[Senate Report 115-130]
[From the U.S. Government Publishing Office]
Calendar No. 173
115th Congress } { Report
SENATE
1st Session } { 115-130
======================================================================
MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES
APPROPRIATION BILL, 2018
_______
July 13, 2017.--Ordered to be printed
_______
Mr. Moran, from the Committee on Appropriations,
submitted the following
REPORT
[To accompany S. 1557]
The Committee on Appropriation reports the bill (S. 1557)
making appropriations for military construction, the Department
of Veterans Affairs, and related agencies for the fiscal year
ending September 30, 2018, and for other purposes, reports
favorably thereon and recommends that the bill do pass.
Amounts in new budget authority
Total of bill as reported to the Senate.................$200,887,098,000
Amount of 2017 appropriations........................... 189,862,366,000
Amount of 2018 budget estimate.......................... 201,453,868,000
Bill as recommended to Senate compared to--
2017 appropriations................................. +11,024,732,000
2018 budget estimate................................ -566,770,000
CONTENTS
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Page
Background:
Purpose of the Bill.......................................... 4
Committee Recommendation..................................... 4
Overview and Summary of Bill................................. 4
Title I:
Military Construction:
Items of Special Interest:
Hearings............................................. 6
Summary of Committee Recommendations................. 6
Reprogramming Guidelines............................. 6
Real Property Maintenance............................ 7
Incremental Funding.................................. 7
Other Matters........................................ 7
Military Construction Overview........................... 15
Military Construction, Army.............................. 15
Military Construction, Navy and Marine Corps............. 17
Military Construction, Air Force......................... 19
Military Construction, Defense-Wide...................... 20
Military Construction, Army National Guard............... 22
Military Construction, Air National Guard................ 22
Military Construction, Army Reserve...................... 23
Military Construction, Navy Reserve...................... 23
Military Construction, Air Force Reserve................. 23
North Atlantic Treaty Organization Security Investment
Program................................................ 23
Department of Defense Base Closure Account............... 24
Family Housing Overview.................................. 24
Family Housing Operation and Maintenance, Army........... 25
Family Housing Operation and Maintenance, Navy and Marine
Corps.................................................. 25
Family Housing Operation and Maintenance, Air Force...... 25
Family Housing Operation and Maintenance, Defense-Wide... 25
Family Housing Construction, Army........................ 25
Family Housing Construction, Navy and Marine Corps....... 26
Family Housing Construction, Air Force................... 26
Department of Defense Family Housing Improvement Fund.... 26
Department of Defense Military Unaccompanied Housing
Improvement Fund....................................... 26
Administrative Provisions................................ 27
Title II:
Department of Veterans Affairs:
Items of Special Interest:
Hearings............................................. 29
Summary of Committee Recommendations................. 29
Department Overview.................................. 29
Veterans Benefits Administration......................... 32
Compensation and Pensions............................ 33
Readjustment Benefits................................ 34
Veterans Insurance and Indemnities................... 34
Veterans Housing Benefit Program Fund................ 35
Vocational Rehabilitation Loans Program Account...... 35
Native American Veteran Housing Loan Program Account. 36
General Operating Expenses, Veteran Benefits
Administration..................................... 37
Veterans Health Administration........................... 41
Medical Services..................................... 44
Medical Community Care............................... 67
Medical Support and Compliance....................... 69
Medical Facilities................................... 70
Medical and Prosthetic Research...................... 71
Medical Care Cost Recovery Collections............... 74
National Cemetery Administration......................... 75
Departmental Administration.............................. 75
General Administration............................... 76
Board of Veterans Appeals............................ 77
Information Technology Systems....................... 78
Office of Inspector General.......................... 80
Construction, Major Projects......................... 80
Construction, Minor Projects......................... 82
Grants for Construction of State Extended Care
Facilities......................................... 83
Grants for Construction of Veterans Cemeteries....... 83
Administrative Provisions................................ 84
Title III:
Related Agencies:
American Battle Monuments Commission:
Salaries and Expenses................................ 88
Foreign Currency Fluctuations........................ 88
United States Court of Appeals for Veterans Claims:
Salaries and Expenses.................................. 89
Department of Defense--Civil: Cemeterial Expenses, Army:
Salaries and Expenses................................ 89
Armed Forces Retirement Home: Trust Fund................. 90
Administrative Provisions................................ 91
Title IV: Overseas Contingency Operations........................ 92
Title V: General Provisions...................................... 93
Program, Project, and Activity................................... 94
Compliance With Paragraph 7, Rule XVI, of the Standing Rules of
the
Senate......................................................... 94
Compliance With Paragraph 7(c), Rule XXVI of the Standing Rules
of the Senate.................................................. 96
Compliance With Paragraph 12, Rule XXVI of the Standing Rules of
the Senate..................................................... 97
Budgetary Impact of Bill......................................... 105
Military Construction Project Listing by Location................ 106
Overseas Contingency Operations.................................. 121
Comparative Statement of Budget Authority........................ 123
BACKGROUND
Purpose of the Bill
The Military Construction, Veterans Affairs, and Related
Agencies appropriations bill provides necessary funding for the
planning, design, construction, alteration, and improvement of
military facilities worldwide. It also finances the cost of
military family housing and the U.S. share of the NATO Security
Investment Program. In addition, the bill provides funding,
including environmental remediation, for base closures and
realignments authorized by law. The bill provides resources to
the Department of Veterans Affairs for veterans benefits and
healthcare and funding for U.S. cemeteries and battlefield
monuments both in the United States and abroad, including the
American Battle Monuments Commission and Arlington National
Cemetery. Additionally, the bill funds the U.S. Court of
Appeals for Veterans Claims and the Armed Forces Retirement
Homes.
Committee Recommendation
The Committee recommends new budget authority totaling
$200,887,098,000 for fiscal year 2018 military construction,
family housing, base closure, veterans healthcare and benefits,
including fiscal year 2019 advance appropriations for veterans
medical care and appropriated mandatories, and related
agencies. This includes $107,723,000,000 in mandatory funding
and $93,164,098,000 in discretionary funding. The table at the
end of the report displays the Committee recommendation in
comparison with the current fiscal year and the President's
fiscal year 2018 request.
APPROPRIATIONS FOR FISCAL YEAR 2018
------------------------------------------------------------------------
Senate
Budget request recommendation
------------------------------------------------------------------------
New budget authority........ $201,453,868,000 $200,887,098,000
Previous advances provided 66,385,032,000 66,385,032,000
for fiscal year 2018 for
medical care...............
Previous advances provided 103,935,996,000 103,935,996,000
for fiscal year 2018 for
appropriated mandatories...
Less advances provided for -70,699,313,000 -70,700,000,000
fiscal year 2019 for
medical care...............
Less advances provided for -107,709,727,000 -107,710,000,000
fiscal year 2019 for
appropriated mandatories...
-------------------------------------------
Total appropriations 193,365,856,000 192,798,126,000
for fiscal year 2018.
------------------------------------------------------------------------
Overview and Summary of Bill
The Military Construction, Veterans Affairs, and Related
Agencies appropriations bill funds an array of programs that
are vital to America's military personnel and their families,
and to the Nations' veterans. For U.S. military forces and
their families worldwide, the bill funds critical
infrastructure, ranging from mission essential operational and
training facilities to key quality-of-life facilities,
including barracks, family housing, child care centers,
schools, and hospitals.
For America's 21.4 million veterans, the bill provides the
necessary funding for veterans benefits and healthcare, from
prescription drugs and clinical services to the construction of
hospitals and other medical facilities throughout the Nation.
The bill also funds veterans cemeteries in the United
States and provides funding for four independent agencies--the
American Battle Monuments Commission, the U.S. Court of Appeals
for Veterans Claims, Arlington National Cemetery, and the Armed
Forces Retirement Homes.
TITLE I
MILITARY CONSTRUCTION
Items of Special Interest
HEARINGS
The Subcommittee on Military Construction, Veterans
Affairs, and Related Agencies held one hearing related to the
fiscal year 2018 military construction budget request.
Witnesses included representatives of the Army, Navy, Marine
Corps, Air Force, and the Office of the Secretary of Defense.
SUMMARY OF COMMITTEE RECOMMENDATIONS
The fiscal year 2018 budget request for military
construction and family housing totals $9,782,451,000. The
Committee recommends $9,536,000,000, which is $246,451,000
below the President's budget request.
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) which has
been specifically reduced by the Congress in acting on the
budget request is considered to be a congressional interest
item and as such, prior approval is required. Accordingly, no
reprogrammings to an item specifically reduced below the
threshold by the Congress are permitted.
The reprogramming criteria that apply to military
construction projects (25 percent of the funded amount or
$2,000,000, whichever is less) continue to apply to new housing
construction projects and to improvements over $2,000,000. 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, provided that such remediation
requirements could not be reasonably anticipated at the time of
the budget submission. 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.
Furthermore, in instances where prior approval of a
reprogramming request for a project or account has been
received from the Committee, the adjusted amount approved
becomes the new base for any future increase or decrease via
below-threshold reprogrammings (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
reprogrammings and notifications, including the pertinent
statutory authorities contained in Department of Defense [DoD]
Financial Management Regulation 7000.14-R and relevant updates
and policy memoranda.
REAL PROPERTY MAINTENANCE
The Committee recommends a continuation of the following
general rules for repairing a facility under ``Operation and
Maintenance'' account funding:
--Components of the facility may be repaired by replacement,
and such replacement may be up to current standards or
code.
--Interior arrangements and restorations may be included as
repair, but additions, new facilities, and functional
conversions must be performed as military construction
projects.
--Such projects may be done concurrent with repair projects,
as long as the final conjunctively funded project is a
complete and usable facility.
--The appropriate Service Secretary shall submit a 21-day
notification prior to carrying out any repair project
with an estimated cost in excess of $7,500,000.
The Department is directed to continue to report on the
real property maintenance backlog at all installations for
which there is a requested construction project in future
budget requests. This information is to be provided on the form
1390. In addition, for all troop housing requests, the form
1391 is to continue to show all real property maintenance
conducted in the past 2 years and all future requirements for
unaccompanied housing at that installation.
INCREMENTAL FUNDING
In general, the Committee supports full funding for
military construction projects. However, it continues to be the
practice of the Committee to provide incremental funding for
certain large projects, despite administration policy to the
contrary, to enable the services to more efficiently allocate
military construction dollars among projects that can be
executed in the year of appropriation. Therefore, the Committee
recommends incremental funding for three projects.
OTHER MATTERS
Naval Shipyard Modernization.--The Committee is concerned
with likely impacts to Fleet readiness and operational
availability of Navy ships and submarines in the absence of
significant long-term improvements to public shipyard
infrastructure and major dry dock capacity. In a 2013 report to
Congress pursuant to the requirements in Section 2865 of the
Fiscal Year 2012 National Defense Authorization Act (Public Law
112-81), the Navy identified a $3,450,000,000 maintenance
backlog comprising more than 1,000 facilities at the public
shipyards.
The Committee is aware that public shipyards involved in
Navy ship maintenance face a number of challenges in completing
maintenance on time, including unanticipated work requirements,
workforce inexperience, workload fluctuations, and inadequate
facilities. These challenges are exacerbated by the failing
conditions of facilities across all four public shipyards. For
example, Norfolk Naval Shipyard has 130 facilities in failing
condition, including 17 mission-critical facilities. These
deteriorated facility conditions combined with an inefficient
and outdated layout of functions at the yards have a direct,
negative impact on the readiness of naval forces as well as the
life, safety and health of sailors and the civilian workforce
at the public shipyards. At the Portsmouth Naval Shipyard,
increasing workload is making it difficult to schedule
necessary maintenance on its three nuclear qualified dry docks.
Within the next 5 years, the workload at Portsmouth will exceed
the available capacity of the dry docks. Additionally, critical
components will reach the end of their service life soon,
placing great strain on the ability to support maintenance on
Los Angeles- and Virginia-class submarines. Significant
military construction is needed to expand and modernize Dry
Dock 1 to meet the growing maintenance requirements of the
submarine fleet.
The Committee also notes that while the Navy has
prioritized dry docks and piers over other failing facilities,
it is nevertheless taking risks in its dry dock infrastructure.
Without significant dry dock investments, the public shipyards
will be unable to meet the Navy's surface and subsurface
maintenance and inactivation requirements through 2040. For
example, at Pearl Harbor Naval Shipyard, the Navy has
identified an urgent requirement to extend Dry Dock 3 and build
a 500 foot-long concrete lock at the entrance of the dry dock.
These improvements are essential to sustain Fleet readiness in
the Pacific and provide maintenance for Virginia-class
submarines but remain unprogrammed in the Navy's Future Years
Defense Plan budget for military construction. Similarly, at
Puget Sound Naval Shipyard in Washington State, the Navy has
been forced to develop mitigation strategies to maximize the
use of Dry Dock 1 to accommodate Los Angeles-class submarine
availabilities and inactivations, as well as availabilities on
all Virginia-class submarines.
Finally, the Committee notes that the Navy is investing in
existing facilities that may not be ideally designed, placed,
sized or configured to support the current work processes,
leading to inefficiencies in ship repair functions. In order
for resources to be expended prudently for maximum benefit for
shipyard operations, the Navy must first review industrial
processes, logistics streams and workload distribution to
develop a facilities plan that optimizes ship repair processes.
Therefore, the Committee directs the Secretary of the Navy to
submit a report by February 1, 2018, providing an engineering
master plan for the optimal placement of facilities and major
equipment to support ship repair functions at each public
shipyard, including an investment strategy to address the
infrastructure requirements at each shipyard. The report shall
include the following elements:
--A review of current and projected workload requirements for
ship repairs to assess efficiencies in the use of
existing facilities including consideration of new ship
characteristics, obsolescence of facilities, siting of
facilities and equipment, and various constrained
process flows;
--An analysis of life cycle costs to repair and modernize
existing mission essential facilities versus the cost
to consolidate functions into modern, right-sized
waterfront facilities to meet current and programmed
future mission requirements;
--A review of the progress made in prioritizing and funding
projects that facilitate implementation of the hub
concept for ship repair in order to improve process
efficiencies, and contribute to availability cost and
schedule reductions;
--A Master Plan for each shipyard incorporating the results
of a review of industrial processes, logistics streams
and workload distribution required to support ship
repairs at each shipyard and the facilities
requirements to support optimized processes; and
--An updated investment strategy planned for each public
shipyard, including timelines to complete the
masterplan for each shipyard, a list of projects and
brief scopes of work, and cost estimates necessary to
complete projects for mission essential facilities.
Informed by the results of this study, the Committee urges
the Navy to prioritize infrastructure investment in its
shipyards within the Department's future years military
construction budget planning.
Federal, State and Local Intelligence Collaboration.--The
Committee is aware that several States utilize National Guard
facilities for intelligence fusion centers according to their
respective State authorities. These centers allow Federal,
State, local, and tribal law enforcement officials to
collaborate and share intelligence and threat information, and
co-locating them with National Guard facilities offers
opportunities for cost savings. Therefore, the Committee urges
the Department, the services, and the National Guard Bureau to
prioritize needed workplace replacement projects, including
Sensitive Compartmented Information Facility [SCIF] projects to
conduct State and Federal intelligence analysis, in the fiscal
year 2019 and future budget submissions.
Historic Buildings.--The Committee recognizes the
historical value of many of our Nation's military
installations, and the need for preserving these historic sites
for posterity. However, the Committee is also aware of the
challenges of maintaining historical buildings, particularly
those that are still in use today. On certain military
installations, these historical structures are still used for
housing and other purposes, which can lead to a struggle to
balance maintaining hospitable living and work environments
with preserving the historical status of the building. The
Committee requests that the Government Accountability Office
conduct a review that assesses historical structures or sites
on Department installations in the United States that may be
utilized for housing and for other purposes. The review shall
include qualitative analysis as it relates to State and Federal
regulatory standards for habitation, and also provide
recommendations concerning the Department's processes and
procedures for assessing whether certain structures or sites
require renovation to meet State and Federal regulatory
standards for habitation or other uses as warranted.
DoD Installation Energy Policy.--Department of Defense
[DoD] installation energy use accounts for nearly a quarter of
all Federal Government energy consumption. In fiscal year 2015,
according to DoD's Annual Energy Management Report, the
Department spent $3,900,000 on installation energy. While DoD
has made great strides in increasing installation energy
efficiency and reducing overall energy consumption, more needs
to be done to bring down the energy costs throughout the
Department. DoD must also ramp up its efforts to enhance energy
security on its installations through a range of actions,
including investing in renewable energy and smart technology
that can shield mission-critical operations from disruptions to
the power grid. According to a January 2017 report commissioned
by the Pew Charitable Trusts (``Power Begins at Home: Assured
Energy for U.S. Military Bases''), DoD could enhance energy
security on installations and save hundreds of millions of
dollars annually by investing in microgrids and renewable
energy systems, and by increasing energy efficiency on military
bases. The report found that microgrid power systems are more
reliable than the stand-alone diesel generators typically used
for backup power and could save $8,000,000 to $20,000,000 over
a 20-year period. The report also found that DoD could save as
much as $1,000,000,000 a year simply by increasing the use of
commercially available energy efficiency measures in its
facilities. The Committee notes that military installations in
Hawaii are among those at the forefront of DoD's efforts to
increase energy efficiency and security, including projects to
develop net-zero energy military housing and installation
facilities, upgrade and retrofit systems to improve energy and
water efficiency, and demonstrate microgrid technology. The
Committee supports DoD's investments in energy efficiency,
renewable energy systems, and energy security, including
through the Energy Resilience and Conservation Investment
Program [ERCIP]. The fiscal year 2018 ERCIP request of
$150,000,000 provides funding for 26 projects, including 7
energy resilience, 12 energy efficiency, 5 renewable energy,
and 2 water conservation projects. The Committee recommends an
increase of $15,000,000 above the request for ERCIP and
encourages the Department to prioritize funding for energy-
related projects, including renewable energy projects, to
mitigate risk to mission-critical assets and promote energy
security and efficiency at military installations.
Major Range and Test Facility Base [MRTFB].--The Committee
recognizes the strategic importance of the key Department of
Defense [DoD] installations, ranges and facilities that
comprise the Major Range and Test Facility Base [MTRFB]. These
ranges, which include Army, Navy, Air Force and Defense Agency
facilities in more than 20 locations, are designated by DoD as
``national assets'' because of their critical role in
maintaining the Nation's military technological advantage.
However, the Committee is concerned about the lack of
investment and sustainment of these facilities. For example,
White Sands Missile Range in New Mexico, which is the Nation's
largest overland testing facility, has not received a military
construction project in support of test and evaluation missions
in over a decade. As a result, support for critical testing on
missile systems such as the Standard Missile-2 [SM2], Patriot
Missile system [PAC3], JASSM, CALCM, and others may be
adversely impacted. The Barking Sands Tactical Underwater Range
at the Pacific Missile Range Facility in Hawaii exceeded its
20-year design service life in 2014. Key underwater cables have
been repeatedly repaired in recent years, but the Navy has
determined that future repairs of the seafloor cables are not
feasible. The Air Force Development Test Center's [AFDTC]
overall mission is to plan conduct, and evaluate testing of
U.S. and allied nonnuclear munitions, electronic combat, target
acquisitions, weapon delivery, base intrusion protection, and
supporting systems. AFDTC carries out this work at Eglin Air
Force Base, FL, whose land test areas encompass 463,000 acres,
and water test areas cover 86,500 square miles in the Gulf of
Mexico, the largest DoD test and training area in the world.
In order to continue to conduct safe and robust testing of
our military's newest munitions and systems, deployed by our
fastest and longest-range aircraft, surface, and subsurface
vessels, test and training range infrastructure and
instrumentation must be modernized. The lack of needed
investment at MRTFB facilities jeopardizes future technology
development and threaten the Nation's ability to counter
emerging threats. The Committee therefore directs the Secretary
of Defense to submit a comprehensive MRTFB modernization plan
within 180 days of enactment of this act outlining a timetable
and specific actions for repair, replacement and renovation of
infrastructure, equipment and instrumentation at mission-
critical facilities.
Infrastructure to Support Third Offset Capabilities.--The
Committee notes that the Department of Defense is increasing
investments in a number of technology areas to support the
Third Offset strategy, an effort to offset declining
technological superiority over near peer rivals using targeted
investments in advanced technologies and through the
development of new operational concepts using existing and next
generation systems. This includes increased funding in undersea
warfare, robotics, directed energy, hypersonics, and precision
munitions, among other areas. The Committee is concerned that
these investments are not being matched by coordinated funding
of modern research and testing infrastructure that will ensure
that these new systems and technologies are developed and
tested as efficiently and quickly as possible, and are deployed
to operational forces as soon as feasible. In testimony to the
Subcommittee on Defense, Deputy Secretary of Defense Robert
Work acknowledged the importance of investing in this type of
research infrastructure, although the current Future Years
Defense Plan includes very few military construction projects
that support research or testing activities. The Committee
directs the Secretary of Defense to develop a plan for
investments in research and testing infrastructure, including
through major military construction projects that support
development of Third Offset capabilities. The strategy should
make clear how the infrastructure investments will be timed so
that they are coordinated with planned programs of record. The
Committee directs that the plan be delivered to the
congressional defense committees no later than 1 year after the
date of enactment of this act.
Water Conservation on Military Installations.--The Senate
Report accompanying H.R. 5325 (S. Rept. 114-237) included
language highlighting the status of water use on military
installations, the vulnerability of installations to water
scarcity, and water conservation potential at military
installations based on both reduced water use and cost savings.
The report directed the Secretary of Defense to report to the
Committees on Appropriations of both Houses of Congress on the
current status of water demand and potential water
conservations opportunities across U.S. military installations,
including water usage rates, water scarcity vulnerabilities,
water conservation potential from reduced water usage, and
potential cost savings from water conservation technologies.
The Committee notes that the report is currently 90 days
overdue and directs the Secretary to provide the report no
later than October 1, 2017.
Sea Level Rise and Coastal Erosion.--The Committee is
concerned about the increasingly harmful impact of sea level
rise and flooding on facilities at DoD's coastal military
installations, both in the United States and overseas. A June
30, 2014, Government Accountability Office [GAO] report to
Congress, (GAO-14-446, ``Climate Change Adaptation: DoD Can
Improve Infrastructure Planning and Processes to Better Account
for Potential Impacts'') assessed 15 sites at defense
installations in the U.S. that are vulnerable to the effects of
climate change and provided recommendations to improve
readiness and reduce fiscal exposure for DoD.
Among several compelling findings, GAO noted that DoD
officials are concerned that the combination of thawing
permafrost, decreasing sea ice, and rising sea levels on the
Alaskan coast have increased coastal erosion at several Air
Force radar early warning and communication installations.
Further, Navy officials are concerned that if a storm surge
occurs while a submarine is undergoing maintenance while
sitting in a dry dock, substantial repair costs likely would be
needed. Officials told GAO that if salt water floods the
submarine's systems, it could result in severe damage.
In a July 23, 2015, report to Congress regarding the
security implications of climate-related risks, the Department
noted that it had directed a global screening level assessment
to determine installation vulnerabilities to climate-related
security risks with the goal of identifying serious
vulnerabilities and developing necessary adaptation strategies.
Senate Report 114-237 accompanying the fiscal year 2017
Military Construction, Veterans Affairs, and Related Agencies
Appropriations Act included language directing the Secretary of
Defense to report to the congressional defense committees not
later than 120 days after the enactment of the act on the
findings of that assessment. The Committee notes that the
fiscal year 2017 Military Construction, Veterans Affairs, and
Related Agencies Appropriations Act was signed into law on
September 29, 2016, and that the report is currently more than
90 days overdue. The Committee therefore directs the Secretary
to comply with the directive not later than October 1, 2017.
Understanding the costs associated with mitigation of
climate vulnerabilities is essential to an accurate assessment
of future DoD infrastructure costs. The Committee believes that
DoD must be proactive in assessing the potential effects of
projected climate change on the design, operation, maintenance,
and repair of buildings; utility systems; and storm water
management systems. DoD requires its components to manage the
risks associated with these effects, including changes--as
appropriate--to design and construction standards. The GAO has
noted that extreme weather events have caused tens of millions
of dollars in damage to DoD infrastructure and that these types
of extreme weather events are expected to become more frequent
or severe with climate change. The Committee expects that DoD
will implement an effective approach to analyzing and
addressing the potential impacts of climate change on military
construction projects during the design phase to mitigate the
need for future costly repair or restoration requirements.
Therefore, the Committee directs the Comptroller General to
undertake a study of DoD's progress in developing a means to
account for potentially damaging weather in project design, and
to report to the Committees on Appropriations of both Houses of
Congress not later than 180 days after enactment of this act.
At a minimum, the Comptroller General should answer the
following questions:
--What is known about the historical and projected costs for
facilities maintenance and repair beyond expected
repair costs of DoD infrastructure stemming from damage
or degradation caused by weather effects associated
with climate change?
--What best practices has DoD adopted for incorporating
climate change adaptation into the design of military
construction or facilities sustainment, restoration, or
modernization projects?
--To what extent has DoD developed a systematic process for
ensuring climate change or severe weather effects are
accounted for in the design of military construction
and facilities sustainment, modernization, or
restoration projects?
Local Hiring in Military Construction.--In March 2015 the
Federal Highway Administration and the Federal Transit
Administration implemented a Local Labor Hiring Pilot Project
which aims to increase local, low income and veteran employment
in construction projects funded by those agencies. The pilot
project was recently extended through 2022. The Committee
encourages the Department of Defense to consider implementing a
similar pilot project with respect to military construction.
The Secretary of Defense is directed to report to the
Congressional defense committees within 6 months of the date of
enactment of this act on the feasibility of implementing such a
program.
Remotely Piloted Aircraft and Joint Use Military/Civilian
Airports.--The Committee is concerned that many existing
Airport Joint Use Agreements [AJUA] were not written to
accommodate the increasing use of remotely piloted aircraft
[RPAs]. In some instances, a long term AJUA may need
significant modifications to allow for the use of RPAs and to
calculate the appropriate Federal compensation. Therefore, the
Committee directs the Secretary of Defense to conduct a review
of the authorities needed to update AJUAs and associated
compensation for airfields impacted by a transition to RPA
missions, and to report such findings to the congressional
defense committees no later than March 30, 2018.
Special Operations Command Training Opportunities.--
Abandoned mine land and surface reclamation projects throughout
the Nation can provide a unique environment for military
training and range capabilities, to include mobility and
irregular warfare opportunities for the Special Operations
Command [SOCOM]. The Committee urges SOCOM to work with the
National Guard Bureau and the States on the development of such
sites to meet its unique training requirements.
Viability of Armed Forces Reserve Centers.--The Committee
is aware of the proposed closure of certain recently
constructed reserve centers due to a lack of usage. This raises
concerns about the adequacy and accuracy of the personnel and
unit forecasting that led to the construction of such
facilities. The Committee directs the Department of Defense to
submit a report on the status of all reserve centers
constructed during the last 15 years, to include those
facilities that were built as part of the 2005 BRAC round. The
report should include a detailed assessment of individual
facility usage rates, identify underutilized or unutilized
facilities, include an assessment of the cause of any
utilization shortfalls, and include a review of any personnel
or units re-stationed away from recently constructed
facilities.
Accidental window fall prevention.--The Committee is
concerned about the risks of unintentional falls from windows
in military family housing. Deaths and injuries often occur
when children push against window screens or climb onto
furniture located near an open window. Therefore, not later
than 180 days after the date of enactment of this act, the
Committee directs the Department of Defense to update its
Unified Facilities Criteria [UFC] for Family Housing (UFC 4-
711-01) to require that all new and existing residential
buildings have corrosion-resistant screens that meet the ANSI/
SMA6001 specifications for at least Medium loads, or successor
standard; or that windows shall be equipped with window fall
prevention screens, guards, or other devices that comply with
ASTM F2006 or ASTM F2090, or a successor standard.
The Committee also directs the Department of Defense, in
updating its UFC for family housing, to: (1) specify that
military housing privatization partners shall be required to
include window fall prevention screens, guards, or other
devices for military housing and shall not be allowed to seek
waivers or exemptions; (2) conduct an oversight program to
ensure that all military housing be equipped with window fall
prevention screens, guards, or other devices; and (3) establish
an awareness campaign that educates families on window fall
risks and window fall prevention measures. The Secretary of
each military department shall brief the Committee within 1
year of enactment of this act on the following: (a) the extent
to which the Secretary is in compliance with the requirements
of the updates to UFC 4-711-01; and (b) a plan for retrofitting
existing military family housing units that are not in
compliance with the revised UFC 4-711-01.
Military Construction Funding Initiatives.--The bill
includes funding for military construction initiatives to
address important unfunded priorities included in the
Department of Defense's unfunded priority lists provided to
Congress. The Committee notes that in recent years the military
construction budget requests have been at historically low
levels. Amounts budgeted for facility sustainment, restoration,
and modernization are similarly low. The infrastructure
initiatives in unfunded priority lists would ordinarily appear
as part of the annual budget request, but were not included as
the military construction budget remains severely constrained.
For this reason, the Committee includes an additional
$68,800,000 for the Army, $110,100,000 for the Navy and Marine
Corps, $127,300,000 for the Air Force, $83,500,000 for the Army
National Guard, $24,000,000 for the Air National Guard,
$30,000,000 for the Army Reserve, and $35,100,000 for the Air
Force Reserve. All additional funding is reserved for projects
that were included in the unfunded priority lists submitted to
Congress.
Rescissions.--The Committee recommends an administrative
provision rescinding prior year unobligated funds due primarily
to project bid savings and the slow execution of projects.
Military Construction Overview
Appropriations, 2017.................................... $7,726,000,000
Budget estimate, 2018................................... 9,782,451,000
Committee recommendation................................ 9,536,000,000
MILITARY CONSTRUCTION ACCOUNTS--PROGRAM DESCRIPTION
The military construction appropriation provides for
acquisition, construction, installation, and equipment of
temporary or permanent public works, military installations,
facilities, and real property for the Department of Defense.
This appropriation also provides for facilities required as
well as funds for infrastructure projects and programs required
to support bases and installations around the world.
Military Construction, Army
Appropriations, 2017.................................... $513,459,000
Budget estimate, 2018................................... 920,394,000
Committee recommendation................................ 930,394,000
COMMITTEE RECOMMENDATION
The Committee recommends $930,394,000 for the Army for
fiscal year 2018. This amount is $416,935,000 above the fiscal
year 2017 enacted level and $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.
Defense Laboratory Enterprise Facilities and
Infrastructure.--The Committee is concerned the unspecified
minor military construction [UMMC] request is insufficient to
support the Army Laboratories. Threats continue to emerge,
construction costs continue to rise, and outdated laboratory
facilities continue to age. Congress established a higher
threshold for UMMC specifically for laboratories so that the
services can keep up with threats that evolve faster than can
be addressed through the normal military construction planning
process. However, the Army has funded very few laboratory
revitalization projects and the request for UMMC has remained
flat. Therefore, an additional $10,000,000 is provided to
supplement unspecified minor construction projects.
Sunflower Army Ammunition Plant.--The Committee understands
that the U.S. Army is currently managing the environmental
remediation of the Sunflower Army Ammunition Plant [SFAAP]
property in excess of 9,000 acres in DeSoto, Kansas, which was
conveyed to Sunflower Redevelopment, LLC [SRL] through the Army
and the General Services Administration on August 3, 2005. Ten
years after the conveyance, on October 29, 2015, the Army
reinforced its responsibility in writing, ``the Army is
committed to programming the necessary resources to carry out a
long-term clean-up and has, for execution in fiscal year 2016,
awarded several services contracts for the short term
requirements.'' The Army further wrote it would ``issue
competitively sourced clean-up contracts, with Army oversight
to ensure its Comprehensive Environmental Response,
Compensation, and Liabilities Act [CERCLA] Sec. 120(h)
obligation at Sunflower.'' The Army confirmed its intention
``to conduct in-depth coordination with Sunflower
Redevelopment, LLC [SRL] to ensure SRL's redevelopment
priorities are synchronized with the Army managed clean-up
activities.'' However, the Committee is disappointed to learn
that the Army has neglected to communicate regularly with SRL
and far less than the in-depth coordination commitment made by
the Army. The Committee recently learned of ongoing risk
assessments of contaminated portions of SFAAP and expects the
Army will work in consultation and coordination with SRL to
ensure transparency. The Committee further expects that the
findings and recommendations of such assessment will receive
approval from State and Federal regulators regarding allowable
levels of contaminants including, but not limited to,
pesticides, asbestos or other contaminants subject to
remediation for commercial use of the property. The Committee
directs the Secretary of the Army to deliver the assessment and
brief the Committee on its findings and to provide a plan that
ensures SRL's redevelopment priorities are synchronized with
Army managed cleanup activities.
Military Construction at Depots and Arsenals.--The
Committee is concerned about the need to maintain critical
investment in Army depots and arsenals. Maintaining the
physical infrastructure of depots and arsenals, which allows
these installations to operate at peak efficiency, is essential
to maintaining military readiness. However, the Future Years
Defense Program [FYDP] for military construction at Army depots
and arsenals does not reflect the need for investment in the
infrastructure of these facilities, with only two depot or
arsenal military construction projects included in the most
recent FYDP, both in fiscal year 2020. For example, the Detroit
Arsenal which hosts the Army's Tank-automotive and Armaments
Command [TACOM] Life Cycle Management Command and the U.S. Army
Tank Automotive Research Development and Engineering Center,
requires an electrical substation to meet electrical demand for
existing missions at the installation. The Army, which included
this project in its fiscal year 2018 list of unfunded
priorities, noted that the Arsenal must currently rely on
substations located outside its perimeter, presenting
vulnerability and mission security issues. The Committee
therefore urges the Army to prioritize and accelerate
construction of the Detroit Arsenal substation and other
critical arsenal and depot military construction and
infrastructure maintenance investments within the fiscal year
2019 FYDP.
Badger Army Ammunition Plant.--In 2011, an Army Feasibility
Study concluded that an offsite drinking water treatment system
was needed as part of a comprehensive groundwater cleanup
remedy for the former Badger Army Ammunition Plant [BAAP].
Accordingly, in 2015, the Town of Merrimac, Wisconsin, designed
and approved a sanitation district required by the Army to
support such a system, and as recently as May 2016, the Army
noted in writing that ``design of the municipal drinking water
system has been initiated.'' Recently, however, the Army
reversed its plans to construct and operate the drinking water
system. The Committee is concerned about this decision, its
potential to delay the provision of clean drinking water to
homes near the site, and the Army's lack of public
communication regarding the decision.
Therefore, the Committee expects the Army to conduct
required human health risk assessments expeditiously, and if
needed, use expedited contracting authorities. Additionally,
the Committee urges the Army to hold regular public meetings to
update and engage with local stakeholders. The Committee
expects the Army to integrate local priorities in its
remediation plans. Furthermore, within 90 days of the date of
enactment of this act, the Secretary of the Army shall submit
to the Committee a report and provide a corresponding briefing
regarding the Army's rationale and process for approving plans
to construct and operate a drinking water system and its
subsequent decision to terminate such plans, as well as the
Army's completed and planned actions for environmental
restoration at the site.
Military Construction, Navy and Marine Corps
Appropriations, 2017.................................... $1,021,580,000
Budget estimate, 2018................................... 1,616,665,000
Committee recommendation................................ 1,565,665,000
COMMITTEE RECOMMENDATION
The Committee recommends $1,565,665,000 for Navy and Marine
Corps military construction for fiscal year 2018. This amount
is $544,085,000 above the fiscal year 2017 enacted level and
$51,000,000 below the budget request. Further detail of the
Committee's recommendation is provided in the State table at
the end of this report.
Navy Strategic Laydown and Dispersal.--The Committee
recognizes the inherent risk of natural and man-made hazards
associated with the stationing of U.S. capital ships at major
ports, and the Navy's corresponding requirement for the
strategic dispersal of its fleet in the Pacific and Atlantic to
mitigate that risk. During the next Future Years Defense
Program [FYDP], the Navy will begin to expand the fleet as it
seeks to achieve its new force structure goal of having a 355-
ship fleet. The Navy's own internal guidance on making
decisions regarding strategic basing requires that the Navy
consider strategic dispersal strategies and that these
strategies be factored into homeporting decisions to limit the
risk associated with natural disasters or man-made catastrophe.
The Committee believes that strategic dispersal should be a key
consideration in expanding the fleet, and that, as a first
step, the Navy should program military construction funding for
necessary infrastructure to achieve strategic dispersal of its
fleet, beginning with the budget request and FYDP for fiscal
year 2019.
Innovative Ship Design & Technology Integration
Collaboration Center.--The Navy has experienced numerous cost
overruns on recent ship acquisition and development programs.
As the Navy has been tasked by the Administration to reach a
fleet size of 355 ships, it is essential that early stage
design efforts are comprehensive and detailed and account for
flexibility and adaptability in ship designs that allow for
rapid reconfiguration, technology and modular systems
integration, as well as design allowances for likely upgrades.
To accomplish this will require considerable time, effort and
strain on the Navy's ship design community. The Committee is
concerned that the Navy has not established the infrastructure
and associated facilities that allow for effective
collaboration, productivity, and innovation in ship design and
recommends that the Navy prioritize future military
construction programs to include a facility for an Innovative
Ship Design & Technology Integration Collaboration Center. Such
a Collaboration Center would provide a Navy venue to bring
together all relevant ship design personnel, technologists and
stakeholders to ensure that all future ship, submarine and
unmanned vehicle designs are developed in a comprehensive,
efficient and collaborative manner to prevent extended ship
construction timelines. The Committee directs the Navy to
provide a report no later than March 30, 2018 detailing a plan
to invest in infrastructure and facilities that will foster
collaborative ship design.
Advanced Electric Ship Testbed.--The Committee notes the
Navy's continued development of advanced ship electric power
systems to support the integration of high power weapons and
sensors. The Navy's development of these technologies requires
continued investment in its major testing ranges to ensure that
these systems are compatible with the fleet, including new
classes of ships. A cost-effective approach would be a land-
based demonstration site representative of an integrated ship
power system that includes power generation, energy storage,
power distribution, and power loads, and that provides for
testing of high power weapons and sensors. The Committee
directs the Navy to assess the feasibility of developing a
land-based advanced electric ship testbed to test and evaluate
high power weapons and systems, identifying what technologies
the Navy must still mature to build such a testbed and the
factors that would influence the siting of a testbed, such as
cost, security, integrated electric grid, ability to integrate
a weapon system on site, minimal encroachment, access to the
open ocean for eventual operationally relevant testing. The
Committee directs the Department to submit this report no later
than March 30, 2018.
