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                                                      Calendar No. 446
115th Congress    }                                      {      Report
                                 SENATE
 2d Session       }                                      {     115-269

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

 
     MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES 
                        APPROPRIATION BILL, 2019
                                _______
                                

                 June  7, 2018.--Ordered to be printed

                                _______
                                

          Mr. Boozman,  from the Committee on Appropriations, 
                        submitted the following

                                 REPORT

                         [To accompany S. 3024]

    The Committee on Appropriations reports the bill (S. 3024) 
making appropriations for military construction, the Department 
of Veterans Affairs, and related agencies for the fiscal year 
ending September 30, 2019, and for other purposes, reports 
favorably thereon and recommends that the bill do pass.


 
Amounts in new budget authority

Total of bill as reported to the Senate.................$225,565,468,000
Amount of 2018 appropriations........................... 205,791,908,000
Amount of 2019 budget estimate.......................... 224,608,740,000
Bill as recommended to Senate compared to--
    2018 appropriations................................. +19,773,560,000
    2019 budget estimate................................    +956,728,000




























                                CONTENTS

                              ----------                              
                                                                   Page
Background:
    Purpose of the Bill..........................................     4
    Committee Recommendation.....................................     4
    Overview and Summary of Bill.................................     4
Title I:
    Military Construction:
        Items of Special Interest:
            Hearings.............................................     6
            Summary of Committee Recommendations.................     6
            Reprogramming Guidelines.............................     6
            Real Property Maintenance............................     7
            Incremental Funding..................................     7
            Other Matters........................................     7
        Military Construction Overview...........................    13
        Military Construction, Army..............................    14
        Military Construction, Navy and Marine Corps.............    16
        Military Construction, Air Force.........................    17
        Military Construction, Defense-Wide......................    18
        Military Construction, Army National Guard...............    18
        Military Construction, Air National Guard................    19
        Military Construction, Army Reserve......................    19
        Military Construction, Navy Reserve......................    19
        Military Construction, Air Force Reserve.................    19
        North Atlantic Treaty Organization Security Investment 
          Program................................................    20
        Department of Defense Base Closure Account...............    20
        Family Housing Overview..................................    21
        Family Housing Construction, Army........................    21
        Family Housing Operation and Maintenance, Army...........    21
        Family Housing Construction, Navy and Marine Corps.......    21
        Family Housing Operation and Maintenance, Navy and Marine 
          Corps..................................................    22
        Family Housing Construction, Air Force...................    22
        Family Housing Operation and Maintenance, Air Force......    22
        Family Housing Operation and Maintenance, Defense-Wide...    23
        Department of Defense Family Housing Improvement Fund....    23
        Department of Defense Military Unaccompanied Housing 
          Improvement Fund.......................................    23
        Administrative Provisions................................    24
Title II:
    Department of Veterans Affairs:
        Items of Special Interest:
            Hearings.............................................    26
            Summary of Committee Recommendations.................    26
            Department Overview..................................    26
        Veterans Benefits Administration.........................    30
            Compensation and Pensions............................    31
            Readjustment Benefits................................    32
            Veterans Insurance and Indemnities...................    33
            Veterans Housing Benefit Program Fund................    33
            Vocational Rehabilitation Loans Program Account......    34
            Native American Veteran Housing Loan Program Account.    34
            General Operating Expenses, Veteran Benefits 
              Administration.....................................    35
        Veterans Health Administration...........................    37
            Medical Services.....................................    42
            Medical Community Care...............................    62
            Medical Support and Compliance.......................    63
            Medical Facilities...................................    63
            Medical and Prosthetic Research......................    64
            Medical Care Cost Recovery Collections...............    67
        National Cemetery Administration.........................    67
        Departmental Administration..............................    68
            General Administration...............................    68
            Board of Veterans Appeals............................    68
            Information Technology Systems.......................    69
            Office of Inspector General..........................    72
            Construction, Major Projects.........................    72
            Construction, Minor Projects.........................    73
            Grants for Construction of State Extended Care 
              Facilities.........................................    74
            Grants for Construction of Veterans Cemeteries.......    75
        Administrative Provisions................................    75
Title III:
    Related Agencies:
        American Battle Monuments Commission:
            Salaries and Expenses................................    79
            Foreign Currency Fluctuations........................    80
        United States Court of Appeals for Veterans Claims: 
          Salaries and Expenses..................................    80
        Department of Defense--Civil: Cemeterial Expenses, Army:
            Salaries and Expenses................................    81
        Armed Forces Retirement Home: Trust Fund.................    82
        Administrative Provision.................................    82
Title IV: Overseas Contingency Operations........................    83
Title V: General Provisions......................................    85
Program, Project, and Activity...................................    86
Compliance With Paragraph 7, Rule XVI, of the Standing Rules of 
  the 
  Senate.........................................................    86
Compliance With Paragraph 7(c), Rule XXVI of the Standing Rules 
  of the Senate..................................................    88
Compliance With Paragraph 12, Rule XXVI of the Standing Rules of 
  the Senate.....................................................    89
Budgetary Impact of Bill.........................................    90
Military Construction Project Listing by Location................    91
Overseas Contingency Operations..................................   106
Comparative Statement of Budget Authority........................   108


                               BACKGROUND

                          Purpose of the Bill

    The Military Construction, Veterans Affairs, and Related 
Agencies appropriations bill provides necessary funding for the 
planning, design, construction, alteration, and improvement of 
military facilities worldwide. It also finances the cost of 
military family housing and the U.S. share of the NATO Security 
Investment Program. In addition, the bill provides funding, 
including environmental remediation, for base closures and 
realignments authorized by law. The bill provides resources to 
the Department of Veterans Affairs for veterans benefits and 
healthcare and funding for U.S. cemeteries and battlefield 
monuments both in the United States and abroad, including the 
American Battle Monuments Commission and Arlington National 
Cemetery. Additionally, the bill funds the U.S. Court of 
Appeals for Veterans Claims and the Armed Forces Retirement 
Homes.

                        Committee Recommendation

    The Committee recommends new budget authority totaling 
$225,565,468,000 for fiscal years 2019 and 2020 military 
construction, family housing, base closure, veterans healthcare 
and benefits, including fiscal year 2020 advance appropriations 
for veterans medical care and appropriated mandatories, and 
related agencies. This includes $122,706,761,000 in mandatory 
funding and $102,858,707,000 in discretionary funding. The 
table at the end of the report displays the Committee 
recommendation in comparison with the current fiscal year and 
the President's fiscal year 2019 request. The following table 
shows total budget authority available for fiscal year 2019.

                   APPROPRIATIONS FOR FISCAL YEAR 2019
------------------------------------------------------------------------
                                                           Senate
                                 Budget request        recommendation
------------------------------------------------------------------------
New budget authority........      $224,608,740,000      $225,565,468,000
Previous advances provided          70,699,313,000        70,699,313,000
 for fiscal year 2019 for
 medical care...............
Previous advances provided         107,709,727,000       107,709,727,000
 for fiscal year 2019 for
 appropriated mandatories...
Less advances provided for         -75,550,600,000       -75,550,600,000
 fiscal year 2020 for
 medical care...............
Less advances provided for        -121,296,429,000      -121,296,429,000
 fiscal year 2020 for
 appropriated mandatories...
                             -------------------------------------------
      Total appropriations         206,170,751,000       207,127,479,000
       for fiscal year 2019.
------------------------------------------------------------------------

                      Overview and Summary of Bill

    The Military Construction, Veterans Affairs, and Related 
Agencies appropriations bill funds an array of programs that 
are vital to America's military personnel and their families, 
and to the Nations' veterans. For U.S. military forces and 
their families worldwide, the bill funds critical 
infrastructure, ranging from mission essential operational and 
training facilities, such as command and control centers, 
airfield improvements, and ranges, to key quality-of-life 
facilities, including barracks, family housing, child care 
centers, schools, and hospitals.
    For America's 20 million veterans, the bill provides the 
necessary funding for veterans benefits and healthcare, from 
prescription drugs and clinical services to the construction of 
hospitals and other medical facilities throughout the Nation.
    The bill also funds veterans cemeteries in the United 
States and provides funding for four independent agencies--the 
American Battle Monuments Commission, the U.S. Court of Appeals 
for Veterans Claims, Arlington National Cemetery, and the Armed 
Forces Retirement Homes.

                                TITLE I

                         MILITARY CONSTRUCTION

                       Items of Special Interest

                                HEARINGS

    The Subcommittee on Military Construction, Veterans 
Affairs, and Related Agencies held one hearing related to the 
fiscal year 2019 military construction budget request. 
Witnesses included representatives of the Army, Navy, Marine 
Corps, Air Force, and the Office of the Secretary of Defense.

                  SUMMARY OF COMMITTEE RECOMMENDATIONS

    The fiscal year 2019 budget request for military 
construction and family housing totals $10,462,617,000. The 
Committee recommends $10,319,000,000, which is $143,617,000 
below the President's budget request.

                        REPROGRAMMING GUIDELINES

    The following reprogramming guidelines apply for all 
military construction and family housing projects. A project or 
account (including the sub-elements of an account) which has 
been specifically reduced by the Congress in acting on the 
budget request is considered to be a congressional interest 
item and as such, prior approval is required. Accordingly, no 
reprogrammings to an item specifically reduced below the 
threshold by the Congress are permitted.
    The reprogramming criteria that apply to military 
construction projects (25 percent of the funded amount or 
$2,000,000, whichever is less) continue to apply to new housing 
construction projects and to improvements over $2,000,000. To 
provide the services the flexibility to proceed with 
construction contracts without disruption or delay, the costs 
associated with environmental hazard remediation such as 
asbestos removal, radon abatement, lead-based paint removal or 
abatement, and any other legislated environmental hazard 
remediation may be excluded, provided that such remediation 
requirements could not be reasonably anticipated at the time of 
the budget submission. This exclusion applies to projects 
authorized in this budget year, as well as projects authorized 
in prior years for which construction has not been completed.
    Furthermore, in instances where prior approval of a 
reprogramming request for a project or account has been 
received from the Committee, the adjusted amount approved 
becomes the new base for any future increase or decrease via 
below-threshold reprogrammings (provided that the project or 
account is not a congressional interest item as defined above).
    In addition to these guidelines, the services are directed 
to adhere to the guidance for military construction 
reprogrammings and notifications, including the pertinent 
statutory authorities contained in Department of Defense [DOD] 
Financial Management Regulation 7000.14-R and relevant updates 
and policy memoranda.

                       REAL PROPERTY MAINTENANCE

    The Committee recommends a continuation of the following 
general rules for repairing a facility under ``Operation and 
Maintenance'' account funding:
  --Components of the facility may be repaired by replacement, 
        and such replacement may be up to current standards or 
        code.
  --Interior arrangements and restorations may be included as 
        repair, but additions, new facilities, and functional 
        conversions must be performed as military construction 
        projects.
  --Such projects may be done concurrent with repair projects, 
        as long as the final conjunctively funded project is a 
        complete and usable facility.
  --The appropriate Service Secretary shall submit a 21-day 
        notification prior to carrying out any repair project 
        with an estimated cost in excess of $7,500,000.
    The Department is directed to continue to report on the 
real property maintenance backlog at all installations for 
which there is a requested construction project in future 
budget requests. This information is to be provided on the form 
1390. In addition, for all troop housing requests, the form 
1391 is to continue to show all real property maintenance 
conducted in the past 2 years and all future requirements for 
unaccompanied housing at that installation.

                          INCREMENTAL FUNDING

    In general, the Committee supports full funding for 
military construction projects. However, it continues to be the 
practice of the Committee to provide incremental funding for 
certain large projects, despite administration policy to the 
contrary, to enable the services to more efficiently allocate 
military construction dollars among projects that can be 
executed in the year of appropriation. Therefore, the Committee 
has recommended incremental funding for six projects.

