[House Report 116-63]
[From the U.S. Government Publishing Office]
116th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 116-63
======================================================================
MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES
APPROPRIATIONS BILL, 2020
_______
May 15, 2019.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Ms. Wasserman Schultz, from the Committee on Appropriations, submitted
the following
R E P O R T
together with
MINORITY VIEWS
[To accompany H.R. 2745]
The Committee on Appropriations submits the following
report in explanation of the accompanying bill making
appropriations for military construction, the Department of
Veterans Affairs, and related agencies for the fiscal year
ending September 30, 2020, and for other purposes.
CONTENTS
Page
Purpose of the Bill.............................................. 2
Summary of Committee Recommendation.............................. 2
Management and Oversight Initiatives............................. 4
Department of Defense:
Military Construction........................................ 7
NATO Security Investment Program............................. 22
Department of Defense Base Closure Account................... 22
Family Housing Construction and Operation and Maintenance.... 23
Department of Defense Family Housing Improvement Fund........ 26
Department of Defense Military Unaccompanied Housing
Improvement Fund........................................... 26
Administrative Provisions.................................... 26
Department of Veterans Affairs:
Veterans Benefits Administration............................. 29
Veterans Health Administration............................... 35
National Cemetery Administration............................. 68
Departmental Administration.................................. 69
Administrative Provisions.................................... 79
Related Agencies:
American Battle Monuments Commission......................... 84
U.S. Court of Appeals for Veterans Claims.................... 85
Cemeterial Expenses, Army.................................... 85
Armed Forces Retirement Home................................. 86
Administrative Provision..................................... 86
Department of Defense:
Overseas Contingency Operations.............................. 86
Administrative Provision..................................... 87
Department of Defense:
Natural Disaster Relief...................................... 87
Administrative Provision..................................... 88
General Provisions............................................... 88
House of Representatives Report Requirements:
Statement of General Performance Goals and Objectives........ 89
Rescissions.................................................. 89
Transfer of Funds............................................ 89
Disclosure of Earmarks and Congressionally Directed Spending
Items...................................................... 91
Ramseyer Rule................................................ 91
Changes in Application of Existing Law....................... 93
Appropriations Not Authorized by Law......................... 98
Program Duplication.......................................... 100
Committee Hearings........................................... 100
Full Committee Votes......................................... 101
Comparison With the Budget Resolution........................ 107
Five-Year Projection of Outlays.............................. 107
Assistance to State and Local Governments.................... 107
Comparative Statement of New Budget Authority................ 108
State and Country Project List............................... 120
Overseas Contingency Operations Project List................. 135
Minority Views............................................... 137
Purpose of the Bill
The purpose of the bill is to support our military and
their families and provide the benefits and medical care that
our Veterans have earned because of their service to our
Nation. This is accomplished through the programs funded in the
bill, which provide the facilities and infrastructure needed to
house, treat, train, and equip our military personnel to defend
this Nation, both in the United States and abroad; provide the
housing and military community infrastructure that supports a
good quality of life for them and their families; and allow the
military to maintain an efficient and effective base structure.
The quality of life for our servicemembers and their families
is a key component of readiness. The bill also funds a wide
variety of assistance programs for Veterans, including
disability and pension benefits, healthcare in many different
settings, educational assistance, and home loan and insurance
programs. Finally, the bill funds four related agencies that
provide support to our Nation's heroes: the American Battle
Monuments Commission, Cemeterial Expenses, Army (including
Arlington National Cemetery), the United States Court of
Appeals for Veterans Claims, and the Armed Forces Retirement
Home.
Summary of Committee Recommendation
The Committee recommends $231,349,814,000 in budget
authority for the fiscal year 2020 programs and activities
funded in the bill. The fiscal year 2020 recommendation is an
increase of $22,588,146,000 above the fiscal year 2019 enacted
level and $6,130,359,000 below the President's request. Of the
increase over the fiscal year 2019 enacted level,
$12,507,301,000 is in mandatory programs. Included in the total
budget authority is $123,211,394,000 in mandatory budget
authority and $108,138,420,000 in discretionary budget
authority which includes $2,000,000,000 in emergency funding.
The Committee recommendation highlights the continued
commitment to our servicemembers and their families and to our
Veterans. In discretionary budget authority, the bill is 10
percent over the fiscal year 2019 enacted level. The bill
includes an increase in military construction, which is 2
percent above the fiscal year 2019 level, and an increase in
the Department of Veterans Affairs budget, which is 9 percent
over the fiscal year 2019 level. While the Committee
recommendation continues essential support for servicemembers
and Veterans, it does not provide funds for projects or
activities that lacked sufficient justification or were less
mission-critical. Where it was prudent, the Committee
recommendation rescinds prior year funding that is no longer
needed for the purpose for which it was originally appropriated
while leaving sufficient resources to close out contracts.
Finally, the recommendation rescinds unobligated balances in
certain military construction and VA accounts.
The programs funded in the bill for the Department of
Defense (DOD) address the priorities of the Department's
Agencies and the Services for the numerous facility challenges
that they face. The funds provided support readiness
improvements with new construction, family housing, and
continued cleanup of military bases closed during previous Base
Realignment and Closure rounds, support Combatant Commanders'
requirements where appropriate, and ensure that our military
personnel and their families' quality of life is preserved.
The total recommended funding level for military
construction and family housing, including base and Overseas
Contingency Operations funding, including the European
Reassurance Initiative, is $13,460,420,000 which is
$2,207,000,000 above the fiscal year 2019 enacted level and
$7,625,759,000 below the budget request. The recommendation
includes funding for Family Housing, funding for necessary
construction on our bases, including barracks, health
facilities and schools, and support for critical overseas
investments as well as an additional $140,800,000 to address
privatized family housing issues. The recommendation includes
$921,420,000 for the European Deterrence Initiative and
construction related to Overseas Contingency Operations, which
helps ensure the protection of our allies and protects the
warfighter. The recommendation also includes $2,000,000,000 to
address the needs of military facilities damaged by Hurricanes
Florence and Michael. The recommendation also includes
$1,093,500,000 for the Services' unfunded priorities that are
more than 35 percent complete in design and can be executed in
fiscal year 2020.
The total funding level for fiscal year 2020 for the
Department of Veterans Affairs is $217,467,894,000, an increase
of $20,277,301,000 over the fiscal year 2019 enacted level. Of
the total, $123,211,394,000 is provided for mandatory benefit
programs and $94,256,500,000 is allocated to discretionary
programs such as medical care, claims processing, and
construction. In this bill, discretionary funding for the
Department of Veterans Affairs is recommended at 9 percent over
the fiscal year 2019 enacted level. For fiscal year 2020,
$75,550,600,000 for medical care has been appropriated in
advance.
In addition, the Committee recommendation includes
$87,636,650,000 in advance appropriations for fiscal year 2021
for the four health care accounts of the Department and
$129,509,505,000 in advance appropriations for mandatory
benefits programs for fiscal year 2021.
The Committee recommendation provides a total of
$421,500,000 for the four Related Agencies: the American Battle
Monuments Commission (ABMC), the U.S. Court of Appeals for
Veterans Claims, Arlington National Cemetery, and the Armed
Forces Retirement Home. The recommendation is an increase of
$175,900,000 over the budget request and $103,845,000 over the
fiscal year 2019 enacted level. These funds are provided to
achieve the level of services and facility maintenance that is
necessary to properly ensure that these agencies are able to
continue their missions of honoring the service and sacrifice
of our servicemembers and Veterans. In addition, the
recommendation includes funding for planning, design, and
construction of the Southern Expansion at Arlington National
Cemetery, in order to extend the life of the cemetery.
Management and Oversight Initiatives
The Committee believes the effective stewardship of
taxpayer dollars is of the highest priority. In the interest of
eliminating waste, fraud, and abuse in Federal programs, the
Committee has and will continue to use public hearings,
briefings, information requests, and reviews by the Government
Accountability Office (GAO) and the Inspectors General to
promote strong financial and program management, oversight and
leadership at the Department of Defense (DOD), the Department
of Veterans Affairs (VA), and Related Agencies under the
jurisdiction of this bill.
The fiscal year 2020 appropriations Act and the
accompanying report address management challenges of the
Federal agencies it funds, including directives to strengthen
financial and program management, eliminate redundancy, and
improve implementation and oversight of initiatives that
support the mission of this bill. The Committee will use every
means at its disposal to reduce mismanagement that results in
waste, fraud, and abuse.
Performance Measures.--The Committee directs each of the
agencies funded by this Act to comply with title 31 of the
United States Code, including the development of their
organizational priority goals and outcomes such as performance
outcome measures, output measures, efficiency measures, and
customer service measures.
Customer Service Standards.--The Committee emphasizes the
importance of implementing proper customer service standards.
Development of these standards includes providing significant
services directly to the public, identifying and surveying
target customers, establishing effective service standards and
tracking internal performance against those standards.
Department of Defense Military Family Housing.--Privatized
housing has come under scrutiny over the last year with
complaints of inadequate housing across the DOD enterprise due
to lack of repairs, rodents, mold, cracks in walls and peeling
paint. The military housing privatization initiative (MHPI) was
established by Congress in 1996 as a tool to help DOD improve
the quality of life for its servicemembers by improving the
condition of their housing. MHPI is a public/private venture
(PPV) where private sector developers may own, operate,
maintain, improve and assume responsibility for military family
housing. The private entity is responsible for managing the
construction, renovation, and day-to-day maintenance and
services for the community. The PPV housing may be located on
or off government property and may be former military family
housing. DOD has mandated that all military family housing in
the United States be eventually privatized. The recommendation
includes an additional $140,800,000 within Housing Support
Costs under Family Housing Operation and Maintenance accounts
for the Services. The funding is to increase the Services'
ability to provide oversight and management, and personnel to
track current and future issues that may occur in military
family housing. The Committee also includes report language
directing DOD to submit various reports and maintain a
maintenance database to track any issues that may be prevalent
in the future. The Committee notes that the general welfare of
a servicemember's family contributes to the overall state of
readiness for DOD.
Department of Veterans Affairs (VA).--With the
$217,467,894,000 provided for VA in this bill, the increase in
the number of Veterans seeking VA medical services, and the
transformative initiatives VA is undertaking, the Committee
believes it is important to strengthen its tools to monitor
spending as well as the operating procedures of the VA
workforce. The following initiatives demonstrate the
Committee's oversight focus:
VA Electronic Health Record Modernization (EHRM).--After at
least a decade of Congressional encouragement to DOD and VA to
develop a single electronic health record (EHR), VA has
completed a contract to acquire the same EHR that DOD is
adopting. The bill includes $1,603,000,000 for the EHR contract
entered in 2018, and continues strict quarterly reporting of
timelines, performance milestones, costs, implementation, and
change management. The bill also continues the requirement for
GAO to review EHRM implementation so that Congress can be
informed of any problems at a point where they can be promptly
and economically addressed.
Disability Claims and Appeals.--Thanks to the significant
investments Congress has provided over the past eight years, VA
has been able to hire the staff, acquire the technology, and
change work processes necessary to reduce the disability claims
backlog to an ``effective'' zero. But as the number of claims
continues to increase and the number of appeals skyrockets once
claims are decided, VA again runs the risk of falling into
serious claims and appeals backlogs. The Committee recognizes
this threat and provides $25,000,000,000 above the Veterans
Benefits Administration request to support staff overtime and
digital claims scanning. The Committee hopes that with this
additional investment and the recently passed legislation to
reform the appeals process, Congress will have taken the
necessary management action to prevent Veterans from enduring
excessive waits to claim the disability benefits they deserve.
Information Technology (IT).--The Committee continues to
include bill language prohibiting obligation or expenditure of
funds for information technology systems development until VA
submits to the Committees a certification of the amounts. The
bill limits the amount of funds that can be transferred into
the IT account to ten percent of the total of either the source
or destination account. The bill contains language that permits
the reprogramming of funds among development projects upon
prior notification to, and approval by, the Committees.
Stricter Control of Construction Funding.--The Committee
continues to request quarterly briefings on the progress and
cost of each facility managed by an outside entity. Several
additional bill language provisions are included to enhance the
Committee's capacity to conduct oversight on VA's facility
construction efforts including: (1) no funding greater than
$7,000,000 may be reprogrammed between construction projects
unless approved by the Committees on Appropriations of both
Houses of Congress; (2) any change to the scope of a
construction project is prohibited without the approval of the
Committees; and (3) VA must report any bid savings of
$5,000,000 or more on projects as soon as they are identified.
American Battle Monuments Commission (ABMC).--The Committee
continues to provide funds to address the maintenance and
repair needs of the American Battle Monuments around the world.
The Committee directs ABMC to undertake these efforts in a
proactive and timely manner, which will ensure that monuments
do not fall into disrepair and require even greater investments
to correct.
Department of Defense Civil Cemeterial Expenses.--The
Committee continues to provide $80,800,000 for Arlington
National Cemetery to maintain current services and ensure that
critical operations do not go unaddressed. Additionally, the
Committee provides $131,000,000 for the Southern Expansion
project, to expand cemetery capacity in a timely manner and
extend the life of the cemetery into the 2050 timeframe. The
bill also maintains an Administrative Provision permitting
funds from concessions at Army National Military Cemeteries to
be used to support activities at the Cemeteries.
Armed Forces Retirement Home (AFRH).--The Committee
provides increased funding to allow AFRH to address anticipated
increases in costs such as personnel costs and contract
inflation, as well as to address critical capital projects,
particularly those affecting the health and safety of
residents. This funding will allow AFRH to begin work on
deferred maintenance projects, ensuring that AFRH is well-
positioned to continue to improve its standing and increase
revenue for the long term. The Committee notes efforts that are
underway to stabilize the AFRH Trust Fund and reduce reliance
on transfers from the General Fund, and directs AFRH to
continue to make progress in improving AFRH's sustainability.
TITLE I
DEPARTMENT OF DEFENSE
Military Construction Overview
Fiscal year 2019 enacted level (including rescissions) $10,332,000,000
Fiscal year 2020 budget request....................... 11,241,653,000
Committee recommendation in the bill (including one 10,539,000,000
rescission)..........................................
Comparison with:
Fiscal year 2019 enacted level.................... 207,000,000
Fiscal year 2020 budget request................... (702,653,000)
Military construction accounts provide funds for new
construction, construction improvements, planning and design,
and host nation support. Projects funded by these accounts
include facilities for operations, training, readiness,
maintenance, research and development, supply, medical care,
and force protection, as well as unaccompanied housing,
military-owned family housing, utilities infrastructure, and
land acquisition.
In addition to the notification and reporting requirements
for military construction programs contained in Title 10,
United States Code, the Committee's recommendations include
several provisions requiring DOD to report on various aspects
of military construction programs, or to provide notification
to the Committee when certain actions are taken. The Committee
also retains prior approval authority for any reprogramming of
funds exceeding a specific threshold.
Reprogramming Guidelines.--The following reprogramming
guidelines apply for all military construction and family
housing projects. A project or account (including the sub-
elements of an account) that has been specifically reduced by
Congress in acting on the budget request is considered to be a
Congressional interest item and as such, prior approval is
required. Accordingly, no reprogramming to an item specifically
reduced below the threshold by Congress is permitted, except
that DOD may seek reprogramming for appropriated increments.
The reprogramming criteria that applies to military
construction projects is one percent of the funded amount to
include new housing construction projects and improvements. To
provide the Services the flexibility to proceed with
construction contracts without disruption or delay, the costs
associated with environmental hazard remediation such as
asbestos removal, radon abatement, lead-based paint removal or
abatement, and any other legislated environmental hazard
remediation may be excluded, if such remediation requirements
could not be reasonably anticipated at the time of the budget
submission. Reprogramming is a courtesy provided to DOD and can
be taken away if the authority is abused. This exclusion
applies to projects authorized in this budget year, as well as
projects authorized in prior years for which construction has
not been completed. Planning and design costs associated with
military construction and family housing projects may also be
excluded from these guidelines. In instances where prior
approval for a reprogramming request for a project or account
has been received from the Committees on Appropriations of both
Houses of Congress, the adjusted amount approved becomes the
new base for any future increase or decrease via below-
threshold reprogramming (provided that the project or account
is not a Congressional interest item as defined above).
In addition to these guidelines, the Services are directed
to adhere to the guidance for military construction
reprogramming actions and notifications, including the
pertinent statutory authorities contained in DOD Financial
Management Regulation 7000.14-R and relevant updates and policy
memoranda. The Committee further encourages the Office of the
Director of National Intelligence to use a format similar to
that used by the Office of the Secretary of Defense to submit
reprogramming requests.
Diversion of Military Construction Funds for a Border
Wall.--On February 15, 2019, President Trump declared a
National Emergency to use section 2808 of title 10, United
States Code to bypass congressional intent and divert valuable
military construction funding from previously approved national
security projects to fund a border wall. Congress chose not to
fund this wall in the Consolidated Appropriations Act, 2019
(P.L. 116-6). The Committee notes there is bipartisan
opposition to the action taken by the President, as both the
House and Senate voted to disapprove the President's emergency
declaration. Despite bipartisan congressional opposition, the
fiscal year 2020 budget request for military construction
included $7,200,000,000 to restore funding (up to
$3,600,000,000) that would be diverted for the wall as well as
provide the next installment of wall funding ($3,600,000,000).
The Committee recommendation does not provide these requested
funds. Also, the accompanying bill includes language that
protects previously appropriated projects, as well as fiscal
year 2020 projects included in this bill from being used as a
source for wall funding. The Committee believes that Congress
must assert its role as a co-equal branch of the Federal
government and insist upon the regular appropriation of funds--
funds this Committee has previously appropriated for disaster
recovery, flood protection, and military base construction
projects to maintain and improve military readiness. The
Committee believes that military construction dollars should be
used only for the purpose they are provided, which is to
support DOD's mission, servicemembers, and their families.
Facilities Sustainment, Restoration and Modernization
(FSRM).--DOD is directed to continue describing on form 1390
the backlog of FSRM requirements at installations with future
construction projects. For troop housing requests, form 1391
should describe any FSRM conducted in the past two years.
Likewise, future requirements for unaccompanied housing at the
corresponding installation should be included. Additionally,
the forms should include English equivalent measurements for
projects presented in metric measurement. Rules for funding
repairs of facilities under the operation and maintenance
accounts are described below:
(1) components of the facility may be repaired by
replacement. Such replacement can be up to current
standards or codes;
(2) interior arrangements and restorations may be
included as repair;
(3) additions, new facilities, and functional
conversions must be performed as military construction
projects. Such projects may be done concurrently with
repair projects as long as the final conjunctively
funded project is a complete and usable facility; and
(4) the appropriate Service Secretary shall notify
the appropriate committees 21 days prior to carrying
out any repair project with an estimated cost in excess
of $7,500,000. The Committee strongly encourages the
Services and defense agencies to indicate the plant
replacement value of the facility to be repaired on
each such notification.
Quarterly Summary of Notifications.--The Committee directs
the Services and the Office of the Secretary of Defense (on
behalf of itself and defense agencies) to continue to submit a
quarterly report listing all notifications that have been
submitted to the Committees during the preceding three-month
period.
Work in Progress or Planned (WIP) Curve.--The Committee
directs the Services and the Office of the Secretary of Defense
(on behalf of itself and defense agencies) to submit a WIP
curve for each project requested in a budget submission over
$25,000,000 with the form 1391 justification to the
congressional defense committees. The Committee is concerned
that there is an alarming amount of unawarded prior-year
military construction projects, and therefore the Committee
directs the Secretary of Defense to report to the congressional
defense committees quarterly, beginning in the second quarter
of fiscal year 2020 and each quarter thereafter of projects
that remain unawarded from the current and prior fiscal years
and the reasons for delay.
Transfer of Funds To and From the Foreign Currency
Fluctuations, Construction, Defense Account.--The Committee
directs DOD to submit a quarterly report to the Committees on
Appropriations of both Houses of Congress on the transfer of
funds from military construction and family housing accounts to
the Foreign Currency Fluctuations, Construction, Defense
account. The report shall specify the amount transferred to the
Foreign Currency account from each military construction and/or
family housing account, and all other accounts for which an
appropriation is provided in this Act, during the preceding
fiscal quarter, and the amounts transferred from the Foreign
Currency account to the above accounts during the same period.
This report shall be submitted no later than 30 days after the
close of each fiscal quarter. In addition, DOD shall notify the
Committees on Appropriations of both Houses of Congress within
seven days of transferring any amount in excess of $10,000,000
to or from the Foreign Currency account.
Bid Savings.--The Committee has ascertained from cost
variation notices required by 10 U.S.C. 2853 that DOD has
canceled two projects that were previously appropriated
military construction projects. The Committee's recommendation,
therefore, includes a rescission to the Military Construction,
Defense-Wide account. The Committee directs the Secretary of
Defense to continue to submit 1002 reports on military
construction bid savings at the end of each fiscal quarter to
the Subcommittees on Military Construction, Veterans Affairs,
and Related Agencies of both Houses of Congress.
Incremental Funding of Projects.--In general, the Committee
supports full funding for military construction projects if
they are executable. However, it continues to be the practice
of the Committee to provide incremental funding for certain
large projects to enable the Services to more efficiently
allocate military construction dollars among projects that can
be executed in the year of appropriation. Therefore, the
Committee recommendation includes 19 projects that have been
incrementally funded; however, the full authorization of the
projects will be provided in the fiscal year 2020 National
Defense Authorization Act.
Impacts of Climate Change and Investing in Multi-Hazard
Resilient Defense Infrastructure.--The Committee is concerned
by increasing magnitudes and frequencies of environmental
shocks (e.g., hurricane-force winds, storm surge, and extreme
rainfall) and long-term stresses (e.g., from sea level rise) on
DOD facilities worldwide. Recent extreme weather and natural
disasters, for example, Hurricane Michael in 2018 that heavily
damaged Tyndall Air Force Base in Florida, illustrate the
challenges facing DOD in mitigating and preparing for
inevitable future disasters and improving the security and
readiness of the Nation's coastal military installations and
the safety of military housing. The Committee supports the
military's continued focus on building lasting and resilient
military installations, including methods that update
hurricane-resistant building codes for bases, barracks,
hospitals, and airfields. It also encourages continued
consideration of severe drought and desertification as
potential threats to military installations and missions. In
addition to Department-wide initiatives, such as revised
structure planning, conservation programs and modeling new
installations with the threat of sea-level rise in mind, the
Committee encourages DOD to prioritize investing in climate-
sustainable infrastructure projects. Such investments have
yielded positive results including increased resiliency and
cost savings. The Committee urges DOD to collaborate with
existing research universities with federally designated
testing facilities to accelerate investments to assess DOD
installation vulnerabilities at home and abroad and to develop
and test resilient infrastructure and technologies capable of
withstanding 200 mph winds and high levels of storm surge and
flooding. Furthermore, the Committee directs the Secretary of
Defense to report to the congressional defense committees no
later than 180 days after enactment of this Act detailing DOD's
plans to develop lasting and resilient military installations,
and what year these projects will appear in the Future Years
Defense Plan.
Hawaii Infrastructure Readiness Initiative.--The Committee
recognizes the strategic and critical role the Hawaii
Infrastructure Readiness Initiative (HIRI) plays in DOD's
strategic plans for the Indo-Pacific region. At the direction
of Congress, United States Army Pacific (USARPAC) created the
HIRI to address critical priorities established in USARPAC's
military construction submissions and major restoration and
maintenance (R&M) programming requests. According to the Army's
analysis, 45 percent of the infrastructure in Hawaii is failed
or failing, putting efforts to meet operational needs at risk.
To fix this crisis, HIRI allocates between $50,000,000 and
$150,000,000 per year through fiscal year 2030 to address major
infrastructure needs, with a ten-year cost of $1,100,000,000.
The program addresses several major facility and infrastructure
deficiencies, including aviation maintenance facilities,
operations facilities, tactical equipment maintenance
facilities, Pohakuloa Training Area, West Loch Ammunition
Storage, and base operations. The President's Budget for fiscal
year 2019 included funds for this critical initiative. The
fiscal year 2020 budget submission includes the West Loch
Ammunition Storage Facility, a vital military construction
project. Continued and consistent funding is needed at a time
of growing national security needs in the Pacific. Therefore,
the Committee directs the Secretary of the Army to certify that
the Initiative's plan for the next 10 fiscal years does not
create gaps in funding that will result in inconsistent program
implementation that could undermine the interconnected nature
of HIRI's projects.
Strengthening our Alliances in the Indo-Pacific Area of
Responsibility (AOR).--According to the National Defense
Strategy, the United States is seeking to strengthen our
alliances and partnerships in the Indo-Pacific AOR to include a
networked security architecture capable of deterring
aggression, maintaining stability and ensuring free access to
common domains. This effort to rebalance toward the Pacific
will include significant military construction requirements
throughout the Indo-Pacific AOR. Therefore, the Committee
directs the Service Secretaries to submit a report to the
congressional defense committees no later than 180 days after
enactment of this Act detailing (1) military construction
requirements in the Indo-Pacific AOR over the next ten years,
sorted by fiscal year, country and State and (2) efforts to
coordinate these requirements across the Services.
Adequate Childcare for Military Families.--The Committee is
aware of the importance of helping military families secure
adequate childcare for their children. DOD has argued that
these childcare benefits help support their recruiting,
retention and readiness goals, and that there is generally a
high level of satisfaction among servicemembers who use DOD
childcare services. However, the success of the program
depends, in part, on ensuring adequate facilities for child
development centers (CDCs) and School Age Care (SAC) Program
facilities, preferably on military installations. Hearings
before the Committee have noted a lack of facilities in some
locations. Thus, the Committee directs the Service Secretaries
to submit a report to the congressional defense committees no
later than 180 days after enactment of this Act detailing (1)
all installations that have CDCs and SAC facilities, (2) the
physical condition of these facilities, and (3) the length of
time military families must wait before enrolling their
children into CDCs and SAC programs.
Recycling of Tire Rubber.--The Committee is aware of recent
advances in the use of waste tire rubber in asphalt, known as
rubber modified asphalt (RMA), and encourages the Army to
engage the research community and academia to study the
potential benefits of rubber modified asphalt and to consider
utilizing RMA on domestic military installations.
Quality of Life (QOL) Projects Priority List.--The
Committee notes the ongoing challenges that the lack of QOL
projects, such as the lack of Childcare Development Centers
(CDCs), creates a hardship to servicemembers and their
families. The Committee is concerned that too often QOL
projects are not included in budget submissions and this
absence negatively impacts the QOL for servicemembers and their
families. Given the demanding jobs that servicemembers must
execute, creating unique solutions is required. The Committee
notes that stable family life is a key component to mission
readiness and retention. The Committee believes that requesting
these QOL projects, like CDCs, should be a top priority amongst
the Services. The recommendation includes an additional
$11,000,000 in each of the Services' planning and design
accounts to support the Services preparation for construction
of new CDCs at the most underserved military installation.
Therefore, the Committee directs the Service Secretaries to
submit a report to the congressional defense committees no
later than 90 days after the enactment of this Act that
provides a plan to provide address QOL shortfalls, with an
emphasis on CDCs, and at what installations they are most
needed for the fiscal year 2020 and in the FYDP. The report
should include associated funding requirements for every
installation with an emphasis on CDCs. Further, the Committee
directs that the Secretary of Defense to create a unified list
of needed QOL projects with an emphasis on CDCs across the
enterprise which shall be submitted concurrently with the
annual budget submission hereafter.
Federally Recognized Tribes.--The Committee notes our
Nation's commitment to honoring treaty and trust obligations to
Federally Recognized Tribes. While military operations and
facility protection are important, upholding our commitments to
Indian Country must be an equal priority. It has been observed
that DOD has struggled to proactively engage with affected
Tribes at the start of the planning process to ensure
meaningful consultation can occur. Moreover, the Department
does not identify sufficient funds to cover mitigation and
alternatives should they be agreed upon. To understand the
scale of this problem, the Committee directs the Secretary of
Defense to provide the Committee a list of military
construction projects related to mitigation and/or changes to
projects were required within the past five years where
consultation with a Federally Recognized Tribe, the outcome of
each consultation, a list of all project modifications and/or
mitigation requests made by the Tribe (or Tribes) in question
for each project, the cost of each measure, and which
modifications and or mitigations were adopted no later than 180
days after enactment of this Act.
Securing Mission-Critical Infrastructure.--The Committee is
aware that DOD is undertaking efforts to secure mission-
critical infrastructure through modernization of industrial
control systems at priority locations. Modernized electrical,
mechanical, and hydraulic systems can improve energy management
and reduce operating costs at DOD facilities. However, higher
connectivity to these systems exposes exploitable
vulnerabilities and increases the threat from potential
cyberattacks. The Committee directs quarterly reports by DOD
beginning in the first quarter of fiscal year 2020 showing the
steps the Department is taking to ensure that industrial
control systems in ongoing and future military construction
projects are secure.
Other Transaction Authority.--The Committee is aware that
the use of Other Transaction Authority provides a streamlined
acquisition tool to accelerate project delivery. When leveraged
appropriately, Other Transaction Authority also gives the
Federal government greater access to innovative, state-of-the-
art technology solutions from the commercial sector. DOD is
encouraged, in consultation with the Corps of Engineers, to
expand its use of Other Transaction Agreements to execute the
Military Construction program.
High Performance and Sustainable Building Requirements.--
The Committee recognizes that innovative technologies,
including advanced wood products and recycled aerospace grade
carbon fiber composite, have expanded the availability of
materials with lower embodied energy for facilities that
require exceptional durability and blast resistance. In
addition, design techniques such as advanced framing contribute
to lower material costs, increased energy efficiency, and
reduced waste in facilities. Therefore, the Committee directs
the Secretary of Defense to continue to utilize innovative
renewable building materials, systems, and design techniques
that support the requirements of UFC 1 200 02 and UFGS 06 17
19. Furthermore, the Committee directs the Secretary of Defense
to work with universities, public agencies, and experienced
nonprofit organizations to develop a plan to expand the
application of these innovative technologies in future military
construction projects and report to the Committee no later than
90 days after enactment of this Act on how the Department will
implement the plan.
Defense Access Roads (DAR) Program.--The Committee is
supportive of the DAR program as a vital mechanism in providing
transportation infrastructure to domestic installations and
additional funding from DOD for mission-critical, off-base
transportation improvements. The Committee notes the expansion
of DAR for the first time in fiscal year 2019, which made funds
available to pay the cost of repairing and mitigating damage to
infrastructure and highways by recurrent flooding and sea-level
fluctuation if the Secretary determined that continued access
to military installations were affected by flooding and
projected sea-level fluctuation. The Services recently reported
to Congress that there currently are no flood-prone locations
creating a national security risk to transportation access for
military installations and that DOD has the necessary means to
address any flooding issues or risks (storm or non-storm surge)
that may impact DOD missions for roads that meet DAR criteria.
The Committee understands that there are numerous roadways
providing transportation access to military installations that
experience flooding and sea-level fluctuation and expects the
Services to work with the local communities to certify these
public roads that are hampering readiness for the military.
Cyberspace Operations Facilities.--The Committee recognizes
the importance of secure, up-to-date, and centralized
cyberspace operations facilities at military installations
because of the crucial role they play in securing information
technology infrastructure. Therefore, the Secretary of Defense
is directed to conduct a review of the condition of cyberspace
operations facilities at military installations and submit the
review and a plan to address the issues identified in the
review by fiscal year to the congressional defense committees
no later than 180 days after the enactment of this Act.
HVAC Efficiency.--The Committee recognizes that the Federal
Acquisition Regulation (48 C.F.R. Subpart 23.8) requires DOD,
in servicing or replacing existing HVAC systems that use R-22,
to give preference to alternatives that reduce overall risks to
the environment, including stratospheric ozone depletion and
global warming potential (GWP). Where feasible, DOD must use R-
22 alternatives that have been approved by EPA as acceptable
under its Significant New Alternatives Policy (SNAP) program
and that have lower GWP than R-22. Accordingly, the Committee
instructs DOD to use such alternatives in servicing or
replacing existing HVAC systems. The Committee believes that
DOD's replacement of R-22 with alternatives that have a GWP
lower than R-22, and are at least as energy efficient, will
greatly reduce the overall environmental impacts of DOD
operations.
