retary. The term ‘‘rural Alaska’’ shall mean those lands 
which are not within the boundaries of the municipality 
of Anchorage or the Fairbanks North Star Borough. 
(INCLUDING TRANSFER OF FUNDS) 
SEC. 216. Such sums as may be deposited into the 
Department of Veterans Affairs Capital Asset Fund pur-
suant to section 8118 of title 38, United States Code, may 
be transferred to the ‘‘Construction, Major Projects’’ and 
‘‘Construction, Minor Projects’’ accounts, to remain avail-
able until expended for the purposes of these accounts. 
SEC. 217. Not later than 30 days after the end of 
each fiscal quarter, the Secretary of Veterans Affairs shall 
submit to the Committees on Appropriations of both 
Houses of Congress a report on the financial status of the 
Department of Veterans Affairs for the preceding quarter: 
Provided, That, at a minimum, the report shall include 
the direction contained in the paragraph entitled ‘‘Quar-
terly reporting’’, under the heading ‘‘General Administra-
tion’’ in the joint explanatory statement accompanying 
Public Law 114–223. 
(INCLUDING TRANSFER OF FUNDS) 
SEC. 218. Amounts made available under the ‘‘Med-
ical Services’’, ‘‘Medical Community Care’’, ‘‘Medical Sup-
port and Compliance’’, ‘‘Medical Facilities’’, ‘‘General Op-
erating Expenses, Veterans Benefits Administration’’, 
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‘‘Board of Veterans Appeals’’, ‘‘General Administration’’, 
and ‘‘National Cemetery Administration’’ accounts for fis-
cal year 2023 may be transferred to or from the ‘‘Informa-
tion Technology Systems’’ account: Provided, That such 
transfers may not result in a more than 10 percent aggre-
gate increase in the total amount made available by this 
Act for the ‘‘Information Technology Systems’’ account: 
Provided further, That, before a transfer may take place, 
the Secretary of Veterans Affairs shall request from the 
Committees on Appropriations of both Houses of Congress 
the authority to make the transfer and an approval is 
issued. 
(INCLUDING TRANSFER OF FUNDS) 
SEC. 219. Of the amounts appropriated to the De-
partment of Veterans Affairs for fiscal year 2023 for 
‘‘Medical Services’’, ‘‘Medical Community Care’’, ‘‘Medical 
Support and Compliance’’, ‘‘Medical Facilities’’, ‘‘Con-
struction, Minor Projects’’, and ‘‘Information Technology 
Systems’’, up to $330,140,000, plus reimbursements, may 
be transferred to the Joint Department of Defense—De-
partment of Veterans Affairs Medical Facility Demonstra-
tion Fund, established by section 1704 of the National De-
fense Authorization Act for Fiscal Year 2010 (Public Law 
111–84; 123 Stat. 2571) and may be used for operation 
of the facilities designated as combined Federal medical 
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facilities as described by section 706 of the Duncan Hun-
ter National Defense Authorization Act for Fiscal Year 
2009 (Public Law 110–417; 122 Stat. 4500): Provided, 
That additional funds may be transferred from accounts 
designated in this section to the Joint Department of De-
fense—Department of Veterans Affairs Medical Facility 
Demonstration Fund upon written notification by the Sec-
retary of Veterans Affairs to the Committees on Appro-
priations of both Houses of Congress: Provided further, 
That section 220 of title II of division J of Public Law 
117–103 is repealed. 
(INCLUDING TRANSFER OF FUNDS) 
SEC. 220. Of the amounts appropriated to the De-
partment of Veterans Affairs which become available on 
October 1, 2023, for ‘‘Medical Services’’, ‘‘Medical Com-
munity Care’’, ‘‘Medical Support and Compliance’’, and 
‘‘Medical Facilities’’, up to $314,825,000, plus reimburse-
ments, may be transferred to the Joint Department of De-
fense—Department of Veterans Affairs Medical Facility 
Demonstration Fund, established by section 1704 of the 
National Defense Authorization Act for Fiscal Year 2010 
(Public Law 111–84; 123 Stat. 2571) and may be used 
for operation of the facilities designated as combined Fed-
eral medical facilities as described by section 706 of the 
Duncan Hunter National Defense Authorization Act for 
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Fiscal Year 2009 (Public Law 110–417; 122 Stat. 4500): 
Provided, That additional funds may be transferred from 
accounts designated in this section to the Joint Depart-
ment of Defense—Department of Veterans Affairs Med-
ical Facility Demonstration Fund upon written notifica-
tion by the Secretary of Veterans Affairs to the Commit-
tees on Appropriations of both Houses of Congress. 
