House Report 117-391 - MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES APPROPRIATIONS BILL, 2023

[House Report 117-391]
[From the U.S. Government Publishing Office]

117th Congress } { Report
HOUSE OF REPRESENTATIVES
2nd Session } { 117-391

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

MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES
APPROPRIATIONS BILL, 2023

_______

June 27, 2022.--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. 8238]

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, 2023.

INDEX TO BILL AND REPORT

Page Number

Bill Report
Purpose of the Bill........................................
2
Summary of Committee Recommendation........................
2
Management and Oversight Initiatives.......................
3
Department of Defense:
Military Construction.............................. 2
6
NATO Security Investment Program................... 9
21
Department of Defense Base Closure Account......... 10
22
Family Housing Construction and Operation and
Maintenance.................................... 10
23
Department of Defense Family Housing Improvement
Fund........................................... 12
25
Department of Defense Military Unaccompanied
Housing Improvement Fund....................... 12
26
Administrative Provisions.......................... 13
26
Department of Veterans Affairs:
Veterans Benefits Administration................... 30
31
Veterans Health Administration..................... 34
38
National Cemetery Administration................... 38
76
Departmental Administration........................ 39
77
Administrative Provisions.......................... 47
87
Related Agencies:
American Battle Monuments Commission............... 80
92
U.S. Court of Appeals for Veterans Claims.......... 81
93
Cemeterial Expenses, Army.......................... 81
93
Armed Forces Retirement Home....................... 82
94
Administrative Provision........................... 83
95
General Provisions......................................... 84
95

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
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 $314,057,258,000 in total budget
authority, for the fiscal year 2023 programs and activities
funded in the bill. The fiscal year 2023 recommendation
represents an increase of $29,459,676,000 above the comparable
fiscal year 2022 enacted level and $2,850,075,000 above the
President's request. Of the increase over the fiscal year 2022
enacted level, $6,509,676,000 is in mandatory programs.
Included in the total budget authority is $163,557,258,000 in
mandatory budget authority and $150,500,000,000 in
discretionary budget authority.
The Committee recommendation highlights the continued
commitment to our servicemembers and their families and to our
veterans. In overall discretionary budget authority, the bill
is 18 percent above the fiscal year 2022 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 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 military personnel and their
families' quality of life is preserved.
The total recommended funding level for military
construction and family housing is $15,053,000,000, which is
$153,000,000 more than the fiscal year 2022 enacted level and
$2,899,035,000 above the budget request. The recommendation
provides critical investments in Family Housing and
construction on our bases, including additional resources above
the budget request for child development centers, unaccompanied
housing, the North Atlantic Treaty Organization Security
Investment Program, installation resiliency, land and water
remediation, natural disaster recovery expenses, laboratory
infrastructure, support for critical overseas investments, and
increased oversight of the Department's privatized housing
portfolio.
The total recommended funding level for fiscal year 2023
for the Department of Veterans Affairs is $298,563,339,000, an
increase of $29,299,957,000 over the fiscal year 2022 enacted
level. Of the total, $163,557,258,000 is provided for mandatory
benefit programs and $135,006,081,000 is allocated to
discretionary programs, such as medical care and research,
claims processing, and construction, with $118,814,000,000
specifically for medical care. In this bill, discretionary
funding for the Department of Veterans Affairs is recommended
at 20.3 percent over the fiscal year 2022 enacted level. Of the
total for fiscal year 2023, $111,287,000,000 for medical care
has been appropriated in advance.
In addition, the Committee recommendation includes
$128,104,000,000 in advance appropriations for fiscal year 2024
for the four health care accounts of the Department and
$155,351,762,000 in advance appropriations for mandatory
benefits programs in fiscal year 2024.
The Committee recommendation provides a total of
$440,919,000 for the four Related Agencies: The American Battle
Monuments Commission (ABMC), the U.S. Court of Appeals for
Veterans Claims, Army Cemeterial Expenses (including Arlington
National Cemetery), and the Armed Forces Retirement Home. 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 the Related Agencies under the
jurisdiction of this bill.
The fiscal year 2023 appropriations bill and the
accompanying report address management challenges of the
Federal agencies it funds, including directives to strengthen
financial and program management, eliminate redundancy, and
improve implementation and oversight of initiatives that
support the mission of this bill. The Committee will use every
means at its disposal to reduce mismanagement that results in
waste, fraud, and abuse.
Department of Defense 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.
Additionally, some housing providers have admitted to
incidences of incentive fee fraud. 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. The Committee 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 and that increased oversight of the MHPI is
essential in order to ensure proper maintenance, quality
service, and legal operations.
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 $1,759,000,000 in fiscal year 2023
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. The Committee recognizes this threat and
provides resources within the Veterans Benefits Administration
to support staffing, automation, and other efforts to respond
to 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,
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 on
Appropriations of both Houses of Congress.
Strict 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.
Army Cemeterial Expenses.--The Committee has provided
funding for Arlington National Cemetery to complete its
Southern Expansion project to sustain the active life of the
Cemetery, as well as additional construction projects to
improve the Cemetery. The Committee requires the Cemetery to
provide regular reports on the status of these funds, and
previously appropriated funds, to continue to provide oversight
over these projects.
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 continues to
make 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. The Committee has also
provided funding in a Major Construction account to support the
renovation of the main resident building at the Washington
campus, and directs AFRH to provide quarterly reports on the
status of this construction project, including obligations of
funds, anticipated timelines, and any changes to the overall
cost of the project.
Army Corps of Engineers Updates on VA Projects.--The
Committee directs VA to continue to provide monthly updates on
all current and subsequent VA construction projects worth more
than $100,000,000 and jointly managed by VA and the Army Corps
of Engineers. 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.
Advertising 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 2024 budget
justification: Expenditures for fiscal year 2022 and expected
expenditures for fiscal year 2024, 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.
Non-disparagement and Non-disclosure Clauses Covering
Workplace Harassment.--The Committee is strongly opposed to
contracts with any company that requires employees or
independent contractors to enter into agreements containing a
non-disparagement or non-disclosure clause covering workplace
harassment, including sexual harassment and sexual assault, or
retaliation for reporting, resisting, opposing, or otherwise
participating in a workplace harassment proceeding, as a
condition of employment, promotion, compensation, benefits, or
change in employment status.
Federal Law Enforcement.--The explanatory statement that
accompanied the Commerce, Justice, Science, and Related
Agencies Appropriations Act, 2022 directed the Attorney General
to ensure implementation of evidence-based training programs on
de-escalation, the use-of-force, and the protection of civil
rights, that are broadly applicable and scalable to all Federal
law enforcement agencies. Several agencies funded by this Act
employ Federal law enforcement officers and are Federal Law
Enforcement Training Centers partner organizations. These
agencies are again directed to consult with the Attorney
General regarding the implementation of these programs for
their law enforcement officers. The Committee further directs
such agencies to submit a report to the Committee on their
efforts relating to such implementation not later than 90 days
after consultation with the Attorney General. In addition, the
Committee continues to direct such agencies to the extent that
they are not already participating, to consult with the
Attorney General and the Director of the FBI regarding
participation in the National Use-of-Force Data Collection. The
Committee further directs such agencies to submit a report to
the Committee not later than 180 days after enactment of this
Act on their efforts to so participate.

TITLE I

DEPARTMENT OF DEFENSE

Military Construction Overview

Appropriation, fiscal year 2022....................... $14,900,000,000
Budget request, fiscal year 2023...................... 12,153,965,000
Committee Recommendation, fiscal year 2023............ 15,053,000,000
Change from enacted level......................... +153,000,000
Change from budget request........................ +2,899,035,000

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.
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 2023 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 submit 1002 reports on military construction bid
savings not later than 180 days after enactment of this Act,
and biannually thereafter, to the Committees on Appropriations
of both Houses of Congress.
Supporting Resilient Military Installations.--The Committee
supports the military's continued focus on building lasting and
resilient military installations, including methods that update
hurricane-resistant building codes for bases, barracks,
hospitals, and airfields. It further considers the impact of
severe drought and desertification as high potential
instability areas and how these two hazards impact bases 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 of Defense to
prioritize investing in climate-sustainable infrastructure
projects that have yielded positive results like increased
resiliency and cost-savings. As such, the bill includes section
411 prohibiting the use of funds to construct facilities that
do not meet resiliency standards.
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.
Federally Recognized Tribes.--The Committee reminds the
Services that consultations with the Tribes are required by
current law and as such expects the Services to begin tribal
consultations on proposed military construction projects that
are likely to affect tribal lands, cultural properties, or
treaty rights as early as possible and preferably prior to
submission of DD Form 1391 Project Data Sheet.
Child Development Centers (CDCs).--The bill includes
$274,383,000 for planning and design and construction of child
development center projects. This investment of resources is
necessary to address both insufficient accessibility to
childcare facilities, as well as the poor conditions of
existing facilities. Such shortfalls in capacity are an
unacceptable burden to military families, leading to thousands
of children of servicemembers forced onto waitlists for
childcare. The Committee is disappointed by the lack of
attention paid to this priority in the budget requests and
directs the Department to assign greater priority to CDC
construction projects in future budget requests.
Unaccompanied Personnel Housing.--The Committee provides
$510,443,000 for 10 construction projects to ensure that
servicemembers who live in unaccompanied personnel housing have
safe, modern, and secure living facilities.
New Construction Technologies.--The Committee is encouraged
by reports that three dimensional (3D) construction could
provide military civil engineers with a faster means of
building facilities when deployed and reduce supply lines and
the number of personnel needed for construction and related
activities and urges the Department to study, develop, and
utilize 3D construction capabilities as appropriate.
Agile Combat Employment Concept of Operations.--The
logistical burden of operating and sustaining forces under
constant threat of attack is a significant challenge, and the
Committee encourages the Services to thoughtfully consider
various initiatives that reduce their logistical footprints,
including rapid repair and additive manufacturing construction
capabilities that can exploit locally available natural
resources or native materials in contested logistics
environments.
U.S. Indo-Pacific Command Planning and Design.--The
recommendation includes $50,000,000 for U.S. Indo-Pacific
Command Planning and Design, World-Wide Unspecified (Pacific
Deterrence Initiative).
Unfunded Priority Lists (UPL) and Future Years Defense
Program (FYDP).--The Committee directs the Department of
Defense and all Services, active and reserve components, as
well as combatant commanders, as required by law, to submit
updated UPL and FYDP lists to the congressional defense
committees for military construction projects no later than 10
days after the transmission of the annual President's Budget.
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,
limiting environmental impact, and increasing functionality of
various military structures. The Committee encourages the
Secretary of Defense to expand the application of these
innovative technologies in future planning and design for
military construction projects. Furthermore, the Department is
directed to provide a report not later than 180 days after
enactment of this Act on how it is currently using cross
laminated timber and other mass timber products, as well as the
feasibility and advisability of expanding their use.
Project Cost Increases.--The Committee provided
$230,851,000 in fiscal year 2022 and provides $698,057,000 in
fiscal year 2023 to supplement discrepancies in outdated cost
estimates and current cost estimates. The Committee is
concerned that the Department is not being proactive in
determining future cost increases when developing and
submitting project cost estimates to Congress in the yearly
President's budget request, Future Years Defense Program
(FYDP), and unfunded priorities lists (UPLs). The Committee
recognizes that market conditions, supply chain issues, and the
COVID-19 pandemic contributed to volatile shifts in cost.
However, the Department has not properly adjusted to
incorporate these factors into its project estimate submissions
nor communicated realized cost increases to Congress, thus
placing the burden on Congress to supplement the costs of
projects in order to meet the actual needs, which is woefully
unacceptable. Therefore, the Committee directs the Department
to implement practices to better address future cost increases
and submit official project cost adjustments to the Committee
every 30 days following the original submission and until
enactment of the next fiscal year appropriations Act.
Laboratory Infrastructure.--The Committee directs the
Department to prioritize laboratory infrastructure construction
projects in the fiscal year 2024 submission to Congress. For
too long, labs have been neglected to the detriment of
research, development, technological advancement, and
readiness. Therefore, the Committee includes $100,000,000 for
planning and design necessary for laboratory infrastructure.
The Department is further directed to prioritize laboratory
infrastructure that is needed to address safety and
environmental concerns on installations and requires a spend
plan not later than 90 days after enactment of this Act on how
the Department plans to use these funds.
Open Air Burn Pans.--No later than 180 days after enactment
of this Act, the Department is directed to submit a report to
the Committee detailing a plan to eliminate burning of
hazardous materials, including open air burn pans, at
installations located in the United States. Such a plan should
detail at what installations each Service is still utilizing
open-air burning, including burn pans, and how the Department
will transition away from the use of open-air burn pans.
Airborne Infectious Diseases.--The COVID-19 pandemic has
created unique challenges for buildings that were not designed
to directly address the risks posed by bacteria or viruses
commonly transmitted through respiratory droplets. As the
current pandemic unfolded, the Department of Defense made
responsive modifications to existing buildings, such as
reopening windows that had been permanently sealed shut, adding
new air filtration systems, installing plexiglass barriers and
mandating social distancing where possible. Despite these
efforts, risks remain to employees in shared office spaces. To
help better understand potential solutions that can be
implemented in a cost-effective manner, the Committee
encourages the Under Secretary of Defense for Acquisition and
Sustainment to consider lessons learned from implementing cost-
effective techniques for reducing airborne infectious diseases
in existing buildings and assess how to incorporate designs in
future construction projects that can reduce the spread of
airborne infectious diseases.

Military Construction, Army

Appropriation, fiscal year 2022....................... $1,051,772,000
Budget request, fiscal year 2023...................... 845,565,000
Committee Recommendation, fiscal year 2023............ 997,425,000
Change from enacted level......................... -54,347,000
Change from budget request........................ +151,860,000

The Committee recommends $997,425,000 for the Army in
fiscal year 2023, of which $101,860,000 is for the following
projects in the following amounts:

----------------------------------------------------------------------------------------------------------------
State Location Project Amount
----------------------------------------------------------------------------------------------------------------
HI..................................... Fort Shafter............. Water System Upgrade..... $2,000,000
HI..................................... Tripler Medical Center... Water System Upgrade..... 2,000,000
LA..................................... Fort Polk................ Joint Operations Center.. 61,000,000
MD..................................... Aberdeen Proving Ground.. Test Maintenance 7,600,000
Fabrication Facility.
NC..................................... Fort Bragg............... Child Development Center. 3,600,000
NY..................................... Fort Drum................ Automated Record Fire 3,600,000
Plus Range.
TX..................................... Fort Hood................ Automated Infantry Battle 600,000
Squad Course.
TX..................................... Fort Hood................ Automated Infantry 1,220,000
Platoon Battle Course.
TX..................................... Fort Hood................ Automated Multipurpose 1,240,000
Machine Gun Range.
TX..................................... Fort Hood................ Barracks................. 19,000,000
----------------------------------------------------------------------------------------------------------------

Within the total for Military Construction, Army, the
recommendation also includes $240,011,000 for planning and
design, which is $46,860,000 above the budget request; and
$105,414,000 for unspecified minor construction, which is
$25,000,000 above the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.
Mobilization Force Generation Installations.--The Committee
continues to be concerned that installations with rapid
deployment requirements, including Mobilization Force
Generation Installations, have insufficient rail and transport
logistics infrastructure to efficiently move equipment in
support of deployments, training operations, and evolving Army
requirements.
Army Barracks.--The Committee understands the importance of
maintaining our servicemembers at the highest level of
readiness as our nation continues to face new threats. A key
component of that readiness is providing high-quality barracks.
The Committee recommends the refurbishment of housing
installations where conditions have fallen below the Army's
high standards.
Guantanamo Bay Detention Facility Closure.--The Committee
directs the Secretary of Defense to submit a report to the
Committees on Appropriations of both Houses of Congress not
later than 60 days after enactment of this Act, and quarterly
thereafter, on the current number of detainees at the
Guantanamo Bay detention facility; their legal status; a
description of all Department of Defense costs associated with
the facility during the last two fiscal years by program,
account, and activity; the status of funds for the current
fiscal year; and a description of steps taken to close the
facility.
Hawaii Infrastructure Readiness Initiative (HIRI).--HIRI
was created to address critical military construction and
readiness shortfalls because failing and failed infrastructure
has put operational needs at risk in the military's priority
theater. To address this crisis, HIRI proposed to allocate
between $50,000,000 and $150,000,000 per year through fiscal
year 2030 to address major readiness related infrastructure
needs, with a ten-year cost of $1,100,000,000. These projects
were intended to be fully separate from and supplemental to the
Army's consideration of other military construction needs at
U.S. Army Garrison Hawaii in the normal course. While the U.S.
Army's FYDP currently includes various HIRI projects or
projects similar to HIRI projects, it currently only contains
one non-HIRI project. This suggests that HIRI projects are
potentially displacing other projects critical to the
recapitalization of U.S. Army Garrison Hawaii's aging
infrastructure. This was not Congress' intent nor direction.
Therefore, the Committee directs the Secretary of the Army to
submit a report no later than 180 days after the enactment of
this Act consisting of: (1) the strategy for addressing poor or
failing infrastructure at U.S. Army Garrison Hawaii that were
not part of HIRI; and (2) an explanation of how the U.S. Army
evaluates non-HIRI projects for Hawaii when selecting
construction projects for the FYDP.
Tobyhanna Army Depot (ARD) Microelectronics Development.--
The Committee views Tobyhanna ARD as an advantageous location
for the build-out of physical space for future Army Materiel
Command (AMC) packaging of ``digital twins'' or
microelectronics for replacement in equipment. The Committee
requests that the Army keep the Committee informed regarding
AMC construction needs in this area.
Recycling of Tire Rubber.--The Committee is aware of recent
advances in the use of rubber modified asphalt (RMA), a
resilient pavement technology which incorporates ground tire
rubber made from scrap tires into asphalt. RMA delivers
significant, proven benefits in terms of pavement durability,
economics, and environmental sustainability. Compared to
traditional asphalt, RMA improves fuel economy, provides cost
savings over the life of the asphalt, extends pavement life,
and reduces maintenance activities, noise pollution, carbon
dioxide emissions, and tire and road wear particles. Therefore,
the Army is encouraged to work with its industry partners and
the research community to assess the durability and economic
feasibility of widescale deployment of RMA on domestic military
installations.
Army Responsiveness to Congressional Requests.--The
Committee is concerned with the Army's lack of responsiveness
to questions and requests for technical assistance. Overly
bureaucratic processes among administrative offices, major
commands, and program offices for responding to inquiries from
Members and Committees can negatively affect congressional
decisions, which ultimately can negatively affect the Army. The
Committee directs the Department to immediately and
systematically improve these processes and its communications
with Congress.

Military Construction, Navy and Marine Corps

Appropriation, fiscal year 2022....................... $2,644,277,000
Budget request fiscal year 2023....................... 3,752,391,000
Committee Recommendation, fiscal year 2023............ 3,808,340,000
Change from enacted level......................... +1,164,063,000
Change from budget request........................ +55,949,000

The Committee recommends $3,808,340,000 for the Navy and
Marine Corps in fiscal year 2023, of which $5,949,000 is for
the following project in the following amount:

Within the total for Military Construction, Navy and Marine
Corps, the recommendation also includes $428,073,000 for
planning and design, which is $30,949,000 above the budget
request; and $134,994,000 for unspecified minor construction,
which is $25,000,000 above the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.
Shipyard Infrastructure Optimization Plan (SIOP).--The
Committee recognizes the critical strategic and logistics role
public shipyards play in the security of the nation. To address
chronically unmet infrastructure needs at the shipyards, the
fiscal year 2018 National Defense Authorization Act included
language directing the Department of Defense to create and
implement a Shipyard Infrastructure Optimization Plan. The
Committee strongly supports efforts to modernize and improve
facilities at the Navy's four public shipyards to equip them to
address the maintenance needs of the Navy's current and future
active fleet and emphasizes the important role military
construction must play in achieving this goal.
Additionally, the Committee expects clear communication
from the Navy to the Committee regarding additional
flexibilities or authorizations necessary to successfully
coordinate with tribal governments for expeditious completion
of SIOP. The Committee remains concerned that without
additional authorities from Congress, the Navy risks delaying
critical dry dock construction projects and harming their
valuable relationships with tribal governments.
Project Labor Agreements (PLAs).--The Committee recognizes
that 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 over $250,000,000 when it was completed in 2016. For
these reasons, the Committee encourages the Department of the
Navy to follow Executive Order 14063 and make use of PLAs with
essential elements of Community Workforce Agreements for
military construction projects associated with SIOP.
Naval Air Weapons Station (NAWS) China Lake Earthquake
Recovery Efforts.--NAWS China Lake is a critical installation
that provides important capabilities to support our national
defense. The Committee appreciates the Navy's efforts to
rebuild NAWS China Lake in response to the 2019 earthquakes
that caused significant damage to the installation and applauds
the close coordination with supporting communities to maximize
these rebuilding efforts. The Committee directs the Navy to
continue to prioritize the rebuilding efforts and maintain open
communication with the supporting communities to ensure the
projects stay on track for timely completion.
Defense Support Infrastructure in The Bahamas.--The
Committee is concerned with the state of infrastructure
supporting U.S. Navy installations in the Commonwealth of The
Bahamas. The Committee recognizes that damage inflicted by
Hurricane Dorian has strained local government resources and
therefore impedes the ability to rebuild Bahamian-owned
structures integral to the Navy's mission in the region.
Therefore, the Committee directs the Department of the Navy to
provide a briefing no later than 90 days after the enactment of
this Act on the condition of supporting infrastructure for Navy
installations in The Bahamas, potential infrastructure projects
that may be eligible for the Defense Access Roads Program, and
resources available to assist The Bahamas in development of
Defense-related support infrastructure.

Military Construction, Air Force

Appropriation, fiscal year 2022....................... $2,204,750,000
Budget request, fiscal year 2023...................... 2,055,456,000
Committee Recommendation, fiscal year 2023............ 2,291,156,000
Change from enacted level......................... +86,406,000
Change from budget request........................ +235,700,000

The Committee recommends $2,291,156,000 for the Air Force
in fiscal year 2023, of which $185,700,000 is for the following
projects in the following amounts:

----------------------------------------------------------------------------------------------------------------
State Location Project Amount
----------------------------------------------------------------------------------------------------------------
AL..................................... Maxwell AFB.............. Commercial Vehicle $15,000,000
Inspection Gate.
FL..................................... Eglin AFB................ F-35A ADAL Squadron 2,500,000
Operations.
FL..................................... Eglin AFB................ F-35A Developmental Test 3,700,000
2-Bay Test Hangar.
FL..................................... Eglin AFB................ F-35A Developmental Test 4,100,000
2-Bay MX Hangar.
FL..................................... Patrick SFB.............. Consolidated 97,000,000
Communications Facility.
OH..................................... Wright-Patterson AFB..... Child Development Center. 29,000,000
TX..................................... JBSA Lackland AFB........ Basic Military Training 5,400,000
Recruit Dormitory 8.
TX..................................... JBSA Randolph AFB........ Child Development Center. 29,000,000
----------------------------------------------------------------------------------------------------------------

Within the total for Military Construction, Air Force, the
recommendation also includes $171,094,000 for planning and
design, which is $35,300,000 above the budget request; and
$91,162,000 for unspecified minor construction, which is
$25,000,000 above the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.
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 for AETC. Outdated and inadequate AETC facilities,
including dormitories, harm the Air Force's ability to recruit,
train, and retain Airmen and increases operations and
maintenance costs. The Committee urges the Air Force to
prioritize funding for AETC facility design, construction, and
construction improvements and requests a report within 90 days
of enactment of this Act regarding plans to modernize, upgrade,
and construct new AETC facilities over the next five years.
Air Traffic Control Towers.--The Committee is aware that
some control towers along the Gulf Coast have fire safety
concerns, lack proper heating and air conditioning, and are
vulnerable to tropical storms and hurricanes and therefore
encourages the Air Force to ensure they are properly maintained
and upgraded or replaced as necessary, to meet mission
requirements. The Committee urges the Department of the Air
Force to prioritize replacing their oldest towers in a timely
manner. The Committee believes that these towers are valuable
national security assets that the Department of the Air Force
should maintain in a manner that will ensure their vital role
in protecting U.S. national security interests.
PFAS Water Treatment Demonstration Project.--The Committee
remains concerned about the areas that have been contaminated
with PFAS by the Air Force's previous use of firefighting foam
on former installations, resulting in PFAS contamination that
has spread beyond the installations and traveled to neighboring
private lands and water sources, including agricultural lands.
Therefore, the Committee encourages the Department to consider
the creation of a water treatment demonstration project for
areas impacted by PFAS contamination from BRAC sites.

