[House Report 115-673]
[From the U.S. Government Publishing Office]
115th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 115-673
======================================================================
MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES
APPROPRIATIONS BILL, 2019
_______
May 11, 2018.--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. 5786]
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, 2019, and for other purposes.
CONTENTS
Page
Purpose of the Bill.............................................. 2
Summary of Committee Recommendation.............................. 2
Management and Oversight Initiatives............................. 4
Department of Defense:
Military Construction........................................ 6
NATO Security Investment Program............................. 16
Family Housing Construction and Operation and Maintenance.... 17
Department of Defense Family Housing Improvement Fund........ 18
Department of Defense Military Unaccompanied Housing
Improvement Fund........................................... 19
Department of Defense Base Closure Account.................. 19
Administrative Provisions.................................... 19
Department of Veterans Affairs:
Veterans Benefits Administration............................. 22
Veterans Health Administration............................... 28
National Cemetery Administration............................. 54
Departmental Administration.................................. 54
Administrative Provisions.................................... 67
Related Agencies:
American Battle Monuments Commission......................... 71
U.S. Court of Appeals for Veterans Claims.................... 71
Cemeterial Expenses, Army.................................... 71
Armed Forces Retirement Home................................. 72
Administrative Provisions.................................... 72
Department of Defense:
Overseas Contingency Operations.............................. 73
Administrative Provisions.................................... 73
General Provisions............................................... 73
House of Representatives Report Requirements..................... 74
Statement of General Performance Goals and Objectives........ 74
Rescissions.................................................. 75
Transfer of Funds............................................ 75
Disclosure of Earmarks and Congressionally Directed Spending
Items...................................................... 76
Changes in Application of Existing Law....................... 77
Appropriations Not Authorized by Law......................... 80
Program Duplication.......................................... 82
Directed Rule Making......................................... 82
Full Committee Votes......................................... 83
Ramseyer Rule................................................ 85
Comparison With the Budget Resolution........................ 85
Five-Year Projection of Outlays.............................. 85
Assistance to State and Local Governments.................... 85
Comparative Statement of New Budget Authority................ 86
State Project List........................................... 99
Overseas Contingency Operations Project List................. 111
Minority Views............................................... 113
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 because of 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 a wide variety of assistance programs for
veterans--disability and pension benefits, health care in many
different settings, educational assistance, and home loan and
insurance programs. 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 $206,040,134,000 in budget
authority for the fiscal year 2019 programs and activities
funded in the bill. The fiscal year 2019 recommendation is an
increase of $9,350,699,000 above the fiscal year 2018 enacted
level and $130,617,000 below the President's request. Of the
increase over the fiscal year 2018 enacted level,
$5,171,624,000 is in mandatory programs. Included in the total
budget authority is $109,120,059,000 in mandatory budget
authority and $96,920,075,000 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 4.5
percent over the fiscal year 2018 enacted level. The bill
includes an increase in military construction, which is 3.8
percent above the fiscal year 2018 level, and an increase in
the Department of Veterans Affairs budget, which is 4.8 percent
over the fiscal year 2018 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 originally 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, support 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 $11,253,420,000, which is
$412,420,000 above the fiscal year 2018 enacted level and
$130,617,000 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 recommendation also includes $837,000,000 for
the Services' unfunded priorities. In addition, the
recommendation also includes $921,420,000 for European
Deterrence Initiative to help ensure the protection of our
allies.
The total funding level for fiscal year 2019 for the
Department of Veterans Affairs is $194,469,059,000, an increase
of $9,045,324,000 over the fiscal year 2018 enacted level. Of
the total, $109,120,059,000 is provided for mandatory benefit
programs and $85,349,000,000 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 4.8 percent
over the fiscal year 2018 enacted level. For fiscal year 2019,
$70,699,313,000 for medical care has been appropriated in
advance. The recommendation includes $2,922,000,000, an
increase of $53,091,000 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 $174,748,000 for the Board of Veterans
Appeals, a $13,700,000 increase over fiscal year 2018, to
target the growing caseload of appeals of initial benefits
decisions. In addition, the Committee recommendation includes
$75,550,600,000 in advance appropriations for fiscal year 2020
for the four health care accounts of the Department and
$121,296,429,000 in advance appropriations for mandatory
benefits programs for fiscal year 2020.
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, 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 2019 appropriations Act and the
accompanying report address management challenges of the
Federal agencies it funds, 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
$194,469,059,000 provided for 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 as 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 (EHR), VA has completed a contract to
acquire the same EHR that DOD is adopting. The bill includes
$1,207,000,000 for the EHR contract in 2019, but also includes
requirements for strict quarterly reporting of timelines,
performance milestones, costs, implementation, and change
management. The bill also requires the Government
Accountability Office to conduct an ongoing review so that
Congress can be informed of any problems at a point where they
can be promptly and economically addressed.
Disability claims and appeals.--Thanks to the significant
investments Congress has provided over the past seven 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 $53,091,000 above the Veterans
Benefits Administration 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 until VA
submits to the Committees a certification of the amounts. The
bill limits the amount of funds that can be transferred into
the IT account 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 projects
upon prior notification to, and approval by, the Committees.
Financial management system.--The Committee provides
$83,621,000 for the replacement of VA's antiquated financial
management system. However, the Committee has concerns that VA
may have problems managing the conversion without the planned
management by the Department of Agriculture, which developed
the system but has subsequently withdrawn its participation.
Consequently, the Committee requires quarterly reporting by VA
comparing actual performance in implementing the system to the
metrics and timelines established in the initial operating plan
required by the fiscal year 2018 appropriations bill. The
Committee also requires its investigative staff to monitor
periodically the system's development and report to the
Committee.
Stricter control of construction funding.--In response to
the egregious management of the Denver hospital construction
project, permanent law blocks 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. The Committee receives quarterly briefings
on the progress and cost of each facility managed by an outside
entity. 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 $7,000,000 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.
High performance and sustainable building requirements.--
The Committee recognizes that innovative technologies,
including advanced wood products and recycled aerospace grade
carbon fiber composite, have expanded the availability of
materials with lower embodied energy for facilities that
require exceptional durability and blast resistance. 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 continue to utilize innovative
renewable building materials, systems, and design techniques
that support the requirements of UFC 1 200 02 and UFGS 06 17
19. Furthermore, the Committee directs the Secretary of Defense
to work with universities, public agencies, and experienced
non-profit organizations to develop a plan to expand the
application of these innovative technologies in future military
construction projects and report to the Committee no later than
90 days after enactment of this Act on how the Department will
implement the plan.
TITLE I
DEPARTMENT OF DEFENSE
Military Construction Overview
Fiscal year 2018 enacted level (including rescissions) $10,091,000,000
Fiscal year 2019 budget request....................... 10,462,617,000
Committee recommendation in the bill (including 10,332,000,000
rescissions).........................................
Comparison with:
Fiscal year 2018 enacted level.................... 241,000,000
Fiscal year 2018 budget request................... (130,617,000)
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 for 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
no 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, although
declining, on previously appropriated military construction
projects. The Committee's recommendation therefore includes
rescissions to the Air Force, NATO Security Investment Program
and HAP 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 Houses of Congress.
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 12 projects that have been
incrementally funded; however the full authorization of the
projects will be provided in the fiscal year 2019 National
Defense Authorization 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 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 of Defense to provide the Committee with a list of
military construction projects where mitigation and/or changes
to projects within the past five years where 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 which
modifications and or mitigations were adopted.
Impacts of weather and security for Military
Installations.--The Department of Defense must pay close
attention to potential adverse impacts of the weather 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 weather
impacts. The Committee urges the Secretary of Defense to plan
infrastructure and other projects using the best available data
and to mitigate risks to our armed forces serving domestically
and abroad.
Joint Military Bases.--The Committee is concerned that
Joint Bases lack a full complement of training facilities such
as aquatic facilities for complete education. This often
results in burdening local communities to attempt to
accommodate training at insufficient facilities. The Department
is encouraged to prioritize construction of training facilities
that will diminish impacts on surrounding communities and
increase readiness.
Defense Access Roads.--The Committee is concerned about the
lack of future planning for Defense Access Roads (DAR) and
transportation infrastructure needs as continued flooding of
vital access roads occurs more frequently. The Committee
directs the Secretary of Defense to work with the Secretary of
Transportation to prioritize DAR roads and projects
specifically examining bases in communities that have
experienced flooding by both non-storm surge flooding and
flooding due to storm surge and report to the Committee no
later than 30 days after enactment of this Act on its findings.
Further, the Committee is concerned about the increasingly
harmful impact of flooding on facilities at DOD's coastal
military installations and on the roads and infrastructure to
access these installations. In January 2018, the Office of the
Assistant Secretary of Defense for Energy, Installations and
Environment, initiated a preliminary Screening Level
Vulnerability Assessment Survey of DOD installations worldwide.
With this report and other similar reports by GAO, the
Committee directs the Secretary of Defense to incorporate
efforts from the reports to mitigate the effects of flooding on
roads and infrastructure on domestic installations that are
vital to military operations.
Enhancing force protection and security on military
installations.--The Committee, in collaboration with the House
Armed Services Committee, includes section 130 that provides
$50,000,000 to each of the military construction accounts for
Army, Navy and Marine Corps and the Air Force to alleviate
deficiencies in access control points, air traffic control
towers, fire stations, and AT/FP deficiencies across the
enterprise. There has been much concern on both sides of the
aisle that these types of military construction projects
continually fall short of securing funding in a fiscal year due
to higher priorities within the Services. Each Service
Secretary is directed to provide a spend plan for these
additional funds no later than 30 days after enactment of this
Act to the congressional defense committees.
Military Construction, Army
Fiscal year 2018 enacted level........................ $923,994,000
Fiscal year 2019 budget request....................... 1,011,768,000
Committee recommendation in the bill.................. 1,001,768,000
Comparison with:
Fiscal year 2018 enacted level.................... 77,774,000
Fiscal year 2019 budget request................... (10,000,000)
The 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.
Aircraft maintenance hangars.--The Committee is concerned
that many of our aircraft maintenance hangar facilities are
unsafe, antiquated, and do not provide adequate space for
storage and maintenance of our aircraft. For example, the
current Combat Aviation Brigade, at Hunter Army Airfield,
utilizes hangars that are outdated and require millions of
dollars in funding for maintenance yearly. Therefore, the
Secretary of the Army is directed to conduct a cost analysis on
a review of Aircraft Hangars throughout the Army enterprise and
a plan to update these facilities. This analysis shall be
submitted to the congressional defense committees no later than
60 days after enactment of this Act.
Rapid deployment requirements.--The Committee is concerned
that the Army is not adequately prioritizing logistics
infrastructure on bases with rapid deployment requirements.
Therefore, the Secretary of the Army is directed to report to
the congressional defense committees no later than 60 days
after enactment of this Act on the backlog of infrastructure
and the plan to eliminate the backlog by fiscal year.
Army Futures Command.--The Committee is aware that the Army
is in the process of standing up a new Army Futures Command
which is the most significant Army reorganization effort since
1973. This will be the fourth Army Command, and its mission is
to drive the Army into the future to achieve clear overmatch in
future conflicts. The Army has identified 15 locations where
Army Futures Command could be located. The Committee is
concerned that the Army is failing to consider existing
locations that could be suitable for this new Command. The
Committee directs the Secretary of the Army to provide a report
on how the 15 locations were selected and identify current Army
locations where Futures Command could be established no later
than 30 days after enactment of this Act.
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. The Committee is aware that the
Office of the Secretary of Defense is conducting a risk
assessment of certain access control points and developing a
plan to update these facilities, including a cost estimate for
each facility. The Committee looks forward to reviewing the
report and the plan in coming weeks.
Military Construction, Navy and Marine Corps
Fiscal year 2018 enacted level........................ $1,553,275,000
Fiscal year 2019 budget request....................... 2,543,189,000
Committee recommendation in the bill.................. 2,100,298,000
Comparison with:
Fiscal year 2018 enacted level.................... 547,023,000
Fiscal year 2019 budget request................... (442,891,000)
The 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.
Public Law 115-141 provided funding for the TBS Fire
Station at Quantico, Virginia therefore, the recommendation
does not include funding for the project in fiscal year 2019
recommendation.
F-35 beddown.--The Committee is concerned that there is
little coordination among the Navy and Marine Corps for the
construction of aircraft and support facilities associated with
the beddown of F-35s. The Committee believes that it would not
be prudent to have 5th generation air assets like the F-35
housed in inappropriate hangars that fail to protect the
aircraft from the elements. Therefore, the Committee directs
the Navy and Marine Corps to provide a detailed timeline by
fiscal year and cost of F-35 facilities to the congressional
defense committees no later than 60 days after enactment of
this Act.
Shipyard Infrastructure.--The Committee recognizes the
strategic and critical role our public shipyards play in the
national security of our nation. However, our shipyards are in
direct need of maintenance and upgrade. The Fiscal Year 2018
National Defense Authorization Act included language directing
the Department of Defense to create a Shipyard Infrastructure
Optimization Plan. This plan, included recommendations and
future year projects that would help to restore our public
shipyards in order to help support our fleet around the world.
The Committee directs that the Secretary of Defense expedite or
accelerate the funding of projects listed in the Future Years
Defense Plan and Shipyard Infrastructure Optimization Plan
necessary for national security requirements.
Military Construction, Air Force
Fiscal year 2018 enacted level........................ $1,543,558,000
Fiscal year 2019 budget request....................... 1,725,707,000
Committee recommendation in the bill.................. 1,454,723,000
Comparison with:
Fiscal year 2018 enacted level.................... (88,835,000)
Fiscal year 2019 budget request................... (270,984,000)
The 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.
The recommendation includes a rescission of $31,158,000
from unobligated balances in section 126 under Administrative
Provisions.
Public Law 115-141 provided additional funding for
increment I of the Presidential Aircraft Recap Complex.
Therefore, the recommendation does not fully fund the
Presidential Aircraft Recap Complex, Increment II as requested.
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.
MIT/Lincoln Labs.--As previously stated, at times, the
Committee incrementally funds projects. The Committee has
incrementally funded the Air Force MIT/Lincoln Lab project
commensurate with the outlay rate of funds reflected in budget
documents. While the Committee does not provide full funding
for this project, it strongly supports its completion and fully
expects the Air Force to continue to prioritize funding for
this project in executable increments.
Military Construction, Defense-Wide
(INCLUDING TRANSFER OF FUNDS)
Fiscal year 2018 enacted level........................ $2,811,513,000
Fiscal year 2019 budget request....................... 2,693,324,000
Committee recommendation in the bill.................. 2,465,738,000
Comparison with:
Fiscal year 2018 enacted level.................... (345,775,000)
Fiscal year 2019 budget request................... (227,586,000)
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.
The recommendation includes a reduction of $10,000,000 from
contingency construction account.
The recommendation does not include $10,000,000 for the
Ambulatory Care Center Addition/Alteration at RAF Croughton due
to the construction pause on other projects at the installation
by the Secretary of Defense and the EUCOM Commander.
Inadequate roads infrastructure.--The Committee is
concerned that inadequate local, state, and federal roads and
insufficient parking accommodations and structures are unable
to accommodate the volume of cars and are causing delays for
civilians and service members working at critical national
security mission locations, such as the National Security
Agency and United States Cyber Command. The Department of
Defense is therefore directed to submit to the Committee a
report detailing the locations in which traffic congestion and
insufficient parking facilities potentially impact the
performance of national security missions, and their detailed
plans to mitigate these detrimental impacts no later than 60
days after enactment of this Act.
Information Technology Infrastructure for Military
Construction Projects.--The Committee recognizes that
information technology is an essential component in
constructing modern facilities for military missions as well as
planning for future requirements. Technology advancements can
lead to increased productivity as well as efficiencies on
energy and space, which impact military construction and
modernization projects. It is essential that military planning
keep up with advancements in technology in order to take
advantage of these efficiencies and benefits. The mission-sets
behind numerous military construction projects include
requirements for access to multiple classified networks. The
Committee is aware of technology that can streamline
historically compartmented classified networks through cross
domain solutions. Not only does this drastically impact future
productivity for the workforce but it could also yield
substantial savings and efficiencies on space, energy, and HVAC
requirements. In an effort to ensure these technology
advancements are incorporated at the early stages of planning
for military construction, the Secretary of Defense shall
report to the Committee no later than 60 days after enactment
of this Act on how each department is staying apprised of
technology advancements, working with industry partners on ways
to gain efficiencies and savings on military construction
projects, and how they plan to utilize cross domain solutions
early in the planning stages for construction projects.
National Maritime Intelligence Center.--The National
Maritime Intelligence Center (NMIC) is located on the Suitland
Federal Center in Suitland, Maryland. The NMIC is an
Intelligence Facility designed and built with NFIP funds
completed in 1993. The Office of Naval Intelligence (ONI) is
the host command of the NMIC. The NMIC facility is required to
provide safe and adequate parking for all tenet commands, which
include 3,700 employees. Since 2008, parking at the NMIC has
been inadequate due to significant facility expansion for 700
new FTEs and the discovery of structural and safety
deficiencies of the NMIC garage. NAVFAC engineers have assessed
that useful life of the garage will expire in 2021-2023.
Therefore, the Secretary of Defense is directed to provide a
way forward to correct these deficiencies no later than 60 days
after enactment of this Act.
Rhine Ordnance Barracks Medical Center Replacement.--In
Public Law 115-141 the Committee directed 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 U.S. sources of energy the
new German energy laws incorporate; (3) what U.S. 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. In addition to this requirement, the
Committee directs the Director of the Defense Health Agency to
provide to the congressional defense committees no later than
60 days after enactment of this Act: (1) an updated 1391 to
include a WIP curve; (2) the total amount of funding for the
utility plant that is within the military construction program;
and (3) a list of other of appropriations, if any, that are
being used for utility costs.
