51–240

[FULL COMMITTEE PRINT]

118TH CONGRESS REPORT " HOUSE OF REPRESENTATIVES !

1st Session 118–XXX

MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND

RELATED AGENCIES APPROPRIATIONS BILL, 2024

XXXX XX, 2023.—Committed to the Committee of the Whole House on the State

of the Union and ordered to be printed

Mr. JOHN R. CARTER of Texas, from the Committee on

Appropriations, submitted the following

R E P O R T

together with

MINORITY VIEWS

[To accompany H.R. XXXX]

The Committee on Appropriations submits the following report in

explanation of the accompanying bill making appropriations for

military construction, veterans affairs, and related agencies for the

fiscal year ending September 30, 2024.

INDEX TO BILL AND REPORT

Page Number

Bill Report

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

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

Title I—Department of Defense: 2 3

Military Construction ......................................................................... 2 3

NATO Security Investment Program ................................................ 9 14

Department of Defense Base Closure Account ................................. 10 14

Family Housing Construction and Operation and Maintenance .... 10 14

Department of Defense Family Housing Improvement Fund ......... 12 16

Department of Defense Military Unaccompanied Housing Improvement Fund .............................................................................. 12 16

Administrative Provisions .................................................................. 12 16

Title II—Department of Veterans Affairs: 29 18

Veterans Benefits Administration ..................................................... 29 21

Veterans Health Administration ....................................................... 33 26

National Cemetery Administration ................................................... 38 48

Departmental Administration ............................................................ 39 49


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Page Number

Bill Report

Administrative Provisions .................................................................. 48 56

Title III—Related Agencies: 80 61

American Battle Monuments Commission ........................................ 80 61

U.S. Court of Appeals for Veterans Claims ...................................... 81 62

Cemeterial Expenses, Army ............................................................... 81 62

Armed Forces Retirement Home ....................................................... 82 62

Administrative Provision .................................................................... 83 63

Title IV—General Provisions: 84 63

PURPOSE OF THE BILL

The Military Construction, Veterans Affairs, and Related Agencies Appropriations bill funds the Department of Defense’s activities related to military construction; family housing construction,

maintenance, and oversight; and environmental remediation at

closed military bases. The bill also funds the Department of Veterans Affairs, including programs to assist veterans, such as disability and pension benefits, education, healthcare, and insurance

and loan programs. The bill funds four related agencies that honor

and respect the Nation’s veterans including the American Battle

Monuments Commission; Cemeterial Expenses, Army (including

Arlington National Cemetery); the U.S. Court of Appeals for Veterans Claims; and the Armed Forces Retirement Home.

SUMMARY OF COMMITTEE RECOMMENDATION

The Committee recommends $337,909,342,000 in total budget authority for the fiscal year 2024 programs and activities funded in

the bill. This is an increase of $15,184,084,000 above the fiscal year

2023 enacted level and $999,443,000 above the President’s request.

The bill includes $167,282,342,000 for mandatory programs and

$170,627,000,000 for discretionary programs.

The bill provides $17,674,000,000 for military construction and

family housing. This is $1,326,000,000 below the fiscal year 2023

enacted level and $999,056,000 above the budget request. It includes $2,302,810,000 to address unfunded requirements of the

Services and Combatant Commanders and increases investment in

infrastructure in the Pacific region, unaccompanied personnel housing, and child development centers.

The bill provides $319,763,645,000 for fiscal year 2024 for the

Department of Veterans Affairs, which is an increase of

$16,481,047,000 above the fiscal year 2023 enacted level. Of the

total, $167,282,342,000 is provided for mandatory benefit programs

and $152,481,303,000 is provided for discretionary programs, which

is a 13 increase above the fiscal year 2023 level. Of the total for

fiscal year 2024, $128,104,000,000 for veterans’ healthcare was advanced in the Consolidated Appropriations Act, 2023 (P.L 117–328).

For fiscal year 2025, the Committee recommendation includes

$134,036,542,000 in advance appropriations for the four discretionary veterans’ medical care accounts and $193,048,534,000 in

advance appropriations for mandatory benefits programs.

The Committee recommendation provides a total of $471,697,000,

which is $29,037,000 above the fiscal year 2023 enacted level, for

the four Related Agencies: The American Battle Monuments Commission, the U.S. Court of Appeals for Veterans Claims, Army


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Cemeterial Expenses (including Arlington National Cemetery), and

the Armed Forces Retirement Home.

TITLE I

DEPARTMENT OF DEFENSE

MILITARY CONSTRUCTION OVERVIEW

Appropriation, fiscal year 2023 ......................................................... $19,000,000,000

Budget request, fiscal year 2024 ....................................................... 16,674,944,000

Committee recommendation, fiscal year 2024 ................................. 17,674,000,000

Change from enacted level ......................................................... ¥1,326,000,000

Change from budget request ...................................................... +999,056,000

Military construction accounts provide funds for new construction, construction improvements, planning and design, and host nation support. Projects funded by these accounts include facilities for

operations, training, readiness, maintenance, research and development, supply, medical care, and force protection as well as unaccompanied housing, military-owned family housing, utilities infrastructure, and land acquisition.

COMMITTEE DIRECTIVES

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 and to provide notification to the

Committee when certain actions are taken. The Committee also retains prior approval authority for any reprogramming of funds exceeding a specific threshold.

Reprogramming Guidelines.—The following reprogramming

guidelines apply for all military construction and family housing

projects. A project or account (including the sub-elements of an account) that has been specifically reduced by Congress in acting on

the budget request is considered to be a Congressional interest

item and as such, prior approval is required. Accordingly, no reprogramming to an item specifically reduced below the threshold

by Congress is permitted, except that the Department may seek reprogramming for appropriated increments.

The reprogramming criteria that applies to military construction

projects is 25 percent of the funded amount or $6,000,000 and includes new housing construction projects and improvements. To

provide the Services the flexibility to proceed with construction contracts without disruption or delay, the costs associated with environmental hazard remediation such as asbestos removal, radon

abatement, lead-based paint removal or abatement, and any other

legislated environmental hazard remediation may be excluded, if

such remediation requirements could not be reasonably anticipated

at the time of the budget submission. Reprogramming is a courtesy

provided to the Department and can be taken away if the authority

is abused. This exclusion applies to projects authorized in this

budget year as well as projects authorized in prior years for which

construction has not been completed. Planning and design costs associated with military construction and family housing projects

may also be excluded from these guidelines. In instances where


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prior approval for a reprogramming request for a project or account

has been received from the Committees on Appropriations of both

Houses of Congress, the adjusted amount approved becomes the

new base for any future increase or decrease via below-threshold

reprogramming (provided that the project or account is not a Congressional interest item as defined above).

In addition to these guidelines, the Services are directed to adhere to the guidance for military construction reprogramming actions and notifications, including the pertinent statutory authorities contained in DOD Financial Management Regulation 7000.14–

R and relevant updates and policy memoranda. The Committee further encourages the Office of the Director of National Intelligence

to use a format similar to that used by the Office of the Secretary

of Defense to submit reprogramming requests.

Facilities Sustainment, Restoration and Modernization

(FSRM).—The Department 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 and new facilities, 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.

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 above $90,000,000 with

the form 1391 justification to the congressional defense committees.

The Committee also directs the Secretary of Defense to report to

the congressional defense committees quarterly, beginning in the

second quarter of fiscal year 2024 and each quarter thereafter, of

projects that remain unawarded from the current and prior fiscal

years and the reasons for delay.

Transfer of Funds to and from the Foreign Currency Fluctuations, Construction, Defense Account.—The Committee directs the

Department of Defense to submit a quarterly report to the Committees on Appropriations of both Houses of Congress on the transfer


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of funds from military construction and family housing accounts to

the Foreign Currency Fluctuations, Construction, Defense account.

The report shall specify the amount transferred to the Foreign Currency account from each military construction and/or family housing account, and all other accounts for which an appropriation is

provided in this Act, during the preceding fiscal quarter, and the

amounts transferred from the Foreign Currency account to the

above accounts during the same period. This report shall be submitted no later than 30 days after the close of each fiscal quarter.

In addition, the Department 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 directs the Secretary of Defense to

submit 1002 reports on military construction bid savings not later

than 180 days after enactment of this Act, and biannually thereafter, to the Committees on Appropriations of both Houses of Congress.

Incremental Funding of Projects.—In general, the Committee

supports full funding for military construction projects if they are

executable. However, it continues to be the practice of the Committee to provide incremental funding for certain large projects to

enable the Services to more efficiently allocate military construction dollars among projects that can be executed in the year of appropriation.

Unfunded Priority List (UPL) and Future Years Defense Program

(FYDP).—The Committee directs the Department of Defense and

Military Services, active and reserve components as well as Combatant Commanders, as required by law, to submit a UPL and

FYDP to the congressional defense committees for military construction projects no later than 10 days and 5 days, respectively,

after the President’s budget is submitted to Congress.

ITEMS OF INTEREST

Advanced Manufacturing.—The Committee is encouraged by reports that three-dimensional (3D) construction could provide military civil engineers with a faster means of building facilities which

could reduce supply lines and the number of personnel needed for

construction and related activities. The Department of Defense is

encouraged to study, develop, and utilize advanced manufacturing

capabilities to the extent practicable.

Barracks.—The bill provides $362,300,000 for 9 construction

projects to ensure that servicemembers who live in barracks have

safe, modern, and secure living facilities. The Committee also provides $195,000,000 for barracks replacement planning and design.

Blood Processing Laboratory Infrastructure.—The Committee

continues to recognize the importance of Department of Defense

laboratory infrastructure and the investment needed to modernize

outdated facilities and equipment. While the Department has taken

steps in recent years to upgrade its laboratory infrastructure, the

Committee is concerned that the Department is not properly

prioritizing critical improvements to blood processing laboratory infrastructure and that this presents a risk to readiness. Therefore,

the Committee directs the Department to provide a report on the

status of blood processing laboratory infrastructure and its strategy


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to modernize such infrastructure within 180 days of enactment of

this Act.

Delivery and Cost of Military Construction Projects.—The Committee appreciates the U.S. Army Corps of Engineers’ March 2023

report titled, ‘‘U.S. Army Corps of Engineers Contracting Study Response: Recommended Reforms to Reduce Cost and Accelerate

Project Delivery.’’ The Committee encourages the Department to

review progressive design-build as a potential construction contract

method as it may provide efficiencies.

Demolition of Excess Infrastructure.—The bill includes

$160,000,000 for unspecified minor military construction for demolition across the active and reserve components. The Committee is

concerned about the amount of excess and obsolete infrastructure

found on installations. While the Committee understands the need

to balance demolition with other infrastructure needs, excess infrastructure can be costly to maintain and diverts resources away

from current requirements.

Child Development Centers (CDCs).—The bill includes

$75,000,000 for planning and design and $293,820,000 for construction of 7 CDC projects.

Infrastructure Needs to Support Alliance with the Philippines.—

The Committee notes the importance of the recently reinvigorated

alliance with the Philippines. To better understand the Department

of Defense’s needs to support the expanded alliance, the Committee

directs the Secretary of Defense to provide a report, not later than

180 days after the date of the enactment of this Act, summarizing

the plans for military construction and associated infrastructure

needs to maximize the effectiveness of an enhanced posture in and

alliance with the Philippines.

Laboratory Infrastructure.—The Committee is concerned that

aging laboratory infrastructure threatens the ability of Services to

maintain the advanced technology necessary to keep ahead of U.S.

adversaries across all domains. Accordingly, the Committee provides an additional $90,000,000 for planning and design for laboratory infrastructure projects. The Services are directed to provide a

spend plan not later than 90 days after enactment of this Act regarding the use of these funds.

Mass Timber.—The Committee is aware that the use of cross

laminated timber and other mass timber products as a building

material has the potential to reduce costs, limit environmental impact, and increase functionality of various military structures. The

Committee encourages the Department of Defense to continue exploring the application of these innovative technologies in future

planning and design for military construction projects.

Open Air Burn Pans.—The Committee remains concerned about

the burning of hazardous materials, including open air burn pans,

at installations located in the United States and looks forward to

receiving the report on the Department’s plans to address this

issue as required by House Report 117–391.

Resilient Military Installations.—The Committee supports the

Department’s continued efforts to build lasting and resilient military installations. These efforts include using methods that update

hurricane-resistant building codes for bases, barracks, hospitals,

and airfields and reviewing the effect of severe drought and

desertification and how these two hazards effect installations and


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missions. The Committee encourages the Department to continue

investing in innovative infrastructure projects to increase infrastructure resiliency and reduce costs.

Unspecified Minor Military Construction (UMMC).—The bill includes $414,192,000 for UMMC across the active and reserve components, which is $80,000,000 above the budget request. The Committee believes the UMMC authority is a helpful tool as the Services address their most critical infrastructure needs.

U.S. Indo-Pacific Command (USINDOPACOM).—The recommendation includes $69,000,000 for planning and design and

$62,000,000 for unspecified minor military construction for

USINDOPACOM.

MILITARY CONSTRUCTION, ARMY

Appropriation, fiscal year 2023 ......................................................... $1,553,825,000

Budget request, fiscal year 2024 ....................................................... 1,470,555,000

Committee recommendation, fiscal year 2024 ................................. 1,517,455,000

Change from enacted level ......................................................... ¥36,370,000

Change from budget request ...................................................... +46,900,000

The Committee recommends $1,517,455,000 for the Army in fiscal year 2024, of which $162,900,000 is for the following projects

in the following amounts:

State Location Project Amount

AL ...................... Anniston Army Depot ................. Access Control Point ............................................ $5,500,000

AL ...................... Anniston Army Depot ................. Component Rebuild Shop ..................................... 8,100,000

AL ...................... Anniston Army Depot ................. Vehicle Paint Shop ............................................... 2,900,000

FL ...................... Camp Bull Simons ..................... 7th Special Forces Group Child Development

Center.

17,000,000

HI ....................... Wheeler Army Airfield ................ Air Traffic Control Tower ...................................... 5,400,000

NC ..................... Fort Bragg .................................. Aircraft Maintenance Hangar ............................... 61,000,000

NC ..................... Fort Bragg .................................. Child Development Center ................................... 36,000,000

TX ...................... Fort Bliss ................................... Collective Training Barracks ................................ 7,200,000

TX ...................... Fort Hood ................................... Barracks (PN 100948) ......................................... 9,900,000

TX ...................... Fort Hood ................................... Barracks (PN 94937) ........................................... 9,900,000

Within the total for Military Construction, Army, the recommendation includes $345,775,000 for planning and design, which

is $48,900,000 above the budget request; and $86,280,000 for unspecified minor construction, which is $10,000,000 above the budget request.

Further detail of the Committee’s recommendation is provided in

the State table at the end of this report.

Army Barracks.—The Committee notes the importance of providing high-quality barracks on Army bases and recommends the

refurbishment of barracks that have fallen below the Army’s set

standards. The Committee believes that adequate housing is an important quality of life issue that impacts readiness.

Dugway Proving Ground.—The Committee notes the importance

of the chemical and biological testing and evaluation done at

Dugway Proving Ground (DPG) through its laboratories, ranges,

test grids, airfield, and other testing facilities. The Committee is

concerned about the condition of the facilities at DPG given that

several facilities, including all three chemical surety facilities, are

in poor to failing conditions, at or near their life expectancy.

The Committee hopes that the recent memorandum of agreement

between the Assistant Secretary of Defense for Nuclear, Biological,


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and Chemical Defense and the Department of the Army to transfer

certain institutional funding will ensure adequate facilities are

maintained at DPG.

To better understand this issue, the Committee directs the Secretary of the Army and the Assistant Secretary of Defense for Nuclear, Chemical, and Biological Defense Programs to provide a report to the congressional defense committees, not later than 180

days after the date of the enactment of this Act, on the facility conditions and requirements at DPG. The report shall include the following: (1) an outline of military construction (MILCON) funding

responsibilities for mission-critical facilities at DPG; (2) a list of

high-priority MILCON projects at DPG; (3) an assessment of facilities needed at DPG to meet current and future requirements; (4)

the Department’s plan to address facilities at DPG that are in poor

to failing condition.

Fort Bragg Roadway Infrastructure.—The Committee is concerned about the roadway infrastructure at Fort Bragg, especially

the 47 miles that were originally constructed to serve troop training functions but are now being used by servicemembers, their

families, and civilians for commuting purposes. The Committee is

aware that the North Carolina Department of Transportation

(NCDOT) has offered to assume maintenance of the 47 miles of

roadway infrastructure at Fort Bragg under a proposed intergovernmental support agreement, which may help the Army mitigate

risks associated with the inadequate road infrastructure. Accordingly, the Committee directs the Secretary of the Army to provide

a report to the Committee, not later than 120 days after the date

of the enactment of this Act, that details the following: (1) the

Army’s plan to bring the 47 miles of roadway infrastructure at Fort

Bragg up to NCDOT’s minimum standards; (2) the cost for such

roadway repairs; (3) a timeline for performing such roadway repairs; and (4) an estimate of the savings by the Army if it no longer

needs to perform annual maintenance on the relevant roadway infrastructure at Fort Bragg.

Recapitalization of Army Infrastructure in Hawaii.—The Committee is concerned about the condition of Army infrastructure in

Hawaii. In a November 2022 Congressional Budget Office (CBO)

report titled, ‘‘The Army’s Costs to Eliminate Its Deferred Maintenance Backlog and to Renovate and Modernize Its Buildings’’ the

CBO notes that the deferred maintenance costs for U.S. Army Garrison Hawaii are approximately $1.4 billion and its modernization

costs are approximately $2.6 billion. To better understand the

Army’s efforts to address this problem, the Committee directs the

Assistant Secretary of the Army for Installations, Energy, and Environment to provide a report on the following: (1) the Army’s plan

for addressing its maintenance backlog; (2) the military construction projects in the future years defense program for U.S. Army

Garrison Hawaii related to the backlog; and (3) how the Army intends to ensure efforts to address the backlog do not interfere with

planned investments under the Hawaii Infrastructure Readiness

Initiative. The report shall be provided to the Committees on Appropriations of both Houses of Congress not later than 180 days

after the date of the enactment of this Act.

Tobyhanna Army Depot.—The Committee views Tobyhanna

Army Depot as an advantageous location for the build-out of physVerDate Sep 11 2014 06:57 May 18, 2023 Jkt 051240 PO 00000 Frm 00008 Fmt 6659 Sfmt 6602 E:\HR\OC\A240.XXX PFRM68

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ical space for future Army Materiel Command (AMC) manufacturing of microelectronics, including semi conductors. As such, the

Committee requests that the Army keep the Committee informed

of AMC construction needs at Tobyhanna Army Depot.

MILITARY CONSTRUCTION, NAVY AND MARINE CORPS

Appropriation, fiscal year 2023 ......................................................... $4,345,320,000

Budget request fiscal year 2024 ........................................................ 6,022,187,000

Committee recommendation, fiscal year 2024 ................................. 4,567,961,000

Change from enacted level ......................................................... +222,641,000

Change from budget request ...................................................... ¥1,454,226,000

The Committee recommends $4,567,961,000 for the Navy and

Marine Corps in fiscal year 2024, of which $52,683,000 is for the

following projects in the following amounts:

State Location Project Amount

CA ...................... Marine Corps Base Camp Pendleton.Fire/Emergency Response Station (53 Area) Replacement.$2,683,000

FL ...................... Naval Air Station Whiting Field Advanced Helicopter Training System Hangar .... 50,000,000

Within the total for Military Construction, Navy and Marine

Corps, the recommendation includes $602,625,000 for planning and

design, which is $2,683,000 above the budget request; and

$44,430,000 for unspecified minor construction, which is

$10,000,000 above the budget request.

Further detail of the Committee’s recommendation is provided in

the State table at the end of this report.

Joint Base Pearl Harbor-Hickam (JBPHH) Infrastructure Investments.—The Committee is concerned about the condition of the infrastructure at JBPHH, especially given recent issues with water

and wastewater infrastructure that may have deferred infrastructure improvements in other critical areas. The Committee directs

the Assistant Secretary of the Navy for Installations, Energy, and

Environment to provide a report, no later than 180 days after enactment of this Act, on the condition of JBPHH’s infrastructure.

The report shall include, at a minimum, the following: (1) the plan

for addressing failed or failing infrastructure; (2) a list of critical

infrastructure projects that must be addressed to meet operational

plan requirements; and (3) how the Navy plans on meeting current

operational plan requirements while addressing the construction

backlog.

Naval Aviation Training Enterprise.—The Committee notes the

importance of the Naval Aviation Training Enterprise and encourages the Navy to prioritize infrastructure projects within the coastal Naval Aviation Training Enterprise, especially those that build,

remodel, and restore unaccompanied and family housing, child and

youth development centers, and quality of life projects for

servicemembers and their families.

Public Shipyard Construction Planning for Crisis and Conflict.—

The Committee is concerned about the Navy’s ability to fulfill its

battle damage requirements using the current shipyard infrastructure and urges the Navy to assess how to best utilize the Shipyard

Infrastructure Optimization Program to better prepare the public

shipyards for conflict and to provide additional resources to develop

the Wartime Acquisition and Sustainment Support Plan, which will

require infrastructure investments.


