- TXT
-
PDF
(PDF provides a complete and accurate display of this text.)
Tip
?
108th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 108-210
======================================================================
VETERANS HEALTH CARE FACILITIES CAPITAL IMPROVEMENT ACT
_______
July 15, 2003.--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. 1720]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred the
bill (H.R. 1720) to authorize the Secretary of Veterans Affairs
to carry out construction projects for the purpose of
improving, renovating, establishing, and updating patient care
facilities at Department of Veterans Affairs medical centers,
having considered the same, reports favorably thereon with
amendments and recommends that the bill as amended do pass.
The amendments are as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Veterans Health Care Facilities
Capital Improvement Act''.
SEC. 2. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS FOR PATIENT
CARE IMPROVEMENTS.
(a) In General.--(1) Subject to paragraph (3), the Secretary of
Veterans Affairs is authorized to carry out major medical facility
projects in accordance with this section, using funds appropriated for
fiscal year 2004 or 2005 pursuant to subsection (e). The cost of any
such project may not exceed
(A) $100,000,000 in fiscal year 2004; and
(B) $125,000,000 in fiscal year 2005.
(2) Projects carried out under this section are not subject to
section 8104(a)(2) of title 38, United States Code.
(3) The Secretary may not award a contract by reason of the
authorization provided by paragraph (1) until after the Secretary has
awarded a contract for each construction project authorized by section
3(a) and a contract for each lease authorized by section 3(d).
(b) Type of Projects.--A project carried out under subsection (a) may
be carried out only at a Department of Veterans Affairs medical center
and only for the purpose of one or more of the following:
(1) Improving a patient care facility.
(2) Replacing a patient care facility.
(3) Renovating a patient care facility.
(4) Updating a patient care facility to contemporary
standards.
(5) Establishing a new patient care facility at a location
where no Department patient care facility exists.
(6) Improving, replacing, or renovating a research facility
or updating such a facility to contemporary standards.
(c) Purpose of Projects.--In selecting medical centers for projects
under subsection (a), the Secretary shall select projects to improve,
replace, renovate, update, or establish 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.
(d) Review Process.--(1) The Secretary shall provide that, before a
project is submitted to the Secretary with a recommendation that it be
approved as a project to be carried out under the authority of this
section, the project shall be reviewed by a board within the Department
of Veterans Affairs that is independent of the Veterans Health
Administration and that is constituted by the Secretary to evaluate
capital investment projects. The board shall review such project to
determine the project's relevance to the medical care mission of the
Department and whether the project improves, renovates, repairs,
establishes, or updates facilities of the Department in accordance with
this section.
(2) In selecting projects to be carried out under the authority
provided by this section, the Secretary shall consider the
recommendations of the board under paragraph (1). In any case in which
the Secretary approves a project to be carried out under this section
that was not recommended for such approval by the board under paragraph
(1), the Secretary shall include in the report of the Secretary under
subsection (g)(2) notice of such approval and the Secretary's reasons
for not following the recommendation of the board with respect to that
project.
(e) Authorization of Appropriations.--There are authorized to be
appropriated to the Secretary of Veterans Affairs for the Construction,
Major Projects, account for projects under this section--
(1) $500,000,000 for fiscal year 2004;
(2) $600,000,000 for fiscal year 2005; and
(f) Limitation.--Projects may be carried out under this section only
using funds appropriated pursuant to the authorization of
appropriations in subsection (e), except that funds appropriated for
advance planning may be used for the purposes for which appropriated in
connection with such projects.
(g) Reports.--(1) Not later than April 1, 2005, the Comptroller
General shall submit to the Committees on Veterans' Affairs and on
Appropriations of the Senate and House of Representatives a report
evaluating the advantages and disadvantages of congressional
authorization for projects of the type described in subsection (b)
through general authorization as provided by subsection (a), rather
than through specific authorization as would otherwise be applicable
under section 8104(a)(2) of title 38, United States Code. Such report
shall include a description of the actions of the Secretary of Veterans
Affairs during fiscal year 2004 to select and carry out projects under
this section.
(2) Not later than 120 days after the date on which the site for the
final project under this section for each such fiscal year is selected,
the Secretary shall submit to the committees referred to in paragraph
(1) a report on the authorization process under this section. The
Secretary shall include in each such report the following:
(A) A listing by project of each such project selected by the
Secretary under that section, together with a prospectus
description of the purposes of the project, the estimated cost
of the project, and a statement attesting to the review of the
project under subsection (c), and, if that project was not
recommended by the board, the Secretary's justification under
subsection (d) for not following the recommendation of the
board.
(B) An assessment of the utility to the Department of
Veterans Affairs of that authorization process.
(C) Such recommendations as the Secretary considers
appropriate for future congressional policy for authorizations
of major and minor medical facility construction projects for
the Department of Veterans Affairs.
(D) Any other matter that the Secretary considers to be
appropriate with respect to oversight by Congress of capital
facilities projects of the Department of Veterans Affairs.
SEC. 3. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS AND LEASES.
(a) Project Authorizations.--The Secretary of Veterans Affairs may
carry out the following major medical facility projects, with each
project to be carried out in the amount specified for that project:
(1) Construction of a new bed tower to consolidate two
inpatient sites of care in inner city Chicago at the West Side
Division of the Department of Veterans Affairs health care
system in Chicago, Illinois, in an amount not to exceed
$98,500,000.
(2) Seismic corrections to strengthen Medical Center Building
1 of the Department of Veterans Affairs health care system in
San Diego, California, in an amount not to exceed $48,600,000.
(3) A project for (A) renovation of all inpatient care wards
at the West Haven, Connecticut, facility of the Department of
Veterans Affairs health system in Connecticut to improve the
environment of care and enhance safety, privacy, and
accessibility, and (B) establishment of a consolidated medical
research facility at that facility, in an amount not to exceed
$50,000,000.
(4) Construction of a medical facility on available Federal
land at the Defense Supply Center, Columbus, Ohio, in an amount
not to exceed $90,000,000.
(5) Construction of a Department of Veterans Affairs-
Department of Navy joint venture, comprehensive outpatient
medical care facility to be built on the grounds of the
Pensacola Naval Air Station, Pensacola, Florida, in an amount
not to exceed $45,000,000.
(b) Authorization of Appropriations.--There is authorized to be
appropriated to the Secretary of Veterans Affairs for fiscal year 2004
for the Construction, Major Projects, account $332,100,000 for the
projects authorized in subsection (a).
(c) Limitation.--The projects authorized in subsection (a) may only
be carried out using--
(1) funds appropriated for fiscal year 2004 pursuant to the
authorization of appropriations in subsection (b);
(2) funds appropriated for Construction, Major Projects, for
a fiscal year before fiscal year 2004 that remain available for
obligation; and
(3) funds appropriated for Construction, Major Projects, for
fiscal year 2004 for a category of activity not specific to a
project.
