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107th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 107-473
======================================================================
VETERANS' MAJOR MEDICAL FACILITIES CONSTRUCTION ACT OF 2002
_______
May 16, 2002.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Smith of New Jersey, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 4514]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred the
bill (H.R. 4514) to authorize the Secretary of Veterans Affairs
to carry out construction projects for the purpose of
improving, renovating, and updating patient care facilities at
Department of Veterans Affairs medical centers, and for other
purposes, having considered the same, reports favorably thereon
with amendments and recommends that the bill as amended do
pass.
The amendments (stated in terms of the page and line numbers
of the introduced bill) are as follows:
Page 3, after line 9, insert the following new section (and
redesignate the succeeding sections accordingly):
SEC. 3. AUTHORIZATION OF A MAJOR MEDICAL FACILITY LEASE.
The Secretary of Veterans Affairs may enter into a lease for
a Satellite Outpatient Clinic, Charlotte, North Carolina, in an
amount not to exceed $2,626,000.
Page 3, strike lines 10 through 14 and insert the following:
SEC. 4. AUTHORIZATION OF APPROPRIATIONS.
(a) In General.--There is authorized to be appropriated to
the Secretary of Veterans Affairs for fiscal year 2003--
(1) for the Construction, Major Projects, account
$285,000,000 for the projects authorized in section 2;
and
(2) for the Medical Care account, $2,626,000 for the
lease authorized in section 3.
Page 4, strike lines 6 through 14 and insert the following:
(b) Applicability to Projects Already Funded.--The amendment
made by subsection (a) shall apply with respect to any facility
project of the Department of Veterans Affairs, except for a
project for which the Secretary obligated funds before October
1, 2002.
Page 4, line 23, strike ``shall'' and insert ``shall, to the
extent practicable,''.
Introduction
The Committee in hearings, meetings, and through other
oversight mechanisms reviewed over the course of this session
of the 107th Congress the need to construct, renovate, and
improve major medical facilities of the Department of Veterans
Affairs.
On April 24, 2002, the Subcommittee on Health received
testimony on H.R. 4514, Veterans' Major Medical Facilities
Construction Act of 2002, and issues related to the
Department's major medical facilities construction policies and
planning. Those testifying at that hearing were: Mr. D. Mark
Catlett, Principal Deputy Assistant Secretary for Management,
Department of Veterans Affairs (VA); accompanied by Mr. Robert
L. Neary, Associate Chief Facilities Management Officer, Mr.
Gary Rossio, Chief Executive Officer VA San Diego Health Care
System, and Mr. Alex Spector, Director Alaska VA Health Care
System and Regional Office; Colonel David D. Gilbreath,
Commander, Elmendorf Air Force Base Hospital; Mr. Antonio
Laracuente, Chairman, National Association of Veterans'
Research and Education Foundations, on behalf of Friends of VA
Medical Care and Health Research (FOVA); and Dr. Donald E.
Wilson, Vice President for Medical Affairs and Dean, University
of Maryland School of Medicine. The Subcommittee also received
testimony from: Mr. Brian E. Lawrence, Associate National
Legislative Director, Disabled American Veterans; Mr. Robert L.
Jones, Executive Director, AMVETS; Mr. Thomas H. Corey,
National President, Vietnam Veterans of America; Mr. Paul A.
Hayden, Associate Director, National Legislative Service,
Veterans of Foreign Wars of the United States; Mr. Delatorro L.
McNeal, Executive Director, Paralyzed Veterans of America; and
Mr. James R. Fischl, Director, National Veterans Affairs and
Rehabilitation Commission, The American Legion.
The Subcommittee on Health met on May 1, 2002 to mark up
H.R. 4514, Veterans' Major Medical Facilities Construction Act
Of 2002. The bill was endorsed unanimously by the Subcommittee,
as amended, and ordered reported favorably to the full
Committee.
On May 9, 2002, the full Committee met and ordered H.R.
4514, as amended, reported favorably to the House by unanimous
voice vote.
