call ``reliance on us.'' So, more vets 
are getting more services from us, as a result of some of the 
authorities in the MISSION Act, so what you see in that budget 
is our best assessment based on our model, and a model that has 
proven pretty decent over time, at what we anticipate in terms 
of complexity of care, and reliance on us for our services from 
our vets.
    Anything you want to add, Jon? Did I miss anything?
    Mr. Rychalski. Yeah, just one thing. I think when you look 
at our budget, there is a request--an increase in the requests, 
but when you compare how much we plan to spend in 2022, which 
includes ARP funding, and then you compare what we plan to 
spend in 2023, our budget actually goes down by about $4 
billion. And I think from a strategic standpoint, what you see 
is us hiring up, and then those FTEs staying on, but we are 
putting most of our requests in 2023 in the direct care system, 
and as the Secretary mentioned, we are betting that is going to 
be where people are going to want to get their care.
    And that this dramatic increase in community care is going 
to level off a bit. And you also see, going back to what I 
said, the $4 billion--sort of comes down about $4 billion in 
2023, because we think that the community care will level off, 
you know, that the demand for services in the direct care 
system will rise. But net-net, we actually have a lower planned 
expenditure in 2023 than 2022, because we don't have the same 
supplemental funding.
    Senator Boozman. So, what do you all feel, like is driving 
the increased demand for community care now? Because when you 
look at your modeling, and you look at the numbers that you are 
requesting, certainly, you know, there is a bunch of community 
care dollars now, but not in the future. And again, don't 
misunderstand, myself, the entire committee is committed to in-
house specialists, you know, the quality of care, you know, 
again, as good as anybody. And I think we can be very proud 
that the VA has achieved that. On the other hand, I think what 
we don't want are a bunch of surprises, going down the line, 
which we have really seen in the last year or two.
    Secretary McDonough. Look, I couldn't agree more Senator. 
And I would start on your last point, which is, I don't 
misunderstand you, and we couldn't misunderstand you because 
you have been regularly supportive of all of our efforts. So we 
are very grateful for that.
    I think that what is driving community care at the moment 
is that, by necessity, I think many providers in the community, 
open to full services sooner than many of our providers did. So 
that is one of the things that is driving this. The other is 
that we are experiencing now what we have been talking about 
for some months, which is that as the pandemic ebbs more of our 
vets are coming back to address care that they forewent during 
the pandemic. And that is also happening at a time when not all 
of our facilities are fully open. And so, we do think that what 
is driving the care in the community are the particulars of the 
pandemic, and less a stated desire of our veterans to get into 
the community.
    That said, partly to inform our going-forward process. We 
are in the field right now through our Veterans Experience 
Office, talking to veterans about what their experience in care 
during the pandemic was, and what that says about what they 
expect going forward.
    Senator Boozman. Good, very good. Thank you, Mr. Chairman.
    Senator Heinrich. Senator Schatz.
    Senator Schatz. Thank you, chairman; vice chairman.
    Secretary, Assistant Secretary, thank you for being here. 
Thank you for your service. I want to talk first about 
telehealth.
    Secretary McDonough. Yes.
    Senator Schatz. Obviously VA has made tremendous strides in 
telehealth as has the private sector, Medicare, Medicaid, DOD, 
it is happening everywhere. The specific question I have to 
start is: To what extent are any of the expansions of 
telehealth services, dependent on or precipitated by the 
pandemic, and likely to snap back to the Stone Ages when the 
pandemic is over? Or are there plans in place to not only 
institutionalize all these expansions of services, but to 
expand them?
    Secretary McDonough. Yes. So bottom line is that we have--
let me just give you some numbers around the expansion, 
basically, we estimated at about an 1,800 percent increase in 
video visits from VA to home, going from about 10,500 visits in 
the first week of March 2020, to 220,000, or almost 230,000 
visits at the end of February of this year. So, the numbers are 
a dramatic expansion.
    Another way to look at it is, halfway through this year, 
nearly two million vets--this fiscal year--have had one or more 
episodes of video care through our vets' Video Connect Program. 
So that tells us that there is massive demand. We are 
institutionalizing that as you say, we want to maintain it 
because it is ease of access for vets who don't need to be seen 
in person. We see a large degree of satisfaction from our vets. 
In full candor, our clinicians sometimes are less excited about 
it than our vets, but we are working that.
    Senator Schatz. That is kind of what I am trying to get at, 
is to what extent are any of these, at least currently 
temporary changes in clinical standards, or standards of care 
that need to be made permanent lest we go back to where 
something is more comfortable for either VA docs, or 
supervisors, or fiscal people.
    Secretary McDonough. Yeah.
    Senator Schatz. Do we need to institutionalize some of 
these. Like, are there specific places we need to burrow into 
the bureaucracy, or into the statutory law to make sure these 
things stick?
    Secretary McDonough. We are looking at exactly those 
questions. I think overwhelmingly there is going to continue to 
need to be things that are done in person, and we are looking--
we are developing those lists of what those are, working with 
VHA. But I think as a system, we recognize the huge efficiency 
gains and huge satisfaction gains, which come from the fact 
that vets are spending less time traveling to our facilities, 
while getting good care.
    And so, we have a bias toward institutionalizing, but we 
are going to let the data drive that too. So we will be more 
than happy to stay in close touch with you on that.
    Senator Schatz. Okay. I think I will send a QFR on this.
    Secretary McDonough. Good.
    Senator Schatz. So that we can get a little bit deeper 
fidelity on----
    Secretary McDonough. Fair enough.
    Senator Schatz [continuing].--what changes you need to make 
and how we can be supportive of it, because I have just seen in 
Private Pay and Medicare, you know, there is going to be a 
tendency to want to snap back to pre-pandemic time. And, I just 
think there is going to be a patient revolt if--you know, 10 
years ago if you told someone to interact with their clinician 
via their iPhone, it would be an insult. And now if you can't 
do that, it is an insult.
    And so, I just think we are underestimating the extent to 
which people are going to freak out in 18 months, if something 
that was fantastic and available is suddenly not. And we want 
to help you to make sure it is all permanent.
    Secretary McDonough. I agree with that. And I don't want to 
waste any more of your time, but I just make this point, which 
is, we have such demand for mental health care, like everybody 
else in our health care system, writ large, at such a position 
of competing for providers, we get not insignificant marginal 
gain of access through using video platforms, that it would be 
foolhardy to walk away from that.
    Senator Schatz. And there is at least anecdotal evidence 
among veterans that accessing mental health services via 
telemedicine can sort of overcome or circumvent the stigma.
    Secretary McDonough. No doubt.
    Senator Schatz. And so, it is all to the good, we just want 
to help you to make it permanent. Final question, when we spoke 
in January I mentioned the veterans on Hawaii Island are still 
waiting for VA to break ground on the new outpatient clinic in 
Hilo, Hawaii.
    Secretary McDonough. Yes.
    Senator Schatz. Can you please give me an update?
    Secretary McDonough. Yes, so we have an interim lease, fix 
in place, the permanent lease is taking far too long, both in 
Hilo, but across the board. So, we are looking at that 
systematically. The interim lease is in place, and I think we 
are in a position now to execute against that interim lease as 
we try to push on the permanent lease, which is now about 9 
months delayed. So, we are staying on top of it.
    Senator Schatz. Thank you.
    Senator Heinrich. Senator Hoeven
    Senator Hoeven. Thank you, Mr. Chairman.
    Secretary McDonough, it is good to see you again.
    Secretary McDonough. Nice to see you.
    Senator Hoeven. For all that work you did as chief of 
staff, and good to see you in your new role, congratulations on 
that.
    Secretary McDonough. Thank you.
    Senator Hoeven. Appreciate the opportunity to work with you 
again. Thanks for being here today, to both of you. One of the 
things that I have been working on for a long time is--and we 
have included language in a number of the bills, we passed the 
VA MISSION Act, and a number of the other veterans' bills that 
we passed.
    If a nursing home takes Medicaid or Medicare reimbursement, 
they have a set of standards and inspections that they have to 
meet. But if they take VA reimbursement, then they have 
additional standards they have to meet. So, they ended up with 
multiple inspections and additional regulations. As a result, 
only about 20 percent of the nursing homes in the country take 
VA reimbursement for long-term care.
    That makes a huge difference to our veterans because 
qualifying veterans can actually draw on the VA benefit without 
having to expand all our assets, unlike Medicaid, for example, 
where they would have to first dissipate their assets down to, 
you know, standard testing, varies a little bit by state. So, 
for qualifying veterans, this is a big deal.
    Now, about 20 percent of the nursing homes do take VA 
care--or VA reimbursement, but a lot don't for that reason. And 
so, we are trying to work with you, and with Labor, and with 
HHS to get these veteran care agreements simplified so that, 
you know, these nursing homes will take veterans with VA 
reimbursement, because like I say, the asset test.
    And so I would ask for your help. And we have just had a 
number of different challenges. Sometimes the VA tells us, 
``well, you know, those additional requirements, and those 
additional inspections are--we are just trying to take care of 
veterans,'' and ``we are just trying to protect the veterans.'' 
Well, I mean, that almost kind of makes the assumption that, 
you know, HHS and states are not taking care of other seniors.
    So, I mean, that does not really seem to fly. It really is 
a red-tape problem. And so, if we could work with you to 
streamline that, so that if a nursing home meets all the 
requirements for Medicare or Medicaid, then they should not 
have additional set of requirements for VA reimbursement. So 
that is the issue, and I would ask for your help on it.
    Secretary McDonough. Thank you, Senator. I confess that it 
is, and I know you have been working with us, I am not deep on 
this. I will just say the following, which is that our 
experience during the pandemic is that our clinicians far 
exceeded performance on reduction of COVID infection in our 
facilities, as related to other facilities, both state-run 
facilities, state-run veterans' facilities, and private 
privately-run facilities. So, I think there is a lot of work 
that we have done in this space, but I would be more than happy 
to take this and commit to work with you on it.
    Senator Hoeven. Yeah. And the key is access, you know, 
because you may have loved ones that have to travel a distance 
if they can't get their loved one in a nursing home close.
    Secretary McDonough. Yeah.
    Senator Hoeven. And this is not just a North Dakota 
problem, this is a nationwide--that stat I have cited is a 
nationwide stat.
    Hyperbaric Oxygen Therapy, HBOT: the veterans really feel 
that this is important to them, particularly for PTS. And we 
have got a pilot program going, there is a number of locations, 
including the VA center in Fargo, which is a high quality 
outstanding center, serves a lot of North Dakota, but a lot of 
Minnesota too. But are you committed to making sure that our 
veterans can get access to HBOT?
    Secretary McDonough. Yeah. Well, we are running that pilot 
currently. I just asked for an update on it yesterday. It runs, 
as you know, through this fiscal year, so we are absolutely 
committed to making sure that we run this through, we get high 
quality review of this, and then as we have assured you, we 
will make the decisions based on that. So, I will be more than 
happy to do that and stay in close touch with you.
    Senator Hoeven. Yeah. We would like to work with you on 
that too. We have talked to so many veterans that really, 
really swear by it, and so I think this is going to be 
something, and not just veterans, as you know, for concussions 
and other things as well.
    Secretary McDonough. Yeah.
    Senator Hoeven. You know, All-Star football players like 
John Boozman, and others, you know, sometimes--I think it has 
been very beneficial to them. I am sure you have seen the Joe 
Namath commercials, and he talks about it. The last thing I 
will bring up.
    Senator Boozman. The secretary played.
    Senator Hoeven. Oh, is that right?
    Senator Boozman. Yeah.
    Secretary McDonough. Yes, I did.
    Senator Hoeven. Where did you--where at, Minnesota 
somewhere?
    Secretary McDonough. I played at St. John's University.
    Senator Hoeven. Oh, you are a Johnny. Was that back when 
they had the fabulous teams? They had a long string of 
championships.
    Secretary McDonough. Yeah, they had a bad defensive back in 
me, but very good teams.
    Senator Hoeven. Good for you, fantastic.
    A last question, I will be quick. I am sorry, Mr. Chairman. 
It is just, ask for your help at the rural--we have the Rural 
Initiative (cemeteries), great program.
    Secretary McDonough. Yes.
    Senator Hoeven. Huge kudos to you. We have one now in 
eastern North Dakota. I just ask for your continued commitment 
as we add, you know, really important things, like restrooms, 
and storage, and wind walls, and things like that. Fabulous 
initiative in rural America, and I would just ask your strong 
support for it.
    Secretary McDonough. Yes. You got it.
    Senator Hoeven. Yes. Thank you. Thank you, Mr. Chairman.
    Senator Heinrich. Senator Tester.
    Senator Tester. Thank you, Mr. Chairman. A couple of 
housekeeping things, first of all: I want to thank Secretary 
McDonough for bringing up John Warner. John Warner gave me the 
best advice I have had since I got here. And I have seen this 
advice play out several times. His advice was, ``Don't stay 
here too long, kid'' which was, which is good advice.
    And then the other thing, Mr. Chairman, I just want to 
point out that you have possibly the best staff director of any 
of the appropriations committees, in Michelle Dominguez, she is 
absolutely the most competent staff member on the 
Appropriations Committee that I have ever been affiliated with. 
And she used to work for me.
    So, Mr. Secretary, you, or the VHA, brought on nearly 8,000 
employees under the Temporary Emergency Funding of COVID-19. 
What is your plan to keep those folks on board when the ARP 
money runs out?
    Secretary McDonough. Well, we are letting the demand for 
services inform that. We have a particular set of demands, and 
I know this is particularly important to you, around mental 
health. So, our first and biggest effort is to retain the 
excellent clinicians that we have, even as we approach a series 
of expected retirements.
    We are right in the middle of the annual Employee Survey at 
the moment, we will get data from that, which will give us a 
sense of what to expect coming in the new year. But the first 
and biggest challenge for us is to retain the people that we 
have. And then next is to make sure that we are not just out 
competing with other health care systems, but that we are 
adding to the available clinicians. And this is where our 
education component and our residency programs become so 
important to us. So, that is why we have the funding that we 
have requested in the budget. And we will continue to work with 
you guys on precisely that.
    Senator Tester. Thank you. Community care was brought up 
previously, but I just want to approach this from a little 
different angle. There has been a lot of talk about the wait 
time to see a doctor within the VA. And correct me if I am 
wrong, but I understand you are meeting the guidelines for wait 
time, is that correct?
    Secretary McDonough. We are. Yes.
    Senator Tester. Okay. Are you able to track the wait times 
in the private sector?
    Secretary McDonough. We are looking at that now to make 
sure that we have a good handle on this. You know, come a year 
from now, we have to make some decisions about our access 
standards. That is what the law requires us to do. I have 
implemented and started a process over the course of the last 
six weeks, or so, where we get the data to help us inform the 
decisionmaking that we have to make in consultation with you 
for a year from now.
    Among the data I am asking for is veteran satisfaction, 
health outcomes, wait times, and commensurate wait times for 
care in the community.
    Senator Tester. I think it is really, really important, 
because, the fact is wait times have been an issue which, by 
the way, why we have community care to begin with. And if we 
are not addressing that issue, the community care, then we need 
to go back and address it.
    Speaking of mental health, I was surprised in this year's 
budget that the VA projects treating 6,000 fewer vets via 