(d) Authorization of Major Medical Facility Leases.--The Secretary of
Veterans Affairs may enter into leases as follows:
(1) For an outpatient clinic in Charlotte, North Carolina, in
an amount not to exceed $3,000,000.
(2) For facilities for a multi-specialty outpatient clinic
for the Veterans Health Administration and a satellite office
for the Veterans Benefits Administration in Clark County,
Nevada, at an annual lease amount not to exceed $6,500,000.
SEC. 4. LIMITATION ON DISPOSAL OF LAKESIDE DIVISION, DEPARTMENT OF
VETERANS AFFAIRS MEDICAL FACILITIES, CHICAGO,
ILLINOIS.
(a) Limitation.--The Secretary of Veterans Affairs may not make a
final disposal under section 8162 of title 38, United States Code, of
the Lakeside Division facility of the Department of Veterans Affairs
medical facilities in Chicago, Illinois, until the Secretary has
entered into a contract for the construction project authorized by
section 3(a)(1).
(b) Definition.-- For purposes of this section, the term
``disposal'', with respect to the Lakeside Division facility, includes
entering into a long-term lease or sharing agreement under which a
party other than the Secretary has operational control of the facility.
SEC. 5. PLANS FOR FACILITIES IN SOUTHERN NEW JERSEY AND FAR SOUTH
TEXAS.
(a) Plan.--(1) The Secretary of Veterans Affairs shall develop--
(A) a plan to establish an inpatient facility to meet
hospital care needs of veterans who reside in southern New
Jersey; and
(B) a plan for hospital care needs of veterans who reside in
far south Texas.
(2) In developing the plans under paragraph (1), the Secretary shall,
at a minimum, consider options using the existing authorities of
section 8111 and 8153 of title 38, United States Code--
(A) to establish a hospital staffed and managed by employees
of the Department, either in private or public facilities,
including Federal facilities; or
(B) to enter into contracts with existing private facilities
and private providers for that care.
(b) Reports.--The Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives a report
on each plan under subsection (a) not later than January 31, 2004.
(c) Definitions.--In this section:
(1) The term ``far south Texas'' means the following counties
of the State of Texas: Bee, Calhoun, Crockett, DeWitt, Dimmit,
Goliad, Jackson, Victoria, Webb, Aransas, Duval, Jim Wells,
Kleberg, Nueces, Refugio, San Patricio, Brooks, Cameron,
Hidalgo, Jim Hogg, Kenedy, Starr, Willacy, and Zapata.
(2) The term ``southern New Jersey'' means the following
counties of the State of New Jersey: Ocean, Burlington, Camden,
Gloucester, Salem, Cumberland, Atlantic, and Cape May.
SEC. 6. INCREASE IN MAJOR MEDICAL FACILITY CONSTRUCTION COST THRESHOLD.
Section 8104(a)(3)(A) of title 38, United States Code, is amended by
striking ``$4,000,000'' and inserting ``$6,000,000''.
SEC. 7. NAME OF DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE FACILITY,
CHICAGO, ILLINOIS.
The Department of Veterans Affairs health care facility located at
820 South Damen Avenue in Chicago, Illinois, shall after the date of
the enactment of this Act be known and designated as the ``Jesse Brown
Department of Veterans Affairs Medical Center''. Any reference to such
facility in any law, map, regulation, document, paper, or other record
of the United States shall be considered to be a reference to the Jesse
Brown Department of Veterans Affairs Medical Center.
SEC. 8. STUDY AND REPORT ON FEASIBILITY OF COORDINATION OF VETERANS
HEALTH CARE SERVICES IN SOUTH CAROLINA WITH NEW
UNIVERSITY MEDICAL CENTER.
(a) Study Required.--The Secretary of Veterans Affairs shall conduct
a study to examine the feasibility of coordination by the Department of
Veterans Affairs of its needs for inpatient hospital, medical care, and
long-term care services for veterans with the pending construction of a
new university medical center at the Medical University of South
Carolina, Charleston, South Carolina.
(b) Matters To Be Included in Study.--(1) As part of the study under
subsection (a), the Secretary shall consider the following:
(A) Integration with the Medical University of South Carolina
of some or all of the services referred to in subsection (a)
through contribution to the construction of that university's
new medical facility or by becoming a tenant provider in that
new facility.
(B) Construction by the Department of Veterans Affairs of a
new independent inpatient or outpatient facility alongside or
nearby the university's new facility.
(2) In carrying out paragraph (1), the Secretary shall consider the
degree to which the Department of Veterans Affairs and the university
medical center would be able to share expensive technologies and scarce
specialty services that would affect any such plans of the Secretary or
the university.
(3) In carrying out the study, the Secretary shall especially
consider the applicability of the authorities under section 8153 of
title 38, United States Code (relating to sharing of health care
resources between the Department and community provider organizations)
to govern future arrangements and relationship between the Department
and the Medical University of South Carolina.
(c) Consultation With Secretary of Defense.--The Secretary of
Veterans Affairs shall consult with the Secretary of Defense in
carrying out the study under this section. Such consultation shall
include consideration of establishing a Department of Veterans Affairs-
Department of Defense joint health-care venture at the site referred to
in subsection (a).
(d) Report.--Not later than March 31, 2004, the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate and House
of Representatives a report on the results of the study. The report
shall include the Secretary's recommendations with respect to
coordination described in subsection (a), including recommendations
with respect to each of the matters referred to in subsection (b).
Amend the title so as to read:
A bill to authorize the Secretary of Veterans Affairs to
carry out construction projects for the purpose of improving,
renovating, establishing, and updating patient care facilities
at Department of Veterans Affairs medical centers, and for
other purposes.
Introduction
The reported bill reflects the Committee's consideration of
several bills introduced during the 108th Congress, to include
H.R. 1720, H.R. 2307, and H.R. 2349.
On June 11, 2003, the Subcommittee on Health held a hearing
on four bills, among them H.R. 1720, the Veterans Health Care
Facilities Capital Improvement Act, introduced by Honorable Rob
Simmons and Honorable Christopher H. Smith on April 10, 2003;
H.R. 2307, to provide for the establishment of new Department
of Veterans Affairs medical facilities for veterans in the area
of Columbus, Ohio, and in south Texas, introduced by Honorable
David L. Hobson, Honorable Solomon P. Ortiz, Honorable Deborah
Pryce, Honorable Patrick J. Tiberi, Honorable Paul E. Gillmor,
Honorable Ciro D. Rodriguez, Honorable Ralph Regula, Honorable
Silvestre Reyes, and Honorable Michael G. Oxley on June 3,
2003; and H.R. 2349, to authorize certain major medical
facility projects for the Department of Veterans Affairs,
introduced by Honorable Lane Evans, Honorable Rob Simmons,
Honorable Luis V. Gutierrez, Honorable Bob Filner, Honorable
Shelley Berkley, and Honorable Susan A. Davis on June 5, 2003.