Military Construction, Defense-Wide

(INCLUDING TRANSFER OF FUNDS)

Appropriation, fiscal year 2022....................... $2,206,051,000
Budget request, fiscal year 2023...................... 2,416,398,000
Committee Recommendation, fiscal year 2023............ 2,675,128,000
Change from enacted level......................... +469,077,000
Change from budget request........................ +258,730,000

The Committee recommends $2,675,128,000 for Military
Construction, Defense-Wide in fiscal year 2023, of which
$58,730,000 is for the following projects in the following
amounts:

Within the total, the recommendation provides $144,072,000
for unspecified minor construction, and $506,107,000 for
planning and design, including $50,000,000 above the budget
request for U.S. Indo-Pacific Command (USINDOPACOM).
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.
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 $653,250,000 for ERCIP
construction, an increase of $100,000,000 above the request.
Leadership in Energy and Environmental Design (LEED).--The
Committee encourages DOD to capitalize on the current energy
efficiency, management, and resiliency momentum and explore
opportunities to make more significant progress towards
reducing energy costs, increasing the use of renewable energy
sources, and reducing carbon emissions. As DOD works to
construct new bases and upgrade facilities, the Committee
directs DOD to leverage new energy technologies and maximize
the integration of clean renewable and alternative energy
sources throughout all military facilities and installations.
DOD should brief the Committee with details on necessary
resources to ensure all new construction and renovations are
``Platinum'' LEED certified. In addition, climate change is
increasing the frequency and duration of severe weather events.
When these weather events damage military facilities and
installations, they reduce readiness by delaying operations and
training. The briefing should also address how to assess
resources and the strategy necessary to ensure new construction
and/or renovations are designed to withstand severe weather
events or are relocated to lower risk of damage.
Energy Efficiency and Security.--DOD installation energy
use accounts for nearly a quarter of all Federal government
energy consumption. In fiscal year 2015, according to DOD's
Annual Energy Management Report, the Department spent
$3,900,000,000 on installation energy. While DOD has made great
strides in increasing installation energy efficiency and
reducing overall energy consumption, more needs to be done to
bring down the energy costs throughout the Department. DOD must
also increase its efforts to enhance energy security on its
installations through a range of actions, including investing
in renewable energy and smart technology that can shield
mission-critical operations from disruptions to the power grid.
According to a January 2017 report commissioned by the Pew
Charitable Trusts, ``Power Begins at Home: Assured Energy for
U.S. Military Bases'', DOD could enhance energy security on
installations and save hundreds of millions of dollars annually
by investing in microgrids and renewable energy systems and by
increasing energy efficiency on military bases.
The Committee notes that military installations in Hawaii
are among those at the forefront of DOD's efforts to increase
energy efficiency and security, including projects to develop
net-zero energy military housing and installation facilities,
upgrade and retrofit systems to improve energy and water
efficiency, and demonstrate microgrid technology. The Committee
supports DOD's investments in energy efficiency, renewable
energy systems, and energy security, including through ERCIP.
The Committee encourages the Department to prioritize funding
for energy-related projects, including renewable energy
projects, to mitigate risk to mission-critical assets and to
promote energy security and efficiency at military
installations.
Stormwater Management Projects.--The Committee recognizes
that resilient built and natural infrastructure on and around
military bases are essential in maintaining military readiness.
The Committee also recognizes the increasing variability of the
frequency and intensity of precipitation globally and the need
to mitigate flooding and runoff. The Committee supports the
implementation of stormwater best management practices, but
recognizes there is currently no dedicated, authorized DOD
entity that prioritizes stormwater management projects on and
off military installations. Therefore, the Committee directs
the Department to conduct a feasibility study and submit a
report no later than 180 days after enactment of this Act
assessing the potential creation of a program that prioritizes
stormwater management projects in order to enhance resilience
and improve water quality in stormwater-stressed ecosystems,
where the Department has restoration partnership obligations,
and where land subsidence and the expansion of non-permeable
surfaces exacerbate flooding on and around military bases.
Additionally, the Committee applauds states and localities that
utilize current precipitation data to inform the design of
stormwater management features that are built to address
current and future needs.
Unified Facilities Guide Specifications.--The Committee
recognizes the importance of the Unified Facilities Guide
Specifications but remains concerned it references building
materials that no longer exist or no longer reflect high
standards of resiliency and reduced environmental impact.
Therefore, the Committee directs the Department to update the
Unified Facilities Guide Specifications and directs the
Department to ensure lower-carbon materials are included as
appropriate. As steps are being taken to reduce the
environmental footprint of infrastructure projects, the
Committee supports the use of lower-carbon building materials,
which will reduce the initial embodied carbon of a project over
its full life cycle, and therefore directs the Department to
prioritize the use of these materials.
Homeland Defense Radar--Hawaii and other Missile Defense
Military Construction Requirements.--Providing an updated
missile defense architecture for the State of Hawaii is
critical to protecting the roughly 1.4 million Americans living
in Hawaii. It is also needed to properly protect critical
military regional headquarters in Hawaii (U.S. Indo-Pacific
Command, U.S. Pacific Fleet, Pacific Air Forces, U.S. Army
Pacific, Marine Corps Forces Pacific, Special Operations
Command Pacific, and National Security Agency Hawaii) and key
military installations in the state (Joint Base Pearl Harbor-
Hickam, Marine Corps Base Hawaii, Schofield Barracks, Fort
Shafter, the Pacific Missile Range Facility, and Pearl Harbor
Naval Shipyard and Intermediate Maintenance Facility). The
Joint Explanatory Statement accompanying the Consolidated
Appropriations Act, 2022 (P.L. 117-103) directed the Director
of the Missile Defense Agency, in consultation with the
Commander of U.S. Indo-Pacific Command and the Director of Cost
Assessment and Program Evaluation, to provide to congressional
defense committees a briefing on the current and evolving
threats, the capability that Homeland Defense Radar-Hawaii
provides against these threats, and other realistic solutions
to defend Hawaii from current and evolving ballistic missile
threats. In addition, the Department of Defense is conducting
its own broad review of missile defense options for Hawaii to
address the evolving threat landscape that has changed
significantly over the last few years. To better understand the
potential military construction needs for these efforts, the
Department is directed to include a list of potential
construction projects associated with enhancing the missile
defense of Hawaii within their upcoming report, which should
include a description, estimated cost, and construction
timeline for each project.
Cross-Service Facility Master Planning and Investments for
the Indo-Pacific.--Locations in the Indo-Pacific, such as Wake
Island, face a plethora of logistical, infrastructural,
environmental, and fiscal challenges that hinder their ability
to maintain mission readiness, provide adequate quality of life
for inhabitants, and ensure their ability to support strategic
requirements. For example, nearly all of the facilities on Wake
Island, faced with the intense corrosive nature of the region,
are falling into disrepair and the sanitary sewage system is
rapidly trending towards collapse. Despite these challenges and
the potential strategic importance of this location, project
planning and major construction funding requests have not
recently made the Services' priority lists. To help the
Committee assess the challenges facing locations in the Indo-
Pacific, the Committee directs the Assistant Secretary of
Defense for Sustainment, in conjunction with the INDOPACOM and
Services that have expressed interests in building facilities
or stationing personnel in these locations, to provide a
classified briefing within 180 days of the enactment of this
Act on military construction needs at Wake Island, Midway,
Guam, Tinian, the Republic of Marshall Islands, the Federated
States of Micronesia, the Republic of Palau, and any other
location in the Pacific Islands. The briefing should include
the following items: (1) a summary of outdated facilities that
must be modernized or replaced to meet current mission needs;
(2) a list of unfunded construction requirements; (3) a
consolidated list of projects at these locations considered by
U.S. Indo-Pacific Command and the Services that could
potentially be built over the next five years; (4) the ability
of these locations to support the power, water, sewage and
other critical life-support needs of future potential
construction projects; (5) the timeline for updating the
installation development plan at each location; and (6) steps
taken by the Services to advance projects supported through
INDOPACOM's planning and design funding.
Military Facility Resilience Funding.--The Committee
recognizes that the Armed Services must continue to improve
efforts to ensure its military installations are resilient to
flooding, sea level rise, and hurricanes, which are increasing
in frequency and scale. The Committee continues to support
efforts to improve the resilience of military installations and
encourages installations to develop plans that take into
account current and future risks from extreme weather,
including by utilizing modeling technologies that measure sea-
level rise. Therefore, the Committee directs the Services to
prioritize and commit funding to projects that improve the
resilience of military installations and their missions and
notes the need to ensure that infrastructure and facilities
remain operational against natural and manmade threats.
Recognizing that such investments are critical to
installation readiness, the bill provides $40,000,000 in
planning and design and construction funding for each of the
Services, including the Army, Navy and Marine Corps, and Air
Force, and $15,000,000 for Defense-Wide, to continue to develop
projects, conduct studies and analyses, and update Unified
Facilities Criteria that will directly enhance military
installation resilience. No later than 90 days after enactment
of this Act, the Services are directed to provide a spend plan
on the funds appropriated in this Act.
Alternative Fuel Infrastructure.--The Committee encourages
DOD to prioritize funding for the installation of alternative
fuel infrastructure at military installations to ensure
continuity of operations as DOD transitions to utilizing
alternative fuel vehicles.
United States Southern Command (SOUTHCOM).--The Committee
recognizes there are facilities within the SOUTHCOM enterprise,
including the Joint Interagency Task Force South (JIATF-S),
located at Naval Air Station Key West, that are severely
degraded, not optimized, and create a continual risk to mission
execution. The Committee also recognizes the installation is
critical to SOUTHCOM's Congressionally mandated mission, and a
new command and control facility is required to ensure
resiliency and enable modernization at JIATF-S. Therefore, the
Committee directs the Department to submit a report no later
than 120 days after enactment of this Act detailing the
condition of all facilities supporting the JIATF-S mission, to
include adequacy and sufficiency of military and civilian
housing at Naval Air Station Key West, and the status of
construction for the new Command and Control Facility, to
ensure the long-term success of the JIATF-S mission.

Military Construction, Army National Guard

Appropriation, fiscal year 2022....................... $337,893,000
Budget request, fiscal year 2023...................... 297,278,000
Committee Recommendation.............................. 325,658,000
Change from enacted level......................... -12,235,000
Change from Budget Request........................ +28,380,000

The Committee recommends $325,658,000 for the Army National
Guard in fiscal year 2023, of which $3,380,000 is for the
following projects in the following amounts:

Within the total for Military Construction, Army National
Guard, the recommendation also includes $43,625,000 for
planning and design, which is $15,380,000 above the budget
request; and $48,933,000 for unspecified minor construction,
which is $13,000,000 above the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.
Army National Guard (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
with 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.--The 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 is
directed to continue its efforts to establish the Center.

Military Construction, Air National Guard

Appropriation, fiscal year 2022....................... $305,050,000
Budget request, fiscal year 2023...................... 148,883,000
Committee Recommendation.............................. 193,983,000
Change from enacted level......................... -111,067,000
Change from budget request........................ +45,100,000

The Committee recommends $193,983,000 for the Air National
Guard in fiscal year 2023, of which $20,100,000 is for the
following projects in the following amounts:

Within the total for Military Construction, Air National
Guard, the recommendation also includes $41,712,000 for
planning and design, which is $13,300,000 above the budget
request; and $57,171,000 for unspecified minor construction,
which is $13,000,000 above the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.
Air National Guard Infrastructure.--The Committee
recognizes that some Aviation Support Facilities are not
configured to protect and maintain modern airframes and
encourages the Air National Guard to upgrade these facilities
using unspecified minor military construction funds as
appropriate.
Green Energy Projects.--The Committee is aware of National
Guard green energy projects that are at 35 percent design,
shovel-ready, and are below the unspecified minor military
construction threshold. However, these projects are not
receiving priority funding from the National Guard. The
Committee encourages the Air National Guard to prioritize green
energy projects that are ready and eligible for current
unspecified minor military construction funding.

Military Construction, Army Reserve

Appropriation, fiscal year 2022....................... $94,111,000
Budget request, fiscal year 2023...................... 99,878,000
Committee Recommendation, fiscal year 2023............ 119,878,000
Change from enacted level......................... +25,767,000
Change from budget request........................ +20,000,000

The Committee recommends $119,878,000 for the Army Reserve
in fiscal year 2023, including $19,829,000 for planning and
design, which is $10,000,000 above the budget request; and
$30,049,000 for unspecified minor construction, which is
$10,000,000 above the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.

Military Construction, Navy Reserve

Appropriation, fiscal year 2022....................... $71,804,000
Budget request, fiscal year 2023...................... 30,337,000
Committee Recommendation, fiscal year 2023............ 30,337,000
Change from enacted level......................... -41,467,000
Change from budget request........................ - - -

The Committee recommends $30,337,000 for the Navy Reserve
in fiscal year 2023, including $2,590,000 for planning and
design, which is the same as the budget request; and
$27,747,000 for unspecified minor construction, which is the
same as the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.

Military Construction, Air Force Reserve

Appropriation, fiscal year 2022....................... $120,074,000
Budget request, fiscal year 2023...................... 56,623,000
Committee Recommendation, fiscal year 2023............ 82,123,000
Change from enacted level......................... -37,951,000
Change from budget request........................ +25,500,000

The Committee recommends $82,123,000 for the Air Force
Reserve in fiscal year 2023, of which $5,500,000 is for the
following project in the following amount:

Within the total for Military Construction, Air Force
Reserve, the recommendation also includes $21,773,000 for
planning and design, which is $10,000,000 above the budget
request; and $21,850,000 for unspecified minor construction,
which is $10,000,000 above the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.

North Atlantic Treaty Organization Security Investment Program

Appropriation, fiscal year 2022....................... $215,853,000
Budget request, fiscal year 2023...................... 210,139,000
Committee Recommendation, fiscal year 2023............ 220,139,000
Change from enacted level......................... +4,286,000
Change from budget request........................ +10,000,000

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.
Russian Aggression.--In response to the unprovoked Russian
Federation invasion of the sovereign state of Ukraine on
February 24, 2022, the Committee includes an additional
$10,000,000 above the budget request for the NATO Security
Investment Program.

Department of Defense Base Closure Account

Appropriation, fiscal year 2022....................... $529,639,000
Budget request, fiscal year 2023...................... 284,687,000
Committee Recommendation, fiscal year 2023............ 574,687,000
Change from enacted level......................... +45,048,000
Change from budget request........................ +290,000,000

The Committee recommends $574,687,000 for the Base Closure
account, which is $45,048,000 more than fiscal year 2022 and
$290,000,000 above the budget request.
The recommendation includes an additional $90,000,000 above
the budget request for the Navy to accelerate environmental
remediation at installations closed under previous Base Closure
and Realignment (BRAC) rounds and for the demolition or removal
of non-historically designated buildings and structures under
Navy control where the sampling or remediation of
radiologically contaminated materials have been the subject of
substantiated allegations of fraud. Furthermore, the Navy is
directed to provide to the Committee a spend plan for these
additional funds no later than 60 days after enactment of this
Act.
Army Ordinance Remediation.--The Committee is concerned
that the Army is not adequately addressing the backlog in
ordinance remediation at former installations. Therefore, the
Committee directs the Department to submit to the Committee a
report on the current backlog of ordinance remediation and the
cost estimate of completing all remediation efforts no later
than 90 days after enactment of this Act.
Per- and Polyfluoroalkyl Substances (PFAS).--The Committee
continues to be very concerned about the extent of PFAS
contamination at U.S. military installations and how that
contamination is measured. 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 PFAS and directs the
Department to provide a spend plan to the Committees on
Appropriations of both Houses of Congress not later than 60
days after enactment of this Act.
PFAS Regulation and Research.--The Committee expects the
Department to continue working with the U.S. Environmental
Protection Agency on its regulatory initiatives and engaging
Federal health agencies, including the Agency for Toxic
Substances and Disease Registry, to ensure that it is using the
best and most up-to-date science to guide DOD remediation plans
and processes.
PFAS Reporting Requirement.--Over the past three fiscal
years, the Committee has directed the Department to keep it
apprised of new findings of PFAS at BRAC sites. The Committee
recognizes that the Services have provided some information.
However, the process for identifying PFAS contamination at BRAC
sites and determining the appropriate remediation plan remains
unclear. Therefore, the Deputy Assistant Secretary of Defense
for Environment is directed to prepare an updated comprehensive
report for the congressional defense committees no later than
60 days after enactment of this Act that establishes a baseline
of information regarding PFAS at closed military installations.
At a minimum, the report should (1) provide a list of all
closed military installations; (2) indicate whether PFAS has
been detected in drinking water and groundwater; (3) indicate
the level of contamination that has been detected; (4) provide
information on the likely sources of contamination; (5) explain
current mitigation efforts and proposed remediation plans; (6)
discuss the status of remediation; (7) provide a timeline for
cleanup; and (8) estimate the total cost of detection,
mitigation and remediation.

Family Housing Overview

Appropriation, fiscal year 2022....................... $1,423,554,000
Budget request, fiscal year 2023...................... 1,956,330,000
Committee Recommendation, fiscal year 2023............ 1,986,330,000
Change from enacted level......................... +562,776,000
Change from budget request........................ +30,000,000

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.
Military Housing Privatization Initiative (MHPI).--The
Committee believes that the MHPI management companies have
woefully neglected responsibilities outlined in their
partnership agreements with the Services. The Committee
continues to receive evidence of poor housing conditions,
inadequate maintenance response times, mishandling of claims,
indifference towards the wellbeing of servicemembers and their
families, and some incidences of illegal incentive fee fraud.
Therefore, the Committee provides an additional $30,000,000 for
increased oversight of DOD's housing portfolio, including
government-owned and controlled family housing, and privatized
family and unaccompanied housing. Additionally, the Committee
directs each Service to submit a report no later than 120 days
after enactment of this Act detailing: (1) the current
condition of all MHPI housing, including the current backlog of
maintenance requests; (2) a summary of all MHPI tenant
complaints; (3) a performance review of each MHPI management
company; and (4) an update on all known and alleged incidences
of incentive fee fraud. Furthermore, the Committee directs the
Services to brief the Committee and provide a spend plan on how
it will use the additional funding no later than 45 days after
enactment of this Act.
The Committee recognizes the importance of the MHPI and
continues to prioritize the state of homes within the MHPI, as
well as the timeliness and thoroughness of repair and
remediation of reported problems, and the Department of Defense
and Services' oversight communications with tenants and the
base housing property management companies.
Evan's Law.--The Committee is concerned that the MHPI
management companies are not purchasing and installing the
mandatory, lifesaving window fall prevention devices in
compliance with International Building Code standards and
required by section 2823 of the National Defense Authorization
Act for Fiscal Year 2019 (P.L. 115-232), which is commonly
referred to as ``Evan's Law'', in a timely manner. The
Committee directs the Department to prioritize the installation
of these devices and provide the MHPI partners with all
necessary, authorized resources to do so, if needed.
Additionally, the Committee directs the Department to submit a
report no later than 90 days after enactment of this Act on the
progress of window fall prevention device installation, as well
as an estimate of any additional funding and/or authorizations
required to expedite the completion of necessary device
installations at all privatized military housing.
Indoor Air Quality.--The Committee remains concerned that
servicemembers and their families are subject to unhealthy
living conditions, including potentially dangerous indoor air
quality, in military family housing constructed and operated
under the MHPI, as well as Unaccompanied Personnel Housing. The
Committee has been aware of poor quality of service provided by
MHPI management companies as well as deteriorating conditions
of MHPI housing and Unaccompanied Personnel Housing. The
Department and MHPI partners are directed to regularly monitor
housing conditions and adhere to Environmental Protection
Agency guidance and recommended mitigation procedures for those
areas where there is evidence of potential health effects,
including mold and other indoor air health risks. Additionally,
the Committee directs the Department to provide a briefing for
the Committee within 90 days of enactment of this Act on how
the Department will work with the MHPI partners to monitor and
enhance indoor air quality in MHPI housing. The briefing should
at a minimum include, but not be limited to: (1) whether and to
what extent private housing providers include air purification
in their procedures for mold mitigation; (2) an evaluation of
both commercially and non-commercially available air
purification technology capable of destroying airborne mold and
other harmful substances; and (3) recommendations for the
deployment of air purification technology within the MHPI.
Homeownership Education.--The Committee encourages the
Services to work with privatized housing partners to develop
and provide basic homeownership education programs for
servicemembers and their families.

Family Housing Construction, Army

Appropriation, fiscal year 2022....................... $99,849,000
Budget request, fiscal year 2023...................... 169,339,000
Committee Recommendation, fiscal year 2023............ 169,339,000
Change from enacted level......................... +69,490,000
Change from budget request........................ - - -

Family Housing Operation and Maintenance, Army

Appropriation, fiscal year 2022....................... $391,227,000
Budget request, fiscal year 2023...................... 436,411,000
Committee Recommendation, fiscal year 2023............ 446,411,000
Change from enacted level......................... +55,184,000
Change from budget request........................ +10,000,000

Family Housing Construction, Navy and Marine Corps

Appropriation, fiscal year 2022....................... $77,616,000
Budget request, fiscal year 2023...................... 337,297,000
Committee Recommendation, fiscal year 2023............ 337,297,000
Change from enacted level......................... +259,681,000
Change from budget request........................ - - -

Family Housing Operation and Maintenance, Navy and Marine Corps

Appropriation, fiscal year 2022....................... $357,341,000
Budget request, fiscal year 2023...................... 368,224,000
Committee Recommendation, fiscal year 2023............ 378,224,000
Change from enacted level......................... +20,883,000
Change from budget request........................ +10,000,000

Family Housing Construction, Air Force

Appropriation, fiscal year 2022....................... $115,716,000
Budget request, fiscal year 2023...................... 232,788,000
Committee Recommendation, fiscal year 2023............ 232,788,000
Change from enacted level......................... +117,072,000
Change from budget request........................ - - -

Family Housing Operation and Maintenance, Air Force

Appropriation, fiscal year 2022....................... $325,445,000
Budget request, fiscal year 2023...................... 355,222,000
Committee Recommendation, fiscal year 2023............ 365,222,000
Change from enacted level......................... +39,777,000
Change from budget request........................ +10,000,000

Family Housing Operation and Maintenance, Defense Wide

Appropriation, fiscal year 2022....................... $49,785,000
Budget request, fiscal year 2023...................... 50,113,000
Committee Recommendation, fiscal year 2023............ 50,113,000
Change from enacted level......................... +328,000
Change from budget request........................ - - -

Department of Defense Family Housing Improvement Fund

Appropriation, fiscal year 2022....................... $6,081,000
Budget request, fiscal year 2023...................... 6,442,000
Committee Recommendation, fiscal year 2023............ 6,442,000
Change from enacted level......................... +361,000
Change from budget request........................ - - -

Department of Defense Military Unaccompanied Housing Improvement Fund

Appropriation, fiscal year 2022....................... $494,000
Budget request, fiscal year 2023...................... 494,000
Committee Recommendation, fiscal year 2023............ 494,000
Change from enacted level......................... - - -
Change from budget request........................ - - -

Administrative Provisions

The bill includes a total of 36 Administrative provisions,
25 of which are effective in fiscal year 2022.
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 $35,000 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 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 124 extending the eligibility of
unobligated funding for fiscal years 2017 and 2018 projects
that have not lapsed.
The bill includes section 125 defining the congressional
defense committees.
The bill includes section 126 providing additional funds
for improving resilience and the effects of climate change on
military installations.
The bill includes section 127 providing additional planning
and design funds for child development centers.
The bill includes section 128 providing additional cost to
complete funds for the Air Force for expenses incurred as a
result of natural disasters.
The bill includes section 129 providing funds for various
military construction accounts for DOD labs.
The bill includes section 130 providing additional funds
for an Air Force Reserve unfunded priorities project.
The bill includes section 131 providing funds specified to
address cost increases identified subsequent to the fiscal year
2023 budget request for construction projects across various
accounts.
The bill includes section 132 providing funds specified to
address cost increases for major construction projects funded
by this Act.
The bill includes section 133 providing the Navy with
planning and design funds for water treatment and distribution
infrastructure.
The bill includes section 134 providing the Army National
Guard and Reserve additional funds for barracks and
unaccompanied personnel housing.
The bill includes section 135 providing additional funds
for Army housing cost to complete projects.
The bill includes section 136 providing additional funds
for construction of child development centers.

TITLE II

DEPARTMENT OF VETERANS AFFAIRS

Appropriation, fiscal year 2022\1\................... $269,263,382,000
Budget request, fiscal year 2023\1\.................. 298,611,258,000
Committee recommendation, fiscal year 2023\1\........ 298,563,339,000
Change from enacted level........................ +29,299,957,000
Change from budget request....................... -47,919,000

Fiscal year 2024 advance budget request.............. 283,455,762,000
Fiscal year 2024 Committee recommendation in the bill 283,455,762,000
Change from budget request....................... - - -

\1\All funding cited excludes amounts in the Medical Care Collections
Fund.

The Department of Veterans Affairs (VA) provides health
care for 9,200,000 veteran enrollees, disability compensation
benefits to an estimated 5,538,958 veterans and 482,949
survivors, pension benefits for an estimated 162,377 veterans
and 114,250 survivors, life insurance for more than 5,500,000
veterans, servicemembers and their families, educational
assistance for nearly 900,000 trainees, and interment of more
than 130,000 veterans and eligible family members in national
cemeteries. To serve adequately the nation's veterans, VA
employs more than 425,000 people, making it one of the largest
Federal agencies in terms of employment.
The Committee strongly supports the implementation of the
Deborah Sampson Act, enacted into law as part of the Johnny
Isakson and David P. Roe, M.D. Veterans Health Care and
Benefits Improvement Act of 2020 (P.L. 116-315), and notes that
the funding level provided for the Department for fiscal year
2023 continues to fund the implementation of the Deborah
Sampson Act. The Committee believes firmly that the Department
should dedicate sufficient resources to support the needs of
women veterans in all program areas, including hiring and
training staff, strategic planning, health research,
eliminating sexual harassment and sexual assault, and
retrofitting existing medical facilities to make it safer and
easier for women veterans to get care. The Committee directs VA
to provide an updated plan and timeline for implementation of
this law, including an expenditure plan in each of these areas,
to the Committees on Appropriations of both Houses of Congress,
no later than 90 days after enactment of this Act.
Sexual Harassment and Sexual Assault Protections for VA
Beneficiaries and Employees.--Eliminating sexual harassment and
assault at VA is critical to creating a safe and welcoming
environment for veterans, their families, caregivers, and
survivors, as well as VA employees. The Committee has
previously expressed concern about the lack of centralized
reporting mechanisms and resources for VA beneficiaries who are
harassed or assaulted by VA employees or on VA property, as
well as the potential for retaliation from within the
Department. The Committee notes that VA has published a
handbook with comprehensive policy guidance and instructions
addressing harassment and sexual assault and directs VA to
ensure that these policies are fully communicated and complied
with. The Committee appreciates the Department's efforts to
better address harassment and sexual assault, and requests an
updated report annually on the Department's comprehensive
approach.
Native Hawaiian, Pacific Islander and United States-
Affiliated Pacific Islander (NHPIUSAPI) Veteran Healthcare.--
The Committee recognizes the significant contributions of
NHPIUSAPI servicemembers in the U.S. military and the
disproportionate number of NHPIUSAPI servicemembers and
veterans. These veterans are more likely to be female, report
military sexual trauma, receive care for conditions such as
diabetes, hypertension, post-traumatic stress disorder and
addiction and receive more physical and mental diagnoses
overall than their non-native and NHPIUSAPI counterparts. Given
the unique clinical and geographic needs of NHPIUSAPI veterans
and recognizing the Department's support for creating a new
center focused on the NHPIUSAPI community, the Committee
provides $5,000,000 to establish a Center for NHPIUSAPI Health
to focus on research, data collection, and practice improvement
to better serve NHPIUSAPI veterans. The Committee supports VA's
approach of housing the new center in the VA Office of Health
Equity with a field office in the Pacific, and encourages VA to
partner with non-government institutions and universities. The
Committee encourages VA to focus on issues specific to the
NHPIUSAPI community, including extending the use of telehealth
and telepharmacy to reach remote and isolated areas; using
multi-disciplinary teams that incorporate community outreach
workers; integrating clinical pharmacists into primary care
practices to improve chronic disease control; incorporating
local and indigenous cultural practices into VA's healthcare
system; leveraging data analytics from modernized electronic
health records to analyze gaps, costs, and healthcare
disparities due to race and ethnicity; creating a more diverse
healthcare workforce; and improving language access.
Combatting Online Misinformation and Extremism.--The
Committee is concerned by foreign and domestic actions to
exploit veterans through the use of online misinformation and
manipulation. These efforts to spread extremist views and
conspiracy theories among the veteran community have severely
damaging effects, such as spreading conspiracies that may have
motivated participation in the Capitol insurrection on January
6, 2021. The Committee feels strongly that VA should engage
with the veteran community to better understand the unique
vulnerabilities that veterans face online, and that the
Department should establish a comprehensive, evidence-based
program to educate veterans about malign influences, transition
assistance to include specialized counseling services, as well
as research into operations and methods to discern against
disinformation. This should include developing evidence-based
social media and internet propaganda literacy programs that are
appropriately targeted to different veteran populations and an
understanding of appropriate counseling options. The Committee
encourages the Department to engage with the Departments of
Justice and Homeland Security, as well as civil society
partners, in developing this program, and looks forward to the
report required in House Report 117-81 on VA's plans to
implement this program, including a cost estimate of additional
resources that would assist in implementation.
Protecting Immigrant Veterans.--The Committee recognizes
the value and service of immigrant veterans and is concerned
about the deportation of veterans, as well as family members,
workers, and other visitors interacting with VA who may also be
at risk for deportation. The Committee is strongly supportive
of VA's role in the Immigrant Military Members and Veterans
Initiative and looks forward to receiving the plan requested in
House Report 117-81. The Committee continues to direct VA to
take steps to ensure that non-citizen veterans are made aware
of their options to naturalize as U.S. citizens. Finally, the
Committee strongly urges VA to take every step possible to
assist detained and previously deported veterans, including by
providing administrative guidance and assistance with relevant
applications and paperwork. The Department is encouraged to
continue to coordinate with the Department of Homeland Security
to develop methods that allow the Department to maintain
contact with detained and previously deported veterans and
ensure that they are able to access this and other VA
assistance and benefits to which they are entitled.
Performance Measures.--The Committee directs the Department
to comply with title 31 of the United States Code, including
the development of organizational priority goals and outcomes
such as performance outcome measures, output measures,
efficiency measures, and customer service measures. The
Secretary is directed to submit a report to the Committee
within 60 days of enactment of this 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 and encourages the Secretary to
continuously improve customer service standards and incorporate
them into the performance plans required under section 1115 of
title 31, United States Code.
The Committee is aware of reports that Members have had
challenges providing casework services to their constituents
because the Department's local offices are lacking staff and
strongly encourages VA to ensure sufficient staff, including
in-person employees, are available.

VETERANS BENEFITS ADMINISTRATION

COMPENSATION AND PENSIONS

(INCLUDING TRANSFER OF FUNDS)

Fiscal year 2022 enacted level....................... $139,183,014,000
Fiscal year 2023 enacted level....................... 152,016,542,000
Fiscal year 2023 budget year request................. - - -
Committee 2023 budget year recommendation............ - - -

Fiscal year 2024 advance appropriation request....... 146,778,136,000
Committee 2024 advance appropriation recommendation.. 146,778,136,000
Comparison with:
Fiscal year 2023 enacted level................... -5,238,406,000
Fiscal year 2024 advance budget request.......... - - -

This appropriation provides funds for service-connected
compensation payments to an estimated 5,538,958 veterans and
482,949 survivors in fiscal year 2023. In addition, pension
payments will be funded for an estimated 162,377 veterans and
114,250 survivors. The average payment per compensation case
for veterans in fiscal year 2023 is estimated at $23,245 and
pension payments are projected at $14,173.
The appropriation includes authority to transfer funding
not to exceed $21,423,000 in fiscal year 2024 to General
Operating Expenses, Veterans Benefits Administration (VBA) 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.
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. For example, disability-related benefits
not only honor the service and sacrifice of the veterans who
receive them, but also help to replace lost wages and provide a
critical source of economic well-being.

READJUSTMENT BENEFITS

Fiscal year 2022 enacted level........................ $14,946,618,000
Fiscal year 2023 enacted level........................ 8,906,851,000
Fiscal year 2023 budget year request.................. - - -
Committee 2023 budget year recommendation............. - - -

Fiscal year 2024 advance appropriation request........ 8,452,500,000
Committee 2024 advance appropriation recommendation... 8,452,500,000
Comparison with:
Fiscal year 2023 enacted level.................... -454,351,000
Fiscal year 2024 advance budget request........... - - -

This appropriation finances the education and training of
veterans and servicemembers through the Post-9/11 GI Bill and
the All-Volunteer Force Educational Assistance Program.
Supplemental education benefits are also provided to certain
veteran members of the Selected Reserve and are funded through
transfers from DOD. In addition, certain disabled veterans are
provided with vocational rehabilitation, specially adapted
housing grants, and grants for automobiles with approved
adaptive equipment. This account also finances educational
assistance allowances for eligible dependents of veterans who
died from service-connected causes or have a total and
permanent service-connected disability, as well as dependents
of servicemembers who were captured or are missing in action.
Almost 80 percent of the funds in the account support the Post-
9/11 GI Bill.
For fiscal year 2024, the bill provides $8,452,500,000.
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 Veterans Service Organizations (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. The Committee
requests a report on these efforts not later than 180 days
after enactment of this Act.
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. The Committee directs VA to submit a report
not later than 60 days after enactment of this Act on the steps
VA has taken to fulfill the directive included in House Report
117-81 on VA's GI Bill Comparison Tool requirement.
Technology for Student Veterans.--During the pandemic,
remote learning technology such as computers and routers for
internet were more important than ever for so many veteran
students. The Committee directs VA to explore options for
ensuring all veteran students have access to the technology and
connectivity they need to be successful in school.
VetSuccess on Campus.--The Committee recognizes the
importance of the VetSuccess on Campus program and its role in
ensuring success in post-secondary education for veterans,
servicemembers, and qualified dependents. The Committee
encourages the Department to expand the program, including at
institutions that collaborate to provide additional
opportunities for students.
Training and Upskilling for Veterans.--According to the
Syracuse University Institute for Veterans & Military Families,
47 percent of veterans are employed in occupations expected to
shrink between now and 2030, namely, where automation is a
threat to the workforce. Veterans receiving professional
coaching and training are more likely to be promoted in their
first job after transitioning from the military. The Committee
encourages the Department to continue efforts to implement
training and upskilling programs, such as the Veteran
Employment Through Technology Education Courses (VET TEC) and
Transition Assistance Grant programs, to help ensure veterans
are not left behind in the new talent economy. The Committee
directs VA to provide a report not later than 90 days after
enactment of this Act on efforts to improve training and
upskilling of veterans and their families.
VA Work-Study Program.--The Committee supports VA's efforts
to provide work-based experiences that could help improve
student veterans' employment opportunities after graduation and
that do not disadvantage student veterans compared to their
non-veteran peers. Therefore, the Committee directs VA to
submit a report, not later than 180 days after enactment of
this Act, consisting of: (1) an overview of the VA Work-Study
program, to include types of work-study activities undertaken
through the program, number and demographics of beneficiaries,
and participating institutions; (2) an assessment of work-study
opportunities available to student veterans; (3) an analysis of
the feasibility and advisability of expanding the scope of
eligible work-study opportunities supported through the VA
Work-Study program; and, (4) any recommendations for
improvements to the program, to include legislative proposals,
that might better position student veterans for future
employment.
VET TEC Pilot Program.--The VET TEC Pilot Program has
enabled veterans to use their GI Bill benefits to access non-
traditional, technology-oriented educational courses. The
Committee expects the Department to fully fund the program,
consistent with current law, at $45,000,000 for fiscal year
2023.

VETERANS INSURANCE AND INDEMNITIES

Fiscal year 2022 enacted level........................ $136,950,000
Fiscal year 2023 enacted level........................ 109,865,000
Fiscal year 2023 budget year request.................. - - -
Committee 2023 budget year recommendation............. - - -

Fiscal year 2024 advance appropriation request........ 121,126,000
Committee 2024 advance appropriation recommendation... 121,126,000
Comparison with:
Fiscal year 2023 enacted level.................... +11,261,000
Fiscal year 2024 advance budget request........... - - -

The Veterans Insurance and Indemnities appropriation is
made up of the former appropriations for military and naval
insurance, applicable to World War I veterans; national service
life insurance (NSLI), applicable to certain World War II
veterans; 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.
For fiscal year 2024, the bill provides $121,126,000.
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 2022.......................... - - - ($500,000) $229,500,000
Budget request est., fiscal year 2023.................... - - - (500,000) 282,361,131
Committee recommendation, fiscal year 2023............... - - - (500,000) 282,361,131
Change from enacted level............................ - - - - - - +52,861,131
Change from budget request........................... - - - - - - - - -
----------------------------------------------------------------------------------------------------------------

The purpose of the home loan guaranty program is to
facilitate the extension of mortgage credit on favorable terms
by private lenders to eligible veterans. This appropriation
provides for all costs, with the exception of the Native
American Veterans Housing Loan Program, of the Department's
direct and guaranteed loans programs. The Federal Credit Reform
Act of 1990 (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 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 understands that VA is
working to improve communication with eligible lending
institutions to reduce confusion among lenders and borrowers on
this matter and looks forward to receiving the report to the
Committee requested in House Report 117-81.

VOCATIONAL REHABILITATION LOANS PROGRAM ACCOUNT

----------------------------------------------------------------------------------------------------------------
Limitation on Administrative
Program Account direct loans Expenses
----------------------------------------------------------------------------------------------------------------
Appropriation, fiscal year 2022.......................... $2,838 (1,662,758) $429,467
Budget request, fiscal year 2023......................... 7,171 (942,330) 445,698
Committee recommendation, fiscal year 2023............... 7,171 (942,330) 445,698
Change from enacted level............................ +4,333 (-720,428) +16,231
Change from budget request........................... - - - - - - - - -
----------------------------------------------------------------------------------------------------------------

This appropriation covers the subsidy cost of direct loans
for vocational rehabilitation of eligible veterans and includes
administrative expenses necessary to carry out the direct loan
program. Loans of up to $1,300 (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 870 loans in
fiscal year 2023, with an average amount of $1,083.

NATIVE AMERICAN VETERAN HOUSING LOAN PROGRAM ACCOUNT

Administrative expenses:
Appropriation, fiscal year 2022....................... $1,400,000
Budget request, fiscal year 2023...................... 1,186,000
Committee recommendation, fiscal year 2023............ 1,400,000
Change from enacted level......................... - - -
Change from budget request........................ +214,000

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.
The Committee continues to provide resources above the
budget request in fiscal year 2023 to boost awareness of the
program through improved communication and outreach to veterans
eligible for a loan under this program. The Committee directs
the Secretary to provide a report on efforts to improve
outreach to eligible veterans not later than 90 days after the
enactment of this Act.

GENERAL OPERATING EXPENSES, VETERANS BENEFITS ADMINISTRATION

Appropriation, fiscal year 2022....................... $3,453,813,000
Budget request, fiscal year 2023...................... 3,863,000,000
Committee recommendation, fiscal year 2023............ 3,863,000,000
Change from enacted level......................... +409,187,000
Change from budget request........................ - - -

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, 2024, up to
ten percent of these funds.
The Committee provides $3,863,000,000, for the General
Operating Expenses, VBA account, to enable VBA to deliver the
benefits that veterans rely on. These resources will fully fund
VA's request for fiscal year 2023 and improve VBA's ability to
address compensation and benefit claims in a timely manner by
hiring new claims processors and continued adoption of
automation efforts to deliver fast, accurate, and consistent
claim decisions for veterans.
Toxic Exposures.--The Committee remains concerned about
service-connected exposures to toxic substances among veterans,
such as Agent Orange, per- and polyfluoroalkyl substances
(PFAS), radiation, asbestos, and open burn pits. The Committee
believes that VA's recent rulemaking activities expanding
presumptive benefits for veterans with certain toxic exposures
is a step in the right direction. More must be done, both in
expanding access to healthcare for veterans exposed to toxins,
as well as ensuring they are receiving the disability
compensation benefits that they have earned.
Disability Claims.--The Committee continues to be concerned
about reports of delays that 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
Committee encourages the Department to work diligently to
reduce the backlog of compensation and benefit claims to pre-
pandemic levels to lessen the burden of excessive wait times.
The funding level provided is sufficient to continue programs
that support effective management of claims, including the
Veterans Claims Intake Program.
Burn Pits Data Tracking and Reporting.--The Committee
continues to be concerned with the lack of data on veteran
exposure to open burn pits (burn pits) and reiterates the
direction provided in House Report 117-81, requiring a report
within 180 days on burn pit data tracking and reporting. The
Committee urges VA to work with DOD to ensure that VA has
information about every location in which servicemembers may
have been exposed to toxins in order to appropriately
adjudicate claims and make determinations about presumptive
eligibility.
Equitable Relief.--The Committee 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, 2023, the
Secretary is directed to submit to the Committee a report
containing a statement as to the disposition of each case
recommended to the Secretary for equitable relief under section
503 of title 38, United States Code during the preceding
calendar year.
Military Sexual Trauma (MST) Claims.--The Committee is
frustrated by the findings of the August 2021 Office of
Inspector General (OIG) Report titled ``Improvements Still
Needed in Processing Military Sexual Trauma Claims,'' which
found VBA has failed to ensure all claims processors handling
MST-related claims have received specialized MST training. The
Committee urges VBA to prioritize specialized MST training for
claims processors, and to continue to involve MST survivors in
the development of specialized training. Additionally, the
Committee remains 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,
and 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 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).
Compensation and Pension Exams.--The Committee is aware
that the majority of veterans filing claims for disabilities
incurred or aggravated by MST are referred to a third-party
contract provider for the required Compensation and Pension
(C&P) exam, and is aware that veterans filing MST-related
claims may have unique needs and safety concerns. Therefore,
the Committee reiterates the direction included in House Report
117-81 related to required, specialized MST training for both
contract and VHA examiners and looks forward to receiving the
report expeditiously. The Committee further directs VA to allow
veterans filing an MST-related claim to request a VHA provider
for the required C&P exam.
Hearing Loss Prevention.--Hearing loss and auditory
injuries account for one of the most prevalent service-
connected disabilities for veterans receiving compensation
benefits. As such, the Committee requests a report, not later
than 180 days after enactment of this Act, on the number of
veterans affected and amount of compensation benefits provided
over the last five fiscal years and directs the Department to
work with the Department of Defense to identify options,
strategies, and technologies to reduce the incidence of hearing
loss by military personnel through exposure to excessive
auditory pressure impulses during weapons training.
Expand Accessibility for Toxic-Exposed Veterans.--The
Committee encourages VA to ensure resources and materials
provided by VA to toxic-exposed veterans be made available in
the most commonly spoken languages in the United States, as
mandated in the Veterans and Family Information Act (P.L. 117-
62).
Transition Assistance Grant Program.--The transition from
military to civilian life brings significant challenges, which
can be exacerbated by difficulties navigating a patchwork of
different programs. The Committee believes that centralized
community resources are needed to ensure veterans have a
successful transition. The Committee directs VA to work towards
timely implementation of the transition assistance grant
program established by Section 4304 of the Johnny Isakson and
David P. Roe, M.D. Veterans Health Care and Benefits
Improvement Act of 2020 (P.L. 116-315) and includes $1,300,000
for the initial implementation of this program, as requested.
The Committee encourages VBA to explore options to expand these
grants in future years. The Committee further directs VBA to
provide a briefing, not later than 90 days after awarding the
initial grants, on progress and an interim assessment of
effectiveness of these grants to improve veteran transition and
a report on the effectiveness of these grants not later than 90
days after completion of the grant period.
Digitizing Veteran Records.--The Committee commends the
efforts of VBA, in partnership with the National Archives and
Records Administration (NARA), to address the backlog of
veterans' records requests by creating digital copies of
records that currently exist only in hardcopy form at the
National Personnel Records Center (NPRC). The Committee
strongly encourages VBA to continue its efforts to create
digital copies of veterans' records housed at NPRC. Therefore,
the Committee encourages VBA to allocate within the budgeted
amounts any necessary funding to continue to digitize veterans'
records housed at NPRC. In addition, to assist with
Congressional efforts to properly resource digitization
efforts, the Committee directs VBA to produce an analysis of
the resources needed to digitize all hardcopy veteran records
housed at NPRC not later than 90 days after the enactment of
this Act.

Veterans Health Administration (VHA)

The Department operates the largest Federal medical care
delivery system in the country, with 145 hospitals, 124
residential rehabilitation treatment programs, 135 nursing
homes, 300 Vet Centers, 83 Mobile Vet Centers, and 740
Community-Based Outpatient Clinics (CBOCs). Approximately
7,347,400 patients will be treated in fiscal year 2023.
The Veterans Health Administration budget comprises five
accounts: Medical Services, Medical Community Care, Medical
Support and Compliance, Medical Facilities, and Medical and
Prosthetic Research. For the first four accounts, which are
funded in advance, the Committee provides an additional
$7,527,000,000 for fiscal year 2023, which is an increase of
$66,000,000 over the budget request. In addition, VA will
receive an estimated $3,910,000,000 in the Medical Care
Collections Fund in fiscal year 2023. The Administration has
requested total resources for fiscal year 2024 of
$128,104,000,000 to fund the four advance appropriations of
VHA. The Committee also provides $926,000,000 for Medical and
Prosthetic Research, an increase of $10,000,000 over the budget
request.
The Committee supports the efforts of the Office of Care
Management and Social Work, which provides comprehensive
transition assistance and case management for wounded, ill, and
injured Post-9/11 veterans. The Committee notes the overall
trend for recently transitioned servicemembers that pose the
highest risk of suicide during the three years immediately
post-discharge. VHA should continue to support effective
initiatives that cover transition from military service to
veteran status.
Billing of Private Insurers.--The Committee expresses
concerns with the Department's challenges in effectively
billing private health insurers, as detailed in the OIG's May
2022 report, ``VHA Continues to Face Challenges with Billing
Private Insurers for Community Care'' (Report No. 21-00846-
104). The Inspector General identified inefficient processes,
problems with data completeness, and workload and staffing
challenges that led to VA being unable to recover significant
amounts of funds. The Committee directs VA to submit a report
within 60 days of enactment of this Act on how it is addressing
these identified deficiencies and how it is responding to the
Inspector General's recommendations to improve billing
processes.
Veterans Transportation.--The Committee continues to
support the Department's programs to provide veterans across
the country with transportation to VA medical facilities,
making it easier for rural and disabled and impaired veterans
to receive medical care. The Committee directs the Department
to allocate robust funding for these programs, including the
Veterans Transportation Program and the Volunteer
Transportation Network, so that they can continue to expand
access to VA services for veterans across the country. The
Committee further directs VA to explore all options to
strengthen and sustain the Volunteer Transportation Network,
including increased funding to recruit and retain drivers and
support vehicle maintenance.
Dispute Resolution.--The Committee urges VA to ensure that
veterans are clearly advised of their rights to contest VA
billing charges and determinations and of the step-by-step
process for disputing billing charges. VA is further urged to
ensure this information is available both online and in
publicly accessible areas at each VA medical center, and that
it is made available in English, Spanish, and other languages,
as appropriate, in a given geographic region, with information
directing veterans where to find further translations of the
information into the eight other most commonly spoken languages
in the United States.
Healthcare Information Transparency.--The Committee urges
VA to ensure that information that is required to be disclosed
by law, such as wait time and patient safety data, is
consolidated and streamlined onto an easily accessible and
usable website. VA is encouraged to consult with Veterans
Service Organizations, veterans, and caregivers of veterans
from geographically diverse areas and representing different
eras of service to gather insights about potential
modifications that could help improve the understanding and use
of such data.

TOXIC EXPOSURE

The Committee strongly supports efforts to improve
diagnosis and treatment of conditions resulting from toxic
exposures, and appreciates the work of the Health Outcomes
Military Exposures (HOME) program, the Office of Research and
Development, and other VA program offices to increase attention
to this issue.
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 VA's
work through the Airborne Hazards and Burn Pits Center of
Excellence on diagnoses, mitigation, and treatment of
conditions related to airborne hazards and burn pits, and
includes $13,000,000, as requested, to carry out
responsibilities and activities of the Airborne Hazards and
Burn Pits Center of Excellence.
Burn Pits Center of Excellence Expansion.--Research and
clinical trials are urgently needed to develop effective
treatments for veterans exposed to toxic environmental hazards,
and 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. However, the effects of toxic exposure may manifest
differently between genders. Therefore, the Committee directs
the Department to provide a report within 120 days of enactment
of this Act on the feasibility, including cost estimates, of
establishing a new Center of Excellence or expanding the
existing Burn Pits Center of Excellence to focus on gender-
based differences in disease and treatment. The report should
include details on how the Department is including
investigations of gender-based differences in disease and
treatment and ways it can expand; how it is expanding provider
education to focus on gender-based differences; how it is
working with outside groups and clinical experts to inform best
practices on including women veterans in clinical trials; and
how it is leveraging research funding through partnerships,
particularly those with experience with research consortia
working on Gulf War Illness with funding through the Department
of Defense's Congressionally Directed Medical Research
Programs, partnerships with VA medical centers and minority
serving institutions, and expertise in gender-based differences
in disease diagnosis and treatment.
Toxic Exposure Research.--The Committee is pleased that
toxic exposures will continue to be an area of focus for VA's
research programs in fiscal year 2023 through the Military
Exposure Research Program. The Committee encourages the
Department to continue to expand its research on the effects of
and treatments for veterans exposed to toxins, such as Agent
Orange, open burn pits, per- and polyfluoroalkyl substances
(PFAS), radiation, and asbestos, during the course of their
active duty service. In addition, the Committee urges the
Department to reference data from existing medical records of
veterans to determine how veterans who served in areas where
toxins were dispersed may have more frequent or unexplained
diseases compared to the civilian population.
Gender-Specific Toxic Exposure Research.--The Committee
recognizes the gender-specific impacts of toxic exposure and
notes that in order to provide full and effective medical care,
it is essential for the Department to understand the health
effects of women veterans exposed to toxins during their
service. The Committee encourages the Department to continue
and expand its research on the effects of toxic exposure and
ensure gender-specific research on women veterans is included
in these efforts. Further, the Committee is concerned that a
commensurate number of women veterans relative to the total
women veteran population are not being utilized in research
studies, especially in those pertaining to effects of toxic
exposure on veterans. The Committee directs VA to provide a
report within 120 days of enactment of this Act on the metrics
of women veterans participating in trials and strategies on how
VA is recruiting and designing their studies to be properly
inclusive of women.
PFAS Research.--The Committee is deeply concerned about the
impact of PFAS at military bases on servicemembers, their
families, and surrounding communities, and recognizes that the
effects of PFAS exposure may continue for servicemembers once
they are under the care of VA. While the Committee directs VA
to continue collaborating with DOD's PFAS Task Force, academia,
and other health institutions and agencies to monitor research
activities, results, and publications on the health effects
from PFAS, the Committee also believes that VA can and should
play an active role in research on the effects of PFAS exposure
and health monitoring as it relates to veterans.
Burn Pit Population Surveillance.--The Committee continues
to express its concern regarding the devastating effects that
toxic particulate matter from sources such as burn pits, dust
storms and sulphur mine fires have had on veterans who were
deployed to Iraq, Afghanistan, Southwest Asia, and other
theaters of operations in the period after 9/11. While the
Department has attempted to quantify the number of veterans who
were exposed to airborne hazards, a full accounting of the
scope and severity of the impacts of these exposures across the
affected population has not been undertaken. The Committee is
aware of emerging technology that uses existing x-ray imaging
equipment to derive four-dimensional models of lung function,
to identify respiratory illnesses and accompanying loss of lung
function earlier than was previously feasible. The Committee
urges the Department to evaluate this technology for the
purposes of conducting population-wide surveillance of veterans
who have likely been exposed to airborne hazards, in order to
conduct a full accounting of the health impacts suffered by
veterans and to provide full and effective medical care to this
population.
Early Detection Diagnostics.--The Committee encourages VA
to consider all options to better incorporate available early
detection diagnostics into veterans' care. Particularly for
veterans exposed to toxic substances, early detection
diagnostics can help identify early onset cancers and other
illnesses to ensure that toxic-exposed veterans get the care
and help they need from the VA. The Committee directs the VA to
submit a report to the Committee no later than 180 days after
enactment of this Act on how it is incorporating early
detection diagnostics into veterans' care and areas for
potential improvement.

