[House Report 117-81]
[From the U.S. Government Publishing Office]


117th Congress    }                                     {      Report
                        HOUSE OF REPRESENTATIVES
 1st Session      }                                     {      117-81

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



 
     MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES 
                       APPROPRIATIONS BILL, 2022

                                _______
                                

  July 2, 2021.--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. 4355]

    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, 2022.

                        INDEX TO BILL AND REPORT

                                                            Page Number

                                                            Bill Report
Purpose of the Bill........................................     1
                                                                      2
Summary of Committee Recommendation........................     1
                                                                      2
Management and Oversight Initiatives.......................     2
                                                                      3
Department of Defense:
        Military Construction..............................     2
                                                                      6
        NATO Security Investment Program...................     9
                                                                     21
        Department of Defense Base Closure Account.........    10
                                                                     21
        Family Housing Construction and Operation and 
            Maintenance....................................    10
                                                                     22
        Department of Defense Family Housing Improvement 
            Fund...........................................    12
                                                                     24
        Department of Defense Military Unaccompanied 
            Housing Improvement Fund.......................    12
                                                                     24
        Administrative Provisions..........................    12
                                                                     24
Department of Veterans Affairs:
        Veterans Benefits Administration...................    27
                                                                     29
        Veterans Health Administration.....................    31
                                                                     38
        National Cemetery Administration...................    35
                                                                     72
        Departmental Administration........................    36
                                                                     73
        Administrative Provisions..........................    44
                                                                     84
Related Agencies:
        American Battle Monuments Commission...............    71
                                                                     89
        U.S. Court of Appeals for Veterans Claims..........    72
                                                                     89
        Cemeterial Expenses, Army..........................    72
                                                                     89
        Armed Forces Retirement Home.......................    73
                                                                     90
        Administrative Provision...........................    74
                                                                     91
General Provisions.........................................    74
                                                                     91

                          Purpose of the Bill

    The purpose of the bill is to support our military and 
their families and provide the benefits and medical care that 
our Veterans have earned because of their service to our 
Nation. This is accomplished through the programs funded in the 
bill, which provide the facilities and infrastructure needed to 
house, treat, train, and equip our military personnel to defend 
this Nation, both in the United States and abroad; provide the 
housing and military community infrastructure that supports a 
good quality of life for them and their families; and allow the 
military to maintain an efficient and effective base structure. 
The quality of life for our servicemembers and their families 
is a key component of readiness. The bill also funds a wide 
variety of assistance programs for Veterans, including 
disability and pension benefits, healthcare in many different 
settings, educational assistance, and home loan and insurance 
programs. Finally, the bill funds four related agencies that 
provide support to our Nation's heroes: the American Battle 
Monuments Commission, Cemeterial Expenses, Army (including 
Arlington National Cemetery), the United States Court of 
Appeals for Veterans Claims, and the Armed Forces Retirement 
Home.

                  Summary of Committee Recommendation

    The Committee recommends $279,940,055,000 in total budget 
authority, for the fiscal year 2022 programs and activities 
funded in the bill. The fiscal year 2022 recommendation 
represents an increase of $28,085,503,000 above the comparable 
fiscal year 2021 enacted level and $1,252,791,000 above the 
President's request. Of the increase over the fiscal year 2021 
enacted level, $16,709,491,000 is in mandatory programs. 
Included in the total budget authority is $155,440,055,000 in 
mandatory budget authority and $124,500,000,000 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 10.1 percent above the fiscal year 2021 enacted level. While 
the Committee recommendation continues essential support for 
servicemembers and Veterans, it does not provide funds for 
projects or activities that lacked sufficient justification or 
urgency.
    The programs funded in the bill for the Department of 
Defense (DOD) address the priorities of the Department's 
Agencies and the Services for the numerous facility challenges 
that they face. The funds provided support readiness 
improvements with new construction, family housing, and 
continued cleanup of military bases closed during previous Base 
Realignment and Closure rounds, support Combatant Commanders' 
requirements where appropriate, and ensure that our military 
personnel and their families' quality of life is preserved.
    The total recommended funding level for military 
construction and family housing, is $10,918,400,000 which is 
$2,854,400,000 more than the fiscal year 2021 enacted level and 
$1,071,369,000 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 care development centers, 
barracks, the Shipyard Infrastructure Optimization Plan, 
installation resiliency, natural disaster recovery expenses, 
and support for critical overseas investments. Finally, the 
total provides $149,800,000 for the Services' cost to complete 
projects, which are previously appropriated projects that have 
experienced an increase in cost from the original contract 
award.
    The total recommended funding level for fiscal year 2022 
for the Department of Veterans Affairs is $268,586,855,000, an 
increase of $25,424,618,000 over the fiscal year 2021 enacted 
level. Of the total, $155,440,055,000 is provided for mandatory 
benefit programs and $113,146,800,000 is allocated to 
discretionary programs such as medical care, claims processing, 
and construction. In this bill, discretionary funding for the 
Department of Veterans Affairs is recommended at 8.3 percent 
over the fiscal year 2021 enacted level. Of the total for 
fiscal year 2022, $94,183,260,000 for medical care has been 
appropriated in advance.
    In addition, the Committee recommendation includes 
$111,287,000,000 in advance appropriations for fiscal year 2023 
for the four health care accounts of the Department and 
$156,586,190,000 in advance appropriations for mandatory 
benefits programs in fiscal year 2023.
    The Committee recommendation provides a total of 
$434,800,000 for the four Related Agencies: The American Battle 
Monuments Commission (ABMC), the U.S. Court of Appeals for 
Veterans Claims, Arlington National Cemetery, and the Armed 
Forces Retirement Home. The recommendation represents an 
increase of $5,000,000 above the budget request. These funds 
are provided to ensure that these agencies are able to continue 
their missions of honoring the service and sacrifice of our 
servicemembers and Veterans.

                  Management and Oversight Initiatives

    The Committee believes the effective stewardship of 
taxpayer dollars is of the highest priority. In the interest of 
eliminating waste, fraud, and abuse in Federal programs, the 
Committee has and will continue to use public hearings, 
briefings, information requests, and reviews by the Government 
Accountability Office (GAO) and the Inspectors General to 
promote strong financial and program management, oversight and 
leadership at the Department of Defense (DOD), the Department 
of Veterans Affairs (VA), and Related Agencies under the 
jurisdiction of this bill.
    The fiscal year 2022 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.
    The Committee notes that the Commerce, Justice, Science, 
and Related Agencies Appropriations Act, 2022 directs the 
Attorney General to continue efforts to implement training 
programs to cover the use of force and de-escalation, racial 
profiling, implicit bias, and procedural justice, to include 
training on the duty of Federal law enforcement officers to 
intervene in cases where another law enforcement officer is 
using excessive force, and make such training a requirement for 
Federal law enforcement officers. The Committee further notes 
that several Departments and agencies funded by this Act employ 
Federal law enforcement officers and are Federal Law 
Enforcement Training Centers partner organizations. The 
Committee directs such Departments and agencies to adopt and 
follow the training programs implemented by the Attorney 
General, and to make such training a requirement for its 
Federal law enforcement officers. The Committee further directs 
such Departments and agencies to brief the House and Senate 
Committees on Appropriations on their efforts relating to 
training no later than 90 days after the date of enactment of 
this Act.
    In addition, the Committee directs such Departments and 
agencies, to the extent that such Departments and agencies have 
not already done so, to submit their use of force data to the 
Federal Bureau of Investigation (FBI)'s National Use of Force 
Data Collection database. The Committee further directs such 
Departments and agencies to brief the House and Senate 
Committees on Appropriations no later than 90 days after the 
date of enactment of this Act on their current efforts to 
tabulate and submit their use of force data to the FBI.
    Department of Defense Military Family Housing.--Privatized 
housing has come under scrutiny in recent years. Complaints of 
inadequate housing across the DOD enterprise include lack of 
repairs, rodents, mold, cracks in walls and peeling paint. The 
military housing privatization initiative (MHPI) was 
established by Congress in 1996 as a tool to help DOD improve 
the quality of life for its servicemembers by improving the 
condition of their housing. MHPI is a public/private venture 
(PPV) where private sector developers may own, operate, 
maintain, improve and assume responsibility for military family 
housing. The private entity is responsible for managing the 
construction, renovation, and day-to-day maintenance and 
services for the community. The PPV housing may be located on 
or off government property and may be former military family 
housing. Congress has mandated that all military family housing 
in the United States be eventually privatized. The Committee 
also includes report language directing DOD to submit various 
reports and maintain a maintenance database to track any issues 
that may be prevalent in the future. The Committee notes that 
the general welfare of a servicemember's family contributes to 
the overall state of readiness for DOD.
    VA Electronic Health Record Modernization (EHRM).--After at 
least a decade of Congressional encouragement to DOD and VA to 
develop a single electronic health record (EHR), VA finalized a 
contract in 2018 to acquire the same EHR system that DOD is 
adopting. The bill includes $2,637,000,000 for EHRM and 
continues strict quarterly reporting of timelines, performance 
milestones, costs, implementation, and change management. The 
bill also continues the requirement for GAO to review EHRM 
implementation so that Congress can be informed of any problems 
at a point where they can be promptly and economically 
addressed.
    Disability Claims and Appeals.--Due to the significant 
investments Congress has provided in recent years, VA has been 
able to hire the staff, acquire the technology, and change work 
processes necessary to significantly reduce the disability 
claims backlog. But as the number of claims continues to 
increase and the number of appeals skyrockets once claims are 
decided, VA again runs the risk of falling into serious claims 
and appeals backlogs. The Committee recognizes this threat and 
provides resources within the Veterans Benefits Administration 
to support staffing, scanning of records, and other efforts to 
respond to claims. The Committee additionally provides 
increases to the Board of Veterans Appeals and the Court of 
Appeals for Veterans Claims to help ensure the prompt 
resolution of cases. The Committee hopes that with these 
additional investments and the recently passed legislation to 
reform the appeals process, Congress will have taken the 
necessary management action to prevent Veterans from enduring 
excessive wait times to receive the disability benefits they 
deserve.
    Information Technology (IT).--The Committee continues to 
include bill language indicating that funds for information 
technology systems development are available only for the 
projects and in the amounts specified in the report. The bill 
limits the amount of funds that can be transferred into the IT 
account to ten percent of the total of either the source or 
destination account. The bill contains language that permits 
the reprogramming of funds among development projects upon 
prior notification to, and approval by, the Committees.
    Stricter Control of Construction Funding.--The Committee 
continues to request that VA provide quarterly briefings on the 
progress and cost of each facility managed by an outside 
entity. Several additional bill language provisions are 
included to enhance the Committee's capacity to conduct 
oversight of VA's facility construction efforts including: (1) 
no funding greater than $7,000,000 may be reprogrammed between 
construction projects unless approved by the Committees on 
Appropriations of both Houses of Congress; (2) any change to 
the scope of a construction project is prohibited without the 
approval of the Committees; and (3) VA must report any bid 
savings of $5,000,000 or more on projects as soon as they are 
identified.
    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.
    Army Corps of Engineers Updates on VA projects.--The 
Committee is concerned that VA projects under management of the 
Army Corps of Engineers (USACE) might be delayed due to 
administrative delays during the initial transitional phase 
between projects being authorized and appropriated by Congress, 
and an interagency agreement being signed. Accordingly, the 
Committee directs VA to continue to provide monthly updates on 
all current and subsequent VA construction projects worth more 
than $100,000,000 and jointly managed by VA and USACE. Regular 
reports for certain projects may be submitted on a quarterly 
basis if the Department and Committee come to an agreement that 
more frequent reports are not necessary.
    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 2023 budget 
justification: Expenditures for fiscal year 2021 and expected 
expenditures for fiscal year 2023, 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.
    VA-DOD Joint Venture Facilities.--The Committee recognizes 
the significant potential to improve access, quality and cost-
effectiveness of healthcare delivery to veterans, 
servicemembers and their families across the Indo-Pacific 
through greater integration of the Spark M. Matsunaga VA 
Medical Center and Tripler Army Medical Center VA-DOD Joint 
Venture. The Committee encourages the DOD and VA to seek 
further opportunities to cooperate and integrate medical 
personnel and services. Therefore the Committee directs the DOD 
and VA to each submit a report no later than 180 days after the 
enactment of this Act on (1) lessons learned from existing VA-
DOD joint ventures facilities; (2) performance measures used 
for each joint venture to assess and manage shared healthcare 
resource-sharing goals; and (3) the benefits of further 
integration of staff and services between VA-DOD joint venture 
facilities to include communication channels, facility 
planning, primary healthcare, specialty healthcare, mental 
healthcare, and training.

                                TITLE I


                         DEPARTMENT OF DEFENSE


                     Military Construction Overview


 
 
 
Appropriation, fiscal year 2021.......................    $8,064,000,000
Budget request, fiscal year 2022......................     9,847,031,000
Committee Recommendation, fiscal year 2022............    10,918,400,000
    Change from enacted level.........................    +2,854,400,000
    Change from budget request........................    +1,071,369,000
 

    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 2022 and each quarter thereafter of projects 
that remain unawarded from the current and prior fiscal years 
and the reasons for delay.
    Transfer of Funds To and From the Foreign Currency 
Fluctuations, Construction, Defense Account.--The Committee 
directs DOD to submit a quarterly report to the Committees on 
Appropriations of both Houses of Congress on the transfer of 
funds from military construction and family housing accounts to 
the Foreign Currency Fluctuations, Construction, Defense 
account. The report shall specify the amount transferred to the 
Foreign Currency account from each military construction and/or 
family housing account, and all other accounts for which an 
appropriation is provided in this Act, during the preceding 
fiscal quarter, and the amounts transferred from the Foreign 
Currency account to the above accounts during the same period. 
This report shall be submitted no later than 30 days after the 
close of each fiscal quarter. In addition, DOD shall notify the 
Committees on Appropriations of both Houses of Congress within 
seven days of transferring any amount in excess of $10,000,000 
to or from the Foreign Currency account.
    Bid Savings.--The Committee directs the Secretary of 
Defense to continue to submit 1002 reports on military 
construction bid savings at the end of each fiscal quarter to 
the subcommittees on Military Construction, Veterans Affairs, 
and Related Agencies of both Houses of Congress.
    Investing in Multi-hazard Resilient Defense Infrastructure 
Planning, Development, and Testing.--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. Therefore, the 
Committee recommendation includes twelve projects that have 
been incrementally funded; however, the full authorization of 
the projects will be provided in the fiscal year 2022 National 
Defense Authorization Act.
    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 
$213,000,000 for 7 child development center projects. This 
investment of resources is necessary to address both 
insufficient accessibility to child care 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 child care. 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 Housing.--The Committee provides $237,200,000 
for 7 additional barracks projects to ensure that 
servicemembers who live in unaccompanied personnel housing have 
safe, modern, and secure living facilities, for a total of 
$550,000,000 in fiscal year 2022.
    ROTC Facilities.--The Committee is concerned that certain 
new ROTC sites may not have adequate infrastructure for the 
success of the program, particularly in non-contiguous states. 
The Committee directs the DOD to report back no later than 180 
days after enactment of this legislation on (1) unmet 
requirements for ROTC facilities in non-contiguous states, 
particularly in states and territories with relatively new ROTC 
programs; and (2) options for addressing these requirements.
    U.S. Indo-Pacific Command Planning and Design.--The 
recommendation includes $15,000,000 for U.S. Indo-Pacific 
Command Planning and Design, World-Wide Unspecified (Pacific 
Deterrence Initiative).
    DOD Strategy for Joint-Use Facilities.--When planning for 
facilities and infrastructure that might be used by multiple 
services with the DOD or by another Federal Agency, the DOD has 
no written long-term strategy. Instead, joint use facilities 
are authorized on a case-by-case basis. In the Indo-Pacific 
area of operations, where facility locations are limited by 
geography and host country agreements, this results in the 
potential inefficient use of facilities and infrastructure and 
missed opportunities to address military construction needs in 
a cost-effective manner. Therefore, the Committee directs the 
Assistant Secretary of Defense for Sustainment to report no 
later than 180 days after the enactment of this legislation on: 
(1) the overall strategy for joint use facilities in the Indo-
Pacific; (2) the challenges and benefits of adding ports to the 
DODs joint-use planning; and (3) limitations imposed by current 
authorities that may hinder cost-sharing efforts.
    Unfunded Priority Lists (UPL) and Future Years Defense 
Program (FYDP).--The Committee directs the Department of 
Defense to submit updated UPL and FYDP lists to the 
congressional defense committees for military construction 
projects no later than the transmission of the yearly 
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 and 
increasing functionality of various military structures. The 
Committee encourages the Secretary of Defense to expand the 
application of these innovative technologies in future military 
construction projects.
    Efficiency within the Military Construction Accounts.--The 
Committee supports military construction projects that 
incorporate requirements from both Active Duty and Reserve and 
Guard components in order to maximize efficiency within 
military construction accounts and eliminate the need for 
multiple construction projects and reduces costs.
    Joint Base Pearl Harbor-Hickam.--The Committee recognizes 
the challenges the Navy and Air Force face to preserve key 
aspects of historical structures related to the December 7, 
1941, attacks on Joint Base Pearl Harbor-Hickam (JBPHH), 
including aircraft hangars. While the JBPHH continues to 
maintain its hangars and works to meet its legal obligations 
under the National Historic Preservation Act, many of its 
hangar facilities have become unsafe, costly-to-maintain, or no 
longer used for their intended purpose. This exposes many 
aviation assets to the elements, shortening their useful lives 
and increasing operating costs. To better assess this 
assistance and determine what additional support may be needed 
to help JBPHH meet its operational needs and ensure compliance 
with existing laws, the Committee directs the Assistant 
Secretary of the Navy for Energy, Installations, and the 
Environment, to submit a report no later than 180 days after 
the enactment of this legislation describing the status of all 
historic aircraft hangars at JBPHH including: (1) how many 
hangars are no longer capable of housing aircraft; (2) current 
use limitations for each hanger that can support aircraft; (3) 
how JBPHH uses hangers that cannot support aircraft; (4) a 
description of the outstanding repairs needed to ensure the 
efficient and effective use of the hangers; and (5) how many 
aircraft remain unprotected on the flight line due to lack of 
sufficient hangar space.

                      Military Construction, Army


 
 
 
Appropriation, fiscal year 2021.......................      $628,900,000
Budget request, fiscal year 2022......................       834,692,000
Committee Recommendation, fiscal year 2022............       898,692,000
    Change from enacted level.........................      +269,792,000
    Change from budget request........................       +64,000,000
 

    The Committee recommends $898,692,000 for the Army in 
fiscal year 2022, of which $62,010,000 is for the following 
projects in the following amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Camp Bullis at Joint Base San Antonio--Vehicle               $10,000,000
 Maintenance Shop....................................
Anniston Army Depot--Welding Facility................         25,010,000
Fort Drum--Wellfield Expansion Resilience Project....         27,000,000
------------------------------------------------------------------------

    Within the total for Military Construction, Army, the 
recommendation also includes $181,649,000 for planning and 
design, which is $30,000,000 above the budget request; and 
$60,543,000 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.
    Redstone Arsenal.--The Committee is concerned that the 
projected project timeline for the Gate 7 Access Control Point 
at the Redstone Arsenal is insufficient to meet current and 
future demands at the base. The Committee encourages the Army 
to expedite the planning and construction of Gate 7.
    Mobilization Force Generation Installations.--The Committee 
is 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. Therefore, the Secretary of the Army is directed 
to conduct a review of rail and transport logistics 
infrastructure and equipment deployment methods at 
installations with rapid deployment requirements. This review 
and a plan to address the issues identified in the review, 
delineated by fiscal year, must be submitted to the 
congressional defense committees no later than 90 days after 
the enactment of this Act.
    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 on 
installations whose condition has fallen below the Army's high 
standards.
    Immediate Response Force (IRF).--The Committee is concerned 
that without significant investment, the Army is not prepared 
to maintain the requirements of the Immediate Response Force 
(IRF) to be able to deploy anywhere in the world within 18 
hours. In order to deter aggression against U.S. interests and 
maintain an effective global deterrent, there are significant 
military construction needs across installations that cannot be 
sufficiently mitigated with other funding sources. The 
Committee urges the Army to prioritize facilities that will 
support the global mission of the IRF and maintain this 
critical capability.
    Kawaihapai (Dillingham) Airfield.--The Committee is aware 
that the Hawai'i Department of Transportation (HDOT) is seeking 
to cancel its lease with the U.S. Army for civilian use of 
Kawaihapai (Dillingham) Airfield. The Committee encourages the 
U.S. Army Garrison Hawai'i to work with HDOT, the Federal 
Aviation Administration, and other stakeholders to assess 
various long-term options to maximize the use of Kawaihapai 
Airfield. The Committee recognizes that a confounding lease 
term for HDOT is maintenance of the airfield's private water 
system. Potable water for the airfield comes from an on-site 
well. Water is distributed free of charge to the City and 
County of Honolulu for use at Mokuleia Beach Park, Camp Erdman 
YMCA, several private residences, and the Kaena Point Satellite 
Tracking Station, five miles to the west. The Committee directs 
the U.S. Army to develop a plan for establishing a water 
utility cooperative or other structure to manage the water 
system on the airfield.

              Military Construction, Navy and Marine Corps


 
 
 
Appropriation, fiscal year 2021.......................    $1,716,144,000
Budget request, fiscal year 2022......................     2,368,352,000
Committee Recommendation, fiscal year 2022............     1,937,428,000
    Change from enacted level.........................      +221,284,000
    Change from budget request........................      -430,924,000
 

    The Committee recommends $1,937,428,000 for the Navy and 
Marine Corps in fiscal year 2022, of which $7,000,000 is for 
the following planning and design project in the following 
amount:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Marine Corps Support Facility Blount Island--P-021            $7,000,000
 Lighterage and Small Craft Facility Center..........
------------------------------------------------------------------------

    Within the total for Military Construction, Navy and Marine 
Corps, the recommendation also includes $413,252,000 for 
planning and design, which is $50,000,000 above the budget 
request; and $81,435,000 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.--The Committee 
recognizes the critical strategic and logistics role our public 
shipyards play in the security of our 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 is very concerned that the Navy's Shipyard 
Infrastructure Optimization Plan is falling behind schedule 
because details on multiple projects that are needed to 
properly assess and evaluate this critical recapitalization 
effort have not been timely and fully provided to the 
Committee. There are also concerns whether the Navy can 
maintain its current operational depot level maintenance 
schedule as dry docks are temporarily unavailable when they are 
upgraded and replaced, if current construction plans accounts 
for unforeseen ship and submarine maintenance, whether adequate 
resourcing has been provided to the managing program office to 
mitigate the risk of construction cost increases, and how the 
Navy will meet its commitment to its budget for these projects. 
Additionally, despite a previously enacted reporting 
requirement outlined in Section 346 of the National Defense 
Authorization Act for Fiscal Year 2021 (P.L. 116-57), no 
information from the Navy has been forthcoming. Therefore, the 
Committee directs the Navy to suspend further expenditure of 
the supplemental planning and design funding provided to the 
Shipyard Infrastructure Optimization Plan under Public Law 116-
260 unless and until a detailed status report on plan 
implementation is transmitted to all committees of 
jurisdiction.
    The Committee recognizes that Project Labor Agreements 
(PLAs) promote economy and efficiency in contracting, as well 
as foster labor-management stability and ensure compliance with 
worker protection laws. The Committee is also aware that the 
first military construction project which used a PLA, the 
Explosive Handling Wharf at Naval Base Kitsap, came under 
budget by over $250,000,000 when it was completed in 2016. For 
these reasons, the Committee encourages the Department of the 
Navy to utilize PLAs for military construction projects that 
will take place at the Navy's four public shipyards as part of 
the Shipyard Infrastructure Optimization Plan.
    The Committee is also concerned that the Navy's Shipyard 
Infrastructure Optimization Plan may not sufficiently account 
for the differences between the nation's four historical public 
shipyards. Each shipyard has a unique history, design, and 
local workforce with valuable knowledge of its respective 
facilities that can help ensure the proper modernization and 
optimization of these facilities. Rather than relying solely on 
a one-size-fits-all approach that is centralized without fully 
considering local conditions, the Committee urges the Navy's 
Shipyard Infrastructure Optimization Plan program office to 
seek more input and engagement from these local workforces and 
their installation leadership to efficiently and effectively 
build and maintain shipyards that can sustain the fleet for 
generations to come.
    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. The Committee also 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.
    JB Pearl-Harbor Dry Dock 3.--The older Dry Dock 3 will be 
filled in during the construction of the newer and larger Dry 
Dock 5. The Committee is concerned that with the last scheduled 
availability for Dry Dock 3 in 2023 and with Dry Dock 5 not 
scheduled for completion until 2028, there will be a 
significant lack of facilities to maintain fleet readiness. 
Additionally, during this time the local shipyard workforce 
will be underutilized, adversely affecting the local defense 
industrial base. Therefore, the Committee directs Naval Sea 
Systems Command to submit a report, no later than 180 days 
after enactment of this legislation, detailing (1) the impact 
of the current military construction timelines shipyard 
availabilities from FY 2024 through FY 2029, and (2) the 
planned utilization of the PHYNSY & IMF workforce during this 
same period if Dry Dock 5 is not completed before the closure 
of Dry Dock 3.
    Hawaii Infrastructure Readiness Initiative (HIRI).--HIRI 
was created by Congress to address critical military 
construction and readiness shortfalls. Failing and failed 
infrastructure has put operational needs at risk. To fix this 
crisis, HIRI allocates between $50,000,000 and $150,000,000 per 
year through FY 2030 to address major infrastructure needs, 
with a ten-year cost of $1,100,000,000 billion. However, it has 
come to the Committee's attention that competing demands with 
the Army military construction plan may have caused the 
deferral of several HIRI projects until later years. 
Additionally, the Committee is concerned that the Army has 
arbitrarily limited annual HIRI spending to $100,000,000, which 
has caused several inefficiencies such as the segmented 
construction of aviation facilities over several years in order 
to keep annual construction within $100,000,000. Therefore, the 
Committee directs the Secretary of the Army to submit a report 
no later than 180 days after the enactment of this legislation 
consisting of: (1) a certified list of HIRI projects for the 
next 8 fiscal years; (2) a list of infrastructure requirements 
that cannot be met under current HIRI funding; (3) detailed 
criteria as to how the Army selects and prioritized HIRI 
projects; and (4) confirmation that the Army has not self-
imposed yearly spending caps that are resulting in cost 
inefficiencies.

                    Military Construction, Air Force


 
 
 
Appropriation, fiscal year 2021.......................      $616,156,000
Budget request, fiscal year 2022......................     2,102,690,000
Committee Recommendation, fiscal year 2022............     1,893,690,000
    Change from enacted level.........................    +1,277,534,000
    Change from budget request........................      -209,000,000
 

    The Committee recommends $1,893,690,000 for the Air Force 
in fiscal year 2022, of which $82,000,000 is for the following 
projects in the following amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Lackland AFB at Joint Base San Antonio--Child                $22,000,000
 Development Center..................................
Barksdale AFB--New Entrance Road and Gate Complex....         36,000,000
Wright Patterson Air Force Base--Child Development            24,000,000
 Center..............................................
------------------------------------------------------------------------

    Within the total for Military Construction, Air Force, the 
recommendation also includes $279,301,000 for planning and 
design, which is $50,000,000 above the budget request; and 
$83,884,000 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 because of the critical role training 
plays in the force readiness for future threats to national 
security. The Committee looks forward to receiving the report 
on the Secretary of the Air Forces efforts in these areas 
within 60 days of enactment of the Act.
    Access Control Points.--The Committee encourages the Air 
Force to accelerate funding for current access control point 
construction projects at installations that face high-security 
risks to critical missions and to prioritize funding for access 
control points in heavily congested areas in large urban 
settings that place major transportation links at risk of 
incident closures or that are required for heavy traffic hazard 
mitigation, airport security and installation force protection.
    Air Force Laboratory Infrastructure.--The Committee is 
concerned that aging laboratory infrastructure threatens the 
ability of the Air Force and Space Force to maintain the 
advanced technology necessary to keep ahead of U.S. adversaries 
in air, space, and cyberspace. No later than January 31, 2022, 
the Committee directs the Air Force to advance the top science 
and technology laboratories Major MILCON project or projects to 
a level of 35 percent complete design, based on the priorities 
established pursuant to section 2806 of the Duncan Hunter 
National Defense Authorization Act for Fiscal Year 2018 (P.L. 
115-91).

                  Military Construction, Defense-Wide


 
 
 
Appropriation, fiscal year 2021.......................    $2,041,909,000
Budget request, fiscal year 2022......................     1,957,289,000
Committee Recommendation, fiscal year 2022............     2,023,416,000
    Change from enacted level.........................       -18,493,000
    Change from budget request........................       +66,127,000
 

    The Committee recommends $2,023,416,000 for Military 
Construction, Defense-Wide in fiscal year 2022. Within the 
total, the recommendation provides $61,464,000 for unspecified 
minor construction, and $261,313,000 for planning and design, 
including $15,000,000 above the budget request for INDOPACOM.
    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 $382,980,000 for the Energy 
Resilience and Conservation Program, an increase of 
$136,380,000 above the request.
    Tripler Army Medical Center and Veterans Affairs.--As the 
largest military and veterans medical facility in the Pacific 
Basin, Tripler Army Medical Center and VA 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. According to Army's own assessment using 
formulas included in the Department of Defense Unified 
Facilities Criteria (UFC) 4-510-01, Design: Medical Military 
Facilities, the facility should have 5,936 parking stalls to 
accommodate its workforce and patients, but the facility only 
has 3,713 stalls. The facility is also not readily accessible 
to public transit, making ground transportation with parking 
the only reliable option for care. Currently there are no plans 
to construct a parking structure at Tripler Army Medical Center 
until tentative recapitalization plans for the entire facility 
are completed, which would further delay solutions to a problem 
that is already affecting elderly veterans, servicemembers and 
their families who depend upon this facility. Therefore, the 
Committee directs the Secretary of the Army and the Director of 
the Defense Health Agency, in consultation with the Department 
of Veterans Affairs, to submit a joint report to the 
congressional defense committees no later than 90 days after 
enactment of this Act detailing (1) the current parking 
situation and requirements of the facility over the next four 
years; (2) the estimated cost of constructing a parking 
facility separately from the recapitalization efforts of the 
primary Tripler Army Medical Center facility, to include likely 
cost items and possible category codes; and (3) estimated 
timeline for designing and constructing a typical parking 
structure in Hawaii.
    Defense Access Roads (DAR) Program.--The Committee supports 
Defense Access Roads as a vital mechanism to improve 
transportation infrastructure at domestic installations and 
their surrounding communities. The Fiscal Year 2020 National 
Defense Authorization Act clarified that appropriated funds for 
the DAR Program may be used to cover the cost of repairing 
damage or mitigating infrastructure risk to access roads caused 
by recurrent flooding or sea level fluctuation. The Committee 
urges the Department to identify military installations with 
transportation infrastructure affected by sea level fluctuation 
and recurrent flooding and, through the appropriate contacts at 
affected installations and sites, work with surrounding local 
communities to identify affected transportation infrastructure 
and conduct transportation needs assessments to understand the 
magnitude of the improvement required.
    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 
to encourage 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. Furthermore, 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 agreement provides $25,000,000 in planning and 
design and construction funding for each of the Services, and 
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 
fiscal year 2022.
    Missile Defense Capabilities on Guam.--The Committee is 
concerned about the lack of progress in addressing the military 
construction requirements to provide 360 degrees of persistent 
air and missile defense capability for Guam. Addressing this 
requirement is critical to protecting Guam, which is home to 
over 170,000 U.S. citizens, over 21,700 military members and 
their families, and vital defense assets. While the DOD has yet 
to settle on a qualified program of record to meet this 
requirement, progress can still be made to assess possible 
future locations and preliminary military construction planning 
for systems that could help protect Guam from precision, long-
range strikes. Therefore, the Committee directs the Director of 
the Missile Defense Agency to submit a report no later than 180 
days after enactment of this act detailing: (1) potential 
locations on Guam that could host either a large fixed or 
mobile platform capable of fulfilling requirements for an air 
and missile defense system; (2) approximate military 
construction costs associated with preparing each location to 
host a system; and (3) the time it will take before each 
location could be viable to the military construction need to 
host an acquired system.
    Energy Conservation.--The Committee commends the DOD's 
forward posture on the need to increase energy conservation 
efforts, limit carbon emissions, and reduce energy costs. As 
the DOD works to construct new facilities and upgrade 
facilities, the Committee urges the Secretary to evaluate and 
integrate the use of new and innovative technologies, such as 
batteryless sensors, to monitor and manage DOD energy resources 
more effectively.
    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.
    Resilient Military Installations.--The Committee supports 
the Department's efforts, including updating hurricane-related 
building codes for bases, barracks, hospitals, and airfields 
and investing in energy efficiency, renewable energy and water 
conservation projects, to ensure U.S. military installations 
are resilient and encourages the Services to seek out projects 
that mitigate risk to mission-critical assets while also 
providing resiliency.
    Comprehensive Energy Audits.--The Department of Defense is 
urged to increase the use of third-party comprehensive energy 
audits through the ERCIP.
    Batteryless Sensor Technology.--The Committee encourages 
the Energy Resilience and Conservation Investment Program to 
support technologies, including batteryless sensor technology, 
to monitor and reduce energy consumption and deliver a more 
resilient and sustainable infrastructure for the Department of 
Defense.
    Stormwater Best Management Practices.--The Committee 
commends the Department's work to address energy resiliency on 
military installations and encourages the Department to take 
similar steps to address water and flood resiliency. Of the 
amounts available for the Energy Resilience and Conservation 
Investment Program, the Committee supports investment in 
implementing and maintaining stormwater Best Management 
Practices that enhance resiliency and water quality on military 
installations. In addition to meeting force protection 
requirements, implementing and maintaining these Best 
Management Practices will help military installations reduce 
pollution runoff consistent with state-based watershed 
implementation plans required by the Environmental Protection 
Agency.
    Joint Spectrum Center.--The Committee directs the Secretary 
of Defense to provide the Committee with an update on the 
facility chosen for the Joint Spectrum Center's relocation and 
the timeline for execution, no later than 120 days after the 
enactment of this Act.

                      Guard and Reserve Initiative

    Regional Training Institutes.--The Committee recognizes the 
importance of Regional Training Institutes (RTI) across the 
country for the readiness of Army National Guard (ARNG) and is 
concerned about the lack of infrastructure to support the 
mission of the RTIs. For example, the RTI at Fort Hood is 
lacking sufficient facilities to provide the proper training to 
achieve optimum readiness. The Committee urges the Department 
of Defense to prioritize facilities for this important and 
vital mission of ARNG and Army Reserve.
    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 shall 
continue its efforts to establish the Center.

               Military Construction, Army National Guard


 
 
 
Appropriation, fiscal year 2021.......................      $349,437,000
Budget request, fiscal year 2022......................       257,103,000
Committee Recommendation, fiscal year 2022............       335,603,000
    Change from enacted level.........................       -13,834,000
    Change from Budget Request........................       +78,500,000
 

    The Committee recommends $335,603,000 for the Army National 
Guard in fiscal year 2022, of which $15,500,000 is for the 
following projects in the following amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Camp Shelby Joint Forces Training Center--                   $15,500,000
 Mobilization and Annual Training Equipment Site
 (MATES) Project.....................................
------------------------------------------------------------------------

    Within the total for Military Construction, Army National 
Guard, the recommendation also includes $72,000,000 for 
planning and design, which is $50,000,000 above the budget 
request; and $52,471,000 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.
    Readiness Center Transformation Master Plan.--The Army 
National Guard (ARNG) completed its Readiness Center 
Transformation Master Plan (RCTMP) in 2015; however, since that 
time, the investment in executing the military construction 
required under the RCTMP has not kept up with the demand. The 
Committee is concerned that the mission readiness of these 
critical facilities is further deteriorating, and it encourages 
increased investments in ARNG Readiness Centers over the FYDP. 
Further, given the changing conditions of readiness centers 
across the country since the last RCTMP was completed, the 
Committee encourages the ARNG to update the RCTMP to ensure 
current its military construction priorities align with the 
Transformation Master Plan. Accordingly, the Committee provides 
an additional $50,000,000 in Army National Guard planning & 
design and $100,000,000 for construction.
    ARNG Aviation Support Facilities.--The Committee is 
concerned that ARNG Aviation Support Facilities (AASF) are not 
prepared to protect and properly maintain next generation 
airframe priorities simultaneously as the Army. The operation 
and maintenance of new aircraft platforms requires significant 
investment in AASFs across the country so that they can provide 
the required shelter and support for new airframes, as well as 
regular maintenance for the existing airframes. The Committee 
urges both the Army and the ARNG to prioritize facilities that 
support readiness of ARNG aviation units as they prepare to 
gain new aircraft platforms.

               Military Construction, Air National Guard


 
 
 
Appropriation, fiscal year 2021.......................       $64,214,000
Budget request, fiscal year 2022......................       197,770,000
Committee Recommendation, fiscal year 2022............       246,770,000
    Change from enacted level.........................      +182,556,000
    Change from budget request........................       +49,000,000
 

    The Committee recommends $246,770,000 for the Air National 
Guard in fiscal year 2022, of which $24,000,000 is for the 
following projects in the following amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
New Castle County Airport--Delaware National Guard--         $17,500,000
 Fuel Cell and Corrosion Control Hangar..............
Boise Air Terminal (Gowen Field)--Medical Training             6,500,000
 Facility............................................
------------------------------------------------------------------------

    Within the total for Military Construction, Air National 
Guard, the recommendation also includes $28,402,000 for 
planning and design, which is $10,000,000 above the budget 
request; and $44,088,000 for unspecified minor construction, 
which is $15,000,000 above the budget request.
    Further detail of the Committee's recommendation is 
provided in the State table at the end of this report.
    C130-J Requirements.--The Committee is concerned with the 
state of ANG infrastructure across the country. Specifically, 
many of the ANG Aviation Support Facilities are not configured 
to protect and properly maintain the most modernized airframes. 
As the Air Force continues to select ANG units to receive the 
most current and modernized airframes, investments must be made 
in current facilities. The Committee encourages the ANG to 
utilize unspecified minor military construction, as authorized, 
to speed up projects across the country and increase the 
readiness of the ANG.
    Aviation Support Facility Relocation (AASF) and Aircraft 
Maintenance Hangar.--The Committee is concerned that there are 
existing inadequate facilities for Army National Guard aviation 
support. There are no other DoD aviation facilities available 
to support the requirement of certain aircraft. If replacement 
facilities are not constructed to meet maintenance and 
sustainment requirements it will directly result in the loss 
and relocation of aircraft and units. These types of facilities 
directly enable training, administrative, operational, and 
logistical requirements Army National Guard Army Aviation 
mission. Therefore, the Committee urges the Director of the 
National Guard to provide planning and design funds to these 
critical projects, that would facilitate the most efficient and 
least costly solution.

                  Military Construction, Army Reserve


 
 
 
Appropriation, fiscal year 2021.......................       $88,337,000
Budget request, fiscal year 2022......................        64,911,000
Committee Recommendation, fiscal year 2022............        77,411,000
    Change from enacted level.........................       -10,926,000
    Change from budget request........................       +12,500,000
 

    The Committee recommends $77,411,000 for the Army Reserve 
in fiscal year 2022, including $12,167,000 for planning and 
design, which is $5,000,000 above the budget request; and 
$22,044,000 for unspecified minor construction, which is 
$7,500,000 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 2021.......................       $70,955,000
Budget request, fiscal year 2022......................        71,804,000
Committee Recommendation, fiscal year 2022............        84,804,000
    Change from enacted level.........................       +13,809,000
    Change from budget request........................       +13,000,000
 

    The Committee recommends $84,804,000 for the Navy Reserve 
in fiscal year 2022, including $13,005,000 for planning and 
design, which is $7,000,000 above the budget request; and 
$8,359,000 for unspecified minor construction, which is 
$6,000,000 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, Air Force Reserve


 
 
 
Appropriation, fiscal year 2021.......................       $23,117,000
Budget request, fiscal year 2022......................        78,374,000
Committee Recommendation, fiscal year 2022............       104,574,000
    Change from enacted level.........................       +81,457,000
    Change from budget request........................       +26,200,000
 

    The Committee recommends $104,574,000 for the Air Force 
Reserve in fiscal year 2022, of which $8,700,000 is for the 
following projects in the following amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Youngstown Air Reserve Station--Assault Strip                 $8,700,000
 Widening............................................
------------------------------------------------------------------------

    Within the total for Military Construction, Air Force 
Reserve, the recommendation also includes $12,330,000 for 
planning and design, which is $6,500,000 above the budget 
request; and $26,444,000 for unspecified minor construction, 
which is $11,000,000 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 2021.......................      $173,030,000
Budget request, fiscal year 2022......................       205,835,000
Committee Recommendation, fiscal year 2022............       205,835,000
    Change from enacted level.........................       +32,823,000
    Change from budget request........................             - - -
 

    The North Atlantic Treaty Organization Security Investment 
Program (NSIP) consists of annual contributions by North 
Atlantic Treaty Organization (NATO) member countries. The 
program finances the costs of construction needed to support 
the roles of the major NATO commands. The investments cover 
facilities such as airfields, fuel pipelines and storage, 
harbors, communications and information systems, radar and 
navigational aids, and military headquarters, both within NATO 
Nations and for ``out of area'' operations such as Afghanistan.
    The United States occasionally has been forced to 
temporarily delay the authorization of projects due to 
shortfalls in United States obligation authority. The Committee 
directs the Secretary of Defense to notify the Committee within 
14 days of the United States taking action to delay the 
authorization of projects temporarily, or to temporarily 
withhold funds from previously authorized projects, due to 
shortfalls in U.S. obligation authority.

               Department of Defense Base Closure Account


 
 
 
Appropriation, fiscal year 2021.......................      $480,447,000
Budget request, fiscal year 2022......................       284,639,000
Committee Recommendation, fiscal year 2022............       564,639,000
    Change from enacted level.........................       +84,192,000
    Change from budget request........................      +280,000,000
 

    The Committee recommends $564,639,000 for the Base Closure 
account, which is $84,192,000 more than fiscal year 2021 and 
$280,000,000 above the budget request.
    The recommendation includes an additional $80,000,000 above 
the budget request for the Navy to accelerate environmental 
remediation at installations closed under previous Base Closure 
and Realignment (BRAC) rounds. Furthermore, the Navy shall 
provide to the Committee a spend plan for these additional 
funds no later than 60 days after enactment of this Act.
    The recommendation also provides an additional $50,000,000 
above the budget request for the Army to accelerate ordnance 
remediation at installations closed under previous Base Closure 
and Realignment rounds where the Army has a legal requirement 
to complete the clean-up by a specified date. Furthermore, the 
Army shall provide to the congressional defense committees a 
spend plan for these additional funds no later than 60 days 
after enactment of this Act.
    Hensley Field.--The Committee is concerned that 23 years 
after the closure of Naval Air Station Dallas (Hensley Field) 
in BRAC 1998, the Department of the Navy has not yet completed 
environmental remediation at the former Naval Air Station 
Dallas. The Committee therefore instructs the Navy to work with 
the City of Dallas and the Texas Commission on Environmental 
Quality to complete the environmental remediation of former 
Naval Air Station Dallas.
    Remediation Technologies at BRAC Sites.--The Committee is 
aware of promising technologies, including the supercritical 
water oxidation process, for destroying PFAS and encourages the 
Services to utilize these technologies, as appropriate, at BRAC 
cleanup sites.
    Perfluorooctane Sulfonate (PFOS) and Perfluorooctanoic Acid 
(PFOA).--The Committee continues to be very concerned about the 
extent of PFOS/PFOA contamination at U.S. military 
installations and how that contamination is measured. 
Therefore, the Committee includes an additional $150,000,000 
above the budget request within the Base Closure Account to 
increase the pace of cleanup at the military installations 
affected by PFOS/PFOA.
    PFOS/PFOA Regulation and Research.--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.
    PFOS/PFOA Reporting Requirement.--Over the past two fiscal 
years, the Committee has directed the Department to keep it 
apprised of new findings of PFOS/PFOA at BRAC sites. The 
Committee recognizes that the Services have provided some 
information. However, the process for identifying PFOS/PFOA 
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 a comprehensive report for the congressional defense 
committees no later than 60 days after enactment of this Act 
that establishes a baseline of information regarding PFOS/PFOA 
at closed military installations. At a minimum, the report 
should 1) provide a list of all closed military installations; 
2) indicate whether PFOS/PFOA 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 2021.......................    $1,336,592,000
Budget request, fiscal year 2022......................     1,423,554,000
Committee Recommendation, fiscal year 2022............     1,423,554,000
    Change from enacted level.........................       +86,962,000
    Change from budget request........................             - - -
 

    Family housing construction accounts provide funds for new 
construction, construction improvements, the federal 
government's costs for family housing privatization projects, 
and planning and design. The operation and maintenance accounts 
provide funds to pay for maintenance and repair, furnishings, 
management, services, utilities, leasing, interest, mortgage 
insurance, and miscellaneous expenses.
    Housing Support Costs and Management Accounts.--The 
recommendation includes sufficient funds within Housing Support 
Costs under Family Housing Operation and Maintenance accounts 
in order to support the Services' ability to provide oversight 
and management, and personnel to track current and future 
issues that may occur in military family housing.
    Military Housing Privatization Initiative (MHPI).--A 
priority for the Committee continues to be the state of homes 
within the MHPI, 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. The Department is 
directed to report to the Committee all progress in these areas 
within 30 days of enactment of this Act.
    At this time, the Tenant Bill of Rights, as proscribed by 
the National Defense Authorization Act for Fiscal Year 2020, 
has been implemented except for Rights #16, #17, and #18. The 
Committee directs the Services to report on the status of 
implementation of these three Rights within 60 days of 
enactment of this Act.
    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 2021.......................      $119,400,000
Budget request, fiscal year 2022......................        99,849,000
Committee Recommendation, fiscal year 2022............        99,849,000
    Change from enacted level.........................       -19,551,000
    Change from budget request........................             - - -
 

             Family Housing Operation and Maintenance, Army


 
 
 
Appropriation, fiscal year 2021.......................      $352,342,000
Budget request, fiscal year 2022......................       391,227,000
Committee Recommendation, fiscal year 2022............       391,227,000
    Change from enacted level.........................       +38,885,000
    Change from budget request........................             - - -
 

           Family Housing Construction, Navy and Marine Corps


 
 
 
Appropriation, fiscal year 2021.......................       $42,897,000
Budget request, fiscal year 2022......................        77,616,000
Committee Recommendation, fiscal year 2022............        77,616,000
    Change from enacted level.........................       +34,719,000
    Change from budget request........................             - - -
 

    Family Housing Operation and Maintenance, Navy and Marine Corps


 
 
 
Appropriation, fiscal year 2021.......................      $346,493,000
Budget request, fiscal year 2022......................       357,341,000
Committee Recommendation, fiscal year 2022............       357,341,000
    Change from enacted level.........................       +10,848,000
    Change from budget request........................             - - -
 

                 Family Housing Construction, Air Force


 
 
 
Appropriation, fiscal year 2021.......................       $97,214,000
Budget request, fiscal year 2022......................       115,716,000
Committee Recommendation, fiscal year 2022............       115,716,000
    Change from enacted level.........................       +18,502,000
    Change from budget request........................             - - -
 

          Family Housing Operation and Maintenance, Air Force


 
 
 
Appropriation, fiscal year 2021.......................      $317,021,000
Budget request, fiscal year 2022......................       325,445,000
Committee Recommendation, fiscal year 2022............       325,445,000
    Change from enacted level.........................        +8,424,000
    Change from budget request........................             - - -
 

         Family Housing Operation and Maintenance, Defense-Wide


 
 
 
Appropriation, fiscal year 2021.......................       $54,728,000
Budget request, fiscal year 2022......................        49,785,000
Committee Recommendation, fiscal year 2022............        49,785,000
    Change from enacted level.........................        -4,943,000
    Change from budget request........................             - - -
 

         Department of Defense Family Housing Improvement Fund


 
 
 
Appropriation, fiscal year 2021.......................        $5,897,000
Budget request, fiscal year 2022......................         6,081,000
Committee Recommendation, fiscal year 2022............         6,081,000
    Change from enacted level.........................          +184,000
    Change from budget request........................             - - -
 

 Department of Defense Military Unaccompanied Housing Improvement Fund


 
 
 
Appropriation, fiscal year 2021.......................          $600,000
Budget request, fiscal year 2022......................           494,000
Committee Recommendation, fiscal year 2022............           494,000
    Change from enacted level.........................          -106,000
    Change from budget request........................             - - -
 