Witnesses who appeared before the Subcommittee included Ms.
Cathleen C. Wiblemo, Deputy Director, Health Care, Veterans
Affairs and Rehabilitation Division, The American Legion; Mr.
Richard Jones, National Legislative Director, AMVETS; Mr.
Adrian M. Atizado, Associate National Legislative Director,
Disabled American Veterans; Mr. Carl Blake, Associate
Legislative Director, Paralyzed Veterans of America; Mr. Paul
A. Hayden, Deputy Director, National Legislative Service,
Veterans of Foreign Wars; and Honorable Robert H. Roswell,
M.D., Under Secretary for Health, Department of Veterans
Affairs, who was accompanied by Mr. D. Mark Catlett, Principal
Deputy Assistant Secretary for Management, and Mr. Robert L.
Neary, Jr., Associate Chief Facilities Management Officer for
Service Delivery. Written testimonies were received from
Honorable Joel Hefley, Member of Congress from the State of
Colorado; Honorable David L. Hobson, Member of Congress from
the State of Ohio; Honorable Solomon P. Ortiz, Member of
Congress from the State of Texas; and Honorable Deborah Pryce,
Member of Congress from the State of Ohio.
On June 24, 2003, the Subcommittee on Health met and
unanimously ordered H.R. 1720, as amended, reported favorably
to the full Committee.
On June 26, 2003, the full Committee met and ordered H.R.
1720, as amended, reported favorably to the House by unanimous
voice vote.
Summary of the Reported Bill
H.R. 1720, as amended, would:
1. LAuthorize the Secretary of Veterans Affairs to carry
out major medical facility construction projects to improve,
renovate, replace, update or establish patient care facilities
of the Department of Veterans Affairs (VA), using funds
appropriated for two fiscal years beginning with fiscal year
2004.
2. LLimit the cost of a single project to no more than
$100,000,000 in fiscal year 2004; and $125,000,000 in fiscal
year 2005.
3. LRequire the Secretary to award the specific major
construction projects this bill would authorize before the
Secretary may authorize additional capital improvement projects
using the delegation of authority provided in this bill.
4. LLimit the projects only to VA medical centers for the
purposes of improving, replacing, renovating or updating a
patient care facility; or for the purpose of establishing a new
patient care facility at a location where no VA patient care
facility exists.
5. LRequire the Secretary to meet certain criteria in
approving projects under this authority, including review by an
independent board appointed by the Secretary.
6. LRequire the Secretary to consider the recommendations
of the board and to disclose such reasons for deviating from
the recommendations of the board.
7. LAuthorize a total of $500,000,000 for fiscal year
2004; and $600,000,000 for fiscal year 2005 to be appropriated
to the Secretary for construction of undesignated major
projects.
8. LRequire the Comptroller General to make a report to
the Committees on Veterans' Affairs and on Appropriations of
the Senate and House of Representatives by April 1, 2005,
evaluating the effectiveness of this legislation compared to
previous authorizations, and describing the actions of the
Secretary to select and carry out projects under this
authority.
9. LRequire the Secretary to make a report each fiscal
year to the Committees on Veterans' Affairs and on
Appropriations of the Senate and House of Representatives on
the authorization process, providing a list of the projects
selected, their purposes and costs, the results of the
selection and the authorization processes, and recommendations
for amending or extending this authority, and other appropriate
recommendations.
10. LAuthorize $98,500,000 to consolidate two inpatient
sites of care in Chicago by constructing a new bed tower at
West Side Division.
11. LAuthorize $48,600,000 for seismic corrections to
Building 1 at the San Diego, California VA Medical Center.
12. LAuthorize $50,000,000 to renovate all inpatient care
wards at the West Haven, Connecticut VA Medical Center to
improve the environment of care and enhance safety, privacy and
accessibility; and to consolidate medical research at that
facility.
13. LAuthorize a new VA Medical Center in Columbus, Ohio,
at a cost of $90,000,000.
14. LAuthorize a joint VA-DOD venture to construct a
comprehensive outpatient medical care facility on the grounds
of the Pensacola Naval Air Station, in an amount not to exceed
$45,000,000.
15. LAuthorize a lease for an outpatient clinic in
Charlotte, North Carolina, in the amount of $3,000,000, to be
paid from the medical care account.
16. LAuthorize the lease of a multi-specialty outpatient
clinic for the Veterans Health Administration and a satellite
office for the Veterans Benefits Administration in Clark
County, Nevada, at an annual rental cost not to exceed
$6,500,000.
17. LRequire the Secretary to develop a plan for meeting
the future inpatient hospitalization needs of veterans who
reside in a number of counties of southern New Jersey, with a
report to the Committees by January 31, 2004.
18. LRequire the Secretary to develop a plan for meeting
the future inpatient hospitalization needs of veterans who
reside in a number of the far southern counties of the State of
Texas, with a report to the Committees by January 31, 2004.
19. LProhibit the Secretary from disposing of the Lakeside
Division facility in Chicago, Illinois, before the construction
contract for the new bed tower at the West Side Division is
awarded.
20. LRaise the threshold for major construction projects
from $4,000,000 to $6,000,000.
21. LName the VA Medical Center (West Side Division) at 820
South Damen Avenue in Chicago, Illinois, the Jesse Brown
Department of Veterans Affairs Medical Center.
22. LRequire the Secretary to conduct a feasibility study
in coordination with the Medical University of South Carolina
and in consultation with the Secretary of Defense to consider
establishing a joint health-care venture to deliver inpatient,
outpatient and/or long-term care to veterans, DOD and other
beneficiaries who reside in Charleston, South Carolina, with a
report to the Committees by March 31, 2004.
Background and Discussion
Major Medical Facility Projects and Leases in VA.--For
fiscal years 1998 to 2003, the Department of Veterans Affairs
(VA) requested an average of two major medical facility
construction projects per year. The average funding requested
by VA for such projects was $52.2 million for the major
construction account. Congress, realizing that safety, quality,
and improved health care are enhanced by facilities that
comport to contemporary standards of care, has authorized an
average of five major medical projects and appropriated an
average of $104.7 million for major construction projects
during the same period.
