[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]