Summary of the Reported Bill
H.R. 4514, as amended, would:
Authorize the Secretary of Veterans Affairs to
carry out ten major medical facility construction projects, the
cost of which may not exceed the amount specified for each
project, as follows:
Seismic corrections on Building No. 2
at the VA Medical Center in Palo Alto, California, in
the amount of $14,020,000;
Seismic corrections on Building No. 4
at the VA Medical Center in Palo Alto, California, in
the amount of $21,750,000;
Seismic corrections at the VA Medical
Center in San Francisco, California, in the amount of
$31,000,000;
Seismic corrections at the VA Medical
Center in West Los Angeles, California, in the amount
of $27,200,000;
Seismic corrections and clinical
improvements at the VA Medical Center in Long Beach,
California, in the amount of $24,600,000;
Seismic corrections on Building No. 1
at the VA Medical Center in San Diego, California, in
the amount of $47,100,000;
Construction involving the
consolidation of the Ambulatory Surgery and Clinical
Care facilities at the VA Medical Center in Cleveland,
Ohio, in the amount of $32,500,000;
Construction involving the
consolidation of VA and DoD health and benefits offices
in Anchorage, Alaska, in the amount of $59,000,000;
Construction involving the renovation
of certain wards at the VA Medical Center in West
Haven, Connecticut, in the amount of $15,300,000; and,
Construction involving the expansion of
the Ambulatory Care facility at the VA Medical Center
in Tampa, Florida, in the amount of $18,230,000.
Authorize $285 million in appropriations to carry
out the ten projects.
Increase the threshold for major medical facility
construction projects from $4 million to $6 million.
Establish criteria for minor construction
projects.
Authorize a lease for a satellite outpatient
clinic in Charlotte, North Carolina, in the amount of
$2,626,000, to be paid from the medical care account.
Background and Discussion
The reported bill would authorize the Secretary of Veterans
Affairs to initiate ten major medical facility construction
projects in fiscal year 2003. These projects would improve,
renovate, and update patient care facilities at VA Medical
Centers (VAMC). These particular projects were chosen from the
Secretary's top twenty major medical facility construction
projects submitted to Congress on February 13, 2002, in
accordance with requirements for such reporting under section
8107(d)(1) of title 38, United States Code.
In the First Session of the 107th Congress, the Honorable
Christopher H. Smith, introduced H.R. 811, the Veterans
Hospital Emergency Repair Act, with other Members.
Unfortunately, the Senate did not address this measure. As a
consequence, capital facilities maintenance and repair have not
kept pace with known needs in the Department, and many
facilities are deteriorating.
Veterans enrolled in VA health care--who are dependent on
the capital assets of the system to provide their care--deserve
medical facilities that provide quality services and improve
access to their health care. In addition, VA medical centers
should be safe. The reported bill would help improve the safety
of veterans who are provided medical care in VA health care as
well as for the VA staff who provide that care.
The total amount authorized for ten projects is $285
million.
The bill particularly would address seismic risks at a
number of VA facilities. Those facilities receiving seismic
upgrades and corrections or seismic bracing and anchorage of
non-structural items throughout the centers would include VA
medical facilities in Palo Alto, San Francisco, West Los
Angeles, Long Beach, and San Diego, California. Completion of
these engineered upgrades would bring each facility into
conformance with current VA seismic standards, and would
eliminate significant risks to safety.
Another important project would authorize VA to replace the
mechanical and electrical systems at the VA Medical Center in
Cleveland, Ohio. They were installed in 1961 and are in dire
need of attention.
The Anchorage, Alaska project would construct a
consolidated Veterans Affairs-Department of Defense health care
and benefits facility, to help address growing workload and
demands, provide space for additional personnel, and confirm
the Committee's strong interest in encouraging the two
departments to better share health care resources under the
Department of Veterans Affairs and Department of Defense Health
Resources Sharing and Emergency Operations Act of 1982. The
Anchorage VA-Air Force project is an important step in
promoting such coordination between these departments.
A number of important improvements would be made at the VA
Medical Center in West Haven, Connecticut, if this bill is
enacted. These essential renovations to inpatient wards would
correct patient privacy inadequacies; consolidate support
services; correct deficiencies in air quality, comply with
Americans with Disabilities Act (ADA) accessibility, and
improve the general safety of patients and staff.
The construction project for the VA medical facility in
Tampa, Florida would relocate three Spinal Cord Injury (SCI)
inpatient wards and ancillary support functions to the new SCI
building dedicated in February 2002. The completion of this
project would allow more space for further expansion of the
VAMC.