                             OTHER MATTERS

    Military Construction Funding Initiatives.--The Committee 
is disappointed that military construction request levels do 
not reflect the level of investment needed to ensure both 
current and future force readiness. After years of deliberately 
``taking risk'' by underfunding known military construction 
requirements, when the Department finally had the opportunity 
to take advantage of the significant resources provided under 
the 2018 budget agreement, the Department once again chose to 
ignore its growing list of infrastructure and construction 
needs. The fiscal year 2019 military construction budget 
request comprises less than 1.5 percent of the Department's 
$686 billion total request. Continued underfunding of 
infrastructure requirements will yield disastrous results as 
facilities deteriorate and resources for repair or replacement 
are not available.
    In addition to the long list of deferred recapitalization 
and critical vulnerabilities, there are several multi-billion 
dollar high priority initiatives critical to rebuilding 
readiness and enabling joint warfighter capabilities that the 
Department has been tasked with funding and executing. For 
example, the Army has been tasked with funding a 
$17,000,000,000 modernization of Readiness Centers across the 
country. The Navy is taking steps to execute its Shipyard 
Infrastructure Optimization Plan, which will require a 
$21,000,000,000 investment over the next 20 years. The Air 
Force is undertaking a Ground Based Strategic Deterrent 
facility modernization. All of this competes with ongoing and 
upcoming platform beddown and facility upgrade projects.
    The Committee is concerned that reversing years of 
underfunding while simultaneously trying to accommodate the 
initiatives needed to provide ready and resilient installations 
that enable a platform for global operations is not viable 
without additional investment. The Committee urges the 
Secretary of Defense to ensure adequate funding for military 
construction in its planning, programming and budgeting 
processes. Further, the Committee directs the Secretary of each 
Service to provide an assessment at the time of submission of 
the fiscal year 2020 budget request identifying all military 
construction initiatives and targeted investments, such as the 
aforementioned, with a total estimated cost in excess of 
$1,000,000,000 and how the request ensures sufficient progress 
in buying down these infrastructure needs.
    The Committee also notes that major defense acquisition 
programs, particularly in the Air Force and Navy, do not 
adequately consider associated beddown and related 
infrastructure, which can result in late to need facilities, 
deferred recapitalization, and avoidable miscalculations in 
budget development. Therefore, the Committee also directs the 
Secretary of each Service to include in the above assessment 
expected military construction costs associated with new 
platform beddown by fiscal year, and process improvements to 
better identify these needs as well as obstacles in fully 
accounting for future projected infrastructure requirements.
    Energy Assurance.--The Committee recognizes DOD's efforts 
to understand the vulnerability of its power generation, 
distribution, and storage systems on all of its military 
installations and to develop technologies, plans, and policies 
to mitigate its risks. However, the Committee remains concerned 
that DOD's plan to 'island' its military bases in an emergency 
is not a solution to addressing the hazards that exist outside 
the DOD property line, where vulnerabilities to civilian energy 
infrastructure pose a risk to troops, DOD civilians, and other 
mission-critical personnel living in the community. The 
Committee directs the Secretary to provide a report within 180 
days of enactment of this act on the Department's efforts to 
address risks to critical energy systems outside of DOD 
property. The report should assess the ability of military 
installations to develop and sustain relationships with public 
utilities regardless of leadership rotations; the necessary 
legal authorities to enter arrangements with private or public 
companies to make improvements to energy infrastructure outside 
of DOD property; what, if any, plans exist for local military 
bases to provide excess base load power to communities during 
long-term emergencies; and the efficacy of appointing an 
executive agent charged with department-wide decisionmaking and 
funding of resiliency projects outside of DOD property.
    Joint Strike Fighter [JSF] Initial Joint Training Site.--
The 2005 Base Realignment and Closure [BRAC] Commission 
recommended Eglin Air Force Base [AFB], Florida, as an Initial 
Joint Training Site [IJTS] that teaches entry-level aviators 
and maintenance technicians how to safely operate and maintain 
the new Joint Strike Fighter [JSF] [F-35] aircraft. To 
implement the JSF IJTS, the Air Force, Navy, and Marines 
identified the need for a cantonment area, sufficient airspace, 
and ground targets to support 107 F-35 Primary Assigned 
Aircraft [PAA] comprised of Air Force, Marine, and Navy 
variants. Development plans included training and maintenance 
facilities, hangars, dormitories, munitions storage and loading 
facilities as well as airfields, airspace and ground support to 
accommodate 107 PAA. The Committee is aware that since the 
selection of Eglin AFB as the site for JSF IJTS, the PAA has 
been reduced from 107 to 59 and that some Services conduct JSF 
training at installations other than Eglin AFB. The Committee 
is concerned that building construction, renovation and 
demolition may have already started to support the initial plan 
of 107 PAA and the full training mission. Therefore, the 
Committee directs the Secretary of Defense to report no later 
than 180 days after enactment of this act on the infrastructure 
plan supporting the JSF IJTS at Eglin AFB, to include completed 
facilities and associated capacity and current utilization, and 
how remaining infrastructure requirements have been adjusted to 
adapt to the reduced PAA and training mission. Additionally, 
the report should include the status of the Department's 
compliance with the 2005 BRAC decision to establish Eglin AFB 
as the JSF IJTS and the rationale and impact of not fully 
implementing the decision.
    DOD Installation Energy Policy.--The Committee notes that 
DOD continues to take steps to increase installation energy 
efficiency and reduce overall energy consumption. However, more 
can be done bring down energy costs, and DOD must also ramp up 
its efforts to enhance energy security on its installations 
through a range of actions, to include exploring ways to 
mitigate potential vulnerabilities where installations draw 
from off-base energy sources.
    The Committee supports DOD's investments in energy 
efficiency, renewable energy systems, and energy security, 
including through the Energy Resilience and Conservation 
Investment Program [ERCIP], however, is concerned that funding 
requested for the program has not increased since fiscal year 
2014. This has resulted in a continued reduction of projects 
that can be undertaken, down to 18 this year from 33 projects 
in fiscal year 2016. The Committee directs the Secretary of 
Defense to provide a report within 90 days of enactment 
detailing how DOD integrates and prioritizes ERCIP projects in 
the future years defense program and to certify whether there 
are unfunded requirements within the program. The Committee 
recommends an increase of $45,000,000 above the request for 
ERCIP and encourages the Department to prioritize funding for 
energy-related projects, including renewable energy projects, 
to mitigate risk to mission-critical assets and promote energy 
security and efficiency at military installations.
    Defense Access Roads.--The Committee is concerned about the 
lack of future planning for Defense Access Roads [DAR] and 
transportation infrastructure needs as flooding on roads at 
domestic installations that are vital to military operations 
increases in frequency and severity. The Committee directs the 
Secretary of Defense, in consultation with the Secretary of 
Transportation, to establish a process for assessing the flood 
risk to defense access roads, with particular attention to 
communities that have experienced severe flooding from non-
storm surge flooding and flooding due to storm surge. The 
Committee expects that process to be informed by the best 
available science regarding flood risk in the United States. 
Further, the Committee directs the Secretary of Defense to 
report no later than 90 days after enactment of this act on the 
national security risks of neglected DAR roads and projects 
affected by flooding due to storm surge, including what data 
and other appropriate information it is using to inform its 
risk and need assessment, and any relevant obstacles, to 
include legal, in carrying out such projects.
    Reserve Component Parity.--The Committee notes significant 
decreases in funding across the Reserve Component in the fiscal 
year 2019 Military Construction request from the fiscal year 
2018 level. While the Committee understands that critical 
demand fluctuates by year and ongoing large-scale initiatives 
can skew data, it is concerned that reliance on the Real 
Property Asset Database [RPAD] as a key criterion does not 
accurately reflect current and future infrastructure needs 
across the components based on evolving operational 
requirements. Furthermore, despite steps taken by the 
Department to improve oversight of its global real property 
portfolio, multiple reports by the Government Accountability 
Office have found deficiencies in its tracking of real property 
assets and leased facilities, further undermining the 
credibility of this data. Therefore, the Committee directs the 
Secretaries of each Service to provide a report within 90 days 
of enactment of this act on if and how each determines base 
ratios for respective Active and Reserve Component military 
construction funding allocations, to include what data is used, 
specifically the extent to which the RPAD is weighted, and how 
frequently these ratios are updated.
    Flight Line Infrastructure.--The Committee is concerned 
with the lack of sufficient flight line infrastructure and the 
potentially adverse impact it may have on aircraft and 
personnel. There are many examples throughout the Department 
where improvements in facilities and airfield infrastructure 
would save resources, and improve personnel and aircraft 
readiness. For example, at Laughlin Air Force Base, 82 percent 
of the T-1 fleet was unsheltered and damaged in a hail storm. 
The damaged aircraft were grounded, resulting in an 80 percent 
loss of T-1 pilot training production capability. At Al Dhafra 
Air Base, host nation sun shades are utilized to help protect 
F-22s from extreme heat and sunlight but are not always 
available. Adequate flight line infrastructure can help protect 
the Department's assets from not only damage but resulting 
decreased mission accomplishment. The Committee recommends the 
Secretary of Defense review flight line infrastructure for both 
minor and major revitalization and recapitalization 
opportunities. This could include simple infrastructure such as 
sun shelters that protect both personnel and equipment from 
extreme heat and inclement weather, to more elaborate 
construction and maintenance projects such as repairing 
drainage issues on flight lines to keep ramp areas useable 
during extended rainy periods and prevent aircraft from sitting 
in standing water. The Committee urges the Department to 
prioritize these projects in future budget submissions.
    Water Conservation on Military Installations.--Senate 
Report 115-130 reiterated a directive from Senate Report 114-
237 requesting the Secretary of Defense provide a report on 
water usage and conservation on military installations. The 
Committee notes that the report is currently overdue and 
directs the Secretary to provide the report no later than 
October 1, 2018.
    Federal, State and Local Intelligence Collaboration.--The 
Committee remains supportive of collaborative intelligence 
fusion centers that utilize National Guard facilities. These 
centers allow Federal, state, local, and tribal law enforcement 
officials to collaborate and share intelligence and threat 
information, and co-locating them with National Guard 
facilities offers opportunities for cost savings. The Committee 
urges the Department, the services, and the National Guard 
Bureau to prioritize needed workplace replacement projects, 
including Sensitive Compartmented Information Facility [SCIF] 
projects to conduct state and Federal intelligence analysis, in 
the fiscal year 2020 and future budget submissions.
    Major Range and Test Facility Base [MRTFB].--The Committee 
remains concerned about the lack of investment and sustainment 
in MRTFB facilities. These ranges, which include Army, Navy, 
Air Force and Defense Agency facilities are critical to 
developing and maintaining the Nation's military technological 
superiority. In order to support development of emerging 
advanced technologies, test and training range infrastructure 
and instrumentation must be modernized. Senate Report 115-130 
contained direction to the Secretary of Defense to submit a 
comprehensive MRTFB modernization plan within 180 days of 
enactment outlining a timetable and specific actions for 
repair, replacement and renovation of infrastructure, equipment 
and instrumentation at mission-critical facilities. The 
Committee looks forward to receiving this report.
    Family Housing Management.--The Committee is concerned that 
at times military families are faced with housing unit 
relocation or otherwise forced disposition due to untimely and 
mismanaged family housing renovations, particularly when 
service members and their families are in need of housing due 
to a permanent change of station. To understand the scale of 
this problem, the Committee directs the Department to assess 
the management of family housing renovations and identify any 
and all instances whereby military families have been relocated 
or forced to move from their assigned housing unit because of 
renovation or repair, specifically for government-controlled 
housing [owned and leased], with a focus on instances on duty 
stations outside the continental United States. The report 
should also include detailed data on wait times, identification 
of contributing factors, and potential mitigating solutions. 
The Committee directs the Department to provide the report 
within 120 days of enactment of this act.
    Simulation Center Planning Bays.--The Committee notes that 
combat maneuver simulation centers offer a valuable resource to 
train combat forces in real world situations while reducing 
cost, preserving equipment, enhancing training and decreasing 
risk to the warfighter. Military students utilize these 
centers, such as the Maneuver Center of Excellence and other 
educational posts, to augment their training and enhance 
readiness and should continue to do so at an increasing rate in 
the coming years. These centers often do not have the capacity 
for the entire unit to communicate, coordinate, and plan on 
site during their training. Therefore, the Committee encourages 
the Department to consider additional structures, such as 
covered planning bay areas, that could enhance the value of 
training by providing space to communicate, coordinate, and 
plan on site amidst the simulation training. As such, the 
Committee directs the Department to submit a report within 180 
days of enactment of this Act assessing the value of having 
covered planning bay areas adjacent to or within current 
facilities that provide combat maneuver simulation training. 
The report should identify potential installations where these 
structures could be constructed adjacent to or within 
simulations centers.
    Information Technology Infrastructure for Military 
Construction Projects.--The Committee recognizes that 
information technology is an essential component in 
constructing modern facilities for military missions as well as 
planning for future requirements. Technological advancements 
can lead to increased productivity and efficiencies on energy 
and space, which impact military construction and modernization 
projects. For example, the Committee is aware of technology 
that can streamline historically compartmented classified 
networks through cross domain solutions. Not only does this 
drastically impact future productivity for the workforce but it 
could also yield substantial savings and efficiencies on space, 
energy, and HVAC requirements. The Committee urges the Services 
to utilize such cost cutting solutions early in the planning 
process to gain efficiencies and savings on military 
construction projects.
    Defense Workplace Facilities Improvements.--The Committee 
is concerned that continued constraints on the Defense budget 
in the face of increasing operational requirements is taking a 
serious toll on the Department's aging and structurally 
deficient workplace facilities inventory. The parking garage at 
the National Maritime Intelligence Center [NMIC], which serves 
a workforce of approximately 3,700 personnel, continues to be 
certified as unsafe and structurally deficient. While 
$12,000,000 has already been spent on repairs in an effort to 
maintain the facility, the Committee remains concerned about 
the deficient operational status. A Navy commissioned 
engineering analysis validated the repairs as a stopgap measure 
because of the severity of the structural flaws, but needed 
investment continues to be deferred. In recognition of the fact 
that aging and structurally deficient workplace and support 
facility infrastructure has a significant impact on personnel 
safety and operational readiness, the Committee urges the 
Department and the services to prioritize needed workplace 
replacement projects, including the NMIC parking structure, in 
the fiscal year 2020 and future budget submissions.
    Special Operations Command Planning and Design.--The 
Committee is aware of numerous recent reprogramming requests 
submitted by U.S. Special Operations Command [SOCOM]. The 
additional funds requested, and delayed project execution 
timelines, have largely been a result of poor planning and 
design fundamentals, such as contracting design-build when 
requirements necessitated design-bid-build. The committee is 
encouraged that SOCOM is evaluating its planning and budgeting 
process to ensure that projects requested are appropriately 
scoped and prepared for execution. It also recognizes that 
SOCOM manpower and infrastructure needs continue to increase in 
demand. The committee urges SOCOM to continue to work with the 
Army Corps of Engineers and Naval Facilities Engineering 
Command to ensure best practices are being followed.
    Fiscal Year 2018 Savings.--The Committee notes that the 
Department based certain project funding levels in the fiscal 
year 2019 Budget Request on lower expected appropriations than 
were provided in Public Law 115-141. As a result, the fiscal 
year 2019 requests for the Next NGA West Complex Phase 1 and 
Presidential Aircraft Recapitalization Complex exceed need. The 
Committee fully funds these projects as authorized in Public 
Law 115-91.
    Military Construction Funding Initiatives.--The bill 
includes funding for military construction initiatives to 
address important unfunded priorities included in the 
Department of Defense's unfunded priority lists provided to 
Congress. This includes an additional $77,600,000 for the Army, 
$244,400,000 for the Navy and Marine Corps, $118,516,000 for 
the Air Force, $22,000,000 for the Army National Guard, 
$11,100,000 for the Air National Guard, $10,000,000 for the 
Army Reserve, and $14,400,000 for the Air Force Reserve. All 
additional funding is reserved for projects that were included 
in the unfunded priority lists submitted to Congress.
    Rescissions.--The Committee recommends an administrative 
provision rescinding prior year unobligated funds due primarily 
to project bid savings and the slow execution of projects.

