[House Report 118-122]
[From the U.S. Government Publishing Office]


118th Congress  }                                             {    Report
                         HOUSE OF REPRESENTATIVES
 1st Session    }                                             {    118-122

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



 
     MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES 
                       APPROPRIATIONS BILL, 2024

                                _______
                                

 June 27, 2023.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

 Mr. Carter of Texas, from the Committee on Appropriations, submitted 
                             the following

                              R E P O R T

                             together with

                             MINORITY VIEWS

                        [To accompany H.R. 4366]

    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, 2024.

                        INDEX TO BILL AND REPORT

                                                            Page Number

                                                            Bill Report
Purpose of the Bill........................................
                                                                      2
Summary of Committee Recommendation........................
                                                                      2
Title I--Department of Defense:                                 2
                                                                      3
        Military Construction..............................     2
                                                                      3
        NATO Security Investment Program...................     9
                                                                     14
        Department of Defense Base Closure Account.........    10
                                                                     14
        Family Housing Construction and Operation and 
            Maintenance....................................    10
                                                                     16
        Department of Defense Family Housing Improvement 
            Fund...........................................    12
                                                                     16
        Department of Defense Military Unaccompanied 
            Housing Improvement Fund.......................    12
                                                                     17
        Administrative Provisions..........................    12
                                                                     17
Title II--Department of Veterans Affairs:                      30
                                                                     19
        Veterans Benefits Administration...................    30
                                                                     22
        Veterans Health Administration.....................    34
                                                                     27
        National Cemetery Administration...................    39
                                                                     49
        Departmental Administration........................    39
                                                                     50
        Administrative Provisions..........................    48
                                                                     57
Title III--Related Agencies:                                   82
                                                                     62
        American Battle Monuments Commission...............    82
                                                                     62
        U.S. Court of Appeals for Veterans Claims..........    83
                                                                     63
        Cemeterial Expenses, Army..........................    83
                                                                     63
        Armed Forces Retirement Home.......................    84
                                                                     64
        Administrative Provision...........................    85
                                                                     64
Title IV--General Provisions:                                  86
                                                                     65

                          Purpose of the Bill

    The Military Construction, Veterans Affairs, and Related 
Agencies Appropriations bill funds the Department of Defense's 
activities related to military construction; family housing 
construction, maintenance, and oversight; and environmental 
remediation at closed military bases. The bill also funds the 
Department of Veterans Affairs, including programs to assist 
veterans, such as disability and pension benefits, education, 
healthcare, and insurance and loan programs. The bill funds 
four related agencies that honor and respect the Nation's 
veterans including the American Battle Monuments Commission; 
Cemeterial Expenses, Army (including Arlington National 
Cemetery); the U.S. Court of Appeals for Veterans Claims; and 
the Armed Forces Retirement Home.

                  Summary of Committee Recommendation

    The Committee recommends $317,441,342,000 in total budget 
authority for the fiscal year 2024 programs and activities 
funded in the bill.
    The bill includes $161,740,342,000 for mandatory programs 
and $155,701,000,000 for discretionary programs.
    The bill provides $17,474,000,000 for military construction 
and family housing. This is $1,526,000,000 below the fiscal 
year 2023 enacted level and $799,056,000 above the budget 
request. It includes $2,095,810,000 to address unfunded 
requirements of the Services and Combatant Commanders and 
increases investment in infrastructure in the Pacific region, 
unaccompanied personnel housing, and child development centers.
    The bill provides $299,495,645,000 for fiscal year 2024 for 
the Department of Veterans Affairs, which is a decrease of 
$3,786,953,000 below the fiscal year 2023 enacted level. Of the 
total, $161,740,342,000 is provided for mandatory benefit 
programs and $137,755,303,000 is provided for discretionary 
programs. Of the total for fiscal year 2024, $128,104,000,000 
for veterans' healthcare was advanced in the Consolidated 
Appropriations Act, 2023 (P.L 117-328).
    For fiscal year 2025, the Committee recommendation includes 
$112,582,000,000 in advance appropriations for the four 
discretionary veterans' medical care accounts and 
$193,048,534,000 in advance appropriations for mandatory 
benefits programs.
    The Committee recommendation provides a total of 
$471,697,000, which is $29,037,000 above the fiscal year 2023 
enacted level, for the four Related Agencies: The American 
Battle Monuments Commission, the U.S. Court of Appeals for 
Veterans Claims, Army Cemeterial Expenses (including Arlington 
National Cemetery), and the Armed Forces Retirement Home.

                                TITLE I


                         DEPARTMENT OF DEFENSE


                     Military Construction Overview


 
 
 
Appropriation, fiscal year 2023.......................   $19,000,000,000
Budget request, fiscal year 2024......................    16,674,944,000
Committee recommendation, fiscal year 2024............    17,474,000,000
    Change from enacted level.........................    -1,526,000,000
    Change from budget request........................      +799,056,000
 

    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.

                          COMMITTEE DIRECTIVES

    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 the Department of Defense to 
report on various aspects of military construction programs and 
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 the Department may seek reprogramming for appropriated 
increments.
    The reprogramming criteria that applies to military 
construction projects is 25 percent of the funded amount or 
$6,000,000 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 the Department 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).--The Department 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 also directs 
the Secretary of Defense to report to the congressional defense 
committees quarterly, beginning in the second quarter of fiscal 
year 2024 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 the Department of Defense 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, the Department shall notify the Committees on 
Appropriations of both Houses of Congress within 7 days of 
transferring any amount in excess of $10,000,000 to or from the 
Foreign Currency account.
    Bid Savings.--The Committee directs the Secretary of 
Defense to submit 1002 reports on military construction bid 
savings not later than 180 days after enactment of this Act, 
and biannually thereafter, to the Committees on Appropriations 
of both Houses of Congress.
    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.
    Unfunded Priority List (UPL) and Future Years Defense 
Program (FYDP).--The Committee directs the Department of 
Defense and Military Services, active and reserve components as 
well as Combatant Commanders, as required by law, to submit a 
UPL and FYDP to the congressional defense committees for 
military construction projects no later than 10 days and 5 
days, respectively, after the President's budget is submitted 
to Congress.

                           ITEMS OF INTEREST

    Advanced Manufacturing.--The Committee is encouraged by 
reports that three-dimensional (3D) construction could provide 
military civil engineers with a faster means of building 
facilities which could reduce supply lines and the number of 
personnel needed for construction and related activities. The 
Department of Defense is encouraged to study, develop, and 
utilize advanced manufacturing capabilities to the extent 
practicable.
    Barracks.--The bill provides $362,300,000 for 9 
construction projects to ensure that servicemembers who live in 
barracks have safe, modern, and secure living facilities. The 
Committee also provides $195,000,000 for barracks replacement 
planning and design.
    Blood Processing Laboratory Infrastructure.--The Committee 
continues to recognize the importance of Department of Defense 
laboratory infrastructure and the investment needed to 
modernize outdated facilities and equipment. While the 
Department has taken steps in recent years to upgrade its 
laboratory infrastructure, the Committee is concerned that the 
Department is not properly prioritizing critical improvements 
to blood processing laboratory infrastructure and that this 
presents a risk to readiness. Therefore, the Committee directs 
the Department to provide a report on the status of blood 
processing laboratory infrastructure and its strategy to 
modernize such infrastructure within 180 days of enactment of 
this Act.
    Delivery and Cost of Military Construction Projects.--The 
Committee appreciates the U.S. Army Corps of Engineers' March 
2023 report titled, ``U.S. Army Corps of Engineers Contracting 
Study Response: Recommended Reforms to Reduce Cost and 
Accelerate Project Delivery.'' The Committee encourages the 
Department to review progressive design-build as a potential 
construction contract method as it may provide efficiencies.
    Demolition of Excess Infrastructure.--The bill includes 
$90,000,000 for unspecified minor military construction for 
demolition across the active and reserve components. The 
Committee is concerned about the amount of excess and obsolete 
infrastructure found on installations. While the Committee 
understands the need to balance demolition with other 
infrastructure needs, excess infrastructure can be costly to 
maintain and diverts resources away from current requirements.
    Child Development Centers (CDCs).--The bill includes 
$75,000,000 for planning and design and $293,820,000 for 
construction of 7 CDC projects.
    Infrastructure Needs to Support Alliance with the 
Philippines.--The Committee notes the importance of the 
recently reinvigorated alliance with the Philippines. To better 
understand the Department of Defense's needs to support the 
expanded alliance, the Committee directs the Secretary of 
Defense to provide a report, not later than 180 days after the 
date of the enactment of this Act, summarizing the plans for 
military construction and associated infrastructure needs to 
maximize the effectiveness of an enhanced posture in and 
alliance with the Philippines.
    Laboratory Infrastructure.--The Committee is concerned that 
aging laboratory infrastructure threatens the ability of 
Services to maintain the advanced technology necessary to keep 
ahead of U.S. adversaries across all domains. Accordingly, the 
Committee provides an additional $90,000,000 for planning and 
design for laboratory infrastructure projects. The Services are 
directed to provide a spend plan not later than 90 days after 
enactment of this Act regarding the use of these funds.
    Mass Timber.--The Committee is aware that the use of cross 
laminated timber and other mass timber products as a building 
material has the potential to reduce costs, limit environmental 
impact, and increase functionality of various military 
structures. The Committee encourages the Department of Defense 
to continue exploring the application of these innovative 
technologies in future planning and design for military 
construction projects.
    Open Air Burn Pans.--The Committee remains concerned about 
the burning of hazardous materials, including open air burn 
pans, at installations located in the United States and looks 
forward to receiving the report on the Department's plans to 
address this issue as required by House Report 117-391.
    Resilient Military Installations.--The Committee supports 
the Department's continued efforts to build lasting and 
resilient military installations. These efforts include using 
methods that update hurricane-resistant building codes for 
bases, barracks, hospitals, and airfields and reviewing the 
effect of severe drought and desertification and how these two 
hazards effect installations and missions. The Committee 
encourages the Department to continue investing in innovative 
infrastructure projects to increase infrastructure resiliency 
and reduce costs.
    Unspecified Minor Military Construction (UMMC).--The bill 
includes $414,192,000 for UMMC across the active and reserve 
components, which is $80,000,000 above the budget request. The 
Committee believes the UMMC authority is a helpful tool as the 
Services address their most critical infrastructure needs.
    U.S. Indo-Pacific Command (USINDOPACOM).--The 
recommendation includes $69,000,000 for planning and design and 
$62,000,000 for unspecified minor military construction for 
USINDOPACOM.

                      Military Construction, Army


 
 
 
Appropriation, fiscal year 2023.......................    $1,553,825,000
Budget request, fiscal year 2024......................     1,470,555,000
Committee recommendation, fiscal year 2024............     1,517,455,000
    Change from enacted level.........................       -36,370,000
    Change from budget request........................       +46,900,000
 

    The Committee recommends $1,517,455,000 for the Army in 
fiscal year 2024, of which $162,900,000 is for the following 
projects in the following amounts:

----------------------------------------------------------------------------------------------------------------
                 State                            Location                   Project                 Amount
----------------------------------------------------------------------------------------------------------------
AL.....................................  Anniston Army Depot......  Access Control Point.....         $5,500,000
AL.....................................  Anniston Army Depot......  Component Rebuild Shop...          8,100,000
AL.....................................  Anniston Army Depot......  Vehicle Paint Shop.......          2,900,000
FL.....................................  Camp Bull Simons.........  7th Special Forces Group          17,000,000
                                                                     Child Development Center.
HI.....................................  Wheeler Army Airfield....  Air Traffic Control Tower          5,400,000
NC.....................................  Fort Bragg...............  Aircraft Maintenance              61,000,000
                                                                     Hangar.
NC.....................................  Fort Bragg...............  Child Development Center.         36,000,000
TX.....................................  Fort Bliss...............  Collective Training                7,200,000
                                                                     Barracks.
TX.....................................  Fort Hood................  Barracks (PN 100948).....          9,900,000
TX.....................................  Fort Hood................  Barracks (PN 94937)......          9,900,000
----------------------------------------------------------------------------------------------------------------

    Within the total for Military Construction, Army, the 
recommendation includes $345,775,000 for planning and design, 
which is $48,900,000 above the budget request; and $86,280,000 
for unspecified minor construction, which is $10,000,000 above 
the budget request.
    Further detail of the Committee's recommendation is 
provided in the State table at the end of this report.
    Army Barracks.--The Committee notes the importance of 
providing high-quality barracks on Army bases and recommends 
the refurbishment of barracks that have fallen below the Army's 
set standards. The Committee believes that adequate housing is 
an important quality of life issue that impacts readiness.
    Dugway Proving Ground.--The Committee notes the importance 
of the chemical and biological testing and evaluation done at 
Dugway Proving Ground (DPG) through its laboratories, ranges, 
test grids, airfield, and other testing facilities. The 
Committee is concerned about the condition of the facilities at 
DPG given that several facilities, including all three chemical 
surety facilities, are in poor to failing conditions, at or 
near their life expectancy.
    The Committee hopes that the recent memorandum of agreement 
between the Assistant Secretary of Defense for Nuclear, 
Biological, and Chemical Defense and the Department of the Army 
to transfer certain institutional funding will ensure adequate 
facilities are maintained at DPG.
    To better understand this issue, the Committee directs the 
Secretary of the Army and the Assistant Secretary of Defense 
for Nuclear, Chemical, and Biological Defense Programs to 
provide a report to the congressional defense committees, not 
later than 180 days after the date of the enactment of this 
Act, on the facility conditions and requirements at DPG. The 
report shall include the following: (1) an outline of military 
construction (MILCON) funding responsibilities for mission-
critical facilities at DPG; (2) a list of high-priority MILCON 
projects at DPG; (3) an assessment of facilities needed at DPG 
to meet current and future requirements; (4) the Department's 
plan to address facilities at DPG that are in poor to failing 
condition.
    Fort Bragg Roadway Infrastructure.--The Committee is 
concerned about the roadway infrastructure at Fort Bragg, 
especially the 47 miles that were originally constructed to 
serve troop training functions but are now being used by 
servicemembers, their families, and civilians for commuting 
purposes. The Committee is aware that the North Carolina 
Department of Transportation (NCDOT) has offered to assume 
maintenance of the 47 miles of roadway infrastructure at Fort 
Bragg under a proposed intergovernmental support agreement, 
which may help the Army mitigate risks associated with the 
inadequate road infrastructure. Accordingly, the Committee 
directs the Secretary of the Army to provide a report to the 
Committee, not later than 120 days after the date of the 
enactment of this Act, that details the following: (1) the 
Army's plan to bring the 47 miles of roadway infrastructure at 
Fort Bragg up to NCDOT's minimum standards; (2) the cost for 
such roadway repairs; (3) a timeline for performing such 
roadway repairs; and (4) an estimate of the savings by the Army 
if it no longer needs to perform annual maintenance on the 
relevant roadway infrastructure at Fort Bragg.
    Recapitalization of Army Infrastructure in Hawaii.--The 
Committee is concerned about the condition of Army 
infrastructure in Hawaii. In a November 2022 Congressional 
Budget Office (CBO) report titled, ``The Army's Costs to 
Eliminate Its Deferred Maintenance Backlog and to Renovate and 
Modernize Its Buildings'' the CBO notes that the deferred 
maintenance costs for U.S. Army Garrison Hawaii are 
approximately $1.4 billion and its modernization costs are 
approximately $2.6 billion. To better understand the Army's 
efforts to address this problem, the Committee directs the 
Assistant Secretary of the Army for Installations, Energy, and 
Environment to provide a report on the following: (1) the 
Army's plan for addressing its maintenance backlog; (2) the 
military construction projects in the future years defense 
program for U.S. Army Garrison Hawaii related to the backlog; 
and (3) how the Army intends to ensure efforts to address the 
backlog do not interfere with planned investments under the 
Hawaii Infrastructure Readiness Initiative. The report shall be 
provided to the Committees on Appropriations of both Houses of 
Congress not later than 180 days after the date of the 
enactment of this Act.
    Tobyhanna Army Depot.--The Committee views Tobyhanna Army 
Depot as an advantageous location for the build-out of physical 
space for future Army Materiel Command (AMC) manufacturing of 
microelectronics, including semi conductors. As such, the 
Committee requests that the Army keep the Committee informed of 
AMC construction needs at Tobyhanna Army Depot.

              Military Construction, Navy and Marine Corps


 
 
 
Appropriation, fiscal year 2023.......................    $4,345,320,000
Budget request fiscal year 2024.......................     6,022,187,000
Committee recommendation, fiscal year 2024............     4,477,961,000
    Change from enacted level.........................      +132,641,000
    Change from budget request........................    -1,544,226,000
 

    The Committee recommends $4,477,961,000 for the Navy and 
Marine Corps in fiscal year 2024, of which $52,683,000 is for 
the following projects in the following amounts:

----------------------------------------------------------------------------------------------------------------
                 State                            Location                   Project                 Amount
----------------------------------------------------------------------------------------------------------------
CA.....................................  Marine Corps Base Camp     Fire/Emergency Response           $2,683,000
                                          Pendleton.                 Station (53 Area)
                                                                     Replacement.
FL.....................................  Naval Air Station Whiting  Advanced Helicopter               50,000,000
                                          Field.                     Training System Hangar.
----------------------------------------------------------------------------------------------------------------

    Within the total for Military Construction, Navy and Marine 
Corps, the recommendation includes $602,625,000 for planning 
and design, which is $2,683,000 above the budget request; and 
$44,430,000 for unspecified minor construction, which is 
$10,000,000 above the budget request.
    Further detail of the Committee's recommendation is 
provided in the State table at the end of this report.
    Joint Base Pearl Harbor-Hickam (JBPHH) Infrastructure 
Investments.--The Committee is concerned about the condition of 
the infrastructure at JBPHH, especially given recent issues 
with water and wastewater infrastructure that may have deferred 
infrastructure improvements in other critical areas. The 
Committee directs the Assistant Secretary of the Navy for 
Installations, Energy, and Environment to provide a report, no 
later than 180 days after enactment of this Act, on the 
condition of JBPHH's infrastructure. The report shall include, 
at a minimum, the following: (1) the plan for addressing failed 
or failing infrastructure; (2) a list of critical 
infrastructure projects that must be addressed to meet 
operational plan requirements; and (3) how the Navy plans on 
meeting current operational plan requirements while addressing 
the construction backlog.
    Naval Aviation Training Enterprise.--The Committee notes 
the importance of the Naval Aviation Training Enterprise and 
encourages the Navy to prioritize infrastructure projects 
within the coastal Naval Aviation Training Enterprise, 
especially those that build, remodel, and restore unaccompanied 
and family housing, child and youth development centers, and 
quality of life projects for servicemembers and their families.
    Public Shipyard Construction Planning for Crisis and 
Conflict.--The Committee is concerned about the Navy's ability 
to fulfill its battle damage requirements using the current 
shipyard infrastructure and urges the Navy to assess how to 
best utilize the Shipyard Infrastructure Optimization Program 
to better prepare the public shipyards for conflict and to 
provide additional resources to develop the Wartime Acquisition 
and Sustainment Support Plan, which will require infrastructure 
investments.
    Shipyard Infrastructure Optimization Program (SIOP).--The 
Committee supports efforts to modernize and improve facilities 
at the Navy's four public shipyards to equip them to address 
the maintenance needs of the Navy's current and future active 
fleet and emphasizes the important role military construction 
must play in achieving this goal.
    Additionally, the Committee expects the Navy to keep it 
informed of additional flexibilities or authorizations 
necessary to successfully coordinate with tribal governments 
for expeditious completion of SIOP. The Committee recognizes 
the importance of these critical dry dock construction projects 
and the importance of relationships with tribal governments.
    The management and oversight of SIOP is key to the 
program's success. As such, the Committee directs the 
Government Accountability Office to submit a report or reports, 
as necessary, not later than 180 days after the date of the 
enactment of this Act, on options for improving the management 
and oversight of SIOP. The report shall include, at a minimum, 
the following: (1) staffing and contracting options for 
ensuring the adequate oversight of contracted activities; (2) 
support provided to the public shipyards and local shipyard 
construction agents; (3) best practices for the management of 
large multi-contractor projects; and (4) how the Navy's 
policies and procedures for large facility improvements greater 
than $500,000,000 compare to those of other Federal agencies.

                    Military Construction, Air Force


 
 
 
Appropriation, fiscal year 2023.......................    $2,614,996,000
Budget request, fiscal year 2024......................     2,605,314,000
Committee recommendation, fiscal year 2024............     2,439,614,000
    Change from enacted level.........................      -175,382,000
    Change from budget request........................      -165,700,000
 

    The Committee recommends $2,439,614,000 for the Air Force 
in fiscal year 2024, of which $30,300,000 is for the following 
projects in the following amounts:

----------------------------------------------------------------------------------------------------------------
                 State                            Location                   Project                 Amount
----------------------------------------------------------------------------------------------------------------
FL.....................................  Eglin Air Force Base.....  LRSO Hardware Software           $14,600,000
                                                                     Development & Test
                                                                     Facility
OH.....................................  Wright-Patterson Air       Acquisition Management             9,900,000
                                          Force Base.                Complex.
OK.....................................  Tinker Air Force Base....  F-35 Aircraft Oxygen Shop          5,800,000
----------------------------------------------------------------------------------------------------------------

    Within the total for Military Construction, Air Force, the 
recommendation includes $450,614,000 for planning and design, 
which is $15,700,000 above the budget request; and $74,900,000 
for unspecified minor construction, which is $10,000,000 above 
the budget request.
    Further detail of the Committee's recommendation is 
provided in the State table at the end of this report.
    Air Education and Training Command Facilities (AETC).--The 
Committee recognizes the importance of adequate facilities for 
basic military training, flying training, and the other 
training missions of AETC and believes that outdated and 
inadequate AETC facilities, including dormitories, harm the Air 
Force's ability to recruit, train, and retain Airmen and 
increase operation and maintenance costs. The Committee urges 
the Air Force to prioritize funding for AETC facility design, 
construction, and refurbishment.
    Air Traffic Control Towers.--The Committee is concerned 
that some air traffic control towers along the Gulf Coast have 
fire safety concerns, lack proper heating and air conditioning, 
and are vulnerable to tropical storms and hurricanes. As such, 
the Committee directs the Air Force ensure its air traffic 
control towers are properly maintained and upgraded, or 
replaced as necessary, to meet mission requirements.
    Data link infrastructure.--The Committee is aware of the 
importance of data link capabilities to national security and 
encourages the Air Force to ensure it has the adequate 
infrastructure to support its data link requirements.
    Ground Based Strategic Deterrent (GBSD) Infrastructure.--
The Committee is encouraged by the Air Force's future years 
defense program expectations for military construction related 
to the GBSD. The Committee requests that the Air Force continue 
engaging with Congress on its infrastructure needs related to 
the GBSD.
    Hardened Infrastructure in the Pacific.--The Committee 
notes the importance of air power in the Pacific and the 
infrastructure required to support, maintain, and protect those 
requirements. The Committee encourages the Air Force to ensure 
U.S. and allied air force facilities are appropriately hardened 
to deter aggression and defend U.S. interests.
    U.S. Space Command Headquarters.--The Committee is 
concerned that the Department has not finalized a permanent 
location for the United States Space Command headquarters after 
nearly five years of consideration and the impact on national 
security. Therefore, the Committee directs the Secretary to 
announce a decision expeditiously and directs the Department to 
provide a report within 90 days of enactment of this Act 
regarding any funds that have been obligated or expended in all 
previous fiscal years for the construction, renovation, or 
improvement of facilities, including all leases, for Space 
Command Headquarters.

                  Military Construction, Defense-Wide


 
 
 
Appropriation, fiscal year 2023.......................    $2,626,078,000
Budget request, fiscal year 2024......................     2,984,682,000
Committee recommendation, fiscal year 2024............     2,651,047,000
    Change from enacted level.........................       +24,969,000
    Change from budget request........................      -333,635,000
 

    The Committee recommends $2,651,047,000 for Military 
Construction, Defense-Wide, in fiscal year 2024, including 
$304,045,000 for planning and design, which is $41,000,000 
above the budget request; and $48,618,000 for unspecified minor 
construction, which is $10,365,000 above the budget request.
    Further detail of the Committee's recommendation is 
provided in the State table at the end of this report.
    Defense Health Agency (DHA) Hawaii Market Facilities Master 
Plan.--The Committee notes the importance of the Tripler Army 
Medical Center and is concerned about infrastructure challenges 
as DHA works to restructure and realign military medical 
facilities. The Hawaii Market Facilities Master Plan Study is 
expected to evaluate options to recapitalize the Tripler Army 
Medical Center. The Committee looks forward to the DHA 
submitting this study in a timely manner.
    Energy Resilience and Conservation Investment Program 
(ERCIP).--The Committee provides $548,000,000 for ERCIP 
construction, which is the same as the budget request; and 
$107,250,000 for ERCIP design, which is $21,000,000 above the 
budget request.
    The Committee supports the Department's efforts to improve 
energy resilience, contribute to mission assurance, save 
energy, and reduce energy costs through ERCIP. The Committee 
encourages the Department to continue using all available tools 
and authorities to ensure the timely execution of ERCIP 
projects. Additionally, as the Department works to achieve base 
energy independence, the Committee encourages the Department to 
leverage new energy technologies.
    Military Construction at Cold Weather Installations.--The 
Committee recognizes that certain installations have unique 
challenges due to extreme cold temperatures and significant 
snowfall during the fall and winter months. The Committee 
believes that the unspecified minor military construction 
authority can help with these challenges by ensuring there are 
adequate facilities to house and protect property and equipment 
at these installations. The Committee encourages the military 
services to ensure the proper facilities and structure are in 
place to protect property and equipment at cold weather 
installations, such as Fort Drum.

               Military Construction, Army National Guard


 
 
 
Appropriation, fiscal year 2023.......................      $459,018,000
Budget request, fiscal year 2024......................       340,186,000
Committee recommendation, fiscal year 2024............       369,261,000
    Change from enacted level.........................       -89,757,000
    Change from budget request........................       +29,075,000
 

    The Committee recommends $369,261,000 for the Army National 
Guard in fiscal year 2024, of which $19,075,000 is for the 
following projects in the following amounts:

----------------------------------------------------------------------------------------------------------------
                 State                            Location                   Project                 Amount
----------------------------------------------------------------------------------------------------------------
FL.....................................  Camp Blanding............  Automated Multipurpose           $11,000,000
                                                                     Machine Gun Range.
FL.....................................  Camp Blanding............  Training Aids Center.....          1,200,000
FL.....................................  Camp Blanding............  Infantry Squad Battle                840,000
                                                                     Course.
OK.....................................  Shawnee..................  National Guard Readiness           1,800,000
                                                                     Center.
PA.....................................  Fort Indiantown Gap......  Automated Multipurpose             1,550,000
                                                                     Machine Gun Range.
TX.....................................  Fort Hood................  General Purpose                    2,685,000
                                                                     Instruction Building.
----------------------------------------------------------------------------------------------------------------

    Within the total for Military Construction, Army National 
Guard, the recommendation includes $42,361,000 for planning and 
design, which is $8,075,000 above the budget request; and 
$73,000,000 for unspecified minor construction, which is 
$10,000,000 above the budget request.
    Further detail of the Committee's recommendation is 
provided in the State table at the end of this report.

               Military Construction, Air National Guard


 
 
 
Appropriation, fiscal year 2023.......................      $279,353,000
Budget request, fiscal year 2024......................       178,722,000
Committee recommendation, fiscal year 2024............       189,322,000
    Change from enacted level.........................       -90,031,000
    Change from budget request........................       +10,600,000
 

    The Committee recommends $189,322,000 for the Air National 
Guard in fiscal year 2024, of which $600,000 is for the 
following project in the following amount:

----------------------------------------------------------------------------------------------------------------
                 State                            Location                   Project                 Amount
----------------------------------------------------------------------------------------------------------------
FL.....................................  Jacksonville               F-35 Munitions Storage              $600,000
                                          International Airport.     Area Admin.
----------------------------------------------------------------------------------------------------------------

    Within the total for Military Construction, Air National 
Guard, the recommendation includes $36,200,000 for planning and 
design, which is $600,000 above the budget request; and 
$73,122,000 for unspecified minor construction, which is 
$10,000,000 above the budget request.
    Further detail of the Committee's recommendation is 
provided in the State table at the end of this report.
    Air National Guard Infrastructure.--The Committee 
recognizes that some Aviation Support Facilities are not 
configured to protect and maintain modern airframes and 
encourages the Air National Guard to upgrade these facilities 
using unspecified minor military construction funds, as 
appropriate, to ensure current facilities are upgraded to 
adequately support current airframes.

                  Military Construction, Army Reserve


 
 
 
Appropriation, fiscal year 2023.......................      $193,878,000
Budget request, fiscal year 2024......................       107,076,000
Committee recommendation, fiscal year 2024............       117,076,000
    Change from enacted level.........................       -76,802,000
    Change from budget request........................       +10,000,000
 

    The Committee recommends $117,076,000 for the Army Reserve 
in fiscal year 2024, including $23,389,000 for planning and 
design, which is the same as the budget request; and 
$24,687,000 for unspecified minor construction, which is 
$10,000,000 above the budget request.
    Further detail of the Committee's recommendation is 
provided in the State table at the end of this report.

                  Military Construction, Navy Reserve


 
 
 
Appropriation, fiscal year 2023.......................       $36,837,000
Budget request, fiscal year 2024......................        51,291,000
Committee recommendation, fiscal year 2024............        61,291,000
    Change from enacted level.........................       +24,454,000
    Change from budget request........................       +10,000,000
 

    The Committee recommends $61,291,000 for the Navy Reserve 
in fiscal year 2024, including $6,495,000 for planning and 
design, which is the same as the budget request; and 
$17,847,000 for unspecified minor construction, which is 
$10,000,000 above the budget request.
    Further detail of the Committee's recommendation is 
provided in the State table at the end of this report.

                Military Construction, Air Force Reserve


 
 
 
Appropriation, fiscal year 2023.......................       $85,423,000
Budget request, fiscal year 2024......................       291,572,000
Committee recommendation, fiscal year 2024............       330,572,000
    Change from enacted level.........................      +245,149,000
    Change from budget request........................       +39,000,000
 

    The Committee recommends $330,572,000 for the Air Force 
Reserve in fiscal year 2024, of which $29,000,000 is for the 
following projects in the following amounts:

----------------------------------------------------------------------------------------------------------------
                 State                            Location                   Project                 Amount
----------------------------------------------------------------------------------------------------------------
GA.....................................  Dobbins Air Reserve Base.  Security Forces Facility.        $22,000,000
LA.....................................  Barksdale Air Force Base.  307 Bomb Wing Medical              7,000,000
                                                                     Facility Expansion.
----------------------------------------------------------------------------------------------------------------

    Within the total for Military Construction, Air Force 
Reserve, the recommendation includes $12,146,000 for planning 
and design, which is the same as the budget request; and 
$19,926,000 for unspecified minor construction, which is 
$10,000,000 above the budget request.
    Further detail of the Committee's recommendation is 
provided in the State table at the end of this report.

     North Atlantic Treaty Organization Security Investment Program


 
 
 
Appropriation, fiscal year 2023.......................      $220,139,000
Budget request, fiscal year 2024......................       293,434,000
Committee recommendation, fiscal year 2024............       293,434,000
    Change from enacted level.........................       +73,295,000
    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 to finance 
the costs of construction needed to support the roles of the 
major NATO commands.
    As requested, the bill provides additional funding above 
the fiscal year 2023 enacted level to support efforts to deter 
Russian aggression against NATO allies and partners.

               Department of Defense Base Closure Account


 
 
 
Appropriation, fiscal year 2023.......................      $574,687,000
Budget request, fiscal year 2024......................       389,174,000
Committee recommendation, fiscal year 2024............       539,174,000
    Change from enacted level.........................       -35,513,000
    Change from budget request........................      +150,000,000
 

    The Committee recommends $539,174,000 for the Base Closure 
account, which is $150,000,000 above the budget request.
    The Committee supports the Navy's efforts towards the 
demolition and removal of non-historically designated buildings 
and structures under Navy control where the sampling or 
remediation of radiologically contaminated materials have been 
the subject of substantiated allegations of fraud.

                        Family Housing Overview


 
 
 
Appropriation, fiscal year 2023.......................    $1,986,330,000
Budget request, fiscal year 2024......................     1,940,751,000
Committee recommendation, fiscal year 2024............     1,970,751,000
    Change from enacted level.........................       -15,579,000
    Change from budget request........................       +30,000,000
 

    Family housing construction accounts provide funds for new 
construction, construction improvements, the Federal 
government's costs for family housing privatization projects, 
and planning and design. The operation and maintenance accounts 
provide funds to pay for maintenance and repair, furnishings, 
management, services, utilities, leasing, interest, mortgage 
insurance, and miscellaneous expenses.
    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. The Committee believes that 
the Army's recent counter-mold operation, a holistic, global 
effort to reduce the risk of hazardous mold in Army facilities 
and housing, is a step in the right direction and commends 
these efforts to inform and educate Soldiers and their families 
about mold conditions, mitigation, and reporting.
    Indoor Air Quality.--The Committee remains concerned that 
servicemembers and their families could be subject to unhealthy 
living conditions, including potentially dangerous indoor air 
quality, in military family housing constructed and managed by 
privatized housing providers, as well as in Unaccompanied 
Personnel Housing. The Committee has been aware of the poor 
quality of service provided by privatized housing partners, as 
well as the deteriorating housing conditions. The Department 
and housing partners are directed to regularly monitor housing 
conditions and adhere to Environmental Protection Agency 
guidance and recommended mitigation procedures for those areas 
where there is evidence of potential health effects, including 
mold and other indoor air health risks.
    Kwajalein Atoll.--The Committee commends the Army's 
revitalization of family housing on U.S. Army Garrison 
Kwajalein Atoll and believes these updates improve the quality 
of life for servicemembers and their families as well as 
increase force readiness.
    Military Housing Privatization Initiative (MHPI).--
Recognizing the importance of adequate and safe housing to the 
readiness of the U.S. military and wellbeing of servicemembers 
and their families, the Committee continues to direct the 
Services to prioritize the oversight of the privatized housing. 
While the Department and Services have improved their internal 
processes, hired staff, and increased their oversight of 
housing partners, the Committee continues to hear reports of 
poor housing conditions, slow response times, and indifference 
towards requests for assistance. The Committee looks forward to 
reviewing the report required by Division J of Public Law 117-
328 regarding the plan to address these issues.
    The Committee provides an additional $30,000,000 above the 
budget request to expand oversight of the entire housing 
portfolio, including government-owned and controlled family 
housing and privatized family and unaccompanied housing. The 
Committee requests an expenditure plan detailing the planned 
use of these funds within 30 days of enactment of this Act, 
including the specific, additional oversight activities these 
funds above the budget request will allow.
    Pacific Northwest Military Housing Enhancements.--The 
Committee recognizes the need to address the shortage of 
affordable and suitable military family housing units in the 
Pacific Northwest and the effect this shortage has on military 
readiness and the quality of life of servicemembers and their 
families. The Committee supports efforts to address this 
shortfall.

                   Family Housing Construction, Army


 
 
 
Appropriation, fiscal year 2023.......................      $169,339,000
Budget request, fiscal year 2024......................       304,895,000
Committee recommendation, fiscal year 2024............       304,895,000
    Change from enacted level.........................      +135,556,000
    Change from budget request........................             - - -
 

             Family Housing Operation and Maintenance, Army


 
 
 
Appropriation, fiscal year 2023.......................      $446,411,000
Budget request, fiscal year 2024......................       385,485,000
Committee recommendation, fiscal year 2024............       395,485,000
    Change from enacted level.........................       -50,926,000
    Change from budget request........................       +10,000,000
 

           Family Housing Construction, Navy and Marine Corps


 
 
 
Appropriation, fiscal year 2023.......................      $337,297,000
Budget request, fiscal year 2024......................       277,142,000
Committee recommendation, fiscal year 2024............       277,142,000
    Change from enacted level.........................       -60,155,000
    Change from budget request........................             - - -
 

    Family Housing Operation and Maintenance, Navy and Marine Corps


 
 
 
Appropriation, fiscal year 2023.......................      $378,224,000
Budget request, fiscal year 2024......................       363,854,000
Committee recommendation, fiscal year 2024............       373,854,000
    Change from enacted level.........................        -4,370,000
    Change from budget request........................       +10,000,000
 

                 Family Housing Construction, Air Force


 
 
 
Appropriation, fiscal year 2023.......................      $232,788,000
Budget request, fiscal year 2024......................       237,097,000
Committee recommendation, fiscal year 2024............       237,097,000
    Change from enacted level.........................        +4,309,000
    Change from budget request........................             - - -
 

          Family Housing Operation and Maintenance, Air Force


 
 
 
Appropriation, fiscal year 2023.......................      $365,222,000
Budget request, fiscal year 2024......................       314,386,000
Committee recommendation, fiscal year 2024............       324,386,000
    Change from enacted level.........................       -40,836,000
    Change from budget request........................       +10,000,000
 

         Family Housing Operation and Maintenance, Defense-Wide


 
 
 
Appropriation, fiscal year 2023.......................       $50,113,000
Budget request, fiscal year 2024......................        50,785,000
Committee recommendation, fiscal year 2024............        50,785,000
    Change from enacted level.........................          +672,000
    Change from budget request........................             - - -
 

         Department of Defense Family Housing Improvement Fund


 
 
 
Appropriation, fiscal year 2023.......................        $6,442,000
Budget request, fiscal year 2024......................         6,611,000
Committee recommendation, fiscal year 2024............         6,611,000
    Change from enacted level.........................          +169,000
    Change from budget request........................             - - -
 

 Department of Defense Military Unaccompanied Housing Improvement Fund


 
 
 
Appropriation, fiscal year 2023.......................          $494,000
Budget request, fiscal year 2024......................           496,000
Committee recommendation, fiscal year 2024............           496,000
    Change from enacted level.........................            +2,000
    Change from budget request........................             - - -
 

                       Administrative Provisions

    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 bordering the Arabian Gulf, 
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 associated supervision, 
inspection, overhead, engineering and design on those projects 
and on subsequent claims.
    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 unit annually 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 allowing the transfer of 
funds in accordance with reprogramming guidelines.
    The bill includes section 123 prohibiting the use of funds 
for projects at Arlington National Cemetery.
    The bill includes section 124 providing funds for certain 
projects identified in the respective military department's 
unfunded priority list for fiscal year 2024.
    The bill includes section 125 directing all amounts 
appropriated to Military Construction (all accounts) be 
immediately available and allotted for the full scope of the 
authorized project.
    The bill includes section 126 extending the eligibility of 
unobligated funding for fiscal year 2017, 2018, and 2019 
projects that have not lapsed.
    The bill includes section 127 defining the congressional 
defense committees.
    The bill includes section 128 providing additional funds 
for planning and design for construction improvements to 
laboratory facilities.
    The bill includes section 129 providing additional funds 
for the Air Force for expenses incurred as a result of natural 
disasters.
    The bill includes section 130 providing funds for planning 
and design for child development centers.
    The bill includes section 131 providing funds for planning 
and design for barracks.
    The bill includes section 132 providing funds for 
unspecified minor construction for demolition.
    The bill includes section 133 providing funds for cost to 
complete projects identified in the respective military 
department's unfunded priority list for fiscal year 2024.
    The bill includes section 134 providing funds for planning 
and design associated with the Shipyard Infrastructure 
Optimization Program.
    The bill includes section 135 prohibiting funds from being 
used to carry out the closure or realignment of Naval Station 
Guantanamo Bay.
    The bill includes section 136 regarding U.S. Space Command 
Headquarters.

                                TITLE II


                     DEPARTMENT OF VETERANS AFFAIRS


 
 
 
Appropriation, fiscal year 2023\1\...................   $303,282,598,000
Budget request, fiscal year 2024\1\..................    319,763,645,000
Committee recommendation, fiscal year 2024\1\........    299,495,645,000
    Change from enacted level........................     -3,786,953,000
    Change from budget request.......................    -20,268,000,000
Fiscal year 2025 advance budget request..............    327,085,076,000
Fiscal year 2025 Committee recommendation in the bill    305,633,534,000
    Change from budget request.......................    -21,454,542,000
 
\1\All funding cited excludes amounts in the Medical Care Collections
  Fund.

