[House Report 116-445]
[From the U.S. Government Publishing Office]
116th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 116-445
======================================================================
MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES
APPROPRIATIONS BILL, 2021
_______
July 13, 2020.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Ms. Wasserman Schultz of Florida, from the Committee on Appropriations,
submitted the following
R E P O R T
together with
MINORITY VIEWS
[To accompany H.R. 7609]
The Committee on Appropriations submits the following
report in explanation of the accompanying bill making
appropriations for military construction, veterans affairs and
related agencies for the fiscal year ending September 30, 2021.
INDEX TO BILL AND REPORT
Page Number
Bill Report
Purpose of the Bill........................................
2
Summary of Committee Recommendation........................
2
Management and Oversight Initiatives.......................
4
Department of Defense:
Military Construction.............................. 2
8
NATO Security Investment Program................... 8
28
Department of Defense Base Closure Account......... 9
28
Family Housing Construction and Operation and
Maintenance.................................... 9
31
Department of Defense Family Housing Improvement
Fund........................................... 11
32
Department of Defense Military Unaccompanied
Housing Improvement Fund....................... 11
32
Administrative Provisions......................... 12
32
Department of Veterans Affairs:
Veterans Benefits Administration................... 26
36
Veterans Health Administration..................... 30
44
National Cemetery Administration................... 36
86
Departmental Administration........................ 36
88
Administrative Provisions.......................... 44
100
Related Agencies:
American Battle Monuments Commission............... 73
106
U.S. Court of Appeals for Veterans Claims.......... 74
106
Cemeterial Expenses, Army.......................... 75
107
Armed Forces Retirement Home....................... 75
107
Administrative Provision........................... 76
108
Department of Defense:
Overseas Contingency Operations.................... 76
108
Administrative Provision........................... 77
109
General Provisions......................................... 78
109
House of Representatives Report Requirements:
Statement of General Performance Goals and
Objectives.....................................
110
Rescissions........................................
111
Transfer of Funds..................................
111
Disclosure of Earmarks and Congressionally Directed
Spending Items.................................
112
Ramseyer Rule......................................
112
Changes in Application of Existing Law.............
114
Appropriations Not Authorized by Law...............
120
Program Duplication................................
122
Committee Hearings.................................
122
Comparison With the Budget Resolution..............
124
Five-Year Projection of Outlays....................
124
Assistance to State and Local Governments..........
124
Full Committee Votes...............................
125
Comparative Statement of New Budget (Obligational)
Authority......................................
127
State and Country Project List.....................
148
Overseas Contingency Operations Project List.......
157
Minority Views.....................................
159
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 quality of life for our servicemembers and their families
is a key component of readiness. The bill also funds a wide
variety of assistance programs for Veterans, including
disability and pension benefits, healthcare 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 $250,926,222,000 in total budget
authority, including emergency funding, for the fiscal year
2021 programs and activities funded in the bill. The fiscal
year 2021 recommendation represents an increase of
$15,214,696,000 above the comparable fiscal year 2020 enacted
level and $2,262,624,000 above the President's request. Of the
increase over the fiscal year 2020 enacted level,
$10,081,909,000 is in mandatory programs. Included in the total
budget authority is $135,434,234,000 in mandatory budget
authority and $115,491,988,000 in discretionary budget
authority, which includes $12,493,988,000 in emergency funding.
The Committee recommendation highlights the continued
commitment to our servicemembers and their families and to our
Veterans. In overall discretionary budget authority, including
emergency and overseas contingency funding, the bill is 4.7
percent above the fiscal year 2020 enacted 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
urgency.
The programs funded in the bill for the Department of
Defense (DOD) address the priorities of the Department's
Agencies and the Services for the numerous facility challenges
that they face. The funds provided support readiness
improvements with new construction, family housing, and
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 Overseas Contingency
Operations, is $10,440,000,000 which is $1,519,526,000 below
the fiscal year 2020 enacted level (not including hurricane
disaster funding) and $2,276,675,000 above the budget request.
The recommendation provides funding for Family Housing,
construction on our bases, including barracks, health
facilities and schools, and support for critical overseas
investments as well as an additional $135,000,000 to address
privatized family housing issues. Within the total,
$350,000,000 is included for the European Deterrence Initiative
and construction, which helps ensure the protection of our
allies and protects the warfighter. The recommendation also
supports $1,809,972,000 for the Services' unfunded priorities
that are more than 35 percent complete in design and can be
executed in fiscal year 2021. Finally, the total provides
$554,500,000 for the Services' cost to complete projects, which
are previously appropriated projects that have experienced an
increase in cost from the original contract award.
The total recommended funding level for fiscal year 2021
for the Department of Veterans Affairs, including emergency
funding, is $240,210,107,000, an increase of $22,347,382,000
over the fiscal year 2020 enacted level. Of the total,
$135,434,234,000 is provided for mandatory benefit programs and
$104,775,873,000, including $12,493,988,000 in emergency
funding, 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 13 percent over the fiscal year 2020 enacted
level. Of the total for fiscal year 2021, $87,636,650,000 for
medical care has been appropriated in advance.
In addition, the Committee recommendation includes
$94,183,260,000 in advance appropriations for fiscal year 2022
for the four health care accounts of the Department and
$145,311,218,000 in advance appropriations for mandatory
benefits programs in fiscal year 2022.
The Committee recommendation provides a total of
$276,115,000 for the four Related Agencies: the American Battle
Monuments Commission (ABMC), the U.S. Court of Appeals for
Veterans Claims, Arlington National Cemetery, and the Armed
Forces Retirement Home. The recommendation represents an
increase of $21,015,000 above the budget request. These funds
are provided to ensure that these agencies are able to continue
their missions of honoring the service and sacrifice of our
servicemembers and Veterans.
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 (GAO) and the Inspectors General to
promote strong financial and program management, oversight and
leadership at the Department of Defense (DOD), the Department
of Veterans Affairs (VA), and Related Agencies under the
jurisdiction of this bill.
The fiscal year 2021 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.
Performance Measures.--The Committee directs each of the
agencies funded by this Act to comply with title 31 of the
United States Code, including the development of their
organizational priority goals and outcomes such as performance
outcome measures, output measures, efficiency measures, and
customer service measures. Each of the agencies funded by the
Act shall submit a report to the Committee within 60 days of
enactment of the Act on the progress it has made on Performance
Measures.
Customer Service Standards.--The Committee continues to
support efforts to improve customer service in accordance with
Executive Order 13571--Streamlining Service Delivery and
Improving Customer Service. The Committee directs the Secretary
of Veterans Affairs to develop standards to improve customer
service and incorporate the standards into the performance
plans required under 31 U.S.C. 1115. The Committee requests a
report on the progress the Secretary has made on this issue
within 60 days of enactment of the Act.
Federal Law Enforcement.--The Committee notes that the
Commerce, Justice, Science, and Related Agencies Appropriations
Act, 2021 directs the Attorney General to establish a training
program to cover the use of force and de-escalation, racial
profiling, implicit bias, and procedural justice, to include
training on the duty of Federal law enforcement officers to
intervene in cases where another law enforcement officer is
using excessive force, and make such training a requirement for
Federal law enforcement officers. The Committee further notes
that several offices funded by this Act employ Federal law
enforcement officers and are Federal Law Enforcement Training
Centers partner organizations. The Committee directs such
offices to adopt and follow the training program established by
the Attorney General, and to make such training a requirement
for its Federal law enforcement officers. The Committee further
directs such offices to brief the House and Senate Committees
on Appropriations on their efforts relating to training no
later than 90 days after the Attorney General has established
such a training program.
In addition, the Committee directs such offices, to the
extent that such offices have not already done so, to submit
their use of force data to the Federal Bureau of Investigation
(FBI)'s National Use of Force Data Collection database. The
Committee further directs such offices to brief the House and
Senate Committees on Appropriations no later than 90 days after
enactment of this Act on their current efforts to tabulate and
submit its use of force data to the FBI.
Department of Defense Military Family Housing.--Privatized
housing has come under scrutiny in recent years. Complaints of
inadequate housing across the DOD enterprise include lack of
repairs, rodents, mold, cracks in walls and peeling paint. The
military housing privatization initiative (MHPI) was
established by Congress in 1996 as a tool to help DOD improve
the quality of life for its servicemembers by improving the
condition of their housing. MHPI is a public/private venture
(PPV) where private sector developers may own, operate,
maintain, improve and assume responsibility for military family
housing. The private entity is responsible for managing the
construction, renovation, and day-to-day maintenance and
services for the community. The PPV housing may be located on
or off government property and may be former military family
housing. Congress has mandated that all military family housing
in the United States be eventually privatized. In order to
address ongoing concerns regarding unacceptable housing
conditions, the recommendation includes $135,000,000 in section
127. Although these funds are not proposed in the budget
request, the Committee believes additional resources are
required in order to secure a satisfactory outcome to enhance
the Services' ability to provide oversight and management,
including personnel to track current and future issues that may
occur in privatized housing. The Committee also includes report
language directing DOD to submit various reports and maintain a
maintenance database to track any issues that may be prevalent
in the future. The Committee notes that the general welfare of
a servicemember's family contributes to the overall state of
readiness for DOD.
VA Electronic Health Record Modernization (EHRM).--After at
least a decade of Congressional encouragement to DOD and VA to
develop a single electronic health record (EHR), VA finalized a
contract in 2018 to acquire the same EHR system that DOD is
adopting. The bill includes $2,627,000,000 for EHRM and
continues strict quarterly reporting of timelines, performance
milestones, costs, implementation, and change management. The
bill also continues the requirement for GAO to review EHRM
implementation so that Congress can be informed of any problems
at a point where they can be promptly and economically
addressed.
Disability Claims and Appeals.--Due to the significant
investments Congress has provided in recent years, VA has been
able to hire the staff, acquire the technology, and change work
processes necessary to significantly reduce the disability
claims backlog. 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. This is of particular concern as VA
receives additional claims under the Blue Water Navy Vietnam
Veterans Act. The Committee recognizes this threat and provides
resources within the Veterans Benefits Administration to
support staffing, scanning of records, and other efforts to
respond to Blue Water Navy claims. The Committee additionally
provides increases to the Board of Veterans Appeals and the
Court of Appeals for Veterans Claims to help ensure the prompt
resolution of cases. The Committee hopes that with these
additional investments and the recently passed legislation to
reform the appeals process, Congress will have taken the
necessary management action to prevent Veterans from enduring
excessive wait times to receive the disability benefits they
deserve.
Information Technology (IT).--The Committee continues to
include bill language indicating that funds for information
technology systems development are available only for the
projects and in the amounts specified in the report. The bill
limits the amount of funds that can be transferred into the IT
account to ten percent of the total of either the source or
destination account. The bill contains language that permits
the reprogramming of funds among development projects upon
prior notification to, and approval by, the Committees.
Stricter Control of Construction Funding.--The Committee
continues to request that VA provide 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 of 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.
Department of Defense Civil Cemeterial Expenses.--The
Committee rejects the proposed cut in the President's budget
request and instead provides $81,815,000 for Arlington National
Cemetery so that it can maintain a consistent level of services
and ensure that critical operations continue.
Armed Forces Retirement Home (AFRH).--The Committee
continues to provide funding for AFRH to work on deferred
maintenance projects and directs AFRH to provide an expenditure
plan for these projects. Additionally, the bill makes
operations and maintenance funds available for two years to
allow AFRH to make more effective use of its funds. These
efforts will ensure that AFRH is well-positioned to continue to
improve its standing and increase revenue for the long term.
The Committee notes that efforts are underway to stabilize the
AFRH Trust Fund and reduce reliance on transfers from the
General Fund, and directs AFRH to continue making progress
toward improving AFRH's sustainability.
Army Corps of Engineers Updates on VA projects.--The
Committee is concerned that VA projects under management of the
Army Corps of Engineers (USACE) might be delayed due to
administrative delays during the initial transitional phase
between projects being authorized and appropriated by Congress,
and an interagency agreement being signed. Accordingly, the
Committee directs VA to continue to provide monthly updates on
all current and subsequent VA construction projects worth more
than $100 million and jointly managed by VA and USACE. Regular
reports for certain projects may be submitted on a quarterly
basis if the Department and Committee come to an agreement that
more frequent reports are not necessary.
Historic Preservation Study.--Section 106 of the National
Historic Preservation Act requires Federal agencies to take
into account the effects of their undertakings on historic
properties. The Section 106 process seeks to accommodate
historic preservation concerns through consultations with
interested parties with a goal of commencing consultations
during the early stages of project planning. The consultations
seek to identify historic properties potentially affected by
any undertaking, assess their potential effects and find ways
to avoid, minimize or mitigate adverse effects on a historic
property. This consultative process generally includes State
Historic Preservation Offices (SHPOs), and a Federal agency can
provide various assistance to a SHPO under limited
circumstances. To better assess this assistance and determine
what additional support may be needed to help the services more
effectively work with SHPOs, the Assistant Deputy Under
Secretary of Defense Energy, Installations, and Environment
shall issue a report within 180 days of enactment of this Act
detailing: (1) discretionary services provided by the
Department to SHPOs, such as tailored training, cultural
resources surveys, data recovery, and data recordation; (2)
systemic departmental challenges to obtaining historical
designation from SHPOs; (3) best practices for enhancing the
Section 106 compliance; and (4) potential regulatory and legal
options for accelerating individual project reviews at the
installation level.
Advertising and Contracts for Small Business.--The
Committee understands that, as the largest advertiser in the
United States, the Federal government should work to ensure
fair access to its advertising contracts for small
disadvantaged businesses and businesses owned by minorities and
women. The Committee directs each department and agency to
include the following information in its fiscal year 2022
budget justification: Expenditures for fiscal year 2020 and
expected expenditures for fiscal year 2022, respectively, for
(1) all contracts for advertising services; and (2) contracts
for the advertising services of (I) socially and economically
disadvantaged small businesses concerns (as defined in section
8(a)(4) of the Small Business Act (15 U.S.C. 637 (a)(4)); and
(II) women-and minority-owned businesses.
TITLE I
DEPARTMENT OF DEFENSE
Military Construction Overview
Appropriation, fiscal year 2020....................... $11,315,000,000
Budget request, fiscal year 2021...................... 7,813,563,000
Recommended in the bill............................... 10,090,000,000
Bill compared with:
Appropriation, fiscal year 2020................... -1,225,000,000
Budget request, fiscal year 2021.................. +2,276,437,000
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, readiness,
maintenance, research and development, supply, medical care,
and force protection, as well as unaccompanied housing,
military-owned family housing, utilities infrastructure, and
land acquisition.
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 DOD 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.
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) that has been specifically reduced by
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 Congress is permitted, except
that DOD may seek reprogramming for appropriated increments.
The reprogramming criteria that applies to military
construction projects is 25 percent of the funded amount or
$2,000,000, and includes new housing construction projects and
improvements. 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. Reprogramming is a courtesy
provided to DOD and can be taken away if the authority is
abused. 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 DOD 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.
Diversion of Military Construction Funds for a Border
Wall.--On February 15, 2019, President Trump declared a
National Emergency for the purpose of using section 2808 of
title 10, United States Code to bypass congressional intent and
divert valuable military construction funding from previously
approved national security projects to fund a border wall
instead. Congress chose not to fund this wall in the
Consolidated Appropriations Act, 2019 (P.L. 116-6). The
Committee notes there is bipartisan opposition to the action
taken by the President, as both the House and Senate voted to
disapprove the President's emergency declaration. Despite
bipartisan congressional opposition, the fiscal year 2020
budget request for military construction included
$7,200,000,000 to restore funding (up to $3,600,000,000) that
would be diverted for the wall as well as provide the next
installment of wall funding ($3,600,000,000). Throughout the
fiscal year 2020 appropriations cycle, the Committee rejected
the Administration's proposal and made clear that Congress
would not provide resources to ``backfill'' these projects.
This position was ratified when the final enacted appropriation
for fiscal year 2020 explicitly included zero funds to backfill
projects whose funding had been redirected.
In defiance of such unmistakable congressional intent, on
April 28, 2020 DOD announced its intention to cancel fiscal
year 2020 Overseas Contingency Operations Funds for the
European Deterrence Initiative in order to provide the
necessary resources to backfill projects originally funded in
fiscal years 2018 and 2019 and subsequently canceled for the
border wall in 2019. The Committee previously appropriated
these funds for disaster recovery, flood protection, military
base construction projects, defense of Europe against Russia
aggression and to maintain and improve military readiness. As
such, the Committee expects that the resources should indeed be
used for those specific purposes. The Committee believes that
the deferral or ultimate cancellation of those projects will
inhibit military construction project planning in the future
and diminish military readiness. The Committee emphasizes that
in the interest of national security and constitutional
prerogatives, military construction funding should only be used
for the purpose they are provided, which is to support DOD's
mission, military readiness, servicemembers, and their
families.
The accompanying fiscal year 2021 bill includes language
that protects both previously appropriated projects, as well as
fiscal year 2021 projects funded in this bill from being used
as a source for border wall projects. The Committee believes
that Congress must assert its role as a co-equal branch of the
Federal government and insist upon the appropriate and
constitutional use of appropriated funds.
Facilities Sustainment, Restoration and Modernization
(FSRM).--DOD 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 and new facilities, 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.
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 above
$90,000,000 with the form 1391 justification to the
congressional defense committees. The Committee acknowledges
that there is an alarming amount of unawarded prior-year
military construction projects, and therefore the Committee
directs the Secretary of Defense to report to the congressional
defense committees quarterly, beginning in the second quarter
of fiscal year 2021 and each quarter thereafter of projects
that remain unawarded from the current and prior fiscal years
and the reasons for delay.
Transfer of Funds To and From the Foreign Currency
Fluctuations, Construction, Defense Account.--The Committee
directs DOD 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, DOD shall notify the
Committees on Appropriations of both Houses of Congress within
seven days of transferring any amount in excess of $10,000,000
to or from the Foreign Currency account.
Bid Savings.--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 Subcommittees 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 four projects that have been
incrementally funded; however, the full authorization of the
projects will be provided in the fiscal year 2021 National
Defense Authorization Act.
Hawaii Infrastructure Readiness Initiative.--The Committee
recognizes the strategic and critical role the Hawaii
Infrastructure Readiness Initiative (HIRI) plays in DOD's
strategic plans for the Indo-Pacific region. At the direction
of Congress, United States Army Pacific created the HIRI to
address critical priorities established in its military
construction submissions and major restoration and maintenance
(R&M) programming requests. According to the Army's analysis,
45 percent of the infrastructure in Hawaii is failed or
failing, putting efforts to meet operational needs at risk. To
remedy this issue, HIRI allocates between $50,000,000 and
$150,000,000 per year through fiscal year 2030 to address major
infrastructure needs, and has a ten-year cost of
$1,100,000,000. The program addresses several major facility
and infrastructure deficiencies, including aviation maintenance
facilities, operations facilities, tactical equipment
maintenance facilities, Pohakuloa Training Area, West Loch
Ammunition Storage, and base operations. Continued and
consistent funding is needed at a time of growing national
security needs in the Pacific. Therefore, the Committee directs
the Secretary of the Army to certify that the Initiative's plan
for the next 10 fiscal years does not create gaps in funding
that will result in inconsistent program implementation that
could undermine the interconnected nature of HIRI's projects.
Adequate Childcare for Military Families.--The Committee is
aware of the importance of secure and adequate childcare for
military families. DOD has argued that these childcare services
and benefits help support their recruiting, retention and
readiness goals, and that there is generally a high level of
satisfaction among servicemembers who use DOD childcare
services. However, the success of the program depends, in part,
on ensuring adequate facilities for child development centers
(CDCs) and School Age Care (SAC) Program facilities, preferably
on military installations. Hearings before the subcommittee
have noted a lack of facilities in some locations. Thus, the
Committee directs the Service Secretaries to submit a report to
the congressional defense committees no later than 180 days
after enactment of this Act detailing (1) all installations
that have CDCs and SAC facilities, (2) the physical condition
of these facilities, and (3) the length of time military
families must wait before enrolling their children into CDCs
and SAC programs.
Quality of Life (QOL) Project Funding and Priority List.--
In recognition of the difficulties the lack of QOL facilities
can cause for servicemembers and their families, the Committee
provides an additional $152,000,000 for the construction of
three Child Development Centers (CDCs) on Army installations,
as identified on the unfunded requirements list submitted to
Congress. Understanding that stable family life is a key
component of mission readiness and retention, the Committee
believes the Services should make QOL projects, particularly
CDCs, a priority in their annual budget requests and directs
the Service Secretaries to submit a report to the congressional
defense committees, no later than 90 days after enactment of
this Act, to address QOL shortfalls. The report should identify
the installations that are most in need of QOL projects in
fiscal year 2022 and the following four fiscal years, the
specific projects needed, and associated funding requirements.
In addition, the Committee directs the Secretary to create a
unified list of QOL projects to be submitted with the annual
budget request.
Review of Area Cost Factors for the Indo-Pacific.--The DOD
Facilities Pricing Guide (UFC 3-701-01) supports a spectrum of
facility planning, investment, and analysis needs for each
Service. This guide reflects updated cost, pricing data, and
methodologies used to prepare the military's construction
budget. It is essential for project scoping and cost estimates
built using this guide to be accurate for the effective
utilization of scarce taxpayer resources. The methodology
behind these estimates must take into account the unique market
specific considerations, especially in geographically isolated
locations in the Indo-Pacific, including Hawaii. Therefore, the
Committee directs the Secretary to submit a report to the
congressional defense committees, no later than 180 days after
enactment of this Act, that: (1) compares initial price guide
estimates to final construction costs for each of fiscal years
2015 through 2019 for construction projects in the Indo-
Pacific, to include Hawaii; (2) describes factors unique to
construction on Indo-Pacific islands that are included in the
Services' pricing estimates based on the DOD Facilities Pricing
Guide; (3) compares military and private sector construction
costs in the Indo-Pacific for buildings of comparable purposes;
(4) describes the major cost factors considered by private
sector construction companies operating in the Indo-Pacific
that are not considered by the military and why; and (5)
analyzes the effect of ocean shipping rates and U.S. ocean
shipping laws on construction costs and regulatory and legal
options for reducing those costs.
Naval Air Weapons Station (NAWS) China Lake Earthquake
Recovery Efforts.--NAWS China Lake is a critical installation
that serves as a cornerstone of our national defense
architecture. The Committee appreciates the Navy's efforts to
rebuild NAWS China Lake as expeditiously as possible and
recognizes the important role that supporting communities will
play with the rebuilding effort. By strengthening ties with the
local community, the Committee believes that this action
enables the base to be rebuilt in a timely manner while also
fostering a good return on taxpayer funds. In order to help
facilitate good communication and long-term, strategic planning
by local stakeholders and to assist with congressional
oversight responsibilities, the Committee directs the Secretary
to produce a biannual publicly releasable report that provides
an update on the rebuilding efforts of NAWS China Lake until
all work is complete. The report should not only discuss the
past, present, and future construction efforts, but also
highlight opportunities that local community members may be
able to help address. The report shall be submitted to the
Committees on Appropriations and be posted online.
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 DOD 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
alternatives should they be agreed upon. To understand the
scale of this problem, the Committee directs the Secretary of
Defense to provide the Committee a list of military
construction projects related to mitigation and/or changes to
projects were required within the past five years where
consultation with a Federally Recognized Tribe, 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 no later than 180
days after enactment of this Act. Further DOD is encouraged to
each establish a central account from which mitigation projects
can be funded.
Military Construction Planning for the Indo-Pacific
Region.--According to the National Defense Strategy, the United
States is seeking to strengthen our nation's alliances and
partnerships in the Indo-Pacific Region with a networked
security architecture capable of deterring aggression,
maintaining stability, and ensuring free access to common
domains. This effort will include significant military
construction requirements throughout the Indo-Pacific region.
Properly executing this investment requires advance planning
and design work to develop DD Form 1391s matched to mission-
critical requirements. Thus, the Committee directs the
Assistant Secretary of Defense (Sustainment) to submit a report
to the congressional defense committees within 180 days of
enactment of this Act detailing: (1) the number of DD Form
1391s for facilities in the Indo-Pacific generated by each
military service and agency for fiscal year 2015 through fiscal
year 2020, (2) the number of military construction projects in
the Indo-Pacific that were included in the Future Years Defense
Program for each military service and agency for fiscal year
2015 through fiscal year 2020, and (3) efforts by the
department to accelerate planning and design efforts by the
Services to better align departmental strategies with
executable projects.
Efficiency within the Military Construction Accounts.--The
Committee supports military construction projects that
incorporate requirements from Active Duty, Reserve and Guard
components in order to maximize efficiency, eliminate the need
for multiple construction projects and reduces costs.
Cross Laminated Timber.--The Committee is aware that the
use of cross laminated timber and other mass timber products as
a building material has the potential for reducing costs and
increasing functionality of various military structures. The
Committee encourages the Secretary of Defense to expand the
application of these innovative technologies in future military
construction projects.
Defense Access Roads (DAR) Program.--The Committee supports
Defense Access Roads as a vital mechanism to improve
transportation infrastructure at domestic installations and
their surrounding communities. The Fiscal Year 2020 National
Defense Authorization Act clarified that appropriated funds for
the DAR Program may be used to cover the cost of repairing
damage or mitigating infrastructure risk to access roads caused
by recurrent flooding or sea level fluctuation. The Committee
urges the Department to identify military installations with
transportation infrastructure affected by sea level fluctuation
and recurrent flooding and, through the appropriate contacts at
affected installations and sites, work with surrounding local
communities to identify affected transportation infrastructure
and conduct transportation needs assessments to understand the
magnitude of the improvement required.
Investing in Multi-hazard Resilient Defense Infrastructure
Planning, Development, and Testing.--The Committee supports the
Department's continued focus on building lasting and resilient
military installations, including its update of hurricane-
resistant building codes for bases, barracks, hospitals, and
airfields, and consideration of the effects of severe drought
and desertification on military installations and missions. In
addition to Department-wide initiatives, such as revised
structure planning, conservation programs and modeling new
installations with the threat of sea-level rise in mind, the
Committee encourages the Department to prioritize investing in
climate-sustainable infrastructure projects that have yielded
positive results. To support these efforts, the bill includes
section 512 prohibiting the use of funds to construct
facilities that do not meet resiliency standards.
Broadband In/Around Military Installations.--The Committee
is concerned with the lack of broadband access at remote or
rural installations across the United States. The absence of
high-quality broadband significantly limits professional
development and employment opportunities for military spouses,
exacerbating existing workforce challenges faced by spouses who
often relocate their families every two to three years. It also
means children of servicemembers may not have the resources to
complete their homework and can creates difficulty accessing
the telemedicine services military families need when
specialists and advanced treatment facilities are hours of
driving away. Therefore, the Secretary is directed to provide a
report to the congressional defense committees no later than 90
days after enactment of this Act that discusses broadband
access at remote and rural military installations, identifies
installations that lack such access, and assesses the
availability of low-cost broadband technologies that could
extend access to these installations.
Ultra-High Performance Concrete.--The Committee is aware of
the Department of Defense's collaboration with Federally
designated research universities to accelerate research on the
development of additive manufacturing techniques and processes
that use superior and resilient building products, in
particular ultra-high performance concrete. Additive
manufacturing will be critical for rapidly enhancing the
resilience and readiness of military installations, base
housing, roads and bridges in a cost-effective manner. The
Committee encourages the Secretary of Defense to expand the
application of these innovative technologies and building
products in future military construction projects.
Military Construction, Army
Appropriation, fiscal year 2020....................... $1,178,499,000
Budget request, fiscal year 2021...................... 650,336,000
Recommended in the bill............................... 608,336,000
Bill compared with:
Appropriation, fiscal year 2020................... -570,163,000
Budget request, fiscal year 2021.................. -42,000,000
Military Construction, Army.--The bill includes
$608,336,000 for the following projects in the following
amounts:
------------------------------------------------------------------------
Project Amount
------------------------------------------------------------------------
Yuma Proving Ground--Ready Building.................. $14,000,000
Fort Carson--Physical Fitness Facility............... 28,000,000
Fort Gillem--Forensic Laboratory..................... 71,000,000
Fort Gordon--Advanced Individual Training Barracks 80,000,000
Complex, Phase 3....................................
Wheeler Army Airfield--Aircraft Maintenance Hangar... 89,000,000
Fort Polk--Information Systems Facility.............. 25,000,000
McAlester APP--Ammunition Demolition Shop............ 35,000,000
Carlisle Barracks--General Instruction Building, 38,000,000
Increment 2.........................................
Humphreys Engineering Center--Training Support 51,000,000
Facility............................................
Planning and Design.................................. 126,436,000
Minor Construction................................... 50,900,000
Total, Military Construction, Army............... 608,336,000
------------------------------------------------------------------------
Within the total for Army planning and design, the
recommendation includes $8,000,000 for a SOUTHCOM headquarters
replacement facility, as requested by the Command.
In addition, for unfunded requirements and cost to complete
projects of the Army, the bill includes $567,500,000 in
sections 123 and 126 for the following projects in the
following amounts:
------------------------------------------------------------------------
Project Amount
------------------------------------------------------------------------
Cost to Complete (Section 126)
Fort Irwin--Multi-purpose Range...................... $23,000,000
Lucius D. Clay Kaserne--Controlled Humidity.......... 2,500,000
Kwajalein Atoll--Air Traffic Control Tower........... 17,500,000
White Sands Missile Range--Information Systems 20,000,000
Facility............................................
Fort Drum--Railhead.................................. 9,000,000
Fort Sill--AIT Barracks Complex, Phase 2............. 19,000,000
Fort Jackson--Trainee Barracks Complex 3, Phase 2.... 19,000,000
Fort Jackson--Reception Barracks Complex, Phase 1.... 18,200,000
Corpus Christi Army Depot--Powertrain Facility....... 4,300,000
Fort Hood--Battalion Headquarters Complex............ 19,200,000
Fort Hood--Vehicle Maintenance Shop.................. 10,500,000
Camp Bullis--Vehicle Maintenance Shop................ 11,600,000
Camp Williams--Live Fire Shoothouse.................. 4,100,000
Fort Belvoir--Vehicle Maintenance Shop............... 15,000,000
Joint Base Langley-Eustis--AIT Barracks Complex, 32,000,000
Phase 4.............................................
Total, Cost to Complete, Army.................... 224,900,000
Unfunded Requirements (Section 123)
Fort Jackson--Trainee Barracks Complex 3, Phase 2.... $7,000,000
Fort Wainwright--Unaccompanied Enlisted Personnel 59,000,000
Housing.............................................
Schofield Barracks--Child Development Center......... 39,000,000
Fort Shafter--Child Development Center--School Age... 58,000,000
Fort Wainwright--Child Development Center............ 55,000,000
Fort McCoy--Transient Training Enlisted Barracks..... 29,200,000
Fort McCoy--Transient Training Enlisted Barracks..... 29,200,000
Caserma Renato Del Din--Access Control Point......... 10,200,000
Military Ocean Terminal Concord--Ammunition Holding 46,000,000
Area................................................
Fort Detrick--Incinerator Facility................... 10,000,000
Total, Unfunded Requirements, Army............... 342,600,000
------------------------------------------------------------------------
Immediate Response Force.--The Committee is concerned that
without significant investment, the Army is not prepared to
maintain the requirements of the Immediate Response Force (IRF)
to be able to deploy anywhere in the world within 18 hours. In
order to deter aggression against US interests and maintain an
effective global deterrent, there are significant military
construction needs at several installations that cannot be
sufficiently mitigated with other funding sources. The
Committee urges the Army to prioritize facilities that will
support the global mission of the IRF and maintain this
critical capability.
Motor Pools.--In order to be able to deploy on command and
conduct decisive full-spectrum operations, the Army must have
well-maintained and ready-to-deploy equipment. The readiness of
this equipment relies on an effective, comprehensive
maintenance program, which in turn, enhances and facilitates
training and warfighting. This is particularly important for
units that rely on armored vehicles as their primary weapons
system. However, quality maintenance requires appropriately
designed, sized, supplied, and staffed motor pools and
maintenance facilities. The Committee requests a report on the
condition, current and anticipated capacity requirements, and
modernization needs of motor pools that support the rapid
deployment of armored combat units within 90 days after
enactment of this Act. The report should include information on
recent upgrades and construction of motor pools, as well as
planned investments included in the future years defense
program.
Firefighting Houses and Equipment.--The Secretary of the
Army is directed to provide a report to the Committee, within
180 days of enactment of this Act, regarding firehouses,
firefighting equipment, and firefighting personnel on military
installations in noncontiguous states and territories. This
report should include a timeline, details, and projected costs
for the building of any firehouses on DOD installations that
have firefighting personnel but have substandard working and
living conditions for personnel and their equipment, suited to
their mission and needs. The report also should include
information on remediation efforts to mitigate substandard
conditions and to protect personnel and equipment.
