```

[House Report 115-673]
[From the U.S. Government Publishing Office]

115th Congress     }                                {          Report
                        HOUSE OF REPRESENTATIVES
 2d Session        }                                {          115-673

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

 
     MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES 
                       APPROPRIATIONS BILL, 2019

                                _______
                                

  May 11, 2018.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

            Mr. Dent, from the Committee on Appropriations, 
                        submitted the following

                              R E P O R T

                             together with

                             MINORITY VIEWS

                        [To accompany H.R. 5786]

    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, 2019, 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........................................     6
    NATO Security Investment Program.............................    16
    Family Housing Construction and Operation and Maintenance....    17
    Department of Defense Family Housing Improvement Fund........    18
    Department of Defense Military Unaccompanied Housing 
      Improvement Fund...........................................    19
     Department of Defense Base Closure Account..................    19
    Administrative Provisions....................................    19
Department of Veterans Affairs:
    Veterans Benefits Administration.............................    22
    Veterans Health Administration...............................    28
    National Cemetery Administration.............................    54
    Departmental Administration..................................    54
    Administrative Provisions....................................    67
Related Agencies:
    American Battle Monuments Commission.........................    71
    U.S. Court of Appeals for Veterans Claims....................    71
    Cemeterial Expenses, Army....................................    71
    Armed Forces Retirement Home.................................    72
    Administrative Provisions....................................    72
Department of Defense:
    Overseas Contingency Operations..............................    73
    Administrative Provisions....................................    73
General Provisions...............................................    73
House of Representatives Report Requirements.....................    74
    Statement of General Performance Goals and Objectives........    74
    Rescissions..................................................    75
    Transfer of Funds............................................    75
    Disclosure of Earmarks and Congressionally Directed Spending 
      Items......................................................    76
    Changes in Application of Existing Law.......................    77
    Appropriations Not Authorized by Law.........................    80
    Program Duplication..........................................    82
    Directed Rule Making.........................................    82
    Full Committee Votes.........................................    83
    Ramseyer Rule................................................    85
    Comparison With the Budget Resolution........................    85
    Five-Year Projection of Outlays..............................    85
    Assistance to State and Local Governments....................    85
    Comparative Statement of New Budget Authority................    86
    State Project List...........................................    99
    Overseas Contingency Operations Project List.................   111
    Minority Views...............................................   113

                          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 bill also funds a wide variety of assistance programs for 
veterans--disability and pension benefits, health care 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 $206,040,134,000 in budget 
authority for the fiscal year 2019 programs and activities 
funded in the bill. The fiscal year 2019 recommendation is an 
increase of $9,350,699,000 above the fiscal year 2018 enacted 
level and $130,617,000 below the President's request. Of the 
increase over the fiscal year 2018 enacted level, 
$5,171,624,000 is in mandatory programs. Included in the total 
budget authority is $109,120,059,000 in mandatory budget 
authority and $96,920,075,000 in discretionary budget 
authority.
    The Committee recommendation highlights the continued 
commitment to our servicemembers and their families and to our 
veterans. In discretionary budget authority, the bill is 4.5 
percent over the fiscal year 2018 enacted level. The bill 
includes an increase in military construction, which is 3.8 
percent above the fiscal year 2018 level, and an increase in 
the Department of Veterans Affairs budget, which is 4.8 percent 
over the fiscal year 2018 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 accounts.
    The programs funded in the bill for the Department of 
Defense address the priorities of the Department's Agencies and 
the Services for numerous facility challenges that they face. 
The funds provided support readiness improvements with new 
construction, family housing, 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 $11,253,420,000, which is 
$412,420,000 above the fiscal year 2018 enacted level and 
$130,617,000 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. The recommendation also includes $837,000,000 for 
the Services' unfunded priorities. In addition, the 
recommendation also includes $921,420,000 for European 
Deterrence Initiative to help ensure the protection of our 
allies.
    The total funding level for fiscal year 2019 for the 
Department of Veterans Affairs is $194,469,059,000, an increase 
of $9,045,324,000 over the fiscal year 2018 enacted level. Of 
the total, $109,120,059,000 is provided for mandatory benefit 
programs and $85,349,000,000 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 4.8 percent 
over the fiscal year 2018 enacted level. For fiscal year 2019, 
$70,699,313,000 for medical care has been appropriated in 
advance. The recommendation includes $2,922,000,000, an 
increase of $53,091,000 over the President's budget request for 
the administrative costs of Veterans Benefits Administration, 
including funding for scanning claims and staff overtime. The 
bill also provides $174,748,000 for the Board of Veterans 
Appeals, a $13,700,000 increase over fiscal year 2018, to 
target the growing caseload of appeals of initial benefits 
decisions. In addition, the Committee recommendation includes 
$75,550,600,000 in advance appropriations for fiscal year 2020 
for the four health care accounts of the Department and 
$121,296,429,000 in advance appropriations for mandatory 
benefits programs for fiscal year 2020.

                  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 and the Inspectors General to promote 
strong financial and program management, oversight and 
leadership at the Department of Defense, the Department of 
Veterans Affairs, and other agencies under the jurisdiction of 
this bill.
    The fiscal year 2019 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.
    Department of Defense (DOD).--In addition to the 
notification and reporting requirements for military 
construction programs contained in Title 10, United States 
Code, the Committee's recommendations include several 
provisions requiring the Department of Defense to report on 
various aspects of military construction programs, 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.
    Department of Veterans Affairs (VA).--With the 
$194,469,059,000 provided for VA in this bill and the increase 
in the number of veterans seeking VA medical services, 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.--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 
$1,207,000,000 for the EHR contract in 2019, but also includes 
requirements for strict quarterly reporting of timelines, 
performance milestones, costs, implementation, and change 
management. The bill also requires the Government 
Accountability Office to conduct an ongoing review 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 seven 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 $53,091,000 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 10 percent of the total of either the source 
or destination account. The bill contains language which 
permits the reprogramming of funds among development projects 
upon prior notification to, and approval by, the Committees.
    Financial management system.--The Committee provides 
$83,621,000 for the replacement of VA's antiquated financial 
management system. However, the Committee has concerns that VA 
may have problems managing the conversion without the planned 
management by the Department of Agriculture, which developed 
the system but has subsequently withdrawn its participation. 
Consequently, the Committee requires quarterly reporting by VA 
comparing actual performance in implementing the system to the 
metrics and timelines established in the initial operating plan 
required by the fiscal year 2018 appropriations bill. The 
Committee also requires its investigative staff to monitor 
periodically the system's development and report to the 
Committee.
    Stricter control of construction funding.--In response to 
the egregious management of the Denver hospital construction 
project, permanent law blocks funding for major construction 
projects over $100,000,000 in cost until VA certifies that it 
has contracted with a non-VA governmental entity to design and 
manage the project. The Committee receives 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.
    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 
non-profit 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.

                                TITLE I

                         DEPARTMENT OF DEFENSE

                     Military Construction Overview

 
 
 
Fiscal year 2018 enacted level (including rescissions)   $10,091,000,000
Fiscal year 2019 budget request.......................    10,462,617,000
Committee recommendation in the bill (including           10,332,000,000
 rescissions).........................................
Comparison with:
    Fiscal year 2018 enacted level....................       241,000,000
    Fiscal year 2018 budget request...................     (130,617,000)
 

    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, maintenance, 
research and development, supply, medical care, and force 
protection, as well as unaccompanied housing, utilities 
infrastructure, and land acquisition.
    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) which has been specifically reduced by 
the 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 the Congress is permitted, 
except that the Department of Defense may seek reprogramming 
for appropriated increments.
    The reprogramming criteria that apply to military 
construction projects (25 percent of the funded amount or 
$2,000,000, whichever is less) continue to apply to new housing 
construction projects and to improvements over $2,000,000. 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. 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 Department of 
Defense Financial Management Regulation 7000.14-R and relevant 
updates and policy memoranda. The Committee further encourages 
the Office of the Director of National Intelligence to use a 
format similar to that used by the Office of the Secretary of 
Defense to submit reprogramming requests.
    Facilities Sustainment, Restoration and Modernization 
(FSRM).--The Department of Defense 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 
$100,000,000 with the 1391 justification to the congressional 
defense committees.
    Transfer of funds to and from the Foreign Currency 
Fluctuations, Construction, Defense Account.--The Committee 
directs the Department of Defense to submit a quarterly report 
to the Committees on Appropriations of both Houses of Congress 
on the transfer of funds from military construction and family 
housing accounts to the Foreign Currency Fluctuations, 
Construction, Defense account. The report shall specify the 
amount transferred to the Foreign Currency account from each 
military construction and/or family housing account, and all 
other accounts for which an appropriation is provided in this 
Act, during the preceding fiscal quarter, and the amounts 
transferred from the Foreign Currency account to the above 
accounts during the same period. This report shall be submitted 
no later than 30 days after the close of each fiscal quarter. 
In addition, the Department of Defense shall notify the 
Committees on Appropriations of both Houses of Congress within 
7 days of transferring any amount in excess of $10,000,000 to 
or from the Foreign Currency account.
    Bid savings.--The Committee has ascertained from cost 
variation notices required by 10 U.S.C. 2853 that the 
Department of Defense continues to have bid savings, although 
declining, on previously appropriated military construction 
projects. The Committee's recommendation therefore includes 
rescissions to the Air Force, NATO Security Investment Program 
and HAP accounts. 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 Subcommittee 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 12 projects that have been 
incrementally funded; however the full authorization of the 
projects will be provided in the fiscal year 2019 National 
Defense Authorization Act.
    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 the Department of Defense 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/or alternatives should they be agreed upon. To 
understand the scale of this problem, the Committee directs the 
Secretary of Defense to provide the Committee with a list of 
military construction projects where mitigation and/or changes 
to projects within the past five years where consultation with 
a Federally Recognized Tribe was required, 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.
    Impacts of weather and security for Military 
Installations.--The Department of Defense must pay close 
attention to potential adverse impacts of the weather as a 
driver of instability. From sea level rise to increased drought 
and flooding across the country and the world, proper defense 
planning must include considerations related to weather 
impacts. The Committee urges the Secretary of Defense to plan 
infrastructure and other projects using the best available data 
and to mitigate risks to our armed forces serving domestically 
and abroad.
    Joint Military Bases.--The Committee is concerned that 
Joint Bases lack a full complement of training facilities such 
as aquatic facilities for complete education. This often 
results in burdening local communities to attempt to 
accommodate training at insufficient facilities. The Department 
is encouraged to prioritize construction of training facilities 
that will diminish impacts on surrounding communities and 
increase readiness.
    Defense Access Roads.--The Committee is concerned about the 
lack of future planning for Defense Access Roads (DAR) and 
transportation infrastructure needs as continued flooding of 
vital access roads occurs more frequently. The Committee 
directs the Secretary of Defense to work with the Secretary of 
Transportation to prioritize DAR roads and projects 
specifically examining bases in communities that have 
experienced flooding by both non-storm surge flooding and 
flooding due to storm surge and report to the Committee no 
later than 30 days after enactment of this Act on its findings. 
Further, the Committee is concerned about the increasingly 
harmful impact of flooding on facilities at DOD's coastal 
military installations and on the roads and infrastructure to 
access these installations. In January 2018, the Office of the 
Assistant Secretary of Defense for Energy, Installations and 
Environment, initiated a preliminary Screening Level 
Vulnerability Assessment Survey of DOD installations worldwide. 
With this report and other similar reports by GAO, the 
Committee directs the Secretary of Defense to incorporate 
efforts from the reports to mitigate the effects of flooding on 
roads and infrastructure on domestic installations that are 
vital to military operations.
    Enhancing force protection and security on military 
installations.--The Committee, in collaboration with the House 
Armed Services Committee, includes section 130 that provides 
$50,000,000 to each of the military construction accounts for 
Army, Navy and Marine Corps and the Air Force to alleviate 
deficiencies in access control points, air traffic control 
towers, fire stations, and AT/FP deficiencies across the 
enterprise. There has been much concern on both sides of the 
aisle that these types of military construction projects 
continually fall short of securing funding in a fiscal year due 
to higher priorities within the Services. Each Service 
Secretary is directed to provide a spend plan for these 
additional funds no later than 30 days after enactment of this 
Act to the congressional defense committees.

                      Military Construction, Army

 
 
 
Fiscal year 2018 enacted level........................      $923,994,000
Fiscal year 2019 budget request.......................     1,011,768,000
Committee recommendation in the bill..................     1,001,768,000
Comparison with:
    Fiscal year 2018 enacted level....................        77,774,000
    Fiscal year 2019 budget request...................      (10,000,000)
 

    The recommendation includes additional funding for the Army 
in section 125 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.
    Aircraft maintenance hangars.--The Committee is concerned 
that many of our aircraft maintenance hangar facilities are 
unsafe, antiquated, and do not provide adequate space for 
storage and maintenance of our aircraft. For example, the 
current Combat Aviation Brigade, at Hunter Army Airfield, 
utilizes hangars that are outdated and require millions of 
dollars in funding for maintenance yearly. Therefore, the 
Secretary of the Army is directed to conduct a cost analysis on 
a review of Aircraft Hangars throughout the Army enterprise and 
a plan to update these facilities. This analysis shall be 
submitted to the congressional defense committees no later than 
60 days after enactment of this Act.
    Rapid deployment requirements.--The Committee is concerned 
that the Army is not adequately prioritizing logistics 
infrastructure on bases with rapid deployment requirements. 
Therefore, the Secretary of the Army is directed to report to 
the congressional defense committees no later than 60 days 
after enactment of this Act on the backlog of infrastructure 
and the plan to eliminate the backlog by fiscal year.
    Army Futures Command.--The Committee is aware that the Army 
is in the process of standing up a new Army Futures Command 
which is the most significant Army reorganization effort since 
1973. This will be the fourth Army Command, and its mission is 
to drive the Army into the future to achieve clear overmatch in 
future conflicts. The Army has identified 15 locations where 
Army Futures Command could be located. The Committee is 
concerned that the Army is failing to consider existing 
locations that could be suitable for this new Command. The 
Committee directs the Secretary of the Army to provide a report 
on how the 15 locations were selected and identify current Army 
locations where Futures Command could be established no later 
than 30 days after enactment of this Act.
    Access Control Points.--Since September 11, 2001, the 
Department has made significant safety improvements at base 
entry points across many installations, but more needs to be 
done. The Committee is concerned that many of the Army's access 
control points do not provide adequate controls for traffic 
flow on and off the installation. For example, the current 
access control points at Picatinny Arsenal need modernization 
to maintain its security and to enhance commercial and 
personnel traffic movement. The Committee is aware that the 
Office of the Secretary of Defense is conducting a risk 
assessment of certain access control points and developing a 
plan to update these facilities, including a cost estimate for 
each facility. The Committee looks forward to reviewing the 
report and the plan in coming weeks.

              Military Construction, Navy and Marine Corps

 
 
 
Fiscal year 2018 enacted level........................    $1,553,275,000
Fiscal year 2019 budget request.......................     2,543,189,000
Committee recommendation in the bill..................     2,100,298,000
Comparison with:
    Fiscal year 2018 enacted level....................       547,023,000
    Fiscal year 2019 budget request...................     (442,891,000)
 

    The recommendation includes additional funding for the Navy 
and Marine Corps in section 125 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.
    Public Law 115-141 provided funding for the TBS Fire 
Station at Quantico, Virginia therefore, the recommendation 
does not include funding for the project in fiscal year 2019 
recommendation.
    F-35 beddown.--The Committee is concerned that there is 
little coordination among the Navy and Marine Corps for the 
construction of aircraft and support facilities associated with 
the beddown of F-35s. 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 Navy and Marine Corps to provide a detailed timeline by 
fiscal year and cost of F-35 facilities to the congressional 
defense committees no later than 60 days after enactment of 
this Act.
    Shipyard Infrastructure.--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 Fiscal Year 2018 
National Defense Authorization Act included language directing 
the Department of Defense to create a Shipyard Infrastructure 
Optimization Plan. This plan, included recommendations and 
future year projects that would help to restore our public 
shipyards in order to help support our fleet around the world. 
The Committee directs that the Secretary of Defense expedite or 
accelerate the funding of projects listed in the Future Years 
Defense Plan and Shipyard Infrastructure Optimization Plan 
necessary for national security requirements.

                    Military Construction, Air Force

 
 
 
Fiscal year 2018 enacted level........................    $1,543,558,000
Fiscal year 2019 budget request.......................     1,725,707,000
Committee recommendation in the bill..................     1,454,723,000
Comparison with:
    Fiscal year 2018 enacted level....................      (88,835,000)
    Fiscal year 2019 budget request...................     (270,984,000)
 

    The recommendation includes additional funding for the Air 
Force in section 125 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.
    The recommendation includes a rescission of $31,158,000 
from unobligated balances in section 126 under Administrative 
Provisions.
    Public Law 115-141 provided additional funding for 
increment I of the Presidential Aircraft Recap Complex. 
Therefore, the recommendation does not fully fund the 
Presidential Aircraft Recap Complex, Increment II as requested.
    Air traffic control towers.--The Committee is concerned 
that the Department of the Air Force's Air Traffic Control 
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 U.S. national 
security interests.
    MIT/Lincoln Labs.--As previously stated, at times, the 
Committee incrementally funds projects. The Committee has 
incrementally funded the Air Force MIT/Lincoln Lab project 
commensurate with the outlay rate of funds reflected in budget 
documents. While the Committee does not provide full funding 
for this project, it strongly supports its completion and fully 
expects the Air Force to continue to prioritize funding for 
this project in executable increments.

                  Military Construction, Defense-Wide

                     (INCLUDING TRANSFER OF FUNDS)

 
 
 
Fiscal year 2018 enacted level........................    $2,811,513,000
Fiscal year 2019 budget request.......................     2,693,324,000
Committee recommendation in the bill..................     2,465,738,000
Comparison with:
    Fiscal year 2018 enacted level....................     (345,775,000)
    Fiscal year 2019 budget request...................     (227,586,000)
 

    Transfer of funds.--The accompanying bill provides transfer 
authority to the Secretary of Defense to allow the transfer of 
funds to such appropriations of the Department of Defense 
available for military construction or family housing as the 
Secretary may designate.
    The recommendation includes a reduction of $10,000,000 from 
contingency construction account.
