House Report 112-209 - VETERANS HEALTH CARE FACILITIES CAPITAL IMPROVEMENT ACT OF 2011

[House Report 112-209]
[From the U.S. Government Publishing Office]

112th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 112-209

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

VETERANS HEALTH CARE FACILITIES CAPITAL IMPROVEMENT ACT OF 2011

_______

September 15, 2011.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed

_______

Mr. Miller of Florida, from the Committee on Veterans' Affairs,
submitted the following

R E P O R T

[To accompany H.R. 2646]

[Including cost estimate of the Congressional Budget Office]

The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 2646) to authorize certain Department of
Veterans Affairs major medical facility projects and leases, to
extend certain expiring provisions of law, and to modify
certain authorities of the Secretary of Veterans Affairs, and
for other purposes, having considered the same, report
favorably thereon with an amendment and recommend that the bill
as amended do pass.

CONTENTS

Page
Amendments....................................................... 2
Purpose and Summary.............................................. 4
Background and Need for Legislation.............................. 5
Hearings......................................................... 11
Subcommittee Consideration....................................... 11
Committee Consideration.......................................... 12
Committee Votes.................................................. 12
Committee Oversight Findings..................................... 12
Statement of General Performance Goals and Objectives............ 12
New Budget Authority, Entitlement Authority, and Tax Expenditures 12
Earmarks and Tax and Tariff Benefits............................. 12
Committee Cost Estimate.......................................... 13
Congressional Budget Office Estimate............................. 13
Federal Mandates Statement....................................... 15
Advisory Committee Statement..................................... 15
Constitutional Authority Statement............................... 15
Applicability to Legislative Branch.............................. 15
Section-by-Section Analysis of the Legislation................... 15
Changes in Existing Law Made by the Bill as Reported............. 17

Amendment

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 ``Veterans Health Care Facilities
Capital Improvement Act of 2011''.

SEC. 2. AUTHORIZATION OF FISCAL YEAR 2012 MAJOR MEDICAL FACILITY
PROJECTS.

The Secretary of Veterans Affairs may carry out the following major
medical facility projects in fiscal year 2012, with each project to be
carried out in the amount specified for each project:
(1) Construction of seismic corrections for Building 100 at
the Department of Veterans Affairs Medical Center in Seattle,
Washington, in an amount not to exceed $51,800,000.
(2) Construction of seismic corrections and renovation of
various buildings to include Building 209 for housing
facilities for homeless veterans at the Department of Veterans
Affairs Medical Center in West Los Angeles, California, in an
amount not to exceed $35,500,000.

SEC. 3. MODIFICATION OF AUTHORIZATION FOR CERTAIN MAJOR MEDICAL
FACILITY CONSTRUCTION PROJECTS PREVIOUSLY
AUTHORIZED.

(a) Modification of Authorization of Fiscal Year 2007 Major Medical
Facility Project at Department of Veterans Affairs Medical Center in
Fayetteville, Arkansas.--Section 803(3) of the Veterans Benefits,
Health Care, and Information Technology Act of 2006 (Public Law 109-
461) is amended--
(1) by inserting ``and a parking garage'' after ``clinical
addition''; and
(2) by striking ``$56,163,000'' and inserting
``$90,600,000''.
(b) Modification of Extension of Authorization for Major Medical
Facility Construction Project in Orlando, Florida, Previously
Authorized in Connection With Capital Asset Realignment Initiative.--
Section 802(11) of the Veterans Benefits, Health Care, and Information
Technology Act of 2006 (Public Law 109-461), as amended by section
702(b)(4) of the Veterans' Mental Health and Other Care Improvements
Act of 2008 (Public Law 110-387; 122 Stat. 4137), is amended by
inserting ``, including a Simulation, Learning, Education, and Research
Network Center,'' after ``Florida, area''.
(c) Increase in Amount of Authorization of Fiscal Year 2008 Major
Medical Facility Project at Department of Veterans Affairs Medical
Center in Palo Alto, California.--The Secretary of Veterans Affairs may
carry out the major medical facility project at the Department of
Veterans Affairs Medical Center in Palo Alto, California, for which
amounts were appropriated under chapter 3 of title I of the
Supplemental Appropriations Act, 2008 (Public Law 110-252; 122 Stat.
2326) under the heading ``construction, major projects'' under the
heading ``DEPARTMENT OF VETERANS AFFAIRS'' in an amount not to exceed
$716,600,000.
(d) Increase in Amount of Authorization of Fiscal Year 2009 Major
Medical Facility Project at Department of Veterans Affairs Medical
Center, San Juan, Puerto Rico.--Section 701(3) of the Veterans' Mental
Health and Other Care Improvements Act of 2008 (Public Law 110-387; 122
Stat. 4137) is amended by striking ``$225,900,000'' and inserting
``$277,000,000''.
(e) Increase in Amount of Authorization of Fiscal Year 2007 Major
Medical Facility Project at Department of Veterans Affairs Medical
Center, St. Louis, Missouri.--Section 803(5) of the Veterans Benefits,
Health Care, and Information Technology Act of 2006 (Public Law 109-
461) is amended by striking ``$69,053,000'' and inserting
``$346,300,000''.

SEC. 4. AUTHORIZATION OF FISCAL YEAR 2012 MAJOR MEDICAL FACILITY
LEASES.

The Secretary of Veterans Affairs may carry out the following fiscal
year 2012 major medical facility leases at the locations specified, in
an amount not to exceed the amount shown for that location:
(1) Columbus, Georgia, Community-Based Outpatient Clinic, in
an amount not to exceed $5,335,000.
(2) Fort Wayne, Indiana, Outpatient Clinic, in an amount not
to exceed $2,845,000.
(3) Mobile, Alabama, Outpatient Clinic, in an amount not to
exceed $6,565,000.
(4) Rochester, New York, Outpatient Clinic, in an amount not
to exceed $9,232,000.
(5) Salem, Oregon, Community-Based Outpatient Clinic, in an
amount not to exceed $2,549,000.
(6) San Jose, California, Outpatient Clinic, in an amount not
to exceed $9,546,000.
(7) South Bend, Indiana, Outpatient Clinic, in an amount not
to exceed $6,731,000.
(8) Springfield, Missouri, Community-Based Outpatient Clinic,
in an amount not to exceed $6,489,000.

SEC. 5. AUTHORIZATION OF APPROPRIATIONS.