In the First Session of the 107th Congress, Honorable
Christopher H. Smith, Chairman of the Committee on Veterans'
Affairs, along with other Members, introduced H.R. 811, the
Veterans Hospital Emergency Repair Act. H.R. 811 would have
provided the Department with $550 million in emergency repair
funds over a two-year period for VA's crumbling health care
infrastructure. The House unanimously passed H.R. 811 on March
27, 2001, and it was associated subsequently with a House-
passed construction appropriation of $300,000,000. In the
Second Session of the 107th Congress, the Committee reported
H.R. 4514, the Veterans' Major Medical Facilities Construction
Act of 2002. H.R. 4514 would have authorized the Secretary of
Veterans Affairs to initiate ten major medical facility
construction projects in fiscal year 2003 at a cost of
$285,000,000. These particular projects were chosen from a list
of the Secretary's top twenty major medical facility
construction projects submitted to Congress on February 13,
2002, in accordance with requirements of section 8107(d)(1) of
title 38, United States Code. The House unanimously passed this
construction authorization measure on May 21, 2002. The Senate
did not address these measures during either session of the
107th Congress.
The Committee believes that veterans enrolled in VA health
care deserve medical facilities that provide high quality
services, ensure safety and improve efficiency. The reported
bill would establish a two-year delegation of authority
enabling the Secretary to establish, improve and replace VA
health care facilities where needed. H.R. 1720, as amended,
would give the Secretary the authority to approve individual
facility projects based on recommendations of an independent
capital investments board. The criteria detailed in the
reported bill would place a high premium on projects that
address patient safety and privacy, seismic protection,
barrier-free accommodations, and patient care capabilities. In
order to meet the contemporary standards of care that veterans
need, these criteria are intended to encourage VA to focus on
several specialized areas of concern, such as privacy needs,
specialized care programs (spinal cord injury, blind
rehabilitation, and long-term care) and other high priorities
of Congress. The reported bill would also help improve the
safety of veterans who are furnished medical care in VA health
care facilities, as well as the Department staff who must work
in them to provide that care.
H.R. 1720, as amended, would authorize appropriations of
$500 million in fiscal year 2004, and $600 million in fiscal
year 2005 to accommodate vitally needed and overdue
construction projects. The discretionary budget approved by
Congress for veterans benefits and services accommodates this
level of commitment in appropriations for fiscal year 2004.
The bill would mandate a review and a report of findings by
the General Accounting Office of this delegated-project
approach. This review would compare the Secretary's use of this
authority to previous authorizations, and describe the actions
of the Secretary to select and carry out projects under this
authority so that Congress can determine the effectiveness of
this approach.
The Secretary would be required to make a report each
fiscal year to the Committees on Veterans' Affairs and on
Appropriations of the Senate and House of Representatives on
the authorization process. This report would provide a list of
the projects selected, their purposes and costs, the results of
the selection and the authorization processes, recommendations
for amending or extending this authority, and other appropriate
recommendations.
In addition to the broad delegation of authority granted to
the Secretary, this bill would authorize several specific VA
major medical facility construction projects in fiscal year
2004, as follows:
Columbus, Ohio: This project would construct a new medical
facility on available Federal land at the Defense Supply
Center. Columbus is the largest city in the United States
without a VA hospital.
West Side Division, Illinois: This project would
consolidate two existing inpatient sites of care in Chicago
that are located in 50-year old facilities only five miles
apart. The bill would authorize a new VA bed tower at the West
Side Division to consolidate all inpatient acute VA care within
the city of Chicago. The West Side Division project that would
be authorized by this bill was included in the President's
fiscal year 2004 budget request.
San Diego, California: This project would seismically
strengthen the primary medical center building. This seismic
upgrade would correct significant risks to life safety in an
area that is known to be highly prone to earthquakes.
West Haven, Connecticut: This project would make essential
renovations to inpatient wards to correct privacy inadequacies,
upgrade the environment, consolidate support services, correct
deficiencies in air quality, and make other improvements in the
delivery of care and in the general safety of patients and
staff. It would provide a new research facility to offer
functional and safe laboratories for investigators currently
working in inadequate, antiquated facilities.
Pensacola, Florida: This project would authorize a joint
venture between the Department of Veterans Affairs and the
Department of the Navy to construct a state-of-the-art
outpatient care facility on the grounds of the Pensacola Naval
Air Station.
Clark County, Nevada: This project would authorize the
Department to lease space for a multi-specialty clinic in Clark
County, Nevada, to replace an unsafe facility that the
Department has abandoned. This clinic would include a satellite
benefits claims office.
Charlotte, North Carolina: This project would authorize the
Department to lease outpatient clinical space in Charlotte,
North Carolina, to replace an inadequate clinic in one of the
largest and fastest growing municipalities in the country which
lacks a VA hospital.
South Texas and Southern New Jersey: The Committee desires
that VA investigate opportunities for providing geographically
isolated veterans reasonable access to inpatient care. This
bill is not a specific project authorization. However, it would
require the Secretary to develop a plan for meeting the
inpatient hospitalization needs of veterans who reside in a
number of the far south counties of the State of Texas, where
access to VA facilities is nearly impossible due to geographic
and economic factors and extreme remoteness. This region is the
most underserved in the United States, in terms of access to
acute inpatient hospital care. The Department's CARES
initiative makes no provision for these veterans' needs for VA
inpatient care. Presumably these veterans would continue to
travel several hours to the distant San Antonio VA medical
center for their hospitalizations.
The bill would also require the Secretary to develop a plan
for meeting the inpatient hospitalization needs of veterans who
reside in southern New Jersey, an area that is also rural and
isolated from the remainder of the State of New Jersey and
sources of VA care in other eastern states. VA's CARES
initiative projects that VA needs to accommodate an average
daily hospitalization census range of 22-24 patients for
southern New Jersey veterans through the year 2022. Thus far,
VA has made no commitments with respect as to how these
veterans' needs are to be met, except to suggest that they will
be met primarily at the over-crowded VA Medical Center in
Philadelphia, Pennsylvania, or at the more distant but less
crowded VA Medical Center in Wilmington, Delaware. The
Committee believes these are unacceptable alternatives.
The Committee concludes that in both cases VA seems more
focused on ensuring the viability of existing VA facilities,
than on meeting the needs of veterans. The bill would require
the Secretary to submit separate special reports to the
Committees on Veterans' Affairs of the Senate and House of
Representatives reflecting these required plans.
Charleston, South Carolina: The reported bill would require
the Secretary to conduct a feasibility study to examine
coordinating and integrating the delivery of health care in a
joint venture with the Department of Defense (DOD) and the
Medical University of South Carolina at the site of the Medical
University. No later than March 31, 2004, the Secretary would
report to the Committees on Veterans' Affairs of the Senate and
House of Representatives regarding the results and
recommendations of this study.