    The recommendation does not include $10,000,000 for the 
Ambulatory Care Center Addition/Alteration at RAF Croughton due 
to the construction pause on other projects at the installation 
by the Secretary of Defense and the EUCOM Commander.
    Inadequate roads infrastructure.--The Committee is 
concerned that inadequate local, state, and federal roads and 
insufficient parking accommodations and structures are unable 
to accommodate the volume of cars and are causing delays for 
civilians and service members working at critical national 
security mission locations, such as the National Security 
Agency and United States Cyber Command. The Department of 
Defense is therefore directed to submit to the Committee a 
report detailing the locations in which traffic congestion and 
insufficient parking facilities potentially impact the 
performance of national security missions, and their detailed 
plans to mitigate these detrimental impacts no later than 60 
days after enactment of this Act.
    Information Technology Infrastructure for Military 
Construction Projects.--The Committee recognizes that 
information technology is an essential component in 
constructing modern facilities for military missions as well as 
planning for future requirements. Technology advancements can 
lead to increased productivity as well as efficiencies on 
energy and space, which impact military construction and 
modernization projects. It is essential that military planning 
keep up with advancements in technology in order to take 
advantage of these efficiencies and benefits. The mission-sets 
behind numerous military construction projects include 
requirements for access to multiple classified networks. The 
Committee is aware of technology that can streamline 
historically compartmented classified networks through cross 
domain solutions. Not only does this drastically impact future 
productivity for the workforce but it could also yield 
substantial savings and efficiencies on space, energy, and HVAC 
requirements. In an effort to ensure these technology 
advancements are incorporated at the early stages of planning 
for military construction, the Secretary of Defense shall 
report to the Committee no later than 60 days after enactment 
of this Act on how each department is staying apprised of 
technology advancements, working with industry partners on ways 
to gain efficiencies and savings on military construction 
projects, and how they plan to utilize cross domain solutions 
early in the planning stages for construction projects.
    National Maritime Intelligence Center.--The National 
Maritime Intelligence Center (NMIC) is located on the Suitland 
Federal Center in Suitland, Maryland. The NMIC is an 
Intelligence Facility designed and built with NFIP funds 
completed in 1993. The Office of Naval Intelligence (ONI) is 
the host command of the NMIC. The NMIC facility is required to 
provide safe and adequate parking for all tenet commands, which 
include 3,700 employees. Since 2008, parking at the NMIC has 
been inadequate due to significant facility expansion for 700 
new FTEs and the discovery of structural and safety 
deficiencies of the NMIC garage. NAVFAC engineers have assessed 
that useful life of the garage will expire in 2021-2023. 
Therefore, the Secretary of Defense is directed to provide a 
way forward to correct these deficiencies no later than 60 days 
after enactment of this Act.
    Rhine Ordnance Barracks Medical Center Replacement.--In 
Public Law 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 U.S. sources of energy the 
new German energy laws incorporate; (3) what U.S. 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 directs the Director of the Defense Health Agency to 
provide to the congressional defense committees no later than 
60 days after enactment of this Act: (1) an updated 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.
    Installation resourcing.--The Committee is concerned that 
some DOD installations' access control points and roads do not 
provide adequate means on and off the installation. For 
example, the current access control points and roads at Fort 
Meade, Maryland need significant improvements to mitigate 
traffic congestion and accommodate the installation's growing 
population. Unfortunately, current installation management 
criteria only recognize Fort Meade as an Army installation, and 
limit its resourcing to an inappropriate, Army-only level. This 
Army-only funding level has continued despite an expanding 
joint-DOD and Federal tenant population that includes the 
National Security Agency, U.S. Cyber Command, DOD Consolidated 
Adjudications Facility, Defense Information Systems Agency, 
National Background Investigations Bureau, Environmental 
Research Laboratories, Architect of the Capitol, and the 
Defense Security Service. In fact, only 22 percent of the Fort 
Meade-installation's supported population is constituted by 
Army-affiliated personnel. With a growing population currently 
in excess of 55,000 personnel, Fort Meade, Maryland is now the 
Army's second largest installation. However, despite this large 
population, Fort Meade is only resourced at a level consistent 
with an installation supporting 12,000 Army personnel. 
Therefore, the Secretary of Defense is directed to submit a 
plan to the congressional defense committees no later than 180 
days after enactment of this Act on the plan to resource 
installations hampered by inappropriate, service-only funding, 
at an installation support-level consistent with the missions 
performed.
    DOD Installation Energy Policy.--DOD must 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, including projects through the Energy 
Resilience and Conservation Investment Program [ERCIP]. The 
Committee encourages the Department to prioritize funding for 
energy-related projects, including renewable energy projects, 
to mitigate risk to mission-critical assets and promote energy 
security and efficiency at military installations.

                   Guard and Reserve Item of Interest

    Fiscal Year 2018 National Guard Reporting Requirement.--
Since fiscal year 2012 the Committee has noted the need to 
bolster National Guard resources and explore public-private 
partnerships with state and local governments. Due to the late 
passage of the fiscal year 2018 bill, the reporting requirement 
regarding this issue remains outstanding. Therefore, the 
Committee reiterates its interest in this report and looks 
forward to its submission.

               Military Construction, Army National Guard

 
 
 
Fiscal year 2018 enacted level........................      $220,652,000
Fiscal year 2019 budget request.......................       180,122,000
Committee recommendation in the bill..................       180,122,000
Comparison with:
    Fiscal year 2018 enacted level....................      (40,530,000)
    Fiscal year 2019 budget request...................             - - -
 

    The recommendation includes additional funding for the Army 
National Guard in section 125 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 the 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 future years 
defense program to include the $1,200,000,000 for the Army 
National Guard transformation Plan.

               Military Construction, Air National Guard

 
 
 
Fiscal year 2018 enacted level........................      $171,491,000
Fiscal year 2019 budget request.......................       129,126,000
Committee recommendation in the bill..................       129,126,000
Comparison with:
    Fiscal year 2018 enacted level....................      (42,365,000)
    Fiscal year 2019 budget request...................             - - -
 

    The recommendation includes additional funding for the Air 
National Guard in section 125 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.

                  Military Construction, Army Reserve

 
 
 
Fiscal year 2018 enacted level........................       $83,712,000
Fiscal year 2019 budget request.......................        64,919,000
Committee recommendation in the bill..................        64,919,000
Comparison with:
    Fiscal year 2018 enacted level....................      (18,793,000)
    Fiscal year 2019 budget request...................             - - -
 

    The recommendation includes additional funding for the Army 
Reserve in section 125 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.

                  Military Construction, Navy Reserve

 
 
 
Fiscal year 2018 enacted level........................       $95,271,000
Fiscal year 2019 budget request.......................        43,065,000
Committee recommendation in the bill..................        43,065,000
Comparison with:
    Fiscal year 2018 enacted level....................      (52,206,000)
    Fiscal year 2019 budget request...................             - - -
 

                Military Construction, Air Force Reserve

 
 
 
Fiscal year 2018 enacted level........................       $73,535,000
Fiscal year 2019 budget request.......................        50,163,000
Committee recommendation in the bill..................        50,163,000
Comparison with:
    Fiscal year 2018 enacted level....................      (23,372,000)
    Fiscal year 2019 budget request...................             - - -
 

    The Committee recommendation includes additional funding 
for the Air Force Reserve in section 125 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 have been 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, hangers 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 
the Department of Defense'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 2020-2024 
future years defense plan. This assessment shall be submitted 
to the congressional defense committees no later than 30 days 
after this report is filed.

     North Atlantic Treaty Organization Security Investment Program

 
 
 
Fiscal year 2018 enacted level........................      $177,932,000
Fiscal year 2019 budget request.......................       171,064,000
Committee recommendation in the bill..................       171,064,000
Comparison with:
    Fiscal year 2018 enacted level....................       (6,868,000)
    Fiscal year 2019 budget request...................             - - -
 

    The recommendation includes a rescission of $25,000,000 
from unobligated balances under Administrative Provisions.
    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 U.S. occasionally has been forced to temporarily delay 
the authorization of projects due to shortfalls in U.S. 
obligation authority. The Committee directs the Secretary of 
Defense to notify the Committee within 14 days of the U.S. 
taking action to temporarily delay the authorization of 
projects, or to temporarily withhold funds from previously 
authorized projects, due to shortfalls in U.S. obligation 
authority.

                        Family Housing Overview

 
 
 
Fiscal year 2018 enacted level........................    $1,409,437,000
Fiscal year 2019 budget request.......................     1,582,632,000
Committee recommendation in the bill..................     1,582,632,000
Comparison with:
    Fiscal year 2018 enacted level....................       173,195,000
    Fiscal year 2019 budget request...................             - - -
 

    Family housing construction accounts provide funds for new 
construction, construction improvements, the Federal government 
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.
    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 exceed 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 prior to entering into such an agreement; 
and (3) base leasing decisions on the economic analysis.

                   Family Housing Construction, Army

 
 
 
Fiscal year 2018 enacted level........................      $182,662,000
Fiscal year 2019 budget request.......................       330,660,000
Committee recommendation in the bill..................       330,660,000
Comparison with:
    Fiscal year 2018 enacted level....................       147,998,000
    Fiscal year 2019 budget request...................             - - -
 

             Family Housing Operation and Maintenance, Army

 
 
 
Fiscal year 2018 enacted level........................      $348,907,000
Fiscal year 2019 budget request.......................       376,509,000
Committee recommendation in the bill..................       376,509,000
Comparison with:
    Fiscal year 2018 enacted level....................        27,602,000
    Fiscal year 2019 budget request...................             - - -
 

           Family Housing Construction, Navy and Marine Corps

 
 
 
Fiscal year 2018 enacted level........................       $83,682,000
Fiscal year 2019 budget request.......................       104,581,000
Committee recommendation in the bill..................       104,581,000
Comparison with:
    Fiscal year 2018 enacted level....................        20,899,000
    Fiscal year 2019 budget request...................             - - -
 

    Family Housing Operation and Maintenance, Navy and Marine Corps

 
 
 
Fiscal year 2018 enacted level........................      $328,282,000
Fiscal year 2019 budget request.......................       314,536,000
Committee recommendation in the bill..................       314,536,000
Comparison with:
    Fiscal year 2018 enacted level....................      (13,746,000)
    Fiscal year 2019 budget request...................             - - -
 

                 Family Housing Construction, Air Force

 
 
 
Fiscal year 2018 enacted level........................       $85,062,000
Fiscal year 2019 budget request.......................        78,446,000
Committee recommendation in the bill..................        78,446,000
Comparison with:
    Fiscal year 2018 enacted level....................       (6,616,000)
    Fiscal year 2019 budget request...................             - - -
 

          Family Housing Operation and Maintenance, Air Force

 
 
 
Fiscal year 2018 enacted level........................      $318,324,000
Fiscal year 2019 budget request.......................       317,274,000
Committee recommendation in the bill..................       317,274,000
Comparison with:
    Fiscal year 2018 enacted level....................       (1,050,000)
    Fiscal year 2019 budget request...................             - - -
 

         Family Housing Operation and Maintenance, Defense-Wide

 
 
 
Fiscal year 2018 enacted level........................       $59,169,000
Fiscal year 2019 budget request.......................        58,373,000
Committee recommendation in the bill..................        58,373,000
Comparison with:
    Fiscal year 2018 enacted level....................         (796,000)
    Fiscal year 2019 budget request...................             - - -
 

         Department of Defense Family Housing Improvement Fund

 
 
 
Fiscal year 2018 enacted level........................        $2,726,000
Fiscal year 2019 budget request.......................         1,653,000
Committee recommendation in the bill..................         1,653,000
Comparison with:
    Fiscal year 2018 enacted level....................       (1,073,000)
    Fiscal year 2019 budget request...................             - - -
 

 Department of Defense Military Unaccompanied Housing Improvement Fund

 
 
 
Fiscal year 2018 enacted level........................          $623,000
Fiscal year 2019 budget request.......................           600,000
Committee recommendation in the bill..................           600,000
Comparison with:
    Fiscal year 2018 enacted level....................          (23,000)
    Fiscal year 2019 budget request...................             - - -
 

               Department of Defense Base Closure Account

 
 
 
Fiscal year 2018 enacted level........................      $310,000,000
Fiscal year 2019 budget request.......................       267,538,000
Committee recommendation in the bill..................       322,390,000
Comparison with:
    Fiscal year 2018 enacted level....................        12,390,000
    Fiscal year 2019 budget request...................        54,852,000
 

    The recommendation provides additional funding 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 not later than 60 days after 
enactment of this Act.
    Perfluorooctane Sulfonate (PFOS) and Perfluorooctanoic Acid 
(PFOA).--The Committee has provided additional funds for the 
continued review of contaminations across the Department of 
Defense from PFOS and PFOA. This issue not limited to one 
Service nor is to be funded solely out of a single account. DOD 
has inspected 524 DOD-wide installations and is directed to 
keep the Committee apprised of what contaminated locations are 
to be funded with the BRAC account only, as that is solely the 
jurisdiction of this bill.

                       Administrative Provisions

    The bill retains 29 provisions that were in effect in 
fiscal year 2018 and includes two new administrative provision 
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.
    The bill includes section 122 prohibiting the use of funds 
to relocate a unit of the Army that would impact more than 200 
personnel.
    The bill includes section 123 allowing the transfer of 
funds among projects and activities in accordance with the 
reprogramming guidelines.
    The bill includes section 124 prohibiting the use of funds 
for projects at Arlington National Cemetery.
    The bill includes section 125 providing additional funds 
for various military construction accounts and requires a spend 
plan for each.

                         (RESCISSIONS OF FUNDS)

    The bill includes section 126 rescinding funds from prior 
appropriations Acts.
    The bill includes section 127 defining the congressional 
defense committees.
    The bill includes section 128 prohibiting the use of funds 
to close or realign Naval Station Guantanamo Bay. The provision 
is intended to prevent the closure or realignment of the 
installation out of the possession of the United States, and 
maintain the Naval Station's long-standing regional security 
and migrant operations missions.
    The bill includes section 129 prohibiting the relocation of 
any element of REDHORSE until certain conditions are met.
    The bill includes section 130 directing all amounts 
appropriated to Military Construction (all accounts) be 
immediately available and allotted for the full scope of the 
authorized project.
    The bill includes section 131 providing additional funds 
for various military construction accounts for enhancing force 
protection and safety at military installations.

                                TITLE II

                     DEPARTMENT OF VETERANS AFFAIRS

 
 
 
Fiscal year 2018 enacted level\1\...................    $185,423,735,000
Fiscal year 2019 budget request\1\..................     194,469,059,000
Committee recommendation in the bill\1\.............     194,469,059,000
Comparison with:
    Fiscal year 2018 enacted........................      $9,045,324,000
    Fiscal year 2019 budget request.................               - - -
    Fiscal year 2020 advance budget request.........     196,847,029,000
    Fiscal year 2020 Committee recommendation in the     196,847,029,000
 bill...............................................
 
\1\All funding cited excludes amounts in the Medical Care Collections
  Fund.

    The Department of Veterans Affairs (VA) serves 
approximately 43,500,000 people--20,000,000 veterans and 
23,500,000 family members and dependents who may be eligible 
for certain VA benefits. To serve adequately the nation's 
veterans, VA employs more than 385,000 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 2019 enacted level......................     $95,768,462,000
Fiscal year 2019 current year request...............       1,410,332,000
Fiscal year 2019 current year Committee                    1,410,332,000
 recommendation in the bill.........................
Fiscal year 2020 advance budget request.............     107,119,807,000
Fiscal year 2020 Committee recommendation in the         107,119,807,000
 bill...............................................
Comparison with:
    Fiscal year 2019 enacted level..................      11,351,345,000
    Fiscal year 2020 budget request.................               - - -
 

    This appropriation will provide funds for service-connected 
compensation payments to an estimated 5,283,000 veterans, 
survivors, and dependents in 2019. In addition, pension 
payments will be funded for 469,000 veterans and their 
survivors. The average cost per compensation case for veterans 
in 2019 is estimated at $17,553 and pension payments are 
projected at $13,345.
    The appropriation includes authority to transfer funding 
not to exceed $18,047,000 in 2020 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, Public Law 101-508, 
the Veterans' Benefits Act of 1992, Public Law 102-568, and the 
Veterans' Benefits Improvements Act of 1994, Public Law 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 
the SSA to obtain verification of Social Security numbers; and 
applying the VA pension cap for Medicaid-eligible single 
veterans and surviving spouses alone in Medicaid-covered 
nursing homes. The bill also continues to include language 
permitting this appropriation to reimburse such sums as may be 
earned to the Medical Care Collections Fund to help defray the 
operating expenses of individual medical facilities for nursing 
home care provided to pensioners.
    Financial hardship and bankruptcy.--The Committee continues 
to support VA programs that combat the root causes of veteran 
and dependent financial hardship, which is a known contributory 
factor to negative outcomes such as mental health issues, 
substance use disorder, and suicide. For example, disability-
related benefits not only honor the service and sacrifice of 
the veterans who receive them, but also help to replace lost 
wages and provide a critical source of economic well-being. The 
Committee is concerned by an inequity in current bankruptcy law 
that results in the inclusion of VA and DOD disability benefits 
in the calculation of a debtor's disposable income, while at 
the same time excluding Social Security disability benefits for 
non-veterans. The Department, therefore, is directed to submit 
to the Committee a report, no later than 90 days after 
enactment of this Act, outlining the legislative authority 
needed to end this inequity.

                         READJUSTMENT BENEFITS

 
 
 
Fiscal year 2019 enacted level........................   $11,832,175,000
Fiscal year 2020 advance budget request...............    14,065,282,000
Fiscal year 2020 Committee recommendation in the bill.    14,065,282,000
Comparison with:
    Fiscal year 2019 enacted level....................     2,233,107,000
    Fiscal year 2020 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 expand the availability of services 
through the VSOC program to additional sites, with particular 
attention to geographic regions without current access to VSOC 
programs.