Navy Yard Land Acquisition.--The Committee does not
recommend providing $60,000,000 as requested by the Navy to
acquire four acres of land adjacent to the Navy Yard in
Southeast Washington, D.C., to provide an anti-terrorism force
protection [ATFP] buffer zone. Although the Committee supports
enhancing ATFP measures at the Navy Yard, it is concerned by
the high price of the land acquisition and by the budget
justification explanation that the Navy's recommended use of
the land is for a Navy Museum. The Committee questions whether
the Navy fully explored alternative options for the acquisition
and use of the land, including consultation with other Federal
agencies to evaluate the potential use of this parcel to meet
pending land acquisition requirements for other Federal
agencies. The Committee also notes that the proposed land
acquisition addresses only a portion of the Navy Yard's ATFP
deficiencies. The Secretary of the Navy is therefore directed
to provide a report to the Committees on Appropriations of both
Houses of Congress no later than 180 days after enactment of
this act on a Government-wide assessment of the potential uses
by other Federal agencies for the proposed Navy Yard land
acquisition and a comprehensive ATFP Master Plan for the Navy
Yard.
Military Construction, Air Force
Appropriations, 2017.................................... $1,491,058,000
Budget estimate, 2018................................... 1,738,796,000
Committee recommendation................................ 1,569,296,000
COMMITTEE RECOMMENDATION
The Committee recommends $1,569,296,000 for the Air Force
in fiscal year 2018. This amount is $78,238,000 above the
fiscal year 2017 enacted level and $169,500,000 below the
budget request. Further detail of the Committee's
recommendation is provided in the State table at the end of
this report.
Air Force Ballistic Missile Facilities.--The Committee is
concerned with the deteriorating infrastructure of the ground-
based intercontinental ballistic missile [ICBM] facilities at
Malmstrom Air Force Base [AFB], Montana; Minot AFB, North
Dakota; and F.E. Warren AFB, Wyoming. The Missile Alert
Facilities [MAF] at these bases are in advanced states of
disrepair. For example, the Committee is aware that the power
lines providing electricity to these ICBM launch facilities
were constructed in the 1960s in conjunction with the
deployment of the original Minuteman ICBM. In order to ensure
these launch facilities retain a reliable source of power
through 2075, the expected lifespan of the Ground Based
Strategic Deterrent [GBSD] program, these power lines
eventually will require replacement. In April 2017, the Air
Force provided the Committee with a study that highlighted the
need to recapitalize the MAFs. The report also noted that while
the Air Force is developing plans to recapitalize MAFs, the Air
Force does not have a reliable estimate of military
construction requirements at this time.
Infrastructure is critically important to the nuclear
mission, and the Committee urges the Secretary of the Air Force
to finalize MAF recapitalization requirements; upon being
finalized, the Secretary of the Air Force is directed to
provide these MAF recapitalization requirements to the
Committee. The report should include an assessment of the
reliability of existing power lines, a review of Federal
partnerships with local electrical cooperatives to build and
maintain power lines, and an estimate of when investments in
electrical power will be required. The Committee also directs
the Secretary of the Air Force to provide an assessment of the
lessons learned in fielding the prototype Weapons Storage
Facility at F.E. Warren, and the timeline to replace Weapons
Storage Facilities at Malmstrom and Minot.
Presidential Aircraft Recapitalization Complex.--The
Committee notes that the work in progress curve submitted with
the budget request shows that the Air Force cannot execute the
full request of $254,000,000. Therefore, the Committee provides
$100,000,000 for the first increment of this project.
KC-46 Main Operating Base 4.--The Committee notes that the
budget request included a funding wedge for the KC-46 Main
Operating Base 4. Shortly after the budget submission, the
Secretary of the Air Force announced that the first aircraft
would arrive at Joint Base McGuire-Dix-Lakehurst in fiscal year
2021 and the first aircraft will arrive at Travis Air Force
Base in fiscal year 2023. Accordingly, the Committee provides
funding for the specific KC-46 Main Operating Base 4 projects
at the designated locations rather than the unspecified wedge.
Furthermore, as a result of the Secretary of the Air Force's
sequencing decision, the Committee defers funding on three
associated projects at Travis Air Force Base pending further
review, and directs the Air Force to promptly provide an
updated schedule for these projects.
Launch Support and Infrastructure Modernization.-- The
Launch and Test Range System [LTRS] located at the Eastern
Range (Patrick AFB, Cape Canaveral AS and Kennedy SC, FL) and
the Western Range (Vandenberg AFB, CA) consists of ground based
surveillance, navigation, flight operations and analysis,
command and control, communications and weather assets used to
support space missions. The mission is to provide DOD, NASA and
commercial customers a highly reliable, integrated system to
support spacecraft launch, ballistic missile and aeronautical
testing. The Committee is concerned with the current state of
space launch support and infrastructure as launch schedules
continue to increase in tempo. The Committee directs the
Secretary of Defense to provide a report to the congressional
defense committees not later than 120 days after the enactment
of this act on the plan for the implementation of launch
support and infrastructure modernization program. The report
shall include a description of plans and the resources needed
to improve launch support infrastructure, utilities, support
equipment, and range operations; a description of plans to
streamline and normalize processes, systems, and products at
the Eastern and Western ranges, to ensure consistency for range
users; and recommendations for improving transparency,
flexibility, and responsiveness in launch scheduling.
Military Construction, Defense-Wide
(INCLUDING TRANSFER OF FUNDS)
Appropriations, 2017.................................... $2,025,444,000
Budget estimate, 2018................................... 3,114,913,000
Committee recommendation................................ 2,612,583,000
COMMITTEE RECOMMENDATION
The Committee recommends $2,612,583,000 for projects
considered within the Defense-Wide account in fiscal year 2018.
This amount is $587,139,000 above the fiscal year 2017 enacted
level and $502,330,000 below the budget request. Further detail
of the Committee's recommendation is provided in the State
table at the end of this report.
Hydrant Fuel Systems in Support of Humanitarian Assistance
and Disaster Relief Operations.--The Committee notes that the
Department of Defense has a long history of successfully
conducting urgently needed humanitarian assistance and disaster
relief [HADR] missions. In recent years HADR missions have
responded to major earthquakes, tsunamis, typhoons, hurricanes,
floods, and the nuclear disaster in Fukushima, Japan. The
Committee believes that hydrant fuel systems capable of
supporting large scale fueling of heavy aircraft are an
essential component of our HADR capability. The Committee
encourages the services and the Defense Logistics Agency to
prioritize construction and enhancement of these systems in
locations that serve as staging bases for HADR operations.
Fort Bliss Hospital Replacement.--The Committee is deeply
concerned about the past performance of the Army Corps of
Engineers [the Corps] in its management of major Defense Health
Agency [DHA] construction projects. Recently, the Corps reached
a $22,000,000 settlement with its contractors involved with the
Irwin Army Community Hospital at Fort Riley, Kansas. The
settlement resulted from ``design deficiencies and associated
delays.'' Earlier this year, the Committee approved a
$74,000,000 reprogramming request to cover cost overruns on the
Fort Bliss Hospital replacement project. This additional
funding was needed to cover ``design errors, design omissions,
and settlement of contractor requests for equitable
adjustments.'' These are two examples of a pattern of
mismanagement and a lack of accountability from the Corps that
raise questions about the cost estimates and the planned
execution of major projects included in DHA's fiscal year 2018
budget request, which represents an increase of more than
$550,000,000 from the fiscal year 2017 enacted level. Given
that DHA already has 45 active construction projects underway
worldwide totaling more than $5,000,000,000, the need for
effective and efficient project management is clear.
The Committee is not convinced that the $251,000,000
requested as the final increment for the Fort Bliss Hospital
will, in fact, be the final increment. Continued delays and an
extensive backlog of contractor claims against the Corps will
likely result in another increment or another request to
reprogram funds onto the project. This is a subject the
Committee will conduct extensive oversight on in the coming
months. As a result, the Committee provides $100,000,000 for
Increment 8 of the Fort Bliss Hospital Replacement and directs
the Secretary of the Army not later than 90 days after the
enactment of this act to submit a report listing projects
managed by the Army Corps of Engineers that resulted in a
settlement with a contractor, to include settlement cost,
dating back to 2010.
Fort Leonard Wood Hospital Replacement.--The Committee
notes that the work in progress curve submitted by the Defense
Health Agency shows it is unable to execute the full
$250,000,000 request in fiscal year 2018. Therefore, the
Committee provides $100,000,000 for the first increment of this
project.
National Geospatial Intelligence Agency West Campus.--The
Committee is concerned that the Administration chose to request
funding for this project in two phases, rather than
incrementally. The Committee notes that similar large buildings
designed for intelligence missions for the National Security
Agency are incrementally funded. The work in progress curve
submitted with the budget request shows that the NGA can only
execute a fraction of the $381,000,000, and will not take
possession of the required land until the 4th quarter of fiscal
year 2018. The Committee believes this is a textbook example of
a project that should be incrementally funded. Therefore, the
Committee provides $175,000,000 for the first increment of this
project.
Military Construction, Army National Guard
Appropriations, 2017.................................... $232,930,000
Budget estimate, 2018................................... 210,652,000
Committee recommendation................................ 210,652,000
COMMITTEE RECOMMENDATION
The Committee recommends $210,652,000 for Military
Construction, Army National Guard for fiscal year 2018. This
amount is $22,278,000 below the fiscal year 2017 enacted level
and equal to the budget request. Further detail of the
Committee's recommendation is provided in the State table at
the end of this report.
Army National Guard Readiness Center Transformation Plan.--
The Committee remains concerned by the deteriorating condition
of the Army National Guard Readiness Center national portfolio
and the Army's lack of an implementable investment plan to
address it. In April 2017, the Army submitted a report on a
plan to implement the National Guard's ``Affordable Readiness''
Transformation Plan, as required by last year's Committee
report. However, the Army failed to include any meaningful
investment strategy for closing the gap between the resources
required by the ``Affordable Readiness'' scenario's 15-year
implementation timeline and the resources currently budgeted by
the Department over the same period. Therefore, the Committee
directs the Army to provide a report no later than March 30,
2018 on such an investment strategy, including detailed
estimates of the annual resources, activities, and possible
budgetary tradeoffs required to make progress toward the
``Affordable Readiness'' scenario. Further, the Committee
encourages the Department to use the National Readiness
Portfolio to prioritize investment in facilities with low
readiness ratings, and to examine where efficiencies and cost-
sharing can be achieved by co-locating Readiness Centers with
other public facilities.
Military Construction, Air National Guard
Appropriations, 2017.................................... $143,957,000
Budget estimate, 2018................................... 161,491,000
Committee recommendation................................ 161,491,000
COMMITTEE RECOMMENDATION
The Committee recommends $161,491,000 for Military
Construction, Air National Guard for fiscal year 2018. This
amount is $17,534,000 above the fiscal year 2017 enacted level
and equal to the budget request. Further detail of the
Committee's recommendation is provided in the State table at
the end of this report.
Military Construction, Army Reserve
Appropriations, 2017.................................... $68,230,000
Budget estimate, 2018................................... 73,712,000
Committee recommendation................................ 73,712,000
COMMITTEE RECOMMENDATION
The Committee recommends $73,712,000 for Military
Construction, Army Reserve for fiscal year 2018. This amount is
$5,482,000 above the fiscal year 2017 enacted level and equal
to 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
Appropriations, 2017.................................... $38,597,000
Budget estimate, 2018................................... 65,271,000
Committee recommendation................................ 65,271,000
COMMITTEE RECOMMENDATION
The Committee recommends $65,271,000 for Military
Construction, Navy Reserve for fiscal year 2018. This amount is
$26,674,000 above the fiscal year 2017 enacted level and equal
to 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
Appropriations, 2017.................................... $188,950,000
Budget estimate, 2018................................... 63,535,000
Committee recommendation................................ 63,535,000
COMMITTEE RECOMMENDATION
The Committee recommends $63,535,000 for Military
Construction, Air Force Reserve for fiscal year 2018. This
amount is $125,415,000 below the fiscal year 2017 enacted level
and equal to 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
Appropriations, 2017.................................... $177,932,000
Budget estimate, 2018................................... 154,000,000
Committee recommendation................................ 154,000,000
PROGRAM DESCRIPTION
The North Atlantic Treaty Organization [NATO] appropriation
provides for the U.S. cost share of the NATO Security
Investment Program for the acquisition and construction of
military facilities and installations (including international
military headquarters) and for related expenses for the
collective defense of the NATO Treaty area.
COMMITTEE RECOMMENDATION
The Committee recommends $154,000,000 for the North
Atlantic Treaty Organization Security Investment Program [NSIP]
for fiscal year 2018 as requested. This amount is $23,932,000
below the fiscal year 2017 enacted level and equal to the
budget request.
Department of Defense Base Closure Account
Appropriations, 2017.................................... $240,237,000
Budget estimate, 2018................................... 255,867,000
Committee recommendation................................ 255,867,000
PROGRAM DESCRIPTION
Section 2711 of the National Defense Authorization Act for
Fiscal Year 2014 (Public Law 112-239) consolidated the Base
Closure Account 1990 and the Base Closure Account 2005 into a
single Department of Defense Base Closure Account. The Base
Closure Account provides for cleanup and disposal of property
consistent with the four closure rounds required by the base
closure acts of 1988 and 1990, and with the 2005 closure round
required by the Defense Base Closure and Realignment Act of
1990 (10 U.S.C. 2687 note).
COMMITTEE RECOMMENDATION
The Committee recommends a total of $255,867,000 for the
Department of Defense Base Closure Account for fiscal year
2018. This amount is $15,630,000 above the fiscal year 2017
enacted level and equal to the budget request. Funds provided
for fiscal year 2018 are for environmental cleanup and ongoing
operations and maintenance.
Family Housing Overview
Appropriations, 2017.................................... $1,276,289,000
Budget estimate, 2018................................... 1,407,155,000
Committee recommendation................................ 1,409,437,000
FAMILY HOUSING ACCOUNTS--PROGRAM DESCRIPTION
The Family Housing appropriation provides funds for
military family housing construction activities, operation and
maintenance, the Family Housing Improvement Fund, and the
Homeowners Assistance Program. Construction accounts provide
funding for new construction, improvements and the Federal
Government share of housing privatization. Operation and
maintenance accounts fund costs associated with the maintenance
and leasing of military family housing, including utilities,
services, management, and furnishings.
COMMITTEE RECOMMENDATION
The Committee recommends $1,409,437,000 for Family Housing
Construction, Operations and Maintenance, and the Department's
family housing improvement fund for fiscal year 2018. This
amount is $133,148,000 above the fiscal year 2017 enacted level
and $2,282,000 above the budget request.
Family Housing Operation and Maintenance, Army
Appropriations, 2017.................................... $325,995,000
Budget estimate, 2018................................... 346,625,000
Committee recommendation................................ 348,907,000
COMMITTEE RECOMMENDATION
The Committee recommends $348,907,000 for family housing
operation and maintenance, Army for fiscal year 2018. This
amount is $22,912,000 above the fiscal year 2017 enacted level
and $2,282,000 above the budget request.
Family Housing Operation and Maintenance, Navy and Marine Corps
Appropriations, 2017.................................... $300,915,000
Budget estimate, 2018................................... 328,282,000
Committee recommendation................................ 328,282,000
COMMITTEE RECOMMENDATION
The Committee recommends $328,282,000 for family housing
operation and maintenance, Navy and Marine Corps, in fiscal
year 2018. This amount is $27,367,000 above the fiscal year
2017 enacted level and equal to the budget request.
Family Housing Operation and Maintenance, Air Force
Appropriations, 2017.................................... $274,429,000
Budget estimate, 2018................................... 318,324,000
Committee recommendation................................ 318,324,000
COMMITTEE RECOMMENDATION
The Committee recommends $318,324,000 for family housing
operation and maintenance, Air Force, in fiscal year 2018. This
amount is $43,895,000 above the fiscal year 2017 enacted level
and equal to the budget request.
Family Housing Operation and Maintenance, Defense-Wide
Appropriations, 2017.................................... $59,157,000
Budget estimate, 2018................................... 59,169,000
Committee recommendation................................ 59,169,000
COMMITTEE RECOMMENDATION
The Committee recommends $59,169,000 for family housing
operation and maintenance, Defense-Wide, for fiscal year 2018.
This amount is $12,000 above the fiscal year 2017 enacted level
and equal to the budget request.
Family Housing Construction, Army
Appropriations, 2017.................................... $157,172,000
Budget estimate, 2018................................... 182,662,000
Committee recommendation................................ 182,662,000
COMMITTEE RECOMMENDATION
The Committee recommends $182,662,000 for Army Family
Housing Construction in fiscal year 2018. This amount is
$25,490,000 above the fiscal year 2017 enacted level and equal
to the budget request. Further detail of the Committee's
recommendation is provided in the State table at the end of
this report.
Family Housing Construction, Navy and Marine Corps
Appropriations, 2017.................................... $94,011,000
Budget estimate, 2018................................... 83,682,000
Committee recommendation................................ 83,682,000
COMMITTEE RECOMMENDATION
The Committee recommends $83,682,000 for Family Housing
Construction, Navy and Marine Corps. This amount is $10,329,000
below the fiscal year 2017 enacted level and equal to the
budget request. Further detail of the Committee's
recommendation is provided in the State table at the end of
this report.
Family Housing Construction, Air Force
Appropriations, 2017.................................... $61,352,000
Budget estimate, 2018................................... 85,062,000
Committee recommendation................................ 85,062,000
COMMITTEE RECOMMENDATION
The Committee recommends $85,062,000 for Family Housing
Construction, Air Force, in fiscal year 2018. This amount is
$23,710,000 above the fiscal year 2017 enacted level and equal
to the budget request. Further detail of the Committee's
recommendation is provided in the State table at the end of
this report.
Department of Defense Family Housing Improvement Fund
Appropriations, 2017.................................... $3,258,000
Budget estimate, 2018................................... 2,726,000
Committee recommendation................................ 2,726,000
PROGRAM DESCRIPTION
The Family Housing Improvement Fund appropriation provides
for the Department of Defense to undertake housing initiatives
and to provide an alternative means of acquiring and improving
military family housing and supporting facilities. This account
provides seed money for housing privatization initiatives.
COMMITTEE RECOMMENDATION
The Committee recommends $2,726,000 for the Family Housing
Improvement Fund in fiscal year 2018. This amount is $532,000
below the fiscal year 2017 enacted level and equal to the
budget request.
Department of Defense Military Unaccompanied Housing Improvement Fund
Appropriations, 2017....................................................
Budget estimate, 2018................................... $623,000
Committee recommendation................................ 623,000
PROGRAM DESCRIPTION
The Military Unaccompanied Housing Improvement Fund
appropriation provides for the Department of Defense to
undertake housing initiatives and to provide an alternative
means of acquiring and improving military unaccompanied housing
and supporting facilities. This account provides seed money for
housing privatization initiatives.
COMMITTEE RECOMMENDATION
The Committee recommends $623,000 for the Military
Unaccompanied Housing Improvement Fund in fiscal year 2018.
This amount is equal to the budget request.
Administrative Provisions
Sec. 101. The Committee includes a provision that restricts
payments under a cost-plus-a-fixed-fee contract for work,
except in cases of contracts for environmental restoration at
base closure sites.
Sec. 102. The Committee includes a provision that permits
the use of funds for the hire of passenger motor vehicles.
Sec. 103. The Committee includes a provision that permits
the use of funds for defense access roads.
Sec. 104. The Committee includes a provision that prohibits
construction of new bases inside the continental United States
for which specific appropriations have not been made.
Sec. 105. The Committee includes a provision that limits
the use of funds for purchase of land or land easements.
Sec. 106. The Committee includes a provision that prohibits
the use of funds to acquire land, prepare a site, or install
utilities for any family housing except housing for which funds
have been made available.
Sec. 107. The Committee includes a provision that limits
the use of minor construction funds to transfer or relocate
activities among installations.
Sec. 108. The Committee includes a provision that prohibits
the procurement of steel unless American producers,
fabricators, and manufacturers have been allowed to compete.
Sec. 109. The Committee includes a provision that prohibits
payments of real property taxes in foreign nations.
Sec. 110. The Committee includes a provision that prohibits
construction of new bases overseas without prior notification.
Sec. 111. The Committee includes a provision that
establishes a threshold for American preference of $500,000
relating to architect and engineering services for overseas
projects.
Sec. 112. The Committee includes a provision that
establishes preference for American contractors for military
construction in the United States territories and possessions
in the Pacific, and on Kwajalein Atoll, or in countries
bordering the Arabian Gulf.
Sec. 113. The Committee includes a provision that requires
notification of military exercises involving construction in
excess of $100,000.
Sec. 114. The Committee includes a provision that permits
funds appropriated in prior years to be available for
construction authorized during the current session of Congress.
Sec. 115. The Committee includes a provision that permits
the use of expired or lapsed funds to pay the cost of
supervision for any project being completed with lapsed funds.
Sec. 116. The Committee includes a provision that permits
obligation of funds from more than 1 fiscal year to execute a
construction project, provided that the total obligation for
such project is consistent with the total amount appropriated
for the project.
Sec. 117. The Committee includes a provision that permits
the transfer of funds from Family Housing Construction accounts
to the DoD Family Housing Improvement Fund and from Military
Construction accounts to the DoD Military Unaccompanied Housing
Improvement Fund.
Sec. 118. The Committee includes a provision that provides
transfer authority to the Homeowners Assistance Fund.
Sec. 119. The Committee includes a provision that requires
all acts making appropriations for military construction be the
sole funding source of all operation and maintenance for family
housing, including flag and general officer quarters, and
limits the repair on flag and general officer quarters to
$35,000 per unit per year without prior notification to the
congressional defense committees.
Sec. 120. The Committee includes a provision that provides
authority to expend funds from the ``Ford Island Improvement''
account.
Sec. 121. The Committee includes a provision that allows
the transfer of expired funds to the Foreign Currency
Fluctuation, Construction, Defense Account.
Sec. 122. The Committee includes a provision that allows
the reprogramming of military construction and family housing
construction funds among projects and activities within the
account in which they are funded.
Sec. 123. The Committee includes a provision that prohibits
the use of funds in this title for planning and design and
construction of projects at Arlington National Cemetery.
Sec. 124. The Committee includes a provision defining the
congressional defense committees.
Sec. 125. The Committee includes a provision providing
additional funds for unfunded military construction priorities.
Sec. 126. The Committee includes a provision rescinding
unobligated balances from the Military Construction Defense-
Wide account.
Sec. 127. The Committee includes a provision prohibiting
the use of funds in this title to close or realign Naval
Station Guantanamo Bay, Cuba. The provision is intended to
prevent the closure or transfer of the installation out of the
possession of the United States, and maintain the Naval
Station's long-standing regional security and migrant
operations missions.
Sec. 128. The Committee includes a provision regarding the
consolidation or relocation of a U.S. Air Force RED HORSE
Squadron outside of the United States.
TITLE II
DEPARTMENT OF VETERANS AFFAIRS
Items of Special Interest
HEARINGS
The Subcommittee on Military Construction, Veterans
Affairs, and Related Agencies held one hearing related to the
fiscal year 2018 and 2019 Department of Veterans Affairs [VA]
budget request. The subcommittee heard testimony from Poonam L.
Alaigh, M.D., Acting Under Secretary for Health, Veterans
Health Administration, Mr. Thomas J. Murphy, Acting Under
Secretary for Benefits, Veterans Benefits Administration, Mr.
Ronald E. Walters, Interim Under Secretary for Memorial
Affairs, National Cemetery Administration, and the Honorable
David J. Shulkin, Secretary of the Department of Veterans
Affairs.
SUMMARY OF COMMITTEE RECOMMENDATIONS
The Committee recommendation includes $182,366,088,000 for
the Department of Veterans Affairs for fiscal year 2018,
including $103,948,996,000 in mandatory spending and
$78,417,092,000 in discretionary spending. The Committee also
recommends $70,700,000,000 in advance appropriations for
veterans medical care for fiscal year 2019 and $107,710,000,000
in advance appropriations for appropriated mandatories for
fiscal year 2019.
DEPARTMENT OVERVIEW
The Veterans Administration was established on July 21,
1930, as an independent agency by Executive Order 5398, in
accordance with the act of July 3, 1930 (46 Stat. 1016). This
act authorized the President to consolidate and coordinate
Federal agencies specially created for or concerned with the
administration of laws providing benefits to veterans,
including the Veterans' Bureau, the Bureau of Pensions, and the
National Home for Disabled Volunteer Soldiers. On March 15,
1989, the Veterans Administration was elevated to Cabinet-level
status as the Department of Veterans Affairs.
VA's mission is to serve America's veterans and their
families as their principal advocate in ensuring they receive
the care, support, and recognition they have earned in service
to the Nation. As of September 30, 2016, there were an
estimated 21.4 million living veterans, with 21.3 million of
them residing in the United States and Puerto Rico. There were
an estimated 25.1 million dependents (spouses and dependent
children) of living veterans in the United States and Puerto
Rico, and there were 598,000 survivors of deceased veterans
receiving VA survivor benefits in the United States and Puerto
Rico. Thus, approximately 47.0 million people, or 14.4 percent
of the total estimated resident population of the United States
and Puerto Rico, were recipients or potential recipients of
veterans benefits from the Federal Government. VA's operating
units include the Veterans Benefits Administration, Veterans
Health Administration, National Cemetery Administration, and
staff support offices.
The Veterans Benefits Administration [VBA] provides an
integrated program of nonmedical veterans benefits. VBA
administers a broad range of benefits to veterans and other
eligible beneficiaries through 56 regional offices and a
records processing center in St. Louis, Missouri. The benefits
provided include: compensation for service-connected
disabilities; pensions for wartime, needy, and totally disabled
veterans; vocational rehabilitation assistance; educational and
training assistance; home buying assistance; estate protection
services for veterans under legal disability; information and
assistance through personalized contacts; and six life
insurance programs.
The Veterans Health Administration [VHA] develops,
maintains, and operates a national healthcare delivery system
for eligible veterans; carries out a program of education and
training of healthcare personnel; conducts medical research and
development; and furnishes health services to members of the
Armed Forces during periods of war or national emergency. A
system consisting of 144 VA Hospitals; 22 Health Care Centers
[HCC]; 210 Multi-Specialty Community-Based outpatient clinics;
527 Primary Care Community-Based outpatient clinics; 305
Outpatient Services Sites; 135 community living centers; 115
domiciliary residential rehabilitation treatment programs
[DRRTP]; 300 readjustment counseling vet centers; and 80 mobile
vet centers is maintained to meet the VA's medical mission.
The National Cemetery Administration [NCA] provides for the
interment of the remains of eligible deceased servicemembers
and discharged veterans in any national cemetery with available
grave space; permanently maintains these graves; provides
headstones and markers for the graves of eligible persons in
national and private cemeteries; administers the grant program
for aid to States in establishing, expanding, or improving
State veterans cemeteries; and provides certificates to
families of deceased veterans recognizing their contributions
and service to the Nation. In 2018, cemetery activities will
encompass 136 national cemeteries, one national veterans'
burial ground, and 33 soldiers' lots and monument sites.
Staff support offices include the Office of Inspector
General, Boards of Contract Appeals and Veterans Appeals, and
General Administration offices, which support the Secretary,
Deputy Secretary, Under Secretary for Benefits, Under Secretary
for Health, Under Secretary for Memorial Affairs, and General
Counsel.
Contracting Oversight.--The Committee is concerned about
the lack of transparency in the contract oversight process,
given the substantial changes that are made by modifications,
as well as the lack of visibility into contractor performance.
For major contracts, whenever the Secretary provides notice to
a contracted service provider that the service provider is
failing to meet contractual obligations, VA must submit to the
Committees on Appropriations and Veterans Affairs of both
Houses of Congress notification of such failure, along with: an
explanation of the reasons for providing such notice; a
description of the effect of such failure, including with
respect to cost, schedule, and requirements; a description of
the actions taken by the Secretary to mitigate such failure;
and a description of the actions taken by the contractor to
address such failure, and no later than 45 days after the last
day of each quarter for the duration of the contract, submit to
the Committees a report detailing any material change or
modifications made to the contract, if any, and a justification
for such modifications; and publish on the Internet website of
the Department information about the contract and the
modifications made to the contract, if any.
Regrettable Turnover.--The Committee is concerned the
Department has failed to follow-up on repeated recommendations
of the Office of Inspector General to review data on
regrettable turnover and consider implementing measures to
reduce such losses. Given the staffing demands on the
Department and the challenges it faces in recruiting personnel,
VA should work expeditiously to better understand why personnel
leave the Department and work to mitigate such losses.
Veterans Service Centers.--The Committee remains concerned
that in many small communities access to information and
resources from VA can be difficult. Private, non-profit centers
can help bridge the gap, provide subject matter experts and
service providers to assist in a wide-variety of circumstances,
including but not limited to homelessness, unemployment, VA
benefits and disability, financial assistance, VA healthcare,
education assistance, travel assistance, and community events.
The Committee encourages the Department to evaluate the
feasibility of establishing a competitive grant program to
support local Veterans Service Centers including those that
were previously funded under the Army Reserve's Army Strong
Community Center program. The Department is directed to report
back to the Committees on Appropriations of both Houses of
Congress on progress made or statutory changes needed to
establish such a program.
Financial Management and Health Care Delivery.--The
Committee is aware of and fully supports the VA's Financial
Management Business Transformation [FMBT] effort to procure a
new core accounting and financial management system. However, a
new system, by itself, will not likely fix the Department's
persistent inability to reliably and accurately estimate
budgetary needs for delivering healthcare to veterans. VA
healthcare remains on the Government Accountability Office's
[GAO] High Risk List in part due to the Department's inability
to ensure its resourcing is improving veterans' timely access
to quality healthcare services. According to the GAO report
Managing Risks and Improving VA Health Care (GAO-17-317 High
Risk Series): ``VA faces challenges regarding the reliability,
transparency, and consistency of its budget estimates for
medical services, as well as weaknesses in tracking obligations
for medical services and estimating budgetary needs for future
years.'' VA faced multi-billion dollar healthcare budget
shortfalls in fiscal year 2005 and in fiscal year 2015. And
again this year, the Department faces a budgetary failure and
has presented Congress with an urgent need for additional
resources in the Choice Fund to maintain the Veterans Choice
Program and its provider network built by third party
administrators. The Committee cannot reconcile how an Agency
with 18 consecutive years of unmodified (``clean'') audit
opinions on its consolidated financial statements can have such
dysfunction. The Department is aware its data and budgeting
system for veteran healthcare is ineffective and not scalable
to accurately project appropriations in future years, but has
not taken definitive action to make improvements to their
system. The Committee requires the Department, in consultation
with the Office of Management and Budget, to pursue a
comprehensive healthcare modeling system and consider solutions
and best practices from third party administrators or other
healthcare systems as it relates to informing the Department of
reforms to more accurately forecast the cost of healthcare for
veterans. The Department is directed to provide an update on
progress in this effort to the Committees on Appropriations of
Houses of Congress within 120 days, as well as furnish
quarterly reports on all major facets of the initiative, to
include cooperation with an independent audit conducted by GAO.
Veterans Benefits Administration
Appropriations, 2017
$105,577,085,000
Advance Appropriations, 2018
103,935,996,000
Budget estimate, 2018
3,036,653,000
Committee recommendation, 2018
3,103,214,000
Budget estimate, advance appropriations, 2019
107,709,727,000
Committee recommendation, advance appropriations, 2019
107,710,000,000
ADMINISTRATION OVERVIEW
The Veterans Benefits Administration [VBA] is responsible
for the payment of compensation and pension benefits to
eligible service-connected disabled veterans, as well as
education benefits and housing loan guarantees.
COMMITTEE RECOMMENDATION
In fiscal year 2017, the Committee provided
$103,935,996,000 in advance appropriations for the Veterans
Benefits Administration for fiscal year 2018. This included
$90,119,449,000 for Compensation and pensions; $13,708,648,000
for Readjustment benefits; and $107,899,000 for Veterans
insurance and indemnities.
For fiscal year 2018, the Committee recommends an
additional $13,000,000 for Veterans insurance and indemnities.
Additionally, the Committee recommendation includes
$178,626,000 for the Veterans Housing Benefit Program Fund
administrative expenses; $30,000 for the Vocational
Rehabilitation Loans Program account, with $395,000 for
administrative expenses; $1,163,000 for the Native American
Veteran Housing Loan Program account; $2,910,000,000 for
General Operating Expenses, Veterans Benefits Administration
account. The Committee recommendation also provides
$107,710,000,000 in advance appropriations for the Veterans
Benefits Administration for fiscal year 2019.
Public Law 114-223 moved the General Operating Expenses,
Veterans Benefits Administration account from Departmental
Administration to the Veterans Benefits Administration, its
appropriate section within the act, with the instruction that
the Department should place GOE,VBA in this location with the
fiscal year 2018 request. The Committee notes this did not
happen, and therefore, once again, instructs the Department to
adhere to this direction with the fiscal year 2019 request.
COMPENSATION AND PENSIONS
(INCLUDING TRANSFER OF FUNDS)
Appropriations, 2017.................................... $86,083,128,000
Advance Appropriations, 2018............................ 90,119,449,000
Budget estimate, advance appropriations, 2019........... 95,768,462,000
Committee recommendation, advance appropriations, 2019.. 95,769,000,000
PROGRAM DESCRIPTION
Compensation is payable to living veterans who have
suffered impairment of earning power from service-connected
disabilities. The amount of compensation is based upon the
impact of disabilities on a veteran's earning capacity. Death
compensation or dependency and indemnity compensation is
payable to the surviving spouses and dependents of veterans
whose deaths occur while on active duty or result from service-
connected disabilities. A clothing allowance may also be
provided for service-connected veterans who use a prosthetic or
orthopedic device. In fiscal year 2018, the Department
estimates it will obligate $84,598,945 for payments to
4,616,764 veterans, 419,948 survivors, and 1,137 dependents
receiving special benefits.
Pensions are an income security benefit payable to needy
wartime veterans who are precluded from gainful employment due
to nonservice-connected disabilities which render them
permanently and totally disabled. Public Law 107-103, the
Veterans Education and Benefits Expansion Act of 2001, restored
the automatic presumption of permanent and total nonservice
connected disability for purposes of awarding a pension to
veterans age 65 and older, subject to the income limitations
that apply to all pensioners. Death pensions are payable to
needy surviving spouses and children of deceased wartime
veterans. The rate payable for both disability and death
pensions is determined on the basis of the annual income of the
veteran or their survivors. In fiscal year 2018, the Department
estimates that the Pensions program will provide benefits to
289,178 veterans and 204,006 survivors totaling $5,989,847.
The Compensation and Pensions program funds certain burial
benefits on behalf of eligible deceased veterans. These
benefits provide the purchase and transportation costs for
headstones and markers, graveliners, and pre-placed crypts; and
provide partial reimbursement for privately purchased outer
burial receptacles. In fiscal year 2018, the Department
estimates the Compensation and Pensions program will obligate
$243,492,000 providing burial benefits. This funding will
provide 37,212 burial allowances, 26,737 burial plot
allowances, 21,222 service-connected death awards, 497,644
burial flags, 373,895 headstones or markers, 41,759 graveliners
or reimbursement for privately purchased outer burial
receptacles, and 305 caskets and urns for the internment of the
remains of veterans without next of kin.
COMMITTEE RECOMMENDATION
In fiscal year 2017, the Committee provided an advance
appropriation of $90,119,449,000 for fiscal year 2018 for the
Compensation and Pensions account.
The Committee recommendation includes an advance
appropriation of $95,769,000,000 for Compensation and pensions
for fiscal year 2019. This is $538,000 above the request to
reflect proper rounding of a budget estimate.
READJUSTMENT BENEFITS
Appropriations, 2017.................................... $16,340,828,000
Advance Appropriations, 2018............................ 13,708,648,000
Budget estimate, advance appropriations, 2019........... 11,832,175,000
Committee recommendation, advance appropriations, 2019.. 11,832,000,000
PROGRAM DESCRIPTION
The Readjustment benefits appropriation finances the
education and training of veterans and servicemembers under
chapters 30, 31, 32, 33, 34, 35, 36, 37, 39, 41, 42 and 43 of
title 38, United States Code. These benefits include the All-
Volunteer Force Educational Assistance Program (Montgomery GI
bill) and the Post 9/11 Educational Assistance Program. Basic
benefits are funded through appropriations made to the
readjustment benefits appropriation and by transfers from the
Department of Defense. This account also finances vocational
rehabilitation, specially adapted housing grants, specially
adapted automobile grants for certain disabled veterans, and
educational assistance allowances for eligible dependents of
those veterans who died from service-connected causes or who
have a total permanent service-connected disability, as well as
dependents of servicemembers who were captured or missing in
action.
COMMITTEE RECOMMENDATION
In fiscal year 2017, the Committee provided an advance
appropriation of $13,708,648,000 for the Readjustment Benefits
account for fiscal year 2018.
The Committee recommendation includes an advance
appropriation of $11,832,000,000 for Readjustment benefits for
fiscal year 2019. This is $175,000 below the request to reflect
proper rounding of a budget estimate.
VETERANS INSURANCE AND INDEMNITIES
Appropriations, 2017.................................... $108,525,000
Advance Appropriations, 2018............................ 107,899,000
Budget estimate, 2018................................... 12,439,000
Committee recommendation, 2018.......................... 13,000,000
Budget estimate, advance appropriations, 2019........... 109,090,000
Committee recommendation, advance appropriations, 2019.. 109,000,000
PROGRAM DESCRIPTION
The Veterans insurance and indemnities appropriation
consists 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;
servicemen's indemnities, applicable to Korean conflict
veterans; and veterans mortgage life insurance to individuals
who have received a grant for specially adapted housing.
COMMITTEE RECOMMENDATION
In fiscal year 2017, the Committee provided an advance
appropriation of $107,899,000 for fiscal year 2018 for the
Veterans Insurance and Indemnities account. The recommendation
for fiscal year 2018 also includes an additional $13,000,000.
This is $561,000 above the request to reflect proper rounding
of a budget estimate.