inpatient mental health care in 2022 than it did in 2021. Is 
that because of telehealth, or is there another reason here?
    Secretary McDonough. I think it is principally due to 
telehealth. But, Jon, am I missing anything on this?
    Mr. Rychalski. Don't have the answer to that.
    Secretary McDonough. Okay. Well, let me take that 
specifically, Chairman. But I think that is due to telehealth 
because frankly we will see our demand is up across the board.
    Senator Tester. Appreciate that. And I agree. Now I want to 
talk about something that is near and dear to both our hearts; 
and that is toxic exposure, and in a bill that Senator Boozman 
is very familiar with, as well as myself, and other folks that 
are on a VA committee. The budget supports about $7 million in 
new spending on toxic exposure research, to focus on 
collaboration between the VA, DOD, and the national academies, 
and other stakeholders. My question is: Do you think the VA 
should be the lead Federal agency on veteran toxic exposure 
research?
    Secretary McDonough. I do believe we should be. And I think 
that we are.
    Senator Tester. And do you feel that that increase of $7 
million establishes the VA as a leader on this research?
    Secretary McDonough. I think it does, but I also think, 
Chairman, as you are aware, we have also set up a process 
whereby we are getting the benefit of all the other science 
agencies, DOD, Department of Labor, HHS, and their attendant 
offices and capabilities on a very regular basis, in addition 
to the National Academy of Science. And my commitment to you 
all is to not only to continue to get that science, but to 
report to you on a quarterly basis what that science is telling 
us, including about whether we are in a position to connect 
other conditions to service in Southwest Asia.
    Senator Tester. I know that community care was talked about 
earlier, and the amount of money that is being spent on 
community care. And in some aspects, that is simply not 
sustainable, especially as it applies to emergency room 
treatment. I want to give you an example. And if I might, Mr. 
Chairman, of a story that was relayed to me just last week by a 
doctor that works for the VA, and is very proud to work for the 
VA. And a patient came in, I believe he had kidney stones, and 
he got to see him at about 4:30. And, of course the day ran out 
at 5:00.
    And the advice that was given to him by his superiors was: 
just send him to the private sector. The guy wanted to be 
treated by the VA and the easy way to do it--and maybe this is 
the problem--the easy way to do it was just get him to the 
private sector. I know you are concerned about this, and I 
appreciate your concern. And I just think that we need to be 
wise about how we utilize the private sector. It is the 
veteran's choice, it is not the VA's choice. Thank you.
    Secretary McDonough. Yeah. I would just say one thing about 
that is--two things about that. One, what the clinicians tell 
me is that to refer a vet to the community takes, in our 
current electronic system, two clicks. To refer somebody back 
into care in the system is something like 18 to 20 clicks. That 
does not seem right to me.
    That suggests, I think, as Senator Schatz was asking, a 
kind of an institutional direction. So, have asked us to look 
at that. The second is our facility in Ann Arbor is going 
through and running a pilot about access to emergency care, 
including access to mental health services. And this is 
anecdotal, this is why we are out getting some kind of 
statistically significant information from our vets.
    But the anecdote there was, our hospital administrator told 
me, is that when she invited vets back into care in the system, 
they all asked--three of them said to her: I am grateful that 
you ask, and I always wondered why he pushed me into the 
community in the first instance.
    And so, I don't know that that anecdote adds up to 
something statistically significant, but I want to make sure 
that we are giving the vet and the clinician the opportunity to 
make the best--what the statute requires, the best possible 
outcome for the vet deciding this. That requires us meeting our 
wait times, but it also requires us making sure that we don't 
tilt the--tilt the record.
    Senator Tester. Thank you.
    Senator Heinrich. Senator Baldwin.
    Senator Baldwin. Thank you, Mr. Chairman.
    And welcome, Secretary McDonough.
    Secretary McDonough. It is good to see you, too.
    Senator Baldwin. I know that when we spoke earlier this 
year that we talked a bit about bipartisan legislation that I 
had sponsored: the Jason Simcakoski Memorial and Promise Act.
    Secretary McDonough. Yes. Jason's Law.
    Senator Baldwin. Jason's Law. And, it was signed into law 
in 2016, and the law has been effective in strengthening 
oversight of the VA's opioid prescribing practices and 
providing safer care for our veterans. So, I thank you for the 
Department's support of Jason's Law in the fiscal year 2022 
budget. The progress that Jason's law is making to improve the 
care of veterans is, I think, really quite remarkable.
    And I remain committed to working with you to ensure 
delivery of the highest quality of care to our nation's 
veterans. But I also want to thank you for your commitment to 
meet with this Simcakoski family, to discuss implementation of 
the law that is named after their son, Jason. Can you give me 
any updates today on the VA's effort to reduce or right-size 
the prescribing of opioids, in addition to the latest VA-wide 
statistics on the rate of opioid and benzodiazepine 
prescribing?
    Secretary McDonough. I don't have those. I would be more 
than happy to provide those data to you, you know, when we 
leave here, I don't have those at my fingertips here. I believe 
informed both by the tumultuous experience--traumatic 
experience at Tomah, as well as, a national epidemic on 
substance use disorder.
    Our programming continues, as you suggest, to make good 
progress. This includes very aggressive recordkeeping about 
prescription practices, and that includes us working very hard 
to harmonize our records, for prescribing in the community, as 
well as for prescribing in the system. So, I think we are 
making good progress there. But the fact is that substance use 
disorder remains an epidemic in the country. And so, we will 
stay on top of this.
    Senator Baldwin. You know, on that note, the COVID-19 
pandemic has, I think, increased the severity of our opioid 
epidemic.
    Secretary McDonough. Yeah.
    Senator Baldwin. And I am wondering if there are any 
particular Departmental programs to address this within the 
veterans population, you know, pandemic-related, adverse mental 
health and opioid abuse, or is this----
    Secretary McDonough. There has been reporting on incidences 
of increased prescription of opioids for pain treatment in Long 
COVID. And overall, there has been reports, and across the 
health system, not the VA system, but across U.S. health 
system, of prescription of opioids for pain management in the 
context of COVID.
    In light--in reaction to those stories we went back in VHA 
to look at prescribing practices. We don't see that currently 
in our system. We have looked at that and we will stay on top 
of that for the obvious reasons. But it also goes to the point 
that I think the budget request also goes to, which is, the 
research capacity that you enable through the budget at VA is 
incredibly important.
    Nobody is doing as much research right now on Long COVID as 
we are. That is facilitated by how we aggregate data, and that 
will be improved even greater when we get this electronic 
health record on track. But it also speaks to the fact that 
that is a fundamental capacity we need in house, and that we 
need to make sure that we sustain over time. And we are using 
that expressly on substance use disorder and watching it very 
closely. And we will--obviously we know of your personal 
interest in this, and we will stay in close touch with you on 
it.
    Senator Baldwin. Thank you very much, Mr. Secretary. I have 
run out of time. I will submit two additional questions for the 
record, one pertaining to K2 veterans and exposures. And the 
other, dealing with, partnerships between the VA and, county or 
tribal veterans, service officers, to make veterans in local 
communities aware of the full array of services that they might 
be eligible for.
    Secretary McDonough. I would just--at the risk of going 
over, we have the Annual Tribal Nations Summit at the White 
House in this fall. This is one of the things that we will be--
we are trying to develop more robustly in anticipation of that. 
We are seeing really useful, collaboration between our national 
facilities, and local, and community facilities, and IHS 
facilities that build on some authorities you have given us. 
That might be something that we should follow up with.
    Senator Baldwin. Great. Thank you.
    Senator Heinrich. Mr. Secretary, I look forward to hearing 
more on that front. Actually, I think Senator Baldwin and I 
share an interest in, and that is a very complicated, 
coordinated care model that oftentimes our tribal veterans have 
to utilize.
    I want to ask you a question about compensation and pension 
exams. Under the previous administration, the Department 
indicated that it planned to contract out nearly all of the 
compensation and pension medical exams, and despite a number of 
VSOs, many senators raising concerns, the VA continues to, 
largely, privatize this component of its mission, and it is 
requesting funding for more staff to oversee those contracts. 
What is the financial basis, first off, for contracting out? 
And how does the cost of providing this service internally 
compare with providing it through these contracts?
    Secretary McDonough. Yeah. So first and--first and 
foremost, we have a significant backlog at the moment which--
so, I think part of the funding that you see reflected in the 
budget is our commitment to get that backlog down. That backlog 
springs from the pandemic. There is about a two-month period 
during which we did no exams, out of deference to the safety 
and health of our vets. That number is now at about 180,000 
[sic]. That is down from about a hundred--sorry, about 220,000.
    So, I don't have the dollar-for-dollar comparison, but I 
will get that for you and submit that. But I think you are 
right that we continue to rely a great deal on contracted C&MP 
exams, but we have cranked up volume on two other ways to 
administer the exams. One is in the system that is out of a 
collaboration among Dr. Stone at VHA and Tom Murphy at VBA, 
where VHA is now providing additional in-system C&MP exams. 
That does come at the expense of other, or at the cost of other 
services that VHA is providing. So, we are looking closely at 
that and tracking that closely to make sure that that does not 
tip in the wrong direction.
    And then we are providing C&MP exams through video 
telehealth, video and telehealth, and so that also increases 
demand on our in-house practitioners. But I think it is really 
important that we not--that we get that backlog down. So that 
is what is reflected in the budget. As to the specific dollar-
for-dollar comparison, to let us make that, and we will get 
that back to you unless you have that off the top of your head.
    Mr. Rychalski. No.
    Secretary McDonough. Okay.
    Senator Heinrich. Great. No, I appreciate that. We have 
talked a little bit about the unique challenges that rural 
veterans face but, you know, access to care in-person or via 
telehealth, it is just hard recruiting and retaining primary 
care and specialty providers. This budget requests $307 million 
to support rural health initiatives. It is a modest increase 
over prior years, especially in comparison to the overall 
budget growth, but can you talk to us just how is--how is VA 
developing and implementing enterprise-wide initiatives to make 
sure that we are serving veterans in those rural areas 
adequately?
    Secretary McDonough. Yeah, it is a great question. I mean, 
we have our Office of Rural Health, which is kind of the 
principal place where we are innovating on policy there. I will 
give you a couple of examples that I think are useful.
    And let me just correct the record on one thing. I looked 
at my notes after my answer, and what it says here as, as of 
June 21, the rating claims pending over 125 days is 190,000, 
not 180,000. So, I misspoke there.
    What we find is, a couple of different things about our 
primary care physicians in rural areas. One is, obviously, 
distances traveled. We have a relatively small number of 
practitioners covering a lot of different CBOCs over, as you 
know very well, over a wide expanse. We are trying to address 
that by increasing the number of practitioners.
    You have some isolation, professional isolation, where it 
may be a very vibrant, and I know it does not happen with my 
colleagues who work with me, but sometimes you work with a 
colleague who happens to be, or colleagues who happen to be 
very smart, very engaging, gives you opportunities to grow. 
When you are on the road all the time, you get less of that. 
So, we are trying to use, for example, telehealth 
opportunities--sorry--and video connect opportunities to 
increase that interaction.
    We are also using available authorities through that same 
Office of Rural Health to increase travel options for those 
practitioners, so they are getting to additional career 
development, specialty development options. Lastly, we are 
increasing the use of econ--sorry--educational partnerships to, 
again, enhance career building opportunities. So, none of these 
alone adds up to everything we need, but each innovation in 
that space I think is important. And we will continue, and this 
budget does continue, to invest in our ability to do that.
    Senator Heinrich. Yeah. I think all of us up here would 
agree that that is incredibly important. And I am running short 
on time, but I will just raise one more issue that is related 
to that, which is the VA's Highly Rural Transportation Grant 
Program. In fiscal year 2021, it was funded at less than $3 
million. You know, our discretionary budget this year is $113 
billion. I just think this is a place where we need to look to 
make sure we are actually meeting demand, and that number in 
fiscal year 2022 as it actually gets implemented, I think is a 
place we need to look at beefing things up.
    And with that, turn back to the ranking member.
    Senator Boozman. Thank you, Mr. Chairman. I just want to 
touch base on the Electronic Health Record Modernization 
Program.
    Secretary McDonough. Yes. Yes.
    Senator Boozman. It is such a huge, huge issue, a big 
expense, and just, you know, a gigantic project that is so, so 
very important. I know the budget requests $2.7 billion for 
fiscal year 2022, I understand there the review will reshape 
the program significantly in every facet and, again, its 
financial needs. The House is going to begin marking up their 
version of this bill on Friday without the benefits of the 
results of the strategic review.
    So, I know you can't go into it, you know, in the sense 
that it is not done, but can you just, kind of tell us how it 
is going and when we can expect the information to come out?
    Secretary McDonough. Yeah.
    Senator Boozman. And the deployments.
    Secretary McDonough. We don't anticipate changing the 
budget request, the shape of it may change, but the numbers 
themselves will not change as a result. You know, I am tempted 
to try to say: it will be reduced over time, but I am not, I am 
not going to say that.
    Senator Boozman. Sure.
    Secretary McDonough. But hopefully we can do that. We have 
identified that--we believe that the technology, basically, is 
sound. We think that we probably undervalued and underinvested 
in training and support to our team in the field. And as they 
are going through the change of this process, we also, I think, 
have identified some structural inefficiencies in headquarters 
in how we govern the project, so that--we will be changing 
that, too.
    We have not--the big question is, when we go to a next site 
to deploy the system and the next site, under current--under 
previous course and speed, we would be going next to Columbus, 
Ohio, in fairly short order. That decision, I have not yet made 
that, but that is a threshold decision. I anticipate making all 
those decisions and talking to you about the full shape of this 
by the middle of next week, by the 30th.
    We owe you some answers, as you laid out in your opening 
statement, pursuant to statute from last year. We are going to 
live up to that and make sure that we get you the information 
you need immediately on the 30th, but we will maintain a very 
fluid conversation with you on this.
    The last thing I would just say is, one of the reasons I 
really want our deputy who is, you know, still pending here, 
confirmed is, he is the person who will be overseeing this, 
given both the traditional, the deputy in our Department, and 
the statutory requirements that he personally oversee the 
budget. I would love to get him down there soon, so he and I 
can spend some time over the weekend, making sure that we are 
on the same page before we submit all this paperwork to you on 
Wednesday.
    Senator Boozman. Good. We appreciate that. And again, you 
know, the committee is very, very supportive of the project and 
understands how important it is. I think I can speak for all of 
us. And so, like I say, all of this is an effort to help you, 
you know, push forward and, you know, we certainly will do that 
any way we can.
    So thank you, Mr. Chairman.
    Senator Heinrich. No, thank you. And thanks to Secretary 
McDonough, and Mr. Rychalski, and all of our senators for 
participating in today's hearing. I think we all look forward 
to working together to make sure we provide the resources for 
the VA to be able to do its job, and do its job at the best 
possible quality.