(INCLUDING TRANSFER OF FUNDS) 
SEC. 221. Such sums as may be deposited into the 
Medical Care Collections Fund pursuant to section 1729A 
of title 38, United States Code, for healthcare provided 
at facilities designated as combined Federal medical facili-
ties as described by section 706 of the Duncan Hunter 
National Defense Authorization Act for Fiscal Year 2009 
(Public Law 110–417; 122 Stat. 4500) shall also be avail-
able: (1) for transfer to the Joint Department of De-
fense—Department of Veterans Affairs Medical Facility 
Demonstration Fund, established by section 1704 of the 
National Defense Authorization Act for Fiscal Year 2010 
(Public Law 111–84; 123 Stat. 2571); and (2) for oper-
ations of the facilities designated as combined Federal 
medical facilities as described by section 706 of the Dun-
can Hunter National Defense Authorization Act for Fiscal 
Year 2009 (Public Law 110–417; 122 Stat. 4500): Pro-
vided, That, notwithstanding section 1704(b)(3) of the 
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National Defense Authorization Act for Fiscal Year 2010 
(Public Law 111–84; 123 Stat. 2573), amounts trans-
ferred to the Joint Department of Defense—Department 
of Veterans Affairs Medical Facility Demonstration Fund 
shall remain available until expended. 
(INCLUDING TRANSFER OF FUNDS) 
SEC. 222. Of the amounts available in this title for 
‘‘Medical Services’’, ‘‘Medical Community Care’’, ‘‘Medical 
Support and Compliance’’, and ‘‘Medical Facilities’’, a 
minimum of $15,000,000 shall be transferred to the 
DOD–VA Health Care Sharing Incentive Fund, as au-
thorized by section 8111(d) of title 38, United States 
Code, to remain available until expended, for any purpose 
authorized by section 8111 of title 38, United States Code. 
SEC. 223. The Secretary of Veterans Affairs shall no-
tify the Committees on Appropriations of both Houses of 
Congress of all bid savings in a major construction project 
that total at least $5,000,000, or 5 percent of the pro-
grammed amount of the project, whichever is less: Pro-
vided, That such notification shall occur within 14 days 
of a contract identifying the programmed amount: Pro-
vided further, That the Secretary shall notify the Commit-
tees on Appropriations of both Houses of Congress 14 
days prior to the obligation of such bid savings and shall 
describe the anticipated use of such savings. 
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SEC. 224. None of the funds made available for 
‘‘Construction, Major Projects’’ may be used for a project 
in excess of the scope specified for that project in the origi-
nal justification data provided to the Congress as part of 
the request for appropriations unless the Secretary of Vet-
erans Affairs receives approval from the Committees on 
Appropriations of both Houses of Congress. 
SEC. 225. Not later than 30 days after the end of 
each fiscal quarter, the Secretary of Veterans Affairs shall 
submit to the Committees on Appropriations of both 
Houses of Congress a quarterly report containing perform-
ance measures and data from each Veterans Benefits Ad-
ministration Regional Office: Provided, That, at a min-
imum, the report shall include the direction contained in 
the section entitled ‘‘Disability claims backlog’’, under the 
heading ‘‘General Operating Expenses, Veterans Benefits 
Administration’’ in the joint explanatory statement accom-
panying Public Law 114–223: Provided further, That the 
report shall also include information on the number of ap-
peals pending at the Veterans Benefits Administration as 
well as the Board of Veterans Appeals on a quarterly 
basis. 
SEC. 226. The Secretary of Veterans Affairs shall 
provide written notification to the Committees on Appro-
priations of both Houses of Congress 15 days prior to or-
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ganizational changes which result in the transfer of 25 or 
more full-time equivalents from one organizational unit of 
the Department of Veterans Affairs to another. 
SEC. 227. The Secretary of Veterans Affairs shall 
provide on a quarterly basis to the Committees on Appro-
priations of both Houses of Congress notification of any 
single national outreach and awareness marketing cam-
paign in which obligations exceed $1,000,000. 
