[Senate Report 108-358]
[From the U.S. Government Publishing Office]
Calendar No. 718
108th Congress Report
SENATE
2d Session 108-358
======================================================================
DEPARTMENT OF VETERANS AFFAIRS REAL PROPERTY AND FACILITIES MANAGEMENT
IMPROVEMENT ACT OF 2004
_______
September 27, 2004.--Ordered to be printed
_______
Mr. Specter, from the Committee on Veterans' Affairs, submitted the
following
R E P O R T
[To accompany S. 2485]
The Committee on Veterans' Affairs (hereinafter, ``the
Committee''), to which was referred the bill (S. 2485), to
amend title 38, United States Code, to improve and enhance the
authorities of the Secretary of Veterans Affairs relating to
the management and disposal of real property and facilities,
and for other purposes, having considered the same, reports
favorably thereon with an amendment in the nature of a
substitute, and recommends that the bill, as amended, do pass.
Introduction
On June 1, 2004, Committee Chairman Arlen Specter
introduced, at the request of the Administration, S. 2485, the
``Department of Veterans Affairs Real Property and Facilities
Management Improvement Act of 2003.'' S. 2485, as introduced,
would have allowed the Department of Veterans Affairs
(hereinafter, ``VA'') to use major construction project funds
to construct or relocate parking facilities when such
relocations or construction projects are incident to a major
construction project; would have authorized the VA's Under
Secretaries for Benefits and Memorial Affairs to enter into
enhanced-use lease projects; would have authorized VA to
dispose of, or transfer, real property under its jurisdiction
without complying with certain provisions of the McKinney-Vento
Homeless Assistance Act and deposit any proceeds from such
disposal or transfer into a newly-created Capital Asset Fund;
would have terminated the VA's Nursing Home Revolving Fund; and
would have limited VA's authority to dispose of real property
with a value of more than $7 million unless the disposal was
proposed in the most recent budget submitted to Congress by the
President of the United States.
On October 16, 2003, Senator Barbara Boxer introduced S.
1745, a bill to designate a Prisoner of War/Missing in Action
National Memorial at Riverside National Cemetery in Riverside,
California. The bill was referred to the Committee on Veterans'
Affairs.
On February 26, 2004, Senator Hillary Rodham Clinton
introduced S. 2133, a bill to designate the Department of
Veterans Affairs Medical Center in Bronx, New York, as the
James J. Peters Department of Veterans Affairs Medical Center.
Senator Charles E. Schumer was later added as a cosponsor of
the bill. The bill was referred to the Committee on Veterans'
Affairs.
On April 7, 2004, Committee Member Jim Bunning introduced
S. 2296, a bill to require the Secretary of Veterans Affairs to
give the Commonwealth of Kentucky the first option on the
Louisville Department of Veterans Affairs Medical Center,
Kentucky, upon its conveyance, lease or other disposal by the
Department of Veterans Affairs. The bill was referred to the
Committee on Veterans' Affairs.
On April 21, 2004, Committee Member Ben Nighthorse Campbell
introduced S. 2327, a bill to amend title 38, United States
Code, to clarify that per diem payments made by the Department
of Veterans Affairs for the care of veterans in State Veterans
Homes shall not be used to offset or reduce other payments made
to assist veterans. Senators Olympia Snowe and Susan Collins
are original cosponsors of S. 2327. Committee Member Patty
Murray and Senator Hillary Rodham Clinton were later added as
cosponsors of the bill. The bill was referred to the Committee
on Veterans' Affairs.
On May 13, 2004, Senator Norm Coleman introduced S. 2417, a
bill to amend title 38, United States Code, to authorize the
Secretary of Veterans Affairs to furnish care for newborn
children of women veterans receiving maternity care, and for
other purposes. Committee Members Kay Bailey Hutchison, Lindsey
Graham, Lisa Murkowski, and Zell Miller, and Senators Ted
Stevens and Susan Collins, were later added as cosponsors of
the bill. The bill was referred to the Committee on Veterans'
Affairs.
On June 1, 2004, Chairman Specter introduced, at the
request of the Administration, S. 2486, a bill to amend title
38, United States Code, to improve and enhance education,
housing, employment, medical, and other benefits for veterans,
to improve and extend certain authorities relating to the
administration of benefits for veterans, and for other
purposes. Committee Member Lisa Murkowski is an original
cosponsor of S. 2486, and Committee Member Patty Murray was
later added as a cosponsor of the bill. The bill was referred
to the Committee on Veterans' Affairs.
On June 16, 2004, Committee Ranking Member Bob Graham
introduced S. 2524, a bill to amend title 38, United States
Code, to improve the provision of health care, rehabilitation,
and related services to veterans suffering from trauma related
to a blast injury, and for other purposes. The bill was
referred to the Committee on Veterans' Affairs.
Committee Hearings
On June 22, 2004, the Committee held a hearing to receive
testimony on, among other bills, S. 1745, S. 2133, S. 2296, S.
2327, S.2417, S. 2485, S. 2486, and S. 2524. Testimony was
heard from: Senators Kent Conrad, Jon S. Corzine, and Hillary Rodham
Clinton; The Honorable Tim S. McClain, VA's General Counsel and Michael
J. Kussman, M.D., Acting Deputy Under Secretary for Health, Veterans
Health Administration; Mr. Donald L. Mooney, Assistant Director for
Resource Development, Veterans Affairs and Rehabilitation Commission,
The American Legion; Mr. Paul A. Hayden, Deputy Director, National
Legislative Service, Veterans of Foreign Wars; Mr. Adrian M. Atizado,
Assistant National Legislative Director, Disabled American Veterans;
Mr. Carl Blake, Associate Legislative Director, Paralyzed Veterans of
America; and Mr. Richard Jones, National Legislative Director, AMVETS.
Committee Meeting
After carefully reviewing the testimony from the foregoing
hearing, the Committee met in open session on July 20, 2004,
and voted by unanimous voice vote to report favorably S. 2485,
as amended to also incorporate provisions derived from S. 1745,
S. 2133, S. 2296, S. 2327, S. 2417, S. 2486, and S. 2524.
Summary of the Committee Bill as Reported
S. 2485, as reported (hereinafter, the ``Committee bill''),
consists of two titles, summarized below.
TITLE I--REAL PROPERTY AND FACILITIES MATTERS
Title I contains freestanding provisions and amendments to
Title 38, United States Code, that would:
1. Authorize VA for five years to dispose of its
excess real property by sale, transfer or exchange to a
Federal agency, a State, political subdivision of a
State, or to any public or private entity, and allow VA
to retain the proceeds from such transfers in a Capital
Asset Fund to be used for non-recurring capital
projects, maintenance, clean-up, or improvements of
properties identified for disposal (section 101);
2. Remove the requirement that VA consider certain
statutory strictures of the McKinney-Vento Homeless
Assistance Act, 42 U.S.C. Sec. 11411, when it disposes
of excess real property and allow VA to enter into real
property enhanced-use leases for the benefit of the
Veterans Benefits Administration and the National
Cemetery Administration (section 102);
3. Authorize the use of major construction project
funds to construct or relocate surface parking lots if
the parking construction or relocation is incidental to
the underlying major construction project for which the
funds have been appropriated (section 103);
4. Terminate the Nursing Home Revolving Fund (section
104);
5. Allow VA to use advance-planning funds on any
construction project without notifying Congress if the
planning is for a project that has already been
authorized by law (section 105);
6. Permit VA to lease certain undeveloped or
underutilized land of the National Cemetery
Administration (section 106);
7. Transfer to VA jurisdiction over certain property
in Boise, Idaho, currently administered by the General
Services Administration (section 111);
8. Designate the VA Medical Center in Bronx, New
York, the ``James J. Peters Department of Veterans
Affairs Medical Center'' (section 121);
9. Designate a Prisoner of War/Missing in Action
National Memorial at the Riverside National Cemetery in
Riverside, California (section 122); and
10. Grant to the Commonwealth of Kentucky the first
option on the VA Medical Center in Louisville,
Kentucky, upon its proposed conveyance, lease or other
disposal by VA (section 131).
TITLE II--BENEFITS MATTERS
Title II contains freestanding provisions and amendments to
title 38, United States Code, that would:
1. Prohibit the collection of copayments for VA-
provided hospice care (section 201);
2. Expand and make permanent VA's authority to
provide counseling and treatment for veterans suffering
from sexual trauma (section 202);
3. Clarify that per diem payments made by VA for the
care of veterans in State Veterans Homes shall not be
used to offset or reduce other payments made to assist
veterans (section 203);
4. Authorize care for newborn children of women
veterans receiving maternity care in a VA facility or
in a private facility under a VA contract (section
204);
5. Establish centers for research, education, and
clinical activities that specialize in blast injuries
sustained by active duty service personnel (section
205);
6. Extend for five years the requirement that VA's
special medical advisory group issue certain reports
and extend VA pilot programs that are currently in
force relating to long term care (section 206); and
7. Require VA to report annually on waiting times for
appointments for care and services (section 207).
Background and Discussion
TITLE I--REAL PROPERTY AND FACILITIES MATTERS
Section 101. Restatement and enhancement of real property disposal
authorities
Under current law, the Secretary is authorized to dispose
ofproperty administered by VA and to retain the proceeds from
such a disposal but only if: (1) the property is considered excess to
the needs of VA; (2) there is no use for it in providing services to
homeless veterans; and (3) the property is valued at less than $50,000
or, in cases where it is valued at more than $50,000, the disposal was
proposed in the most recent budget submitted to Congress by the
President of the United States. In the event VA disposes of property,
all proceeds must be deposited into the Nursing Home Revolving Fund.
Funds in the Nursing Home Revolving Fund may only be used for the
construction, acquisition, or alteration of VA nursing home facilities.
Section 101 of the Committee bill would authorize VA for
five years to dispose of excess real property by sale, transfer
or exchange to a Federal agency, a State, or a political
subdivision of a State, or to any public or private entity.
Such transfers would not be subject to restrictions currently
in force. Further, the Committee bill would allow VA to retain
the proceeds generated by such disposals of property in a new
Capital Asset Fund rather than in the Nursing Home Revolving
Fund. Funds in the new account could be used to perform non-
recurring maintenance, develop construction proposals, or
dispose of other VA property. Removal of current limitations on
the use of land transfer proceeds would assist VA in carrying
out the goals as outlined in VA's Capital Asset Realignment for
Enhanced Services (CARES) plan.