Access Control Points in Urban Areas.--The Committee
supports accelerating funding for access control point projects
to installations that face high-security risks to critical
missions. Priority in allocating funds shall be given to access
control points in heavily congested areas in large urban
settings that place major transportation links at risk of
incident closures.
Military Construction, Army
Fiscal year 2019 enacted level........................ $1,021,768,000
Fiscal year 2020 budget request....................... 1,453,499,000
Committee recommendation in the bill.................. 1,132,499,000
Comparison with:
Fiscal year 2019 enacted level.................... 110,731,000
Fiscal year 2020 budget request................... (321,000,000)
The recommendation includes additional funding for the Army
in section 124 under Administrative Provisions for projects on
the Services Unfunded Priority lists as provided by the Office
of the Secretary of Defense and submitted to Congress in
priority order.
Rapid Deployment Requirements.--The Committee is concerned
that installations with rapid deployment requirements have
insufficient rail and transport logistics infrastructure to
efficiently move equipment in support of deployments, training
operations, and evolving Army requirements. For example, Fort
Bliss has only one railhead connection point for its deployment
and redeployment activities. Therefore, the Secretary of the
Army is directed to conduct a review of rail and transport
logistics infrastructure and equipment deployment methods at
installations with rapid deployment requirements and submit the
review and a plan to address the issues identified in the
review by fiscal year to the congressional defense committees
no later than 90 days after the enactment of this Act.
Access Control Points.--The Committee is aware that the
Army has access control points (ACP) at military installations
that do not meet current design criteria and U.S. Army Corps of
Engineers standards as noted in House Report 115-673.
Unfortunately, these concerns have not been addressed. Army
installations are still encountering traffic backups, are
operating at less than optimal efficiency and are vulnerable to
hostile direct action and penetration attempts. Replacing an
ACP is a military construction project that includes several
discrete components, such as a visitor control center,
gatehouses, canopy areas, guard booths, barriers, and
cybersecurity and surveillance systems. Given that upgrading an
ACP can take several years, the Committee directs the Army to
both prioritize these important security projects in its
construction program and to review the backlog of existing ACP
projects to determine which can be accomplished sooner through
smaller, incremental components within the minor construction
account that would enhance installation security and achieve
U.S. Army Corps of Engineers Standards.
Motor Pools.--In order to be able to deploy on command and
conduct decisive full-spectrum operations, the Army must have
well-maintained and ready-to-deploy equipment. The readiness of
this equipment relies on an effective, comprehensive
maintenance program, which in turn, enhances and facilitates
training and warfighting. This is particularly important for
units that rely on armored vehicles as their primary weapons
system. However, quality maintenance requires appropriately
designed, sized, supplied, and staffed motor pools and
maintenance facilities. The Committee requests a report on the
condition, current and anticipated capacity requirements, and
modernization needs of motor pools that support the rapid
deployment of armored combat units within 90 days of enactment
of this Act. The report should include information on recent
upgrades and construction of motor pools, as well as planned
investments included in the future years defense program.
Military Construction, Navy and Marine Corps
Fiscal year 2019 enacted level........................ $2,118,619,000
Fiscal year 2020 budget request....................... 2,805,743,000
Committee recommendation in the bill.................. 2,205,771,000
Comparison with:
Fiscal year 2019 enacted level.................... 87,152,000
Fiscal year 2020 budget request................... (599,972,000)
The recommendation includes additional funding for the Navy
and Marine Corps in section 124 under Administrative Provisions
for projects on the Services Unfunded Priority lists as
provided by the Office of Secretary of Defense and submitted to
Congress in priority order.
Navy Pier Replacement Master Plan.--The Committee is
concerned that the Navy has not properly synchronized or
prioritized pier replacement projects. Many of the current
piers are in disrepair or in need of complete replacement. The
Committee directs the Secretary of the Navy to provide to the
congressional defense committees a report 90 days after
enactment of this Act on pier replacement projects in the
fiscal years defense plan for 2021-2025.
Major Range and Test Infrastructure.--The Committee is
aware of significant infrastructure and upgrades that are
needed across the enterprise of Major Range and Test Facility
bases (MRTFB) of the Department of Defense. Many MRTFBs have
significant backlogs in infrastructure needs because they do
not score well in the military construction prioritization
process. The Committee is concerned that as new technologies
are tested, there are not adequate facilities that will allow
for successful testing, like with hypersonic weapons and other
emerging technologies. Additionally, the Committee notes that
DOD has not provided to the congressional defense committees an
annual report, as required by section 2806 of the National
Defense Authorization Act for Fiscal Year 2018, (P.L. 115-91),
on DOD laboratory construction needs. The Committee is also
aware of a specific backlog of construction projects at Naval
Air Station (NAS) Patuxent River. NAS Patuxent River has been
pivotal in testing many new systems that support the fleet. The
Aircraft Prototype Facility has enabled aircraft preparation
and technology support to permit full-scale fabrication of
advanced structures. The third and final phase would directly
support the Navy's emphasis on rapid prototyping consistent
with Maritime Accelerated Capabilities Office to capture
innovation and speed solutions to the warfighters. The Navy
expects that the facility is needed given current capacity
constraints. The Committee is also aware that significant
upgrades are needed to the Webster Outlying Field (WOLF) Air
Traffic Control (ATC) tower to enable basic operational needs
for the Navy test pilot program and UAV platforms. The current
ATC was constructed in 1978 and needs urgent replacement. The
Navy has included these projects in their FYDP. The Committee
urges the Navy to keep these projects, as planned, and more
broadly, better address the broader infrastructure needs at
MRTFBs.
The Strategic and Critical Role of Public Shipyards.--The
Committee recognizes the strategic and critical role our public
shipyards play in the national security of our Nation. However,
our shipyards are in direct need of maintenance and upgrade.
The National Defense Authorization Act for Fiscal Year 2018,
(P.L. 115-91) included language directing DOD to create a
Shipyard Infrastructure Optimization Plan. This plan included
recommendations and future year projects that would help to
restore our public shipyards to support our fleet around the
world. The Committee directs the Secretary of Defense no later
than 180 days after enactment of this Act to submit to
congressional defense committees a prioritized list of projects
to be constructed under the Shipyard Infrastructure
Optimization Plan necessary for national security requirements
over the next ten years.
Military Construction, Air Force
Fiscal year 2019 enacted level........................ $1,440,323,000
Fiscal year 2020 budget request....................... 2,179,230,000
Committee recommendation in the bill.................. 1,588,730,000
Comparison with:
Fiscal year 2019 enacted level.................... 148,407,000
Fiscal year 2019 budget request................... (590,500,000)
The recommendation includes additional funding for the Air
Force in section 124 under Administrative Provisions for
projects on the Services Unfunded Priority lists as provided by
the Office of the Secretary of Defense and submitted to
Congress in priority order.
F-35 Beddown and 21st Century Installation.--The current
estimate for F-35 beddown at Tyndall Air Force Base is
$350,000,000. It is the understanding of the Committee that the
Air Force is still determining what additional facilities would
be required for the additional three squadrons. The Committee
believes that it would not be prudent to have 5th generation
air assets like the F-35 housed in inappropriate hangars that
fail to protect the aircraft from the elements. Therefore, the
Committee directs the Air Force to provide a detailed timeline
by fiscal year, location and costs of necessary facilities,
including estimates for hurricane-related military construction
at Tyndall Air Force Base and the F-35 aircraft delivery
timeline, by base to the congressional defense committees no
later than 60 days after enactment of this Act.
F-22 Rebasing.--Hurricane Michael caused catastrophic
damage to the Tyndall Air Force Base and dislocated the 43rd
Fighter Squadron. It is the understanding of the Committee that
the Air Force has the opportunity to restructure F-22 Raptor
rebasing for long-term health and readiness. The current
estimate for the relocation of F-22s is $150,000,000 for
additional facilities required at existing F-22 bases to
support the formal training unit and operational squadron. The
Committee directs the Secretary of the Air Force to provide by
cost, location and fiscal year the necessary military
construction projects no later than 60 days after enactment of
this Act.
Air Traffic Control Towers.--The Committee is concerned
that the Department of the Air Force's ATC Towers have been
neglected over the years, and funding for military construction
has been deferred to the out years of budget submissions. Many
of the air towers are deteriorating and antiquated, creating
significant life, safety, and health concerns. In some cases,
towers have developed extensive mold issues and contain health
risks related to the use of asbestos and lead-based paint.
Additionally, obstructed views in some cases prevent 100
percent positive visual control of aircraft landing and taxiing
on the airfield. The Committee urges the Department of the Air
Force to prioritize funding for these towers in a much timelier
manner. The Committee believes that these towers are valuable
national security assets that the Department of the Air Force
should maintain in a manner that will ensure their vital role
in protecting United States national security interests.
Air Force Dormitories.--The Committee is concerned with the
condition of dormitories at numerous Air Force bases around the
country, especially at those in cities with large military
populations. The Committee, therefore, directs the Secretary of
the Air Force to submit a report to the congressional defense
committees detailing the process and formulas it uses to
prioritize its infrastructure renovation and upgrade projects
no later than 60 days after enactment of this Act.
Offutt Air Force Base.--The Committee continues to have
concerns on the impacts of recent flooding at Offutt Air Force
Base. The Committee is committed to ensuring United States
Strategic Command, the 55th Wing, and the Nebraska National
Guard receive the necessary funding to return Offutt Air Force
Base to fully mission capable. The unique facilities and assets
at Offutt Air Force Base are a cornerstone of our national
security and provide many one-of-a-kind capabilities, thereby
guaranteeing the Nation's airborne intelligence gathering
superiority, survivable nuclear command and control, and the
effectiveness of our strategic deterrent.
Air Education and Training Command (AETC).--The Committee
recognizes the importance of adequate facilities for basic
military training, flying training, and the other training
missions of the AETC. Outdated and inadequate AETC facilities,
including dormitories, harm the Department of the Air Force's
ability to recruit, train, and retain Airmen and increase
operations and maintenance costs. The Committee urges the
Department of the Air Force to prioritize funding for AETC
facility design, construction, and construction improvements
because of the critical role training plays in force readiness
for future threats to U.S. national security.
Air Education and Training Command Drainage Projects.--The
Committee recognizes the adverse impact that flooding and other
infrastructure challenges have had on AETC facilities,
equipment, operations, and training. The Committee also
recognizes the steps that the Air Force has taken to begin
mitigating the damage through multi-year projects. The
Committee supports these efforts and urges the Secretary of the
Air Force to prioritize these projects.
Military Construction, Defense-Wide
(INCLUDING TRANSFER OF FUNDS)
Fiscal year 2019 enacted level........................ $2,550,728,000
Fiscal year 2020 budget request....................... 2,504,190,000
Committee recommendation in the bill.................. 2,025,799,000
Comparison with:
Fiscal year 2019 enacted level.................... (524,929,000)
Fiscal year 2020 budget request................... (478,391,000)
Transfer of Funds.--The accompanying bill provides transfer
authority to the Secretary of Defense to allow the transfer of
funds to such appropriations of DOD available for military
construction or family housing as the Secretary may designate.
The recommendation includes a reduction of $10,000,000 from
the contingency construction account.
The recommendation includes a rescission of $45,055,000
from unobligated balances in section 125 under Administrative
Provisions.
Excess Inventory of Infrastructure.--The Committee
recognizes the issue of excess inventory within DOD and
encourages the Department to consider a Military Installation
Savings Commission (MISC). This would create a focus on
integrating and consolidating functions, outsourcing services,
assisting in the transition of underused facilities to higher
economic use, and provision of the necessary resources for
successful outcomes in affected communities.
Investment in Renewable Energy Systems.--The Committee
supports the military's continued investment in renewable
energy systems, including the use and application of solar
energy for mobility and resilience capabilities at defense
military installations including military bases, barracks,
hospitals, and airfields. Such investments have yielded
positive results such as increased resiliency and cost-savings.
The Committee encourages DOD to prioritize funding for
renewable energy-related projects, including solar, to mitigate
risk to mission-critical assets and to promote energy security
and efficiency at military installations. Accordingly, the
Committee requests a report no later than 180 days after
enactment of this Act detailing DOD's plans for further
development of renewable energy systems at military
installations and a timeline and goals for increased
utilization.
Natural Disasters and Military Installations Resiliency.--
The Committee supports the military's continued focus on
building lasting and resilient military installations,
including methods that update hurricane-resistant building
codes for bases, barracks, hospitals, and airfields. It further
considers the impact of severe drought and desertification as
high potential instability areas and how these two hazards
impact bases and missions. In addition to Department-wide
initiatives such as revised structure planning, conservation
programs and modeling new installations with the threat of sea-
level rise in mind, the Committee encourages DOD to prioritize
investing in climate-sustainable infrastructure projects. Such
investments have yielded positive results like increased
resiliency and cost-savings. Accordingly, the Committee
requests a report no later than 180 days after enactment of
this Act detailing DOD's plans to further develop lasting and
resilient military installations.
Energy Conservation.--The Committee commends DOD's forward
posture on the need to improve energy resilience, improve
mission assurance, save energy, and reduce energy costs. DOD
must continue to increase the integration of alternative energy
sources, particularly through renewable sources, throughout
military facilities and installations. Energy resilience is
critical to mission assurance for military units that perform
cyber and intelligence, surveillance, and reconnaissance
functions, missions vitally important to America's complex
global engagements. The Committee directs the Secretary of
Defense to provide a report no later than 90 days after
enactment of this Act on DOD's strategy to increase energy
conservation efforts and on energy cost savings, improved unit
readiness, and opportunities for return on investments of
existing and planned projects.
Rhine Ordnance Barracks Medical Center Replacement.--The
Committee fully understands the strategic importance of this
hospital. In the Consolidated Appropriations Act, 2018 (P.L.
115-141) the Committee directed the Director of the Defense
Health Agency to report to the congressional defense
committees: (1) specific changes in German energy law that
affected the energy study; (2) what United States sources of
energy the new German energy laws incorporate; (3) what United
States sources are no longer able to be used in Germany; (4)
what effect the changes in law have on other military
construction projects, construction costs and current utilities
contracts in the region; and (5) what effect this delay may
have on other aspects of the Rhine Ordnance Barracks Medical
Center Replacement Project. In addition to this requirement,
the Committee directed the Director of the Defense Health
Agency to provide to the congressional defense committees (1)
an updated form 1391 to include a WIP curve; (2) the total
amount of funding for the utility plant that is within the
military construction program; and (3) a list of other of
appropriations, if any, that are being used for utility costs.
This report has not yet been received by the Committee. In
addition to the prior reporting requirement, the Committee
directs the Director of the Defense Health Agency to provide
the total amount of funding that has been obligated of the
$50,095,000 requested in the original form 1391 for the central
utility plant and the percentages of Russian-exported natural
gas and domestically-sourced natural gas that will be used at
the utility plant no later than 90 days after enactment of this
Act. We need to ensure our military installations are not
compromised, as well as ensure energy security through
diversification of fuel sources.
DOD Installation Energy Policy.--DOD installation energy
use accounts for nearly a quarter of all Federal government
energy consumption. In fiscal year 2015, according to DOD's
Annual Energy Management Report, the Department spent
$3,900,000 on installation energy. While DOD has made great
strides in increasing installation energy efficiency and
reducing overall energy consumption, more needs to be done to
bring down the energy costs throughout the Department. DOD must
also ramp up its efforts to enhance energy security on its
installations through a range of actions, including investing
in renewable energy and smart technology that can shield
mission-critical operations from disruptions to the power grid.
According to a January 2017 report commissioned by the Pew
Charitable Trusts (Power Begins at Home: Assured Energy for
U.S. Military Bases), DOD could enhance energy security on
installations and save hundreds of millions of dollars annually
by investing in microgrids and renewable energy systems, and by
increasing energy efficiency on military bases. The report
found that microgrid power systems are more reliable than the
stand-alone diesel generators typically used for backup power
and could save $8,000,000 to $20,000,000 over a 20-year period.
The report also found that DOD could save as much as
$1,000,000,000 a year simply by increasing the use of
commercially available energy efficiency measures in its
facilities. The Committee notes that military installations in
Hawaii are among those at the forefront of DOD's efforts to
increase energy efficiency and security, including projects to
develop net-zero energy military housing and installation
facilities, upgrade and retrofit systems to improve energy and
water efficiency and demonstrate microgrid technology. The
Committee supports DOD's investments in energy efficiency,
renewable energy systems, and energy security, and provides
$190,000,000 for the Energy Resilience and Conservation
Program, an increase of $40,000,000 above the request.
Information Technology Infrastructure for Military
Construction Projects.--In the fiscal year 2019 conference
agreement, the Committee directed the Secretary of Defense to
report to the Committee no later than 60 days after enactment
on how the Department is incorporating technology advancements
and working with industry partners to gain efficiencies and
savings on military construction projects. The Committee
directs the Secretary to provide a status on the fiscal year
2019 directive.
Military Construction, Army National Guard
Fiscal year 2019 enacted level........................ $190,122,000
Fiscal year 2020 budget request....................... 210,819,000
Committee recommendation in the bill.................. 210,819,000
Comparison with:
Fiscal year 2019 enacted level.................... 20,697,000
Fiscal year 2020 budget request................... - - -
The recommendation includes additional funding for the Army
National Guard in section 124 under Administrative Provisions
for projects on the Services Unfunded Priority lists as
provided by the Office of the Secretary of Defense and
submitted to Congress in priority order.
Army National Guard Readiness Centers Investment.--The
Committee remains concerned by the failure of the Army to
prioritize investment in Army National Guard Readiness Centers.
These facilities are critical infrastructure in the protection
of the homeland and in responding to domestic emergencies.
Their deteriorating conditions are detrimental to the readiness
of the Army Guard and present significant safety concerns. The
Committee encourages the Army to accelerate investments in
Readiness Centers within the fiscal year 2020 FYDP to include
the $1,200,000,000 for the Army National Guard Transformation
Plan.
Military Construction, Air National Guard
Fiscal year 2019 enacted level........................ $129,126,000
Fiscal year 2020 budget request....................... 165,971,000
Committee recommendation in the bill.................. 115,971,000
Comparison with:
Fiscal year 2019 enacted level.................... (13,155,000)
Fiscal year 2020 budget request................... (50,000,000)
The recommendation includes additional funding for the Air
National Guard in section 124 under Administrative Provisions
for projects on the Services Unfunded Priority lists as
provided by the Office of the Secretary of Defense and
submitted to Congress in priority order.
Puerto Rico Construction.--The Committee is concerned that
the Department has yet to obligate supplemental funding
provided by Congress to assist Puerto Rico in recovering from
the devastating Hurricane Maria. The Committee believes
hurricane-related damage should be addressed prior to new
construction, and as such, the recommendation does not include
funding for Air National Guard projects at the Luis Munoz-Marin
International Airport. However, the Committee expects the
Department to submit these projects for consideration in the
future.
Dannelly Field Environmental Impact Statement (EIS) and
Record of Decision (ROD).--The Committee encourages the
Department to maintain its schedule for finalizing the EIS and
ROD for Dannelly Field and to ensure future projects are not
delayed.
Military Construction, Army Reserve
Fiscal year 2019 enacted level........................ $64,919,000
Fiscal year 2020 budget request....................... 60,928,000
Committee recommendation in the bill.................. 60,928,000
Comparison with:
Fiscal year 2019 enacted level.................... (3,991,000)
Fiscal year 2020 budget request................... - - -
Military Construction, Navy Reserve
Fiscal year 2019 enacted level........................ $43,065,000
Fiscal year 2020 budget request....................... 54,955,000
Committee recommendation in the bill.................. 54,955,000
Comparison with:
Fiscal year 2019 enacted level.................... 11,890,000
Fiscal year 2020 budget request................... - - -
Military Construction, Air Force Reserve
Fiscal year 2019 enacted level........................ $38,063,000
Fiscal year 2020 budget request....................... 59,750,000
Committee recommendation in the bill.................. 59,750,000
Comparison with:
Fiscal year 2019 enacted level.................... 21,687,000
Fiscal year 2020 budget request................... - - -
The recommendation includes additional funding for the Air
Force Reserve in section 124 under Administrative Provisions
for projects on the Services Unfunded Priority lists as
provided by the Office of the Secretary of Defense and
submitted to Congress in priority order.
Air Force Reserve Hangars.--The Committee is concerned that
many of the Air Force Reserve hangars that were damaged during
the record-breaking 2017 hurricane season are unsafe,
antiquated, and do not provide adequate protection of Air Force
Reserve air assets. For example, hangars located at Homestead
Air Reserve Base have become wholly inadequate due to
constrained military construction budgets and devastating storm
damage and are putting equipment and air assets at risk. The
Committee is concerned that this could be a problem throughout
the Air Force Reserve enterprise with the recent reductions to
DOD's construction accounts. Therefore, the Secretary of the
Air Force is directed to conduct a risk assessment on Air Force
Reserve hangars damaged by natural events throughout the Air
Force Reserve enterprise and develop a plan to update these
facilities in the fiscal years 2021-2025 FYDP. This assessment
shall be submitted to the congressional defense committees no
later than 60 days after enactment of this Act.
North Atlantic Treaty Organization Security Investment Program
Fiscal year 2019 enacted level........................ $171,064,000
Fiscal year 2020 budget request....................... 144,040,000
Committee recommendation in the bill.................. 172,005,000
Comparison with:
Fiscal year 2019 enacted level.................... 941,000
Fiscal year 2020 budget request................... 27,965,000
The North Atlantic Treaty Organization Security Investment
Program (NSIP) consists of annual contributions by NATO member
countries. The program finances the costs of construction
needed to support the roles of the major NATO commands. The
investments cover facilities such as airfields, fuel pipelines
and storage, harbors, communications and information systems,
radar and navigational aids, and military headquarters, both
within NATO Nations and for ``out of area'' operations such as
Afghanistan.
The United States occasionally has been forced to
temporarily delay the authorization of projects due to
shortfalls in United States obligation authority. The Committee
directs the Secretary of Defense to notify the Committee within
14 days of the United States taking action to delay the
authorization of projects temporarily, or to temporarily
withhold funds from previously authorized projects, due to
shortfalls in U.S. obligation authority.
The recommendation includes an increase of $27,965,000 for
the NATO Security Investment Program (NSIP) for fiscal year
2020 to continue to assure our partner Nations and provide
support against Russian aggression.
Department of Defense Base Closure Account
Fiscal year 2019 enacted level........................ $342,000,000
Fiscal year 2020 budget request....................... 278,526,000
Committee recommendation in the bill.................. 398,526,000
Comparison with:
Fiscal year 2019 enacted level.................... 56,526,000
Fiscal year 2020 budget request................... 120,000,000
The recommendation provides an additional $60,000,000 for
the Navy to accelerate environmental remediation at
installations closed under previous Base Closure and
Realignment rounds. Furthermore, the Navy shall provide to the
Committee a spend plan for these additional funds no later than
60 days after enactment of this Act.
Perfluorooctane Sulfonate (PFOS) and Perfluorooctanoic Acid
(PFOA).--The Committee is concerned about the extent of PFOS/
PFOA contamination at United States military installations.
While this bill only covers military installations funded
through the Base Realignment and Closure (BRAC) account that
are affected by PFOS/PFOA, the issue is not limited to the
Defense Department and affects many communities across the
Nation. The Committee is encouraged by the Environmental
Protection Agency's (EPA) announced plan to evaluate the need
for a maximum contaminant level, as provided by the Safe
Drinking Water Act, as well as designate these chemicals as
hazardous substances under the Comprehensive Environmental
Response, Compensation, and Liability Act, and urges the
Department and affected communities to work closely with EPA.
The Committee directs the Department to keep it apprised of new
findings of PFOS/PFOA at BRAC sites and provides additional
funds in this bill for the continued review of sites
contaminated by PFOS/PFOA. Furthermore, the recommendation
provides an additional $60,000,000 above the budget request to
address PFOS and PFOA cleanup.
Family Housing Overview
Fiscal year 2019 enacted level........................ $1,582,632,000
Fiscal year 2020 budget request....................... 1,324,002,000
Committee recommendation in the bill.................. 1,464,802,000
Comparison with:
Fiscal year 2019 enacted level.................... 117,830,000
Fiscal year 2020 budget request................... 140,800,000
Family housing construction accounts provide funds for new
construction, construction improvements, the Federal
government's costs for family housing privatization projects,
and planning and design. The operation and maintenance accounts
provide funds to pay for maintenance and repair, furnishings,
management, services, utilities, leasing, interest, mortgage
insurance, and miscellaneous expenses.
Housing Support Costs.--The recommendation includes an
additional $140,800,000 within Housing Support Costs under
Family Housing Operation and Maintenance accounts for the
Services. The additional funds were identified by the Services
on the Unfunded Priority list submitted to Congress by the
Service Secretaries. The funding is to increase the Services'
ability to provide oversight and management, and personnel to
track current and future issues that may occur in military
family housing.
Military Privatized Housing.--The Committee is concerned
about the ability of the Department to readily assess the
quality of its privatized housing. The quality of military
housing is a key component of military readiness and quality of
life. The National Defense Authorization Act for Fiscal Year
1996 (P.L. 104-106) allowed DOD to work with the private sector
to build and renovate military housing. The Committee's
oversight work has identified potentially unsafe conditions at
privatized military housing throughout the Nation, ranging from
electrical issues to mold, which undermines the
congressionally-authorized privatized housing initiative. The
Committee urges DOD to work with the private contractor
management companies to prioritize funding for mold remediation
in military housing in a timelier manner. The Committee
believes that the health of our servicemembers is of the utmost
importance, and substandard living conditions negatively impact
the ability to recruit and retain servicemembers, to the
detriment of United States national security interests. In
addition, DOD had to conduct extensive work to obtain an
overview status report about these facilities since they do not
feed into standard defense installations systems. Further, the
Committee directs the Service Secretaries to submit a report to
the congressional defense committees no later than 180 days
after enactment of this Act detailing (1) how the Services
monitor privatized facilities at a national level and (2) any
planned upgrades to this system to improve transparency.
Privatized Housing-Safety and Health Threat Reporting.--The
Committee expects DOD and the Services to establish and
maintain procedures for ensuring response and remediation
efforts to safety and health threats in military housing
managed by private sector property management companies. The
Committee expects privatized housing companies chosen by the
Department to be knowledgeable, professionally trained, and
capable of performing the proper response for the safety and
health threats. The Services should constantly review the
competency of repair personnel and contractors. The Committee
notes that military personnel and family members are by their
very nature temporary tenants of base housing. They are often
not in a particular housing unit or building long enough to
undertake a lengthy administrative process with a landlord.
Rather than relying on the temporary tenants for much of the
overall oversight of the safety and health aspects of
privatized base housing, the Committee believes that the
Services must fully shoulder this responsibility as the only
reliable, long-term stewards of living standards in privatized
base quarters. The Committee also urges DOD to take the
necessary steps to ensure that families who have suffered as a
result of negligent maintenance that resulted in issues such as
mold, asbestos, radon, faulty electrical wiring, rodent and
insect infestations, gas leaks and other safety and health
threats are made whole when there has been failure of
performance by contractors. Additionally, the Committee directs
DOD to take immediate action when servicemembers or base
housing residents experience the onset of physical or mental
ailments, or disabilities caused or suspected to be caused by
negligent property maintenance and management. Furthermore, the
Committee directs DOD and the Services to establish and
maintain procedures for tenant reporting of safety and health
threats in military family housing managed by private
contractors, that include the following: (1) active outreach on
how to file a complaint or make a maintenance request, (2) a
record-keeping and reporting system of housing complaints and
maintenance requests that are reviewable by Department
leadership and available to Members of Congress upon request,
and (3) provide the annual reports regarding the status of
remediation requests and efforts acted upon by private
contractors, and should be reviewable by base commanders, DOD
leadership, and submitted to the congressional defense
committees annually.
Tenant Rights.--The Committee is aware that DOD is creating
a process to assist servicemembers with their tenant rights
while living in base housing, and simultaneously renegotiating
department leases with private housing providers. The Committee
directs the Department to provide a report no later than 60
days after enactment of this Act, and then every quarter,
regarding the status of the tenant contracts, leases with
private housing providers and overall implementation measures
that were taken to improve quality of housing for
servicemembers.
Foreign Currency Savings and Sub-Account Transfers.--The
Committee directs that savings in family housing operation and
maintenance accounts from foreign currency re-estimates be used
to maintain and repair existing family housing units. The
Comptroller is directed to report to the Committees on
Appropriations of both Houses of Congress on how these savings
are allocated 90 days after enactment of this Act. In addition,
the Committee directs the Services and Defense agencies to
notify the Committees on Appropriations of both Houses of
Congress within 30 days of a transfer of funds between sub-
accounts within the family housing construction and family
housing operation and maintenance accounts, if such transfer is
in excess of 10 percent of the funds appropriated to the sub-
account to which the funds are being transferred. Notifications
to the Committees shall indicate the sub-accounts and amounts
that are being used to source the transfer.
Leasing Reporting Requirements.--The Secretary of Defense
is directed to report to the Committees on Appropriations of
both Houses of Congress quarterly on the details of all new or
renewed domestic leases entered into during the previous
quarter that exceeds the cost threshold set by 10 U.S.C.
2828(b)(2), including certification that less expensive housing
was not available for lease. For foreign leases, the Department
is directed to (1) perform an economic analysis on all new
leases or lease/contract agreements where more than 25 units
are involved; (2) report the details of new or renewed lease
agreements that exceed the cost threshold set by 10 U.S.C.
2828(e)(1) 21 days before entering into such an agreement; and
(3) base leasing decisions on the economic analysis.
Family Housing Construction, Army
Fiscal year 2019 enacted level........................ $330,660,000
Fiscal year 2020 budget request....................... 141,372,000
Committee recommendation in the bill.................. 141,372,000
Comparison with:
Fiscal year 2019 enacted level.................... (189,288,000)
Fiscal year 2020 budget request................... - - -
Family Housing Operation and Maintenance, Army
Fiscal year 2019 enacted level........................ $376,509,000
Fiscal year 2020 budget request....................... 357,907,000
Committee recommendation in the bill.................. 407,907,000
Comparison with:
Fiscal year 2019 enacted level.................... 31,398,000
Fiscal year 2020 budget request................... 50,000,000
Family Housing Construction, Navy and Marine Corps
Fiscal year 2019 enacted level........................ $104,581,000
Fiscal year 2020 budget request....................... 47,661,000
Committee recommendation in the bill.................. 47,661,000
Comparison with:
Fiscal year 2019 enacted level.................... (56,920,000)
Fiscal year 2020 budget request................... - - -
Family Housing Operation and Maintenance, Navy and Marine Corps
Fiscal year 2019 enacted level........................ $314,536,000
Fiscal year 2020 budget request....................... 317,870,000
Committee recommendation in the bill.................. 377,470,000
Comparison with:
Fiscal year 2019 enacted level.................... 62,934,000
Fiscal year 2020 budget request................... 59,600,000
Family Housing Construction, Air Force
Fiscal year 2019 enacted level........................ $78,446,000
Fiscal year 2020 budget request....................... 103,631,000
Committee recommendation in the bill.................. 103,631,000
Comparison with:
Fiscal year 2019 enacted level.................... 25,185,000
Fiscal year 2020 budget request................... - - -
Family Housing Operation and Maintenance, Air Force
Fiscal year 2019 enacted level........................ $317,274,000
Fiscal year 2020 budget request....................... 295,016,000
Committee recommendation in the bill.................. 326,216,000
Comparison with:
Fiscal year 2019 enacted level.................... 8,942,000
Fiscal year 2020 budget request................... 31,200,000
Family Housing Operation and Maintenance, Defense-Wide
Fiscal year 2019 enacted level........................ $58,373,000
Fiscal year 2020 budget request....................... 57,000,000
Committee recommendation in the bill.................. 57,000,000
Comparison with:
Fiscal year 2019 enacted level.................... (1,373,000)
Fiscal year 2020 budget request................... - - -
Department of Defense Family Housing Improvement Fund
Fiscal year 2019 enacted level........................ $1,653,000
Fiscal year 2020 budget request....................... 3,045,000
Committee recommendation in the bill.................. 3,045,000
Comparison with:
Fiscal year 2019 enacted level.................... 1,392,000
Fiscal year 2020 budget request................... - - -
Department of Defense Military Unaccompanied Housing Improvement Fund
Fiscal year 2019 enacted level........................ $600,000
Fiscal year 2020 budget request....................... 500,000
Committee recommendation in the bill.................. 500,000
Comparison with:
Fiscal year 2019 enacted level.................... (100,000)
Fiscal year 2020 budget request................... - - -
Administrative Provisions
The bill retains 27 provisions that were in effect in
fiscal year 2019. The administrative provisions included in the
bill are as follows:
The bill includes section 101 prohibiting the use of funds
for payments under a cost-plus-a-fixed-fee contract for
construction where cost estimates exceed $25,000. An exception
for Alaska is provided.
