25–912 

115TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 115–188 

MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND 

RELATED AGENCIES APPROPRIATIONS BILL, 2018 

JUNE 22, 2017.— 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. 2998 ] 

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, 2018, and 

for other purposes. 

CONTENTS 

Page 

Purpose of the Bill ................................................................................................... 2 

Summary of Committee Recommendation ............................................................ 2 

Comparative Statement of New Budget Authority ............................................... 5 

Management and Oversight Initiatives ................................................................. 18 

Item of Interest ........................................................................................................ 19 

Department of Defense: 

Military Construction ....................................................................................... 19 

NATO Security Investment Program .............................................................. 31 

Family Housing Construction and Operation and Maintenance .................. 32 

Department of Defense Family Housing Improvement Fund ....................... 34 

Department of Defense Military Unaccompanied Housing Improvement 

Fund ............................................................................................................... 34 

Department of Defense Base Closure Account ............................................... 34 

Administrative Provisions ................................................................................ 34 

Department of Veterans Affairs: 

Veterans Benefits Administration ................................................................... 37 

Veterans Health Administration ..................................................................... 43 

National Cemetery Administration ................................................................. 69 

Departmental Administration ......................................................................... 71 

2 

Administrative Provisions ................................................................................ 81 

Related Agencies: 

American Battle Monuments Commission ..................................................... 85 

U.S. Court of Appeals for Veterans Claims .................................................... 86 

Cemeterial Expenses, Army ............................................................................ 86 

Armed Forces Retirement Home ..................................................................... 86 

Administrative Provisions ................................................................................ 87 

Department of Defense: 

Overseas Contingency Operations .................................................................. 87 

Administrative Provisions ................................................................................ 88 

General Provisions ................................................................................................... 88 

House of Representatives Report Requirements ................................................... 89 

Statement of General Performance Goals and Objectives ............................ 89 

Rescissions ........................................................................................................ 90 

Transfer of Funds ............................................................................................. 90 

Disclosure of Earmarks and Congressionally Directed Spending Items ...... 91 

Changes in Application of Existing Law ........................................................ 92 

Appropriations Not Authorized by Law .......................................................... 95 

Program Duplication ........................................................................................ 97 

Directed Rule Making ...................................................................................... 97 

Full Committee Votes ...................................................................................... 97 

Ramseyer Rule .................................................................................................. 97 

Comparison With the Budget Resolution ....................................................... 100 

Five-Year Projection of Outlays ...................................................................... 100 

Assistance to State and Local Governments .................................................. 100 

State Project List .............................................................................................. 101 

Minority Views .................................................................................................. 117 

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 for 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 programs to ensure that all 

veterans receive the benefits and medical care that they have 

earned as a result of the sacrifices they have made in their service 

to our country. 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 $192,752,435,000 in budget authority for the fiscal year 2018 programs and activities funded in the 

bill. The fiscal year 2018 recommendation is an increase of 

$7,424,221,000 above the fiscal year 2017 enacted level and 

$573,421,000 below the President’s request. Of the increase over 

the fiscal year 2017 enacted level, $1,415,954,000 is in mandatory 

programs. Included in the total budget authority is 

$103,948,435,000 in mandatory budget authority and 

$88,804,000,000 in discretionary budget authority. 

The Committee recommendation highlights the continued commitment to our servicemembers and their families and to our vetVerDate Sep 11 2014 06:22 Jun 23, 2017 Jkt 025912 PO 00000 Frm 00002 Fmt 6659 Sfmt 6602 E:\HR\OC\HR188.XXX HR188
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erans. In discretionary budget authority, the bill is 7.3 percent over 

the fiscal year 2017 enacted level. The bill includes an increase in 

military construction, which is 25.5 percent above the fiscal year 

2017 level, and an increase in the Department of Veterans Affairs 

budget, which is 5.3 percent over the fiscal year 2017 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 missioncritical. Where it was prudent, the Committee recommendation rescinds prior year funding that is no longer needed for the purpose 

for which it was 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, resource 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 

$10,223,000,000, which is $2,077,267,000 above the fiscal year 2017 

enacted level and $197,581,000 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 total funding level for fiscal year 2018 for the Department 

of Veterans Affairs is $182,277,635,000, an increase of 

$5,336,299,000 over the fiscal year 2017 enacted level. Of the total, 

$103,948,435,000 is provided for mandatory benefit programs and 

$78,329,200,000 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 5.3 percent over the fiscal year 2017 enacted level. 

For fiscal year 2018, $66,385,032,000 for medical care has been appropriated in advance, and the recommendation includes an additional $2,650,000,000 in newly identified needs for VA, focusing on 

funds required to support staff previously hired under the Choice 

Act, mental health and suicide prevention, opioid abuse prevention, 

hepatitis C treatment, homelessness, long-term care, and caregiver 

stipends. The recommendation includes $2,894,000,000, an increase 

of $50,000,000 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 

$156,096,000 for the Board of Veterans Appeals, a $500,000 increase over the request, to target the growing caseload of appeals 

of initial benefits decisions. In addition, the Committee recommendation includes $70,699,313,000 in advance appropriations 

for fiscal year 2019 for the four health care accounts of the Department and $107,709,727,000 in advance appropriations for mandatory benefits programs for fiscal year 2019. 

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The following table compares amounts recommended in the bill 

to the President’s request and amounts appropriated in fiscal year 

2017: 

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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, and 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 2018 appropriations Act and the accompanying 

report address management challenges of the Federal agencies 

funded herein, 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 $182,277,635,000 

provided for the 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 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, the VA Secretary has just announced that he is directing VA to acquire the same electronic health record that DOD 

is adopting. While enthusiastic about the Secretary’s choice, the 

Committee has watched an integrated electronic record emerge and 

crash multiple times. Therefore, the Committee includes bill language fencing 75 percent of the development funding for the new 

electronic health record until VA provides extensive data on: the 

solicitation to Cerner Corporation; how the new record will replicate the DOD record while adding VA-specific features; a strategic 

plan with timeline, performance milestones, annual and life-cycle 

costs; plans to maintain current functionality and integration with 

DOD health records during the transition; and complete implementation and change management plans. 

Disability claims and appeals.—Thanks to the significant investments Congress has provided over the past six 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 

19 

$50,000,000 above the Veterans Benefits Administration President’s 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, modernization 

and enhancement until VA submits to the Committees a certification of the amounts. The bill limits the amount of funds that can 

be transferred into IT 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, modernization 

and enhancement projects upon prior notification to, and approval 

by, the Committees. 

Stricter control of construction funding.—In response to the egregious management of the Denver hospital construction project, the 

Committee includes bill language to fence 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. 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 $5,000,000 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. 

ITEM OF INTEREST

Construction Contracting Outreach.—In House Report 114–497 

the Committee directed the Secretaries of the Army, Navy and the 

VA to ensure that their respective regional and district offices responsible for construction projects inform and engage local construction industry contractors, especially small businesses, minority-owned businesses, and women-owned business, about Federal 

procurement opportunities and the bidding process. The Committee 

directs the Secretaries of each agency to submit a report to the congressional defense committees on outreach efforts conducted in fiscal year 2017 within 180 days of enactment of this Act. 

TITLE I 

DEPARTMENT OF DEFENSE 

MILITARY CONSTRUCTION OVERVIEW

Fiscal year 2017 enacted level (including rescissions) .................... $7,726,000,000 

Fiscal year 2018 budget request ....................................................... 9,782,451,000 

Committee recommendation in the bill (including rescissions) ...... 9,585,000,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 1,859,000,000 

Fiscal year 2018 budget request ................................................ (197,451,000) 

20 

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 to 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: 

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(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 not 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 on previously appropriated military 

construction projects. The Committee’s recommendation therefore 

includes rescissions to the Army, Navy and Marine Corps, and Air 

Force family housing construction 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 the House and Senate. 

Incremental funding of projects.—In general, the Committee supports full funding for military construction projects if they are exeVerDate Sep 11 2014 06:22 Jun 23, 2017 Jkt 025912 PO 00000 Frm 00021 Fmt 6659 Sfmt 6602 E:\HR\OC\HR188.XXX HR188
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cutable. 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 three 

projects that have been incrementally funded. 

High performance and sustainable building requirements.—The 

Committee recognizes that innovative technologies have expanded 

the availability of materials with lower embodied energy for facilities that require tall walls and large open spaces with minimal intermediate supports. 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 incorporate the use of innovative renewable building materials, systems, and design techniques that support the requirements of UFC 1 200 02 and the 

goals of achieving greater efficiency and lower environmental impacts at a lower material cost. Furthermore, the Committee encourages the Department of Defense to collaborate with the United 

States Department of Agriculture and the United States Forest 

Service to advance its understanding of innovative renewable 

building materials and systems and jointly develop a plan on expanding their use not later than 90 days after enactment of this 

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 of Defense 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 to provide the Committee with a list 

of military construction projects where mitigation and or changes 

to projects within the past five years were 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 indicate which modifications and or 

mitigations were adopted not later than 90 days after enactment 

of this Act. 

Facilities in excess of mission.—The Committee is concerned that 

Department of Defense officials have stated an estimated 22 percent of Department of Defense facilities are in excess of mission requirements. This is a fiscally unsustainable diversion of scarce resources from readiness. The Committee directs, not later than 60 

days after enactment of this Act, the Secretary of Defense to provide to the congressional defense committees a report detailing 

each Department of Defense facility with a utilization rate of less 

than 50 percent of available capacity. This report should also include the number of uniformed personnel and civilian employees at 

each of these facilities, the annual budget for personnel, and the 

23 

operation and maintenance costs associated with each identified facility. 

Water Conservation on Military Installations.—The Committee 

recognizes that the Department of Defense has the opportunity to 

play a key role in advancing our Nation’s water security by implementing water conservation, reuse, and recharge practices on military installations. This should include efforts to incorporate water 

conservation technologies into new infrastructure design, as well as 

to update existing infrastructure to make it more water efficient. 

The Committee also recognizes that many technologies that increase water efficiency do not result in competitive returns on investment. Therefore, the Department of Defense is encouraged to 

implement water conservation projects that are not solely contingent on cost savings performance, but also take into account reduced water use. To assess the current status of water demand and 

potential water conservation opportunities across U.S. military installations, the Secretary of Defense is directed to report to the congressional defense committees not later than 180 days of enactment of this Act the following: (1) the current water usage on military installations; (2) the vulnerability of each military installation 

to water scarcity; and, (3) the water conservation potential according to (a) reduced water use and (b) cost savings if current water 

conservation technologies and efficient design were implemented at 

military installations. 

Coastal Erosion.—Senate Report 114–57 accompanying the fiscal 

year 2016 Military Construction, Veterans Affairs, and Related 

Agencies appropriations bill included language directing the Department of Defense to include an assessment of coastal erosion 

and potential flooding risks in the siting of proposed military construction projects. In a July 23, 2015 report to Congress regarding 

the security implications of climate-related risks, the Department 

noted that it has directed a global screening level assessment to determine installation vulnerabilities to climate-related security risks 

with the goal of identifying serious vulnerabilities and developing 

necessary adaptation strategies. The Committee directs the Secretary of Defense to report to the congressional defense committees 

not later than 120 days after enactment of this Act, describing the 

results or the status of the vulnerability assessment, the adaptation strategies developed for vulnerable installations, and the estimated costs associated with implementing these strategies. 

Recycled plastic lumber.—The Committee understands that the 

Department of Defense has been utilizing recycled plastic lumber 

in various manners on its military installations. Applications include, but are not limited to, bridge infrastructure, dunnage 

boards, landscape timbers, rub rails, construction sleepers, fence 

posts, and nailer boards. Manufactured from post-consumer and industrial waste, recycled plastic lumber is insect resistant, will not 

rot, splinter, crack or fail in the manner of traditional wood. Recycled plastic lumber carries positive environmental impacts by reducing deforestation, diverting waste materials from landfills and 

lowering greenhouse gas emissions. The Committee directs the Secretary of Defense to further explore applications for use of recycled 

plastic lumber, particularly recycled plastic lumber that uses no 

virgin plastic, in military installations, and provide a report to the 

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Committee not later than 120 days after enactment of this Act on 

its findings. 

Rural Airfields.—The Committee recognizes that the active components, as well as the National Guard and reserve components, 

often use rural airfield facilities for refueling and training missions. 

This permits larger, urban airports to avoid overutilization during 

busy times. Additionally, rural airfields are often used by the military for emergency evacuations and staging areas. The Committee 

believes it is important to keep these regionally and nationally significant airfields secure and in a state of good repair. The Committee encourages the Secretary of Defense to invest in improving 

and updating rural airfield facilities where able, that are frequently used by the military Services and National Guard for 

training exercises and emergency operations. 

Climate and security for Military Installations.—The Department 

of Defense must pay close attention to potential adverse impacts of 

climate change 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 climate change impacts. The Committee urges the Secretary of Defense to plan infrastructure and other projects using the best available data and science on climate change to mitigate risks to our 

armed forces serving domestically and abroad. 

Air traffic control facilities.—The Committee is concerned that 

many Department of Defense Air Traffic Control facilities are unsafe, antiquated, and do not provide adequate control, communications or observation abilities for the current air traffic levels at certain locations. For example, the current facility located at Fort 

Benning will become wholly inadequate at the current pace of operations, and a replacement facility is necessary to ensure Air Traffic 

Services are available to support mission readiness and deployment 

platforms and the military flying community. The Committee is 

concerned that this could be a problem throughout the DOD enterprise with the recent reductions to the Department of Defense’s 

Construction accounts. Therefore, the Secretary of Defense is directed to conduct a risk assessment on Air Traffic Control Facilities 

throughout the Defense enterprise and develop a plan to update 

these facilities. This assessment shall be submitted to the congressional defense committees not later than 60 days after enactment 

of this Act. 

MILITARY CONSTRUCTION, ARMY

Fiscal year 2017 enacted level ........................................................... $513,459,000 

Fiscal year 2018 budget request ....................................................... 920,394,000 

Committee recommendation in the bill ............................................ 923,994,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 410,535,000 

Fiscal year 2018 budget request ................................................ 3,600,000 

The Committee recommendation includes a rescission of 

$10,000,000 from unobligated balances for unspecified minor construction under Administrative Provisions. 

The Committee 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 

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Office of the Secretary of Defense and submitted to Congress in priority order. 

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. Therefore, 

the Secretary of Defense is directed to conduct a risk assessment 

of all access control points throughout the Army enterprise and develop a plan to update these facilities, including a cost estimate for 

each facility. This assessment shall be submitted to the congressional defense committees not later than 60 days after enactment 

of this Act. 

MILITARY CONSTRUCTION, NAVY AND MARINE CORPS

Fiscal year 2017 enacted level ........................................................... $1,021,580,000 

Fiscal year 2018 budget request ....................................................... 1,616,665,000 

Committee recommendation in the bill ............................................ 1,558,085,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 536,505,000 

Fiscal year 2018 budget request ................................................ (58,580,000) 

The Committee recommendation includes a rescission of 

$10,000,000 from unobligated balances for unspecified minor construction under Administrative Provisions. 

The Committee 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. 

Marine Corps Air Station Beaufort.—The Committee is concerned 

that the level of aircraft noise surrounding the base has been increasing with the amount of flying hours and training. The Committee directs the Commandant of the Marine Corps to report to 

the congressional defense committees not later than 180 days after 

enactment of this Act on (1) Whether there is a need, based on environmental factors, increased training, or other factors, for the 

construction and maintenance of an Alternative Landing Field to 

service Marine Corps Air Station Beaufort; (2) Whether it is feasible to construct an Alternative Landing Field to service Marine 

Corps Air Station Beaufort; (3) If no determination of need or feasibility, an explanation of the reasons for that determination. 

MILITARY CONSTRUCTION, AIR FORCE

Fiscal year 2017 enacted level ........................................................... $1,491,058,000 

Fiscal year 2018 budget request ....................................................... 1,738,796,000 

Committee recommendation in the bill ............................................ 1,540,474,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 49,416,000 

Fiscal year 2018 budget request ................................................ (198,322,000) 

The Committee 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 

26 

Office of the Secretary of Defense and submitted to Congress in priority order. 

Basing of KC–46 aircraft.—The Committee is concerned that the 

Department of the Air Force has not appropriately prioritized funding for the military construction of infrastructure necessary for the 

Air Force’s aerial refueling recapitalization strategy. It has come to 

the attention of the Committee that a number of emergent construction requirements necessary for effective basing of the KC–46 

at Pease Air National Guard Base and Seymour Johnson Air Base 

could create delays in fielding the KC–46. The Committee urges 

the Department of the Air Force to prioritize funding for these 

emergent requirements to ensure the fielding of the KC–46s without delays and the successful completion of the aerial refueling recapitalization strategy. 

Construction of airfield and base camp.—The Committee is concerned that the Department of Defense has failed to report quarterly on the status of construction of airfield infrastructure and elements at the Agadez, Niger Airfield and Base Camp in support of 

operations by AFRICOM as requested by the Committee in the Report to accompany the Military Construction, Veterans Affairs, and 

Related Agencies Appropriations Bill, 2016. Therefore, the Committee directs the Department to submit a report not later than 60 

days after enactment of this Act providing an updated status of 

construction of infrastructure elements, number of U.S. uniformed, 

civilian, and contracted personnel on site, and timeline for completion of construction. 

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. 

Air Force flight line safety.—The Committee is concerned that 

aging air traffic control towers can negatively impact airfield operations and be safety concerns on the flight line. Control towers that 

are not of sufficient height do not allow personnel to adequately 

control aircraft and vehicle movements on the airfield, therefore, 

priority should be given to installations that have these safety concerns. 

27 

MILITARY CONSTRUCTION, DEFENSE-WIDE

(INCLUDING TRANSFER OF FUNDS)

Fiscal year 2017 enacted level ........................................................... $2,025,444,000 

Fiscal year 2018 budget request ....................................................... 3,114,913,000 

Committee recommendation in the bill ............................................ 2,791,272,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 765,828,000 

Fiscal year 2018 budget request ................................................ (323,641,000) 

The Committee recommendation includes a rescission of 

$27,440,000 from unobligated balances for unspecified minor construction under Administrative Provisions. 

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. 

Rhine Ordnance Barracks Medical Center Replacement.—The 

Committee is concerned that the completion date for the Rhine 

Ordnance Barracks Medical Center Replacement’s Life Cycle Cost 

Analysis (LCCA) (energy study) has been revised to be completed 

sometime mid-2017. The change in timeframe from the November 

2016 completion date to incorporate recent (2016) changes in German energy law (EnEv2016) causes angst for the Committee. The 

original energy study that was estimated to be completed in November 2016 for the LCCA was based on energy requirements established in 2009 German law. The Committee therefore directs 

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 US sources of energy 

the new German energy laws incorporate; (3) what US 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. 

Ft. Bliss hospital replacement.—The Committee remains concerned about Ft. Bliss hospital replacement construction project 

delays and the costs to complete. This project has suffered from 

mismanagement and management deficiencies which have caused 

major delays and cost overruns. The fiscal year 2018 request included $251,330,000 for increment 8, which is to be the last funding necessary to complete the project and is to cover the remaining 

design errors and omissions. However, the Committee remains 

skeptical that this is accurate. The recommendation provides the 

full request and directs the Acting Director of the Facilities Division within Defense Health Agency to provide quarterly reports to 

the congressional defense committees on the progress of this project 

to include future funding requests as they are known and notice of 

any further delay. With growing population at Ft. Bliss, working 

to complete this project is of the utmost importance. Further, the 

Committee believes that blood processing centers should be collocated with a hospital especially during new construction of a hospital. Since construction is still ongoing with the Ft. Bliss hospital 

replacement project, Defense Health Agency should re-examine incorporating the center into the current construction timeline. 