The reported bill would provide the Secretary authority to
move forward on VA's highest construction priorities without
further, unacceptable delays. The Department has indicated its
intention to rely on the ``Capital Assets Realignment for
Enhanced Services,'' or ``CARES'' system to determine whether
its capital projects in medical facilities are funded. By doing
so, the Department continues to delay funding projects that
meet crucial and in some cases, emergent, needs. In its report
to Congress under title 38, section 8107, the Department of
Veterans Affairs states that the following projects represent
its highest major medical facility priorities, yet only four of
them were included in the President's fiscal year 2003 budget
request. The Committee agrees that these four are high
priorities, but the reported bill would authorize an additional
six projects that the Committee concludes also warrant funding
on a high priority basis, without further delay. The synopsis
of VA's top twenty projects is as follows, in order of priority
presented by the Secretary in his report to Congress:
1. Palo Alto, CA: This project would renovate
Building 2, a two-story inpatient building constructed
in 1960, at the Palo Alto Division. Renovations would
include seismic corrections to the entire building,
correction of patient privacy deficiencies on one
nursing unit in C Wing, correction of fire safety
deficiencies in C Wing, and functional improvements on
one floor for the Sierra Pacific Network's Mental
Illness Research, Education and Clinical Center
(MIRECC). Building 2 would provide consolidated acute
inpatient psychiatry services at the Palo Alto
Division. These services are currently located in
several buildings on campus. Completion of this project
would allow occupancy of the building by three 26-bed
psychiatric nursing units as well as the MIRECC offices
and dry labs.
2. Cleveland, OH: This project would renovate vacated
space on the second floor and basement for the
relocation of the medical laboratory of the Wade Park
Division, Veterans Integrated Service Network (VISN)
10. The second floor space planned for renovation is
adjacent to the existing operating suites and recovery
areas. This project would include the replacement of
all mechanical, electrical, and architectural systems
installed in this 1961 facility.
3. San Francisco, CA: This project would seismically
upgrade the main inpatient Building 203 at the San
Francisco VA Medical Center, and bring the facility
into conformance with current VA seismic standards. In
order to meet current VA seismic design standards for
life safety, this project would seismically retrofit
Building 203, a five-story concrete structure, by
strengthening existing lateral force resisting
elements, adding supplemental members and non-
structural systems, and bracing equipment. Minor
functional improvements for patient privacy, disability
access, and building efficiency would be included.
4. Anchorage, AK: The project would construct a new
facility next to the Joint Venture Medical Treatment
Facility on Elmendorf Air Force Base (AFB), Alaska. The
new facility would address the Alaska Veterans Affairs
Healthcare System and Regional Office increasing
workload demands and provide space for the projected
Veterans Health Administration (VHA)/Veterans Benefits
Administration (VBA) 500+ peak housed personnel
required to meet the station's workload demands of the
future.
5. West Los Angeles, CA: The seismic upgrade of
Building 500 would strengthen 16 of the 64 braced
frames below the second floor, strengthen collector
plate connections to the braced frames, and add new
collector plates to transfer loads in the central core
area to the braced frames located at the wings. Seismic
bracing and anchorage of non-structural items
throughout the hospital would also be included.
6. West Haven, CT: This project would substantially
renovate three inpatient wards to correct for patient
privacy inadequacies as well as consolidate associated
support services. It would correct deficiencies such as
ADA accessibility, general safety, air quality, and
patient privacy. Correcting the deficiencies on these
units would result in improved patient privacy, staff
morale, and health care delivery efficiencies. This
project would involve renovating 3 wards in Building 1:
two inpatient Medical, Surgical and Neurological as
[KHC1]well as one psychiatric unit.
7. Long Beach, CA: Building 7 of the VA Long Beach
Medical Center would be seismically upgraded and
retrofitted. The project would provide an addition of
24,000 gross square feet. The project would allow for
the consolidation of specialty clinics, improve work
processes, and maximize efficiency.
8. Palo Alto, CA: This project would renovate
Building 4, a three-story research building constructed
in 1960, at the Palo Alto Division. Renovations would
include seismic corrections to the entire building,
correction of fire safety deficiencies throughout the
building, and functional laboratory improvements in
areas formerly occupied by inpatient psychiatric wards.
Building 205, Menlo Park campus, would be demolished.
Most research personnel, housed in Building 205, would
be relocated to Building 4. This includes members of
the Geriatric Research and Education and Clinical
Center (GRECC), Health Services Research and
Development (HSR&D;), and the Cooperative Studies
program. Completion of this project would allow
consolidation of a large segment of wet and dry lab
research programs. Building 4 would provide for
consolidated research services at the Palo Alto
Division. It would allow the consolidation of the Menlo
Park Division research programs from Building 205 into
a two or three major building complex at the Palo Alto
campus.