                     Military Construction Overview

Appropriations, 2018\1\................................. $10,091,000,000
Budget estimate, 2019...................................  10,462,617,000
Committee recommendation................................  10,319,000,000

\1\Total excludes $920,981,000 in emergency funding provided in Public 
Law 115-123, the Further Additional Supplemental Appropriations for 
Disaster Relief Requirements Act and Public Law 115-96, Continuing 
Appropriations Act, Department of Defense Missile Defeat and Defense 
Enhancements Appropriations Act, 2018.
---------------------------------------------------------------------------

          MILITARY CONSTRUCTION ACCOUNTS--PROGRAM DESCRIPTION

    The military construction appropriation provides for 
acquisition, construction, installation, and equipment of 
temporary or permanent public works, military installations, 
facilities, and real property for the Department of Defense. 
This appropriation also provides for facilities required as 
well as funds for infrastructure projects and programs required 
to support bases and installations around the world.

                      Military Construction, Army

Appropriations, 2018....................................    $923,994,000
Budget estimate, 2019...................................   1,011,768,000
Committee recommendation................................   1,021,768,000

                        COMMITTEE RECOMMENDATION

    The Committee recommends $1,021,768,000 for the Army for 
fiscal year 2019. This amount is $97,774,000 above the fiscal 
year 2018 enacted level and $10,000,000 above the budget 
request. Further detail of the Committee's recommendation is 
provided in the State table at the end of this report.
    Army Training Schools.--The Committee is concerned about 
the impact of deferred investments in Army schoolhouses, 
especially those with aging facilities directly tied to 
warfighter training and readiness across the components. In 
particular, the Army Mountain Warfare School [AMWS], which 
directly supports the Army's top priority of building and 
sustaining readiness, continues to see increased demand with 
insufficient and outdated space requirements, while deferred 
maintenance compounds challenges with its aging infrastructure. 
AMWS provides critical mountain warfare and cold weather 
operations training to support the creation of an agile and 
highly mobile force, but is nearly 40 years old and sited in a 
flood plain, and has been forced to cap attendance due to 
inadequate facilities, despite continual demand for throughput. 
Therefore, the Committee urges the Secretary of the Army to 
prioritize funding for ready-to-execute schoolhouse projects, 
in particular those that support the growing demand for 
mountaineering skills and training.
    Defense Laboratory Enterprise Facilities and 
Infrastructure.--The Committee remains concerned the 
unspecified minor military construction [UMMC] request is 
insufficient to support the Army Laboratories. As threats 
continue to emerge and construction costs continue to rise, 
outdated laboratory facilities lack the investment needed to 
deliver next generation capability to the U.S. military. While 
the Army can utilize funds from research, development, test and 
evaluation or operations and maintenance to fund laboratory 
projects, the higher UMMC threshold provided in Public Law 115-
91 is intended to allow the services greater opportunity to 
keep up with threats that evolve faster than can be addressed 
through the normal military construction planning process. 
Therefore, an additional $10,000,000 is provided to supplement 
Army unspecified minor construction projects. The committee 
urges the Secretary of the Army to adequately prioritize UMMC 
projects that support the Army Laboratories to ensure that Army 
Science and Technology continue to lay the foundation for 
future capabilities.
    Army National Guard Readiness Center Investment.--The 
Committee remains concerned that the Department of the Army has 
not adequately prioritized funding to implement the 
``Affordable Readiness'' strategy recommended by the 2014 Army 
National Guard Readiness Center Transformation Master Plan 
[RCTMP]. While the committee understands that the Army must 
balance these additional costs with existing infrastructure 
demands, the Committee also notes that the fiscal year 2019 
Military Construction request for the Army National Guard was a 
14 percent decrease from the fiscal year 2018 request, 
representing its smallest portion of the Army military 
construction budget since 2008. Except for the fiscal year 2015 
budget request, the funding level is at its lowest in the post-
2001 era. The Committee urges the Army to provide additional 
funding for the Army National Guard in its future years defense 
program in order to expedite execution of the RCTMP.
    Army Pacific Readiness.--The Committee remains concerned 
about the risks that the Army, like the other military 
Services, has taken in funding infrastructure and the continued 
degradation these risks have on long-term readiness. The 
Committee is aware of the Army's $2,600,000,000, 30-year plan 
to improve readiness in the Pacific by addressing critical 
shortfalls in aviation, operations, training, and munitions 
facilities at Schofield Barracks, Wheeler Army Airfield, and 
the Pohakuloa Training Area, in Hawaii. The Committee 
recognizes that the planned investment of $300,000,000 over the 
future years defense program is important to meeting the Army's 
short- and long-term readiness needs and ensuring that U.S. 
Army Garrison Hawaii remains a deployment platform from which 
soldiers in the state can continue to meet critical national 
defense missions across the Asia-Pacific region. The Committee 
urges the Army to continue to obligate funding toward its long-
range plan to improve its readiness in the Pacific over the 
next several decades.
    Sunflower Army Ammunition Plant.--The Committee continues 
to urge the Army to proactively manage the environmental 
remediation of the former Sunflower Army Ammunition Plant 
[SFAAP]. The Committee is encouraged that the Army has 
addressed the need for improved communications with Sunflower 
Redevelopment, LLC [SRL] and supports regular stakeholder 
meetings and monthly conference calls with SRL to address 
questions or issues related to cleanup and redevelopment of the 
former SFAAP. The Committee expects the Army to continue its 
risk assessments and evaluations, consistent with applicable 
regulations and permit requirements, and to work with 
regulatory agencies to ensure all response sites are remediated 
to applicable and approved standards. The Committee further 
expects the Army to continue work in consultation and 
coordination with SRL and ensure SRL redevelopment priorities 
are synchronized with Army managed cleanup activities.
    Badger Army Ammunition Plant.--The Committee continues to 
urge the Army to accelerate, to the extent practicable and 
appropriate, its environmental remediation actions at the 
former Badger Army Ammunition Plant and directs the Army to 
hold regular public meetings to update and engage with local 
stakeholders and to integrate local priorities in its 
remediation plans and final groundwater remedy for the site and 
affected surrounding communities. The Committee supports the 
Army's decision to work with the U.S. Geological Survey to 
review the current groundwater monitoring program and directs 
the Army to use the results of the review to improve the 
program to ensure that contaminated groundwater plumes are 
monitored and private drinking water wells are protected. The 
Committee recognizes that the Town of Merrimac, Wisconsin, 
acted in good faith to partner with the Army on the now-
reversed plans to construct a municipal drinking water system, 
and directs the Army to consider the construction of a such a 
system as a remedial alternative.

              Military Construction, Navy and Marine Corps

Appropriations, 2018\1\.................................  $1,553,275,000
Budget estimate, 2019...................................   2,543,189,000
Committee recommendation................................   2,222,522,000

\1\Total excludes $201,636,000 in emergency funding provided in Public 
Law 115-123, the Further Additional Supplemental Appropriations for 
Disaster Relief Requirements Act, 2018.
---------------------------------------------------------------------------

                        COMMITTEE RECOMMENDATION

    The Committee recommends $2,222,522,000 for Navy and Marine 
Corps military construction for fiscal year 2019. This amount 
is $669,247,000 above the fiscal year 2018 enacted level and 
$320,667,000 below the budget request. Further detail of the 
Committee's recommendation is provided in the State table at 
the end of this report.
    Causeway, Boat Channel & Turning Basin.--The Committee 
notes that the work in progress curve submitted with the budget 
request shows that the Navy cannot execute the full request of 
$117,830,000 in fiscal year 2019. Therefore the Committee 
provides $60,000,000 for the first increment of this project.
    Naval Shipyard Modernization.--The committee is aware of 
the Shipyard Infrastructure Optimization Plan submitted to 
Congress in February 2018. The plan seeks to, among other 
requirements, assess existing facilities for efficiencies and 
address future infrastructure requirements at public shipyards. 
It also includes a master plan for each shipyard, including, 
but not limited to, capital equipment and facility investment 
requirements. The committee believes the Navy's assessment of 
public shipyard dry dock capacity is particularly important, as 
it identifies 68 deferred maintenance availabilities under the 
status quo, 67 of which are restored upon making the public 
shipyard dry dock investments within the timeframe recommended 
by the plan. Accordingly, the Secretary of the Navy is urged to 
adequately prioritize the timely funding of public shipyard 
infrastructure, in particular dry dock and shore infrastructure 
necessary to support critical maintenance of surface and 
submarine fleets by public shipyards.
    Navy Strategic Laydown and Dispersal.--The Committee 
continues to recognize the inherent risk of natural and man-
made hazards associated with the stationing of U.S. capital 
ships at major ports, and the Navy's corresponding requirement 
for the strategic dispersal of its fleet in the Pacific and 
Atlantic to mitigate that risk. The Navy's internal guidance on 
making decisions regarding strategic basing requires that the 
Navy consider strategic dispersal strategies and that these 
strategies be factored into homeporting decisions to limit the 
risk associated with natural disasters or man-made 
catastrophes. The Committee continues to believe that strategic 
dispersal should be a key consideration in expanding the fleet, 
and that, as a first step, the Navy should program military 
construction funding, to include planning and design funds, for 
necessary infrastructure to achieve strategic dispersal of its 
fleet, beginning with the budget request and future years 
defense program for fiscal year 2020.