28 

Therefore, the recommendation does not provide funding for the 

blood processing center at Ft. Bliss. 

Ft. Leonard Wood hospital replacement.—The Committee is concerned that the Defense Health Agency’s hospital construction program is stretched thin. Currently, DHA has 45 active construction 

projects in the U.S. and abroad totaling approximately 

$5,200,000,000. The fiscal year 2018 request is $857,721,000 which 

is an increase of $553,721,000 over the fiscal year 2017 enacted 

level. Within the increase is a request for $250,000,000 for phase 

1 of the Ft. Leonard Wood hospital and $11,941,000 for a blood 

processing center replacement at Ft. Leonard Wood. Due to the 

amount of current construction the Committee believes that the 

DHA is unable to obligate the full amount as requested for the hospital and instead provides $150,000,000 for phase I instead of the 

budget request of $250,000,000. Further, the Committee believes 

that the blood processing centers should be collocated with the hospital especially when planning and constructing a new hospital. 

Therefore, the recommendation does not provide any funding for 

the blood processing center at Ft. Leonard Wood and directs DHA 

to incorporate the center into the hospital’s new construction in future phases. Lastly, the Committee directs DHA to report to the 

congressional defense committees not later than 120 days after enactment of this Act on the status, construction timeline, and the 

current working estimate of the 45 active construction projects. 

Parking issues at DOD facilities.—Military construction budget 

constraints are negatively affecting the ability of the Department 

of Defense to address urgent parking requirements at certain U.S. 

military installations. The lack of parking is a safety issue and a 

detriment to the well-being of employees, both civilian and military. The Committee is concerned that many DOD facilities in the 

Department’s inventory do not have sufficient parking to meet installation requirements. Furthermore, these deficiencies can contribute to traffic congestion and are serious problems on base. The 

Committee is concerned that the Department does not have a coherent strategy to address the growing parking requirements at installations that have seen significant growth. For example, Fort 

Meade, which already was home to the National Security Agency 

(NSA), became the headquarters of the newly formed U.S. Cyber 

Command in 2010. By 2011, the Defense Information Systems 

Agency, which handles the Pentagon’s IT and communications 

needs, had moved onto the base. In 2005, the base had just over 

33,500 employees. Today, it has about 57,000, more than double 

the number of workers at the Pentagon. As a result of this growth, 

parking at Fort Meade has become a serious issue. Therefore, the 

Secretary of Defense is directed to submit to the Committee with 

the fiscal year 2019 military construction budget request: an updated list of unfunded requirements for parking facilities, access 

control points, and road construction at DOD facilities that have 

serious parking, access, and road congestion issues. Finally, the 

Secretary is further directed to submit, with the fiscal year 2019 

military construction budget request, a list of how those requirements will be incorporated into their construction requests for fiscal years 2019 through 2023. 

Energy Policy.—The Department of Defense is the largest consumer of energy in the Federal Government, accounting for nearly 

29 

80 percent of the Government’s total energy consumption. The 

Committee commends the Department for its efforts to improve the 

energy efficiency of its facilities and installations, reduce its energy 

consumption, and invest in renewable energy projects and energy 

security. The Committee continues to support the Department’s efforts to incorporate green building technologies into new facility 

construction and into the renovation of existing buildings, including 

leading-edge technologies that can minimize life-cycle costs. DOD 

and the Services should engage with government, industry, and 

academia to identify and utilize innovative technologies to reduce 

long-term energy costs, limit the constraints of energy and water 

resources on military mission capabilities and readiness, and meet 

congressional and DOD mandated goals for renewable energy generation and energy and water efficiency. The Committee encourages the development of net-zero energy military housing and installation facilities, upgrades and retrofits for improved energy and 

water efficiency, and microgrid demonstrations. The Committee 

supports the Department’s investments in microgrid energy security and encourages the Department to continue to explore ways to 

mitigate the risk to mission critical assets and promote energy 

independence at military installations through the Energy Resilience Conservation Investment Program. 

Energy Resilience Conservation and Investment Program.—On 

January 29, 2016 the U.S. Government Accountability Office (GAO) 

released a report (GAO–16–162) regarding the DOD’s Energy Conservation Investment Program (ERCIP). GAO recommended that 

DOD improve reporting on both expected and actual savings of selected projects as well as update guidance on selecting projects to 

receive program funding. Currently, ERCIP is focused primarily on 

energy conservation projects that yield returns on investment. Recognizing that energy resiliency should also be a strategic aim of the 

program, the Committee urges the Department to consider ERCIP 

project selection criteria that also prioritizes installations’ energy 

resiliency and security. 

National Geospatial Intelligence Agency West Campus.—The 

Committee continues to have concerns about the new National 

Geospatial Intelligence Agency (NGA) West Campus Headquarters 

project. This project has a total cost of $821,000,000 and has been 

proposed in a two-phased approach with $381,000,000 requested in 

fiscal year 2018 with the second phase to be requested in fiscal 

year 2019. The project has already been de-scoped during the initial design process, the $801,000 appropriated in fiscal year 2017 

has not been obligated and transferred to the Corps and, based on 

the work in progress curve submitted with the budget request, 

NGA is not able to obligate the full request of $381,000,000. Therefore, the Committee has reduced the request by $181,000,000. 

SOCOM military construction requirements.—The Committee remains concerned about the lack of coordination with the Services 

for guidance that better defines support facilities and the horizontal (installation) infrastructure requirements to support 

SOCOM military construction at tenant installations. Therefore, 

the Committee directs the SOCOM Commander to coordinate with 

the Services to document and report to the congressional defense 

committees non-MFP–11 horizontal infrastructure projects that are 

necessary for execution of SOCOM construction projects not later 

30 

than 90 days after enactment of this Act. This report should include any project synchronization issues that would delay planned 

construction projects in the outyears. 

GUARD AND RESERVE ITEMS OF INTERESTS

Enforcement of border security.—Recognizing the need to bolster 

resources for the enforcement of border security, the Committee 

urges the Army National Guard and the Air National Guard to explore public-private partnerships with state and local governments, 

to design, and construct facilities adjacent to our southwestern border that will support National Guard activities and house and support assets used by Customs and Border Protection and other law 

enforcement agencies for the terrestrial, maritime, and aerial surveillance of those borders, to include aircraft hangars suitable for 

unmanned aerial systems and report back to the Committee 180 

days after the enactment of the this Act. 

MILITARY CONSTRUCTION, ARMY NATIONAL GUARD

Fiscal year 2017 enacted level ........................................................... $232,930,000 

Fiscal year 2018 budget request ....................................................... 210,652,000 

Committee recommendation in the bill ............................................ 210,652,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... (22,278,000) 

Fiscal year 2018 budget request ................................................ – – – 

The Committee 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. 

MILITARY CONSTRUCTION, AIR NATIONAL GUARD

Fiscal year 2017 enacted level ........................................................... $143,957,000 

Fiscal year 2018 budget request ....................................................... 161,491,000 

Committee recommendation in the bill ............................................ 161,491,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 17,534,000 

Fiscal year 2018 budget request ................................................ – – – 

The Committee 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 2017 enacted level ........................................................... $68,230,000 

Fiscal year 2018 budget request ....................................................... 73,712,000 

Committee recommendation in the bill ............................................ 73,712,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 5,482,000 

Fiscal year 2018 budget request ................................................ – – – 

The Committee 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. 

31 

MILITARY CONSTRUCTION, NAVY RESERVE

Fiscal year 2017 enacted level ........................................................... $38,597,000 

Fiscal year 2018 budget request ....................................................... 65,271,000 

Committee recommendation in the bill ............................................ 65,271,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 26,674,000 

Fiscal year 2018 budget request ................................................ – – – 

MILITARY CONSTRUCTION, AIR FORCE RESERVE

Fiscal year 2017 enacted level ........................................................... $188,950,000 

Fiscal year 2018 budget request ....................................................... 63,535,000 

Committee recommendation in the bill ............................................ 63,535,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... (125,415,000) 

Fiscal year 2018 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 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 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 throughout the Air Force Reserve 

enterprise and develop a plan to update these facilities in the 

2019–2023 future years defense plan. This assessment shall be 

submitted to the congressional defense committees not later than 

90 days after enactment of this Act. 

NORTH ATLANTIC TREATY ORGANIZATION SECURITY INVESTMENT

PROGRAM

Fiscal year 2017 enacted level ........................................................... $177,932,000 

Fiscal year 2018 budget request ....................................................... 154,000,000 

Committee recommendation in the bill ............................................ 177,932,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... – – – 

Fiscal year 2018 budget request ................................................ 23,932,000 

The Committee 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. 

32 

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 2017 enacted level ........................................................... $1,276,289,000 

Fiscal year 2018 budget request ....................................................... 1,407,155,000 

Committee recommendation in the bill ............................................ 1,407,155,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 130,866,000 

Fiscal year 2018 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. 

33 

FAMILY HOUSING CONSTRUCTION, ARMY

Fiscal year 2017 enacted level ........................................................... $157,172,000 

Fiscal year 2018 budget request ....................................................... 182,662,000 

Committee recommendation in the bill ............................................ 182,662,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 25,490,000 

Fiscal year 2018 budget request ................................................ – – – 

The Committee recommendation includes a rescission of 

$18,000,000 from bid savings under Administrative provisions. 

FAMILY HOUSING OPERATION AND MAINTENANCE, ARMY

Fiscal year 2017 enacted level ........................................................... $325,995,000 

Fiscal year 2018 budget request ....................................................... 346,625,000 

Committee recommendation in the bill ............................................ 346,625,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 20,630,000 

Fiscal year 2018 budget request ................................................ – – – 

FAMILY HOUSING CONSTRUCTION, NAVY AND MARINE CORPS

Fiscal year 2017 enacted level ........................................................... $94,011,000 

Fiscal year 2018 budget request ....................................................... 83,682,000 

Committee recommendation in the bill ............................................ 83,682,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... (10,329,000) 

Fiscal year 2018 budget request ................................................ – – – 

The Committee recommendation includes a rescission of 

$8,000,000 from bid savings under Administrative provisions. 

FAMILY HOUSING OPERATION AND MAINTENANCE, NAVY AND

MARINE CORPS

Fiscal year 2017 enacted level ........................................................... $300,915,000 

Fiscal year 2018 budget request ....................................................... 328,282,000 

Committee recommendation in the bill ............................................ 328,282,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 27,367,000 

Fiscal year 2018 budget request ................................................ – – – 

FAMILY HOUSING CONSTRUCTION, AIR FORCE

Fiscal year 2017 enacted level ........................................................... $61,352,000 

Fiscal year 2018 budget request ....................................................... 85,062,000 

Committee recommendation in the bill ............................................ 85,062,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 23,710,000 

Fiscal year 2018 budget request ................................................ – – – 

The Committee recommendation includes a rescission of 

$20,000,000 from bid savings under Administrative provisions. 

FAMILY HOUSING OPERATION AND MAINTENANCE, AIR FORCE

Fiscal year 2017 enacted level ........................................................... $274,429,000 

Fiscal year 2018 budget request ....................................................... 318,324,000 

Committee recommendation in the bill ............................................ 318,324,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 43,895,000 

Fiscal year 2018 budget request ................................................ – – – 

34 

FAMILY HOUSING OPERATION AND MAINTENANCE, DEFENSE-WIDE

Fiscal year 2017 enacted level ........................................................... $59,157,000 

Fiscal year 2018 budget request ....................................................... 59,169,000 

Committee recommendation in the bill ............................................ 59,169,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 12,000 

Fiscal year 2018 budget request ................................................ – – – 

DEPARTMENT OF DEFENSE FAMILY HOUSING IMPROVEMENT FUND

Fiscal year 2017 enacted level ........................................................... $3,258,000 

Fiscal year 2018 budget request ....................................................... 2,726,000 

Committee recommendation in the bill ............................................ 2,726,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... (532,000) 

Fiscal year 2018 budget request ................................................ – – – 

DEPARTMENT OF DEFENSE MILITARY UNACCOMPANIED HOUSING

IMPROVEMENT FUND

Fiscal year 2017 enacted level ........................................................... $– – – 

Fiscal year 2018 budget request ....................................................... 623,000 

Committee recommendation in the bill ............................................ 623,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 623,000 

Fiscal year 2018 budget request ................................................ – – – 

DEPARTMENT OF DEFENSE BASE CLOSURE ACCOUNT

Fiscal year 2017 enacted level ........................................................... $240,237,000 

Fiscal year 2018 budget request ....................................................... 255,867,000 

Committee recommendation in the bill ............................................ 290,867,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 50,630,000 

Fiscal year 2018 budget request ................................................ 35,000,000 

The additional funding is 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. 

The need to address inventory and excess of facilities.—The Committee is concerned about the cost of maintaining excess inventory 

of facilities or space at military installations and the effect on surrounding communities of underutilized bases, and encourages the 

Secretary to work with Congress to address the situation. The Department is encouraged to consider new options such as a Military 

Installations Savings Commission (MISC), to focus on integrating 

services, assisting in the transition of underused facilities to higher 

economic use, and supporting the affected communities. 

ADMINISTRATIVE PROVISIONS

The bill retains 28 provisions that were in effect in fiscal year 

2017. 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. 

35 

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. 

36 

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. 

(INCLUDING RESCISSION 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 does not include section 121 as requested to provide authority under a continuing resolution when an authorization bill 

has been enacted to obligate funds that have not been appropriated. 

TITLE II 

DEPARTMENT OF VETERANS AFFAIRS 

Fiscal year 2017 enacted level 1 .................................................... $176,941,336,000 

Fiscal year 2018 budget request 1 ................................................. 182,661,467,000 

Committee recommendation in the bill 1 ...................................... 182,277,635,000 

Comparison with: 

Fiscal year 2017 enacted ........................................................ $5,336,299,000 

Fiscal year 2018 budget request ............................................ (383,832,000) 

Fiscal year 2019 advance budget request 1 .................................. 178,409,040,000 

Fiscal year 2019 Committee recommendation in the bill 1 ......... 178,409,040,000 1 All funding cited excludes amounts in the Medical Care Collections Fund. 

The Department of Veterans Affairs (VA) serves approximately 

48,100,000 people, 21,400,000 veterans and 26,700,000 family 

members of living veterans or survivors of deceased veterans. To 

serve adequately the nation’s veterans, VA employs 364,000 people, 

37 

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 2018 enacted level ........................................................... $90,119,449,000 

Fiscal year 2019 advance budget request ......................................... 95,768,462,000 

Fiscal year 2019 Committee recommendation in the bill ............... 95,768,462,000 

Comparison with: 

Fiscal year 2018 enacted level ................................................... 5,649,013,000 

Fiscal year 2019 budget request ................................................ – – – 

This appropriation will provide funds for service-connected compensation payments to an estimated 5,020,000 veterans, survivors, 

and dependents in 2018. In addition, pension payments will be 

funded for 493,000 veterans and their survivors. The average cost 

per compensation case for veterans in 2018 is estimated at $16,784 

and pension payments are projected at $13,488. 

The appropriation includes authority to transfer funding not to exceed $17,882,000 in 2018 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 Medicaideligible single veterans and surviving spouses alone in Medicaidcovered 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. 

READJUSTMENT BENEFITS

Fiscal year 2018 enacted level ........................................................... $13,708,648,000 

Fiscal year 2019 advance budget request ......................................... 11,832,175,000 

Fiscal year 2019 Committee recommendation in the bill ............... 11,832,175,000 

Comparison with: 

Fiscal year 2018 enacted level ................................................... (1,876,473) 

Fiscal year 2019 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 the 

Department of Defense (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 disVerDate Sep 11 2014 06:22 Jun 23, 2017 Jkt 025912 PO 00000 Frm 00037 Fmt 6659 Sfmt 6602 E:\HR\OC\HR188.XXX HR188
38 

ability, as well as dependents of servicemembers who were captured or are missing in action. More than 80 percent of the funds 

in the account support the Post–9–11 GI Bill. Funding provided for 

fiscal year 2019 is a reduction from the prior year because of expected unobligated balances available from fiscal year 2018. 

VETERANS INSURANCE AND INDEMNITIES

Fiscal year 2018 enacted level ........................................................... $107,899,000 

Fiscal year 2018 additional request .................................................. 12,439,000 

Fiscal year 2018 recommendation in the bill ................................... 12,439,000 

Fiscal year 2019 advance budget request ......................................... 109,090,000 

Fiscal year 2019 Committee recommendation in the bill ............... 109,090,000 

Comparison with: 

Fiscal year 2018 enacted level ................................................... 1,191,000 

Fiscal year 2019 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. Funds provided are lower than prior year 

levels because of lower estimates of transfers to the various insurance funds. 

VETERANS HOUSING BENEFIT PROGRAM FUND PROGRAM ACCOUNT

Program account 

Limitation on 

direct loans for 

specially adapted 

housing loans 

Administrative 

expenses 

Fiscal year 2017 enacted level ........................................................ – – – ($500,000) $198,856,000 

Fiscal year 2018 budget request est. .............................................. – – – (500,000) 178,626,000 

Committee recommendation est. in the bill .................................... – – – (500,000) 178,626,000 

Comparison with: 

Fiscal year 2017 enacted level ............................................... – – – – – – (20,230,000) 

Fiscal year 2018 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 mortVerDate Sep 11 2014 06:22 Jun 23, 2017 Jkt 025912 PO 00000 Frm 00038 Fmt 6659 Sfmt 6602 E:\HR\OC\HR188.XXX HR188
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gage 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 is concerned with the ability of 

veterans to benefit from the Department of Veterans Home Loan 

Program in areas with a large population of veterans and competitive housing markets and a shortage of appraisers approved by VA. 

The Committee therefore directs the Secretary to review applicable 

statutory, regulatory, and agency policy and report back to the 

Committee within 90 days of enactment a series of options to support the greater utilization of the Home Loan Program in locations 

with a large veterans population and competitive housing markets. 

VOCATIONAL REHABILITATION LOANS PROGRAM ACCOUNT

Program account Limitation on 

direct loans 

Administrative 

expenses 

Fiscal year 2017 enacted level ........................................................ $36,000 ($2,517,000) $389,000 

Fiscal year 2018 budget request ..................................................... 30,000 (2,356,000) 395,000 

Committee recommendation in the bill ............................................ 30,000 (2,356,000) 395,000 

Comparison with: 

Fiscal year 2017 enacted level ............................................... (6,000) (161,000) 6,000 

Fiscal year 2018 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 $1,214 (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 2,402 loans in fiscal year 2018, with an average amount of $981. 

NATIVE AMERICAN VETERAN HOUSING LOAN PROGRAM

Administrative expenses: 

Fiscal year 2017 enacted level ........................................................... $1,163,000 

Fiscal year 2018 budget request ....................................................... 1,163,000 

Committee recommendation in the bill ............................................ 1,163,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... – – – 

Fiscal year 2018 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. 

40 

These loans are available to purchase, construct, or improve homes 

to be occupied as veterans’ residences. 

GENERAL OPERATING EXPENSES, VETERANS BENEFITS

ADMINISTRATION

Fiscal year 2017 enacted level ........................................................... $2,856,160,000 

Fiscal year 2018 budget request ....................................................... 2,844,000,000 

Committee recommendation in the bill ............................................ 2,894,000,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 37,840,000 

Fiscal year 2018 budget request ................................................ 50,000,000 

The General Operating Expenses, Veterans Benefits Administration (VBA) account provides funding for VBA to administer entitlement programs such as service-connected disability compensation, 

education benefits, and vocational rehabilitation services. 