9. Tampa, FL: The project is an offshoot of the
``Spinal Cord Injury/Rehab Center, Phase 2'' which
would relocate three Spinal Cord Injury (SCI) inpatient
wards and ancillary support functions to a new SCI
building. As a result of the relocation, space would be
vacated in the main hospital. This space needs
renovation for expansion and improvement of the
outpatient care facility. The Capital Investment Panel
[KHC2]relates to the renovation in the three vacated
inpatient wards in the main hospital and would involve
asbestos abatement of the space involved. The renovated
space would house the hospital functions now
temporarily located in several modular buildings
adversely affecting smooth workflow and also taking up
needed space for parking.
10. VISN 4: This multi-facility project would
renovate and expand outpatient clinics at seven
different medical centers located in VISN 4. The needed
renovations and expansions would address the
insufficient space and accommodations that negatively
impact outpatient care delivery at seven VAMCs. Six of
the eight projects would renovate and expand primary
and specialty care clinic areas. The other two projects
would expand outpatient ambulatory surgery and
outpatient day programs. Together, the projects would
renovate and expand exam, treatment and operating
rooms; staff support areas; waiting, staff and patient
education areas; and office space, including travel
coordinator, information center and volunteer offices.
Hazardous materials, such as asbestos, that are not
already abated or whose containment would be disrupted
as a result of construction would be removed according
to regulations. Windows would be replaced, and
outdated, inadequate and unacceptable heating,
ventilating, and air-conditioning (HVAC) units and
utilities, such as mechanical, plumbing and
communications, would be upgraded and constructed to be
compatible with existing VAMC systems.
11. Beckley, WV: This project would consist of design
and construction of a 120-bed nursing home care unit at
the VAMC Beckley, West Virginia.
12. Lebanon, PA: The Lebanon VAMC is a 31-building
campus on 215 acres that serves south central
Pennsylvania. This project would reconfigure two floors
located in Building 2 at the VAMC. Building 2 is
currently unfit to house inpatients. The project would
be limited to renovations within the confines of two
floors of the building. The renovated space would
include the following units: the Dementia Unit (floor
2), the Hospice Unit (floor 1), and the Adult Day
Health Care Unit (floor 1). In addition, utilities
would be upgraded or added as required to support the
new areas. Further, a new elevator shaft and entrance
would be built to meet the needs of the patients.
13. San Diego, CA: This project would seismically
strengthen the 854,000 square foot Medical Center
(Building 1) by adding two new exterior unbonded braced
frames at the end of each building wing, replacing the
braces in all of the existing braced frames with new
unbonded braces, and adding new collector elements.
This seismic upgrade would correct significant risks to
life safety.
14. Hines, IL: Blind rehabilitation center
(authorized and appropriated in fiscal year 2002).
15. San Juan, PR: This project is needed so that the
medical center can sustain its daily operations after a
seismic event. It would also complete essential items
that were not completed in the Seismic Corrections
Project due to dollar limitations. Additionally, three
areas on the existing basement, first and second floors
would have the air conditioning repaired and overhauled
in conjunction with asbestos abatement.
16. VISN 6: This multi-facility, VISN-wide project
would renovate five VAMCs' Mental Health (MH) and
Spinal Cord Injury/Dysfunction (SCI/D) Units. The
needed renovations would occur only in special emphasis
bed units. The project (with the exception of VAMC
Richmond) would completely replace each special
emphasis ward. Hazardous materials not already abated
or whose containment would be disrupted would be
removed. Windows would be replaced. Inadequate HVAC and
utilities would be upgraded. Floor/room layouts would
be changed to provide private and semi-private bedrooms
with adjacent private or semi-private toileting/bathing
facilities. VAMC Richmond's Special Emphasis wards
require handrails and handicap-designed door handles;
some floor layout problems would also be addressed.
17. VISN 4: This multi-facility, VISN-wide project
would renovate and upgrade seven major VA medical
centers. These renovations would be made for patient
safety and patient/employee welfare. This project would
focus on critical major infrastructure needs in VISN 4,
which encompasses Delaware, Pennsylvania, and parts of
Ohio, West Virginia, New York, and New Jersey. The VISN
4 medical facilities that would benefit from these
proposed projects are: Butler, PA VAMC, Louis A.