(INCLUDING TRANSFER OF FUNDS) 
SEC. 228. The Secretary of Veterans Affairs, upon 
determination that such action is necessary to address 
needs of the Veterans Health Administration, may trans-
fer to the ‘‘Medical Services’’ account any discretionary 
appropriations made available for fiscal year 2023 in this 
title (except appropriations made to the ‘‘General Oper-
ating Expenses, Veterans Benefits Administration’’ ac-
count) or any discretionary unobligated balances within 
the Department of Veterans Affairs, including those ap-
propriated for fiscal year 2023, that were provided in ad-
vance by appropriations Acts: Provided, That transfers 
shall be made only with the approval of the Office of Man-
agement and Budget: Provided further, That the transfer 
authority provided in this section is in addition to any 
other transfer authority provided by law: Provided further, 
That no amounts may be transferred from amounts that 
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were designated by Congress as an emergency requirement 
pursuant to a concurrent resolution on the budget or the 
Balanced Budget and Emergency Deficit Control Act of 
1985: Provided further, That such authority to transfer 
may not be used unless for higher priority items, based 
on emergent healthcare requirements, than those for 
which originally appropriated and in no case where the 
item for which funds are requested has been denied by 
Congress: Provided further, That, upon determination that 
all or part of the funds transferred from an appropriation 
are not necessary, such amounts may be transferred back 
to that appropriation and shall be available for the same 
purposes as originally appropriated: Provided further, 
That before a transfer may take place, the Secretary of 
Veterans Affairs shall request from the Committees on 
Appropriations of both Houses of Congress the authority 
to make the transfer and receive approval of that request. 
(INCLUDING TRANSFER OF FUNDS) 
SEC. 229. Amounts made available for the Depart-
ment of Veterans Affairs for fiscal year 2023, under the 
‘‘Board of Veterans Appeals’’ and the ‘‘General Operating 
Expenses, Veterans Benefits Administration’’ accounts 
may be transferred between such accounts: Provided, That 
before a transfer may take place, the Secretary of Vet-
erans Affairs shall request from the Committees on Appro-
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priations of both Houses of Congress the authority to 
make the transfer and receive approval of that request. 
SEC. 230. The Secretary of Veterans Affairs may not 
reprogram funds among major construction projects or 
programs if such instance of reprogramming will exceed 
$7,000,000, unless such reprogramming is approved by 
the Committees on Appropriations of both Houses of Con-
gress. 
SEC. 231. (a) The Secretary of Veterans Affairs shall 
ensure that the toll-free suicide hotline under section 
1720F(h) of title 38, United States Code— 
(1) provides to individuals who contact the hot-
line immediate assistance from a trained profes-
sional; and 
(2) adheres to all requirements of the American 
Association of Suicidology. 
(b)(1) None of the funds made available by this Act 
may be used to enforce or otherwise carry out any Execu-
tive action that prohibits the Secretary of Veterans Affairs 
from appointing an individual to occupy a vacant civil 
service position, or establishing a new civil service position, 
at the Department of Veterans Affairs with respect to 
such a position relating to the hotline specified in sub-
section (a). 
(2) In this subsection— 
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(A) the term ‘‘civil service’’ has the meaning 
given such term in section 2101(1) of title 5, United 
States Code; and 
(B) the term ‘‘Executive action’’ includes— 
(i) 
any 
Executive 
order, 
Presidential 
memorandum, or other action by the President; 
and 
(ii) any agency policy, order, or other di-
rective. 
(c)(1) The Secretary of Veterans Affairs shall con-
duct a study on the effectiveness of the hotline specified 
in subsection (a) during the 5-year period beginning on 
January 1, 2016, based on an analysis of national suicide 
data and data collected from such hotline. 
(2) At a minimum, the study required by paragraph 
(1) shall— 
(A) determine the number of veterans who con-
tact the hotline specified in subsection (a) and who 
receive follow up services from the hotline or mental 
health services from the Department of Veterans Af-
fairs thereafter; 
(B) determine the number of veterans who con-
tact the hotline who are not referred to, or do not 
continue receiving, mental health care who commit 
suicide; and 
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(C) determine the number of veterans described 
in subparagraph (A) who commit or attempt suicide. 
SEC. 232. Effective during the period beginning on 
October 1, 2018, and ending on January 1, 2024, none 
of the funds made available to the Secretary of Veterans 
Affairs by this or any other Act may be obligated or ex-
pended in contravention of the ‘‘Veterans Health Adminis-
tration Clinical Preventive Services Guidance Statement 
on the Veterans Health Administration’s Screening for 
Breast Cancer Guidance’’ published on May 10, 2017, as 
issued by the Veterans Health Administration National 
Center for Health Promotion and Disease Prevention. 
SEC. 233. Subchapter II of chapter 17 of title 38, 
United States Code, is amended by adding at the end the 
following new section (and conforming the table of sections 
at the beginning of such chapter accordingly): 
‘‘§ 1720K. Infertility counseling and treatment; reim-
bursement of adoption expenses 
‘‘(a) INFERTILITY COUNSELING AND TREATMENT.— 
(1) Pursuant to regulations the Secretary shall prescribe 
to carry out this subsection, the Secretary may provide 
infertility counseling and treatment, using assisted repro-
ductive technology, including in vitro fertilization, intra-
uterine insemination, and other advanced reproductive 
technologies, to the following: 
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