                   VETERANS INSURANCE AND INDEMNITIES

 
 
 
Fiscal year 2019 enacted level........................      $109,090,000
Fiscal year 2020 advance budget request...............       111,340,000
Fiscal year 2020 Committee recommendation in the bill.       111,340,000
Comparison with:
    Fiscal year 2019 enacted level....................         2,250,000
    Fiscal year 2020 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; servicemen'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 Indemnity 
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 2018 enacted level.............................              - - -       ($500,000)     $178,626,000
Fiscal year 2019 budget request est........................              - - -        (500,000)      200,612,000
Committee recommendation est. in the bill..................              - - -        (500,000)      200,612,000
Comparison with:
    Fiscal year 2018 enacted level.........................              - - -            - - -       21,986,000
    Fiscal year 2019 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 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.
    Access problems.--The Committee remains concerned with the 
ability of veterans to benefit from the VA Home Loan Program 
given the shortage of appraisers approved by VA and program 
requirements that may deter prospective sellers from accepting 
applicants with VA loans. The Committee therefore directs the 
Secretary to provide a report to the Committee, no later than 
180 days of enactment of this Act, which reviews the program's 
requirements and determines if viable options exist for 
improving VA home loan utilization rates. The report should 
include, if possible, a comparison of utilization rates between 
VA home loans and non-VA home loans. Additionally, the report 
should assess the impact of aligning VA's appraiser 
qualifications with those of the Appraisal Foundation, which is 
authorized by Congress as a source of appraisal standards and 
qualifications. This assessment should include the estimated 
change, if any, in the number of available appraisers and loan 
utilization rates that would result from such an alignment.

            VOCATIONAL REHABILITATION LOANS PROGRAM ACCOUNT

----------------------------------------------------------------------------------------------------------------
                                                                                 Limitation on    Administrative
                                                              Program account     direct loans       expenses
----------------------------------------------------------------------------------------------------------------
Fiscal year 2018 enacted level.............................            $30,000     ($2,356,000)         $395,000
Fiscal year 2019 budget request............................             39,000      (2,037,000)          396,000
Committee recommendation in the bill.......................             39,000      (2,037,000)          396,000
Comparison with:
    Fiscal year 2018 enacted level.........................              9,000        (319,000)            1,000
    Fiscal year 2019 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 $1,235 (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 requires budgetary resources to be available prior to 
incurring a direct loan obligation.
    It is estimated that the Department will make 2,039 loans 
in fiscal year 2019, with an average amount of $999.

              NATIVE AMERICAN VETERAN HOUSING LOAN PROGRAM

 
 
 
Administrative expenses:
Fiscal year 2018 enacted level........................        $1,163,000
Fiscal year 2019 budget request.......................         1,149,000
Committee recommendation in the bill..................         1,149,000
Comparison with:
    Fiscal year 2018 enacted level....................          (14,000)
    Fiscal year 2019 budget request...................             - - -
 

    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 2018 enacted level........................    $2,910,000,000
Fiscal year 2019 budget request.......................     2,869,909,000
Committee recommendation in the bill..................     2,922,000,000
Comparison with:
    Fiscal year 2018 enacted level....................        12,000,000
    Fiscal year 2019 budget request...................        53,091,000
 

    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, 2020, up to 
five percent of these funds.
    The Committee provides $2,922,000,000 for the General 
Operating Expenses, VBA account, which is $53,091,000 above the 
Administration request. The Committee intends that VA use these 
additional funds for the Veterans Claims Intake Program (VCIP) 
to scan paper claims and convert them into digital format. In 
addition, the Committee intends that VA use a portion of the 
additional funding to hire additional staff and finance 
overtime payments if that becomes necessary to manage 
disability claims and appeals backlogs.
    Equitable relief.--The Committee understands that VA is 
continuing work on implementing new systems and protocols to 
eliminate instances of administrative error. As the Committee 
noted previously, if VA, during implementation of these system-
wide reforms, erroneously ended equitable relief to eligible 
veterans initially deemed eligible, it would be placing an 
unfair burden on veterans and their families. The Secretary is, 
therefore, directed to continue to grant or extend equitable 
relief to eligible veterans initially deemed eligible in 
instances of administrative error. No later than April 1, 2019, 
the Secretary shall submit to the Committee a report containing 
a statement as to the disposition of each case recommended to 
the Secretary for equitable relief under 38 U.S.C 503 during 
the preceding calendar year.
    Military sexual trauma (MST) claims.--The Committee is 
pleased with the increased focus on MST and encourages VA to 
continue to build on the strides that have been made and to 
include intensive training and specialized claims employees for 
MST-related claims. As the Committee has noted previously, like 
posttraumatic stress disorder (PTSD), MST can lead to other 
mental health disorders, such as anxiety and depression. 
Therefore, the Committee applauds VA's use of a relaxed 
evidentiary standard, such as that available to PTSD claimants, 
and urges the extension of this standard to those suffering 
from other mental health disorders as a result of MST. The 
Committee also urges VA to continue veteran outreach 
initiatives and publicize benefits veterans may be entitled to 
as a result of MST. Additionally, since MST is not gender-
specific, the Committee encourages VA to provide equal 
treatment and assistance to all veterans affected by MST.
    Outreach to remote locations.--The Committee urges VBA to 
renew efforts to increase presence and outreach to veterans 
living in remote and underserved areas, such as the 
Commonwealth of the Northern Mariana Islands, by sending VBA 
staff to these areas on a regular basis. 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, in-person, with VBA 
staff.
    Claims prioritization.--The Committee is very concerned 
about ensuring the prioritization of the most vulnerable 
veterans in regard to initial claims processing and claims 
appeals. The Committee, therefore, urges VA to prioritize 
claims processing and appeals for veterans that are elderly, or 
in poor health, so that they may receive their benefits while 
those benefits are still able to assist them. Further, the 
Committee directs VA to provide a report within 30 days of the 
enactment of this Act. The report should detail VA's 
prioritization process, if any, in regard to initial claims and 
appeals by age, health status, and income. The report should 
also include information on any triggers that are used in such 
a process, or any triggers that VA assesses may be useful to 
achieve the objective of prioritizing these subgroups of 
veterans.
    Veterans who participated in nuclear clean-up activities in 
Palomares, Spain and on Enewetak Atoll.--The Committee is 
concerned about the adjudication of service-connected 
disability claims for veterans who participated in nuclear 
clean-up activities in Palomares, Spain and on Enewetak Atoll 
in the Marshall Islands. The Committee understands that some of 
these veterans' claims are not subject to the presumption of 
radiation exposure under 38 CFR 3.309(d), but rather are 
adjudicated on a case-by-case basis under the more burdensome 
requirements of 38 CFR 3.311. To understand the justification 
for this variation in claims adjudication, the Committee 
directs VA to submit a report no later than 90 days of the 
enactment of this Act. The report should assess the 
requirements in 38 CFR 3.309(d) and determine, based on 
scientific and medical data, whether the regulation should be 
modified to apply to the group of veterans currently subject to 
38 CFR 3.311.
    Cholangiocarcinoma.--The Committee understands that some 
Vietnam veterans have been diagnosed with cholangiocarcinoma, a 
rare cancer, and that VA is currently conducting research to 
determine whether this disease occurs at a higher rate in such 
veterans than in the general population. The Committee also 
notes that less than one-third of claims for service connected 
disabilities related to this disease have been granted by VA. 
To better understand this affliction and the adjudication of 
these claims, the Committee directs VA to submit a report no 
later than 90 days of enactment of this Act. The report should 
include a status update of current research efforts and an 
assessment of how service-connected disability claim 
adjudication rates for this disease compare with other cancers.
    Tactical Communication and Protective Systems (TCAPS).--The 
Committee understands that VA's Remote Order Entry System 
(ROES) is designed to allow VA and DOD audiologists to order 
hearing aids and related items for veterans and military 
personnel. However, it is not currently possible for clinicians 
to order devices that help prevent hearing loss, such as the 
U.S. Army's TCAPS, through ROES due to a lack of a contract 
vehicle. Based on information provided by VA, the lack of such 
a contract vehicle is due solely to an assessment by VA's 
Audiology and Speech Pathology Service (ASPS) of insufficient 
need. While the Committee understands that there may be minimal 
need among veterans, the same may not be true for military 
personnel given the environments to which they are routinely 
exposed. Further, preventing hearing loss for military 
personnel today, may reduce the number of veterans with hearing 
loss tomorrow. This, in turn, may reduce VA's future costs. 
Therefore, the Committee urges VA to work with DOD to determine 
if they have a need for a contract vehicle in ROES to allow the 
ordering of hearing loss prevention devices and to report to 
the Committee, within 90 days of the enactment of this Act, 
their decision and whether they plan to add these devices to 
ROES.
    Transition assistance.--The Committee is aware of VA's 
effort 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. 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) 
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 10 of the 21 Veterans Integration Service Networks 
(VISNs) within the next 3 years, projected timelines for 
implementation of this expansion effort, an analysis of 
projected added benefits to veterans under the expansion, as 
well as potential funding costs and needs. This report shall be 
submitted to the Committee no later than 90 days after 
enactment of this Act.
    Veterans service data.--The Committee continues to note 
employers' enduring interest in minimizing the barriers to 
veteran employment. Often, businesses seeking to hire veterans 
and take advantage of the Work Opportunity Tax Credit are faced 
with difficulty in verifying veterans' disabilities and service 
data. While the Committee recognizes the multiple means for 
veterans to obtain access to their DD 214 and medical records, 
the Committee also recognizes the benefits of making these 
documents available to prospective employers electronically in 
controlled settings. Unfortunately, data sharing agreements 
between VA, DOD, and States, which have addressed this concern, 
have not been maintained. The Committee therefore directs the 
Secretary to work with the Secretary of Defense and State 
governors to identify and implement opportunities to improve 
use of the Work Opportunity Tax Credit and support the 
employment of veterans.

                  Veterans Health Administration (VHA)

    The Department operates the largest Federal medical care 
delivery system in the country, with 145 hospitals, 112 
residential rehabilitation treatment programs, 133 nursing 
homes, 300 Vet Centers, 80 mobile Vet Centers, and 743 
outpatient clinics. About 7,000,000 patients will be treated in 
2019.
    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 
2020 of $75,550,600,000 in direct appropriations to fund the 
four advance appropriations of the VHA. In addition, VA will 
receive an estimated $3,443,000,000 in Medical Care Collections 
Fund in fiscal year 2019. The Committee also provides 
$732,262,000 for medical and prosthetic research.

                     Choice Program and Non-VA Care

    The Committee recognizes the need for and supports the 
provision of non-VA care for veterans who lack access to VA 
services because of distance from VA facilities or the lack of 
capacity to provide care in a timely way at certain facilities. 
Indeed, VA has operated some non-VA care programs for years. 
The Choice program was created in 2014 to address continuing 
patient access issues. While the program has resulted in 
significant increases in the number of patients treated, the 
Committee has been concerned about budgetary and management 
challenges that have developed with the Choice program. The 
Committee is pleased that the authorizing committees are in the 
midst of negotiating legislation to create one consolidated 
non-VA medical care program that includes both Choice and the 
multiple other non-VA care programs VA operates. Further, the 
authorizers plan to convert the program's budget to regular 
discretionary funding subject to annual appropriations once the 
new program has been implemented and regulations finalized. 
This change will bring greater stability and oversight of the 
program, although it presents a significant new funding 
requirement for the Committee. Additional mandatory funding is 
now expected to be required after May, 2018 and throughout the 
period of implementation of the new program. The Committee is 
ready to meet its responsibility of funding the new 
discretionary program, which may not be implemented until the 
end of fiscal year 2019.
    The Committee will continue to use the budget structure 
first proposed by the Administration--to provide two separate 
accounts for Medical Services and Medical Community Care for 
non-VA care. That structure provides the most transparency for 
the Committee to monitor and control spending in these two 
areas. The Committee does not accept the more recent 
Administration proposal to combine both these funding streams 
into one account. Anticipating that there may be circumstances 
where the Department needs to transfer funding from one of 
these accounts to the other, the Committee continues to provide 
authority in section 228 to transfer funding from any VA 
account, except the administrative account for VBA, to the 
Medical Services account as well as section 202 allowing the 
transfer of funding between the four medical care accounts.

                            Medical Services

 
 
 
Fiscal year 2018 enacted level........................   $46,098,538,000
Fiscal year 2019 enacted level........................    49,161,165,000
Fiscal year 2020 advance budget request...............    48,747,988,000
Committee 2020 recommendation in the bill.............    48,747,988,000
Comparison with:
    Fiscal year 2019 enacted level....................     (413,177,000)
    Fiscal year 2020 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 
the DOD civilian health and medical programs.
    The bill provides the request of $48,747,988,000 for 
advance fiscal year 2020 funding. The Committee has included 
bill language to make available through September 30, 2021, 
$1,400,000,000 of the Medical Services advance appropriation 
for fiscal year 2020. The Committee is skeptical that this 
advance appropriation will be adequate to support full needs in 
fiscal year 2020. A year-to-year reduction in funding is highly 
unusual in this 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, that 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 $496,032,000 for caregivers, but is concerned 
that the funding levels estimated for the program have 
decreased significantly in the past two years. The Committee 
requests a report, no later than 60 days after enactment of 
this Act, explaining the reasons for the decrease in program 
funding estimates. It 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 issues

    The Committee provides $8,608,500,000 for mental health 
programs, which is $6,000,000 above the budget request. Of the 
amounts provided for mental health programs in fiscal year 
2019, $196,128,000 shall be used for suicide prevention 
outreach. The Department is directed to provide a report to the 
Committee, not later than 30 days after enactment of this Act, 
identifying a detailed expenditure plan for all suicide 
outreach programs.
    Skill-based interventions.--The Committee remains very 
concerned about the suicide rate for veterans and applauds VA 
for developing novel and innovative approaches for suicide 
prevention, such as the Department's Recovery Engagement and 
Coordination for Health--Veterans Enhanced Treatment (REACH 
VET) program. The Committee encourages VA to continue its 
efforts in this area and to prioritize the deployment of such 
technologies. The Committee also requests a report, within 90 
days of enactment of this Act, which details the innovative 
application of technology to reduce the risk of suicide among 
veterans.
    Posttraumatic growth programs.--To improve the mental 
health of veterans, the Committee directs VA to conduct a study 
regarding the potential effectiveness and benefits of nonprofit 
posttraumatic growth programs. The study should compare the 
effectiveness of these programs to traditional models of mental 
health care, assess the possible integration of such nonprofit 
programs into traditional mental health care programs, and 
estimate the budgetary impact of such integration. The 
Committee directs VA to complete the study within 90 days of 
the enactment of this Act and report back to the Committee 
within 30 days of the study's completion. The report should 
provide the study results, define post-traumatic growth 
programs, and assess the feasibility, requirements, and cost of 
conducting a pilot program to further assess their value.
    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. In addition, the Committee requests that the 
Secretary provide the Committee a report, no later than 90 days 
after enactment of this Act, which contains an update detailing 
findings on the outcomes and efficacy of the VCL from the 
Veterans Crisis Line Study Act of 2017.
    The Committee has repeated bill language included in the 
fiscal year 2018 Act 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.--While the 
Committee is awaiting a briefing to learn more about how VA 
establishes mental health care in individual community-based 
outpatient clinics, the Committee remains concerned that in-
person mental health is not available to veterans who require 
this care. The 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.
    PTSD service dogs.--The Committee recognizes the positive 
role that service, guide, and hearing dogs have played in 
mitigating veterans' disabilities and providing therapy, 
assistance, and rehabilitation. As such, the Committee urges VA 
to prioritize support of veterinary health care and other 
benefits for service dogs for wounded warriors. The Committee 
also notes 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 requests a copy of the results of this 
study as soon as it is completed.
    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. 
The Committee requests VA to submit a report, no later than 90 
days after enactment of this Act, providing an update on the VA 
plans to further expand the use of telemedicine for mental 
health care.
    Inpatient substance abuse care.--While veterans are able to 
access inpatient substance abuse care through VA, the Committee 
remains concerned that veterans still wait weeks to actually 
receive the inpatient support they need. In fact, the Committee 
understands from VA that the median time between screening and 
admission for Substance Use Disorder (SUD) Residential 
Rehabilitation Treatment Programs (RRTP) increased from 15 days 
to 21 days between fiscal years 2017 and 2018. This is very 
concerning and the Committee urges VA to focus on reducing this 
burdensome wait time for substance abuse treatment. In 
addition, the Committee requests a report, no later than 90 
days after enactment of this Act, which shows the trends in 
program wait times over the last five years and any proposed 
solutions to reduce such wait times.
    Public-private partnerships.--The Committee continues to 
recommend that VA 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. Additionally, 
the Committee directs VA to provide a report, within 90 days of 
enactment of this Act, regarding the feasibility of expanding 
public-private partnerships related to suicide prevention, 
PTSD, TBI, and substance use disorders.
    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, encourages VA to implement a program that 
would designate a VA liaison to work with local law enforcement 
to address such circumstances.
    Non-citizen veteran outreach.--The Committee is concerned 
about the level of awareness regarding mental health services 
by at-risk, non-citizen veterans. It urges VA, therefore, 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.
    Cultural competency training.--The Committee recognizes the 
role that the National Center for Posttraumatic Stress Disorder 
(NCPTSD) plays in promoting better prevention, diagnoses, and 
treatment of PTSD. Consistent with findings from the Center, 
the Committee recognizes that minority groups of veterans, 
including African Americans and Latinos, are more likely than 
their white counterparts to develop PTSD. As such, the 
Committee directs VHA, in coordination with NCPTSD, to provide 
a report within 180 days of enactment of this Act detailing 
whether cultural competency training is provided to health care 
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, as well as the 
disparities in the care they receive.

Homeless assistance

    The Committee provides $1,773,534,000 for VA homeless 
assistance programs, in addition to an estimated $5,633,442,000 
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 
$340,000,000 for the Supportive Services to Veteran Families 
program, which is the same as the fiscal year 2018 funding 
level and $20,000,000 above the request.
    Allocation of funding for homeless programs.--The Committee 
has been concerned about the Department's tentative decision 
last fall to convert almost $1,000,000,000 of funding for 
homeless programs from Special Purpose funding to General 
Purpose funding. This proposal would have potentially risked 
funding for important programs such as the Supportive Services 
to Veteran Families program. While the Committee is pleased 
that the Department decided not to move forward with the 
proposal for fiscal year 2018, it expects VA to consult with 
the Committee before any attempt is made to change the manner 
in which funding allocations are made to the field for fiscal 
year 2019.
