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-
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 $2,000,000. 
(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 2019 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 2019, 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 
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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: 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 2019, under the 
‘‘Board of Veterans Appeals’’ and the ‘‘General Operating 
Expenses, Veterans Benefits Administration’’ accounts 
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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-
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 
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such a position relating to the hotline specified in sub-
section (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 di-
rective. 
SEC. 232. None of the funds in this or any other Act 
may be used to close Department of Veterans Affairs (VA) 
hospitals, domiciliaries, or clinics, conduct an environ-
mental assessment, or to diminish healthcare services at 
existing Veterans Health Administration medical facilities 
located in Veterans Integrated Service Network 23 as part 
of a planned realignment of VA services until the Sec-
retary provides to the Committees on Appropriations of 
both Houses of Congress a report including the following 
elements: 
(1) a national realignment strategy that in-
cludes a detailed description of realignment plans 
within each Veterans Integrated Services Network 
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(VISN), including an updated Long Range Capital 
Plan to implement realignment requirements; 
(2) an explanation of the process by which 
those plans were developed and coordinated within 
each VISN; 
(3) a cost versus benefit analysis of each 
planned realignment, including the cost of replacing 
Veterans Health Administration services with con-
tract care or other outsourced services; 
(4) an analysis of how any such planned re-
alignment of services will impact access to care for 
veterans living in rural or highly rural areas, includ-
ing travel distances and transportation costs to ac-
cess a VA medical facility and availability of local 
specialty and primary care; 
(5) an inventory of VA buildings with historic 
designation and the methodology used to determine 
the buildings’ condition and utilization; 
(6) a description of how any realignment will be 
consistent with requirements under the National 
Historic Preservation Act; and 
(7) consideration given for reuse of historic 
buildings within newly identified realignment re-
quirements: Provided, That, this provision shall not 
apply to capital projects in VISN 23, or any other 
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