The reported bill would also prohibit the Secretary from
disposing of the Chicago Lakeside Division property until the
Secretary awards a construction contract for the new bed tower
at the Chicago West Side Division. The Committee believes that
VA should keep its commitment to the veterans of Chicago and
begin the West Side project before it concludes any disposition
of the Lakeside property. Throughout the duration of the CARES
initiative, veterans have relied on VA's commitment to provide
the funds to improve the West Side Division.
VA has not identified the source of funds for the West Side
inpatient tower project. VA is negotiating either a sale or an
enhanced-use lease of the Lakeside facility for non-veteran,
commercial purposes. VA is proposing to use the revenues from
this enhanced-use lease for construction.
In addition to these matters, the bill would also raise the
dollar threshold for VA major medical facility construction
projects from its current level of $4 million to $6 million.
This higher threshold would provide flexibility to VA in
selecting and scheduling smaller construction projects. The
Committee notes that under existing law, VA tends to split
major construction projects into projects that are less than
the current $4 million threshold, in order to avoid delays
attendant to the Congressional approval process. Split-funded
projects add contract administration burdens, complicate the
process for local managers, often require more time and added
expense to complete, and may not receive sufficient oversight.
Naming of VA Medical Facility.--The Committee bill would
honor the late former Secretary of Veterans Affairs, Jesse
Brown, for his exemplary service to his country as a combat-
wounded U.S. Marine Corps veteran of the Vietnam War and
dedicated leader of the Department of Veterans Affairs.
Mr. Brown enlisted in the Marine Corps in 1963. During the
Vietnam War he was wounded in combat in 1965 while on patrol in
Danang, Republic of Vietnam, leaving him partially paralyzed.
After a lengthy recuperation, Mr. Brown began a career in
advocacy for veterans that spanned the remainder of his life.
He worked for fellow veterans for 25 years with the Disabled
American Veterans, culminating his career by serving as
executive director from 1989 to 1993.
The Honorable Jesse Brown was sworn in by President Clinton
as the Secretary of Veterans Affairs on January 22, 1993. Under
his leadership for nearly five years, VA expanded benefits and
treatment services for those exposed to Agent Orange,
radiation, mustard gas, and veterans suffering from post-
traumatic stress disorder. He made programs for homeless
veterans the ``fifth mission'' of VA.
On August 21, 2002, following a lengthy battle with
amyotrophic lateral sclerosis (ALS), commonly known as Lou
Gehrig's disease, Mr. Brown was laid to rest at Arlington
National Cemetery with full military honors.
The Committee believes naming the West Side Division of the
VA Chicago Health Care System after Secretary Brown would
appropriately memorialize his earnest efforts to help those
wounded in battle and would recognize his accomplishments and
commitment to improving the quality of life for all veterans.
The Illinois Congressional delegation is unanimous in its
support for this provision of the bill, as are the major
veterans organizations of the State of Illinois.
Section-By-Section Analysis
Section 1 of the bill would name the Act the ``Veterans
Health Care Facilities Capital Improvement Act''.
Section 2(a)(1) of the bill would authorize the Secretary
of Veterans Affairs to carry out major medical facility
projects using appropriated funds for fiscal year 2004 or 2005.
Section 2(a)(1)(A) of the bill would prohibit appropriated
funds used in fiscal year 2004 for a major medical facility
project from exceeding $100,000,000.
Section 2(a)(1)(B) of the bill would prohibit appropriated
funds used in fiscal year 2005 for a major medical facility
project from exceeding $125,000,000.
Section 2(a)(2) of the bill would exempt major medical
projects in this bill from the requirements of section
8104(a)(2) of title 38, United States Code, which states that
the Secretary cannot obligate or expend funds (other than for
advance planning and design) for any major medical facility
project or lease unless those projects have been authorized by
law.
Section 2(a)(3) of the bill would prohibit the Secretary
from awarding contracts for any major medical facility projects
or leases until projects and leases listed in section 3 of the
bill are awarded.
Section 2(b) of the bill would limit the type of major
medical facility projects to be carried out using funds
authorized by this bill to projects with one or more of the
following purposes: (1) improve a patient care facility; (2)
replace a patient care facility; (3) renovate a patient care
facility; (4) update a patient care facility so that it meets
contemporary standards; (5) establish a new patient care
facility in a location where no other VA facilities exist; or
(6) improve, replace, renovate, or update a research facility
so that it meets contemporary standards.
Section 2(c) of the bill would limit the Secretary's
authority to select major medical facility projects that
improve, replace, renovate, update, or establish new
facilities, in order to (1) make seismic protection
improvements to provide patient safety, or in the case of a
research facility, to provide patient and employee safety; (2)
make fire safety improvements; (3) improve utility systems and
ancillary patient care facilities, including any research
facilities associated with these systems and facilities; (4)
improve accommodations for persons with disabilities, including
barrier-free access to facilities; (5) make improvements at
patient care facilities which specialize in (A) blind
rehabilitation; (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) geriatric research, long-term care, adult day care, and
nursing home care; (F) amputation care, including facilities
for prosthetics, orthotics programs, and sensory aids; (G)
spinal cord injuries; (H) traumatic brain injuries; (I) women
veterans' health programs involving privacy and accommodation
for female patients; and (J) hospice and palliative care
programs.
Section 2(d)(1) of the bill would require a review process
by an independent board within VA to evaluate proposed capital
investment projects before making recommendations to the
Secretary. This board would review projects to determine
whether or not a project would improve, renovate, repair,
establish, or update VA facilities.
Section 2(d)(2) of the bill would require the Secretary to
consider the recommendations made by the board when approving
major medical facility projects. If the Secretary does not
implement the board's recommendations, the Secretary must
provide an explanation for not doing so in a report to the
Committees on Veterans' Affairs and on Appropriations of the
Senate and House of Representatives.
Section 2(e)(1) of the bill would authorize $500,000,000 to
be appropriated for major construction projects at VA for
fiscal year 2004.
Section 2(e)(2) of the bill would authorize $600,000,000 to
be appropriated for major construction projects at VA for
fiscal year 2005.
Section 2(f) of the bill would require the appropriated
amounts listed in subsection (e) to be the only funds used to
carry out the major construction projects authorized by this
bill, except for any funds appropriated for the advance
planning of projects.
Section 2(g)(1) of the bill would require the Comptroller
General to submit a report to the Committees on Veterans'
Affairs and on Appropriations of the Senate and House of
Representatives by April 1, 2005. The report would evaluate the
advantages and disadvantages of general authorization versus
specific authorization, and a description of the projects the
Secretary approved during fiscal year 2004.