The Committee recommendation also includes an advance
appropriation of $109,000,000 for Veterans insurance and
indemnities for fiscal year 2019. This is $90,000 below the
request to reflect proper rounding of a budget estimate.
VETERANS HOUSING BENEFIT PROGRAM FUND
------------------------------------------------------------------------
Administrative
Program account expenses
------------------------------------------------------------------------
Appropriations, 2017................ ................ $198,856,000
Budget estimate, 2018............... ................ 178,626,000
Committee recommendation............ ................ 178,626,000
------------------------------------------------------------------------
PROGRAM DESCRIPTION
The Veterans housing benefit program fund provides for all
costs associated with VA's direct and guaranteed housing loan
programs, with the exception of the Native American veteran
housing loan program.
VA loan guaranties are made to servicemembers, veterans,
reservists, and unremarried surviving spouses for the purchase
of homes, condominiums, and manufactured homes, and for
refinancing loans. VA guarantees part of the total loan,
permitting the purchaser to obtain a mortgage with a
competitive interest rate, even without a downpayment, if the
lender agrees. VA requires a downpayment be made for a
manufactured home. With a VA guaranty, the lender is protected
against loss up to the amount of the guaranty if the borrower
fails to repay the loan.
COMMITTEE RECOMMENDATION
The Committee recommends such sums as may be necessary for
funding subsidy payments, and $178,626,000 for administrative
expenses for fiscal year 2018. Bill language limits gross
obligations for direct loans for specially adapted housing to
$500,000.
VOCATIONAL REHABILITATION LOANS PROGRAM ACCOUNT
------------------------------------------------------------------------
Administrative
Program account expenses
------------------------------------------------------------------------
Appropriations, 2017................ $36,000 $389,000
Budget estimate, 2018............... 30,000 395,000
Committee recommendation............ 30,000 395,000
------------------------------------------------------------------------
PROGRAM DESCRIPTION
The Vocational Rehabilitation Loans Program account covers
the cost of direct loans for vocational rehabilitation of
eligible veterans and, in addition, includes administrative
expenses necessary to carry out the direct loan program. Loans
of up to $1,214 (based on the indexed chapter 31 subsistence
allowance rate) are currently available to service-connected
disabled veterans enrolled in vocational rehabilitation
programs, as provided under 38 U.S.C. chapter 31, when the
veteran is temporarily in need of additional assistance.
Repayment is made in monthly installments, without interest,
through deductions from future payments of compensation,
pension, subsistence allowance, educational assistance
allowance, or retirement pay. Virtually all loans are repaid in
full and most in less than one year.
COMMITTEE RECOMMENDATION
The Committee recommends $30,000 for program costs and
$395,000 for administrative expenses for the Vocational
Rehabilitation Loans Program account. The administrative
expenses may be paid to the General Operating Expenses,
Veterans Benefits Administration account. Bill language is
included limiting program direct loans to $2,356,000. It is
estimated VA will make 2,402 loans in fiscal year 2018, with an
average amount of $981.
NATIVE AMERICAN VETERAN HOUSING LOAN PROGRAM ACCOUNT
Appropriations, 2017.................................... $1,163,000
Budget estimate, 2018................................... 1,163,000
Committee recommendation................................ 1,163,000
PROGRAM DESCRIPTION
The Native American veteran housing loan program is
authorized by 38 U.S.C. chapter 37, section 3761 to provide
direct loans to Native American veterans living on trust lands.
The loans are available to purchase, construct, or improve
homes to be occupied as veteran residences or to refinance a
loan previously made under this program in order to lower the
interest rate. The principal amount of a loan under this
authority generally may not exceed $424,100; however, in some
locations this limit may be higher depending on median area
home prices. Veterans pay a funding fee of 1.25 percent of the
loan amount, although veterans with a service-connected
disability are exempt from paying the fee. Before a direct loan
can be made, the veteran's tribal organization must sign a
memorandum of understanding with VA regarding the terms and
conditions of the loan. The Native American Veteran Housing
Loan Program began as a pilot program in 1993 and was made
permanent by Public Law 109-233, the Veterans Housing
Opportunity and Benefits Act of 2006.
COMMITTEE RECOMMENDATION
The Committee recommends $1,163,000 for administrative
expenses associated with this program. This is equal to the
fiscal year 2017 enacted level and equal to the budget request.
GENERAL OPERATING EXPENSES, VETERANS BENEFITS ADMINISTRATION
Appropriations, 2017.................................... $2,844,160,000
Budget estimate, 2018................................... 2,844,000,000
Committee recommendation................................ 2,910,000,000
PROGRAM DESCRIPTION
The General Operating Expenses, Veterans Benefits
Administration account provides funding for the Veterans
Benefits Administration to administer entitlement programs such
as service-connected disability compensation, education
benefits, and vocational rehabilitation services.
COMMITTEE RECOMMENDATION
The Committee recommends $2,910,000,000 for the General
Operating Expenses, Veterans Benefits Administration account,
which is $65,840,000 above the fiscal year 2017 enacted level
and $66,000,000 above the budget request. The Committee has
included bill language to make available through September 30,
2019, up to 10 percent of the General Operating Expenses,
Veterans Benefits Administration account.
Disability Claims Processing.--The Committee has not only
fully funded the budget request for claims processing in recent
years, but has provided increases above the budget requests for
hiring and training claims processors, bolstering the migration
to electronic claims processing systems, and addressing the
increasing backlog of appeals at the Board of Veterans Appeals.
The Committee commends the Department on its efforts to reduce
the disability claims backlog and increase the accuracy of
claims decisions, yet the processing of disability claims
remains a major concern of the Committee. In particular,
progress in reducing the backlog seems to have stalled this
year, hovering weekly between 99,000 and 90,000. The Department
must consider processing all claims within 125 days with 98
percent accuracy a mandate of VBA, and the Department should
fund and staff this agency accordingly. In addition to efforts
to ensure there is not a recurrence of a sizeable disability
claims backlog, the Department must also ensure that proper
staffing and resources are available to reduce the growing wait
time and backlog of disability decisions on appeal and meet
demand for other benefit programs. To that end, the Committee
recommends an additional $66,000,000 to VBA, GOE to hire
additional claims and appellate staff, as well as to increase
staff for the Vocational Rehabilitation and Employment Program.
The VBA may also use these resources to finance overtime
payments, if that becomes necessary, and support increased
resources for the Veterans Claims Intake Program [VCIP] to scan
and convert paper files into digital records. The Committee
will continue to assert its oversight ability by monitoring the
key agencies involved in veteran disability claims processing--
VA, DoD, the Social Security Administration, and the Internal
Revenue Service--these agencies as they work to better expedite
the flow of interagency information needed to process claims in
a timely manner. The Committee will continue to require the
Department provide monthly updates on performance measures for
each Regional Office.
Financial Hardship and Bankruptcy.--The Committee continues
to support VA programs that combat the root causes of veteran
and dependent financial hardship, which is a known contributory
factor to negative outcomes such as mental health issues,
substance use disorder, and suicide. For example, disability-
related benefits not only honor the service and sacrifice of
the veterans who receive them, but also help to replace lost
wages and provide a critical source of economic well-being. The
Committee is concerned by an inequity in current bankruptcy law
that results in the inclusion of VA and DoD disability benefits
in the calculation of a debtor's disposable income, while at
the same time excluding Social Security disability benefits for
non-veterans. The Department is directed to submit to the
Committees on Appropriations and Veterans Affairs of both
Houses of Congress a report outlining the statutory and
legislative authority is needed to end this inequity.
Women Veterans Participation Rates.--The Committee directs
VA to include an analysis of trends and satisfaction rates
among women veterans participating in the Vocational
Rehabilitation & Employment program in the annual report to
Congress to ensure these services are adapting to changing
demographics of veterans and the needs of women veterans with
disabilities.
State Accrediting Agency Oversight.--The Committee is
concerned current laws and regulations related to conflicting
interests may be inadequate to identify conflicts of interest
that can develop through the provision of meals or de minimus
gifts to officers of State Accrediting Agencies. The Department
is directed to conduct an assessment of the effectiveness of 38
U.S.C. 3683 and 38 CFR 21.4005 in preventing conflicts of
interests and submit a report to the Committees on
Appropriations of both Houses of Congress no later than 180
days after enactment of this act regarding the findings.
State Approving Agencies.--Under the G.I. Bill and the
Post-9/11 Veterans Educational Assistance Improvements Act of
2010 (Public Law 111-377, 38 U.S.C. Ch. 36 sec. 3670) VA
contracts with States to establish State Approving Agencies
[SAAs] in promoting and safeguarding quality education and
training programs for veterans, ensuring greater education and
training opportunities for veterans, and protecting the
integrity of the G.I. Bill. The Committee is concerned VA's
formula for determining each SAA's allocation fails to take
into account travel times. This is of particular concern in
rural States where travel between school inspections can be
costly in both time and monetary expense. The Committee
instructs VA to ensure SAAs have sufficient resources to cover
travel expenses and accomplish their mandate under the G.I.
Bill.
Rural Veterans Coordination Pilot.--Section 506 of the
Caregivers and Veterans Omnibus Health Services Act of 2010
(Public Law 111-163; 38 U.S.C. 523 note) established the Rural
Veterans Coordination Pilot [RVCP] at VA. Eligible grant
recipients are community based organizations and/or local,
State, or tribal government entities. The pilot enabled each
grant recipient to support local veterans in unique ways that
will be suitable for the challenges faced at these locations.
Upon completion of the pilot, the Department is directed to
provide a report and recommendations to the Committee
identifying effective models in which State and local entities
are able to successfully coordinate multi-sector benefits for
veterans and their families who reside in rural or underserved
communities. The Committee urges the Department to consider
extending the RVCP beyond its current deadline and expanding
the program to include additional locations.
Assessment of GI Bill Utilization.--The Committee notes the
Department's responsibility to provide GI bill benefits to
servicemembers as they transition to civilian life and status
as a veterans, however the Committee believes there is an
opportunity to increase utilization of these benefits. To
better understand the current utilization and drive future
decisions regarding educational benefits to veterans, the
Committee directs the Department to conduct a comprehensive
assessment to accurately account the number of veterans
utilizing their educational benefits. The first report should
analyze fiscal years 2010 to 2017, but thereafter, the
Committee directs the Department to submit an annual report
that tracks outcomes for Post-9/11 GI bill benefits. The report
should include: the number of veterans who qualify for either a
partial or the full GI bill benefit; veteran use of the GI bill
benefit among the total number of eligible veterans; veteran
use or transfer of unused GI bill benefit to dependents; use of
the GI bill benefit toward 4-year, 2-year, and vocational
educational and training programs, and distinguish the
programs; the average dollar amount of usage; and an aggregate
graduation rate, loan default rate, and average indebtedness by
degree program, type of degree, and field of study.
Additionally, the Department is encouraged to make an effort to
gather data on the jobs attained after graduation, specifically
whether those jobs can be reasonably said to be in the field of
study identified in the students' education plans. The
Department is directed to submit the first report to the
Committees on Appropriations of both Houses of Congress no
later than 180 days after enactment of this act.
Education Benefits.--The Committee is concerned about the
levels of overpayments and improper payments being paid to GI
Bill beneficiaries. The Committee directs VA to work with
education stakeholders to ensure that veteran educational
benefits are paid in a timely and accurate manner and that
efforts to recoup any overpayments or improper payments is done
fairly and in a manner that is not overly burdensome on student
veterans and their families. The Committee further directs VA,
in collaboration with the Department of Defense and Department
of Education, to provide an interagency report on the
development and continued implementation of the Principles of
Excellence, oversight of institutions complying with the
Principles, and appropriate and timely accountability measures
for educational programs receiving Federal funding. Lastly, the
Committee directs VA to continue to reform the compliance
survey process to allow early detection of fraudulent marketing
or predatory recruiting practices among institutions of higher
learning and to codify a set of tools that is sufficiently
agile enough to curtail the behavior of scamming institutions
that are wasting the VA education benefits of service members
and their families.
Education Data Collection and Sharing.--The Committee wants
for both students and VA to be able to make more evidence-based
decisions when it comes to veterans' education. The Committee
directs VA to work with the Department of Education and
Department of Defense to ensure that there is a comprehensive
database or, at a minimum, a set of robust data-sharing
agreements in place between Federal entities involved in the
administration of Federal resources related to veteran
educational attainment. The Committee further directs VA, in
collaboration with the Department of Education and Department
of Defense, to provide an interagency report on data-sharing
priorities, the development and implementation of subsequent
data-sharing agreements, and the uses and effectiveness of the
data shared.
Reforms to Expedite the Appeals Process.--The Committee
directs the Secretary to fully implement the GAO's
recommendation to improve the timeliness of VA's disability
benefits appeals decisions and to document its progress in its
monthly reports to the Committee on appeals claims processing
performance. The Committee concurs with GAO's recommendations
that VA should apply sensitivity analyses when projecting staff
needs, develop a more timely and detailed workforce plan,
develop a robust plan monitoring process reform, develop a
strategy for assessing process reform, and create a schedule
for IT improvements that takes into account plans for potential
process reform. The Committee also supports GAO's view that any
VA-proposed appeals process reforms be subject to a pilot test.
Home Loan Counseling.--The Committee remains concerned
about the percentage of veteran homeowners that are not using
the VA home loan benefit because they were unaware of the
program or because they were discouraged by their lender and/or
realtor from using a VA loan. Despite significant demand among
veterans for home buying counseling services and education, too
few receive housing counseling or VA loan education while
serving on active duty or after separating from the military.
The Committee believes that in establishing the VA home loan
benefit, Congress authorized and intended for VA to provide
such counseling services and education in its administration of
the program. Therefore, the Committee directs the Department to
conduct a study to assess the feasibility of establishing a VA
housing counseling program that would include a network of
counselors across the country. To the extent practicable, the
feasibility study should look at the Department of Housing and
Urban Development's Office of Housing Counseling for
opportunities to collaborate, including sharing expertise and
personnel. The Department is directed to submit a report to the
Committees on Appropriations of both Houses of Congress no
later than 180 days after enactment of this act on the findings
of the study.
Benefits for Veterans with Service-Connected
Disabilities.--The Committee notes that many veterans are
eligible for a full discharge of their Federal student loan
debt due to a service-connected disability, but have not
received the benefits Congress intended. Under Section 437 of
the Higher Education Act of 1965, borrowers who have been
determined by the Secretary to be unemployable due to a
service-connected condition are eligible for a full discharge
of their liability to repay their loans and are not required to
submit additional documentation. Beginning in April 2016, the
Department of Education established a secure data sharing
agreement with the Social Security Administration [SSA] to
identify Federal student loan borrowers who also receive the
relevant disability payments that qualify them for loan
forgiveness under the Total and Permanent Disability [TPD] loan
discharge program. Approximately 387,000 disabled borrowers
were positively identified with SSA in the first set of
matches. However, this data sharing did not include veterans
who are also eligible for loan discharge and have submitted
appropriate documentation to the Department. As a result, too
many eligible veterans with severe service-connected
disabilities have been left out of this streamlined path to
loan discharge due to a lack of communication between the
Department of Education, Department of Veterans Affairs, and
Federal student loan servicers. Therefore, the Department is
directed, in coordination with the Department of Education
(including its student loan servicers), to make every practical
effort to automate the application of loan discharge to
eligible veterans using information in existing Federal
databases at the Departments of Education and Veterans Affairs
in a timely manner so that veterans can receive the benefits
due under law. The Department is directed to submit a report to
the Committees on Appropriations of both Houses of Congress no
later than 90 days after enactment of this act on the plan of
action for implementing this automation process.
Veterans Health Administration
Appropriations, 2017.................................... $65,152,027,000
Advance appropriations, 2018............................ 66,385,032,000
Budget estimate, 2018................................... 3,290,000,000
Committee recommendation, 2018.......................... 3,689,262,000
Budget estimate, advance appropriations, 2019........... 70,699,313,000
Committee recommendation, advance appropriations, 2019.. 70,700,000,000
ADMINISTRATION OVERVIEW
The Veterans Health Administration [VHA] is home to the
United States' largest integrated healthcare system consisting
of 144 VA Hospitals; 22 Health Care Centers [HCC]; 210 Multi-
Specialty Community-Based outpatient clinics; 527 Primary Care
Community-Based outpatient clinics; 305 Outpatient Services
Sites; 135 community living centers; 115 domiciliary
residential rehabilitation treatment programs [DRRTP]; 300
readjustment counseling vet centers; and 80 mobile vet centers.
The Department of Veterans Affairs Medical Care Collections
Fund [MCCF] was established by the Balanced Budget Act of 1997
(Public Law 105-33). In fiscal year 2004, Public Law 108-199
allowed the Department to deposit first-party and
pharmaceutical 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 Parking Program provides funds for the construction,
alteration, and acquisition (by purchase or lease) of parking
garages at VA medical facilities authorized by 38 U.S.C. 8109.
The Secretary is required under certain circumstances to
establish and collect fees for the use of such garages and
parking facilities. Receipts from the parking fees are to be
deposited into the MCCF and are used for medical services
activities.
COMMITTEE RECOMMENDATION
In fiscal year 2017, the Committee provided $66,385,032,000
in advance appropriations for VA's medical care accounts for
fiscal year 2018. This included $44,886,554,000 for Medical
services, $9,409,118,000 for Medical community care,
$6,654,480,000 for Medical support and compliance, and
$5,434,880,000 for Medical facilities. The Committee also
includes an Administrative Provision allowing the Department to
carry forward into fiscal year 2018 certain amounts provided as
an advance for fiscal year 2017.
For fiscal year 2018, the Committee recommends an
additional $1,923,000,000 for Medical services, $254,000,000
for Medical community care, $100,000,000 for Medical support
and compliance, and $707,000,000 for Medical facilities.
Additionally, the Committee recommendation includes
$705,262,000 for Medical and prosthetic research. Medical care
collections are expected to be $2,507,000,000. The Committee
recommendation also provides $70,700,000,000 in advance
appropriations for VA's medical care accounts for fiscal year
2019.
Education Debt Reduction Program.--The Department is
directed provide a breakdown of spending by VA in connection
with the education debt reduction program of the Department
under subchapter VII of chapter 76 of title 38, United States
Code. The breakout shall include the following elements: (1)
the amount spent by the Department in debt reduction payments
during the three year period preceding the submittal of the
report disaggregated by the medical profession of the
individual receiving the payments; (2) a description of how the
Department prioritizes such spending by medical profession,
including an assessment of whether such priority reflects the
five occupations identified in the most recent determination by
VA OIG as having the largest staffing shortages in VHA; and (3)
a description of the actions taken by the Secretary to increase
the effectiveness of such spending for purposes of recruitment
of healthcare providers to the Department, including efforts to
more consistently include eligibility for the education debt
reduction program in vacancy announcements of positions for
healthcare providers at VA. The Department is directed to
submit a report to the Committees on Appropriations of both
Houses of Congress no later than 90 days after enactment of
this act detailing the findings.
Office of Patient Advocacy.--The Committee urges the
Department to swiftly and comprehensively implement the reforms
made to the patient advocacy program as required by the Jason
Simcakoski Memorial and Promise Act [Title IX, Public Law 114-
198]. The law's establishment of the Office of Patient Advocacy
will ensure that patient advocates are independent of local
facility management, work strictly on behalf of veterans, and
are properly trained according to national standards.
Furthermore, the Committee believes the Inspector General's
March 2017 audit of the patient advocacy program's fiscal year
2015 operations [VA OIG 15-05379-146] provides additional
evidence of the need to institute strong operational controls
and standardization to ensure program effectiveness and the
reliability of complaint data. Accordingly, the Department is
directed to submit a report to the Committees on Appropriations
of both Houses of Congress no later than 30 days after
enactment of this act outlining progress implementing the
relevant sections of Public Law 114-198 and the OIG
recommendations.
Veteran Medical Debt.--The Committee is concerned that
despite the Department's efforts to streamline administrative
burdens of the Veterans Choice Program, VA payments to non-VA
healthcare providers continue to face delays, and medical bills
continue to be inappropriately assigned to veterans rather than
VA. Incorrectly assigned bills and delayed payments have
resulted in medical bills going into collection and damaging
veterans' credit. Therefore, the Committee directs the Under
Secretary for Health to consult with the Consumer Financial
Protection Bureau, national credit reporting agencies, and
appropriate consumer protection stakeholders and develop an
action plan to protect veterans from collections efforts and
credit damage due to medical bills that should have been paid
by VA. The Department is directed to submit a report to the
Committees on Appropriations of both Houses of Congress no
later than 90 days after enactment of this act on the status of
developing an action plan.
Cross Government Credentialing of VA Healthcare
Providers.--In order to better facilitate active recruitment of
individuals who served in the healthcare field for the U.S.
Armed Forces or while on duty with the U.S. Coast Guard, the
Committee directs VA to establish coordinating relationships
with the appropriate personnel divisions dealing with
separating military personnel at the Departments of Defense and
Homeland Security. As part of this coordination, the Department
shall determine whether establishing a formal system for
receiving advanced notice of separating members of the armed
forces is feasible. The Committee further directs VHA to
conduct an internal audit of its procedures for the
recredentialing of providers when transferring within the VHA
system. The Committee directs VHA to institute such policies
and procedures to ensure the speedy and timely transfer of
licensed personnel between facilities and to remove the
unnecessary barrier of recredentaling triggered solely by a
provider transferring facilities.
West Los Angeles Master Plan.--While the Committee is
encouraged by recent progress made at the West Los Angeles VA
Campus, the Committee continues to be concerned that
approximately 3,000 veterans remain homeless in the Greater Los
Angeles Area. The Committee directs VA to brief the Committees
on Appropriations of both Houses of Congress each quarter on
its progress toward implementing the Master Plan, ensuring that
lease revenues are being used to benefit veterans, and
coordinating closely with the local community.
Corporate Planning and High Performing Networks.--Various
documents published by VHA, such as the Blueprint for
Excellence and the fiscal year 2016 Annual Restoring Trust in
Veterans Health Care Report, recognize the need for creating a
high-performing, integrated health network that includes VHA
providers and facilities, other federally funded providers and
facilities, and VHA-credentialed community providers and
facilities. To date, VA has not articulated an overarching
strategy to achieve such a goal, does not provide metrics to
show progress towards achieving stated goals, and has no
structure to identify accountable senior officials for such an
effort. The Committee recognizes the complex and transformative
nature of creating a system capable of serving veterans in the
future requires direct and sustained VHA leadership
involvement. To achieve this goal, the Committee directs VHA to
form a corporate planning function patterned after high
performing commercial healthcare delivery systems. Such
function must include representation from VHA clinical
leadership, and leaders from VHA offices that control, oversee,
or manage facility investments, transition, facility
operations, and organizational change, as well as the
appropriate VA offices that are dedicated to the planning and
procurement of capital infrastructure, whether built or leased
by VA. The corporate planning function shall be responsible for
planning and implementing a high performing, integrated health
network. The Department is directed to submit a report to the
Committees on Appropriations of both Houses of Congress no
later than 180 days after enactment of this act detailing the
corporate planning function and a plan to achieve a high-
performing, integrated health network for the next twenty
years. At a minimum, the plan shall clearly articulate VA's
vision of a future network, include goals VA is working towards
to achieve the vision, Key Performance Indicators, and other
metrics VA will use to judge success, and an organizational
chart detailing the corporate planning function's direct
reporting relationship to the Under Secretary of Health. The
Committee recommends VA seek objective analysis and
recommendations from organizations outside VA that have
successfully created, implemented, or advised corporate
planning functions at high-performing community healthcare
systems. The Committee recommends VHA seek guidance from the
leadership of the Department of Defense's Military Health
System Facility Shared Service. Additionally, the Committee
understands VHA is now conducting market surveys to examine how
VHA can develop a high-performing network by looking at
community healthcare supplies and VHA services and
capabilities. The Department is directed to report to the
Committees on Appropriations of both Houses of Congress the
findings of these market surveys within 180 days of the
completion of the surveys.
MEDICAL SERVICES
(INCLUDING TRANSFER OF FUNDS)
Appropriations, 2017.................................... $45,421,812,000
Advance appropriations, 2018............................ 44,886,554,000
Budget estimate, 2018................................... 1,031,808,000
Committee recommendation, 2018.......................... 1,923,000,000
Budget estimate, advance appropriations, 2019........... 49,161,165,000
Committee recommendations, advance appropriations, 2019. 49,161,000,000
PROGRAM DESCRIPTION
The Medical Services account provides for medical services
for eligible enrolled veterans and other beneficiaries in VA
healthcare facilities, including VA medical centers and VA
outpatient clinics.
COMMITTEE RECOMMENDATION
In fiscal year 2017, the Committee provided an advance
appropriation of $44,886,554,000 for fiscal year 2018 for the
Medical Services account. The recommendation for fiscal year
2018 includes an additional $1,923,000,000 which is
$891,192,000 above the budget request. The additional
appropriation coupled with the advance appropriation provided
for fiscal year 2018 provides the Department with total budget
authority of $46,809,554,000 which is $1,387,742,000 above the
fiscal year 2017 enacted amount. In addition, VA has the
authority to retain co-payments and third-party collections,
estimated to total $2,507,000,000 in fiscal year 2018.
The Committee recommendation also includes an advance
appropriation of $49,161,000,000 for Medical services for
fiscal year 2019. This is $165,000 below the request to reflect
proper rounding of a budget estimate.
RURAL ACCESS TO CARE
Office of Rural Health.--The Committee recommendation
includes $20,000,000 in addition to the budget request for the
Office Rural Health [ORH]. Through collaborations with other VA
program offices, Federal partners, State partners, and rural
communities, ORH works to optimize the use of available and
emerging technologies, establish new access points to care, and
employ strategies to increase healthcare options for all rural
veterans. Currently, ORH identifies and implements initiatives
that support rural clinics and rural home-based primary care,
address barriers to access and quality of healthcare delivery
in rural areas, develop workforce recruitment and retention
initiatives, and accelerate and expand telehealth. ORH also
operates Rural Health Resource Centers and works with Federal
and non-Federal community partners to share resources and
expand access to care for rural veterans. Given the important
role these centers play in expanding access, the Committee
encourages the Department to consider expanding these centers.
ORH has played a major role in VA's overall strategy to
combat opioid abuse by funding pilot programs through the Rural
Health Initiative focused on pain coaching and modalities which
increase veterans' access to alternatives to opioid-centered
pain management. Participants of one pain coaching program--
which linked professional coaches to veteran patients for
biweekly meetings by phone--reported a 40 percent reduction in
pain outcomes after 1 year. Another program allowed veterans to
utilize noninvasive modality devices to help reduce pain
intensity. Both of these programs have shown progress but more
must be done. The Committee encourages ORH to build upon these
programs by replicating them at additional sites. One of the
objectives of VHA's Pain Management Strategy policy is to
provide for an interdisciplinary, multi-modal approach to pain
management, and funding for these pilot programs can help VA
apply the successes of these and other programs in furtherance
of this objective.
Rural Veterans Health.--The Committee notes persistent
issues for VA health facilities in rural areas to recruit and
retain health providers in the face of national provider
shortages and a highly competitive environment. The Committee
encourages the Department to consider the expanded use of
doctors of osteopathic medicine [DOs] and physician assistants
[PAs] through physical facilities and expanded access to
telehealth services to address the rural health provider gap.
Furthermore, the Committee is concerned about lack of mental
healthcare providers, counselors, and caseworkers in rural
areas. The criteria used by the Department in establishing the
priority of hiring and placement of mental healthcare
providers, counselors, and caseworkers should take into
consideration the higher rate of facility-use in rural States
due to lower numbers of facilities and the increased amount of
outreach they must do with geographical barriers. To better
understand staffing gaps that exist in rural, highly rural and
remote areas, the Department is directed to conduct an agency-
wide assessment of the rural and highly rural healthcare
workforce to identify geographic areas where staffing needs
exist. The evaluation shall identify specific occupations
within these geographic areas that are of the most need.
TELEHEALTH SERVICES
Telehealth.--The Committee held an oversight hearing on May
4, 2017, where testimony was received from experts within VA
and the private sector on the topic of telehealth. The
Committee is pleased to note the Department is a leader in this
field of emerging technology and medicine. Telehealth creates a
bridge between rural and urban centers--providers at an urban
site can diagnose and provide a care plan for veterans hundreds
of miles away, and therefore, VA is able to expand the
resources of one facility by connecting those providers to
providers in another area. Through telehealth, the Department
has the means and flexibility to provide care to veterans who
do not have easy access to a VA hospital or access to a VA
hospital staffed with the care they need. Telehealth is not
only allowing the Department to expand access to care in areas
where services are limited, but telehealth also allows care to
be provided more effectively and efficiently for veterans
closer to home and also through direct in-home access. While VA
is once again leading the healthcare industry in the expansion
of in-home telehealth and remote patient monitoring services,
these services are often limited by the lack of broadband
service in remote and rural areas. In order to better leverage
other Federal partners, the Department is directed to provide a
report to the Committee on Appropriations of both Houses of
Congress by January 31, 2018, regarding ongoing collaborations
VA has with other Federal agencies in targeting remote and
rural areas with veteran populations in order to ensure that
grant programs administered by other Federal Agencies maximize
coverage areas to veterans. The Committee is also aware
telehealth has a potential for significant cost savings and
cost avoidance for the Department, and the Department is urged
to maintain its focus on this type of care, not only to better
serve veterans, but also to be a good steward of its financial
resources. The positive findings from the use of telehealth for
mental health services is especially encouraging to the
Committee. The Committee supports the Departments expansive use
of telehealth for medical services and encourages VA to strive
to be even more innovative, more expansive, more connected in
this area. The recommendation includes the full budget request
of $1,343,883,000 for telehealth services. This is $121,108,000
more than fiscal year 2017.
PREVENTING VETERAN SUICIDE AND MENTAL HEALTHCARE
Pilot Program for Agritherapy.--An increasing number of
States now have programs that assist veterans in starting
farms, and many veterans turning to farming also suffer from
Post-Traumatic Stress Disorder [PTSD]. The benefits of
agritherapy have been reported in the news media; however
limited research and insufficient opportunities exist to offer
the benefits of agritherapy to those suffering from PTSD.
Therefore, the Department is urged to consider agritherapy for
inclusion among VA's Complementary and Alternative Medicine
therapies. Additionally, the Committee directs no less than
$2,000,000, made available through the Office of Rural Health,
toward a pilot program to train veterans in agricultural
vocations while also tending to behavioral and mental health
needs with behavioral healthcare services and treatments from
licensed providers at no fewer than three locations. The pilot
locations may be sites that currently have an operational
construct to train veterans for agricultural vocations and have
the potential to expand operations that tend to veterans
medical needs while creating a pathway to employment in
agriculture related fields. The Department is directed to
submit a report to the Committees on Appropriations of both
Houses of Congress no later than 180 days after enactment of
this act detailing the metrics developed to determine the value
of agritherapy as it relates to PTSD and steps taken to carry
out the agritherapy pilot as directed.
Preventing Veteran Suicide.--The Committee is encouraged
that the Secretary of Veterans Affairs has made preventing
veteran suicide his number one clinical priority. The Committee
supports the Department's ``Getting to Zero'' initiative, and
the Committee is pleased to see the national implementation of
the Recovery Engagement And Coordination for Health--Veterans
Enhanced Treatment [REACH VET] program which uses predictive
modeling to guide early interventions to prevent suicide for at
risk veterans in VHA care. The Committee is grateful for those
within the Department who work tirelessly each day to save the
lives of veterans.
For years, the Department has received from this Committee
above budget request amounts for suicide prevention programs,
yet veteran suicide rates remain steady year after year. While
additional and targeted funding increases are important, the
Committee remains concerned that more should be done to prevent
veterans from taking their lives. To that end, the Committee
held an oversight hearing on April 26, 2017, on this topic. The
hearing discussion focused on options for supporting veterans
that are not currently the primary means by which the
Department aims to prevent veteran suicide, such as
complementary and alternative treatments, job training and
education, and family support, like marriage and family
counseling, caregiver support, and mechanisms for connecting
families caring for veterans in need.
According to data compiled by the VA Office of Suicide
Prevention, veterans experience a suicide rate 50 percent
higher than the general population, and female veterans commit
suicide at a rate 6 times that of their civilian counterparts.
The Committee notes 20 percent of veterans with PTSD have a
substance abuse disorder, and substance abuse is proven to lead
to increased suicidal tendencies. The Committee encourages the
prioritization of funding for substance abuse counseling based
treatment for veterans in order to decrease suicide rates among
veterans suffering from PTSD. On average, 20 veterans die by
suicide a day, and only six of those 20 are users of VHA
services.
The Committee remains concerned about the alarming
prevalence of suicide among rural veterans as they are more
likely than urban veterans to commit suicide. The Committee
urges VA to prioritize suicide prevention within rural
communities and increase the availability of mental health
resources available within States with great geographic
barriers. The Committee continues to be concerned about the
prioritization of funding for mental healthcare providers,
counselors, and caseworkers in rural areas. The criteria used
by the Department in establishing the priority of hiring and
placement of mental healthcare providers, counselors, and
caseworkers should take into consideration the higher rate of
facility use in rural States due to lower numbers of facilities
and the increased amount of outreach needed given geographical
barriers. The Department is directed to provide additional
resources to rural or highly rural medical facilities to hire
medical and clinical personnel who support veterans with mental
health services for the prevention of veteran suicide.
Veteran Crisis Line.--The Committee continues to be greatly
concerned with the continued high rate of suicide among
veterans and the growing mental health needs of veterans. Based
on that concern, the Committee held an oversight hearing on
April 4, 2017, titled ``Preventing Veteran Suicide'' and a
topic of great concern and extensive discussion at the hearing
was the performance of VA's Veterans Crisis Line [VCL]. A
number of recent VA Inspector General and Government
Accountability Office [GAO] reports have highlighted serious,
ongoing and distressing deficiencies in the operational
performance of the VCL. (Three reports in particular: VA
Inspector General reports Veterans Crisis Line Caller Response
and Quality Assurance Concerns, Canandaigua, NY (14-03540-123,
dated February 11, 2016) and Evaluation of the Veterans Health
Administration Veterans Crisis Line (16-03985-181, dated March
20, 2017), and the Government Accountability Office [GAO]
report Veterans Crisis Line: Additional Testing, Monitoring,
and Information Needed to Ensure Better Quality Service [GAO-
16-373, dated May 2016]). During the hearing, it became
apparent the Department had not promptly implemented the
recommendations made by these oversight agencies. For example,
at the time of our April 4, 2017 hearing, all seven of the
recommendations from the OIG's February 2016 report remained
open--some of them open a full year beyond the ``target dates''
for completion that VHA committed to implement. Fortunately,
and shortly after the Committee's hearing, VHA did close 6 of
the 7 open recommendations from that OIG report. The Committee
directs the Secretary to implement the remaining
recommendations of the Inspector General and the GAO
immediately and with a demonstrable and necessary sense of
urgency. The Committee recommends an additional $10,000,000
above the budget request to support the important work of the
VCL.
Suicide Data Report.--The Department's Suicide Data Report,
2012, was an important step in understanding the prevalence,
distribution, and risk factors for suicide. The Committee
further directs the Secretary to conduct a new study on the
prevalence of suicide among veterans, which shall include an
assessment of the data provided by each State and an
identification of which States should increase or improve data
reporting to the Department.
Magnetic EEG/EKG-Guided Resonance Therapy.--The Committee
understands Magnetic EEG/EKG-guided Resonance Therapy [MERT]
has successfully treated veterans with Post Traumatic Stress
Disorder [PTSD], Traumatic Brain Injuries [TBI], chronic pain,
and opiate addiction. Recent non-significant risk and non-
invasive clinical trials and pilot studies have produced
promising results in the evolution of MERT treatment. The
Committee encourages VA to undertake MERT pilot programs at up
to five VA facilities of its determining to create access to
MERT in treating larger populations of veterans suffering from
PTSD/TBI, chronic pain, and addiction. One of these five pilot
programs should demonstrate the viability of a mobile
capability to provide access in rural areas.
Marriage and Family Therapists and Licensed Professional
Mental Health Counselors.--The Committee remains concerned
about the number of veterans committing suicide each day, and
is particularly concerned that of the 20 per day, 14 have not
had contact with the Department. In an effort to increase the
number of mental health providers at the Department able to
provide care, the Committee encourages the Department to
increase efforts to hire more Licensed Professional Mental
Health Counselors [LPMHCs] and Marriage and Family Therapists
[MFTs]. The Committee recognizes the Department has attempted
to create qualification standards to permit the employment of
LPMHCs and MFTs, however, the Committee is aware obstacles
remain, given that there are still thousands of vacancies in
mental healthcare delivery positions. The Committee strongly
urges VA to report on the number of current vacancies that
could be filled by MFTs and LPMHCs, as well as develop a
strategic plan for hiring more MFTs and LPMHCs to both fill
vacancies and also augment current mental healthcare teams
within the Department. The Committee also recommends
coordinating with the Office of Management and Budget to create
an Occupational Series for LPMHCs and MFTs to permit the
Department to more easily hire staff able to provide mental
health services to veterans in a timely manner.
National Center for Post-Traumatic Stress Disorder.--The
National Center for Post-Traumatic Stress Disorder [NCPTSD] is
the Federal Government's foremost center of expertise on
evidence-based treatment of post-traumatic stress. The
Committee continues to support the mission and work of the
NCPTSD and has provided $40,000,000 to continue the center's
advancement of the clinical care and social welfare of
America's veterans who have experienced trauma or suffer from
PTSD through research, education, and training in the science,
diagnosis, and treatment of PTSD and stress-related disorders.
In recent years, the Committee has invested in the addition of
a brain bank for assisting researchers, and the expansion of
the consultation program for providers so that clinicians,
particularly those in rural areas, have access to expert advice
on the latest evidence-based treatment for post-traumatic
stress. The Committee directs the Department to ensure the
NCPTSD has the appropriate number of full time staff to support
both expansions. The Committee also directs the Department to
submit a report to the Committees on Appropriations of both
Houses of Congress no later than 180 days after enactment of
this act on the activities of NCPTSD, including: (1) how the
Center supports the implementation of evidence-based treatments
as specified in the VA/DoD Clinical Practice Guideline for the
Management of PTSD within veteran care at VA medical centers;
(2) utilization of its resources and the consultation program
by non-VA providers; (3) utilization of resources and the brain
bank by researchers; (4) consultation and information sharing
with other government entities; and (5) any resource or
staffing gaps or near gaps that exist in carrying out its
missions.
Treatment for Post-Traumatic Stress Disorder.--One in five
veterans with Post-Traumatic Stress Disorder have a substance
abuse disorder, and the Department of Health and Human Services
reports there is a connection to alcohol and substance abuse
leading to suicidal tendencies. VA funds many substance abuse
treatment options, but should not default to prescribing
medicine rather than counseling and therapy, if counseling and
therapy are available options. Overmedication has continued to
be an issue within VA, and the impact of therapy and counseling
for substance abuse treatment is, in many cases, reported to be
of equal help to a veteran. The Department should prioritize
substance abuse treatment for veterans through counseling for
veterans struggling with substance abuse disorder given that 20
percent of veterans with Post-Traumatic Stress Disorder have a
substance abuse disorder and substance abuse is proven to lead
to increased suicidal tendencies.
The Committee is aware that patient outcomes at university-
based medical clinics are a viable option for providing PTSD
treatment to veterans and have shown great preliminary
successes. As such, the Committee directs the Department to
conduct a study to determine whether this model of care
presents an opportunity to provide the best patient care to
veterans. The Department is directed to submit a report to the
Committees on Appropriations of both Houses of Congress no
later than 180 days after enactment of this act on the
feasibility of pursuing a pilot program at no fewer than 3
university sites providing PTSD treatments.
Other Than Honorable Discharge.--The Committee remains
concerned that for many veterans with other-than-honorable
discharges, the misconduct that precipitated that discharge may
have been related to in-service mental health issues. After
service in combat or other high-stress environments, or after
experiencing military sexual trauma, service members may
undergo behavioral changes stemming from post-traumatic stress
disorder, traumatic brain injury, major depressive disorder,
and operational stress. Behavioral changes may result in
injuries, which superiors often do not recognize as symptoms of
mental health conditions, but instead attribute to bad
character. The Committee is pleased VA is beginning to address
the problem by offering emergent care for up to 90 days to
veterans with other-than-honorable discharges. However, the
Committee believes the Department has the statutory authority
to provide care for many of these veterans. The statutory
requirement under 38 U.S.C. 101 and 501 excludes only former
service members whose conduct meets specific statutory bars or
would justify a dishonorable discharge. The statute does not
define that conduct standard explicitly, which leaves the
Department with authority to adopt a standard by regulation.
The Department is directed to conduct a review to align VA
regulatory guidelines with the statutory authority and modern
discharge characterizations issued by the Department of
Defense. The Department is directed to submit a report to the
Committees on Appropriations of both Houses of Congress no
later than 180 days after enactment of this act detailing the
findings of the review.
WOMEN'S HEALTH
Women Veterans.--Women represent 15.5 percent of today's
active duty force and 19 percent of our National Guard and
Reserves. Accordingly, women veterans are enrolling for VA
healthcare at record levels. As these numbers continue to rise,
most VA medical facilities across the country are not equipped
to handle the specific needs of the women veterans' population.
Therefore, the Department should continue to expand efforts
that address the current barriers to gender-specific healthcare
services. The Committee continues to believe VA must be poised
to address the changing demographic of today's and tomorrow's
veterans in order to fulfill its mission. Toward this end, the
Committee recommendation includes an additional $20,000,000
over the budget request for fiscal year 2018 to support gender-
specific healthcare services. The Committee also encourages the
Department to consider a mobile healthcare pilot program,
prioritizing rural and high need areas, to provide gender-
specific services, awareness of benefits, and outreach to women
veterans utilizing mobile healthcare infrastructure. This
innovative model is designed to fill the current gap in gender-
specific services as VA works to expand infrastructure and hire
the needed staff for specialty care.
Female Primary Care and Mental Healthcare Providers.--The
Committee urges VA to make every effort to hire more women
healthcare professionals and offer all women the opportunity to
choose the gender of their primary care and mental healthcare
providers.
Intimate Partner Violence Program.--The VA Intimate Partner
Violence Program expands VA's screening, prevention, and
intervention services to veterans and strengthens collaboration
with community partners as well as the Caregivers Support
Program and VA programs to address homelessness. The program
focuses on developing a culture of safety and adopts a
holistic, trauma-informed, veteran-centered approach to
services and support for those veterans involved in a domestic
violence situation. In recent years, VHA has run this program
using general funds, and at times, the program has lapsed due
to a lack of funds. The Committee directs the Department to
fully resource this program at $17,000,000 in fiscal year 2018
and include it as a program of interest with budget detail in
the justifications accompanying the fiscal year 2019 budget
submission.
ASSISTING HOMELESS VETERANS AND PREVENTING VETERAN HOMELESSNESS
Assessing Homelessness in Rural Areas.--The Committee
remains concerned about the fidelity of data on homeless and
at-risk veterans in rural areas and directs the Department to
identify more precise ways to obtain better and more accurate
data for veterans in these areas. The Committee encourages VA
to evaluate whether changes to the universal homeless screening
clinical reminder would result in more accurate identification
of these veterans, and to report to the Committees on
Appropriations of both Houses of Congress actions VA is taking
to reduce homelessness among the rural veteran population.
Homeless Veterans Prevention Programs.--The Committee
remains strongly supportive of VA's homeless prevention
programs and as such the recommendation includes $1,747,784,000
to support these programs. This total includes an additional
$20,000,000 over the current estimate of $320,000,000 for the
Supportive Services for Veterans Families program. The
Department has made significant progress toward ending veteran
homelessness. According to VA, the number of veterans
experiencing homelessness in the U.S. has declined almost 50
percent since 2010 and the 17 percent reduction between 2015
and 2016 is quadruple the previous year's annual rate of
decline. As communities nationwide reach critical junctures in
their efforts to end veteran homelessness, occupancy in
transitional housing programs continues to decrease. The
Committee directs VA to continue to encourage and support
community homeless providers to adapt to the bridge housing
transitional housing model, emphasizing short lengths of stay
and rapid connections to permanent supportive housing.
Additionally, VA should use data to adapt homelessness programs
to meet the needs of the changing homeless population and
expand permanent supportive housing options.
Legal Assistance for the Supportive Services for Veteran
Families Program.--The Committee notes that university law
schools are willing to work with veterans on a pro-bono basis
to provide legal assistance. This can result in additional
benefits such as training law students in veteran disability
law and legal skills critical to providing advocacy within the
VA system and inspiring next-generation lawyers to serve
veterans in practice. The Committee encourages the Supportive
Services for Veteran Families [SSVF] program to work with
grantees to expand their legal service offerings, particularly
in rural States where access to private legal assistance can be
limited. Within funds provided, the Department is encouraged to
establish one or more pilot projects to partner SSVF grantees
with university law schools in rural areas to enhance legal
assistance to Veterans.
PREVENTING DRUG ABUSE
Oversight of Substance Inspection Programs.--The Committee
understands the veteran population is at greater risk than the
general population for opioid abuse and dependency. A recent
GAO report recommended VA should ensure VAMCs have established
an additional control procedure, such as an alternate
controlled substance coordinator or a poll of extra inspectors,
to help coordinators meet their responsibilities and prevent
missed inspections. The Committee concurs with GAO's
recommendations and directs the Secretary to fully implement
these recommendations to improve oversight of the controlled
substance inspection program and to document its progress.
Opioid Safety.--The Committee supports VA's Opioid Safety
Initiative [OSI] and encourages continued implementation at all
VA medical facilities, as directed under Title IX of Public Law
114-198, the Jason Simcakoski Memorial and Promise Act. A
critical aspect of the OSI is the Opioid Therapy Risk Report
tool, an electronic tool that helps providers manage their
entire panel of patients prescribed pharmacotherapy for acute
or chronic pain. It is imperative all VA providers who
prescribe opioids use this tool consistently, including prior
to initiating opioid therapy, to ensure safe prescribing, and
to help prevent diversion, abuse, and double-prescribing.
Public Law 114-198 required the Department to implement
mandatory use of such tool for all providers prior to
initiating opioid therapy to assess the risk for adverse
outcomes; to implement standards with respect to the use of
routine and random drug tests; to ensure providers use the tool
to access the State Prescription Drug Monitoring Program
[PDMP]; and to ensure the tool includes information identifying
when healthcare providers access the tool and the most recent
drug test for each veteran. The Committee also urges VA to
further improve the timeliness of data available in the tool to
allow a provider to have real-time access to data on a patient
who was prescribed opioid therapy by another facility, in
another State, or by mail order to prevent overprescribing and
abuse potential. It is critical that VA clinicians have access
to a patient's opioid therapy history from outside providers to
ensure safe pain management care, as many veterans also seek
care from providers in the community who may prescribe them
medication. Sections 911 and 914 of Public Law 114-198 require
the Department to ensure VA providers can access information in
the State PDMP including by seeking to enter into memoranda of
understanding with States to allow shared access of such
information between VA and the States. The Department must also
include such information in the Opioid Therapy Risk Report tool
and require VA providers to disclose certain veteran
information to State controlled substance or PDMPs. The
Department is directed to submit a report to the Committees on
Appropriations of both Houses of Congress no later than 180
days after enactment of this act assessing compliance with
mandatory provider use of the tool, including a timeline of
implementation, the rate of compliance and compliance measures,
and utilization of and reporting to State PDMPs.
Prescription Drug Monitoring Program Utility.--Opioid
addiction represents a major and growing epidemic in the public
health system generally and specifically among America's
youngest veterans. Among combat-injured veterans serving in the
wars in Afghanistan and Iraq, post-traumatic stress disorder
[PTSD] and co-occurring substance use disorder [SU] is common
and found to be associated with increases in opioid addiction
and mortality. The Department is directed to submit a report to
the Committees on Appropriations of both Houses of Congress on
the Department's usage of State prescription drug monitoring
programs [PDMP] and databases used for detecting and reducing
fraud, diversion, and abuse of prescription drugs. The report
shall include--(A) an assessment of legal, technical, fiscal,
privacy, or security challenges that have an impact on utility;
(B) any recommendations for addressing challenges that impact
the Department's access to State prescription drug monitoring
programs in order to reduce fraud, diversion, and abuse of
prescription drugs; and (C) an assessment of the extent to
which VA providers use prescription drug management programs in
delivering care and preventing prescription drug abuse.
Opioid Therapy Clinical Practice Guidelines and Training.--
The Committee commends the Department for releasing the updated
2017 VA/DoD Clinical Practice Guideline [CPG] for Management of
Opioid Therapy for Chronic Pain, as required under Public Law
114-198. The Committee is encouraged the new CPG includes
enhanced guidance concerning contraindications and risk factors
for opioid therapy, such as prescribing opioids and
benzodiazepines concurrently, and for treating those with co-
occurring mental health conditions, and recommendations against
initiating long-term opioid therapy for chronic pain. To
continue to improve chronic pain management and access to safe,
quality care, the Committee directs the Department to
immediately disseminate and implement the new CPG and update
education and training materials for all VA employees who
prescribe opioids to include the new recommendations. The
Department is further directed to ensure pain management teams
at each facility certify that all healthcare professionals
responsible for coordinating and overseeing pain management
therapy utilize the updated CPG. To ensure all providers have
access to most recent scientific evidence, it is critical for
opioid prescribing guidance to be as up to date and as
consistent as possible across Federal agencies. As such, the
Committee directs the Department to continue to routinely
coordinate and consult with the Centers for Disease Control and
Prevention [CDC] and other relevant groups and Federal agencies
on continued implementation and compliance with the CPG and
latest scientific recommendations.
Opioid Addiction Treatment Protocols.--The Committee
appreciates VA's submittal of a report regarding the
Department's ongoing review of prescription practices and
addiction treatment protocols for opioids. According to the
report, however, VA has failed to adopt the Substance Abuse and
Mental Health Administration's [SAMHSA] full recommendation for
treatment including ``all drugs approved by the Food and Drug
Administration for the treatment of opioid abuse disorder,
including for maintenance, detoxification, overdose reversal,
and relapse prevention; and appropriate counseling and
appropriate ancillary services.'' The Department is directed to
submit a report to the Committee on Appropriations of both
House of Congress no later than 180 days providing an update of
this report to address VA's intent to include the full spectrum
of prescription practices and addiction treatment protocols for
opioids recommended by SAMHSA and prescribed in Public Law 114-
198, the Comprehensive Addiction and Recovery Act of 2016.
Capabilities in Treating Addiction.--The Committee directs
the Government Accountability Office to conduct a study on VA's
capabilities and capacity to treat veterans with addiction.
This study should include the following: (1) VA's number of
residential rehabilitation beds and the average wait time; (2)
the number of veterans being treated in outpatient veterans
centers based on current VA resources; (3) the percentage of
veterans who are referred to either non-VA outpatient or
residential rehabilitation treatment and wait times for both
types of treatment; (4) statistics on staffing and other
pertinent resources to the treatment of veterans struggling
with addiction; and (5) the availability and accessibility of
alternative facilities capable of providing comparable care in
rural and highly rural areas. This study should also identify
which States are particularly in need of increased resources to
resolve the opioid epidemic. The Committee requests an update
on this study no later than 90 days following the enactment of
this act and a report within 180 days.
Dependents and Prescription Drug Monitoring Programs.--The
Committee commends the Department for efforts to increase
participation in State prescription drug monitoring programs
[PDMPs]. However, the Committee is concerned that due to
deficiencies in Veterans Information Systems and Technology
Architecture [VistA], VA is unable to provide information to
PDMPs on non-veteran dependents who receive VA healthcare.
Given the continued opioid epidemic, it is important VA correct
this deficiency. Therefore, the Committee directs the Under
Secretary for Health, in consultation with the Assistant
Secretary for Information and Technology and General Counsel,
to develop a plan to enable VA to provide relevant information
on veterans' dependents to State PDMPs. The Department is
directed to submit a report to the Committees on Appropriations
of both Houses of Congress no later than 180 days after
enactment of this act detailing the plan, to include
recommendations for additional resources or authorities
necessary to address this issue.
STAFFING ISSUES
Transition of Military Healthcare Professionals.--The
Committee has received reports that separating military
healthcare professionals have expressed interest in
transitioning to work within the VA healthcare system in the
communities in which they separate. In some cases, the
competencies and skills of these professionals match current
local vacancies. The Committee notes in some places local VA
managers lack a pathway within the VA recruitment and hiring
process to ensure these experienced professionals are able to
be hired where they live. The requirement that separating
military healthcare professionals be recredentialed by VA
through its own proprietary system creates additional applicant
burden and delay. VA is encouraged to establish a recruitment
channel for separating military healthcare professionals to
identify and receive expedited consideration for VA healthcare
vacancies.
Certified Surgical Assistant Training.--The Committee
acknowledges VHA's positive response to language in last year's
report regarding the potential benefits of using full-time
surgical assistants in VHA surgical operations. The Committee
strongly encourages the Department to follow through in the
form of a proposal to fund Surgical Assistant education and
certification for retiring military medics through its Office
of Academic Affiliations helping them to provide a higher level
of care to their fellow veterans.
Hiring Clinical Psychologists.--The Committee understands
VHA each year uses the services of the Association of
Psychological Postdoctoral and Internship Centers [APPIC], a
non-profit organization, to help select and match clinical
psychologists for available VA internships. The Committee is
concerned APPIC has decided to not include psychologists from
programs accredited by the Psychological Clinical Science
Accreditation System [PCSAS] even though VHA has just published
new Psychologist Qualification Standards to encompass the
graduates of PCSAS accredited programs. The Committee is
pleased to learn VHA is working to resolve this situation to
insure all appropriately trained and qualified psychologists
are given equal access to VA internships. The Department is
directed to submit a report to the Committees on Appropriations
of both Houses of Congress no later than 90 days after
enactment of this act on the status of this issue.
Nursing Academic Partnerships.--The Committee encourages
the Under Secretary for Health and the Chief Academic
Affiliations Office to further support the VA Nursing Academic
Partnership Programs [VANAP], expansion of the Post-
Baccalaureate Nurse Residency [PBNR], the VA Nursing Academic
Partnerships in Graduate Education [VANAP-GE], and the
Enhancing Academic Partnerships programs. These programs
enhance recruitment and retention of highly trained nursing
professionals, while elevating inter-professional education
concentrating on behavioral health services, women's health,
gerontology services, services for homeless veterans, and rural
healthcare initiatives. These initiatives ensure that our
nation's veterans and their families have access to high-
quality and appropriate care by building strong partnerships
between academia and VA practice.
Orthotics and Prosthetics Workforce.--The Committee is
concerned about the sustainability of the orthotics and
prosthetics workforce treating veterans, particularly given an
aging workforce with imminent retirements as well as a lack of
availability of advanced degree programs necessary to train new
professionals. Reports indicate that up to twenty percent of
the field's 7,100 clinicians nationwide are either past
retirement age or within 5 years of retiring. The Committee
recognizes the contributions made by VHA's Orthotic and
Prosthetic Residency Program to provide rotation opportunities
throughout the VA system but acknowledges this program alone is
inadequate to ensure a sustainable workforce for the future,
especially in light of the skill set necessary to provide the
increasingly complex, state-of-the-art orthotics and
prosthetics care for OEF/OIF veterans. The Department is
directed to explore cost effective opportunities to grow the
workforce pipeline in order to ensure the future orthotic and
prosthetic workforce required by the nation's new generation of
veterans. The Department is directed to submit a report to the
Committees on Appropriations of both Houses of Congress no
later than 180 days after enactment of this act detailing the
findings.
Partnerships with Academic Medical Institutions.--In 2015,
the Committee included report language encouraging the
Department to seek out public-private partnerships,
particularly with research universities, those with and without
medical schools, to expand its efforts related to suicide
prevention, post-traumatic stress disorder, traumatic brain
injury, and substance abuse disorders. The Committee continues
to believe, as stated in report language last year, the
Department should make broader use of existing partnering
authority to collaborate with academic institutions, and
further encourages VA to enter into partnerships with
accredited medical schools and teaching hospitals for the
mutually beneficial coordination, use, or exchange of health-
care resources with the goal of improving access to and quality
of the hospital care and medical services furnished by the
Department.
Tribal Health Partnerships.--The Committee is pleased VA
has implemented a robust series of partnerships with Indian
Health Service facilities and tribally operated health
facilities that operate under self-determination contracts and
self-governance compacts with the Indian Health Service. These
partnerships are necessary not only to extend care to the
remote and highly rural areas where Native veterans reside but
in some cases has also helped VA address capacity and personnel
shortages affecting its overall beneficiary population. For
example, to address longstanding staffing problems at the
Wasilla Community Based Outpatient Clinic, the Alaska VA
Healthcare System offers beneficiaries care at the Southcentral
Foundation Benteh Nuutah Primary Care Center, a tribal facility
in Wasilla. The Committee notes some of the initial 5-year
partnership agreements are expiring and VA has been reluctant
to renew them for an additional 5-year term, preferring instead
short-term extensions. This has caused VA's tribal partners to
question whether VA has a long-term commitment to continue
these successful partnerships. The Committee encourages VA to
express its commitment to maintain its tribal partnerships and
work collaboratively with their tribal health partners on
reimbursement formulas and terms going forward. The Committee
notes losing these important partnerships over
misunderstandings or contracting disagreements would have
serious effects on VA healthcare in Alaska.
Staffing of the Alaska VA Healthcare System.--The Committee
continues to be concerned about chronic staffing issues within
the Alaska VA Healthcare System. As of July 2017, the Wasilla
Community Based Outpatient Clinic still lacks a single full
time physician even though patient demand would justify two
full time physicians. The Committee understands that
recruitment and retention of medical professionals to serve in
Alaska is difficult, but it is also worth noting that community
hospitals and tribal health facilities in Alaska have faced and
overcome similar difficulties. The Committee encourages VA to
formulate a strategy to permanently fill chronic vacancies in
the Alaska VA Healthcare System. This requires Central Office
cooperation to ensure recruitment and retention incentives are
readily available to these positions and that medical
professionals offered employment are smoothly on boarded. VA
should reach out to other healthcare organizations in Alaska to
identify best practices for recruitment of medical
professionals from out of State. The Fairbanks Memorial
Hospital, for example, has expressed a willingness to partner
with VA in addressing recruitment issues. The Committee
encourages VA to work in collaboration with willing Alaska
healthcare providers to encourage medical professionals to
consider work in Alaska.
Critical Needs Occupational Staffing Model.--It is critical
VHA develop a staffing model so that it can better understand,
and more quickly address, its staffing needs in critical need
occupations. The Committee remains concerned that after nearly
2 years, VA has failed to follow-up on repeated OIG
recommendations to develop staffing models for critical need
occupations, as well as set forth milestones and a timetable
for further critical need occupations' staffing model
development, piloting, and implementation with the urgency
required given the importance of having adequate staff to
appropriately care for veterans. The Committee recognizes the
Department has put forward some effort to move forward the
process for creating a staffing model forward but is
disappointed with the pace. As such, the Department is directed
to accelerate the creation of such a model so that veterans
have access to the care they need.
Health Professional Scholarship Program.--The Health
Professional Scholarship Program [HPSP] provides scholarships
to students receiving education or training in a direct or
indirect healthcare services discipline. Awards are offered on
a competitive basis and are exempt from Federal taxation. In
exchange for the award, scholarship program participants agree
to a service obligation in a VA healthcare facility. The
Committee continues to support this program and is concerned VA
has not fully been utilizing this program in fiscal year 2017,
based on data from fiscal year 2016. The Committee believes
strongly ample resources exist within the Department to ensure
hard to fill specialties are not excluded from participation.
In spite of this, the Committee continues to hear VA is not
utilizing these tools in the most judicious and efficient
manner. The Department is directed to submit a report to the
Committees on Appropriations of both Houses of Congress no
later than October 30, 2017, on each profession eligible to
receive HPSP scholarship and any limitation VA is placing on
awards. In addition, VHA is also directed to submit to the
Committees on Appropriations of both Houses of Congress no
later than 90 days after enactment of this act a strategic plan
which identifies difficult to recruit occupations and outlines
specific actions being taken to address those shortages.
ITEMS OF INTEREST
Hepatitis C Treatment.--The Department has received
targeted and significant resources for the past 2 years from
this Committee to aggressively treat and cure veterans with
hepatitis C, and the Committee is pleased VA has made
significant progress doing so. The Department is to be
commended for innovative and directed outreach to the cohort
most likely affected by the disease, including effective
marketing campaigns, partnerships with veteran service
organizations, and holding weekend and after hours clinics to
increase access to care. The Committee is aware VA has treated
upwards of 87,000 veterans with new generation oral hepatitis C
drugs which have a cure rate of more than 90 percent. The
remaining cohort of veterans who have not been treated but
potentially have the disease are the most difficult to contact
and persuade to seek treatment, but the Committee directs VA to
continue efforts to reach all veterans who would benefit from
care as soon as possible.
Due to the change in drug pricing, the Committee notes VA
has been able to treat more veterans with significantly less
funding than was anticipated at the time of the original
appropriation. Given that slightly more than half of the
funding remaining available for Hepatitis C was specifically
fenced in statute, the Department lacks the authority to
transfer this funding before it lapses. Therefore, the
Committee's recommendation includes a rescission of
$751,000,000 and appropriates back the same amount to the
Medical Services account to ensure that this funding does not
lapse. The Committee notes, that the Department will still have
more than $600,000,000 in unobligated Hepatitis C funds
originally appropriated in fiscal year 2016 and directs the
Department to continue to aggressively fund the Hepatitis C
program consistent with the fiscal year 2018 budget request.
The Department is directed to continue its quarterly
updates to the Committees on Appropriations of both Houses of
Congress detailing the expenditures and obligations of funding
hepatitis C treatment, the number of veterans treated, the
number of veterans deemed cured, the projection of spending,
the number of new starts for drug treatment, and number of
veterans who have been cured.
DoD and VA Prescription Drug Purchasing.--The Committee
believes there are potential savings in combining DoD and VA
prescription drug purchasing. A 2014 GAO report surveyed 83
common drugs purchased by both Departments and found that if
purchasing drugs for both Departments at the lowest DoD or VA
price, the taxpayer could have realized a combined savings of
$120,000,000 in 2012. GAO recommended DoD, VA, and Medicare
align the structure, statutory parameters, and regulatory
guidance across all Federal prescription buying programs to
increase buying power and reduce costs. The Department is
directed to work with the Department of Defense and submit a
report to the Committees on Appropriations of both Houses of
Congress no later than 180 days after enactment of this act
detailing the feasibility of aligning their structures,
statutory parameters, and regulatory guidance with the
Department of Defense for their prescription buying program in
order to increase buying power and reduce cost.
Encouraging Public-Private Partnerships.--The Committee is
aware of private-sector solutions and financial support that
can effectively and efficiently develop and construct
facilities that create greater access to care while reducing
costs in the near and long term. The Committee encourages VA to
pursue public-private partnerships to implement projects in
VISN 15 and others that include but are not limited to VA
facility leases, renovations, or construction to increase
access to healthcare services for veterans. The Committee
further directs VA to utilize existing and new authorities that
permit such partnerships and potential cost-share solutions,
such as Communities Helping Invest through Property and
Improvements Needed for Veterans Act of 2016 and the CHIP IN
for Vets Act of 2016. The Department is directed to submit
reports on a quarterly basis to the Committees on
Appropriations of both Houses of Congress regarding current and
new projects resulting from this initiative.
Travel Reimbursement.--The Beneficiary Travel program
provides eligible veterans and other beneficiaries mileage
reimbursement, common carrier (plane, train, bus, taxi, light
rail etc.), or when medically indicated, ``special mode''
(ambulance, wheelchair van) transport for travel to and from VA
healthcare, or VA authorized non-VA healthcare for which the
veteran is eligible. The Committee appreciates recent steps to
modernize the program's processes but remains concerned about
the time it takes for veterans to be reimbursed. Therefore, the
Department is directed to submit a report to the Committees on
Appropriations of both Houses of Congress no later than 90 days
after enactment of this act on steps taken to make the process
to receive travel reimbursement more timely and user-friendly
for veterans. The report should also include how filling
vacancies in the travel office are prioritized and how the
Department is addressing challenges with kiosks, particularly
for veterans with disabilities such as blindness.
Hearing Aid Specialists.--The Committee understands hearing
loss and tinnitus are among the most common injuries facing
veterans of the recent conflicts in Iraq and Afghanistan.
Hearing loss can contribute to depression, heightened stress,
fatigue, and other challenges veterans face as they reintegrate
into civilian life. The Committee is aware of the high demand
for healthcare services among veterans and supports the recent
passage of legislation aimed at addressing gaps in the
provision of care within VA by allowing the Department to hire
hearing aid specialists. The Committee is concerned VA has not
completed the process of developing basic qualification
requirements, work assignments, and qualification standards
under title 38 for this occupation. The Department is directed
to submit a report to the Committees on Appropriations of both
Houses of Congress no later than 90 days after enactment of
this act detailing the progress made in developing and
publishing this criteria and how and when VA will begin hiring
such providers to offer such services.
National Veterans Sports Programs and Special Events.--The
Committee supports the continued efforts of the Department to
provide disabled veterans and disabled members of the Armed
Forces with unique alternative therapies such as adaptive
sports. The Department is directed to submit a report to the
Committees on Appropriations of both Houses of Congress no
later than 90 days after enactment of this act on the status of
the current adaptive sports program and recommendations for
expansion of the program, as well as how the Department may
better leverage grants for greater access to rural communities
as well as possible integration into mental health alternative
therapies. The Committee notes is has provided an additional
$2,000,000 to support community-based qualifying sports
programs or other events in rural locations through the Office
of Rural Health.
Enabling Independent Federal Investigations of VA Health
Care.--The Committee is concerned by reports that independent
Federal investigations into VA opioid prescribing practices
have been hampered by the Department's inability or
unwillingness to share information with investigators. The
Committee places the highest priority on maintaining robust
protections for veterans' privacy but emphasizes these
protections are for the rights of patients, not providers. The
Committee believes the Department should take every appropriate
action to fully comply with investigators requests to supply
relevant information in ongoing and future investigations by
the Drug Enforcement Agency into potential violations of the
Controlled Substances Act by VA employees, and inform the
Committees on Appropriations and Veterans Affairs of both
Houses of Congress if additional authorities are required to do
so.
Complementary and Integrative Health.--Expanding access to
comprehensive pain management and complementary and integrative
health [CIH] services is vital to improving the delivery of
high-quality care for our veterans, especially those struggling
with co-occurring conditions like chronic pain, mental health
and substance use disorders. The Committee supports VA's work
in developing a plan to expand the scope of research,
education, delivery, and integration of CIH into the healthcare
services provided to veterans and urges robust implementation.
In addition, as required under Section 932 of Public Law 114-
198, VA must continue to prioritize implementation of the pilot
program at VA medical centers, including polytrauma
rehabilitation centers, to assess the feasibility,
advisability, and methods of delivery of wellness-based
programs to complement pain management and related healthcare
services. While the Committee supports the progress being made
to reduce misuse and abuse of opioids and to improve pain care,
the Committee believes that consideration of VISNs or medical
centers with a history of or current prescription rates of
opioids inconsistent with the standards of appropriate and safe
care should be given priority. The Committee encourages the
Department to continue to expand access to CIH services as part
of the VA's Whole Health System approach, and the Department is
directed to submit a report to the Committees on Appropriations
of both Houses of Congress on later than 90 days after
enactment of this act on the progress of the 18 flagship
facilities being launched to effectuate this effort.
Antimicrobial Stewardship Program.--The Committee is aware
that commercially proven integrated technology for infectious
disease and pharmacy management is the industry standard for
meeting national Antimicrobial Stewardship directives. While VA
has successfully used these tools in a limited number of
facilities, VA has not deployed it system wide. Therefore, the
Committee encourages VA to implement a system wide electronic
solution for all medical facilities that would provide
infectious disease control monitoring, provide appropriate
treatment and pharmacy care plans, help prevent potential
healthcare risks, document interventions that improve patient
care, and reduce hospital costs. These capabilities would bring
VA into compliance with all Federal and State regulatory
antimicrobial program directives.
Long-Term Care.--The bill provides $8,821,657,000 as
requested by the Department for long-term care. This includes
the $6,073,862,000 for institutional care and $2,747,795,000
for non-institutional care. The Committee is concerned about
the Department's fiscal year 2018 proposal to fund more than
$690,000,000 of non-institutional care through the Choice
program. Should Congress not provide additional funding for the
Choice program, the Committee directs VA to fulfill its
obligations to non-institutional care programs as proposed in
the original fiscal year 2018 advance appropriation request. To
ensure proper budgetary oversight of the non-institutional care
programs, the Department is directed to report quarterly to the
Committees on Appropriations of both Houses of Congress on the
quarterly demand and execution of the non-institutional
programs. In addition, VA is directed to include in the budget
justifications accompanying the fiscal year 2019 budget request
detailed data on the number of veterans receiving non-
institutional care disaggregated by the appropriate medical
care account.
Headache Disorders Centers of Excellence.--The Committee
recognizes that over 350,000 veterans sustained traumatic brain
injury [TBI] during the Global War on Terror and that chronic
migraine/post-traumatic headache is the signature symptom of
TBI. The Committee is concerned that veterans with chronic
migraine/post-traumatic headache often do not receive specialty
care, and that only three VA-affiliated physicians are
certified with training in Headache Medicine by the United
Council for Neurological Subspecialties. The Committee
recognizes the importance of VA centers of excellence and the
need for VA Headache Centers of Excellence. The Committee
provides $10,000,000 for the creation of at least five headache
centers to be placed at the existing sites for polytrauma and
traumatic brain injury [TBI] or at locations that the Secretary
sees fit.
Readjustment Counseling.--The Committee strongly supports
readjustment counseling provided through the Departments 300
Vet Centers, 80 mobile Vet Centers, and the Vet Center Combat
Call Center. Vet Centers are community-based counseling centers
that provide a wide range of social and psychological services.
These services include: professional readjustment counseling to
veterans and active duty servicemembers, counseling for the
victims of military sexual trauma, bereavement counseling for
families who experience an active duty death, substance abuse
assessments and referrals, VBA benefit information and
referrals to Regional Offices, and employment counseling.
Certain services also extend to the family members as a means
to assist in the readjustment for veterans and active duty
servicemembers. In order to bolster readjustment counseling
capacity across the country, the recommendation provides an
additional $15,000,000 over the budget estimate for the Vet
Center program. The Committee recognizes the unique
opportunities that Vet Centers provide in collaborating and
developing alternative treatments with other community
organizations to create programs for veterans to share
experiences, develop bonds, and address common challenges.
Therefore, within the additional funding provided, the
Committee directs $2,500,000 be utilized to develop a program
to partner with organizations that provide outdoor experiences
for veterans as part of a continuum of care that helps support
veterans in developing a community of support to treat combat-
related injuries, including those related to behavioral health.
Increased Infectious Disease Screening.--The Department is
directed to submit a report to the Committees on Appropriations
of both Houses of Congress no later than 180 days after
enactment of this act on VHA's efforts to improve HIV/AIDS and
hepatitis screening rates in traditional and non-traditional
settings, including to what extent the Department utilizes
innovative strategies like point-of-care testing and public
health outreach. The Committee notes the racial disparities in
these diseases and requests that the report include a section
which focuses on minority groups including but not limited to,
Native Americans, Asian Americans, Pacific Islanders, Alaska
Natives, Native Hawaiians, and African Americans.
Colorectal Cancer Screening.--Approximately one-third of
eligible U.S. adults have never been screened for colorectal
cancer despite it being the second-leading cause of cancer
death in the United States. To help address this, in 2016, the
United States Preventive Services Task Force [USPSTF] updated
its recommendation for colorectal cancer screening, issuing it
an A-grade, and included several strategies determined with
high certainty to have a substantial net benefit and noted that
offering choice in screening strategies may increase the number
of screened individuals. The strategies have subsequently been
adopted by the National Committee for Quality Assurances
Healthcare Effectiveness Data and Information Set [HEDIS]
measures, which are used by more than 90 percent of America's
health plans to measure performance. TRICARE covers the
majority of the strategies identified by USPSTF, however VA
does not offer veterans coverage for the same options and
covers fewer screening methodologies. To improve colorectal
cancer screening of veterans and enhance access to the most
updated screening technologies, the Committee directs VA to
offer all seven USPSTF strategies now recognized in the HEDIS
measures to all veterans enrolled in the VA health system.
Domiciliary Program.--The Committee is concerned VA has not
yet completed its assessment of the VA domiciliary program as
required by Senate Report 114-237. The Committee directs VA to
complete this assessment and within 60 days submit a formal
report to the Committees on Appropriations of both Houses of
Congress, with recommendations if applicable, addressing
security gaps in the VA domiciliary program and whether the
current program can meet the needs of veterans who are at
heightened risk for overdose or suicide. The assessment should
include alternatives to the domiciliary program if it is found
that the current program cannot meet the needs of these
veterans.
Sleep Disorders.--The Committee recognizes the importance
of sleep, including its impacts on PTSD, TBI, and mental
health. The Committee supports VA considering all treatment
options for these conditions, including ensuring proper sleep
health. The Committee continues to recommend the Department
assign a program manager for sleep disorders, including sleep
apnea, which affects at least 200,000 veterans of the Persian
Gulf War and Operations Iraqi Freedom and Enduring Freedom. The
Department is directed to submit a report to the Committees on
Appropriations of both Houses of Congress no later than 90 days
after enactment of this act on the status of this
recommendation.
Stroke Care.--More than half of veterans are over age 65,
putting them at an increased risk of stroke, a leading cause of
serious, long-term disability and dementia. Immediate care is
essential to preventing permanent disability, and it is
critical the Department work to improve its stroke care and
provide timely access to assessment and treatment.
Unacceptably, there have been cases in which veterans have died
or have suffered severe injury due to lack of timely diagnosis
and treatment. A December 2015 report evaluating the quality of
stroke care in VA facilities, conducted by the Department's
Office of Inspector General, found several areas needing
improvement, including the need to increase access to
clinicians with stroke expertise, and the need to ensure
compliance with current stroke care requirements at each VA
facility's designated level. To improve access to providers
with stroke expertise, the Committee urges VA to continue its
efforts to implement stroke telemedicine, or telestroke, within
VA medical centers that do not currently have around-the-clock
neurological expertise available to veterans who suffer a
stroke. Telestroke has proven to be beneficial in improving
access to high quality stroke care in rural and underserved
areas and in reducing disability and the need for long-term
care following a stroke. The Committee also encourages the
Department to continue to reinforce compliance with stroke care
requirements, including prompt and thorough assessment,
treatment, and patient education, and ensure the gathering and
reporting of required stroke data elements, consistent with the
recommendations in the December 2015 report.
Prosthetic Digital Health Technology.--VA's Office of
Rehabilitation and Prosthetic Services shall, not later than 90
days after enactment of this act, provide a report to the
Committees on Appropriations of both Houses of Congress,
detailing which VA Medical Centers and Clinics this technology
is available. In addition, the report shall include the number
of veterans utilizing this technology, any plans for increasing
the availability of this technology to more veterans, and any
plans to make prosthetic related outcomes-based data collection
standard throughout the Veterans Health Administration.
Caregivers.--The Committee notes the robust usage of the
post-9/11 Caregiver program with its more than 23,000 approved
applications, as well as the consistent reviews by caregiver
families noting that the program's stipend, respite care,
formal training, and support structure are critical components
to its success. Given the demonstrated success of the program,
the Committee encourages VA to ensure the Caregiver
coordinators at each Medical Center are fully resourced and, to
the maximum extent possible, assigned designated Caregiver
duties as their chief and only responsibility. In addition, the
Committee encourages VA to examine expansion of the program
beyond the post-9/11 population. The Committee encourages VA to
work with the Department of Defense in order to develop and
share best practices. The Committee recognizes many caregivers
for severely wounded veterans are working dramatically reduced
hours outside the home or have left the workforce completely,
leading to financial hardship. This reduction in outside
earnings results in difficulties meeting financial obligations,
including student loan debt held by the caregiver. VA is
directed to survey all caregivers currently in the program to
identify those possessing outstanding student loan debt,
develop a plan to monitor this issue, including future data
collection and regular reports to the Committee, and report
survey findings and details of the plan to the Committees on
Appropriations of both Houses of Congress no later than 120
days after enactment of this act and every 6 months thereafter.
The Committee is concerned by the steep decline in requested
funding for the Caregivers Program. Given the increasing demand
for these services and the consistent reports and findings of
inconsistent or inappropriate removal of veterans from the
program, the Committee questions whether the Department's
request is an accurate reflection of the program's true needs.
The Committee, therefore, recommends $839,828,000, which is
consistent with the fiscal year 2018 advance appropriation, to
continue full operation of this essential program. The
Committee directs the Department to implement a freeze on
reductions or removals of veterans from the program until all
outstanding recommendations from the Office of Inspector
General and the Comptroller General are fully implemented.
Veterans Transportation Service.--In order to ensure the
Veterans Transportation Service [VTS] is improving veterans'
access to healthcare and VA's ability to provide quality care
in a cost effective manner, the Department is directed to
submit a report to the Committees on Appropriations of both
Houses of Congress no later than 90 days after enactment of
this act outlining the progress made on these metrics. At a
minimum, the report should include analysis of the healthcare
costs impacted by non-emergency medical transportation, the
impact of VTS on missed appointment rates at facilities
utilizing the program, and VTS impact on health outcomes for
veterans.
Center for Compassionate Innovation.--The Committee
understands VA has been operating a Center for Compassionate
Innovation. The Center's stated purpose is to explore emerging
therapies targeted to enhance veteran physical and mental well-
being when other treatments have not been successful. The
Committee encourages VA to always be testing and researching
new and innovative treatments that may benefit veterans' lives.
To more fully understand these treatments, the Department is
directed to submit a report to the Committees on Appropriations
of both Houses of Congress no later than 180 days after
enactment of this act with a description of the proposals the
Center received in fiscal year 2017 and the cost and
disposition of such proposals. Further, to the extent the
Center undertook any projects during fiscal year 2016, the
Committee directs VA to report on the status of those projects
and any findings or preliminary data.
Nurse Advice Line.--The Department is directed to pursue a
pilot program for a nurse advice line targeting rural areas and
highly rural areas with a large percentage of veterans.
Licensed Registered Nurses at the call center will triage VHA-
enrolled veteran callers to the clinically appropriate care
venue and provide appointment and cancellation services and
information on the availability of benefits from the VA. The
pilot should be based on and improve upon the nurse advice line
implemented by DoD for beneficiaries under the TRICARE program.
The pilot shall provide responsive service around-the-clock for
callers. The Department is directed to submit a report to the
Committees on Appropriations of both Houses of Congress no
later than 90 days after enactment of this act, and every 90
days thereafter, on the progress of pilot program. The reports
shall contain information on utilization of the pilot, to
include a description of the individuals who benefitted from
advice under the pilot program, a description of any
impediments in carrying out the pilot program, a description of
any impediments encountered by individuals in seeking advice or
services through the pilot program, a description of any cost
savings to the Department, and an assessment of the feasibility
and advisability of expanding the pilot program to more
veterans.
Gulf War Illness.--The role of the Research Advisory
Committee on Gulf War Veterans' Illnesses [RAC] was intended to
provide a meaningful consultative role to help shape the
Persian Gulf War research agenda, strengthen the process by
which the government sets its Persian Gulf War research agenda,
and lend credibility to future research activities. However,
concerns continue to be raised that this role has been degraded
and compromised. The RAC charter no longer requires it to
assess the effectiveness of Federal Gulf War research, no
longer contains a requirement for its own staff, and its
purview is presently limited solely to research conducted by
the Department. Determinations by the RAC and IOM that Gulf War
illness is physiological and not psychological should be the
basis in determining the type of medical practitioners and
scientific researchers needed to create a well-qualified
membership. The Committee notes the RAC has provided no new
recommendations since September 2014 and encourages the RAC to
renew its efforts in studying Gulf War Illness. The Committee
directs the Department to brief the Committee on its efforts to
address these concerns. The Committee also continues to urge
the Department to restore regular reporting throughout the year
of healthcare and benefits utilization by Gulf War and post-9/
11 veterans, to publish these reports on the Department's Web
site, and to consider for adoption the ``Recommendations for
New VA Gulf War-Era Data Report,'' adopted by the RAC on
February 1, 2012.
Lung Cancer Screening.--The Committee notes with concern
that not all veterans who are at high risk for developing lung
cancer have access to lung cancer screening programs offered to
Medicare beneficiaries. The Department is directed to submit a
report to the Committees on Appropriations of both Houses of
Congress no later than 90 days after enactment of this act
regarding how VHA can institute a high quality program to make
lung cancer screening broadly available to the appropriate
veterans who are at high risk.
Hospice Care.--From 1964 to 1975, more than nine million
Americans served in the armed services, with more than one-
third of them having served in Vietnam. As these Vietnam-era
veterans age, many of them are facing unique end-of-life
challenges related to their combat experience that standard
hospice care and palliative services are not fully equipped to
address. These challenges include psychological and post-
traumatic stress disorders, a history of substance abuse, and
neurological conditions resulting from toxic chemical exposure.
While the VA provides hospice care and palliative services to
qualified veterans, the Committee is aware that organizations
such as the non-profit National Partnership for Hospice
Innovation are developing programs designed to meet the
specific end-of-life care needs for Vietnam-era veterans. The
Committee also recognizes that such an approach could be
beneficial to Iraq and Afghanistan combat veterans in the
future. Therefore, VA is directed to undertake a study on the
feasibility of implementing hospice care protocols tailored to
the unique needs of combat veterans, including Vietnam-era
veterans, and is encouraged to deploy a pilot program to
develop the techniques, best practices and support mechanisms
to serve these veterans. The Department is directed to submit a
report to the Committees on Appropriations of both Houses of
Congress no later than 180 days after enactment of this act on
this effort.
Improving Federal Burn Pits Registry.--The Committee
provides an additional $5,000,000 for the purpose of
implementing the recommendations included in the National
Academies of Sciences, Engineering, and Medicine's Assessment
of the Department of Veterans Affairs Airborne Hazards and Open
Burn Pit Registry for improving the registry. The Department is
directed to submit a report to the Committees on Appropriations
of both Houses of Congress no later than 90 days after
enactment of this act assessing the cost and timeline of
implementation of each of the report's recommendations.
MEDICAL COMMUNITY CARE
Appropriations, 2017.................................... $7,246,181,000
Advance appropriations, 2018............................ 9,409,118,000
Budget estimate, 2018................................... 254,000,000
Committee recommendation, 2018.......................... 254,000,000
Budget estimate, advance appropriations, 2019........... 8,384,704,000
Committee recommendation, advance appropriations, 2019.. 8,385,000,000
PROGRAM DESCRIPTION
The Medical Community Care account provides for medical
services for eligible enrolled veterans and other beneficiaries
that is purchased from and provided by non-Department of
Veterans Affairs facilities and providers, including contract
hospitals, State homes, and outpatient services.
COMMITTEE RECOMMENDATION
In fiscal year 2017, the Committee provided an advance
appropriation of $9,409,118,000 for fiscal year 2018 for the
Medical Community Care account. The recommendation for fiscal
year 2018 includes an additional $254,000,000 as included in
the budget request. The additional appropriation coupled with
the advance appropriation provided for fiscal year 2018
provides the Department with total budget authority of
$9,663,118,000 which is $2,416,937,000 above the fiscal year
2017 enacted amount.
The Committee recommendation also includes an advance
appropriation of $8,385,000,000 for Medical community care for
fiscal year 2019. This is $296,000 above the request to reflect
proper rounding of a budget estimate.
The Future of Community Care.--The Department is directed
to continue efforts to consolidate all types of community care
available to veterans within one program in the Medical
Community Care account. The Committee recognizes that the
Committees on Veterans Affairs of both Houses of Congress have
jurisdiction over the authorization of the consolidation, as
well as the current Choice Program, which has been funded with
mandatory appropriations. Once the latest round of funding
available for the Choice Program has been expended, the
functions of the Choice Program should be merged with the
functions that are currently funded by and provided for under
the Medical Community Care account, and that the consolidated
program should be funded by this Committee. The Committee is
aware that this would significantly increase discretionary
spending for community care. The Committee would like to work
with all interested parties within the Congress and the
Administration to increase the discretionary spending limits to
accommodate such increased future costs for a consolidated
community care program. At the same time, the Committee directs
the Department to maintain intense focus on responsibly
providing care under the Choice Program, while working
diligently to build the successor program and enable the
consolidation of all community care under one account that
would be funded by annual appropriations.
Federally Qualified Health Centers in the Choice Program.--
The Committee recognizes the importance of Federally Qualified
Health Centers in [FQHCs] in providing care to Americans across
the country, including the most vulnerable. The Department is
directed to submit a report to the Committees on Appropriations
of both Houses of Congress no later than 90 days after
enactment of this act regarding the role of FQHCs play in
providing veterans care through the Veterans Choice Program and
outlining opportunities for further engagement.
Community Provider Agreements.--As illustrated by the
success of the former Access Received Closer to Home [ARCH]
program, community provider agreements have successfully
benefited veterans in rural and highly rural States by
increasing access to care and significantly shortening travel
times. The Committee supports sustaining continuity of care for
rural veterans through community provider agreements, based on
previous models such as the ARCH program, to ensure veterans do
not experience a lapse in healthcare during the transition to
the new Choice program and any resulting integrated networks.
Home and Community Based Services.--The Committee supports
the Department's efforts to broaden veterans' options regarding
long-term care support and services. As the Department realigns
these programs under the Medical Community Care account, the
Committee encourages VA to continue to prioritize veterans'
preferences in receiving home based services. The Committee
notes the positive results of pilot programs such as the
Veterans Independence Program, a veterans-directed Home and
Community Based Services [HCBS] grant program originally
created as a pilot administered jointly by VA and the
Department of Health and Human Services [HHS]. The Committee
encourages enhanced cooperation with HHS to expand and grow
these programs. The Department is directed to submit a report
to the Committees on Appropriations of both Houses of Congress
no later than 180 days after enactment of this act on the cost
avoidance associated with various non-institutional care
programs. The report should include information on the demand
for HCBS among the veteran population, the number of veterans
currently being served by each program under HCBS, and the
Department's plans to expand the size and scope of HCBS. Given
the success of current HCBS pilot programs, the Department
should include a cost analysis of growing the existing pilot
programs prior to national expansion to leverage coordination
with HHS, in addition to detail regarding the Department's
efforts to coordinate with HHS on HCBS in future years. Given
that mandatory eligibility for certain types of care is
associated with disability levels adjudicated by VBA, this
report should also include recommendations for modernizing the
claims process for veterans requiring long-term care.
Non-VA Long-Term Care.--The Committee supports enabling the
Department to enter into provider agreements with non-VA long-
term care providers, including skilled nursing facilities, in
lieu of the current onerous Federal contracting requirements.
Rural Health Continuity of Care.--The Committee notes the
Access Received Closer to Home [ARCH] pilot program had been
highly successful in some areas in providing healthcare
services to veterans who live in the rural and highly rural
States in which it operated, such as in northern Maine and in
Kansas. During the pilot, VISN analysis demonstrated that more
than 90 percent of veterans who received medical care though
ARCH were ``completely satisfied'' with their care and cited
significantly shortened travel and wait times to receive care.
Further, the Committee is pleased the Department has made
efforts to provide continuous, ARCH-like access to rural
healthcare in northern Maine through the use of provider
agreements. Accordingly, the Committee directs the Secretary to
ensure that veterans who participated in the ARCH pilots
maintain continuity of care through the use of provider
agreements or other mechanisms.
MEDICAL SUPPORT AND COMPLIANCE
Appropriations, 2017.................................... $6,498,000,000
Advance appropriations, 2018............................ 6,654,480,000
Budget estimate, 2018................................... 284,397,000
Committee recommendation, 2018.......................... 100,000,000
Budget estimate, advance appropriation, 2019............ 7,239,156,000
Committee recommendation, advance appropriation, 2019... 7,239,000,000
PROGRAM DESCRIPTION
The Medical Support and Compliance account provides funds
for management, security, and administrative expenses within
the VA healthcare system, in addition to providing costs
associated with the operation of VA medical centers and
clinics, VISN offices, and the VHA Central Office in
Washington, DC. This appropriation also covers Chief of Staff
and Facility Director operations, quality of care oversight,
legal services, billing and coding activities, procurement,
financial management, security, and human resource management.
COMMITTEE RECOMMENDATION
In fiscal year 2017, the Committee provided an advance
appropriation of $6,654,480,000 for fiscal year 2018 for the
Medical Support and Compliance account. The recommendation for
fiscal year 2018 includes an additional $100,000,000 which is
$184,397,000 below the budget request. The additional
appropriation coupled with the advance appropriation provided
for fiscal year 2018 provides the Department with total budget
authority of $6,754,480,000 which is $256,480,000 above the
fiscal year 2017 enacted amount.
The Committee recommendation also includes an advance
appropriation of $7,239,000,000 for Medical support and
compliance for fiscal year 2019. This is $156,000 below the
request to reflect proper rounding of a budget estimate.
MEDICAL FACILITIES
Appropriations, 2017.................................... $5,312,668,000
Advance appropriations, 2018............................ 5,434,880,000
Budget estimate, 2018................................... 1,079,795,000
Committee recommendation, 2018.......................... 707,000,000
Budget estimate, advance appropriation, 2019............ 5,914,288,000
Committee recommendation, advance appropriation, 2019... 5,915,000,000
PROGRAM DESCRIPTION
The Medical Facilities account provides funds for the
operation and maintenance of the VA healthcare system's vast
capital infrastructure. This appropriation provides for costs
associated with utilities, engineering, capital planning,
leases, laundry, groundskeeping, housekeeping, facility repair,
and property disposition and acquisition.
COMMITTEE RECOMMENDATION
In fiscal year 2017, the Committee provided an advance
appropriation of $5,434,880,000 for fiscal year 2018 for the
Medical Facilities account. The recommendation for fiscal year
2018 includes an additional $707,000,000 which is $372,795,000
below the budget request. The additional appropriation coupled
with the advance appropriation provided for fiscal year 2018
provides the Department with total budget authority of
$6,141,880,000 which is $829,212,000 above the fiscal year 2017
enacted amount.
The Committee recommendation also includes an advance
appropriation of $5,915,000,000 for Medical community care for
fiscal year 2019. This is $712,000 above the request to reflect
proper rounding of a budget estimate.
Medical Facilities Leases Authorization.--The Committee
continues to be concerned by the extensive delays in
authorizing VA medical facilities leases, which would provide
increased healthcare access for veterans across throughout the
VA system and in many cases reduce inefficiencies and simplify
veteran care by consolidating multiple existing facilities. The
Committee is aware the Department recognizes the need for
additional VA medical facilities and has proposed leases in its
budget request, but budgetary challenges have prevented the
authorization of such leases. The Committee urges the
Department to continue working with the Office of Management
and Budget and Congressional Budget and Veterans' Affairs
Committees to identify a long-term solution to these budgetary
challenges.
MEDICAL AND PROSTHETIC RESEARCH
Appropriations, 2017.................................... $673,366,000
Budget estimate, 2018................................... 640,000,000
Committee recommendation................................ 722,262,000
PROGRAM DESCRIPTION
The Medical and Prosthetic Research account provides funds
for medical, rehabilitative, and health services research.
Medical research supports basic and clinical studies that
advance knowledge leading to improvements in the prevention,
diagnosis, and treatment of diseases and disabilities.
Rehabilitation research focuses on rehabilitation engineering
problems in the fields of prosthetics, orthotics, adaptive
equipment for vehicles, sensory aids and related areas. Health
services research focuses on improving the effectiveness and
economy of the delivery of health services.
COMMITTEE RECOMMENDATION
The Committee recommends $722,262,000 for the Medical and
Prosthetic Research account. This is $48,896,000 above the
fiscal year 2017 enacted level and $82,262,000 above the budget
request.
The Committee remains highly supportive of this program,
and recognizes its importance both in improving healthcare
services to veterans and recruiting and retaining high quality
medical professionals in the Veterans Health Administration.
Through the Department's research and development program,
VA has implemented a comprehensive research agenda to develop
new treatments and tools for clinicians to ease the physical
and psychological pain of men and women returning from war
zones, to improve access to VA healthcare services, and to
accelerate discoveries and applications, especially for
neurotrauma, sensory loss, amputation, polytrauma, and related
prosthetic needs. The Committee encourages VA to continue its
research into developing novel approaches to restoring veterans
with amputation, central nervous system injuries, loss of sight
or hearing, or other physical and cognitive impairments to full
and productive lives.
Advanced Medical Device Study.--The Committee commends VA
for its research and use of exoskeleton technology. The
Committee is also aware of an important pilot program to
research the home-based use and medical advantages of
exoskeletons for spinal cord injuries [SCI]. The Committee
notes the early success that mobility-focused exoskeleton
technologies are having with this patient population and the
resulting improvement in health and well-being. The Committee
directs the Department to undertake a study on the
appropriateness and efficacy of exoskeletons in rehabilitation
of patients who have suffered a stroke or traumatic brain
injury.
Continuous Health Monitoring Technology.--The Committee has
a longstanding interest in improving VA healthcare outcomes by
decreasing hospital acquired complications, including reducing
sepsis, falls, and pressure ulcers. Recent advancements in the
ability of continuous vital signs monitoring for non-ICU
patients have shown a tremendous potential for improved patient
outcomes. The Committee is aware of research at the James A.
Haley VAMC in Tampa, Florida, and the Boise VAMC in Boise,
Idaho, that shows remarkable decreases in Medical Response Team
[MRT] activations, Code Blue activations, ICU transfers and,
most importantly, decreases in mortality rates following these
activations. Furthermore, research has shown that continuous
monitoring systems have allowed the VA to recover its
investment in the technology within 6 months or less. All of
the positive results show a significant decrease in length of
patient stay which allows facilities adopting this technology
to significantly increase the number of patients seen at the
facility, thereby decreasing the waiting times and backlogs
that have been of great concern to this Committee. To ensure
VHA is benefitting from the outcomes achieved at these
facilities and civilian facilities where continuous monitoring
technology is deployed, the Committee urges the VA to
expeditiously proceed with research surrounding continuous
monitoring technologies and complete on-going projects related
to contact-free technologies being conducted by the Health
Services Research and Development Service [HSRD]. The
Department is directed to submit a report to the Committees on
Appropriations of both Houses of Congress no later than 90 days
after enactment of this act detailing recommendations for
increased deployment of proven continuous monitoring
technologies within the VHA, including a proposed timeline.
Burn Pits Research.--The Committee recommends VA continue
conducting medical trials, using available treatments for
pulmonary, cardiovascular, and other diseases and conditions
related to the exposure to open air burn pits. The Department
is directed to provide an update to the Committees on
Appropriations of both Houses of Congress no later than 180
days after enactment of this act on the status and progress of
such medical trials. Furthermore, where appropriate, VA is
encouraged to work with private and public institutions which
have already begun to research the chronic impacts of exposure
to burn pits in order to develop treatments for veterans
exposed to burn pits.
Public Access to Scientific Publications and Data.--The
Committee commends the Department on issuing its Policy and
Implementation Plan for Public Access to Scientific
Publications and Digital Data from Research Funded by the
Department of Veterans Affairs on July 23, 2015. The Department
is directed to continue its efforts toward full implementation
of the plan and directs an update on progress made be included
in its fiscal year 2019 budget request.
Geriatrics and Extended Care Services.--The Committee
recognizes VA's growing need to prioritize research focusing on
increasingly complex and chronic conditions of aging veterans,
with more than half of veterans estimated to be over the age of
65 in 2018. As VA continues to develop successful models for
innovative and clinically integrated care for veterans with
more than one chronic disease and declining mental and physical
capabilities, the findings from these models should be widely
shared to inform Federal, State and local efforts to address
the healthcare needs of America's aging population and American
families. The Committee urges VA to continue to support
evidence-based clinical research that reduces costs and
improves the quality of care for older veterans by preventing
hospital readmissions and enhancing the ability of older
veterans to remain in their homes and communities safely,
independently, and comfortably, through expanded tele-medicine,
technological advances, coordinated care, and well-designed
long-term services and supports. The Committee also recognizes
the important contributions the Geriatrics and Extended Care
Services [GEC] and Geriatric Research Education and Clinical
Centers [GRECCs] have made in developing successful innovations
in coordinated home and community-based care that benefit older
veterans and provide proven, successful models that can inform
development of integrated delivery systems for non-veteran
seniors. The Committee encourages VA to continue utilizing its
funds to bolster its existing research programs focusing on
aging to meet the current and future needs of the veteran
population.
Enewetak Atoll Registry Research.--The Committee is aware
that thousands of veterans served on the Enewetak Atoll to
clean up the island following its use for nuclear weapons
testing. The Committee is also aware of many instances of
veterans who conducted the cleanup suffering serious health
problems, such as brittle bones, cancers, and birth defects in
their children. The Committee urges the Department to study
whether there is a connection between certain illnesses and the
potential exposure of individuals to radiation related to
service at Enewetak Atoll between January 1, 1977, and December
31, 1980.
Exposure to Agent Orange by Certain Navy Veterans.--Under
the Agent Orange Act of 1991 (Public Law 102-4), most veterans
of deployments to Vietnam between 1962 and 1975 became entitled
to compensation for certain illnesses linked to exposure to
Agent Orange defoliant, including the ``Blue Water'' Navy
veterans who served in the Navy outside of the riverine and
coastal areas. However, beginning in 2002, new Department
interpretation of the law prevented Blue Water Navy veterans
from collecting benefits unless they could prove to have been
on a ship proven to have entered inland water or sailors who
proved they had been ashore. In 2016, the Department reiterated
its policy and added further restrictions by removing certain
harbors that used to carry a presumption of exposure, while
outside the VA a growing body of research supports the
assumption of presumption of exposure. In a fact sheet
published about the decision, VA noted only a 2011 Institute of
Medicine study on Agent Orange exposure among Blue Water Navy
veterans, which found that exposure at sea could not be proven,
assuming ships followed certain best practices that veterans
anecdotally report were regularly ignored. The Department is
directed to submit a report to the Committees on Appropriations
of both Houses of Congress no later than 90 days after
enactment of this act evaluating each of the U.S. and non-U.S.
studies on Agent Orange exposure since 1980 that are relevant
to the question of Blue Water Navy sailors to justify the 2016
decision.
Cancer Moonshot Contribution.--The Committee supports the
Beau Biden Cancer Moonshot initiative and the Department's
contribution utilizing advances in genomic science to provide
targeted treatment to veterans. The Department has identified
prostate cancer, triple-negative breast cancer, and colorectal
cancer as areas of priority. Due to the prevalence of various
skin cancers among service members, the Committee directs that
skin cancer be included as well.
Overprescription Prevention Report.--The Committee is
discouraged by multiple GAO reports retaining VHA on the
``high-risk'' list and the unfathomable increase in polydrug
use and narcotics prescriptions by VA related to pain
management and mental health treatment. Specifically,
combinations of opioid and Benzodiazepines have proven fatal
when taken concurrently, with research demonstrating this
phenomenon for nearly 40 years. The Committee provides $500,000
to enter into an agreement with the National Academies of
Sciences, Engineering, and Medicine to conduct an assessment to
research, collect, and analyze the potential overmedication of
veterans during fiscal years 2010-2017 that led to veterans
deaths, veterans suicides, treatment of mental disorders, pain
management practices, mental health staffing levels, and combat
related trauma.
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 Committee is
concerned by the lack of public availability of the findings of
all research conducted by or for the Executive Branch relating
to the health consequences of military service in the Persian
Gulf theater of operations during the Persian Gulf War and by
the lack of coordination by the Department in ensuring the
public availability of this information. The Committee urges
the Department to publish disease-specific mortality data
related specifically to Persian Gulf War veterans. The
Committee remains concerned by VA's ever-evolving terminology
for the signature adverse health outcome of the Persian Gulf
War as recognized by the Institute of Medicine [IOM]--Gulf War
illness--and encourages the Department to utilize the term,
``Gulf War illness,'' as IOM has recommended. The Committee
continues to urge the Secretary to consider revising and
updating the Clinical Practice Guideline for Chronic
Multisymptom Illness [CMI] consistent with the July 2011
Veterans Health Initiative, ``Caring for Gulf War Veterans,''
in that it, ``cannot be reliably ascribed to any known
psychiatric disorder,'' and to focus on recent Gulf War illness
treatment research findings and ongoing Gulf War illness
treatment research direction. Furthermore, the Committee once
again encourages VA to strengthen the training of primary,
specialty, and mental healthcare providers on the Gulf War
illness case definitions recommended by IOM.
MEDICAL CARE COST RECOVERY COLLECTIONS
MEDICAL CARE COLLECTION FUND
Appropriations, 2017.................................... $2,637,000,000
Budget estimate, 2018................................... 2,507,000,000
Committee recommendation................................ 2,507,000,000
MEDICAL CARE COLLECTION FUND--REVENUES APPLIED
Appropriations, 2017.................................... -$2,637,000,000
Budget estimate, 2018................................... -2,507,000,000
Committee recommendation................................ -2,507,000,000
PROGRAM DESCRIPTION
The Medical Care Collection Fund [MCCF] was established by
the Balanced Budget Act of 1997 (Public Law 105-33). In fiscal
year 2004, Public Law 108-199 allowed the Department of
Veterans Affairs to deposit first-party and pharmacy co-
payments; third-party insurance payments and enhanced-use
collections; long-term care co-payments; Compensated Work
Therapy Program collections; and Parking Program fees into the
MCCF. The Secretary of Veterans Affairs has the authority to
transfer funds from the MCCF to the Medical Services account.
COMMITTEE RECOMMENDATION
The Committee recommendation includes the authority to
retain co-payments and third-party collections, estimated to
total $2,507,000,000 in fiscal year 2018.
National Cemetery Administration
Appropriations, 2017.................................... $286,193,000
Budget estimate, 2018................................... 306,193,000
Committee recommendation................................ 306,193,000
ADMINISTRATION OVERVIEW
The National Cemetery Administration [NCA] was established
in accordance with Public Law 93-94, the National Cemeteries
Act of 1973. It has a four-fold mission: to provide for the
interment in any national cemetery of the remains of eligible
deceased servicemembers and discharged veterans, together with
their spouses and certain dependents, and permanently maintain
their graves; to provide headstones for, and to mark graves of,
eligible persons in national, State, and private cemeteries; to
administer the grant program for aid to States in establishing,
expanding, or improving State veterans cemeteries; and to
administer the Presidential Memorial Certificate Program.
COMMITTEE RECOMMENDATION
The Committee recommends $306,193,000 for the National
Cemetery Administration. This is an increase of $20,000,000
above the fiscal year 2017 enacted level and equal to the
budget request.
The Committee has included bill language to make available
through September 30, 2019, up to 10 percent of the National
Cemetery Administration appropriation.
Departmental Administration
Appropriations, 2017.................................... $5,966,031,000
Budget estimate, 2018................................... 5,707,593,000
Committee recommendation................................ 5,725,391,000
ADMINISTRATION OVERVIEW
Departmental Administration provides for the administration
of veterans benefits through the Veterans Benefits
Administration [VBA], the executive direction of the
Department, several top level supporting offices, the Board of
Contract Appeals, and the Board of Veterans Appeals.
COMMITTEE RECOMMENDATION
The Committee recommends $5,725,391,000 for Departmental
Administration. The amount is composed of $329,891,000 for
General administration; $166,000,000 for the Board of Veterans
Appeals; $4,055,500,000 for Information technology systems;
$164,000,000 for the Office of the Inspector General;
$512,430,000 for Construction, major projects; $342,570,000 for
Construction, minor projects; $110,000,000 for Grants for
construction of State extended care facilities; and $45,000,000
for Grants for the construction of State veterans cemeteries.
Public Law 114-223 moved the General Operating Expenses,
Veterans Benefits Administration account from Departmental
Administration to the Veterans Benefits Administration, its
appropriate section within the act, with the instruction that
the Department should place GOE,VBA in this location with the
fiscal year 2019 request. The Committee notes this did not
happen, and therefore, once again, instructs the Department to
adhere to this direction with the fiscal year 2019 request.
GENERAL ADMINISTRATION
(INCLUDING TRANSFER OF FUNDS)
Appropriations, 2017.................................... $345,391,000
Budget estimate, 2018................................... 346,891,000
Committee recommendation................................ 329,891,000
PROGRAM DESCRIPTION
The General Administration account provides funding for the
Office of the Secretary, six assistant secretaries, and three
independent staff offices.
COMMITTEE RECOMMENDATION
The Committee recommends $329,891,000 for General
Administration. This amount is $15,500,000 below the fiscal
year 2017 enacted level and $17,000,000 below the budget
request. The Committee has included bill language to make
available through September 30, 2019, up to 10 percent of the
General Administration appropriation.
Filling Vacant Positions.--The Committee remains concerned
about the length of time veterans are waiting for appointments,
claims processing, and other essential veteran's services at
VA. Exacerbating this problem has been VA's failure to hire
employees for a reported 49,000 vacant positions in the
Department. VA must do more to hire, recruit, and retain
quality employees to provide care and services for our nation's
veterans. The Department is directed to use the funds
appropriated by this act to fill staff vacancies and submit a
report to the Committees on Appropriations of both Houses of
Congress no later than 180 days after enactment of this act,
and each month thereafter, detailing both the progress of
hiring and filling vacant positions and what positions remain
vacant.
Veterans Identification Card Act of 2015.--Public Law 114-
31 directed the Secretary of Veterans Affairs to issue an
identification card to veterans. This bill was unanimously
passed by Congress and signed into law on July 20, 2015.
Unfortunately, these cards are still not available to veterans.
The Committee directs the Department to move swiftly in making
these cards available.
BOARD OF VETERANS APPEALS
Appropriations, 2017.................................... $155,596,000
Budget estimate, 2018................................... 155,596,000
Committee recommendation................................ 166,000,000
PROGRAM DESCRIPTION
As set forth in section 7101(a) of title 38 United States
Code, the Board of Veterans Appeals is responsible for making
final decisions on claims for veterans benefits presented to
the Board for appellate review. The vast majority of the
Board's workload derives from benefit claims initiated by the
Veterans Benefits Administration's Regional Offices. The
appellate process has multiple steps, most of which occur at
the local Regional Office level. If a veteran is not satisfied
with the Regional Office determination, he or she may appeal to
the Board for a final agency decision. The Board adjudicates
appeals covering all areas of veterans benefits, including:
service connection, increased disability ratings, total
disability ratings, pensions, insurance benefits, educational
benefits, home loan guaranties, vocational rehabilitation,
waivers of indebtedness, fee basis medical care, and dependency
and indemnity compensation.
COMMITTEE RECOMMENDATION
The Committee recommends $166,000,000 for the Board of
Veterans Appeals, which is $10,404,000 above fiscal year 2017
enacted level and the budget request. The Committee has
included bill language to make available through September 30,
2019, up to 10 percent of the Board of Veterans Appeals
appropriation.
Growing Backlog of Appeals.--The Committee remains
concerned over the growing backlog of disability claims at all
stages of the appeals process but is particularly concerned
about the increase at the Board of Veterans Appeals. The fiscal
year 2018 justification accompanying the Department's budget
submission notes the number of cases received by the Board
continues to grow rapidly, projected to increase by 23 percent
from 115,847 pending appeals at the end of 2016 to 142,756
pending appeals by the end of 2017. Each year since 1996, the
volume of appeals received by VBA equated to 9 to 15 percent of
the total claims completed in those years. The Committee
understands as VBA sees increases in the number of claims,
appeals at the Board increase proportionally. The Board notes
that it expects the backlog to increase dramatically over the
coming years without additional resources and legislative
reform. To that end, the Committee recommends an additional
$10,404,000 above the budget request for additional staffing
needs. In addition, BVA in conjunction with VBA shall provide a
report to the Committee on Appropriations of both Houses of
Congress no later than January 1, 2018, outlining a 5-year
staffing plan to ensure that the appellate backlog is addressed
in a timely manner.
INFORMATION TECHNOLOGY SYSTEMS
Appropriations, 2017.................................... $4,270,259,000
Budget estimate, 2018................................... 4,055,500,000
Committee recommendation................................ 4,055,500,000
PROGRAM DESCRIPTION
The Information Technology [IT] Systems appropriation,
along with reimbursements, funds the costs of all IT staff
salaries and expenses, the operations and maintenance of all
existing information technology systems, and the development of
new projects and programs designed to improve the delivery of
service to veterans. This appropriation also funds the costs
associated with the Office of Information and Technology which
oversees the functions highlighted above.
COMMITTEE RECOMMENDATION
The Committee recommends $4,055,500,000 for the Information
Technology Systems account. This amount is $214,759,000 below
the fiscal year 2017 enacted level and equal to the budget
request. The Committee recommendation includes $1,230,320,000
for staff salaries and expenses, $2,466,650,000 for operation
and maintenance of existing programs, and $358,530,000 for
program development.
The Committee has appropriated the Information Technology
Systems account as three subaccounts. This funding structure
enhances the Committee's ability to ensure funds are executed
in a manner consistent with the Department's budget submission.
The Committee has provided sufficient flexibility within the
subaccounts by way of authorized carryover amounts and
reprogramming authority to give the Office of Information
Technology as much flexibility as possible to accomplish its
mission and goals, while ensuring proper accountability and
oversight. The Committee will continue to work with the
Department to ensure the IT projects currently underway, as
well as the projects planned for the future, have the resources
needed for success.
INFORMATION TECHNOLOGY DEVELOPMENT PROJECTS
[In thousands of dollars]
------------------------------------------------------------------------
Fiscal year 2018 Committee
Project budget request recommendation
------------------------------------------------------------------------
Electronic Health Record [EHR] 10,000 10,000
Interoperability and VLER Health...
Electronic Health Record [EHR]...... 39,000 39,000
Veterans Benefits Management System 59,904 59,904
[VBMS].............................
Virtual Lifetime Electronic Record 20,968 20,968
[VLER].............................
Veterans Customer Experience........ 58,473 58,473
Other IT Systems Development........ 170,185 170,185
-----------------------------------
Total Development............. 358,530 358,530
------------------------------------------------------------------------
Electronic Health Record.--Achieving interoperability
between the health records of the Department of Veterans
Affairs and the Department of Defense remains one of the
highest priorities of the Committee. The Committee believes
from a servicemember's initial military entrance physical to
their final interaction with VA, a seamless health record
should follow the individual. With the Secretary's decision on
June 5, 2017, to acquire by a sole-source contract the same
electronic health record system as the DoD, the Committee is
unable at the time of this printing to precisely and
comprehensively opine on the future of the system. The
Department has proactively offered to remain in regular contact
about the acquisition of the new system and the needed addition
functionalities VA will pursue to address the VA-specific
mission. The Committee notes there is no direct request in the
budget request this year to provide funding for an acquisition.
Given the lack of information about the cost of a new EHR, but
the Committee's awareness of the final cost estimate of the DoD
acquisition, it can be assumed the VA total cost will exceed
previous estimates for VistA Evolution. To that end, in its
oversight capacity, the Committee will reevaluate, with the
Committee on Appropriations of the House of Representatives,
the constraints on the obligation or expenditure of funding for
the new acquisition at the appropriate time.
Additionally, the Committee remains concerned about the
continued status of electronic health record interoperability
between VA and DoD and whether lack of interoperability limits
VA clinicians' ability to readily access information from DoD
records, potentially impeding their ability to make the most
informed decisions on treatment options, and possibly putting
veterans' health at risk. Although VA and DoD have certified
interoperability, there are more developed goals that can be
realized. While several applications exist to facilitate health
data access for clinicians, more must be done to ensure that
the most relevant data is accessible in a user-friendly format
to facilitate efficient clinical encounters. Both Departments
must remain committed to working towards assuring continued VA
and DoD interoperability as each Department adopts its new
electronic health record system. The Committee directs VA and
DoD to establish clear and agreed-upon metrics and goals for
interoperability, to establish clear timeframes for meeting
those goals, to ensure clinician feedback is sought and
considered as the respective electronic medical record systems
are modernized, and to update the VA/DoD Interagency Program
Office guidance to reflect agreed-upon metrics and goals. The
need for well-functioning, up-to-date electronic health record
technology is absolutely critical as VA plans for a shift to a
model of care that greatly expands its use of care in the
community.
Cybersecurity.--The Committee recommends the full budget
request of $340,000,000 for the VA's Office of Information
Security. Over the past year, the Department has been executing
an enterprise-wide cybersecurity strategy which defines a
comprehensive set of actions, processes, and emerging security
technologies that will further enhance the cybersecurity of
VA's information and assets and improve the resilience of VA
networks. To better increase oversight and to ensure VA is
aggressively pursuing a robust cybersecurity plan, the Chief
Information Officer id directed submit a report to the
Committees on Appropriations of both Houses of Congress no
later January 1, 2018, on VA's current and future plans to
increase security protocols across VA's networks. At a minimum,
the CIO should include how much was obligated in in fiscal year
2017 and estimates for fiscal year 2018 to: secure the over
60,000 medical devices that connect to VA's network, implement
Digital Rights Management technology, strengthen encryption
services, and improve VA's cybersecurity workforce recruitment,
hiring, and training. Given the sensitive nature of this topic,
the CIO may provide this report as a briefing to the
Committees.
Network Capabilities.--As VA maximizes the use of
telehealth and remote patient monitoring technology,
particularly technology that which makes use of high-resolution
interfaces, enhanced and modern network capability will be
needed. In order to ensure proper budgetary resources are being
utilized to modernize VA's healthcare networks, the Department
is directed to include in the justifications accompanying the
fiscal year 2019 budget request a section specific to network
modernization, including fiscal year 2018 accomplishments.
OFFICE OF INSPECTOR GENERAL
Appropriations, 2017.................................... $159,606,000
Budget estimate, 2018................................... 159,606,000
Committee recommendation................................ 164,000,000
PROGRAM DESCRIPTION
The Office of Inspector General [OIG] was established by
the Inspector General Act of 1978 and is responsible for the
audit, investigation, and inspection of all Department of
Veterans Affairs programs and operations.
COMMITTEE RECOMMENDATION
The Committee recommends $164,000,000 for the Office of
Inspector General. This is $4,394,000 above the fiscal year
2017 enacted level and the budget request. The Committee has
included bill language to make available through September 30,
2019, up to 10 percent of the Office of the Inspector General
appropriation.
CONSTRUCTION, MAJOR PROJECTS
Appropriations, 2017.................................... $528,110,000
Budget estimate, 2018................................... 512,430,000
Committee recommendation................................ 512,430,000
PROGRAM DESCRIPTION
The Construction, Major Projects account provides for
constructing, altering, extending, and improving any of the
facilities (including parking projects) under the jurisdiction
or for the use of VA, including planning, architectural and
engineering services, needs assessment, and site acquisition
where the estimated cost of a project is more than the amount
set forth in 38 U.S.C. 8104(a)(3)(A). Proceeds realized from
Enhanced Use Lease activities may be deposited into the
Construction, Major Projects and Construction, Minor Projects
accounts.
COMMITTEE RECOMMENDATION
The Committee recommends an appropriation of $512,430,000
for the construction of major projects. This is $15,680,000
below the fiscal year 2017 enacted level and equal the budget
request.
The following table reflects the President's budget request
for major construction projects and the corresponding Committee
recommendations.
MAJOR CONSTRUCTION PROJECTS
[In thousands of dollars]
------------------------------------------------------------------------
Fiscal year 2018 Committee
Location and description budget request recommendation
------------------------------------------------------------------------
Veterans Health Administration
[VHA]:
Livermore, CA: Realignment and 117,300 117,300
Closure of the Livermore Campus
Advance Planning and Design 57,500 57,500
Fund: Various Locations........
Asbestos: Various Locations..... 7,500 7,500
Major Construction Staff: 27,500 27,500
Various Locations..............
Hazardous Waste: Various 15,000 15,000
Locations......................
Judgement Fund: Various 10,000 10,000
Locations......................
Non-Departmental Federal Entity 16,730 16,730
Project Management Support.....
-----------------------------------
Total, VHA.................... 251,530 251,530
National Cemetery Administration
[NCA]:
Sacremento, California: Grave 35,000 35,000
Site Expansion.................
Bushnell, Florida: Grave Site 51,500 51,500
Expansion and Cemetery
Improvement Sites..............
Elwood, Illinois: Gravesite 35,000 35,000
Expansion, Phase 3.............
Calverton, New York: Gravesite 50,000 50,000
Expansion......................
Phoenix, Arizona: Gravesite 31,900 31,900
Expansion......................
Bridgeville, Pennslyvania: 39,000 39,000
Gravesite Expansion, Phase 3...
Advance Planning and Design Fund 8,500 8,500
NCA Land Acquisition Fund....... 5,000 5,000
-----------------------------------
Total, NCA.................... 255,900 255,900
General Administration--Staff 5,000 5,000
Offices, Advance Planning Fund.....
-----------------------------------
Total Construction, Major 512,430 512,430
Projects.....................
------------------------------------------------------------------------
The Future of VA Construction.--The Committee remains
concerned about the state of VA's major construction program.
In the wake of the massive cost overruns at the Denver VA
Medical Center, Congress required VA to utilize the U.S. Army
Corps of Engineers (the Corps) as its construction agent for
all major construction projects over $100,000,000. Bringing the
Corps into the VA construction process has exposed major
differences between the standardized policies, practices and
procedures the Corps follows in the military construction world
and the procedures for major construction and capital
investment VA uses in practice. This has forced VA to take a
hard look at many of its construction business practices, and
in many cases, implement changes to adhere to Corps polices
into order for the Corps to agree to move forward managing VA
projects. For example, VA traditionally views a project as a
whole campus, meaning a project will consist of multiple
buildings with construction timelines spanning an often
indefinite number of years. In the military construction world,
this would be known as a master plan, which would consist of
multiple individual projects, each of which represents a
complete and usable building. Each military construction
project is planned in advance, has a set scope and estimated
cost, and specific project details reflected on a form DD 1391.
The Committee believes the level of analysis and rigor put into
the form DD 1391 and the Department of Defense processes for
construction should serve as a model for VA to follow,
particularly in light of the partnership with the Corps.
Another Department of Defense process VA should begin to
follow is the future years defense plan [FYDP], a document that
lays out the military construction projects in the current
year's budget request and the projects anticipated to be in the
next 5 year's requests. Although always subject to change, the
[FYDP] shows the Committee that DoD has a well-reasoned plan
for the next few years to address its infrastructure needs.
Contrast this with the VA's SCIP list and the differences are
glaring. The SCIP list is monstrous, laying out all VA's
infrastructure needs with seemingly no prioritization or
indication of which projects VA intends to pursue first, and no
timeline for when projects will be completed. Judging from the
past several year's budget requests, correcting seismic
deficiencies seems to be one of the VA's top priorities.
However, other serious life, health, and safety projects seem
to languish on the SCIP list. For example, the outpatient
clinic at Hilo, Hawaii lies within a tsunami flood zone. While
VA plans to close this facility and move to temporary space
that veterans cite as difficult to get to and will likely
result in a decrease in access, plans for the new permanent
clinic remain stalled on the SCIP list, despite the fact that
the current facility has to be closed because of the tsunami
threat. The SCIP list also proves to be a very ineffective tool
for the Committee to use to understand the future of VA
construction. For example, projects move up or down the list
from year to year without any obvious explanation to the
Congressional staff who follow their home State project
closely. The Committee and its staff are the primary consumers
of the data included in VA's annual budget justifications to
Congress, yet the SCIP list as included in the justifications
is not a useful document. The Committee directs the Department
to work diligently to move towards a DoD-like 5-year
construction plan and concurrently craft a better way to
provide construction information annually to Congress.
CONSTRUCTION, MINOR PROJECTS
Appropriations, 2017.................................... $372,069,000
Budget estimate, 2018................................... 342,570,000
Committee recommendation................................ 342,570,000
PROGRAM DESCRIPTION
The Construction, Minor Projects account provides for
constructing, altering, extending, and improving any of the
facilities (including parking) under the jurisdiction or for
the use of VA, including planning, assessment of needs,
architectural and engineering services, and site acquisition,
where the estimated cost of a project is equal to or less than
$10,000,000. Public Law 106-117, the Veterans Millennium Health
Care and Benefits Act of 1999, gave VA authority to make
capital contributions from minor construction in enhanced-use
leases. Proceeds realized from enhanced-use lease activities
may be deposited into the Construction, Major Projects and
Construction, Minor Projects accounts.
COMMITTEE RECOMMENDATION
The Committee recommends $342,570,000 for minor
construction. This is $29,499,000 below the fiscal year 2017
enacted level and equal to the budget request.
The recommendation includes $193,610,000 for the Veterans
Health Administration, $97,950,000 for the National Cemetery
Administration, and $29,895,000 for the Veterans Benefits
Administration. The Department is directed to provide an
expenditure plan to the Committees on Appropriations of both
Houses of Congress no later than 30 days after enactment of
this act for the amount appropriated for minor construction.
GRANTS FOR CONSTRUCTION OF STATE EXTENDED CARE FACILITIES
Appropriations, 2017.................................... $90,000,000
Budget estimate, 2018................................... 90,000,000
Committee recommendation................................ 110,000,000
PROGRAM DESCRIPTION
This account is used to provide grants to assist States in
acquiring or constructing State home facilities for furnishing
domiciliary or nursing home care to veterans, and to expand,
remodel, or alter existing buildings for furnishing
domiciliary, nursing home, or hospital care to veterans in
State homes. The grant may not exceed 65 percent of the total
cost of the project. Public Law 102-585 granted permanent
authority for this program, and Public Law 106-117 provided
greater specificity in directing VA to prescribe regulations
for the number of beds for which grant assistance may be
furnished. This program has been a successful partnership
between States and VA in meeting the long-term care needs of
elderly veterans for decades.
COMMITTEE RECOMMENDATION
The Committee recommends $110,000,000 for Grants for
construction of State extended care facilities. This is
$20,000,000 above the budget request.
Funding Prioritization.--The Committee continues to be
concerned about the prioritization of funding for new State
veterans homes. The criteria used by the Department when making
funding decisions for new facilities should consider the unique
needs of geographically small States that depend on just one
facility, straining capacity and leaving those States without
alternative facilities to care for veterans while their
projects are pending. Similarly, the Department should also
prioritize large rural States where veterans may live hundreds
of miles from the next nearest facility.
GRANTS FOR CONSTRUCTION OF VETERANS CEMETERIES
Appropriations, 2017.................................... $45,000,000
Budget estimate, 2018................................... 45,000,000
Committee recommendation................................ 45,000,000
PROGRAM DESCRIPTION
Public Law 105-368 amended title 38 U.S.C. 2408 and
established authority to provide aid to States for
establishment, expansion, and improvement of State veterans
cemeteries, which are operated and permanently maintained by
the States. This statutory change increased the maximum Federal
share from 50 percent to 100 percent in order to fund
construction costs and initial equipment expenses when the
cemetery is established. States remain responsible for
providing the land and for paying all costs related to
operation and maintenance of the cemeteries, including the
costs for subsequent equipment purchases.
COMMITTEE RECOMMENDATION
The Committee recommends $45,000,000 for Grants for
construction of State veterans cemeteries. This is equal to the
budget request.
Administrative Provisions
(INCLUDING TRANSFERS AND RESCISSIONS OF FUNDS)
Sec. 201. The Committee includes a provision which outlines
transfer authority and responsibilities for the Veterans
Benefits Administration.
Sec. 202. The Committee includes a provision which outlines
transfer authority and responsibilities for the Veterans Health
Administration.
Sec. 203. The Committee includes a provision which outlines
the use of funds appropriated for salaries and expenses.
Sec. 204. The Committee includes a provision mandating that
only construction funds may be used for land procurement or the
construction of any new hospital or home.
Sec. 205. The Committee includes a provision allowing for
reimbursements to the Medical Services account.
Sec. 206. The Committee includes a provision allowing for
payments of prior year obligations.
Sec. 207. The Committee includes a provision which allows
for the use of funds for prior year obligations.
Sec. 208. The Committee includes a provision which allows
for payments from the National Service Life Insurance Fund.
Sec. 209. The Committee includes a provision which outlines
the use of funds from enhanced-use lease proceeds.
Sec. 210. The Committee includes a provision which provides
for funds for the Office of Resolution Management, the Office
of Employment Discrimination Complaint Adjudication, the Office
of Accountability and Whistleblower Protection, and the Office
of Diversity and Inclusion.
Sec. 211. The Committee includes a provision which requires
disclosure of third-party reimbursement information.
Sec. 212. The Committee includes a provision which allows
for the transfer of revenue derived from enhanced-use leases
into the construction accounts.
Sec. 213. The Committee includes a provision which outlines
authorized uses for Medical Services account funds.
Sec. 214. The Committee includes a provision which allows
funds in the Medical Care Collection Fund to be transferred
into the Medical Services and Medical Community Care accounts.
Sec. 215. The Committee includes a provision which allows
eligible veterans in the State of Alaska to obtain medical care
services.
Sec. 216. The Committee includes a provision which allows
for the transfer of funds into the construction accounts.
Sec. 217. The Committee includes a provision rescinding
funds from Medical services.
Sec. 218. The Committee includes a provision requiring the
Secretary of Veterans Affairs to submit quarterly financial
reports on the Veterans Health Administration.
Sec. 219. The Committee includes a provision outlining
transfer authority for the Information Technology Systems
account.
Sec. 220. The Committee includes a provision prohibiting
any funds to be used to contract out any functions performed by
more than 10 employees without a fair competition process.
Sec. 221. The Committee includes a provision allowing for
the transfer of funds from certain accounts to the Joint
Department of Defense/Department of Veterans Affairs Medical
Facility Demonstration Fund, as authorized by Public Law 111-
84.
Sec. 222. The Committee includes a provision allowing for
the transfer of funds from certain advance appropriation
accounts to the Joint Department of Defense/Department of
Veterans Affairs Medical Facility Demonstration Fund, as
authorized by Public Law 111-84.
Sec. 223. The Committee includes a provision allowing for
the transfer of certain funds deposited in the Medical Care
Collections Fund to the Joint Department of Defense/Department
of Veterans Affairs Medical Facility Demonstration Fund, as
authorized by Public Law 111-84.
Sec. 224. The Committee includes a provision directing a
minimum of $15,000,000 be transferred from Medical Services,
Medical Support and Compliance, and Medical Facilities to the
Department of Defense/Department of Veterans Affairs Health
Care Sharing Incentive Fund, as authorized by section 8111 of
title 38, United States Code.
Sec. 225. The Committee includes a provision directing the
Department to make every effort to fund State Veterans Nursing
Home Construction grants on the fiscal year 2017 list.
Sec. 226. The Committee includes a provision requiring
notification of all bid savings for major construction
projects.
Sec. 227. The Committee includes a provision restricting
scope increases for major construction projects above that
specified in the original project justification.
Sec. 228. The Committee includes a provision requiring the
Department to submit reports relating to the Veterans Benefits
Administration on claims processing at Regional Offices.
Sec. 229. The Committee includes a provision limiting the
funding from the Medical Support and Compliance account for the
VistA Evolution and electronic health record interoperability
projects.
Sec. 230. The Committee includes a provision requiring VA
to notify the Committee 15 days prior to any organizational
changes within VA of 25 or more FTE.
Sec. 231. The Committee includes a provision directing
funding for non-recurring maintenance.
Sec. 232. The Committee includes a provision permitting the
transfer to the Medical Services account of fiscal year
discretionary 2018 appropriated funds.
Sec. 233. The Committee includes a provision permitting the
transfer of funds between GOE,VBA and BVA.
Sec. 234. The Committee includes a provision prohibiting
the reprogramming of funds in excess of $7,000,000 among major
construction projects or programs.
Sec. 235. The Committee includes a provision rescinding
unobligated balances from the DoD-VA Health Care Sharing
Incentive Fund.
Sec. 236. The Committee includes a provision pertaining to
Native Hawaiian small businesses.
Sec. 237. The Committee includes a provision limiting
bonuses for senior executives.
Sec. 238. The Committee includes a provision directing the
discontinuation of the usage of social security numbers with
the Department of Veterans Affairs.
Sec. 239. The Committee includes a provision pertaining to
the certification of marriage and family therapists.
Sec. 240. The Committee includes a provision restricting
funds for the purpose of using groups of subject matter experts
to evaluation compensation claims.
Sec. 241. The Committee includes a provision prohibiting
the transfer of funds from the Filipino Veterans Equity
Compensation Fund to any other VA account.
Sec. 242. The Committee includes a provision denying or
revoking the eligibility of a healthcare provider to provide
non-VA care for various reasons.
Sec. 243. The Committee includes a provision relating to
the availability of Construction, Major Projects funds.
Sec. 244. The Committee includes a provision relating to
the availability of Construction, Major Projects funds.
Sec. 245. The Committee includes a provision regarding a
childcare program.
Sec. 246. The Committee includes a provision relating to
the availability of chiropractic care.
Sec. 247. The Committee includes a provision on a pilot
program for the education and training of physician assistants.
Sec. 248. The Committee includes a provision on coastwise
merchant seamen.
Sec. 249. The Committee includes a provision on fertility
treatment and counseling for service-connected disabled
veterans.
Sec. 250. The Committee includes a provision rescinding
funds from the Information Technology Systems account.
Sec. 251. The Committee includes a provision related to a
demand profile for healthcare services.
Sec. 252. The Committee includes a provision regarding
uniform access standards for healthcare services.
Sec. 253. The Committee includes a provision regarding
vacant, mostly vacant, or underutilized buildings and
structures.
Sec. 254. The Committee includes a provision ensuring
particular ratios of veterans to full-time employment
equivalents within any VA program of rehabilitation.
Sec. 255. The Committee includes a provision indicating
that no funds may be used to deny the Inspector General timely
access to VA records and documents.
Sec. 256. The Committee includes a provision prohibiting
funds to be used to restrict an individual's ability to speak
with a Member of Congress or his or her staff.
Sec. 257. The Committee includes a provision providing
authority for VHA to administer the National Veterans Sports
Program.
Sec. 258. The Committee includes a provision requiring
certain data to be included in the budget justifications for
the Construction, Major account.
Sec. 259. The Committee includes a provision related to the
Rural Veterans Coordination Pilot.
Sec. 260. The Committee includes a provision on a national
realignment strategy for VA facilities.
Sec. 261. The Committee includes a provision concerning
eligibility for burial at National Cemetery Administration
cemeteries.
Sec. 262. The Committee includes a provision related to
veteran health and wellness programs.
Sec. 263. The Committee includes a provision regarding new
construction in the State Extended Care Facilities grant
program.
Sec. 264. The Committee includes a provision related to
eligibility for certain medical services for veterans with
other than honorable discharges.
Sec. 265. The Committee includes a provision prohibiting
the use of funds to interfere with the ability of veterans to
participate in State-approved medicinal marijuana programs or
deny services to such veterans.
TITLE III
RELATED AGENCIES
American Battle Monuments Commission
OVERVIEW
The American Battle Monuments Commission was established by
Congress in 1923 and is responsible for the following:
designing, constructing, operating, and maintaining permanent
American cemeteries in foreign countries; establishing and
maintaining U.S. military memorials, monuments, and markers
where American Armed Forces have served overseas since April 6,
1917, the date of the United States entry into World War I, and
within the United States when directed by public law; and
controlling the design and construction of permanent U.S.
military monuments and markers by other U.S. citizens and
organizations, both public and private, and encouraging their
maintenance. ABMC administers, operates, and maintains 26
permanent American military cemeteries, 29 Federal memorial,
monuments, and markers, and 8 non-Federal memorials located in
15 foreign countries, the U.S. Commonwealth of the Northern
Mariana Islands, the British Dependency of Gibraltar, and the
United States of America.
SALARIES AND EXPENSES
Appropriations, 2017.................................... $75,100,000
Budget estimate, 2018................................... 75,100,000
Committee recommendation................................ 79,000,000
COMMITTEE RECOMMENDATION
The Committee recommends $79,000,000 for the Salaries and
Expenses account. This amount is $3,900,000 above the fiscal
year 2017 enacted level and the budget request. The
recommendation includes an additional $3,900,000 to bolster the
Commission's maintenance and infrastructure program, including
the interpretive program. The additional funds will restore the
reduction proposed in the budget request for this program and
provide additional funds to accelerate the Commission's 5-year
plan, not only to maintain the cemeteries and monuments
honoring America's war dead, but also to preserve and
communicate these veterans' stories of courage and sacrifice.
FOREIGN CURRENCY FLUCTUATIONS
The Committee includes in the accompanying act, as proposed
by the administration, such sums as necessary for the Foreign
Currency Fluctuations account. Funding the account in this
manner allows the Commission to maintain cemeteries regardless
of the volatility of foreign currency fluctuations.
United States Court of Appeals for Veterans Claims
OVERVIEW
The United States Court of Appeals for Veterans Claims was
established by the Veterans' Judicial Review Act of 1988. The
Court is an independent judicial tribunal with exclusive
jurisdiction to review decisions of the Board of Veterans
Appeals. It has the authority to decide all relevant questions
of law; interpret constitutional, statutory, and regulatory
provisions; and determine the meaning or applicability of the
terms of an action by the Secretary of Veterans Affairs. It is
authorized to compel action by the Secretary. It is authorized
to hold unconstitutional or otherwise unlawful and set aside
decisions, findings, conclusions, rules, and regulations issued
or adopted by the Secretary of Veterans Affairs, the Board of
Veterans Appeals, or the Chairman of the Board that are found
to be arbitrary or capricious. The Court's principal office
location is Washington, DC; however, it is a national court,
empowered to sit anywhere in the United States.
SALARIES AND EXPENSES
Appropriations, 2017.................................... $30,945,000
Budget estimate, 2018................................... 33,608,000
Committee recommendation................................ 33,608,000
COMMITTEE RECOMMENDATION
The Committee recommends $33,608,000 for the U.S. Court of
Appeals for Veterans Claims. This amount is $2,663,000 above
the fiscal year 2017 enacted level and equal to the budget
request. The Committee recommends $800,000 to be transferred to
the General Services Administration for the planning and design
of a new courthouse as included in the budget request.
Department of Defense--Civil
Cemeterial Expenses, Army
OVERVIEW
The Secretary of the Army is responsible for the
administration, operation, and maintenance of Arlington
National Cemetery and the Soldiers' and Airmen's Home National
Cemetery. In addition to its principal function as a national
cemetery, Arlington hosts more than 3,000 public wreath laying
ceremonies, approximately 100 distinguished visitor honors
wreath laying ceremonies, and approximately 4,000,000 visitors
annually.
SALARIES AND EXPENSES
Appropriations, 2017.................................... $70,800,000
Budget estimate, 2018................................... 70,800,000
Committee recommendation................................ 81,000,000
COMMITTEE RECOMMENDATION
The Committee recommends $81,000,000 for the Salaries and
Expenses account. This amount is $10,200,000 above both the
fiscal year 2017 enacted level and the budget request.
The Committee convened a field hearing at Arlington
National Cemetery on March 29, 2017, which was a fitting and
special place to hold the Committee's first hearing of this
Congress. The field hearing was very informative and productive
and carefully examined the Cemetery's current operations and
workload, existing expansion plans, and the serious capacity
constraints on the Cemetery in the 2040-2050 timeframe.
The hearing identified a significant shortfall in the
Cemetery's operating account which directly funds the
Cemetery's day-to-day operations, salaries, maintenance, and
expenses. The Committee determined ANC's operating account had
been held artificially flat for a number of years, and this
action is beginning to have deleterious effects on the
Cemetery's performance and ability to meet its mission.
Arlington performs over 7,000 burial services each year for
veterans and family members and an average of 27-30 each
weekday. With this heavy workload, ANC cannot be under-
resourced, and accordingly, the Committee has provided an
additional $10,200,000 to correct this problem.
This Committee will be unwavering in its support for the
Cemetery and the successful completion of the Cemetery's truly
unique and honored mission. Accordingly, the Secretary of the
Army is directed to include this increase in the Cemetery's
baseline budget and ensure future budget requests provide ample
resources for Arlington National Cemetery.
Armed Forces Retirement Home
TRUST FUND
OVERVIEW
Appropriations, 2017.................................... $64,300,000
Budget estimate, 2018................................... 64,300,000
Committee recommendation................................ 64,300,000
COMMITTEE RECOMMENDATION
The Committee recommends authority to expend $64,300,000
from the Armed Forces Retirement Home [AFRH] Trust Fund to
operate and maintain the Armed Forces Retirement Home--
Washington, DC, and the Armed Forces Retirement Home--Gulfport,
Mississippi.
Trust Fund Solvency.--The Explanatory Statement
accompanying H.R. 5325, the Continuing Appropriations and
Military Construction, Veterans Affairs, and Related Agencies
Appropriations Act, 2017, and Zika Response and Preparedness
Act (Public Law 114-223) directed AFRH and the Department of
Defense to submit by October 1, 2016, a proposal to ensure the
long-term sustainability of the Trust Fund by replenishing the
Trust Fund's revenues, not by cutting core AFRH operations. The
Committee also requested further information regarding an in-
depth study that DoD has undertaken to develop plans to improve
Trust Fund solvency. The Committee is disappointed to note
neither this report nor the requested information has been made
available as directed. AFRH and DoD are directed to deliver
these materials as soon as possible to the Committees on
Appropriations of both Houses of Congress.
Administrative Provisions
Sec. 301. The Committee includes a provision allowing the
relocation of a federally owned water main.
Sec. 302. The Committee includes a provision making
available funds as authorized by 10 U.S.C. 4727.
TITLE IV
OVERSEAS CONTINGENCY OPERATIONS
DEPARTMENT OF DEFENSE
The Committee recommends title IV, Overseas Contingency
Operations, for military construction projects related to the
Global War on Terrorism and the European Reassurance Initiative
that were requested by the Administration in the Fiscal Year
2018 Overseas Contingency Operations [OCO] budget request.
Military Construction, Army
The Committee recommends $139,700,000 for ``Military
Construction, Army'', as requested in the Fiscal Year 2018
Overseas Contingency Operations budget request, for military
construction and planning and design in support of Overseas
Contingency Operations and the European Reassurance Initiative.
Military Construction, Navy and Marine Corps
The Committee recommends $18,500,000 for ``Military
Construction, Navy and Marine Corps'', as requested in the
Fiscal Year 2018 Overseas Contingency Operations budget
request, for planning and design in support of the European
Reassurance Initiative.
Military Construction, Air Force
The Committee recommends $478,030,000 for ``Military
Construction, Air Force'', as requested in the Fiscal Year 2018
Overseas Contingency Operations budget request, for military
construction and planning and design in support of Overseas
Contingency Operations and the European Reassurance Initiative.
Military Construction, Defense-Wide
The Committee recommends $1,900,000 for ``Military
Construction, Defense-Wide'', as requested in the Fiscal Year
2018 Overseas Contingency Operations budget request, for
planning and design in support of the European Reassurance
Initiative.
Administrative Provision
Sec. 401. The Committee includes a provision which provides
the contingent emergency designation for the Overseas
Contingency Operations accounts.
TITLE V
GENERAL PROVISIONS
Sec. 501. The Committee includes a provision that prohibits
the obligation of funds beyond the current fiscal year unless
expressly so provided.
Sec. 502. The Committee includes a provision that prohibits
the use of funds for programs, projects, or activities not in
compliance with Federal law relating to risk assessment, the
protection of private property rights, or unfunded mandates.
Sec. 503. The Committee includes a provision that
encourages the expansion of E-commerce technologies and
procedures.
Sec. 504. The Committee includes a provision that specifies
the congressional committees that are to receive all reports
and notifications.
Sec. 505. The Committee includes a provision that limits
funds from being transferred from this appropriations measure
to any instrumentality of the United States Government without
authority from an appropriations act.
Sec. 506. The Committee includes a provision regarding the
posting of congressional reports on agency Web sites.
Sec. 507. The Committee includes a provision 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.
Sec. 508. The Committee includes a provision prohibiting
the use of funds for the payment of first-class travel by an
employee of the executive branch.
Sec. 509. The Committee includes a provision limiting the
construction of facilities in the United States, its
territories, or possessions for the purposes of housing
individuals detained at Guantanamo Bay, Cuba.
PROGRAM, PROJECT, AND ACTIVITY
In fiscal year 2017, for purposes of the Balanced Budget
and Emergency Deficit Control Act of 1985 (Public Law 99-177)
or the Balanced Budget and Emergency Deficit Control
Reaffirmation Act of 1987 (Public Law 100-119), the following
information provides the definition of the term ``program,
project, and activity'' for departments, agencies and programs
under the jurisdiction of the Military Construction and
Veterans Affairs, and Related Agencies subcommittee. The term
``program, project, and activity'' shall include the most
specific level of budget items identified in the Military
Construction, Veterans Affairs, and Related Agencies
Appropriations Act, 2017, the House and Senate Committee
reports, and the conference report and accompanying joint
explanatory statement of managers of the committee of
conference.
If a sequestration order is necessary, in implementing the
Presidential order, departments, and agencies shall apply any
percentage reduction required for fiscal year 2017 pursuant to
the provisions of Public Law 99-177 or Public Law 100-119 to
all items specified in the justifications submitted to the
Committees on Appropriations of the Senate and House of
Representatives in support of the fiscal year 2017 budget
estimates, as amended, for such departments and agencies, as
modified by congressional action, and in addition, for the
Department of Defense, Military Construction, the definition
shall include specific construction locations as identified in
the explanatory notes.
COMPLIANCE WITH PARAGRAPH 7, RULE XVI, OF THE STANDING RULES OF THE
SENATE
Paragraph 7 of rule XVI requires that Committee reports
accompanying general appropriations bills identify each
recommended amendment which proposes an item of appropriation
which is not made to carry out the provisions of an existing
law, a treaty stipulation, or an act or resolution previously
passed by the Senate during that session.
The Committee recommends funding for the following programs
which currently lack authorization:
Title I: Department of Defense
Military Construction, Army
Military Construction, Navy and Marine Corps
Military Construction, Air Force
Military Construction, Defense-Wide
Military Construction, Army National Guard
Military Construction, Air National Guard
Military Construction, Army Reserve
Military Construction, Navy Reserve
Military Construction, Air Force Reserve
North Atlantic Treaty Organization Security Investment
Program
Department of Defense Base Closure Account
Family Housing Operation and Maintenance, Army
Family Housing Operation and Maintenance, Navy and Marine
Corps
Family Housing Operation and Maintenance, Air Force
Family Housing Operation and Maintenance, Defense-Wide
Family Housing Construction, Army
Family Housing Construction, Navy and Marine Corps
Family Housing Construction, Air Force
Department of Defense Family Housing Improvement Fund
Department of Defense Military Unaccompanied Housing
Improvement Fund
Title II: Department of Veterans Affairs
Veterans Benefits Administration
Veterans Health Administration
National Cemetery Administration
Departmental Administration
Title III: Related Agencies
American Battle Monuments Commission
U.S. Court of Appeals for Veterans Claims
Cemeterial Expenses, Army
Armed Forces Retirement Home
COMPLIANCE WITH PARAGRAPH 7(c), RULE XXVI OF THE STANDING RULES OF THE
SENATE
Pursuant to paragraph 7(c) of rule XXVI, on July 13, 2017,
the Committee ordered favorably reported a bill (S. 1557)
making appropriations for military construction, the Department
of Veterans Affairs, and related agencies for the fiscal year
ending September 30, 2018, and for other purposes, provided,
that the bill be subject to amendment and that the bill be
consistent with the funding level approved by the subcommittee,
by a recorded vote of 31-0, a quorum being present. The vote
was as follows:
Yeas Nays
Chairman Cochran
Mr. McConnell
Mr. Shelby
Mr. Alexander
Ms. Collins
Ms. Murkowski
Mr. Graham
Mr. Blunt
Mr. Moran
Mr. Hoeven
Mr. Boozman
Mrs. Capito
Mr. Lankford
Mr. Daines
Mr. Kennedy
Mr. Rubio
Mr. Leahy
Mrs. Murray
Mrs. Feinstein
Mr. Durbin
Mr. Reed
Mr. Tester
Mr. Udall
Mrs. Shaheen
Mr. Merkley
Mr. Coons
Mr. Schatz
Ms. Baldwin
Mr. Murphy
Mr. Manchin
Mr. Van Hollen
COMPLIANCE WITH PARAGRAPH 12, RULE XXVI OF THE STANDING RULES OF THE
SENATE
Paragraph 12 of rule XXVI requires that Committee reports
on a bill or joint resolution repealing or amending any statute
or part of any statute include ``(a) the text of the statute or
part thereof which is proposed to be repealed; and (b) a
comparative print of that part of the bill or joint resolution
making the amendment and of the statute or part thereof
proposed to be amended, showing by stricken-through type and
italics, parallel columns, or other appropriate typographical
devices the omissions and insertions which would be made by the
bill or joint resolution if enacted in the form recommended by
the committee.''
In compliance with this rule, changes in existing law
proposed to be made by the bill are shown as follows: existing
law to be omitted is enclosed in black brackets; new matter is
printed in italic; and existing law in which no change is
proposed is shown in roman.
TITLE 38--VETERANS' BENEFITS
PART II--GENERAL BENEFITS
Chapter 5--Authority and Duties of the Secretary
Subchapter II--Specified Functions
Sec. 523. Coordination and promotion of other programs affecting
veterans and their dependents
Pilot Program on Use of Community-Based Organizations and Local and
State Government Entities To Ensure That Veterans Receive Care and
Benefits for Which They Are Eligible
``(a) Pilot Program Required.--* * *
* * * * * * *
``[(b) Duration of Program.--The pilot program shall be
carried out during the 2-year period beginning on the date that
is 180 days after the date of the enactment of this Act [May 5,
2010].]
(b) Duration of Program.--The Secretary may not carry out
the pilot program after September 30, 2019.
``(c) Program Locations.--
``(1) In general.--* * *
``(2) Considerations.--In selecting locations for the
pilot program, the Secretary shall consider the advisability of
selecting locations in--
``(A) * * *
* * * * * * *
``(D) * * *
(3) Additional locations.--The Secretary may expand the
pilot program to include additional locations if the Secretary
recommends that the pilot program be expanded in the initial
report submitted under subsection (g)(2)(C).
* * * * * * *
``(g) [Report on Program] Reports._
``(1) In general.--Not later than September 30, 2017
and not later than 180 days after the completion of the pilot
program, the Secretary shall submit to Congress a report on the
pilot program.
``(2) Elements.--[The report] Each report required by
paragraph (1) shall include the following:
``(A) * * *
* * * * * * *
``(C) The recommendations of the Secretary as to the
advisability of continuing or expanding the pilot
program.
* * * * * * *
Chapter 17--Hospital, Nursing Home, Domiciliary, and Medical Care
Subchapter I--General
Sec. 1701. Definitions
For the purpose of this chapter--
(1) * * *
* * * * * * *
(6) The term ``medical services'' includes, in addition to
medical examination, treatment, and rehabilitative services,
the following:
(A) Surgical services.
* * * * * * *
(G) Travel and incidental expenses pursuant to section
111 of this title.
(H) Chiropractic services.
* * * * * * *
(8) The term ``rehabilitative services'' means such
professional, chiropractic, counseling, and guidance services
and treatment programs as are necessary to restore, to the
maximum extent possible, the physical, mental, and
psychological functioning of an ill or disabled person.
(9) The term ``preventive health services'' means--
(A) periodic medical and dental examinations;
* * * * * * *
(F) periodic and preventive chiropractic examinations
and services;
[(F)] (G) immunizations against infectious diseases,
including each immunization on the recommended adult
immunization schedule at the time such immunization is
indicated on that schedule;
[(G)] (H) prevention of musculoskeletal deformity or
other gradually developing disabilities of a metabolic or
degenerative nature;
[(H)] (I) genetic counseling concerning inheritance of
genetically determined diseases;
[(I)] (J) routine vision testing and eye care services;
[(J)] (K) periodic reexamination of members of likely
target populations (high-risk groups) for selected diseases and
for functional decline of sensory organs, together with
attendant appropriate remedial intervention; and
[(K)] (L) such other health-care services as the
Secretary may determine to be necessary to provide effective
and economical preventive health care.
* * * * * * *
------
subchapter ii--hospital, nursing home, or domiciliary care and medical
treatment
Sec.
1710. Eligibility for hospital, nursing home, and domiciliary care
* * * * * * *
1712C. Dental insurance plan for veterans and survivors and dependents
of veterans
1712D. Mental and behavioral health care for certain individuals
discharged or released from the active military, naval, or air
service under conditions other than honorable
Subchapter II--Hospital, Nursing Home, or Domiciliary Care and Medical
Treatment
Sec. 1710. Eligibility for hospital, nursing home, and domiciliary care
Chiropractic Treatment
``(a) Requirement for Program.--* * *
* * * * * * *
``(c) Location of Program.--(1) The program shall be
carried out at sites designated by the Secretary for purposes
of the program. The Secretary shall designate at least one site
for such program in each geographic service area of the
Veterans Health Administration. The sites so designated shall
be medical centers and clinics located in urban areas and in
rural areas.
(2) The program shall be carried out at not fewer
than two medical centers or clinics in each Veterans
Integrated Service Network by not later than December
31, 2019, and at not fewer than 50 percent of all
medical centers in each Veterans Integrated Service
Network by not later than December 31, 2021.
* * * * * * *
Sec. 1712C. Dental insurance plan for veterans and survivors and
dependents of veterans
(a) In General.--* * *
* * * * * * *
(j) Termination.--This section terminates on December 31,
2021.
Sec. 1712D. Mental and behavioral health care for certain individuals
discharged or released from the active military,
naval, or air service under conditions other than
honorable
(a) In General.--Notwithstanding section 5303(a) of this
title and subject to subsection (c), the Secretary shall
furnish to an eligible individual covered mental and behavioral
health care.
(b) Eligible Individuals.--For purposes of this section, an
eligible individual is any of the following:
(1) An individual who--
(A) served in the active military, naval, or air
service for a period of more than 180 days and was
deployed in a theater of combat operations, in support
of a contingency operation, or in an area at a time
during which hostilities are occurring in that area,
for a period of more than 30 days during such service;
(B) was discharged or released from such service by
reason of committing a covered offense; and
(C) was diagnosed by a qualified mental health care
provider with a mental or behavioral health condition
before committing the covered offense.
(2) An individual who--
(A) served in the active military, naval, or air
service for a period of more than 180 days and was
deployed in a theater of combat operations, in support
of a contingency operation, or in an area at a time
during which hostilities are occurring in that area,
for a period of more than 30 days during such service;
(B) was discharged or released from such service by
reason of committing a covered offense;
(C) is diagnosed with a mental or behavioral health
condition after committing such covered offense but
before the expiration of the five-year period beginning
on the later of--
(i) the date of the enactment of this section; or
(ii) the date on which the individual is discharged
or released from such service;
(D) submits to the Secretary--
(i) a certification from a qualified mental health
care provider that the provider believes such condition
may have led the individual to commit such offense; and
(ii) the Certificate of Release or Discharge from
Active Duty (DD Form 214) of the individual; and
(E) is determined by the Secretary pursuant to
subsection (c) to have had a mental or behavioral
health condition at the time the individual committed
the covered offense that contributed to the commission
of the offense.
(c) Determination by Secretary.--(1) Not later than 90 days
after receiving the information submitted under subsection
(b)(2)(D) with respect to an individual,23 the Secretary shall
determine whether, at the time of committing the covered
offense, the individual had a mental or behavioral health
condition that contributed to the commission of the offense.
(2) If the Secretary does not make a determination under
paragraph (1) with respect to a mental or behavioral health
condition of an individual before the end of the 90-day period
beginning on the date of the submittal of the information
described in subsection (b)(2)(D), the condition is deemed to
be a mental or behavioral health condition that contributed to
the commission of the offense until such time as the Secretary
makes the determination.
(d) Initial Mental Health Screening.--(1) The Secretary may
furnish to each individual described14 in paragraph (2) an
initial mental health screening not later than the later of--
(A) five years after the date of the enactment of this
section; or
(B) five years after the date on which the individual
was discharged or released from the active military, naval, or
air service.
(2) Individuals described in this paragraph are the
following:
(A) Eligible individuals described in subsection
(b)(1).
(B) Individuals described in subparagraphs (A),
(B), and (C) of subsection (b)(2).
(3) The mental health screening provided to an individual
under paragraph (1) shall be at no cost to the individual.
(e) Notification of Eligibility.--The Secretary shall notify
each eligible individual described in subsection (b)(1) about
the eligibility of the individual for covered mental and
behavioral health care under this section not later than the
later of--
(1) 180 days after the date of the enactment of this
section; or
(2) 180 days after the date on which the individual was
discharged or released from the active military, naval, or air
service.
(f) Annual Report.--Not less frequently than annually, the
Secretary shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the House
of Representatives a report that includes, with respect to the
year preceding the submittal of the report, the following:
(1) The number of eligible individuals who were furnished
covered mental and behavioral health care under this section.
(2) The number of individuals who the Secretary
determined under subsection (c) did not have a mental or
behavioral health condition at the time of committing a covered
offense that contributed to the commission of the offense.
(3) The number of individuals who requested an initial
mental health screening under subsection (d).
(4) The number of individuals who were furnished an
initial mental health screening under subsection (d).
(g) Definitions.--In this section:
(1) The term ``covered mental and behavioral health
care'' means the same types of medical services furnished by
the Department to individuals with service-connected mental or
behavioral health conditions to treat such conditions.
(2) The term ``covered offense'' means an offense for
which an individual is discharged or separated from the active
military, naval, or air service under conditions other than
honorable but not a dishonorable discharge or a discharge by
court-martial.
(3) The term ``qualified mental health care provider''
means a licensed or certified health care provider whose scope
of practice includes diagnosing mental or behavioral health
conditions and includes physicians, psychologists, psychiatric
nurse practitioners, physician assistants, clinical social
workers, and licensed professional counselors.
* * * * * * *
Chapter 24--National Cemeteries and Memorials
Sec. 2402. Persons eligible for interment in national cemeteries
(a) * * *
(1) * * *
* * * * * * *
(9)(A) * * *
(B) * * *
(i) * * *
* * * * * * *
(iii) undergoing that hospitalization or treatment
at the expense of the United States.
(10) Any individual--
(A) who--
(i) was naturalized pursuant to section 2(1) of the
Hmong Veterans' Naturalization Act of 2000 (Public Law
106-207; 8 U.S.C. 1423 note); and
(ii) at the time of the individual's death resided
in the United States; or
(B) who--
(i) the Secretary determines served honorably with
a special guerrilla unit or irregular forces operating
from a base in Laos in support of the Armed Forces of
the United States at any time during the period
beginning February 28, 1961, and ending May 7, 1975;
and
(ii) at the time of the individual's death--
(I) was a citizen of the United States or
an alien lawfully admitted for permanent
residence in the United States; and
(II) resided in the United States.
* * * * * * *
PART VI--ACQUISITION AND DISPOSITION OF PROPERTY
Chapter 81--Acquisition and Operation of Hospital and Domiciliary
Facilities; Procurement and Supply; Enhanced-Use Leases of Real
Property
Subchapter III--State Home Facilities for Furnishing Domiciliary,
Nursing Home, and Hospital Care
Sec. 8135. Applications with respect to projects; payments
(a) * * *
* * * * * * *
(c)(1) * * *
(2) Subject to [paragraphs (3) and (5)(C)] paragraphs
(3), (4)(B), and (5)(C) of this subsection, the Secretary shall
accord priority to applications in the following order:
* * * * * * *
(4) [The Secretary] (A) The Secretary shall establish a
list of approved projects (including projects that have been
conditionally approved under paragraph (6) of this subsection),
in the order of their priority, as of August 15 of each year.
The Secretary shall award grants in the order of their priority
on the list during the fiscal year beginning on October 1 of
the calendar year in which the list was made.
(B) With respect to a project that is approved in a
fiscal year but for which a grant has not been awarded
under this subchapter in that fiscal year, the
Secretary may not accord a lower priority on the list
described in subparagraph (A) to that project in any
subsequent fiscal year (as compared to the priority
accorded that project in any previous fiscal year)
unless the reason for such lower priority is the
inclusion in such list of a project described in
subparagraph (A) or (B) of paragraph (2).
* * * * * * *
(7)(A) * * *
(B) A grant may not be increased under subparagraph
(A) of this paragraph by more than 10 percent of the
amount of the grant initially awarded for such project,
and the amount of such grant, as increased, may not
exceed 65 percent of the cost of the project.
(8) In determining under subparagraphs (D), (F), and
(H) of paragraph (2) whether a State has a great, significant,
or limited need for beds in connection with an application
under subsection (a), the Secretary shall--
(A) consider the availability and accessibility to
individuals in that State of private facilities
providing similar care to the care for which the
application is submitted under such subsection; and
(B) accord a lower priority in the list established
under paragraph (4) to applications by States with a
significant number of such private facilities, as
determined by the Secretary.
------
CONTINUING APPROPRIATIONS AND MILITARY CONSTRUCTION, VETERANS AFFAIRS,
AND RELATED AGENCIES APPROPRIATIONS ACT, 2017, AND ZIKA RESPONSE AND
PREPAREDNESS ACT, PUBLIC LAW 114-223
DIVISION A--MILITARY CONSTRUCTION AND VETERANS AFFAIRS, AND RELATED
AGENCIES APPROPRIATIONS ACT, 2017
* * * * * * *
TITLE II
DEPARTMENT OF VETERANS AFFAIRS
Administrative Provisions
* * * * * * *
[(INCLUDING TRANSFER OF FUNDS)
Sec. 222. Of the amounts appropriated to the Department of
Veterans Affairs which become available on October 1, 2017, for
``Medical Services'', ``Medical Support and Compliance'', and
``Medical Facilities'', up to $280,802,000, plus
reimbursements, may be transferred to the Joint Department of
Defense-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. 3571) 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 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 Affairs to the Committees on
Appropriations of both Houses of Congress.] Repealed.
BUDGETARY IMPACT OF BILL
PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SEC. 308(a), PUBLIC LAW 93-344, AS
AMENDED
[In millions of dollars]
----------------------------------------------------------------------------------------------------------------
Budget authority Outlays
-----------------------------------------------------------
Amount in Amount in
Allocation\1\ bill Allocation\1\ bill
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with the
subcommittee allocation for 2018: Subcommittee on
Military Construction and Veterans Affairs, and
Related Agencies:
Mandatory....................................... 97,618 97,618 97,272 \2\97,272
Discretionary................................... 88,211 88,849 84,677 \2\84,683
Security.................................... 9,536 10,174 NA NA
Nonsecurity................................. 78,675 78,675 NA NA
Projections of outlays associated with the
recommendation:
2018............................................ .............. ............ .............. \3\104,134
2019............................................ .............. ............ .............. 5,151
2020............................................ .............. ............ .............. 4,108
2021............................................ .............. ............ .............. 2,819
2022 and future years........................... .............. ............ .............. 2,195
Financial assistance to State and local governments NA 234 NA \3\52
forP 2018..........................................
----------------------------------------------------------------------------------------------------------------
\1\There is no section 302(a) allocation to the Committee on Appropriations for fiscal year 2018.
\2\Includes outlays from prior-year budget authority.
\3\Excludes outlays from prior-year budget authority.
NA: Not applicable.
NOTE.--Consistent with the funding recommended in the bill for overseas contingency operations and in accordance
with subparagraph (A)(ii) of section 251(b)(2) of the BBEDCA of 1985, the Committee anticipates that the
Budget Committee will provide, at the appropriate time, a 302(a) allocation for the Committee on
Appropriations reflecting an upward adjustment of $638,000,000 in budget authority plus the associated
outlays.
MILITARY CONSTRUCTION PROJECT LISTING BY LOCATION
[In thousands of dollars]
----------------------------------------------------------------------------------------------------------------
Committee
recommendation
Installation and project Budget Committee compared to
estimate recommendation budget
estimate
----------------------------------------------------------------------------------------------------------------
ALABAMA
ARMY:
FORT RUCKER:
TRAINING SUPPORT FACILITY............................... 38,000 38,000 ..............
ALASKA
AIR FORCE:
EIELSON AFB:
F-35A ADAL CONVENTIONAL MUNITIONS FACILITY.............. 2,500 2,500 ..............
F-35A AGE FACILITY / FILLSTAND.......................... 21,000 21,000 ..............
F-35A CONSOLIDATED MUNITIONS ADMIN FACILITY............. 27,000 27,000 ..............
F-35A EXTEND UTILIDUCT TO SOUTH LOOP.................... 48,000 48,000 ..............
F-35A OSS/WEAPONS/INTEL FACILITY........................ 11,800 11,800 ..............
F-35A R-11 FUEL TRUCK SHELTER........................... 9,600 9,600 ..............
F-35A SATELLITE DINING FACILITY......................... 8,000 8,000 ..............
REPAIR CENTRAL HEAT/POWER PLANT BOILER PH 4............. 41,000 41,000 ..............
-----------------------------------------------
TOTAL, ALASKA............................................. 168,900 168,900 ..............
ARIZONA
ARMY:
DAVIS-MONTHAN AFB:
GENERAL INSTRUCTION BUILDING............................ 22,000 22,000 ..............
FORT HUACHUCA:
GROUND TRANSPORT EQUIPMENT BUILDING..................... 30,000 30,000 ..............
NAVY:
YUMA:
ENLISTED DINING FACILITY & COMMUNITY BLDGS.............. 36,358 36,358 ..............
-----------------------------------------------
TOTAL, ARIZONA........................................ 88,358 88,358 ..............
CALIFORNIA
ARMY:
FORT IRWIN:
LAND ACQUISITION........................................ 3,000 3,000 ..............
NAVY:
BARSTOW:
COMBAT VEHICLE REPAIR FACILITY.......................... 36,539 36,539 ..............
CAMP PENDLETON:
AMMUNITION SUPPLY POINT UPGRADE......................... 61,139 61,139 ..............
LEMOORE:
F/A 18 AVIONICS REPAIR FACILITY REPLACEMENT............. 60,828 60,828 ..............
MIRAMAR:
AIRCRAFT MAINTENANCE HANGAR (INC 2)..................... 39,600 39,600 ..............
TWENTYNINE PALMS:
POTABLE WATER TREATMENT/BLENDING FACILITY............... 55,099 55,099 ..............
AIR FORCE:
TRAVIS AFB:
Note: Budget request is under worldwide unspecified Air
Force. The Secretary of the Air Force determined the
specific projects and costs after the submission.
AIRCRAFT 3-BAY MAINTENANCE HANGAR....................... .............. 107,000 +107,000
ALTER B811 CORROSION CONTROL HANGAR..................... .............. .............. ..............
ALTER B181/185/187 SQUAD OPS/AMU........................ .............. .............. ..............
ADAL D14 FUEL CELL HANGAR............................... .............. .............. ..............
DEFENSE-WIDE:
CAMP PENDLETON:
AMBULATORY CARE CENTER REPLACEMENT...................... 26,400 26,400 ..............
SOF MARINE BATTALION COMPANY/TEAM FACILITIES............ 9,958 9,958 ..............
SOF MOTOR TRANSPORT FACILITY EXPANSION.................. 7,284 7,284 ..............
CORONADO:
SOF BASIC TRAINING COMMAND.............................. 96,077 96,077 ..............
SOF LOGISTICS SUPPORT UNIT ONE OPS FAC. #3.............. 46,175 46,175 ..............
SOF SEAL TEAM OPS FACILITY.............................. 66,218 66,218 ..............
SOF SEAL TEAM OPS FACILITY.............................. 50,265 50,265 ..............
AIR NATIONAL GUARD:
MARCH AFB:
TFI CONSTRUCT RPA FLIGHT TRAINING UNIT.................. 15,000 15,000 ..............
ARMY RESERVE:
FALLBROOK:
ARMY RESERVE CENTER..................................... 36,000 36,000 ..............
NAVY RESERVE:
LEMOORE:
NAVAL OPERATIONAL SUPPORT CENTER........................ 17,330 17,330 ..............
-----------------------------------------------
TOTAL, CALIFORNIA..................................... 626,912 733,912 +107,000
COLORADO
ARMY:
FORT CARSON:
AMMUNITION SUPPLY POINT................................. 21,000 21,000 ..............
BATTLEFIELD WEATHER FACILITY............................ 8,300 8,300 ..............
AIR FORCE:
BUCKLEY AIR FORCE BASE:
SBIRS OPERATIONS FACILITY............................... 38,000 38,000 ..............
FORT CARSON, COLORADO:
13 ASOS EXPANSION....................................... 13,000 13,000 ..............
U.S. AIR FORCE ACADEMY:
AIR FORCE CYBERWORX..................................... 30,000 30,000 ..............
DEFENSE-WIDE:
SCHRIEVER AFB:
AMBULATORY CARE CENTER/DENTAL ADD./ALT.................. 10,200 10,200 ..............
AIR NATIONAL GUARD:
PETERSON AFB:
SPACE CONTROL FACILITY.................................. 8,000 8,000 ..............
-----------------------------------------------
TOTAL, COLORADO........................................... 128,500 128,500 ..............
CONNECTICUT
AIR NATIONAL GUARD:
BRADLEY IAP:
CONSTRUCT BASE ENTRY COMPLEX............................ 7,000 7,000 ..............
DELAWARE
ARMY NATIONAL GUARD:
NEW CASTLE:
COMBINED SUPPORT MAINTENANCE SHOP....................... 36,000 36,000 ..............
DISTRICT OF COLUMBIA
NAVY:
NSA WASHINGTON:
ELECTRONICS SCIENCE AND TECHNOLOGY LABORATORY........... 37,882 37,882 ..............
WASHINGTON NAVY YARD AT/FP.............................. 60,000 .............. -60,000
-----------------------------------------------
TOTAL, DISTRICT OF COLUMBIA............................... 97,882 37,882 -60,000
FLORIDA
ARMY:
EGLIN AFB:
MULTIPURPOSE RANGE COMPLEX.............................. 18,000 18,000 ..............
NAVY:
MAYPORT:
ADVANCED WASTEWATER TREATMENT PLANT..................... 74,994 74,994 ..............
MISSILE MAGAZINES....................................... 9,824 9,824 ..............
AIR FORCE:
EGLIN AFB:
F-35A ARMAMENT RESEARCH FAC ADDITION (B614)............. 8,700 8,700 ..............
LONG-RANGE STAND-OFF ACQUISITION FAC.................... 38,000 38,000 ..............
MACDILL AFB:
KC-135 BEDDOWN OG/MXG HQ................................ 8,100 8,100 ..............
DEFENSE-WIDE:
EGLIN AFB:
SOF SIMULATOR FACILITY.................................. 5,000 5,000 ..............
UPGRADE OPEN STORAGE YARD............................... 4,100 4,100 ..............
HURLBURT FIELD:
SOF COMBAT AIRCRAFT PARKING APRON....................... 34,700 34,700 ..............
SOF SIMULATOR & FUSELAGE TRAINER FACILITY............... 11,700 11,700 ..............
AIR FORCE RESERVE:
PATRICK AFB:
GUARDIAN ANGEL FACILITY................................. 25,000 25,000 ..............
-----------------------------------------------
TOTAL, FLORIDA............................................ 238,118 238,118 ..............
GEORGIA
ARMY:
FORT BENNING:
TRAINING SUPPORT FACILITY............................... 28,000 28,000 ..............
FORT GORDON:
ACCESS CONTROL POINT.................................... 33,000 33,000 ..............
AUTOMATION-AIDED INSTRUCTIONAL BUILDING................. 18,500 18,500 ..............
AIR FORCE:
ROBINS AFB:
COMMERCIAL VEHICLE VISITOR CONTROL FACILITY............. 9,800 9,800 ..............
DEFENSE-WIDE:
FORT GORDON:
BLOOD DONOR CENTER REPLACEMENT.......................... 10,350 10,350 ..............
NAVY RESERVE:
FORT GORDON:
NAVAL OPERATIONAL SUPPORT CENTER........................ 17,797 17,797 ..............
-----------------------------------------------
TOTAL, GEORGIA............................................ 117,447 117,447 ..............
HAWAII
ARMY:
FORT SHAFTER:
COMMAND AND CONTROL FACILITY, INCR 3.................... 90,000 90,000 ..............
NAVY:
JOINT BASE PEARL HARBOR-HICKAM:
SEWER LIFT STATION & RELIEF SEWER LINE.................. 73,200 73,200 ..............
KANEOHE BAY:
LHD PAD CONVERSIONS MV-22 LANDING PADS.................. 19,012 19,012 ..............
WAHIAWA:
COMMUNICATIONS/CRYPTO FACILITY.......................... 65,864 65,864 ..............
DEFENSE-WIDE:
KUNIA:
NSAH KUNIA TUNNEL ENTRANCE.............................. 5,000 5,000 ..............
AIR FORCE RESERVE:
JOINT BASE PEARL HARBOR-HICKAM:
CONSOLIDATED TRAINING FACILITY.......................... 5,500 5,500 ..............
-----------------------------------------------
TOTAL, HAWAII............................................. 258,576 258,576 ..............
IDAHO
ARMY NATIONAL GUARD:
ORCHARD TRAINING AREA:
DIGITAL AIR/GROUND INTEGRATION RANGE.................... 22,000 22,000 ..............
INDIANA
ARMY:
CRANE ARMY AMMUNITION PLANT:
SHIPPING AND RECEIVING BUILDING......................... 24,000 24,000 ..............
KANSAS
AIR FORCE:
MCCONNELL AFB:
COMBAT ARMS FACILITY.................................... 17,500 17,500 ..............
KENTUCKY
AIR NATIONAL GUARD:
LOUISVILLE IAP:
ADD/ALTER RESPONSE FORCES FACILITY...................... 9,000 9,000 ..............
MAINE
NAVY:
KITTERY:
PAINT, BLAST, AND RUBBER FACILITY....................... 61,692 61,692 ..............
ARMY NATIONAL GUARD:
PRESQUE ISLE:
NATIONAL GUARD READINESS CENTER......................... 17,500 17,500 ..............
-----------------------------------------------
TOTAL, MAINE.............................................. 79,192 79,192 ..............
MARYLAND
AIR FORCE:
JOINT BASE ANDREWS:
PAR LAND ACQUISITION.................................... 17,500 17,500 ..............
PRESIDENTIAL AIRCRAFT RECAP COMPLEX..................... 254,000 100,000 -154,000
DEFENSE-WIDE:
BETHESDA NAVAL HOSPITAL:
MEDICAL CENTER ADDITION/ALTERATION INCR 2............... 123,800 123,800 ..............
FORT MEADE:
NSAW RECAPITALIZE BUILDING #2 INCR 3.................... 313,968 313,968 ..............
ARMY NATIONAL GUARD:
SYKESVILLE:
NATIONAL GUARD READINESS CENTER......................... 19,000 19,000 ..............
-----------------------------------------------
TOTAL, MARYLAND....................................... 728,268 574,268 -154,000
MASSACHUSETTS
AIR FORCE:
HANSCOM AFB:
VANDENBERG GATE COMPLEX................................. 11,400 11,400 ..............
AIR FORCE RESERVE:
WESTOVER ARB:
INDOOR SMALL ARMS RANGE................................. 10,000 10,000 ..............
-----------------------------------------------
TOTAL, MASSACHUSETTS...................................... 21,400 21,400 ..............
MINNESOTA
ARMY NATIONAL GUARD:
ARDEN HILLS:
NATIONAL GUARD READINESS CENTER......................... 39,000 39,000 ..............
MISSOURI
DEFENSE-WIDE:
FORT LEONARD WOOD:
BLOOD PROCESSING CENTER REPLACEMENT..................... 11,941 11,941 ..............
HOSPITAL REPLACEMENT.................................... 250,000 100,000 -150,000
ST LOUIS:
NEXT NGA WEST (N2W) COMPLEX............................. 381,000 175,000 -206,000
AIR NATIONAL GUARD:
ROSECRANS MEMORIAL AIRPORT:
REPLACE COMMUNICATIONS FACILITY......................... 10,000 10,000 ..............
-----------------------------------------------
TOTAL, MISSOURI........................................... 652,941 296,941 -356,000
NEVADA
AIR FORCE:
NELLIS AFB:
RED FLAG 5TH GEN FACILITY ADDITION...................... 23,000 23,000 ..............
VIRTUAL WARFARE CENTER OPERATIONS FACILITY.............. 38,000 38,000 ..............
-----------------------------------------------
TOTAL, NEVADA............................................. 61,000 61,000 ..............
NEW JERSEY
AIR FORCE:
JOINT BASE MCGUIRE-DIX-LAKEHURST:
Note: Budget request is under worldwide unspecified Air
Force. The Secretary of the Air Force determined the
specific projects and costs after the submission.
2-BAY GENERAL PURPOSE MIX HANGAR........................ .............. 72,000 +72,000
ADAL B2324 REGIONAL MAINTENANCE TRAINING FACILITY....... .............. 18,000 +18,000
ALTER APRON AND FUEL HYDRANT............................ .............. 17,000 +17,000
ALTER BUILDINGS FOR OPS AND TFI AMU-AMXS................ .............. 9,000 +9,000
ADAL B1816 FOR SUPPLY................................... .............. 6,900 +6,900
ADAL B2319 FOR BOOM OPERATOR TRAINER.................... .............. 6,100 +6,100
ALTER FACILITIES FOR MAINTENANCE........................ .............. 5,800 +5,800
AEROSPACE GROUND EQUIPMENT STORAGE...................... .............. 4,100 +4,100
ADAL B3209 FOR FUSELAGE TRAINER......................... .............. 3,300 +3,300
ADD TO B1837 FOR BODY TANKS STORAGE..................... .............. 2,300 +2,300
ADAL 1749 FOR ATGL AND LST SERVICING.................... .............. 2,000 +2,000
NAVY RESERVE:
JOINT BASE MCGUIRE-DIX-LAKEHURST:
AIRCRAFT APRON, TAXIWAY & SUPPORT FACILITIES............ 11,573 11,573 ..............
-----------------------------------------------
TOTAL, NEW JERSEY......................................... 11,573 158,073 +146,500
NEW MEXICO
AIR FORCE:
CANNON AFB:
DANGEROUS CARGO PAD RELOCATE CATM....................... 42,000 42,000 ..............
HOLLOMAN AFB:
RPA FIXED GROUND CONTROL STATION FACILITY............... 4,250 4,250 ..............
DEFENSE-WIDE:
CANNON AFB:
SOF C-130 AGE FACILITY.................................. 8,228 8,228 ..............
ARMY NATIONAL GUARD:
LAS CRUCES:
NATIONAL GUARD READINESS CENTER ADDITION................ 8,600 8,600 ..............
-----------------------------------------------
TOTAL, NEW MEXICO......................................... 63,078 63,078 ..............
NEW YORK
ARMY:
U.S. MILITARY ACADEMY:
CEMETERY................................................ 22,000 22,000 ..............
AIR NATIONAL GUARD:
HANCOCK FIELD:
ADD TO FLIGHT TRAINING UNIT, BUILDING 641............... 6,800 6,800 ..............
-----------------------------------------------
TOTAL, NEW YORK........................................... 28,800 28,800 ..............
NORTH CAROLINA
NAVY:
CAMP LEJEUNE:
BACHELOR ENLISTED QUARTERS.............................. 37,983 37,983 ..............
WATER TREATMENT PLANT REPLACEMENT HADNOT PT............. 65,784 65,784 ..............
CHERRY POINT MARINE CORPS AIR STATION:
F-35B VERTICAL LIFT FAN TEST FACILITY................... 15,671 15,671 ..............
DEFENSE-WIDE:
CAMP LEJEUNE:
AMBULATORY CARE CENTER ADDITION/ALTERATION.............. 15,300 15,300 ..............
AMBULATORY CARE CENTER/DENTAL CLINIC.................... 21,400 21,400 ..............
AMBULATORY CARE CENTER/DENTAL CLINIC.................... 22,000 22,000 ..............
SOF HUMAN PERFORMANCE TRAINING CENTER................... 10,800 10,800 ..............
SOF MOTOR TRANSPORT MAINTENANCE EXPANSION............... 20,539 20,539 ..............
FORT BRAGG:
SOF HUMAN PERFORMANCE TRAINING CTR...................... 20,260 20,260 ..............
SOF SUPPORT BATTALION ADMIN FACILITY.................... 13,518 13,518 ..............
SOF TACTICAL EQUIPMENT MAINTENANCE FACILITY............. 20,000 20,000 ..............
SOF TELECOMM RELIABILITY IMPROVEMENTS................... 4,000 4,000 ..............
SEYMOUR JOHNSON AFB:
CONSTRUCT TANKER TRUCK DELIVERY SYSTEM.................. 20,000 20,000 ..............
AIR FORCE RESERVE:
SEYMOUR JOHNSON AFB:
KC-46A ADAL FOR ALT MISSION STORAGE..................... 6,400 6,400 ..............
-----------------------------------------------
TOTAL, NORTH CAROLINA................................. 293,655 293,655 ..............
NORTH DAKOTA
AIR FORCE:
MINOT AFB:
INDOOR FIRING RANGE..................................... 27,000 27,000 ..............
OHIO
AIR NATIONAL GUARD:
TOLEDO EXPRESS AIRPORT:
NORTHCOM--CONSTRUCT ALERT HANGAR........................ 15,000 15,000 ..............
OKLAHOMA
AIR FORCE:
ALTUS AFB:
KC-46A FTU FUSELAGE TRAINER PHASE 2..................... 4,900 4,900 ..............
OREGON
AIR NATIONAL GUARD:
KLAMATH FALLS IAP:
CONSTRUCT CORROSION CONTROL HANGAR...................... 10,500 10,500 ..............
CONSTRUCT INDOOR RANGE.................................. 8,000 8,000 ..............
-----------------------------------------------
TOTAL, OREGON............................................. 18,500 18,500 ..............
SOUTH CAROLINA
ARMY:
FORT JACKSON:
RECEPTION BARRACKS COMPLEX, PH1......................... 60,000 60,000 ..............
SHAW AFB:
MISSION TRAINING COMPLEX................................ 25,000 25,000 ..............
DEFENSE-WIDE:
SHAW AFB:
CONSOLIDATE FUEL FACILITIES............................. 22,900 22,900 ..............
TOTAL, SOUTH CAROLINA..................................... 107,900 107,900 ..............
SOUTH DAKOTA
AIR NATIONAL GUARD:
JOE FOSS FIELD:
AIRCRAFT MAINTENANCE SHOPS.............................. 12,000 12,000 ..............
TENNESSEE
AIR NATIONAL GUARD:
MCGHEE-TYSON AIRPORT:
REPLACE KC-135 MAINTENANCE HANGAR AND SHOPS............. 25,000 25,000 ..............
TEXAS
ARMY:
CAMP BULLIS:
VEHICLE MAINTENANCE SHOP................................ 13,600 13,600 ..............
FORT HOOD:
BATTALION HEADQUARTERS COMPLEX.......................... 37,000 37,000 ..............
AIR FORCE:
JOINT BASE SAN ANTONIO:
AIR TRAFFIC CONTROL TOWER............................... 10,000 10,000 ..............
BMT CLASSROOMS/DINING FACILITY 4........................ 38,000 38,000 ..............
BMT RECRUIT DORMITORY 7................................. 90,130 90,130 ..............
CAMP BULLIS DINING FACILITY............................. 18,500 18,500 ..............
DEFENSE-WIDE:
FORT BLISS:
BLOOD PROCESSING CENTER................................. 8,300 8,300 ..............
HOSPITAL REPLACEMENT INCR 8............................. 251,330 100,000 -151,330
NAVY RESERVE:
FORT WORTH:
KC130-J EACTS FACILITY.................................. 12,637 12,637 ..............
-----------------------------------------------
TOTAL, TEXAS.............................................. 479,497 328,167 -151,330
UTAH
AIR FORCE:
HILL AFB:
UTTR CONSOLIDATED MISSION CONTROL CENTER................ 28,000 28,000 ..............
DEFENSE-WIDE:
HILL AFB:
REPLACE POL FACILITIES.................................. 20,000 20,000 ..............
AIR FORCE RESERVE:
HILL AFB:
ADD/ALTER LIFE SUPPORT FACILITY......................... 3,100 3,100 ..............
-----------------------------------------------
TOTAL, UTAH............................................... 51,100 51,100 ..............
VIRGINIA
ARMY:
FORT BELVOIR:
SECURE ADMIN/OPERATIONS FACILITY, INCR 3................ 14,124 14,124 ..............
JOINT BASE LANGLEY-EUSTIS:
AIRCRAFT MAINTENANCE INSTRUCTIONAL BLDG................. 34,000 34,000 ..............
JOINT BASE MYER-HENDERSON:
SECURITY FENCE.......................................... 20,000 20,000 ..............
NAVY:
DAM NECK:
ISR OPERATIONS FACILITY EXPANSION....................... 29,262 29,262 ..............
JOINT EXPEDITIONARY BASE LITTLE CREEK--STORY:
ACU-4 ELECTRICAL UPGRADES............................... 2,596 2,596 ..............
NORFOLK:
CHAMBERS FIELD MAGAZINE RECAP PH 1...................... 34,665 34,665 ..............
PORTSMOUTH:
SHIP REPAIR TRAINING FACILITY........................... 72,990 72,990 ..............
YORKTOWN:
BACHELOR ENLISTED QUARTERS.............................. 36,358 36,358 ..............
DEFENSE-WIDE:
JOINT EXPEDITIONARY BASE LITTLE CREEK--STORY:
SOF SATEC RANGE EXPANSION............................... 23,000 23,000 ..............
NORFOLK:
REPLACE HAZARDOUS MATERIALS WAREHOUSE................... 18,500 18,500 ..............
PENTAGON:
PENTAGON CORR 8 PEDESTRIAN ACCESS CONTROL PT............ 8,140 8,140 ..............
S.E. SAFETY TRAFFIC AND PARKING IMPROVEMENTS............ 28,700 28,700 ..............
SECURITY UPDATES........................................ 13,260 13,260 ..............
PORTSMOUTH:
REPLACE HARARDOUS MATERIALS WAREHOUSE................... 22,500 22,500 ..............
ARMY NATIONAL GUARD:
FORT PICKETT:
TRAINING AIDS CENTER.................................... 4,550 4,550 ..............
-----------------------------------------------
TOTAL, VIRGINIA........................................... 362,645 362,645 ..............
WASHINGTON
ARMY:
JOINT BASE LEWIS-MCCHORD:
CONFINEMENT FACILITY.................................... 66,000 66,000 ..............
YAKIMA:
FIRE STATION............................................ 19,500 19,500 ..............
NAVY:
INDIAN ISLAND:
MISSILE MAGAZINES....................................... 44,440 44,440 ..............
ARMY NATIONAL GUARD:
TURNWATER:
NATIONAL GUARD READINESS CENTER......................... 31,000 31,000 ..............
-----------------------------------------------
TOTAL, WASHINGTON......................................... 160,940 160,940 ..............
WISCONSIN
ARMY RESERVE:
FORT MCCOY:
AT/MOB DINING FACILITY.................................. 13,000 13,000 ..............
WYOMING
AIR FORCE:
F. E. WARREN AFB:
CONSOLIDATED HELO/TRF OPS/AMU AND ALERT FAC............. 62,000 62,000 ..............
CONUS CLASSIFIED
DEFENSE-WIDE:
CLASSIFIED LOCATION:
BATTALION COMPLEX, PH 1................................. 64,364 64,364 ..............
AUSTRALIA
AIR FORCE:
DARWIN:
APR--BULK FUEL STORAGE TANKS............................ 76,000 76,000 ..............
DJIBOUTI
NAVY:
CAMP LEMONIER:
AIRCRAFT PARKING APRON EXPANSION........................ 13,390 13,390 ..............
GERMANY
ARMY:
STUTTGART:
EIC: COMMISSARY......................................... 40,000 40,000 ..............
WIESBADEN:
EIC: ADMINISTRATIVE BUILDING............................ 43,000 43,000 ..............
DEFENSE-WIDE:
RHINE ORDNANCE BARRACKS:
MEDICAL CENTER REPLACEMENT INCR 7....................... 106,700 106,700 ..............
SPANGDAHLEM AB:
SPANGDAHLEM ELEMENTARY SCHOOL REPLACEMENT............... 79,141 79,141 ..............
STUTTGART:
ROBINSON BARRACKS ELEM. SCHOOL REPLACEMENT.............. 46,609 46,609 ..............
-----------------------------------------------
TOTAL, GERMANY............................................ 315,450 315,450 ..............
GREECE
NAVY:
SOUDA BAY:
STRATEGIC AIRCRAFT PARKING APRON EXPANSION.............. 22,045 22,045 ..............
DEFENSE-WIDE:
SOUDA BAY:
CONSTRUCT HYDRANT SYSTEM................................ 18,100 18,100 ..............
-----------------------------------------------
TOTAL, GREECE............................................. 40,145 40,145 ..............
GUAM
NAVY:
JOINT REGION MARIANAS:
AIRCRAFT MAINTENANCE HANGAR #2.......................... 75,233 75,233 ..............
CORROSION CONTROL HANGAR................................ 66,747 66,747 ..............
MALS FACILITIES......................................... 49,431 49,431 ..............
NAVY-COMMERCIAL TIE-IN HARDENING........................ 37,180 37,180 ..............
WATER WELL FIELD........................................ 56,088 56,088 ..............
DEFENSE-WIDE:
ANDERSEN AFB:
CONSTRUCT TRUCK LOAD & UNLOAD FACILITY.................. 23,900 23,900 ..............
AIR FORCE RESERVE:
JOINT REGION MARIANAS:
RESERVE MEDICAL TRAINING FACILITY....................... 5,200 5,200 ..............
-----------------------------------------------
TOTAL, GUAM............................................... 313,779 313,779 ..............
ITALY
AIR FORCE:
AVIANO AB:
GUARDIAN ANGEL OPERATIONS FACILITY...................... 27,325 27,325 ..............
DEFENSE-WIDE:
SIGONELLA:
CONSTRUCT HYDRANT SYSTEM................................ 22,400 22,400 ..............
VICENZA:
VICENZA HIGH SCHOOL REPLACEMENT......................... 62,406 62,406 ..............
-----------------------------------------------
TOTAL, ITALY.............................................. 112,131 112,131 ..............
JAPAN
NAVY:
IWAKUNI:
KC130J ENLISTED AIRCREW TRAINER FACILITY................ 21,860 21,860 ..............
DEFENSE-WIDE:
IWAKUNI:
CONSTRUCT BULK STORAGE TANKS PH 1....................... 30,800 30,800 ..............
KADENA AB:
SOF MAINTENANCE HANGAR.................................. 3,972 3,972 ..............
SOF SPECIAL TACTICS OPERATIONS FACILITY................. 27,573 27,573 ..............
OKINAWA:
REPLACE MOORING SYSTEM.................................. 11,900 11,900 ..............
SASEBO:
UPGRADE FUEL WHARF...................................... 45,600 45,600 ..............
TORRI COMMO STATION:
SOF TACTICAL EQUIPMENT MAINTENANCE FACILITY............. 25,323 25,323 ..............
YOKOTA AB:
AIRFIELD APRON.......................................... 10,800 10,800 ..............
HANGAR/AIRCRAFT MAINTENANCE UNIT........................ 12,034 12,034 ..............
OPERATIONS AND WAREHOUSE FACILITIES..................... 8,590 8,590 ..............
SIMULATOR FACILITY...................................... 2,189 2,189 ..............
-----------------------------------------------
TOTAL, JAPAN.............................................. 200,641 200,641 ..............
KOREA
ARMY:
KUNSAN AB:
UNMANNED AERIAL VEHICLE HANGAR.......................... 53,000 53,000 ..............
MARIANA ISLANDS
AIR FORCE:
TINIAN:
APR LAND ACQUISITION.................................... 12,900 12,900 ..............
PUERTO RICO
DEFENSE-WIDE:
PUNTA BORINQUEN:
RAMEY UNIT SCHOOL REPLACEMENT........................... 61,071 61,071 ..............
ARMY RESERVE:
AGUADILLA:
ARMY RESERVE CENTER..................................... 12,400 12,400 ..............
-----------------------------------------------
TOTAL, PUERTO RICO........................................ 73,471 73,471 ..............
QATAR
AIR FORCE:
AL UDEID:
CONSOLIDATED SQUADRON OPERATIONS FACILITY............... 15,000 15,000 ..............
TURKEY
ARMY:
TURKEY VARIOUS:
FORWARD OPERATING SITE.................................. 6,400 6,400 ..............
AIR FORCE:
INCIRLIK AB:
DORMITORY............................................... 25,997 25,997 ..............
TOTAL, TURKEY............................................. 32,397 32,397 ..............
UNITED KINGDOM
AIR FORCE:
ROYAL AIR FORCE FAIRFORD:
EIC RC-135 INFRASTRUCTURE............................... 2,150 2,150 ..............
EIC RC-135 INTEL AND SQUAD OPS FACILITY................. 38,000 38,000 ..............
EIC RC-135 RUNWAY OVERRUN RECONFIGURATION............... 5,500 5,500 ..............
ROYAL AIR FORCE LAKENHEATH:
CONSOLIDATED CORROSION CONTROL FACILITY................. 20,000 20,000 ..............
F-35A 6-BAY HANGAR...................................... 24,000 24,000 ..............
F-35A F-15 PARKING...................................... 10,800 10,800 ..............
F-35A FIELD TRAINING DETACHMENT FACILITY................ 12,492 12,492 ..............
F-35A FLIGHT SIMULATOR FACILITY......................... 22,000 22,000 ..............
F-35A INFRASTRUCTURE.................................... 6,700 6,700 ..............
F-35A SQUADRON OPERATIONS AND AMU....................... 41,000 41,000 ..............
DEFENSE-WIDE:
MENWITH HILL STATION:
RAFMH MAIN GATE REHABILITATION.......................... 11,000 11,000 ..............
-----------------------------------------------
TOTAL, UNITED KINGDOM..................................... 193,642 193,642 ..............
NATO SECURITY INVESTMENT PROGRAM........................ 154,000 154,000 ..............
WORLDWIDE UNSPECIFIED
ARMY:
HOST NATION SUPPORT......................................... 28,700 28,700 ..............
MINOR CONSTRUCTION.......................................... 31,500 41,500 +10,000
PLANNING AND DESIGN......................................... 72,770 72,770 ..............
NAVY:
PLANNING AND DESIGN......................................... 219,069 228,069 +9,000
MINOR CONSTRUCTION.......................................... 23,842 23,842 ..............
AIR FORCE:
KC-46A MAIN OPERATING BASE 4................................ 269,000 .............. -269,000
Note: The recommended funding is provided under Travis Air
Force Base, CA and Joint Base McGuire-Dix-Lakehurst, NJ as
determined by the Secretary of the Air Force.
PLANNING AND DESIGN..................................... 97,852 97,852 ..............
MINOR CONSTRUCTION...................................... 31,400 31,400 ..............
