[House Report 108-200]
[From the U.S. Government Publishing Office]



108th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                    108-200

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



 
       NEW FITZSIMONS REGIONAL FEDERAL MEDICAL CENTER ACT OF 2003

                                _______
                                

 July 14, 2003.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

   Mr. Smith of New Jersey, from the Committee on Veterans' Affairs, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 116]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Veterans' Affairs, to whom was referred the 
bill (H.R. 116) to authorize the Secretary of Veterans Affairs 
to construct, lease or modify major medical facilities at the 
site of the former Fitzsimons Army Medical Center, Aurora, 
Colorado, having considered the same, reports favorably thereon 
with an amendment and recommends that the bill as amended do 
pass.

  The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``New Fitzsimons Regional Federal 
Medical Center Act of 2003''.

SEC. 2. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS, FORMER 
                    FITZSIMONS ARMY MEDICAL CENTER, AURORA, COLORADO.

    (a) Authorization.--The Secretary of Veterans Affairs may carry out 
major medical facility projects under section 8104 of title 38, United 
States Code, at the site of the former Fitzsimons Army Medical Center, 
Aurora, Colorado. Projects to be carried out at such site shall be 
selected by the Secretary and may include inpatient and outpatient 
facilities providing acute, sub-acute, primary, and long-term care 
services. Project costs shall be limited to an amount not to exceed a 
total of $300,000,000 if a combination of direct construction by the 
Department of Veterans Affairs and capital leasing is selected under 
subsection (b) and no more than $30,000,000 per year in capital leasing 
costs if a leasing option is selected as the sole option under 
subsection (b).
    (b) Selection of Capital Option.--The Secretary of Veterans shall 
select the capital option to carry out the authority provided in 
subsection (a) of either--
          (1) direct construction by the Department of Veterans Affairs 
        or a combination of direct construction and capital leasing; or
          (2) capital leasing alone.
    (c) Consultation With Secretary of Defense.--The Secretary of 
Veterans Affairs shall consult with the Secretary of Defense in 
carrying out this section. Such consultation shall include 
consideration of establishing a Department of Veterans Affairs-
Department of Defense joint health-care venture at the site of the 
project or projects under subsection (a).
    (d) Authorization of Appropriations.--There is authorized to be 
appropriated to the Secretary of Veterans Affairs for fiscal years 
2004, 2005, and 2006 for ``Construction, Major Projects'' for the 
purposes authorized in subsection (a)--
          (1) a total of $300,000,000, if direct construction, or a 
        combination of direct construction and capital leasing, is 
        chosen pursuant to subsection (b) for purposes of the projects 
        authorized in subsection (a); and
          (2) $30,000,000 for each such fiscal year, if capital leasing 
        alone is chosen pursuant to subsection (b) for purposes of the 
        projects authorized in subsection (a).
    (e) Limitation.--The projects authorized in subsection (a) may only 
be carried out using--
          (1) funds appropriated for fiscal year 2004, 2005, or 2006 
        pursuant to the authorization of appropriations in subsection 
        (a);
          (2) funds appropriated for Construction, Major Projects, for 
        a fiscal year before fiscal year 2004 that remain available for 
        obligation; and
          (3) funds appropriated for Construction, Major Projects, for 
        fiscal year 2004, 2005, or 2006 for a category of activity not 
        specific to a project.
    (f) Report to Congressional Committees.--Not later than 120 days 
after the date of the enactment of this Act, the Secretary shall submit 
to the Committees on Appropriations and the Committees on Veterans' 
Affairs of the Senate and House of Representatives a report on this 
section. The report shall include the following:
          (1) Notice of the option selected by the Secretary pursuant 
        to subsection (b) to carry out the authority provided by 
        subsection (a).
          (2) Information on any further planning required to carry out 
        the authority provided in subsection (a).
          (3) Other information of assistance to the committees with 
        respect to such authority.

