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110th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     110-648

======================================================================



 
DEPARTMENT OF VETERANS AFFAIRS MEDICAL FACILITY AUTHORIZATION AND LEASE 
                              ACT OF 2008

                                _______
                                

  May 15, 2008.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

  Mr. Filner, from the Committee on Veterans' Affairs, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 5856]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Veterans' Affairs, to whom was referred the 
bill (H.R. 5856) to authorize major medical facility projects 
and major medical facility leases for the Department of 
Veterans Affairs for fiscal year 2009, and for other purposes, 
having considered the same, report favorably thereon without 
amendment and recommend that the bill do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Discussion........................................     3
Hearings.........................................................     9
Committee Consideration..........................................     9
Committee Votes..................................................     9
Committee Oversight Findings.....................................     9
Statement of General Performance Goals and Objectives............     9
New Budget Authority, Entitlement Authority, and Tax Expenditures    10
Earmarks and Tax and Tariff Benefits.............................    10
Committee Cost Estimate..........................................    10
Congressional Budget Office Estimate.............................    10
Federal Mandates Statement.......................................    12
Advisory Committee Statement.....................................    12
Constitutional Authority Statement...............................    12
Applicability to Legislative Branch..............................    13
Section-by-Section Analysis of the Legislation...................    13
Changes in Existing Law Made by the Bill as Reported.............    15

                          Purpose and Summary

    H.R. 5856 was introduced by Representative Michael H. 
Michaud of Maine, the Chairman of the Subcommittee on Health, 
on April 22, 2008. This legislation would authorize major 
construction projects and medical facility leases for the 
Department of Veterans Affairs for fiscal year 2009. This bill 
would expand and improve the health care delivery to veterans 
throughout the VA health care system. It would also provide for 
state-of-the-art facilities and address current gaps in 
services.

H.R. 5856 would:

    1. Authorize appropriations for:
     Seismic corrections to building 2 at the VAMC in 
Palo Alto, California in the amount of $54 million.
     Construction of a polytrauma health care and 
rehabilitation center at the VAMC in San Antonio, Texas, in the 
amount of $66 million.
     Seismic correction to building 1, at the VAMC in 
San Juan, Puerto Rico, in the amount of $225,900 million.
    2. Increase authorization amounts for previously authorized 
construction projects:
     Increases the authorization level for the New 
Orleans VAMC replacement facility to $625,000,000.
     Increases the authorization level for the Denver 
VAMC, replacement medical facility to $769,200,000.
     Increases the authorization for the correction of 
patient privacy issues at the Gainesville, Florida VAMC to 
$136,700,000.
     Increases the authorization for the construction 
of a new medical facility in Las Vegas, Nevada to $600,400,000.
     Increases the authorization for the construction 
of a new outpatient clinic in Lee County, Florida to 
$131,800,000 million.
     Increases the authorization for the construction 
of a new medical facility in Orlando, Florida to $656,800,000.
     Increases the authorization for the consolidation 
of campuses at the University Drive and H. John Heinz III 
Divisions to $295,600,000.
    3. Authorize the Secretary of Veterans Affair to carry out 
major medical facility leases in the following twelve 
locations:
     Brandon, Florida outpatient clinic in the amount 
of $4,326,000.
     Colorado Springs, Colorado outpatient clinic in 
the amount of $3,995,000.
     Eugene, Oregon outpatient clinic in the amount of 
$5,826,000.
     Greenville, South Carolina outpatient clinic in 
the amount of $3,731,000.
     Mansfield, Ohio outpatient clinic in the amount of 
$2,212,000.
     Mayaguez, Puerto Rico outpatient clinic in the 
amount of $6,276,000.
     Mesa, Arizona outpatient clinic in the amount of 
$5,106,000.
     Sun City, Arizona outpatient clinic in the amount 
of $2,295,000.
     Expansion of an outpatient clinic in Green Bay, 
Wisconsin, in the amount of $5,891,000.
     Expansion of an outpatient clinic in Savannah, 
Georgia in the amount of $3,168,000.
     Interim research space in Palo Alto, California in 
the amount of $8,636,000.
     Primary care annex in Tampa, Florida in the amount 
of $8,652,000.
    4. Authorize the Secretary of Veterans Affairs to construct 
a new medical facility in Okaloosa County, Florida, in an 
amount not to exceed $54,475,000.
    5. Authorize $345,900,000 to be appropriated for Major 
Medical Facility Projects for Fiscal Year 2009.
    6. Authorize $1,694,295,000 to be appropriated for 
modifications of major medical facility authorizations for FY 
2009 and modifications for certain major medical facility 
construction projects previously authorized in connection with 
the Capital Asset Realignment for Enhanced Services (CARES).
    7. Authorize $54,475,000 to be appropriated for the 
construction of a major medical facility in section 5.
    8. Require the Secretary to submit a report on the progress 
in complying with Section 312A of 38 U.S.C. Section 312A 
governs the establishment and responsibilities of the Director 
of Construction and Facilities Management which was a position 
established in P.L. 109-461.
    9. Require Secretary to submit an annual report on 
outpatient clinics.

                       Background and Discussion

    VA's medical infrastructure is old and outdated. The 
average age of a VA facility is over 50 years old. With the 
enactment of eligibility reform in 1996, VA's health care 
delivery model has undergone a transformation from inpatient-
centered care to one of outpatient-centered care. The Capital 
Asset Realignment for Enhanced Services (CARES) process 
initiated in 1998 by VA created a blueprint for the future 
construction needs of the Department. CARES is a comprehensive 
assessment for identifying the demand for VA care and 
projecting future appropriate models of delivery of health care 
to veterans throughout the VA's system of health care.
    Section 8104(a)(2) of title 38, United States Code, 
requires statutory authorization for all major medical facility 
construction projects (defined as those which cost more than 
$10 million) and all major medical facility leases exceeding 
$600,000 (including parking facilities) prior to the 
appropriation or expenditure of funds.

                 MAJOR MEDICAL FACILITY AUTHORIZATIONS

    H.R. 5856 provides authorization for 11 major medical 
facility projects and 12 major medical facility leases.
    Palo Alto, California: The Palo Alto project received $34 
million in fiscal year 2005 and an additional $20 million in 
fiscal year 2008 budget authority to complete construction, 
with a total estimated cost of $54 million. This project would 
replace an obsolete, functionally deficient and seismically 
unsafe acute psychiatric inpatient building by constructing an 
80-bed, 78,000 square-foot replacement facility at VA Palo Alto 
Heath Care System's Palo Alto Division. After completion of the 
80-bed acute psychiatric inpatient replacement facility, 
Building 2 would be decommissioned and razed, with the land 
being converted to patient parking.
    San Antonio, Texas: The San Antonio project received the 
total estimated cost of $66 million in a reprogramming action 
in fiscal year 2008 to complete design and construction. This 
project would provide a new 84,000 state-of-the-art Polytrauma 
Healthcare and Rehabilitation Center. The Center would consist 
of a polytrauma ward, transitional housing, Physical Medicine 
and Rehabilitation Service, Prosthetics Service, and polytrauma 
research and support programs. Additionally, spaces vacated by 
programs moving to the new center would be renovated and 
parking deficiencies addressed.
    San Juan, Puerto Rico: The San Juan project received $14.88 
million in fiscal year 2005, which was reduced by $4 million in 
a reprogramming action in fiscal year 2006, and received $59 
million in fiscal year 2008. This project requires an 
additional $64.4 million in fiscal year 2009 budget authority 
to construct the administrative building, with a total 
estimated cost of approximately $225.9 million. This project 
would complete the seismic corrections in the main hospital 
building to comply with occupancy standards. The second phase 
of approximately 100,000 square feet of new construction would 
house administrative functions to meet VA's immediate occupancy 
standards.
    Okaloosa County, Florida: Okaloosa County, Florida, is home 
to one of the largest veteran populations in the nation, yet 
veterans have to drive over three hours to receive VA inpatient 
care. The area is located in the Eastern Southern Market of 
Veterans Integrated Service Network 16, which the CARES 
decision identified as ``the only market in the VISN without a 
medical center and it. . . is underserved for inpatient care. 
The CARES decision further stated that ``[t]he VISN also will 
continue to pursue opportunities to expand its current sharing 
with Eglin Air Force Base (AFB) to enhance inpatient care 
services.''
    As of April 2008, veterans in this area were only able to 
receive outpatient care at a VA community-based outpatient 
clinic located at Eglin AFB in Okaloosa County. On November 1, 
2007, Major General David W. Eidsaune, Commander, Air Armament 
Center, Eglin AFB, Florida, testified before the Subcommittee 
on Health of the Committee on Veterans' Affairs that the VA and 
the Department of Defense (DoD) have developed a successful 
partnership to provide accessible health care in northwest 
Florida.
    Based on the CARES recommendations and the existing 
cooperative VA/DoD history, section 823 of Public Law 109-461 
required that the Secretary of VA conduct a study in 
conjunction with the Secretary of DoD and the Secretary of the 
Air Force to develop options for the VA on the placement of a 
VA Medical Center in Okaloosa County, Florida. Completed in 
June 2007, the study identified three options for providing 
inpatient care in Okaloosa County, Florida. Implementing Option 
2 was identified as the most feasible of the three options. 
Option 2 would expand the outpatient specialty care space at 
Eglin AFB Hospital through Federal construction, and would 
establish a VA/DoD sharing agreement with Eglin AFB Hospital to 
provide medical and surgical acute inpatient services to 
veterans, and expand specialty outpatient care.