                     ADDITIONAL COMMITTEE QUESTIONS

    Finally, I will keep the hearing record open for a week. 
Any committee members who would like to submit written 
questions for the record should do so by 5:00 p.m., Wednesday, 
June the 30th. And we very much appreciate the Department 
responding to them in a reasonable period of time.
    Secretary McDonough. Thank you very much.
             Questions Submitted by Senator Martin Heinrich
    Question. The Department, and particularly the Veterans Health 
Administration, has struggled to address workforce vacancies. VA used 
administrative flexibilities and supplemental appropriations to hire 
staff, which VHA plans to maintain through FY 2023 with base funding.
    What is VA's personnel strategy to address clinical vacancies?
    Answer.As the Nation's largest integrated health care delivery 
system, the Veterans Health Administration's (VHA) workforce challenges 
mirror those of the private health care industry. Demand for clinical 
staff in all health care sectors exceeds the supply of appropriately-
trained health care professionals to meet projected Nation-wide health 
care needs. VHA's strategy is to prioritize clinical vacancies as they 
arise and use all the flexibilities authorized for recruitment and 
retention to attract top talent, including direct and non-competitive 
hiring authorities, competitive pay-setting, recruitment and retention 
incentives, and education loan repayment and scholarships. VA also 
utilizes a host of marketing efforts, including participation in 
recruiting events, award-winning digital and social media marketing 
campaigns and trainee recruitment events to transition VA Health 
Professions Trainees to permanent employment.
    At the end of fiscal year (FY) 2020, VA conducted a position 
validation review resulting in a reduction of vacant positions by more 
than 41%. As of March 31, 2021, there were 32,647 vacant total Full 
Time Equivalents (FTE).\1\ Of those, 16,965 were clinical vacancies in 
VHA. It is important to note that these vacancies do not represent 
staffing gaps or shortages, nor do they represent the true unfunded 
need of the organization or the number of positions that could possibly 
be filled at any given time; instead, they reflect the constantly-
occurring turnover of employees in the organization and funded levels 
of growth in FTE. For example, in response to the Coronavirus Disease 
2019 (COVID-19) pandemic, clinical occupations in VHA grew by 4.2% in 
FY 2020 and have continued to grow by another 1.2% in FY 2021 through 
March 31, 2021, reflecting a total net increase of more than 12,600 
additional clinical staff since the end of FY 2019.
---------------------------------------------------------------------------
    \1\ This count does not include more than 20,000 FTEs that are 
undergoing a position validation review.
---------------------------------------------------------------------------
    Question. How does VA plan to recruit, retain, and train staff in 
regions where they are needed the most, including rural areas?
    Answer. VA has taken great steps to increase access to care for 
rural Veterans. The workforce shortage occupations for rural VA 
facilities are comparable to those of non-rural VA facilities. The 2019 
All Employee Survey found no difference in responses for job 
satisfaction and burnout between employees at rural and non-rural 
facilities. The Office of Rural Health (ORH) and its partners in 
clinical program offices, Workforce Management and Consulting Office 
and the Office of Academic Affiliations (OAA) have created a number of 
initiatives designed to expand the rural workforce and to provide 
training to keep providers in rural health care. These initiatives 
include:

  --Rural Health Training Initiative provides rural clinical training 
        sites for health professions students and clinical residents. 
        Trainees include social workers, nurse practitioners, 
        pharmacists, psychiatrists, optometry students and dental and 
        family medicine residents. The focus is on training 
        professionals at rural sites with the goal of recruiting 
        graduates to rural-serving VA facilities.

  --Rural Interprofessional Faculty Development Initiative provides 
        training for residency proctors, enabling them to train, mentor 
        and monitor residents serving rural areas. Participants who 
        become professional faculty for academic partners have highly 
        regarded this professional development program. This evidence-
        based program impacts job satisfaction for participants, 
        educates trainees in the nuances of rural health care and 
        expands the workforce in participating VA medical centers. In 
        all, this program has provided training for more than 256 new 
        faculty to date. ORH and OAA are working on expanding the 
        program, creating a new cohort in FY 2022.

  --ORH Rural Scholars Fellowship Program provides professional 
        development opportunities for rural VA providers to develop the 
        skills and knowledge needed to lead innovation in rural health 
        care delivery, and ultimately improve recruitment and retention 
        of VA providers in rural facilities serving primary care. This 
        program allows providers to stay onsite in their rural 
        facilities and conduct research and process improvement 
        projects while receiving virtual mentoring from recognized 
        experts.

  --Rural Health Career Development Award Program supports early 
        investigators in developing a research program focused on 
        issues of relevance to rural Veterans and their health care. 
        This award provides protected time, research funding and 
        methodologic guidance to help recipients develop an innovative 
        program of research in rural Veterans' health and help support 
        their overall career development as an independently-funded 
        investigator.

  --Geriatric Scholars Program addresses the shortage of specialized 
        geriatric skills and knowledge in rural VA clinical settings by 
        training VA general clinicians in the treatment of older rural 
        Veterans.

  --Simulation Learning, Education and Research Network Rural 
        Coordinators develop simulation-based training infrastructure 
        to improve rural clinicians' technical skills without leaving 
        their home clinic.

  --Geriatric Research Education and Clinical Center Connect Program 
        trains VA providers to manage medically-complex cases through 
        case-based conferences, electronic consultations, virtual 
        meetings and clinical video telehealth.

  --Extension for Community Health Outcomes (ECHO) programs provide 
        training to VA and some non-VA rural providers in a variety of 
        different areas. Rural participant satisfaction data indicate 
        that this professional exchange of knowledge results in greater 
        job satisfaction among participants. ORH currently partners on 
        three ECHO programs across VHA, including:

    --VA-ECHO Expansion in Specialty Care uses telehealth to train 
            providers in a wide variety of specialties, including 
            treatment for chronic kidney disease, hepatitis C and pain 
            management.

    --National Mental Health and Suicide Prevention ECHO connects rural 
            providers to national mental specialists for regular 
            discussion of clinical cases and targeted skill-building 
            training on suicide prevention and substance use disorder 
            treatment.

    --COVID-19 VA ECHO focuses on COVID-19 care for patient care 
            providers from all disciplines in inpatient, outpatient and 
            residential care settings (also open to community 
            providers).

    Question. After making tremendous progress in reducing the claims 
backlog, it increased significantly over the past year due to the 
pandemic, including challenges in completing medical exams and 
accessing service records, and the inclusion of presumptive eligibility 
for three conditions related to Agent Orange Exposures. The Budget 
requests funding for an additional 429 FTE to address the increase in 
claims.
    What lessons from addressing the Blue Water Navy claims is VA 
applying to the current workload?
    Answer. VA recognizes the criticality of a robust and timely 
evidence supply chain to support qualifying service review, which is 
evident in the reviews of Blue Water Navy claims. VA has aggressive 
plans to digitize personnel and medical records supporting benefits 
determinations before a Veteran or survivor even files a claim. 
Congress provided VA with $150 million in the American Rescue Plan 
(ARP) Act of 2021 to proactively scan National Personnel Records Center 
records. VA and the National Archives and Records Administration (NARA) 
are collaborating to build an on-site scanning capability for this 
effort. VA will provide digital copies of all scanned records to NARA 
to help expedite future requests for records.
    Question. How long will it take VA to work through the backlog and 
return to a normal claims workload?
    Answer. The disability compensation claims backlog is impacted by 
two large claim groups. In April 2021, VA established more than 60,000 
claims for review pursuant to the Nehmer court order and claims 
remaining in the inventory from this group aged into backlog status, 
resulting in more than 42,000 claims entering the backlog in August 
2021. In June 2021, VA also established approximately 70,000 claims for 
review for three new disabilities presumptively linked to Agent Orange 
Exposure by the National Defense Authorization Act, and any unprocessed 
claims from this group were added to the current backlog as of the end 
of October 2021. As of November 4, 2021, there were 260,510 rating 
claims in the backlog.
    Increased receipts, fueled by the expansion of presumptive benefits 
for Gulf War Veterans (which VA began processing in August 2021) and 
typical annual receipt growth, will further impact backlog reduction. 
To mitigate backlog growth, VA is leveraging ARP grants to fund 
overtime to ensure timely claims processing, as well as aggressively 
hiring nearly 2,000 claims processors during FY 2022. Assuming 
continued improvement of the Veterans Benefits Administration's (VBA) 
evidence supply chain (Compensation & Pension examinations and Federal 
records), VA plans to reduce the current claims backlog to 100,000 
claims by mid-FY 2024.
    Any additional expansion in presumptive benefits, without 
commensurate resource increases in FTE, technology and other process 
improvement funding, as well as time to implement such changes, will 
increase the current claims backlog further and reduce timely claims 
decisions for all Veterans.