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Shipyard Infrastructure Optimization Program (SIOP).—The

Committee supports efforts to modernize and improve facilities at

the Navy’s four public shipyards to equip them to address the

maintenance needs of the Navy’s current and future active fleet

and emphasizes the important role military construction must play

in achieving this goal.

Additionally, the Committee expects the Navy to keep it informed of additional flexibilities or authorizations necessary to successfully coordinate with tribal governments for expeditious completion of SIOP. The Committee recognizes the importance of these

critical dry dock construction projects and the importance of relationships with tribal governments.

The management and oversight of SIOP is key to the program’s

success. As such, the Committee directs the Government Accountability Office to submit a report or reports, as necessary, not later

than 180 days after the date of the enactment of this Act, on options for improving the management and oversight of SIOP. The report shall include, at a minimum, the following: (1) staffing and

contracting options for ensuring the adequate oversight of contracted activities; (2) support provided to the public shipyards and

local shipyard construction agents; (3) best practices for the management of large multi-contractor projects; and (4) how the Navy’s

policies and procedures for large facility improvements greater

than $500,000,000 compare to those of other Federal agencies.

MILITARY CONSTRUCTION, AIR FORCE

Appropriation, fiscal year 2023 ......................................................... $2,614,996,000

Budget request, fiscal year 2024 ....................................................... 2,605,314,000

Committee recommendation, fiscal year 2024 ................................. 2,439,614,000

Change from enacted level ......................................................... ¥175,382,000

Change from budget request ...................................................... ¥165,700,000

The Committee recommends $2,439,614,000 for the Air Force in

fiscal year 2024, of which $30,300,000 is for the following projects

in the following amounts:

State Location Project Amount

FL ...................... Eglin Air Force Base .................. LRSO Hardware Software Development & Test

Facility

$14,600,000

OH ..................... Wright-Patterson Air Force Base Acquisition Management Complex ....................... 9,900,000

OK ...................... Tinker Air Force Base ................ F–35 Aircraft Oxygen Shop .................................. 5,800,000

Within the total for Military Construction, Air Force, the recommendation includes $450,614,000 for planning and design, which

is $15,700,000 above the budget request; and $74,900,000 for unspecified minor construction, which is $10,000,000 above the budget request.

Further detail of the Committee’s recommendation is provided in

the State table at the end of this report.

Air Education and Training Command Facilities (AETC).—The

Committee recognizes the importance of adequate facilities for

basic military training, flying training, and the other training missions of AETC and believes that outdated and inadequate AETC facilities, including dormitories, harm the Air Force’s ability to recruit, train, and retain Airmen and increase operation and maintenance costs. The Committee urges the Air Force to prioritize funding for AETC facility design, construction, and refurbishment.


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Air Traffic Control Towers.—The Committee is concerned that

some air traffic control towers along the Gulf Coast have fire safety

concerns, lack proper heating and air conditioning, and are vulnerable to tropical storms and hurricanes. As such, the Committee directs the Air Force ensure its air traffic control towers are properly

maintained and upgraded, or replaced as necessary, to meet mission requirements.

Data link infrastructure.—The Committee is aware of the importance of data link capabilities to national security and encourages

the Air Force to ensure it has the adequate infrastructure to support its data link requirements.

Ground Based Strategic Deterrent (GBSD) Infrastructure.—The

Committee is encouraged by the Air Force’s future years defense

program expectations for military construction related to the

GBSD. The Committee requests that the Air Force continue engaging with Congress on its infrastructure needs related to the GBSD.

Hardened Infrastructure in the Pacific.—The Committee notes

the importance of air power in the Pacific and the infrastructure

required to support, maintain, and protect those requirements. The

Committee encourages the Air Force to ensure U.S. and allied air

force facilities are appropriately hardened to deter aggression and

defend U.S. interests.

MILITARY CONSTRUCTION, DEFENSE-WIDE

Appropriation, fiscal year 2023 ......................................................... $2,626,078,000

Budget request, fiscal year 2024 ....................................................... 2,984,682,000

Committee recommendation, fiscal year 2024 ................................. 2,665,047,000

Change from enacted level ......................................................... +38,969,000

Change from budget request ...................................................... ¥319,635,000

The Committee recommends $2,665,047,000 for Military Construction, Defense-Wide, in fiscal year 2024, including $308,045,000

for planning and design, which is $45,000,000 above the budget request; and $58,618,000 for unspecified minor construction, which is

$20,365,000 above the budget request.

Further detail of the Committee’s recommendation is provided in

the State table at the end of this report.

Defense Health Agency (DHA) Hawaii Market Facilities Master

Plan.—The Committee notes the importance of the Tripler Army

Medical Center and is concerned about infrastructure challenges as

DHA works to restructure and realign military medical facilities.

The Hawaii Market Facilities Master Plan Study is expected to

evaluate options to recapitalize the Tripler Army Medical Center.

The Committee looks forward to the DHA submitting this study in

a timely manner.

Energy Resilience and Conservation Investment Program

(ERCIP).— The Committee provides $548,000,000 for ERCIP construction, which is the same as the budget request; and

$111,250,000 for ERCIP design, which is $25,000,000 above the

budget request.

The Committee supports the Department’s efforts to improve energy resilience, contribute to mission assurance, save energy, and

reduce energy costs through ERCIP. The Committee encourages

the Department to continue using all available tools and authorities to ensure the timely execution of ERCIP projects. Additionally,

as the Department works to achieve base energy independence, the


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Committee encourages the Department to leverage new energy

technologies.

Military Construction at Cold Weather Installations.—The Committee recognizes that certain installations have unique challenges

due to extreme cold temperatures and significant snowfall during

the fall and winter months. The Committee believes that the unspecified minor military construction authority can help with these

challenges by ensuring there are adequate facilities to house and

protect property and equipment at these installations. The Committee encourages the military services to ensure the proper facilities and structure are in place to protect property and equipment

at cold weather installations, such as Fort Drum.

MILITARY CONSTRUCTION, ARMY NATIONAL GUARD

Appropriation, fiscal year 2023 ......................................................... $459,018,000

Budget request, fiscal year 2024 ....................................................... 340,186,000

Committee recommendation, fiscal year 2024 ................................. 369,261,000

Change from enacted level ......................................................... ¥89,757,000

Change from budget request ...................................................... +29,075,000

The Committee recommends $369,261,000 for the Army National

Guard in fiscal year 2024, of which $19,075,000 is for the following

projects in the following amounts:

State Location Project Amount

FL ...................... Camp Blanding .......................... Automated Multipurpose Machine Gun Range .... $11,000,000

FL ...................... Camp Blanding .......................... Training Aids Center ............................................ 1,200,000

FL ...................... Camp Blanding .......................... Infantry Squad Battle Course .............................. 840,000

OK ...................... Shawnee ..................................... National Guard Readiness Center ....................... 1,800,000

PA ...................... Fort Indiantown Gap .................. Automated Multipurpose Machine Gun Range .... 1,550,000

TX ...................... Fort Hood ................................... General Purpose Instruction Building .................. 2,685,000

Within the total for Military Construction, Army National Guard,

the recommendation includes $42,361,000 for planning and design,

which is $8,075,000 above the budget request; and $73,000,000 for

unspecified minor construction, which is $10,000,000 above the

budget request.

Further detail of the Committee’s recommendation is provided in

the State table at the end of this report.

MILITARY CONSTRUCTION, AIR NATIONAL GUARD

Appropriation, fiscal year 2023 ......................................................... $279,353,000

Budget request, fiscal year 2024 ....................................................... 178,722,000

Committee recommendation, fiscal year 2024 ................................. 189,322,000

Change from enacted level ......................................................... ¥90,031,000

Change from budget request ...................................................... +10,600,000

The Committee recommends $189,322,000 for the Air National

Guard in fiscal year 2024, of which $600,000 is for the following

project in the following amount:

State Location Project Amount

FL ...................... Jacksonville International Airport F–35 Munitions Storage Area Admin ................... $600,000

Within the total for Military Construction, Air National Guard,

the recommendation includes $36,200,000 for planning and design,

which is $600,000 above the budget request; and $73,122,000 for


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unspecified minor construction, which is $10,000,000 above the

budget request.

Further detail of the Committee’s recommendation is provided in

the State table at the end of this report.

Air National Guard Infrastructure.—The Committee recognizes

that some Aviation Support Facilities are not configured to protect

and maintain modern airframes and encourages the Air National

Guard to upgrade these facilities using unspecified minor military

construction funds, as appropriate, to ensure current facilities are

upgraded to adequately support current airframes.

MILITARY CONSTRUCTION, ARMY RESERVE

Appropriation, fiscal year 2023 ......................................................... $193,878,000

Budget request, fiscal year 2024 ....................................................... 107,076,000

Committee recommendation, fiscal year 2024 ................................. 117,076,000

Change from enacted level ......................................................... ¥76,802,000

Change from budget request ...................................................... +10,000,000

The Committee recommends $117,076,000 for the Army Reserve

in fiscal year 2024, including $23,389,000 for planning and design,

which is the same as the budget request; and $24,687,000 for unspecified minor construction, which is $10,000,000 above the budget request.

Further detail of the Committee’s recommendation is provided in

the State table at the end of this report.

MILITARY CONSTRUCTION, NAVY RESERVE

Appropriation, fiscal year 2023 ......................................................... $36,837,000

Budget request, fiscal year 2024 ....................................................... 51,291,000

Committee recommendation, fiscal year 2024 ................................. 61,291,000

Change from enacted level ......................................................... +24,454,000

Change from budget request ...................................................... +10,000,000

The Committee recommends $61,291,000 for the Navy Reserve in

fiscal year 2024, including $6,495,000 for planning and design,

which is the same as the budget request; and $17,847,000 for unspecified minor construction, which is $10,000,000 above the budget request.

Further detail of the Committee’s recommendation is provided in

the State table at the end of this report.

MILITARY CONSTRUCTION, AIR FORCE RESERVE

Appropriation, fiscal year 2023 ......................................................... $85,423,000

Budget request, fiscal year 2024 ....................................................... 291,572,000

Committee recommendation, fiscal year 2024 ................................. 179,572,000

Change from enacted level ......................................................... +94,149,000

Change from budget request ...................................................... ¥112,000,000

The Committee recommends $179,572,000 for the Air Force Reserve in fiscal year 2024, of which $29,000,000 is for the following

projects in the following amounts:

State Location Project Amount

GA ...................... Dobbins Air Reserve Base ......... Security Forces Facility ........................................ $22,000,000

LA ...................... Barksdale Air Force Base .......... 307 Bomb Wing Medical Facility Expansion ....... 7,000,000

Within the total for Military Construction, Air Force Reserve, the

recommendation includes $12,146,000 for planning and design,


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which is the same as the budget request; and $19,926,000 for unspecified minor construction, which is $10,000,000 above the budget request.

Further detail of the Committee’s recommendation is provided in

the State table at the end of this report.

NORTH ATLANTIC TREATY ORGANIZATION SECURITY INVESTMENT

PROGRAM

Appropriation, fiscal year 2023 ......................................................... $220,139,000

Budget request, fiscal year 2024 ....................................................... 293,434,000

Committee recommendation, fiscal year 2024 ................................. 293,434,000

Change from enacted level ......................................................... +73,295,000

Change from budget request ...................................................... – – –

The North Atlantic Treaty Organization Security Investment

Program (NSIP) consists of annual contributions by North Atlantic

Treaty Organization (NATO) member countries to finance the costs

of construction needed to support the roles of the major NATO commands.

As requested, the bill provides additional funding above the fiscal

year 2023 enacted level to support efforts to deter Russian aggression against NATO allies and partners.

DEPARTMENT OF DEFENSE BASE CLOSURE ACCOUNT

Appropriation, fiscal year 2023 ......................................................... $574,687,000

Budget request, fiscal year 2024 ....................................................... 389,174,000

Committee recommendation, fiscal year 2024 ................................. 539,174,000

Change from enacted level ......................................................... ¥35,513,000

Change from budget request ...................................................... +150,000,000

The Committee recommends $539,174,000 for the Base Closure

account, which is $150,000,000 above the budget request.

The Committee supports the Navy’s efforts towards the demolition and removal of non-historically designated buildings and structures under Navy control where the sampling or remediation of

radiologically contaminated materials have been the subject of substantiated allegations of fraud.

FAMILY HOUSING OVERVIEW

Appropriation, fiscal year 2023 ......................................................... $1,986,330,000

Budget request, fiscal year 2024 ....................................................... 1,940,751,000

Committee recommendation, fiscal year 2024 ................................. 1,940,751,000

Change from enacted level ......................................................... ¥45,579,000

Change from budget request ...................................................... – – –

Family housing construction accounts provide funds for new construction, construction improvements, the Federal government’s

costs for family housing privatization projects, and planning and

design. The operation and maintenance accounts provide funds to

pay for maintenance and repair, furnishings, management, services, utilities, leasing, interest, mortgage insurance, and miscellaneous expenses.

Homeownership Education.—The Committee encourages the

Services to work with privatized housing partners to develop and

provide basic homeownership education programs for

servicemembers and their families. The Committee believes that

the Army’s recent counter-mold operation, a holistic, global effort

to reduce the risk of hazardous mold in Army facilities and housVerDate Sep 11 2014 06:57 May 18, 2023 Jkt 051240 PO 00000 Frm 00014 Fmt 6659 Sfmt 6602 E:\HR\OC\A240.XXX PFRM68

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ing, is a step in the right direction and commends these efforts to

inform and educate Soldiers and their families about mold conditions, mitigation, and reporting.

Indoor Air Quality.—The Committee remains concerned about reports of unhealthy living conditions, including potentially dangerous indoor air quality, and looks forward to receiving the report

requested in House Report 117–39 on how the Department will

work with Military Housing Privatization Initiative partners to

monitor and enhance indoor air quality in privatized housing.

Kwajalein Atoll.—The Committee commends the Army’s revitalization of family housing on U.S. Army Garrison Kwajalein Atoll

and believes these updates improve the quality of life for

servicemembers and their families as well as increase force readiness.

Military Housing Privatization Initiative (MHPI).—The Committee is pleased that the Department and Services have improved

their oversight of privatized housing and have held MHPI partners

accountable. Unfortunately, the Committee continues to hear reports of poor housing conditions, slow response times, and indifference towards the wellbeing of servicemembers and their families.

As such, there is more to be done, and the Committee looks forward to reviewing the report required by Division J of Public Law

117–328.

Pacific Northwest Military Housing Enhancements.—The Committee recognizes the need to address the shortage of affordable

and suitable military family housing units in the Pacific Northwest

and the effect this shortage has on military readiness and the quality of life of servicemembers and their families. The Committee

supports efforts to address this shortfall.

FAMILY HOUSING CONSTRUCTION, ARMY

Appropriation, fiscal year 2023 ......................................................... $169,339,000

Budget request, fiscal year 2024 ....................................................... 304,895,000

Committee recommendation, fiscal year 2024 ................................. 304,895,000

Change from enacted level ......................................................... +135,556,000

Change from budget request ...................................................... – – –

FAMILY HOUSING OPERATION AND MAINTENANCE, ARMY

Appropriation, fiscal year 2023 ......................................................... $446,411,000

Budget request, fiscal year 2024 ....................................................... 385,485,000

Committee recommendation, fiscal year 2024 ................................. 385,485,000

Change from enacted level ......................................................... ¥60,926,000

Change from budget request ...................................................... – – –

FAMILY HOUSING CONSTRUCTION, NAVY AND MARINE CORPS

Appropriation, fiscal year 2023 ......................................................... $337,297,000

Budget request, fiscal year 2024 ....................................................... 277,142,000

Committee recommendation, fiscal year 2024 ................................. 277,142,000

Change from enacted level ......................................................... ¥60,155,000

Change from budget request ...................................................... – – –


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FAMILY HOUSING OPERATION AND MAINTENANCE, NAVY AND

MARINE CORPS

Appropriation, fiscal year 2023 ......................................................... $378,224,000

Budget request, fiscal year 2024 ....................................................... 363,854,000

Committee recommendation, fiscal year 2024 ................................. 363,854,000

Change from enacted level ......................................................... ¥14,370,000

Change from budget request ...................................................... – – –

FAMILY HOUSING CONSTRUCTION, AIR FORCE

Appropriation, fiscal year 2023 ......................................................... $232,788,000

Budget request, fiscal year 2024 ....................................................... 237,097,000

Committee recommendation, fiscal year 2024 ................................. 237,097,000

Change from enacted level ......................................................... +4,309,000

Change from budget request ...................................................... – – –

FAMILY HOUSING OPERATION AND MAINTENANCE, AIR FORCE

Appropriation, fiscal year 2023 ......................................................... $365,222,000

Budget request, fiscal year 2024 ....................................................... 314,386,000

Committee recommendation, fiscal year 2024 ................................. 314,386,000

Change from enacted level ......................................................... ¥50,836,000

Change from budget request ...................................................... – – –

FAMILY HOUSING OPERATION AND MAINTENANCE, DEFENSE-WIDE

Appropriation, fiscal year 2023 ......................................................... $50,113,000

Budget request, fiscal year 2024 ....................................................... 50,785,000

Committee recommendation, fiscal year 2024 ................................. 50,785,000

Change from enacted level ......................................................... +672,000

Change from budget request ...................................................... – – –

DEPARTMENT OF DEFENSE FAMILY HOUSING IMPROVEMENT FUND

Appropriation, fiscal year 2023 ......................................................... $6,442,000

Budget request, fiscal year 2024 ....................................................... 6,611,000

Committee recommendation, fiscal year 2024 ................................. 6,611,000

Change from enacted level ......................................................... +169,000

Change from budget request ...................................................... – – –

DEPARTMENT OF DEFENSE MILITARY UNACCOMPANIED HOUSING

IMPROVEMENT FUND

Appropriation, fiscal year 2023 ......................................................... $494,000

Budget request, fiscal year 2024 ....................................................... 496,000

Committee recommendation, fiscal year 2024 ................................. 496,000

Change from enacted level ......................................................... +2,000

Change from budget request ...................................................... – – –

ADMINISTRATIVE PROVISIONS

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.


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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 bordering the Arabian Gulf, 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 associated supervision, inspection,

overhead, engineering and design on those projects and on subsequent claims.

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 unit annually without notification.


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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 allowing the transfer of funds in accordance with reprogramming guidelines.

The bill includes section 123 prohibiting the use of funds for

projects at Arlington National Cemetery.

The bill includes section 124 providing funds for certain projects

identified in the respective military department’s unfunded priority

list for fiscal year 2024.

The bill includes section 125 directing all amounts appropriated

to Military Construction (all accounts) be immediately available

and allotted for the full scope of the authorized project.

The bill includes section 126 extending the eligibility of unobligated funding for fiscal year 2017, 2018, and 2019 projects that

have not lapsed.

The bill includes section 127 defining the congressional defense

committees.

The bill includes section 128 providing additional funds for planning and design for construction improvements to laboratory facilities.

The bill includes section 129 providing additional funds for the

Air Force for expenses incurred as a result of natural disasters.

The bill includes section 130 providing funds for planning and

design for child development centers.

The bill includes section 131 providing funds for planning and

design for barracks.

The bill includes section 132 providing funds for unspecified

minor construction for demolition.

The bill includes section 133 providing funds for cost to complete

projects identified in the respective military department’s unfunded

priority list for fiscal year 2024.

The bill includes section 134 providing funds for planning and

design associated with the Shipyard Infrastructure Optimization

Program.

The bill includes section 135 prohibiting funds from being used

to carry out the closure or realignment of Naval Station Guantanamo Bay.

TITLE II

DEPARTMENT OF VETERANS AFFAIRS

Appropriation, fiscal year 2023 1 ..................................................... $303,282,598,000

Budget request, fiscal year 2024 1 ................................................... 319,763,645,000

Committee recommendation, fiscal year 2024 1 ............................. 319,763,645,000

Change from enacted level ....................................................... +16,481,047,000

Change from budget request .................................................... – – –

Fiscal year 2025 advance budget request ....................................... 327,085,076,000

Fiscal year 2025 Committee recommendation in the bill ............. 327,085,076,000

Change from budget request .................................................... – – –

1 All funding cited excludes amounts in the Medical Care Collections Fund.


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The Department of Veterans Affairs (VA) provides health care for

9,000,000 veteran enrollees; disability compensation benefits to an

estimated 6,094,440 veterans and 562,448 survivors; pension benefits for an estimated 136,678 veterans and 112,179 survivors; life

insurance for more than 5,600,000 veterans, servicemembers and

their families; educational assistance for nearly 820,000 students;

and interment of more than 140,000 veterans and eligible family

members in national cemeteries. To serve adequately the nation’s

veterans, VA employs more than 450,000 staff, making it one of the

largest Federal agencies in terms of employment.

Advertising Contracts for Small Business.—The Committee understands that, as the largest advertiser in the United States, the

Federal government should work to ensure fair access to its advertising contracts for small, disadvantaged businesses and businesses

owned by minorities and women. The Committee directs the Department to include the following information in its fiscal year

2025 budget justification: Expenditures for fiscal year 2023 and expected expenditures for fiscal year 2025, respectively, for (1) all

contracts for advertising services; and (2) contracts for the advertising services of (I) socially and economically disadvantaged small

businesses concerns (as defined in section 8(a)(4) of the Small Business Act (15 U.S.C. 637(a)(4)); and (II) women-and minority-owned

businesses.

