[House Report 118-251]
[From the U.S. Government Publishing Office]


118th Congress  }                                              {    Report
                        HOUSE OF REPRESENTATIVES
 1st Session    }                                              {  118-251

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



 
             CAREGIVER OUTREACH AND PROGRAM ENHANCEMENT ACT

                                _______
                                

October 25, 2023.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

          Mr. Bost, from the Committee on Veterans' Affairs, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 3581]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 3581) to amend title 38, United States Code, to 
modify the family caregiver program of the Department of 
Veterans Affairs to include services related to mental health 
and neurological disorders, and for other purposes, having 
considered the same, reports favorably thereon with an 
amendment and recommends that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     2
Purpose and Summary..............................................     5
Background and Need for Legislation..............................     5
Hearings.........................................................     7
Subcommittee Consideration.......................................     8
Committee Consideration..........................................     9
Committee Votes..................................................     9
Committee Oversight Findings.....................................     9
Statement of General Performance Goals and Objectives............     9
Earmarks and Tax and Tariff Benefits.............................    10
Committee Cost Estimate..........................................    10
Budget Authority and Congressional Budget Office Estimate........    10
Federal Mandates Statement.......................................    13
Advisory Committee Statement.....................................    13
Applicability to Legislative Branch..............................    13
Statement on Duplication of Federal Programs.....................    13
Section-by-Section Analysis of the Legislation...................    13
Changes in Existing Law Made by the Bill as Reported.............    15

    The amendment is as follows:
    Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Caregiver Outreach and Program 
Enhancement Act'' or the ``COPE Act''.

SEC. 2. AUTHORITY FOR SECRETARY OF VETERANS AFFAIRS TO AWARD GRANTS TO 
                    ENTITIES TO IMPROVE PROVISION OF MENTAL HEALTH 
                    SUPPORT TO FAMILY CAREGIVERS OF VETERANS.

  (a) In General.--Subchapter II of chapter 17 of title 38, United 
States Code, is amended by adding at the end the following new section:

``Sec. 1720K. Grants to provide mental health support to family 
                    caregivers of veterans

  ``(a) Authority.--The Secretary may award grants to carry out, 
coordinate, improve, or otherwise enhance mental health counseling, 
treatment, or support to the family caregivers of veterans 
participating in the family caregiver program.
  ``(b) Application.--(1) To be eligible for a grant under this 
section, an entity shall submit to the Secretary an application 
therefor at such time, in such manner, and containing such information 
as the Secretary may require.
  ``(2) Each application submitted under paragraph (1) shall include 
the following:
          ``(A) A detailed plan for the use of the grant.
          ``(B) A description of the programs or efforts through which 
        the entity will meet the outcome measures developed by the 
        Secretary under subsection (g).
          ``(C) A description of how the entity will distribute grant 
        amounts equitably among areas with varying levels of 
        urbanization.
          ``(D) A plan for how the grant will be used to meet the 
        unique needs of veterans residing in rural areas, American 
        Indian or Alaska Native veterans, elderly veterans, women 
        veterans, and veterans from other underserved communities.
  ``(c) Distribution.--The Secretary shall seek to ensure that grants 
awarded under this section are equitably distributed among entities 
located in States with varying levels of urbanization.
  ``(d) Priority.--The Secretary shall prioritize awarding grants under 
this section that will serve the following areas:
          ``(1) Areas with high rates of veterans enrolled in the 
        family caregiver program.
          ``(2) Areas with high rates of--
                  ``(A) suicide among veterans; or
                  ``(B) referrals to the Veterans Crisis Line.
  ``(e) Required Activities.--Any grant awarded under this section 
shall be used--
          ``(1) to expand existing programs, activities, and services;
          ``(2) to establish new or additional programs, activities, 
        and services; or
          ``(3) for travel and transportation to facilitate carrying 
        out paragraph (1) or (2).
  ``(f) Outcome Measures.--(1) The Secretary shall develop and provide 
to each entity that receives a grant under this section written 
guidance on the following:
          ``(A) Outcome measures.
          ``(B) Policies of the Department.
  ``(2) In developing outcome measures under paragraph (1), the 
Secretary shall consider the following goals:
          ``(A) Increasing the utilization of mental health services 
        among family caregivers of veterans participating in the family 
        caregiver program.
          ``(B) Reducing barriers to mental health services among 
        family caregivers of veterans participating in such program.
  ``(g) Tracking Requirements.--(1) The Secretary shall establish 
appropriate tracking requirements with respect to the entities 
receiving a grant under this section.
  ``(2) Not less frequently than annually, the Secretary shall submit 
to Congress a report on such tracking requirements.
  ``(h) Performance Review.--The Secretary shall--
          ``(1) review the performance of each entity that receives a 
        grant under this section; and
          ``(2) make information regarding such performance publicly 
        available.
  ``(i) Remediation Plan.--(1) In the case of an entity that receives a 
grant under this section and does not meet the outcome measures 
developed by the Secretary under subsection (g), the Secretary shall 
require the entity to submit to the Secretary a remediation plan under 
which the entity shall describe how and when it plans to meet such 
outcome measures.
  ``(2) The Secretary may not award a subsequent grant under this 
section to an entity described in paragraph (1) unless the Secretary 
approves the remediation plan submitted by the entity under such 
paragraph.
  ``(j) Maximum Amount.--The amount of a grant awarded under this 
section may not exceed 10 percent of amounts made available for grants 
under this section for the fiscal year in which the grant is awarded.
  ``(k) Supplement, Not Supplant.--Any grant awarded under this section 
shall be used to supplement and not supplant funding that is otherwise 
available through the Department to provide mental health support among 
family caregivers of veterans participating in the family caregiver 
program.
  ``(l) Outreach to Family Caregivers.--The Secretary shall include, in 
the outreach materials regularly mailed to a family caregiver who 
participates in the family caregiver program, notice of mental health 
support provided by recipients of grants under this section that are 
located in the relevant Veterans Integrated Service Network.
  ``(m) Funding.--(1) Amounts for the activities of the Department 
under this section shall be budgeted and appropriated through a 
separate appropriation account.
  ``(2) In the budget justification materials submitted to Congress in 
support of the budget of the Department for any fiscal year (as 
submitted with the budget of the President under section 1105(a) of 
title 31), the Secretary shall include a separate statement of the 
amount requested to be appropriated for that fiscal year for the 
account specified in paragraph (1).
  ``(n) Authorization of Appropriations.--There is authorized to be 
appropriated to the Secretary, for each of fiscal years 2024 through 
2026, $50,000,000 to carry out this section.
  ``(o) Definitions.--In this section:
          ``(1) The terms `caregiver' and `family caregiver' have the 
        meanings given those terms in section 1720G of this title.
          ``(2) The term `family caregiver program' means the program 
        of comprehensive assistance for family caregivers under section 
        1720G of this title.
          ``(3) The term `Veterans Crisis Line' means the toll-free 
        hotline for veterans established under section 1720F of this 
        title.''.
  (b) Clerical Amendment.--The table of sections at the beginning of 
such subchapter is amended by adding at the end the following new item:

``1720K. Grants to provide mental health support to family caregivers 
of veterans.''.

