[House Report 112-209]
[From the U.S. Government Publishing Office]


112th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                    112-209

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



 
    VETERANS HEALTH CARE FACILITIES CAPITAL IMPROVEMENT ACT OF 2011

                                _______
                                

 September 15, 2011.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

    Mr. Miller of Florida, from the Committee on Veterans' Affairs, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 2646]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 2646) to authorize certain Department of 
Veterans Affairs major medical facility projects and leases, to 
extend certain expiring provisions of law, and to modify 
certain authorities of the Secretary of Veterans Affairs, and 
for other purposes, having considered the same, report 
favorably thereon with an amendment and recommend that the bill 
as amended do pass.

                                CONTENTS

                                                                   Page
Amendments.......................................................     2
Purpose and Summary..............................................     4
Background and Need for Legislation..............................     5
Hearings.........................................................    11
Subcommittee Consideration.......................................    11
Committee Consideration..........................................    12
Committee Votes..................................................    12
Committee Oversight Findings.....................................    12
Statement of General Performance Goals and Objectives............    12
New Budget Authority, Entitlement Authority, and Tax Expenditures    12
Earmarks and Tax and Tariff Benefits.............................    12
Committee Cost Estimate..........................................    13
Congressional Budget Office Estimate.............................    13
Federal Mandates Statement.......................................    15
Advisory Committee Statement.....................................    15
Constitutional Authority Statement...............................    15
Applicability to Legislative Branch..............................    15
Section-by-Section Analysis of the Legislation...................    15
Changes in Existing Law Made by the Bill as Reported.............    17

                               Amendment

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

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Veterans Health Care Facilities 
Capital Improvement Act of 2011''.

SEC. 2. AUTHORIZATION OF FISCAL YEAR 2012 MAJOR MEDICAL FACILITY 
                    PROJECTS.

  The Secretary of Veterans Affairs may carry out the following major 
medical facility projects in fiscal year 2012, with each project to be 
carried out in the amount specified for each project:
          (1) Construction of seismic corrections for Building 100 at 
        the Department of Veterans Affairs Medical Center in Seattle, 
        Washington, in an amount not to exceed $51,800,000.
          (2) Construction of seismic corrections and renovation of 
        various buildings to include Building 209 for housing 
        facilities for homeless veterans at the Department of Veterans 
        Affairs Medical Center in West Los Angeles, California, in an 
        amount not to exceed $35,500,000.

SEC. 3. MODIFICATION OF AUTHORIZATION FOR CERTAIN MAJOR MEDICAL 
                    FACILITY CONSTRUCTION PROJECTS PREVIOUSLY 
                    AUTHORIZED.

  (a) Modification of Authorization of Fiscal Year 2007 Major Medical 
Facility Project at Department of Veterans Affairs Medical Center in 
Fayetteville, Arkansas.--Section 803(3) of the Veterans Benefits, 
Health Care, and Information Technology Act of 2006 (Public Law 109-
461) is amended--
          (1) by inserting ``and a parking garage'' after ``clinical 
        addition''; and
          (2) by striking ``$56,163,000'' and inserting 
        ``$90,600,000''.
  (b) Modification of Extension of Authorization for Major Medical 
Facility Construction Project in Orlando, Florida, Previously 
Authorized in Connection With Capital Asset Realignment Initiative.--
Section 802(11) of the Veterans Benefits, Health Care, and Information 
Technology Act of 2006 (Public Law 109-461), as amended by section 
702(b)(4) of the Veterans' Mental Health and Other Care Improvements 
Act of 2008 (Public Law 110-387; 122 Stat. 4137), is amended by 
inserting ``, including a Simulation, Learning, Education, and Research 
Network Center,'' after ``Florida, area''.
  (c) Increase in Amount of Authorization of Fiscal Year 2008 Major 
Medical Facility Project at Department of Veterans Affairs Medical 
Center in Palo Alto, California.--The Secretary of Veterans Affairs may 
carry out the major medical facility project at the Department of 
Veterans Affairs Medical Center in Palo Alto, California, for which 
amounts were appropriated under chapter 3 of title I of the 
Supplemental Appropriations Act, 2008 (Public Law 110-252; 122 Stat. 
2326) under the heading ``construction, major projects'' under the 
heading ``DEPARTMENT OF VETERANS AFFAIRS'' in an amount not to exceed 
$716,600,000.
  (d) Increase in Amount of Authorization of Fiscal Year 2009 Major 
Medical Facility Project at Department of Veterans Affairs Medical 
Center, San Juan, Puerto Rico.--Section 701(3) of the Veterans' Mental 
Health and Other Care Improvements Act of 2008 (Public Law 110-387; 122 
Stat. 4137) is amended by striking ``$225,900,000'' and inserting 
``$277,000,000''.
  (e) Increase in Amount of Authorization of Fiscal Year 2007 Major 
Medical Facility Project at Department of Veterans Affairs Medical 
Center, St. Louis, Missouri.--Section 803(5) of the Veterans Benefits, 
Health Care, and Information Technology Act of 2006 (Public Law 109-
461) is amended by striking ``$69,053,000'' and inserting 
``$346,300,000''.

SEC. 4. AUTHORIZATION OF FISCAL YEAR 2012 MAJOR MEDICAL FACILITY 
                    LEASES.

  The Secretary of Veterans Affairs may carry out the following fiscal 
year 2012 major medical facility leases at the locations specified, in 
an amount not to exceed the amount shown for that location:
          (1) Columbus, Georgia, Community-Based Outpatient Clinic, in 
        an amount not to exceed $5,335,000.
          (2) Fort Wayne, Indiana, Outpatient Clinic, in an amount not 
        to exceed $2,845,000.
          (3) Mobile, Alabama, Outpatient Clinic, in an amount not to 
        exceed $6,565,000.
          (4) Rochester, New York, Outpatient Clinic, in an amount not 
        to exceed $9,232,000.
          (5) Salem, Oregon, Community-Based Outpatient Clinic, in an 
        amount not to exceed $2,549,000.
          (6) San Jose, California, Outpatient Clinic, in an amount not 
        to exceed $9,546,000.
          (7) South Bend, Indiana, Outpatient Clinic, in an amount not 
        to exceed $6,731,000.
          (8) Springfield, Missouri, Community-Based Outpatient Clinic, 
        in an amount not to exceed $6,489,000.

SEC. 5. AUTHORIZATION OF APPROPRIATIONS.