    Grant and per diem (GPD) rate.--The Committee is concerned 
that the cost incurred by nonprofit organizations, who are 
providing clinical services as part of their GPD program, are 
not covered by the current GPD rate. VA is required to report 
back to the Committee, within 30 days of the enactment of this 
Act, on whether the current GPD rate is effectively covering 
the costs of clinical services and, if not, options for 
adjusting the GPD rate to ensure these nonprofit organizations 
have the necessary resources to cover the cost of providing the 
lifesaving clinical care our homeless veterans deserve.
    Construction assistance for nonprofit organizations.--The 
Committee strongly supports innovative approaches and public-
private partnerships that can help reduce homelessness among 
our veterans. As such, the Committee urges VA to assess the 
possibility of assisting nonprofit organizations with capital 
costs related to the construction of new housing units for 
homeless veterans on non-VA property, particularly those 
utilizing HUD-VASH vouchers. When considering assistance to 
such organizations, VA should limit its consideration to those 
that have secured over 50 percent of the needed financing so as 
to reduce the federal burden for establishing new housing.
    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.
    Legal assistance for the Supportive Services for Veteran 
Families Program.--The Committee notes that university law 
schools may be 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, as well as inspiring the next generation 
of lawyers to serve veterans. The Committee encourages the 
Supportive Services for Veteran Families (SSVF) program to work 
with grantees to expand their legal service offerings, 
particularly in rural areas where access to private legal 
assistance can be limited. The Committee further encourages VA 
to establish one or more pilot projects to partner SSVF 
grantees with university law schools in rural areas to enhance 
legal assistance to veterans.
    Female homeless veterans.--The Committee remains committed 
to helping homeless veterans and commends VA for its efforts in 
reducing homelessness among the veteran population. However, 
the Committee is concerned about VA's efforts to reduce 
homelessness among female veterans, and particularly those 
veterans with minor children. These veterans may be faced with 
additional challenges when trying to obtain homeless services 
from VA. The Committee urges the Department to address the 
challenges facing homeless female veterans.
    Homeless veterans near the U.S.-Mexico border.--The 
Committee notes that there may be homeless veterans living near 
the U.S.-Mexico border who, historically, may not have been 
counted in point-in-time homeless surveys. The Committee 
encourages VA to work with HUD to develop strategies and 
recommendations for addressing U.S. veteran homelessness near 
the U.S.-Mexico border and to take into account these 
undercounted veterans when awarding HUD-VASH vouchers. VA shall 
report on these strategies and recommendations within 90 days 
of enactment of this Act.
    Related needs of homeless veterans.--With significant help 
from the Committee, VA has made great strides in reducing 
veteran homelessness. The Committee believes that more could be 
done to address veterans' homelessness and remains interested 
in the feasibility, advisability, and cost of VA conducting a 
pilot program that would award grants to eligible organizations 
to provide furniture, household items, and other assistance to 
formerly homeless veterans who have transitioned to permanent 
housing. The Committee looks forward to the report requested in 
House Report 115-118 on this concept and expects the deadline 
for the report to be met.

Staffing issues

    Medical staff retention.--The Committee expects VA to 
continue to report every six months on the number of medical 
staff who have left the VA system, including a summary of the 
principal reasons explaining their departure, and a detailed 
plan of how VA will address and 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, within 90 days after 
enactment of this Act, on efforts to recruit and hire medical 
officers and nurses at each VA medical facility, as well as any 
impediments to such efforts. The report should include the 
resources provided for these efforts and recommendations for 
relevant legislation.
    Advanced practice registered nurses.--The Committee is 
concerned that some VA facilities have failed to implement VA's 
final rule granting full practice authority to advanced 
practice registered nurses. While the Committee understands 
that implementation must be voted on and approved by each 
facility's organized medical staff, the Committee urges the 
Secretary to work with the remaining facilities to ensure quick 
implementation of this directive.
    Psychology internships.--The Committee understands that VHA 
each year uses the services of the Association of Psychological 
Postdoctoral and Internship Centers (APPIC), a nonprofit 
organization, to help select and match clinical psychologists 
for available VA internships. The Committee is concerned, 
however, that APPIC has repeatedly decided to not include 
psychologists from programs accredited only by the 
Psychological Clinical Science Accreditation System (PCSAS) in 
the match, even though VHA regulations recognize PCSAS-
accredited programs. The Committee is also concerned with the 
lack of progress by VHA to require APPIC to address this issue 
and therefore urges VHA to request that APPIC modify its policy 
within 90 days of enactment of this Act.

Access for rural veterans

    Office of Rural Health.--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. The VA Office of Rural Health (ORH) improves 
access and quality of care for enrolled veterans residing in 
geographically rural areas. Developing evidence-based policies 
and innovative practices to bring health care to rural areas is 
key to serving veterans in geographically remote areas, 
including remote facilities in Hawaii, many of whom would 
otherwise need to fly to reach their nearest VA facility. In 
addition to providing health care services, ORH's important 
work includes identifying barriers to health care delivery in 
rural areas and implementing new ways to deliver health care 
and services to veterans in these locations.
    Operating plan.--The Committee directs ORH to submit to the 
Committee not later than 30 days after enactment of this Act an 
operating plan for fiscal year 2019 funding, as well as the 
fiscal year 2020 funding provided in advance by this Act.
    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 which 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 doctors of osteopathic medicine and 
physician assistants, through both physical facilities and 
expanded access to telehealth services, to address the rural 
health provider gap.
    Telehealth in rural areas.--The Committee is encouraged 
with recent efforts by VA with regard to investment in 
telehealth programs. Additionally, the Committee acknowledges 
the recent report submitted by VA outlining their collaboration 
efforts with several other Federal agencies on this issue. 
However, the report fails to provide an adequate explanation of 
the specific plan/strategy which VA will pursue to provide 
telehealth access to the 33 percent of veterans that reside in 
rural areas nationwide. 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 the VHA Office of Rural 
Health, to elaborate with specificity on measures to expand 
capabilities of telehealth to these regions, and continue 
collaboration with 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 directs the department to 
submit a report to the Committee, no later than 90 days after 
enactment of this Act.

Women's issues

    As the number of female veterans increases, VA needs to 
prioritize the expansion of health care services to accommodate 
women. This means more gender-specific services and the 
availability of appropriate infrastructure facilities to 
safeguard the privacy needs and proper gender-specific care and 
treatment of female veterans. The bill provides $511,352,000 
for VA to continue redesigning its women's health care delivery 
system and facilities to ensure women receive equitable, 
timely, and high-quality health care.
    Women's access to medical services.--While the Committee is 
currently awaiting a report from VA on its plan to implement 
standards of care for female veterans, the Committee remains 
concerned that female veterans face remarkably different 
experiences than their male counterparts when transitioning in 
and out of combat roles, in between services, or back to 
civilian life and that VA is not adequately addressing the 
health needs of female veterans. These include obstetrics and 
gynecological care, treatment for gender-specific conditions 
and diseases, and female veteran suicide. The VA must ensure an 
improved quality of life for female veterans with gender-
specific health care to meet their needs. Therefore, the 
Committee urges VA to continue its efforts to expand access to 
care in these areas and ensure the gender-specific health needs 
of female veterans are met.
    Female medical staff.--The Committee supports the hiring of 
more female health care professionals in order to provide 
female veterans greater opportunities to choose the gender of 
their health care provider. To enhance the Committee's 
understanding of VHA's staff demographic, the Committee 
requests a report, no later than 90 days after enactment of 
this Act, on the number of female health care professionals 
hired by VHA each year over the past five years. The report 
should include information pertaining to job type and 
employment location.
    Breast cancer screening guidelines.--The Committee commends 
the Department of Veterans Affairs decision to offer breast 
cancer screening and mammography to eligible female veterans 
beginning at age 40. However, the Department should be prepared 
to offer screening to eligible younger female veterans should a 
physician determine or risk factors warrant screening before 
age 40. The Committee supports this effort to ensure that the 
care female veterans receive is consistent with the private 
sector, and the Committee will continue to monitor the 
Department's implementation of this policy. The Department 
should closely follow ongoing debate as the scientific 
community reaches a consensus on breast cancer screening and 
mammography coverage to provide veterans the best care 
possible. Bill language is included to ensure VA maintains this 
policy through fiscal year 2024.

Pharmacy issues

    Vaccines.--To improve the health of veterans and to reduce 
health care costs due to avoidable hospitalizations and 
complications, the Committee directs VHA to incorporate, when 
available, peer-reviewed and published randomized and other 
high-quality, well-controlled clinical trials and economic 
data, particularly from the VA population, into its influenza 
vaccine procurement decisions and educational efforts to enable 
better informed decision making to positively impact the health 
of senior veterans.

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 $386,530,000 
for opioid treatment and prevention efforts, of which 
$52,025,000 is provided for activities authorized by the 
Comprehensive Addiction and Recovery Act of 2016 (CARA).
    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.
    State prescription drug monitoring programs.--The Committee 
notes that, with the problem of opioid use disorders escalating 
among veterans, it is very important that VA continue its 
efforts to partner with States to ensure that they have the 
capacity to exchange prescription drug information with VA. The 
Committee understands that two States currently have not 
installed the technology to exchange data from their State 
prescription drug monitoring boards with VA. VA is urged to 
assist these States to speed their exchange.
    Opioid addiction treatment.--The Committee appreciates VA's 
submittal of a report to the Committee on VA's ongoing review 
of prescription practices and addiction treatment protocols for 
opioids. The Committee requests an update of this report, not 
later than 90 days after enactment of this Act, that describes 
VA's commitment to the goal of enabling veterans to become free 
of all opioids and having access to non-opioid alternative 
medications and recovery supports. In conjunction with its 
overall efforts to address opioid abuse, the Committee also 
encourages VA to explore the use of advanced data analytics to 
detect and deter abuse and to treat addiction.
    Naloxone.--United States public health agencies have 
appropriately highlighted the risk of overdose from doses of 
opioids greater than 90 morphine milligram equivalents (MME) 
per day. However, the vast majority of patients, including the 
vast majority who die from overdose, are below 90 MME, making 
broad education about opioid-related risks essential for all 
patients prescribed opioids, regardless of dose or formulation. 
Hundreds of millions of patients receive 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 may be 
to assess the benefit of providing Opioid Overdose Education 
and Naloxone Distribution (OEND), regarding how to prevent, 
recognize, and respond to an opioid overdose, including 
responding with naloxone, to patients prescribed 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 broad Opioid Overdose 
Education and co-prescribing naloxone to those with an opioid 
prescription. The Committee requests that VHA develop a 
strategy to test this hypothesis and consider executing a pilot 
program to assess the benefit for veteran patients.
    Complementary and integrative health (CIH).--The Committee 
supports VA's work in developing a plan to expand the scope of 
research, education, delivery, and integration of CIH into the 
health care services provided to veterans and urges its robust 
implementation. The Committee supports the progress being made 
to reduce misuse and abuse of opioids and to improve pain care 
and encourages VHA to accord priority for CIH to VISNs or VA 
medical centers with a history of opioid prescription rates, or 
current opioid prescription rates, inconsistent with the 
standards of appropriate and safe care.
    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 abuse disorder data.--The Committee supports the 
VA's ongoing work to reduce substance use disorder among 
veterans. The Committee directs VA to provide a report no later 
than 120 days after the enactment of this Act providing the 
number and proportion of veterans with substance use disorder, 
broken down by age, including a breakdown by State. The report 
should also include available demographic data.

Other health issues

    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 
that it continues to dedicate resources towards the goal of 
screening and treating veterans who are disproportionately 
impacted by the disease. Now that the easiest to identify and 
treat HCV caseload has been largely addressed, it is important 
for VA to use other tools to reach the remaining caseload. 
Participating in community events, with on-site HCV testing, 
that are organized by veterans services organizations is an 
excellent way to reach veterans, both those who may be enrolled 
for VA services, but are not actively using them, or veterans 
who don't know their eligibility status. Therefore, VA is 
encouraged to explore innovative partnerships with stakeholder 
organizations to effectively engage and test additional 
veterans with rapid HCV screening outside of traditional sites 
of care. The Department is also encouraged to make available, 
at community events involving on-site screening, department 
staff who have the capacity to check a veteran's status on-site 
so that eligibility for VA reimbursement for testing is known 
instantly.
    Lung cancer screening.--The Committee continues to note 
with concern that veterans at risk for lung cancer are not 
afforded the same access to lung cancer screening programs that 
are offered to Medicare beneficiaries. The Committee looks 
forward to receiving the report from VA, as requested in House 
Report 115-188, presenting the steps the VHA is taking to make 
lung cancer screening broadly available to veterans at high 
risk for lung cancer.
    Colorectal cancer screening.--The Committee reminds VA of 
the direction in the Statement of Managers accompanying Public 
Law 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 to learn of the 
December 2017 signing of a collaboration agreement between the 
VA, the John P. Murtha Cancer Center at Walter Reed National 
Military Medical Center, and the National Cancer Institute 
(NCI) focused on improving cancer care for common cancers 
affecting military personnel and veterans. However, the 
Committee remains concerned about the need for a better 
understanding of, and treatment options for, rare cancers that 
may disproportionately impact veterans. Military personnel are 
uniquely exposed to carcinogens including asbestos, industrial 
solvents, nuclear radiation, depleted uranium, lead, fuels, 
PCBs, and components of Chemical Agent Resistance Coating. Each 
of these hazards may increase the risk of certain cancers for 
both military personnel and veterans. Therefore, the Committee 
directs VA to assess options for modifying the December 2017 
agreement to include collaboration on rare cancers. Further, 
the Committee seeks clarification regarding VA's authorities to 
provide funding to commercial firms for the development of 
treatments for rare cancers. The Committee directs VA to 
provide a report on these topics within 90 days of the 
enactment of this Act.
    Sepsis.--Sepsis is a leading cause of mortality for 
veterans with spinal cord injuries. The Committee believes that 
VA, through its Center for Clinical Management Research and its 
Spinal Cord Injuries and Disorders Centers, can help improve 
the diagnosis and management of sepsis. The Committee, 
therefore, directs the Department to provide a report, within 
90 days of the enactment of this Act, on its costs related to 
sepsis management and how it has incorporated the latest 
improvements in sepsis screening and diagnostics, including 
biomarker testing, across its health care facilities.
    Safety of blood products.--The Committee is concerned about 
the safety of blood products being transfused to veterans at VA 
medical facilities given the aging and medically fragile 
populations being treated. Therefore, the Committee urges VA to 
request that all blood product providers use FDA-approved 
pathogen reduction technology, where it is available, before 
providing blood products for transfusion at VHA medical 
facilities, including VA medical centers, outpatient clinics, 
community-based outpatient clinics, and community living center 
programs.
    Diabetes treatment.--The Committee is concerned about the 
incidence of diabetes impacting veterans and seeks approaches 
to reduce both the prevalence of this disease and any wait 
times associated with treatment. Therefore, the Committee 
requests that VA provide a report, no later than 90 days after 
the enactment of this Act, on the feasibility and potential 
cost of building a fully-equipped diabetes center that would be 
open 24 hours per day, 7 days a week, and 365 days a year. In 
describing in the report suitable locations for such a 
facility, VA should consider areas with the highest prevalence 
of diabetes, a large concentration of veterans, and a system of 
established VA medical centers and clinics. Any willingness of 
medical providers to defray the expense of such a facility by 
paying the capital costs of construction, if permitted in law, 
should also be taken into account in considering potential 
locations.
    Pressure ulcer prevention.--The Committee is concerned 
about facility-acquired pressure ulcers (PU) and the associated 
costs for the treatment of hospitalized patients with PUs in 
VHA facilities. The Committee, therefore, commends VA for its 
current studies on the VA Smart Modular Adaptive Electrotherapy 
Delivery System (SmartMAEDS), the use of smartphone technology 
for PU screening, and the prevention of community-acquired PU 
in individuals living with a spinal cord injury. Given the 
importance of this research, the Committee encourages VA to 
prioritize clinical care and research focused on wound care, 
particularly in locations with higher incidence rates of PUs, 
such as sites that serve patient populations with limited 
mobility and spinal-cord injury. Furthermore, the Committee 
encourages VA to explore the feasibility of including military 
treatment facilities in this care and research to increase the 
cost-effectiveness of the health care provided by the Military 
Health System and VA, as authorized under Joint DOD/VA Sharing 
Incentive Funds, 38 USC 8111. To assess VA's progress in this 
area, the Committee requests a report, no later than one year 
after the enactment of this Act, regarding the status and 
preliminary results of these studies, as well as any other 
innovative technologies VA has assessed, particularly those 
involving biometric sensor technologies.
    Antimicrobial stewardship.--The Committee continues to be 
pleased with VA's efforts to reduce antibiotic use so as to 
avoid development of resistance to important drugs, without 
increasing 30-day readmission and mortality rates. Per VHA 
Directive 1031, the VA has focused on the implementation and 
effectiveness of the VA Antimicrobial Stewardship Program. This 
program establishes stewardship programs in all VA facilities 
and fosters the judicious use of antimicrobials through 
education, direct provider-to-provider stewardship, and 
surveillance. It also supports and expands ongoing efforts to 
prevent the emergence of multidrug-resistant organisms. The 
Committee encourages VA to continue improvements in the 
effectiveness and implementation of its Antimicrobial 
Stewardship Program.
    Wheelchairs.--The Committee is extremely concerned by the 
March 2018 report from VA's Office of Inspector General 
regarding the repair times and policies for powered wheelchairs 
and scooters. The report noted that, due to VA staff failures, 
some veterans waited an average of 69 days to have their 
powered wheelchair or scooter repaired and were provided manual 
wheelchairs or scooters in the interim jeopardizing their 
quality of life. Therefore, the Committee requests a report, no 
later than 60 days after enactment of this Act, explaining VA's 
policy in regard to the types of wheelchairs or scooters issued 
as replacements when powered wheelchairs or scooters are turned 
in for repair. It should also provide the estimated cost of 
maintaining sufficient powered wheelchairs and scooters on hand 
to enable veterans to receive one as a replacement, instead of 
a manual wheelchair or scooter, while awaiting repair of their 
powered wheelchair or scooter. The report should also include a 
description of VA's authority to provide wheelchairs that 
restore an ability that relates exclusively to participation in 
a recreational activity.
