[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:

----------------------------------------------------------------------------------------------------------------
                 State                            Location                   Project                 Amount
----------------------------------------------------------------------------------------------------------------
FL.....................................  MCSF Blount Island.......  Communications                    $5,949,000
                                                                     Infrastructure
                                                                     Modernization.
----------------------------------------------------------------------------------------------------------------

    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:

----------------------------------------------------------------------------------------------------------------
                 State                            Location                   Project                 Amount
----------------------------------------------------------------------------------------------------------------
FL.....................................  MacDill AFB..............  SOF Joint MISO Web-               $8,730,000
                                                                     Operations Facility.
FL.....................................  MacDill AFB..............  SOF Operations                    50,000,000
                                                                     Integration Facility.
----------------------------------------------------------------------------------------------------------------

    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:

----------------------------------------------------------------------------------------------------------------
                 State                            Location                   Project                 Amount
----------------------------------------------------------------------------------------------------------------
FL.....................................  Camp Blanding............  Automated Multipurpose            $1,080,000
                                                                     Machine Gun Range.
FL.....................................  Camp Blanding............  Scout Recce Gunnery                2,300,000
                                                                     Complex.
----------------------------------------------------------------------------------------------------------------

    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:

----------------------------------------------------------------------------------------------------------------
                 State                            Location                   Project                 Amount
----------------------------------------------------------------------------------------------------------------
AL.....................................  Montgomery Regional        F-35 Weapons Load Crew            $6,800,000
                                          Airport ANG Base.          Training Facility.
AZ.....................................  Morris ANG Base..........  Base Entry Complex.......         12,000,000
FL.....................................  Jacksonville               F-35 Munitions                       530,000
                                          International Airport.     Maintenance & Inspection
                                                                     Facility.
FL.....................................  Jacksonville               F-35 Construct Munitions             770,000
                                          International Airport.     Storage Area Admin & Pad.
----------------------------------------------------------------------------------------------------------------

    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:

----------------------------------------------------------------------------------------------------------------
                 State                            Location                   Project                 Amount
----------------------------------------------------------------------------------------------------------------
VA.....................................  Joint Base Langley-Eustis  AFRC Intelligence Group           $5,500,000
                                                                     Facility.
----------------------------------------------------------------------------------------------------------------

    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]