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ments of any medical facility under the jurisdiction or for 
the use of the Department of Veterans Affairs. Such sums 
as realized are in addition to the amount provided for in 
‘‘Construction, Major Projects’’ and ‘‘Construction, Minor 
Projects’’. 
SEC. 213. Amounts made available under ‘‘Medical 
Services’’ are available— 
(1) for furnishing recreational facilities, sup-
plies, and equipment; and 
(2) for funeral expenses, burial expenses, and 
other expenses incidental to funerals and burials for 
beneficiaries receiving care in the Department. 
(INCLUDING TRANSFER OF FUNDS) 
SEC. 214. Such sums as may be deposited into the 
Medical Care Collections Fund pursuant to section 1729A 
of title 38, United States Code, may be transferred to the 
‘‘Medical Services’’ and ‘‘Medical Community Care’’ ac-
counts to remain available until expended for the purposes 
of these accounts. 
SEC. 215. The Secretary of Veterans Affairs may enter 
into agreements with Federally Qualified Health Centers in 
the State of Alaska and Indian Tribes and Tribal organiza-
tions which are party to the Alaska Native Health Compact 
with the Indian Health Service, to provide healthcare, in-
cluding behavioral health and dental care, to veterans in
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rural Alaska. The Secretary shall require participating vet-
erans and facilities to comply with all appropriate rules 
and regulations, as established by the Secretary. 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 De-
partment of Veterans Affairs Capital Asset Fund pursuant 
to section 8118 of title 38, United States Code, may be 
transferred to the ‘‘Construction, Major Projects’’ and ‘‘Con-
struction, Minor Projects’’ accounts, to remain available 
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 Con-
gress 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 ‘‘Quarterly reporting’’, 
under the heading ‘‘General Administration’’ in the joint 
explanatory statement accompanying Public Law 114–223. 
(INCLUDING TRANSFER OF FUNDS) 
SEC. 218. Amounts made available under the ‘‘Medical 
Services’’, ‘‘Medical Community Care’’, ‘‘Medical Support
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and Compliance’’, ‘‘Medical Facilities’’, ‘‘General Oper-
ating Expenses, Veterans Benefits Administration’’, ‘‘Board 
of Veterans Appeals’’, ‘‘General Administration’’, and ‘‘Na-
tional Cemetery Administration’’ accounts for fiscal year 
2026 may be transferred to or from the ‘‘Information Tech-
nology Systems’’ account: Provided, That such transfers 
may not result in a more than 10 percent aggregate increase 
in the total amount made available by this Act for the ‘‘In-
formation Technology Systems’’ account: Provided further, 
That, before a transfer may take place, the Secretary of Vet-
erans Affairs shall request from the Committees on Appro-
priations 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 Depart-
ment of Veterans Affairs for fiscal year 2026 for ‘‘Medical 
Services’’, ‘‘Medical Community Care’’, ‘‘Medical Support 
and Compliance’’, ‘‘Medical Facilities’’, ‘‘Construction, 
Minor Projects’’, and ‘‘Information Technology Systems’’, 
up to $654,954,000, plus reimbursements, may be trans-
ferred to the Joint Department of Defense—Department of 
Veterans Affairs Medical Facility Demonstration Fund, es-
tablished by section 1704 of the National Defense Authoriza-
tion Act for Fiscal Year 2010 (Public Law 111–84; 123 
Stat. 2571) and may be used for operation of the facilities
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designated as combined Federal medical facilities as de-
scribed by section 706 of the Duncan Hunter National De-
fense Authorization Act for Fiscal Year 2009 (Public Law 
110–417; 122 Stat. 4500): Provided, That additional funds 
may be transferred from accounts designated in this section 
to the Joint Department of Defense—Department of Vet-
erans Affairs Medical Facility Demonstration Fund upon 
written notification by the Secretary of Veterans Affairs to 
the Committees on Appropriations of both Houses of Con-
gress: Provided further, That section 220 of title II of divi-
sion A of Public Law 118–42, as continued by section 
1101(a)(10) of division A of Public Law 119–4, is repealed. 
(INCLUDING TRANSFER OF FUNDS) 
SEC. 220. Of the amounts appropriated to the Depart-
ment of Veterans Affairs which become available on October 
1, 2026, for ‘‘Medical Services’’, ‘‘Medical Community 
Care’’, ‘‘Medical Support and Compliance’’, and ‘‘Medical 
Facilities’’, up to $739,918,000, plus reimbursements, may 
be transferred to the Joint Department of Defense—Depart-
ment 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 Federal medical facilities 
as described by section 706 of the Duncan Hunter National
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Defense Authorization Act for Fiscal Year 2009 (Public 
Law 110–417; 122 Stat. 4500): Provided, That additional 
funds may be transferred from accounts designated in this 
section to the Joint Department of Defense—Department 
of Veterans Affairs Medical Facility Demonstration Fund 
upon written notification by the Secretary of Veterans Af-
fairs to the Committees 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 facilities 
as described by section 706 of the Duncan Hunter National 
Defense Authorization Act for Fiscal Year 2009 (Public 
Law 110–417; 122 Stat. 4500) shall also be available: (1) 
for transfer to the Joint Department of Defense—Depart-
ment 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 operations of the facilities 
designated as combined Federal medical facilities as de-
scribed by section 706 of the Duncan Hunter National De-
fense Authorization Act for Fiscal Year 2009 (Public Law 
110–417; 122 Stat. 4500): Provided, That, notwithstanding
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section 1704(b)(3) of the National Defense Authorization 
Act for Fiscal Year 2010 (Public Law 111–84; 123 Stat. 