Land Use and Housing Issues at U.S. Army Garrison.--The
Committee is aware of the Army's desire to examine various
options to address land use and housing issues at U.S. Army
Garrison Hawaii. Among the options under consideration is an
unsolicited gift of real property under Army Regulation 1-100,
The Army Gift Program. Although the gift process requires a
National Environmental Policy Act (NEPA) Environmental Impact
Assessment, the Committee notes that members of the local
community may have expectations regarding the land use rules
for properties that may have been designated solely for
agricultural and other non-housing uses. To provide the
greatest public transparency possible consistent with existing
law, the Committee directs the Secretary of the Army to provide
to the congressional defense committees a report no later than
180 days after enactment of this Act on: (1) what state and
county land use laws in the State of Hawaii would be negated if
the Army processes a land proffer under NEPA and (2) the Army's
public engagement plan for ensuring reasonable community
engagement before accepting a proffer.
Military Construction, Navy and Marine Corps
Appropriation, fiscal year 2020....................... $2,449,632,000
Budget request fiscal year 2021....................... 1,975,606,000
Recommended in the bill............................... 1,611,914,000
Comparison with:
Appropriation, fiscal year 2020................... -837,718,000
Budget request, fiscal year 2021.................. -363,692,000
Military Construction, Navy and Marine Corps.--The bill
includes $1,611,914,000 for the following projects in the
following amounts:
------------------------------------------------------------------------
Project Amount
------------------------------------------------------------------------
Camp Pendleton--1st MARDIV Operations Complex........ $68,530,000
Camp Pendleton--I MEF Consolidated Information 37,000,000
Center, Increment 2.................................
LeMoore--F-35C Hangar 6, Phase 2 (MOD 3/4)........... 98,070,000
LeMoore--F-35C Simulator Facility and Electrical 59,150,000
Upgrade.............................................
San Diego--Pier 8 Replacement, Increment 2........... 98,500,000
Twentynine Palms--Wastewater Treatment Plant......... 76,500,000
JB Pearl Harbor-Hickam--Waterfront Improvements 48,990,000
Wharves S1,S11-13,S20-21............................
Joint Base Pearl Harbor-Hickam--Waterfront 65,910,000
Improvements Wharves S8-S10.........................
Kittery--Multi-mission Drydock 1 Extension, Phase 1.. 160,000,000
Fallon--Range Training Complex, Phase 1.............. 29,040,000
Camp Lejeune--II MEF Operations Center and 20,000,000
Replacement, Increment 2............................
Norfolk--E-2D Training Facility...................... 30,400,000
Norfolk--MH-60 & CMV-22B Corrosion Control & Paint 17,671,000
Facility............................................
SW Asia--Ship to Shore Utility Services.............. 68,340,000
Souda Bay--Communications Center..................... 50,180,000
Andersen AFB--Ordnance Operations Admin.............. 21,280,000
Joint Region Marianas--Base Warehouse................ 55,410,000
Joint Region Marianas--Central Fuel Station.......... 35,950,000
Joint Region Marianas--Central Issue Facility........ 45,290,000
Joint Region Marianas--Combined EOD Facility......... 37,600,000
Joint Region Marianas--DAR Bridge Improvements....... 40,180,000
Joint Region Marianas--DAR Road Strengthening........ 70,760,000
Joint Region Marianas--Distribution Warehouse........ 77,930,000
Joint Region Marianas--Individual Combat Skills 17,430,000
Training............................................
Joint Region Marianas--Joint Communications Upgrade.. 22,000,000
Rota--MH-60R Squadron Support Facilities............. 60,110,000
Planning and Design.................................. 160,710,000
Minor Construction................................... 38,983,000
Total, Military Construction, Navy and Marine 1,611,914,000
Corps...........................................
------------------------------------------------------------------------
In addition, for unfunded requirements and cost to complete
projects of the Navy and Marine Corps, the bill includes
$910,837,000 in sections 123 and 126 for the following projects
in the following:
------------------------------------------------------------------------
Project Amount
------------------------------------------------------------------------
Cost to Complete (Section 126)
Joint Region Marianas--Hardening Petroleum Oil, and $19,200,000
Lubricant Infrastructure............................
NAS Key West--Aircraft Maintenance Hangar............ 37,200,000
NAS Whiting Field--Air Traffic Control Tower......... 7,900,000
NAS Point Mugu--Missile Assembly Building and High 13,100,000
Explosive Magazine..................................
MCAS Cherry Point--F-35B Vertical Lift Fan Test 7,000,000
Facility............................................
MCAS Beaufort--Recycling and Hazardous Waste Facility 10,000,000
Camp Lejeune--Water Treatment Plant Replacement, 50,500,000
Hadnot Point........................................
Total, Cost to Complete, Navy and Marine Corps... 144,900,000
Unfunded Requirements (Section 123)
Yuma--Bachelor Enlisted Quarters..................... $31,537,000
NC TAMSLANT Cutler--Perimeter Security............... 26,100,000
Camp Pendleton--Combat Water Survival Training 25,200,000
Facility............................................
Comalpa--Long Range Maritime Patrol Aircraft Hangar 28,000,000
and Ramp............................................
Seal Beach--Magazines................................ 46,800,000
Port Hueneme--Combat Vehicle Maintenance Facility.... 43,500,000
Mechanicsburg--Machinery Control Development Center.. 74,600,000
Point Mugu--Directed Energy Test Facility............ 26,700,000
Norfolk--Sub Logistics Support....................... 9,400,000
Coronado--CMV-22 Hangar.............................. 75,800,000
NS Guam--X-Ray Wharf Berth 2......................... 94,500,000
NOSC Minneapolis--Joint Reserve Intel Center......... 12,800,000
Whidbey Island--E/A-18G Fleet Readiness Squadron 29,900,000
Training Facility...................................
Norfolk--CMV-22 Airfield and Hangar Improvements..... 56,100,000
NAS Jacksonville--Consolidated Ordnance Operations 14,300,000
Facility............................................
Yorktown--Ordnance Facilities........................ 71,800,000
Camp Pendleton--Combat Water Survival Training 25,200,000
Facility............................................
Camp Pendleton--Warehouse Consolidation and 21,800,000
Modernization.......................................
MCAS Cherry Point--Fitness Center Replacement and 51,900,000
Training Pool.......................................
Total, Unfunded Requirements, Navy and Marine 765,937,000
Corps...........................................
------------------------------------------------------------------------
Marine Corps Military Construction Projects in Darwin,
Australia.--The Committee is concerned that the Navy has not
properly synchronized or planned the necessary construction
projects needed for a Marine Corps presence in the INDOPACOM
AOR. The Committee directs the Secretary of Navy to provide a
master plan, in unclassified and classified format, to the
congressional defense committees. The plan should outline by
fiscal year and dollar amount the planned military construction
projects to support Marines in Darwin no later than 90 days
after enactment of this Act.
Support Planning for Unmanned Vehicles.--The Committee
notes that the Navy's recent budget submissions include
significant investments into the research, development and
procurement of unmanned undersea vehicles (UUVs), Extra Large
Unmanned Undersea Vehicles (XLUUVs), Medium Unmanned Surface
Vehicles (MUSVs) and Large Unmanned Surface Vehicles (LUSVs).
These platforms are part of an effort to shift the Navy to a
new fleet architecture that is more widely distributed. These
vessels will require changes to the support requirement at
various Naval installations throughout the globe that were
built for manned naval vessels. Thus, the Committee directs the
Department of the Navy to submit a report to the congressional
defense committees within 180 days of enactment of this Act
detailing: (1) the current capability of existing pier and
related shore infrastructure to support unmanned vehicles, (2)
currently planned investments to prepare pier and related shore
infrastructure to support unmanned vehicles, and (3) plans for
utilizing existing public naval shipyards to support unmanned
vehicles.
Shipyard Infrastructure Optimization Plan.--The Committee
recognizes that Project Labor Agreements (PLAs) promote economy
and efficiency in contracting, as well as foster labor-
management stability and ensure compliance with worker
protection laws. The Committee is also aware that the first
military construction project which used a PLA, the Explosive
Handling Wharf at Naval Base Kitsap, came under budget by more
than $250,000,000 when it was completed in 2016. For these
reasons, the Committee encourages the Department of the Navy to
utilize PLAs for military construction projects that will take
place at the Navy's four public shipyards as part of the
Shipyard Infrastructure Optimization Plan.
Military Construction, Air Force
Appropriation, fiscal year 2020....................... $1,687,230,000
Budget request, fiscal year 2021...................... 767,132,000
Recommended in the bill............................... 569,792,000
Bill compared with:
Appropriation, fiscal year 2020................... -1,117,438,000
Budget request, fiscal year 2021.................. -197,340,000
Military Construction, Air Force.--The bill includes
$569,792,000 for the following projects in the following
amounts:
------------------------------------------------------------------------
Project Amount
------------------------------------------------------------------------
Schriever AFB--Consolidated Space Operations Facility $88,000,000
JB McGuire-Dix-Lakehurst--Munitions Storage Area..... 22,000,000
JB San Antonio--BMT Recruit Dormitory 8, Increment 2. 36,000,000
JB San Antonio--T-XADAL Ground Based Training System 19,500,000
Simulator...........................................
Hill AFB--GBSD Mission Integration Facility, 68,000,000
Increment 2.........................................
JB Langley-Eustis--Access Control Point Main Gate 19,500,000
with Land Acquisitions..............................
Joint Region Marianas--Stand Off Weapons Complex, MSA 56,000,000
2...................................................
Al Udeid--Cargo Marshalling Yard..................... 26,000,000
Planning and Design.................................. 166,192,000
Minor Construction................................... 68,600,000
Total, Military Construction, Air Force.......... 569,792,000
------------------------------------------------------------------------
In addition, for unfunded requirements and cost to complete
projects of the Air Force, the bill includes $594,500,000 in
sections 123 and 126 for the following projects in the
following amounts:
------------------------------------------------------------------------
Project Amount
------------------------------------------------------------------------
Cost to Complete (Section 126)
FE Warren AFB--Weapons Storage Facility.............. $12,000,000
Joint Base Andrews--Consolidate Communications Center 13,000,000
Eglin AFB--Advanced Munitions Technology Complex..... 35,000,000
Scott AFB--Add/Alt Consolidated Communications 3,000,000
Facility............................................
Joint Base Charleston--Fire and Rescue Station....... 5,000,000
Joint Base Langley-Eustis--Targeting Center Facility. 10,000,000
Joint Base Langley-Eustis--Fuel System Maintenance 7,000,000
Dock................................................
Hanscom AFB--Vandenberg Gate Complex................. 6,000,000
US Air Force Academy--Air Force Cyberworx............ 17,000,000
RAF Lakenheath--Consolidate Corrosion Control 35,500,000
Facility............................................
Cannon AFB--Dangerous Cargo Pad Relocate CATM........ 2,000,000
Shaw AFB--CPIP MQ-9 MCE Group........................ 5,000,000
Patrick AFB--Main Gate............................... 5,000,000
Andersen AFB--Munitions Storage Igloos Phase 3....... 8,000,000
Yokota AB--Fuel Receipt and Distribution Upgrades.... 3,000,000
Total, Cost to Complete, Air Force............... 166,500,000
Unfunded Requirements (Section 123)
Hill AFB--GBSD Organic Software Sustainment Center... $132,000,000
Fort Worth JRB--F-35 Squadron Ops/Aircraft 25,000,000
Maintenance Unit....................................
US Air Force Academy--Cadet Preparatory School 49,000,000
Dormitory...........................................
Joint Base Andrews--Crash Rescue Station #1.......... 26,000,000
Edwards AFB--Flight Test Engineering Laboratory 40,000,000
Complex.............................................
Ellsworth AFB--B-21 2-Bay Low Observable Restoration 96,000,000
Facility............................................
Space Command (various locations)--Planning and 60,000,000
Design..............................................
Total, Unfunded Requirements, Air Force.......... 428,000,000
------------------------------------------------------------------------
The recommendation does not include funding for the three
Air Force projects requested for Tinian. The Committee directs
the Secretary of the Air Force to provide an update to the
congressional defenses committees on the timeline and updated
costs for executing military construction on the island and the
role of the airfield and related support infrastructure to
support INDOPACOM AOR no later than 120 days after enactment of
this Act.
The Weapons Technology Integration Center (WTIC).--The
Committee is concerned that the WTIC infrastructure is old,
inefficient, and lacking in secure areas. As directed by the
National Security Strategy (NSS) and National Defense Strategy
(NDS), to keep our asymmetric military advantage, the Nation
needs to modernize our weapon systems, and be able to do so at
the speed of relevance. The WTIC would enable the US to achieve
these needs with modern, secure laboratory space that allows
the digital transition in weapons research and development and
increases collaboration across a multi-disciplinary workforce
that enables rapid transition of technologies to the
warfighter. The Committee directs the Secretary of the Air
Force to report to the congressional defense committees on the
total cost of the WTIC and what fiscal years the replacement
construction would be submitted no later than 60 days after
enactment of this Act.
MIT Lincoln West Lab CSL/MIF, Increment 3.--The Committee
is concerned that the Air Force did not submit a request for
the final increment of the MIT-Lincoln West Lab CSL/MIF in the
fiscal year 2021 budget request. The Committee provided
increments 1 and 2 in fiscal years 2019 and 2020. The Committee
understands the importance of labs to the Air Force, especially
MIT-Lincoln Lab and is perplexed as to why the final increment
has not been requested. Therefore, the Committee directs the
Secretary of the Air Force to report to the congressional
defense committees no later than 60 days after enactment of
this Act on the status of obligation and execution for
increments 1 and 2, the fiscal year in which the third
increment will be requested and the amount and a timeline for
completion of the project.
Air Traffic Control Towers.--The Committee is concerned
that the Air Force's ATC 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 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 United States national security interests.
Air Education and Training Command (AETC).--The Committee
recognizes the importance of adequate facilities for basic
military training, flight training, and the other training
missions of the AETC. Outdated and inadequate AETC facilities,
including dormitories, harm the Air Force's ability to recruit,
train, and retain Airmen and increase operations and
maintenance costs. The Committee urges the Air Force to
prioritize funding for AETC facility design, construction, and
construction improvements because of the critical role training
plays in force readiness for future threats to U.S. national
security.
Air Education and Training Command Drainage Projects.--The
Committee recognizes the adverse impact that flooding and other
infrastructure challenges have had on AETC facilities,
equipment, operations, and training. The Committee also
recognizes the steps that the Air Force has taken to begin
mitigating the damage through multi-year projects. The
Committee supports these efforts and urges the Secretary of the
Air Force to prioritize these projects.
Access Control Points at Air Force and Air National Guard
Installations in Urban Areas.--The Committee expects the Air
Force to accelerate funding for current access control point
construction projects to installations that face high-security
risks to critical missions. Priority in allocating funds shall
be given to access control points in heavily congested areas in
large urban settings that place major transportation links at
risk of incident closures, or that are required for heavy
traffic hazard mitigation, airport security and installation
force protection.
Military Construction, Defense-Wide
Appropriation, fiscal year 2020....................... $2,362,529,000
Budget request, fiscal year 2021.................. 2,027,520,000
Recommended in the bill........................... 2,234,517,000
Comparison with:
Appropriation, fiscal year 2020................... -128,012,000
Budget request, fiscal year 2021.................. +206,997,000
Military Construction, Defense-Wide.--The bill includes
$2,234,517,000 for the following projects in the following
amounts:
------------------------------------------------------------------------
Project Amount
------------------------------------------------------------------------
Anniston Army Depot--Demilitarization Facility....... $18,000,000
Fort Greely--Communications Center................... 48,000,000
Fort Huachuca--Laboratory Building................... 33,728,000
Yuma--SOF Hangar..................................... 49,500,000
Beale AFB--Bulk Fuel Tank............................ 22,800,000
Fort Carson--SOF Tactical Equipment Maintenance 15,600,000
Facility............................................
Hurlburt Field--SOF Combat Aircraft Parking Apron, 38,310,000
North...............................................
Hurlburt Field--SOF Special Tactics Ops Facility (23 44,810,000
STS)................................................
Fort Knox--Van Voorhis Elementary School............. 69,310,000
Bethesda Naval Hospital--MEDCEN Addition/Alteration, 100,000,000
Increment 4.........................................
Fort Meade--NSAW Recapitalize Building, Increment 3.. 250,000,000
Fort Leonard Wood--Hospital Replacement, Increment 3. 40,000,000
St. Louis--NGA West (N2W) Complex Phase, Increment 2. 119,000,000
Kirtland AFB--Administrative Building................ 46,600,000
Fort Bragg--SOF Group Headquarters................... 53,100,000
Fort Bragg--SOF Military Working Dog Facility........ 17,700,000
Fort Bragg--SOF Operations Facility.................. 43,000,000
Wright Patterson AFB--Hydrant Fuel System............ 23,500,000
Fort Hood--Fuel Facilities........................... 32,700,000
JEB Little Creek-Story--SOF DCS Operations Facility & 54,500,000
Command Center......................................
JEB Little Creek-Story--SOF NSWG-2 NSWTG CSS 58,000,000
Facilities..........................................
Joint Base Lewis-McChord--Fuel Facilities (Lewis 10,900,000
Main)...............................................
Joint Base Lewis-McChord--Fuel Facilities (Lewis 10,900,000
North)..............................................
Manchester--Bulk Fuel Storage Tanks, Phase 1......... 82,000,000
CONUS Unspecified--Training Target Structure......... 14,400,000
Rhine Ordnance Barracks--Medical Center Replacement, 200,000,000
Increment 9.........................................
Def Fuel Support Point Tsurumi--Fuel Wharf........... 49,500,000
Energy Resilience & Conservation Investment Program.. 439,497,000
Planning and Design.................................. 179,976,000
Minor Construction................................... 69,186,000
Total, Military Construction, Defense-Wide....... 2,234,517,000
------------------------------------------------------------------------
Energy Resilience and Conservation Investment Program
(ERCIP).--The Committee supports DOD's investments in energy
efficiency, resilience, renewable energy systems, and energy
security, and as such provides $439,497,000 for the Energy
Resilience and Conservation Program, an increase of
$296,997,000 above the request. The recommendation also
includes an increase of $10,000,000 for planning and design
specifically for ERCIP.
The bill includes $296,997,000 for the following projects
in the following amounts:
------------------------------------------------------------------------
Project Amount
------------------------------------------------------------------------
Unfunded Requirements ERCIP--Defense-Wide:
Fort Bragg--SOTF Chilled Water Upgrade............... $6,100,000
Fort Smith--ANG PV Arrays and Battery Storage........ 2,600,000
Joint Base Anacostia Bolling--Industrial Controls 8,749,000
System Modernization................................
NSA Bethesda--NSAB-16 Replace Chillers 3 Through 9... 13,840,000
Fort Benning--Construct 4.8MW Generation & Microgrid. 17,000,000
Wright Patterson AFB--Intelligence Facility Central 35,000,000
Utility Plant.......................................
NAWS China Lake--Solar Energy Storage System......... 8,950,000
Fort Rucker--10MW Generation & Microgrid............. 24,000,000
Memphis ANG--PV Arrays and Battery Storage........... 4,780,000
Joint Base Anacostia Bolling--PV Carports............ 25,221,000
Joint Base Anacostia Bolling--DIA HQ Cooling Towers 1,963,000
and Cond Pumps......................................
MTA Camp Shelby--10MW Generation Plant and Microgrid 30,000,000
System..............................................
Aguadilla-Ramey--Microgrid Control System............ 8,400,000
Camp Grayling--600 kW Gas-Fired Microturbine......... 5,700,000
Fort Allen--Microgrid Control System................. 10,400,000
MTA Camp Shelby--Electrical Distribution............. 9,700,000
NSA Andersen--ICS Infrastructure Andersen Smart Grid. 16,970,000
Mountain Home AFB--Water Treatment Plant and Pump 31,000,000
Station.............................................
Fort Drum--Well Field Expansion Project.............. 22,000,000
Pentagon--Three High Efficiency Trim Chillers........ 12,024,000
Pentagon--Recommissioning of HVAC Systems, Part B.... 2,600,000
Total, Military Construction, Defense-Wide, ERCIP 296,997,000
------------------------------------------------------------------------
Investment in Renewable Energy Systems.--The Committee
supports the military's continued investment in renewable
energy systems, including the use and application of solar
energy for mobility and resilience capabilities at defense
military installations including military bases, barracks,
hospitals, and airfields. Such investments have yielded
positive results such as increased resiliency and cost-savings.
The Committee encourages DOD to prioritize funding for
renewable energy-related projects, including solar, to mitigate
risk to mission-critical assets and to promote energy security
and efficiency at military installations. Accordingly, the
Committee requests a report no later than 180 days after
enactment of this Act, detailing DOD's plans for further
development of renewable energy systems at military
installations and a timeline and goals for increased
utilization.
Renewable Energy Supply Investment.--The Committee
recognizes the advances the Department has made in increasing
sustainable and renewable energy supply to its facilities and
encourages the continued investment in renewable energy
systems, including the use of solar energy, which is vital to
preserving national security and ensuring military preparedness
and response. Construction of resilient, renewable energy
infrastructure on military bases, both foreign and domestic,
aids our military in building defenses against threats such as
natural disasters, extreme weather, and cyber-attacks, and
decreases our military's vulnerabilities while reducing energy
costs.
Tripler Army Medical Center Parking Assessment.--The
Tripler Army Medical Center and the Spark M. Matsunaga Veterans
Affairs (VA) Medical Center share a facility on the Island of
Oahu. As the largest military and Veterans medical facility in
the Pacific Basin, it is responsible for nearly 450,000
beneficiaries who are eligible to receive care at the facility.
According to the Army's own assessment using formulas included
in the Department of Defense Unified Facilities Criteria (UFC)
4-510-01, Design: Medical Military Facilities, the facility
should have 5,936 parking stalls to accommodate its workforce
and patients. However, the facility only has 3,713 stalls. The
facility is also not readily accessible to public transit,
making ground transportation with parking the only reasonable
option. Due to this geographic fact and parking shortfall,
veterans and servicemembers have difficulty finding parking,
which is particularly challenging for elderly veterans, wounded
soldiers and those who have difficulty walking unassisted.
Therefore, the Committee directs the Secretary of the Army and
the Director of the Defense Health Agency to submit a joint
report to the congressional defense committees no later than
180 days after enactment of this Act detailing the efforts to:
(1) update the facility's master infrastructure plan and (2)
address the parking shortfall at the facility, to include the
possible location, cost, and timeline for building a new
parking garage that sufficiently fulfills the parking demands
for both the Army and VA.
Energy Conservation.--The Committee commends DOD's forward
posture on the need to improve energy resilience and mission
assurance, save energy, and reduce energy costs. As DOD works
to construct new facilities and upgrade facilities, the
Committee directs DOD to increase the integration of
alternative energy sources, particularly through renewable
sources, throughout military facilities and installations. The
Committee directs the Secretary of Defense to provide an
updated report no later than 60 days after enactment of this
Act on DOD's strategy to: (1) provide latest summary of
progress toward achieving Defense base energy independence,
including Guard and Reserve facilities; (2) increase energy
conservation efforts and on energy cost savings; (3) improved
unit readiness; (4) and opportunities for return on investments
of existing and planned projects.
Defense Information Systems Agency (DISA).--The Committee
recognizes the need to move the Joint Spectrum Center (JSC)
from the David Taylor Research Center (DTRC) site in Annapolis,
Maryland. DTRC was closed 2005 under Base Realignment and
Closure process and the surrounding facilities and grounds are
no longer maintained by the Federal government. JSC's current
building at the DTRC site contains asbestos, significant
infrastructure problems, and cannot meet Anti-Terrorism Force
Protection (AT/FP) security standards. Failure to meet these
security standards requires ongoing security waivers by JCS's
parent organization, DISA, for its remaining lease term. JSC's
relocation and existing lease termination were authorized in
the Fiscal Year 2008 National Defense Authorization Act and
were intended to ensure JSC personnel are performing JSC's
mission in a building that meets all required AT/FP,
environmental protection, and building safety requirements. The
Committee reminds the Department of its responsibility to
ensure the safety and security of military and civilian
personnel and recommends DISA begin the process to relocate
JSC's to a more suitable facility as soon as possible.
Guard and Reserve Initiative
Regional Training Institutes.--The Committees recognize the
importance of Regional Training Institutes (RTI) across the
country for the readiness of Army National Guard (ARNG) and are
concerned about the lack of infrastructure to support the
mission of the RTIs. For example, the RTI at Fort Hood is
lacking sufficient facilities to provide the proper training to
achieve optimum readiness. The Committee urges the Department
to prioritize facilities for this important and vital mission
of ARNG and Army Reserve.
Military Construction, Army National Guard
Appropriation, fiscal year 2020....................... $210,819,000
Budget request, fiscal year 2021.................. 321,437,000
Recommended in the bill........................... 349,437,000
Bill compared with:
Appropriation, fiscal year 2020................... +138,618,000
Budget request, fiscal year 2021.................. +28,000,0000
Military Construction, Army National Guard.--The bill
includes $349,437,000 for the following projects in the
following amounts:
------------------------------------------------------------------------
Project Amount
------------------------------------------------------------------------
Tucson--National Guard Readiness Center.............. $18,100,000
Peterson AFB--National Guard Readiness Center........ 15,000,000
Shelbyville--National Guard/Reserve Center Building 12,000,000
Add/Alt.............................................
Frankfort--National Guard/Reserve Center Building.... 15,000,000
Brandon--National Guard Vehicle Maintenance Shop..... 10,400,000
North Platte--National Guard Vehicle Maintenance Shop 9,300,000
Joint Base McGuire-Dix-Lakehurst--National Guard 15,000,000
Readiness Center....................................
Columbus--National Guard Readiness Center............ 15,000,000
Hermiston--Enlisted Barracks, Transient Training..... 9,300,000
Joint Base Charleston--National Guard Readiness 15,000,000
Center..............................................
McMinnville--National Guard Readiness Center......... 11,200,000
Fort Worth--Aircraft Maintenance Hangar Addition/Alt. 6,000,000
Fort Worth--Vehicle Maintenance Shop Addition/Alt.... 7,800,000
Nephi--National Guard Readiness Center............... 12,000,000
Appleton--National Guard Readiness Center Add/Alt.... 11,600,000
Fort Allen--National Guard Readiness Center.......... 37,000,000
St. Croix--Army Aviation Support Facility (AASF)..... 28,000,000
St. Croix--CTS Ready Building........................ 11,400,000
Planning and Design.................................. 44,593,000
Minor Construction................................... 45,744,000
Total, Military Construction, Army National Guard 349,437,000
------------------------------------------------------------------------
In addition, for unfunded requirements of the Army National
Guard in section 123, the bill includes $34,835,000 for the
following projects in the following amounts:
------------------------------------------------------------------------
Project Amount
------------------------------------------------------------------------
Unfunded Requirements (Section 123)
Herminston--Enlisted Barracks Transient Training..... $15,735,000
Bakersfield--Vehicle Maintenance Shop................ 9,300,000
Ardmore--Vehicle Maintenance Shop.................... 9,800,000
Total, Unfunded Requirements, Army National Guard 34,835,000
------------------------------------------------------------------------
Army National Guard (ARNG) Readiness Center Transformation
Master Plan.--The ARNG completed its Readiness Center
Transformation Master Plan (RCTMP) in 2015; however, since that
time, the investment in executing the military construction
required under the RCTMP has not kept up with the demand. The
Committee is concerned that the mission readiness of these
critical facilities is further deteriorating, and it encourages
increased investments in ARNG Readiness Centers over the FYDP.
Further, given the changing conditions of readiness centers
across the country since the last RCTMP was completed, the
Committee encourages the ARNG to update the RCTMP to ensure its
current military construction priorities align with the
Transformation Master Plan. Accordingly, the Committee provides
an additional $15,000,000 in Army National Guard planning &
design for completion of a Readiness Center Transformation
Master Plan update.
Army National Guard Readiness Centers Investment.-- The
Committee appreciates the Army's prioritization of Army
National Guard Readiness Centers in its budget request for
fiscal year 2021. The Committee remains concerned by the
failure of the Army to prioritize investment in ARNG Readiness
Centers and arsenals. These facilities are critical to
protecting the homeland and responding to domestic emergencies.
Their deteriorating conditions are detrimental to the readiness
of the ARNG and, in some cases, present significant safety
concerns. The Committee encourages the Army to accelerate
investments in Readiness Centers in the fiscal year 2022 budget
request and Future Years Defense Program and include
$1,200,000,000 for the ARNG Transformation Plan.
Army National Guard Infrastructure and Unspecified Minor
Military Construction.--The Committee is concerned with the
state of ARNG infrastructure across the country. The ARNG has
been continuously underfunded for the last several decades. The
Committee is aware that reviews have found that billions of
dollars will be needed to bring Readiness Centers up to modern
standards, yet despite that little progress has been made. With
new higher thresholds for Unspecified Minor Military
Construction (UMMC), many smaller projects can be accomplished
with an increase in this account. While not completely solving
the ARNG military construction appropriations issue, this will
speed up projects across the country and increase the readiness
of the ARNG. The Committee provides $13,000,000 for this effort
in fiscal year 2021 and directs DOD to properly budget for the
UMMC account in future years.
ARNG Aviation Support Facilities.--The Committee is
concerned that ARNG Aviation Support Facilities (AASF) are not
prepared to protect and properly maintain next generation
airframe priorities simultaneously as the Army. The operation
and maintenance of new aircraft platforms requires significant
investment in AASFs across the country so that they can provide
the required shelter and support for new airframes, as well as
regular maintenance for the existing airframes. The Committee
urges both the Army and the ARNG to prioritize facilities that
support readiness of ARNG aviation units as they prepare to
gain new aircraft platforms.
National Guard Training Center.--Committee recognizes the
importance of the National Guard Texas Training Center, which
has been in development since 2010 and has had execution
delays. The Committee recognizes that the Texas Training Center
remains a high priority and the Texas Army National Guard shall
continue its efforts to establish the Center.
Maneuver Area Training Equipment Site (MATES).--The
Committee recognizes the critical role of the Maneuver Area
Training Equipment Site (MATES) in providing needed wheel
vehicle maintenance for M1 Abrams Tanks and M2 Bradley Infantry
Fighting Vehicles at installations such as Camp Shelby.
Therefore, the Committee encourages the Army National Guard to
prioritize the modernization of these types of facilities.
Military Construction, Air National Guard
Appropriation, fiscal year 2020....................... $164,471,000
Budget request, fiscal year 2021...................... 64,214,000
Recommended in the bill............................... 64,214,000
Comparison with:
Appropriation, fiscal year 2020................... -100,257,000
Budget request, fiscal year 2021.................. - - -
Military Construction, Air National Guard.--The bill
includes $64,214,000 for the following projects in the
following amounts:
------------------------------------------------------------------------
Project Amount
------------------------------------------------------------------------
Montgomery Regional Airport--F-35 Simulator Facility. $11,600,000
Joint Base Andrews--F-16 Mission Training Center..... 9,400,000
Joint Base San Antonio--F-16 Mission Training Center. 10,800,000
Joint Region Marianas--Space Control Facility 5...... 20,000,000
Planning and Design.................................. 3,414,000
Minor Construction................................... 9,000,000
Total, Military Construction, Air National Guard. 64,214,000
------------------------------------------------------------------------
In addition, for unfunded requirements of the Air National
Guard, the bill includes $54,700,000 in section 123 for the
following projects in the following amounts:
------------------------------------------------------------------------
Project Amount
------------------------------------------------------------------------
Unfunded Requirements (Section 123)
Hector International Airport--Consolidated RPA $17,500,000
Operational Facilities..............................
Montgomery International Airport--Base Supply Complex 10,200,000
Camp Murray--Air Support Operations Complex.......... 27,000,000
Total, Unfunded Requirements, Air National Guard. 54,700,000
------------------------------------------------------------------------
Wildland Fire Mission.--The Committee directs the National
Guard Bureau to prioritize the remodeling and replacement of
Air National Guard (ANG) Wing Buildings that support the
wildland fire suppression mission and utilize the Modular
Airborne Fire Fighting System but are not in compliance with
Executive Order 13423. The Committee requests a report within
60 days of enactment of this Act regarding the condition of ANG
facilities that support the wildland fire-fighting mission.
Military Construction, Army Reserve
Appropriation, fiscal year 2020....................... $60,928,000
Budget request, fiscal year 2021...................... 88,337,000
Recommended in the bill............................... 88,337,000
Bill compared with:
Appropriation, fiscal year 2020................... +27,409,000
Budget request, fiscal year 2021.................. - - -
Military Construction, Army Reserve.--The bill includes
$88,337,000 for the following projects in the following
amounts:
------------------------------------------------------------------------
Project Amount
------------------------------------------------------------------------
Gainesville--ECS TEMF Warehouse...................... $36,000,000
Devens RFTS--Automated Multipurpose Machine Gun Range 8,700,000
Ashevelle--Army Reserve Center & Land................ 24,000,000
Fort McCoy--Scout Reconnaissance Range............... 14,600,000
Planning and Design.................................. 1,218,000
Minor Construction................................... 3,819,000
Total, Military Construction, Army Reserve....... 88,337,000
------------------------------------------------------------------------
In addition, for unfunded requirements and cost to complete
projects of the Army Reserve, the bill includes $59,100,000 in
sections 123 and 126 for the following projects in the
following amounts:
------------------------------------------------------------------------
Project Amount
------------------------------------------------------------------------
Cost to Complete (Section 126)
Fort McCoy--Transient Training Barracks.............. $1,000,000
Yakima--ECS/TEMF..................................... 7,000,000
Starkville--Reserve Center........................... 2,200,000
Total, Cost to Complete, Army Reserve............ 10,200,000
Unfunded Requirements (Section 123)
Wright Patterson AFB--Area Maintenance Support $11,300,000
Activity............................................
Sheridan--Area Maintenance Support Activity.......... 18,900,000
Yakima--Equipment Concentration Site Warehouse....... 16,200,000
Fort McCoy--Transient Trainee Barracks............... 2,500,000
Total, Unfunded Requirements, Army Reserve....... 48,900,000
------------------------------------------------------------------------
Military Construction, Navy Reserve
Appropriation, fiscal year 2020....................... $54,955,000
Budget request, fiscal year 2021...................... 70,995,000
Recommended in the bill............................... 70,995,000
Comparison with:
Appropriation, fiscal year 2020................... +16,040,000
Budget request, fiscal year 2021.................. - - -
Military Construction, Navy Reserve.--The bill includes
$70,995,000 for the following projects in the following
amounts:
------------------------------------------------------------------------
Project Amount
------------------------------------------------------------------------
Reisterstown--Reserve Training Center................ $39,500,000
Hill AFB--Naval Operations Support Center............ 25,010,000
Planning and Design.................................. 3,485,000
Minor Construction................................... 3,000,000
Total, Military Construction, Navy Reserve....... 70,995,000
------------------------------------------------------------------------
In addition, for cost to complete projects of the Navy
Reserve, the bill includes $3,500,000 in section 126 for the
following projects in the following amounts:
------------------------------------------------------------------------
Project Amount
------------------------------------------------------------------------
Cost to Complete (Section 126)
Marine Corps Reserve Station Galveston--Reserve $3,500,000
Center Annex........................................
Total, Unfunded Requirements, Navy Reserve....... 3,500,000
------------------------------------------------------------------------
Military Construction, Air Force Reserve
Appropriation, fiscal year 2020....................... $59,750,000
Budget request, fiscal year 2021...................... 23,117,000
Recommended in the bill............................... 23,117,000
Bill compared with:
Appropriation, fiscal year 2020................... -36,633,000
Budget request, fiscal year....................... - - -
Military Construction, Air Force Reserve.--The bill
includes $23,117,000 for the following projects in the
following amounts:
------------------------------------------------------------------------
Project Amount
------------------------------------------------------------------------
Fort Worth--F-35A Simulator Facility................. $14,200,000
Planning and Design.................................. 3,270,000
Minor Construction................................... 5,647,000
Total, Military Construction, Air Force Reserve.. 23,117,000
------------------------------------------------------------------------
North Atlantic Treaty Organization Security Investment Program
Appropriation, fiscal year 2020....................... $172,005,000
Budget request, fiscal year 2021...................... 173,030,000
Recommended in the bill............................... 173,030,000
Comparison with:
Appropriation, fiscal year 2020................... +1,025,000
Budget request, fiscal year 2021.................. - - -
The North Atlantic Treaty Organization Security Investment
Program (NSIP) consists of annual contributions by North
Atlantic Treaty Organization (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 United States occasionally has been forced to
temporarily delay the authorization of projects due to
shortfalls in United States obligation authority. The Committee
directs the Secretary of Defense to notify the Committee within
14 days of the United States taking action to delay the
authorization of projects temporarily, or to temporarily
withhold funds from previously authorized projects, due to
shortfalls in U.S. obligation authority.
Department of Defense Base Closure Account
Appropriation, fiscal year 2020....................... $398,526,000
Budget request, fiscal year 2021.................. 300,447,000
Recommended in the bill........................... 580,447,000
Bill compared with:
Appropriation, fiscal year 2020................... +181,921,000
Budget request, fiscal year 2021.................. +280,000,000
The recommendation provides an additional $80,000,000 for
the Navy to accelerate environmental remediation at
installations closed under previous Base Closure and
Realignment (BRAC) rounds. Furthermore, the Navy shall provide
to the Committee a spend plan for these additional funds no
later than 60 days after enactment of this Act.
Perfluorooctane Sulfonate (PFOS) and Perfluorooctanoic Acid
(PFOA).--The Committee is concerned about the extent of PFOS/
PFOA contamination at U.S. military installations and how that
contamination is measured. The Committee believes the
Department should prioritize protecting servicemembers, their
families, and the Department's civilian employees from the
health problems associated with exposure to these chemicals
that are linked in various ways to developmental delays in
fetuses and children; premature births and low birth weights;
decreased fertility; immune suppression; liver damage;
respiratory disorders; metabolic disorders; and prostate,
kidney, and testicular cancer. Therefore, the Committee
includes an additional $200,000,000 above the budget request
within the Base Closure Account to increase the pace of cleanup
at the military installations affected by PFOS/PFOA.
PFOS/PFOA Regulation and Research.--Recognizing that this
issue is not limited to DOD and affects many communities across
the Nation, the Committee is encouraged by the Environmental
Protection Agency's (EPA) February 2020 announcement that it
plans to regulate PFOS/PFOA and to require that proposed new
uses be reviewed under the Toxic Substances Control Act. DOD
and affected communities are urged to work closely with EPA on
these regulatory initiatives. DOD is also encouraged to engage
the research community so as to ensure that it is using the
best and most up-to-date science to guide DOD remediation plans
and processes.
PFOS/PFOA Reporting Requirement.--In fiscal year 2020, the
Committee directed the Department to keep it apprised of new
findings of PFOS/PFOA at BRAC sites. The Committee recognizes
that the Services have provided some information. However, the
Committee is concerned that the process for identifying PFOS/
PFOA contamination at BRAC sites and determining the
appropriate remediation plan is not transparent. Therefore, the
Deputy Assistant Secretary of Defense for Environment is
directed to report to the congressional defense committees no
later than 30 days after this report is been filed with the
Clerk of the U.S. House of Representatives, and quarterly
thereafter, on the progress the Department is making on
identifying and remediating PFOS/PFOA at closed military
installations. At a minimum, the first report should include
information on the existing process and make recommendations
for improving its transparency; identifying all detections of
PFOS/PFOA and existing remediation sites plans; and estimating
current and future costs and timelines for remediation.
Family Housing Overview
Appropriation, fiscal year 2020....................... $1,324,002,000
Budget request, fiscal year 2021...................... 1,351,392,000
Recommended in the bill............................... 1,351,392,000
Bill compared with:
Appropriation, fiscal year 2020................... +27,390,000
Budget request, fiscal year 2021.................. - - -
Family housing construction accounts provide funds for new
construction, construction improvements, the Federal
government's 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.
Housing Support Costs and Management Accounts.--The
recommendation includes $135,000,000 within Housing Support
Costs under Family Housing Operation and Maintenance accounts
for the Services. The funding is to increase the Services'
ability to provide oversight and management, and personnel to
track current and future issues that may occur in military
family housing.
Privatized Military Housing.--Quality military housing a
key component of military readiness and military family
stability. Recognizing the chronic underinvestment in military
housing on domestic military installations and related
readiness concerns, Congress authorized the Military Privatized
Housing Initiative (MPHI) as part of the National Defense
Authorization Act for Fiscal Year 1996, (P.L. 104-106). Under
MPHI, the Department partnered with private sector companies to
build and renovate military housing.
Through MPHI, military housing improved. However, serious
shortcomings were uncovered over the past two years. Through
the Committee's oversight work, unsafe conditions, mold
contamination, and unresponsive and unhelpful private partners
were brought to light.
The Committee recognizes the efforts of the Services to
improve their management and oversight of their private sector
partners and appreciates the new requirements developed by the
House and Senate Armed Services Committees in the National
Defense Authorization Act for Fiscal Year 2020, (P.L. 116-92).
However, the Committee continues to have numerous concerns and
requests the Services report back to the Committee within 90
days of enactment of this Act, except as otherwise noted,
regarding the following issues.
The Committee is concerned that the Services do not have
the ability to readily assess the satisfaction of
servicemembers with the quality of their privatized homes and
housing communities because existing installation reporting
systems do not capture this type of information. The Committee
requests that the Services provide a report analyzing this
concern and include options and recommendations.
At this time, the Tenant Bill of Rights, as proscribed by
the National Defense Authorization Act for Fiscal Year 2020,
has been implemented except for Rights #16, #17, and #18. The
Committee directs the Services to report on the status of
implementation of these three Rights within 60 days of
enactment of this Act.
The Committee remains concerned with the number and
seriousness of complaints regarding mold. It directs DOD to
work with the private sector partners to prioritize funding for
mold remediation and report on its efforts.
The Committee expects the Services to hold their private
sector partners to a standard of both good performance and
accurate and transparent reporting to military commanders and
managers regarding their actions and practices. The Services
should not tolerate any systemic or specific instances of
dishonesty, deception, or fraud by their private sector
partners. Instead, they should remain actively engaged with
them and keep the Committee informed of any issues as they
arise.
The Committee is concerned that claim settlement non-
disclosure agreements between servicemember tenants and private
sector partners that are not part of a litigated matter but
purport to bar tenants from reporting or speaking out about
their housing conditions may have contributed to delays in
addressing ongoing health and safety threats in military
housing, as well as mismanagement by MHPI companies. The
Committee directs the Services to prevent, to the extent
practicable, the use of non-disclosure agreements by MHPI
companies in the settlement of non-litigated housing condition-
related claims with military tenants and report to the
Committee if a non-disclosure agreement has been used within 30
days of discovering the use.
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 exceeds 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 before entering into such an agreement; and
(3) base leasing decisions on the economic analysis.
Family Housing Construction, Army
Appropriation, fiscal year 2020....................... $141,372,000
Budget request, fiscal year 2021...................... 119,400,000
Recommended in the bill............................... 119,400,000
Bill compared with:
Appropriation, fiscal year 2020................... -21,972,000
Budget request, fiscal year 2021.................. - - -
The bill includes $4,500,000 for the following cost to
complete project in the following amount in section 126:
------------------------------------------------------------------------
Project Amount
------------------------------------------------------------------------
Project Amount Cost to Complete (Section 126)
Fort Gordon--Army Family Housing Construction........ $4,500,000
Total, Cost to Complete, Family Housing 4,500,000
Construction, Army..............................
------------------------------------------------------------------------
Family Housing Operation and Maintenance, Army
Appropriation, fiscal year 2020....................... $357,907,000
Budget request, fiscal year 2021...................... 367,142,000
Recommended in the bill............................... 367,142,000
Bill compared with:
Appropriation, fiscal year 2020................... +9,235,000
Budget request, fiscal year 2021.................. - - -
Family Housing Construction, Navy and Marine Corps
Appropriation, fiscal year 2020....................... $47,661,000
Budget request, fiscal year 2021...................... 42,897,000
Recommended in the bill............................... 42,897,000
Bill compared with:
Appropriation, fiscal year 2020................... -4,764,000
Budget request, fiscal year 2021.................. - - -
Family Housing Operation And Maintenance, Navy And Marine Corps
Appropriation, fiscal year 2020....................... $317,870,000
Budget request, fiscal year 2021...................... 346,493,000
Recommended in the bill............................... 346,493,000
Bill compared with:
Appropriation, fiscal year 2020................... 28,623,000
Budget request, fiscal year 2021.................. - - -
Family Housing Construction, Air Force
Appropriation, fiscal year 2020....................... $103,631,000
Budget request, fiscal year 2021...................... 97,214,000
Recommended in the bill............................... 97,214,000
Bill compared with:
Appropriation, fiscal year 2020................... -6,417,000
Budget request, fiscal year 2021.................. - - -
Family Housing Operation and Maintenance, Air Force
Appropriation, fiscal year 2020....................... $295,016,000
Budget request, fiscal year 2021...................... 317,021,000
Recommended in the bill............................... 317,021,000
Bill compared with:
Appropriation, fiscal year 2020................... +22,005,000
Budget request, fiscal year 2021.................. - - -
Family Housing Operation and Maintenance, Defense-Wide
Appropriation, fiscal year 2020....................... $57,000,000
Budget request, fiscal year 2021...................... 54,728,000
Recommended in the bill............................... 54,728,000
Bill compared with:
Appropriation, fiscal year 2020................... -2,272,000
Budget request, fiscal year 2021.................. - - -
Department of Defense Family Housing Improvement Fund
Appropriation, fiscal year 2020....................... $3,045,000
Budget request, fiscal year 2021...................... 5,897,000
Recommended in the bill............................... 5,897,000
Bill compared with:
Appropriation, fiscal year 2020................... +2,852,000
Budget request, fiscal year 2021.................. - - -
Department of Defense Military Unaccompanied Housing Improvement Fund
Appropriation, fiscal year 2020....................... $500,000
Budget request, fiscal year 2021...................... 600,000
Recommended in the bill............................... 600,000
Bill compared with:
Appropriation, fiscal year 2020................... +100,000
Budget request, fiscal year 2021.................. - - -
Administrative Provisions
The bill includes a total of 30 Administrative provisions,
27 of which are effective in fiscal year 2020.
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
for projects at Arlington National Cemetery.
The bill includes section 123 providing additional funds
for various military construction accounts and requires a spend
plan for each.
The bill includes section 124 defining the congressional
defense committees.
The bill includes section 125 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 126 providing additional funds
for cost to complete projects identified by the Services.
The bill includes section 127 providing additional funds
for family housing operation and maintenance.
The bill includes section 128 prohibiting the use of funds
for any other purpose not specified in the bill.
The bill includes section 129 prohibiting the use of funds
in this Act and previous Acts for the construction of a wall,
barrier, fence, or road along the Southern border of the United
States or a road to provide access to a wall, barrier, or fence
constructed along the Southern border of the United States or
for any military construction projects for which previously
appropriated funds were rescinded or postponed by the emergency
declaration of a national emergency on February 15, 2019.
The bill includes section 130 prohibiting the construction
of a facility on a military installation bearing the name of a
confederate officer unless a process has been initiated to
rename the installation.
TITLE II
DEPARTMENT OF VETERANS AFFAIRS
Fiscal year 2020 enacted level1........... $217,862,725,000
Fiscal year 2021 budget request1.......... 240,245,173,000
Committee recommendation in the bill1..... 240,210,107,000
Comparison with:
Fiscal year 2020 enacted.............. +22,347,382,000
Fiscal year 2021 budget request....... -35,066,000
Fiscal year 2022 advance budget request... 239,494,478,000
Fiscal year 2022 Committee recommendation 239,494,478,000
in the bill..............................
1All funding cited excludes amounts in the Medical Care Collections
Fund.
The Department of Veterans Affairs (VA) provides health
care for 9,300,000 Veteran enrollees, disability compensation
benefits to over 5,700,000 Veterans and survivors, pension
benefits for over 392,000 Veterans and survivors, life
insurance for nearly 5,800,000 Veterans, servicemembers and
their families, educational assistance for nearly 950,000
trainees, and interment of 137,000 Veterans and eligible family
members in national cemeteries. To serve adequately the
Nation's Veterans, VA employs more than 400,000 people, making
it one of the largest Federal agencies in terms of employment.
Resiliency.--The Stafford Act requires VA and its
facilities to be prepared to support local communities in the
event of a major disaster or medical emergency. In such a
scenario, VA's ability to adequately respond relies heavily
upon the energy resiliency of its medical centers. VA Medical
Centers must be able to recover from energy disruptions and
have access to reliable power to ensure it can handle a
significant emergency. To ensure VA is adequately prioritizing
the reliability of its energy and water infrastructure, the
Committee directs VA to provide a report within 180 days of
enactment of this Act detailing VA's plans to develop energy
resilient medical facilities, including planned investments in
distributed generation, energy and water efficiency efforts,
and other improvements that can protect mission-critical
operations at VA facilities from disruptions to the power grid.
This plan should include details on VHA energy engineering and
VHA energy contracting staffing needs.
Native Hawaiian, Pacific Islander and United States-
Affiliated Pacific Islander Veteran Health Care.--Native
Hawaiian, Pacific Islander, and United States-Affiliated
Pacific Islanders disproportionately serve in the U.S. military
and therefore represent significant numbers of Veterans across
the United States and Pacific, particularly in rural and remote
locations. While VA has centers dedicated to health policy,
innovation, health economics and more, the Committee notes that
VA would benefit from additional research, service, and
education to improve the lives of Native Hawaiian, Pacific
Islander and U.S.-Affiliated Pacific Islander Veterans. In
performing this effort, VA should consider partnering with non-
government institutions and universities to examine telehealth
and telepharmacy; models of interprofessional primary care,
including the integration of pharmacists and behavioral health;
electronic health records and data analytics; health workforce;
and indigenous people innovation.
Fraud Protection System.--VA continues to face challenges
preventing fraud, waste, and abuse (FWA), despite previous
efforts. A January 2019 report issued by a VA-established FWA
panel recommended six specific actions VA could adopt to reduce
FWA, including a recommendation to expand the Department's use
of data analytics and predictive modeling capabilities across
the enterprise, creating a holistic view of FWA, and providing
comprehensive prevention solutions. VA is encouraged to
investigate the feasibility of establishing a department-wide
Fraud Prevention System that uses predicative modeling and
other analytics technologies to identify and prevent FWA.
Women Veteran Transitional Housing Support.--The Committee
recognizes the need for transitional and supportive housing
services for women Veterans who are experiencing homelessness
or housing insecurity. The Committee also recognizes that in
the past, Veteran services were primarily designed for men and
do not always meet the needs of women Veterans. Women Veterans
struggling with the acclimation to civilian and community life
often find themselves in at-risk circumstances that may differ
from those of men, and therefore women Veterans require
specialized interventions and programming. The Committee
encourages the Department to work with the Department of
Defense and the Department of Labor to provide robust gender-
specific case management services for women Veterans
transitioning from military service.
Veterans Benefits Administration (VBA)
COMPENSATION AND PENSIONS
(INCLUDING TRANSFER OF FUNDS)
Appropriation, fiscal year 2021...................... $118,246,975,000
Budget request, fiscal year 2021..................... 2,813,922,000
Recommended in the bill, fiscal year 2021............ 2,813,922,000
Budget request, fiscal year 2022..................... 130,227,650,000
Recommended in the bill, fiscal year 2022............ 130,227,650,000
Bill compared with:
Appropriation, fiscal year 2021.................. +11,980,675,000
Budget request, fiscal year 2022................. - - -
This appropriation provides funds for service-connected
compensation payments to an estimated 5,724,000 Veterans,
survivors, and dependents in fiscal year 2021. In addition,
pension payments will be funded for 393,000 Veterans and their
survivors. The average payment per compensation case for
Veterans in fiscal year 2021 is estimated at $19,974 and
pension payments are projected at $14,186.
The appropriation includes authority to transfer funding
not to exceed $20,115,000 in fiscal year 2022 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 (P.L.
101-508), the Veterans' Benefits Act of 1992 (P.L. 102-568),
and the Veterans' Benefits Improvements Act of 1994 (P.L. 103-
446). These cost-saving provisions include verifying pension
income against Internal Revenue Service and Social Security
Administration (SSA) data; establishing a match with 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.
Pro-bono Legal Services.--The Committee recognizes an unmet
need for holistic programs that offer pro-bono legal services
to Veterans and their dependents. The Committee acknowledges
existing VA initiatives that guide Veterans during benefit-
related interactions with administrative agencies and believes
that public land-grant university law schools are suited to
complement existing agency efforts in underserved areas.
Financial Hardship and Bankruptcy.--The Committee continues
to support VA programs, such as disability-related benefits,
that seek to address 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.
Performance Measures and Communication Efforts.--The
Committee remains interested in VA's implementation of
performance measures in response to the findings of the
Government Accountability Office (GAO) report entitled,
``Better Measures Needed to Assess Regional Office Performance
in Processing Claims'' (GAO 19-15). The Committee encourages VA
to continue to improve regional office communication with
Veterans Service Organizations (VSOs) and congressional
caseworkers, including discussions surrounding the feasibility
of locating satellite congressional member offices within VA
Medical Centers (VAMCs).
READJUSTMENT BENEFITS
Appropriation, fiscal year 2021....................... $12,578,965,000
Budget request, fiscal year 2022...................... 14,946,618,000
Recommended in the bill, fiscal year 2022............. 14,946,618,000
Bill compared with:
Appropriation, fiscal year 2021................... +2,367,653,000
Budget request, fiscal year 2022.................. - - -
This appropriation funds 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 funds 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 continue 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, or where travel time makes current
VSOC programs difficult to access.
Vocational Rehabilitation and Employment.--The Committee
supports the work of vocational rehabilitation and employment
programs that provide no-cost, wrap-around support services for
the Veterans community, including career track and job
readiness programs. These services help participants develop
both job-specific knowledge and abilities, as well as the
attitudes, habits, and behaviors needed to successfully secure
and retain employment and earn family-sustaining wages in
occupations that offer opportunities for career progression.
Veteran Readiness and Employment Service Counselor to
Client Ratio.--The Committee continues to encourage the
Department to seek opportunities to expand staffing counselors
within the Veteran Readiness and Employment Service (VR&E),
formerly known as the Vocational Rehabilitation and Employment
Service, in order to maintain a ratio of 125 Veterans to one
full-time equivalent (FTE) position, and to provide the
comprehensive individualized services that these Veterans have
earned. The Committee is also concerned about reports that
Veterans experience frustration when being transferred from one
counselor to another, often without proper notification to the
Veteran. The Committee urges the Department to put procedures
in place to improve implementation of the program by ensuring a
smooth transition when Veterans are transferred among
counselors.
Improving Technology to Deliver GI Bill Benefits.--The
Committee notes that to fully achieve the promise of the Harry
W. Colmery Veterans Educational Assistance Act (P.L. 115-48),
also known as the ``Forever GI Bill,'' and other educational
benefits provided to Veterans, a modernized information
technology platform is needed to provide GI Bill beneficiaries
with the world-class experience they have earned and deserve.
The Committee encourages VBA to pursue a digital platform that
will provide faster and more accurate payments to GI Bill
beneficiaries and ensure Veterans and their families have more
convenient options when interacting with the Veterans Benefit
Administration, including the use of mobile phones and
electronic correspondence.
GI Bill Allowance for Housing.--The Post-9/11 GI Bill
allowance for housing is a critical benefit to GI Bill
recipients. The Committee is aware that in municipalities
covered by more than one military housing area, GI Bill housing
benefits may differ substantially throughout the municipality,
creating inequities. The Committee directs the Department to
review whether housing benefits in municipalities covered by
more than one military housing area are adequate to meet the
financial needs of GI Bill recipients located in those areas
and to report to the Committee on Appropriations no later than
180 days after enactment of this Act on whether changes to the
housing benefit are needed to ensure fairly distributed housing
benefits that provide sufficient assistance to students. The
Committee encourages VA to incorporate into this review
publicly available housing data, including the median rent in
affected municipalities, as paid by the same population used to
calculate the housing allowance. Additionally, the Committee
urges the Department to raise this issue as part of the DOD-VA
working group on GI Bill issues.
Cyber Training.--The Committee urges VA to establish a
cyber training pilot program that, in addition to training VA's
internal cyber workforce, can be scaled up and offered to
transitioning military to help Veterans reintegrate into the
workforce. In doing so, VA should also consider collaboratively
working with the Centers of Academic Excellence in
Cybersecurity (CAE-C) community to jointly develop cyber
curriculums, hands-on skills development, and performance-based
assessment solutions that align specifically to work roles
within the National Initiative for Cybersecurity Education
(NICE) Cyber Workforce Framework and can be integrated into the
cyber training program.
Transition Coordination.--The Committee believes that VA,
in consultation with the Departments of Labor and Defense,
should further coordinate efforts and resources to ensure
Veterans have a successful transition to civilian life. This
includes sharing information on community resources, including
nonprofits and VSOs, that are available to the Veteran and
their family as they depart the service. The Committee also
urges VA to explore options for Veterans to access hands-on job
placement services that connect Veterans directly with
employers, and encourages VA to look at successful state and
local programs in this area.
Veteran Awareness of Student Loan Forgiveness.--The
Committee understands that Veterans may have student loans they
acquired either prior to enlistment or outside of their GI Bill
benefits. The Committee encourages VA to coordinate with other
agencies, including the Departments of Education and Defense,
and increase efforts to ensure that Veterans are aware of all
their student loan forgiveness options or repayment programs
for which they may be eligible.
GI Bill Comparison Tool.--The Committee emphasizes the
importance of providing Veterans with the necessary information
to make informed decisions when selecting institutions of
higher education (IHE). The Committee strongly urges VA to make
available through the GI Bill Comparison Tool, in a searchable
format, the following information: whether an IHE is a minority
serving institution (MSI), a gender-specific institution, or a
religiously-affiliated school. These categories should be
broken down into subcategories that specify the type of MSI and
religious affiliation.
VETERANS INSURANCE AND INDEMNITIES
Appropriation, fiscal year 2021....................... $129,224,000
Budget request, fiscal year 2021...................... 2,148,000
Recommended in the bill, fiscal year 2021............. 2,148,000
Budget request, fiscal year 2022...................... 136,950,000
Recommended in the bill, fiscal year 2022............. 136,950,000
Bill compared with:
Appropriation, fiscal year 2021................... +7,726,000
Budget request, fiscal year 2022.................. - - -
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; servicemember'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 Indemnities
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 for Administrative
Program Account specially adapted Expenses
housing loans
----------------------------------------------------------------------------------------------------------------
Appropriation, fiscal year 2020.......................... - - - ($500,000) $200,377,391
Budget request est., fiscal year 2021.................... - - - (500,000) 204,400,000
Recommended in the bill.................................. - - - (500,000) 204,400,000
Bill compared with:
Appropriation, fiscal year 2020...................... - - - - - - +4,022,609
Budget request, fiscal year 2021..................... - - - - - - - - -
----------------------------------------------------------------------------------------------------------------
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 (P.L. 101-508) 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.
Home Loan Income Verification.--The Committee is aware of
the Department's denial of home loan guarantees to Veterans
solely on the basis of the Veteran's documented income being
derived from state-legalized cannabis activities, and has
previously expressed concern that confusion on this issue
hinders Veterans' ability to fully understand and consider how
employment decisions could affect future eligibility for earned
benefits. The Committee understands that as directed by House
Report 116-63, VA has clarified that nothing in VA statutes or
regulations specifically prohibits a Veteran whose income is
derived from state-legalized cannabis activities from obtaining
a certificate of eligibility for VA home loan benefits. The
Committee directs the VA to improve communication with eligible
lending institutions to reduce confusion among lenders and
borrowers on this matter.
VOCATIONAL REHABILITATION LOANS PROGRAM ACCOUNT
----------------------------------------------------------------------------------------------------------------
Limitation on Administrative
Program Account direct loans Expenses
----------------------------------------------------------------------------------------------------------------
Appropriation, fiscal year 2020.......................... $57,729 ($2,008,232) $401,880
Budget request, fiscal year 2021......................... 33,826 (2,469,522) 424,272
Recommended in the bill.................................. 33,826 (2,469,522) 424,272
Bill compared with:
Appropriation, fiscal year 2020...................... -23,903 (461,290) +22,392
Budget request, fiscal year 2021..................... - - - - - - - - -
----------------------------------------------------------------------------------------------------------------
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 $1,260 (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 (P.L. 101-508) requires budgetary resources to be
available prior to incurring a direct loan obligation.
It is estimated that the Department will make 2,376 loans
in fiscal year 2021, with an average amount of $1,040.
NATIVE AMERICAN VETERAN HOUSING LOAN PROGRAM
Administrative expenses:
Appropriation, fiscal year 2020....................... $1,186,000
Budget request, fiscal year 2021...................... 1,163,000
Recommended in the bill............................... 1,186,000
Bill compared with:
Appropriation, fiscal year 2020................... - - -
Budget request, fiscal year 2021.................. +23,000
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
Appropriation, fiscal year 2020....................... $3,125,000,000
Budget request, fiscal year 2021...................... 3,207,000,000
Recommended in the bill............................... 3,187,000,000
Bill compared with:
Appropriation, fiscal year 2020................... +62,000,000
Budget request, fiscal year 2021.................. -20,000,000
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, 2022, up to
ten percent of these funds.
The Committee provides $3,187,000,000 for the General
Operating Expenses, VBA account, to enable VBA to deliver the
benefits that our Veterans rely on.
In addition, the Coronavirus Aid, Relief, and Economic
Security Act (CARES Act) (P.L. 116-136) included $13,000,000
for VBA to prevent, prepare for, and respond to coronavirus.
Blue Water Navy Veterans.--The Committee continues to
closely follow the implementation of the Blue Water Navy
Vietnam Veterans Act (P.L. 116-23). The Committee provides
requested funds to support implementation of the law, including
staffing, scanning of records, and correspondence with
Veterans. The Committee continues the requirement that VA
report to the Committees on Appropriations of both Houses of
Congress on a quarterly basis information related to claims
considered under the Blue Water Navy Vietnam Veterans Act. This
information should include timeliness measures as well as grant
and denial rates for these claims.
Disability Claims.--The Committee continues to be concerned
about reports of delays Veterans experience in the resolution
of pending compensation and pension claims. While the Committee
appreciates the focus in attention and resources the Department
has given to this concern, reducing the claims backlog and
making sustainable improvement in the waiting period for claims
adjudication is essential. The Committee urges the Department
to prioritize resources toward providing Veterans with the
timely relief and support they deserve. The funding level is
sufficient to continue programs that support effective
management of claims, including the Veterans Claims Intake
Program.
Conditions Presumptively Associated with Agent Orange.--The
Committee is aware that VA has not yet acted in response to the
2018 report from the National Academies of Science,
Engineering, and Medicine that concluded that bladder cancer,
hypothyroidism, Parkinson-like syndromes, and hypertension all
have at least ``limited or suggestive'' evidence of an
association with exposure to Agent Orange herbicides. The
Committee notes that the ``limited or suggestive'' threshold
has been deemed sufficient by VA in years past to add multiple
prior conditions to the category of diseases presumptively
recognized by VA as service-connected. However, Veterans with
these four particular conditions have been made to wait for
fair treatment in light of VA's inaction on adding these
conditions to the presumptive category. The Committee is
concerned that VA officials intend to wait for evidence these
conditions are caused by, rather than associated with, exposure
to Agent Orange. As such, the Committee reminds the Department
that there is no legal requirement that sets causation as the
standard. To the contrary, the Department's apparent policy
runs counter to statutory text and longstanding case law,
including the landmark Nehmer v. U.S. Department of Veterans
Affairs case. The Committee directs the Department to report to
the Committees on Appropriations of both Houses of Congress no
later than 60 days after enactment of this Act, detailing the
legal basis the Department is relying upon to demand causation
as the standard for adding these four conditions to the
presumptively service-connected category. Further, the
Committee expects the Department to act on the conclusions of
the National Academies of Science, Engineering, and Medicine in
a fair and expeditious manner to avoid causing Veterans
additional delays in receiving the benefits they have earned.
Equitable Relief.--The Committee reiterates that it
understands VA is working to implement new systems and
protocols to eliminate instances of administrative error.
However, as VA enacts system-wide reforms, ending equitable
relief for Veterans who were deemed eligible for benefits in
error would place an unfair burden on Veterans and their
families. The Secretary is directed to continue to grant or
extend equitable relief to eligible Veterans initially deemed
eligible in instances of administrative error. Not later than
April 1, 2021, the Secretary shall submit to the Committees a
report containing a statement as to the disposition of each
case recommended to the Secretary for equitable relief under 38
U.S.C 503 during the preceding calendar year.
Military Sexual Trauma (MST) Claims.--The 2018 Inspector
General's report found that almost half of denied MST-related
claims were not properly adjudicated in accordance with VBA
policies. The Committee is concerned that VBA has not
implemented all of the recommendations of the Inspector
General's report and that OIG's concerns regarding VBA's
process for reevaluating previously denied claims has resulted
in a new audit of VBA. The Committee directs VA to report to
the Committee by October 31, 2020, on implementation of the
Inspector General's recommendations, and to consult with the
Committee prior to any changes in the system for handling MST-
related claims. The Committee welcomes VBA's expressed
commitment to engaging with MST survivors and willingness to
incorporate input from MST survivors in its training for MST
claim processors. However, the Committee is concerned that
research has shown that MST-related claims by males are less
likely to be approved than those filed by females. The
Committee urges VBA to investigate this discrepancy and to
ensure that input from male MST survivors is also incorporated
in training. The Committee is also concerned that Veterans
suffering from a mental health disorder as a result of sexual
trauma during service have different standards of evidence
based on their diagnosis. The Committee recognizes that
evidence in personnel files is rare, no matter the resulting
condition following MST. Therefore, the Committee urges VA to
support the extension of the relaxed evidentiary standard to
all those suffering from mental health disorders as a result of
MST. Further, the Committee urges VA to continue to report to
the Committees on Appropriations of both Houses of Congress on
information relating to claims for disabilities incurred or
aggravated by MST, as provided by section 113 of the Jeff
Miller and Richard Blumenthal Veterans Health Care and Benefits
Improvement Act of 2016 (P.L. 114-315).