SEC. 3. CONTRIBUTIONS TO LOCAL AUTHORITIES TO MITIGATE THE RISK OF 
                    FLOODING ON LOCAL PROPERTY ADJACENT TO MEDICAL 
                    FACILITIES OF THE DEPARTMENT OF VETERANS AFFAIRS.

  (a) In General.--Section 8108 of title 38, United States Code, is 
amended by inserting ``, or to mitigate the risk of flooding, including 
the risk of flooding associated with rising sea levels'' before the 
period at the end.
  (b) Report.--Not later than two years after the date of the enactment 
of this Act, the Secretary of Veterans Affairs shall submit to the 
Committees on Veterans' Affairs of the House of Representatives and the 
Senate a report that includes an assessment of--
          (1) the extent to which each medical facility (as such term 
        is defined in section 8101(3) of title 38, United States Code) 
        is at risk of flooding, including the risk of flooding 
        associated with rising sea levels; and
          (2) whether additional resources are necessary to address the 
        risk of flooding at each such facility.
  (c) Authorization of Appropriations.--There is authorized to be 
appropriated for the Department of Veterans Affairs for each of fiscals 
year 2024 through 2028 $25,000,000 to carry out the amendment made by 
subsection (a).

SEC. 4. GAO REPORT ON MENTAL HEALTH SUPPORT FOR CAREGIVERS.

  (a) Report Required.--Not later than one year after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall submit to the Committee on Veterans' Affairs of the Senate and 
the Committee on Veterans' Affairs of the House of Representatives a 
report on the provision of mental health support to caregivers of 
veterans.
  (b) Contents.--The report submitted under subsection (a) shall 
include the following:
          (1) An assessment of the need for mental health support among 
        caregivers participating in the caregiver programs.
          (2) An assessment of options for mental health support in 
        facilities of the Department of Veterans Affairs and in the 
        community for caregivers participating in the caregiver 
        programs.
          (3) An assessment of the availability and accessibility of 
        mental health support in facilities of the Department and in 
        the community for caregivers participating in the caregiver 
        programs.
          (4) An assessment of the awareness among caregivers of the 
        availability of mental health support in facilities of the 
        Department and in the community for caregivers participating in 
        the caregiver programs.
          (5) An assessment of barriers to mental health support in 
        facilities of the Department and in the community for 
        caregivers participating in the caregiver programs.
  (c) Definitions.--In this section:
          (1) The term ``caregiver'' has the meaning given that term in 
        section 1720G of title 38, United States Code.
          (2) The term ``caregiver programs'' means--
                  (A) the program of comprehensive assistance for 
                family caregivers under subsection (a) of section 1720G 
                of title 38, United States Code; and
                  (B) the program of support services for caregivers 
                under subsection (b) of such section.

SEC. 5. ANNUAL REVIEW OF SECURITY AT COVERED FACILITIES OF THE 
                    DEPARTMENT OF VETERANS AFFAIRS.

  (a) Annual Survey.--Not later than one year after the date of the 
enactment of this Act, and annually thereafter for each of the 
following five years, the Secretary of Veterans Affairs, in 
coordination with the Director of the Office of Security and Law 
Enforcement of the Department of Veterans Affairs, shall conduct an 
annual survey of covered employees to collect information regarding 
security at each covered facility. Each annual survey shall include 
questions about--
          (1) the type and frequency of criminal activity experienced 
        at the covered facility during the 12 months prior to the date 
        the covered employee completes the survey;
          (2) the number of vacant positions for Department police 
        officers at the covered facility and the number of days each 
        vacant position has been vacant;
          (3) the availability and adequacy of covered equipment;
          (4) the availability and adequacy of resources, classes, or 
        other time set aside for training Department police officers 
        who work at each covered facility about any skill or tactic 
        related to law enforcement, including the proper use of force, 
        firearms qualifications and training, procedures for responding 
        to an active threat, and any other training required for 
        Department police officers;
          (5) any security weakness;
          (6) an analysis of the relationship between the covered 
        facility (including the Department police officers who work at 
        the covered facility) and local law enforcement agencies;
          (7) efforts by the personnel of the covered facility to 
        address and reduce criminal activity at, or in close proximity 
        to, the covered facility; and
          (8) recommendations for the Secretary to better address and 
        reduce criminal activity at, or in close proximity to, covered 
        facilities.
  (b) Report.--Not later than one year after the date of the enactment 
of this Act, and annually thereafter for each of the following five 
years, the Secretary shall submit to each of the Committees on 
Veterans' Affairs of the Senate and the House of Representatives an 
annual report regarding security at covered facilities that includes--
          (1) the results of the annual survey described under 
        subsection (a) for the year covered by the report;
          (2) an analysis, made in coordination with the Director of 
        the Office of Security and Law Enforcement of such Department 
        and each director and police chief of a Veterans Integrated 
        Service Network, of the results of the annual survey described 
        under subsection (a) for the year covered by the report;
          (3) a plan of action that describes how the Secretary plans 
        to address any security weakness identified in the results of 
        the annual survey and includes clearly-stated goals with 
        measurable benchmarks for each goal and deadlines for each 
        benchmark; and
          (4) a list of each vacant position for police chief or deputy 
        police chief at each covered facility, and the number of days 
        the position has been vacant.
  (c) Definitions.--In this section:
          (1) The term ``covered equipment'' means any item issued by 
        the Secretary of Veterans Affairs to a Department police 
        officer (including batons, firearms, pepper spray, ballistic 
        vests, body-worn cameras, and radios) for use in the provision 
        of services under section 902 of title 38, United States Code.
          (2) The term ``covered employee'' means any employee of the 
        Department of Veterans Affairs who is employed at a covered 
        facility as a police chief, a facility emergency management 
        leader, a facility director, or a person carrying out the 
        responsibilities of one of these positions in an acting 
        capacity.
          (3) The term ``covered facility'' means any facility of the 
        Department of Veterans Affairs where Department police officers 
        have jurisdiction.
          (4) The term ``Department police officer'' has the meaning 
        given to such term as used in section 902 of title 38, United 
        States Code.
          (5) The term ``security weakness'' means a deficiency in the 
        facilities, staffing, or covered equipment at a covered 
        facility that a covered employee of the covered facility 
        determines presents a risk to the safety of visitors or staff, 
        including an unsecured door, inoperable security camera, 
        unsecured police operations room, a lack of security presence 
        at an entrance to the covered facility, and a lack of security 
        presence in an area of the covered facility or the grounds of 
        the covered facility that the director of the covered facility 
        determines requires an increased security presence.

SEC. 6. DEPARTMENT OF VETERANS AFFAIRS HOUSING LOAN FEES.

  The loan fee table in section 3729(b)(2) of title 38, United States 
Code, is amended by striking ``November 14, 2031'' each place it 
appears and inserting ``March 12, 2032''.