2573), amounts transferred to the Joint Department of De-
fense—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 authorized by 
section 8111(d) of title 38, United States Code, to remain 
available until expended, for any purpose authorized by sec-
tion 8111 of title 38, United States Code. 
SEC. 223. None of the funds available to the Depart-
ment of Veterans Affairs, in this or any other Act, may 
be used to replace the current system by which the Veterans 
Integrated Service Networks select and contract for diabetes 
monitoring supplies and equipment. 
SEC. 224. 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: Provided, 
That such notification shall occur within 14 days of a con-
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tract identifying the programmed amount: Provided fur-
ther, That the Secretary shall notify the Committees on Ap-
propriations of both Houses of Congress 14 days prior to 
the obligation of such bid savings and shall describe the an-
ticipated use of such savings. 
SEC. 225. None of the funds made available for ‘‘Con-
struction, Major Projects’’ may be used for a project in ex-
cess of the scope specified for that project in the original 
justification data provided to the Congress as part of the 
request for appropriations unless the Secretary of Veterans 
Affairs receives approval from the Committees on Appro-
priations of both Houses of Congress. 
SEC. 226. 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 Con-
gress a quarterly report containing performance measures 
and data from each Veterans Benefits Administration Re-
gional Office: Provided, That, at a minimum, 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 accompanying Public Law 
114–223: Provided further, That the report shall also in-
clude information on the number of appeals pending at the
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Veterans Benefits Administration as well as the Board of 
Veterans Appeals on a quarterly basis. 
SEC. 227. The Secretary of Veterans Affairs shall pro-
vide written notification to the Committees on Appropria-
tions of both Houses of Congress 15 days prior to organiza-
tional 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. 228. The Secretary of Veterans Affairs shall pro-
vide on a quarterly basis to the Committees on Appropria-
tions of both Houses of Congress notification of any single 
national outreach and awareness marketing campaign in 
which obligations exceed $1,000,000. 
(INCLUDING TRANSFER OF FUNDS) 
SEC. 229. The Secretary of Veterans Affairs, upon de-
termination that such action is necessary to address needs 
of the Veterans Health Administration, may transfer to the 
‘‘Medical Services’’ account not to exceed 1 percent of any 
discretionary appropriations made available for fiscal year 
2026 in this title (except the appropriation made to the 
‘‘General Operating Expenses, Veterans Benefits Adminis-
tration’’ account) or not to exceed 1 percent of any discre-
tionary unobligated balances within the Department of Vet-
erans Affairs, including not to exceed 1 percent of those ap-
propriated for fiscal year 2026, that were provided in ad-
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vance by appropriations Acts: Provided, 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 
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: Pro-
vided further, That, upon determination that all or part 
of the funds transferred from an appropriation are not nec-
essary, such amounts may be transferred back to that ap-
propriation and shall be available for the same purposes 
as originally appropriated: Provided further, That before 
a transfer may take place pursuant to this section, the Sec-
retary of Veterans Affairs must provide written notification 
of the amount and purpose of the transfer to the Committees 
on Appropriations of both Houses of Congress. 
(INCLUDING TRANSFER OF FUNDS) 
SEC. 230. Amounts made available for the Department 
of Veterans Affairs for fiscal year 2026, under the ‘‘Board 
of Veterans Appeals’’ and the ‘‘General Operating Expenses,
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Veterans Benefits Administration’’ accounts may be trans-
ferred between such accounts: Provided, That before a trans-
fer 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. 
SEC. 231. The Secretary of Veterans Affairs may not 
reprogram funds among major construction projects or pro-
grams if such instance of reprogramming will exceed a cu-
mulative $7,000,000, unless such reprogramming is ap-
proved by the Committees on Appropriations of both Houses 
of Congress. 
SEC. 232. (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 professional; 
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 Executive 
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
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† HR 5371 EAS 
Department of Veterans Affairs with respect to such a posi-
tion relating to the hotline specified in subsection (a). 
(2) In this subsection— 
(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 memo-
randum, or other action by the President; and 
(ii) any agency policy, order, or other direc-
tive. 
(c)(1) The Secretary of Veterans Affairs shall conduct 
a study on the effectiveness of the hotline specified in sub-
section (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 con-
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tinue receiving, mental health care who commit sui-
cide; and 
(C) determine the number of veterans described 
in subparagraph (A) who commit or attempt suicide. 
SEC. 233. Effective during the period beginning on Oc-
tober 1, 2018, and ending on January 1, 2027, none of the 
funds made available to the Secretary of Veterans Affairs 
by this or any other Act may be obligated or expended in 
contravention of the ‘‘Veterans Health Administration Clin-
ical Preventive Services Guidance Statement on the Vet-
erans Health Administration’s Screening for Breast Cancer 
Guidance’’ published on May 10, 2017, as issued by the Vet-
erans Health Administration National Center for Health 
Promotion and Disease Prevention. 
SEC. 234. (a) Notwithstanding any other provision of 
law, the amounts appropriated or otherwise made available 
to the Department of Veterans Affairs for the ‘‘Medical 
Services’’ account may be used to provide— 
(1) fertility counseling and treatment using as-
sisted reproductive technology to a covered veteran or 
the spouse of a covered veteran; or 
(2) adoption reimbursement to a covered veteran. 
(b) In this section: