69–006 

110TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 110–648 

DEPARTMENT OF VETERANS AFFAIRS MEDICAL FACILITY 

AUTHORIZATION AND LEASE ACT OF 2008 

MAY 15, 2008.—Committed to the Committee of the Whole House on the State of 

the Union and ordered to be printed 

Mr. FILNER, from the Committee on Veterans’ Affairs, 

submitted the following 

R E P O R T 

[To accompany H.R. 5856] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Veterans’ Affairs, to whom was referred the 

bill (H.R. 5856) to authorize major medical facility projects and 

major medical facility leases for the Department of Veterans Affairs for fiscal year 2009, and for other purposes, having considered 

the same, report favorably thereon without amendment and recommend that the bill do pass. 

CONTENTS 

Page 

Purpose and Summary ............................................................................................ 2 

Background and Discussion .................................................................................... 3 

Hearings ................................................................................................................... 9 

Committee Consideration ........................................................................................ 9 

Committee Votes ...................................................................................................... 9 

Committee Oversight Findings ............................................................................... 9 

Statement of General Performance Goals and Objectives .................................... 9 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 10 

Earmarks and Tax and Tariff Benefits .................................................................. 10 

Committee Cost Estimate ....................................................................................... 10 

Congressional Budget Office Estimate ................................................................... 10 

Federal Mandates Statement ................................................................................. 12 

Advisory Committee Statement .............................................................................. 12 

Constitutional Authority Statement ...................................................................... 12 

Applicability to Legislative Branch ........................................................................ 13 

Section-by-Section Analysis of the Legislation ...................................................... 13 

Changes in Existing Law Made by the Bill as Reported ...................................... 15 


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PURPOSE AND SUMMARY

H.R. 5856 was introduced by Representative Michael H. Michaud 

of Maine, the Chairman of the Subcommittee on Health, on April 

22, 2008. This legislation would authorize major construction 

projects and medical facility leases for the Department of Veterans 

Affairs for fiscal year 2009. This bill would expand and improve the 

health care delivery to veterans throughout the VA health care system. It would also provide for state-of-the-art facilities and address 

current gaps in services. 

H.R. 5856 would: 

1. Authorize appropriations for: 

• Seismic corrections to building 2 at the VAMC in Palo Alto, 

California in the amount of $54 million. 

• Construction of a polytrauma health care and rehabilitation 

center at the VAMC in San Antonio, Texas, in the amount of $66 

million. 

• Seismic correction to building 1, at the VAMC in San Juan, 

Puerto Rico, in the amount of $225,900 million. 

2. Increase authorization amounts for previously authorized construction projects: 

• Increases the authorization level for the New Orleans VAMC 

replacement facility to $625,000,000. 

• Increases the authorization level for the Denver VAMC, replacement medical facility to $769,200,000. 

• Increases the authorization for the correction of patient privacy 

issues at the Gainesville, Florida VAMC to $136,700,000. 

• Increases the authorization for the construction of a new medical facility in Las Vegas, Nevada to $600,400,000. 

• Increases the authorization for the construction of a new outpatient clinic in Lee County, Florida to $131,800,000 million. 

• Increases the authorization for the construction of a new medical facility in Orlando, Florida to $656,800,000. 

• Increases the authorization for the consolidation of campuses 

at the University Drive and H. John Heinz III Divisions to 

$295,600,000. 

3. Authorize the Secretary of Veterans Affair to carry out major 

medical facility leases in the following twelve locations: 

• Brandon, Florida outpatient clinic in the amount of $4,326,000. 

• Colorado Springs, Colorado outpatient clinic in the amount of 

$3,995,000. 

• Eugene, Oregon outpatient clinic in the amount of $5,826,000. 

• Greenville, South Carolina outpatient clinic in the amount of 

$3,731,000. 

• Mansfield, Ohio outpatient clinic in the amount of $2,212,000. 

• Mayaguez, Puerto Rico outpatient clinic in the amount of 

$6,276,000. 

• Mesa, Arizona outpatient clinic in the amount of $5,106,000. • Sun City, Arizona outpatient clinic in the amount of $2,295,000. • Expansion of an outpatient clinic in Green Bay, Wisconsin, in the amount of $5,891,000. • Expansion of an outpatient clinic in Savannah, Georgia in the amount of $3,168,000. 


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• Interim research space in Palo Alto, California in the amount 

of $8,636,000. 

• Primary care annex in Tampa, Florida in the amount of 

$8,652,000. 

4. Authorize the Secretary of Veterans Affairs to construct a new 

medical facility in Okaloosa County, Florida, in an amount not to 

exceed $54,475,000. 

5. Authorize $345,900,000 to be appropriated for Major Medical 

Facility Projects for Fiscal Year 2009. 

6. Authorize $1,694,295,000 to be appropriated for modifications 

of major medical facility authorizations for FY 2009 and modifications for certain major medical facility construction projects previously authorized in connection with the Capital Asset Realignment for Enhanced Services (CARES). 

7. Authorize $54,475,000 to be appropriated for the construction 

of a major medical facility in section 5. 

8. Require the Secretary to submit a report on the progress in 

complying with Section 312A of 38 U.S.C. Section 312A governs the 

establishment and responsibilities of the Director of Construction 

and Facilities Management which was a position established in 

P.L. 109–461. 

