[House Report 115-188]
[From the U.S. Government Publishing Office]
115th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 115-188
======================================================================
MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES
APPROPRIATIONS BILL, 2018
_______
June 22, 2017.-- Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Dent, from the Committee on Appropriations,
submitted the following
R E P O R T
together with
MINORITY VIEWS
[To accompany H.R. 2998 ]
The Committee on Appropriations submits the following
report in explanation of the accompanying bill making
appropriations for military construction, the Department of
Veterans Affairs, and related agencies for the fiscal year
ending September 30, 2018, and for other purposes.
CONTENTS
Page
Purpose of the Bill.............................................. 2
Summary of Committee Recommendation.............................. 2
Comparative Statement of New Budget Authority.................... 5
Management and Oversight Initiatives............................. 18
Item of Interest................................................. 19
Department of Defense:
Military Construction........................................ 19
NATO Security Investment Program............................. 31
Family Housing Construction and Operation and Maintenance.... 32
Department of Defense Family Housing Improvement Fund........ 34
Department of Defense Military Unaccompanied Housing
Improvement Fund........................................... 34
Department of Defense Base Closure Account................... 34
Administrative Provisions.................................... 34
Department of Veterans Affairs:
Veterans Benefits Administration............................. 37
Veterans Health Administration............................... 43
National Cemetery Administration............................. 69
Departmental Administration.................................. 71
Administrative Provisions.................................... 81
Related Agencies:
American Battle Monuments Commission......................... 85
U.S. Court of Appeals for Veterans Claims.................... 86
Cemeterial Expenses, Army.................................... 86
Armed Forces Retirement Home................................. 86
Administrative Provisions.................................... 87
Department of Defense:
Overseas Contingency Operations.............................. 87
Administrative Provisions.................................... 88
General Provisions............................................... 88
House of Representatives Report Requirements..................... 89
Statement of General Performance Goals and Objectives........ 89
Rescissions.................................................. 90
Transfer of Funds............................................ 90
Disclosure of Earmarks and Congressionally Directed Spending
Items...................................................... 91
Changes in Application of Existing Law....................... 92
Appropriations Not Authorized by Law......................... 95
Program Duplication.......................................... 97
Directed Rule Making......................................... 97
Full Committee Votes......................................... 97
Ramseyer Rule................................................ 97
Comparison With the Budget Resolution........................ 100
Five-Year Projection of Outlays.............................. 100
Assistance to State and Local Governments.................... 100
State Project List........................................... 101
Minority Views............................................... 117
Purpose of the Bill
The purpose of the bill is to support our military and
their families and provide the benefits and medical care that
our veterans have earned for their service to our Nation. This
is accomplished through the programs funded in the bill, which
provide the facilities and infrastructure needed to house,
treat, train, and equip our military personnel to defend this
Nation, both in the United States and abroad; provide the
housing and military community infrastructure that supports a
good quality of life for them and their families; and allow the
military to maintain an efficient and effective base structure.
The bill also funds programs to ensure that all veterans
receive the benefits and medical care that they have earned as
a result of the sacrifices they have made in their service to
our country. Finally, the bill funds four related agencies that
provide support to our Nation's heroes: the American Battle
Monuments Commission, Cemeterial Expenses, Army (including
Arlington National Cemetery), the United States Court of
Appeals for Veterans Claims, and the Armed Forces Retirement
Home.
Summary of Committee Recommendation
The Committee recommends $192,752,435,000 in budget
authority for the fiscal year 2018 programs and activities
funded in the bill. The fiscal year 2018 recommendation is an
increase of $7,424,221,000 above the fiscal year 2017 enacted
level and $573,421,000 below the President's request. Of the
increase over the fiscal year 2017 enacted level,
$1,415,954,000 is in mandatory programs. Included in the total
budget authority is $103,948,435,000 in mandatory budget
authority and $88,804,000,000 in discretionary budget
authority.
The Committee recommendation highlights the continued
commitment to our servicemembers and their families and to our
veterans. In discretionary budget authority, the bill is 7.3
percent over the fiscal year 2017 enacted level. The bill
includes an increase in military construction, which is 25.5
percent above the fiscal year 2017 level, and an increase in
the Department of Veterans Affairs budget, which is 5.3 percent
over the fiscal year 2017 level. While the Committee
recommendation continues essential support for servicemembers
and veterans, it does not provide funds for projects or
activities that lacked sufficient justification or were less
mission-critical. Where it was prudent, the Committee
recommendation rescinds prior year funding that is no longer
needed for the purpose for which it was appropriated while
leaving sufficient resources to close out contracts. Finally,
the recommendation rescinds unobligated balances in certain
military construction accounts.
The programs funded in the bill for the Department of
Defense address the priorities of the Department's Agencies and
the Services for numerous facility challenges that they face.
The funds provided support readiness improvements with new
construction, family housing, continued cleanup of military
bases closed during previous Base Realignment and Closure
rounds, resource Combatant Commanders requirements where
appropriate, and ensure that our military personnel and their
families' quality of life is preserved.
The total recommended funding level for military
construction and family housing, including base and Overseas
Contingency Operations funding, including the European
Reassurance Initiative, is $10,223,000,000, which is
$2,077,267,000 above the fiscal year 2017 enacted level and
$197,581,000 below the budget request. The recommendation
includes funding for Family Housing, funding for necessary
construction on our bases, including barracks, health
facilities and schools, and support for critical overseas
investments.
The total funding level for fiscal year 2018 for the
Department of Veterans Affairs is $182,277,635,000, an increase
of $5,336,299,000 over the fiscal year 2017 enacted level. Of
the total, $103,948,435,000 is provided for mandatory benefit
programs and $78,329,200,000 is allocated to discretionary
programs such as medical care, claims processing, and
construction. In this bill, discretionary funding for the
Department of Veterans Affairs is recommended at 5.3 percent
over the fiscal year 2017 enacted level. For fiscal year 2018,
$66,385,032,000 for medical care has been appropriated in
advance, and the recommendation includes an additional
$2,650,000,000 in newly identified needs for VA, focusing on
funds required to support staff previously hired under the
Choice Act, mental health and suicide prevention, opioid abuse
prevention, hepatitis C treatment, homelessness, long-term
care, and caregiver stipends. The recommendation includes
$2,894,000,000, an increase of $50,000,000 over the President's
budget request for the administrative costs of Veterans
Benefits Administration, including funding for scanning claims
and staff overtime. The bill also provides $156,096,000 for the
Board of Veterans Appeals, a $500,000 increase over the
request, to target the growing caseload of appeals of initial
benefits decisions. In addition, the Committee recommendation
includes $70,699,313,000 in advance appropriations for fiscal
year 2019 for the four health care accounts of the Department
and $107,709,727,000 in advance appropriations for mandatory
benefits programs for fiscal year 2019.
The following table compares amounts recommended in the
bill to the President's request and amounts appropriated in
fiscal year 2017:
Management and Oversight Initiatives
The Committee believes the effective stewardship of
taxpayer dollars is of the highest priority. In the interest of
eliminating waste, fraud, and abuse in Federal programs, the
Committee has and will continue to use public hearings,
briefings, and information requests, and reviews by the
Government Accountability Office and the Inspectors General to
promote strong financial and program management, oversight and
leadership at the Department of Defense, the Department of
Veterans Affairs, and other agencies under the jurisdiction of
this bill.
The fiscal year 2018 appropriations Act and the
accompanying report address management challenges of the
Federal agencies funded herein, including directives to
strengthen financial and program management, eliminate
redundancy, and improve implementation and oversight of
initiatives that support the mission of this bill. The
Committee will use every means at its disposal to reduce
mismanagement that results in waste, fraud, and abuse.
Department of Defense (DOD).--In addition to the
notification and reporting requirements for military
construction programs contained in Title 10, United States
Code, the Committee's recommendations include several
provisions requiring the Department of Defense to report on
various aspects of military construction programs, or to
provide notification to the Committee when certain actions are
taken. The Committee also retains prior approval authority for
any reprogramming of funds exceeding a specific threshold.
Department of Veterans Affairs (VA).--With the
$182,277,635,000 provided for the VA in this bill and the
increase in the number of veterans seeking VA medical services,
the Committee believes it is important to strengthen its tools
to monitor spending as well the operating procedures of the VA
workforce. The following initiatives demonstrate the
Committee's oversight focus:
VA Electronic health record.--After at least a decade of
Congressional encouragement to DOD and VA to develop a single
electronic health record, the VA Secretary has just announced
that he is directing VA to acquire the same electronic health
record that DOD is adopting. While enthusiastic about the
Secretary's choice, the Committee has watched an integrated
electronic record emerge and crash multiple times. Therefore,
the Committee includes bill language fencing 75 percent of the
development funding for the new electronic health record until
VA provides extensive data on: the solicitation to Cerner
Corporation; how the new record will replicate the DOD record
while adding VA-specific features; a strategic plan with
timeline, performance milestones, annual and life-cycle costs;
plans to maintain current functionality and integration with
DOD health records during the transition; and complete
implementation and change management plans.
Disability claims and appeals.--Thanks to the significant
investments Congress has provided over the past six years, VA
has been able to hire the staff, acquire the technology, and
change work processes necessary to reduce the disability claims
backlog to an ``effective'' zero. But as the number of claims
continues to increase and the number of appeals skyrockets once
claims are decided, VA again runs the risk of falling into
serious claims and appeals backlogs. The Committee recognizes
this threat and provides $50,000,000 above the Veterans
Benefits Administration President's request to support staff
overtime and digital claims scanning. The Committee hopes that
with this additional investment and the recently passed
legislation to reform the appeals process, Congress will have
taken the necessary management action to prevent veterans from
enduring excessive waits to claim the disability benefits they
deserve.
Information technology (IT).--The Committee continues to
include bill language prohibiting obligation or expenditure of
funds for information technology systems development,
modernization and enhancement until VA submits to the
Committees a certification of the amounts. The bill limits the
amount of funds that can be transferred into IT to 10 percent
of the total of either the source or destination account. The
bill contains language which permits the reprogramming of funds
among development, modernization and enhancement projects upon
prior notification to, and approval by, the Committees.
Stricter control of construction funding.--In response to
the egregious management of the Denver hospital construction
project, the Committee includes bill language to fence funding
for major construction projects over $100,000,000 in cost until
VA certifies that it has contracted with a non-VA governmental
entity to design and manage the project. Several additional
bill language provisions are included to enhance the
Committee's capacity to conduct oversight on VA's facility
construction efforts including: (1) no funding greater than
$5,000,000 may be reprogrammed between construction projects
unless approved by the Committees on Appropriations of both
Houses of Congress; (2) any change to the scope of a
construction project is prohibited without the approval of the
Committees; and (3) VA must report any bid savings of
$5,000,000 or more on projects as soon as they are identified.
ITEM OF INTEREST
Construction Contracting Outreach.--In House Report 114-497
the Committee directed the Secretaries of the Army, Navy and
the VA to ensure that their respective regional and district
offices responsible for construction projects inform and engage
local construction industry contractors, especially small
businesses, minority-owned businesses, and women-owned
business, about Federal procurement opportunities and the
bidding process. The Committee directs the Secretaries of each
agency to submit a report to the congressional defense
committees on outreach efforts conducted in fiscal year 2017
within 180 days of enactment of this Act.
TITLE I
DEPARTMENT OF DEFENSE
Military Construction Overview
Fiscal year 2017 enacted level (including rescissions) $7,726,000,000
Fiscal year 2018 budget request....................... 9,782,451,000
Committee recommendation in the bill (including 9,585,000,000
rescissions).........................................
Comparison with:
Fiscal year 2017 enacted level.................... 1,859,000,000
Fiscal year 2018 budget request................... (197,451,000)
Military construction accounts provide funds for new
construction, construction improvements, planning and design,
and host nation support. Projects funded by these accounts
include facilities for operations, training, maintenance,
research and development, supply, medical care, and force
protection, as well as unaccompanied housing, utilities
infrastructure, and land acquisition.
Reprogramming guidelines.--The following reprogramming
guidelines apply for all military construction and family
housing projects. A project or account (including the sub-
elements of an account) which has been specifically reduced by
the Congress in acting on the budget request is considered to
be a Congressional interest item and as such, prior approval is
required. Accordingly, no reprogramming to an item specifically
reduced below the threshold by the Congress is permitted,
except that the Department of Defense may seek reprogramming
for appropriated increments.
The reprogramming criteria that apply to military
construction projects (25 percent of the funded amount or
$2,000,000, whichever is less) continue to apply to new housing
construction projects and to improvements over $2,000,000. To
provide the services the flexibility to proceed with
construction contracts without disruption or delay, the costs
associated with environmental hazard remediation such as
asbestos removal, radon abatement, lead-based paint removal or
abatement, and any other legislated environmental hazard
remediation may be excluded, if such remediation requirements
could not be reasonably anticipated at the time of the budget
submission. This exclusion applies to projects authorized in
this budget year, as well as projects authorized in prior years
for which construction has not been completed. Planning and
design costs associated with military construction and family
housing projects may also be excluded from these guidelines. In
instances where prior approval to a reprogramming request for a
project or account has been received from the Committees on
Appropriations of both Houses of Congress, the adjusted amount
approved becomes the new base for any future increase or
decrease via below-threshold reprogramming (provided that the
project or account is not a Congressional interest item as
defined above).
In addition to these guidelines, the services are directed
to adhere to the guidance for military construction
reprogramming actions and notifications, including the
pertinent statutory authorities contained in Department of
Defense Financial Management Regulation 7000.14-R and relevant
updates and policy memoranda. The Committee further encourages
the Office of the Director of National Intelligence to use a
format similar to that used by the Office of the Secretary of
Defense to submit reprogramming requests.
Facilities Sustainment, Restoration and Modernization
(FSRM).--The Department of Defense is directed to continue
describing on form 1390 the backlog of FSRM requirements at
installations with future construction projects. For troop
housing requests, form 1391 should describe any FSRM conducted
in the past two years. Likewise, future requirements for
unaccompanied housing at the corresponding installation should
be included. Additionally, the forms should include English
equivalent measurements for projects presented in metric
measurement. Rules for funding repairs of facilities under the
Operation and Maintenance accounts are described below:
(1) components of the facility may be repaired by
replacement. Such replacement can be up to current
standards or codes;
(2) interior arrangements and restorations may be
included as repair;
(3) additions, new facilities, and functional
conversions must be performed as military construction
projects. Such projects may be done concurrently with
repair projects as long as the final conjunctively
funded project is a complete and usable facility; and
(4) the appropriate service secretary shall notify
the appropriate committees 21 days prior to carrying
out any repair project with an estimated cost in excess
of $7,500,000. The Committee strongly encourages the
services and defense agencies to indicate the plant
replacement value of the facility to be repaired on
each such notification.
Quarterly summary of notifications.--The Committee directs
the services and the Office of the Secretary of Defense (on
behalf of itself and defense agencies) to continue to submit a
quarterly report listing all notifications that have been
submitted to the Committees during the preceding three-month
period.
Work in Progress or Planned (WIP) curve.--The Committee
directs the services and the Office of the Secretary of Defense
(on behalf of itself and defense agencies) to submit a WIP
curve for each project requested in a budget submission over
$100,000,000 with the 1391 justification to the congressional
defense committees.
Transfer of funds to and from the Foreign Currency
Fluctuations, Construction, Defense Account.--The Committee
directs the Department of Defense to submit a quarterly report
to the Committees on Appropriations of both Houses of Congress
on the transfer of funds from military construction and family
housing accounts to the Foreign Currency Fluctuations,
Construction, Defense account. The report shall specify the
amount transferred to the Foreign Currency account from each
military construction and/or family housing account, and all
other accounts for which an appropriation is provided in this
Act, during the preceding fiscal quarter, and the amounts
transferred from the Foreign Currency account to the above
accounts during the same period. This report shall be submitted
not later than 30 days after the close of each fiscal quarter.
In addition, the Department of Defense shall notify the
Committees on Appropriations of both Houses of Congress within
7 days of transferring any amount in excess of $10,000,000 to
or from the Foreign Currency account.
Bid savings.--The Committee has ascertained from cost
variation notices required by 10 U.S.C. 2853 that the
Department of Defense continues to have bid savings on
previously appropriated military construction projects. The
Committee's recommendation therefore includes rescissions to
the Army, Navy and Marine Corps, and Air Force family housing
construction accounts. The Committee directs the Secretary of
Defense to continue to submit 1002 reports on military
construction bid savings at the end of each fiscal quarter to
the Subcommittee on Military Construction, Veterans Affairs,
and Related Agencies of both the House and Senate.
Incremental funding of projects.--In general, the Committee
supports full funding for military construction projects if
they are executable. However, it continues to be the practice
of the Committee to provide incremental funding for certain
large projects to enable the services to more efficiently
allocate military construction dollars among projects that can
be executed in the year of appropriation. Therefore, the
Committee recommendation includes three projects that have been
incrementally funded.
High performance and sustainable building requirements.--
The Committee recognizes that innovative technologies have
expanded the availability of materials with lower embodied
energy for facilities that require tall walls and large open
spaces with minimal intermediate supports. In addition, design
techniques such as advanced framing contribute to lower
material costs, increased energy efficiency, and reduced waste
in facilities. Therefore, the Committee directs the Secretary
of Defense to incorporate the use of innovative renewable
building materials, systems, and design techniques that support
the requirements of UFC 1 200 02 and the goals of achieving
greater efficiency and lower environmental impacts at a lower
material cost. Furthermore, the Committee encourages the
Department of Defense to collaborate with the United States
Department of Agriculture and the United States Forest Service
to advance its understanding of innovative renewable building
materials and systems and jointly develop a plan on expanding
their use not later than 90 days after enactment of this Act.
Federally Recognized Tribes.--The Committee notes our
Nation's commitment to honoring treaty and trust obligations to
Federally Recognized Tribes. While military operations and
facility protection are important, upholding our commitments to
Indian Country must be an equal priority. It has been observed
that the Department of Defense has struggled to proactively
engage with affected Tribes at the start of the planning
process to ensure meaningful consultation can occur. Moreover,
the Department of Defense does not identify sufficient funds to
cover mitigation and or alternatives should they be agreed
upon. To understand the scale of this problem, the Committee
directs the Secretary to provide the Committee with a list of
military construction projects where mitigation and or changes
to projects within the past five years were consultation with a
Federally Recognized Tribe was required, the outcome of each
consultation, a list of all project modifications and/or
mitigation requests made by the Tribe (or Tribes) in question
for each project, the cost of each measure, and indicate which
modifications and or mitigations were adopted not later than 90
days after enactment of this Act.
Facilities in excess of mission.--The Committee is
concerned that Department of Defense officials have stated an
estimated 22 percent of Department of Defense facilities are in
excess of mission requirements. This is a fiscally
unsustainable diversion of scarce resources from readiness. The
Committee directs, not later than 60 days after enactment of
this Act, the Secretary of Defense to provide to the
congressional defense committees a report detailing each
Department of Defense facility with a utilization rate of less
than 50 percent of available capacity. This report should also
include the number of uniformed personnel and civilian
employees at each of these facilities, the annual budget for
personnel, and the operation and maintenance costs associated
with each identified facility.
Water Conservation on Military Installations.--The
Committee recognizes that the Department of Defense has the
opportunity to play a key role in advancing our Nation's water
security by implementing water conservation, reuse, and
recharge practices on military installations. This should
include efforts to incorporate water conservation technologies
into new infrastructure design, as well as to update existing
infrastructure to make it more water efficient. The Committee
also recognizes that many technologies that increase water
efficiency do not result in competitive returns on investment.
Therefore, the Department of Defense is encouraged to implement
water conservation projects that are not solely contingent on
cost savings performance, but also take into account reduced
water use. To assess the current status of water demand and
potential water conservation opportunities across U.S. military
installations, the Secretary of Defense is directed to report
to the congressional defense committees not later than 180 days
of enactment of this Act the following: (1) the current water
usage on military installations; (2) the vulnerability of each
military installation to water scarcity; and, (3) the water
conservation potential according to (a) reduced water use and
(b) cost savings if current water conservation technologies and
efficient design were implemented at military installations.
Coastal Erosion.--Senate Report 114-57 accompanying the
fiscal year 2016 Military Construction, Veterans Affairs, and
Related Agencies appropriations bill included language
directing the Department of Defense to include an assessment of
coastal erosion and potential flooding risks in the siting of
proposed military construction projects. In a July 23, 2015
report to Congress regarding the security implications of
climate-related risks, the Department noted that it has
directed a global screening level assessment to determine
installation vulnerabilities to climate-related security risks
with the goal of identifying serious vulnerabilities and
developing necessary adaptation strategies. The Committee
directs the Secretary of Defense to report to the congressional
defense committees not later than 120 days after enactment of
this Act, describing the results or the status of the
vulnerability assessment, the adaptation strategies developed
for vulnerable installations, and the estimated costs
associated with implementing these strategies.
Recycled plastic lumber.--The Committee understands that
the Department of Defense has been utilizing recycled plastic
lumber in various manners on its military installations.
Applications include, but are not limited to, bridge
infrastructure, dunnage boards, landscape timbers, rub rails,
construction sleepers, fence posts, and nailer boards.
Manufactured from post-consumer and industrial waste, recycled
plastic lumber is insect resistant, will not rot, splinter,
crack or fail in the manner of traditional wood. Recycled
plastic lumber carries positive environmental impacts by
reducing deforestation, diverting waste materials from
landfills and lowering greenhouse gas emissions. The Committee
directs the Secretary of Defense to further explore
applications for use of recycled plastic lumber, particularly
recycled plastic lumber that uses no virgin plastic, in
military installations, and provide a report to the Committee
not later than 120 days after enactment of this Act on its
findings.
Rural Airfields.--The Committee recognizes that the active
components, as well as the National Guard and reserve
components, often use rural airfield facilities for refueling
and training missions. This permits larger, urban airports to
avoid overutilization during busy times. Additionally, rural
airfields are often used by the military for emergency
evacuations and staging areas. The Committee believes it is
important to keep these regionally and nationally significant
airfields secure and in a state of good repair. The Committee
encourages the Secretary of Defense to invest in improving and
updating rural airfield facilities where able, that are
frequently used by the military Services and National Guard for
training exercises and emergency operations.
Climate and security for Military Installations.--The
Department of Defense must pay close attention to potential
adverse impacts of climate change as a driver of instability.
From sea level rise to increased drought and flooding across
the country and the world, proper defense planning must include
considerations related to climate change impacts. The Committee
urges the Secretary of Defense to plan infrastructure and other
projects using the best available data and science on climate
change to mitigate risks to our armed forces serving
domestically and abroad.
Air traffic control facilities.--The Committee is concerned
that many Department of Defense Air Traffic Control facilities
are unsafe, antiquated, and do not provide adequate control,
communications or observation abilities for the current air
traffic levels at certain locations. For example, the current
facility located at Fort Benning will become wholly inadequate
at the current pace of operations, and a replacement facility
is necessary to ensure Air Traffic Services are available to
support mission readiness and deployment platforms and the
military flying community. The Committee is concerned that this
could be a problem throughout the DOD enterprise with the
recent reductions to the Department of Defense's Construction
accounts. Therefore, the Secretary of Defense is directed to
conduct a risk assessment on Air Traffic Control Facilities
throughout the Defense enterprise and develop a plan to update
these facilities. This assessment shall be submitted to the
congressional defense committees not later than 60 days after
enactment of this Act.
Military Construction, Army
Fiscal year 2017 enacted level........................ $513,459,000
Fiscal year 2018 budget request....................... 920,394,000
Committee recommendation in the bill.................. 923,994,000
Comparison with:
Fiscal year 2017 enacted level.................... 410,535,000
Fiscal year 2018 budget request................... 3,600,000
The Committee recommendation includes a rescission of
$10,000,000 from unobligated balances for unspecified minor
construction under Administrative Provisions.
The Committee recommendation includes additional funding
for the Army in section 125 under Administrative Provisions for
projects on the Services Unfunded Priority lists as provided by
the Office of the Secretary of Defense and submitted to
Congress in priority order.
Access Control Points.--Since September 11, 2001, the
Department has made significant safety improvements at base
entry points across many installations, but more needs to be
done. The Committee is concerned that many of the Army's access
control points do not provide adequate controls for traffic
flow on and off the installation. For example, the current
access control points at Picatinny Arsenal need modernization
to maintain its security and to enhance commercial and
personnel traffic movement. Therefore, the Secretary of Defense
is directed to conduct a risk assessment of all access control
points throughout the Army enterprise and develop a plan to
update these facilities, including a cost estimate for each
facility. This assessment shall be submitted to the
congressional defense committees not later than 60 days after
enactment of this Act.
Military Construction, Navy and Marine Corps
Fiscal year 2017 enacted level........................ $1,021,580,000
Fiscal year 2018 budget request....................... 1,616,665,000
Committee recommendation in the bill.................. 1,558,085,000
Comparison with:
Fiscal year 2017 enacted level.................... 536,505,000
Fiscal year 2018 budget request................... (58,580,000)
The Committee recommendation includes a rescission of
$10,000,000 from unobligated balances for unspecified minor
construction under Administrative Provisions.
The Committee recommendation includes additional funding
for the Navy and Marine Corps in section 125 under
Administrative Provisions for projects on the Services Unfunded
Priority lists as provided by the Office of Secretary of
Defense and submitted to Congress in priority order.
Marine Corps Air Station Beaufort.--The Committee is
concerned that the level of aircraft noise surrounding the base
has been increasing with the amount of flying hours and
training. The Committee directs the Commandant of the Marine
Corps to report to the congressional defense committees not
later than 180 days after enactment of this Act on (1) Whether
there is a need, based on environmental factors, increased
training, or other factors, for the construction and
maintenance of an Alternative Landing Field to service Marine
Corps Air Station Beaufort; (2) Whether it is feasible to
construct an Alternative Landing Field to service Marine Corps
Air Station Beaufort; (3) If no determination of need or
feasibility, an explanation of the reasons for that
determination.