                    Military Construction, Air Force

Appropriations, 2018....................................  $1,543,558,000
Budget estimate, 2019...................................   1,725,707,000
Committee recommendation................................   1,495,423,000

                        COMMITTEE RECOMMENDATION

    The Committee recommends $1,495,423,000 for the Air Force 
in fiscal year 2019. This amount is $48,135,000 below the 
fiscal year 2018 enacted level and $230,284,000 below the 
budget request. Further detail of the Committee's 
recommendation is provided in the State table at the end of 
this report.
    Little Rock Air Force Base.--The Committee is concerned 
with the failed attempt to repair the runway at Little Rock 
AFB, Arkansas. Little Rock AFB, the nation's tactical airlift 
Center of Excellence, has the world's largest fleet of C-130 
aircraft and is the largest C-130 training base in the world, 
training C-130 crews from the U.S. and 47 other nations. The 
contract to repair the base's only runway, overseen by the Army 
Corps of Engineers [the Corps], was awarded in September 2014 
and terminated in June 2017 due to problems with the project. 
Despite an estimated contract completion date of April 2017, 
the project was only one quarter complete when the Corps 
terminated the contract in June 2017. The Committee is 
concerned with the issues that led to termination of the 
contract, the coordination between the Air Force and the Corps, 
and ensuring a follow-on replacement project is adequately 
prioritized and funded. Prior Congressional inquiries have 
yielded conflicting and inconsistent information. Therefore, 
the Committee directs the Secretary of the Air Force to submit 
a report coordinated with the Corps no later than 90 days after 
enactment of this act providing the status on the cancelled 
project and replacement project, including what happened to the 
funding used for the original contract, a justification for the 
increase in cost for the new project, if any of the completed 
work from the cancelled project is salvageable, how the Air 
Force is resolving the issues that led to contract termination 
and ensuring, to the extent possible, that they are not 
repeated in follow-on contracts, and how and when a future 
project will be funded. Additionally, the Committee directs the 
Air Force to appoint a senior official who shall be responsible 
for the project and will provide quarterly project updates to 
the congressional defense committees.
    Air Force Ballistic Missile Facilities.--The Committee 
remains concerned with the deteriorating infrastructure of the 
ground-based intercontinental ballistic missile facilities at 
Malmstrom AFB, Montana; Minot AFB, North Dakota; and F.E. 
Warren AFB, Wyoming. The Missile Alert Facilities [MAF] at 
these bases are in advanced states of disrepair. In February 
2018, the Air Force provided the Committee a study that 
highlighted the need to recapitalize the MAFs. Further, the 
Committee understands that Air Force Global Strike Command 
continues to be in the process of identifying, validating, and 
finalizing facility requirements, as well as analyzing 
commercial electrical power infrastructure to support the 
missile fields. The Committee directs the Secretary of the Air 
Force to provide compiled results as soon as they become 
available.
    Air Force Space Rapid Capabilities Office.--The Committee 
notes that Air Force facilities supporting the space enterprise 
reorganization are lacking the secure compartmentalized 
information facility [SCIF] space needed to interact with all 
commercial partners, especially small business partners that 
may be developing cutting edge technology to aid the Air 
Force's space capabilities. This includes both secure office/
meeting spaces as well as secure hardware development, 
integration and testing spaces. Therefore, the Committee 
directs the Air Force to submit an analysis within 180 days of 
enactment of this Act detailing the SCIF needs for both secure 
office/meeting spaces as well as secure hardware development, 
integration and testing spaces that could improve small 
business engagement with the Space RCO and the Space and 
Missile Systems Center. The analysis shall include a sample of 
current and would be business partners' needs, as well as 
inputs from Space RCO, Space Command, and the Space and Missile 
Systems Center.

                  Military Construction, Defense-Wide


                     (INCLUDING TRANSFER OF FUNDS)

Appropriations, 2018\1\.................................  $2,811,513,000
Budget estimate, 2019...................................   2,693,324,000
Committee recommendation................................   2,575,938,000

\1\Total excludes $200,000,000 in emergency funding provided in Public 
Law 115-96, Continuing Appropriations Act, Department of Defense Missile 
Defeat and Defense Enhancements Appropriations Act, 2018.
---------------------------------------------------------------------------

                        COMMITTEE RECOMMENDATION

    The Committee recommends $2,575,938,000 for projects 
considered within the Defense-Wide account in fiscal year 2019. 
This amount is $235,575,000 below the fiscal year 2018 enacted 
level and $117,386,000 below the budget request. Further detail 
of the Committee's recommendation is provided in the State 
table at the end of this report.
    Hydrant Fuel Systems in Support of Humanitarian Assistance 
and Disaster Relief Operations.--The Committee notes that the 
Department of Defense has a long history of successfully 
conducting urgently needed humanitarian assistance and disaster 
relief [HADR] missions. In recent years HADR missions have 
responded to major earthquakes, tsunamis, typhoons, hurricanes, 
floods, and the nuclear disaster in Fukushima, Japan. The 
Committee believes that hydrant fuel systems capable of 
supporting large scale fueling of heavy aircraft are an 
essential component of our HADR capability. The Committee 
continues to encourage the services and the Defense Logistics 
Agency to prioritize construction and enhancement of these 
systems in locations that serve as staging bases for HADR 
operations.

               Military Construction, Army National Guard

Appropriations, 2018\1\.................................    $220,652,000
Budget estimate, 2019...................................     180,122,000
Committee recommendation................................     190,122,000

\1\Total excludes $519,345,000 in emergency funding provided in Public 
Law 115-123, the Further Additional Supplemental Appropriations for 
Disaster Relief Requirements Act, 2018.
---------------------------------------------------------------------------

                        COMMITTEE RECOMMENDATION

    The Committee recommends $190,122,000 for Military 
Construction, Army National Guard for fiscal year 2019. This 
amount is $30,530,000 below the fiscal year 2018 enacted level 
and $10,000,000 above the budget request. Further detail of the 
Committee's recommendation is provided in the State table at 
the end of this report.

               Military Construction, Air National Guard

Appropriations, 2018....................................    $171,491,000
Budget estimate, 2019...................................     129,126,000
Committee recommendation................................     139,126,000

                        COMMITTEE RECOMMENDATION

    The Committee recommends $139,126,000 for Military 
Construction, Air National Guard for fiscal year 2019. This 
amount is $32,365,000 below the fiscal year 2018 enacted level 
and $10,000,000 above the budget request. Further detail of the 
Committee's recommendation is provided in the State table at 
the end of this report.

                  Military Construction, Army Reserve

Appropriations, 2018....................................     $83,712,000
Budget estimate, 2019...................................      64,919,000
Committee recommendation................................      64,919,000

                        COMMITTEE RECOMMENDATION

    The Committee recommends $64,919,000 for Military 
Construction, Army Reserve for fiscal year 2019. This amount is 
$18,793,000 below the fiscal year 2018 enacted level and equal 
to the budget request. Further detail of the Committee's 
recommendation is provided in the State table at the end of 
this report.

                  Military Construction, Navy Reserve

Appropriations, 2018....................................     $95,271,000
Budget estimate, 2019...................................      43,065,000
Committee recommendation................................      43,065,000

                        COMMITTEE RECOMMENDATION

    The Committee recommends $43,065,000 for Military 
Construction, Navy Reserve for fiscal year 2019. This amount is 
$52,206,000 below the fiscal year 2018 enacted level and equal 
to the budget request. Further detail of the Committee's 
recommendation is provided in the State table at the end of 
this report.

                Military Construction, Air Force Reserve

Appropriations, 2018....................................     $73,535,000
Budget estimate, 2019...................................      50,163,000
Committee recommendation................................      50,163,000

                        COMMITTEE RECOMMENDATION

    The Committee recommends $50,163,000 for Military 
Construction, Air Force Reserve for fiscal year 2019. This 
amount is $23,372,000 below the fiscal year 2018 enacted level 
and equal to the budget request. Further detail of the 
Committee's recommendation is provided in the State table at 
the end of this report.

                   North Atlantic Treaty Organization

                      SECURITY INVESTMENT PROGRAM

Appropriations, 2018....................................    $177,932,000
Budget estimate, 2019...................................     171,064,000
Committee recommendation................................     171,064,000

                          PROGRAM DESCRIPTION

    The North Atlantic Treaty Organization [NATO] appropriation 
provides for the U.S. cost share of the NATO Security 
Investment Program for the acquisition and construction of 
military facilities and installations (including international 
military headquarters) and for related expenses for the 
collective defense of the NATO Treaty area.

                        COMMITTEE RECOMMENDATION

    The Committee recommends $171,064,000 for the North 
Atlantic Treaty Organization Security Investment Program for 
fiscal year 2019. This amount is $6,868,000 below the fiscal 
year 2018 enacted level and equal to the budget request.

               Department of Defense Base Closure Account

Appropriations, 2018....................................    $310,000,000
Budget estimate, 2019...................................     267,538,000
Committee recommendation................................     277,538,000

                          PROGRAM DESCRIPTION

    Section 2711 of the National Defense Authorization Act for 
Fiscal Year 2014 (Public Law 112-239) consolidated the Base 
Closure Account 1990 and the Base Closure Account 2005 into a 
single Department of Defense Base Closure Account. The Base 
Closure Account provides for cleanup and disposal of property 
consistent with the four closure rounds required by the base 
closure acts of 1988 and 1990, and with the 2005 closure round 
required by the Defense Base Closure and Realignment Act of 
1990 (10 U.S.C. 2687 note).

                        COMMITTEE RECOMMENDATION

    The Committee recommends a total of $277,538,000 for the 
Department of Defense Base Closure Account for fiscal year 
2019. This amount is $32,462,000 below the fiscal year 2018 
enacted level and $10,000,000 above the budget request. Funds 
provided for fiscal year 2019 are for environmental cleanup and 
ongoing operations and maintenance.
    Perfluorooctane Sulfonate [PFOS] and Perfluorooctanoic Acid 
[PFOA].--The Committee has provided $10,000,000 in additional 
funds for identification, mitigation, and clean-up costs across 
the Department of Defense for PFOS and PFOA. DOD is directed to 
provide a spend plan for these additional funds to the 
Committee no later than 30 days after enactment of this act.

                        Family Housing Overview

Appropriations, 2018....................................  $1,409,437,000
Budget estimate, 2019...................................   1,582,632,000
Committee recommendation................................   1,582,632,000

              FAMILY HOUSING ACCOUNTS--PROGRAM DESCRIPTION

    The Family Housing appropriation provides funds for 
military family housing construction activities, operation and 
maintenance, the Family Housing Improvement Fund, and the 
Homeowners Assistance Program. Construction accounts provide 
funding for new construction, improvements and the Federal 
Government share of housing privatization. Operation and 
maintenance accounts fund costs associated with the maintenance 
and leasing of military family housing, including utilities, 
services, management, and furnishings.

                        COMMITTEE RECOMMENDATION

    The Committee recommends $1,582,632,000 for Family Housing 
Construction, Operations and Maintenance, and the Department's 
family housing improvement fund for fiscal year 2019. This 
amount is $173,195,000 above the fiscal year 2018 enacted level 
and equal to the budget request.