                              Introduction

    On January 7, 2003, Honorable Joel Hefley, Honorable Mark 
Udall, Honorable Scott McInnis, Honorable Marilyn N. Musgrave, 
Honorable Thomas G. Tancredo, Honorable Bob Beauprez, and 
Honorable Diana DeGette introduced H.R. 116, the Veterans' New 
Fitzsimons Health Care Facilities Act of 2003.
    On June 11, 2003, the Subcommittee on Health held a hearing 
on several bills, among them H.R. 116, the Veterans' New 
Fitzsimons Health Care Facilities Act of 2003. Witnesses who 
appeared before the Subcommittee included Ms. Cathleen C. 
Wiblemo, Deputy Director, Health Care, Veterans Affairs and 
Rehabilitation Division, The American Legion; Mr. Richard 
Jones, National Legislative Director, AMVETS; Mr. Adrian M. 
Atizado, Associate National Legislative Director, Disabled 
American Veterans; Mr. Carl Blake, Associate Legislative 
Director, Paralyzed Veterans of America; Mr. Paul A. Hayden, 
Deputy Director, National Legislative Service, Veterans of 
Foreign Wars; Honorable Robert H. Roswell, M.D., Under 
Secretary for Health, Department of Veterans Affairs, who was 
accompanied by Mr. D. Mark Catlett, Principal Deputy Assistant 
Secretary for Management, and Mr. Robert L. Neary, Jr., 
Associate Chief Facilities Management Officer for Service 
Delivery. Written testimonies were received from Honorable Joel 
Hefley, Member of Congress from the State of Colorado; 
Honorable David L. Hobson, Member of Congress from the State of 
Ohio; Honorable Solomon P. Ortiz, Member of Congress from the 
State of Texas; and Honorable Deborah Pryce, Member of Congress 
from the State of Ohio.
    On June 24, 2003, the Subcommittee on Health met and 
unanimously ordered H.R. 116, as amended, reported favorably to 
the full Committee.
    On June 26, 2003, the full Committee met and ordered H.R. 
116 reported favorably to the House with an amendment in the 
nature of a substitute by unanimous voice vote.

                      Summary of the Reported Bill

    H.R. 116, as amended, would:

    1. LAuthorize the Secretary of Veterans Affairs to carry 
out a major medical facility project at the site of the former 
Fitzsimons Army Medical Center in Aurora, Colorado, in 
consultation with the Secretary of Defense.

    2. LAllow the Secretary to determine the types of care, 
including inpatient, outpatient, acute, sub-acute, primary and/
or long-term care services, and to determine the type of 
capital project delivery, whether through construction or a 
capital lease arrangement.

    3. LRequire the Secretary after consulting with the 
Secretary of Defense to select a capital option for carrying 
out the authority between direct construction, capital leasing 
or a combination of the two.

    4. LLimit the amount appropriated for direct construction 
to no more than $300,000,000; and limit the amount spent each 
year for the capital leasing option to no more than $30,000,000 
in annual rental costs.

    5. LAuthorize the project to be carried out using a total 
appropriation of $300 million, if direct construction or a 
combination of direct construction and capital leasing is 
chosen by the Secretary; and $30 million for each fiscal year 
of a capital lease.

    6. LLimit the project authorization to be carried out using 
funds appropriated for fiscal year 2004, 2005 and 2006 for the 
purposes of providing a new Fitzsimons Health Care Facility; 
using available fiscal year 2004 major construction funds; or 
using major construction funds appropriated for fiscal year 
2004, 2005 or 2006 not specific to a project.

    7. LRequire the Secretary to report no later than 120 days 
after enactment to the Committees on Veterans' Affairs and on 
Appropriations of the Senate and House of Representatives the 
option the Secretary chooses to carry out the authority 
provided in this bill, and any further planning required or 
assistance from the Committees needed to carry out this 
project.