  (a) Authorization of Appropriations for Construction.--There is 
authorized to be appropriated to the Secretary of Veterans Affairs for 
fiscal year 2012 or the year in which funds are appropriated for the 
Construction, Major Projects account $87,300,000 for the projects 
authorized in section 2.
  (b) Modification of Authorization for Certain Major Medical Facility 
Construction Projects Previously Authorized.--There is authorized to be 
appropriated to the Secretary of Veterans Affairs for fiscal year 2012 
or the year in which funds are appropriated for the Construction, Major 
Projects account $850,070,000 for the projects authorized in section 3.
  (c) Authorization of Appropriations for Medical Facility Leases.--
There is authorized to be appropriated to the Secretary of Veterans 
Affairs for fiscal year 2012 or the year in which funds are 
appropriated for the Medical Facilities account $49,292,000 for the 
leases authorized in section 4.
  (d) Limitation.--The projects authorized in sections 2, 3, and 4 may 
only be carried out using--
          (1) funds appropriated for fiscal year 2012 pursuant to the 
        authorization of appropriations in subsection (a) of this 
        section;
          (2) funds available for Construction, Major Projects, for a 
        fiscal year before fiscal year 2012 that remain available for 
        obligation;
          (3) funds available for Construction, Major Projects, for a 
        fiscal year after fiscal year 2012 that remain available for 
        obligation;
          (4) funds appropriated for Construction, Major Projects, for 
        fiscal year 2012 for a category of activity not specific to a 
        project;
          (5) funds appropriated for Construction, Major Projects, for 
        a fiscal year before 2012 for a category of activity not 
        specific to a project; and
          (6) funds appropriated for Construction, Major Projects, for 
        a fiscal year after 2012 for a category of activity not 
        specific to a project.

SEC. 6. MODIFICATION OF REQUIREMENTS RELATING TO CONGRESSIONAL APPROVAL 
                    OF CERTAIN MEDICAL FACILITY ACQUISITIONS.

  Section 8104 of title 38, United States Code, is amended--
          (1) in subsection (b)--
                  (A) in paragraph (1)--
                          (i) by striking ``detailed description'' and 
                        inserting ``detailed estimate of the total 
                        costs'';
                          (ii) by striking ``a description of the 
                        consideration'' and inserting ``a detailed 
                        report of the consideration''; and
                          (iii) by adding at the end the following: 
                        ``Such detailed estimate shall include an 
                        identification of each of the following:
                  ``(A) Total construction costs.
                  ``(B) Activation costs.
                  ``(C) Special purpose alterations (lump-sum payment) 
                costs.
                  ``(D) Number of personnel.
                  ``(E) Total costs of ancillary services, equipment, 
                and all other items.'';
                  (B) by striking paragraphs (2) and (3) and 
                redesignating paragraphs (4) through (8) as paragraphs 
                (2) through (6), respectively;
                  (C) in paragraph (2), as so redesignated, by striking 
                ``a five-year period and a ten-year period'' and 
                inserting ``a five-year period, a ten-year period, and 
                a twenty-year period'';
                  (D) in paragraph (3), as so redesignated, by 
                inserting before the period at the end the following: 
                ``, including information on projected changes in 
                workload and utilization over a five-year period, a 
                ten-year period, and a twenty-year period'';
                  (E) in paragraph (4), as so redesignated--
                          (i) by striking ``Current and projected'' and 
                        inserting ``Projected''; and
                          (ii) by inserting before the period at the 
                        end the following: ``(including and identifying 
                        both recurring and non-recurring costs 
                        (including activation costs and total costs of 
                        ancillary services, equipment and all other 
                        items)) over a five-year period, a ten-year 
                        period, and a twenty-year period''; and
                  (F) in paragraph (6), as so redesignated--
                          (i) by striking ``a description of each 
                        alternative to construction of the facility 
                        that was considered.'' and inserting ``each of 
                        the following:''; and
                          (ii) by adding at the end the following new 
                        subparagraphs:
                  ``(A) A detailed estimate of the total costs 
                (including total construction costs, activation costs, 
                special purpose alterations (lump-sum payment) costs, 
                number of personnel and total costs of ancillary 
                services, equipment and all other items) for each 
                alternative to construction of the facility that was 
                considered.
                  ``(B) A comparison of total costs to total benefits 
                for each such alternative.
                  ``(C) An explanation of why the preferred alternative 
                is the most effective means to achieve the stated 
                project goals and the most cost-effective 
                alternative.''; and
          (2) in subsection (d)--
                  (A) by striking ``major medical facility project'' 
                each place it appears and inserting ``major 
                construction project''; and
                  (B) in paragraph (2)--
                          (i) in subparagraph (A), by striking ``major 
                        medical facility projects'' and inserting 
                        ``major construction projects''; and
                          (ii) in subparagraph (B), by striking ``major 
                        medical facility'' and inserting ``major 
                        construction project''.

SEC. 7. NAME OF DEPARTMENT OF VETERANS AFFAIRS TELEHEALTH CLINIC, 
                    CRAIG, COLORADO.

  The Department of Veterans Affairs telehealth clinic in Craig, 
Colorado, shall after the date of the enactment of this Act be known 
and designated as the ``Major William Edward Adams Department of 
Veterans Affairs Clinic''. Any reference to such clinic in any law, 
regulation, map, document, record, or other paper of the United States 
shall be considered to be a reference to the ``Major William Edward 
Adams Department of Veterans Affairs Clinic''.

SEC. 8. EXTENSION OF CERTAIN EXPIRING AUTHORITIES.

  (a) Recovery Audits for Certain Contracts.--Section 1703(d)(4) of 
title 38, United States Code, is amended by striking ``September 30, 
2013'' and inserting ``September 30, 2020''.
  (b) Treatment and Rehabilitation for Seriously Mentally Ill and 
Homeless Veterans.--Section 2031(b) of such title is amended by 
striking ``December 31, 2011'' and inserting ``December 31, 2012''.
  (c) Additional Services for Seriously Mentally Ill and Homeless 
Veterans.--Section 2033(d) of such title is amended by striking 
``December 31, 2011'' and inserting ``December 31, 2012''.
  (d) Housing Assistance for Homeless Veterans.--Section 2041(c) of 
such title is amended by striking ``December 31, 2011'' and inserting 
``December 31, 2012''.
  (e) Advisory Committee on Homeless Veterans.--Section 2066(d) of such 
title is amended by striking ``December 30, 2011'' and inserting 
``December 31, 2012''.
  (f) Authority To Transfer Real Property.--Section 8118(a)(5) of such 
title is amended by striking ``the date that is seven years after the 
date of the enactment of this section'' and inserting ``December 31, 
2018''.

SEC. 9. GEORGE H. O'BRIEN, JR., DEPARTMENT OF VETERANS AFFAIRS MEDICAL 
                    CENTER.

  (a) Designation.--The Department of Veterans Affairs medical center 
located in Big Spring, Texas, shall be known and designated as the 
``George H. O'Brien, Jr., Department of Veterans Affairs Medical 
Center''.
  (b) References.--Any reference in a law, map, regulation, document, 
paper, or other record of the United States to the Department of 
Veterans Affairs medical center referred to in subsection (a) shall be 
deemed to be a reference to the ``George H. O'Brien, Jr., Department of 
Veterans Affairs Medical Center''.

                          Purpose and Summary

    H.R. 2646, the ``Veterans Health Care Facilities Capital 
Improvement Act of 2011'', was introduced by Representative 
Bill Johnson of Ohio, Chairman of the Subcommittee on Oversight 
and Investigations of the Committee on Veterans' Affairs, on 
July 26, 2011. H.R. 2646, as amended, would: (1) authorize a 
major medical facility project in Seattle, WA, in an amount not 
to exceed $51,800,000 and in West Los Angeles, CA, in an amount 
not to exceed $35,500,000; (2) modify the authorization for the 
following major medical facility projects previously 
authorized: Fayetteville, AR, increasing the authorization 
amount from $56,163,000 to $90,600,000; Orlando, FL, including 
the addition of a Simulation, Learning, Education, and Research 
Network Center; Palo Alto, CA, authorizing an amount not to 
exceed $716,600,000, San Juan, PR, increasing the authorization 
amount from $225,900,000 to $277,000,000; and St. Louis, MO, 
increasing the authorization amount from $69,053,000 to 
$346,300,000; (3) authorize major medical facility leases for 
Community-Based Outpatient Clinics (CBOC) in Columbus, GA, in 
an amount not to exceed $5,335,000; Salem, OR in an amount not 
to exceed $2,549,000; and Springfield, MO, in an amount not to 
exceed $6,489,000 and Outpatient Clinics (OC) in Fort Wayne, 
IN, in an amount not to exceed $2,845,000; Mobile, AL, in an 
amount not to exceed $6,565,000; Rochester, NY, in an amount 
not to exceed $9,232,000; San Jose, CA, in an amount not to 
exceed $9,546,000; and South Bend, IN, in an amount not to 
exceed $6,731,000; (4) modify requirements for information VA 
must provide to Congress when seeking authorization for a major 
medical facility project or lease; (5) name the VA telehealth 
clinic in Craig, CO, the ``Major William Edward Adams 
Department of Veterans Affairs Clinic''; (6) extend certain 
expiring authorities related to recovery audits for certain 
contracts, treatment and rehabilitation for seriously mentally 
ill and homeless veterans, additional services for seriously 
mentally ill and homeless veterans, housing assistance for 
homeless veterans, and the Advisory Committee on Homeless 
Veterans, through December 31, 2012; and the authority to 
transfer real property, through December 31, 2018; and, (7) 
name the VA Medical Center in Big Spring, TX, the ``George H. 
O'Brien, Jr., Department of Veterans Affairs Medical Center.''

                  Background and Need for Legislation

    Section 8104(2) of title 38, U.S.C., requires Congressional 
authorization for VA major medical facility projects and major 
medical facility leases. A major medical facility project is 
defined as a project involving construction, alteration, or 
acquisition of a medical facility involving a total expenditure 
of more than $10,000,000. A major medical facility lease is 
defined as a lease for space for use as a new medical facility 
at an average annual rental of more than $1,000,000. Along with 
each major medical facility project or lease funding request, 
section 8104(b) of title 38 U.S.C. requires VA to submit a 
prospectus of the proposed medical facility to include a 
detailed description of the medical facility and an estimate of 
the cost for the construction, alteration, lease, or other 
acquisition as well as an estimate of the cost of the equipment 
required for operation of such facility, demographic data, 
current and projected workload and utilization data, current 
and projected operating costs, the priority score assigned to 
the project under the VA's prioritization methodology, and a 
description of each alternative that was considered in the case 
of a new or replacement medical ideology.

Administration request for authorization to carry out the following VA 
        major medical facility projects in fiscal year 2012

    Seattle, Washington: seismic corrections for Building 100 
at the Seattle Veterans Affairs Medical Center (VAMC) in an 
amount not to exceed $51,800,000. On the Seattle VAMC campus, 
building 100 houses a nursing tower and nursing home care unit. 
Providing seismic strengthening of this structure would allow 
for the continued operation of these programs throughout 
renovation of the existing building, and, therefore, offer 
aggregated safety, functional, and fiscal advantages to the 
project.
    West Los Angeles, California: seismic corrections and 
renovation of various buildings to include Building 209 for 
housing facilities for homeless veterans at the West Los 
Angeles VAMC, in an amount not to exceed $35,500,000. Building 
209 currently sits vacant on the West LA campus. However, 
seismic corrections, utilizing $20,000,000 from existing prior 
year bid savings funds, would allow for the development of a 
therapeutic and supportive homeless housing program, to include 
long-term transitional housing to aid homeless veterans, 
especially those with on-going medical and/or mental health 
needs, in both obtaining and maintaining supportive employment.
    Fayetteville, Arkansas: modification of the FY 2007 
authorization for a major medical facility project at the 
Fayetteville VAMC raising the authorization level from 
$56,163,000 to $90,600,000, an increase of $34,437,000. The 
modification of the initial authorization would expand the 
scope of the project to include a new clinical addition with 
minor renovations, as well as the construction of a new parking 
facility. No additional appropriation is required to complete 
this project.
    Orlando, Florida: modification of extension of the 
authorization for a major medical facility construction project 
in Orlando, Florida, previously authorized in connection with 
the Capital Asset Realignment Initiative by authorizing a 
Simulation, Learning, Education, and Research Network Center 
(SIMLEARN Center). The SIMLEARN Center would encompass a 
clinical simulation program to support clinical training, an 
essential component of education, training, competency 
assessment, and maintenance of professional certification 
throughout the VA health care system. SIMLEARN would provide 
expert `train-the-trainer' simulation experiences, national 
curricula for high priority clinical topics, and acquisition 
support to VA medical facilities to facilitate local simulation 
training deployment. This modification of the original 
authorization amount would also provide VA with the opportunity 
to fund the installation of renewable energy opportunities and 
source energy through a co-generation energy installation. No 
additional appropriation is required to complete this project.
    Palo Alto, California: increase in the amount of the FY 
2008 authorization for a major medical facility project at the 
Palo Alto VAMC, in an amount not to exceed $716,600,000. Such 
an increase would provide seismic upgrade to the main hospital 
building, as well as provide the necessary emergency 
sustainment features including fire sprinklers and an abatement 
of existing asbestos. In addition, a new administrative 
building, parking structure, and an expansion of the outpatient 
clinic would be constructed.
    San Juan, Puerto Rico: increase in the amount of the FY 
2009 authorization for a major medical facility project at the 
San Juan VAMC from $225,900,000 to $277,000,000, an increase of 
$51,100,000. With these funds, VA would construct a new 
administrative building, parking structure, and an expansion of 
the outpatient clinic as well as provide seismic upgrades to 
the main hospital building, emergency sustainment features 
including fire sprinklers, and an abatement of existing 
asbestos.
    St. Louis, Missouri: increase in the amount of the FY 2007 
authorization for a major medical facility project at the 
Jefferson Barracks division of the St. Louis VAMC from 
$69,053,000 to $346,300,000, an increase of $277,247,000. Such 
an increase in authorization would allow for a five phase 
project aimed at demolishing deteriorated and unsuitable 
medical center facilities and new construction to consolidate 
operations and free approximately 30 acres to extend operations 
at the adjacent VA National Cemetery.

Administration request for authorization to carry out the following VA 
        major medical facility leases in fiscal year 2012

    Columbus, Georgia: CBOC in an amount not to exceed 
$5,335,000, to provide mental health services to Georgia 
veterans.
    Fort Wayne, Indiana: OC in an amount not to exceed 
$2,845,000. The Fort Wayne OC would support the VA Northern 
Indiana Health Care System and serve Northern Indiana's veteran 
population while expanding mental health service space and 
accommodating support services to meet increased veteran 
demand. This project would allow VA to continue to provide 
timely access to state-of-the-art mental health care, including 
care for substance abuse and post-traumatic stress disorder in 
an adequately-sized facility to meet increased workload.
    Mobile, Alabama: OC in an amount not to exceed $6,565,000. 
The current lease is housed in a functionally obsolete building 
that has space, safety and functional deficiencies. The new 
lease would provide for administrative and clinical space and 
would provide greater capacity for medical staff in a more 
appropriately sized, modern facility. This replacement OC would 
ensure continued provision of current and expanded medical 
services to veterans residing in or near Mobile, AL.
    Rochester, New York: OC in an amount not to exceed 
$9,232,000. The current lease is set to expire in 2016 and 
cannot be renewed. The new lease would provide expanded 
outpatient services to address current utilization and space 
gaps. This lease would allow for VA to serve a greater number 
of veterans, reduce travel time for clinical services, and 
consolidate three single leases--Mt. Hope Avenue, Clinton 
Crossings, and Rochester--into one state-of-the-art facility.
    Salem, Oregon: CBOC in an amount not to exceed $2,549,000 
for a replacement lease for the existing 10,000 net usable 
square feet (NUSF) CBOC in Salem, OR, which supports the parent 
facility in Portland, OR. The current leased space is too small 
to support the projected workload growth in the Salem area. The 
new lease would continue to provide primary and specialty care, 
mental health and ancillary services. Expanded high demand VA 
specialty care services that would be provided in the new 
leased space include eye care, rehabilitation, audiology, and 
speech pathology. The new CBOC will allow for relocation to an 
area of higher veteran population.
    San Jose, California: OC in an amount not to exceed 
$9,546,000 for a replacement lease for existing 72,000 NUSF 
CBOC in San Jose, which supports the parent facility of the VA 
Palo Alto Health Care System. The current lease is set to 
expire in 2016 with no additional option years remaining on the 
existing lease. The lease would address the need to provide 
ongoing primary care, mental health, and specialty care 
services to veterans residing in San Jose, CA.
    South Bend, Indiana: OC in an amount not to exceed 
$6,731,000 to replace existing CBOC. The new leased facility 
would enable VA to expand services to include outpatient 
primary care and mental health services. This lease would 
provide infrastructure that supports increased integration of 
services, coordination of care, provider productivity, 
efficiency, and patient satisfaction. This lease would allow VA 
to respond to the changing needs of veterans and their families 
in South Bend.
    Springfield, Missouri: CBOC in an amount not to exceed 
$6,489,000 for a replacement lease for existing 41,000 NUSF 
CBOC, supporting the parent facility of the Veterans Health 
Care System of the Ozarks (VHSO) in Fayetteville, AR. The new 
CBOC would relocate and expand Gene Taylor OC from Mount 
Vernon, Missouri. The State of Missouri has elected to close 
the Missouri Rehabilitation Center (MRC) in Mount Vernon, where 
the current clinic is located, and will be unable to continue 
to support the current lease agreement. Moving the CBOC to 
Springfield would better support the VHSO strategic 
initiatives. The new CBOC would continue to provide primary and 
specialty care, mental health and ancillary services and would 
also provide sleep studies, radiology, Magnetic Resonance 
Imaging (MRI), laboratory, and dental services to veterans.

Modification of requirements relating to Congressional approval of 
        certain medical facility acquisitions

    VA holds a substantial real property inventory that 
includes a medical infrastructure of over 5,400 owned 
buildings, 1,300 leases, 33,000 acres of land, and 
approximately 159 million gross square feet (owned and leased).
    This nationwide infrastructure is a critically important 
resource enabling VA to provide the best possible care to our 
veterans. Such an enormous structural network, however, 
generates a great deal of costly construction, which the 
Department must address even as it faces unprecedented 
challenges in providing our Nation's heroes with access to 
care.
    The Administration has identified 4,808 necessary capital 
projects with an estimated total cost between $53 billion and 
$65 billion to correct infrastructure gaps over the next ten 
years. This estimate does not include activation or life cycle 
costs.
    Congress takes an oversight role for this decision-making 
process in section 8104(a)(1) of title 38 U.S.C., whose purpose 
is ``to enable Congress to ensure the equitable distribution of 
medical facilities throughout the United States, taking into 
consideration the comparative urgency of the need for the 
services to be provided in the case of each particular 
facility.''
    So that Congress can adequately fulfill its oversight 
responsibilities, section 8104 directs VA to submit a 
prospectus for all major medical facility projects. This 
prospectus is intended to provide a clear understanding of the 
project costs and benefits and include detailed information 
such as construction costs, alternatives to construction 
considered, equipment costs for the proposed facility and data 
on projected utilization and operating costs.
    However, the Committee remains concerned that VA does not 
provide this information in sufficient detail for Congress to 
accurately evaluate proposed Department projects. Without 
accurate and complete information as required by the law, 
Congress cannot carry out its statutory mission of ensuring the 
``equitable distribution'' of medical facilities and access to 
care for our veterans.
    Section 6 of the bill would modify requirements for 
information VA must provide to Congress when seeking 
authorization for a major medical facility project or lease by 
specifying the level of detailed information related to the 
total cost of the project including construction costs, 
activation costs, special purpose alterations (lump-sum 
payments) costs, personnel costs, ancillary services costs, 
equipment costs, and all other costs; demographic data 
extending over a twenty-year period; current and project 
workload and utilization data for the proposed facility or 
lease including information on any and all projected changes 
over a five-, ten-, and twenty-year period; projected operating 
costs to include an identification of recurring and non-
recurring costs including activation costs and total costs of 
ancillary services, equipment and all other items over a five-
year period, a ten-year period and a twenty-year period; and, 
in the case of a prospective proposing the construction of a 
new or replacement medical facility, a detailed estimate of the 
total costs including total construction costs, activation 
costs, special purpose alterations (lump-sum payments) costs, 
personnel costs, and ancillary services costs, equipment costs, 
and all other costs for each alternative as well as total 
benefits for each alternative and a detailed explanation of why 
the preferred alternative is both the most effective means to 
achieve the stated project goals and the most cost-effective 
alternative.

Name of Department of Veterans Affairs telehealth clinic, Craig, 
        Colorado

    On May 25th, 1971, Major Adams willingly volunteered for a 
helicopter rescue mission to fly into a remote fire base that 
was under heavy attack to pick up three critically wounded 
soldiers. While directing and coordinating fire support from 
other attack helicopters, Maj. Adams landed his aircraft and 
picked up the three wounded soldiers. As he began his return 
flight, his helicopter was bombarded with enemy rocket and 
gunfire. Though Maj. Adams prepared to make an emergency 
landing, his helicopter exploded before he could touch down. 
For his brave actions, Maj. Adams posthumously received the 
Medal of Honor. Section 7 of the bill would appropriately 
memorialize his brave service in battle and his commitment to 
both his country and his fellow veterans by naming the VA 
telehealth clinic in Craig, Colorado, as ``Major William Edward 
Adams Department of Veterans Affairs Clinic.'' The Colorado 
Congressional delegation and the major veterans' organizations 
in the State of Colorado are unanimous in their support of this 
provision.