Sec. 102. Improvements of enhanced-use lease authorities
VA is currently authorized to lease real property
administered by VA to non-Federal entities in cases where VA
determines that such a lease will advance the mission of VA and
enhance the use of the property. See 38 U.S.C. Sec. 8161 et
seq. In making the determination to enter into such an
``enhanced-use lease,'' VA may only consider the needs of the
Veterans Health Administration as outlined in business plans
set forth by the Under Secretary for Health. Once a
determination to lease is made, VA may receive facilities,
space, or services as consideration for the lease, but only if
the facilities, space or services are on the VA-leased
property.
Section 102 of the Committee bill would allow VA, as part
of making a determination to enter into an enhanced-use lease,
to consider the needs of the Veterans Benefits Administration
or the National Cemetery Administration as outlined in business
plans prepared by the respective Under Secretaries of those
Administrations. For a number of years, Congress has encouraged
VA to stop operating as three distinct health, benefits, and
memorial affairs administrations and instead act as a single
Department for the benefit of former service members. VA has
responded with plans such as this one; the Committee believes
it merits support.
Further, this section would permit VA to receive
facilities, space, or services in consideration for a lease
regardless of whether the facilities, space, or services are on
the leased property. The Committee agrees with VA that the
requirement that space, services, or facilities offered in
consideration be on the affected property advances no
compelling policy interest. The overarching goal of leasing in
exchange for space, services, or facilities is that the
consideration, wherever it might be delivered, be for the
benefit of veterans.
Sec. 103. Authority to use project funds to construct or relocate
surface parking incidental to a construction or non-recurring
maintenance project
When construction projects are undertaken at VA medical
centers, it is often necessary to move existing surface parking
facilities to permit the project to proceed. In addition, major
construction projects often require the addition of new surface
parking spaces to accommodate a programmatic mission or special
requirements, e.g., handicapped spaces adjacent to the new
building.
Under current law, all money spent for the construction of
VA parking lots must be derived from the Parking Revolving
Fund, which receives all of its deposits from fees charged for
parking. VA may not spend ``construction'' funds on parking
lots.
The Committee supports the basic concept that parking
facilities at VA should be constructed using monies derived
from the Parking Revolving Fund. Notwithstanding that, section
103 would authorize the use of funds in a construction or
capital account for the relocation of a surface parking
facility if the relocation is necessitated by a construction or
non-recurring maintenance project.
Sec. 104. Termination of Nursing Home Revolving Fund
Under current law, proceeds from the transfer of an
interest in real property under the jurisdiction of the
Secretary of Veterans Affairs must be deposited in the Nursing
Home Revolving Fund. This fund may only be used for the purpose
of constructing, altering or acquiring nursing home care
facilities.
Section 104 of the Committee bill would terminate the VA
Nursing Home Revolving Fund. In light of the Committee's
approval of section 101 of the bill, creating a new Capital
Asset Fund to serve as the repository of funds received by VA
as a consequence of real property transfers, the Nursing Home
Revolving Fund would no longer be needed.
Sec. 105. Inapplicability of limitation on use of Advance Planning Fund
to authorized major medical facility projects
Under current law, VA may not spend more than $500,000 from
its Advanced Planning Fund for the development of a
construction proposal unless it notifies Congress of its
intention to do so, and it waits for a period of 30 days. The
reporting requirement was established to ensure that the
Veterans' Affairs Committees of the United States Senate and
House of Representatives have advance knowledge of VA project
development activities.
The above-summarized reporting requirement applies
irrespective of whether a project has already been authorized
by Congress. Thus, VA is precluded from spending advanced-
planning funds on a project that has been vetted and approved
by Congress until VA gives further notification to Congress and
the 30-day period has lapsed. The requirement that Congress be
given notice of something it has already reviewed and approved
is, at best, inefficient. Further, the requirement causes delay
of up to three months for no compelling purpose. Accordingly,
Section 105 of the Committee bill would eliminate the ``notice
and wait'' provision if the project VA is planning has already
been authorized by law.
Sec. 106. Lease of certain National Cemetery Administration property
National Cemetery Administration (hereinafter ``NCA'')
burial sites are developed in 10-year increments using a
``just-in-time'' approach. NCA's premise is that it would be
wasteful to develop an entire cemetery the first year VA
operates the property when much of the land will not be needed
until far into the future. NCA monitors the depletion of grave
sites, projected burial requirements, and estimated timing for
new construction activities and then develops increments of new
space as needed.
Under current law, VA is not permitted to lease NCA lands.
As a consequence, the NCA has in its possession significant
acreage that is not yet needed and might be useful for other
purposes until it is needed for burial sites. Under current
law, it must remain idle.
Section 106 of the Committee bill would allow the NCA to
lease land that is not yet needed or is unsuitable for use by
NCA. Under this authority, proceeds from such leases would be
retained by NCA for the operation of the national cemeteries.
Congress has already determined that using land administered by
the Veterans Health Administration to generate revenues for VA
to use for the betterment of veterans is both sound public
policy and a good stewardship of taxpayer resources. This
section simply extends that philosophy to the National Cemetery
Administration.
Sec. 111. Transfer of jurisdiction, General Services Administration
property, Boise, Idaho
Section 111 of the Committee bill would direct the transfer
of certain land in Boise, Idaho, administered by the General
Services Administration (hereinafter, ``GSA'') to VA. The land
in question was originally under the jurisdiction of the
Department of the Army as part of Ft. Boise. The Army
transferred the land to VA for use in caring for veterans.
Subsequently, VA transferred the land to GSA for the purpose of
building a Federal courthouse in Boise.
Today, the land is, at best, underutilized, serving as an
overflow courthouse parking lot. VA spends $500,000 annually
leasing space from a private developer for the operation its
Boise Veterans Benefits Administration regional office.
Transfer of this land back to VA would potentially reduce
VA's annual leasing costs and, just as important, make
appropriate use of an otherwise underutilized parcel of Federal
land.
Sec. 121. Designation of Department of Veterans Affairs Medical Center,
Bronx, New York
For 31 years, James J. Peters, now deceased, was the
Executive Director of the Eastern Paralyzed Veterans
Association (hereinafter, ``EPVA''), a service organization now
known as the United Spinal Association. During his tenure, EPVA
invested significantly in spinal cord injury care and research.
The Bronx VA Medical Center is now a premier center for the
treatment of spinal cord injured veterans.
Section 121 of the Committee bill would designate the VA
Medical Center in Bronx, New York the ``James J. Peters
Department of Veterans Affairs Medical Center.'' The Committee
has concluded that naming the VA Medical Center in Bronx, New
York would be an appropriate tribute to Mr. Peters'
longstanding commitment to veterans.
Sec. 122. Designation of Prisoner of War/Missing in Action National
Memorial at the Riverside National Cemetery in Riverside,
California
Section 2403 of title 38, United States Code, authorizes
the NCA to establish memorial areas to honor veterans who are
missing in action or whose remains are otherwise unavailable
for burial. Under current law, VA is permitted to erect group
memorials to honor the memory of two or more service members
who died in service and whose remains were never recovered.
Section 122 of the Committee bill would designate at the
Riverside National Cemetery a memorial to former Prisoners of
War and members of the Armed Services listed as missing in
action. The section directs that the memorial be known as the
``Prisoner of War/Missing in Action National Memorial.''
Sec. 131. First option for Commonwealth of Kentucky on the VA Medical
Center in Louisville, Kentucky
Under current law, VA generally may not transfer any
property to a State unless VA receives compensation equal to
the fair market value of the property and the transfer, as
proposed, is described in the budget submitted by the President
of the United States to the Congress for the fiscal year within
which the proposed transfer would take place. VA may, however,
transfer excess land to a State for use as the site of a State
nursing home or domiciliary without adhering to these
restrictions.
Section 131 of the Committee bill would require VA, if it
determines that it will convey, lease, or otherwise dispose of
all or part of the Louisville VA Medical Center, to negotiate
for the conveyance, lease, or other disposal of the Medical
Center with the Commonwealth of Kentucky for its use to provide
services for veterans or for otherpurposes. The Committee bill
would not relieve the Commonwealth of the burden of paying fair market
value for the land if VA were to transfer the Medical Center to
Kentucky.
TITLE II--BENEFITS MATTERS
Sec. 201. Prohibition on collection of copayments for hospice care
Section 1710B of title 38, United States Code, requires VA
to operate a program to provide extended care services,
including hospice care, to eligible veterans. However, section
1710B(c)(1) prohibits VA from providing such care for a non-
service-connected disabling condition unless the veteran agrees
to pay a copayment. The law does exempt compensable service-
connected veterans and low-income veterans from the copayment
requirement.
Hospice care is provided to patients who are suffering
during the last phase of an incurable disease. As stated by the
American Cancer Society, ``hospice philosophy recognizes death
as the final stage of life and seeks to enable patients to
continue an alert, pain-free life and to manage other symptoms
so that their last days may be spent with dignity and quality,
surrounded by their loved ones.'' Given the nature of hospice
care, the Committee believes that waiving the copayment
obligation for such services would advance the requirement that
VA provide compassionate care. Accordingly, section 201 of the
Committee bill would exempt veterans receiving hospice care
under section 1710B from the copayment requirement.
Sec. 202. Expansion and permanent extension of authority for counseling
and treatment for sexual trauma
Section 1720D of title 38, United States Code, authorizes
VA to provide counseling and treatment to victims who suffer
from an incident of sexual trauma while in service. That
authority expires on December 31, 2004. To ensure that
appropriate treatment will at least be available to victims of
sexual trauma after they separate from service, the Committee
bill would make permanent VA's authority to provide these
services.
As a further matter, the Committee notes that VA's current
authority does not extend to the treatment of members of the
Reserves who are victims of sexual trauma while serving on
active duty for training. This section would also authorize VA
to provide counseling to members of the Reserves who were
victims of sexual trauma during such periods.
Sec. 203. Treatment of VA per diem payments to state homes for veterans
Under current law, VA pays each State a per diem payment of
$57.78 for each veteran provided nursing home care in a State
veterans' home. Costs above $57.78 are borne by the State.