Installation resourcing.--The Committee is concerned that
some DOD installations' access control points and roads do not
provide adequate means on and off the installation. For
example, the current access control points and roads at Fort
Meade, Maryland need significant improvements to mitigate
traffic congestion and accommodate the installation's growing
population. Unfortunately, current installation management
criteria only recognize Fort Meade as an Army installation, and
limit its resourcing to an inappropriate, Army-only level. This
Army-only funding level has continued despite an expanding
joint-DOD and Federal tenant population that includes the
National Security Agency, U.S. Cyber Command, DOD Consolidated
Adjudications Facility, Defense Information Systems Agency,
National Background Investigations Bureau, Environmental
Research Laboratories, Architect of the Capitol, and the
Defense Security Service. In fact, only 22 percent of the Fort
Meade-installation's supported population is constituted by
Army-affiliated personnel. With a growing population currently
in excess of 55,000 personnel, Fort Meade, Maryland is now the
Army's second largest installation. However, despite this large
population, Fort Meade is only resourced at a level consistent
with an installation supporting 12,000 Army personnel.
Therefore, the Secretary of Defense is directed to submit a
plan to the congressional defense committees no later than 180
days after enactment of this Act on the plan to resource
installations hampered by inappropriate, service-only funding,
at an installation support-level consistent with the missions
performed.
DOD Installation Energy Policy.--DOD must ramp up its
efforts to enhance energy security on its installations through
a range of actions, including investing in renewable energy and
smart technology that can shield mission-critical operations
from disruptions to the power grid. According to a January 2017
report commissioned by the Pew Charitable Trusts (Power Begins
at Home: Assured Energy for U.S. Military Bases), DOD could
enhance energy security on installations and save hundreds of
millions of dollars annually by investing in microgrids and
renewable energy systems, and by increasing energy efficiency
on military bases. The report found that microgrid power
systems are more reliable than the stand-alone diesel
generators typically used for backup power and could save
$8,000,000 to $20,000,000 over a 20 year period. The report
also found that DOD could save as much as $1,000,000,000 a year
simply by increasing the use of commercially available energy
efficiency measures in its facilities. The Committee notes that
military installations in Hawaii are among those at the
forefront of DOD's efforts to increase energy efficiency and
security, including projects to develop net-zero energy
military housing and installation facilities, upgrade and
retrofit systems to improve energy and water efficiency, and
demonstrate microgrid technology. The Committee supports DOD's
investments in energy efficiency, renewable energy systems, and
energy security, including projects through the Energy
Resilience and Conservation Investment Program [ERCIP]. The
Committee encourages the Department to prioritize funding for
energy-related projects, including renewable energy projects,
to mitigate risk to mission-critical assets and promote energy
security and efficiency at military installations.
Guard and Reserve Item of Interest
Fiscal Year 2018 National Guard Reporting Requirement.--
Since fiscal year 2012 the Committee has noted the need to
bolster National Guard resources and explore public-private
partnerships with state and local governments. Due to the late
passage of the fiscal year 2018 bill, the reporting requirement
regarding this issue remains outstanding. Therefore, the
Committee reiterates its interest in this report and looks
forward to its submission.
Military Construction, Army National Guard
Fiscal year 2018 enacted level........................ $220,652,000
Fiscal year 2019 budget request....................... 180,122,000
Committee recommendation in the bill.................. 180,122,000
Comparison with:
Fiscal year 2018 enacted level.................... (40,530,000)
Fiscal year 2019 budget request................... - - -
The 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.
Army National Guard Readiness Centers Investment.--The
Committee remains concerned by the failure of the Army to
prioritize investment in Army National Guard Readiness Centers.
These facilities are critical infrastructure in the protection
of the homeland and in the responding to domestic emergencies.
Their deteriorating conditions are detrimental to the readiness
of the Army Guard and present significant safety concerns. The
Committee encourages the Army to accelerate investments in
Readiness Centers within the fiscal year 2020 future years
defense program to include the $1,200,000,000 for the Army
National Guard transformation Plan.
Military Construction, Air National Guard
Fiscal year 2018 enacted level........................ $171,491,000
Fiscal year 2019 budget request....................... 129,126,000
Committee recommendation in the bill.................. 129,126,000
Comparison with:
Fiscal year 2018 enacted level.................... (42,365,000)
Fiscal year 2019 budget request................... - - -
The 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 2018 enacted level........................ $83,712,000
Fiscal year 2019 budget request....................... 64,919,000
Committee recommendation in the bill.................. 64,919,000
Comparison with:
Fiscal year 2018 enacted level.................... (18,793,000)
Fiscal year 2019 budget request................... - - -
The 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 2018 enacted level........................ $95,271,000
Fiscal year 2019 budget request....................... 43,065,000
Committee recommendation in the bill.................. 43,065,000
Comparison with:
Fiscal year 2018 enacted level.................... (52,206,000)
Fiscal year 2019 budget request................... - - -
Military Construction, Air Force Reserve
Fiscal year 2018 enacted level........................ $73,535,000
Fiscal year 2019 budget request....................... 50,163,000
Committee recommendation in the bill.................. 50,163,000
Comparison with:
Fiscal year 2018 enacted level.................... (23,372,000)
Fiscal year 2019 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 that have been damaged
during the record breaking 2017 hurricane season 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 devastating storm
damage 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 damaged by natural
events throughout the Air Force Reserve enterprise and develop
a plan to update these facilities in the fiscal years 2020-2024
future years defense plan. This assessment shall be submitted
to the congressional defense committees no later than 30 days
after this report is filed.
North Atlantic Treaty Organization Security Investment Program
Fiscal year 2018 enacted level........................ $177,932,000
Fiscal year 2019 budget request....................... 171,064,000
Committee recommendation in the bill.................. 171,064,000
Comparison with:
Fiscal year 2018 enacted level.................... (6,868,000)
Fiscal year 2019 budget request................... - - -
The 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 2018 enacted level........................ $1,409,437,000
Fiscal year 2019 budget request....................... 1,582,632,000
Committee recommendation in the bill.................. 1,582,632,000
Comparison with:
Fiscal year 2018 enacted level.................... 173,195,000
Fiscal year 2019 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 2018 enacted level........................ $182,662,000
Fiscal year 2019 budget request....................... 330,660,000
Committee recommendation in the bill.................. 330,660,000
Comparison with:
Fiscal year 2018 enacted level.................... 147,998,000
Fiscal year 2019 budget request................... - - -
Family Housing Operation and Maintenance, Army
Fiscal year 2018 enacted level........................ $348,907,000
Fiscal year 2019 budget request....................... 376,509,000
Committee recommendation in the bill.................. 376,509,000
Comparison with:
Fiscal year 2018 enacted level.................... 27,602,000
Fiscal year 2019 budget request................... - - -
Family Housing Construction, Navy and Marine Corps
Fiscal year 2018 enacted level........................ $83,682,000
Fiscal year 2019 budget request....................... 104,581,000
Committee recommendation in the bill.................. 104,581,000
Comparison with:
Fiscal year 2018 enacted level.................... 20,899,000
Fiscal year 2019 budget request................... - - -
Family Housing Operation and Maintenance, Navy and Marine Corps
Fiscal year 2018 enacted level........................ $328,282,000
Fiscal year 2019 budget request....................... 314,536,000
Committee recommendation in the bill.................. 314,536,000
Comparison with:
Fiscal year 2018 enacted level.................... (13,746,000)
Fiscal year 2019 budget request................... - - -
Family Housing Construction, Air Force
Fiscal year 2018 enacted level........................ $85,062,000
Fiscal year 2019 budget request....................... 78,446,000
Committee recommendation in the bill.................. 78,446,000
Comparison with:
Fiscal year 2018 enacted level.................... (6,616,000)
Fiscal year 2019 budget request................... - - -
Family Housing Operation and Maintenance, Air Force
Fiscal year 2018 enacted level........................ $318,324,000
Fiscal year 2019 budget request....................... 317,274,000
Committee recommendation in the bill.................. 317,274,000
Comparison with:
Fiscal year 2018 enacted level.................... (1,050,000)
Fiscal year 2019 budget request................... - - -
Family Housing Operation and Maintenance, Defense-Wide
Fiscal year 2018 enacted level........................ $59,169,000
Fiscal year 2019 budget request....................... 58,373,000
Committee recommendation in the bill.................. 58,373,000
Comparison with:
Fiscal year 2018 enacted level.................... (796,000)
Fiscal year 2019 budget request................... - - -
Department of Defense Family Housing Improvement Fund
Fiscal year 2018 enacted level........................ $2,726,000
Fiscal year 2019 budget request....................... 1,653,000
Committee recommendation in the bill.................. 1,653,000
Comparison with:
Fiscal year 2018 enacted level.................... (1,073,000)
Fiscal year 2019 budget request................... - - -
Department of Defense Military Unaccompanied Housing Improvement Fund
Fiscal year 2018 enacted level........................ $623,000
Fiscal year 2019 budget request....................... 600,000
Committee recommendation in the bill.................. 600,000
Comparison with:
Fiscal year 2018 enacted level.................... (23,000)
Fiscal year 2019 budget request................... - - -
Department of Defense Base Closure Account
Fiscal year 2018 enacted level........................ $310,000,000
Fiscal year 2019 budget request....................... 267,538,000
Committee recommendation in the bill.................. 322,390,000
Comparison with:
Fiscal year 2018 enacted level.................... 12,390,000
Fiscal year 2019 budget request................... 54,852,000
The recommendation provides additional funding 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.
Perfluorooctane Sulfonate (PFOS) and Perfluorooctanoic Acid
(PFOA).--The Committee has provided additional funds for the
continued review of contaminations across the Department of
Defense from PFOS and PFOA. This issue not limited to one
Service nor is to be funded solely out of a single account. DOD
has inspected 524 DOD-wide installations and is directed to
keep the Committee apprised of what contaminated locations are
to be funded with the BRAC account only, as that is solely the
jurisdiction of this bill.
Administrative Provisions
The bill retains 29 provisions that were in effect in
fiscal year 2018 and includes two new administrative provision
in fiscal year 2019. 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.
(RESCISSIONS 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 includes section 129 prohibiting the relocation of
any element of REDHORSE until certain conditions are met.
The bill includes section 130 directing all amounts
appropriated to Military Construction (all accounts) be
immediately available and allotted for the full scope of the
authorized project.
The bill includes section 131 providing additional funds
for various military construction accounts for enhancing force
protection and safety at military installations.
TITLE II
DEPARTMENT OF VETERANS AFFAIRS
Fiscal year 2018 enacted level\1\................... $185,423,735,000
Fiscal year 2019 budget request\1\.................. 194,469,059,000
Committee recommendation in the bill\1\............. 194,469,059,000
Comparison with:
Fiscal year 2018 enacted........................ $9,045,324,000
Fiscal year 2019 budget request................. - - -
Fiscal year 2020 advance budget request......... 196,847,029,000
Fiscal year 2020 Committee recommendation in the 196,847,029,000
bill...............................................
\1\All funding cited excludes amounts in the Medical Care Collections
Fund.
The Department of Veterans Affairs (VA) serves
approximately 43,500,000 people--20,000,000 veterans and
23,500,000 family members and dependents who may be eligible
for certain VA benefits. To serve adequately the nation's
veterans, VA employs more than 385,000 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 2019 enacted level...................... $95,768,462,000
Fiscal year 2019 current year request............... 1,410,332,000
Fiscal year 2019 current year Committee 1,410,332,000
recommendation in the bill.........................
Fiscal year 2020 advance budget request............. 107,119,807,000
Fiscal year 2020 Committee recommendation in the 107,119,807,000
bill...............................................
Comparison with:
Fiscal year 2019 enacted level.................. 11,351,345,000
Fiscal year 2020 budget request................. - - -
This appropriation will provide funds for service-connected
compensation payments to an estimated 5,283,000 veterans,
survivors, and dependents in 2019. In addition, pension
payments will be funded for 469,000 veterans and their
survivors. The average cost per compensation case for veterans
in 2019 is estimated at $17,553 and pension payments are
projected at $13,345.
The appropriation includes authority to transfer funding
not to exceed $18,047,000 in 2020 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.
Financial hardship and bankruptcy.--The Committee continues
to support VA programs that combat the root causes of veteran
and dependent financial hardship, which is a known contributory
factor to negative outcomes such as mental health issues,
substance use disorder, and suicide. For example, disability-
related benefits not only honor the service and sacrifice of
the veterans who receive them, but also help to replace lost
wages and provide a critical source of economic well-being. The
Committee is concerned by an inequity in current bankruptcy law
that results in the inclusion of VA and DOD disability benefits
in the calculation of a debtor's disposable income, while at
the same time excluding Social Security disability benefits for
non-veterans. The Department, therefore, is directed to submit
to the Committee a report, no later than 90 days after
enactment of this Act, outlining the legislative authority
needed to end this inequity.
READJUSTMENT BENEFITS
Fiscal year 2019 enacted level........................ $11,832,175,000
Fiscal year 2020 advance budget request............... 14,065,282,000
Fiscal year 2020 Committee recommendation in the bill. 14,065,282,000
Comparison with:
Fiscal year 2019 enacted level.................... 2,233,107,000
Fiscal year 2020 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 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.
Almost 80 percent of the funds in the account support the Post-
9/11 GI Bill.
VetSuccess on Campus (VSOC).--The Committee recognizes the
tremendous value of counseling in assisting the transition of
veterans from military service to academic life. Therefore, the
Committee encourages VBA to expand the availability of services
through the VSOC program to additional sites, with particular
attention to geographic regions without current access to VSOC
programs.
VETERANS INSURANCE AND INDEMNITIES
Fiscal year 2019 enacted level........................ $109,090,000
Fiscal year 2020 advance budget request............... 111,340,000
Fiscal year 2020 Committee recommendation in the bill. 111,340,000
Comparison with:
Fiscal year 2019 enacted level.................... 2,250,000
Fiscal year 2020 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.
VETERANS HOUSING BENEFIT PROGRAM FUND PROGRAM ACCOUNT
----------------------------------------------------------------------------------------------------------------
Limitation on
direct loans
Program account for specially Administrative
adapted expenses
housing loans
----------------------------------------------------------------------------------------------------------------
Fiscal year 2018 enacted level............................. - - - ($500,000) $178,626,000
Fiscal year 2019 budget request est........................ - - - (500,000) 200,612,000
Committee recommendation est. in the bill.................. - - - (500,000) 200,612,000
Comparison with:
Fiscal year 2018 enacted level......................... - - - - - - 21,986,000
Fiscal year 2019 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 remains concerned with the
ability of veterans to benefit from the VA Home Loan Program
given the shortage of appraisers approved by VA and program
requirements that may deter prospective sellers from accepting
applicants with VA loans. The Committee therefore directs the
Secretary to provide a report to the Committee, no later than
180 days of enactment of this Act, which reviews the program's
requirements and determines if viable options exist for
improving VA home loan utilization rates. The report should
include, if possible, a comparison of utilization rates between
VA home loans and non-VA home loans. Additionally, the report
should assess the impact of aligning VA's appraiser
qualifications with those of the Appraisal Foundation, which is
authorized by Congress as a source of appraisal standards and
qualifications. This assessment should include the estimated
change, if any, in the number of available appraisers and loan
utilization rates that would result from such an alignment.
VOCATIONAL REHABILITATION LOANS PROGRAM ACCOUNT
----------------------------------------------------------------------------------------------------------------
Limitation on Administrative
Program account direct loans expenses
----------------------------------------------------------------------------------------------------------------
Fiscal year 2018 enacted level............................. $30,000 ($2,356,000) $395,000
Fiscal year 2019 budget request............................ 39,000 (2,037,000) 396,000
Committee recommendation in the bill....................... 39,000 (2,037,000) 396,000
Comparison with:
Fiscal year 2018 enacted level......................... 9,000 (319,000) 1,000
Fiscal year 2019 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 $1,235 (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 2,039 loans
in fiscal year 2019, with an average amount of $999.
NATIVE AMERICAN VETERAN HOUSING LOAN PROGRAM
Administrative expenses:
Fiscal year 2018 enacted level........................ $1,163,000
Fiscal year 2019 budget request....................... 1,149,000
Committee recommendation in the bill.................. 1,149,000
Comparison with:
Fiscal year 2018 enacted level.................... (14,000)
Fiscal year 2019 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 2018 enacted level........................ $2,910,000,000
Fiscal year 2019 budget request....................... 2,869,909,000
Committee recommendation in the bill.................. 2,922,000,000
Comparison with:
Fiscal year 2018 enacted level.................... 12,000,000
Fiscal year 2019 budget request................... 53,091,000
The General Operating Expenses, Veterans Benefits
Administration 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, 2020, up to
five percent of these funds.
The Committee provides $2,922,000,000 for the General
Operating Expenses, VBA account, which is $53,091,000 above the
Administration request. The Committee intends that VA use these
additional funds 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 hire additional staff and finance
overtime payments if that becomes necessary to manage
disability claims and appeals backlogs.
Equitable relief.--The Committee understands that VA is
continuing work on implementing new systems and protocols to
eliminate instances of administrative error. As the Committee
noted previously, if VA, during implementation of these system-
wide reforms, erroneously ended equitable relief to eligible
veterans initially deemed eligible, it would be placing an
unfair burden on veterans and their families. The Secretary is,
therefore, directed to continue to grant or extend equitable
relief to eligible veterans initially deemed eligible in
instances of administrative error. No later than April 1, 2019,
the Secretary shall submit to the Committee 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 is
pleased with the increased focus on MST and encourages VA to
continue to build on the strides that have been made and to
include intensive training and specialized claims employees for
MST-related claims. As the Committee has noted previously, like
posttraumatic stress disorder (PTSD), MST can lead to other
mental health disorders, such as anxiety and depression.