(a) Authorization of Appropriations for Construction.--There is
authorized to be appropriated to the Secretary of Veterans Affairs for
fiscal year 2012 or the year in which funds are appropriated for the
Construction, Major Projects account $87,300,000 for the projects
authorized in section 2.
(b) Modification of Authorization for Certain Major Medical Facility
Construction Projects Previously Authorized.--There is authorized to be
appropriated to the Secretary of Veterans Affairs for fiscal year 2012
or the year in which funds are appropriated for the Construction, Major
Projects account $850,070,000 for the projects authorized in section 3.
(c) Authorization of Appropriations for Medical Facility Leases.--
There is authorized to be appropriated to the Secretary of Veterans
Affairs for fiscal year 2012 or the year in which funds are
appropriated for the Medical Facilities account $49,292,000 for the
leases authorized in section 4.
(d) Limitation.--The projects authorized in sections 2, 3, and 4 may
only be carried out using--
(1) funds appropriated for fiscal year 2012 pursuant to the
authorization of appropriations in subsection (a) of this
section;
(2) funds available for Construction, Major Projects, for a
fiscal year before fiscal year 2012 that remain available for
obligation;
(3) funds available for Construction, Major Projects, for a
fiscal year after fiscal year 2012 that remain available for
obligation;
(4) funds appropriated for Construction, Major Projects, for
fiscal year 2012 for a category of activity not specific to a
project;
(5) funds appropriated for Construction, Major Projects, for
a fiscal year before 2012 for a category of activity not
specific to a project; and
(6) funds appropriated for Construction, Major Projects, for
a fiscal year after 2012 for a category of activity not
specific to a project.

SEC. 6. MODIFICATION OF REQUIREMENTS RELATING TO CONGRESSIONAL APPROVAL
OF CERTAIN MEDICAL FACILITY ACQUISITIONS.

Section 8104 of title 38, United States Code, is amended--
(1) in subsection (b)--
(A) in paragraph (1)--
(i) by striking ``detailed description'' and
inserting ``detailed estimate of the total
costs'';
(ii) by striking ``a description of the
consideration'' and inserting ``a detailed
report of the consideration''; and
(iii) by adding at the end the following:
``Such detailed estimate shall include an
identification of each of the following:
``(A) Total construction costs.
``(B) Activation costs.
``(C) Special purpose alterations (lump-sum payment)
costs.
``(D) Number of personnel.
``(E) Total costs of ancillary services, equipment,
and all other items.'';
(B) by striking paragraphs (2) and (3) and
redesignating paragraphs (4) through (8) as paragraphs
(2) through (6), respectively;
(C) in paragraph (2), as so redesignated, by striking
``a five-year period and a ten-year period'' and
inserting ``a five-year period, a ten-year period, and
a twenty-year period'';
(D) in paragraph (3), as so redesignated, by
inserting before the period at the end the following:
``, including information on projected changes in
workload and utilization over a five-year period, a
ten-year period, and a twenty-year period'';
(E) in paragraph (4), as so redesignated--
(i) by striking ``Current and projected'' and
inserting ``Projected''; and
(ii) by inserting before the period at the
end the following: ``(including and identifying
both recurring and non-recurring costs
(including activation costs and total costs of
ancillary services, equipment and all other
items)) over a five-year period, a ten-year
period, and a twenty-year period''; and
(F) in paragraph (6), as so redesignated--
(i) by striking ``a description of each
alternative to construction of the facility
that was considered.'' and inserting ``each of
the following:''; and
(ii) by adding at the end the following new
subparagraphs:
``(A) A detailed estimate of the total costs
(including total construction costs, activation costs,
special purpose alterations (lump-sum payment) costs,
number of personnel and total costs of ancillary
services, equipment and all other items) for each
alternative to construction of the facility that was
considered.
``(B) A comparison of total costs to total benefits
for each such alternative.
``(C) An explanation of why the preferred alternative
is the most effective means to achieve the stated
project goals and the most cost-effective
alternative.''; and
(2) in subsection (d)--
(A) by striking ``major medical facility project''
each place it appears and inserting ``major
construction project''; and
(B) in paragraph (2)--
(i) in subparagraph (A), by striking ``major
medical facility projects'' and inserting
``major construction projects''; and
(ii) in subparagraph (B), by striking ``major
medical facility'' and inserting ``major
construction project''.

SEC. 7. NAME OF DEPARTMENT OF VETERANS AFFAIRS TELEHEALTH CLINIC,
CRAIG, COLORADO.

The Department of Veterans Affairs telehealth clinic in Craig,
Colorado, shall after the date of the enactment of this Act be known
and designated as the ``Major William Edward Adams Department of
Veterans Affairs Clinic''. Any reference to such clinic in any law,
regulation, map, document, record, or other paper of the United States
shall be considered to be a reference to the ``Major William Edward
Adams Department of Veterans Affairs Clinic''.

SEC. 8. EXTENSION OF CERTAIN EXPIRING AUTHORITIES.

(a) Recovery Audits for Certain Contracts.--Section 1703(d)(4) of
title 38, United States Code, is amended by striking ``September 30,
2013'' and inserting ``September 30, 2020''.
(b) Treatment and Rehabilitation for Seriously Mentally Ill and
Homeless Veterans.--Section 2031(b) of such title is amended by
striking ``December 31, 2011'' and inserting ``December 31, 2012''.
(c) Additional Services for Seriously Mentally Ill and Homeless
Veterans.--Section 2033(d) of such title is amended by striking
``December 31, 2011'' and inserting ``December 31, 2012''.
(d) Housing Assistance for Homeless Veterans.--Section 2041(c) of
such title is amended by striking ``December 31, 2011'' and inserting
``December 31, 2012''.
(e) Advisory Committee on Homeless Veterans.--Section 2066(d) of such
title is amended by striking ``December 30, 2011'' and inserting
``December 31, 2012''.
(f) Authority To Transfer Real Property.--Section 8118(a)(5) of such
title is amended by striking ``the date that is seven years after the
date of the enactment of this section'' and inserting ``December 31,
2018''.

SEC. 9. GEORGE H. O'BRIEN, JR., DEPARTMENT OF VETERANS AFFAIRS MEDICAL
CENTER.

(a) Designation.--The Department of Veterans Affairs medical center
located in Big Spring, Texas, shall be known and designated as the
``George H. O'Brien, Jr., Department of Veterans Affairs Medical
Center''.
(b) References.--Any reference in a law, map, regulation, document,
paper, or other record of the United States to the Department of
Veterans Affairs medical center referred to in subsection (a) shall be
deemed to be a reference to the ``George H. O'Brien, Jr., Department of
Veterans Affairs Medical Center''.