    Non-invasive cardiac artery disease diagnosis.--The 
Committee understands that significant health advantages and 
cost savings may be possible through non-invasive diagnosis of 
cardiac artery disease. Therefore, the Committee commends VA on 
having conducted such diagnoses through cardiac CT angiography 
(CTA) on approximately 2,300 veterans in the past year. The 
Committee is also interested in newly-developed CTA-related 
technologies that may provide even greater benefits to 
veterans. The Committee directs VA to conduct a study on such 
technologies assessing their capabilities, the anticipated 
annual net cost impact (the estimated annual cost of the 
testing and the estimated cost savings and offsets that would 
result from avoidance of invasive CTA and other non-invasive 
cardiac testing), and any issues that might impact their 
incorporation into clinical practice guidelines, such as 
privacy and information technology issues, if such technologies 
are proprietary. The Committee requests that VA submit the 
results of this study within 180 days after enactment of this 
Act.
    Mobile magnetic resonance imaging (MRI).--The Committee is 
concerned about MRI wait times for veterans. Delays in MRI use 
have the potential to keep veterans in pain or cause injuries 
to heal incorrectly without proper diagnosis. Therefore, the 
Committee requests a report from VA, no later than 90 days 
after the enactment of this Act, on any MRI backlog that may 
exist. The report should include data on average wait times by 
location, an assessment as to whether a mobile MRI service 
would help reduce any existing backlog, and an estimate of the 
cost for implementing such a service.
    Wellness.--Public Law 115-141 included funding for a 
veteran services organizations (VSOs) wellness pilot program to 
upgrade, through construction and repair, veteran service 
organization facilities to expand access to wellness programs 
and expanded complementary and integrative health promotion. 
The Committee strongly supports this program and directs VA to 
report the progress of this pilot no later than 15 days after 
enactment of this Act and then provide quarterly status 
updates.
    Tobacco.--In a 2018 Centers for Disease Control and 
Prevention study, 56.8 percent of servicemembers and veterans 
between the ages of 18-25 reported being current smokers. 
Interventions for active duty and veteran servicemembers are 
important to reduce tobacco use and could lead to improved 
health outcomes. The Committee encourages VA to implement 
evidence-based tobacco interventions to support servicemembers 
now and in the future.
    Nutrition.--The Committee recognizes the value of proper 
nutrition and food's impact 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, 79 percent of veterans receiving VA care are 
overweight and 43 percent are obese. The Committee urges VHA to 
be proactive in promoting wellness and disease prevention by 
providing evidence-based nutritional services and requests to 
be briefed on current practices, as well as on a plan to expand 
nutritional education and means to increase access to 
nutritional foods for veterans.
    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.
    Veterans' end-of-life care.--Public Law 115-141 directed VA 
to undertake a study on the feasibility of implementing hospice 
care protocols tailored to the unique needs of combat veterans, 
including Vietnam-era veterans, and to develop a report 
outlining the techniques, best practices, and support 
mechanisms to serve these veterans. The Vietnam Veterans End of 
Life Care report submitted to the Committee is woefully 
inadequate, failed to meet any of the reporting requirements, 
and is frankly of no use to the Committee. Furthermore, the 
report stated that there are over 4,000 community hospice care 
providers who all maintain their own resources and training 
materials which leads the Committee to believe there is no 
clear standard being provided by VA for veterans hospice care 
and veterans facing unique end-of-life challenges are failing 
to receive proper care. Due to the lack of information provided 
in the report, VA is again directed to provide a detailed 
report outlining the techniques, best practices, and support 
mechanisms for end-of-life care. The Committee strongly 
reiterates that such an approach could be beneficial to Iraq, 
Afghanistan, and Syria combat veterans in the future. This 
report shall be submitted to the Committee within 30 days after 
the enactment of this Act.
    Patients rights.--The statement of managers for Public Law 
115-141 contained a VA patients rights reporting requirement. 
However, due to the late passage of the fiscal year 2018 bill, 
the reporting requirement remains outstanding. The Committee 
strongly supports veterans making decisions regarding their 
medical care and having the right to accept or refuse 
treatment, and the right to formulate advance directives. The 
Committee remains interested in this report and looks forward 
to its submission.
    Teague-Cranston medical schools.--The Committee recognizes 
that the 1972 Teague-Cranston Act, also known as the Medical 
School Assistance and Health Manpower Training Act, established 
five medical schools to be built on VA campuses in conjunction 
with these universities: Wright State University, the 
University of South Carolina, Texas A&M University, Marshall 
University, and East Tennessee State University. These schools 
were built on VA campuses for the express purpose of training 
physicians for service in underserved areas and benefitting 
veterans. The Committee also understands that VA maintains a 
robust academic affiliation with these schools. Given 
congressional intent regarding the establishment of these 
schools, and the critical role they play in caring for 
veterans, the Committee directs VA to notify Congress in 
advance of any plan to move resources or assets from these 
schools, if such a move would have a negative impact on them.
    Hispanic-Serving Institution (HSI) affiliations with VA 
health care facilities.--The Committee continues to be 
concerned by the lack of Hispanic-Serving Institutions (HSIs) 
medical school participation and collaboration with local VA 
hospitals in areas where HSI medical schools are located. The 
Committee urges the Secretary to develop a plan to expand local 
VA medical facilities' participation with HSI medical schools. 
The Committee looks forward to the report mandated by Public 
Law 115-141.
    Historically Black Colleges and Universities medical 
research programs.--Over the past five years the Committee has 
urged VA to increase its efforts to improve its academic 
affiliation activities with minority medical schools and 
institutions for the purposes of enhancing training 
initiatives, improving patient care, and providing educational 
opportunities. At one point the Committee directed VA to have a 
symposium in order to achieve these goals. The Committee once 
again directs VHA and the Office of Academic Affiliations to 
take concrete steps to improve this ongoing commitment to, and 
partnership with, minority health professions schools and 
report back to the Committee, no later than 30 days after the 
enactment of this Act, regarding the actions it will take to 
address this issue. Thereafter, the Committee directs a 
quarterly report on this issue be submitted to the Committee 
explaining how each action has been fulfilled.
    Minority veteran care.--The Committee acknowledges VA's 
efforts to streamline data collection practices via a working 
group and other initiatives. The Committee also notes that the 
veteran population is becoming increasingly diverse. 
Accordingly, the Committee directs VA to provide a report 
within 180 days of enactment of this Act, which details how it 
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 the acquisition of a new electronic health record 
program, which will combine the Department's current data 
collecting programs, and make recommendations on 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 health care 
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 health care. 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 the VA works to 
transform its Community Care programs, the Committee directs 
VA, no later than 90 days after enactment of this Act, to 
provide the Committee a report that assesses options for 
improving access to VA health care 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 
(VAPIHCS) 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 health care facilities and 
educational institutions, to leverage shared resources and 
improve access for delivery of care through collaboration.
    Volunteer physicians.--The Committee continues to be 
encouraged by the success of the Physician Ambassadors Helping 
Veterans Pilot Program to date and encourages VA to expand this 
program to additional facilities throughout the country, 
prioritizing VHA sites that serve the largest veteran 
populations as well as those which experience the longest wait 
times.
    National Veterans Sport Program.--The bill includes 
$17,825,000 for the National Veterans Sports Program, which is 
$1,000,000 above the request and $860,000 above the fiscal year 
2018 funding. Within the total, $6,825,000 is provided for the 
support of national veterans' sports and special events 
programs; $2,000,000 is designated for veterans' monthly 
assistance allowances; and $9,000,000 is provided for the 
Adaptive Sports Grants Program. The Adaptive Sports Grants 
Program currently awards a limited number of grants for equine 
therapy, mostly related to physical disabilities. The Committee 
provides $1,000,000 above the request to encourage VA to 
increase its use of these grants for the purpose of equine 
therapy targeted to mental health issues.
    Prosthetics regulation.--The statement of managers for 
Public Law 115-141 indicated the conferees' concern that VA's 
proposed prosthetics services regulation may limit veteran 
choice in obtaining prosthetic, orthotic and other 
rehabilitative services. The Committee strongly encourages the 
Department to revise the final rule to be more closely aligned 
with the principle of patient choice as reflected in the 
Veterans Access, Choice and Accountability Act.

                         Medical Community Care

 
 
 
Fiscal year 2018 enacted level........................    $9,828,294,000
Fiscal year 2019 enacted level........................     8,384,704,000
Fiscal year 2019 additional request...................       500,000,000
Committee 2019 additional recommendation..............       500,000,000
Fiscal year 2020 advance appropriation request........    14,419,786,000
Committee 2020 advance appropriation recommendation...    14,419,786,000
Comparison with:
    Fiscal year 2019 enacted level....................     6,035,082,000
    Fiscal year 2020 advance budget request...........             - - -
 

    The Medical Community Care account was created in the 
Surface Transportation and Veterans Health Care Choice 
Improvement Act of 2015. It is intended to consolidate all 
community care programs under a single appropriation. For 
fiscal year 2020, the bill provides $14,419,786,000, of which 
$2,000,000,000 is available until September 30, 2021.
    The Committee provides $500,000,000 as requested in the 
April 13 Administration budget amendment for this activity.
    Peer support services.--The Committee understands that 
private nonprofit peer-to-peer organizations have provided 
important services for veterans in areas such as crisis 
interventions, services to improve community integration such 
as rehabilitation, mental health assessments, referral 
services, and treatment plan development. The Committee 
encourages VA to review the types of services provided by peer-
to-peer organizations and determine whether the Department is 
permitted to contract for their services under current law. The 
Committee requests a report, no later than 60 days after 
enactment of this Act, describing whether VA is permitted to 
reimburse peer-to-peer organizations and whether these 
providers could be a useful component in the Department's 
comprehensive strategy for health care services for veterans.
    Problems with network administrators.--The Committee 
recognizes the massive undertaking 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. As such, the Committee is 
interested in ensuring that, going forward, the Veterans Choice 
Program is providing maximum benefit to veterans, attracting 
top quality providers, and meeting program goals. To this end, 
the Committee requests VHA to submit a report, within 90 days 
of enactment of this Act, on the effectiveness of the program's 
third party administrators with regard to patients and 
providers and the challenges this program has created for them.

                              CHOICE FUND

 
 
 
Fiscal year 2018 enacted..............................             - - -
Fiscal year 2019 enacted..............................             - - -
Fiscal year 2019 additional request...................    $1,900,000,000
Committee recommendation in the bill..................             - - -
Comparison with:
    Fiscal year 2018 enacted level....................             - - -
    Fiscal year 2019 additional request...............   (1,900,000,000)
 

    The Choice Fund was created in P.L. 113-146, the 
legislation establishing the Choice program and providing 
mandatory funding for it. Since its inception, the authorizers 
have provided nearly $20,000,000,000 in emergency mandatory 
funding to support the Choice program. The account has never 
received discretionary funding. It was anticipated that the 
funding would last until the authorizing committees created a 
program to consolidate the Choice program with other non-VA 
care programs. However, the new program has not yet been passed 
into law. The Administration proposes a budget amendment of 
$1,900,000,000 in discretionary funding as a patch until a 
consolidated non-VA care program is in place. The Committee is 
reluctant to provide discretionary funding for a mandatory 
program, but is ready to meet its responsibility to provide 
funding after the new discretionary program is implemented.

                     Medical Support and Compliance

 
 
 
Fiscal year 2018 enacted level........................    $6,754,480,000
Fiscal year 2019 enacted level........................     7,239,156,000
Fiscal year 2020 advance budget request...............     7,106,150,000
Committee 2020 recommendation in the bill.............     7,106,150,000
Comparison with:
    Fiscal year 2019 enacted level....................     (133,006,000)
    Fiscal year 2020 advance budget request...........             - - -
 

    The Medical Support and Compliance appropriation funds the 
expenses of management and administration of the Department's 
health care 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 $7,106,150,000 in advance fiscal year 
2020 funding. The Committee has included bill language to make 
available through September 30, 2021, $100,000,000 of the 
Medical Support and Compliance appropriation for fiscal year 
2020.

                           Medical Facilities

 
 
 
Fiscal year 2018 enacted level........................    $6,141,880,000
Fiscal year 2019 enacted level........................     5,914,288,000
Fiscal year 2020 advance budget request...............     5,276,676,000
Committee 2020 recommendation in the bill.............     5,276,676,000
Comparison with:
    Fiscal year 2019 enacted level....................     (637,612,000)
    Fiscal year 2020 advance budget request...........             - - -
 

    The Medical Facilities appropriation provides funds for the 
operation and maintenance of the Department's health care 
system's capital infrastructure. Included under this heading 
are provisions for costs associated with utilities, 
engineering, capital planning, leases, laundry, grounds 
keeping, garbage, housekeeping, facility repair, and property 
disposition and acquisition.
    The bill provides $5,276,676,000 in advance fiscal year 
2020 funding. The Committee has included bill language to make 
available through September 30, 2021, $250,000,000 of the 
advance Medical Facilities appropriation for fiscal year 2020.
    In addition to funding provided in this account, 
$800,000,000 is provided in sec. 238 for non-recurring 
maintenance as part of a $2,000,000,000 infrastructure 
initiative. A similar initiative provided $1,000,000,000 for 
this account for non-recurring maintenance in fiscal year 2018.
    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 2019 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 
Community Based Outpatient Clinic (CBOC) facilities, with a 
priority in rural 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. The VA is encouraged to look at 
existing CBOCs which are operating at full capacity, have a 
proven record of delivering services, and have community 
support to expand the facility. Additionally, VA is directed to 
complete a study, within 120 days after enactment of this Act, 
on the potential benefits of placing VA clinics on military 
installations located in areas with high veteran populations 
and where nearby VA infrastructure is overburdened. The study 
should emphasize locations with readily available, unused 
medical facilities on military installations. The report should 
identify potential cost savings and determine if increased 
quality and improved timeliness of care can be provided to 
veterans in these communities through on-post VA medical care. 
The results of the study are to be provided to the Committee 
once available.
    Bakersfield outpatient clinic.--The Committee remains 
concerned that VA has not yet established a new outpatient 
clinic in Bakersfield, California as authorized in Public Law 
111-82. Based on information provided by VA, the Committee 
expects the lease for this facility to be awarded in the summer 
of 2018 and that clinic activation will occur in the fall of 
2020. Furthermore, the Committee directs the Secretary to 
continue to provide regular updates to Congress as directed in 
House Report 114-497.
    Center of Excellence for Research on Returning War 
Veterans.--The Committee understands that VA is planning to 
move the Posttraumatic-stress Residential Rehabilitation 
Program (PRRP) that is currently co-located with the Center of 
Excellence (COE) for Research on Returning War Veterans on the 
campus of the VA Medical Center in Waco, Texas. The Committee 
is concerned that this may have an adverse impact on the COE's 
PTSD research, which is critical in helping develop treatments 
for veterans suffering from PTSD. Therefore, the Committee 
directs VA to provide a report, within 30 days of the enactment 
of this Act, which details the mission of the COE, the mission 
of the PRRP, and the relationship between these two programs. 
The report should include an assessment of the research 
benefits of having inpatient programs co-located with mental 
health centers of excellence in general, an assessment specific 
to benefits resulting from the current co-location of the COE 
with the PRRP on the Waco campus, and any costs associated with 
VA's planned move of the PRRP. Further, the Committee reminds 
VA that the conference report accompanying Public Law 109-114, 
House Report 109-305, expressly designated the establishment of 
three VA ``centers of excellence to focus on mental health/PTSD 
needs,'' with one of these being at the VA Medical Center in 
Waco, Texas. The Committee expects VA to adhere to 
congressional intent, as expressed in the report, regarding the 
location of this center of excellence.
    Medical imaging equipment.--The Committee remains committed 
to helping VA in its efforts to ensure a timely process for VA 
medical centers to receive medical imaging equipment to 
effectively and efficiently deliver care to veterans. The 
Committee urges VA to strive to maintain a 120-day turnaround 
for these equipment orders during their three, annual 
consolidated purchase periods for high tech medical equipment. 
The Committee requests that VA consider more education for 
contracting officers and individual VA medical centers 
regarding high-tech medical equipment purchasing processes and 
seek ways to eliminate redundant paperwork requirements for 
such orders. The Committee encourages VA to make public 
information regarding current requirements and regulations and 
any changes or revisions to procurement processes in the area 
of high tech medical equipment. In addition, the Committee 
urges VA to coordinate between capital equipment purchases, 
facilities funding for site readiness, and clinical staff 
training to ensure that facilities are prepared to install and 
operate equipment as quickly as possible after purchase.
    Operating room patient safety and fire prevention.--Given 
the importance of patient safety, the Committee requests that 
VA provide a report, within 90 days of enactment of this Act, 
that provides information regarding incidents of operating room 
fires at VA medical facilities over the last ten years. The 
report should include the Department's policies and procedures 
for tracking and evaluating patient burn and fire risk 
exposures in live operating room environments and data that 
shows 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 Judgement Fund or any other taxpayer-funded 
sources as a result of VA operating room fires and related 
safety issues. The report should also include information on 
the Department's public reporting of patient outcome measures 
based on Agency for Healthcare Research and Quality (AHRQ) 
Patient Safety Indicators (PSI).

                    Medical and Prosthetic Research

 
 
 
Fiscal year 2019 enacted level........................      $722,262,000
Fiscal year 2019 budget request.......................       727,369,000
Committee recommendation in the bill..................       732,262,000
Comparison with:
    Fiscal year 2018 enacted level....................        10,000,000
    Fiscal year 2019 budget request...................         4,893,000
 

    This appropriation provides for medical, rehabilitative, 
and health services research. The bill makes $705,262,000 of 
this funding available through September 30, 2020. The 
Committee recognizes the importance of the research conducted 
by VA for veterans' quality of life and health and provides 
$4,893,000 above the request and $10,000,000 above last year 
for these activities. Of the funding provided, $27,000,000 
supports VA's collaboration with the Department of Energy (DOE) 
via a long-term inter-agency agreement to leverage DOE's next 
generation artificial intelligence, big data, and high-
performance computing technologies, as well as multi-modal 
diagnostics and data integration, in order to develop specific 
precision medicine applications. This funding is made available 
through September 30, 2023.
    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 health care 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 
2019 research resources beyond the research account are 
$1,188,000,000.
    PTSD 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 bill provides up to $40,000,000 for the Center 
in fiscal year 2019, compared to the budget request of 
$19,680,000.
    Modeling and simulation treatment of PTSD.--As a mechanism 
to explore treatments for PTSD, the Committee is aware that the 
use of modeling and simulation technology has enabled the 
development of innovative and immersive therapies, which can 
extend trauma management therapy protocol. The Committee 
encourages VA to continue its research into therapeutic virtual 
environments using real-time modeling and simulation training 
to treat PTSD.