Military Construction, Air Force
Fiscal year 2017 enacted level........................ $1,491,058,000
Fiscal year 2018 budget request....................... 1,738,796,000
Committee recommendation in the bill.................. 1,540,474,000
Comparison with:
Fiscal year 2017 enacted level.................... 49,416,000
Fiscal year 2018 budget request................... (198,322,000)
The Committee recommendation includes additional funding
for the Air Force in section 125 under Administrative
Provisions for projects on the Services Unfunded Priority lists
as provided by the Office of the Secretary of Defense and
submitted to Congress in priority order.
Basing of KC-46 aircraft.--The Committee is concerned that
the Department of the Air Force has not appropriately
prioritized funding for the military construction of
infrastructure necessary for the Air Force's aerial refueling
recapitalization strategy. It has come to the attention of the
Committee that a number of emergent construction requirements
necessary for effective basing of the KC-46 at Pease Air
National Guard Base and Seymour Johnson Air Base could create
delays in fielding the KC-46. The Committee urges the
Department of the Air Force to prioritize funding for these
emergent requirements to ensure the fielding of the KC-46s
without delays and the successful completion of the aerial
refueling recapitalization strategy.
Construction of airfield and base camp.--The Committee is
concerned that the Department of Defense has failed to report
quarterly on the status of construction of airfield
infrastructure and elements at the Agadez, Niger Airfield and
Base Camp in support of operations by AFRICOM as requested by
the Committee in the Report to accompany the Military
Construction, Veterans Affairs, and Related Agencies
Appropriations Bill, 2016. Therefore, the Committee directs the
Department to submit a report not later than 60 days after
enactment of this Act providing an updated status of
construction of infrastructure elements, number of U.S.
uniformed, civilian, and contracted personnel on site, and
timeline for completion of construction.
Air traffic control towers.--The Committee is concerned
that the Department of the Air Force's Air Traffic Control
Towers have been neglected over the years and funding for
military construction has been deferred to the out years of
budget submissions. Many of the air towers are deteriorating
and antiquated, creating significant life, safety, and health
concerns. In some cases, towers have developed extensive mold
issues and contain health risks related to the use of asbestos
and lead-based paint. Additionally, obstructed views in some
cases prevent 100 percent positive visual control of aircraft
landing and taxiing on the airfield. The Committee urges the
Department of the Air Force to prioritize funding for these
towers in a much timelier manner. The Committee believes that
these towers are valuable national security assets that the
Department of the Air Force should maintain in a manner that
will ensure their vital role in protecting U.S. national
security interests.
Air Force flight line safety.--The Committee is concerned
that aging air traffic control towers can negatively impact
airfield operations and be safety concerns on the flight line.
Control towers that are not of sufficient height do not allow
personnel to adequately control aircraft and vehicle movements
on the airfield, therefore, priority should be given to
installations that have these safety concerns.
Military Construction, Defense-Wide
(INCLUDING TRANSFER OF FUNDS)
Fiscal year 2017 enacted level........................ $2,025,444,000
Fiscal year 2018 budget request....................... 3,114,913,000
Committee recommendation in the bill.................. 2,791,272,000
Comparison with:
Fiscal year 2017 enacted level.................... 765,828,000
Fiscal year 2018 budget request................... (323,641,000)
The Committee recommendation includes a rescission of
$27,440,000 from unobligated balances for unspecified minor
construction under Administrative Provisions.
Transfer of funds.--The accompanying bill provides transfer
authority to the Secretary of Defense to allow the transfer of
funds to such appropriations of the Department of Defense
available for military construction or family housing as the
Secretary may designate.
Rhine Ordnance Barracks Medical Center Replacement.--The
Committee is concerned that the completion date for the Rhine
Ordnance Barracks Medical Center Replacement's Life Cycle Cost
Analysis (LCCA) (energy study) has been revised to be completed
sometime mid-2017. The change in timeframe from the November
2016 completion date to incorporate recent (2016) changes in
German energy law (EnEv2016) causes angst for the Committee.
The original energy study that was estimated to be completed in
November 2016 for the LCCA was based on energy requirements
established in 2009 German law. The Committee therefore directs
the Director of the Defense Health Agency to report to the
congressional defense committees: (1) specific changes in
German energy law that affected the energy study; (2) what US
sources of energy the new German energy laws incorporate; (3)
what US sources are no longer able to be used in Germany; (4)
what effect the changes in law have on other military
construction projects, construction costs and current utilities
contracts in the region; and (5) what effect this delay may
have on other aspects of the Rhine Ordnance Barracks Medical
Center Replacement Project.
Ft. Bliss hospital replacement.--The Committee remains
concerned about Ft. Bliss hospital replacement construction
project delays and the costs to complete. This project has
suffered from mismanagement and management deficiencies which
have caused major delays and cost overruns. The fiscal year
2018 request included $251,330,000 for increment 8, which is to
be the last funding necessary to complete the project and is to
cover the remaining design errors and omissions. However, the
Committee remains skeptical that this is accurate. The
recommendation provides the full request and directs the Acting
Director of the Facilities Division within Defense Health
Agency to provide quarterly reports to the congressional
defense committees on the progress of this project to include
future funding requests as they are known and notice of any
further delay. With growing population at Ft. Bliss, working to
complete this project is of the utmost importance. Further, the
Committee believes that blood processing centers should be
collocated with a hospital especially during new construction
of a hospital. Since construction is still ongoing with the Ft.
Bliss hospital replacement project, Defense Health Agency
should re-examine incorporating the center into the current
construction timeline. Therefore, the recommendation does not
provide funding for the blood processing center at Ft. Bliss.
Ft. Leonard Wood hospital replacement.--The Committee is
concerned that the Defense Health Agency's hospital
construction program is stretched thin. Currently, DHA has 45
active construction projects in the U.S. and abroad totaling
approximately $5,200,000,000. The fiscal year 2018 request is
$857,721,000 which is an increase of $553,721,000 over the
fiscal year 2017 enacted level. Within the increase is a
request for $250,000,000 for phase 1 of the Ft. Leonard Wood
hospital and $11,941,000 for a blood processing center
replacement at Ft. Leonard Wood. Due to the amount of current
construction the Committee believes that the DHA is unable to
obligate the full amount as requested for the hospital and
instead provides $150,000,000 for phase I instead of the budget
request of $250,000,000. Further, the Committee believes that
the blood processing centers should be collocated with the
hospital especially when planning and constructing a new
hospital. Therefore, the recommendation does not provide any
funding for the blood processing center at Ft. Leonard Wood and
directs DHA to incorporate the center into the hospital's new
construction in future phases. Lastly, the Committee directs
DHA to report to the congressional defense committees not later
than 120 days after enactment of this Act on the status,
construction timeline, and the current working estimate of the
45 active construction projects.
Parking issues at DOD facilities.--Military construction
budget constraints are negatively affecting the ability of the
Department of Defense to address urgent parking requirements at
certain U.S. military installations. The lack of parking is a
safety issue and a detriment to the well-being of employees,
both civilian and military. The Committee is concerned that
many DOD facilities in the Department's inventory do not have
sufficient parking to meet installation requirements.
Furthermore, these deficiencies can contribute to traffic
congestion and are serious problems on base. The Committee is
concerned that the Department does not have a coherent strategy
to address the growing parking requirements at installations
that have seen significant growth. For example, Fort Meade,
which already was home to the National Security Agency (NSA),
became the headquarters of the newly formed U.S. Cyber Command
in 2010. By 2011, the Defense Information Systems Agency, which
handles the Pentagon's IT and communications needs, had moved
onto the base. In 2005, the base had just over 33,500
employees. Today, it has about 57,000, more than double the
number of workers at the Pentagon. As a result of this growth,
parking at Fort Meade has become a serious issue. Therefore,
the Secretary of Defense is directed to submit to the Committee
with the fiscal year 2019 military construction budget request:
an updated list of unfunded requirements for parking
facilities, access control points, and road construction at DOD
facilities that have serious parking, access, and road
congestion issues. Finally, the Secretary is further directed
to submit, with the fiscal year 2019 military construction
budget request, a list of how those requirements will be
incorporated into their construction requests for fiscal years
2019 through 2023.
Energy Policy.--The Department of Defense is the largest
consumer of energy in the Federal Government, accounting for
nearly 80 percent of the Government's total energy consumption.
The Committee commends the Department for its efforts to
improve the energy efficiency of its facilities and
installations, reduce its energy consumption, and invest in
renewable energy projects and energy security. The Committee
continues to support the Department's efforts to incorporate
green building technologies into new facility construction and
into the renovation of existing buildings, including leading-
edge technologies that can minimize life-cycle costs. DOD and
the Services should engage with government, industry, and
academia to identify and utilize innovative technologies to
reduce long-term energy costs, limit the constraints of energy
and water resources on military mission capabilities and
readiness, and meet congressional and DOD mandated goals for
renewable energy generation and energy and water efficiency.
The Committee encourages the development of net-zero energy
military housing and installation facilities, upgrades and
retrofits for improved energy and water efficiency, and
microgrid demonstrations. The Committee supports the
Department's investments in microgrid energy security and
encourages the Department to continue to explore ways to
mitigate the risk to mission critical assets and promote energy
independence at military installations through the Energy
Resilience Conservation Investment Program.
Energy Resilience Conservation and Investment Program.--On
January 29, 2016 the U.S. Government Accountability Office
(GAO) released a report (GAO-16-162) regarding the DOD's Energy
Conservation Investment Program (ERCIP). GAO recommended that
DOD improve reporting on both expected and actual savings of
selected projects as well as update guidance on selecting
projects to receive program funding. Currently, ERCIP is
focused primarily on energy conservation projects that yield
returns on investment. Recognizing that energy resiliency
should also be a strategic aim of the program, the Committee
urges the Department to consider ERCIP project selection
criteria that also prioritizes installations' energy resiliency
and security.
National Geospatial Intelligence Agency West Campus.--The
Committee continues to have concerns about the new National
Geospatial Intelligence Agency (NGA) West Campus Headquarters
project. This project has a total cost of $821,000,000 and has
been proposed in a two-phased approach with $381,000,000
requested in fiscal year 2018 with the second phase to be
requested in fiscal year 2019. The project has already been de-
scoped during the initial design process, the $801,000
appropriated in fiscal year 2017 has not been obligated and
transferred to the Corps and, based on the work in progress
curve submitted with the budget request, NGA is not able to
obligate the full request of $381,000,000. Therefore, the
Committee has reduced the request by $181,000,000.
SOCOM military construction requirements.--The Committee
remains concerned about the lack of coordination with the
Services for guidance that better defines support facilities
and the horizontal (installation) infrastructure requirements
to support SOCOM military construction at tenant installations.
Therefore, the Committee directs the SOCOM Commander to
coordinate with the Services to document and report to the
congressional defense committees non-MFP-11 horizontal
infrastructure projects that are necessary for execution of
SOCOM construction projects not later than 90 days after
enactment of this Act. This report should include any project
synchronization issues that would delay planned construction
projects in the outyears.
Guard and Reserve Items of Interests
Enforcement of border security.--Recognizing the need to
bolster resources for the enforcement of border security, the
Committee urges the Army National Guard and the Air National
Guard to explore public-private partnerships with state and
local governments, to design, and construct facilities adjacent
to our southwestern border that will support National Guard
activities and house and support assets used by Customs and
Border Protection and other law enforcement agencies for the
terrestrial, maritime, and aerial surveillance of those
borders, to include aircraft hangars suitable for unmanned
aerial systems and report back to the Committee 180 days after
the enactment of the this Act.
Military Construction, Army National Guard
Fiscal year 2017 enacted level........................ $232,930,000
Fiscal year 2018 budget request....................... 210,652,000
Committee recommendation in the bill.................. 210,652,000
Comparison with:
Fiscal year 2017 enacted level.................... (22,278,000)
Fiscal year 2018 budget request................... - - -
The Committee recommendation includes additional funding
for the Army National Guard in section 125 under Administrative
Provisions for projects on the Services Unfunded Priority lists
as provided by the Office of the Secretary of Defense and
submitted to Congress in priority order.
Military Construction, Air National Guard
Fiscal year 2017 enacted level........................ $143,957,000
Fiscal year 2018 budget request....................... 161,491,000
Committee recommendation in the bill.................. 161,491,000
Comparison with:
Fiscal year 2017 enacted level.................... 17,534,000
Fiscal year 2018 budget request................... - - -
The Committee recommendation includes additional funding
for the Air National Guard in section 125 under Administrative
Provisions for projects on the Services Unfunded Priority lists
as provided by the Office of the Secretary of Defense and
submitted to Congress in priority order.
Military Construction, Army Reserve
Fiscal year 2017 enacted level........................ $68,230,000
Fiscal year 2018 budget request....................... 73,712,000
Committee recommendation in the bill.................. 73,712,000
Comparison with:
Fiscal year 2017 enacted level.................... 5,482,000
Fiscal year 2018 budget request................... - - -
The Committee recommendation includes additional funding
for the Army Reserve in section 125 under Administrative
Provisions for projects on the Services Unfunded Priority lists
as provided by the Office of the Secretary of Defense and
submitted to Congress in priority order.
Military Construction, Navy Reserve
Fiscal year 2017 enacted level........................ $38,597,000
Fiscal year 2018 budget request....................... 65,271,000
Committee recommendation in the bill.................. 65,271,000
Comparison with:
Fiscal year 2017 enacted level.................... 26,674,000
Fiscal year 2018 budget request................... - - -
Military Construction, Air Force Reserve
Fiscal year 2017 enacted level........................ $188,950,000
Fiscal year 2018 budget request....................... 63,535,000
Committee recommendation in the bill.................. 63,535,000
Comparison with:
Fiscal year 2017 enacted level.................... (125,415,000)
Fiscal year 2018 budget request................... - - -
The Committee recommendation includes additional funding
for the Air Force Reserve in section 125 under Administrative
Provisions for projects on the Services Unfunded Priority lists
as provided by the Office of the Secretary of Defense and
submitted to Congress in priority order.
Air Force Reserve Hangars.--The Committee is concerned that
many of the Air Force Reserve Hangars are unsafe, antiquated,
and do not provide adequate protection of Air Force Reserve air
assets. For example, hangers located at Homestead Air Reserve
Base have become wholly inadequate due to constrained military
construction budgets and are putting equipment and air assets
at risk. The Committee is concerned that this could be a
problem throughout the Air Force Reserve enterprise with the
recent reductions to the Department of Defense's Construction
accounts. Therefore, the Secretary of the Air Force is directed
to conduct a risk assessment on Air Force Reserve Hangars
throughout the Air Force Reserve enterprise and develop a plan
to update these facilities in the 2019-2023 future years
defense plan. This assessment shall be submitted to the
congressional defense committees not later than 90 days after
enactment of this Act.
North Atlantic Treaty Organization Security Investment Program
Fiscal year 2017 enacted level........................ $177,932,000
Fiscal year 2018 budget request....................... 154,000,000
Committee recommendation in the bill.................. 177,932,000
Comparison with:
Fiscal year 2017 enacted level.................... - - -
Fiscal year 2018 budget request................... 23,932,000
The Committee recommendation includes a rescission of
$25,000,000 from unobligated balances under Administrative
Provisions.
The North Atlantic Treaty Organization Security Investment
Program (NSIP) consists of annual contributions by NATO member
countries. The program finances the costs of construction
needed to support the roles of the major NATO commands. The
investments cover facilities such as airfields, fuel pipelines
and storage, harbors, communications and information systems,
radar and navigational aids, and military headquarters, both
within NATO nations and for ``out of area'' operations such as
Afghanistan.
The U.S. occasionally has been forced to temporarily delay
the authorization of projects due to shortfalls in U.S.
obligation authority. The Committee directs the Secretary of
Defense to notify the Committee within 14 days of the U.S.
taking action to temporarily delay the authorization of
projects, or to temporarily withhold funds from previously
authorized projects, due to shortfalls in U.S. obligation
authority.
Family Housing Overview
Fiscal year 2017 enacted level........................ $1,276,289,000
Fiscal year 2018 budget request....................... 1,407,155,000
Committee recommendation in the bill.................. 1,407,155,000
Comparison with:
Fiscal year 2017 enacted level.................... 130,866,000
Fiscal year 2018 budget request................... - - -
Family housing construction accounts provide funds for new
construction, construction improvements, the Federal government
costs for family housing privatization projects, and planning
and design. The operation and maintenance accounts provide
funds to pay for maintenance and repair, furnishings,
management, services, utilities, leasing, interest, mortgage
insurance, and miscellaneous expenses.
Foreign currency savings and sub-account transfers.--The
Committee directs that savings in family housing operation and
maintenance accounts from foreign currency re-estimates be used
to maintain and repair existing family housing units. The
Comptroller is directed to report to the Committees on
Appropriations of both Houses of Congress on how these savings
are allocated 90 days after enactment of this Act. In addition,
the Committee directs the services and Defense agencies to
notify the Committees on Appropriations of both Houses of
Congress within 30 days of a transfer of funds between sub-
accounts within the family housing construction and family
housing operation and maintenance accounts, if such transfer is
in excess of 10 percent of the funds appropriated to the sub-
account to which the funds are being transferred. Notifications
to the Committees shall indicate the sub-accounts and amounts
that are being used to source the transfer.
Leasing reporting requirements.--The Secretary of Defense
is directed to report to the Committees on Appropriations of
both Houses of Congress quarterly on the details of all new or
renewed domestic leases entered into during the previous
quarter that exceed the cost threshold set by 10 U.S.C.
2828(b)(2), including certification that less expensive housing
was not available for lease. For foreign leases, the Department
is directed to: (1) perform an economic analysis on all new
leases or lease/contract agreements where more than 25 units
are involved; (2) report the details of new or renewed lease
agreements that exceed the cost threshold set by 10 U.S.C.
2828(e)(1) 21 days prior to entering into such an agreement;
and (3) base leasing decisions on the economic analysis.
Family Housing Construction, Army
Fiscal year 2017 enacted level........................ $157,172,000
Fiscal year 2018 budget request....................... 182,662,000
Committee recommendation in the bill.................. 182,662,000
Comparison with:
Fiscal year 2017 enacted level.................... 25,490,000
Fiscal year 2018 budget request................... - - -
The Committee recommendation includes a rescission of
$18,000,000 from bid savings under Administrative provisions.
Family Housing Operation and Maintenance, Army
Fiscal year 2017 enacted level........................ $325,995,000
Fiscal year 2018 budget request....................... 346,625,000
Committee recommendation in the bill.................. 346,625,000
Comparison with:
Fiscal year 2017 enacted level.................... 20,630,000
Fiscal year 2018 budget request................... - - -
Family Housing Construction, Navy and Marine Corps
Fiscal year 2017 enacted level........................ $94,011,000
Fiscal year 2018 budget request....................... 83,682,000
Committee recommendation in the bill.................. 83,682,000
Comparison with:
Fiscal year 2017 enacted level.................... (10,329,000)
Fiscal year 2018 budget request................... - - -
The Committee recommendation includes a rescission of
$8,000,000 from bid savings under Administrative provisions.
Family Housing Operation and Maintenance, Navy and Marine Corps
Fiscal year 2017 enacted level........................ $300,915,000
Fiscal year 2018 budget request....................... 328,282,000
Committee recommendation in the bill.................. 328,282,000
Comparison with:
Fiscal year 2017 enacted level.................... 27,367,000
Fiscal year 2018 budget request................... - - -
Family Housing Construction, Air Force
Fiscal year 2017 enacted level........................ $61,352,000
Fiscal year 2018 budget request....................... 85,062,000
Committee recommendation in the bill.................. 85,062,000
Comparison with:
Fiscal year 2017 enacted level.................... 23,710,000
Fiscal year 2018 budget request................... - - -
The Committee recommendation includes a rescission of
$20,000,000 from bid savings under Administrative provisions.
Family Housing Operation and Maintenance, Air Force
Fiscal year 2017 enacted level........................ $274,429,000
Fiscal year 2018 budget request....................... 318,324,000
Committee recommendation in the bill.................. 318,324,000
Comparison with:
Fiscal year 2017 enacted level.................... 43,895,000
Fiscal year 2018 budget request................... - - -
Family Housing Operation and Maintenance, Defense-Wide
Fiscal year 2017 enacted level........................ $59,157,000
Fiscal year 2018 budget request....................... 59,169,000
Committee recommendation in the bill.................. 59,169,000
Comparison with:
Fiscal year 2017 enacted level.................... 12,000
Fiscal year 2018 budget request................... - - -
Department of Defense Family Housing Improvement Fund
Fiscal year 2017 enacted level........................ $3,258,000
Fiscal year 2018 budget request....................... 2,726,000
Committee recommendation in the bill.................. 2,726,000
Comparison with:
Fiscal year 2017 enacted level.................... (532,000)
Fiscal year 2018 budget request................... - - -
Department of Defense Military Unaccompanied Housing Improvement Fund
Fiscal year 2017 enacted level........................ $- - -
Fiscal year 2018 budget request....................... 623,000
Committee recommendation in the bill.................. 623,000
Comparison with:
Fiscal year 2017 enacted level.................... 623,000
Fiscal year 2018 budget request................... - - -
Department of Defense Base Closure Account
Fiscal year 2017 enacted level........................ $240,237,000
Fiscal year 2018 budget request....................... 255,867,000
Committee recommendation in the bill.................. 290,867,000
Comparison with:
Fiscal year 2017 enacted level.................... 50,630,000
Fiscal year 2018 budget request................... 35,000,000
The additional funding is for the Navy to accelerate
environmental remediation at installations closed under
previous Base Closure and Realignment rounds. Furthermore, the
Navy shall provide to the Committee a spend plan for these
additional funds not later than 60 days after enactment of this
Act.
The need to address inventory and excess of facilities.--
The Committee is concerned about the cost of maintaining excess
inventory of facilities or space at military installations and
the effect on surrounding communities of underutilized bases,
and encourages the Secretary to work with Congress to address
the situation. The Department is encouraged to consider new
options such as a Military Installations Savings Commission
(MISC), to focus on integrating services, assisting in the
transition of underused facilities to higher economic use, and
supporting the affected communities.
Administrative Provisions
The bill retains 28 provisions that were in effect in
fiscal year 2017. The administrative provisions included in the
bill are as follows:
The bill includes section 101 prohibiting the use of funds
for payments under a cost-plus-a-fixed-fee contract for
construction where cost estimates exceed $25,000. An exception
for Alaska is provided.
The bill includes section 102 permitting the use of
construction funds for the hire of passenger motor vehicles.
The bill includes section 103 permitting funds to be
expended on the construction of defense access roads under
certain circumstances.
The bill includes section 104 prohibiting construction of
new bases in the United States without a specific
appropriation.
The bill includes section 105 limiting the use of funds for
the purchase of land or land easements that exceed 100 percent
of value except under certain conditions.
The bill includes section 106 prohibiting the use of funds
to acquire land, prepare sites, or install utilities for family
housing except housing for which funds have been appropriated.
The bill includes section 107 limiting the use of minor
construction funds to relocate any activity from one
installation to another without prior notification.
The bill includes section 108 prohibiting the procurement
of steel unless American producers, fabricators, and
manufacturers have been allowed to compete.
The bill includes section 109 prohibiting the use of funds
to pay real property taxes in foreign nations.
The bill includes section 110 prohibiting the use of funds
to initiate a new installation overseas without prior
notification.
The bill includes section 111 establishing a preference for
United States architectural and engineering services where the
services are in Japan, NATO member countries, or countries
bordering the Arabian Sea.
The bill includes section 112 establishing a preference for
United States contractors for military construction in the
United States territories and possessions in the Pacific and on
Kwajalein Atoll, or countries within the Central Command area
of responsibility, except bids by Marshallese contractors for
military construction on Kwajalein Atoll.
The bill includes section 113 requiring the Secretary of
Defense to give prior notice to Congress of military exercises
where construction costs exceed $100,000.
The bill includes section 114 allowing funds appropriated
in prior years to be used for new projects authorized during
the current session of Congress.
The bill includes section 115 allowing the use of expired
or lapsed funds to pay the cost of supervision for any project
being completed with lapsed funds.
The bill includes section 116 providing that funds for
military construction projects are available until the end of
the fourth fiscal year following the fiscal year in which funds
are appropriated, subject to certain conditions.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 117 allowing for the transfer of
funds from Family Housing Construction accounts to the
Department of Defense Family Housing Improvement Fund and funds
from Military Construction accounts to the Department of
Defense Military Unaccompanied Housing Improvement Fund.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 118 providing transfer authority
to the Homeowners Assistance Program.
The bill includes section 119 requiring that funds in this
title be the sole source of all operation and maintenance for
flag and general officer quarter houses, and limits the repair
on these quarters to $15,000 per year without notification.
The bill includes section 120 making funds in the Ford
Island Improvement Fund available until expended.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 121 allowing the transfer of
expired funds to the ``Foreign Currency Fluctuations,
Construction, Defense'' account.
The bill includes section 122 prohibiting the use of funds
to relocate a unit of the Army that would impact more than 200
personnel.
The bill includes section 123 allowing the transfer of
funds among projects and activities in accordance with the
reprogramming guidelines.
The bill includes section 124 prohibiting the use of funds
for projects at Arlington National Cemetery.
The bill includes section 125 providing additional funds
for various military construction accounts and requires a spend
plan for each.
(INCLUDING RESCISSION OF FUNDS)
The bill includes section 126 rescinding funds from prior
appropriations Acts.
The bill includes section 127 defining the congressional
defense committees.
The bill includes section 128 prohibiting the use of funds
to close or realign Naval Station Guantanamo Bay. The provision
is intended to prevent the closure or realignment of the
installation out of the possession of the United States, and
maintain the Naval Station's long-standing regional security
and migrant operations missions.
The bill does not include section 121 as requested to
provide authority under a continuing resolution when an
authorization bill has been enacted to obligate funds that have
not been appropriated.
TITLE II
DEPARTMENT OF VETERANS AFFAIRS
Fiscal year 2017 enacted level\1\................... $176,941,336,000
Fiscal year 2018 budget request\1\.................. 182,661,467,000
Committee recommendation in the bill\1\............. 182,277,635,000
Comparison with:
Fiscal year 2017 enacted........................ $5,336,299,000
Fiscal year 2018 budget request................. (383,832,000)
Fiscal year 2019 advance budget request\1\.......... 178,409,040,000
Fiscal year 2019 Committee recommendation in the 178,409,040,000
bill\1\............................................
\1\All funding cited excludes amounts in the Medical Care Collections
Fund.
The Department of Veterans Affairs (VA) serves
approximately 48,100,000 people, 21,400,000 veterans and
26,700,000 family members of living veterans or survivors of
deceased veterans. To serve adequately the nation's veterans,
VA employs 364,000 people, making it one of the largest Federal
agencies in terms of employment.
Veterans Benefits Administration (VBA)
COMPENSATION AND PENSIONS
(INCLUDING TRANSFER OF FUNDS)
Fiscal year 2018 enacted level........................ $90,119,449,000
Fiscal year 2019 advance budget request............... 95,768,462,000
Fiscal year 2019 Committee recommendation in the bill. 95,768,462,000
Comparison with:
Fiscal year 2018 enacted level.................... 5,649,013,000
Fiscal year 2019 budget request................... - - -
This appropriation will provide funds for service-connected
compensation payments to an estimated 5,020,000 veterans,
survivors, and dependents in 2018. In addition, pension
payments will be funded for 493,000 veterans and their
survivors. The average cost per compensation case for veterans
in 2018 is estimated at $16,784 and pension payments are
projected at $13,488.
The appropriation includes authority to transfer funding
not to exceed $17,882,000 in 2018 to General Operating
Expenses, Veterans Benefits Administration and Information
Technology Systems. These funds are for the administrative
expenses of implementing cost-saving provisions required by the
Omnibus Budget Reconciliation Act of 1990, Public Law 101-508,
the Veterans' Benefits Act of 1992, Public Law 102-568, and the
Veterans' Benefits Improvements Act of 1994, Public Law 103-
446. These cost-saving provisions include verifying pension
income against Internal Revenue Service (IRS) and Social
Security Administration (SSA) data; establishing a match with
the SSA to obtain verification of Social Security numbers; and
applying the VA pension cap for Medicaid-eligible single
veterans and surviving spouses alone in Medicaid-covered
nursing homes. The bill also continues to include language
permitting this appropriation to reimburse such sums as may be
earned to the Medical Care Collections Fund to help defray the
operating expenses of individual medical facilities for nursing
home care provided to pensioners.
READJUSTMENT BENEFITS
Fiscal year 2018 enacted level........................ $13,708,648,000
Fiscal year 2019 advance budget request............... 11,832,175,000
Fiscal year 2019 Committee recommendation in the bill. 11,832,175,000
Comparison with:
Fiscal year 2018 enacted level.................... (1,876,473)
Fiscal year 2019 budget request................... - - -
This appropriation finances the education and training of
veterans and servicemembers through the Post 9-11 GI Bill and
the All-Volunteer Force Educational Assistance Program.
Supplemental education benefits are also provided to certain
veteran members of the Selected Reserve and are funded through
transfers from the Department of Defense (DOD). In addition,
certain disabled veterans are provided with vocational
rehabilitation, specially adapted housing grants, and grants
for automobiles with approved adaptive equipment. This account
also finances educational assistance allowances for eligible
dependents of veterans who died from service-connected causes
or have a total and permanent service-connected disability, as
well as dependents of servicemembers who were captured or are
missing in action. More than 80 percent of the funds in the
account support the Post-9-11 GI Bill. Funding provided for
fiscal year 2019 is a reduction from the prior year because of
expected unobligated balances available from fiscal year 2018.
VETERANS INSURANCE AND INDEMNITIES
Fiscal year 2018 enacted level........................ $107,899,000
Fiscal year 2018 additional request................... 12,439,000
Fiscal year 2018 recommendation in the bill........... 12,439,000
Fiscal year 2019 advance budget request............... 109,090,000
Fiscal year 2019 Committee recommendation in the bill. 109,090,000
Comparison with:
Fiscal year 2018 enacted level.................... 1,191,000
Fiscal year 2019 budget request................... - - -
The Veterans Insurance and Indemnities appropriation is
made up of the former appropriations for military and naval
insurance, applicable to World War I veterans; national service
life insurance (NSLI), applicable to certain World War II
veterans; servicemen's indemnities, applicable to Korean
conflict veterans; and veterans mortgage life insurance,
applicable to individuals who have received a grant for
specially adapted housing.
The amount provided will enable the Department to transfer
funding to the service-disabled veterans insurance fund and
transfer additional amounts for payments for policies under the
veterans mortgage life insurance program. These policies are
identified under the Veterans Insurance and Indemnity
appropriation since they provide insurance to service-disabled
veterans unable to qualify under basic NSLI. Funds provided are
lower than prior year levels because of lower estimates of
transfers to the various insurance funds.
VETERANS HOUSING BENEFIT PROGRAM FUND PROGRAM ACCOUNT
----------------------------------------------------------------------------------------------------------------
Limitation on
direct loans
Program account for specially Administrative
adapted expenses
housing loans
----------------------------------------------------------------------------------------------------------------
Fiscal year 2017 enacted level............................. - - - ($500,000) $198,856,000
Fiscal year 2018 budget request est........................ - - - (500,000) 178,626,000
Committee recommendation est. in the bill.................. - - - (500,000) 178,626,000
Comparison with:
Fiscal year 2017 enacted level......................... - - - - - - (20,230,000)
Fiscal year 2018 budget request........................ - - - - - - - - -
----------------------------------------------------------------------------------------------------------------
The purpose of the home loan guaranty program is to
facilitate the extension of mortgage credit on favorable terms
by private lenders to eligible veterans. This appropriation
provides for all costs, with the exception of the Native
American veterans housing loan program, of the Department's
direct and guaranteed loans programs. The Federal Credit Reform
Act of 1990 requires budgetary resources to be available prior
to incurring a direct loan obligation or a loan guaranty
commitment. In addition, the bill requires all administrative
expenses of a direct or guaranteed loan program to be funded
through a program account. Loan guaranties are made to
servicemembers, veterans, reservists, and single surviving
spouses for the purchase of homes, condominiums, and
manufactured homes and for refinancing loans. The Department
guarantees part of the total loan, permitting the purchaser to
obtain a mortgage with a competitive interest rate, even
without a down payment if the lender agrees. The Department
requires that a down payment be made for a manufactured home.
With a Department guaranty, the lender is protected against
loss, up to the amount of the guaranty, if the borrower fails
to repay the loan.
Access problems.--The Committee is concerned with the
ability of veterans to benefit from the Department of Veterans
Home Loan Program in areas with a large population of veterans
and competitive housing markets and a shortage of appraisers
approved by VA. The Committee therefore directs the Secretary
to review applicable statutory, regulatory, and agency policy
and report back to the Committee within 90 days of enactment a
series of options to support the greater utilization of the
Home Loan Program in locations with a large veterans population
and competitive housing markets.
VOCATIONAL REHABILITATION LOANS PROGRAM ACCOUNT
----------------------------------------------------------------------------------------------------------------
Limitation on Administrative
Program account direct loans expenses
----------------------------------------------------------------------------------------------------------------
Fiscal year 2017 enacted level............................. $36,000 ($2,517,000) $389,000
Fiscal year 2018 budget request............................ 30,000 (2,356,000) 395,000
Committee recommendation in the bill....................... 30,000 (2,356,000) 395,000
Comparison with:
Fiscal year 2017 enacted level......................... (6,000) (161,000) 6,000
Fiscal year 2018 budget request........................ --- --- ---
----------------------------------------------------------------------------------------------------------------
This appropriation covers the subsidy cost of direct loans
for vocational rehabilitation of eligible veterans and includes
administrative expenses necessary to carry out the direct loan
program. Loans of up to $1,214 (based on indexed chapter 31
subsistence allowance rate) are available to service-connected
disabled veterans enrolled in vocational rehabilitation
programs when the veteran is temporarily in need of additional
assistance. Repayment is made in monthly installments, without
interest, through deductions from future payments of
compensation, pension, subsistence allowance, educational
assistance allowance, or retirement pay. Most loans are repaid
in full in less than one year. The Federal Credit Reform Act of
1990 requires budgetary resources to be available prior to
incurring a direct loan obligation.
It is estimated that the Department will make 2,402 loans
in fiscal year 2018, with an average amount of $981.
NATIVE AMERICAN VETERAN HOUSING LOAN PROGRAM
Administrative expenses:
Fiscal year 2017 enacted level........................ $1,163,000
Fiscal year 2018 budget request....................... 1,163,000
Committee recommendation in the bill.................. 1,163,000
Comparison with:
Fiscal year 2017 enacted level.................... ---
Fiscal year 2018 budget request................... ---
The Native American Veteran Housing Loan Program, as
authorized by title 38 United States Code, chapter 37,
subchapter V, provides the Secretary with authority to make
direct housing loans to Native American veterans for the
purpose of purchasing, constructing, or improving dwellings on
trust lands, including Hawaiian Home Lands. Native Hawaiians,
Alaska Natives and Native Americans, enroll in the military at
higher rates than non-Natives. These loans are available to
purchase, construct, or improve homes to be occupied as
veterans' residences.
GENERAL OPERATING EXPENSES, VETERANS BENEFITS ADMINISTRATION
Fiscal year 2017 enacted level........................ $2,856,160,000
Fiscal year 2018 budget request....................... 2,844,000,000
Committee recommendation in the bill.................. 2,894,000,000
Comparison with:
Fiscal year 2017 enacted level.................... 37,840,000
Fiscal year 2018 budget request................... 50,000,000
The General Operating Expenses, Veterans Benefits
Administration (VBA) account provides funding for VBA to
administer entitlement programs such as service-connected
disability compensation, education benefits, and vocational
rehabilitation services.
The bill makes available through September 30, 2019, up to
five percent of these funds.
The Committee provides $2,894,000,000 for the General
Operating Expenses, VBA account, which is $50,000,000 above the
Administration request. The Committee intends that VA use these
additional funds to restore some of the decrease proposed in
the budget for the Veterans Claims Intake Program (VCIP) to
scan paper claims and convert them into digital format. In
addition, the Committee intends that VA use a portion of the
additional funding to finance overtime payments if that becomes
necessary to manage disability claims and appeals backlogs.
Addressing backlogs.--The Committee is pleased that VA
achieved an `effective zero' on its backlog of disability
claims. However, it is concerned that the disability claims
backlog is now creeping slightly upward as VA devotes more
resources to non-rating claims. In addition, the appeals
backlog is dramatically increasing, as the volume of initial
claims decisions has risen. The Committee urges VA to use the
additional resources provided to tackle both types of backlogs
before they reach troubling levels.
Performance reporting.--The bill includes language
directing VA to continue the specific reporting requirements on
claims processing performance and backlog identified in the
fiscal year 2017 enacted law. In addition, the Committee
directs VA to include in this report the number of appeals, how
many appeals are with the jurisdiction of VBA versus the Board
of Veterans Appeals, and the median age of pending appeals.
Reforms to expedite VA appeals process.--The Committee
expects the Secretary to fully implement the Government
Accountability Office's (GAO) recommendations to improve the
timeliness of VA's disability benefits appeals decisions and to
document its progress in its monthly reports to the Committee
on appeals claims processing performance. The Committee concurs
with the GAO's recommendations that VA should apply sensitivity
analyses when projecting staff needs, develop a more detailed
workforce plan, develop a robust plan for assessing process
reform, and create a schedule for information technology (IT)
improvements accommodating potential process reform. The
Committee also supports GAO's recommendation that any VA
proposed appeals process reforms be first subject to a pilot
test.
Oakland regional office.--The Committee is concerned that
errors in providing dispositions on claims at the Oakland
Regional Office may have resulted in an unreasonable number of
appeals. Therefore, the Committee requests that VA provide not
later than 60 days after enactment of this Act the number of
appeals originating in Oakland from each of the calendar years
2014-2017.
Equitable relief.--The Committee understands that VA is
working to implement new systems and protocols to eliminate
instances of administrative error. However, as VA enacts
system-wide reforms, ending equitable relief for veterans who
were deemed eligible for benefits in error would place an
unfair burden on veterans and their families. The Secretary is
directed to continue to grant or extend equitable relief to
eligible veterans initially deemed eligible in instances of
administrative error. Not later than April 1, 2018, VA is
requested to submit to the Committees a report containing a
statement as to the disposition of each case recommended to the
Secretary for equitable relief under 38 U.S.C 503 during the
preceding calendar year.
Military sexual trauma (MST) claims.--The Committee
understands VBA is developing and implementing new training
initiatives and procedures for posttraumatic stress disorder
(PTSD) claims related to MST. The Committee is pleased with the
increased focus on this area and encourages VA to continue to
build on the strides that have been made, to include intensive
training and changes identifying specialized claims employees
for MST-related claims. However, the Committee also realizes
that, in addition to PTSD, MST can lead to other mental health
disorders. The Committee urges VA to consider, in addition to
PTSD, anxiety, depression, and other mental health disorders in
their treatment of victims of MST. The Committee also urges VA
to conduct veteran outreach initiatives and publicize benefits
veterans may be entitled to as a result of MST. In addition,
the Committee recognizes that MST affects both female and male
veterans and encourages VA to continue its efforts to provide
equal treatment and assistance for both female and male
veterans.
Transition assistance.--The Committee encourages VA to
expand veterans education connection centers at medical centers
and outpatient clinics, such as the one established at the
Louis Stokes Veterans Medical Center in Cleveland, Ohio.
Veterans service data.--The Committee notes the enduring
interest in minimizing the barriers to veteran employment.
Often, businesses seeking to hire veterans and take advantage
of the Work Opportunity Tax Credit are faced with difficulty in
verifying veterans' disabilities and service data. While the
Committee recognizes the multiple means for veterans to obtain
access to their DD-214 and medical records, the Committee
recognizes the benefits of making these documents available to
prospective employers electronically in controlled settings if
privacy and confidentiality issues can be addressed. The
Committee encourages the Secretary to work with the Secretary
of Defense and State governors to create mechanisms to share
this data to help support the employment of veterans.
State and county veteran service officers receiving access
to VA records.--The Committee encourages the Secretary to work
with State and county Veteran Service Officers to explore
options for allowing authorized Veteran Service Officers ``read
only'' access to Veterans Benefit Management System (VBMS)
records for the purpose of identifying individuals who may be
eligible for State or local benefits in addition to Federal VA
benefits.
Therapeutic benefits of farming.--Currently, 40 percent of
the nation's farms are operated and owned by farmers over the
age of 65, and over the next 15 years there will be a demand
for one million new farmers. In addition, over 800,000
servicemembers will transition out of the military over the
next decade. Veterans face obstacles accessing mental health
services in rural and highly rural areas and filling the
shortfall of working farmers could provide therapeutic benefits
for veterans and transitioning servicemembers. Therefore, the
Committee encourages the Department to coordinate with the
Departments of Defense and Agriculture in identifying and
promoting vocational programs that provide the following:
educational or vocational training in agriculture-related
fields, behavioral health services on-site through licensed
providers, if possible, and a pathway to employment in
agriculture-related fields.
Minority outreach.--The Committee is concerned that current
outreach efforts to educate minority veterans about benefits to
which they are entitled may not be adequate. The Committee
requests that, within 180 days of enactment of this Act, VBA
submit a report, in coordination with the Center for Minority
Veterans, VSOs and other stakeholders, describing strategies
for effective, targeted outreach to educate minority veterans
and their families about available VA benefits, and VBA's plans
to implement these strategies.
Vision assistive technology.--Recent innovation in vision
assistive technology provides an opportunity for VA to support
blind and vision-impaired veterans to become more independent
and mobile. As one example, remote assistive technology exists
to connect veterans with a network of certified agents via
wearable smart glasses and an augmented reality dashboard that
allows the agents to see what is in the blind person's vision
field sees in real time. The Committee encourages VA to test a
variety of these vision assistive technology devices to assess
their utility in VA rehabilitation efforts.
Service dogs.--The Committee recognizes that more than
20,000 service members have been wounded in action in Operation
Iraqi Freedom, Operation Enduring Freedom, Operation Inherent
Resolve, and Operation Freedom's Sentinel. Many of these men
and women have suffered severe injuries such as spinal cord
injuries, amputations, traumatic brain injuries, and visual and
hearing impairments. For many of those most severely injured
warriors, service, guide and hearing dogs provide crucial tasks
to mitigate a veteran's disabilities, as well as provide
therapy, assistance, and rehabilitation. Currently, there is a
waiting list of veterans and active military personnel who seek
the support of assistance dogs. Given the growing need for
service dogs and the positive impact these dogs will have on
the lives of wounded service members, the Committee believes
that VA should expand its participation with the accredited
non-government organizations that provide assistance dogs for
rehabilitation and enhanced recovery care to injured service
members of all eras who have suffered service-related injuries.
The Committee urges VA to prioritize support of veterinary
healthcare and other benefits for service dogs for wounded
warriors.
Veterans Health Administration (VHA)
The Department operates the largest Federal medical care
delivery system in the country, with 145 hospitals, 115
domiciliary residential rehabilitation treatment programs, 136
nursing homes, 300 Vet Centers, 80 mobile Vet Centers, and
1,252 outpatient clinics which include independent, satellite,
community-based, and rural outreach clinics. More than
7,000,000 patients will be treated in 2018.
The Veterans Health Administration is comprised of five
accounts: Medical Services, Medical Community Care, Medical
Support and Compliance, Medical Facilities, and Medical and
Prosthetic Research. For the first four accounts, the
Administration has requested total resources for fiscal year
2019 of $70,699,313,000 in direct appropriations to fund the
four advance appropriations of the VHA. The bill also provides
the requested $2,650,000,000 in additional fiscal year 2018
funding for the four Medical Care accounts. In addition, VA
will receive an estimated $3,271,000,000 in Medical Care
Collections Fund in fiscal year 2018. The Committee also
provides $698,228,000 for medical and prosthetic research.
VA medical care is provided both at VA facilities and in
non-VA community care settings. VA in-house care is financed
through the Medical Services account and non-VA community care
is supported through the Medical Community Care account. Non-VA
care has also been provided through the mandatory Choice
program, which was not funded in an appropriations bill. As the
Choice program funding ends, the authorizers are developing
legislation that would consolidate all non-VA care programs,
including a successor program to Choice. The budget proposes to
fund the successor program to Choice with continued mandatory
funding, but under the same policies as the discretionary non-
VA community care programs.
MEDICAL SERVICES
Fiscal year 2017 enacted level........................ $45,555,812,000
Fiscal year 2018 enacted level........................ 44,886,554,000
Fiscal year 2018 additional request................... 1,031,808,000
Committee 2018 additional recommendation.............. 1,031,808,000
Fiscal year 2019 advance budget request............... 49,161,165,000
Committee 2019 recommendation in the bill............. 49,161,165,000
Comparison with:
Fiscal year 2018 enacted level.................... 4,274,611,000
Fiscal year 2019 budget request................... ---
This appropriation provides for medical services of
eligible veterans and beneficiaries in Department medical
centers, outpatient clinic facilities, contract hospitals,
State homes, and outpatient programs on a fee basis. VA also
supports hospital and outpatient care through the private
sector for certain dependents and survivors of veterans under
the Department of Defense (DOD) civilian health and medical
programs.
The bill provides the request of $49,161,165,000 for
advance fiscal year 2019 funding as well as $1,031,808,000 in
additional fiscal year 2018 funding as requested. The Committee
has included requested bill language to make available through
September 30, 2020, $1,400,000,000 of the Medical Services
advance appropriation for fiscal year 2019.
Funding identified in the bill does not include the
$2,847,000,000 in mandatory funding requested by the
Administration, financed by mandatory benefit program
reductions. That proposal is within the jurisdiction of the
authorizing committees.
Changes in funding requirements due to modeling.--The
Committee expects VA to continue to include in the sufficiency
letter required by section 117(d) of title 38, United States
Code, that is due to the Congress on July 31 of each year, a
description of any changes exceeding $250,000,000 in funding
requirements for the Medical Services account resulting from
the spring recalculation of the Enrollee Healthcare Projection
Model.
Allocation of health funding.--The Committee continues to
be concerned that the process VA uses to allocate the health
services appropriation through the Veterans Integrated Service
Networks (VISNs) and from them to the medical centers may
shortchange the ultimate users because of excessive funding
retained at headquarters or at the VISNs. The Committee
continues to request a report each year not later than thirty
days after VA allocates the medical services appropriation to
the VISNs that identifies: (1) the amount of general purpose
funding that is allocated to each VISN; (2) the amount of
funding that is retained by central headquarters for specific
purposes, with amounts identified for each purpose; and (3) the
amount of funding that is retained by each VISN before
allocating it to the medical centers, identifying separately
the amounts retained for purposes such as network operations,
network initiatives, and emergencies.
Mental health issues
The Committee provides the full fiscal year 2018 budget
request of $8,353,200,000 for mental health programs. Of the
amounts provided for mental health programs in fiscal year
2018, $186,128,000 shall be used for suicide prevention
outreach. The Department is directed to provide a report to the
Committee not later than 30 days after enactment of this Act
identifying a detailed expenditure plan for all suicide
outreach programs.
Veterans crisis line (VCL).--According to the U.S. Census
Bureau, there are 21,800,000 million veterans in the U.S. While
veterans constitute only 8.5 percent of the population, they
accounted for 18 percent of all deaths from suicide among
adults, and, according to VA, approximately 20 veterans die
from suicide every day. One tool VA has to combat high suicide
rates and help those who are considering suicide is the VCL, a
24-hour, toll-free hotline that veterans can call to connect to
a responder trained in crisis management. While the Crisis Line
is invaluable, it is not without shortcomings and some calls
are not answered in an appropriate amount of time. The
Committee remains concerned by the continuing deficiencies
identified at the VCL in a second investigative report from the
Office of Inspector General (OIG). The Committee requests an
update from VA in the form of a report due not later than
September 30, 2017, detailing how VA is working to implement
the recommendations from both VA OIG reports and the Government
Accountability Office on the VCL. The report should address how
the VCL is working to hire a permanent director; how many VCL
staff (including Social Service Assistants, call responders,
managers, and supervisors) have received training and
orientation (including how many remain to receive such
training); changes the VCL has made with its backup center
contractors, including efforts to track how long veterans
remain in a queue to have their call answered; what percentage
of calls are transferred to a non-VA hotline; how the VHA
Member Services is working to collaborate with the Office of
Suicide Prevention to ensure veterans are receiving appropriate
clinical care; what processes are now in place to track and
analyze performance data from the two VCL centers and its four
contracted backup centers; and how the VCL is complying with
the requirements from the No Veterans Crisis Line Call Should
Go Unanswered Act.
The Committee has repeated bill language included in the
fiscal year 2017 Act requiring the VCL to: (1) provide to
individuals who contact the hotline immediate assistance from a
trained professional; and (2) to adhere to all requirements of
the American Association of Suicidology.
Suicide prevention training.--VA has implemented
comprehensive, broad-ranging suicide prevention initiatives,
including the toll-free Veterans Crisis Line, placement of
Suicide Prevention Coordinators at all VA medical centers and
large outpatient facilities, and improvements in case
management and tracking. These initiatives have improved mental
healthcare access for veterans across the nation. However, the
Committee is interested in how VA employees are trained to deal
with veterans in crisis. Veterans are at a disproportionately
high risk for suicide compared to the rate of U.S. civilian
adults, and these initiatives are a lifeline for many veterans.
While the Committee understands that training will vary due to
education and position, there must be consistent protocol
across the VA enterprise when dealing with veterans in crisis.
The Committee is concerned that the variations in the protocol
may be a threat to the health and safety of veterans.
Therefore, the Committee urges the Secretary to develop a basic
protocol for all employees who deal with veterans in crisis.
Furthermore, the Committee directs VHA to provide a report on
the training methods currently in place at the VCL and VA
medical centers not later than 90 days after enactment of this
Act.
Clay Hunt SAV Act.--The Committee is pleased that VA has
initiated the five pilot programs required by the Clay Hunt SAV
Act. These pilots provide a community-oriented veteran peer
support network carried out in partnership with an entity that
has experience in peer support programs, and a community
outreach team for each medical center in the five pilot areas.
The networks establish peer support training guidelines,
conduct training, develop teams of veteran peer support
counselors and deliver peer support to veterans identified by
the VA outreach teams. The Committee requests a report on the
status of VA's efforts not later than 60 days after enactment
of this Act.
Suicide among female veterans.--Female veterans are six
times more likely to commit suicide than women in the general
population. This alarming trend must be addressed by the
Department without delay. The Committee directs the VA to renew
its focus on improving access to mental health services for
female veterans and ensure that female mental health needs,
which often differ from male needs in prevalence and
expression, are met.
Community clinic mental health services.--The Committee
understands that VA policy requires that mental health services
be available regardless of the location of the veteran--either
in person, on-site, through referral to the nearest VA medical
center, through telemental health, or through community
referral. Understanding that location, capacity, and
availability of providers affect where a veteran receives
mental health services and through which mechanism, the
Committee would like a briefing to learn more about how VA
establishes the method of providing mental health care in an
individual community-based outpatient clinic, how VA makes the
judgment that the method is adequate for the type of cases
encountered at the facility, and how frequently VA reviews the
adequacy of the mechanism for provision of quality mental
healthcare.
Public-private partnerships.--The Committee continues to
recommend that VA actively seek out public-private
partnerships, in particular with research universities,
teaching hospitals, and other partners, to expand upon its
existing efforts related to suicide prevention, PTSD, traumatic
brain injury (TBI), and substance use disorders.
National Center for Posttraumatic Stress Disorder (PTSD).--
The Committee recognizes the importance of the VA National
Center for PTSD in promoting better prevention, diagnoses, and
treatment of PTSD. The Committee further recognizes the
importance of this research for veterans, their family members
and those experiencing community violence. Consistent with
recommendations from the 2016 National Veterans Health Equity
report, the Committee urges the Center to conduct an evidence-
based analysis of neighborhood effects and other social
determinants of health on PTSD in minority veterans, and
propose recommendations to address disparities. This report
should include an examination of how veterans' PTSD diagnoses
may be exacerbated by gun violence in the neighborhoods they
return to after their service.
PTSD service dogs.--The Committee is pleased that VA is
conducting a pilot through the Center for Compassionate
Innovation on the use of mental health mobility service dogs
for veterans whose mental health disorder is so debilitating
that he or she cannot leave home or move about independently.
In this study, VA provides veterinary health benefits, but does
not provide the actual service dogs. In addition, VA is
conducting a more traditional research study on the use of
service dogs for veterans with PTSD. In that study, VA supports
both the purchase of the dog and its veterinary health care.
The Committee hopes that the results of these two research
projects will provide the evidence VA needs to finance
veterinary health care for service dogs for behavioral
conditions as well as physical conditions. Given that waiting
lists for service dogs average between 18 and 24 months, the
Committee urges VA to reconsider whether it will purchase the
dogs for veterans, if research results validate the utility of
service dogs for behavioral conditions.
Postpartum depression.--An estimated one out of seven new
mothers experience postpartum depression. The Committee
requests a report on what maternal mental health services are
available to women veterans at each VISN through the VHA and
the Choice program. The report should include mental health
support services for women veterans who: have miscarried; had a
still born baby; who have had challenges related to fertility;
have or have had a high risk pregnancy; or have postpartum
depression. The report should also specifically address if
women veterans are screened for postpartum depression, as well
as how many female mental health professionals are available in
each VA medical facility.
Law enforcement liaison.--The Committee is pleased that VHA
is working with the Law Enforcement Training Center to develop
education for community law enforcement to ensure the needs of
veterans who are considered an immediate threat to themselves
or others are addressed. The goal of the Outside Law
Enforcement-First Responder Veteran Assistance Training is to
provide training and education to first responders about the
unique issues facing veterans (specifically recently returned
combat veterans) and to increase collaboration with local first
responders in the community.
Veterans treatment courts.--The Committee is aware of the
successful outcome-oriented support system developed by
Veterans Treatment Courts that connects veterans with
appropriate treatment and services that can reduce recidivism
and break the cycle of crime, arrest and incarceration.
Bringing together a team that usually includes a judge,
prosecutor, defense counsel, law enforcement officer, probation
officer, court coordinator, treatment provider and case
manager, is similar to what a veteran experienced in the
military and is conducive for them to confront and correct the
underlying cause of their crime. The Committee urges the
Department to continue to make treatment services a priority in
the treatment court system as more jurisdictions implement
Veterans Treatment Courts.
Independent review of mental health care.--The Committee is
aware of occasional reports of gross negligence in VA care of
patients with mental health or substance abuse issues. While
there are regular mechanisms within VA to investigate reports
of poor quality care, including investigations by the Office of
Inspector General, and less frequent reviews by outside
organizations like the Joint Commission, the Committee would
like to learn if there are other entities qualified and able to
respond in real-time to charges of inappropriate care. The
Committee requests a report not later than 60 days after
enactment of this Act identifying non-VA government bodies that
would be equipped to investigate on short notice allegations of
poor quality VA care. This report should include a description
of State protection and advocacy agencies and their role in
investigating poor quality care.
Mental health services training for community providers.--
Community providers play an essential role in ensuring our
Nation's veterans receive the support they have earned. The
Committee supports providing care to veterans within the
community because while many veterans seek mental health care
at VA, others choose to go to providers in their community. The
Committee was pleased that VA developed a Community Provider
Toolkit aimed at delivering support, therapeutic tools, and
resources to community providers treating veterans for mental
health concerns. While the Provider Toolkit was a positive
step, challenges still remain for veterans receiving mental
health care in the community. For example, civilian mental
health providers are not always trained to address the unique
psychological needs of veterans suffering from military sexual
trauma and other mental health problems unique to veterans.
Therefore, the Committee directs the Secretary to provide a
report on the training methods currently offered to community
mental health providers and to develop a plan to train
community providers on these unique challenges not later than
120 days of enactment of this Act.
Discrimination in PTSD claims.--The Committee is concerned
that veterans of color may be disproportionately denied claims
for post-traumatic stress disorder. Therefore, the Committee
requests a report not later than 90 days after enactment of
this Act detailing the number of claims from each of the years
2015, 2016, and 2017 related to PSTD that were filed, the
number granted, and the number that were appealed. These
numbers should be broken down by racial and ethnic group.
Hepatitis C
The bill provides $751,200,000 for hepatitis C treatment in
fiscal year 2018, the same amount as the administration
request. The Committee commends VA for its efforts to respond
to the disproportionate infection rate of hepatitis C among
veterans. More than 87,000 veterans have been treated with the
new generation oral hepatitis C drugs, with 90 to 95 percent
cure rates. These cures are having profound effects in
preventing liver disease and cancer for those veterans as well
as the costs otherwise borne by VA for treating these
illnesses. VA indicates that 58,000 veterans in the VA
healthcare system remain potential candidates for hepatitis C
treatment. However, an increasing proportion of this cohort are
more difficult to engage and treat, due to factors such as
inability to adhere to therapy, psychosocial determinants, or
unstable or uncontrolled medical comorbidities. VA is
encouraged to increase its outreach efforts to screen and treat
the remaining hepatitis C patients in the veteran community.
The Committee requests a report not later than 60 days after
enactment of this Act describing the Department's efforts to
improve hepatitis C screening rates in traditional and non-
traditional settings, and the utilization of innovative
strategies like point-of-care testing collaboration with
veterans' service organizations, voluntary health
organizations, and other stakeholders.
Homeless assistance
The Committee provides the full fiscal year 2018 budget
request of $1,727,784,000 for VA homeless assistance programs,
in addition to an estimated $5,573,956,000 for homeless
veterans treatment costs. These programs include the Homeless
Providers Grant and Per Diem, the Domiciliary Care for Homeless
Veterans, the Supportive Services for Low Income Veterans and
Families, and the Department of Housing and Urban Development--
Department of Veterans Affairs Supported Housing (HUD-VASH)
programs.
Enhanced use lease (EUL) authority.--The Committee believes
that enhanced use lease authority, with which VA establishes a
cooperative arrangement in which underutilized VA properties
are made available to public or private entities in exchange
for consideration allowing expanded services to veterans, has
been a very valuable tool in creating housing for homeless
veterans. VA currently participates in 31 EUL projects that
provide supportive housing for homeless veterans. The Committee
is pleased that VA expects to continue to increase the number
of permanent homeless housing facilities in 2017.
Related needs of homeless veterans.--While VA has made
strides in reducing veteran homelessness, its program clients
need additional support beyond shelter. The Committee continues
to be interested in the feasibility, advisability and cost of
VA conducting a pilot program to award grants to eligible
organizations to provide furniture, household items, and other
assistance to formerly homeless veterans who have transitioned
to permanent housing. The Committee requests an updated report
on the Department's views of such a program not later than 60
days after enactment of this Act.
HUD-VASH program.--The Committee recognizes the important
contributions the HUD-VASH program has made in reducing the
number of homeless veterans and commends VA for implementing a
case management system that keeps veterans housed longer by
providing the supportive care many of them require. The
Committee encourages VA to more creatively and collaboratively
work with local social service agencies, especially in rural
and small communities, to ensure that HUD-VASH voucher
recipients are receiving the most comprehensive services
available to them. Many jurisdictions around the country are
implementing their own coordinated care initiatives alongside
public housing programs, and in the interest of maximizing
public investment and providing the best, most comprehensive
care available, VA should seek to partner with local and State
governments when possible. The Committee requests an annual
report identifying how many HUD-VASH vouchers are given to
female veterans with children, female veterans without
children, male veterans with children, and male veterans
without children in each State. The report should also include
the number of HUD-VASH vouchers distributed to veterans in
rural, suburban, and urban areas per State. An annual report
will be an important data point over time to assess the success
of VA's efforts to combat veteran homelessness.
Female homeless veterans.--The Committee remains committed
to helping homeless veterans and commends VA for its efforts in
reducing homelessness among the veteran population. However,
the Committee is concerned about VA's efforts to reduce
homelessness among female veterans, and particularly those
veterans with minor children. These veterans may be faced with
additional challenges when trying to obtain homeless services
from VA. The Committee requests the Department to provide an
analysis of the challenges facing homeless female veterans with
minor children and the services VA has developed to address
those challenges. This report should be provided to the
Committee not later than 90 days of enactment of this Act.
Homeless veterans in rural areas.--The Committee continues
to be concerned about VA's efforts to combat homelessness among
rural veterans. The Committee encourages VA to identify ways to
obtain more accurate data on homeless and at-risk veterans in
rural areas, and is pleased that VA will be hosting a Homeless
Evidence and Research Synthesis later this year to discuss the
challenges that exist in identifying and providing services to
rural and highly rural veterans. The Committee requests VA to
report not later than 60 days after enactment of this Act new
approaches the Department is designing to measure and address
homelessness among the rural veteran population.
Construction of housing for rural homeless veterans.--The
Department has made great efforts to find housing for homeless
veterans and their families. However, to date, VA has not
tested the concept of awarding grants to eligible entities to
purchase and construct rural, single unit, tiny homes for
homeless veterans, who may prefer to live in rural communities.
This approach could provide a pathway to stable housing for
veterans. The Committee requests the Department to outline what
legislative changes would be required to establish such a
program on a pilot basis, the feasibility, and estimated cost
of such a program. The report should be provided to the
Committee not later than 60 days after enactment of this Act.
Staffing issues
Hiring delays.-- The Committee is concerned about whether
the VA hiring and credentialing process may contribute to
longer wait times for veterans seeking healthcare. The
Committee requests VA to report on the average length of time
to fill a healthcare provider slot at a representative sample
of medical centers, including: the time it takes the resource
board to approve the hire of a new position; the time it takes
to post the job announcement; how long the interview process
takes; and the length of time for credentialing; as well as any
internal VA goals that exist for the time each step in the
process should take. The report should also describe how often
a healthcare provider reaches the credentialing process phase
of the process, but exits the process because of another
opportunity outside VA. This report should be provided to the
Committee not later than 60 days after enactment of this Act.
Medical staff retention.--The Committee expects VA to
continue to report every six months on the number of medical
staff who have left the VA system, including a summary of the
principal reasons explaining their departure, and a detailed
plan of how VA will address and mitigate the principal reasons
providers leave. The data should be aggregated at the VISN
level and should also include the percentage of staff in
primary care versus specialty care and mental health health
care, and the percentage of medical staff at each facility who
complete an exit survey upon their departure. Exit surveys
should be conducted anonymously, including through the use of a
location that allows for privacy, is not directly visible by
another employee, and does not require the departing employee
to input any personally identifiable data.
Position vacancies.--The Committee is concerned about the
large number of vacancies among senior positions at VA medical
centers throughout the country. Not later than 120 days after
enactment of this Act, the Secretary is requested to develop
and submit to the Committee a plan describing: (1) methods to
hire highly qualified medical directors for each medical center
that lacks a permanent director; (2) possible impediments to
staffing facilities with permanent directors; and (3)
possibilities of promoting and training qualified candidates
from within the VA for promotion to Senior Executive Service
positions.
Nurse training programs.--The Committee encourages VA to
further support the VA Nursing Academic Partnership Programs
(VANAP), the Post-Baccalaureate Nurse Residency (PBNR), the VA
Nursing Academic Partnerships in Graduate Education (VANAP-GE),
and the Enhancing Academic Partnerships program. These programs
enhance recruitment and retention of highly trained nursing
professionals, while elevating interprofessional education
concentrating on behavioral health services, women's health,
gerontology services, services for homeless veterans, and rural
health care initiatives. These initiatives ensure that veterans
and their families have access to the right provider, at the
right time, by building strong partnerships between academia
and VA practice.
Nursing locality pay systems.--Recognizing the importance
of recruitment and retention of qualified nurses, the Committee
requests VA to submit a report within 90 days of enactment of
this Act that analyzes how individual VA medical centers set
pay rates for nurses at their facilities and how those rates
compare to pay rates set by other VAMCs within their VISN. This
report should also include an analysis across VISNs about
whether a consistent methodology is used when setting pay
scales.
Leveraging military expertise.--The Committee recognizes
that civilian medical personnel may have a difficult time
communicating with military veterans due to the distinct nature
of military language and culture. The Committee urges the
Secretary to conduct a feasibility study regarding the
expansion of existing programs that allow guard and reserve
members to maintain clinical competencies by conducting a
portion of their contractual reserve time at VA facilities. The
Committee recommends that the Secretary consider expanding this
program to leverage telemedicine technologies used by rural
providers participating in the CHOICE program, as these reserve
and guard personnel are in a unique position to provide
expertise and military knowledge in medical communities that
may be lacking.
Psychology internships.--The Committee understands that VHA
each year uses the services of the Association of Psychological
Postdoctoral and Internship Centers (APPIC), a non-profit
organization, to help select and match clinical psychologists
for available VA internships. The Committee is concerned,
however, that APPIC has decided to not include psychologists
from programs accredited by the Psychological Clinical Science
Accreditation System (PCSAS) even though VHA has recently
published new Psychologist Qualification Standards that
recognize graduates of PCSAS-accredited programs. The Committee
is pleased to learn that VHA is working to resolve this
situation to insure that all appropriately trained and
qualified psychologists are given equal access to VA
internships. The Committee requests a report on the status of
this issue by August 1, 2017, including a discussion of the
contribution of psychology in meeting the overall healthcare
mission of VA.
Recruitment incentives.--The Committee is concerned with
the shortage of medical providers at VA facilities and the
inability to compete with private practice in the recruitment
and retention of such providers. VA is encouraged to prioritize
funding for student loan repayment options and other hiring
incentives, such as signing bonuses and relocation expenses, to
remain competitive in efforts to recruit and retain providers.
The Committee also requests VA to report not later than 90 days
after enactment of this Act on the differences between student
loan repayment options for VA providers versus providers
serving Health Professional Shortage Areas through the National
Health Service Corps.
Residency positions.--In the Veterans Access, Choice, and
Accountability Act of 2014, Congress instructed VA to focus
graduate medical education residency positions in those
locations experiencing a shortage of physicians, those located
in a community that is designated as a health professional
shortage area, and to give priority to residency positions and
programs in primary care and mental health. The Committee
requests that VA increase its focus on these underserved
locations when determining residency positions.
Access for rural veterans
Office of Rural Health.--The Committee provides the full
fiscal year 2018 budget request of $250,000,000 to improve
access and quality of care for the more than 3,000,000 enrolled
veterans residing in rural and highly rural areas. The VA
Office of Rural Health (ORH) improves access and quality of
care for enrolled Veterans residing in geographically rural
areas. Developing evidence-based policies and innovative
practices to bring healthcare to rural areas is key to serving
veterans in geographically remote areas, including remote
facilities in Hawaii, many of whom would otherwise need to fly
to reach their nearest VA facility. In addition to providing
healthcare services, ORH's important work includes identifying
barriers to healthcare delivery in rural areas and implementing
new ways to deliver healthcare and services to veterans in
these locations.
Operating plan.--The Committee directs ORH to submit to the
Committee not later than 30 days after enactment of this Act an
operating plan for fiscal year 2018 funding, as well as the
fiscal year 2019 funding provided in advance by this Act.
Rural caregivers.--The report VA produced last year in
response to the Committee's request for information about
special barriers faced by rural caregivers identified problems
such as lack of providers, hospital closings due to financial
instability, internet access, unfamiliarity with available VA
services, training needs, poor transportation, and social
isolation. The Committee requests ORH to develop a group of
policy proposals that, if adopted, could be used on behalf of
rural caregivers to reduce the difficulties common to their
situations. This package of possible policy options should be
provided to the Committee not later than 120 days after
enactment of this Act.
Telemedicine.--The Committee encourages further development
and implementation of telemedicine to help veterans in rural
areas. Telemedicine is useful for a number of types of
appointments, including helping veterans with mental health
issues. The Committee requests VA to submit a report not later
than 90 days after enactment of this Act providing with an
update on the uses of telemedicine in rural communities and VA
plans to further expand the use of telemedicine for mental
health care.
Improving access for rural veterans.--According to the most
recent census data, usage of VA healthcare by rural veterans
increases by level of rurality, with almost 40 percent of
veterans in completely rural counties enrolled in or using the
system. Rural veterans had the highest rates of disability
overall and at all ages, and rural veterans from every period
of service also have higher rates of disability than similar
urban veterans. Rural veterans who served during World War II
(the oldest cohort) had the highest rate of disability. Rural
Gulf War veterans, however, had the highest rate of service-
connected disability. Healthcare services required for these
cohorts may differ dramatically, and access to those services
may be more difficult in rural areas. The Committee urges VA to
consider age disparity among the rural veteran population when
working to increase accessibility to telehealth services.
Remote areas.--The Committee directs the Department to
conduct a study of the feasibility of establishing health
clinics in remote and underserved areas, such as the Northern
Mariana Islands, where a veteran must travel by air or sea in
order to reach the nearest full service VA health facility. The
study should include an evaluation of the capability of
existing health care providers in these areas to meet the needs
of veterans. The study should be submitted to the Committee not
later than 120 days after enactment of this Act.
Facility expansion.--The Committee encourages VA to
identify Community-Based Outpatient Clinic (CBOC) facilities,
with a priority in rural areas, for facility expansion
opportunities in order to accommodate additional patients and
provide enhanced services, reducing the need for veterans to
travel long distances for care. The VA is encouraged to look at
existing CBOCs which are operating at full capacity, have a
proven record of delivering services, and have community
support to expand the facility.
Womens' issues
Women's access to medical services.--In 2010, in
recognition of the increasing number of women veterans and the
fact that they were not being served adequately at VA
facilities, both in terms of attention to gender-specific
health issues or infrastructure that could accommodate gender-
specific needs, VA established a comprehensive instruction
handbook specifically for healthcare services for women
veterans that provided guidance in many of these areas. In
2015, Booz Allen Hamilton conducted an assessment of VA medical
facility response to the 2010 guidance. In the area of
facilities' ability to ensure the dignity, privacy, and
security of women veterans where they receive healthcare
services, the assessment found that 71 percent of the sites
were not adequately designed to meet the standard in diagnostic
or patient care areas and 83 percent of the sites did not meet
the standard in examination rooms. While the Committee
appreciates VA's system-wide attention to the needs of women,
it is clear that more improvements must be made to create
appropriate settings for women's care. The Committee directs VA
to provide not later than 90 days after enactment of this Act a
description of the locations where VA facilities do not meet
the standards established in 2010 and a timeline for meeting
those standards, along with associated costs.
Childbirth data.--The Committee requests a report not later
than 90 days after enactment of this Act identifying the number
of women veterans participating in the VA healthcare system who
have given birth in the five most recent years for which data
are available, how many of the pregnancies were high risk, the
number of complications related to the mother or baby, and the
number of maternal mortalities that occurred.
Maternity care benefit, survey, and education campaign.--
The Committee requests a report on the following data related
to VA maternity care benefits: the number of eligible female
veterans and actual utilization from each of the last 10 years
in each Veterans Integrated Service Network (VISN), to the
extent that data are available; the number of veterans who
receive prenatal care and have births at a VA facility, and the
number of veterans who receive prenatal care-related services
through contracted non-VA providers; information on the
transition from VA to non-VA providers and how medical records
are returned to VA once a woman is postpartum, particularly if
she has an underlying medical condition; the number of
maternity care coordinators in each VISN and specific data on
minimum employment requirements and case load. The Committee
also directs VHA to develop a patient survey to collect
feedback from women veterans who utilize the maternity care
benefit, including their satisfaction with VA maternity care
benefits; whether the benefit met their needs; the patient's
interaction with the maternity care coordinator; and whether
there were barriers to care, providers, or specific services
related to the maternity care benefit. Further, the Committee
encourages VHA to develop an education campaign publicizing the
maternity care benefit, including clarifying who is eligible,
what the benefit covers, and does not cover, and any cost
sharing that may be required with the benefit. The education
campaign materials should be easy for patients to understand
and be easily accessible online and at each center for women's
health, medical center, and CBOC.
Womens' psychiatric needs.--The Committee encourages VA to
offer real-time or tele-psychiatric services to pregnant and
postpartum women modeled on existing evidence-based programs to
adequately address women veterans' mental health needs.
Delivery of gender-specific care to female VA patients.--
The Committee is concerned that VA is not adequately addressing
the health needs of female veterans, including obstetrics and
gynecological care, and treatment for gender-specific
conditions and diseases. The Committee urges VA to continue its
efforts to expand access to care in these areas and ensure
efficient delivery of treatment for women veterans.
Breast cancer screening guidelines.--The Committee commends
the Department of Veterans Affairs decision to offer breast
cancer screening and mammography to eligible female veterans
beginning at age 40, yearly mammograms at age 45, and then
every other year from age 55. The Committee supports this
effort to ensure that the care female veterans receive is
consistent with the private sector, and the Committee will
continue to monitor the Department's implementation of this
policy. The Department should closely follow ongoing debate as
the scientific community reaches a consensus on breast cancer
screening and mammography coverage to provide veterans the best
care possible. Bill language is included to ensure VA maintains
this policy through fiscal year 2018.
Maternal mental health.--The Committee requests a report
not later than 90 days after enactment of this Act identifying
how many pregnant veterans were screened for depression in
2017, and, on average, at what points during pregnancy women
were screened. The report should include how many times
referrals were made based on the screening results, the number
of pregnant veterans who utilized treatment based on the
referral, and whether they accessed care at VA or through
community care, by VISN. The report should also identify the
five most frequent psychosocial risks for pregnant veterans
identified for each VISN during that time period.
Pharmacy issues
VA retail immunization care coordination program.--The
Committee commends the VA Retail Immunization Care Coordination
Program, which is a convenient way for veterans to ensure that
they receive flu shots to avoid the dangerous effects of the
disease. The Committee encourages VA to build upon the existing
flu immunization program and expand the concept to other
immunizations such as pneumococcal and zoster vaccines.
Pharmacy workflow.--The Committee requests VA to provide a
report describing how it manages pharmacy workflow processes at
its centers and how those processes address preparation safety,
reduce waste, and improve pharmacy productivity. The report
should describe any major variations among the more than 1,000
workflow systems presently in use at VA and whether there are
particular systems that have achieved higher levels of safety
and productivity. This report should be provided not later than
90 days after enactment of this Act.
Vaccine procurement.--The Committee is pleased that VA
includes vaccines produced through recombinant DNA technology,
in addition to traditionally produced vaccines, in its
solicitations to facilitate the competitive process for all
vaccine manufactures.
VA drug prices.--Rising drug prices are a significant cost
driver in healthcare. However, VA receives substantial
discounts when purchasing prescription drugs. Common sense
approaches such as using lower-cost generic drugs, providing
care from expert pharmacists and making drug companies compete
for business can help drive down the cost of healthcare. The
Committee is interested in VA's spending on prescription drugs.
The Committee directs the Secretary of Veterans Affairs, to
submit a report to the Committee on Appropriations not later
than 120 days after the date of the enactment of this Act. The
report should include prescription drug prices (net of rebates)
paid by VA for the ten most frequently prescribed drugs and the
ten highest-cost drugs for VA. In addition, the report should
include total annual costs to the VA for all prescription
drugs.
Prescription drug abuse
Comprehensive Addiction and Recovery Act (CARA).--The bill
includes $55,821,000, as requested, for opioid addiction
prevention and recovery efforts as authorized by CARA. Of this
total, $8,991,000 is provided through the Medical Support and
Compliance account.
State prescription drug monitoring programs.--The Committee
notes that, with the problem of opioid use disorders escalating
among veterans, it is very important that VA continue its
efforts to partner with States to ensure that they have the
capacity to exchange prescription drug information with VA. The
Committee understands that 47 States currently have installed
the technology to exchange data from their State prescription
drug monitoring boards with VA. One State and Puerto Rico have
not acquired the necessary technology; three States are
resolving legal issues with VA on their memoranda of
understanding to share data. VA is urged to assist these
remaining States to speed their exchange.
Opioid addiction treatment.--The Committee appreciates VA's
submittal of a report to the Committee on VA's ongoing review
of prescription practices and addiction treatment protocols for
opioids. Unfortunately, the report fails to recognize the
Substance Abuse and Mental Health Services Administration's
(SAMHSA) recommendation for the use of all drugs approved by
the Food and Drug Administration for the treatment of opioid
addiction including medications that enable veterans to become
free of all opioids and non-opioid alternatives that are less
subject to diversion. The Committee requests an update of this
report not later than 90 days after enactment of this Act that
describes VA's commitment to the goal of enabling veterans to
become free of all opioids and having access to non-opioid
alternative medications and recovery supports. In conjunction
with its overall efforts to address opioid abuse, the Committee
also encourages VA to explore the use of advanced data
analytics to detect and deter abuse and to treat addiction.
Oversight of VA substance abuse inspection programs.--The
Committee is aware that the veteran population is at greater
risk than the general population for opioid addiction. A recent
GAO report recommended that the Secretary should ensure that
medical centers establish an additional control procedure, such
as an alternate controlled substance coordinator or a pool of
extra inspectors, to help coordinators meet their
responsibilities and prevent missed inspections. The Committee
concurs with the GAO's recommendations and encourages the
Secretary to fully implement these recommendations to improve
oversight of the controlled substance abuse inspection program
and to document its progress. The Committee requests that VA
provide an update on its progress adopting these best practices
not later than September 30, 2017.
Other health issues
Hispanic-serving institution affiliations with VA health
care facilities.--The Committee is pleased with VA's effort to
stimulate connections with Hispanic-serving institutions
(HSIs), but continues to be concerned by the lack of HSIs'
medical school participation and collaboration with local VA
hospitals in areas where HSI medical schools are located. The
Committee urges the Secretary to develop a plan to expand local
VA medical facilities' participation with HSI medical schools
and provide that report to the Committee not later than 60 days
after enactment of this Act.
Historically black colleges and universities (HBCU) health
professions schools.--The Committee is pleased that VA is
moving forward with a symposium in June, 2017 with national VA
leaders, VISN leaders, and leadership of the HBCUs that award
doctoral level degrees in the health professions. The Committee
requests a report on this event as well as the planned followup
action at all levels of VA and the HBCU health professions
schools not later than 90 days after enactment of this Act.
Minority veteran care.--The Committee recognizes that in
the last ten years, the number of minority veterans enrolled in
the VA health system has increased and is projected to continue
to grow. The Committee encourages the Veterans Health
Administration to make preparations to accommodate this growing
population of veterans. The Committee is encouraged that the
Center for Minority Veterans (CMV) and Office of Health Equity
(OHE) have recently published reports outlining preliminary
recommendations to investigate delivery of healthcare, and to
improve disparities in health outcomes in minority veterans.
However, the Committee is concerned there is not a coordinated
effort to convey these recommendations to all offices in the
Department. Therefore, the Committee directs the Undersecretary
of Health to form a working group which should include senior
department executives to develop a comprehensive implementation
plan of the CMV and OHE recommendations for the Department. The
Advisory Committee on Minority Veterans is directed to publish,
on an annual basis, a review of the Department's progress in
implementing these recommendations. The Committee also directs
the GAO to conduct a nationwide review of whether VA provides
quality and culturally appropriate care for minority veterans.
This report should include recommendations on how the
Department can structure its next generation of electronic
health record to collect data on quality and patient experience
data by race and ethnicity.
Veterans end-of-life care.--Veterans often have a unique
set of physical, psychological and emotional needs at the end
of life, including post-traumatic stress disorder, service-
related disabilities, and other emotional and spiritual needs.
The Committee applauds VA for their efforts to develop and/or
strengthen partnerships with local hospice organizations, to
increase access to hospice and palliative care for veterans,
and to provide information and resources to improve end-of-life
care for veterans. The Committee encourages VA to continue to
foster delivery models that allow veterans to receive
concurrent hospice or palliative care while receiving active
disease treatment.
Vietnam-age veterans and younger veterans face special
challenges, compared to WWII veterans, which impact end-of-life
caregiving and hospice care. The Committee requests VA to
submit a report not later than 90 days after enactment of this
Act identifying the unique challenges faced by Vietnam veterans
receiving specialized palliative and hospice care and
identifying best practices for hospice care specifically
tailored to Vietnam veterans. In developing this report, VA
should engage hospice and palliative care providers with
Vietnam veteran-centric programs.
Volunteer physicians.--The Committee is encouraged by the
success of the Physician Ambassadors Helping Veterans Pilot
Program to date and encourages VA to expand these programs to
additional facilities throughout the country, prioritizing VHA
sites that serve the largest veteran population as well as
those which experience the longest wait times.
Antimicrobial stewardship directives
The Committee is pleased with VA's efforts to reduce
antibiotic use to avoid development of resistance to important
drugs, without increasing 30-day readmission and mortality
rates. Per the VHA Directive 1031, the VA has focused on the
implementation and effectiveness of the VA Antimicrobial
Stewardship Program. This program establishes stewardship
programs in all VA facilities and fosters the judicious use of
antimicrobials through education, direct provider-to-provider
stewardship, and surveillance, and supports and expands ongoing
efforts to prevent emergence of multidrug-resistant organisms.
Regarding another aspect of antimicrobial stewardship,
Congress recognizes that patient-focused, real-time clinical
infectious disease surveillance and pharmacy tools are required
for hospitals to meet national Antimicrobial Stewardship
directives. While individual VA medical facilities have
incorporated commercially-proven infectious disease and
pharmacy tools, VA has not deployed a nationwide system. The
Committee encourages VA to consider implementing a nationwide
electronic solution for all VA medical facilities that would
provide infectious disease control monitoring, provide
appropriate treatment and pharmacy care plans, help prevent
potential health care risks, document interventions that
improve patient care, and reduce hospital costs.
Vet centers.--The Committee appreciates the efforts VA has
made in terms of providing vet centers and mobile vet centers
to address the varied physical and mental health needs of
veterans. Given the changing dynamics and increased number of
combat veterans, the Committee requests VA to provide an
analysis of the need for additional vet centers to serve this
population, disaggregated by Veterans Integrated Service
Network. This report should be submitted to the Committee not
later than 90 days after enactment of this Act.
National Veterans Sport Programs.--The bill includes
$15,830,000 for the Office of National Veterans Sports Programs
and Special Events, which is the same as the request and the
fiscal year 2017 funding for the program. The Committee
recognizes that veterans have shown marked improvements in
mental and physical health from participating in adaptive
sports and recreational therapy. The Committee also recognizes
that adaptive sports and recreational therapy provide a lower-
cost alternative to other healthcare services that produce
similar health outcomes.
Colorectal cancer screening.--In 2016, the United States
Preventive Services Task Force (USPSTF) identified 7 strategies
to increase colorectal cancer screening, designating them as A-
rated. The strategies have subsequently been adopted by the
National Committee for Quality Assurances Healthcare
Effectiveness Data and Information Set (HEDIS) measures, which
are used by more than 90 percent of America's health plans to
measure performance. The Committee encourages VA to offer all
seven USPSTF strategies now recognized in the HEDIS measures to
all veterans enrolled in the VA health system. Colorectal
cancer remains the second leading cause of cancer death in the
United States, killing 50,000 Americans every year. Treatment
costs reached $6,500,000,000 last year, much of this borne by
the Medicare system; overall spending is expected to exceed
$20,000,000,000 annually by 2020. Many of these deaths and
later-stage diagnoses could be prevented and hundreds of
millions of dollars could be saved if these cancers were
detected earlier through a range of scientifically proven
screening techniques. Higher compliance and adherence to a
testing strategy can also be achieved if more screening
alternatives are offered by VA, further reducing mortality and
morbidity in the veteran's population.
Veterans identification card fee.--The Veterans
Identification Card Act requires the Department to issue
identification cards to any requesting veteran who was
discharged from the armed forces. The Committee is concerned
that the law requires VA to cover the cost of issuing the cards
by charging veterans a fee for the card. The Committee
understands that, at this time, VA has not issued any veteran
ID cards, and the actual cost of the proposed ID card has not
been determined. The Department indicates that it is trying to
make the costs as low as possible to facilitate the widest
possible distribution of cards and will consider low-income
waivers for some veterans. In addition, the Committee
encourages VA to partner with private charities and individuals
to assist low-income veterans with the cost of the cards.
Patients' rights.--The Committee notes that veterans'
rights while in treatment at VA facilities do not match in all
instances the standards at some of the nation's leading private
medical institutions. The Committee urges the Secretary to
analyze the differences in the rights of VA medical
beneficiaries compared to those at leading private medical
service providers and develop a plan no later than 180 days
after enactment of this Act to better align VA's policies with
common standards of leading private medical service providers.
Provision of kidney dialysis services.--The Committee is
aware that VA has a long history of providing dialysis services
for veterans through national contracts when VA is unable to
directly provide those services. As the Choice program is
reconfigured, the Committee understands that VA may consider
including provision of dialysis services as part of the Choice
networks rather than renewing the existing national contracts.
However, VA has stated that its decision on this issue is
unresolved and the national contracts may well be extended when
up for renewal September 30, 2018. The Committee encourages VA
to consider carefully the benefits provided by the current
national contracts and whether they could be replicated as part
of a Choice network. The Committee also applauds VA's desire to
move to value-based care in dialysis. To start, VA should
explore the Center for Medicare and Medicaid Service's renal-
focused efforts to move dialysis providers nationally in more
quality-focused and value-based arrangements.
Patient safety.--The Committee applauds the Department for
continuing to make strides in safe, high quality healthcare
through its efforts to become a high reliability organization,
as recommended by the Joint Commission throughout all
healthcare, and is encouraged by the interest of a number of VA
facilities in innovative, proven methods for care delivery like
the Military Acuity Model developed by U.S. Air Force medical
staff.
Eye screening pilot.--The Committee is aware that VA has
begun an experimental eye and vision screening pilot program,
called Technology-Based Eye Care Services (TECS), currently in
operation at the Atlanta VA Medical Center. While appreciating
that VA is operating the pilot to provide eye care to veterans
in areas in which it can be difficult to find timely care, the
Committee is concerned that the TECS program may be offering a
reduced level of care for veterans that does not conform to
existing VA policy. The Committee urges VA to critically
examine the use of the program and ensure that all veterans
receive a standard of care in conformity with existing VA
policy.
Lung cancer screening.-- The Committee notes with concern
that veterans at risk for lung cancer are not always afforded
the same access to lung cancer screening programs that are
offered to Medicare beneficiaries. The Committee requests the
Secretary to report to the Committee not later than 90 days
after enactment of this Act on the steps VA is taking to make
lung cancer screening broadly available to veterans at high
risk for lung cancer.
Analytic surgery evaluations.--The Committee is committed
to ensuring that veterans receive the most appropriate, least
invasive, quality surgical care possible in order to decrease
the clinical risk to patients while simultaneously reducing
costs through greater efficiencies. The Committee encourages
the Secretary to explore systems and approaches that would
objectively compare VA surgical outcomes data against best
practice data to identify unwanted variation at the procedure
and surgeon level and help ensure that surgical procedures are
being carried out in an efficient and high quality manner.
Delays in reimbursements.--The Committee is concerned by
reports that veterans can wait months for reimbursement for the
costs of their travel to VA facilities for medical treatment.
The Committee directs VA to report back not later than 90 days
after enactment of this Act, detailing actions VA has taken to
process travel vouchers within 60 days of receipt of the
voucher.
Services to Indian veterans.--In 2010, VA entered into a
memorandum of understanding (MOU) with the Indian Health
Service (IHS). On January 17, 2017, the MOU was extended
through June 30, 2019. Under this agreement with IHS, VA
reimburses care provided to Indian veterans at IHS facilities
and Tribal health programs. The agreement benefits VA, which
cannot reasonably maintain full service VA facilities in low
population, highly rural areas. Reimbursement rates are
substantially above customary rates because of costs of
providing service in highly rural locations. There is community
interest in extending the VA special reimbursements to Indian
urban clinics. In order to understand the impact of this
expansion, the Committee requests VA to provide a comprehensive
report describing how an expansion of the current agreement
with IHS would integrate with care currently provided to Indian
veterans in VA clinics in urban areas and through the Choice
program of non-VA community care. The report should include:
(1) estimates of the number of veterans who are likely to leave
the VA healthcare system in urban areas to seek service through
Indian urban clinics; (2) the annual estimated cost
differential for VA to reimburse IHS rather than provide
services directly in urban areas; (3) the potential for Indian
urban clinics to qualify as providers in VA Choice provider
networks; (4) estimated capacity of Indian urban clinics to
treat increased Indian veteran caseloads; and (5) any data
supporting the use of the higher negotiated reimbursement rate
in urban settings versus highly rural areas. VA should consult
with IHS in the preparation of this report, which should be
provided to the Committee not later than 90 days after
enactment of this Act.
Detection of early pressure ulcers in veterans.--VA has
been a leader in the use of telehealth services. For veterans
who have a health problem like diabetes, chronic heart failure,
chronic obstructive pulmonary disease, depression or post-
traumatic stress disorder, getting treatment can be complex and
inconvenient, and these innovative telehealth approaches can be
lifesaving. The Committee is interested in how biometric sensor
technology can be used as a diagnostic to accurately detect
early pressure ulcers in veterans. The Committee urges the
Secretary of VA to explore the use of early detection
technology for early pressure ulcers and the possible impact it
could have on the cost of care related that condition.
Outdoor recreational therapy.--The Committee supports VA
utilization of outdoor recreation as a means of addressing the
physiological, psychological, social, and emotional wellbeing
of patients. The Committee requests a report not later than 90
days after enactment of this Act that identifies the number of
recreational therapists employed by each VISN, the frequency
with which recreational therapy was prescribed in fiscal year
2016 by each VISN, and whether it was prescribed by a primary
care provider or specialist. The report should also describe
the primary barriers providers experience in prescribing
outdoor recreational therapy, including but not limited to
geographical limitations, cost, lack of research basis on
effectiveness or health outcomes, and physical health
constraints of veterans.
Disruption in medical facility moves.--The Committee
recognizes that VA is reorganizing its healthcare system as it
makes decisions about locations where services will be provided
by outside healthcare entities versus VA facilities. Such
reorganizations can create disruption and confusion in
communities. To prevent potential disruptions in the future,
the Committee directs VA to submit a written notification to
the community and to the State's Congressional delegation 30
days before it plans to close a healthcare facility. Such
notification should identify the alternative facility or
facilities where VA plans that veterans in the area will
receive care; address distance and travel concerns that may
occur for veterans; and provide information on the type of care
available at the alternative facilities.
Organ donation policy.--The Committee is concerned that
veterans may not have a complete understanding of VA policy
regarding reimbursement of organ transplants. VA is requested
to provide a report to the Committee not later than 60 days
after enactment of this Act about VA organ donation policies,
explaining such issues as: (1) which conditions qualify a
veteran for an organ transplant paid for by VA; (2) whether
live donation transplants are covered by VA; (3) what share of
the organ transplantation cost must be financed by the veteran;
(4) reimbursement policy for veterans receiving organs from
non-veteran live donation, as well as possible reimbursement
for the non-veteran surgical costs; and (5) whether live
donation organ transplants, if reimbursed, can be financed
through the Choice program or can only be performed in VA or
VA-affiliated hospitals.
Medical Community Care
Fiscal year 2017 enacted level........................ $7,246,181,000
Fiscal year 2018 enacted level........................ 9,409,118,000
Fiscal year 2018 additional request................... 254,000,000
Committee 2018 additional recommendation.............. 254,000,000
Fiscal year 2019 advance appropriation request........ 8,384,704,000
Committee 2019 advance appropriation recommendation... 8,384,704,000
Comparison with:
Fiscal year 2018 enacted level.................... (1,024,414,000)
Fiscal year 2019 advance budget request........... - - -
The Medical Community Care account was created in the
Surface Transportation and Veterans Health Care Choice
Improvement Act of 2015. It is intended to consolidate all
community care programs under a single appropriation. For
fiscal year 2018, the bill provides an additional $254,000,000
as requested by the Administration and for fiscal year 2019,
the bill provides $8,384,704,000, of which $2,000,000,000 is
available until September 30, 2022.
As the Choice program reaches the end of its mandatory
funding in 2018, the authorizing committees are considering
legislation to consolidate VA's traditional community care
programs with a successor program to the original Choice
program. The Administration has proposed to finance the
successor Choice program as a mandatory program, funded with
policy changes that would reduce mandatory VA benefits.
Regardless of whether or not the mandatory successor program is
established, the efforts to consolidate VA's multiple community
care programs are important. As VA and the authorizers consider
this consolidation, the Committee highlights the following
issues in the current Choice program that it hopes will be
addressed:
Exceptions to distance rules.--The Committee is
pleased that VA has continued to `open the aperture' of care
that can be provided outside of VA facilities. The Secretary
now has discretion to identify ``other factors'' that create an
unusual or excessive burden, which create eligibility for
Choice services. These factors include the nature or complexity
of the medical services the veteran requires; the frequency
that those services must be furnished to the veteran; and the
need for an attendant for a veteran to travel to a VA medical
facility. The Committee encourages VA to continue to use and
possibly expand these criteria, for example, in situations
where the veteran is receiving chemotherapy or dialysis, as the
successor program to Choice is designed. In addition, the
Committee directs VA to report to the Committee not later than
60 days after enactment of this Act the number of instances
during 2017 in which veterans were not permitted to use non-VA
care in instances meeting the definition of ``unusual or
excessive burden''.
Problems with network administrators.--The
Committee is concerned about the continued communication gaps
between patients and third party administrators (TPAs) who
operate the Choice provider networks. The Committee is aware of
numerous complaints from veterans and community care providers
about program eligibility, delays in scheduling of
appointments, and inadequate resources to resolve billing
issues. The Committee urges VA to work with the TPAs to
restructure the Choice program to improve these issues and to
work with State veterans agencies to continue to strengthen and
improve the Choice program's provider network.
Referral delays.--The Committee is concerned by a
recent GAO report suggesting that VA has not set a limit on the
number of days VA hospitals are allowed to compile relevant
clinical information and send referrals to the TPAs. The
Committee directs the Secretary to review this report and
establish a reasonable limit on the number of days VA hospitals
can take to transfer relevant clinical information and
referrals to TPAs to ensure that veterans receive timely care.
Travel burdens.--All too often, infirm or elderly
veterans are required to travel long distances or endure
significant drive times to access VA care, even though local
non-VA hospital care and medical services are readily
available. The Committee hopes that program modifications will
continue to reduce the travel burden for senior veterans
needing care.
Delayed provider payments.--The Committee
continues to be concerned about the timeliness of
reimbursements from VA to private healthcare providers. Delays
in processing of such payments seriously undermine the ability
to recruit and retain private healthcare providers to care for
veterans. The Committee repeats its request that not later than
90 days after enactment of this Act, VA provide the Committee a
comprehensive report detailing the amount owed to outside
providers in each State. The report should document outstanding
invoices over 6 months due and the corrective actions being
implemented to address these outstanding balances. Furthermore,
this report should describe any planned future actions that
will prevent this problem from recurring.
Network administrator poor performance.--The
Committee is aware of problems experienced by veterans
utilizing the Choice program, including challenges scheduling
appointments; appointments being canceled without notification;
and slow payments to physicians for services provided. The
Committee remains concerned that VA has not included safeguards
in its Choice Act contracts to hold contractors accountable for
the quality and flexibility of care provided to veterans.
Choice Act staffing increases.--The Committee repeats its
request for a report due not later than 90 days after enactment
of this Act describing for each VISN the amount of Choice Act
funding received in fiscal year 2016 to hire additional staff;
the number of staff hired; the number of employees who left VA
during that period; and the net gain for each of the following
position categories--primary care, specialty care physicians
and mental health staff.
Medical Support and Compliance
Fiscal year 2017 enacted level........................ $6,524,000,000
Fiscal year 2018 enacted level........................ 6,654,480,000
Fiscal year 2018 additional request................... 284,397,000
Committee 2018 additional recommendation.............. 284,397,000
Fiscal year 2019 advance budget request............... 7,239,156,000
Committee 2018 recommendation in the bill............. 7,239,156,000
Comparison with:
Fiscal year 2018 enacted level.................... 584,676,000
Fiscal year 2019 advance budget request........... - - -
The Medical Support and Compliance appropriation funds the
expenses of management and administration of the Department's
health care system, including financial management, public
health and environmental hazard, quality and performance
management, medical inspection, human research oversight,
training programs and continuing education, security, volunteer
operations, and human resources.
The bill provides $7,239,156,000 in advance fiscal year
2019 funding, as requested, as well as $284,397,000 requested
in additional fiscal year 2018 funding. The Committee has
included requested bill language to make available through
September 30, 2020, $100,000,000 of the Medical Support and
Compliance appropriation for fiscal year 2019.
Medical Facilities
Fiscal year 2017 enacted level........................ $5,321,668,000
Fiscal year 2018 enacted level........................ 5,434,880,000
Fiscal year 2018 additional request................... 1,079,795,000
Committee 2018 additional recommendation.............. 1,079,795,000
Fiscal year 2019 advance budget request............... 5,914,288,000
Committee 2019 recommendation in the bill............. 5,914,288,000
Comparison with:
Fiscal year 2018 enacted level.................... 479,408,000
Fiscal year 2019 advance budget request........... - - -
The Medical Facilities appropriation provides funds for the
operation and maintenance of the Department's health care
system's capital infrastructure. Included under this heading
are provisions for costs associated with utilities,
engineering, capital planning, leases, laundry, grounds
keeping, garbage, housekeeping, facility repair, and property
disposition and acquisition.
The bill provides $5,914,288,000 in advance fiscal year
2019 funding, as requested, as well as $1,079,795,000 in
additional fiscal year 2018 funding. The Committee has included
requested bill language to make available through September 30,
2020, $250,000,000 of the advance Medical Facilities
appropriation for fiscal year 2019.
Spending plan.--The Committee expects VA to provide not
later than 30 days after enactment of this Act an expenditure
plan detailing the planned use of the funds provided. The
Committee understands that some of the projects planned for
fiscal year 2018 may not be ready within that timeframe,
requiring an adjustment to the spending plan. The Committee
requests a quarterly update of the plan if the funding for any
single project changes by more than $3,000,000 during that time
period.
Medical imaging equipment.--The Committee remains committed
to helping VA in its efforts to ensure a timely process for VA
medical centers to receive the medical imaging equipment that
they need to take care of veterans. The Committee urges VA to
adhere to their set timelines for consolidated procurements of
high-tech medical equipment and strive for a 120-day turnaround
for these orders. Delays to this timeline negatively impact
patient and clinician access to diagnostic and imaging
services, and the Committee asks VA to be mindful of these
potential risks. The Committee requests that VA increase
education opportunities at individual VA medical centers
regarding high-tech medical equipment purchasing processes and
seek ways to eliminate redundant paperwork requirements for
such orders. The Committee encourages VA to share information
regarding procurement processes in the area of high-tech
medical equipment with VISN imaging communities and VA medical
centers. In addition, the Committee urges VA to coordinate
between capital equipment purchases, facilities funding for
site readiness, and training of staff to use the equipment to
ensure that facilities can use it as quickly as possible after
purchase.
Medical and Prosthetic Research
Fiscal year 2017 enacted level........................ $675,366,000
Fiscal year 2018 budget request....................... 640,000,000
Committee recommendation in the bill.................. 698,228,000
Comparison with:
Fiscal year 2017 enacted level.................... 22,862,000
Fiscal year 2018 budget request................... 58,228,000
This appropriation provides for medical, rehabilitative,
and health services research. The bill makes this account
funding available through September 30, 2019. The Committee
recognizes the importance of the research conducted by VA for
veterans' quality of life and provides $58,228,000 above the
request to address important research areas like genomic
precision medicine and the Million Veteran Program database.
Medical research is an important aspect of the Department's
programs, providing complete medical and hospital services for
veterans. The prosthetic research program is also essential in
the development and testing of prosthetic, orthopedic, and
sensory aids for the purpose of improving the care and
rehabilitation of eligible disabled veterans, including
amputees, paraplegics, and the blind. The health services
research program provides unique opportunities to improve the
effectiveness and efficiency of the health care delivery
system. Budgetary resources from a number of areas, including
appropriations from the medical care accounts, reimbursements
from DOD, grants from the National Institutes of Health,
private proprietary sources, and voluntary organizations,
provide support for the Department's researchers. Estimated
2018 research resources beyond the research account are
$1,114,000,000.
PTSD research.--The National Center for PTSD sets the VA
agenda for research and education on PTSD, with seven research
divisions located at VA facilities. The Center also conducts
education and training, and coordinates the VA National PTSD
Brain Bank. The bill provides up to $40,000,000 for the Center
in fiscal year 2018, compared to the budget request of
$19,680,000.
PTSD is a clinically diagnosed psychiatric disorder that
can occur following life-threatening events or exposure to
traumatic events. Military service can be a strong contributor
to PTSD. For example, nearly 20 percent of enlisted soldiers--
approximately 300,000--who returned from Iraq and Afghanistan
have reported symptoms of PTSD or major depression. The
Committee urges VA to expand and strengthen its research on
PTSD and trauma-related brain disorders, and use every
available technology including research focused on finding a
diagnostic biomarker for PTSD. Unlike other neuro-psychiatric
diseases, it is not yet known how genetic variants affect a
person's risk of developing PTSD. Such biomarker information
may provide a mechanism to more reliably predict the risk of
PTSD in different populations and afford an opportunity for
preventive interventions. To address PTSD, the Committee urges
the Secretary of Veterans Affairs to engage in public/private
pilot projects with non-profit entities that are committed to
the provision of mental health services for veterans.
The Committee recognizes the importance of the VA National
Center for PTSD in promoting better prevention, diagnoses, and
treatment of PTSD. The Committee further recognizes the
importance of this research for veterans, their family members
and those experiencing community violence. The Committee
encourages the National Center to conduct further research on
the effects of PTSD for veterans who live in communities
affected by violence, particularly in low-income and
communities of color and how neighborhood conditions, including
gun violence, may exacerbate their PTSD diagnosis.
The Committee remains concerned by the rates of PTSD among
the veteran population. The Committee is aware of innovative
medical and pharmacological treatments for PTSD that are
currently in development, and encourages VA to maintain
investments in medical research related to the treatment of
PTSD. The Committee further encourages the VA to proactively
pursue opportunities for public-private partnerships in
developing treatments for PTSD and to expand efforts to study
correlations between PTSD and military service.
As a mechanism to explore treatments for PTSD, the
Committee is aware that the use of modeling and simulation
technology has enabled the development of innovative and
immersive therapies, which can extend trauma management therapy
protocol. The Committee encourages VA to continue its research
into therapeutic virtual environments using real-time modeling
and simulation training.
Collaboration with private sector research.--The Committee
is aware of research efforts conducted in the private sector on
medical and pharmacological treatments for a number of
conditions that affect veterans, such as PTSD. VA may not be
able to directly finance such research efforts, but it has
important assets unavailable to private sector researchers that
could ensure the success of these efforts to produce treatments
for veterans. However, the Committee understands that VA has
not historically provided to outside researchers access to data
bases or biological samples already collected in populations
afflicted with the diseases being studied or provided the
targeted veteran population with information or encouragement
to participate in clinical trials. The Committee encourages VA
to take steps to increase its cooperation with private sector
researchers in these areas. The Department is directed to
submit a report to the Committee not later than 90 days after
enactment of this Act describing any constraints that VA may
face in terms of sharing data bases and biological samples with
private sector research teams or in identifying potential
clinical trial participants--for example, whether it is
precluded by privacy statutes or VA-specific investigational
review board requirements.
Prosthetics research for female veterans.--While the number
of female veterans who have been wounded in action and lost a
limb is low (less than 1.5 percent), women have unique needs
when they lose an arm or leg. According to VHA, female veteran
amputees use more health care, rehabilitation services and are
seen more frequently when compared to men. Furthermore, female
veterans are also more likely to be unsuccessful in fitting of
their prosthesis, to experience skin problems after lower
extremity amputation, and to have greater intensity of pain.
Women with upper extremity amputation are more likely to reject
their prosthesis. Female veterans with lower extremity
amputations have higher rates of hip and knee osteoarthritis.
The Committee is concerned that VA is not properly assessing
prosthetics for all veterans nor investing in prosthetic
development for female veterans. For example, special
prosthetics needs occur in female veterans, especially during
pregnancy. Pregnant female veterans with limb loss experience
increased wear on prosthetic components, need for realignment
and frequent modifications. Due to these issues, the Committee
believes that VA should support additional research on
rehabilitation and prosthetics meant for females and directs
the GAO to examine this issue. This report should examine: (1)
the number of female veterans in need of prosthetics; (2) the
extent of problems female veterans have when being fitted with
prosthetics; (3) whether any internal research policy changes
are needed to facilitate research on prosthetics for female
veterans; (4) any elements in the overall VA culture that
hinder such research; and (5) current practices of VA
prosthetics service models for cost effectiveness, health
benefits, data collections, staff efficiency and overall
patient satisfaction.
Innovative treatments.--The Committee appreciates the
efforts VA has made to create a hub for research on innovative
treatments through the Center for Compassionate Innovation. The
Committee understands that the Center is considering developing
a research project on the possible benefits of EEG/EKG-guided
resonance therapy with a larger population of veterans
suffering from PTSD, TBI, chronic pain, and opiate addiction.
The Committee requests VA to provide a report describing the
status of the Center, its budget resources, and a summary of
research projects supported by the Center not later than 120
days after enactment of this Act.
Specialized and modular prosthetics research.--While VA is
a global leader and pioneer in specialty care for service-
connected injuries, the needs of today's veterans are changing,
both within an aging population and the post-9/11 generation.
The field of specialized and modular prosthetics is evolving at
a faster pace than VA has been able to match. The Committee is
concerned that VA does not have an effective, streamlined model
of service for specialized or innovative modular prosthetics,
unlike both the Departments of Defense and the Centers for
Medicare and Medicaid Services, which have begun to explore
this field. The Committee believes VA should conduct
comparative analyses of prosthetic manufacturing processes to
assess results relating to data, clinician experience, staff
efficiency and training, and patient satisfaction to improve
functional outcomes for veterans.
Exoskeleton rehabilitation studies.--The Committee commends
VA for its research on and early use of exoskeleton technology
for the rehabilitation of veterans with spinal cord injuries.
The Food and Drug Administration (FDA) has also approved
exoskeleton technology to provide advanced neurorehabilitation,
including for individuals who have had a stroke and need
physical therapy to improve their ability to walk. The
Committee notes that the size of this veteran patient
population is significantly greater than the spinal cord injury
population, and will continue to expand as veterans age. The
results for individuals with a stroke in terms of improved
clinical outcomes with greater therapy efficiency have been
promising and warrant greater attention. The Committee urges VA
to expand its research on the efficacy of exoskeleton
technology for veterans with stroke and other conditions for
which FDA has approved its usage.
Canine therapy.--The Committee is aware that canine therapy
for treatment of PTSD and TBI symptoms is an emerging
alternative therapy to pharmaceutical treatments. While still
experimental, canine therapy has demonstrated effectiveness in
treating PTSD and other psychological disorders for psychiatric
patients, patients with substance abuse problems, and victims
of trauma. The Committee notes that canine therapy is a
promising area for further research as a complementary or
alternative treatment for the signature wounds of the wars in
Iraq and Afghanistan. The Committee continues to encourage VA
to expand its research on canine therapy to validate its
therapeutic effectiveness in the treatment of PTSD and TBI.
Intergenerational effects of toxic exposures.--The
Committee understands that exposure to toxic chemicals can have
lifelong and intergenerational effects, the impacts of which
are still being determined. The Committee recognizes that the
generational effects of toxic exposure have not been
sufficiently studied to determine what conditions children and
grandchildren of exposed veterans may face. The Committee
requests that VA provide to the Committee not later than 120
days after enactment of this Act an analysis of the feasibility
of establishing a large-scale repository of data from
descendants of individuals with toxic exposures. This analysis
should include any limitations due to difficulty of data
collection and statutory limitations on which populations VA is
permitted to study.
Research transparency.--The Committee commends VA for
issuing its policy and implementation plan for public access to
scientific publications and digital data generated by VA
research. The Committee encourages VA to continue its efforts
towards full implementation of the plan, and requests that an
update on progress be included in the fiscal year 2019 budget
request.
Use of animals in research.--The Committee is concerned by
recent reports of medical experimentation on dogs at VA
research facilities, which are being reviewed by the VA
Inspector General. While the Committee values the innovative
and groundbreaking medical research occurring at VA medical
facilities, it believes that all animal experimentation should
be conducted with strict adherence to animal welfare laws and
regulations. VA is instructed to submit a report to the
Committee that describes: the number of VA research studies
using animals compared to the total number of VA research
projects; the number of animals by type used in VA research
projects in fiscal year 2017; the number that were euthanized
or failed to survive the experimental studies; the number of
incidents reported to each Institutional Animal Care and Use
Committee; any citations or critical reviews of VA animal
research from the United States Department of Agriculture or
the Association for Assessment and Accreditation of Animal and
Laboratory Animal Care International; any personnel actions
taken in response to external reviews of VA animal research
projects; and the availability of these reports to the public.
This report shall be submitted to the Committee not later than
90 days after enactment of this Act.
Mental health treatments.--The Committee supports the
progress made by the Center for Compassionate Innovation, which
operates in coordination with the private sector to identify
and develop new and emerging therapies for PTSD and other
emotional disorders. The Committee recognizes that veterans and
their active duty counterparts benefit from participating in
creative art therapy programs, through acceptance into a
service dog program, or through enrollment in other interactive
community based-programs. The Committee supports the
Secretary's continued expansion of these, and other innovative
programs.
Burn pit exposures.--The Committee understands that many
post-9/11 veterans have experienced health effects potentially
associated with exposure to burn pits, the potential impacts of
which are still being determined. The Committee recognizes the
need for further studies into the issue of service-connected
conditions caused from exposure to burn pits and urges VA to
explore further options for addressing this problem.
Respiratory disease.--The Committee notes the high burden
of respiratory illnesses, such as lung cancer, in the veteran
population. The Committee urges VA to provide support for
respiratory research proposals commensurate with the burden of
respiratory disease.
Medical Care Collections Fund
The Department of Veterans Affairs Medical Care Collections
Fund (MCCF) was established by the Balanced Budget Act of 1997
(Public Law 105-33). The Department deposits first-party and
pharmacy co-payments, third-party insurance payments and
enhanced-use collections, long-term care co-payments,
Compensated Work Therapy Program collections, Compensation and
Pension Living Expenses Program collections, and Parking
Program fees into the MCCF. The Department uses these funds for
medical care and services to veterans. The estimate of fees
that will be collected in fiscal year 2018 is $3,271,000,000.
National Cemetery Administration
Fiscal year 2017 enacted level........................ $286,193,000
Fiscal year 2018 budget request....................... 306,193,000
Committee recommendation in the bill.................. 306,193,000
Comparison with:
Fiscal year 2017 enacted level.................... 20,000,000
Fiscal year 2018 budget request................... - - -
The National Cemetery Administration (NCA) was established
in accordance with Public Law 93-43, the National Cemeteries
Act of 1973. It has a fourfold mission: to provide for the
interment of, in any national cemetery with available grave
space, the remains of eligible deceased servicemembers and
discharged veterans, together with their spouses and certain
dependents, and to permanently maintain their graves; to
provide headstones for, and to mark graves of eligible persons
in national, State and tribal, and private cemeteries; to
administer the grant program for aid to States and tribal
governments in establishing, expanding, or improving State and
tribal government veterans' cemeteries; and to administer the
Presidential Memorial Certificate Program. This appropriation
will provide for the operation and maintenance of 136
operational national cemeteries and 33 other cemeterial
installations.
The bill includes language making ten percent of the total
available until September 30, 2019.
Rural cemetery access.--In H. Rept. 112-94, the Committee
first expressed concern that NCA is not adequately serving the
nation's veterans in rural areas. According to the fiscal year
2012 budget submission, NCA anticipated that 10 percent of all
veterans would not have access to a burial option in a
national, State or tribal government veteran's cemetery within
75 miles of their home. In five years, VA has only reduced this
number to eight percent while receiving generous funding
increase in a tight budget environment. As a result, the
Committee continues to be concerned that there are geographic
pockets in the country that are not being served, and VA has
failed to meet its goal of having access to a burial option
within 75 miles of a veteran's home. The Committee has
requested a report on this issue three times and is still not
satisfied with VA responses or the reports submitted to the
Committee. Therefore, the Committee requests that GAO examine
and provide a report not later than 120 days after enactment of
this Act: (1) describing VA's plans to narrow the gap of
veterans without reasonable access to burial; (2) examining the
effect the NCA Urban Initiative and Rural Initiative have had
on access; (3) outlining a strategy addressing the NCA
shortcomings for rural areas; and (4) providing changes in
policy to resolve this matter, with an estimated timeline and
cost estimate for implementation.
Cemetery deferred maintenance.--The Committee was concerned
about the level of deferred maintenance at NCA cemeteries and
asked the Committee's Surveys and Investigations group to
conduct an analysis. The group's report indicated that NCA's
Facilities Condition Assessment (FCA) survey conducted every
three years had several weaknesses: it does not adequately
reflect true costs associated with correcting maintenance
deficiencies and addressing deferred maintenance balances;
maintenance priorities are not developed or weighted uniformly
across districts; and costs are limited to the date on which
the FCA is completed with no ability to project costs into the
future. The U.S. Army Corps of Engineers developed a software
system, the Sustainment Management System (SMS), that provides
a predictive capability that facilitates forecasting of work
requirements, cost projections, and prioritization. The
Committee requests VA to report to the Committee not later than
60 days after enactment of this Act the costs associated with
implementing and evaluating a pilot project using SMS to
conduct FCAs across at least two districts. The Committee also
encourages NCA to separate maintenance costs from costs
associated with upgrades and enhancements to provide a more
accurate depiction of the physical state of VA cemeteries.
Thirdly, the Committee strongly recommends that VA weight and
prioritize maintenance needs uniformly across districts and
allocate funding proportionately to ensure that the highest
priority projects are funded first.
Departmental Administration
GENERAL ADMINISTRATION
(INCLUDING TRANSFER OF FUNDS)
Fiscal year 2017 enacted level........................ $345,391,000
Fiscal year 2018 budget request....................... 346,891,000
Committee recommendation in the bill.................. 346,891,000
Comparison with:
Fiscal year 2017 enacted level.................... 1,500,000
Fiscal year 2018 budget request................... - - -
The General Administration account provides funds for the
Office of the Secretary, six Assistant Secretaries, and three
independent staff offices. The Committee has included bill
language to make available through September 30, 2019, up to
five percent of these funds and to permit the transfer of funds
in this account to the General Operating Expenses, Veterans
Benefits Administration account.
VA budget office communication.--The Committee has
traditionally channeled most of its inquiries and requests for
information and assistance through VA budget office. The
Committee reiterates its longstanding position that, while the
Committee reserves the right to call upon all VA offices, the
primary communication between the Committee and VA should
normally be through the budget office. Responses to Committee
inquiries, regardless of whether they concern funding or
policy, are to be transmitted without delay by other offices
within VA, unless otherwise requested by the Committee. In
addition, to facilitate the work of the Committee, it expects
that the Department will make available to all personal and
committee staff of Members of the Committee the same direct
contact with the budget office. The Committee also expects that
a staff member of VA budget office will be present at every
meeting held between the chairman and ranking member of the
Full Committee and Subcommittee and the Secretary or other
senior VA officials.
White House Veterans Complaint Hotline.--The Committee did
not learn until the Secretary's ``State of VA'' address on May
31, 2017 that a White House veterans complaint hotline, which
was mentioned during the Presidential campaign, was going into
operation on June 1st. The Committee has concerns about how
this new hotline will be integrated with the other hotlines
already in operation in VA. VA indicates it already has an
astonishing 975 customer service numbers. Those hotlines
address benefits, health, insurance, cemeteries, women's
issues, suicide crises, debt management, and whistleblower
issues, but the sheer number of call lines makes it difficult
for veterans to navigate the labyrinth and get the services
they need without delays. VA has been in the process of
reducing and rationalizing the current plethora of hotlines to
reduce the frustration and confusion veterans feel when trying
to contact the agency for help. The Committee is concerned that
the creation of this new White House hotline will further
confuse veterans and potentially add dangerous delays when the
contractors running the hotline have to refer callers to
another office in VA with the necessary expertise. The
Committee expects additional information as the hotline is
stood up, describing the source and size of the funding
required to operate the hotline, whether the staff answering
calls will be VA employees, how many staff will operate the
hotline on a weekly basis, what call volume is expected, what
hours the hotline will be available, where the hotline will be
located, how operators plan to channel calls to agency staff
with the necessary expertise, and what performance measures are
built into its operation. This report shall be due to the
Committee not later than September 15, 2017, a month after the
hotline becomes fully operational.
Central office responsiveness.--The Secretary testified
before the Committee that he was committed to responding to
Congressional requests in a timely way--within 14 days for
urgent matters and within 30 days for less time-sensitive
issues--and he acknowledged that it was not a standard the
Department had met in the past. The Committee is disturbed to
learn that VA has already failed to meet these performance
standards, and in some cases, has failed to respond to
Congressional inquiries at all. The Committee directs the
Secretary to review the correspondence process within the
Department and make the necessary changes to ensure that all
Congressional inquiries are responded to in a consistent and
timely fashion. Furthermore, not more than 30 days after this
report is filed and then on a quarterly basis the Secretary
shall submit to the Committee a Congressional correspondence
tracker showing only by party, the date the correspondence was
received and the date a response was sent.
Additional budgetary information.--The Committee continues
its request that items described in the fiscal year 2015, 2016
and 2017 House reports continue to be included in the budget
justifications submitted each year.
Quarterly financial information reports.--The bill includes
an administrative provision which extends the requirement for
submission of the quarterly financial information required in
the fiscal year 2017 bill and conference report.
Staff relocations within VA.--The bill continues the
administrative provision requiring written notification 15 days
prior to organizational changes which result in the transfer of
25 or more full-time equivalent staff from one organizational
unit of the Department to another.
Minority veteran population increase.--The Committee
recognizes that the veteran population is becoming increasingly
diverse. According to VA's Center for Minority Veterans, more
than one-third of veterans will come from minority groups by
the year 2040. Accordingly, the Committee directs GAO to
conduct a review of the VA's data collection and reporting
procedures for information on gender, race, ethnicity, and
sexual orientation of veterans, and to submit a report no later
than 180 days after this report is filed. This report should
include how compliant VA is with existing statues and
regulations related to data collection and reporting of race
and ethnicity, and recommendations on how to improve these
processes to better support veterans from historically
underrepresented groups. The Committee further directs GAO to
report and disaggregate data by race in its reports pertaining
to VA, when the data is available, GAO has authority to collect
it, and its inclusion is relevant to the report topic.
Small, minority-and women-owned businesses.--The Committee
directs the Department to submit a quarterly report to the
Committee on its efforts to work with small-, minority-, and
women-owned businesses. The report shall specify the following
data about use of funds appropriated under this Act: the total
number of contracts awarded by the Department; the number of
contracts awarded to small businesses, veteran-, minority-, and
women-owned businesses; the median dollar value of contracts
awarded in each category; and the median, mean and range of
length of contracts awarded in each category. When data are
available, this report should include data disaggregated by
race and ethnicity.
Data on women and minority veterans.--The Committee
recognizes the lack of data specific to women and minority
veterans made available to Congress by VA. The Committee
continues to recommend, when applicable and when the data
exist, VA display information in the annual report(s) submitted
to Congress separately for women veterans and minority
veterans.
Improved patient access to VA hospitals.--The Committee is
distressed that current law prevents VA from using shuttle
buses to transport employees from remote parking lots to their
hospital employment, thus requiring VA to allocate nearby
parking lots for employee use and relegating patients to remote
lots. The Committee bill includes language modifying current
law to permit VA hospitals to use shuttle buses for employees
so that they can reserve nearby lots for VA patients.
Kingdomware decision.--The Committee understands that the
Kingdomware court decision has necessitated significant
alterations in VA's contracting processes. The Committee
requests VA to submit a report not later than 60 days after
enactment of this Act explaining the changes in contracting
requirements resulting from the court decision and describing
how the changes have affected the participation of Service-
Disabled Veteran-Owned Small Businesses (SDVOSBs), including
whether SDVOSBs have been disadvantaged in particular
industries.
Telework productivity.--The Committee expects VA to conduct
vigorous oversight of its telework program, including: (1)
implementing controls to verify that supervisors have completed
telework training prior to entering into telework agreements
with their employees and completion of the training is
documented; (2) requiring documentation of regular or periodic
reviews of all telework agreements in agency telework policies,
including requiring supervisors to track and determine the
number of actual hours employees telework in its time and
attendance system; and (3) developing and implementing a plan
to modernize telework productivity tracking by monitoring
performance and collecting data to compare the productivity and
accuracy of teleworkers to the productivity and accuracy of
non-teleworkers. The plan should provide feedback to employees
and measure employee productivity and accuracy.
Third party fee collection pilot.--The report that
accompanied P.L. 114-113 included language instructing VA to
conduct a pilot similar to the one described in Senate Report
114-57. The Committee reiterates its support for such a pilot
program and expects VA to respond to Committee directives.
Management reforms.--The Committee notes that VA has not
yet implemented many of the recommendations from outside
reviews that address ongoing VA management challenges.
Therefore, the Committee directs VA to issue a report not later
than 180 days after enactment of this Act identifying VA's
responses to the recommendations on key VA management
challenges identified in: (1) the Independent Assessment
required by P.L. 113-146; (2) the report of the Commission on
Care established in P.L. 113-146; and (3) the internal VA
report issued on February 28, 2015, entitled ``Task Force on
Improving Effectiveness of VHA Governance''. The report should
delineate roles and responsibilities to optimize the
organizational effectiveness and accountability of each
administration, staff office, or staff organization, including
the roles of key leaders of the department. In addition, GAO is
directed to compile and submit to the Committee no later than
30 days after enactment of this Act a list of the most
significant VA management issues on which GAO has made
recommendations in reports during the past three years, along
with VA responses to those recommendations.
Board of Veterans Appeals
Fiscal year 2017 enacted level........................ $156,096,000
Fiscal year 2018 budget request....................... 155,596,000
Committee recommendation in the bill.................. 156,096,000
Comparison with:
Fiscal year 2017 enacted level.................... - - -
Fiscal year 2018 budget request................... 500,000
The bill makes ten percent of this funding available
through September 30, 2019.
The Board of Veterans Appeals (BVA) is the component of VA
responsible for making final decisions on behalf of the
Secretary for the thousands of claims for veterans benefits
that are presented to BVA for appellate review. The majority of
the BVA's workload derives from the benefit claims initiated at
VBA regional offices. The appellate process has multiple steps,
most of which occur at the local regional office level. If a
veteran is not satisfied with a regional office determination,
he or she may appeal to BVA for a final agency decision. BVA
adjudicates appeals covering all areas of veterans benefits,
but most of the workload concerns appeals for veterans'
disability compensation or pension benefits. As the disability
compensations claims backlog at VA dwindles, the appeals
workload at the Board increases correspondingly. Pending
appeals are projected to increase by 23 percent from 115,847 at
the end of 2016 to 142,756 by the end of 2018.
The bill also provides the $7,500,000 requested in the
Information Technology Systems budget to support the Appeals
Modernization initiative. The initiative will convert the
Board's 1980's-era case control and locator system to a new,
automated integrated community developed suite that is used to
process initial disability claims.
INFORMATION TECHNOLOGY SYSTEMS
(INCLUDING TRANSFER OF FUNDS)
Fiscal year 2017 enacted level........................ $4,278,259,000
Fiscal year 2018 budget request....................... 4,055,500,000
Committee recommendation in the bill.................. 4,135,500,000
Comparison with:
Fiscal year 2017 enacted level.................... (142,759,000)
Fiscal year 2018 budget request................... 80,000,000
The Information Technology Systems account supports IT
services such as systems development and performance,
operations and maintenance, information protection, and
customer support. The program permits the effective and
efficient delivery of veterans' healthcare services and
benefits programs.
Within the account total, the Committee allocates in bill
language $1,230,320,000 for pay and associated costs, which is
the same as the budget request; $2,486,650,000 for operations
and maintenance, which is $20,000,000 above the request; and
$418,530,000 for development, modernization, and enhancement,
which is $60,000,000 above the request. The bill makes
available $36,000,000 of pay and associated costs and
$174,000,000 of operations and maintenance funds until
September 30, 2019. All development, modernization, and
enhancement funds are available until September 30, 2019.
The bill provides an $80,000,000 increase above the request
to permit additional investment in high priority areas such as
cybersecurity, the electronic health record (EHR), and
conversion of legacy systems such as the financial management
system and the benefits delivery network. In particular, the
Committee provides $31,000,000 for the Veterans Benefits
Management System (in addition to the $38,118,000 which is
provided for VBMS in the General Operating Expenses, Veterans
Benefits Administration account); $83,000,000 for the
replacement of the Financial Management System; $65,277,000 for
development of a new EHR; $22,768,000 for replacement of the
NCA burial operations support system; and $7,500,000 for the
Board of Veterans Appeals modernization effort.
Electronic health record.--The Committee has had a longtime
interest in assuring that DOD and VA health records for
servicemembers and veterans can be exchanged electronically so
that doctors across the street or across the world will be able
to learn the patient's health history. After multiple false
starts with plans for a unified DOD-VA system and then a stand-
alone VA VistA record modernization, VA has now decided to
acquire by sole source contract the same EHR being developed
for DOD--the Military Health System (MHS) Genesis record. VA
will need to add functionality specific to the VA mission. The
Committee is pleased with the decision to pursue a single EHR,
which its Members have advocated for years. However, the
Committee is concerned about the implications of this detour on
the completion time for the project (previously promised for
2018), its cost, the ability to meet the growing need for
interoperability with non-VA community providers, and the
usability of the VistA modernization products already
completed.
Given the substantial uncertainty at the time of Committee
markup about the design of the new EHR, the Committee feels it
is necessary to include bill language fencing 75 percent of
funding provided for the development of the record until VA
provides requested information listed in the bill language. The
language requires VA to provide: a detailed explanation of the
solicitation; an explanation of how the new record will
replicate the DOD record with enhanced functionality for
interoperability with DOD and private community providers; a
strategic plan with timelines and performance milestones, a
master schedule and annual and lifecycle cost estimates; and
information on the plan for transition from VistA to MHS
Genesis, including how current EHR functionality and
interoperability with DOD will be maintained.
An administrative provision similarly restricts 75 percent
of the funding for development of the EHR that is provided by
the Veterans Health Administration from either the Medical
Services or the Medical Support and Compliance account until
similar information is provided to the Committee. The budget
request for EHR funded by VHA increases to $226,012,000--an
increase of $161,012,000 from fiscal year 2017. By contrast,
the EHR request in the Information Technology Systems account
drops by $102,836,000 to $65,277,000. The Committee is
perplexed by this substantial VHA increase, given that VA
acknowledges that 2018 will be largely a developmental year
when VA formulates a solicitation to acquire the type of system
chosen. The Committee directs VA to provide a report not later
than 60 days after publication of this report explaining the
reasons for the contrasting patterns in the VHA and IT budgets
and persuading the Committee that the Department has not
shifted the EHR request between accounts because funding is
more constrained in the smaller account.
Cost of the new electronic health record.--It is clear that
the total cost of the new EHR will vastly exceed the amount
requested in the budget, if the experience with the DOD record
is any guide. The Committee realizes it will take VA some time
to develop a reliable cost estimate for the EHR solicitation,
but the Committee wants to be clear that it will not be
satisfied to receive estimates that describe only phases of the
project without providing total estimated project costs. The
Committee will expect to be briefed about the Administration's
long range strategy to finance the future costs of the new EHR
within its proposed budget ceilings.
The Committee continues to include bill language
prohibiting obligation or expenditure of funds for information
technology systems development, modernization and enhancement
until VA submits to the Committees a certification of the
amounts. In addition, the Committee continues bill language
permitting the transfer of funding among the three subaccounts
upon approval of the Committees. The bill contains language
which allows for the reprogramming of funds among development,
modernization and enhancement projects upon prior notification
to, and approval by, the Committees. The bill continues to
include language indicating that funds for development,
modernization and enhancement are available only for the
projects and in the amounts specified in the report
accompanying the bill.
The chart below reflects the Administration's budget
request for development projects and includes the Committee's
recommendation for each. This chart will serve as the
Department's approved list of development projects, and all
requested changes are subject to the reprogramming guidelines
as outlined in the accompanying Act.
Not later than 30 days after enactment of this Act, the
Department is required to provide a spending plan for the
$60,000,000 in additional funding the Committee provides for
development, maintenance, and enhancement projects.
INFORMATION TECHNOLOGY DEVELOPMENT PROJECTS
(in thousands of dollars)
------------------------------------------------------------------------
Committee
Project Budget Request Recommendation
------------------------------------------------------------------------
Electronic Health Record 10,000 10,000
Interoperability and VLER Health.
Electronic Health Record 50,305 50,305
Replacement......................
Veterans Benefits Management 59,904 59,904
System (VBMS)....................
Virtual Lifetime Electronic Record 20,968 20,968
(VLER)...........................
Veterans Customer Experience (VCE) 73,624 73,624
Other IT Systems Development...... 143,729 203,729
-------------------------------------
Total All Development......... 358,530 418,530
------------------------------------------------------------------------
The Committee expects the Office of Information Technology
to continue to provide an IT expenditure report to the
Committees on Appropriations on a monthly basis. This report
shall include a comparison to the project costs included in the
development, modernization, and enhancement project funding
chart included in the House report, and provide an explanation
for any differences in excess of $1,000,000.
Appointment scheduling system.--The Committee is frustrated
that VA has spent years attempting to modernize its appointment
scheduling system, investing in two systems and ultimately
abandoning them. The Department has made some patchwork changes
to the current scheduling system to temporarily address some of
the worst problems, and intends to test a pilot program called
the Medical Appointments Scheduling System (MASS). After a
false start and stop of the pilot, the Committee encourages VA
to begin implementation of the pilot without delay. While it is
not known if the decision on the electronic health record will
ultimately influence the type of scheduling system VA will
need, it is important to improve scheduling in the short term.
VA is directed to inform the Committee when the pilot begins,
with monthly notification every month past June, 2017, if it is
delayed. The Committee directs the Secretary to submit to the
Committee not later than 30 days after enactment of this Act a
report that clearly defines the long-term plan of the
Department to replace or modernize the legacy scheduling
system, including the cost and schedule of the effort, and how
the system will communicate with the increasing number of
outside providers now being used by VA.
Legacy system decommissioning plan.--VA's legacy IT systems
face tremendous challenges with innovation. With budgets
consumed in supporting older existing applications and
infrastructure, there is clearly a need to invest in new
software. Many of VA's software systems are legacy systems,
such as the Financial Management System (FMS) and the Burial
Operations Support System (BOSS), which are over 30 years old
and are in need of replacement. It is evident to the Committee
that the value of these current systems decreases with every
passing year. While the fiscal year 2018 OIT budget request
prioritizes the replacement of these legacy systems, there is
concern that OIT does not have a concrete plan for the
decommissioning of VA legacy systems. An effective strategy for
investing in new and innovative deployments is to retire legacy
systems and simultaneously identify what system will follow and
how its capabilities will improve over the old system.
Therefore, the Committee directs VA to develop a Legacy System
Decommissioning Plan not later than 180 days after enactment of
this Act. This plan should include, but not be limited to, the
following information; (1) identify all legacy systems that
will be decommissioned by fiscal year; (2) describe how long it
will take to transition to each new system; (3) identify
redundant legacy systems; (4) determine the capabilities gained
by the replacement system; (5) identify the cost and savings
associated with decommissioning each legacy system; (6) and
identify which legacy systems that will be replaced by in-house
development and which systems will be replaced with a
commercial off the shelf system.
Veterans data protection.--The Committee encourages VA to
take proactive steps to protect and prevent the unauthorized
review, redistribution and modification of sensitive VA
information. The fiscal year 2017 VA Information Security
budget proposed the implementation of digital rights management
(DRM) technologies to enhance the cybersecurity of VA's
information and assets and to improve the resilience of VA
networks and data. The Committee requests VA to provide a
report to the Committee not later than 30 days after enactment
of this Act describing whether it still intends to implement
department-wide DRM capabilities, and if so, its anticipated
timeline.
Digital workspace technologies.--The Committee recognizes
that the use of digital workspace technologies can increase
user productivity, enhance security, and allow workforce
flexibility. The Committee encourages the Department to adopt
strategies and programs that reduce the total life cycle costs
of traditional legacy workspace infrastructure.
OFFICE OF INSPECTOR GENERAL
Fiscal year 2017 enacted level........................ $160,106,000
Fiscal year 2018 budget request....................... 159,606,000
Committee recommendation in the bill.................. 160,106,000
Comparison with:
Fiscal year 2017 enacted level.................... - - -
Fiscal year 2018 budget request................... 500,000
The Office of Inspector General (OIG) was established by
the Inspector General Act of 1978 and is responsible for the
audit, investigation, and inspection of all VA programs and
operations. The overall operational objective is to focus
available resources on areas which would help improve services
to veterans and their beneficiaries, assist managers of
Department programs to operate economically in accomplishing
program goals, and to prevent and deter recurring and potential
fraud, waste, and inefficiencies.
The bill makes ten percent of this funding available until
September 30, 2019.
CONSTRUCTION, MAJOR PROJECTS
Fiscal year 2017 enacted level........................ $528,110,000
Fiscal year 2018 budget request....................... 512,430,000
Committee recommendation in the bill.................. 410,530,000
Comparison with:
Fiscal year 2017 enacted level.................... (117,580,000)
Fiscal year 2018 budget request................... (101,900,000)
The Construction, Major Projects appropriation provides for
constructing, altering, extending, and improving any of the
facilities under the jurisdiction or for the use of VA,
including planning, architectural and engineering services,
assessments, and site acquisition where the estimated cost of a
project is $10,000,000 or more.
The Committee recommendation makes all but $38,530,000 of
these funds available for a five-year period.
Continuing the practice first established in fiscal year
2017, the bill restricts the availability of funding for major
construction projects costing more than $100,000,000 until VA
certifies it has signed an agreement with an appropriate non-VA
government entity to serve as the design and/or construction
agent for the project. For fiscal year 2018, one major
construction project above the $100,000,000 threshold is
funded, with restricted funds totaling $117,300,000. Within the
account, the bill also provides $16,730,000 for the contract
fees for the outside agent chosen for the projects. The
Committee has taken this action in hopes that the gross
mismanagement of the Denver, Colorado VA hospital project will
never recur.
The bill provides the full request of $117,300,000 for the
Livermore, California project and $140,000,000 for gravesite
expansion projects. The Department is instructed to allocate
the gravesite expansion funding to the sites that are expected
to run out of burial space the earliest. The remainder of the
budget request for activities such as planning and design, land
acquisition, and hazardous waste is fully funded.
Spending plan.--No later than thirty days after enactment
of the Act, the Department is required to provide a spending
plan indicating how it plans to allocate the appropriated
funding among the various line items within the Major
Construction account, as well as which cemetery expansion
projects will receive fiscal year 2018 funding.
To enhance the Committee's capacity to conduct oversight on
VA's facility construction efforts, several administrative
provisions are continued in the bill: (1) no funding amount
greater than $5,000,000 may be reprogrammed between
construction projects unless approved by the Committees on
Appropriations of both House of Congress; (2) any change to the
scope of a construction project is not permitted without the
approval of the Committees; and (3) VA must report any bid
savings of $5,000,000 or more on projects as soon as they are
identified.
Budget justification documents.--The Committee reminds the
Department of the requirement in Sec. 258 of Division A of P.L.
114-223 regarding specific materials to be included in Major
Construction budget justification documents for fiscal year
2017 and each fiscal year thereafter.
Training for VA personnel engaged in facility management.--
The Committee continues to be concerned by the lack of training
and certification provided to VA engineering, construction and
facility management staff with regard to building operations
and maintenance. The Committee requests a report detailing
progress made by the Office of Construction and Facility
Management and the Office of Health Care Engineering in
training and certifying engineers, associate engineers, and
covered building professionals in compliance with the Federal
Buildings Personnel Training Act (FBPTA) (P.L. 111-308). The
Committee believes that the number of FBPTA-compliant employees
and contractors demonstrates intent to protect existing
facilities and will note the total number of certified
individuals during evaluations of future requests for
construction funding.
Parking facilities.--Although VA has identified numerous
parking facilities projects throughout the Strategic Capital
Investment Planning (SCIP) list, it continues to prioritize
other projects over parking needs. The lack of prioritization
of parking facilities has caused challenges for adequate
parking for Veterans, doctors, nurses, and families at VA
medical centers as well as CBOCs. While the SCIP process has
improved, the VA construction process and ranking of projects
still lacks transparency about future plans for parking at VA
facilities. The Committee believes parking facility projects
can be completed quickly and are vital to help veterans gain
timely access to appointments, and to improve the quality of
life and care given to veterans. The Committee directs VA to
provide a report to the Committee not later than 60 after
enactment of this Act that explains how parking facility
projects are rated in the SCIP process, a timeline for
completion of these pending parking facility projects, and
their cost. In addition, the report should include any notable
actions taken by VA medical centers to address parking issues.
Public-private partnerships.--The Committee is pleased that
VA has begun a program of pilot projects to construct needed VA
facilities by developing partnerships with private funders who
may contribute land, facilities or financing. The Committee
hopes that the track record of the pilot projects currently
underway will provide strong proof of concept so that VA is
granted more general authority to address its facility needs
through cost-sharing with the private sector.
CONSTRUCTION, MINOR PROJECTS
Fiscal year 2017 enacted level........................ $372,069,000
Fiscal year 2018 budget request....................... 342,570,000
Committee recommendation in the bill.................. 342,570,000
Comparison with:
Fiscal year 2017 enacted level.................... (29,499,000)
Fiscal year 2018 budget request................... - - -
The Construction, Minor Projects appropriation provides for
constructing, altering, extending, and improving any of the
facilities under the jurisdiction or for the use of the
Department, including planning, assessment of needs,
architectural and engineering services, and site acquisition,
where the estimated cost of a project is less than $10,000,000.
As with the Major Construction account, the Committee
recommendation makes these funds available for a five-year
period.
The Committee encourages VA to prioritize the need for
fixing deficient roofs in its minor construction projects for
medical facilities.
GRANTS FOR CONSTRUCTION OF STATE EXTENDED CARE FACILITIES
Fiscal year 2017 enacted level........................ $90,000,000
Fiscal year 2018 budget request....................... 90,000,000
Committee recommendation in the bill.................. 90,000,000
Comparison with:
Fiscal year 2017 enacted level.................... - - -
Fiscal year 2018 budget request................... - - -
This appropriation provides grants to assist States to
construct State home facilities, for furnishing domiciliary or
nursing home care to veterans, and to expand, remodel, or alter
existing buildings for furnishing domiciliary, nursing home, or
hospital care to veterans in State homes. A grant may not
exceed 65 percent of the total cost of the project. The bill
makes this funding available until expended.
Rural access.--The Committee appreciates the efforts by VA
and the work of State Veterans Homes for their support in
restorative and rehabilitative care for veterans. The Committee
also recognizes the need to ensure States are equipped and
prepared to meet the needs of the growing veteran population.
Therefore, the Committee urges VA to include a `rural (mileage
access)' consideration as part of the statutory priority
guideline of ``a great need for the beds to be established at
such home or facility''.
GRANTS FOR CONSTRUCTION OF VETERANS CEMETERIES
Fiscal year 2017 enacted level........................ $45,000,000
Fiscal year 2018 budget request....................... 45,000,000
Committee recommendation in the bill.................. 45,000,000
Comparison with:
Fiscal year 2017 enacted level.................... - - -
Fiscal year 2018 budget request................... - - -
This program provides grants to assist States and tribal
governments with the establishment, expansion, and improvement
of veterans cemeteries which are operated and permanently
maintained by the States and tribal governments. Grants under
this program fund up to 100 percent of construction costs and
the initial equipment expenses when the cemetery is
established. The States and tribal governments remain
responsible for providing the land and for paying all costs
related to the operation and maintenance of the State
cemeteries, including the costs for subsequent equipment
purchases. The bill makes this funding available until
expended.
Public-private partnerships.--In order to provide a burial
option to those veterans who may not have reasonable access to
a national veterans cemetery or State cemetery, the Committee
encourages VA to prioritize funding under the State veterans
cemetery grant program for the establishment of veterans
cemeteries in rural and highly rural areas. Additionally, State
and local governments are encouraged to utilize public-private
partnerships that are currently available to help defray the
cost of operation and maintenance of a State veterans cemetery.
Administrative Provisions
The bill includes 39 administrative provisions, 36 of which
were included in the fiscal year 2017 bill and 3 of which are
new.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 201 allowing for the transfer of
funds among three mandatory appropriations. The Administration
proposal to modify this provision is not adopted.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 202 allowing the Department to
transfer funding among the four medical appropriations accounts
in fiscal year 2018. The Administration proposal to modify this
provision is not adopted.
The bill includes section 203 allowing for salaries and
expenses funds to be used for hire of passenger vehicles, lease
of facilities or land, and purchase of uniforms.
The bill includes section 204 providing that only funding
in ``Construction, Major Projects'' and ``Construction, Minor
Projects'' can be used for the purchase of any site for any new
hospital or home or to construct any new hospital or home.
The bill includes section 205 requiring the Department to
be reimbursed for medical services it provides to any person
not defined as a beneficiary to ensure the Department is
receiving payment for all medical services provided.
The bill includes section 206 allowing for the use of funds
appropriated in fiscal year 2018 for ``Compensation and
Pensions'', ``Readjustment Benefits'', and ``Veterans Insurance
and Indemnities'' for payment of accrued obligations recorded
in the last quarter of fiscal year 2017.
The bill includes section 207 allowing for the use of
fiscal year 2018 funds to pay prior year obligations resulting
from implementation of sections 3328(a), 3334, and 3712(a) of
title 31, United States Code.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 208 allowing the Department to
use surplus earnings from the national service life insurance,
U.S. Government life insurance, and veterans special life
insurance program to administer these programs.
The bill includes section 209 allowing the Department to
obligate enhanced-use lease proceeds for administrative
expenses that were incurred in a prior fiscal year during the
year funds are received.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 210 limiting the amount of
reimbursement the Office of Resolution Management, the Office
of Employment Discrimination Complaint Adjudication, the Office
of Accountability Review, the Central Whistleblower Office, the
Office of Diversity and Inclusion, and the Office of the
Executive Director of Accountability and Whistleblower
Protection can charge other offices and accounts of the
Department for services provided.
The bill includes section 211 requiring the Department to
collect current and accurate third-party reimbursement
information for the purposes of third-party insurance
collections. If persons receiving care or medical services do
not disclose this information, the Department is allowed to
bill them reasonable charges for services provided.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 212 allowing the Department to
use enhanced-use lease funds for construction and alteration of
medical facilities.
The bill includes section 213 allowing the Department to
use the Medical Services appropriation for expenses related to
the broader mission of medical care to veterans.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 214 allowing the Department to
transfer Medical Care Collections to the ``Medical Services''
and ``Medical Community Care'' accounts to be used for veterans
medical care and makes those funds available until expended.
The bill includes section 215 allowing veterans who reside
in Alaska to obtain medical services from medical facilities
supported by the Indian Health Service or tribal organizations,
and provides for reimbursement for those services from VA.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 216 allowing the Department to
transfer the proceeds received from the transfer of real
property deposited into the VA Capital Asset Fund to the major
and minor construction appropriations accounts and makes those
funds available until expended.
The bill includes section 217 requiring the Secretary to
submit quarterly reports to the Committees on Appropriations of
both Houses of Congress on the financial status of the Veterans
Health Administration. The Administration proposed to delete
this provision.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 218 prohibiting the Department
from increasing total resources of the Information Technology
appropriation by more than ten percent by transferring funding
from the other VA accounts and requires the Department to
receive approval from the Committees on Appropriations before
such transfer. The Administration proposal to modify this
provision is not adopted.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 219 permitting the transfer of
$297,137,000 appropriated for medical accounts, minor
construction, and information technology systems to the Joint
Department of Defense-Department of Veterans Affairs Medical
Facility Demonstration Fund for the operation of facilities
designated as combined Federal medical facilities.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 220 permitting the transfer of
$306,378,000 of fiscal year 2019 advance funding appropriated
for medical accounts to the Joint Department of Defense-
Department of Veterans Affairs Medical Facility Demonstration
Fund for the operation of facilities designated as combined
Federal medical facilities.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 221 permitting the transfer of
funds deposited in the Medical Care Collections Fund to the
Joint Medical Facility Demonstration Fund for facilities
designated as combined Federal medical facilities. The
Administration proposal to modify this provision is not
adopted.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 222 directing that a minimum of
$15,000,000 shall be transferred from the four medical care
appropriations to the Department of Defense/Department of
Veterans Affairs Health Care Sharing Incentive Fund, to be
available until expended.
The bill includes section 223 prohibiting funds from being
used to replace the current system by which VISNs select and
contract for diabetes monitoring supplies and equipment. The
administration proposal to delete this provision is not
adopted.
The bill includes section 224 requiring the Secretary to
notify the Committees on Appropriations of both Houses of
Congress of all bid savings when identified in Major
Construction projects that total at least $5,000,000 or 5
percent of the programmed amount of the project. The
Administration proposal to delete this provision is not
adopted.
The bill includes section 225 prohibiting the original
scope of work for a Major Construction project from being
increased above the scope specified for that project in the
original justification data provided to the Congress unless
approved by the Committees. The Administration proposal to
delete this provision is not adopted.
The bill includes section 226 requiring a quarterly report
from each VBA regional office on pending disability claims,
both initial and supplemental; error rates; the number of
claims processing personnel; corrective actions taken; training
programs; review team audit results. In addition, the bill
requires quarterly reporting on pending appeals at VBA, as well
as BVA. The Administration proposal to delete this provision is
not adopted.
The bill includes section 227 limiting the funding that may
be obligated from VHA accounts for the development of an
electronic health record until the Secretary provides a
detailed explanation of the activities associated with the
development of the VA electronic health record that will be
funded by the Veterans Health Administration rather than the
Office of Information Technology. The Administration proposal
to delete this provision is not adopted.
The bill includes section 228 requiring advance written
notification to the Committees on Appropriations of both Houses
of Congress 15 days prior to organizational changes which
result in the transfer of 25 or more full-time equivalent staff
from one organizational unit to another. The Administration
proposal to delete this provision is not adopted.
The bill includes section 229 requiring the Secretary to
provide on a quarterly basis to the Committees on
Appropriations of both Houses of Congress notification of any
single national outreach and awareness marketing campaign in
which obligations exceed $2,000,000. The Administration
proposal to delete this provision is not adopted.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 230 permitting the transfer to
``Medical Services'' from any discretionary program except
``General Operating Expenses, Veterans Benefits
Administration'' upon approval of both Appropriations
Committees. This provision is intended to give VA flexibility
as it administers the changes to its traditional health care
program and the Choice Act. The budget request to modify this
provision is not adopted.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 231 permitting the transfer of
funds between the ``Board of Veterans Appeals'' and ``General
Operating Expenses, Veterans Benefits Administration'' upon
approval of both Appropriations Committees. The budget request
to modify this provision is not adopted.
The bill includes section 232 prohibiting the reprogramming
of funds exceeding $5,000,000 among the major construction
projects unless both Appropriations Committees approve the
request. The Administration proposal to delete this provision
is not adopted.
(RESCISSIONS OF FUNDS)
The bill includes section 233 which rescinds Medical Care
advance funding and section 234 which reduces funding in
current year-funded accounts to incorporate assumed absorption
of the proposed 1.9 percent payraise. The Department has
authority to use whatever appropriated funds are available to
support the payraise if it chooses to do so.
The bill includes section 235 requiring the Secretary to
ensure that the toll-free suicide hotline provides immediate
assistance from a trained professional and adheres to all
requirements of the American Association of Suicidology. The
administration request to delete this provision is not adopted.
The bill includes section 236 restricting funds from being
used to close certain medical facilities in the absence of a
national realignment strategy. The budget request to delete
this provision is not adopted.
The bill includes section 237 language modifying current
law to permit VA hospitals to use shuttle buses for employees
so patients can use the closer parking lots.
The bill includes section 238 requiring VA to use the
mammography screening guidelines announced by the Secretary on
May 10, 2017.
The bill includes section 239 allowing the use of Medical
Services funding for assisted reproductive technology treatment
and adoption reimbursement for veterans and their spouses if
the veteran has a service-connected disability that results in
being unable to procreate without such fertility treatment. The
Administration's proposed language to provide this treatment
has been modified.
TITLE III
RELATED AGENCIES
American Battle Monuments Commission
SALARIES AND EXPENSES
The recommendation includes $75,100,000 for Salaries and
Expenses of the American Battle Monuments Commission (ABMC), as
requested.
FOREIGN CURRENCY FLUCTUATIONS ACCOUNT
The recommendation includes such sums as necessary for the
Foreign Currency Fluctuations Account.
United States Court of Appeals for Veterans Claims
SALARIES AND EXPENSES
The recommendation includes $33,600,000 for Salaries and
Expenses for the United States Court of Appeals for Veterans
Claims, as requested.
Department of Defense--Civil Cemeterial Expenses, Army
SALARIES AND EXPENSES
The agreement provides $78,800,000 for Salaries and
Expenses for Arlington National Cemetery (ANC), which is
$8,000,000 over the budget request. The Committee appreciates
ANC's emphasis on acquisition improvements, including training,
certification and workforce, to improve procurement and
accountability.
The Committee has provided an additional $8,000,000 to
cover a shortfall that was identified by Arlington Cemetery
during budget briefs within the operations and maintenance
account. The Committee therefore directs ANC to report to the
Committee 30 days after floor action in the House of
Representatives on any additional shortfalls that have
occurred.
Armed Forces Retirement Home
TRUST FUND
The recommendation includes $64,300,000 for the Armed
Forces Retirement Home (AFRH), which is the same as requested,
although $22,000,000 of the total is provided from the general
fund of the Treasury, and not the Trust Fund. The Committee
notes that there are major challenges for the near and long-
term sustainability of the Trust Fund, which was created to
provide all resources required for operations and expenses of
the two AFRH locations. The Trust Fund is replenished from a
variety of sources, including fines and forfeitures and Active
Duty Withholding. However, the largest source of funds, which
is derived from fines and forfeitures, is diminishing. Annual
outlays for the Fund have exceeded revenues since 2011, and in
November 2015 the Department of Defense and AFRH officials
informed the Committee that, counter to the assumptions in the
fiscal year 2016 budget request, the Trust Fund balances were
not sufficient to support the expenses of AFRH; therefore, the
Fund was projected to be insolvent by April 2016. As an
emergency measure to assure solvency for AFRH, in the fiscal
years 2016 and 2017 Appropriations Acts, AFRH was provided with
a total of $42,000,000 from the General Fund.
Although AFRH and the Department of Defense (DOD) were
directed by Congress to develop an approach that will replenish
the Trust Fund in a sustainable, reliable manner and to present
that approach to the Congress in the President's Request for
fiscal year 2017, and then for fiscal year 2018 along with
legislative proposals, the Administration did not do so.
Instead, the budget request for AFRH for FY2018 includes a
transfer of $22,000,000 from the General Fund of the Treasury.
Further, the Committee has never received any information on
the DOD-commissioned study of AFRH operations to include
benchmarking and potential legislative changes to revise AFRH's
funding model. The Committee requests further information from
DOD regarding the study, including a report on its findings,
cost, scope of work, deliverables, and timeline.
The Committee again asserts that the use of the General
Fund is not a long-term solution, and AFRH is directed to work
with DOD to develop an alternative during fiscal year 2018, to
be included in the fiscal year 2019 budget request. In
addition, AFRH is directed to report to the Committee
quarterly, beginning immediately, on the Trust Fund balance,
receipts and expenditures, and the progress of its efforts to
lease property at the Washington, D.C. facility.
Administrative Provisions
The bill includes two provisions that were in effect in
fiscal year 2017. The administrative provisions included in the
bill are as follows:
The bill includes section 301 permitting Arlington National
Cemetery to provide funds to Arlington County to relocate a
water main.
The bill includes section 302 permitting funds from
concessions at Army National Military Cemeteries to be used to
support activities at the Cemeteries.
TITLE IV
OVERSEAS CONTINGENCY OPERATIONS
Department of Defense
Fiscal year 2017 enacted level........................ $419,733,000
Fiscal year 2018 budget request....................... 638,130,000
Committee recommendation in the bill.................. 638,000,000
Comparison with:
Fiscal year 2017 enacted level.................... 218,267,000
Fiscal year 2018 budget request................... (130,000)
Note: enacted level includes fiscal year 2017 additional appropriations.
The Committee recommendation includes Overseas Contingency
Operations, for military construction projects and planning and
design related to the Global War on Terrorism and European
Reassurance Initiative.
The recommendation does not include funding for three
countries as stated in a June 2017 classified Government
Accountability Office draft report.
The recommendation also includes six projects in four
countries that were requested in title I but have been funded
in this title.
Planning and Design.--The Committee is providing the
planning and design as requested however the Committee directs
that any future planning and design funds to be requested in
fiscal year 2019 and beyond are to be requested as part of the
base request. The Committee further directs the Secretary of
Defense to submit 10 U.S.C. 2807 notifications to the
congressional defense committees prior to obligation of the
funds.
Overseas Contingency Operations Future Year Defense
Program.--The Committee is concerned that funding requested for
Overseas Contingency Operations (OCO) does not follow the same
process as the required Department of Defense process for
planning, programming, budgeting and execution of funds
required to support military operations, readiness,
infrastructure and military force modernization. Therefore, the
Committee directs the Secretary of Defense to provide to the
congressional defense committee a future year defense program
for OCO projects beginning with fiscal year 2018 and each
subsequent year where military construction funds are being
requested in an OCO budget submission not later than 60 days
after enactment of this Act.
Military Construction, Army
The Committee recommendation includes $147,158,000 for Army
military construction and planning and design for Overseas
Contingency Operations and European Reassurance Initiative
projects.
Military Construction, Navy and Marine Corps
The Committee recommendation includes $31,890,000 for Navy
and Marine Corps military construction and planning and design
for Overseas Contingency Operations and European Reassurance
Initiative projects.
Military Construction, Air Force
The Committee recommendation includes $434,652,000 for Air
Force military construction and planning and design for
Overseas Contingency Operations and European Reassurance
Initiative projects.
Military Construction, Defense-Wide
The Committee recommendation includes $24,300,000 for
Defense-Wide Overseas Contingency Operations and planning and
design for Special Operations Command European Reassurance
Initiative project.
Administrative Provision
The bill includes section 401 that designates that funding
shall only be available only if the President so designates all
amounts and transmits such designations to Congress.
TITLE V
GENERAL PROVISIONS
The bill includes a total of 13 provisions: 12 provisions
that are effective in fiscal year 2017 and a new provision as
follows:
The bill includes section 501 prohibiting the obligation of
funds beyond the current fiscal year unless expressly so
provided.
The bill includes section 502 prohibiting the use of funds
for programs, projects or activities not in compliance with
Federal law relating to risk assessment, the protection of
private property rights, or unfunded mandates.
The bill includes section 503 encouraging all departments
and agencies funded in this Act to expand the use of ``E-
Commerce'' technologies and procedures.
The bill includes section 504 specifying the Congressional
committees that are to receive all reports and notifications.
The bill includes section 505 prohibiting the transfer of
funds to any instrumentality of the United States Government
without authority from an appropriations Act.
The bill includes section 506 prohibiting any funds in this
Act to be used for a project or program named for an individual
serving as a Member, Delegate, or Resident Commissioner of the
United States House of Representatives.
The bill includes section 507 requiring all reports
submitted to the Congress to be posted on official websites of
the submitting agency.
The bill includes section 508 prohibiting the use of funds
to establish or maintain a computer network unless such network
blocks the viewing, downloading, and exchanging of pornography,
except for law enforcement investigation, prosecution or
adjudication activities.
The bill includes section 509 prohibiting the use of funds
for payment of first-class travel by an employee of the
executive branch.
The bill includes section 510 prohibiting the use of funds
in this Act for any contract where the contractor has not
complied with E-Verify requirements.
The bill includes section 511 prohibiting the use of funds
in this Act by the Department of Defense or the Department of
Veterans Affairs for the purchase or lease of a new vehicle
except in accordance with Presidential Memorandum--Federal
Fleet Performance, dated May 24, 2011.
The bill includes section 512 prohibiting the use of funds
in this Act for the renovation, expansion, or construction of
any facility in the continental United States for the purpose
of housing any individual who has been detained at the United
States Naval Station, Guantanamo Bay, Cuba.
The bill includes section 513 establishing a ``Spending
Reduction Account'' in the bill.
House of Representatives Report Requirements
The following items are included in accordance with various
requirements of the Rules of the House of Representatives.
Statement of General Performance Goals and Objectives
Pursuant to clause 3(c)(4) of rule XIII of the Rules of the
House of Representatives, the following is a statement of
general performance goals and objectives for which this measure
authorizes funding:
The Committee on Appropriations considers program
performance, including a program's success in developing and
attaining outcome-related goals and objectives, in developing
funding recommendations.
RESCISSIONS
Pursuant to clause 3(f)(2) of rule XIII of the Rules of the
House of Representatives, the following table lists the
rescissions in the accompanying bill:
Department/Activity
AMOUNTS RECOMMENDED FOR RESCISSION
Department of Defense, Military Construction, Army $10,000,000
(Sec. 126)...........................................
Department of Defense, Military Construction, Navy and 10,000,000
Marine Corps (Sec. 126)..............................
Department of Defense, Defense-Wide (Sec. 126)........ 27,440,000
Department of Defense, NATO Security Investment 25,000,000
Program (Sec. 126)...................................
Department of Defense, Family Housing Construction, 18,000,000
Army (Sec. 126)......................................
Department of Defense, Family Housing Construction, 8,000,000
Navy and Marine Corps (Sec. 126).....................
Department of Defense, Family Housing Construction, 20,000,000
Air Force (Sec. 126).................................
Department of Veterans Affairs, Medical Services (Sec. 313,730,000
233).................................................
Department of Veterans Affairs, Medical Support and 63,282,000
Compliance (Sec. 233)................................
Department of Veterans Affairs, Medical Facilities 22,960,000
(Sec. 233)...........................................
Transfer of Funds
Pursuant to clause 3(f)(2) of rule XIII of the Rules of the
House of Representatives, the following statements are
submitted describing the transfer of funds provided in the
accompanying bill.
Language is included that allows transfer of funds from
``Military Construction, Defense-Wide'' to other military
construction accounts and family housing.
Language is included to allow for the transfer of funds
from Family Housing, Construction accounts to the Department of
Defense Family Housing Improvement Fund and funds from Military
Construction accounts to the Department of Defense Military
Unaccompanied Housing Improvement Fund.
Language is included to provide transfer authority from the
BRAC account to the Homeowners Assistance Program.
Language is included to allow the transfer of expired funds
to the ``Foreign Currency Fluctuations, Construction, Defense''
account.
Language is included to transfer not to exceed $17,882,000
in fiscal year 2018 from Compensation and Pensions to General
Operating Expenses, Veterans Benefits Administration and
Information Technology Systems. These funds are for the
administrative costs of implementing cost-savings proposals
required by the Omnibus Budget Reconciliation Act of 1990 and
the Veterans' Benefits Act of 1992. Language is also included
transferring funds to the medical care collections fund to
augment funding of medical facilities for nursing home care
provided to pensioners.
Language is included to permit the transfer of funds from
General Administration to General Operating Expenses, Veterans
Benefits Administration.
Language is included to permit the transfer of funds
between Information Technology Systems development projects and
among the three sub-accounts identified in bill language
subject to the approval of the Committee.
Language is included to provide authority for the
Department of Veterans Affairs for any funds appropriated in
2018 for Compensation and Pensions, Readjustment Benefits, and
Veterans Insurance and Indemnities to be transferred among
those three accounts.
Language is included to transfer funds among the Medical
Services, Medical Support and Compliance, and Medical
Facilities accounts.
Language is included to permit the funds from three life
insurance funds to be transferred to General Operating
Expenses, Veterans Benefits Administration and Information
Technology Systems for the costs of administering such
programs.
Language is included to permit funding up to $47,668,000 to
be transferred to General Administration and Information
Technology Systems from any funds appropriated in fiscal year
2018 to reimburse six headquarters offices for services
provided.
Language is included to transfer certain funds derived from
enhanced-use leasing activities to the Construction, Major
Projects and Construction, Minor Projects accounts.
Language is included to transfer funds from the Medical
Care Collections Fund to the Medical Services account.
Language is included to allow the transfer of funds from
the Capital Asset Fund to the Construction, Major Projects and
Construction, Minor Projects accounts.
Language is included to allow the transfer of funds from
various accounts to the Information Technology Systems account
in an aggregate amount not to exceed ten percent of the account
appropriation, subject to approval by the Committee.
Language is included to allow the transfer of funds in
fiscal years 2018 and 2019 provided for the Department of
Veterans Affairs to the Joint Department of Defense-Department
of Veterans Affairs Medical Facility Demonstration Fund.
Language is included permitting funds deposited to the
Medical Care Collections Fund for health care provided at a
combined Federal medical facility to be transferred to the
Joint Department of Defense-Department of Veterans Affairs
Medical Facility Demonstration Fund.
Language is included under the Department of Veterans
Affairs that would transfer no less than $15,000,000 for the
DOD/VA Health Care Sharing Incentive Fund as authorized by
section 8111(d) of title 38, United States Code.
Language is included that permits the transfer from all
discretionary accounts except General Operating Expenses,
Veterans Benefits Administration, to Medical Services, subject
to approval by the Committee.
Language is included that permits transfer of funds between
General Operating Expenses, Veterans Benefits Administration
and the Board of Veterans Appeals, subject to approval by the
Committee.
Disclosure of Earmarks and Congressionally Directed Spending Items
Neither the bill nor the report contains any Congressional
earmarks, limited tax benefits, or limited tariff benefits as
defined in clause 9 of rule XXI.
Changes in Application of Existing Law
Pursuant to clause 3(f)(1)(A) of rule XIII of the Rules of
the House of Representatives, the following statements are
submitted describing the effect of provisions in the
accompanying bill that directly or indirectly change the
application of existing law.
Language is included in various parts of the bill to
continue on-going activities that require annual authorization
or additional legislation, which to date have not been enacted.
Language is included in various parts of the bill to place
limitations on the use of funds in the bill or change existing
limitations and which might, under some circumstances, be
construed as changing the application of existing law.
Language is included in various parts of the bill to allow
the Secretary of Defense to exceed certain limitations upon
notification to the Committee.
Language is included in various parts of the bill to allow
funding to be used for official reception and representation
expenses.
Language is included in various parts of the bill to enable
various appropriations to remain available for more than one
year for some programs for which the basic authority
legislation does not presently authorize such extended
availability.
Language is included in various parts of the bill to permit
the transfer of funds to other accounts.
Language is included under Title I to prohibit payments for
cost-plus-a-fixed-fee contracts under certain circumstances.
Language is included in various parts of the bill to allow
funds to be used for the hire of passenger motor vehicles.
Language is included under Title I to allow advances to the
Federal Highway Administration, Department of Transportation
under certain circumstances.
Language is included under Title I to prohibit the use of
funds to begin construction of new bases without specific
appropriations.
Language is included under Title I to prohibit the use of
funds for purchase of land or land easements under certain
circumstances.
Language is included under Title I to prohibit the use of
funds for land acquisition, site preparation, and utility
installation for family housing unless funds have been made
available in annual appropriations Acts.
Language is included under Title I to prohibit the use of
minor construction funds to transfer an activity between
installations without prior notification.
Language is included under Title I to prohibit the use of
funds for the procurement of steel for any activity if American
steel producers have been denied the opportunity to compete for
such steel procurements.
Language is included under Title I to prohibit the use of
funds to pay real property taxes in any foreign nation.
Language is included under Title I to prohibit the use of
funds to initiate a new installation overseas without prior
notification.
Language is included under Title I to limit the use of
funds for architect and engineer contracts under certain
circumstances.
Language is included under Title I to limit the use of
funds for awarding contracts to foreign contractors under
certain circumstances.
Language is included under Title I to require the
Department of Defense to notify the appropriate committees of
Congress of any proposed military exercises under certain
circumstances.
Language is included under Title I to allow prior year
construction funding to be available for currently authorized
projects.
Language is included under Title I to allow payment for the
cost associated with supervision, inspection, overhead,
engineering and design on family housing or military
construction projects that are being completed with expired or
lapsed funds.
Language is included under Title I to allow funds to be
expended on military construction projects for four fiscal
years after enactment under certain circumstances.
Language is included under Title I to allow construction
funds to be transferred to Housing Improvement Funds.
Language is included under Title I to allow for the
transfer of BRAC funds to the Homeowners Assistance Program.
Language is included under Title I to limit funds for the
operation and maintenance of family housing to those provided
in this appropriation and to limit amounts expended on repairs
of general and flag officer quarters under certain
circumstances.
Language is included under Title I to allow funds in the
Ford Island Improvement Account to be available until expended
for certain purposes.
Language is included under Title I to allow for the
transfer of expired funding to the Foreign Currency Fluctuation
Account under certain circumstances.
Language is included under Title I limiting movement of an
Army unit with a testing mission.
Language is included under Title I to allow for transfer of
funds among projects and activities in accordance with
reprogramming guidelines.
Language is included under Title I to prohibit funds to be
used for projects at Arlington Cemetery.
Language is included under Title I that rescinds funds from
prior year appropriations Acts.
Language is included under Title I providing additional
funds for Military Construction, Army.
Language is included under Title I providing additional
funds for Military Construction, Navy and Marine Corps.
Language is included under Title I providing additional
funds for Military Construction, Army National Guard.
Language is included under Title I providing additional
funds for Military Construction, Army Reserve.
Language is included under Title I providing additional
funds for Military Construction, Air Force.
Language is included under Title I providing additional
funds for BRAC.
Language is included under Title I providing additional
funds for Military Construction, Air National Guard.
Language is included under Title I providing additional
funds for Military Construction, Air Force Reserve.
Language is included under Title I defining the
congressional defense committees.
Language is included under Title I prohibiting the use of
Title I funds for Arlington Cemetery.
Language is included under Title II to require that the
Secretary of Veterans Affairs establish a priority for
treatment of veterans who are service-connected disabled, lower
income, or have special needs.
Language is included under Title II to require that the
Secretary of Veterans Affairs give priority funding of basic
medical benefits to priority groups 1 through 6.
Language is included under Title II to allow the Secretary
of Veterans Affairs to dispense prescription drugs from VHA
facilities to enrolled veterans with privately written
prescriptions.
Language is included under Title II providing for the
reimbursement to the Department of Defense for the costs of
overseas employee mail.
Language is included under Title II to require approval of
a transfer between development, modernization, and enhancement
projects in the Information Technology Systems account.
Language is included under Title II establishing time
limitations and reporting requirements concerning the
obligation of Major Construction funds, limiting the use of
funds, and allowing the use of funds for program costs.
Language is included under Title II to allow Minor
Construction funds to be used to repair non-medical facilities
damaged by natural disaster or catastrophe.
Language is included under Title II permitting transfers
between mandatory and discretionary accounts, limiting and
providing for the use of certain funds, funding administrative
expenses associated with life insurance programs from excess
program revenues, allowing reimbursement from enhanced-use
leases and for certain services, requiring notification of
construction bid savings, limiting reprogramming amount major
construction projects, restricting changes in the scope of
major construction projects, requiring disclosure of insurance
and income information, allowing a recovery audit collection
program, allowing veterans in the State of Alaska to use Indian
Health Service facilities under certain conditions, allowing
medical services funds for recreational and funeral expenses,
and requiring notification of organizational changes that
transfer 25 or more employees from one VA organizational unit
to another.
Language is included under Title II requiring the Secretary
to maintain certain requirements in operating the toll-free
suicide hotline.
Language is included under Title II prohibiting funds from
being used to close hospitals, domiciliaries, or clinics, or
conduct environmental assessment or diminish services in the
Veterans Integrated Service Network 23 as part of a realignment
of VA services until the Secretary provides a report that
includes a national realignment strategy, a cost benefit
analysis, and an inventory of buildings with historic
designation.
Language is included in Title II amending section 8109(b)
of Title 38 to allow the Department of Veterans Affairs to
provide a shuttle bus to transport an employee from an employee
parking facility to the medical facility at which the employee
works.
Language is included under title II to allow covered
veterans and their spouses, under certain conditions, to
receive assisted reproductive technology services and adoption
reimbursement.
Language is included under Title III United States Court of
Appeals for Veterans Claims, Salaries and Expenses, to permit
the use of funds for a pro bono program.
Language is included under Title III Cemeterial Expenses,
Army, Salaries and Expenses, to permit the use of funds for
parking maintenance and repairs.
Language is included under Title III Armed Forces
Retirement Home to permit payment from the general fund of the
Treasury to the Trust Fund.
Language is included under Title III to permit the use of
funds to relocate a water main.
Language is included under Title III to allow for the use
of concession fees.
Language is included under Title V to limit the use of
funds for Federal entities when they are not in compliance with
Federal law relating to risk assessment, the protection of
private property rights, or unfunded mandates.
Language is included under Title V to prohibit the use of
funds for a project or program named for a serving Member of
the United States Congress.
Language is included under Title V prohibiting funds from
being used to maintain or establish a computer network unless
such network blocks the viewing, downloading, and exchanging of
pornography.
Language is included under Title V prohibiting funds from
being used to pay for first class travel in violation of
federal regulations.
Language is included under Title V prohibiting funds from
being used to execute a contract for goods or services where a
contractor has not complied with Executive Order 12989.
Language is included under Title V prohibiting funds from
being used by the Department of Defense or the Department of
Veterans Affairs for the purchase or lease of a new vehicle
except in accordance with Presidential Memorandum--Federal
Fleet Performance, dated May 24, 2011.
Appropriations Not Authorized by Law
Pursuant to clause 3(f)(1)(B) of rule XIII of the Rules of
the House of Representatives, the following table lists the
appropriations in the accompanying bill which are not
authorized by law for the period concerned:
Program Duplication
No provision of this bill establishes or reauthorizes a
program of the Federal Government known to be duplicative of
another Federal program, a program that was included in any
report from the Government Accountability Office to Congress
pursuant to section 21 of Public Law 111-139, or a program
related to a program identified in the most recent Catalog of
Federal Domestic Assistance.
Directed Rule Making
The bill does not direct any rule making.
Full Committee Votes
No roll call votes were held.
Compliance With Rule XIII, Cl. 3(e) (Ramseyer Rule)
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 italics, existing law in which no change
is proposed is shown in roman):
SECTION 222 OF THE MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED
AGENCIES APPROPRIATIONS ACT, 2017
(Public Law 114-223, title II of division A)
[(including transfer of funds)
[Sec. 222. Of the amounts appropriated to the Department of
Veterans Affairs which become available on October 1, 2017, for
``Medical Services'', ``Medical Community Care'', ``Medical
Support and Compliance'', and ``Medical Facilities'', up to
$280,802,000, plus reimbursements, may be transferred to the
Joint Department of Defense-Department of Veterans Affairs
Medical Facility Demonstration Fund, established by section
1704 of the National Defense Authorization Act for Fiscal Year
2010 (Public Law 111-84; 123 Stat. 3571) and may be used for
operation of the facilities designated as combined Federal
medical facilities as described by section 706 of the Duncan
Hunter National Defense Authorization Act for Fiscal Year 2009
(Public Law 110-417; 122 Stat. 4500): Provided, That additional
funds may be transferred from accounts designated in this
section to the Joint Department of Defense-Department of
Veterans Affairs Medical Facility Demonstration Fund upon
written notification by the Secretary of Veterans Affairs to
the Committees on Appropriations of both Houses of Congress.]
----------
TITLE 38, UNITED STATES CODE
* * * * * * *
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. 8109. Parking facilities
(a) For the purpose of this section--
(1) The term ``garage'' means a structure (or part of
a structure) in which vehicles may be parked.
(2) The term ``parking facility'' includes--
(A) a surface parking lot; and
(B) a garage.
(3) The term ``eligible person'' means an individual
to whom the Secretary is authorized to furnish medical
examination or treatment.
(b) In order to accommodate the vehicles of employees of
medical facilities, vehicles used to transport veterans and
eligible persons to or from such facilities for the purpose of
examination or treatment, and the vehicles of visitors and
other individuals having business at such facilities, the
Secretary--
(1) may construct or alter parking facilities, and
may acquire, by purchase, lease, condemnation,
donation, exchange, or otherwise, such land or
interests in land as the Secretary considers necessary
for use as the site for any such construction or
alteration;
(2) may acquire, by purchase, lease, condemnation,
donation, exchange, or otherwise, any facility that the
Secretary considers necessary for use as a parking
facility; [and]
(3) may operate and maintain parking facilities[.];
and
(4) notwithstanding subsection (a) of section 1344 of
title 31, may use a passenger carrier (as such term is
defined in subsection (h)(1) of such section) to
transport such an employee between a parking facility
and the medical facility of the Department at which the
employee works.
(c)(1) Except as provided in paragraph (2) of this
subsection, each employee, visitor, and other individual having
business at a medical facility for which parking fees have been
established under subsection (d) or (e) of this section shall
be charged the applicable parking fee for the use of a parking
facility at such medical facility.
(2) A parking fee shall not be charged under this subsection
for the accommodation of any vehicle used to transport to or
from a medical facility--
(A) a veteran or eligible person in connection with
such veteran or eligible person seeking examination or
treatment; or
(B) a volunteer worker (as determined in accordance
with regulations which the Secretary shall prescribe)
in connection with such worker performing services for
the benefit of veterans receiving care at a medical
facility.
(3) The Secretary shall collect (or provide for the
collection of) parking fees charged under this subsection.
(d)(1) For each medical facility where funds from the
revolving fund described in subsection (h) of this section are
expended for--
(A) a garage constructed or acquired by the
Department at a cost exceeding $500,000 (or, in the
case of acquisition by lease, $100,000 per year); or
(B) a project for the alteration of a garage at a
cost exceeding $500,000,
the Secretary shall prescribe a schedule of parking fees to be
charged at all parking facilities used in connection with such
medical facility.
(2) The parking fee schedule prescribed for a medical
facility referred to in paragraph (1) of this subsection shall
be designed to establish fees which the Secretary determines
are reasonable under the circumstances.
(e) The Secretary may prescribe a schedule of parking fees
for the parking facilities at any medical facility not referred
to in subsection (d) of this section. Any such schedule shall
be designed to establish fees which the Secretary determines to
be reasonable under the circumstances and shall cover all
parking facilities used in connection with such medical
facility.
(f) The Secretary may contract (by lease or otherwise) for
the operation of parking facilities at medical facilities under
such terms and conditions as the Secretary prescribes and may
do so without regard to laws requiring full and open
competition.
(g) Subject to subsections (h) and (i) of this section, there
are authorized to be appropriated such amounts as are necessary
to finance (in whole or in part) the construction, alteration,
and acquisition (including site acquisition) of parking
facilities at medical facilities.
(h)(1) Amounts appropriated pursuant to subsection (g) of
this section and parking fees collected under subsection (c) of
this section 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.
(3)(A) Except as provided in subparagraph (B) of this
paragraph, no funds other than funds from the revolving fund
may be expended for the construction, alteration, or
acquisition (including site acquisition) of a garage at a
medical facility after September 30, 1986.
(B) Subparagraph (A) of this paragraph does not apply to the
use of funds for investigations and studies, surveys, designs,
plans, construction documents, specifications, and similar
actions not directly involved in the physical construction of a
structure.
(i)(1) The expenditure of funds from the revolving fund may
be made only for the construction, alteration, and acquisition
(including site acquisition) of parking facilities at medical
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 (including any funds proposed in such bill,
resolution, or amendment to be appropriated to the revolving
fund) may be expended for a project involving a total
expenditure of more than $4,000,000 for the construction,
alteration, or acquisition (including site acquisition) of a
parking facility or facilities at a medical facility shall be
considered to be a bill, resolution, or amendment making an
appropriation which may be expended for a major medical
facility project.
(j) Funds in a construction account or capital account that
are available for a construction project or a nonrecurring
maintenance project may be used for the construction or
relocation of a surface parking lot incidental to that project.
* * * * * * *
COMPARISON WITH THE BUDGET RESOLUTION
Pursuant to clause 3(c)(2) of rule XIII of the Rules of the
House of Representatives and section 308(a)(1)(A) of the
Congressional Budget Act of 1974, the following table compares
the levels of new budget authority provided in the bill with
the appropriate allocation under section 302(b) of the Budget
Act.
FIVE-YEAR PROJECTION OF OUTLAYS
Pursuant to clause 3(c)(2) of rule XIII of the Rules of the
House of Representatives and section 308(a)(1)(B) of the
Congressional Budget Act of 1974, the following table contains
five-year projections prepared by the Congressional Budget
Office of outlays associated with the budget authority provided
in the accompanying bill:
ASSISTANCE TO STATE AND LOCAL GOVERNMENTS
Pursuant to clause 3(c)(2) of rule XIII of the Rules of the
House of Representatives and section 308(a)(1)(C) of the
Congressional Budget Act of 1974, the amount of financial
assistance to State and local governments is as follows:
STATE LIST
The following is a complete listing, by title, State and
country, of the Committee's recommendations for military
construction and family housing projects, including Overseas
Contingency Operations projects:
MINORITY VIEWS
The fiscal year (FY) 2018 Military Construction, Veterans
Affairs, and Related Agencies Appropriations bill funds
critical military construction, family housing and quality of
life improvements and enhancements for our brave men and women
in uniform and their families. This bill provides $88.7 billion
in total discretionary funding. This is $6 billion above the FY
2017 enacted funding level but $573 million below the FY 2018
budget request.
The bill funds military construction at $9.5 billion, which
is $197 million below the FY 2018 request. It rejects President
Trump's proposed cut to the North Atlantic Treaty Organization
(NATO) Security Investment Program and restores funding to the
FY 2017 enacted level of $178 million. Additionally, Base
Realignment and Closure is funded at $291 million, which is an
increase of $35 million. The bill provides $78.3 billion in
discretionary funding for the Department of Veterans Affairs,
which is $3.9 billion above the FY 2017 enacted level but $384
million below the President's request. The recommendation also
includes the budget request of $70.7 billion in discretionary
funds for the FY 2019 advance appropriations for VA medical
services. The bill includes $75.1 million, equal to the FY 2017
enacted level, for our heroes who have made the ultimate
sacrifice and are honored in the battle monuments and
cemeteries funded in this bill.
We are pleased the bill continues to build on efforts to
end the veterans' claims backlog that began in FY 2015. The
bill continues both the aggressive monthly reporting
requirements from each specific regional office on claims
processing performance as well as quarterly reports on
remediation efforts at the poorest performing regional offices.
The Committee has had a longstanding interest in ensuring
that DOD and VA health records for service members and veterans
can be exchanged electronically so doctors across the street or
across the world can best treat patients. After multiple false
starts with plans for a unified DOD-VA system and then a stand-
alone VA VistA record modernization, VA has now decided to
acquire the same electronic health record system (EHR) being
developed for DOD--the MH Genesis record. We are pleased with
VA's decision to pursue a single EHR, which many Members have
advocated for years. However, we are concerned about the
implications of this detour on the completion time for the
project (previously promised for 2018), project cost, and the
ability to meet the growing need for interoperability with non-
VA community providers. Therefore, it is appropriate to fence
75 percent of funding until VA provides certain information.
The Committee does not intend to delay the progress of
acquiring a new system, but believes continuing close oversight
is necessary to ensure that the new system will have the
necessary capabilities to provide superior care.
We are also pleased that the bill provides the full FY 2018
budget request of $8.4 billion for mental health programs, of
which $186 million dollars is for Suicide Prevention, $13
million above the FY 2017 enacted level. Furthermore, the bill
repeats language first included in the FY 2017 bill requiring
the Veterans Crisis Line (VCL) to provide immediate assistance
from a trained professional and to adhere to all requirements
of the American Association of Suicidology. The funding and the
bill language are vital pieces in helping VA combat veterans
suicide.
Two Democratic amendments were offered during the markup.
We were pleased the Majority accepted the Democratic amendment
that bars counselors at the VCL from being subject to any
hiring freeze. With over twenty veterans tragically taking
their own lives each day, it is critical that the VCL is
properly staffed. Unfortunately, the Majority opposed the
second amendment, which would have prohibited the use of funds
to establish a White House Veterans Complaint Hotline, a
political proposal from President Trump that would make it more
difficult for veterans to receive timely services they earned.
VA currently has 975 customer service numbers in operation for
veterans to call. They cover issues ranging from benefits to
debt management. We believe we need to use our resources wisely
and establishing this new hotline would only confuse and
frustrate our veterans when they are looking for help. And,
worse, it could potentially add dangerous delays in service.
We are extremely pleased that the bill provides access to
IVF treatment, which is consistent with the VA's goal to
support veterans and improve their quality of life. We believe
that veterans who are unable to conceive children deserve the
care and support they need to start a family.
While there are numerous measures to praise in the bill, we
are concerned that the increases in this bill will result in
deep cuts to programs in the other yet-to-be-considered
appropriations bills. Veterans rely on programs across the
government that are funded in the other appropriations bills,
such as afterschool programs, job training, and public
transportation. Potential cuts to those programs would make it
difficult for veterans to rejoin civilian life and prosper
after their service to the country. Also cutting federal jobs
across the government would have a severe impact on veterans.
In FY 2015, the Office of Personnel Management reported that
30.9 percent of federal jobs were occupied by veterans. Cuts
across the government that would be harmful to veterans will
certainly take place under the limitations set forth in the
Budget Control Act (BCA). The BCA reduces the FY 2018
discretionary budget by $5 billion total, a $2 billion dollar
reduction to defense and $3 billion reduction to non-defense.
The only way to get back to regular order and consider each of
the 12 appropriations bills is to raise the BCA caps.
Nita M. Lowey.
Debbie Wasserman Schultz.
[all]