Purpose and Summary

H.R. 2646, the ``Veterans Health Care Facilities Capital
Improvement Act of 2011'', was introduced by Representative
Bill Johnson of Ohio, Chairman of the Subcommittee on Oversight
and Investigations of the Committee on Veterans' Affairs, on
July 26, 2011. H.R. 2646, as amended, would: (1) authorize a
major medical facility project in Seattle, WA, in an amount not
to exceed $51,800,000 and in West Los Angeles, CA, in an amount
not to exceed $35,500,000; (2) modify the authorization for the
following major medical facility projects previously
authorized: Fayetteville, AR, increasing the authorization
amount from $56,163,000 to $90,600,000; Orlando, FL, including
the addition of a Simulation, Learning, Education, and Research
Network Center; Palo Alto, CA, authorizing an amount not to
exceed $716,600,000, San Juan, PR, increasing the authorization
amount from $225,900,000 to $277,000,000; and St. Louis, MO,
increasing the authorization amount from $69,053,000 to
$346,300,000; (3) authorize major medical facility leases for
Community-Based Outpatient Clinics (CBOC) in Columbus, GA, in
an amount not to exceed $5,335,000; Salem, OR in an amount not
to exceed $2,549,000; and Springfield, MO, in an amount not to
exceed $6,489,000 and Outpatient Clinics (OC) in Fort Wayne,
IN, in an amount not to exceed $2,845,000; Mobile, AL, in an
amount not to exceed $6,565,000; Rochester, NY, in an amount
not to exceed $9,232,000; San Jose, CA, in an amount not to
exceed $9,546,000; and South Bend, IN, in an amount not to
exceed $6,731,000; (4) modify requirements for information VA
must provide to Congress when seeking authorization for a major
medical facility project or lease; (5) name the VA telehealth
clinic in Craig, CO, the ``Major William Edward Adams
Department of Veterans Affairs Clinic''; (6) extend certain
expiring authorities related to recovery audits for certain
contracts, treatment and rehabilitation for seriously mentally
ill and homeless veterans, additional services for seriously
mentally ill and homeless veterans, housing assistance for
homeless veterans, and the Advisory Committee on Homeless
Veterans, through December 31, 2012; and the authority to
transfer real property, through December 31, 2018; and, (7)
name the VA Medical Center in Big Spring, TX, the ``George H.
O'Brien, Jr., Department of Veterans Affairs Medical Center.''

Background and Need for Legislation

Section 8104(2) of title 38, U.S.C., requires Congressional
authorization for VA major medical facility projects and major
medical facility leases. A major medical facility project is
defined as a project involving construction, alteration, or
acquisition of a medical facility involving a total expenditure
of more than $10,000,000. A major medical facility lease is
defined as a lease for space for use as a new medical facility
at an average annual rental of more than $1,000,000. Along with
each major medical facility project or lease funding request,
section 8104(b) of title 38 U.S.C. requires VA to submit a
prospectus of the proposed medical facility to include a
detailed description of the medical facility and an estimate of
the cost for the construction, alteration, lease, or other
acquisition as well as an estimate of the cost of the equipment
required for operation of such facility, demographic data,
current and projected workload and utilization data, current
and projected operating costs, the priority score assigned to
the project under the VA's prioritization methodology, and a
description of each alternative that was considered in the case
of a new or replacement medical ideology.

Administration request for authorization to carry out the following VA
major medical facility projects in fiscal year 2012

Seattle, Washington: seismic corrections for Building 100
at the Seattle Veterans Affairs Medical Center (VAMC) in an
amount not to exceed $51,800,000. On the Seattle VAMC campus,
building 100 houses a nursing tower and nursing home care unit.
Providing seismic strengthening of this structure would allow
for the continued operation of these programs throughout
renovation of the existing building, and, therefore, offer
aggregated safety, functional, and fiscal advantages to the
project.
West Los Angeles, California: seismic corrections and
renovation of various buildings to include Building 209 for
housing facilities for homeless veterans at the West Los
Angeles VAMC, in an amount not to exceed $35,500,000. Building
209 currently sits vacant on the West LA campus. However,
seismic corrections, utilizing $20,000,000 from existing prior
year bid savings funds, would allow for the development of a
therapeutic and supportive homeless housing program, to include
long-term transitional housing to aid homeless veterans,
especially those with on-going medical and/or mental health
needs, in both obtaining and maintaining supportive employment.
Fayetteville, Arkansas: modification of the FY 2007
authorization for a major medical facility project at the
Fayetteville VAMC raising the authorization level from
$56,163,000 to $90,600,000, an increase of $34,437,000. The
modification of the initial authorization would expand the
scope of the project to include a new clinical addition with
minor renovations, as well as the construction of a new parking
facility. No additional appropriation is required to complete
this project.
Orlando, Florida: modification of extension of the
authorization for a major medical facility construction project
in Orlando, Florida, previously authorized in connection with
the Capital Asset Realignment Initiative by authorizing a
Simulation, Learning, Education, and Research Network Center
(SIMLEARN Center). The SIMLEARN Center would encompass a
clinical simulation program to support clinical training, an
essential component of education, training, competency
assessment, and maintenance of professional certification
throughout the VA health care system. SIMLEARN would provide
expert `train-the-trainer' simulation experiences, national
curricula for high priority clinical topics, and acquisition
support to VA medical facilities to facilitate local simulation
training deployment. This modification of the original
authorization amount would also provide VA with the opportunity
to fund the installation of renewable energy opportunities and
source energy through a co-generation energy installation. No
additional appropriation is required to complete this project.
Palo Alto, California: increase in the amount of the FY
2008 authorization for a major medical facility project at the
Palo Alto VAMC, in an amount not to exceed $716,600,000. Such
an increase would provide seismic upgrade to the main hospital
building, as well as provide the necessary emergency
sustainment features including fire sprinklers and an abatement
of existing asbestos. In addition, a new administrative
building, parking structure, and an expansion of the outpatient
clinic would be constructed.
San Juan, Puerto Rico: increase in the amount of the FY
2009 authorization for a major medical facility project at the
San Juan VAMC from $225,900,000 to $277,000,000, an increase of
$51,100,000. With these funds, VA would construct a new
administrative building, parking structure, and an expansion of
the outpatient clinic as well as provide seismic upgrades to
the main hospital building, emergency sustainment features
including fire sprinklers, and an abatement of existing
asbestos.
St. Louis, Missouri: increase in the amount of the FY 2007
authorization for a major medical facility project at the
Jefferson Barracks division of the St. Louis VAMC from
$69,053,000 to $346,300,000, an increase of $277,247,000. Such
an increase in authorization would allow for a five phase
project aimed at demolishing deteriorated and unsuitable
medical center facilities and new construction to consolidate
operations and free approximately 30 acres to extend operations
at the adjacent VA National Cemetery.

Administration request for authorization to carry out the following VA
major medical facility leases in fiscal year 2012

Columbus, Georgia: CBOC in an amount not to exceed
$5,335,000, to provide mental health services to Georgia
veterans.
Fort Wayne, Indiana: OC in an amount not to exceed
$2,845,000. The Fort Wayne OC would support the VA Northern
Indiana Health Care System and serve Northern Indiana's veteran
population while expanding mental health service space and
accommodating support services to meet increased veteran
demand. This project would allow VA to continue to provide
timely access to state-of-the-art mental health care, including
care for substance abuse and post-traumatic stress disorder in
an adequately-sized facility to meet increased workload.
Mobile, Alabama: OC in an amount not to exceed $6,565,000.
The current lease is housed in a functionally obsolete building
that has space, safety and functional deficiencies. The new
lease would provide for administrative and clinical space and
would provide greater capacity for medical staff in a more
appropriately sized, modern facility. This replacement OC would
ensure continued provision of current and expanded medical
services to veterans residing in or near Mobile, AL.
Rochester, New York: OC in an amount not to exceed
$9,232,000. The current lease is set to expire in 2016 and
cannot be renewed. The new lease would provide expanded
outpatient services to address current utilization and space
gaps. This lease would allow for VA to serve a greater number
of veterans, reduce travel time for clinical services, and
consolidate three single leases--Mt. Hope Avenue, Clinton
Crossings, and Rochester--into one state-of-the-art facility.
Salem, Oregon: CBOC in an amount not to exceed $2,549,000
for a replacement lease for the existing 10,000 net usable
square feet (NUSF) CBOC in Salem, OR, which supports the parent
facility in Portland, OR. The current leased space is too small
to support the projected workload growth in the Salem area. The
new lease would continue to provide primary and specialty care,
mental health and ancillary services. Expanded high demand VA
specialty care services that would be provided in the new
leased space include eye care, rehabilitation, audiology, and
speech pathology. The new CBOC will allow for relocation to an
area of higher veteran population.
San Jose, California: OC in an amount not to exceed
$9,546,000 for a replacement lease for existing 72,000 NUSF
CBOC in San Jose, which supports the parent facility of the VA
Palo Alto Health Care System. The current lease is set to
expire in 2016 with no additional option years remaining on the
existing lease. The lease would address the need to provide
ongoing primary care, mental health, and specialty care
services to veterans residing in San Jose, CA.
South Bend, Indiana: OC in an amount not to exceed
$6,731,000 to replace existing CBOC. The new leased facility
would enable VA to expand services to include outpatient
primary care and mental health services. This lease would
provide infrastructure that supports increased integration of
services, coordination of care, provider productivity,
efficiency, and patient satisfaction. This lease would allow VA
to respond to the changing needs of veterans and their families
in South Bend.
Springfield, Missouri: CBOC in an amount not to exceed
$6,489,000 for a replacement lease for existing 41,000 NUSF
CBOC, supporting the parent facility of the Veterans Health
Care System of the Ozarks (VHSO) in Fayetteville, AR. The new
CBOC would relocate and expand Gene Taylor OC from Mount
Vernon, Missouri. The State of Missouri has elected to close
the Missouri Rehabilitation Center (MRC) in Mount Vernon, where
the current clinic is located, and will be unable to continue
to support the current lease agreement. Moving the CBOC to
Springfield would better support the VHSO strategic
initiatives. The new CBOC would continue to provide primary and
specialty care, mental health and ancillary services and would
also provide sleep studies, radiology, Magnetic Resonance
Imaging (MRI), laboratory, and dental services to veterans.

Modification of requirements relating to Congressional approval of
certain medical facility acquisitions

VA holds a substantial real property inventory that
includes a medical infrastructure of over 5,400 owned
buildings, 1,300 leases, 33,000 acres of land, and
approximately 159 million gross square feet (owned and leased).
This nationwide infrastructure is a critically important
resource enabling VA to provide the best possible care to our
veterans. Such an enormous structural network, however,
generates a great deal of costly construction, which the
Department must address even as it faces unprecedented
challenges in providing our Nation's heroes with access to
care.
The Administration has identified 4,808 necessary capital
projects with an estimated total cost between $53 billion and
$65 billion to correct infrastructure gaps over the next ten
years. This estimate does not include activation or life cycle
costs.
Congress takes an oversight role for this decision-making
process in section 8104(a)(1) of title 38 U.S.C., whose purpose
is ``to enable Congress to ensure the equitable distribution of
medical facilities throughout the United States, taking into
consideration the comparative urgency of the need for the
services to be provided in the case of each particular
facility.''
So that Congress can adequately fulfill its oversight
responsibilities, section 8104 directs VA to submit a
prospectus for all major medical facility projects. This
prospectus is intended to provide a clear understanding of the
project costs and benefits and include detailed information
such as construction costs, alternatives to construction
considered, equipment costs for the proposed facility and data
on projected utilization and operating costs.
However, the Committee remains concerned that VA does not
provide this information in sufficient detail for Congress to
accurately evaluate proposed Department projects. Without
accurate and complete information as required by the law,
Congress cannot carry out its statutory mission of ensuring the
``equitable distribution'' of medical facilities and access to
care for our veterans.
Section 6 of the bill would modify requirements for
information VA must provide to Congress when seeking
authorization for a major medical facility project or lease by
specifying the level of detailed information related to the
total cost of the project including construction costs,
activation costs, special purpose alterations (lump-sum
payments) costs, personnel costs, ancillary services costs,
equipment costs, and all other costs; demographic data
extending over a twenty-year period; current and project
workload and utilization data for the proposed facility or
lease including information on any and all projected changes
over a five-, ten-, and twenty-year period; projected operating
costs to include an identification of recurring and non-
recurring costs including activation costs and total costs of
ancillary services, equipment and all other items over a five-
year period, a ten-year period and a twenty-year period; and,
in the case of a prospective proposing the construction of a
new or replacement medical facility, a detailed estimate of the
total costs including total construction costs, activation
costs, special purpose alterations (lump-sum payments) costs,
personnel costs, and ancillary services costs, equipment costs,
and all other costs for each alternative as well as total
benefits for each alternative and a detailed explanation of why
the preferred alternative is both the most effective means to
achieve the stated project goals and the most cost-effective
alternative.

Name of Department of Veterans Affairs telehealth clinic, Craig,
Colorado

On May 25th, 1971, Major Adams willingly volunteered for a
helicopter rescue mission to fly into a remote fire base that
was under heavy attack to pick up three critically wounded
soldiers. While directing and coordinating fire support from
other attack helicopters, Maj. Adams landed his aircraft and
picked up the three wounded soldiers. As he began his return
flight, his helicopter was bombarded with enemy rocket and
gunfire. Though Maj. Adams prepared to make an emergency
landing, his helicopter exploded before he could touch down.
For his brave actions, Maj. Adams posthumously received the
Medal of Honor. Section 7 of the bill would appropriately
memorialize his brave service in battle and his commitment to
both his country and his fellow veterans by naming the VA
telehealth clinic in Craig, Colorado, as ``Major William Edward
Adams Department of Veterans Affairs Clinic.'' The Colorado
Congressional delegation and the major veterans' organizations
in the State of Colorado are unanimous in their support of this
provision.