In an effort in increase revenues, many States have had
their State homes Medicaid-certified; they have thus secured
eligibility for payment of a fixed daily cost for each veteran
who qualifies for care under the Medicaid program. Under
current Medicaid rules, payments from any source other than
Medicaid made on behalf of an individual patient must be
reimbursed to the Medicaid program by the treating facility.
For example, if Medicaid provided $150 per day for the care of
a veteran and the facility caring for the veteran receives $20
per day from the veteran's spouse, Medicaid is entitled to
reimbursement of the $20 received from the spouse. Recently,
Medicaid officials determined that VA per diem payments are
``additional payments'' made on behalf on an individual
patient. Thus, VA's per diem payments must now be reimbursed to
the Medicaid program.
The purpose of the VA's program of supporting State homes
is to provide high quality nursing home care to aging veterans.
VA's per diem payments are an integral part of that effort and
were never intended to be reimbursed to Medicaid. Section 203
of the Committee bill would assure that per diem payments
accomplish their intended purpose--assistance to the States in
providing care to veterans--and that they are not being passed
from one Governmental account (VA) to another (Medicaid).
Section 203 is not intended to alter the current rules
applicable to patients who wish to qualify for Medicaid
treatment. And it is not intended to exempt from Medicaid
recoupment any other payments made on behalf of a veteran.
Rather, the bill would simply specify that per diem payments
made by VA for the care of veterans in State homes will not be
used to offset or reduce any other payment made to assist
veterans in securing health care services.
Sec. 204. Care for newborn children of women veterans receiving
maternity care
Under current law, a former servicewoman can use her
eligibility for VA care to secure prenatal care, delivery
services, and postnatal care. In most instances, VA provides
such care by contract with community hospitals. VA does not,
however, provide care (or pay for care) needed by the veteran's
newborn following delivery.
In many cases, where a veteran-mother seeks care from VA,
the newborn is uninsured until a hospital social worker or the
newborn's parents can arrange for private healthcare coverage
or, in other cases, Medicaid assistance. This uninsured period
of time often reaches two weeks.
Section 204 of the Committee bill would authorize VA to
furnish care to a newborn child of a female veteran who is
receiving maternity care furnished by VA for up to 14 days
after the birth of the child. This authorization applies if the
veteran delivered the child in a VA facility or in a non-VA
facility under a contract agreement with VA.
Sec. 205. Centers for research, education, and clinical activities on
blast injuries of veterans
Modern technologies and advanced body armor have led to an
increase in the number of service personnel who survive
explosions while serving overseas in hostile territory.
Additionally, better triage and battlefield care have also
contributed to the increased survival rate among service
members who have suffered such injuries.
Section 205 of the Committee bill would establish at VA, in
collaboration with the Department of Defense, at least one, but
not more than three, War-Related Blast Injury Centers. These
centers would provide comprehensive rehabilitation programs,
targeted education and outreach programs, and research
initiatives. The structure for the Center(s) would be modeled
after similar research, education, and clinical centers that
now exist within VA, namely the Geriatric Research Education
and Clinical Centers and the Mental Illness Research Education
and Clinical Centers.
Sec. 206. Extension of various authorities relating to veterans
benefits
Special Medical Advisory Group
Under current law, VA is required to establish a Special
Medical Advisory Group to advise the Secretary on the care and
treatment provided to disabled veterans. The Special Medical
Advisory Group is required to report its findings to the
Secretary on February 1st of each year through December 31,
2004.
The contributions of this body are, in the Committee's
view, highly valuable. Section 206 would extend the authority
for the Special Medical Advisory Group through December 31,
2009.
Pilot program relating to long-term care
Public Law 106-117, the Veterans Millennium Health Care and
Benefits Act, established a three-year pilot program to
evaluate three different models of providing long-term care to
veterans. One model was to provide the care wholly ``in-house''
using VA employees. Another was to provide the entirety of care
by contract with a private provider. The third was to be a mix
of in-house and contract care. The law requires VA to report on
its experience under each of the models so that Congress might
determine whether it is appropriate to continue or promote the
advancement of any or all of the models.
The expiration date of the pilot falls during the summer of
2004. However, the report required by statute will not be
available until the spring of 2005. VA states that, absent an
extension in the underlying authority to provide these forms of
care, it will be forced to suspend contract-based care programs
before advising Congress as to whether the programs are
working.
Section 206 of the Committee bill allows the pilot program
to continue through December 31, 2005. This extension will
provide VA with sufficient time to evaluate its experience
under this pilot program, prepare the report, and allow a
reasonable opportunity for Congress to review its
recommendations.
Sec. 207. Annual reports on waiting times for appointments for health
care and services
In July 2002, VA took a ``one day snapshot look'' at
waiting times for clinical care in facilities throughout the
country. At that time, VA reported over 300,000 veterans were
waiting more than 30 days for appointments in primary and
specialty care clinics. Since then, members of the Committee
have received numerous complaints about widely-varying lengths
of time veterans must wait to see a physician at a VA medical
center. Anecdotally, Committee members have been told of waits
of up to one year.
In January 2004, VA required that all facilities schedule
an appointment within 30 days of a service-connected veteran's
request or, in the alternative, that the facility arrange for
care for that veteran at another VA facility or at a community
facility. Problems continue to persist for those who are not
service-connected inasmuch as they do not fall under this
directive.
In an effort to obtain more frequent updates on the
progress VA is making in reducing waiting times, Section 207 of
the Committee bill would require VA to report annually on
patient appointment waiting times. The required reports would
break out data by facility and service network, and would
contain data relating to both speciality and primary care
services.
Cost Estimate
In compliance with paragraph 11(a) of rule XXVI of the
Standing Rules of the Senate, the Committee, based on
information supplied by the Congressional Budget Office
(hereinafter, ``CBO''), estimates that enactment of the
Committee bill would increase direct spending for veterans
programs by $16 million over the 2005-2009 period, and $40
million over the 2005-2014 period. In addition, CBO estimates
that enactment of the Committee bill would cost $20 million in
2005 and $110 million over the 2005-2009 period, assuming
appropriation of the estimated amounts. Enactment of the
Committee bill might benefit public academic institutions in
the form of grants for research. And the Commonwealth of
Kentucky would benefit from the exclusive right to negotiate
for the VA Medical Center in Louisville, KY if VA chooses to
lease, convey, or dispose of the facility. Any costs to those
institutions would be incurred voluntarily.
The cost estimate provided by CBO, setting forth a detailed
breakdown of costs, follows:
Washington, DC,
September 2, 2004.
Hon. Arlen Specter,
Chairman, Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office
hasprepared the enclosed cost estimate for S. 2485, the Department of
Veterans Affairs Real Property Facilities Improvement Act of 2004.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sam
Papenfuss.
Sincerely,
Douglas Holtz-Eakin, Director.
S. 2485--Department of Veterans Affairs Real Property and Facilities
Management Improvement Act of 2004
Summary: S. 2485 would permanently extend the authority for
the Department of Veterans Affairs A) to provide counseling to
those veterans who have suffered from sexual trauma and would
allow VA to provide care to newborn infants when the mother is
a veteran receiving maternity care from the department. The
bill also would extend, through the end of calendar year 2005,
the authority for VA to provide long-term care for veterans
already enrolled in certain pilot programs and would direct VA
to create at least one center for research on blast injuries.
Additionally, S. 2485 would create a new fund, the Department
of Veterans Affairs Capital Asset Fund, that the department
could use to pay for certain construction projects, subject to
appropriation of the necessary amounts. Finally, the bill would
allow both the Veterans Benefits Administration (VBA) and the
National Cemetery Administration (NCA) to use enhanced-use
lease authority.
CBO estimates that implementing S. 2485 would cost $20
million in 2005 and $110 million over the 2005-2009 period,
assuming appropriation of the necessary amounts. CBO also
estimates that enacting S. 2485 would increase direct spending
for enhanced-use leases by $16 million over the 2005-2009
period, and about $40 million over the 2005-2014 period.
S. 2485 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
Public academic institutions may benefit from grants for
research and the state of Kentucky would benefit from exclusive
rights to negotiate for the Louisville Medical Center if the VA
chooses to lease, convey, or dispose of the facility; any costs
to those institutions or the state would be incurred
voluntarily.
Estimated cost to the Federal Government: The estimated
budgetary impact of S. 2485 is summarized in Table 1. The costs
of this legislation fall within budget function 700 (veterans
benefits and services).
TABLE 1.--ESTIMATED COSTS TO THE FEDERAL GOVERNMENT
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
--------------------------------------------
2005 2006 2007 2008 2009
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Estimated Authorization Level...................................... 28 22 21 23 17
Estimated Outlays.................................................. 20 25 24 24 17
CHANGES IN DIRECT SPENDING
Estimated Budget Authority......................................... 0 5 10 0 5
Estimated Outlays.................................................. 0 1 5 5 5
----------------------------------------------------------------------------------------------------------------
Basis of estimate: For this estimate, CBO assumes that the
bill will be enacted before the end of calendar year 2004 and
that the necessary amounts for implementing the bill will be
appropriated each year.
Spending subject to appropriation: CBO estimates that
implementing S. 2485 would increase discretionary spending for
veterans' medical care by $20 million in 2005 and $110 million
over the 2005-2009 period, assuming appropriation of the
necessary amounts (see Table 2).
TABLE 2.--SPENDING SUBJECT TO APPROPRIATION IN S. 2485
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-----------------------------------------------------
2004 2005 2006 2007 2008 2009
----------------------------------------------------------------------------------------------------------------
SPENDING SUBJECT TO APPROPRIATION
Spending Under Current Law for Veterans' Medical Care:
Estimated Authorization Level*........................ 27,957 28,888 29,706 30,608 31,117 32,104
Estimated Outlays..................................... 27,141 28,334 29,293 30,210 30,846 31,756
Proposed Changes:
Sexual Trauma Counseling:
Estimated Authorization Level..................... 0 7 11 11 12 12
Estimated Outlays................................. 0 7 10 11 12 12
Newborn Care:
Estimated Authorization Level..................... 0 3 4 4 5 5
Estimated Outlays................................. 0 3 4 4 5 5
Centers for Blast Injuries:
Estimated Authorization Level..................... 0 3 6 6 6 0
Estimated Outlays................................. 0 3 6 6 6 0
Capital Asset Fund:
Estimated Authorization Level..................... 0 10 0 0 0 0
Estimated Outlays................................. 0 2 4 3 1 0
Pilot Program Extension:
Estimated Authorization Level..................... 0 5 1 0 0 0
Estimated Outlays................................. 0 5 1 0 0 0
Total Changes:
Estimated Authorization Level..................... 0 28 22 21 23 17
Estimated Outlays................................. 0 20 25 24 24 17
Spending for Veterans' Medical Care Under S. 2485:
Estimated Authorization Level..................... 27,957 28,916 29,728 30,629 31,140 32,121
Estimated Outlays................................. 27,141 28,354 29,318 30,234 31,870 31,773
----------------------------------------------------------------------------------------------------------------
*The 2004 level is the amount appropriated for that year. No full-year appropriation has yet been provided for
fiscal year 2005. The current-law amounts for the 2005-2009 period assume appropriations remain at the 2004
level with adjustments for anticipated inflation.