Customer Service Standards and Performance Plan.—The Committee continues to support efforts to improve customer service in

accordance with Executive Order 13571, Streamlining Service Delivery and Improving Customer Service, and encourages the Secretary to continuously improve customer service standards and incorporate them into the performance plan required by section 1115

of title 31, United States Code. The Committee requests that the

Department confirm its compliance with 31 U.S.C. 1115 within 30

days of enactment of the Act.

Former Members of Guard and Reserve Components.—The Committee notes that since 2020 the National Veteran Suicide Prevention Annual Reports have not included information regarding

former members of the Guard and Reserve Components who were

not activated for military service. The Committee encourages the

Department to continue to collaborate with the Department of Defense to monitor and to ensure appropriate measures are available

to reduce suicide in this population.

Protecting Immigrant Veterans.—The Committee supports VA’s

role in the Immigrant Military Members and Veterans Initiative

and urges VA to take steps to ensure non-citizen veterans are

aware of their options to naturalize as U.S. citizens and provide administrative guidance and assistance with relevant applications

and paperwork. The Department is encouraged to continue to coordinate with the Department of Homeland Security to develop

methods that allow the Department to maintain contact with immigrant and non-citizen veterans and ensure that they can access immigration related assistance and other VA assistance and benefits

to which they are entitled by law.

Service-Disabled Veteran Owned Small Business Program.—The

Committee understands that Congress created the Service-Disabled

Veteran Owned Small Business (SDVOSB) program to honor the

service of veterans who incurred disabilities on active service and


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to leverage their unique skill sets and perspectives for the public

benefit. However, SDVOSB contract awards and obligations often

fall short of targets, and SDVOSBs remain an underutilized agency

partner. The Committee urges VA to prioritize meeting SDVOB

targets utilizing available acquisition tools including best-in-class

acquisition solutions, including for new and emerging information

technology requirements.

Sexual Harassment and Sexual Assault Protections for VA Beneficiaries and Employees.—Eliminating sexual harassment and assault at VA is critical to creating a safe and welcoming environment for veterans, their families, caregivers, and survivors, as well

as VA employees. The Committee notes that VA has published a

handbook with comprehensive policy guidance and instructions addressing harassment and sexual assault and directs VA to ensure

that these policies are fully communicated and complied with. The

Committee appreciates the Department’s efforts to better address

harassment and sexual assault and requests an updated report annually on its approach.

Veterans First Contracting Program.—The Committee encourages

VA to continue to expand and standardize the training of contracting officers in the requirements of the Veterans First Contracting Program, with particular attention being paid to conducting the market research necessary to ensure service-disabled

veteran and veterans-owned small businesses, including women

and minority veteran-led small businesses, are awarded VA contracts when appropriate.

Veterans Records.—The Committee is aware some veterans are

receiving records through the U.S. Postal Service instead of electronically, as requested. This is contrary to the 21st Century Cares

Act, unnecessarily increases costs, and causes delays. The Committee directs the Department to ensure employees are aware of

this requirement and not to send requested documents through the

U.S. Postal Service unless the veteran has no other means available to receive the records.

Veterans in the Pacific.—The Committee acknowledges and appreciates the service of Pacific island veterans and recognizes the

challenges they have in securing the benefits they have earned. As

such, the Committee directs the Department to (1) expand and improve the delivery and services of the Foreign Medical Program; (2)

expand the availability of preventative and wellness programs, suicide prevention, military sexual trauma, and women’s health to

veterans in the Pacific islands; (3) fully utilize telehealth in the region; (4) expand the capabilities, including staffing, of the Guam

and/or Manila regional offices to allow quarterly visits to the territories and Freely Associated States; (5) develop training programs

so that local veterans can become advocates for other veterans; (6)

develop methods to securely provide payments to veterans and providers, using U.S. embassy resources, as appropriate; (7) allow for

the prescribing and mailing, through the U.S. Postal Service, of

medications by U.S. providers to veterans in the territories and

Freely Associated States, consistent with Federal law; (8) seek to

train local healthcare providers in the unique needs of veterans; (9)

allow healthcare providers in the territories and Freely Associated

States to directly bill for services provided; (10) ensure beneficiary

travel reimbursement rates are commensurate with travel costs in


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the region; and (11) ensure veterans in the territories, Freely Associated States, other locales, and nations are noted in expenditure

reporting, such as in the appendix to the Federal Budget. The

Committee requests a report within 60 days of enactment of this

Act regarding the status of these efforts. The report should include

a detailed description of the Department’s efforts, identify barriers

to implementation, and provide legislative and funding recommendations. The Committee continues to support the Center for

Native Hawaiians, Pacific Islanders, and U.S. Affiliated Pacific Islanders.

VETERANS BENEFITS ADMINISTRATION

COMPENSATION AND PENSIONS

(INCLUDING TRANSFER OF FUNDS)

Fiscal year 2023 enacted level ......................................................... $152,016,542,000

Fiscal year 2024 enacted level ......................................................... 146,778,136,000

Fiscal year 2024 budget year request ............................................. 4,655,879,000

Committee 2024 budget year recommendation .............................. 4,655,879,000

Fiscal year 2025 advance appropriation request ........................... 181,390,281,000

Committee 2025 advance appropriation recommendation ............ 181,390,281,000

Comparison with:

Fiscal year 2024 enacted level ................................................. +34,612,145,0000

Fiscal year 2025 advance budget request ............................... – – –

This appropriation provides funds for service-connected compensation payments to an estimated 6,094,446 veterans and

562,448 survivors in fiscal year 2024. In addition, pension payments will be funded for an estimated 150,678 veterans and

112,179 survivors. The average payment per compensation case for

veterans in fiscal year 2024 is estimated to be $24,307 and pension

payments are projected to be $14,063.

The appropriation includes authority to transfer funding not to

exceed $22,109,000 in fiscal year 2024 to General Operating Expenses, Veterans Benefits Administration (VBA) and Information

Technology Systems. These funds are for the administrative expenses of implementing cost-saving provisions required by the Omnibus Budget Reconciliation Act of 1990 (P.L. 101–508), the Veterans’ Benefits Act of 1992 (P.L. 102–568), and the Veterans’ Benefits Improvements Act of 1994 (P.L. 103–446). 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.

The Committee recommendation includes $4,655,879,000 in additional funding for fiscal year 2024 for a total of $151,434,015,000

for the fiscal year, which includes the advance appropriation provided in the prior fiscal year. For fiscal year 2025, the Committee

recommendation includes an advance appropriation of

$181,390,281,000.

Disability Claims and Appeals.—Due to the significant investments Congress has provided in recent years, VA has been able to

hire staff, acquire technology, and modify work processes necessary

to significantly reduce the disability claims backlog. The Committee encourages VA to continue its effort to reduce the claims

backlog to pre-pandemic levels and work expeditiously to resolve

the oldest and most emergent claims.


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READJUSTMENT BENEFITS

Fiscal year 2023 enacted level ........................................................... $8,906,851,000

Fiscal year 2024 enacted level ........................................................... 8,452,500,000

Fiscal year 2024 budget year request ............................................... – – –

Committee 2024 budget year recommendation ................................ – – –

Fiscal year 2025 advance appropriation request ............................. 11,523,134,000

Committee 2025 advance appropriation recommendation .............. 11,523,134,000

Comparison with:

Fiscal year 2025 enacted level ................................................... +3,070,634,000

Fiscal year 202 advance 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. 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.

The Committee recommendation includes an advance appropriation of $11,523,134,000 for fiscal year 2025.

GI Bill Comparison Tool.—The Committee emphasizes the importance of providing veterans with the necessary information to

make informed decisions when selecting institutions of higher education. The Committee urges the Department to continue to monitor and assess the effectiveness of the GI comparison tool, including usage metrics, the frequency that caution flags are checked and

updated, and technical performance.

Skills and Certifications.—The Committee recognizes the importance of expanding job opportunities for veterans after their discharge and encourages VA to work with other Federal agencies and

State licensing bureaus, as appropriate, to evaluate the transferability of DoD skills and certifications, including mechanical skills

and certifications, to state certifications to aid in transition to civilian employment.

Technology for Student Veterans.—During the pandemic, remote

learning technologies, such as computers and routers for internet

access, were widely used so students could continue their studies.

Within 180 days of enactment of this Act, the Department is directed to submit a report on the cost, feasibility, and advisability

of ensuring student veterans have access to the technologies needed to be successful in school.

Transition Coordination.—The Committee encourages VA, in

consultation with the Departments of Defense and Labor, to coordinate efforts and resources to ensure veterans have a successful

transition to civilian life. This includes sharing information on community resources, including nonprofits and Veterans Service Organizations, that are available to veterans and their families. The

Committee also urges VA to explore options for veterans to access

hands-on job placement services that connect them directly with

employers, including those offered through successful state and

local programs.

VET TEC Pilot Program.—The Committee expects the Department to fund the program, consistent with current law, at

$45,000,000 for fiscal year 2024, and encourages it to take steps to


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expand access by including additional providers, particularly in

areas of the country where the initiative is not currently available

or only allowing access to online courses, as well as to help train

and employ women veterans and veterans with disabilities.

Veteran Transitional Assistance Grant Program (VTAG).—The

Committee continues to support VTAG and includes an additional

$5,000,000 above the fiscal year 2023 level, as requested.

VETERANS INSURANCE AND INDEMNITIES

Fiscal year 2023 enacted level ........................................................... $109,865,000

Fiscal year 2024 enacted level ........................................................... 121,126,000

Fiscal year 2024 budget year request ............................................... 12,701,000

Committee 2024 budget year recommendation ................................ 12,701,000

Fiscal year 2025 advance appropriation request ............................. 135,119,000

Committee 2025 advance appropriation recommendation .............. 135,119,000

Comparison with:

Fiscal year 2024 enacted level ................................................... +13,993,000

Fiscal year 2025 advance 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

applicable to certain World War II veterans; servicemember’s indemnities, applicable to Korean Conflict veterans; and veterans

mortgage life insurance, applicable to individuals who have received a grant for specially adapted housing.

The Committee recommendation includes an additional

$12,701,000 for fiscal year 2024 for a total of $133,828,000 for the

fiscal year. This includes the advance appropriation provided in the

prior fiscal year. For fiscal year 2025, the Committee recommendation includes an advance appropriation of $135,119,000.

VETERANS HOUSING BENEFIT PROGRAM FUND PROGRAM ACCOUNT

Program Account

Limitation on direct

loans for specially

adapted housing

loans

Administrative

Expenses

Appropriation, fiscal year 2023 .................................................... – – – ($500,000) $282,361,131

Budget request est., fiscal year 2024 ......................................... – – – (500,000) 316,742,419

Committee recommendation, fiscal year 2024 ............................ – – – (500,000) 316,742,419

Change from enacted level ................................................. – – – – – – +34,381,288

Change from 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 Committee recommendation includes $316,742,419 for fiscal

year 2024 for administrative expenses to carry out the Veterans

Housing Loan Program.

Home Loan Income Verification.—The Committee understands

that as directed by House Report 116–63, VA has clarified that

nothing in VA statutes or regulations specifically prohibits a veteran whose income is derived from state-legalized cannabis activities from obtaining a certificate of eligibility for VA home loan benefits. The Committee understands that VA is working to improve


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communication with eligible lending institutions to reduce confusion among lenders and borrowers on this matter.

VOCATIONAL REHABILITATION LOANS PROGRAM ACCOUNT

Program Account Limitation on

direct loans

Administrative

Expenses

Appropriation, fiscal year 2023 .................................................... $7,171 ($942,330) $445,698

Budget request, fiscal year 2024 ................................................. 78,337 (2,026,000) 460,698

Committee recommendation, fiscal year 2024 ............................ 78,337 (2,206,000) 460,698

Change from enacted level ................................................. +71,116 (+1,083,670) +15,000

Change from 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 $1,300 (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.

The Committee recommendation includes $460,698 for fiscal year

2024 for administrative expenses to carry out the Vocational Rehabilitation Direct Loan program. It is estimated that the Department will make 1,559 loans in fiscal year 2024.

NATIVE AMERICAN VETERAN HOUSING LOAN PROGRAM ACCOUNT

Administrative expenses:

Appropriation, fiscal year 2023 ......................................................... $1,400,000

Budget request, fiscal year 2024 ....................................................... 2,718,546

Committee recommendation, fiscal year 2024 ................................. 2,718,546

Change from enacted level ......................................................... +1,318,645

Change from budget request ...................................................... – – –

The Native American Veteran Housing Loan Program, as authorized by title 38 United States Code, chapter 37, subchapter V, provides the Secretary 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. These loans are available to purchase, construct, or improve

homes to be occupied as veterans’ residences.

The Committee recommendation includes $2,718,546 for fiscal

year 2024 for administrative expenses for the Native American

Veteran Housing Loan Program.

GENERAL OPERATING EXPENSES, VETERANS BENEFITS

ADMINISTRATION

Appropriation, fiscal year 2023 ......................................................... $3,863,000,000

Budget request, fiscal year 2024 ....................................................... 3,899,000,000

Committee recommendation, fiscal year 2024 ................................. 3,899,000,000

Change from enacted level ......................................................... +36,000,000

Change from budget request ...................................................... – – –

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 Committee recommendation includes $3,899,000,000 for fiscal year 2024 for General Operating Expenses, VBA. These resources will fully fund VA’s request for fiscal year 2024 and imVerDate Sep 11 2014 06:57 May 18, 2023 Jkt 051240 PO 00000 Frm 00024 Fmt 6659 Sfmt 6602 E:\HR\OC\A240.XXX PFRM68

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prove VBA’s ability to address compensation and benefit claims.

The bill makes available through September 30, 2025, up to ten

percent of these funds.

Benefits Usage.—The Committee encourages VA to include veteran benefit usage into its annual suicide prevention report, including usage of disability compensation, education and employment,

home loan and foreclosure assistance benefits, as well as participation in housing and food security programs. Additional data may

enable a better understanding of the correlation between benefit

use and suicide and allow for more effective programs to assist veterans.

Compensation and Pension (C&P) Claims.—The Committee continues to be concerned about reports of delays that veterans experience in the resolution of pending C&P claims. The Committee encourages the Department to work diligently to reduce the backlog

of compensation and benefit claims to pre-pandemic levels to lessen

the burden of excessive wait times.

Compensation and Pension Exams.—The Committee is aware

that the majority of veterans filing claims for disabilities incurred

or aggravated by Military Sexual Trauma (MST) are referred to a

third-party contract provider for the required C&P exam, and that

veterans filing MST-related claims may have unique needs and

safety concerns. The Committee requests a report, not later than

90 days after enactment of this Act, describing information related

to the required, specialized training for contracted and VA examiners. The report should include claim outcome data, by congressional district as practicable, for veterans referred to a third-party

provider as compared to those evaluated by a VA provider. The

Committee directs VA to allow veterans filing an MST-related

claim to request a VA provider for the required C&P exam.

Digitizing Veteran Records.—The Committee commends the efforts of VBA, in partnership with the National Archives and

Records Administration, to address the backlog of veterans’ records

requests by creating digital copies of records that currently exist

only in hardcopy form at the National Personnel Records Center

(NPRC). The Committee strongly encourages VBA to continue its

efforts to create digital copies of veterans’ records housed at NPRC.

Equitable Relief.—The Committee understands VA is working to

implement new systems and protocols to eliminate instances of administrative error. However, as VA enacts system-wide reforms,

ending equitable relief for veterans who were deemed eligible for

benefits in error would place an unfair burden on veterans and

their families. The Secretary is directed to continue to grant or extend equitable relief to eligible veterans initially deemed eligible in

instances of administrative error. Not later than April 1, 2024, the

Secretary is directed to submit to the Committee a report containing a statement as to the disposition of each case recommended

to the Secretary for equitable relief under section 503 of title 38,

United States Code during the preceding calendar year.

Filipino Veterans.—There are approximately 1,721 living WWII

Filipino Veterans. The Committee directs the Department to provide a report within 180 days of the enactment of this Act describing an outreach plan and required budget to extend the time limit

for accepting initial and revised applications for a sufficient period


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of time to ensures all eligible, living WWII Filipino Veterans can

apply for and receive the benefits they are entitled to.

Hearing Loss Prevention.—Hearing loss and auditory injuries account for one of the most prevalent service-connected disabilities

for veterans receiving compensation benefits. The Committee encourages the Department to work with the Department of Defense

to identify options, strategies, and technologies to reduce the incidence of hearing loss by military personnel through exposure to excessive auditory pressure impulses during weapons training.

Information for Toxic-Exposed Veterans.—The Committee encourages VA to ensure resources and materials provided by VA to toxicexposed veterans be made available in the most commonly spoken

languages in the United States, as required by the Veterans and

Family Information Act (P.L. 117–62).

Military Sexual Trauma.—The Committee continues to direct VA

to prioritize specialized MST training for claims processors and involve MST survivors in the development of specialized training.

The Committee additionally remains concerned that veterans

suffering from a mental health disorder because of sexual trauma

during service have different standards of evidence based on their

diagnosis. The Committee recognizes that evidence in personnel

files is rare, no matter the resulting condition following MST. As

such, the Committee urges VA to support the extension of the relaxed evidentiary standard to all those suffering from mental

health disorders as a result of MST. The Committee also urges VA

to continue to report on information relating to claims for disabilities incurred or aggravated by MST, as provided by section 113 of

the Jeff Miller and Richard Blumenthal Veterans Health Care and

Benefits Improvement Act of 2016 (P.L. 114–315).

Toxic Exposure Claims.—The Committee recognizes that an increase in claims and associated workload increases is expected as

a result of enactment of the Honoring our Promise to Address Comprehensive Toxics Act (PACT Act) and encourages the Department

to implement thorough and special training protocols to ensure accuracy and efficiency in the claims adjudication process.

VETERANS HEALTH ADMINISTRATION

The Department operates the largest integrated medical care delivery system in the United States, providing care at nearly 1,300

health care facilities, including 171 medical centers and more than

1,100 outpatient sites, to more than 9,000,000 veterans enrolled in

the VA healthcare program.

Funding for veterans’ health care, VA research, and the Veterans

Health Administration is provided through five discretionary accounts and the mandatory Cost of War Toxic Exposure Fund. The

discretionary accounts are Medical Services, Medical Community

Care, Medical Support and Compliance, Medical Facilities, and

Medical and Prosthetic Research.

For fiscal year 2024, the President’s Budget requested a total of

$138,127,303,000 for veterans’ medical care, including funding for

medical care for the treatment of conditions related to toxic exposures. Of this total, $121,011,303,000 was requested as discretionary funding and $17,116,000 was requested as mandatory. The

bill provides $138,127,303,000, equal to the request. However, the

Committee does not support the proposed shift of funding from the


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discretionary accounts to the mandatory Toxic Exposure Fund. Instead, the Committee recommends $135,737,303,000 in discretionary funding and $2,390,000,000 in mandatory funding for these

purposes.

The Committee notes that the President’s Budget for fiscal year

2024 for veterans’ medical care is below the $128,104,000,000 requested and appropriated in advance for fiscal year 2024 as part

of the fiscal year 2023 bill. Included in the revised fiscal year 2024

request are several rescissions and transfers that lower the discretionary funding already appropriated for veterans’ medical care in

an attempt to shift discretionary funding to the mandatory side of

the budget. These proposed recissions and transfers are not included in the Committee’s recommendation for fiscal year 2024 and

are inconsistent with the Committee’s intention for the fiscal year

2023 enacted bill, as expressed in the accompanying explanatory

statement, as well as the Honoring our PACT Act of 2022 (P.L.

117–168).

In fiscal year 2024, VA will collect an estimated $3,991,000,000

in the Medical Care Collections Fund.

The Committee provides $938,000,000 for Medical and Prosthetic

Research for fiscal year 2024, equal to the requested level.

The Committee provides $134,036,542,000, the total amount requested, in advance for fiscal year 2025 but does not provide any

advanced funding for the Toxic Exposure Fund.

Ambulance Services.—The Committee recognizes the critical

value of Special Modes of Transportation but is concerned the

change in rates that VA pays may jeopardize access to ambulance

services. The Committee directs VA to expeditiously contract with

providers of special modes of transportation at fair and appropriate

reimbursement rates to provide certainty about payments and ensure the availability of ambulance services.

Beneficiary Travel.—The Committee continues to hear from veterans frustrated with the system and the inability of VA staff to

assist them. The Department is directed to ensure the new system

is user-friendly and staff are trained and available to provide the

required assistance.

Dispute Resolution.—The Committee urges VA to ensure that

veterans are advised of their rights to contest VA billing charges

and determinations and of the step-by-step process for disputes. VA

should ensure this information is available online and in publicly

accessible areas at each VA medical center, and that it is made

available in English, Spanish, and the eight other most commonly

spoken languages in the United States per current laws (P.L. 117–

62).

Essential Medical Products.—The Committee urges the Department to prioritize purchasing decisions that support domestic-based

manufacturing for critical healthcare products, such as those that

supply medical supplies like needles and syringes, and supports efforts to protect national security and vulnerable domestic supply

chains for critical industries, including medical supplies. The Committee requests the Department provide a report, no later than 90

days after the enactment of this Act, on efforts to strengthen VA’s

medical supply chain with domestically produced products. Specifically, the Department should report on any cross-agency efforts it

is involved in to support the domestic supply of essential medical


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products and steps taken to expand VA’s use of domestically produced essential medical products.