    The Department of Veterans Affairs (VA) provides health 
care for 9,000,000 veteran enrollees; disability compensation 
benefits to an estimated 6,094,440 veterans and 562,448 
survivors; pension benefits for an estimated 136,678 veterans 
and 112,179 survivors; life insurance for more than 5,600,000 
veterans, servicemembers and their families; educational 
assistance for nearly 820,000 students; and interment of more 
than 140,000 veterans and eligible family members in national 
cemeteries. To serve adequately the nation's veterans, VA 
employs more than 450,000 staff, making it one of the largest 
Federal agencies in terms of employment.
    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 the Department to include the following 
information in its fiscal year 2025 budget justification: 
Expenditures for fiscal year 2023 and expected expenditures for 
fiscal year 2025, 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.
    Congressional Oversight of VA's Actions on Abortion.--The 
bill prohibits funding to implement, administer, or otherwise 
carry out the Department's illegal actions in the interim final 
rule published September 9, 2022. The interim final rule 
clearly violated Section 106 of the Veterans Health Care Act of 
1992 (P.L. 102-585; Title 38 U.S.C. 1710 note). The Committee 
directs the Department to provide a report within 30 days of 
enactment, and every 180 days thereafter, to the Committee on 
Appropriations of the United States House of Representatives 
and the Committee on Appropriations of the United States Senate 
containing the following information, disaggregated by State: 
(1) the number of abortions the Department has provided in VA 
facilities since September 9, 2022; (2) the number of abortions 
performed elsewhere and funded by the Department since 
September 9, 2022; (3) under which exception each abortion 
provided or funded by the Department has qualified; (4) the 
total amount expended on each abortion; and (5) the criteria 
used and documentation required by the Department to determine 
when an exception allowing for an abortion applies.
    Customer Service Standards and Performance Plan.--The 
Committee continues to support efforts to improve customer 
service in accordance with Executive Order 13571, Streamlining 
Service Delivery and Improving Customer Service, and encourages 
the Secretary to continuously improve customer service 
standards and incorporate them into the performance plan 
required by section 1115 of title 31, United States Code. The 
Committee requests that the Department confirm its compliance 
with 31 U.S.C. 1115 within 30 days of enactment of the Act.
    Former Members of Guard and Reserve Components.--The 
Committee notes that since 2020 the National Veteran Suicide 
Prevention Annual Reports have not included information 
regarding former members of the Guard and Reserve Components 
who were not activated for military service. The Committee 
encourages the Department to continue to collaborate with the 
Department of Defense to monitor and to ensure appropriate 
measures are available to reduce suicide in this population.
    Protecting Immigrant Veterans.--The Committee supports VA's 
role in the Immigrant Military Members and Veterans Initiative 
and urges VA to take steps to ensure non-citizen veterans are 
aware of their options to naturalize as U.S. citizens and 
provide administrative guidance and assistance with relevant 
applications and paperwork. The Department is encouraged to 
continue to coordinate with the Department of Homeland Security 
to develop methods that allow the Department to maintain 
contact with immigrant and non-citizen veterans and ensure that 
they can access immigration related assistance and other VA 
assistance and benefits to which they are entitled by law.
    Service-Disabled Veteran Owned Small Business Program.--The 
Committee understands that Congress created the Service-
Disabled Veteran Owned Small Business (SDVOSB) program to honor 
the service of veterans who incurred disabilities on active 
service and to leverage their unique skill sets and 
perspectives for the public benefit. However, SDVOSB contract 
awards and obligations often fall short of targets, and SDVOSBs 
remain an underutilized agency partner. The Committee urges VA 
to prioritize meeting SDVOB targets utilizing available 
acquisition tools including best-in-class acquisition 
solutions, including for new and emerging information 
technology requirements.
    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 notes that VA 
has published a handbook with comprehensive policy guidance and 
instructions addressing harassment and sexual assault and 
directs VA to ensure that these policies are fully communicated 
and complied with. The Committee appreciates the Department's 
efforts to better address harassment and sexual assault and 
requests an updated report annually on its approach.
    Veterans First Contracting Program.--The Committee 
encourages VA to continue to expand and standardize 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 service-disabled veteran and veterans-owned small 
businesses, including women and minority veteran-led small 
businesses, are awarded VA contracts when appropriate.
    Veterans Records.--The Committee is aware some veterans are 
receiving records through the U.S. Postal Service instead of 
electronically, as requested. This is contrary to the 21st 
Century Cares Act, unnecessarily increases costs, and causes 
delays. The Committee directs the Department to ensure 
employees are aware of this requirement and not to send 
requested documents through the U.S. Postal Service unless the 
veteran has no other means available to receive the records.
    Veterans in the Pacific.--The Committee acknowledges and 
appreciates the service of Pacific island veterans and 
recognizes the challenges they have in securing the benefits 
they have earned. As such, the Committee directs the Department 
to (1) expand and improve the delivery and services of the 
Foreign Medical Program; (2) expand the availability of 
preventative and wellness programs, suicide prevention, 
military sexual trauma, and women's health to veterans in the 
Pacific islands; (3) fully utilize telehealth in the region; 
(4) expand the capabilities, including staffing, of the Guam 
and/or Manila regional offices to allow quarterly visits to the 
territories and Freely Associated States; (5) develop training 
programs so that local veterans can become advocates for other 
veterans; (6) develop methods to securely provide payments to 
veterans and providers, using U.S. embassy resources, as 
appropriate; (7) allow for the prescribing and mailing, through 
the U.S. Postal Service, of medications by U.S. providers to 
veterans in the territories and Freely Associated States, 
consistent with Federal law; (8) seek to train local healthcare 
providers in the unique needs of veterans; (9) allow healthcare 
providers in the territories and Freely Associated States to 
directly bill for services provided; (10) ensure beneficiary 
travel reimbursement rates are commensurate with travel costs 
in the region; and (11) ensure veterans in the territories, 
Freely Associated States, other locales, and nations are noted 
in expenditure reporting, such as in the appendix to the 
Federal Budget. The Committee requests a report within 60 days 
of enactment of this Act regarding the status of these efforts. 
The report should include a detailed description of the 
Department's efforts, identify barriers to implementation, and 
provide legislative and funding recommendations. The Committee 
continues to support the Center for Native Hawaiians, Pacific 
Islanders, and U.S. Affiliated Pacific Islanders.

                    Veterans Benefits Administration


                       COMPENSATION AND PENSIONS

                     (INCLUDING TRANSFER OF FUNDS)

 
 
 
Fiscal year 2023 enacted level.......................   $152,016,542,000
Fiscal year 2024 enacted level.......................    146,778,136,000
Fiscal year 2024 budget year request.................      4,655,879,000
Committee 2024 budget year recommendation............      4,655,879,000
Fiscal year 2025 advance appropriation request.......    181,390,281,000
Committee 2025 advance appropriation recommendation..    181,390,281,000
Comparison with:
    Fiscal year 2024 enacted level...................    +34,612,145,000
    Fiscal year 2025 advance budget request..........              - - -
 

    This appropriation provides funds for service-connected 
compensation payments to an estimated 6,094,446 veterans and 
562,448 survivors in fiscal year 2024. In addition, pension 
payments will be funded for an estimated 150,678 veterans and 
112,179 survivors. The average payment per compensation case 
for veterans in fiscal year 2024 is estimated to be $24,307 and 
pension payments are projected to be $14,063.
    The appropriation includes authority to transfer funding 
not to exceed $22,109,000 in fiscal year 2024 to General 
Operating Expenses, Veterans Benefits Administration (VBA) and 
Information Technology Systems. These funds are for the 
administrative expenses of implementing cost-saving provisions 
required by the Omnibus Budget Reconciliation Act of 1990 (P.L. 
101-508), the Veterans' Benefits Act of 1992 (P.L. 102-568), 
and the Veterans' Benefits Improvements Act of 1994 (P.L. 103-
446). 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.
    The Committee recommendation includes $4,655,879,000 in 
additional funding for fiscal year 2024 for a total of 
$151,434,015,000 for the fiscal year, which includes the 
advance appropriation provided in the prior fiscal year. For 
fiscal year 2025, the Committee recommendation includes an 
advance appropriation of $181,390,281,000.
    Disability Claims and Appeals.--Due to the significant 
investments Congress has provided in recent years, VA has been 
able to hire staff, acquire technology, and modify work 
processes necessary to significantly reduce the disability 
claims backlog. The Committee encourages VA to continue its 
effort to reduce the claims backlog to pre-pandemic levels and 
work expeditiously to resolve the oldest and most emergent 
claims.

                         READJUSTMENT BENEFITS

 
 
 
Fiscal year 2023 enacted level........................    $8,906,851,000
Fiscal year 2024 enacted level........................     8,452,500,000
Fiscal year 2024 budget year request..................             - - -
Committee 2024 budget year recommendation.............             - - -
Fiscal year 2025 advance appropriation request........    11,523,134,000
Committee 2025 advance appropriation recommendation...    11,523,134,000
Comparison with:
    Fiscal year 2025 enacted level....................    +3,070,634,000
    Fiscal year 2025 advance budget request...........             - - -
 

    This appropriation finances the education and training of 
veterans and servicemembers through the Post-9/11 GI Bill and 
the All-Volunteer Force Educational Assistance Program. 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.
    The Committee recommendation includes an advance 
appropriation of $11,523,134,000 for fiscal year 2025.
    GI Bill Comparison Tool.--The Committee emphasizes the 
importance of providing veterans with the necessary information 
to make informed decisions when selecting institutions of 
higher education. The Committee urges the Department to 
continue to monitor and assess the effectiveness of the GI 
comparison tool, including usage metrics, the frequency that 
caution flags are checked and updated, and technical 
performance.
    Skills and Certifications.--The Committee recognizes the 
importance of expanding job opportunities for veterans after 
their discharge and encourages VA to work with other Federal 
agencies and State licensing bureaus, as appropriate, to 
evaluate the transferability of DoD skills and certifications, 
including mechanical skills and certifications, to state 
certifications to aid in transition to civilian employment.
    Technology for Student Veterans.--During the pandemic, 
remote learning technologies, such as computers and routers for 
internet access, were widely used so students could continue 
their studies. Within 180 days of enactment of this Act, the 
Department is directed to submit a report on the cost, 
feasibility, and advisability of ensuring student veterans have 
access to the technologies needed to be successful in school.
    Transition Coordination.--The Committee encourages VA, in 
consultation with the Departments of Defense and Labor, to 
coordinate efforts and resources to ensure veterans have a 
successful transition to civilian life. This includes sharing 
information on community resources, including nonprofits and 
Veterans Service Organizations, that are available to veterans 
and their families. The Committee also urges VA to explore 
options for veterans to access hands-on job placement services 
that connect them directly with employers, including those 
offered through successful state and local programs.
    VET TEC Pilot Program.--The Committee expects the 
Department to fund the program, consistent with current law, at 
$45,000,000 for fiscal year 2024, and encourages it to take 
steps to expand access by including additional providers, 
particularly in areas of the country where the initiative is 
not currently available or only allowing access to online 
courses, as well as to help train and employ women veterans and 
veterans with disabilities.
    Veteran Transitional Assistance Grant Program (VTAG).--The 
Committee continues to support VTAG and includes an additional 
$5,000,000 above the fiscal year 2023 level, as requested.

                   VETERANS INSURANCE AND INDEMNITIES

 
 
 
Fiscal year 2023 enacted level........................      $109,865,000
Fiscal year 2024 enacted level........................       121,126,000
Fiscal year 2024 budget year request..................        12,701,000
Committee 2024 budget year recommendation.............        12,701,000
Fiscal year 2025 advance appropriation request........       135,119,000
Committee 2025 advance appropriation recommendation...       135,119,000
Comparison with:
    Fiscal year 2024 enacted level....................       +13,993,000
    Fiscal year 2025 advance budget request...........             - - -
 

    The Veterans Insurance and Indemnities appropriation is 
made up of the former appropriations for military and naval 
insurance, applicable to World War I veterans; national service 
life insurance applicable to certain World War II veterans; 
servicemember's indemnities, applicable to Korean Conflict 
veterans; and veterans mortgage life insurance, applicable to 
individuals who have received a grant for specially adapted 
housing.
    The Committee recommendation includes an additional 
$12,701,000 for fiscal year 2024 for a total of $133,827,000 
for the fiscal year. This includes the advance appropriation 
provided in the prior fiscal year. For fiscal year 2025, the 
Committee recommendation includes an advance appropriation of 
$135,119,000.

         VETERANS HOUSING BENEFIT PROGRAM FUND PROGRAM ACCOUNT

----------------------------------------------------------------------------------------------------------------
                                                                              Limitation on
                                                                             direct loans for    Administrative
                                                           Program Account  specially adapted       Expenses
                                                                              housing loans
----------------------------------------------------------------------------------------------------------------
Appropriation, fiscal year 2023..........................            - - -         ($500,000)       $282,361,131
Budget request est., fiscal year 2024....................            - - -          (500,000)        316,742,419
Committee recommendation, fiscal year 2024...............            - - -          (500,000)        316,742,419
    Change from enacted level............................            - - -              - - -        +34,381,288
    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 Committee recommendation includes $316,742,419 for 
fiscal year 2024 for administrative expenses to carry out the 
Veterans Housing Loan Program.
    Home Loan Income Verification.--The Committee understands 
that as directed by House Report 116-63, VA has clarified that 
nothing in VA statutes or regulations specifically prohibits a 
veteran whose income is derived from state-legalized cannabis 
activities from obtaining a certificate of eligibility for VA 
home loan benefits. The Committee understands that VA is 
working to improve communication with eligible lending 
institutions to reduce confusion among lenders and borrowers on 
this matter.

            VOCATIONAL REHABILITATION LOANS PROGRAM ACCOUNT

----------------------------------------------------------------------------------------------------------------
                                                                              Limitation on      Administrative
                                                           Program Account     direct loans         Expenses
----------------------------------------------------------------------------------------------------------------
Appropriation, fiscal year 2023..........................           $7,171         ($942,330)           $445,698
Budget request, fiscal year 2024.........................           78,337        (2,026,000)            460,698
Committee recommendation, fiscal year 2024...............           78,337        (2,206,000)            460,698
    Change from enacted level............................          +71,116       (+1,083,670)            +15,000
    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.
    The Committee recommendation includes $460,698 for fiscal 
year 2024 for administrative expenses to carry out the 
Vocational Rehabilitation Direct Loan program. It is estimated 
that the Department will make 1,559 loans in fiscal year 2024.

          NATIVE AMERICAN VETERAN HOUSING LOAN PROGRAM ACCOUNT

 
 
 
Administrative expenses:
Appropriation, fiscal year 2023.......................        $1,400,000
Budget request, fiscal year 2024......................         2,718,546
Committee recommendation, fiscal year 2024............         2,718,546
    Change from enacted level.........................        +1,318,546
    Change from budget request........................             - - -
 

    The Native American Veteran Housing Loan Program, as 
authorized by title 38 United States Code, chapter 37, 
subchapter V, provides the Secretary 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. These loans are available 
to purchase, construct, or improve homes to be occupied as 
veterans' residences.
    The Committee recommendation includes $2,718,546 for fiscal 
year 2024 for administrative expenses for the Native American 
Veteran Housing Loan Program.

      GENERAL OPERATING EXPENSES, VETERANS BENEFITS ADMINISTRATION

 
 
 
Appropriation, fiscal year 2023.......................    $3,863,000,000
Budget request, fiscal year 2024......................     3,899,000,000
Committee recommendation, fiscal year 2024............     3,899,000,000
    Change from enacted level.........................       +36,000,000
    Change from budget request........................             - - -
 

    The General Operating Expenses, Veterans Benefits 
Administration (VBA) account provides funding for VBA to 
administer entitlement programs such as service-connected 
disability compensation, education benefits, and vocational 
rehabilitation services.
    The Committee recommendation includes $3,899,000,000 for 
fiscal year 2024 for General Operating Expenses, VBA. These 
resources will fully fund VA's request for fiscal year 2024 and 
improve VBA's ability to address compensation and benefit 
claims. The bill makes available through September 30, 2025, up 
to ten percent of these funds.
    Benefits Usage.--The Committee encourages VA to include 
veteran benefit usage into its annual suicide prevention 
report, including usage of disability compensation, education 
and employment, home loan and foreclosure assistance benefits, 
as well as participation in housing and food security programs. 
Additional data may enable a better understanding of the 
correlation between benefit use and suicide and allow for more 
effective programs to assist veterans.
    Compensation and Pension (C&P) Claims.--The Committee 
continues to be concerned about reports of delays that veterans 
experience in the resolution of pending C&P claims. The 
Committee encourages the Department to work diligently to 
reduce the backlog of compensation and benefit claims to pre-
pandemic levels to lessen the burden of excessive wait times.
    Compensation and Pension Exams.--The Committee is aware 
that the majority of veterans filing claims for disabilities 
incurred or aggravated by Military Sexual Trauma (MST) are 
referred to a third-party contract provider for the required 
C&P exam, and that veterans filing MST-related claims may have 
unique needs and safety concerns. The Committee requests a 
report, not later than 90 days after enactment of this Act, 
describing information related to the required, specialized 
training for contracted and VA examiners. The report should 
include claim outcome data, by congressional district as 
practicable, for veterans referred to a third-party provider as 
compared to those evaluated by a VA provider. The Committee 
directs VA to allow veterans filing an MST-related claim to 
request a VA provider for the required C&P exam.
    Digitizing Veteran Records.--The Committee commends the 
efforts of VBA, in partnership with the National Archives and 
Records Administration, to address the backlog of veterans' 
records requests by creating digital copies of records that 
currently exist only in hardcopy form at the National Personnel 
Records Center (NPRC). The Committee strongly encourages VBA to 
continue its efforts to create digital copies of veterans' 
records housed at NPRC.
    Equitable Relief.--The Committee understands VA is working 
to implement new systems and protocols to eliminate instances 
of administrative error. However, as VA enacts system-wide 
reforms, ending equitable relief for veterans who were deemed 
eligible for benefits in error would place an unfair burden on 
veterans and their families. The Secretary is directed to 
continue to grant or extend equitable relief to eligible 
veterans initially deemed eligible in instances of 
administrative error. Not later than April 1, 2024, the 
Secretary is directed to submit to the Committee a report 
containing a statement as to the disposition of each case 
recommended to the Secretary for equitable relief under section 
503 of title 38, United States Code during the preceding 
calendar year.
    Filipino Veterans.--There are approximately 1,721 living 
WWII Filipino Veterans. The Committee directs the Department to 
provide a report within 180 days of the enactment of this Act 
describing an outreach plan and required budget to extend the 
time limit for accepting initial and revised applications for a 
sufficient period of time to ensures all eligible, living WWII 
Filipino Veterans can apply for and receive the benefits they 
are entitled to.
    Hearing Loss Prevention.--Hearing loss and auditory 
injuries account for one of the most prevalent service-
connected disabilities for veterans receiving compensation 
benefits. The Committee encourages the Department to work with 
the Department of Defense to identify options, strategies, and 
technologies to reduce the incidence of hearing loss by 
military personnel through exposure to excessive auditory 
pressure impulses during weapons training.
    Information for Toxic-Exposed Veterans.--The Committee 
encourages VA to ensure resources and materials provided by VA 
to toxic-exposed veterans be made available in the most 
commonly spoken languages in the United States, as required by 
the Veterans and Family Information Act (P.L. 117-62).
    Military Sexual Trauma.--The Committee continues to direct 
VA to prioritize specialized MST training for claims processors 
and involve MST survivors in the development of specialized 
training.
    The Committee additionally remains concerned that veterans 
suffering from a mental health disorder because 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. As such, 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. The Committee also urges VA to continue to report 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).
    Toxic Exposure Claims.--The Committee recognizes that an 
increase in claims and associated workload increases is 
expected as a result of enactment of the Honoring our Promise 
to Address Comprehensive Toxics Act (PACT Act) and encourages 
the Department to implement thorough and special training 
protocols to ensure accuracy and efficiency in the claims 
adjudication process.