Therefore, the Committee applauds VA's use of a relaxed
evidentiary standard, such as that available to PTSD claimants,
and urges the extension of this standard to those suffering
from other mental health disorders as a result of MST. The
Committee also urges VA to continue veteran outreach
initiatives and publicize benefits veterans may be entitled to
as a result of MST. Additionally, since MST is not gender-
specific, the Committee encourages VA to provide equal
treatment and assistance to all veterans affected by MST.
Outreach to remote locations.--The Committee urges VBA to
renew efforts to increase presence and outreach to veterans
living in remote and underserved areas, such as the
Commonwealth of the Northern Mariana Islands, by sending VBA
staff to these areas on a regular basis. Veterans living in
these areas, particularly elderly and disabled veterans who may
have difficulty accessing VBA services via the internet or
phone, should have an opportunity to speak, in-person, with VBA
staff.
Claims prioritization.--The Committee is very concerned
about ensuring the prioritization of the most vulnerable
veterans in regard to initial claims processing and claims
appeals. The Committee, therefore, urges VA to prioritize
claims processing and appeals for veterans that are elderly, or
in poor health, so that they may receive their benefits while
those benefits are still able to assist them. Further, the
Committee directs VA to provide a report within 30 days of the
enactment of this Act. The report should detail VA's
prioritization process, if any, in regard to initial claims and
appeals by age, health status, and income. The report should
also include information on any triggers that are used in such
a process, or any triggers that VA assesses may be useful to
achieve the objective of prioritizing these subgroups of
veterans.
Veterans who participated in nuclear clean-up activities in
Palomares, Spain and on Enewetak Atoll.--The Committee is
concerned about the adjudication of service-connected
disability claims for veterans who participated in nuclear
clean-up activities in Palomares, Spain and on Enewetak Atoll
in the Marshall Islands. The Committee understands that some of
these veterans' claims are not subject to the presumption of
radiation exposure under 38 CFR 3.309(d), but rather are
adjudicated on a case-by-case basis under the more burdensome
requirements of 38 CFR 3.311. To understand the justification
for this variation in claims adjudication, the Committee
directs VA to submit a report no later than 90 days of the
enactment of this Act. The report should assess the
requirements in 38 CFR 3.309(d) and determine, based on
scientific and medical data, whether the regulation should be
modified to apply to the group of veterans currently subject to
38 CFR 3.311.
Cholangiocarcinoma.--The Committee understands that some
Vietnam veterans have been diagnosed with cholangiocarcinoma, a
rare cancer, and that VA is currently conducting research to
determine whether this disease occurs at a higher rate in such
veterans than in the general population. The Committee also
notes that less than one-third of claims for service connected
disabilities related to this disease have been granted by VA.
To better understand this affliction and the adjudication of
these claims, the Committee directs VA to submit a report no
later than 90 days of enactment of this Act. The report should
include a status update of current research efforts and an
assessment of how service-connected disability claim
adjudication rates for this disease compare with other cancers.
Tactical Communication and Protective Systems (TCAPS).--The
Committee understands that VA's Remote Order Entry System
(ROES) is designed to allow VA and DOD audiologists to order
hearing aids and related items for veterans and military
personnel. However, it is not currently possible for clinicians
to order devices that help prevent hearing loss, such as the
U.S. Army's TCAPS, through ROES due to a lack of a contract
vehicle. Based on information provided by VA, the lack of such
a contract vehicle is due solely to an assessment by VA's
Audiology and Speech Pathology Service (ASPS) of insufficient
need. While the Committee understands that there may be minimal
need among veterans, the same may not be true for military
personnel given the environments to which they are routinely
exposed. Further, preventing hearing loss for military
personnel today, may reduce the number of veterans with hearing
loss tomorrow. This, in turn, may reduce VA's future costs.
Therefore, the Committee urges VA to work with DOD to determine
if they have a need for a contract vehicle in ROES to allow the
ordering of hearing loss prevention devices and to report to
the Committee, within 90 days of the enactment of this Act,
their decision and whether they plan to add these devices to
ROES.
Transition assistance.--The Committee is aware of VA's
effort 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. The Committee continues to encourage VA to
explore opportunities for education connection centers at VA
medical centers with a high need. Furthermore, the Committee
directs VA to provide the Committee with a report detailing: 1)
the current education connection centers project, 2)
explanation of how the center currently benefits veterans it
serves, and 3) its potential plans to expand the number of
education connection centers. In addition, this report should
include an action plan with a detailed timeline for possible
further expansion to one education connection center in at
least 10 of the 21 Veterans Integration Service Networks
(VISNs) within the next 3 years, projected timelines for
implementation of this expansion effort, an analysis of
projected added benefits to veterans under the expansion, as
well as potential funding costs and needs. This report shall be
submitted to the Committee no later than 90 days after
enactment of this Act.
Veterans service data.--The Committee continues to note
employers' 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 also recognizes the benefits of making these
documents available to prospective employers electronically in
controlled settings. Unfortunately, data sharing agreements
between VA, DOD, and States, which have addressed this concern,
have not been maintained. The Committee therefore directs the
Secretary to work with the Secretary of Defense and State
governors to identify and implement opportunities to improve
use of the Work Opportunity Tax Credit and support the
employment of veterans.
Veterans Health Administration (VHA)
The Department operates the largest Federal medical care
delivery system in the country, with 145 hospitals, 112
residential rehabilitation treatment programs, 133 nursing
homes, 300 Vet Centers, 80 mobile Vet Centers, and 743
outpatient clinics. About 7,000,000 patients will be treated in
2019.
The Veterans Health Administration budget 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
2020 of $75,550,600,000 in direct appropriations to fund the
four advance appropriations of the VHA. In addition, VA will
receive an estimated $3,443,000,000 in Medical Care Collections
Fund in fiscal year 2019. The Committee also provides
$732,262,000 for medical and prosthetic research.
Choice Program and Non-VA Care
The Committee recognizes the need for and supports the
provision of non-VA care for veterans who lack access to VA
services because of distance from VA facilities or the lack of
capacity to provide care in a timely way at certain facilities.
Indeed, VA has operated some non-VA care programs for years.
The Choice program was created in 2014 to address continuing
patient access issues. While the program has resulted in
significant increases in the number of patients treated, the
Committee has been concerned about budgetary and management
challenges that have developed with the Choice program. The
Committee is pleased that the authorizing committees are in the
midst of negotiating legislation to create one consolidated
non-VA medical care program that includes both Choice and the
multiple other non-VA care programs VA operates. Further, the
authorizers plan to convert the program's budget to regular
discretionary funding subject to annual appropriations once the
new program has been implemented and regulations finalized.
This change will bring greater stability and oversight of the
program, although it presents a significant new funding
requirement for the Committee. Additional mandatory funding is
now expected to be required after May, 2018 and throughout the
period of implementation of the new program. The Committee is
ready to meet its responsibility of funding the new
discretionary program, which may not be implemented until the
end of fiscal year 2019.
The Committee will continue to use the budget structure
first proposed by the Administration--to provide two separate
accounts for Medical Services and Medical Community Care for
non-VA care. That structure provides the most transparency for
the Committee to monitor and control spending in these two
areas. The Committee does not accept the more recent
Administration proposal to combine both these funding streams
into one account. Anticipating that there may be circumstances
where the Department needs to transfer funding from one of
these accounts to the other, the Committee continues to provide
authority in section 228 to transfer funding from any VA
account, except the administrative account for VBA, to the
Medical Services account as well as section 202 allowing the
transfer of funding between the four medical care accounts.
Medical Services
Fiscal year 2018 enacted level........................ $46,098,538,000
Fiscal year 2019 enacted level........................ 49,161,165,000
Fiscal year 2020 advance budget request............... 48,747,988,000
Committee 2020 recommendation in the bill............. 48,747,988,000
Comparison with:
Fiscal year 2019 enacted level.................... (413,177,000)
Fiscal year 2020 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 DOD civilian health and medical programs.
The bill provides the request of $48,747,988,000 for
advance fiscal year 2020 funding. The Committee has included
bill language to make available through September 30, 2021,
$1,400,000,000 of the Medical Services advance appropriation
for fiscal year 2020. The Committee is skeptical that this
advance appropriation will be adequate to support full needs in
fiscal year 2020. A year-to-year reduction in funding is highly
unusual in this account.
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.
Caregivers program.--The caregivers program provides an
unprecedented level of benefits to families with veterans
seriously injured in the line of duty in post-9/11 service.
These benefits include stipends paid directly to the family
caregiver, enrollment for the family member in the VA Civilian
Health and Medical Program (CHAMPVA), an expanded respite
benefit, and mental health treatment. The Committee provides
the request of $496,032,000 for caregivers, but is concerned
that the funding levels estimated for the program have
decreased significantly in the past two years. The Committee
requests a report, no later than 60 days after enactment of
this Act, explaining the reasons for the decrease in program
funding estimates. It also continues the requirement from the
fiscal year 2018 conference report on quarterly reporting on
obligations for the caregivers program.
Allocation of health funding.--The Committee continues to
be concerned that the process VA uses to allocate the health
services appropriation through the 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, no later
than 30 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 $8,608,500,000 for mental health
programs, which is $6,000,000 above the budget request. Of the
amounts provided for mental health programs in fiscal year
2019, $196,128,000 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.
Skill-based interventions.--The Committee remains very
concerned about the suicide rate for veterans and applauds VA
for developing novel and innovative approaches for suicide
prevention, such as the Department's Recovery Engagement and
Coordination for Health--Veterans Enhanced Treatment (REACH
VET) program. The Committee encourages VA to continue its
efforts in this area and to prioritize the deployment of such
technologies. The Committee also requests a report, within 90
days of enactment of this Act, which details the innovative
application of technology to reduce the risk of suicide among
veterans.
Posttraumatic growth programs.--To improve the mental
health of veterans, the Committee directs VA to conduct a study
regarding the potential effectiveness and benefits of nonprofit
posttraumatic growth programs. The study should compare the
effectiveness of these programs to traditional models of mental
health care, assess the possible integration of such nonprofit
programs into traditional mental health care programs, and
estimate the budgetary impact of such integration. The
Committee directs VA to complete the study within 90 days of
the enactment of this Act and report back to the Committee
within 30 days of the study's completion. The report should
provide the study results, define post-traumatic growth
programs, and assess the feasibility, requirements, and cost of
conducting a pilot program to further assess their value.
Improving the Veterans Crisis Line (VCL).--The Committee
continues to monitor the VCL to ensure veterans are receiving
appropriate clinical care. To support this critical care, the
Committee instructs the Secretary to ensure that Federal
funding for the VCL is utilized to make any necessary
improvements to VCL's operations in order to best meet the
needs of veterans seeking assistance. This includes, but is not
limited to, ensuring appropriate staffing for call centers and
back-up centers, providing necessary training for VCL staff,
and ensuring that staff are able to appropriately and
effectively respond to the needs of veterans needing assistance
through the VCL. In addition, the Committee requests that the
Secretary provide the Committee a report, no later than 90 days
after enactment of this Act, which contains an update detailing
findings on the outcomes and efficacy of the VCL from the
Veterans Crisis Line Study Act of 2017.
The Committee has repeated bill language included in the
fiscal year 2018 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.
Community clinic mental health services.--While the
Committee is awaiting a briefing to learn more about how VA
establishes mental health care in individual community-based
outpatient clinics, the Committee remains concerned that in-
person mental health is not available to veterans who require
this care. The VA is encouraged to ensure critical in-person
mental health services are available at facilities that
currently are not served, even on a temporary basis.
PTSD service dogs.--The Committee recognizes the positive
role that service, guide, and hearing dogs have played in
mitigating veterans' disabilities and providing therapy,
assistance, and rehabilitation. As such, the Committee urges VA
to prioritize support of veterinary health care and other
benefits for service dogs for wounded warriors. The Committee
also notes that VA is currently engaged in a study to assess
the potential therapeutic effectiveness of service dogs in the
treatment of PTSD and that the study will be completed in June
2019. The Committee requests a copy of the results of this
study as soon as it is completed.
Telehealth for mental health.--The Committee recognizes the
strides made by the Department to reach rural communities with
telehealth solutions. The Committee encourages further
development and implementation of telemedicine to treat
veterans with mental health issues in rural communities.
Telemedicine should be used to its maximum capabilities by VA.
The Committee requests VA to submit a report, no later than 90
days after enactment of this Act, providing an update on the VA
plans to further expand the use of telemedicine for mental
health care.
Inpatient substance abuse care.--While veterans are able to
access inpatient substance abuse care through VA, the Committee
remains concerned that veterans still wait weeks to actually
receive the inpatient support they need. In fact, the Committee
understands from VA that the median time between screening and
admission for Substance Use Disorder (SUD) Residential
Rehabilitation Treatment Programs (RRTP) increased from 15 days
to 21 days between fiscal years 2017 and 2018. This is very
concerning and the Committee urges VA to focus on reducing this
burdensome wait time for substance abuse treatment. In
addition, the Committee requests a report, no later than 90
days after enactment of this Act, which shows the trends in
program wait times over the last five years and any proposed
solutions to reduce such wait times.
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. Additionally,
the Committee directs VA to provide a report, within 90 days of
enactment of this Act, regarding the feasibility of expanding
public-private partnerships related to suicide prevention,
PTSD, TBI, and substance use disorders.
Law enforcement liaison.--The Committee appreciates VHA's
past efforts in working to educate the law enforcement
community regarding the unique issues facing veterans,
especially those returning from combat operations. Such
education is invaluable in cases where veterans are determined
to be an immediate threat to themselves or others. In such
instances, it is imperative that the veteran's needs be
addressed in an expeditious, humane, and respectful manner. The
Committee, therefore, encourages VA to implement a program that
would designate a VA liaison to work with local law enforcement
to address such circumstances.
Non-citizen veteran outreach.--The Committee is concerned
about the level of awareness regarding mental health services
by at-risk, non-citizen veterans. It urges VA, therefore, to
conduct more aggressive outreach targeting this group of
veterans to offer mental health and other early intervention
services, drug and alcohol services, and mental health
counseling.
Cultural competency training.--The Committee recognizes the
role that the National Center for Posttraumatic Stress Disorder
(NCPTSD) plays in promoting better prevention, diagnoses, and
treatment of PTSD. Consistent with findings from the Center,
the Committee recognizes that minority groups of veterans,
including African Americans and Latinos, are more likely than
their white counterparts to develop PTSD. As such, the
Committee directs VHA, in coordination with NCPTSD, to provide
a report within 180 days of enactment of this Act detailing
whether cultural competency training is provided to health care
professionals serving veterans of color, and at what stage(s)
in their career, and analyzing whether minority veterans
receive quality and culturally appropriate care. This report
shall also include recommendations on how to address the unique
mental health needs of minority veterans, as well as the
disparities in the care they receive.
Homeless assistance
The Committee provides $1,773,534,000 for VA homeless
assistance programs, in addition to an estimated $5,633,442,000
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. Within this total, the bill includes
$340,000,000 for the Supportive Services to Veteran Families
program, which is the same as the fiscal year 2018 funding
level and $20,000,000 above the request.
Allocation of funding for homeless programs.--The Committee
has been concerned about the Department's tentative decision
last fall to convert almost $1,000,000,000 of funding for
homeless programs from Special Purpose funding to General
Purpose funding. This proposal would have potentially risked
funding for important programs such as the Supportive Services
to Veteran Families program. While the Committee is pleased
that the Department decided not to move forward with the
proposal for fiscal year 2018, it expects VA to consult with
the Committee before any attempt is made to change the manner
in which funding allocations are made to the field for fiscal
year 2019.
Grant and per diem (GPD) rate.--The Committee is concerned
that the cost incurred by nonprofit organizations, who are
providing clinical services as part of their GPD program, are
not covered by the current GPD rate. VA is required to report
back to the Committee, within 30 days of the enactment of this
Act, on whether the current GPD rate is effectively covering
the costs of clinical services and, if not, options for
adjusting the GPD rate to ensure these nonprofit organizations
have the necessary resources to cover the cost of providing the
lifesaving clinical care our homeless veterans deserve.
Construction assistance for nonprofit organizations.--The
Committee strongly supports innovative approaches and public-
private partnerships that can help reduce homelessness among
our veterans. As such, the Committee urges VA to assess the
possibility of assisting nonprofit organizations with capital
costs related to the construction of new housing units for
homeless veterans on non-VA property, particularly those
utilizing HUD-VASH vouchers. When considering assistance to
such organizations, VA should limit its consideration to those
that have secured over 50 percent of the needed financing so as
to reduce the federal burden for establishing new housing.
HUD-VASH program.--The Committee continues to support the
HUD-VASH program and reminds the Department to continue to
provide the annual report on distribution of HUD-VASH vouchers
as requested in House Report 115-188.
Legal assistance for the Supportive Services for Veteran
Families Program.--The Committee notes that university law
schools may be willing to work with veterans on a pro-bono
basis to provide legal assistance. This can result in
additional benefits, such as training law students in veteran
disability law and legal skills critical to providing advocacy
within the VA system, as well as inspiring the next generation
of lawyers to serve veterans. The Committee encourages the
Supportive Services for Veteran Families (SSVF) program to work
with grantees to expand their legal service offerings,
particularly in rural areas where access to private legal
assistance can be limited. The Committee further encourages VA
to establish one or more pilot projects to partner SSVF
grantees with university law schools in rural areas to enhance
legal assistance to veterans.
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 urges the Department to address the
challenges facing homeless female veterans.