The bill makes available through September 30, 2019, up to five 

percent of these funds. The Committee provides $2,894,000,000 for the General Oper- ating Expenses, VBA account, which is $50,000,000 above the Administration request. The Committee intends that VA use these additional funds to restore some of the decrease proposed in the budget 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 

finance overtime payments if that becomes necessary to manage 

disability claims and appeals backlogs. 

Addressing backlogs.—The Committee is pleased that VA 

achieved an ‘effective zero’ on its backlog of disability claims. However, it is concerned that the disability claims backlog is now creeping slightly upward as VA devotes more resources to non-rating 

claims. In addition, the appeals backlog is dramatically increasing, 

as the volume of initial claims decisions has risen. The Committee 

urges VA to use the additional resources provided to tackle both 

types of backlogs before they reach troubling levels. 

Performance reporting.—The bill includes language directing VA 

to continue the specific reporting requirements on claims processing performance and backlog identified in the fiscal year 2017 

enacted law. In addition, the Committee directs VA to include in 

this report the number of appeals, how many appeals are with the 

jurisdiction of VBA versus the Board of Veterans Appeals, and the 

median age of pending appeals. 

Reforms to expedite VA appeals process.—The Committee expects 

the Secretary to fully implement the Government Accountability 

Office’s (GAO) recommendations to improve the timeliness of VA’s 

disability benefits appeals decisions and to document its progress 

in its monthly reports to the Committee on appeals claims processing performance. The Committee concurs with the GAO’s recommendations that VA should apply sensitivity analyses when projecting staff needs, develop a more detailed workforce plan, develop 

a robust plan for assessing process reform, and create a schedule 

for information technology (IT) improvements accommodating potential process reform. The Committee also supports GAO’s recommendation that any VA proposed appeals process reforms be 

first subject to a pilot test. 

Oakland regional office.—The Committee is concerned that errors 

in providing dispositions on claims at the Oakland Regional Office 

41 

may have resulted in an unreasonable number of appeals. Therefore, the Committee requests that VA provide not later than 60 

days after enactment of this Act the number of appeals originating 

in Oakland from each of the calendar years 2014–2017. 

Equitable relief.—The Committee understands that VA is working to implement new systems and protocols to eliminate instances 

of administrative error. However, as VA enacts system-wide reforms, ending equitable relief for veterans who were deemed eligible for benefits in error would place an unfair burden on veterans 

and their families. The Secretary is directed to continue to grant 

or extend equitable relief to eligible veterans initially deemed eligible in instances of administrative error. Not later than April 1, 

2018, VA is requested to submit to the Committees a report containing a statement as to the disposition of each case recommended 

to the Secretary for equitable relief under 38 U.S.C 503 during the 

preceding calendar year. 

Military sexual trauma (MST) claims.—The Committee understands VBA is developing and implementing new training initiatives and procedures for posttraumatic stress disorder (PTSD) 

claims related to MST. The Committee is pleased with the increased focus on this area and encourages VA to continue to build 

on the strides that have been made, to include intensive training 

and changes identifying specialized claims employees for MST-related claims. However, the Committee also realizes that, in addition to PTSD, MST can lead to other mental health disorders. The 

Committee urges VA to consider, in addition to PTSD, anxiety, depression, and other mental health disorders in their treatment of 

victims of MST. The Committee also urges VA to conduct veteran 

outreach initiatives and publicize benefits veterans may be entitled 

to as a result of MST. In addition, the Committee recognizes that 

MST affects both female and male veterans and encourages VA to 

continue its efforts to provide equal treatment and assistance for 

both female and male veterans. 

Transition assistance.—The Committee encourages VA 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. 

Veterans service data.—The Committee notes the 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 DD214 and medical records, the Committee recognizes the benefits of 

making these documents available to prospective employers electronically in controlled settings if privacy and confidentiality issues 

can be addressed. The Committee encourages the Secretary to work 

with the Secretary of Defense and State governors to create mechanisms to share this data to help support the employment of veterans. 

State and county veteran service officers receiving access to VA 

records.—The Committee encourages the Secretary to work with 

State and county Veteran Service Officers to explore options for allowing authorized Veteran Service Officers ‘‘read only’’ access to 

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pose of identifying individuals who may be eligible for State or 

local benefits in addition to Federal VA benefits. 

Therapeutic benefits of farming.—Currently, 40 percent of the nation’s farms are operated and owned by farmers over the age of 65, 

and over the next 15 years there will be a demand for one million 

new farmers. In addition, over 800,000 servicemembers will transition out of the military over the next decade. Veterans face obstacles accessing mental health services in rural and highly rural 

areas and filling the shortfall of working farmers could provide 

therapeutic benefits for veterans and transitioning servicemembers. 

Therefore, the Committee encourages the Department to coordinate 

with the Departments of Defense and Agriculture in identifying 

and promoting vocational programs that provide the following: educational or vocational training in agriculture-related fields, behavioral health services on-site through licensed providers, if possible, 

and a pathway to employment in agriculture-related fields. 

Minority outreach.—The Committee is concerned that current 

outreach efforts to educate minority veterans about benefits to 

which they are entitled may not be adequate. The Committee requests that, within 180 days of enactment of this Act, VBA submit 

a report, in coordination with the Center for Minority Veterans, 

VSOs and other stakeholders, describing strategies for effective, 

targeted outreach to educate minority veterans and their families 

about available VA benefits, and VBA’s plans to implement these 

strategies. 

Vision assistive technology.—Recent innovation in vision assistive 

technology provides an opportunity for VA to support blind and vision-impaired veterans to become more independent and mobile. As 

one example, remote assistive technology exists to connect veterans 

with a network of certified agents via wearable smart glasses and 

an augmented reality dashboard that allows the agents to see what 

is in the blind person’s vision field sees in real time. The Committee encourages VA to test a variety of these vision assistive 

technology devices to assess their utility in VA rehabilitation efforts. 

Service dogs.—The Committee recognizes that more than 20,000 

service members have been wounded in action in Operation Iraqi 

Freedom, Operation Enduring Freedom, Operation Inherent Resolve, and Operation Freedom’s Sentinel. Many of these men and 

women have suffered severe injuries such as spinal cord injuries, 

amputations, traumatic brain injuries, and visual and hearing impairments. For many of those most severely injured warriors, service, guide and hearing dogs provide crucial tasks to mitigate a veteran’s disabilities, as well as provide therapy, assistance, and rehabilitation. Currently, there is a waiting list of veterans and active 

military personnel who seek the support of assistance dogs. Given 

the growing need for service dogs and the positive impact these 

dogs will have on the lives of wounded service members, the Committee believes that VA should expand its participation with the 

accredited non-government organizations that provide assistance 

dogs for rehabilitation and enhanced recovery care to injured service members of all eras who have suffered service-related injuries. 

The Committee urges VA to prioritize support of veterinary 

healthcare and other benefits for service dogs for wounded warriors. 

43 

VETERANS HEALTH ADMINISTRATION (VHA) 

The Department operates the largest Federal medical care delivery system in the country, with 145 hospitals, 115 domiciliary residential rehabilitation treatment programs, 136 nursing homes, 300 

Vet Centers, 80 mobile Vet Centers, and 1,252 outpatient clinics 

which include independent, satellite, community-based, and rural 

outreach clinics. More than 7,000,000 patients will be treated in 

2018. 

The Veterans Health Administration 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 2019 of $70,699,313,000 in 

direct appropriations to fund the four advance appropriations of the 

VHA. The bill also provides the requested $2,650,000,000 in additional fiscal year 2018 funding for the four Medical Care accounts. 

In addition, VA will receive an estimated $3,271,000,000 in Medical 

Care Collections Fund in fiscal year 2018. The Committee also provides $698,228,000 for medical and prosthetic research. 

VA medical care is provided both at VA facilities and in non-VA 

community care settings. VA in-house care is financed through the 

Medical Services account and non-VA community care is supported 

through the Medical Community Care account. Non-VA care has 

also been provided through the mandatory Choice program, which 

was not funded in an appropriations bill. As the Choice program 

funding ends, the authorizers are developing legislation that would 

consolidate all non-VA care programs, including a successor program to Choice. The budget proposes to fund the successor program 

to Choice with continued mandatory funding, but under the same 

policies as the discretionary non-VA community care programs. 

MEDICAL SERVICES

Fiscal year 2017 enacted level ........................................................... $45,555,812,000 

Fiscal year 2018 enacted level ........................................................... 44,886,554,000 

Fiscal year 2018 additional request .................................................. 1,031,808,000 

Committee 2018 additional recommendation ................................... 1,031,808,000 

Fiscal year 2019 advance budget request ......................................... 49,161,165,000 

Committee 2019 recommendation in the bill ................................... 49,161,165,000 

Comparison with: 

Fiscal year 2018 enacted level ................................................... 4,274,611,000 

Fiscal year 2019 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 Department of Defense (DOD) civilian health 

and medical programs. The bill provides the request of $49,161,165,000 for advance fis- cal year 2019 funding as well as $1,031,808,000 in additional fiscal 

year 2018 funding as requested. The Committee has included requested bill language to make available through September 30, 

2020, $1,400,000,000 of the Medical Services advance appropriation 

for fiscal year 2019. 

Funding identified in the bill does not include the $2,847,000,000 

in mandatory funding requested by the Administration, financed by 

44 

mandatory benefit program reductions. That proposal is within the 

jurisdiction of the authorizing committees. 

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. 

Allocation of health funding.—The Committee continues to be 

concerned that the process VA uses to allocate the health services 

appropriation through the Veterans Integrated Service Networks 

(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 not later than thirty 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 the full fiscal year 2018 budget request of $8,353,200,000 for mental health programs. Of the amounts provided for mental health programs in fiscal year 2018, $186,128,000 

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. 

Veterans crisis line (VCL).—According to the U.S. Census Bureau, there are 21,800,000 million veterans in the U.S. While veterans constitute only 8.5 percent of the population, they accounted 

for 18 percent of all deaths from suicide among adults, and, according to VA, approximately 20 veterans die from suicide every day. 

One tool VA has to combat high suicide rates and help those who 

are considering suicide is the VCL, a 24-hour, toll-free hotline that 

veterans can call to connect to a responder trained in crisis management. While the Crisis Line is invaluable, it is not without 

shortcomings and some calls are not answered in an appropriate 

amount of time. The Committee remains concerned by the continuing deficiencies identified at the VCL in a second investigative 

report from the Office of Inspector General (OIG). The Committee 

requests an update from VA in the form of a report due not later 

than September 30, 2017, detailing how VA is working to implement the recommendations from both VA OIG reports and the Government Accountability Office on the VCL. The report should address how the VCL is working to hire a permanent director; how 

many VCL staff (including Social Service Assistants, call responders, managers, and supervisors) have received training and orientation (including how many remain to receive such training); changes 

the VCL has made with its backup center contractors, including efVerDate Sep 11 2014 06:22 Jun 23, 2017 Jkt 025912 PO 00000 Frm 00044 Fmt 6659 Sfmt 6602 E:\HR\OC\HR188.XXX HR188
45 

forts to track how long veterans remain in a queue to have their 

call answered; what percentage of calls are transferred to a nonVA hotline; how the VHA Member Services is working to collaborate with the Office of Suicide Prevention to ensure veterans are 

receiving appropriate clinical care; what processes are now in place 

to track and analyze performance data from the two VCL centers 

and its four contracted backup centers; and how the VCL is complying with the requirements from the No Veterans Crisis Line 

Call Should Go Unanswered Act. 

The Committee has repeated bill language included in the fiscal 

year 2017 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. 

Suicide prevention training.—VA has implemented comprehensive, broad-ranging suicide prevention initiatives, including the 

toll-free Veterans Crisis Line, placement of Suicide Prevention Coordinators at all VA medical centers and large outpatient facilities, 

and improvements in case management and tracking. These initiatives have improved mental healthcare access for veterans across 

the nation. However, the Committee is interested in how VA employees are trained to deal with veterans in crisis. Veterans are at 

a disproportionately high risk for suicide compared to the rate of 

U.S. civilian adults, and these initiatives are a lifeline for many 

veterans. While the Committee understands that training will vary 

due to education and position, there must be consistent protocol 

across the VA enterprise when dealing with veterans in crisis. The 

Committee is concerned that the variations in the protocol may be 

a threat to the health and safety of veterans. Therefore, the Committee urges the Secretary to develop a basic protocol for all employees who deal with veterans in crisis. Furthermore, the Committee directs VHA to provide a report on the training methods 

currently in place at the VCL and VA medical centers not later 

than 90 days after enactment of this Act. 

Clay Hunt SAV Act.—The Committee is pleased that VA has initiated the five pilot programs required by the Clay Hunt SAV Act. 

These pilots provide a community-oriented veteran peer support 

network carried out in partnership with an entity that has experience in peer support programs, and a community outreach team for 

each medical center in the five pilot areas. The networks establish 

peer support training guidelines, conduct training, develop teams of 

veteran peer support counselors and deliver peer support to veterans identified by the VA outreach teams. The Committee requests a report on the status of VA’s efforts not later than 60 days 

after enactment of this Act. 

Suicide among female veterans.—Female veterans are six times 

more likely to commit suicide than women in the general population. This alarming trend must be addressed by the Department 

without delay. The Committee directs the VA to renew its focus on 

improving access to mental health services for female veterans and 

ensure that female mental health needs, which often differ from 

male needs in prevalence and expression, are met. 

Community clinic mental health services.—The Committee understands that VA policy requires that mental health services be available regardless of the location of the veteran—either in person, onVerDate Sep 11 2014 06:22 Jun 23, 2017 Jkt 025912 PO 00000 Frm 00045 Fmt 6659 Sfmt 6602 E:\HR\OC\HR188.XXX HR188
46 

site, through referral to the nearest VA medical center, through 

telemental health, or through community referral. Understanding 

that location, capacity, and availability of providers affect where a 

veteran receives mental health services and through which mechanism, the Committee would like a briefing to learn more about how 

VA establishes the method of providing mental health care in an 

individual community-based outpatient clinic, how VA makes the 

judgment that the method is adequate for the type of cases encountered at the facility, and how frequently VA reviews the adequacy 

of the mechanism for provision of quality mental healthcare. 

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. 

National Center for Posttraumatic Stress Disorder (PTSD).—The 

Committee recognizes the importance of the VA National Center 

for PTSD in promoting better prevention, diagnoses, and treatment 

of PTSD. The Committee further recognizes the importance of this 

research for veterans, their family members and those experiencing 

community violence. Consistent with recommendations from the 

2016 National Veterans Health Equity report, the Committee urges 

the Center to conduct an evidence-based analysis of neighborhood 

effects and other social determinants of health on PTSD in minority veterans, and propose recommendations to address disparities. 

This report should include an examination of how veterans’ PTSD 

diagnoses may be exacerbated by gun violence in the neighborhoods they return to after their service. 

PTSD service dogs.—The Committee is pleased that VA is conducting a pilot through the Center for Compassionate Innovation 

on the use of mental health mobility service dogs for veterans 

whose mental health disorder is so debilitating that he or she cannot leave home or move about independently. In this study, VA 

provides veterinary health benefits, but does not provide the actual 

service dogs. In addition, VA is conducting a more traditional research study on the use of service dogs for veterans with PTSD. In 

that study, VA supports both the purchase of the dog and its veterinary health care. The Committee hopes that the results of these 

two research projects will provide the evidence VA needs to finance 

veterinary health care for service dogs for behavioral conditions as 

well as physical conditions. Given that waiting lists for service dogs 

average between 18 and 24 months, the Committee urges VA to reconsider whether it will purchase the dogs for veterans, if research 

results validate the utility of service dogs for behavioral conditions. 

Postpartum depression.—An estimated one out of seven new 

mothers experience postpartum depression. The Committee requests a report on what maternal mental health services are available to women veterans at each VISN through the VHA and the 

Choice program. The report should include mental health support 

services for women veterans who: have miscarried; had a still born 

baby; who have had challenges related to fertility; have or have 

had a high risk pregnancy; or have postpartum depression. The report should also specifically address if women veterans are 

screened for postpartum depression, as well as how many female 

47 

mental health professionals are available in each VA medical facility. 

Law enforcement liaison.—The Committee is pleased that VHA is 

working with the Law Enforcement Training Center to develop 

education for community law enforcement to ensure the needs of 

veterans who are considered an immediate threat to themselves or 

others are addressed. The goal of the Outside Law EnforcementFirst Responder Veteran Assistance Training is to provide training 

and education to first responders about the unique issues facing 

veterans (specifically recently returned combat veterans) and to increase collaboration with local first responders in the community. 

Veterans treatment courts.—The Committee is aware of the successful outcome-oriented support system developed by Veterans 

Treatment Courts that connects veterans with appropriate treatment and services that can reduce recidivism and break the cycle 

of crime, arrest and incarceration. Bringing together a team that 

usually includes a judge, prosecutor, defense counsel, law enforcement officer, probation officer, court coordinator, treatment provider and case manager, is similar to what a veteran experienced 

in the military and is conducive for them to confront and correct 

the underlying cause of their crime. The Committee urges the Department to continue to make treatment services a priority in the 

treatment court system as more jurisdictions implement Veterans 

Treatment Courts. 

Independent review of mental health care.—The Committee is 

aware of occasional reports of gross negligence in VA care of patients with mental health or substance abuse issues. While there 

are regular mechanisms within VA to investigate reports of poor 

quality care, including investigations by the Office of Inspector 

General, and less frequent reviews by outside organizations like 

the Joint Commission, the Committee would like to learn if there 

are other entities qualified and able to respond in real-time to 

charges of inappropriate care. The Committee requests a report not 

later than 60 days after enactment of this Act identifying non-VA 

government bodies that would be equipped to investigate on short 

notice allegations of poor quality VA care. This report should include a description of State protection and advocacy agencies and 

their role in investigating poor quality care. 

Mental health services training for community providers.—Community providers play an essential role in ensuring our Nation’s 

veterans receive the support they have earned. The Committee 

supports providing care to veterans within the community because 

while many veterans seek mental health care at VA, others choose 

to go to providers in their community. The Committee was pleased 

that VA developed a Community Provider Toolkit aimed at delivering support, therapeutic tools, and resources to community providers treating veterans for mental health concerns. While the Provider Toolkit was a positive step, challenges still remain for veterans receiving mental health care in the community. For example, 

civilian mental health providers are not always trained to address 

the unique psychological needs of veterans suffering from military 

sexual trauma and other mental health problems unique to veterans. Therefore, the Committee directs the Secretary to provide a 

report on the training methods currently offered to community 

mental health providers and to develop a plan to train community 

48 

providers on these unique challenges not later than 120 days of enactment of this Act. 

Discrimination in PTSD claims.—The Committee is concerned 

that veterans of color may be disproportionately denied claims for 

post-traumatic stress disorder. Therefore, the Committee requests 

a report not later than 90 days after enactment of this Act detailing the number of claims from each of the years 2015, 2016, and 

2017 related to PSTD that were filed, the number granted, and the 

number that were appealed. These numbers should be broken down 

by racial and ethnic group. 