9. Require Secretary to submit an annual report on outpatient 

clinics. 

BACKGROUND AND DISCUSSION

VA’s medical infrastructure is old and outdated. The average age 

of a VA facility is over 50 years old. With the enactment of eligibility reform in 1996, VA’s health care delivery model has undergone a transformation from inpatient-centered care to one of outpatient-centered care. The Capital Asset Realignment for Enhanced 

Services (CARES) process initiated in 1998 by VA created a blueprint for the future construction needs of the Department. CARES 

is a comprehensive assessment for identifying the demand for VA 

care and projecting future appropriate models of delivery of health 

care to veterans throughout the VA’s system of health care. 

Section 8104(a)(2) of title 38, United States Code, requires statutory authorization for all major medical facility construction 

projects (defined as those which cost more than $10 million) and 

all major medical facility leases exceeding $600,000 (including 

parking facilities) prior to the appropriation or expenditure of 

funds. 

MAJOR MEDICAL FACILITY AUTHORIZATIONS

H.R. 5856 provides authorization for 11 major medical facility 

projects and 12 major medical facility leases. 

Palo Alto, California: The Palo Alto project received $34 million 

in fiscal year 2005 and an additional $20 million in fiscal year 2008 

budget authority to complete construction, with a total estimated 

cost of $54 million. This project would replace an obsolete, functionally deficient and seismically unsafe acute psychiatric inpatient 

building by constructing an 80-bed, 78,000 square-foot replacement 

facility at VA Palo Alto Heath Care System’s Palo Alto Division. 

After completion of the 80–bed acute psychiatric inpatient replaceVerDate Aug 31 2005 21:50 May 16, 2008 Jkt 069006 PO 00000 Frm 00003 Fmt 6659 Sfmt 6602 E:\HR\OC\HR648.XXX HR648

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ment facility, Building 2 would be decommissioned and razed, with 

the land being converted to patient parking. 

San Antonio, Texas: The San Antonio project received the total 

estimated cost of $66 million in a reprogramming action in fiscal 

year 2008 to complete design and construction. This project would 

provide a new 84,000 state-of-the-art Polytrauma Healthcare and 

Rehabilitation Center. The Center would consist of a polytrauma 

ward, transitional housing, Physical Medicine and Rehabilitation 

Service, Prosthetics Service, and polytrauma research and support 

programs. Additionally, spaces vacated by programs moving to the 

new center would be renovated and parking deficiencies addressed. 

San Juan, Puerto Rico: The San Juan project received $14.88 

million in fiscal year 2005, which was reduced by $4 million in a 

reprogramming action in fiscal year 2006, and received $59 million 

in fiscal year 2008. This project requires an additional $64.4 million in fiscal year 2009 budget authority to construct the administrative building, with a total estimated cost of approximately 

$225.9 million. This project would complete the seismic corrections 

in the main hospital building to comply with occupancy standards. 

The second phase of approximately 100,000 square feet of new construction would house administrative functions to meet VA’s immediate occupancy standards. 

Okaloosa County, Florida: Okaloosa County, Florida, is home to 

one of the largest veteran populations in the nation, yet veterans 

have to drive over three hours to receive VA inpatient care. The 

area is located in the Eastern Southern Market of Veterans Integrated Service Network 16, which the CARES decision identified as 

‘‘the only market in the VISN without a medical center and it. . . 

is underserved for inpatient care. The CARES decision further stated that ‘‘[t]he VISN also will continue to pursue opportunities to 

expand its current sharing with Eglin Air Force Base (AFB) to enhance inpatient care services.’’

As of April 2008, veterans in this area were only able to receive 

outpatient care at a VA community-based outpatient clinic located 

at Eglin AFB in Okaloosa County. On November 1, 2007, Major 

General David W. Eidsaune, Commander, Air Armament Center, 

Eglin AFB, Florida, testified before the Subcommittee on Health of 

the Committee on Veterans’ Affairs that the VA and the Department of Defense (DoD) have developed a successful partnership to 

provide accessible health care in northwest Florida. 

Based on the CARES recommendations and the existing cooperative VA/DoD history, section 823 of Public Law 109–461 required 

that the Secretary of VA conduct a study in conjunction with the 

Secretary of DoD and the Secretary of the Air Force to develop options for the VA on the placement of a VA Medical Center in 

Okaloosa County, Florida. Completed in June 2007, the study identified three options for providing inpatient care in Okaloosa County, Florida. Implementing Option 2 was identified as the most feasible of the three options. Option 2 would expand the outpatient 

specialty care space at Eglin AFB Hospital through Federal construction, and would establish a VA/DoD sharing agreement with 

Eglin AFB Hospital to provide medical and surgical acute inpatient 

services to veterans, and expand specialty outpatient care. 


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INCREASES IN PRIOR YEAR AUTHORIZATIONS

Authorizations for appropriations were increased for projects authorized in Public Law 109–461, the ‘‘Veterans Benefits, Health 

Care, and Information Technology Act of 2006.’’ VA has reported 

that these projects have increased in cost and new authorization 

levels must be obtained to move forward with the projects. There 

are six projects that have increased in cost and require increased 

authorizations: New Orleans VA Medical Center (VAMC); Denver 

VAMC; Gainesville, Florida, VAMC; new medical facility in Las 

Vegas; new outpatient clinic in Lee County, Florida; and new medical facility in Orlando, Florida. 