Sexual Trauma Counseling. Section 202 would permanently
extend a provision allowing VA to provide counseling to
veterans who suffered from sexual trauma while serving on
active duty. Under current law, the authority to provide such
counseling expires on December 31, 2004. Using information from
VA, CBO estimates that about 2 percent (approximately 100,000)
of veterans who received care from VA were eligible to receive
counseling for sexual trauma in 2003. Data from VA, although
incomplete, suggests that about 5,000, or 5 percent, of those
eligible veterans received such counseling in 2003, at an
average per capita cost of almost $2,000. Assuming that about
this same number of veterans receives counseling for sexual
trauma each year over the 2005-2009 period, CBO estimates that
permanently extending this provision would cost $7 million in
2005 and $52 million over the 2005-2009 period, assuming
appropriation of the necessary amounts.
Newborn Care. Section 204 would allow VA to provide care to
newborn infants when the mother is a veteran receiving
maternity care from VA. According to VA, a little more than 700
women a year are expected to receive maternity care from VA.
Based on data from VA, CBO estimates that the cost of providing
neonatal care to those infants would be about $5,700 per infant
in 2005. (providing neonatal care for most infants would cost
much less; the high average cost is driven by those infants who
require extensive care for longer periods of time.) Based on
assumed enactment late in calendar year 2004, CBO estimates
that implementing section 204 would cost $3 million in 2005 and
$21 million over the 2005-2009 period, assuming appropriation
of the necessary amounts.
Centers for Blast Injuries. Section 205 would require VA to
establish at least one, but not more than three, centers for
research and study of blast injuries to provide better health
care for veterans with such injuries. The provision would
authorize $3 million in 2005 and $6 million for 2006, 2007, and
2008 for these centers and would require that VA provide
additional amounts if necessary. Based on information from VA,
CBO believes that the authorized amounts would be sufficient to
operate at least one center over the four years. Thus, CBO
estimates that implementing this section would cost $3 million
in 2005 and $21 million over the 2005-2008 period, assuming
appropriation of the authorized amounts.
Capital Asset Fund. Section 101 would make it easier for VA
to dispose of real property to both public and private entities
and would establish a new fund in the Treasury to be known as
the Department of Veterans Affairs Capital Asset Fund. Under
the bill, VA would be able to dispose of real property without
the requirement to use the General Services Administration
(GSA), though VA would still have to notify GSA of its intent
to dispose of real property. The proceeds from property
disposal would be deposited into the Capital Asset Fund and
could be used to pay for costs associated with the transfer of
property including demolition, environmental clean-up, and
administrative expenses. However, expenditures from the fund
would be subject to appropriation action. Thus, CBO does not
expect that VA would increase its sales or other dispositions
of real property.
Section 101 also would authorize the appropriation of $10
million to the Capital Asset Fund where it could be used for
the purposes stated above. Using historical spending patterns
for construction, CBO estimates that implementing this
provision would cost $3 million in 2005 and $10 million over
the 2005-2009 period, assuming appropriation of the authorized
amount.
Pilot Program Extension. Section 206 would allow VA to
extend three pilot programs for long-term care through the end
of calendar year 2005. According to VA, it spent about $5
million in 2003 on these pilot programs. Thus, CBO estimates
that implementing section 107 would cost about $5 million in
2005 and $6 million over the 2005-2006 period, assuming the
appropriation of the necessary amounts.
Direct spending
Section 102 would permit both the VBA and the NCA to use
enhanced-use leasing authority, which is only available to the
Veterans Health Administration (VHA) under current law. With
this enhanced-use leasing authority, VHA can lease land to
private partners for up to 75 years, and in exchange these
partners renovate or construct facilities on the land for the
benefit of VHA. Although the partner is allowed to lease the
facilities to non-VHA tenants, VHA has the priority for
occupancy. In February 2003, CBO published a study, The
Budgetary Treatment of Leases and Public/Private Ventures, that
examined how VHA had used its enhanced-use leasing authority.
That study found that VHA has used enhanced-use leases to
acquire office buildings for its regional headquarters, parking
facilities, nursing homes, and child care centers for its
employees.
Under its enhanced-use lease authority, VHA enters into an
array of long-term agreements with a property developer who
establishes a limited liability company, partnership, or other
special-purpose entity, specifically for the purpose of
renovating, constructing, operating, and maintaining the
facilities for each project. These agreements establish
government control over the project, protect the government's
interests, and ensure that VHA will receive guaranteed access
to whatever facility is being developed. For example, under its
enhanced-use leasing authority, VHA was able to obtain a new
regional headquarters facility in Chicago. Although VHA's
initial lease was for two years, that lease is automatically
renewed unless VHA decides to terminate the lease. Furthermore,
VHA must cover all of the project's financing, as long as it
maintains any presence in the building. Because agreements and
leases like the one described in thisexample allow VHA to
effectively acquire new buildings, CBO believes that the full cost of
the project should be recorded up front in the budget. We assume that
VBA and NCA would use enhanced use lease authority in a similar manner
as VHA. Accordingly, CBO expects that an authorization to use enhanced-
use lease authority would result in new direct spending.
Over the past 10 years, CBO estimates that VHA has entered
into enhanced-use leases with a total value of more than $300
million over that period, though VHA's activity has increased
significantly in the last few years. Because the value of real
property owned by both VBA and NCA is much less than VHA, the
total value of enhanced-use leases for the two agencies would
be correspondingly lower. Although we do not have information
on leasing plans for VBA and NCA, we assume that over the next
10 years VBA and NCA would use this authority to acquire three
new office buildings and three other projects such as child
care centers or parking facilities.
Based on information from the General Services
Administration, CBO estimates that each additional building
would cost about $10 million. We assume that the smaller
projects would cost about $5 million each. Accordingly, CBO
estimates that enacting section 102 would increase direct
spending for enhanced-use leases by $16 million over the 2005-
2009 period and about $40 million over the 2005-1014 period, as
shown in Table 3. The timing of those projects is uncertain.
Table 3 shows one plausible set of staggered acquisitions;
actual project commitments could be either faster or slower
than shown.
Intergovernmental and private sector impact: S. 2485
contains no intergovernmental or private-sector mandates as
defined in UMRA. Public academic institutions may benefit from
grants for research and the state of Kentucky would benefit
from exclusive rights to negotiate for the Louisville Medical.
Center if the VA chooses to lease, convey, or dispose of the
facility; any costs to those institutions or the state would be
incurred voluntarily.
TABLE 3.--CHANGES IN DIRECT SPENDING UNDER S. 2485
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
---------------------------------------------------------------------
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
----------------------------------------------------------------------------------------------------------------
Estimated Budget Authority................ 0 5 10 0 5 10 0 5 10 0
Estimated Outlays......................... 0 1 5 5 5 5 5 5 5 5
----------------------------------------------------------------------------------------------------------------
Previous CBO estimates: Many of the provisions in S. 2485
are similar or identical to provisions in other bills recently
estimated by CBO and have similar or identical costs. The
differences in estimated costs between those estimates reflect
differences in the bills.
On June 4, 2004, CBO transmitted a cost estimate for H.R.
4248, the Homeless Veterans Assistance Reauthorization Act of
2004, as ordered reported by the House Committee on Veterans'
Affairs on May 19, 2004. Section 3 of H.R. 4248, which would
permanently extend the authority to provide counseling to
veterans who suffered from sexual trauma, is almost identical
to section 202 of S. 2485; the estimated costs for those two
sections are identical. H.R. 4248 also contains a provision
that would authorize increased spending for homeless veterans.
S. 2485 does not contain a similar provision.
On August 24, 2004, CBO transmitted a cost estimate for
H.R. 4658, the Service members and Veterans Legal Protections
Act of 2004, as ordered reported by the House Committee on
Veterans' Affairs on July 21, 2004. Section 402 of H.R. 4658,
which would allow VA to provide care to newborn infants when
the mother is a veteran receiving maternity care from VA, is
identical to section 204 of S. 2485, as are the estimated
costs. H.R. 4658 contains other provisions regarding education,
disability compensation, and pension benefits for veterans, as
well as VA's fiduciary responsibilities. S. 2485 does not
contain similar provisions.
On August 26, 2004, CBO transmitted a cost estimate for
H.R. 4768, the Veterans Health Programs and Facilities
Enhancement Act of 2004, as ordered reported by the House
Committee on Veterans' Affairs on July 21, 2004. section 102 of
H.R. 4768, which would establish the Capital Asset Fund, is
different in minor ways from section 101 of S. 2485, though the
estimated costs are identical for the two sections. In
addition, section 107 of H.R. 4768, which would extend the
operation of certain pilot programs for long-term care, is
similar to section 206 in S. 2485, and the estimated costs are
the same. H.R. 4758 also contains provisions that would
authorize the leasing of medical facilities and the creation of
medical preparedness centers, while S. 2485 does not.
Finally, S. 2485 contains a provision to create a center
for the research and study of blast injuries that does not
appear in any of the above bills.
Regulatory Impact Statement
In compliance with paragraph 11(b) of rule XXVI of the
Standing Rules of the Senate, the Committee on Veterans'
Affairs has made an evaluation of the regulatory impact that
would be incurred in carrying out the Committee bill. The
Committee finds that the Committee bill would not entail any
regulation of individuals or businesses or result in any impact
on the personal privacy of any individuals and that the
paperwork resulting from enactment would be minimal.