                          Purpose and Summary

    H.R. 3581, the ``Caregiver Outreach and Program Enhancement 
Act'' or ``COPE Act,'' was introduced by Representative 
Jennifer Kiggans of Virginia, on May 22, 2023.
    H.R. 3581, as amended, would amend Title 38 of the United 
States Code by authorizing the Secretary of Veterans' Affairs 
to award grants to entities to improve the provision of mental 
health support to family caregivers of veterans participating 
in the family caregiver program. This legislation would also 
require a Comptroller General report on the provision of mental 
health support to caregivers of veterans. The bill as amended 
also includes the following bills:
    H.R. 2683, the ``VA Flood Preparedness Act'' was introduced 
by Representative Nancy Mace of South Carolina, on April 18, 
2023. H.R. 2683 would amend Section 8108 of title 38 of the 
United States Code to allow local authorities to mitigate the 
risk of flooding on local property adjacent to Department of 
Veterans Affairs (VA) medical facilities. This legislation 
would also require a report from the Secretary of Veterans' 
Affairs no later than two years after the date of enactment.
    H.R. 3504, the ``VA Medical Center Security Report of 
2023'' was introduced by Representative Jennifer Kiggans of 
Virginia, on May 18, 2023. H.R. 3504 would require the 
Secretary of Veterans' Affairs to submit to each of the 
Committees on Veterans' Affairs of the Senate and House of 
Representatives an annual report regarding security at VA 
facilities.
    Finally, the bill as amended would provide an offset for 
the cost of these programs by extending current rates for VA 
home loan funding fees.

                  Background and Need for Legislation


Section 1: Short title

    This Act may be cited as the ``Caregiver Outreach and 
Program Enhancement Act'' or ``COPE Act.''

Section 2: Authority for Secretary of Veterans Affairs to award grants 
        to entities to improve provision of mental health to support 
        caregivers of veterans

    The Program of Comprehensive Assistance for Family 
Caregivers (PCAFC) along with the Program of General Caregiver 
Support Services (PGCSS) make up the VA programs that provide 
certification and access to resources for those caring for 
veterans. Both programs provide access to training and peer-
support through online and in-person sessions, skills training 
focused on caregiving for a veteran's unique needs, counseling 
as related to the care of the veteran, and respite care. PCAFC 
is specifically for a family member or close friend who decides 
to take on the caregiving responsibility for a seriously ill or 
injured veteran. In addition to the services offered in both 
programs, these caregivers receive an additional stipend to 
compensate for their time and effort, mental health counseling, 
access to CHAMPVA if no other health insurance available, and 
beneficiary travel compensation.
    Even with the support elements made available via PCAFC, 
the stress of providing care often leaves caregivers wrestling 
with their own mental and physical hardships while they 
struggle to maintain a strong front for the veterans dependent 
on their care. In the current program, while caregivers are 
eligible for mental health support from VA, that aid has been 
constrained due to limited access and resources, as well as for 
intangible reasons such as stigma or fear of being disenrolled 
from the program. This challenging circumstance leaves 
caregivers with partially fulfilled mental health needs. 
Committee staff have met with several organizations 
representing caregivers who have expressed the level of concern 
and hesitancy from their members about seeking mental health 
care at VA facilities. This bill would help address this issue 
by setting up a grant program that would help caregivers seek 
the mental health they need without fear of reducing access for 
veterans or concerns about stigma. The Committee believes this 
change would be an important step toward providing access to a 
critical service that would not only help caregivers, but also 
the veterans who depend on them.

Section 3: Contributions to local authorities to mitigate the risk of 
        flooding on local property adjacent to medical facilities of 
        the Department of Veterans Affairs

    Many VA medical facilities are at least 60 years old. Some 
of these facilities have, over the years and due to locations 
in low-lying areas, been subject to flooding that impacts 
ingress or egress, or even threatens building functions. Flood 
preparedness is a prudent focus for VA facilities that are 
historically at risk of flooding from storms or from water 
encroachment that may or may not be tied to climate change. In 
certain instances, collaboration with local authorities is 
necessary for VA's flood preparedness, but the current statute 
only allows VA to contribute to local authorities for ``the 
construction of traffic controls, road improvements, or other 
devices adjacent to a medical facility if considered necessary 
for safe ingress or egress.'' This bill would allow VA to 
assist in locality flood mitigation investments on non-VA 
property that may be adjacent to facilities. The Secretary 
would also be required to do an assessment of each VA medical 
facility as to the extent that flooding may be a risk and 
identify what resources may be needed to address that risk. The 
Committee believes that this change will help protect VA 
facilities from future flooding, which will improve the ability 
to provide healthcare to veterans at these facilities safely.

Section 4: GAO report on mental health support for caregivers

    This section would require a Government Accountability 
Office report no later than one year after the enactment of the 
section. The report would assess the options for mental health 
support at VA facilities and in the community for caregivers, 
the availability of it, awareness of caregivers of options, and 
barriers to mental health at VA and the community for 
caregivers.

Section 5: Annual review of security at covered facilities of the 
        Department of Veterans Affairs

    In the 117th Congress, the Committee requested a 
significant amount of data about crime at VA medical centers. 
Violent crime, defined as active shooter, homicide, aggravated 
assault, sexual assault, and robbery, at VA medical centers has 
increased dramatically in the last few years. In FY 2018, 3,141 
violent crimes were committed. This increased to 5,002 in FY 
2020 and in FY 2021, 6,505 violent crimes occurred at VA 
medical centers. This increase in crime occurred despite the 
number of people at VA medical centers decreasing due to COVID-
19. To address these challenges, VA claims it has reworked its 
policing structure and hired a record number of officers; 
however, our committee lacks data to validate these claims.
    While the Committee knows that crime is increasing at VA 
medical centers, the Committee lacks a clear picture of the 
specific challenges all VA facilities are facing, as well as 
the broader issues impeding VA policing. The report in this 
section would give the Committee insight into the criminal 
activity on VA campuses as well as the status of equipment, 
training, current vacancies, and a host of other important 
information. This data would enable the Committee to identify 
the specific factors inhibiting safety at VA facilities--
including medical facilities, benefits offices, and 
cemeteries--and would allow the Committee to intelligently 
address the issues through appropriate and targeted oversight 
and legislation.

Section 6: Department of Veterans Affairs Housing Loan Fees

    Currently, veterans who take advantage of the VA Home Loan 
Program pay a small fee that is included in their monthly 
mortgage payment. This language would provide funding for the 
programs included in the larger legislation by extending the 
current rates for VA home loan funding fees by a few months. 
This funding method has been used since 1989, and extending the 
funding fee increases a veteran's monthly cost by about $5 on 
top of the monthly mortgage. The funding fee is not paid by 
disabled veterans, so they are not affected by this extension 
of the home loan fees.