MEDICAL SERVICES

Fiscal year 2022 enacted level...................... $58,897,219,000
Fiscal year 2023 enacted level...................... 70,323,116,000
Fiscal year 2023 budget year request................ 261,000,000
Committee 2023 budget year recommendation........... 327,000,000

Fiscal year 2024 advance appropriation request...... 74,004,000,000
Committee 2024 advance appropriation recommendation. 74,004,000,000
Comparison with:
Fiscal year 2023 enacted level.................. +3,680,884,000
Fiscal year 2024 advance budget request......... - - -

The bill includes an additional $327,000,000 for Medical
Services in fiscal year 2023 as well as $74,004,000,000 for
advance fiscal year 2024 funding. The Committee has included
bill language to make $1,500,000,000 of the Medical Services
advance appropriation for fiscal year 2024 available through
September 30, 2025.
Of the funds provided for fiscal year 2023, $13,920,415,000
is for mental health, which is $1,500,000 above the budget
request; $2,685,392,000 is provided for homelessness
initiatives; $307,455,000 is for rural health; $911,119,000 is
for gender-specific care and programmatic efforts to deliver
care for women, which is $10,000,000 above the budget request;
$85,851,000 is for Whole Health initiatives, which is
$10,000,000 above the budget request; $498,098,000 is provided
for suicide prevention outreach efforts, which is $1,500,000
above the budget request; $662,805,000 is provided for opioid
prevention and treatment; and $183,287,000 is provided for
Substance Use Disorder programs, which is $2,000,000 above the
budget request.
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.
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 $13,920,415,000 in discretionary
funding for mental health programs. Of the amounts provided for
mental health programs in fiscal year 2023, $2,883,874,000 is
for suicide prevention and treatment programs. Specifically,
$498,098,000 is for suicide prevention outreach, which is
$1,500,000 above the budget request.
The Committee notes that in fiscal year 2023, the three-
year PREVENTS program, which was established by Executive Order
13861 to develop an interagency public health strategy to
address veteran suicide, will come to an end and its suicide
prevention treatment and outreach programs will be absorbed
into VA's ongoing suicide prevention programs. While this will
reduce duplication of efforts and enable more effective
programming, the Committee strongly believes that suicide
prevention must continue to be an area of investment for the
Department to make progress on this issue.
The Committee continues to direct the Department to focus
on efforts to address parking lot suicides and connect veterans
to care. 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.
The Department should continue to work to improve community
outreach and increase access to care regardless of discharge
status or service history. The Department should also continue
to engage with 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 and ensure that mental health needs are addressed
throughout the transition process.
Improving the Veterans Crisis Line (VCL).--The Committee
provides funding to support the VCL, as requested, and
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 maintains 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.
Peer Specialist Program.--The Committee is encouraged by
the success of VA's Peer Specialist program. By providing
connections to their peers, this program is ensuring veterans
can access mental health benefits and resources in a supportive
context. The Committee encourages VHA to explore opportunities
to add new peers to support the Substance Use Disorder programs
administered by the Office of Mental Health and Suicide
Prevention. The Committee also encourages the Peer Specialist
program to ensure community-based peer mentoring organizations
are activated to direct candidate veterans to the VHA's
program, and encourages eliminating barriers to participation.
Improving Depression Treatment with Precision Medicine.--
The Committee recognizes that depression is one of the most
common conditions associated with military service and combat
exposure. Further, the risk of suicide increases with this
diagnosis and each time a veteran tries and fails a medication.
The Committee is aware that VA-led studies focusing on
precision medicine tests to treat depression are nearing
completion and will be submitted for peer review and
publication. VHA is encouraged to ensure access to
pharmacogenomic tests in the treatment of depression if the
tests have been shown to improve health outcomes of veterans in
clinical trials.
Public-Private Partnerships.--The Committee continues to be
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 that the Department continue to
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, post-traumatic stress disorder (PTSD), traumatic
brain injury (TBI), and substance use disorders. Of the funds
provided for mental health programs in fiscal year 2023, up to
$5,000,000 is included for expansion of 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. The
Committee requests a report on VA's efforts to educate law
enforcement about the issues facing veterans, including mental
health needs, no later than 60 days after enactment of this
Act.
Non-Citizen Veteran Outreach.--The Committee is concerned
about the level of awareness regarding mental health services
among 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.
Reporting on Wait Times for Psychiatric Inpatient Care.--
The Committee notes its concern with reports of wait times
faced by veterans for inpatient emergency mental health
treatment programs. As VA prepares for implementation of
Section 201 of the COMPACT Act (P.L. 116-214), it is even more
critical to have a full understanding of limitations and
obstacles to veteran access to inpatient care. Within 180 days
of enactment of this Act, the Committee requests a report
outlining whether and how VHA tracks wait times for psychiatric
beds, how any such wait times have impacted health outcomes or
possible suicides, remediation efforts undertaken or
recommended to be taken, and any resource requirements needed
to meet such objectives. The report should include data from
the past five years on whether resource limitations, staff or
inpatient unit shortfalls, or wait-lists have kept veterans in
state-managed mental healthcare that wished to transfer to VA
care, as well as data on whether VA's lack of facilities able
to handle veterans with coincident mental and medical
conditions and a broader lack of psychiatric care beds has
limited access to care for veterans.
Military Sexual Assault.--The Committee continues to be
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, substance use
disorders, 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.
Cancer and Mental Health Screening at Veterans Affairs
Medical Centers.--The Department is encouraged to ensure its
healthcare providers screen for the numerous types of cancers
and mental health issues that veterans experience so they can
receive the best possible care.
National Center for Post-Traumatic Stress Disorder.--
Recognizing the importance of VA's National Center for PTSD in
promoting better prevention, diagnoses and treatment of PTSD,
the Committee provides $45,000,000 for the Center, which is
$5,000,000 above the budget request.
The Committee remains concerned that, consistent with
findings from the Center, some groups of veterans, including
African Americans and Latinos, are more likely to develop PTSD,
and less likely to see improvement from treatment. As such, the
Secretary is directed to report to the Committee on
Appropriations no later than 90 days after enactment of this
Act on efforts to implement recommendations made by the Office
of Health Equity at VHA to improve outcomes for African
American and Latino veterans with PTSD, as well as improving
the collection, use and dissemination of data disaggregated by
race and ethnicity.
The Committee also continues to encourage the Center to
explore academic and interagency collaborations that
investigate novel and multifactor approaches, such as dietary
interventions and non-invasive brain stimulations, and
investigational trials to test and develop new methods to treat
PTSD, including neuromodulation, family-inclusive therapies,
and alternative treatments, such as those recommended by the
Creating Options for Veterans' Expedited Recovery (COVER)
Commission.
Post-Traumatic Growth Programs.--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 encourages the Department
to continue to collaborate, partner with and support non-profit
post-traumatic growth organizations and programs.
Post-Traumatic Stress Disorder 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 Committee is
encouraged that a pilot program created by the PAWS Act of 2021
(P.L. 117-37) is underway at five VA medical centers, which
will assess the potential therapeutic effectiveness of service
dogs in the treatment of PTSD, and urges VA to ensure it is
properly resourced to achieve the best possible outcomes. The
Committee directs VA to provide a report on the status of this
program within 120 days of enactment of this Act, including the
status of agreements with participating canine training
organizations and whether the Department has identified any
barriers to participation of these entities.
Hyperbaric Oxygen Therapy.--The Committee encourages the
Department to provide hyperbaric oxygen treatment to veterans
suffering from chronic post-traumatic stress disorder, as
appropriate.
Modeling and Simulation Treatment of PTSD.--As a mechanism
to explore treatments for PTSD, the Committee is aware that the
use of modeling and simulation technology has enabled the
development of innovative and immersive therapies, which can
extend trauma management therapy protocol. The Committee
encourages VA to continue its Trauma Management Therapy study
that explores exposure therapy involving virtual reality in
combination with group therapy for the treatment of individuals
with symptoms relating to PTSD, and requests a report at the
conclusion of the study.
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.
Cognitive Behavioral Therapy Virtual Care.--The Committee
understands that wounded, ill, and injured veterans and their
families face complicated and complex challenges, which at
times can lead to attempts at self-medication, other substance
use disorders, and general struggles with mental health, which
have been exacerbated by the COVID-19 pandemic. The Committee
recognizes the evidence that more veterans will require greater
access to mental healthcare and that the demand for accessible
and virtual care is likely to increase concurrently. As such,
the Committee recognizes the promise of commercially available,
virtual programs with therapist-guided cognitive behavioral
therapy that can support the VA in delivering timely and
quality care to veterans. To meet the growing demand for
telehealth or virtual mental healthcare, the Committee
encourages VA to provide veterans access to virtual cognitive
behavioral therapy, including ensuring that options are
available over low broadband. The Committee directs VA to
provide the Committees on Appropriations of both Houses of
Congress a report, not later than 90 days after enactment of
this Act, on the status of efforts to utilize solutions and
partners in the delivery of mental health services virtually
and how to make these solutions more accessible to patients.
Vet Centers.--The Committee recognizes the importance of
Vet Centers and the role they play in helping veterans readjust
to civilian life. The Committee provides funding for VA's
Readjustment Counseling Service programs and 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.

SUICIDE PREVENTION OUTREACH

Suicide Prevention Coordinators.--The Committee recognizes
the importance of Suicide Prevention Coordinators, who follow
up with and coordinate care for veterans who have been directly
referred to them by responders at the Veterans Crisis Line.
Given that VA anticipates an increased volume of calls as the
crisis line transitions to a three-digit number, the Committee
directs VA to ensure that it maintains adequate staffing levels
of Suicide Prevention Coordinators to respond to this increase
and provides an additional $1,500,000 above the budget request
to help support staffing of Suicide Prevention Coordinators.
The Committee further directs VA to submit a report within 60
days of the transition to the three-digit number, and quarterly
thereafter, on the volume of calls received by the crisis line
and a comparison to the prior year; the number of callers
referred to Suicide Prevention Coordinators; the metrics that
VA is using to measure and ensure adequate staff response by
both crisis line staff and Suicide Prevention Coordinators; and
recommendations, including cost estimates, of any needed
adjustments to staffing levels.
VetsCorps.--The Committee continues to strongly support the
VetsCorps pilot program and urges that it be fully implemented
without further delay. Although VA has other outreach programs,
a key and unique aspect of VetsCorps is that veterans
themselves, working with VA, proactively seek out and connect
with veterans in their communities who have not been served by
the Department, in order to help connect them with available
programs and services. VA should track veterans brought into
the system through this outreach. The Committee continues to
direct the Department to provide quarterly reports on the
status of the implementation of the VetsCorps 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.
Governor's and Mayor's Challenges to Prevent Suicide Among
Service Members, Veterans, and their Families.--The Committee
applauds the work of the Governor's and Mayor's Challenges to
Prevent Suicide Among Service Members, Veterans, and their
Families, and the bill includes sufficient funding to support
the Department's efforts to extend this program to additional
States. The Committee urges VA to continue to engage with
participating states on technical assistance around
implementation of action plans, and to provide resources to
states to assist with efforts to improve data collection to
better inform suicide prevention activities.
Zero Suicide Initiative.--The Committee recognizes the
value of innovative, systems-focused efforts to combat veteran
suicide across the country and notes the use of the Zero
Suicide model across various healthcare systems and through the
Department of Health and Human Services. The Committee
encourages VA to evaluate, in consultation with experts and
VSOs, the feasibility and effectiveness of implementing a Zero
Suicide initiative that provides training and support to VA
employees, in order to reduce the rate of veteran suicide.
Suicide Risk Assessment and Training.--The Committee
recognizes the ongoing need to support the success of the
Clinical Resource Hub at the Office of Rural Health. This
program is an innovative model that delivers high-quality
healthcare services to veterans in underserved locations. The
Committee also recognizes the high risk of suicide among
veterans and the need to train additional behavioral and mental
health providers to assist veterans living in both rural and
urban communities. The Committee directs VA to expand ways for
urban and rural academic institutions with expertise in suicide
risk assessment and training, particularly minority-serving
institutions, to engage with Clinical Resource Hubs to share
best practices on meeting the needs of all veterans, as well as
on combining telehealth services with in-person care to train
providers and provide care to veterans in rural communities.
Collaboration on Lethal Means Safety.--The Committee
welcomes the Administration's new national strategy, ``Reducing
Military and Veteran Suicide: Advancing a Comprehensive, Cross-
Sector, Evidence-Informed Approach'', and commends the
Strategy's focus on improving Lethal Means Safety education and
training for veterans, including firearms safety. The Committee
notes that the Strategy called for VA to partner with the
Departments of Defense, Health and Human Services, Homeland
Security, Justice, and the Office of Emergency Medical Services
within the Department of Transportation to create and implement
a coordinated approach for improving lethal means safety. The
Committee requests a report within 180 days of enactment of
this Act on the development of this coordinated approach and
VA's plans to incorporate the coordinated approach into the
Department's existing lethal means safety initiatives.
The Committee continues to support 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. The
Committee additionally supports VA's investment in
demonstration projects to support innovative and promising
practices to address suicide, in particular VA's project to
evaluate a novel firearm safety storage and mental health
crisis planning intervention, which will engage veterans and
their families in conversations about safe firearm storage,
identifying warning signs for mental health symptoms or suicide
risk, and how to create a collaborative safe storage plan.
The Committee is pleased that VA has implemented mandatory
lethal means safety trainings for clinical healthcare providers
in VHA facilities. To ensure that every employee who regularly
interacts with veterans is prepared to have a conversation that
could save a veteran's life, the Committee continues to urge VA
to implement mandatory lethal means safety trainings for all
VHA and VBA employees who regularly interact with veterans in
their work, compensation and pension examiners, employees of
Veterans Centers and vocational rehabilitation facilities,
community care providers, and family caregivers to the extent
practicable.
Suicide Prevention Technology.--The Committee recognizes
the importance of consistent and timely follow-up care for
veterans identified as at high risk for suicide. Although VA
has been an innovator in implementing an enterprise-wide
suicide screening initiative, monitoring and management of
veterans identified as at-risk falls on the responsibility of
already overworked suicide prevention coordinators and case
managers, as documented in an April 2021 Government
Accountability Office (GAO) report (21-326: Efforts Needed to
Ensure Effective Use and Appropriate Staffing of Suicide
Prevention Teams). To help address this challenge, VA medical
centers need the latest real-time technologies that complement
the existing retrospective reporting tools from the VA Central
Office. Suicide prevention coordinators need real-time case
monitoring and management tools that improve situational
awareness, patient safety, and compliance with VA Risk ID
policies. The Committee encourages VA to provide integrated,
real-time data, interactive push notifications, data
visualization tools and VA suicide prevention performance
measure analytics. The Committee directs the Department to
provide a report, no more than 180 days after enactment of this
Act, on the benefits of an enterprise-wide, real-time, and
interactive technology to support suicide prevention
coordinators. The report must include: (1) a list of facilities
currently using this type of technology and the outcomes that
have been seen, (2) the Department's plans to deploy this type
of technology across all VA medical facilities, and (3) total
program cost and schedule to implement an enterprise-wide
solution.

HOMELESS ASSISTANCE

The Committee provides $2,685,392,000 for VA homeless
assistance programs, an increase of $530,942,000 above the
comparable fiscal year 2022 enacted level and fully funding the
President's budget request. An estimated $9,145,900,000 is
provided for homeless veterans treatment costs, an increase of
$294,400,000 above the comparable fiscal year 2022 enacted
level.
Programs to assist homeless veterans include the Homeless
Providers Grant and Per Diem (GPD), Health Care for Homeless
Veterans (HCHV), the Domiciliary Care for Homeless Veterans,
the Supportive Services for Low Income Veterans and Families
(SSVF), Veterans Justice Outreach Homeless Prevention (VJO),
Compensated Work Therapy, 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 notes the
benefits of the Healthcare for Homeless Veterans Program H-PACT
program, and encourages VA to expand this program to additional
sites, including rural areas, and to consider additional
services to improve the program. The Committee directs the
Department to include a plan to expand this program to
additional sites, including cost estimates, with its fiscal
year 2024 budget request.
Ending Veteran Homelessness.--The Committee recognizes the
value and impact of the HUD-VASH program, which serves veterans
experiencing homelessness and pairs each HUD affordable housing
voucher earmarked for veterans with intensive case management
from VA to assist with benefits and income, mental healthcare,
recovery services, and permanent housing stability. 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 and to account for increased
costs in staffing and recent expansions in eligibility.
Tiny Homes.--The Committee notes the Department has made
great efforts to find suitable housing for homeless veterans
and their families, and strongly encourages the Department to
continue its efforts to implement more non-traditional efforts,
such as ``Micro'' or ``Tiny Homes'' or renovated shipping
containers, to eliminate the problem of suitable housing for
homeless veterans and their families. The Committee directs VA
to allocate $8,000,000 to fund a pilot program to build
villages of tiny homes for homeless veterans, with preference
given to grant recipients who use energy efficient building
materials. Of the funds provided, the Committee recommends
$2,000,000 to be used for continuing operations and maintenance
costs of these tiny home villages.
Legal Assistance for Veterans.--The Committee notes that
the Department has begun implementing the Legal Services for
Veterans Grant Program, which builds upon existing services
offered to veterans through partnerships with legal service
providers. The Department is encouraged to expeditiously
finalize the rule and fully implement this program.
Furthermore, the Committee continues to encourage 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, and to establish one or more
pilot projects to partner SSVF grantees with university law
schools in rural areas or within underserved populations to
enhance legal assistance to veterans. This can result in
additional benefits such as training law students in veteran
disability law and legal skills critical to providing advocacy
within the VA system, as well as inspiring next-generation
lawyers to serve veterans in practice.
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 continues to direct 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. The Committee requests an updated report within
60 days of enactment of this Act on its efforts to serve
homeless veterans on the border.
Supportive Housing for Veterans with Serious Mental
Illness.--The Committee applauds the HUD-VASH program for
providing housing opportunities for veterans experiencing
homelessness and commends their success in decreasing the rate
of homeless veterans by nearly 50 percent since 2010. The
Committee understands not all veterans in need fit the
traditional definition of homeless and that veterans
experiencing serious mental illness also experience
difficulties acquiring housing, whether due to a co-occurring
substance use disorder or conditions related to their service,
including PTSD and TBI. Thus, the Committee encourages VA to
build upon the tangible achievements of the HUD-VASH program
and explore whether a new model of vouchers could provide
housing opportunities for low-income veterans experiencing
serious mental illness who seek healthcare services from VA.

STAFFING ISSUES

Staffing Shortages.--The Committee has long recognized 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 the nation's
veterans. The Committee looks forward to the annual
comprehensive report required by the Joint Explanatory
Statement accompanying the Consolidated Appropriations Act,
2022 (P.L. 117-103) on the Department's plan to address
critical workforce issues.
VA/HHS Collaboration on Health Workforce Shortages.--The
Committee continues to encourage VA to work with HHS to explore
ways the agencies can work together, such as by creating a
taskforce, to increase the availability of providers, including
in the behavioral health workforce and among physicians
specializing in cancer, spinal cord, and neuropsychiatric
conditions. This collaboration is urged to examine VA's
recruitment challenges, review programs that could enhance
recruitment and retention, and to think creatively on how other
Federal agencies like HHS can identify and address provider
shortages. VA is also encouraged to consult with DOD to explore
recruiting those who have left the military.
Enhancing Recruitment.--The Committee recognizes the
challenge VA has in the recruitment and retention of
clinicians. To help VA better keep pace with other providers
and continue to train its workforce to improve their service to
veterans, the Committee urges VA to explore potential options
to enhance recruitment and retention, such as expanding
reimbursement to clinicians for Continuing Professional
Education.
Physical Therapists.--The Committee encourages VA to ensure
pain treatment alternatives to opioids, such as physical
therapy, are available to veterans where they are most needed.
As part of these efforts, the Committee encourages VA to
examine how more competitive pay for physical therapists and
physical therapist assistants can help hire and retain these
professionals. The Committee further encourages VA to explore
how the Health Professional Scholarship Program can be expanded
to include physical therapists, and to develop a staffing plan
on how to utilize physical therapists and physical therapist
assistants within Primary Care, Rural Health, Women's Health,
and other areas of the Department.

ACCESS FOR RURAL VETERANS

Office of Rural Health (ORH).--The bill includes
$307,455,000 for rural health, which is equal to the budget
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. 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.
Office of Rural Health 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 2023 funding, as well as for the fiscal
year 2024 funding provided in advance by this Act.
Transportation Challenges.--The Committee recognizes the
transportation challenges and barriers to care that rural and
remote veterans face, and that the veteran population is
disproportionately both rural and mobility challenged when
compared to the public at large. The Committee directs the
Office of Rural Health to increase efforts to improve
transportation mobility for veterans and to allocate funding to
enhance rural access and transportation services, and continues
to encourage VA to consider utilizing accessible autonomous
electric vehicles to overcome these challenges. The Committee
appreciates VA's progress in beginning to study veterans'
experiences using autonomous transportation, and requests VA
report to the Committee no later than 90 days after enactment
of this Act with a plan for additional expected studies and
detail on the benchmarks and metrics that VA will use to
determine feasibility of this technology.
Rural Transportation Study.--In fiscal year 2021, the
Committee provided funding, as requested, for the Office of
Rural Health's rural transportation study by the Veterans Rural
Health Resource Center, Iowa City. The Committee directs the
Office of Rural Health to expeditiously conclude the study and
provide a report to the Committee so that it can assess whether
there are gaps in the Department's comprehensive rural
transportation program, how they should be closed, and if
additional funding is needed.
Rural Veteran Transportation.--The Committee acknowledges
continued progress in addressing transportation barriers for
veterans, especially those in areas that have limited
transportation services, including 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 many VA service areas,
especially predominantly exurban and rural ones. The Committee
notes that as new forms of mobility are being developed and
becoming increasingly available, options like on-demand shared
ride microtransit may help improve accessibility for veterans,
and encourages the Veterans Transportation Program to explore
increased adoption of this transit model and study the use of
software technology to enable this transportation option.
Clinical Resource Hub.--The Committee supports the success
of the Clinical Resource Hub at the Office of Rural Health.
This program is an innovative model that delivers high-quality
healthcare 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 Committee also recognizes the impact that
expanded access to telehealth services has had on rural
veterans that live beyond the reach of critical care services.
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.
Rural Access Network for Growth Enhancement (RANGE).--The
RANGE Program provides case management and treatment services
to mentally ill veterans in rural areas. These centers are
essential for providing care to veterans who have served
honorably and are now in crisis and need serious mental
healthcare resources. No veteran should be turned away from
receiving mental healthcare services due to a lack of access
and availability of appointments. The Committee provides
$1,200,000 to establish and maintain three new centers of the
RANGE Program, as authorized by the Sgt. Ketchum Rural Veterans
Mental Health Act of 2021 (P.L. 117-21).

TELEHEALTH AND CONNECTED CARE

The bill includes $5,174,818,000 for telehealth and
connected care, which includes home telehealth, home telehealth
prosthetics, and clinic-based telehealth.
Telehealth Improvements.--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. The
Committee particularly recognizes and appreciates the
significant improvements made in Telehealth Service by VA in
the past two years. These timely improvements were critical in
meeting the healthcare needs of veterans during the COVID-19
pandemic. As the pandemic travel restrictions are relaxed, the
Committee urges the Department to evaluate current telehealth
services to improve and inform a normalized, sustainable
Telehealth Service model and to focus on easing the burdens of
rural veterans with limited travel options. Additionally, VA is
encouraged to leverage newly gained telehealth capacity to
address backlogs for disability exams and healthcare
appointments when appropriate. The Committee further directs VA
to continue to implement plans to improve veteran and provider
satisfaction, increase awareness of the telehealth program, and
enhance adoption of telehealth by veterans and providers. The
Department's plans should include efforts to make telehealth
more accessible to patients in highly rural areas. The
Committee requests a report on these efforts within 90 days of
enactment of this Act.