Extension of certain expiring authorities

    Current law authorizes VA to establish an inpatient 
recovery audit program for fee basis and other medical services 
contracts. This authority, which is set to expire on September 
30, 2013, allows VA to identify and collect overpayments made 
through the VA's Purchased Care Program and redirect the 
recovered funds to provide health care services to eligible 
veterans and their families. Through this program, VA has 
identified an estimated $111 million in overpayments. If VA's 
recovery audit authority were to lapse, VA may lose the 
incentive to aggressively pursue improper payments as recovered 
funds would be redirected to the United States Treasury rather 
than to VA facilities to provide health care services to 
veterans. Further, in order to prevent disruptions to the 
recovery audit program, VA must have sufficient time to plan 
for a contract competition and award. As such, section 8(a) of 
the bill would amend Sec. 1703(d)(4) of title 38 U.S.C. to 
extend VA's authority to conduct recovery audits for fee basis 
and other medical service contracts until September 30, 2020.
    Current law authorizes VA to provide seriously mentally ill 
veterans, including homeless veterans, with: (1) outreach 
services, (2) care, treatment, rehabilitation, and other 
services, and (3) therapeutic transitional housing assistance. 
This authority, which is currently set to expire on December 
31, 2011, allows VA to conduct specialized programs and 
services for veterans struggling with serious mental illness 
and homelessness to target those most at-risk and in need in 
the veteran population. Section 8(b) would amend Sec. 2031(b) 
of title 38 U.S.C. to extend VA's authority regarding treatment 
and rehabilitation for seriously mentally ill and homeless 
veterans through December 31, 2012.
    Current law authorizes VA, subject to appropriations, to 
operate a program to expand and improve the provision of 
benefits and services to homeless veterans, including 
establishing sites under VA jurisdiction to be centers for the 
provision of comprehensive services to homeless veterans in, at 
a minimum, each of the 20 largest metropolitan statistical 
areas. Given the prevalence of veterans in the homeless 
population, it is vitally important for VA to provide 
appropriate programs and services to assist those struggling 
with homelessness. This authority is currently set to expire on 
December 31, 2011. Section 8(c) would amend Sec. 2033(d) of 
title 38 U.S.C. to extend VA's authority to expand and improve 
benefits to homeless veterans through September 30, 2012.
    Similarly, Sec. 2041(c) of title 38, U.S.C. provides VA the 
authority to enter into agreements with homeless providers for 
the purpose of selling, leasing, or donating homes acquired 
through the guaranteed loan program. This authority is 
currently set to expire on December 31, 2011. Section 8(d) 
would amend Sec. 2041(c) of title 38, U.S.C. to extend this 
authority until December 31, 2012.
    Though VA provides more direct assistance to the homeless 
than any other Federal agency, veterans continue to be 
overrepresented in the homeless population. Public Law 107-95 
mandated the creation of an Advisory Committee on Homeless 
Veterans. The purpose of the Advisory Committee is to provide 
advice and make recommendations to VA regarding the provision 
of benefits and services to homeless veterans, to assess the 
effectiveness of policies and programs relating to homeless 
veterans, to identify gaps in programs serving homeless 
veterans, highlight barriers in law and Federal policy that 
hinder homeless veterans programs, and liaise with other 
Federal, State and local agencies that work on homeless issues. 
This authority is currently set to expire on December 30, 2011. 
Section 8(e) would amend Sec. 2066(d) of title 38 U.S.C. to 
extend Congressional authority to continue the Advisory 
Committee on Homeless Veterans until December 31, 2018.
    Current law provides VA the authority to transfer real 
property under VA jurisdiction and control to other Federal 
agencies, State agencies, public or private entities, or Indian 
tribes. Such authority provides the Department with the 
flexibility to make efficient and effective use of VA's 
extensive real property holdings, including vacant or 
underutilized property. This authority is currently set 
to expire on December 31, 2011. Section 8(f) would amend 
Sec. 8118(a)(5) of title 38, U.S.C. to extend this authority 
through December 31, 2012.

Name of Department of Veterans Affairs Medical Center, Big Spring, 
        Texas

    George H. O'Brien, Jr., was a Korean War veteran from Big 
Spring, TX. While wounded, Mr. O'Brien led his Marine unit in 
an uphill assault on a heavily defended position. After relief 
arrived, Mr. O'Brien refused medical evacuation and remained to 
cover his unit's withdrawal. For his heroism, Mr. O'Brien was 
awarded the Medal of Honor by President Eisenhower. After 
returning to Big Spring, Mr. O'Brien lent his services as a 
volunteer at the Big Spring VAMC. He died in 2005 at the age of 
78.
    Section 9 of the bill would appropriately memorialize his 
brave service in battle and his commitment to both his country 
and his fellow veterans by naming the VA Medical Center in Big 
Spring, TX, the ``George H. O'Brien, Jr., Department of 
Veterans Affairs Medical Center.'' The Texas Congressional 
delegation and the major veterans' organizations in the State 
of Texas are unanimous in their support of this provision.

                                Hearings

    On July 25, 2011, the Subcommittee on Health held a 
legislative hearing on several bills introduced in the 112th 
Congress, including a draft bill which was later introduced as 
H.R. 2646. The following witnesses testified: the Honorable 
Michael G. Grimm of New York; the Honorable John R. Carter of 
Texas, the Honorable Timothy J. Walz of Minnesota; the 
Honorable Larry Bucshon of Indiana; Shane Barker, Senior 
Legislative Associate, National Veterans Service, Veterans of 
Foreign Wars of the United States; Joy J. Ilem, Deputy National 
Legislative Director, Disabled American Veterans; Thomas J. 
Berger, Ph.D., Executive Director, Veterans Health Council, 
Vietnam Veterans of America; Carl Blake, National Legislative 
Director, Paralyzed Veterans of America: Christina M. Roof, 
National Acting Legislative Director, AMVETS; and Robert L. 
Jesse, M.D., Ph.D., Principal Deputy Under Secretary for 
Health, Veterans Health Administration, U.S. Department of 
Veterans Affairs.

                       Subcommittee Consideration

    On July 28, 2011, the Subcommittee on Health met in open 
markup session, a quorum being present. An amendment was 
offered by Chairwoman Ann Marie Buerkle of New York to amend 
H.R. 2646. Ms. Buerkle's amendment modified the extensions of 
Sec. 1703(d)(4), recovery audits for certain contracts, 
Sec. 2031(b), treatment and rehabilitation for seriously 
mentally ill and homeless veterans, Sec. 2033(d), additional 
services for seriously mentally ill and homeless veterans, 
Sec. 2041(c), housing assistance for homeless veterans, and 
Sec. 2066(d), Advisory Committee on Homeless Veterans from 2018 
to 2012. The amendment was agreed to by voice vote. Ranking 
Member Michaud of Maine offered a motion to report H.R. 2646, 
as amended, favorably to the full Committee. His motion was 
agreed to by voice vote.

                        Committee Consideration

    On September 8, 2011, the full Committee met in an open 
markup session, a quorum being present. An Amendment was 
offered by Representative Bill Flores of Texas to insert a new 
section 9 to name the George H. O'Brien VA Medical Center. The 
amendment was adopted and H.R. 2646, as amended, was reported 
favorably to the House of Representatives, by voice vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report the legislation and amendments thereto. 
There were no record votes taken on amendments or in connection 
with ordering H.R. 2646 reported to the House. A motion by Mr. 
Filner of California to order H.R. 2646, as amended, reported 
favorably to the House of Representatives was agreed to by 
voice vote.

