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[House Report 115-188]
[From the U.S. Government Publishing Office]

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
    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 
veterans. 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 
mission-critical. Where it was prudent, the Committee 
recommendation rescinds prior year funding that is no longer 
needed for the purpose for which it was 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.
    The following table compares amounts recommended in the 
bill to the President's request and amounts appropriated in 
fiscal year 2017:

                  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 $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            9,585,000,000
 rescissions).........................................
Comparison with:
    Fiscal year 2017 enacted level....................     1,859,000,000
    Fiscal year 2018 budget request...................     (197,451,000)
 

    Military construction accounts provide funds for new 
construction, construction improvements, planning and design, 
and host nation support. Projects funded by these accounts 
include facilities for operations, training, maintenance, 
research and development, supply, medical care, and force 
protection, as well as unaccompanied housing, utilities 
infrastructure, and land acquisition.
    Reprogramming guidelines.--The following reprogramming 
guidelines apply for all military construction and family 
housing projects. A project or account (including the sub-
elements of an account) which has been specifically reduced by 
the Congress in acting on the budget request is considered to 
be a Congressional interest item and as such, prior approval is 
required. Accordingly, no reprogramming to an item specifically 
reduced below the threshold by the Congress is permitted, 
except that the Department of Defense may seek reprogramming 
for appropriated increments.
    The reprogramming criteria that apply to military 
construction projects (25 percent of the funded amount or 
$2,000,000, whichever is less) continue to apply to new housing 
construction projects and to improvements over $2,000,000. To 
provide the services the flexibility to proceed with 
construction contracts without disruption or delay, the costs 
associated with environmental hazard remediation such as 
asbestos removal, radon abatement, lead-based paint removal or 
abatement, and any other legislated environmental hazard 
remediation may be excluded, if such remediation requirements 
could not be reasonably anticipated at the time of the budget 
submission. This exclusion applies to projects authorized in 
this budget year, as well as projects authorized in prior years 
for which construction has not been completed. Planning and 
design costs associated with military construction and family 
housing projects may also be excluded from these guidelines. In 
instances where prior approval 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:
          (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 executable. However, it continues to be the practice 
of the Committee to provide incremental funding for certain 
large projects to enable the services to more efficiently 
allocate military construction dollars among projects that can 
be executed in the year of appropriation. Therefore, the 
Committee recommendation includes 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 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 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 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 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.

                  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. 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 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 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.

                  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.
    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.

                   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...................             - - -
 

         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.
    The bill includes section 103 permitting funds to be 
expended on the construction of defense access roads under 
certain circumstances.
    The bill includes section 104 prohibiting construction of 
new bases in the United States without a specific 
appropriation.
    The bill includes section 105 limiting the use of funds for 
the purchase of land or land easements that exceed 100 percent 
of value except under certain conditions.
    The bill includes section 106 prohibiting the use of funds 
to acquire land, prepare sites, or install utilities for family 
housing except housing for which funds have been appropriated.
    The bill includes section 107 limiting the use of minor 
construction funds to relocate any activity from one 
installation to another without prior notification.
    The bill includes section 108 prohibiting the procurement 
of steel unless American producers, fabricators, and 
manufacturers have been allowed to compete.
    The bill includes section 109 prohibiting the use of funds 
to pay real property taxes in foreign nations.
    The bill includes section 110 prohibiting the use of funds 
to initiate a new installation overseas without prior 
notification.
    The bill includes section 111 establishing a preference for 
United States architectural and engineering services where the 
services are in Japan, NATO member countries, or countries 
bordering the Arabian Sea.
    The bill includes section 112 establishing a preference for 
United States contractors for military construction in the 
United States territories and possessions in the Pacific and on 
Kwajalein Atoll, or countries within the Central Command area 
of responsibility, except bids by Marshallese contractors for 
military construction on Kwajalein Atoll.
    The bill includes section 113 requiring the Secretary of 
Defense to give prior notice to Congress of military exercises 
where construction costs exceed $100,000.
    The bill includes section 114 allowing funds appropriated 
in prior years to be used for new projects authorized during 
the current session of Congress.
    The bill includes section 115 allowing the use of expired 
or lapsed funds to pay the cost of supervision for any project 
being completed with lapsed funds.
    The bill includes section 116 providing that funds for 
military construction projects are available until the end of 
the fourth fiscal year following the fiscal year in which funds 
are appropriated, subject to certain conditions.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 117 allowing for the transfer of 
funds from Family Housing Construction accounts to the 
Department of Defense Family Housing Improvement Fund and funds 
from Military Construction accounts to the Department of 
Defense Military Unaccompanied Housing Improvement Fund.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 118 providing transfer authority 
to the Homeowners Assistance Program.
    The bill includes section 119 requiring that funds in this 
title be the sole source of all operation and maintenance for 
flag and general officer quarter houses, and limits the repair 
on these quarters to $15,000 per year without notification.
    The bill includes section 120 making funds in the Ford 
Island Improvement Fund available until expended.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 121 allowing the transfer of 
expired funds to the ``Foreign Currency Fluctuations, 
Construction, Defense'' account.
    The bill includes section 122 prohibiting the use of funds 
to relocate a unit of the Army that would impact more than 200 
personnel.
    The bill includes section 123 allowing the transfer of 
funds among projects and activities in accordance with the 
reprogramming guidelines.
    The bill includes section 124 prohibiting the use of funds 
for projects at Arlington National Cemetery.
    The bill includes section 125 providing additional funds 
for various military construction accounts and requires a spend 
plan for each.