Vet Centers.—The Committee directs VA to ensure that Vet Centers have data on eligible veterans in their service areas so that

they can tailor their outreach activities and veterans are aware of

available services.

Veterans Enrollment in Medicare.—The Committee is aware that

information gaps exist for some veterans related to the differences

between the hospital care and medical services available in the VA

system versus coverage provided under Medicare. The Committee

encourages VA to work with the Department of Health and Human

Services to ensure that veterans have complete information regarding the differences between the VA system and Medicare coverage,

including for prescription drugs.

VHA Phone Operations.—The Committee encourages VA to improve its phone operations to ensure communications between

major regional VA Medical Centers and community based outpatient clinics (CBOC) route veterans’ calls to their local CBOC, as

appropriate.

MEDICAL SERVICES

Fiscal year 2023 enacted level ........................................................... $70,584,116,000

Fiscal year 2024 enacted level ........................................................... 74,004,000,000

Fiscal year 2024 budget year request ............................................... ¥4,933,113,000

Committee 2024 budget year recommendation ................................ 2,277,955,000

Fiscal year 2025 advance appropriation request ............................. 71,000,000,000

Committee 2025 advance appropriation recommendation .............. 78,231,685,000

Comparison with:

Fiscal year 2024 enacted level ................................................... +4,227,955,000

Fiscal year 2025 advanced budget request ............................... +7,231,685,000

The bill includes an additional $2,277,955,000 for Medical Services in fiscal year 2024 and $78,231,000,000 for advance fiscal year

2025 funding. The Committee has included bill language to make

$2,000,000,000 of the Medical Services advance appropriation for

fiscal year 2025 available through September 30, 2026. The Committee does not include the proposed rescission of funds.

Allocation of Health Funding.—The Committee continues to request a report each year, no later than 30 days after VA allocates

the medical services appropriation to the VISNs, that identifies: (1)

the amount of general purpose funding that is allocated to each

VISN; (2) the amount of funding that is retained by central headquarters for specific purposes, with amounts identified for each

purpose; and (3) the amount of funding that is retained by each

VISN before allocating it to the medical centers, identifying separately the amounts retained for purposes such as network operations, network initiatives, and emergencies.

Changes in Funding Requirements Due to Modeling.—The Committee expects VA to continue to include in the sufficiency letter required by section 117(d) of title 38, United States Code, which is

due to the Congress on July 31 of each year, a description of any

changes exceeding $250,000,000 in funding requirements for the

Medical Services account resulting from the spring recalculation of

the Enrollee Healthcare Projection Model.


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CANCER AND RARE DISEASES

Cancer Screening at Veterans Affairs Medical Centers.—The Department is encouraged to ensure its healthcare providers screen

for the numerous types of cancers that veterans experience so they

can receive the best possible care.

Creutzfeldt-Jakob Disease (CJD) Monitoring.—The Committee

continues to urge VA to utilize reference data from existing medical

records of veterans to determine the percentage of veterans who

have more frequent or unexplained symptoms associated with CJD

compared to the civilian population. This data could be helpful in

clarifying the extent and specifics of the medical issues suffered by

veterans because of CJD.

Dermatological Care for Veterans.—The Committee is concerned

about increased risk of skin cancers among veterans and directs

VA to provide a report, no later than 180 days after enactment of

the Act, on veterans’ access to dermatology screening, dermatologic

preventative care, and trained Mohs micrographic surgeons.

Lung Precision Oncology Program.—The Committee notes with

approval the launch of the VA’s Lung Precision Oncology Program

and its effort to expand access to lung cancer screening for veterans and accelerate the science on lung cancer prevention, detection, and treatment. The Committee provides $14,000,000 for this

program, as requested.

Molecular Diagnostics and Precision Oncology.—The Committee

recommendation includes $215,433,000 for Precision Oncology, an

increase of $48,206,000 above the fiscal year 2023 enacted level; as

well as $30,300,000 for Molecular Diagnostics, as requested, to accelerate the adoption of molecular diagnostics for additional cancers, including rare cancers and hematopoietic cancers.

VA is encouraged to continue to provide information to clinicians

on the value of using molecular diagnostics for cancer patients and

on how to contribute tissue specimens to a repository started

among the Department, Department of Defense, and the National

Institute of Health. The Committee requests an update, no later

than 60 days after the enactment of this Act, describing how these

funds will be used to enhance the use of molecular diagnostics, including information on the use of specific types of molecular

diagnostics, such as microarray, whole exome, whole genome, and

RNA Seq.

CAREGIVER SUPPORT PROGRAM

Caregivers Program.—The Committee provides $2,422,410,000,

as requested, for the caregivers program. The Committee continues

to require quarterly reporting on obligations for this program.

CENTERS OF EXCELLENCE

Epilepsy Center of Excellence.—The Committee encourages the

Department to ensure that all veterans with epilepsy are comprehensively evaluated at a VHA Epilepsy Center of Excellence to

identify drug-resistant epilepsy patients who may be candidates for

FDA-approved non-drug therapies.

Neurology Centers of Excellence.—The Committee recognizes the

increasing number of veterans affected by neurologic conditions, including epilepsy, headache, multiple sclerosis, and Parkinson’s disVerDate Sep 11 2014 06:57 May 18, 2023 Jkt 051240 PO 00000 Frm 00029 Fmt 6659 Sfmt 6602 E:\HR\OC\A240.XXX PFRM68

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ease. The Neurology Centers of Excellence provide essential innovative clinical care, education, and research efforts focused on these

conditions. The Committee encourages further investment and collaboration of the Centers across disciplines and includes the requested $59,540,000 for Neurology Centers of Excellence. This includes $23,590,000 for epilepsy; $21,000,000 for headache;

$10,330,000 for Parkinson’s; and $4,620,000 for multiple sclerosis.

COLLABORATIONS AND PARTNERSHIPS

Academic Collaborations at Community Based Outpatient Clinics

(CBOC).—The Committee encourages VA to expand academic collaborations with CBOCs, as they provide valuable patient care and

access to services that can be strengthened by collaboration with

educational institutions. Through clinical traineeships and research

fellowships, emerging health professionals can gain a better understanding of veterans’ specific healthcare needs, improve patient

outcomes, advance specialized research, and increase the talented

workforce pipeline. VA is encouraged to consider including public

academic medical centers in CBOC collaborations.

Partnerships.—The Committee commends the efforts of private

organizations to support veterans and recognizes that they can

sometimes provide services, such as counseling and wellness programs, for the families of veterans that the Department cannot.

Recognizing that Congress, the Department, and private organizations share the same goal of supporting veterans, the Committee

directs the Department to build upon its existing partnerships and

seek opportunities to establish new ones and provides up to

$5,000,000 for this purpose. The Committee is specifically interested in partnerships focused on providing mental health care, including the mental health of veterans’ families, and requests a report on the Department’s current partnership activities within 90

days of enactment of this Act. The report should identify types of

partnerships and their best practices and the opportunities, barriers, and cost of expanding them. It also should include an analysis of potential and innovative options to simplify the process for

veterans seeking mental health care, such as through modifications

to referral requirements, technologies to ease scheduling, and the

use of telemedicine.

Strategic Collaboration.—The Committee encourages the Department to engage with potential partners, including through lease

agreements, to modernize and provide increased access to veterans

services, especially in areas with many veterans where VA cannot

meet demand.

DENTAL CARE

Dental Care.—The recommendation includes $2,573,291,000, as

requested, to provide dental care for veterans. The Committee requests that the fiscal year 2025 budget justification include information on the role, resources, and staffing required for the Assistant Under Secretary of Health for Dentistry and the Office of Dentistry.

Dental Care Report.—The Committee requests a report within

180 days of enactment of this Act assessing the state of the Department’s oral healthcare program and its ability to adequately meet

the needs of current and future veterans. The report should include


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an assessment of the Department’s infrastructure dedicated to dental health.

DIABETES CARE

Diabetic Foot Ulcers.—The Committee continues to be concerned

about diabetic foot and related limb loss among veterans. Based

upon the September 2022 report entitled ‘‘Report to Congress on

Remote Patient Diabetes Foot Ulcer Monitoring,’’ which details disparate outcomes due to disparate training provided to VA clinicians, within 30 days of enactment of the Act, the Committee requests the Department provide a report detailing its plan for ensuring that all VA employees utilizing remote temperature monitoring are receiving the training necessary to ensure optimal outcomes.

EMERGING AND NOTABLE HEALTHCARE ISSUES

Air Filtration Equipment and Technologies.—The Committee appreciates the Department’s review of its air filtration standards;

encourages it to exceed industry standards on single-pass air and

levels of air filtration; and urges it to continue to research, evaluate, and implement new technologies, including commercial off-theshelf technologies.

Central Line Associated Blood Stream Infections (CLABSIs).—

The Committee is aware of the reported 31 percent increase in

(CLABSI) rates in acute care facilities during the coronavirus pandemic. The Department is urged to enhance and sustain conventional infection prevention and control strategies to reduce this significant increase in CLASBIs and any other hospital-associated infections. The Committee requests the fiscal year 2025 budget request include a detailed plan that describes the steps accomplished

and planned to reduce the rate of CLASBIs and other hospital-associated infections.

Dialysis.—Understanding that some dialysis services are provided through community providers under nation-wide contracts

when the care cannot be provided directly, the Committee expects

the Department to ensure veterans receive the highest quality care

and access to care and looks forward to receiving the report requested in P.L. 117–328.

Marriage and Family Therapists.—The Committee urges VA to

improve access to marriage and family therapists and to ensure

that there are no unnecessary barriers to increasing the Department’s capacity to serve veterans seeking this care.

Needle Stick Injuries (NSI).—The Committee requests a report

within 90 days of enactment of this Act regarding options to reduce

or eliminate (NSIs) among clinicians, including the use of electronic

digital needle destruction technology, as well as potential time and

cost savings associated with the options.

Nuclear Medicine Quality Improvements.—The Committee notes

the Nuclear Regulatory Commission’s (NRC) commencement of a

rulemaking to require reporting of some nuclear medicine

extravasations and acknowledges that significant nuclear medicine

extravasations can cause patient injury. The Committee requests a

report, not later than 180 days after enactment of this Act, regarding VA implementation of new NRC regulatory requirements, inVerDate Sep 11 2014 06:57 May 18, 2023 Jkt 051240 PO 00000 Frm 00031 Fmt 6659 Sfmt 6602 E:\HR\OC\A240.XXX PFRM68

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cluding any requirements related to the monitoring of injection

quality, image extravasations, dosimetry, and patient notification.

Pressure Injuries.—The Committee supports the development

and use of an evidence-based standard of care for pressure injury

prevention and encourages VA to update recommendations and

guidelines to ensure they are consistent with current evidence from

a variety of relevant sources.

Produce Prescription Program.—The Committee is concerned

with food insecurity among the veteran population and provides up

to $2,000,000 for the Office of Nutrition & Food Services to work

with clinicians to create and test delivery and coverage work

streams to facilitate integration, such as produce prescription service delivery. Within one year of enactment of this Act, the Department is directed to provide a report on this effort to include metrics

that can be used to measure value, including appropriate health

outcomes, and the feasibility and advisability of expanding produce

prescriptions to all veterans.

Rideshare Program.—The Committee recognizes the success of

VA’s temporary rideshare authority and is interested in expanding

transportation services for veterans. As such, the Committee requests a report not later than 120 days after enactment of this Act

assessing the feasibility of establishing a national VA Rideshare

Program. The report should include the following: (1) an analysis

of the impact of the VA Rideshare Program on eligible veterans

from August 2021 to April 2023; (2) an assessment of the availability and cost of transportation required to support stability and

health of eligible veterans, which includes transportation to appointments with service providers, conducting housing and employment searches, and obtaining food and supplies; (3) any plan of the

Secretary to expand the ability for veteran homelessness programs

to assist with transportation needs of eligible veterans; (4) an assessment of the feasibility of establishing a national VA Rideshare

Program; (5) a determination of the direct or indirect costs to the

Department that would arise from the establishment of such a program; and (6) any other element the Secretary determines appropriate.

Stellate Ganglion Block Therapy.—The Committee encourages

the Department to make stellate ganglion block therapy available

as a first-line treatment at VA medical facilities, as appropriate.

Use of Autonomous Robots.—The Committee encourages VA to

consider the use of autonomous robots during the planning for new

construction or modernization of VA hospitals and requests VA report to the Committee not later than 180 days after the enactment

of this Act on the use of robots at VA hospitals, including current

use and potential benefits from expanded use in the future.

Veterans Transportation.—The Committee supports the Department’s programs that provide veterans with transportation to VA

medical facilities and make it easier for veterans to receive medical

care and encourages VA to explore options to strengthen and sustain the Volunteer Transportation Network, such as increased

funding to recruit and retain drivers and provide vehicle maintenance.


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HEALTHCARE TECHNOLOGIES

Bioelectronic Medicine for Veterans.—The Committee recognizes

that Bioelectronic Medicine has the potential to harness the body’s

electrical signaling to advance treatments that save lives and lower

medical expenditures. Accelerating studies, additional data collection, and the development and adoption of novel applications for

Bioelectronic Medicine combined with machine learning and artificial intelligence (AI) can address challenging and expensive diseases by personalizing treatments and improving therapy delivery.

The Committee encourages the Department to ensure that combined Bioelectronic Medicine and AI technologies are available to

veterans.

Early Detection Diagnostics.—The Committee encourages VA to

consider all options to better incorporate available early detection

diagnostics into veterans’ care. The Committee looks forward to the

report required by House Report 117–391 on how it is incorporating early detection diagnostics into veterans’ care and areas

for potential improvement.

Focused Ultrasound Therapy.—The Committee understands focused ultrasound is a non-invasive, non-pharmacological, safe, and

cost-effective alternative or complement to conventional surgery,

radiation therapy, or drug-based treatments and encourages the

Department to ensure it is available to veterans to the extent practicable.

Medical Image Exchange.—The Committee supports the use of

modern medical image exchange software and notes that most VA

facilities have deployed a modern software solution that supports

bi-directional exchange of diagnostic quality medical images between VA facilities and with community providers, without requiring secondary storage of veterans’ images. The Committee encourages the Department to ensure software solutions like this are

available in the new Electronic Health Record system and the VA

Enterprise Cloud.

Migraine Prevention and Treatment.—The Committee recognizes

approximately one in three servicemembers experience severe

headaches and migraines and encourages the Department to ensure neuromodulation devices with FDA-indication for migraine

prevention and treatment are available to veterans and to educate

clinicians and veterans on such devices.

Respiratory Illness.—The Committee is aware of emerging technology that uses existing x-ray imaging equipment to derive fourdimensional models of lung function, which helps to identify respiratory illnesses and accompanying loss of lung function earlier

than was previously feasible. The Committee requests a report, no

later than 180 days after enactment of this Act, on the potential

efficacy of using a four-dimensional functional lung scan to triage

veterans with unexplained shortness of breath following deployment.

HOMELESS ASSISTANCE PROGRAMS

The Committee provides $3,111,148,000 for VA homeless assistance programs, an increase of $240,589,000 above the fiscal year

2023 enacted level and equal to the budget request. An estimated


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$9,522,772,000 is provided for homeless veterans treatment costs,

an increase of $173,873,000 above the fiscal year 2023 level.

Programs to assist homeless veterans include the Homeless Providers Grant and Per Diem (GPD), Health Care for Homeless Veterans (HCHV), the Domiciliary Care for Homeless Veterans, the

Supportive Services for Low Income Veterans and Families (SSVF),

Veterans Justice Outreach Homeless Prevention (VJO), Compensated Work Therapy, and the Department of Housing and

Urban Development-Department of Veterans Affairs Supported

Housing (HUD–VASH) programs.

Healthcare for Homeless Veterans.—The Committee notes the

benefits of the Homeless Patient Aligned Care Team (HPACT) program and encourages VA to expand this program to additional

sites, including rural areas, and to consider additional services to

improve the program. The Committee directs the Department to

explore options to expand this program to additional sites, including cost estimates, with its fiscal year 2025 budget request.

Homeless Veterans in the Southwest.—The Committee continues

to direct VA to work with HUD to develop strategies and recommendations for addressing veteran homelessness in the Southwest and to take into account undercounted veterans when awarding HUD–VASH vouchers. The Committee appreciates VA’s efforts

to implement strategies to decrease veteran homelessness in the

Southwest and requests an updated report within 60 days of enactment of this Act on its efforts.

HUD–VASH.—The Committee recognizes the value and positive

effects of HUD–VASH program. Due to the joint nature of HUD–

VASH funding, the Committee recommends that VA’s budget for

case managers be increased commensurate with any increases in

HUD’s budget for new vouchers and to account for increased costs

in staffing and recent expansions in eligibility.

Legal Assistance for Veterans.—The Committee continues to support the Veterans Justice Outreach and the Legal Services for Veterans programs and provides $109,721,000 for these programs, as

requested.

Recovery-Oriented Care.—The Committee notes the National

Center for Homelessness Among Veterans’ development of housing

models that promote recovery-oriented care for veterans experiencing or at risk of homelessness. The Committee requests that not

later than 180 days after enactment of this Act the Department

provide a report on the effectiveness of recovery-oriented care housing programs, including a review of the barriers that homeless veterans face when attempting to secure permanent housing.

Supportive Housing for Veterans with Serious Mental Illness.—

The Committee encourages VA to build upon the tangible achievements of the HUD–VASH program and explore whether a new

model of vouchers could provide housing opportunities for low-income veterans experiencing serious mental illness who seek

healthcare services from VA.

Supportive Services for Veterans Families and Inflation.—To

meet the rising costs of goods and help veterans achieve financial

stability and access to services, the Committee requests a report on

cost, feasibility, and advisability of increasing the cap on Tenant

Incentives and allowance for car repairs, as well as expanding the

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pense. In addition, the Department is encouraged to ensure it has

a consistent and understandable policy regarding covered costs for

pet deposits/rent, utility deposits, car repairs, and childcare.

Supportive Services for Veteran Families and Legal Services.—

The Committee continues to encourage the SSVF program to work

with grantees to expand their legal service offerings, particularly in

rural areas where access to private legal assistance can be limited.

The Department is encouraged to partner SSVF grantees with university law schools in rural areas or within underserved populations to enhance legal assistance to veterans.

Tiny Homes.—The Committee notes the success of the tiny home

village model by multiple veterans service organizations (VSOs)

and encourages VA, in coordination with the Department of Housing and Urban Development to support this work and facilitate the

creation of additional villages of tiny homes villages within VA’s

existing GPD program. Not later than one year after the date of

the enactment of this Act, the Committee requests a report comparing the outcomes of grantees under current GPD programs to

the outcomes of existing VSO operated tiny homes villages that

contain individual homes and a community center with supportive

services. This report should compare: (1) the amount of time a veteran stayed in a tiny home village compared to a similar GPD facility; (2) the percentage of veterans who exit a tiny home village

compared to a similar GPD facility; (3) the percentage of veterans

who exit the tiny homes village with competitive employment compared to a similar GPD facility; (4) the percentage of veterans who

have a negative exit from the tiny homes village compared to a

similar GPD facility; and (5) other matters, as appropriate.

INTIMATE PARTNER VIOLENCE ASSISTANCE PROGRAM

Intimate Partner Violence (IPV) Program.—The Committee continues to support VA’s efforts to expand its IPV program, which

provides a holistic approach that involves understanding, recognizing and responding to the effects of all types of trauma, with the

ultimate goals to end violence, prevent further violence, and promote healthy relationships.

MENTAL HEALTH PROGRAMS

The Committee provides $16,587,825,000 for mental health programs. Of the total, $3,552,888,000 is for suicide prevention and

treatment programs, including $558,794,000 for suicide prevention

outreach, of which $300,500,000 is for the Veterans Crisis Line.

The Committee continues to direct the Department to focus on

efforts to address parking lot suicides and connect veterans to care.

The Department is directed to provide a report to the Committee,

no later than 90 days after enactment of this Act, identifying a detailed expenditure plan for all suicide outreach and treatment programs and how VA is meeting the Committee’s directives.

AANHPI Veterans.—The Committee understands that Asian

American, Native Hawaiian, and Pacific Islander (AANHPI) veterans have a lower use of VA and non-VA mental health services

and requests a report Committee not later 180 days after enactment of this Act on a plan to improve access of AANHPI veterans

to mental health care and increase outreach, especially for those in


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harder-to-reach populations, including rural communities and

English-as-a-second-language households.

Agritherapy.—The Committee supports efforts to train veterans

in agricultural vocations, while also tending to behavioral and mental health needs with behavioral healthcare services and treatments from licensed providers. The Department is urged to consider including agritherapy as a Complementary and Alternative

Medicine therapy.

Cognitive Behavioral Therapy Virtual Care.—To meet the growing demand for telehealth or virtual mental healthcare, the Committee encourages VA to provide veterans access to virtual cognitive behavioral therapy. The Committee directs VA to provide a

report, not later than 90 days after enactment of this Act, on the

status of efforts to utilize solutions and partners in the delivery of

mental health services virtually and how to make these solutions

more accessible to patients.

Improving Depression Treatment with Precision Medicine.—The

Committee recognizes that depression is one of the most common

conditions associated with military service and combat exposure.

VA is encouraged to ensure access to pharmacogenomic tests in the

treatment of depression if the tests have been shown to improve

health outcomes of veterans in clinical trials.

Law Enforcement Liaison.—The Committee appreciates VA’s

past efforts to educate the law enforcement community regarding

the unique issues facing veterans, especially those returning from

combat operations. Such education is invaluable in cases where

veterans are determined to be an immediate threat to themselves

or others. In such instances, it is imperative that the veteran’s

needs be addressed in an expeditious, humane, and respectful manner.

Mental Health Screening at Veterans Affairs Medical Centers.—

The Department is encouraged to ensure its healthcare providers

screen for the numerous types of mental health issues that veterans experience so they can receive the best possible care.

Military Sexual Assault.—The Committee recommends that all

veterans seeking treatment services are screened for sexual assault

using an evidence-based screening tool in order to successfully

treat those who have experienced assault.

Modeling and Simulation Treatment of PTSD.—The Committee

is aware that 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 Trauma Management Therapy study and

provide a report within 90 days of enactment of this Act regarding

the results of the study.

Non-Citizen Veteran Outreach.—The Committee is concerned

about the level of awareness regarding mental health services

among at-risk, non-citizen veterans. The Committee urges VA to

conduct outreach targeting this group of veterans to offer mental

health and other early intervention services, drug and alcohol services, and mental health counseling.

Veterans Crisis Line (VCL).—The Committee provides funding to

support the VCL, as requested, and continues to monitor the VCL

to ensure veterans are receiving appropriate clinical care. To support this critical care, the Committee encourages VA to utilize


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funds provided by the bill to ensure appropriate staffing for call

centers and back-up centers, provide necessary training for VCL

staff, and ensure that staff are able to appropriately and effectively

respond to the needs of veterans. The Committee maintains bill

language requiring the VCL to: (1) provide to individuals who contact the hotline immediate assistance from a trained professional;

and (2) to adhere to all requirements of the American Association

of Suicidology.

MILITARY TOXIC EXPOSURE RESEARCH PROGRAM

The bill includes $68,012,000, as requested, for research on military environmental exposures. The Committee supports efforts to

improve diagnosis and treatment of conditions resulting from toxic

exposures and appreciates the work of the Health Outcomes Military Exposures (HOME) program, the Office of Research and Development, and other VA program offices to increase attention to

this issue.

The Committee encourages the Department to continue research

on the effects of and treatments for veterans exposed to toxins,

such as Agent Orange, open burn pits, PFAS, radiation, and asbestos, during the course of their active-duty service. The Committee

also urges the Department to utilize reference data from existing

medical records to determine how veterans who served in areas

where toxins were dispersed may have more frequent or unexplained diseases compared to the civilian population.

Airborne Hazards and Burn Pits Center of Excellence.—The Committee provides $15,000,000 and continues to support the Airborne

Hazards and Burn Pits Center of Excellence on diagnoses, mitigation, and treatment of conditions related to airborne hazards and

burn pits.

PFAS Research.—The Committee is concerned about the effect of

PFAS at military bases on servicemembers, their families, and surrounding communities, and recognizes that the effects of PFAS exposure may continue for servicemembers once they are under the

care of VA. The Committee continues to direct VA to collaborate

with the Department of Defense PFAS Task Force, academia, and

other health institutions and agencies to monitor research activities, results, and publications on the health effects from PFAS.

Service-Connected Colorectal Cancer.—The Committee is aware

that colorectal cancer is a common cancer diagnosis among veterans and directs the Department to submit a report, no later than

180 days after enactment of the Act, on colorectal cancer among

veterans and the potential effect of exposures to burn pits and

other environmental hazards during military service on incidence

rates.

War Related Illness and Injury Study Center Expansion.—Research and clinical trials are needed to develop effective treatments

for veterans exposed to toxic environmental hazards, and the VA

Research Advisory Committee has recommended the establishment

of Centers of Excellence to facilitate the development and availability of new treatments in clinical settings. However, the effects

of toxic exposure may manifest differently between men and

women. The Committee is encouraged by the work of the War Related Illness and Injury Study Center (WRIISC)—Women’s Operational Military Exposure Network (WOMEN) to meet the unique


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needs of women veterans. However, with only one physical center

in California, the Committee is concerned that toxic-exposed

women veterans who live and seek care in other regions may not

have equal access to the Center’s unique resources. The Committee

directs the Department to report on the feasibility, including cost

estimates, of establishing a new WRIISC–WOMEN within 60 days

of enactment of this Act.

OPIOID PREVENTION AND TREATMENT PROGRAM

The bill includes $715,356,000 for opioid treatment and prevention efforts, which is $26,876,000 above the fiscal year 2023 enacted level. Of the total, $254,478,000 is provided for activities authorized by the Comprehensive Addiction and Recovery Act of 2016

(P.L. 114–198).

PHARMACEUTICAL ISSUES

Drug Pricing Report.—The Committee remains interested in information regarding VA drug pricing and appreciates VA providing

a report as requested in previous fiscal years on VA’s spending on

prescription drugs. The Committee encourages VA to conduct this

analysis annually and requests robust and routine updates to Congress, including updated information for fiscal year 2024 on prescription drug prices (net of rebates) paid by VA for the ten most

frequently prescribed drugs and the ten highest-cost drugs for VA.

In addition, the report should include total annual costs to VA for

all prescription drugs. As VA has noted that country of origin information on drugs and active pharmaceutical ingredients is not yet

available on a national level, the Committee urges the VA’s National Acquisition Center to work with the Food and Drug Administration to track this data and establish a national database for

such information.

Medication Optimization for Veterans.—The Committee commends VA’s work to implement a National Pharmacogenomics Program to ensure all eligible veterans have access to appropriate, evidenced-based pharmacogenomic testing, and that VA has a robust

and highly trained healthcare professional workforce to help veterans who have undergone pharmacogenomic testing. The Committee provides $35,616,000, as requested, for this work.

Pharmaceutical On-dose Tracking and Tracing Technologies.—

The Committee is committed to providing veterans safe and reliable medication. Track and trace systems are increasingly being

implemented as a technological solution to secure pharmaceutical

supply chains. These systems offer the potential to minimize reimbursement fraud, facilitate fast market recalls, and help identify

medicine shortages. The Committee looks forward to receiving the

report requested in House Report 117–391, especially regarding solutions to prevent counterfeit medicines from entering the VA supply chain.

Weight Loss and Weight Management Tools.—The Committee is

aware of growing interest in the use of FDA-approved pharmaceuticals that help veterans lose and manage weight, which can

help them prevent disease, manage chronic and co-morbid conditions, and improve their quality of life. The Committee encourages

the Department to review its clinical practice guidelines and other

criteria for use to ensure veterans have access to evidence-based


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weight management interventions and provide a report within 60

days of enactment of this Act regarding its current approach to

weight management and plans to review and update its clinical

practice guidelines.

POST-TRAUMATIC STRESS DISORDER CARE

Hyperbaric Oxygen Therapy.—The Committee encourages the Department to provide hyperbaric oxygen treatment to veterans suffering from chronic post-traumatic stress disorder, as appropriate.

National Center for Post-traumatic Stress Disorder.—Recognizing

the importance of VA’s National Center for PTSD in promoting better prevention, diagnoses and treatment of PTSD, the Committee

provides $42,000,000 for the Center, as requested.

New Treatments for PTSD.—The Committee is aware of privately

funded research regarding potential new treatments for PTSD and

encourages the Department to monitor these efforts and review the

results of existing and future clinical trials. The Committee requests a detailed report within 30 days of enactment of this Act regarding VA activities, including investigators and facilites, participating in this research and, within 120 days of enactment of this

Act, an assessment of any potential therapeutic value and potential

risk of new treatments.

Service Dogs for Veterans’ Mental Health.—The Committee recognizes the positive role that service, guide, and hearing dogs have

played in mitigating veterans’ disabilities and providing assistance

and rehabilitation. The Committee is encouraged that a pilot program created by the PAWS Act of 2021 is underway at VA medical

centers, which will assess the potential therapeutic effectiveness of

service dogs in the treatment of PTSD. The Committee encourages

VA to expand the number of pilot sites to include medical centers

that primarily serve veterans in rural areas and in states with few

VA medical facilities.

Women Veterans Network.—The Committee continues to support

the role of Women Veterans Network (WoVeN), a national peer

support network for women veterans managed by the National

Center for PTSD—Women’s Health Sciences Division, and provides

up to $3,000,000 for peer support programs for women veterans.

RURAL HEALTH

Office of Rural Health.—The bill includes $337,455,000 for rural

health, which is equal to the budget request, to improve access and

quality of care for the more than 3,000,000 enrolled veterans residing in rural and highly rural areas.

Office of Rural Health Operating Plan.—The Committee directs

the Office of Rural Health to submit no later than 30 days after

enactment of this Act an operating plan for fiscal year 2024 funding, as well as for the fiscal year 2025 funding provided in advance

by this Act.

Rural Access Network for Growth Enhancement (RANGE).—The

RANGE Program provides case management and treatment services to mentally ill veterans in rural areas. The bill includes sufficient funding to maintain the three new centers of the RANGE

Program, as authorized by the Sgt. Ketchum Rural Veterans Mental Health Act of 2021 (P.L. 117–21).


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Transportation Challenges.—The Committee recognizes the

transportation challenges and barriers to care that rural and remote veterans face and directs the Office of Rural Health to increase efforts to improve transportation mobility for veterans and

to allocate funding to enhance rural access and transportation services.

SUBSTANCE USE DISORDER CARE

The bill includes $230,947,000 for Substance-Use Disorder (SUD)

efforts to ensure veterans can receive timely SUD specialty services.

Jason Simcakoski Memorial and PROMISE Act Implementation.—The Committee supports the continued implementation of

the Jason Simcakoski Memorial and Promise Act, Title IX of the

Comprehensive Addiction and Recovery Act of 2016 (P.L. 114–198),

including updating therapy and pain management guidelines,

strengthening provider education and training, and improving patient advocacy.

Medication-Assisted Treatments.—The Committee encourages VA

to increase education among its primary care practitioners on the

diagnosis and treatment of alcohol use disorders with FDA-approved medication-assisted treatments and counseling, as clinically

indicated.

Substance Use Disorder Screening.—The Committee recommends

that all veterans seeking treatment services in a VA facility be

screened for SUD, using evidence-based assessment tools.

Substance Abuse Education and Outreach.—The Committee recognizes the importance of intervention and support programs for

at-risk veterans and their families that offer confidential education

information that can reduce substance use, relapse, hospital visits

and suicide, and continues to support internet-based substance

abuse education and outreach.

SUICIDE PREVENTION

Lethal Means Safety Collaboration.—The Committee notes that

VA has been called to partner with the Departments of Defense,

Health and Human Services, Homeland Security, Justice, and the

Office of Emergency Medical Services within the Department of

Transportation to create and implement a coordinated approach for

improving lethal means safety. The Committee looks forward to the

report required by House Report 117–391 on this coordinated approach and VA’s plans to incorporate the coordinated approach into

the Department’s existing lethal means safety initiatives.

Lethal Means Safety Training.—To ensure that every employee

who regularly interacts with veterans is prepared to have a conversation that could save a veteran’s life, the Committee continues

to urge VA to implement mandatory lethal means safety trainings

for all VA employees who regularly interact with veterans in their

work, compensation and pension examiners, employees of Veterans

Centers and vocational rehabilitation facilities, community care

providers, and family caregivers to the extent practicable.

Suicide Prevention Coordinators.—The Committee recognizes the

importance of Suicide Prevention Coordinators, who follow up with

and coordinate care for veterans who have been directly referred to


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them by responders at the Veterans Crisis Line, and directs VA to

fully staff suicide prevention coordinator positions.

Zero Suicide Initiative.—The Committee recognizes the value of

innovative, systems-focused efforts to combat veteran suicide across

the country and notes the use of the Zero Suicide model across various healthcare systems and through the Department of Health

and Human Services. The Committee directs VA to evaluate, in

consultation with experts and VSOs, the feasibility and advisability

of implementing a Zero Suicide initiative. Within 180 days of the

enactment of this Act, the Department is directed to submit a report, including recommendations for incorporating the Zero Suicide

model in VA suicide prevention programming.

TELEHEALTH AND CONNECTED CARE

The bill includes $5,165,336,000 for teleheath and connected

care, which includes home telehealth, home telehealth prosthetics,

and clinic-based telehealth.

The Committee directs VA to continue to expand telehealth

availability, including the facilitation of public private partnerships, to include additional mental health, primary care, and rehabilitation services as a means to deliver care in rural and underserved communities.

VA is encouraged to leverage newly gained telehealth capacity to

address backlogs for disability exams and healthcare appointments

when appropriate. The Committee further directs VA to continue to

implement plans to improve veteran and provider satisfaction, increase awareness of the telehealth program, and enhance adoption

of telehealth by veterans and providers.

WHOLE HEALTH

The Committee recommendation includes $107,848,000 for Whole

Health, as requested, which is $21,997,000 above the fiscal year

2023 enacted level. The Committee supports the Whole Health

model of care and the expansion of Whole Health to all VA facilities.

Adaptive Sports.—As requested, the bill provides $30,414,000 for

National Veterans Sports Programs, including $16,000,000 for

adaptive sports programs and up to $5,000,000 equine therapy.

Creative Arts Therapies.—The Committee continues to acknowledge the effective use of creative arts therapies and arts and humanities partnerships in treating veterans with traumatic brain injuries and psychological health conditions and provides up to

$5,000,000 to do so.

Nutrition and Food Services.—The Committee encourages the

Department to work with the Centers for Disease Control to implement the Food Service Guidelines for Federal Facilities and to expand its plant-based menu options. The Committee requests within

two years of the date of enactment of this Act a report that includes an assessment of how VA’s food purchasing and food service

practices align with the Food Service Guidelines and recommendations for changes to procurement or other laws that would facilitate

ongoing implementation of the Food Service Guidelines.


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WOMEN VETERANS HEALTH CARE

The recommendation includes a total of $1,279,096,000, as requested, to meet the estimated need for specific care for women

veterans and support the Office of Women’s Health and programmatic efforts, including the childcare initiative. Within this

amount, VA is encouraged to continue hiring women primary care

providers and increase the number of peer support specialists for

women veterans.

The Committee recognizes women are now the fastest growing

cohort within the veteran community. The number of women veterans using VHA services has more than tripled since 2001, growing from 159,810 in 2001 to 627,000 today. The increased number

of women using VHA services necessitates a greater investment of

resources to provide and expand VA’s specific services for women

veterans and ensure women veterans’ health needs, which often

differ from men, are met. The Committee supports continued efforts to identify and address the unique issues experienced by

women veterans. VA is directed to continue redesigning its women’s healthcare delivery system and improving its facilities to ensure women receive equitable, timely, and high-quality healthcare.

The Committee requests an expenditure plan no later than 45 days

after enactment of this Act.

Breast Cancer Screening Guidelines.—The Committee commends

VA’s decision to offer breast cancer screening and mammography

to eligible women veterans beginning at age 40. However, the Department should offer screening to eligible younger women veterans before age 40 if a physician determines it necessary or risk

factors warrant it. The Committee supports this effort to ensure

that the care women veterans receive is consistent with the private

sector and will continue to monitor the Department’s implementation of this policy. The Department should closely follow ongoing

debate within the scientific community on breast cancer screening

and mammography coverage to provide veterans the best care possible. The recommendation includes bill language to ensure VA

maintains this policy through fiscal year 2024.

Maternal and Infant Health Outcomes for Women Veterans.—The

Committee directs the Department to provide a report within 180

days of enactment of this Act regarding the incidence of birth defects, miscarriage, stillbirth, and maternal morbidity and mortality

that can be related to military service and provide recommendations to raise awareness and improve maternal and infant health

outcomes.

Maternity Healthcare and Coordination Programs.—The Committee is pleased that to coordinate prenatal and postpartum care

provided in the community, the Department has established maternity healthcare and coordination programs, which have been successful in ensuring that veterans can receive high-quality care and

robust support during and after pregnancy. The Committee supports these programs and encourages VA to continue to ensure veterans have access to high-quality, well-coordinated care, and robust

services and directs VA to continue to implement and fully resource

the Protecting Moms Who Served Act (P.L. 117–69).


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WORKFORCE AND STAFFING ISSUES

Expanding Recruitment.—The Committee recognizes the challenge VA has in the recruitment and retention of clinicians. To help

VA better keep pace with other providers and continue to train its

workforce to improve their service to veterans, the Committee

urges VA to explore potential options to enhance recruitment and

retention, such as expanding benefits to relocate to underserved VA

medical facilities and expanding reimbursement to clinicians for

Continuing Professional Education, regardless of individual specialty or board certification.

Homeless Veterans Caseworkers.—The Committee requests that

the Department evaluate staffing needs for caseworkers for homeless veterans and veterans at risk of homelessness and evaluate

the potential benefits and effectiveness of contracting for caseworkers in the annual Staffing Report.

Respiratory Therapists.—The Committee requests that the Department evaluate staffing needs for respiratory therapists using a

validated system and include the results in the annual Staffing Report.

Staffing Report.—The Committee looks forward to the annual

comprehensive report required by the Joint Explanatory Statement

accompanying the Consolidated Appropriations Act, 2022 (P.L.

117–103) on the Department’s plan to address critical workforce

issues.

VA/HHS Collaboration on Health Workforce Shortages.—The

Committee continues to encourage VA to work with the Department of Health and Human Services (HHS) to explore ways the

agencies can work together, such as by creating a taskforce, to increase the availability of providers, including in the behavioral

health workforce and among physicians specializing in cancer, spinal cord, and neuropsychiatric conditions. This collaboration is

urged to examine VA’s recruitment challenges, review programs

that could enhance recruitment and retention, and to think creatively on how other Federal agencies like HHS can identify and

address provider shortages. VA also is encouraged to consult with

the Department of Defense to explore recruiting those who have

left military service.

MEDICAL COMMUNITY CARE

Fiscal year 2023 enacted level ........................................................... $28,456,659,000

Fiscal year 2024 enacted level ........................................................... 33,000,000,000

Fiscal year 2024 budget year request ............................................... ¥5,828,150,000

Committee 2024 budget year recommendation ................................ 836,782,000

Fiscal year 2025 advance appropriation request ............................. 20,382,000,000

Committee 2025 advance appropriation recommendation .............. 33,604,857,000

Comparison with:

Fiscal year 2024 enacted level ................................................... +604,857,000

Fiscal year 2025 advance budget request ................................. +13,222,857,000

The Committee recommendation includes an additional

$836,732,000 for fiscal year 2024 for Medical Community Care. Including the advance appropriation provided in the prior fiscal year,

the total Committee recommendation for fiscal year 2024 is

$33,836,782,000. For fiscal year 2025, the Committee recommendation includes an advance appropriation of $33,604,857,000, of which

$2,000,000,000 is available until September 30, 2026. The Committee does not include the proposed rescission of funds.


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Long-Term Care for Veterans with Severe Traumatic Brain Injury.—The Committee is encouraged by the Department’s progress

in using agreements with non-VA providers to ensure all veterans

receive long-term specialty care for severe traumatic brain injury

in their communities and directs the Department to continue entering into such agreements and to educate case managers on all tools

available to provide veterans with long-term specialty care in the

community.

Third-Party Payments and Reimbursements.—The Committee

continues to direct VA to provide comprehensive reports on a quarterly basis detailing the amount owed to outside providers for every

state, outstanding payments over six months, the corrective actions

being implemented to address these outstanding balances, and the

average time for repayment.

MEDICAL SUPPORT AND COMPLIANCE

Fiscal year 2023 enacted level ........................................................... $11,073,409,000

Fiscal year 2024 enacted level ........................................................... 12,300,000,000

Fiscal year 2024 budget year request ............................................... ¥850,000,000

Committee 2024 budget year recommendation ................................ 0

Fiscal year 2025 advance appropriation request ............................. 11,800,000,000

Committee 2025 advance appropriation recommendation .............. 12,800,000,000

Comparison with:

Fiscal year 2024 enacted level ................................................... +500,000

Fiscal year 2025 advance budget request ................................. +1,000,000

The Committee recommendation includes an advance appropriation of $12,800,000 for fiscal year 2025 for Medical Support and

Compliance, of which $350,000,000 shall remain available through

September 30, 2026.

MEDICAL FACILITIES

Fiscal year 2023 enacted level ........................................................... $,8,633,816,000

Fiscal year 2024 enacted level ........................................................... 8,800,000,000

Fiscal year 2024 budget year request ............................................... 4,518,566,000

Committee 2024 budget year recommendation ................................ 4,518,566,000

Fiscal year 2025 advance appropriation request ............................. 9,400,000,000

Committee 2025 advance appropriation recommendation .............. 9,400,000,000

Comparison with:

Fiscal year 2024 enacted level ................................................... +600,000,000

Fiscal year 2025 advance budget request ................................. – – –

The Committee recommendation includes an additional

$4,518,566,000 for fiscal year 2024 for Medical Facilities for a total

of $13,318,566,000 for the fiscal year, including the advance appropriation provided in the previous fiscal year. The Committee does

not include the proposed transfer of funds.