Tabulation of Votes Cast by Committee
In compliance with paragraph 7 of rule XXVI of the Standing
Rules of the Senate, the following is a tabulation of votes
cast in person or by proxy by members of the Committee on
Veterans' Affairs at its July 22, 2004, meeting. On that date,
the Committee, by unanimous voice vote, ordered S. 2485, as
amended, a bill to improve and enhance the authorities of the
Secretary of Veterans Affairs relating to the management and
disposal of real property and facilities, and for other
purposes, as amendment, reported favorably to the Senate.
Agency Report
On June 22, 2004, Deputy Secretary of Veterans Affairs, the
Honorably Gordon H. Mansfield, appeared before the Committee on
Veterans' Affairs and submitted testimony on, among other
things, S. 2486, as introduced, and also on the following
additional bills from which provisions in S. 2485, as amended,
are derived: S. 2099, S. 2522, and S. 2534. Excerpts from this
statement are reprinted below:
Statement of the Honorable Gordon Mansfield, Deputy Secretary of
Veterans Affairs
This bill contains provisions designed to improve VA's
enhanced-use lease program under 38 U.S.C. Sec. Sec. 8161 et
seq. We acknowledge the need to reform the enhanced-use (EU)
leasing process to make it more efficient, as recommended by
the Capital Asset Realignment for Enhanced Services (CARES)
Commission's February 2004 report to the Secretary, and we
appreciate the Committee's interest in this subject. We note
that such interest already has led to inclusion of many of the
bill's provisions in legislation enacted as Public Law 108-170
(i.e., requiring only one notice to Congress of VA's intent to
enter into an EU lease, reducing the congressional notice and
review period before executing such lease from 90 to 45 days,
reducing by the same number of days the congressional notice
and review period regarding a planned disposal of EU leased
property, giving the Secretary sole discretion and control of
such property disposal by eliminating GSA involvement in the
process, and authorizing use of EU lease proceeds to reimburse
VA appropriations for expenses incurred in developing
additional EU leases). That legislation, together with other
initiatives we are pursuing, will help us to significantly
reduce the time required to consummate these lease
transactions.
Mr. Chairman, we also appreciate the provisions that
recognize our EU lease projects can and do involve initiatives
not only of the Veterans Health Administration, but also of the
Veterans Benefits Administration (VBA) and National Cemetery
Administration (NCA). In this regard, section 3 would authorize
EU leases implementing VBA and NCA business plans providing for
applying lease consideration to programs and activities of
those Administrations. Further, it would direct that net
proceeds from VBA or NCA EU leases be credited to applicable
appropriations of the affected Administration. We are studying
the budgetary impact of the latter provision and, following
executive-branch review, will advise the Committee of our
views.
Finally, should a Capital Asset Fund be established (as
proposed under this bill), we would support having the proceeds
from a disposal of EU lease property deposited into such fund
as provided by this bill.
Disposal of VA Property
S. 2485 would authorize VA to dispose of its excess real
property by sale, transfer or exchange to a Federal agency, a
state or political subdivision of a state or to any public or
private entity and to retain the proceeds generated by the
disposals. Under the proposal, the disposal of real property
would be exempt from GSA's requirements in 40 U.S.C.
Sec. Sec. 521, 522 and 541-545 and those in the McKinney-Vento
Homeless Assistance Act (which provides that unused or
underutilized Federal real property may be used to assist the
homeless). VA would receive compensation equal to the fair
market value of the property, and the proceeds would be
deposited in a Capital Asset Fund (the ``Fund''), as provided
for by this legislation. The bill would also terminate the
Nursing Home Revolving Fund and deposit funds therein into the
Fund.
Amounts in the Fund would have to be used for the costs of
actual or planned disposals of real estate, including
demolition, environmental cleanup, necessary improvement to
facilitate the sales, transfers or exchanges, and
administrative expenses. They could also be used for non-
recurring VA capital projects.
We support S. 2485 because it would eliminate an existing
disincentive to the disposal of Departmental real property.
Currently, VA must report all transfers of real property valued
in excess of $50,000 (to another Federal agency or to a state
or a political subdivision of a state for fair market value) in
its annual budget document. This is administratively
burdensome. Further, absent extension of current appropriations
law allowing proceeds from the disposal of excessed property to
be deposited in the Medical Care Collections Fund, provisions
in title 38, United States Code, require such proceeds to be
deposited into the Nursing Home Revolving Fund. S. 2485 would
enhance VA's ability to manage Departmental capital resources,
while promoting efficiencies and cost savings. However, we
suggest the proposal be amended to provide that VA receive
consideration not less than the fair market value of the
disposed property to maximize the Government's return.
Limits on Disposal Authority
S. 2485 would also limit VA's authority to dispose of real
property in excess of the major medical facility project dollar
limitation unless the disposal has been in the budget
justification documents for the current fiscal year. The bill
would also require VA to receive consideration equal to the
fair market value of the property. Proceeds from disposals
would be similarly deposited in the Fund.
VA supports this proposal. However, we again recommend that
the bill language be amended to require VA receive
consideration that is not less than the fair market value of
the property.
Advance Planning Funding for Major Medical Facilities
S. 2485 would also exempt projects that have already been
authorized by law from current statutory notice and wait
requirements that apply to certain major medical facility
projects. It would also do so for such projects that are
included in the President's budget. VA supports this proposal.
National Cemetery Administration Property
We are pleased that S. 2485 also includes VA's proposal to
permit the leasing of unused or underutilized real property
that is administered by the National Cemetery Administration.
These leases would be limited to a maximum term of ten years.
Leases to a public or non-profit organization would not be
required to be advertised. Consideration for these leases could
be monetary or, in whole or in part, maintenance, protection or
restoration of the leased property. Proceeds would be deposited
in a special account in the Treasury, The National Cemetery
Administration Facilities Operation Fund (the ``NCA Fund''),
and available until expended. The NCA Fund would consist of
amounts appropriated by law, the proceeds from the leases of
land or buildings or agricultural licenses, and any other
amounts authorized by law. Again, we appreciate your inclusion
of this VA proposal in the bill and strongly urge its
enactment.
Co-payment Exemption for Hospice Care
S. 2486 would exempt veterans receiving hospice care under
VA's extended care services program from the requirement to
agree to pay co-payments. We support section 311 but recommend
that its scope be broadened to include hospice care provided in
any treatment setting. Currently, veterans receiving hospice
care through the Department may be subject to a co-payment,
which can vary depending upon the type of VA facility or
setting in which the care is given.
Permanent Authority for Sexual Trauma Care and Counseling Program
This bill would also permanently authorize VA's sexual
trauma care and counseling program. We strongly support this
proposal, noting that it is identical to a legislative proposal
we submitted to Congress in 2003. Making this particular
treatment authority permanent is essential. The number of
veterans seeking VA counseling and treatment for military
sexual trauma continues to increase. Likewise, the number of
women who serve in the Armed Forces, the Reserves, and the
National Guard continues to grow. VA must be able to provide
needed sexual trauma counseling and related health care to
these current and future veterans without any lapse in program
authority. We estimate there would be no additional costs
associated with enactment of this section.
S. 2417--Newborn Care
S. 2417 would authorize VA to provide care to newborn
children of women veterans for whom VA furnishes maternity and
delivery care. To receive this benefit, the mother must be
enrolled in the VA health care system. Currently, VA has no
authority to provide care to newborns, although VA provides
maternity benefits as part of its medical benefits package.
We strongly support this bill, which is identical to a
legislative proposal we submitted to Congress in 2003. After
childbirth, some veterans may need this limited benefit to give
them time to apply for medical assistance. Offering this care
would also be consistent with the normal pregnancy and delivery
coverage in the community. The modest cost of the proposal was
included in the President's Budget submitted earlier this year.
S. 2327--State Home Per Diem Payment--Relation to Medicaid
For many years, a number of State homes have accepted both
VA per diem payments for the care of veterans and Medicaid
payments for those veterans without reducing the Medicaid
payments by the amount of per diem payments. The Department of
Health and Human Services (HHS) has determined that this
practice violates its rules and is investigating whether to
seek reimbursement. S. 2327 appears aimed at rectifying this
situation by deeming that VA state home per diem payments
``shall not be considered a liability of a third party, or
otherwise be utilized to offset or reduce any other payment
made to assist veterans.'' Because this bill would primarily
impact the Medicaid program, we defer to the views of HHS on
the matter.
S. 2296--Option for Commonwealth of Kentucky for Certain Property
Mr. Chairman, S. 2296 would grant the Commonwealth of
Kentucky a first option should the VA decide to convey, lease
or otherwise dispose of the Louisville, KY Veterans Affairs
Medical Center. This bill would require the VA to negotiate
with the Commonwealth of Kentucky and restrict for one year the
Department from negotiating with any other party.
Let me note first of all that because VA does not presently
have direct disposal authority, we do not currently have the
authority to negotiate with the Commonwealth. However, as
discussed earlier in my statement, we do support being given
such disposal authority. Having said that, we, nonetheless,
oppose this legislation because we believe it could prevent VA
from achieving maximum value from disposal of the property
should the property no longer be needed by VA. Achieving best
value in a property transaction involves market timing and
competition, and this proposal would remove both of these
considerations.
S. 2133--Designation of Bronx VAMC
This bill would designate the Bronx VAMC as the ``James J.
Peters Department of Veterans Affairs Medical Center.'' We
defer to Congress in the naming of federal property.
Changes in Existing Law Made by the Committee Bill, as Reported
In compliance with rule XXVI paragraph 12 of the Standing
Rules of the Senate, changes in existing law made by the
Committee bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
* * * * * * *
Subchapter II--Hospital, Nursing Home, or Domiciliary and Medical
Treatment
* * * * * * *
Sec. 1710B. Extended care services
* * * * * * *
(c)(1) * * *
(2)(A) to a veteran whose annual income (determined under
section 1503 of this title) is less than the amount in effect
under section 1521(b) of this title; [or]
(B) to a veteran being furnished hospice care under this
section; or
[(B)] (C) with respect to an episode of extended care
services that a veteran is being furnished by the Department on
November 30, 1999.