                       Administrative Provisions

    The bill includes a total of 32 Administrative provisions, 
27 of which are in effect in fiscal year 2021.
    The bill includes section 101 prohibiting the use of funds 
for payments under a cost-plus-a-fixed-fee contract for 
construction where cost estimates exceed $25,000. An exception 
for Alaska is provided.
    The bill includes section 102 permitting the use of 
construction funds for the hire of passenger motor vehicles.
    The bill includes section 103 permitting funds to be 
expended on the construction of defense access roads under 
certain circumstances.
    The bill includes section 104 prohibiting construction of 
new bases in the United States without a specific 
appropriation.
    The bill includes section 105 limiting the use of funds for 
the purchase of land or land easements that exceed 100 percent 
of value except under certain conditions.
    The bill includes section 106 prohibiting the use of funds 
to acquire land, prepare sites, or install utilities for family 
housing except housing for which funds have been appropriated.
    The bill includes section 107 limiting the use of minor 
construction funds to relocate any activity from one 
installation to another without prior notification.
    The bill includes section 108 prohibiting the procurement 
of steel unless American producers, fabricators, and 
manufacturers have been allowed to compete.
    The bill includes section 109 prohibiting the use of funds 
to pay real property taxes in foreign nations.
    The bill includes section 110 prohibiting the use of funds 
to initiate a new installation overseas without prior 
notification.
    The bill includes section 111 establishing a preference for 
United States architectural and engineering services where the 
services are in Japan, NATO member countries, or countries 
bordering the Arabian Sea.
    The bill includes section 112 establishing a preference for 
United States contractors for military construction in the 
United States territories and possessions in the Pacific and on 
Kwajalein Atoll, or countries within the Central Command area 
of responsibility, except bids by Marshallese contractors for 
military construction on Kwajalein Atoll.
    The bill includes section 113 requiring the Secretary of 
Defense to give prior notice to Congress of military exercises 
where construction costs exceed $100,000.
    The bill includes section 114 allowing funds appropriated 
in prior years to be used for new projects authorized during 
the current session of Congress.
    The bill includes section 115 allowing the use of expired 
or lapsed funds to pay the cost of supervision for any project 
being completed with lapsed funds.
    The bill includes section 116 providing that funds for 
military construction projects are available until the end of 
the fourth fiscal year following the fiscal year in which funds 
are appropriated, subject to certain conditions.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 117 allowing for the transfer of 
funds from Family Housing Construction accounts to the 
Department of Defense Family Housing Improvement Fund and funds 
from Military Construction accounts to the Department of 
Defense Military Unaccompanied Housing Improvement Fund.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 118 providing transfer authority 
to the Homeowners Assistance Program.
    The bill includes section 119 requiring that funds in this 
title be the sole source of all operation and maintenance for 
flag and general officer quarter houses and limits the repair 
on these quarters to $15,000 per year without notification.
    The bill includes section 120 making funds in the Ford 
Island Improvement Fund available until expended.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 121 allowing the transfer of 
expired funds to the ``Foreign Currency Fluctuations, 
Construction, Defense''' account.
    The bill includes section 122 prohibiting the use of funds 
for projects at Arlington National Cemetery.
    The bill includes section 123 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 defining the congressional 
defense committees.
    The bill includes section 125 providing additional funds 
for various military construction accounts and requires a spend 
plan for each.
    The bill includes section 126 prohibiting funds from being 
used to consolidate or relocate any element of RED HORSE 
outside of the United States until the Secretary of the Air 
Force provides certain requirements.
    The bill includes section 127 providing additional funds 
for improving resilience and the effects of climate change on 
military installations.
    The bill includes section 128 providing additional funds 
for child development centers.
    The bill includes section 129 providing additional funds 
for barracks.
    The bill includes section 130 providing additional funds 
for the Shipyard Infrastructure Optimization Program.
    The bill includes section 131 providing additional funds 
for the Army National Guard Transformation Plan.
    The bill includes section 132 providing additional funds 
for the Air Force and Navy and Marine Corps for expenses 
incurred as a result of natural disasters.
    The bill includes section 133 prohibiting funds from being 
used for construction or planning and design of Space Force 
projects until a site selection audit is complete.

                                TITLE II


                     DEPARTMENT OF VETERANS AFFAIRS


 
 
 
Appropriation, fiscal year 2021\1\.............         $243,162,237,000
Budget request, fiscal year 2022\1\............         $268,410,433,000
Committee recommendation, fiscal year 2022\1\..         $268,586,855,000
    Change from enacted level..................         +$25,424,618,000
    Change from budget request.................            +$176,422,000
Fiscal year 2023 advance budget request........         $267,873,190,000
Fiscal year 2023 Committee recommendation in            $267,873,190,000
 the bill......................................
 
\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 nearly 6,000,000 Veterans and survivors, pension 
benefits for over 357,000 Veterans and 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 
2022 will fully fund the implementation of the Deborah Sampson 
Act, as indicated in the Department's budget justification 
materials. The Committee believes firmly that the Department 
should dedicate sufficient resources to support the needs of 
women veterans in a variety of 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 a 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 is concerned 
by 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 is 
further concerned that the Department has not yet issued a 
comprehensive sexual assault and harassment policy, as required 
by Section 5303 of P.L. 116-315, despite continued reports of 
incidences of sexual assault and harassment at the Department, 
and directs the Department to report to the Committee no later 
than 30 days after the date of enactment of this Act on the 
status of its efforts to comply with this statutory 
requirement. It is critical for VA to move swiftly with the 
implementation of Section 5303, create a centralized reporting 
mechanism with a comprehensive information technology database, 
and designate sexual harassment and assault prevention 
coordinators, so that veterans know where to turn when 
subjected to degrading treatment while accessing care and 
benefits.
    Native Hawaiian, Pacific Islander and United States-
Affiliated Pacific Islander Veteran Health Care.--Native 
Hawaiian, Pacific Islander, and United States-Affiliated 
Pacific Islanders disproportionately serve in the U.S. military 
and therefore represent significant numbers of Veterans across 
the United States and Pacific, particularly in rural and remote 
locations. The Committee continues to support additional 
research, service, and education to improve the lives of Native 
Hawaiian, Pacific Islander and U.S.-Affiliated Pacific Islander 
Veterans, and looks forward to the results of VA's feasibility 
study on the establishment of a dedicated VA Center for this 
population, as directed in Division J of the Joint Explanatory 
Statement accompanying the Consolidated Appropriations Act, 
2021 (P.L. 116-260). In performing this effort, VA should 
consider partnering with non-government institutions and 
universities to examine telehealth and telepharmacy; models of 
interprofessional primary care, including the integration of 
pharmacists and behavioral health; electronic health records 
and data analytics; health workforce; and indigenous people 
innovation.
    Women Veteran Transitional Housing Support.--The Committee 
recognizes the need for transitional and supportive housing 
services for women Veterans, and minority women veterans, who 
are experiencing homelessness or housing insecurity. The 
Committee also recognizes that in the past, Veteran services 
were primarily designed for men and do not always meet the 
needs of women and minority women Veterans. Women and minority 
women Veterans struggling with the acclimation to civilian and 
community life often find themselves in at-risk circumstances 
that may differ from those of men, such as women with children 
escaping domestic violence, and therefore women and minority 
women Veterans require specialized interventions and 
programming. The Committee encourages the Department to work 
with the Department of Defense and the Department of Labor to 
provide robust gender-specific case management services for 
women and minority women Veterans transitioning from military 
service. Additionally, the Committee supports VA's continued 
investment in the Women's Health Transition Training Program, 
as this highly successful and innovative program helps 
servicewomen across every branch of our armed forces transition 
out of active duty service.
    Eliminating Barriers to Accessing Earned Benefits for 
Veterans in the Outlying Areas.--The Committee directs the 
Department of Veterans Affairs to conduct a comprehensive 
review of its programs and services to identify those that are 
unavailable to veterans residing in outlying areas such as the 
Northern Mariana Islands and the Freely Associated States, the 
reasons for the lack of availability, and the actions needed to 
eliminate the barriers to access. The VA shall report its 
findings and recommendations to the Committee within 180 days 
of enactment of this paragraph.
    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 the 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 directs VA to report 
to the Committee within 60 days of the enactment of this Act on 
its 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 asserts that VA should 
take action to prevent deportations and ensure veterans and 
their families feel welcome at VA, and directs the Department 
to undertake a review of its policies and practices within 180 
days to ensure that VA is not engaging in any policies that put 
veterans or others at risk for deportations. VA is additionally 
directed to submit to the Committee a plan to implement 
corrections to any policies identified. This review and plan 
must include a clarification that mutual support agreements 
with federal, state and local law enforcement agencies cannot 
include the sharing of information that puts veterans at risk 
for deportation. Further, VA is directed 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 
work 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 
of Veterans Affairs 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 shall submit a report to the 
Committee within 60 days of enactment of the Act on the 
progress it has made on Performance Measures.
    Customer Service Standards.--The Committee continues to 
support efforts to improve customer service in accordance with 
Executive Order 13571--Streamlining Service Delivery and 
Improving Customer Service. The Committee directs the Secretary 
of Veterans Affairs to develop standards to improve customer 
service and incorporate the standards into the performance 
plans required under 31 U.S.C. 1115. The Committee requests a 
report on the progress the Secretary has made on this issue 
within 60 days of enactment of the Act.

                 Veterans Benefits Administration (VBA)


                       COMPENSATION AND PENSIONS

                     (INCLUDING TRANSFER OF FUNDS)

 
 
 
Appropriation, fiscal year 2021...................      $124,357,226,552
Budget request, fiscal year 2022..................       137,575,487,000
Committee recommendation, fiscal year 2022........       137,575,487,000
    Change from enacted level.....................       +13,218,260,000
    Change from budget request....................                 - - -
 

    This appropriation provides funds for service-connected 
compensation payments to an estimated 5,503,550 Veterans, 
475,146 survivors, and 1,281 dependents in fiscal year 2022. In 
addition, pension payments will be funded for an estimated 
209,355 Veterans and 147,472 survivors. The average payment per 
compensation case for Veterans in fiscal year 2022 is estimated 
at $20,403 and pension payments are projected at $13,760.
    For fiscal year 2023, the bill provides an advance 
appropriation of $147,569,474,000.
    The appropriation includes authority to transfer funding 
not to exceed $20,115,000 in fiscal year 2023 to General 
Operating Expenses, Veterans Benefits Administration and 
Information Technology Systems. These funds are for the 
administrative expenses of implementing cost-saving provisions 
required by the Omnibus Budget Reconciliation Act of 1990 (P.L. 
101-508), the Veterans' Benefits Act of 1992 (P.L. 102-568), 
and the Veterans' Benefits Improvements Act of 1994 (P.L. 103-
446). These cost-saving provisions include verifying pension 
income against Internal Revenue Service and Social Security 
Administration (SSA) data; establishing a match with SSA to 
obtain verification of Social Security numbers; and applying 
the VA pension cap for Medicaid-eligible single Veterans and 
surviving spouses alone in Medicaid-covered nursing homes. The 
bill also continues to include language permitting this 
appropriation to reimburse such sums as may be earned to the 
Medical Care Collections Fund to help defray the operating 
expenses of individual medical facilities for nursing home care 
provided to pensioners.
    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.
    Performance Measures and Communication Efforts.--The 
Committee remains interested in VA's implementation of 
performance measures in response to the findings of the 
Government Accountability Office (GAO) report entitled, 
``Better Measures Needed to Assess Regional Office Performance 
in Processing Claims'' (GAO 19-15). The Committee encourages VA 
to continue to improve regional office communication with 
Veterans Service Organizations (VSOs) and congressional 
caseworkers, including discussions surrounding the feasibility 
of locating satellite congressional member offices within VA 
Medical Centers (VAMCs).
    Dependency and Indemnity Compensation.--To address concerns 
with the processing of Dependency and Indemnity Compensation 
claims where the cause of death is listed as COVID-19, the 
Committee directs the Department to provide additional guidance 
for survivors on how to request a medical opinion to determine 
if a service-connected cause of death exists.
    Pro-bono Legal Services.--The Committee recognizes an unmet 
need for holistic programs that offer pro-bono legal services 
to Veterans and their dependents. The Committee acknowledges 
existing VA initiatives that guide Veterans during benefit-
related interactions with administrative agencies and believes 
that public land-grant university law schools are suited to 
complement existing agency efforts in underserved areas.
    Disability Claims Backlogs during COVID-19.--The Committee 
remains concerned about delays that Veterans experience in the 
resolution of pending compensation and pension claims, which 
have reportedly worsened during the COVID-19 pandemic. The 
Committee urges VA to dedicate sufficient resources and 
attention to reducing the claims backlog to ensure that 
Veterans have timely access to the benefits they have earned. 
The Committee continues to require quarterly reporting on the 
status of disability claims backlog and requests that VA 
provide a report within 90 days of the enactment of this Act.

                         READJUSTMENT BENEFITS

 
 
 
Appropriation, fiscal year 2021......................    $12,578,965,000
Budget request, fiscal year 2022.....................     14,946,618,000
Committee recommendation, fiscal year 2022...........     14,946,618,000
    Change from enacted level........................     +2,367,653,000
    Change from 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 2023, the bill provides $8,906,851,000.
    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 VSOs, that are available to the Veteran and 
their family as they depart the service. The Committee also 
urges VA to explore options for Veterans to access hands-on job 
placement services that connect Veterans directly with 
employers, and encourages VA to look at successful state and 
local programs in this area.
    Veteran Awareness of Student Loan Forgiveness.--The 
Committee understands that Veterans may have student loans they 
acquired either prior to enlistment or outside of their GI Bill 
benefits. The Committee encourages VA to coordinate with other 
agencies, including the Departments of Education and Defense, 
and increase efforts to ensure that Veterans are aware of all 
their student loan forgiveness options or repayment programs 
for which they may be eligible.
    GI Bill Comparison Tool.--The Committee emphasizes the 
importance of providing Veterans with the necessary information 
to make informed decisions when selecting institutions of 
higher education (IHE). The Committee understands that VA is 
working to make available through the GI Bill Comparison Tool, 
in a searchable format, the following information: whether an 
IHE is a minority serving institution (MSI), a gender-specific 
institution, or a religiously-affiliated school. The Committee 
looks forward to the launch of the updated GI Bill Comparison 
Tool.
    GI Benefits During COVID-19.--Public Law 116-128 and Public 
Law 116-140 provided the VA temporary authority until December 
21, 2021 to pay education benefits and Monthly Housing 
Allowance (MHA) payments to GI Bill students at the resident 
rate when the training modalities of programs are converted 
from in-person to online learning solely due to COVID-19. These 
laws cover situations where schools are offering hybrid 
training (combining online with resident training) or schools 
are offering students the option to choose online training in 
lieu of physically, in-person training. While these changes 
were necessitated due to the recent COVID-19 pandemic, the 
Committee is aware that there have been many benefits to 
students and institutions in having flexibility in training 
modalities (i.e., in person or online training) such as giving 
adult students more flexibility to schedule coursework around 
other commitments in their lives. The Committee is also aware 
that industry and even the VA itself are increasingly using 
both online and in-person training modalities to train their 
employees and partners. Therefore, the Committee encourages the 
VA to explore options to support education benefits and MHA at 
the resident rate for approved resident training programs that 
continue to offer hybrid training in a combination of online 
and in-person modalities after December 21, 2021.
    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 the VA to explore options for 
ensuring all veteran students have access to the technology and 
connectivity they need to be successful in school.
    Vocational Rehabilitation and Employment.--The Committee 
continues to support the work of vocational rehabilitation and 
employment programs that provide no-cost, wrap-around support 
services for the Veteran community, including career track and 
job readiness programs. These services help participants 
develop both job-specific knowledge and abilities, as well as 
the attitudes, habits, and behaviors needed to successfully 
secure and retain employment and earn family-sustaining wages 
in occupations that offer opportunities for career progression. 
Given the impacts of COVID-19 on employment for Veterans, the 
services provided by VA's vocational rehabilitation and 
employment programs are especially important.
    Student Veterans and Access to Child Care.--The Committee 
requests a report no later than 120 days after the enactment of 
this Act on student veterans who lack access to reliable, 
affordable, and quality child care. The report should identify 
barriers that student veterans encounter in accessing child 
care, the number of veterans who have struggled to find 
reliable child care, and establish whether lack of child care 
has impacted veterans' ability to complete education or 
training programs. The report should include veterans who are 
in college, university, or a job training program full or part 
time. It also should capture veterans that use family, friend, 
or neighbor forms of child care and/or child care centers.
    Veterans Benefits Administration, Workforce Development.--
The Committee recognizes that there is an acute need to improve 
the coordination of federal efforts around the preparation of 
our national security and defense workforce. The Committee 
recognizes the success in the small-scale implementation of the 
Veterans Technology Education Course and Edith Nourse Rogers 
STEM Scholarship and encourages further review to inform 
potential expansion of the programs. The Committee directs the 
VA to participate and coordinate as essential federal 
stakeholders with the Department of Defense as it leads efforts 
to establish a Defense Education and Workforce Pipeline 
Strategy.
    Student Housing Assistance.--In light of the VAOIG report 
in April of this year documenting how post-9/11 GI Bill Non-
college degree entitlement calculations lead to differences in 
Housing Allowance Payments, the Committee directs the VA to 
submit to Congress a report on how VA is working to ensure 
efficient Housing Allowance Payments to all students. This 
report should include any recommendations for legislative 
proposals to change the statutory formula for charging 
entitlement for the pursuit of programs at educational 
institutions other than institutions of higher learning.
    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. Therefore, 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).

                   VETERANS INSURANCE AND INDEMNITIES

 
 
 
Appropriation, fiscal year 2021.......................      $131,372,000
Budget request, fiscal year 2022......................       136,950,000
Committee Recommendation, fiscal year 2022............       136,950,000
    Change from enacted level.........................        +5,578,000
    Change from 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 2023, the bill provides $109,865,000.
    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 2021..........................            - - -         ($500,000)       $204,400,000
Budget request est., fiscal year 2022....................            - - -          (500,000)        229,500,000
Committee recommendation, fiscal year 2022...............            - - -          (500,000)        229,500,000
    Change from enacted level............................            - - -              - - -        +25,100,000
    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 is disappointed with VA's 
inaction on the directive included in House Report 116-445 and 
again directs the VA to improve communication with eligible 
lending institutions to reduce confusion among lenders and 
borrowers on this matter and to report to the Committee on 
progress made no later than 180 days after the enactment of 
this Act.

            VOCATIONAL REHABILITATION LOANS PROGRAM ACCOUNT

----------------------------------------------------------------------------------------------------------------
                                                                              Limitation on      Administrative
                                                           Program Account     direct loans         Expenses
----------------------------------------------------------------------------------------------------------------
Appropriation, fiscal year 2021..........................          $33,826       ($2,469,522)           $424,272
Budget request, fiscal year 2022.........................            2,838        (1,662,758)            429,467
Committee recommendation, fiscal year 2022...............            2,838        (1,662,758)            429,467
    Change from enacted level............................          -30,988         (-806,764)             +5,195
    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 1,570 loans 
in fiscal year 2022, with an average amount of $1,059.

              NATIVE AMERICAN VETERAN HOUSING LOAN PROGRAM

 
 
 
Administrative expenses:
Appropriation, fiscal year 2021.......................        $1,186,000
Budget request, fiscal year 2022......................         1,186,000
Committee recommendation, fiscal year 2022............         1,400,000
    Change from enacted level.........................          +214,000
    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 includes increased resources in FY 2022 to 
boost awareness of the program through improved communication 
and outreach to Veterans eligible for a loan under this 
program.

      GENERAL OPERATING EXPENSES, VETERANS BENEFITS ADMINISTRATION

 
 
 
Appropriation, fiscal year 2021.......................    $3,180,000,000
Budget request, fiscal year 2022......................     3,423,000,000
Committee recommendation, fiscal year 2022............     3,419,400,000
    Change from enacted level.........................      +239,400,000
    Change from budget request........................        -3,600,000
 

    The General Operating Expenses, Veterans Benefits 
Administration account provides funding for VBA to administer 
entitlement programs such as service-connected disability 
compensation, education benefits, and vocational rehabilitation 
services.
    The bill makes available through September 30, 2023, up to 
ten percent of these funds.
    The Committee provides $3,419,400,000 for the General 
Operating Expenses, VBA account, to enable VBA to deliver the 
benefits that our Veterans rely on. VBA should prioritize use 
of these funds to process claims, including claims related to 
new Agent Orange presumptive conditions, and reduce the claims 
backlog.
    Toxic Exposures.--The Committee has long been concerned 
about service-connected exposures to toxic substances, such as 
burn pits, Agent Orange, PFAS, radiation, and asbestos, among 
veterans and the VA's presumption process. The Committee is 
very interested in VA's research and efforts to confirm new 
conditions that are associated with service-related toxic 
exposures and encourages the Department to establish a 
consistent, transparent and evidence-based framework to be used 
to expeditiously establish new presumptions of service-
connection between health conditions and toxic exposures.
    Blue Water Navy Vietnam Veterans Health Care Eligibility.-- 
Since the passage of the Blue Water Navy Vietnam Veterans Act 
of 2019, some veterans who were made eligible for VA Health 
Care benefits by the law have applied and been denied access to 
care. Instead, these veterans have received instructions to 
submit a claim for VA disability compensation to become 
eligible for health care because of a VA disability rating. The 
Committee understands that Blue Water Navy Vietnam veterans, 
who are not otherwise eligible for health care due to 
disability or income, must undergo a VBA eligibility 
confirmation process before gaining access to VA Health Care. 
These non-rating requests from VHA to VBA for eligibility 
confirmation are not prioritized, so veterans may wait 
indefinitely to confirm their eligibility and be denied access 
to critical health care resources during that time. The 
Committee encourages the Secretary to consider ways to give 
these requests pertaining to VA health care benefits the same 
priority as VBA rating claims for disability compensation and 
pension. Further, the Committee requests a report on how VBA is 
supporting VHA efforts to enroll veterans who, like these Blue 
Water Navy Vietnam veterans, are eligible for VA health care 
only through special authority and not otherwise eligible due 
to disability rating or income level.
    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 
funding level 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 is 
concerned with the lack of data concerning veteran exposure to 
open burn pits (burn pits), which may result in chronic health 
effects. The Committee believes it is vital for the VA to place 
a stronger emphasis on this issue by beginning to properly 
track cases of exposure. Such an approach will enable VA to 
learn more about the hazards veterans are exposed to and to 
better understand how to care for and coordinate veterans' 
resulting health issues. To date, there has been no large-scale 
systematic data collection or maintenance effort focused on the 
effects of exposure to burn pit emissions other than the Burn 
Pits Registry.
    The Committee directs the VA to partner with the Department 
of Defense, TRICARE, private sector health providers, and the 
Centers for Medicare & Medicaid Services (CMS) system to 
compile a report to the Committee on Appropriations within 180 
days. The report should address the following: the total number 
of veterans who have filed claims for disability compensation 
related to burn pits; the demographics of these veterans, 
including age, sex, and race; the medical diagnoses of the 
veterans and the treatment provided, approved and denied by the 
Secretary of Veterans Affairs and the rationale of the denials; 
and the locations of the open burn pits at which the covered 
veterans were exposed to toxic airborne chemicals and fumes. 
When compiling this Report, the VA is directed to make every 
attempt possible to track data as far back as January 1, 1990.
    Equitable Relief.--The Committee reiterates that it 
understands VA is working to implement new systems and 
protocols to eliminate instances of administrative error. 
However, as VA enacts system-wide reforms, ending equitable 
relief for Veterans who were deemed eligible for benefits in 
error would place an unfair burden on Veterans and their 
families. The Secretary is directed to continue to grant or 
extend equitable relief to eligible Veterans initially deemed 
eligible in instances of administrative error. Not later than 
April 1, 2022, the Secretary shall submit to the Committee a 
report containing a statement as to the disposition of each 
case recommended to the Secretary for equitable relief under 38 
U.S.C 503 during the preceding calendar year.
    Military Sexual Trauma (MST) claims.--The Committee 
welcomes the VA's commitment to specialized MST training for 
claims processors and encourages the continued inclusion of MST 
survivors in training programs. Because veterans filing claims 
for disabilities incurred or aggravated by MST may be referred 
to a third-party contract provider for the required 
Compensation and Pension (C&P) exam, the Committee directs the 
VA to provide information to Congress, in the form of a report, 
related to required, specialized MST training for both contract 
and VHA examiners. Further, the Committee seeks claim outcome 
data for veterans referred to a third-party provider as 
compared to those evaluated by a VHA medical provider, and 
requests that this data be provided at the smallest geographic-
level as possible, such as zip code. 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, 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).
    WWII Filipino Veterans Equity Compensation Fund.--The 
Committee understands the unique challenges for WWII Filipino 
veterans and their families to verify eligibility for the WWII 
Filipino Veterans Equity Compensation Fund. Although the VA has 
conducted outreach efforts, many WWII veterans and their 
families may live without adequate records or the means to 
communicate their eligibility for this program. The Committee 
directs the Department to provide a report no later than 180 
days after the enactment of this Act on (1) the estimated 
number of remaining WWII Filipino veterans; (2) outreach 
barriers and documentation challenges facing WWII Filipino 
veterans and how the VA attempted to overcome these challenges; 
and (3) the feasibility and costs of options for extending the 
time limit for accepting initial and revised claims for the 
program.