                       Background and Discussion

    Since the end of World War II, the Denver Department of 
Veterans Affairs (VA) Medical Center and the University of 
Colorado have been in partnership to provide care to veterans. 
This partnership has included the significant sharing of health 
care resources, including physician faculty, house staff, 
facilities, equipment, supplies, services, as well as the long-
term shared mission of health-professions education and 
biomedical research.
    Today, nearly all the physicians caring for veterans at the 
Denver VA Medical Center also practice medicine at the 
University of Colorado Health Sciences Center and are faculty 
members of its medical school. From the inception of their 
relationship, the two institutions have shared expensive and 
specialized medical equipment and facilities, such as surgical 
suites and imaging equipment. For example, veterans under care 
at the VA facility who are candidates for organ transplantation 
receive those specialized services at the University of 
Colorado Hospital by surgical staffs in dual appointment at 
both institutions, governed by a sharing agreement between the 
two.
    Due to the lack of space, inability to renovate or 
construct newer facilities and the prohibitive cost associated 
with continuing to develop its downtown site, the university 
determined in 1995 that the Denver campus was no longer 
compatible with its mission. The closure of the Fitzsimons Army 
Medical Center in Aurora, Colorado, provided the university an 
opportunity to relocate to a new site with over four times the 
acreage of the existing campus, and to build a new complex.
    To date, the development of the 217-acre Fitzsimons campus 
includes an outpatient and cancer pavilion, an eye institute, a 
library, and a power plant. Construction is underway on the 
first phase of the university hospital, biomedical and cancer 
research towers, and the Native American building. Other 
development is planned or already programmed.
    While the move to Fitzsimons solved existing problems and 
provided future advantages for the university, it will be 
separated from its sharing partner and health-professions 
affiliate, the VA facility. A separation of more than eight 
miles would create new barriers and challenges to continued 
quality care for veterans who receive their care at the VA.
    A study commissioned by the Department concluded health 
care demand by Colorado veterans will continue unabated for the 
next 20 years. The cost of maintaining the VA facility in its 
current location, a medical center that opened in 1955, was 
estimated to be over $200 million, and the study estimated 
rebuilding the facility in 2020 could cost as much as $377 
million in today's dollars.
    The basic elements of a relocated VA medical center at 
Fitzsimons would include a free-standing inpatient care 
hospital building for veterans and Department of Defense (DOD) 
beneficiaries, as well as facilities for ambulatory care. 
Consolidated and improved VA research facilities could also be 
included in this plan, as well as long-term care facilities 
coordinated with a new Colorado State veterans home currently 
operating on the Fitzsimons campus.
    This project could offer vital services to DOD 
beneficiaries. The Air Force plans to develop a new military 
medical treatment facility at Buckley Air Force Base near 
Aurora. A significant population of active duty, reserve and 
retiree beneficiaries resides in the Denver area. The Air Force 
has initiated a study to determine whether joint location and 
construction of health facilities with the VA at the Fitzsimons 
site is the best option.
    In the report accompanying the House-passed National 
Defense Authorization Act for Fiscal Year 2004, H.R. 1588, an 
amount of $4 million was included for DOD to contribute to the 
design and plan of a new Air Force-VA joint venture health care 
facility at the former Fitzsimons Army Medical Center site in 
Aurora. Additionally, recognizing the importance of cost 
savings and other efficiencies that such a joint venture might 
produce, the H.R. 1588 bill report directed DOD and VA to make 
every effort to share health care facilities.
    The Committee welcomes these developments that could bring 
this community of federal beneficiaries a modern 
intergovernmental health care resource able to meet their needs 
comprehensively, while conserving Federal funds.
    The bill was amended to require the Secretary of Veterans 
Affairs to consult with the Secretary of Defense, principally 
respecting the concerns and needs of the United States Air 
Force, in selecting an option to move forward with a new 
medical center at the Fitzsimons site. It is the intent of the 
Committee that the Secretary of Veterans Affairs, in carrying 
out this required consultation, consider the opportunities for 
the achievement of the goals restated in Title VII, Subtitle C, 
sections 722-725 of the Bob Stump National Defense 
Authorization Act for Fiscal Year 2003.

                      Section by Section Analysis

    Section 1 of the bill would name the Act the ``New 
Fitzsimons Regional Federal Medical Center Act of 2003''.

    Section 2(a) of the bill would provide authority to the 
Secretary of Veterans Affairs to carry out major medical 
facility projects at the site of the former Fitzsimons Army 
Medical Center in Aurora, Colorado; projects chosen by the 
Secretary at this site may include inpatient and outpatient 
facilities that provide acute, sub-acute, primary, and long-
term care services. The costs of these projects would be 
limited to $300,000,000 for new construction, and $30,000,000 
in annual rent if the Secretary elected a capital lease option.

    Section 2(b) of the bill would require the Secretary to 
select from two capital options: (1) direct construction by VA 
or a combination of direct construction and capital leasing, or 
(2) capital leasing alone to fund the major medical facility 
projects at the site of the former Fitzsimons Army Medical 
Center in Aurora, Colorado.

    Section 2(c) of the bill would require the Secretary to 
consult with the Secretary of Defense to consider establishing 
a VA-DOD joint health-care venture at the site of the project 
or projects at the former Fitzsimons Army Medical Center in 
Aurora, Colorado.

    Section 2(d) of the bill would authorize funds to be 
appropriated to the Secretary for fiscal years 2004, 2005, and 
2006 for major construction projects at the site of the former 
Fitzsimons Army Medical Center in Aurora, Colorado.

    Section 2(d)(1) of the bill would provide $300,000,000 in 
funding authorization for major construction projects at the 
site of the former Fitzsimons Army Medical Center in Aurora, 
Colorado, if the Secretary chooses to fund this construction 
through direct construction or a combination of direct 
construction and capital leasing.

    Section 2(d)(2) of the bill would authorize $30,000,000 for 
each fiscal year (2004-2006) for major construction projects at 
the site of the former Fitzsimons Army Medical Center in 
Aurora, Colorado, if the Secretary chooses to fund this 
construction through capital leasing alone.

    Section 2(e) of the bill would limit funds used for major 
construction projects at the site of the former Fitzsimons Army 
Medical Center in Aurora, Colorado, so that the projects may be 
completed by using funds: (1) appropriated for fiscal year 
2004, 2005, or 2006; (2) appropriated for major construction 
projects prior to fiscal year 2004 which are still available; 
or (3) appropriated for major construction projects for fiscal 
year 2004, 2005, or 2006 for any activity not specified for any 
particular project.

    Section 2(f) of the bill would require the Secretary to 
submit a report to the Committees on Appropriations and 
Veterans' Affairs of the Senate and House of Representatives 
120 days after enactment of this Act that would include: (1) 
the funding option chosen by the Secretary to complete major 
construction projects at the site of the former Fitzsimons Army 
Medical Center in Aurora, Colorado; (2) information on any 
further planning for those projects; and (3) additional 
information on those projects which might be of assistance to 
the Committees.

                    Performance Goals and Objectives

    The performance goals and objectives of VA programs dealing 
with major medical facility construction and the activity of 
the Department in sharing health care resources with the 
Department of Defense are established in the Department's 
annual performance plans and budget formulation processes, and 
are subject to the Committee's regular oversight.

              Statement of the Views of the Administration

  Testimony of Honorable Robert H. Roswell, M.D., Under Secretary for 
Health, Health Subcommittee Hearing on H.R. 1720, Veterans Health Care 
Facilities Capital Improvement Act; H.R. 116, Veterans' New Fitzsimons 
   Health Care Facilities Act of 2003; H.R. 2307, to provide for the 
establishment of new VA medical facilities for veterans in the area of 
Columbus, Ohio, and in south Texas; and H.R. 2349, to authorize certain 
         major medical facility projects for VA, June 11, 2003