                    (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        178,409,040,000
 bill\1\............................................
 
\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, 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 Medicaid-eligible single 
veterans and surviving spouses alone in Medicaid-covered 
nursing homes. The bill also continues to include language 
permitting this appropriation to reimburse such sums as may be 
earned to the Medical Care Collections Fund to help defray the 
operating expenses of individual medical facilities for nursing 
home care provided to pensioners.

                         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 disability, 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

----------------------------------------------------------------------------------------------------------------
                                                                                 Limitation on
                                                                                  direct loans
                                                              Program account    for  specially   Administrative
                                                                                    adapted          expenses
                                                                                 housing loans
----------------------------------------------------------------------------------------------------------------
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 mortgage with a competitive interest rate, even 
without a down payment if the lender agrees. The Department 
requires that a down payment be made for a manufactured home. 
With a Department guaranty, the lender is protected against 
loss, up to the amount of the guaranty, if the borrower fails 
to repay the loan.
    Access problems.--The Committee 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

----------------------------------------------------------------------------------------------------------------
                                                                                 Limitation on    Administrative
                                                              Program account     direct loans       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. 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 
Operating 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 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 DD-214 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 Veterans Benefit Management System (VBMS) 
records for the purpose 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.

                  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 fiscal 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 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 efforts to track how long veterans 
remain in a queue to have their call answered; what percentage 
of calls are transferred to a non-VA 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, on-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 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 
Enforcement-First 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 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.
    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.
    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 
Nursing Academic Partnerships in Graduate Education (VANAP-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.
    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 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.
    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 made based on the screening results, the number 
of pregnant veterans 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 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. 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 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.
    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 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 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 
VA-affiliated 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
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 clinical 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 requested 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 high-tech 
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.

                    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 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 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.
    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 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.
    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.

                      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 answering 
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 full-time 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 
Committee on its efforts to work with small-, minority-, and 
women-owned 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 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
 

    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 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.

               INFORMATION TECHNOLOGY DEVELOPMENT PROJECTS
                        (in thousands of dollars)
------------------------------------------------------------------------
                                                           Committee
              Project                Budget  Request     Recommendation
------------------------------------------------------------------------
Electronic Health Record                       10,000             10,000
 Interoperability and VLER Health.
Electronic Health Record                       50,305             50,305
 Replacement......................
Veterans Benefits Management                   59,904             59,904
 System (VBMS)....................
Virtual Lifetime Electronic Record             20,968             20,968
 (VLER)...........................
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 
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, architectural and engineering services, 
assessments, and site acquisition where the estimated cost of a 
project is $10,000,000 or more.
    The Committee recommendation makes all but $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 
Livermore, 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 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...................             - - -
 

    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 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.

                     (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.

                     (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 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.

                 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, 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.
    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.
    The bill includes section 503 encouraging all departments 
and agencies funded in this Act to expand the use of ``E-
Commerce'' technologies and procedures.
    The bill includes section 504 specifying the Congressional 
committees that are to receive all reports and notifications.
    The bill includes section 505 prohibiting the transfer of 
funds to any instrumentality of the United States Government 
without authority from an appropriations Act.
    The bill includes section 506 prohibiting any funds in this 
Act to be used for a project or program named for an individual 
serving as a Member, Delegate, or Resident Commissioner of the 
United States House of Representatives.
    The bill includes section 507 requiring all reports 
submitted to the Congress to be posted on official websites of 
the submitting agency.
    The bill includes section 508 prohibiting the use of funds 
to establish or maintain a computer network unless such network 
blocks the viewing, downloading, and exchanging of pornography, 
except for law enforcement investigation, prosecution or 
adjudication activities.
    The bill includes section 509 prohibiting the use of funds 
for payment of first-class travel by an employee of the 
executive branch.
    The bill includes section 510 prohibiting the use of funds 
in this Act for any contract where the contractor has not 
complied with E-Verify requirements.
    The bill includes section 511 prohibiting the use of funds 
in this Act by the Department of Defense or the Department of 
Veterans Affairs for the purchase or lease of a new vehicle 
except in accordance with Presidential Memorandum--Federal 
Fleet Performance, dated May 24, 2011.
    The bill includes section 512 prohibiting the use of funds 
in this Act for the renovation, expansion, or construction of 
any facility in the continental United States for the purpose 
of housing any individual who has been detained at the United 
States Naval Station, Guantanamo Bay, Cuba.
    The bill includes section 513 establishing a ``Spending 
Reduction Account'' in the bill.

              House of Representatives Report Requirements

    The following items are included in accordance with various 
requirements of the Rules of the House of Representatives.

         Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII of the Rules of the 
House of Representatives, the following is a statement of 
general performance goals and objectives for which this measure 
authorizes funding:
    The Committee on Appropriations considers program 
performance, including a program's success in developing and 
attaining outcome-related goals and objectives, in developing 
funding recommendations.

                              RESCISSIONS

    Pursuant to clause 3(f)(2) of rule XIII of the Rules of the 
House of Representatives, the following table lists the 
rescissions in the accompanying bill:

                          Department/Activity

                   AMOUNTS RECOMMENDED FOR RESCISSION

 
 
 
Department of Defense, Military Construction, Army           $10,000,000
 (Sec. 126)...........................................
Department of Defense, Military Construction, Navy and        10,000,000
 Marine Corps (Sec. 126)..............................
Department of Defense, Defense-Wide (Sec. 126)........        27,440,000
Department of Defense, NATO Security Investment               25,000,000
 Program (Sec. 126)...................................
Department of Defense, Family Housing Construction,           18,000,000
 Army (Sec. 126)......................................
Department of Defense, Family Housing Construction,            8,000,000
 Navy and Marine Corps (Sec. 126).....................
Department of Defense, Family Housing Construction,           20,000,000
 Air Force (Sec. 126).................................
Department of Veterans Affairs, Medical Services (Sec.       313,730,000
 233).................................................
Department of Veterans Affairs, Medical Support and           63,282,000
 Compliance (Sec. 233)................................
Department of Veterans Affairs, Medical Facilities            22,960,000
 (Sec. 233)...........................................
 

                           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.
    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.