Extension of certain expiring authorities

Current law authorizes VA to establish an inpatient
recovery audit program for fee basis and other medical services
contracts. This authority, which is set to expire on September
30, 2013, allows VA to identify and collect overpayments made
through the VA's Purchased Care Program and redirect the
recovered funds to provide health care services to eligible
veterans and their families. Through this program, VA has
identified an estimated $111 million in overpayments. If VA's
recovery audit authority were to lapse, VA may lose the
incentive to aggressively pursue improper payments as recovered
funds would be redirected to the United States Treasury rather
than to VA facilities to provide health care services to
veterans. Further, in order to prevent disruptions to the
recovery audit program, VA must have sufficient time to plan
for a contract competition and award. As such, section 8(a) of
the bill would amend Sec. 1703(d)(4) of title 38 U.S.C. to
extend VA's authority to conduct recovery audits for fee basis
and other medical service contracts until September 30, 2020.
Current law authorizes VA to provide seriously mentally ill
veterans, including homeless veterans, with: (1) outreach
services, (2) care, treatment, rehabilitation, and other
services, and (3) therapeutic transitional housing assistance.
This authority, which is currently set to expire on December
31, 2011, allows VA to conduct specialized programs and
services for veterans struggling with serious mental illness
and homelessness to target those most at-risk and in need in
the veteran population. Section 8(b) would amend Sec. 2031(b)
of title 38 U.S.C. to extend VA's authority regarding treatment
and rehabilitation for seriously mentally ill and homeless
veterans through December 31, 2012.
Current law authorizes VA, subject to appropriations, to
operate a program to expand and improve the provision of
benefits and services to homeless veterans, including
establishing sites under VA jurisdiction to be centers for the
provision of comprehensive services to homeless veterans in, at
a minimum, each of the 20 largest metropolitan statistical
areas. Given the prevalence of veterans in the homeless
population, it is vitally important for VA to provide
appropriate programs and services to assist those struggling
with homelessness. This authority is currently set to expire on
December 31, 2011. Section 8(c) would amend Sec. 2033(d) of
title 38 U.S.C. to extend VA's authority to expand and improve
benefits to homeless veterans through September 30, 2012.
Similarly, Sec. 2041(c) of title 38, U.S.C. provides VA the
authority to enter into agreements with homeless providers for
the purpose of selling, leasing, or donating homes acquired
through the guaranteed loan program. This authority is
currently set to expire on December 31, 2011. Section 8(d)
would amend Sec. 2041(c) of title 38, U.S.C. to extend this
authority until December 31, 2012.
Though VA provides more direct assistance to the homeless
than any other Federal agency, veterans continue to be
overrepresented in the homeless population. Public Law 107-95
mandated the creation of an Advisory Committee on Homeless
Veterans. The purpose of the Advisory Committee is to provide
advice and make recommendations to VA regarding the provision
of benefits and services to homeless veterans, to assess the
effectiveness of policies and programs relating to homeless
veterans, to identify gaps in programs serving homeless
veterans, highlight barriers in law and Federal policy that
hinder homeless veterans programs, and liaise with other
Federal, State and local agencies that work on homeless issues.
This authority is currently set to expire on December 30, 2011.
Section 8(e) would amend Sec. 2066(d) of title 38 U.S.C. to
extend Congressional authority to continue the Advisory
Committee on Homeless Veterans until December 31, 2018.
Current law provides VA the authority to transfer real
property under VA jurisdiction and control to other Federal
agencies, State agencies, public or private entities, or Indian
tribes. Such authority provides the Department with the
flexibility to make efficient and effective use of VA's
extensive real property holdings, including vacant or
underutilized property. This authority is currently set
to expire on December 31, 2011. Section 8(f) would amend
Sec. 8118(a)(5) of title 38, U.S.C. to extend this authority
through December 31, 2012.

Name of Department of Veterans Affairs Medical Center, Big Spring,
Texas

George H. O'Brien, Jr., was a Korean War veteran from Big
Spring, TX. While wounded, Mr. O'Brien led his Marine unit in
an uphill assault on a heavily defended position. After relief
arrived, Mr. O'Brien refused medical evacuation and remained to
cover his unit's withdrawal. For his heroism, Mr. O'Brien was
awarded the Medal of Honor by President Eisenhower. After
returning to Big Spring, Mr. O'Brien lent his services as a
volunteer at the Big Spring VAMC. He died in 2005 at the age of
78.
Section 9 of the bill would appropriately memorialize his
brave service in battle and his commitment to both his country
and his fellow veterans by naming the VA Medical Center in Big
Spring, TX, the ``George H. O'Brien, Jr., Department of
Veterans Affairs Medical Center.'' The Texas Congressional
delegation and the major veterans' organizations in the State
of Texas are unanimous in their support of this provision.

Hearings

On July 25, 2011, the Subcommittee on Health held a
legislative hearing on several bills introduced in the 112th
Congress, including a draft bill which was later introduced as
H.R. 2646. The following witnesses testified: the Honorable
Michael G. Grimm of New York; the Honorable John R. Carter of
Texas, the Honorable Timothy J. Walz of Minnesota; the
Honorable Larry Bucshon of Indiana; Shane Barker, Senior
Legislative Associate, National Veterans Service, Veterans of
Foreign Wars of the United States; Joy J. Ilem, Deputy National
Legislative Director, Disabled American Veterans; Thomas J.
Berger, Ph.D., Executive Director, Veterans Health Council,
Vietnam Veterans of America; Carl Blake, National Legislative
Director, Paralyzed Veterans of America: Christina M. Roof,
National Acting Legislative Director, AMVETS; and Robert L.
Jesse, M.D., Ph.D., Principal Deputy Under Secretary for
Health, Veterans Health Administration, U.S. Department of
Veterans Affairs.

Subcommittee Consideration

On July 28, 2011, the Subcommittee on Health met in open
markup session, a quorum being present. An amendment was
offered by Chairwoman Ann Marie Buerkle of New York to amend
H.R. 2646. Ms. Buerkle's amendment modified the extensions of
Sec. 1703(d)(4), recovery audits for certain contracts,
Sec. 2031(b), treatment and rehabilitation for seriously
mentally ill and homeless veterans, Sec. 2033(d), additional
services for seriously mentally ill and homeless veterans,
Sec. 2041(c), housing assistance for homeless veterans, and
Sec. 2066(d), Advisory Committee on Homeless Veterans from 2018
to 2012. The amendment was agreed to by voice vote. Ranking
Member Michaud of Maine offered a motion to report H.R. 2646,
as amended, favorably to the full Committee. His motion was
agreed to by voice vote.