GENDER-SPECIFIC CARE FOR WOMEN

Women are now the fastest growing cohort within the veteran
community. The number of women veterans using VHA services has
more than tripled in the last two decades, growing from 159,810
in 2001 to over 600,000 today. The increased number of women
using VHA services necessitates a greater investment of
resources in order to provide and expand VA's gender-specific
services to women veterans and ensure women veterans' health
needs, which often differ from men, are met. The bill provides
$911,119,000 for gender-specific care and programmatic efforts
to deliver care for women, which is $70,673,000 above the
fiscal year 2022 enacted level and $10,000,000 above the budget
request. This includes funding to support the Office of Women's
Health at VHA and its efforts to expand programs and strategic
planning for women veterans. The Committee supports continued
efforts to identify and address the unique issues experienced
by women veterans. VA is directed to continue redesigning its
women's healthcare delivery system and improving its facilities
to ensure women receive equitable, timely, and high-quality
healthcare.
VA is directed to provide an expenditure plan no later than
90 days after enactment of this Act, detailing how the funding
for gender-specific care and for programmatic support will be
spent. Furthermore, the Committee requires quarterly briefings
on the expenditure of these funds. The Committee continues to
direct 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.
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.
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 to ensure that these
resources are being properly used at these levels. As such, 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 Committee remains strongly supportive of efforts by the
Department to train and hire Women's Health Primary Care
Providers (WH-PCPs) and notes that women veterans are twice as
likely to choose to stay in VA care over time if they are
assigned a WH-PCP. The Committee appreciates that to reinforce
advancements in hiring and purchasing equipment specific for
women's healthcare, VA launched the Women's Health Innovations
and Staffing Enhancements Initiative, and therefore directs VA
to ensure that sufficient resources are made available to hire
and train WH-PCPs, Women's Health Patient Aligned Care Team
staff, and other essential women's health personnel.
Peer Support for Women Veterans.--Peer support programs
offered at VA have proven effective in improving health
outcomes, and they continue providing vital support to veterans
across the nation. The Committee appreciates VA's continued
investments in hiring additional women peer specialists and in
enhancing peer support services for women veterans, such as
through developing peer support trainings and clinical
resources. The Committee provides increased funding above
current levels for VA to hire additional women peer specialists
at all VA medical centers and notes that VA plans to conduct a
staffing assessment to identify further peer specialist hiring
needs. In addition to this funding, the Committee directs VA to
provide no less than $1,300,000 to implement women-specific
peer support interventions like Women Veterans Network (WoVeN),
a national peer support network for women veterans run by
researchers from the National Center for PTSD--Women's Health
Sciences Division. The research component of this peer support
program will drive innovation in addressing PTSD in women
veterans.
Maternity Healthcare and Coordination Programs.--The
Committee notes that the United States has the highest maternal
mortality rate among high-income countries and significant
racial and ethnic disparities in maternal health outcomes. Some
of the causes of adverse maternal health outcomes can be even
more prevalent in veterans, such as military sexual trauma,
which is linked with risk factors for pregnancy-related
complications. The Committee is pleased that to coordinate
prenatal and postpartum care provided in the community, VA has
established maternity healthcare and coordination programs,
which have been successful in ensuring that veterans can
receive high-quality, culturally appropriate care and robust
support during and after pregnancy. The Committee supports
these maternity healthcare and coordination programs and
encourages VA to continue to ensure veterans have access to
high-quality, well-coordinated care and robust services to
address social determinants of maternal health, including
access to housing, nutrition, and transportation. The Committee
directs VA to continue to implement and fully resource the
Protecting Moms Who Served Act (P.L. 117-69).
Access to Maternity Care.--The Committee notes that studies
have demonstrated that maternity care provided by midwives in
birth centers is high value care that significantly improves
outcomes for mothers and newborns, while resulting in
significant cost savings for every mother-baby pair during the
first year of life. The Committee is aware that VA is working
to improve interoperability of health records and
communications between community providers in the VA Community
Care Network and VA facilities in order to improve access and
quality of care for women veterans, and directs VA to ensure
in-network birth centers and their collaborating physician
practices are included in efforts to improve interoperability
of electronic health information between facilities and levels
of care. The Committee further directs VA to reduce barriers to
care, including those relating to obtaining community
referrals, for women veterans seeking maternity care at birth
centers and other community care providers. The Committee
requests a report on the progress to achieve these goals no
later than 180 days after enactment of this Act.
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.

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 remains interested in information regarding VA drug
pricing and appreciates VA providing a report as requested in
previous fiscal years on VA's spending on prescription drugs.
The Committee encourages VA to conduct this analysis annually
and requests robust and routine updates to Congress, including
updated information for fiscal year 2023 on 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. As VA has noted that country of
origin information on drugs and active pharmaceutical
ingredients is not yet available on a national level, the
Committee urges the VA's National Acquisition Center to work
with the Food and Drug Administration to track this data and
establish a national database for such information.
At-Home Drug Disposal for Veterans.--The Committee is aware
that many unused and unwanted prescription opioids and other
powerful medications remain in homes and are subject to
diversion. This is too often the beginning of a pathway to
dependence, addiction, and overdose. The Committee is pleased
that in response to the directions in House Report 116-445 and
House Report 117-81, VA has begun a pilot program to evaluate
the benefits of co-dispensing at-home drug disposal products
for post-surgical patients. The Committee directs VA to
continue to invest in this pilot program and appreciates that
VA has expanded this pilot to additional sites. Further, the
Committee encourages VA to include patients in this
demonstration from a variety of geographic locations and VA
medical facility types, as well as patients who are prescribed
opioids for chronic pain management or other long-term use. No
later than 60 days upon conclusion of the pilot, VA is directed
to submit a report on the results of this program and a
detailed plan, including cost estimates, of how this program
could be expanded throughout VA.
Safe Medicine.--The Committee recognizes that the nation's
increased reliance on foreign-based sources of medicine and
active pharmaceutical ingredients may present a health security
risk to VA as they provide medicine for veterans. The Committee
continues to encourage VA to examine potential vulnerabilities
and safety risks VA faces purchasing medicine from off-shore
sources, including supply chain and dependency issues, and
encourages VA to address strategies to buy American and produce
medicine domestically.
Pharmaceutical On-dose Tracking and Tracing Technologies.--
Track and trace systems are increasingly being implemented as a
technological solution to secure pharmaceutical supply chains.
These systems offer the potential to minimize reimbursement
fraud, facilitate fast market recalls, and help identify
medicine shortages. Therefore, the Committee directs VA to
submit a report within 180 days of the enactment of this Act on
the Department's efforts, including technologies being used, to
secure the VA pharmaceutical supply chain, reduce illegal
distribution of opioid products within VA, and eliminate the
distribution of counterfeit pharmaceutical products within VA.
Pharmaceutical Catalog.--The Committee notes the Federal
government's investments in a competitive process to develop
domestically produced radiopharmaceuticals. To reflect the on-
shoring of manufacturing, the Committee encourages VA to strive
to procure, if feasible, 20 percent in fiscal year 2023 (and 35
percent in fiscal year 2024) of their molybdenum-99 and its
daughter, technetium-99m from domestic producers of sustainable
medical radioisotopes. The Committee requests a report from VA
on the availability of domestic sources of sustainable medical
radioisotopes available to them for procurement in fiscal year
2023.

OPIOID SAFETY INITIATIVES AND SUBSTANCE USE DISORDER CARE

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 encourages VA to continue the challenging effort to
reduce opioid use among veterans, half of whom suffer from
chronic pain. The bill includes $662,805,000 for opioid
treatment and prevention efforts, which is $41,471,000 above
fiscal year 2022, and of which $245,754,000 is provided for
activities authorized by the Comprehensive Addiction and
Recovery Act of 2016 (P.L. 114-198). With veteran opioid
addiction numbers outpacing those for the rest of the U.S.
population, and the full effects of the coronavirus global
pandemic on veteran opioid addiction still unknown, this
funding will allow VA to reach more veterans in need of
assistance with their opioid addiction and lessen the numbers
who fall victim to COVID-19.
The bill also includes $183,287,000 for Substance Use
Disorder (SUD) efforts, an increase of $2,000,000 over the
budget request, to ensure veterans can receive timely SUD
specialty services. The Committee is concerned with challenges
veterans face in accessing treatment, including wait times for
inpatient admission, and directs the Department to continue to
increase investment in this program to reduce delays and ensure
adequate bed availability and staffing.
Jason Simcakoski Memorial and PROMISE Act Implementation.--
The Committee supports robust funding to facilitate 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.
Behavioral Health and Substance Use Screening.--The
Committee continues to be 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 Use Disorder Programs.--The Committee recognizes
the ongoing work of VA to reduce substance use disorder among
veterans. 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 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 and counseling, as clinically indicated.
Additionally, 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
continues to direct VA to establish an internet-based substance
abuse education program to expand its efforts related to SUD
education and outreach. The Committee directs the Department to
report to the Committees on Appropriations of both Houses of
Congress within 60 days of enactment of this Act on the efforts
made in establishing this program.

WHOLE HEALTH INITIATIVE

Traditionally, 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 $85,851,000 in the
bill, which is $10,000,000 above the request and $2,251,000
above the fiscal year 2022 enacted level, to continue to
implement and expand Whole Health to all VA facilities.
Continued Support and Expansion for Whole Health.--The
Committee notes that data shows participation in the Whole
Health system of care resulted in a 24 percent drop in total
healthcare costs among the participating veterans.
Additionally, a recent survey found that 97 percent of veterans
are interested in using Whole Health. The Committee is pleased
by this evidence that points to the ability of the Whole Health
System to deliver care efficiently and effectively to the
nation's veterans, and urges VA to continue supporting the
program and to expand it further in fiscal year 2023. The
Committee further directs VA to report to the Committee within
60 days of enactment of this Act with the details, timeline,
and expected year by year costs of its plan to expand the Whole
Health system to all VA facilities.
Creative Arts Therapies.--The Committee continues to
acknowledge the effective use of creative arts therapies and
arts and humanities partnerships in treating veterans with
traumatic brain injuries and psychological health conditions.
The Committee supports the ongoing 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, particularly in
areas that are serving rural, isolated or underserved veteran
populations, and includes $5,000,000 to do so.
Health and Wellness Through Digital and At-Home Fitness.--
The Committee continues to believe the health and well-being of
veterans and their families is important to maintain.
Furthermore, the Committee is aware of the ways in which new
technologies, including digital and at-home fitness
applications, can further improve and personalize exercising
experiences for best results. The Committee encourages VA to
make all available efforts to ensure veterans and their
families can benefit from digital and at-home fitness programs
in its quality-of-life programming. As such, the Committee
requests a report within 180 days of enactment of this Act
identifying the potential benefits of digital and at-home
fitness to promote force readiness, mental health, suicide
prevention, and rehabilitation from injury.

CAREGIVERS PROGRAM

Caregivers Program.--The caregivers program provides an
unprecedented level of benefits to families with veterans
seriously injured in the line of duty. 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 level of
$1,846,210,000 for the caregivers program. The Committee also
continues the requirement on quarterly reporting on obligations
for the caregivers program.
Caregiver Support Program.--The Committee strongly
encourages VA to ensure parity in the Program of Comprehensive
Assistance for Family Caregivers and the Program of General
Caregiver Support Services for all eligible veterans and their
families by ensuring at least one VA Caregiver Support
Coordinator is responsible for each state or U.S. territory
that does not currently have a VA Caregiver Support Coordinator
located within its jurisdiction, such as the Commonwealth of
the Northern Mariana Islands, within 180 days of enactment of
this Act. 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 Caregiver Support Coordinator is
available to provide services, including enrollment assistance,
to them and their families. Furthermore, no later than 180 days
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 enrollment, services, and outreach
relating to the caregiver program conducted by VA in such
areas, an evaluation of such activities, and an assessment of
the need to provide additional resources and VA caregiver
support staff in such areas, which should include input from
veterans residing in these areas.

OTHER HEALTH ISSUES

Neurology Centers of Excellence.--The Committee recognizes
the increasing number of veterans affected by neurologic
conditions, including but not limited to epilepsy, headache,
multiple sclerosis, and Parkinson's disease. The Neurology
Centers of Excellence provide essential and innovative clinical
care, education, and research efforts focused on these
conditions, and the Department is directed to continue to
increase its investment to maintain and expand these centers to
enhance their ability to serve veterans. The Committee
appreciates VA's acknowledgment of the additional need for
equitable access to headache care, specialists, and clinical
research through the Headache Centers of Excellence (HCoE)
system, and provides $5,000,000 to begin expansion of the
system as described in the report referenced in the Joint
Explanatory Statement accompanying the Consolidated
Appropriations Act, 2022 (P.L. 117-103). The Department is
directed to submit a report on the use of these funds, as well
as a funding plan for further expansion, within 90 days of
enactment of this Act. The Committee also notes that similar
expansion of the Parkinson's Disease Research Education and
Clinical Centers (PADRECCs) may help to increase access to high
quality neurology care, and directs VA to provide a report
within 120 days of enactment of this Act on the feasibility,
advisability, and cost estimates to expand PADRECCs to
additional sites and fund increased staff at each site.
Epilepsy Centers of Excellence.--The bill includes
$19,086,000 toward maintaining and expanding the Epilepsy
Centers of Excellence within VA.
Central Alabama Veterans Health Care System (CAVHCS).--The
Committee reminds the Department of the urgent need to improve
the management of CAVHCS and directs that the Department
thoroughly and expeditiously implement plans to promote a safe
culture and enhance care to veterans, fill permanent leadership
vacancies, hire for all levels of permanent staffing, and
provide incentives and bonuses. The Committee requests a status
update of the plans within 60 days of enactment of this Act.
Nuclear Medicine Quality Improvements.--The Committee is
aware of the consequence of extravasations in nuclear medicine
procedures, and understands that the Nuclear Regulatory
Commission and Centers for Medicare and Medicaid Services are
considering regulatory actions to improve nuclear medicine
injection quality. The Committee continues to encourage VA to
monitor injection quality, as well as image extravasations,
perform dosimetry and notify patients when they occur, and
urges the Department to adopt any new regulatory requirements.
Hospital-Acquired Pressure Ulcers and Pressure Injuries.--
The Committee reiterates that VA is urged to update VHA
Directive 1352 based on the 2019 International Guidelines for
the Prevention and Treatment of Pressure Injuries as VA's
standard of care, and appreciates that VA has begun to evaluate
and update the directive. The Committee requests that VHA
expedite the update of the directive, which should include the
Standardized Pressure Injury Prevention Protocol (SPIPP)
Checklist. Furthermore, the Committee requests the fiscal year
2024 budget request include a detailed timeline with steps
accomplished and planned to full adoption.
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. The Committee expects the Department to work
with the Centers for Disease Control to implement the Food
Service Guidelines for Federal Facilities, and encourages the
Department to expand its plant-based menu options, including
offering vegetarian and vegan meal options at every facility.
Produce Prescription Programs.--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 healthcare utilization. The
Committee is further 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 understands that VA has demonstrated
interest in supporting efforts to provide produce prescriptions
to veterans in partnership with community-based organizations
and/or government entities with demonstrated experience and
expertise, and provides up to $2,000,000 for VA to continue to
provide guidance and resources for VA facilities to develop
local programs and pursue strategies for patient education and
outreach.
Expanded Access to Noninstitutional Long Term and Extended
Care.--The Committee recognizes that veterans prefer to receive
long-term and extended care services in their local
communities. The Committee continues to encourage VA to
increase the number of Veterans Care Agreements executed at VA
Medical Centers located within the geographic service areas of
Programs of All-Inclusive Care (PACE). These collaborations
will enable veterans to experience improved quality of life,
heightened independence, and increased support for their family
caregivers, while reducing costs by preventing or delaying
nursing home placement. For these reasons, the Committee also
urges the Department to ascertain if its eligibility criteria
for PACE should be expanded to facilitate serving more veterans
with this proven model of care.
Medical School Affiliations.--The Committee continues to be
pleased with VA's implementation of its collaborative
agreements with academically affiliated minority medical
schools. The Committee encourages VHA and the Office of
Academic Affiliations to further align academic partnerships
with training opportunities and patient needs of veterans in
surrounding communities.
Academic Collaborations at Community-Based Outpatient
Clinics.--The Committee encourages VA to expand academic
collaborations with CBOCs. CBOCs provide valuable patient care
and access to services that can be strengthened by
collaboration with educational institutions. Through clinical
traineeships and research fellowships, emerging health
professionals can gain a better understanding of veterans'
specific healthcare needs, improve patient outcomes, advance
specialized research, and increase the talented workforce
pipeline. VA should look to include wholly public academic
medical centers in CBOC collaborations.
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 that 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. In addition, the Committee looks forward to
receiving the report referenced in the Joint Explanatory
Statement accompanying the Consolidated Appropriations Act,
2022 (P.L. 117-103) that will evaluate the feasibility of a
value-based care model.
Reducing Airborne Infections.--The Committee recognizes
that airborne bacteria and viruses remain a significant source
of healthcare-associated infections at healthcare facilities.
Although High Efficiency Particulate Air (HEPA) filters are
widely used to filter the air, airborne transmission still
accounts for a significant portion of healthcare-associated
infections. The Committee appreciates that VA has undertaken a
review of its air filtration standards as a result of the
coronavirus pandemic, which has increased the urgency of
addressing airborne contaminants. The Committee continues to
encourage VA to review and adopt new commercial, off-the-shelf
technology with the potential to capture and destroy airborne
contaminants to ensure that facilities are not using outdated
technology and putting veterans at risk. Not later than 90 days
after enactment of this Act, the Committee directs the
Secretary to submit a report to the Committees on
Appropriations of both Houses of Congress on how the Department
evaluates and incorporates new technology in its air filtration
procedures.
Creutzfeldt-Jakob Disease Monitoring.--The Committee is
committed to understanding the residual impacts of Creutzfeldt-
Jakob Disease (CJD) within the veteran community, particularly
among those who are barred from donating blood due to their
potential exposure during their military service to beef that
was infected with bovine spongiform encephalopathy. The
Committee continues to urge 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.
Molecular Diagnostics and Precision Oncology.--The
Committee believes that every veteran with cancer deserves the
highest quality and most medically advanced diagnosis and
treatment available. Molecular diagnostics and precision
oncology, performed at the first occurrence of cancer, can
provide vital information regarding the specific tumor type and
its drivers, which can lead to the most accurate precision
medicine for patients. The Committee commends the Department's
Precision Oncology Program and supports the budget's requested
increase of $67,000,000 over fiscal year 2022 to expand
precision oncology clinical services, including molecular
diagnostics. The Committee includes up to $15,000,000 to
accelerate the adoption of molecular diagnostics for additional
cancers, including rare cancers and hematopoietic cancers. VA
is further encouraged to continue to provide information to
clinicians on the value of using molecular diagnostics to
cancer patients and on how to contribute tissue specimens to a
repository started among the Department, Department of Defense
and the National Institute of Health. The Committee further
directs the Department to issue an updated report no later than
60 days after the enactment of this Act describing how these
funds will be used to enhance the use of molecular diagnostics,
including information on the use of specific types of molecular
diagnostics, such as microarray, whole exome, whole genome, and
RNA-Seq.
Oral Contraceptives.--Given the potential advantages for
patients in receiving a full year's supply of hormonal
contraceptive products at once that are for regular use, the
Committee continues to urge the Department to encourage
prescribers to proactively offer patients the option to receive
a full year's supply and to ensure patients are notified of
that option. The Committee is aware that VA is currently
evaluating the results of a demonstration project for potential
enterprise-wide implementation, and requests a report with the
findings of this demonstration within 30 days of the conclusion
of the evaluation.
Intimate Partner Violence Program.--The Committee continues
to support VA's efforts to expand its Intimate Partner Violence
(IPV) Program, which provides a holistic approach that involves
understanding, recognizing and responding to the effects of all
types of trauma, with the ultimate goals to end violence,
prevent further violence, and promote healthy relationships.
The Committee directs VA to increase funding to this program.
Additionally, the Committee notes that IPV is a leading cause
of maternal mortality and morbidity in the United States and
can negatively impact fetal outcomes, as well as that research
indicates that IPV rates are of significant concern among U.S.
veterans. Therefore, the Committee urges the Department to
develop a Pregnancy IPV awareness campaign to address the
prevalence of IPV among childbearing veterans, and further,
supports programs designed to actively engage fathers and
partners in an effort to assist in breaking cycles of abuse.
Adaptive Sports.--The bill provides $27,229,000 for
National Veterans Sports Programs, including $16,000,000 for
adaptive sports programs, and recommends that the Department
use no less than $1,500,000 of funding provided for the
adaptive sports program for equine therapy. The Committee
recognizes the significant improvements that adaptive sports
and recreational therapy have on veterans' mental and physical
health, as well as the efforts of community providers,
especially in rural areas, who have been able to use this key
program to successfully reintegrate veterans back into their
communities. The Committee acknowledges that community
providers of adaptive sports grants spend considerable time and
effort in planning and implementing their veteran service
programs.
Assisted Reproductive Services.--The Committee continues to
believe that the limitations of VA's current policy for
providing assisted reproductive services are completely
unacceptable, resulting in a discriminatory, unjust, and
antiquated approach in practice. Such services include in vitro
fertilization (IVF) treatment for 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. It
is outrageous that VA infertility services have been denied to
a growing number of veterans due to marital status, and it is
similarly unacceptable that veterans who cannot use their own
genetic material or carry their own child to term are being
discriminated against with the current barriers to coverage for
donated gametes and gestational surrogacy. Additionally, the
Committee notes that veterans have different needs than active
duty servicemembers, and it is vital that VA be able to create
a unique policy that benefits the population it serves. The
Committee is further concerned by the inequities presented when
VA must maintain different sets of eligibility standards for
different types of reproductive services, such as intrauterine
insemination or in vitro fertilization. As such, the Committee
applauds VA's inclusion of a proposal in the fiscal year 2023
budget request to revise the access policy for assisted
reproductive services, as the Committee has requested in
previous years. The Committee has included this proposal in the
bill, which is crucial to ensure a permanent, equitable
solution.
Fertility Treatment Data.--The Committee remains concerned
by the Department's challenges in tracking how many veterans
have been able to access fertility treatment or have been
denied these benefits. The Committee looks forward to the
annually required report detailing the number of veterans and
spouses who have received fertility treatment, and those who
are ineligible, and urges VA to include in future reports
information on partners of veterans who have received fertility
treatment or counseling, as well as information on veterans who
are denied these benefits as a result of their infertility not
having been determined to be service-connected. The Department
is further urged to develop a system for better understanding
the population of veterans who are denied or determined to be
ineligible for these benefits, as the Committee understands
they currently may not be properly captured in data systems.
Adoption Reimbursement and Assisted Reproductive
Services.--The Committee remains concerned that many veterans
who could benefit from adoption reimbursement and assisted
reproductive services benefits may not be aware of the full
range of services available to them, and continues to urge the
Department to increase its efforts to ensure veterans are
informed about these services, including during earlier medical
visits. The Committee provides an additional $500,000 above the
budget request to support increased outreach efforts on these
benefits, including to veterans newly eligible under the
expanded access policy included in this bill. The Committee
requests an expenditure plan for these funds within 60 days of
enactment of this Act.
Medication Optimization for Veterans.--The Committee
recognizes that many veterans have at least one gene variant
that impacts medication efficacy or safety and that over half
of veterans are prescribed at least one drug where
pharmacogenomic information would be critical to drug or dose
selection to prevent patient harm. The Committee commends the
work of VHA to implement a National Pharmacogenomics Program to
ensure all eligible veterans have access to appropriate,
evidence-based pharmacogenomic testing and that VA has a robust
and highly trained healthcare professional workforce to help
interpret and manage veterans who have undergone
pharmacogenomic testing. The Committee provides $15,610,000, as
requested, for this work.
Diabetic Foot Ulcers.--The Consolidated Appropriations Act,
2022 (P.L. 117-103) directed VA to continue, and expand,
efforts to monitor diabetes patients remotely and to provide a
report to the Committees on Appropriations of both Houses of
Congress within 180 days of enactment of the Act on the
effectiveness of current efforts to prevent foot amputation.
The Committee looks forward to the report and the findings from
The Initiative to End Diabetic Limb Loss in Veterans, which are
anticipated to show improved patient outcomes and significant
projected cost avoidance. The Committee expects the report to,
as directed, detail the feasibility, including cost estimates,
of expanding these programs to reach an additional 20,000
veterans, as well as expansion to eligible VISNs, and directs
the Department to begin expanding the program to cover
additional veterans at high risk of amputation and expand to
eligible VISNs by the end of fiscal year 2023.
Remote Diabetes Monitoring.--The Committee recognizes that
Type 2 Diabetes can be a serious health concern for veterans
and their family members and that the rate of this condition is
more than doubled among veterans, who are at a higher risk due
to service-related chronic pain, joint damage, and exposure to
herbicides such as Agent Orange. To address this issue, the
Committee encourages VA to pursue a Veterans Diabetes Remote
Patient Monitoring solution that would increase patient access
to diabetes care management and improve health outcomes by
connecting to the VA Electronic Health Record system for
participants to push near-real time testing data into the
patient's record. The Committee recognizes that a Veterans
Diabetes Remote Patient Monitoring program could facilitate
data and analytics access and sharing for physicians,
specialists, family, and other care team members by populating
the Electronic Health Record of the veteran in the VA system.
The Committee directs the Department to report to the
Committees on Appropriations of both Houses of Congress within
90 days of enactment of this Act on the feasibility,
advisability, and cost of establishing this program to provide
real-time patient monitoring and care coordination for
veterans.
Osteopathic Manipulative Treatment.--The Committee is aware
that doctors of osteopathic medicine receive intensive training
in osteopathic manipulative treatment (OMT) and play an
important role in the treatment of veterans, who experience
higher prevalence of pain and more severe pain than
nonveterans. To ensure veterans have access to effective non-
addictive treatments for back and other pain, the Committee
directs VA to provide a report, including outcomes data, to the
Committees on Appropriations of both Houses of Congress within
120 days of enactment on the VA's use of OMT in the treatment
of back and other pain in veterans.
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.
Improving Access to Programs and Services.--The Committee
strongly encourages VA to ensure the Veteran Directed Care
Program and the Homemaker Home Health Aide Care program are
available in each state or U.S. territory where they are
currently not operative, such as the Commonwealth of the
Northern Mariana Islands. VA should promptly identify and
address barriers to providing these programs in these areas. No
later than 180 days 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 enrollment in
these two programs, services, and outreach conducted by VA in
areas where the programs are currently not operative, an
evaluation of such activities, and an assessment of the need to
provide additional resources and VA staff in such areas that
should include input from veterans residing in these areas.
Improved VA Healthcare for Veterans Living in the
Philippines.--The VA Manila Regional Office and Outpatient
Clinic is the only VA office located outside the United States
or its territories. The Committee notes that the clinic and
regional office are located in Manila, but a large number of
veterans reside near the former Clark Air Base. Given VA's
obligation to help veterans regardless of where they live, no
later than 180 days after the enactment of this Act, the
Committee directs VA to submit a report on how it is serving
veterans in the Philippines who live outside Manila, including
whether additional physical locations would help to improve
access to hospital care, medical services, telehealth services,
and veterans benefits.
Migraine Prevention and Treatment.--The Committee
recognizes approximately one in three servicemembers experience
severe headaches and migraines within the first months of
returning from deployment. Furthermore, 36 percent of U.S.
veterans who completed a 12-month deployment were either
diagnosed with or exhibited symptoms of migraines, which is
three times higher than the general population. The Committee
is aware that some veterans with migraines taking prescription
headache medication report poor mental status changes, higher
rates of psychiatric symptoms, and higher rates of traumatic
events. Therefore, the Committee directs the Department to
ensure neuromodulation devices with FDA-indication for migraine
prevention and treatment are available to veterans and to
educate clinicians and veterans on such devices.
Automated Discharge Planning.--The Committee recognizes
that delays in the discharge process can result in extended
stays for veteran patients in VA Medical Centers and increased
cost of care for VA. The Committee understands that VHA seeks
to improve patient satisfaction and productivity through
automating the discharge process and eliminating time-consuming
fax and phone processes to refer patients to more appropriate
levels of care. VHA is encouraged to ensure that all VA Medical
Centers implement efficiencies and automation into the
discharge process.
Technology to Improve Patient & Staff Safety.--The
Committee encourages VA to explore the use of commercial off-
the-shelf sensor-based automated technology platforms to
increase the safety of patient veterans and staff, especially
in reducing healthcare-acquired infections through rapid
contact tracing and improved hand hygiene. The Department is
encouraged to consider integrating these technologies into its
ongoing system-wide patient and staff safety improvement
efforts and to prioritize any necessary information technology
reviews.
Bioelectronic Medicine for Veterans.--The Committee
recognizes that Bioelectronic Medicine has the potential to
harness the body's electrical signaling to advance treatments
that save lives and lower medical expenditures across many
diseases impacting veterans, including arrhythmia, atrial
fibrillation, Parkinson's, major depressive disorder,
treatment-resistant epilepsy, incontinence, and chronic pain,
among others. Acceleration of studies, further data collection,
and the development and adoption of novel applications for
Bioelectronic Medicine combined with machine learning and
artificial intelligence (AI) can address the most challenging
and expensive diseases by personalizing treatments and
improving therapy delivery. Therefore, the Committee encourages
the Department to ensure that combined Bioelectronic Medicine
and AI technologies are available to veterans and includes
$2,000,000 for a Bioelectronic Medicine pilot to further expand
access to this technology.
Air Ambulance Services.--The Committee urges the Department
to ensure that any changes to the beneficiary travel
reimbursement for air ambulances do not reduce the availability
of emergency services to veterans or increase mortality and
morbidity among veterans needing air ambulance care.
Health Navigator.--The Committee encourages the Department
to continue to investigate the potential benefits of utilizing
a health navigator model of care for veterans.
Marriage and Family Therapists.--The Committee urges VA to
improve access to marriage and family therapists and to ensure
that there are not unnecessary barriers to increasing the
Department's capacity to serve veterans seeking this care.
Philanthropic Partnerships.--The Committee encourages VA to
explore philanthropic partnerships with nonprofit and for-
profit patient organizations that help advance patient care and
ensure adequate resources for all healthcare providers with a
strategic focus on the critical role of clinician engagement,
so long as such partnerships do not advance privatization or
degrade the core missions of VA.
Beneficiary Travel.--The Committee recognizes the
Department is currently transitioning to the Beneficiary Travel
Self Service System (BTSSS) to consolidate its reimbursement
structure. While the Committee applauds this effort, it is
concerned about availability for veterans to submit travel pay
requests who do not have access to internet or have limited
digital literacy. The Committee directs the Department to
ensure all VA staff involved in the beneficiary travel program
understand that veterans have the option to continue using the
paper claim form No. 10-3542 even as VA transitions to BTSSS
and further encourages the Department to ensure BTSSS does not
negatively affect veterans, especially those in rural areas
without reliable internet access.
Acquisition of Personal Protective Equipment.--The
Committee strongly encourages the Department to seek to
prioritize acquisition of American-made personal protective
equipment when possible, including nitrile and vinyl gloves,
surgical masks, respirator masks and powered air purifying
respirators and required filters, face shields and protective
eyewear, surgical and isolation gowns, and head and foot
coverings or clothing, and the materials and components
thereof, instead of purchasing from countries like Russia,
China, North Korea, or Iran. The Committee notes that in
accordance with the Infrastructure Investment and Jobs Act
(P.L. 117-58), VA is working with Federal interagency partners
on a long-term strategy for PPE produced in the United States,
and urges the Department to continue to make progress in this
area.