The bill includes section 102 permitting the use of
construction funds for the hire of passenger motor vehicles.
The bill includes section 103 permitting funds to be
expended on the construction of defense access roads under
certain circumstances.
The bill includes section 104 prohibiting construction of
new bases in the United States without a specific
appropriation.
The bill includes section 105 limiting the use of funds for
the purchase of land or land easements that exceed 100 percent
of value except under certain conditions.
The bill includes section 106 prohibiting the use of funds
to acquire land, prepare sites, or install utilities for family
housing except housing for which funds have been appropriated.
The bill includes section 107 limiting the use of minor
construction funds to relocate any activity from one
installation to another without prior notification.
The bill includes section 108 prohibiting the procurement
of steel unless American producers, fabricators, and
manufacturers have been allowed to compete.
The bill includes section 109 prohibiting the use of funds
to pay real property taxes in foreign nations.
The bill includes section 110 prohibiting the use of funds
to initiate a new installation overseas without prior
notification.
The bill includes section 111 establishing a preference for
United States architectural and engineering services where the
services are in Japan, NATO member countries, or countries
bordering the Arabian Sea.
The bill includes section 112 establishing a preference for
United States contractors for military construction in the
United States territories and possessions in the Pacific and on
Kwajalein Atoll, or countries within the Central Command area
of responsibility, except bids by Marshallese contractors for
military construction on Kwajalein Atoll.
The bill includes section 113 requiring the Secretary of
Defense to give prior notice to Congress of military exercises
where construction costs exceed $100,000.
The bill includes section 114 allowing funds appropriated
in prior years to be used for new projects authorized during
the current session of Congress.
The bill includes section 115 allowing the use of expired
or lapsed funds to pay the cost of supervision for any project
being completed with lapsed funds.
The bill includes section 116 providing that funds for
military construction projects are available until the end of
the fourth fiscal year following the fiscal year in which funds
are appropriated, subject to certain conditions.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 117 allowing for the transfer of
funds from Family Housing Construction accounts to the
Department of Defense Family Housing Improvement Fund and funds
from Military Construction accounts to the Department of
Defense Military Unaccompanied Housing Improvement Fund.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 118 providing transfer authority
to the Homeowners Assistance Program.
The bill includes section 119 requiring that funds in this
title be the sole source of all operation and maintenance for
flag and general officer quarter houses and limits the repair
on these quarters to $15,000 per year without notification.
The bill includes section 120 making funds in the Ford
Island Improvement Fund available until expended.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 121 allowing the transfer of
expired funds to the ``Foreign Currency Fluctuations,
Construction, Defense'' account.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 122 allowing the transfer of
funds among projects and activities in accordance with the
reprogramming guidelines.
The bill includes section 123 prohibiting the use of funds
for projects at Arlington National Cemetery.
The bill includes section 124 providing additional funds
for various military construction accounts and requires a spend
plan for each.
(RESCISSION OF FUNDS)
The bill includes section 125 rescinding funds from prior
appropriations Acts.
The bill includes section 126 defining the congressional
defense committees.
The bill includes section 127 directing all amounts
appropriated to Military Construction (all accounts) be
immediately available and allotted for the full scope of the
authorized project.
TITLE II
DEPARTMENT OF VETERANS AFFAIRS
Fiscal year 2019 enacted level\1\ (Including one $197,190,593,000
rescission)........................................
Fiscal year 2020 budget request\1\.................. 216,148,394,000
Committee recommendation in the bill\1\ (Including 217,467,894,000
one rescission)....................................
Comparison with:
Fiscal year 2019 enacted........................ 20,277,301,000
Fiscal year 2020 budget request................. 1,319,500,000
Fiscal year 2021 advance budget request............. 217,146,155,000
Fiscal year 2021 Committee recommendation in the 217,146,155,000
bill...............................................
\1\All funding cited excludes amounts in the Medical Care Collections
Fund.
The Department of Veterans Affairs (VA) serves
approximately 41,350,000 people--19,500,000 Veterans and
23,900,000 family members and dependents who may be eligible
for certain VA benefits. To serve adequately the Nation's
Veterans, VA employs more than 377,000 people, making it one of
the largest federal agencies in terms of employment.
Veterans Benefits Administration (VBA)
COMPENSATION AND PENSIONS
(INCLUDING TRANSFER OF FUNDS)
Fiscal year 2020 enacted level...................... $109,017,152,000
Fiscal year 2021 advance budget request............. 116,801,316,000
Fiscal year 2021 Committee recommendation in the 116,801,316,000
bill...............................................
Comparison with:
Fiscal year 2020 enacted level.................. 7,784,164,000
Fiscal year 2021 budget request................. - - -
This appropriation will provide funds for service-connected
compensation payments to an estimated 5,477,000 Veterans,
survivors, and dependents in 2020. In addition, pension
payments will be funded for 444,000 Veterans and their
survivors. The average payment per compensation case for
Veterans in 2020 is estimated at $18,883 and pension payments
are projected at $13,619.
The appropriation includes authority to transfer funding
not to exceed $18,147,000 in 2021 to General Operating
Expenses, Veterans Benefits Administration and Information
Technology Systems. These funds are for the administrative
expenses of implementing cost-saving provisions required by the
Omnibus Budget Reconciliation Act of 1990 (P.L. 101-508), the
Veterans' Benefits Act of 1992 (P.L. 102-568), and the
Veterans' Benefits Improvements Act of 1994 (P.L. 103-446).
These cost-saving provisions include verifying pension income
against Internal Revenue Service (IRS) and Social Security
Administration (SSA) data; establishing a match with SSA to
obtain verification of Social Security numbers; and applying
the VA pension cap for Medicaid-eligible single Veterans and
surviving spouses alone in Medicaid-covered nursing homes. The
bill also continues to include language permitting this
appropriation to reimburse such sums as may be earned to the
Medical Care Collections Fund to help defray the operating
expenses of individual medical facilities for nursing home care
provided to pensioners.
Performance Measures.--Based on the findings of the
Government Accountability Office (GAO) report entitled,
``Better Measures Needed to Assess Regional Office Performance
in Processing Claims'' (GAO 19-15), the Committee directs the
Under Secretary for Benefits to: (1) implement a new measure to
assess regional offices' performance and accuracy to better
target resources to low-performing offices; (2) clarify how
Veterans Services Representatives should handle claims when
they identify an error; (3) evaluate its policy for regional
office communication with Veterans Service Organizations (VSOs)
to ensure that it is clear, that it aligns with practice, and
that it meets the communication needs of VSOs; and (4) develop
and implement a mechanism to obtain periodic feedback from
congressional caseworkers on their communication with regional
offices regarding claims and needed information or support. The
Committee requests a report on the Department's efforts no
later than 60 days after enactment of this Act.
Pro-bono Legal Services.--The Committee recognizes an unmet
need for holistic programs that offer pro-bono legal services
to Veterans and their dependents. The Committee acknowledges
existing VA initiatives that guide Veterans during benefit-
related interactions with administrative agencies and believes
that public land-grant university law schools are suited to
complement existing agency efforts in underserved areas.
READJUSTMENT BENEFITS
Fiscal year 2020 enacted level...................... $14,065,282,000
Fiscal year 2021 advance budget request............. 12,578,965,000
Fiscal year 2021 Committee recommendation in the 12,578,965,000
bill...............................................
Comparison with:
Fiscal year 2020 enacted level.................. (1,486,317,000)
Fiscal year 2021 budget request................. - - -
This appropriation finances the education and training of
Veterans and servicemembers through the Post-9/11 GI Bill and
the All-Volunteer Force Educational Assistance Program.
Supplemental education benefits are also provided to certain
Veteran members of the Selected Reserve and are funded through
transfers from DOD. In addition, certain disabled Veterans are
provided with vocational rehabilitation, specially adapted
housing grants, and grants for automobiles with approved
adaptive equipment. This account also finances educational
assistance allowances for eligible dependents of Veterans who
died from service-connected causes or have a total and
permanent service-connected disability, as well as dependents
of servicemembers who were captured or are missing in action.
Almost 80 percent of the funds in the account support the Post-
9/11 GI Bill.
VetSuccess on Campus (VSOC).--The Committee recognizes the
tremendous value of counseling in assisting the transition of
Veterans from military service to academic life. Therefore, the
Committee encourages VBA to continue to expand the availability
of services through the VSOC program to additional sites, with
particular attention to geographic regions without current
access to VSOC programs.
Transition Coordination.--The Committee believes that VA,
in consultation with the Departments of Labor and Defense,
should further coordinate efforts and resources to ensure
Veterans have a successful transition to civilian life. This
includes sharing information on community resources, including
nonprofits and VSOs, that are available to the Veteran and
their family as they depart the service. The Committee also
urges the Secretary to use the Veteran treatment courts system
to educate Veterans on job training and small business services
offered by the Department (and in partnership with the Small
Business Administration and the Department of Labor).
Gender-Specific Women Veteran Case Management.--The
Committee recognizes traditional Veteran services were
primarily designed for men and do not always meet the needs of
women Veterans. Women Veterans struggling with the acclimation
to civilian and community life often find themselves in at-risk
circumstances that may differ from those of men, and therefore
women Veterans require specialized interventions and
programming. The Committee encourages the Department to work
with the Department of Defense and the Department of Labor to
provide robust gender-specific case management services for
women Veterans transitioning from military service.
VETERANS INSURANCE AND INDEMNITIES
Fiscal year 2020 enacted level........................ $111,340,000
Fiscal year 2020 budget year request.................. 17,620,000
Fiscal year 2020 budget year Committee recommendation 17,620,000
in the bill..........................................
Fiscal year 2021 advance budget request............... 129,224,000
Fiscal year 2021 Committee recommendation in the bill. 129,224,000
Comparison with:
Fiscal year 2020 enacted level.................... 17,884,000
Fiscal year 2021 budget request................... - - -
The Veterans Insurance and Indemnities appropriation is
made up of the former appropriations for military and naval
insurance, applicable to World War I Veterans; national service
life insurance (NSLI), applicable to certain World War II
Veterans; servicemember's indemnities, applicable to Korean
conflict Veterans; and Veterans mortgage life insurance,
applicable to individuals who have received a grant for
specially adapted housing.
The amount provided will enable the Department to transfer
funding to the service-disabled Veterans insurance fund and
transfer additional amounts for payments for policies under the
Veterans mortgage life insurance program. These policies are
identified under the Veterans Insurance and Indemnities
appropriation since they provide insurance to service-disabled
Veterans unable to qualify under basic NSLI.
VETERANS HOUSING BENEFIT PROGRAM FUND PROGRAM ACCOUNT
----------------------------------------------------------------------------------------------------------------
Limitation on
direct loans
Program account for specially Administrative
adapted expenses
housing loans
----------------------------------------------------------------------------------------------------------------
Fiscal year 2019 enacted level............................. - - - ($500,000) $200,612,000
Fiscal year 2020 budget request est........................ - - - (500,000) 200,377,391
Committee recommendation est. in the bill.................. - - - (500,000) 200,377,391
Comparison with:
Fiscal year 2019 enacted level......................... - - - - - - (234,609)
Fiscal year 2020 budget request........................ - - - - - - - - -
----------------------------------------------------------------------------------------------------------------
The purpose of the home loan guaranty program is to
facilitate the extension of mortgage credit on favorable terms
by private lenders to eligible Veterans. This appropriation
provides for all costs, with the exception of the Native
American Veterans housing loan program, of the Department's
direct and guaranteed loans programs. The Federal Credit Reform
Act of 1990 (P.L. 101-508) requires budgetary resources to be
available prior to incurring a direct loan obligation or a loan
guaranty commitment. In addition, the bill requires all
administrative expenses of a direct or guaranteed loan program
to be funded through a program account. Loan guaranties are
made to servicemembers, Veterans, reservists, and single
surviving spouses for the purchase of homes, condominiums, and
manufactured homes and for refinancing loans. The Department
guarantees part of the total loan, permitting the purchaser to
obtain a mortgage with a competitive interest rate, even
without a down payment if the lender agrees. The Department
requires that a down payment be made for a manufactured home.
With a Department guaranty, the lender is protected against
loss, up to the amount of the guaranty, if the borrower fails
to repay the loan.
Home Loan Income Verification.--The Committee is aware of
the Department's denial of home loan guarantees to Veterans
solely on the basis of the Veteran's documented income being
derived from state-legalized cannabis activities. The Committee
is concerned that the Department has never publicly stated its
position on this matter, hindering Veterans' ability to fully
understand and consider how employment decisions could affect
future eligibility for earned benefits. The Committee therefore
directs VA to publicly clarify its position on this matter no
later than 180 days after the enactment of this Act.
Home Loan Utilization.--The Committee notes with concern
that Veterans significantly under-utilize their available Home
Loan Benefit from the Department of Veterans Affairs.
Therefore, VA is directed to provide a report no later than 180
days after enactment of this Act determining the reasons for
this under-utilization, along with recommendations to improve
its use and effectiveness.
VOCATIONAL REHABILITATION LOANS PROGRAM ACCOUNT
----------------------------------------------------------------------------------------------------------------
Limitation on Administrative
Program account direct loans expenses
----------------------------------------------------------------------------------------------------------------
Fiscal year 2019 enacted level............................. $39,000 ($2,037,000) $396,000
Fiscal year 2020 budget request............................ 57,729 (2,008,232) 401,880
Committee recommendation in the bill....................... 57,729 (2,008,232) 401,880
Comparison with:
Fiscal year 2019 enacted level......................... 18,729 (28,768) 5,880
Fiscal year 2020 budget request........................ - - - - - - - - -
----------------------------------------------------------------------------------------------------------------
This appropriation covers the subsidy cost of direct loans
for vocational rehabilitation of eligible Veterans and includes
administrative expenses necessary to carry out the direct loan
program. Loans of up to $1,260 (based on indexed chapter 31
subsistence allowance rate) are available to service-connected
disabled Veterans enrolled in vocational rehabilitation
programs when the Veteran is temporarily in need of additional
assistance. Repayment is made in monthly installments, without
interest, through deductions from future payments of
compensation, pension, subsistence allowance, educational
assistance allowance, or retirement pay. Most loans are repaid
in full in less than one year. The Federal Credit Reform Act of
1990 (P.L. 101-508) requires budgetary resources to be
available prior to incurring a direct loan obligation.
It is estimated that the Department will make 1,970 loans
in fiscal year 2020, with an average amount of $1,019.
NATIVE AMERICAN VETERAN HOUSING LOAN PROGRAM
Administrative expenses:
Fiscal year 2019 enacted level........................ $1,163,000
Fiscal year 2020 budget request....................... 1,163,000
Committee recommendation in the bill.................. 1,186,000
Comparison with:
Fiscal year 2019 enacted level.................... 23,000
Fiscal year 2020 budget request................... 23,000
The Native American Veteran Housing Loan Program, as
authorized by title 38 United States Code, chapter 37,
subchapter V, provides the Secretary with authority to make
direct housing loans to Native American Veterans for the
purpose of purchasing, constructing, or improving dwellings on
trust lands, including Hawaiian Home Lands. Native Hawaiians,
Alaska Natives, and Native Americans enroll in the military at
higher rates than non-Natives. These loans are available to
purchase, construct, or improve homes to be occupied as
Veterans' residences.
GENERAL OPERATING EXPENSES, VETERANS BENEFITS ADMINISTRATION
Fiscal year 2019 enacted level........................ $2,956,316,000
Fiscal year 2020 budget request....................... 3,000,000,000
Committee recommendation in the bill.................. 3,025,000,000
Comparison with:
Fiscal year 2019 enacted level.................... 68,684,000
Fiscal year 2020 budget request................... 25,000,000
The General Operating Expenses, Veterans Benefits
Administration account provides funding for VBA to administer
entitlement programs such as service-connected disability
compensation, education benefits, and vocational rehabilitation
services.
The bill makes available through September 30, 2021, up to
ten percent of these funds.
The Committee provides $3,025,000,000 for the General
Operating Expenses, VBA account, which is $25,000,000 above the
Administration request. The Committee provides these additional
funds for hiring additional claims and appellate staff, digital
scanning of health records, and overtime pay.
Equitable Relief.--The Committee reiterates that it
understands VA is working to implement new systems and
protocols to eliminate instances of administrative error.
However, as VA enacts system-wide reforms, ending equitable
relief for Veterans who were deemed eligible for benefits in
error would place an unfair burden on Veterans and their
families. The Secretary is directed to continue to grant or
extend equitable relief to eligible Veterans initially deemed
eligible in instances of administrative error. Not later than
April 1, 2020, the Secretary shall submit to the Committees a
report containing a statement as to the disposition of each
case recommended to the Secretary for equitable relief under 38
U.S.C 503 during the preceding calendar year.
Military Sexual Trauma (MST) claims.--The 2018 Inspector
General's report that found that almost half of denied MST-
related claims were not properly adjudicated in accordance with
VBA policies. The Committee is concerned that efforts to
address the massive claim backlog caused VBA leadership to lose
focus regarding these sensitive claims, abandoning appropriate
and ongoing training, case audits, and specialized processors
for MST-related claims. The Committee directs VA to report to
the Committee by October 31, 2019, on implementation of the
Inspector General's recommendations, and to consult with the
Committee prior to any changes in the system for handling MST-
related claims. The Committee is concerned that Veterans
suffering from a mental health disorder as a result of sexual
trauma during service have different standards of evidence
based on their diagnosis. The Committee recognizes that
evidence in personnel files is rare, no matter the resulting
condition following MST, therefore, the Committee urges VA to
support the extension of the relaxed evidentiary standard to
all those suffering from mental health disorders as a result of
MST. Further, the Committee urges VA to continue to report to
Congress on information relating to claims for disabilities
incurred or aggravated by MST, as provided by section 113 of
the Jeff Miller and Richard Blumenthal Veterans Health Care and
Benefits Improvement Act of 2016 (P.L. 114-315).
Transition Assistance.--The Committee is aware of VA's
efforts to expand Veterans education connection centers at
medical centers and outpatient clinics, such as the one
established at the Louis Stokes Veterans Medical Center in
Cleveland, Ohio. As directed in fiscal year 2019, the Committee
continues to encourage VA to explore opportunities for
education connection centers at VA Medical Centers with a high
need. Furthermore, the Committee directs VA to provide the
Committee with a report detailing: (1) the current education
connection centers project, (2) an explanation of how the
center currently benefits Veterans it serves and, (3) its
potential plans to expand the number of education connection
centers. In addition, this report should include an action plan
with a detailed timeline for possible further expansion to one
education connection center in at least ten of the 21 Veterans
Integration Service Networks (VISN) within the next three
years, projected timelines for implementation of this expansion
effort, an analysis of projected added benefit to Veterans
under the expansion, as well as potential funding costs and
needs. The fiscal year 2019 report has not yet been submitted
to the Committee, thus the Committee requires VA to provide a
briefing to the Committee no later than 30 days after enactment
of this Act on how they will produce this report in a timely
manner.
Outreach to Remote Locations.--The Committee directs VBA to
improve access and outreach to Veterans living in remote and
underserved areas, such as the Commonwealth of the Northern
Mariana Islands, by increasing staff presence in these areas.
Veterans living in these areas, particularly elderly and
disabled Veterans who may have difficulty accessing VBA
services via the internet or phone, should have an opportunity
to speak and obtain assistance, in-person, with VBA staff.
Weatherization and Other Benefits.--The Committee
recognizes the importance of housing stability for Veterans and
encourages VA to increase its outreach efforts to make Veterans
aware of the Department of Energy's Weatherization Assistance
Program, Department of Housing and Urban Development grants,
and similar programs in conjunction with existing Veterans
Benefit Administration programs as Veterans start the claims
submission process. The Committee urges VA to take steps to
inform Veterans about benefits beyond traditional Veterans
benefits and incorporate this information into education and
outreach materials when Veterans utilize the VA Home Loan
program or housing assistance programs.
GI Bill Benefits.--The Committee recognizes the GI Bill is
an earned benefit from service with limits, so it is critical
Veterans have the information they need to make informed
decisions. They need better information not just on colleges,
but on outcomes of the programs that will prepare them well for
their civilian careers. Currently, all public Federal databases
lack program level data that would allow potential students to
compare the outcomes of specific programs across institutions.
Therefore, the Committee encourages VA to work with other
Federal agencies and the private sector to provide program
level information on Veterans on the GI Bill Comparison Tool or
other Federal databases including, but not limited to,
graduation rates, total cost, time to completion, and percent
of graduates employed in the field and post-graduate salaries.
Providing such information would empower Veterans to choose
both the college and program that is best for them by
considering outcomes of other Veterans in the specific programs
they are considering.
Veterans Health Administration (VHA)
The Department operates the largest Federal medical care
delivery system in the country, with 143 hospitals, 119
residential rehabilitation treatment programs, 134 nursing
homes, 300 Vet Centers, 80 mobile Vet Centers, and 728
outpatient clinics. Approximately 7,000,000 patients will be
treated in 2020.
The Veterans Health Administration budget is comprised of
five accounts: Medical Services, Medical Community Care,
Medical Support and Compliance, Medical Facilities, and Medical
and Prosthetic Research. For the first four accounts, the
Administration has requested total resources for fiscal year
2021 of $87,636,650,000 in direct appropriations to fund the
four advance appropriations of the VHA. The Committee provides
an additional $4,809,360,000 for the first four accounts for
fiscal year 2020, which is $189,160,000 over the budget
request. In addition, VA will receive an estimated
$3,912,000,000 in the Medical Care Collections Fund in fiscal
year 2020. The Committee also provides $840,000,000 for medical
and prosthetic research.
MEDICAL SERVICES
Fiscal year 2019 enacted level........................ $49,911,165,000
Fiscal year 2020 enacted level........................ 51,411,165,000
Fiscal year 2020 budget year request.................. - - -
Committee 2020 budget year recommendation............. 169,160,000
Fiscal year 2021 advance appropriation request........ 56,158,015,000
Committee 2021 advance appropriation recommendation... 56,158,015,000
Comparison with:
Fiscal year 2020 enacted level.................... 4,746,850,000
Fiscal year 2021 budget request................... - - -
This appropriation provides for medical services of
eligible Veterans and beneficiaries in Department medical
centers, outpatient clinic facilities, contract hospitals,
State homes, and outpatient programs on a fee basis. VA also
supports hospital and outpatient care through the private
sector for certain dependents and survivors of Veterans under
DOD civilian health and medical programs.
The bill provides the request of $56,158,015,000 for
advance fiscal year 2021 funding. The Committee has included
bill language to make available through September 30, 2022,
$1,500,000,000 of the Medical Services advance appropriation
for fiscal year 2021. The Committee provides an additional
$169,160,000 to be available for fiscal year 2020; of which
$35,000,000 shall be for gender-specific care for women;
$30,000,000 shall be for suicide prevention, $20,000,000 shall
be for Whole Health initiatives; $40,000,000 shall be for
homelessness initiatives; $17,000,000 shall be for other
initiatives specified by the Committee; and $27,160,000 shall
be to reimburse the Medical Care account for the April 2019
reprogramming to the Information Technology (IT) Systems
account to support the John S. McCain III, Daniel K. Akaka, and
Samuel R. Johnson VA Maintaining Internal Systems and
Strengthening Integrated Outside Networks (MISSION) Act of 2018
(P.L. 115-182) implementation. The Committee directs that as of
the date of enactment of this Act, all reprogramming requests
from the Department to the Committees on Appropriations of both
Houses of Congress to support the MISSION Act may come from the
Medical Community Care account only, and not from the Medical
Services account.
Changes in Funding Requirements Due to Modeling.--The
Committee expects VA to continue to include in the sufficiency
letter required by section 117(d) of title 38, United States
Code, which is due to the Congress on July 31 of each year, a
description of any changes exceeding $250,000,000 in funding
requirements for the Medical Services account resulting from
the spring recalculation of the Enrollee Healthcare Projection
Model.
Caregivers Program.--The caregivers program provides an
unprecedented level of benefits to families with Veterans
seriously injured in the line of duty in post-9/11 service.
These benefits include stipends paid directly to the family
caregiver, enrollment for the family member in the VA Civilian
Health and Medical Program (CHAMPVA), an expanded respite
benefit, and mental health treatment. The Committee provides
the request of $705,219,000 for the caregivers. The Committee
also continues the requirement from the fiscal year 2018
conference report on quarterly reporting on obligations for the
caregivers program.
Allocation of Health Funding.--The Committee continues to
be concerned that the process VA uses to allocate the health
services appropriation through the VISNs and from them to the
medical centers may shortchange the ultimate users because of
excessive funding retained at headquarters or at the VISNs. The
Committee continues to request a report each year, no later
than 30 days after VA allocates the medical services
appropriation to the VISNs, that identifies: (1) the amount of
general purpose funding that is allocated to each VISN; (2) the
amount of funding that is retained by central headquarters for
specific purposes, with amounts identified for each purpose;
and (3) the amount of funding that is retained by each VISN
before allocating it to the medical centers, identifying
separately the amounts retained for purposes such as network
operations, network initiatives, and emergencies.
MENTAL HEALTH
The Committee provides $9,452,633,000 for mental health
programs, which is $30,000,000 above the budget request. Of the
amounts provided for mental health programs in fiscal year
2020, $1,526,059,000 shall be used for suicide prevention and
treatment programs. Specifically, $221,764,000 shall be used
for suicide prevention outreach. With the additional funds, the
Committee directs the Department to implement suicide safety
plans that address parking lot suicides and expand the Coaching
Into Care Program to better help Veterans, their family
members, and other loved ones find the appropriate services at
their local VA facilities and/or in their community. The
Department should also engage with VSOs to help remove the
stigma that is associated with seeking mental healthcare.
Furthermore, VA is directed to remove barriers that impact a
Veteran when trying to receive mental healthcare. The Committee
also directs VA to implement a twenty-first century outreach
program that incorporates social media and other electronic
means to reach Veterans before they are at a crisis point.
In addition, the Committee directs VA to engage with DOD to
help servicemembers transition from active duty to civilian
life to ensure that mental health needs are addressed
throughout the transition process. The Department is directed
to provide a report to the Committee, no later than 90 days
after enactment of this Act, identifying a detailed expenditure
plan for all suicide outreach and treatment programs and how VA
is meeting the Committee's directives.
Mental Health Services.--Women Veterans are twice as likely
to commit suicide than women in the general population. To
address this alarming trend, the Committee directs VA to take
aggressive steps to improve mental health services for women
Veterans and ensure that women's mental health needs, which
often differ from men in prevalence and expression, are met.
PREVENTS Initiative.--The Committee is aware of efforts to
coordinate Veteran suicide prevention efforts under the
Presidential Task Force established under the PREVENTS
Initiative. A primary focus of these efforts is to engender
collaboration across public and private sectors to end the
national tragedy of suicide, including the use of public-
private partnerships. This is a strategy the Committee has
supported and believes vital to address critical mental health
issues in our Veteran population. VA has awarded grants as part
of an existing public-private pilot program in six states and
the District of Columbia to address the causes and contributing
factors that lead to suicides among our Veteran populations.
Because firearms were used in nearly 70 percent of all Veteran
suicide deaths, an important focus of the pilot program
includes the safe storage of firearms. The Committee provides
an additional $3,000,000 above the request to continue and
broaden this initiative.
Post-traumatic Growth Programs.--The Committee recognizes
there is a shortage of adequate, timely, and effective mental
health care available to Veterans across the United States. As
the Department continues to highlight Veterans' mental
healthcare and suicide prevention as a key priority, there is
an opportunity to explore effective alternative treatments
focused on the area of post-traumatic growth. The Committee
encourages the establishment of a pilot program to study the
effectiveness and benefits of nonprofit post-traumatic growth
programs to determine the outcomes of such programs in contrast
to traditional models of mental healthcare, the possible
integration of such nonprofit programs into mental healthcare
programs provided by the Department, and the budgetary impacts
of such integration. The Secretary shall submit a report no
later than 180 days after enactment of this Act, detailing the
feasibility of such a pilot program and the metrics required to
determine the value of post-traumatic growth programs.
Improving the Veterans Crisis Line (VCL).--The Committee
continues to monitor the VCL to ensure Veterans are receiving
appropriate clinical care. To support this critical care, the
Committee instructs the Secretary to ensure that Federal
funding for the VCL is utilized to make any necessary
improvements to VCL's operations in order to best meet the
needs of Veterans seeking assistance. This includes, but is not
limited to, ensuring appropriate staffing for call centers and
back-up centers, providing necessary training for VCL staff,
and ensuring that staff are able to appropriately and
effectively respond to the needs of Veterans needing assistance
through the VCL.
The Committee has repeated bill language requiring the VCL
to: (1) provide to individuals who contact the hotline
immediate assistance from a trained professional; and (2) to
adhere to all requirements of the American Association of
Suicidology.
Community Clinic Mental Health Services.--The Committee
remains concerned that in-person mental healthcare is not
available to all Veterans who require this care. VA is
encouraged to ensure critical in-person mental health services
are available at facilities that currently are not served, even
on a temporary basis.
Post-Traumatic Stress Disorder (PTSD) Service Dogs.--The
Committee recognizes the positive role that service, guide, and
hearing dogs have played in mitigating Veterans' disabilities
and providing assistance and rehabilitation. The Energy and
Water, Legislative Branch, and Military Construction and
Veterans Affairs Appropriations Act, 2019 (P.L. 115-244) urged
VA to prioritize support of veterinary healthcare and other
benefits for service dogs for wounded warriors. The Committee
also noted that VA is currently engaged in a study to assess
the potential therapeutic effectiveness of service dogs in the
treatment of PTSD and that the study will be completed in June
2019. The Committee is interested in the possibility of
providing service dogs to Veterans with a mental health
mobility disorder related to post-traumatic stress or traumatic
brain injury. According to the Department of Veterans Affairs,
as many as 20 percent of those who served in Iraq or
Afghanistan are diagnosed with post-traumatic stress. This
disorder can cause debilitating symptoms in Veterans, leading
to depression, social isolation, and suicide. Studies
demonstrate that service dogs provide support to Veterans by
mitigating their disability, allowing for professional and
social reintegration. Currently, waiting lists for service dogs
average between 18 and 24 months, with intensive compulsory
training costing an average of $25,000 per service dog, which
makes this an expensive option for Veterans. The Committee
looks forward to this study and will address this issue as the
bill moves through the process.
Public-Private Partnerships.--The Committee is concerned by
the alarming number of suicides committed by Veterans each day.