                 Changes in Application of Existing Law

    Pursuant to clause 3(f)(1)(A) of rule XIII of the Rules of 
the House of Representatives, the following statements are 
submitted describing the effect of provisions in the 
accompanying bill that directly or indirectly change the 
application of existing law.
    Language is included in various parts of the bill to 
continue on-going activities that require annual authorization 
or additional legislation, which to date have not been enacted.
    Language is included in various parts of the bill to place 
limitations on the use of funds in the bill or change existing 
limitations and which might, under some circumstances, be 
construed as changing the application of existing law.
    Language is included in various parts of the bill to allow 
the Secretary of Defense to exceed certain limitations upon 
notification to the Committee.
    Language is included in various parts of the bill to allow 
funding to be used for official reception and representation 
expenses.
    Language is included in various parts of the bill to enable 
various appropriations to remain available for more than one 
year for some programs for which the basic authority 
legislation does not presently authorize such extended 
availability.
    Language is included in various parts of the bill to permit 
the transfer of funds to other accounts.
    Language is included under Title I to prohibit payments for 
cost-plus-a-fixed-fee contracts under certain circumstances.
    Language is included in various parts of the bill to allow 
funds to be used for the hire of passenger motor vehicles.
    Language is included under Title I to allow advances to the 
Federal Highway Administration, Department of Transportation 
under certain circumstances.
    Language is included under Title I to prohibit the use of 
funds to begin construction of new bases without specific 
appropriations.
    Language is included under Title I to prohibit the use of 
funds for purchase of land or land easements under certain 
circumstances.
    Language is included under Title I to prohibit the use of 
funds for land acquisition, site preparation, and utility 
installation for family housing unless funds have been made 
available in annual appropriations Acts.
    Language is included under Title I to prohibit the use of 
minor construction funds to transfer an activity between 
installations without prior notification.
    Language is included under Title I to prohibit the use of 
funds for the procurement of steel for any activity if American 
steel producers have been denied the opportunity to compete for 
such steel procurements.
    Language is included under Title I to prohibit the use of 
funds to pay real property taxes in any foreign nation.
    Language is included under Title I to prohibit the use of 
funds to initiate a new installation overseas without prior 
notification.
    Language is included under Title I to limit the use of 
funds for architect and engineer contracts under certain 
circumstances.
    Language is included under Title I to limit the use of 
funds for awarding contracts to foreign contractors under 
certain circumstances.
    Language is included under Title I to require the 
Department of Defense to notify the appropriate committees of 
Congress of any proposed military exercises under certain 
circumstances.
    Language is included under Title I to allow prior year 
construction funding to be available for currently authorized 
projects.
    Language is included under Title I to allow payment for the 
cost associated with supervision, inspection, overhead, 
engineering and design on family housing or military 
construction projects that are being completed with expired or 
lapsed funds.
    Language is included under Title I to allow funds to be 
expended on military construction projects for four fiscal 
years after enactment under certain circumstances.
    Language is included under Title I to allow construction 
funds to be transferred to Housing Improvement Funds.
    Language is included under Title I to allow for the 
transfer of BRAC funds to the Homeowners Assistance Program.
    Language is included under Title I to limit funds for the 
operation and maintenance of family housing to those provided 
in this appropriation and to limit amounts expended on repairs 
of general and flag officer quarters under certain 
circumstances.
    Language is included under Title I to allow funds in the 
Ford Island Improvement Account to be available until expended 
for certain purposes.
    Language is included under Title I to allow for the 
transfer of expired funding to the Foreign Currency Fluctuation 
Account under certain circumstances.
    Language is included under Title I limiting movement of an 
Army unit with a testing mission.
    Language is included under Title I to allow for transfer of 
funds among projects and activities in accordance with 
reprogramming guidelines.
    Language is included under Title I to prohibit funds to be 
used for projects at Arlington Cemetery.
    Language is included under Title I 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.
    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 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:

                          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)

                     [(including transfer of funds)

  [Sec. 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

           *       *       *       *       *       *       *

PART VI--ACQUISITION AND DISPOSITION OF PROPERTY

           *       *       *       *       *       *       *

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

           *       *       *       *       *       *       *

SUBCHAPTER I--ACQUISITION AND OPERATION OF MEDICAL FACILITIES

           *       *       *       *       *       *       *

Sec. 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; [and]
          (3) may operate and maintain parking facilities[.]; 
        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
          (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.
  (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 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:

                             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.
    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.

                                  [all]
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