    Question. How many claims raters will be needed if toxic exposure 
legislation currently under consideration in the Senate is passed?
    Answer. As part of VA's enhanced technical assistance for the 
Comprehensive and Overdue Support for Troops (COST) of War Act of 2021, 
VBA has identified a need for 9,871 FTE in the first year and an 
average of approximately 8,000 FTE over 10 years, after passage. VA 
provided this estimate to the United States Senate on July 30, 2021.
    Question. VA provides for direct health care for tribal veterans 
through partnerships with the Indian Health Service and Tribal Health 
Programs, as well as through VA facilities. As veterans may need to go 
to different facilities for different types of services, coordination 
of care can be challenging. How does VA plan to improve access to care 
for veterans who live in Indian Country, including coordination of care 
with non-VA providers?
    Answer. VA operates the Indian Health Service/Tribal Health 
Programs (IHS/THP) Reimbursement Agreements Program (RAP) which 
improves access to care by reimbursing IHS/THP facilities for direct 
care provided to Veterans. To improve care coordination for Veterans 
who need services beyond what IHS/THP facilities directly provide and 
are referred back to VA, VA established the Healthcare Coordination 
Advisory Board to assist in developing a standardized care coordination 
process. Details of the approach can be found on the IHS/THP RAP 
website under the Care Coordination section. VA has made progress in 
implementing key elements of this effort. VA successfully partnered 
with IHS and THP facilities to expand reimbursement coverage to include 
telehealth through a modification signed by IHS and distributed to 
tribes in late September/early October 2020. VA is currently developing 
and implementing the Community Provider Orders/Standardized Request for 
Service Process, a Nation-wide effort to improve care coordination 
between community providers (including IHS/THP providers) and VA. This 
process and accompanying tools allow for community providers to 
electronically send referrals back to VA. Upon receipt of referrals, VA 
staff will then be able to coordinate the care needed by the Veteran--
either in a VA facility or by a community provider through VA's 
Community Care Network. VA is sharing information about this process 
during training sessions with IHS/THP held as of July 2021 to 
understand their interest in using this approach.
    Question. About half of the States have veterans living in highly 
rural areas, and main obstacles to veterans in these areas obtaining VA 
health care is distance and transportation. VA's Highly Rural 
Transportation Grant Program, which was funded at less than $3.0 
million in FY 2021, is one tool to improve these Veterans access to 
care. How does VA determine the demand for this program, and whether 
the Department is meeting the demand?
    Answer. VA establishes Highly-Rural Transportation Grant Program 
demand through a grant request process by issuing an annual Notice of 
Funding Availability (NOFA) letter. Eligible Veterans Service 
Organizations and state Veterans agencies are responsible for 
submitting grant requests. Demand for the program is gauged by the 
number of requests received in response to the annual NOFA, and future 
budget funding levels are informed by previous years' program demand 
balanced against total funds available for competing priorities.

                                 ______
                                 

              Questions Submitted by Senator Brian Schatz
                             va telehealth
    Question. Does VA's ability to make permanent any of the telehealth 
policies that it adopted during the COVID-19 pandemic rely on the 
current federal public health declaration?
    Answer. During the Coronavirus Disease 2019-declared public health 
emergency, VA providers are authorized to prescribe controlled 
substances following an audio-visual assessment of a Veteran using 
telehealth technologies in the home. Once the public health declaration 
is rescinded, VA will lose this authority. VA has advocated for this 
authority to become permanent through a special registration for 
telemedicine from the Drug Enforcement Administration. A special 
registration for telemedicine is already authorized under Federal law 
in the Controlled Substances Act but has not yet been established (21 
U.S.C. Sec. 831(h)).
    Question. What structural changes does VA need to make so that it 
can institutionalize and expand on the telehealth policies and services 
that it adopted during the COVID-19 pandemic, including with respect to 
the following:

  --Changes to the policies related to VA's electronic medical record 
        and appointment referral system;

  --Changes to the way VA contracts for community care;

  --Changes to the way VA contracts for internal medical care;

  --Changes to the way that VA provides pay retention or other 
        incentives to internal health care physicians and staff;

  --Changes to the way VA establishes standard of care models for its 
        patients;

  --Changes to the equipment and training that VA providers need to 
        deliver care through telehealth; and

  --Changes to the way VA ensures veterans have the ability to acquire 
        tablets or other devices to access telehealth care.

    Answer. The Veterans Health Administration's (VHA) Connected Care 
Strategic Vision builds on VA's strong foundation in virtual care 
delivery and will contribute significantly to enhancing the exceptional 
care that VHA already delivers. Solidifying connected care foundations 
is one of three goals in the strategic vision.
    Connected care foundations are the policies, legal authorities, 
technical infrastructure, equipment and processes on top of which 
connected care services operate. Key foundational goals have already 
been achieved as part of VA's ongoing Anywhere to Anywhere telehealth 
initiative, begun in 2017. These include license portability under 
Federal law for VA health care professionals (VA Maintaining Internal 
Systems and Strengthening Integrated Outside Networks Act of 2018, P.L. 
115-182) and for health professions trainees and other qualified health 
care professionals (National Defense Authorization Act of 2021, P.L. 
116-283). These also include modernization of bandwidth infrastructure 
at community-based outpatient clinics, development of a standard 
platform for telehealth delivery to Veteran homes (i.e., VA Video 
Connect), a system to efficiently grant providers access to one or 
multiple facility medical records, a systematic process to help 
Veterans overcome the digital divide and publication of VA policy for 
cross-facility clinical resource sharing and telework-telehealth.
    As part of its next phase of solidifying connected care 
foundations, VA is focused on:

  --Integrating VA Video Connect scheduling into its front-line 
        Veterans Health Information Systems and Technology Architecture 
        scheduling application and increasing appointment flexibility;

  --Establishing policy authorizing national health care professional 
        telehealth privileging;

  --Enhancing cross-facility scheduling applications to facilitate 
        additional clinical resource sharing from telehealth hubs;

  --Resolving legal barriers to controlled substance prescribing 
        including for substance abuse treatment;

  --Developing a certification program for telehealth support staff 
        inside and outside VA;

  --Enhancing accessibility options in telehealth applications;

  --Integrating required components of VA connected care into Cerner;

  --Developing systems to support provider collaboration across 
        facilities;

  --Adding options to assist Veterans with overcoming the digital 
        divide; and

  --Modernizing and simplifying telehealth equipment.

    As part of its efforts to modernize care delivery, all options to 
enhance VA's connected care foundations, and therefore VA services, are 
being considered. While VA has not yet identified the need for specific 
changes to community care policy, provider pay incentives, standards of 
care or changes to the way Veterans obtain tablets from VA, these could 
become future focus areas.
    Question. Does VA require any new statutory authority to make any 
of the structural changes identified above?
    Answer. Legislative changes are needed to resolve barriers to 
controlled substance prescribing, including for substance abuse 
treatment. VA would appreciate engagement with Congress regarding 
authorities for prescribing controlled substance(s) via telehealth.

                                 ______
                                 

              Questions Submitted by Senator John Boozman
    Question. Since Congress passed the 21st Century IDEA [Integrated 
Digital Experience Act], the nature of how individuals engage with 
government has fundamentally changed-in large part because of the 
coronavirus pandemic. These changes underscore an even stronger need to 
implement the 21st Century IDEA and allow federal agencies to deliver 
an excellent customer experience from anywhere, to anyone, on any 
device.
    Has the Department of Veterans Affairs fully implemented the 21st 
Century IDEA Act (Public Law No: 115-336)?
    Answer. The breadth of services, transactions and content available 
to Veterans on VA.gov is extremely large, and despite not fully 
implementing the 21st Century Integrated Digital Experience Act (IDEA), 
we have made great progress. VA has been working to modernize and 
consolidate various tools into an enterprise-wide self-service platform 
accessible from a single place: VA.gov. The new VA.gov launched in 
November 2018, and it now serves as the primary front door to VA.
    The site-wide navigation, on VA.gov web pages, allows users to sign 
in or search VA.gov, and just below that on the homepage are the top 
tasks Veterans told VA are the most important to them--representing 
over 80% of the tasks users visited VA.gov to accomplish. The 
modernized pages are all compliant with section 508 of the Americans 
with Disabilities Act. Since relaunch, the Customer Satisfaction Score 
for all VA.gov websites (including both modernized and legacy pages) 
rose from 52.9% to 67.9 % (a 28% increase).
    In order to continue to align VA's digital experience with our 
users' expectations--and to meet the goals put forth by the 21st 
Century IDEA--VA has placed a major focus on modernizing our digital 
experience. Our Agency digital strategy has three primary goals: 1) 
increase the use of self-service tools; 2) enable faster access to care 
and more timely delivery of services; and 3) improve customer 
experience and reliability on VA's online services. VA has continued to 
make progress on these goals throughout 2021, even as we continue to 
create new digital experience capabilities to support VA's Coronavirus 
Disease 2019 pandemic response that began in March 2020.
    Question. What barriers has the VA faced in implementing this law 
and modernizing its digital services?
    Answer. The process to modernize VA's inventory of forms and 
digital services is driven by the demands and priorities of the Office 
of Information and Technology's business partners. The Department 
provides hundreds of benefits, with forms to enable Veterans to apply 
for each and in many cases, online tools to help track and manage both 
the application as well as the benefit itself.
    Question. The final FY21 MilConVA Appropriations bill included 
report language and funding direction for the VA to implement Section 4 
of PL 115-336 ``21st Century IDEA,'' which required that no later than 
two years after the date of enactment, each executive agency was 
required to digitize and ensure any paper-based form was made available 
to the public in a fully usable mobile friendly option.
    Who is responsible inside VA for ensuring the agency fully 
implements PL 115-336?
    Answer. The Digital Experience product line, within the Office of 
the Chief Technology Officer, is charged with executing VA's Digital 
Modernization Strategy. This includes initial and ongoing efforts to 
implement the 21st Century IDEA.
    Question. Where does the VA stand in ensuring its forms can be 
filled out and submitted electronically on all common, digital devices?
    Answer. Currently, there are approximately 500 public-facing forms 
available on VA's web properties. This number varies as forms are 
added, removed or expire. Additionally, many VA medical centers create 
and manage their own forms in a decentralized fashion, adding to and/or 
subtracting from that overall total. All public-facing customer VA 
forms are currently accessible online as fillable Portable Document 
File forms. Those can be completed digitally, printed and then 
submitted to VA by mail, fax or in-person. Approximately 20 of VA's 
most used forms can be completed and submitted through an online 
wizard. These comprise about 350,000 submissions per month. All of VA's 
digital online experiences are compliant with section 508 and conform 
to both the Privacy Act and the Paperwork Reduction Act. VA is working 
to ensure that all digitized forms meet these standards.
    VA is also working to identify and prioritize the digitization of 
paper forms and non-digital services that are highly utilized by 
Veterans. On VA.gov today, over 40% of traffic comes from mobile users, 
so introducing new forms and services that are secure and mobile-
responsive will not only allow us to better connect with our users and 
have a greater impact on their lives, but it will also help VA achieve 
cost savings and workflow efficiencies.
    Question. For more than ten years, VA has successfully provided 
timely access to high quality dialysis services through community 
providers under the Nationwide Dialysis Services contracts when VA 
cannot directly provide such care. What factors have changed to trigger 
consideration of changing contracts which has been successful in 
providing care to these vulnerable veterans?
    Answer. VA's Office of Community Care implemented the next 
generation of Veteran Community Care in fiscal year 2020 with the 
Community Care Network (CCN) roll out. As of today, CCN is operational 
across the United States and will soon be operational in the Outer 
Pacific Islands. With this implementation, previous Community Care 
contracts began to sunset. The National Dialysis Services Contract 
(NDSC), which had been VA's previous community Dialysis Program, also 
began the sunset process for some contracts. However, nine NDSC 
contracts will be renewed for another year. NDSC was a successful 
program, but it did not encompass the full spectrum of dialysis care--
for example, nephrologist oversight and Acute Kidney Injury (AKI) were 
not covered. Under the new CCN contracts, End Stage Renal Disease, 
nephrologist oversight and AKI can be managed by the same Contractor's 
in-network provider base.

                                 ______
                                 

        Questions Submitted by Questions Senator Mitch McConnell
                  louisville va medical center (vamc)
    Question. As you know, Kentucky veterans have been waiting for a 
new VA medical facility in Louisville since 2006. Please provide an 
update on the new Robley Rex Louisville VAMC, including the expected 
timeline for construction and when the hospital will begin serving the 
region's veterans.
    Answer. On August 17, 2021, the United States Army Corps of 
Engineers awarded the base construction contract to Walsh Turner Joint 
Venture II (located in Chicago, Illinois) for construction of the new 
Robley Rex Louisville VA Medical Center. At this time, construction 
completion is scheduled for winter 2025, with the Beneficial Occupancy 
Date of winter 2026.
    Question. The VA's budget includes an additional $93 million for 
this project to address increased costs stemming from project delays. 
Please provide an explanation of these costs, as well as the potential 
for additional funding needed to complete the project.
    Answer. Of the budgeted $93 million requested for fiscal year (FY) 
2022, $51 million is for cost escalation associated with a 2-year 
solicitation delay (at approximately 3.8% per year) due to the lawsuit 
by the Crossgate community over VA's compliance with the National 
Environmental Policy Act. VA prevailed in spring 2021. The remaining 
$42 million of the $93 million is for cost escalation and additional 
contingency funds associated with executing contract options that will 
not be awarded for 12-18 months after the base contract award.
    Question. Can you please detail how the new Louisville VAMC will be 
specifically equipped to provide state-of-the-art health services to 
female veterans?
    Answer. To specifically address the needs of our women Veterans, 
the new hospital will include a Women's Health Clinic with four Patient 
Aligned Care Teams (PACT). The clinic will include a dedicated 
reception and waiting area, gynecology examination rooms with private 
restrooms, general examination rooms, telehealth examination rooms, 
PharmD consultation/examination, behavioral health consultation, 
nutritional consultation, phlebotomy laboratory, procedure room with a 
private restroom and an imaging suite. The imaging suite will include 
equipment for comprehensive women's health care including Ultrasound, 
Bone Densitometry and Mammography. In addition, the Women's Health 
Clinic will have dedicated support space for all assigned staff. For 
cases in which a woman Veteran would like to see a provider not 
specifically assigned to the Women's Health Clinic, all other PACT 
modules include gynecology examination rooms with private restrooms.
                              rural health
    Question. Will you provide information on the VA's plans to improve 
access to health care for Kentucky's rural veterans?
    Answer. The Office of Rural Health, in collaboration with other VA 
program offices, plans to maximize high-quality virtual care options 
for Kentucky's rural Veterans by continuing its efforts to increase 
access to health care by providing opportunities for the delivery of 
health care services to rural Veterans through funding the following 
initiatives: Telehealth Clinical Resource Hubs, Pharmacist Providers 
for Rural Veterans with Opioid Use Disorder, VA Maintaining Internal 
Systems and Strengthening Integrated Outside Networks Act Emergency 
Room Specialty Care Scribe Program, Women Veteran Care Coordination and 
Management Program, Veteran Transportation Services and Telehealth 
Equipment Modernization efforts, all delivered via telehealth, in-home 
or in-clinic. VA will continue to expand our telehealth partnerships 
with community partners and create strong partnerships to utilize 
available facilities and resources to better serve rural Veterans, 
their families and the communities where they live. Additionally, VA's 
Community Care Network will provide a direct link with community 
providers when needed that will ensure VA provides the right care, at 
the right time, to Veterans.
    Question. What are the VA's plans to expand telehealth options for 
rural veterans who lack reliable access to the internet?
    Answer. VA has established a 5-year strategic vision for connected 
care which will enhance Veteran digital engagement, deliver health care 
without walls, sustain and increase capacity in rural and highly rural 
locations and solidify VA's connected care foundations. The strategy 
includes initiatives that will enhance the accessibility of VA health 
care in rural areas by delivering enhanced video telehealth care in the 
home using VA Video Connect and VA-provided examination peripherals 
(e.g., digital stethoscopes, blood pressure cuffs, pulse oximeters, 
thermometers, etc.). The strategy also includes continued focus on 
expanding the capacity of VA services in rural and underserved areas by 
distributing clinical resources using telehealth through clinical 
resource hubs and other virtual health care delivery initiatives. 
Services that will be distributed include inpatient services such as 
tele-critical care; high-volume outpatient services such primary care 
and mental health; and low volume, highly-specialized services such as 
stroke neurology. Additionally, the strategy supports expanding remote 
patient monitoring capabilities, allowing rural and highly-rural 
Veterans to attentively monitor and manage chronic health conditions, 
in partnership with VA, from their homes.
    As part of its vision to deliver trusted VA care, anytime and 
anywhere, VA will continue efforts to bridge the digital divide for 
Veterans who lack the technology or broadband internet connectivity 
required to participate in VA telehealth services irrespective of their 
location in the country. Central to this effort, VA has implemented a 
national digital divide consult process in the electronic medical 
record. Through this process, qualifying Veterans can obtain an 
internet-connected device from VA or assistance in applying for Federal 
Communications Commission (FCC)-administered internet subsidies. The 
FCC subsidies are available through the Lifeline and Emergency 
Broadband Benefit (EBB) programs. The Lifeline and EBB programs can 
combine to provide many qualifying Veterans up to $59.25 per month for 
their internet services. Veterans on tribal lands can receive up to 
$109.25 through these programs. VA has completed over 49,500 digital 
divide consultations since the beginning of FY 2021 and has distributed 
more than 84,000 internet connected tablets since the start of the 
pandemic. Additionally, VA has worked with major wireless carriers such 
as Verizon, T-Mobile, SafeLink by Tracfone and AT&T to support 
Veterans' access to VA telehealth services through Zero Rating the 
telehealth platform VA uses to deliver telehealth to the home. Zero 
Rating this platform allows Veterans, their families and caregivers to 
use VA Video Connect with fewer worries about data fees.
    VA will also continue enhancing existing telehealth infrastructure 
at community-based clinics serving rural and highly-rural parts of the 
country. Clinical video telehealth visits, with full remote examination 
capabilities, allow Veterans to receive specialty care services at 
their closest clinic, even if the specialist is elsewhere in the VA 
system. This supports care in rural areas, even where affordable 
broadband is not readily available in the community.
    VA is also evaluating the opportunity to leverage community-based 
telehealth access points through its Accessing Telehealth through Local 
Area Stations (ATLAS) pilot program. ATLAS is a pilot designed to 
bridge the digital divide and reach rural and underserved Veterans in 
areas with limited access to broadband and health care. Through this 
initiative, VA is teaming up with Philips, Walmart, Veterans of Foreign 
Wars and The American Legion to provide convenient locations within 
Veterans' communities equipped with the broadband and telehealth 
technology necessary to access VA health care. Walmart has provided 
space within their health services room as well as equipment, while 
Philips designed unique and private spaces equipped with state-of-the-
art telehealth equipment within Veterans Service Organizations. VA 
currently has 12 ATLAS locations nationally that are open and available 
for scheduling. By the end of 2021, it is anticipated that a total of 
13 ATLAS sites will offer clinical services by telehealth from VA 
providers.
                             mental health
    Question. Will you provide an update on the VA's efforts to improve 
veterans' access to mental health care services, including through the 
implementation of the President's Roadmap to Empower Veterans and End a 
National Tragedy of Suicide (PREVENTS) and the Commander John Scott 
Hannon Veterans Mental Health Care Improvement Act (P.L. 116-171)?
    Answer. The Veteran Wellness, Empowerment and Suicide Prevention 
Task Force under the President's Roadmap to Empower Veterans and End a 
National Tragedy of Suicide (PREVENTS) Task Force was formed as a 
result of Executive Order 13861, signed on March 5, 2019, with a call 
to action to amplify and accelerate the progress in addressing Veteran 
suicide in the United States. On June 17, 2020, the Task Force released 
PREVENTS, which contains recommendations for a federally-coordinated 
national public health strategy to address Veteran suicide.
    In FY 2021, the PREVENTS national public health campaign called 
Reach, Engage, Attend, Connect, Help (REACH), has garnered 
approximately 5.7 billion impressions since it was launched in July 
2020. The REACH website, https://www.reach.gov, has been visited more 
than 12 million times and PREVENTS-produced public service 
announcements have had nearly 1.3 million views. In March 2021, 
PREVENTS launched the How We R.E.A.C.H. Coaching Tool to teach people 
how to ``reach out'' to help someone in need. In 1 month, the Coaching 
Tool was downloaded more than 1,600 times and its accompanying 
application nearly 900 times. More than 16,000 individuals signed an 
online pledge to help increase awareness of mental health challenges 
and suicide prevention practices. These efforts demonstrate the 
efficacy of PREVENTS contributions to VA's collective efforts to 
improve Veterans' access to mental health care services.
    Paid media is a critical component of any national public health 
campaign. In FY 2021, paid media was implemented through a variety of 
media platforms, including social media, television, radio, digital 
content (such as news websites) and online media streaming services 
(e.g., Pandora and Spotify). Paid media also included running public 
service announcements in communities that have had high rates of 
Veteran suicide, and during programming that is watched, listened to or 
visited by targeted audiences as well as during events or activities 
attended by Veterans (e.g., the Army/Navy football game). In FY 2022, 
PREVENTS communications will continue to target Veterans at risk for 
suicide and people in their communities to get them the resources they 
need to prevent suicide with a goal of decreasing risk factors and 
increasing prevention factors, particularly lethal means safety. VA 
will also be evaluating the campaign to see what is effective in 
driving exposure, awareness and engagement, and we will adjust efforts 
as needed. All of this will be done in coordination with other VA 
suicide prevention initiatives and programs to ensure public health 
campaign communications are appropriately aligned and research is 
informed. VA will also collaborate with others to carry the public 
health campaign message forward when the PREVENTS Task Force terminates 
on June 17, 2022.
    Implementation of the Commander John Scott Hannon Veterans Mental 
Health Care Improvement Act (P.L. 116-171) continues to move forward. 
Prior to the President signing the legislation into law, VA established 
a team within the Office of Mental Health and Suicide Prevention to 
oversee implementation. Each section was assigned a primary Point of 
Contact who is responsible for ensuring all actions in that section are 
completed. All Congressionally-mandated reports due to date have been 
submitted on time. A series of White Papers on each section, along with 
responses to any questions or concerns needing clarification from 
Congress, have been provided to the staff of the House Committee on 
Veterans' Affairs (HVAC) and Senate Committee on Veterans' Affairs 
(SVAC). VA continues to brief HVAC and SVAC on a regular basis (last 
briefings were completed July 1 and July 6, respectively). Development 
and implementation of the Staff Sergeant Parker Gordon Fox Suicide 
Grant Program (section 201) and the Readjustment Counseling Service 
Scholarship Program (section 502) continue to make exceptional 
progress. Regarding section 502, the proposed regulation has been 
reviewed and approved by VA's Office of General Counsel (OGC). The 
Office Management and Budget (OMB) has determined that the Secretary 
can sign the proposed rule for publication in the Federal Register 
without full OMB review, which is anticipated to result in expediting 
the scholarship award cycle.
                            toxic exposures
    Question. I have heard from Kentucky veterans who were exposed to 
contaminated water while stationed at Marine Corps Base Camp Lejeune 
between 1953 and 1987. What steps has the VA taken to provide resources 
and information on benefit eligibility to veterans and their family 
members who may suffer from medical conditions caused by toxic exposure 
at Camp Lejeune?
    Answer. On March 14, 2017, VA effectuated 38 C.F.R. 
Sec. 3.307(a)(7) to address the presumption of service connection for 
certain conditions associated with exposure to contaminants in the 
water supply at Camp Lejeune. The rule allows Service members with 
records demonstrating no less than 30 days of service (either 
consecutive or cumulative) at Camp Lejeune during the specified 
timeframe, and who have been diagnosed with any of the eight 
presumptive diseases, to be presumed to have a service-connected 
disability for purposes of entitlement to VA benefits. The rule applies 
to all military Active Duty, Reserve and National Guard personnel who 
meet the requirements of the regulation. To address community concerns 
and provide information, VA has held joint community meetings, 
partnering with the Department of Defense (DoD), on Camp Lejeune. 
Further, VA provides resources and information to the public regarding 
benefit eligibility through its website at Camp Lejeune water 
contamination health issues. Veterans and survivors may also call the 
benefits toll-free hotline at 1-800-827-1000 to speak directly with a 
VA employee, who may assist with benefit eligibility questions.
    The Agency for Toxic Substances and Disease Registry held Community 
Assistance Panel (CAP) meetings for 15 years. These quarterly meetings 
included large public meetings and CAP board member meetings, and VA 
attended these meetings. These meetings were online and in person, as 
they were held before the onset of the Coronavirus Disease 2019 (COVID-
19) pandemic. VA discussed the programs available for both Veterans and 
family members. VA answered an average of 200 individual questions for 
these meetings. VA placed posters (electronic and/or paper when 
available) in VA medical centers and clinics. VA prepared and conducted 
training regarding Camp Lejeune exposures for its health care providers 
and Compensation and Pension examiners. This was also available to 
civilian providers via a platform called the TrainingFinder Real-time 
Affiliate Integrated Network, or better known as TRAIN. VA newsletters 
have featured articles about Camp Lejeune and benefits available to 
Veterans and family members.
    If one searches the term Camp Lejeune programs online, the first 
items to appear are VA's Public Health website at https://
www.publichealth.va.gov/exposures/camp-lejeune/index.asp, which covers 
Camp Lejeune questions and offers resources. VA's Community Care 
website also offers information regarding Camp Lejeune at: https://
www.va.gov/COMMUNITYCARE/programs/dependents/CLFMP.asp. There are many 
civilian, advocacy and law firm websites that reiterate VA benefits 
when searched. VA coordinates with DoD mailings to those on the DoD 
Camp Lejeune rosters about VA benefits. DoD has also placed full-page 
advertisements in newspapers across the country to discuss the benefits 
available.
    Question. What statutory limitations, if any, prevent the VA from 
efficiently accessing the Department of Defense records needed to 
provide benefits or establish service connections for diseases related 
to toxic exposures, both at Camp Lejeune and elsewhere?
    Answer. 38 U.S.C. Sec. 320 codified the VA-DoD Joint Executive 
Committee, which is, in part, tasked with providing recommendations to 
both Secretaries about the strategic direction for the joint 
coordination and sharing efforts between and within the two 
Departments.
    DoD and VA have worked together extensively since at least 2011 on 
exposure-related issues. Regarding Camp Lejeune drinking water 
contamination, the United States Marine Corps supported VA by providing 
computerization of millions of personnel and housing records of 
Veterans. Other efforts include the development of the Individual 
Longitudinal Exposure Record (ILER), a web-based application that will 
reference multiple data sources to create the exposure record for 
Service members. ILER will provide medical providers with an available 
exposure record, support VA clams processing for claims due to in-
service environmental exposures and have other functions and benefits.
    Question. Veterans dealing with health conditions due to service-
related toxic exposures need timely access to life-saving VA benefits. 
Once scientific research has identified a connection between a disease 
and a toxic exposure, what steps does the VA take to ensure decisions 
regarding service connections are made and implemented quickly?
    Answer. Once rulemaking is complete, VA will develop procedures and 
training curriculum to deploy to claims processors, as well as make any 
required system updates to allow for processing of the condition(s). 
This will include any needed updates to the Veterans Benefits 
Management System. The scope of training will be dependent on the 
number of impacted Veterans and scale of expected receipts; therefore, 
training may be deployed to a subset of claims processors at a limited 
number of sites or to all claims processors. Additionally, for efforts 
with larger numbers of expected receipts, VA is likely to request 
additional resources in future budgets or supplemental requests to 
ensure timely claims processing.
                          veteran homelessness
    Question. Will you provide an update on the permanent supportive 
housing project in Lexington, Kentucky, which became operational in 
fiscal year 2020? How many veterans are currently being served through 
this enhanced-use lease project?
    Answer. The Victory Point Apartments and Townhomes supportive 
housing enhanced use lease project in Lexington, Kentucky, received its 
first Certificate of Occupancy on May 6, 2020. The 50 units of 
permanent supportive housing currently have 26 Veteran and 24 non-
Veteran residents.
    Question. Will you provide an update on how the VA is meeting the 
specific needs of female veterans who are homeless or at risk of 
homelessness?
    Answer. The national VA Homeless Program Office (HPO) provides a 
full spectrum of services designed to meet the unique needs of all 
Veterans, including women Veterans who are at-risk of or who are 
experiencing homelessness. These services include clinical outreach, 
treatment, transitional housing, supportive services and permanent 
housing. VA's efforts are enhanced by harnessing the strength of 
community providers in coordination with VA health care and benefits. 
In FY 2020, including all homeless services provide under HPO, over 
32,700 unique women Veterans were served. In 2021, HPO conducted an 
analysis to identify potential gaps in services provided by VA homeless 
programs for women Veterans experiencing or who are at-risk for 
homelessness. Results from this analysis show that there are no 
significant gaps in service delivery, outcomes and Veteran 
satisfaction, and to the extent possible, VA is meeting the needs of 
homeless and at-risk women Veterans.\2\ Additionally, the Johnny 
Isakson and David P. Roe, M.D. Veterans Health Care and Benefits 
Improvement Act of 2020 (P.L. 116-315) provides VA homeless programs 
with flexibilities to address identified gaps, as detailed in the 
summary below.
---------------------------------------------------------------------------
    \2\ A detailed review of data for corresponding findings will be 
provided in a Congressionally Mandated Report (CMR) titled ``Gap 
Analysis of Department of Veterans Affairs Programs that provide 
assistance to women Veterans who are homeless.'' The CMR is currently 
in concurrence for clearance and pending submission to Congress.
---------------------------------------------------------------------------
    Population Comparison: As of FY 2020, women Veterans represented 
8.4% of the overall homeless Veteran population and 38.5% of women in 
the general homeless population. Since 2017, the number of homeless 
women Veterans decreased, while the number of homeless women in the 
general homeless population increased. Women were equally represented 
among the Veteran population (8.9%) and the homeless Veteran population 
(8.7%); however, women Veterans comprised 11.5% of all Veterans served 
by VA homeless programs. These data demonstrate that VA homeless 
programs successfully reach women Veterans experiencing or who are at-
risk for homelessness and are providing services designed to resolve 
their housing needs.
    Homeless and At-Risk Veterans Served by VA Homeless Programs: A 
demographic overview shows VA homeless programs provide a wide variety 
of services to meet the diverse needs of the homeless population. This 
analysis identified gender gaps in service engagement, which are 
attributed to the often unique service needs and family composition of 
women Veterans. Specifically, homeless and at-risk women Veterans are 
more likely than men Veterans to have children in their custody and 
require additional services and resources to accommodate dependents. 
Additionally, many congregate living settings, like VA's residential 
treatment programs, are mostly populated by men, with women as the 
extreme minority. These congregate settings have limited designated 
space available for women, such as separate living and bathroom 
facilities. Traditionally, women Veterans are more likely to utilize 
services that provide independent housing options such as housing 
subsidies for an apartment/house or temporary shelter in a private 
hotel. As a result, women Veterans have a higher rate of admission to 
the Department of Housing and Urban Development-VA Supportive Housing 
(HUD-VASH), Supportive Services for Veteran Families (SSVF) Prevention 
and SSVF Rapid Re-housing (RRH) programs than to programs more 
congregate in nature. VA's residential treatment Grant and Per Diem 
(GPD) program serves approximately 50% less women Veterans than HUD-
VASH, SSVF or RRH. It should be noted that the Johnny Isakson and David 
P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020 
(P.L. 116-315 Sec. 4204) provides that in cases of a homeless Veteran 
who has care of a minor dependent, GPD must pay, in addition to the 
daily cost of care of the eligible Veteran, an amount that equals 50% 
of the daily cost of care for each minor dependent.
    We expect that this ability to pay for care for dependents will 
make GPD a more viable option for women Veterans with minor dependents 
and should increase the percentage of women served in GPD as time goes 
on. Within HUD-VASH, there is a significant difference in service 
utilization when comparing rates of program entry among women and men 
Veterans with children, with close to 30% more women with children 
entering HUD-VASH compared to men with children. In SSVF and RRH, there 
are no significant differences in admission rates for this cohort. 
Beyond the specified limitations of programs offering congregate living 
settings, no significant gender gaps in homeless program service 
provision or access were identified in this analysis.
    VA Homeless Program Outreach: VA's Health Care for Homeless 
Veterans (HCHV) program provides outreach and case management services 
to at-risk and homeless Veterans. Women Veterans received more outreach 
contacts proportionally than what they represent in the homeless women 
Veteran population (10.9% of all outreach contacts were with women 
Veterans, compared to the 8.4% of women represented in the homeless 
Veteran population). This demonstrates that VA is actively reaching out 
to women Veterans experiencing homelessness to ensure equitable access 
to services. No significant gender gaps in outreach services were 
identified in this analysis.
    VA Homeless Program Referrals: VA homeless programs receive 
referrals from community partners, self-referrals from Veterans and 
other VA services. Self-referrals from Veterans can come through the 
National Call Center for Homeless Veterans (NCCHV), which provides a 
24-hour/7-day-a-week hotline for Veterans seeking housing services. 
There were no significant gaps in referrals generated through NCCHV 
when comparing men and women Veteran callers. While men represented 
higher numbers of calls to NCCHV, a slightly higher proportion of Women 
Veterans had a service provider visit within 90 days of reaching out to 
NCCHV. Veterans receiving care across VA health care settings complete 
an annual Homeless Screening Clinical Reminder (HSCR), which is a brief 
screening to determine if a Veteran needs assistance with housing. 
While men represented higher numbers of positive HSCRs, they also had a 
slightly higher proportion of subsequent visits with a VA service 
provider within 90 days of being screened. No significant gender gaps 
in referrals and service provision from these two main referral sources 
were identified in this analysis.
    SSVF has innovative features that allow its grantees to address the 
needs of women and in households where women were head of household. 
These features, described below, have allowed SSVF to serve 
significantly more women Veterans than would be expected as women 
currently represent 8.4% of the homeless Veteran population but 13% of 
Veterans served by SSVF in FY 2020.

  --SSVF can offer families temporary child-care, thereby providing 
        opportunity for women Veterans with children to seek employment 
        and needed medical and mental health care.

  --SSVF offers additional assistance to those fleeing domestic 
        violence. This provision allows the full range of SSVF 
        services, including financial assistance, to be offered to 
        victims of domestic violence whether they are Veterans or the 
        victim of violence in a Veteran's household.

  --SSVF is unique in that it can directly serve all household members, 
        including dependent children, of homeless and at-risk Veterans. 
        As women are often the primary caretakers for a family's 
        dependent children, this feature of SSVF is critical to meeting 
        the needs of these women Veterans.

  --SSVF is currently working with communities across the country on a 
        national initiative that seeks to help at-risk Veteran families 
        avoid homelessness through family reunification. By training 
        staff on mediation techniques, supported by limited financial 
        assistance, SSVF seeks to work with families and friends to 
        prevent the trauma of homelessness.

  --If a Veteran is separated from their family for any reason 
        (including discord, hospitalization, incarceration or other 
        forms of institutionalization), services can be maintained and 
        provided to the Veteran's family members for up to 1 year.

    VA Homeless Programs Outcomes: There were no significant gender 
gaps in outcomes for women Veterans served in VA homeless programs, and 
overall, women had better outcomes compared to men. Across all 
programs, women had higher rates of permanent housing placements and 
lower rates of negative program exits. Women were more likely than men 
to exit HUD-VASH case management with a voucher at exit. Women Veterans 
were also more likely than men to have full or part-time employment at 
exit, except in the GPD program, where women and men were equally 
likely to have full or part-time employment at exit. Finally, apart 
from the Health Care for Homeless Veterans Contract Residential 
Services/Low Demand Safe Haven (HCHV CRS/LDSH) programs, women Veterans 
had higher rates of income and non-cash benefits at exit than men, with 
slightly lower proportions of women exiting HCHV CRS/LDSH having income 
and non-cash benefits at exit.
    Veteran Satisfaction: VA's two primary satisfaction surveys reveal 
that both women and men Veterans reported similarly high levels of 
satisfaction with VA services. Over 90% of women and men agreed that 
the services they received met their expectations and needs, and over 
95% of women and men were satisfied with the overall services they 
received. In 2019, three of the top five Veteran-met needs were the 
same for homeless women and men Veteran respondents: Medical Services, 
Medication Management and Tuberculosis Testing and Treatment. Of the 
unmet Veteran needs in 2019, three of the top five were the same for 
homeless women and men Veteran respondents: Legal Assistance to Expunge 
a Criminal Record, Legal Assistance for Credit Issues/Debt Collection 
and Tax Issues. It should be noted that under section 5105 of the 
Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits 
Improvement Act of 2020, VA must enter into one or more agreements with 
public or private entities to provide legal services to women Veterans. 
As of this report, HPO has identified communities with the most 
pronounced indications of unmet need for legal services among homeless 
women Veterans and is conferring with OGC regarding the potential for 
new or expanded partnerships with legal service providers in these 
communities as a result of this legislation. No significant gender gaps 
in reported satisfaction with VA homeless programs and services between 
men and women served were identified in this analysis.
    Question. Will you provide an update on how the VA is meeting the 
specific needs of rural veterans who are homeless or at risk of 
homelessness?
    Answer. The Veterans Benefits Administration's (VBA) Veterans 
Transportation Program (VTP) offers Veterans many travel solutions to 
and from their VA health care facilities at little or no cost to 
eligible Veterans. VTP provides safe and reliable transportation to 
Veterans who require assistance traveling to and from VA health care 
facilities and authorized non-VA health care appointments. In addition, 
the VHA Office of Connected Care's ATLAS service is part of VA's 
Anywhere to Anywhere telehealth initiative, which sets out to better 
serve the nearly 9 million Veterans who receive care through VA no 
matter where they are. ATLAS has teamed up with public and private 
organizations to enhance underserved Veterans' access to VA health care 
by offering them convenient locations to receive VA care closer to 
home. This new option reduces obstacles such as long travel times to 
appointments and poor internet connectivity at home.
    HPO provides a full spectrum of services designed to meet the 
unique needs of all Veterans, including the needs of rural Veterans who 
are homeless or at risk of homelessness. VA's efforts are enhanced by 
harnessing the strength of community providers in coordination with VA 
health care and benefits.

  --Grant and Per Diem: GPD's grant funding decisions consider a 
        variety of factors including geographic dispersion. When funds 
        are made available for a grant or per diem award under 38 
        C.F.R. part 61, VA will publish a Notice of Funding 
        Availability in the Federal Register. The notice will state any 
        priorities for or exclusions from funding to meet the statutory 
        mandate of 38 U.S.C. 2011, to ensure that awards do not result 
        in the duplication of ongoing services and to reflect to the 
        maximum extent practicable appropriate geographic dispersion 
        and an appropriate balance between urban and non-urban 
        locations. In this way, GPD promotes equity and is responsive 
        to the needs of communities. GPD continues to work to support 
        communities in need, such as rural communities, as they work to 
        end homelessness among Veterans by providing transitional 
        housing resources for use by Veterans experiencing or at risk 
        of homelessness.

  --Supportive Services for Veteran Families: Through the SSVF program, 
        generally, grantees may use a maximum of 40% of the temporary 
        financial assistance to provide homeless prevention assistance 
        to those most at risk of becoming homeless. However, this 
        requirement has been waived for the duration of the COVID-19 
        health emergency. SSVF recognizes that rural areas often lack 
        the shelter capacity to meet local needs and therefore, rural 
        Veterans are more likely to be in temporary housing 
        arrangements that qualify only as prevention. To address this 
        unique feature of rural communities, SSVF allows rural grantees 
        to apply for a waiver to this 40% prevention spending limit. 
        Additionally, when selecting applicants to receive supportive 
        services grants, VA will, ``[t]o the extent practicable, ensure 
        that supportive services grants are equitably distributed 
        across geographic regions, including rural communities and 
        tribal lands.'' 38 C.F.R. Sec. 62.23(d).

  --HUD-VA Supportive Housing: Approximately 9% of Veterans housed with 
        HUD-VASH vouchers live in rural or highly-rural areas. These 
        Veterans often require additional or modified case management 
        services to accommodate their remote locations. Even prior to 
        the challenges posed by the global COVID-19 pandemic, the 
        national HUD-VASH program office had encouraged facility-level 
        programs to adopt telehealth as a means to ensure Veterans were 
        able to access adequate case management supports.

  --Tribal HUD-VASH: Serves American Indian/Alaska Native Veterans (AI/
        AN) within the tribe's service area. HUD provides the grant 
        funding for rental assistance, administered by the tribe or 
        tribally-designated housing entity grantee, and VA provides the 
        case management and supportive services to enrolled AI/AN 
        Veterans. There are currently 26 tribes participating in the 
        program. Tribal HUD-VASH has case managers who travel to the 
        grantee's reservation or tribal areas to provide outreach to 
        homeless Veterans and Veterans at risk of homelessness. The 
        program has been developed to specifically address the unique 
        aspects of homelessness in tribal communities. Throughout the 
        pandemic, some of the tribal grantees have closed their borders 
        to non-tribal persons but made an exception for VA staff. These 
        tribes expressed their support for VA tribal HUD-VASH staff as 
        VA brings services to Veterans, instead of Veterans having to 
        travel to services. VA staff aided tribal members with 
        individual contacts, VA Video Connect (VVC) or other virtual 
        telehealth-type meetings, and through contactless delivery of 
        goods such as food, clothing and masks. VA was able to lend 
        smart phones with data plans to Veterans who did not have these 
        resources and assisted Veterans with use of the devices to 
        allow them to complete VVC meetings or to at least connect by 
        telephone if the Veteran was not comfortable using video 
        technology. Staff provided support and assistance to Veterans 
        who were experiencing significant losses of family, friends and 
        cultural connections due to the pandemic.

  --Homeless Patient Aligned Care Teams (HPACT): The HPACT program is 
        committed to addressing the physical, mental health and social 
        needs of all Veterans experiencing homelessness or at risk of 
        homelessness including those residing in rural and highly-rural 
        areas. Work is focused on the expansion of HPACT sites and 
        services to provide optimal health to rural Veterans through 
        utilization of extensive outreach, engagement and telehealth to 
        increase access to care. Many HPACTs offer some form of 
        outreach and engagement including health assessment, health 
        education, medication prescriptions and referrals to homeless 
        programs or other needed VA services. Additionally, telehealth 
        services, such as VVC, enhance access and allow Veterans to 
        receive additional services when indicated.

                                 ______
                                 

             Questions Submitted by Senator Lisa Murkowski
    Question. I appreciate that the Department is increasing its 
request for suicide prevention initiatives to $598 million dollars. A 
92% increase is an impressive ask and I believe that it indicates that 
you are making a serious commitment to provide support to our nations 
veterans who are facing desperate situations, and you have my 
wholehearted support in doing so. In 2019 and the wake of a tragic 
cluster of suicides, the U.S. Army at Fort Wainwright in Fairbanks, 
Alaska completed an in-depth Behavioral Health Epidemiological 
Consultation that identified several actions they could take to try and 
reduce suicide among active duty service members. Despite the Army's 
serious commitment to implementing these changes, we have not seen a 
significant decrease in suicides. I am worried that this may happen at 
the VA, where we continually appropriate money at the problem but don't 
see improvement in the situation.
    What is different about this year's suicide prevention portion of 
the budget request that will justify such a large ask?
    Answer. There are four primary programmatic areas that account for 
the suicide prevention budget increase: 1) Veterans Crisis Line's (VCL) 
implementation of 988; 2) Suicide Prevention 2.0 (SP 2.0); 3) 
President's Roadmap to Empower Veterans and End a National Tragedy of 
Suicide (PREVENTS); and 4) the Staff Sergeant Parker Gordon Fox Suicide 
Prevention Grant Program (SSG Fox SPGP).
    First, VCL accounts for 50% of the total increase, which is to 
support operational readiness in fulfillment of the National Suicide 
Hotline Designation Act of 2020, which requires the Federal 
Communications Commission (FCC) to designate 9-8-8 as the universal 
telephone number for the National Suicide Prevention Lifeline and VCL. 
A volume increase of 122% to 154% is anticipated for VCL, and the 
transition to 988 must be complete by July 16, 2022. Once activated, 
the 988 expansion will directly address the need for ease of access and 
clarity in times of crisis, both for Veterans and non-Veterans alike. 
By providing a universal, unique 3-digit dialing code, it will also 
give VA an opportunity to work in greater collaboration with the 
suicide prevention community across the United States and open the door 
to engage new individuals in life-saving care.
    Second, the increase for SP 2.0, which accounts for 12% of the 
total increase, is to further the implementation of our public health 
approach to suicide prevention. To accomplish its goal of reducing 
suicide among all 20 million U.S. Veterans, and to reach Veterans both 
inside and outside VA care, SP 2.0 is moving suicide prevention beyond 
a one-size-fits-all model to a blended model combining community 
prevention strategies and evidence-based clinical strategies that will 
empower action at the national, regional and local levels. This 
initiative is informed by the evidence supporting suicide prevention 
interventions and public health approaches. The Centers for Disease 
Control and Prevention, the Substance Abuse and Mental Health Services 
Administration and the National Action Alliance for Suicide Prevention 
have all moved toward a public health approach to suicide prevention. 
The model works to incorporate reaching both Veterans in the community 
as well as those we currently serve in VA with innovative community-
based prevention strategies combined with strategies with known 
outcomes for reducing suicide and suicide attempts based upon the 2019 
updated VA-DoD Clinical Practice Guideline (CPG) for the Assessment and 
Management of Patients at Risk for Suicide.
    Third, the increase for PREVENTS, which accounts for 18% of the 
total increase, is to support Roadmap implementation and completion to 
include an aggressive plan integrating Roadmap recommendation 1 with 
Roadmap recommendation 8 across fiscal year (FY) 2022.
    Fourth, SSG Fox SPGP accounts for 19% of the total increase. SSG 
Fox SPGP supports section 201 of the Commander John Scott Hannon 
Veterans Mental Health Care Improvement Act of 2019 (P.L. 116-171) and 
will enable VA to provide resources toward community-based suicide 
prevention efforts to meet the needs of Veterans and their families 
through outreach, suicide prevention services and connection to VA and 
community resources. In alignment with VA's National Strategy for 
Preventing Veteran Suicide (2018), this grant program will assist in 
further implementing a public health approach that blends community-
based prevention with evidence-based clinical strategies through 
community efforts.
    Question. Does this budget request have any points of focus on 
Veteran suicide prevention programs that target rural or remote 
communities like so many in Alaska?
    Answer. The Office of Rural Health (ORH), in collaboration with 
other VA program offices and research entities, have funded over 40 
mental health and suicide prevention initiatives targeted at rural or 
remote Veterans. The following programs have been established and are 
delivered in rural and highly-rural communities to Veterans in 
locations similar to those in Alaska: Telehealth Clinical Resource 
Hubs, Rural Access Network for Growth Enhancement, Pharmacist Providers 
for Rural Veterans with Opioid Use Disorder and Clinical Pharmacy 
Specialist Providers programs. In addition, ORH funds several 
initiatives in other rural communities such as the VA Farming and 
Recovery Mental Health Services, National Mental Health and Suicide 
Prevention Extension for Community Healthcare Outcomes, Community 
Clergy Training to Support Rural Veterans Mental Health and the Rural 
Suicide Prevention Program, just to name a few. These mental health and 
suicide prevention programs contribute to VA's continuing efforts to 
increase access to health care and to expand delivery of health care 
services to rural Veterans where they live. Active partnership with the 
Tribal Health Organizations in implementing these suicide prevention 
programs will be essential in highly-rural Alaska. In addition, 
providing postvention support when suicides happen and honoring those 
individuals in their communities would help them heal and assist them 
in being open to the resources.
    The budget includes expansion of our Community-Based Interventions 
for Suicide Prevention (CBI-SP) program to all Veterans Integrated 
Service Networks (VISN), including VISN 20. This program brings 
together the Governor's Challenge initiative (Alaska will be invited to 
join in FY 2022), the Together With Veterans peer led rural program and 
Veterans Health Administration (VHA) Community Engagement and 
Partnership Coordinators to facilitate community-led suicide prevention 
efforts. CBI-SP will facilitate the spread of the community suicide 
prevention efforts to all communities by deploying trained and 
dedicated VA staff who will help community coalitions organize, provide 
technical assistance and provide training all within a unifying model.
    Question. The VA is running a Native Veteran Suicide Prevention 
Project with the goal of addressing risk factors or enhancing known 
protective factors of suicide and developing Tribal partnerships. The 
program is in the process of establishing, or has already established, 
partnerships with 32 Tribes. Is the VA planning to expand this program 
to any Alaskan Tribes?
    Answer. The Tribal-VHA Partnerships for Suicide Prevention project 
is a demonstration project with three VA medical centers: VA Puget 
Sound Health Care System, Northern Arizona VA Health Care System and 
the Oscar G. Johnson VA Medical Center in Iron Mountain, Michigan. The 
tribal partnerships and outreach being conducted as part of this 
project are specific to tribes in these health care systems within the 
states of Washington, Arizona, Michigan and Wisconsin (which is served 
by the facility in Iron Mountain). The goal of this project is to 
develop and demonstrate a model for increasing partnership between VA 
suicide prevention and rural tribes. This initial project deliverable 
is due at the end of FY 2022, after which we expect to propose to roll 
the model out further in order to support additional VA health care 
systems that serve Native American Veterans.

                                 ______
                                 

               Questions Submitted by Senator John Hoeven
    Question. Section 102 of the VA MISSION Act called for the creation 
of Veterans Care Agreements (VCAs), a new type of contract between the 
VA and its community care providers. These types of contracts are 
intended to be used in areas where VA community care is either not 
provided or not sufficient to ensure that veterans can receive the care 
they need. For example, Bismarck--the second largest city in North 
Dakota--has zero nursing homes contracting with the VA, resulting in 
veterans having to pay out-of-pocket to receive the long-term care they 
need, or having to relocate away from family and friends.
    What is the current status of Veterans Care Agreements?
    Answer. Veterans Care Agreements (VCA) are currently being utilized 
to supply providers to support VA's ability to deliver timely care to 
Veterans to meet their medical needs. Pursuant to the legal standard 
for use of VCAs that is set forth in the VA Maintaining Internal 
Systems and Strengthening Integrated Outside Networks Act, a provider 
with a VCA is used to serve a Veteran when the hospital care, medical 
services and/or extended care services needed for that Veteran is not 
feasibly available from VA or through a conventional procurement 
contract or a sharing agreement (e.g., health care resource sharing 
agreement with the Department of Defense). There are 16,945 active VCAs 
as of October 13, 2021, according to the VA Provider Portal Management 
System.
    Generally, the use of VCAs has been gradually decreasing as the 
Community Care Network (CCN) has stabilized, and VA is less reliant on 
them as the implementation of the CCN becomes more robust. Some of the 
services VA is currently most reliant on utilization of VCAs to acquire 
are homemaker/home health, mental health and dental services.
    Question. Can you provide examples of where VA is currently using 
Veterans Care Agreements?
    Answer. A few examples of where VCAs are currently being used 
include CCN Regions 4 and 5 (Alaska/California/Arizona), where VA 
utilizes VCAs for mental health services, when necessary, to ensure 
Veterans have timely access to mental health care. Additionally, VCAs 
are currently VA's primary means of procuring family member Bowel and 
Bladder coverage.
    In many geographic areas, particularly rural areas, VCAs bridge the 
gap for providing specialties related to homemaker home health care, as 
well as for dental services in those areas where providers are still 
being recruited into the CCN. As of October 13, 2021, there are 
approximately 2,970 VCAs for Bowel and Bladder care, 3,300 VCAs for 
home health care and 8,300 VCAs for dental services.
    Question. Since 2019, the Fargo VA has carried out a hyperbaric 
oxygen therapy (HBOT) clinical demonstration project. Under the 
project, veterans who have yet to experience positive outcomes from two 
traditional post-traumatic stress disorder (PTSD) therapies can be 
referred for HBOT in the community.
    Do you agree that in order to put an end to veteran suicide, we 
need to address the problem with every possible option--including 
expanding access to innovative, alternative treatment options like 
HBOT?
    Answer. VA agrees with the importance of providing effective mental 
health care to address Veteran suicide and supports the use of 
promising practices along with evidence-based treatments for mental 
health. The effects of Hyperbaric Oxygen Therapy (HBOT) on suicidal 
thoughts and behaviors have not been tested; however, HBOT does not 
appear to be an effective treatment for mental health disorders. The 
evidence on HBOT for traumatic brain injury (TBI), with or without 
posttraumatic stress disorder (PTSD), that is based on the results of 
four randomized controlled trials is largely negative, with only one 
study showing some short-term benefit for PTSD. VA offers Veterans 
access to a range of promising practices through its Whole Health 
Program and will continue to monitor the evidence on HBOT and 
potentially innovative strategies for addressing Veteran suicide.
    Question. Given it is already July and the country is still 
recovering from the COVID-19 pandemic, do you anticipate extending the 
HBOT demonstration project beyond this fiscal year so that more 
veterans can access this treatment option?
    Answer. VA does not anticipate extending the HBOT clinical 
demonstration project (program evaluation) beyond this fiscal year. VA 
clinicians and Fargo VA Health Care System leadership will continue to 
make case-by-case, evidence-based determinations on clinical care and 
case management, including community care authorizations for HBOT for 
any medical indication, consistent with VA policy and with 
consideration for the unique needs, health factors and treatment 
history of individual Veterans.
    The clinical demonstration project was intended to identify 
administrative implications of administering this therapy within VA and 
has successfully accomplished that goal. It was never intended or 
designed to address efficacy of HBOT for these conditions or influence 
clinical care decisions, which are made by the provider in 
collaboration with the Veteran patient.
    On October 22, 2020, the Acting Under Secretary for Health agreed 
to increase the total number of Veterans who could enroll in the 
program evaluation across all five sites from 215 to 250, which 
facilitated consistent opportunity for Veteran participation at each 
location. At the end of fiscal year (FY) 2020, leadership at four of 
the sites concluded their participation in the program evaluation 
following the planned active period of approximately 24 months. Due to 
the impact of Coronavirus Disease 2019 and the later start date, VA 
leadership supported the continuation of the program evaluation at the 
Fargo VA Health Care System for an additional 12 months (through the 
end of FY 2021), which would be consistent with the 24-month active 
period of the other four program evaluation sites. To maintain 
consistency across sites, the program evaluation concluded at the end 
of FY 2021.