Committee Consideration

On September 8, 2011, the full Committee met in an open
markup session, a quorum being present. An Amendment was
offered by Representative Bill Flores of Texas to insert a new
section 9 to name the George H. O'Brien VA Medical Center. The
amendment was adopted and H.R. 2646, as amended, was reported
favorably to the House of Representatives, by voice vote.

Committee Votes

Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report the legislation and amendments thereto.
There were no record votes taken on amendments or in connection
with ordering H.R. 2646 reported to the House. A motion by Mr.
Filner of California to order H.R. 2646, as amended, reported
favorably to the House of Representatives was agreed to by
voice vote.

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 are reflected in the descriptive portions
of this report.

New Budget Authority, Entitlement Authority, and
Tax Expenditures

In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee adopts as its
own the estimate of new budget authority, entitlement
authority, or tax expenditures or revenues contained in the
cost estimate prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.

Earmarks and Tax and Tariff Benefits

H.R. 2646, 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.
2646 prepared by the Director of the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act
of 1974.

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. 2646 provided by the Congressional Budget Office
pursuant to section 402 of the Congressional Budget Act of
1974:

U.S. Congress,
Congressional Budget Office,
Washington, DC, September 15, 2011.
Hon. Jeff Miller,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 2646, the Veterans
Health Care Facilities Capital Improvement Act of 2011.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Ann E.
Futrell.
Sincerely,
Douglas W. Elmendorf.
Enclosure.

H.R. 2646--Veterans Health Care Facilities Capital Improvement Act of
2011

Summary: H.R. 2646 would authorize the Department of
Veterans Affairs (VA) to build and lease several medical
facilities and extend programs for homeless veterans. In total,
CBO estimates that implementing the bill would cost $1.2
billion over the 2012-2016 period, assuming appropriation of
the necessary amounts. CBO estimates that enacting the bill
would have no effect on direct spending or revenues; therefore,
pay-as-you-go procedures do not apply.
H.R. 2646 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
Estimated cost to the Federal Government: The estimated
budgetary impact of H.R. 2646 is summarized in the following
table. The costs of this legislation fall within budget
function 700 (veterans benefits and services).
Basis of estimate: For this estimate, CBO assumes the
legislation will be enacted near the start of fiscal year 2012,
that the necessary amounts will be appropriated each year, and
that outlays will follow historical patterns for similar and
existing programs.
H.R. 2646 would authorize appropriations for major
construction and leasing of VA medical facilities. The bill
also would extend the authority for several programs for
homeless veterans. CBO estimates that implementing H.R. 2646
would cost $1.2 billion over the 2012-2016 period, assuming
appropriation of the necessary amounts.

----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
------------------------------------------------------------
2012 2013 2014 2015 2016 2012-2016
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Major Construction Projects:
Authorization Level............................ 850 0 0 0 0 850
Estimated Outlays.............................. 37 229 277 204 77 824
Leases for Medical Facilities:
Estimated Authorization Level.................. 50 22 22 22 22 138
Estimated Outlays.............................. 45 22 22 22 22 133
Seismic Corrections and Renovations:
Estimated Authorization Level.................. 68 0 0 0 0 68
Estimated Outlays.............................. 3 18 22 16 6 65
Extension of Certain Authorities for Homeless
Veterans:
Estimated Authorization Level.................. 107 37 0 0 0 144
Estimated Outlays.............................. 96 43 4 0 0 143
Total Changes:
Estimated Authorization Level.............. 1,075 59 22 22 22 1,200
Estimated Outlays.......................... 181 312 325 242 105 1,165
----------------------------------------------------------------------------------------------------------------

Major construction projects

Section 3 would authorize the appropriation of $850 million
to construct and modify medical facilities in Palo Alto,
California; St. Louis, Missouri; and San Juan, Puerto Rico. CBO
estimates that if appropriated, that authorization would result
in discretionary costs of $824 million over the 2012-2016
period.

Leases for medical facilities

Section 4 would authorize the appropriation of $50 million
for leasing eight medical facilities. Based on information from
VA's 2012 budget request, CBO expects that VA would enter into
20-year lease agreements for those facilities. CBO estimates
that in addition to the specified amounts authorized to be
appropriated in 2012, entering into those leases would cost $22
million a year starting in 2013. (Costs would be higher in the
first year because VA would pay up front for necessary
improvements and upgrades.) CBO estimates that entering into
those leases would cost $133 million over the 2012-2016 period,
assuming appropriation of the authorized and estimated amounts.

Seismic corrections and renovations

Section 2 would authorize the appropriation of $87 million
for seismic corrections and renovations at facilities in Los
Angeles, California, and Seattle, Washington. Based on VA's
current estimate for construction costs and the amounts that
have already been appropriated for those projects, CBO
estimates that VA would require additional funding of $68
million in 2012. We estimate that implementing those projects
would cost a total of $65 million over the 2012-2016 period,
assuming appropriation of the estimated amounts.

Extension of certain authorities for homeless veterans

Section 8 would extend, for various periods, the expiring
authorities for several programs that provide services to
homeless veterans. CBO estimates that extending such programs
would cost $143 million over the 2012-2016 period, assuming
appropriation of the necessary amounts.
Pay-as-you-go considerations: None.
Intergovernmental and private-sector impact: H.R. 2646
contains no intergovernmental or private-sector mandates as
defined in UMRA. Public hospitals that contract with VA to
provide hospital care or medical services to veterans would be
required to comply with auditing procedures extended under the
bill. Any costs to those hospitals would be incurred
voluntarily.
Previous CBO estimate: On August 30, 2011, CBO transmitted
a cost estimate for S. 914, the Veterans Programs Improvement
Act of 2011, as ordered reported by the Senate Committee on
Veterans' Affairs on June 29, 2011. Sections 2, 3, 4, and 8 of
H.R. 2646 contain language similar to sections 601, 602, 603,
and 205 of S. 914, respectively, and their estimated costs are
the same.
Estimate prepared by: Federal costs: Ann E. Futrell; Impact
on State, local, and Tribal Governments: Lisa Ramirez-Branum;
Impact on the Private Sector: Elizabeth Bass.
Estimate approved by: Theresa Gullo, Deputy Assistant
Director for Budget Analysis.

Federal Mandates Statement

The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 2646 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.
2646.

Constitutional Authority Statement

Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds that the
Constitutional authority for H.R. 2646 is provided by Article
I, section 8 of the Constitution of the United States.

Applicability to Legislative Branch

The Committee finds that the legislation 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.

Section-by-Section Analysis of the Legislation

Section 1. Short title

Section 1 of the bill would name the Act the ``Veterans
Health Care Facilities Capital Improvement Act of 2011.''