* * * * * * *
Sec. 1720D. Counseling and treatment for sexual trauma
(a)(1) [During the period through December 31, 2004, the
Secretary] The Secretary shall operate a program under which
the Secretary provides counseling and appropriate care and
services to veterans who the Secretary determines require such
counseling and care and services to overcome psychological
trauma, which in the judgment of a mental health professional
employed by the Department, resulted from a physical assault of
a sexual nature, battery of a sexual nature, or sexual
harassment which occurred while the veteran was serving on
active duty.
(2) In operating the program under paragraph (1), the
Secretary shall also provide counseling and appropriate care
and services to former members of the Reserves who the
Secretary determines require such counseling and care and
services to overcome psychological trauma, which in the
judgment of such a mental health professional, resulted from a
physical assault of a sexual nature, battery of a sexual
nature, or sexual harassment which occurred while such
individual was a member of the Reserves not serving on active
duty.
[(2)] (3) In furnishing counseling to [a veteran] an
individual underthis subsection, the Secretary may [, during
the period through December 31, 2004,] provide such counseling pursuant
to a contract with a qualified mental health professional if (A) in the
judgment of a mental health professional employed by the Department,
the receipt of counseling by [that veteran] that individual in
facilities of the Department would be clinically inadvisable, or (B)
Department facilities are not capable of furnishing such counseling to
[that veteran] that individual economically because of geographical
inaccessibility.
* * * * * * *
(c) The Secretary shall provide information on the
counseling and treatment available to veterans and other
individuals under this section. Efforts by the Secretary to
provide such information--
(1) shall include availability of a toll-free
telephone number (commonly referred to as an 800
number);
(2) shall ensure that information about the
counseling and treatment available to veterans and
other individuals under this section--
(A) is revised and updated as appropriate:
(B) is made available and visibly posted at
appropriate facilities of the Department; and
(C) is made available through appropriate
public information services; and
(3) shall include coordination with the Secretary of
Defense seeking to ensure that individuals who are
being separated from active military, naval, or air
service are provided appropriate information about
programs, requirements, and procedures for applying for
counseling and treatment under this section.
* * * * * * *
Subchapter III--Miscellaneous Provisions Relating to Hospital and
Nursing Home Care and Medical Treatment of Veterans
* * * * * * *
Sec. 1730A. Annual reports on waiting times for appointments for care
and services
* * * * * * *
Sec. 1730A. Annual reports on waiting times for appointments for care
and services
(a) Annual Reports.--Not later than January 31 each year,
the Secretary shall submit to the Committees on Veterans'
Affairs of the Senate and the House of Representatives a report
on the waiting times of veterans for appointments for care and
services from the Department under this chapter during the
preceding year.
(b) Report Elements.--Each report under subsection (a)
shall specify, for the year covered by the report, the
following:
(1) A tabulation of the waiting time of veterans for
appointments with the Department for each category of
primary or specialty care or services furnished by the
Department, broken out by particular Department
facility and by Veterans Integrated Service Network.
(2) An identification of the categories of specialty
care or services for which there are lengthy delays for
appointments at particular Department facilities or
throughout particular Veterans Integrated Service
Networks, and, for each category so identified,
recommendations for the reallocation of personnel,
financial, and other resources to address such delays.
* * * * * * *
Subchapter V--Payments to State Homes
Sec. 1741. Criteria for payment
(a) * * *
* * * * * * *
(e) Payments to States pursuant to this section shall not
be considered a liability of a third party, or otherwise be
utilized to offset or reduce any other payment made to assist
veterans.
* * * * * * *
Subchapter VIII--Health Care of Persons Other Than Veterans
* * * * * * *
Sec. 1786. Care for newborn children of women veterans receiving
maternity care
* * * * * * *
Sec. 1786. Care for newborn children of women veterans receiving
maternity care
The Secretary may furnish care to a newborn child of a
woman veteran who is receiving maternity care furnished by the
Department for up to 14 days after the birth of the child if
the veterans delivered the child in a Department facility or in
a non-Department facility pursuant to a Department contract for
the delivery services.
CHAPTER 24--NATIONAL CEMETERIES AND MEMORIALS
* * * * * * *
Sec. 2412. Lease of land and buildings
* * * * * * *
Sec. 2412. Lease of Land and Buildings
(a) Lease Authorized.--The Secretary may lease any
undeveloped land and unused or underutilized buildings, or
parts and parcels thereof, belonging to the United States and
part of the National Cemetary Administration.
(b) Term.--The term of a lease under subsection (a) may not
exceed 10 years.
(c) Lease to Public or Nonprofit Organizations.--(1) A
lease under subsection (a) to any public or nonprofit
organization may be made without regard to the provisions of
section 3709 of the Revised Statutes (41 U.S.C. 5).
(2) Notwithstanding section 1302 of title 40 or any other
provision of law, a lease under subsection (a) to any public or
nonprofit organization may provide for the maintenance,
protection, or restoration of the leased property by the
lessee, as part or all of the consideration for the lease.
(d) Notice.--Before entering into a lease under subsection
(a), the Secretary shall give appropriate public notice of the
intention of the Secretary to enter into the lease in a
newspaper of general circulation in the community in which the
lands or building concerned are located.
(e) National Cemetery Administration Facilities Operation
Fund.--
(1) There is established on the book of the Treasury
an account to be known as the ``National Cemetery
Administration Facilities Operation Fund'' (in this
section referred to as the ``Fund'').
(2) The Fund shall consist of the following:
(A) Amounts authorized to be appropriated to
the Fund.
(B) Proceeds from the lease of land or
buildings under this section.
(C) Proceeds of agricultural licenses of
lands of the National Cemetery Administration.
(D) Any other amounts authorized for deposit
in the Fund by law.
(3) Amounts in the Fund shall be available to cover
costs incurred by the National Cemetery Administration
in the operation and maintenance of property of the
Administration.
(4) Amounts in the Fund shall remain available until
expended.
* * * * * * *
CHAPTER 73--VETERANS HEALTH ADMINISTRATION--ORGANIZATION AND FUNCTIONS
* * * * * * *
Subchapter II--General Authority and Administration
* * * * * * *
Sec. 7327. Centers for research, education, and clinical activities on
blast injury
* * * * * * *
Sec. 7312. Special medical advisory group
(a) * * *
* * * * * * *
(d) Not later than February 1 of each year, the special
medical advisory group shall submit to the Secretary and the
Congress a report on the activities of the advisory group
during the preceding fiscal year. No report shall be required
under this subsection after [December 31, 2004] December 31,
2009.
* * * * * * *
Sec. 7327. Centers for research, education, and clinical activities on
blast injuries
(a) Purpose.--The purpose of this section is to provide for
the improvement of the provision of health care services and
related rehabilitation and education services to eligible
veterans suffering from multiple traumas associated with a
blast injury through--
(1) the conduct of research to support the provision
of such services in accordance with the most current
evidence on blast injuries;
(2) the education and training of health care
personnel of the Department; and
(3) the development of improved models and systems
for the furnishing of services by the Department for
blast injuries
(b) Establishment.--(1) The Secretary shall establish and
operate at lease one, but not more than three, centers for
research, education, and clinical activities on blast injuries.
(2) Each center shall function as a center for--
(A) research on blast injury to support the provision
of services in accordance with the most current
evidence on blast injuries, with such research to
specifically address injury epidemiology and cost
functional outcomes, blast injury taxonomy and
measurement system, and longitudinal outcomes;
(B) the development of a rehabilitation program for
blast injuries, including referral protocol, post-acute
assessment, and coordination of comprehensive treatment
service;
(C) the development of protocols to optimize linkages
between the Department and the Department of Defense on
matters relating to research, education, and clinical
activities on blast injuries;
(D) the creation of innovative models for education
and outreach on healthcare and related rehabilitation
and education services on blast injuries, with such
education and outreach to target those who have
sustained a blast injury and health care providers and
researchers in the Veterans Health Administration, the
Department of Defense, and the Department of Homeland
Security;
(E) the development of educational tools and products
on blast injuries, and the maintenance of such tools
and products in a resource clearinghouse that can serve
as resources for the Veterans Health Administration,
the Department of Defense, the Department of Homeland
Security, and other departments and agencies of the
federal government:
(F) the development of interdisciplinary training
programs on the provision of health care and
rehabilitation care services for blast injuries that
provide an integrated understanding of the continuum of
care for such injuries to the broad range of providers
of such services, including first responders, acute
care providers, and rehabilitation service providers;
and
(G) the implementation of strategies for improving
the medical diagnostic coding of blast injuries in the
Department to reliably identify veterans with blast
injuries and track outcomes over time,
(3) The Secretary may designate a center on this section
only if--
(A) the proposal submitted for the designation of the
center meets the requirements of subsection (c);
(B) the Secretary makes the findings described in
subsection (d); and
(C) the peer review panel established under
subsection (e) makes the determination specified in
subsection (e)(3) with respect to that proposal.
(c) Proposal Requirements.--A proposal submitted for the
designation of a center under this subsection shall--
(1) provide for close collaboration in the
establishment and operation of the center, and for the
provision of care and the conduct of research and
education at the center, by a Department facility or
facilities (in this subsection referred to as
`collaborating facilities') in the same geographic area
that have a mission centered on the care of individuals
with blast injuries and a Department facility in that
area which has a mission of providing tertiary care;
(2) provide that not less than 50 percent of the
funds appropriated for the center for support of
clinical care, research, and education will be provided
to the collaborating facilities with respect to the
center; and
(3) provide for a governance arrangement among the
facilities described in paragraph (1) with respect to
the center that ensures that the center will be
established and operated in a manner aimed at improving
the quality of care for blast injuries at the
collaborating facilities with respect to the center.
(d) Finding Related to Proposals.--The finding referred to
in subsection (b)(4)(B) with respect to a proposal for the
designation of a site as a location of a center under this
section is a finding by the Secretary, upon the recommendation
of the Under Secretary for Health, that the facilities
submitting the proposal have developed (or may reasonably be
anticipated to develop) each of the following:
(1) An arrangement with an affiliated accredited
medical school or university that provides education
and training in disaster preparedness, homeland
security, and bio-defense.
(2) Comprehensive and effective treatment services
for head injury, spinal cord injury, audiology,
amputation, gait and balance, and mental health.