                     Veterans Health Administration

    The Department operates the largest integrated medical care 
delivery system in the United States, providing care at nearly 
1,300 health care facilities, including 171 medical centers and 
more than 1,100 outpatient sites, to more than 9,000,000 
veterans enrolled in the VA healthcare program.
    The bill includes a total of $121,011,303,000 for veterans' 
medical care. The Fiscal Responsibility Act of 2023 (P.L. 118-
5) provided a total of $20,268,000,000 for the Cost of War 
Toxic Exposures Fund for fiscal year 2024, including 
$17,116,000,000 for veterans' medical care. The combined total 
appropriated by this Act and the Fiscal Responsibility Act for 
veterans medical care is $138,127,303,000, equal to the 
President's Budget request.
    In addition, the bill includes a total of $112,582,000,000 
in advance appropriations for fiscal year 2025. The Fiscal 
Responsibility Act also provided $24,455,000,000 in advance 
appropriations for the Toxic Exposures Fund for fiscal year 
2025, including $21,454,542,000 for veterans' medical care. The 
combined total appropriated by this Act and the Fiscal 
Responsibility Act is $134,036,542,000 for medical care for 
fiscal year 2025, as requested.
    In fiscal year 2024, VA will collect an estimated 
$3,991,000,000 in the Medical Care Collections Fund.
    The Committee provides $938,000,000 for Medical and 
Prosthetic Research for fiscal year 2024, equal to the 
requested level.
    The Committee provides $112,582,000,000 in advance for 
fiscal year 2025, equal to the budget request.
    Ambulance Services.--The Committee recognizes the critical 
value of Special Modes of Transportation but is concerned the 
change in rates that VA pays may jeopardize access to ambulance 
services. The Committee directs VA to expeditiously contract 
with providers of special modes of transportation at fair and 
appropriate reimbursement rates to provide certainty about 
payments and ensure the availability of ambulance services.
    Beneficiary Travel.--The Committee continues to hear from 
veterans frustrated with the system and the inability of VA 
staff to assist them. The Department is directed to ensure the 
new system is user-friendly and staff are trained and available 
to provide the required assistance.
    Dispute Resolution.--The Committee urges VA to ensure that 
veterans are advised of their rights to contest VA billing 
charges and determinations and of the step-by-step process for 
disputes. VA should ensure this information is available online 
and in publicly accessible areas at each VA medical center, and 
that it is made available in English, Spanish, and the eight 
other most commonly spoken languages in the United States per 
current laws (P.L. 117-62).
    Essential Medical Products.--The United States' 
manufacturing capacity for essential medical products is at 
serious risk due to organized efforts by Chinese manufacturers 
to enter the U.S. market in response to inflationary pressures 
faced by U.S.-based manufacturers, distributors, and providers. 
The current shift toward purchasing Chinese-made health care 
supplies is drastic and occurring at a pace that will leave 
U.S. hospitals dependent on Chinese supplied products. The 
Committee strongly urges the Department to address this issue 
and prioritize purchasing decisions that support domestic-based 
manufacturing for critical healthcare products required for VA 
medical facility operations, such as those that supply medical 
supplies like needles and syringes. The Committee strongly 
supports efforts to protect national security and vulnerable 
domestic supply chains for critical industries, like medical 
supplies. The Committee requests the Department provide a 
report, no later than 90 days after the enactment of this Act, 
on efforts to strengthen the VA's medical facilities supply 
chain with U.S. domestically produced products. Specifically, 
the Department should report on any cross-agency efforts it is 
involved in to shore up the domestic supply of essential 
medical products and steps taken to expand VA's use of 
domestically produced essential medical products.
    Vet Centers.--The Committee directs VA to ensure that Vet 
Centers have data on eligible veterans in their service areas 
so that they can tailor their outreach activities and veterans 
are aware of available services.
    Veterans Enrollment in Medicare.--The Committee is aware 
that information gaps exist for some veterans related to the 
differences between the hospital care and medical services 
available in the VA system versus coverage provided under 
Medicare. The Committee encourages VA to work with the 
Department of Health and Human Services to ensure that veterans 
have complete information regarding the differences between the 
VA system and Medicare coverage, including for prescription 
drugs.
    VHA Phone Operations.--The Committee encourages VA to 
improve its phone operations to ensure communications between 
major regional VA Medical Centers and community based 
outpatient clinics (CBOC) route veterans' calls to their local 
CBOC, as appropriate.

                            MEDICAL SERVICES

 
 
 
Fiscal year 2023 enacted level........................   $70,584,116,000
Fiscal year 2024 enacted level........................    74,004,000,000
Fiscal year 2024 budget year request..................             - - -
Committee 2024 budget year recommendation.............             - - -
Fiscal year 2025 advance appropriation request........    71,000,000,000
Committee 2025 advance appropriation recommendation...    71,000,000,000
Comparison with:
    Fiscal year 2024 enacted level....................    -3,004,000,000
    Fiscal year 2025 advanced budget request..........             - - -
 

    The bill includes $71,000,000,000 for advance fiscal year 
2025 funding. The Committee has included bill language to make 
$2,000,000,000 of the Medical Services advance appropriation 
for fiscal year 2025 available through September 30, 2026.
    Allocation of Health Funding.--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.
    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.

                        CANCER AND RARE DISEASES

    Cancer Screening at Veterans Affairs Medical Centers.--The 
Department is encouraged to ensure its healthcare providers 
screen for the numerous types of cancers that veterans 
experience so they can receive the best possible care.
    Creutzfeldt-Jakob Disease (CJD) Monitoring.--The Committee 
continues to urge VA to utilize reference data from existing 
medical records of veterans to determine the percentage of 
veterans who have more frequent or unexplained symptoms 
associated with CJD compared to the civilian population. This 
data could be helpful in clarifying the extent and specifics of 
the medical issues suffered by veterans because of CJD.
    Dermatological Care for Veterans.--The Committee recognizes 
that veterans may have experienced large amounts of ultraviolet 
radiation during their service in the military and have an 
increased risk of skin cancer. Recent studies, including those 
by the National Institutes of Health and as reported in the 
Journal of the American Academy of Dermatology, compared the 
rates of skin cancer among military and veteran populations to 
nonmilitary populations in the United States, finding members 
of the military and veterans may have higher incidence of skin 
cancer. As such, the Committee directs the department to 
provide a report no later than 180 days after the enactment of 
this Act regarding the Department's approach to skin cancer, 
its views on recent studies, and on veterans' access to 
dermatology screening, dermatologists, and trained Mohs 
micrographic surgeons.
    Lung Precision Oncology Program.--The Committee notes with 
approval the launch of the VA's Lung Precision Oncology Program 
and its effort to expand access to lung cancer screening for 
veterans and accelerate the science on lung cancer prevention, 
detection, and treatment. The Committee provides $14,000,000 
for this program, as requested.
    Molecular Diagnostics and Precision Oncology.--The 
Committee recommendation includes $215,433,000 for Precision 
Oncology, an increase of $48,206,000 above the fiscal year 2023 
enacted level; as well as $30,300,000 for Molecular 
Diagnostics, as requested, to accelerate the adoption of 
molecular diagnostics for additional cancers, including rare 
cancers and hematopoietic cancers.
    VA is encouraged to continue to provide information to 
clinicians on the value of using molecular diagnostics for 
cancer patients and on how to contribute tissue specimens to a 
repository started among the Department, Department of Defense, 
and the National Institutes of Health. The Committee requests 
an update, 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.

                       CAREGIVER SUPPORT PROGRAM

    Caregivers Program.--The Committee provides $2,422,410,000, 
as requested, for the caregivers program. The Committee 
continues to require quarterly reporting on obligations for 
this program.

                         CENTERS OF EXCELLENCE

    Epilepsy Center of Excellence.--The Committee encourages 
the Department to ensure that all veterans with epilepsy are 
comprehensively evaluated at a VHA Epilepsy Center of 
Excellence to identify drug-resistant epilepsy patients who may 
be candidates for FDA-approved non-drug therapies.
    Neurology Centers of Excellence.--The Committee recognizes 
the increasing number of veterans affected by neurologic 
conditions, including epilepsy, headache, multiple sclerosis, 
and Parkinson's disease. The Neurology Centers of Excellence 
provide essential innovative clinical care, education, and 
research efforts focused on these conditions. The Committee 
encourages further investment and collaboration of the Centers 
across disciplines and includes the requested $59,540,000 for 
Neurology Centers of Excellence. This includes $23,590,000 for 
epilepsy; $21,000,000 for headache; $10,330,000 for 
Parkinson's; and $4,620,000 for multiple sclerosis.

                    COLLABORATIONS AND PARTNERSHIPS

    Academic Collaborations at Community Based Outpatient 
Clinics (CBOC).--The Committee encourages VA to expand academic 
collaborations with CBOCs, as they provide valuable patient 
care and access to services that can be strengthened by 
collaboration with educational institutions. Through clinical 
traineeships and research fellowships, emerging health 
professionals can gain a better understanding of veterans' 
specific healthcare needs, improve patient outcomes, advance 
specialized research, and increase the talented workforce 
pipeline. VA is encouraged to consider including public 
academic medical centers in CBOC collaborations.
    Partnerships.--The Committee commends the efforts of 
private organizations to support veterans and recognizes that 
they can sometimes provide services, such as counseling and 
wellness programs, for the families of veterans that the 
Department cannot. Recognizing that Congress, the Department, 
and private organizations share the same goal of supporting 
veterans, the Committee directs the Department to build upon 
its existing partnerships and seek opportunities to establish 
new ones and provides up to $5,000,000 for this purpose. The 
Committee is specifically interested in partnerships focused on 
providing mental health care, including the mental health of 
veterans' families, and requests a report on the Department's 
current partnership activities within 90 days of enactment of 
this Act. The report should identify types of partnerships and 
their best practices and the opportunities, barriers, and cost 
of expanding them. It also should include an analysis of 
potential and innovative options to simplify the process for 
veterans seeking mental health care, such as through 
modifications to referral requirements, technologies to ease 
scheduling, and the use of telemedicine.
    Strategic Collaboration.--The Committee encourages the 
Department to engage with potential partners, including through 
lease agreements, to modernize and provide increased access to 
veterans services, especially in areas with many veterans where 
VA cannot meet demand.

                              DENTAL CARE

    Dental Care.--The recommendation includes $2,573,291,000, 
as requested, to provide dental care for veterans. The 
Committee requests that the fiscal year 2025 budget 
justification include information on the role, resources, and 
staffing required for the Assistant Under Secretary of Health 
for Dentistry and the Office of Dentistry.
    Dental Care Report.--The Committee understands that 
veterans may experience a large oral disease burden, and 
therefore an integrated and whole-person approach is needed to 
prevent and manage oral disease in this population. The 
Committee urges the Department to offer robust dental 
healthcare services to veterans and requests a report within 
180 days of enactment of this Act assessing the state of the 
Department's oral healthcare program and its ability to 
adequately meet current and future needs. The report should 
include an assessment of the Department's infrastructure 
serving the oral health needs of veterans enrolled in VA 
healthcare and the additional infrastructure that would be 
needed if eligibility were expanded.

                             DIABETES CARE

    Diabetic Foot Ulcers.--The Committee continues to be 
concerned about diabetic foot and related limb loss among 
veterans. Based upon the September 2022 report entitled 
``Report to Congress on Remote Patient Diabetes Foot Ulcer 
Monitoring,'' which details disparate outcomes due to disparate 
training provided to VA clinicians, within 30 days of enactment 
of the Act, the Committee requests the Department provide a 
report detailing its plan for ensuring that all VA employees 
utilizing remote temperature monitoring are receiving the 
training necessary to ensure optimal outcomes.

                 EMERGING AND NOTABLE HEALTHCARE ISSUES

    Air Filtration Equipment and Technologies.--The Committee 
appreciates the Department's review of its air filtration 
standards; encourages it to exceed industry standards on 
single-pass air and levels of air filtration; and urges it to 
continue to research, evaluate, and implement new technologies, 
including commercial off-the-shelf technologies.
    Central Line Associated Blood Stream Infections 
(CLABSIs).--The Committee is aware of the reported 31 percent 
increase in (CLABSI) rates in acute care facilities during the 
coronavirus pandemic. The Department is urged to enhance and 
sustain conventional infection prevention and control 
strategies to reduce this significant increase in CLASBIs and 
any other hospital-associated infections. The Committee 
requests the fiscal year 2025 budget request include a detailed 
plan that describes the steps accomplished and planned to 
reduce the rate of CLASBIs and other hospital-associated 
infections.
    Dialysis.--Understanding that some dialysis services are 
provided through community providers under nation-wide 
contracts when the care cannot be provided directly, the 
Committee expects the Department to ensure veterans receive the 
highest quality care and access to care and looks forward to 
receiving the report requested in P.L. 117-328.
    Marriage and Family Therapists.--The Committee urges VA to 
improve access to marriage and family therapists and to ensure 
that there are no unnecessary barriers to increasing the 
Department's capacity to serve veterans seeking this care.
    Needle Stick Injuries (NSI).--The Committee requests a 
report within 90 days of enactment of this Act regarding 
options to reduce or eliminate (NSIs) among clinicians, 
including the use of electronic digital needle destruction 
technology, as well as potential time and cost savings 
associated with the options.
    Nuclear Medicine Quality Improvements.--The Committee notes 
the Nuclear Regulatory Commission's (NRC) commencement of a 
rulemaking to require reporting of some nuclear medicine 
extravasations and acknowledges that significant nuclear 
medicine extravasations can cause patient injury. The Committee 
requests a report, not later than 180 days after enactment of 
this Act, regarding VA implementation of new NRC regulatory 
requirements, including any requirements related to the 
monitoring of injection quality, image extravasations, 
dosimetry, and patient notification.
    Pressure Injuries.--The Committee supports the development 
and use of an evidence-based standard of care for pressure 
injury prevention and treatment and encourages VA to update 
recommendations and guidelines to ensure they are consistent 
with current evidence from a variety of relevant sources, such 
as the 2019 International Guidelines and the newly revised 
SPIPP Checklist (version 2.0).
    Produce Prescription Program.--The Committee is concerned 
with food insecurity among the veteran population and provides 
up to $2,000,000 for the Office of Nutrition & Food Services to 
work with clinicians to create and test delivery and coverage 
work streams to facilitate integration, such as produce 
prescription service delivery. Within one year of enactment of 
this Act, the Department is directed to provide a report on 
this effort to include metrics that can be used to measure 
value, including appropriate health outcomes, and the 
feasibility and advisability of expanding produce prescriptions 
to all veterans.
    Rideshare Program.--The Committee recognizes the success of 
VA's temporary rideshare authority and is interested in 
expanding transportation services for veterans. As such, the 
Committee requests a report not later than 120 days after 
enactment of this Act assessing the feasibility of establishing 
a national VA Rideshare Program. The report should include the 
following: (1) an analysis of the impact of the VA Rideshare 
Program on eligible veterans from August 2021 to April 2023; 
(2) an assessment of the availability and cost of 
transportation required to support stability and health of 
eligible veterans, which includes transportation to 
appointments with service providers, conducting housing and 
employment searches, and obtaining food and supplies; (3) any 
plan of the Secretary to expand the ability for veteran 
homelessness programs to assist with transportation needs of 
eligible veterans; (4) an assessment of the feasibility of 
establishing a national VA Rideshare Program; (5) a 
determination of the direct or indirect costs to the Department 
that would arise from the establishment of such a program; and 
(6) any other element the Secretary determines appropriate.
    Stellate Ganglion Block Therapy.--The Committee encourages 
the Department to make stellate ganglion block therapy 
available as a first-line treatment at VA medical facilities, 
as appropriate.
    Veterans Transportation.--The Committee supports the 
Department's programs that provide veterans with transportation 
to VA medical facilities and make it easier for veterans to 
receive medical care and encourages VA to explore options to 
strengthen and sustain the Volunteer Transportation Network, 
such as increased funding to recruit and retain drivers and 
provide vehicle maintenance.

                        HEALTHCARE TECHNOLOGIES

    Bioelectronic Medicine for Veterans.--The Committee 
recognizes that Bioelectronic Medicine has the potential to 
harness the body's electrical signaling to advance treatments 
that save lives and lower medical expenditures. Accelerating 
studies, additional data collection, and the development and 
adoption of novel applications for Bioelectronic Medicine 
combined with machine learning and artificial intelligence (AI) 
can address challenging and expensive diseases by personalizing 
treatments and improving therapy delivery. The Committee 
encourages the Department to ensure that combined Bioelectronic 
Medicine and AI technologies are available to veterans.
    Early Detection Diagnostics.--The Committee encourages VA 
to consider all options to better incorporate available early 
detection diagnostics into veterans' care. The Committee looks 
forward to the report required by House Report 117-391 on how 
it is incorporating early detection diagnostics into veterans' 
care and areas for potential improvement.
    Focused Ultrasound Therapy.--The Committee understands 
focused ultrasound is a non-invasive, non-pharmacological, 
safe, and cost-effective alternative or complement to 
conventional surgery, radiation therapy, or drug-based 
treatments and encourages the Department to ensure it is 
available to veterans to the extent practicable.
    Medical Image Exchange.--The Committee supports the use of 
modern medical image exchange software and notes that most VA 
facilities have deployed a modern software solution that 
supports bi-directional exchange of diagnostic quality medical 
images between VA facilities and with community providers, 
without requiring secondary storage of veterans' images. The 
Committee encourages the Department to ensure software 
solutions like this are available in the new Electronic Health 
Record system and the VA Enterprise Cloud.
    Migraine Prevention and Treatment.--The Committee 
recognizes approximately one in three servicemembers experience 
severe headaches and migraines and encourages the Department to 
ensure neuromodulation devices with FDA-indication for migraine 
prevention and treatment are available to veterans and to 
educate clinicians and veterans on such devices.
    Respiratory Illness.--The Committee is aware of emerging 
technology that uses existing x-ray imaging equipment to derive 
four-dimensional models of lung function, which helps to 
identify respiratory illnesses and accompanying loss of lung 
function earlier than was previously feasible. The Committee 
requests a report, no later than 180 days after enactment of 
this Act, on the potential efficacy of using a four-dimensional 
functional lung scan to triage veterans with unexplained 
shortness of breath following deployment.

                      HOMELESS ASSISTANCE PROGRAMS

    The Committee provides $3,111,148,000 for VA homeless 
assistance programs, an increase of $240,589,000 above the 
fiscal year 2023 enacted level and equal to the budget request. 
An estimated $9,522,772,000 is provided for homeless veterans 
treatment costs, an increase of $173,873,000 above the fiscal 
year 2023 level.
    Programs to assist homeless veterans include the Homeless 
Providers Grant and Per Diem (GPD), Health Care for Homeless 
Veterans (HCHV), the Domiciliary Care for Homeless Veterans, 
the Supportive Services for Low Income Veterans and Families 
(SSVF), Veterans Justice Outreach Homeless Prevention (VJO), 
Compensated Work Therapy, and the Department of Housing and 
Urban Development-Department of Veterans Affairs Supported 
Housing (HUD-VASH) programs.
    Healthcare for Homeless Veterans.--The Committee notes the 
benefits of the Homeless Patient Aligned Care Team (HPACT) 
program and encourages VA to expand this program to additional 
sites, including rural areas, and to consider additional 
services to improve the program. The Committee directs the 
Department to explore options to expand this program to 
additional sites, including cost estimates, with its fiscal 
year 2025 budget request.
    Homeless Veterans in the Southwest.--The Committee 
continues to direct VA to work with HUD to develop strategies 
and recommendations for addressing veteran homelessness in the 
Southwest and to take into account undercounted veterans when 
awarding HUD-VASH vouchers. The Committee appreciates VA's 
efforts to implement strategies to decrease veteran 
homelessness in the Southwest and requests an updated report 
within 60 days of enactment of this Act on its efforts.
    HUD-VASH.--The Committee recognizes the value and positive 
effects of HUD-VASH program. 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.
    Legal Assistance for Veterans.--The Committee continues to 
support the Veterans Justice Outreach and the Legal Services 
for Veterans programs and provides $109,721,000 for these 
programs, as requested.
    Recovery-Oriented Care.--The Committee notes the National 
Center for Homelessness Among Veterans' development of housing 
models that promote recovery-oriented care for veterans 
experiencing or at risk of homelessness. The Committee requests 
that not later than 180 days after enactment of this Act the 
Department provide a report on the effectiveness of recovery-
oriented care housing programs, including a review of the 
barriers that homeless veterans face when attempting to secure 
permanent housing.
    Supportive Housing for Veterans with Serious Mental 
Illness.--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.
    Supportive Services for Veterans Families and Inflation.--
To meet the rising costs of goods and help veterans achieve 
financial stability and access to services, the Committee 
requests a report on cost, feasibility, and advisability of 
increasing the cap on Tenant Incentives and allowance for car 
repairs, as well as expanding the circumstances in which car 
repairs are an eligible program expense. In addition, the 
Department is encouraged to ensure it has a consistent and 
understandable policy regarding covered costs for pet deposits/
rent, utility deposits, car repairs, and childcare.
    Supportive Services for Veteran Families and Legal 
Services.--The Committee continues to encourage the SSVF 
program to work with grantees to expand their legal service 
offerings, particularly in rural areas where access to private 
legal assistance can be limited. The Department is encouraged 
to partner SSVF grantees with university law schools in rural 
areas or within underserved populations to enhance legal 
assistance to veterans.
    Tiny Homes.--The Committee notes the success of the tiny 
home village model by multiple veterans service organizations 
(VSOs) and encourages VA, in coordination with the Department 
of Housing and Urban Development to support this work and 
facilitate the creation of additional villages of tiny homes 
villages within VA's existing GPD program. Not later than one 
year after the date of the enactment of this Act, the Committee 
requests a report comparing the outcomes of grantees under 
current GPD programs to the outcomes of existing VSO operated 
tiny homes villages that contain individual homes and a 
community center with supportive services. This report should 
compare: (1) the amount of time a veteran stayed in a tiny home 
village compared to a similar GPD facility; (2) the percentage 
of veterans who exit a tiny home village compared to a similar 
GPD facility; (3) the percentage of veterans who exit the tiny 
homes village with competitive employment compared to a similar 
GPD facility; (4) the percentage of veterans who have a 
negative exit from the tiny homes village compared to a similar 
GPD facility; and (5) other matters, as appropriate.

              INTIMATE PARTNER VIOLENCE ASSISTANCE PROGRAM

    Intimate Partner Violence (IPV) Program.--The Committee 
continues to support VA's efforts to expand its IPV program, 
which provides a holistic approach that involves understanding, 
recognizing and responding to the effects of all types of 
trauma, with the ultimate goals to end violence, prevent 
further violence, and promote healthy relationships.