Denver, Colorado: H.R. 5856 would provide VA an authorization 

in the amount not to exceed $769,200,000 for the replacement of 

the Denver, Colorado, VAMC. This authorization was requested by 

the Administration in February in the fiscal year 2009 budget submission. However, on April 24, 2008, the Secretary of Veterans Affairs announced his decision to change the scope of the project. VA 

now intends to construct a new bed tower in partnership with the 

University of Colorado Denver and the University of Colorado Hospital (UCH) on University property at the former Fitzsimons Army 

Medical Center campus. 

The Committee strongly supports the Secretary’s decision to once 

again move forward with a joint use facility. We recognize that it 

may be necessary to amend the authorization as planning and design for a new shared facility is developed. 

There has been a long and detailed history of planning for a 

shared facility to replace the existing Denver VAMC. Discussions 

between VA and UCH regarding the relocation of the Denver 

VAMC to the Fitzsimons campus started in 2000. In 2003, Congress enacted Public Law 108–170, the ‘‘Veterans Health Care, 

Capital Asset, and Business Improvement Act of 2003.’’ The law 

authorized advance planning in an amount not to exceed $30 million for the contemplated joint use facility. Additionally, Public Law 

108–422, the ‘‘Veterans Health Programs Improvement Act of 

2004,’’ authorized VA to enter into a long-term lease of up to 75 

years at UCH. This authority was necessary for VA to acquire a 

sufficient land interest for the construction of a shared facility on 

the Fitzsimons Campus. Following enactment of the law, to the disappointment of the Committee, VA gave notice of its intention not 

to enter into a lease and instead purchase land on a separate site 

at the Fitzsimons campus for a freestanding VA medical center. On 

March 29, 2007, VA acquired 17.8 acres of land that is now intended to be used for a state-of-the-art VA Ambulatory Health Care 

Center, parking garage and administrative offices. 

However, the Committee remains concerned that the new plan 

for Denver does not reflect the authorization included in this bill. 

We expect VA to provide the Committee with a detailed prospectus 

and briefing on the announced changes for the major medical facility project in Denver. 

LEASE AUTHORIZATIONS

Twelve leases require authorization for FY 2009: Brandon, Florida; Colorado Springs, Colorado; Eugene, Oregon; Greenville, South 

Carolina; Mansfield, Ohio; Mayaguez, Puerto Rico; Mesa, Arizona; 


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Sun City, Arizona; Expansion of an outpatient clinic in Green Bay, 

Wisconsin; Expansion of an outpatient clinic in Savannah, Georgia; 

Interim research space in Palo Alto, California; and primary care 

annex in Tampa, Florida. 

Brandon, Florida: The bill would authorize a 50,000 square foot 

multi-specialty clinic lease in Brandon, Florida, that would affect 

10,425 unique veterans. Because of the rapidly expanding population growth, lack of public transportation, and inadequate highway infrastructure, the Brandon Clinic would significantly improve 

access to veterans in Southeastern Hillsborough County. The lease 

is fully authorized in the measure for $4,326,000. 

Colorado Springs, Colorado: The existing Colorado Springs Community Based Outpatient Clinic (CBOC) lease expires on August 

31, 2010. The project would relocate and expand the current clinic 

into approximately 47,000 square feet of outpatient clinic space. 

This project would allow the VA to continue to provide timely access to state-of-the-art primary care, specialty care, and mental 

health services for veterans in the area. The lease is fully authorized in the measure for $3,995,000. 

Eugene, Oregon: The existing Eugene CBOC lease expires in 

2012. This lease would relocate and expand the current clinic into 

approximately 66,000 square feet of outpatient clinic space. The 

lease is fully authorized in this measure for $5,826,000. 

Greenville, South Carolina: The lease in Greenville, South Carolina would relocate and expand the current clinic to approximately 

45,900 square feet of new outpatient clinic space due to the expiration of the current lease. This expansion would address the access 

and capacity issues for primary care and specialty care services 

that currently exist. The lease is fully authorized in this measure 

for $3,731,000. 

Mansfield, Ohio: The lease in Mansfield, Ohio would construct a 

new Mansfield CBOC to augment existing services provided and 

add new services to the more than 5,800 unique veterans served. 

The new clinic would be approximately 27,500 square feet and 

would eliminate the physical separation between primary care and 

mental health services that currently exists. The lease is fully authorized in this measure for $2,212,000. 

Mayaguez, Puerto Rico: The current leased clinic space has significant infrastructure deficiencies that would be very costly to repair. Under a new lease contract, the Mayaguez clinic would continue to provide the same services to its veteran service area in a 

structure that measures approximately 70,100 square feet. The 

lease is fully authorized in this measure for $6,276,000. 

Southeast Mesa, Arizona: The lease for the existing Southeast 

Mesa, Arizona CBOC expires on December 30, 2011. This lease 

would relocate and expand the current 42,500 square foot clinic 

into approximately 60,000 square feet of outpatient clinic space. 