                      Committee Oversight Findings

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

         Statement of General Performance Goals and Objectives

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

           New Budget Authority, Entitlement Authority, and 
                            Tax Expenditures

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

                  Earmarks and Tax and Tariff Benefits

    H.R. 2646, as amended, does not contain any congressional 
earmarks, limited tax benefits, or limited tariff benefits as 
defined in clause 9 of rule XXI of the Rules of the House of 
Representatives.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate on H.R. 
2646 prepared by the Director of the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974.

               Congressional Budget Office Cost Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 2646 provided by the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                Washington, DC, September 15, 2011.
Hon. Jeff Miller,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 2646, the Veterans 
Health Care Facilities Capital Improvement Act of 2011.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Ann E. 
Futrell.
            Sincerely,
                                              Douglas W. Elmendorf.
    Enclosure.

H.R. 2646--Veterans Health Care Facilities Capital Improvement Act of 
        2011

    Summary: H.R. 2646 would authorize the Department of 
Veterans Affairs (VA) to build and lease several medical 
facilities and extend programs for homeless veterans. In total, 
CBO estimates that implementing the bill would cost $1.2 
billion over the 2012-2016 period, assuming appropriation of 
the necessary amounts. CBO estimates that enacting the bill 
would have no effect on direct spending or revenues; therefore, 
pay-as-you-go procedures do not apply.
    H.R. 2646 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
    Estimated cost to the Federal Government: The estimated 
budgetary impact of H.R. 2646 is summarized in the following 
table. The costs of this legislation fall within budget 
function 700 (veterans benefits and services).
    Basis of estimate: For this estimate, CBO assumes the 
legislation will be enacted near the start of fiscal year 2012, 
that the necessary amounts will be appropriated each year, and 
that outlays will follow historical patterns for similar and 
existing programs.
    H.R. 2646 would authorize appropriations for major 
construction and leasing of VA medical facilities. The bill 
also would extend the authority for several programs for 
homeless veterans. CBO estimates that implementing H.R. 2646 
would cost $1.2 billion over the 2012-2016 period, assuming 
appropriation of the necessary amounts.

----------------------------------------------------------------------------------------------------------------
                                                               By fiscal year, in millions of dollars--
                                                    ------------------------------------------------------------
                                                       2012      2013      2014      2015      2016    2012-2016
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Major Construction Projects:
    Authorization Level............................       850         0         0         0         0        850
    Estimated Outlays..............................        37       229       277       204        77        824
Leases for Medical Facilities:
    Estimated Authorization Level..................        50        22        22        22        22        138
    Estimated Outlays..............................        45        22        22        22        22        133
Seismic Corrections and Renovations:
    Estimated Authorization Level..................        68         0         0         0         0         68
    Estimated Outlays..............................         3        18        22        16         6         65
Extension of Certain Authorities for Homeless
 Veterans:
    Estimated Authorization Level..................       107        37         0         0         0        144
    Estimated Outlays..............................        96        43         4         0         0        143
    Total Changes:
        Estimated Authorization Level..............     1,075        59        22        22        22      1,200
        Estimated Outlays..........................       181       312       325       242       105      1,165
----------------------------------------------------------------------------------------------------------------

Major construction projects

    Section 3 would authorize the appropriation of $850 million 
to construct and modify medical facilities in Palo Alto, 
California; St. Louis, Missouri; and San Juan, Puerto Rico. CBO 
estimates that if appropriated, that authorization would result 
in discretionary costs of $824 million over the 2012-2016 
period.

Leases for medical facilities

    Section 4 would authorize the appropriation of $50 million 
for leasing eight medical facilities. Based on information from 
VA's 2012 budget request, CBO expects that VA would enter into 
20-year lease agreements for those facilities. CBO estimates 
that in addition to the specified amounts authorized to be 
appropriated in 2012, entering into those leases would cost $22 
million a year starting in 2013. (Costs would be higher in the 
first year because VA would pay up front for necessary 
improvements and upgrades.) CBO estimates that entering into 
those leases would cost $133 million over the 2012-2016 period, 
assuming appropriation of the authorized and estimated amounts.

Seismic corrections and renovations

    Section 2 would authorize the appropriation of $87 million 
for seismic corrections and renovations at facilities in Los 
Angeles, California, and Seattle, Washington. Based on VA's 
current estimate for construction costs and the amounts that 
have already been appropriated for those projects, CBO 
estimates that VA would require additional funding of $68 
million in 2012. We estimate that implementing those projects 
would cost a total of $65 million over the 2012-2016 period, 
assuming appropriation of the estimated amounts.

Extension of certain authorities for homeless veterans

    Section 8 would extend, for various periods, the expiring 
authorities for several programs that provide services to 
homeless veterans. CBO estimates that extending such programs 
would cost $143 million over the 2012-2016 period, assuming 
appropriation of the necessary amounts.
    Pay-as-you-go considerations: None.
    Intergovernmental and private-sector impact: H.R. 2646 
contains no intergovernmental or private-sector mandates as 
defined in UMRA. Public hospitals that contract with VA to 
provide hospital care or medical services to veterans would be 
required to comply with auditing procedures extended under the 
bill. Any costs to those hospitals would be incurred 
voluntarily.
    Previous CBO estimate: On August 30, 2011, CBO transmitted 
a cost estimate for S. 914, the Veterans Programs Improvement 
Act of 2011, as ordered reported by the Senate Committee on 
Veterans' Affairs on June 29, 2011. Sections 2, 3, 4, and 8 of 
H.R. 2646 contain language similar to sections 601, 602, 603, 
and 205 of S. 914, respectively, and their estimated costs are 
the same.
    Estimate prepared by: Federal costs: Ann E. Futrell; Impact 
on State, local, and Tribal Governments: Lisa Ramirez-Branum; 
Impact on the Private Sector: Elizabeth Bass.
    Estimate approved by: Theresa Gullo, Deputy Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 2646 prepared by the Director of the 
Congressional Budget Office pursuant to section 423 of the 
Unfunded Mandates Reform Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
2646.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for H.R. 2646 is provided by Article 
I, section 8 of the Constitution of the United States.

                  Applicability to Legislative Branch

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

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 of the bill would name the Act the ``Veterans 
Health Care Facilities Capital Improvement Act of 2011.''

Section 2. Authorization of fiscal year 2012 major medical facility 
        projects

    Section 2(1) of the bill would authorize a major medical 
facility project in Seattle, WA, in an amount not to exceed 
$51,800,000.
    Section 2(2) of the bill would authorize a major medical 
facility project in West Los Angeles, CA, in an amount not to 
exceed $35,500,000.

Section 3. Modification of authorization for certain major medical 
        facility construction projects previously authorized

    Section 3(a) of the bill would modify the authorization of 
fiscal year 2007 major medical facility project at the VAMC in 
Fayetteville, AR, by inserting the addition of a parking garage 
and increasing the authorization amount from $56,163,000 to 
$90,600,000.
    Section 3(b) of the bill would modify the extension of 
authorization for major medical facility construction in 
Orlando, FL, by inserting the addition of a Simulation, 
Learning, Education, and Research Network Center.
    Section 3(c) of the bill would increase the amount of 
authorization of fiscal year 2008 Major Medical Facility 
Project at VAMC in Palo Alto, CA, in an amount not to exceed 
$716,600,000.
    Section 3(d) of the bill would increase the authorization 
of fiscal year 2009 major medical facility project at the VAMC 
in San Juan, PR, increasing the authorization amount from 
$225,900,000 to $277,000,000.
    Section 3(e) of the bill would increase the amount of 
authorization of fiscal year 2007 major medical facility 
project at the VAMC in St. Louis, MO, by increasing the 
authorization amount from $69,053,000 to $346,300,000.

Section 4. Authorization of fiscal year 2012 major medical facility 
        leases

    Section 4(1) of the bill would authorize VA to carry out a 
major medical facility lease for a CBOC in Columbus, GA, in an 
amount not to exceed $5,335,000.
    Section 4(2) of the bill would authorize VA to carry out a 
major medical facility lease for an OC in Fort Wayne, IN, in an 
amount not to exceed $2,845,000.
    Section 4(3) of the bill would authorize VA to carry out a 
major medical facility lease for an OC in Mobile, AL, in an 
amount not to exceed $6,565,000.
    Section 4(4) of the bill would authorize VA to carry out a 
major medical facility lease for an OC in Rochester, NY, in an 
amount not to exceed $9,232,000.
    Section 4(5) of the bill would authorize VA to carry out a 
major medical facility lease for a CBOC in Salem, OR, in an 
amount not to exceed $2,549,000.
    Section 4(6) of the bill would authorize VA to carry out a 
major medical facility lease for an OC in San Jose, CA, in an 
amount not to exceed $9,546,000.
    Section 4(7) of the bill would authorize VA to carry out a 
major medical facility lease for an OC in South Bend, IN, in an 
amount not to exceed $6,731,000.
    Section 4(8) of the bill would authorize VA to carry out a 
major medical facility lease for a CBOC in Springfield, MO, in 
an amount not to exceed $6,489,000.

Section 5. Authorization of appropriations

    Section 5(a) of the bill would authorize $87,300,000 in 
appropriations for the Construction, Major Projects account for 
the projects authorized in section 2.
    Section 5(b) of the bill would authorize $850,070,000 in 
appropriations for the Construction, Major Projects account for 
the projects authorized in Section 3.
    Section 5(c) of the bill would authorize $49,292,000 in 
appropriations for the Medical Facilities account for the 
leases authorized in Section 4.

Section 6. Modification of requirements relating to Congressional 
        approval of certain medical facility acquisitions

    Section 6 of the bill would amend Section 8104 of title 38, 
United States Code, to clarify the level of detailed 
information VA must provide when requesting authorization for a 
major medical facility project or lease.

Section 7. Name of Department of Veterans Affairs telehealth clinic, 
        Craig, Colorado

    Section 7 of the bill would name the VA telehealth clinic 
in Craig, CO, the ``Major William Edward Adams Department of 
Veterans Affairs Clinic.''

Section 8. Extension of certain expiring authorities

    Section 8(a) of the bill would amend Sec. 1703(d)(4) of 
title 38 U.S.C. to extend VA's authority to conduct recovery 
audits for fee basis and other medical service contracts 
through September 30, 2020.
    Section 8(b) of the bill would amend Sec. 2031(b) of title 
38 U.S.C. to extend VA's authority regarding treatment and 
rehabilitation for seriously mentally ill and homeless veterans 
through December 31, 2012.
    Section 8(c) of the bill would amend Sec. 2033(d) of title 
38 U.S.C. to extend VA's authority to expand and improve 
benefits to homeless veterans through September 30, 2012.
    Section 8(d) of the bill would amend Sec. 2041(c) of title 
38 U.S.C. to extend VA's authority to enter into agreements 
with homeless providers for the purpose of selling, leasing, or 
donating homes acquired through the guaranteed loan program 
through December 31, 2012.
    Section 8(e) of the bill would amend Sec. 2066(d) of title 
38 U.S.C. to extend Congressional authority to continue the 
Advisory Committee for Homeless Veterans through December 31, 
2012.
    Section 8(f) of the bill would amend Sec. 8118(a) of title 
38 U.S.C. to extend VA's authority to transfer real property 
under VA jurisdiction and control to other Federal agencies, 
State agencies, public or private entities, or Indian tribes 
through December 31, 2018.

Section 9. George H. O'Brien, Jr. Department of Veterans Affairs 
        Medical Center

    Section 9 of the bill would name the VA medical center 
located in Big Spring, TX, the ``George H. O'Brien, Jr. 
Department of Veterans Affairs Medical Center.''

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

 VETERANS BENEFITS, HEALTH CARE, AND INFORMATION TECHNOLOGY ACT OF 2006




           *       *       *       *       *       *       *
                    TITLE VIII--CONSTRUCTION MATTERS

Subtitle A--Construction and Lease Authorities

           *       *       *       *       *       *       *


SEC. 802.  EXTENSION OF AUTHORIZATION FOR CERTAIN MAJOR MEDICAL 
                    FACILITY CONSTRUCTION PROJECTS PREVIOUSLY 
                    AUTHORIZED IN CONNECTION WITH CAPITAL ASSET 
                    REALIGNMENT INITIATIVE.

  The Secretary of Veterans Affairs may carry out the following 
major medical facility projects, with each such project to be 
carried out in the amount specified for that project:
          (1) * * *

           *       *       *       *       *       *       *

          (11) Construction of a new medical center facility in 
        the Orlando, Florida, area, including a Simulation, 
        Learning, Education, and Research Network Center, in an 
        amount not to exceed $377,700,000.

           *       *       *       *       *       *       *


SEC. 803.  AUTHORIZATION OF FISCAL YEAR 2007 MAJOR MEDICAL FACILITY 
                    PROJECTS.

  The Secretary of Veterans Affairs may carry out the following 
major medical facility projects in fiscal year 2007 in the 
amount specified for each project:
          (1) * * *

           *       *       *       *       *       *       *

          (3) Construction of a new clinical addition and a 
        parking garage at the Department of Veterans Affairs 
        Medical Center, Fayetteville, Arkansas, in an amount 
        not to exceed [$56,163,000] $90,600,000.

           *       *       *       *       *       *       *

          (5) Medical facility improvements and cemetery 
        expansion of Jefferson Barracks at the Department of 
        Veterans Affairs Medical Center, St. Louis, Missouri, 
        in an amount not to exceed [$69,053,000] $346,300,000.

           *       *       *       *       *       *       *

                              ----------                              


    VETERANS' MENTAL HEALTH AND OTHER CARE IMPROVEMENTS ACT OF 2008




           *       *       *       *       *       *       *
TITLE VII--AUTHORIZATION OF MEDICAL FACILITY PROJECTS AND MAJOR MEDICAL 
                            FACILITY LEASES

SEC. 701.  AUTHORIZATION FOR FISCAL YEAR 2009 MAJOR MEDICAL FACILITY 
                    PROJECTS.