Section 2. Authorization of fiscal year 2012 major medical facility
projects

Section 2(1) of the bill would authorize a major medical
facility project in Seattle, WA, in an amount not to exceed
$51,800,000.
Section 2(2) of the bill would authorize a major medical
facility project in West Los Angeles, CA, in an amount not to
exceed $35,500,000.

Section 3. Modification of authorization for certain major medical
facility construction projects previously authorized

Section 3(a) of the bill would modify the authorization of
fiscal year 2007 major medical facility project at the VAMC in
Fayetteville, AR, by inserting the addition of a parking garage
and increasing the authorization amount from $56,163,000 to
$90,600,000.
Section 3(b) of the bill would modify the extension of
authorization for major medical facility construction in
Orlando, FL, by inserting the addition of a Simulation,
Learning, Education, and Research Network Center.
Section 3(c) of the bill would increase the amount of
authorization of fiscal year 2008 Major Medical Facility
Project at VAMC in Palo Alto, CA, in an amount not to exceed
$716,600,000.
Section 3(d) of the bill would increase the authorization
of fiscal year 2009 major medical facility project at the VAMC
in San Juan, PR, increasing the authorization amount from
$225,900,000 to $277,000,000.
Section 3(e) of the bill would increase the amount of
authorization of fiscal year 2007 major medical facility
project at the VAMC in St. Louis, MO, by increasing the
authorization amount from $69,053,000 to $346,300,000.

Section 4. Authorization of fiscal year 2012 major medical facility
leases

Section 4(1) of the bill would authorize VA to carry out a
major medical facility lease for a CBOC in Columbus, GA, in an
amount not to exceed $5,335,000.
Section 4(2) of the bill would authorize VA to carry out a
major medical facility lease for an OC in Fort Wayne, IN, in an
amount not to exceed $2,845,000.
Section 4(3) of the bill would authorize VA to carry out a
major medical facility lease for an OC in Mobile, AL, in an
amount not to exceed $6,565,000.
Section 4(4) of the bill would authorize VA to carry out a
major medical facility lease for an OC in Rochester, NY, in an
amount not to exceed $9,232,000.
Section 4(5) of the bill would authorize VA to carry out a
major medical facility lease for a CBOC in Salem, OR, in an
amount not to exceed $2,549,000.
Section 4(6) of the bill would authorize VA to carry out a
major medical facility lease for an OC in San Jose, CA, in an
amount not to exceed $9,546,000.
Section 4(7) of the bill would authorize VA to carry out a
major medical facility lease for an OC in South Bend, IN, in an
amount not to exceed $6,731,000.
Section 4(8) of the bill would authorize VA to carry out a
major medical facility lease for a CBOC in Springfield, MO, in
an amount not to exceed $6,489,000.

Section 5. Authorization of appropriations

Section 5(a) of the bill would authorize $87,300,000 in
appropriations for the Construction, Major Projects account for
the projects authorized in section 2.
Section 5(b) of the bill would authorize $850,070,000 in
appropriations for the Construction, Major Projects account for
the projects authorized in Section 3.
Section 5(c) of the bill would authorize $49,292,000 in
appropriations for the Medical Facilities account for the
leases authorized in Section 4.

Section 6. Modification of requirements relating to Congressional
approval of certain medical facility acquisitions

Section 6 of the bill would amend Section 8104 of title 38,
United States Code, to clarify the level of detailed
information VA must provide when requesting authorization for a
major medical facility project or lease.

Section 7. Name of Department of Veterans Affairs telehealth clinic,
Craig, Colorado

Section 7 of the bill would name the VA telehealth clinic
in Craig, CO, the ``Major William Edward Adams Department of
Veterans Affairs Clinic.''

Section 8. Extension of certain expiring authorities

Section 8(a) of the bill would amend Sec. 1703(d)(4) of
title 38 U.S.C. to extend VA's authority to conduct recovery
audits for fee basis and other medical service contracts
through September 30, 2020.
Section 8(b) of the bill would amend Sec. 2031(b) of title
38 U.S.C. to extend VA's authority regarding treatment and
rehabilitation for seriously mentally ill and homeless veterans
through December 31, 2012.
Section 8(c) of the bill would amend Sec. 2033(d) of title
38 U.S.C. to extend VA's authority to expand and improve
benefits to homeless veterans through September 30, 2012.
Section 8(d) of the bill would amend Sec. 2041(c) of title
38 U.S.C. to extend VA's authority to enter into agreements
with homeless providers for the purpose of selling, leasing, or
donating homes acquired through the guaranteed loan program
through December 31, 2012.
Section 8(e) of the bill would amend Sec. 2066(d) of title
38 U.S.C. to extend Congressional authority to continue the
Advisory Committee for Homeless Veterans through December 31,
2012.
Section 8(f) of the bill would amend Sec. 8118(a) of title
38 U.S.C. to extend VA's authority to transfer real property
under VA jurisdiction and control to other Federal agencies,
State agencies, public or private entities, or Indian tribes
through December 31, 2018.

Section 9. George H. O'Brien, Jr. Department of Veterans Affairs
Medical Center

Section 9 of the bill would name the VA medical center
located in Big Spring, TX, the ``George H. O'Brien, Jr.
Department of Veterans Affairs Medical Center.''

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 italic, existing law in which no change is
proposed is shown in roman):

VETERANS BENEFITS, HEALTH CARE, AND INFORMATION TECHNOLOGY ACT OF 2006

* * * * * * *
TITLE VIII--CONSTRUCTION MATTERS

Subtitle A--Construction and Lease Authorities

* * * * * * *

SEC. 802. EXTENSION OF AUTHORIZATION FOR CERTAIN MAJOR MEDICAL
FACILITY CONSTRUCTION PROJECTS PREVIOUSLY
AUTHORIZED IN CONNECTION WITH CAPITAL ASSET
REALIGNMENT INITIATIVE.

The Secretary of Veterans Affairs may carry out the following
major medical facility projects, with each such project to be
carried out in the amount specified for that project:
(1) * * *

* * * * * * *

(11) Construction of a new medical center facility in
the Orlando, Florida, area, including a Simulation,
Learning, Education, and Research Network Center, in an
amount not to exceed $377,700,000.

* * * * * * *

SEC. 803. AUTHORIZATION OF FISCAL YEAR 2007 MAJOR MEDICAL FACILITY
PROJECTS.

The Secretary of Veterans Affairs may carry out the following
major medical facility projects in fiscal year 2007 in the
amount specified for each project:
(1) * * *

* * * * * * *

(3) Construction of a new clinical addition and a
parking garage at the Department of Veterans Affairs
Medical Center, Fayetteville, Arkansas, in an amount
not to exceed [$56,163,000] $90,600,000.