                 INCREASES IN PRIOR YEAR AUTHORIZATIONS

    Authorizations for appropriations were increased for 
projects authorized in Public Law 109-461, the ``Veterans 
Benefits, Health Care, and Information Technology Act of 
2006.'' VA has reported that these projects have increased in 
cost and new authorization levels must be obtained to move 
forward with the projects. There are six projects that have 
increased in cost and require increased authorizations: New 
Orleans VA Medical Center (VAMC); Denver VAMC; Gainesville, 
Florida, VAMC; new medical facility in Las Vegas; new 
outpatient clinic in Lee County, Florida; and new medical 
facility in Orlando, Florida.
    Denver, Colorado: H.R. 5856 would provide VA an 
authorization in the amount not to exceed $769,200,000 for the 
replacement of the Denver, Colorado, VAMC. This authorization 
was requested by the Administration in February in the fiscal 
year 2009 budget submission. However, on April 24, 2008, the 
Secretary of Veterans Affairs announced his decision to change 
the scope of the project. VA now intends to construct a new bed 
tower in partnership with the University of Colorado Denver and 
the University of Colorado Hospital (UCH) on University 
property at the former Fitzsimons Army Medical Center campus.
    The Committee strongly supports the Secretary's decision to 
once again move forward with a joint use facility. We recognize 
that it may be necessary to amend the authorization as planning 
and design for a new shared facility is developed.
    There has been a long and detailed history of planning for 
a shared facility to replace the existing Denver VAMC. 
Discussions between VA and UCH regarding the relocation of the 
Denver VAMC to the Fitzsimons campus started in 2000. In 2003, 
Congress enacted Public Law 108-170, the ``Veterans Health 
Care, Capital Asset, and Business Improvement Act of 2003.'' 
The law authorized advance planning in an amount not to exceed 
$30 million for the contemplated joint use facility. 
Additionally, Public Law 108-422, the ``Veterans Health 
Programs Improvement Act of 2004,'' authorized VA to enter into 
a long-term lease of up to 75 years at UCH. This authority was 
necessary for VA to acquire a sufficient land interest for the 
construction of a shared facility on the Fitzsimons Campus. 
Following enactment of the law, to the disappointment of the 
Committee, VA gave notice of its intention not to enter into a 
lease and instead purchase land on a separate site at the 
Fitzsimons campus for a freestanding VA medical center. On 
March 29, 2007, VA acquired 17.8 acres of land that is now 
intended to be used for a state-of-the-art VA Ambulatory Health 
Care Center, parking garage and administrative offices.
    However, the Committee remains concerned that the new plan 
for Denver does not reflect the authorization included in this 
bill. We expect VA to provide the Committee with a detailed 
prospectus and briefing on the announced changes for the major 
medical facility project in Denver.

                          LEASE AUTHORIZATIONS

    Twelve leases require authorization for FY 2009: Brandon, 
Florida; Colorado Springs, Colorado; Eugene, Oregon; 
Greenville, South Carolina; Mansfield, Ohio; Mayaguez, Puerto 
Rico; Mesa, Arizona; Sun City, Arizona; Expansion of an 
outpatient clinic in Green Bay, Wisconsin; Expansion of an 
outpatient clinic in Savannah, Georgia; Interim research space 
in Palo Alto, California; and primary care annex in Tampa, 
Florida.
    Brandon, Florida: The bill would authorize a 50,000 square 
foot multi-specialty clinic lease in Brandon, Florida, that 
would affect 10,425 unique veterans. Because of the rapidly 
expanding population growth, lack of public transportation, and 
inadequate highway infrastructure, the Brandon Clinic would 
significantly improve access to veterans in Southeastern 
Hillsborough County. The lease is fully authorized in the 
measure for $4,326,000.
    Colorado Springs, Colorado: The existing Colorado Springs 
Community Based Outpatient Clinic (CBOC) lease expires on 
August 31, 2010. The project would relocate and expand the 
current clinic into approximately 47,000 square feet of 
outpatient clinic space. This project would allow the VA to 
continue to provide timely access to state-of-the-art primary 
care, specialty care, and mental health services for veterans 
in the area. The lease is fully authorized in the measure for 
$3,995,000.
    Eugene, Oregon: The existing Eugene CBOC lease expires in 
2012. This lease would relocate and expand the current clinic 
into approximately 66,000 square feet of outpatient clinic 
space. The lease is fully authorized in this measure for 
$5,826,000.
    Greenville, South Carolina: The lease in Greenville, South 
Carolina would relocate and expand the current clinic to 
approximately 45,900 square feet of new outpatient clinic space 
due to the expiration of the current lease. This expansion 
would address the access and capacity issues for primary care 
and specialty care services that currently exist. The lease is 
fully authorized in this measure for $3,731,000.
    Mansfield, Ohio: The lease in Mansfield, Ohio would 
construct a new Mansfield CBOC to augment existing services 
provided and add new services to the more than 5,800 unique 
veterans served. The new clinic would be approximately 27,500 
square feet and would eliminate the physical separation between 
primary care and mental health services that currently exists. 
The lease is fully authorized in this measure for $2,212,000.
    Mayaguez, Puerto Rico: The current leased clinic space has 
significant infrastructure deficiencies that would be very 
costly to repair. Under a new lease contract, the Mayaguez 
clinic would continue to provide the same services to its 
veteran service area in a structure that measures approximately 
70,100 square feet. The lease is fully authorized in this 
measure for $6,276,000.
    Southeast Mesa, Arizona: The lease for the existing 
Southeast Mesa, Arizona CBOC expires on December 30, 2011. This 
lease would relocate and expand the current 42,500 square foot 
clinic into approximately 60,000 square feet of outpatient 
clinic space. The lease is fully authorized in this measure for 
$5,106,000.
    Sun City, Arizona: The existing Sun City, Arizona Northwest 
Extension Clinic lease expires on April 30, 2009. This project 
would relocate and expand the current 8,916 square feet clinic 
into approximately 25,000 square feet of outpatient clinic 
space. This project would allow the VA to continue to provide 
timely access to state-of-the-art primary care clinics, 
specialty care clinics, mental health and ancillary diagnostic 
services in a properly sized clinic to meet increased workload. 
Dental care would be introduced as a new service offered after 
relocation into the larger space. The lease is fully authorized 
in this measure for $2,295,000.
    Green Bay, Wisconsin: The lease authorization in Green Bay, 
Wisconsin, would provide authority to construct an Ambulatory 
Surgery/Outpatient Diagnostic Center and CBOC for the North and 
Central submarket of VISN 12. The current clinic has reached 
its physical capacity and the expansion is needed to meet the 
needs of more than 1,500 patients currently on temporary fee 
authorization, and to provide closer access for nearly 4,000 
patients from this catchment area currently being seen at the 
Appleton and Cleveland CBOC. Additional space would be 
necessary to support the ancillary services needed to provide 
appropriate services to these patients including laboratory, 
radiology, mental health, social work and home based primary 
care. The lease is fully authorized in the measure for 
$5,891,000.
    Savannah, Georgia: The Savannah, Georgia, CBOC is a long 
established facility serving southeastern Georgia and the 
southern tip of South Carolina. This lease would maintain the 
clinic presence in the Savannah area while increasing the net 
usable space from 34,760 square feet to 38,900 square feet. 
This facility would provide access to primary care, mental 
health services, specialty care, diagnostic services and home-
based health care for area veterans and the Fort Stewart and 
Fort Hunter Army Airfield communities. The lease is fully 
authorized in this measure for $3,168,000.
    Palo Alto, California: The Palo Alto lease authorization 
would authorize the lease of up to 100,000 square feet of wet 
and dry bench research laboratory facilities in the San 
Francisco Bay area to house approximately 300 VA researchers 
and other miscellaneous programs displaced due to major and 
minor construction projects. The lease is fully authorized in 
this measure for $8,636,000.
    Tampa, Florida: The proposed lease in Tampa, Florida would 
move all Primary Care services to a 100,000 square foot off-
site location within close proximity of the parent campus. This 
relocation would have the primary benefit of decompressing the 
parent facility so that Specialty Clinics can be expanded. The 
lease is fully authorized in this measure for $8,652,000.