Johnson VAMC (Clarksburg, WV), Coatesville, PA VAMC,
Philadelphia, PA VAMC, Pittsburgh, PA VAMC, Wilkes-
Barre, PA VAMC, and Wilmington, DE VAMC.
18. Atlanta, GA: This project would renovate three
inpatient floors of the VAMC Atlanta. The renovations
would correct patient privacy issues, improve staff
efficiencies, improve the functional layout, and meet
ADA requirements and female patient issues.
19. Tampa, FL: The project would provide for an
addition of approximately 1,170 parking spaces for the
Tampa VA Medical Center. This would be accomplished
through construction of a parking garage. There would
be some ancillary work to be performed, such as road
and access, pedestrian connections, utility re-routing,
and a possible pedestrian overpass.
20. Washington DC: This project would add a one-story
addition onto the current Medical Center. The addition
would be adjacent to the existing ambulance entrance.
The ambulance entrance would be moved. The new addition
would house the primary care clinics and the specialty
care clinics would expand and backfill the existing
primary care clinics. The project would allow for three
new clinics to be added to the Medical Center, and
would improve patient flow between primary care and
specialty care clinics.
Since fiscal year 1998, the Department has requested an
average of two projects per year through fiscal year 2003. The
average funding requested by the Department to fund such
projects was $52.2 million for the major construction account.
Congress, realizing the importance of safety, quality, and
improved health care, has authorized an average five projects
and appropriated an average of $104.7 million for major
construction projects during the same time period.
From all available indications and based on past practices,
the Committee concludes that, absent Congressional
authorization of the projects identified in the Committee bill,
VA's CARES review process in all likelihood would delay the
initiation of these projects by several additional years.
Congress should not permit such delays in meeting these
important capital needs.
The Committee believes that facilities, which house VA
medical and prosthetic research, should be part of the VA's
capital improvement program. The Committee notes, and has
reported previously (House Report 107-28, March 26, 2001) that
the Department does not give sufficient priority to
maintaining, upgrading, and replacing VA research facilities.
Yet, the Department prominently and regularly cites
accomplishments and new discoveries generated by VA research in
its public documents and media releases. The Committee urges
the Secretary to review the testimony presented to the
Subcommittee on Health at its hearing on April 24, 2002, and to
take appropriate action to ensure that VA research laboratories
and other facilities affiliated with its research programs
receive more infrastructure funding than VA has provided in the
past.
Section-By-Section Analysis
Section 1 is the short title of the bill.
Section 2 would authorize ten major medical facility
projects: seismic corrections at the Department of Veterans
Affairs Medical Center, Palo Alto, California, building number
2, $14,020,000 and building number 4, $21,750,000; seismic
correction at the Department of Veterans Affairs Medical
Center, San Francisco, California, $31,000,000; seismic
correction at the Department of Veterans Affairs Medical
Center, West Los Angeles, California, $27,000,000; seismic
correction and clinical improvement at the Department of
Veterans Affairs Medical Center, Long Beach, California,
$24,600,000; seismic correction for building number 1 at the
Department of Veterans Affairs Medical Center, San Diego,
California, $47,100,000; ambulatory surgery and clinical
consolidation at the Department of Veterans Affairs Medical
Center, Cleveland, Ohio, $32,500,000; consolidation of
Department of Veterans Affairs and Department of Defense health
and benefits offices, Anchorage, Alaska, $59,000,000; ward
renovation at the Department of Veterans Affairs Medical
Center, West Haven, Connecticut, $15,300,000; and ambulatory
care expansion at the Department of Veterans Affairs Medical
Center, Tampa, Florida, $18,230,000.
Section 3 would authorize a lease for a Satellite Clinic in
Charlotte, North Carolina, in the amount of $2,626,000.
Section 4(a) would authorize $2,626,000 in appropriations
for the lease in section 3 and $285 million for major project
construction authorized in section 2 for fiscal year 2003.
Section 4(b) would limit the projects to: funds
appropriated for fiscal year 2003 pursuant to the authorization
of appropriations in subsection (a), funds appropriated for
Construction, Major Projects for a fiscal year before fiscal
year 2003 that remain available for obligation, and funds
appropriated for Construction, Major Projects, for fiscal year
2003 for a category of activity not specific to a project.
Section 5(a) would amend title 38, United States Code,
Section 8104, by increasing the threshold for major medical
facility construction projects from $4,000,000 to $6,000,000.