The lease is fully authorized in this measure for $5,106,000. 

Sun City, Arizona: The existing Sun City, Arizona Northwest Extension Clinic lease expires on April 30, 2009. This project would 

relocate and expand the current 8,916 square feet clinic into approximately 25,000 square feet of outpatient clinic space. This 

project would allow the VA to continue to provide timely access to 

state-of-the-art primary care clinics, specialty care clinics, mental 

health and ancillary diagnostic services in a properly sized clinic to 


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meet increased workload. Dental care would be introduced as a 

new service offered after relocation into the larger space. The lease 

is fully authorized in this measure for $2,295,000. 

Green Bay, Wisconsin: The lease authorization in Green Bay, 

Wisconsin, would provide authority to construct an Ambulatory 

Surgery/Outpatient Diagnostic Center and CBOC for the North and 

Central submarket of VISN 12. The current clinic has reached its 

physical capacity and the expansion is needed to meet the needs 

of more than 1,500 patients currently on temporary fee authorization, and to provide closer access for nearly 4,000 patients from 

this catchment area currently being seen at the Appleton and 

Cleveland CBOC. Additional space would be necessary to support 

the ancillary services needed to provide appropriate services to 

these patients including laboratory, radiology, mental health, social 

work and home based primary care. The lease is fully authorized 

in the measure for $5,891,000. 

Savannah, Georgia: The Savannah, Georgia, CBOC is a long established facility serving southeastern Georgia and the southern 

tip of South Carolina. This lease would maintain the clinic presence in the Savannah area while increasing the net usable space 

from 34,760 square feet to 38,900 square feet. This facility would 

provide access to primary care, mental health services, specialty 

care, diagnostic services and home-based health care for area veterans and the Fort Stewart and Fort Hunter Army Airfield communities. The lease is fully authorized in this measure for $3,168,000. 

Palo Alto, California: The Palo Alto lease authorization would 

authorize the lease of up to 100,000 square feet of wet and dry 

bench research laboratory facilities in the San Francisco Bay area 

to house approximately 300 VA researchers and other miscellaneous programs displaced due to major and minor construction 

projects. The lease is fully authorized in this measure for 

$8,636,000. 

Tampa, Florida: The proposed lease in Tampa, Florida would 

move all Primary Care services to a 100,000 square foot off-site location within close proximity of the parent campus. This relocation 

would have the primary benefit of decompressing the parent facility so that Specialty Clinics can be expanded. The lease is fully authorized in this measure for $8,652,000. 

OTHER MATTERS

Far South Texas: Veterans in far South Texas face an excessive 

travel burden to obtain inpatient care at the San Antonio VA Medical Center. Round trip travel time from Harlingen is about ten 

hours and from Corpus Christi, about five hours. Public Law 108–

170 required VA to develop a plan for meeting the future hospital 

care needs of veterans who reside in this region. On April 30, 2004, 

VA submitted a report to Congress with a plan consistent with the 

CARES Decision. The plan included an expansion of services in 

Harlingen, Corpus Christi, and the McAllen Clinic. 

In August 2007, Booz Allen Hamilton released a report on veteran health care needs in South Texas that was requested by Senator Kay Bailey Hutchison of Texas. The Booz Allen Hamilton report included options for expanding VA health care services in the 

Harlingen and Corpus Christi areas. 


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As recommended, the Committee supports expanding services at 

the McAllen Clinic, Corpus Christi, and Harlingen. 

VA is moving forward with an expansion of services in Harlingen 

that would be comprehensive in terms of providing medical care 

and reduce the rate of travel to San Antonio VAMC by about at 

least 90 percent. VA is implementing a plan in collaboration with 

the University of Texas Regional Academic Health Center, to provide a full spectrum of services in Harlingen with a lease-build out 

over the next three years. The Committee expects the new facility 

to be named the ‘‘Far South Texas VA Medical Care Center.’’

Additionally, the Committee expects that the current Deputy Director position that has been established for far South Texas will 

be transitioned to the title of Health Care System Director, Coastal 

Bend/Lower Rio Grande Valley/Laredo Health Care System starting in fiscal year 2010. This Director will report directly to the VA 

Heart of Texas Health Care Network Director. 

We remain committed to ensuring that VA fully funds, and remains focused on, an aggressive plan to maximize local access to 

care for veterans in far South Texas. 

Guam: The Committee is concerned about the future provision of 

health care services for veterans residing in Guam and the Pacific 

Islands that make up the Compact of Free Association. 

VA and DoD currently have a memorandum of understanding 

(MOU) to provide inpatient and specialty care for veteran beneficiaries on a space available basis. The MOU is set to expire on 

December 31, 2010. Additionally, DoD is anticipating the relocation 

of 8,000 to 12,000 Marines from Okinawa to Guam by 2014 that 

would nearly double the total patient population served by the U.S. 

Naval Hospital Guam. To meet the increased demand, the Navy 

will replace the existing facility. Several sites are being considered. 

The Secretary of the Navy informed the Committee that a site location decision will be made by May 31, 2008. The Committee strongly recommends that the new Naval Hospital be built at the current 

location. Further, to ensure continued access to the Naval Hospital 

by veterans, we recommend that VA and DoD enter into a joint 

agreement whereby veterans are guaranteed access to inpatient 

and specialty services at U.S Naval Hospital Guam. 