Veterans Benefits Staffing in Remote Locations.--The
Committee directs VBA to continue to improve access and
outreach to Veterans living in remote and underserved areas,
such as the Commonwealth of the Northern Mariana Islands, by
increasing staff presence in these areas. VA shall provide the
necessary staff and resources to provide more frequent outreach
and ensure access to benefits, and must also ensure the
Veterans in these areas are notified when a benefits counselor
is available to provide assistance and information about the VA
claims process and benefits available to Veterans and their
families. Additionally, the Committee directs VA to assess the
feasibility of placing at least one full-time Veterans Benefits
Counselor in remote and underserved areas that do not have a VA
Benefits Office, such as the Northern Mariana Islands, and
providing such staff the necessary support, space and
equipment, and funds to travel to other areas within each
jurisdiction where Veterans reside on a regular basis. The
Committee directs the Department to report to the Committee on
this assessment no later than 180 days after enactment of this
Act. The report shall include information on the beneficiary
population (Veterans, spouses, and dependents), including their
feedback on VBA services, the demand for direct VBA assistance,
VBA's current efforts to serve the beneficiary population, and
the plan to serve them in the future. The Committee also
encourages the department to assess the feasibility of having
such staff conduct outreach to Veterans living in the Freely
Associated States.
Veterans Health Administration (VHA)
The Department operates the largest Federal medical care
delivery system in the country, with 148 hospitals, 116
residential rehabilitation treatment programs, 135 nursing
homes, 300 Vet Centers, 80 Mobile Vet Centers, and 765
Community-Based outpatient Clinics (CBOCs). Approximately
7,200,000 patients will be treated in fiscal year 2021.
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
2022 of $94,183,260,000 in direct appropriations to fund the
four advance appropriations of VHA. The Committee provides an
additional $2,328,268,000 for the first four accounts for
fiscal year 2021, which is equal to the budget request. In
addition, VA will receive an estimated $4,403,000,000 in the
Medical Care Collections Fund in fiscal year 2021. The
Committee also provides $840,000,000 for Medical and Prosthetic
Research.
VA Fourth Mission.--The Committee encourages VA, as part of
its Fourth Mission, to support national, state, and local
emergency management, public health, and safety efforts in
response to the COVID-19 national public health emergency, when
called upon by the Department of Health and Human Services and/
or the Federal Emergency Management Agency, and to take steps
to identify and make available VA resources and facilities,
such as hospital beds and medical personnel, that can be
utilized to help address this unprecedented national emergency.
Health Navigator.--Section 731 of the National Defense
Authorization Act for Fiscal Year 2018 (P.L. 115-91) required
the Secretary of Defense to conduct a pilot program to improve
health outcomes and patient experience for beneficiaries with
complex medical conditions. The Committee believes that VA
should conduct a similar pilot and looks forward to the results
of the report due no later than January 1, 2021 containing an
evaluation of its success. The Committee will continue to
address this issue as the bill moves through the process.
MEDICAL SERVICES
Fiscal year 2020 enacted level........................ $51,411,165,000
Fiscal year 2021 enacted level........................ 56,158,015,000
Fiscal year 2021 budget year request.................. 497,468,000
Committee 2021 budget year recommendation............. 497,468,000
Fiscal year 2022 advance appropriation request........ 58,897,219,000
Committee 2022 advance appropriation recommendation... 58,897,219,000
Comparison with:
Fiscal year 2021 enacted level.................... +2,739,204,000
Fiscal year 2022 advance budget request........... - - -
The bill provides the request of $58,897,219,000 for
advance fiscal year 2022 funding. The Committee has included
bill language to make available through September 30, 2023,
$1,500,000,000 of the Medical Services advance appropriation
for fiscal year 2022. The Committee provides an additional
$497,468,000 to be available for fiscal year 2021, of which
$40,000,000 is provided for mental health for a total of
$10,297,500,000; $40,000,000 is provided for homelessness
initiatives for a total of $1,928,508,000; $30,000,000 is
provided for rural health for a total of $300,000,000;
$35,000,000 is provided for gender-specific care for women for
a total of $660,691,000; $20,000,000 is provided for Whole
Health initiatives for a total of $83,600,000; $85,008,000 is
provided for suicide prevention efforts for a total of
$312,635,000, as requested in the budget; $75,000,000 is
provided for precision oncology, as requested in the budget;
$64,650,000 is provided for opioid prevention and treatment for
a total of $503,660,000, as requested in the budget;
$93,810,000 is provided for medical equipment; and $14,000,000
is provided for other initiatives specified by the Committee.
In addition, the Coronavirus Preparedness and Response
Supplemental Appropriations Act (P.L. 116-123) included
$30,000,000 and the Coronavirus Aid, Relief, and Economic
Security Act (CARES Act) (P.L. 116-136) included
$14,432,000,000 for the Medical Services account to prevent,
prepare for, and respond to coronavirus, including related
impacts on health care delivery, and for support to Veterans
who are homeless or at risk of becoming homeless.
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, which 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 $1,195,486,000 for the caregivers. The Committee
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 Veterans Integrated Service
Networks (VISNs) and from them to the medical centers may
shortchange the ultimate users because of excessive funding
retained at headquarters or at the VISNs. The Committee
continues to request a report each year, 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
The Committee provides $10,297,500,000 for mental health
programs, which is $40,000,000 above the request. Of the
amounts provided for mental health programs in fiscal year
2021, $1,939,329,000 shall be used for suicide prevention and
treatment programs. Specifically, $312,635,000 shall be used
for suicide prevention outreach, which is $90,870,000 above
fiscal year 2020. With the additional funds, the Committee
directs the Department to implement suicide safety plans that
address parking lot suicides and expand the Coaching Into Care
Program to better help Veterans, their family members, and
other loved ones find the appropriate services at their local
VA facilities and/or in their community. The Committee requests
a report within 90 days of enactment of this Act on the
Department's plans.
The Department should also continue to engage with Veterans
Service Organizations (VSOs) to help remove the stigma that is
associated with seeking mental healthcare. Furthermore, VA is
directed to remove barriers that affect a Veteran when trying
to receive mental healthcare and to implement a twenty-first
century outreach program that incorporates social media and
other electronic means to reach Veterans before they are at a
crisis point.
In addition, the Committee directs VA to engage with DOD to
help servicemembers transition from active duty to civilian
life to ensure that mental health needs are addressed
throughout the transition process. The Department is directed
to provide a report to the Committee, no later than 90 days
after enactment of this Act, identifying a detailed expenditure
plan for all suicide outreach and treatment programs and how VA
is meeting the Committee's directives.
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.
The Committee has repeated bill language 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.--The Committee
remains concerned that in-person mental healthcare is not
available to all Veterans who require this care. 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.
Mental Health Services.--Women Veterans are twice as likely
as women in the general population to die by suicide. To
address this alarming trend, the Committee encourages VA to
take aggressive steps to improve mental health services for
women Veterans and ensure that women's mental health needs,
which often differ from men in prevalence and expression, are
met.
Post-Traumatic Growth Programs.--The Committee recognizes
there is a shortage of adequate, timely, and effective mental
health care available to Veterans across the United States. As
the Department continues to highlight Veterans' mental
healthcare and suicide prevention as a key priority, there is
an opportunity to explore effective alternative treatments
focused on the area of post-traumatic growth. The Committee
continues to encourage the establishment of a pilot program to
study the effectiveness and benefits of nonprofit post-
traumatic growth programs to determine the outcomes of such
programs in contrast to traditional models of mental
healthcare, the possible integration of such nonprofit programs
into mental healthcare programs provided by the Department, and
the budgetary impacts of such integration.
Post-Traumatic Stress Disorder (PTSD) Service Dogs.--The
Committee recognizes the positive role that service, guide, and
hearing dogs have played in mitigating Veterans' disabilities
and providing assistance and rehabilitation. The Energy and
Water, Legislative Branch, and Military Construction and
Veterans Affairs Appropriations Act, 2019 (P.L. 115-244) urged
VA to prioritize support of veterinary healthcare 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 was originally expected to
be completed in June 2020. However, the Committee is concerned
that the report detailing the results and economic impact of
the study will be delayed, and the results of the study will be
broken up into two reports. The Committee directs VA to
expeditiously provide the results of the study to the
Committees on Appropriations of both Houses of Congress within
30 days of enactment of this Act and further requires monthly
reports on the status of the study until it is fully completed
beginning 30 days after this report is filed. The Committee is
interested in the possibility of providing service dogs to
Veterans with a mental health mobility disorder related to
post-traumatic stress or traumatic brain injury. According to
the Department, as many as 20 percent of those who served in
Iraq or Afghanistan are diagnosed with post-traumatic stress.
This disorder can cause debilitating symptoms in Veterans,
leading to depression, social isolation, and suicide. Studies
demonstrate that service dogs provide support to Veterans by
mitigating their disability, allowing for professional and
social reintegration. Currently, waiting lists for service dogs
average between 18 and 24 months, with intensive compulsory
training costing an average of $25,000 per service dog, which
makes this an expensive option for Veterans. The Committee
looks forward to this study and will address this issue as the
bill moves through the process.
Service Dogs for Veterans.--The assistance that service,
guide, and hearing dogs provide to Veterans, especially those
with mobility, visual, auditory, psychological, or psychiatric
disabilities, is encouraging and sometimes life-saving.
However, the Committee is aware of the time and cost of
appropriately training a dog and matching it with a Veteran. As
such, the Committee requests a comprehensive report within 180
days of enactment of this Act regarding potential options and
estimated costs associated with each option, as practicable, to
help meet the increasing demand from Veterans for service dogs.
The report should include information on the number of service
dogs matched with Veterans and in training, accreditation
standards and the number of accredited service dog training
organizations, and estimated current and future demand for
service dogs. The Department should consult with accredited
service dog training organizations and the Wounded Warrior
Service Dog Program, which is funded through the Defense Health
Program and is managed by the Uniformed Services University of
the Health Sciences, on the benefits and challenges of the
existing model for training and matching service dogs with
Veterans.
Public-Private Partnerships.--The Committee is concerned by
the alarming number of suicides committed by Veterans each day.
While the Committee appreciates the important work being done
by the Department to combat suicide and improve mental health
among Veterans, more can and must be done. The Committee
recommends the Department 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. The Secretary
shall report to the Committee no later than 60 days after
enactment of this Act on the status of creating public-private
partnerships related to suicide prevention, PTSD, TBI, and
substance use disorders. Of the funds provided for mental
health programs in fiscal year 2021, no less than $5,000,000 is
to expand the public-private partnerships.
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.
Non-Citizen Veteran Outreach.--The Committee is concerned
about the level of awareness regarding mental health services
by at-risk, non-citizen Veterans. The Committee therefore urges
VA 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.
Post-Traumatic Stress Disorder Research.--The Committee
welcomes the Secretary's commitment to addressing mental health
in the Veteran population. The Committee also recognizes the
importance of the National Center for PTSD at VA in promoting
better prevention, diagnoses, and treatment of PTSD. Consistent
with findings from the VA National Center for PTSD, the
Committee recognizes that some groups of Veterans, including
African-Americans and Latino-Americans, are more likely to
develop PTSD. As such, the Committee directs VHA in
coordination with the VA National Center for PTSD to provide a
report no later than 180 days after enactment of this Act
detailing whether cultural competency training is provided to
healthcare 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 should also include recommendations on how to address
the unique mental health needs of minority Veterans, and
disparities, whether perceived or real, in the care they
receive.
Adverse Childhood Experiences (ACEs).--ACEs exist within
the Veteran population at a substantially higher rate than the
general public. These experiences correlate with significant
negative health outcomes, including on behavioral, mental, and
physical health. The Committee encourages VA to track ACEs
among Veterans and target individualized treatment. To ensure
appropriate treatment from the moment a Veteran enters VA, it
is critical that VA coordinate with DOD to obtain information
on ACEs from servicemembers and provide a seamless transition
in care.
Agritherapy.--An increasing number of states now have
programs that assist Veterans in starting farms, and many
Veterans turning to farming suffer from PTSD. The benefits of
agritherapy have been reported in the news media; however,
limited research and insufficient opportunities exist to offer
the benefits of agritherapy to those suffering from PTSD. VA is
encouraged to work with the Department of Agriculture on
providing agritherapy programs to Veterans. Additionally, the
Committee supports a pilot program to train Veterans in
agricultural vocations, including urban and vertical farming,
while also tending to behavioral and mental health needs with
behavioral healthcare services and treatments from licensed
providers at no fewer than three locations.
Mental Health Data on Asian Pacific American Veterans.--The
Committee recognizes the lack of mental health data specific to
Asian Pacific American Veterans. The Committee directs the
Department to submit a report within 90 days after enactment of
this Act on its data collection efforts.
Military Sexual Assault.--The Committee is aware of the
high prevalence of sexual assault, among both men and women,
during their service. Effects from this assault persist once
servicemembers return home and can manifest in mental health
disorders such as depression, PTSD, SUDs, eating disorders, and
anxiety. Because sexual trauma is so prevalent, the Committee
recommends that all Veterans seeking treatment services are
screened for sexual assault using an evidence-based screening
tool in order to successfully treat those who have experienced
assault.
Military Sexual Trauma-Related Care for Servicemembers at
VA Facilities.--The Veterans Access, Choice and Accountability
Act of 2014 (P.L. 113-146), as amended, allows all
servicemembers regardless of duty status to receive military
sexual trauma-related care from VA, although a VA directive
limits the access to servicemembers to Vet Centers only. VA has
invested considerable resources to increase the capacity of the
VA health care system to provide a range of mental health and
medical care services to assist those who have experienced
military sexual assault. The Committee believes that
servicemembers would benefit from greater access to this
capacity and directs the Secretary to provide to the Committee
no later than 90 days after enactment of this Act a plan to
expand access to military sexual trauma-related care at all VA
health facilities.
Aiding Military Personnel Transitioning to Civilian Life.--
Military Personnel transitioning to civilian life have reported
significant challenges in reintegrating into civilian culture.
Filmmaking has been used as a therapeutic intervention to
enhance the community reintegration of Veterans by encouraging
self-reflection and interactions with other Veterans about
shared experiences. The Committee notes the outcomes of
filmmaking workshops among Veterans, which included Veteran
engagement in mental health care, improved attitudes toward
engaging in mental health care, mitigating symptoms of PTSD and
depression, and reported perception of community interest in
their experience as Veterans. Accordingly, VA is urged to make
funds available to implement these workshops at VA medical
centers across the country so that all Veterans struggling with
PTSD and depression can benefit from this encouraging therapy.
Timely Mental Health Checks.--The Committee recognizes that
Veterans are significantly more likely to suffer from trauma,
PTSD, or to die by suicide than civilians and often times are
undiagnosed. To combat the increasing suicide rate among
Veterans, the Committee strongly recommends that VA identify,
establish, and support programs that promote mental health
screenings for Veterans preparing to transition to civilian
life. It is the Committee's understanding that these mental
health screenings should occur within 30 days of a Veteran's
end of service date to ensure they have the proper resources
needed to transition to civilian life.
Post-Deployment Rehabilitation and Evaluation Program
(PREP).--The Committee believes that the physical
rehabilitation and mental health needs of our active duty
servicemembers and Veterans is a top priority. The Post-
Deployment Rehabilitation and Evaluation Program (PREP) run by
VA is an inpatient initiative that focuses on an individualized
evaluation for servicemembers and Veterans to treat combat-
related physical, cognitive and mental health systems. The
Committee believes it is important to expand the number of
servicemembers and Veterans able to receive care through this
initiative. The Committee is pleased to see further investment
in fiscal year 2020 in PREP and expects to see VA continue the
trend of furthering the investment in the program in fiscal
year 2021. The Committee directs VA to include programmatic
information and funding levels for PREP in future budget
requests.
Wrongfully Turned Away Due to ``Bad Paper''.--The Committee
is concerned about reports that VA has erroneously and
unlawfully turned away Veterans who seek VA care and whose DD
Form 214, Certificate of Release or Discharge from Active Duty,
does not reflect an ``Honorable Discharge,'' also known as
``bad paper.'' Studies have shown that higher rates of Veterans
with bad paper suffer from mental health conditions. The
Committee directs the Secretary to submit a report no later
than 90 days after enactment of this Act on (1) actions taken,
such as requiring VHA staff to notify denied Veterans of their
appeal rights and VHA staff retraining, to eliminate wrongful
turn away of Veterans, and (2) plans to collaborate with VSOs,
Veterans Claims Officers, and state and local Veterans services
on correcting any misinformation on eligibility of VA care for
all Veterans.
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 the establishment of a Trauma Management Therapy
pilot program that utilizes exposure therapy involving virtual
reality in combination with group therapy for the treatment of
individuals with symptoms relating to PTSD. House Report 116-63
directed VA to provide a report detailing the feasibility of
such a pilot program and the metrics required. The Committee
further directs the Department to update this report to include
the feasibility of allowing these technologies to provide
treatment through telehealth to treat PTSD within 90 days of
enactment of this Act.
Collaboration on Gun Safety and Storage.--The Committee
supports continued collaboration across public and private
sectors to end the national tragedy of suicide, and encourages
VA medical centers to collaborate with state and local law
enforcement and health officials in states that have adopted
extreme risk protection orders, also known as ``red flag''
laws, and similar gun safety laws, to adopt programs and
protocols on firearm safety and storage to assist Veterans who
may be struggling with suicidal thoughts.
SUICIDE PREVENTION OUTREACH
VetsCorps.--The Committee continues to strongly support the
VetsCorps pilot program directed in House Report 116-63. The
VetsCorps, comprised of Veterans themselves, will conduct
outreach and recruitment to bring in Veterans who have not been
served by the Department and will connect them with available
programs and services. The VetsCorps should be designed to
reach Veterans wherever they are and provide a personal
connection to VA, including peer-to-peer Veteran support
networks with VetsCorp for Veterans who are trained in suicide
prevention and crisis intervention to help other Veterans
transition from military service to civilian life. The
Committee continues to direct the pilot be carried out at no
fewer than six sites, targeted to regions with low rates of VA
utilization and including at least one rural and urban site.
The Committee directs the Department to provide quarterly
reports on the status of the implementation of the VetsCorp
pilot program. Furthermore, at the conclusion of the pilot, the
Committee directs the Department to report to the Committees on
Appropriations of both Houses of Congress on the effectiveness
of the pilot program at reaching Veterans, particularly those
in need, and increasing utilization of VA services and evaluate
the cost-effectiveness of the program compared to existing
outreach efforts.
GRIT Suicide Prevention Mobile Application.--The Committee
supports the Department's current efforts to use twenty-first
century technology to promote social connectedness in order to
prevent Veteran suicides. The Department, in collaboration with
technology organizations, is developing mobile applications and
online platforms in an effort to reach more Veterans, such as
the Getting Results in Transition (GRIT) mobile application for
transitioning servicemembers and Veterans. The Committee
directs the Department to continue its efforts to work with
technology organizations to develop and implement innovative
platforms to prevent Veteran suicide and requests a report
within 90 days of enactment of this Act on the status of these
efforts.
Veterans Suicide Prevention Grant Program.--The Committee
continues to support VA's efforts to coordinate suicide
prevention efforts across Federal agencies, prioritize research
activities, and strengthen coordination across the public and
private sectors under the PREVENTS Initiative.
Social Media.--The Committee encourages the Department to
investigate using social media platforms to identify and engage
Veterans at risk of suicide and work with academic partners to
develop and test tools for identifying and engaging these
veterans.
Artificial Intelligence and Machine Learning.--The
Committee urges the Department to utilize its growing
electronic data resources to provide improved services to
Veterans, including preventing Veteran suicides, and notes that
commercial off-the-shelf tools, such as artificial intelligence
and machine learning software, can provide predictive analysis
and can help prevent suicides before they occur.
Suicide Prevention Outreach.--The Committee directs the
Secretary to submit a report to the Committees on
Appropriations of both Houses of Congress on Suicide Prevention
Outreach activities within 60 days of enactment of this Act.
The report should include how VA has executed Federal funding
for the last two fiscal years and an assessment on what funding
and resources are needed to accomplish the Department's suicide
prevention outreach mission. Furthermore, the report should
include the number of Veterans that VA has reached out to
through the suicide prevention outreach initiative, and an
analysis of the program's effectiveness, including how COVID-19
has impacted this initiative in fiscal year 2020.
Models of Care for Suicide Prevention.--Soldier and Veteran
suicide remains a significant scourge on America. Despite
diligent efforts to prevent suicide, the existing clinical care
model does not appear to be improving outcomes. As such, the
Committee encourages VA to determine whether current clinical
care practices should be enhanced, and new models of care
developed. In making such a determination, the Department
should involve its clinical leaders and experts, academia,
advocate organizations, and other stakeholders and also ensure
survivors of attempted suicide and families who have lost a
loved one are provided the opportunity to engage in the
process.
HOMELESS ASSISTANCE
The Committee provides $1,928,508,000 for VA homeless
assistance programs, which is $40,000,000 above the budget
request. Additionally, an estimated $7,868,860,000 is provided
for homeless Veterans treatment costs. Programs to assist
homeless Veterans include the Homeless Providers Grant and Per
Diem (GPD), Health Care for Homeless Vets (HCHV), the
Domiciliary Care for Homeless Veterans, the Supportive Services
for Low Income Veterans and Families (SSVF), Justice Outreach
Homeless Prevention, and the Department of Housing and Urban
Development-Department of Veterans Affairs Supported Housing
(HUD-VASH) programs, among others.
Healthcare for Homeless Veterans.--The Committee directs
the Secretary to submit a report to the Committees on
Appropriations of both Houses of Congress within 90 days of
enactment of this Act on the benefits of expanding the
Healthcare for Homeless Veterans Program H-PACT program, to
include the benefits of expanding the program, location of
additional locations, to include rural areas, and additional
services to improve the program.
Ending Veteran Homelessness.--The Committee recognizes the
value and impact of the HUD-VASH program, which serves Veterans
experiencing homelessness. Case management services are
critically important to the function of the program, and public
housing authorities rely on VA Medical Centers referrals to
house Veterans. Due to the joint nature of HUD-VASH funding,
the Committee recommends that VA's budget for case managers be
increased commensurate with any increases in HUD's budget for
new vouchers.
HUD-VASH Program.--The Committee continues to support the
HUD-VASH program and reminds the Department to provide the
annual report on distribution of HUD-VASH vouchers as requested
in House Report 115-188. Furthermore, the Committee requests
that this annual report also identify how many HUD-VASH
vouchers are given to women Veterans with children, women
Veterans without children, male Veterans with children, and
male Veterans without children in each state. The report should
also include the number of HUD-VASH vouchers distributed to
Veterans in rural, suburban, and urban areas per state. The
Committee believes that an annual report with this information
will be an important data point over time to assess the success
of VA's efforts to combat Veteran homelessness.
Extended HUD-VASH Support Services.--The Committee is aware
of the positive role the HUD-VASH program plays in helping
homeless Veterans. A key component of the program is VA's case
management services. These services are designed to assist
Veterans in obtaining and sustaining permanent housing and
engage in needed treatment and other supportive services that
improve Veterans' quality of life and end their homelessness.
Examples include access to a caseworker that could help prevent
Veterans from hurting themselves or others, committing a
serious crime, or damaging the rented property when
experiencing an emergent mental health or substance abuse
crisis. To assist with efforts to evaluate the case management
services, the Committee directs VHA to provide a report to the
Committees on Appropriations of both Houses of Congress within
180 days after enactment of this Act detailing: (1) a summary
of the current agency guidance for implementing case management
services after core working hours, (2) a list of any VISN that
does not offer extended support services after core working
hours, (3) how a VISN provides support to Veterans in locations
that do not provide extended case management services after
core business hours, and (4) plans to provide expanded extended
case management services in locations that do not currently
have these services after core business hours.
HUD-VASH Caseworker Staffing.--The Committee remains
concerned that the Department is not properly staffing its HUD-
VASH program to meet the needs of the homeless Veterans
population, which may be contributing to increasing
homelessness nationwide. As of December 31, 2019, there were
over 650 vacant HUD-VASH caseworker positions across the
country. Accordingly, the Committee urges the Secretary to use
existing authority to contract for HUD-VASH caseworker
positions when such positions have remained vacant for more
than nine months and when a VA Medical Center has not used 15
percent of its allotted vouchers in the previous year.
Furthermore, the Committee directs the Secretary to submit a
report to the Committees on Appropriations of both Houses of
Congress within 90 days of the enactment of this Act that is
consistent with the report requirements set forth in Division F
of the Joint Explanatory Statement accompanying the
Consolidated Appropriations Act, 2020 (Public Law 116-94).
Legal Assistance for the SSVF Program.--The Committee notes
that university law schools are 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 and inspiring next-generation
lawyers to serve Veterans in practice. The Committee encourages
the 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. Within the funds
provided, the Department is encouraged to establish one or more
pilot projects to partner SSVF grantees with university law
schools in rural areas to enhance legal assistance to Veterans.
Shallow Subsidy Initiative.--The Committee encourages VA to
prioritize funding within the SSVF program for the Shallow
Subsidy Initiative to expand the number of counties eligible to
provide the Shallow Subsidy, targeting areas with high rental
costs and large homeless Veteran populations.
Homeless Veterans Near the United States-Mexico Border.--
The Committee notes that there may be homeless Veterans living
near the United States-Mexico border who, historically, may not
have been counted in point-in-time homeless surveys. The
Committee directs VA to work with HUD to develop strategies and
recommendations for addressing Veteran homelessness near the
United States-Mexico border and to take into account these
undercounted Veterans when awarding HUD-VASH vouchers. The
Committee appreciates VA's efforts to implement strategies and
make recommendations to decrease Veteran homelessness on the
border, such as the development of a Homelessness Screening
Clinical Reminder, data sharing, improving the accuracy of
data, and contracting case management in rural areas.
STAFFING ISSUES
Mental Health Professionals Hiring.--The Committee
continues to direct the Department to prioritize hiring mental
health professionals.
Unfilled Positions.--The current number of unfilled
positions at VA is nearly 49,000 system-wide. These unfilled
positions include VHA physicians and mental health
professionals, and the lack of these professionals negatively
impacts the delivery of care for Veterans at VHA medical
centers and CBOCs across the country. VHA facilities have been
forced to provide care with fewer staff than are medically
necessary to properly care for our Nation's Veterans. As a
result, the Committee is concerned that the significant number
of vacancies will lead to longer wait times for Veterans.
Section 505 of the John S. McCain III, Daniel K. Akaka, and
Samuel R. Johnson VA Maintaining Internal Systems and
Strengthening Integrated Outside Networks (MISSION) Act of 2018
(P.L. 115-182), requires VA to post data on unfilled positions.
The Committee expects VA to continue to comply with this
mandate and expects VA to actively recruit and hire full-time
professionals to fill these system-wide vacancies with the
resources provided by the Committee. The Committee continues to
direct the Secretary to provide a quarterly report to the
Committees on Appropriations of both Houses of Congress
detailing hiring initiatives and system-wide progress on hiring
and specifically what actions are being taken to fill physician
positions and mental health provider positions, as well as any
impediments to such efforts. The report should include the
resources provided for these efforts and recommendations for
relevant legislation.
Medical Staff Retention.--The Committee expects VA to
continue to report every six months on the number of all
clinical staff directly responsible for patient care who have
left VA, including a summary of the principal reasons
explaining their departure, and the steps being taken to
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 include any personally identifiable data.
Hiring Delays.--The Committee is concerned that VA's hiring
and credentialing process may be contributing to longer wait
times for Veterans seeking healthcare. The Committee requests
VA to report on the average length of time to fill a healthcare
provider slot at a representative sample of medical centers,
including: the time it takes the resource board to approve the
hire of a new position; the time it takes to post the job
announcement; how long the interview process takes; and the
length of time for credentialing; as well as any internal VA
goals that exist for the time each step in the process should
take. The report should also describe how often a healthcare
provider reaches the credentialing process phase of the
process, but exits the process because of another opportunity
outside VA. This report should be provided to the Committee no
later than 60 days after enactment of this Act.
Lack of Team-based Staffing.--The Committee is encouraged
by improvement in Primary Care access and wait times. However,
the Committee remains concerned about primary care Patient
Aligned Care Team (PACT) team staffing at VA Medical Centers.
Team-based care has been shown to improve health outcomes,
improve team member satisfaction, including providers, which
also correlates to lower team burnout, and increases Veteran
experience and satisfaction. The Committee directs VA to submit
a report, no later than 120 days after enactment of this Act,
providing information on the number and percentage of fully
staffed and implemented PACTs as well as the number of fully
trained PACTs within VA. This report should also include
correlation of fully staffed PACTs to health outcomes as well
as employee and Veteran satisfaction.
Staffing Shortages.--The Committee recognizes the growing
shortage of VHA physicians and medical professionals has
negatively affected the delivery of care for Veterans at VHA
medical centers and clinics across the country. VHA facilities
have been forced to provide care with fewer staff than are
medically necessary to properly care for our nation's Veterans.
In House Report 116-63 and in Division F of the Joint
Explanatory Statement accompanying the Consolidated
Appropriations Act, 2020 (Public Law 116-94), the Committee
requested various reports on what VHA is doing to fill medical
vacancies, recruit new talent, and address workforce-training
opportunities, not limited to, but including, psychiatric and
behavioral health professionals. The Committee is concerned VA
has not produced these reports in a timely manner and is
further concerned as VA health professional staff vacancies
have not decreased. The Committee directs VA to submit the
staffing issues reports no later than 30 days after enactment
of this Act.
ACCESS FOR RURAL VETERANS
Office of Rural Health (ORH).--The Committee provides
$300,000,000 for rural health, which is $30,000,000 above the
request, to improve access and quality of care for the more
than 3,000,000 enrolled Veterans residing in rural and highly
rural areas. ORH improves access and quality of care for
enrolled Veterans residing in geographically rural areas.
Developing evidence-based policies and innovative practices to
bring healthcare to rural areas is key to serving Veterans in
geographically remote areas, including remote facilities in
Hawaii, many of whom would otherwise need to travel by air to
reach their nearest VA facility. In addition to providing
healthcare services, ORH's important work includes identifying
barriers to healthcare delivery in rural areas and implementing
new ways to deliver healthcare and services to Veterans in
these locations. The Committee supports the Office of Rural
Health's ongoing efforts to refine and promulgate best
practices and innovative and successful programs to improve
care and services for Veterans who reside in rural areas,
including the designation of Rural Promising Practices.
Operating Plan.--The Committee directs the Office of Rural
Health to submit to the Committee no later than 30 days after
enactment of this Act an operating plan for fiscal year 2021
funding, as well as for the fiscal year 2022 funding provided
in advance by this Act.
VSO Wellness.--The Committee is concerned that VA is taking
too much time to implement the VSO Wellness pilot program,
authorized in Section 252 of the Consolidated Appropriations
Act, 2018 (P.L. 115-141). This remains a priority of the
Committee, and the Department is directed to implement the
pilot program expeditiously. House Report 116-63 directed the
Department to provide a status update on the pilot program no
later than 14 days after the report was filed, and the
Committee has yet to receive the status report. The Committee
directs the Department to provide monthly updates on the status
of the VSO Wellness pilot program, in addition to the initial
status report required in House Report 116-63 no later than 14
days after this report is filed.
Rural Transportation Study.--The Committee provides
funding, as requested, for the Office of Rural Health's rural
transportation study by the Veterans Rural Health Resource
Center, Iowa City. The Committee supports this study and
directs the Secretary to provide a report with the President's
Budget Request for fiscal year 2022 that assesses whether there
are gaps in the Department's comprehensive rural transportation
program, how they should be closed, and if additional funding
is needed.
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 that 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.
Vet Center Travel Reimbursement.--The Committee
acknowledges continued progress in addressing transportation
barriers for Veterans, especially those in rural or highly
rural areas. While the Committee recognizes the important work
of VSOs and the existence of the Veterans Transportation
Program, a transportation gap still exists for rural and non-
rural areas. The Committee directs VA to submit a report
outlining the feasibility of expansion of payments and
allowances for beneficiary travel in connection with Veterans
receiving care from Vet Centers in (a) rural areas and (b) all
areas. The Committee is aware of the Congressional Report
submitted in November 2018 in response to Public Law 112-154;
126 Stat.1169, Section 104a where the Department performed a
feasibility study for expansion of beneficiary travel for
highly rural Veterans receiving care from Vet Centers and
ultimately advised against expanding beneficiary travel to
Veterans due to the lack of software and/or automation between
Vet Centers and VA Medical Centers. This report should also
include an analysis of options for automating the process for
information sharing and workload tracking between Vet Centers
and VA Medical Centers and building an infrastructure at Vet
Centers for processing beneficiary claims in order to expand
beneficiary travel to Veterans traveling to Vet Centers. This
report is due no later than 120 days after enactment of this
Act.