                  Veterans Health Administration (VHA)

    The Department operates the largest Federal medical care 
delivery system in the country, with 146 hospitals, 120 
residential rehabilitation treatment programs, 134 nursing 
homes, 300 Vet Centers, 83 Mobile Vet Centers, and 783 
Community-Based outpatient Clinics (CBOCs). Approximately 
7,100,000 patients will be treated in fiscal year 2022.
    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 
$3,369,000,000 for fiscal year 2022, which is $100,000,000 
above the budget request. In addition, VA will receive an 
estimated $3,386,000,000 in the Medical Care Collections Fund 
in fiscal year 2022. The Administration has requested total 
resources for fiscal year 2023 of $111,287,000,000 in direct 
appropriations to fund the four advance appropriations of VHA. 
The Committee also provides $902,000,000 for Medical and 
Prosthetic Research.
    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.
    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 in publicly accessible 
areas at each VA medical center.

                            MEDICAL SERVICES

 
 
 
Appropriation, fiscal year 2021.......................   $56,655,483,000
Budget request, fiscal year 2022......................    58,897,219,000
Committee recommendation, fiscal year 2022............    58,997,219,000
    Change from enacted level.........................    +2,341,736,000
    Change from budget request........................      +100,000,000
 

    The bill includes an additional $100 million for Medical 
Services in fiscal year 2022 as well as $70,323,116,000 for 
advance fiscal year 2023 funding. The Committee has included 
bill language to make $1,500,000,000 of the Medical Services 
advance appropriation for fiscal year 2023 available through 
September 30, 2024.
    Of the funds provided for fiscal year 2022, a total of 
$13,179,171,000 is for mental health; a total of $2,154,450,000 
in base funding is provided for homelessness initiatives, in 
addition to the $486,000,000 made available by the American 
Rescue Plan; a total of $307,455,000 is for rural health; a 
total of $778,500,000 is for gender-specific care for women; a 
total of $83,600,000 is for Whole Health initiatives, which is 
$10,000,000 above the budget request; a total of $598,997,000 
is provided for suicide prevention efforts; and a total of 
$621,334,000 is provided for opioid prevention and treatment.
    Changes in Funding Requirements Due to Modeling.--The 
Committee expects VA to continue to include in the sufficiency 
letter required by section 117(d) of title 38, United States 
Code, which is due to the Congress on July 31 of each year, a 
description of any changes exceeding $250,000,000 in funding 
requirements for the Medical Services account resulting from 
the spring recalculation of the Enrollee Healthcare Projection 
Model.
    Caregivers Program.--The caregivers program provides an 
unprecedented level of benefits to families with Veterans 
seriously injured in the line of duty. 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 
$1,353,133,000 for the caregivers program. The Committee also 
continues the requirement from the fiscal year 2018 on 
quarterly reporting on obligations for the caregivers program.
    Allocation of Health Funding.--The Committee continues to 
be concerned that the process VA uses to allocate the health 
services appropriation through the Veterans Integrated Service 
Networks (VISNs) and from them to the medical centers may 
shortchange the ultimate users because of excessive funding 
retained at headquarters or at the VISNs. The Committee 
continues to request a report each year, no later than 30 days 
after VA allocates the medical services appropriation to the 
VISNs, that identifies: (1) the amount of general purpose 
funding that is allocated to each VISN; (2) the amount of 
funding that is retained by central headquarters for specific 
purposes, with amounts identified for each purpose; and (3) the 
amount of funding that is retained by each VISN before 
allocating it to the medical centers, identifying separately 
the amounts retained for purposes such as network operations, 
network initiatives, and emergencies.

                             MENTAL HEALTH

    The Committee provides $13,179,171,000 in base funding for 
mental health programs. Of the amounts provided for mental 
health programs in fiscal year 2022, $2,340,341,000 shall be 
used for suicide prevention and treatment programs. 
Specifically, $598,997,000 shall be used for suicide prevention 
outreach, which is $286,362,000 above fiscal year 2021. 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 Veterans Service Organizations (VSOs) to help 
remove the stigma that is associated with seeking mental 
healthcare. Furthermore, VA is directed to remove barriers that 
affect a Veteran when trying to receive mental healthcare and 
to implement a twenty-first century outreach program that 
incorporates social media and other electronic means to reach 
Veterans before they are at a crisis point.
    In addition, the Committee directs VA to engage with DOD to 
help servicemembers transition from active duty to civilian 
life to ensure that mental health needs are addressed 
throughout the transition process.
      
    Improving the Veterans Crisis Line (VCL).--The Committee 
provides funding to support the VCL at a level of $255,968,000 
to meet the growing demand, 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 OMHSP. 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 for Veterans in law enforcement and other fields 
by expanding patient/participant confidentiality where 
appropriate.
    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 encouraged by ongoing genetic testing research 
to aid in depression treatment selection. VHA is encouraged to 
use pharmacogenomic tests in the treatment of depression if 
they 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, PTSD, traumatic brain injury (TBI), and substance 
use disorders. Of the funds provided for mental health programs 
in fiscal year 2022, 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.
    Non-Citizen Veteran Outreach.--The Committee is concerned 
about the level of awareness regarding mental health services 
by at-risk, non-citizen Veterans. The Committee therefore urges 
VA to conduct more aggressive outreach targeting this group of 
Veterans to offer mental health and other early intervention 
services, drug and alcohol services, and mental health 
counseling.
    Adverse Childhood Experiences (ACEs).--ACEs exist within 
the Veteran population at a substantially higher rate than the 
general public. These experiences correlate with significant 
negative health outcomes, including on behavioral, mental, and 
physical health. The Committee encourages VA to track ACEs 
among Veterans and target individualized treatment. To ensure 
appropriate treatment from the moment a Veteran enters VA, it 
is critical that VA coordinate with DOD to obtain information 
on ACEs from servicemembers and provide a seamless transition 
in care.
    Agritherapy.--An increasing number of states now have 
programs that assist Veterans in starting farms, and many 
Veterans turning to farming suffer from PTSD. The benefits of 
agritherapy have been reported in the news media; however, 
limited research and insufficient opportunities exist to offer 
the benefits of agritherapy to those suffering from PTSD. VA is 
encouraged to work with the Department of Agriculture on 
providing agritherapy programs to Veterans. Additionally, the 
Committee supports a pilot program to train Veterans in 
agricultural vocations, including urban and vertical farming, 
while also tending to behavioral and mental health needs with 
behavioral healthcare services and treatments from licensed 
providers at no fewer than three locations.
    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, SUDs, eating 
disorders, and anxiety. Because sexual trauma is so prevalent, 
the Committee recommends that all Veterans seeking treatment 
services are screened for sexual assault using an evidence-
based screening tool in order to successfully treat those who 
have experienced assault.
    Post-Deployment Rehabilitation and Evaluation Program 
(PREP).--The Committee believes that the physical 
rehabilitation and mental health needs of our active duty 
servicemembers and Veterans is a top priority. The Post-
Deployment Rehabilitation and Evaluation Program (PREP) run by 
VA is an inpatient initiative that focuses on an individualized 
evaluation for servicemembers and Veterans to treat combat-
related physical, cognitive and mental health systems. The 
Committee believes it is important to expand the number of 
servicemembers and Veterans able to receive care through this 
initiative. The Committee directs VA to include programmatic 
information and funding levels for PREP in future budget 
requests.
    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 (PTSD) Service Dogs.--The 
Committee recognizes the positive role that service, guide, and 
hearing dogs have played in mitigating Veterans' disabilities 
and providing assistance and rehabilitation. The Committee also 
notes that VA is currently completing a study to assess the 
potential therapeutic effectiveness of service dogs in the 
treatment of PTSD. The Committee remains concerned that the 
report detailing the results and economic impact of the study 
has been so long delayed and continues to require monthly 
reports on the status of the study until it is fully completed, 
beginning 30 days after this report is filed. The Committee is 
interested in the possibility of providing service dogs to 
Veterans with a mental health mobility disorder related to 
post-traumatic stress or traumatic brain injury. VA is urged to 
use the results of the study to identify barriers that limit 
access to service dogs for Veterans with a mental health 
mobility disorder related to post-traumatic stress or traumatic 
brain injury.
    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.
    The Committee supports the Center's continuing efforts to 
ensure that groups of Veterans who are more likely to develop 
PTSD, such as African-Americans and Latinos, receive 
appropriate care and support, and looks forward to receiving 
the report requested in House Report 116-445 on this matter.
    The Committee continues to expect VA to provide cultural 
competency training to healthcare professionals serving 
Veterans of color; analyze whether minority Veterans receive 
quality and culturally appropriate care; ensure the unique 
mental health needs of minority Veterans are addressed; and 
correct any disparities, whether perceived or real, in care.
    The Committee also encourages the Center to explore 
academic and interagency collaborations that investigate novel 
approaches, such as dietary interventions and non-invasive 
brain stimulations, and test new integrative treatments to 
treat PTSD. The Committee supports efforts by the Center to 
expand its partnerships, as appropriate, and participate in 
cooperative efforts that support medium to large scale trials 
on promising integrative treatments.
    Alternative PTSD Treatments.--The Committee recognizes the 
challenges in treating and healing posttraumatic stress 
disorder (PTSD), and notes the Comprehensive Addiction and 
Recovery Act of 2016 (P.L. 114-198) authorized the Creating 
Options for Veterans Expedited Recovery (COVER) Commission, a 
federal commission tasked with providing recommendations to the 
President of the United States, the United States Congress, and 
the Secretary of Veterans Affairs to guarantee our nation's 
Veterans receive the mental health care they need. The 
Committee directs VA to report to the Committees on 
Appropriations of both Houses of Congress within 90 days of 
enactment of this Act on its progress on implementing the COVER 
Commission's ten recommendations.
    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.

                      SUICIDE PREVENTION OUTREACH

    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. The bill includes sufficient funding to extend this 
program to additional States. The Committee additionally urges 
VA to use up to $1,000,000 to improve data collection with 
states to better inform suicide prevention activities.
    Social Media.--The Committee continues to encourage the 
Department to investigate using social media platforms to 
identify and engage Veterans at risk of suicide and work with 
academic partners to develop and test tools for identifying and 
engaging these Veterans.
    Collaboration on Gun Safety and Storage.--The Committee 
supports continued collaboration across public and private 
sectors to end the national tragedy of suicide, and encourages 
VA medical centers to collaborate with state and local law 
enforcement and health officials in states that have adopted 
extreme risk protection orders, also known as ``red flag'' 
laws, and similar gun safety laws, to adopt programs and 
protocols on firearm safety and storage to assist Veterans who 
may be struggling with suicidal thoughts.
    Lethal Means Safety Training.--Data show that individuals 
who reduce their access to lethal means during times of 
heightened risk are reducing their risk of dying by suicide. 
The Committee is pleased that VA has implemented mandatory 
lethal means safety trainings for clinical health care 
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 
urges 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.
    Suicide Prevention Coordinators.--The Committee recognizes 
the importance of consistent and timely follow-up engagement 
with Veterans identified as at-high-risk for suicide. The 
Committee encourages VA to explore the use of real-time, 
interactive technology to help Suicide Prevention Coordinators 
manage and identify opportunities to improve performance.

                          HOMELESS ASSISTANCE

    The Committee provides $2,154,450,000 in base funding for 
VA homeless assistance programs, an increase of $167,568,000 
above the comparable fiscal year 2021 enacted level and fully 
funding the President's budget request. An estimated 
$8,247,124,000 is provided for homeless Veterans treatment 
costs, an increase of $247,012,000 above the comparable fiscal 
year 2021 enacted level. In addition, $486,000,000 in funds 
made available by the American Rescue Plan (P.L. 117-2) will 
support VA's homelessness programs in fiscal year 2022.
    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), 
and the Department of Housing and Urban Development-Department 
of Veterans Affairs Supported Housing (HUD-VASH) programs, 
among others.
    Healthcare for Homeless Veterans.--The Committee directs 
the Secretary to submit an updated report to the Committees on 
Appropriations of both Houses of Congress within 90 days of 
enactment of this Act on the benefits of expanding the 
Healthcare for Homeless Veterans Program H-PACT program, to 
include the benefits of expanding the program, location of 
additional locations, to include rural areas, and additional 
services to improve the program.
    Ending Veteran Homelessness.--The Committee recognizes the 
value and impact of the HUD-VASH program, which serves Veterans 
experiencing homelessness and pairs each HUD affordable housing 
voucher earmarked for Veterans with intensive case management 
from VA to assist with benefits and income, mental health care, 
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.
    HUD-VASH Case Manager Contracting.--The Committee remains 
concerned that the Department is not properly staffing its HUD-
VASH program to meet the needs of the homeless Veterans 
population, which may be contributing to increasing 
homelessness nationwide. The Committee directs the Secretary to 
provide quarterly reports on the implementation of Section 4207 
of P.L. 116-315, as related to the contracting of HUD-VASH case 
manager positions to local community providers, as well as on 
the Department's efforts to notify rural areas of the 
implementation of these provisions.
    Legal Assistance for the SSVF Program.--The Committee notes 
that university law schools are willing to work with Veterans 
on a pro-bono basis to provide legal assistance. This can 
result in additional benefits such as training law students in 
Veteran disability law and legal skills critical to providing 
advocacy within the VA system and inspiring next-generation 
lawyers to serve Veterans in practice. The Committee encourages 
the SSVF program to work with grantees to expand their legal 
service offerings, particularly in rural areas where access to 
private legal assistance can be limited. Within the funds 
provided, the Department is encouraged to establish one or more 
pilot projects to partner SSVF grantees with university law 
schools in rural areas or within underserved populations to 
enhance legal assistance to Veterans.
    Shallow Subsidy Initiative.--The Committee encourages VA to 
prioritize funding within the SSVF program for the Shallow 
Subsidy Initiative to expand the number of Veterans served by 
the program, targeting areas with high rental costs and large 
homeless Veteran populations.
    Homeless Veterans Near the United States-Mexico Border.--
The Committee notes that there may be homeless Veterans living 
near the United States-Mexico border who, historically, may not 
have been counted in point-in-time homeless surveys. The 
Committee directs VA to work with HUD to develop strategies and 
recommendations for addressing Veteran homelessness near the 
United States-Mexico border and to take into account these 
undercounted Veterans when awarding HUD-VASH vouchers. The 
Committee appreciates VA's efforts to implement strategies and 
make recommendations to decrease Veteran homelessness on the 
border, such as the development of a Homelessness Screening 
Clinical Reminder, data sharing, improving the accuracy of 
data, and contracting case management in rural areas.
    Chronic Homelessness.--The Committee notes that the HUD-
VASH program aims to help Veterans who are homeless and their 
families find and sustain permanent housing, and that the HUD-
VASH program prioritizes the ``chronically homeless.'' However, 
the Committee is concerned about the program's ability to reach 
Veterans who may not meet the statutory definition under the 
McKinney-Vento Homeless Assistance Act, but still experience 
unstable housing. The Committee directs the Department of 
Veterans Affairs to provide a report to the Committee no later 
than 180 days after enactment of this Act that identifies the 
number of Veterans who meet the program's definition of 
``homelessness,'' but who do not meet the definition of 
``chronically homeless'' due to being homeless for a duration 
less than one year or less than four separate occasions in the 
last three years. Further, the Department should address in its 
report whether unused HUD-VASH vouchers are available for use 
by homeless Veterans who fail to meet the definition of 
``chronically homeless.''
    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 our nation's 
Veterans. The Committee looks forward to the comprehensive 
report required in the Joint Explanatory Statement accompanying 
the Consolidated Appropriations Act, 2021 (P.L. 116-260) on the 
Department's plan to address critical workforce issues.
    Addressing Mental and Behavioral Health Workforce 
Shortages.--The Committee remains concerned about the negative 
effects of VHA workforce shortages on the delivery of care for 
Veterans at VHA medical centers and clinics across the country, 
particularly in the areas of mental and behavioral health care. 
A VA Office of the Inspector General Report published on 
September 23, 2020 found severe occupational staffing shortages 
across 277 occupations in VHA medical centers. Some of the most 
common facility-designated severe occupational staffing 
shortages were in psychiatry, psychology, and nurse 
practitioners focusing on mental health and substance use 
disorders. The Committee continues to direct the Department to 
prioritize hiring mental health professionals, and encourages 
VA to prioritize initiatives to recruit and retain mental and 
behavioral health professionals at VHA medical centers and 
clinics to ensure Veterans with mental health conditions and 
substance use disorders have access to high-quality care.
    VA/HHS Taskforce on Health Workforce Shortages.--The 
Committee encourages VA to create a taskforce with HHS to 
explore ways the agencies can work together to increase the 
availability of providers, including in the behavioral health 
workforce and among physicians specializing in cancer, spinal 
cord, and neuropsychiatric conditions. The taskforce is urged 
to examine VA's recruitment challenges, review programs that 
could enhance recruitment and retainment, and to think 
creatively on how other federal agencies like HHS can identify 
and address provider shortages. The taskforce is also 
encouraged to consult with DOD to explore recruiting those who 
have left the military.
    Medical and Nursing Understaffing.--The Committee 
recognizes that understaffing, especially in medical and 
nursing positions, is a principal obstacle to timely access to 
care for Veterans and encourages the Department to investigate 
the use of commercially available hospital management 
information technologies to reduce nursing administrative 
workloads while simultaneously improving patient flow and 
access to care.

                       ACCESS FOR RURAL VETERANS

    Office of Rural Health (ORH).--The bill includes 
$307,455,000 for rural health, which is $7,455,000 above the 
enacted level, 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 2022 funding, as well as for the fiscal 
year 2023 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 our nation's Veterans and includes 
funding to enhance rural access and transportation services. 
Additionally, the Committee continues to encourage VA to look 
into the feasibility of utilizing accessible autonomous 
electric vehicles in the future to overcome these challenges, 
and requests VA report to the Committee on the benchmarks and 
metrics that VA will use to determine feasibility of this 
technology.
    Rural Transportation Study.--The Committee continues to 
support the Office of Rural Health's rural transportation study 
by the Veterans Rural Health Resource Center, Iowa City, Iowa, 
and requests an interim report to the Committees on 
Appropriations of both Houses of Congress regarding initial 
findings by December 31, 2021.
    Rural Veteran Transportation.--The Committee acknowledges 
continued progress in addressing transportation barriers for 
Veterans, especially those in rural or highly rural areas. 
While the Committee recognizes the important work of Veteran 
Service Organizations (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 demand-responsive microtransit may help improve 
accessibility for Veterans, and encourages the Veterans 
Transportation Program to explore increased adoption of this 
technology.
    Lack of Rural Health Providers.--The Committee is aware of 
a shortage of medical healthcare providers nationwide, which 
corresponds to persistent issues for VA health facilities in 
rural areas in recruiting and retaining health providers in 
this highly competitive environment. To address the rural 
health provider gap, the Committee encourages VA to continue to 
consider expanded use of physician assistants, through both 
physical facilities and expanded access to telehealth services. 
The Committee directs VA to submit a report to the Committees 
on Appropriations of both Houses of Congress, no later than 90 
days after enactment of this Act providing an update on VA 
hiring needs in rural areas and VA plans to address the 
provider gap in rural areas. The Committee also directs VA to 
submit an updated report to the Committees on Appropriations of 
both Houses of Congress providing an analysis of the hardest-
to-reach rural Veterans, the barriers to accessing these 
Veterans, and next steps to address the needs of these 
Veterans, no later than 120 days after enactment of this Act.
    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 
health care services to Veterans in underserved locations. The 
Committee recognizes the unique challenges faced by Veterans 
living in rural communities who often require access to a suite 
of health services across a spectrum of specialty medical 
professionals. The 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.

                     TELEHEALTH AND CONNECTED CARE

    The bill includes $2,585,182,000 for telehealth and 
connected care, which includes home telehealth, home telehealth 
prosthetics, and clinic-based telehealth.
    Telehealth Benefits.--Telehealth services increase Veteran 
access to care. The Committee directs VA to continue to expand 
telehealth availability to include additional mental health, 
primary care, and rehabilitation services as a means to deliver 
care in rural and underserved communities. Additionally, VA is 
encouraged to leverage newly gained telehealth capacity to 
address backlogs for disability exams and health care 
appointments when appropriate.
    Telehealth Services.--The Committee 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.
    Telehealth Access.--The Committee recognizes and 
appreciates the significant improvements made in Telehealth 
Service by VA in the past year. These timely improvements were 
critical in meeting the health care needs of our Veterans 
during the COVID-19 pandemic. As the pandemic travel 
restrictions are relaxed, the Committee urges the Department to 
continue to develop and implement Telehealth Services with a 
focus on easing the burdens of rural Veterans with limited 
travel options. The Committee encourages the continued growth 
of the Accessing Telehealth through Local Area Stations (ATLAS) 
program and investment in supportive peripheral technologies. 
The Committee also encourages the Department to continue to 
seek partnerships, such as ATLAS sites, to bridge gaps in 
access to broadband services that prevent Veterans in rural and 
underserved communities from accessing telehealth resources.
    ATLAS Program Implementation.--The Committee commends VA 
for being a leader in the adoption of connected care solutions 
through its Anywhere-to-Anywhere telehealth initiative, such as 
the ATLAS Program. Where deployed, ATLAS offers Veterans the 
ability to securely access VA care in purpose-built settings 
from easily accessed locations in their home communities. The 
Committee urges VA to continue the Department's Anywhere-to-
Anywhere initiative, and directs the Secretary to submit a 
report to the Committees on Appropriations of both Houses of 
Congress, no later than 180 days after enactment of this Act, 
that (1) details VA's progress on, and timetable for, the 
expansion of the program, particularly in rural and tribal 
areas where in-person healthcare options are even more limited; 
and (2) assesses the feasibility, cost, possible partner 
locations and advisability of expanding the project to remote 
Veteran communities in the Pacific Islands Region by opening 
new ATLAS stations in Hawaii, Guam, American Samoa, the 
Commonwealth of the Northern Mariana Islands, and the Freely 
Associated States.
    Telehealth Technology and Capabilities.--While the 
Department has made considerable advancements in telehealth 
solutions for patient Veterans since the onset of the 
coronavirus pandemic, the Committee recognizes the further 
potential in the use of software as a service (SaaS) and cloud 
data storage systems. The Committee encourages the Department 
to adopt telehealth and remote monitoring device systems which 
utilize such software as a service model and cloud data 
delivery with commercial off the shelf solutions which are 
device agnostic and capable of integrating as many commercially 
available patient monitoring devices as possible.