                                Hearings

    On June 21, 2023, the Subcommittee on Health held a 
legislative hearing on H.R. 3581, H.R. 2683, and other bills 
pending before the subcommittee. The following witnesses 
testified:
          The Honorable Jenniffer Gonzalez-Colon, U.S. House of 
        Representatives, District At Large, Puerto Rico; Dr. 
        Erica Scavella, M.D., Assistant Under Secretary for 
        Health for Clinical Services, Veterans Health 
        Administration, U.S. Department of Veterans Affairs; 
        Dr. Colleen Richardson, Psy.D., Executive Director, 
        Caregiver Support Program, Veterans Health 
        Administration, U.S. Department of Veterans Affairs; 
        Dr. Scotte Hartronft, M.D., Executive Director, Office 
        of Geriatrics and Extended Care, Veterans Health 
        Administration, U.S. Department of Veterans Affairs; 
        Dr. Mark Hausman, M.D., Executive Director, Integrated 
        Access, Office of Integrated Veteran Care, Veterans 
        Health Administration, U.S. Department of Veterans 
        Affairs; Mr. Jon Retzer, Assistant National Legislative 
        Director, Disabled American Veterans; Ms. Tiffany 
        Ellett, Director, Veterans Affairs and Rehabilitation 
        Division, The American Legion; Mr. Cole Lyle, Executive 
        Director, Mission Roll Call, America's Warrior 
        Partnership.
    The following individuals and organizations submitted 
statements for the record:
          Wounded Warrior Project, The Independence Fund, 
        Concerned Veterans for America, American Federation of 
        Government Employees, All Points North, Veterans of 
        Foreign War.
    On July 12, 2023, the Subcommittee on Oversight and 
Investigations held a legislative hearing on H.R. 3504, and 
other bills pending before the subcommittee. The following 
witnesses testified:
          Mr. Lewis Ratchford, Chief Security Officer and 
        Deputy Assistant Secretary for the Office of Emergency 
        Management and Resilience, Office of Operations, 
        Security, and Preparedness, U.S. Department of Veterans 
        Affairs; Mr. Rondy Waye, Executive Director, Human 
        Capital Programs, Office of the Chief Human Capital 
        Officer, U.S. Department of Veterans Affairs; Mr. Ray 
        Tellez, Acting Deputy Under Secretary for Automated 
        Benefits Delivery, Veterans Benefits Administration, 
        U.S. Department of Veterans Affairs; Dr. Angela 
        Billups, Executive Director, Office of Acquisition and 
        Logistics, Office of Acquisition, Logistics, and 
        Construction, U.S. Department of Veterans Affairs; Mr. 
        David Case, Deputy Inspector General, Office of the 
        Inspector General, U.S. Department of Veterans Affairs; 
        Mr. Joshua Hastings, Veterans Benefits Policy Analyst, 
        The American Legion; Mr. Patrick Murray, Director, 
        National Legislative Service, Veterans of Foreign Wars; 
        Mr. Clint Romesha, SSG (ret), Board of Director, 
        Emeritus, America's Warrior Partnership; Ms. Terry 
        Gerton, President and Chief Executive Officer, National 
        Academy of Public Administration.
    The following individuals and organizations submitted 
statements for the record:
          American Federation of Government Employees (AFL-
        CIO), Concerned Veterans for America, Dr. Donald F. 
        Kettl, National Federation of Federal Employees, 
        Partnership for Public Service, Senior Executives 
        Association, and United Nurses Association of 
        California/Union of Health Care Professionals.

                       Subcommittee Consideration

    On July 18, 2023, the Subcommittee on Health met in open 
markup session, a quorum being present, and ordered H.R. 3581 
and H.R. 2683, be reported favorably to the House Committee on 
Veterans Affairs by voice vote.
    A motion by Ranking Member Brownley of California to report 
H.R. 3581 and H.R. 2683 favorably to the House Committee on 
Veterans Affairs was agreed to by voice vote.
    On July 19, 2023, the Subcommittee on Oversight and 
Investigations met in open mark-up session, a quorum being 
present, and ordered H.R. 3504, as amended, be reported 
favorably to the House Committee on Veterans Affairs by voice 
vote. During consideration of the bill, the following amendment 
was considered:
          An amendment in the nature of a substitute was 
        offered by Chairwoman Kiggans of Virginia that amended 
        H.R. 3504 to apply to all VA facilities, not just VA 
        medical facilities. The amendment in the nature of 
        substitute was approved by voice vote.
    A motion by Ranking Member Mrvan of Indiana, to report H.R. 
3504, as amended, favorably to the House Committee on Veterans 
Affairs was agreed to by voice vote.

                        Committee Consideration

    On July 26, 2023, the full Committee met in open markup 
session, a quorum being present. During consideration of the 
bill, the following amendment was considered:
          An amendment in the nature of a substitute was 
        offered by Representative Miller-Meeks of Iowa that 
        included the text of H.R. 3581, adopted by the 
        Subcommittee on Heath, and added the text of the 
        following bills: H.R. 2688, and H.R. 3504, as amended, 
        and as adopted by the Subcommittee on Oversight and 
        Investigations. The amendment would also extend current 
        rates for VA home loan funding fees to pay for programs 
        in the bill. The amendment in the nature of substitute 
        was approved by voice vote.
    A motion by Ranking Member Takano of California to report 
H.R. 3581, as amended, favorably to the House of 
Representatives was agreed to by voice vote.

                            Committee Votes

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, no recorded votes were taken on 
amendments or in connection with ordering H.R. 3581, as 
amended, reported to the House.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII and clause 
(2)(b)(1) of rule X of the Rules of the House of 
Representatives, the Committee's oversight findings and 
recommendations are reflected in the descriptive portions of 
this report.

         Statement of General Performance Goals and Objectives

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's performance 
goals and objectives of H.R. 3581, as amended, are to provide 
improvements to healthcare benefits provided to veterans.

                  Earmarks and Tax and Tariff Benefits

    H.R. 3581, as amended, does not contain any Congressional 
earmarks, limited tax benefits, or limited tariff benefits as 
defined in clause 9 of rule XXI of the Rules of the House of 
Representatives.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate on H.R. 
3581, as amended, prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

     Budget Authority and Congressional Budget Office Cost Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 3581, as amended, provided by the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974:




    The bill would:
           Extend the higher rates for fees that the 
        Department of Veterans Affairs (VA) now charges 
        borrowers for home loan guarantees
           Authorize VA to make grants to entities that 
        support mental health care for family caregivers
           Allow VA to contribute funds to local 
        authorities for projects to mitigate flood risks at VA 
        medical facilities
           Require the Government Accountability Office 
        to report on VA's efforts to support family caregivers' 
        mental health
           Require several studies, surveys, and 
        reports on flood risks and security at VA facilities
    Estimated budgetary effects would mainly stem from:
           Extending the higher rates for fees charged 
        by VA for home loan guarantees
           Authorizing grants to entities that provide 
        mental health support and services
           Providing contributions to local authorities
    Bill summary: H.R. 3581 would make changes to the home loan 
guarantee program of the Department of Veterans Affairs (VA). 
The bill also would authorize VA to make grants to entities 
that provide mental health services to family caregivers of 
veterans and to contribute funds to local authorities to help 
mitigate flood risks at VA medical facilities. In addition, the 
bill would require several studies, surveys, and reports by VA 
and the Government Accountability Office (GAO).
    Estimated Federal cost: The estimated budgetary effects of 
H.R. 3581 are shown in Table 1. The costs of the legislation 
fall within budget function 700 (veterans benefits and 
services).