                         MENTAL HEALTH PROGRAMS

    The Committee provides $16,587,825,000 for mental health 
programs. Of the total, $3,552,888,000 is for suicide 
prevention and treatment programs, including $558,794,000 for 
suicide prevention outreach, of which $300,500,000 is for the 
Veterans Crisis Line.
    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.
    AANHPI Veterans.--The Committee understands that Asian 
American, Native Hawaiian, and Pacific Islander (AANHPI) 
veterans have a lower use of VA and non-VA mental health 
services and requests a report Committee not later 180 days 
after enactment of this Act on a plan to improve access of 
AANHPI veterans to mental health care and increase outreach, 
especially for those in harder-to-reach populations, including 
rural communities and English-as-a-second-language households.
    Agritherapy.--The Committee supports efforts to train 
veterans in agricultural vocations, while also tending to 
behavioral and mental health needs with behavioral healthcare 
services and treatments from licensed providers. The Department 
is urged to consider including agritherapy as a Complementary 
and Alternative Medicine therapy.
    Cognitive Behavioral Therapy Virtual Care.--To meet the 
growing demand for telehealth or virtual mental healthcare, the 
Committee encourages VA to provide veterans access to virtual 
cognitive behavioral therapy. The Committee directs VA to 
provide a report, not later than 90 days after enactment of 
this Act, on the status of efforts to utilize solutions and 
partners in the delivery of mental health services virtually 
and how to make these solutions more accessible to patients.
    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. VA is encouraged to ensure access to pharmacogenomic 
tests in the treatment of depression if the tests have been 
shown to improve health outcomes of veterans in clinical 
trials.
    Law Enforcement Liaison.--The Committee appreciates VA's 
past efforts 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.
    Mental Health Screening at Veterans Affairs Medical 
Centers.--The Department is encouraged to ensure its healthcare 
providers screen for the numerous types of mental health issues 
that veterans experience so they can receive the best possible 
care.
    Military Sexual Assault.--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.
    Modeling and Simulation Treatment of PTSD.--The Committee 
is aware that 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 
and provide a report within 90 days of enactment of this Act 
regarding the results of the study.
    Non-Citizen Veteran Outreach.--The Committee is concerned 
about the level of awareness regarding mental health services 
among at-risk, non-citizen veterans. The Committee urges VA to 
conduct outreach targeting this group of veterans to offer 
mental health and other early intervention services, drug and 
alcohol services, and mental health counseling.
    Veterans Crisis Line (VCL).--The Committee provides funding 
to support the VCL, as requested, and continues to monitor the 
VCL to ensure veterans are receiving appropriate clinical care. 
To support this critical care, the Committee encourages VA to 
utilize funds provided by the bill to ensure appropriate 
staffing for call centers and back-up centers, provide 
necessary training for VCL staff, and ensure that staff are 
able to appropriately and effectively respond to the needs of 
veterans. 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.

                MILITARY TOXIC EXPOSURE RESEARCH PROGRAM

    The bill includes $68,012,000, as requested, for research 
on military environmental exposures. The Committee supports 
efforts to improve diagnosis and treatment of conditions 
resulting from toxic exposures and appreciates the work of the 
Health Outcomes Military Exposures (HOME) program, the Office 
of Research and Development, and other VA program offices to 
increase attention to this issue.
    The Committee encourages the Department to continue 
research on the effects of and treatments for veterans exposed 
to toxins, such as Agent Orange, open burn pits, PFAS, 
radiation, and asbestos, during the course of their active-duty 
service. The Committee also urges the Department to utilize 
reference data from existing medical records to determine how 
veterans who served in areas where toxins were dispersed may 
have more frequent or unexplained diseases compared to the 
civilian population.
    Airborne Hazards and Burn Pits Center of Excellence.--The 
Committee provides $15,000,000 and continues to support the 
Airborne Hazards and Burn Pits Center of Excellence on 
diagnoses, mitigation, and treatment of conditions related to 
airborne hazards and burn pits.
    Use of Burn Pits During the Vietnam War.--The Committee 
notes that burn-barrel latrines and burn pits were used in many 
base camps, fire bases, and landing zones in Southeast Asia 
during the Vietnam War, and that exposure at that time may be 
causing or contributing to chronic conditions that adversely 
affect the health and wellness today of veterans of that era. 
The Committee requests the Government Accountability Office 
report on the health outcomes, including an assessment of the 
data available, of veterans exposed to burn pits and other 
related sites during the Vietnam War.
    PFAS Research.--The Committee is concerned about the effect 
of PFAS at military bases on servicemembers, their families, 
and surrounding communities, and recognizes that the effects of 
PFAS exposure may continue for servicemembers once they are 
under the care of VA. The Committee continues to direct VA to 
collaborate with the Department of Defense PFAS Task Force, 
academia, and other health institutions and agencies to monitor 
research activities, results, and publications on the health 
effects from PFAS.
    Service-Connected Colorectal Cancer.--The Committee is 
aware that colorectal cancer is a common cancer diagnosis among 
veterans and directs the Department to submit a report, no 
later than 180 days after enactment of the Act, on colorectal 
cancer among veterans and the potential effect of exposures to 
burn pits and other environmental hazards during military 
service on incidence rates.
    War Related Illness and Injury Study Center Expansion.--
Research and clinical trials are needed to develop effective 
treatments for veterans exposed to toxic environmental hazards, 
and the VA Research Advisory Committee has recommended the 
establishment of Centers of Excellence to facilitate the 
development and availability of new treatments in clinical 
settings. However, the effects of toxic exposure may manifest 
differently between men and women. The Committee is encouraged 
by the work of the War Related Illness and Injury Study Center 
(WRIISC)--Women's Operational Military Exposure Network (WOMEN) 
to meet the unique needs of women veterans. However, with only 
one physical center in California, the Committee is concerned 
that toxic-exposed women veterans who live and seek care in 
other regions may not have equal access to the Center's unique 
resources. The Committee directs the Department to report on 
the feasibility, including cost estimates, of establishing a 
new WRIISC-WOMEN within 60 days of enactment of this Act.

                OPIOID PREVENTION AND TREATMENT PROGRAM

    The bill includes $715,356,000 for opioid treatment and 
prevention efforts, which is $26,876,000 above the fiscal year 
2023 enacted level. Of the total, $254,478,000 is provided for 
activities authorized by the Comprehensive Addiction and 
Recovery Act of 2016 (P.L. 114-198).

                         PHARMACEUTICAL ISSUES

    Community Pharmacies.--The Committee requests a report, 
within 120 days of enactment of this Act, on the feasibility 
and advisability of expanding the use of community pharmacies, 
including an assessment of cost, veteran access, and effect on 
rural delivery.
    Drug Pricing Report.--The Committee remains interested in 
information regarding VA drug pricing and appreciates VA 
providing a report as requested in previous fiscal years on 
VA's spending on prescription drugs. The Committee encourages 
VA to conduct this analysis annually and requests robust and 
routine updates to Congress, including updated information for 
fiscal year 2024 on prescription drug prices (net of rebates) 
paid by VA for the ten most frequently prescribed drugs and the 
ten highest-cost drugs for VA. In addition, the report should 
include total annual costs to VA for all prescription drugs. As 
VA has noted that country of origin information on drugs and 
active pharmaceutical ingredients is not yet available on a 
national level, the Committee urges the VA's National 
Acquisition Center to work with the Food and Drug 
Administration to track this data and establish a national 
database for such information.
    Medication Optimization for Veterans.--The Committee 
commends VA's work to implement a National Pharmacogenomics 
Program to ensure all eligible veterans have access to 
appropriate, evidenced-based pharmacogenomic testing, and that 
VA has a robust and highly trained healthcare professional 
workforce to help veterans who have undergone pharmacogenomic 
testing. The Committee provides $35,616,000, as requested, for 
this work.
    Pharmaceutical On-dose Tracking and Tracing Technologies.--
The Committee is committed to providing veterans safe and 
reliable medication. Track and trace systems are increasingly 
being implemented as a technological solution to secure 
pharmaceutical supply chains. These systems offer the potential 
to minimize reimbursement fraud, facilitate fast market 
recalls, and help identify medicine shortages. The Committee 
looks forward to receiving the report requested in House Report 
117-391, especially regarding solutions to prevent counterfeit 
medicines from entering the VA supply chain.
    Weight Loss and Weight Management Tools.--The Committee is 
aware of growing interest in the use of FDA-approved 
pharmaceuticals that help veterans lose and manage weight, 
which can help them prevent disease, manage chronic and co-
morbid conditions, and improve their quality of life. The 
Committee encourages the Department to review its clinical 
practice guidelines and other criteria for use to ensure 
veterans have access to evidence-based weight management 
interventions and provide a report within 60 days of enactment 
of this Act regarding its current approach to weight management 
and plans to review and update its clinical practice 
guidelines.

                  POST-TRAUMATIC STRESS DISORDER CARE

    Hyperbaric Oxygen Therapy.--The Committee encourages the 
Department to provide hyperbaric oxygen treatment to veterans 
suffering from chronic post-traumatic stress disorder, as 
appropriate.
    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 $42,000,000 for the Center, as 
requested.
    New Treatments for PTSD.--The Committee is aware of 
privately funded research regarding potential new treatments 
for PTSD and encourages the Department to monitor these efforts 
and review the results of existing and future clinical trials. 
The Committee requests a detailed report within 30 days of 
enactment of this Act regarding VA activities, including 
investigators and facilites, participating in this research 
and, within 120 days of enactment of this Act, an assessment of 
any potential therapeutic value and potential risk of new 
treatments.
    Service Dogs for Veterans' Mental Health.--The Committee 
recognizes the positive role that service, guide, and hearing 
dogs have played in mitigating veterans' disabilities and 
providing assistance and rehabilitation. The Committee is 
encouraged that a pilot program created by the PAWS Act of 2021 
is underway at VA medical centers, which will assess the 
potential therapeutic effectiveness of service dogs in the 
treatment of PTSD. The Committee encourages VA to expand the 
number of pilot sites to include medical centers that primarily 
serve veterans in rural areas and in states with few VA medical 
facilities.
    Women Veterans Network.--The Committee continues to support 
the role of Women Veterans Network (WoVeN), a national peer 
support network for women veterans managed by the National 
Center for PTSD--Women's Health Sciences Division, and provides 
up to $3,000,000 for peer support programs for women veterans.

                              RURAL HEALTH

    Office of Rural Health.--The bill includes $337,455,000 for 
rural health, which is equal to the budget request, to improve 
access and quality of care for the more than 3,000,000 enrolled 
veterans residing in rural and highly rural areas.
    Office of Rural Health Operating Plan.--The Committee 
directs the Office of Rural Health to submit no later than 30 
days after enactment of this Act an operating plan for fiscal 
year 2024 funding, as well as for the fiscal year 2025 funding 
provided in advance by this Act.
    Rural Access Network for Growth Enhancement (RANGE).--The 
RANGE Program provides case management and treatment services 
to mentally ill veterans in rural areas. The bill includes 
sufficient funding to maintain the three new centers of the 
RANGE Program, as authorized by the Sgt. Ketchum Rural Veterans 
Mental Health Act of 2021 (P.L. 117-21).
    Transportation Challenges.--The Committee recognizes the 
transportation challenges and barriers to care that rural and 
remote veterans face and directs the Office of Rural Health to 
increase efforts to improve transportation mobility for 
veterans and to allocate funding to enhance rural access and 
transportation services.

                      SUBSTANCE USE DISORDER CARE

    The bill includes $230,947,000 for Substance-Use Disorder 
(SUD) efforts to ensure veterans can receive timely SUD 
specialty services.
    Jason Simcakoski Memorial and PROMISE Act Implementation.--
The Committee supports the continued implementation of the 
Jason Simcakoski Memorial and Promise Act, 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.
    Medication-Assisted Treatments.--The Committee encourages 
VA to increase education among its primary care practitioners 
on the diagnosis and treatment of alcohol use disorders with 
FDA-approved medication-assisted treatments and counseling, as 
clinically indicated.
    Substance Use Disorder Screening.--The Committee recommends 
that all veterans seeking treatment services in a VA facility 
be screened for SUD, using evidence-based assessment tools.
    Substance Abuse Education and Outreach.--The Committee 
recognizes the importance of intervention and support programs 
for at-risk veterans and their families that offer confidential 
education information that can reduce substance use, relapse, 
hospital visits and suicide, and continues to support internet-
based substance abuse education and outreach.

                           SUICIDE PREVENTION

    Lethal Means Safety Collaboration.--The Committee notes 
that VA has been called to partner with the Departments of 
Defense, Health and Human Services, Homeland Security, Justice, 
and the Office of Emergency Medical Services within the 
Department of Transportation to create and implement a 
coordinated approach for improving lethal means safety. The 
Committee looks forward to the report required by House Report 
117-391 on this coordinated approach and VA's plans to 
incorporate the coordinated approach into the Department's 
existing lethal means safety initiatives.
    Lethal Means Safety Training.--To ensure that every 
employee who regularly interacts with veterans is prepared to 
have a conversation that could save a veteran's life, the 
Committee continues to urge VA to implement mandatory lethal 
means safety trainings for all VA employees who regularly 
interact with veterans in their work, compensation and pension 
examiners, employees of Veterans Centers and vocational 
rehabilitation facilities, community care providers, and family 
caregivers to the extent practicable.
    Suicide Prevention Coordinators.--The Committee recognizes 
the importance of Suicide Prevention Coordinators, who follow 
up with and coordinate care for veterans who have been directly 
referred to them by responders at the Veterans Crisis Line, and 
directs VA to fully staff suicide prevention coordinator 
positions.
    Zero Suicide Initiative.--The Committee recognizes the 
value of innovative, systems-focused efforts to combat veteran 
suicide across the country and notes the use of the Zero 
Suicide model across various healthcare systems and through the 
Department of Health and Human Services. The Committee directs 
VA to evaluate, in consultation with experts and VSOs, the 
feasibility and advisability of implementing a Zero Suicide 
initiative. Within 180 days of the enactment of this Act, the 
Department is directed to submit a report, including 
recommendations for incorporating the Zero Suicide model in VA 
suicide prevention programming.

                     TELEHEALTH AND CONNECTED CARE

    The bill includes $5,165,336,000 for teleheath and 
connected care, which includes home telehealth, home telehealth 
prosthetics, and clinic-based telehealth.
    The Committee directs VA to continue to expand telehealth 
availability, including the facilitation of public private 
partnerships, to include additional mental health, primary 
care, and rehabilitation services as a means to deliver care in 
rural and underserved communities.
    VA is encouraged to leverage newly gained telehealth 
capacity to address backlogs for disability exams and 
healthcare appointments when appropriate. The Committee further 
directs VA to continue to implement plans to improve veteran 
and provider satisfaction, increase awareness of the telehealth 
program, and enhance adoption of telehealth by veterans and 
providers.

                              WHOLE HEALTH

    The Committee recommendation includes $107,848,000 for 
Whole Health, as requested, which is $21,997,000 above the 
fiscal year 2023 enacted level. The Committee supports the 
Whole Health model of care and the expansion of Whole Health to 
all VA facilities.
    Adaptive Sports.--As requested, the bill provides 
$30,414,000 for National Veterans Sports Programs, including 
$16,000,000 for adaptive sports programs and up to $5,000,000 
equine therapy.
    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 
and provides up to $5,000,000 to do so.
    Nutrition and Food Services.--The Committee encourages the 
Department to work with the Centers for Disease Control to 
implement the Food Service Guidelines for Federal Facilities 
and to expand its plant-based menu options. The Committee 
requests within two years of the date of enactment of this Act 
a report that includes an assessment of how VA's food 
purchasing and food service practices align with the Food 
Service Guidelines and recommendations for changes to 
procurement or other laws that would facilitate ongoing 
implementation of the Food Service Guidelines.

                       WOMEN VETERANS HEALTH CARE

    The recommendation includes a total of $1,279,096,000, as 
requested, to meet the estimated need for specific care for 
women veterans and support the Office of Women's Health and 
programmatic efforts, including the childcare initiative. 
Within this amount, VA is encouraged to continue hiring women 
primary care providers and increase the number of peer support 
specialists for women veterans.
    The Committee recognizes women are now the fastest growing 
cohort within the veteran community. The number of women 
veterans using VHA services has more than tripled since 2001, 
growing from 159,810 in 2001 to 627,000 today. The increased 
number of women using VHA services necessitates a greater 
investment of resources to provide and expand VA's specific 
services for women veterans and ensure women veterans' health 
needs, which often differ from men, are met. The Committee 
supports continued efforts to identify and address the unique 
issues experienced by women veterans. VA is directed to 
continue redesigning its women's healthcare delivery system and 
improving its facilities to ensure women receive equitable, 
timely, and high-quality healthcare. The Committee requests an 
expenditure plan no later than 45 days after enactment of this 
Act.
    Breast Cancer Screening Guidelines.--The Committee commends 
VA's decision to offer breast cancer screening and mammography 
to eligible women veterans beginning at age 40. However, the 
Department should offer screening to eligible younger women 
veterans before age 40 if a physician determines it necessary 
or risk factors warrant it. 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.
    Maternal and Infant Health Outcomes for Women Veterans.--
The Committee directs the Department to provide a report within 
180 days of enactment of this Act regarding the incidence of 
birth defects, miscarriage, stillbirth, and maternal morbidity 
and mortality that can be related to military service and 
provide recommendations to raise awareness and improve maternal 
and infant health outcomes.
    Maternity Healthcare and Coordination Programs.--The 
Committee is pleased that to coordinate prenatal and postpartum 
care provided in the community, the Department has established 
maternity healthcare and coordination programs, which have been 
successful in ensuring that veterans can receive high-quality 
care and robust support during and after pregnancy. The 
Committee supports these programs and encourages VA to continue 
to ensure veterans have access to high-quality, well-
coordinated care, and robust services and directs VA to 
continue to implement and fully resource the Protecting Moms 
Who Served Act (P.L. 117-69).

                     WORKFORCE AND STAFFING ISSUES

    Expanding Recruitment.--The Committee recognizes the 
challenge VA has in the recruitment and retention of 
clinicians. To help VA better keep pace with other providers 
and continue to train its workforce to improve their service to 
veterans, the Committee urges VA to explore potential options 
to enhance recruitment and retention, such as expanding 
benefits to relocate to underserved VA medical facilities and 
expanding reimbursement to clinicians for Continuing 
Professional Education, regardless of individual specialty or 
board certification.
    Homeless Veterans Caseworkers.--The Committee requests that 
the Department evaluate staffing needs for caseworkers for 
homeless veterans and veterans at risk of homelessness and 
evaluate the potential benefits and effectiveness of 
contracting for caseworkers in the annual Staffing Report.
    Respiratory Therapists.--The Committee recognizes the 
important role respiratory therapists play as part of care 
teams treating respiratory conditions in veterans and 
encourages the Department to ensure respiratory therapists are 
available where needed. The Committee is concerned there may be 
gaps in coverage of respiratory therapists in VA for veterans 
with certain respiratory conditions, particularly as additional 
veterans become eligible under the PACT Act (P.L. 117-168). The 
Committee requests that the Department evaluate staffing needs 
for respiratory therapists using a validated system and include 
the results in the annual Staffing Report.
    Staffing Report.--The Committee looks forward to the annual 
comprehensive report required by the Joint Explanatory 
Statement accompanying the Consolidated Appropriations Act, 
2022 (P.L. 117-103) on the Department's plan to address 
critical workforce issues.
    VA/HHS Collaboration on Health Workforce Shortages.--The 
Committee continues to encourage VA to work with the Department 
of Health and Human Services (HHS) to explore ways the agencies 
can work together, such as by creating a taskforce, to increase 
the availability of providers, including in the behavioral 
health workforce and among physicians specializing in cancer, 
spinal cord, and neuropsychiatric conditions. This 
collaboration is urged to examine VA's recruitment challenges, 
review programs that could enhance recruitment and retention, 
and to think creatively on how other Federal agencies like HHS 
can identify and address provider shortages. VA also is 
encouraged to consult with the Department of Defense to explore 
recruiting those who have left military service.
    Primary Care Provider Shortages.--The Committee is 
concerned by the growing shortage of primary care providers 
across the VA Health Care system, and therefore directs VA to 
provide a report to the Committees on Appropriations of both 
Houses of Congress within 90 days of enactment of this Act that 
(1) describes the current benchmark for patient-to-primary care 
physician ratio, including what the standard is and how many 
hospitals and clinics fall short of the standard; (2) details 
which VA clinics have seen a 50 percent or greater reduction of 
full time primary care physicians in the previous 15 months; 
and (3) explains how the Department intends to address these 
primary care physician shortages while reducing individual 
clinic dependence on VISN floating staff. The report should 
also include recommendations for legislative or administrative 
action that could support efforts to address this primary care 
physician shortage.