Transportation Challenges.--The Committee recognizes the
transportation challenges and barriers to care that rural and
remote Veterans face and encourages VA to look into the
feasibility of utilizing autonomous electric vehicles in the
future to overcome these challenges.
Clinical Resource Hub.--The Committee supports the success
of the recently established Clinical Resource Hub at the Office
of Rural Health. This program is an innovative model that
delivers high-quality health care services to Veterans in
underserved locations. The Committee recognizes the unique
challenges faced by Veterans living in rural communities who
often require access to a suite of health services across a
spectrum of specialty medical professionals. The Clinical
Resource Hub combines telehealth services with in-person care
to bring access within reach for Veterans across rural America.
The Committee will continue monitoring the progress of this
program through the fiscal year.
TELEHEALTH AND CONNECTED CARE
The Committee provides $1,329,566,000 for telehealth and
connected care, which includes home telehealth, home telehealth
prosthetics, and clinic-based telehealth.
The Committee notes that within the total amount provided
for Medical Services in the Coronavirus Aid, Relief, and
Economic Security Act (CARES Act) (P.L. 116-136), VA allocated
$250,000,000 for telehealth expansion.
Telehealth Benefits.--Telehealth services increase Veteran
access to care. The Committee directs VA to continue to expand
telehealth availability to include additional mental health,
primary care, and rehabilitation services as a means to deliver
care in rural and underserved communities.
Telehealth Services.--The Committee directs VA to develop a
plan to improve Veteran and provider satisfaction, increase
awareness of the telehealth program, and enhance adoption of
telehealth by Veterans and providers. The Department's plan
should include actions that will be taken to make telehealth
more accessible to patients in highly rural areas. The
Committee looks forward to the Department's report, as directed
in Division F of the Joint Explanatory Statement accompanying
the Consolidated Appropriations Act, 2020 (Public Law 116-94)
within 60 days of enactment of the Act.
Telehealth for Maternal Fetal Medicine.--The Committee
recognizes the needs of women Veterans and expanding access to
maternal fetal medicine (MFM) via telehealth to ensure the
health of mothers, pregnancies, and babies. The Committee also
recognizes the further potential for VA to partner with
universities to expand access to maternal and perinatal care
via telehealth. To assist with efforts to evaluate the
potential for creating pilot programs in support of MFM, the
Committee directs the Department to provide a report to the
Committees on Appropriations of both Houses of Congress with
180 days after enactment of this Act detailing: (1) the current
extent of VA support for MFM telehealth and (2) the potential
for entering into MFM partnerships with academic institutions
in states that serve a high percentage of Veterans and their
families in rural, isolated communities in noncontiguous states
and territories.
GENDER-SPECIFIC CARE FOR WOMEN
The number of women Veterans using VHA services has
increased 29 percent in five years from 423,642 women Veterans
in 2014 to 545,670 in 2019. The increased number of women using
VHA services necessitates the greater need to provide and
expand VA's gender-specific services to women Veterans. The
bill provides $660,691,000 for gender-specific care for women,
which is $35,000,000 above the request. VA is directed to
continue redesigning its women's healthcare delivery system and
facilities to ensure women receive equitable, timely, and high-
quality healthcare.
The additional $35,000,000 is provided for the purposes of
expanding programmatic support for women's healthcare. VA is
directed to provide an expenditure plan detailing how the
additional funding will be spent no later than 90 days after
enactment of this Act, and the Committee further requires
quarterly briefings on the expenditure of these funds. The
Committee directs the delivery of care to women Veterans be
through an organized program within normal business operations
of VA. The women's health program is required to have
appropriate staffing levels and executive support that is
operationalized to ensure all aspects of care for women
Veterans are available.
Program managers within each VA facility should be
equipped, at a minimum, with at least one designated women's
health provider, the appropriate number of nurses,
administrative support, care coordinators, and peer navigators.
The Committee directs VA to continue to build on its training
initiatives for women's health providers and nurses in order to
meet the increased demand in care. VA is further directed to
provide greater resources at the field level to build visible
women-specific health programs, including suicide prevention
programs, reproductive mental health programs, and combined
pain and opioid use programs, and the Committee requests a
report within 90 days of enactment of this Act on VA's plans to
provide and expand these programs for women.
The Department is further directed to prioritize hiring
women primary care providers and psychologists for women's
clinics using the Medical Services appropriation. To supplement
VA's recruitment efforts to hire and retain women clinicians at
the field and VISN levels, the Committee directs the Department
to deploy a large national women-specific advertising campaign
to appeal to women Veterans to receive their care at VA
facilities and to women-specific healthcare providers to work
at VA.
Additionally, the Committee continues to direct that
Women's Health Program Managers be full-time jobs and not be
tasked with supplemental responsibilities outside of their
specified job descriptions.
Gender-Specific Women Veterans' Healthcare.--Women are now
the fastest growing cohort within the Veteran community. The
Committee remains concerned that VA is not adequately
addressing the health needs of women Veterans, including
obstetrics, gynecological care, and treatment for gender-
specific conditions and diseases. The Committee urges VA to
continue expanding access to care in these areas and ensure
women Veterans' health needs, which often differ from men, are
met.
Women Medical Staff.--The Committee continues to support
the hiring of more women healthcare professionals in order to
provide women Veterans greater opportunities to choose the
gender of their healthcare provider.
Access to Gender-Specific Care for Women.--The Committee
expects VA to continue to work to improve care for women
Veterans. VA must provide women Veterans equitable access to
the same health care services and programs as male Veterans,
including VA's specialized services for substance use
disorders, homelessness, and treatment for PTSD related to
combat military sexual trauma. Most importantly, these programs
must be tailored to meet the unique needs of women Veterans by
expanding the list of requirements that facility staff inspects
for compliance to align with the women's health handbook of the
Veterans Health Administration. The Committee further directs
VA to ensure proper coordination of care for 1) women patients
with complex care needs who must frequently access gender-
specific health care services in the community and 2) for women
Veterans with war-related injuries and/or service conditions
who are at higher risk for poor outcomes. VA should monitor
these efforts and report to the Committees on Appropriations of
both Houses of Congress within 120 days of enactment of this
Act on its work to improve these outcomes for women Veterans.
Breast Cancer Screening Guidelines.--The Committee commends
VA's decision to offer breast cancer screening and mammography
to eligible women Veterans beginning at age 40. However, the
Department should be prepared to offer screening to eligible
younger women Veterans should a physician determine, or risk
factors warrant, screening before age 40. The Committee
supports this effort to ensure that the care women Veterans
receive is consistent with the private sector and will continue
to monitor the Department's implementation of this policy. The
Department should closely follow ongoing debate within the
scientific community on breast cancer screening and mammography
coverage to provide Veterans the best care possible. The
recommendation includes bill language to ensure VA maintains
this policy through fiscal year 2024.
Maternity Care Benefits, Survey, and Education Campaign.--
The Committee requests a report within 90 days of enactment of
this Act on the following data related to VA maternity care
benefits: the number of eligible women Veterans and actual
utilization from each of the last 10 years in each VISN, to the
extent that data are available; the number of Veterans who
receive prenatal care and have births at a VA facility, and the
number of Veterans who receive prenatal care-related services
through contracted non-VA providers; information on the
transition from VA to non-VA providers and how medical records
are returned to VA once a woman is postpartum, particularly if
she has an underlying medical condition; and the number of
maternity care coordinators in each VISN and specific data on
minimum employment requirements and caseload. The Committee
also directs VHA to develop a patient survey to collect
feedback from women Veterans who utilize the maternity care
benefit, including their satisfaction with VA maternity care
benefits; whether the benefit met their needs; the patient's
interaction with the maternity care coordinator; and whether
there were barriers to care, providers, or specific services
related to the maternity care benefit. Further, the Committee
encourages VHA to develop an education campaign publicizing the
maternity care benefit, including clarifying who is eligible,
what the benefit covers and does not cover, and any cost
sharing that may be required with the benefit. The education
campaign materials should be easy for patients to understand
and be easily accessible online and at each center for women's
health, medical center and CBOC.
Women Veterans Peer Support.--The Committee welcomes the
role of Women Veterans Network (WoVeN), a national peer support
network for women Veterans in providing group support
specifically tailored to the unique needs of women Veterans,
including life transitions, balance, stress relief,
connections, healthy living and esteem, which is run by
researchers from the National Center for PTSD--Women's Health
Sciences Division, which develops clinical practices to treat
PTSD in women. The research component of this peer support
program will drive innovation in addressing PTSD in women
Veterans. The Committee provides no less than $1,000,000 for
peer support programs for women Veterans.
Combatting Maternal Mortality.--The Committee recognizes
that the United States maternal mortality rates are
significantly higher than many of our international
counterparts. In 2018, the Center for Disease Control and
Prevention found that in the United States, 658 women,
including women Veterans, died from complications while giving
birth. The Committee directs VA to provide a report within 90
days of enactment of this Act on the historical maternal
mortality rates of women Veterans and recommendations on how to
combat the rising rates.
Women Veterans Contact Call Center.--The Committee directs
the Secretary to enhance the capabilities of the women Veterans
contact call center to respond to requests by women Veterans
for assistance with accessing health care and benefits
furnished under the laws administered by the Secretary, and to
refer such Veterans to resources provided by the Federal
government and the community to obtain assistance with services
not furnished by the Department.
Sexual Assault and Harassment Policy at VA.--The Committee
continues to be concerned about the harassment women Veterans
have had to endure at some VA healthcare facilities, but is
pleased VHA has initiated the Stand-Up to Stop Harassment
Campaign to promote a harassment-free healthcare environment
for staff, Veterans and visitors to VA health facilities. The
Committee directs the Secretary to provide a report no later
than 90 days after enactment of this Act to the Committees on
Appropriations of both Houses of Congress on VA's plan to
expand and implement a similar initiative across all VA
components, including implementing mandatory bystander
intervention training for all employees, contractors, on-site
vendors, and volunteers.
PHARMACY ISSUES
Drug Pricing Report.--Rising drug prices are a significant
cost driver in healthcare. However, VA receives substantial
discounts when purchasing prescription drugs. Common sense
approaches such as using lower-cost generic drugs, providing
care from expert pharmacists, and making drug companies compete
for business can help drive down the cost of healthcare. The
Committee is interested in VA's spending on prescription drugs
and requests a robust report on drug pricing no later than 120
days after enactment of this Act. The report should include
prescription drug prices (net of rebates) paid by VA for the
ten most frequently prescribed drugs and the ten highest-cost
drugs for VA. In addition, the report should include total
annual costs to VA for all prescription drugs. If data is
unavailable, the report should provide a detailed explanation
of why.
At-home Drug Disposal for Veterans.--In 2019, over 125
million prescriptions, representing 80 percent of outpatient
prescriptions were mailed directly to the Veteran's home. While
extremely beneficial to Veterans, this method may contribute to
the prevalence of excess, expired, unused, and unwanted
prescriptions remaining in Veterans' medicine cabinets. In a
recent VA study of almost 5 million Veterans with prescriptions
through VA, 64 percent had at least one duplicated medication,
which can increase the risk of adverse events and overdose. In
addition, recent studies indicate as many as 72 percent of
opioids prescribed for post-surgical pain go unused by the
patient, but without active engagement at discharge, patients
are highly unlikely to dispose of unused drugs leaving them
vulnerable for misuse and abuse. The Committee supports VA's
efforts to engage Veterans on the safe disposal of prescribed
medication while continuing to pursue and advance additional
methods to limit and dispose of excess medications in Veteran
homes. The Committee directs the Department to provide a report
within 120 days of enactment of this Act on the feasibility of
conducting a pilot program to evaluate the benefits of co-
dispensing at-home drug disposal products for post-surgical
patients as a part of the Opioid Overdose Education and
Naloxone Distribution program and drug-take back activities of
the Department.
Safe Medicine.--The Committee recognizes the nation's
increased reliance on foreign-based sources of medicine and
active pharmaceutical ingredients. The Committee is concerned
the health security risk this presents VA as it provides
medicine to Veterans. The Committee requests a report within 90
days of enactment of this Act detailing potential
vulnerabilities VA faces purchasing medicine from offshore
sources, including dependency issues, and that addresses
strategies to buy American and produce medicine domestically.
The report should also provide information on VA's medicinal
purchasing guidelines, with relation to drug cost and safety,
to ensure VA is acquiring the safest medicine possible for
Veterans.
OPIOID SAFETY INITIATIVES AND SUBSTANCE USE DISORDER CARE
Opioid Abuse.--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 Committee is pleased to see that despite
the 7 percent increase in the number of Veterans using pharmacy
services between 2012 and 2019, there has been a 60 percent
reduction of Veterans on long-term opioids and an 82 percent
reduction of Veterans receiving opioid and benzodiazepine
medications together. The Committee encourages VA to continue
the challenging effort to reduce opioid use among Veterans,
half of whom suffer from chronic pain. The Committee provides
$503,660,000 for opioid treatment and prevention efforts, of
which $120,812,000 is provided for activities authorized by the
Comprehensive Addiction and Recovery Act of 2016 (P.L. 114-
198), which is $66,758,000 above fiscal year 2020.
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 providers to have real-time
access to data. It is critical that VA clinicians have access
to patients' 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.
Behavioral Health and Substance Use Screening.--The
Committee is aware of the high prevalence of mental illness and
substance abuse among Veterans, particularly PTSD, depression,
anxiety, and alcohol and opioid abuse. The Committee strongly
recommends that all Veterans seeking treatment services in a VA
facility be screened for the listed illnesses, at a minimum
annually, using evidence-based assessment tools.
Substance Abuse Among Women.--In recent years, rates of
problematic substance use among women Veterans have been
increasing. While men have greater rates of addiction than
women, many women Veterans have characteristics that make them
more prone to substance use disorders than men, including past
trauma (physical and sexual). As such, the Committee recommends
that the Department ensures women Veterans have timely access
to a full spectrum of integrated substance abuse treatment
services, from detoxification to rehabilitation. Additionally,
the Department should increase the availability of gender-
specific substance use disorder programming and ensure all
programming venues comply with the environment of care
standards for women's privacy and safety.
Substance Use Disorders.--The Committee supports new and
innovative solutions to address substance use disorders and
substance misuse, including efforts to intervene early with at-
risk Veterans and support programs that provide Veterans and
their families with the tools they need to meet these
challenges, such as harm reduction techniques and confidential
education that can reduce substance use, relapse, hospital
visits and suicide. The Committee encourages VA to increase
education among its primary care practitioners on the diagnosis
and treatment of alcohol use disorders with Federal Drug
Administration (FDA)-approved medication assisted treatments.
Internet-based Substance Abuse Education.--The Committee
recognizes the ongoing work of VA to reduce substance use
disorder among Veterans. The Committee is aware of Substance
Abuse and Mental Health Services Administration studies that
conclude that 90 percent of people who die by suicide suffer
from depression, substance use disorders, or both. Veterans
face unique health challenges and the suicide rate among
Veterans continues to be unacceptable. The Committee is aware
that male Veterans have greater rates of substance abuse
addiction but that the rates of problematic substance use among
women Veterans is increasing. The Committee supports new and
innovative solutions to intervene early with at-risk Veterans
and supports programs that provide Veterans and their families
with the tools they need to meet these challenges. The
Committee recognizes the importance of programs that utilize
harm reduction techniques and offer confidential education
information that can reduce substance use, relapse, hospital
visits and suicide, and therefore directs the Department to
provide a feasibility study to establish a comprehensive,
evidence-based and confidential internet-based substance abuse
education, case management, and peer coaching pilot program
within 90 days of enactment on this Act.
WHOLE HEALTH INITIATIVE
Traditionally, Veteran medical providers have focused on
the physical symptoms of Veterans, zeroing in on their diseases
and ailments. However, VA is continuing to work to expand this
focus by incorporating a whole health model of care, which is a
holistic look at the many areas of life that can affect a
Veteran's health, including their work environment,
relationships, diet, sleep patterns, and more. Whole Health is
an approach to healthcare that empowers and enables the Veteran
to take charge of their health and well-being and live their
life to the fullest. The Committee is extremely pleased with
the Whole Health model of care and includes $83,600,000, which
is $20,000,000 above the request, to continue to implement and
expand Whole Health to all VA facilities.
Interactive Patient Care Beyond the Inpatient Setting.--The
Committee supports Whole Health as a model of care delivery at
all points of care whether in VA facilities, in the community,
or at home. The Committee understands that several VA Medical
Centers (VAMC) are implementing the Whole Health model through
interactive patient care, but the Committee is concerned about
how the Department will ensure the Whole Health model is
sustained when the Veteran is outside of the VA inpatient
setting. To achieve success, VA must facilitate the Veteran's
care team's ability to provide the same consistent and
collaborative patient engagement and interactive patient care
outside of VAMCs and enable the Veteran and the Veteran's care
team to be actively involved in the Veteran's Whole Health
Plan. The Committee directs the Department to leverage
technology to facilitate management and adaptations of the
Veterans Whole Health Plan, ongoing communication, and
awareness of additional VA services to support fulfillment of
the Whole Health Plan.
Creative Arts Therapies.--The Committee acknowledges the
effective use of creative arts therapies in treating Veterans
with traumatic brain injuries and psychological health
conditions. The Committee supports the integration of the arts
and creative arts therapies provided by VA's Office of Patient
Centered Care and Cultural Transformation through the Whole
Health initiative and encourages VA's continued partnerships
with healing arts providers. The Committee strongly supports
the Secretary in continuing to expand these innovative programs
throughout the Veterans Healthcare Networks and provides an
additional $5,000,000 to do so.
Continued Support and Expansion for Whole Heath.--As of
October 2017, 18 VA medical centers have received funding to
implement the Whole Health System of Care (WHS). WHS, a three-
year pilot program, meets the intent of the Comprehensive
Addiction and Recovery Act by delivering patient-centered care
and complementary and integrative health approaches to our
nation's Veterans especially those who are struggling with
opioid use disorder and chronic pain. In January 2020, VA
released an evaluation of the WHS, which concluded: (1) the
program had a positive impact on reducing opioid use among
Veterans; (2) Veterans who used WHS, compared to those who did
not, experienced greater improvements in perceived stress
indicating improvements in overall well-being; and (3)
comprehensive WHS service revealed potential savings in
pharmacy costs. The Committee is pleased by the results of this
evaluation and urges VA to continue supporting the WHS and to
expand it beyond the 18 flagship sites in fiscal year 2021.
Whole Health Services.--The Committee supports VA's focus
on Whole Health and as VA continues to expand access to Whole
Health services, the Committee directs VA to analyze the
accessibility and availability of each of the following
services: massage, chiropractic services, whole health
clinician services, whole health coaching, acupuncture, healing
touch, whole health group services, guided imagery, meditation,
hypnosis, yoga, Tai chi or Qi gong, equine assisted therapy,
and any other services the Secretary determines appropriate, at
VA medical facilities, including Medical Centers, Community-
Based Outpatient Clinics, Vet Centers, and Community Living
Centers. Furthermore, the Committee directs the Department to
submit a report to Committees on Appropriations of both Houses
of Congress on the outcomes derived from these specified Whole
Health services, the resources required to expand these
specified services, and the plan to provide these specified
services to Veterans who reside in geographic areas where no
Medical Center, Community-Based Outpatient Clinic, Vet Center,
or Community Living Center is located. The report should be
submitted no later than 180 days after enactment of this Act.
OTHER HEALTH ISSUES
Central Alabama Veterans Health Care System (CAVHCS).--The
Committee calls the Department's attention to the urgent need
to improve the care provided at and the management of CAVHCS.
The Department is directed to immediately and fully correct
deficiencies and problems at CAVHCS and ensure VA Southeast
Network (VISN 7) is focused on providing appropriate and
additional assistance to the system. The Committee directs the
Department to develop a plan to resolve these problems and to
fill vacancies of permanent leadership and senior member staff
and to submit quarterly reports describing implementation of
the plan, including current status of hiring permanent
leadership and senior member staff. The Committee strongly
urges the Department to fully utilize every incentive, bonus,
or other measures to hire and retain permanent medical staff to
provide quality care for Veterans in Central Alabama. The
Committee directs the Department to issue quarterly reports on
all levels of permanent staffing at CAVHCS along with vacancies
and efforts that are being made to fill those vacancies.
Cancer Moonshot Contribution.--The Committee supports the
Beau Biden Cancer Moonshot Initiative and the Department's
contribution utilizing advances in genomic science to provide
targeted treatment to Veterans. The Department has identified
prostate cancer, triple-negative breast cancer, and colorectal
cancer as areas of priority. Due to the prevalence of various
skin cancers among servicemembers, the Committee directs that
skin cancer be included as a priority as well.
Rare Cancers.--The Committee is pleased by the December
2017 signing of the collaboration agreement between the
Department, the John P. Murtha Cancer Center at Walter Reed
National Military Medical Center, and the National Cancer
Institute focused on improving cancer care for common cancers
affecting servicemembers and Veterans. However, the Committee
remains concerned about the need for a better understanding of,
and treatment options for, rare cancers. There are 55 cancers
that disproportionately affect those serving in the military
and 67 percent of them are rare. Of the 396 total cancers, 374
are rare and few treatment options are available.
Servicemembers are uniquely exposed to carcinogens, including
asbestos, industrial solvents, nuclear radiation, depleted
uranium, lead, fuels, polychlorinated biphenyls, and components
of Chemical Agent Resistance Coating, all hazards that may
increase the risk of cancer for servicemembers and Veterans.
Therefore, the Committee directs the Department to issue a
report no later than 90 days after enactment of this Act on how
the collaboration between the Department, the John P. Murtha
Cancer Center at Walter Reed National Military Medical Center,
and the National Cancer Institute will address rare cancer,
including molecular subtyping, systemic research and
development gaps, and inadequacies in targeted treatment
options.
Nuclear Medicine Quality Improvements.--The Committee is
aware of evidence demonstrating the prevalence of
extravasations in nuclear medicine procedures. Extravasations
of diagnostic radio-pharmaceuticals negatively affect the
sensitivity and quantification of nuclear medicine scans.
Extravasations can affect disease staging and treatment
assessment, result in unnecessary invasive procedures and
additional radiation exposure, and lead to higher costs for
patients and payers. Additionally, extravasations of diagnostic
and therapeutic radiopharmaceuticals can expose patient's
tissue to radiation doses that far exceed dose thresholds that
are known to lead to side effects. As America's largest
integrated healthcare system, VHA should lead by example in
acting to reduce medical errors and medical waste. The
Committee encourages VHA to monitor injection quality, image
extravasations when they occur, perform dosimetry, notify
patients and their physicians when doses exceed reportable
limits, and implement programs to reduce extravasations in the
future. The Committee requests an update on this issue in the
fiscal year 2022 Congressional Budget Justification.
Hospital-Acquired Pressure Ulcers and Pressure Injuries.--
The Committee understands that ulcers and pressure injuries are
reported to be 52 percent more prevalent in VA hospitals than
in non-VA hospitals, and that the application of evidence-based
protocols can help prevent Hospital-Acquired Pressure Ulcers.
The Committee urges VA to implement the Standardized Pressure
Injury Prevention Protocol, as included in the 2019
International Clinical Practice Guidelines for the Prevention
and Treatment of Pressure Ulcers/Injuries, and directs VA to
provide a report to the Committees on Appropriations of both
Houses of Congress no later than 90 days after enactment of
this Act on steps taken to implement such protocols.
Wheelchairs.--The Committee encourages the Department to
work with Veterans who are eligible to receive a wheelchair to
determine the best options for restoring their maximum
achievable mobility and function for daily life.
Nutrition and Food Services.--The Committee recognizes the
value of proper nutrition and food's impact on one's health and
remains concerned regarding the nutritional health and well-
being of Veterans. Patients with three or more chronic
conditions represent 35 percent of Veterans receiving VA care
and account for 65 percent of VHA costs. Acknowledging the
correlation between obesity and co-occurring chronic
conditions, such as diabetes, the Committee directs VA to
provide a report on the ways VA is currently promoting positive
nutritional habits among Veterans, such as nutritional coaching
and meal programs. The report should include how many Veterans
the Department is currently serving in this capacity, and how
to expand the initiative to more Veterans. Furthermore, the
Committee urges VA to be proactive in promoting wellness and
disease prevention by providing evidence-based nutritional
guidelines for Veterans and their caretakers.
Produce Prescription Pilot Program.--The Committee is
concerned with food insecurity among the Veteran population and
recognizes the role of access to healthy produce in managing
chronic disease and reducing health care utilization. The
Committee is aware of produce prescription programs across the
country that allow medical providers to prescribe fresh fruits
and vegetables to individuals or households who are at-risk due
to health status or income, often pairing these prescriptions
with financial incentives or nutrition education resources. The
Committee encourages the Secretary to create a pilot program to
provide produce prescriptions to Veterans in partnership with
community-based organizations and/or government entities with
demonstrated experience and expertise in providing produce
prescriptions.
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.
Medical School Affiliations.--The Committee continues to be
pleased with VHA's implementation of its collaborative
agreements with academically affiliated minority medical
schools. The Committee encourages VHA and the Office of
Academic Affiliations (OAA) to further align academic
partnerships with training opportunities and patient needs of
Veterans in surrounding communities and to convene a summit of
minority health professions schools to achieve this goal. The
Committee directs VA to provide a report to the Committees on
Appropriations of both Houses of Congress on the progress. The
Committee further encourages VA to identify opportunities to
expand community-based inpatient and outpatient clinical
facilities on the campuses of Historically Black Colleges and
Universities (HBCUs) and other minority serving medical
schools. The Committee recommends that VA solicit and expand
its medical support systems to HBCUs that have medical
facilities on their campuses. Within 120 days of enactment of
this Act, the Committee directs the Department to report back
to the Committees on Appropriations of both Houses of Congress
on the progress of both initiatives.
Minority Veteran Care.--The Committee acknowledges the
Department's efforts to streamline data collection practices
through a working group and other initiatives. The Committee
notes that the Veteran population is becoming increasingly
diverse. According to VA's Center for Minority Veterans, more
than one-third of Veterans will come from minority groups by
the year 2040. The Committee also acknowledges that the
Department currently has a working group, which has the goal of
developing streamlined data collection processes. Accordingly,
the Committee directs the Secretary to provide a report to the
Committees on Appropriations of both Houses of Congress no
later than 180 days after enactment of this Act that details
how VA 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
should take into consideration VA's new electronic health
record system that will combine the Department's current data
collecting programs and make recommendations on how the
implementation of this new system can help improve data
collection on Veterans.
Hispanic-Serving Institution (HSI) Affiliations with VA
Health Care Facilities.--The Committee continues to be
concerned by the lack of HSI 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.
Freely Associated States (FAS) Veterans.--The Committee
directs the Department to provide hospital care and medical
services to Veterans in the FAS, and to provide a report within
180 days of enactment of this Act to the Committees on
Appropriations of both Houses of Congress on the feasibility
and advisability of establishing regional offices, sub-offices,
contact units, or other subordinate offices in the FAS to
provide such care and services.
VA Healthcare Expansion.--The Committee directs VA to
increase access to direct VA care for Veterans living in remote
and underserved areas, such as the Commonwealth of the Northern
Mariana Islands, and strongly urges VA to increase the number
of full-time, dedicated, VA medical and mental health providers
in these areas.
Cost Analysis of Community Care versus Direct Care in the
United States Pacific Territories.--The Committee directs VA to
conduct an analysis of the costs to send Veterans residing in
the U.S. Pacific territories, including the Northern Mariana
Islands, into the community to receive care, and the cost of
placing or adding a full-time VA clinician to provide such
services. For jurisdictions that do not have a VA Community-
Based Outpatient Clinic, or full-time clinicians providing
services exclusively to Veterans, the analysis should include
an evaluation and comparison of costs, the quality of care
provided to, and health outcomes of, Veterans receiving care
through community providers. The analysis should also include
feedback on access to care, the quality of care, and health
outcomes from the Veterans who reside in the jurisdiction. The
Department is directed to submit this report to the Committees
on Appropriations of both Houses of Congress and to the
Government Accountability Office (GAO) no later than 180 days
after enactment of this Act. GAO is directed to review and
analyze the Department's cost estimates and analysis and report
to the Committees on Appropriations of both Houses of Congress
whether the Department's estimates and the evaluations are
comprehensive, accurate, and credible.
Audit of Hiring Practices for VA positions in the
Pacific.--The Committee directs GAO to report to the Committees
on Appropriations of both Houses of Congress on VA's efforts
over the last 10 years to fill vacancies/positions with duty
stations in the U.S. Pacific Insular Areas, to evaluate the use
of current hiring authorities, and to provide recommendations
on additional authorities that may be needed to recruit and
retain qualified candidates to serve Veterans in these areas.
Vet Center Services.--The Committee strongly encourages VA
to provide at least one full-time VA Readjustment Counseling
Therapist in each state or U.S. territory that does not have a
Vet Center located within its jurisdiction within 180 days of
enactment of this Act to ensure parity of services for all
Veterans receiving care through VA. Such staff should be
provided the necessary support, space, equipment, and funds to
facilitate travel to other areas within such jurisdiction where
Veterans reside on a regular basis. The Committee urges VA to
ensure Veterans in these areas are notified that a VA
Readjustment Counseling Therapist is available to provide
services to them and their families. Furthermore, no later than
one year after the date this report is filed, the Committee
directs VA to provide a report to the Committees on
Appropriations of both Houses of Congress on the services and
outreach conducted by VA in such areas, an evaluation of such
activities, and an assessment of the need to establish a Vet
Center in such areas that should include input from Veterans
residing in these areas. If VA determines there is no need to
establish a Vet Center in a particular jurisdiction, VA is
directed to include in the report its plans to continue serving
Veterans and their families in such areas.
Dialysis Services.--The Committee understands that VA has a
long history of providing dialysis services through community
dialysis providers under the Nationwide Dialysis Services
contracts when VA is unable to directly provide such care. The
Committee expects VA will ensure that care is not disrupted or
diminished for the Veterans who receive treatment through
experienced providers under the Nationwide Dialysis Services
contracts.
Reducing Airborne Infections.--The Committee recognizes
airborne bacteria and viruses remain a significant source of
healthcare-associated infections at health care facilities.
Although High Efficiency Particulate Air (HEPA) filters are
widely used to filter the air, airborne transmission still
accounts for a significant portion of health care-associated
infections. Within 120 days of enactment of this Act, the
Committee directs VA to initiate a pilot program of new
commercial, off-the-shelf technology that has the potential to
capture and destroy airborne contaminants.
Creutzfeldt-Jakob Disease Monitoring.--Veterans and their
dependents who resided at United States military installations
in Germany, Belgium, and the Netherlands for six months or more
from 1980 through 1990, and Veterans and their dependents who
resided at United States military installations in Greece,
Turkey, Spain, Portugal, and Italy for six months or more from
1980 through 1996 are barred from donating blood due to their
potential exposure during their military service to beef that
was infected with bovine spongiform encephalopathy, resulting
in possible infection of Creutzfeldt-Jakob Disease (CJD), a
human prion disease. The Committee is committed to
understanding the residual impacts of CJD within the Veteran
community. The Committee urges the Department 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 symptoms associated with CJD
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 CJD.
Tobacco Use Among Veterans.--A 2018 government study found
almost 30 percent of Veterans are smokers. Interventions for
Veterans are critical to reduce tobacco use and lead to
improved health outcomes. Women Veterans are uniquely impacted
by the effects of tobacco use, including difficulty getting
pregnant, early menopause, osteoporosis, cervical cancer, and
breast cancer. The Committee encourages VA to continue
promoting cessation and evidence-based tobacco interventions
for our Veterans.
Veterans Exposed to Open Burn Pits and Airborne Hazards.--
In order to provide full and effective medical care, it is
essential for the Department to better understand the impacts
that exposure during military service has had on the health of
Veterans. Therefore, the Committee continues to support
language included in House Report 116-63 on burn pits and
includes $7,500,000 to carry out responsibilities and
activities of the Airborne Hazards and Burn Pits Center of
Excellence.
Burn Pits Center of Excellence Expansion.--The Committee is
concerned that research and clinical trials are urgently needed
to develop effective treatments for Veterans exposed to toxic
environmental hazards. The VA Research Advisory Committee has
recommended the establishment of Centers of Excellence to
facilitate the development and availability of new treatments
in clinical settings. Cost effective models for rapid
development of new treatments for Gulf War Illness using
computational models, research funding through the Department
of Defense's Congressionally Directed Medical Research
Programs, and clinical experts in environmental medicine have
been proven effective in partnership with VA medical centers.
The Committee directs the Secretary to establish a Center of
Excellence focused on toxic environmental exposures including
investigations of gender-based differences in disease and
treatment to leverage research funding through partnerships.
Jason Simcakoski Memorial and PROMISE Act Implementation.--
The Committee supports robust funding to support the continued
implementation of the Jason Simcakoski Memorial and Promise
Act, which passed as Title IX of the Comprehensive Addiction
and Recovery Act of 2016 (P.L. 114-198), including updating
therapy and pain management guidelines, strengthening provider
education and training, and improving patient advocacy.