While the Committee appreciates the important work being done
by the Department to combat suicide and improve mental health
among Veterans, more can and must be done. The Committee
recommends the Department actively seek out public-private
partnerships, in particular with research universities,
teaching hospitals, and other partners, to expand upon its
existing efforts related to suicide prevention, PTSD, traumatic
brain injury (TBI), and substance use disorders. The Secretary
shall report to the Committee no later than 60 days after
enactment of this Act on the status of creating public-private
partnerships related to suicide prevention, PTSD, TBI, and
substance use disorders. Of the funds appropriated for mental
health programs in fiscal year 2020, no less than $5,000,000
shall be appropriated to expand the public-private
partnerships.
Law Enforcement Liaison.--The Committee appreciates VHA's
past efforts in working to educate the law enforcement
community regarding the unique issues facing Veterans,
especially those returning from combat operations. Such
education is invaluable in cases where Veterans are determined
to be an immediate threat to themselves or others. In such
instances, it is imperative that the Veteran's needs be
addressed in an expeditious, humane, and respectful manner. The
Committee, therefore, directs VA to implement a program that
would designate a VA liaison to work with local law enforcement
to address such circumstances and to submit a report to the
Committees on Appropriations of both Houses of Congress
detailing its efforts no later than 60 days after enactment of
this Act.
Non-Citizen Veteran Outreach.--The Committee is concerned
about the level of awareness regarding mental health services
by at-risk, non-citizen Veterans. The Committee therefore urges
VA to conduct more aggressive outreach targeting this group of
Veterans to offer mental health and other early intervention
services, drug and alcohol services, and mental health
counseling, and directs the Department to submit a report to
Congress no later than 60 days after the enactment of this Act.
Cultural Competency Training.--The Committee welcomes the
Secretary's commitment to addressing mental health in the
Veteran population. The Committee also recognizes the
importance of the National Center for PTSD at VA in promoting
better prevention, diagnoses, and treatment of PTSD. Consistent
with findings from the VA National Center for PTSD, the
Committee recognizes that some groups of Veterans, including
African-Americans and Latinos, are more likely to develop PTSD.
As such, the Committee directs the Veterans Health
Administration in coordination with the VA National Center for
PTSD to provide a report no later than 180 days after enactment
of this Act detailing whether cultural competency training is
provided to healthcare professionals serving Veterans of color,
and at what stage(s) in their career; and analyzing whether
minority Veterans receive quality and culturally appropriate
care. This report shall also include recommendations on how to
address the unique mental health needs of minority Veterans,
and disparities, whether perceived or real, in the care they
receive.
National Academies of Sciences.--A survey conducted by the
National Academies of Sciences, Engineering, and Medicine in
2017 found that while the Department of Veterans Affairs
provides mental healthcare to Veterans of the Iraq and
Afghanistan Wars of comparable or superior quality to other
providers, substantial needs remain unmet. The Committee
strongly encourages the implementation of the Academy's
recommendations, including the development of a comprehensive
five-year strategic plan for mental health services. Moreover,
the plan should address how VA will become a high-reliability
organization that provides accessible, high-quality, and
integrated mental healthcare services while also providing
explicit attention to the unique needs of women Veterans within
the VA system.
Adverse Childhood Experiences (ACEs).--ACEs exist within
the Veterans population at a substantially higher rate than the
general public. These experiences correlate with significant
negative health outcomes, including on behavioral, mental and
physical health. The Committee encourages VA to track ACEs
among Veterans and target individualized treatment. To ensure
appropriate treatment from the moment a Veteran enters VA, it
is critical that VA coordinate with the Department of Defense
to obtain information on ACEs from servicemembers and provide a
seamless transition in care.
Mental Health Pilot Program.--The Committee urges VA to
implement a comprehensive medication selection, adherence,
compliance and digital education pilot program for Veterans
suffering from mental health issues, including PTSD and the
long-term side-effects of increased exposure to TBI, through
the utilization of cutting-edge, off-the-shelf technology and
pharmacy management protocols to reduce suicide, relapse and
hospital visits.
Agritherapy.--An increasing number of States now have
programs that assist Veterans in starting farms, and many
Veterans turning to farming suffer from PTSD. The benefits of
agritherapy have been reported in the news media; however,
limited research and insufficient opportunities exist to offer
the benefits of agritherapy to those suffering from PTSD. The
Department is encouraged to work with the Department of
Agriculture on providing agritherapy programs to Veterans.
Mental Health Data on Asian Pacific American Veterans.--The
Committee recognizes the lack of mental health data specific to
Asian Pacific American Veterans. The Committee directs the
Department to submit a report within 90 days after enactment of
this Act on its data collection efforts.
SUICIDE PREVENTION OUTREACH
The Committee remains concerned that 14 of the 20 Veterans
who commit suicide each day are not using VA services. The
Committee urges VA to develop and implement a strategy to
conduct outreach to this Veteran population and report to the
House Committee on Appropriations 90 days after enactment of
this Act.
VetsCorps.--Existing suicide prevention efforts are failing
to reach the majority of Veterans in need. The Committee
directs the Department to create a pilot program, carried out
over a two-year period, establishing a VetsCorps. This Corps,
comprised of Veterans themselves, will conduct outreach and
recruitment to bring in Veterans who have not been served by
the Department and connect them with available programs and
services. The VetsCorps will be designed to reach Veterans
wherever they are and provide a personal connection to VA.
Furthermore, the Committee encourages the Department to
facilitate peer-to-peer Veteran support networks within
VetsCorps for Veterans who are trained in suicide prevention
and crisis intervention to help other Veterans transition from
military service to civilian life. The pilot program shall be
carried out at no fewer than six sites, targeted to regions
with low rates of VA utilization and including at least one
rural and one urban site. At the conclusion of the pilot
program, the Department shall report to Congress on the
effectiveness of the pilot program at reaching Veterans,
particularly those in need, and increasing utilization of VA
services and evaluate the cost-effectiveness of the program
compared to existing outreach efforts. The Committee provides
$5,000,000 for this pilot program.
Suicide Prevention Paid Media GAO Report.--The Committee is
concerned with the findings of the GAO report entitled,
``Improvements Needed in Suicide Prevention Media Outreach
Campaign Oversight and Evaluation'' (GAO-19-66), which found
that VHA had only spent $57,000 of its $6,200,000 fiscal year
2018 budget for suicide prevention paid media as of September
2018. In accordance with the GAO report, the Committee
recommends that the Office of Suicide Prevention and Mental
Health (OSPMH) establish targets for its metrics to improve its
evaluation of the effectiveness of its suicide prevention media
outreach campaign. Further, the Committee directs that OSPMH
provide the Committee with an expenditure plan on how it
intends to effectively use fiscal year 2020 suicide prevention
outreach funds no later than 30 days after enactment of this
Act.
Social Media Contact.--The Committee recognizes the
incidence of mental illness within the Veteran community, and
the Committee encourages the Department to investigate the use
of technology, specifically social media database algorithms,
to detect and identify, via indirect contact such as social
media, Veterans who are at risk of harming themselves or
others. Once these individuals are identified, the Department
would use indirect means of communication to interact with the
troubled individual to provide help and support in the hope of
preventing tragedy.
GRIT Suicide Prevention Mobile Application.--The Committee
supports the Department's current efforts to use twenty-first
century technology to promote social connectedness in order to
prevent Veteran suicides. The Department, in collaboration with
technology organizations, is developing mobile applications and
online platforms in an effort to reach more Veterans, such as
the Getting Results in Transition (GRIT) mobile application for
transitioning servicemembers and Veterans. The Committee
directs the Department to continue its efforts to work with
technology organizations to develop and implement innovative
platforms to prevent Veteran suicide.
HOMELESS ASSISTANCE
The Committee provides $1,858,534,000 for VA homeless
assistance programs, an increase of $40,000,000 above the
budget request. Additionally, an estimated $7,465,430,000 is
provided for homeless Veterans treatment costs. These programs
include the Homeless Providers Grant and Per Diem, the
Domiciliary Care for Homeless Veterans, the Supportive Services
for Low Income Veterans and Families, and the Department of
Housing and Urban Development-Department of Veterans Affairs
Supported Housing (HUD-VASH) programs. Within this total, the
bill includes $380,000,000 for the Supportive Services to
Veteran Families program.
Homeless Patient Aligned Care Teams (H-PACT) Expansion.--
The Committee directs the Secretary to submit to the Committees
on Appropriations of both Houses of Congress within 180 days of
enactment of this Act a report on (1) the benefits of expanding
the H-PACT program; (2) the expansion to additional locations,
including rural areas; and (3) additional services to improve
the program.
HUD-VASH Program.--The Committee continues to support the
HUD-VASH program and reminds the Department to continue to
provide the annual report on distribution of HUD-VASH vouchers
as requested in House Report 115-188. Furthermore, the
Committee requests that this annual report also identify how
many HUD-VASH vouchers are given to women Veterans with
children, women Veterans without children, male Veterans with
children, and male Veterans without children in each State. The
report should also include the number of HUD-VASH vouchers
distributed to Veterans in rural, suburban, and urban areas per
State. The Committee believes that an annual report with this
information will be an important data point over time to assess
the success of VA's efforts to combat Veteran homelessness.
HUD-VASH Case Management.--The Committee recognizes the
value and impact of the HUD-VASH program, which serves Veterans
experiencing homelessness. Case management services are
critically important to the function of the program, and public
housing authorities rely on VA Medical Centers referrals to
house Veterans. Due to the joint nature of HUD-VASH funding,
the Committee recommends that VA's budget for case managers be
increased commensurate with any increases in HUD's budget for
new vouchers.
Legal Assistance for the Supportive Services for Veteran
Families (SSVF) Program.--The Committee notes that university
law schools are willing to work with Veterans on a pro-bono
basis to provide legal assistance. This can result in
additional benefits such as training law students in Veteran
disability law and legal skills critical to providing advocacy
within the VA system and inspiring next-generation lawyers to
serve Veterans in practice. The Committee encourages the SSVF
program to work with grantees to expand their legal service
offerings, particularly in rural areas where access to private
legal assistance can be limited. Within funds provided, the
Department is encouraged to establish one or more pilot
projects to partner SSVF grantees with university law schools
in rural areas to enhance legal assistance to Veterans.
Homeless Women Veterans.--The Committee is concerned with
the growing number of women Veterans identified as homeless or
unstably housed and strongly encourages the Department to
complete an analysis of programs that provide assistance to
women Veterans to identify the areas in which such programs are
failing to meet the needs of such women. Therefore, no later
than 180 days after enactment of this Act, the Committee
directs the Department to submit a report on the analyses to
the Committees on Appropriations of both Houses of Congress.
Homeless Veterans Near the United States-Mexico Border.--
The Committee notes that there may be homeless Veterans living
near the United States-Mexico border who, historically, may not
have been counted in point-in-time homeless surveys. The
Committee directs VA to work with HUD to develop strategies and
recommendations for addressing Veteran homelessness near the
United States-Mexico border and to take into account these
undercounted Veterans when awarding HUD-VASH vouchers. The
Committee appreciates VA's efforts to implement strategies and
make recommendations to decrease Veteran homelessness on the
border, such as the development of a Homelessness Screening
Clinical Reminder, data sharing, improving the accuracy of
data, and contracting case management in rural areas. The
Committee directs VA to work with HUD to submit a report to
Congress detailing the effectiveness of these measures in
addressing Veteran homelessness on the United States-Mexico
border no later than 60 days after enactment of this Act.
Underemployment of Veterans.--The Committee is encouraged
by the historically low rates of unemployment and homelessness
among Veterans. The Committee urges the Secretary to develop a
strategy to address underemployment, which includes
partnerships with non-governmental organizations, the private
sector, and appropriate Federal agencies, which ensures that
the job skills Veterans gain during active duty service are
fully realized in professional workplaces.
STAFFING ISSUES
Mental Health Professionals Hiring.--The Committee
recognizes the growing need for mental health professionals and
in particular the need for mental health professionals at VA
facilities. Therefore, the Committee directs the Department to
prioritize hiring mental health professionals.
Medical Staff Retention.--The Committee expects VA to
continue to report every six months on the number of all
clinical staff directly responsible for patient care who have
left VA, including a summary of the principal reasons
explaining their departure, and the steps being taken to
mitigate the principal reasons providers leave. The data should
be aggregated at the VISN level and should also include the
percentage of staff in primary care versus specialty care and
mental health care, and the percentage of medical staff at each
facility who complete an exit survey upon their departure. Exit
surveys should be conducted anonymously, including through the
use of a location that allows for privacy, is not directly
visible by another employee, and does not require the departing
employee to input any personally identifiable data. In
addition, the Committee directs VA to submit a separate report,
no later than 90 days after enactment of this Act, on efforts
to recruit and hire medical officers and nurses within VHA, as
well as any impediments to such efforts. The report should
include the resources provided for these efforts and
recommendations for relevant legislation.
Hiring and Credentialing.--The Committee is concerned if
the VA hiring and credentialing process may contribute to
longer wait times for Veterans seeking healthcare. The
Committee requests VA to report on the average length of time
to fill a healthcare provider slot at a representative sample
of medical centers, including: the time it takes the resource
board to approve the hire of a new position; the time it takes
to post the job announcement; how long the interview process
takes; and the length of time for credentialing; as well as any
internal VA goals that exist for the time each step in the
process should take. The report should also describe how often
a healthcare provider reaches the credentialing process phase
of the process, but exits the process because of another
opportunity outside VA. This report should be provided to the
Committee no later than 60 days after enactment of this Act.
Unfilled Positions.--The number of unfilled positions at VA
has steadily grown and is at present nearly 49,000 system-wide.
These unfilled positions include VHA physicians and mental
health professionals, and the lack of these professionals
negatively impacts the delivery of care for Veterans at VHA
medical centers and CBOCs across the country. VHA facilities
have been forced to provide care with fewer staff than are
medically necessary to properly care for our Nation's Veterans.
As a result, The Committee is concerned that the significant
number of vacancies will lead to longer waits for Veterans
going without service. Section 505 of the MISSION Act required
VA to post data on unfilled positions and the Committee expects
VA to comply with this mandate. Therefore, the Committee
expects VA to actively recruit and hire full-time professionals
to fill these system-wide vacancies with the resources provided
from the Committee. The Committee directs the Secretary of
Veterans Affairs to provide a quarterly report to the
Committees on Appropriations of both Houses of Congress
detailing hiring initiatives and system-wide progress on hiring
and specifically what actions are being taken to fill physician
positions and mental health provider positions. Finally, the
Committee directs the Secretary to include in this report an
analysis of the amount of care and services carried out by non-
Department facilities because of unfilled VA positions and how
much money that has cost taxpayers.
ACCESS FOR RURAL VETERANS
Office of Rural Health (ORH).--The Committee provides
$270,000,000 to improve access and quality of care for the more
than 3,000,000 enrolled Veterans residing in rural and highly
rural areas. ORH improves access and quality of care for
enrolled Veterans residing in geographically rural areas.
Developing evidence-based policies and innovative practices to
bring healthcare to rural areas is key to serving Veterans in
geographically remote areas, including remote facilities in
Hawaii, many of whom would otherwise need to travel by air to
reach their nearest VA facility. In addition to providing
healthcare services, ORH's important work includes identifying
barriers to healthcare delivery in rural areas and implementing
new ways to deliver healthcare and services to Veterans in
these locations.
Operating Plan.--The Committee directs the Office of Rural
Health to submit to the Committee no later than 30 days after
enactment of this Act an operating plan for fiscal year 2020
funding, as well as the fiscal year 2021 funding provided in
advance by this Act.
Hard-to-Reach Veterans.--The Committee directs VA to submit
a report providing an analysis of the hardest-to-reach rural
Veterans, the barriers to accessing these Veterans, and next
steps to address the needs of these Veterans, no later than 120
days after enactment of this Act.
Rural Transportation Barriers.--The Committee recognizes
that many Veterans in rural areas face significant
transportation barriers, such as limited transit options or
long distances without the capability to drive, to attending in
person appointments. While the Committee recognizes the
important work of VSOs and the existence of the Veterans
Transportation Program, a rural transportation gap still
exists. Of the funds provided for ORH, $5,000,000 shall be for
a pilot program in which VA provides grants to State Veterans
Affairs Agencies and VSOs to provide transportation to VA
appointments for Veterans who live in rural areas. Further, the
Committee directs the Secretary to submit a report concurrent
with the President's Budget Request for fiscal year 2021 that
assesses the viability of this pilot grant program, an analysis
of rural transportation needs, and whether there is sufficient
need to increase its funding level to reach additional rural
Veterans.
Rural Health Resource Centers.--Given the important role
ORH's Rural Health Resource Centers play in expanding access to
care, the Committee encourages VA to continue considering
expanding these centers. ORH has played a major role in VA's
overall strategy to combat opioid abuse by funding pilot
programs through the Rural Health Initiative focused on pain
coaching and modalities that increase Veterans' access to
alternatives to opioid-centered pain management. The Committee
recommends that as ORH considers expansion, combatting the
opioid epidemic and non-opioid pain management in rural areas
remain key components of its focus.
Lack of Rural Health Providers.--The Committee notes
persistent issues for VA health facilities in rural areas in
recruiting and retaining health providers in the face of
national provider shortages and a highly competitive
environment. The Committee encourages VA to continue to
consider expanded use of physician assistants, through both
physical facilities and expanded access to telehealth services,
to address the rural health provider gap. The Committee directs
VA to submit a report, no later than 90 days after enactment of
this Act, providing an update on VA hiring needs in rural areas
and VA plans to address the provider gap in rural areas to the
Committees on Appropriations of both Houses of Congress.
Telehealth in Rural Areas.--The Committee is encouraged by
recent efforts by VA with regard to investment in telehealth
programs. The Committee acknowledges the recent report
submitted by VA outlining their collaborative efforts with
several other Federal agencies on this issue. However, the
report fails to provide an adequate explanation of the specific
plan/strategy that VA will pursue to provide telehealth access
to the 33 percent of Veterans who reside in rural areas
nationwide. Additionally, the Committee remains concerned that
not enough is being done to expand access to those Veterans in
rural areas with limited broadband internet access. The
Committee directs the Secretary and ORH, to elaborate with
specificity on measures to expand capabilities of telehealth to
these regions, and continue collaborating with the Department
of Health and Human Services, which has dedicated programs
specifically for rural hospital access, and the Department of
Agriculture, which has dedicated programs specifically for
rural broadband access, as well as continued participation with
the President's Rural Prosperity Task Force. The Committee also
encourages VA to consider partnerships with state and local
governments to ensure VA and medical facility inclusion in
ongoing broadband expansion projects. The Committee directs the
Department to submit a report to the Committee on the cross
collaboration of departments and programs in regards to a
specific plan and/or strategy to expand telehealth in rural
areas, no later than 60 days after enactment of this Act.
Telehealth For Mental Health.--The Committee recognizes the
strides made by the Department to reach rural communities with
telehealth solutions. The Committee encourages further
development and implementation of telemedicine to treat
Veterans with mental health issues in rural communities.
Telemedicine should be used to its maximum capabilities by VA.
GENDER-SPECIFIC CARE FOR WOMEN
The number of women Veterans using VHA services has
increased 22 percent in four years from 423,642 women Veterans
in 2014 to 517,241 in 2018. The increased number of women using
VHA services necessitates the greater need to provide and
expand VA's gender-specific services to women Veterans. The
bill provides $581,514,000 for gender-specific care for women,
which is $35,000,000 above the request. VA is directed to
continue redesigning its women's healthcare delivery system and
facilities to ensure women receive equitable, timely, and high-
quality healthcare.
Of the amount provided, no less than $35,000,000 shall be
used to implement women's healthcare programs, and VA is
directed to provide an expenditure plan detailing how the
additional funding will be spent no later than 90 days after
enactment of this Act. The Committee further requires quarterly
briefings on the expenditure of these funds. The Committee
directs VA to provide greater resources at VA Central Office
and in the field for Mental Health to support the new Women's
Mental Health initiatives and directs funding to be provided
for three new staff for the Women's Mental Health section in
the Office of Mental Health and Suicide Prevention. The
Committee directs funding for the education of primary care
providers and women-specific programs, including weight loss
and pain management, and for the education of peer navigators.
The Department is further directed to prioritize hiring women
primary care providers and psychologists for women's clinics
out of the Medical Services appropriation.
Additionally, the Committee directs that Women's Health
Program Managers be full-time jobs and not be tasked with
supplemental responsibilities outside of their specified job
descriptions.
Gender-Specific Women Veterans' Healthcare.--The Committee
remains concerned that VA is not adequately addressing the
health needs of women veterans, including obstetrics,
gynecological care, and treatment for gender-specific
conditions and diseases. The Committee urges VA to continue its
efforts to expand access to care in these areas and ensure
women veteran health needs, which often differ from men, are
met.
Access to Gender-Specific Care for Women.--The Committee
expects VA to improve care for women Veterans by monitoring
women Veterans' access to gender-specific care services under
current and future community care contracts. The monitoring
should include an examination of appointment scheduling and
completion times, driving times to appointments, and reasons
appointments could not be scheduled with community providers.
VA must provide women Veterans equitable access to the same
healthcare services and programs as male Veterans, including
VA's specialized services for substance use disorders,
homelessness and treatment for PTSD related to combat military
sexual trauma. Most importantly, these programs must be
tailored to meet the unique needs of women Veterans, and the
Committee expects VHA will expand the list of inspection
requirements for facility staff to ensure compliance with the
womens health handbook. It is also important to ensure proper
coordination of care for women patients with complex care needs
who must frequently access gender-specific healthcare services
in the community. This is especially important for women
Veterans with war-related injuries and/or service conditions
who are at higher risk for poor outcomes.
Women Medical Staff.--The Committee continues to support
the hiring of more women healthcare professionals in order to
provide women Veterans greater opportunities to choose the
gender of their healthcare provider.
Breast Cancer Screening Guidelines.--The Committee commends
VA's decision to offer breast cancer screening and mammography
to eligible women Veterans beginning at age 40. However, the
Department should be prepared to offer screening to eligible
younger women Veterans should a physician determine or risk
factors warrant screening before age 40. The Committee supports
this effort to ensure that the care women Veterans receive is
consistent with the private sector and will continue to monitor
the Department's implementation of this policy. The Department
should closely follow ongoing debate within the scientific
community on breast cancer screening and mammography coverage
to provide Veterans the best care possible. The recommendation
includes bill language to ensure VA maintains this policy
through fiscal year 2024.
Childbirth Data.--The Committee directs VA to provide a
report no later than 180 days after enactment of this Act
identifying the number of women Veterans participating in the
VA healthcare system who have given birth in the five most
recent years for which data are available, how many of the
pregnancies were high risk, the number of complications related
to the mother or baby, and the number of maternal mortalities
that occurred.
Maternity Care Benefits, Survey, and Education Campaign.--
The Committee requests a report on the following data related
to VA maternity care benefits: the number of eligible women
Veterans and actual utilization from each of the last 10 years
in each VISN, to the extent that data are available; the number
of Veterans who receive prenatal care and have births at a VA
facility, and the number of Veterans who receive prenatal care-
related services through contracted non-VA providers;
information on the transition from VA to non-VA providers and
how medical records are returned to VA once a woman is
postpartum, particularly if she has an underlying medical
condition; the number of maternity care coordinators in each
VISN and specific data on minimum employment requirements and
caseload. The Committee also directs VHA to develop a patient
survey to collect feedback from women Veterans who utilize the
maternity care benefit, including their satisfaction with VA
maternity care benefits; whether the benefit met their needs;
the patient's interaction with the maternity care coordinator;
and whether there were barriers to care, providers, or specific
services related to the maternity care benefit. Further, the
Committee encourages VHA to develop an education campaign
publicizing the maternity care benefit, including clarifying
who is eligible, what the benefit covers and does not cover,
and any cost sharing that may be required with the benefit. The
education campaign materials should be easy for patients to
understand and be easily accessible online and at each center
for women's health, medical center and CBOC.
Women's Health Transition Training.--Women are the fastest
growing subgroup of Veterans, yet fewer women Veterans seek
services and support from the Department than men. The
Committee expresses its support for the expansion of the
Veterans Affairs Women's Health Transition Training Pilot
Program and programs similar to it to better support the
increasing numbers of women who leave the military and enter
the Veterans Affairs support system.
Personal Hygiene Products.--The Committee is concerned that
not all VA facilities have committed to VHA Directive
1330.01(2) with regards to personal hygiene products,
specifically menstrual hygiene products, being available in
public female, unisex, and family restrooms at no charge. The
Committee directs VHA to submit a report no later than 180 days
after enactment of this Act on the distribution and
accessibility of these products across all VA facilities.
Maternal Mental Health Services.--An estimated one out of
seven new mothers experience postpartum depression. The
Committee requests a report on the maternal mental health
services available to women Veterans at each VISN through VHA
and the MISSION Act. The report should include mental health
support services for women Veterans who: have miscarried; had a
stillborn baby; who have had challenges related to fertility;
have or have had a high-risk pregnancy; or have postpartum
depression. The report should also specifically address if
women Veterans are screened for postpartum depression, as well
as how many women mental health professionals are available in
each VA medical facility.
PHARMACY ISSUES
Drug Pricing Report.--Rising drug prices are a significant
cost driver in healthcare. However, VA receives substantial
discounts when purchasing prescription drugs. Common sense
approaches such as using lower-cost generic drugs, providing
care from expert pharmacists and making drug companies compete
for business can help drive down the cost of healthcare. The
Committee is interested in VA's spending on prescription drugs.
The Committee directs the Secretary of Veterans Affairs to
submit a report to the Committee on Appropriations of both
Houses of Congress no later than 120 days after enactment of
this Act. The report should include prescription drug prices
(net of rebates) paid by VA for the ten most frequently
prescribed drugs and the ten highest-cost drugs for VA. In
addition, the report should include total annual costs to VA
for all prescription drugs. If data is unavailable, the report
should provide a detailed explanation of why.
PRESCRIPTION DRUG ABUSE
Opioid Abuse.--As the reports of increasing numbers of
opioid overdoses roil the Nation, the Committee is pleased that
VA has taken an aggressive posture in reducing the volume of
opioid prescriptions it dispenses and is turning to alternative
approaches to pain relief, including the use of complementary
medicine tools. The VA Opioid Safety Initiative, begun in 2013,
has resulted in a 25 percent reduction in the number of
Veterans prescribed opioids for pain relief and the rate of
overdose among Veterans prescribed a prescription opioid has
been cut in half. The Committee encourages VA to continue the
challenging effort to reduce opioid use among Veterans, half of
whom suffer from chronic pain. The bill provides $396,924,000
for opioid treatment and prevention efforts, of which
$54,054,000 is provided for activities authorized by the
Comprehensive Addiction and Recovery Act of 2016 (P.L. 114-
198).
Opioid Safety Initiative.--The Committee recognizes that
VHA has made progress in addressing opioid safety for Veterans
through its Opioid Safety Initiative (OSI). The Committee
requests VHA to provide an impact study of OSI's effectiveness
and challenges no later than 90 days after enactment of this
Act.
Opioid Therapy Risk Report.--The Committee urges VA to
ensure that all VA providers who prescribe opioids use VA's
Opioid Therapy Risk Report tool consistently, including prior
to initiating opioid therapy, to ensure safe prescribing and to
help prevent diversion, abuse, and double-prescribing. The
Committee also urges VA to further improve the timeliness of
data available in the tool to allow a provider to have real-
time access to data. It is critical that VA clinicians have
access to a patient's opioid therapy history from outside
providers to ensure safe pain management care, as many Veterans
also seek care from providers in the community who may
prescribe them medication.
Naloxone.--Public health agencies have appropriately
highlighted the risk of overdose from doses of opioids greater
than 90 morphine milligram equivalents (MME) per day. The
Committee is concerned about the hundreds of millions of
prescriptions each year of immediate release (IR) lower MME
opioids, such as hydrocodone and oxycodone. These opioids are
commonly associated with abuse, are a common pathway to
addiction, and present a risk of overdose. Some States have
limited the prescribing of these IR opioids. An alternative
approach might be to assess the benefit of co-prescribing
naloxone with IR and extended release opioids. Prescribers,
including dentists and other primary care providers, have an
opportunity to become more attuned to the risks of all opioids
through the consideration of co-prescribing naloxone with each
opioid prescription. The Committee awaits the report for the
Veterans Health Administration to develop a strategy to test
this hypothesis, execute a pilot program and assess the benefit
for enacting such a policy for Veteran patients, as directed in
House Report 115-673.
Opioid Treatment Alternatives.--The Committee notes that
the United States is grappling with an opioid epidemic. Some
areas, such as Appalachia, are disproportionately hard-hit by
this crisis. The Committee, therefore, encourages VA to ensure
pain treatment alternatives to opioids, such as chiropractic
care, are available to Veterans where they are most needed.
Further, the Committee encourages VA to integrate such
treatments into VA's medical centers or clinics to be provided
by VA staff, or on a contract basis where needed.
Pain University.--The Committee recognizes the excellent
and inspiring work from the Tomah VA facility in Tomah,
Wisconsin, which has successfully implemented a program called
Pain University. The program seeks to incorporate alternative
medicine, such as acupuncture and meditation, to reduce
Veterans' reliance on prescription pain medications, which have
a higher likelihood of addiction leading to substance abuse.
The Pain University program was recognized as a gold status
program by VHA in 2016 for its work. The Committee encourages
VHA to continue to expand implementation of the Pain University
program to other VA clinics so more Veterans have access to
non-addictive pain management therapies.
Substance Use Disorder (SUD) Study.--As the Committee
supports VA's ongoing work to reduce substance use disorder
among Veterans, the Committee is concerned VA has yet to report
on the number and proportion of Veterans with substance use
disorder, broken down by age, including a breakdown by state,
and additionally include available demographic data, as
requested in House Report 115-673. The report deadline was 120
days after passage and VA should consider this report a
priority. The Committee directs VA to provide a status update
on this study 15 days after this report is filed.
Opioid Safety and SUD.--The Committee urges VA to implement
a comprehensive medication selection, adherence, compliance and
internet-based education pilot program related to opioid safety
and substance use disorder in order to provide assistance for
at-risk Veterans. Using off-the-shelf technology, such as smart
pill bottles, internet-based technologies, and bi-lateral text
messaging, VA can reduce suicide, relapse, and hospital visits.
Military Sexual Assault Screening.--In 2016, it was
estimated that 14,900 servicemembers, both men and women, were
sexually assaulted, usually more than once. One in four women
and one in three men were assaulted by someone in their chain
of command. Due to this high prevalence, it is important to
ensure that all those who are victims are identified and
receive proper treatment. The Committee is concerned about the
high prevalence of sexual assault among servicemembers, both
men and women, during their service. The Committee is concerned
that the effects from this assault persist once servicemembers
return home and can manifest in mental health disorders such as
depression, PTSD, substance use disorders, eating disorders,
and anxiety. Because military sexual trauma is prevalent, the
Committee recommends that all Veterans seeking treatment
services are screened for sexual assault using evidence-based
screening tools in order to successfully treat those who have
experienced assault.
Behavioral Health and Substance Use Screening.--The
Committee is aware of the high prevalence of mental illness and
substance abuse among Veterans, particularly PTSD, depression,
anxiety, and alcohol and opioid abuse. The Committee strongly
recommends that all Veterans seeking treatment services in a VA
facility be screened for the listed illnesses, at a minimum
annually, using evidence-based assessment tools.
Substance Abuse Among Women.--In recent years, rates of
problematic substance use among women Veterans have been
increasing. While men have greater rates of addiction than
women, many women Veterans have characteristics that make them
more prone to substance use disorders than men, including past
trauma (physical and sexual). As such, the Committee recommends
that the Department ensures women Veterans have timely access
to a full spectrum of integrated substance abuse treatment
services, from detoxification to rehabilitation. Additionally,
the Department should increase the availability of gender-
specific substance use disorder programming and ensure all
programming venues comply with the environment of care
standards for women's privacy and safety.