The bill includes language making fiscal year 2024 funding provided in the bill available under September 30, 2029, and making

such funds available for transfer to Construction, Major Projects

and Construction, Minor Projects.

For fiscal year 2025, the Committee recommendation includes an

advance appropriation of $9,400,000,000, of which $350,000,000

shall remain available until September 30, 2026.

Community-Based Outpatient Clinic in Alameda Point, California.—The Committee is concerned that the Alameda Point

CBOC remains unbuilt more than a decade after Congress authorized this facility in fiscal year 2010 through Public Law 111–82;


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and after this project was fully funded by Congress. The Committee

directs the Department to expeditiously execute the lease and commence construction of the CBOC by no later than June 30, 2024.

The Committee also directs the Department to provide monthly reports to the Committees on Appropriations on the progress until

completion and activation. These reports shall include an action

plan and timeline of the project and a status update on the appropriated funds for the project.

Community-Based Outpatient Clinic in Bakersfield, California.—

The Committee remains disappointed that the new Bakersfield

CBOC remains unbuilt more than a decade after Congress authorized this facility in fiscal year 2010 through Public Law 111–82.

The Committee directs the Secretary to expeditiously execute Lease

No. 36C10F20L0008 and commence construction of the CBOC by

no later than September 30, 2023, as provided in the lease. Furthermore, the Committee directs the Secretary to provide monthly

reports to the Committees on Appropriations of both Houses of

Congress on the CBOC ’s progress until completion and activation.

The bill includes section 252 prohibiting the use of funds for

monthly payments under Lease No. VA10112R0032, including section 11 of the lease, that exceeds $223,166.67 unless required for

maintenance and repairs or improvements related to the form, fit,

or function of the facility that directly enhances the safety of veterans or improves healthcare services.

Facilities Security and Communication Technology Refresh.—The

Committee encourages the Department to continue security and

communications technology upgrades at VA facilities to ensure the

safety of veterans, visitors, and employees. The Committee recommends that VA take a holistic approach and continue efforts to

deploy proven technologies that can provide actionable, real-time

data and communications to improve safety.

Facility Transformations.—The Committee urges VA to continue

efforts to keep up with a growing population of women veterans

who deserve equitable access to medical care. The Committee directs the Department to prioritize funding for medical facilities to

accommodate women veterans and to make it safer and easier for

women veterans to get care. This includes correcting environment

of care deficiencies, such as adding doors, curtains, and soundproofing in treatment and check-in areas.

Medical Center Services.—The Committee reminds the Department to ensure it consults with a wide variety of stakeholders regarding any changes to services, hours, and staffing prior to making changes and to ensure veterans are not negatively affected.

Richard A. Pittman Community Based Outpatient Clinic, San

Joaquin County, California.—The Committee believes that an estimated 5,724 added daily traffic trips in a congested area with key

community infrastructure warrants additional traffic mitigation

measures. The Committee directs the Department to take expeditious actions to complete traffic mitigation projects associated with

this new clinic and encourages it to implement all traffic mitigation

measures in the first phase of opening. The Committee also directs

VA to provide quarterly reports describing updates and expected

timelines for the completion of the clinic and implementation of

these traffic mitigation measures.


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Spend Plan.—The Committee expects VA to provide, no later

than 30 days after enactment of this Act, an expenditure plan detailing the planned use of the funds provided. The Committee understands that some of the projects planned for fiscal year 2024

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.

Use of Autonomous Robots.—The Committee is aware of the Department’s use of autonomous mobile robots at a growing number

of VA hospitals and understands there is a potential to utilize such

technology for certain functions, such as handling laboratory, pharmacy, food, linen, waste and other materials. The Committee encourages the VA to consider the future use of autonomous robots

during the planning for new construction or modernization of VA

hospitals and requests the VA report to the Committee not later

than 180 days after the enactment of the Act on use of robots at

VA hospitals, including current use and potential benefits expanded use in the future.

MEDICAL AND PROSTHETIC RESEARCH

Appropriation, fiscal year 2023 ......................................................... $916,000,000

Budget request, fiscal year 2024 ....................................................... 938,000,000

Committee recommendation, fiscal year 2024 ................................. 938,000,000

Change from enacted level ......................................................... +22,000,000

Change from budget request ...................................................... – – –

The Committee recommendation includes $938,000,000 for Medical and Prosthetic Research, available through September 30,

2025, which is $22,000,000 above the fiscal year 2023 level. The

Committee appreciates the Department’s plans to focus on critical

research areas that include environmental exposures, traumatic

brain injury, cancer and precision oncology, and mental health.

In addition to this appropriation, resources from other sources,

including appropriations from the medical care accounts, reimbursements from the Department of Defense, grants from the National Institutes of Health, private sources, and voluntary organizations, support the Department’s researchers. The total amount estimated available for fiscal year 2024 is $1,437,400,000.

Advanced Platform Technology (APT) Center.—The Committee

applauds the Department for progress being made to provide veterans with new assistive and restorative technologies that address

sensory, motor, or cognitive deficits, as well as limb loss. The APT

Center has effectively utilized a partnership model to leverage local

and national research expertise to drive progress in diverse areas

including artificial lung development, wound healing, and neurally

connected sensory prosthesis. The Committee continues to support

the APT Center’s efforts.

Effects of Toxic Exposures on Women Veterans.—The Committee

recognizes the effects of toxic exposure on women veterans, and

that the effects of toxic exposure may manifest differently between

men and women. To provide full and effective medical care, it is

essential for the Department to understand the health effects of

women veterans exposed to toxins during their service. The Committee encourages the Department to continue and expand its research on the effects of toxic exposure and ensure specific research


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on women veterans is included in these efforts. The Committee also

encourages that a commensurate number of women veterans relative to the total women veteran population are utilized in research

studies, especially in those pertaining to effects of toxic exposure on

veterans.

Endometriosis.—The Committee encourages the Department to

conduct research into the needs and concerns of women veterans

with endometriosis and investigate new diagnostic and treatment

methods.

Gulf War Illness Studies.—The Committee recommends the Department continue to conduct epidemiological studies regarding the

prevalence of Gulf War Illness, morbidity, and mortality in Persian

Gulf War veterans and the development of effective treatments,

preventions, and cures. The Department is encouraged to make the

findings of all research conducted by or for the Executive Branch

publicly available as soon as possible and continue to publish disease-specific mortality data related specifically to Persian Gulf War

veterans. The Committee continues to encourage the Department

to utilize the term ‘‘Gulf War Illness,’’ as recommended by the Institute of Medicine. The Committee appreciates the Department’s

work to strengthen the training of primary, specialty, and mental

healthcare providers on effective assessment, diagnosis, and clinical

management of Gulf War Illness.

Herbicide-Related Toxic Exposure Research.—To understand the

residual effects of Agent Orange, dioxins, and other herbicide-related toxic exposures, the Committee urges the Department to utilize reference data from existing medical records of veterans who

served in Vietnam, Thailand, Guam, the Northern Mariana Islands, American Samoa, and other geographic areas where these

toxic substances were dispersed to determine the percentage who

have frequent or unexplained diseases compared to the civilian

population.

Metastatic Cancer Research.—While recent research has revealed

that there is a genetic basis for susceptibility to metastatic cancer

or resistance to metastasis, more research is required to develop a

comprehensive understanding of this complex process. To achieve

representation of the demographics of the U.S. population in these

trials, the Committee directs VA to partner with the Department

of Defense to fully implement the outstanding recommendations

made by the April 2018 Task Force Report to Congress on Metastatic Cancer.

National Intrepid Center of Excellence (NICoE).—The Committee

recognizes the high-quality mental health care and neurological research being conducted at the NICoE and directs the Department

to expand its work with NICoE to strengthen VA’s research capacity. The Committee continues to encourage the Department to pursue new collaborative initiatives with NICoE, consider public academic medical centers as partners in such efforts, and assist Department of Defense efforts to optimize research to implement solutions and deliver better health outcomes for veterans.

Research Using Animals.—The Department is directed to include

in any report to Congress describing animal research approved

under Section 247 in Division J of the Consolidated Appropriations

Act, 2023 (P.L. 117–328), submitted after the date of filing of this

report, details on the specific alternatives to animals that were conVerDate Sep 11 2014 06:57 May 18, 2023 Jkt 051240 PO 00000 Frm 00047 Fmt 6659 Sfmt 6602 E:\HR\OC\A240.XXX PFRM68

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sidered, why those alternatives were not chosen, and an explanation for why these animal subjects were the only viable option

for this research. Also, the Committee looks forward to the Department fully implementing its plan to eliminate or reduce the research conducted using canines, felines, or non-human primates in

2024, as directed in Public Law 116–94.

Women Veterans Research.—Women veterans have unique health

needs that are substantially different than civilian women and men

veterans. The Committee directs the Department to ensure its research program adequately addresses the unique needs and concerns of women veterans and to prioritize medical and prosthetic

research for women, given that women have different physical requirements for prosthetics. The Department should ensure that

conditions that affect women are included in VA’s research efforts

to better understand the impact of military service on veterans

with these conditions.

MEDICAL CARE COLLECTIONS FUND

The Department of Veterans Affairs Medical Care Collections

Fund (MCCF) was established by the Balanced Budget Act of 1997

(P.L. 105–33). The Department deposits first-party and pharmacy

co-payments, third-party insurance payments and enhanced-use

collections, long-term care co-payments, Compensated Work Therapy Program collections, Compensation and Pension Living Expenses Program collections, and Parking Program fees into the

MCCF. The Department uses these funds for medical care and

services to veterans. The estimate of fees that will be collected in

fiscal year 2024 is $3,991,000,000.

NATIONAL CEMETERY ADMINISTRATION

Appropriation, fiscal year 2023 ......................................................... $430,000,000

Budget request, fiscal year 2024 ....................................................... 480,000,000

Committee recommendation, fiscal year 2024 ................................. 480,000,000

Change from enacted level ......................................................... +50,000,000

Change from budget request ...................................................... – – –

The Committee recommends $480,000,000 for fiscal year 2024,

which is $50,000,000 above the fiscal year 2023 enacted level. NCA

should prioritize maintaining the current level of services at existing cemeteries and activating new cemeteries to increase burial access. In addition, the bill includes language making ten percent of

the total available until September 30, 2025.

Geographically Isolated National Cemeteries.—The Committee

looks forward to receiving the report requested in House Report

117–391 regarding the Department’s criteria for establishing new

national cemeteries and meeting the needs of veterans and families

in geographically isolated areas.


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DEPARTMENTAL ADMINISTRATION

GENERAL ADMINISTRATION

(INCLUDING TRANSFER OF FUNDS)

Appropriation, fiscal year 2023 ......................................................... $433,000,000

Budget request, fiscal year 2024 ....................................................... 475,000,000

Committee recommendation, fiscal year 2024 ................................. 475,000,000

Change from enacted level ......................................................... +42,000,000

Change from budget request ...................................................... – – –

The General Administration account provides funds for the Office

of the Secretary, the General Counsel, six Assistant Secretaries,

and two Department-level staff offices.

The Committee recommendation includes $475,000,000 for General Administration, an increase of $42,000,000 above the fiscal

year 2023 enacted level.

The Committee has included bill language to make available

through September 30, 2025, up to ten percent of these funds and

to permit the transfer of funds in this account to the General Operating Expenses, Veterans Benefits Administration account.

Additional Budgetary Information.—The Committee continues its

request that items described in previous House reports continue to

be included in the budget justifications submitted each year. Further, the Committee directs VA to include in its budget justification

materials a table for each account that shows a five-year funding

history for requested and enacted levels.

Data Strategy.—The Committee recommends $13,575,000 for the

Office of Enterprise Integration’s Data Governance, as requested,

which is $608,000 more than the prior fiscal year and supports the

Department’s continued efforts to manage VA data as a strategic

asset in order to strengthen the delivery of services and benefits to

veterans, their families, survivors, and caregivers.

Data on Women and Minority Veterans.—The Committee recognizes the lack of data specific to women and minority veterans

made available to Congress by the Department. The Committee

continues to recommend that, when applicable, the Secretary display information in the annual reports submitted to Congress separately for women veterans and minority veterans.

Office of Resolution Management, Diversity, and Inclusion.—The

Committee is concerned the Department requests an increase of

360 full-time equivalent staff with no justification and, as such,

provides no funding for the increase. The Committee directs the

Department to comply with Section 415 of the bill that prohibits

funds to be used to carry out any program, project, or activity that

promotes or advances Critical Race Theory or any concept associated with Critical Race Theory.

Quarterly Financial Information Reports.—The bill includes an

administrative provision that extends the requirement for submission of the quarterly financial information required in the fiscal

year 2017 bill and conference report.

Staff Relocations Within VA.—The bill continues the administrative provision requiring written notification 15 days prior to organizational changes that result in the transfer of 25 or more full-time

equivalent staff from one organizational unit of the Department to

another.


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Supporting Minority and Disadvantaged Contractors.—The Committee reiterates the reporting requirement included in House Report 117–81 on this topic and looks forward to receiving the requested report.

VA Public Affairs.—The Committee is disappointed the Department issued a news release on April 21, 2023, titled ‘‘Budget Cut

Proposals Would Hurt Veterans.’’ In addition to being factually

wrong, the news release was intended to influence the legislative

process and negotiations between Congress and the Executive

Branch, which is a violation of Section 715 of Division E of Public

Law 117–328. Appropriated funds are prohibited from being used

by the executive branch for partisan political purposes, including

attempting to support or defeat legislation pending before Congress. As such, the bill includes a new general provision to specifically prohibit this type of activity by the Departments and agencies

funded in this bill. It also provides zero funding for the Department’s Public Affairs office.

BOARD OF VETERANS APPEALS

Appropriation, fiscal year 2022 ......................................................... $285,000,000

Budget request, fiscal year 2023 ....................................................... 287,000,000

Committee recommendation, fiscal year 2023 ................................. 287,000,000

Change from enacted level ......................................................... +2,000,000

Change from budget level ........................................................... – – –

The Committee recommendation includes $287,000,000 for the

Board of Veterans Appeals, which is $2,000,000 above the prior fiscal year. Ten percent of this funding is available through September 30, 2025.

The Committee recognizes the challenges VA has in recruitment

and retention of attorneys at BVA. To help the Board retain its attorneys, the Committee supports efforts to enhance recruitment

and retention, such as expanding reimbursement for bar fees and

Continuing Legal Education.

INFORMATION TECHNOLOGY SYSTEMS

(INCLUDING TRANSFER OF FUNDS)

Appropriation, fiscal year 2023 ......................................................... $5,782,000,000

Budget request, fiscal year 2024 ....................................................... 6,401,000,000

Committee recommendation, fiscal year 2024 ................................. 6,401,000,000

Change from enacted level ......................................................... +619,000,000

Change from budget request ...................................................... – – –

The Committee recommendation includes $6,401,000,000 for Information Technology Systems, which is $619,000,000 above the fiscal year 2023 enacted amount. Within the account total, the Committee allocates $1,606,977,000 for pay and associated costs;

$4,668,373,000 for operations and maintenance; and $125,650,000

for development.

The bill makes available three percent of pay and associated

costs and five percent of operations and maintenance funds until

September 30, 2025. All development funds are available until September 30, 2026.

The Committee continues bill language permitting the transfer of

funding among the three subaccounts upon approval of the Committees on Appropriations of both Houses of Congress.


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The bill also continues language allowing for the reprogramming

of funds among development projects upon approval by the Committees on Appropriations of both Houses of Congress.

The Committee continues to include bill language limiting the

funds available for information technology systems development to

the projects and in the amounts specified in the report. The bill

limits the amount of funds that can be transferred into the IT account to ten percent of the total of either the source or destination

account. The bill contains language that permits the reprogramming of funds among development projects upon prior notification

to, and approval by, the Committees on Appropriations of both

Houses of Congress.

The chart below reflects the Committee’s allocation for development projects. This chart will serve as the Department’s approved

list of development projects, and all requested changes are subject

to the reprogramming guidelines as outlined in the accompanying

Act.

INFORMATION TECHNOLOGY DEVELOPMENT PROJECTS

[In thousands of dollars]

Project Committee

Recommendation

Clinical Enabling Capabilities ....................................................................................................................... $53,656

Health Business Services ............................................................................................................................... 14,694

Care Coverage Capabilities ............................................................................................................................ 13,608

Clinical Care Capabilities .............................................................................................................................. 7,949

Health IT Services .......................................................................................................................................... 2,000

Patient Management Capabilities .................................................................................................................. 559

Benefit Services .............................................................................................................................................. 16,000

Veteran Experience Services ........................................................................................................................... 14,184

Corporate Services .......................................................................................................................................... 3,000

Total All Development ........................................................................................................................... 125,650

The Committee expects the Office of Information and Technology

to continue to provide an IT expenditure report to the Committees

on Appropriations of both Houses of Congress on a monthly basis.

This report should include a comparison to the project costs included in the development funding chart above and provide an explanation for any differences in excess of $3,000,000.

Small Business IT Security Partners.—The Committee urges the

Office of Information Technology to increase utilization of small

businesses in implementing IT security programs, including in the

areas of secure storage and encryption.

VETERANS ELECTRONIC HEALTH RECORD

Appropriation, fiscal year 2023 ......................................................... $1,759,000,000

Budget request, fiscal year 2024 ....................................................... 1,863,000,000

Committee recommendation, fiscal year 2024 ................................. 1,863,000,000

Change from enacted level ......................................................... +104,000,000

Change from budget request ...................................................... – – –

The bill includes $1,863,000,000, as requested, for Veterans Electronic Health Record for activities related to the development and

rollout of VA’s Electronic Health Record Modernization (EHRM)

initiative, the associated contractual costs, and the salaries and expenses of employees hired under titles 5 and 38, United States

Code. Within the total, the bill includes $1,186,000,000 for the electronic health record contract; $424,000,000 for infrastructure readiVerDate Sep 11 2014 06:57 May 18, 2023 Jkt 051240 PO 00000 Frm 00051 Fmt 6659 Sfmt 6602 E:\HR\OC\A240.XXX PFRM68

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ness; and $253,000,000 for program management. Funding is made

available for three fiscal years.

This account is intended to be the single source of funding within

VA for the electronic health record effort. No authority is provided

for funds from other VA accounts to be transferred into this account nor for funds from this account to be transferred out to other

accounts.

The bill continues to require quarterly reporting of obligations,

expenditures, and deployment schedule by facility and the Office of

Deputy Secretary to administer the initiative. It also continues to

make 25 percent of funds contingent upon the Secretary, within

specified deadlines: (1) providing a report detailing the status of

outstanding issues impacting the stability and usability of the new

electronic health record (EHR) system, including those that contributed to deployment delays, along with a timeline and measurable

metrics; (2) certifying and detailing any changes to the full deployment schedule; and (3) certifying the status of outstanding issues

impacting the stability and usability of the system, and whether

the system is ready and optimized for further deployment at VA

sites.

The Committee directs the Department to continue monthly

briefings on program implementation, including updates on

progress resolving outstanding issues, and to provide quarterly updates to review timelines, performance milestones, implementation,

and change management progress. The Government Accountability

Office is directed to continue quarterly performance reviews of

EHRM deployment and to report to the Committees each quarter.

The Committee notes that the Department is not expected to request the release of the 25 percent of funds set aside for fiscal year

2023, and that it plans to pause new deployments in fiscal year

2024. While this bill provides the full amount requested for fiscal

year 2024, the Committee will work with the Department and the

Senate Appropriations Committee to determine the appropriate

amount to provide in a final conference agreement.

Contractor Accountability.—The Committee expects the Department to hold its contractors accountable. The Department is expected to work closely with Oracle Cerner to resolve usability problems and dramatically improve training to ensure that when deployments restart the new system can be adopted easily by clinicians and healthcare staff.

Cost and Budget Estimates.—The Committee appreciates the information included in the fiscal year 2024 budget request and accompanying justifications that better identifies all costs related to

EHRM implementation, including those that would be incurred in

other budget accounts, in meeting the reporting requirements

above and in the justifications accompanying the President’s budget request.

Enterprise Integration and Standardization.—The Committee is

very concerned that little progress has been made to standardize

the processes, products, and workflows associated with the new

system, especially since this is increasing the cost of implementation. For example, the Committee is aware that the Department of

Defense has fewer than one-third of the interfaces the Department

is considering.


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An interoperable, enterprise-wide system presumes a standardized system and operating structure. As such, the Department is

directed to set enterprise standards, including readiness criteria

and training requirements, and strictly limit customization. The

standards should be in place as soon as practicable to ensure new

deployments are swift and smooth. The Committee requests a report of each new requirement and customized interface added in

fiscal years 2022 and 2023, including the cost of each, reasons for

inclusion, and whether they were outside of the scope of the contract within 30 days of enactment of this Act, as well as a briefing

within 45 days of the filing of this bill on how the Department’s

plan to set enterprise standards.

Life-Cycle Cost Estimate.—The Committee anticipates receiving

an updated Life Cycle Cost Estimate for the program that takes

into account the estimate provided by the Institute for Defense

Analyses and continues to require that at least annually the Department provide a report to the Committees on Appropriations

that compares current estimated costs to the revised Life Cycle

Cost Estimate.