                   Family Housing Construction, Army

Appropriations, 2018....................................    $182,662,000
Budget estimate, 2019...................................     330,660,000
Committee recommendation................................     330,660,000

                        COMMITTEE RECOMMENDATION

    The Committee recommends $330,660,000 for Army Family 
Housing Construction in fiscal year 2019. This amount is 
$147,998,000 above the fiscal year 2018 enacted level and equal 
to the budget request. Further detail of the Committee's 
recommendation is provided in the State table at the end of 
this report.

             Family Housing Operation and Maintenance, Army

Appropriations, 2018....................................    $348,907,000
Budget estimate, 2019...................................     376,509,000
Committee recommendation................................     376,509,000

                        COMMITTEE RECOMMENDATION

    The Committee recommends $376,509,000 for family housing 
operation and maintenance, Army for fiscal year 2019. This 
amount is $27,602,000 above the fiscal year 2018 enacted level 
and equal to the budget request.

           Family Housing Construction, Navy and Marine Corps

Appropriations, 2018....................................     $83,682,000
Budget estimate, 2019...................................     104,581,000
Committee recommendation................................     104,581,000

                        COMMITTEE RECOMMENDATION

    The Committee recommends $104,581,000 for Family Housing 
Construction, Navy and Marine Corps. This amount is $20,899,000 
above the fiscal year 2018 enacted level and equal to the 
budget request. Further detail of the Committee's 
recommendation is provided in the State table at the end of 
this report.

    Family Housing Operation and Maintenance, Navy and Marine Corps

Appropriations, 2018....................................    $328,282,000
Budget estimate, 2019...................................     314,536,000
Committee recommendation................................     314,536,000

                        COMMITTEE RECOMMENDATION

    The Committee recommends $314,536,000 for family housing 
operation and maintenance, Navy and Marine Corps, in fiscal 
year 2019. This amount is $13,746,000 below the fiscal year 
2018 enacted level and equal to the budget request.
    Naval Support Activity Bahrain General and Flag Officers 
Quarters.--Public Law 115-141 provided $2,138,000 for the 
construction of on-base housing. The Committee understands that 
the Navy no longer intends to construct the housing facility, 
and is in the process of determining a suitable alternative. 
Therefore, the Committee rescinds $2,138,000 from the Navy 
Family Housing Construction account. Furthermore, the Committee 
is deeply concerned by the current off-base high cost lease and 
directs the Secretary of the Navy to keep the Committee 
apprised of progress on lease negotiation.

                 Family Housing Construction, Air Force

Appropriations, 2018....................................     $85,062,000
Budget estimate, 2019...................................      78,446,000
Committee recommendation................................      78,446,000

                        COMMITTEE RECOMMENDATION

    The Committee recommends $78,446,000 for Family Housing 
Construction, Air Force, in fiscal year 2019. This amount is 
$6,616,000 below the fiscal year 2018 enacted level and equal 
to the budget request. Further detail of the Committee's 
recommendation is provided in the State table at the end of 
this report.

          Family Housing Operation and Maintenance, Air Force

Appropriations, 2018....................................    $318,324,000
Budget estimate, 2019...................................     317,274,000
Committee recommendation................................     317,274,000

                        COMMITTEE RECOMMENDATION

    The Committee recommends $317,274,000 for family housing 
operation and maintenance, Air Force, in fiscal year 2019. This 
amount is $1,050,000 below the fiscal year 2018 enacted level 
and equal to the budget request.

         Family Housing Operation and Maintenance, Defense-Wide

Appropriations, 2018....................................     $59,169,000
Budget estimate, 2019...................................      58,373,000
Committee recommendation................................      58,373,000

                        COMMITTEE RECOMMENDATION

    The Committee recommends $58,373,000 for family housing 
operation and maintenance, Defense-Wide, for fiscal year 2019. 
This amount is $796,000 below the fiscal year 2018 enacted 
level and equal to the budget request.

         Department of Defense Family Housing Improvement Fund

Appropriations, 2018....................................      $2,726,000
Budget estimate, 2019...................................       1,653,000
Committee recommendation................................       1,653,000

                          PROGRAM DESCRIPTION

    The Family Housing Improvement Fund appropriation provides 
for the Department of Defense to undertake housing initiatives 
and to provide an alternative means of acquiring and improving 
military family housing and supporting facilities. This account 
provides seed money for housing privatization initiatives.

                        COMMITTEE RECOMMENDATION

    The Committee recommends $1,653,000 for the Family Housing 
Improvement Fund in fiscal year 2019. This amount is $1,073,000 
below the fiscal year 2018 enacted level and equal to the 
budget request.

 Department of Defense Military Unaccompanied Housing Improvement Fund

Appropriations, 2018....................................        $623,000
Budget estimate, 2019...................................         600,000
Committee recommendation................................         600,000

                          PROGRAM DESCRIPTION

    The Military Unaccompanied Housing Improvement Fund 
appropriation provides for the Department of Defense to 
undertake housing initiatives and to provide an alternative 
means of acquiring and improving military unaccompanied housing 
and supporting facilities. This account provides seed money for 
housing privatization initiatives.

                        COMMITTEE RECOMMENDATION

    The Committee recommends $600,000 for the Military 
Unaccompanied Housing Improvement Fund in fiscal year 2019. 
This amount is $23,000 below the fiscal year 2018 enacted level 
and equal to the budget request.

                       Administrative Provisions

    Sec. 101. The Committee includes a provision that restricts 
payments under a cost-plus-a-fixed-fee contract for work, 
except in cases of contracts for environmental restoration at 
base closure sites.
    Sec. 102. The Committee includes a provision that permits 
the use of funds for the hire of passenger motor vehicles.
    Sec. 103. The Committee includes a provision that permits 
the use of funds for defense access roads.
    Sec. 104. The Committee includes a provision that prohibits 
construction of new bases inside the continental United States 
for which specific appropriations have not been made.
    Sec. 105. The Committee includes a provision that limits 
the use of funds for purchase of land or land easements.
    Sec. 106. The Committee includes a provision that prohibits 
the use of funds to acquire land, prepare a site, or install 
utilities for any family housing except housing for which funds 
have been made available.
    Sec. 107. The Committee includes a provision that limits 
the use of minor construction funds to transfer or relocate 
activities among installations.
    Sec. 108. The Committee includes a provision that prohibits 
the procurement of steel unless American producers, 
fabricators, and manufacturers have been allowed to compete.
    Sec. 109. The Committee includes a provision that prohibits 
payments of real property taxes in foreign nations.
    Sec. 110. The Committee includes a provision that prohibits 
construction of new bases overseas without prior notification.
    Sec. 111. The Committee includes a provision that 
establishes a threshold for American preference of $500,000 
relating to architect and engineering services for overseas 
projects.
    Sec. 112. The Committee includes a provision that 
establishes preference for American contractors for military 
construction in the United States territories and possessions 
in the Pacific, and on Kwajalein Atoll, or in countries 
bordering the Arabian Gulf.
    Sec. 113. The Committee includes a provision that requires 
notification of military exercises involving construction in 
excess of $100,000.
    Sec. 114. The Committee includes a provision that permits 
funds appropriated in prior years to be available for 
construction authorized during the current session of Congress.
    Sec. 115. The Committee includes a provision that permits 
the use of expired or lapsed funds to pay the cost of 
supervision for any project being completed with lapsed funds.
    Sec. 116. The Committee includes a provision that permits 
obligation of funds from more than 1 fiscal year to execute a 
construction project, provided that the total obligation for 
such project is consistent with the total amount appropriated 
for the project.
    Sec. 117. The Committee includes a provision that permits 
the transfer of funds from Family Housing Construction accounts 
to the DOD Family Housing Improvement Fund and from Military 
Construction accounts to the DOD Military Unaccompanied Housing 
Improvement Fund.
    Sec. 118. The Committee includes a provision that provides 
transfer authority to the Homeowners Assistance Fund.
    Sec. 119. The Committee includes a provision that requires 
all acts making appropriations for military construction be the 
sole funding source of all operation and maintenance for family 
housing, including flag and general officer quarters, and 
limits the repair on flag and general officer quarters to 
$35,000 per unit per year without prior notification to the 
congressional defense committees.
    Sec. 120. The Committee includes a provision that provides 
authority to expend funds from the ``Ford Island Improvement'' 
account.
    Sec. 121. The Committee includes a provision that allows 
the transfer of expired funds to the Foreign Currency 
Fluctuation, Construction, Defense Account.
    Sec. 122. The Committee includes a provision that allows 
the reprogramming of military construction and family housing 
construction funds among projects and activities within the 
account in which they are funded.
    Sec. 123. The Committee includes a provision that prohibits 
the use of funds in this title for planning and design and 
construction of projects at Arlington National Cemetery.
    Sec. 124. The Committee includes a provision providing 
additional funds for unfunded military construction priorities.
    Sec. 125. The Committee includes a provision rescinding 
unobligated balances from various Military Construction 
accounts.
    Sec. 126. The Committee includes a provision defining the 
congressional defense committees.
    Sec. 127. The Committee includes a provision prohibiting 
the use of funds in this title to close or realign Naval 
Station Guantanamo Bay, Cuba. The provision is intended to 
prevent the closure or transfer of the installation out of the 
possession of the United States, and maintain the Naval 
Station's long-standing regional security and migrant 
operations missions.
    Sec. 128. The Committee includes a provision regarding the 
consolidation or relocation of a U.S. Air Force RED HORSE 
Squadron outside of the United States.
    Sec. 129. The Committee includes a provision providing 
additional funding for Defense Access Roads.
    Sec. 130. The Committee includes a provision directing all 
amounts appropriated to military construction accounts be 
immediately available and allotted for the full scope of 
authorized projects.

                                TITLE II

                     DEPARTMENT OF VETERANS AFFAIRS

                       Items of Special Interest

                                HEARINGS

    The Subcommittee on Military Construction, Veterans 
Affairs, and Related Agencies held one hearing related to the 
fiscal year 2019 and 2020 Department of Veterans Affairs [VA] 
budget request. The subcommittee heard testimony from The 
Honorable Randy C. Reeves, Under Secretary for Memorial 
Affairs, National Cemetery Administration; The Honorable Jon J. 
Rychalski, Assistant Secretary for Management and Chief 
Financial Officer, Department of Veterans Affairs; Carolyn M. 
Clancy, M.D., Executive in Charge, Veterans Health 
Administration; and Mr. Thomas J. Murphy, Executive in Charge, 
Veterans Benefits Administration.

                  SUMMARY OF COMMITTEE RECOMMENDATIONS

    The Committee recommendation includes $195,569,404,000 for 
the Department of Veterans Affairs for fiscal year 2019, 
including $109,120,059,000 in mandatory spending and 
$86,449,345,000 in discretionary spending. The Committee also 
recommends $75,550,600,000 in advance appropriations for 
veterans medical care for fiscal year 2020 and $121,296,429,000 
in advance appropriations for appropriated mandatories for 
fiscal year 2020.