WHOLE HEALTH INITIATIVE
Traditionally, Veteran medical providers have focused on
the physical symptoms of Veterans, zeroing in on their diseases
and ailments. However, VA is working to shift this focus by
moving to a whole health model, which is a holistic look at the
many areas of life that can affect a Veteran's health,
including their work environment, relationships, diet, sleep
patterns, and more. Whole Health is an approach to healthcare
that empowers and enables the Veteran to take charge of their
health and well-being and live their life to the fullest. The
Committee is extremely pleased with the Whole Health model of
care. The recommendation provides $20,000,000 above the request
to expand the use of the Whole Health model.
Interactive Patient Care.--The Committee is impressed by
the remarkable work that the Office of Patient Centered Care
and Cultural Transformation is doing to approach Veterans'
health with a holistic effort. Early data indicates that
Veterans who are using Whole Health are using less opioids and
derive greater satisfaction and meaning in their lives. Yet,
only 18 Flagship Whole Health facilities exist that are
implementing the Whole Health System. The Committee is
concerned that only one-third of VA Medical Centers have
implemented the Whole Health initiative through interactive
patient care, a model that empowers patients and educates them
on the care they receive. Interactive patient care
implementation has shown increases in patient satisfaction and
improvement in quality and safety outcomes. Therefore, the
Committee directs VA to expand use of interactive patient care
through use of a national contract to ensure coordination and
standardization of field implementation of the Whole Health
initiative. Furthermore, the Committee directs the Department
to submit a report to Congress on the outcomes derived from the
Whole Health System and the resources needed to expand the
Whole Health System across all VISNs. The report shall be
submitted no later than 180 days after enactment of this Act.
Interactive Patient Care Outside VA Medical Centers
(VAMCs).--The Committee understands that several VAMCs are
implementing the Whole Health model through interactive patient
care, but the Committee is concerned how the Department will
ensure the Whole Health model is sustained when the Veteran is
outside of the VA inpatient setting. To achieve success, VA
must facilitate the Veteran's care team's ability to provide
the same consistent and collaborative patient engagement and
interactive patient care outside of VAMCs and enable the
Veteran and the Veteran's care team to be actively involved in
the Veteran's Whole Health Plan. The Committee directs the
Department to leverage technology to facilitate management and
adaptations of the Veterans Whole Health Plan, ongoing
communication, and awareness of additional VA services to
support fulfillment of the Whole Health Plan.
Creative Arts Therapies.--The Committee acknowledges the
effective use of creative arts therapies in treating Veterans
with traumatic brain injuries and psychological health
conditions. The Committee supports the integration of the arts
and creative arts therapies provided by VA's Office of Patient
Care and Cultural Transformation through the Whole Health
initiative and encourages VA's continued partnerships with
healing arts providers. The Committee strongly supports the
Secretary in continuing to expand these innovative programs
throughout the Veterans Healthcare Networks and provides an
additional $5,000,000 to do so.
OTHER HEALTH ISSUES
Central Alabama Veterans Health Care System (CAVHCS).--The
Committee calls the Department's attention to the urgent need
to improve the care provided at and the management of CAVHCS.
The Department is directed to immediately and fully correct
deficiencies and problems at CAVHCS and ensure VA Southeast
Network (VISN 7) is focused on providing appropriate and
additional assistance to the system. The Committee directs the
Department to develop a plan to resolve these problems and to
submit the plan by August 1, 2019, to the Committees on
Appropriations of both Houses of Congress. In addition, the
Department is directed to submit quarterly reports describing
implementation of the plan and improvements made for Veterans
in central Alabama. The Committee further directs the
Department to develop a plan to address urgent needs at other
VA healthcare systems with poor or failing grades and to submit
the report to the Committees on Appropriations of both Houses
of Congress within 90 days after enactment of this Act.
Hepatitis C Virus (HCV) Outreach and Testing.--The
Committee is pleased with VA's significant progress in reaching
and treating Veterans who have lived with HCV for years, and it
continues to dedicate resources towards the goal of screening
and treating Veterans who are disproportionately affected by
the disease. The Committee notes that the prevalence of
Hepatitis C is higher among servicemembers, but that prevalence
data for the cohort at greatest risk, Vietnam Era Veterans,
remains unknown. VA is encouraged to work with other
stakeholders and VSOs to conduct an outreach testing campaign
that establishes the prevalence number for this cohort while
evaluating point-of-care testing opportunities that can reach
Veterans outside of the VA system. Furthermore, the Secretary
is urged to implement a pilot program to evaluate the benefits
of providing access to rapid point-of-care outreach testing for
Hepatitis C for Vietnam and Vietnam-era Veterans utilizing
enhanced eligibility criteria that would make such services
available to all honorably discharged servicemembers who served
between February 28, 1961, and May 7, 1975.
Lung Cancer Screening.--The Committee continues to note
with concern that Veterans at high risk of developing lung
cancer do not have access to lung cancer screening programs
that are available to Medicare beneficiaries. The Committee
encourages the Department to expand access to lung cancer
screening for high-risk Veterans by developing a VA Centers of
Excellence for Lung Cancer program.
Cancer Moonshot Contribution.--The Committee supports the
Beau Biden Cancer Moonshot Initiative and the Department's
contribution utilizing advances in genomic science to provide
targeted treatment to Veterans. The Department has identified
prostate cancer, triple-negative breast cancer, and colorectal
cancer as areas of priority. Due to the prevalence of various
skin cancers among servicemembers, the Committee directs that
skin cancer be included as a priority as well.
Colorectal Cancer Screening.--The Committee reminds VA of
the direction in the Statement of Managers accompanying the
Consolidated Appropriations Act, 2018 (P.L. 115-141) that
directed the Department to offer all seven colorectal cancer
screening strategies recommended by the United States
Preventive Services Task Force or to notify the Committee if it
is not using all seven approaches.
Prostate Cancer.--Prostate cancer is the most frequently
detected cancer among Veterans, with an estimated 10,000 new
cases diagnosed annually. Unfortunately, early detection is not
yet an exact science. Although prostate biopsies are the
standard of care, they often miss detecting cancer. This fear
of missed cancer often leads to multiple, invasive biopsies,
many of which may be unnecessary. Recent biotechnology
advancements within the emerging field of prostate cancer
biomarkers have hastened the detection of prostate cancer and
curbed the financial costs associated with unnecessary repeat
diagnostic procedures. The Committee encourages VA to
accelerate the adoption of such technologies within VHA,
particularly for biomarker tests on the Federal supply
schedule, to help rule out false-negative biopsy concerns and
alleviate financial and mental anguish for Veterans.
Rare Cancers.--The Committee is pleased by the December
2017 signing of the collaboration agreement between the
Department, the John P. Murtha Cancer Center at Walter Reed
National Military Medical Center, and the National Cancer
Institute focused on improving cancer care for common cancers
affecting servicemembers and Veterans. However, the Committee
remains concerned about the need for a better understanding of,
and treatment options for, rare cancers. There are 55 cancers
that disproportionately affect those serving in the military
and 67 percent of them are rare. Of the 396 total cancers, 374
are rare and few treatment options are available.
Servicemembers are uniquely exposed to carcinogens, including
asbestos, industrial solvents, nuclear radiation, depleted
uranium, lead, fuels, polychlorinated biphenyls, and components
of Chemical Agent Resistance Coating, all hazards that may
increase the risk of cancer for servicemembers and Veterans.
Therefore, the Committee directs the Department to issue a
report no later than 90 days after enactment of this Act on how
the collaboration between the Department, the John P. Murtha
Cancer Center at Walter Reed National Military Medical Center,
and the National Cancer Institute will address rare cancer,
including molecular subtyping, systemic research and
development gaps, and inadequacies in targeted treatment
options.
Nuclear Medicine Quality Improvements.--The Committee is
aware of evidence demonstrating the prevalence of
extravasations in nuclear medical procedures. Extravasations of
diagnostic radiopharmaceuticals negatively affect the
sensitivity and quantification of nuclear medicine scans.
Extravasations can affect disease staging and treatment
assessment, result in unnecessary invasive procedures and
additional radiation exposure, and lead to higher costs for
patients and payers. As America's largest integrated healthcare
system, the VAMC should lead by example in acting to reduce
medical errors and medical waste. The Committee encourages
VAMCs to monitor injection quality and develop a physician/
patient reporting system to disclose when extravasations occur.
No later than 90 days after the enactment of this Act, VHA
shall provide to the Committees on Appropriations of both
Houses of Congress a report on efforts to monitor injection
quality and reduce the incidence of extravasations.
Pressure Ulcer Prevention.--The Committee remains concerned
about the incidence of facility-acquired pressure ulcers and
the associated $1,300,000,000 to $3,600,000,000 in annual costs
for the treatment of hospitalized patients with pressure ulcers
in VA facilities. The Committee understands that significant
health benefits and cost savings may be possible through non-
invasive innovative biometric sensor technologies that have
produced promising results in the early detection of pressure
ulcers. The Committee looks forward to receiving the report
from VA, as requested in House Report 115-673, presenting the
steps VHA is taking in this area, including the status of
technologies VA has assessed. However, the Committee believes
more can be done to reduce the rate of facility-acquired
pressure ulcers that affect thousands of Veterans each year.
The Committee directs the Secretary to continue prioritizing
wound care by executing a pilot program to reduce the incidence
of pressure ulcers in VA facilities. The Committee provides
$2,000,000 for the purpose of carrying out a pressure ulcer
prevention pilot program. The Committee encourages VA to
consider pilot sites with a clinical and research focus on
wound care, and locations with higher incidence rates of
pressure ulcers, such as sites that serve patient populations
with limited mobility and spinal-cord injury.
Pressure Ulcer Transparency.--The Committee acknowledges
the need to better analyze and prevent hospital-acquired
pressure ulcers/injuries, as well as associated complications,
in the VA healthcare system. To date, inadequate information is
available to measure the incidence rates and impact of pressure
ulcers/injuries at VHA facilities. Department of Health and
Human Services data demonstrates growing rates of fatal
hospital-acquired pressure ulcers/injuries nationwide, and
research published by the National Institutes of Health shows
more than one-third of Veterans with spinal cord injuries
report costly pressure ulcer/injuries annually. The Committee
directs VHA to conduct an assessment of the Department's
efforts to (1) monitor the incidence and impact of unintended
Hospital-Acquired Conditions; (2) reduce the incidence of
pressure ulcers/injuries and Surgical Site Infections; and (3)
expand public reporting on U.S. Centers for Medicare and
Medicaid Services hospital comparisons to include total
pressure ulcer/injury incidence at VA medical centers. The
Committee further instructs VHA to incorporate never-event
reduction protocols into existing best practices for its
Veterans healthcare providers. VHA has adopted healthcare
transparency as a strategy to enhance public trust and to help
Veterans make informed choices about their healthcare and
therefore, the Committee encourages the Department to continue
its efforts in transparency.
Wheelchairs.--The Committee encourages the Department to
work with Veterans who are eligible to receive a wheelchair to
determine the best options for restoring their maximum
achievable mobility and function for daily life.
Food as Medicine.--The Committee recognizes the value of
proper nutrition and food's effect on health. Patients with
three or more chronic conditions represent 35 percent of
Veterans receiving VA care and account for 65 percent of VHA
costs. Additionally, 78 percent of Veterans receiving VA care
are overweight and 41 percent are obese. The Committee
continues to urge VHA to be proactive in promoting wellness and
disease prevention by providing evidence-based nutritional
services. The Committee directs VA to provide a status update
on current practices as well as a plan to expand nutritional
education and means to increase access to nutritional foods for
Veterans 15 days after this report is filed.
Long-Term Care.--The Committee is aware of the aging
Veteran population and supports long-term care that focuses on
facilitating Veteran independence, enhancing quality of life,
and supporting the family members of Veterans. The Committee
supports home- and community-based care, residential settings,
nursing homes, geriatric services, and advanced care planning
for Veterans and their families. Multiple chronic conditions,
life-limiting illness, or disability associated with disease,
aging, or injury can be factors of consideration. The Committee
acknowledges that the Veteran population faces unique health
risks and that each Veteran requires an individualized approach
to care.
Hospice Care for Veterans.--The Energy and Water,
Legislative Branch, and Military Construction and Veterans
Affairs Appropriations Act, 2019 (P.L. 115-244) urged VA to
undertake a pilot program to develop techniques, best
practices, and support mechanisms to improve end-of-life care
for combat Veterans and Vietnam-era Veterans. Due to the lack
of meaningful advancement toward addressing the unique needs of
Vietnam Veterans, VA is directed to carry out this pilot
program and to engage nonprofit hospice and palliative care
providers with Vietnam Veteran-centric programs in implementing
the pilot program. The Committee is aware that organizations
such as the nonprofit National Partnership for Hospice
Innovation are developing programs designed to meet the
specific end-of-life care needs for Vietnam-era Veterans and
strongly reiterates that such an approach could be beneficial
to Iraq, Afghanistan, and Syria combat Veterans in the future.
The Committee directs VA to provide to the Committees on
Appropriations for both Houses of Congress an update, no later
than 30 days after enactment of this Act, on the status of this
pilot program.
VA Affiliation With Minority Medical Schools.--The
Committee is pleased with the Department's improvements to its
academic affiliation activities with minority medical schools.
For the purposes of enhancing training initiatives, improving
patient care, and providing educational opportunities for our
Nation's Veterans, the Committee urges VHA and the Office of
Academic Affiliations to maintain this ongoing commitment to
minority health professions schools and report back to Congress
no later than 90 days after enactment of this Act on the
progress.
Minority Veteran Care.--The Committee acknowledges the
Department's efforts to streamline data collection practices
through a working group and other initiatives. The Committee
notes that the Veteran population is becoming increasingly
diverse. According to VA's Center for Minority Veterans, more
than one-third of Veterans will come from minority groups by
the year 2040. The Committee also acknowledges that the
Department currently has a working group, which has the goal of
developing streamlined data collection processes. Accordingly,
the Committee directs the Secretary to provide a report no
later than 180 days after enactment of this Act that details
how VA can restructure its data collection practices to more
accurately and consistently capture data on the race and
ethnicity of Veterans across its various systems. This report
shall take into consideration that the Department is in the
midst of an acquisition of a new electronic health record
system that will combine the Department's current data
collecting programs and make recommendations of how
implementation of this new program can help improve data
collection on Veterans.
Freely Associated States (FAS) Veterans' Access.--The
Committee is concerned about impediments to VA healthcare
access for FAS Veterans. Veterans in the FAS must travel
hundreds to thousands of miles to the nearest VA medical center
in Guam or Hawaii, in some circumstances at their own expense,
to get healthcare. For those who are able to travel to seek
care, the collective costs are magnified by lost wages
resulting from missed days at work and childcare costs, as well
as time away from families. Given the significant time,
resources, and high costs for travel for some Veterans,
including airfare, transportation, and lodging, many FAS
Veterans are never able to access the VA health services they
have earned through their military service. As VA works to
transform its Community Care programs, the Committee directs
VA, no later than 90 days after enactment of this Act, to
provide a report that assesses options for improving access to
VA healthcare for FAS Veterans. The report should include the
number of Veterans residing in the FAS who have utilized
services in VA Pacific Islands Health Care System facilities
over the last three fiscal years, the extent of travel benefits
offered to Veterans and eligibility requirements for the
benefits, an average estimated personal cost for an FAS Veteran
to access VA care, the estimated costs for providing telehealth
services in FAS through a pilot program, and recommendations
for how VA can reduce burdensome restrictions under the Foreign
Medical Program using existing authorities. Furthermore, the
Committee encourages VA to work with Federal and non-Federal
partners, including the Departments of Defense, Interior, and
Health and Human Services, as well as non-VA healthcare
facilities and educational institutions, to leverage shared
resources and improve access for delivery of care through
collaboration.
VA Healthcare Expansion.--The Committee directs VA to
increase access to direct VA care for Veterans living in remote
and underserved areas, such as the Commonwealth of the Northern
Mariana Islands, by increasing the number of full-time,
dedicated, VA medical and mental health providers in these
areas.
FAS Data Collection.--The Committee remains concerned about
the challenges to accessing quality healthcare for Veterans
residing in outlying areas, such as the Northern Mariana
Islands and the Freely Associated States. The Committee is
aware of potential obstacles in data collection to account for
the number of Veterans residing in these areas. The Committee
seeks to understand the data limitations that may exist, and
how VA can improve data collection from the outlying areas to
help inform the development of proposals to ensure that health
needs of Veterans, including Pacific Island Veterans, are met.
The Committee looks forward to receiving the strategic plan as
requested in Conference Report 115-929 to improve the
utilization of healthcare services of Veterans in outlying
areas. In addition, the Secretary is directed to provide the
Committees on Appropriations of both Houses of Congress with
information regarding VA's process for informing Veterans in
the outlying areas about enrollment in the Foreign Medical
Program and if the Department discloses information about
potential barriers Veterans may face in utilizing services and
other VA benefits in outlying and remote areas.
Dialysis Services.--The Committee understands that VA has a
long history of providing dialysis services through community
dialysis providers under the Nationwide Dialysis Services
contracts when VA is unable to directly provide such care.
Today, approximately 15,000 Veterans receive timely access to
high-quality dialysis services through these national dialysis
contracts. The Committee will monitor the Department's
transition to the Community Care Network (CCN) contracts when
an adequate network of dialysis providers is available in the
CCN. The Committee expects VA will ensure that care is not
disrupted or diminished for the Veterans who receive treatment
through experienced providers under the Nationwide Dialysis
Services contracts.
Healthcare-Associated Infection (HAI) Reduction.--The
Committee is concerned with improving the quality of healthcare
for Veterans and their family members, including by reducing
the incidence of HAIs and methicillin-resistant Staphylococcus
aureus (MRSA) infections. According to the Centers for Disease
Control and Prevention, roughly one in thirty-one hospital
patients has at least one HAI at any given time. HAIs are
associated with roughly 99,000 deaths per year and contribute
billions of dollars annually to the total cost of healthcare.
Within medical treatment facilities, medical gowns, bed linens,
and other textiles and hard surfaces such as bed-rails, work
stations, and trays are major vectors for these types of
infections. Therefore, the Committee directs the Department to
submit a report no later than 180 days after enactment of this
Act to the Committees on Appropriations of both Houses of
Congress on the rate of incidence of HAIs within all medical
care facilities under its jurisdiction; recommend means of
reducing the incidence of HAIs at such facilities; and consider
infection reduction functionality in procurement decisions
regarding textiles and hard-surface items. The Committee
further encourages the Department to use evidence-based tools
to significantly reduce the incidence of HAIs.
Creutzfeldt-Jakob Disease Monitoring.--Veterans and their
dependents who resided at United States Military bases in
Germany, Belgium, and the Netherlands for six months or more
from 1980 through 1990, and Veterans and their dependents who
resided at United States Military bases in Greece, Turkey,
Spain, Portugal, and Italy for six months or more from 1980
through 1996 are barred from donating blood due to their
potential exposure during their military service to beef that
was infected with bovine spongiform encephalopathy, resulting
in possible infection of Creutzfeldt-Jakob Disease (CJD), a
human prion disease. The Committee is committed to
understanding the residual impacts of CJD within the Veteran
community. The Committee urges the Department to reference data
from existing medical records of Veterans to determine the
percentage of Veterans from the above referenced subgroup that
have more frequent or unexplained symptoms associated with CJD
compared to the civilian population. This body of data could be
helpful in clarifying the extent and specifics of the medical
issues suffered by Veterans from exposure to CJD.
Artificial Intelligence And Machine Learning.--The
Committee directs the Secretary to submit a report to the
Committees on Appropriations of both Houses of Congress no
later than 180 days after enactment of this Act on how the
Department is utilizing artificial intelligence and machine
learning to improve healthcare services to Veterans.
Prosthetics.--The Committee is concerned about the proposed
regulation regarding prosthetic and orthotic providers and
strongly encourages the Department to allow Veterans to choose
the best provider for their needs.
Tobacco Use Among Veterans.--A 2018 government study found
almost 30 percent of Veterans are smokers. Interventions for
Veterans are critical to reduce tobacco use and lead to
improved health outcomes. Women Veterans are uniquely impacted
by the effects of tobacco use, including difficulty getting
pregnant, early menopause, osteoporosis, cervical cancer, and
breast cancer. The Committee encourages VA to continue
promoting cessation and evidence-based tobacco interventions
for our Veterans.
Burn Pits.--The Committee continues to support VA's work
through the Airborne Hazards and Burn Pits Center of Excellence
on diagnoses, mitigation, and treatment of conditions related
to airborne hazards and burn pits. The Committee continues to
encourage VA to partner with the Department of Defense,
institutes of higher learning, and other public and private
entities to carry out this initiative and provides an
additional $5,000,000 for the Center.
Jason Simcakoski Memorial and PROMISE Act Implementation.--
The Committee supports robust funding to support the continued
implementation of the Jason Simcakoski Memorial and Promise
Act, which passed as Title IX of the Comprehensive Addiction
and Recovery Act of 2016 (P.L. 114-198), including updating
therapy and pain management guidelines, strengthening provider
education and training, and improving patient advocacy.
VSO Wellness Pilot Program.--The Committee is concerned
that VA is taking too much time to implement the VSO Wellness
pilot program, authorized in Section 252 of the Consolidated
Appropriations Act, 2018 (P.L. 155-141). This is a priority of
the Committee, and the Department is directed to implement the
pilot program expeditiously. The Committee directs VA to
provide a status update on the pilot program no later than 14
days after the report is filed.
Health Videos for Veterans.--Hospitals and physicians'
offices around the country are currently utilizing health
videos in their lobbies, waiting rooms, and exam rooms to
supplement and reinforce the medical care, advice, and
instruction physicians are providing. The Committee notes that
educational resources, such as these could result in cost
savings and quality of life improvement for Veterans. The
Committee encourages VHA, where possible, to have health videos
available to Veterans and directs the Secretary to develop a
plan to implement educational video systems within VHA.
Medical Community Care
Fiscal year 2019 enacted level...................... $9,384,704,000
Fiscal year 2020 enacted level...................... 10,758,399,000
Fiscal year 2020 budget year request................ 4,521,400,000
Committee 2020 budget year recommendation........... 4,521,400,000
Fiscal year 2021 advance appropriation request...... 17,131,179,000
Committee 2021 advance appropriation recommendation. 17,131,179,000
Comparison with:
Fiscal year 2020 enacted level.................. 6,372,780,000
Fiscal year 2021 advance budget request......... - - -
The Medical Community Care account was created in the
Surface Transportation and Veterans Health Care Choice
Improvement Act of 2015 (P.L. 114-41). Per the MISSION Act of
2018, all community care programs are consolidated into one
community care program. For fiscal year 2021, the bill provides
$17,131,179,000, of which $2,000,000,000 is available until
September 30, 2022.
The Committee provides $4,521,400,000 for an additional
amount for fiscal year 2020 as requested in the budget request.
Third-Party Payments and Reimbursements.--The Committee
is concerned about the timeliness of reimbursements by VA to
private healthcare/third-party providers. The Committee remains
concerned that VA has created an inefficient process that must
be reformed. As VA continues the MISSION Act implementation,
the Committee believes VA must further prioritize efficient and
prompt payment to community providers to ensure timely access
to quality care. Delays in processing of such payments
undermines the ability to recruit and retain private healthcare
providers to service our Nation's Veterans, especially among
rural communities. Therefore, no later than 90 days after
enactment of this Act and then on a quarterly basis, the
Secretary shall provide the Committees on Appropriations of
both Houses of Congress a comprehensive report detailing the
amount owed to outside providers for every State. The report
shall include outstanding payments over six months old and the
corrective actions being implemented to address these
outstanding balances as well as average time for repayment.
Furthermore, this report will include a comprehensive plan to
prevent this issue from reoccurring in the future.
Choice Program Third-Party Payments and Reimbursements.--
The Committee recognizes the massive undertaking it took to
develop and implement the Veterans Choice Program and the
difficulties that patients and providers have experienced in
dealing with the third-party administrators of the program. The
Committee awaits the fiscal year 2019 report, as requested in
House Report 115-673, on the effectiveness of the programs with
third-party administrators.
Transportation to Community Care Providers.--The Committee
is concerned with the lack of access to transportation for
Veterans who have challenges traveling to work, school or
medical appointments due to disability, illness, or financial
hardships. Veterans who live in both rural and urban areas
experience a lack of consistent and efficient travel,
especially access to medical care. As VA continues to implement
the Veterans Community Care Program, transportation to medical
care and services in the community will be an even bigger
obstacle for Veterans moving forward. The Committee urges VA to
prioritize transportation assistance for Veterans who live in
both rural and urban areas, and encourages VA to work with
state, regional and local groups, local VSOs, and nonprofits on
transportation assistance programs and provide direct
transportation services for Veterans who have limited access to
transportation networks.
Medical Support and Compliance
Fiscal year 2019 enacted level...................... $7,239,156,000
Fiscal year 2020 enacted level...................... 7,239,156,000
Fiscal year 2020 budget year request................ 98,800,000
Committee 2020 budget year recommendation........... 98,800,000
Fiscal year 2021 advance appropriation request...... 7,914,191,000
Committee 2021 advance appropriation recommendation. 7,914,191,000
Comparison with:
Fiscal year 2020 enacted level.................. 675,035,000
Fiscal year 2021 advance budget request......... - - -
The Medical Support and Compliance appropriation funds the
expenses of management and administration of the Department's
healthcare system, including financial management, public
health and environmental hazard, quality and performance
management, medical inspection, human research oversight,
training programs and continuing education, security, volunteer
operations, and human resources.
The bill provides $7,914,191,000 in advance fiscal year
2021 funding. The Committee has included bill language to make
available through September 30, 2022, $150,000,000 of the
Medical Support and Compliance appropriation for fiscal year
2021.
The Committee provides $98,880,000 for an additional amount
for fiscal year 2020 as requested in the budget request.
Medical Facilities
Fiscal year 2019 enacted level...................... $6,004,468,000
Fiscal year 2020 enacted level...................... 6,141,880,000
Fiscal year 2020 budget year request................ - - -
Committee 2020 budget year recommendation........... 20,000,000
Fiscal year 2021 advance appropriation request...... 6,433,265,000
Committee 2021 advance appropriation recommendation. 6,433,265,000
Comparison with:
Fiscal year 2020 enacted level.................. 291,385,000
Fiscal year 2021 advance budget request......... - - -
The Medical Facilities appropriation provides funds for the
operation and maintenance of the Department's healthcare
system's capital infrastructure. Included under this heading
are provisions for costs associated with utilities,
engineering, capital planning, leases, laundry, groundskeeping,
garbage, housekeeping, facility repair, and property
disposition and acquisition.
The bill provides $6,433,265,000 in advance fiscal year
2021 funding. The Committee has included bill language to make
available through September 30, 2022, $250,000,000 of the
advance Medical Facilities appropriation for fiscal year 2021.
The Committee provides $20,000,000 as an additional amount
above the non-recurring maintenance (NRM) fiscal year 2020
appropriation of $1,175,581,000 for women's health and mental
health NRM projects. Within the additional NRM funding for
mental health, the Committee directs VA to prioritize
construction to increase the number of beds available for
overnight mental health treatment for Veterans.
Spending Plan.--The Committee expects VA to provide, no
later than 30 days after enactment of this Act, an expenditure
plan detailing the planned use of the funds provided. The
Committee understands that some of the projects planned for
fiscal year 2020 may not be ready within that timeframe,
requiring an adjustment to the spending plan. The Committee
requests a quarterly update of the plan if the funding for any
single project changes by more than $3,000,000 during that time
period.
Facility Expansion.--The Committee continues to support an
expansion of the number of clinics available to Veterans. To
help accomplish this, the Committee encourages VA to identify
CBOC facilities, with a priority in underserved, rural, and
remote areas, for facility expansion opportunities in order to
accommodate additional patients and provide enhanced services,
thereby reducing the need for Veterans to travel long distances
for care. VA is encouraged to look at existing CBOCs that are
operating at full capacity, have a proven record of delivering
services, and have community support to expand the facility.
Additionally, the Committee urges VA to continue to explore the
potential benefits of placing VA clinics on military
installations located in areas with high Veteran populations
and where nearby VA infrastructure is overburdened.
Community-Based Outpatient Clinic in California.--The
Committee is encouraged by the issuance of a lease for a new
community-based outpatient clinic in Bakersfield, California,
and directs the Department to expeditiously finalize this
project and continue to provide regular updates as directed in
House Report 114-497.
Operating Room Patient Safety and Fire Prevention.--The
Committee is concerned that operating room fires have been
increasing and encourages the Department to look at technology
that can mitigate risks of fires. The Committee directs of the
funds provided not less than $1,000,000 shall be utilized by
the Department to carry out a pilot project that tests and
validates operating room fire safety technology at multiple VHA
medical facilities and report back to the Committee on the
status of the pilot within 90 days of enactment of this Act.
Furthermore, the Committee directs the Department to provide an
annual report concurrent with the budget submission to the
Committees on Appropriations of both Houses of Congress, on the
number of operating room fire events, data showing the total
number of tort claims, the amount per claim, and the total
amount of these claims, paid by the Department of the
Treasury's Judgment Fund or any other taxpayer-funded sources
as a result of VA operating room fires and safety issues and
VHA's effort to reduce the risk of operating room fires
utilizing available technology.
Strategic Analytics for Improvement and Learning (SAIL).--
The Committee directs the Secretary to quarterly address and
provide the Committees on Appropriations of both Houses of
Congress material on failing VA facilities as defined by VA's
SAIL data. The quarterly update will include the current state
of failing facilities and any steps or improvements that are in
place.
Facility Transformations.--The Committee directs the
Department to report on specific measures it takes to track and
prioritize both the physical and cultural transformation within
VA medical facilities to better serve women Veterans. The
Committee is concerned that VA has failed to keep up with a
growing population of women Veterans who need equitable access
to medical care. When one in four women Veterans report having
experienced unwanted sexual attention while serving, it is
concerning that the very system intended to address their
trauma is failing to foster a safe environment for them. VA's
own 2015 Study of Barriers for Women Veterans to VA Health Care
noted that women Veterans experienced unwanted sexual attention
at VA facilities. The President's Budget for Fiscal Year 2020
identifies the need to upgrade facilities to better serve women
Veterans, such as separate entrances and parking accommodations
that will take several years to implement. VA's construction
priority list was established over decades and contains
billions of urgently needed repairs. The 2019 VA Strategic
Capital Investment Planning Process (SCIP) list of construction
projects had approximately $120,000,000 in unfunded facilities
improvements for women Veterans. The Committee directs the
Department to prioritize funding for medical facilities to
accommodate women Veterans.
Use of Smart Technologies.--The Committee is interested in
the potential use of new and innovative devices, systems, and
networks to improve the operation and management of VA
facilities, such as energy, traffic control, perimeter security
and access control systems, and encourages the Department to
work with industry leaders to develop a demonstration project
that could be adapted by a variety of VA facilities.
Medical Facilities Realignment.--The Committee remains
concerned that VA medical care realignments are being
approached in an ad hoc manner by each individual VISN rather
than on a comprehensive basis by VA Central Office. Moreover,
such an approach may lead to inequitable and inefficient
distribution of medical resources throughout the Nation. Before
VA makes any decision to relocate, close, or diminish services
at an existing facility, or proceeds with any such realignment
already underway, consideration must be given to the impact
such action would have on Veterans, especially tribal Veterans
or Veterans in rural or highly rural areas. The Committee
directs VA to adhere to a clear and transparent process that
engages all parties from the onset and is consistent with a
national realignment strategy. Since the conference report for
the Consolidated Appropriations Act, 2016 (P.L. 114-113), the
Committees have suspended the proposed realignment of services
in VISN 23 until a report was transmitted to the Committees,
and that report has not been received. The Department is again
directed to comply with the request for the report and
meanwhile suspend the proposed realignment of services in VISN
23 until such time as the Department transmits to the Committee
a report that outlines the following: (1) a national
realignment strategy that includes a detailed description of
realignment plans within each VISN; (2) an explanation of the
process by which those plans were developed and coordinated
within each VISN; (3) a cost versus benefit analysis of each
realignment, including the cost of replacing VHA services with
contract or other outsourced services; (4) an analysis of how
any realignment will impact tribal, rural, and highly rural
Veteran healthcare within each VISN; and (5) an analysis of how
any realignment will impact access to, enrollment in, and the
capacity of VA PTSD and Residential Rehabilitation Treatment
Program services within each VISN and nationally.
War Related Illness and Injury Study Centers (WRIISC).--The
Committee is concerned that research and clinical trials are
urgently needed to develop effective treatments for Veterans
exposed to toxic environmental hazards, such as burn pits. Cost
effective models for rapid development of new treatments for
Gulf War Illness using computational models, research funding
through DOD's Congressionally Directed Medical Research Program
(CDMRP), and clinical experts in environmental medicine have
proven effective in partnership with VA medical centers. The
Committee notes the Department's extensive discussions of
adding additional WRIISC sites, and directs the Secretary to
establish a WRIISC focused on toxic environmental exposures to
leverage research funding through the CDMRP and clinical
partnerships.
Women Veterans Health Facilities.--The Committee is
concerned about the harassment women Veterans have had to
endure at VA healthcare facilities. The Committee requests VHA
to conduct a feasibility study of establishing women-only
clinics in each VISN no later than 180 days after enactment of
this Act.
Medical and Prosthetic Research
Fiscal year 2019 enacted level........................ $779,000,000
Fiscal year 2020 budget request....................... 762,000,000
Committee recommendation in the bill.................. 840,000,000
Comparison with:
Fiscal year 2019 enacted level.................... 61,000,000
Fiscal year 2020 budget request................... 78,000,000
This appropriation provides for medical, rehabilitative,
and health services research. The bill provides $840,000,000
available through September 30, 2021. The Committee recognizes
the importance of the research conducted by VA for Veterans'
quality of life and health and provides $78,000,000 above the
request and $61,000,000 above fiscal year 2019 for these
activities.
Medical research is an important aspect of the Department's
programs, providing complete medical and hospital services for
Veterans. The prosthetic research program is also essential in
the development and testing of prosthetic, orthopedic, and
sensory aids for the purpose of improving the care and
rehabilitation of eligible disabled Veterans, including
amputees, paraplegics, and the blind. The health services
research program provides unique opportunities to improve the
effectiveness and efficiency of the healthcare delivery system.
Budgetary resources from a number of areas, including
appropriations from the medical care accounts, reimbursements
from DOD, grants from the National Institutes of Health,
private proprietary sources, and voluntary organizations,
provide support for the Department's researchers. Estimated
fiscal year 2020 research resources beyond the research account
are $1,217,000,000.
National Center for Post-traumatic Stress Disorder
Research.--The National Center for PTSD sets the VA agenda for
research and education on PTSD, with seven research divisions
located at VA facilities. The Center also conducts education
and training and coordinates the VA National PTSD Brain Bank.
The Committee provides $40,000,000 for the Center in fiscal
year 2020, which includes $10,000,000 for the coordination of
the VA National PTSD Brain Bank. The Committee encourages the
National Center to use funding for the Brain Bank to accelerate
the discovery of novel therapeutic targets for the treatment of
PTSD utilizing post-mortem brain datasets, cell-based and other
models for target identification and validation.
Modeling and Simulation Treatment of PTSD.--As a mechanism
to explore treatments for PTSD, the Committee is aware that the
use of modeling and simulation technology has enabled the
development of innovative and immersive therapies, which can
extend trauma management therapy protocol. The Committee
encourages the establishment of a Trauma Management Therapy
pilot program that utilizes exposure therapy involving virtual
reality in combination with group therapy for the treatment of
individuals with symptoms relating to PTSD. The Secretary shall
submit a report to the Committees on Appropriations of both
Houses of Congress no later than 180 days after enactment of
this Act, detailing the feasibility of such a pilot program and
the metrics required to determine the value of exposure therapy
utilizing therapeutic virtual environments using real-time
modeling and simulation training to treat PTSD.
Dystonia.--The Committee notes the connection between
traumatic brain injury and the onset of dystonia. The Committee
continues to urge VA to pursue collaboration with stakeholders
to advance critical research on dystonia.
Cannabis Research.--The Committee recognizes that continued
focus on the discovery of treatment alternatives for Veterans
diagnosed with various conditions, such as chronic pain and
PTSD, is essential to reducing the number of Veteran suicides.
For this reason, the Energy and Water, Legislative Branch, and
Military Construction and Veterans Affairs Appropriations Act,
2019 (P.L. 115-244) urged VA to utilize funds to prioritize
investments in research on the efficacy and safety of cannabis
usage among the Veteran population for medicinal purposes and
submit a report to the Committee no later than 180 days after
enactment of that Act. The report has yet to be submitted to
the Committee, therefore the Committee directs VA to provide a
status update of this outstanding report no later than 15 days
after the report is filed.
Access to Clinical Trials.--The Committee applauds the
ongoing collaborative efforts between VA medical centers and
NCI-designated comprehensive cancer centers that will allow
Veterans to have access to the highest quality cancer care
available, including cutting-edge clinical trials. The
Committee is concerned that States with large Veteran
populations are not able to access these treatments. The
Committee directs VA to expand these efforts, especially as
they relate to providing Veterans access to groundbreaking new
treatments through clinical trials led by academic cancer
centers, as well as the linking of VA oncology care with
national research databases involving patients at multiple
academic cancer centers. The Committee commends the work of the
NAVIGATE partnership (NCI and VA Interagency Group to
Accelerate Trials Enrollment) in providing NCI funding for VA
health centers, which have already established clinical trials
partnerships with academic cancer centers. The Committee is
concerned, however, that this partnership does not include
certain States with large Veteran populations. To address this
need, the Committee directs VA to provide up to $5,000,000 to
support the establishment of partnerships between VA hospitals
and NCI-designated facilities that allow for Veterans to access
cancer clinical trials at VA health centers.
Exposure to Herbicide-Related Toxins.--Veterans have
frequently expressed long-held concerns that toxic exposure
during their military service is related to adverse health
conditions. The Committee is committed to understanding the
residual impacts of Agent Orange/Dioxin and other herbicide-
related toxic exposures among Veterans who served in Vietnam,
Thailand, Guam, the Northern Mariana Islands, America Samoa,
and all other geographic areas where these toxic substances
were dispersed. The Committee urges the Department to reference
data from existing medical records of Veterans to determine the
percentage of Veterans from the above referenced subgroup that
have more frequent or unexplained diseases compared to the
civilian population. This body of data could be helpful in
clarifying the extent and specifics of the medical issues
suffered by Veterans from exposure to herbicides.
Female Prosthetics Research.--The Committee strongly
supports robust funding for medical and prosthetic research.
Recognizing that approximately six percent of wounded Veterans
returning from Iraq and Afghanistan are amputees, and the
number of Veterans accessing VA healthcare for prosthetics and
sensory aids continues to increase, this funding greatly
enhances Veterans' quality of life. However, there is an acute
need for research specializing in female prosthetics, as most
prostheses are designed to fit male Veterans. Since three
percent of military amputees are female, the Committee directs
VA to prioritize medical and prosthetic research to adequately
address prosthetics meant for women.
Neural-Enabled Prosthetics.--The Committee understands the
uniqueness of limb trauma injuries sustained by servicemembers
in combat. Traumatic injury or neurological diseases can also
significantly alter or impair the lifestyle of the individual
and their caregivers. The Committee encourages VA to fund
research that will design and develop technology to offset the
effects of limb amputation, orthopedic injury and disease,
neuropathic pain, and other neurodegenerative diseases. The
Committee directs $25,000,000 for VA to prioritize and fund
extramural research that accelerates functional recovery and
rehabilitation of sensorimotor function through engineering of
wirelessly activated implantable biomedical technologies
capable of focal stimulation inside nerves and that is
personalized to the needs of the patient.
Gulf War Illness Studies.--The Committee recommends the
Department continue to conduct epidemiological studies
regarding the prevalence of Gulf War Illness, morbidity, and
mortality in Persian Gulf War Veterans and the development of
effective treatments, preventions, and cures. The Committee is
concerned by the lack of public availability of the findings of
all research conducted by or for the Executive Branch relating
to the health consequences of military service in the Persian
Gulf theater of operations during the Persian Gulf War, and by
the lack of coordination by the Department in ensuring the
public availability of this information. The Committee urges
the Department to publish disease-specific mortality data
related specifically to Persian Gulf War Veterans. The
Committee remains concerned by VA's ever-evolving terminology
for the signature adverse health outcome of the Persian Gulf
War, recognized by the Institute of Medicine (IOM) as Gulf War
Illness, and encourages the Department to utilize the term,
Gulf War Illness, as IOM has recommended. The Committee
continues to urge the Secretary to consider revising and
updating the Clinical Practice Guideline for Chronic
Multisymptom Illness consistent with the July 2011 Veterans
Health Initiative, Caring for Gulf War Veterans, in that it
cannot be reliably ascribed to any known psychiatric disorder,
and to focus on recent Gulf War Illness treatment research
findings and ongoing Gulf War Illness treatment research
direction. Furthermore, the Committee once again encourages VA
to strengthen the training of primary, specialty, and mental
healthcare providers on the Gulf War Illness case definitions
recommended by IOM.
Public Access to Scientific Data.--This Committee commends
the Department on issuing its Policy and Implementation Plan
for Public Access to Scientific Publications and Digital Data
from Research Funded by the Department of Veterans Affairs on
July 23, 2015. The Committee urges VA to continue its efforts
towards full implementation of the plan and requires an update
on progress made be included in its fiscal year 2021 budget
request.
Ultrasound Guided Regional Anesthesia for Opioid
Reduction.--The Committee continues to be concerned about the
use of opioids to address pain in the VA Healthcare System. The
Committee is aware of several protocols being tested in non-VA
hospitals, such as Alternatives to Opioids in the Emergency
Department, Enhanced Recovery After Surgery, and the
Perioperative Surgical Medical Home. The Committee encourages
VA as part of its opioid prevention efforts to provide VA
clinicians with resources to study and potentially adopt these
and other ultrasound guided regional anesthesia protocols to
reduce the number of opioids prescribed and used to treat
Veterans' acute and urgent pain.
NICoE Collaboration.--The Committee recognizes the high-
quality mental health care and neurological research being
conducted at Walter Reed National Intrepid Center of Excellence
(NICoE). The Committee directs the Department of Veterans
Affairs to strengthen its collaboration with NICoE so VA
researchers and health professionals can learn from NICoE's
important work and contribution to the health community. The
Committee directs VA to submit a report no later than 120 days
after enactment of this Act to the Committees on Appropriations
of both Houses of Congress on existing collaborative efforts
between VA and NICoE and the expansion of such collaborations.
Collaboration on Precision Medicine.--The Committee
supports expanding the reach of the Department's research
program, such as by partnering with non-federal entities and
initiatives and co-locating VA and university biomedical
scientists, and encourages the Department to expeditiously seek
opportunities for collaboration on precision medicine and other
multi-disciplinary research for wounded warriors and other at-
risk Veterans.
Hyperbaric Therapy.--The Committee supports continued study
of the use of hyperbaric oxygen treatments for Veterans
suffering from post-traumatic stress disorder.
Drug Development for Depression and Suicide Prevention.--
Depression, post-traumatic stress disorder, and suicide
threaten to reach epidemic proportions among America's Veteran
warfighters. Recent National Institute of Mental Health
clinical trials investigating the use of intravenous
Scopolamine to treat depression have shown potentially
promising initial results to address this issue and the
potential to assist in the prevention of suicide. The Committee
encourages the Department to look at all drug development to
build upon current research efforts to prevent depression and
suicides.
Rapid Cerebral Therapeutic Hypothermia.--Veterans who
suffer from brain injury frequently experience long-term
cognitive effects. Evidence has demonstrated that immediate
cooling of the brain following traumatic injury can reduce
brain damage and improve outcomes. The Committee supports the
research of rapid cerebral therapeutic hypothermia to lessen
the long-term effects of traumatic brain injuries.
Parkinson's Disease Research.--Parkinson's Disease
Research, Education and Clinical Centers (PADRECCs) allow for
approximately 110,000 United States Veterans diagnosed with
Parkinson's disease to receive specialized, multidisciplinary
care of the highest quality, leading to improved quality of
life and improved health outcomes. The six PADRECCs located
throughout the United States have expanded care through a
National Consortium that offers specialized Parkinson's disease
and movement disorder specialty care in 51 Consortium Centers
to Veterans who cannot travel to a PADRECC. The mission of the
PADRECCs is to support quality of life by providing
comprehensive medical and surgical care to Veteran patients
with Parkinson's disease and other movement disorders,
advancing investigation into the cause and cure for Parkinson's
disease, and enhancing understanding of the disorder through
education and research. The Committee strongly supports
Parkinson's disease research and encourages the Department to
increase funding to PADRECCs to allow the Centers to address
the growing and complex needs of the population, while
continuing to provide specialized, multidisciplinary care to
Veterans diagnosed with Parkinson's disease and other movement
disorders.
Medical Care Collections Fund
The Department of Veterans Affairs Medical Care Collections
Fund (MCCF) was established by the Balanced Budget Act of 1997
(P.L. 105-33). The Department deposits first-party and pharmacy
co-payments, third-party insurance payments and enhanced-use
collections, long-term care co-payments, Compensated Work
Therapy Program collections, Compensation and Pension Living
Expenses Program collections, and Parking Program fees into the
MCCF. The Department uses these funds for medical care and
services to Veterans. The estimate of fees that will be
collected in fiscal year 2020 is $3,912,000,000.
MCCF Third-Party Billing.--Congress remains concerned over
potential discrepancies in VA's billing process. Procedures to
provide for correct billing and prompt collection must improve
at VA. Therefore, the Department shall submit to Congress a
quarterly report identifying the amount of third-party health
billings that were owed to VA in the previous quarter and the
amount collected. The report shall include billings and
collections data for both large claims (greater than $1,000)
and small claims (equal to or less than $1,000). In addition,
the first quarter report shall include current efforts underway
to increase VA's efficiency, accuracy, and collection process,
as well as what management practices are in place to provide
proper oversight of the billing process, including appeals, so
as to eliminate unnecessary and duplicative functions.
National Cemetery Administration
Fiscal year 2019 enacted level........................ $315,836,000
Fiscal year 2020 budget request....................... 329,000,000
Committee recommendation in the bill.................. 329,000,000
Comparison with:
Fiscal year 2019 enacted level.................... 13,164,000
Fiscal year 2020 budget request................... - - -
The National Cemetery Administration (NCA) was established
in accordance with the National Cemeteries Act of 1973 (P.L.
93-43). It has a fourfold mission: to provide for the interment
of, in any national cemetery with available grave space, the
remains of eligible deceased servicemembers and discharged
Veterans, together with their spouses and certain dependents,
and to permanently maintain their graves; to provide headstones
for, and to mark graves of eligible persons in National, State
and Tribal, and private cemeteries; to administer the grant
program for aid to States and tribal governments in
establishing, expanding, or improving State and tribal
government Veterans' cemeteries; and to administer the
Presidential Memorial Certificate Program. This appropriation
will provide for the operation and maintenance of 144
operational national cemeteries, 11 cemeteries transferred from
the Department of the Army, and 33 other cemeterial
installations.
The bill includes language making ten percent of the total
available until September 30, 2021.
Rural Cemetery Access.--In House Report 112-94 and House
Report 115-188 the Committee expressed concern that NCA is not
adequately serving the Nation's Veterans in rural areas. The
Committee continues to be concerned that there are geographic
pockets in the country that are not being served, as VA has
failed to meet its goals of having access for all Veterans to a
burial option within 75 miles of a Veteran's home. The
Committee has previously requested a report on this issue and
in fiscal year 2018 requested that GAO examine this issue as
well. The Committee remains interested and looks forward to
this report no later than 60 days after enactment of this Act.
Departmental Administration
GENERAL ADMINISTRATION
(INCLUDING TRANSFER OF FUNDS)
Fiscal year 2019 enacted level........................ $355,897,000
Fiscal year 2020 budget request....................... 369,200,000
Committee recommendation in the bill.................. 369,200,000
Comparison with:
Fiscal year 2019 enacted level.................... 13,303,000
Fiscal year 2020 budget request................... - - -
The General Administration account provides funds for the
Office of the Secretary, seven Assistant Secretaries, and three
independent staff offices. The Committee has included bill
language to make available through September 30, 2021, up to
ten percent of these funds and to permit the transfer of funds
in this account to the General Operating Expenses, Veterans
Benefits Administration account. Included in this funding is
$22,000,000 for the Office of Accountability and Whistleblower
Protection. This office was previously funded out of
reimbursements, and the recommendation provides a direct
funding source to ensure its independence from Department
leadership.
VA Five Year Development Plan (VFYDP).--The Committee is
very pleased that the Department has provided a VFYDP in its
fiscal year 2020 budget. The Committee looks forward to
continued annual review of the VFYDP in VA budget submissions.
Quarterly Financial Information Reports.--The bill includes
an administrative provision that extends the requirement for
submission of the quarterly financial information required in
the fiscal year 2017 bill and conference report.
Additional Budgetary Information.--The Committee continues
its request that items described in previous House reports
continue to be included in the budget justifications submitted
each year. Further, the Committee directs VA to include in its
budget justification materials a table for each account that
shows a five-year funding history, for requested and enacted
levels.
Staff Relocations Within VA.--The bill continues the
administrative provision requiring written notification 15 days
prior to organizational changes that result in the transfer of
25 or more full-time equivalent staff from one organizational
unit of the Department to another.
Performance Bonuses.--The Committee feels it is important
to know how VA is allocating its resources with regard to
performance bonuses. Therefore, the Committee directs VA to
submit a report, no later than 90 days after enactment of this
Act, which provides the aggregate total of VA performance
bonuses covering the five most recent fiscal years for which
the data is available. The data should be divided between
bonuses for Senior Executive Service (SES) staff and non-SES
staff. The report should also include the percentage of SES and
non-SES employees who received a bonus and the average dollar
amount of the bonuses by grade covering the same time period.
The report, however, should not include any personally
identifiable information.
Financial Management Business Transformation (FMBT).--The
Committee provides $11,900,000 in this account as well as
$66,000,000 in the Information Technology Systems account for
FMBT. An additional $107,000,000 will be provided from the VA
customer offices through the Franchise Fund. The current legacy
financial management system is over 30 years old, and its
imminent failure presents significant risks to VA. In the
fiscal year 2018 conference report, VA was directed to provide
the Committee, on a quarterly basis, a report that compares
actual progress on the financial management system to the
performance benchmarks and timeline provided in the first
report. The Committee continues to expect the Department to
continue this quarterly report throughout fiscal year 2020.
Whistleblower Protection.--The Committee reiterates that
the purpose of the Department of Veterans Affairs
Accountability and Whistleblower Protection Act of 2017 (P.L.
115-41), was to increase accountability and the integrity of
Veterans services and care. Public Law 115-41 is not a
retaliatory tool for management to use against employees or a
means of discrimination against employees who are also
Veterans. In order for this legislation to work as intended, it
must be applied consistently and as intended, which is why the
Department of Defense and Labor, Health and Human Services, and
Education Appropriations Act, 2019 and Continuing
Appropriations Act, 2019 (P.L. 115-245) directed the Secretary
of Veterans Affairs to provide a report on this matter.
Unfortunately, the Committee has yet to receive a report, which
is concerning as the congressional intent was to receive
information on the application of such authorities to employees
organized by wage grade, an assessment of whether such
authorities are being disproportionately applied to lower wage
grades, as well as the information on the frequency of appeals.
In addition, the report was to include demographic data on
overall VA workforce terminations since fiscal year 2016.
Therefore, the Committee directs the Secretary of Veterans
Affairs to provide a status update on this report 15 days after
the filing of this report.
Small, Minority- and Women-Owned Businesses.--The Committee
recognizes the need for the Department to continue to meet its
goals for contracting with minority, disadvantaged, and women-
owned businesses. The Committee is concerned that in fiscal
years 2016 and 2017, the Department missed its prime
contracting goals for women-owned businesses, and businesses in
HUBZones. In fiscal year 2016, the Department missed all of its
subcontracting goals for women-owned businesses, small
disadvantaged businesses, service-disabled Veteran-owned
businesses, and businesses in HUBZones. Therefore, the
Committee directs the Department to prioritize awarding
contracts to contractors that consistently execute approved
small business subcontracting plans. The Committee further
urges the Department to prioritize minority-owned and
disadvantaged contractors and subcontractors. The Committee
directs the Department to submit a report, no later than 180
days after enactment of this Act and annually thereafter,
detailing the number of contractors that submitted a small
business subcontracting plan during the fiscal year. This
report shall include an analysis detailing which contractors
successfully implemented subcontracting plans and
recommendations on how the Department could better achieve its
prime and subcontracting goals for small businesses.
Advertising With Small and Disadvantaged Businesses.--The
Committee notes that, as the largest advertiser in the United
States, the Federal government should work to ensure fair
access to its advertising contracts for small disadvantaged
businesses and businesses owned by minorities and women. The
Committee directs the Department to include the following
information concurrent with the fiscal year 2021 budget
request: Expenditures for fiscal year 2020 and expected
expenditures for fiscal year 2021, respectively, for (1) all
contracts for advertising services; and (2) contracts for the
advertising services of (i) socially and economically
disadvantaged small business concerns (as defined in section
8(a)(4) of the Small Business Act (15 U.S.C. 637(a)(4)); and
(ii) women- and minority-owned businesses.
Data on Women and Minority Veterans.--The Committee
recognizes the lack of data specific to women and minority
Veterans made available to Congress by the Department. The
Committee recommends, when applicable, the Secretary of
Veterans Affairs display information in the annual report(s)
submitted to Congress separately for women Veterans and
minority Veterans.
Mail Management.--The Committee notes the GAO report
titled, ``VA: Actions Needed to More Effectively Manage
Outgoing Mail'' (GAO-17-581), and requests the Department
provide a report on the potential costs and benefits of
centralizing its mail management system no later than 180 days
after enactment of this Act. The report should include
information on innovative information technology platforms that
could result in savings and increased efficiency.
Board of Veterans' Appeals
Fiscal year 2019 enacted level........................ $174,748,000
Fiscal year 2020 budget request....................... 182,000,000
Committee recommendation in the bill.................. 182,000,000
Comparison with:
Fiscal year 2019 enacted level.................... 7,252,000
Fiscal year 2020 budget request................... - - -
The bill makes ten percent of this funding available
through September 30, 2021.
The Board of Veterans' Appeals (BVA) is the component of VA
responsible for making final decisions on behalf of the
Secretary for the thousands of claims for Veterans' benefits
that are presented to BVA for appellate review. The majority of
BVA's workload derives from the benefit claims initiated at VBA
regional offices. The appellate process has multiple steps,
most of which occur at the local regional office level. If a
Veteran is not satisfied with a regional office determination,
he or she may appeal to BVA for a final agency decision. BVA
adjudicates appeals covering all areas of Veterans' benefits,
but most of the workload concerns appeals for Veterans'
disability compensation or pension benefits. On February 19,
2019, VA implemented the new legislative framework that
modernized the claims and appeals process and provided greater
choice to Veterans by providing them three options for claims
and appeals: (1) a supplemental claim; (2) a higher-level
review; or (3) a direct appeal to the Board of Veterans'
Appeals. VA decided 85,000 cases in fiscal year 2018, which was
a record level by 25,000 cases, and was VA's best year since
2009 for efficiencies. VA is on pace to exceed the 2019 goal of
90,050 decisions.
The bill also provides the $4,100,000 as requested in the
Information Technology Systems budget to support phase three of
the Appeals Modernization initiative. The initiative will
convert the Board's 1980s-era case control and locator system
to a new, automated integrated community developed suite that
is used to process initial disability claims.
INFORMATION TECHNOLOGY SYSTEMS
(INCLUDING TRANSFER OF FUNDS)
Fiscal year 2019 enacted level........................ $4,103,000,000
Fiscal year 2020 budget request....................... 4,343,000,000
Committee recommendation in the bill.................. 4,343,000,000
Comparison with:
Fiscal year 2019 enacted level.................... 240,000,000
Fiscal year 2020 budget request................... - - -
The Information Technology (IT) Systems account supports IT
services such as systems development and performance,
operations and maintenance, information protection, and
customer support. The program permits the effective and
efficient delivery of Veterans' healthcare services and
benefits programs.
Within the account total, the Committee allocates in bill
language $1,204,238,000 for pay and associated costs, which is
equal to the budget request; $2,737,482,000 for operations and
maintenance, which is equal to the request; and $401,280,000
for development, which is equal to the request. The bill makes
available three percent of pay and associated costs and five
percent of operations and maintenance funds until September 30,
2021. All development funds are available until September 30,
2021.
The bill provides $66,000,000 to continue the Financial
Management Business Transformation (in addition to the
$11,900,000 provided for FMBT in the General Administration
account and the $107,000,000 provided out of the Franchise
Fund), $36,785,000 for the supply chain management
modernization, and $6,000,000 for the VA Center for Innovation
to improve existing programs or inform decisions about new
programs.
The Committee continues bill language permitting the
transfer of funding among the three subaccounts upon approval
of the Committees on Appropriations of both Houses of Congress.
The bill contains language allowing for the reprogramming
of funds among development projects upon prior notification to,
and approval by, the Committees on Appropriations of both
Houses of Congress. The bill continues to include language
indicating that funds for development are available only for
the projects and in the amounts specified in the report
accompanying the Act.
The chart below reflects the Committee's recommendation for
each development project. This chart will serve as the
Department's approved list of development projects, and all
requested changes are subject to the reprogramming guidelines
as outlined in the accompanying Act.
INFORMATION TECHNOLOGY DEVELOPMENT PROJECTS
(In thousands of dollars)
------------------------------------------------------------------------
Committee
Project Recommendation
------------------------------------------------------------------------
Clinical Applications................................ $32,910
Health Management Platforms.......................... 80,690
Benefits Systems..................................... 136,823
Memorial Affairs..................................... 13,877
Other IT Systems..................................... 100,480
Cybersecurity........................................ 16,600
Information/Infrastructure Management................ 19,900
Total All Development............................ 401,280
------------------------------------------------------------------------
The Committee expects the Office of Information Technology
to continue to provide an IT expenditure report to the
Committees on Appropriations of both Houses of Congress on a
monthly basis. This report shall include a comparison to the
project costs included in the development funding chart above
and provide an explanation for any differences in excess of
$1,000,000.
Information Technology National Standards.--The Committee
encourages the Veterans Health Administration to vigilantly
pursue the Department of Veterans Affairs national IT goals and
do all that is necessary to maintain needed national standards
in IT while at the same time meeting short-term local IT needs
of individual VA Medical Centers, including maintaining up-to-
date security systems and security infrastructure. VHA should
solicit, review, and respond in a timely fashion to short-term
IT requests from its Medical Centers. The Committee supports
keeping on track with beneficial national IT plans and
standards, but the Committee also supports serving Veterans
well on location in the short run. Long-term IT sync and short-
term outstanding service should both be a part of VHA's
management strategy.
VETERANS ELECTRONIC HEALTH RECORD (EHR)
Fiscal year 2019 enacted level........................ $1,107,000,000
Fiscal year 2020 budget request....................... 1,603,000,000
Committee recommendation in the bill.................. 1,603,000,000
Comparison with:
Fiscal year 2019 enacted level.................... 496,000,000
Fiscal year 2020 budget request................... - - -
The Veterans Electronic Health Record is a unified account
designed to manage the effort to develop an interoperable
electronic health record system that will access seamlessly the
records of Veterans in the VA system and those of the
Department of Defense and of community providers. The VA system
is the same as the one chosen by DOD and is planned to be
rolled out with the same timeline and geographic areas as DOD
in order to realize cost efficiency savings.
Within the total funding, the bill provides $1,106,500,000
for the electronic health record contract, $161,800,000 for
program management, and $334,700,000 for infrastructure
support. Funding is made available for three years because of
the uncertainty of the timing of obligations in this
substantial new effort.
The recommendation includes a rescission of $70,000,000
from unobligated balances in section 250 under Administration
Provisions.
The Department has committed in future years to provide
approximately 30 percent of the total cost of this ten-year
project. The Committee expects that this pledge will be
maintained even if there are changes in the Department's
leadership.
The bill does not include the transfer language requested
by the Administration. This account is intended to be the
single source of funding within VA for the electronic health
record effort. No authority is provided for funds from other VA
accounts to be transferred to this account or for funds from
this account to be transferred to other accounts. Consistent
with the effort to centralize financial management of the
development of the electronic health record, the Committee
continues to direct the Department to manage this effort at the
headquarters level in the Office of the Deputy Secretary.
The bill language for this account continues to require the
Secretary to submit a report quarterly to the Committees on
Appropriations of both Houses of Congress detailing
obligations, expenditures, and deployment strategy by facility.
In addition, bill language is included requiring notice to the
Committees on Appropriations of both Houses of Congress on any
changes to the deployment schedule. The Committee repeats the
fiscal year 2019 directive for GAO to perform quarterly
performance reviews of the VA electronic health record
deployment. It is expected that this quarterly reporting will
provide the Committees and VA with timely information to
properly oversee this effort and address important issues.
Furthermore, the Committee directs VA to provide quarterly
reporting on EHRM obligations.
Medical Records Portability.--The Committee supports
Veterans having real-time, seamless, and portable access to all
of their medical records and urges VA to develop, as part of
EHRM, the means by which Veterans can have secure, portable
access to their own medical records.
Cybersecurity Implementation.--The Committee is concerned
about the pace at which implementation of cybersecurity best
practices are occurring at the Department, especially as VA and
DOD continue to integrate electronic health information. The
Committee directs the Department to identify for the Committee
steps it has taken to protect data and patient records across
physical, virtual, and mobile networks and the devices and
systems attached to these networks. If such review warrants,
the Department should consider a layered defensive strategy
that includes perimeter security, segmentation within the data
center to increase lateral security, and data and application
protections. The Committee also urges VA to ensure that patient
records being transferred from DOD to VA have the same level of
security and data-level protections as provided by DOD.
Informatics.--In conjunction with the implementation of the
EHRM program, the Committee recommends that VA continue to
develop and implement, within the Veterans Health
Administration, a comprehensive enterprise interoperability and
intelligence strategy in order to benefit from advances in the
health information technology marketplace for utilization by
both Office of Information Technology and Informatics purposes.
Such a strategy should include modernized enterprise data and
analytics capabilities, a clinical interoperability platform,
and open-application program interfaces leveraging community
healthcare interoperability standards.
Cybersecurity.--Recognizing the cybersecurity challenges of
sharing data between the Military Healthcare System GENESIS and
the VA EHRM initiative, the Committee urges the Department to
explore and invest in modern, software-defined networking and
hybrid cloud technologies to ensure that its EHRM network and
IT infrastructure will effectively support the Cerner
implementation and its subsequent use.
Open Architecture.--The Committee encourages VA to ensure
the new EHR initiative provides an open architecture that
allows a governance and oversight process for administering
access and support to deploy third-party applications,
components, and application programming interfaces to ensure
longevity of the EHR platform and requests information on the
EHRM architecture be included in quarterly reports.
Clinical Workflow Challenges.--The Committee is concerned
about the significant amount of time clinicians spend on the
current electronic health record documentation in their
treatment of Veterans, as well as their inability to easily
incorporate such information from within the Veterans'
continuum of care, particularly the community care environment.
This administrative burden also means clinicians have less time
to spend providing care to each patient and fewer patients are
seen in a given day, resulting in long wait times for Veterans.
VA's ongoing efforts with EHRM and interoperability with the
Department of Defense provide an opportunity to assess
innovative technologies' ability to solve this challenge. The
EHRM technology must enhance clinicians' efficacy so they can
spend more time with patients. The Committee commends the
Department's efforts to involve clinicians at all stages of the
EHRM rollout and encourages the continued collaboration with
clinicians to ensure the most efficient workflow solutions are
developed with clinician input.