  The Secretary of Veterans Affairs may carry out the following 
major medical facility projects in fiscal year 2009 in the 
amount specified for each project:
          (1) * * *

           *       *       *       *       *       *       *

          (3) Seismic corrections, Building 1, at the 
        Department of Veterans Affairs Medical Center, San 
        Juan, Puerto Rico, in an amount not to exceed 
        [$225,900,000] $277,000,000.

           *       *       *       *       *       *       *

                              ----------                              


                      TITLE 38, UNITED STATES CODE




           *       *       *       *       *       *       *
PART II--GENERAL BENEFITS

           *       *       *       *       *       *       *


   CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE


SUBCHAPTER I--GENERAL

           *       *       *       *       *       *       *



Sec. 1703.  Contracts for hospital care and medical services in non-
                    Department facilities

  (a) * * *

           *       *       *       *       *       *       *

  (d)(1) * * *

           *       *       *       *       *       *       *

  (4) The authority of the Secretary under this subsection 
terminates on [September 30, 2013] September 30, 2020.

           *       *       *       *       *       *       *


CHAPTER 20--BENEFITS FOR HOMELESS VETERANS

           *       *       *       *       *       *       *



SUBCHAPTER IV--TREATMENT AND REHABILITATION FOR SERIOUSLY MENTALLY ILL 
                         AND HOMELESS VETERANS


Sec. 2031.  General treatment

  (a) * * *
  (b) The authority of the Secretary under subsection (a) 
expires on [December 31, 2011] December 31, 2012.

           *       *       *       *       *       *       *


Sec. 2033.  Additional services at certain locations

  (a) * * *

           *       *       *       *       *       *       *

  (d) The program under this section shall terminate on 
[December 31, 2011] December 31, 2012.

           *       *       *       *       *       *       *


                    SUBCHAPTER V--HOUSING ASSISTANCE


Sec. 2041.  Housing assistance for homeless veterans

  (a) * * *

           *       *       *       *       *       *       *

  (c) The Secretary may not enter into agreements under 
subsection (a) after [December 31, 2011] December 31, 2012.

           *       *       *       *       *       *       *


SUBCHAPTER VII--OTHER PROVISIONS

           *       *       *       *       *       *       *



Sec. 2066.  Advisory Committee on Homeless Veterans

  (a) * * *

           *       *       *       *       *       *       *

  (d) Termination.--The Committee shall cease to exist 
[December 30, 2011] December 31, 2012.

           *       *       *       *       *       *       *


PART VI--ACQUISITION AND DISPOSITION OF PROPERTY

           *       *       *       *       *       *       *


   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. 8104.  Congressional approval of certain medical facility 
                    acquisitions

  (a) * * *
  (b) Whenever the President or the Secretary submit to the 
Congress a request for the funding of a major medical facility 
project (as defined in subsection (a)(3)(A)) or a major medical 
facility lease (as defined in subsection (a)(3)(B)), the 
Secretary shall submit to each committee, on the same day, a 
prospectus of the proposed medical facility. Any such 
prospectus shall include the following:
          (1) A [detailed description] detailed estimate of the 
        total costs of the medical facility to be constructed, 
        altered, leased, or otherwise acquired under this 
        subchapter, including a description of the location of 
        such facility and, in the case of a prospectus 
        proposing the construction of a new or replacement 
        medical facility, [a description of the consideration] 
        a detailed report of the consideration that was given 
        to acquiring an existing facility by lease or purchase 
        and to the sharing of health-care resources with the 
        Department of Defense under section 8111 of this title. 
        Such detailed estimate shall include an identification 
        of each of the following:
                  (A) Total construction costs.
                  (B) Activation costs.
                  (C) Special purpose alterations (lump-sum 
                payment) costs.
                  (D) Number of personnel.
                  (E) Total costs of ancillary services, 
                equipment, and all other items.
          [(2) An estimate of the cost to the United States of 
        the construction, alteration, lease, or other 
        acquisition of such facility (including site costs, if 
        applicable).
          [(3) An estimate of the cost to the United States of 
        the equipment required for the operation of such 
        facility.]
          [(4)] (2) Demographic data applicable to such 
        facility, including information on projected changes in 
        the population of veterans to be served by the facility 
        over [a five-year period and a ten-year period] a five-
        year period, a ten-year period, and a twenty-year 
        period.
          [(5)] (3) Current and projected workload and 
        utilization data regarding the facility, including 
        information on projected changes in workload and 
        utilization over a five-year period, a ten-year period, 
        and a twenty-year period.
          [(6) Current and projected] (4) Projected operating 
        costs of the facility, including both recurring and 
        non-recurring costs (including and identifying both 
        recurring and non-recurring costs (including activation 
        costs and total costs of ancillary services, equipment 
        and all other items)) over a five-year period, a ten-
        year period, and a twenty-year period.

           *       *       *       *       *       *       *

          [(7)] (5) The priority score assigned to the project 
        or lease under the Department's prioritization 
        methodology and, if the project or lease is being 
        proposed for funding before a project or lease with a 
        higher score, a specific explanation of the factors 
        other than the priority score that were considered and 
        the basis on which the project or lease is proposed for 
        funding ahead of projects or leases with higher 
        priority scores.
          [(8)] (6) In the case of a prospectus proposing the 
        construction of a new or replacement medical facility, 
        [a description of each alternative to construction of 
        the facility that was considered.] each of the 
        following:
                  (A) A detailed estimate of the total costs 
                (including total construction costs, activation 
                costs, special purpose alterations (lump-sum 
                payment) costs, number of personnel and total 
                costs of ancillary services, equipment and all 
                other items) for each alternative to 
                construction of the facility that was 
                considered.
                  (B) A comparison of total costs to total 
                benefits for each such alternative.
                  (C) An explanation of why the preferred 
                alternative is the most effective means to 
                achieve the stated project goals and the most 
                cost-effective alternative.

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  (d)(1) * * *
  (2)(A) In any fiscal year, unobligated amounts in the 
Construction, Major Projects account that are a direct result 
of bid savings from a [major medical facility project] major 
construction project may only be obligated for [major medical 
facility projects] major construction projects authorized for 
that fiscal year or a previous fiscal year.
  (B) Whenever the Secretary obligates amounts for a [major 
medical facility] major construction project under subparagraph 
(A), the Secretary shall submit to the Committee on Veterans' 
Affairs and the Committee on Appropriations of the Senate and 
the Committee on Veterans' Affairs and the Committee on 
Appropriations of the House of Representatives notice of the 
following:
          (i) The [major medical facility project] major 
        construction project that is the source of the bid 
        savings.
          (ii) The other [major medical facility project] major 
        construction project for which the amounts are being 
        obligated.
          (iii) The amounts being obligated for such other 
        [major medical facility project] major construction 
        project.

           *       *       *       *       *       *       *


Sec. 8118.  Authority for transfer of real property; Department of 
                    Veterans Affairs Capital Asset Fund

  (a)(1) * * *

           *       *       *       *       *       *       *

  (5) The authority of the Secretary under paragraph (1) 
expires on [the date that is seven years after the date of the 
enactment of this section] December 31, 2018.

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