                          DEPARTMENT OVERVIEW

    The Veterans Administration was established on July 21, 
1930, as an independent agency by Executive Order 5398, in 
accordance with the act of July 3, 1930 (46 Stat. 1016). This 
act authorized the President to consolidate and coordinate 
Federal agencies specially created for or concerned with the 
administration of laws providing benefits to veterans, 
including the Veterans' Bureau, the Bureau of Pensions, and the 
National Home for Disabled Volunteer Soldiers. On March 15, 
1989, the Veterans Administration was elevated to Cabinet-level 
status as the Department of Veterans Affairs.
    VA's mission is to serve America's veterans and their 
families as their principal advocate in ensuring they receive 
the care, support, and recognition they have earned in service 
to the Nation. As of September 30, 2017, there were an 
estimated 20 million living veterans, with 19.9 million of them 
residing in the United States and Puerto Rico. There were an 
estimated 23.5 million dependents (spouses and dependent 
children) of living veterans in the United States and Puerto 
Rico, and there were 579,000 survivors of deceased veterans 
receiving VA survivor benefits in the United States and Puerto 
Rico. Thus, approximately 44 million people, or 13.4 percent of 
the total estimated resident population of the United States 
and Puerto Rico, were recipients or potential recipients of 
veterans benefits from the Federal Government. VA's operating 
units include the Veterans Benefits Administration, Veterans 
Health Administration, National Cemetery Administration, and 
staff support offices.
    The Veterans Benefits Administration [VBA] provides an 
integrated program of nonmedical veterans benefits. VBA 
administers a broad range of benefits to veterans and other 
eligible beneficiaries through 56 regional offices; three 
Pension Management Centers; six Fiduciary Hubs; three 
Educational Regional Processing Offices; eight Regional Loan 
Centers; one Insurance Center; eight National Call Centers; and 
a records processing center in St. Louis, Missouri. The 
benefits provided include: compensation for service-connected 
disabilities; pensions for wartime, needy, and totally disabled 
veterans; vocational rehabilitation assistance; educational and 
training assistance; home buying assistance; estate protection 
services for veterans under legal disability; information and 
assistance through personalized contacts; and six life 
insurance programs.
    The Veterans Health Administration [VHA] develops, 
maintains, and operates a national healthcare delivery system 
for eligible veterans; carries out a program of education and 
training of healthcare personnel; conducts medical research and 
development; and furnishes health services to members of the 
Armed Forces during periods of war or national emergency. A 
system consisting of 145 VA Hospitals; 24 Health Care Centers 
[HCC]; 199 Multi-Specialty Community-Based outpatient clinics; 
544 Primary Care Community-Based outpatient clinics; 294 
Outpatient Services Sites; 134 community living centers; 120 
domiciliary residential rehabilitation treatment programs 
[DRRTP]; 300 readjustment counseling vet centers; and 80 mobile 
vet centers is maintained to meet the VA's medical mission.
    The National Cemetery Administration [NCA] provides for the 
interment of the remains of eligible deceased servicemembers 
and discharged veterans in any national cemetery with available 
grave space; permanently maintains these graves; provides 
headstones and markers for the graves of eligible persons in 
national and private cemeteries; administers the grant program 
for aid to States in establishing, expanding, or improving 
State veterans cemeteries; and provides certificates to 
families of deceased veterans recognizing their contributions 
and service to the Nation. In 2019, cemetery activities will 
encompass 139 national cemeteries (including four new national 
cemeteries), one national veterans' burial ground, and 33 
soldiers' lots and monument sites.
    Staff support offices include the Office of Inspector 
General, Boards of Contract Appeals and Veterans Appeals, and 
General Administration offices, which support the Secretary, 
Deputy Secretary, Under Secretary for Benefits, Under Secretary 
for Health, Under Secretary for Memorial Affairs, and General 
Counsel.
    Aligning Veteran Benefits with Veteran Medical Care.--The 
Committee is concerned by reports that many veterans utilizing 
education benefits are not also registered for health benefits 
and are, therefore, not receiving adequate medical care for 
treatable conditions such as mental health and musculoskeletal 
ailments. Given the impact that untreated psychological and 
physical ailments can have on educational success, the 
Department is directed to submit to the Committees on 
Appropriations of both Houses of Congress a report within 180 
days of enactment of this act, detailing the number of veterans 
enrolled in education benefits but not medical benefits and any 
disparities in educational outcomes between veterans utilizing 
medical benefits as compared to those who are not.
    Transitioning Servicemembers.--The ability of communities 
to build networks, including through public-private 
partnerships, to provide resources to servicemembers, veterans, 
and their families is critical for ensuring that transitioning 
service members and veterans have the support they need in 
their civilian lives. The Committee encourages the Department 
to provide support for such networked approaches, including 
through public-private partnerships.
    Study and Measures to Address Regrettable Losses.--The 
Committee is concerned that VA has failed to follow-up on 
repeated recommendations of the Office of Inspector General to 
review data on regrettable losses and consider implementing 
measures to reduce such losses. Given the staffing demands on 
the Department and the challenges it faces in recruiting 
personnel, VA should work to retain those staff who could have 
remained with the Department but left. The Secretary should 
work expeditiously to better understand why personnel leave the 
Agency and work to mitigate such losses.
    Contractor Accountability.--The Committee is concerned 
about the lack of transparency in the contract oversight 
process, as well as the lack of visibility into contractor 
performance. Whenever the Secretary provides notice to a 
contracted service provider that the service provider is 
failing to meet contractual obligations, VA must submit to the 
Appropriations Committees and the Committees on Veterans' 
Affairs of the Senate and the House of Representatives 
notification of such failure. At a minimum, the notification 
should include: (1) an explanation of the reasons for providing 
such notice; (2) a description of the effect of such failure, 
including with respect to cost, schedule, and requirements; (3) 
a description of the actions taken by the Secretary to mitigate 
such failure; and, (4) a description of the actions taken by 
the contractor to address such failure.
    Contracting Fraud.--The Committee is concerned by continued 
incidents of willful misrepresentation of veteran or service-
disabled veteran status for the purposes of winning Federal 
contract set-asides and believes that a more effective 
disincentive is required to prevent this fraudulent behavior, 
which harms legitimate veteran-owned and service-disabled 
veteran owned small businesses. The Committee encourages the 
Department, in consultation with relevant agency partners, to 
examine potential regulatory and legislative actions to more 
effectively prevent contracting fraud, including the 
possibility of expanding the current VA mandatory 5-year 
contracting debarment penalty to all Federal agencies.
    Financial Hardship and Bankruptcy.--The Committee continues 
to support VA programs that combat the root causes of veteran 
and dependent financial hardship, which is a known contributory 
factor to negative outcomes such as mental health issues, 
substance use disorder, and suicide. For example, disability-
related benefits not only honor the service and sacrifice of 
the veterans who receive them, but also help to replace lost 
wages and provide a critical source of economic well-being. The 
Committee continues to be concerned by an inequity in current 
bankruptcy law that results in the inclusion of VA and DOD 
disability benefits in the calculation of a debtor's disposable 
income, while at the same time excluding Social Security 
disability benefits for non-veterans. The Committee hopes that 
this discrepancy between VA and Social Security disability 
benefits with regard to calculating a debtor's disposable 
income can be resolved in the near future.
    Appeals Process.--The Committee directs the Secretary to 
ensure the Department is in full compliance with all 
requirements of the Veterans Appeals Improvement and 
Modernization Act of 2017 (Public Law 115-55). Additionally, 
the Committee urges the Department to fully implement the GAO's 
recommendations to better ensure the successful implementation 
of a new disability appeals process while attending to appeals 
in the current process.
    Public Private Partnerships.--The Committee is aware of the 
need to expand the Department's research investment to leverage 
non-Federal initiatives which provide the opportunity for 
strong co-location of VA and university biomedical scientists 
for translational investigation which has high potential for 
precision medicine outcomes for wounded warriors and other high 
at risk veteran's populations. The Committee notes the high 
concentration of VA research enterprises on the Nation's two 
coasts. The Committee urges the Undersecretary for Health 
Affairs to expedite consideration of proposals for research 
complexes where there is multi-disciplinary investigation 
related to veterans and wounded warriors, including medicine, 
engineering and veterinary science. Such consideration should 
be timely to inform action in the fiscal year 2020 budget.
    Improper Benefits.--The Department of Veterans Affairs [VA] 
currently uses the Social Security Administration's [SSA] Death 
Master File [DMF] as a tool for reducing improper benefits. 
Following a Government Accountability Office [GAO] report that 
highlighted the DMF did not always reflect the most current and 
accurate data, SSA began to take steps to address these 
shortcomings. The Committee encourages the Department to 
explore the utilization of commercially available sources for 
obtaining the most accurate and extensive deceased data 
resources to identify, validate, and document deceased veterans 
in order to prevent improper payment of benefits.
    Security Risk Management.--The Committee understands the 
challenges associated with providing secure and accessible 
access to Department facilities. However, the Committee is 
concerned that the Department's current risk management 
policies are not sufficient to ensure medical facilities are 
adequately protected. The Department is urged to, in 
coordination with the Interagency Security Committee, review 
and revise its current risk management process, and develop an 
oversight strategy that allows the Department to properly 
assess risk management programs in all VHA facilities. The 
Department is directed to submit a report to the Committees on 
Appropriations of both Houses of Congress no later than 180 
days after enactment of this act detailing the findings of its 
review and the steps taken to develop the oversight strategy.
    Compensation Claims for Camp Lejeune Contaminated Water 
Veterans.--There is concern regarding the lack of consistency 
in the Department's handling of disability compensation claims 
for veterans, former reservists, and former National Guard 
members who served at Marine Corps Base Camp Lejeune for no 
less than 30 days (consecutive or nonconsecutive) between 
August 1, 1953 and December 31, 1987. VA established a 
presumption of service connection for eight diseases associated 
with exposure to contaminants in the water supply at Camp 
Lejeune during that period. The Department made the decision to 
subject nonpresumptive Camp Lejeune Contaminated Water [CLCW] 
exposure claims to a higher level of scrutiny than is applied 
to other exposure claims and did so without providing notice or 
an opportunity for public comment. In addition, no other toxic 
exposure claims require a positive medical opinion to warrant 
service connection. The evidentiary burden VA requires for CLCW 
nonpresumptive exposure claims is significantly greater than 
the standard used for Agent Orange or any other exposure 
claims. Furthermore, there currently exists a wealth of 
``competent medical evidence'' specific to diseases related to 
exposure to contaminated water at Camp Lejeune, as published by 
the Agency for Toxic Substances and Disease Registry [ATSDR], 
the Institute of Medicine [IoM], and other government 
sanctioned medical experts. Nevertheless, the Department's same 
Clinical Subject Matter Experts, who provide medical opinions, 
have routinely rejected ATSDR and IoM's findings without 
providing any justification or explanation for doing so.
    The Department was directed to conduct a Special Focus 
Review for the CLCW claims process and submit the results of 
the review in the Explanatory Statement accompanying Public Law 
115-141, the Consolidated Appropriations Act, 2018. The 
Committee looks forward to receiving this report in a timely 
manner.
    Community Wellness Programs.--Public Law 115-141, the 
Consolidated Appropriations Act, 2018, established a 2-year 
program for VA to award grants to nonprofit Veterans Services 
Organizations [VSOs] to upgrade, through construction and 
repair, VSO community facilities into health and wellness 
centers, and to promote and expand complementary and 
integrative wellness programs. Complementary and integrative 
wellness programs are increasingly being recognized as useful 
adjuncts to meet the needs of veterans who have experienced 
trauma.

                    Veterans Benefits Administration

Appropriations, 2018

                                                        $107,038,649,000

Advance Appropriations, 2019

                                                         107,709,727,000

Budget estimate, 2019

                                                           4,481,437,000

Committee recommendation, 2019

                                                           4,568,858,000

Budget estimate, advance appropriations, 2020

                                                         121,296,429,000
Committee recommendation, advance appropriations, 2020
                                                         121,296,429,000

                        ADMINISTRATION OVERVIEW

    The Veterans Benefits Administration is responsible for the 
payment of compensation and pension benefits to eligible 
service-connected disabled veterans, as well as education 
benefits and housing loan guarantees.

                        COMMITTEE RECOMMENDATION

    In fiscal year 2018, the Committee provided 
$107,709,727,000 in advance appropriations for the Veterans 
Benefits Administration for fiscal year 2019. This included 
$95,768,462,000 for Compensation and pensions; $11,832,175,000 
for Readjustment benefits; and $109,090,000 for Veterans 
insurance and indemnities.
    For fiscal year 2019, the Committee recommends an 
additional $1,410,332,000 for Compensation and Pensions as 
requested by the administration. Additionally, the Committee 
recommendation includes $200,612,000 for the Veterans Housing 
Benefit Program Fund administrative expenses; $39,000 for the 
Vocational Rehabilitation Loans Program account, with $396,000 
for administrative expenses; $1,163,000 for the Native American 
Veteran Housing Loan Program account; $2,956,316,000 for 
General Operating Expenses, Veterans Benefits Administration 
account.
    The Committee recommendation also provides $121,296,429,000 
in advance appropriations for the Veterans Benefits 
Administration's mandatory accounts for fiscal year 2020.