Homeless veterans near the U.S.-Mexico border.--The
Committee notes that there may be homeless veterans living near
the U.S.-Mexico border who, historically, may not have been
counted in point-in-time homeless surveys. The Committee
encourages VA to work with HUD to develop strategies and
recommendations for addressing U.S. veteran homelessness near
the U.S.-Mexico border and to take into account these
undercounted veterans when awarding HUD-VASH vouchers. VA shall
report on these strategies and recommendations within 90 days
of enactment of this Act.
Related needs of homeless veterans.--With significant help
from the Committee, VA has made great strides in reducing
veteran homelessness. The Committee believes that more could be
done to address veterans' homelessness and remains interested
in the feasibility, advisability, and cost of VA conducting a
pilot program that would 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 looks forward to the report requested in
House Report 115-118 on this concept and expects the deadline
for the report to be met.
Staffing issues
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 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. In addition, the Committee
directs VA to submit a separate report, within 90 days after
enactment of this Act, on efforts to recruit and hire medical
officers and nurses at each VA medical facility, as well as any
impediments to such efforts. The report should include the
resources provided for these efforts and recommendations for
relevant legislation.
Advanced practice registered nurses.--The Committee is
concerned that some VA facilities have failed to implement VA's
final rule granting full practice authority to advanced
practice registered nurses. While the Committee understands
that implementation must be voted on and approved by each
facility's organized medical staff, the Committee urges the
Secretary to work with the remaining facilities to ensure quick
implementation of this directive.
Psychology internships.--The Committee understands that VHA
each year uses the services of the Association of Psychological
Postdoctoral and Internship Centers (APPIC), a nonprofit
organization, to help select and match clinical psychologists
for available VA internships. The Committee is concerned,
however, that APPIC has repeatedly decided to not include
psychologists from programs accredited only by the
Psychological Clinical Science Accreditation System (PCSAS) in
the match, even though VHA regulations recognize PCSAS-
accredited programs. The Committee is also concerned with the
lack of progress by VHA to require APPIC to address this issue
and therefore urges VHA to request that APPIC modify its policy
within 90 days of enactment of this Act.
Access for rural veterans
Office of Rural Health.--The Committee provides
$270,000,000 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 health care 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 health care services, ORH's important
work includes identifying barriers to health care delivery in
rural areas and implementing new ways to deliver health care
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 2019 funding, as well as the
fiscal year 2020 funding provided in advance by this Act.
Rural Health Resource Centers.--Given the important role
ORH's Rural Health Resource Centers play in expanding access to
care, the Committee encourages VA to continue considering
expanding these centers. ORH has played a major role in VA's
overall strategy to combat opioid abuse by funding pilot
programs through the Rural Health Initiative focused on pain
coaching and modalities which increase veterans' access to
alternatives to opioid-centered pain management. The Committee
recommends that as ORH considers expansion, combatting the
opioid epidemic and non-opioid pain management in rural areas
remain key components of its focus.
Lack of rural health providers.--The Committee notes
persistent issues for VA health facilities in rural areas in
recruiting and retaining health providers in the face of
national provider shortages and a highly competitive
environment. The Committee encourages VA to continue to
consider expanded use of doctors of osteopathic medicine and
physician assistants, through both physical facilities and
expanded access to telehealth services, to address the rural
health provider gap.
Telehealth in rural areas.--The Committee is encouraged
with recent efforts by VA with regard to investment in
telehealth programs. Additionally, the Committee acknowledges
the recent report submitted by VA outlining their collaboration
efforts with several other Federal agencies on this issue.
However, the report fails to provide an adequate explanation of
the specific plan/strategy which VA will pursue to provide
telehealth access to the 33 percent of veterans that reside in
rural areas nationwide. The Committee remains concerned that
not enough is being done to expand access to those veterans in
rural areas with limited broadband internet access. The
Committee directs the Secretary, and the VHA Office of Rural
Health, to elaborate with specificity on measures to expand
capabilities of telehealth to these regions, and continue
collaboration with the Department of Agriculture, which has
dedicated programs specifically for rural broadband access, as
well as continued participation with the President's Rural
prosperity Task Force. The Committee directs the department to
submit a report to the Committee, no later than 90 days after
enactment of this Act.
Women's issues
As the number of female veterans increases, VA needs to
prioritize the expansion of health care services to accommodate
women. This means more gender-specific services and the
availability of appropriate infrastructure facilities to
safeguard the privacy needs and proper gender-specific care and
treatment of female veterans. The bill provides $511,352,000
for VA to continue redesigning its women's health care delivery
system and facilities to ensure women receive equitable,
timely, and high-quality health care.
Women's access to medical services.--While the Committee is
currently awaiting a report from VA on its plan to implement
standards of care for female veterans, the Committee remains
concerned that female veterans face remarkably different
experiences than their male counterparts when transitioning in
and out of combat roles, in between services, or back to
civilian life and that VA is not adequately addressing the
health needs of female veterans. These include obstetrics and
gynecological care, treatment for gender-specific conditions
and diseases, and female veteran suicide. The VA must ensure an
improved quality of life for female veterans with gender-
specific health care to meet their needs. Therefore, the
Committee urges VA to continue its efforts to expand access to
care in these areas and ensure the gender-specific health needs
of female veterans are met.
Female medical staff.--The Committee supports the hiring of
more female health care professionals in order to provide
female veterans greater opportunities to choose the gender of
their health care provider. To enhance the Committee's
understanding of VHA's staff demographic, the Committee
requests a report, no later than 90 days after enactment of
this Act, on the number of female health care professionals
hired by VHA each year over the past five years. The report
should include information pertaining to job type and
employment location.
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. However, the Department should be prepared
to offer screening to eligible younger female veterans should a
physician determine or risk factors warrant screening before
age 40. 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 2024.
Pharmacy issues
Vaccines.--To improve the health of veterans and to reduce
health care costs due to avoidable hospitalizations and
complications, the Committee directs VHA to incorporate, when
available, peer-reviewed and published randomized and other
high-quality, well-controlled clinical trials and economic
data, particularly from the VA population, into its influenza
vaccine procurement decisions and educational efforts to enable
better informed decision making to positively impact the health
of senior veterans.
Prescription drug abuse
Opioid abuse.--As the reports of increasing numbers of
opioid overdoses roil the nation, the Committee is pleased that
VA has taken an aggressive posture in reducing the volume of
opioid prescriptions it dispenses and is turning to alternative
approaches to pain relief, including the use of complementary
medicine tools. The VA Opioid Safety Initiative, begun in 2013,
has resulted in a 25 percent reduction in the number of
veterans prescribed opioids for pain relief and the rate of
overdose among veterans prescribed a prescription opioid has
been cut in half. The Committee encourages VA to continue the
challenging effort to reduce opioid use among veterans, half of
whom suffer from chronic pain. The bill provides $386,530,000
for opioid treatment and prevention efforts, of which
$52,025,000 is provided for activities authorized by the
Comprehensive Addiction and Recovery Act of 2016 (CARA).
Opioid Therapy Risk Report.--The Committee urges VA to
ensure that all VA providers who prescribe opioids use VA's
Opioid Therapy Risk Report tool consistently, including prior
to initiating opioid therapy, to ensure safe prescribing and to
help prevent diversion, abuse, and double-prescribing. The
Committee also urges VA to further improve the timeliness of
data available in the tool to allow a provider to have real-
time access to data. It is critical that VA clinicians have
access to a patient's opioid therapy history from outside
providers to ensure safe pain management care, as many veterans
also seek care from providers in the community who may
prescribe them medication.
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 two States currently have not
installed the technology to exchange data from their State
prescription drug monitoring boards with VA. VA is urged to
assist these 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. 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.
Naloxone.--United States public health agencies have
appropriately highlighted the risk of overdose from doses of
opioids greater than 90 morphine milligram equivalents (MME)
per day. However, the vast majority of patients, including the
vast majority who die from overdose, are below 90 MME, making
broad education about opioid-related risks essential for all
patients prescribed opioids, regardless of dose or formulation.
Hundreds of millions of patients receive prescriptions each
year of immediate release (IR) lower MME opioids, such as
hydrocodone and oxycodone. These opioids are commonly
associated with abuse, are a common pathway to addiction, and
present a risk of overdose. Some States have limited the
prescribing of these IR opioids. An alternative approach may be
to assess the benefit of providing Opioid Overdose Education
and Naloxone Distribution (OEND), regarding how to prevent,
recognize, and respond to an opioid overdose, including
responding with naloxone, to patients prescribed opioids.
Prescribers including dentists and other primary care providers
have an opportunity to become more attuned to the risks of all
opioids through the consideration of broad Opioid Overdose
Education and co-prescribing naloxone to those with an opioid
prescription. The Committee requests that VHA develop a
strategy to test this hypothesis and consider executing a pilot
program to assess the benefit for veteran patients.
Complementary and integrative health (CIH).--The Committee
supports VA's work in developing a plan to expand the scope of
research, education, delivery, and integration of CIH into the
health care services provided to veterans and urges its robust
implementation. The Committee supports the progress being made
to reduce misuse and abuse of opioids and to improve pain care
and encourages VHA to accord priority for CIH to VISNs or VA
medical centers with a history of opioid prescription rates, or
current opioid prescription rates, inconsistent with the
standards of appropriate and safe care.
Opioid treatment alternatives.--The Committee notes that
the United States is grappling with an opioid epidemic. Some
areas, such as Appalachia, are disproportionately hard-hit by
this crisis. The Committee, therefore, encourages VA to ensure
pain treatment alternatives to opioids, such as chiropractic
care, are available to veterans where they are most needed.
Further, the Committee encourages VA to integrate such
treatments into VA's medical centers or clinics to be provided
by VA staff, or on a contract basis where needed.
Pain University.--The Committee recognizes the excellent
and inspiring work from the Tomah VA facility in Tomah,
Wisconsin, which has successfully implemented a program called
Pain University. The program seeks to incorporate alternative
medicine, such as acupuncture and meditation, to reduce
veterans' reliance on prescription pain medications, which have
a higher likelihood of addiction leading to substance abuse.
The Pain University program was recognized as a gold status
program by VHA in 2016 for its work. The Committee encourages
VHA to continue to expand implementation of the Pain University
program to other VA clinics so more veterans have access to
non-addictive pain management therapies.
Substance abuse disorder data.--The Committee supports the
VA's ongoing work to reduce substance use disorder among
veterans. The Committee directs VA to provide a report no later
than 120 days after the enactment of this Act providing the
number and proportion of veterans with substance use disorder,
broken down by age, including a breakdown by State. The report
should also include available demographic data.
Other health issues
Hepatitis C Virus (HCV) outreach and testing.--The
Committee is pleased with VA's significant progress in reaching
and treating veterans who have lived with HCV for years and
that it continues to dedicate resources towards the goal of
screening and treating veterans who are disproportionately
impacted by the disease. Now that the easiest to identify and
treat HCV caseload has been largely addressed, it is important
for VA to use other tools to reach the remaining caseload.
Participating in community events, with on-site HCV testing,
that are organized by veterans services organizations is an
excellent way to reach veterans, both those who may be enrolled
for VA services, but are not actively using them, or veterans
who don't know their eligibility status. Therefore, VA is
encouraged to explore innovative partnerships with stakeholder
organizations to effectively engage and test additional
veterans with rapid HCV screening outside of traditional sites
of care. The Department is also encouraged to make available,
at community events involving on-site screening, department
staff who have the capacity to check a veteran's status on-site
so that eligibility for VA reimbursement for testing is known
instantly.
Lung cancer screening.--The Committee continues to note
with concern that veterans at risk for lung cancer are not
afforded the same access to lung cancer screening programs that
are offered to Medicare beneficiaries. The Committee looks
forward to receiving the report from VA, as requested in House
Report 115-188, presenting the steps the VHA is taking to make
lung cancer screening broadly available to veterans at high
risk for lung cancer.
Colorectal cancer screening.--The Committee reminds VA of
the direction in the Statement of Managers accompanying Public
Law 115-141 that directed the Department to offer all seven
colorectal cancer screening strategies recommended by the
United States Preventive Services Task Force or to notify the
Committee if it is not using all seven approaches.
Prostate cancer.--Prostate cancer is the most frequently
detected cancer among veterans, with an estimated 10,000 new
cases diagnosed annually. Unfortunately, early detection is not
yet an exact science. Although prostate biopsies are the
standard of care, they often miss detecting cancer. This fear
of missed cancer often leads to multiple, invasive biopsies,
many of which may be unnecessary. Recent biotechnology
advancements within the emerging field of prostate cancer
biomarkers have hastened the detection of prostate cancer and
curbed the financial costs associated with unnecessary repeat
diagnostic procedures. The Committee encourages VA to
accelerate the adoption of such technologies within VHA,
particularly for biomarker tests on the federal supply
schedule, to help rule out false-negative biopsy concerns and
alleviate financial and mental anguish for veterans.
Rare cancers.--The Committee is pleased to learn of the
December 2017 signing of a collaboration agreement between the
VA, the John P. Murtha Cancer Center at Walter Reed National
Military Medical Center, and the National Cancer Institute
(NCI) focused on improving cancer care for common cancers
affecting military personnel and veterans. However, the
Committee remains concerned about the need for a better
understanding of, and treatment options for, rare cancers that
may disproportionately impact veterans. Military personnel are
uniquely exposed to carcinogens including asbestos, industrial
solvents, nuclear radiation, depleted uranium, lead, fuels,
PCBs, and components of Chemical Agent Resistance Coating. Each
of these hazards may increase the risk of certain cancers for
both military personnel and veterans. Therefore, the Committee
directs VA to assess options for modifying the December 2017
agreement to include collaboration on rare cancers. Further,
the Committee seeks clarification regarding VA's authorities to
provide funding to commercial firms for the development of
treatments for rare cancers. The Committee directs VA to
provide a report on these topics within 90 days of the
enactment of this Act.
Sepsis.--Sepsis is a leading cause of mortality for
veterans with spinal cord injuries. The Committee believes that
VA, through its Center for Clinical Management Research and its
Spinal Cord Injuries and Disorders Centers, can help improve
the diagnosis and management of sepsis. The Committee,
therefore, directs the Department to provide a report, within
90 days of the enactment of this Act, on its costs related to
sepsis management and how it has incorporated the latest
improvements in sepsis screening and diagnostics, including
biomarker testing, across its health care facilities.
Safety of blood products.--The Committee is concerned about
the safety of blood products being transfused to veterans at VA
medical facilities given the aging and medically fragile
populations being treated. Therefore, the Committee urges VA to
request that all blood product providers use FDA-approved
pathogen reduction technology, where it is available, before
providing blood products for transfusion at VHA medical
facilities, including VA medical centers, outpatient clinics,
community-based outpatient clinics, and community living center
programs.
Diabetes treatment.--The Committee is concerned about the
incidence of diabetes impacting veterans and seeks approaches
to reduce both the prevalence of this disease and any wait
times associated with treatment. Therefore, the Committee
requests that VA provide a report, no later than 90 days after
the enactment of this Act, on the feasibility and potential
cost of building a fully-equipped diabetes center that would be
open 24 hours per day, 7 days a week, and 365 days a year. In
describing in the report suitable locations for such a
facility, VA should consider areas with the highest prevalence
of diabetes, a large concentration of veterans, and a system of
established VA medical centers and clinics. Any willingness of
medical providers to defray the expense of such a facility by
paying the capital costs of construction, if permitted in law,
should also be taken into account in considering potential
locations.
Pressure ulcer prevention.--The Committee is concerned
about facility-acquired pressure ulcers (PU) and the associated
costs for the treatment of hospitalized patients with PUs in
VHA facilities. The Committee, therefore, commends VA for its
current studies on the VA Smart Modular Adaptive Electrotherapy
Delivery System (SmartMAEDS), the use of smartphone technology
for PU screening, and the prevention of community-acquired PU
in individuals living with a spinal cord injury. Given the
importance of this research, the Committee encourages VA to
prioritize clinical care and research focused on wound care,
particularly in locations with higher incidence rates of PUs,
such as sites that serve patient populations with limited
mobility and spinal-cord injury. Furthermore, the Committee
encourages VA to explore the feasibility of including military
treatment facilities in this care and research to increase the
cost-effectiveness of the health care provided by the Military
Health System and VA, as authorized under Joint DOD/VA Sharing
Incentive Funds, 38 USC 8111. To assess VA's progress in this
area, the Committee requests a report, no later than one year
after the enactment of this Act, regarding the status and
preliminary results of these studies, as well as any other
innovative technologies VA has assessed, particularly those
involving biometric sensor technologies.
Antimicrobial stewardship.--The Committee continues to be
pleased with VA's efforts to reduce antibiotic use so as to
avoid development of resistance to important drugs, without
increasing 30-day readmission and mortality rates. Per 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. It also supports and expands ongoing efforts to
prevent the emergence of multidrug-resistant organisms. The
Committee encourages VA to continue improvements in the
effectiveness and implementation of its Antimicrobial
Stewardship Program.
Wheelchairs.--The Committee is extremely concerned by the
March 2018 report from VA's Office of Inspector General
regarding the repair times and policies for powered wheelchairs
and scooters. The report noted that, due to VA staff failures,
some veterans waited an average of 69 days to have their
powered wheelchair or scooter repaired and were provided manual
wheelchairs or scooters in the interim jeopardizing their
quality of life. Therefore, the Committee requests a report, no
later than 60 days after enactment of this Act, explaining VA's
policy in regard to the types of wheelchairs or scooters issued
as replacements when powered wheelchairs or scooters are turned
in for repair. It should also provide the estimated cost of
maintaining sufficient powered wheelchairs and scooters on hand
to enable veterans to receive one as a replacement, instead of
a manual wheelchair or scooter, while awaiting repair of their
powered wheelchair or scooter. The report should also include a
description of VA's authority to provide wheelchairs that
restore an ability that relates exclusively to participation in
a recreational activity.