Section 2(g)(2) of the bill would require the Secretary to
submit a report to the Committees on Veterans' Affairs and on
Appropriations of the Senate and House of Representatives no
later than four months after the Secretary approves the final
major medical facility projects for each fiscal year. This
report would (A) include a list of each project selected by the
Secretary, the purpose for each project, and a review of each
project; the Secretary would be required to justify his reasons
should he choose to not implement recommendations of the board;
(B) assess VA's utilization of the authorization process; (C)
include recommendations from the Secretary on future
authorizations for major and minor medical facility
construction projects for VA; and (D) include any other
oversight matter deemed appropriate by the Secretary.
Section 3(a) of the bill would authorize the Secretary to
carry out the following major medical facility projects: (1)
construction of a new bed tower to consolidate two inpatient
sites of care in the West Side Division of the VA health care
system in Chicago, Illinois, in an amount not to exceed
$98,500,000; (2) seismic corrections to strengthen Medical
Center Building 1 of the VA health care system in San Diego,
California, in an amount not to exceed $48,600,000; (3)(A) a
project for renovation of all inpatient care wards at the West
Haven, Connecticut, facility of the VA health care system to
improve the environment of care and enhance safety, privacy,
and accessibility, and (B) a project to establish a
consolidated medical research facility at that facility, in an
amount not to exceed $50,000,000; (4) construction of a medical
facility on available Federal land at the Defense Supply Center
in Columbus, Ohio, in an amount not to exceed $90,000,000; and
(5) construction of a Department of Veterans Affairs-Department
of Navy joint venture, comprehensive outpatient medical care
facility on the grounds of the Pensacola Navel Air Station,
Pensacola, Florida, in an amount not to exceed $45,000,000.
Section 3(b) of the bill would authorize $332,100,000 to be
appropriated in fiscal year 2004 to VA for the major medical
facility projects listed in subsection (a).
Section 3(c) of the bill would limit the funds used to
carry out the major medical facility projects listed in
subsection (a) to (1) funds appropriated in fiscal year 2004 as
required by subsection (b); (2) funds appropriated for major
construction projects prior to fiscal year 2004 which are still
available for obligation; and (3) funds appropriated in fiscal
year 2004 for major construction projects which are not
obligated to a specific project.
Section 3(d) of the bill would authorize the Secretary to
enter into major medical facility leases for (1) an outpatient
clinic in Charlotte, North Carolina, in an amount not to exceed
$3,000,000; and (2) a multi-specialty outpatient clinic for the
Veterans Health Administration and a satellite office for the
Veterans Benefits Administration in Clark County, Nevada, at an
annual lease amount not to exceed $6,500,000.
Section 4(a) of the bill would prohibit the Secretary from
disposing of the Lakeside Division facility of VA in Chicago,
Illinois, until a contract is awarded and executed for
construction of a new bed tower at the West Side Division of
the VA health care system in Chicago, Illinois.
Section 4(b) of the bill would define the term ``disposal''
used in subsection (a) as entering into a long-term lease or
sharing agreement in which a party other than the Secretary has
operational control of the facility.
Section 5(a)(1) of the bill would require the Secretary to
develop a plan to (A) establish an inpatient care facility to
meet the health care needs of southern New Jersey veterans, and
(B) establish a plan to meet the health care needs of far south
Texas veterans.
Section 5(a)(2) of the bill would require the Secretary to
consider options using the existing authorities in sections
8111 and 8153 of title 38, United States Code, when developing
the plans under section 5(a)(1)(A) and (B) in developing the
plans to (A) establish a hospital staffed and managed by
Department employees in private, public, or federal facilities,
or (B) enter into contracts with private facilities and
providers for health care of veterans.
Section 5(b) of the bill would require the Secretary to
submit a report to the Committees on Veterans' Affairs of the
Senate and House of Representatives by January 31, 2004; the
report would include the Secretary's plans for facilities in
southern New Jersey and far south Texas, as authorized in
subsection (a).
Section 5(c)(1) of the bill would define the term ``far
south Texas'' as the region that includes the following
counties of the State of Texas: Bee, Calhoun, Crockett, DeWitt,
Dimmit, Goliad, Jackson, Victoria, Webb, Aransas, Duval, Jim
Wells, Kleberg, Nueces, Refugio, San Patricio, Brooks, Cameron,
Hidalgo, Jim Hogg, Kenedy, Starr, Willacy, and Zapata.
Section 5(c)(2) of the bill would define the term
``southern New Jersey'' as the region that includes the
following counties of the State of New Jersey: Ocean,
Burlington, Camden, Gloucester, Salem, Cumberland, Atlantic,
and Cape May.
Section 6 of the bill would amend section 8104(a)(3)(A) of
title 38, United States Code, to define a ``major medical
facility project'' as a project for the construction,
alteration, or acquisition of a medical facility which has a
total expenditure of more than $6,000,000, thus increasing the
ceiling for minor construction projects by $2,000,000.
Section 7 of the bill would designate the VA health care
facility located at 820 South Damen Avenue in Chicago,
Illinois, as the ``Jesse Brown Department of Veterans Affairs
Medical Center'' after the enactment of this Act.
Section 8(a) of the bill would require the Secretary to
conduct a study to examine the feasibility of coordination by
VA of its needs for inpatient hospital, medical care, and long-
term care services for veterans, with the pending construction
of a new university medical center at the Medical University of
South Carolina, Charleston, South Carolina.
Section 8(b)(1) of the bill would require the study to
examine (A) the integration with the Medical University of
South Carolina of some or all of VA's needs for inpatient
hospital, medical care, and long-term care services for
veterans through contribution to the construction of the
university's new medical facility or by becoming a tenant
provider in the new facility, and (B) construction by VA of a
new independent inpatient or outpatient facility alongside or
nearby the university's new facility.
Section 8(b)(2) of the bill would require the Secretary to
consider the degree to which VA and the university medical
center would be able to share expensive technologies and scarce
specialty services that would affect construction plans of the
Secretary or the university.
Section 8(b)(3) of the bill would require the Secretary to
consider the applicability of the authorities under section
8153 of title 38, United States Code, relating to sharing of
health care resources between VA and community provider
organizations, to govern future arrangements and relationships
between VA and the Medical University of South Carolina.
Section 8(c) of the bill would require the Secretary to
consult with the Secretary of Defense to consider establishing
a VA-DOD joint health-care venture at this site.
Section 8(d) of the bill would require the Secretary to
report to the Committees on Veterans' Affairs of the Senate and
House of Representatives on the results of the study and the
Secretary's recommendations based on the findings of the study
by March 31, 2004.
Performance Goals and Objectives
The performance goals and objectives of VA programs dealing
with VA major medical facility construction authorizations, the
management of VA's capital investment and capital maintenance
programs, management of the portfolio of VA minor construction
projects, and prioritization of major medical facility
construction projects, are established in VA's annual
performance plans and budget formulation processes, and are
subject to the Committee's regular oversight.