DEFENSE-WIDE:
CONTINGENCY CONSTRUCTION.................................... 10,000 .............. -10,000
ENERGY RESILIENCE CONSERVATION INVESTMENT PROGRAM........... 150,000 165,000 +15,000
PLANNING AND DESIGN:
DEFENSE WIDE............................................ 23,500 23,500 ..............
DEFENSE HEALTH AGENCY................................... 40,220 40,220 ..............
DEPARTMENT OF DEFENSE DEPENDENT EDUCATION............... 26,147 26,147 ..............
DEFENSE INFORMATION SYSTEMS AGENCY...................... 1,150 1,150 ..............
DEFENSE LOGISTICS AGENCY................................ 23,012 23,012 ..............
MISSILE DEFENSE AGENCY.................................. .............. .............. ..............
NATIONAL SECURITY AGENCY................................ 20,000 20,000 ..............
SPECIAL OPERATIONS COMMAND.............................. 39,746 39,746 ..............
WASHINGTON HEADQUARTERS SERVICE......................... 1,942 1,942 ..............
-----------------------------------------------
SUBTOTAL, PLANNING AND DESIGN............................. 175,717 175,717 ..............
UNSPECIFIED MINOR CONSTRUCTION:
DEFENSE-WIDE............................................ 3,000 3,000 ..............
DEPARTMENT OF DEFENSE DEPENDENT EDUCATION............... 8,000 8,000 ..............
DEFENSE HEALTH AGENCY................................... 10,000 10,000 ..............
DEFENSE LOGISTICS AGENCY................................ 2,039 2,039 ..............
JOINT CHIEFS OF STAFF................................... 11,490 11,490 ..............
MISSILE DEFENSE AGENCY.................................. 3,000 3,000 ..............
NATIONAL SECURITY AGENCY................................ 3,000 3,000 ..............
SPECIAL OPERATIONS COMMAND.............................. 7,384 7,384 ..............
-----------------------------------------------
SUBTOTAL, UNSPECIFIED MINOR CONSTRUCTION.................. 47,913 47,913 ..............
ARMY NATIONAL GUARD:
PLANNING AND DESIGN......................................... 16,271 16,271 ..............
MINOR CONSTRUCTION.......................................... 16,731 16,731 ..............
AIR NATIONAL GUARD:
PLANNING AND DESIGN......................................... 18,000 18,000 ..............
MINOR CONSTRUCTION.......................................... 17,191 17,191 ..............
ARMY RESERVE:
PLANNING AND DESIGN......................................... 6,887 6,887 ..............
MINOR CONSTRUCTION.......................................... 5,425 5,425 ..............
NAVY RESERVE:
PLANNING AND DESIGN......................................... 4,430 4,430 ..............
MINOR CONSTRUCTION.......................................... 1,504 1,504 ..............
AIR FORCE RESERVE:
PLANNING AND DESIGN......................................... 4,725 4,725 ..............
MINOR CONSTRUCTION.......................................... 3,610 3,610 ..............
FAMILY HOUSING, ARMY
OPERATION AND MAINTENANCE:
UTILITIES ACCOUNT........................................... 60,251 60,251 ..............
SERVICES ACCOUNT............................................ 8,930 9,106 +176
MANAGEMENT ACCOUNT.......................................... 37,089 37,089 ..............
MISCELLANEOUS ACCOUNT....................................... 400 400 ..............
FURNISHINGS ACCOUNT......................................... 12,816 12,816 ..............
LEASING..................................................... 148,538 150,644 +2,106
MAINTENANCE OF REAL PROPERTY................................ 57,708 57,708 ..............
PRIVATIZATION SUPPORT COSTS................................. 20,893 20,893 ..............
-----------------------------------------------
SUBTOTAL, OPERATION AND MAINTENANCE....................... 346,625 348,907 +2,282
FAMILY HOUSING, NAVY AND MARINE CORPS
OPERATION AND MAINTENANCE:
UTILITIES ACCOUNT........................................... 62,167 62,167 ..............
SERVICES ACCOUNT............................................ 15,649 15,649 ..............
MANAGEMENT ACCOUNT.......................................... 50,989 50,989 ..............
MISCELLANEOUS ACCOUNT....................................... 336 336 ..............
FURNISHINGS ACCOUNT......................................... 14,529 14,529 ..............
LEASING..................................................... 61,921 61,921 ..............
MAINTENANCE OF REAL PROPERTY................................ 95,104 95,104 ..............
PRIVATIZATION SUPPORT COSTS................................. 27,587 27,587 ..............
-----------------------------------------------
SUBTOTAL, OPERATION AND MAINTENANCE....................... 328,282 328,282 ..............
FAMILY HOUSING, AIR FORCE
OPERATION AND MAINTENANCE:
UTILITIES ACCOUNT........................................... 47,504 47,504 ..............
MANAGEMENT ACCOUNT.......................................... 53,464 53,464 ..............
SERVICES ACCOUNT............................................ 13,517 13,517 ..............
FURNISHINGS ACCOUNT......................................... 29,424 29,424 ..............
MISCELLANEOUS ACCOUNT....................................... 1,839 1,839 ..............
LEASING..................................................... 16,818 16,818 ..............
MAINTENANCE................................................. 134,189 134,189 ..............
PRIVATIZATION SUPPORT COSTS................................. 21,569 21,569 ..............
-----------------------------------------------
SUBTOTAL, OPERATION AND MAINTENANCE....................... 318,324 318,324 ..............
FAMILY HOUSING, DEFENSE-WIDE
OPERATION AND MAINTENANCE:
NATIONAL SECURITY AGENCY:
UTILITIES............................................... 268 268 ..............
FURNISHING.............................................. 407 407 ..............
LEASING................................................. 12,390 12,390 ..............
MAINTENANCE OF REAL PROPERTY............................ 655 655 ..............
DEFENSE INTELLIGENCE AGENCY:
UTILITIES............................................... 4,100 4,100 ..............
FURNISHINGS............................................. 641 641 ..............
LEASING................................................. 39,716 39,716 ..............
DEFENSE LOGISTICS AGENCY:
UTILITIES............................................... 86 86 ..............
FURNISHINGS............................................. 6 6 ..............
SERVICES................................................ 14 14 ..............
MANAGEMENT.............................................. 319 319 ..............
MAINTENANCE OF REAL PROPERTY............................ 567 567 ..............
-----------------------------------------------
SUBTOTAL, OPERATION AND MAINTENANCE....................... 59,169 59,169 ..............
FAMILY HOUSING, ARMY
CONSTRUCTION:
GEORGIA:
FORT GORDON:
FAMILY HOUSING NEW CONSTRUCTION..................... 6,100 6,100 ..............
MASSACHUSETTS:
NATICK SOLDIER SUPPORT CENTER (28 UNITS)................ 21,000 21,000 ..............
KOREA:
CAMP HUMPHRIES:
FAMILY HOUSING NEW CONSTRUCTION INC 2............... 34,402 34,402 ..............
KWAJALEIN:
FAMILY HOUSING NEW CONSTRUCTION (22 UNITS).............. 31,000 31,000 ..............
GERMANY:
SOUTH CAMP VILSECK:
FAMILY HOUSING NEW CONSTRUCTION (36 UNITS).......... 22,445 22,445 ..............
CONSTRUCTION IMPROVEMENTS--BAUMHOLDER (96 UNITS)............ 34,156 34,156 ..............
ITALY:
PLANNING AND DESIGN..................................... 33,559 33,559 ..............
-----------------------------------------------
SUBTOTAL, CONSTRUCTION.................................... 182,662 182,662 ..............
FAMILY HOUSING, NAVY AND MARINE CORPS
CONSTRUCTION:
MARIANA ISLANDS:
NSA ANDERSON:
REPLACEMENT HOUSING PHASE II........................ 40,875 40,875 ..............
BAHRAIN:
SW ASIA:
CONSTRUCTION OF ON-BASE GENERAL FLAG OFFICER:
QUARTERS........................................ 2,138 2,138 ..............
CONSTRUCTION IMPROVEMENTS................................... 36,251 36,251 ..............
PLANNING AND DESIGN......................................... 4,418 4,418 ..............
-----------------------------------------------
SUBTOTAL, CONSTRUCTION.................................... 83,682 83,682 ..............
FAMILY HOUSING, AIR FORCE
CONSTRUCTION:
CONSTRUCTION IMPROVEMENTS................................... 80,617 80,617 ..............
PLANNING AND DESIGN......................................... 4,445 4,445 ..............
-----------------------------------------------
SUBTOTAL, CONSTRUCTION.................................... 85,062 85,062 ..............
DOD MILITARY UNACCOMPANIED HOUSING IMPROVEMENT FUND............. 623 623 ..............
DOD FAMILY HOUSING IMPROVEMENT FUND............................. 2,726 2,726 ..............
BASE REALIGNMENT AND CLOSURE
BASE REALIGNMENT AND CLOSURE ACCOUNT............................ 255,867 255,867 ..............
MILITARY CONSTRUCTION, ARMY..................................... .............. 68,800 +68,800
MILITARY CONSTRUCTION, NAVY AND MARINE CORPS.................... .............. 110,100 +110,100
MILITARY CONSTRUCTION, AIR FORCE................................ .............. 127,300 +127,300
MILITARY CONSTRUCTION, ARMY NATIONAL GUARD...................... .............. 83,500 +83,500
MILITARY CONSTRUCTION, AIR NATIONAL GUARD....................... .............. 24,000 +24,000
MILITARY CONSTRUCTION, ARMY RESERVE............................. .............. 30,000 +30,000
MILITARY CONSTRUCTION, NAVY RESERVE............................. .............. .............. ..............
MILITARY CONSTRUCTION, AIR FORCE RESERVE........................ .............. 35,100 +35,100
RESCISSIONS FROM PRIOR YEAR UNOBLIGATED BALANCES
ARMY............................................................ .............. .............. ..............
NAVY AND MARINE CORPS........................................... .............. .............. ..............
AIR FORCE....................................................... .............. .............. ..............
DEFENSE-WIDE.................................................... .............. -14,703 -14,703
AIR NATIONAL GUARD.............................................. .............. .............. ..............
42 USC 3374 (SEC. 135).......................................... .............. .............. ..............
NATO SECURITY INVESTMENT PROGRAM................................ .............. .............. ..............
FAMILY HOUSING CONSTRUCTION, ARMY............................... .............. .............. ..............
FAMILY HOUSING CONSTRUCTION, NAVY AND MARINE CORPS.............. .............. .............. ..............
FAMILY HOUSING CONSTRUCTION, AIR FORCE.......................... .............. .............. ..............
RECAP
ARMY............................................................ 920,394 930,394 +10,000
RESCISSION.............................................. .............. .............. ..............
NAVY AND MARINE CORPS........................................... 1,616,665 1,565,665 -51,000
RESCISSION.............................................. .............. .............. ..............
AIR FORCE....................................................... 1,738,796 1,569,296 -169,500
RESCISSION.............................................. .............. .............. ..............
DEFENSE-WIDE.................................................... 3,114,913 2,612,583 -502,330
RESCISSION.............................................. .............. -14,703 -14,703
ARMY NATIONAL GUARD............................................. 210,652 210,652 ..............
RESCISSION.............................................. .............. .............. ..............
AIR NATIONAL GUARD.............................................. 161,491 161,491 ..............
RESCISSION.............................................. .............. .............. ..............
ARMY RESERVE.................................................... 73,712 73,712 ..............
RESCISSION.............................................. .............. .............. ..............
NAVY RESERVE.................................................... 65,271 65,271 ..............
RESCISSION.............................................. .............. .............. ..............
AIR FORCE RESERVE............................................... 63,535 63,535 ..............
RESCISSION.............................................. .............. .............. ..............
NATO............................................................ 154,000 154,000 ..............
RESCISSION.............................................. .............. .............. ..............
CHEMICAL DEMILITARIZATION CONSTRUCTION, DEFENSE-WIDE............ .............. .............. ..............
RESCISSION.............................................. .............. .............. ..............
DOD MILITARY UNACCOMPANIED HOUSING IMPROVEMENT FUND............. 623 623 ..............
RESCISSION.............................................. .............. .............. ..............
DOD FAMILY HOUSING IMPROVEMENT FUND............................. 2,726 2,726 ..............
RESCISSION.............................................. .............. .............. ..............
HOMEOWNERS ASSISTANCE PROGRAM................................... .............. .............. ..............
RESCISSION.............................................. .............. .............. ..............
FAMILY HOUSING, ARMY............................................ 529,287 531,569 +2,282
CONSTRUCTION................................................ (182,662) (182,662) ..............
OPERATION AND MAINTENANCE................................... (346,625) (348,907) (+2,282)
RESCISSION.............................................. .............. .............. ..............
FAMILY HOUSING, NAVY AND MARINE CORP............................ 411,964 411,964 ..............
CONSTRUCTION................................................ (83,682) (83,682) ..............
OPERATION AND MAINTENANCE................................... (328,282) (328,282) ..............
RESCISSION.............................................. .............. .............. ..............
FAMILY HOUSING, AIR FORCE....................................... 403,386 403,386 ..............
CONSTRUCTION................................................ (85,062) (85,062) ..............
OPERATION AND MAINTENANCE................................... (318,324) (318,324) ..............
RESCISSION.............................................. .............. .............. ..............
FAMILY HOUSING, DEFENSE-WIDE.................................... 59,169 59,169 ..............
CONSTRUCTION................................................ .............. .............. ..............
OPERATION AND MAINTENANCE................................... (59,169) (59,169) ..............
RESCISSION.............................................. .............. .............. ..............
BRAC............................................................ 255,867 255,867 ..............
RESCISSION.............................................. .............. .............. ..............
42 USC 3374 (Sec. 135).......................................... .............. .............. ..............
ADMINISTRATIVE PROVISIONS....................................... .............. 478,800 +478,800
RESCISSION.............................................. .............. .............. ..............
===============================================
GRAND TOTAL............................................... 9,782,451 9,536,000 -246,451
----------------------------------------------------------------------------------------------------------------
OVERSEAS CONTINGENCY OPERATIONS
[In thousands of dollars]
----------------------------------------------------------------------------------------------------------------
Committee
recommendation
Budget Committee compared to
estimate recommendation budget
estimate
----------------------------------------------------------------------------------------------------------------
CUBA
ARMY:
GUANTANAMO BAY NAVAL STATION:
BARRACKS................................................ 115,000 115,000 ..............
WORLDWIDE UNSPECIFIED
ARMY:
PLANNING AND DESIGN......................................... 9,000 9,000 ..............
AIR FORCE:
PLANNING AND DESIGN......................................... 41,500 41,500 ..............
JORDAN
AIR FORCE:
MUWAFFAQ SALTI AIR BASE:
MUWAFFAQ SALTI AIR BASE................................. 143,000 .............. -143,000
AIRFIELD PAVEMENTS...................................... .............. 52,735 +52,735
ISR SHELTERS............................................ .............. 10,000 +10,000
CAS REVETMENTS/SUN SHADES............................... .............. 11,168 +11,168
DORMITORY............................................... .............. 8,003 +8,003
CARGO MARSHALLING YARD FACILITY......................... .............. 1,034 +1,034
SUPPORTING FACILITIES/UTILITIES......................... .............. 60,060 +60,060
AIR FORCE:
INCIRLIK AB:
RELOCATE BASE MAIN ACCESS CONTROL POINT................. 14,600 14,600 ..............
REPLACE PERIMETER FENCE................................. 8,100 8,100 ..............
-----------------------------------------------
TOTAL, OVERSEAS CONTINGENCY OPERATIONS.................... 331,200 331,200 ..............
ARMY.................................................... (124,000) (124,000) ..............
AIR FORCE............................................... (207,200) (207,200) ..............
EUROPEAN REASSURANCE INITIATIVE
ESTONIA:
AIR FORCE:
AMARI AIR BASE:
POL CAPACITY PHASE II................................... 4,700 4,700 ..............
TACTICAL FIGHTER AIRCRAFT PARKING APRON................. 9,200 9,200 ..............
HUNGARY
AIR FORCE:
KECSKEMET AIR BASE:
AIRFIELD UPGRADES....................................... 12,900 12,900 ..............
CONSTRUCT PARALLEL TAXIWAY.............................. 30,000 30,000 ..............
INCREASE POL STORAGE CAPACITY........................... 12,500 12,500 ..............
ICELAND
AIR FORCE:
KEFLAVIK:
AIRFIELD UPGRADES....................................... 14,400 14,400 ..............
LATVIA
AIR FORCE:
LIELVARDE AIR BASE:
EXPAND STRATEGIC RAMP PARKING........................... 3,850 3,850 ..............
LUXEMBOURG
AIR FORCE:
SANEM:
ECAOS DEPLOYABLE AIRBASE SYSTEM STORAGE................. 67,400 67,400 ..............
NORWAY
AIR FORCE:
RYGGE:
REPLACE/EXPAND QUICK REACTION ALERT PAD................. 10,300 10,300 ..............
ROMANIA
AIR FORCE:
CAMP TURZII:
UPGRADE UTILITIES INFRASTRUCTURE........................ 2,950 2,950 ..............
SLOVAKIA
AIR FORCE:
MALACKY:
AIRFIELD UPGRADES....................................... 4,000 4,000 ..............
INCREASE POL STORAGE CAPACITY........................... 20,000 20,000 ..............
SLIAC AIRPORT:
AIRFIELD UPGRADES....................................... 22,000 22,000 ..............
WORLDWIDE UNSPECIFIED
ARMY:
PLANNING AND DESIGN......................................... 15,700 15,700 ..............
NAVY:
PLANNING AND DESIGN......................................... 18,500 18,500 ..............
AIR FORCE:
PLANNING AND DESIGN......................................... 56,630 56,630 ..............
DEFENSE-WIDE:
SOCOM:
PLANNING AND DESIGN..................................... 1,900 1,900 ..............
-----------------------------------------------
TOTAL, EUROPEAN REASSURANCE INITIATIVE.................... 306,930 306,930 ..............
ARMY.................................................. (15,700) (15,700) ..............
NAVY AND MARINE CORPS................................. (18,500) (18,500) ..............
AIR FORCE............................................. (270,830) (270,830) ..............
DEFENSE-WIDE.......................................... (1,900) (1,900) ..............
===============================================
TOTAL, FY2018 OVERSEAS CONTINGENCY OPERATIONS............. 638,130 638,130 ..............
----------------------------------------------------------------------------------------------------------------
COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL FOR FISCAL
YEAR 2018
[In thousands of dollars]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Senate Committee recommendation
compared with (+ or -)
Item 2017 Budget estimate Committee ---------------------------------
appropriation recommendation 2017
appropriation Budget estimate
--------------------------------------------------------------------------------------------------------------------------------------------------------
TITLE I--DEPARTMENT OF DEFENSE
Military Construction, Army........................................ 513,459 920,394 930,394 +416,935 +10,000
Military Construction, Navy and Marine Corps....................... 1,021,580 1,616,665 1,565,665 +544,085 -51,000
Military Construction, Air Force................................... 1,491,058 1,738,796 1,569,296 +78,238 -169,500
Military Construction, Defense-Wide................................ 2,025,444 3,114,913 2,612,583 +587,139 -502,330
------------------------------------------------------------------------------------
Subtotal..................................................... 5,051,541 7,390,768 6,677,938 +1,626,397 -712,830
Military Construction, Army National Guard......................... 232,930 210,652 210,652 -22,278 ...............
Military Construction, Air National Guard.......................... 143,957 161,491 161,491 +17,534 ...............
Military Construction, Army Reserve................................ 68,230 73,712 73,712 +5,482 ...............
Military Construction, Navy Reserve................................ 38,597 65,271 65,271 +26,674 ...............
Military Construction, Air Force Reserve........................... 188,950 63,535 63,535 -125,415 ...............
------------------------------------------------------------------------------------
Subtotal,.................................................... 672,664 574,661 574,661 -98,003 ...............
North Atlantic Treaty Organization Security Investment Program..... 177,932 154,000 154,000 -23,932 ...............
Department of Defense Base Closure Account..................... 240,237 255,867 255,867 +15,630 ...............
------------------------------------------------------------------------------------
Total, Military Construction................................. 6,142,374 8,375,296 7,662,466 +1,520,092 -712,830
====================================================================================
Family Housing Operation and Maintenance, Army................. 325,995 346,625 348,907 +22,912 +2,282
Family Housing Operation and Maintenance, Navy and Marine Corps 300,915 328,282 328,282 +27,367 ...............
Family Housing Operation and Maintenance, Air Force............ 274,429 318,324 318,324 +43,895 ...............
Family Housing Operation and Maintenance, Defense-Wide......... 59,157 59,169 59,169 +12 ...............
------------------------------------------------------------------------------------
Subtotal..................................................... 960,496 1,052,400 1,054,682 +94,186 +2,282
Family Housing Construction, Army.................................. 157,172 182,662 182,662 +25,490 ...............
Family Housing Construction, Navy and Marine Corps................. 94,011 83,682 83,682 -10,329 ...............
Family Housing Construction, Air Force............................. 61,352 85,062 85,062 +23,710 ...............
------------------------------------------------------------------------------------
Subtotal..................................................... 312,535 351,406 351,406 +38,871 ...............
DoD Family Housing Improvement Fund................................ 3,258 2,726 2,726 -532 ...............
DoD Military Unaccompanied Housing Improvement Fund................ ............... 623 623 +623 ...............
------------------------------------------------------------------------------------
Total, Family Housing........................................ 1,276,289 1,407,155 1,409,437 +133,148 +2,282
====================================================================================
ADMINISTRATIVE PROVISIONS
Military Construction, Army (Sec. 126) (rescission)................ -29,602 ............... ............... +29,602 ...............
Military Construction, Navy and Marine Corps (H. Sec. 126) ............... ............... ............... ............... ...............
(rescission)......................................................
Military Construction, Air Force (Sec. 127) (rescission)........... -51,460 ............... ............... +51,460 ...............
Military Construction, Defense-Wide--Planning and Design (Sec. 127) -30,000 ............... ............... +30,000 ...............
Military Construction, Army (Sec. 125)............................. 40,500 ............... 68,800 +28,300 +68,800
Military Construction, Navy and Marine Corps (Sec. 125)............ 227,099 ............... 110,100 -116,999 +110,100
Military Construction, Air Force (Sec. 125)........................ 149,500 ............... 127,300 -22,200 +127,300
Military Construction, Army National Guard (Sec. 125).............. 67,500 ............... 83,500 +16,000 +83,500
Military Construction, Air National Guard (Sec. 125)............... 11,000 ............... 24,000 +13,000 +24,000
Military Construction, Army Reserve (Sec. 125)..................... 30,000 ............... 30,000 ............... +30,000
Military Construction, Air Force Reserve (Sec. 125)................ ............... ............... 35,100 +35,100 +35,100
NATO Security Investment Program (Sec. 127) (rescission)........... -30,000 ............... ............... +30,000 ...............
42 USC 3374 (Sec. 128)............................................. -25,000 ............... ............... +25,000 ...............
Military Construction, Navy and Marine Corps (Sec. 126)............ 89,400 ............... ............... -89,400 ...............
Military Construction, Defense-Wide (Sec. 126) (rescission)........ -141,600 ............... -14,703 +126,897 -14,703
NATO Security Investment Program (Sec. 126)........................ ............... ............... ............... ............... ...............
Family Housing Construction, Army (Sec. 126)....................... ............... ............... ............... ............... ...............
Family Housing Construction, Navy and Marine Corps (Sec. 126)...... ............... ............... ............... ............... ...............
Family Housing Construction, Air Force (Sec. 126).................. ............... ............... ............... ............... ...............
------------------------------------------------------------------------------------
Total, Administrative Provisions............................. 307,337 ............... 464,097 +156,760 +464,097
Appropriations............................................. (614,999) ............... (478,800) (-136,199) (+478,800)
Rescissions................................................ (-307,662) ............... (-14,703) (+292,959) (-14,703)
====================================================================================
Total, title I, Department of Defense........................ 7,726,000 9,782,451 9,536,000 +1,810,000 -246,451
Appropriations............................................. (8,033,662) (9,782,451) (9,550,703) (+1,517,041) (-231,748)
Rescissions................................................ (-307,662) ............... (-14,703) (+292,959) (-14,703)
====================================================================================
TITLE II--DEPARTMENT OF VETERANS AFFAIRS
Veterans Benefits Administration
Compensation and pensions:
Advance from prior year........................................ (86,083,128) (90,119,449) (90,119,449) (+4,036,321) ...............
------------------------------------------------------------------------------------
Subtotal, current year................................... 86,083,128 90,119,449 90,119,449 +4,036,321 ...............
Advance appropriation, fiscal year 2019........................ 90,119,449 95,768,462 95,769,000 +5,649,551 +538
Readjustment benefits:
Advance from prior year........................................ (16,340,828) (13,708,648) (13,708,648) (-2,632,180) ...............
------------------------------------------------------------------------------------
Subtotal................................................. 16,340,828 13,708,648 13,708,648 -2,632,180 ...............
Advance appropriation, fiscal year 2019........................ 13,708,648 11,832,175 11,832,000 -1,876,648 -175
Veterans insurance and indemnities:
Advance from prior year........................................ (91,920) (107,899) (107,899) (+15,979) ...............
Current year request........................................... 16,605 12,439 13,000 -3,605 +561
------------------------------------------------------------------------------------
Subtotal..................................................... 108,525 120,338 120,899 +12,374 +561
Advance appropriation, fiscal year 2019........................ 107,899 109,090 109,000 +1,101 -90
Veterans housing benefit program fund:
(Limitation on direct loans)................................... (500) (500) (500) ............... ...............
Administrative expenses........................................ 198,856 178,626 178,626 -20,230 ...............
Vocational rehabilitation loans program account.................... 36 30 30 -6 ...............
(Limitation on direct loans)............................... (2,517) (2,356) (2,356) (-161) ...............
Administrative expenses.................................... 389 395 395 +6 ...............
Native American veteran housing loan program account....... 1,163 1,163 1,163 ............... ...............
General operating expenses, VBA............................ 2,856,160 2,844,000 2,910,000 +53,840 +66,000
====================================================================================
Total, Veterans Benefits Administration...................... 107,009,205 110,746,380 110,813,214 +3,804,009 +66,834
Appropriations............................................. (3,073,209) (3,036,653) (3,103,214) (+30,005) (+66,561)
Advance appropriations, fiscal year 2019................... (103,935,996) (107,709,727) (107,710,000) (+3,774,004) (+273)
Advances from prior year appropriations.................... (102,515,876) (103,935,996) (103,935,996) (+1,420,120) ...............
====================================================================================
Veterans Health Administration
Medical services:
Advance from prior year........................................ (51,673,000) (44,886,554) (44,886,554) (-6,786,446) ...............
Current year request........................................... 1,078,993 1,031,808 1,923,000 +844,007 +891,192
Supplemental funding for opioid abuse prevention (Public Law 50,000 ............... ............... -50,000 ...............
115-31)\1\....................................................
Medical Services (Sec. 217) (rescission)................... -7,246,181 ............... ............... +7,246,181 ...............
------------------------------------------------------------------------------------
Subtotal..................................................... 45,555,812 45,918,362 46,809,554 +1,253,742 +891,192
Advance appropriation, fiscal year 2019........................ 44,886,554 49,161,165 49,161,000 +4,274,446 -165
Medical community care:
Advance from prior year........................................ ............... (9,409,118) (9,409,118) (+9,409,118) ...............
Current year request........................................... 7,246,181 254,000 254,000 -6,992,181 ...............
------------------------------------------------------------------------------------
Subtotal..................................................... 7,246,181 9,663,118 9,663,118 +2,416,937 ...............
Advance appropriation, fiscal year 2019........................ 9,409,118 8,384,704 8,385,000 -1,024,118 +296
Medical support and compliance:
Advance from prior year........................................ (6,524,000) (6,654,480) (6,654,480) (+130,480) ...............
Current year request........................................... ............... 284,397 100,000 +100,000 -184,397
------------------------------------------------------------------------------------
Subtotal..................................................... 6,524,000 6,938,877 6,754,480 +230,480 -184,397
Advance appropriation, fiscal year 2019........................ 6,654,480 7,239,156 7,239,000 +584,520 -156
Medical facilities:
Advance from prior year........................................ (5,074,000) (5,434,880) (5,434,880) (+360,880) ...............
Current year request........................................... 247,668 1,079,795 707,000 +459,332 -372,795
------------------------------------------------------------------------------------
Subtotal..................................................... 5,321,668 6,514,675 6,141,880 +820,212 -372,795
Advance appropriation, fiscal year 2019........................ 5,434,880 5,914,288 5,915,000 +480,120 +712
Medical and prosthetic research.................................... 675,366 640,000 722,262 +46,896 +82,262
Medical care cost recovery collections:
Offsetting collections......................................... -2,637,000 -2,507,000 -2,507,000 +130,000 ...............
Appropriations (indefinite).................................... 2,637,000 2,507,000 2,507,000 -130,000 ...............
------------------------------------------------------------------------------------
Subtotal..................................................... ............... ............... ............... ............... ...............
DoD-VA Joint Medical Funds (transfer out).......................... (-274,731) (-297,137) (-297,137) (-22,406) ...............
DoD-VA Joint Medical Funds (by transfer)........................... (274,731) (297,137) (297,137) (+22,406) ...............
DoD-VA Health Care Sharing Incentive Fund (Transfer out) (-15,000) (-15,000) (-15,000) ............... ...............
DoD-VA Health Care Sharing Incentive Fund (by transfer) (15,000) (15,000) (15,000) ............... ...............
====================================================================================
Total, Veterans Health Administration........................ 68,437,059 73,989,313 74,406,262 +5,969,203 +416,949
Appropriations........................................... (2,052,027) (3,290,000) (3,706,262) (+1,654,235) (+416,262)
Rescissions.............................................. ............... ............... ............... ............... ...............
(By transfer)............................................ (289,731) (312,137) (312,137) (+22,406) ...............
Advance appropriations, fiscal year 2019................. (66,385,032) (70,699,313) (70,700,000) (+4,314,968) (+687)
Advances from prior year appropriations...................... (63,271,000) (66,385,032) (66,385,032) (+3,114,032) ...............
====================================================================================
National Cemetery Administration
National Cemetery Administration................................... 286,193 306,193 306,193 +20,000 ...............
Departmental Administration
General administration............................................. 345,391 346,891 329,891 -15,500 -17,000
Board of Veterans Appeals.......................................... 156,096 155,596 166,000 +9,904 +10,404
Information technology systems..................................... 4,278,259 4,055,500 4,055,500 -222,759 ...............
Office of Inspector General........................................ 160,106 159,606 164,000 +3,894 +4,394
Construction, major projects....................................... 528,110 512,430 512,430 -15,680 ...............
Construction, minor projects....................................... 372,069 342,570 342,570 -29,499 ...............
Grants for construction of State extended care facilities.......... 90,000 90,000 110,000 +20,000 +20,000
Grants for the construction of veterans cemeteries................. 45,000 45,000 45,000 ............... ...............
------------------------------------------------------------------------------------
Total, Departmental Administration........................... 5,975,031 5,707,593 5,725,391 -249,640 +17,798
====================================================================================
Administrative Provisions
JIF rescission (Sec. 235).......................................... -40,000 ............... -15,000 +25,000 -15,000
General rescission (Sec. 233)...................................... -169,000 ............... ............... +169,000 ...............
General reduction (Sec. 234)....................................... -23,000 ............... ............... +23,000 ...............
Proposed mandatory disability exams language....................... ............... 40,000 ............... ............... -40,000
Medical services (Sec. 217) (rescission)........................... ............... ............... -751,000 -751,000 -751,000
Information technology services (Sec. 250) (rescission) ............... ............... -30,000 -30,000 -30,000
Construction, major projects:
Sec. 243(a) rescission (emergency)............................. ............... ............... ............... ............... ...............
Sec. 243(b) reappropriation (emergency)........................ ............... ............... ............... ............... ...............
Sec. 244(a) rescission......................................... ............... ............... -10,000 -10,000 -10,000
Sec. 244(b) reappropriation.................................... ............... ............... 10,000 +10,000 +10,000
Sec. 244(c) rescission......................................... ............... ............... -410,000 -410,000 -410,000
Sec. 244(d) reappropriation.................................... ............... ............... 410,000 +410,000 +410,000
------------------------------------------------------------------------------------
Total. Administrative Provisions............................. -232,000 40,000 -796,000 -564,000 -836,000
====================================================================================
Total, title II.............................................. 181,475,488 190,789,479 190,455,060 +8,979,572 -334,419
Appropriations........................................... (11,363,460) (12,380,439) (12,841,060) (+1,477,600) (+460,621)
Reappropriations......................................... ............... ............... (420,000) (+420,000) (+420,000)
Reappropriations (emergency)............................. ............... ............... ............... ............... ...............
Rescissions.............................................. (-209,000) ............... (-1,216,000) (-1,007,000) (-1,216,000)
Rescissions (emergency).................................. ............... ............... ............... ............... ...............
(By transfer)............................................ (289,731) (312,137) (312,137) (+22,406) ...............
Advance Appropriations, fiscal year 2019:
(Limitation on direct loans)................................... (3,017) (2,856) (2,856) (-161) ...............
Advances from prior year less fiscal year 2019 advances.... ............... ............... ............... ............... ...............
Advances from prior year less fiscal year 2019 advances.... ............... ............... ............... ............... ...............
TITLE III--RELATED AGENCIES
American Battle Monuments Commission
Salaries and expenses.............................................. 75,100 75,100 79,000 +3,900 +3,900
Foreign currency fluctuations account.............................. ............... ............... ............... ............... ...............
------------------------------------------------------------------------------------
Total, American Battle Monuments Commission.................. 75,100 75,100 79,000 +3,900 +3,900
====================================================================================
U.S. Court of Appeals for Veterans Claims
Salaries and expenses.............................................. 30,945 33,608 33,608 +2,663 ...............
Department of Defense--Civil
Cemeterial Expenses, Army
Salaries and expenses.............................................. 70,800 70,800 81,000 +10,200 +10,200
Armed Forces Retirement Home--Trust Fund
Operation and maintenance.......................................... 41,300 41,300 41,300 ............... ...............
Capital program.................................................... 1,000 1,000 1,000 ............... ...............
Payment from General Fund.......................................... 22,000 22,000 22,000 ............... ...............
------------------------------------------------------------------------------------
Total, Armed Forces Retirement Home.......................... 64,300 64,300 64,300 ............... ...............
====================================================================================
Total, title III............................................. 241,145 243,808 257,908 +16,763 +14,100
====================================================================================
TITLE IV--OVERSEAS CONTINGENCY OPERATIONS
Overseas Contingency Operations
Army............................................................... ............... 124,000 124,000 +124,000 ...............
Additional funding for planning and design (Public Law 115-31). 39,500 ............... ............... -39,500 ...............
Navy....................................................... 38,409 ............... ............... -38,409 ...............
Additional funding for construction (Public Law 115-31)........ 66,708 ............... ............... -66,708 ...............
------------------------------------------------------------------------------------
Subtotal..................................................... 105,117 ............... ............... -105,117 ...............
Air Force.......................................................... 11,440 207,200 207,200 +195,760 ...............
Additional funding for construction (Public Law 115-31)........ 93,000 ............... ............... -93,000 ...............
------------------------------------------------------------------------------------
Subtotal..................................................... 104,440 207,200 207,200 +102,760 ...............
Defense-Wide....................................................... ............... ............... ............... ............... ...............
Army National Guard:
Additional funding for planning and design (Public Law 115-31). 12,000 ............... ............... -12,000 ...............
Air National Guard:
Additional funding for construction (Public Law 115-31)........ 13,000 ............... ............... -13,000 ...............
Army Reserve:
Additional funding for planning and design (Public Law 115-31). 10,000 ............... ............... -10,000 ...............
Navy Reserve:
Additional funding for construction (Public Law 115-31)........ 4,525 ............... ............... -4,525 ...............
Air Force Reserve:
Additional funding for planning and design (Public Law 115-31). 9,000 ............... ............... -9,000 ...............
------------------------------------------------------------------------------------
Subtotal................................................. 297,582 331,200 331,200 +33,618 ...............
European Reassurance Initiative
Army............................................................... 18,900 15,700 15,700 -3,200 ...............
Navy............................................................... 21,400 18,500 18,500 -2,900 ...............
Air Force.......................................................... 68,280 270,830 270,830 +202,550 ...............
Additional funding for planning and design (Public Law 115-31). 12,300 ............... ............... -12,300 ...............
------------------------------------------------------------------------------------
Subtotal..................................................... 80,580 270,830 270,830 +190,250 ...............
Defense-Wide....................................................... 5,000 1,900 1,900 -3,100 ...............
Administrative Provision
Military Construction, Air Force (Sec. 101, Public Law 115-31) -12,300 ............... ............... +12,300 ...............
(rescission)......................................................
------------------------------------------------------------------------------------
Subtotal..................................................... 113,580 306,930 306,930 +193,350 ...............
Counterterrorism Support
Air Force.......................................................... 8,571 ............... ............... -8,571 ...............
====================================================================================
Total, title IV.............................................. 419,733 638,130 638,130 +218,397 ...............
====================================================================================
Grand total.................................................. 189,862,366 201,453,868 200,887,098 +11,024,732 -566,770
Appropriations........................................... (19,638,267) (22,406,698) (22,649,671) (+3,011,404) (+242,973)
Reappropriations......................................... ............... ............... (420,000) (+420,000) (+420,000)
Reappropriations (emergency)............................. ............... ............... ............... ............... ...............
Rescissions.............................................. (-516,662) ............... (-1,230,703) (-714,041) (-1,230,703)
Rescission of OCO........................................ (-12,300) ............... ............... (+12,300) ...............
Rescissions (emergency).................................. ............... ............... ............... ............... ...............
Advance appropriations, fiscal year 2019................. (170,321,028) (178,409,040) (178,410,000) (+8,088,972) (+960)
Overseas contingency operations.......................... (432,033) (638,130) (638,130) (+206,097) ...............
Advances from prior year appropriations...................... (165,786,876) (170,321,028) (170,321,028) (+4,534,152) ...............
(By transfer)................................................ (289,731) (312,137) (312,137) (+22,406) ...............
(Transfer out)............................................... (-289,731) (-312,137) (-312,137) (-22,406) ...............
(Limitation on direct loans)................................. (3,017) (2,856) (2,856) (-161) ...............
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\Funding for opioid abuse prevention was included in the fiscal year 2017 supplemental. In fiscal year 2018, it is provided within the amount
recommended by the Committee.
[all]