(3) The ability to attract scientists who have
demonstrated achievement in research--
(A) into the evaluation of innovative
approaches to the rehabilitation of blast
injuries; or
(B) into the treatment of blast injuries
(4) The capability to evaluate effectively the
activities of the center, including activities relating
to the evaluation of specific efforts to improve the
quality and effectiveness of services on blast injuries
that are provided by the Department at or through
individual facilities.
(e) Department Support on Evaluation of Center Proposals.--
(1) In order to provide advice to assist the Secretary or Under
Secretary for Health to carry out their responsibilities under
this section, the official within the central office of the
Veterans Health Administration responsible for blast injury
matters shall establish a peer review panel to assess the
scientific and clinical merit of proposals that are submitted
to the Secretary for the designation of centers under this
section.
(2) The panel shall consist of experts in the fields of
research, education and training, and clinical care on blast
injuries. Members of the panel shall serve as consultants to
the Department.
(3) The panel shall review each proposal submitted to the
panel by the official referred to in paragraph (1`) and shall
submit to that official its views on the relative scientific
and clinical merit of each such proposal. The panel shall
specifically determine with respect to each such proposal
whether or not that proposal is among those proposals which
have met the highest competitive standards of scientific and
clinical merit.
(4) The panel shall not be subject to the Federal Advisory
Committee Act (5 U.S.C. App.).
(f) Award of Funding.--Clinical and scientific
investigation activities at each center established under this
section--
(1) may compete for the award of funding from amount
appropriated for the Department for medical and
prosthetic research; and
(2) shall receive priority in the award of funding
from such amounts insofar as funds are awarded from
such amounts to projects and activities relating to
blast injuries.
(g) Dissemination of Information.--(1) The Under Secretary
for Health shall ensure that information produced by the
centers established under this section that may be useful for
other activities of the Veterans Health Administration is
disseminated throughout the Administration.
(2) Information shall be disseminated under this subsection
through publications, through programs of continuing medical
and related education provided through regional medical
education centers under subchaper VI of chapter 74 of this
title, and through other means. Such programs of continuing
medical education shall receive priority in the award of
funding.
(h) Supervision.--The official within the central office of
the Veterans Health Administration responsible for blast injury
mattersshall be responsible for supervising the operation of
the centers established under this section and shall provide for
ongoing evaluation of the centers and their compliance with the
requirements of the section.
(i) Authorization of Appropriations--(1) There are
authorized to be appropriated to the Department of Veterans
Affairs for the centers established under this section amounts
as follows:
(A) $3,125,000 for fiscal year 2005.
(B) $6,250,000 for each of fiscal years 2006 through
2008.
(2) In addition to amounts authorized to be appropriated by
paragraph (1) for a fiscal year, the Under Secretary for Health
shall allocate to each center established under this section,
from other funds authorized to be appropriated for such fiscal
year for the Department generally for medical and prosthetics
research, such additional amounts as the Under Secretary
determines appropriate to carry out the purpose of this section
* * * * * * *
CHAPTER 81--ACQUISITION AND OPERATION OF HOSPITAL AND DOMICILIARY
FACILITIES; PROCUREMENT AND SUPPLY; ENHANCED-USE LEASES OF REAL
PROPERTY
Subchapter I--Acquisition and Operation of Medical Facilities
* * * * * * *
[Sec. 8816. Nursing Home Revolving Fund]
* * * * * * *
Sec. 8104. Congressional approval of certain medical facility
acquisitions
(a) * * *
* * * * * * *
(g) The limitation specified in subsection (f) shall not
apply to projects for which funds have already been authorized
by law in accordance with subsection (a)(2).
Sec. 8109. Parking facilities
(a) * * *
* * * * * * *
(j) Funds in a construction account or capital account that
are available for a construction project or non-recurring
maintenance project may be used for the construction or
relocation of a surface parking lot incidental to such a
project.
Sec. 8110. Operation of medical facilities
(a) * * *
* * * * * * *
(e)(1) The Secretary may not implement a mission change for
a medical facility (other than a mission change prescribed by
the Secretary of the Capital Asset Realignment for Enhanced
Services (CARES) initiative) until 90 days after the date on
which the Secretary submits to the committees written notice of
the mission change.
(2) For purposes of this subsection, a mission change for a
medical facility shall consist of any of the following:
(A) Closure of the facility.
(B) Consolidation of the facility.
(C) An administration reorganization of the facility
covered by section 510(b) of this title.
(3) Written notice of a mission change for a medical
facility under paragraph (1) shall include--
(A) an assessment of the impact of the mission change
on the population of veterans served by the facility;
(B) a description of the availability and quality of
health care, including long-term care, mental health
care, and substance abuse programs, available in the
area served by the facility;
(C) an assessment of the impact of the mission change
on the economy of the community in which the facility
is located; and
(D) an analysis of any alternatives to the mission
change proposed by the community in which the facility
is located, organizations recognized by the Secretary
under section 5902 of this title, organizations that
represent Department employees in such community, or
the Department.
(4) In the case of a mission change covered by paragraph
(1) that is also an administrative reorganization covered by
section 510(b) of this title, both this subsection and such
section 510(b) shall apply with respect to the implementation
of such mission change.
[(e)] (f) The Secretary shall submit to the Committee on
Veterans' Affairs of the Senate and the House of
Representatives, not later than January 20 of each year, a
report documenting by network for the preceding fiscal year the
following:
(1) The number of medical service and surgical
service beds, respectively, that were closed during
that fiscal year and, for each such closure, a
description of the changes in delivery of services that
allowed such closure to occur.
(2) The number of nursing home beds that were the
subject of a mission change during that fiscal year and
the nature of each such mission change.
[(f)] (g) For purposes of this section:
(1) The term ``closure'', with respect to beds in a
medical center,means ceasing to provide staffing for,
and to operate, those beds. Such term includes converting the provision
of such bed care from care in a Department facility to care under
contract arrangements.
(2) The term ``bed section'', with respect to a
medical center, means psychiatric beds (including beds
for treatment of substance abuse and post-traumatic
stress disorder), intermediate, neurology, and
rehabilitation medicine beds, extended care (other than
nursing home) beds, and domiciliary beds.
(3) The term ``justification'', with respect to
closure of beds, means a written report that includes
the following:
(A) An explanation of the reasons for the
determination that the closure is appropriate
and advisable.
(B) A description of the changes in the
functions to be carried out and the means by
which such care and services would continue to
be provided to eligible veterans.
(C) A description of the anticipated effects
of the closure on veterans and on their access
to care.
* * * * * * *
[Sec. 8116. Nursing home revolving fund
[(a)(1) Amounts realized from a transfer pursuant to
section 8122(a)(2)(C) of this title shall be administered as a
revolving fund and shall be available without fiscal year
limitation.
[(2) The revolving fund shall be deposited in a checking
account with the Treasurer of the United States.
[(b)(1) The expenditure of funds from the revolving fund
may be made only for the construction, alteration, and
acquisition (including site acquisition) of nursing home
facilities and may be made only as provided for in
appropriation Acts.
[(2) For the purpose of section 8104(a)(2) of this title, a
bill, resolution, or amendment which provides that funds in the
revolving fund may be expended for a project involving a total
expenditure of more than $2,000,000 for the construction,
alteration, or acquisition (including site acquisition) of a
nursing home facility shall be considered to be a bill,
resolution, or amendment making an appropriation which may be
expended for a major medical facility project.]
Sec. 8122. Authority to procure [and dispose of] property and to
negotiate for common services
(a)[(1)] The Secretary may lease for a term not exceeding
three years lands or buildings, or parts or parcels thereof,
belonging to the United States under the Secretary's control.
Any lease made pursuant to this subsection to any public or
nonprofit organization may be made without regard to the
provisions of section 3709 of the Revised Statutes (41 U.S.C.
5). Notwithstanding section 1302 of title 40, or any other
provision of law, a lease made pursuant to this subsection to
any public or nonprofit organization may provide for the
maintenance, protection, or restoration, by the lessee, of the
property leased, as a part or all of the consideration for the
lease. Prior to the execution of any such lease, the Secretary
shall give appropriate public notice of the Secretary's
intention to do so in the newspaper of the community in which
the lands or buildings to be leased are located. The proceeds
from such leases, less expenses for maintenance, operation, and
repair of buildings leased for living quarters, shall be
covered into the Treasury of the United States as miscellaneous
receipts.
[(2)(A) Except as provided in paragraph (3) of this
subsection, the Secretary may not during any fiscal year
transfer to another Federal agency or to a State (or any
political subdivision of a State) any interest in real property
described in subparagraph (B) of this paragraph unless (i) the
transfer (as proposed) was described in the budget for that
fiscal year submitted to Congress pursuant to section 1105 of
title 31, and (ii) the Department receives compensation equal
to the fair market value of the property.
[(B) An interest in real property described in this
subparagraph is an interest in real property that is owned by
the United States and administered by the Department and that
has an estimated value in excess of $50,000.
[(C) Amounts realized from the transfer of any interest in
real property described in subparagraph (B) of this paragraph
shall be deposited in the nursing-home revolving fund
established under section 8116 of this title.
[(3)(A) Subject to subparagraph (B) of this paragraph, the
Secretary may, without regard to paragraph (2) of this
subsection or any other provision of law relating to the
disposition of real property by the United States, transfer to
a State for use as the site of a State nursing-home or
domiciliary facility real property described in subparagraph
(E) of this paragraph which the Secretary determines to be
excess to the needs of the Department.
[(B) A transfer of real property may not be made under this
paragraph unless--
[(i) the Secretary has determined that the State has
provided sufficient assurance that it has the resources
(including any resources which are reasonably likely to
be available to the State under subchapter III of
chapter 81 of this title and section 1741 of this
title) necessary to construct and operate a State home
nursing or domiciliary care facility; and
[(ii) the transfer is made subject to the conditions
(I) that the property be used by the State for a
nursing-home or domiciliary care facility in accordance
with the conditions and limitations applicable to State
home facilities constructed with assistance under
subchapter III of chapter 81 of this title, and (II)
that, if the property is used at any time for any other
purpose, all right, title, and interest in and to the
property shall revert to the United States.
[(C) A transfer of real property may not be made under this
paragraph until--
[(i) the Secretary submits to the Committees on
Veterans' Affairs of the Senate and House of
Representatives, not laterthan June 1 of the year in
which the transfer is proposed to be made (or the year preceding that
year), a report providing notice of the proposed transfer; and
[(ii) a period of 90 consecutive days elapses after
the report is received by those committees.