    Identifying at-risk veterans through social media 
algorithms.--The committee encourages VA to investigate the use 
of technology, specifically social media database algorithms, 
to detect and identify, via indirect contact such as on social 
media, veterans who are at risk of harming themselves or 
others. Once an individual is 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.
    Dystonia.--The Committee is concerned that there may be a 
connection between traumatic brain injury (TBI) and the onset 
of dystonia and that this may disproportionately impact 
veterans. The Committee, therefore, urges the 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 
are essential to reducing the number of veteran suicides. For 
this reason, the Committee urges VA to utilize funds, in an 
amount deemed appropriate by the Secretary, to prioritize 
investments in research on the efficacy and safety of cannabis 
usage among the veteran population for medicinal purposes. The 
Committee also requests a report, within 180 days after the 
enactment of this Act, by the Secretary containing a detailed 
plan on how the Department expects to pursue this research. The 
Committee also urges VA to ensure any research conducted or 
supported by VA on cannabis therapy is preserved in a manner 
that will facilitate further research.
    Comprehensive cancer centers.--The Committee seeks to 
ensure that veterans have access to the highest quality cancer 
care available. The Committee, therefore, applauds the ongoing 
collaborative efforts between VA medical centers and NCI-
designated comprehensive cancer centers. The Committee supports 
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 is 
also pleased that VA is engaged with the NCI and VA Interagency 
Group to Accelerate Trials Enrollment (NAVIGATE) partnership, 
which will improve access to certain clinical trials at a 
number of VA facilities. The Committee understands that 
initiating new clinical trials is a resource-intensive process 
requiring experienced coordination staff with specialized 
expertise in data management and regulatory compliance. To 
improve its own capacity to coordinate a full range of cancer 
clinical trials with non-VA organizations, the Committee 
encourages VA to provide resources for coordination staff and 
continue to develop partnerships with non-VA organizations that 
have initiated pilot clinical trials programs. The Committee 
also requests a report, within 90 days of enactment of this 
Act, which provides an overview of VA's credentialing process 
for non-VA clinical trial coordinators and recommendations, if 
any, to improve this process.
    Respiratory disease.--The Committee notes the high burden 
of respiratory illnesses, such as lung cancer, on the veteran 
population. The Committee urges VA to provide support for 
respiratory research proposals commensurate with the burden of 
respiratory disease in this population.
    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, and all other geographic areas where these toxic 
substances were dispersed. The Committee urges VA 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 health care 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 urges 
that a proportionate amount of prosthetics research should be 
focused on prosthetics meant for female veterans. The Committee 
repeats its direction that VA, in collaboration with the 
Prosthetic Women's Workgroup, issue a comprehensive report on 
female veteran amputees and their access to prosthetics. 
Furthermore, the Committee directs VA to submit this report on 
an annual basis that coincides with the annual VA budget 
submission as its own chapter in the relevant budget documents.
    Hydraulic prosthetic technology.--The Committee is aware of 
recent developments in hydraulic prosthetic technology. 
Hydraulic designs fill the gap between standard myoelectric 
grippers and premium, bionic-like hand prostheses, offering 
cost-effective solutions with advanced motion control and 
flexibility. The Committee also understands that VA is limited 
to providing prosthetic devices that have been approved by the 
Food and Drug Administration (FDA). Therefore, the Committee 
encourages the Department to monitor the development of this 
technology and, if approved by the FDA, to implement pilot 
programs that assess its benefits for veterans.
    Specialized and modular prosthetics research.--As 
referenced in the Statement of Managers accompanying Public Law 
115-141, the field of specialized and modular prosthetics is 
evolving at a faster pace than VA has been able to match. The 
Statement of Managers directed VA to provide a report on this 
issue; however, due to the late passage of the fiscal year 2018 
Omnibus the report remains outstanding. The Committee 
reiterates its interest in this report and urges the Department 
to complete the report as soon as possible.
    Neuromuscular junction (NMJ) regeneration research.--The 
Committee applauds VHA for its support of cutting edge research 
into the molecular mechanisms that govern NMJ. This knowledge 
is essential to making improvements in the re-innervation of 
denervated muscles. Progress in this area is critical to 
reducing the incidence of long-term disability among military 
personnel as a result of combat-related extremity injuries and 
other non-combat related incidents. It is also crucial to 
mitigating the disproportionate incidence of neurodegenerative 
disorders among the veteran population. Consequently, the 
Committee strongly encourages VHA to dedicate additional 
research resources to efforts to better understand the 
underlying mechanisms of NMJ regeneration.
    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 
also urges VA to make public all of its available research data 
on Gulf War illness, particularly disease-specific mortality 
data related specifically to Gulf War veterans.
    Gulf War illness.--The Committee encourages VA to continue 
inclusion of research on functional gastrointestinal (GI) 
disorders in its research related to Gulf War Illness.
    Post-deployment integrated care.--Each new generation of 
veteran faces unique service-related conditions. Historically, 
it has been a challenge, when large-scale deployments occur, to 
identify signature wounds and develop and implement appropriate 
care models for returning combat veterans in a timely way. 
Given the evolving responsibilities for current and future 
military service personnel, the Committee directs VA, through 
the War Related Illness and Injury Study Center (WRIISC) and 
the Offices of Patient Care Services and Post-Deployment Health 
Services, to provide to Congress, no later than 120 days after 
enactment of this Act, an assessment of the process by which VA 
develops and improves its approaches to post-deployment 
integrated care for returning combat veterans. The report shall 
build on lessons learned from previous veteran cohorts and care 
models, including the Post-Deployment Integrated Care 
Initiative (PDICI). The report shall include recommendations to 
ensure VA has the capabilities and agility to identify and meet 
the needs of the next generation of combat veterans.
    The Million Veteran Program (MVP) Computational Health 
Analytics for Medical Precision to Improve Outcomes Now 
(CHAMPION) project.--The Committee supports the MVP-CHAMPION 
project, and encourages VA to continue leveraging the high 
performance computer facilities available through its 
partnership with the Department of Energy to focus on the 
secure analysis of large digital health and genomic data. The 
Committee also encourages VA to provide principal investigators 
at VA sites across the country for participation in the 
project. Further, the Committee recognizes that VA may benefit 
from the help of academic institutions across the country 
regarding sample collecting, contributions to relevant 
research, precision medicine, and health informatics. The 
Committee, therefore, encourages VA to consider a small number 
of pilot programs with academic health institutions that have 
biorepositories, existing clinical partnerships with VA, data 
security programs, and clinical care strengths in at least one 
of the following three identified areas of priority: suicide 
prevention, prostate cancer, and cardiovascular disease. 
Priority may be given to institutions that also have existing 
partnerships with the Department of Energy.
    Canine research.--The Committee understands there may be 
times that research involving canines leads to advances that 
benefit the health of our veterans. However, the Committee 
remains concerned about the extent of such experimentation and 
continues the language in the Consolidated Appropriations Act, 
2018 limiting canine research to those studies in which the 
scientific objectives of the study can only be met by research 
with canines, the study has been directly approved by the 
Secretary, and the study is consistent with the revised VA 
canine research policy document released on December 18, 2017. 
Additionally, the Committee is aware that on March 13, 2018, 
the VA publicly announced that VHA's Office of Research and 
Development would be conducting a ``rapid, in-depth internal 
review of existing canine research projects.'' The Committee 
directs VA to provide the results of this review to the 
Committee as soon as it is completed.
    Public access to scientific data.--The Committee commends 
VA 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 requests a status 
report be submitted in conjunction with the fiscal year 2020 VA 
budget.

                     Medical Care Collections Fund

    The Department of Veterans Affairs Medical Care Collections 
Fund (MCCF) was established by the Balanced Budget Act of 1997 
(Public Law 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 2019 is $3,590,000,000.

                    National Cemetery Administration

 
 
 
Fiscal year 2018 enacted level........................      $306,193,000
Fiscal year 2019 budget request.......................       315,836,000
Committee recommendation in the bill..................       315,836,000
Comparison with:
    Fiscal year 2018 enacted level....................         9,643,000
    Fiscal year 2019 budget request...................             - - -
 

    The National Cemetery Administration (NCA) was established 
in accordance with Public Law 93-43, the National Cemeteries 
Act of 1973. 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 135 
operational national cemeteries and 33 other cemeterial 
installations.
    The bill includes language making ten percent of the total 
available until September 30, 2020.
    Unclaimed remains of veterans.--Throughout the country, 
there are reports of unclaimed remains of veterans being stored 
due to the absence of someone to claim these remains and begin 
the process for proper interment. The Committee was pleased to 
learn that NCA has recently taken steps to establish a process 
to address unclaimed remains of veterans at various locations. 
As VA establishes a process for unclaimed remains the Committee 
urges VA, in consultation with the National Park Service, to 
also consider including in this process ways to deal with 
remains of veterans that are left at National Memorials.
    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. In 
five years, VA has only reduced this number to eight percent 
while receiving generous funding increases in a tight budget 
environment. As a result, the Committee continues to be 
concerned that there are geographic pockets in the country that 
are not being served, and VA has failed to meet its goal 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.

                      Departmental Administration

                         GENERAL ADMINISTRATION

                     (INCLUDING TRANSFER OF FUNDS)

 
 
 
Fiscal year 2018 enacted level........................      $335,891,000
Fiscal year 2019 budget request.......................       367,629,000
Committee recommendation in the bill..................       346,091,000
Comparison with:
    Fiscal year 2018 enacted level....................        10,200,000
    Fiscal year 2019 budget request...................      (21,538,000)
 

    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, 2020, up to 
five percent of these funds and to permit the transfer of funds 
in this account to the General Operating Expenses, Veterans 
Benefits Administration account.
    Five year development plan.--The Committee is very pleased 
that the Department has provided a Five Year Development Plan 
(FYDP) in its fiscal year 2019 budget. The Committee has asked 
for such a document for years, but has faced resistance in the 
past. The FYPD has proved very useful in analysis of Military 
Construction budgets and the Committee looks forward to annual 
review of the FYDP in VA budget submissions.
    Quarterly financial information reports.--The bill includes 
an administrative provision which extends the requirement for 
submission of the quarterly financial information required in 
the fiscal year 2018 bill and conference report.
    Additional budgetary information.--The Committee continues 
its request that items described in the fiscal year 2015, 2016 
and 2017 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 which 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, within 90 days of 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 System (FMS) replacement.--The 
agreement includes $10,800,000 in this account as well as 
$72,821,000 in the Information Technology Systems account for 
development of a new financial management system. The current 
legacy financial management system is 30 years old, and its 
imminent failure presents significant risks to VA. 
Unfortunately, the VA agreement to use the Department of 
Agriculture's (USDA) Federal Shared Services financial 
management system to develop its FMS has collapsed, and VA is 
trying to use the contracts established by USDA to reconstruct 
the financial management system it had anticipated acquiring 
through USDA. The Committee continues to be concerned with VA 
moving forward alone, given the disastrous outcomes of its two 
previous attempts to create a modern financial management 
system. In the fiscal year 2018 conference report, VA was 
directed to provide a report to the Committee, within 60 days 
of enactment of that Act, which described the components to be 
included in its planned financial management system, such as 
acquisition, the cost of the contracts and staffing that VA has 
acquired from USDA, the annual and total costs of the project, 
and its timeline and performance benchmarks. In addition, 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 2019. The Committee has also assigned its own 
investigative staff to review the system VA plans to develop 
and to provide the Committee periodic reports on the project.
    Management reforms.--In House Report 115-188 the Committee 
was concerned that the Department had not yet implemented 
hundreds of recommendations that would address ongoing 
management challenges and directed VA to provide 
recommendations for legislation regarding the roles, 
responsibilities, and accountability of elements and 
individuals of the Department of Veterans Affairs. The 
Committee looks forward to the submission of this report.
    Poverty trends in the veteran population.--The Committee 
requests that VA update its 2015 analysis of poverty trends in 
the veteran population by the National Center for Veterans 
Analysis and Statistics (NCVAS) and submit it to the Committee 
no later than 180 days after the enactment of this Act. The 
Committee urges VA to include in this analysis the relationship 
between veterans' labor force activity and poverty status and a 
demographic break-out, if available, by race and gender. 
Additionally, the Committee requests that VA continue such 
analyses on a biannual basis.
    Implementing the VA Accountability and Whistleblower 
Protection Act.--To ensure that the authorities granted in the 
Department of Veterans Affairs Accountability and Whistleblower 
Protection Act of 2017 are being applied consistently and as 
intended, the Committee directs VA to provide a report no later 
than 120 days after the enactment of this Act. The report 
should include data 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, and data regarding the frequency of appeals when 
such authorities are applied. The report should also include 
any available demographic data on overall VA workforce 
terminations since fiscal year 2016.
    Small, minority- and women-owned businesses.--The Committee 
recognizes the need for VA to continue to meet its goals for 
contracting with minority, disadvantaged, and women-owned 
businesses. The Committee is concerned that in fiscal year 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 encourages the 
Department to prioritize awarding contracts to contractors that 
consistently execute approved small business subcontracting 
plans. The Committee further urges the Department to prioritize 
minority-owned and disadvantaged contractors and 
subcontractors. The Committee requests a report, within 180 
days of enactment of this Act and annually thereafter, 
detailing the number of contractors which 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.
    Data on women and minority veterans.--The Committee 
recognizes the lack of data specific to women and minority 
veterans made available to Congress by VA. The Committee 
continues to recommend, when applicable, that VA display 
information separately for female and minority veterans in its 
annual report(s) to Congress.
    Veterans Day parade.--The Committee understands that the 
Administration may conduct a large military parade to honor 
American veterans on November 11, 2018, Veterans Day, to 
commemorate the one-hundredth anniversary of the ending of 
World War One. The authorizing committees plan to authorize the 
DOD Secretary to conduct the parade and to expend funds for 
particular purposes relevant to the parade. If VA is asked to 
contribute resources to the parade, the Committee expects the 
Department to follow DOD's example and limit expenditures to 
specific purposes that are directly associated with benefits to 
and recognition of veterans. The Committee directs VA to notify 
the Committee if and when it first expends funds related to the 
parade and to provide a quarterly report thereafter identifying 
any resources provided for the parade, including programmatic 
funding and personnel.

                       Board of Veterans Appeals

 
 
 
Fiscal year 2018 enacted level........................      $161,048,000
Fiscal year 2019 budget request.......................       174,748,000
Committee recommendation in the bill..................       174,748,000
Comparison with:
    Fiscal year 2018 enacted level....................        13,700,000
    Fiscal year 2019 budget request...................             - - -
 

    The bill makes ten percent of this funding available 
through September 30, 2020.
    The bill also provides the $9,505,000 requested in the 
Information Technology Systems budget to support the Appeals 
Modernization initiative. The initiative will convert the 
Board's 1980's-era case control and locator system to a new, 
automated integrated community developed suite that is used to 
process initial disability claims.
    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 
the 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. As the disability 
compensations claims backlog at VBA dwindles, the appeals 
workload at the Board increases correspondingly. Pending 
appeals are projected to increase by 31 percent from 153,513 at 
the end of 2017 to 201,816 by the end of 2019.
    Appeals reform.--The Committee is relieved that the 
historic Veterans Appeals Improvement and Modernization Act of 
2017, signed into law in August, 2017 will provide both VBA and 
BVA with the tools they need to reduce the troubling backlog of 
appeals. Although implementation of the new law will not be 
complete until March, 2019, the Committee is encouraged that 
both agencies are taking steps now to implement some of the 
Act's new authorities to reduce the appeals backlog. VBA has 
launched the Rapid Appeals Modernization Program (RAMP), which 
provides veterans with pending disability claims the option to 
participate in the new ``three lane'' appeals process 
authorized by RAMP during the implementation period. BVA is 
also testing a process to outsource a large majority of the 
case review process to reduce the administrative work currently 
done by decision-writing attorneys, which pulls them from their 
primary role of writing draft decisions. With the appeals 
received by VBA and BVA increasing dramatically each year as 
the backlog of initial disability claims is reduced, these 
efforts are vital to containing the volume of pending appeals 
and serving veterans who have waited years, in some cases, for 
adjudication of their claims. The Committee urges BVA to commit 
the necessary resources to reduce this backlog of appeals.
    Appeals modernization.--The Committee concurs with the 
recommendations in GAO report 18-352 regarding modernizing and 
improving VA's appeals process. The VA should articulate a more 
complete and balanced set of goals and measures for monitoring 
and assessing performance on a range of dimensions of success; 
include key planned activities; articulate interim goals and 
needed resources for, and inter-dependencies among, activities; 
and identify and mitigate key risks associated with 
implementing the new processes. The Committee directs the 
Secretary to fully implement the GAO's recommendations to 
ensure successful implementation of the new appeals process.
    Service-connected disability appeals.--The Committee 
continues to remain concerned about the excessive wait times 
that veterans must endure to receive appeals decisions, 
particularly appeals of service-connected disability claims. To 
assist the Committee in its oversight responsibilities, VA is 
directed to provide an analysis of appeals wait times related 
to service-connected disability claims since fiscal year 2014. 
The analysis should determine the average time, by fiscal year, 
for these appeals to be resolved and highlight VA's efforts to 
accelerate this appeals resolution process.
    Tele-appeals.--The Committee seeks to reduce the logistical 
burden for veterans during the claims appeals process. Current 
law, as stipulated in 38 USC 7107, requires that appeals made 
using video teleconferencing equipment be conducted at VA 
facilities. The Committee is interested in understanding the 
feasibility and cost of allowing veterans to conduct such 
appeals from locations of their own choosing, such as their 
homes. Therefore, the Committee requests a report, no later 
than 90 days after the enactment of this Act, that assesses the 
statutory, technological, and security issues that would need 
to be addressed to implement such a program. The report should 
include an assessment of currently available technologies and 
the cost associated with such technologies in the context of 
implementing such a program. The report should also include 
recommendations on legislative changes that would be needed to 
implement such a program.

                     INFORMATION TECHNOLOGY SYSTEMS

                     (INCLUDING TRANSFER OF FUNDS)

 
 
 
Fiscal year 2018 enacted level........................    $4,055,500,000
Fiscal year 2019 budget request.......................     4,184,571,000
Committee recommendation in the bill..................     4,105,500,000
Comparison with:
    Fiscal year 2018 enacted level....................        50,000,000
    Fiscal year 2019 budget request...................      (79,071,000)
 

    The Information Technology 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' health care services and 
benefits programs.