                       COMPENSATION AND PENSIONS

                     (INCLUDING TRANSFER OF FUNDS)

Appropriations, 2018.................................... $90,119,449,000
Advance Appropriations, 2019............................  95,768,462,000
Budget estimate, 2019...................................   1,410,332,000
Committee recommendation, 2019..........................   1,410,332,000
Budget estimate, advance appropriations, 2020........... 107,119,807,000
Committee recommendation, advance appropriations, 2020.. 107,119,807,000

                          PROGRAM DESCRIPTION

    Compensation is payable to living veterans who have 
suffered impairment of earning power from service-connected 
disabilities. The amount of compensation is based upon the 
impact of disabilities on a veteran's earning capacity. Death 
compensation or dependency and indemnity compensation is 
payable to the surviving spouses and dependents of veterans 
whose deaths occur while on active duty or result from service-
connected disabilities. A clothing allowance may also be 
provided for service-connected veterans who use a prosthetic or 
orthopedic device. In fiscal year 2019, the Department 
estimates it will obligate $92,477,647,000 for payments to 
4,850,289 veterans, 432,353 survivors, and 1,134 dependents 
receiving special benefits.
    Pensions are an income security benefit payable to needy 
wartime veterans who are precluded from gainful employment due 
to nonservice-connected disabilities which render them 
permanently and totally disabled. Public Law 107-103, the 
Veterans Education and Benefits Expansion Act of 2001, restored 
the automatic presumption of permanent and total nonservice 
connected disability for purposes of awarding a pension to 
veterans age 65 and older, subject to the income limitations 
that apply to all pensioners. Death pensions are payable to 
needy surviving spouses and children of deceased wartime 
veterans. The rate payable for both disability and death 
pensions is determined on the basis of the annual income of the 
veteran or their survivors. In fiscal year 2019, the Department 
estimates that the Pensions program will provide benefits to 
268,729 veterans and 199,972 survivors totaling $5,560,719,000.
    The Compensation and Pensions program funds certain burial 
benefits on behalf of eligible deceased veterans. These 
benefits provide the purchase and transportation costs for 
headstones and markers, graveliners, and pre-placed crypts; and 
provide partial reimbursement for privately purchased outer 
burial receptacles. In fiscal year 2019, the Department 
estimates the Compensation and Pensions program will obligate 
$261,943,000 providing burial benefits. This funding will 
provide 62,184 burial allowances, 34,089 burial plot 
allowances, 44,609 service-connected death awards, 497,644 
burial flags, 378,701 headstones or markers, 42,295 graveliners 
or reimbursement for privately purchased outer burial 
receptacles, and 310 caskets and urns for the internment of the 
remains of veterans without next of kin.

                        COMMITTEE RECOMMENDATION

    In fiscal year 2018, the Committee provided an advance 
appropriation of $95,768,462,000 for fiscal year 2019 for the 
Compensation and Pensions account. The Committee recommendation 
includes an additional $1,410,332,000 for Compensation and 
Pensions as requested.
    The Committee recommendation includes an advance 
appropriation of $107,119,807,000 for Compensation and pensions 
for fiscal year 2020.

                         READJUSTMENT BENEFITS

Appropriations, 2018.................................... $13,708,648,000
Advance Appropriations, 2019............................  11,832,175,000
Budget estimate, advance appropriations, 2020...........  14,065,282,000
Committee recommendation, advance appropriations, 2020..  14,065,282,000

                          PROGRAM DESCRIPTION

    The Readjustment benefits appropriation finances the 
education and training of veterans and servicemembers under 
chapters 30, 31, 32, 33, 34, 35, 36, 37, 39, 41, 42 and 43 of 
title 38, United States Code. These benefits include the All-
Volunteer Force Educational Assistance Program (Montgomery GI 
bill) and the Post 9/11 Educational Assistance Program. Basic 
benefits are funded through appropriations made to the 
readjustment benefits appropriation and by transfers from the 
Department of Defense. This account also finances vocational 
rehabilitation, specially adapted housing grants, specially 
adapted automobile grants for certain disabled veterans, and 
educational assistance allowances for eligible dependents of 
those veterans who died from service-connected causes or who 
have a total permanent service-connected disability, as well as 
dependents of servicemembers who were captured or missing in 
action.

                        COMMITTEE RECOMMENDATION

    In fiscal year 2018, the Committee provided an advance 
appropriation of $11,832,175,000 for the Readjustment Benefits 
account for fiscal year 2019.
    The Committee recommendation includes an advance 
appropriation of $14,065,282,000 for Readjustment benefits for 
fiscal year 2020.

                   VETERANS INSURANCE AND INDEMNITIES

Appropriations, 2018....................................    $120,338,000
Advance Appropriations, 2019............................     109,090,000
Budget estimate, advance appropriations, 2020...........     111,340,000
Committee recommendation, advance appropriations, 2020..     111,340,000

                          PROGRAM DESCRIPTION

    The Veterans insurance and indemnities appropriation 
consists of the former appropriations for military and naval 
insurance, applicable to World War I veterans; National Service 
Life Insurance, applicable to certain World War II veterans; 
servicemen's indemnities, applicable to Korean conflict 
veterans; and veterans mortgage life insurance to individuals 
who have received a grant for specially adapted housing.

                        COMMITTEE RECOMMENDATION

    In fiscal year 2018, the Committee provided an advance 
appropriation of $109,090,000 for fiscal year 2019 for the 
Veterans Insurance and Indemnities account.
    The Committee recommendation includes an advance 
appropriation of $111,340,000 for Veterans insurance and 
indemnities for fiscal year 2020.

                 VETERANS HOUSING BENEFIT PROGRAM FUND

------------------------------------------------------------------------
                                                         Administrative
                                       Program account      expenses
------------------------------------------------------------------------
Appropriations, 2018................  ................      $178,626,000
Budget estimate, 2019...............  ................       200,612,000
Committee recommendation............  ................       200,612,000
------------------------------------------------------------------------

                          PROGRAM DESCRIPTION

    The Veterans housing benefit program fund provides for all 
costs associated with VA's direct and guaranteed housing loan 
programs, with the exception of the Native American veteran 
housing loan program.
    VA loan guaranties are made to servicemembers, veterans, 
reservists, and unremarried surviving spouses for the purchase 
of homes, condominiums, and manufactured homes, and for 
refinancing loans. VA guarantees part of the total loan, 
permitting the purchaser to obtain a mortgage with a 
competitive interest rate, even without a downpayment, if the 
lender agrees. VA requires a downpayment be made for a 
manufactured home. With a VA guaranty, the lender is protected 
against loss up to the amount of the guaranty if the borrower 
fails to repay the loan.

                        COMMITTEE RECOMMENDATION

    The Committee recommends such sums as may be necessary for 
funding subsidy payments, and $200,612,000 for administrative 
expenses for fiscal year 2019. Bill language limits gross 
obligations for direct loans for specially adapted housing to 
$500,000.

            VOCATIONAL REHABILITATION LOANS PROGRAM ACCOUNT

------------------------------------------------------------------------
                                                         Administrative
                                       Program account      expenses
------------------------------------------------------------------------
Appropriations, 2018................           $30,000          $395,000
Budget estimate, 2019...............            39,000           396,000
Committee recommendation............            39,000           396,000
------------------------------------------------------------------------

                          PROGRAM DESCRIPTION

    The Vocational Rehabilitation Loans Program account covers 
the cost of direct loans for vocational rehabilitation of 
eligible veterans and, in addition, includes administrative 
expenses necessary to carry out the direct loan program. Loans 
of up to $1,235 (based on the indexed chapter 31 subsistence 
allowance rate) are currently available to service-connected 
disabled veterans enrolled in vocational rehabilitation 
programs, as provided under 38 U.S.C. chapter 31, when the 
veteran is temporarily in need of additional assistance. 
Repayment is made in monthly installments, without interest, 
through deductions from future payments of compensation, 
pension, subsistence allowance, educational assistance 
allowance, or retirement pay. Virtually all loans are repaid in 
full and most in less than one year.

                        COMMITTEE RECOMMENDATION

    The Committee recommends $39,000 for program costs and 
$396,000 for administrative expenses for the Vocational 
Rehabilitation Loans Program account. The administrative 
expenses may be paid to the General Operating Expenses, 
Veterans Benefits Administration account. Bill language is 
included limiting program direct loans to $2,037,366. It is 
estimated VA will make 2,039 loans in fiscal year 2019, with an 
average amount of $999.

          NATIVE AMERICAN VETERAN HOUSING LOAN PROGRAM ACCOUNT

Appropriations, 2018....................................      $1,163,000
Budget estimate, 2019...................................       1,149,000
Committee recommendation................................       1,163,000

                          PROGRAM DESCRIPTION

    The Native American veteran housing loan program is 
authorized by 38 U.S.C. chapter 37, section 3761 to provide 
direct loans to Native American veterans living on trust lands. 
The loans are available to purchase, construct, or improve 
homes to be occupied as veteran residences or to refinance a 
loan previously made under this program in order to lower the 
interest rate. The principal amount of a loan under this 
authority generally may not exceed $424,100; however, in some 
locations, this limit may be higher depending on median area 
home prices. Veterans pay a funding fee of 1.25 percent of the 
loan amount, although veterans with a service-connected 
disability are exempt from paying the fee. Before a direct loan 
can be made, the veteran's tribal organization must sign a 
memorandum of understanding with VA regarding the terms and 
conditions of the loan. The Native American Veteran Housing 
Loan Program began as a pilot program in 1993 and was made 
permanent by Public Law 109-233, the Veterans Housing 
Opportunity and Benefits Act of 2006.

                        COMMITTEE RECOMMENDATION

    The Committee recommends $1,163,000 for administrative 
expenses associated with this program. This is equal to the 
fiscal year 2018 enacted level and $14,000 more than the budget 
request.

      GENERAL OPERATING EXPENSES, VETERANS BENEFITS ADMINISTRATION

Appropriations, 2018....................................  $2,910,000,000
Budget estimate, 2019...................................   2,868,909,000
Committee recommendation................................   2,956,316,000

                          PROGRAM DESCRIPTION

    The General Operating Expenses, Veterans Benefits 
Administration account provides funding for the Veterans 
Benefits Administration to administer entitlement programs such 
as service-connected disability compensation, education 
benefits, and vocational rehabilitation services.

                        COMMITTEE RECOMMENDATION

    The Committee recommends $2,956,316,000 for the General 
Operating Expenses, Veterans Benefits Administration account, 
which is $46,316,000 above the fiscal year 2018 enacted level 
and $87,407,000 above the budget request. The Committee has 
included bill language to make available through September 30, 
2020, up to 10 percent of the General Operating Expenses, 
Veterans Benefits Administration account.
    Disability Claims Processing.--The Committee has not only 
fully funded the budget request for claims processing in recent 
years, but has provided increases above the budget requests for 
hiring and training claims processors, bolstering the migration 
to electronic claims processing systems, and addressing the 
increasing backlog of appeals at the Board of Veterans Appeals. 
The Committee expects for the Department to utilize theses 
resources effectively to not only protect against a recurrence 
of a sizable disability backlog, but to also ensure that proper 
staffing and resources are being utilized to reduce the wait 
time and backlog of disability decisions on appeal and to meet 
the demand for other benefit programs. To that end, the 
Committee recommends an additional $87,407,000 for VBA, GOE to 
hire additional claims and appellate staff, as well as to 
increase staff for the Vocational Rehabilitation and Employment 
Program. The VBA may also use these resources to support 
increased resources for the Veterans Claims Intake Program 
[VCIP] to scan and convert paper files into digital records. 
The Committee will continue to require the Department to 
provide monthly updates on performance measures for each 
Regional Office.
    Education Benefits.--The Committee is concerned about the 
levels of overpayments and improper payments being paid to GI 
Bill beneficiaries. The Committee directs VA to work with 
education stakeholders to ensure that veteran educational 
benefits are paid in a timely and accurate manner and that 
efforts to recoup any overpayments or improper payments is done 
fairly and in a manner that is not overly burdensome on student 
veterans and their families. The Committee further directs VA, 
in collaboration with the Department of Defense and Department 
of Education, to provide an interagency report on the 
development and continued implementation of the Principles of 
Excellence, oversight of institutions complying with the 
Principles, and appropriate and timely accountability measures 
for educational programs receiving Federal funding. Lastly, the 
Committee directs VA to continue to reform the compliance 
survey process to allow early detection of fraudulent marketing 
or predatory recruiting practices among institutions of higher 
learning and to codify a set of tools that is sufficiently 
agile enough to curtail the behavior of scamming institutions 
that are wasting the VA education benefits of service members 
and their families.
    Education Data Collection and Sharing.--The Committee 
believes that both students and VA should be able to make more 
evidence-based decisions when it comes to veterans' education. 
The Committee directs VA to work with the Department of 
Education and Department of Defense to ensure that there is a 
comprehensive database or at a minimum, a set of data-sharing 
agreements in place between Federal entities involved in the 
administration of Federal resources related to veteran 
educational attainment. The Committee further directs VA, in 
collaboration with the Department of Education and Department 
of Defense, to provide an interagency report on data-sharing 
priorities, the development and implementation of subsequent 
data-sharing agreements, and the uses and effectiveness of the 
data shared.
    Gulf War Veterans Claims for Service-Connected Disability 
Compensation.--The Committee continues to be concerned by the 
Department's high rates of denial of Gulf War veterans' claims 
for undiagnosed illnesses and chronic multi-symptom illnesses. 
The Committee notes that according to the most recent VA data, 
44 percent of Gulf War veterans develop Gulf War illness, but 
only 26 percent receive benefits. The Committee also notes that 
according to a 2016 GAO study, VA is still only approving 17 
percent of Gulf War illness claims. To improve the accuracy and 
fairness of claims evaluation, the Committee directs the 
Department to adopt a single Disability Benefits Questionnaire 
[DBQ] for Gulf War illness. The Department is directed to 
submit to Committees on Appropriations of both Houses of 
Congress a report explaining the reasons for the high denial 
rate of claims, the Department's actions to increase the number 
of approved claims, the Department's efforts to ensure claims 
adjudicators are trained and held accountable for consistently 
following the Compensation and Pension manual, and the 
Department's timeline for finalizing the required DBQ.
    Medical Disability Exams.--The Committee is concerned by 
recent reports indicating that contract physicians with revoked 
medical licenses have been performing medical disability 
examinations on behalf of the Department. Consistent with 
statute, the Committee directs the Department to ensure that 
any non-VA physician contracted to conduct medical disability 
examinations must have a current unrestricted license to 
practice as a physician, and is not barred from practicing in 
any State, the District of Columbia, or a Commonwealth, 
Territory, or possession of the United States.