Fort Ord, California: The Committee is aware there is a VA feasibility study underway to determine the need for a CBOC in the 

Ord Military Community. We strongly encourage the completion of 

this study as expeditiously as possible and look forward to the results and recommendations that will address future health care 

needs for veterans in the area. 

Northeast Iowa: The Committee is concerned that the Veterans 

Integrated Service Network 23 has identified rural Northeast Iowa 

as an underserved area. Veterans in Northeastern Iowa do not 

meet the VA access standard of having VA primary care community based outpatient clinic located within 30 minutes of 70 percent 

of veterans living in the area. The VA is now conducting a more 

comprehensive analysis to determine what strategies might improve delivery of VA health care services in the area. The study is 

expected to be completed by June 30, 2008. We encourage VA to 

have a strategy in place that will meet the access to care needs of 

veterans residing in Northeast Iowa in fiscal year 2010. This may 


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include community-based outpatient or outreach clinics, telemedicine, or contract care with existing local medical facilities. 

HEARINGS

On February 27, 2008, the Subcommittee on Health held a hearing entitled ‘‘U.S. Department of Veterans Affairs Construction Authorization.’’ The following witnesses testified: Mr. Dennis M. 

Cullinan, Director, National Legislative Service, Veterans of Foreign Wars of the United States, On Behalf of The Independent 

Budget; Mr. Joseph L. Wilson, Deputy Director, Veterans Affairs 

and Rehabilitation Commission, The American Legion; Mr. Richard 

F. Weidman, Executive Director for Policy and Government Affairs, 

Vietnam Veterans of America; and Mr. Donald H. Orndoff, Director, Office of Construction and Facilities Management, U.S. Department of Veterans Affairs, accompanied by Mr. Robert L. Neary, Director, Service Delivery Office, U.S. Department of Veterans Affairs; Mr. James M. Sullivan, Deputy Director, Office of Asset Enterprise Management, Office of Management, U.S. Department of 

Veterans Affairs; and, Mr. Joseph Williams, Assistant Deputy 

Under Secretary for Health for Operations and Management, Veterans Health Administration, U.S. Department of Veterans Affairs. 

COMMITTEE CONSIDERATION

On April 23, 2008, the Subcommittee on Health met in open 

markup session and ordered favorably forwarded to the full Committee H.R. 5856, without amendment, by voice vote. 

On April 30, 2008, the full Committee met in open markup session, a quorum being present, and ordered H.R. 5856 favorably reported to the House of Representatives, by voice vote. 

COMMITTEE VOTES

Clause 3(b) of rule XIII of the Rules of the House of Representatives requires the Committee to list the record votes on the motion 

to report the legislation and amendments thereto. There were no 

record votes taken on amendments or in connection with ordering 

H.R. 5856 reported to the House. A motion by Mr. Buyer of Indiana 

to order H.R. 5856 reported favorably to the House of Representatives was agreed to by voice vote. 

COMMITTEE OVERSIGHT FINDINGS

In compliance with clause 3(c)(1) of rule XIII and clause (2)(b)(1) 

of rule X of the Rules of the House of Representatives, the Committee’s oversight findings and recommendations are reflected in the 

descriptive portions of this report. 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

In accordance with clause 3(c)(4) of rule XIII of the Rules of the 

House of Representatives, the Committee’s performance goals and 

objectives are reflected in the descriptive portions of this report. 


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NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

In compliance with clause 3(c)(2) of rule XIII of the Rules of the 

House of Representatives, the Committee adopts as its own the estimate of new budget authority, entitlement authority, or tax expenditures or revenues contained in the cost estimate prepared by 

the Director of the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974. 

EARMARKS AND TAX AND TARIFF BENEFITS

H.R. 5856 contains the following congressional earmark, limited 

tax benefit, or limited tariff benefit as defined in clause 9(d), 9(e), 

or 9(f) of rule XXI of the Rules of the House of Representatives: 

1. Authorization for the VA to construct a new medical facility 

in Okaloosa County, Florida, in an amount not to exceed 

$54,455,000, offered by Representative Jeff Miller of Florida, Ranking Member of the Subcommittee on Health of the Committee on 

Veterans’ Affairs. 

COMMITTEE COST ESTIMATE

The Committee adopts as its own the cost estimate on H.R. 5856 

prepared by the Director of the Congressional Budget Office pursuant to section 402 of the Congressional Budget Act of 1974. 

CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

Pursuant to clause 3(c)(3) of rule XIII of the Rules of the House 

of Representatives, the following is the cost estimate for H.R. 5856 

provided by the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974: 

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, 

Washington, DC, May 12, 2008. 

Hon. BOB FILNER, 

Chairman, Committee on Veterans’ Affairs, 

House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 5856, the Department of 

Veterans Affairs Medical Facility Authorization and Lease Act of 

2008. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Sunita D’Monte. 

Sincerely, 

ROBERT A. SUNSHINE

(For Peter R. Orszag, Director). 

Enclosure. 

H.R. 5856—Department of Veterans Affairs Medical Facility Authorization and Lease Act of 2008 

Summary: H.R. 5856 would authorize funding for the construction, renovation, improvement, or leasing of several medical facilities by the Department of Veterans Affairs (VA). The bill would 

specifically authorize the appropriation of $2.1 billion in 2009 for 


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11 projects, and $60 million for leasing 12 clinics or other facilities. 

CBO estimates that implementing H.R. 5856 would cost $146 million in 2009 and about $2.2 billion over the 2009–2013 period, assuming appropriation of the authorized and estimated amounts. 

CBO estimates that enacting the bill would have no effect on direct 

spending or revenues. 

H.R. 5856 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act (UMRA) 

and would not affect the budgets of state, local, or tribal governments. 

Estimated cost to the Federal Government: The estimated budgetary impact of H.R. 5856 is shown in the following table. The costs 

of this legislation fall within budget function 700 (veterans benefits 

and services). 

By fiscal year, in millions of dollars— 

2008 2009 2010 2011 2012 2013 

SPENDING SUBJECT TO APPROPRIATION 

Spending Under Current Law for Major Construction of Veterans Medical Facilities: 

Budget Authority 1 ............................................................... 1,135 0 0 0 0 0 

Estimated Outlays ............................................................... 525 680 572 343 119 33 

Proposed Changes: 

Major Medical Facility Projects: 

Authorization Level ..................................................... 0 2,095 0 0 0 0 

Estimated Outlays ...................................................... 0 92 563 681 503 191 

Leases for Medical Facilities: 

Estimated Authorization Level .................................... 0 60 22 22 22 22 

Estimated Outlays ...................................................... 0 54 25 22 22 22 

Total Changes: 

Estimated Authorization Level ........................... 0 2,155 22 22 22 22 

Estimated Outlays ............................................. 0 146 589 702 524 212 

Spending Under H.R. 5856: 

Estimated Authorization Level 1 .......................................... 1,135 2,155 22 22 22 22 

Estimated Outlays ............................................................... 525 826 1,161 1,045 643 245 

1 The 2008 level is the amount appropriated for that year. 

Basis of estimate: For this estimate, CBO assumes that the legislation will be enacted before the end of fiscal year 2008, that the 

authorized and estimated amounts will be appropriated near the 

start of each fiscal year, and that outlays will follow historical 

spending patterns for similar programs. 

H.R. 5856 would authorize appropriations for major construction 

and leasing of medical facilities by VA. It also would require VA 

to prepare reports addressing specific construction issues. CBO estimates that implementing H.R. 5856 would cost about $2.2 billion 

over the 2009–2013 period, assuming appropriation of the necessary amounts. 

Major medical facility projects 

Sections 2, 3, and 5 would authorize work on a number of medical facility projects. CBO estimates that implementing those three 

sections would cost $2 billion over the 2009–2013 period, assuming 

appropriation of the authorized amounts. 

Section 3 would authorize the appropriation of about $1.7 billion 

in 2009 for additional funding for construction, renovation, repairs, 

and upgrades to seven major projects that were previously authorized under Public Law 109–461. 


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Section 2 would authorize the appropriation of $346 million in 

2009 for three new construction projects including a polytrauma 

center in San Antonio, Texas, and seismic corrections to facilities 

in Palo Alto, California, and San Juan, Puerto Rico. 

Section 5 would authorize the appropriation of $55 million in 

2009 to construct a new medical facility in Okaloosa County, Florida. 

Leases for medical facilities 

Section 4 would authorize the Secretary of VA to lease facilities 

for 10 outpatient clinics, a primary care annex, and a research laboratory. The bill would authorize the appropriation of $60 million 

in 2009 for lease payments for the first year. Based on information 

from VA’s 2009 budget request, CBO estimates that VA would 

enter into 20-year lease agreements for those facilities, and that 

VA would have additional costs of about $22 million a year starting 

in 2010. (Costs are higher in 2009 than other years because VA 

would pay the lessors additional amounts in the first year of the 

lease for necessary improvements and upgrades.) Thus, CBO estimates that implementing this section would cost $145 million over 

the 2009–2013 period, assuming appropriation of the necessary 

amounts. 

Other provisions 

Section 7 would require VA to prepare a report on its progress 

in appointing a Director of Construction and Facilities Management. Section 8 would require VA to prepare an annual report on 

outpatient clinics. CBO estimates that implementing those provisions would have an insignificant impact on discretionary spending. 

Intergovernmental and private-sector impact: H.R. 5856 contains 

no intergovernmental or private-sector mandates as defined in 

UMRA and would not affect the budgets of state, local, or tribal 

governments. 

Estimate prepared by: Federal costs: Sunita D’Monte; Impact on 

state, local, and tribal governments: Lisa Ramirez-Branum; Impact 

on the private sector: Daniel Frisk. 

Estimate approved by: Theresa Gullo, Deputy Assistant Director 

for Budget Analysis. 

FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of Federal mandates regarding H.R. 5856 prepared by the Director of the Congressional Budget Office pursuant to section 423 of the Unfunded Mandates Reform Act. 

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act would be created by H.R. 5856. 