Non-invasive cardiac artery disease diagnosis.--The
Committee understands that significant health advantages and
cost savings may be possible through non-invasive diagnosis of
cardiac artery disease. Therefore, the Committee commends VA on
having conducted such diagnoses through cardiac CT angiography
(CTA) on approximately 2,300 veterans in the past year. The
Committee is also interested in newly-developed CTA-related
technologies that may provide even greater benefits to
veterans. The Committee directs VA to conduct a study on such
technologies assessing their capabilities, the anticipated
annual net cost impact (the estimated annual cost of the
testing and the estimated cost savings and offsets that would
result from avoidance of invasive CTA and other non-invasive
cardiac testing), and any issues that might impact their
incorporation into clinical practice guidelines, such as
privacy and information technology issues, if such technologies
are proprietary. The Committee requests that VA submit the
results of this study within 180 days after enactment of this
Act.
Mobile magnetic resonance imaging (MRI).--The Committee is
concerned about MRI wait times for veterans. Delays in MRI use
have the potential to keep veterans in pain or cause injuries
to heal incorrectly without proper diagnosis. Therefore, the
Committee requests a report from VA, no later than 90 days
after the enactment of this Act, on any MRI backlog that may
exist. The report should include data on average wait times by
location, an assessment as to whether a mobile MRI service
would help reduce any existing backlog, and an estimate of the
cost for implementing such a service.
Wellness.--Public Law 115-141 included funding for a
veteran services organizations (VSOs) wellness pilot program to
upgrade, through construction and repair, veteran service
organization facilities to expand access to wellness programs
and expanded complementary and integrative health promotion.
The Committee strongly supports this program and directs VA to
report the progress of this pilot no later than 15 days after
enactment of this Act and then provide quarterly status
updates.
Tobacco.--In a 2018 Centers for Disease Control and
Prevention study, 56.8 percent of servicemembers and veterans
between the ages of 18-25 reported being current smokers.
Interventions for active duty and veteran servicemembers are
important to reduce tobacco use and could lead to improved
health outcomes. The Committee encourages VA to implement
evidence-based tobacco interventions to support servicemembers
now and in the future.
Nutrition.--The Committee recognizes the value of proper
nutrition and food's impact on health. Patients with three or
more chronic conditions represent 35 percent of veterans
receiving VA care and account for 65 percent of VHA costs.
Additionally, 79 percent of veterans receiving VA care are
overweight and 43 percent are obese. The Committee urges VHA to
be proactive in promoting wellness and disease prevention by
providing evidence-based nutritional services and requests to
be briefed on current practices, as well as on a plan to expand
nutritional education and means to increase access to
nutritional foods for veterans.
Long-term care.--The Committee is aware of the aging
veteran population and supports long-term care that focuses on
facilitating veteran independence, enhancing quality of life,
and supporting the family members of veterans. The Committee
supports home- and community-based care, residential settings,
nursing homes, geriatric services, and advanced care planning
for veterans and their families. Multiple chronic conditions,
life-limiting illness, or disability associated with disease,
aging, or injury can be factors of consideration. The Committee
acknowledges that the veteran population faces unique health
risks and that each veteran requires an individualized approach
to care.
Veterans' end-of-life care.--Public Law 115-141 directed VA
to undertake a study on the feasibility of implementing hospice
care protocols tailored to the unique needs of combat veterans,
including Vietnam-era veterans, and to develop a report
outlining the techniques, best practices, and support
mechanisms to serve these veterans. The Vietnam Veterans End of
Life Care report submitted to the Committee is woefully
inadequate, failed to meet any of the reporting requirements,
and is frankly of no use to the Committee. Furthermore, the
report stated that there are over 4,000 community hospice care
providers who all maintain their own resources and training
materials which leads the Committee to believe there is no
clear standard being provided by VA for veterans hospice care
and veterans facing unique end-of-life challenges are failing
to receive proper care. Due to the lack of information provided
in the report, VA is again directed to provide a detailed
report outlining the techniques, best practices, and support
mechanisms for end-of-life care. The Committee strongly
reiterates that such an approach could be beneficial to Iraq,
Afghanistan, and Syria combat veterans in the future. This
report shall be submitted to the Committee within 30 days after
the enactment of this Act.
Patients rights.--The statement of managers for Public Law
115-141 contained a VA patients rights reporting requirement.
However, due to the late passage of the fiscal year 2018 bill,
the reporting requirement remains outstanding. The Committee
strongly supports veterans making decisions regarding their
medical care and having the right to accept or refuse
treatment, and the right to formulate advance directives. The
Committee remains interested in this report and looks forward
to its submission.
Teague-Cranston medical schools.--The Committee recognizes
that the 1972 Teague-Cranston Act, also known as the Medical
School Assistance and Health Manpower Training Act, established
five medical schools to be built on VA campuses in conjunction
with these universities: Wright State University, the
University of South Carolina, Texas A&M University, Marshall
University, and East Tennessee State University. These schools
were built on VA campuses for the express purpose of training
physicians for service in underserved areas and benefitting
veterans. The Committee also understands that VA maintains a
robust academic affiliation with these schools. Given
congressional intent regarding the establishment of these
schools, and the critical role they play in caring for
veterans, the Committee directs VA to notify Congress in
advance of any plan to move resources or assets from these
schools, if such a move would have a negative impact on them.
Hispanic-Serving Institution (HSI) affiliations with VA
health care facilities.--The Committee continues to be
concerned by the lack of Hispanic-Serving Institutions (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.
The Committee looks forward to the report mandated by Public
Law 115-141.
Historically Black Colleges and Universities medical
research programs.--Over the past five years the Committee has
urged VA to increase its efforts to improve its academic
affiliation activities with minority medical schools and
institutions for the purposes of enhancing training
initiatives, improving patient care, and providing educational
opportunities. At one point the Committee directed VA to have a
symposium in order to achieve these goals. The Committee once
again directs VHA and the Office of Academic Affiliations to
take concrete steps to improve this ongoing commitment to, and
partnership with, minority health professions schools and
report back to the Committee, no later than 30 days after the
enactment of this Act, regarding the actions it will take to
address this issue. Thereafter, the Committee directs a
quarterly report on this issue be submitted to the Committee
explaining how each action has been fulfilled.
Minority veteran care.--The Committee acknowledges VA's
efforts to streamline data collection practices via a working
group and other initiatives. The Committee also notes that the
veteran population is becoming increasingly diverse.
Accordingly, the Committee directs VA to provide a report
within 180 days of enactment of this Act, which details how it
can restructure its data collection practices to more
accurately and consistently capture data on the race and
ethnicity of veterans across its various systems. This report
shall take into consideration that the Department is in the
midst of the acquisition of a new electronic health record
program, which will combine the Department's current data
collecting programs, and make recommendations on how
implementation of this new program can help improve data
collection on veterans.
Freely Associated States (FAS) veterans' access.--The
Committee is concerned about impediments to VA health care
access for FAS veterans. Veterans in the FAS must travel
hundreds to thousands of miles to the nearest VA medical center
in Guam or Hawaii, in some circumstances at their own expense,
to get health care. For those who are able to travel to seek
care, the collective costs are magnified by lost wages
resulting from missed days at work and childcare costs, as well
as time away from families. Given the significant time,
resources, and high costs for travel for some veterans,
including airfare, transportation, and lodging, many FAS
veterans are never able to access the VA health services they
have earned through their military service. As the VA works to
transform its Community Care programs, the Committee directs
VA, no later than 90 days after enactment of this Act, to
provide the Committee a report that assesses options for
improving access to VA health care for FAS veterans. The report
should include the number of veterans residing in the FAS who
have utilized services in VA Pacific Islands Health Care System
(VAPIHCS) facilities over the last three fiscal years, the
extent of travel benefits offered to veterans and eligibility
requirements for the benefits, an average estimated personal
cost for an FAS veteran to access VA care, the estimated costs
for providing telehealth services in FAS through a pilot
program, and recommendations for how VA can reduce burdensome
restrictions under the Foreign Medical Program using existing
authorities. Furthermore, the Committee encourages VA to work
with Federal and non-Federal partners, including the
Departments of Defense, Interior, and Health and Human
Services, as well as non-VA health care facilities and
educational institutions, to leverage shared resources and
improve access for delivery of care through collaboration.
Volunteer physicians.--The Committee continues to be
encouraged by the success of the Physician Ambassadors Helping
Veterans Pilot Program to date and encourages VA to expand this
program to additional facilities throughout the country,
prioritizing VHA sites that serve the largest veteran
populations as well as those which experience the longest wait
times.
National Veterans Sport Program.--The bill includes
$17,825,000 for the National Veterans Sports Program, which is
$1,000,000 above the request and $860,000 above the fiscal year
2018 funding. Within the total, $6,825,000 is provided for the
support of national veterans' sports and special events
programs; $2,000,000 is designated for veterans' monthly
assistance allowances; and $9,000,000 is provided for the
Adaptive Sports Grants Program. The Adaptive Sports Grants
Program currently awards a limited number of grants for equine
therapy, mostly related to physical disabilities. The Committee
provides $1,000,000 above the request to encourage VA to
increase its use of these grants for the purpose of equine
therapy targeted to mental health issues.
Prosthetics regulation.--The statement of managers for
Public Law 115-141 indicated the conferees' concern that VA's
proposed prosthetics services regulation may limit veteran
choice in obtaining prosthetic, orthotic and other
rehabilitative services. The Committee strongly encourages the
Department to revise the final rule to be more closely aligned
with the principle of patient choice as reflected in the
Veterans Access, Choice and Accountability Act.
Medical Community Care
Fiscal year 2018 enacted level........................ $9,828,294,000
Fiscal year 2019 enacted level........................ 8,384,704,000
Fiscal year 2019 additional request................... 500,000,000
Committee 2019 additional recommendation.............. 500,000,000
Fiscal year 2020 advance appropriation request........ 14,419,786,000
Committee 2020 advance appropriation recommendation... 14,419,786,000
Comparison with:
Fiscal year 2019 enacted level.................... 6,035,082,000
Fiscal year 2020 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 2020, the bill provides $14,419,786,000, of which
$2,000,000,000 is available until September 30, 2021.
The Committee provides $500,000,000 as requested in the
April 13 Administration budget amendment for this activity.
Peer support services.--The Committee understands that
private nonprofit peer-to-peer organizations have provided
important services for veterans in areas such as crisis
interventions, services to improve community integration such
as rehabilitation, mental health assessments, referral
services, and treatment plan development. The Committee
encourages VA to review the types of services provided by peer-
to-peer organizations and determine whether the Department is
permitted to contract for their services under current law. The
Committee requests a report, no later than 60 days after
enactment of this Act, describing whether VA is permitted to
reimburse peer-to-peer organizations and whether these
providers could be a useful component in the Department's
comprehensive strategy for health care services for veterans.
Problems with network administrators.--The Committee
recognizes the massive undertaking to develop and implement the
Veterans Choice Program and the difficulties that patients and
providers have experienced in dealing with the third party
administrators of the program. As such, the Committee is
interested in ensuring that, going forward, the Veterans Choice
Program is providing maximum benefit to veterans, attracting
top quality providers, and meeting program goals. To this end,
the Committee requests VHA to submit a report, within 90 days
of enactment of this Act, on the effectiveness of the program's
third party administrators with regard to patients and
providers and the challenges this program has created for them.
CHOICE FUND
Fiscal year 2018 enacted.............................. - - -
Fiscal year 2019 enacted.............................. - - -
Fiscal year 2019 additional request................... $1,900,000,000
Committee recommendation in the bill.................. - - -
Comparison with:
Fiscal year 2018 enacted level.................... - - -
Fiscal year 2019 additional request............... (1,900,000,000)
The Choice Fund was created in P.L. 113-146, the
legislation establishing the Choice program and providing
mandatory funding for it. Since its inception, the authorizers
have provided nearly $20,000,000,000 in emergency mandatory
funding to support the Choice program. The account has never
received discretionary funding. It was anticipated that the
funding would last until the authorizing committees created a
program to consolidate the Choice program with other non-VA
care programs. However, the new program has not yet been passed
into law. The Administration proposes a budget amendment of
$1,900,000,000 in discretionary funding as a patch until a
consolidated non-VA care program is in place. The Committee is
reluctant to provide discretionary funding for a mandatory
program, but is ready to meet its responsibility to provide
funding after the new discretionary program is implemented.
Medical Support and Compliance
Fiscal year 2018 enacted level........................ $6,754,480,000
Fiscal year 2019 enacted level........................ 7,239,156,000
Fiscal year 2020 advance budget request............... 7,106,150,000
Committee 2020 recommendation in the bill............. 7,106,150,000
Comparison with:
Fiscal year 2019 enacted level.................... (133,006,000)
Fiscal year 2020 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 $7,106,150,000 in advance fiscal year
2020 funding. The Committee has included bill language to make
available through September 30, 2021, $100,000,000 of the
Medical Support and Compliance appropriation for fiscal year
2020.
Medical Facilities
Fiscal year 2018 enacted level........................ $6,141,880,000
Fiscal year 2019 enacted level........................ 5,914,288,000
Fiscal year 2020 advance budget request............... 5,276,676,000
Committee 2020 recommendation in the bill............. 5,276,676,000
Comparison with:
Fiscal year 2019 enacted level.................... (637,612,000)
Fiscal year 2020 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 $5,276,676,000 in advance fiscal year
2020 funding. The Committee has included bill language to make
available through September 30, 2021, $250,000,000 of the
advance Medical Facilities appropriation for fiscal year 2020.
In addition to funding provided in this account,
$800,000,000 is provided in sec. 238 for non-recurring
maintenance as part of a $2,000,000,000 infrastructure
initiative. A similar initiative provided $1,000,000,000 for
this account for non-recurring maintenance in fiscal year 2018.
Spending plan.--The Committee expects VA to provide, no
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 2019 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.
Facility expansion.--The Committee continues to support an
expansion of the number of clinics available to veterans. To
help accomplish this, 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, thereby 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. Additionally, VA is directed to
complete a study, within 120 days after enactment of this Act,
on the potential benefits of placing VA clinics on military
installations located in areas with high veteran populations
and where nearby VA infrastructure is overburdened. The study
should emphasize locations with readily available, unused
medical facilities on military installations. The report should
identify potential cost savings and determine if increased
quality and improved timeliness of care can be provided to
veterans in these communities through on-post VA medical care.
The results of the study are to be provided to the Committee
once available.
Bakersfield outpatient clinic.--The Committee remains
concerned that VA has not yet established a new outpatient
clinic in Bakersfield, California as authorized in Public Law
111-82. Based on information provided by VA, the Committee
expects the lease for this facility to be awarded in the summer
of 2018 and that clinic activation will occur in the fall of
2020. Furthermore, the Committee directs the Secretary to
continue to provide regular updates to Congress as directed in
House Report 114-497.
Center of Excellence for Research on Returning War
Veterans.--The Committee understands that VA is planning to
move the Posttraumatic-stress Residential Rehabilitation
Program (PRRP) that is currently co-located with the Center of
Excellence (COE) for Research on Returning War Veterans on the
campus of the VA Medical Center in Waco, Texas. The Committee
is concerned that this may have an adverse impact on the COE's
PTSD research, which is critical in helping develop treatments
for veterans suffering from PTSD. Therefore, the Committee
directs VA to provide a report, within 30 days of the enactment
of this Act, which details the mission of the COE, the mission
of the PRRP, and the relationship between these two programs.
The report should include an assessment of the research
benefits of having inpatient programs co-located with mental
health centers of excellence in general, an assessment specific
to benefits resulting from the current co-location of the COE
with the PRRP on the Waco campus, and any costs associated with
VA's planned move of the PRRP. Further, the Committee reminds
VA that the conference report accompanying Public Law 109-114,
House Report 109-305, expressly designated the establishment of
three VA ``centers of excellence to focus on mental health/PTSD
needs,'' with one of these being at the VA Medical Center in
Waco, Texas. The Committee expects VA to adhere to
congressional intent, as expressed in the report, regarding the
location of this center of excellence.
Medical imaging equipment.--The Committee remains committed
to helping VA in its efforts to ensure a timely process for VA
medical centers to receive medical imaging equipment to
effectively and efficiently deliver care to veterans. The
Committee urges VA to strive to maintain a 120-day turnaround
for these equipment orders during their three, annual
consolidated purchase periods for high tech medical equipment.
The Committee requests that VA consider more education for
contracting officers and 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 make public
information regarding current requirements and regulations and
any changes or revisions to procurement processes in the area
of high tech medical equipment. In addition, the Committee
urges VA to coordinate between capital equipment purchases,
facilities funding for site readiness, and clinical staff
training to ensure that facilities are prepared to install and
operate equipment as quickly as possible after purchase.
Operating room patient safety and fire prevention.--Given
the importance of patient safety, the Committee requests that
VA provide a report, within 90 days of enactment of this Act,
that provides information regarding incidents of operating room
fires at VA medical facilities over the last ten years. The
report should include the Department's policies and procedures
for tracking and evaluating patient burn and fire risk
exposures in live operating room environments and data that
shows the total number of tort claims, the amount per claim,
and the total amount of these claims, paid by the Department of
the Treasury's Judgement Fund or any other taxpayer-funded
sources as a result of VA operating room fires and related
safety issues. The report should also include information on
the Department's public reporting of patient outcome measures
based on Agency for Healthcare Research and Quality (AHRQ)
Patient Safety Indicators (PSI).