Health Videos for Veterans.--Hospitals and physicians'
offices around the country are currently utilizing health
videos in their lobbies, waiting rooms, and exam rooms to
supplement and reinforce the medical care, advice, and
instruction physicians are providing. The Committee notes that
educational resources, such as these could result in cost
savings and quality of life improvement for Veterans. The
Committee encourages VHA to continue its efforts in providing
informative video content to veterans in VA facility lobbies
with a focus on health education and suicide prevention.
Reliance on Community Care Versus VA Medical Center and
Clinic Expansion and Development.--The Committee recommends the
Department develop a system to accurately compare the costs of
providing care in the community, as envisioned by the MISSION
Act, to the costs of providing care within the VA healthcare
system. The data captured by the system should be gathered and
made available in a manner that allows the accurate comparison
of the cost of various services to help inform future decisions
regarding the most cost-effective delivery of healthcare
services to Veterans. The Committee looks forward to working
with the Department to develop a medical care cost data
collection system.
Residency Programs.--The MISSION Act expanded VA's support
of residency programs. However, the Committee understands some
states have not taken advantage of this expansion. The
Committee requests a status report, within 180 days of
enactment of this Act, on the implementation of the MISSION
Act's residency program expansion and its efforts to encourage
states, especially rural and non-contiguous states, to utilize
the program.
Domiciliary Care for Veterans with Dementia.--The Committee
is aware that Veterans with dementia who require less than
Skilled Nursing Care are not eligible for VA domiciliary care
under current regulations, and that the population of Veterans
with dementia is expected to grow. The Committee appreciates
the Secretary's willingness to consider appropriate revisions
of regulations and directs VA to provide a report to the
Committee no later than 90 days after enactment of this Act on
the Department's plan to address care for such Veterans.
Antimicrobial Resistance.--The Committee recognizes the
growing threat from bacterial resistant infections and is
interested in novel antibiotic remedies. The Secretary is
directed to submit a report to the Committees on Appropriations
of both Houses of Congress on the Department's approach to
preventing and managing antibiotic-resistant infections and its
activities regarding novel antibiotic medicines and treatments
no later than 120 days after enactment of this Act.
Sleep Apnea.--Noting the Office of Inspector General report
titled, ``Opportunities Missed to Contain Spending on Sleep
Apnea Devices and Improve Veterans Outcomes'' (VAOIG-19-00021-
41), the Committee directs VHA to expeditiously implement the
Inspector General's recommendations, especially that the Under
Secretary coordinate with appropriate offices whether
purchasing and distributing sleep apnea devices is in the best
interest of the Department and Veterans and develop and provide
clear guidance before any changes to current purchasing
processes. Should the recommendations not be implemented within
30 days of enactment of this Act, VHA should provide a report
on its proposed timeline and milestones to the Committees on
Appropriations of both Houses of Congress.
Prostate and Breast Cancer Molecular Diagnostics.--Prostate
cancer and breast cancer are among the most frequently detected
cancers among male and female Veterans, respectively.
Unfortunately, early detection and diagnosis is not yet an
exact science. Advancements in molecular diagnostics have been
proven to improve clinical outcomes and reduce economic spend.
The Committee includes $5,000,000 for VA to accelerate the
adoption of prostate and breast cancer molecular diagnostics.
Rapid Testing and Self-Testing.--The Committee notes the
growing body of public health literature touting the impact of
rapid point-of-care testing and rapid self-testing for Human
Immunodeficiency Virus and Hepatitis C Virus. VA is encouraged
to integrate innovative testing options to ensure screening
services engage hard-to-reach Veterans, including affected
Veterans that do not regularly receive care at VA facilities.
Innovative Technological Solutions for Injured Veterans.--
The Department is encouraged to ensure injured Veterans are
integrated into product development teams so that adaptive
technologies are effectively tailored to meet the needs of
these Veterans.
Musical, Occupational, and Rehabilitative Therapies.--The
Committee encourages VA to utilize musical, occupational, and
rehabilitative therapeutic care at VA facilities. Early results
of these types of care indicate improved patient outcomes and
reduced overall Veteran rehabilitation time. The Committee
directs VA to provide a report within 120 days of enactment of
this Act on the types of new technologies and therapy models
developed for the purpose of adaptive therapeutic care offered
at VA facilities and a plan for how to expand this type of care
across all VA facilities.
Child Care Demonstration Program.--The Committee strongly
supports efforts by VA to provide access to free child care for
Veterans receiving treatment at VISNs, as authorized by the
Caregivers and Veterans Omnibus Health Services Act of 2010
(P.L. 111-163), and encourages the Department to furnish
qualified veterans with assistance for childcare. Past VA
surveys have found that one in ten Veterans have had to either
cancel or reschedule a VA healthcare appointment due to a lack
of childcare. A 2015 report to Congress from VA found the
program achieved a reasonable cost per hour as the number of
children cared for increased. The Committee therefore expects
VA to adhere to the authorized funding level given for the
operation of the Veterans Access to Child Care demonstration
program so that Veterans may continue uninterrupted access to
medical appointments.
Epilepsy Centers of Excellence.--The Committee includes
$10,000,000 toward maintaining and expanding the Epilepsy
Centers of Excellence within VA. The Committee directs the
Department to provide an update on the status of these Centers
to the Committee no later than 30 days after enactment of this
Act.
Oral Contraceptives.--Given the findings of the 2019 study,
``Financial Implications of 12-Month Dispensing of Oral
Contraceptive Pills in the Veterans Affairs Health Care
System'', published in JAMA Internal Medicine, VA is strongly
encouraged to investigate the feasibility of offering patients
the option to receive a full year's supply of birth control at
one time and ensuring Veterans are notified of that option.
Intimate Partner Violence Program.--The Committee continues
to support VA's efforts to expand its Intimate Partner Violence
Program to all sites within the next three years and directs VA
to expeditiously implement this program. The Committee supports
VA's plans to screen all Veterans for Intimate Partner Violence
and directs the Department provide the appropriate resources to
do so. Therefore, the Committee requests a report with 90 days
of enactment of this Act on VA's implementation timeline to
deploy this program across the healthcare system.
Adaptive Sports.--The Committee includes $27,048,000 for
National Veterans Sports Programs, which is $2,500,000 above
the request, including $16,000,000 for adaptive sports
programs. Veterans have shown marked improvements in mental and
physical health from participating in adaptive sports and
recreational therapy and Veterans have expressed the need for
these activities to be included in the healthcare services VA
offers. The Committee also recognizes that adaptive sports and
recreational therapy provide a low-cost alternative to other
healthcare services that produce similar health outcomes. The
Department is directed to make recreational and lifelong
sports, such as open-ocean swimming, surfing, outrigger
canoeing, hunting, and fishing eligible for grants.
Equine Therapy.--The Committee recommends the Department
use no less than $1,500,000 of funding provided for the
adaptive sports program for equine therapy. Moreover, the
Department should utilize funding to conduct a comprehensive
program evaluation to ensure the continued effectiveness of
equine therapy in addressing the mental health needs of
Veterans that participate in these programs, including through
the systematic assessment and tracking of mental health issues
and symptoms, and the measurement of key outcomes, such as
functional improvement in Veterans' different life domains.
Medical Waste.--The Committee is interested in the costs
and benefits of on-site medical waste treatment systems and
requests a report that discusses VA's current approach to
handling regulated medical waste, the costs of installing and
operating onsite systems, the incidence of their use within the
VA system, and includes a comparison with other medical waste
treatment options, and makes potential recommendations.
Access to Safe and Effective Therapies for Difficult to
Treat Depression.--The Committee is aware of a recent
international consensus statement acknowledging the challenges
individuals, including many Veterans, face when their
depression does not respond to common therapies. The Committee
supports Veterans' access to alternative, innovative treatments
for difficult to treat depression, including FDA-approved
medical devices, and encourages VHA to ensure access to safe
and effective treatment options.
Vet Centers.--The Committee recognizes the importance of
Vet Centers and the role they play in helping Veterans readjust
to civilian life. The Committee encourages VA to work with
local stakeholders to increase access to the readjustment
counseling services provided by Vet Centers, Mobile Vet
Centers, Outstations, and Community Access Points, and directs
the Department to increase outreach to Veterans so they are
aware of these counseling centers and services.
Coronary Heart Disease.--In House Report 115-673, the
Committee directed the Department to conduct a study on non-
invasive diagnostic technologies for cardiac heart disease. The
Committee is aware the Department has prepared a preliminary
report, but that it includes technologies not yet approved by
FDA. In order to provide the greatest benefit to the greatest
number of Veterans, the Committee directs the Department to
provide an updated report to the Committees on Appropriations
of both Houses of Congress on FDA-approved technologies within
180 days of enactment of this Act.
Joint Appointment Arrangements.--The Committee encourages
the Department to pursue joint appointment arrangements between
VA medical staff and other outside VA organizations, including
industry, universities, and academic affiliates, and further
encourages the Department to ensure that VA medical staff are
granted sufficient time to engage in clinical research.
Assisted Reproductive Services.--The Committee is extremely
displeased that VA does not have its own policy on providing
assisted reproductive services to Veterans who have sustained
serious or severe illness and/or injury while on active duty
that led to the loss of their natural procreative ability, and
instead relies on outdated and discriminatory guidance from
DOD. VA should develop its own guidance on providing assisted
reproductive services that does not discriminate against women
who cannot carry their own child to term, and therefore should
include gestational surrogacy benefits. The Committee directs
the Department, in consultation with DOD, to review how VA can
adopt a policy that removes barriers to gestational surrogacy
as a covered fertility benefit for eligible Veterans. Within 90
days of enactment of this Act, VA shall provide a
recommendation to the Committees on Appropriations of both
Houses of Congress on how VA can fix this gap in coverage so
that gestational surrogacy is included as an assisted
reproductive service available to wounded Veterans with
impacted fertility due to combat.
Fertility Treatment.--The Committee directs the Secretary
to submit to the Committees on Appropriations of both Houses of
Congress a report on the fertility treatment and counseling
furnished by VA during the year preceding the submittal of the
report no later than 120 days after enactment of this Act. The
report should include the following: (1) the number of Veterans
who received fertility treatment or counseling furnished by the
Department of Veterans Affairs, disaggregated by era of
military service of such Veterans; (2) the number of spouses,
partners, and gestational surrogates of Veterans who received
fertility treatment or counseling furnished by the Department;
(3) the cost to the Department of furnishing fertility
treatment and counseling, disaggregated by cost of services and
administration; (4) the average cost to the Department per
recipient of fertility treatment and counseling; (5) in cases
in which the Department furnished fertility treatment through
the use of assisted reproductive technology, the average number
of cycles per person furnished, disaggregated by type of
treatment; and (6) a description of how fertility treatment and
counseling services of the Department are coordinated with
similar services of the Department of Defense.
Infertility Services.--The Committee recognizes the
Department's effort to allow eligible Veterans to receive in
vitro fertilization (IVF) treatment or other forms of assisted
reproductive technology services. However, the Committee is
concerned that VA infertility services are denied to a growing
number of women Veterans due to marital status. The Committee
strongly encourages VHA to not disqualify unmarried women
Veterans from IVF treatment due to marital status and to submit
a report within 180 days of enactment of this Act on the number
of unmarried women Veterans denied of these services since the
inception of the program, disaggregated by state of residence,
race, and age.
Affiliation Agreements with Accredited International
Medical Schools.--The Committee is concerned VA may not be
fully utilizing the available physician pipeline to develop its
current and future physician workforce. The Committee
understands there are many highly qualified United States
citizens from international medical schools, but VA does not
currently permit international medical students to participate
in VA clinical training programs, regardless of whether the
students are United States citizens. The Committee urges the
Office of Academic Affiliation to consider the feasibility of
allowing new affiliation agreements with accredited
international medical schools that would permit students who
are United States citizens from these medical schools to
perform their clinical training requirements at VA facilities
as space and faculty allow. OAA should submit a report to the
Committee within 180 days of the enactment of this Act that
describes the findings of its review.
MEDICAL COMMUNITY CARE
Fiscal year 2020 enacted level........................ $15,279,799,000
Fiscal year 2021 enacted level........................ 17,131,179,000
Fiscal year 2021 budget year request.................. 1,380,800,000
Committee 2021 budget year recommendation............. 1,380,800,000
Fiscal year 2022 advance appropriation request........ 20,148,244,000
Committee 2022 advance appropriation recommendation... 20,148,244,000
Comparison with:
Fiscal year 2021 enacted level.................... +3,017,065,000
Fiscal year 2022 advance budget request........... - - -
The Medical Community Care account was created in the
Surface Transportation and Veterans Health Care Choice
Improvement Act of 2015 (P.L. 114-41). Per the MISSION Act of
2018, all community care programs are consolidated into one
community care program. For fiscal year 2022, the bill provides
$20,148,244,000, of which $2,000,000,000 is available until
September 30, 2023.
The Committee provides an additional $1,380,800,000 to be
available for fiscal year 2021 as requested in the budget
request to readjust the actuarial estimates for medical
community care.
In addition, the Coronavirus Preparedness and Response
Supplemental Appropriations Act (P.L. 116-123) included
$30,000,000 and the Coronavirus Aid, Relief, and Economic
Security Act (CARES Act) (P.L. 116-136) included $2,100,000,000
for the Medical Community Care account to prevent, prepare for,
and respond to coronavirus, including related impacts on health
care delivery.
Third-Party Payments and Reimbursements.--The Committee
continues to be concerned about the timeliness of
reimbursements by VA to private healthcare/third-party
providers and believes VA has created an inefficient process
that must be reformed. As VA continues the MISSION Act
implementation, the Committee believes VA must prioritize
efficient and prompt payment to community providers to ensure
timely access to quality care. Delays in processing of such
payments undermine the ability to recruit and retain private
healthcare providers to service our Nation's Veterans. House
Report 116-63 required comprehensive reports on a quarterly
basis detailing the amount owed to outside providers for every
state, and the Committee has yet to receive a single report.
The Committee reiterates the direction to provide quarterly
reports to include outstanding payments over six months old and
the corrective actions being implemented to address these
outstanding balances as well as average time for repayment.
Furthermore, the initial report should include a comprehensive
plan to prevent this issue from reoccurring in the future. The
Committee directs the Department to provide its first report no
later than 7 days of the filing of this report.
Choice Program Third-Party Payments and Reimbursements.--
The Committee recognizes the massive undertaking it took 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. The
Committee continues to await the fiscal year 2019 report, as
requested in House Report 115-673 and House Report 116-63, on
the effectiveness of the programs with third-party
administrators, and directs the Department to provide the
report no later than 7 days of the filing of this report.
Transportation Assistance.--The Committee is concerned with
the lack of access to transportation for Veterans who have
challenges traveling to work, school or medical appointments
due to disability, illness, or financial hardships. Veterans
who live in both rural and urban areas experience a lack of
consistent and efficient travel, especially access to medical
care. As VA continues to implement the Veterans Community Care
Program, transportation to medical care and services in the
community will be an even bigger obstacle for Veterans in the
future. The Committee urges VA to prioritize transportation
assistance for Veterans who live in both rural and urban areas,
and encourages VA to work with state, regional and local
groups, local VSOs, and nonprofits on transportation assistance
programs and provide direct transportation services for
Veterans who have limited access to transportation networks.
Long-Term Care for Veterans with TBI.--The Committee notes
the increasing prevalence of deployment-related traumatic brain
injuries. This increase continues to demonstrate the
longstanding need for providing adequate long-term specialty
care for Veterans suffering from severe TBIs. The Committee
further notes the GAO report entitled, ``Veterans Use of Long-
Term Care is Increasing, and VA Faces Challenges in Meeting the
Demand'' (GAO-20-284), which reached a similar conclusion. The
Committee remains concerned about the Department's inability to
articulate a plan to provide such residential care to Veterans
with severe TBIs. The Committee directs VA to 1) ensure an
adequate number of long-term residential care facilities are
available; 2) provide a report within 120 days of enactment of
this Act detailing VA's plan for how it will provide long-term
residential care for these Veterans if VA does not have its own
facilities to do so; and 3) make publicly available and easily
accessible on VA's website a list of long-term care community
providers that are within VA's community care networks.
Long-Term Care for Veterans in Rural Areas.--The Committee
notes the conclusion in GAO's report entitled, ``Veterans Use
of Long-Term Care is Increasing, and VA Faces Challenges in
Meeting the Demand'' (GAO-20-284), that the Department faces
challenges providing long-term residential care to Veterans in
rural areas, and directs the Department to submit a report on
the current and projected need for residential care for
Veterans with severe TBI, especially in rural areas, no later
than 180 days after enactment of this Act.
MEDICAL SUPPORT AND COMPLIANCE
Fiscal year 2020 enacted level........................ $7,337,956,000
Fiscal year 2021 enacted level........................ 7,914,191,000
Fiscal year 2021 budget year request.................. 300,000,000
Committee 2021 budget year recommendation............. 279,880,000
Fiscal year 2022 advance appropriation request........ 8,403,117,000
Committee 2022 advance appropriation recommendation... 8,403,117,000
Comparison with:
Fiscal year 2021 enacted level.................... +488,926,000
Fiscal year 2022 advance budget request........... - - -
The Medical Support and Compliance appropriation funds the
expenses of management and administration of the Department's
healthcare 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 $8,403,117,000 in advance fiscal year
2022 funding. The Committee has included bill language to make
available through September 30, 2023, $150,000,000 of the
Medical Support and Compliance appropriation for fiscal year
2022.
The Committee provides an additional $279,880,000 to be
available for fiscal year 2021, of which $124,000,000 is
provided for logistics system enhancements, as requested in the
budget and $155,880,000 is provided for additional medical
center administrative support, which is equal to the budget
request. The Committee does not include additional funding for
the high reliability organization initiative requested in the
budget.
In addition, the Coronavirus Aid, Relief, and Economic
Security Act (CARES Act) (P.L. 116-136) included $100,000,000
for the Medical Support and Compliance account to prevent,
prepare for, and respond to coronavirus, including related
impacts on health care delivery.
Report on Wage Surveys for Housekeeping Aides of Department
of Veterans Affairs.--The Committee directs the Secretary of
Veterans Affairs, in consultation with the Secretary of Defense
and the Director of the Office of Personnel Management (OPM),
to submit to the Committees on Appropriations of both Houses of
Congress, no later than 90 days after enactment of this Act, a
report on the methodology used to conduct wage surveys for the
Federal Wage System pursuant to section 5343 of title 5, United
States Code, for Housekeeping Aides of the Department of
Veterans Affairs. The report should include: (1) whether the
methodology used to conduct wage surveys for the Federal Wage
System considers differences in sanitation requirements with
respect to Housekeeping Aides employed in healthcare settings
versus non-healthcare settings; (2) whether the Secretary of VA
requires Housekeeping Aides to receive specialized training to
satisfy requirements relating to infection control at medical
facilities of VA, and whether the methodology used to conduct
such wage surveys considers the effectiveness of the relevant
wage schedule in accounting for such requirements; and (3) how
the methodology of the Department of Defense used to establish
wage schedules and rates of pay pursuant to section 5343 of
title 5, United States Code, for Housekeeping Aides compares to
the methodology OPM used to establish rates of pay under the
General Schedule pursuant to section 5332 of such title for
positions involving substantially equal work.
Clinical Trials Administrative Support.--The Committee
includes $3,000,000 to provide additional administrative
support to VA clinicians conducting clinical trials so that VA
is better able to assist veterans navigate the clinical trials
process.
MEDICAL FACILITIES
Fiscal year 2020 enacted level........................ $6,141,880,000
Fiscal year 2021 enacted level........................ 6,433,265,000
Fiscal year 2021 budget year request.................. 150,000,000
Committee 2021 budget year recommendation............. 170,120,000
Fiscal year 2022 advance appropriation request........ 6,734,680,000
Committee 2022 advance appropriation recommendation... 6,734,680,000
Comparison with:
Fiscal year 2021 enacted level.................... +301,415,000
Fiscal year 2022 advance budget request........... - - -
The Medical Facilities appropriation provides funds for the
operation and maintenance of the Department's healthcare
system's capital infrastructure. Included under this heading
are provisions for costs associated with utilities,
engineering, capital planning, leases, laundry, groundskeeping,
garbage, housekeeping, facility repair, and property
disposition and acquisition.
The bill provides $6,734,680,000 in advance fiscal year
2022 funding. The Committee has included bill language to make
available through September 30, 2023, $250,000,000 of the
advance Medical Facilities appropriation for fiscal year 2022.
The Committee provides an additional $170,120,000 to be
available for fiscal year 2021, of which $150,000,000 is
provided for non-recurring maintenance (NRM) projects to
support the electronic health record modernization as requested
in the budget, and $20,120,000 is provided for NRM projects to
repurpose vacant and underutilized space for mental health
needs and to expand women's access to gender-specific care.
Within the additional NRM funding for mental health, the
Committee directs VA to prioritize construction to increase the
number of beds available for overnight mental health treatment
for Veterans. VA is directed to provide an expenditure plan
detailing how the additional funding will meet both of these
initiatives no later than 90 days after enactment of this Act.
In addition, the Coronavirus Aid, Relief, and Economic
Security Act (CARES Act) (P.L. 116-136) included $606,000,000
for the Medical Facilities account to prevent, prepare for, and
respond to coronavirus, including related impacts on health
care delivery.
Spend 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
2021 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.
Community-Based Outpatient Clinic in Bakersfield,
California.--The Committee remains extremely concerned about
the delays to a new community-based outpatient clinic in
Bakersfield, California that was authorized by Congress over 10
years ago. Accordingly, the Committee directs the Secretary to
expeditiously execute the timeline, including awarding a lease
no later than August 31, 2020, and beginning sitework shortly
before the end of calendar year 2020. Furthermore, the
Committee directs the Secretary to provide monthly update
reports to the Committees on Appropriations of both Houses of
Congress, which should include an assessment on maintaining the
November 20, 2019 timeline and detailed reasons for any
deviations from that timeline, until the new clinic in
Bakersfield is activated.
Facility Transformations.--The Committee directs the
Department to provide a report no later than 90 days after
enactment of this Act on specific measures it takes to track
and prioritize both the physical and cultural transformation
within VA medical facilities to better serve women Veterans.
The Committee is concerned that VA has failed to keep up with a
growing population of women Veterans who deserve equitable
access to medical care. When one in four women Veterans report
having experienced unwanted sexual attention while serving, it
is concerning that the very system intended to address their
trauma is failing to foster a safe environment for them. The
Committee directs the Department to prioritize funding for
medical facilities to accommodate women Veterans.
Use of Smart Technologies.--The Committee continues to
encourage VA to pursue a demonstration program regarding the
use of innovative devices, systems, networks, and sensors to
improve, enhance, and modernize methods to operate and manage
VA facility energy, infrastructure, mechanical and waste
management systems, emergency response, perimeter security and
access, and traffic control systems that could be adapted for
use by a variety of VA facilities.
Medical Facilities Realignment.--The Committee remains
concerned that VA medical care realignments are being
approached in an ad hoc manner by each individual VISN rather
than on a comprehensive basis by VA Central Office. Moreover,
such an approach may lead to inequitable and inefficient
distribution of medical resources throughout the Nation. Before
VA makes any decision to relocate, close, or diminish services
at an existing facility, or proceeds with any such realignment
already underway, consideration must be given to the impact
such action would have on Veterans, especially tribal Veterans
or Veterans in rural or highly rural areas. The Committee
directs VA to adhere to a clear and transparent process that
engages all parties from the onset and is consistent with a
national realignment strategy. Since the conference report for
the Consolidated Appropriations Act, 2016 (P.L. 114-113), the
Committees have suspended the proposed realignment of services
in VISN 23 until a report was transmitted to the Committees,
and that report has not been received. The Department is again
directed to comply with the request for the report and
meanwhile suspend the proposed realignment of services in VISN
23 until such time as the Department transmits to the Committee
a report that outlines the following: (1) a national
realignment strategy that includes a detailed description of
realignment plans within each VISN; (2) an explanation of the
process by which those plans were developed and coordinated
within each VISN; (3) a cost versus benefit analysis of each
realignment, including the cost of replacing VHA services with
contract or other outsourced services; (4) an analysis of how
any realignment will impact tribal, rural, and highly rural
Veteran healthcare within each VISN; and (5) an analysis of how
any realignment will impact access to, enrollment in, and the
capacity of VA PTSD and Residential Rehabilitation Treatment
Program services within each VISN and nationally.
Research Facilities Infrastructure Report.--The Committee
is pleased it received the Phase II Research Facilities
Infrastructure report requested in House Report 116-63 and
directs the Department to provide a report within 120 days of
enactment on its plan to correct the infrastructure
deficiencies identified in the report.
High Enrollee Growth.--The Committee is concerned that
Veterans health care systems with high enrollee growth, such as
those in Texas and Florida, are not receiving sufficient
priority for much-needed capital improvements. The Committee
urges VA to prioritize infrastructure projects in high enrollee
growth systems to ensure that VA infrastructure is prepared for
the growing number of Veterans needing care. Therefore, the
Secretary is directed to submit to the Committees on
Appropriations of both Houses of Congress a report on the
infrastructure needs of high enrollee growth Veterans health
care systems and a plan by fiscal year to address those needs
no later than 90 days after the enactment of this Act.
VA Facility Security.--The Committee continues to encourage
the Department to improve the security of its campuses and
facilities to ensure the safety of Veterans, visitors, and
employees and supports the Department's investments in this
area. The Committee recommends that security and technology
upgrades take a holistic approach and deploy proven
technologies. The Committee directs the Department to provide
an update to the ``Response to Security Threats'' report as
requested in Division J of the Explanatory Statement
accompanying P.L. 114-113, and provided to the Committees on
Appropriations of both Houses of Congress on May 13, 2016, to
include current VA security policy, an assessment of security
at VA facilities, initiatives to improve the safety of patients
and staff in VA facilities, and how intelligent policing
solutions could enhance security in VA facilities, within 120
days of enactment of this Act.
Facility Donations.--The Committee recognizes the vital
role of VA's health care facilities in serving the unique needs
of Veterans. The Committee also recognizes the potential for
innovative partnerships with community stakeholders,
particularly when it comes to community donations of well-
maintained medical facilities that can be converted into VA
health care facilities. Therefore, the Committee encourages VA
to continue working with community stakeholders that have
expressed an interest in medical facility donations.
Research Lease.--The Committee supports the long-standing
affiliation between the Truman VA and the University of
Missouri and encourages the Department and the House Veterans
Affairs Committee to expeditiously resolve outstanding budget
scoring issues.
Landscaping at VA Facilities.--The Committee encourages the
Department to include landscaping and the planting of trees in
its designs for new or replacement facilities, as practicable.
Major Medical Lease.--The Veterans Access, Choice, and
Accountability Act of 2014 (VACAA) (P.L. 113-146) authorized VA
to enter into various major medical leases across the nation.
This includes the Advanced Leeward Outpatient Healthcare Access
(ALOHA) Project that will open a 66,000 square foot leased
facility to better serve Veterans in Hawaii and those enrolled
in the VA Pacific Islands Health Care System. The Committee
notes that multiple lease projects were included in the fiscal
year 2014 budget request and authorized in VACAA, but certain
facilities have been significantly delayed and still have not
opened. Therefore, the Committee directs the Secretary to
provide a report to the Committees on Appropriations and
Veterans Affairs of both Houses of Congress no later than 60
days after enactment of this Act detailing: (1) the timeline
and explanation of events that have delayed any major medical
lease authorized under VACAA that has not been awarded,
including the ALOHA Project, (2) planned award dates and other
major actions that need to occur for these projects to proceed,
including an estimated timeline for completing each action, and
(3) a summary of any concerns raised by other Federal agencies
assisting the VA with awarding these projects.
MEDICAL AND PROSTHETIC RESEARCH
Fiscal year 2020 enacted level........................ $800,000,000
Fiscal year 2021 budget request....................... 787,000,000
Committee recommendation in the bill.................. 840,000,000
Comparison with:
Fiscal year 2020 enacted level.................... +40,000,000
Fiscal year 2021 budget request................... +53,000,000
This appropriation provides for medical, rehabilitative,
and health services research. The bill provides $840,000,000
available through September 30, 2022. The Committee recognizes
the importance of the research conducted by VA for Veterans'
quality of life and health and provides $53,000,000 above the
request and $40,000,000 above fiscal year 2020 for these
activities.
Medical research, which helps ensure the best medical and
hospital services for Veterans, is an important aspect of the
Department's programs. 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 healthcare
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 fiscal year 2021 research resources in
addition to those provided in the research account are
$1,263,950,000.
National Center for Post-traumatic Stress Disorder
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 Committee recognizes the importance of the VA National
Center for PTSD in promoting better prevention, diagnoses, and
treatment of PTSD, and applauds the VA National PTSD Brain Bank
on its development of the largest data set of PTSD. The
Committee provides $40,000,000 for the Center in fiscal year
2021, which includes $10,000,000 for the coordination of the VA
National PTSD Brain Bank. The Committee encourages the National
Center to use funding for the Brain Bank to accelerate the
discovery of novel therapeutic targets for the treatment of
PTSD utilizing post-mortem brain datasets, cell-based and other
models for target identification and validation.
Dystonia.--The Committee notes the connection between
traumatic brain injury and the onset of dystonia. The Committee
further notes recent events that have led more servicemembers
to be diagnosed with TBI and continues to urge VA to pursue
collaboration with stakeholders to advance critical research on
dystonia.
Cannabis Research.--The Committee requests an update on the
status of the study on cannabis research, as described in House
Report 116-63.
Access to Clinical Trials.--The Committee applauds the
ongoing collaborative efforts between VA medical centers and
NCI-designated comprehensive cancer centers that will allow
Veterans to have access to the highest quality cancer care
available, including cutting-edge clinical trials. The
Committee is concerned that States with large Veteran
populations are not able to access these treatments. The
Committee directs VA to expand 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 commends the work of the
NAVIGATE partnership (NCI and VA Interagency Group to
Accelerate Trials Enrollment) in providing NCI funding for VA
health centers, which have already established clinical trials
partnerships with academic cancer centers. The Committee is
concerned, however, that this partnership does not include
certain States with large Veteran populations. To address this
need, the Committee directs VA to provide up to $5,000,000 to
support the establishment of partnerships between VA hospitals
and NCI-designated facilities that allow for Veterans to access
cancer clinical trials at VA health centers. Additionally, the
Committee directs the Department to provide a report within 120
days of enactment of this Act detailing best practices of VA
facilities in providing access to clinical trials to Veterans.
PFAS Contamination.--The Committee directs VA to continue
collaborating with the Defense Department's Per- and
Polyfluoroalkyl Substances (PFAS) Task Force, academia, and
other health institutions to monitor research activities,
results, and publications on the health effects from PFAS.
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, Guam, the Northern Mariana Islands, America Samoa,
and all other geographic areas where these toxic substances
were dispersed. The Committee urges the Department 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.
Research on Toxic Exposures.--The Committee encourages the
Department to continue and expand its research on the effects
of and treatments for Veterans exposed to toxins, such as Agent
Orange, burn pits, PFOS/PFOA, radiation, and asbestos, during
the course of their active duty service.
Prosthetics Research.--Women have different physical
requirements for prosthetics compared to men. The Committee
directs VA to prioritize medical and prosthetic research to
adequately address prosthetics meant for women.
Neural-Enabled Prosthetics.--The Committee understands the
uniqueness of limb trauma injuries sustained by servicemembers
in combat. Traumatic injury or neurological diseases can also
significantly alter or impair the lifestyle of the individual
and their caregivers. The Committee encourages VA to fund
research that will design and develop technology to offset the
effects of limb amputation, orthopedic injury and disease,
neuropathic pain, and other neurodegenerative diseases. Thus,
the Committee includes $25,000,000 for VA to prioritize and
fund collaborative research with a coalition of universities
aimed at accelerating functional recovery and rehabilitation of
sensorimotor function through engineering of wirelessly
activated implantable biomedical technologies capable of focal
stimulation inside nerves and that is personalized to the needs
of the patient.
Gulf War Illness Studies.--Even as Congress, the
Administration, and the public await the results of the
National Academies of Sciences report on Gulf War illness, 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 encourages the findings of all research
conducted by or for the Executive Branch relating to the health
consequences of military service in the Persian Gulf theater of
operations during the Persian Gulf War be made publicly
available as soon as possible. The Committee also urges the
Department to publish disease-specific mortality data related
specifically to Persian Gulf War Veterans. The Committee
remains concerned by VA's ever-evolving terminology for the
signature adverse health outcome of the Persian Gulf War,
recognized by the Institute of Medicine (IOM) as Gulf War
Illness, and encourages the Department to utilize the term,
``Gulf War Illness'', as IOM has recommended. The Committee
continues to urge the Secretary to consider revising and
updating the Clinical Practice Guideline for Chronic
Multisymptom Illness consistent with the July 2011 Veterans
Health Initiative, ``Caring for Gulf War Veterans'' in that it
cannot be reliably ascribed to any known psychiatric disorder,
and to focus on recent Gulf War Illness treatment research
findings and ongoing Gulf War Illness treatment research
direction. Furthermore, the Committee once again encourages VA
to strengthen the training of primary, specialty, and mental
healthcare providers on the Gulf War Illness case definitions
recommended by IOM.