    Within the account total, the Committee allocates in bill 
language $1,235,320,000 for pay and associated costs, which is 
$7,900,000 below the budget request; $2,521,650,000 for 
operations and maintenance, which is $39,130,000 below the 
request; and $348,530,000 for development, which is $32,041,000 
below the request. The bill makes available five percent of pay 
and associated costs and of operations and maintenance funds 
until September 30, 2020. All development funds are available 
until September 30, 2020.
    The bill provides $32,013,000 for the Veterans Benefits 
Management System (in addition to the $36,212,000 which is 
provided for VBMS in the General Operating Expenses, Veterans 
Benefits Administration account); $72,821,000 for the 
replacement of the Financial Management System, in addition to 
the $10,800,000 provided in General Administration; $22,081,000 
for replacement of the NCA burial operations support system; 
and $9,505,000 for the Board of Veterans Appeals modernization 
effort.
    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. In addition, the 
Committee continues bill language permitting the transfer of 
funding among the three subaccounts upon approval of the 
Committees. The bill contains language which allows for the 
reprogramming of funds among development projects upon prior 
notification to, and approval by, the Committees. 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 Administration's budget 
request for development projects and includes the Committee's 
recommendation for each. 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)
------------------------------------------------------------------------
                                     Fiscal year 2019      Committee
              Project                 Budget request     Recommendation
------------------------------------------------------------------------
Clinical Applications.............            $32,479            $27,479
Health Management Platforms.......             70,391             60,391
Benefits Systems..................            129,615            112,574
Memorial Affairs..................             18,800             18,800
Other IT Systems..................             78,571             78,571
Cybersecurity.....................             17,000             17,000
Information/Infrastructure                     33,715             33,715
 Management.......................
                                   -------------------------------------
    Total, Development............            380,571            348,530
------------------------------------------------------------------------

    The Committee expects the Office of Information Technology 
to continue to provide an IT expenditure report to the 
Committees on Appropriations 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.
    Appointment scheduling system.--The Committee remains 
concerned about patient scheduling challenges and seeks to 
understand the Department's plan for a solution that will 
improve veteran access to care, shorten veteran wait times, 
allow the VA to track and manage patient progress throughout 
the care continuum, and improve resource utilization across the 
VA health care system. The Committee understands that a 
scheduling system will be a component of the new Electronic 
Health Record (EHR) program and that VA plans to deploy this 
new system to its first facilities within 18 months of the EHR 
program's contract award and to all its facilities within 10 
years of contract award. The Committee also understands that VA 
is conducting pilot programs involving commercial off-the-shelf 
solutions (COTS) scheduling systems to assess if they provide 
substantial value over its current interim systems. In order to 
determine whether full deployment of one of these pilot 
programs is warranted as an interim solution, pending full 
operational capability of the new EHR system, the Committee 
directs VA to provide the results of its evaluation of the 
pilot programs as soon as those evaluations are complete. 
Further, the Committee requests a report, within 90 days of 
enactment of this Act, that evaluates the cost and benefits of 
its interim scheduling systems, the commercial solutions 
considered in its pilot programs, including the pilot program 
referenced in House Report 115-188, and the EHR scheduling 
system, based on current contract requirements. The report's 
evaluation of the systems, or contract requirements, should 
include an assessment of mobile interface capabilities and the 
ability to schedule appointments outside the VA system.
    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 VA 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.
    Information technology solutions.--The Committee is 
encouraged by VA's efforts to modernize its electronic health 
record, but remains concerned about the use of critical 
resources on the development of internal Information Technology 
(IT) applications. To improve patient health outcomes and 
ensure the best possible care for veterans, the Committee urges 
VA to complete its review of its inventory of IT solutions and 
standardize best practices and proven technologies across the 
continuum of care for veterans. The Committee directs the 
Secretary to provide a report, no later than 90 days after 
enactment of this Act, outlining the Department's plan to 
evaluate and incorporate these IT applications to improve and 
promote veteran-centered care.

                   VETERANS ELECTRONIC HEALTH RECORD

 
 
 
Fiscal year 2018 enacted level........................      $782,000,000
Fiscal year 2019 budget request.......................     1,207,000,000
Committee recommendation in the bill..................     1,207,000,000
Comparison with:
    Fiscal year 2018 enacted level....................       425,000,000
    Fiscal year 2019 budget request...................             - - -
 

    The Veterans Electronic Health Record is a unified account 
designed to manage the effort to develop an electronic health 
record that will access seamlessly the records of veterans in 
the VA system and those of DOD 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 $675,000,000 
for the electronic health record contract, $120,000,000 for 
program management, and $412,000,000 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 Department has committed in future years to provide 
about 30 percent of the total cost of this ten-year project. 
The Committee expects that this pledge will be maintained 
throughout Department leadership changes.
    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 place top management of 
the project at the headquarters level above either the VHA or 
the Office of Information Technology, 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 
detailing obligations, expenditures, and deployment strategy by 
facility. In addition, the Committee repeats the fiscal year 
2018 directive for GAO to perform quarterly performance reviews 
of the VA electronic health record deployment so that the 
Committees are kept abreast of important issues such as cost 
and operational capability. It is expected that this quarterly 
reporting will avail the Committees and VA with timely 
information to properly oversee this effort and address 
important issues.
    The Committee remains concerned that the effort to deploy a 
different type of electronic record than the VistA system that 
VA physicians are accustomed to could run into major 
resistance. Other major electronic health record system start-
ups have failed in the face of internal resistance. The 
Committee urges VA to focus sufficient resources and attention 
to this change management challenge, which could be more 
difficult than the technical issues of implementing the new 
record.
    Delays in contract finalization.--The Committee was 
encouraged that VA finally decided to use the same EHR system 
as DOD, since it is vital that the two systems be 
interoperable. Last July, the Secretary announced that Cerner 
Corporation, which had participated in the DOD EHR contract, 
had received the sole source contract to develop the VA EHR. 
The Committee had a hearing last November in closed session to 
learn the details of the contract, its cost, design features, 
and anticipated project rollout across the VA network. 
Subsequently, the Committee provided the initial $782,000,000 
funding for the project, with the expectation that the Cerner 
contract would be signed soon after that funding became 
available. However, the contract may not be signed until the 
new Secretary is confirmed. The Committee is concerned that 
further delays could jeopardize VA's plans to roll out the EHR 
in the same regions and under the same timeframe as DOD is 
using for its new EHR system, as well as increase the program's 
cost. With a decade of futile effort and billions of dollars 
spent to develop the VA EHR, the agency needs to complete its 
contract as soon as possible. The Committee will continue to 
monitor VA expenditures for the new EHR, and if it is clear 
that delays in project management are slowing obligations, 
funding levels may be revisited during conference.
    Medical records portability.--The Committee supports 
veterans having real-time, seamless, and portable access to all 
of their medical records. As such, the Committee urges VA to 
develop, as part of its new EHR system, the means by which 
veterans can have secure, portable access to their own medical 
records.

                      OFFICE OF INSPECTOR GENERAL

 
 
 
Fiscal year 2018 enacted level........................      $164,000,000
Fiscal year 2019 budget request.......................       172,054,000
Committee recommendation in the bill..................       172,054,000
Comparison with:
    Fiscal year 2018 enacted level....................         8,054,000
    Fiscal year 2019 budget request...................             - - -
 

    The Office of Inspector General (OIG) was established by 
the Inspector General Act of 1978 and is responsible for the 
audit, investigation, and inspection of all VA programs and 
operations. The overall operational objective is to focus 
available resources on areas which 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, 2020.

                      CONSTRUCTION, MAJOR PROJECTS

 
 
 
Fiscal year 2018 enacted level........................      $512,430,000
Fiscal year 2019 budget request.......................     1,127,486,000
Committee recommendation in the bill..................     1,127,486,000
Comparison with:
    Fiscal year 2018 enacted level....................       615,056,000
    Fiscal year 2019 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 $10,000,000 or more.
    The Committee recommendation makes all but $480,000,000 of 
these funds available for a five-year period.
    In addition, Sec. 238 provides a total of $850,000,000 in 
additional funding for this account as part of the 
infrastructure initiative--$750,000,000 for seismic corrections 
and $100,000,000 for cemetery Major Construction.
    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 Administration's budget 
request for Major Construction projects and includes the 
Committee's recommendation for each.

                      CONSTRUCTION, MAJOR PROJECTS
                        (in thousands of dollars)
------------------------------------------------------------------------
     Location and description            Request          Recommended
------------------------------------------------------------------------
Veterans Health Admin. (VHA):
    St. Louis, MO, medical                     34,400             34,400
     facility improvements and
     cemetery expansion...........
    Canandaigua, NY, construction             190,000            190,000
     and renovation...............
    Dallas, TX, spinal cord injury            135,686            135,686
     facility.....................
    North Chicago, IL, renovate                 6,000              6,000
     building #4..................
    Oklahoma, OK new surgical                  10,800             10,800
     intensive care unit..........
    Advance Planning and Design                95,000             95,000
     Fund: various locations......
    Asbestos: various locations...             15,000             15,000
    Major Construction Staff:                  27,500             27,500
     various locations............
    Hazardous Waste: various                   26,200             26,200
     locations....................
    Judgment Fund: various                     25,000             25,000
     locations....................
    Non-Dept. Fed. Entity Project              38,700             38,700
     Management Support...........
    Seismic Corrections: various              400,000            400,000
     location.....................
                                   -------------------------------------
    Total, VHA....................          1,004,286          1,004,286
National Cemetery Admin. (NCA):
    Ohio Western Reserve:                      29,000             29,000
     gravesite expansion..........
    Great Lakes, MI: gravesite                 35,200             35,200
     expansion....................
    Cape Canaveral, FL: gravesite              38,000             38,000
     expansion....................
    Advance Planning and Design                10,000             10,000
     Fund.........................
    NCA Land Acquisition..........              5,000              5,000
                                   -------------------------------------
    Total, NCA....................            117,200            117,200
General Admin.:
    Staff Offices Advance Planning              6,000              6,000
     Fund.........................
                                   -------------------------------------
        Total, Construction Major          $1,127,486         $1,127,486
         Projects.................
------------------------------------------------------------------------

    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 House 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 Sec. 258 of Division A of 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.--While 
the Committee has strongly endorsed the management of large VA 
construction projects by the U.S. Army Corps of Engineers 
(``the Corps''), as required by section 502 of Public Law 114-
58, it recognizes that the transition to this new process has 
created some unavoidable delays in construction schedules. To 
better understand the timetable and construction issues 
associated with each VA project managed by the Corps, the 
Committee requests, within 60 days of enactment of this Act, 
the initiation of quarterly reports on each VA project managed 
by the Corps.
    Market assessment.--The Committee supports VA's efforts to 
obtain analysis that provides a more holistic view of VA 
facilities and thereby allows the Department to make more 
informed, data driven decisions about its facilities and 
buildings. The Committee recognizes that annual analysis and 
benchmarking across the Department's facilities will provide an 
invaluable tool for long-term system-wide planning, needs 
identification, and cost management for the Department. The 
Committee, therefore, encourages the Department to utilize an 
independent, third-party to provide facilities analysis, 
benchmarking and recommendations for all VHA hospitals, nursing 
homes, domiciliary facilities, and other necessary facilities.
    Training for VA personnel engaged in facility management.--
The Committee continues to be concerned by the lack of training 
and certification provided to engineering, construction and 
facility management staff with regard to building operations 
and maintenance. The Committee looks forward to receiving the 
report from VA on this topic as requested in House Report 115-
188.
    Parking facilities.--In H. Rpt. 115-188, the Committee 
noted that numerous parking facility projects throughout the 
Strategic Capital Investment Planning (SCIP) list are often 
skipped for more traditional VA construction projects, which 
has caused a backlog in parking facilities. In response, the 
Committee directed VA to provide information regarding how 
parking facility projects are rated, a timeline for completion 
of these projects, their cost, and any notable actions taken by 
VA medical centers to address parking issues. However due to 
the late passage of the fiscal year 2018 bill, this reporting 
requirement remains incomplete. The Committee reiterates its 
interest in this issue and looks forward to the final report.
    Public-private partnerships.--The Committee applauds VA for 
engaging in partnerships with academic institutions to 
facilitate closer scientific collaboration, while increasing 
the research space available to VA. Such partnerships are 
important in expanding the Department's research investment to 
leverage non-federal initiatives, which provide the opportunity 
for strong co-location of VA and university biomedical 
scientists for translational investigation. Such co-location 
and collaboration may enable precision medicine outcomes for 
wounded warriors and other high-at-risk veteran populations. 
Therefore, the Committee encourages VA to expedite 
consideration of proposals for the Department to co-locate its 
research facilities with academic institutions that are engaged 
in the conduct of multi-disciplinary investigations related to 
veterans and wounded warriors, including those related to 
medicine, engineering, and veterinary science.

                      Construction, Minor Projects

 
 
 
Fiscal year 2018 enacted level........................      $342,570,000
Fiscal year 2019 budget request.......................       706,889,000
Committee recommendation in the bill..................       649,514,000
Comparison with:
    Fiscal year 2018 enacted level....................       306,944,000
    Fiscal year 2019 budget request...................      (57,375,000)
 

    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 less than $10,000,000.
    In addition to this funding, $350,000,000 is provided in 
Sec. 238 for VHA Minor Construction projects as part of a 
$2,000,000,000 infrastructure initiative. A similar initiative 
provided $425,000,000 in additional funds for this account in 
fiscal year 2018.
    As with the Major Construction account, the Committee 
recommendation makes these funds available for a five-year 
period.
    Ambulatory surgical centers (ASC).--The Committee is 
concerned about VA's ambulatory surgical capacity and believes 
a focus on ambulatory surgical services, as provided by ASCs, 
has the potential to provide substantial cost savings and 
improve health outcomes for veterans. However, the Committee 
understands that VHA does not consider ASCs to be one of its 
foundational services and, therefore, does not place any 
special priority on construction of ASCs during the SCIP 
process. To better understand the role of ASCs, the Committee 
directs VHA to provide a report, no later than 60 days after 
enactment of this Act, which assesses whether assigning a 
specific prioritization to ASCs during the SCIP process would 
provide substantial cost savings and improve health outcomes 
for veterans by increasing VHA's ambulatory surgical capacity. 
The report should also include a timeline for completion of 
pending ambulatory surgical center projects, their costs, and 
any notable actions taken by VA medical centers to address 
ambulatory surgical needs.
    Construction of housing for rural homeless veterans.--The 
Department has made great efforts to find suitable housing for 
homeless veterans and their families. However, more non-
traditional efforts should be made to eliminate this problem. 
For example, some cities and towns have started pilot programs 
using Micro or ``Tiny Homes'' to help deal with homelessness. 
However, due to the lack of legislative authority the VA is 
unable to utilize tiny homes for homeless veterans. The 
Committee is interested in what statutory changes would be 
needed for VA to be able purchase and construct, single unit, 
Micro or ``Tiny Homes'' for homeless veterans. This approach 
could provide a pathway to stable housing for veterans. The 
Committee directs VA to identify the necessary statutory 
changes in a report no later than 60 days after enactment of 
this Act.
    Impact of changes to Historic Preservation Tax Credit to 
historic VA facilities.--The Committee encourages VA to work 
with Enhanced-Use Lease (EUL) project sponsors, the Internal 
Revenue Service, local VA, and any other relevant officials to 
address the adverse impacts that changes to the Historic 
Preservation Tax Credit made by Public Law 115-97, are having 
on EUL projects to renovate and rehabilitate historic VA 
facilities. The Committee is aware that some of the recent tax 
law changes have made it harder to complete longstanding 
projects because they reduced the value of tax credits needed 
to bring the projects to fruition, resulting in a funding gap. 
For example, VA selected a Preferred Developer to carry out a 
EUL to renovate historic VA buildings in July 2016 but still 
has not yet formally signed the lease. Without action by VA, 
this critical project to provide permanent supportive housing 
for veterans and their families that are homeless, or at risk 
of homelessness, is now at risk due to additional and 
unanticipated costs directly related to how the historic 
preservation tax credit can be used for the project. Therefore, 
the Committee urges VA to work with interested parties to find 
a solution, including developing options to directly provide 
capital funding, technical, and other assistance to prevent the 
loss of benefits to veterans should these projects stall as a 
direct result of changes beyond the sponsor's control that were 
unforeseen when these projects were put out to bid.

       Grants for Construction of State Extended Care Facilities

 
 
 
Fiscal year 2018 enacted level........................      $110,000,000
Fiscal year 2019 budget request.......................       150,000,000
Committee recommendation in the bill..................       150,000,000
Comparison with:
    Fiscal year 2018 enacted level....................        40,000,000
    Fiscal year 2019 budget request...................             - - -
 

    In addition to funding provided in this account, as part of 
a $2,000,000,000 VA infrastructure initiative, the fiscal year 
2018 appropriations bill provided $575,000,000 for State homes. 
This funding, in conjunction with the regular fiscal year 2018 
appropriation, was sufficient to clear the longstanding backlog 
of approved State applications.
    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 2018 enacted level........................       $45,000,000
Fiscal year 2019 budget request.......................        45,000,000
Committee recommendation in the bill..................        45,000,000
Comparison with:
    Fiscal year 2018 enacted level....................             - - -
    Fiscal year 2019 budget request...................             - - -
 

    This program provides grants to assist States and tribal 
governments with the establishment, expansion, and improvement 
of veterans' cemeteries which 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. The States 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 38 administrative provisions, all of 
which were included in the fiscal year 2018 bill in some form.

                     (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 2018. 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 2018 for ``Compensation and 
Pensions'', ``Readjustment Benefits'', and ``Veterans Insurance 
and Indemnities'' for payment of accrued obligations recorded 
in the last quarter of fiscal year 2018.
    The bill includes section 207 allowing for the use of 
fiscal year 2019 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, the Office 
of Accountability and Whistleblower Protection, 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. The Administration proposed to delete 
this provision.