Report.—The Committee looks forward to receiving the report required in Division J of Public Law 113–328 detailing steps taken

to: (1) revise and enhance the EHR training program; (2) independently validate the efficacy of the super user program and the training for such program; (3) ensure proper medication management

and accurate patient data through such record; (4) demonstrate

that patient record flags that identify veterans who are at high risk

for suicide are properly displayed in such record; and (5) implement

a policy for regular updates to affected employees about progress

on and estimated completion dates for issues arising from trouble

tickets.

OFFICE OF INSPECTOR GENERAL

Appropriation, fiscal year 2023 ......................................................... $273,000,000

Budget request, fiscal year 2024 ....................................................... 296,000,000

Committee recommendation, fiscal year 2024 ................................. 296,000,000

Change from enacted level ......................................................... +23,000,000

Change from budget request ...................................................... – – –

The Committee recommendation includes $296,000,000 for fiscal

year 2024 for the Office of the Inspector General, which is

$23,000,000 above the prior year level. The bill makes up to ten

percent of this funding available until September 30, 2025.

The Committee continues to request robust oversight of the Electronic Health Record Modernization initiative.

VA Claims Backlog.—The OIG is encouraged to continue to review the VA’s work to address the claims backlog and report to the

Committee about such efforts. This report should analyze how VA’s

partnership with the National Archives and Records Administration to digitally scan all paper-based military personnel files has

helped address and resolve the backlog as well as any changes in

wait times and size of the claims backlog.


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CONSTRUCTION, MAJOR PROJECTS

Appropriation, fiscal year 2023 ......................................................... $1,447,890,000

Budget request, fiscal year 2024 ....................................................... 881,000,000

Committee recommendation, fiscal year 2024 ................................. 881,000,000

Change from enacted level ......................................................... ¥566,890,000

Change from budget request ...................................................... – – –

The Committee recommendation includes $881,000,000 for Construction, Major Projects for fiscal year 2024, of which

$373,096,000 shall remain available until September 30, 2029, and

$507,904,000 shall remain available until expended. In addition,

the Committee supports the Department’s plan to allocate

$600,000,000 to support major construction projects in American

Lake, WA; Dallas, TX; El Paso, TX; Perry Point, MD; Portland, OR;

San Diego, CA; San Francisco, CA; and San Juan, PR.

As required by language that is in permanent law, all major construction projects costing more than $100,000,000 must be managed by a non-VA government entity, such as the Army Corps of

Engineers. While the Committee no longer duplicates this language, the Committee intends to continue its oversight of the quality of the outside entity management and expects to receive quarterly briefings on each of the large construction projects.

Construction Reports.—The Committee continues to request that

VA provide quarterly briefings on the progress and cost of each facility managed by an outside entity. Several additional bill language provisions are included to enhance the Committee’s capacity

to conduct oversight of VA’s facility construction efforts including:

(1) no funding greater than $7,000,000 may be reprogrammed between construction projects unless approved by the Committees on

Appropriations of both Houses of Congress; (2) any change to the

scope of a construction project is prohibited without the approval

of the Committees; and (3) VA must report any bid savings of

$5,000,000 or more on projects as soon as they are identified.

The Committee does not provide $1,930,000,000 in mandatory

funding, as requested, does not support the shift of discretionary

funding to the mandatory side for construction, and discourages

such requests in future fiscal years.

The chart below reflects the Committee’s recommendation for

Major Construction projects.

CONSTRUCTION, MAJOR PROJECTS

[In thousands of dollars]

Project Amount

Veterans Health Administration (VHA):

West Haven, CT—New Surgical and Clinical Space Tower, Renovation of Buildings 1 and 2 and Demolition ........................................................................................................................................................... 153,128

Advance Planning and Design Fund—Various Stations ............................................................................... 196,872

Construction & Facilities Management Staff—Various Stations .................................................................. 153,000

Hazardous Waste—Various Stations ............................................................................................................. 1,000

Judgement Fund—Various Stations .............................................................................................................. 25,000

Non-Departmental Federal Entity Project Management Support—Various Stations .................................... 112,000

Seismic Corrections—Various Stations ......................................................................................................... 110,00

Total, VHA .............................................................................................................................................. 759,000

National Cemetery Administration (NCA):

St. Louis, MO—Phase 1 Gravesite Development (New Land) ....................................................................... 28,800

Advance Planning and Design Fund—Various Stations ............................................................................... 78,200

NCA Land Acquisition Fund—Various Stations ............................................................................................. 5,000

Total, NCA .............................................................................................................................................. 112,000


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CONSTRUCTION, MAJOR PROJECTS—Continued

[In thousands of dollars]

Project Amount

General Administration/Staff Offices:

Department Advance Planning and Design Fund for Major Construction .................................................... 10,000

Total, Major Construction ...................................................................................................................... 881,000

To enhance the Committee’s capacity to conduct oversight on

VA’s facility construction efforts, several administrative provisions

are continued in the bill: (1) No funding amount greater than

$7,000,000 may be reprogrammed between construction projects

unless approved by the Committees on Appropriations of both

Houses of Congress; (2) any change to the scope of a construction

project is not permitted without the approval of the Committees;

and (3) VA must report any bid savings of $5,000,000 or more on

projects as soon as they are identified.

CONSTRUCTION, MINOR PROJECTS

Appropriation, fiscal year 2023 ......................................................... $626,110,000

Budget request, fiscal year 2024 ....................................................... 680,000,000

Committee recommendation, fiscal year 2024 ................................. 680,000,000

Change from enacted level ......................................................... +53,890,000

Change from budget request ...................................................... – – –

The Committee recommendation includes $680,000,000 for Construction, Minor Project for fiscal year 2024, of which $612,000,000

shall remain available until September 30, 2028, and $68,000,000

shall remain available until expended.

Greater Los Angeles Healthcare System’s Master Plan.—The Committee continues to encourage the VA to engage with the Principal

Developer Team responsible for the Greater Los Angles Health

Care System’s Master Plan and support the operationalization of

the Master Plan, as appropriate.

GRANTS FOR CONSTRUCTION OF STATE EXTENDED CARE FACILITIES

Appropriation, fiscal year 2023 ......................................................... $150,000,000

Budget request, fiscal year 2024 ....................................................... 164,000,000

Committee recommendation, fiscal year 2024 ................................. 164,000,000

Change from enacted level ......................................................... +14,000,000

Change from budget request ...................................................... – – –

The Committee recommendation includes $164,000,000 for fiscal

year 2024 for Grants for Construction of State Extended Care Facilities, which is $14,000,000 above the fiscal year 2023 level. A

grant may not exceed 65 percent of the total cost of the project. The

bill makes this funding available until expended.

GRANTS FOR CONSTRUCTION OF VETERANS CEMETERIES

Appropriation, fiscal year 2023 ......................................................... $50,000,000

Budget request, fiscal year 2024 ....................................................... 60,000,000

Committee recommendation, fiscal year 2024 ................................. 50,000,000

Change from enacted level ......................................................... +10,000,000

Change from budget request ...................................................... – – –

The Committee recommendation includes $60,000,000 for Grants

for Construction of Veterans Cemeteries, which is $10,000,000

above the fiscal year 2023 level. The bill makes this funding available until expended.


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COST OF WAR TOXIC EXPOSURE FUND

Fiscal year 2023 enacted level ..................................... $5,000,000,000

Fiscal year 2024 enacted level ..................................... – – –

Fiscal year 2024 budget year request ......................... 20,268,000,000

Committee 2024 budget year recommendation .......... 5,542,000,000

Fiscal year 2025 advance appropriation request ....... 21,454,542,000

Committee 2025 advance appropriation recommendation ............................................................. – – –

Comparison with:

Fiscal year 2024 enacted level ............................. – – –

Fiscal year 2025 advance budget request ........... ¥21,452,542,000

The bill provides $5,542,000,000 for the Cost of War Toxic Exposure Fund (TEF). Of this total, $2,390,000,000 is for veterans’ medical care; $1,769,000,000 is for General Operating Expenses, Veterans Benefits Administration; $1,243,000,000 is for Information

Technology Systems; $90,000,000 is for General Administration;

$46,000,000 is for Medical and Prosthetic Research; and $4,000,000

is for the Board of Veterans Appeals.

The Committee provides the incremental costs for implementation of the Honoring our PACT Act of 2022 (Public Law 117–168)

in the TEF. It does not support the proposed shift of

$14,726,000,000 from the four discretionary medical care accounts

(Medical Services, Medical Community Care, Medical Support and

Compliance, and Medical Facilities) to the TEF. Instead, the Committee provides this amount through these discretionary accounts,

consistent with congressional intent as stated in the explanatory

statement accompany the Military Construction, Veterans Affairs

and Related Agencies Appropriations Act, 2023 (P.L. 117–328).

For veterans’ medical care, the Committee provides a total of

$138,127,303,000, which is equal to the President’s Budget Request. This includes $2,390,000,000 through the TEF and

$135,737,303,000 through the discretionary accounts.

PACT Act Incremental Costs.—The Committee directs the Department to include in its fiscal year 2025 and all future budget

justification materials a detailed description of the incremental

costs for implementation of the PACT Act for all requested funds

on an account-by-account basis.

ADMINISTRATIVE PROVISIONS

The administrative provisions included in the bill are as follows:

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 201 allowing for the transfer of funds

among three mandatory appropriations. The Administration proposal to modify this provision is not adopted.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 202 allowing the Department to transfer

funding among the four medical appropriations accounts in fiscal

year 2024. 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.


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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 2024 for ‘‘Compensation and Pensions’’, ‘‘Readjustment Benefits’’, and ‘‘Veterans Insurance and Indemnities’’

for payment of accrued obligations recorded in the last quarter of

fiscal year 2023.

The bill includes section 207 allowing for the use of fiscal year

2024 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 enhanced-use lease proceeds deducted for administrative expenses that were incurred in

a prior fiscal year to be available until expended.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 210 limiting the amount of reimbursement the Office of Resolution Management, Diversity and Inclusion, the Office of Employment Discrimination Complaint Adjudication, and the Alternative Dispute Resolution function within the

Office of Human Resources and Administration 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.


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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 Department of

Veterans Affairs.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 218 prohibiting the Department from increasing total resources of the Information Technology appropriation by more than ten percent by transferring funding from the

other VA accounts and requires the Department to receive approval

from the Committees on Appropriations of both Houses of Congress

before such transfer. The Administration proposal to modify this

provision is not adopted.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 219 providing up to $430,532,000 of fiscal year 2024 funds for transfer to the Joint DOD–VA Medical Facility Demonstration Fund. Additional funding may be transferred

from these accounts upon written notification to the Committees on

Appropriations of both Houses of Congress.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 220 permitting the transfer of

$456,547,000 of fiscal year 2025 funding appropriated for medical

accounts to the Joint DOD–VA Medical Facility Demonstration

Fund for the operation of facilities designated as combined Federal

medical facilities.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 221 permitting the transfer of funds deposited in the Medical Care Collections Fund to the Joint DOD–VA

Medical Facility Demonstration Fund for facilities designated as

combined Federal medical facilities.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 222 directing that a minimum of

$15,000,000 shall be transferred from the four medical care appropriations to the Department of Defense/Department of Veterans Affairs Health Care Sharing Incentive Fund, to be available until expended.

The bill includes section 223 requiring the Secretary to notify the

Committees on Appropriations of both Houses of Congress of all bid

savings when identified in Major Construction projects that total at


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least $5,000,000 or five percent of the programmed amount of the

project. The Administration proposal to delete this provision is not

adopted.

The bill includes section 224 prohibiting the original scope of

work for a Major Construction project from being increased above

the scope specified for that project in the original justification data

provided to Congress unless approved by the Committees on Appropriations of both Houses of Congress. The Administration proposal

to delete this provision is not adopted.

The bill includes section 225 requiring a quarterly report from

each VBA regional office on pending disability claims, both initial

and supplemental; error rates; the number of claims processing

personnel; corrective actions taken; training programs; and review

team audit results. In addition, the bill requires quarterly reporting on pending appeals at VBA, as well as BVA. The Administration proposal to delete this provision is not adopted.

The bill includes section 226 requiring advance written notification to the Committees on Appropriations of both Houses of Congress 15 days prior to organizational changes which result in the

transfer of 25 or more full-time equivalent staff from one organizational unit to another. The Administration proposal to delete this

provision is not adopted.

The bill includes section 227 requiring the Secretary to provide,

on a quarterly basis to the Committees on Appropriations of both

Houses of Congress, notification of any single national outreach

and awareness marketing campaign in which obligations exceed

$1,000,000. The Administration proposal to delete this provision is

not adopted.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 228 permitting the transfer to ‘‘Medical

Services’’ from any discretionary program except ‘‘General Operating Expenses, Veterans Benefits Administration’’ upon approval

of the Committees on Appropriations of both Houses of Congress.

This provision is intended to give VA flexibility as it administers

the changes to its traditional healthcare program and the MISSION Act. The Administration proposal to modify this provision is

not adopted.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 229 permitting the transfer of funds between the ‘‘Board of Veterans Appeals’’ and ‘‘General Operating Expenses, Veterans Benefits Administration’’ upon approval of the

Appropriations Committees on Appropriations of both Houses of

Congress. The Administration proposal to modify this provision is

not adopted.

The bill includes section 230 prohibiting the reprogramming of

funds exceeding $7,000,000 among the Major Construction projects

unless the Committees on Appropriations of both Houses of Congress approve the request. The Administration proposal to modify

this provision is not adopted.

The bill includes section 231 requiring the Secretary to ensure

that the toll-free suicide hotline provides immediate assistance

from a trained professional and adheres to all requirements of the


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American Association of Suicidology. The Administration request to

delete this provision is not adopted.

The bill includes section 232 requiring VA to use the mammography screening guidelines announced by the Secretary on May 10,

2017, through January 1, 2025. The Administration request to delete this provision is not adopted.

The bill includes section 233 allowing the use of Medical Services

funding for assisted reproductive technology treatment and adoption reimbursement for veterans and their spouses.

The bill includes section 234 prohibiting any funds from being

used in a manner that is inconsistent with statutory limitations on

outsourcing.

The bill includes section 235 pertaining to exceptions for Indianor Native Hawaiian-owned businesses contracting with VA.

The bill includes section 236 directing the elimination over a series of years of the use of Social Security numbers in VA programs.

The bill includes section 237 referencing the provision in the

Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2017, and Zika Response and Preparedness Act (P.L. 114–223) pertaining to certification of marriage and family therapists. The Administration request to delete this provision is not adopted.

The bill includes section 238 which prohibits funds from being

used to transfer funding from the Filipino Veterans Equity Compensation Fund to any other VA account. The Administration request to delete this provision is not adopted.

The bill includes section 239 permitting funding to be used in fiscal years 2024 and 2025 to carry out and expand the childcare pilot

program authorized by section 205 of the Caregivers and Veterans

Omnibus Health Services Act of 2010 (P.L. 111–163).

The bill includes section 240 prohibiting VA from using funds to

enter into an agreement to resolve a dispute or claim with an individual that would restrict the individual from speaking to Members

of Congress or their staff on any topic, except those required to be

kept secret in the interest of national defense or the conduct of foreign affairs. The Administration request to delete this provision is

not adopted.

The bill includes section 241 referencing language in the Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2017, and Zika Response and Preparedness Act (P.L. 114–223) requiring certain data

to be included in budget justifications for major construction

projects. The Administration request to delete this provision is not

adopted.

The bill includes section 242 prohibiting the use of funds to deny

the Inspector General timely access to information unless a provision of law expressly refers to the Inspector General and expressly

limits such access.

The bill includes section 243 prohibiting funding from being used

in a manner that would increase wait times for veterans at medical

facilities. The Administration request to delete this provision is not

adopted.

The bill includes section 244 prohibiting the use of funds in fiscal

year 2024 to convert any program that received specific purpose

funds in fiscal year 2023 to a general purpose-funded program


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without the approval of the Committees on Appropriations of both

Houses of Congress at least 30 days prior to any such action. The

Administration request to delete this provision is not adopted.

The bill includes section 245 regarding verification of service for

coastwise merchant seamen.

The bill includes section 246 regarding the use of canines, felines, and non-human primates in VA research.

The bill includes section 247 regarding staffing ratios.

The bill includes section 248 to allow fiscal year 2024 and 2025

‘‘Medical Community Care’’ funds to be used to cover obligations

that would have otherwise been paid by the Veterans Choice Fund.

The bill includes section 249 allowing obligations and expenditures applicable to the ‘‘Medical Services’’ account in fiscal years

2017 through 2019 for aid to state homes to remain in the ‘‘Medical

Community Care’’ account for such fiscal years.

This bill includes section 250 specifying an amount from the four

medical care accounts for specific care for women veterans. The administration request to delete this provision is not adopted.

The bill includes section 251 regarding construction of a community-based outpatient clinic in Bakersfield, California.

The bill includes section 252 regarding the lease of a communitybased outpatient clinic in Bakersfield, California.

The bill includes section 253 requiring quarterly reports on the

status of the ‘‘Veterans Medical Care and Health Fund,’’ established to execute section 8002 of the American Rescue Plan (P.L.

117–2).

The bill includes section 254 establishing a timeline for construction in accordance with a lease.

The bill includes section 255 regarding the use of unobligated

balances to support construction projects in the CHIP–IN program.

TITLE III

RELATED AGENCIES

AMERICAN BATTLE MONUMENTS COMMISSION

SALARIES AND EXPENSES

Appropriation, fiscal year 2023 ......................................................... $87,500,000

Budget request, fiscal year 2024 ....................................................... 114,630,000

Committee recommendation, fiscal year 2024 ................................. 114,630,000

Change from enacted level ......................................................... 27,130,000

Change from budget request ...................................................... – – –

The recommendation includes $114,630,000 for Salaries and Expenses of the American Battle Monuments Commission. The Committee directs the Commission to provide a spend plan for the additional funds provided this fiscal year, including funding for the capital program, within 60 days of enactment of this Act.

FOREIGN CURRENCY FLUCTUATIONS ACCOUNT

The recommendation includes such sums as necessary for the

Foreign Currency Fluctuations Account.


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CAPITAL PROGRAM

Appropriation, fiscal year 2023 ......................................................... $– – –

Budget request, fiscal year 2024 ....................................................... 44,000,000

Committee recommendation, fiscal year 2024 ................................. 44,000,000

Change from enacted level ......................................................... +44,000,000

Change from budget request ...................................................... – – –

The recommendation includes $44,000,000, as requested.

UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS

SALARIES AND EXPENSES

Appropriation, fiscal year 2023 ......................................................... $46,900,000

Budget request, fiscal year 2024 ....................................................... 47,200,000

Committee recommendation, fiscal year 2024 ................................. 47,200,000

Change from enacted level ......................................................... +300

Change from budget request ...................................................... – – –

The recommendation includes $47,200,000 for Salaries and Expenses for the United States Court of Appeals for Veterans Claims.

DEPARTMENT OF DEFENSE—CIVIL

CEMETERIAL EXPENSES, ARMY

SALARIES AND EXPENSES

Appropriation, fiscal year 2023 ......................................................... $93,400,000

Budget request, fiscal year 2024 ....................................................... 99,880,000

Committee recommendation, fiscal year 2024 ................................. 100,267,000

Change from enacted level ......................................................... +6,867,000

Change from budget request ...................................................... +387,000

The recommendation includes $100,267,000 for Salaries and Expenses for Arlington National Cemetery, which is equal to the fiscal year 2024 budget request.

CONSTRUCTION

Appropriation, fiscal year 2023 ......................................................... $62,500,000

Budget request, fiscal year 2024 ....................................................... 88,600,000

Committee recommendation, fiscal year 2024 ................................. 88,600,000

Change from enacted level ......................................................... +26,100,000

Change from budget request ...................................................... – – –

The recommendation includes $88,600,000 to complete the Southern Expansion, to remain available until expended. The Committee

reminds the Army to include status updates in its required quarterly reports on funds obligated, including previously appropriated

funds, and funds remaining for the Southern Expansion project, as

well as any remaining unfunded needs to complete the project.

ARMED FORCES RETIREMENT HOME

TRUST FUND

The recommendation includes a total of $77,000,000 for the

Armed Forces Retirement Home (AFRH) Trust Fund, including

$8,940,000 for capital projects and $25,000,000 from the general

fund of the Treasury.

General Fund.—The Committee continues to be concerned about

the use of the General Fund to support the AFRH and directs it


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to make progress to increase revenues and stabilize the Trust Fund

for the long term.

Land Redevelopment.—The Committee continues to be interested

in the redevelopment of the 80-acre master planned parcel on the

Washington campus and continues to direct AFRH to report to the

Committee on the progress of the redevelopment project.

OPERATION AND MAINTENANCE

Appropriation, fiscal year 2023 ......................................................... $68,060,000

Budget request, fiscal year 2024 ....................................................... 68,060,000

Committee recommendation, fiscal year 2024 ................................. 68,060,000

Change from enacted level ......................................................... – – –

Change from budget request ...................................................... – – –

The Committee makes these operation and maintenance funds

available until September 30, 2025, as requested, to provide AFRH

greater ability to respond to emergency situations and ensure stable operations.