MEDICAL COMMUNITY CARE

Fiscal year 2022 enacted level........................ $23,417,244,000
Fiscal year 2023 enacted level........................ 24,156,659,000
Fiscal year 2023 budget year request.................. 4,300,000,000
Committee 2023 budget year recommendation............. 4,300,000,000

Fiscal year 2024 advance appropriation request........ 33,000,000,000
Committee 2024 advance appropriation recommendation... 33,000,000,000
Comparison with:
Fiscal year 2023 enacted level.................... +8,843,341,000
Fiscal year 2024 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 2024, the bill provides
an advance appropriation of $33,000,000,000, of which
$2,000,000,000 is available until September 30, 2025.
The Committee provides an additional $4,300,000,000 to be
available for fiscal year 2023, as proposed in the budget
request, in response to readjusted actuarial estimates for
medical community care.
Third-Party Payments and Reimbursements.--The Committee
continues to be concerned about the timeliness of
reimbursements by VA to private healthcare/third-party
providers. 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 serve the nation's veterans. The Committee
continues to direct VA to provide comprehensive reports on a
quarterly basis detailing the amount owed to outside providers
for every state, outstanding payments over six months old and
the corrective actions being implemented to address these
outstanding balances, and average time for repayment.
Long-Term Care for Veterans with Severe Traumatic Brain
Injury.--The Committee continues to note the 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 is encouraged by the Department's
progress in using agreements with non-VA providers to ensure
all veterans receive such long-term specialty care in their
communities and directs the Department to continue entering
into such agreements, to educate case managers on all tools
available to provide veterans with long-term specialty care
outside the VA system, and to provide an update within 270 days
of enactment of this Act on the Department's progress on
providing access to long-term care to veterans with severe
TBIs.
Shortage of VA Community Care Providers in Rural Areas.--
The Committee is aware that certain rural regions of the
country are experiencing a shortage in private healthcare
providers electing to participate in VA's Community Care
Program, as authorized by the VA MISSION Act (P.L. 115-182).
The Committee notes that a lack of Community Care Providers,
specifically in regions with recent facility closures, has the
potential to compromise veterans' access to care. The Committee
encourages the Secretary to continue working with its partners
to recruit private healthcare providers in rural communities to
participate in the Community Care Network System to serve
veterans in their local communities. The Committee directs VA
to submit a report on the progress of these efforts within 180
days of enactment of this Act. The report should include the
number of community care providers brought into the system over
the past year, the locations of the providers, and how much
funding VA has allocated for provider recruitment efforts in
fiscal year 2023 and fiscal year 2024. The report should also
detail a three-year plan on how the VA will continue to recruit
private healthcare providers in rural communities to
participate in the Community Care Network System.
State Veterans Homes Reporting of COVID-19 Data.--While VA
has made considerable improvements in its public reporting of
data on COVID-19 infections and deaths in State Veterans Homes,
significant gaps in this reporting remains. The Committee
directs VA to increase its efforts to publicly report on its
website the corrected numbers, where the current data has been
found to be incorrect, dating back as close as possible to the
start of the public health emergency for all State Veterans
Homes. Not later than 90 days after the enactment of this Act,
the VA shall submit to the Committee a home-by-home breakdown
of all reported COVID-19 infections and deaths in State
Veterans Homes as of the earliest date possible since the start
of the public health emergency.
State Veterans Homes.--The Committee notes the challenges
that the COVID-19 pandemic has posed to State Veterans Homes,
particularly with regards to staffing shortages and reduced
admissions. The Committee encourages VA to continue to explore
ways to assist State Veterans Homes.

MEDICAL SUPPORT AND COMPLIANCE

Fiscal year 2022 enacted level........................ $8,403,117,000
Fiscal year 2023 enacted level........................ 9,673,409,000
Fiscal year 2023 budget year request.................. 1,400,000,000
Committee 2023 budget year recommendation............. 1,400,000,000

Fiscal year 2024 advance appropriation request........ 12,300,000,000
Committee 2024 advance appropriation recommendation... 12,300,000,000
Comparison with:
Fiscal year 2023 enacted level.................... +2,626,591,000
Fiscal year 2024 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 $12,300,000,000 in advance fiscal year
2024 funding. The Committee has included bill language to make
$200,000,000 of the Medical Support and Compliance
appropriation for fiscal year 2024 available through September
30, 2025.

MEDICAL FACILITIES

Fiscal year 2022 enacted level........................ $6,734,680,000
Fiscal year 2023 enacted level........................ 7,133,816,000
Fiscal year 2023 budget year request.................. 1,500,000,000
Committee 2023 budget year recommendation............. 1,500,000,000

Fiscal year 2024 advance appropriation request........ 8,800,000,000
Committee 2024 advance appropriation recommendation... 8,800,000,000
Comparison with:
Fiscal year 2023 enacted level.................... +1,666,184,000
Fiscal year 2024 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 $8,800,000,000 in advance fiscal year
2024 funding. The Committee has included bill language to make
available through September 30, 2025, $350,000,000 of the
advance Medical Facilities appropriation for fiscal year 2024.
The Committee provides an additional $1,500,000,000 to be
available for fiscal year 2023 to support non-recurring
maintenance (NRM) projects nationwide, as requested. Of the
funds provided for NRM, the Committee directs VA to prioritize
projects that expand women's access to gender-specific care and
that repurpose vacant and underutilized space for mental health
needs, particularly projects that 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.
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
2023 may not be ready within that timeframe, requiring an
adjustment to the spending plan. The Committee requests a
quarterly update of the plan if the funding for any single
project changes by more than $3,000,000 during that time
period.
Facility Transformations.--The Committee strongly urges VA
to continue efforts 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 and to make it safer and easier for
women veterans to get care. This includes correcting
environment of care deficiencies, such as adding doors,
curtains, and soundproofing in treatment and check-in areas.
Community-Based Outpatient Clinic in Bakersfield,
California.--The Committee remains disappointed that the new
Bakersfield CBOC remains unbuilt more than a decade after
Congress authorized this facility in fiscal year 2010 through
Public Law 111-82. The Committee directs the Secretary to
expeditiously execute Lease No. 36C10F20L0008 and commence
construction of the CBOC by no later than September 30, 2023,
as provided in the lease. Furthermore, the Committee directs
the Secretary to provide monthly reports to the Committees on
Appropriations of both Houses of Congress on the CBOC's
progress until completion and activation.
Veteran Affairs Facilities Security and Communication
Technology Refresh.--The Committee encourages the Department to
continue security and communications technology upgrades at VA
facilities to ensure the safety of veterans, visitors, and
employees. The Committee recommends that VA take a holistic
approach and continue efforts to deploy proven technologies
that can provide actionable, real-time data and communications
to improve safety.
VA Facility Leases.--The Committee supports the 31 leases
proposed in the fiscal year 2023 budget request, but
acknowledges the challenges related to their authorization.
Recognizing that the primary obstacle is not related to
appropriations, the Committee continues to direct the
Department to work with the Office of Management and Budget and
Congress, including the Budget and Veterans Affairs Committees
of the House and Senate, to resolve the issues that inhibit
VA's ability to execute leases for medical, research and
administrative offices and facilities.
Efficiencies at VA Medical Facilities.--As the largest
healthcare system in the country, the Committee encourages VA
to explore potential options to reduce emissions and waste at
medical facilities, including identifying approaches that can
improve supply chain resilience. The Committee requests a
report on VA's efforts in this area not later than 90 days of
enactment of this Act.
Clinic Closures.--The Committee is concerned about closures
of CBOCs and the effect on veterans' access to care, especially
for veterans living in rural areas. The Committee directs the
Secretary to provide a report on CBOC closures over the past
five years and the effect on care for veterans living in rural
areas. The report should list the locations of clinics that
have closed and include an assessment of the time veterans must
wait for care after the closure, the availability of community
care provider networks, the availability of Mobile Medical
Units for veterans impacted by clinic closures, and the effect
on the continuity of care for these veterans. The Secretary is
directed to provide a report to the Committee within 60 days of
enactment of this Act.

MEDICAL AND PROSTHETIC RESEARCH

Appropriation, fiscal year 2022....................... $882,000,000
Budget request, fiscal year 2023...................... 916,000,000
Committee recommendation, fiscal year 2023............ 926,000,000
Change from enacted level......................... +44,000,000
Change from budget request........................ +10,000,000

This appropriation provides for medical, rehabilitative,
and health services research. The Committee recognizes the
importance of the research conducted by VA for veterans'
quality of life and health and provides $926,000,000, available
through September 30, 2024, which is $44,000,000 above fiscal
year 2022 and $10,000,000 above the budget request, for these
activities. The Committee appreciates the Department's plans to
focus on critical research areas that include environmental
exposures, traumatic brain injury, cancer and precision
oncology, and mental health as priorities.
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 2023 research resources in
addition to those provided in the research account are
$1,379,600,000.
Women Veterans Research.--Women veterans have unique health
needs that are substantially different than both civilian women
and men veterans. The Committee directs the Department to
ensure its research program adequately addresses the unique
needs and concerns of women veterans. Additionally, the
Committee continues to direct VA to prioritize medical and
prosthetic research to adequately address prosthetics meant for
women, given that women have different physical requirements
for prosthetics compared to men. The Committee also directs VA
to ensure that conditions with widespread impact on women, such
as endometriosis, are included in VA's research efforts to
better understand the impact of military service on veterans
with these conditions.
Animal Research.--The Committee has included bill language
to prohibit painful research on dogs and cats beginning in
fiscal year 2023. Additionally, the Department is directed to
include in any report to Congress describing animal research
approved under Section 247 of the Consolidated Appropriations
Act, 2022 (P.L. 117-103), submitted after the date of filing of
this report, detail on what specific alternatives to animals
were considered, why those alternatives were not chosen, and
therefore supporting why these animal subjects are the only
viable option for this research.
Access to Clinical Oncology Trials.--The Committee
continues to support efforts to expand opportunities for
veterans receiving cancer care at VA facilities to participate
in promising oncology clinical trials in collaboration with
National Cancer Institute (NCI)-designated cancer centers, but
notes the lack of infrastructure for these clinical trials in
other areas of the country. The Committee urges the Department
to continue to focus on States with the largest veteran
populations and on securing the participation of NCI-designated
centers in those States that are not already part of the VA's
NAVIGATE program. The Department is directed to draw best
practices from locations with long-standing partnerships and
NAVIGATE participation and build on those efforts to create
similar, successful partnerships in other locations. The
Committee notes the budget request has highlighted expanding
access to oncology clinical trials as a priority for fiscal
year 2023 funds and directs that not less than $10,000,000 be
continued to be allocated toward clinical trial partnerships,
with an emphasis on expanding to new sites outside the current
NAVIGATE structure. The Committee directs the Department to
submit a report within 60 days of enactment of this Act with a
plan to further expand access to clinical trials and how staff
and resources will be dedicated to this effort.
Million Veteran Program.--The Committee recognizes and
supports the VA Medical and Prosthetic Research Program's
significant investment in the Million Veteran Program (MVP)
research program. The Committee notes with concern that
scientific access to this valuable research tool is severely
limited by the computing infrastructure, and urges VA to
provide the funds needed to ensure appropriate access to the
MVP database for the VA research community. Additionally, the
Committee urges VA to enhance this program by accelerating the
development of risk assessment tools related to gene/
environment interactions as they relate to cancer risk, with a
focus on carcinogens and other environmental pollutants being
potentially important given recent combat areas and strategic
global centers of conflict. Identifying novel gene/environment
interactions based on observations collected during previous
military engagements could result in target identification and
drug development in cancer, which could generate a ground-
breaking data set for the understanding of impacts of burn pit
emissions and environmental exposure on cancer and other
disease risks.
Monoamine Oxidase A Deficiency.--The Committee encourages
VA to investigate connections between Monoamine Oxidase A
Deficiency (MAO/A) and veterans with PTSD, suicidal tendencies,
impulse control, aggressive and obsessive behavior, or ADHD
using, if viable, genetic samples taken from the participants
of the Million Veteran Program and to research possible cures
and treatments for MAO/A deficiency.
Gulf War Illness Studies.--The Committee recommends the
Department continue to conduct epidemiological studies
regarding the prevalence of Gulf War Illness, morbidity, and
mortality in Persian Gulf War veterans and the development of
effective treatments, preventions, and cures. The Committee
continues to encourage 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, and that the Department continue
to publish disease-specific mortality data related specifically
to Persian Gulf War veterans. The Committee also continues to
encourage the Department to utilize the term ``Gulf War
Illness'' for the signature adverse health outcome of the
Persian Gulf War, as recommended by the Institute of Medicine
(IOM), and appreciates the Department's work to strengthen the
training of primary, specialty, and mental healthcare providers
on effective assessment, diagnosis, and clinical management of
Gulf War Illness.
Dystonia.--The Committee appreciates VA's work to examine
the connection between traumatic brain injury and dystonia and
continues to urge VA to pursue collaborative efforts with the
dystonia stakeholder community and related Federal agencies.
Cannabis Research.--The Committee notes that VA has made
progress on cannabis research and continues to request updates
on the status of this research, as described in House Report
116-63.
National Intrepid Center of Excellence (NICoE)
Collaboration.--The Committee recognizes the high-quality
mental healthcare and neurological research being conducted at
Walter Reed NICoE. As veterans and servicemembers continue to
face higher rates of brain trauma than civilians, impacting
brain function, agencies should continue to collaborate to
study neurological conditions such as PTSD, bipolar,
schizophrenia, depression, suicide and substance use disorders.
The Committee directs VA to expand its work with NICoE to
strengthen VA's research capacity, streamline servicemembers'
access to preventive care, and share best practices so health
professionals can learn from NICoE's important work and
contribution to the health community. The Committee encourages
VA to pursue new collaborative initiatives with NICoE and
consider public academic medical centers as partners in such
efforts. Furthermore, the Committee encourages VA to assist DOD
with their efforts to optimize research to implement solutions
and deliver better health outcomes for veterans.
Advanced Platform Technology (APT) Center.--The Committee
applauds VA for progress being made to provide 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 drive
dramatic progress in diverse areas including artificial lung
development, wound healing, and neurally-connected sensory
prosthesis. The Committee continues to support the APT Center's
efforts.
Tinnitus Research.--The Committee encourages the Department
to work with academic partners, as appropriate, to address and
improve the outcomes for veterans experiencing problematic
tinnitus, including research to identify contributing factors
associated with tinnitus onset and progression to chronic
tinnitus and develop novel interventional therapies and self-
management models.
Metastatic Cancer Research.--While recent research has
revealed that there is a genetic basis for susceptibility to
metastatic cancer or resistance to metastasis, more research is
required to develop a comprehensive understanding of this
complex process. Clinical trials are an important aspect of
that progress, and diverse representation of patients in
clinical trials is integral to the development of medications
and therapies that effectively treat disease. Ethnicity,
gender, age and genetics all play a role in the safety and
efficacy of a treatment for an individual. Therefore, in order
to achieve representation of the demographics of the United
States population in these trials, the Committee directs VA to
partner with DOD to fully implement the outstanding
recommendations in this area made to the Department by DOD's
April 2018 Task Force Report to Congress on Metastatic Cancer.
Aviator Cancer Report.--The Department is directed to
provide a report within 90 days of enactment of this Act
regarding the incidence and mortality of cancers experienced by
veterans who served as air crew members or support personnel of
fixed-wing aircraft. To the extent possible, the report should
identify whether the presence of certain chemicals and
compounds used in fixed-wing aircraft, including radiofrequency
radiation, is linked to cancer incidence or mortality risk.
Transcendental Meditation.--The Committee looks forward to
reviewing VA's report, as directed in Senate Report 117-35, on
resources needed to deploy transcendental meditation (TM)
across the VA system. The Committee remains interested in TM's
potential as an evidence-based, non-invasive treatment for
veterans of all backgrounds in treating acute mental health and
pain management needs. The Committee also supports the ongoing
Phase III clinical trial and pilot at nine VA Medical Centers
and research hospitals evaluating TM as a first-line treatment
for PTSD and suicidality and offering TM instruction to VA
patients and staff, and urges VA to ensure timely completion of
the trial and pilot.
Precision Oncology Platform.--The Committee notes VA's
establishment of a hub for Computer Vision and Machine Learning
in Precision Oncology (CoMPL), and urges VA to continue efforts
to accelerate machine learning tools and other technologies
that enhance cancer diagnosis and treatment, including
potentially developing a precision oncology platform that
integrates next-generation sequencing data, bioinformatics,
machine learning, and mathematics, including algorithms to help
predict the probability of a patient's response to a specific
drug. This platform could help move beyond a single target-
based approach to drug-patient or cancer matching, identify
which therapy works best for each specific cancer or a specific
patient, and improve patient outcomes by optimizing clinical
trial population selection. VA is directed to submit a report
no later than 180 days after enactment of this Act on the
progress of the CoMPL hub, as well as the feasibility,
including cost estimates, of further developing a precision
oncology platform that has this functionality.

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 2023 is $3,910,000,000.
MCCF Third-Party Billing.--The Committee remains concerned
over potential discrepancies in VA's billing and collection
processes. Procedures to provide for not only correct billing,
but also prompt collection must continue to be improved at VA.
Therefore, the Department is directed to submit quarterly
reports to the Committees on Appropriations of both Houses of
Congress identifying the amount of third-party health billings
that were owed to VA in the previous quarter, and the amount
collected, with an explanation of why amounts were not
collected. The report should differentiate the amount expected
to be collected out of the total billings from the amount
actually collected. Additionally, each report should include
VA's net collections ratio for the quarter, how the net
collections ratio for that quarter compares to industry
standards, and how VA plans to improve the collection process.
The reports should include billings and collections data for
both large claims (greater than $1,000) and small claims (equal
to or less than $1,000). Lastly, each report should also
describe current management practices to provide proper
oversight of the billing process, including appeals (both
manual and automated), to eliminate unnecessary and duplicative
functions.

National Cemetery Administration

Appropriation, fiscal year 2022....................... $394,000,000
Budget request, fiscal year 2023...................... 430,000,000
Committee recommendation, fiscal year 2023............ 430,000,000
Change from enacted level......................... +36,000,000
Change from budget request........................ - - -

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 158 national
cemeteries and 34 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, 2024.
Cemetery Access and Unmet Needs.--The Committee remains
concerned that NCA is not adequately serving the nation's
veterans in certain areas, particularly rural areas and
geographically isolated areas, and that there are 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. Additionally, the Committee is concerned that
the Department's current criteria for establishing new national
cemeteries may not adequately address the needs of veterans and
their families in geographically isolated areas and states
where state veterans cemeteries do not meet national shrine
standards. The Committee notes that the Department has
previously indicated interest in undertaking a review and
considering potential revisions of the current criteria.
Therefore, the Department is directed to report to the
Committee within 180 days of enactment of this Act on its
progress to review and amend the criteria for establishing new
national cemeteries, including changes to allow for the
establishment of new national veterans cemeteries in
geographically isolated areas and states where state veterans
cemeteries do not meet national shrine standards, and how
revised criteria will help address the remaining need of
unserved veteran populations.
Cremation.--The Committee is aware of interest in allowing
cremation under the Department's existing burial allowance and
requests a report, within 90 days of enactment of this Act, on
the estimated cost of providing this expanded benefit,
including an evaluation of the feasibility of directly covering
the cost in place of the existing reimbursement system.