                     (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 before 
such transfer. The Administration proposal to modify this 
provision is not adopted.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 219 permitting the transfer of 
$307,609,000 of fiscal year 2020 funding appropriated for 
medical accounts to the Joint Department of Defense-Department 
of Veterans Affairs Medical Facility Demonstration Fund for the 
operation of facilities designated as combined Federal medical 
facilities.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 220 permitting the transfer of 
funds deposited in the Medical Care Collections Fund to the 
Joint Medical Facility Demonstration Fund for facilities 
designated as combined federal medical facilities.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 221 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 222 prohibiting funds from being 
used to replace the current system by which VISNs select and 
contract for diabetes monitoring supplies and equipment. The 
administration proposal to delete this provision is not 
adopted.
    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 5 
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. 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 $2,000,000. 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 both Appropriations 
Committees. This provision is intended to give VA flexibility 
as it administers the changes to its traditional health care 
program and the Choice 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 both Appropriations Committees. 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 both Appropriations Committees 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 budget 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 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 retains the language for this provision included in the 
2018 bill rather than returning to the 2017 language, as the 
Administration proposed.
    The bill includes section 235 prohibiting any funds being 
used in a manner that is inconsistent with statutory 
limitations on outsourcing.
    The bill includes section 236 which prohibits funds from 
being used to transfer funding from the Filipino Veterans 
Equity Compensation Fund to any other VA account.
    The bill includes section 237 prohibiting the use of 
canines in VA research unless: the scientific objectives of the 
study can only be met by using canines; the study has been 
directly approved by the Secretary; and the study is consistent 
with the revised VA canine research policy document released in 
December, 2017.
    The bill includes section 238 providing $2,000,000,000 for 
infrastructure improvements, allocated between $750,000,000 for 
seismic corrections, $800,000,000 for non-recurring 
maintenance, $100,000,000 in Major Construction for National 
Cemetery Administration projects, and $350,000,000 in Minor 
Construction for Veterans Health Administration projects.

                               TITLE III

                            RELATED AGENCIES

                  American Battle Monuments Commission

                         SALARIES AND EXPENSES

    The recommendation includes $75,100,000 for Salaries and 
Expenses of the American Battle Monuments Commission (ABMC), as 
requested.

                 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 $33,600,000 for Salaries and 
Expenses for the United States Court of Appeals for Veterans 
Claims. The fiscal year 2018 omnibus included bill language 
requiring a feasibility study prior to the purchase of a new 
courthouse. The study has not been completed, therefore the 
recommendation does not include the funds requested for a new 
courthouse.

         Department of Defense--Civil Cemeterial Expenses, Army

                         SALARIES AND EXPENSES

    The recommendation includes $70,800,000 for Salaries and 
Expenses for Arlington National Cemetery (ANC), as requested. 
The Committee appreciates ANC's emphasis on acquisition 
improvements, including training, certification and workforce, 
to improve procurement and accountability.

                              CONSTRUCTION

    The recommendation includes $73,855,000 for planning and 
design and construction of Southern Expansion to remain 
available until expended.
    Southern Expansion.--The recommendation includes 
$73,855,000 for planning and design and construction of 
Southern Expansion to remain available until expended. The 
Committee notes that Public law 115-141 included $167,000,000 
above the budget request for the Southern Expansion and road 
realignments to extend the life of the cemetery. For fiscal 
year 2019 the bill again includes additional funds for Southern 
Expansion which brings the total funds available for this 
project to $240,855,000, well short of the projected 
$300,000,000 plus that will be needed to complete this project. 
The Committee notes that the Office of Management and Budget 
will need to dedicate resources in future budget submissions to 
ensure that the life of our Nation's most prestigious cemetery 
is extended into the 2050 timeframe.

                      Armed Forces Retirement Home

                               TRUST FUND

    The recommendation includes $64,300,000 for the Armed 
Forces Retirement Home (AFRH), which is the same as requested, 
although $22,000,000 of the total is provided from the general 
fund of the Treasury, and not the Trust Fund. The Committee 
notes that there are major challenges for the near- and long-
term sustainability of the Trust Fund, which was created to 
provide all resources required for operations and expenses of 
the two AFRH locations. The Trust Fund is replenished from a 
variety of sources, including fines and forfeitures and Active 
Duty Withholding. However, the largest source of funds, which 
is derived from fines and forfeitures, is diminishing.
    AFRH and the Department of Defense (DOD) were directed by 
Congress to develop an approach that will replenish the Trust 
Fund in a sustainable, reliable manner. The Committee again 
asserts that the use of the General Fund is not a long-term 
solution, and AFRH is directed to work with DOD to continue to 
develop alternatives during fiscal year 2019, to be included in 
the fiscal year 2020 budget request. In addition, AFRH is 
directed to report to the Committee quarterly, on the Trust 
Fund balance, receipts and expenditures, and the progress of 
its efforts to lease property at the Washington, D.C. facility. 
Further, AFRH is directed to submit a report to the Committee 
on business practice reforms, revised funding models, and long-
term plan to stabilize the Armed Forces Retirement Home Trust 
Fund.

                        Administrative Provision

    The bill includes one provision that was in effect in 
fiscal year 2018. The administrative provision included in the 
bill 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 2018 enacted level........................      $750,000,000
Fiscal year 2019 budget request.......................       921,420,000
Committee recommendation in the bill..................       921,420,000
Comparison with:
    Fiscal year 2018 enacted level....................       171,420,000
    Fiscal year 2019 budget request...................             - - -
 

    The Committee 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 $261,250,000 for Army military 
construction and planning and design for European Deterrence 
Initiative projects.

              Military Construction, Navy and Marine Corps

    The recommendation includes $227,320,000 for Navy and 
Marine Corps military construction and planning and design for 
European Deterrence Initiative projects.

                    Military Construction, Air Force

    The recommendation includes $345,800,000 for Air Force 
military construction and planning and design for European 
Deterrence Initiative projects.

                  Military Construction, Defense-Wide

    The recommendation includes $87,050,000 for Defense-Wide 
Overseas Contingency Operations and planning and design for 
Special Operations Command and European Deterrence Initiative 
projects.

                       Administrative Provisions

    The bill includes one provision that was in effect in 
fiscal year 2018 and includes one new administrative provision. 
The administrative provisions included in the bill are as 
follows:
    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.
    The bill includes section 402 prohibiting obligation or 
expenditure of planning and design funds for any project 
associated with European Deterrence Initiative in this title 
until a list of projects is submitted to the congressional 
defense committees.

                                TITLE V

                           GENERAL PROVISIONS

    The bill includes a total of 13 provisions: 12 provisions 
that are effective in fiscal year 2018 and a new provision as 
follows:
    The bill includes section 501 prohibiting the obligation of 
funds beyond the current fiscal year unless expressly so 
provided.
    The bill includes section 502 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 503 encouraging all departments 
and agencies funded in this Act to expand the use of ``E-
Commerce'' technologies and procedures.
    The bill includes section 504 specifying the Congressional 
committees that are to receive all reports and notifications.
    The bill includes section 505 prohibiting the transfer of 
funds to any instrumentality of the United States Government 
without authority from an appropriations Act.
    The bill includes section 506 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 507 requiring all reports 
submitted to the Congress to be posted on official websites of 
the submitting agency.
    The bill includes section 508 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 509 prohibiting the use of funds 
for payment of first-class travel by an employee of the 
executive branch.
    The bill includes section 510 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 511 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 512 prohibiting the use of funds 
in this Act for the renovation, expansion, or construction of 
any facility in the continental United States for the purpose 
of housing any individual who has been detained at the United 
States Naval Station, Guantanamo Bay, Cuba.
    The bill includes section 513 establishing a ``Spending 
Reduction Account'' in the bill.

              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, Air            $31,158,000
 Force (Sec. 126).....................................
Department of Defense, NATO Security Investment               25,000,000
 Program (Sec. 126)...................................
Department of Defense, Home Owners Assistance Program         15,000,000
 (Sec. 126)...........................................
 

                           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 transfer not to exceed $18,047,000 
in fiscal year 2020 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 
2019 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 $73,694,000 to 
be transferred to General Administration and Information 
Technology Systems from any funds appropriated in fiscal year 
2019 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 permitting funds deposited to the 
Medical Care Collections Fund for health care 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.

                 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 limiting movement of an 
Army unit with a testing mission.
    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, Army Reserve.
    Language is included under Title I providing additional 
funds for Military Construction, Air Force Reserve.
    Language is included under Title I that rescinds funds from 
prior year appropriations Acts.
    Language is included under Title I defining the 
congressional defense committees.
    Language is included under Title I to prohibit closure or 
realignment of Naval Station, Guantanamo Bay, Cuba.
    Language is included under Title I limiting the movement of 
any element of the Rapid Engineer Deployable Heavy Operational 
Repair Squadron Engineer outside the United States.
    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 I providing additional 
funds for enhancing force protection and safety at Military 
Installations.
    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 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 approval of 
a transfer between development projects in the Information 
Technology Systems account.
    Language is included under Title II establishing time 
limitations and reporting requirements concerning the 
obligation of Major Construction funds, limiting the use of 
funds, and allowing the use of funds for program costs.
    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 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 V 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 V 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 V 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 V prohibiting funds from 
being used to pay for first class travel in violation of 
federal regulations.
    Language is included under Title V 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 V 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.

          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):
    None.

                  Appropriations Not Authorized by Law

    Pursuant to clause 3(f)(1)(B) of rule XIII of the Rules of 
the House of Representatives, the following table lists the 
appropriations in the accompanying bill which are not 
authorized by law for the period concerned:

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                          Program Duplication

    No provision of this bill establishes or reauthorizes a 
program of the Federal Government known to be duplicative of 
another Federal program, a program that was included in any 
report from the Government Accountability Office to Congress 
pursuant to section 21 of Public Law 111-139, or a program 
related to a program identified in the most recent Catalog of 
Federal Domestic Assistance.

                          Directed Rule Making

    The bill does not direct any rule making.
    
    
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
    
    
    
          Compliance With Rule XIII, Cl. 3(e) (Ramseyer Rule)

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, existing law in which no change 
is proposed is shown in roman): None.

                 Comparison With the 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 of 1974, the following table compares 
the levels of new budget authority provided in the bill with 
the appropriate allocation under section 302(b) of the Budget 
Act:

                        [In millions of dollars]
------------------------------------------------------------------------
                                302(b) Allocation         This bill
                             -------------------------------------------
                                Budget                Budget
                              authority   Outlays   authority   Outlays
------------------------------------------------------------------------
Mandatory...................    106,125    105,903    106,125  \1\105,90
                                                                       3
Discretionary...............     96,920     89,311     96,920     89,311
    General Purpose.........     95,999     89,311     95,999     89,311
    Overseas Contingency            921          0        921          0
     (OCO)..................
------------------------------------------------------------------------
\1\Includes outlays from prior-year budget authority.

                    Five-Year Projection of Outlays

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

                        [In millions of dollars]
------------------------------------------------------------------------
   Projection of outlays associated with the
                recommendation                    Non-OCO        OCO
------------------------------------------------------------------------
2019..........................................   \1\113,849            0
2020..........................................        5,427            0
2021..........................................        5,248            0
2022..........................................        3,229            0
2023 and future years.........................        3,549            0
------------------------------------------------------------------------
\1\Excludes outlays from prior-year budget authority.

               Assistance to State and Local Governments

    Pursuant to clause 3(c)(2) of rule XIII of the Rules of the 
House of Representatives and section 308(a)(1)(C) of the 
Congressional Budget Act of 1974, the amount of financial 
assistance to State and local governments is as follows:

                        [In millions of dollars]
------------------------------------------------------------------------
                                                        This bill
                                               -------------------------
                                                   Budget
                                                 authority     Outlays
------------------------------------------------------------------------
Financial assistance to State and local                 267        \1\50
 governments for 2019.........................
------------------------------------------------------------------------
\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

    The fiscal year (FY) 2019 Military Construction, Veterans 
Affairs, and Related Agencies Appropriations bill funds 
critical military construction, family housing and quality of 
life improvements and enhancements for our brave men and women 
in uniform and their families. This bill provides $96.9 billion 
in total discretionary funding. This level is $4.2 billion 
above the FY 2018 enacted funding level, but $131 million below 
the FY 2019 budget request.

                         Military Construction

    The bill funds military construction at $10.3 billion, 
which is $131 million below the FY 2019 request. The bill fully 
funded the Services' Construction budget request in all but a 
few cases. For certain projects, documents submitted with the 
budget showed that not all the funding would be executed 
promptly. For those projects, the subcommittee provided 
incremental funding, which is a long-standing subcommittee 
practice. The bill fully funded Family Housing accounts and 
provides $322 million for the Base Realignment and Closure 
(BRAC).
    The bill also prioritizes safety projects by including $150 
million to address shortfalls in access control points, air 
traffic control towers, fire stations, and Anti-Terrorism/Force 
Protection deficiencies across the Department of Defense (DOD) 
enterprise. These additional funds will improve safety at DOD 
facilities, providing safer working environments for service 
members.

                            Veterans Affairs

    The bill provides $85.3 billion in discretionary funding 
for the Department of Veterans Affairs (VA), which is $3.9 
billion above the FY 2018 enacted level and equal to the 
President's request. The recommendation also includes the 
budget request of $75.6 billion in discretionary funds for the 
FY 2020 advance appropriations for VA medical services. The 
bill includes $318 million, equal to the FY 2019 President's 
request, for battle monuments and cemeteries for our heroes who 
have made the ultimate sacrifice.
    We are delighted the bill rejects the Administration's 
proposal to combine the Medical Services and Community Care 
accounts into one enormous account. We believe that maintaining 
the current structure of two accounts offers the most 
transparency for the Committee to both monitor and control 
spending in these two areas.
    This bill also honors the budget deal and includes $2 
billion for infrastructure improvements to support seismic 
corrections and address non-recurring maintenance issues. 
Democrats continue to believe that the administration must make 
rebuilding the VA system a priority. This funding is vital to 
helping the VA address its infrastructure issues and provide 
adequate in-house care for our nation's veterans.
    One of our biggest concerns has been to enhance the VA's 
capabilities for suicide prevention. The bill rightfully 
provides the full FY 2019 budget request of $8.6 billion for 
mental health programs, of which $196 million is for Suicide 
Prevention. Furthermore, the bill repeats language first 
included in the FY 2017 bill requiring the Veterans Crisis Line 
(VCL) to provide immediate assistance from a trained 
professional and to adhere to all requirements of the American 
Association of Suicidology. The funding and the bill language 
are vital pieces in helping VA combat veterans suicide.
    Finally, we are extremely pleased that the bill continues 
to provide access to in-vitro fertilization treatments, which 
is consistent with the VA's goal to support veterans and 
improve their quality of life. We believe that veterans who are 
unable to conceive children deserve the care and support they 
need to start a family.
    This bill does a lot of things we all support. However, it 
could have been improved if the Committee had adopted two 
amendments offered by Ranking Member Wasserman Schultz.
    The first amendment would have struck funding for a $69 
million High-Value Detention Facility at Guantanamo Bay Naval 
Station and instead provide those funds to the Enhancing 
Security and Safety provision. We believe this project is a 
colossal waste of resources, especially when balanced against 
the needs of our military service members. Placing the needs 
and wellbeing of 40 detainees at Guantanamo Bay above the needs 
of the service members who serve our country does not reflect 
our nation's priorities.
    The second amendment would have prohibited military 
construction dollars from being used to build the 
Administration's ill-conceived border wall. Using Department of 
Defense (DOD) funding for construction would dramatically 
change how our government has approached border security. If 
DOD is tasked to build a border wall, it will shift the 
responsibility of securing the border from the Department of 
Homeland Security, which has long had jurisdiction, to DOD and 
would put DOD in a position to lead where it has chiefly held a 
supporting role. Furthermore, using DOD funding for the 
construction of border infrastructure would be unprecedented 
and is extremely alarming knowing that currently 31 percent of 
DOD infrastructure is rated as poor or failing.
    Unfortunately, the majority spoke against both of these 
amendments, and they both failed.

                     The Broken Republican Process

    The Bipartisan Budget Agreement enacted early this year 
provided relief from unworkable discretionary spending caps. 
The agreement was supposed to provide the country with 
stability following a year of shutdowns, last-minute veto 
threats, and general uncertainty in government. That stability 
lasted long enough for Congress to pass a bipartisan Omnibus 
appropriations bill for FY 2018 and then Republican chaos 
reigned again. The President threatened to veto the bill, 
unhappy with Congress' large investments in programs to help 
low- and middle-income Americans and rejection of his campaign-
promised border wall.
    Even after the President backed off his threat and signed 
the bill, the Administration and Republican leadership in 
Congress who voted for the Bipartisan Budget Act and the 
Omnibus bill have continued to attempt to undo those bipartisan 
agreements. Now, the majority is seeking to pass a rescissions 
bill to undo funding and mollify an angry President. We have 
been told by OMB Director Mick Mulvaney that this is the first 
of many rescission packages meant to bring spending in line 
with the President's priorities, ignoring Congressional action 
that dismissed the President's FY 2017 and FY 2018 draconian 
budget requests.
    In addition to the unacceptable rescissions proposals, the 
majority's lack of transparency with regards to how it will 
allocate the FY 2019 discretionary budget also endangers future 
bipartisan compromise. The majority has abandoned longstanding 
committee practice to provide the Members and the public with a 
budget blueprint for domestic spending, known as 302(b) 
allocations. Members are being asked to vote on bills without 
having the full picture on what impact each bill will have on 
other bills. We are very concerned about what that means for 
programs in other bills that have yet to be considered. 
Democrats can only be left to assume that the majority is 
siphoning money from bills at the end of the process like the 
State and Foreign Operations bill and the Labor, Health and 
Human Services, and Education appropriations bill.
    In conclusion, we commend the Chairman for the funding 
levels within the bill and his receptiveness to Democratic 
Members' concerns. The bill reported out of the Committee 
represents a good, reasonable approach, preserves our long 
commitment to our veterans and our military facilities, and 
continues a bipartisan tradition of providing funding levels 
that Members on both sides agree are appropriate while avoiding 
controversial legislative riders that complicate passage. 
However, we are extremely disappointed in the 302(b) allocation 
process because hiding these numbers only makes our Committee's 
work more difficult. Inviting partisanship back into the 
appropriations process by shortchanging critical domestic and 
international priorities will endanger the good work in this 
and other bills.

                                   Nita M. Lowey.
                                   Debbie Wasserman Schultz.

                                  [all]
```