          * * * * * * *
    VA also supports the intent of H.R. 116, the Veterans' New 
Fitzsimmons Health Care Facilities Act of 2003, to authorize the 
Secretary to carry out major medical facility projects at the former 
Fitzsimons Army Medical Center in Aurora, Colorado. The bill provides 
the Secretary flexibility in selecting the projects by providing that 
they may include acute, sub-acute, primary, and long-term care 
services. H.R. 116 limits project costs to an amount not to exceed 
$300,000,000 if a combination of direct construction and capital 
leasing is selected and no more that $30,000,000 per year in capital 
leasing costs if a leasing option is selected. In addition, the bill 
places certain limitations on the fiscal years from which appropriated 
funds can come.
    We have been involved in evaluating and planning for a facility for 
the Fitzsimons site and there is a potential for a joint venture with 
DoD to provide health care to both veterans and DoD beneficiaries. Many 
issues still remain including the availability of land, but VA would be 
able to provide the report to Congress as required if the bill is 
enacted.
          * * * * * * *

               Congressional Budget Office Cost Estimate

    The following letter was received from the Congressional 
Budget Office concerning the cost of the reported bill:

                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, June 27, 2003
Hon. Christopher H. Smith
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC

    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 116, the New 
Fitzsimons Regional Federal Medical Center Act of 2003.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Sam 
Papenfuss, who can be reached at 226-2840.

            Sincerely,
                                       Douglas Holtz-Eakin,
                                                           Director
    Enclosure.

               Congressional Budget Office Cost Estimate

  H.R. 116, New Fitzsimons Regional Federal Medical Center Act of 2003

As ordered reported by the House Committee on Veterans' Affairs on June 
                                26, 2003

    H.R. 116 would authorize three different options for the 
Department of Veterans Affairs (VA) to carry out major 
construction projects at the site of the former Fitzsimons Army 
Medical Center in Aurora, Colorado. Under the bill, and at the 
discretion of the Secretary of Veterans Affairs, VA could opt 
to engage in major construction, engage in major construction 
with leasing of some facilities, or forgo major construction in 
favor of leasing. If the Secretary chooses either option 
entailing major construction, the bill would authorize the 
appropriation of $300 million over the 2004-2006 period. 
However, if the Secretary chooses to forgo major construction, 
the bill would authorize funding of only $90 million over the 
same period.
    Absent information from VA, CBO assumes that VA would opt 
to carry out these projects solely through major construction. 
Under that assumption, CBO estimates--as shown in the following 
table-that implementing H.R. 116 would cost $13 million in 2004 
and $291 million over the 2004-2008 period, assuming 
appropriation of the authorized amount.






                                                                        By Fiscal Year, in Millions of Dollars
                                                                    --------------------------------------------
                                                                       2004     2005     2006     2007     2008
----------------------------------------------------------------------------------------------------------------

                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Authorization Level................................................      300        0        0        0        0
Estimated Outlays..................................................       13       81       98       72       27
----------------------------------------------------------------------------------------------------------------




    If VA were to choose to carry out these projects through 
both major construction and some leasing, CBO estimates that 
the total costs over the 2004-2008 period would be roughly the 
same, but estimated outlays in 2004 would be $23 million 
higher. If, on the other hand, VA were to choose to forgo major 
construction and lease facilities for only three years, CBO 
estimates that costs over the 2004-2006 period would total $90 
million. While total costs over the first three years would be 
lower under the leasing-only option, that course of action 
would only provide services for the three-year period, while 
the major construction option would provide services over a 
much longer period of time.
    H.R. 116 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would not affect the budgets of state, local, or tribal 
governments.
    The CBO staff contact is Sam Papenfuss, who can be reached 
at 226-2840. This estimate was approved by Peter H. Fontaine, 
Deputy Assistant Director for Budget Analysis.

                     Statement of Federal Mandates

    The preceding Congressional Budget Office cost estimate 
states that the bill contains no intergovernmental or private 
sector mandates as defined in the Unfunded Mandates Reform Act.

                 Statement of Constitutional Authority

    Pursuant to Article I, section 8 of the United States 
Constitution, the reported bill is authorized by Congress' 
power to ``provide for the common Defense and general Welfare 
of the United States.''

                                
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