                             OTHER MATTERS

    Far South Texas: Veterans in far South Texas face an 
excessive travel burden to obtain inpatient care at the San 
Antonio VA Medical Center. Round trip travel time from 
Harlingen is about ten hours and from Corpus Christi, about 
five hours. Public Law 108-170 required VA to develop a plan 
for meeting the future hospital care needs of veterans who 
reside in this region. On April 30, 2004, VA submitted a report 
to Congress with a plan consistent with the CARES Decision. The 
plan included an expansion of services in Harlingen, Corpus 
Christi, and the McAllen Clinic.
    In August 2007, Booz Allen Hamilton released a report on 
veteran health care needs in South Texas that was requested by 
Senator Kay Bailey Hutchison of Texas. The Booz Allen Hamilton 
report included options for expanding VA health care services 
in the Harlingen and Corpus Christi areas.
    As recommended, the Committee supports expanding services 
at the McAllen Clinic, Corpus Christi, and Harlingen.
    VA is moving forward with an expansion of services in 
Harlingen that would be comprehensive in terms of providing 
medical care and reduce the rate of travel to San Antonio VAMC 
by about at least 90 percent. VA is implementing a plan in 
collaboration with the University of Texas Regional Academic 
Health Center, to provide a full spectrum of services in 
Harlingen with a lease-build out over the next three years. The 
Committee expects the new facility to be named the ``Far South 
Texas VA Medical Care Center.''
    Additionally, the Committee expects that the current Deputy 
Director position that has been established for far South Texas 
will be transitioned to the title of Health Care System 
Director, Coastal Bend/Lower Rio Grande Valley/Laredo Health 
Care System starting in fiscal year 2010. This Director will 
report directly to the VA Heart of Texas Health Care Network 
Director.
    We remain committed to ensuring that VA fully funds, and 
remains focused on, an aggressive plan to maximize local access 
to care for veterans in far South Texas.
    Guam: The Committee is concerned about the future provision 
of health care services for veterans residing in Guam and the 
Pacific Islands that make up the Compact of Free Association.
    VA and DoD currently have a memorandum of understanding 
(MOU) to provide inpatient and specialty care for veteran 
beneficiaries on a space available basis. The MOU is set to 
expire on December 31, 2010. Additionally, DoD is anticipating 
the relocation of 8,000 to 12,000 Marines from Okinawa to Guam 
by 2014 that would nearly double the total patient population 
served by the U.S. Naval Hospital Guam. To meet the increased 
demand, the Navy will replace the existing facility. Several 
sites are being considered. The Secretary of the Navy informed 
the Committee that a site location decision will be made by May 
31, 2008. The Committee strongly recommends that the new Naval 
Hospital be built at the current location. Further, to ensure 
continued access to the Naval Hospital by veterans, we 
recommend that VA and DoD enter into a joint agreement whereby 
veterans are guaranteed access to inpatient and specialty 
services at U.S Naval Hospital Guam.
    Fort Ord, California: The Committee is aware there is a VA 
feasibility study underway to determine the need for a CBOC in 
the Ord Military Community. We strongly encourage the 
completion of this study as expeditiously as possible and look 
forward to the results and recommendations that will address 
future health care needs for veterans in the area.
    Northeast Iowa: The Committee is concerned that the 
Veterans Integrated Service Network 23 has identified rural 
Northeast Iowa as an underserved area. Veterans in Northeastern 
Iowa do not meet the VA access standard of having VA primary 
care community based outpatient clinic located within 30 
minutes of 70 percent of veterans living in the area. The VA is 
now conducting a more comprehensive analysis to determine what 
strategies might improve delivery of VA health care services in 
the area. The study is expected to be completed by June 30, 
2008. We encourage VA to have a strategy in place that will 
meet the access to care needs of veterans residing in Northeast 
Iowa in fiscal year 2010. This may include community-based 
outpatient or outreach clinics, telemedicine, or contract care 
with existing local medical facilities.