Hepatitis C 

The bill provides $751,200,000 for hepatitis C treatment in fiscal 

year 2018, the same amount as the administration request. The 

Committee commends VA for its efforts to respond to the disproportionate infection rate of hepatitis C among veterans. More than 

87,000 veterans have been treated with the new generation oral 

hepatitis C drugs, with 90 to 95 percent cure rates. These cures are 

having profound effects in preventing liver disease and cancer for 

those veterans as well as the costs otherwise borne by VA for treating these illnesses. VA indicates that 58,000 veterans in the VA 

healthcare system remain potential candidates for hepatitis C 

treatment. However, an increasing proportion of this cohort are 

more difficult to engage and treat, due to factors such as inability 

to adhere to therapy, psychosocial determinants, or unstable or uncontrolled medical comorbidities. VA is encouraged to increase its 

outreach efforts to screen and treat the remaining hepatitis C patients in the veteran community. The Committee requests a report 

not later than 60 days after enactment of this Act describing the 

Department’s efforts to improve hepatitis C screening rates in traditional and non-traditional settings, and the utilization of innovative strategies like point-of-care testing collaboration with veterans’ 

service organizations, voluntary health organizations, and other 

stakeholders. 

Homeless assistance 

The Committee provides the full fiscal year 2018 budget request 

of $1,727,784,000 for VA homeless assistance programs, in addition 

to an estimated $5,573,956,000 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. 

Enhanced use lease (EUL) authority.—The Committee believes 

that enhanced use lease authority, with which VA establishes a cooperative arrangement in which underutilized VA properties are 

made available to public or private entities in exchange for consideration allowing expanded services to veterans, has been a very 

valuable tool in creating housing for homeless veterans. VA currently participates in 31 EUL projects that provide supportive 

housing for homeless veterans. The Committee is pleased that VA 

expects to continue to increase the number of permanent homeless 

housing facilities in 2017. 

49 

Related needs of homeless veterans.—While VA has made strides 

in reducing veteran homelessness, its program clients need additional support beyond shelter. The Committee continues to be interested in the feasibility, advisability and cost of VA conducting a 

pilot program to 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 requests an updated report on the Department’s views 

of such a program not later than 60 days after enactment of this 

Act. 

HUD-VASH program.—The Committee recognizes the important 

contributions the HUD-VASH program has made in reducing the 

number of homeless veterans and commends VA for implementing 

a case management system that keeps veterans housed longer by 

providing the supportive care many of them require. The Committee encourages VA to more creatively and collaboratively work 

with local social service agencies, especially in rural and small communities, to ensure that HUD-VASH voucher recipients are receiving the most comprehensive services available to them. Many jurisdictions around the country are implementing their own coordinated care initiatives alongside public housing programs, and in 

the interest of maximizing public investment and providing the 

best, most comprehensive care available, VA should seek to partner 

with local and State governments when possible. The Committee 

requests an annual report identifying how many HUD-VASH 

vouchers are given to female veterans with children, female veterans without children, male veterans with children, and male veterans without children in each State. The report should also include the number of HUD-VASH vouchers distributed to veterans 

in rural, suburban, and urban areas per State. An annual report 

will be an important data point over time to assess the success of 

VA’s efforts to combat veteran homelessness. 

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 requests the Department to provide an analysis of the challenges facing homeless female veterans with minor children and 

the services VA has developed to address those challenges. This report should be provided to the Committee not later than 90 days 

of enactment of this Act. 

Homeless veterans in rural areas.—The Committee continues to 

be concerned about VA’s efforts to combat homelessness among 

rural veterans. The Committee encourages VA to identify ways to 

obtain more accurate data on homeless and at-risk veterans in 

rural areas, and is pleased that VA will be hosting a Homeless Evidence and Research Synthesis later this year to discuss the challenges that exist in identifying and providing services to rural and 

highly rural veterans. The Committee requests VA to report not 

later than 60 days after enactment of this Act new approaches the 

Department is designing to measure and address homelessness 

among the rural veteran population. 

50 

Construction of housing for rural homeless veterans.—The Department has made great efforts to find housing for homeless veterans and their families. However, to date, VA has not tested the 

concept of awarding grants to eligible entities to purchase and construct rural, single unit, tiny homes for homeless veterans, who 

may prefer to live in rural communities. This approach could provide a pathway to stable housing for veterans. The Committee requests the Department to outline what legislative changes would 

be required to establish such a program on a pilot basis, the feasibility, and estimated cost of such a program. The report should be 

provided to the Committee not later than 60 days after enactment 

of this Act. 

Staffing issues 

Hiring delays.— The Committee is concerned about whether the 

VA hiring and credentialing process may contribute to longer wait 

times for veterans seeking healthcare. The Committee requests VA 

to report on the average length of time to fill a healthcare provider 

slot at a representative sample of medical centers, including: the 

time it takes the resource board to approve the hire of a new position; the time it takes to post the job announcement; how long the 

interview process takes; and the length of time for credentialing; as 

well as any internal VA goals that exist for the time each step in 

the process should take. The report should also describe how often 

a healthcare provider reaches the credentialing process phase of 

the process, but exits the process because of another opportunity 

outside VA. This report should be provided to the Committee not 

later than 60 days after enactment of this Act. 

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 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. 

Position vacancies.—The Committee is concerned about the large 

number of vacancies among senior positions at VA medical centers 

throughout the country. Not later than 120 days after enactment 

of this Act, the Secretary is requested to develop and submit to the 

Committee a plan describing: (1) methods to hire highly qualified 

medical directors for each medical center that lacks a permanent 

director; (2) possible impediments to staffing facilities with permanent directors; and (3) possibilities of promoting and training qualified candidates from within the VA for promotion to Senior Executive Service positions. 

Nurse training programs.—The Committee encourages VA to further support the VA Nursing Academic Partnership Programs 

(VANAP), the Post-Baccalaureate Nurse Residency (PBNR), the VA 

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GE), and the Enhancing Academic Partnerships program. These 

programs enhance recruitment and retention of highly trained 

nursing professionals, while elevating interprofessional education 

concentrating on behavioral health services, women’s health, gerontology services, services for homeless veterans, and rural health 

care initiatives. These initiatives ensure that veterans and their 

families have access to the right provider, at the right time, by 

building strong partnerships between academia and VA practice. 

Nursing locality pay systems.—Recognizing the importance of recruitment and retention of qualified nurses, the Committee requests VA to submit a report within 90 days of enactment of this 

Act that analyzes how individual VA medical centers set pay rates 

for nurses at their facilities and how those rates compare to pay 

rates set by other VAMCs within their VISN. This report should 

also include an analysis across VISNs about whether a consistent 

methodology is used when setting pay scales. 

Leveraging military expertise.—The Committee recognizes that 

civilian medical personnel may have a difficult time communicating 

with military veterans due to the distinct nature of military language and culture. The Committee urges the Secretary to conduct 

a feasibility study regarding the expansion of existing programs 

that allow guard and reserve members to maintain clinical competencies by conducting a portion of their contractual reserve time 

at VA facilities. The Committee recommends that the Secretary 

consider expanding this program to leverage telemedicine technologies used by rural providers participating in the CHOICE program, as these reserve and guard personnel are in a unique position to provide expertise and military knowledge in medical communities that may be lacking. 

Psychology internships.—The Committee understands that VHA 

each year uses the services of the Association of Psychological 

Postdoctoral and Internship Centers (APPIC), a non-profit organization, to help select and match clinical psychologists for available 

VA internships. The Committee is concerned, however, that APPIC 

has decided to not include psychologists from programs accredited 

by the Psychological Clinical Science Accreditation System (PCSAS) 

even though VHA has recently published new Psychologist Qualification Standards that recognize graduates of PCSAS-accredited 

programs. The Committee is pleased to learn that VHA is working 

to resolve this situation to insure that all appropriately trained and 

qualified psychologists are given equal access to VA internships. 

The Committee requests a report on the status of this issue by August 1, 2017, including a discussion of the contribution of psychology in meeting the overall healthcare mission of VA. 

Recruitment incentives.—The Committee is concerned with the 

shortage of medical providers at VA facilities and the inability to 

compete with private practice in the recruitment and retention of 

such providers. VA is encouraged to prioritize funding for student 

loan repayment options and other hiring incentives, such as signing bonuses and relocation expenses, to remain competitive in efforts to recruit and retain providers. The Committee also requests 

VA to report not later than 90 days after enactment of this Act on 

the differences between student loan repayment options for VA providers versus providers serving Health Professional Shortage Areas 

through the National Health Service Corps. 

52 

Residency positions.—In the Veterans Access, Choice, and Accountability Act of 2014, Congress instructed VA to focus graduate 

medical education residency positions in those locations experiencing a shortage of physicians, those located in a community that 

is designated as a health professional shortage area, and to give 

priority to residency positions and programs in primary care and 

mental health. The Committee requests that VA increase its focus 

on these underserved locations when determining residency positions. 

Access for rural veterans 

Office of Rural Health.—The Committee provides the full fiscal year 2018 budget request of $250,000,000 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 healthcare to rural areas 

is key to serving veterans in geographically remote areas, including 

remote facilities in Hawaii, many of whom would otherwise need 

to fly to reach their nearest VA facility. In addition to providing 

healthcare services, ORH’s important work includes identifying 

barriers to healthcare delivery in rural areas and implementing 

new ways to deliver healthcare and services to veterans in these 

locations. 

Operating plan.—The Committee directs ORH to submit to the 

Committee not later than 30 days after enactment of this Act an 

operating plan for fiscal year 2018 funding, as well as the fiscal 

year 2019 funding provided in advance by this Act. 

Rural caregivers.—The report VA produced last year in response 

to the Committee’s request for information about special barriers 

faced by rural caregivers identified problems such as lack of providers, hospital closings due to financial instability, internet access, 

unfamiliarity with available VA services, training needs, poor 

transportation, and social isolation. The Committee requests ORH 

to develop a group of policy proposals that, if adopted, could be 

used on behalf of rural caregivers to reduce the difficulties common 

to their situations. This package of possible policy options should 

be provided to the Committee not later than 120 days after enactment of this Act. 

Telemedicine.—The Committee encourages further development 

and implementation of telemedicine to help veterans in rural areas. 

Telemedicine is useful for a number of types of appointments, including helping veterans with mental health issues. The Committee requests VA to submit a report not later than 90 days after 

enactment of this Act providing with an update on the uses of telemedicine in rural communities and VA plans to further expand the 

use of telemedicine for mental health care. 

Improving access for rural veterans.—According to the most recent census data, usage of VA healthcare by rural veterans increases by level of rurality, with almost 40 percent of veterans in 

completely rural counties enrolled in or using the system. Rural 

veterans had the highest rates of disability overall and at all ages, 

and rural veterans from every period of service also have higher 

rates of disability than similar urban veterans. Rural veterans who 

53 

served during World War II (the oldest cohort) had the highest rate 

of disability. Rural Gulf War veterans, however, had the highest 

rate of service-connected disability. Healthcare services required for 

these cohorts may differ dramatically, and access to those services 

may be more difficult in rural areas. The Committee urges VA to 

consider age disparity among the rural veteran population when 

working to increase accessibility to telehealth services. 

Remote areas.—The Committee directs the Department to conduct a study of the feasibility of establishing health clinics in remote and underserved areas, such as the Northern Mariana Islands, where a veteran must travel by air or sea in order to reach 

the nearest full service VA health facility. The study should include 

an evaluation of the capability of existing health care providers in 

these areas to meet the needs of veterans. The study should be 

submitted to the Committee not later than 120 days after enactment of this Act. 

Facility expansion.—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, 

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. 

Womens’ issues 

Women’s access to medical services.—In 2010, in recognition of 

the increasing number of women veterans and the fact that they 

were not being served adequately at VA facilities, both in terms of 

attention to gender-specific health issues or infrastructure that 

could accommodate gender-specific needs, VA established a comprehensive instruction handbook specifically for healthcare services 

for women veterans that provided guidance in many of these areas. 

In 2015, Booz Allen Hamilton conducted an assessment of VA medical facility response to the 2010 guidance. In the area of facilities’ 

ability to ensure the dignity, privacy, and security of women veterans where they receive healthcare services, the assessment found 

that 71 percent of the sites were not adequately designed to meet 

the standard in diagnostic or patient care areas and 83 percent of 

the sites did not meet the standard in examination rooms. While 

the Committee appreciates VA’s system-wide attention to the needs 

of women, it is clear that more improvements must be made to create appropriate settings for women’s care. The Committee directs 

VA to provide not later than 90 days after enactment of this Act 

a description of the locations where VA facilities do not meet the 

standards established in 2010 and a timeline for meeting those 

standards, along with associated costs. 

Childbirth data.—The Committee requests a report not later 

than 90 days after enactment of this Act identifying the number of 

women veterans participating in the VA healthcare system who 

have given birth in the five most recent years for which data are 

available, how many of the pregnancies were high risk, the number 

of complications related to the mother or baby, and the number of 

maternal mortalities that occurred. 

54 

Maternity care benefit, survey, and education campaign.—The 

Committee requests a report on the following data related to VA 

maternity care benefits: the number of eligible female veterans and 

actual utilization from each of the last 10 years in each Veterans 

Integrated Service Network (VISN), to the extent that data are 

available; the number of veterans who receive prenatal care and 

have births at a VA facility, and the number of veterans who receive prenatal care-related services through contracted non-VA providers; information on the transition from VA to non-VA providers 

and how medical records are returned to VA once a woman is 

postpartum, particularly if she has an underlying medical condition; the number of maternity care coordinators in each VISN and 

specific data on minimum employment requirements and case load. 

The Committee also directs VHA to develop a patient survey to collect feedback from women veterans who utilize the maternity care 

benefit, including their satisfaction with VA maternity care benefits; whether the benefit met their needs; the patient’s interaction 

with the maternity care coordinator; and whether there were barriers to care, providers, or specific services related to the maternity 

care benefit. Further, the Committee encourages VHA to develop 

an education campaign publicizing the maternity care benefit, including clarifying who is eligible, what the benefit covers, and does 

not cover, and any cost sharing that may be required with the benefit. The education campaign materials should be easy for patients 

to understand and be easily accessible online and at each center for 

women’s health, medical center, and CBOC. 

Womens’ psychiatric needs.—The Committee encourages VA to 

offer real-time or tele-psychiatric services to pregnant and 

postpartum women modeled on existing evidence-based programs 

to adequately address women veterans’ mental health needs. 

Delivery of gender-specific care to female VA patients.—The Committee is concerned that VA is not adequately addressing the 

health needs of female veterans, including obstetrics and gynecological care, and treatment for gender-specific conditions and diseases. The Committee urges VA to continue its efforts to expand 

access to care in these areas and ensure efficient delivery of treatment for women veterans. 

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, yearly mammograms at age 45, and then every other 

year from age 55. 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 2018. 

Maternal mental health.—The Committee requests a report not 

later than 90 days after enactment of this Act identifying how 

many pregnant veterans were screened for depression in 2017, and, 

on average, at what points during pregnancy women were 

screened. The report should include how many times referrals were 

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erans who utilized treatment based on the referral, and whether 

they accessed care at VA or through community care, by VISN. The 

report should also identify the five most frequent psychosocial risks 

for pregnant veterans identified for each VISN during that time period. 

Pharmacy issues 

VA retail immunization care coordination program.—The Committee commends the VA Retail Immunization Care Coordination 

Program, which is a convenient way for veterans to ensure that 

they receive flu shots to avoid the dangerous effects of the disease. 

The Committee encourages VA to build upon the existing flu immunization program and expand the concept to other immunizations 

such as pneumococcal and zoster vaccines. 

Pharmacy workflow.—The Committee requests VA to provide a 

report describing how it manages pharmacy workflow processes at 

its centers and how those processes address preparation safety, reduce waste, and improve pharmacy productivity. The report should 

describe any major variations among the more than 1,000 workflow 

systems presently in use at VA and whether there are particular 

systems that have achieved higher levels of safety and productivity. 

This report should be provided not later than 90 days after enactment of this Act. 

Vaccine procurement.—The Committee is pleased that VA includes vaccines produced through recombinant DNA technology, in 

addition to traditionally produced vaccines, in its solicitations to facilitate the competitive process for all vaccine manufactures. 

VA drug prices.—Rising drug prices are a significant cost driver 

in healthcare. However, VA receives substantial discounts when 

purchasing prescription drugs. Common sense approaches such as 

using lower-cost generic drugs, providing care from expert pharmacists and making drug companies compete for business can help 

drive down the cost of healthcare. The Committee is interested in 

VA’s spending on prescription drugs. The Committee directs the 

Secretary of Veterans Affairs, to submit a report to the Committee 

on Appropriations not later than 120 days after the date of the enactment of this Act. The report should include prescription drug 

prices (net of rebates) paid by VA for the ten most frequently prescribed drugs and the ten highest-cost drugs for VA. In addition, 

the report should include total annual costs to the VA for all prescription drugs. 

Prescription drug abuse 

Comprehensive Addiction and Recovery Act (CARA).—The bill includes $55,821,000, as requested, for opioid addiction prevention 

and recovery efforts as authorized by CARA. Of this total, 

$8,991,000 is provided through the Medical Support and Compliance account. 

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 47 States currently have installed the technology to 

exchange data from their State prescription drug monitoring 

56 

boards with VA. One State and Puerto Rico have not acquired the 

necessary technology; three States are resolving legal issues with 

VA on their memoranda of understanding to share data. VA is 

urged to assist these remaining 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. 

Unfortunately, the report fails to recognize the Substance Abuse 

and Mental Health Services Administration’s (SAMHSA) recommendation for the use of all drugs approved by the Food and 

Drug Administration for the treatment of opioid addiction including 

medications that enable veterans to become free of all opioids and 

non-opioid alternatives that are less subject to diversion. 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. 

Oversight of VA substance abuse inspection programs.—The Committee is aware that the veteran population is at greater risk than 

the general population for opioid addiction. A recent GAO report 

recommended that the Secretary should ensure that medical centers establish an additional control procedure, such as an alternate 

controlled substance coordinator or a pool of extra inspectors, to 

help coordinators meet their responsibilities and prevent missed inspections. The Committee concurs with the GAO’s recommendations and encourages the Secretary to fully implement these recommendations to improve oversight of the controlled substance 

abuse inspection program and to document its progress. The Committee requests that VA provide an update on its progress adopting 

these best practices not later than September 30, 2017. 

Other health issues 

Hispanic-serving institution affiliations with VA health care facilities.—The Committee is pleased with VA’s effort to stimulate 

connections with Hispanic-serving institutions (HSIs), but continues to be concerned by the lack of 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 and provide that report to the 

Committee not later than 60 days after enactment of this Act. 

Historically black colleges and universities (HBCU) health professions schools.—The Committee is pleased that VA is moving forward with a symposium in June, 2017 with national VA leaders, 

VISN leaders, and leadership of the HBCUs that award doctoral 

level degrees in the health professions. The Committee requests a 

report on this event as well as the planned followup action at all 

levels of VA and the HBCU health professions schools not later 

than 90 days after enactment of this Act. 

Minority veteran care.—The Committee recognizes that in the 

last ten years, the number of minority veterans enrolled in the VA 

health system has increased and is projected to continue to grow. 

57 

The Committee encourages the Veterans Health Administration to 

make preparations to accommodate this growing population of veterans. The Committee is encouraged that the Center for Minority 

Veterans (CMV) and Office of Health Equity (OHE) have recently 

published reports outlining preliminary recommendations to investigate delivery of healthcare, and to improve disparities in health 

outcomes in minority veterans. However, the Committee is concerned there is not a coordinated effort to convey these recommendations to all offices in the Department. Therefore, the Committee directs the Undersecretary of Health to form a working 

group which should include senior department executives to develop a comprehensive implementation plan of the CMV and OHE 

recommendations for the Department. The Advisory Committee on 

Minority Veterans is directed to publish, on an annual basis, a review of the Department’s progress in implementing these recommendations. The Committee also directs the GAO to conduct a 

nationwide review of whether VA provides quality and culturally 

appropriate care for minority veterans. This report should include 

recommendations on how the Department can structure its next 

generation of electronic health record to collect data on quality and 

patient experience data by race and ethnicity. 