Statement of the Views of the Administration
Testimony of Honorable Robert H. Roswell, M.D., Under Secretary for
Health, Department of Veterans Affairs, Health Subcommittee Hearing on
H.R. 1720, Veterans Health Care Facilities Capital Improvement Act;
H.R. 2307, to provide for the establishment of new VA medical
facilities for veterans in the area of Columbus, OH, and in south TX;
and H.R. 2349, to authorize certain major medical facility projects for
VA, June 11, 2003
H.R. 1720--VETERANS HEALTH CARE FACILITIES CAPITAL IMPROVEMENT ACT
VA supports H.R. 1720, the Veterans Health Care Facilities Capital
Improvement Act, which would authorize the Secretary to carry out
construction of certain projects using funds appropriated for fiscal
years 2004, 2005, or 2006 without requiring specific authorization on
an individual project basis. Enactment would accelerate the process for
correcting deficiencies in the infrastructure of VA hospitals and help
bring VA hospitals in compliance with existing Federal standards. It
would also facilitate the future planning of projects.
The physical infrastructure of the VA health care system remains
one of the largest in the Federal government with over 5,000 buildings
and 150 million square feet in the inventory. VA has been significantly
challenged to maintain this aging infrastructure and to make the
improvements necessary to meet the needs of modern health care
delivery. We believe H.R. 1720 would improve our ability to respond to
immediate needs of the system's infrastructure and to implement CARES.
The bill would require the review and recommendation of a VA board
independent of the Veterans Health Administration to evaluate each
project before it is proposed to the Secretary for approval. The Senior
Management Council within VA, which has been in place for many years,
can serve this important purpose. The Senior Management Council
provides VA with a comprehensive strategic tool to evaluate capital
program requirements. VA intends to continue with its current capital
asset management program that includes this independent board. VA is
committed to a set of capital programming principles that ensure that
investment decisions are made wisely and efficiently based on accurate
data, after consideration of reasonable alternatives, and provide
veterans high quality health care in safe facilities where they need
it. VA capital asset decision-making continues to evolve and
continuously improve. Many external groups including the General
Accounting Office have commended the process.
VA is encouraged by the intention of H.R. 1720 to provide VA the
flexibility in funding necessary to make critical improvements to its
health care infrastructure. VA's interpretation of the legislation is
that it will not alter the opportunity of VA to propose other projects
through the traditional authorization process.
* * * * * * *
H.R. 2307--A BILL TO ESTABLISH NEW VA MEDICAL FACILITIES IN THE AREA OF
COLUMBUS, OHIO AND SOUTH TEXAS
VA agrees that the need for an expanded/replacement outpatient
clinic in Columbus, as called for in H.R. 2307, will likely be borne
out by the CARES study. The outpatient workload at the existing clinic
has increased beyond the planning level projected when the clinic was
opened. It is premature to endorse the new facility proposed in South
Texas. We are reviewing the need for additional sites in CARES and
until that effort is complete, we do not have a position. Without the
benefit of additional planning, it would be difficult to accurately
estimate the cost of either of the contemplated facilities.
H.R. 2349
In the President's Fiscal Year 2004 budget, VA is requesting
authorization for a major construction project at Chicago (West Side),
Illinois for a new inpatient tower; outpatient clinic leases in Boston,
Massachusetts and Pensacola, Florida; and a lease for the Health
Administration Center in Denver, Colorado. In addition we request an
authorization for the outpatient lease in Charlotte, North Carolina
that received an appropriation in FY 2002.
VA requests an authorization for a lease instead of construction
for the Las Vegas replacement Ambulatory Care Center. VA has determined
that a lease can be procured sooner than construction and that it will
reduce the initial funding required.
The construction projects in the bill for West Haven, Connecticut
and San Diego, California are projects that VA identified in our
``Priority Major Medical Construction Projects'' report to Congress
that we submitted in 2002 for the FY 2003 budget. Based on our
preliminary data from CARES, both medical centers will retain their
current missions and would represent valid projects.
VA asks that the Committee also consider authorizing those seismic
projects that were listed in the President's FY 2003 budget. The
facilities at Palo Alto, San Francisco, and West Los Angeles remain as
a critical risk to the safety of patients and staff in the case of a
seismic event and remain a high priority for VA. We are confident that
the CARES studies will validate the continued need for these major
facilities.
VA supports Sections 1, 2 and 3 of H.R. 2349 and requests that the
Subcommittee consider the additional projects that Dr. Roswell
mentioned.
VA strongly objects to Section 4 of H.R. 2349, which prohibits VA
from spending funds to dispose of the VA's Lakeside property until
after VA has awarded a contract to construct a new bed tower on the
VA's West Side campus. VA is proceeding with design of the bed tower
project for West Side, and concurrently taking steps needed to dispose
of its Lakeside property as soon as possible through an enhanced-use
lease. Both projects are critical to VA's successful realignment of
health care activities to improve veteran services in the City of
Chicago.
Planning and successful execution of a real estate disposal in a
major urban center (like Chicago) is time consuming and complex, taking
anywhere from twelve to twenty months to close. A complex enhanced-use
project like Lakeside requires VA to take a number of actions before it
can actually dispose of the property, including conducting
environmental baseline surveys and assessments as well as initiating
critical discussions with veterans, local officials, the public, and
potential users. For VA to complete these steps and comply with the
congressional notification requirements for enhanced-use leases, VA
must act now to be in position to take full advantage of market
interest and favorable local conditions. Both activities are now on
schedule and actions are progressing independently without adversely
impacting progress on either design or construction of the West Side
project or planning for the execution of the enhanced-use lease.
Section 4 of H.R 2349 will require VA to cease efforts currently
underway, and restart them in approximately 14 months. VA awarded a
schematic design contract on November 2002, a design development
contract in May 2003 for the West Side bed tower and currently
estimates a construction award to be made on schedule in August 2004.
Under the current schedule, an enhanced-use lease might be executed as
early as spring of 2004. This 14 month hiatus will push that execution
back to no earlier than Summer/Fall of 2005.
Linking the two activities, however, will limit VA's ability to use
revenues generated by the disposal of Lakeside to help finance VA's
VISN 12 CARES Implementation Plan. Moreover, if award of the
construction project is delayed due to reasons beyond VA's control,
changing market conditions would likely reduce VA's return and benefit
to veterans.
VA is encouraged by the Subcommittee's interest and actions to
improve the infrastructure of VA's heath care system. VA's capital
infrastructure has suffered for many years from an uncertainty of the
demands and needs for the VA system. I can assure you that there needs
to be a strong and viable infrastructure to support veterans' health
care and that these bills will enable VA to meet those needs. We look
forward to continuing to work with the Subcommittee to ensure that VA
continues to fulfill a grateful Nation's obligation to care for its
veterans.