[(D) A transfer under this paragraph shall be made under
such additional terms and conditions as the Secretary considers
appropriate to protect the interests of the United States.
[(E) Real property described in this subparagraph is real
property that is owned by the United States and administered by
the Secretary.]
* * * * * * *
[(d) Real property under the jurisdiction of the Secretary
may not be declared excess by the Secretary and disposed of by
the General Services Administration or any other entity of the
Federal Government unless the Secretary determines that the
property is no longer needed by the Department in carrying out
its functions and is not suitable for use for the provision of
services to homeless veterans by the Department or by another
entity under an enhanced-use lease of such property under
section 8162 of this title.]
Sec. 8122A. Disposal of real property
(a) Authority To Dispose of Real Property.--To the extent
provided in advance in appropriations Acts, the Secretary may
dispose of real property of the Department, including land and
structures and equipment associated with such property, that is
under the jurisdiction or control of the Secretary by--
(1) transfer to or exchange with another department
or agency of the Federal Government;
(2) conveyance to or exchange with a State or a
political subdivision of a State, an Indian tribe, or
another public entity; or
(3) conveyance to or exchange with any private person
or entity.
(b) Inapplicability of Certain Disposal Requirements.--The
Secretary may exercise the authority in subsection (a) without
regard to the following provisions of law:
(1) Sections 521, 522, and 541 through 545 of title
40.
(2) Section 501 of the McKinney-Vento Homeless
Assistance Act (42 U.S.C. 11411).
(c) Limitation on Determination of Property To Be Excess.--
Real property under the jurisdiction of the Secretary may not
be declared excess by the Secretary and disposed of by the
General Services Administration or any other entity of the
Federal Government unless the Secretary determines that the
property is no longer needed by the Department in carrying out
its functions and is not suitable for use for the provision of
services to homeless veterans by the Department or by another
entity under an enhanced-use lease of such property under
section 8162 of this title.
(d) Disposal Procedures.--(1) Except as provided in
paragraph (3), the Secretary may not during any fiscal year
dispose of real property (including land and structures and
equipment associated with such property) owned by the United
States and administered by the Secretary that has an estimated
value in excess of the major medical facility project threshold
specified in section 8104(a)(3)(A) of this title unless--
(A) the disposal is described in the budget
justification documents submitted to Congress with the
budget of the President for the fiscal year beginning
in such year (as submitted pursuant to section 1105 of
title 31);
(B) the Secretary--
(i) notifies the Administrator of General
Services of an intent to dispose of the
property;
(ii) publishes in the Federal Register notice
of an intent to dispose of the property; and
(iii) notifies the committees of an intent to
dispose of the property;
(C) a period of 30 days elapses after notice under
subparagraph (B)(i) during which period no other
department or agency of the Federal Government
expresses an interest in assuming jurisdiction of the
property under the condition of paying the Secretary
the fair market value of the property, as determined by
the Secretary, of the property; and
(D) a period of 60 days elapses after notice under
subparagraph (B)(iii).
(2) Except as provided in paragraph (3), the Secretary may
dispose of real property (including land structures and
equipment associated with such property) owned by the United
States and administered by the Secretary that has an estimated
value less than the major medical facility project threshold
specified in section 8104(a)(3)(A) of this title if--
(A) the Secretary notifies the committees and the
Administrator of General Services of an intent to
dispose of the property;
(B) the Secretary publishes a notice of sale in the
real estate section of a local newspaper of general
circulation serving the market in which the property is
located; and
(C) a period of 30 days elapses after notice under
subparagraph (A) during which period no other
department or agency of the Federal Government
expresses an interest in assuming jurisdiction of the
property under the condition of paying the Secretary
the fair market value of the property, as determined by
the Secretary, of the property.
(3)(A) Notwithstanding paragraphs (1) and (2) or any other
provision of law relating to the disposition of real property
by the United States and subject to subparagraph (B), the
Secretary may transfer to a State for use as the site of a
State nursing-home or domiciliary facility real property owned
by the United States and administered by the Secretary that the
Secretary determines to be excess to the needs of the
Department.
(B) A transfer of real property may not be made under this
paragraph unless--
(i) the Secretary has determined that the State has
provided sufficient assurance that it has the resources
(including any resources which are reasonably likely to
be available to the State under subchapter III of
chapter 81 of this title and section 1741 of this
title) necessary to construct and operate a State home
nursing or domiciliary care facility; and
(ii) the transfer is made subject to the conditions
that--
(I) the property be used by the State for a
nursing home or domiciliary care facility in
accordance with the conditions and limitations
applicable to State home facilities constructed
with assistance under subchapter III of chapter
81 of this title; and
(II) if the property is used at any time for
any other purpose, all right, title, and
interest in and to the property shall revert to
the United States.
(C) A transfer of real property may not be made under this
paragraph until--
(i) the Secretary submits to the committees, not
later than June 1 of the year in which the transfer is
proposed to be made (or the year preceding that year),
a report providing notice of the proposed transfer; and
(ii) a period of 90 consecutive days elapses after
the report is received by the committees.
(D) A transfer under this paragraph shall be made under
such additional terms and conditions as the Secretary considers
appropriate to protect the interests of the United States.
(e) Consideration.--In any transfer, exchange, or
conveyance under the authority in this section (other than a
transfer described in subsection (d)(3)), the Secretary shall
obtain consideration in an amount equal to the fair market
value of the property, as determined by the Secretary.
(f) Treatment of Proceeds.--Proceeds from the transfer,
exchange, or conveyance of real property under this section
shall be deposited in the Capital Asset Fund under section
8122B of this title.
(g) Reports.--The Secretary shall include with the budget
justification documents submitted to Congress each year with
the budget of the President for the fiscal year beginning in
such year (as submitted pursuant to section 1105 of title 31) a
report setting forth the following:
(1) A statement of each disposal of real property to
be undertaken in such fiscal year that is valued in
excess of the major medical facility project threshold
specified in section 8104(a)(3)(A) of this title.
(2) A description of each disposal of real property
that was completed in the fiscal year ending in the
year before such report is submitted.
Sec. 8122B. Capital Asset Fund
(a) Capital Asset Fund.--There is established on the books
of the Treasury of the United States a revolving fund known as
the Capital Asset Fund (in this section referred to as the
``Fund'').
(b) Elements of Fund.--The Fund shall consist of the
following:
(1) Amounts authorized to be appropriated to the
Fund.
(2) Proceeds from the transfer, exchange, or
conveyance of real property under subsection (a) of
section 8122A of this title that are deposited in the
Fund under subsection (f) of such section.
(3) Funds to be deposited in the Fund under section
8165(a)(3) of this title.
(4) Any other amounts specified for transfer to or
deposit in the Fund by law.
(c) Use of Amounts in Fund.--Subject to the provisions of
appropriations Acts, amounts in the Fund shall be available for
purposes as follows and in the following order of priority:
(1) For costs of the Department in disposing of real
property under sections 8122A and 8164 of this title,
including costs associated with demolition,
environmental clean-up, maintenance and repair,
improvements to facilitate disposal, and associated
administrative expenses.
(2) For costs of the Department associated with
proposed disposals of real property of the Department
under such sections.
(3) For costs of non-recurring capital projects of
the Department.
* * * * * * *
Sec. 8162. Enhanced-use leases
(a)(1) * * *
(2) * * *
(B) the Secretary determines that the implementation
of a business plan proposed by [the Under Secretary for
Health for applying the consideration under such a
lease to the provision of medical care and services]
one of the Under Secretaries for applying the
consideration under such a lease to the programs and
activities of the Department would result in a
demonstrable improvement of services to eligible
veterans in the geographic service-delivery area within
which the property is located.
* * * * * * *
(b)(1) * * *
(4)(A) obtain facilities, space, or services [on the leased
property]; and
(B) use minor construction funds for capital contribution
payments.
* * * * * * *
Sec. 8164. Authority for disposition of leased property
(a) If, during the term of an enhanced-use lease or within
30 days after the end of the term of the lease, the Secretary
determines that the leased property is no longer needed by the
Department, the Secretary may initiate action for the transfer
to the lessee of all right, title, and interest of the United
States in the property. A disposition of property may not be
made under this section unless the Secretary determines that
the disposition under this section rather than under [section
8122] section 8122A of this title is in the best interests of
the Department.
(b) The Secretary may dispose of property under this
section without regard to the following provisions of law:
(1) Sections 521, 522, and 541 through 545 of title 40.
(2) Section 501 of the McKinney-Vento Homeless
Assistance Act (42 U.S.C. 11411).
[(b)] (c) A disposition under this section may be made for
such consideration as the Secretary determines is in the best
interest of the United States and upon such other terms and
conditions as the Secretary considers appropriate.
[(c)] (d) Not less than 45 days before a disposition of
property is made under this section, the Secretary shall notify
the congressional veterans' affairs committees of the
Secretary's intent to dispose of the property and shall publish
notice of the proposed disposition in the Federal Register. The
notice shall describe the background of, rationale for, and
economic factors in support of, the proposed disposition
(including a cost-benefit analysis summary) and the method,
terms, and conditions of the proposed disposition.
Sec. 8165. Use of proceeds
(a)(1) [Funds received] Except as provided in paragraph
(2), funds received by the Department under an enhanced-use
lease and remaining after any deduction from those funds under
subsection (b) shall be deposited in the Department of Veterans
Affairs Medical Care Collections Fund established under section
1729A of this title.
(2) Funds received by the Department under an enhanced-use
lease implementing a business plan proposed by the Under
Secretary for Benefits or the Under Secretary for Memorial
Affairs and remaining after any deduction from such funds under
subsection (b) shall be credited to applicable appropriations
of the Veterans Benefits Administration or National Cemetery
Administration, as the case may be.
[(2)] (3) Funds received by the Department from a disposal
of leased property under section 8164 of this title shall be
deposited in the [nursing home revolving fund] Capital Asset
Fund under section 8122B of this title.
* * * * * * *
Sec. 1710B note. Pilot programs relating to Long Term Care
(a) * * *
* * * * * * *
(h) Duration of Programs.--The authority of the Secretary
to provide services under a pilot program under this section
shall cease on [the date that is three years after the date of
the commencement of that pilot program] December 31, 2005.
* * * * * * *