                                                   TABLE 1.--ESTIMATED BUDGETARY EFFECTS OF H.R. 3581
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                  By fiscal year, millions of dollars--
                                                --------------------------------------------------------------------------------------------------------
                                                  2023   2024   2025   2026   2027   2028   2029   2030    2031     2032     2033   2023-2028  2023-2033
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                              Decreases in Direct Spending
 
Estimated Budget Authority.....................      0      0      0      0      0      0      0      0        0     -288        0         0       -288
Estimated Outlays..............................      0      0      0      0      0      0      0      0        0     -288        0         0       -288
 
                                                     Increases in Spending Subject to Appropriation
 
Estimated Authorization........................      0     75     76     76     25     25      0      0        0        0        0       277        277
Estimated Outlays..............................      0     70     76     76     30     25      0      0        0        0        0       277        277
--------------------------------------------------------------------------------------------------------------------------------------------------------

    Basis of estimate: For this estimate, CBO assumes that H.R. 
3581 will be enacted at the beginning of fiscal year 2024 and 
that provisions will take effect upon enactment or on the dates 
specified by the bill. CBO also estimates that outlays will 
follow historical spending patterns for affected programs.
    Direct spending: The bill would extend--for about four 
months--the higher fees that VA charges borrowers for its loan 
guarantees. VA provides loan guarantees to lenders that allow 
eligible borrowers to obtain better loan terms--such as lower 
interest rates or smaller down payments--to purchase, build, 
improve, or refinance a home. VA typically pays lenders up to 
25 percent of the outstanding mortgage balance if a borrower's 
home is foreclosed upon. Those payments, net of fees paid by 
borrowers and recoveries by lenders, constitute the subsidy 
cost for the loan guarantees.\1\
---------------------------------------------------------------------------
    \1\Under the Federal Credit Reform Act of 1990, the subsidy cost of 
a loan guarantee is the net present value of estimated payments by the 
government to cover defaults and delinquencies, interest subsidies, or 
other expenses offset by any payments to the government, including 
origination or other fees, penalties, and recoveries on defaulted 
loans. Such subsidy costs are calculated by discounting those expected 
cash flows using the rate on Treasury securities of comparable 
maturity. The resulting estimated subsidy costs are recorded in the 
budget when the loans are disbursed or modified. A positive subsidy 
indicates that the loan results in net outlays from the Treasury; a 
negative subsidy indicates that the loan results in net receipts to the 
Treasury.
---------------------------------------------------------------------------
    Under current law, the rates for most fees that borrowers 
pay to VA for loans guaranteed on or after November 14, 2031, 
will drop from a weighted average of about 2.4 percent to about 
1.2 percent of the loan amount. Section 6 of the bill would 
extend the higher rates through March 12, 2032, thereby 
reducing the subsidy cost of loans guaranteed during that four-
month period. Using information from VA, CBO estimates that 
extending the higher rates would decrease direct spending by 
$288 million over the 2023-2033 period.
    Spending subject to appropriation: H.R. 3581 also would 
authorize appropriations for several purposes and would require 
VA and GAO to produce several reports. In total, implementing 
those provisions would cost $277 million over the 2023-2028 
period (see Table 2). Such spending would be subject to the 
appropriation of the specified and estimated amounts.

               TABLE 2.--ESTIMATED INCREASES IN SPENDING SUBJECT TO APPROPRIATION UNDER H.R. 3581
----------------------------------------------------------------------------------------------------------------
                                                              By fiscal year, millions of dollars--
                                                ----------------------------------------------------------------
                                                   2023     2024     2025     2026     2027     2028   2023-2028
----------------------------------------------------------------------------------------------------------------
Grants:
    Authorization..............................        0       50       50       50        0        0       150
    Estimated Outlays..........................        0       45       50       50        5        0       150
Contributions:
    Authorization..............................        0       25       25       25       25       25       125
    Estimated Outlays..........................        0       25       25       25       25       25       125
Reports:
    Estimated Authorization....................        0        *        1        1        *        *         2
    Estimated Outlays..........................        0        *        1        1        *        *         2
    Total Changes:
        Estimated Authorization................        0       75       76       76       25       25       277
        Estimated Outlays......................        0       70       76       76       30       25       277
----------------------------------------------------------------------------------------------------------------
*= between zero and $500,000.

    Grants. Section 2 would authorize VA to award grants to 
entities that provide and coordinate services to improve the 
mental health of people who participate in the department's 
family caregiver program. The bill would authorize 
appropriations of $50 million for each of fiscal years 2024 
through 2026 for those grants. Using historical spending rates 
for similar activities, CBO estimates that the grants would 
cost $150 million over the 2023-2028 period.
    Contributions. Section 3 would authorize annual 
appropriations of $25 million over the 2024-2028 period for 
contributions to local authorities for projects to mitigate the 
risk of flooding on properties that are adjacent to VA's 
medical facilities. CBO estimates that implementing section 3 
would cost $125 million over the 2023-2028 period.
    Reports. H.R. 3581 would require GAO to evaluate the need 
for and availability of mental health support for family 
caregivers of veterans and to report those findings to the 
Congress. The bill also would require VA to survey employees 
concerning security at the department's facilities and to 
report that information annually to the Congress. In addition, 
the bill would require a onetime report on flood risks at its 
facilities. Based on costs for similar activities, CBO 
estimates the cost of implementing at $2 million over the 2023-
2028 period.
    Pay-As-You-Go considerations: The Statutory Pay-As-You-Go 
Act of 2010 establishes budget-reporting and enforcement 
procedures for legislation affecting direct spending or 
revenues. The net changes in outlays that are subject to those 
pay-as-you-go procedures are shown in Table 1.
    Increase in long-term net direct spending and deficits: 
None.
    Mandates: None.
    Estimate prepared by: Federal Costs: Paul B.A. Holland (for 
home loans), Etaf Khan (for veterans' health); Mandates: Grace 
Watson.
    Estimate reviewed by: David Newman, Chief, Defense, 
International Affairs, and Veterans' Affairs Cost Estimates 
Unit; Christina Hawley Anthony, Deputy Director of Budget 
Analysis.
    Estimate approved by: Phillip L. Swagel, Director, 
Congressional Budget Office.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 3581, as amended, prepared by the 
Director of the Congressional Budget Office pursuant to section 
423 of the Unfunded Mandates Reform Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
3581, as amended.

                  Applicability to Legislative Branch

    The Committee finds that H.R. 3581, as amended, does not 
relate to the terms and conditions of employment or access to 
public services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

              Statement on Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that no provision 
of H.R. 3581, as amended, establishes or reauthorizes a program 
of the Federal Government known to be duplicative of another 
Federal program, a program that was included in any report from 
the Government Accountability Office to Congress pursuant to 
section 21 of Public Law 111-139, or a program related to a 
program identified in the most recent Catalog of Federal 
Domestic Assistance.