Health Navigator.--Section 731 of the National Defense
Authorization Act for Fiscal Year 2018 (P.L. 115-91) required
the Secretary of Defense to conduct a pilot program to improve
health outcomes and patient experience for beneficiaries with
complex medical conditions. The Committee believes that VA
should conduct a similar pilot. VA is encouraged to conduct
this pilot in a VA Region where it can operate in tandem with
DOD's rollout of the EHR platform and the Defense Health
Agency's pilot project as directed in Section 731 of Public Law
115-91.
OFFICE OF INSPECTOR GENERAL
Fiscal year 2019 enacted level........................ $192,000,000
Fiscal year 2020 budget request....................... 207,000,000
Committee recommendation in the bill.................. 222,000,000
Comparison with:
Fiscal year 2019 enacted level.................... 30,000,000
Fiscal year 2020 budget request................... 15,000,000
The Office of Inspector General (OIG) was established by
the Inspector General Act of 1978 and is responsible for the
audit, investigation, and inspection of all VA programs and
operations. The overall operational objective is to focus
available resources on areas that would help improve services
to Veterans and their beneficiaries, assist managers of
Department programs to operate economically in accomplishing
program goals, and to prevent and deter recurring and potential
fraud, waste, and inefficiencies.
The bill makes up to ten percent of this funding available
until September 30, 2021.
The Committee provides an additional $15,000,000 above the
budget request to ensure robust oversight by OIG of MISSION Act
and EHRM implementation.
CONSTRUCTION, MAJOR PROJECTS
Fiscal year 2019 enacted level........................ $1,127,486,000
Fiscal year 2020 budget request....................... 1,235,200,000
Committee recommendation in the bill.................. 1,235,200,000
Comparison with:
Fiscal year 2019 enacted level.................... 107,714,000
Fiscal year 2020 budget request................... - - -
The Construction, Major Projects appropriation provides for
constructing, altering, extending, and improving any of the
facilities under the jurisdiction or for the use of VA,
including planning, architectural and engineering services,
assessments, and site acquisition where the estimated cost of a
project is more than $20,000,000.
The Committee recommendation makes all but $480,000,000 of
these funds available for a five-year period.
In past years, this appropriations bill repeated language
that is in permanent law requiring that all major construction
projects costing more than $100,000,000 be managed by a non-VA
government entity such as the Army Corps of Engineers. Because
this policy is now well-established, the Committee no longer
feels a need to duplicate the language. However, the Committee
intends to continue its oversight of the quality of the outside
entity management and will continue to receive quarterly
briefings on each of the large construction projects.
The chart below reflects the Committee's recommendation for
Major Construction projects.
CONSTRUCTION, MAJOR PROJECTS
(In thousands of dollars)
------------------------------------------------------------------------
Committee
Location Description Recommendation
------------------------------------------------------------------------
VHA:
New York, NY, Manhattan VAMC.... Flood Recovery..... 150,000
Bay Pines, FL................... Inpatient/ 30,000
Outpatient
Improvements.
San Juan, PR.................... Seismic 30,000
Corrections--Build
ing #1.
San Diego, CA................... SCI & Seismic 20,000
Corrections.
Reno, NV........................ Correct Seismic 10,000
Deficiencies &
Expand Clinical
Services Building.
Louisville, KY.................. New Medical 410,000
Facility.
West Los Angeles, CA............ Build New Critical 25,000
Care Center.
Alameda, CA..................... Outpatient Clinic & 26,000
National Cemetery.
Advance Planning and Design Fund Various Locations.. 72,000
Asbestos:....................... Various Locations.. 12,000
Major Construction Staff:....... Various Locations.. 88,700
Judgment Fund:.................. Various Locations.. 25,000
Non-Dept. Fed. Entity Project Various Locations.. 120,000
Management Support.
Seismic Corrections:............ Various Locations.. 35,000
Total VHA................... ................... 1,053,700
National Cemetery Admin. (NCA):
Bayamon, PR..................... Replacement 10,000
Cemetery (Morovis).
Riverside, CA................... Gravesite Expansion 3,000
& Cemetery
Improvements.
Elmira, NY...................... Western New York 10,000
Cemetery.
Houston, TX..................... Gravesite Expansion 34,000
Bourne, MA...................... Massachusetts Phase 32,000
4 Expansion.
Dallas, TX...................... Dallas National 28,000
Cemetery Expansion.
Advance Planning and Design Fund ................... 35,000
NCA Land Acquisition............ ................... 20,000
Total, NCA.................. ................... 172,000
General Admin.:................. Staff Offices 9,500
Advance Planning
Fund.
Major Construction Total.... ................... 1,235,200
------------------------------------------------------------------------
To enhance the Committee's capacity to conduct oversight on
VA's facility construction efforts, several administrative
provisions are continued in the bill: (1) No funding amount
greater than $7,000,000 may be reprogrammed between
construction projects unless approved by the Committees on
Appropriations of both Houses of Congress; (2) any change to
the scope of a construction project is not permitted without
the approval of the Committees; and (3) VA must report any bid
savings of $5,000,000 or more on projects as soon as they are
identified.
Budget Justification Documents.--The Committee reminds the
Department of the requirement in section 258 of Division A of
the Continuing Appropriations and Military Construction,
Veterans Affairs, and Related Agencies Appropriations Act,
2017, and Zika Response and Preparedness Act (P.L. 114-223)
regarding specific materials to be included in Major
Construction budget justification documents for fiscal year
2017 and each fiscal year thereafter.
Joint VA and U.S. Army Corps of Engineers Projects.--The
Committee is concerned the Department projects under management
of the United States Army Corps of Engineers (USACE) may
experience unecessary administrative delays during the initial
transitional phase between projects being authorized and
appropriated by Congress and an interagency agreement being
signed by VA and USACE. Accordingly, no later than 60 days
after enactment of this Act, the Committee directs VA to
provide monthly updates on all current and subsequent VA
construction projects worth more than $100,000,000, and jointly
managed by VA and USACE. Regular reports for certain projects
may be submitted on a quarterly basis if the Department and
Committee come to an agreement that more frequent reports are
not necessary.
Research Facilities Infrastructure Report.--In fiscal year
2006, the Committee directed VA to conduct a comprehensive
review of its research facilities and report to Congress on the
deficiencies found and suggestions for correction. VA released
its initial review in 2012, and recently completed Phase II
assessments of a subset of those facilities. The Committee
directs VA to submit the completed Phase II research facilities
infrastructure report updates to the Committees on
Appropriations of both Houses of Congress no later than October
1, 2019.
CONSTRUCTION, MINOR PROJECTS
Fiscal year 2019 enacted level........................ $649,514,000
Fiscal year 2020 budget request....................... 398,800,000
Committee recommendation in the bill.................. 421,117,000
Comparison with:
Fiscal year 2019 enacted level.................... (228,397,000)
Fiscal year 2020 budget request................... 22,317,000
The Construction, Minor Projects appropriation provides for
constructing, altering, extending, and improving any of the
facilities under the jurisdiction of, or for the use of, the
Department, including planning, assessment of needs,
architectural and engineering services, and site acquisition,
where the estimated cost of a project is equal to or less than
$20,000,000.
As with the Major Construction account, the Committee
recommendation makes these funds available for a five-year
period.
Within the amounts provided, the Committee directs
$22,317,000 for the construction related to expanding gender-
specific care for women and mental health programs.
The recommendation includes $150,000,000 in additional
funding in section 243 under Administration Provisions for
minor construction projects.
Construction of Housing for Rural Homeless Veterans.--The
Department has made great efforts to find suitable housing for
homeless Veterans and their families. The Committee encourages
more non-traditional efforts to eliminate Veteran homelessness.
For example, some cities and towns have started pilot programs
using ``Micro'' or ``Tiny Homes'' to help deal with
homelessness. The Committee encourages VA to continue its
efforts to house homeless Veterans and their families and
explore the feasibility of providing ``Tiny Homes''.
GRANTS FOR CONSTRUCTION OF STATE EXTENDED CARE FACILITIES
Fiscal year 2019 enacted level........................ $150,000,000
Fiscal year 2020 budget request....................... 90,000,000
Committee recommendation in the bill.................. 150,000,000
Comparison with:
Fiscal year 2019 enacted level.................... - - -
Fiscal year 2020 budget request................... 60,000,000
This appropriation provides grants to assist States to
construct State home facilities, for furnishing domiciliary or
nursing home care to Veterans, and to expand, remodel, or alter
existing buildings for furnishing domiciliary, nursing home, or
hospital care to Veterans in State homes. A grant may not
exceed 65 percent of the total cost of the project. The bill
makes this funding available until expended.
GRANTS FOR CONSTRUCTION OF VETERANS CEMETERIES
Fiscal year 2019 enacted level........................ $45,000,000
Fiscal year 2020 budget request....................... 45,000,000
Committee recommendation in the bill.................. 45,000,000
Comparison with:
Fiscal year 2019 enacted level.................... - - -
Fiscal year 2020 budget request................... - - -
This program provides grants to assist States and tribal
governments with the establishment, expansion, and improvement
of Veterans' cemeteries that are operated and permanently
maintained by the States and tribal governments. Grants under
this program fund up to 100 percent of construction costs and
the initial equipment expenses when the cemetery is
established. State and tribal governments remain responsible
for providing the land and for paying all costs related to the
operation and maintenance of the State cemeteries, including
the costs for subsequent equipment purchases. The bill makes
this funding available until expended.
Administrative Provisions
The bill includes 52 administrative provisions, of which 47
were in effect in fiscal year 2019 in some form and 5 are new
provisions. The administrative provisions included in the bill
are as follows:
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 201 allowing for the transfer of
funds among three mandatory appropriations. The Administration
proposal to modify this provision is not adopted.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 202 allowing the Department to
transfer funding among the four medical appropriations accounts
in fiscal year 2020. The Administration proposal to modify this
provision is not adopted.
The bill includes section 203 allowing for salaries and
expenses funds to be used for hire of passenger vehicles, lease
of facilities or land, and purchase of uniforms.
The bill includes section 204 providing that only funding
in ``Construction, Major Projects'' and ``Construction, Minor
Projects'' can be used for the purchase of any site for any new
hospital or home or to construct any new hospital or home.
The bill includes section 205 requiring the Department to
be reimbursed for medical services it provides to any person
not defined as a beneficiary to ensure the Department is
receiving payment for all medical services provided.
The bill includes section 206 allowing for the use of funds
appropriated in fiscal year 2020 for ``Compensation and
Pensions'', ``Readjustment Benefits'', and ``Veterans Insurance
and Indemnities'' for payment of accrued obligations recorded
in the last quarter of fiscal year 2019.
The bill includes section 207 allowing for the use of
fiscal year 2020 funds to pay prior year obligations resulting
from implementation of sections 3328(a), 3334, and 3712(a) of
title 31, United States Code.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 208 allowing the Department to
use surplus earnings from the national service life insurance,
U.S. Government life insurance, and Veterans' special life
insurance program to administer these programs.
The bill includes section 209 allowing the Department to
obligate enhanced-use lease proceeds for administrative
expenses that were incurred in a prior fiscal year during the
year funds are received.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 210 limiting the amount of
reimbursement the Office of Resolution Management, the Office
of Employment Discrimination Complaint Adjudication, and the
Office of Diversity and Inclusion can charge other offices and
accounts of the Department for services provided.
The bill includes section 211 requiring the Department to
collect current and accurate third-party reimbursement
information for the purposes of third-party insurance
collections. If persons receiving care or medical services do
not disclose this information, the Department is allowed to
bill them reasonable charges for services provided.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 212 allowing the Department to
use enhanced-use lease funds for construction and alteration of
medical facilities.
The bill includes section 213 allowing the Department to
use the Medical Services appropriation for expenses related to
the broader mission of medical care to Veterans.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 214 allowing the Department to
transfer Medical Care Collections to the ``Medical Services''
and ``Medical Community Care'' accounts to be used for Veterans
medical care and makes those funds available until expended.
The bill includes section 215 allowing Veterans who reside
in Alaska to obtain medical services from medical facilities
supported by the Indian Health Service or tribal organizations,
and provides for reimbursement for those services from VA.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 216 allowing the Department to
transfer the proceeds received from the transfer of real
property deposited into the VA Capital Asset Fund to the Major
and Minor Construction appropriations accounts and makes those
funds available until expended.
The bill includes section 217 requiring the Secretary to
submit quarterly reports to the Committees on Appropriations of
both Houses of Congress on the financial status of the Veterans
Health Administration.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 218 prohibiting the Department
from increasing total resources of the Information Technology
appropriation by more than ten percent by transferring funding
from the other VA accounts and requires the Department to
receive approval from the Committees on Appropriations of both
Houses of Congress before such transfer. The Administration
proposal to modify this provision is not adopted.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 219 providing up to $314,409,000
of fiscal year 2020 funds for transfer to the Joint DOD-VA
Medical Facility Demonstration Fund. Additional funding may be
transferred from these accounts upon written notification to
the Committees on Appropriations of both Houses of Congress.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 220 permitting the transfer of
$322,931,000 of fiscal year 2020 funding appropriated for
medical accounts to the Joint DOD-VA Medical Facility
Demonstration Fund for the operation of facilities designated
as combined Federal medical facilities.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 221 permitting the transfer of
funds deposited in the Medical Care Collections Fund to the
Joint DOD-VA Medical Facility Demonstration Fund for facilities
designated as combined federal medical facilities.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 222 directing that a minimum of
$15,000,000 shall be transferred from the four medical care
appropriations to the Department of Defense/Department of
Veterans Affairs Health Care Sharing Incentive Fund, to be
available until expended.
The bill includes section 223 requiring the Secretary to
notify the Committees on Appropriations of both Houses of
Congress of all bid savings when identified in Major
Construction projects that total at least $5,000,000 or five
percent of the programmed amount of the project. The
Administration proposal to delete this provision is not
adopted.
The bill includes section 224 prohibiting the original
scope of work for a Major Construction project from being
increased above the scope specified for that project in the
original justification data provided to Congress unless
approved by the Committees on Appropriations of both Houses of
Congress. The Administration proposal to delete this provision
is not adopted.
The bill includes section 225 requiring a quarterly report
from each VBA regional office on pending disability claims,
both initial and supplemental; error rates; the number of
claims processing personnel; corrective actions taken; training
programs; and review team audit results. In addition, the bill
requires quarterly reporting on pending appeals at VBA, as well
as BVA. The Administration proposal to delete this provision is
not adopted.
The bill includes section 226 requiring advance written
notification to the Committees on Appropriations of both Houses
of Congress 15 days prior to organizational changes which
result in the transfer of 25 or more full-time equivalent staff
from one organizational unit to another. The Administration
proposal to delete this provision is not adopted.
The bill includes section 227 requiring the Secretary to
provide, on a quarterly basis to the Committees on
Appropriations of both Houses of Congress, notification of any
single national outreach and awareness marketing campaign in
which obligations exceed $1,000,000. The Administration
proposal to delete this provision is not adopted.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 228 permitting the transfer to
``Medical Services'' from any discretionary program except
``General Operating Expenses, Veterans Benefits
Administration'' upon approval of the Committees on
Appropriations of both Houses of Congress. This provision is
intended to give VA flexibility as it administers the changes
to its traditional healthcare program and the MISSION Act. The
budget request to modify this provision is not adopted.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 229 permitting the transfer of
funds between the ``Board of Veterans Appeals'' and ``General
Operating Expenses, Veterans Benefits Administration'' upon
approval of the Appropriations Committees on Appropriations of
both Houses of Congress. The budget request to modify this
provision is not adopted.
The bill includes section 230 prohibiting the reprogramming
of funds exceeding $7,000,000 among the Major Construction
projects unless the Committees on Appropriations of both Houses
of Congress approve the request. The Administration proposal to
delete this provision is not adopted.
The bill includes section 231 requiring the Secretary to
ensure that the toll-free suicide hotline provides immediate
assistance from a trained professional and adheres to all
requirements of the American Association of Suicidology. The
Administration request to delete this provision is not adopted.
The bill includes section 232 restricting funds from being
used to close certain medical facilities in the absence of a
national realignment strategy. The Administration request to
delete this provision is not adopted.
The bill includes section 233 requiring VA to use the
mammography screening guidelines announced by the Secretary on
May 10, 2017 through January 1, 2024. The Administration
request to delete this provision is not adopted.
The bill includes section 234 permanently allowing the use
of Medical Services funding for assisted reproductive
technology treatment and adoption reimbursement for Veterans
and their spouses if the Veteran has a service-connected
disability that results in being unable to procreate without
such fertility treatment.
The bill includes section 235 prohibiting any funds from
being used in a manner that is inconsistent with statutory
limitations on outsourcing.
The bill includes section 236 pertaining to exceptions for
Indian- or Native Hawaiian-owned businesses contracting with
VA. The Administration request to delete this provision is not
adopted.
The bill includes section 237 directing the elimination
over a series of years of the use of Social Security numbers in
VA programs. The Administration request to delete this
provision is not adopted.
The bill includes section 238 referencing the provision in
the Continuing Appropriations and Military Construction,
Veterans Affairs, and Related Agencies Appropriations Act,
2017, and Zika Response and Preparedness Act (P.L. 114-223)
pertaining to certification of marriage and family therapists.
The Administration request to delete this provision is not
adopted.
The bill includes section 239 which prohibits funds from
being used to transfer funding from the Filipino Veterans
Equity Compensation Fund to any other VA account. The
Administration request to delete this provision is not adopted.
The bill includes section 240 permitting funding to be used
in fiscal years 2020 and 2021 to carry out and expand the
childcare pilot program authorized by section 205 of the
Caregivers and Veterans Omnibus Health Services Act of 2010
(P.L. 111-163).
The bill includes section 241 prohibiting VA from using
funds to enter into an agreement to resolve a dispute or claim
with an individual that would restrict the individual from
speaking to Members of Congress or their staff on any topic,
except those required to be kept secret in the interest of
national defense or the conduct of foreign affairs. The
Administration request to delete this provision is not adopted.
The bill includes section 242 referencing language in the
Continuing Appropriations and Military Construction, Veterans
Affairs, and Related Agencies Appropriations Act, 2017, and
Zika Response and Preparedness Act (P.L. 114-223) requiring
certain data to be included in budget justifications for major
construction projects. The Administration request to delete
this provision is not adopted.
The bill includes section 243 providing $1,000,000,000 to
be available until expended for VA infrastructure needs, of
which $850,000,000 is for seismic improvement projects and
seismic management activities and $150,000,000 is for Minor
Construction. This funding is not made available until VA
provides and the Committees on Appropriations of both Houses of
Congress approve a detailed expenditure plan.
The bill includes section 244 prohibiting the use of funds
to deny the Inspector General timely access to information,
unless a provision of law expressly refers to the Inspector
General and expressly limits such access. The Administration
request to delete this provision is not adopted.
The bill includes section 245 prohibiting funding from
being used in a manner that would increase wait times for
Veterans at medical facilities. The Administration request to
delete this provision is not adopted.
The bill includes section 246 prohibiting the use of funds
in fiscal year 2020 to convert any program that received
specific purpose funds in fiscal year 2019 to a general
purpose-funded program without the approval of the Committees
on Appropriations of both Houses of Congress at least 30 days
prior to any such action. The Administration request to delete
this provision is not adopted.
The bill includes section 247 eliminating category D or E
pain testing on dogs.
The bill includes section 248 prohibiting the closure of
the CBOC in Bainbridge, New York until the Secretary submits a
completed market area assessment to the Committees on
Appropriations of both Houses of Congress.
The bill includes section 249 requiring the Department to
update the Planning and Activating CBOC handbook every five
years and provide guidance and training to employees on each
update of the handbook.
(INCLUDING RESCISSION OF FUNDS)
The bill includes section 250 rescinding $70,000,000 of
unobligated fiscal year 2019 funding for the Veterans
Electronic Health Record account.
The bill includes section 251 extending the VSO wellness
pilot program authorized in section 252 of the Consolidated
Appropriations Act, 2018 (P.L. 155-141) until 2022.
TITLE III
RELATED AGENCIES
Funds under Title III support the agencies that honor and
respect the service of our Nation's heroes. Though it may be a
smaller title of the bill, the agencies funded under Title III
are the public face of America's commitment to our
servicemembers and Veterans. The American Battle Monuments
Commission and Arlington Cemetery commemorate those who made
the ultimate sacrifice, while the Armed Forces Retirement Home
and the United States Court of Appeals for Veterans Claims are
critical parts of keeping our promise to serve those who served
our Nation.
The Committee is disappointed that these agencies are kept
largely flat funded in their requests by the Office of
Management and Budget (OMB), despite the very real needs of
these agencies. The Committee expects OMB to provide budget
requests that properly reflect the needs of these agencies, not
to shortchange these critical agencies under the guise of
fiscal responsibility.
American Battle Monuments Commission
SALARIES AND EXPENSES
The recommendation includes $104,000,000 for Salaries and
Expenses of the ABMC, an increase of $28,900,000 above the
request to support ABMC's unfunded requirements for high-
priority projects.
The Committee notes the significant maintenance needs of
the American Battle Monuments around the world, which are
specifically designed to honor our fallen servicemembers. The
Committee directs ABMC to emphasize maintaining and repairing
these monuments and memorials in a proactive and timely manner
that honors the service, achievements, and sacrifices of the
United States Armed Forces.
World War I Memorial Preservation.--The Committee supports
the preservation and rehabilitation of World War I memorials
across the country and in Europe to honor the more than four
million men and women who bravely served the United States and
fought to preserve our freedom.
FOREIGN CURRENCY FLUCTUATIONS ACCOUNT
The recommendation includes such sums as necessary for the
Foreign Currency Fluctuations Account.
United States Court of Appeals for Veterans Claims
SALARIES AND EXPENSES
The recommendation includes $35,400,000 for Salaries and
Expenses for the United States Court of Appeals for Veterans
Claims (the Court). The Consolidated Appropriations Act, 2018
(P.L. 115-141) included bill language requiring a feasibility
study before the purchase of a new courthouse. The study has
not been completed, and the Committee does not support the
Court using the requested fiscal year 2020 funds for this
purpose. Instead, the Committee directs the Court to use the
$800,000 to address its growing caseload.
Caseload.--The Committee is concerned about indications of
a growing caseload at the Court, particularly as the Court has
now received authority to hear class action litigation. While
reforms have recently been enacted that may slow this increase,
the Committee acknowledges that the Court may need additional
resources in the future, potentially including additional
judges, to meet the caseload needs.
Department of Defense Civil Cemeterial Expenses, Army
SALARIES AND EXPENSES
The recommendation includes $80,800,000 for Salaries and
Expenses for Arlington National Cemetery (the Cemetery), which
is $10,000,000 above the fiscal year 2020 budget request. The
Committee has provided this additional $10,000,000 to maintain
current services, as was previously identified as a need during
the fiscal year 2019 cycle.
CONSTRUCTION
The recommendation includes $131,000,000 for planning and
design and construction of Southern Expansion to remain
available until expended.
Southern Expansion.--The recommendation includes
$131,000,000 for planning and design and construction of
Southern Expansion to remain available until expended. This
will complete the anticipated $350,000,000 cost of the Southern
Expansion and road realignments to extend the life of the
cemetery. The Committee provides this funding to ensure that
the life of our Nation's most prestigious cemetery is extended
into the 2050 timeframe.
Updated Interment Policy.--The Committee notes that the
National Defense Authorization Act for Fiscal Year 2019 (P.L.
115-232) required the Secretary of the Army to revise criteria
for interment at Arlington National Cemetery to preserve the
Cemetery as an active burial ground well into the future. The
Committee understands that the Secretary is currently reviewing
proposals and notes that it will be following closely to ensure
that the Cemetery can continue to live up to its mission to
honor those who have served.
Armed Forces Retirement Home
TRUST FUND
The recommendation includes $70,300,000 for the Armed
Forces Retirement Home (AFRH), an increase of $6,000,000 above
the requested amount, although $22,000,000 of the total is
provided from the general fund of the Treasury, and not the
Trust Fund. The Committee provides this increase to keep pace
with anticipated personnel costs and contract cost inflation,
as well as to support urgently needed capital maintenance and
other improvements, in particular, infrastructure related to
the health and safety of AFRH residents. The Committee
understands that deferred maintenance projects are in critical
need of attention, and provides this funding as a clear
statement of priorities for future budget requests.
General Fund.--The Committee has previously expressed
concern about the use of the General Fund to support the work
of AFRH. The Committee is pleased that efforts are underway to
increase revenues and stabilize the AFRH Trust Fund for the
long term, and directs AFRH to continue to make progress in
this area and report to the Committee on its further
initiatives to improve sustainability and maintain the high-
quality services provided to AFRH residents.
Land Redevelopment.--The Committee understands that AFRH
has issued a request for proposals to redevelop the 80-acre
master planned parcel on the Washington campus, and looks
forward to seeing the selection process conducted in a fair,
open, and transparent manner without undue outside influence.
AFRH is directed to report to the Committee on the status of
the selection process and resulting lease negotiations.
Administrative Provision
The bill includes one provision that was in effect in
fiscal year 2019. The administrative provision included in the
bill is as follows:
The bill includes section 301 permitting funds from
concessions at Army National Military Cemeteries to be used to
support activities at the Cemeteries.
TITLE IV
OVERSEAS CONTINGENCY OPERATIONS
Department of Defense
Fiscal year 2019 enacted level........................ $921,000,000
Fiscal year 2020 budget request....................... 9,844,526,000
Committee recommendation in the bill.................. 921,000,000
Comparison with:
Fiscal year 2019 enacted level.................... - - -
Fiscal year 2020 budget request................... (8,923,526,000)
The recommendation includes Overseas Contingency Operations
for military construction projects and planning and design
related to the European Deterrence Initiative (EDI).
Military Construction, Army
The recommendation includes $156,860,000 for Army military
construction and planning and design for Overseas Contingency
Operations and European Deterrence Initiative projects.
The recommendation does not include $88,500,000 as
requested for the High-Value Detention Facility replacement at
Guantanamo Bay, Cuba.
The recommendation does not include $7,200,000,000 for a
border wall as requested by the Administration.
Military Construction, Navy and Marine Corps
The recommendation includes $281,576,000 for Navy and
Marine Corps military construction and planning and design for
European Deterrence Initiative projects.
Military Construction, Air Force
The recommendation includes $436,564,000 for Air Force
military construction and planning and design for European
Deterrence Initiative projects.
Military Construction, Defense-Wide
The recommendation includes $46,000,000 for Defense-Wide
Overseas Contingency Operations and planning and design for
European Deterrence Initiative projects.
Administrative Provision
The bill includes one provision that was in effect in
fiscal year 2019.
The bill includes section 401 that designates that funding
shall be available only if the President so designates all
amounts and transmits such designations to Congress.
TITLE V
NATURAL DISASTER RELIEF
Department of Defense
Fiscal year 2019 enacted level................. - - -
Fiscal year 2020 budget request................ $9,200,000,000
Committee recommendation in the bill........... 2,300,000,000
Comparison with:
Fiscal year 2019 enacted level............. 2,300,000,000
Fiscal year 2020 budget request............ (6,900,000,000)
Military Construction, Navy and Marine Corps
The recommendation includes $1,210,948,000 for Navy and
Marine Corps military construction and planning and design for
damages related to Hurricanes Florence and Michael.
Military Construction, Air Force
The recommendation includes $1,035,752,000 for Air Force
military construction and planning and design for damages
related to Hurricanes Florence and Michael and 2019 flooding.
Military Construction, Army National Guard
The recommendation includes $50,000,000 for Army National
Guard military construction and planning and design for damages
related to Hurricanes Florence and Michael.
Military Construction, Army Reserve
The recommendation includes $3,300,000 for Army Reserve
military construction and planning and design for damages
related to Hurricanes Florence and Michael.
Administrative Provision
The bill includes one new Administrative Provision.
The bill includes section 501 that designates that funding
shall be available only if the President so designates all
amounts and transmits such designation to Congress and requires
a spend plan.
TITLE VI
GENERAL PROVISIONS
The bill includes a total of 14 provisions: 11 provisions
that are effective in fiscal year 2019:
The bill includes section 601 prohibiting the obligation of
funds beyond the current fiscal year unless expressly so
provided.
The bill includes section 602 prohibiting the use of funds
for programs, projects or activities not in compliance with
Federal law relating to risk assessment, the protection of
private property rights, or unfunded mandates.
The bill includes section 603 encouraging all departments
and agencies funded in this Act to expand the use of ``E-
Commerce'' technologies and procedures.
The bill includes section 604 specifying the Congressional
committees that are to receive all reports and notifications.
The bill includes section 605 prohibiting the transfer of
funds to any instrumentality of the United States Government
without authority from an appropriations Act.
The bill includes section 606 prohibiting any funds in this
Act to be used for a project or program named for an individual
serving as a Member, Delegate, or Resident Commissioner of the
United States House of Representatives.
The bill includes section 607 requiring all reports
submitted to the Congress to be posted on official websites of
the submitting agency.
The bill includes section 608 prohibiting the use of funds
to establish or maintain a computer network unless such network
blocks the viewing, downloading, and exchanging of pornography,
except for law enforcement investigation, prosecution or
adjudication activities.
The bill includes section 609 prohibiting the use of funds
for payment of first-class travel by an employee of the
executive branch.
The bill includes section 610 prohibiting the use of funds
in this Act for any contract where the contractor has not
complied with E-Verify requirements.
The bill includes section 611 prohibiting the use of funds
in this Act by the Department of Defense or the Department of
Veterans Affairs for the purchase or lease of a new vehicle
except in accordance with Presidential Memorandum--Federal
Fleet Performance, dated May 24, 2011.
The bill includes section 612 prohibiting the use of funds
in this Act and previous Acts for the construction of a wall,
barrier, fence, or road along the Southern border of the United
States or a road to provide access to a wall, barrier, or fence
constructed along the Southern border of the United States.
The bill includes section 613 prohibiting childcare
centers, agencies, or providers to employ an individual
convicted of a sex offense, an offense involving a child
victim, or a violent crime.
The bill includes section 614 prohibiting funds to be used
to replace or diminish the quality of care provided by the
TRICARE program.
House of Representatives Report Requirements
The following items are included in accordance with various
requirements of the Rules of the House of Representatives.
Statement of General Performance Goals and Objectives
Pursuant to clause 3(c)(4) of rule XIII of the Rules of the
House of Representatives, the following is a statement of
general performance goals and objectives for which this measure
authorizes funding:
The Committee on Appropriations considers program
performance, including a program's success in developing and
attaining outcome-related goals and objectives, in developing
funding recommendations.
Rescissions
Pursuant to clause 3(f)(2) of rule XIII of the Rules of the
House of Representatives, the following table lists the
rescissions in the accompanying bill:
Department/Activity
AMOUNTS RECOMMENDED FOR RESCISSION
Department of Defense, Military Construction, Defense- $45,055,000
Wide (Sec. 125)......................................
Department of Veterans Affairs, Departmental $70,000,000
Administration, Veterans Electronic Health Record
(Sec. 250)...........................................
Transfer of Funds
Pursuant to clause 3(f)(2) of rule XIII of the Rules of the
House of Representatives, the following statements are
submitted describing the transfer of funds provided in the
accompanying bill.
Language is included that allows transfer of funds from
``Military Construction, Defense-Wide'' to other military
construction accounts and family housing.
Language is included to allow for the transfer of funds
from Family Housing, Construction accounts to the Department of
Defense Family Housing Improvement Fund and funds from Military
Construction accounts to the Department of Defense Military
Unaccompanied Housing Improvement Fund.
Language is included to provide transfer authority from the
BRAC account to the Homeowners Assistance Program.
Language is included to allow the transfer of expired funds
to the ``Foreign Currency Fluctuations, Construction, Defense''
account.