                                Hearings

    On February 27, 2008, the Subcommittee on Health held a 
hearing entitled ``U.S. Department of Veterans Affairs 
Construction Authorization.'' The following witnesses 
testified: Mr. Dennis M. Cullinan, Director, National 
Legislative Service, Veterans of Foreign Wars of the United 
States, On Behalf of The Independent Budget; Mr. Joseph L. 
Wilson, Deputy Director, Veterans Affairs and Rehabilitation 
Commission, The American Legion; Mr. Richard F. Weidman, 
Executive Director for Policy and Government Affairs, Vietnam 
Veterans of America; and Mr. Donald H. Orndoff, Director, 
Office of Construction and Facilities Management, U.S. 
Department of Veterans Affairs, accompanied by Mr. Robert L. 
Neary, Director, Service Delivery Office, U.S. Department of 
Veterans Affairs; Mr. James M. Sullivan, Deputy Director, 
Office of Asset Enterprise Management, Office of Management, 
U.S. Department of Veterans Affairs; and, Mr. Joseph Williams, 
Assistant Deputy Under Secretary for Health for Operations and 
Management, Veterans Health Administration, U.S. Department of 
Veterans Affairs.

                        Committee Consideration

    On April 23, 2008, the Subcommittee on Health met in open 
markup session and ordered favorably forwarded to the full 
Committee H.R. 5856, without amendment, by voice vote.
    On April 30, 2008, the full Committee met in open markup 
session, a quorum being present, and ordered H.R. 5856 
favorably reported to the House of Representatives, by voice 
vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report the legislation and amendments thereto. 
There were no record votes taken on amendments or in connection 
with ordering H.R. 5856 reported to the House. A motion by Mr. 
Buyer of Indiana to order H.R. 5856 reported favorably to the 
House of Representatives was agreed to by voice vote.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII and clause 
(2)(b)(1) of rule X of the Rules of the House of 
Representatives, the Committee's oversight findings and 
recommendations are reflected in the descriptive portions of 
this report.

         Statement of General Performance Goals and Objectives

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's performance 
goals and objectives are reflected in the descriptive portions 
of this report.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee adopts as its 
own the estimate of new budget authority, entitlement 
authority, or tax expenditures or revenues contained in the 
cost estimate prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

                  Earmarks and Tax and Tariff Benefits

    H.R. 5856 contains the following congressional earmark, 
limited tax benefit, or limited tariff benefit as defined in 
clause 9(d), 9(e), or 9(f) of rule XXI of the Rules of the 
House of Representatives:
    1. Authorization for the VA to construct a new medical 
facility in Okaloosa County, Florida, in an amount not to 
exceed $54,455,000, offered by Representative Jeff Miller of 
Florida, Ranking Member of the Subcommittee on Health of the 
Committee on Veterans' Affairs.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate on H.R. 
5856 prepared by the Director of the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974.

               Congressional Budget Office Cost Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 5856 provided by the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, May 12, 2008.
Hon. Bob Filner,
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. 5856, the 
Department of Veterans Affairs Medical Facility Authorization 
and Lease Act of 2008.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Sunita 
D'Monte.
            Sincerely,
                                         Robert A. Sunshine
                                   (For Peter R. Orszag, Director).
    Enclosure.

H.R. 5856--Department of Veterans Affairs Medical Facility 
        Authorization and Lease Act of 2008

    Summary: H.R. 5856 would authorize funding for the 
construction, renovation, improvement, or leasing of several 
medical facilities by the Department of Veterans Affairs (VA). 
The bill would specifically authorize the appropriation of $2.1 
billion in 2009 for 11 projects, and $60 million for leasing 12 
clinics or other facilities. CBO estimates that implementing 
H.R. 5856 would cost $146 million in 2009 and about $2.2 
billion over the 2009-2013 period, assuming appropriation of 
the authorized and estimated amounts. CBO estimates that 
enacting the bill would have no effect on direct spending or 
revenues.
    H.R. 5856 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. 5856 is shown in the following table. 
The costs of this legislation fall within budget function 700 
(veterans benefits and services).