             Section-by-Section Analysis of the Legislation


Section 1: Short title

    Section 1 would establish the short title as the 
``Caregiver Outreach and Program Enhancement Act'' or the 
``COPE Act.''

Section 2: Authority for Secretary of Veterans Affairs to award grants 
        to entities to improve provision of mental health support to 
        family caregivers of veterans

    Section 2(a) would amend Subchapter II of chapter 17 of 
title 38 U.S.C., by adding at the end the following new 
section: Section 1720K. Grants to provide mental health support 
to family caregivers of veterans.
          Section (a) would allow the Secretary to award grants 
        to carry out, coordinate, improve, or otherwise enhance 
        mental health counseling, treatment, or support to the 
        family caregivers of veterans participating in the 
        family caregiver program.
          Section (b) would establish eligibility by requiring 
        an entity to submit an application that includes a 
        detailed plan for the use of the grant, a description 
        of the program through which outcome measures are met, 
        a description of equitable distribution of grants in 
        different areas, and plans for meeting the unique needs 
        of veterans in underserved areas.
          Section (c) would require the Secretary to seek to 
        distribute grants equitably among entities located in 
        states with varying levels of urbanization.
          Section (d) would prioritize the award of grant to 
        areas with high rates of veterans enrolled in the 
        family caregiver program and areas with high rates of 
        veteran suicide or referrals to the Veteran Crisis 
        Line.
          Section (e) would require that grants awarded under 
        this section shall be used to: expand existing 
        programs, activities and services; establish new or 
        additional programs, activities, and services; or for 
        travel and transportation to facilitate programs, 
        activities, and services.
          Section (f) would require the Secretary to provide 
        written guidance on outcome measures and on policies of 
        the Department. In developing outcome measures, 
        consideration would be given to increasing mental 
        health services utilization and reducing barriers for 
        family caregivers.
          Section (g) would require the Secretary to develop 
        tracking requirements and to report on them annually to 
        Congress.
          Section (h) would require the Secretary to review 
        grantee performance, making such information publicly 
        available.
          Section (i) would require that in the case an entity 
        does not meet the developed outcome measures, the 
        Secretary shall require the entity to submit a 
        remediation plan and describe how and when it plans to 
        meet such outcome measure.
          Section (j) would limit the amount of the grant 
        awarded under this section to not exceed 10 percent of 
        the amounts made available for grants for that fiscal 
        year.
          Section (k) would clarify that grants are intended to 
        supplement, not supplant, other funding available for 
        mental health support.
          Section (l) would require information about mental 
        health support provided by grant recipients be provided 
        in outreach materials sent to family caregivers 
        participating in the program.
          Section (m) would require that amounts for the 
        activities under this section be budgeted and 
        appropriated through a separate appropriation account. 
        In budget justification materials submitted to 
        Congress, the Secretary would also include a separate 
        statement of the amount requested to be appropriated 
        for that fiscal year.
          Section (n) would authorize appropriations of 
        $50,000,000 for each fiscal year 2024 through 2026.
          Section (o) would define certain terms used in this 
        section.
    Section 2(b) would make a clerical amendment.

Section 3: Contributions to local authorities to mitigate the risk of 
        flooding on local property adjacent to medical facilities of 
        the Department of Veterans' Affairs

    Section 3(a) would amend Section 8108 of title 38, United 
States Code, by inserting, ``or to mitigate the risk of 
flooding, including the risk of flooding associated with rising 
sea levels'' before the period at the end.
    Section 3(b) would require the Secretary to submit a report 
no later than two years after the date of enactment to the 
Committees on Veterans' Affairs of the House of Representatives 
and the Senate that includes an assessment of the extent each 
medical facility is at risk of flooding and whether additional 
resources are necessary.
    Section 3(c) would authorize appropriations, for each 
fiscal year 2024 through 2028, of $25,000,000 to carry out the 
amendment made by subsection (a).

Section 4: GAO report on mental health support for caregivers

    Section 4(a) would require the Comptroller General of the 
United States to submit a report to Congress, no later than one 
year after enactment, that reports on the provision of mental 
health support to caregivers.
    Section 4(b) would require that the report include an 
assessment of the need for mental health support among 
caregivers, options for mental health support in VA and in the 
community, availability, accessibility, awareness of, and 
barriers to mental health support in VA facilities and the 
community for caregivers participating in caregiver programs.
    Section 4(c) would define certain terms used in this 
section.

Section 5: Annual review of security at covered facilities of the 
        Department of Veterans' Affairs

    Section 5(a) would require the Secretary in coordination 
with the Director of the Office of Security and Law enforcement 
of the VA to conduct an annual survey no later than one year 
after the date of enactment. The survey would collect 
information regarding security at each covered facility.
    Section 5(b) would require the Secretary to submit a report 
no later than one year after the date of enactment and annually 
for the next five years, to each of the Committees on Veterans' 
Affairs of the Senate and House of Representatives regarding 
security at covered facilities. The annual report should 
include detailing survey results, analyses, action plans to 
address security weaknesses, and information about vacant 
police chief positions.
    Section 5(c) would define certain terms used in this 
section.

Section 6: Department of Veterans Affairs Housing Loan Fees

    Section 6 would amend the loan fee table in section 
3729(b)(2) of title 38, United States Code, by striking 
``November 14, 2031'' each place it appears and inserting 
``March 12, 2032''.

         Changes in Existing Law Made by the Bill, as Reported

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

         Changes in Existing Law Made by the Bill, as Reported

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

                      TITLE 38, UNITED STATES CODE



           *       *       *       *       *       *       *
PART II--GENERAL BENEFITS

           *       *       *       *       *       *       *


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

                          SUBCHAPTER I--GENERAL

Sec.
1701. Definitions.
     * * * * * * *

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

     * * * * * * *
1720K. Grants to provide mental health support to family caregivers of 
          veterans.

           *       *       *       *       *       *       *


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

           *       *       *       *       *       *       *


Sec. 1720K. Grants to provide mental health support to family 
                    caregivers of veterans