Section 5(b) would state the amendment would not apply to
any project for which obligated funds have been made prior to
October 1, 2002.
Section 6 would amend title 38, United States Code, Section
8103, by adding subsection (e). This subsection would define
criteria the Secretary should, when practicable, observe in
selecting minor construction projects. These criteria were
adapted from similar guidance that would have been provided to
the Secretary had Congress enacted H.R. 811 as indicated above.
Under the bill, the projects selected would be prioritized for
seismic protection; fire safety; research facility
improvements; utility systems; ancillary patient care
facilities; accommodation for persons with disabilities;
various improvements to blind rehabilitation centers; inpatient
and residential programs for seriously mentally ill veterans;
residential and rehabilitation programs for veterans with
substance-use disorders; physical medicine and rehabilitation;
long-term care; amputation care; spinal cord injury centers;
traumatic brain injury programs; women's health programs; and,
facilities for hospice and palliative care programs.
Performance Goals and Objectives
The performance goals and objectives of VA programs dealing
with the major medical facility construction, the management of
the Department's capital construction programs, maintenance of
the portfolio of minor construction projects, and the
prioritization of construction projects, are established in the
Department's annual performance plans and budget formulation
processes, and are subject to the Committee's regular
oversight.
Statement of the Views of the Administration
Views from the Statement of Mark Catlett, Principal Deputy Assistant
Secretary for Management, Department of Veterans Affairs, Before the
Subcommittee on Health, House Veterans' Affairs Committee, April 24,
2002
The first four projects in the bill were included in
the President's FY 2003 budget submission to Congress.
The selection of these projects was the result of a
thorough capital investment selection process in which
specific needs of VA were balanced against the
Department's strategic goals, within the parameters of
annual budget constraints. The ultimate result of this
process was the selection of four major construction
projects that VA believes best achieve this balance and
that reflect a sound financial investment. Moreover,
the projects selected by the Department are the least
likely to be affected by the ongoing CARES process. As
you know, the CARES process has been implemented to
improve access and quality of veterans' health care
through realigning VA's capital assets. CARES is an
objective evidence-based evaluation of clinical
services required in the year 2020, by market area. We
believe it is premature at this time to recommend
additional projects.
While I am addressing the projects included in H.R.
4514, I would like to mention that our FY 2003 budget
requested authorization for the lease of a satellite
outpatient clinic in Charlotte, North Carolina, in the
amount of $2,626,000. We would ask that this
authorization be included in the bill when it is marked
up.
The physical infrastructure of the VA health care
system is one of the largest in the Federal government.
While some VA facilities are relatively new, the
average age of VA buildings is 50 years. During the
past few years, there has been a reluctance to commit
to capital investment out of concern that VA was unsure
of facilities that would clearly be needed in the
future. As we complete our CARES initiatives that
identify options to improve our health care system and
provide better access, infrastructure modifications
will create a large number of projects for future
funding and authorization.
Section 4 of H.R. 4514 is entitled Increase in
Threshold for Major Medical Facility Construction
Projects. Subsection (a) of Section 4 increases the
dollar threshold that defines a major construction
project from its current dollar amount of more than
$4,000,000 to more than $6,000,000. Subsection (b) of
Section 4 seeks to identify those projects to which the
increased threshold applies. VA is currently reviewing
Section 4 of the bill and we will provide the Committee
with our views on this provision at a later time.
Section 5 of H.R. 4514 is entitled Criteria For Minor
Construction Projects. The language of this section directs the
Secretary to select minor construction projects to improve,
replace, renovate, or update facilities to achieve improvements
in one or more of five specific areas. While this language may
have been included to provide guidance to VA in prioritizing
the Department's minor construction projects, it eliminates the
discretion that the Secretary now has in identifying those
minor construction projects that will best meet the overall
needs of the Department. VA's comprehensive process for
selecting the minor construction projects that will best
fulfill VA's mission makes Section 5 of the bill unnecessary.
Accordingly, I strongly recommend that it be removed from H.R.
4514.
Congressional Budget Office Cost Estimate
The following letter was received from the Congressional
Budget Office concerning the cost of the reported bill:
U.S. Congress,
Congressional Budget Office,
Washington, DC, May 10, 2002.
Hon. Christopher H. Smith
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 4514, the
Veterans' Major Medical Facilities Construction Act of 2002.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sam
Papenfuss, who can be reached at 226-2840.