CONSTITUTIONAL AUTHORITY STATEMENT

Pursuant to clause 3(d)(1) of rule XIII of the Rules of the House 

of Representatives, the Committee finds that the Constitutional authority for H.R. 5856 is provided by Article I, section 8 of the Constitution of the United States. 


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APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that the legislation does not relate to the 

terms and conditions of employment or access to public services or 

accommodations within the meaning of section 102(b)(3) of the Congressional Accountability Act. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title 

This Act may be cited as the ‘‘Department of Veterans Affairs 

Medical Facility Authorization and Lease Act of 2008.’’

Section 2. Authorization for fiscal year 2009 major medical facility 

projects. The authorization total for this section is $345,900 

million 

This section authorizes appropriations for: 

• Seismic corrections to building 2 at the VAMC in Palo Alto, 

California in the amount of $54 million. 

• Construction of a polytrauma healthcare and rehabilitation 

center at the VAMC in San Antonio, Texas in the amount of $66 

million. 

• Seismic correction to building 1, at the VAMC in San Juan, 

Puerto Rico in the amount of $225,900 million. 

Section 3. Modification of authorization amounts for certain major 

medical facility construction projects previously authorized. The 

authorization total for this section is $1,694,295,000 

This section increases previously authorized construction projects 

that were included in Public Law 109–461 and since that time have 

increased in cost: 

• Raises the authorization level for the New Orleans VAMC replacement facility to $625 million. An increase of $325 million. 

• Raises the authorization level for the Denver VAMC replacement medical facility to $769,200 million. An increase of $671,200 

million. 

• Raises the authorization for the correction of patient privacy 

issues at the Gainesville, Florida VAMC to $136,700 million. An increase of $51,500 million. 

• Raises the authorization for the construction of a new medical 

facility in Las Vegas, Nevada to $600,400 million. An increase of 

$194,400 million. 

• Raises the authorization for the construction of a new outpatient clinic in Lee County, Florida to $131,800 million. An increase of $66,700 million. 

• Raises the authorization for the construction of a new medical 

facility in Orlando, Florida to $656,800. An increase of $279,100 

million. 

• Raises the authorization for the consolidation of campuses at 

the University Drive and H. John Heinz III Divisions to $295,600 

million. An increase of $106,395 million. 


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Section 4. Authorization of fiscal year 2009 major medical facility 

leases. The total for this section is $60,114 million 

This section authorizes the Secretary of Veterans Affairs to carry 

out major medical facility leases in twelve locations. The following 

eight leases are for outpatient clinics: 

• Brandon, Florida, in the amount of $4,326 million. 

• Colorado Springs, Colorado, in the amount of $3,995 million. 

• Eugene, Oregon, in the amount of $5,826 million. 

• Greenville, South Carolina, in the amount of $3,731 million. 

• Mansfield, Ohio, $2,212 million. 

• Mayaguez, Puerto Rico, $6,276 million. 

• Mesa, Arizona, $5,106 million. 

• Sun City, Arizona, in the amount of $2,295 million. 

The other four leases are requested for: 

• Expansion of an outpatient clinic in Green Bay, Wisconsin, in 

the amount of $5,891 million. 

• Expansion of an outpatient clinic in Savannah, Georgia, $3,168 

million. 

• Interim research space in Palo Alto, California in the amount 

of $8,636 million. 

• Primary care annex in Tampa, Florida, $8,652 million. 

Section 5. Authorization of construction of major medical facility, 

Okaloosa County, Florida 

This section authorizes the Secretary of Veterans Affairs to construct a new medical facility in Okaloosa County, Florida in an 

amount not to exceed $54,475 million. 

Section 6. Authorization of appropriation 

For Major Medical Facility Projects for fiscal year 2009, this section authorizes to be appropriated an amount of $345,900 million. 

For modifications of major medical facility authorizations for fiscal year 2009 and modifications for certain major medical facility 

construction projects previously authorized in connection with the 

Capital Asset Realignment for Enhanced Services this section authorizes to be appropriated an amount of $1,694,295,000. 

For the construction of a major medical facility in section 5 in the 

amount of $54,475 million. 

Section 7. Facilities administration 

This section requires the Secretary to submit a report on the 

progress in complying with section 312A of 38 U.S.C. 312A governs 

the establishment and responsibilities of the Director of Construction and Facilities Management which was a position established 

in P.L. 109–461. 

Section 8. Annual report on outpatient clinics 

This section requires VA to submit an annual report on outpatient clinics. 

Section 9. Technical correction 

This section makes a technical correction to P.L. 109–461. 


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CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 

as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italic, 

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

VETERANS BENEFITS, HEALTH CARE, AND 

INFORMATION TECHNOLOGY ACT OF 2006 

* * * * * * * 

TITLE VIII—CONSTRUCTION MATTERS 

Subtitle A—Construction and Lease 

Authorities 

SEC. 801. AUTHORIZATION OF FISCAL YEAR 2006 MAJOR MEDICAL FACILITY PROJECTS. 