Public Access to Scientific Data.--The Committee commends
the Department 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 requires an update
on progress made be included in its fiscal year 2022 budget
request.
NICoE Collaboration.--The Committee recognizes the high-
quality mental health care and neurological research being
conducted at Walter Reed National Intrepid Center of Excellence
(NICoE). The Committee directs VA to strengthen its
collaboration with NICoE so VA researchers and health
professionals can learn from NICoE's important work and
contribution to the health community. Furthermore, as Veterans
and servicemembers continue to face higher rates of brain
trauma than civilians, impacting brain function, it is
imperative agencies collaborate to study neurological
conditions such as PTSD, bipolar, schizophrenia, depression,
suicide and substance use disorders. The Committee requests a
report within 120 days of enactment of this Act on existing
collaborative efforts between VA and NICoE and the expansion of
such collaborations. The report should also include a summary
of current VA neurological research objectives, data from VA
summarizing the presence among Veterans of the conditions
referenced above as a percentage of VA annual inpatient
hospitalizations, the percentage of the annual VA research
budget over the last five years dedicated to researching those
conditions, list any new or ongoing trials for pharmacological
treatments underway to address such conditions, and provide the
total 2019 expenditure by VA for medications to treat these
patients and its percentage of total pharmacological
expenditures.
Hyperbaric Therapy.--The Committee supports continued study
of the use of hyperbaric oxygen treatments for Veterans
suffering from post-traumatic stress disorder.
Advanced Platform Technology (APT) Center.--The Committee
is pleased about the progress being made to provide our
nation's Veterans with new assistive and restorative
technologies that address sensory, motor, or cognitive
deficits, as well as limb loss. The APT Center has effectively
utilized a partnership model to leverage local and national
research expertise to make progress in diverse areas including
artificial lung development, wound healing, and neurally-
connected sensory prosthesis. The Committee supports the APT
Center's efforts.
Regional Research Networks.--The Committee supports the
Department's efforts in continuing to establish regional
research networks in areas where existing small VA research
programs align with a co-located academic partners. The
Committee directs the Department to provide a report within 120
days of enactment of this Act on how it is achieving the
following objectives and/or steps the Department can take to
better meet these objectives: (1) supporting the development
and/or enhancement of infrastructure and human resources
required to address clinical and translational research needs
in small under-resourced VA jurisdictions, (2) fostering and
sustaining collaboration and coordination of clinical and
translational activities within and across VA jurisdictions,
and (3) addressing the broad spectrum of health challenges and
concerns faced by populations served by small underfunded VA
research programs.
Spinal Cord Research.--The Committee encourages the
Department to work with outside organizations on spinal cord
injury translational research to improve the quality of life of
impaired and disabled Veterans, and provides $10,000,000 to do
so.
Rare Cancer and Molecular Diagnostics.--The Committee
believes that every veteran with cancer deserves the highest
quality and most medically advanced diagnosis and treatment
available. Those who have served are uniquely exposed to
numerous hazards, which are associated with an increased risk
of cancer during and following their service. Over 60 forms of
cancer disproportionately impact those who have served in the
military, and the majority of those cancers are rare, defined
as having fewer than six new cases per 100,000 Americans per
year. Molecular diagnostics, including microarray and next
generation sequencing, performed at the first occurrence of
cancer can provide medical providers and patients with vital
information regarding the specific tumor type and its drivers,
which can lead to the most accurate precision medicine for
cancer patients. Therefore, the Committee recommends that VHA
provide molecular diagnostics at the time of diagnosis as well
as at the time of tumor recurrence for all cancer patients.
Further, the Committee requires the Department to issue a
report no later than 60 days after the enactment of this Act
describing the how it is using specific types of molecular
diagnostics, such as microarray, whole exome, and RNA-Seq in
research and development, as well as outlining how it is
collaborating with the external research community to advance
understanding and research in rare cancer treatments for
Veterans.
Severe Depression and Suicide Prevention.--The Committee
recognizes the important work by the Departments of Veterans
Affairs, Defense, and Health and Human Services, including the
National Institutes of Mental Health, to study treatments for
severe depression and options to prevent suicides and
encourages continued collaboration on these studies, including
the potential use of scopolamine in treating depression, for
the benefit of Veterans, servicemembers, and the general
public.
Psychological Health and TBI.--The Committee supports the
Department's research efforts focusing on psychological health
and traumatic brain injury.
Medical Care Collections Fund
The Department of Veterans Affairs Medical Care Collections
Fund (MCCF) was established by the Balanced Budget Act of 1997
(P.L. 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 2021 is $4,403,000,000.
MCCF Third-Party Billing.--The Committee remains concerned
over potential discrepancies in VA's billing and collection
processes. Procedures to provide for correct billing and prompt
collection must be improved at VA. Therefore, the Department is
required to submit to the Committees on Appropriations of both
Houses of Congress a quarterly report identifying the amount of
third-party health billings that were owed to VA in the
previous quarter and the amount collected. The first quarter
report also should include billings and collections data for
fiscal years 2017 through 2020. The report should include
billings and collections data for both large claims (greater
than $1,000) and small claims (equal to or less than $1,000).
In addition, the first quarter report should also include
current efforts underway to increase VA's efficiency, accuracy,
and collection process, as well as what management practices
are in place to provide proper oversight of the billing
process, including appeals, so as to eliminate unnecessary and
duplicative functions. The initial report also should include
the status and results of the pilot program that emphasized the
use of automated solutions and the use of private sector
revenue cycle management techniques and small balance recovery
and appeal processes as directed in the Joint Explanatory
Statement accompanying the Consolidated Appropriations Act,
2016 (P.L. 114-113).
National Cemetery Administration
Appropriation, fiscal year 2020....................... $329,000,000
Budget request, fiscal year 2021...................... 360,000,000
Recommended in the bill............................... 349,000,000
Bill compared with:
Appropriation, fiscal year 2020................... +20,000,000
Budget request, fiscal year 2021.................. -11,000,000
The National Cemetery Administration (NCA) was established
in accordance with the National Cemeteries Act of 1973 (P.L.
93-43). 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 156 national
cemeteries, including 11 cemeteries being transferred from the
Department of the Army, and 33 other cemeterial installations.
The Committee provides these funds to meet increasing
workload and burial expansions. NCA should prioritize
maintaining the current level of services at existing
cemeteries and activating new cemeteries to increase burial
access.
The bill includes language making ten percent of the total
available until September 30, 2022.
Prisoners of War Headstones.--The Committee is extremely
disturbed by the presence of headstones of prisoners of war in
Fort Sam Houston National Cemetery and Fort Douglas National
Cemetery that feature swastikas and inscriptions honoring Adolf
Hitler, and is pleased that the Department has agreed to take
immediate steps to swiftly replace these headstones with ones
that do not feature Nazi insignia or inscriptions glorifying
the Nazi regime. While the Committee understands that the
Department has initiated a consultation process under the
National Historic Preservation Act, the Committee makes clear
that this process should not unnecessarily delay action on
replacing these headstones. The Committee directs VA to provide
its plan for the consultation process and the timeline for
removal of these headstones to the Committees on Appropriations
of both Houses of Congress within 30 days after this report is
filed, and further requires monthly reports on the status of
the process. Furthermore, the Committee understands that VA
intends to add signage at relevant cemeteries providing
historical context on the burial of prisoners of war in U.S.
cemeteries, and emphasizes that the design and wording of such
signage must be carefully crafted in order to allow this
history to be studied without causing undue pain for those most
affected by it. The Committee therefore directs VA to include
details on its proposal to provide historical context for
headstones of prisoners of war in its report to the Committees
on Appropriations of both Houses of Congress.
Rural Cemetery Access.--The Committee continues to be
concerned that NCA is not adequately serving the Nation's
Veterans in rural areas and that there are geographic pockets
in the country which continue to go unserved. The Committee
therefore directs VA to continue to pursue efforts to ensure
that a burial option, including those utilizing public-private
partnerships, within 75 miles of all Veteran homes is available
and accessible.
County-run Veteran Cemeteries.--The Committee is committed
to ensuring Veterans' burial needs are met and that they can be
buried at a Veterans cemetery close to their home. The
Committee encourages the Department to explore ways to support
county-run Veteran cemeteries to further meet the needs of
Veterans seeking burial.
Burial of Unclaimed Veteran Remains.--The Committee
recognizes the efforts of VA to improve the burial of unclaimed
Veteran remains; however, the Committee remains concerned about
the current state of unclaimed Veteran remains nationally. The
Committee directs VA to submit a report to the Committee on
Appropriations, no later than 120 days after enactment of this
Act, providing an update to the Report to Congress on Unclaimed
Veterans' Remains required by Section 303 of the Jeff Miller
and Richard Blumenthal Veterans Health Care and Benefits
Improvement Act of 2016 (P.L. 114-315). The report shall
incorporate input from the Veterans Health Administration,
National Cemetery Administration, and Veterans Benefit
Administration, and include what VA has done to enhance its
efforts to communicate with and educate stakeholders on
applicable VA burial benefits and procedures, including metrics
(e.g. who was contacted, how they were contacted, etc),
obstacles to such communications, and an update on tracking and
reporting mechanisms and implementation of a comprehensive,
web-based Memorial Benefits Management System (MBMS).
Departmental Administration
GENERAL ADMINISTRATION
(INCLUDING TRANSFER OF FUNDS)
Fiscal year 2020 enacted level........................ $355,911,000
Fiscal year 2021 budget request....................... 413,000,000
Committee recommendation in the bill.................. 355,911,000
Comparison with:
Fiscal year 2020 enacted level.................... - - -
Fiscal year 2021 budget request................... -57,089,000
The General Administration account provides funds for the
Office of the Secretary, the General Counsel, six Assistant
Secretaries, and two Department-level staff offices. The
Committee has included bill language to make available through
September 30, 2022, up to ten percent of these funds and to
permit the transfer of funds in this account to the General
Operating Expenses, Veterans Benefits Administration account.
In addition, the Coronavirus Aid, Relief, and Economic
Security Act (CARES Act) (P.L. 116-136) included $6,000,000 for
the General Administration account to prevent, prepare for, and
respond to coronavirus.
VA Five Year Development Plan (VFYDP).--The Committee is
very pleased that the Department has provided a VFYDP in its
fiscal year 2021 budget. The Committee looks forward to
reviewing the VFYDP in future VA budget submissions.
Quarterly Financial Information Reports.--The bill includes
an administrative provision that extends the requirement for
submission of the quarterly financial information required in
the fiscal year 2017 bill and conference report.
Additional Budgetary Information.--The Committee continues
its request that items described in previous 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 that 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 believes 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, no later than 90 days after 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 Business Transformation (FMBT).--The
Committee provides $221,319,000 for FMBT, of which $13,924,000
is provided in this account and $111,060,000 in the Information
Technology Systems account. An additional $96,335,000 will be
provided from the VA customer offices through the Franchise
Fund and Supply Fund. The current legacy financial management
system is over 30 years old, and its imminent failure presents
significant risks to VA. In the fiscal year 2018 conference
report, 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 2021.
Office of Accountability and Whistleblower Protection.--The
Committee views the work of the Office of Accountability and
Whistleblower Protection (OAWP) as very important to the
Veterans community. OAWP was established to provide support and
protection to VA employees who are whistleblowers. However, on
October 24, 2019, the Inspector General released a report
noting failures in implementing critical aspects of the VA
Accountability and Whistleblower Protection Act of 2017. During
a hearing before the Committee on November 14, 2019, the
Inspector General testified that the recommendations to address
the concerns remained open and unimplemented. Further, the
Committee understands that OAWP has not fully performed many of
its core functions. For example, OAWP is required to
investigate allegations by whistleblowers, including
retaliation against whistleblowers, however, OAWP has a backlog
of hundreds of investigations. Further, although required to
recommend actions to the Secretary for actions based on these
recommendations, only one recommendation had been made during
the calendar year as of the Committee's hearing. The Committee
expects OAWP to complete fully, and in a timely manner, all its
core functions. Further, the Committee expects OAWP to report
to the Committees on Appropriations of both Houses of Congress
within 60 days of enactment of this Act on its compliance with
the 2017 statute, including (1) a complete listing of all
recommendations for action to the Secretary; (2) a complete
listing of all stays established during investigations during
the previous two years; (3) progress toward eliminating the
backlog of investigative cases; and (4) progress toward
providing training to VA employees and supervisors.
Supporting Minority and Disadvantaged Contractors.--The
Committee recognizes the need to continue to meet its goals for
contracting with minority, disadvantaged, and women-owned
businesses. Therefore, the Committee directs 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 that submitted a small business subcontracting plan
during the fiscal year, disaggregated by race and ethnicity.
This report should 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 the Department. The
Committee recommends, when applicable, the Secretary display
information in the annual report(s) submitted to Congress
separately for women Veterans and minority Veterans.
Office of Enterprise Integration.--The Committee is
supportive of the work carried out by the Office of Enterprise
Integration and the Innovation Ecosystem for the continuous
improvement of the Veteran experience by utilizing data
analytics and data governance, in addition to other
capabilities. Even with this work there are still gaps in
awareness and knowledge of services in which Veterans are
eligible. With this in mind, the Committee encourages the
Department to prioritize funding for the Office of Enterprise
Integration to streamline innovation efforts and initiatives
across VA and to transform Veterans' experience by providing
customized lifetime communication and outreach through various
channels of communication to ensure Veterans receive eligible
services and benefits from VA.
VA Chief Financial Officer.--The Committee directs the
Secretary to develop and submit to the Committees on
Appropriations of both Houses of Congress within 180 days of
enactment of this Act, a plan to address the material weakness
of the Department, as identified in the November 2019 OIG
Report, ``Audit of VA's Financial Statements for Fiscal Years
2019 and 2018'' (VAOIG-19-06453-12). The report should include
timelines for fully addressing the repeated material weakness
of the Department and recommendations related to entity level
controls, including the organizational structure of the office
of the Chief Financial Officer of the Department, and the steps
the Secretary plans to take to provide sufficient authority to
the Chief Financial Officer to carry out the requirements of
section 902 of title 31, United States Code.
Veterans First Contracting Program.--The Committee
recognizes the tremendous value of the Veterans First
Contracting Program in assisting in the expansion and growth of
service-disabled Veteran and Veteran-owned small businesses.
Therefore, the Committee encourages VA to continue to expand
and make mandatory the training of contracting officers in the
requirements of the Veterans First Contracting Program, with
particular attention being paid to conducting the market
research necessary to ensure that service-disabled Veteran and
Veteran-owned small businesses are awarded VA contracts when
appropriate.
BOARD OF VETERANS APPEALS
Appropriation, fiscal year 2020....................... $182,000,000
Budget request, fiscal year 2021...................... 198,000,000
Recommended in the bill............................... 198,000,000
Bill compared with:
Appropriation, fiscal year 2020................... +16,000,000
Budget request, fiscal year 2021.................. - - -
The bill makes ten percent of this funding available
through September 30, 2022.
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
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. On February 19,
2019, VA implemented the new legislative framework that
modernized the claims and appeals process and provided greater
choice to Veterans by providing them three options for claims
and appeals: (1) a supplemental claim; (2) a higher-level
review; or (3) a direct appeal to the Board of Veterans'
Appeals. BVA decided a record number of 95,000 cases in 2019,
even as the number of individual issues decided within cases
rose by more than 50,000 from the previous year. Additionally,
BVA has increased the number of hearings held by 38 percent
over the previous year.
The bill also provides the $6,000,000 as proposed in the
budget request to support phase three of the Appeals
Modernization initiative. The initiative will convert the
Board's 1980s-era case control and locator system to a new,
automated integrated community developed suite that is used to
process initial disability claims.
Off-site Teleconference Hearings.--The Committee recognizes
the strides made by the Board to make it easier for Veterans to
participate in appeals hearings by allowing appellants to
appear before the board via teleconference from locations other
than VA facilities. The Committee encourages further
implementation of teleconference hearings to allow Veterans to
teleconference without sacrificing the security of Veterans'
personal information and without negatively impacting the
outcome of their appeals. Appellants before the Board should be
permitted to teleconference from a location of their choosing
and via a secure internet platform established and maintained
by the Secretary that protects sensitive personal information
from a data breach. Further, the Committee directs the
Department to submit a report to the Committee detailing the
number of such teleconference hearings that have been
scheduled; the number of such teleconference hearings that were
cancelled; and any statistical difference in outcomes between
cases heard by teleconference at location of the appellant's
choosing and those held at the principal location of the Board
or by picture and voice transmission at a VA facility.
INFORMATION TECHNOLOGY SYSTEMS
(INCLUDING TRANSFER OF FUNDS)
Fiscal year 2020 enacted level........................ $4,371,615,000
Fiscal year 2021 budget request....................... 4,912,000,000
Committee recommendation in the bill.................. 4,912,000,000
Comparison with:
Fiscal year 2020 enacted level.................... +540,385,000
Fiscal year 2021 budget request................... - - -
The Information Technology (IT) Systems account supports IT
services such as systems development and performance,
operations and maintenance, information protection, and
customer support. The program permits the effective and
efficient delivery of Veterans' healthcare services and
benefits programs.
Within the account total, the Committee allocates in bill
language $1,211,238,000 for pay and associated costs,
$3,205,216,000 for operations and maintenance, and $495,546,000
for development. The bill makes available three percent of pay
and associated costs and five percent of operations and
maintenance funds until September 30, 2022. All development
funds are available until September 30, 2022.
In addition, the Coronavirus Aid, Relief, and Economic
Security Act (CARES Act) (P.L. 116-136) included $2,150,000,000
for the Information Technology Systems account to prevent,
prepare for, and respond to coronavirus, including related
impacts on health care delivery.
The bill provides $111,060,000 to continue the Financial
Management Business Transformation (in addition to the
$13,924,000 provided for FMBT in the General Administration
account and the $96,335,000 provided out of the Franchise Fund
and Supply Fund).
The Committee continues bill language permitting the
transfer of funding among the three subaccounts upon approval
of the Committees on Appropriations of both Houses of Congress.
The bill contains language allowing for the reprogramming
of funds among development projects upon prior notification to,
and approval by, the Committees on Appropriations of both
Houses of Congress. 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 Committee's recommendation for
each development project. 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)
------------------------------------------------------------------------
Committee
Project Recommendation
------------------------------------------------------------------------
Clinical Applications................................ $95,763
Health Management Platforms.......................... 63,827
Benefits Systems..................................... 160,216
Memorial Affairs..................................... 15,130
Other IT Systems..................................... 114,550
Cybersecurity........................................ 11,380
Information/Infrastructure Management................ 34,680
------------------
Total All Development............................ 495,546
------------------------------------------------------------------------
The Committee expects the Office of Information and
Technology to continue to provide an IT expenditure report to
the Committees on Appropriations of both Houses of Congress on
a monthly basis. This report should 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.
Balancing VHA IT National Standards with Local, Short-term
IT needs.--The Committee continues to encourage VA to
vigilantly pursue its national IT goals and do all that is
necessary to maintain needed national standards in IT while at
the same time meeting short-term local IT needs of individual
VA medical centers. VA should solicit, review, and respond in a
timely fashion to short-term IT requests from its medical
centers and clinics. The Committee supports keeping on track
with beneficial national IT plans and standards, but the
Committee also supports serving Veterans well on location in
the short run. Long-term IT synchronization and short-term
outstanding service should both be a part of the VA's
management strategy.
VA Forms Modernization.--The Committee supports the
Department's efforts to modernize its internal and external
digital services consistent with the requirements of the 21st
Century Integrated Digital Experience Act (IDEA) (P.L. 115-
336). The Committee believes the 21st Century IDEA will enable
the Office of Information and Technology and Veterans
Experience Office to improve digital service delivery for
Veterans and internal workflows. Therefore, the Committee
recommendation includes $5,000,000 to implement those 21st
Century IDEA requirements that have the most significant impact
on mission enhancement and that most effectively modernize
Veteran-facing services; specifically, the Committee encourages
the Department to modernize and secure its paper-based forms to
ensure they are mobile responsive to help achieve cost savings
and workflow efficiencies.
VA Medical and Prosthetic Research Program IT
Infrastructure.--The Committee directs VA to submit a report
providing an analysis and assessment of information technology
infrastructure needs as well as projects and funding that have
been allocated and/or obligated to the Medical and Prosthetic
Research Program to support VA Research Infrastructure over the
last 5 years as compared to the overall VA IT expenditures or
allocations. This report is due no later than 120 days after
enactment of this Act.
Release of Names and Addresses.--To help make Veterans
aware of the benefits and services they are entitled to, VA was
given the authority to release the names and addresses of
Veterans to non-profit organizations and Members of Congress.
However, VA faces significant challenges in providing name and
address information in a timely and useful manner due to
reliance on legacy mainframe computer systems to store data,
the labor-intensive process of pulling data from mainframe
systems, reductions in IT staff, increasing numbers of
Veterans, and fluctuating numbers of requests. The Committee
encourages the Department to continue to make improvements to
its processes, and directs a report on the stability and
security of VA's existing mainframe computer systems and
estimated costs and benefits of upgrading them within 60 days
of enactment of this Act.
Zero-Trust Data Protection.--The Committee encourages VA to
implement a zero-trust approach to access its information
systems to increase its security posture and protect personally
identifiable information, personal health information, and
Electronic Health Records.
Digital Protection Pilot Program.--The Committee believes
it is our country's duty to protect our Veterans, the
Department of Veterans Affairs, and Congressionally Chartered
VSOs from both foreign and domestic threats across the digital
landscape attempting to steal money, pilfer personal
information or peddle foreign influence via social media or
other online campaigns. The Committee provides $5,000,000 for a
pilot program that taps into commercially available, proven,
automated technology to launch a robust digital protection
initiative.
Standard of Care.--The Committee is encouraged to see some
VA medical facilities have or are pursuing a surgical workflow
solution that provides access to surgical facilities,
coordinates patient, staff and surgical resources, and adheres
to surgical safety standards. The Committee encourages VHA to
standardize these services across all VA medical surgical
facilitates to enhance Veterans' safety and improve surgical
care. Within 60 days of enactment of this Act, the Department
is directed to provide a report to the Committee on its
standard of care for surgical services.
OPEN Government Data Act Implementation.--The Committee
encourages the department to comply with the OPEN Government
Data Act, Title II of the Foundations for Evidence-Based
Policymaking Act (P.L. 115-435), which requires Federal
agencies to default, when possible, to making data (and
metadata) public, to publish that public data in a machine-
readable format, and catalog it online.
VETERANS ELECTRONIC HEALTH RECORD (EHR)
Fiscal year 2020 enacted level........................ $1,500,000,000
Fiscal year 2021 budget request....................... 2,627,000,000
Committee recommendation in the bill.................. 2,627,000,000
Comparison with:
Fiscal year 2020 enacted level.................... +1,127,000,000
Fiscal year 2021 budget request................... - - -
The Veterans Electronic Health Record is a unified account
designed to manage the effort to develop an interoperable
electronic health record system that will access seamlessly the
records of Veterans in the VA system and those of the
Department of Defense 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 $1,191,000,000
for the electronic health record contract, $255,000,000 for
program management, and $1,181,000,000 for infrastructure
support. Funding is made available for three years due to the
uncertainty of the timing of obligations for this substantial
effort.
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
into this account nor for funds from this account to be
transferred out 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 manage this effort at the headquarters level in
the Office of the Deputy Secretary.
The bill continues language requiring the Secretary to
submit a quarterly report to the Committees on Appropriations
of both Houses of Congress detailing obligations, expenditures,
and deployment strategy by facility. VA is directed to continue
quarterly briefings on performance milestones, costs, and
changes to implementation and management plans, and to provide
an accurate up-to-date deployment schedule each quarterly
briefing. In addition, bill language is included requiring
notice to and approval from the Committees on Appropriations of
both Houses of Congress on any changes to the deployment
schedule. Should there be any deviation from the deployment
schedule, the Committee directs the Department to formally
submit in writing a proposed updated deployment schedule within
7 days of notification to the Committees of any potential
change. The Committee repeats the fiscal year 2020 directive
for GAO to perform quarterly performance reviews of the VA
electronic health record deployment. It is expected that this
quarterly reporting will provide the Committees and VA with
timely information to properly oversee this effort and address
important issues.
The Committee is displeased with the lack of transparency
and communication from the Office of Electronic Health Record
Modernization and expects all status updates, changes to
scheduling, cost, or overall execution of the project be
communicated promptly and directly to the Committees on
Appropriations of both Houses of Congress.
Interoperability with the Private Sector.--The Committee is
concerned about the compatibility and interoperability of the
new EHRM system with community care providers and requires
updates on plans and efforts on integration with community care
providers into the system to be submitted concurrently with the
quarterly updates on obligations, expenditure, and deployment
strategy.
Customizing VA's EHR.--The Committee is concerned that too
much customization of VA's EHR system presents risk to
interoperability with DOD's Military Health System (MHS)
GENESIS implementation, and urges the Department to ensure all
customization is fundamentally necessary to meet VA's
healthcare system needs and will not inhibit the
interoperability of records between both Departments.
End-User Adoption.--The Committee directs the Department to
ensure lessons learned from DOD's MHS GENESIS rollout are taken
into consideration when deploying EHRM, including that end
users receive sufficient training prior to the implementation.
Medical Records Portability.--The Committee supports
Veterans having real-time, seamless, and portable access to all
of their medical records and urges VA to develop, as part of
EHRM, the means by which Veterans can have secure, portable
access to their own medical records.
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 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.
Clinical Workflow Challenges.--The Committee is concerned
about the significant amount of time clinicians spend on the
current electronic health record documentation in their
treatment of Veterans, as well as their inability to easily
incorporate such information from within the Veterans'
continuum of care, particularly the community care environment.
This administrative burden also means clinicians have less time
to spend providing care to each patient and fewer patients are
seen in a given day, potentially resulting in longer wait times
for Veterans. VA's ongoing efforts with EHRM and
interoperability with DOD provide an opportunity to assess
innovative technologies' ability to solve this challenge. The
EHRM technology must enhance clinicians' efficacy so they can
spend more time with patients. The Committee commends the
Department's efforts to involve clinicians at all stages of the
EHRM rollout and encourages the continued collaboration with
clinicians to ensure the most efficient workflow solutions are
developed with clinician input.
Electronic Health Records Modernization.--The VA transition
to a commercial-based EHR system continues to be challenging,
and it is uncertain if this capability will be delivered across
the enterprise by 2027. The Committee directs VA to maintain
frequent, timely, and transparent communication with Congress.
Additionally, the Committee recommends VA leverage lessons
learned from the DOD's MHS GENESIS Electronic Health Record
modernization effort to ensure that this capability is
delivered to transitioning servicemembers, Veterans, and
outside care providers as soon as possible.
Interagency Program Office (IPO).--The Committee
understands that the Department, in coordination with DOD,
continues its organizational process for the IPO. The Committee
is concerned that the Director of the IPO does not have a
singular supervisory entity, as this structure could present
challenges with decision making and accountability. Therefore,
the Committee directs the Secretary to work with the Secretary
of Defense to develop a reporting structure that ensures the
Director of the IPO has a single supervisory entity. The
Committee notes that one of the determining factors setting the
timeline for the deployment of the electronic health record is
the need to improve informational technology and related
infrastructure at VA facilities. Therefore, the Committee
directs the Secretary to provide a report to the Committees on
Appropriations of both Houses of Congress no later than
December 1, 2020 on the total cost of the installation of all
remaining information technology and related infrastructure
required to complete the deployment of the electronic health
record, and the timeline to complete this installation.
Cybersecurity for Electronic Health Records.--Recognizing
the ongoing challenges of sharing data between MHS GENESIS and
the Department's EHRM initiative, the Committee requests a
report within 90 days of enactment of this Act on what the
Department is doing to protect Veterans' sensitive information
when implementing EHRM, and recommends the Department consider
emerging technologies, such as blockchain technology, if future
requirements drive a need to modify VA's security architecture
and technical solutions.
Standards of Care and Safety.--The Committee is encouraged
by the Department's use of Integrated Clinical Communities
(ICC) to establish standards of care and safety and requests a
report within 90 days of enactment of this Act describing its
plans to evaluate and incorporate information technology
applications that support ICC efforts.
OFFICE OF INSPECTOR GENERAL
Fiscal year 2020 enacted level........................ $210,000,000
Fiscal year 2021 budget request....................... 228,000,000
Committee recommendation in the bill.................. 228,000,000
Comparison with:
Fiscal year 2020 enacted level.................... +18,000,000
Fiscal year 2021 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 that 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, 2022.
The Committee continues to request robust oversight of
MISSION Act and EHRM implementation.
In addition, the Coronavirus Aid, Relief, and Economic
Security Act (CARES Act) (P.L. 116-136) included $12,500,000
for the Office of Inspector General to prevent, prepare for,
and respond to coronavirus, for oversight and audit of VA
programs, activities, grants and projects funded in the CARES
Act.
CONSTRUCTION, MAJOR PROJECTS
Appropriation, fiscal year 2020....................... $1,235,200,000
Budget request, fiscal year 2021...................... 1,373,000,000
Recommended in the bill............................... 1,373,000,000
Bill compared with:
Appropriation, fiscal year 2020................... +137,800,000
Budget request, fiscal year 2021.................. - - -
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 more than $20,000,000.
The Committee recommendation makes all but $392,362,000 of
these funds available for a five-year period.
As required by language that is in permanent law, all major
construction projects costing more than $100,000,000 must be
managed by a non-VA government entity such as the Army Corps of
Engineers. While the Committee no longer duplicates this
language, 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 Committee's recommendation for
Major Construction projects.
CONSTRUCTION, MAJOR PROJECTS
(In thousands of dollars)
------------------------------------------------------------------------
Project Amount
------------------------------------------------------------------------
Veterans Health Administration:
American Lake, WA New Specialty Care Building 201.... $94,340
Long Beach, CA Mental Health & Community Living 50,000
Center..............................................
Canandaigua, NY Construction & Renovation............ 30,000
Alameda, CA Community Based Outpatient Clinic & 152,868
National Cemetery...................................
San Diego, CA SCI & Seismic Building 11.............. 21,260
Livermore, CA Realignment and Closure of the 143,270
Livermore Campus....................................
Dallas, TX Spinal Cord Injury........................ 78,500
Tulsa, OK Inpatient Facility......................... 120,000
Advance Planning and Design Fund..................... 117,781
Asbestos............................................. 15,000
Major Construction Staff............................. 102,719
Hazardous Waste...................................... 2,000
Judgment Fund........................................ 25,000
Non-Dept. Fed. Entity Project Management Support..... 79,350
Seismic Corrections.................................. 237,198
Total, VHA....................................... 1,269,286
National Cemetery Administration:
San Antonio, TX Ft. Sam Houston Expansion............ 56,000
San Diego, CA Miramar Phase 2 Expansion.............. 31,000
Advance Planning and Design Fund..................... 2,000
NCA Land Acquisition................................. 5,000
Total, NCA....................................... 94,000
General Administration:
Staff Offices Advanced Planning Fund................. 9,714
Total, Major Construction........................ 1,373,000
------------------------------------------------------------------------
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 Houses 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 section 258 of Division A of
the Continuing Appropriations and Military Construction,
Veterans Affairs, and Related Agencies Appropriations Act,
2017, and Zika Response and Preparedness Act (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.
West Los Angeles VA Homeless Housing Development.--The
Committee recognizes the Department's concrete progress in
implementing the Draft Master Plan for the West Los Angeles VA
Campus and in fulfilling the commitments of settlement of the
Valentini v. Shinseki litigation. The Committee encourages the
Department and its Principal Developer to move quickly to
deliver the more than 1,200 homeless housing units on campus,
primarily through Enhanced Use Leases, and supports the
Department's efforts to address known deficiencies in utility
infrastructure.
Flood and Disaster Mitigation Projects.--The Committee
recognizes that deficiencies in flood and disaster mitigation
infrastructure pose challenges to Veterans receiving health
care, particularly when Veterans are unable to access medical
facilities as a result of flooding or other infrastructure
failures. The Committee further notes that state and local
government infrastructure projects may enhance the resilience
of VA medical facilities or the quality of life of Veterans
eligible to receive care at these medical facilities. The
Committee encourages VA to work collaboratively with state and
local governments in support of infrastructure projects that
will benefit VA facilities and the Veterans they serve.
CONSTRUCTION, MINOR PROJECTS
Appropriation, fiscal year 2020....................... $398,800,000
Budget request, fiscal year 2021...................... 400,000,000
Recommended in the bill............................... 400,000,000
Bill compared with:
Appropriation, fiscal year 2020................... +1,200,000
Budget request, fiscal year 2021.................. - - -
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 equal to or less than
$20,000,000.
As with the Major Construction account, the Committee
recommendation makes these funds available for a five-year
period.