    Background:

  --A total of 56 Veterans have been referred across all five sites.

  --A total of 51% Veterans either dropped out or canceled before 
        beginning treatment across all sites.

  --As of June 23, 2021, Fargo VA Health Care System remains the only 
        site that continued to enroll Veterans for FY 2021.

  --A total of 23 Veterans have been referred to the Fargo site since 
        September 2019.

  --A total of 45% of all Veterans have either dropped out or canceled 
        before beginning treatment at Fargo.

  --Data indicate that the number of referrals for the first year (12 
        referrals) is similar to the second year (10 referrals over 10 
        months).

  --HBOT is not recognized as an evidence-based treatment for PTSD or 
        TBI; is not approved by the Food and Drug Administration (under 
        guidance by the Undersea and Hyperbaric Medicine Society); and 
        is not reimbursable by Medicare, Medicaid and insurance.

    Question. The National Cemetery Administration (NCA) has determined 
that additional infrastructure--such as restrooms, storage sheds, and 
wind walls--are necessary at Rural Initiative cemeteries in order to 
better serve veterans and their families. Can you provide my office an 
update on the pending design and construction of the infrastructure 
projects at Fargo National Cemetery?
    Answer. The infrastructure improvement project at Fargo National 
Cemetery is currently under design. We anticipate the design phase will 
be completed this fall. We also anticipate a construction contract will 
be awarded over the winter, and the work will be completed in the fall 
of next year.

                                 ______
                                 

            Questions Submitted by Senator Susan M. Collins
    Question. In December 2020 my legislation, the State Veterans Homes 
Domiciliary Care Flexibility Act, was enacted into law. This 
legislation requires the VA to implement regulations which allow the 
waiver of certain eligibility requirements for domiciliary care per 
diem payments when in the best interest of the veteran. This authority 
would ensure that vulnerable veterans do not fall through the cracks 
and receive the care they need, and I urge the VA to quickly complete 
its rulemaking and delegate this waiver authority to local VA hospitals 
and regional Veterans Integrated Service Networks (VISN). Can you 
please provide the committee with a status update on these efforts?
    Answer. The proposed changes to regulation 38 C.F.R. Sec. 51.51 are 
currently going through the VA regulatory concurrence process which 
follows the Administrative Procedures Act, which typically, though not 
always, requires two rulemaking stages. This process takes generally 18 
to 24 months and involves VA and the Office of Management and Budget. 
Following internal development, review and approval of the regulation, 
the Federal Register publishes VA's Notice of Proposed Rulemaking 
(NPRM). VA's NPRM invites the public to comment on the proposed 
amendments. VA considers and responds to all comments in the final 
rulemaking. The proposed regulations will address the new waiver 
authority in the Public Law.
    Question. A 24-bed Substance Use Disorder Residential 
Rehabilitation Treatment Program (SUD RRTP) facility was approved at 
the Togus VA in August 2020 as an out-of-cycle Strategic Capital 
Investment Plan project. Currently, veterans served by VA Maine are 
unable to get these services within the State, and Maine veterans 
waiting for admission to a SUD RRTP or unwilling to travel out-of-state 
utilize over 500 acute inpatient bed days of care per year at VA Maine. 
The establishment of a residential program at Togus would improve 
veteran continuity of care and accessibility to vitally important 
services for Maine veterans. My understanding is that a design was 
internally approved by VA for FY21 funding in December 2020. However, 
based on the Department's budget request submission, it does not appear 
the VA has adequately prioritized this project. When does the VA plan 
to construct this much needed facility?
    Answer. The following is the anticipated timeline for the Substance 
Use Disorder Residential Rehabilitation Treatment Program facility:

  --Design Award--September 28, 2021

  --Design Completion--February 2022 to June 2022

  --Construction Award--December 2022 to January 2023

  --Construction Completion--March 2024

  --Activation--April 2024

  --Occupancy--May 2024

    Question. New International Guidelines for the Prevention and 
Treatment of Pressure Injuries were made available in 2019. Hospital 
acquired pressure ulcers impact over 2.5 million and cost the health 
care system $26.8 billion annually. Following these guidelines could 
make significant improvements in wound care for veterans being treated 
at VA hospitals. When does VA anticipate adopting these guidelines as 
the VA's standard of care and implementing the Standardized Pressure 
Injury Prevention Protocol (SPIPP) Checklist to improve pressure injury 
prevention?
    Answer. VA is aware of the evolving evidence and research related 
to Pressure Injury (PI) prevention and wound care. Moreover, VA has 
adopted the 2019 International Prevention and Treatment of Pressure 
Ulcer/Injury: Clinical Practice Guidelines, as well as areas contained 
in the Standardized Pressure Injury Prevention Protocol Checklist, 
within the recently-released Veterans Health Administration (VHA) 
Directive 1352, Prevention and Management of Pressure Injuries. This 
directive provides policy and implementation procedures for the 
assessment, prevention and management of PIs across VHA clinical 
practice settings. The directive contains practice recommendations and 
is consistent with both national and international guidelines for PI 
prevention and management. Additionally, the national VA Approved 
Enterprise Standard Skin (VAAES) Inspection/Assessment electronic 
health record template was developed to ensure staff documentation of 
interventions were consistent with evidenced-based recommendations and 
guidelines for PI prevention and management. VAAES also includes the 
link to the 2019 International Prevention and Treatment of Pressure 
Ulcer/Injury: Clinical Practice Guidelines.

                                 ______
                                 

          Questions Submitted by Senator Shelley Moore Capito
    Question. I appreciated you meeting with me and my colleagues last 
month to update us on the actions that the Department is taking at the 
Louis A. Johnson VAMC in Clarksburg, West Virginia, in the wake of the 
horrific events that took place at the facility. As I know you observed 
during your time at the facility, both staff and patient morale is low. 
It is imperative that the VA continues to monitor the progress towards 
restoring trust at the medical center.
    During our visit, I brought up that there is still staff in 
leadership roles at the facility, who were in those positions when the 
murders took place. You told me that part of the issue is that the VA 
could not begin its internal investigation, until after the OIG and DOJ 
investigations concluded. While I understand that the internal 
investigation is probably still ongoing, can you provide me with an 
update on this and if the VA has found any new issues since our last 
meeting, that need to be addressed?
    Answer. The internal Administrative Investigation Board was 
completed on December 18, 2020. No actions were taken until the Office 
of Inspector General (OIG) report was published May 11, 2021. We were 
awaiting completion of the OIG report to implement disciplinary actions 
regarding this incident, all of which have since been effectuated.
    Question. Are there still employees waiting to have disciplinary 
action taken against them?
    Answer. VA has taken the necessary administrative actions against 
all identified employees. The administrative actions ranged from 
written counseling to removal. There were several VA staff members 
including the Medical Center Director, Chief of Staff and Associate 
Chief Nurse who retired from their respective positions before 
administrative action could be taken. Additionally, two staff members, 
a Hospitalist and a Quality Manager, resigned before administrative 
action could be taken.

                          SUBCOMMITTEE RECESS

    Senator Heinrich. And with that, we stand adjourned.
    [Whereupon, at 11:02 a.m., Wednesday, June 23, the hearing 
was adjourned, and the subcommittee was recessed, to reconvene 
at a time subject to the call of the Chair.]





       LIST OF WITNESSES, COMMUNICATIONS, AND PREPARED STATEMENTS

                              ----------                              
                                                                   Page

Berry, Lieutenant General Warren, Deputy Chief of Staff for 
  Logistics, Engineering, and Force Protection:
    Statement of.................................................    29
    Prepared Statement of........................................    30 
Boozman, Senator John, U.S. Senator from Arkansas:
    Questions Submitted by.......................................    85
    Statement of ................................................ 3, 54 
    
Capito, Senator Shelley Moore, U.S. Senator from West Virginia, 
  Questions Submitted by.........................................    98 
Chiarotti, Lieutenant General Charles, Deputy Commandant, 
  Installations & Logistics:
    Prepared Statement of........................................    27
    Statement of.................................................    26 
Collins, Senator Susan M., U.S. Senator from Maine, Questions 
  Submitted by...................................................    97
Cramer, Paul, Performing the Duties of Assistant Secretary of 
  Defense for Sustainment:
    Prepared Statement of........................................     6 
    Summary Statement of.........................................     4 
Evans, Lieutenant General Jason, Deputy Chief of Staff...........    17
    Prepared Statement of........................................    18
Heinrich, Senator Martin, U.S. Senator from New Mexico: 
    Opening Statement of ........................................ 1, 53
    Questions Submitted by.......................................    80
Hoeven, Senator John, U.S. Senator from North Dakota, Questions 
  Submitted by...................................................    95
McConnell, Senator Mitch, U.S. Senator from Kentucky, Questions 
  Submitted by Questions.........................................    86
McDonough, Hon. Denis R., Secretary of Veterans Affairs:
    Prepared Statement of........................................    57 
    Summary Statement of.........................................    55
Murkowski, Senator Lisa, U.S. Senator from Alaska, Questions 
  Submitted by...................................................    94

Schatz, Senator Brian, U.S. Senator from Hawaii, Questions 
  Submitted by...................................................    84 
Williamson, Vice Admiral Ricky, Deputy Chief of Naval Operations 
  for Fleet Readiness and Logistics:
    Prepared Statement of........................................    24
    Statement of.................................................    24





                             SUBJECT INDEX

                              ----------                              
                                                                   Page

                         DEPARTMENT OF DEFENSE

                Military Construction and Family Housing

Base Realignment and Closure (BRAC)..............................    37 
Beyond the Budget................................................    23 
Budget Uncertainty and the Milcon Process........................    28 
Defense Environmental Restoration Programs.......................     9 
Department of Defense Energy Programs............................    12 
Challenges.......................................................    30 
Child Care.......................................................    20 
Climate Change...................................................     6 
Conclusion ......................................... 17, 23, 26, 29, 37 
Energy Innovation................................................    17 
Enterprise-wide Energy Initiatives...............................    13 
Environmental:
    Conservation and Compatible Development......................    11 
    Programs.....................................................     9 
    Technology...................................................    10 
Facilities Sustainment and Recapitalization......................     8 
Facilities Sustainment, Restoration, and Modernization (FSRM)....    36 
Family: 
    And Unaccompanied Housing....................................     8 
    Housing and Barracks.........................................    19 
Force Design and Installations...................................    28 
FY 2022:.........................................................    
Budget Request for Installation Infrastructure...................    22 
    Milcon Program...............................................    34 
Health Care......................................................    20 
Historic Housing Program.........................................    20 
Housing Construction and Operation and Maintenance...............    36 
Infrastructure Sustainment and Restoration.......................    25 
Installation Energy Resilience...................................    15 
Installations Resiliency and Resiliency Initiatives..............    27 
Introduction .................................................... 6, 30 
Key Areas of Concern.............................................     6 
Milcon Execution.................................................    25   
Military:........................................................  
    Construction ................................................ 7, 22  
        And Family Housing.......................................     7  
    Housing......................................................    25 
        Privatization Initiative (MHPI)..........................     6 
Modernize and Innovate...........................................    22 
Operational Energy Resilience....................................    14 
Operation and Maintenance of Facilities..........................    23 
Overcoming Challenges............................................    31 
Per- and Polyfluoroalkyl Substances..............................     9 
Permanent Change of Station (PCS) Moves..........................    21 
Privatized Housing...............................................    36 
PPV Housing......................................................    28 
Quality of Life Priorities.......................................    19 
Special Interest Items...........................................    32  
Spouse Employment................................................    20 
Strengthen Readiness and Resilience..............................    21 
Taking Care of People............................................    18 
The Army Installations Strategy..................................    18 
The Native American Lands Environmental Mitigation Program.......    10 
Threats to Energy................................................    13  

                               __________

                     DEPARTMENT OF VETERANS AFFAIRS

Access to Mental Health and Suicide Prevention...................    59 
Additional Committee Questions...................................    80 
Addressing an Aging Infrastructure...............................    62 
An Evolving Landscape Will Influence How VA Cares for Veterans...    64 
Congressional Support............................................    64 
Diversity, Equity and Inclusion..................................    66 
Economic Opportunity.............................................    62 
EHRM.............................................................    63 
Eliminating Veteran Homelessness.................................    61 
Empowering Leaders to Implement Positive Change..................    66 
Environmental Exposures..........................................    65 
Establishing the Right Balance of VA and Community Care..........    59 
Financial Management Business Transformation.....................    64 
Fiscal Year 2022 Budget and 2023 Advance Appropriations..........    58 
Improving Support for Women Veterans.............................    60 
Leveraging Technology to Support Service and Medical Care 
  Delivery.......................................................    63 
Louisville VA Medical Center (VAMC)..............................    86 
Mental Health....................................................    88 
New Statutory Authorities........................................    65    
Research.........................................................    65  
Rural Health.....................................................    87  
Strategic Focus..................................................    58  
Supporting Caregivers............................................    60  
Toxic Exposures..................................................    89 
VA Logistics Redesign (VALOR)....................................    63 
VA Telehealth....................................................    84 
Veteran Homelessness.............................................    90  

                                   [all]