                     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 
increased 32 percent in six years from 423,642 women Veterans 
in 2014 to 560,737 in 2020. 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 $778,500,000 
for gender-specific care for women, which is $117,809,000 above 
the fiscal year 2021 enacted level. The bill also includes 
$104,946,000 for the purpose of expanding programmatic support 
for women's healthcare. 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 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. 
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. 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 Department is further directed to prioritize hiring 
women primary care providers and psychologists for women's 
clinics using the Medical Services appropriation. To supplement 
VA's recruitment efforts to hire and retain women clinicians at 
the field and VISN levels, the Committee directs the Department 
to deploy a large national women-specific advertising campaign 
to appeal to women Veterans to receive their care at VA 
facilities and to women-specific healthcare providers to work 
at VA.
    Additionally, the Committee continues to direct that 
Women's Health Program Managers be full-time jobs and not be 
tasked with supplemental responsibilities outside of their 
specified job descriptions.
    The Committee also supports the work of the Office of 
Women's Health at the Veterans Health Administration and 
directs the Department to invest resources in strategic 
planning regarding women Veterans, as required in the Deborah 
Sampson Act enacted as part of P.L. 116-315.
    Women Providers.--The Committee is encouraged by the 
Department's recognition of the need to hire additional women's 
health personnel nationally. The desire for women Veterans to 
seek care from women providers extends beyond specialties 
traditionally dominated by women, such as gynecology and mental 
health. Therefore, the Committee encourages the Department to 
hire women providers in specialties within the Department with 
lower rates of such providers, in order to more accurately 
represent the growing number of women Veterans seeking 
services. In addition, the Committee is also strongly 
supportive of efforts by the Department to train and hire 
Women's Health Primary Care Providers (WH-PCP). The Department 
is directed to report to the Committees on Appropriations of 
both Houses of Congress within 180 days of enactment of this 
Act on the total number of women providers providing care in 
the Department, the total number of women providers in each 
care specialty, and the number of women providers in each 
specialty as a percentage of total providers within that 
respective specialty. In addition, the Department is urged to 
note separately for each reporting requirement the number of 
women providers hired since September 30, 2020.
    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.
    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 includes funding for VA to 
hire new qualified peer support specialists to broaden its 
programs and provide targeted support for the gender-specific 
health needs of women Veterans. Additionally, the Committee 
welcomes the role of the 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. The bill includes $1,000,000 for peer support 
programs for women Veterans.
    Maternity Health Care 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 health care 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 health care 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 
further encourages VA to provide trainings for community 
maternity care providers so that nurses, midwives, and 
physicians caring for pregnant and postpartum Veterans 
understand the unique needs of their Veteran patients, 
particularly related to mental and behavioral health conditions 
that might have been caused or exacerbated by military service 
or the transition back to civilian life.
    Doula Access.--According to studies published by the 
National Institutes of Health, expectant mothers who are 
matched with a doula have better birth outcomes than those who 
are not. Doula-assisted mothers were four times less likely to 
have a low birth weight, two times less likely to experience a 
birth complication involving themselves or their baby, and 
significantly more likely to initiate breastfeeding. 
Additionally, pregnant Veterans have been found to be 
disproportionately impacted by mental health disorders, further 
highlighting the need for maternal support. Recognizing the 
positive impact that doulas can have on maternal health 
outcomes, the Committee strongly urges VA to support the use of 
doulas for expectant mothers and explore ways to improve access 
to doula support services.

                            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 
Fiscal Years 2020 and 2021 on VA's spending on prescription 
drugs. The Committee encourages VA to conduct this analysis 
annually and requests robust and routine updates to Congress. 
In addition to cost information, the report is suggested to 
include country of origin information on drugs and active 
pharmaceutical ingredients.
    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. Furthermore, medication 
take-back programs are proving to be difficult to access for 
many Americans and inadequate to broadly impact disposal 
behavior. The Committee notes that newer technologies to 
deactivate and safely dispose of prescription drugs in the home 
have been shown through independent research to lead to 
improved outcomes. The Committee is pleased that in response to 
the direction in House Report 116-445, VA concluded that a 
pilot program to evaluate the benefits of co-dispensing at-home 
drug disposal products for post-surgical patients is both 
appropriate and feasible. VA is directed to move forward with 
this demonstration and evaluation initiative.
    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 our 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.

       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 $621,334,000 for opioid 
treatment and prevention efforts, which is $148,639,000 above 
fiscal year 2021, and of which $245,666,000 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 on the coronavirus global 
pandemic on Veteran opioid addition 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 $155,970,000 for Substance 
Use Disorder (SUD) efforts to ensure greater number of Veterans 
can receive SUD specialty services.
    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 Disorders.--The Committee recognizes the 
ongoing work of VA to reduce substance use disorder among 
Veterans. The Committee is aware of the Substance Abuse and 
Mental Health Services Administration studies concluding that 
90 percent of people who die by suicide suffer from depression, 
substance use disorders, or both. Veterans face unique health 
challenges and the suicide rate among Veterans continues to be 
unacceptable. The Committee is aware that male Veterans have 
greater rates of problematic substance use but that the rates 
of problematic substance use among women Veterans is 
increasing. The Committee supports new and innovative solutions 
to intervene early with at-risk Veterans and supports programs 
that provide Veterans and their families with the tools they 
need to meet these challenges. The Committee 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. 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 includes $1,000,000 in the bill to establish a 
comprehensive, evidence-based and confidential internet-based 
substance abuse education, case management, and peer coaching 
pilot program. 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, Veteran medical providers have focused on 
the physical symptoms of Veterans, zeroing in on their diseases 
and ailments. However, VA is continuing to work to expand this 
focus by incorporating a whole health model of care, which is a 
holistic look at the many areas of life that can affect a 
Veteran's health, including their work environment, 
relationships, diet, sleep patterns, and more. Whole Health is 
an approach to healthcare that empowers and enables the Veteran 
to take charge of their health and well-being and live their 
life to the fullest. The Committee is extremely pleased with 
the Whole Health model of care and includes $83,600,000 in the 
bill, which is $10,000,000 above the request, to continue to 
implement and expand Whole Health to all VA facilities.
    Continued Support and Expansion for Whole Health.--Recent 
data about the Whole Health System reveals participation 
increased more than 140 percent between 2017 and 2019, 
resulting 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 our nation's Veterans, and urges 
VA to continue supporting the program and to expand it further 
in fiscal year 2022.
    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.

                          OTHER HEALTH ISSUES

    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 $7,500,000 to carry out responsibilities and 
activities of the Airborne Hazards and Burn Pits Center of 
Excellence.
    Burn Pits Center of Excellence Expansion.--The Committee 
notes that the VA Research Advisory Committee has recommended 
the establishment of Centers of Excellence to facilitate the 
development and availability of new treatments in clinical 
settings. Cost effective models for rapid development of new 
treatments for Gulf War Illness using computational models, 
research funding through the Department of Defense's 
Congressionally Directed Medical Research Programs, and 
clinical experts in environmental medicine have been proven 
effective in partnership with VA medical centers. The Committee 
directs the Secretary to continue activities as described in 
House Report 116-445 to establish and expand a Center of 
Excellence focused on toxic environmental exposures, including 
investigations of gender-based differences in disease and 
treatment to leverage research funding through partnerships.
    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 Department is 
directed to significantly increase its investment to maintain 
and expand existing centers of excellence within VA dedicated 
to these conditions to enhance their value in coordinating 
innovative clinical care, education, and research efforts. No 
later than 120 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 providing details on 
opportunities to enhance care for Veterans with neurologic 
conditions, including potential collaboration between the 
neurology centers of excellence.
    Epilepsy Centers of Excellence.--The bill includes 
$10,000,000 toward maintaining and expanding the Epilepsy 
Centers of Excellence within VA. The Committee directs the 
Department to provide an update on the status of these Centers 
to the Committee no later than 60 days after enactment of this 
Act.
    Headache Disorders Centers of Excellence.--The Committee 
recognizes that chronic headache disorders commonly affect 
Veterans, particularly as a result of traumatic brain injuries 
and other injuries sustained during the Global War on Terror. 
In fiscal year 2018, Congress provided VHA with $10,000,000 for 
the establishment of at least five Headache Disorders Centers 
of Excellence (HCoEs), and VHA currently maintains 14 active 
HCoE sites. To ensure equitable access to specialized Headache 
Medicine services for all Veterans that seek them, the bill 
includes $20,000,000 for continued support of the active sites, 
as well as expansion of the HCoE system to include a total of 
at least 28 sites nationally. These sites will provide 
equitable access to specialty consultation, direct health care 
delivery, education of VHA health care providers, and research 
to improve the care and clinical outcomes of Veterans. Further, 
the Committee expects VHA to provide sustained support for the 
HCoE system to ensure the successful recruitment and retention 
of health care providers with specialty training in Headache 
Medicine.
    Central Alabama Veterans Health Care System (CAVHCS).--The 
Committee calls the Department's attention to the urgent need 
to improve the care provided at and the management of CAVHCS. 
The Department is directed to immediately and fully correct 
deficiencies and problems at CAVHCS and ensure VA Southeast 
Network is focused on providing appropriate and additional 
assistance to the system. The Committee directs the Department 
to develop a plan to resolve these problems and to fill 
vacancies of permanent leadership and senior member staff and 
to submit quarterly reports describing implementation of the 
plan, including current status of hiring permanent leadership 
and senior member staff. The Committee strongly urges the 
Department to fully utilize every incentive, bonus, or other 
measures to hire and retain permanent medical staff to provide 
quality care for Veterans in Central Alabama. The Committee 
directs the Department to issue a report, no later than 60 days 
after enactment of this Act, on all levels of permanent 
staffing at CAVHCS along with vacancies and efforts that are 
being made to fill those vacancies.
    Nuclear Medicine Quality Improvements.--The Committee 
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 and 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 understands that Veterans treated at VA hospitals 
are more vulnerable to pressure injuries and commends VA for 
the March 2019 guidance (VHA Directive 1352) on Prevention and 
Management of Pressure Injuries. The Committee urges VA to 
update VHA Directive 1352 to follow the 2019 International 
Guidelines for the Prevention and Treatment of Pressure 
Injuries as VA's standard of care that was led and co-published 
by the US National Pressure Injury Advisory Panel. Furthermore, 
the Committee directs VHA to report to the Committees on 
Appropriations of both Houses of Congress within 120 days of 
enactment of this Act with a timeline to implement the 
Standardized Pressure Injury Prevention Protocol (SPIPP) 
Checklist to improve pressure injury prevention and support the 
development of best practices through the VHA medical system.
    Nutrition and Food Services.--The Committee recognizes the 
value of proper nutrition and food's impact on one's health and 
remains concerned regarding the nutritional health and well-
being of Veterans. Patients with three or more chronic 
conditions represent 35 percent of Veterans receiving VA care 
and account for 65 percent of VHA costs. Acknowledging the 
correlation between obesity and co-occurring chronic 
conditions, such as diabetes, the Committee directed in House 
Report 116-445 that VA provide a report on Veterans' 
nutritional habits. The Committee expects this report to be 
completed in a timely manner, and urges that it reflect the 
experiences of a range of individuals from various demographics 
of age, gender, and with varying health conditions. 
Furthermore, the Committee continues to urge VA to be proactive 
in promoting wellness and disease prevention by providing 
evidence-based nutritional guidelines for Veterans and their 
caretakers.
    Produce Prescription Pilot Program.--The Committee is 
concerned with food insecurity among the Veteran population and 
recognizes the role of access to healthy produce in managing 
chronic disease and reducing health care utilization. The 
Committee is 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 provide 
guidance and resources for VA facilities to develop local 
programs and pursue strategies for patient education and 
outreach.
    Long-Term Care.--The Committee notes the aging of the 
Veteran population and supports long-term care that focuses on 
facilitating Veteran independence, enhancing quality of life, 
and supporting the family members of Veterans.
    Long-Term Care Facilities for Spinal Cord Injuries and 
Disorders.--The Committee is concerned with the lack of long-
term care options for Veterans with spinal cord injuries and 
disorders (SCI/D), as well as with the uneven geographic 
distribution of these facilities. Currently, the Department 
operates six facilities, with only one located west of the 
Mississippi River. While the Committee understands that the 
development, design, and funding processes for SCI/D long-term 
care facilities has extensive timeframes, projects that would 
address the geographic distribution have not been properly 
included in long-term planning documents. The Committee directs 
the Department to provide a report to the Committees on 
Appropriations of both Houses of Congress within 120 days of 
enactment of this Act on the strategy to address long-term care 
needs for Veterans with SCI/D that address the geographic 
imbalance of current facilities.
    Expanded Access to Noninstitutional Long Term and Extended 
Care.--The Committee is aware that Veterans prefer to receive 
long-term and extended care services in their local 
communities. The Committee encourages VA to increase the number 
of local VA Medical Center partnerships with Programs of All-
Inclusive Care (PACE). For Veterans at high risk of nursing 
home placement, such collaborations will enable them to 
continue living safely in their homes and enjoy improved 
quality of life, heightened independence, and increased support 
for their family caregivers. Additional PACE-VAMC partnerships 
will provide better outcomes and higher quality of care for 
Veterans, while reducing costs by preventing or delaying 
nursing home placement. For these reasons, the Committee 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 improvements to its academic affiliation 
activities with minority medical schools. As such, VA is urged 
to expand collaboration with minority medical schools in order 
to enhance medical training initiatives, improve patient care, 
and provide educational opportunities for our nation's 
Veterans. The Committee also urges the Veterans Health 
Administration and Office of Academic Affiliations to maintain 
this ongoing commitment to minority health professions schools 
and provide an updated report to the Committees on 
Appropriations of both Houses of Congress within 90 days of 
enactment of this Act on the progress of these efforts.
    Minority Veteran Care.--The Committee notes that the 
Veteran population is becoming increasingly diverse and that 
according to VA's Center for Minority Veterans, more than one 
third of Veterans will come from minority groups by the year 
2040. The Committee supports the Office of Health Equity's 
efforts to address health disparities among Veterans and 
directs VA to provide adequate resources to make sure that VA 
can provide high quality medical care to all groups of 
Veterans. The Committee remains concerned with not only ongoing 
healthcare disparities between Veterans of varying ethnicities, 
but also VA's difficulties in reporting on these disparities. 
The Committee acknowledges that the Department currently has a 
working group which has the goal of developing streamlined data 
collection processes. The Committee looks forward to the report 
directed in House Report 116-445 on how VA can restructure its 
data collection practices to more accurately and consistently 
capture data on the race and ethnicity of Veterans across its 
various systems. Additionally, the Committee directs VA to 
submit a report to the Committees on Appropriations of both 
Houses of Congress within 180 days of enactment of this Act on 
the costs, feasibility and advisability of regularly collecting 
racial data for all major benefits programs and disaggregating 
the data by ethnic categories as defined by the Office of 
Management and Budget Race and Ethnic Standards for Federal 
Statistics and Administrative Reporting.
    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.
    Reducing Airborne Infections.--The Committee recognizes 
that airborne bacteria and viruses remain a significant source 
of healthcare-associated infections at health care facilities. 
Although High Efficiency Particulate Air (HEPA) filters are 
widely used to filter the air, airborne transmission still 
accounts for a significant portion of health care-associated 
infections. The Committee appreciates that VA is undertaking a 
review of its air filtration standards as a result of the 
coronavirus pandemic, which has increased the urgency of 
addressing airborne contaminants, and directs VA to provide a 
report to the Committee with the results of the review no later 
than 60 days after this review is completed. In House Report 
116-445, the Committee directed VA to initiate a pilot program 
of new commercial, off-the-shelf technology that has the 
potential to capture and destroy airborne contaminants, and 
reiterates that this pilot should be carried out expeditiously 
to ensure that facilities are not using outdated technology and 
putting Veterans at risk.
    Negative Air Room Containment Systems for Pandemic and 
Surge Capabilities.--The Committee expresses concern about the 
scalability and surge capacity of negative room containment 
systems. The Department is directed to explore options for 
portable negative air room technology in order to increase 
readiness and respond to surge capacity during pandemics and 
other medical events at Veterans installations.
    Creutzfeldt-Jakob Disease Monitoring.--Veterans and their 
dependents who resided at United States military installations 
in Germany, Belgium, and the Netherlands for six months or more 
from 1980 through 1990, and Veterans and their dependents who 
resided at United States military installations in Greece, 
Turkey, Spain, Portugal, and Italy for six months or more from 
1980 through 1996 are barred from donating blood due to their 
potential exposure during their military service to beef that 
was infected with bovine spongiform encephalopathy, resulting 
in possible infection of Creutzfeldt-Jakob Disease (CJD), a 
human prion disease. The Committee is committed to 
understanding the residual impacts of CJD within the Veteran 
community. The Committee 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 for All Cancers.--The Committee 
believes that every Veteran with cancer deserves the highest 
quality and most medically advanced diagnosis and treatment 
available, given their heightened exposure to hazards during 
their service that may be associated with an increased risk of 
cancer. 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 includes up to $15,000,000 to accelerate 
the adoption of molecular diagnostics for numerous cancers, 
which includes rare cancers. VA is encouraged 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 NIH. The Committee further directs 
the Department to issue a 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.
    Innovative Technological Solutions for Injured Veterans.--
The Department is encouraged to ensure injured Veterans are 
integrated into product development teams so that adaptive 
technologies are effectively tailored to meet the needs of 
these Veterans.
    Oral Contraceptives.--Given the potential advantages for 
patients in receiving a full year's supply of hormonal 
contraceptive products at once, and the findings of the 2019 
study, ``Financial Implications of 12-Month Dispensing of Oral 
Contraceptive Pills in the Veterans Affairs Health Care 
System'', published in JAMA Internal Medicine, the Committee 
urges the Department to encourage prescribers to proactively 
offer patients the option to receive a full year's supply, when 
medically appropriate. The Committee requests a report within 
90 days of enactment of this Act on how VA is implementing this 
option for all Veterans with hormonal contraceptive 
prescriptions and efforts to ensure patients are notified of 
that option.
    Intimate Partner Violence Program.--The Committee continues 
to support VA's efforts to expand its Intimate Partner Violence 
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.
    Adaptive Sports.--The bill provides $27,048,000 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. Additionally, the 
Committee understands that VA is currently conducting a study 
that will inform opportunities to further expand and integrate 
recreation therapy and creative arts therapy across inpatient 
rehabilitation settings, outpatient clinics, and in Veterans' 
home communities, and looks forward to the results of this 
study. 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.
    Vet Centers.--The Committee recognizes the importance of 
Vet Centers and the role they play in helping Veterans readjust 
to civilian life. The Committee encourages VA to work with 
local stakeholders to increase access to the readjustment 
counseling services provided by Vet Centers, Mobile Vet 
Centers, Outstations, and Community Access Points, and directs 
the Department to increase outreach to Veterans so they are 
aware of these counseling centers and services.
    Assisted Reproductive Services.--The Committee considers 
the limitations of VA's current policy for providing assisted 
reproductive services to be completely unacceptable. 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 are 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. The Committee finds the current 
reproductive services policy to be discriminatory, unjust, and 
antiquated. The Committee directs VA to submit a report within 
180 days of enactment of this Act with a recommendation for a 
new policy that is non-discriminatory and equitable. The 
Committee notes that Veterans have different needs than active 
duty servicemembers, and it is imperative that VA be able to 
create a unique policy that benefits the population it serves. 
Additionally, the Committee is 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. VA should 
develop a policy recommendation for providing assisted 
reproductive services that does not discriminate against women 
who cannot carry their own child to term, couples who need the 
use of donated gametes to conceive, and couples who would 
otherwise be ineligible under the existing policy, including 
same-sex couples.
    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 
report required in the Joint Explanatory Statement accompanying 
the Consolidated Appropriations Act, 2021 (P.L. 116-260) 
detailing the number of Veterans and spouses who have received 
fertility treatment, and those who are ineligible, and directs 
VA to provide this report annually. Additionally, future 
reports should include 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 directs VA to provide a report to the 
Committees on Appropriations of both Houses of Congress within 
90 days of enactment of this Act on the Department's outreach 
and education activities to make Veterans aware of the adoption 
reimbursement and assisted reproductive services benefits 
available to them under Sec. 234 of P.L. 116-260 and in 
previous Acts. The Committee is concerned that many Veterans 
who could benefit from these options may not be aware of the 
full range of services available to them, and urges the 
Department to increase its efforts to ensure Veterans are 
informed about these services, including during earlier medical 
visits.
    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. Those taking several 
medications are at the highest risk of negative drug-gene and 
drug-drug interactions leading to adverse drug events (ADEs), 
including death. Training health care professionals on the use 
of pharmacogenomic testing, analysis, alerting, and entry into 
electronic health records are essential parts of precision 
medicine and can save Veterans' lives, improve outcomes and 
lower expenditures. Therefore, the bill includes $5,000,000 for 
the Department to continue to expand the use of clinically 
validated, evidence-based pharmacogenomic analysis, testing and 
clinical decision support tools to assess Veterans, especially 
polypharmacy patients, and those at higher risk for ADEs.
    Acute Post-Surgical Pain Management.--The Committee 
recognizes the notable reduction in prescription opioids for 
Veterans who utilize the VA health care system. The Committee 
credits this to VA's focus on transforming chronic pain 
management with alternative therapies and an aggressive 
educational effort on safe and responsible use of prescription 
opioids. One further area of opportunity is the need to balance 
acute pain management and opioid use post-surgery. The 
Committee is aware that some non-opioid options may not be a 
good option for Veterans with liver problems and others may be 
more effective for post-surgical acute pain management. The 
Committee recognizes that Enhanced Recovery After Surgery 
(ERAS) refers to evidence-based protocols that standardize care 
to minimize pain, reduce opioid administration, expedite 
patient recovery, decrease perioperative complications and 
shorten hospital length of stay. The Committee encourages VA to 
broadly adopt ERAS protocols and ensure that frontline 
clinicians have full access to a range of post-surgical pain 
management tools.
    Commercially Available Pain Management Review.--While 
chiropractic care is authorized for use for Veterans Health 
Administration enrollees with a referral, the Committee notes 
that Veterans with chronic pain and severe disabilities, 
including Veterans with spinal cord injuries and traumatic 
brain injuries, may seek other pain management care outside of 
the services offered by the Department. The Committee 
encourages the Department to conduct reviews of commercially 
available options for pain management not currently authorized 
for use by enrollees.
    Continuous Glucose Monitors.--The Committee understands 
that Veterans are three times more likely than non-Veterans to 
have diabetes, which, if untreated, may lead to higher risk of 
heart disease, kidney failure, limb amputations, and blindness. 
The Committee is encouraged by innovations in diabetes 
treatment options, including recent technological advancements 
to continuous glucose monitoring systems (CGMs) and appreciates 
the Department's decision to facilitate access to CGMs during 
the public health emergency by suspending certain coverage 
criteria. The Committee requests that the Secretary provide a 
report to the Committees on Appropriations of both Houses of 
Congress detailing VA's coverage criteria as it relates to 
frequency of blood glucose testing, including the clinical 
rationale for these criteria, no later than 90 days after 
enactment of this Act.
    Diabetes Care Management.--The Committee directs the 
Veterans Health Administration and the Center for Care and 
Payment Innovation to explore the utilization of episode-based 
alternative payment models for chronic care management, to 
include diabetes and digital diabetes care management.
    Focused Ultrasound Technology.--The Committee supports the 
development and adoption of innovative technologies that 
provide less invasive treatment alternatives, reduce 
complications and other adverse side effects, and lower 
healthcare costs. The Committee encourages VA to explore the 
use of focused ultrasound technologies for use in cancer, 
neurological, and women's health indications, which may give 
Veterans access to non-invasive treatments for conditions that 
often have higher incidence rates in the Veterans' population 
like prostate cancer and Parkinson's disease.
    Infertility and Sexual Assault.--The Committee expresses 
concern with the high incidence of infertility among Veterans, 
particularly in those who experienced sexual assault or 
harassment during their service. The Committee urges the 
Veterans Health Administration to conduct trainings among their 
infertility specialists on the specific needs of this 
population and requests a report to the Committees on 
Appropriations of both Houses of Congress within 180 days of 
the enactment of this Act on how VA is implementing medically-
informed best practices for these health care providers.
    Reducing Blood Contamination.--The Committee is aware that 
blood culture contamination leads to enormous clinical 
implications, laboratory ramifications, and economic costs. The 
Committee directs VA to prioritize the development and 
implementation of a specific quality measure for blood 
contamination based on a recommendation of less than 1% blood 
culture contamination rate within 6 months of enactment. VA is 
directed to report to the Committees on Appropriations of both 
Houses of Congress within 180 days of the enactment of this Act 
detailing the implementation of this standard of care across 
the VA medical system.
    Diabetic Foot Ulcers.--The Committee recognizes that 
expanding access to remote patient diabetes monitoring provides 
more opportunities for continual Veteran monitoring, improving 
care outcomes at a lower cost than traditional methods and 
without the need for in-person encounters. The Committee 
supports the Department's Initiative to End Diabetic Limb Loss, 
which uses remote temperature monitoring in early detection of 
diabetic foot ulcers, preventing the need for amputations and 
other costly and life altering procedures. The Committee 
supports the Department's current expansion and evaluation of 
its remote patient remote monitoring pilot program, and urges 
that it be expanded to additional VISNs and greater numbers of 
Veterans at high risk of amputation as soon as is feasible. The 
Committee further directs the Department to provide a report to 
the Committee on Appropriations of both Houses of Congress 
within 60 days after the conclusion of the pilot detailing the 
amputation rate of Veterans participating in the pilot program 
as compared to non-participating Veterans.
    Bladder Cancer Testing.--The Committee recognizes that 
cancer is the second most common cause of death in Veterans, 
and bladder cancer is the fourth most common cancer among the 
Department's patient population. VA performs roughly 40,000 
cystoscopies annually and diagnoses approximately 3,100 new 
cases of bladder cancer each year. In the wake of the COVID-19 
pandemic, new cancer diagnoses and testing has decreased 
significantly. The Committee is pleased the Department has 
taken an aggressive posture in reducing bladder cancer through 
the Cooperative Studies Program 2022, Screening Asymptomatic 
Veterans for Bladder Cancer Early Detection (SAVE). The 
Committee acknowledges that an increase in non-invasive testing 
may decrease the burden of surveillance and long-term 
management, and is encouraged by technological developments, 
such as non-invasive diaper inserts that monitor moisture and 
test urine content. The Committee directs VA to increase access 
to at-home, non-invasive diagnostic, and surveillance testing 
for bladder cancer to reduce burdens on Veterans, improve early 
detection and maximize healthcare outcomes for Veterans.
    Safe Syringes for VA Health Workers.--The Committee 
recognizes the importance of safety for VA health workers 
providing vaccines to Veterans, particularly in light of the 
COVID-19 vaccination effort. The Committee is concerned about 
the risks that inconsistencies in standards of procured 
syringes present to VA healthcare staff who deliver intravenous 
medicines and vaccines and requests a report to the Committees 
on Appropriations of both Houses of Congress within 90 days of 
enactment of this Act detailing the Department's syringe 
procurement standards and strategies to purchase syringes from 
domestic producers.
    Hyperbaric Oxygen Therapy.--The Committee encourages the 
Department to provide hyperbaric oxygen treatment to Veterans 
suffering from chronic post-traumatic stress disorder, as 
appropriate.