Veterans end-of-life care.—Veterans often have a unique set of 

physical, psychological and emotional needs at the end of life, including post-traumatic stress disorder, service-related disabilities, 

and other emotional and spiritual needs. The Committee applauds 

VA for their efforts to develop and/or strengthen partnerships with 

local hospice organizations, to increase access to hospice and palliative care for veterans, and to provide information and resources to 

improve end-of-life care for veterans. The Committee encourages 

VA to continue to foster delivery models that allow veterans to receive concurrent hospice or palliative care while receiving active 

disease treatment. 

Vietnam-age veterans and younger veterans face special challenges, compared to WWII veterans, which impact end-of-life 

caregiving and hospice care. The Committee requests VA to submit 

a report not later than 90 days after enactment of this Act identifying the unique challenges faced by Vietnam veterans receiving 

specialized palliative and hospice care and identifying best practices for hospice care specifically tailored to Vietnam veterans. In 

developing this report, VA should engage hospice and palliative 

care providers with Vietnam veteran-centric programs. 

Volunteer physicians.—The Committee is encouraged by the success of the Physician Ambassadors Helping Veterans Pilot Program 

to date and encourages VA to expand these programs to additional 

facilities throughout the country, prioritizing VHA sites that serve 

the largest veteran population as well as those which experience 

the longest wait times. 

Antimicrobial stewardship directives 

The Committee is pleased with VA’s efforts to reduce antibiotic 

use to avoid development of resistance to important drugs, without 

increasing 30-day readmission and mortality rates. Per the 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 

58 

fosters the judicious use of antimicrobials through education, direct 

provider-to-provider stewardship, and surveillance, and supports 

and expands ongoing efforts to prevent emergence of multidrug-resistant organisms. 

Regarding another aspect of antimicrobial stewardship, Congress 

recognizes that patient-focused, real-time clinical infectious disease 

surveillance and pharmacy tools are required for hospitals to meet 

national Antimicrobial Stewardship directives. While individual VA 

medical facilities have incorporated commercially-proven infectious 

disease and pharmacy tools, VA has not deployed a nationwide system. The Committee encourages VA to consider implementing a nationwide electronic solution for all VA medical facilities that would 

provide infectious disease control monitoring, provide appropriate 

treatment and pharmacy care plans, help prevent potential health 

care risks, document interventions that improve patient care, and 

reduce hospital costs. 

Vet centers.—The Committee appreciates the efforts VA has 

made in terms of providing vet centers and mobile vet centers to 

address the varied physical and mental health needs of veterans. 

Given the changing dynamics and increased number of combat veterans, the Committee requests VA to provide an analysis of the 

need for additional vet centers to serve this population, 

disaggregated by Veterans Integrated Service Network. This report 

should be submitted to the Committee not later than 90 days after 

enactment of this Act. 

National Veterans Sport Programs.—The bill includes 

$15,830,000 for the Office of National Veterans Sports Programs 

and Special Events, which is the same as the request and the fiscal 

year 2017 funding for the program. The Committee recognizes that 

veterans have shown marked improvements in mental and physical 

health from participating in adaptive sports and recreational therapy. The Committee also recognizes that adaptive sports and recreational therapy provide a lower-cost alternative to other 

healthcare services that produce similar health outcomes. 

Colorectal cancer screening.—In 2016, the United States Preventive Services Task Force (USPSTF) identified 7 strategies to increase colorectal cancer screening, designating them as A-rated. 

The strategies have subsequently been adopted by the National 

Committee for Quality Assurances Healthcare Effectiveness Data 

and Information Set (HEDIS) measures, which are used by more 

than 90 percent of America’s health plans to measure performance. 

The Committee encourages VA to offer all seven USPSTF strategies now recognized in the HEDIS measures to all veterans enrolled in the VA health system. Colorectal cancer remains the second leading cause of cancer death in the United States, killing 

50,000 Americans every year. Treatment costs reached 

$6,500,000,000 last year, much of this borne by the Medicare system; overall spending is expected to exceed $20,000,000,000 annually by 2020. Many of these deaths and later-stage diagnoses could 

be prevented and hundreds of millions of dollars could be saved if 

these cancers were detected earlier through a range of scientifically 

proven screening techniques. Higher compliance and adherence to 

a testing strategy can also be achieved if more screening alternatives are offered by VA, further reducing mortality and morbidity 

in the veteran’s population. 

59 

Veterans identification card fee.—The Veterans Identification 

Card Act requires the Department to issue identification cards to 

any requesting veteran who was discharged from the armed forces. 

The Committee is concerned that the law requires VA to cover the 

cost of issuing the cards by charging veterans a fee for the card. 

The Committee understands that, at this time, VA has not issued 

any veteran ID cards, and the actual cost of the proposed ID card 

has not been determined. The Department indicates that it is trying to make the costs as low as possible to facilitate the widest possible distribution of cards and will consider low-income waivers for 

some veterans. In addition, the Committee encourages VA to partner with private charities and individuals to assist low-income veterans with the cost of the cards. 

Patients’ rights.—The Committee notes that veterans’ rights 

while in treatment at VA facilities do not match in all instances 

the standards at some of the nation’s leading private medical institutions. The Committee urges the Secretary to analyze the differences in the rights of VA medical beneficiaries compared to 

those at leading private medical service providers and develop a 

plan no later than 180 days after enactment of this Act to better 

align VA’s policies with common standards of leading private medical service providers. 

Provision of kidney dialysis services.—The Committee is aware 

that VA has a long history of providing dialysis services for veterans through national contracts when VA is unable to directly provide those services. As the Choice program is reconfigured, the 

Committee understands that VA may consider including provision 

of dialysis services as part of the Choice networks rather than renewing the existing national contracts. However, VA has stated 

that its decision on this issue is unresolved and the national contracts may well be extended when up for renewal September 30, 

2018. The Committee encourages VA to consider carefully the benefits provided by the current national contracts and whether they 

could be replicated as part of a Choice network. The Committee 

also applauds VA’s desire to move to value-based care in dialysis. 

To start, VA should explore the Center for Medicare and Medicaid 

Service’s renal-focused efforts to move dialysis providers nationally 

in more quality-focused and value-based arrangements. 

Patient safety.—The Committee applauds the Department for 

continuing to make strides in safe, high quality healthcare through 

its efforts to become a high reliability organization, as recommended by the Joint Commission throughout all healthcare, and 

is encouraged by the interest of a number of VA facilities in innovative, proven methods for care delivery like the Military Acuity 

Model developed by U.S. Air Force medical staff. 

Eye screening pilot.—The Committee is aware that VA has begun 

an experimental eye and vision screening pilot program, called 

Technology-Based Eye Care Services (TECS), currently in operation 

at the Atlanta VA Medical Center. While appreciating that VA is 

operating the pilot to provide eye care to veterans in areas in 

which it can be difficult to find timely care, the Committee is concerned that the TECS program may be offering a reduced level of 

care for veterans that does not conform to existing VA policy. The 

Committee urges VA to critically examine the use of the program 

60 

and ensure that all veterans receive a standard of care in conformity with existing VA policy. 

Lung cancer screening.— The Committee notes with concern that 

veterans at risk for lung cancer are not always afforded the same 

access to lung cancer screening programs that are offered to Medicare beneficiaries. The Committee requests the Secretary to report 

to the Committee not later than 90 days after enactment of this 

Act on the steps VA is taking to make lung cancer screening broadly available to veterans at high risk for lung cancer. 

Analytic surgery evaluations.—The Committee is committed to 

ensuring that veterans receive the most appropriate, least invasive, 

quality surgical care possible in order to decrease the clinical risk 

to patients while simultaneously reducing costs through greater efficiencies. The Committee encourages the Secretary to explore systems and approaches that would objectively compare VA surgical 

outcomes data against best practice data to identify unwanted variation at the procedure and surgeon level and help ensure that surgical procedures are being carried out in an efficient and high quality manner. 

Delays in reimbursements.—The Committee is concerned by reports that veterans can wait months for reimbursement for the 

costs of their travel to VA facilities for medical treatment. The 

Committee directs VA to report back not later than 90 days after 

enactment of this Act, detailing actions VA has taken to process 

travel vouchers within 60 days of receipt of the voucher. 

Services to Indian veterans.—In 2010, VA entered into a memorandum of understanding (MOU) with the Indian Health Service 

(IHS). On January 17, 2017, the MOU was extended through June 

30, 2019. Under this agreement with IHS, VA reimburses care provided to Indian veterans at IHS facilities and Tribal health programs. The agreement benefits VA, which cannot reasonably maintain full service VA facilities in low population, highly rural areas. 

Reimbursement rates are substantially above customary rates because of costs of providing service in highly rural locations. There 

is community interest in extending the VA special reimbursements 

to Indian urban clinics. In order to understand the impact of this 

expansion, the Committee requests VA to provide a comprehensive 

report describing how an expansion of the current agreement with 

IHS would integrate with care currently provided to Indian veterans in VA clinics in urban areas and through the Choice program 

of non-VA community care. The report should include: (1) estimates 

of the number of veterans who are likely to leave the VA 

healthcare system in urban areas to seek service through Indian 

urban clinics; (2) the annual estimated cost differential for VA to 

reimburse IHS rather than provide services directly in urban areas; 

(3) the potential for Indian urban clinics to qualify as providers in 

VA Choice provider networks; (4) estimated capacity of Indian 

urban clinics to treat increased Indian veteran caseloads; and (5) 

any data supporting the use of the higher negotiated reimbursement rate in urban settings versus highly rural areas. VA should 

consult with IHS in the preparation of this report, which should be 

provided to the Committee not later than 90 days after enactment 

of this Act. 

Detection of early pressure ulcers in veterans.—VA has been a 

leader in the use of telehealth services. For veterans who have a 

61 

health problem like diabetes, chronic heart failure, chronic obstructive pulmonary disease, depression or post-traumatic stress disorder, getting treatment can be complex and inconvenient, and 

these innovative telehealth approaches can be lifesaving. The Committee is interested in how biometric sensor technology can be used 

as a diagnostic to accurately detect early pressure ulcers in veterans. The Committee urges the Secretary of VA to explore the use 

of early detection technology for early pressure ulcers and the possible impact it could have on the cost of care related that condition. 

Outdoor recreational therapy.—The Committee supports VA utilization of outdoor recreation as a means of addressing the physiological, psychological, social, and emotional wellbeing of patients. 

The Committee requests a report not later than 90 days after enactment of this Act that identifies the number of recreational 

therapists employed by each VISN, the frequency with which recreational therapy was prescribed in fiscal year 2016 by each VISN, 

and whether it was prescribed by a primary care provider or specialist. The report should also describe the primary barriers providers experience in prescribing outdoor recreational therapy, including but not limited to geographical limitations, cost, lack of research basis on effectiveness or health outcomes, and physical 

health constraints of veterans. 

Disruption in medical facility moves.—The Committee recognizes 

that VA is reorganizing its healthcare system as it makes decisions 

about locations where services will be provided by outside 

healthcare entities versus VA facilities. Such reorganizations can 

create disruption and confusion in communities. To prevent potential disruptions in the future, the Committee directs VA to submit 

a written notification to the community and to the State’s Congressional delegation 30 days before it plans to close a healthcare facility. Such notification should identify the alternative facility or facilities where VA plans that veterans in the area will receive care; 

address distance and travel concerns that may occur for veterans; 

and provide information on the type of care available at the alternative facilities. 

Organ donation policy.—The Committee is concerned that veterans may not have a complete understanding of VA policy regarding reimbursement of organ transplants. VA is requested to provide 

a report to the Committee not later than 60 days after enactment 

of this Act about VA organ donation policies, explaining such issues 

as: (1) which conditions qualify a veteran for an organ transplant 

paid for by VA; (2) whether live donation transplants are covered 

by VA; (3) what share of the organ transplantation cost must be 

financed by the veteran; (4) reimbursement policy for veterans receiving organs from non-veteran live donation, as well as possible 

reimbursement for the non-veteran surgical costs; and (5) whether 

live donation organ transplants, if reimbursed, can be financed 

through the Choice program or can only be performed in VA or VAaffiliated hospitals. 

MEDICAL COMMUNITY CARE

Fiscal year 2017 enacted level ........................................................... $7,246,181,000 

Fiscal year 2018 enacted level ........................................................... 9,409,118,000 

Fiscal year 2018 additional request .................................................. 254,000,000 

Committee 2018 additional recommendation ................................... 254,000,000 

62 

Fiscal year 2019 advance appropriation request ............................. 8,384,704,000 

Committee 2019 advance appropriation recommendation .............. 8,384,704,000 

Comparison with: 

Fiscal year 2018 enacted level ................................................... (1,024,414,000) 

Fiscal year 2019 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 2018, the bill provides 

an additional $254,000,000 as requested by the Administration and 

for fiscal year 2019, the bill provides $8,384,704,000, of which 

$2,000,000,000 is available until September 30, 2022. 

As the Choice program reaches the end of its mandatory funding 

in 2018, the authorizing committees are considering legislation to 

consolidate VA’s traditional community care programs with a successor program to the original Choice program. The Administration 

has proposed to finance the successor Choice program as a mandatory program, funded with policy changes that would reduce mandatory VA benefits. Regardless of whether or not the mandatory 

successor program is established, the efforts to consolidate VA’s 

multiple community care programs are important. As VA and the 

authorizers consider this consolidation, the Committee highlights 

the following issues in the current Choice program that it hopes 

will be addressed: • Exceptions to distance rules.—The Committee is pleased that 

VA has continued to ‘open the aperture’ of care that can be provided outside of VA facilities. The Secretary now has discretion to 

identify ‘‘other factors’’ that create an unusual or excessive burden, 

which create eligibility for Choice services. These factors include 

the nature or complexity of the medical services the veteran requires; the frequency that those services must be furnished to the 

veteran; and the need for an attendant for a veteran to travel to 

a VA medical facility. The Committee encourages VA to continue 

to use and possibly expand these criteria, for example, in situations 

where the veteran is receiving chemotherapy or dialysis, as the 

successor program to Choice is designed. In addition, the Committee directs VA to report to the Committee not later than 60 

days after enactment of this Act the number of instances during 

2017 in which veterans were not permitted to use non-VA care in 

instances meeting the definition of ‘‘unusual or excessive burden’’. • Problems with network administrators.—The Committee is concerned about the continued communication gaps between patients 

and third party administrators (TPAs) who operate the Choice provider networks. The Committee is aware of numerous complaints 

from veterans and community care providers about program eligibility, delays in scheduling of appointments, and inadequate resources to resolve billing issues. The Committee urges VA to work 

with the TPAs to restructure the Choice program to improve these 

issues and to work with State veterans agencies to continue to 

strengthen and improve the Choice program’s provider network. 

• Referral delays.—The Committee is concerned by a recent GAO 

report suggesting that VA has not set a limit on the number of 

days VA hospitals are allowed to compile relevant clinical information and send referrals to the TPAs. The Committee directs the 

Secretary to review this report and establish a reasonable limit on 

the number of days VA hospitals can take to transfer relevant clinVerDate Sep 11 2014 06:22 Jun 23, 2017 Jkt 025912 PO 00000 Frm 00062 Fmt 6659 Sfmt 6602 E:\HR\OC\HR188.XXX HR188
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ical information and referrals to TPAs to ensure that veterans receive timely care. • Travel burdens.—All too often, infirm or elderly veterans are 

required to travel long distances or endure significant drive times 

to access VA care, even though local non-VA hospital care and medical services are readily available. The Committee hopes that program modifications will continue to reduce the travel burden for 

senior veterans needing care. • Delayed provider payments.—The Committee continues to be 

concerned about the timeliness of reimbursements from VA to private healthcare providers. Delays in processing of such payments 

seriously undermine the ability to recruit and retain private 

healthcare providers to care for veterans. The Committee repeats 

its request that not later than 90 days after enactment of this Act, 

VA provide the Committee a comprehensive report detailing the 

amount owed to outside providers in each State. The report should 

document outstanding invoices over 6 months due and the corrective actions being implemented to address these outstanding balances. Furthermore, this report should describe any planned future 

actions that will prevent this problem from recurring. • Network administrator poor performance.—The Committee is 

aware of problems experienced by veterans utilizing the Choice program, including challenges scheduling appointments; appointments 

being canceled without notification; and slow payments to physicians for services provided. The Committee remains concerned that 

VA has not included safeguards in its Choice Act contracts to hold 

contractors accountable for the quality and flexibility of care provided to veterans. 

Choice Act staffing increases.—The Committee repeats its request 

for a report due not later than 90 days after enactment of this Act 

describing for each VISN the amount of Choice Act funding received in fiscal year 2016 to hire additional staff; the number of 

staff hired; the number of employees who left VA during that period; and the net gain for each of the following position categories— 

primary care, specialty care physicians and mental health staff. 

MEDICAL SUPPORT AND COMPLIANCE

Fiscal year 2017 enacted level ........................................................... $6,524,000,000 

Fiscal year 2018 enacted level ........................................................... 6,654,480,000 

Fiscal year 2018 additional request .................................................. 284,397,000 

Committee 2018 additional recommendation ................................... 284,397,000 

Fiscal year 2019 advance budget request ......................................... 7,239,156,000 

Committee 2018 recommendation in the bill ................................... 7,239,156,000 

Comparison with: 

Fiscal year 2018 enacted level ................................................... 584,676,000 

Fiscal year 2019 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 $7,239,156,000 in advance fiscal year 2019 

funding, as requested, as well as $284,397,000 requested in additional fiscal year 2018 funding. The Committee has included reVerDate Sep 11 2014 06:22 Jun 23, 2017 Jkt 025912 PO 00000 Frm 00063 Fmt 6659 Sfmt 6602 E:\HR\OC\HR188.XXX HR188
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quested bill language to make available through September 30, 

2020, $100,000,000 of the Medical Support and Compliance appropriation for fiscal year 2019. 

MEDICAL FACILITIES

Fiscal year 2017 enacted level ........................................................... $5,321,668,000 

Fiscal year 2018 enacted level ........................................................... 5,434,880,000 

Fiscal year 2018 additional request .................................................. 1,079,795,000 

Committee 2018 additional recommendation ................................... 1,079,795,000 

Fiscal year 2019 advance budget request ......................................... 5,914,288,000 

Committee 2019 recommendation in the bill ................................... 5,914,288,000 

Comparison with: 

Fiscal year 2018 enacted level ................................................... 479,408,000 

Fiscal year 2019 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 $5,914,288,000 in advance fiscal year 2019 

funding, as requested, as well as $1,079,795,000 in additional fiscal 

year 2018 funding. The Committee has included requested bill language to make available through September 30, 2020, $250,000,000 

of the advance Medical Facilities appropriation for fiscal year 2019. 

Spending plan.—The Committee expects VA to provide not 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 2018 

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. 

Medical imaging equipment.—The Committee remains committed 

to helping VA in its efforts to ensure a timely process for VA medical centers to receive the medical imaging equipment that they 

need to take care of veterans. The Committee urges VA to adhere 

to their set timelines for consolidated procurements of high-tech 

medical equipment and strive for a 120-day turnaround for these 

orders. Delays to this timeline negatively impact patient and clinician access to diagnostic and imaging services, and the Committee 

asks VA to be mindful of these potential risks. The Committee requests that VA increase education opportunities at 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 share 

information regarding procurement processes in the area of hightech medical equipment with VISN imaging communities and VA 

medical centers. In addition, the Committee urges VA to coordinate 

between capital equipment purchases, facilities funding for site 

readiness, and training of staff to use the equipment to ensure that 

facilities can use it as quickly as possible after purchase. 

