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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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