The Committee encourages the Department to prioritize
construction for expanding gender-specific care for women and
mental health programs, in particular mental health Residential
Rehabilitation Treatment Program facilities and new inpatient
Substance Use Disorder treatment facilities within the VA
system. The Committee also notes that inpatient Substance Use
Disorder facilities are of particular importance for Veterans
in rural communities.
The Committee notes that restorative and rehabilitative
nursing care provided to elderly Veterans at VA community
living centers is a critical part of the benefits and care
promised to Veterans for their entire life after their service
to our country. Unfortunately, in some Veterans health care
systems there are not enough high-quality contract nursing
homes available to meet Veteran demand. The Committee urges VA
to prioritize construction projects to address nursing care
capacity issues across VA.
Construction of Housing for Rural Homeless Veterans.--The
Department has made great efforts to find suitable housing for
homeless Veterans and their families. The Committee encourages
more non-traditional efforts to eliminate Veteran homelessness.
For example, some cities and towns have started pilot programs
using ``Micro'' or ``Tiny Homes'', or renovated shipping
containers, to help deal with homelessness. The Committee
encourages VA to continue its efforts to house homeless
Veterans and their families and explore the feasibility of
providing ``Tiny Homes'' or renovated shipping containers as
housing.
Expediting VA Projects.--The Committee urges VA to put in
place an improved process to help guide infrastructure
investments through energy performance contracts management,
including Energy Savings Performance Contracts (ESPCs) and
Utility Energy Savings Contracts (UESCs), in order to
effectively and efficiently reduce energy costs and improve
facilities for our Veterans. The Committee understands that
challenges with the energy performance program include a
separate round of required reviews by the Office of Capital
Asset Management (OCAM) that has bottlenecked new projects, as
well as problems of capacity and bandwidth for oversight and
new project starts. The Committee urges VA to streamline and
find efficiencies in the approval of projects in order to
continue to provide Veterans the care they need.
GRANTS FOR CONSTRUCTION OF STATE EXTENDED CARE FACILITIES
Appropriation, fiscal year 2020....................... $90,000,000
Budget request, fiscal year 2021...................... 90,000,000
Recommended in the bill............................... 90,000,000
Bill compared with:
Appropriation, fiscal year 2020................... - - -
Budget request, fiscal year 2021.................. - - -
This appropriation provides grants to assist States in
constructing 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.
In addition, the Coronavirus Aid, Relief, and Economic
Security Act (CARES Act) (P.L. 116-136) included $150,000,000
for Grants for Construction of State Extended Care Facilities
to prevent, prepare for, and respond to coronavirus.
GRANTS FOR CONSTRUCTION OF VETERANS CEMETERIES
Appropriation, fiscal year 2020....................... $45,000,000
Budget request, fiscal year 2021...................... 45,000,000
Recommended in the bill............................... 45,000,000
Bill compared with:
Appropriation, fiscal year 2020................... - - -
Budget request, fiscal year 2021.................. - - -
This program provides grants to assist States and tribal
governments with the establishment, expansion, and improvement
of Veterans' cemeteries that 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. State 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 51 administrative provisions, of which 49
were in effect in fiscal year 2020 in some form and 2 are new
provisions. The administrative provisions included in the bill
are as follows:
(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 2021. 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 2021 for ``Compensation and
Pensions'', ``Readjustment Benefits'', and ``Veterans Insurance
and Indemnities'' for payment of accrued obligations recorded
in the last quarter of fiscal year 2020.
The bill includes section 207 allowing for the use of
fiscal year 2021 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, 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.
(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 of both
Houses of Congress before such transfer. The Administration
proposal to modify this provision is not adopted.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 219 providing up to $322,932,000
of fiscal year 2021 funds for transfer to the Joint DOD-VA
Medical Facility Demonstration Fund. Additional funding may be
transferred from these accounts upon written notification to
the Committees on Appropriations of both Houses of Congress.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 220 permitting the transfer of
$327,126,000 of fiscal year 2021 funding appropriated for
medical accounts to the Joint DOD-VA Medical Facility
Demonstration Fund for the operation of facilities designated
as combined Federal medical facilities.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 221 permitting the transfer of
funds deposited in the Medical Care Collections Fund to the
Joint DOD-VA Medical Facility Demonstration Fund for facilities
designated as combined Federal medical facilities.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 222 directing that a minimum of
$15,000,000 shall be transferred from the four medical care
appropriations to the Department of Defense/Department of
Veterans Affairs Health Care Sharing Incentive Fund, to be
available until expended.
The bill includes section 223 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 five
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 on Appropriations of both Houses of
Congress. 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 $1,000,000. 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 the Committees on
Appropriations of both Houses of Congress. This provision is
intended to give VA flexibility as it administers the changes
to its traditional healthcare program and the MISSION Act. The
Administration proposal 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 the Appropriations Committees on Appropriations of
both Houses of Congress. The Administration proposal 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 the Committees on Appropriations of both Houses
of Congress 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 Administration 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 permanently 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 includes section 235 prohibiting any funds from
being used in a manner that is inconsistent with statutory
limitations on outsourcing. The Administration request to
delete this provision is not adopted.
The bill includes section 236 pertaining to exceptions for
Indian- or Native Hawaiian-owned businesses contracting with
VA. The Administration request to delete this provision is not
adopted.
The bill includes section 237 directing the elimination
over a series of years of the use of Social Security numbers in
VA programs. The Administration request to delete this
provision is not adopted.
The bill includes section 238 referencing the provision in
the Continuing Appropriations and Military Construction,
Veterans Affairs, and Related Agencies Appropriations Act,
2017, and Zika Response and Preparedness Act (P.L. 114-223)
pertaining to certification of marriage and family therapists.
The Administration request to delete this provision is not
adopted.
The bill includes section 239 which prohibits funds from
being used to transfer funding from the Filipino Veterans
Equity Compensation Fund to any other VA account. The
Administration request to delete this provision is not adopted.
The bill includes section 240 permitting funding to be used
in fiscal years 2021 and 2022 to carry out and expand the
childcare pilot program authorized by section 205 of the
Caregivers and Veterans Omnibus Health Services Act of 2010
(P.L. 111-163).
The bill includes section 241 prohibiting VA from using
funds to enter into an agreement to resolve a dispute or claim
with an individual that would restrict the individual from
speaking to Members of Congress or their staff on any topic,
except those required to be kept secret in the interest of
national defense or the conduct of foreign affairs. The
Administration request to delete this provision is not adopted.
The bill includes section 242 referencing language in the
Continuing Appropriations and Military Construction, Veterans
Affairs, and Related Agencies Appropriations Act, 2017, and
Zika Response and Preparedness Act (P.L. 114-223) requiring
certain data to be included in budget justifications for major
construction projects. The Administration request to delete
this provision is not adopted.
The bill includes section 243 prohibiting the use of funds
to deny the Inspector General timely access to information,
unless a provision of law expressly refers to the Inspector
General and expressly limits such access. The Administration
request to delete this provision is not adopted.
The bill includes section 244 prohibiting funding from
being used in a manner that would increase wait times for
Veterans at medical facilities. The Administration request to
delete this provision is not adopted.
The bill includes section 245 prohibiting the use of funds
in fiscal year 2021 to convert any program that received
specific purpose funds in fiscal year 2020 to a general
purpose-funded program without the approval of the Committees
on Appropriations of both Houses of Congress at least 30 days
prior to any such action. The Administration request to delete
this provision is not adopted.
The bill includes section 246 eliminating category D or E
pain testing on dogs.
The bill includes section 247 prohibiting the closure of
the CBOC in Bainbridge, New York until the Secretary submits a
completed market area assessment to the Committees on
Appropriations of both Houses of Congress. The Administration
proposal to delete this provision is not adopted.
The bill includes section 248 requiring the Department to
update the Planning and Activating CBOC handbook every five
years and provide guidance and training to employees on each
update of the handbook. The Administration proposal to delete
this provision is not adopted.
The bill includes section 249 to allow fiscal year 2021 and
2022 ``Medical Community Care'' funds to be used to cover
obligations that would have otherwise been paid by the Veterans
Choice Fund.
The bill includes section 250 allowing obligations and
expenditures applicable to the ``Medical Services'' account in
fiscal years 2017 through 2019 for aid to state homes remain in
the ``Medical Community Care'' account for such fiscal years.
This bill includes section 251 specifying an amount from
the four medical care accounts for gender-specific care for
women.
TITLE III
RELATED AGENCIES
Funds under Title III support the agencies that honor and
respect the service of our Nation's heroes. Though it may be a
smaller title of the bill, the agencies funded under Title III
are the public face of America's commitment to our
servicemembers and Veterans. The American Battle Monuments
Commission and Arlington Cemetery commemorate those who made
the ultimate sacrifice, while the Armed Forces Retirement Home
and the United States Court of Appeals for Veterans Claims are
critical parts of keeping our promise to serve those who served
our Nation.
American Battle Monuments Commission
SALARIES AND EXPENSES
Appropriation, fiscal year 2020....................... $84,100,000
Budget request, fiscal year 2021...................... 75,100,000
Recommended in the bill............................... 84,100,000
Bill compared with:
Appropriation, fiscal year 2020................... - - -
Budget request, fiscal year 2021.................. +9,000,000
The recommendation includes $84,100,000 for Salaries and
Expenses of the American Battle Monuments Commission (ABMC).
The Committee notes the significant maintenance needs of
the American Battle Monuments around the world, which are
specifically designed to honor our fallen servicemembers. The
Committee continues to direct ABMC to emphasize maintaining and
repairing existing monuments and memorials in a proactive and
timely manner that honors the service, achievements, and
sacrifices of the United States Armed Forces.
Non-Federal Memorials.--The Committee appreciates ABMC's
continued dialogue and engagement with non-Federal sponsors of
memorials and other community stakeholders. The Committee
encourages ABMC to continue these efforts and to have
productive exchanges with those looking to best preserve
memorials that reflect significant historical moments.
Pacific Battle Commemorations.--The Committee is grateful
for ABMC's commitment to telling the World War II story at its
sites and visitors centers and urges ABMC to ensure the story
of the Pacific theater is fully told. The Committee requests
that ABMC report to the Committees on Appropriations of both
Houses of Congress on its efforts to commemorate World War II
battles in the Pacific at existing ABMC sites.
World War I Memorial Preservation.--The Committee supports
the preservation and rehabilitation of World War I memorials
across the country and in Europe to honor the more than four
million men and women who bravely served the United States and
fought to preserve our freedom.
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
Appropriation, fiscal year 2020....................... $35,400,000
Budget request, fiscal year 2021...................... 38,900,000
Recommended in the bill............................... 37,100,000
Bill compared with:
Appropriation, fiscal year 2020................... +1,700,000
Budget request, fiscal year 2021.................. -1,800,000
The recommendation includes $37,100,000 for Salaries and
Expenses for the United States Court of Appeals for Veterans
Claims (the Court).
Caseload.--The Committee recognizes that caseloads at the
Court continue to increase and directs the Court to continue
using available resources to respond effectively to the growing
demand. While the recommendation does not include requested
funding to reconfigure the Court's physical space for recalled,
retired Judges, the Committee encourages the Court to continue
to use them efficiently to address increasing caseloads.
Department of Defense--Civil
Cemeterial Expenses, Army
SALARIES AND EXPENSES
Appropriation, fiscal year 2020....................... $80,800,000
Budget request, fiscal year 2021...................... 70,800,000
Recommended in the bill............................... 81,815,000
Bill compared with:
Appropriation, fiscal year 2020................... +1,015,000
Budget request, fiscal year 2021.................. +11,015,000
The recommendation includes $81,815,000 for Salaries and
Expenses for Arlington National Cemetery (the Cemetery), which
is $11,015,000 above the fiscal year 2021 budget request. The
Committee has provided this additional funding to respond to
increased costs and to maintain current services.
The Committee has previously noted its concern that the
budget request for the Cemetery's operating account has been
continually inadequate to maintain the current level of
services, and reiterates that it is unacceptable for the
Cemetery's budget request to fall short of reflecting real
needs.
Updated Interment Policy.--The Committee is aware that the
Secretary of the Army has proposed revised criteria for
interment at the Cemetery to preserve it as an active burial
ground well into the future, and understands that these
criteria will be published as a draft rule in the Federal
Register for public comment. The Committee notes that it will
continue to follow closely to ensure that the Cemetery can
continue to live up to its mission to honor those who have
served.
CONSTRUCTION
Southern Expansion.--The Committee remains strongly
supportive of the Southern Expansion project and recognizes its
importance in extending the life of our Nation's most
prestigious cemetery.
Armed Forces Retirement Home
TRUST FUND
The recommendation includes $73,100,000 for the Armed
Forces Retirement Home (AFRH), including $8,800,000 for capital
projects, although $22,000,000 of the total is provided from
the general fund of the Treasury, and not the Trust Fund. The
Committee makes these operation and maintenance funds available
until September 30, 2022, as requested, to provide AFRH greater
ability to respond to emergency situations and ensure stable
operations.
In addition, the Coronavirus Aid, Relief, and Economic
Security Act (CARES Act) (P.L. 116-136) included $2,800,000 for
AFRH to prevent, prepare for, and respond to coronavirus.
Land Redevelopment.--The Committee understands that AFRH
has selected a developer to redevelop the 80-acre master
planned parcel on the Washington campus and directs AFRH to
continue to report to the Committee on the progress of the
redevelopment project and the status of the lease negotiations.
OPERATION AND MAINTENANCE
Appropriation, fiscal year 2020....................... $63,300,000
Budget request, fiscal year 2021...................... 64,300,000
Recommended in the bill............................... 64,300,000
Bill compared with:
Appropriation, fiscal year 2020................... +1,000,000
Budget request, fiscal year 2021.................. - - -
General Fund.--The Committee has previously expressed
concern about the use of the General Fund to support the work
of AFRH. The Committee is pleased that efforts are underway to
increase revenues and stabilize the AFRH Trust Fund for the
long term, and directs AFRH to continue to make progress in
this area and report to the Committee on its further
initiatives to improve sustainability and maintain the high-
quality services provided to AFRH residents.
CAPITAL PROGRAM
Appropriation, fiscal year 2020....................... $12,000,000
Budget request, fiscal year 2021...................... 6,000,000
Recommended in the bill............................... 8,800,000
Bill compared with:
Appropriation, fiscal year 2020................... -3,200,000
Budget request, fiscal year 2021.................. +2,800,000
Capital Maintenance Spending Plan.--The Committee directs
AFRH to provide, no later than 30 days after enactment of this
Act, an expenditure plan detailing the planned use of the funds
provided for construction and renovation. The Committee further
directs AFRH to prioritize completing projects that are
currently underway.
Administrative Provision
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
Appropriation, fiscal year 2020....................... $644,526,000
Budget request, fiscal year 2021...................... 349,762,000
Recommended in the bill............................... 350,000,000
Bill compared with:
Appropriation, fiscal year 2020................... -294,526,000
Budget request, fiscal year 2021.................. +238,000
The recommendation includes Overseas Contingency Operations
for military construction projects and planning and design
related to the European Deterrence Initiative (EDI).
Military Construction, Army
Appropriation, fiscal year 2020....................... $78,168,000
Budget request, fiscal year 2021...................... 15,873,000
Recommended in the bill............................... 16,111,000
Bill compared with:
Appropriation, fiscal year 2020................... -62,057,000
Budget request, fiscal year 2021.................. +238,000
The recommendation includes $16,111,000 for Army military
construction and planning and design for Overseas Contingency
Operations and European Deterrence Initiative projects.
Military Construction, Navy and Marine Corps
Appropriation, fiscal year 2020....................... $94,570,000
Fiscal year 2021 budget request....................... 70,020,000
Recommended in the bill............................... 70,020,000
Bill compared with:...................................
Appropriation fiscal year 2020.................... -24,550,000
Budget request, fiscal year 2021.................. - - -
The recommendation includes $70,020,000 for Navy and Marine
Corps military construction and planning and design for
European Deterrence Initiative projects.
Military Construction, Air Force
Appropriation, fiscal year 2020....................... $325,988,000
Budget request, fiscal year 2021...................... 263,869,000
Recommended in the bill............................... 263,869,000
Bill compared with:
Appropriation, fiscal year 2020................... -62,119,000
Budget request, fiscal year 2021.................. - - -
The recommendation includes $263,869,000 for Air Force
military construction and planning and design for European
Deterrence Initiative projects.
Administrative Provision
The bill includes one provision that was in effect in
fiscal year 2020.
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.
TITLE V
GENERAL PROVISIONS
The bill includes a total of 14 provisions: 12 provisions
that are effective in fiscal year 2020:
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 to construct facilities on military installations
that do not meet resiliency standards.
The bill includes section 513 prohibiting the use of funds
in this Act and previous Acts for the construction of a wall,
barrier, fence, or road along the Southern border of the United
States or a road to provide access to a wall, barrier, or fence
constructed along the Southern border of the United States.
The bill includes section 514 designating emergency funding
pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and
Emergency Deficit Control Act of 1985.
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
The bill does not contain any rescissions, as defined in
clause 3(f)(2) of rule XIII of the Rules of the House of
Representatives.
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 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 $20,115,000
in fiscal year 2022 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
2021 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 $71,490,000 to
be transferred to General Administration and Information
Technology Systems from any funds appropriated in fiscal year
2021 to reimburse three 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 2021 provided for the Department of Veterans
Affairs to the Joint Department of Defense-Department of
Veterans Affairs Medical Facility Demonstration Fund.
Language is included allowing fiscal year 2022 medical care
funding to be transferred 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 healthcare 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 of the Rules of the House of
Representatives.
Compliance With Rule XIII, cl. 3(e) (Ramseyer Rule)
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, existing law in which no change
is proposed is shown in roman):
SECTION 219 OF THE MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED
AGENCIES APPROPRIATIONS ACT, 2020
(Division F of Public Law 116-94)
[(INCLUDING TRANSFER OF FUNDS)
[Sec. 219. Of the amounts appropriated to the Department of
Veterans Affairs for fiscal year 2020 for ``Medical Services'',
``Medical Community Care'', ``Medical Support and Compliance'',
``Medical Facilities'', ``Construction, Minor Projects'', and
``Information Technology Systems'', up to $314,409,000, plus
reimbursements, may be transferred to the Joint Department of
Defense--Department of Veterans Affairs Medical Facility
Demonstration Fund, established by section 1704 of the National
Defense Authorization Act for Fiscal Year 2010 (Public Law 111-
84; 123 Stat. 3571) and may be used for operation of the
facilities designated as combined Federal medical facilities as
described by section 706 of the Duncan Hunter National Defense
Authorization Act for Fiscal Year 2009 (Public Law 110-417; 122
Stat. 4500): Provided, That additional funds may be transferred
from accounts designated in this section to the Joint
Department of Defense--Department of Veterans Affairs Medical
Facility Demonstration Fund upon written notification by the
Secretary of Veterans Affairs to the Committees on
Appropriations of both Houses of Congress: Provided further,
That section 220 of title II of division C of Public Law 115-
244 is repealed.]
----------
TITLE 38, UNITED STATES CODE
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
SUBCHAPTER I--GENERAL
Sec.
1701. Definitions.
* * * * * * *
SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT
* * * * * * *
1720J. Provision of assisted reproductive technology or adoption
reimbursements for certain disabled veterans.
* * * * * * *
SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT
* * * * * * *
Sec. 1720J. Provision of assisted reproductive technology or adoption
reimbursements for certain disabled veterans
(a) Provision of Services.--Subject to the availability of
appropriations, the Secretary may provide--
(1) fertility counseling and treatment using assisted
reproductive technology to a covered veteran or the
spouse of a covered veteran; or
(2) adoption reimbursement to a covered veteran.
(b) Limitations.--Amounts made available for the purposes
specified in subsection (a) are subject to the requirements for
funds contained in section 508 of division H of the
Consolidated Appropriations Act, 2017 (Public Law 115-31).
(c) Definitions.--In this section:
(1) The term ``adoption reimbursement'' means
reimbursement for the adoption-related expenses for an
adoption that is finalized after the date of the
enactment of this section under the same terms as apply
under the adoption reimbursement program of the
Department of Defense, as authorized in Department of
Defense Instruction 1341.09, including the
reimbursement limits and requirements set forth in such
instruction, as in effect on the date of the enactment
of this section.
(2) The term ``assisted reproductive technology''
means benefits relating to reproductive assistance
provided to a member of the Armed Forces who incurs a
serious injury or illness on active duty pursuant to
section 1074(c)(4)(A) of title 10, as described in the
memorandum on the subject of ``Policy for Assisted
Reproductive Services for the Benefit of Seriously or
Severely Ill/Injured (Category II or III) Active Duty
Service Members'' issued by the Assistant Secretary of
Defense for Health Affairs on April 3, 2012, and the
guidance issued to implement such policy, as in effect
on the date of the enactment of this section, including
any limitations on the amount of such benefits
available to such a member, except that--
(A) the periods regarding embryo
cryopreservation and storage set forth in part
III(G) and in part IV(H) of the first part IV
of such memorandum shall not apply; and
(B) such term includes embryo
cryopreservation and storage without limitation
on the duration of such cryopreservation and
storage.
(3) The term ``covered veteran'' means a veteran who
has a service-connected disability that results in the
inability of the veteran to procreate without the use
of fertility treatment.
* * * * * * *
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 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 defining the
congressional defense committees.
Language is included under Title I directing all amounts
appropriated to Military Construction (all accounts) be
immediately available and allotted for the full scope of the
authorized project.
Language is included under Title I providing additional
funds for Military Construction, Army for cost to complete
projects.
Language is included under Title I providing additional
funds for Military Construction, Navy and Marine Corps for cost
to complete projects.
Language is included under Title I providing additional
funds for Military Construction, Air Force for cost to complete
projects.
Language is included under Title I providing additional
funds for Military Construction, Army Reserve for cost to
complete projects.
Language is included under Title I providing additional
funds for Military Construction, Navy Reserve for cost to
complete projects.
Language is included under Title I providing additional
funds for Family Housing Construction, Army for cost to
complete projects.
Language is included under Title I providing additional
funds for Family Housing Operations and Maintenance, Army.
Language is included under Title I providing additional
funds for Family Housing Operations and Maintenance, Navy and
Marine Corps.
Language is included under Title I providing additional
funds for Family Housing Operations and Maintenance, Air Force.
Language is included under Title I requiring funds made
available are only to be use for the purposes specifically
described under each heading.
Language is included under Title I to prohibit the use of
military construction funds to build a border wall, or road to
access a border wall.
Language is included under Title I to prohibit the
construction of a facility on a military installation bearing
the name of a confederate officer unless a process has been
initiated to rename the installation.
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 designating certain
fiscal year 2020 advance appropriations for fiscal year 2021
within the four medical care accounts be designated as
emergency funding.
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 at no additional cost to the Department.
Language is included under Title II requiring the Secretary
to ensure sufficient funding is available for the acquisition
of prosthetics designed for women Veterans.
Language is included under Title II requiring sufficient
funding is available for prosthetic research specifically for
female Veterans and for toxic exposure research.
Language is included under Title II designating certain
funding within the Information Technology Systems account as
emergency funding.
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 designating certain
funding within the Veterans Electronic Health Record account as
emergency funding.
Language is included under Title II prohibiting funding in
the Veterans Electronic Health Record account from being
obligated in a manner inconsistent with deployment schedules.
Language is included under Title II establishing time
limitations and reporting requirements concerning the
obligation of Major Construction funds, limiting the use of
funds, allowing the use of funds for program costs, and
allowing for the reimbursement to the ``General
Administration'' account for the salaries and expenses of the
Office of Construction and Facilities Management employees.
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,
requiring quarterly reports on the Department's financial
status, performance measures, and data, 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 notification
of any single national outreach and awareness marketing
campaign in which obligations exceed $1,000,000.
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 II pertaining to
exceptions for Indian- or Native Hawaiian-owned businesses
contracting with the Department.
Language is included under Title II directing the
elimination of using Social Security account numbers to
identify individuals in all information systems of the
Department.
Language is included under Title II pertaining to
certification of marriage and family therapists.
Language is included under Title II prohibiting funds from
being used to transfer funding from the Filipino Veterans
Equity Compensation Fund to any other VA account.
Language is included under Title II permitting funds to
carry out and expand the child care program.
Language is included under Title II prohibiting funds to
enter into an agreement to resolve a dispute or claim with an
individual that would restrict the individual from speaking to
Members of Congress or their staff.
Language is included under Title II requiring certain data
to be included in budget justifications for major construction
projects.
Language is included under Title II prohibiting the
Inspector General timely access to information.
Language is included under Title II prohibiting funding to
be used that would increase wait times for Veterans who seek
medical care.
Language is included under Title II prohibiting the use of
funds in fiscal year 2020 to convert any program that received
specific purpose funding in fiscal year 2019 to a general
purpose-funded program.
Language is included under Title II prohibiting the use of
dogs as part of the conduct of any study.
Language is included under Title II prohibiting the closure
of a certain community-based outpatient clinic until the
Secretary completes a market area assessment.
Language is included under Title II requiring the Secretary
to update the ``Planning and Activating Community Based
Outpatient Clinics'' handbook.
Language is included under Title II allowing for funds
within the Medical Community Care account to be used for
expenses that would have otherwise been payable from the
Veterans Choice Fund.
Language is included under Title II allowing for
obligations and expenditures applicable to the Medical Services
account in fiscal years 2017 through 2019 for aid to state
homes to remain in the Medical Community Care account for such
fiscal years.
Language is included under Title II providing for a certain
amount within the medical care accounts to be made available
for gender-specific care for women.
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 IV providing funds with
emergency designation, for Overseas Contingency Operations and
European Deterrence Initiative for the Army.
Language is included under Title IV providing funds with
emergency designation, for Overseas Contingency Operations and
European Deterrence Initiative for the Navy and Marine Corps.
Language is included under Title IV providing funds with
emergency designation, for Overseas Contingency Operations and
European Deterrence Initiative for the Air Force.
Language is included under Title IV directing the Secretary
of Defense to provide, in classified and unclassified format a
list of the construction projects for European Deterrence
Initiative for fiscal years 2022 through 2026.
Language is included under Title V prohibiting funding
beyond the current fiscal year unless expressly so provided.
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 providing funding to
expand the use of ``E Commerce'' technologies and procedures.
Language is included under Title V specifying the
Congressional committees that are to receive all reports and
notifications.
Language is included under Title V prohibiting the transfer
of funds to any instrumentality of the United States Government
without authority from an appropriations Act.
Language is included under Title V prohibiting the use of
funds for a project or program named for an individual serving
as a Member, Delegate, or Resident Commissioner of the United
States House of Representatives.
Language is included under Title V requiring all reports
submitted to the Congress to be posted on the official public
Website of that agency.
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.
Language is included under Title V prohibiting the use of
funds in this Act to construct facilities on military
installations that do not meet resiliency standards.
Language is included under Title V prohibiting the use of
funds for the construction of a wall, barrier, fence, or road
along the Southern border of the United States or a road to
provide access to a wall, barrier, or fence constructed along
the Southern border of the United States.
Language is included under Title V designating amounts in
this Act by Congress are for an emergency requirement pursuant
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency
Control Act of 1985.
Appropriations Not Authorized by Law
Pursuant to clause 3(f)(1)(B) of rule XIII of the Rules of
the House of Representatives, the following table lists the
appropriations in the accompanying bill which are not
authorized by law for the period concerned:
Program Duplication
No provision of this bill establishes or reauthorizes a
program of the Federal Government known to be duplicative of
another Federal program, a program that was included in any
report from the Government Accountability Office to Congress
pursuant to section 21 of Public Law 111-139, or a program
related to a program identified in the most recent Catalog of
Federal Domestic Assistance.
Committee Hearings
For the purposes of section 103(i) of H. Res. 6 of the
116th Congress--
The following hearings were used to develop or consider the
Military Construction, Department of Veterans Affairs, and
Related Agencies Appropriations Act, 2021:
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on
February 27, 2020, entitled ``Oversight of VA's Electronic
Health Record Modernization Implementation''. The Subcommittee
received testimony from:
Dr. Melissa Glynn, Assistant Secretary for Enterprise
Integration
Dr. Richard Stone, Executive in Charge, Veterans Health
Administration
Mr. John H. Windom, Executive Director, Office of
Electronic Health Record Modernization
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on March
3, 2020, entitled ``Military Privatized Housing''. The
Subcommittee received testimony from:
Colonel Scott Gerber
Ms. Linne Gherdovich
Mr. Rick Taylor, President, Facility Operations,
Renovations & Construction, Balfour Beatty Communities
Mr. Heath Burleson, Corvias' Partnership Advisor
Mr. Denis Hickey, CEO, Lendlease Americas
Mr. John Ehle, President, Hunt Military Communities
Mr. Jeff Guild, Vice President, Lincoln Military Housing
Mr. Pete Potochney, Acting Assistant Secretary of Defense
(Sustainment) OSD
Ms. Elizabeth A. Field, Director, Defense Capabilities and
Management (GAO)
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on March
4, 2020, entitled ``Department of Veterans Affairs FY2021
Budget Overview''. The Subcommittee received testimony from:
The Honorable Robert Wilkie, Secretary of Veterans Affairs
Richard A. Stone, M.D., Executive in Charge, Veterans
Health Administration
Dr. Paul R. Lawrence, Under Secretary for Benefits,
Veterans Affairs
Mr. Jon Rychalski, Assistant Secretary for Management and
Chief Financial Officer, Veterans Affairs
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on March
10, 2020, entitled ``Member's Day''. The Subcommittee received
testimony from:
The Honorable Gilbert Cisneros, Member of Congress
The Honorable Jared Golden, Member of Congress
The Honorable Mike Johnson, Member of Congress
The Honorable Jenniffer Gonzalez-Colon, Member of Congress
The Honorable Angie Craig, Member of Congress
The Honorable Richard Hudson, Member of Congress
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on March
10, 2020, entitled ``Public Witness Day''. The Subcommittee
received testimony from:
Mr. Adrian M. Atizado, Deputy National Legislative Director
of Disabled American Veterans
Mr. Roscoe G. Butler, Associate Legislative Director of
Paralyzed Veterans of America
Mr. Carlos Fuentes, Director of National Legislative
Service for Veterans of Foreign Wars of the United States
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on March
11, 2020, entitled ``Impact of PFAS Exposure on
Servicemembers'''. The Subcommittee received testimony from:
Mr. Jim Holmes, U.S. Army and Air Force Veteran
Mr. Scott Faber, Senior Vice President of Government
Affairs Environmental Working Group
Ms. Maureen Sullivan, Deputy Assistant Secretary of Defense
for Environment, Department of Defense
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on May
28, 2020, entitled ``Department of Veterans Affairs Response to
COVID-19''. The Subcommittee received testimony from:
The Honorable Robert Wilkie, Secretary of Veterans Affairs
Dr. Paul Lawrence, Under Secretary for Benefits, Department
of Veterans Affairs
Dr. Jennifer MacDonald, Chief Consultant to the Deputy
Under Secretary for Health, Department of Veterans Affairs
Mr. Jon Rychalski, Assistant Secretary for Management and
Chief Financial Officer, Department of Veterans Affairs
Comparative Statement of New Budget (Obligational) Authority
The following table provides a detailed summary, for each
Department and agency, comparing the amounts recommended in the
bill with amounts enacted for fiscal year 2020 and budget
estimates presented for fiscal year 2021.
MINORITY VIEWS
The Military Construction, Veterans Affairs, and Related
Agencies Appropriations Bill, 2021, includes much needed
funding for Veterans programs, military construction projects,
and military family housing. It provides funding for many of
the Services' unfunded priorities, as well as funding to allow
the Services to complete many projects already underway.
We note with appreciation the $135,000,000 provided to
improve the oversight of privatized military family housing and
the nearly $105,000,000,000 in discretionary funding for
Veterans programs, including funding for Veterans healthcare.
The bill provides funding increases for critical programs,
including mental health, suicide prevention, homeless
assistance, medical center construction, and information
technology.
We strongly support Veterans' programs but are concerned
that the bill pays for these increases by designating
$12,500,000,000 as emergency funding. By doing this, the
majority sets aside the Bipartisan Budget Act of 2019 (P.L.
116-37), which was enacted less than one year ago, and that set
caps for defense and non-defense discretionary spending for
fiscal year 2021. We should maintain these caps and make the
difficult funding choices we have the responsibility to make.
We are also concerned about Sections 129, 130, and 513,
which unnecessarily restrict funds for military construction
projects. These provisions could actually harm our men and
women in uniform and make America less safe.
Despite our concerns with the issues discussed above, we
appreciate the Majority's willingness to address Member
priorities in the bill and report. The Subcommittee has a long-
standing tradition of bipartisanship, and we will continue to
work in good faith with our colleagues as we proceed through
the appropriations process. By working together, we can best
address the needs of our Nation's military and its Veterans and
reach an agreement on funding for the Military Construction,
Veterans Affairs, and Related Agencies for fiscal year 2021.
Kay Granger.
John R. Carter.