65 

MEDICAL AND PROSTHETIC RESEARCH

Fiscal year 2017 enacted level ........................................................... $675,366,000 

Fiscal year 2018 budget request ....................................................... 640,000,000 

Committee recommendation in the bill ............................................ 698,228,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 22,862,000 

Fiscal year 2018 budget request ................................................ 58,228,000 

This appropriation provides for medical, rehabilitative, and 

health services research. The bill makes this account funding available through September 30, 2019. The Committee recognizes the 

importance of the research conducted by VA for veterans’ quality 

of life and provides $58,228,000 above the request to address important research areas like genomic precision medicine and the 

Million Veteran Program database. 

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 2018 research 

resources beyond the research account are $1,114,000,000. 

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 2018, compared to the budget request of $19,680,000. 

PTSD is a clinically diagnosed psychiatric disorder that can occur 

following life-threatening events or exposure to traumatic events. 

Military service can be a strong contributor to PTSD. For example, 

nearly 20 percent of enlisted soldiers—approximately 300,000—who 

returned from Iraq and Afghanistan have reported symptoms of 

PTSD or major depression. The Committee urges VA to expand and 

strengthen its research on PTSD and trauma-related brain disorders, and use every available technology including research focused on finding a diagnostic biomarker for PTSD. Unlike other 

neuro-psychiatric diseases, it is not yet known how genetic variants 

affect a person’s risk of developing PTSD. Such biomarker information may provide a mechanism to more reliably predict the risk of 

PTSD in different populations and afford an opportunity for preventive interventions. To address PTSD, the Committee urges the 

Secretary of Veterans Affairs to engage in public/private pilot 

projects with non-profit entities that are committed to the provision 

of mental health services for veterans. 

The Committee recognizes the importance of the VA National 

Center for PTSD in promoting better prevention, diagnoses, and 

treatment of PTSD. The Committee further recognizes the importance of this research for veterans, their family members and those 

66 

experiencing community violence. The Committee encourages the 

National Center to conduct further research on the effects of PTSD 

for veterans who live in communities affected by violence, particularly in low-income and communities of color and how neighborhood conditions, including gun violence, may exacerbate their 

PTSD diagnosis. 

The Committee remains concerned by the rates of PTSD among 

the veteran population. The Committee is aware of innovative medical and pharmacological treatments for PTSD that are currently in 

development, and encourages VA to maintain investments in medical research related to the treatment of PTSD. The Committee further encourages the VA to proactively pursue opportunities for public-private partnerships in developing treatments for PTSD and to 

expand efforts to study correlations between PTSD and military 

service. 

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. 

Collaboration with private sector research.—The Committee is 

aware of research efforts conducted in the private sector on medical 

and pharmacological treatments for a number of conditions that affect veterans, such as PTSD. VA may not be able to directly finance 

such research efforts, but it has important assets unavailable to 

private sector researchers that could ensure the success of these efforts to produce treatments for veterans. However, the Committee 

understands that VA has not historically provided to outside researchers access to data bases or biological samples already collected in populations afflicted with the diseases being studied or 

provided the targeted veteran population with information or encouragement to participate in clinical trials. The Committee encourages VA to take steps to increase its cooperation with private 

sector researchers in these areas. The Department is directed to 

submit a report to the Committee not later than 90 days after enactment of this Act describing any constraints that VA may face in 

terms of sharing data bases and biological samples with private 

sector research teams or in identifying potential clinical trial participants—for example, whether it is precluded by privacy statutes 

or VA-specific investigational review board requirements. 

Prosthetics research for female veterans.—While the number of female veterans who have been wounded in action and lost a limb 

is low (less than 1.5 percent), women have unique needs when they 

lose an arm or leg. According to VHA, female veteran amputees use 

more health care, rehabilitation services and are seen more frequently when compared to men. Furthermore, female veterans are 

also more likely to be unsuccessful in fitting of their prosthesis, to 

experience skin problems after lower extremity amputation, and to 

have greater intensity of pain. Women with upper extremity amputation are more likely to reject their prosthesis. Female veterans 

with lower extremity amputations have higher rates of hip and 

knee osteoarthritis. The Committee is concerned that VA is not 

properly assessing prosthetics for all veterans nor investing in 

67 

prosthetic development for female veterans. For example, special 

prosthetics needs occur in female veterans, especially during pregnancy. Pregnant female veterans with limb loss experience increased wear on prosthetic components, need for realignment and 

frequent modifications. Due to these issues, the Committee believes 

that VA should support additional research on rehabilitation and 

prosthetics meant for females and directs the GAO to examine this 

issue. This report should examine: (1) the number of female veterans in need of prosthetics; (2) the extent of problems female veterans have when being fitted with prosthetics; (3) whether any internal research policy changes are needed to facilitate research on 

prosthetics for female veterans; (4) any elements in the overall VA 

culture that hinder such research; and (5) current practices of VA 

prosthetics service models for cost effectiveness, health benefits, 

data collections, staff efficiency and overall patient satisfaction. 

Innovative treatments.—The Committee appreciates the efforts 

VA has made to create a hub for research on innovative treatments 

through the Center for Compassionate Innovation. The Committee 

understands that the Center is considering developing a research 

project on the possible benefits of EEG/EKG-guided resonance therapy with a larger population of veterans suffering from PTSD, TBI, 

chronic pain, and opiate addiction. The Committee requests VA to 

provide a report describing the status of the Center, its budget resources, and a summary of research projects supported by the Center not later than 120 days after enactment of this Act. 

Specialized and modular prosthetics research.—While VA is a 

global leader and pioneer in specialty care for service-connected injuries, the needs of today’s veterans are changing, both within an 

aging population and the post-9/11 generation. The field of specialized and modular prosthetics is evolving at a faster pace than VA 

has been able to match. The Committee is concerned that VA does 

not have an effective, streamlined model of service for specialized 

or innovative modular prosthetics, unlike both the Departments of 

Defense and the Centers for Medicare and Medicaid Services, 

which have begun to explore this field. The Committee believes VA 

should conduct comparative analyses of prosthetic manufacturing 

processes to assess results relating to data, clinician experience, 

staff efficiency and training, and patient satisfaction to improve 

functional outcomes for veterans. 

Exoskeleton rehabilitation studies.—The Committee commends 

VA for its research on and early use of exoskeleton technology for 

the rehabilitation of veterans with spinal cord injuries. The Food 

and Drug Administration (FDA) has also approved exoskeleton 

technology to provide advanced neurorehabilitation, including for 

individuals who have had a stroke and need physical therapy to 

improve their ability to walk. The Committee notes that the size 

of this veteran patient population is significantly greater than the 

spinal cord injury population, and will continue to expand as veterans age. The results for individuals with a stroke in terms of improved clinical outcomes with greater therapy efficiency have been 

promising and warrant greater attention. The Committee urges VA 

to expand its research on the efficacy of exoskeleton technology for 

veterans with stroke and other conditions for which FDA has approved its usage. 

68 

Canine therapy.—The Committee is aware that canine therapy 

for treatment of PTSD and TBI symptoms is an emerging alternative therapy to pharmaceutical treatments. While still experimental, canine therapy has demonstrated effectiveness in treating 

PTSD and other psychological disorders for psychiatric patients, 

patients with substance abuse problems, and victims of trauma. 

The Committee notes that canine therapy is a promising area for 

further research as a complementary or alternative treatment for 

the signature wounds of the wars in Iraq and Afghanistan. The 

Committee continues to encourage VA to expand its research on canine therapy to validate its therapeutic effectiveness in the treatment of PTSD and TBI. 

Intergenerational effects of toxic exposures.—The Committee understands that exposure to toxic chemicals can have lifelong and intergenerational effects, the impacts of which are still being determined. The Committee recognizes that the generational effects of 

toxic exposure have not been sufficiently studied to determine what 

conditions children and grandchildren of exposed veterans may 

face. The Committee requests that VA provide to the Committee 

not later than 120 days after enactment of this Act an analysis of 

the feasibility of establishing a large-scale repository of data from 

descendants of individuals with toxic exposures. This analysis 

should include any limitations due to difficulty of data collection 

and statutory limitations on which populations VA is permitted to 

study. 

Research transparency.—The Committee commends VA for 

issuing its policy and implementation plan for public access to scientific publications and digital data generated by VA research. The 

Committee encourages VA to continue its efforts towards full implementation of the plan, and requests that an update on progress 

be included in the fiscal year 2019 budget request. 

Use of animals in research.—The Committee is concerned by recent reports of medical experimentation on dogs at VA research facilities, which are being reviewed by the VA Inspector General. 

While the Committee values the innovative and groundbreaking 

medical research occurring at VA medical facilities, it believes that 

all animal experimentation should be conducted with strict adherence to animal welfare laws and regulations. VA is instructed to 

submit a report to the Committee that describes: the number of VA 

research studies using animals compared to the total number of VA 

research projects; the number of animals by type used in VA research projects in fiscal year 2017; the number that were 

euthanized or failed to survive the experimental studies; the number of incidents reported to each Institutional Animal Care and Use 

Committee; any citations or critical reviews of VA animal research 

from the United States Department of Agriculture or the Association for Assessment and Accreditation of Animal and Laboratory 

Animal Care International; any personnel actions taken in response to external reviews of VA animal research projects; and the 

availability of these reports to the public. This report shall be submitted to the Committee not later than 90 days after enactment of 

this Act. 

Mental health treatments.—The Committee supports the progress 

made by the Center for Compassionate Innovation, which operates 

in coordination with the private sector to identify and develop new 

69 

and emerging therapies for PTSD and other emotional disorders. 

The Committee recognizes that veterans and their active duty 

counterparts benefit from participating in creative art therapy programs, through acceptance into a service dog program, or through 

enrollment in other interactive community based-programs. The 

Committee supports the Secretary’s continued expansion of these, 

and other innovative programs. 

Burn pit exposures.—The Committee understands that many 

post-9/11 veterans have experienced health effects potentially associated with exposure to burn pits, the potential impacts of which 

are still being determined. The Committee recognizes the need for 

further studies into the issue of service-connected conditions caused 

from exposure to burn pits and urges VA to explore further options 

for addressing this problem. 

Respiratory disease.—The Committee notes the high burden of 

respiratory illnesses, such as lung cancer, in the veteran population. The Committee urges VA to provide support for respiratory 

research proposals commensurate with the burden of respiratory 

disease. 

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 2018 is $3,271,000,000. 

NATIONAL CEMETERY ADMINISTRATION

Fiscal year 2017 enacted level ........................................................... $286,193,000 

Fiscal year 2018 budget request ....................................................... 306,193,000 

Committee recommendation in the bill ............................................ 306,193,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 20,000,000 

Fiscal year 2018 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 136 operational national cemeteries and 33 other cemeterial installations. 

The bill includes language making ten percent of the total available until September 30, 2019. 

70 

Rural cemetery access.—In H. Rept. 112–94, the Committee first 

expressed concern that NCA is not adequately serving the nation’s 

veterans in rural areas. According to the fiscal year 2012 budget 

submission, NCA anticipated that 10 percent of all veterans would 

not have access to a burial option in a national, State or tribal government veteran’s cemetery within 75 miles of their home. In five 

years, VA has only reduced this number to eight percent while receiving generous funding increase 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 to a burial option within 75 miles of a veteran’s home. The Committee has requested a report on this issue three times and is still not satisfied 

with VA responses or the reports submitted to the Committee. 

Therefore, the Committee requests that GAO examine and provide 

a report not later than 120 days after enactment of this Act: (1) describing VA’s plans to narrow the gap of veterans without reasonable access to burial; (2) examining the effect the NCA Urban Initiative and Rural Initiative have had on access; (3) outlining a 

strategy addressing the NCA shortcomings for rural areas; and (4) 

providing changes in policy to resolve this matter, with an estimated timeline and cost estimate for implementation. 

Cemetery deferred maintenance.—The Committee was concerned 

about the level of deferred maintenance at NCA cemeteries and 

asked the Committee’s Surveys and Investigations group to conduct 

an analysis. The group’s report indicated that NCA’s Facilities Condition Assessment (FCA) survey conducted every three years had 

several weaknesses: it does not adequately reflect true costs associated with correcting maintenance deficiencies and addressing deferred maintenance balances; maintenance priorities are not developed or weighted uniformly across districts; and costs are limited 

to the date on which the FCA is completed with no ability to 

project costs into the future. The U.S. Army Corps of Engineers developed a software system, the Sustainment Management System 

(SMS), that provides a predictive capability that facilitates forecasting of work requirements, cost projections, and prioritization. 

The Committee requests VA to report to the Committee not later 

than 60 days after enactment of this Act the costs associated with 

implementing and evaluating a pilot project using SMS to conduct 

FCAs across at least two districts. The Committee also encourages 

NCA to separate maintenance costs from costs associated with upgrades and enhancements to provide a more accurate depiction of 

the physical state of VA cemeteries. Thirdly, the Committee strongly recommends that VA weight and prioritize maintenance needs 

uniformly across districts and allocate funding proportionately to 

ensure that the highest priority projects are funded first. 

71 

DEPARTMENTAL ADMINISTRATION

GENERAL ADMINISTRATION

(INCLUDING TRANSFER OF FUNDS)

Fiscal year 2017 enacted level ........................................................... $345,391,000 

Fiscal year 2018 budget request ....................................................... 346,891,000 

Committee recommendation in the bill ............................................ 346,891,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 1,500,000 

Fiscal year 2018 budget request ................................................ – – – 

The General Administration account provides funds for the Office 

of the Secretary, six Assistant Secretaries, and three independent 

staff offices. The Committee has included bill language to make 

available through September 30, 2019, 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. 

VA budget office communication.—The Committee has traditionally channeled most of its inquiries and requests for information 

and assistance through VA budget office. The Committee reiterates 

its longstanding position that, while the Committee reserves the 

right to call upon all VA offices, the primary communication between the Committee and VA should normally be through the 

budget office. Responses to Committee inquiries, regardless of 

whether they concern funding or policy, are to be transmitted without delay by other offices within VA, unless otherwise requested by 

the Committee. In addition, to facilitate the work of the Committee, it expects that the Department will make available to all 

personal and committee staff of Members of the Committee the 

same direct contact with the budget office. The Committee also expects that a staff member of VA budget office will be present at 

every meeting held between the chairman and ranking member of 

the Full Committee and Subcommittee and the Secretary or other 

senior VA officials. 

White House Veterans Complaint Hotline.—The Committee did 

not learn until the Secretary’s ‘‘State of VA’’ address on May 31, 

2017 that a White House veterans complaint hotline, which was 

mentioned during the Presidential campaign, was going into operation on June 1st. The Committee has concerns about how this new 

hotline will be integrated with the other hotlines already in operation in VA. VA indicates it already has an astonishing 975 customer service numbers. Those hotlines address benefits, health, insurance, cemeteries, women’s issues, suicide crises, debt management, and whistleblower issues, but the sheer number of call lines 

makes it difficult for veterans to navigate the labyrinth and get the 

services they need without delays. VA has been in the process of 

reducing and rationalizing the current plethora of hotlines to reduce the frustration and confusion veterans feel when trying to 

contact the agency for help. The Committee is concerned that the 

creation of this new White House hotline will further confuse veterans and potentially add dangerous delays when the contractors 

running the hotline have to refer callers to another office in VA 

with the necessary expertise. The Committee expects additional information as the hotline is stood up, describing the source and size 

of the funding required to operate the hotline, whether the staff anVerDate Sep 11 2014 06:22 Jun 23, 2017 Jkt 025912 PO 00000 Frm 00071 Fmt 6659 Sfmt 6602 E:\HR\OC\HR188.XXX HR188
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swering calls will be VA employees, how many staff will operate 

the hotline on a weekly basis, what call volume is expected, what 

hours the hotline will be available, where the hotline will be located, how operators plan to channel calls to agency staff with the 

necessary expertise, and what performance measures are built into 

its operation. This report shall be due to the Committee not later 

than September 15, 2017, a month after the hotline becomes fully 

operational. 

Central office responsiveness.—The Secretary testified before the 

Committee that he was committed to responding to Congressional 

requests in a timely way—within 14 days for urgent matters and 

within 30 days for less time-sensitive issues—and he acknowledged 

that it was not a standard the Department had met in the past. 

The Committee is disturbed to learn that VA has already failed to 

meet these performance standards, and in some cases, has failed 

to respond to Congressional inquiries at all. The Committee directs 

the Secretary to review the correspondence process within the Department and make the necessary changes to ensure that all Congressional inquiries are responded to in a consistent and timely 

fashion. Furthermore, not more than 30 days after this report is 

filed and then on a quarterly basis the Secretary shall submit to 

the Committee a Congressional correspondence tracker showing 

only by party, the date the correspondence was received and the 

date a response was sent. 

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. 

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 2017 bill and conference report. 

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 fulltime equivalent staff from one organizational unit of the Department to another. 

Minority veteran population increase.—The Committee recognizes 

that the veteran population is becoming increasingly diverse. According to VA’s Center for Minority Veterans, more than one-third 

of veterans will come from minority groups by the year 2040. Accordingly, the Committee directs GAO to conduct a review of the 

VA’s data collection and reporting procedures for information on 

gender, race, ethnicity, and sexual orientation of veterans, and to 

submit a report no later than 180 days after this report is filed. 

This report should include how compliant VA is with existing statues and regulations related to data collection and reporting of race 

and ethnicity, and recommendations on how to improve these processes to better support veterans from historically underrepresented 

groups. The Committee further directs GAO to report and 

disaggregate data by race in its reports pertaining to VA, when the 

data is available, GAO has authority to collect it, and its inclusion 

is relevant to the report topic. 

Small, minority-and women-owned businesses.—The Committee 

directs the Department to submit a quarterly report to the ComVerDate Sep 11 2014 06:22 Jun 23, 2017 Jkt 025912 PO 00000 Frm 00072 Fmt 6659 Sfmt 6602 E:\HR\OC\HR188.XXX HR188
73 

mittee on its efforts to work with small-, minority-, and womenowned businesses. The report shall specify the following data about 

use of funds appropriated under this Act: the total number of contracts awarded by the Department; the number of contracts awarded to small businesses, veteran-, minority-, and women-owned businesses; the median dollar value of contracts awarded in each category; and the median, mean and range of length of contracts 

awarded in each category. When data are available, this report 

should include data disaggregated by race and ethnicity. 

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 and when the data exist, VA display 

information in the annual report(s) submitted to Congress separately for women veterans and minority veterans. 

Improved patient access to VA hospitals.—The Committee is distressed that current law prevents VA from using shuttle buses to 

transport employees from remote parking lots to their hospital employment, thus requiring VA to allocate nearby parking lots for employee use and relegating patients to remote lots. The Committee 

bill includes language modifying current law to permit VA hospitals to use shuttle buses for employees so that they can reserve 

nearby lots for VA patients. 

Kingdomware decision.—The Committee understands that the 

Kingdomware court decision has necessitated significant alterations in VA’s contracting processes. The Committee requests VA 

to submit a report not later than 60 days after enactment of this 

Act explaining the changes in contracting requirements resulting 

from the court decision and describing how the changes have affected the participation of Service-Disabled Veteran-Owned Small 

Businesses (SDVOSBs), including whether SDVOSBs have been 

disadvantaged in particular industries. 