(a) IN GENERAL.—The Secretary of Veterans Affairs may carry 

out the following major medical facility projects in fiscal year 2006, 

with each project to be carried out in the amount specified for that 

project: 

(1) Restoration, new construction or replacement of the medical center facility for the Department of Veterans Affairs Medical Center, New Orleans, Louisiana, due to damage from Hurricane Katrina in an amount not to exceed ø$300,000,000¿ 

$625,000,000. øThe Secretary is authorized to carry out the 

project in or near New Orleans as a collaborative effort consistent with the New Orleans Collaborative Opportunities 

Study Group Report dated June 12, 2006.¿ 

* * * * * * * 

(3) Replacement of the Department of Veterans Affairs Medical Center, Denver, Colorado, in an amount not to exceed 

ø$98,000,000¿ $769,200,000. 

* * * * * * * 

SEC. 802. EXTENSION OF AUTHORIZATION FOR CERTAIN MAJOR MEDICAL FACILITY CONSTRUCTION PROJECTS PREVIOUSLY 

AUTHORIZED IN CONNECTION WITH CAPITAL ASSET REALIGNMENT INITIATIVE. 

The Secretary of Veterans Affairs may carry out the following 

major medical facility projects, with each such project to be carried 

out in the amount specified for that project: 

(1) * * * 

* * * * * * * 

(5) Correction of patient privacy deficiencies at the Department of Veterans Affairs Medical Center, Gainesville, Florida, 

in an amount not to exceed ø$85,200,000¿ $136,700,000. 

* * * * * * * 

(7) Construction of a new Medical Center Facility at the Department of Veterans Affairs Medical Center, Las Vegas, NeVerDate Aug 31 2005 21:50 May 16, 2008 Jkt 069006 PO 00000 Frm 00015 Fmt 6659 Sfmt 6602 E:\HR\OC\HR648.XXX HR648

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vada, in an amount not to exceed ø$406,000,000¿ 

$600,400,000. (8) Construction of an øambulatory surgery/outpatient diagnostic support center in the Gulf South Submarket of Veterans 

Integrated Service Network (VISN) 8 and completion of Phase 

I land purchase,¿ outpatient clinic in Lee County, Florida, in 

an amount not to exceed ø$65,100,000¿ $131,800,000. 

* * * * * * * 

(11) Construction of a new medical center facility in the Orlando, Florida, area in an amount not to exceed 

ø$377,700,000¿ $656,800,000. 

(12) Consolidation of campuses at the University Drive and 

H. John Heinz III divisions, Pittsburgh, Pennsylvania, in an 

amount not to exceed ø$189,205,000¿ $295,600,000. 

* * * * * * * 

SEC. 807. AUTHORIZATION OF APPROPRIATIONS. 

(a) * * * 

* * * * * * * 

(e) AUTHORIZATION OF APPROPRIATIONS FOR MAJOR MEDICAL FACILITY LEASES.—

(1) FISCAL YEAR 2006 LEASES.—There is authorized to be appropriated for the Secretary of Veterans Affairs for fiscal year 

2006 for the øMedical Care¿ Medical Facilities account, 

$24,990,000 for the leases authorized in section 805. 

(2) FISCAL YEAR 2007 LEASES.—There is authorized to be appropriated for the Secretary of Veterans Affairs for fiscal year 

2007 for the øMedical Care¿ Medical Facilities account, 

$26,642,000 for the leases authorized in section 806. 

* * * * * * * 

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. 

8101. Definitions. 

* * * * * * * 

8119. Annual report on outpatient clinics. 

* * * * * * * 


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SUBCHAPTER I—ACQUISITION AND OPERATION OF 

MEDICAL FACILITIES 

* * * * * * * 

§ 8119. Annual report on outpatient clinics 

(a) ANNUAL REPORT REQUIRED.—The Secretary of Veterans Affairs shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives an annual report on communitybased outpatient clinics and other outpatient clinics. The report 

shall be submitted each year not later than the date on which the 

budget for the next fiscal year is submitted to the Congress under 

section 1105 of title 31. 

(b) CONTENTS OF REPORT.—Each report required under subsection (a) shall include the following: 

(1) A list of each community-based outpatient clinic and other 

outpatient clinic of the Department, and for each such clinic, 

the type of clinic, location, size, number of health professionals 

employed by the clinic, workload, whether the clinic is leased or 

constructed and operated by the Secretary, and the annual cost 

of operating the clinic. 

(2) A list of community-based outpatient clinics and other 

outpatient clinics that the Secretary opened during the fiscal 

year preceding the fiscal year during which the report is submitted and a list of clinics the Secretary proposes opening during the fiscal year during which the report is submitted and the 

subsequent fiscal year, together with the cost of activating each 

such clinic and the information required to be provided under 

paragraph (1) for each such clinic and proposed clinic. 

(3) A list of proposed community-based outpatient clinics and 

other outpatient clinics that are, as of the date of the submission of the report, under review by the National Review Panel 

and a list of possible locations for future clinics identified in the 

Department’s strategic planning process, including any identified locations in rural and underserved areas. 

(4) A prioritized list of sites of care identified by the Secretary 

that the Secretary could establish without carrying out construction or entering into a lease, including—

(A) any such sites that could be expanded by hiring additional staff or allocating staff to Federal facilities or facilities operating in collaboration with the Federal Government; and 

(B) any sites established, or able to be established, under 

sections 8111 and 8153 of this title. 

* * * * * * * 

Æ 


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