CAPITAL PROGRAM

Appropriation, fiscal year 2023 ......................................................... $7,300,000

Budget request, fiscal year 2024 ....................................................... 8,940,000

Committee recommendation, fiscal year 2024 ................................. 8,940,000

Change from enacted level ......................................................... +1,640,000

Change from budget request ...................................................... – – –

Capital Maintenance Spending Plan.—The Committee directs

AFRH to provide, no later than 30 days after enactment of this Act,

an expenditure plan detailing the planned use of the funds provided for construction and renovation. The Committee continues to

direct AFRH to prioritize completing projects that are currently underway.

MAJOR CONSTRUCTION

Appropriation, fiscal year 2023 ......................................................... $77,000,000

Budget request, fiscal year 2024 ....................................................... – – –

Committee recommendation, fiscal year 2024 ................................. – – –

Change from enacted level ......................................................... ¥77,000,000

Change from budget request ...................................................... – – –

The Committee reminds AFRH to provide quarterly reports on

the status of this construction project, including obligations of

funds, anticipated timelines, and any changes to the overall cost of

the project.

ADMINISTRATIVE PROVISION

The bill includes section 301 permitting funds from concessions

at Army National Military Cemeteries to be used to support activities at the Cemeteries.

TITLE IV

GENERAL PROVISIONS

The bill includes section 401 prohibiting the obligation of funds

beyond the current fiscal year unless expressly so provided.

The bill includes section 402 prohibiting the use of funds for programs, projects, or activities not in compliance with Federal law reVerDate Sep 11 2014 06:57 May 18, 2023 Jkt 051240 PO 00000 Frm 00063 Fmt 6659 Sfmt 6602 E:\HR\OC\A240.XXX PFRM68

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lating to risk assessment, the protection of private property rights,

or unfunded mandates.

The bill includes section 403 encouraging all departments and

agencies funded in this Act to expand the use of ‘‘E Commerce’’

technologies and procedures.

The bill includes section 404 specifying the Congressional committees that are to receive all reports and notifications.

The bill includes section 405 prohibiting the transfer of funds to

any instrumentality of the United States Government without authority from an appropriations Act.

The bill includes section 406 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 407 requiring all reports submitted to

Congress to be posted on official websites of the submitting agency.

The bill includes section 408 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 409 prohibiting the use of funds for payment of first-class travel by an employee of the executive branch.

The bill includes section 410 prohibiting the use of funds in this

Act for any contract where the contractor has not complied with EVerify requirements.

The bill includes section 411 prohibiting the use of funds in this

Act to construct facilities on military installations that do not meet

resiliency standards.

The bill includes section 412 prohibiting the use of funds in this

Act for the renovation, expansion, or construction of any facility in

the continental United States for the purposes of housing any individual who has been detained at the United States Naval Station,

Guantanamo Bay, Cuba.

The bill includes section 413 prohibiting the use of funds to support or defeat legislation pending before Congress.

The bill includes section 414 prohibiting the use of funds to implement Executive Order 13985, Executive Order 14035, Executive

Order 14091 regarding diversity, equity, and inclusion activities.

The bill includes section 415 prohibiting the use of funds to promote or advance Critical Race Theory or any concept associated

with Critical Race Theory.

The bill includes section 416 establishing a ‘‘Spending Reduction

Account’’ in the bill.

HOUSE OF REPRESENTATIVES REPORTING 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:


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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.

RESCISSION 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 rescissions in the accompanying bill:

[TO BE PROVIDED]

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 under Title I 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 under Title I to provide transfer authority

from the BRAC account to the Homeowners Assistance Program.

Language is included under Title I to allow the transfer of expired funds to the ‘‘Foreign Currency Fluctuations, Construction,

Defense’’ account.

Language is included under Title II to transfer not to exceed

$22,109,000 in fiscal year 2025 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 under Title II to permit the transfer of

funds from General Administration to General Operating Expenses, Veterans Benefits Administration.

Language is included under Title II 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 under Title II to provide authority for the

Department of Veterans Affairs for any funds appropriated in 2024

for Compensation and Pensions, Readjustment Benefits, and Veterans Insurance and Indemnities to be transferred among those

three accounts.

Language is included under Title II to transfer funds among the

Medical Services, Medical Community Care, Medical Support and

Compliance, and Medical Facilities accounts, subject to approval by

the Committee.

Language is included under Title II to allow the transfer of certain funds from Medical Facilities to Construction, Major Projects

and Construction, Minor Projects.


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Language is included under Title II 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 under Title II to permit funding up to

$101,065,000 to be transferred to General Administration and Information Technology Systems from any funds appropriated in fiscal year 2024 to reimburse three headquarters offices for services

provided.

Language is included under Title II to transfer certain funds derived from enhanced-use leasing activities to the Construction,

Major Projects and Construction, Minor Projects accounts.

Language is included under Title II to allow the transfer of funds

from the Medical Care Collections Fund to the Medical Services

and Medical Community Care accounts.

Language is included under Title II to allow the transfer of funds

from the Capital Asset Fund to the Construction, Major Projects

and Construction, Minor Projects accounts.

Language is included under Title II 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 under Title II to allow the transfer of funds

provided for the Department of Veterans Affairs in fiscal year 2024

to the Joint Department of Defense-Department of Veterans Affairs

Medical Facility Demonstration Fund.

Language is included under Title II allowing fiscal year 2024

medical care funding to be transferred to the Joint Department of

Defense-Department of Veterans Affairs Medical Facility Demonstration fund.

Language is included under Title II permitting funds deposited

to the Medical Care Collections Fund for healthcare provided at a

combined Federal medical facility to be transferred to the Joint Department of Defense-Department of Veterans Affairs Medical Facility Demonstration Fund.

Language is included under Title II to 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 under Title II 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 under Title II 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

The following table is submitted in compliance with clause 9 of

rule XXI, and lists the congressional earmarks (as defined in paragraph (e) of clause 9) contained in the bill or in this report. Neither

the bill nor the report contain any limited tax benefits or limited


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tariff benefits as defined in paragraphs (f) or (g) of clause 9 of rule

XXI.


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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):

[TO BE PROVIDED]

CHANGES IN THE APPLICATION OF EXISTING LAW

Pursuant to clause 3(f)(1)(A) of rule XIII of the Rules of the

House of Representatives, the following statements are submitted

describing the effect of provisions in the accompanying bill that directly or indirectly change the application of existing law.

Language is included in various parts of the bill to continue ongoing activities that require annual authorization or additional legislation, which to date have not been enacted.

Language is included in various parts of the bill to place limitations on the use of funds in the bill or change existing limitations

and which might, under some circumstances, be construed as

changing the application of existing law.

Language is included in various parts of the bill to allow the Secretary of Defense to exceed certain limitations upon notification to

the Committee.

Language is included in various parts of the bill to allow funding

to be used for official reception and representation expenses.

Language is included in various parts of the bill to enable various appropriations to remain available for more than one year for

some programs for which the basic authority legislation does not

presently authorize such extended availability.

Language is included in various parts of the bill to permit the

transfer of funds to other accounts.

Language is included under Title I to prohibit payments for costplus-a-fixed-fee contracts under certain circumstances.

Language is included in various parts of the bill to allow funds

to be used for the hire of passenger motor vehicles.

Language is included under Title I to allow advances to the Federal Highway Administration, Department of Transportation under

certain circumstances.

Language is included under Title I to prohibit the use of funds

to begin construction of new bases without specific appropriations.

Language is included under Title I to prohibit the use of funds

for purchase of land or land easements under certain circumstances.

Language is included under Title I to prohibit the use of funds

for land acquisition, site preparation, and utility installation for

family housing unless funds have been made available in annual

appropriations Acts.

Language is included under Title I to prohibit the use of minor

construction funds to transfer an activity between installations

without prior notification.

Language is included under Title I to prohibit the use of funds

for the procurement of steel for any activity if American steel proVerDate Sep 11 2014 06:57 May 18, 2023 Jkt 051240 PO 00000 Frm 00070 Fmt 6659 Sfmt 6602 E:\HR\OC\A240.XXX PFRM68

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ducers have been denied the opportunity to compete for such steel

procurements.

Language is included under Title I to prohibit the use of funds

to pay real property taxes in any foreign nation.

Language is included under Title I to prohibit the use of funds

to initiate a new installation overseas without prior notification.

Language is included under Title I to limit the use of funds for

architect and engineer contracts under certain circumstances.

Language is included under Title I to limit the use of funds for

awarding contracts to foreign contractors under certain circumstances.

Language is included under Title I to require the Department of

Defense to notify the appropriate committees of Congress of any

proposed military exercises under certain circumstances.

Language is included under Title I to allow prior year construction funding to be available for currently authorized projects.

Language is included under Title I to allow payment for the cost

associated with supervision, inspection, overhead, engineering and

design on family housing or military construction projects that are

being completed with expired or lapsed funds.

Language is included under Title I to allow funds to be expended

on military construction projects for four fiscal years after enactment under certain circumstances.

Language is included under Title I to allow construction funds to

be transferred to Housing Improvement Funds.

Language is included under Title I to allow for the transfer of

BRAC funds to the Homeowners Assistance Program.

Language is included under Title I to limit funds for the operation and maintenance of family housing to those provided in this

appropriation and to limit amounts expended on repairs of general

and flag officer quarters under certain circumstances.

Language is included under Title I to allow funds in the Ford Island Improvement Account to be available until expended for certain purposes.

Language is included under Title I to allow for the transfer of expired funding to the Foreign Currency Fluctuation Account under

certain circumstances.

Language is included under Title I to prohibit funds from being

used for projects at Arlington Cemetery.

Language is included under Title I directing all amounts appropriated to Military Construction (all accounts) be immediately

available and allotted for the full scope of the authorized project.

Language is included under Title I providing funds for unfunded

requirements requested by the Services and Combatant Commanders.

Language is included under Title I allowing unobligated funds

from prior appropriations acts for fiscal years 2017, 2018, and 2019

to be obligated under certain circumstances.

Language is included under Title I defining the congressional defense committees.

Language is included under Title I providing funds for military

laboratory facilities.

Language is included under Title I providing funds for natural

disasters.


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Language is included under Title I providing funds for child development centers planning and design.

Language is included under Title I providing funds for barracks

planning and design.

Language is included under Title I providing funds for demolition.

Language is included under Title I providing funds for the Shipyard Infrastructure Optimization Program.

Language is included under Title I prohibiting funds to close

Naval Station Guantanamo Bay, Cuba.

Language is included under Title II providing for the reimbursement to the Department of Defense for the costs of overseas employee mail.

Language is included under Title II to require that the Secretary

of Veterans Affairs establish a priority for treatment of Veterans

who are service-connected disabled, lower income, or have special

needs.

Language is included under Title II to require that the Secretary

of Veterans Affairs give priority funding of basic medical benefits

to priority groups 1 through 6.

Language is included under Title II to allow the Secretary of Veterans Affairs to dispense prescription drugs from VHA facilities to

enrolled Veterans with privately written prescriptions at no additional cost to the Department.

Language is included under Title II requiring the Secretary to

ensure sufficient funding is available for the acquisition of prosthetics designed for women Veterans.

Language is included under Title II requiring sufficient funding

is available for prosthetic research specifically for female Veterans

and for toxic exposure research.

Language is included under Title II to require approval of a

transfer between development projects in the Information Technology Systems account.

Language is included under Title II prohibiting funding in the

Veterans Electronic Health Record account from being obligated in

a manner inconsistent with deployment schedules.

Language is included under Title II establishing time limitations

and reporting requirements concerning the obligation of Major Construction funds, limiting the use of funds, allowing the use of funds

for program costs, and allowing for the reimbursement to the ‘‘General Administration’’ account for the salaries and expenses of the

Office of Construction and Facilities Management employees.

Language is included under Title II to allow Minor Construction

funds to be used to repair non-medical facilities damaged by natural disaster or catastrophe.

Language is included under Title II permitting transfers between

mandatory and discretionary accounts, limiting and providing for

the use of certain funds, funding administrative expenses associated with life insurance programs from excess program revenues,

allowing reimbursement from enhanced-use leases and for certain

services, requiring notification of construction bid savings, limiting

reprogramming amount of major construction projects, restricting

changes in the scope of major construction projects, requiring disclosure of insurance and income information, allowing a recovery

audit collection program, allowing Veterans in the State of Alaska


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to use Indian Health Service facilities under certain conditions, requiring quarterly reports on the Department’s financial status, performance measures, and data, 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 notification of any

single national outreach and awareness marketing campaign in

which obligations exceed $1,000,000.

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 in contravention of certain breast cancer screening guidance.

Language is included under Title II to allow covered veterans

and their spouses or partners, under certain conditions, to receive

assisted reproductive technology services and adoption reimbursement.

Language is included under Title II pertaining to exceptions for

Indian- or Native Hawaiian-owned businesses contracting with the

Department.

Language is included under Title II directing the elimination of

using Social Security account numbers to identify individuals in all

information systems of the Department.

Language is included under Title II pertaining to certification of

marriage and family therapists.

Language is included under Title II prohibiting funds from being

used to transfer funding from the Filipino Veterans Equity Compensation Fund to any other VA account.

Language is included under Title II permitting funds to carry out

and expand the childcare program.

Language is included under Title II prohibiting funds to enter

into an agreement to resolve a dispute or claim with an individual

that would restrict the individual from speaking to Members of

Congress or their staff.

Language is included under Title II requiring certain data to be

included in budget justifications for major construction projects.

Language is included under Title II prohibiting the Inspector

General from being denied timely access to information.

Language is included under Title II prohibiting funding to be

used in a manner that would increase wait times for Veterans who

seek medical care.

Language is included under Title II prohibiting the use of funds

in fiscal year 2024 to convert any program that received specific

purpose funding in fiscal year 2023 to a general purpose-funded

program.

Language is included under Title II prohibiting the use of dogs

or cats as part of the conduct of any study.

Language is included under Title II allowing for funds within the

Medical Community Care account to be used for expenses that

would have otherwise been payable from the Veterans Choice

Fund.

Language is included under Title II allowing for obligations and

expenditures applicable to the Medical Services account in fiscal


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years 2017 through 2019 for aid to state homes to remain in the

Medical Community Care account for such fiscal years.

Language is included under Title II providing for a certain

amount within the medical care accounts to be made available for

gender-specific care and programmatic efforts to deliver care for

women veterans.

Language is included under Title II rescinding unobligated balances in the ‘‘Recurring Expenses Transformational Fund.’’

Language is included under Title II requiring quarterly reports

on the status of the Veterans Medical Care and Health Fund.

Language is included under Title II allowing the use of unobligated balances for CHIP-In construction projects.

Language is included under Title III, United States Court of Appeals for Veterans Claims, Salaries and Expenses, to permit the

use of funds for a pro bono program.

Language is included under Title III, Cemeterial Expenses,

Army, Salaries and Expenses, to permit the use of funds for parking maintenance and repairs.

Language is included under Title III, Armed Forces Retirement

Home to permit payment from the general fund of the Treasury to

the Trust Fund.

Language is included under Title III to allow for the use of concession fees.

Language is included under Title IV prohibiting funding beyond

the current fiscal year unless expressly so provided.

Language is included under Title IV 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 IV providing funding to expand

the use of ‘‘E Commerce’’ technologies and procedures.

Language is included under Title IV specifying the Congressional

committees that are to receive all reports and notifications.

Language is included under Title IV prohibiting the transfer of

funds to any instrumentality of the United States Government

without authority from an appropriations Act.

Language is included under Title IV prohibiting the use of funds

for a project or program named for an individual serving as a Member, Delegate, or Resident Commissioner of the United States

House of Representatives.

Language is included under Title IV requiring all reports submitted to the Congress to be posted on the official public website

of that agency.

Language is included under Title IV 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 IV prohibiting funds from being

used to pay for first-class travel in violation of Federal regulations.

Language is included under Title IV 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 IV prohibiting the use of funds

in this Act to construct facilities on military installations that do

not meet resiliency standards.


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Language is included under Title IV prohibiting funds to build

or house detainees at Naval Station Guantanamo Bay, Cuba.

Language is included under Title IV prohibiting funds for executive orders related to diversity, equity, and inclusion.

Language is included under Title IV prohibiting funds to teach

or promote Critical Race Theory.

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:

[TO BE PROVIDED]

PROGRAM DUPLICATION

Pursuant to clause 3(c)(5) of rule XIII of the Rules of the House

of Representatives, no provision of this bill establishes or reauthorizes a program of the Federal Government known to be duplicative

of another Federal program, a program that was included in any

report from the Government Accountability Office to Congress pursuant to section 21 of Public Law 111–139, or a program related

to a program identified in the most recent Catalog of Federal Domestic Assistance.

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 (P.L. 93–344), as amended, the following table

compares the levels of new budget authority provided in the bill

with the appropriate allocations under section 302(b) of the Budget

Act:

[TO BE PROVIDED]

FIVE YEAR OUTLAY PROJECTIONS

Pursuant to clause 3(c)(2) of rule XIII and section 308(a)(1)(B) of

the Congressional Budget Act of 1974 (P.L. 93–344), as amended,

the following table contains five-year projections associated with

the budget authority provided in the accompanying bill as provided

to the Committee by the Congressional Budget Office.

[TO BE PROVIDED]

ASSISTANCE TO STATE AND LOCAL GOVERNMENTS

Pursuant to clause 3(c)(2) of rule XIII and section 308(a)(1)(C) of

the Congressional Budget Act of 1974 (P.L. 93–344), as amended,

the Congressional Budget Office has provided the following estimates of new budget authority and outlays provided by the accompanying bill for financial assistance to State and local governments.

[TO BE PROVIDED]


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COMMITTEE HEARINGS

Pursuant to clause 3(c)(6) of rule XIII of the Rules of the House

of Representatives, the following hearings were used to develop or

consider the Military Construction, Department of Veterans Affairs, and Related Agencies Appropriations Act, 2024:

The Subcommittee on Military Construction, Department of Veterans Affairs, and Related Agencies held a hearing on February 28,

2023, entitled ‘‘Oversight Hearing—Quality of Life in the Military’’.

The Subcommittee received testimony from:

Sergeant Major Michael A. Grinston, U.S. Army

Master Chief Petty Officer James A. Honea, U.S. Navy

Sergeant Major Troy E. Black, U.S. Marine Corps

Chief Master Sergeant JoAnne S. Bass, U.S. Air Force

Chief Master Sergeant Roger A. Towberman, U.S. Space Force

The Subcommittee on Military Construction, Department of Veterans Affairs, and Related Agencies held a hearing on April 20,

2023, entitled ‘‘FY 2023 Member Day Hearing’’. The Subcommittee

received testimony from:

The Honorable Brian J. Mast, Member of Congress

The Honorable Earl Blumenauer, Member of Congress

The Subcommittee on Military Construction, Department of Veterans Affairs, and Related Agencies held a hearing on March 23,

2023, entitled ‘‘Budget Hearing—Fiscal Year 2024 Request for

Army Military Construction and Family Housing’’. The Subcommittee received testimony from:

The Honorable Rachel Jacobson, Assistant Secretary of the

Army, Installations, Energy, and Environment Department of Veterans Affairs

Lieutenant General Kevin Vereen, Deputy Chief of Staff G9, Installation Management Command

The Subcommittee on Military Construction, Department of Veterans Affairs, and Related Agencies held a hearing on March 29,

2023, entitled ‘‘Budget Hearing—Fiscal Year 2024 Request for the

Department of Veterans Affairs’’. The Subcommittee received testimony from:

The Honorable Denis McDonough, Secretary, Department of Veterans Affairs

The Subcommittee on Military Construction, Department of Veterans Affairs, and Related Agencies held a hearing on April 18,

2023, entitled ‘‘Budget Hearing—Fiscal Year 2024 Request for

Navy and Marine Corps Military Construction and Family Housing’’. The Subcommittee received testimony from:

The Honorable Meredith Berger, Assistant Secretary of the Navy,

Energy, Installations, and Environment

Vice Admiral Ricky Williamson, Deputy Chief of Naval Operations, Fleet Readiness, and Logistics, N4, Office of the Chief of

Naval Operations

Lieutenant General Edward D. Banta, Deputy Commandant, Installations and Logistics, United States Marine Corps

The Subcommittee on Military Construction, Department of Veterans Affairs, and Related Agencies held a hearing on April 20,

2023, entitled ‘‘Budget Hearing—Fiscal Year 2024 Request for Air

Force and Space Force Military Construction and Family Housing’’.

The Subcommittee received testimony from:


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Dr. Ravi I. Chaudhary, Assistant Secretary of the Air Force, Energy, Installations, and Environment, Department of the Air Force

Mr. Bruce Hollywood, Associate Chief Operations Officer, Office

of the Chief Operations Officer, United States Space Force

Brigadier General Brian S. Hartless, Air Force Director of Civil

Engineers, Deputy Chief of Staff for Logistics, Engineering and

Force Protection, United States Air Force

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL)

AUTHORITY

The following table provides a detailed summary, for each Department and agency, comparing the amounts recommended in the

bill with amounts enacted for fiscal year 2023 and budget estimates presented for fiscal year 2024.


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FULL COMMITTEE VOTES

[TO BE PROVIDED]

MINORITY VIEWS

[TO BE PROVIDED]


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