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, July 9, 2003
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. 1720, the Veterans
Health Care Facilities Capital Improvement Act.
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,
Douglas Holtz-Eakin,
Director
Enclosure.
Congressional Budget Office Cost Estimate
H.R. 1720, Veterans Health Care Facilities Capital Improvement Act
As ordered reported by the House Committee on Veterans' Affairs on June
26, 2003
H.R. 1720 would primarily authorize appropriations for
major construction and the leasing of two medical facilities by
the Department of Veterans Affairs (VA). The bill would
specifically authorize $332 million for 2004 for specific
construction projects and another $500 million in 2004 and $600
million in 2005 for unspecified major construction projects
that would be chosen by the Secretary of Veterans Affairs.
The bill also would authorize VA to lease two medical
facilities for annual lease payments that could not exceed $9.5
million a year. H.R. 1720 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
now be considered minor construction.) Finally, the bill would
name the health care facility of the Department of Veterans
Affairs located at 820 South Damen Avenue in Chicago, Illinois,
as the ``Jesse Brown Department of Veterans Affairs Medical
Center.''
CBO estimates that implementing H.R. 1720 would cost $46
million in 2004 and almost $1.4 billion over the 2004-2008
period, assuming appropriation of the authorized amounts. The
bill would not affect direct spending or receipts.
H.R. 1720 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would not affect the budgets of state, local, or tribal
governments.
Estimated cost to the federal government
The estimated budgetary impact of H.R. 1720 is shown in the
following table. This estimate assumes the legislation will be
enacted by the end of fiscal year 2003, that the necessary
funds for implementing the bill will be provided for each year,
and that outlays will follow historical spending patterns for
existing or similar programs. The costs of this legislation
fall within budget function 700 (veterans benefits and
services).
By Fiscal Year, in Millions of Dollars
-----------------------------------------------
2003 2004 2005 2006 2007 2008
----------------------------------------------------------------------------------------------------------------
Spending Under Current Law for Major Construction of Veterans'
Medical Facilities
Authorization Level 1......................................... 99 0 0 0 0 0
Estimated Outlays............................................. 174 151 98 47 15 4
Proposed Changes
Estimated Authorization Level................................. 0 842 610 10 10 10
Estimated Outlays............................................. 0 46 260 442 405 230
Spending Under H.R. 1720 for Major Construction of Veterans'
Medical Facilities
Estimated Authorization Level 1............................... 99 842 610 10 10 10
Estimated Outlays............................................. 174 197 358 489 420 234
----------------------------------------------------------------------------------------------------------------
1 The 2003 level is the amount appropriated for that year.
Basis of estimate
H.R. 1720 contains provisions that would authorize
appropriations for major construction and the leasing of two
medical facilities by the Department of Veterans Affairs. Taken
together, CBO estimates that implementing these provisions
would cost $46 million in 2004 and almost $1.4 billion over the
2004-2008 period, assuming appropriation of the authorized
amounts.
Section 2 would authorize $500 million in 2004 and $600
million in 2005 for major construction projects including
constructing, improving, replacing, renovating, and updating VA
medical centers. Rather than authorize funds for specific
facilities, this provision would give the Secretary of Veterans
Affairs discretion in choosing the projects. CBO estimates that
implementing this provision would cost $22 million in 2004 and
about $1 billion over the 2004-2008 period, assuming
appropriation of the authorized amounts.
Section 3 would authorize $332 million for 2004 for the
construction, renovation, and improvement of VA medical
facilities in Chicago, Illinois; San Diego, California; West
Haven, Connecticut; Columbus, Ohio; and Pensacola, Florida. CBO
estimates that implementing this provision would cost $15
million in 2004 and $332 million over the 2004-2008 period,
assuming appropriation of the authorized amount.
Section 3 also would authorize VA to lease two medical
facilities for annual lease payments that could not exceed $9.5
million a year. One medical facility would be located in
Charlotte, North Carolina. Under the bill, the annual lease
payment for that facility could not exceed $3 million a year.
While the bill does not specify the length of the lease,
according to VA, it expects that to lease this facility for 20
years. Based on information from VA, CBO believes this lease
would meet the criteria for an operating lease. The second
medical facility would be located in Las Vegas, Nevada. Under
the bill, the annual lease payment for that facility could not
exceed $6.5 million a year. According to VA, it does not
currently have information or plans for leasing any new
facilities in Las Vegas. For the purposes of this estimate, CBO
assumes that this lease also would meet the criteria for an
operating lease. CBO estimates that implementing these leases
would cost $9 million in 2004 and $47 million over the 2004-
2008 period, assuming appropriation of the necessary amounts.
Finally, section 7 would name the health care facility of
the Department of Veterans Affairs located at 820 South Damen
Avenue in Chicago, Illinois, as the ``Jesse Brown Department of
Veterans Affairs Medical Center.'' It also would require that
any reference to such outpatient clinic in any law, map,
regulation, document, paper, or other record of the United
States be considered to be a reference to the clinic by the new
name. CBO estimates that implementing this provision would have
a negligible cost, subject to the availability of appropriated
funds.
Intergovernmental and private-sector impact
H.R. 1720 contains no intergovernmental or private-sector
mandates as defined in UMRA and would not affect the budgets of
state, local, or tribal governments.
Previous cbo estimates
On May 13, 2003, CBO transmitted a cost estimate for H.R.
1908, a bill to name the health care facility of the Department
of Veterans Affairs located at 820 South Damen Avenue in
Chicago, Illinois, as the ``Jesse Brown Department of Veterans
Affairs Medical Center,'' as introduced on May 1, 2003. On May
19, 2003, CBO transmitted a cost estimate for H.R. 1562, the
Veterans Health Care Costs Recovery Act of 2003, as ordered
reported by the House Committee on Veterans' Affairs on May 15,
2003. The provisions in those bills regarding the naming of the
health care facility of the Department of Veterans Affairs
located at 820 South Damen Avenue in Chicago, Illinois are
identical to section 7 of H.R. 1720 and the estimate of
negligible cost is the same in all three estimates.
Estimate prepared by:
Federal Costs: Sam Papenfuss (226-2840)
Impact on State, Local, and Tribal Governments: Melissa
Merrell (225-3220)
Impact on the Private Sector: Allison Percy (226-2900)
Estimate 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.
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):
SECTION 8104 OF TITLE 38, UNITED STATES CODE
Sec. 8104. Congressional approval of certain medical facility
acquisitions
(a)(1) * * *
* * * * * * *
(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.
* * * * * * *