Medical and Prosthetic Research
Fiscal year 2019 enacted level........................ $722,262,000
Fiscal year 2019 budget request....................... 727,369,000
Committee recommendation in the bill.................. 732,262,000
Comparison with:
Fiscal year 2018 enacted level.................... 10,000,000
Fiscal year 2019 budget request................... 4,893,000
This appropriation provides for medical, rehabilitative,
and health services research. The bill makes $705,262,000 of
this funding available through September 30, 2020. The
Committee recognizes the importance of the research conducted
by VA for veterans' quality of life and health and provides
$4,893,000 above the request and $10,000,000 above last year
for these activities. Of the funding provided, $27,000,000
supports VA's collaboration with the Department of Energy (DOE)
via a long-term inter-agency agreement to leverage DOE's next
generation artificial intelligence, big data, and high-
performance computing technologies, as well as multi-modal
diagnostics and data integration, in order to develop specific
precision medicine applications. This funding is made available
through September 30, 2023.
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
2019 research resources beyond the research account are
$1,188,000,000.
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 2019, compared to the budget request of
$19,680,000.
Modeling and simulation treatment of PTSD.--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
to treat PTSD.
Identifying at-risk veterans through social media
algorithms.--The committee encourages VA to investigate the use
of technology, specifically social media database algorithms,
to detect and identify, via indirect contact such as on social
media, veterans who are at risk of harming themselves or
others. Once an individual is identified, the Department would
use indirect means of communication to interact with the
troubled individual to provide help and support in the hope of
preventing tragedy.
Dystonia.--The Committee is concerned that there may be a
connection between traumatic brain injury (TBI) and the onset
of dystonia and that this may disproportionately impact
veterans. The Committee, therefore, urges the VA to pursue
collaboration with stakeholders to advance critical research on
dystonia.
Cannabis research.--The Committee recognizes that continued
focus on the discovery of treatment alternatives for veterans
diagnosed with various conditions such as chronic pain and PTSD
are essential to reducing the number of veteran suicides. For
this reason, the Committee urges VA to utilize funds, in an
amount deemed appropriate by the Secretary, to prioritize
investments in research on the efficacy and safety of cannabis
usage among the veteran population for medicinal purposes. The
Committee also requests a report, within 180 days after the
enactment of this Act, by the Secretary containing a detailed
plan on how the Department expects to pursue this research. The
Committee also urges VA to ensure any research conducted or
supported by VA on cannabis therapy is preserved in a manner
that will facilitate further research.
Comprehensive cancer centers.--The Committee seeks to
ensure that veterans have access to the highest quality cancer
care available. The Committee, therefore, applauds the ongoing
collaborative efforts between VA medical centers and NCI-
designated comprehensive cancer centers. The Committee supports
these efforts, especially as they relate to providing veterans
access to groundbreaking new treatments through clinical trials
led by academic cancer centers, as well as the linking of VA
oncology care with national research databases involving
patients at multiple academic cancer centers. The Committee is
also pleased that VA is engaged with the NCI and VA Interagency
Group to Accelerate Trials Enrollment (NAVIGATE) partnership,
which will improve access to certain clinical trials at a
number of VA facilities. The Committee understands that
initiating new clinical trials is a resource-intensive process
requiring experienced coordination staff with specialized
expertise in data management and regulatory compliance. To
improve its own capacity to coordinate a full range of cancer
clinical trials with non-VA organizations, the Committee
encourages VA to provide resources for coordination staff and
continue to develop partnerships with non-VA organizations that
have initiated pilot clinical trials programs. The Committee
also requests a report, within 90 days of enactment of this
Act, which provides an overview of VA's credentialing process
for non-VA clinical trial coordinators and recommendations, if
any, to improve this process.
Respiratory disease.--The Committee notes the high burden
of respiratory illnesses, such as lung cancer, on the veteran
population. The Committee urges VA to provide support for
respiratory research proposals commensurate with the burden of
respiratory disease in this population.
Exposure to herbicide-related toxins.--Veterans have
frequently expressed long-held concerns that toxic exposure
during their military service is related to adverse health
conditions. The Committee is committed to understanding the
residual impacts of Agent Orange/Dioxin and other herbicide-
related toxic exposures among veterans who served in Vietnam,
Thailand, and all other geographic areas where these toxic
substances were dispersed. The Committee urges VA to reference
data from existing medical records of veterans to determine the
percentage of veterans from the above referenced subgroup that
have more frequent or unexplained diseases compared to the
civilian population. This body of data could be helpful in
clarifying the extent and specifics of the medical issues
suffered by veterans from exposure to herbicides.
Female prosthetics research.--The Committee strongly
supports robust funding for medical and prosthetic research.
Recognizing that approximately six percent of wounded veterans
returning from Iraq and Afghanistan are amputees, and the
number of veterans accessing VA health care for prosthetics and
sensory aids continues to increase, this funding greatly
enhances veterans' quality of life. However, there is an acute
need for research specializing in female prosthetics, as most
prostheses are designed to fit male veterans. Since three
percent of military amputees are female, the Committee urges
that a proportionate amount of prosthetics research should be
focused on prosthetics meant for female veterans. The Committee
repeats its direction that VA, in collaboration with the
Prosthetic Women's Workgroup, issue a comprehensive report on
female veteran amputees and their access to prosthetics.
Furthermore, the Committee directs VA to submit this report on
an annual basis that coincides with the annual VA budget
submission as its own chapter in the relevant budget documents.
Hydraulic prosthetic technology.--The Committee is aware of
recent developments in hydraulic prosthetic technology.
Hydraulic designs fill the gap between standard myoelectric
grippers and premium, bionic-like hand prostheses, offering
cost-effective solutions with advanced motion control and
flexibility. The Committee also understands that VA is limited
to providing prosthetic devices that have been approved by the
Food and Drug Administration (FDA). Therefore, the Committee
encourages the Department to monitor the development of this
technology and, if approved by the FDA, to implement pilot
programs that assess its benefits for veterans.
Specialized and modular prosthetics research.--As
referenced in the Statement of Managers accompanying Public Law
115-141, the field of specialized and modular prosthetics is
evolving at a faster pace than VA has been able to match. The
Statement of Managers directed VA to provide a report on this
issue; however, due to the late passage of the fiscal year 2018
Omnibus the report remains outstanding. The Committee
reiterates its interest in this report and urges the Department
to complete the report as soon as possible.
Neuromuscular junction (NMJ) regeneration research.--The
Committee applauds VHA for its support of cutting edge research
into the molecular mechanisms that govern NMJ. This knowledge
is essential to making improvements in the re-innervation of
denervated muscles. Progress in this area is critical to
reducing the incidence of long-term disability among military
personnel as a result of combat-related extremity injuries and
other non-combat related incidents. It is also crucial to
mitigating the disproportionate incidence of neurodegenerative
disorders among the veteran population. Consequently, the
Committee strongly encourages VHA to dedicate additional
research resources to efforts to better understand the
underlying mechanisms of NMJ regeneration.
Gulf War illness studies.--The Committee recommends the
Department continue to conduct epidemiological studies
regarding the prevalence of Gulf War illness, morbidity, and
mortality in Persian Gulf War veterans, and the development of
effective treatments, preventions, and cures. The Committee
also urges VA to make public all of its available research data
on Gulf War illness, particularly disease-specific mortality
data related specifically to Gulf War veterans.
Gulf War illness.--The Committee encourages VA to continue
inclusion of research on functional gastrointestinal (GI)
disorders in its research related to Gulf War Illness.
Post-deployment integrated care.--Each new generation of
veteran faces unique service-related conditions. Historically,
it has been a challenge, when large-scale deployments occur, to
identify signature wounds and develop and implement appropriate
care models for returning combat veterans in a timely way.
Given the evolving responsibilities for current and future
military service personnel, the Committee directs VA, through
the War Related Illness and Injury Study Center (WRIISC) and
the Offices of Patient Care Services and Post-Deployment Health
Services, to provide to Congress, no later than 120 days after
enactment of this Act, an assessment of the process by which VA
develops and improves its approaches to post-deployment
integrated care for returning combat veterans. The report shall
build on lessons learned from previous veteran cohorts and care
models, including the Post-Deployment Integrated Care
Initiative (PDICI). The report shall include recommendations to
ensure VA has the capabilities and agility to identify and meet
the needs of the next generation of combat veterans.
The Million Veteran Program (MVP) Computational Health
Analytics for Medical Precision to Improve Outcomes Now
(CHAMPION) project.--The Committee supports the MVP-CHAMPION
project, and encourages VA to continue leveraging the high
performance computer facilities available through its
partnership with the Department of Energy to focus on the
secure analysis of large digital health and genomic data. The
Committee also encourages VA to provide principal investigators
at VA sites across the country for participation in the
project. Further, the Committee recognizes that VA may benefit
from the help of academic institutions across the country
regarding sample collecting, contributions to relevant
research, precision medicine, and health informatics. The
Committee, therefore, encourages VA to consider a small number
of pilot programs with academic health institutions that have
biorepositories, existing clinical partnerships with VA, data
security programs, and clinical care strengths in at least one
of the following three identified areas of priority: suicide
prevention, prostate cancer, and cardiovascular disease.
Priority may be given to institutions that also have existing
partnerships with the Department of Energy.
Canine research.--The Committee understands there may be
times that research involving canines leads to advances that
benefit the health of our veterans. However, the Committee
remains concerned about the extent of such experimentation and
continues the language in the Consolidated Appropriations Act,
2018 limiting canine research to those studies in which the
scientific objectives of the study can only be met by research
with canines, the study has been directly approved by the
Secretary, and the study is consistent with the revised VA
canine research policy document released on December 18, 2017.
Additionally, the Committee is aware that on March 13, 2018,
the VA publicly announced that VHA's Office of Research and
Development would be conducting a ``rapid, in-depth internal
review of existing canine research projects.'' The Committee
directs VA to provide the results of this review to the
Committee as soon as it is completed.
Public access to scientific data.--The Committee commends
VA on issuing its Policy and Implementation Plan for Public
Access to Scientific Publications and Digital Data from
Research Funded by the Department of Veterans Affairs on July
23, 2015. The Committee urges VA to continue its efforts
towards full implementation of the plan, and requests a status
report be submitted in conjunction with the fiscal year 2020 VA
budget.
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 2019 is $3,590,000,000.
National Cemetery Administration
Fiscal year 2018 enacted level........................ $306,193,000
Fiscal year 2019 budget request....................... 315,836,000
Committee recommendation in the bill.................. 315,836,000
Comparison with:
Fiscal year 2018 enacted level.................... 9,643,000
Fiscal year 2019 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 135
operational national cemeteries and 33 other cemeterial
installations.
The bill includes language making ten percent of the total
available until September 30, 2020.
Unclaimed remains of veterans.--Throughout the country,
there are reports of unclaimed remains of veterans being stored
due to the absence of someone to claim these remains and begin
the process for proper interment. The Committee was pleased to
learn that NCA has recently taken steps to establish a process
to address unclaimed remains of veterans at various locations.
As VA establishes a process for unclaimed remains the Committee
urges VA, in consultation with the National Park Service, to
also consider including in this process ways to deal with
remains of veterans that are left at National Memorials.
Rural cemetery access.--In House Report 112-94 and House
Report 115-188 the Committee expressed concern that NCA is not
adequately serving the nation's veterans in rural areas. In
five years, VA has only reduced this number to eight percent
while receiving generous funding increases 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 for all veterans to a burial option within 75
miles of a veteran's home. The Committee has previously
requested a report on this issue and in fiscal year 2018
requested that GAO examine this issue as well. The Committee
remains interested and looks forward to this report.
Departmental Administration
GENERAL ADMINISTRATION
(INCLUDING TRANSFER OF FUNDS)
Fiscal year 2018 enacted level........................ $335,891,000
Fiscal year 2019 budget request....................... 367,629,000
Committee recommendation in the bill.................. 346,091,000
Comparison with:
Fiscal year 2018 enacted level.................... 10,200,000
Fiscal year 2019 budget request................... (21,538,000)
The General Administration account provides funds for the
Office of the Secretary, seven Assistant Secretaries, and three
independent staff offices. The Committee has included bill
language to make available through September 30, 2020, 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.
Five year development plan.--The Committee is very pleased
that the Department has provided a Five Year Development Plan
(FYDP) in its fiscal year 2019 budget. The Committee has asked
for such a document for years, but has faced resistance in the
past. The FYPD has proved very useful in analysis of Military
Construction budgets and the Committee looks forward to annual
review of the FYDP in VA budget submissions.
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 2018 bill and conference report.
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. Further, the Committee
directs VA to include in its budget justification materials a
table for each account that shows a five-year funding history,
for requested and enacted levels.
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.
Performance bonuses.--The Committee feels it is important
to know how VA is allocating its resources with regard to
performance bonuses. Therefore, the Committee directs VA to
submit a report, within 90 days of enactment of this Act, which
provides the aggregate total of VA performance bonuses covering
the five most recent fiscal years for which the data is
available. The data should be divided between bonuses for
Senior Executive Service (SES) staff and non-SES staff. The
report should also include the percentage of SES and non-SES
employees who received a bonus and the average dollar amount of
the bonuses by grade covering the same time period. The report,
however, should not include any personally identifiable
information.
Financial Management System (FMS) replacement.--The
agreement includes $10,800,000 in this account as well as
$72,821,000 in the Information Technology Systems account for
development of a new financial management system. The current
legacy financial management system is 30 years old, and its
imminent failure presents significant risks to VA.
Unfortunately, the VA agreement to use the Department of
Agriculture's (USDA) Federal Shared Services financial
management system to develop its FMS has collapsed, and VA is
trying to use the contracts established by USDA to reconstruct
the financial management system it had anticipated acquiring
through USDA. The Committee continues to be concerned with VA
moving forward alone, given the disastrous outcomes of its two
previous attempts to create a modern financial management
system. In the fiscal year 2018 conference report, VA was
directed to provide a report to the Committee, within 60 days
of enactment of that Act, which described the components to be
included in its planned financial management system, such as
acquisition, the cost of the contracts and staffing that VA has
acquired from USDA, the annual and total costs of the project,
and its timeline and performance benchmarks. In addition, VA
was directed to provide the Committee, on a quarterly basis, a
report that compares actual progress on the financial
management system to the performance benchmarks and timeline
provided in the first report. The Committee continues to expect
the Department to continue this quarterly report throughout
fiscal year 2019. The Committee has also assigned its own
investigative staff to review the system VA plans to develop
and to provide the Committee periodic reports on the project.
Management reforms.--In House Report 115-188 the Committee
was concerned that the Department had not yet implemented
hundreds of recommendations that would address ongoing
management challenges and directed VA to provide
recommendations for legislation regarding the roles,
responsibilities, and accountability of elements and
individuals of the Department of Veterans Affairs. The
Committee looks forward to the submission of this report.
Poverty trends in the veteran population.--The Committee
requests that VA update its 2015 analysis of poverty trends in
the veteran population by the National Center for Veterans
Analysis and Statistics (NCVAS) and submit it to the Committee
no later than 180 days after the enactment of this Act. The
Committee urges VA to include in this analysis the relationship
between veterans' labor force activity and poverty status and a
demographic break-out, if available, by race and gender.
Additionally, the Committee requests that VA continue such
analyses on a biannual basis.
Implementing the VA Accountability and Whistleblower
Protection Act.--To ensure that the authorities granted in the
Department of Veterans Affairs Accountability and Whistleblower
Protection Act of 2017 are being applied consistently and as
intended, the Committee directs VA to provide a report no later
than 120 days after the enactment of this Act. The report
should include data on the application of such authorities to
employees organized by wage grade, an assessment of whether
such authorities are being disproportionately applied to lower
wage grades, and data regarding the frequency of appeals when
such authorities are applied. The report should also include
any available demographic data on overall VA workforce
terminations since fiscal year 2016.
Small, minority- and women-owned businesses.--The Committee
recognizes the need for VA to continue to meet its goals for
contracting with minority, disadvantaged, and women-owned
businesses. The Committee is concerned that in fiscal year 2016
and 2017, the Department missed its prime contracting goals for
women-owned businesses and businesses in HUBZones. In fiscal
year 2016, the Department missed all of its subcontracting
goals for women-owned businesses, small disadvantaged
businesses, service disabled veteran-owned businesses and
businesses in HUBZones. Therefore, the Committee encourages the
Department to prioritize awarding contracts to contractors that
consistently execute approved small business subcontracting
plans. The Committee further urges the Department to prioritize
minority-owned and disadvantaged contractors and
subcontractors. The Committee requests a report, within 180
days of enactment of this Act and annually thereafter,
detailing the number of contractors which submitted a small
business subcontracting plan during the fiscal year. This
report shall include an analysis detailing which contractors
successfully implemented subcontracting plans and
recommendations on how the Department could better achieve its
prime and subcontracting goals for small businesses.
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, that VA display
information separately for female and minority veterans in its
annual report(s) to Congress.
Veterans Day parade.--The Committee understands that the
Administration may conduct a large military parade to honor
American veterans on November 11, 2018, Veterans Day, to
commemorate the one-hundredth anniversary of the ending of
World War One. The authorizing committees plan to authorize the
DOD Secretary to conduct the parade and to expend funds for
particular purposes relevant to the parade. If VA is asked to
contribute resources to the parade, the Committee expects the
Department to follow DOD's example and limit expenditures to
specific purposes that are directly associated with benefits to
and recognition of veterans. The Committee directs VA to notify
the Committee if and when it first expends funds related to the
parade and to provide a quarterly report thereafter identifying
any resources provided for the parade, including programmatic
funding and personnel.
Board of Veterans Appeals
Fiscal year 2018 enacted level........................ $161,048,000
Fiscal year 2019 budget request....................... 174,748,000
Committee recommendation in the bill.................. 174,748,000
Comparison with:
Fiscal year 2018 enacted level.................... 13,700,000
Fiscal year 2019 budget request................... - - -
The bill makes ten percent of this funding available
through September 30, 2020.
The bill also provides the $9,505,000 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.
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 VBA dwindles, the appeals
workload at the Board increases correspondingly. Pending
appeals are projected to increase by 31 percent from 153,513 at
the end of 2017 to 201,816 by the end of 2019.
Appeals reform.--The Committee is relieved that the
historic Veterans Appeals Improvement and Modernization Act of
2017, signed into law in August, 2017 will provide both VBA and
BVA with the tools they need to reduce the troubling backlog of
appeals. Although implementation of the new law will not be
complete until March, 2019, the Committee is encouraged that
both agencies are taking steps now to implement some of the
Act's new authorities to reduce the appeals backlog. VBA has
launched the Rapid Appeals Modernization Program (RAMP), which
provides veterans with pending disability claims the option to
participate in the new ``three lane'' appeals process
authorized by RAMP during the implementation period. BVA is
also testing a process to outsource a large majority of the
case review process to reduce the administrative work currently
done by decision-writing attorneys, which pulls them from their
primary role of writing draft decisions. With the appeals
received by VBA and BVA increasing dramatically each year as
the backlog of initial disability claims is reduced, these
efforts are vital to containing the volume of pending appeals
and serving veterans who have waited years, in some cases, for
adjudication of their claims. The Committee urges BVA to commit
the necessary resources to reduce this backlog of appeals.
Appeals modernization.--The Committee concurs with the
recommendations in GAO report 18-352 regarding modernizing and
improving VA's appeals process. The VA should articulate a more
complete and balanced set of goals and measures for monitoring
and assessing performance on a range of dimensions of success;
include key planned activities; articulate interim goals and
needed resources for, and inter-dependencies among, activities;
and identify and mitigate key risks associated with
implementing the new processes. The Committee directs the
Secretary to fully implement the GAO's recommendations to
ensure successful implementation of the new appeals process.
Service-connected disability appeals.--The Committee
continues to remain concerned about the excessive wait times
that veterans must endure to receive appeals decisions,
particularly appeals of service-connected disability claims. To
assist the Committee in its oversight responsibilities, VA is
directed to provide an analysis of appeals wait times related
to service-connected disability claims since fiscal year 2014.
The analysis should determine the average time, by fiscal year,
for these appeals to be resolved and highlight VA's efforts to
accelerate this appeals resolution process.
Tele-appeals.--The Committee seeks to reduce the logistical
burden for veterans during the claims appeals process. Current
law, as stipulated in 38 USC 7107, requires that appeals made
using video teleconferencing equipment be conducted at VA
facilities. The Committee is interested in understanding the
feasibility and cost of allowing veterans to conduct such
appeals from locations of their own choosing, such as their
homes. Therefore, the Committee requests a report, no later
than 90 days after the enactment of this Act, that assesses the
statutory, technological, and security issues that would need
to be addressed to implement such a program. The report should
include an assessment of currently available technologies and
the cost associated with such technologies in the context of
implementing such a program. The report should also include
recommendations on legislative changes that would be needed to
implement such a program.
INFORMATION TECHNOLOGY SYSTEMS
(INCLUDING TRANSFER OF FUNDS)
Fiscal year 2018 enacted level........................ $4,055,500,000
Fiscal year 2019 budget request....................... 4,184,571,000
Committee recommendation in the bill.................. 4,105,500,000
Comparison with:
Fiscal year 2018 enacted level.................... 50,000,000
Fiscal year 2019 budget request................... (79,071,000)
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' health care services and
benefits programs.
Within the account total, the Committee allocates in bill
language $1,235,320,000 for pay and associated costs, which is
$7,900,000 below the budget request; $2,521,650,000 for
operations and maintenance, which is $39,130,000 below the
request; and $348,530,000 for development, which is $32,041,000
below the request. The bill makes available five percent of pay
and associated costs and of operations and maintenance funds
until September 30, 2020. All development funds are available
until September 30, 2020.
The bill provides $32,013,000 for the Veterans Benefits
Management System (in addition to the $36,212,000 which is
provided for VBMS in the General Operating Expenses, Veterans
Benefits Administration account); $72,821,000 for the
replacement of the Financial Management System, in addition to
the $10,800,000 provided in General Administration; $22,081,000
for replacement of the NCA burial operations support system;
and $9,505,000 for the Board of Veterans Appeals modernization
effort.
The Committee continues to include bill language
prohibiting obligation or expenditure of funds for information
technology systems development 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 projects upon prior
notification to, and approval by, the Committees. The bill
continues to include language indicating that funds for
development are available only for the projects and in the
amounts specified in the report accompanying the Act.
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.
INFORMATION TECHNOLOGY DEVELOPMENT PROJECTS
(in thousands of dollars)
------------------------------------------------------------------------
Fiscal year 2019 Committee
Project Budget request Recommendation
------------------------------------------------------------------------
Clinical Applications............. $32,479 $27,479
Health Management Platforms....... 70,391 60,391
Benefits Systems.................. 129,615 112,574
Memorial Affairs.................. 18,800 18,800
Other IT Systems.................. 78,571 78,571
Cybersecurity..................... 17,000 17,000
Information/Infrastructure 33,715 33,715
Management.......................
-------------------------------------
Total, Development............ 380,571 348,530
------------------------------------------------------------------------
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 funding chart above and provide an explanation for
any differences in excess of $1,000,000.
Appointment scheduling system.--The Committee remains
concerned about patient scheduling challenges and seeks to
understand the Department's plan for a solution that will
improve veteran access to care, shorten veteran wait times,
allow the VA to track and manage patient progress throughout
the care continuum, and improve resource utilization across the
VA health care system. The Committee understands that a
scheduling system will be a component of the new Electronic
Health Record (EHR) program and that VA plans to deploy this
new system to its first facilities within 18 months of the EHR
program's contract award and to all its facilities within 10
years of contract award. The Committee also understands that VA
is conducting pilot programs involving commercial off-the-shelf
solutions (COTS) scheduling systems to assess if they provide
substantial value over its current interim systems. In order to
determine whether full deployment of one of these pilot
programs is warranted as an interim solution, pending full
operational capability of the new EHR system, the Committee
directs VA to provide the results of its evaluation of the
pilot programs as soon as those evaluations are complete.
Further, the Committee requests a report, within 90 days of
enactment of this Act, that evaluates the cost and benefits of
its interim scheduling systems, the commercial solutions
considered in its pilot programs, including the pilot program
referenced in House Report 115-188, and the EHR scheduling
system, based on current contract requirements. The report's
evaluation of the systems, or contract requirements, should
include an assessment of mobile interface capabilities and the
ability to schedule appointments outside the VA system.
Cybersecurity implementation.--The Committee is concerned
about the pace at which implementation of cybersecurity best
practices are occurring at the Department, especially as VA and
DOD continue to integrate VA electronic health information. The
Committee directs the Department to identify for the Committee
steps it has taken to protect data and patient records across
physical, virtual, and mobile networks and the devices and
systems attached to these networks. If such review warrants,
the Department should consider a layered defensive strategy
that includes perimeter security, segmentation within the data
center to increase lateral security, and data and application
protections. The Committee also urges VA to ensure that patient
records being transferred from DOD to VA have the same level of
security and data-level protections as provided by DOD.
Information technology solutions.--The Committee is
encouraged by VA's efforts to modernize its electronic health
record, but remains concerned about the use of critical
resources on the development of internal Information Technology
(IT) applications. To improve patient health outcomes and
ensure the best possible care for veterans, the Committee urges
VA to complete its review of its inventory of IT solutions and
standardize best practices and proven technologies across the
continuum of care for veterans. The Committee directs the
Secretary to provide a report, no later than 90 days after
enactment of this Act, outlining the Department's plan to
evaluate and incorporate these IT applications to improve and
promote veteran-centered care.
VETERANS ELECTRONIC HEALTH RECORD
Fiscal year 2018 enacted level........................ $782,000,000
Fiscal year 2019 budget request....................... 1,207,000,000
Committee recommendation in the bill.................. 1,207,000,000
Comparison with:
Fiscal year 2018 enacted level.................... 425,000,000
Fiscal year 2019 budget request................... - - -
The Veterans Electronic Health Record is a unified account
designed to manage the effort to develop an electronic health
record that will access seamlessly the records of veterans in
the VA system and those of DOD and of community providers. The
VA system is the same as the one chosen by DOD and is planned
to be rolled out with the same timeline and geographic areas as
DOD in order to realize cost efficiency savings.
Within the total funding, the bill provides $675,000,000
for the electronic health record contract, $120,000,000 for
program management, and $412,000,000 for infrastructure
support. Funding is made available for three years because of
the uncertainty of the timing of obligations in this
substantial new effort.
The Department has committed in future years to provide
about 30 percent of the total cost of this ten-year project.
The Committee expects that this pledge will be maintained
throughout Department leadership changes.
The bill does not include the transfer language requested
by the Administration. This account is intended to be the
single source of funding within VA for the electronic health
record effort. No authority is provided for funds from other VA
accounts to be transferred to this account or for funds from
this account to be transferred to other accounts. Consistent
with the effort to centralize financial management of the
development of the electronic health record, the Committee
continues to direct the Department to place top management of
the project at the headquarters level above either the VHA or
the Office of Information Technology, in the Office of the
Deputy Secretary.
The bill language for this account continues to require the
Secretary to submit a report quarterly to the Committees
detailing obligations, expenditures, and deployment strategy by
facility. In addition, the Committee repeats the fiscal year
2018 directive for GAO to perform quarterly performance reviews
of the VA electronic health record deployment so that the
Committees are kept abreast of important issues such as cost
and operational capability. It is expected that this quarterly
reporting will avail the Committees and VA with timely
information to properly oversee this effort and address
important issues.
The Committee remains concerned that the effort to deploy a
different type of electronic record than the VistA system that
VA physicians are accustomed to could run into major
resistance. Other major electronic health record system start-
ups have failed in the face of internal resistance. The
Committee urges VA to focus sufficient resources and attention
to this change management challenge, which could be more
difficult than the technical issues of implementing the new
record.
Delays in contract finalization.--The Committee was
encouraged that VA finally decided to use the same EHR system
as DOD, since it is vital that the two systems be
interoperable. Last July, the Secretary announced that Cerner
Corporation, which had participated in the DOD EHR contract,
had received the sole source contract to develop the VA EHR.
The Committee had a hearing last November in closed session to
learn the details of the contract, its cost, design features,
and anticipated project rollout across the VA network.
Subsequently, the Committee provided the initial $782,000,000
funding for the project, with the expectation that the Cerner
contract would be signed soon after that funding became
available. However, the contract may not be signed until the
new Secretary is confirmed. The Committee is concerned that
further delays could jeopardize VA's plans to roll out the EHR
in the same regions and under the same timeframe as DOD is
using for its new EHR system, as well as increase the program's
cost. With a decade of futile effort and billions of dollars
spent to develop the VA EHR, the agency needs to complete its
contract as soon as possible. The Committee will continue to
monitor VA expenditures for the new EHR, and if it is clear
that delays in project management are slowing obligations,
funding levels may be revisited during conference.
Medical records portability.--The Committee supports
veterans having real-time, seamless, and portable access to all
of their medical records. As such, the Committee urges VA to
develop, as part of its new EHR system, the means by which
veterans can have secure, portable access to their own medical
records.
OFFICE OF INSPECTOR GENERAL
Fiscal year 2018 enacted level........................ $164,000,000
Fiscal year 2019 budget request....................... 172,054,000
Committee recommendation in the bill.................. 172,054,000
Comparison with:
Fiscal year 2018 enacted level.................... 8,054,000
Fiscal year 2019 budget request................... - - -
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 up to ten percent of this funding available
until September 30, 2020.
CONSTRUCTION, MAJOR PROJECTS
Fiscal year 2018 enacted level........................ $512,430,000
Fiscal year 2019 budget request....................... 1,127,486,000
Committee recommendation in the bill.................. 1,127,486,000
Comparison with:
Fiscal year 2018 enacted level.................... 615,056,000
Fiscal year 2019 budget request................... (- - -)
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 $480,000,000 of
these funds available for a five-year period.
In addition, Sec. 238 provides a total of $850,000,000 in
additional funding for this account as part of the
infrastructure initiative--$750,000,000 for seismic corrections
and $100,000,000 for cemetery Major Construction.
In past years, this appropriations bill repeated language
that is in permanent law requiring that all major construction
projects costing more than $100,000,000 be managed by a non-VA
government entity such as the Army Corps of Engineers. Because
this policy is now well-established, the Committee no longer
feels a need to duplicate the language. However, the Committee
intends to continue its oversight of the quality of the outside
entity management and will continue to receive quarterly
briefings on each of the large construction projects.
The chart below reflects the Administration's budget
request for Major Construction projects and includes the
Committee's recommendation for each.
CONSTRUCTION, MAJOR PROJECTS
(in thousands of dollars)
------------------------------------------------------------------------
Location and description Request Recommended
------------------------------------------------------------------------
Veterans Health Admin. (VHA):
St. Louis, MO, medical 34,400 34,400
facility improvements and
cemetery expansion...........
Canandaigua, NY, construction 190,000 190,000
and renovation...............
Dallas, TX, spinal cord injury 135,686 135,686
facility.....................
North Chicago, IL, renovate 6,000 6,000
building #4..................
Oklahoma, OK new surgical 10,800 10,800
intensive care unit..........
Advance Planning and Design 95,000 95,000
Fund: various locations......
Asbestos: various locations... 15,000 15,000
Major Construction Staff: 27,500 27,500
various locations............
Hazardous Waste: various 26,200 26,200
locations....................
Judgment Fund: various 25,000 25,000
locations....................
Non-Dept. Fed. Entity Project 38,700 38,700
Management Support...........
Seismic Corrections: various 400,000 400,000
location.....................
-------------------------------------
Total, VHA.................... 1,004,286 1,004,286
National Cemetery Admin. (NCA):
Ohio Western Reserve: 29,000 29,000
gravesite expansion..........
Great Lakes, MI: gravesite 35,200 35,200
expansion....................
Cape Canaveral, FL: gravesite 38,000 38,000
expansion....................
Advance Planning and Design 10,000 10,000
Fund.........................
NCA Land Acquisition.......... 5,000 5,000
-------------------------------------
Total, NCA.................... 117,200 117,200
General Admin.:
Staff Offices Advance Planning 6,000 6,000
Fund.........................
-------------------------------------
Total, Construction Major $1,127,486 $1,127,486
Projects.................
------------------------------------------------------------------------
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 $7,000,000 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.
Joint VA and U.S. Army Corps of Engineers projects.--While
the Committee has strongly endorsed the management of large VA
construction projects by the U.S. Army Corps of Engineers
(``the Corps''), as required by section 502 of Public Law 114-
58, it recognizes that the transition to this new process has
created some unavoidable delays in construction schedules. To
better understand the timetable and construction issues
associated with each VA project managed by the Corps, the
Committee requests, within 60 days of enactment of this Act,
the initiation of quarterly reports on each VA project managed
by the Corps.
Market assessment.--The Committee supports VA's efforts to
obtain analysis that provides a more holistic view of VA
facilities and thereby allows the Department to make more
informed, data driven decisions about its facilities and
buildings. The Committee recognizes that annual analysis and
benchmarking across the Department's facilities will provide an
invaluable tool for long-term system-wide planning, needs
identification, and cost management for the Department. The
Committee, therefore, encourages the Department to utilize an
independent, third-party to provide facilities analysis,
benchmarking and recommendations for all VHA hospitals, nursing
homes, domiciliary facilities, and other necessary facilities.
Training for VA personnel engaged in facility management.--
The Committee continues to be concerned by the lack of training
and certification provided to engineering, construction and
facility management staff with regard to building operations
and maintenance. The Committee looks forward to receiving the
report from VA on this topic as requested in House Report 115-
188.
Parking facilities.--In H. Rpt. 115-188, the Committee
noted that numerous parking facility projects throughout the
Strategic Capital Investment Planning (SCIP) list are often
skipped for more traditional VA construction projects, which
has caused a backlog in parking facilities. In response, the
Committee directed VA to provide information regarding how
parking facility projects are rated, a timeline for completion
of these projects, their cost, and any notable actions taken by
VA medical centers to address parking issues. However due to
the late passage of the fiscal year 2018 bill, this reporting
requirement remains incomplete. The Committee reiterates its
interest in this issue and looks forward to the final report.
Public-private partnerships.--The Committee applauds VA for
engaging in partnerships with academic institutions to
facilitate closer scientific collaboration, while increasing
the research space available to VA. Such partnerships are
important in expanding the Department's research investment to
leverage non-federal initiatives, which provide the opportunity
for strong co-location of VA and university biomedical
scientists for translational investigation. Such co-location
and collaboration may enable precision medicine outcomes for
wounded warriors and other high-at-risk veteran populations.
Therefore, the Committee encourages VA to expedite
consideration of proposals for the Department to co-locate its
research facilities with academic institutions that are engaged
in the conduct of multi-disciplinary investigations related to
veterans and wounded warriors, including those related to
medicine, engineering, and veterinary science.
Construction, Minor Projects
Fiscal year 2018 enacted level........................ $342,570,000
Fiscal year 2019 budget request....................... 706,889,000
Committee recommendation in the bill.................. 649,514,000
Comparison with:
Fiscal year 2018 enacted level.................... 306,944,000
Fiscal year 2019 budget request................... (57,375,000)
The Construction, Minor Projects appropriation provides for
constructing, altering, extending, and improving any of the
facilities under the jurisdiction of, 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.
In addition to this funding, $350,000,000 is provided in
Sec. 238 for VHA Minor Construction projects as part of a
$2,000,000,000 infrastructure initiative. A similar initiative
provided $425,000,000 in additional funds for this account in
fiscal year 2018.
As with the Major Construction account, the Committee
recommendation makes these funds available for a five-year
period.
Ambulatory surgical centers (ASC).--The Committee is
concerned about VA's ambulatory surgical capacity and believes
a focus on ambulatory surgical services, as provided by ASCs,
has the potential to provide substantial cost savings and
improve health outcomes for veterans. However, the Committee
understands that VHA does not consider ASCs to be one of its
foundational services and, therefore, does not place any
special priority on construction of ASCs during the SCIP
process. To better understand the role of ASCs, the Committee
directs VHA to provide a report, no later than 60 days after
enactment of this Act, which assesses whether assigning a
specific prioritization to ASCs during the SCIP process would
provide substantial cost savings and improve health outcomes
for veterans by increasing VHA's ambulatory surgical capacity.
The report should also include a timeline for completion of
pending ambulatory surgical center projects, their costs, and
any notable actions taken by VA medical centers to address
ambulatory surgical needs.
Construction of housing for rural homeless veterans.--The
Department has made great efforts to find suitable housing for
homeless veterans and their families. However, more non-
traditional efforts should be made to eliminate this problem.
For example, some cities and towns have started pilot programs
using Micro or ``Tiny Homes'' to help deal with homelessness.
However, due to the lack of legislative authority the VA is
unable to utilize tiny homes for homeless veterans. The
Committee is interested in what statutory changes would be
needed for VA to be able purchase and construct, single unit,
Micro or ``Tiny Homes'' for homeless veterans. This approach
could provide a pathway to stable housing for veterans. The
Committee directs VA to identify the necessary statutory
changes in a report no later than 60 days after enactment of
this Act.
Impact of changes to Historic Preservation Tax Credit to
historic VA facilities.--The Committee encourages VA to work
with Enhanced-Use Lease (EUL) project sponsors, the Internal
Revenue Service, local VA, and any other relevant officials to
address the adverse impacts that changes to the Historic
Preservation Tax Credit made by Public Law 115-97, are having
on EUL projects to renovate and rehabilitate historic VA
facilities. The Committee is aware that some of the recent tax
law changes have made it harder to complete longstanding
projects because they reduced the value of tax credits needed
to bring the projects to fruition, resulting in a funding gap.
For example, VA selected a Preferred Developer to carry out a
EUL to renovate historic VA buildings in July 2016 but still
has not yet formally signed the lease. Without action by VA,
this critical project to provide permanent supportive housing
for veterans and their families that are homeless, or at risk
of homelessness, is now at risk due to additional and
unanticipated costs directly related to how the historic
preservation tax credit can be used for the project. Therefore,
the Committee urges VA to work with interested parties to find
a solution, including developing options to directly provide
capital funding, technical, and other assistance to prevent the
loss of benefits to veterans should these projects stall as a
direct result of changes beyond the sponsor's control that were
unforeseen when these projects were put out to bid.
Grants for Construction of State Extended Care Facilities
Fiscal year 2018 enacted level........................ $110,000,000
Fiscal year 2019 budget request....................... 150,000,000
Committee recommendation in the bill.................. 150,000,000
Comparison with:
Fiscal year 2018 enacted level.................... 40,000,000
Fiscal year 2019 budget request................... - - -
In addition to funding provided in this account, as part of
a $2,000,000,000 VA infrastructure initiative, the fiscal year
2018 appropriations bill provided $575,000,000 for State homes.
This funding, in conjunction with the regular fiscal year 2018
appropriation, was sufficient to clear the longstanding backlog
of approved State applications.
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.
Grants for Construction of Veterans Cemeteries
Fiscal year 2018 enacted level........................ $45,000,000
Fiscal year 2019 budget request....................... 45,000,000
Committee recommendation in the bill.................. 45,000,000
Comparison with:
Fiscal year 2018 enacted level.................... - - -
Fiscal year 2019 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.
Administrative Provisions
The bill includes 38 administrative provisions, all of
which were included in the fiscal year 2018 bill in some form.
(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 2018.
The bill includes section 207 allowing for the use of
fiscal year 2019 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 and Whistleblower Protection, and the Office
of Diversity and Inclusion 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
$307,609,000 of fiscal year 2020 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 220 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.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 221 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 222 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 223 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 224 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 Congress unless
approved by the Committees. The Administration proposal to
delete this provision is not adopted.
The bill includes section 225 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; and 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 226 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 227 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 228 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 229 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 230 prohibiting the reprogramming
of funds exceeding $7,000,000 among the major construction
projects unless both Appropriations Committees approve the
request. The Administration proposal to delete this provision
is not adopted.
The bill includes section 231 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 232 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 233 requiring VA to use the
mammography screening guidelines announced by the Secretary on
May 10, 2017 through January 1, 2024. The administration
request to delete this provision is not adopted.
The bill includes section 234 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
bill retains the language for this provision included in the
2018 bill rather than returning to the 2017 language, as the
Administration proposed.
The bill includes section 235 prohibiting any funds being
used in a manner that is inconsistent with statutory
limitations on outsourcing.
The bill includes section 236 which prohibits funds from
being used to transfer funding from the Filipino Veterans
Equity Compensation Fund to any other VA account.
The bill includes section 237 prohibiting the use of
canines in VA research unless: the scientific objectives of the
study can only be met by using canines; the study has been
directly approved by the Secretary; and the study is consistent
with the revised VA canine research policy document released in
December, 2017.
The bill includes section 238 providing $2,000,000,000 for
infrastructure improvements, allocated between $750,000,000 for
seismic corrections, $800,000,000 for non-recurring
maintenance, $100,000,000 in Major Construction for National
Cemetery Administration projects, and $350,000,000 in Minor
Construction for Veterans Health Administration projects.
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. The fiscal year 2018 omnibus included bill language
requiring a feasibility study prior to the purchase of a new
courthouse. The study has not been completed, therefore the
recommendation does not include the funds requested for a new
courthouse.
Department of Defense--Civil Cemeterial Expenses, Army
SALARIES AND EXPENSES
The recommendation includes $70,800,000 for Salaries and
Expenses for Arlington National Cemetery (ANC), as requested.
The Committee appreciates ANC's emphasis on acquisition
improvements, including training, certification and workforce,
to improve procurement and accountability.
CONSTRUCTION
The recommendation includes $73,855,000 for planning and
design and construction of Southern Expansion to remain
available until expended.
Southern Expansion.--The recommendation includes
$73,855,000 for planning and design and construction of
Southern Expansion to remain available until expended. The
Committee notes that Public law 115-141 included $167,000,000
above the budget request for the Southern Expansion and road
realignments to extend the life of the cemetery. For fiscal
year 2019 the bill again includes additional funds for Southern
Expansion which brings the total funds available for this
project to $240,855,000, well short of the projected
$300,000,000 plus that will be needed to complete this project.
The Committee notes that the Office of Management and Budget
will need to dedicate resources in future budget submissions to
ensure that the life of our Nation's most prestigious cemetery
is extended into the 2050 timeframe.
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.
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. 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 continue to
develop alternatives during fiscal year 2019, to be included in
the fiscal year 2020 budget request. In addition, AFRH is
directed to report to the Committee quarterly, on the Trust
Fund balance, receipts and expenditures, and the progress of
its efforts to lease property at the Washington, D.C. facility.
Further, AFRH is directed to submit a report to the Committee
on business practice reforms, revised funding models, and long-
term plan to stabilize the Armed Forces Retirement Home Trust
Fund.
Administrative Provision
The bill includes one provision that was in effect in
fiscal year 2018. The administrative provision included in the
bill as follows:
The bill includes section 301 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 2018 enacted level........................ $750,000,000
Fiscal year 2019 budget request....................... 921,420,000
Committee recommendation in the bill.................. 921,420,000
Comparison with:
Fiscal year 2018 enacted level.................... 171,420,000
Fiscal year 2019 budget request................... - - -
The Committee recommendation includes Overseas Contingency
Operations, for military construction projects and planning and
design related to the European Deterrence Initiative (EDI).
Military Construction, Army
The recommendation includes $261,250,000 for Army military
construction and planning and design for European Deterrence
Initiative projects.
Military Construction, Navy and Marine Corps
The recommendation includes $227,320,000 for Navy and
Marine Corps military construction and planning and design for
European Deterrence Initiative projects.
Military Construction, Air Force
The recommendation includes $345,800,000 for Air Force
military construction and planning and design for European
Deterrence Initiative projects.
Military Construction, Defense-Wide
The recommendation includes $87,050,000 for Defense-Wide
Overseas Contingency Operations and planning and design for
Special Operations Command and European Deterrence Initiative
projects.
Administrative Provisions
The bill includes one provision that was in effect in
fiscal year 2018 and includes one new administrative provision.
The administrative provisions included in the bill are as
follows:
The bill includes section 401 that designates that funding
shall be available only if the President so designates all
amounts and transmits such designations to Congress.
The bill includes section 402 prohibiting obligation or
expenditure of planning and design funds for any project
associated with European Deterrence Initiative in this title
until a list of projects is submitted to the congressional
defense committees.
TITLE V
GENERAL PROVISIONS
The bill includes a total of 13 provisions: 12 provisions
that are effective in fiscal year 2018 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, Air $31,158,000
Force (Sec. 126).....................................
Department of Defense, NATO Security Investment 25,000,000
Program (Sec. 126)...................................
Department of Defense, Home Owners Assistance Program 15,000,000
(Sec. 126)...........................................
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 $18,047,000
in fiscal year 2020 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
2019 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 Community Care, 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 $73,694,000 to
be transferred to General Administration and Information
Technology Systems from any funds appropriated in fiscal year
2019 to reimburse four 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 and Medical
Community Care accounts.
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 year 2020 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 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, Air Force.
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, Air 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 Reserve.
Language is included under Title I that rescinds funds from
prior year appropriations Acts.
Language is included under Title I defining the
congressional defense committees.
Language is included under Title I to prohibit closure or
realignment of Naval Station, Guantanamo Bay, Cuba.
Language is included under Title I limiting the movement of
any element of the Rapid Engineer Deployable Heavy Operational
Repair Squadron Engineer outside the United States.
Language is included under Title I to require funds
appropriated shall be immediately available and allotted to
contract for the full scope of authorized projects.
Language is included under Title I providing additional
funds for enhancing force protection and safety at Military
Installations.
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 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 of
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 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 allow for the use
of concession fees.
Language is included under Title IV providing Overseas
Contingency Operations funding with an emergency designation.
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.
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 italic, existing law in which no change is
proposed is shown in roman):
None.
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:
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
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.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
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): None.
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:
[In millions of dollars]
------------------------------------------------------------------------
302(b) Allocation This bill
-------------------------------------------
Budget Budget
authority Outlays authority Outlays
------------------------------------------------------------------------
Mandatory................... 106,125 105,903 106,125 \1\105,90
3
Discretionary............... 96,920 89,311 96,920 89,311
General Purpose......... 95,999 89,311 95,999 89,311
Overseas Contingency 921 0 921 0
(OCO)..................
------------------------------------------------------------------------
\1\Includes outlays from prior-year budget authority.
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:
[In millions of dollars]
------------------------------------------------------------------------
Projection of outlays associated with the
recommendation Non-OCO OCO
------------------------------------------------------------------------
2019.......................................... \1\113,849 0
2020.......................................... 5,427 0
2021.......................................... 5,248 0
2022.......................................... 3,229 0
2023 and future years......................... 3,549 0
------------------------------------------------------------------------
\1\Excludes outlays from prior-year budget authority.
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:
[In millions of dollars]
------------------------------------------------------------------------
This bill
-------------------------
Budget
authority Outlays
------------------------------------------------------------------------
Financial assistance to State and local 267 \1\50
governments for 2019.........................
------------------------------------------------------------------------
\1\Excludes outlays from prior-year budget authority.
Comparative Statement of New Budget Authority and 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:
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
MINORITY VIEWS
The fiscal year (FY) 2019 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 $96.9 billion
in total discretionary funding. This level is $4.2 billion
above the FY 2018 enacted funding level, but $131 million below
the FY 2019 budget request.
Military Construction
The bill funds military construction at $10.3 billion,
which is $131 million below the FY 2019 request. The bill fully
funded the Services' Construction budget request in all but a
few cases. For certain projects, documents submitted with the
budget showed that not all the funding would be executed
promptly. For those projects, the subcommittee provided
incremental funding, which is a long-standing subcommittee
practice. The bill fully funded Family Housing accounts and
provides $322 million for the Base Realignment and Closure
(BRAC).
The bill also prioritizes safety projects by including $150
million to address shortfalls in access control points, air
traffic control towers, fire stations, and Anti-Terrorism/Force
Protection deficiencies across the Department of Defense (DOD)
enterprise. These additional funds will improve safety at DOD
facilities, providing safer working environments for service
members.
Veterans Affairs
The bill provides $85.3 billion in discretionary funding
for the Department of Veterans Affairs (VA), which is $3.9
billion above the FY 2018 enacted level and equal to the
President's request. The recommendation also includes the
budget request of $75.6 billion in discretionary funds for the
FY 2020 advance appropriations for VA medical services. The
bill includes $318 million, equal to the FY 2019 President's
request, for battle monuments and cemeteries for our heroes who
have made the ultimate sacrifice.
We are delighted the bill rejects the Administration's
proposal to combine the Medical Services and Community Care
accounts into one enormous account. We believe that maintaining
the current structure of two accounts offers the most
transparency for the Committee to both monitor and control
spending in these two areas.
This bill also honors the budget deal and includes $2
billion for infrastructure improvements to support seismic
corrections and address non-recurring maintenance issues.
Democrats continue to believe that the administration must make
rebuilding the VA system a priority. This funding is vital to
helping the VA address its infrastructure issues and provide
adequate in-house care for our nation's veterans.
One of our biggest concerns has been to enhance the VA's
capabilities for suicide prevention. The bill rightfully
provides the full FY 2019 budget request of $8.6 billion for
mental health programs, of which $196 million is for Suicide
Prevention. 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.
Finally, we are extremely pleased that the bill continues
to provide access to in-vitro fertilization treatments, 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.
This bill does a lot of things we all support. However, it
could have been improved if the Committee had adopted two
amendments offered by Ranking Member Wasserman Schultz.
The first amendment would have struck funding for a $69
million High-Value Detention Facility at Guantanamo Bay Naval
Station and instead provide those funds to the Enhancing
Security and Safety provision. We believe this project is a
colossal waste of resources, especially when balanced against
the needs of our military service members. Placing the needs
and wellbeing of 40 detainees at Guantanamo Bay above the needs
of the service members who serve our country does not reflect
our nation's priorities.
The second amendment would have prohibited military
construction dollars from being used to build the
Administration's ill-conceived border wall. Using Department of
Defense (DOD) funding for construction would dramatically
change how our government has approached border security. If
DOD is tasked to build a border wall, it will shift the
responsibility of securing the border from the Department of
Homeland Security, which has long had jurisdiction, to DOD and
would put DOD in a position to lead where it has chiefly held a
supporting role. Furthermore, using DOD funding for the
construction of border infrastructure would be unprecedented
and is extremely alarming knowing that currently 31 percent of
DOD infrastructure is rated as poor or failing.
Unfortunately, the majority spoke against both of these
amendments, and they both failed.
The Broken Republican Process
The Bipartisan Budget Agreement enacted early this year
provided relief from unworkable discretionary spending caps.
The agreement was supposed to provide the country with
stability following a year of shutdowns, last-minute veto
threats, and general uncertainty in government. That stability
lasted long enough for Congress to pass a bipartisan Omnibus
appropriations bill for FY 2018 and then Republican chaos
reigned again. The President threatened to veto the bill,
unhappy with Congress' large investments in programs to help
low- and middle-income Americans and rejection of his campaign-
promised border wall.
Even after the President backed off his threat and signed
the bill, the Administration and Republican leadership in
Congress who voted for the Bipartisan Budget Act and the
Omnibus bill have continued to attempt to undo those bipartisan
agreements. Now, the majority is seeking to pass a rescissions
bill to undo funding and mollify an angry President. We have
been told by OMB Director Mick Mulvaney that this is the first
of many rescission packages meant to bring spending in line
with the President's priorities, ignoring Congressional action
that dismissed the President's FY 2017 and FY 2018 draconian
budget requests.
In addition to the unacceptable rescissions proposals, the
majority's lack of transparency with regards to how it will
allocate the FY 2019 discretionary budget also endangers future
bipartisan compromise. The majority has abandoned longstanding
committee practice to provide the Members and the public with a
budget blueprint for domestic spending, known as 302(b)
allocations. Members are being asked to vote on bills without
having the full picture on what impact each bill will have on
other bills. We are very concerned about what that means for
programs in other bills that have yet to be considered.
Democrats can only be left to assume that the majority is
siphoning money from bills at the end of the process like the
State and Foreign Operations bill and the Labor, Health and
Human Services, and Education appropriations bill.
In conclusion, we commend the Chairman for the funding
levels within the bill and his receptiveness to Democratic
Members' concerns. The bill reported out of the Committee
represents a good, reasonable approach, preserves our long
commitment to our veterans and our military facilities, and
continues a bipartisan tradition of providing funding levels
that Members on both sides agree are appropriate while avoiding
controversial legislative riders that complicate passage.
However, we are extremely disappointed in the 302(b) allocation
process because hiding these numbers only makes our Committee's
work more difficult. Inviting partisanship back into the
appropriations process by shortchanging critical domestic and
international priorities will endanger the good work in this
and other bills.
Nita M. Lowey.
Debbie Wasserman Schultz.
[all]