                         MEDICAL COMMUNITY CARE

 
 
 
Appropriation, fiscal year 2021.......................   $18,511,979,000
Budget request, fiscal year 2022......................    23,417,244,000
Committee recommendation, fiscal year 2022............    23,417,244,000
    Change from enacted level.........................       + 4,905,265
    Change from 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 2023, the bill provides 
an advance appropriation of $24,156,659,000, of which 
$2,000,000,000 is available until September 30, 2024.
    The Committee provides an additional $3,269,000,000 to be 
available for fiscal year 2022 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 service our 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 (TBI).--The Committee continues to note the increasing 
prevalence of deployment-related traumatic brain injuries. This 
increase continues to demonstrate the longstanding need for 
providing adequate long-term specialty care for Veterans 
suffering from severe TBIs. The Committee appreciates the VA's 
progress on this issue and directs VA to (1) ensure an adequate 
number of long-term residential care facilities tailored to 
care for Veterans with severe TBIs are available and (2) 
consider entering into agreements to provide long-term 
specialty care for Veterans suffering from severe TBIs where 
VA-provided direct care is not available.
    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 health care 
providers electing to participate in VA's Community Care 
Program, as authorized by the VA MISSION Act (P.L. 115-182). 
The Committee encourages the Secretary to continue working with 
its partners to recruit private health care providers in rural 
communities to participate in the Community Care Network System 
to serve veterans in their local communities. The Committee 
requests a report within 60 days of enactment of this Act 
regarding the Department's and its partners' outreach 
strategies to private health care providers located in rural 
areas regarding this program.
    Reliance on Community Care Versus VA Medical Center and 
Clinic Expansion and Development.--The Committee recommends the 
Department develop a system to accurately compare the costs of 
providing care in the community, as envisioned by the MISSION 
Act, to the costs of providing care within the VA healthcare 
system. The data captured by the system should be gathered and 
made available in a manner that allows the accurate comparison 
of the cost of various services to help inform future decisions 
regarding the most cost-effective delivery of healthcare 
services to Veterans. The Committee also recommends that VHA 
solicit ``360-degree'' feedback from VA medical center 
directors on their service and funding needs. The Committee 
continues to look forward to working with the Department to 
develop and refine a medical care cost data collection system.

                     MEDICAL SUPPORT AND COMPLIANCE

 
 
 
Appropriation, fiscal year 2021.......................    $8,214,191,000
Budget request, fiscal year 2022......................     8,403,117,000
Committee recommendation, fiscal year 2022............     8,403,117,000
    Change from enacted level.........................     + 188,926,000
    Change from 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 $9,673,409,000 in advance fiscal year 
2023 funding. The Committee has included bill language to make 
$200,000,000 of the Medical Support and Compliance 
appropriation for fiscal year 2023 available through September 
30, 2024.

                           MEDICAL FACILITIES

 
 
 
Appropriation, fiscal year 2021................           $6,583,265,000
Budget request, fiscal year 2022...............            6,734,680,000
Committee recommendation, fiscal year 2022.....            6,734,680,000
    Change from enacted level..................                 +151,415
    Change from 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 $7,133,816,000 in advance fiscal year 
2023 funding. The Committee has included bill language to make 
available through September 30, 2024, $350,000,000 of the 
advance Medical Facilities appropriation for fiscal year 2023.
    Of the funds provided for non-recurring maintenance (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 
2022 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 remains concerned 
that VA has failed to keep up with a growing population of 
women Veterans who deserve equitable access to medical care. 
When one in four women Veterans report having experienced 
unwanted sexual attention while serving, it is concerning that 
the very system intended to address their trauma is failing to 
foster a safe environment for them. The Committee directs the 
Department to prioritize funding for medical facilities to 
accommodate women Veterans 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 concerned that a new 
Bakersfield CBOC remains unbuilt over a decade after Congress 
authorized this facility in P.L. 111-82. The Committee directs 
the Secretary to expeditiously execute Lease No. 36C10F20L0008 
and activate the CBOC by the third quarter of Fiscal Year 2023, 
as provided in the lease. The Committee directs the Secretary 
to provide monthly reports on the CBOC's progress until 
completion and activation.
    VA Facility Security.--The Committee continues to encourage 
the Department to improve the security of its campuses and 
facilities to ensure the safety of Veterans, visitors, and 
employees and supports the Department's investments in this 
area. The Committee recommends that VA take a holistic approach 
to security and technology upgrades by exploring the deployment 
of proven technologies that allow for greater interoperability 
within the VA and with outside first responders, protect VA 
employees and patients, enhance accountability and 
transparency, and provide actionable, real-time data.
    VA Facility Leases.--The Committee supports the 21 leases 
proposed in the FY22 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.
    Energy Monitoring.--The Committee commends the Department 
for its efforts to improve energy resilience, reduce energy 
waste, and limit energy costs. As the VA explores additional 
ways to conserve energy, the Committee encourages the VA to 
increase its use of advanced technologies, such as batteryless 
sensor networks, that can reduce energy consumption, enhance 
operational readiness, and equip operations and maintenance 
personnel with tools to monitor and manage energy resources 
more effectively.
    Medical Waste Report.--The Committee reminds the Department 
of its interest in the costs and benefits of on-site medical 
waste treatment systems, and that House Report 116-445 
requested a report on the issue. The Committee directs VA to 
provide the report within 30 days of enactment of this Act.
    West Los Angeles VA Homeless Housing Development.--The 
Committee is aware of the ongoing effort to redevelop the West 
Los Angeles VA, one of the largest VA facilities in the country 
that serves one of the largest homeless veteran populations in 
the United States. The Greater Los Angeles Healthcare System's 
Master Plan calls for the delivery of more than 1,200 units of 
housing for veterans experiencing homelessness. This plan would 
include the completion of seismic retrofits and construction on 
seismically deficient buildings, including those that were 
previously funded as Major Construction projects. The Committee 
urges the Department to work with its Principal Developer to 
expeditiously finalize this portion of the project, which is 
crucial to ensuring the rest of the Master Plan may proceed 
toward its goal of delivering housing for veterans in need.

                    MEDICAL AND PROSTHETIC RESEARCH

 
 
 
Appropriation, fiscal year 2021.......................      $815,000,000
Budget request, fiscal year 2022......................       882,000,000
Committee recommendation, fiscal year 2022............       902,000,000
    Change from enacted level.........................           +87,000
    Change from budget request........................           +20,000
 

    This appropriation provides for medical, rehabilitative, 
and health services research. The bill provides $902,000,000 
available through September 30, 2023. The Committee recognizes 
the importance of the research conducted by VA for Veterans' 
quality of life and health and provides $20,000,000 above the 
request and $87,000,000 above fiscal year 2021 for these 
activities.
    Medical research, which helps ensure the best medical and 
hospital services for Veterans, is an important aspect of the 
Department's programs. The prosthetic research program is also 
essential in the development and testing of prosthetic, 
orthopedic, and sensory aids for the purpose of improving the 
care and rehabilitation of eligible disabled Veterans, 
including amputees, paraplegics, and the blind. The health 
services research program provides unique opportunities to 
improve the effectiveness and efficiency of the healthcare 
delivery system. Budgetary resources from a number of areas, 
including appropriations from the medical care accounts, 
reimbursements from DOD, grants from the National Institutes of 
Health, private proprietary sources, and voluntary 
organizations, provide support for the Department's 
researchers. Estimated fiscal year 2022 research resources in 
addition to those provided in the research account are 
$1,350,700,000.
    The Committee is pleased that toxic exposures will be an 
area of focus for VA's research programs in fiscal year 2022 
and supports VA's plan to launch the Military Exposure Research 
Program. The Committee encourages the Department to continue 
and expand its research on the effects of and treatments for 
Veterans exposed to toxins, such as Agent Orange, open burn 
pits, per- and polyfluoroalkyl substances (PFAS), radiation, 
and asbestos, during the course of their active duty service.
    Per- and Polyfluoroalkyl Substances (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 the VA. While the Committee directs VA to 
continue collaborating with the Defense Department's Per- and 
Polyfluoroalkyl Substances (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 our Veterans.
    Gender-Specific Impacts of Toxic Exposure.--The Committee 
recognizes the gender-specific impacts of toxic exposure and 
remains concerned that the VA is not adequately addressing the 
healthcare needs of women Veterans. 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.
    Exposure to Herbicide-Related Toxins.--Veterans have 
frequently expressed long-held concerns that toxic exposure 
during their military service is related to adverse health 
conditions. The Committee is committed to understanding the 
residual impacts of Agent Orange/Dioxin and other herbicide-
related toxic exposures among Veterans who served in Vietnam, 
Thailand, Guam, the Northern Mariana Islands, American Samoa, 
and all other geographic areas where these toxic substances 
were dispersed. The Committee urges the Department to reference 
data from existing medical records of Veterans to determine the 
percentage of Veterans from the above referenced subgroup that 
have more frequent or unexplained diseases compared to the 
civilian population. This body of data could be helpful in 
clarifying the extent and specifics of the medical issues 
suffered by Veterans from exposure to herbicides.
    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.
    Neural-Enabled Prosthetics.--The Committee understands the 
uniqueness of limb trauma injuries sustained by servicemembers 
in combat. Traumatic injury or neurological diseases can also 
significantly alter or impair the lifestyle of the individual 
and their caregivers. The Committee encourages VA to fund 
research that will design and develop technology to offset the 
effects of limb amputation, orthopedic injury and disease, 
neuropathic pain, and other neurodegenerative diseases. Thus, 
the Committee includes $25,000,000 for VA to prioritize this 
line of research, including through collaborative research with 
a coalition of universities aimed at accelerating functional 
recovery and rehabilitation of sensorimotor function through 
engineering of wirelessly activated implantable biomedical 
technologies capable of focal stimulation inside nerves and 
that is personalized to the needs of the patient.
    Access to Clinical Oncology Trials.--The Committee 
continues to applaud the ongoing collaborative efforts between 
VA medical centers and NCI-designated comprehensive cancer 
centers that allow Veterans to have access to the highest 
quality cancer care available, including cutting-edge clinical 
trials for cancers that occur at high rates in the Veteran 
population, such as prostate, lung and melanoma. In each of 
Fiscal Years 2020 and 2021, the Committee provided $5,000,000 
to expand these efforts to ensure that States with large 
Veteran populations are able to access these treatments. The 
Committee appreciates that the Department has begun to 
implement this initiative and looks forward to being kept 
apprised of further progress. To continue this forward 
progress, the Committee directs VA to allocate not less than 
$10,000,000 to support these new partnerships between VA 
hospitals and NCI-designated facilities that allow for Veterans 
to access cancer clinical trials at VA health centers 
consistent with the guidance provided in the FY2020 and FY2021 
Committee reports.
    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. The Committee also urges the 
Department to publish disease-specific mortality data related 
specifically to Persian Gulf War Veterans. The Committee 
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). Furthermore, the Committee once again 
encourages VA to strengthen the training of primary, specialty, 
and mental healthcare providers on the current and soon to be 
revised Gulf War Illness case definitions recommended by IOM, 
as well as education and training of VA clinicians on effective 
assessment, diagnosis, and clinical management of Gulf War 
Illness. The Committee notes that this education and training 
should be aligned with the recently completed revision of the 
Clinical Practice Guidelines for Chronic Multisymptom Illness.
    Dystonia.--The Committee continues to urge the VA to pursue 
collaborative efforts with the dystonia stakeholder community 
and related federal agencies. The Committee also requests an 
update on relevant research projects that examine the 
connection between traumatic brain injury (TBI) and dystonia.
    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.
    Public Access to Scientific Data.--The Committee commends 
the Department on issuing its Policy and Implementation Plan 
for Public Access to Scientific Publications and Digital Data 
from Research Funded by the Department of Veterans Affairs on 
July 23, 2015. The Committee urges VA to continue its efforts 
towards full implementation of the plan.
    NICoE Collaboration.--The Committee recognizes the high-
quality mental health care and neurological research being 
conducted at Walter Reed National Intrepid Center of Excellence 
(NICoE). 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 the 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 the progress being made to provide our nation's 
Veterans with new assistive and restorative technologies that 
address sensory, motor, or cognitive deficits, as well as limb 
loss. The APT Center has effectively utilized a partnership 
model to leverage local and national research expertise to 
drive dramatic progress in diverse areas including artificial 
lung development, wound healing, and neurally-connected sensory 
prosthesis. The Committee supports the APT Center's efforts.
    Spinal Cord Research.--The Committee recognizes the 
severity of spinal cord injuries sustained by servicemembers in 
combat and supports additional research in this area. Thus, the 
Committee encourages the Department to work with outside 
organizations on spinal cord injury research to cure paralysis 
and improve the quality of life of impaired and disabled 
Veterans, and includes $10,000,000 to do so.
    Severe Depression and Suicide Prevention.--The Committee is 
concerned with the continuing problem of suicide among 
Veterans, and notes the need for ongoing efforts to improve 
methods of suicide risk mitigation. The Committee supports VA's 
commitment to understanding Veteran suicide and applying 
epidemiological findings to inform Veteran suicide prevention 
while also proactively implementing outreach, programs, and 
interventions to end suicide. Studies conducted by the National 
Institutes of Mental Health (NIMH) investigating the use of 
Scopolamine in treating depression and suicide prevention have 
shown promising initial results in rapidly decreasing patients' 
Montgomery-Asberg Depression Rating Scale (MADRS) scores, with 
over 50% of patients achieving remission. The Committee directs 
the Department to collaborate with the Departments of Defense 
and Health and Human Services to further validate the findings 
of the NIMH study, including potentially conducting a joint 
study. The Department is requested to provide a report to the 
Committee not later than 180 days after the enactment of this 
Act describing its plan to validate these findings.
    Nanoscale Next-Generation Nonsurgical Neurotechnology.--The 
Committee acknowledges the potential for benefit in 
collaboration between the VA and DARPA in developing and 
testing neurotechnology for Veteran movement rehabilitation. 
The Committee is aware of the success of DARPA's Next-
Generation Nonsurgical Neurotechnology (N3) program, which 
presents the opportunity to help wounded warriors control their 
own limbs via muscle stimulation/rehabilitation and regain 
independence without invasive surgery. The Committee directs VA 
to continue to work together with DARPA, particularly to 
include disabled Veteran candidates in DARPA's human clinical 
trials of the nanoscale minimally invasive brain computer 
interface and demonstrate the potential benefits of this 
emerging neurotechnology in restoring movement and offering 
independence without invasive surgical procedures.
    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.
    Research Facilities and Academic Affiliates.--The close 
partnership between the VA and its academic affiliates has led 
to development of new health care specialties, modern models of 
delivery and has grown into the most comprehensive academic 
health system partnership in history. The Department's academic 
affiliation network has also provided an effective pathway for 
VA to recruit highly qualified health care professionals into 
its health care system. While this partnership has led to a 
number of clinical innovations and better quality of care for 
Veterans, there are areas where the affiliation could be better 
leveraged, including through shared research space. VA is 
encouraged to consider greater utilization of available 
research space available at its academic affiliates to support 
its work, especially given growing capital needs at its own 
facilities. Leveraging these partnerships to include greater 
use of research space on a shared basis could prove to be 
useful, especially for principal investigators who are both VA 
clinicians and on faculty at the respective affiliate. 
Therefore, the Committee directs the Secretary to report back 
no later than 90 days after enactment of this Act, on locations 
where the Department has, can, or plans to employ arrangements 
that would allow for sharing agreements between local VA 
Medical Centers to utilize existing research space at an 
academic affiliate.
    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 the 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.

                     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 2022 is $3,386,000,000.
    MCCF Third-Party Billing.--The Committee remains concerned 
over potential discrepancies in VA's billing and collection 
processes. Procedures to provide for correct billing and prompt 
collection must be improved at VA. Therefore, the Committee 
continues to require the Department to submit to the Committees 
on Appropriations of both Houses of Congress a quarterly report 
identifying the amount of third-party health billings that were 
owed to VA in the previous quarter and the amount collected. 
The 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). In addition, the reports should also 
include updates on current efforts underway to increase VA's 
efficiency, accuracy, and collection process, as well as what 
management practices are in place to provide proper oversight 
of the billing process, including appeals, so as to eliminate 
unnecessary and duplicative functions.

                    National Cemetery Administration


 
 
 
Appropriation, fiscal year 2021.......................      $352,000,000
Budget request, fiscal year 2022......................       394,000,000
Committee recommendation, fiscal year 2022............       392,000,000
    Change from enacted level.........................       +40,000,000
    Change from budget request........................        -2,000,000
 

    The National Cemetery Administration (NCA) was established 
in accordance with the National Cemeteries Act of 1973 (P.L. 
93-43). It has a fourfold mission: to provide for the interment 
of, in any national cemetery with available grave space, the 
remains of eligible deceased servicemembers and discharged 
Veterans, together with their spouses and certain dependents, 
and to permanently maintain their graves; to provide headstones 
for, and to mark graves of eligible persons in National, State 
and Tribal, and private cemeteries; to administer the grant 
program for aid to States and tribal governments in 
establishing, expanding, or improving State and tribal 
government Veterans' cemeteries; and to administer the 
Presidential Memorial Certificate Program. This appropriation 
will provide for the operation and maintenance of 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, 2023.
    Prisoners of War Headstones.--The Committee appreciates the 
Department's actions to replace headstones of prisoners of war 
that feature swastikas and inscriptions glorifying the Nazi 
regime. The Committee understands that this replacement work 
has been partially completed, and strongly urges the Department 
to expeditiously complete the project. The Committee continues 
to direct VA to provide monthly reports on the status of this 
process to the Committees on Appropriations of both Houses of 
Congress. Furthermore, the Committee continues to direct VA to 
include in these monthly reports details on its proposal to 
provide interpretive signs and historical context at cemeteries 
with headstones of prisoners of war, and reminds the Department 
to carefully craft the design and wording of planned 
interpretive signage to provide the appropriate historical 
context but be sensitive to those most affected by it.
    Rural Cemetery Access.--The Committee remains concerned 
that NCA is not adequately serving the Nation's Veterans in 
rural areas and that there are geographic pockets in the 
country which continue to go unserved. The Committee therefore 
directs VA to continue to pursue efforts to ensure that a 
burial option, including those utilizing public-private 
partnerships, within 75 miles of all Veteran homes is available 
and accessible. The Committee directs the Department to report 
to the Committees on progress made in this regard, and on 
strategies to address the remaining need in the future, within 
60 days of enactment of this Act.

                      Departmental Administration


                         GENERAL ADMINISTRATION

                     (INCLUDING TRANSFER OF FUNDS)

 
 
 
Appropriation, fiscal year 2021.......................      $365,911,000
Budget request, fiscal year 2022......................       401,200,000
Committee recommendation, fiscal year 2022............       396,911,000
    Change from enacted level.........................       +31,000,000
    Change from budget request........................        -4,289,000
 

    The General Administration account provides funds for the 
Office of the Secretary, the General Counsel, six Assistant 
Secretaries, and two Department-level staff offices. The 
Committee has included bill language to make available through 
September 30, 2023, 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 2022 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 $19,590,000 for FMBT. The current legacy 
financial management system is over 30 years old, and its 
imminent failure presents significant risks to VA. In the 
fiscal year 2018 conference report, VA was directed to provide 
the Committee, on a quarterly basis, a report that compares 
actual progress on the financial management system to the 
performance benchmarks and timeline provided in the first 
report. The Committee continues to expect the Department to 
continue this quarterly report throughout fiscal year 2022.
    Supporting Minority and Disadvantaged Contractors.--The 
Committee recognizes the need to continue to meet its goals for 
contracting with minority, disadvantaged, and women-owned 
businesses. Therefore, the Committee directs the Department to 
prioritize awarding contracts to contractors that consistently 
execute approved small business subcontracting plans. The 
Committee further urges the Department to prioritize minority-
owned and disadvantaged contractors and subcontractors. The 
Committee requests a report, within 180 days of enactment of 
this Act and annually thereafter, detailing the number of 
contractors that submitted a small business subcontracting plan 
during the fiscal year, disaggregated by race and ethnicity. 
This report should include an analysis detailing which 
contractors successfully implemented subcontracting plans and 
recommendations on how the Department could better achieve its 
prime and subcontracting goals for small businesses.
    Data on Women and Minority Veterans.--The Committee 
recognizes the lack of data specific to women and minority 
Veterans made available to Congress by the Department. The 
Committee recommends, when applicable, the Secretary display 
information in the annual report(s) submitted to Congress 
separately for women Veterans and minority Veterans.
    Veterans First Contracting Program.--The Committee 
recognizes the tremendous value of the Veterans First 
Contracting Program in assisting in the expansion and growth of 
service-disabled Veteran and Veteran-owned small businesses. 
Therefore, the Committee encourages VA to continue to expand 
and make mandatory the training of contracting officers in the 
requirements of the Veterans First Contracting Program, with 
particular attention being paid to conducting the market 
research necessary to ensure that service-disabled Veteran and 
Veteran-owned small businesses are awarded VA contracts when 
appropriate.
    21st Century IDEA Act Compliance for the Center for Women 
Veterans.--The Committee supports the mission of VA's Center 
for Women Veterans to monitor and coordinate VA's 
administration of health care and benefits services, and 
programs for women Veterans. The Committee also supports the 
full implementation of the 21st Century IDEA (Public Law 115-
336) and the need for a customized, self-service website that 
serves as a centralized source for the provision to women 
veterans of information about the benefits and services 
available to them under laws administered by the Secretary. 
Therefore, the bill includes $1 million for the Center for 
Women Veterans to stand up a user-friendly, mobile responsive 
website that fully implements the requirements of PL 115-336. 
The Committee believes this improved digital service delivery 
for women veterans will increase participation in VA benefits 
and services and reduce service costs. The Committee directs 
the Secretary of the VA to brief the appropriate committees of 
Congress not later than 180 days following enactment of this 
Act on plans to modernize its Center for Women Veterans Health 
website and digital service delivery programs.
    Center for Women Veterans.--The Committee recognizes that 
the Center for Women Veterans (CWV) serves to monitor and 
coordinate the Department of Veterans Affairs administration of 
health care and benefits services, and programs for women 
veterans and to serve as an advocate for cultural 
transformation, both within VA and in the general public, in 
recognizing the service and contributions of women Veterans and 
women in the military. The CWV is tasked with 12 specific 
functions under title 38 of U.S. Code. The Committee directs VA 
to submit a report to the Committees on Appropriations of both 
Houses of Congress within 120 days of enactment of this act 
detailing: (1) how the work of the Center fulfills these 12 
Congressionally-mandated functions, including data on the 
Center's previous success and outcomes on delivering these 
functions; (2) how the Center is coordinating with other VA 
entities to meet those functions; (3) any challenges in 
fulfilling those statutorily mandated functions, including any 
specific budgetary constraints; and (4) a strategic plan for 
meeting these functions in the next two years.
    Grant and Federal Assistance Oversight.--The Committee is 
aware that the VA lacks a departmental office to support and 
oversee its growing number of grants and federal assistance 
programs, which could impact program implementation and public 
reporting of data, such as through USAspending reports. The 
Committee encourages the VA to ensure grant programs are stood 
up effectively and in a timely manner, and that improvements 
are made to internal systems responsible for informational 
updates to grant assistance listings, CFDA numbers, and 
USAspending reports.
    Federated Learning.--The Office of Enterprise Integration's 
Innovation Center is encouraged to utilize commercially 
available federated learning solutions to expand diagnostic and 
medical care services that can be provided at rural VA clinics 
with limited or no broadband capabilities.

                    ASSET AND INFRASTRUCTURE REVIEW

 
 
 
Appropriation, fiscal year 2021.......................             - - -
Budget request, fiscal year 2022......................        $5,000,000
Committee recommendation, fiscal year 2022............         5,000,000
    Change from enacted level.........................        +5,000,000
    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 the 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 
staff of the Commission are anticipated to begin preparatory 
work in the first months of FY 2022.

                       BOARD OF VETERANS APPEALS

 
 
 
Appropriation, fiscal year 2021.......................      $196,000,000
Budget request, fiscal year 2022......................       228,000,000
Committee recommendation, fiscal year 2022............       228,000,000
    Change from enacted level.........................       +32,000,000
    Change from budget level..........................             - - -
 

    The bill makes ten percent of this funding available 
through September 30, 2023.
    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.
    Prior to COVID-19, the Board was on target to reach its 
goal of conducting a record 24,300 hearings in 2020 and the 
number of pending hearing requests was 77,621. Due to the 
effects of the pandemic, the Board completed 15,669 hearings in 
2020, resulting in 86,849 pending hearing requests.
    In March 2020, BVA fully implemented a virtual tele-hearing 
solution, allowing Veterans to participate in hearings before 
the Board via voice and video transmission over the Internet 
using non-VA cell phones and laptops. This technology, designed 
to increase hearing show rates, also provides greater access 
and flexibility, especially for rural Veterans and 
representatives. Approximately 97% of hearings are now virtual.

                     INFORMATION TECHNOLOGY SYSTEMS

                     (INCLUDING TRANSFER OF FUNDS)

 
 
 
Appropriation, fiscal year 2021.......................    $4,912,000,000
Budget request, fiscal year 2022......................     4,842,800,000
Committee recommendation, fiscal year 2022............     4,842,800,000
    Change from enacted level.........................       -69,200,000
    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 
$1,414,215,000 for pay and associated costs, $3,131,585,000 for 
operations and maintenance, and $297,000,000 for development. 
The bill makes available three percent of pay and associated 
costs and five percent of operations and maintenance funds 
until September 30, 2023. All development funds are available 
until September 30, 2023.
    The Committee encourages VA to allocate sufficient 
resources for IT improvements that support research and 
research facilities.
    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
------------------------------------------------------------------------
Clinical Applications................................           $103,624
Health Management Platforms..........................             69,096
Health Research and Development......................              8,660
Benefits Systems.....................................             87,390
Memorial Affairs.....................................              9,030
Cybersecurity........................................             11,200
Information/Infrastructure Management................              8,000
    Total All Development............................            297,000
------------------------------------------------------------------------

    The Committee expects the Office of Information and 
Technology to continue to provide an IT expenditure report to 
the Committees on Appropriations of both Houses of Congress on 
a monthly basis. This report should include a comparison to the 
project costs included in the development funding chart above 
and provide an explanation for any differences in excess of 
$3,000,000.
    Cybersecurity Strategy.--The Committee is pleased that the 
Department is updating its cybersecurity strategy and plans to 
publish it by the end of 2021 and encourages it to remain 
vigilant against current and future cybersecurity challenges.
    Technology Investments.--As the Department of Veterans 
Affairs rolls out its enterprise applications and moves toward 
more agile development, the Committee encourages the Department 
to review and consider the Department of Defense's success 
implementing the Software Factory concept of operations.
    21st Century IDEA VA Forms Modernization.--The Committee 
supports the Department's efforts to modernize its internal and 
external digital services, consistent with the requirements of 
the 21st Century IDEA (Public Law No. 115-336). The Committee 
believes that the 21st Century IDEA will enable the VA's Office 
of Information Technology and Veterans Customer Experience to 
improve digital service delivery for both Veterans and internal 
workflows.
    Encrypted Communications for Telehealth.--In coordination 
with the Veterans Health Administration and Office of 
Electronic Health Records Modernization, the Office of 
Information Technology is directed to utilize the best 
technologies, such as end-to-end encrypted communications with 
zero-trust architecture, that can reliably serve Veterans and 
healthcare providers.
    Veterans Affairs Sexual Harassment Tracking.--The Committee 
directs the Department to develop a centralized data supporting 
system cataloguing sexual harassment and assault complaint data 
pursuant to Section 5303 of the Deborah Sampson Act.
    Digital Protection Pilot Program.--The Committee continues 
to believe that it is our country's duty to protect our 
Veterans, the Department of Veterans Affairs (VA), and 
Congressionally Charted VSOs from both foreign and domestic 
threats across the digital landscape attempting to steal money, 
pilfer personal information or peddle foreign influence via 
social media or other online campaigns. In Fiscal Year 2021, 
the Committee provided $5,000,000 million for a ``Digital 
Protection Pilot Program'' within the Office of Information 
Technology Systems at VA to use commercially available, proven, 
automated technology to continuously detect, disrupt and 
disable these threats. The Committee directs the Department to 
provide a report on the status of implementation of the 
``Digital Protection Pilot Program'' within 90 days of the 
enactment of this Act.

                VETERANS ELECTRONIC HEALTH RECORD (EHR)

 
 
 
Appropriation, fiscal year 2021.......................    $2,627,000,000
Budget request, fiscal year 2022......................     2,663,000,000
Committee recommendation, fiscal year 2022............     2,637,000,000
    Change from enacted level.........................       +10,000,000
    Change from budget request........................       -26,000,000
 

    The Veterans Electronic Health Record is a unified account 
designed to manage the effort to develop an interoperable 
electronic health record system that will access seamlessly the 
records of Veterans in the VA system and those of the 
Department of Defense and of community providers. The VA system 
is the same as the one chosen by DOD and is planned to be 
rolled out with the same timeline and geographic areas as DOD 
in order to realize cost efficiency savings.
    The bill provides an increase of $10,000,000 above the 
fiscal year 2021 level to support VA's on-going efforts to 
deploy the new electronic health record system. Within the 
total funding, the bill includes $1,416,498,000 for the 
electronic health record contract, $276,705,000 for program 
management, and $943,797,000 for infrastructure support. 
Funding is made available for three years due to the 
uncertainty of the timing of obligations for this substantial 
effort.
    This account is intended to be the single source of funding 
within VA for the electronic health record effort. No authority 
is provided for funds from other VA accounts to be transferred 
into this account nor for funds from this account to be 
transferred out to other accounts. Consistent with the effort 
to centralize financial management of the development of the 
electronic health record, the Committee continues to direct the 
Department to manage this effort at the headquarters level in 
the Office of the Deputy Secretary.
    The bill continues language requiring the Secretary to 
submit a quarterly report to the Committees on Appropriations 
of both Houses of Congress detailing obligations, expenditures, 
and deployment strategy by facility. VA is directed to continue 
quarterly briefings on performance milestones, costs, and 
changes to implementation and management plans, and to provide 
an accurate up-to-date deployment schedule each quarterly 
briefing. 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 requiring notice to 
and approval from the Committees on Appropriations of both 
Houses of Congress on any changes to the deployment schedule. 
Should there be any deviation from the deployment schedule, the 
Committee directs the Department to formally submit in writing 
a proposed updated deployment schedule within 7 days of 
notification to the Committees of any potential Change, and 
prior to implementation of the updated deployment schedule. The 
Committee repeats the fiscal year 2020 directive for GAO to 
perform quarterly performance reviews of the VA electronic 
health record deployment. It is expected that this quarterly 
reporting will provide the Committees and VA with timely 
information to properly oversee this effort and address 
important issues.
    Cybersecurity for Electronic Health Records and Blockchain 
Technology.--Recognizing the ongoing challenges of sharing data 
between 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 undertaking 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.
    Transparency on EHRM Third-Party Application Review.--The 
Committee continues to encourage VA to ensure that the new EHRM 
initiative provides an open architecture that allows a 
governance and oversight process for administering access and 
support to deploy third-party applications, components, and 
application programming interfaces. The Committee encourages 
the Department and the Federal Electronic Health Record 
Modernization Program Office to ensure the standards and 
evaluation criteria for commercially available software, tools 
and products that advance interoperability and seamless care 
are readily available for review, such as on the EHRM webpage.
    Informatics.--Based on the lessons learned at the Mann-
Grandstaff VA Medical Center, the Committee notes the need for 
integrating informatics infrastructure and capabilities as the 
Department transitions additional facilities to a new 
electronic health record. Workflow process modelling, 
healthcare standards implementation, and terminology 
standardization are critical to multiple areas of veteran care, 
including staff productivity and community care. The Committee 
requests a report within 120 days of enactment of this Act on 
what the Department is doing to integrate informatics 
infrastructure and capabilities as the Department transitions 
from VistA to the new electronic health record system, 
including detailing the minimum informatics requirements that 
all facilities must meet as part of this transition.
    Electronic Health Record Infrastructure.--The Committee 
appreciates the Department's March 2, 2021, response to its 
request for a report on the total cost of the installations of 
all remaining information technology and related infrastructure 
required to complete the deployment of the electronic health 
record. However, in light of the Office of Inspector General's 
Report #20-03178-116, Deficiencies in Reporting Reliable 
Physical Infrastructure Cost Estimates for the Electronic 
Health Record Modernization Program, the Committee is concerned 
with the accuracy and reliability of the data provided. As 
such, the Committee directs the Department to swiftly implement 
the recommended actions and to provide a new estimate that 
includes the information requested in Division J of the FY21 
the conference agreement (P.L. 116-260).

                      OFFICE OF INSPECTOR GENERAL

 
 
 
Appropriation, fiscal year 2021.......................      $228,000,000
Budget request, fiscal year 2022......................       239,000,000
Committee recommendation, fiscal year 2022............       239,000,000
    Change from enacted level.........................       +11,000,000
    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, 2023.
    The Committee continues to request robust oversight of 
MISSION Act and EHRM implementation.
    Federal Electronic Health Record Management Program Office 
(FEHRM).--The Committee looks forward to receiving the VA 
Office of Inspector General audit report regarding the 
governance policies and practices of the FEHRM.
    VA Backlog.--The 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. The 
OIG shall 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.

                      CONSTRUCTION, MAJOR PROJECTS

 
 
 
Appropriation, fiscal year 2021.......................    $1,316,000,000
Budget request, fiscal year 2022......................     1,611,000,000
Committee recommendation, fiscal year 2022............     1,611,000,000
    Change from enacted level.........................      +295,000,000
    Change from budget request........................             - - -
 

    The Construction, Major Projects appropriation provides for 
constructing, altering, extending, and improving any of the 
facilities under the jurisdiction or for the use of VA, 
including planning, architectural and engineering services, 
assessments, and site acquisition where the estimated cost of a 
project is more than $20,000,000. The Committee recommendation 
makes $657,326,000 of these funds available for a five-year 
period.
    As required by language that is in permanent law, all major 
construction projects costing more than $100,000,000 must be 
managed by a non-VA government entity such as the Army Corps of 
Engineers. While the Committee no longer duplicates this 
language, the Committee intends to continue its oversight of 
the quality of the outside entity management and will continue 
to receive quarterly briefings on each of the large 
construction projects.
    The chart below reflects the Committee's recommendation for 
Major Construction projects.

                      CONSTRUCTION, MAJOR PROJECTS
                        [In thousands of dollars]
------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Veterans Health Administration
Biloxi, MS Restoration of Hospital/Consolidation of              $22,500
 Gulfport............................................
Portland, OR Upgrade Portland Bldg 100/101 for                    20,000
 Seismic Retrofit and Renovation.....................
Louisville, KY New Medical Center....................             93,000
San Francisco, CA New Research Facility..............             74,400
West Los Angeles, CA Build New Critical Care Center..             40,000
Long Beach, CA Mental Health & Community Living                   20,000
 Center..............................................
Canandaigua, NY Construction & Renovation............             60,159
San Diego, CA SCI & Seismic Building 11..............             10,000
Dallas, TX Spinal Cord Injury........................             43,239
Oklahoma City, OK Construct Surgical Intensive Care               18,103
 Unit and Renovate Operating Room....................
St. Louis (JC), MO Replace Bed Tower, Clinical Bldg               92,000
 Expansion & Parking Garage..........................
El Paso, TX Construct New Health Care Center.........            150,000
Advance Planning and Design Fund.....................            417,699
Asbestos.............................................             12,000
Construction and Facilities
Staff................................................            124,600
Hazardous Waste......................................              4,000
Judgment Fund........................................             35,000
Non-Dept. Fed. Entity Project Management Support.....            132,000
Seismic Corrections..................................            100,000
    Total, VHA.......................................          1,468,700
National Cemetery Administration
Fort Logan, CO Phase 1 Gravesite Expansion...........             50,000
Indiantown Gap, PA Phase 5 Gravesite Expansion.......             44,500
Advance Planning and Design Fund.....................             35,000
NCA Land Acquisition.................................              1,000
    Total, NCA.......................................            130,500
General Administration
Staff Offices Advanced Planning Fund.................             11,800
    Total, Major Construction........................          1,611,000
------------------------------------------------------------------------

    To enhance the Committee's capacity to conduct oversight on 
VA's facility construction efforts, several administrative 
provisions are continued in the bill: (1) No funding amount 
greater than $7,000,000 may be reprogrammed between 
construction projects unless approved by the Committees on 
Appropriations of both Houses of Congress; (2) any change to 
the scope of a construction project is not permitted without 
the approval of the Committees; and (3) VA must report any bid 
savings of $5,000,000 or more on projects as soon as they are 
identified.

                      CONSTRUCTION, MINOR PROJECTS

 
 
 
Appropriation, fiscal year 2021.......................      $390,000,000
Budget request, fiscal year 2022......................       553,000,000
Committee recommendation, fiscal year 2022............       553,000,000
    Change from enacted level.........................      +163,000,000
    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 makes $55,300,000 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.
    Construction of Housing for Rural Homeless Veterans.--The 
Department has made great efforts to find suitable housing for 
homeless Veterans and their families. The Committee encourages 
more non-traditional efforts to eliminate Veteran homelessness. 
For example, some cities and towns have started pilot programs 
using ``Micro'' or ``Tiny Homes'', or renovated shipping 
containers, to help deal with homelessness. The Committee 
encourages VA to continue its efforts to house homeless 
Veterans and their families and explore the feasibility of 
providing ``Tiny Homes'' or renovated shipping containers as 
housing.
    National VA History Center.--The Committee supports the 
Department's decision to establish the VA History Office and 
the National VA History Center (NVAHC) to collect and preserve 
the department's history. Because the VA was one of the few 
cabinet-level agencies without an official history office, this 
fills a long-standing need to develop an overarching program to 
collect, preserve and provide access to VA's relevant 
historical records and artifacts to tell a comprehensive story 
of VA and its predecessor organizations. The Committee 
encourages VA to continue restoration necessary to develop the 
NVAHC to serve as the principal VA-wide location for 
centralized VA historical collections.

       GRANTS FOR CONSTRUCTION OF STATE EXTENDED CARE FACILITIES

 
 
 
Appropriation, fiscal year 2021.......................       $90,000,000
Budget request, fiscal year 2022......................             - - -
Committee recommendation, fiscal year 2022............        90,000,000
    Change from enacted level.........................             - - -
    Change from budget request........................       +90,000,000
 

    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.
    The American Rescue Plan Act of 2021 (P.L. 117-2) included 
$500 million that allowed VA to fund all projects on the 
priority list, thereby eliminating the backlog of priority 
projects in fiscal year 2021.
    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 
submitted in April 2021, the bill maintains level funding of 
$90 million for fiscal year 2022.

             GRANTS FOR CONSTRUCTION OF VETERANS CEMETERIES

 
 
 
Appropriation, fiscal year 2021.......................       $45,000,000
Budget request, fiscal year 2022......................        45,000,000
Committee recommendation, fiscal year 2022............        47,097,000
    Change from enacted level.........................        +2,097,000
    Change from budget request........................        +2,097,000
 

    This program provides grants to assist States and tribal 
governments with the establishment, expansion, and improvement 
of Veterans' cemeteries that are operated and permanently 
maintained by the States and tribal governments. Grants under 
this program fund up to 100 percent of construction costs and 
the initial equipment expenses when the cemetery is 
established. State and tribal governments remain responsible 
for providing the land and for paying all costs related to the 
operation and maintenance of the State cemeteries, including 
the costs for subsequent equipment purchases. The bill makes 
this funding available until expended.

                       Administrative Provisions

    The bill includes 49 administrative provisions, of which 48 
were in effect in fiscal year 2021 in some form and one is a 
new provision. 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 2022. 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 2022 for ``Compensation and 
Pensions'', ``Readjustment Benefits'', and ``Veterans Insurance 
and Indemnities'' for payment of accrued obligations recorded 
in the last quarter of fiscal year 2021.
    The bill includes section 207 allowing for the use of 
fiscal year 2022 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 $379,009,000 
of fiscal year 2022 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 
$323,242,000 of fiscal year 2023 funding appropriated for 
medical accounts to the Joint DOD-VA Medical Facility 
Demonstration Fund for the operation of facilities designated 
as combined Federal medical facilities.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 221 permitting the transfer of 
funds deposited in the Medical Care Collections Fund to the 
Joint DOD-VA Medical Facility Demonstration Fund for facilities 
designated as combined Federal medical facilities.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 222 directing that a minimum of 
$15,000,000 shall be transferred from the four medical care 
appropriations to the Department of Defense/Department of 
Veterans Affairs Health Care Sharing Incentive Fund, to be 
available until expended.
    The bill includes section 223 requiring the Secretary to 
notify the Committees on Appropriations of both Houses of 
Congress of all bid savings when identified in Major 
Construction projects that total at least $5,000,000 or five 
percent of the programmed amount of the project. The 
Administration proposal to delete this provision is not 
adopted.
    The bill includes section 224 prohibiting the original 
scope of work for a Major Construction project from being 
increased above the scope specified for that project in the 
original justification data provided to Congress unless 
approved by the Committees on Appropriations of both Houses of 
Congress. The Administration proposal to delete this provision 
is not adopted.
    The bill includes section 225 requiring a quarterly report 
from each VBA regional office on pending disability claims, 
both initial and supplemental; error rates; the number of 
claims processing personnel; corrective actions taken; training 
programs; and review team audit results. In addition, the bill 
requires quarterly reporting on pending appeals at VBA, as well 
as BVA. The Administration proposal to delete this provision is 
not adopted.
    The bill includes section 226 requiring advance written 
notification to the Committees on Appropriations of both Houses 
of Congress 15 days prior to organizational changes which 
result in the transfer of 25 or more full-time equivalent staff 
from one organizational unit to another. The Administration 
proposal to delete this provision is not adopted.
    The bill includes section 227 requiring the Secretary to 
provide, on a quarterly basis to the Committees on 
Appropriations of both Houses of Congress, notification of any 
single national outreach and awareness marketing campaign in 
which obligations exceed $1,000,000. The Administration 
proposal to delete this provision is not adopted.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 228 permitting the transfer to 
``Medical Services'' from any discretionary program except 
``General Operating Expenses, Veterans Benefits 
Administration'' upon approval of the Committees on 
Appropriations of both Houses of Congress. This provision is 
intended to give VA flexibility as it administers the changes 
to its traditional healthcare program and the MISSION Act. The 
Administration proposal to modify this provision is not 
adopted.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 229 permitting the transfer of 
funds between the ``Board of Veterans Appeals'' and ``General 
Operating Expenses, Veterans Benefits Administration'' upon 
approval of the Appropriations Committees on Appropriations of 
both Houses of Congress. The Administration proposal to modify 
this provision is not adopted.
    The bill includes section 230 prohibiting the reprogramming 
of funds exceeding $7,000,000 among the Major Construction 
projects unless the Committees on Appropriations of both Houses 
of Congress approve the request. The Administration proposal to 
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 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 2022 and 2023 to carry out and expand the child 
care 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 Administration 
request to modify this provision is not adopted.
    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 2022 to convert any program that received 
specific purpose funds in fiscal year 2021 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 2022 and 
2023 ``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 for 
women.
    The bill includes section 249 establishing a timeline for 
site preparation in accordance with a lease.

                               TITLE III


                            RELATED AGENCIES

    Funds under Title III support the agencies that honor and 
respect the service of our Nation's heroes. Though it may be a 
smaller title of the bill, the agencies funded under Title III 
are the public face of America's commitment to our 
servicemembers and Veterans. The American Battle Monuments 
Commission and Arlington Cemetery commemorate those who made 
the ultimate sacrifice, while the Armed Forces Retirement Home 
and the United States Court of Appeals for Veterans Claims are 
critical parts of keeping our promise to serve those who served 
our Nation.

                  American Battle Monuments Commission


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2021.......................       $84,100,000
Budget request, fiscal year 2022......................        84,800,000
Committee recommendation, fiscal year 2022............        88,100,000
    Change from enacted level.........................        +4,000,000
    Change from budget request........................       + 3,300,000
 

    The recommendation includes $88,100,000 for Salaries and 
Expenses of the American Battle Monuments Commission (ABMC).
    The Committee notes the significant maintenance needs of 
the American Battle Monuments around the world, which are 
specifically designed to honor our fallen servicemembers. The 
Committee continues to direct ABMC to emphasize maintaining and 
repairing existing monuments and memorials in a proactive and 
timely manner that honors the service, achievements, and 
sacrifices of the United States Armed Forces.

                 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 2021.......................       $37,100,000
Budget request, fiscal year 2022......................        41,700,000
Committee recommendation, fiscal year 2022............        41,700,000
    Change from enacted level.........................        +4,600,000
    Change from budget request........................             - - -
 

    The recommendation includes $41,700,000 for Salaries and 
Expenses for the United States Court of Appeals for Veterans 
Claims (the Court).
    Caseload.--The Committee recognizes that caseloads at the 
Court continue to increase and directs the Court to continue 
using available resources to respond effectively to the growing 
demand.

                      Department of Defense--Civil


                       Cemeterial Expenses, Army


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2021.......................       $81,815,000
Budget request, fiscal year 2022......................        87,000,000
Committee recommendation, fiscal year 2022............        87,000,000
    Change from enacted level.........................        +5,185,000
    Change from budget request........................             - - -
 

    The recommendation includes $87,000,000 for Salaries and 
Expenses for Arlington National Cemetery (the Cemetery), which 
is equal to the fiscal year 2022 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 our 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 urges 
the Cemetery to continue 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.

                              CONSTRUCTION

 
 
 
Appropriation, fiscal year 2021.......................            $- - -
Budget request, fiscal year 2022......................       141,000,000
Committee recommendation, fiscal year 2022............       141,000,000
    Change from enacted level.........................     + 141,000,000
    Change from budget request........................             - - -
 

    The recommendation includes $141,000,000 for planning and 
design and construction of Southern Expansion to remain 
available until expended. This will complete the anticipated 
$360,000,000 cost of the Southern Expansion and road 
realignments to extend the life of the cemetery. The Committee 
provides this funding to ensure that the life of our Nation's 
most prestigious cemetery is extended into the 2050 timeframe.

                      Armed Forces Retirement Home


                               TRUST FUND

    The recommendation includes $77,000,000 for the Armed 
Forces Retirement Home (AFRH), including $9,000,000 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 2021.......................       $66,300,000
Budget request, fiscal year 2022......................        68,000,000
Committee recommendation, fiscal year 2022............        68,000,000
    Change from enacted level.........................        +1,700,000
    Change from budget request........................             - - -
 

    The Committee makes these operation and maintenance funds 
available until September 30, 2023, as requested, to provide 
AFRH greater ability to respond to emergency situations and 
ensure stable operations.

                            CAPITAL PROGRAM

 
 
 
Appropriation, fiscal year 2021.......................        $9,000,000
Budget request, fiscal year 2022......................         7,300,000
Committee recommendation, fiscal year 2022............         9,000,000
    Change from enacted level.........................             - - -
    Change from budget request........................        +1,700,000
 

    Capital Maintenance Spending Plan.--The Committee directs 
AFRH to provide, no later than 30 days after enactment of this 
Act, an expenditure plan detailing the planned use of the funds 
provided for construction and renovation. The Committee further 
directs AFRH to prioritize completing projects that are 
currently underway.

                        Administrative Provision

    The bill includes section 301 permitting funds from 
concessions at Army National Military Cemeteries to be used to 
support activities at the Cemeteries.

                                TITLE IV


                           GENERAL PROVISIONS

    The bill includes a total of 11 provisions that were in 
effect in fiscal year 2021:
    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 REPORT REQUIREMENTS

    The following items are included in accordance with various 
requirements of the Rules of the House of Representatives:

         Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII of the Rules of the 
House of Representatives, the following is a statement of 
general performance goals and objectives for which this measure 
authorizes funding:
    The Committee on Appropriations considers program 
performance, including a program's success in developing and 
attaining outcome-related goals and objectives, in developing 
funding recommendations.

                              Rescissions

    The bill does not contain any rescissions, as defined in 
clause 3(f)(2) of rule XIII of the Rules of the House of 
Representatives.

                           Transfer of Funds

    Pursuant to clause 3(f)(2) of rule XIII of the Rules of the 
House of Representatives, the following statements are 
submitted describing the transfer of funds provided in the 
accompanying bill.
    Language is included to allow for the transfer of funds 
from Family Housing, Construction accounts to the Department of 
Defense Family Housing Improvement Fund and funds from Military 
Construction accounts to the Department of Defense Military 
Unaccompanied Housing Improvement Fund.
    Language is included to provide transfer authority from the 
BRAC account to the Homeowners Assistance Program.
    Language is included to allow the transfer of expired funds 
to the ``Foreign Currency Fluctuations, Construction, Defense'' 
account.
    Language is included to transfer not to exceed $20,115,000 
in fiscal year 2022 from Compensation and Pensions to General 
Operating Expenses, Veterans Benefits Administration and 
Information Technology Systems. These funds are for the 
administrative costs of implementing cost-savings proposals 
required by the Omnibus Budget Reconciliation Act of 1990 and 
the Veterans' Benefits Act of 1992. Language is also included 
transferring funds to the medical care collections fund to 
augment funding of medical facilities for nursing home care 
provided to pensioners.
    Language is included to permit the transfer of funds from 
General Administration to General Operating Expenses, Veterans 
Benefits Administration.
    Language is included to permit the transfer of funds 
between Information Technology Systems development projects and 
among the three sub-accounts identified in bill language 
subject to the approval of the Committee.
    Language is included to provide authority for the 
Department of Veterans Affairs for any funds appropriated in 
2022 for Compensation and Pensions, Readjustment Benefits, and 
Veterans Insurance and Indemnities to be transferred among 
those three accounts.
    Language is included to transfer funds among the Medical 
Services, Medical Community Care, Medical Support and 
Compliance, and Medical Facilities accounts.
    Language is included to permit the funds from three life 
insurance funds to be transferred to General Operating 
Expenses, Veterans Benefits Administration and Information 
Technology Systems for the costs of administering such 
programs.
    Language is included to permit funding up to $78,417,225 to 
be transferred to General Administration and Information 
Technology Systems from any funds appropriated in fiscal year 
2022 to reimburse three headquarters offices for services 
provided.
    Language is included to transfer certain funds derived from 
enhanced-use leasing activities to the Construction, Major 
Projects and Construction, Minor Projects accounts.
    Language is included to transfer funds from the Medical 
Care Collections Fund to the Medical Services and Medical 
Community Care accounts.
    Language is included to allow the transfer of funds from 
the Capital Asset Fund to the Construction, Major Projects and 
Construction, Minor Projects accounts.
    Language is included to allow the transfer of funds from 
various accounts to the Information Technology Systems account 
in an aggregate amount not to exceed ten percent of the account 
appropriation, subject to approval by the Committee.
    Language is included to allow the transfer of funds in 
fiscal year 2022 provided for the Department of Veterans 
Affairs to the Joint Department of Defense-Department of 
Veterans Affairs Medical Facility Demonstration Fund.
    Language is included allowing fiscal year 2023 medical care 
funding to be transferred to the Joint Department of Defense-
Department of Veterans Affairs Medical Facility Demonstration 
fund.
    Language is included permitting funds deposited to the 
Medical Care Collections Fund for healthcare provided at a 
combined Federal medical facility to be transferred to the 
Joint Department of Defense-Department of Veterans Affairs 
Medical Facility Demonstration Fund.
    Language is included under the Department of Veterans 
Affairs that would transfer no less than $15,000,000 for the 
DOD-VA Health Care Sharing Incentive Fund as authorized by 
section 8111(d) of title 38, United States Code.
    Language is included that permits the transfer from all 
discretionary accounts except General Operating Expenses, 
Veterans Benefits Administration, to Medical Services, subject 
to approval by the Committee.
    Language is included that permits transfer of funds between 
General Operating Expenses, Veterans Benefits Administration 
and the Board of Veterans Appeals, subject to approval by the 
Committee.

   Disclosure of Earmarks and Congressionally Directed Spending Items

    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.

                                                                  MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES
                                                                                [Community Project Funding Items]
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
             Account                                       Location                                                   Project                                 Amount            Requestor(s)
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Air National Guard                Delaware: New Castle County Airport                        Fuel Cell and Corrosion Control Hangar                           $17,500,000  Blunt Rochester
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Army                              Texas: Joint Base San Antonio Camp Bullis                  Vehicle Maintenance Shop                                         $10,000,000  Gonzales, Tony
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Air Force                         Texas: Joint Base San Antonio Lackland Air Force Base      Child Development Center                                         $22,000,000  Gonzales, Tony
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Air Force                         Louisiana: Barksdale Air Force Base                        New Entrance Road and Gate Complex                               $36,000,000  Johnson (LA)
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Army National Guard               Mississippi: Camp Shelby Joint Forces Training Center      Mobilization and Annual Training Equipment Site (MATES)          $15,500,000  Palazzo
                                                                                              Project
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Army                              Alabama: Anniston Army Depot                               Welding Facility                                                 $25,010,000  Rogers (AL)
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Navy and Marine Corps             Florida: Marine Corps Support Facility Blount Island       Lighterage and Small Craft Facility                               $7,000,000  Rutherford
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Air Force Reserve                 Ohio: Youngstown Air Reserve Station                       Assault Strip Widening                                            $8,700,000  Ryan
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Air National Guard                Idaho: Boise Air Terminal (Gowen Field)                    Medical Training Facility                                         $6,500,000  Simpson
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Army                              New York: Fort Drum                                        Wellfield Expansion Resilience Project                           $27,000,000  Stefanik
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Air Force                         Ohio: Wright Patterson Air Force Base                      Child Development Center                                         $24,000,000  Turner
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

          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 THE CONSOLIDATED APPROPRIATIONS ACT, 2021


                          (Public Law 116-260)

 AN ACT Making consolidated appropriations for the fiscal year ending 
   September 30, 2021, providing coronavirus emergency response and 
                    relief, and for other purposes.

                     [(INCLUDING TRANSFER OF FUNDS)

    [Sec. 220. Of the amounts appropriated to the Department of 
Veterans Affairs which become available on October 1, 2021, for 
``Medical Services'', ``Medical Community Care'', ``Medical 
Support and Compliance'', and ``Medical Facilities'', up to 
$327,126,000, 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 I--GENERAL

    Sec.
    1701. Definitions.

           *       *       *       *       *       *       *


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

1710. Eligibility for hospital, nursing home, and domiciliary 
care.

           *       *       *       *       *       *       *

1720K. Provision of assisted reproductive technology or adoption 
          reimbursements for certain disabled veterans.

           *       *       *       *       *       *       *


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

           *       *       *       *       *       *       *



Sec.  1720K. Provision of assisted reproductive technology or adoption 
                    reimbursements for certain disabled veterans

  (a) Provision of Services.--Subject to the availability of 
appropriations, the Secretary may provide--
          (1) fertility counseling and treatment using assisted 
        reproductive technology to a covered veteran or the 
        spouse of a covered veteran; or
          (2) adoption reimbursement to a covered veteran.
  (b) Limitations.--Amounts made available for the purposes 
specified in subsection (a) are subject to the requirements for 
funds contained in section 508 of division H of the 
Consolidated Appropriations Act, 2017 (Public Law 115-31).
  (c) Definitions.--In this section:
          (1) The term ``adoption reimbursement'' means 
        reimbursement for the adoption-related expenses for an 
        adoption that is finalized after the date of the 
        enactment of this section under the same terms as apply 
        under the adoption reimbursement program of the 
        Department of Defense, as authorized in Department of 
        Defense Instruction 1341.09, including the 
        reimbursement limits and requirements set forth in such 
        instruction, as in effect on the date of the enactment 
        of this section.
          (2) The term ``assisted reproductive technology'' 
        means benefits relating to reproductive assistance 
        provided to a member of the Armed Forces who incurs a 
        serious injury or illness on active duty pursuant to 
        section 1074(c)(4)(A) of title 10, as described in the 
        memorandum on the subject of ``Policy for Assisted 
        Reproductive Services for the Benefit of Seriously or 
        Severely Ill/Injured (Category II or III) Active Duty 
        Service Members'' issued by the Assistant Secretary of 
        Defense for Health Affairs on April 3, 2012, and the 
        guidance issued to implement such policy, as in effect 
        on the date of the enactment of this section, including 
        any limitations on the amount of such benefits 
        available to such a member, except that--
                  (A) the periods regarding embryo 
                cryopreservation and storage set forth in part 
                III(G) and in part IV(H) of the first part IV 
                of such memorandum shall not apply; and
                  (B) such term includes embryo 
                cryopreservation and storage without limitation 
                on the duration of such cryopreservation and 
                storage.
          (3) The term ``covered veteran'' means a veteran who 
        has a service-connected disability that results in the 
        inability of the veteran to procreate without the use 
        of fertility treatment.

           *       *       *       *       *       *       *


                 Changes in Application of Existing Law

    Pursuant to clause 3(f)(1)(A) of rule XIII of the Rules of 
the House of Representatives, the following statements are 
submitted describing the effect of provisions in the 
accompanying bill that directly or indirectly change the 
application of existing law.
    Language is included in various parts of the bill to 
continue on-going activities that require annual authorization 
or additional legislation, which to date have not been enacted.
    Language is included in various parts of the bill to place 
limitations on the use of funds in the bill or change existing 
limitations and which might, under some circumstances, be 
construed as changing the application of existing law.
    Language is included in various parts of the bill to allow 
the Secretary of Defense to exceed certain limitations upon 
notification to the Committee.
    Language is included in various parts of the bill to allow 
funding to be used for official reception and representation 
expenses.
    Language is included in various parts of the bill to enable 
various appropriations to remain available for more than one 
year for some programs for which the basic authority 
legislation does not presently authorize such extended 
availability.
    Language is included in various parts of the bill to permit 
the transfer of funds to other accounts.
    Language is included under Title I to prohibit payments for 
cost-plus-a-fixed-fee contracts under certain circumstances.
    Language is included in various parts of the bill to allow 
funds to be used for the hire of passenger motor vehicles.
    Language is included under Title I to allow advances to the 
Federal Highway Administration, Department of Transportation 
under certain circumstances.
    Language is included under Title I to prohibit the use of 
funds to begin construction of new bases without specific 
appropriations.
    Language is included under Title I to prohibit the use of 
funds for purchase of land or land easements under certain 
circumstances.
    Language is included under Title I to prohibit the use of 
funds for land acquisition, site preparation, and utility 
installation for family housing unless funds have been made 
available in annual appropriations Acts.
    Language is included under Title I to prohibit the use of 
minor construction funds to transfer an activity between 
installations without prior notification.
    Language is included under Title I to prohibit the use of 
funds for the procurement of steel for any activity if American 
steel producers have been denied the opportunity to compete for 
such steel procurements.
    Language is included under Title I to prohibit the use of 
funds to pay real property taxes in any foreign nation.
    Language is included under Title I to prohibit the use of 
funds to initiate a new installation overseas without prior 
notification.
    Language is included under Title I to limit the use of 
funds for architect and engineer contracts under certain 
circumstances.
    Language is included under Title I to limit the use of 
funds for awarding contracts to foreign contractors under 
certain circumstances.
    Language is included under Title I to require the 
Department of Defense to notify the appropriate committees of 
Congress of any proposed military exercises under certain 
circumstances.
    Language is included under Title I to allow prior year 
construction funding to be available for currently authorized 
projects.
    Language is included under Title I to allow payment for the 
cost associated with supervision, inspection, overhead, 
engineering and design on family housing or military 
construction projects that are being completed with expired or 
lapsed funds.
    Language is included under Title I to allow funds to be 
expended on military construction projects for four fiscal 
years after enactment under certain circumstances.
    Language is included under Title I to allow construction 
funds to be transferred to Housing Improvement Funds.
    Language is included under Title I to allow for the 
transfer of BRAC funds to the Homeowners Assistance Program.
    Language is included under Title I to limit funds for the 
operation and maintenance of family housing to those provided 
in this appropriation and to limit amounts expended on repairs 
of general and flag officer quarters under certain 
circumstances.
    Language is included under Title I to allow funds in the 
Ford Island Improvement Account to be available until expended 
for certain purposes.
    Language is included under Title I to allow for the 
transfer of expired funding to the Foreign Currency Fluctuation 
Account under certain circumstances.
    Language is included under Title I to prohibit funds to be 
used for projects at Arlington Cemetery.
    Language is included under Title I providing additional 
funds for Military Construction, Army.
    Language is included under Title I providing additional 
funds for Military Construction, Navy and Marine Corps.
    Language is included under Title I providing additional 
funds for Military Construction, Air Force.
    Language is included under Title I providing additional 
funds for Military Construction, Army National Guard.
    Language is included under Title I providing additional 
funds for Military Construction, Air National Guard.
    Language is included under Title I providing additional 
funds for Military Construction, Army Reserve.
    Language is included under Title I defining the 
congressional defense committees.
    Language is included under Title I directing all amounts 
appropriated to Military Construction (all accounts) be 
immediately available and allotted for the full scope of the 
authorized project.
    Language is included under Title I providing additional 
funds for Military Construction, Army for cost to complete 
projects.
    Language is included under Title I providing additional 
funds for Military Construction, Navy and Marine Corps for cost 
to complete projects.
    Language is included under Title I providing additional 
funds for Military Construction, Air Force for cost to complete 
projects.
    Language is included under Title I providing additional 
funds for Military Construction, Army Reserve for cost to 
complete projects.
    Language is included under Title I providing additional 
funds for Military Construction, Navy Reserve for cost to 
complete projects.
    Language is included under Title I providing additional 
funds for Family Housing Construction, Army for cost to 
complete projects.
    Language is included under Title I providing additional 
funds for Family Housing Operations and Maintenance, Army.
    Language is included under title I for child development 
centers.
    Language is included under title I for barracks.
    Language is included under title I for Natural Disasters.
    Language is included prohibiting funds for construction and 
planning and design associated with Space Force until 
completion of site selection reviews.
    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, under certain conditions, to 
receive assisted reproductive technology services and adoption 
reimbursement.
    Language is included under Title II pertaining to 
exceptions for Indian- or Native Hawaiian-owned businesses 
contracting with the Department.
    Language is included under Title II directing the 
elimination of using Social Security account numbers to 
identify individuals in all information systems of the 
Department.
    Language is included under Title II pertaining to 
certification of marriage and family therapists.
    Language is included under Title II prohibiting funds from 
being used to transfer funding from the Filipino Veterans 
Equity Compensation Fund to any other VA account.
    Language is included under Title II permitting funds to 
carry out and expand the child care program.
    Language is included under Title II prohibiting funds to 
enter into an agreement to resolve a dispute or claim with an 
individual that would restrict the individual from speaking to 
Members of Congress or their staff.
    Language is included under Title II requiring certain data 
to be included in budget justifications for major construction 
projects.
    Language is included under Title II prohibiting the 
Inspector General timely access to information.
    Language is included under Title II prohibiting funding to 
be used that would increase wait times for Veterans who seek 
medical care.
    Language is included under Title II prohibiting the use of 
funds in fiscal year 2022 to convert any program that received 
specific purpose funding in fiscal year 2021 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 for women.
    Language is included under Title II establishing a timeline 
for site preparation 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:


	     [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
	     
	     

                          Program Duplication

    No provision of this bill establishes or reauthorizes a 
program of the Federal Government known to be duplicative of 
another Federal program, a program that was included in any 
report from the Government Accountability Office to Congress 
pursuant to section 21 of Public Law 111-139, or a program 
related to a program identified in the most recent Catalog of 
Federal Domestic Assistance.

                           Committee Hearings

    For the purposes of section 103(i) of H. Res. 6 Pursuant to 
cl. 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, 2022:
    The Subcommittee on Military Construction, Department of 
Veterans Affairs, and Related Agencies held a hearing on 
February 16, 2021, entitled ``Oversight of Military Privatized 
Housing''. The Subcommittee received testimony from:
    Mr. Paul Cramer, Principal Deputy Assistant Secretary of 
Defense for Sustainment (Installations)
    Ms. Elizabeth A. Field, Director, Defense Capabilities 
Management, Government Accountability Office (GAO)
    The Subcommittee on Military Construction, Department of 
Veterans Affairs, and Related Agencies held a hearing on 
February 19, 2021, entitled ``Department of Veterans Affairs 
COVID 19 Response''. The Subcommittee received testimony from:
    Dr. Richard Stone, Acting Under Secretary for Health, 
Veterans Health Administration accompanied by:
    Dr. Kameron L. Matthews, Assistant Under Secretary for 
Health for Clinical Services, Veterans Health Administration
    The Subcommittee on Military Construction, Department of 
Veterans Affairs, and Related Agencies held a hearing on March 
5, 2021, entitled ``Status of Department of Veterans Affairs 
Infrastructure''. The Subcommittee received testimony from:
    Mr. Tony Costa, Deputy Executive Director, Construction & 
Facilities Management, Department of Veterans Affairs
    Mr. Edward Litvin, Deputy to the Assistant Under Secretary 
for Health for Administrative Operations, Veterans Health 
Administration
    Mr. Brett Simms, Executive Director, Office of Asset and 
Enterprise Management, Department of Veterans Affairs
    The Subcommittee on Military Construction, Department of 
Veterans Affairs, and Related Agencies held a hearing on March 
9, 2021, entitled ``Challenges Facing Veterans in Accessing 
Fertility Services''. The Subcommittee received testimony from:
    Ms. Barbara Collura, President CEO, RESOLVE: The National 
Infertility Association
    Ms. Maureen Elias, Associate Legislative Director of 
Government Relations, Paralyzed Veterans of America
    The Subcommittee on Military Construction, Department of 
Veterans Affairs, and Related Agencies held a hearing on March 
12, 2021, entitled ``VA Specialty Healthcare: Oversight of 
Women's Health, Mental Health, and Suicide Prevention, Whole 
Health and Homelessness''. The Subcommittee received testimony 
from:
    Dr. David Carroll, Executive Director, Mental Health 
Operations, Veterans Health Administration
    Ms. Laura Duke, Chief Financial Officer, Veterans Health 
Administration
    Dr. Patricia M. Hayes, Chief Consultant, Women's Health 
Services, Veterans Health Administration
    Dr. Kameron L. Matthews, Assistant Under Secretary for 
Health for Clinical Services, Veterans Health Administration
    The Subcommittee on Military Construction, Department of 
Veterans Affairs, and Related Agencies held a hearing on March 
24, 2021, entitled ``Remediation and Impact of PFAS''. The 
Subcommittee received testimony from:
    Mr. Mark Correll, Deputy Assistant Secretary of the 
Department of the Air Force (Environment, Safety and 
Infrastructure)
    Mr. Paul Cramer, Principal Deputy Assistant Secretary of 
Defense for Sustainment (Installations), Department of Defense
    Dr. Patricia R. Hastings, Chief Consultant, Post Deployment 
Health Services, Veterans Health Administration
    Dr. Terry Rauch, Director of Medical Research and 
Development, Department of Defense
    Ms. Erin Brockovich, Environmental Activist, Consumer 
Advocate, and President of Brockovich Research and Consulting
    Dr. Jamie DeWitt, Associate Professor, East Carolina 
University, Department of Pharmacology & Toxicology, Brody 
School of Medicine
    The Subcommittee on Military Construction, Department of 
Veterans Affairs, and Related Agencies held a hearing on April 
15, 2021, entitled ``FY 2022 Budget Hearing: Department of 
Veterans Affairs''. The Subcommittee received testimony from:
    The Honorable Denis R. McDonough, Secretary, Department of 
Veterans Affairs, accompanied by:
    Mr. Jon Rychalski, Assistant Secretary for Management and 
Chief Financial Officer, Department of Veterans Affairs
    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 
18, 2021, entitled ``Air Force Quality of Life and 
Installations Update''. The Subcommittee received testimony 
from:
    Chief Master Sergeant Joanne Bass, Chief Master Sergeant of 
the Air Force
    Brigadier General William Kale, Air Force Director of Civil 
Engineers
    Ms. Jennifer Miller, Acting 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 
20, 2021, entitled ``Member Day''. The Subcommittee received 
testimony from:
    The Honorable Veronica Escobar, Member of Congress
    The Honorable Richard Hudson, Member of Congress
    The Subcommittee on Military Construction, Department of 
Veterans Affairs, and Related Agencies held a hearing on May 
24, 2021, 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
    Mr. J.E. ``Jack'' Surash, Acting Assistant Secretary of the 
Army for Installations, Energy and Environment

    BUDGETARY IMPACT OF THE FY 2022 MILITARY CONSTRUCTION, VETERANS 
     AFFAIRS, AND RELATED AGENCIES APPROPRIATIONS BILL PREPARED IN 
  CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SEC. 
                 308(A), PUBLIC LAW 93-344, AS AMENDED

                        [In millions of dollars]


                   COMPARISON WITH BUDGET RESOLUTION

    Section 308(a)(1)(A) of the Congressional Budget Act of 
1974 requires the report accompanying a bill providing new 
budget authority to contain a statement comparing the levels in 
the bill to the suballocations submitted under section 302(b) 
of the Act for the most recently agreed to concurrent 
resolution on the budget for the applicable fiscal year.

                                            [In millions of dollars]
----------------------------------------------------------------------------------------------------------------
                                                         302(b) Alocation                    This Bill
                                                 ---------------------------------------------------------------
                                                      Budget                          Budget
                                                     Authority        Outlays        Authority        Outlays
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with Committee
 allocations to its subcommittees: Subcommittees
 on Military Construction, Veterans Affairs, and
 Related Agencies
    Discretionary...............................         124,500         129,500         124,500      \1\128,938
    Mandatory...................................         138,638         149,930         138,638      \1\149,930
----------------------------------------------------------------------------------------------------------------
\1\Includes outlays from prior-year budget authority.

                      FIVE-YEAR OUTLAY PROJECTIONS

    In compliance with 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.

                        [In millions of dollars]
------------------------------------------------------------------------
                                                               Outlays
------------------------------------------------------------------------
Projection of outlays associated with the recommendation:
    2022...................................................   \1\164,059
    2023...................................................      106,202
    2024...................................................       15,259
    2025...................................................        4,070
    2026 and future years..................................        3,189
------------------------------------------------------------------------
\1\Excludes outlays from prior-year budget authority.

          FINANCIAL ASSISTANCE TO STATE AND LOCAL GOVERNMENTS

    In accordance with 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                191               \1\28
 local governments for 2022......
------------------------------------------------------------------------
\1\Excludes outlays from prior-year budget authority.



	   [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                             MINORITY VIEWS

    The Military Construction, Veterans Affairs, and Related 
Agencies Appropriations Bill, 2022, includes funding for 
Veterans programs, military construction projects, military 
family housing, and the Southern Expansion project at Arlington 
National Cemetery.
    We strongly support the funding provided for child 
development centers and barracks projects. We also note with 
appreciation the funding for many important military 
construction, resilience, and environmental remediation 
projects, including for PFAS contamination cleanup at closed 
military installations.
    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 the 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 regarding the Naval Station Guantanamo Bay 
and the use of military construction funds to build or renovate 
a facility on U.S. soil to house detainees currently held at 
Guantanamo Bay. 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 also are concerned that the funding in the bill is not 
part of a framework that appropriately and adequately allocates 
funds between defense and non-defense program. No one wants the 
important programs for Servicemembers, their families, and 
veterans to be held up by larger funding debates.
    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 for fiscal year 2022.

                                   Kay Granger.
                                   John R. Carter.

                                  [all]