                         MEDICAL COMMUNITY CARE

 
 
 
Fiscal year 2023 enacted level......................     $28,456,659,000
Fiscal year 2024 enacted level......................      33,000,000,000
Fiscal year 2024 budget year request................               - - -
Committee 2024 budget year recommendation...........               - - -
Fiscal year 2025 advance appropriation request......      20,382,000,000
Committee 2025 advance appropriation recommendation.      20,382,000,000
Comparison with:
    Fiscal year 2024 enacted level..................     -12,618,000,000
    Fiscal year 2025 advance budget request.........               - - -
 


        For fiscal year 2025, the Committee recommendation 
includes an advance appropriation of $20,382,000,000, of which 
$2,000,000,000 is available until September 30, 2026.
    Long-Term Care for Veterans with Severe Traumatic Brain 
Injury.--The Committee is encouraged by the Department's 
progress in using agreements with non-VA providers to ensure 
all veterans receive long-term specialty care for severe 
traumatic brain injury in their communities and directs the 
Department to continue entering into such agreements and to 
educate case managers on all tools available to provide 
veterans with long-term specialty care in the community.
    Third-Party Payments and Reimbursements.--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, the 
corrective actions being implemented to address these 
outstanding balances, and the average time for repayment.

                     MEDICAL SUPPORT AND COMPLIANCE

 
 
 
Fiscal year 2023 enacted level........................   $11,073,409,000
Fiscal year 2024 enacted level........................    12,300,000,000
Fiscal year 2024 budget year request..................             - - -
Committee 2024 budget year recommendation.............             - - -
 


 
 
 
Fiscal year 2025 advance appropriation request........    11,800,000,000
Committee 2025 advance appropriation recommendation...    11,800,000,000
Comparison with:
    Fiscal year 2024 enacted level....................      -500,000,000
    Fiscal year 2025 advance budget request...........             - - -
 

    The Committee recommendation includes an advance 
appropriation of $11,800,000,000 for fiscal year 2025 for 
Medical Support and Compliance, of which $350,000,000 shall 
remain available through September 30, 2026.

                           MEDICAL FACILITIES

 
 
 
Fiscal year 2023 enacted level........................    $8,633,816,000
Fiscal year 2024 enacted level........................     8,800,000,000
Fiscal year 2024 budget year request..................             - - -
Committee 2024 budget year recommendation.............             - - -
 


 
 
 
Fiscal year 2025 advance appropriation request........     9,400,000,000
Committee 2025 advance appropriation recommendation...     9,400,000,000
Comparison with:
    Fiscal year 2024 enacted level....................      +600,000,000
    Fiscal year 2025 advance budget request...........             - - -
 

    For fiscal year 2025, the Committee recommendation includes 
an advance appropriation of $9,400,000,000, of which 
$350,000,000 shall remain available until September 30, 2026.
    Community-Based Outpatient Clinic in Alameda Point, 
California.--The Committee is concerned that the Alameda Point 
CBOC remains unbuilt more than a decade after Congress 
authorized this facility in fiscal year 2010 through Public Law 
111-82; and after this project was fully funded by Congress. 
The Committee directs the Department to expeditiously execute 
the lease and commence construction of the CBOC by no later 
than June 30, 2024. The Committee also directs the Department 
to provide monthly reports to the Committees on Appropriations 
on the progress until completion and activation. These reports 
shall include an action plan and timeline of the project and a 
status update on the appropriated funds for the project.
    Community-Based Outpatient Clinic in Bakersfield, 
California.--The Committee remains disappointed that the new 
Bakersfield CBOC remains unbuilt more than a decade after 
Congress authorized this facility in fiscal year 2010 through 
Public Law 111-82. The Committee directs the Secretary to 
expeditiously execute Lease No. 36C10F20L0008 and commence 
construction of the CBOC by no later than September 30, 2023, 
as provided in the lease. Furthermore, the Committee directs 
the Secretary to provide monthly reports to the Committees on 
Appropriations of both Houses of Congress on the CBOC 's 
progress until completion and activation. The bill includes 
section 252 prohibiting the use of funds for monthly payments 
under Lease No. VA10112R0032, including section 11 of the 
lease, that exceeds $223,166.67 unless required for maintenance 
and repairs or improvements related to the form, fit, or 
function of the facility that directly enhances the safety of 
veterans or improves healthcare services.
    Facilities Security and Communication Technology Refresh.--
The Committee encourages the Department to continue security 
and communications technology upgrades at VA facilities to 
ensure the safety of veterans, visitors, and employees. The 
Committee recommends that VA take a holistic approach and 
continue efforts to deploy proven technologies that can provide 
actionable, real-time data and communications to improve 
safety.
    Facility Transformations.--The Committee urges VA to 
continue efforts to keep up with a growing population of women 
veterans who deserve equitable access to medical care. 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.
    Medical Center Services.--The Committee reminds the 
Department to ensure it consults with a wide variety of 
stakeholders regarding any changes to services, hours, and 
staffing prior to making changes and to ensure veterans are not 
negatively affected.
    Richard A. Pittman Community Based Outpatient Clinic, San 
Joaquin County, California.--The Committee believes that an 
estimated 5,724 added daily traffic trips in a congested area 
with key community infrastructure warrants additional traffic 
mitigation measures. The Committee directs the Department to 
take expeditious actions to complete traffic mitigation 
projects associated with this new clinic and encourages it to 
implement all traffic mitigation measures in the first phase of 
opening. The Committee also directs VA to provide quarterly 
reports describing updates and expected timelines for the 
completion of the clinic and implementation of these traffic 
mitigation measures.
    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 
2024 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.
    Use of Autonomous Robots.--The Committee is aware of the 
Department's use of autonomous mobile robots at a growing 
number of VA hospitals and understands there is a potential to 
utilize such technology for certain functions, such as handling 
laboratory, pharmacy, food, linen, waste and other materials. 
The Committee encourages the VA to consider the future use of 
autonomous robots during the planning for new construction or 
modernization of VA hospitals and requests the VA report to the 
Committee not later than 180 days after the enactment of the 
Act on use of robots at VA hospitals, including current use and 
potential benefits expanded use in the future.

                    MEDICAL AND PROSTHETIC RESEARCH

 
 
 
Appropriation, fiscal year 2023.......................      $916,000,000
Budget request, fiscal year 2024......................       938,000,000
Committee recommendation, fiscal year 2024............       938,000,000
    Change from enacted level.........................       +22,000,000
    Change from budget request........................             - - -
 

    The Committee recommendation includes $938,000,000 for 
Medical and Prosthetic Research, available through September 
30, 2025, which is $22,000,000 above the fiscal year 2023 
level. The Committee appreciates the Department's plans to 
focus on critical research areas that include environmental 
exposures, traumatic brain injury, cancer and precision 
oncology, and mental health.
    In addition to this appropriation, resources from other 
sources, including appropriations from the medical care 
accounts, reimbursements from the Department of Defense, grants 
from the National Institutes of Health, private sources, and 
voluntary organizations, support the Department's researchers. 
The total amount estimated available for fiscal year 2024 is 
$1,437,400,000.
    Advanced Platform Technology (APT) Center.--The Committee 
applauds the Department for progress being made to provide 
veterans with new assistive and restorative technologies that 
address sensory, motor, or cognitive deficits, as well as limb 
loss. The APT Center has effectively utilized a partnership 
model to leverage local and national research expertise to 
drive progress in diverse areas including artificial lung 
development, wound healing, and neurally connected sensory 
prosthesis. The Committee continues to support the APT Center's 
efforts.
    Effects of Toxic Exposures on Women Veterans.--The 
Committee recognizes the effects of toxic exposure on women 
veterans, and that the effects of toxic exposure may manifest 
differently between men and women. 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 specific research on women 
veterans is included in these efforts. The Committee also 
encourages that a commensurate number of women veterans 
relative to the total women veteran population are utilized in 
research studies, especially in those pertaining to effects of 
toxic exposure on veterans. The Committee looks forward to 
receiving the report requested in House Report 117-391 on the 
metrics of women veterans participating in trials and 
strategies.
    Endometriosis.--The Committee encourages the Department to 
conduct research into the needs and concerns of women veterans 
with endometriosis and investigate new diagnostic and treatment 
methods.
    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 Department is 
encouraged to make the findings of all research conducted by or 
for the Executive Branch publicly available as soon as possible 
and continue 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,'' as recommended by the Institute of 
Medicine. The Committee appreciates the Department's work to 
strengthen the training of primary, specialty, and mental 
healthcare providers on effective assessment, diagnosis, and 
clinical management of Gulf War Illness.
    Herbicide-Related Toxic Exposure Research.--To understand 
the residual effects of Agent Orange, dioxins, and other 
herbicide-related toxic exposures, the Committee urges the 
Department to utilize reference data from existing medical 
records of veterans who served in Vietnam, Thailand, Guam, the 
Northern Mariana Islands, American Samoa, and other geographic 
areas where these toxic substances were dispersed to determine 
the percentage who have frequent or unexplained diseases 
compared to the civilian population.
    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 a diverse representation of patients in 
clinical trials is integral to the development of medications 
and therapies that effectively treat disease. Demographics and 
genetics play a role in the safety and efficacy of a treatment 
for an individual. To achieve representation of the 
demographics of the U.S. population in these trials, the 
Committee directs VA to partner with the Department of Defense 
to fully implement the outstanding recommendations made by the 
April 2018 Task Force Report to Congress on Metastatic Cancer.
    National Intrepid Center of Excellence (NICoE).--The 
Committee recognizes the high-quality mental health care and 
neurological research being conducted at the NICoE and directs 
the Department to expand its work with NICoE to strengthen VA's 
research capacity. The Committee continues to encourage the 
Department to pursue new collaborative initiatives with NICoE, 
consider public academic medical centers as partners in such 
efforts, and assist Department of Defense efforts to optimize 
research to implement solutions and deliver better health 
outcomes for veterans.
    Research Using Animals.--The Department is directed to 
include in any report to Congress describing animal research 
approved under Section 247 in Division J of the Consolidated 
Appropriations Act, 2023 (P.L. 117-328), submitted after the 
date of filing of this report, details on the specific 
alternatives to animals that were considered, why those 
alternatives were not chosen, and an explanation for why these 
animal subjects were the only viable option for this research. 
Also, the Committee looks forward to the Department fully 
implementing its plan to eliminate or reduce the research 
conducted using canines, felines, or non-human primates in 
2024, as directed in Public Law 116-94.
    Women Veterans Research.--Women veterans have unique health 
needs that are substantially different than 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 and to prioritize medical and 
prosthetic research for women, given that women have different 
physical requirements for prosthetics. The Department should 
ensure that conditions that affect women are included in VA's 
research efforts to better understand the impact of military 
service on veterans with these conditions.

                     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 2024 is $3,991,000,000.

                    National Cemetery Administration


 
 
 
Appropriation, fiscal year 2023.......................      $430,000,000
Budget request, fiscal year 2024......................       480,000,000
Committee recommendation, fiscal year 2024............       480,000,000
    Change from enacted level.........................       +50,000,000
    Change from budget request........................             - - -
 

    The Committee recommends $480,000,000 for fiscal year 2024, 
which is $50,000,000 above the fiscal year 2023 enacted level. 
NCA should prioritize maintaining the current level of services 
at existing cemeteries and activating new cemeteries to 
increase burial access. In addition, the bill includes language 
making ten percent of the total available until September 30, 
2025.
    Geographically Isolated National Cemeteries.--The Committee 
looks forward to receiving the report requested in House Report 
117-391 regarding the Department's criteria for establishing 
new national cemeteries and meeting the needs of veterans and 
families in geographically isolated areas.

                      Departmental Administration


                         GENERAL ADMINISTRATION

                     (INCLUDING TRANSFER OF FUNDS)

 
 
 
Appropriation, fiscal year 2023.......................      $433,000,000
Budget request, fiscal year 2024......................       475,000,000
Committee recommendation, fiscal year 2024............       475,000,000
    Change from enacted level.........................       +42,000,000
    Change from budget request........................             - - -
 

    The General Administration account provides funds for the 
Office of the Secretary, the General Counsel, six Assistant 
Secretaries, and two Department-level staff offices.
    The Committee recommendation includes $475,000,000 for 
General Administration, an increase of $42,000,000 above the 
fiscal year 2023 enacted level.
    The Committee has included bill language to make available 
through September 30, 2025, 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.
    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.
    Data Strategy.--The Committee recommends $13,575,000 for 
the Office of Enterprise Integration's Data Governance, as 
requested, which is $608,000 more than the prior fiscal year 
and supports the Department's continued efforts to manage VA 
data as a strategic asset in order to strengthen the delivery 
of services and benefits to veterans, their families, 
survivors, and caregivers.
    Data on Women and Minority Veterans.--The Committee 
recognizes the lack of data specific to women and minority 
veterans made available to Congress by the Department. The 
Committee continues to recommend that, when applicable, the 
Secretary display information in the annual reports submitted 
to Congress separately for women veterans and minority 
veterans.
    Office of Resolution Management, Diversity, and 
Inclusion.--The Committee is concerned the Department requests 
an increase of 360 full-time equivalent staff with no 
justification and, as such, provides no funding for the 
increase. The Committee directs the Department to comply with 
Section 415 of the bill that prohibits funds to be used to 
carry out any program, project, or activity that promotes or 
advances Critical Race Theory or any concept associated with 
Critical Race Theory.
    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.
    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.
    Supporting Minority and Disadvantaged Contractors.--The 
Committee reiterates the reporting requirement included in 
House Report 117-81 on this topic and looks forward to 
receiving the requested report.
    VA Public Affairs.--The Committee is disappointed the 
Department issued a news release on April 21, 2023, titled 
``Budget Cut Proposals Would Hurt Veterans.'' In addition to 
being factually wrong, the news release was intended to 
influence the legislative process and negotiations between 
Congress and the Executive Branch, which is a violation of 
Section 715 of Division E of Public Law 117-328. Appropriated 
funds are prohibited from being used by the executive branch 
for partisan political purposes, including attempting to 
support or defeat legislation pending before Congress. As such, 
the bill includes a new general provision to specifically 
prohibit this type of activity by the Departments and agencies 
funded in this bill. It also provides zero funding for the 
Department's Public Affairs office.

                       BOARD OF VETERANS APPEALS

 
 
 
Appropriation, fiscal year 2023.......................      $285,000,000
Budget request, fiscal year 2024......................       287,000,000
Committee recommendation, fiscal year 2024............       287,000,000
    Change from enacted level.........................        +2,000,000
    Change from budget level..........................             - - -
 

    The Committee recommendation includes $287,000,000 for the 
Board of Veterans Appeals, which is $2,000,000 above the prior 
fiscal year. Ten percent of this funding is available through 
September 30, 2025.
    The Committee recognizes the challenges VA has in 
recruitment and retention of attorneys at BVA. To help the 
Board retain its attorneys, the Committee supports efforts to 
enhance recruitment and retention, such as expanding 
reimbursement for bar fees and Continuing Legal Education.

                     INFORMATION TECHNOLOGY SYSTEMS

                     (INCLUDING TRANSFER OF FUNDS)

 
 
 
Appropriation, fiscal year 2023.......................    $5,782,000,000
Budget request, fiscal year 2024......................     6,401,000,000
Committee recommendation, fiscal year 2024............     6,401,000,000
    Change from enacted level.........................      +619,000,000
    Change from budget request........................             - - -
 

    The Committee recommendation includes $6,401,000,000 for 
Information Technology Systems, which is $619,000,000 above the 
fiscal year 2023 enacted amount. Within the account total, the 
Committee allocates $1,606,977,000 for pay and associated 
costs; $4,668,373,000 for operations and maintenance; and 
$125,650,000 for development.
    The bill makes available three percent of pay and 
associated costs and five percent of operations and maintenance 
funds until September 30, 2025. All development funds are 
available until September 30, 2026.
    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 Committee continues to include bill language limiting 
the funds available for information technology systems 
development to the projects and in the amounts specified in the 
report. The bill limits the amount of funds that can be 
transferred into the IT account to ten percent of the total of 
either the source or destination account. The bill contains 
language that permits the reprogramming of funds among 
development projects upon prior notification to, and approval 
by, the Committees on Appropriations of both Houses of 
Congress.
    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 Enabling Capabilities.......................            $53,656
Health Business Services.............................             14,694
Care Coverage Capabilities...........................             13,608
Clinical Care Capabilities...........................              7,949
Health IT Services...................................              2,000
Patient Management Capabilities......................                559
Benefit Services.....................................             16,000
Veteran Experience Services..........................             14,184
Corporate Services...................................              3,000
    Total All Development............................            125,650
------------------------------------------------------------------------

    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.
    Small Business IT Security Partners.--The Committee urges 
the Office of Information Technology to increase utilization of 
small businesses in implementing IT security programs, 
including in the areas of secure storage and encryption.

                   VETERANS ELECTRONIC HEALTH RECORD

 
 
 
Appropriation, fiscal year 2023.......................    $1,759,000,000
Budget request, fiscal year 2024......................     1,863,000,000
Committee recommendation, fiscal year 2024............     1,863,000,000
    Change from enacted level.........................      +104,000,000
    Change from budget request........................             - - -
 

    The bill includes $1,863,000,000, as requested, for 
Veterans Electronic Health Record for activities related to the 
development and rollout of VA's Electronic Health Record 
Modernization (EHRM) initiative, the associated contractual 
costs, and the salaries and expenses of employees hired under 
titles 5 and 38, United States Code. Within the total, the bill 
includes $1,186,000,000 for the electronic health record 
contract; $424,000,000 for infrastructure readiness; and 
$253,000,000 for program management. Funding is made available 
for three fiscal years.
    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.
    The bill continues to require quarterly reporting of 
obligations, expenditures, and deployment schedule by facility 
and the Office of Deputy Secretary to administer the 
initiative. It also continues to make 25 percent of funds 
contingent upon the Secretary, within specified deadlines: (1) 
providing a report detailing the status of outstanding issues 
impacting the stability and usability of the new electronic 
health record (EHR) system, including those that contributed to 
deployment delays, along with a timeline and measurable 
metrics; (2) certifying and detailing any changes to the full 
deployment schedule; and (3) certifying the status of 
outstanding issues impacting the stability and usability of the 
system, and whether the system is ready and optimized for 
further deployment at VA sites.
    The Committee directs the Department to continue monthly 
briefings on program implementation, including updates on 
progress resolving outstanding issues, and to provide quarterly 
updates to review timelines, performance milestones, 
implementation, and change management progress. The Government 
Accountability Office is directed to continue quarterly 
performance reviews of EHRM deployment and to report to the 
Committees each quarter.
    The Committee notes that the Department is not expected to 
request the release of the 25 percent of funds set aside for 
fiscal year 2023, and that it plans to pause new deployments in 
fiscal year 2024. While this bill provides the full amount 
requested for fiscal year 2024, the Committee will work with 
the Department and the Senate Appropriations Committee to 
determine the appropriate amount to provide in a final 
conference agreement.
    Contractor Accountability.--The Committee expects the 
Department to hold its contractors accountable. The Department 
is expected to work closely with Oracle Cerner to resolve 
usability problems and dramatically improve training to ensure 
that when deployments restart the new system can be adopted 
easily by clinicians and healthcare staff.
    Cost and Budget Estimates.--The Committee appreciates the 
information included in the fiscal year 2024 budget request and 
accompanying justifications that better identifies all costs 
related to EHRM implementation, including those that would be 
incurred in other budget accounts, in meeting the reporting 
requirements above and in the justifications accompanying the 
President's budget request.
    Enterprise Integration and Standardization.--The Committee 
is very concerned that little progress has been made to 
standardize the processes, products, and workflows associated 
with the new system, especially since this is increasing the 
cost of implementation. For example, the Committee is aware 
that the Department of Defense has fewer than one-third of the 
interfaces the Department is considering.
    An interoperable, enterprise-wide system presumes a 
standardized system and operating structure. As such, the 
Department is directed to set enterprise standards, including 
readiness criteria and training requirements, and strictly 
limit customization. The standards should be in place as soon 
as practicable to ensure new deployments are swift and smooth. 
The Committee requests a report of each new requirement and 
customized interface added in fiscal years 2022 and 2023, 
including the cost of each, reasons for inclusion, and whether 
they were outside of the scope of the contract within 30 days 
of enactment of this Act, as well as a briefing within 45 days 
of the filing of this bill on how the Department's plan to set 
enterprise standards.
    Life-Cycle Cost Estimate.--The Committee anticipates 
receiving an updated Life Cycle Cost Estimate for the program 
that takes into account the estimate provided by the Institute 
for Defense Analyses and continues to require that at least 
annually the Department provide a report to the Committees on 
Appropriations that compares current estimated costs to the 
revised Life Cycle Cost Estimate.
    Report.--The Committee looks forward to receiving the 
report required in Division J of Public Law 113-328 detailing 
steps taken to: (1) revise and enhance the EHR training 
program; (2) independently validate the efficacy of the super 
user program and the training for such program; (3) ensure 
proper medication management and accurate patient data through 
such record; (4) demonstrate that patient record flags that 
identify veterans who are at high risk for suicide are properly 
displayed in such record; and (5) implement a policy for 
regular updates to affected employees about progress on and 
estimated completion dates for issues arising from trouble 
tickets.