Departmental Administration

GENERAL ADMINISTRATION

(INCLUDING TRANSFER OF FUNDS)

Appropriation, fiscal year 2022....................... $401,200,000
Budget request, fiscal year 2023...................... 435,000,000
Committee recommendation, fiscal year 2023............ 435,000,000
Change from enacted level......................... +33,800,000
Change from budget request........................ - - -

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, 2024, 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.
VA Five Year Development Plan (VFYDP).--The Committee is
very pleased that the Department has provided a VFYDP in its
fiscal year 2023 budget and 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 $20,300,000 for FMBT, as requested. VA's
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 directs the Department to continue this
quarterly report throughout fiscal year 2023.
Supporting Minority and Disadvantaged Contractors.--The
Committee recognizes the need for VA 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 reiterates the reporting
requirement included in House Report 117-81 on this topic and
looks forward to receiving the requested report.
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 continues to recommend that, when applicable, the
Secretary display information in the annual reports submitted
to Congress separately for women veterans and minority
veterans.
Human Capital Tools.--The Committee is aware the Department
currently uses a product suite to provide cloud-based solutions
to manage various human resource functions such as business
alignment, people performance, and recruitment. The Committee
is supportive of VA's continued use and implementation of
enterprise-wide solutions.
Data Strategy.--The Committee provides $36,229,000 for the
Office of Enterprise Integration, as requested, and supports
the Department's continued efforts to manage VA data as a
strategic asset in order to strengthen the delivery of services
and benefits to veterans, their families, survivors, and
caregivers.
Center for Women Veterans Digital Infrastructure.--The
Committee recognizes and welcomes the Department's movement
towards modernizing the digital infrastructure in the Center
for Women Veterans (CWV). While VA completes and delivers to
Congress its report on plans to modernize the CWV website, the
Committee emphasizes the importance of VA swiftly bringing into
compliance its websites at the center, and across the full VA.
This is essential for VA's employees and the veterans who rely
on VA services, including the women veterans reliant upon the
CWV.

BOARD OF VETERANS APPEALS

Appropriation, fiscal year 2022....................... $228,000,000
Budget request, fiscal year 2023...................... 285,000,000
Committee recommendation, fiscal year 2023............ 285,000,000
Change from enacted level......................... +57,000,000
Change from budget level.......................... - - -

The bill makes ten percent of this funding available
through September 30, 2024.
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.
Despite the unprecedented challenges presented by the
COVID-19 pandemic, BVA held a record 23,777 hearings in 2021,
96 percent of which were conducted virtually, and issued 99,721
decisions. With increased resources provided by Congress for
fiscal year 2023, BVA will be able to adjudicate a higher
number of appeals, with a goal of 40,000 hearings held
virtually and in-person.
Reimbursement of BVA Bar Dues.--The Committee recognizes
the challenge VA has in the recruitment and retention of
attorneys at BVA. To help the Board retain its attorneys, the
Committee is supportive of VA's plans to reimburse bar fees for
eligible staff in fiscal year 2023.

INFORMATION TECHNOLOGY SYSTEMS

(INCLUDING TRANSFER OF FUNDS)

Appropriation, fiscal year 2022....................... $4,842,800,000
Budget request, fiscal year 2023...................... 5,782,000,000
Committee recommendation, fiscal year 2023............ 5,782,000,000
Change from enacted level......................... +939,200,000
Change from 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
$1,494,230,000 for pay and associated costs, $4,145,678,000 for
operations and maintenance, and $142,092,000 for development.
The bill makes available three percent of pay and associated
costs and five percent of operations and maintenance funds
until September 30, 2024. All development funds are available
until September 30, 2024.
The Committee directs VA to allocate sufficient resources
for IT improvements that support research and research
facilities to ensure that computing infrastructure is adequate
to facilitate research needs.
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 also continues language allowing for the
reprogramming of funds among development projects upon approval
by the Committees on Appropriations of both Houses of Congress.
The chart below reflects the Committee's allocation for
development projects. 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
------------------------------------------------------------------------
Health Management Platform........................... $70,736
Clinical Applications................................ 43,277
Health Research and Development...................... 5,209
Benefits Systems..................................... 20,727
Other IT Systems..................................... 2,143
Cybersecurity........................................ .................
Information/Infrastructure Management................ .................
Memorial Affairs..................................... .................
Total All Development............................ 142,092
------------------------------------------------------------------------

The Committee expects the Office of Information and
Technology (OIT) 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 $3,000,000.
Cybersecurity.--The Committee appreciates OIT's
implementation of the Executive Order on Improving the Nation's
Cybersecurity (E.O. 14028) and its use of end-to-end encrypted
communications with zero trust architecture and encourages it
to continue to adhere to development, security, and operations
principles to secure the Department's information systems.
Supply Chain Modernization.--VA has made multiple attempts
to modernize its supply chain yet still lacks an enterprise
solution to effectively purchase and track supplies critical to
providing healthcare for the nation's veterans. Currently, VA
is assessing requirements for an enterprise modernization that
includes both the supply chain and associated support
functions. VA is encouraged to continue to use an innovative
approach to the acquisition through an open competition and a
prototyping evaluation phase to identify an enterprise-wide
solution, scheduled to be completed in January 2023. The
Committee recommends the Department apply rigorous vetting
standards to ensure that industry partners demonstrate the
ability to deliver modernized supply chain solutions at the
scale and scope VA requires. Finally, the Committee directs the
Secretary to submit the final version of VA's Supply Chain
Management Strategy and a full cost estimate of the program no
later than 90 days after enactment of this Act.

VETERANS ELECTRONIC HEALTH RECORD

Appropriation, fiscal year 2022....................... $2,500,000,000
Budget request, fiscal year 2023...................... 1,759,000,000
Committee recommendation, fiscal year 2023............ 1,759,000,000
Change from enacted level......................... -741,000,000
Change from budget request........................ - - -

The Veterans Electronic Health Record (EHR) 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 DOD and of community providers. The VA system is the same as
the one chosen by DOD and is planned to be rolled out with the
same timeline and geographic areas as DOD in order to realize
cost efficiency savings.
The bill provides funding to support VA's on-going efforts
to deploy the new electronic health record system, consistent
with the budget request. Within the total funding, the bill
includes $1,119,145,000 for the electronic health record
contract, $199,116,000 for program management, and $440,739,000
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 prior to each
quarterly briefing. Additionally, the Committee directs the
Department to provide updates on plans and efforts to integrate
community care providers into the new EHR system. Such updates
should be submitted concurrently with the quarterly reports.
In addition, bill language is included that makes 25
percent of the total funding available contingent upon the
Secretary providing notice to and receiving approval from the
Committees on Appropriations of both Houses of Congress of any
changes to the deployment schedule, as well as an updated plan
outlining benchmarks and measurable metrics for deployment and
an updated plan for addressing all required infrastructure
upgrades. The Committee repeats the fiscal year 2019 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.
Patient Harm and Transparency.--The Committee is aware of
recent alleged reports of patient harm connected to the rollout
of the new electronic health record system at the Mann-
Grandstaff VA Medical Center due to thousands of work orders
that were ``lost'' in the system. This information, which is
based on leaked draft documents, has not been confirmed but
includes concerning allegations that VA leadership has known
about incidents of patient harm for many months. The Committee
understands that the final Office of Inspector General report
is forthcoming and looks forward to receiving the report as
soon as possible in order to clarify these issues.
Therefore, the Committee directs VA to provide, no later
than 15 days after the filing of this report, a list of any
patient harm incidents that were identified at Mann-Grandstaff
and any other location that has received the new EHR; a
timeline on when VA leadership was notified of any patient harm
issues and the issue of lost work orders; and an execution plan
and timeline for VA, working with Oracle Cerner, to identify a
solution to any remaining issues that could impact patient
safety, including issues related to system stability. VA is
further directed to provide monthly briefings to the Committee
on the status of these outstanding issues with the system,
beginning in July 2022, until such time that they have been
sufficiently remediated, as determined by the Committee.
Furthermore, the Committee directs VA to provide a report
within 90 days of enactment of this Act on the number of orders
made in the new EHR system for specialty care, lab work, and
other services that did not result in the intended action as
well as those that were lost since October 2020; the number of
staff hours spent by VA employees addressing these lost orders
and the resulting decreased staff productivity and financial
impact on VA; and available options for VA to recoup costs from
Oracle Cerner for the disruption in patient care.
The Committee strongly urges VA to postpone additional
rollouts of the new EHR system until all issues that could
contribute to patient safety or harm have been fully resolved
and staff training on properly utilizing the system, including
any workarounds to prevent lost orders, has been improved. VA
is directed to certify to the Committee that there have been no
patient harm issues 7 days prior to any new deployment. The
Committee supports ongoing and robust oversight of the EHRM
program from VA's Office of Inspector General and directs VA to
be transparent with Congress on all aspects of the rollout
going forward.
Cybersecurity for Electronic Health Records and Blockchain
Technology.--Recognizing the ongoing challenges of sharing data
between DOD's Military Health System (MHS) GENESIS and the
Department's EHRM initiative, the Committee encourages the
Department to continue prioritizing efforts 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.
The Committee understands that the Department is planning a
pilot to study the use of blockchain technology to share data
and looks forward to the results of the pilot being shared with
the Committee.
VA EHRM at VA-Department of Defense Joint Venture
Facilities.--The Committee notes the significant potential to
improve data sharing between DOD's MHS GENESIS and VA's EHRM.
Opportunities to identify areas of improvement can be found at
the VA-Department of Defense Joint Venture Facilities. The
Committee understands that transition to the new electronic
health records system is planned at two VA-DOD joint venture
facilities in fiscal year 2023. Thus, the Committee directs the
Federal Electronic Health Record Modernization Office, in
coordination with VA, to report to the Committee within 180
days of enactment of this Act on: (1) how electronic health
records coordination currently functions at these facilities;
(2) lessons learned from joint venture facilities that can be
applied to the implementation of the VA EHRM; and, (3) how
lessons learned will be disseminated to other joint venture
facilities to help those sites prepare for transition and
ensure better coordination of systems across the two
departments.
Life Cycle Cost Analysis.--The Committee reminds the
Department of its interest in the life-cycle cost analysis of
the EHRM program and requests monthly updates on its progress
until it is completed and shared with the Committee.

OFFICE OF INSPECTOR GENERAL

Appropriation, fiscal year 2022....................... $239,000,000
Budget request, fiscal year 2023...................... 273,000,000
Committee recommendation, fiscal year 2023............ 273,000,000
Change from enacted level......................... +34,000,000
Change from 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, 2024.
The Committee continues to request robust oversight of
MISSION Act and EHRM implementation.
VA Backlog.--OIG is encouraged to review the causes of VA's
current claims backlog and provide all appropriate feedback on
the work VA is doing to address backlog issues. OIG is directed
to report to the Committee on the status of the backlog, how VA
is addressing the backlog, and any changes in the amount of
time veterans are waiting to hear back on their claims. This
report should analyze how VA's partnership with the National
Archives and Records Administration to digitally scan all
paper-based military personnel files has helped address and
resolve the backlog.

CONSTRUCTION, MAJOR PROJECTS

Appropriation, fiscal year 2022....................... $1,611,000,000
Budget request, fiscal year 2023...................... 1,447,890,000
Committee recommendation, fiscal year 2023............ 1,371,890,000
Change from enacted level......................... -239,110,000
Change from budget request........................ -76,000,000

The Construction, Major Projects appropriation provides for
constructing, altering, extending, and improving any of the
facilities under the jurisdiction or for the use of VA,
including planning, architectural and engineering services,
assessments, and site acquisition where the estimated cost of a
project is more than $20,000,000. The Committee recommendation
makes $731,722,000 of these funds available for a five-year
period.
The Committee supports robust funding for VA construction
projects in fiscal year 2023. In addition to the $1,371,890,000
provided to fully support all requested Major Construction
projects, the Committee supports the Department's plan to
allocate $804,510,000 from the Recurring Expenses
Transformational Fund to support Major Construction projects in
Portland, OR, Canandaigua, NY, Fort Harrison, MT, and for other
purposes within the account. In total, this would provide VA
with $2,176,400,000 to support Major Construction projects in
fiscal year 2023, which is $565,400,000 above fiscal year 2022.
The Committee does not provide the requested new authority
for VHA land acquisition or the $76,000,000 requested
specifically for that purpose.
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 expects 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 (VHA)
Louisville, KY--New Medical Facility................. 35,000
Alameda, CA--Community Based Outpatient Clinic and 128,800
National Cemetery...................................
Livermore, CA--Realignment and Closure, Livermore 35,000
Campus..............................................
El Paso, TX--Construct New Health Care Center........ 550,000
Advance Planning and Design Fund--Various Stations... 190,378
Claims Analysis--Various Stations.................... 2,500
Construction & Facilities Management Staff--Various 128,122
Stations............................................
Hazardous Waste--Various Stations.................... 16,000
Non-Departmental Federal Entity Project Management 134,590
Support--Various Stations...........................
Seismic Corrections--Various Stations................ 1,500
Total, VHA....................................... 1,221,890
National Cemetery Administration (NCA)
Elmira, NY--Phase 1 Gravesite Development............ 25,000
Albuquerque, NM--Phase 1 Gravesite Expansion......... 57,000
St. Louis, MO--Phase 1 Gravesite Development (New 44,000
Land)...............................................
Advance Planning and Design Fund--Various Stations... 13,000
NCA Land Acquisition Fund--Various Stations.......... 1,000
Total, NCA....................................... 140,000
General Administration/Staff Offices
Department Advance Planning and Design Fund for Major 10,000
Construction........................................
Total, Major Construction........................ 1,371,890
------------------------------------------------------------------------

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.

CONSTRUCTION, MINOR PROJECTS

Appropriation, fiscal year 2022....................... $553,000,000
Budget request, fiscal year 2023...................... 626,110,000
Committee recommendation, fiscal year 2023............ 626,110,000
Change from enacted level......................... +73,110,000
Change from budget request........................ - - -

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.
The Committee recommendation supports robust funding for VA
construction projects and makes $62,611,000 of the funds
provided available until expended.
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 also encourages VA to
allocate sufficient resources for improvements to research
facilities, particularly to address any priority deficiencies.
Parking Assessment for the Spark M. Matsunaga Veterans
Affairs Medical Center at the Tripler Army Medical Facility.--
The Tripler Army Medical Center and the Spark M. Matsunaga
Veterans Affairs 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.
Due to the constraining geography 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. The
facility is also not readily accessible to public transit,
making ground transportation with parking the only reliable
option for care. To help better understand the need and
potential solutions, the Committee directs the VA Office of
Acquisition, Logistics, and Construction to submit a report to
the Committee not later than 90 days after enactment of this
Act detailing: (1) the current parking requirements and
shortfalls at the facility; (2) the estimated cost of
constructing a new parking facility; and (3) a description of
efforts to coordinate joint solutions to the parking shortfall
with the Defense Health Agency.
Support the Expeditious Enactment of the Greater Los
Angeles Healthcare System's Master Plan.--The Committee
continues to support the expeditious enactment of the Greater
Los Angeles Healthcare System's Master Plan, which calls for
the delivery of more than 1,200 units of housing for more than
4,000 veterans in the area experiencing homelessness. The
Committee appreciates VA's work with the Principal Developer
Team at the West Los Angeles VA to identify opportunities to
operationalize the Master Plan. The Committee encourages VA to
continue to engage with the Principal Developer Team and others
on any potential funding opportunities, including Capital
Contributions.
The Committee supports the Department's plan to allocate
$163,490,000 from the Recurring Expenses Transformational Fund
to support Minor Construction projects, which would support the
completion of construction projects at VA facilities nationwide
as well as installation of zero-emission vehicle charging
infrastructure on VA campuses. In addition, the Committee
encourages VA to use these resources to support Capital
Contributions, as necessary, particularly for projects that
would support housing and supportive services for homeless
veterans.

GRANTS FOR CONSTRUCTION OF STATE EXTENDED CARE FACILITIES

Appropriation, fiscal year 2022....................... $50,000,000
Budget request, fiscal year 2023...................... 150,000,000
Committee recommendation, fiscal year 2023............ 150,000,000
Change from enacted level......................... +100,000,000
Change from budget request........................ - - -

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.
Supporting grants for construction of state extended care
facilities has been and will continue to be a priority of the
Committee. As such, in order to ensure that VA has the
resources required to address priority project applications in
fiscal year 2023, the bill increases funding over the prior
fiscal year by $100,000,000 for fiscal year 2023, as requested.

GRANTS FOR CONSTRUCTION OF VETERANS CEMETERIES

Appropriation, fiscal year 2022....................... $48,500,000
Budget request, fiscal year 2023...................... 50,000,000
Committee recommendation, fiscal year 2023............ 50,000,000
Change from enacted level......................... +1,500,000
Change from budget request........................ - - -

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.

ASSET AND INFRASTRUCTURE REVIEW

Appropriation, fiscal year 2022....................... $5,000,000
Budget request, fiscal year 2023...................... 5,000,000
Committee recommendation, fiscal year 2023............ 5,000,000
Change from enacted level......................... - - -
Change from budget request........................ - - -

This appropriation funds the work of the ``Asset and
Infrastructure Review Commission'' (the Commission), an
independent commission established in the VA MISSION Act of
2018 (P.L. 115-182), Title II, section 202. The Commission will
review VA's recommendations to modernize or realign VHA
facilities, including leased facilities. The Commission will
conduct public hearings and provide a report to the President
on VA's plan along with any additional recommendations from the
Commission. Support staff will conduct in-depth field hearings
to receive input from veterans, Veterans Service Organizations,
local VA providers, and local government.
The Committee urges VA and the Commission to focus on
maintaining or improving veterans' access to medical care when
finalizing the recommendations, in both dense urban and rural
areas. The Committee urges VA and the Commission to be
transparent with and responsive to Congress as the
recommendations continue to evolve and encourages the
Commission to conduct hearings in regions affected by the
recommendations of the Secretary, including rural areas.

Administrative Provisions

The bill includes 52 administrative provisions, of which 50
were in effect in fiscal year 2022 in some form and two 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 2023. 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 2023 for ``Compensation and
Pensions'', ``Readjustment Benefits'', and ``Veterans Insurance
and Indemnities'' for payment of accrued obligations recorded
in the last quarter of fiscal year 2022.
The bill includes section 207 allowing for the use of
fiscal year 2023 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 enhanced-use lease
proceeds deducted for administrative expenses that were
incurred in a prior fiscal year to be available until expended.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 210 limiting the amount of
reimbursement the Office of Resolution Management, Diversity
and Inclusion, the Office of Employment Discrimination
Complaint Adjudication, and the Alternative Dispute Resolution
function within the Office of Human Resources and
Administration 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
Department of Veterans Affairs.

(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 $330,140,000
of fiscal year 2023 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
$314,825,000 of fiscal year 2024 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 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
modify 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 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 233 permanently allowing the use
of Medical Services funding for assisted reproductive
technology treatment and adoption reimbursement for veterans
and their spouses or partners if the veteran has a service-
connected disability that results in being unable to procreate
without such fertility treatment.
The bill includes section 234 prohibiting any funds from
being used in a manner that is inconsistent with statutory
limitations on outsourcing.
The bill includes section 235 pertaining to exceptions for
Indian- or Native Hawaiian-owned businesses contracting with
VA.
The bill includes section 236 directing the elimination
over a series of years of the use of Social Security numbers in
VA programs.
The bill includes section 237 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 238 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 239 permitting funding to be used
in fiscal years 2023 and 2024 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 240 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 241 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 242 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 bill includes section 243 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 244 prohibiting the use of funds
in fiscal year 2023 to convert any program that received
specific purpose funds in fiscal year 2022 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 245 eliminating category D or E
pain testing on dogs or cats.
The bill includes section 246 to allow fiscal year 2023 and
2024 ``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 247 allowing 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.
This bill includes section 248 specifying an amount from
the four medical care accounts for gender-specific care and
programmatic efforts for women. The Administration request to
delete this provision is not adopted.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 249 permitting the transfer of
funds deposited in the ``Medical Facilities'' and ``General
Administration'' accounts to the ``Asset and Infrastructure
Review'' account, under certain circumstances.

(INCLUDING RESCISSION OF FUNDS)

The bill includes section 250 rescinding funds from the
Recurring Expenses Transformational Fund.
The bill includes section 251 requiring quarterly reports
on the status of the ``Veterans Medical Care and Health Fund,''
established to execute section 8002 of the American Rescue Plan
(P.L. 117-2).
The bill includes section 252 establishing a timeline for
construction in accordance with a lease.

TITLE III

RELATED AGENCIES

Funds under Title III support the agencies that honor and
respect the service of the 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 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 the promise to serve those who served the
nation.

American Battle Monuments Commission

SALARIES AND EXPENSES

Appropriation, fiscal year 2022....................... $87,500,000
Budget request, fiscal year 2023...................... 86,800,000
Committee recommendation, fiscal year 2023............ 87,500,000
Change from enacted level......................... - - -
Change from budget request........................ +700,000

The recommendation includes $87,500,000 for Salaries and
Expenses of the American Battle Monuments Commission.
The Committee notes the significant maintenance needs of
the American Battle Monuments around the world, which are
specifically designed to honor fallen servicemembers. The
Committee continues to emphasize that existing monuments and
memorials should be maintained and repaired in a proactive and
timely manner that honors the service, achievements, and
sacrifices of the United States Armed Forces.

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 2022....................... $41,700,000
Budget request, fiscal year 2023...................... 46,900,000
Committee recommendation, fiscal year 2023............ 45,159,000
Change from enacted level......................... +3,459,000
Change from budget request........................ -1,741,000

The recommendation includes $45,159,000 for Salaries and
Expenses for the United States Court of Appeals for Veterans
Claims (the Court).
The Committee notes that the Court's current authorization
is for nine judges and provides funding for the current
activities of the Court. The Committee recognizes that
caseloads at the Court continue to grow and notes that future
statutory changes may increase the size of the Court. The
Committee will continue to closely follow these developments
and their impact on funding needs.

Department of Defense--Civil

Cemeterial Expenses, Army

SALARIES AND EXPENSES

Appropriation, fiscal year 2022....................... $87,000,000
Budget request, fiscal year 2023...................... 93,400,000
Committee recommendation, fiscal year 2023............ 93,400,000
Change from enacted level......................... +6,400,000
Change from budget request........................ - - -

The recommendation includes $93,400,000 for Salaries and
Expenses for Arlington National Cemetery (the Cemetery), which
is equal to the fiscal year 2023 budget request. The Committee
is pleased to see an acknowledgment of its repeated direction
that the Cemetery's budget requests reflect the funding needed
to respond to increased costs and to maintain the current level
of services.
Updated Interment Policy.--The Committee is aware that the
Secretary of the Army is in the process of finalizing revised
criteria for interment at the Cemetery to preserve it as an
active burial ground well into the future, and 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.
Protestant Chaplain Memorial.--The Committee strongly
believes that the nation's deceased military chaplains of all
faiths should be properly honored in Arlington National
Cemetery, and that the monuments located on Chaplains Hill
represent a key part of this commitment. The Committee
continues to urge the Cemetery to work productively with
stakeholders on proposals to restore and update the Protestant
Chaplain Memorial and ensure that it can continue to honor
those who have served without additional delay.
Military Horses.--The Committee is concerned about reports
of disturbing treatment and malnourishment of the horses that
pull the caissons at Arlington National Cemetery. While the
Committee notes that the oversight of these horses may
ultimately fall to other Army entities, these horses are an
integral symbol of the Cemetery's mission to lay to rest those
who have served the nation with dignity and honor, just as any
other employee of the Cemetery. The Committee directs Cemetery
leadership to engage with the 3rd U.S. Infantry Regiment, Joint
Base Myer-Henderson Hall, Fort Belvoir, and others, and take
all possible actions to ensure that the horses that allow the
Cemetery to fulfill its mission are well cared for and treated
with respect.

CONSTRUCTION

Appropriation, fiscal year 2022....................... $141,000,000
Budget request, fiscal year 2023...................... 62,500,000
Committee recommendation, fiscal year 2023............ 62,500,000
Change from enacted level......................... -78,500,000
Change from budget request........................ - - -

The recommendation includes $62,500,000 for construction,
including $60,000,000 for planning and design and construction
of Southern Expansion, to remain available until expended. This
is expected to complete the Southern Expansion project and road
realignments to extend the life of the cemetery. The Committee
provides this funding to ensure that the life of the nation's
most prestigious cemetery is extended into the 2050 timeframe.
The Committee directs the Cemetery to include status updates in
its required quarterly reports on funds obligated, including
previously appropriated funds, and funds remaining for the
Southern Expansion project, as well as any remaining unfunded
needs to complete the project.
The Committee also provides $2,500,000 to begin the process
of a project to make improvements to Memorial Avenue. The
Committee directs the Cemetery to provide updates on the status
of this study and project, including obligations of funds.