* * * * * * *

(5) Medical facility improvements and cemetery
expansion of Jefferson Barracks at the Department of
Veterans Affairs Medical Center, St. Louis, Missouri,
in an amount not to exceed [$69,053,000] $346,300,000.

* * * * * * *

----------

VETERANS' MENTAL HEALTH AND OTHER CARE IMPROVEMENTS ACT OF 2008

* * * * * * *
TITLE VII--AUTHORIZATION OF MEDICAL FACILITY PROJECTS AND MAJOR MEDICAL
FACILITY LEASES

SEC. 701. AUTHORIZATION FOR FISCAL YEAR 2009 MAJOR MEDICAL FACILITY
PROJECTS.

The Secretary of Veterans Affairs may carry out the following
major medical facility projects in fiscal year 2009 in the
amount specified for each project:
(1) * * *

* * * * * * *

(3) Seismic corrections, Building 1, at the
Department of Veterans Affairs Medical Center, San
Juan, Puerto Rico, in an amount not to exceed
[$225,900,000] $277,000,000.

* * * * * * *

----------

TITLE 38, UNITED STATES CODE

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

* * * * * * *

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

SUBCHAPTER I--GENERAL

* * * * * * *

Sec. 1703. Contracts for hospital care and medical services in non-
Department facilities

(a) * * *

* * * * * * *

(d)(1) * * *

* * * * * * *

(4) The authority of the Secretary under this subsection
terminates on [September 30, 2013] September 30, 2020.

* * * * * * *

CHAPTER 20--BENEFITS FOR HOMELESS VETERANS

* * * * * * *

SUBCHAPTER IV--TREATMENT AND REHABILITATION FOR SERIOUSLY MENTALLY ILL
AND HOMELESS VETERANS

Sec. 2031. General treatment

(a) * * *
(b) The authority of the Secretary under subsection (a)
expires on [December 31, 2011] December 31, 2012.

* * * * * * *

Sec. 2033. Additional services at certain locations

(a) * * *

* * * * * * *

(d) The program under this section shall terminate on
[December 31, 2011] December 31, 2012.

* * * * * * *

SUBCHAPTER V--HOUSING ASSISTANCE

Sec. 2041. Housing assistance for homeless veterans

(a) * * *

* * * * * * *

SUBCHAPTER VII--OTHER PROVISIONS

* * * * * * *

Sec. 2066. Advisory Committee on Homeless Veterans

(a) * * *

* * * * * * *

(d) Termination.--The Committee shall cease to exist
[December 30, 2011] December 31, 2012.

* * * * * * *

PART VI--ACQUISITION AND DISPOSITION OF PROPERTY

* * * * * * *

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

* * * * * * *

Sec. 8104. Congressional approval of certain medical facility
acquisitions

(a) * * *
(b) Whenever the President or the Secretary submit to the
Congress a request for the funding of a major medical facility
project (as defined in subsection (a)(3)(A)) or a major medical
facility lease (as defined in subsection (a)(3)(B)), the
Secretary shall submit to each committee, on the same day, a
prospectus of the proposed medical facility. Any such
prospectus shall include the following:
(1) A [detailed description] detailed estimate of the
total costs of the medical facility to be constructed,
altered, leased, or otherwise acquired under this
subchapter, including a description of the location of
such facility and, in the case of a prospectus
proposing the construction of a new or replacement
medical facility, [a description of the consideration]
a detailed report of the consideration that was given
to acquiring an existing facility by lease or purchase
and to the sharing of health-care resources with the
Department of Defense under section 8111 of this title.
Such detailed estimate shall include an identification
of each of the following:
(A) Total construction costs.
(B) Activation costs.
(C) Special purpose alterations (lump-sum
payment) costs.
(D) Number of personnel.
(E) Total costs of ancillary services,
equipment, and all other items.
[(2) An estimate of the cost to the United States of
the construction, alteration, lease, or other
acquisition of such facility (including site costs, if
applicable).
[(3) An estimate of the cost to the United States of
the equipment required for the operation of such
facility.]
[(4)] (2) Demographic data applicable to such
facility, including information on projected changes in
the population of veterans to be served by the facility
over [a five-year period and a ten-year period] a five-
year period, a ten-year period, and a twenty-year
period.
[(5)] (3) Current and projected workload and
utilization data regarding the facility, including
information on projected changes in workload and
utilization over a five-year period, a ten-year period,
and a twenty-year period.
[(6) Current and projected] (4) Projected operating
costs of the facility, including both recurring and
non-recurring costs (including and identifying both
recurring and non-recurring costs (including activation
costs and total costs of ancillary services, equipment
and all other items)) over a five-year period, a ten-
year period, and a twenty-year period.

* * * * * * *

[(7)] (5) The priority score assigned to the project
or lease under the Department's prioritization
methodology and, if the project or lease is being
proposed for funding before a project or lease with a
higher score, a specific explanation of the factors
other than the priority score that were considered and
the basis on which the project or lease is proposed for
funding ahead of projects or leases with higher
priority scores.
[(8)] (6) In the case of a prospectus proposing the
construction of a new or replacement medical facility,
[a description of each alternative to construction of
the facility that was considered.] each of the
following:
(A) A detailed estimate of the total costs
(including total construction costs, activation
costs, special purpose alterations (lump-sum
payment) costs, number of personnel and total
costs of ancillary services, equipment and all
other items) for each alternative to
construction of the facility that was
considered.
(B) A comparison of total costs to total
benefits for each such alternative.
(C) An explanation of why the preferred
alternative is the most effective means to
achieve the stated project goals and the most
cost-effective alternative.

* * * * * * *

(d)(1) * * *
(2)(A) In any fiscal year, unobligated amounts in the
Construction, Major Projects account that are a direct result
of bid savings from a [major medical facility project] major
construction project may only be obligated for [major medical
facility projects] major construction projects authorized for
that fiscal year or a previous fiscal year.
(B) Whenever the Secretary obligates amounts for a [major
medical facility] major construction project under subparagraph
(A), the Secretary shall submit to the Committee on Veterans'
Affairs and the Committee on Appropriations of the Senate and
the Committee on Veterans' Affairs and the Committee on
Appropriations of the House of Representatives notice of the
following:
(i) The [major medical facility project] major
construction project that is the source of the bid
savings.
(ii) The other [major medical facility project] major
construction project for which the amounts are being
obligated.
(iii) The amounts being obligated for such other
[major medical facility project] major construction
project.

* * * * * * *

Sec. 8118. Authority for transfer of real property; Department of
Veterans Affairs Capital Asset Fund

(a)(1) * * *

* * * * * * *

(5) The authority of the Secretary under paragraph (1)
expires on [the date that is seven years after the date of the
enactment of this section] December 31, 2018.

* * * * * * *