                      OFFICE OF INSPECTOR GENERAL

 
 
 
Appropriation, fiscal year 2023.......................      $273,000,000
Budget request, fiscal year 2024......................       296,000,000
Committee recommendation, fiscal year 2024............       296,000,000
    Change from enacted level.........................       +23,000,000
    Change from budget request........................             - - -
 

    The Committee recommendation includes $296,000,000 for 
fiscal year 2024 for the Office of the Inspector General, which 
is $23,000,000 above the prior year level. The bill makes up to 
ten percent of this funding available until September 30, 2025.
    The Committee continues to request robust oversight of the 
Electronic Health Record Modernization initiative.
    VA Claims Backlog.--The OIG is encouraged to continue to 
review the VA's work to address the claims backlog and report 
to the Committee about such efforts. This report should analyze 
how VA's partnership with the National Archives and Records 
Administration to digitally scan all paper-based military 
personnel files has helped address and resolve the backlog as 
well as any changes in wait times and size of the claims 
backlog.

                      CONSTRUCTION, MAJOR PROJECTS

 
 
 
Appropriation, fiscal year 2023.......................    $1,447,890,000
Budget request, fiscal year 2024......................       881,000,000
Committee recommendation, fiscal year 2024............       881,000,000
    Change from enacted level.........................      -566,890,000
    Change from budget request........................             - - -
 

    The Committee recommendation includes $881,000,000 for 
Construction, Major Projects for fiscal year 2024, of which 
$373,096,000 shall remain available until September 30, 2029, 
and $507,904,000 shall remain available until expended. In 
addition, the Committee supports the Department's plan to 
allocate $600,000,000 to support major construction projects in 
American Lake, WA; Dallas, TX; El Paso, TX; Perry Point, MD; 
Portland, OR; San Diego, CA; San Francisco, CA; and San Juan, 
PR.
    As required by language that is in permanent law, all major 
construction projects costing more than $100,000,000 must be 
managed by a non-VA government entity, such as the Army Corps 
of Engineers. While the Committee no longer duplicates this 
language, the Committee intends to continue its oversight of 
the quality of the outside entity management and expects to 
receive quarterly briefings on each of the large construction 
projects.
    Construction Reports.--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.
    The Committee does not provide $1,930,000,000 in mandatory 
funding, as requested, does not support the shift of 
discretionary funding to the mandatory side for construction, 
and discourages such requests in future fiscal years.
    The chart below reflects the Committee's recommendation for 
Major Construction projects.

                      CONSTRUCTION, MAJOR PROJECTS
                        [In thousands of dollars]
------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Veterans Health Administration (VHA):
West Haven, CT--New Surgical and Clinical Space                  153,128
 Tower, Renovation of Buildings 1 and 2 and
 Demolition..........................................
Advance Planning and Design Fund--Various Stations...            196,872
Construction & Facilities Management Staff--Various              153,000
 Stations............................................
Hazardous Waste--Various Stations....................              1,000
Judgement Fund--Various Stations.....................             25,000
Non-Departmental Federal Entity Project Management               112,000
 Support--Various Stations...........................
Seismic Corrections--Various Stations................             110,00
    Total, VHA.......................................            759,000
National Cemetery Administration (NCA):
St. Louis, MO--Phase 1 Gravesite Development (New                 28,800
 Land)...............................................
Advance Planning and Design Fund--Various Stations...             78,200
NCA Land Acquisition Fund--Various Stations..........              5,000
    Total, NCA.......................................            112,000
General Administration/Staff Offices:
Department Advance Planning and Design Fund for Major             10,000
 Construction........................................
    Total, Major Construction........................            881,000
------------------------------------------------------------------------

    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 2023.......................      $626,110,000
Budget request, fiscal year 2024......................       680,000,000
Committee recommendation, fiscal year 2024............       680,000,000
    Change from enacted level.........................       +53,890,000
    Change from budget request........................             - - -
 

    The Committee recommendation includes $680,000,000 for 
Construction, Minor Project for fiscal year 2024, of which 
$612,000,000 shall remain available until September 30, 2028, 
and $68,000,000 shall remain available until expended.
    Greater Los Angeles Healthcare System's Master Plan.--The 
Committee continues to encourage the VA to engage with the 
Principal Developer Team responsible for the Greater Los Angles 
Health Care System's Master Plan and support the 
operationalization of the Master Plan, as appropriate.

       GRANTS FOR CONSTRUCTION OF STATE EXTENDED CARE FACILITIES

 
 
 
Appropriation, fiscal year 2023.......................      $150,000,000
Budget request, fiscal year 2024......................       164,000,000
Committee recommendation, fiscal year 2024............       164,000,000
    Change from enacted level.........................       +14,000,000
    Change from budget request........................             - - -
 

    The Committee recommendation includes $164,000,000 for 
fiscal year 2024 for Grants for Construction of State Extended 
Care Facilities, which is $14,000,000 above the fiscal year 
2023 level. A grant may not exceed 65 percent of the total cost 
of the project. The bill makes this funding available until 
expended.
    The Committee directs the Department to work with states to 
ensure new facilities and expansions are eligible to receive 
the full amount of federal funding as authorized under current 
law.

             GRANTS FOR CONSTRUCTION OF VETERANS CEMETERIES

 
 
 
Appropriation, fiscal year 2023.......................       $50,000,000
Budget request, fiscal year 2024......................        60,000,000
Committee recommendation, fiscal year 2024............        50,000,000
    Change from enacted level.........................       +10,000,000
    Change from budget request........................             - - -
 

    The Committee recommendation includes $60,000,000 for 
Grants for Construction of Veterans Cemeteries, which is 
$10,000,000 above the fiscal year 2023 level. The bill makes 
this funding available until expended.

                    COST OF WAR TOXIC EXPOSURES FUND

 
 
 
Fiscal year 2023 enacted level............                $5,000,000,000
Fiscal year 2024 enacted level............                         - - -
Fiscal year 2024 budget year request......                20,268,000,000
Committee 2024 budget year recommendation.                         - - -
Fiscal year 2025 advance appropriation                    21,454,542,000
 request..................................
Committee 2025 advance appropriation                               - - -
 recommendation...........................
 

    The recently enacted Fiscal Responsibility Act of 2023 
(P.L. 118-5) included $20,268,000,000 for the Cost of War Toxic 
Exposures Fund (TEF), as requested by the President's fiscal 
year 2024 budget request. The Fiscal Responsibility Act also 
included $24,455,000,000 in advance appropriations for fiscal 
year 2025 for the TEF.
    The Department is directed to provide the Committees on 
Appropriations an expenditure plan for funds provided for the 
TEF by the Fiscal Responsibility Act within 30 days of the 
filing of this report with the Clerk of the U.S. House of 
Representatives.
    PACT Act Incremental Costs.--The Committee directs the 
Department to include in its fiscal year 2025 and all future 
budget justification materials a detailed description of the 
incremental costs for implementation of the PACT Act for all 
requested funds on an account-by-account basis.

                       Administrative Provisions

    The administrative provisions included in the bill are as 
follows:

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 201 allowing for the transfer of 
funds among three mandatory appropriations. The Administration 
proposal to modify this provision is not adopted.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 202 allowing the Department to 
transfer funding among the four medical appropriations accounts 
in fiscal year 2024. 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 2024 for ``Compensation and 
Pensions'', ``Readjustment Benefits'', and ``Veterans Insurance 
and Indemnities'' for payment of accrued obligations recorded 
in the last quarter of fiscal year 2023.
    The bill includes section 207 allowing for the use of 
fiscal year 2024 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 $430,532,000 
of fiscal year 2024 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 
$456,547,000 of fiscal year 2025 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, 2025. The Administration 
request to delete this provision is not adopted.
    The bill includes section 233 allowing the use of Medical 
Services funding for assisted reproductive technology treatment 
and adoption reimbursement for veterans and their spouses.
    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 2024 and 2025 to carry out and expand the 
childcare pilot program authorized by section 205 of the 
Caregivers and Veterans Omnibus Health Services Act of 2010 
(P.L. 111-163).
    The bill includes section 240 prohibiting VA from using 
funds to enter into an agreement to resolve a dispute or claim 
with an individual that would restrict the individual from 
speaking to Members of Congress or their staff on any topic, 
except those required to be kept secret in the interest of 
national defense or the conduct of foreign affairs. The 
Administration request to delete this provision is not adopted.
    The bill includes section 241 referencing language in the 
Continuing Appropriations and Military Construction, Veterans 
Affairs, and Related Agencies Appropriations Act, 2017, and 
Zika Response and Preparedness Act (P.L. 114-223) requiring 
certain data to be included in budget justifications for major 
construction projects. The Administration request to delete 
this provision is not adopted.
    The bill includes section 242 prohibiting the use of funds 
to deny the Inspector General timely access to information 
unless a provision of law expressly refers to the Inspector 
General and expressly limits such access.
    The bill includes section 243 prohibiting funding from 
being used in a manner that would increase wait times for 
veterans at medical facilities. The Administration request to 
delete this provision is not adopted.
    The bill includes section 244 prohibiting the use of funds 
in fiscal year 2024 to convert any program that received 
specific purpose funds in fiscal year 2023 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 regarding verification of 
service for coastwise merchant seamen.
    The bill includes section 246 regarding the use of canines, 
felines, and non-human primates in VA research.
    The bill includes section 247 regarding staffing ratios.
    The bill includes section 248 to allow fiscal year 2024 and 
2025 ``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 249 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 250 specifying an amount from 
the four medical care accounts for specific care for women 
veterans. The administration request to delete this provision 
is not adopted.
    The bill includes section 251 regarding construction of a 
community-based outpatient clinic in Bakersfield, California.
    The bill includes section 252 regarding the lease of a 
community-based outpatient clinic in Bakersfield, California.
    The bill includes section 253 requiring quarterly reports 
on the status of the ``Veterans Medical Care and Health Fund,'' 
established to execute section 8002 of the American Rescue Plan 
(P.L. 117-2).
    The bill includes section 254 establishing a timeline for 
construction in accordance with a lease.
    The bill includes section 255 regarding the use of 
unobligated balances to support construction projects in the 
CHIP-IN program.

                    (INCLUDING RESCISSION OF FUNDS)

    The bill includes section 256 rescinding funding from the 
Medical Services, Medical Community Care, and Medical 
Facilities accounts.
    The bill includes section 257 requiring an expenditure plan 
for funds made available through the Fiscal Responsibility Act 
of 2023 (P.L. 118-5).
    The bill includes section 258 prohibiting federal funding 
for abortions except in cases of incest, rape, or life of the 
mother and prohibiting federal funding to implement the 
Department of Veterans Affairs' Interim Final Rule on abortion.
    The bill includes section 259 prohibiting federal funding 
for hormone therapies or surgeries for gender-affirming care.
    The bill includes section 260 permitting certain flags to 
be flown over VA facilities.

                               TITLE III


                            RELATED AGENCIES


                  American Battle Monuments Commission


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2023.......................       $87,500,000
Budget request, fiscal year 2024......................       114,630,000
Committee recommendation, fiscal year 2024............       114,630,000
    Change from enacted level.........................        27,130,000
    Change from budget request........................             - - -
 

    The recommendation includes $114,630,000 for Salaries and 
Expenses of the American Battle Monuments Commission. The 
Committee directs the Commission to provide a spend plan for 
the additional funds provided this fiscal year, including 
funding for the capital program, within 60 days of enactment of 
this Act.

                 FOREIGN CURRENCY FLUCTUATIONS ACCOUNT

    The recommendation includes such sums as necessary for the 
Foreign Currency Fluctuations Account.

                            CAPITAL PROGRAM

 
 
 
Appropriation, fiscal year 2023.......................            $- - -
Budget request, fiscal year 2024......................        44,000,000
Committee recommendation, fiscal year 2024............        44,000,000
    Change from enacted level.........................       +44,000,000
    Change from budget request........................             - - -
 

    The recommendation includes $44,000,000, as requested.

           United States Court of Appeals for Veterans Claims


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2023.......................       $46,900,000
Budget request, fiscal year 2024......................        47,200,000
Committee recommendation, fiscal year 2024............        47,200,000
    Change from enacted level.........................              +300
    Change from budget request........................             - - -
 

    The recommendation includes $47,200,000 for Salaries and 
Expenses for the United States Court of Appeals for Veterans 
Claims.

                      Department of Defense--Civil


                       Cemeterial Expenses, Army


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2023.......................       $93,400,000
Budget request, fiscal year 2024......................        99,880,000
Committee recommendation, fiscal year 2024............       100,267,000
    Change from enacted level.........................        +6,867,000
    Change from budget request........................          +387,000
 

    The recommendation includes $100,267,000 for Salaries and 
Expenses for Arlington National Cemetery, which is equal to the 
fiscal year 2024 budget request.

                              CONSTRUCTION

 
 
 
Appropriation, fiscal year 2023.......................       $62,500,000
Budget request, fiscal year 2024......................        88,600,000
Committee recommendation, fiscal year 2024............        88,600,000
    Change from enacted level.........................       +26,100,000
    Change from budget request........................             - - -
 

    The recommendation includes $88,600,000 to complete the 
Southern Expansion, to remain available until expended. The 
Committee reminds the Army to include status updates in its 
required quarterly reports on funds obligated, including 
previously appropriated funds, and funds remaining for the 
Southern Expansion project, as well as any remaining unfunded 
needs to complete the project.

                      Armed Forces Retirement Home


                               TRUST FUND

    The recommendation includes a total of $77,000,000 for the 
Armed Forces Retirement Home (AFRH) Trust Fund, including 
$8,940,000 for capital projects and $25,000,000 from the 
general fund of the Treasury.
    General Fund.--The Committee continues to be concerned 
about the use of the General Fund to support the AFRH and 
directs it to make progress to increase revenues and stabilize 
the Trust Fund for the long term.
    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 2023.......................       $68,060,000
Budget request, fiscal year 2024......................        68,060,000
Committee recommendation, fiscal year 2024............        68,060,000
    Change from enacted level.........................             - - -
    Change from budget request........................             - - -
 

    The Committee makes these operation and maintenance funds 
available until September 30, 2025, as requested, to provide 
AFRH greater ability to respond to emergency situations and 
ensure stable operations.

                            CAPITAL PROGRAM

 
 
 
Appropriation, fiscal year 2023.......................        $7,300,000
Budget request, fiscal year 2024......................         8,940,000
Committee recommendation, fiscal year 2024............         8,940,000
    Change from enacted level.........................        +1,640,000
    Change from budget request........................             - - -
 

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

                           MAJOR CONSTRUCTION

 
 
 
Appropriation, fiscal year 2023.......................       $77,000,000
Budget request, fiscal year 2024......................             - - -
Committee recommendation, fiscal year 2024............             - - -
    Change from enacted level.........................       -77,000,000
    Change from budget request........................             - - -
 

    The Committee reminds AFRH to provide quarterly reports on 
the status of this construction project, including obligations 
of funds, anticipated timelines, and any changes to the overall 
cost of the project.

                        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 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 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.
    The bill includes section 412 prohibiting the use of funds 
in this Act for the renovation, expansion, or construction of 
any facility in the continental United States for the purposes 
of housing any individual who has been detained at the United 
States Naval Station, Guantanamo Bay, Cuba.
    The bill includes section 413 prohibiting the use of funds 
to support or defeat legislation pending before Congress.
    The bill includes section 414 prohibiting the use of funds 
to implement Executive Order 13985, Executive Order 14035, 
Executive Order 14091 regarding diversity, equity, and 
inclusion activities.
    The bill includes section 415 prohibiting the use of funds 
to promote or advance Critical Race Theory or any concept 
associated with Critical Race Theory.
    The bill includes section 416 prohibiting discrimination 
based on religious beliefs related to marriage.
    The bill includes section 417 prohibiting federal funding 
for Diversity, Equity, and Inclusion training or 
implementation.
    The bill includes section 418 establishing a ``Spending 
Reduction Account'' in the bill.

            House of Representatives Reporting Requirements

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

         STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

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

                          RESCISSION OF FUNDS

    Pursuant to clause 3(f)(2) of rule XIII of the Rules of the 
House of Representatives, the following statements are 
submitted describing the rescissions in the accompanying bill:
    In title II, section 256 recinds $4,933,113,000 of 
unobligated balances from ``Medical Services''; $1,909,069,000 
of unobligated balances from ``Medical Community Care''; and 
$250,515,000 of unobligated balances from ``Medical 
Facilities''.

                           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 under Title I 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 under Title I to provide transfer 
authority from the BRAC account to the Homeowners Assistance 
Program.
    Language is included under Title I to allow the transfer of 
expired funds to the ``Foreign Currency Fluctuations, 
Construction, Defense'' account.
    Language is included under Title II to transfer not to 
exceed $22,109,000 in fiscal year 2025 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 under Title II to permit the transfer 
of funds from General Administration to General Operating 
Expenses, Veterans Benefits Administration.
    Language is included under Title II 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 under Title II to provide authority 
for the Department of Veterans Affairs for any funds 
appropriated in 2024 for Compensation and Pensions, 
Readjustment Benefits, and Veterans Insurance and Indemnities 
to be transferred among those three accounts.
    Language is included under Title II to transfer funds among 
the Medical Services, Medical Community Care, Medical Support 
and Compliance, and Medical Facilities accounts, subject to 
approval by the Committee.
    Language is included under Title II 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 under Title II to permit funding up to 
$101,065,000 to be transferred to General Administration and 
Information Technology Systems from any funds appropriated in 
fiscal year 2024 to reimburse three headquarters offices for 
services provided.
    Language is included under Title II to transfer certain 
funds derived from enhanced-use leasing activities to the 
Construction, Major Projects and Construction, Minor Projects 
accounts.
    Language is included under Title II to allow the transfer 
of funds from the Medical Care Collections Fund to the Medical 
Services and Medical Community Care accounts.
    Language is included under Title II to allow the transfer 
of funds from the Capital Asset Fund to the Construction, Major 
Projects and Construction, Minor Projects accounts.
    Language is included under Title II 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 under Title II to allow the transfer 
of funds provided for the Department of Veterans Affairs in 
fiscal year 2024 to the Joint Department of Defense-Department 
of Veterans Affairs Medical Facility Demonstration Fund.
    Language is included under Title II allowing fiscal year 
2025 medical care funding to be transferred to the Joint 
Department of Defense-Department of Veterans Affairs Medical 
Facility Demonstration fund.
    Language is included under Title II 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 Title II to 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 under Title II 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 under Title II 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.


          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):

 SECTION 220 OF DIVISION J OF THE CONSOLIDATED APPROPRIATIONS ACT, 2023


                          (Public Law 117-328)


                     [(INCLUDING TRANSFER OF FUNDS)

    [Sec. 220. Of the amounts appropriated to the Department of 
Veterans Affairs which become available on October 1, 2023, for 
``Medical Services'', ``Medical Community Care'', ``Medical 
Support and Compliance'', and ``Medical Facilities'', up to 
$314,825,000, 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. 2571) 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 Appropriation of both Houses of Congress.]