Telework productivity.—The Committee expects VA to conduct 

vigorous oversight of its telework program, including: (1) implementing controls to verify that supervisors have completed 

telework training prior to entering into telework agreements with 

their employees and completion of the training is documented; (2) 

requiring documentation of regular or periodic reviews of all 

telework agreements in agency telework policies, including requiring supervisors to track and determine the number of actual hours 

employees telework in its time and attendance system; and (3) developing and implementing a plan to modernize telework productivity tracking by monitoring performance and collecting data to 

compare the productivity and accuracy of teleworkers to the productivity and accuracy of non-teleworkers. The plan should provide 

feedback to employees and measure employee productivity and accuracy. 

Third party fee collection pilot.—The report that accompanied 

P.L. 114–113 included language instructing VA to conduct a pilot 

similar to the one described in Senate Report 114–57. The Committee reiterates its support for such a pilot program and expects 

VA to respond to Committee directives. 

Management reforms.—The Committee notes that VA has not yet 

implemented many of the recommendations from outside reviews 

that address ongoing VA management challenges. Therefore, the 

74 

Committee directs VA to issue a report not later than 180 days 

after enactment of this Act identifying VA’s responses to the recommendations on key VA management challenges identified in: (1) 

the Independent Assessment required by P.L. 113–146; (2) the report of the Commission on Care established in P.L. 113–146; and 

(3) the internal VA report issued on February 28, 2015, entitled 

‘‘Task Force on Improving Effectiveness of VHA Governance’’. The 

report should delineate roles and responsibilities to optimize the organizational effectiveness and accountability of each administration, staff office, or staff organization, including the roles of key 

leaders of the department. In addition, GAO is directed to compile 

and submit to the Committee no later than 30 days after enactment of this Act a list of the most significant VA management 

issues on which GAO has made recommendations in reports during 

the past three years, along with VA responses to those recommendations. 

BOARD OF VETERANS APPEALS

Fiscal year 2017 enacted level ........................................................... $156,096,000 

Fiscal year 2018 budget request ....................................................... 155,596,000 

Committee recommendation in the bill ............................................ 156,096,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... – – – 

Fiscal year 2018 budget request ................................................ 500,000 

The bill makes ten percent of this funding available through September 30, 2019. 

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 VA dwindles, the appeals workload at the Board increases correspondingly. Pending appeals are 

projected to increase by 23 percent from 115,847 at the end of 2016 

to 142,756 by the end of 2018. The bill also provides the $7,500,000 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. 

INFORMATION TECHNOLOGY SYSTEMS

(INCLUDING TRANSFER OF FUNDS)

Fiscal year 2017 enacted level ........................................................... $4,278,259,000 

Fiscal year 2018 budget request ....................................................... 4,055,500,000 

Committee recommendation in the bill ............................................ 4,135,500,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... (142,759,000) 

Fiscal year 2018 budget request ................................................ 80,000,000 

75 

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’ 

healthcare services and benefits programs. 

Within the account total, the Committee allocates in bill language $1,230,320,000 for pay and associated costs, which is the 

same as the budget request; $2,486,650,000 for operations and 

maintenance, which is $20,000,000 above the request; and 

$418,530,000 for development, modernization, and enhancement, 

which is $60,000,000 above the request. The bill makes available 

$36,000,000 of pay and associated costs and $174,000,000 of operations and maintenance funds until September 30, 2019. All development, modernization, and enhancement funds are available until 

September 30, 2019. The bill provides an $80,000,000 increase above the request to 

permit additional investment in high priority areas such as cybersecurity, the electronic health record (EHR), and conversion of legacy systems such as the financial management system and the benefits delivery network. In particular, the Committee provides 

$31,000,000 for the Veterans Benefits Management System (in addition to the $38,118,000 which is provided for VBMS in the General Operating Expenses, Veterans Benefits Administration account); $83,000,000 for the replacement of the Financial Management System; $65,277,000 for development of a new EHR; 

$22,768,000 for replacement of the NCA burial operations support 

system; and $7,500,000 for the Board of Veterans Appeals modernization effort. 

Electronic health record.—The Committee has had a longtime interest in assuring that DOD and VA health records for 

servicemembers and veterans can be exchanged electronically so 

that doctors across the street or across the world will be able to 

learn the patient’s health history. After multiple false starts with 

plans for a unified DOD–VA system and then a stand-alone VA 

VistA record modernization, VA has now decided to acquire by sole 

source contract the same EHR being developed for DOD—the Military Health System (MHS) Genesis record. VA will need to add 

functionality specific to the VA mission. The Committee is pleased 

with the decision to pursue a single EHR, which its Members have 

advocated for years. However, the Committee is concerned about 

the implications of this detour on the completion time for the 

project (previously promised for 2018), its cost, the ability to meet 

the growing need for interoperability with non-VA community providers, and the usability of the VistA modernization products already completed. 

Given the substantial uncertainty at the time of Committee 

markup about the design of the new EHR, the Committee feels it 

is necessary to include bill language fencing 75 percent of funding 

provided for the development of the record until VA provides requested information listed in the bill language. The language requires VA to provide: a detailed explanation of the solicitation; an 

explanation of how the new record will replicate the DOD record 

with enhanced functionality for interoperability with DOD and private community providers; a strategic plan with timelines and performance milestones, a master schedule and annual and lifecycle 

76 

cost estimates; and information on the plan for transition from 

VistA to MHS Genesis, including how current EHR functionality 

and interoperability with DOD will be maintained. 

An administrative provision similarly restricts 75 percent of the 

funding for development of the EHR that is provided by the Veterans Health Administration from either the Medical Services or 

the Medical Support and Compliance account until similar information is provided to the Committee. The budget request for EHR 

funded by VHA increases to $226,012,000—an increase of 

$161,012,000 from fiscal year 2017. By contrast, the EHR request 

in the Information Technology Systems account drops by 

$102,836,000 to $65,277,000. The Committee is perplexed by this 

substantial VHA increase, given that VA acknowledges that 2018 

will be largely a developmental year when VA formulates a solicitation to acquire the type of system chosen. The Committee directs 

VA to provide a report not later than 60 days after publication of 

this report explaining the reasons for the contrasting patterns in 

the VHA and IT budgets and persuading the Committee that the 

Department has not shifted the EHR request between accounts because funding is more constrained in the smaller account. 

Cost of the new electronic health record.—It is clear that the total 

cost of the new EHR will vastly exceed the amount requested in 

the budget, if the experience with the DOD record is any guide. 

The Committee realizes it will take VA some time to develop a reliable cost estimate for the EHR solicitation, but the Committee 

wants to be clear that it will not be satisfied to receive estimates 

that describe only phases of the project without providing total estimated project costs. The Committee will expect to be briefed about 

the Administration’s long range strategy to finance the future costs 

of the new EHR within its proposed budget ceilings. 

The Committee continues to include bill language prohibiting obligation or expenditure of funds for information technology systems 

development, modernization and enhancement 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, modernization and enhancement 

projects upon prior notification to, and approval by, the Committees. The bill continues to include language indicating that funds 

for development, modernization and enhancement are available 

only for the projects and in the amounts specified in the report accompanying the bill. 

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. 

Not later than 30 days after enactment of this Act, the Department is required to provide a spending plan for the $60,000,000 in 

additional funding the Committee provides for development, maintenance, and enhancement projects. 

77 

INFORMATION TECHNOLOGY DEVELOPMENT PROJECTS 

(in thousands of dollars) 

Project Budget 

Request 

Committee 

Recommendation 

Electronic Health Record Interoperability and VLER Health ...................................... 10,000 10,000 

Electronic Health Record Replacement ...................................................................... 50,305 50,305 

Veterans Benefits Management System (VBMS) ........................................................ 59,904 59,904 

Virtual Lifetime Electronic Record (VLER) .................................................................. 20,968 20,968 

Veterans Customer Experience (VCE) ......................................................................... 73,624 73,624 

Other IT Systems Development ................................................................................... 143,729 203,729 

Total All Development ........................................................................................ 358,530 418,530 

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, modernization, and enhancement project funding chart included in the 

House report, and provide an explanation for any differences in excess of $1,000,000. 

Appointment scheduling system.—The Committee is frustrated 

that VA has spent years attempting to modernize its appointment 

scheduling system, investing in two systems and ultimately abandoning them. The Department has made some patchwork changes 

to the current scheduling system to temporarily address some of 

the worst problems, and intends to test a pilot program called the 

Medical Appointments Scheduling System (MASS). After a false 

start and stop of the pilot, the Committee encourages VA to begin 

implementation of the pilot without delay. While it is not known 

if the decision on the electronic health record will ultimately influence the type of scheduling system VA will need, it is important 

to improve scheduling in the short term. VA is directed to inform 

the Committee when the pilot begins, with monthly notification 

every month past June, 2017, if it is delayed. The Committee directs the Secretary to submit to the Committee not later than 30 

days after enactment of this Act a report that clearly defines the 

long-term plan of the Department to replace or modernize the legacy scheduling system, including the cost and schedule of the effort, and how the system will communicate with the increasing 

number of outside providers now being used by VA. 

Legacy system decommissioning plan.—VA’s legacy IT systems 

face tremendous challenges with innovation. With budgets consumed in supporting older existing applications and infrastructure, 

there is clearly a need to invest in new software. Many of VA’s software systems are legacy systems, such as the Financial Management System (FMS) and the Burial Operations Support System 

(BOSS), which are over 30 years old and are in need of replacement. It is evident to the Committee that the value of these current systems decreases with every passing year. While the fiscal 

year 2018 OIT budget request prioritizes the replacement of these 

legacy systems, there is concern that OIT does not have a concrete 

plan for the decommissioning of VA legacy systems. An effective 

strategy for investing in new and innovative deployments is to retire legacy systems and simultaneously identify what system will 

follow and how its capabilities will improve over the old system. 

Therefore, the Committee directs VA to develop a Legacy System 

78 

Decommissioning Plan not later than 180 days after enactment of 

this Act. This plan should include, but not be limited to, the following information; (1) identify all legacy systems that will be decommissioned by fiscal year; (2) describe how long it will take to 

transition to each new system; (3) identify redundant legacy systems; (4) determine the capabilities gained by the replacement system; (5) identify the cost and savings associated with decommissioning each legacy system; (6) and identify which legacy systems 

that will be replaced by in-house development and which systems 

will be replaced with a commercial off the shelf system. 

Veterans data protection.—The Committee encourages VA to take 

proactive steps to protect and prevent the unauthorized review, redistribution and modification of sensitive VA information. The fiscal year 2017 VA Information Security budget proposed the implementation of digital rights management (DRM) technologies to enhance the cybersecurity of VA’s information and assets and to improve the resilience of VA networks and data. The Committee requests VA to provide a report to the Committee not later than 30 

days after enactment of this Act describing whether it still intends 

to implement department-wide DRM capabilities, and if so, its anticipated timeline. 

Digital workspace technologies.—The Committee recognizes that 

the use of digital workspace technologies can increase user productivity, enhance security, and allow workforce flexibility. The Committee encourages the Department to adopt strategies and programs that reduce the total life cycle costs of traditional legacy 

workspace infrastructure. 

OFFICE OF INSPECTOR GENERAL

Fiscal year 2017 enacted level ........................................................... $160,106,000 

Fiscal year 2018 budget request ....................................................... 159,606,000 

Committee recommendation in the bill ............................................ 160,106,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... – – – 

Fiscal year 2018 budget request ................................................ 500,000 

The Office of Inspector General (OIG) was established by the Inspector General Act of 1978 and is responsible for the audit, investigation, and inspection of all VA programs and operations. The 

overall operational objective is to focus available resources on areas 

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 ten percent of this funding available until September 30, 2019. 

CONSTRUCTION, MAJOR PROJECTS

Fiscal year 2017 enacted level ........................................................... $528,110,000 

Fiscal year 2018 budget request ....................................................... 512,430,000 

Committee recommendation in the bill ............................................ 410,530,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... (117,580,000) 

Fiscal year 2018 budget request ................................................ (101,900,000) 

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, arVerDate Sep 11 2014 06:22 Jun 23, 2017 Jkt 025912 PO 00000 Frm 00078 Fmt 6659 Sfmt 6602 E:\HR\OC\HR188.XXX HR188
79 

chitectural 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 $38,530,000 of 

these funds available for a five-year period. 

Continuing the practice first established in fiscal year 2017, the 

bill restricts the availability of funding for major construction 

projects costing more than $100,000,000 until VA certifies it has 

signed an agreement with an appropriate non-VA government entity to serve as the design and/or construction agent for the project. 

For fiscal year 2018, one major construction project above the 

$100,000,000 threshold is funded, with restricted funds totaling 

$117,300,000. Within the account, the bill also provides 

$16,730,000 for the contract fees for the outside agent chosen for 

the projects. The Committee has taken this action in hopes that the 

gross mismanagement of the Denver, Colorado VA hospital project 

will never recur. 

The bill provides the full request of $117,300,000 for the Liver- more, California project and $140,000,000 for gravesite expansion 

projects. The Department is instructed to allocate the gravesite expansion funding to the sites that are expected to run out of burial 

space the earliest. The remainder of the budget request for activities such as planning and design, land acquisition, and hazardous 

waste is fully funded. 

Spending plan.—No later than thirty days after enactment of the 

Act, the Department is required to provide a spending plan indicating how it plans to allocate the appropriated funding among the 

various line items within the Major Construction account, as well 

as which cemetery expansion projects will receive fiscal year 2018 

funding. 

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 

$5,000,000 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. 

Training for VA personnel engaged in facility management.—The 

Committee continues to be concerned by the lack of training and 

certification provided to VA engineering, construction and facility 

management staff with regard to building operations and maintenance. The Committee requests a report detailing progress made 

by the Office of Construction and Facility Management and the Office of Health Care Engineering in training and certifying engineers, associate engineers, and covered building professionals in 

compliance with the Federal Buildings Personnel Training Act 

(FBPTA) (P.L. 111–308). The Committee believes that the number 

of FBPTA-compliant employees and contractors demonstrates intent to protect existing facilities and will note the total number of 

80 

certified individuals during evaluations of future requests for construction funding. 

Parking facilities.—Although VA has identified numerous parking facilities projects throughout the Strategic Capital Investment 

Planning (SCIP) list, it continues to prioritize other projects over 

parking needs. The lack of prioritization of parking facilities has 

caused challenges for adequate parking for Veterans, doctors, 

nurses, and families at VA medical centers as well as CBOCs. 

While the SCIP process has improved, the VA construction process 

and ranking of projects still lacks transparency about future plans 

for parking at VA facilities. The Committee believes parking facility projects can be completed quickly and are vital to help veterans 

gain timely access to appointments, and to improve the quality of 

life and care given to veterans. The Committee directs VA to provide a report to the Committee not later than 60 after enactment 

of this Act that explains how parking facility projects are rated in 

the SCIP process, a timeline for completion of these pending parking facility projects, and their cost. In addition, the report should 

include any notable actions taken by VA medical centers to address 

parking issues. 

Public-private partnerships.—The Committee is pleased that VA 

has begun a program of pilot projects to construct needed VA facilities by developing partnerships with private funders who may contribute land, facilities or financing. The Committee hopes that the 

track record of the pilot projects currently underway will provide 

strong proof of concept so that VA is granted more general authority to address its facility needs through cost-sharing with the private sector. 

CONSTRUCTION, MINOR PROJECTS

Fiscal year 2017 enacted level ........................................................... $372,069,000 

Fiscal year 2018 budget request ....................................................... 342,570,000 

Committee recommendation in the bill ............................................ 342,570,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... (29,499,000) 

Fiscal year 2018 budget request ................................................ – – – 

The Construction, Minor Projects appropriation provides for constructing, altering, extending, and improving any of the facilities 

under the jurisdiction 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. 

As with the Major Construction account, the Committee recommendation makes these funds available for a five-year period. 

The Committee encourages VA to prioritize the need for fixing 

deficient roofs in its minor construction projects for medical facilities. 

GRANTS FOR CONSTRUCTION OF STATE EXTENDED CARE FACILITIES

Fiscal year 2017 enacted level ........................................................... $90,000,000 

Fiscal year 2018 budget request ....................................................... 90,000,000 

Committee recommendation in the bill ............................................ 90,000,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... – – – 

Fiscal year 2018 budget request ................................................ – – – 

81 

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. 

Rural access.—The Committee appreciates the efforts by VA and 

the work of State Veterans Homes for their support in restorative 

and rehabilitative care for veterans. The Committee also recognizes 

the need to ensure States are equipped and prepared to meet the 

needs of the growing veteran population. Therefore, the Committee 

urges VA to include a ‘rural (mileage access)’ consideration as part 

of the statutory priority guideline of ‘‘a great need for the beds to 

be established at such home or facility’’. 

GRANTS FOR CONSTRUCTION OF VETERANS CEMETERIES

Fiscal year 2017 enacted level ........................................................... $45,000,000 

Fiscal year 2018 budget request ....................................................... 45,000,000 

Committee recommendation in the bill ............................................ 45,000,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... – – – 

Fiscal year 2018 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. 

Public-private partnerships.—In order to provide a burial option 

to those veterans who may not have reasonable access to a national 

veterans cemetery or State cemetery, the Committee encourages 

VA to prioritize funding under the State veterans cemetery grant 

program for the establishment of veterans cemeteries in rural and 

highly rural areas. Additionally, State and local governments are 

encouraged to utilize public-private partnerships that are currently 

available to help defray the cost of operation and maintenance of 

a State veterans cemetery. 

ADMINISTRATIVE PROVISIONS

The bill includes 39 administrative provisions, 36 of which were 

included in the fiscal year 2017 bill and 3 of which are new. 

(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 

82 

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 2017. 

The bill includes section 207 allowing for the use of fiscal year 

2018 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 Review, the Central Whistleblower Office, the Office of Diversity and Inclusion, and the Office of the Executive Director of 

Accountability and Whistleblower Protection 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. 

83 

(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 

$297,137,000 appropriated for medical accounts, minor construction, and information technology systems 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 

$306,378,000 of fiscal year 2019 advance 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 221 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. The Administration proposal to modify 

this provision is not adopted. 

84 

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 222 directing that a minimum of 

$15,000,000 shall be transferred from the four medical care appropriations to the Department of Defense/Department of Veterans Affairs Health Care Sharing Incentive Fund, to be available until expended. 

The bill includes section 223 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 224 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 225 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 the Congress unless approved by the Committees. The 

Administration proposal to delete this provision is not adopted. 

The bill includes section 226 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; 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 227 limiting the funding that may be obligated from VHA accounts for the development of an electronic 

health record until the Secretary provides a detailed explanation of 

the activities associated with the development of the VA electronic 

health record that will be funded by the Veterans Health Administration rather than the Office of Information Technology. The Administration proposal to delete this provision is not adopted. 

The bill includes section 228 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 229 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 230 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 

85 

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 231 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 232 prohibiting the reprogramming of 

funds exceeding $5,000,000 among the major construction projects 

unless both Appropriations Committees approve the request. The 

Administration proposal to delete this provision is not adopted. 

(RESCISSIONS OF FUNDS)

The bill includes section 233 which rescinds Medical Care advance funding and section 234 which reduces funding in current 

year-funded accounts to incorporate assumed absorption of the proposed 1.9 percent payraise. The Department has authority to use 

whatever appropriated funds are available to support the payraise 

if it chooses to do so. 

The bill includes section 235 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 236 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 237 language modifying current law to 

permit VA hospitals to use shuttle buses for employees so patients 

can use the closer parking lots. 

The bill includes section 238 requiring VA to use the mammography screening guidelines announced by the Secretary on May 10, 

2017. 