----------------------------------------------------------------------------------------------------------------
                                                                  By fiscal year, in millions of dollars--
                                                           -----------------------------------------------------
                                                              2008     2009     2010     2011     2012     2013
----------------------------------------------------------------------------------------------------------------
                                        SPENDING SUBJECT TO APPROPRIATION

Spending Under Current Law for Major Construction of
 Veterans Medical Facilities:
    Budget Authority\1\...................................    1,135        0        0        0        0        0
    Estimated Outlays.....................................      525      680      572      343      119       33
Proposed Changes:
    Major Medical Facility Projects:
        Authorization Level...............................        0    2,095        0        0        0        0
        Estimated Outlays.................................        0       92      563      681      503      191
    Leases for Medical Facilities:
        Estimated Authorization Level.....................        0       60       22       22       22       22
        Estimated Outlays.................................        0       54       25       22       22       22
        Total Changes:
            Estimated Authorization Level.................        0    2,155       22       22       22       22
            Estimated Outlays.............................        0      146      589      702      524      212
Spending Under H.R. 5856:
    Estimated Authorization Level\1\......................    1,135    2,155       22       22       22       22
    Estimated Outlays.....................................      525      826    1,161    1,045      643     245
----------------------------------------------------------------------------------------------------------------
\1\The 2008 level is the amount appropriated for that year.

    Basis of estimate: For this estimate, CBO assumes that the 
legislation will be enacted before the end of fiscal year 2008, 
that the authorized and estimated amounts will be appropriated 
near the start of each fiscal year, and that outlays will 
follow historical spending patterns for similar programs.
    H.R. 5856 would authorize appropriations for major 
construction and leasing of medical facilities by VA. It also 
would require VA to prepare reports addressing specific 
construction issues. CBO estimates that implementing H.R. 5856 
would cost about $2.2 billion over the 2009-2013 period, 
assuming appropriation of the necessary amounts.

Major medical facility projects

    Sections 2, 3, and 5 would authorize work on a number of 
medical facility projects. CBO estimates that implementing 
those three sections would cost $2 billion over the 2009-2013 
period, assuming appropriation of the authorized amounts.
    Section 3 would authorize the appropriation of about $1.7 
billion in 2009 for additional funding for construction, 
renovation, repairs, and upgrades to seven major projects that 
were previously authorized under Public Law 109-461.
    Section 2 would authorize the appropriation of $346 million 
in 2009 for three new construction projects including a 
polytrauma center in San Antonio, Texas, and seismic 
corrections to facilities in Palo Alto, California, and San 
Juan, Puerto Rico.
    Section 5 would authorize the appropriation of $55 million 
in 2009 to construct a new medical facility in Okaloosa County, 
Florida.

Leases for medical facilities

    Section 4 would authorize the Secretary of VA to lease 
facilities for 10 outpatient clinics, a primary care annex, and 
a research laboratory. The bill would authorize the 
appropriation of $60 million in 2009 for lease payments for the 
first year. Based on information from VA's 2009 budget request, 
CBO estimates that VA would enter into 20-year lease agreements 
for those facilities, and that VA would have additional costs 
of about $22 million a year starting in 2010. (Costs are higher 
in 2009 than other years because VA would pay the lessors 
additional amounts in the first year of the lease for necessary 
improvements and upgrades.) Thus, CBO estimates that 
implementing this section would cost $145 million over the 
2009-2013 period, assuming appropriation of the necessary 
amounts.

Other provisions

    Section 7 would require VA to prepare a report on its 
progress in appointing a Director of Construction and 
Facilities Management. Section 8 would require VA to prepare an 
annual report on outpatient clinics. CBO estimates that 
implementing those provisions would have an insignificant 
impact on discretionary spending.
    Intergovernmental and private-sector impact: H.R. 5856 
contains no intergovernmental or private-sector mandates as 
defined in UMRA and would not affect the budgets of state, 
local, or tribal governments.
    Estimate prepared by: Federal costs: Sunita D'Monte; Impact 
on state, local, and tribal governments: Lisa Ramirez-Branum; 
Impact on the private sector: Daniel Frisk.
    Estimate approved by: Theresa Gullo, Deputy Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 5856 prepared by the Director of the 
Congressional Budget Office pursuant to section 423 of the 
Unfunded Mandates Reform Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
5856.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for H.R. 5856 is provided by Article 
I, section 8 of the Constitution of the United States.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    This Act may be cited as the ``Department of Veterans 
Affairs Medical Facility Authorization and Lease Act of 2008.''

Section 2. Authorization for fiscal year 2009 major medical facility 
        projects. The authorization total for this section is $345,900 
        million

    This section authorizes appropriations for:
     Seismic corrections to building 2 at the VAMC in 
Palo Alto, California in the amount of $54 million.
     Construction of a polytrauma healthcare and 
rehabilitation center at the VAMC in San Antonio, Texas in the 
amount of $66 million.
     Seismic correction to building 1, at the VAMC in 
San Juan, Puerto Rico in the amount of $225,900 million.

Section 3. Modification of authorization amounts for certain major 
        medical facility construction projects previously authorized. 
        The authorization total for this section is $1,694,295,000

    This section increases previously authorized construction 
projects that were included in Public Law 109-461 and since 
that time have increased in cost:
     Raises the authorization level for the New Orleans 
VAMC replacement facility to $625 million. An increase of $325 
million.
     Raises the authorization level for the Denver VAMC 
replacement medical facility to $769,200 million. An increase 
of $671,200 million.
     Raises the authorization for the correction of 
patient privacy issues at the Gainesville, Florida VAMC to 
$136,700 million. An increase of $51,500 million.
     Raises the authorization for the construction of a 
new medical facility in Las Vegas, Nevada to $600,400 million. 
An increase of $194,400 million.
     Raises the authorization for the construction of a 
new outpatient clinic in Lee County, Florida to $131,800 
million. An increase of $66,700 million.
     Raises the authorization for the construction of a 
new medical facility in Orlando, Florida to $656,800. An 
increase of $279,100 million.
     Raises the authorization for the consolidation of 
campuses at the University Drive and H. John Heinz III 
Divisions to $295,600 million. An increase of $106,395 million.

Section 4. Authorization of fiscal year 2009 major medical facility 
        leases. The total for this section is $60,114 million

    This section authorizes the Secretary of Veterans Affairs 
to carry out major medical facility leases in twelve locations. 
The following eight leases are for outpatient clinics:
     Brandon, Florida, in the amount of $4,326 million.
     Colorado Springs, Colorado, in the amount of 
$3,995 million.
     Eugene, Oregon, in the amount of $5,826 million.
     Greenville, South Carolina, in the amount of 
$3,731 million.
     Mansfield, Ohio, $2,212 million.
     Mayaguez, Puerto Rico, $6,276 million.
     Mesa, Arizona, $5,106 million.
     Sun City, Arizona, in the amount of $2,295 
million.
    The other four leases are requested for:
     Expansion of an outpatient clinic in Green Bay, 
Wisconsin, in the amount of $5,891 million.
     Expansion of an outpatient clinic in Savannah, 
Georgia, $3,168 million.
     Interim research space in Palo Alto, California in 
the amount of $8,636 million.
     Primary care annex in Tampa, Florida, $8,652 
million.

Section 5. Authorization of construction of major medical facility, 
        Okaloosa County, Florida

    This section authorizes the Secretary of Veterans Affairs 
to construct a new medical facility in Okaloosa County, Florida 
in an amount not to exceed $54,475 million.

Section 6. Authorization of appropriation

    For Major Medical Facility Projects for fiscal year 2009, 
this section authorizes to be appropriated an amount of 
$345,900 million.
    For modifications of major medical facility authorizations 
for fiscal year 2009 and modifications for certain major 
medical facility construction projects previously authorized in 
connection with the Capital Asset Realignment for Enhanced 
Services this section authorizes to be appropriated an amount 
of $1,694,295,000.
    For the construction of a major medical facility in section 
5 in the amount of $54,475 million.

Section 7. Facilities administration

    This section requires the Secretary to submit a report on 
the progress in complying with section 312A of 38 U.S.C. 312A 
governs the establishment and responsibilities of the Director 
of Construction and Facilities Management which was a position 
established in P.L. 109-461.

Section 8. Annual report on outpatient clinics

    This section requires VA to submit an annual report on 
outpatient clinics.

Section 9. Technical correction

    This section makes a technical correction to P.L. 109-461.

         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 italic, existing law in which no change is 
proposed is shown in roman):

VETERANS BENEFITS, HEALTH CARE, AND INFORMATION TECHNOLOGY ACT OF 2006

           *       *       *       *       *       *       *



                    TITLE VIII--CONSTRUCTION MATTERS

             Subtitle A--Construction and Lease Authorities

SEC. 801. AUTHORIZATION OF FISCAL YEAR 2006 MAJOR MEDICAL FACILITY 
                    PROJECTS.

  (a) In General.--The Secretary of Veterans Affairs may carry 
out the following major medical facility projects in fiscal 
year 2006, with each project to be carried out in the amount 
specified for that project:
          (1) Restoration, new construction or replacement of 
        the medical center facility for the Department of 
        Veterans Affairs Medical Center, New Orleans, 
        Louisiana, due to damage from Hurricane Katrina in an 
        amount not to exceed [$300,000,000] $625,000,000. [The 
        Secretary is authorized to carry out the project in or 
        near New Orleans as a collaborative effort consistent 
        with the New Orleans Collaborative Opportunities Study 
        Group Report dated June 12, 2006.]

           *       *       *       *       *       *       *

          (3) Replacement of the Department of Veterans Affairs 
        Medical Center, Denver, Colorado, in an amount not to 
        exceed [$98,000,000] $769,200,000.

           *       *       *       *       *       *       *


SEC. 802. EXTENSION OF AUTHORIZATION FOR CERTAIN MAJOR MEDICAL FACILITY 
                    CONSTRUCTION PROJECTS PREVIOUSLY AUTHORIZED IN 
                    CONNECTION WITH CAPITAL ASSET REALIGNMENT 
                    INITIATIVE.

  The Secretary of Veterans Affairs may carry out the following 
major medical facility projects, with each such project to be 
carried out in the amount specified for that project:
          (1) * * *

           *       *       *       *       *       *       *

          (5) Correction of patient privacy deficiencies at the 
        Department of Veterans Affairs Medical Center, 
        Gainesville, Florida, in an amount not to exceed 
        [$85,200,000] $136,700,000.

           *       *       *       *       *       *       *

          (7) Construction of a new Medical Center Facility at 
        the Department of Veterans Affairs Medical Center, Las 
        Vegas, Nevada, in an amount not to exceed 
        [$406,000,000] $600,400,000.
          (8) Construction of an [ambulatory surgery/outpatient 
        diagnostic support center in the Gulf South Submarket 
        of Veterans Integrated Service Network (VISN) 8 and 
        completion of Phase I land purchase,] outpatient clinic 
        in Lee County, Florida, in an amount not to exceed 
        [$65,100,000] $131,800,000.

           *       *       *       *       *       *       *

          (11) Construction of a new medical center facility in 
        the Orlando, Florida, area in an amount not to exceed 
        [$377,700,000] $656,800,000.
          (12) Consolidation of campuses at the University 
        Drive and H. John Heinz III divisions, Pittsburgh, 
        Pennsylvania, in an amount not to exceed [$189,205,000] 
        $295,600,000.

           *       *       *       *       *       *       *


SEC. 807. AUTHORIZATION OF APPROPRIATIONS.

  (a) * * *

           *       *       *       *       *       *       *

  (e) Authorization of Appropriations for Major Medical 
Facility Leases.--
          (1) Fiscal year 2006 leases.--There is authorized to 
        be appropriated for the Secretary of Veterans Affairs 
        for fiscal year 2006 for the [Medical Care] Medical 
        Facilities account, $24,990,000 for the leases 
        authorized in section 805.
          (2) Fiscal year 2007 leases.--There is authorized to 
        be appropriated for the Secretary of Veterans Affairs 
        for fiscal year 2007 for the [Medical Care] Medical 
        Facilities account, $26,642,000 for the leases 
        authorized in section 806.

           *       *       *       *       *       *       *

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TITLE 38, UNITED STATES CODE

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PART VI--ACQUISITION AND DISPOSITION OF PROPERTY

           *       *       *       *       *       *       *



   CHAPTER 81--ACQUISITION AND OPERATION OF HOSPITAL AND DOMICILIARY 
    FACILITIES; PROCUREMENT AND SUPPLY; ENHANCED-USE LEASES OF REAL 
                                PROPERTY


      SUBCHAPTER I--ACQUISITION AND OPERATION OF MEDICAL FACILITIES

Sec.
8101.  Definitions.
     * * * * * * *
8119.  Annual report on outpatient clinics.

           *       *       *       *       *       *       *


SUBCHAPTER I--ACQUISITION AND OPERATION OF MEDICAL FACILITIES

           *       *       *       *       *       *       *


Sec. 8119. Annual report on outpatient clinics

  (a) Annual Report Required.--The Secretary of Veterans 
Affairs shall submit to the Committees on Veterans' Affairs of 
the Senate and House of Representatives an annual report on 
community-based outpatient clinics and other outpatient 
clinics. The report shall be submitted each year not later than 
the date on which the budget for the next fiscal year is 
submitted to the Congress under section 1105 of title 31.
  (b) Contents of Report.--Each report required under 
subsection (a) shall include the following:
          (1) A list of each community-based outpatient clinic 
        and other outpatient clinic of the Department, and for 
        each such clinic, the type of clinic, location, size, 
        number of health professionals employed by the clinic, 
        workload, whether the clinic is leased or constructed 
        and operated by the Secretary, and the annual cost of 
        operating the clinic.
          (2) A list of community-based outpatient clinics and 
        other outpatient clinics that the Secretary opened 
        during the fiscal year preceding the fiscal year during 
        which the report is submitted and a list of clinics the 
        Secretary proposes opening during the fiscal year 
        during which the report is submitted and the subsequent 
        fiscal year, together with the cost of activating each 
        such clinic and the information required to be provided 
        under paragraph (1) for each such clinic and proposed 
        clinic.
          (3) A list of proposed community-based outpatient 
        clinics and other outpatient clinics that are, as of 
        the date of the submission of the report, under review 
        by the National Review Panel and a list of possible 
        locations for future clinics identified in the 
        Department's strategic planning process, including any 
        identified locations in rural and underserved areas.
          (4) A prioritized list of sites of care identified by 
        the Secretary that the Secretary could establish 
        without carrying out construction or entering into a 
        lease, including--
                  (A) any such sites that could be expanded by 
                hiring additional staff or allocating staff to 
                Federal facilities or facilities operating in 
                collaboration with the Federal Government; and
                  (B) any sites established, or able to be 
                established, under sections 8111 and 8153 of 
                this title.

           *       *       *       *       *       *       *