Armed Forces Retirement Home

TRUST FUND

The recommendation includes $75,360,000 for the Armed
Forces Retirement Home (AFRH) Trust Fund, including $7,300,000
for capital projects, although $25,000,000 of the total is
provided from the general fund of the Treasury, and not the
Trust Fund.
General Fund.--The Committee continues to express concern
about the use of the General Fund to support the work of AFRH.
The Committee directs AFRH to continue to make progress on
efforts to increase revenues and stabilize the AFRH Trust Fund
for the long term, and to continue to report to the Committee
on its further initiatives to improve sustainability and
maintain the high-quality services provided to AFRH residents.
Land Redevelopment.--The Committee continues to be
interested in the redevelopment of the 80-acre master planned
parcel on the Washington campus and continues to direct AFRH to
report to the Committee on the progress of the redevelopment
project.

OPERATION AND MAINTENANCE

Appropriation, fiscal year 2022....................... $68,000,000
Budget request, fiscal year 2023...................... 68,060,000
Committee recommendation, fiscal year 2023............ 68,060,000
Change from enacted level......................... +60,000
Change from budget request........................ - - -

The Committee makes these operation and maintenance funds
available until September 30, 2024, as requested, to provide
AFRH greater ability to respond to emergency situations and
ensure stable operations.

CAPITAL PROGRAM

Appropriation, fiscal year 2022....................... $9,000,000
Budget request, fiscal year 2023...................... 7,300,000
Committee recommendation, fiscal year 2023............ 7,300,000
Change from enacted level......................... -1,700,000
Change from budget request........................ - - -

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.

MAJOR CONSTRUCTION

Appropriation, fiscal year 2022....................... $- - -
Budget request, fiscal year 2023...................... 77,000,000
Committee recommendation, fiscal year 2023............ 77,000,000
Change from enacted level......................... +77,000,000
Change from budget request........................ - - -

The Committee provides $77,000,000, as requested, for
renovation of the Sheridan Building on the Washington campus,
which will improve resident safety and quality of life, address
needed maintenance projects, and provide additional
opportunities for AFRH to increase occupancy rates. The
Committee requests quarterly reports on the status of this
construction project, including obligations of funds,
anticipated timelines, and any changes to the overall cost of
the project.

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

GENERAL PROVISIONS

The bill includes a total of 11 provisions that were in
effect in fiscal year 2022:
The bill includes section 401 prohibiting the obligation of
funds beyond the current fiscal year unless expressly so
provided.
The bill includes section 402 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 403 encouraging all departments
and agencies funded in this Act to expand the use of ``E-
Commerce'' technologies and procedures.
The bill includes section 404 specifying the Congressional
committees that are to receive all reports and notifications.
The bill includes section 405 prohibiting the transfer of
funds to any instrumentality of the United States Government
without authority from an appropriations Act.
The bill includes section 406 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 407 requiring all reports
submitted to the Congress to be posted on official websites of
the submitting agency.
The bill includes section 408 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 409 prohibiting the use of funds
for payment of first-class travel by an employee of the
executive branch.
The bill includes section 410 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 411 prohibiting the use of funds
in this Act to construct facilities on military installations
that do not meet resiliency standards.

House of Representatives Reporting 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.

RESCISSION 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 rescissions in the accompanying bill:
In title II Section 250 rescinds $48,132,853 of unobligated
balances in the ``Recurring Expenses Transformational Fund''
established in section 243 of division J of Public Law 114-113.

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 $21,423,000
in fiscal year 2024 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
2023 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, subject to
approval by the Committee.
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 $97,869,000 to
be transferred to General Administration and Information
Technology Systems from any funds appropriated in fiscal year
2023 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 allow the transfer of 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
provided for the Department of Veterans Affairs in fiscal year
2023 to the Joint Department of Defense-Department of Veterans
Affairs Medical Facility Demonstration Fund.
Language is included allowing fiscal year 2024 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.
Language is included that permits the transfer of funds
from the Medical Facilities and General Administration accounts
to the Asset and Infrastructure Review account.

Disclosure of Earmarks and Congressionally Directed Spending Items

The following table is submitted in compliance with clause
9 of rule XXI, and lists the congressional earmarks (as defined
in paragraph (e) of clause 9) contained in the bill or in this
report. Neither the bill nor the report contain any limited tax
benefits or limited tariff benefits as defined in paragraphs
(f) or (g) of clause 9 of rule XXI.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

Compliance With Rule XIII, Cl. 3(e) (Ramseyer Rule)

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

SECTION 220 OF DIVISION J OF PUBLIC LAW 117-103

[Sec. 220. Of the amounts appropriated to the Department of
Veterans Affairs which become available on October 1, 2022, for
``Medical Services'', ``Medical Community Care'', ``Medical
Support and Compliance'', and ``Medical Facilities'', up to
$323,242,000, plus reimbursements, may be transferred to the
Joint Department of Defense--Department of Veterans Affairs
Medical Facility Demonstration Fund, established by section
1704 of the National Defense Authorization Act for Fiscal Year
2010 (Public Law 111-84; 123 Stat. 3571) and may be used for
operation of the facilities designated as combined Federal
medical facilities as described by section 706 of the Duncan
Hunter National Defense Authorization Act for Fiscal Year 2009
(Public Law 110-417; 122 Stat. 4500): Provided, That additional
funds may be transferred from accounts designated in this
section to the Joint Department of Defense--Department of
Veterans Affairs Medical Facility Demonstration Fund upon
written notification by the Secretary of Veterans Affairs to
the Committees on Appropriations of both Houses of Congress.]
----------

TITLE 38, UNITED STATES CODE

* * * * * * *

PART II--GENERAL BENEFITS

* * * * * * *

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

SUBCHAPTER SUBCHAPTER I--GENERAL

Sec.
1701. Definitions.

* * * * * * *

SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT

* * * * * * *

1720K. Infertility counseling and treatment; reimbursement of adoption
expenses.

* * * * * * *

Sec. 1720K. Infertility counseling and treatment; reimbursement of
adoption expenses

(a) Infertility Counseling and Treatment.--(1) Pursuant to
regulations the Secretary shall prescribe to carry out this
subsection, the Secretary may provide infertility counseling
and treatment, using assisted reproductive technology,
including in vitro fertilization, intrauterine insemination,
and other advanced reproductive technologies, to the following:
(A) A veteran--
(i) who is enrolled in the system of annual
patient enrollment established and operated
under section 1705 of this title; and
(ii) who, in the judgment of a health care
professional of the Department--
(I) has a service-connected
disability or condition causing or
aggravating infertility; or
(II) is infertile as a result of
having received medically necessary
treatment pursuant to this chapter.
(B) The spouse of a veteran described in subparagraph
(A), or the partner of a veteran described in
subparagraph (A) whom the veteran designates for
purposes of this subsection.
(2)(A) The Secretary may contract with a provider of in
vitro fertilization services to obtain donor gametes or embryos
from thirdparty donors.
(B) The Secretary may only obtain third-party donation of
gametes or embryos through a contract.
(C) The Secretary may not provide assisted reproductive
technology services or medical services to third-party donors.
(3)(A) The Secretary may contract with a facility to
furnish the cryopreservation, storage, and transportation of
gametes and embryos.
(B) The Secretary may not impose any limitation on the
period in which an embryo or gamete is cryopreserved and stored
pursuant to this subsection.
(4) The legal status, custody, future use, donation,
disposition, or destruction, of gametes or embryos relating to
infertility or treatment furnished under this subsection shall
be determined in accordance with the law of the State in which
the gametes or embryos are located.
(5)(A) In prescribing regulations to carry out this
subsection, the Secretary shall ensure that any in vitro
fertilization (including with respect to the number of
retrieval attempts and completed embryo transfer cycles) will
be--
(i) determined using the best medical evidence
available; and
(ii) provided in accordance with applicable standards
of care.
(B) In furnishing in vitro fertilization to a covered
individual pursuant to this subsection, the Secretary is
responsible only for payment of the costs of the in vitro
fertilization services.
(C) The Secretary may not furnish an in vitro fertilization
cycle to a covered individual under this subsection unless the
Secretary receives consent for such cycle from each of the
following:
(i) The covered individual.
(ii) If the covered individual is a spouse or partner
of a veteran as described in subparagraph (l)(B), the
veteran.
(iii) If applicable, the third-party donor.
(6) In this subsection:
(A) The term ``covered individual'' means a veteran,
spouse, or partner who receives infertility counseling
and treatment under paragraph (1).
(B) The term ``gamete'' means a mature sperm or an
oocyte or egg germ cell, as applicable.
(C) The term ``infertility'' means the inability to
procreate without the use of infertility treatment.
(D) The term ``in vitro fertilization'' means the
procedure in which an oocyte is removed from a mature
ovarian follicle and fertilized by a sperm cell outside
the human body and, at the appropriate time,
transferred into the uterus.
(E) The term ``third-party donor'' means an
individual who consents to donate the gametes or embryo
of the individual for use in treatment furnished
pursuant to this subsection.
(b) Adoption Reimbursement.--(1) Pursuant to regulations
the Secretary shall prescribe to carry out this subsection, the
Secretary may reimburse an eligible veteran for qualifying
adoption expenses incurred by the veteran in the adoption of a
child.
(2) For purposes of this subsection, an eligible veteran is
a veteran who meets the following criteria:
(A) The veteran is enrolled in the system of annual
patient enrollment established and operated under
section 1705 of this title.
(B) The veteran, in the judgment of the health care
professional of the Department--
(i) has a service-connected disability or
condition causing or aggravating infertility;
or
(ii) is infertile as a result of having
received medically necessary treatment pursuant
to this chapter.
(3) An adoption for which expenses may be reimbursed under
this subsection includes an adoption by a single person, an
infant adoption, an intercountry adoption, or an adoption of a
child with special needs (as defined in section 473(c) of the
Social Security Act (42 U.S.C. 673(c))).
(4) The Secretary may reimburse an eligible veteran for
qualifying adoption expenses under this subsection only after
the adoption is final.
(5) The Secretary may not reimburse an eligible veteran for
qualifying adoption expenses under this subsection for any
expense paid to or for the veteran under any other adoption
benefits program administered by the Federal Government or
under any such program administered by a State or local
government.
(6)(A)(i) The Secretary may not reimburse an eligible
veteran, or two eligible veterans who are partners, for
qualifying adoption expenses under this subsection for more
than one adoption.
(ii) The Secretary may not reimburse more than one eligible
veteran for the qualifying adoption expenses under this
subsection for the adoption of the same child.
(B) In prescribing regulations to carry out this
subsection, the Secretary shall establish minimum and maximum
amounts for the reimbursement of qualifying adoption expenses.
(7) In this subsection:
(A) Notwithstanding section 101 of this title, the
term ``child'' means an individual who is under the age
of eighteen years.
(B) The term ``qualified adoption agency'' means--
(i) a State or local government agency that
has responsibility under State or local law for
child placement through adoption;
(ii) a nonprofit, voluntary adoption agency
that is authorized by State or local law to
place children for adoption;
(iii) any other source authorized by a State
to provide adoption placement if the adoption
is supervised by a court under State or local
law; or
(iv) a foreign government or an agency
authorized by a foreign government to place
children for adoption, in any case in which--
(I) the adopted child is entitled to
automatic citizenship under section 320
of the Immigration and Nationality Act
(8 U.S.C. 1431); or
(II) a certificate of citizenship has
been issued for such child under
section 322 of that Act (8 U.S.C.
1433).
(C) The term ``qualifying adoption expenses'' means
reasonable and necessary expenses that are directly
related to the legal adoption of a child, but only if
such adoption is arranged by a qualified adoption
agency. Such term does not include any expense
incurred--
(i) by an adopting parent for travel; or
(ii) in connection with an adoption arranged
in violation of Federal, State, or local law.
(D) The term ``reasonable and necessary expenses''
includes--
(i) public and private agency fees, including
adoption fees charged by an agency in a foreign
country;
(ii) placement fees, including fees charged
adoptive parents for counseling;
(iii) legal fees (including court costs) or
notary expenses; and
(iv) medical expenses, including hospital
expenses of the biological mother of the child
to be adopted and of a newborn infant to be
adopted.

* * * * * * *

Changes in the 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 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 allowing unobligated
funds from prior appropriations acts for fiscal years 2017 and
2018 to be obligated under certain circumstances.
Language is included under Title I defining the
congressional defense committees.
Language is included under Title I for improving military
installation resilience.
Language is included under Title I for child development
centers planning and design.
Language is included under Title I for Natural Disasters.
Language is included under Title I for laboratory
facilities.
Language is included under Title I for Air Force Reserve
cost to complete projects.
Language is included under Title I for cost increases
identified subsequent to the fiscal year 2023 budget request.
Language is included under Title I providing additional
funds for Military Construction, Defense-Wide for cost
increases for major construction projects.
Language is included in Title I for planning and design of
water treatment and distribution facilities.
Language is included under Title I for unaccompanied
housing.
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 for child development
centers construction.
Language is included under Title II providing for the
reimbursement to the Department of Defense for the costs of
overseas employee mail.
Language is included under Title II to require 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 to require approval of
a transfer between development projects in the Information
Technology Systems account.
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 in contravention of certain breast cancer screening
guidance.
Language is included under Title II to allow covered
veterans and their spouses or partners, 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 from being denied timely access to
information.
Language is included under Title II prohibiting funding to
be used in a manner 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 2023 to convert any program that received
specific purpose funding in fiscal year 2022 to a general
purpose-funded program.
Language is included under Title II prohibiting the use of
dogs or cats as part of the conduct of any study.
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 and programmatic efforts to deliver
care for women veterans.
Language is included under Title II rescinding unobligated
balances in the ``Recurring Expenses Transformational Fund.''
Language is included under Title II requiring quarterly
reports on the status of the Veterans Medical Care and Health
Fund.
Language is included under Title II establishing a timeline
for construction in accordance with a lease.
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 prohibiting funding
beyond the current fiscal year unless expressly so provided.
Language is included under Title IV 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 IV providing funding to
expand the use of ``E-Commerce'' technologies and procedures.
Language is included under Title IV specifying the
Congressional committees that are to receive all reports and
notifications.
Language is included under Title IV prohibiting the
transfer of funds to any instrumentality of the United States
Government without authority from an appropriations Act.
Language is included under Title IV 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 IV requiring all reports
submitted to the Congress to be posted on the official public
Website of that agency.
Language is included under Title IV 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 IV prohibiting funds from
being used to pay for first-class travel in violation of
Federal regulations.
Language is included under Title IV 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 IV prohibiting the use of
funds in this Act to construct facilities on military
installations that do not meet resiliency standards.

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:

[dollars in thousands]
----------------------------------------------------------------------------------------------------------------
Appropriations in
Agency/program Last year of Authorization last year of Appropriations in
authorization level authorization this bill
----------------------------------------------------------------------------------------------------------------
Military Construction, Army............. 2022 1,727,943 1,051,772 997,425
Military Construction, Navy and Marine 2022 3,895,117 2,644,277 3,808,340
Corps..................................
Military Construction, Air Force........ 2022 2,485,424 2,204,750 2,291,156
Military Construction, Defense-Wide..... 2022 2,029,569 2,206,051 2,675,128
Military Construction, Army National 2022 391,993 337,893 325,658
Guard..................................
Military Construction, Air National 2022 382,250 305,050 193,983
Guard..................................
Military Construction, Army Reserve..... 2022 123,311 94,111 119,878
Military Construction, Navy Reserve..... 2022 71,804 71,804 30,337
Military Construction, Air Force Reserve 2022 164,074 120,074 82,123
North Atlantic Treaty Organization 2022 205,853 215,853 220,139
Security Investment Program............
Family Housing Construction, Army....... 2022 161,349 99,849 169,339
Family Housing Operation and 2022 391,227 391,227 446,411
Maintenance, Army......................
Family Housing Construction, Navy and 2022 77,616 77,616 337,297
Marine Corps...........................
Family Housing Operation and 2022 357,341 357,341 378,224
Maintenance, Navy and Marine Corps.....
Family Housing Construction, Air Force.. 2022 115,716 115,716 232,788
Family Housing Operation and 2022 325,445 325,445 365,222
Maintenance, Air Force.................
Family Housing Operation and 2022 49,785 49,785 50,113
Maintenance, Defense-Wide..............
Department of Defense Family Housing 2022 6,081 6,081 6,442
Improvement Fund.......................
Department of Defense Military 2022 494 494 494
Unaccompanied Housing Improvement Fund.
Base Realignment and Closure Account.... 2022 384,639 529,639 574,687
Dept. of Veterans Affairs, Major done each yr. ............... 1,611,000 1,371,890
Construction...........................
Dept. of Veterans Affairs, Major Leases. done each yr. ............... 283,381 224,075
Armed Forces Retirement Home............ 2022 75,300 77,000 152,360
----------------------------------------------------------------------------------------------------------------

Program Duplication

Pursuant to clause 3(c)(5) of rule XIII of the Rules of the
House of Representatives, 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.

BUDGETARY IMPACT OF THE FY 2023 MILITARY CONSTRUCTION, VETERANS
AFFAIRS, AND RELATED AGENCIES APPROPRIATIONS BILL PREPARED IN
CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SECTION
308(A) OF THE CONGRESSIONAL BUDGET ACT OF 1974

[In millions of dollars]

COMPARISON WITH BUDGET RESOLUTION

Pursuant to clause 3(c)(2) of rule XIII of the Rules of the
House of Representatives and section 308(a)(1)(A) of the
Congressional Budget Act of 1974, the following table compares
the levels of new budget authority provided in the bill with
the appropriate allocation under section 302(b) of the Budget
Act.

[In millions of dollars]
----------------------------------------------------------------------------------------------------------------
302(b) Allocation This Bill
---------------------------------------------------------------
Budget Budget
Authority Outlays Authority Outlays
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with Committee
allocations to its subcommittees: Subcommittee
on Military Construction, Veterans Affairs, and
Related Agencies
Discretionary............................... 150,500 145,000 150,500 \1\144,809
Mandatory................................... 147,729 149,341 147,729 \1\149,341
----------------------------------------------------------------------------------------------------------------
\1\Includes outlays from prior-year budget authority.

FIVE-YEAR OUTLAY PROJECTIONS

Pursuant to clause 3(c)(2) of rule XIII and section
308(a)(1)(B) of the Congressional Budget Act of 1974, the
following table contains five-year projections associated with
the budget authority provided in the accompanying bill as
provided to the Committee by the Congressional Budget Office.

[In millions of dollars]
------------------------------------------------------------------------
Outlays
------------------------------------------------------------------------
Projection of outlays associated with the recommendation:
2023................................................... \1\168,207
2024................................................... 122,940
2025................................................... 17,411
2026................................................... 5,230
2027 and future years.................................. 4,760
------------------------------------------------------------------------
\1\Excludes outlays from prior-year budget authority.

FINANCIAL ASSISTANCE TO STATE AND LOCAL GOVERNMENTS

Pursuant to clause 3(c)(2) of rule XIII and section
308(a)(1)(C) of the Congressional Budget Act of 1974, the
Congressional Budget Office has provided the following
estimates of new budget authority and outlays provided by the
accompanying bill for financial assistance to State and local
governments.

[In millions of dollars]
------------------------------------------------------------------------
Budget Authority Outlays
------------------------------------------------------------------------
Financial assistance to State and 265 \1\36
local governments for 2023.......
------------------------------------------------------------------------
\1\Excludes outlays from prior-year budget authority.

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

Committee Hearings

Pursuant to clause 3(c)(6) of rule XIII of the Rules of the
House of Representatives, the following hearings were used to
develop or consider the Military Construction, Department of
Veterans Affairs, and Related Agencies Appropriations Act,
2023:
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on March
31, 2022, entitled ``Military Privatized Housing Oversight''.
The Subcommittee received testimony from:
Major General Al Aycock, Military Partnership Executive,
Corvias Military Living
Mr. Cody Calderon, Private First Class, Military Privatized
Housing Resident
Rachel Christian, Founder and Chief Legislative Officer,
Armed Forces Housing Advocates
Patricia Coury, Deputy Assistant Secretary of Defense for
Housing, Department of Defense
Ms. Elizabeth A. Field, Director, Defense Capabilities
Management, Government Accountability Office (GAO)
Philip Rizzo, CEO/COO, Liberty Military Housing
Brian Stann, President/CEO, Hunt Military Communities
Rick Taylor, President, Facility Operations, Renovation,
and Construction, Balfour Beatty Communities
Carolyn Tregarthen, Managing Director, Lendlease
Communities
Nikki Wylie, Military Privatized Housing Resident
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on April
6, 2022, entitled ``FY 2023 Department of Veterans Affairs
Budget Hearing''. The Subcommittee received testimony from:
The Honorable Denis R. McDonough, Secretary, Department of
Veterans Affairs
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on April
27, 2022, entitled ``Meeting Veterans' Full Needs: Update on
Women's Health, Mental Health, Homelessness and Other
Programs''. The Subcommittee received testimony from:
Dr. Erica Scavella, Assistant Under Secretary for Health
for Clinical Services, Department of Veterans Affairs,
accompanied by:
Dr. David Carroll, Executive Director, Office of Mental
Health and Suicide Prevention, Department of Veterans Affairs
Dr. Patricia Hayes, Chief Officer, Office of Women's
Health, Department of Veterans Affairs
Dr. Benjamin Kligler, Executive Director, Office of Patient
Centered Care and Cultural Transformation, Department of
Veterans Affairs
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on April
28, 2022, entitled ``Air Force Installations and Quality of
Life Update''. The Subcommittee received testimony from:
Chief Master Sergeant JoAnne Bass, Chief Master Sergeant of
the Air Force
Mr. Bruce Hollywood, Space Force Associate Chief Operations
Officer
Brigadier General William Kale, Air Force Director of Civil
Engineers
Mr. Edwin H. Oshiba, Acting Assistant Secretary of the Air
Force for Installations, Environment and Energy
Chief Master Sergeant Roger Towberman, Chief Master
Sergeant of the Space Force
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on May
11, 2022, entitled ``Impacts of VA's Research Efforts on
Veterans''. The Subcommittee received testimony from:
Dr. Rachel Ramoni, Chief Research and Development Officer
(CRADO), accompanied by:
Dr. Patricia Hastings, Chief Consultant, Health Outcomes
Military Exposures
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on May
12, 2022, entitled ``Army Quality of Life and Installations
Update''. The Subcommittee received testimony from:
Lieutenant General Jason T. Evans, Deputy Chief of Staff of
the Army, G9
Sergeant Major Michael A. Grinston, Sergeant Major of the
Army
Ms. Rachel Jacobson, Assistant Secretary of the Army for
Installations, Energy and Environment
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on May
18, 2022, entitled ``Navy and Marine Corps Quality of Life and
Installations Update''. The Subcommittee received testimony
from:
Lt. General Edward Banta, Deputy Commandant of
Installations and Logistics for the Marine Corps
Ms. Meredith Berger, Assistant Secretary of the Navy for
Environment, Installations and Energy
Sergeant Major Troy Black, Sergeant Major of the Marine
Corps
Master Chief Petty Officer Russell Smith, Master Chief
Petty Officer of the Navy
Vice Admiral Ricky Williamson, Deputy Chief of Naval
Operations for Fleet Readiness and Logistics
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on May
19, 2022, entitled ``FY 2023 Member Day Hearing''. The
Subcommittee received testimony from:
The Honorable Veronica Escobar, Member of Congress
The Honorable Richard Hudson, Member of Congress
The Honorable Mikie Sherrill, Member of Congress

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 2022 and budget
estimates presented for fiscal year 2023.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

MINORITY VIEWS

The Military Construction, Veterans Affairs, and Related
Agencies Appropriations Bill for Fiscal Year 2023 includes
funding for veterans' programs, military construction projects,
military family housing, as well as the American Battle
Monuments Commission, Armed Forces Retirement Home, Arlington
National Cemetery, and the Court of Appeals for Veterans
Claims.
We strongly support the funding provided for child
development centers and barracks projects. We also appreciate
the funding for many important military construction,
installation resilience, and environmental remediation
projects.
We support the funding provided for veterans' programs,
especially for mental health, suicide prevention, homelessness,
gender-specific care for women veterans, and research. We also
support funding for the Electronic Health Record Modernization
Initiative and the strong oversight mechanisms included in bill
and report language.
We are concerned the bill does not include previously
enacted provisions prohibiting the closure of Naval Station,
Guantanamo Bay and the use of funds to build or renovate a
facility on U.S. soil to house detainees currently held there.
In various forms, these provisions have been included in the
bill since December 2009. We believe these provisions provide
protections to the American people and support our national
security interests in the Caribbean and Latin America.
We are also concerned this bill is based on a funding
framework that the Majority party developed without Republican
support, and that it does not appropriately allocate funds
between defense and non-defense programs.
If enacted into law, the Committee will need to address the
Sergeant First Class Heath Robinson Honoring our Promise to
Address Comprehensive Toxics Act of 2022 (i.e. PACT Act). It
would authorize funds to be appropriated to a new mandatory
fund in fiscal years 2023 through 2031 to increase funding,
over the fiscal year 2021 level, for veterans' health care
associated with exposure to environmental hazards and related
administrative expenses and research.
The shift of some veterans' health care costs from
discretionary spending (counted against the bill's 302(b)
allocation) to mandatory spending will have significant effects
on the annual appropriations process and topline discretionary
funding level. Even though these funds will move off of our
books, this Committee should work with the House Veterans
Affairs Committee to ensure this new authority is used
appropriately and the Department of Veterans Affairs is held
accountable.
Despite our concerns, 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 bill for Fiscal Year 2023.

Kay Granger.
John R. Carter.

[all]