  (a) Authority.--The Secretary may award grants to carry out, 
coordinate, improve, or otherwise enhance mental health 
counseling, treatment, or support to the family caregivers of 
veterans participating in the family caregiver program.
  (b) Application.--(1) To be eligible for a grant under this 
section, an entity shall submit to the Secretary an application 
therefor at such time, in such manner, and containing such 
information as the Secretary may require.
  (2) Each application submitted under paragraph (1) shall 
include the following:
          (A) A detailed plan for the use of the grant.
          (B) A description of the programs or efforts through 
        which the entity will meet the outcome measures 
        developed by the Secretary under subsection (g).
          (C) A description of how the entity will distribute 
        grant amounts equitably among areas with varying levels 
        of urbanization.
          (D) A plan for how the grant will be used to meet the 
        unique needs of veterans residing in rural areas, 
        American Indian or Alaska Native veterans, elderly 
        veterans, women veterans, and veterans from other 
        underserved communities.
  (c) Distribution.--The Secretary shall seek to ensure that 
grants awarded under this section are equitably distributed 
among entities located in States with varying levels of 
urbanization.
  (d) Priority.--The Secretary shall prioritize awarding grants 
under this section that will serve the following areas:
          (1) Areas with high rates of veterans enrolled in the 
        family caregiver program.
          (2) Areas with high rates of--
                  (A) suicide among veterans; or
                  (B) referrals to the Veterans Crisis Line.
  (e) Required Activities.--Any grant awarded under this 
section shall be used--
          (1) to expand existing programs, activities, and 
        services;
          (2) to establish new or additional programs, 
        activities, and services; or
          (3) for travel and transportation to facilitate 
        carrying out paragraph (1) or (2).
  (f) Outcome Measures.--(1) The Secretary shall develop and 
provide to each entity that receives a grant under this section 
written guidance on the following:
          (A) Outcome measures.
          (B) Policies of the Department.
  (2) In developing outcome measures under paragraph (1), the 
Secretary shall consider the following goals:
          (A) Increasing the utilization of mental health 
        services among family caregivers of veterans 
        participating in the family caregiver program.
          (B) Reducing barriers to mental health services among 
        family caregivers of veterans participating in such 
        program.
  (g) Tracking Requirements.--(1) The Secretary shall establish 
appropriate tracking requirements with respect to the entities 
receiving a grant under this section.
  (2) Not less frequently than annually, the Secretary shall 
submit to Congress a report on such tracking requirements.
  (h) Performance Review.--The Secretary shall--
          (1) review the performance of each entity that 
        receives a grant under this section; and
          (2) make information regarding such performance 
        publicly available.
  (i) Remediation Plan.--(1) In the case of an entity that 
receives a grant under this section and does not meet the 
outcome measures developed by the Secretary under subsection 
(g), the Secretary shall require the entity to submit to the 
Secretary a remediation plan under which the entity shall 
describe how and when it plans to meet such outcome measures.
  (2) The Secretary may not award a subsequent grant under this 
section to an entity described in paragraph (1) unless the 
Secretary approves the remediation plan submitted by the entity 
under such paragraph.
  (j) Maximum Amount.--The amount of a grant awarded under this 
section may not exceed 10 percent of amounts made available for 
grants under this section for the fiscal year in which the 
grant is awarded.
  (k) Supplement, Not Supplant.--Any grant awarded under this 
section shall be used to supplement and not supplant funding 
that is otherwise available through the Department to provide 
mental health support among family caregivers of veterans 
participating in the family caregiver program.
  (l) Outreach to Family Caregivers.--The Secretary shall 
include, in the outreach materials regularly mailed to a family 
caregiver who participates in the family caregiver program, 
notice of mental health support provided by recipients of 
grants under this section that are located in the relevant 
Veterans Integrated Service Network.
  (m) Funding.--(1) Amounts for the activities of the 
Department under this section shall be budgeted and 
appropriated through a separate appropriation account.
  (2) In the budget justification materials submitted to 
Congress in support of the budget of the Department for any 
fiscal year (as submitted with the budget of the President 
under section 1105(a) of title 31), the Secretary shall include 
a separate statement of the amount requested to be appropriated 
for that fiscal year for the account specified in paragraph 
(1).
  (n) Authorization of Appropriations.--There is authorized to 
be appropriated to the Secretary, for each of fiscal years 2024 
through 2026, $50,000,000 to carry out this section.
  (o) Definitions.--In this section:
          (1) The terms ``caregiver'' and ``family caregiver'' 
        have the meanings given those terms in section 1720G of 
        this title.
          (2) The term ``family caregiver program'' means the 
        program of comprehensive assistance for family 
        caregivers under section 1720G of this title.
          (3) The term ``Veterans Crisis Line'' means the toll-
        free hotline for veterans established under section 
        1720F of this title.

           *       *       *       *       *       *       *


PART III--READJUSTMENT AND RELATED BENEFITS

           *       *       *       *       *       *       *


CHAPTER 37--HOUSING AND SMALL BUSINESS LOANS

           *       *       *       *       *       *       *


SUBCHAPTER III--ADMINISTRATIVE PROVISIONS

           *       *       *       *       *       *       *


Sec. 3729. Loan fee

  (a) Requirement of Fee.--(1) Except as provided in subsection 
(c), a fee shall be collected from each person obtaining a 
housing loan guaranteed, insured, or made under this chapter, 
and each person assuming a loan to which section 3714 of this 
title applies. No such loan may be guaranteed, insured, made, 
or assumed until the fee payable under this section has been 
remitted to the Secretary.
  (2) The fee may be included in the loan and paid from the 
proceeds thereof.
  (b) Determination of Fee.--(1) The amount of the fee shall be 
determined from the loan fee table in paragraph (2). The fee is 
expressed as a percentage of the total amount of the loan 
guaranteed, insured, or made, or, in the case of a loan 
assumption, the unpaid principal balance of the loan on the 
date of the transfer of the property.
  (2) The loan fee table referred to in paragraph (1) is as 
follows:


 
----------------------------------------------------------------------------------------------------------------
             Type of loan                Active duty  veteran          Reservist              Other obligor
----------------------------------------------------------------------------------------------------------------
(A)(i) Initial loan described in       2.15                     2.40                     NA
 section 3710(a) to purchase or
 construct a dwelling with 0-down, or
 any other initial loan described in
 section 3710(a) other than with 5-
 down or 10-down (closed on or after
 October 1, 2004, and before January
 1, 2020).
(A)(ii) Initial loan described in      2.30                     2.30                     NA
 section 3710(a) to purchase or
 construct a dwelling with 0-down, or
 any other initial loan described in
 section 3710(a) other than with 5-
 down or 10-down (closed on or after
 January 1, 2020, and before April 7,
 2023).
(A)(iii) Initial loan described in     2.15                     2.15                     NA
 section 3710(a) to purchase or
 construct a dwelling with 0-down, or
 any other initial loan described in
 section 3710(a) other than with 5-
 down or 10-down (closed on or after
 April 7, 2023, and before [November
 14, 2031] March 12, 2032 ).
(A)(iv) Initial loan described in      1.40                     1.40                     NA
 section 3710(a) to purchase or
 construct a dwelling with 0-down, or
 any other initial loan described in
 section 3710(a) other than with 5-
 down or 10-down (closed on or after
 [November 14, 2031] March 12, 2032 ).
(B)(i) Subsequent loan described in    3.30                     3.30                     NA
 section 3710(a) to purchase or
 construct a dwelling with 0-down, or
 any other subsequent loan described
 in section 3710(a) (closed on or
 after October 1, 2004, and before
 January 1, 2020).
(B)(ii) Subsequent loan described in   3.60                     3.60                     NA
 section 3710(a) to purchase or
 construct a dwelling with 0-down, or
 any other subsequent loan described
 in section 3710(a) (closed on or
 after January 1, 2020, and before
 April 7, 2023).
(B)(iii) Subsequent loan described in  3.30                     3.30                     NA
 section 3710(a) to purchase or
 construct a dwelling with 0-down, or
 any other subsequent loan described
 in section 3710(a) (closed on or
 after April 7, 2023, and before
 [November 14, 2031] March 12, 2032 ).
(B)(iv) Subsequent loan described in   1.25                     1.25                     NA
 section 3710(a) to purchase or
 construct a dwelling with 0-down, or
 any other subsequent loan described
 in section 3710(a) (closed on or
 after [November 14, 2031] March 12,
 2032 ).
(C)(i) Loan described in section       1.50                     1.75                     NA
 3710(a) to purchase or construct a
 dwelling with 5-down (closed before
 January 1, 2020).
(C)(ii) Loan described in section      1.65                     1.65                     NA
 3710(a) to purchase or construct a
 dwelling with 5-down (closed on or
 after January 1, 2020, and before
 April 7, 2023).
(C)(iii) Loan described in section     1.50                     1.50                     NA
 3710(a) to purchase or construct a
 dwelling with 5-down (closed on or
 after April 7, 2023, and before
 [November 14, 2031] March 12, 2032 ).
(C)(iv) Loan described in section      0.75                     0.75                     NA
 3710(a) to purchase or construct a
 dwelling with 5-down (closed on or
 after [November 14, 2031] March 12,
 2032 ).
(D)(i) Loan described in section       1.25                     1.50                     NA
 3710(a) to purchase or construct a
 dwelling with 10-down (closed before
 January 1, 2020).
(D)(ii) Loan described in section      1.40                     1.40                     NA
 3710(a) to purchase or construct a
 dwelling with 10-down (closed on or
 after January 1, 2020, and before
 April 7, 2023).
(D)(iii) Loan described in section     1.25                     1.25                     NA
 3710(a) to purchase or construct a
 dwelling with 10-down (closed on or
 after April 7, 2023, and before
 [November 14, 2031] March 12, 2032 ).
(D)(iv) Loan described in section      0.50                     0.50                     NA
 3710(a) to purchase or construct a
 dwelling with 10-down (closed on or
 after [November 14, 2031] March 12,
 2032 ).
(E) Interest rate reduction            0.50                     0.50                     NA
 refinancing loan.
(F) Direct loan under section 3711...  1.00                     1.00                     NA
(G) Manufactured home loan under       1.00                     1.00                     NA
 section 3712 (other than an interest
 rate reduction refinancing loan).
(H) Loan to Native American veteran    1.25                     1.25                     NA
 under section 3762 (other than an
 interest rate reduction refinancing
 loan).
(I) Loan assumption under section      0.50                     0.50                     0.50
 3714.
(J) Loan under section 3733(a).......  2.25                     2.25                     2.25.
----------------------------------------------------------------------------------------------------------------

  (3) Any reference to a section in the ``Type of loan'' column 
in the loan fee table in paragraph (2) refers to a section of 
this title.
  (4) For the purposes of paragraph (2):
          (A) The term ``active duty veteran'' means any 
        veteran eligible for the benefits of this chapter other 
        than a Reservist.
          (B) The term ``Reservist'' means a veteran described 
        in section 3701(b)(5)(A) of this title who is eligible 
        under section 3702(a)(2)(E) of this title.
          (C) The term ``other obligor'' means a person who is 
        not a veteran, as defined in section 101 of this title 
        or other provision of this chapter.
          (D)(i) The term ``initial loan'' means a loan to a 
        veteran guaranteed under section 3710 or made under 
        section 3711 of this title if the veteran has never 
        obtained a loan guaranteed under section 3710 or made 
        under section 3711 of this title.
          (ii) If a veteran has obtained a loan guaranteed 
        under section 3710 or made under section 3711 of this 
        title and the dwelling securing such loan was 
        substantially damaged or destroyed by a major disaster 
        declared by the President under section 401 of the 
        Robert T. Stafford Disaster Relief and Emergency 
        Assistance Act (42 U.S.C. 5170), the Secretary shall 
        treat as an initial loan, as defined in clause (i), the 
        next loan the Secretary guarantees or makes to such 
        veteran under section 3710 or 3711, respectively, if--
                  (I) such loan is guaranteed or made before 
                the date that is three years after the date on 
                which the dwelling was substantially damaged or 
                destroyed; and
                  (II) such loan is only for repairs or 
                construction of the dwelling, as determined by 
                the Secretary.
          (E) The term ``subsequent loan'' means a loan to a 
        veteran, other than an interest rate reduction 
        refinancing loan, guaranteed under section 3710 or made 
        under section 3711 of this title that is not an initial 
        loan.
          (F) The term ``interest rate reduction refinancing 
        loan'' means a loan described in section 3710(a)(8), 
        3710(a)(9)(B)(i), 3710(a)(11), 3712(a)(1)(F), or 
        3762(h) of this title.
          (G) The term ``0-down'' means a downpayment, if any, 
        of less than 5 percent of the total purchase price or 
        construction cost of the dwelling.
          (H) The term ``5-down'' means a downpayment of at 
        least 5 percent or more, but less than 10 percent, of 
        the total purchase price or construction cost of the 
        dwelling.
          (I) The term ``10-down'' means a downpayment of 10 
        percent or more of the total purchase price or 
        construction cost of the dwelling.
  (c) Waiver of Fee.--(1) A fee may not be collected under this 
section from a veteran who is receiving compensation (or who, 
but for the receipt of retirement pay or active service pay, 
would be entitled to receive compensation), from a surviving 
spouse of any veteran (including a person who died in the 
active military, naval, air, or space service) who died from a 
service-connected disability, or from a member of the Armed 
Forces who is serving on active duty and who provides, on or 
before the date of loan closing, evidence of having been 
awarded the Purple Heart.
  (2)(A) A veteran described in subparagraph (B) shall be 
treated as receiving compensation for purposes of this 
subsection as of the date of the rating described in such 
subparagraph without regard to whether an effective date of the 
award of compensation is established as of that date.
  (B) A veteran described in this subparagraph is a veteran who 
is rated eligible to receive compensation--
          (i) as the result of a pre-discharge disability 
        examination and rating; or
          (ii) based on a pre-discharge review of existing 
        medical evidence (including service medical and 
        treatment records) that results in the issuance of a 
        memorandum rating.

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PART VI--ACQUISITION AND DISPOSITION OF PROPERTY

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   CHAPTER 81--ACQUISITION AND OPERATION OF HOSPITAL AND DOMICILIARY 
    FACILITIES; PROCUREMENT AND SUPPLY; ENHANCED-USE LEASES OF REAL 
                                PROPERTY

SUBCHAPTER I--ACQUISITION AND OPERATION OF MEDICAL FACILITIES

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Sec. 8108. Contributions to local authorities

  The Secretary may make contributions to local authorities 
toward, or for, the construction of traffic controls, road 
improvements, or other devices adjacent to a medical facility 
if considered necessary for safe ingress or egress, or to 
mitigate the risk of flooding, including the risk of flooding 
associated with rising sea levels.

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