Sincerely,
Dan L. Crippen,
Director.
Enclosure.
Congressional Budget Office Cost Estimate May 10, 2002
H.R. 4514, Veterans' Major Medical Facilities Construction Act of 2002,
As ordered reported by the House Committee on Veterans' Affairs on May
9, 2002
H.R. 4514 would authorize the appropriation of $285 million
in 2003 to be used for improving, renovating, and updating
medical centers in the Department of Veterans Affairs (VA). It
also would authorize about $3 million to lease an outpatient
clinic in Charlotte, North Carolina. The bill would authorize
specific projects for improved earthquake protection, and other
changes to existing facilities and set spending limits for each
project. H.R. 4514 also would raise the threshold for projects
to be financed out of the appropriation for major medical
facility construction from $4 million to $6 million. (Thus,
under the bill projects costing up to $6 million would be
considered minor construction.) Finally, H.R. 4514 would define
in greater detail the criteria for VA to use in selecting minor
construction projects.
CBO estimates that implementing H.R. 4514 would cost $13
million in 2003 and $279 million over the 2003-2007 period,
assuming appropriation of the authorized amounts. Because the
bill would not affect direct spending or receipts, pay-as-you-
go procedures would not apply.
H.R. 4514 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act and
would impose no costs on state, local, or tribal governments.
The CBO staff contact is Sam Papenfuss. This estimate was
approved by Peter H. Fontaine, Deputy Assistant Director for
Budget Analysis.
Statement of Federal Mandates
The preceding Congressional Budget Office cost estimate
states that the bill contains no intergovernmental or private
sector mandates as defined in the Unfunded Mandates Reform Act.
Applicability to Legislative Branch
The reported bill would not be applicable to the
legislative branch under the Congressional Accountability Act,
Public Law 104-1, because the bill would only affect certain
Department of Veterans Affairs programs.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, the reported bill is authorized by Congress'
power to ``provide for the common Defense and general Welfare
of the United States.''
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, existing law in which no change
is proposed is shown in roman):
TITLE 38, UNITED STATES CODE
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PART VI--ACQUISITION AND DISPOSITION OF PROPERTY
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CHAPTER 81--ACQUISITION AND OPERATION OF HOSPITAL AND DOMICILIARY
FACILITIES; PROCUREMENT AND SUPPLY; ENHANCED-USE LEASES OF REAL
PROPERTY
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SUBCHAPTER I--ACQUISITION AND OPERATION OF MEDICAL FACILITIES
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Sec. 8103. Authority to construct and alter, and to acquire sites for,
medical facilities
(a) * * *
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(e) Purpose of Minor Construction Projects.--In selecting
medical facilities (including research facilities) for projects
under subsection (a) other than major medical facility projects
subject to section 8104 of this title, the Secretary shall, to
the extent practicable, select projects to improve, replace,
renovate, or update facilities to achieve one or more of the
following:
(1) Seismic protection improvements related to
patient safety (or, in the case of a research facility,
patient or employee safety).
(2) Fire safety improvements.
(3) Improvements to utility systems and ancillary
patient care facilities (including such systems and
facilities that may be exclusively associated with
research facilities).
(4) Improved accommodation for persons with
disabilities, including barrier-free access.
(5) Improvements at patient care facilities to
specialized programs of the Department, including the
following:
(A) Blind rehabilitation centers.
(B) Inpatient and residential programs for
seriously mentally ill veterans, including
mental illness research, education, and
clinical centers.
(C) Residential and rehabilitation programs
for veterans with substance-use disorders.
(D) Physical medicine and rehabilitation
activities.
(E) Long-term care, including geriatric
research, education, and clinical centers,
adult day care centers, and nursing home care
facilities.
(F) Amputation care, including facilities for
prosthetics, orthotics programs, and sensory
aids.
(G) Spinal cord injury centers.
(H) Traumatic brain injury programs.
(I) Women veterans' health programs
(including particularly programs involving
privacy and accommodation for female patients).
(J) Facilities for hospice and palliative
care programs.
Sec. 8104. Congressional approval of certain medical facility
acquisitions
(a)(1) * * *
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(3) For the purpose of this subsection:
(A) The term ``major medical facility project'' means
a project for the construction, alteration, or
acquisition of a medical facility involving a total
expenditure of more than [$4,000,000] $6,000,000, but
such term does not include an acquisition by exchange.
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