               Changes in the Application of Existing Law

    Pursuant to clause 3(f)(1)(A) of rule XIII of the Rules of 
the House of Representatives, the following statements are 
submitted describing the effect of provisions in the 
accompanying bill that directly or indirectly change the 
application of existing law.
    Language is included in various parts of the bill to 
continue on-going activities that require annual authorization 
or additional legislation, which to date have not been enacted.
    Language is included in various parts of the bill to place 
limitations on the use of funds in the bill or change existing 
limitations and which might, under some circumstances, be 
construed as changing the application of existing law.
    Language is included in various parts of the bill to allow 
the Secretary of Defense to exceed certain limitations upon 
notification to the Committee.
    Language is included in various parts of the bill to allow 
funding to be used for official reception and representation 
expenses.
    Language is included in various parts of the bill to enable 
various appropriations to remain available for more than one 
year for some programs for which the basic authority 
legislation does not presently authorize such extended 
availability.
    Language is included in various parts of the bill to permit 
the transfer of funds to other accounts.
    Language is included under Title I to prohibit payments for 
cost-plus-a-fixed-fee contracts under certain circumstances.
    Language is included in various parts of the bill to allow 
funds to be used for the hire of passenger motor vehicles.
    Language is included under Title I to allow advances to the 
Federal Highway Administration, Department of Transportation 
under certain circumstances.
    Language is included under Title I to prohibit the use of 
funds to begin construction of new bases without specific 
appropriations.
    Language is included under Title I to prohibit the use of 
funds for purchase of land or land easements under certain 
circumstances.
    Language is included under Title I to prohibit the use of 
funds for land acquisition, site preparation, and utility 
installation for family housing unless funds have been made 
available in annual appropriations Acts.
    Language is included under Title I to prohibit the use of 
minor construction funds to transfer an activity between 
installations without prior notification.
    Language is included under Title I to prohibit the use of 
funds for the procurement of steel for any activity if American 
steel producers have been denied the opportunity to compete for 
such steel procurements.
    Language is included under Title I to prohibit the use of 
funds to pay real property taxes in any foreign nation.
    Language is included under Title I to prohibit the use of 
funds to initiate a new installation overseas without prior 
notification.
    Language is included under Title I to limit the use of 
funds for architect and engineer contracts under certain 
circumstances.
    Language is included under Title I to limit the use of 
funds for awarding contracts to foreign contractors under 
certain circumstances.
    Language is included under Title I to require the 
Department of Defense to notify the appropriate committees of 
Congress of any proposed military exercises under certain 
circumstances.
    Language is included under Title I to allow prior year 
construction funding to be available for currently authorized 
projects.
    Language is included under Title I to allow payment for the 
cost associated with supervision, inspection, overhead, 
engineering and design on family housing or military 
construction projects that are being completed with expired or 
lapsed funds.
    Language is included under Title I to allow funds to be 
expended on military construction projects for four fiscal 
years after enactment under certain circumstances.
    Language is included under Title I to allow construction 
funds to be transferred to Housing Improvement Funds.
    Language is included under Title I to allow for the 
transfer of BRAC funds to the Homeowners Assistance Program.
    Language is included under Title I to limit funds for the 
operation and maintenance of family housing to those provided 
in this appropriation and to limit amounts expended on repairs 
of general and flag officer quarters under certain 
circumstances.
    Language is included under Title I to allow funds in the 
Ford Island Improvement Account to be available until expended 
for certain purposes.
    Language is included under Title I to allow for the 
transfer of expired funding to the Foreign Currency Fluctuation 
Account under certain circumstances.
    Language is included under Title I to prohibit funds from 
being used for projects at Arlington Cemetery.
    Language is included under Title I directing all amounts 
appropriated to Military Construction (all accounts) be 
immediately available and allotted for the full scope of the 
authorized project.
    Language is included under Title I providing funds for 
unfunded requirements requested by the Services and Combatant 
Commanders.
    Language is included under Title I allowing unobligated 
funds from prior appropriations acts for fiscal years 2017, 
2018, and 2019 to be obligated under certain circumstances.
    Language is included under Title I defining the 
congressional defense committees.
    Language is included under Title I providing funds for 
military laboratory facilities.
    Language is included under Title I providing funds for 
natural disasters.
    Language is included under Title I providing funds for 
child development centers planning and design.
    Language is included under Title I providing funds for 
barracks planning and design.
    Language is included under Title I providing funds for 
demolition.
    Language is included under Title I providing funds for the 
Shipyard Infrastructure Optimization Program.
    Language is included under Title I prohibiting funds to 
close Naval Station Guantanamo Bay, Cuba.
    Language is included under Title II providing for the 
reimbursement to the Department of Defense for the costs of 
overseas employee mail.
    Language is included under Title II to require that the 
Secretary of Veterans Affairs establish a priority for 
treatment of Veterans who are service-connected disabled, lower 
income, or have special needs.
    Language is included under Title II to require that the 
Secretary of Veterans Affairs give priority funding of basic 
medical benefits to priority groups 1 through 6.
    Language is included under Title II to allow the Secretary 
of Veterans Affairs to dispense prescription drugs from VHA 
facilities to enrolled Veterans with privately written 
prescriptions at no additional cost to the Department.
    Language is included under Title II requiring the Secretary 
to ensure sufficient funding is available for the acquisition 
of prosthetics designed for women Veterans.
    Language is included under Title II requiring sufficient 
funding is available for prosthetic research specifically for 
female Veterans and for toxic exposure research.
    Language is included under Title II to require approval of 
a transfer between development projects in the Information 
Technology Systems account.
    Language is included under Title II prohibiting funding in 
the Veterans Electronic Health Record account from being 
obligated in a manner inconsistent with deployment schedules.
    Language is included under Title II establishing time 
limitations and reporting requirements concerning the 
obligation of Major Construction funds, limiting the use of 
funds, allowing the use of funds for program costs, and 
allowing for the reimbursement to the ``General 
Administration'' account for the salaries and expenses of the 
Office of Construction and Facilities Management employees.
    Language is included under Title II to allow Minor 
Construction funds to be used to repair non-medical facilities 
damaged by natural disaster or catastrophe.
    Language is included under Title II permitting transfers 
between mandatory and discretionary accounts, limiting and 
providing for the use of certain funds, funding administrative 
expenses associated with life insurance programs from excess 
program revenues, allowing reimbursement from enhanced-use 
leases and for certain services, requiring notification of 
construction bid savings, limiting reprogramming amount of 
major construction projects, restricting changes in the scope 
of major construction projects, requiring disclosure of 
insurance and income information, allowing a recovery audit 
collection program, allowing Veterans in the State of Alaska to 
use Indian Health Service facilities under certain conditions, 
requiring quarterly reports on the Department's financial 
status, performance measures, and data, allowing medical 
services funds for recreational and funeral expenses, and 
requiring notification of organizational changes that transfer 
25 or more employees from one VA organizational unit to 
another.
    Language is included under Title II requiring notification 
of any single national outreach and awareness marketing 
campaign in which obligations exceed $1,000,000.
    Language is included under Title II requiring the Secretary 
to maintain certain requirements in operating the toll-free 
suicide hotline.
    Language is included under Title II prohibiting funds from 
being used in contravention of certain breast cancer screening 
guidance.
    Language is included under Title II to allow covered 
veterans and their spouses or partners, under certain 
conditions, to receive assisted reproductive technology 
services and adoption reimbursement.
    Language is included under Title II pertaining to 
exceptions for Indian- or Native Hawaiian-owned businesses 
contracting with the Department.
    Language is included under Title II directing the 
elimination of using Social Security account numbers to 
identify individuals in all information systems of the 
Department.
    Language is included under Title II pertaining to 
certification of marriage and family therapists.
    Language is included under Title II prohibiting funds from 
being used to transfer funding from the Filipino Veterans 
Equity Compensation Fund to any other VA account.
    Language is included under Title II permitting funds to 
carry out and expand the childcare program.
    Language is included under Title II prohibiting funds to 
enter into an agreement to resolve a dispute or claim with an 
individual that would restrict the individual from speaking to 
Members of Congress or their staff.
    Language is included under Title II requiring certain data 
to be included in budget justifications for major construction 
projects.
    Language is included under Title II prohibiting the 
Inspector General from being denied timely access to 
information.
    Language is included under Title II prohibiting funding to 
be used in a manner that would increase wait times for Veterans 
who seek medical care.
    Language is included under Title II prohibiting the use of 
funds in fiscal year 2024 to convert any program that received 
specific purpose funding in fiscal year 2023 to a general 
purpose-funded program.
    Language is included under Title II prohibiting the use of 
dogs or cats as part of the conduct of any study.
    Language is included under Title II allowing for funds 
within the Medical Community Care account to be used for 
expenses that would have otherwise been payable from the 
Veterans Choice Fund.
    Language is included under Title II allowing for 
obligations and expenditures applicable to the Medical Services 
account in fiscal years 2017 through 2019 for aid to state 
homes to remain in the Medical Community Care account for such 
fiscal years.
    Language is included under Title II providing for a certain 
amount within the medical care accounts to be made available 
for gender-specific care and programmatic efforts to deliver 
care for women veterans.
    Language is included under Title II rescinding unobligated 
balances in the ``Recurring Expenses Transformational Fund.''
    Language is included under Title II requiring quarterly 
reports on the status of the Veterans Medical Care and Health 
Fund.
    Language is included under Title II allowing the use of 
unobligated balances for CHIP-In construction projects.
    Language is included under Title II to require an 
expenditure plan for funds made available in the Fiscal 
Responsibility Act of 2023 (P.L. 118-5).
    Language is included under Title II prohibiting federal 
funding for abortions except in cases of incest, rape, or life 
of the mother and prohibiting federal funding for implementing 
the Department of Veterans Affairs Interim Final Rule on 
abortion.
    Language is included under Title II regarding funding for 
hormone therapies or surgeries for gender-affirming care.
    Language is included under Title II permitting certain 
flags to be flown at VA facilities.
    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.
    Language is included under Title IV prohibiting funds to 
build or house detainees at Naval Station Guantanamo Bay, Cuba.
    Language is included under Title IV prohibiting funds for 
executive orders related to diversity, equity, and inclusion.
    Language is included under Title IV prohibiting funds to 
teach or promote Critical Race Theory.
    Language is included under Title IV prohibiting 
discrimination based on religious beliefs related to marriage.
    Language is included under Title IV prohibiting Diversity, 
Equity, and Inclusion training or implementation.
    Language is included under Title IV regarding a Spending 
Reduction Account.

                  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:


    BUDGETARY IMPACT OF THE FY 2024 MILITARY CONSTRUCTION, VETERANS 
     AFFAIRS, AND RELATED AGENCIES APPROPRIATIONS BILL PREPARED IN 
 CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SECTION 
             308(A) OF THE CONGRESSIONAL BUDGET ACT OF 1974

                        [In millions of dollars]


                   COMPARISON WITH BUDGET RESOLUTION

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

                                            [In millions of dollars]
----------------------------------------------------------------------------------------------------------------
                                                         302(b) Allocation                   This Bill
                                                 ---------------------------------------------------------------
                                                      Budget                          Budget
                                                     Authority        Outlays        Authority        Outlays
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with Committee
 allocations to its subcommittees: Subcommittee
 on Military Construction, Veterans Affairs, and
 Related Agencies
    Discretionary...............................         155,701         152,724         155,701      \1\152,730
    Mandatory...................................         204,556         190,242         204,556      \1\188,230
----------------------------------------------------------------------------------------------------------------
\1\Includes outlays from prior-year budget authority.

                      FIVE-YEAR OUTLAY PROJECTIONS

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

                        [In millions of dollars]
------------------------------------------------------------------------
                                                               Outlays
------------------------------------------------------------------------
Projection of outlays associated with the recommendation:
    2024...................................................   \1\162,986
    2025...................................................     104,7220
    2026...................................................       18,330
    2027...................................................        5,497
    2028 and future years..................................        5,158
------------------------------------------------------------------------
\1\Excludes outlays from prior-year budget authority.

          FINANCIAL ASSISTANCE TO STATE AND LOCAL GOVERNMENTS

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

                        [In millions of dollars]
------------------------------------------------------------------------
                                     Budget Authority       Outlays
------------------------------------------------------------------------
Financial assistance to State and                 190             \1\189
 local governments for 2024.......
------------------------------------------------------------------------
\1\Excludes outlays from prior-year budget authority.



                           Committee Hearings

    Pursuant to clause 3(c)(6) of rule XIII of the Rules of the 
House of Representatives, the following hearings were used to 
develop or consider the Military Construction, Department of 
Veterans Affairs, and Related Agencies Appropriations Act, 
2024:
    The Subcommittee on Military Construction, Department of 
Veterans Affairs, and Related Agencies held a hearing on 
February 28, 2023, entitled ``Oversight Hearing--Quality of 
Life in the Military''. The Subcommittee received testimony 
from:
    Sergeant Major Michael A. Grinston, U.S. Army
    Master Chief Petty Officer James A. Honea, U.S. Navy
    Sergeant Major Troy E. Black, U.S. Marine Corps
    Chief Master Sergeant JoAnne S. Bass, U.S. Air Force
    Chief Master Sergeant Roger A. Towberman, U.S. Space Force
    The Subcommittee on Military Construction, Department of 
Veterans Affairs, and Related Agencies held a hearing on April 
20, 2023, entitled ``FY 2023 Member Day Hearing''. The 
Subcommittee received testimony from:
    The Honorable Brian J. Mast, Member of Congress
    The Honorable Earl Blumenauer, Member of Congress
    The Subcommittee on Military Construction, Department of 
Veterans Affairs, and Related Agencies held a hearing on March 
23, 2023, entitled ``Budget Hearing--Fiscal Year 2024 Request 
for Army Military Construction and Family Housing''. The 
Subcommittee received testimony from:
    The Honorable Rachel Jacobson, Assistant Secretary of the 
Army, Installations, Energy, and Environment Department of 
Veterans Affairs
    Lieutenant General Kevin Vereen, Deputy Chief of Staff G9, 
Installation Management Command
    The Subcommittee on Military Construction, Department of 
Veterans Affairs, and Related Agencies held a hearing on March 
29, 2023, entitled ``Budget Hearing--Fiscal Year 2024 Request 
for the Department of Veterans Affairs''. The Subcommittee 
received testimony from:
    The Honorable Denis McDonough, Secretary, Department of 
Veterans Affairs
    The Subcommittee on Military Construction, Department of 
Veterans Affairs, and Related Agencies held a hearing on April 
18, 2023, entitled ``Budget Hearing--Fiscal Year 2024 Request 
for Navy and Marine Corps Military Construction and Family 
Housing''. The Subcommittee received testimony from:
    The Honorable Meredith Berger, Assistant Secretary of the 
Navy, Energy, Installations, and Environment
    Vice Admiral Ricky Williamson, Deputy Chief of Naval 
Operations, Fleet Readiness, and Logistics, N4, Office of the 
Chief of Naval Operations
    Lieutenant General Edward D. Banta, Deputy Commandant, 
Installations and Logistics, United States Marine Corps
    The Subcommittee on Military Construction, Department of 
Veterans Affairs, and Related Agencies held a hearing on April 
20, 2023, entitled ``Budget Hearing--Fiscal Year 2024 Request 
for Air Force and Space Force Military Construction and Family 
Housing''. The Subcommittee received testimony from:
    Dr. Ravi I. Chaudhary, Assistant Secretary of the Air 
Force, Energy, Installations, and Environment, Department of 
the Air Force
    Mr. Bruce Hollywood, Associate Chief Operations Officer, 
Office of the Chief Operations Officer, United States Space 
Force
    Brigadier General Brian S. Hartless, Air Force Director of 
Civil Engineers, Deputy Chief of Staff for Logistics, 
Engineering and Force Protection, United States Air Force

      COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY

    The following table provides a detailed summary, for each 
Department and agency, comparing the amounts recommended in the 
bill with amounts enacted for fiscal year 2023 and budget 
estimates presented for fiscal year 2024.


                             MINORITY VIEWS

    The fiscal year (FY) 2024 Military Construction, Veterans 
Affairs, and Related Agencies (MilCon-VA) bill funds critical 
military construction, family housing, and quality of life 
improvements and enhancements for our brave men and women in 
uniform and their families. The bill also funds a wide variety 
of assistance programs for veterans, including disability and 
pension benefits, healthcare services, educational assistance, 
and home loan and insurance programs they have earned through 
their service to our country. It also funds the American Battle 
Monuments Commission, Armed Forces Retirement Home, Arlington 
National Cemetery, and the Court of Appeals for Veterans 
Claims. This bill provides $155.7 billion in total 
discretionary funding, which is $1.5 billion above the FY 2023 
enacted funding level and $799.4 million above the budget 
request.
    We thank Chairman Carter and his staff for their work in 
keeping a professional process in place and engaging in 
respectful debate on difficult issues, in spite of clear policy 
differences. While efforts were made to accommodate Democratic 
priorities, the funding levels and policy riders in the MilCon-
VA bill are not workable or sustainable.

                     DEPARTMENT OF VETERANS AFFAIRS

    On August 10, 2022, President Biden signed the Sergeant 
First Class Heath Robinson Honoring our Promise to Address 
Comprehensive Toxics (PACT) Act of 2022 (P.L. 117-168) after 
passing the House with overwhelming bipartisan support with a 
vote of 342-88. Included in the PACT Act is the Cost of War 
Toxic Exposures Fund (TEF)--the dedicated funding source for 
care and services for veterans of all wars exposed to Agent 
Orange, burn pits, and other toxic substances. As such, the 
budget requested $20.3 billion for the TEF in FY 2024 and $21.5 
billion in advance appropriations in FY 2025, consistent with 
the law and congressional intent to fund all toxic exposures 
related care and services out of the TEF.
    House Republican's subcommittee mark included only $5.5 
billion for the Fund, rejecting the budget request to provide 
all required resources for care and services related to toxic 
exposures through the dedicated funding source, and 
backtracking on our promises made in the PACT Act. 
Subsequently, on June 3, 2023, the Fiscal Responsibility Act of 
2023 (P.L. 118-5) was signed into law, setting topline spending 
levels for defense and domestic spending and providing full 
funding for the TEF for FY 2024 and 2025. We are pleased to see 
the Managers' amendment incorporate changes to comport to the 
Fiscal Responsibility Act.
    The current version of the bill funds the Department of 
Veterans Affairs at $299.5 billion in total budgetary 
resources, which is $3.8 billion below FY 2023 and $20.3 
billion below the budget request. However, combined with the 
amounts provided for the TEF in the Fiscal Responsibility Act, 
the Department of Veterans Affairs is funded at the budget 
request level. The bill provides $121 billion for the four 
medical care accounts. Combined with the $17.1 billion provided 
for medical care through the TEF in the Fiscal Responsibility 
Act, a total of $138 billion is available for medical care in 
2024, equal to the budget request. The bill further provides 
$112.6 billion in advance appropriations for medical care. 
Combined with the $21.5 billion provided in advance for 2025 
for medical care through the TEF in the Fiscal Responsibility 
Act, a total of $134 billion will be available for medical care 
in 2025, equal to the budget request.
    We are disappointed that the bill rejects the budget 
request to provide $2 billion in mandatory funding to start to 
whittle down the over $100 billion infrastructure backlog. We 
will not be able to make real progress in VA's infrastructure 
backlog without dedicated investment in our facilities outside 
the normal discretionary funding streams. We need this funding 
to improve the quality of care at VA's facilities for our 
veterans and VA employees.

                         MILITARY CONSTRUCTION

    The bill funds military construction at $17.5 billion, 
which is $1.5 billion below the FY 2023 enacted level. This 
amount is $200 million lower than the level marked up in 
subcommittee, which only exacerbates the problem of 
underfunding military construction. Since 2021, this committee 
has built on the progress from the previous year and continued 
to increase investments in military construction. This bill 
backtracks on that progress. In a time when we have a 
recruitment and retention issue, the condition of military 
facilities has a direct impact on the quality of life of our 
servicemembers and their families. We need to be strongly 
investing in infrastructure that supports quality of life--
including child development centers, gyms, barracks, family 
housing, among others, to better the lives of our 
servicemembers and their families.
    We are pleased that the bill includes Ranking Member 
Wasserman Schultz's request to provide $30 million in dedicated 
funding to expand the oversight of the housing portfolio at the 
Department of Defense, including government-owned and 
controlled family housing and privatized family and 
unaccompanied housing in the Managers' amendment. We appreciate 
Chairman Carter's shared commitment to this oversight and 
ensuring privatized housing providers are held accountable. The 
wellbeing of servicemembers and their families is of utmost 
importance, and continuing to hear reports of poor housing 
conditions, slow response times, and indifference towards 
requests for assistance is unacceptable.
    We are disappointed that the bill only provides $539 
billion for the Department of Defense Base Closure Account 
(BRAC), which is a cut of $35.5 million compared to the current 
level and does not include dedicated funding for PFAS 
remediation and cleanup, which is a cut of $200 million. It 
also does not include additional, dedicated funding for 
military installation climate change and resilience projects, 
which is a cut of $90 million from the current level.
    The bill would have been improved if the amendments offered 
by Ranking Member Wasserman Schultz and Congresswoman Lee were 
adopted to strike the partisan poison pill riders related to 
Guantanamo Bay, Critical Race Theory, and Diversity, Equity, 
and Inclusion. There is no funding in this bill related to 
housing Guantanamo Bay prisoners and is not germane to the 
bill.
    Furthermore, the majority added even more partisan poison 
pill riders during the full committee markup--prohibiting VA 
from implementing its Interim Final Rule on abortion, 
prohibiting VA from flying Pride flags at its facilities, 
prohibiting VA from providing hormone therapy or surgical 
treatment for gender affirming care, further prohibitions on 
Diversity, Equity, and Inclusion training or implementation, 
and prohibiting the discrimination against people who believe 
marriage is between a man and a woman. These riders only 
further politicize this bill, and takes away from the focus on 
veterans, servicemembers, and their families.
    This subcommittee has a long-standing tradition of 
bipartisanship, and we will work in good faith with our 
colleagues as we proceed through the appropriations process 
with the hope of restoring bipartisan priorities in this bill. 
By working together, we can best address the needs of our 
Nation's military and its veterans and reach an agreement on 
the Military Construction, Veterans Affairs, and Related 
Agencies bill for FY 2024.

                                   Rosa DeLauro.
                                   Debbie Wasserman Schultz.