The bill includes section 239 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 Administration’s 

proposed language to provide this treatment has been modified. 

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. 

86 

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, 

as requested. 

DEPARTMENT OF DEFENSE—CIVIL CEMETERIAL EXPENSES, ARMY

SALARIES AND EXPENSES

The agreement provides $78,800,000 for Salaries and Expenses 

for Arlington National Cemetery (ANC), which is $8,000,000 over 

the budget request. The Committee appreciates ANC’s emphasis on 

acquisition improvements, including training, certification and 

workforce, to improve procurement and accountability. 

The Committee has provided an additional $8,000,000 to cover a 

shortfall that was identified by Arlington Cemetery during budget 

briefs within the operations and maintenance account. The Committee therefore directs ANC to report to the Committee 30 days 

after floor action in the House of Representatives on any additional 

shortfalls that have occurred. 

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. Annual outlays for the Fund have exceeded revenues since 2011, and in November 2015 the Department of Defense and AFRH officials informed the Committee that, 

counter to the assumptions in the fiscal year 2016 budget request, 

the Trust Fund balances were not sufficient to support the expenses of AFRH; therefore, the Fund was projected to be insolvent 

by April 2016. As an emergency measure to assure solvency for 

AFRH, in the fiscal years 2016 and 2017 Appropriations Acts, 

AFRH was provided with a total of $42,000,000 from the General 

Fund. 

Although 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 and to present that 

approach to the Congress in the President’s Request for fiscal year 

2017, and then for fiscal year 2018 along with legislative proposals, 

87 

the Administration did not do so. Instead, the budget request for 

AFRH for FY2018 includes a transfer of $22,000,000 from the General Fund of the Treasury. Further, the Committee has never received any information on the DOD-commissioned study of AFRH 

operations to include benchmarking and potential legislative 

changes to revise AFRH’s funding model. The Committee requests 

further information from DOD regarding the study, including a report on its findings, cost, scope of work, deliverables, and timeline. 

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 develop an alternative during fiscal year 2018, to be included in the fiscal year 2019 budget request. In addition, AFRH 

is directed to report to the Committee quarterly, beginning immediately, on the Trust Fund balance, receipts and expenditures, and 

the progress of its efforts to lease property at the Washington, D.C. 

facility. 

Administrative Provisions 

The bill includes two provisions that were in effect in fiscal year 

2017. The administrative provisions included in the bill are as follows: 

The bill includes section 301 permitting Arlington National Cemetery to provide funds to Arlington County to relocate a water 

main. 

The bill includes section 302 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 2017 enacted level ........................................................... $419,733,000 

Fiscal year 2018 budget request ....................................................... 638,130,000 

Committee recommendation in the bill ............................................ 638,000,000 

Comparison with: 

Fiscal year 2017 enacted level ................................................... 218,267,000 

Fiscal year 2018 budget request ................................................ (130,000) 

Note: enacted level includes fiscal year 2017 additional appropriations. 

The Committee recommendation includes Overseas Contingency 

Operations, for military construction projects and planning and design related to the Global War on Terrorism and European Reassurance Initiative. 

The recommendation does not include funding for three countries 

as stated in a June 2017 classified Government Accountability Office draft report. 

The recommendation also includes six projects in four countries 

that were requested in title I but have been funded in this title. 

Planning and Design.—The Committee is providing the planning 

and design as requested however the Committee directs that any 

future planning and design funds to be requested in fiscal year 

2019 and beyond are to be requested as part of the base request. 

The Committee further directs the Secretary of Defense to submit 

10 U.S.C. 2807 notifications to the congressional defense committees prior to obligation of the funds. 

88 

Overseas Contingency Operations Future Year Defense Program.—The Committee is concerned that funding requested for 

Overseas Contingency Operations (OCO) does not follow the same 

process as the required Department of Defense process for planning, programming, budgeting and execution of funds required to 

support military operations, readiness, infrastructure and military 

force modernization. Therefore, the Committee directs the Secretary of Defense to provide to the congressional defense committee 

a future year defense program for OCO projects beginning with fiscal year 2018 and each subsequent year where military construction funds are being requested in an OCO budget submission not 

later than 60 days after enactment of this Act. 

MILITARY CONSTRUCTION, ARMY

The Committee recommendation includes $147,158,000 for Army 

military construction and planning and design for Overseas Contingency Operations and European Reassurance Initiative projects. 

MILITARY CONSTRUCTION, NAVY AND MARINE CORPS

The Committee recommendation includes $31,890,000 for Navy 

and Marine Corps military construction and planning and design 

for Overseas Contingency Operations and European Reassurance 

Initiative projects. 

MILITARY CONSTRUCTION, AIR FORCE

The Committee recommendation includes $434,652,000 for Air 

Force military construction and planning and design for Overseas 

Contingency Operations and European Reassurance Initiative 

projects. 

MILITARY CONSTRUCTION, DEFENSE-WIDE

The Committee recommendation includes $24,300,000 for Defense-Wide Overseas Contingency Operations and planning and design for Special Operations Command European Reassurance Initiative project. 

ADMINISTRATIVE PROVISION

The bill includes section 401 that designates that funding shall 

only be available only if the President so designates all amounts 

and transmits such designations to Congress. 

TITLE V 

GENERAL PROVISIONS 

The bill includes a total of 13 provisions: 12 provisions that are 

effective in fiscal year 2017 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. 

89 

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 EVerify 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. 

90 

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, Army (Sec. 126) ... $10,000,000 

Department of Defense, Military Construction, Navy and Marine 

Corps (Sec. 126) .............................................................................. 10,000,000 

Department of Defense, Defense-Wide (Sec. 126) ............................ 27,440,000 

Department of Defense, NATO Security Investment Program 

(Sec. 126) ......................................................................................... 25,000,000 

Department of Defense, Family Housing Construction, Army 

(Sec. 126) ......................................................................................... 18,000,000 

Department of Defense, Family Housing Construction, Navy and 

Marine Corps (Sec. 126) ................................................................. 8,000,000 

Department of Defense, Family Housing Construction, Air Force 

(Sec. 126) ......................................................................................... 20,000,000 

Department of Veterans Affairs, Medical Services (Sec. 233) ........ 313,730,000 

Department of Veterans Affairs, Medical Support and Compliance (Sec. 233) ................................................................................. 63,282,000 

Department of Veterans Affairs, Medical Facilities (Sec. 233) ....... 22,960,000 

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 $17,882,000 in fiscal year 2018 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. 

91 

Language is included to provide authority for the Department of 

Veterans Affairs for any funds appropriated in 2018 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 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 $47,668,000 to be 

transferred to General Administration and Information Technology 

Systems from any funds appropriated in fiscal year 2018 to reimburse six 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 account. 

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 years 

2018 and 2019 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. 

92 

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 ongoing 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 costplus-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. 

93 

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 that rescinds funds from prior 

year appropriations Acts. 

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, Army 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. 

Language is included under Title I providing additional funds for 

BRAC. 

Language is included under Title I providing additional funds for 

Military Construction, Air National Guard. 

Language is included under Title I providing additional funds for 

Military Construction, Air Force Reserve. 

94 

Language is included under Title I defining the congressional defense committees. 

Language is included under Title I prohibiting the use of Title 

I funds for Arlington Cemetery. 

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, modernization, and enhancement 

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 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 in Title II amending section 8109(b) of Title 

38 to allow the Department of Veterans Affairs to provide a shuttle 

95 

bus to transport an employee from an employee parking facility to 

the medical facility at which the employee works. 

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 permit the use of funds 

to relocate a water main. 

Language is included under Title III to allow for the use of concession fees. 

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. 

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: 

96 


Insert offset folio 013 here HR188.001
97 

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. 

FULL COMMITTEE VOTES

No roll call votes were held. 

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): 

SECTION 222 OF THE MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES APPROPRIATIONS ACT, 2017 

(Public Law 114–223, title II of division A) 

ø(INCLUDING TRANSFER OF FUNDS) 

øSEC. 222. Of the amounts appropriated to the Department of 

Veterans Affairs which become available on October 1, 2017, for 

‘‘Medical Services’’, ‘‘Medical Community Care’’, ‘‘Medical Support 

and Compliance’’, and ‘‘Medical Facilities’’, up to $280,802,000, plus 

reimbursements, may be transferred to the Joint Department of 

Defense-Department of Veterans Affairs Medical Facility Demonstration Fund, established by section 1704 of the National Defense Authorization Act for Fiscal Year 2010 (Public Law 111-84; 

123 Stat. 3571) and may be used for operation of the facilities designated as combined Federal medical facilities as described by section 706 of the Duncan Hunter National Defense Authorization Act 

for Fiscal Year 2009 (Public Law 110-417; 122 Stat. 4500): Provided, That additional funds may be transferred from accounts designated in this section to the Joint Department of Defense-Department of Veterans Affairs Medical Facility Demonstration Fund 

upon written notification by the Secretary of Veterans Affairs to 

the Committees on Appropriations of both Houses of Congress.¿ 

TITLE 38, UNITED STATES CODE 

* * * * * * * 

98 

PART VI—ACQUISITION AND DISPOSITION OF 

PROPERTY 

* * * * * * * 

CHAPTER 81—ACQUISITION AND OPERATION OF HOSPITAL AND DOMICILIARY FACILITIES; PROCUREMENT 

AND SUPPLY; ENHANCED-USE LEASES OF REAL PROPERTY 

* * * * * * * 

SUBCHAPTER I—ACQUISITION AND OPERATION OF 

MEDICAL FACILITIES 

* * * * * * * 

§ 8109. Parking facilities 

(a) For the purpose of this section— 

(1) The term ‘‘garage’’ means a structure (or part of a structure) in which vehicles may be parked. 

(2) The term ‘‘parking facility’’ includes— 

(A) a surface parking lot; and 

(B) a garage. 

(3) The term ‘‘eligible person’’ means an individual to whom 

the Secretary is authorized to furnish medical examination or 

treatment. 

(b) In order to accommodate the vehicles of employees of medical 

facilities, vehicles used to transport veterans and eligible persons 

to or from such facilities for the purpose of examination or treatment, and the vehicles of visitors and other individuals having 

business at such facilities, the Secretary— 

(1) may construct or alter parking facilities, and may acquire, by purchase, lease, condemnation, donation, exchange, 

or otherwise, such land or interests in land as the Secretary 

considers necessary for use as the site for any such construction or alteration; 

(2) may acquire, by purchase, lease, condemnation, donation, 

exchange, or otherwise, any facility that the Secretary considers necessary for use as a parking facility; øand¿ 

(3) may operate and maintain parking facilitiesø.¿; and 

(4) notwithstanding subsection (a) of section 1344 of title 31, 

may use a passenger carrier (as such term is defined in subsection (h)(1) of such section) to transport such an employee between a parking facility and the medical facility of the Department at which the employee works. 

(c)(1) Except as provided in paragraph (2) of this subsection, each 

employee, visitor, and other individual having business at a medical facility for which parking fees have been established under 

subsection (d) or (e) of this section shall be charged the applicable 

parking fee for the use of a parking facility at such medical facility. 

(2) A parking fee shall not be charged under this subsection for 

the accommodation of any vehicle used to transport to or from a 

medical facility— 

(A) a veteran or eligible person in connection with such veteran or eligible person seeking examination or treatment; or 

99 

(B) a volunteer worker (as determined in accordance with 

regulations which the Secretary shall prescribe) in connection 

with such worker performing services for the benefit of veterans receiving care at a medical facility. 

(3) The Secretary shall collect (or provide for the collection of) 

parking fees charged under this subsection. 

(d)(1) For each medical facility where funds from the revolving 

fund described in subsection (h) of this section are expended for— 

(A) a garage constructed or acquired by the Department at 

a cost exceeding $500,000 (or, in the case of acquisition by 

lease, $100,000 per year); or 

(B) a project for the alteration of a garage at a cost exceeding 

$500,000, 

the Secretary shall prescribe a schedule of parking fees to be 

charged at all parking facilities used in connection with such medical facility. 

(2) The parking fee schedule prescribed for a medical facility referred to in paragraph (1) of this subsection shall be designed to 

establish fees which the Secretary determines are reasonable under 

the circumstances. 

(e) The Secretary may prescribe a schedule of parking fees for 

the parking facilities at any medical facility not referred to in subsection (d) of this section. Any such schedule shall be designed to 

establish fees which the Secretary determines to be reasonable 

under the circumstances and shall cover all parking facilities used 

in connection with such medical facility. 

(f) The Secretary may contract (by lease or otherwise) for the operation of parking facilities at medical facilities under such terms 

and conditions as the Secretary prescribes and may do so without 

regard to laws requiring full and open competition. 

(g) Subject to subsections (h) and (i) of this section, there are authorized to be appropriated such amounts as are necessary to finance (in whole or in part) the construction, alteration, and acquisition (including site acquisition) of parking facilities at medical facilities. 

(h)(1) Amounts appropriated pursuant to subsection (g) of this 

section and parking fees collected under subsection (c) of this section shall be administered as a revolving fund and shall be available without fiscal year limitation. 

(2) The revolving fund shall be deposited in a checking account 

with the Treasurer of the United States. 

(3)(A) Except as provided in subparagraph (B) of this paragraph, 

no funds other than funds from the revolving fund may be expended for the construction, alteration, or acquisition (including 

site acquisition) of a garage at a medical facility after September 

30, 1986. 

(B) Subparagraph (A) of this paragraph does not apply to the use 

of funds for investigations and studies, surveys, designs, plans, construction documents, specifications, and similar actions not directly 

involved in the physical construction of a structure. 

(i)(1) The expenditure of funds from the revolving fund may be 

made only for the construction, alteration, and acquisition (including site acquisition) of parking facilities at medical facilities and 

may be made only as provided for in appropriation Acts. 

100 

(2) For the purpose of section 8104(a)(2) of this title, a bill, resolution, or amendment which provides that funds in the revolving 

fund (including any funds proposed in such bill, resolution, or 

amendment to be appropriated to the revolving fund) may be expended for a project involving a total expenditure of more than 

$4,000,000 for the construction, alteration, or acquisition (including 

site acquisition) of a parking facility or facilities at a medical facility shall be considered to be a bill, resolution, or amendment making an appropriation which may be expended for a major medical 

facility project. 

(j) Funds in a construction account or capital account that are 

available for a construction project or a nonrecurring maintenance 

project may be used for the construction or relocation of a surface 

parking lot incidental to that project. 

* * * * * * * 

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. 

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: 

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 


Insert graphic folio 015 HR188.002 Insert graphic folio 016 HR188.003
101 

Budget Act of 1974, the amount of financial assistance to State and 

local governments is as follows: 

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: 


Insert graphic folio 018 HR188.004
102 


Insert graphic folio 19 here 23924A.014
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Insert graphic folio 20 here 23924A.015
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Insert graphic folio 21 here 23924A.016
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Insert graphic folio 22 here 23924A.017
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Insert graphic folio 23 here 23924A.018
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Insert graphic folio 24 here 23924A.019
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Insert graphic folio 25 here 23924A.020
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Insert graphic folio 26 here 23924A.021
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Insert graphic folio 27 here 23924A.022
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Insert graphic folio 28 here 23924A.023
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Insert graphic folio 29 here 23924A.024
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Insert graphic folio 30 here 23924A.025
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Insert graphic folio 31 here 23924A.026
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Insert graphic folio 31A here 23924A.028
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Insert graphic folio 51 here 23924A.027
(117) 

MINORITY VIEWS 

The fiscal year (FY) 2018 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 $88.7 billion in total discretionary 

funding. This is $6 billion above the FY 2017 enacted funding level 

but $573 million below the FY 2018 budget request. 

The bill funds military construction at $9.5 billion, which is $197 

million below the FY 2018 request. It rejects President Trump’s 

proposed cut to the North Atlantic Treaty Organization (NATO) Security Investment Program and restores funding to the FY 2017 

enacted level of $178 million. Additionally, Base Realignment and 

Closure is funded at $291 million, which is an increase of $35 million. The bill provides $78.3 billion in discretionary funding for the 

Department of Veterans Affairs, which is $3.9 billion above the FY 

2017 enacted level but $384 million below the President’s request. 

The recommendation also includes the budget request of $70.7 billion in discretionary funds for the FY 2019 advance appropriations 

for VA medical services. The bill includes $75.1 million, equal to 

the FY 2017 enacted level, for our heroes who have made the ultimate sacrifice and are honored in the battle monuments and cemeteries funded in this bill. 

We are pleased the bill continues to build on efforts to end the 

veterans’ claims backlog that began in FY 2015. The bill continues 

both the aggressive monthly reporting requirements from each specific regional office on claims processing performance as well as 

quarterly reports on remediation efforts at the poorest performing 

regional offices. 

The Committee has had a longstanding interest in ensuring that 

DOD and VA health records for service members and veterans can 

be exchanged electronically so doctors across the street or across 

the world can best treat patients. After multiple false starts with 

plans for a unified DOD–VA system and then a stand-alone VA 

VistA record modernization, VA has now decided to acquire the 

same electronic health record system (EHR) being developed for 

DOD—the MH Genesis record. We are pleased with VA’s decision 

to pursue a single EHR, which many Members have advocated for 

years. However, we are concerned about the implications of this detour on the completion time for the project (previously promised for 

2018), project cost, and the ability to meet the growing need for 

interoperability with non-VA community providers. Therefore, it is 

appropriate to fence 75 percent of funding until VA provides certain information. The Committee does not intend to delay the 

progress of acquiring a new system, but believes continuing close 

oversight is necessary to ensure that the new system will have the 

necessary capabilities to provide superior care. 

118 

We are also pleased that the bill provides the full FY 2018 budget request of $8.4 billion for mental health programs, of which $186 

million dollars is for Suicide Prevention, $13 million above the FY 

2017 enacted level. 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. 

Two Democratic amendments were offered during the markup. 

We were pleased the Majority accepted the Democratic amendment 

that bars counselors at the VCL from being subject to any hiring 

freeze. With over twenty veterans tragically taking their own lives 

each day, it is critical that the VCL is properly staffed. Unfortunately, the Majority opposed the second amendment, which would 

have prohibited the use of funds to establish a White House Veterans Complaint Hotline, a political proposal from President 

Trump that would make it more difficult for veterans to receive 

timely services they earned. VA currently has 975 customer service 

numbers in operation for veterans to call. They cover issues ranging from benefits to debt management. We believe we need to use 

our resources wisely and establishing this new hotline would only 

confuse and frustrate our veterans when they are looking for help. 

And, worse, it could potentially add dangerous delays in service. 

We are extremely pleased that the bill provides access to IVF 

treatment, 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. 

While there are numerous measures to praise in the bill, we are 

concerned that the increases in this bill will result in deep cuts to 

programs in the other yet-to-be-considered appropriations bills. 

Veterans rely on programs across the government that are funded 

in the other appropriations bills, such as afterschool programs, job 

training, and public transportation. Potential cuts to those programs would make it difficult for veterans to rejoin civilian life and 

prosper after their service to the country. Also cutting federal jobs 

across the government would have a severe impact on veterans. In 

FY 2015, the Office of Personnel Management reported that 30.9 

percent of federal jobs were occupied by veterans. Cuts across the 

government that would be harmful to veterans will certainly take 

place under the limitations set forth in the Budget Control Act 

(BCA). The BCA reduces the FY 2018 discretionary budget by $5 

billion total, a $2 billion dollar reduction to defense and $3 billion 

reduction to non-defense. The only way to get back to regular order 

and consider each of the 12 appropriations bills is to raise the BCA 

caps. 

NITA M. LOWEY. 

DEBBIE WASSERMAN SCHULTZ. 

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