Language is included to allow the transfer of funds among
projects and activities in accordance with reprogramming
guidelines.
Language is included to transfer not to exceed $18,147,000
in fiscal year 2021 from Compensation and Pensions to General
Operating Expenses, Veterans Benefits Administration and
Information Technology Systems. These funds are for the
administrative costs of implementing cost-savings proposals
required by the Omnibus Budget Reconciliation Act of 1990 and
the Veterans' Benefits Act of 1992. Language is also included
transferring funds to the medical care collections fund to
augment funding of medical facilities for nursing home care
provided to pensioners.
Language is included to permit the transfer of funds from
General Administration to General Operating Expenses, Veterans
Benefits Administration.
Language is included to permit the transfer of funds
between Information Technology Systems development projects and
among the three sub-accounts identified in bill language
subject to the approval of the Committee.
Language is included to provide authority for the
Department of Veterans Affairs for any funds appropriated in
2020 for Compensation and Pensions, Readjustment Benefits, and
Veterans Insurance and Indemnities to be transferred among
those three accounts.
Language is included to transfer funds among the Medical
Services, Medical Community Care, Medical Support and
Compliance, and Medical Facilities accounts.
Language is included to permit the funds from three life
insurance funds to be transferred to General Operating
Expenses, Veterans Benefits Administration and Information
Technology Systems for the costs of administering such
programs.
Language is included to permit funding up to $67,891,000 to
be transferred to General Administration and Information
Technology Systems from any funds appropriated in fiscal year
2020 to reimburse four headquarters offices for services
provided.
Language is included to transfer certain funds derived from
enhanced-use leasing activities to the Construction, Major
Projects and Construction, Minor Projects accounts.
Language is included to transfer funds from the Medical
Care Collections Fund to the Medical Services and Medical
Community Care accounts.
Language is included to allow the transfer of funds from
the Capital Asset Fund to the Construction, Major Projects and
Construction, Minor Projects accounts.
Language is included to allow the transfer of funds from
various accounts to the Information Technology Systems account
in an aggregate amount not to exceed ten percent of the account
appropriation, subject to approval by the Committee.
Language is included to allow the transfer of funds in
fiscal year 2020 provided for the Department of Veterans
Affairs to the Joint Department of Defense-Department of
Veterans Affairs Medical Facility Demonstration Fund.
Language is included allowing fiscal year 2021 medical care
funding to be transferred to the Joint Department of Defense-
Department of Veterans Affairs Medical Facility Demonstration
fund.
Language is included permitting funds deposited to the
Medical Care Collections Fund for healthcare provided at a
combined Federal medical facility to be transferred to the
Joint Department of Defense-Department of Veterans Affairs
Medical Facility Demonstration Fund.
Language is included under the Department of Veterans
Affairs that would transfer no less than $15,000,000 for the
DOD-VA Health Care Sharing Incentive Fund as authorized by
section 8111(d) of title 38, United States Code.
Language is included that permits the transfer from all
discretionary accounts except General Operating Expenses,
Veterans Benefits Administration, to Medical Services, subject
to approval by the Committee.
Language is included that permits transfer of funds between
General Operating Expenses, Veterans Benefits Administration
and the Board of Veterans Appeals, subject to approval by the
Committee.
Disclosure of Earmarks and Congressionally Directed Spending Items
Neither the bill nor the report contains any Congressional
earmarks, limited tax benefits, or limited tariff benefits as
defined in clause 9 of rule XXI.
Compliance With Rule XIII, Cl. 3(e) (Ramseyer Rule)
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
SECTION 220 OF THE MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED
AGENCIES APPROPRIATIONS ACT, 2019
[Sec. 220. Of the amounts appropriated to the Department of
Veterans Affairs which become available on October 1, 2019, for
``Medical Services'', ``Medical Community Care'', ``Medical
Support and Compliance'', and ``Medical Facilities'', up to
$307,609,000, plus reimbursements, may be transferred to the
Joint Department of Defense--Department of Veterans Affairs
Medical Facility Demonstration Fund, established by section
1704 of the National Defense Authorization Act for Fiscal Year
2010 (Public Law 111-84; 123 Stat. 3571) and may be used for
operation of the facilities designated as combined Federal
medical facilities as described by section 706 of the Duncan
Hunter National Defense Authorization Act for Fiscal Year 2009
(Public Law 110-417; 122 Stat. 4500): Provided, That additional
funds may be transferred from accounts designated in this
section to the Joint Department of Defense--Department of
Veterans Affairs Medical Facility Demonstration Fund upon
written notification by the Secretary of Veterans Affairs to
the Committees on Appropriations of both Houses of Congress.]
----------
TITLE 38, UNITED STATES CODE
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
SUBCHAPTER I--GENERAL
Sec.
1701. Definitions.
* * * * * * *
SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT
* * * * * * *
1720J. Provision of assisted reproductive technology or adoption
reimbursements for certain disabled veterans.
* * * * * * *
SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT
* * * * * * *
Sec. 1720J. Provision of assisted reproductive technology or adoption
reimbursements for certain disabled veterans
(a) Provision of Services.--Subject to the availability of
appropriations, the Secretary may provide--
(1) fertility counseling and treatment using assisted
reproductive technology to a covered veteran or the
spouse of a covered veteran; or
(2) adoption reimbursement to a covered veteran.
(b) Limitations.--Amounts made available for the purposes
specified in subsection (a) are subject to the requirements for
funds contained in section 508 of division H of the
Consolidated Appropriations Act, 2017 (Public Law 115-31).
(c) Definitions.--In this section:
(1) The term ``adoption reimbursement'' means
reimbursement for the adoption-related expenses for an
adoption that is finalized after the date of the
enactment of this section under the same terms as apply
under the adoption reimbursement program of the
Department of Defense, as authorized in Department of
Defense Instruction 1341.09, including the
reimbursement limits and requirements set forth in such
instruction, as in effect on the date of the enactment
of this section.
(2) The term ``assisted reproductive technology''
means benefits relating to reproductive assistance
provided to a member of the Armed Forces who incurs a
serious injury or illness on active duty pursuant to
section 1074(c)(4)(A) of title 10, as described in the
memorandum on the subject of ``Policy for Assisted
Reproductive Services for the Benefit of Seriously or
Severely Ill/Injured (Category II or III) Active Duty
Service Members'' issued by the Assistant Secretary of
Defense for Health Affairs on April 3, 2012, and the
guidance issued to implement such policy, as in effect
on the date of the enactment of this section, including
any limitations on the amount of such benefits
available to such a member, except that--
(A) the periods regarding embryo
cryopreservation and storage set forth in part
III(G) and in part IV(H) of such memorandum
shall not apply; and
(B) such term includes embryo
cryopreservation and storage without limitation
on the duration of such cryopreservation and
storage.
(3) The term ``covered veteran'' means a veteran who
has a service-connected disability that results in the
inability of the veteran to procreate without the use
of fertility treatment.
* * * * * * *
----------
SECTION 252 OF THE MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED
AGENCIES APPROPRIATIONS ACT, 2018
Sec. 252. [The Secretary may carry out a 2-year pilot
program] During the period preceding October 1, 2022, the
Secretary of Veterans Affairs may carry out a 2-year pilot
program making grants to nonprofit veterans services
organizations recognized by the Secretary in accordance with
section 5902 of title 38, United States Code, to upgrade,
through construction and repair, VSO community facilities into
health and wellness centers and to promote and expand
complementary and integrative wellness programs: Provided, That
no single grant may exceed a total of $500,000: Provided
further, That the Secretary may not provide more than 20 grants
during the 2-year pilot program: Provided further, That the
recipient of a grant under this section may not use the grant
to purchase real estate or to carry out repair of facilities
leased by the recipient or to construct facilities on property
leased by the recipient: Provided further, That the Secretary
ensures that the grant recipients use grant funds to construct
or repair facilities located in at least 10 different
geographic locations in economically depressed areas or areas
designated as highly rural that are not in close proximity to
Department of Veterans Affairs medical centers: Provided
further, That the Secretary shall report to the Committees on
Appropriations of both Houses of Congress no later than 180
days after enactment of this Act, on the grant program
established under this section.
Changes in Application of Existing Law
Pursuant to clause 3(f)(1)(A) of rule XIII of the Rules of
the House of Representatives, the following statements are
submitted describing the effect of provisions in the
accompanying bill that directly or indirectly change the
application of existing law.
Language is included in various parts of the bill to
continue on-going activities that require annual authorization
or additional legislation, which to date have not been enacted.
Language is included in various parts of the bill to place
limitations on the use of funds in the bill or change existing
limitations and which might, under some circumstances, be
construed as changing the application of existing law.
Language is included in various parts of the bill to allow
the Secretary of Defense to exceed certain limitations upon
notification to the Committee.
Language is included in various parts of the bill to allow
funding to be used for official reception and representation
expenses.
Language is included in various parts of the bill to enable
various appropriations to remain available for more than one
year for some programs for which the basic authority
legislation does not presently authorize such extended
availability.
Language is included in various parts of the bill to permit
the transfer of funds to other accounts.
Language is included under Title I to prohibit payments for
cost-plus-a-fixed-fee contracts under certain circumstances.
Language is included in various parts of the bill to allow
funds to be used for the hire of passenger motor vehicles.
Language is included under Title I to allow advances to the
Federal Highway Administration, Department of Transportation
under certain circumstances.
Language is included under Title I to prohibit the use of
funds to begin construction of new bases without specific
appropriations.
Language is included under Title I to prohibit the use of
funds for purchase of land or land easements under certain
circumstances.
Language is included under Title I to prohibit the use of
funds for land acquisition, site preparation, and utility
installation for family housing unless funds have been made
available in annual appropriations Acts.
Language is included under Title I to prohibit the use of
minor construction funds to transfer an activity between
installations without prior notification.
Language is included under Title I to prohibit the use of
funds for the procurement of steel for any activity if American
steel producers have been denied the opportunity to compete for
such steel procurements.
Language is included under Title I to prohibit the use of
funds to pay real property taxes in any foreign nation.
Language is included under Title I to prohibit the use of
funds to initiate a new installation overseas without prior
notification.
Language is included under Title I to limit the use of
funds for architect and engineer contracts under certain
circumstances.
Language is included under Title I to limit the use of
funds for awarding contracts to foreign contractors under
certain circumstances.
Language is included under Title I to require the
Department of Defense to notify the appropriate committees of
Congress of any proposed military exercises under certain
circumstances.
Language is included under Title I to allow prior year
construction funding to be available for currently authorized
projects.
Language is included under Title I to allow payment for the
cost associated with supervision, inspection, overhead,
engineering and design on family housing or military
construction projects that are being completed with expired or
lapsed funds.
Language is included under Title I to allow funds to be
expended on military construction projects for four fiscal
years after enactment under certain circumstances.
Language is included under Title I to allow construction
funds to be transferred to Housing Improvement Funds.
Language is included under Title I to allow for the
transfer of BRAC funds to the Homeowners Assistance Program.
Language is included under Title I to limit funds for the
operation and maintenance of family housing to those provided
in this appropriation and to limit amounts expended on repairs
of general and flag officer quarters under certain
circumstances.
Language is included under Title I to allow funds in the
Ford Island Improvement Account to be available until expended
for certain purposes.
Language is included under Title I to allow for the
transfer of expired funding to the Foreign Currency Fluctuation
Account under certain circumstances.
Language is included under Title I to allow for transfer of
funds among projects and activities in accordance with
reprogramming guidelines.
Language is included under Title I to prohibit funds to be
used for projects at Arlington Cemetery.
Language is included under Title I providing additional
funds for Military Construction, Army.
Language is included under Title I providing additional
funds for Military Construction, Navy and Marine Corps.
Language is included under Title I providing additional
funds for Military Construction, Air Force.
Language is included under Title I providing additional
funds for Military Construction, Army National Guard.
Language is included under Title I providing additional
funds for Military Construction, Air National Guard.
Language is included under Title I providing additional
funds for Military Construction, Air Force Reserve.
Language is included under Title I defining the
congressional defense committees.
Language is included under Title I to require funds
appropriated shall be immediately available and allotted to
contract for the full scope of authorized projects.
Language is included under Title II providing for the
reimbursement to the Department of Defense for the costs of
overseas employee mail.
Language is included under Title II to require that the
Secretary of Veterans Affairs establish a priority for
treatment of veterans who are service-connected disabled, lower
income, or have special needs.
Language is included under Title II to require that the
Secretary of Veterans Affairs give priority funding of basic
medical benefits to priority groups 1 through 6.
Language is included under Title II to allow the Secretary
of Veterans Affairs to dispense prescription drugs from VHA
facilities to enrolled veterans with privately written
prescriptions.
Language is included until Title II requiring the Secretary
to ensure sufficient funding is available for the acquisition
of prosthetics designed for women Veterans.
Language is included until Title II specifies funding for
gender-specific care for women.
Language is included under Title II to require approval of
a transfer between development projects in the Information
Technology Systems account.
Language is included prohibiting funding in the Veterans
Health Record account from being obligated in a manner
inconsistent with deployment schedules.
Language is included under Title II establishing time
limitations and reporting requirements concerning the
obligation of Major Construction funds, limiting the use of
funds, allowing the use of funds for program costs, and
allowing for the reimbursement to the ``General
Administration'' account for the salaries and expenses of the
Office of Construction and Facilities Management employees.
Language is included under Title II to allow Minor
Construction funds to be used to repair non-medical facilities
damaged by natural disaster or catastrophe.
Language is included under Title II permitting transfers
between mandatory and discretionary accounts, limiting and
providing for the use of certain funds, funding administrative
expenses associated with life insurance programs from excess
program revenues, allowing reimbursement from enhanced-use
leases and for certain services, requiring notification of
construction bid savings, limiting reprogramming amount of
major construction projects, restricting changes in the scope
of major construction projects, requiring disclosure of
insurance and income information, allowing a recovery audit
collection program, allowing veterans in the State of Alaska to
use Indian Health Service facilities under certain conditions,
allowing medical services funds for recreational and funeral
expenses, and requiring notification of organizational changes
that transfer 25 or more employees from one VA organizational
unit to another.
Language is included under Title II requiring the Secretary
to maintain certain requirements in operating the toll-free
suicide hotline.
Language is included under Title II prohibiting funds from
being used to close hospitals, domiciliaries, or clinics, or
conduct environmental assessment or diminish services in the
Veterans Integrated Service Network 23 as part of a realignment
of VA services until the Secretary provides a report that
includes a national realignment strategy, a cost benefit
analysis, and an inventory of buildings with historic
designation.
Language is included under Title II to allow covered
veterans and their spouses, under certain conditions, to
receive assisted reproductive technology services and adoption
reimbursement.
Language is included under Title II pertaining to
exceptions for Indian- or Native Hawaiian-owned businesses
contracting with the Department.
Language is included in Title II directing the elimination
of using Social Security account numbers to identify
individuals in all information systems of the Department.
Language is included in Title II pertaining to
certification of marriage and family therapists.
Language is included in Title II prohibiting funds from
being used to transfer funding from the Filipino Veterans
Equity Compensation Fund to any other VA account.
Language is included in Title II permitting funds to carry
out and expand the child care program.
Language is included in Title II prohibiting funds to enter
into an agreement to resolve a dispute or claim with an
individual that would restrict the individual from speaking to
Members of Congress or their staff.
Language is included in Title II requiring certain data to
be included in budget justifications for major construction
projects.
Language is included until Title II providing funding for
infrastructure improvements.
Language is included in Title II prohibiting the Inspector
General timely access to information.
Language is included in Title II prohibiting funding to be
used that would increase wait times for veterans who seek
medical care.
Language is included in Title II prohibiting the use of
funds in fiscal year 2020 to convert any program that received
specific purpose funding in fiscal year 2019 to a general
purpose-funded program.
Language is included under Title II prohibiting the use of
dogs as part of the conduct of any study.
Language is included under Title II prohibiting the closure
of a certain community-based outpatient clinic until the
Secretary completes a market area assessment.
Language is included under Title II requiring the Secretary
to update the ``Planning and Activating Community Based
Outpatient Clinics'' handbook.
Language is included under Title II extending the duration
of the VSO pilot program.
Language is included under Title III United States Court of
Appeals for Veterans Claims, Salaries and Expenses, to permit
the use of funds for a pro bono program.
Language is included under Title III Cemeterial Expenses,
Army, Salaries and Expenses, to permit the use of funds for
parking maintenance and repairs.
Language is included under Title III Armed Forces
Retirement Home to permit payment from the general fund of the
Treasury to the Trust Fund.
Language is included under Title III to allow for the use
of concession fees.
Language is included under Title IV providing Overseas
Contingency Operations funding with an emergency designation.
Language is included under Title IV providing funds with
emergency designation, for Overseas Contingency Operations and
European Defense Initiative for the Army.
Language is included under Title IV providing funds with
emergency designation, for Overseas Contingency Operations and
European Defense Initiative for the Navy and Marine Corps.
Language is included under Title IV providing funds with
emergency designation, for Overseas Contingency Operations and
European Defense Initiative for the Air Force.
Language is included under Title IV providing funds with
emergency designation, for Overseas Contingency Operations and
European Defense Initiative for the Defense Agencies.
Language is include under Title V providing Natural
Disaster Relief funding with an emergency designation.
Language is included under Title V providing funds with an
emergency designation, for hurricane damages sustained by the
Navy and Marine Corps.
Language is included under Title V providing funds with an
emergency designation, for hurricane damages sustained by the
Air Force.
Language is included under Title V providing funds with an
emergency designation, for hurricane damages sustained by the
Army National Guard.
Language is included under Title V providing funds with an
emergency designation, for hurricane damages sustained by the
Army Reserve.
Language is included under Title VI to limit the use of
funds for Federal entities when they are not in compliance with
Federal law relating to risk assessment, the protection of
private property rights, or unfunded mandates.
Language is included under Title VI to prohibit the use of
funds for a project or program named for a serving Member of
the United States Congress.
Language is included under Title VI prohibiting funds from
being used to maintain or establish a computer network unless
such network blocks the viewing, downloading, and exchanging of
pornography.
Language is included under Title VI prohibiting funds from
being used to pay for first class travel in violation of
federal regulations.
Language is included under Title VI prohibiting funds from
being used to execute a contract for goods or services where a
contractor has not complied with Executive Order 12989.
Language is included under Title VI prohibiting funds from
being used by the Department of Defense or the Department of
Veterans Affairs for the purchase or lease of a new vehicle
except in accordance with Presidential Memorandum Federal Fleet
Performance, dated May 24, 2011.
Appropriations Not Authorized by Law
Pursuant to clause 3(f)(1)(B) of rule XIII of the Rules of
the House of Representatives, the following table lists the
appropriations in the accompanying bill which are not
authorized by law for the period concerned:
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Program Duplication
Pursuant to clause 3(c)(5) of rule XIII of the Rules of the
House of Representatives, no provision of this bill establishes
or reauthorizes a program of the Federal Government known to be
duplicative of another Federal program, a program that was
included in any report from the Government Accountability
Office to Congress pursuant to section 21 of Public Law 111-
139, or a program related to a program identified in the most
recent Catalog of Federal Domestic Assistance.
Committee Hearings
In compliance with Sec. 103(i) of H. Res. 6 (116th
Congress) the following hearings were used to develop the
fiscal year 2020 Military Construction, Department of Veterans
Affairs, and Related Agencies Appropriations Bill:
------------------------------------------------------------------------
Date Title of Hearing Witnesses
------------------------------------------------------------------------
Feb. 7, 2019.................... Quality of Life in Sergeant Major
the Military Daniel A. Dailey,
Hearing. Sergeant Major of
the Army; Master
Chief Petty
Officer Russell
Smith, Master
Chief Petty
Officer of the
Navy; Sergeant
Major Ronald L.
Green, Sergeant
Major of the
Marine Corps; and
Chief Master
Sergeant Kaleth
O. Wright, Chief
Master Sergeant
of the Air Force
Feb. 13, 2019................... Veterans Long Term Dr. Teresa Boyd,
Care and Health ADUSH for
Challenges Clinical
Hearing. Operations; and
Dr. Scotte R.
Hartronft, Acting
Executive
Director, VA
Office of
Geriatrics &
Extended Care
Feb. 26, 2019................... VA General The Honorable
Oversight Hearing. Robert Wilkie,
Secretary of
Veterans Affairs;
and Richard A.
Stone, M.D.
Executive in
Charge, Veterans
Health
Administration
Feb. 27, 2019................... The President's The Honorable
2019 National Robert H.
Emergency McMahon,
Declaration Assistant
Circumventing Secretary of
Congress to Build Defense for
a Border Wall & Sustainment; Mr.
its Effect on Robert G.
Military Salesses, Deputy
Construction and Assistant
Readiness. Secretary of
Defense for
Homeland Defense
Integration and
DSCA; Mr. Alex A.
Beehler,
Assistant
Secretary of the
Army
Installations,
Energy and
Environment; The
Honorable Phyllis
L. Bayer,
Assistant
Secretary of the
Navy Energy,
Installations and
Environment; and
The Honorable
John W.
Henderson,
Assistant
Secretary of the
Air Force
Installations,
Environment and
Energy
Feb. 28, 2019................... Female Veterans Dr. Patricia
Access to VA Hayes, Chief
Hearing. Consultant,
Women's Health
Services; and Dr.
Susan McCutcheon,
National MH
Director, Family
Svc/Women's MH/
MST
Mar. 6, 2019.................... Electronic Health James M. Byrne,
Record General Counsel,
Modernization and Performing the
Information Duties of the
Technology Deputy Secretary;
Oversight Hearing. James P. Gfrerer,
Assistant
Secretary for
Information and
Technology and
Chief Information
Officer; and John
Windom, Executive
Director, OEHRM
Mar. 7, 2019.................... VA Whole Health, Dr. Tracy Gaudet,
Mental Health and Director, Office
Homelessness of Patient
Hearing. Centered Care
(10NE), VHA; Dr.
David Carroll,
Executive
Director, Mental
Health
Operations; and
Dr. Roger Casey,
Director,
Education-
Dissemination,
National Center
on Homelessness
Mar. 12, 2019................... Related Agencies Secretary William
Hearing. M. Matz Jr.,
American Battle
Monuments
Commission; Ms.
Karen Durham-
Aguilera,
Executive
Director,
Department of the
Army, Arlington
National
Cemetery; Stephen
T. Rippe, Chief
Executive
Officer, Armed
Forces Retirement
Home; and Chief
Judge Robert N.
Davis, United
States Court of
Appeals for
Veterans Claims
Mar. 13, 2019................... Veterans Affairs The Honorable
Office of Michael J.
Inspector General Missal, Inspector
Hearing. General
Mar. 26, 2019................... Military The Honorable
Installations and Robert H. McMahon
BRAC Budget Assistant
Hearing. Secretary of
Defense for
Sustainment;
Lieutenant
General Gwen
Bingham,
Assistant Chief
for Installations
Management; Vice
Admiral Dixon R.
Smith, Deputy
Chief of Naval
Operations, Fleet
Readiness and
Logistics; Major
General Vincent
A. Coglianese,
Marine Corps
Installations
Command/Assistant
Deputy
Commandant,
Installations &
Logistics
(Facilities); and
Brigadier General
John J. Allen,
Air Force
Director of Civil
Engineers, Deputy
Chief of Staff
for Logistics,
Engineering &
Force Protection
Mar. 27, 2019................... Veterans Affairs The Honorable
FY 2020 Budget Robert Wilkie
Hearing. Secretary of
Veterans Affairs;
Dr. Paul R.
Lawrence, Under
Secretary for
Benefits; Richard
A. Stone, M.D.
Executive in
Charge, Veterans
Health
Administration;
and Jon
Rychalski,
Assistant
Secretary for
Management and
Chief Financial
Officer
Apr. 2, 2019.................... Members Day The Honorable
Hearing. Anthony Brindisi;
The Honorable
Salud O.
Carbajal; The
Honorable Gilbert
Ray Cisneros; The
Honorable Neal P.
Dunn, The
Honorable Daniel
T. Kildee; The
Honorable
Gregorio Kilili
Camacho Sablan;
and The Honorable
Glenn Thompson
Apr. 2, 2019.................... Public Witness Ms. Heather L.
Hearing. Ansley, Associate
Executive
Director of
Government
Affairs,
Paralyzed
Veterans of
America,
Washington, D.C.;
Ms. Joy J. Ilem,
National
Legislative
Director,
Disabled Veterans
of America,
Washington, D.C.;
and Mr. Patrick
D. Murray,
National
Legislative
Service, Veterans
of Foreign Wars,
Washington, D.C.
------------------------------------------------------------------------
Full Committee Votes
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
BUDGETARY IMPACT OF THE FY 2020 MILITARY CONSTRUCTION, VETERANS
AFFAIRS, AND RELATED AGENCIES APPROPRIATIONS BILL PREPARED IN
CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SEC.
308(A), PUBLIC LAW 93-344, AS AMENDED
[IN MILLIONS OF DOLLARS]
COMPARISION WITH BUDGET RESOLUTION
Pursuant to clause 3(c)(2) of rule XIII of the Rules of the
House of Representatives and Section 308(a)(1)(A) of the
Congressional Budget Act requires the report accompanying a
bill providing new budget authority to contain a statement
comparing the levels in the bill to the suballocations
submitted under section 302(b) of the Act for the most recently
agreed to concurrent resolution on the budget for the
applicable fiscal year.
[In millions of dollars]
----------------------------------------------------------------------------------------------------------------
302(b) Allocation This Bill
---------------------------------------------------
Budget Budget
Authority Outlays Authority Outlays
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with Committee allocations
to its subcommittees: Subcommittee on Military
Construction, Veterans Affairs, and Related Agencies
General Purpose Discretionary........................... 105,217 99,500 106,138\1\ 99,219
Mandatory............................................... 114,950 114,775 114,950\1\ 114,775
----------------------------------------------------------------------------------------------------------------
\1\Includes outlays from prior-year budget authority.
NOTE--Consistent with the funding recommended in the bill for overseas contingency operations/global war on
terrorism, in accordance with section 251(b)(2) of the Balanced Budget and Emergency Deficit Control Act of
1985, and after the bill is reported to the House, the Chairman of the Committee on the Budget will provide a
revised section 302(a) allocation reflecting an additional $921,000,000 in discretionary budget authority and
$7,000,000 in associated outlays. That new allocation will eliminate the technical difference prior to Floor
consideration.
In addition, the amounts in this report do not include $2,300,000,000 in discretionary budget authority and
$23,000,000 in associated outlays from funding designated as being for emergency requirements pursuant to
section 251 of the Balanced Budget and Emergency Deficit Control Act of 1985. Consistent with the
Congressional Budget Act of 1974, in the House of Representatives such funding does not count against the
Committee's allocation.
FIVE-YEAR PROJECTION OF OUTLAYS
Pursuant to clause 3(c)(2) of rule XIII of the Rules of the
House of Representatives and in compliance with section
308(a)(1)(B) of the Congressional Budget and Impoundment
Control Act of 1974 (Public Law 93-344), as amended, the
following table contains five-year projections
[In millions of dollars]
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
Projection of outlays associated with the recommendation:
2020.................................................... ........... ........... \1\ 128,782
2021.................................................... ........... ........... ........... 7,442
2022.................................................... ........... ........... ........... 5,680
2023.................................................... ........... ........... ........... 3,322
2024 and future years................................... ........... ........... ........... 3,298
----------------------------------------------------------------------------------------------------------------
\1\Excludes outlays from prior-year budget authority.
FINANCIAL ASSISTANCE TO STATE AND LOCAL GOVERNMENTS
Pursuant to clause 3(c)(2) of rule XIII of the Rules of the
House of Representatives and in accordance with section
308(a)(1)(C) of the Congressional Budget Act of 1974, as
amended, the Congressional Budget Office has provided the
following estimates of new budget authority and
[In millions of dollars]
------------------------------------------------------------------------
Budget
Authority Outlays
------------------------------------------------------------------------
Financial assistance to State and local 260\1\ 47
governments for 2020.........................
------------------------------------------------------------------------
\1\Excludes outlays from prior-year budget authority.
Comparative Statement of New Budget Authority and State List
The following is a complete listing, by title, State and
country, of the Committee's recommendations for military
construction and family housing projects, including Overseas
Contingency Operations projects:
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
MINORITY VIEWS
As reported by the Committee, the Military Construction,
Veterans Affairs, and Related Agencies Appropriations bill for
fiscal year 2020 provides a total of $231,349,814,000 in budget
authority. Of this amount, $123,211,394,000 is for mandatory
programs and $108,438,000,000 is for discretionary programs.
The discretionary funding total includes $2,300,000,000 in
emergency funds. The bill also includes $87,636,650,000 in
advance appropriations for the Department of Veterans Affairs'
health care accounts and $129,509,505,000 in advance
appropriations for mandatory veterans' benefits programs for
fiscal year 2021. Unfortunately, due to concerns about spending
levels and numerous policy provisions contained in the bill, we
are unable to support the bill as written at this time.
We are troubled that the Majority party's budget framework
does not reflect a bipartisan, bicameral agreement. That
framework puts the Federal government on track to add nearly
$2,000,000,000,000 in deficits over 10 years, while the
national debt is already more than $22,000,000,000,000. In
addition, the Majority supports more than twice as much
additional funding in fiscal year 2020 for non-defense programs
as for defense programs.
We need to come together with the Senate and the
Administration to reach an agreement on the topline funding
level before we allocate funding among the various
appropriations bills. We should see how the Military
Construction and Veterans Affairs bill fits into the larger
picture before moving forward.
In addition to overall funding concerns, Republican Members
of the Committee were disappointed by several policy provisions
and funding decisions made within the bill. These positions
could prevent this bill from being signed into law, and House
Republicans will continue to work to address these issues as
the appropriations process continues.
Of particular concern is Section 612, which limits the
President's use of military construction funds. It is an
unnecessary restriction on the President's ability and
responsibility to respond to national emergencies. We believe
we must provide the President with the tools to address the
humanitarian and security crisis on our Southern border.
The facts are undeniable, and the strain on the system is
unsustainable. Record-breaking numbers of people, primarily
from Central American countries but also from other countries
around the world, are coming through Mexico to the Southern
border. Unauthorized border crossings are now at a 12-year
high, and the system is overwhelmed by unaccompanied children
and family units. More than 109,000 people came to the border
in April alone, compared to approximately 400,000 in all of
2018.
Recognizing the bipartisan concern about using previously
appropriated military construction funds for border security
projects and well aware of the indisputable need to reinvest in
our military's readiness and infrastructure, Republican Members
of the Committee supported Subcommittee Ranking Member Rep.
John Carter's amendment to provide $7,200,000,000 in emergency
funding for border security projects. The amendment provided
the same amount the President requested in the fiscal year 2020
budget request and would have transferred funds to the
Department of Homeland Security to implement the Border
Security Improvement Plan.
While the amendment was defeated, we continue to believe
the Committee will need to address the President's request and
provide funding for border security and humanitarian needs
before the fiscal year 2020 appropriations cycle concludes.
The bill also does not continue the current prohibition on
the transfer of detainees at Guantanamo Bay, Cuba, to the
United States, nor does it provide funding for a new detention
facility at Guantanamo Bay. We believe the prohibition on
transferring detainees to the United States and the new funding
are needed. We must not bring the world's most dangerous
terrorists to American soil, and the Service men and women
guarding the detainees at Guantanamo Bay must have the safest
possible work environment.
Despite our disagreements over the issues discussed above,
we appreciate the Majority's willingness to address Member
priorities in the bill and report and to include Minority
Committee Members in the development of the bill. The
Subcommittee has a long-standing tradition of bipartisanship,
and we will continue to work in good faith with our colleagues
as we proceed through the appropriations process. By working
together, we can best address the needs of our Nation's
military and its Veterans and reach an agreement on funding for
the Military Construction, Veterans Affairs, and Related
Agencies for the next fiscal year.
Kay Granger.
John R. Carter.
[all]