                     Veterans Health Administration

Appropriations, 2018\1\................................. $70,296,454,000
Advance appropriations, 2019............................  70,699,313,000
Budget estimate, 2019\2\................................   3,127,369,000
Committee recommendation, 2019..........................   2,740,000,000
Budget estimate, advance appropriations, 2020...........  75,550,600,000
Committee recommendation, advance appropriations, 2020..  75,550,600,000

\1\Total excludes $89,392,000 in emergency funding provided in Public 
Law 115-123, the Further Additional Supplemental Appropriations for 
Disaster Relief Requirements Act, 2018.
\2\Total includes $1,900,000,000 requested in discretionary funding for 
the Mandatory Choice Program.
---------------------------------------------------------------------------

                        ADMINISTRATION OVERVIEW

    The Veterans Health Administration [VHA] is home to the 
United States' largest integrated healthcare system consisting 
of 145 VA Hospitals; 24 Health Care Centers [HCC]; 199 Multi-
Specialty Community-Based outpatient clinics; 544 Primary Care 
Community-Based outpatient clinics; 294 Outpatient Services 
Sites; 134 community living centers; 120 domiciliary 
residential rehabilitation treatment programs [DRRTP]; 300 
readjustment counseling vet centers; and 80 mobile vet centers.
    The Department of Veterans Affairs Medical Care Collections 
Fund [MCCF] was established by the Balanced Budget Act of 1997 
(Public Law 105-33). In fiscal year 2004, Public Law 108-199 
allowed the Department to deposit first-party and 
pharmaceutical co-payments, third-party insurance payments and 
enhanced-use collections, long-term care co-payments, 
Compensated Work Therapy Program collections, Compensation and 
Pension Living Expenses Program collections, and Parking 
Program fees into the MCCF.
    The Parking Program provides funds for the construction, 
alteration, and acquisition (by purchase or lease) of parking 
garages at VA medical facilities authorized by 38 U.S.C. 8109. 
The Secretary is required under certain circumstances to 
establish and collect fees for the use of such garages and 
parking facilities. Receipts from the parking fees are to be 
deposited into the MCCF and are used for medical services 
activities.

                        COMMITTEE RECOMMENDATION

    In fiscal year 2018, the Committee provided $70,699,313,000 
in advance appropriations for VA's medical care accounts for 
fiscal year 2019. This included $49,161,165,000 for Medical 
services, $8,384,704,000 for Medical community care, 
$7,239,156,000 for Medical support and compliance, and 
$5,914,288,000 for Medical facilities. The Committee also 
includes an Administrative Provision allowing the Department to 
carry forward into fiscal year 2019 certain amounts provided as 
an advance for fiscal year 2018.
    For fiscal year 2019, the Committee recommends an 
additional $750,000,000 for Medical services, $1,000,000,000 
for Medical community care, and $211,000,000 for Medical 
facilities. Additionally, the Committee recommendation includes 
$779,000,000 for Medical and prosthetic research. Medical care 
collections are expected to be $3,590,000,000. The Committee 
recommendation also provides $75,550,600,000 in advance 
appropriations for VA's medical care accounts for fiscal year 
2020.
    Allocations.--At the beginning of fiscal year 2018, without 
public notice, the Department considered fundamentally changing 
the manner in which Medical Service allocations were made to 
the Veterans Integrated Service Networks. Specifically, 
consideration was being given to converting almost 
$1,000,000,000 of Specific Purpose funding to General Purpose 
funding. After consultation with Congress regarding the unknown 
and potentially serious impacts the conversion could have to 
programs, such as the successful Housing and Urban Development-
Veterans Affairs Supportive Services program, the Department 
ceased implementation and determined that conversion to General 
Purpose funding would not go forward in fiscal year 2018. In 
the Explanatory Statement accompanying Public Law 115-141, the 
Consolidated Appropriations Act of 2018, the Department was 
directed to consult with the Committees on Appropriations and 
the Committees on Veterans Affairs of both Houses of Congress 
before any future attempts are made to realign these funds and 
to propose such proposals in an annual budget submission. The 
Committee notes, that no such consultation has occurred and 
that the fiscal year 2019 budget submission did not reflect any 
conversion of funding. Therefore, the Committee directs that 
the Department not convert any Special Purpose funding to 
General Purpose funding in fiscal year 2019.
    Cross Government Credentialing of VA Healthcare 
Providers.--In order to better facilitate active recruitment of 
individuals who served in the healthcare field for the U.S. 
Armed Forces or while on duty with the U.S. Coast Guard, the 
Committee directs VA to establish coordinating relationships 
with the appropriate personnel divisions dealing with 
separating military personnel at the Departments of Defense and 
Homeland Security. As part of this coordination, the Department 
shall determine whether establishing a formal system for 
receiving advanced notice of separating members of the armed 
forces is feasible. The Committee further directs VHA to 
conduct an internal audit of its procedures for the 
recredentialing of providers when transferring within the VHA 
system. The Committee directs VHA to institute such policies 
and procedures to ensure the speedy and timely transfer of 
licensed personnel between facilities and to remove the 
unnecessary barrier of recredentialing triggered solely by a 
provider transferring facilities.
    National Intrepid Center of Excellence Satellite Strategic 
Basing.--The Committee recognizes the value of the National 
Intrepid Center of Excellence [NICoE] at Walter Reed National 
Military Center as a global leader in traumatic brain injury 
[TBI] care, research and education. In recent years, the NICoE 
has broadened its reach to service members and families by 
establishing a successful model of satellite centers, known as 
Intrepid Spirit Centers, which are located in highly populated 
military and defense communities. The Committee believes the 
Departments of Defense and Veterans Affairs can benefit from a 
similar model and joint project to serve both the active and 
veteran populations in support of complementary and 
comprehensive recovery from the effects of TBI. The Committee 
directs the Departments to study the value and merit to 
establishing a joint DOD/VA, NICoE Intrepid Spirit Center that 
serves both the active duty and veteran populations for the 
mutual benefit and growth in treatment and care. The study will 
be reported to the Committees on Appropriations of both Houses 
of Congress no later than 180 days after enactment of this act, 
and include inputs from NICoE personnel and analysis regarding 
localities in geographically rural areas that may have existing 
DOD medical facilities that partner with the VA, academic 
institutions specializing in neurology and are distant from 
existing or planned NICoE satellite locations.
    Unmet Healthcare Benefits Concerning Veterans in the 
Commonwealth of the Northern Mariana Islands, American Samoa, 
Guam, and Freely Associated States.--The Committee recognizes 
the challenges for veterans residing in the Commonwealth of the 
Northern Mariana Islands, American Samoa, Guam, and the Freely 
Associated States to access quality healthcare and is 
interested in exploring options to improve access and reduce 
overall costs. The Committee directs the Government 
Accountability Office to conduct a comparative analysis of 
delivering care to these veterans through the Department of 
Veterans Affairs Pacific Islands Health Care System [VAPIHCS] 
versus foreign medical facilities nearby, including the 
Philippines, Western Samoa, and New Zealand. The report should 
review the costs of providing care for these veterans, 
including travel and lodging costs in Hawaii and Guam; the 
medical outcomes and financial and psychological impacts of 
such referrals; and how veterans from other Pacific areas may 
reduce access to care for veterans residing in Hawaii. The 
report should also examine whether there is or needs to be 
existing administrative or legislative authority authorizing 
veteran care at foreign medical facilities.
    In addition, as VA works to transform its Community Care 
programs, the Committee directs the Secretary to provide the 
Committees on Appropriations of both Houses of Congress with a 
strategic plan to implement and improve the utilization of 
healthcare services for veterans in outlying areas through 
piloting the expansion of health services via telehealth or 
other community care providers within 180 days of enactment of 
this act. The plan should include an assessment of the number 
of veterans residing in outlying areas who have utilized 
services in the VAPIHCS facilities over the last three fiscal 
years and an average estimated cost for these veterans to 
access VA care; the estimated costs for providing telehealth 
services in outlying areas through a pilot program; 
identification of statutory authorities which may impede the 
necessary steps to implement such a plan and; recommendations 
for how VA can reduce burdensome restrictions under the Foreign 
Medical Program under its existing authorities.
    Furthermore, the Committee encourages the Department of 
Veterans Affairs to work with Federal and non-Federal partners, 
including the Departments of Defense, Interior, and Health and 
Human Services, non-VA healthcare facilities, and educational 
institutions to leverage shared resources and improve access 
for delivery of care through collaboration.
    Prompt Payment.--The Committee remains committed to 
supporting VA's efforts to ensure timely reimbursement for non-
VA healthcare providers and facilities that provide necessary 
care for our veterans. As VA plans to award new Community Care 
Network contracts in 2018, the Committee encourages the 
Department to provide stronger oversight and improve timely 
payment to non-VA providers. The Committee also urges VA to 
facilitate the completion of all outstanding reimbursement as 
promptly as possible.
    Veterans Integrated Service Networks.--The Committee is 
aware that the Department intends to develop a plan to 
reorganize several regional Veterans Integrated Services 
Network [VISNs]. As the Department develops this reorganization 
plan, the Committee urges the Department to consider 
realignment strategies that keep whole States within the same 
VISN.
    Critical Need Occupations Staffing Model.--It is critical 
that the Veterans Health Administration develop a staffing 
model so that it can better understand, and more quickly 
address, its staffing needs in critical need occupations. The 
Committee remains concerned that after nearly 2 years, VA has 
failed to follow-up on repeated recommendations of the Office 
of Inspector General [OIG] regarding the development of 
staffing models for critical need occupations, as well as set 
forth milestones and a timetable for further critical need 
occupations' staffing model development. The Committee 
recognizes that the Department has put forward some effort to 
move forward the process for creating a staffing model, but is 
disappointed with the pace. As such, the Committee directs VA 
to accelerate the creation of such a model so that veterans 
have access to the care they need.
    VHA Corporate Planning & Market Survey Functions.--Various 
documents published by VHA, such as the Blueprint for 
Excellence and the fiscal year 2016 Annual Restoring Trust in 
Veterans Health Care Report, recognize the need for creating a 
high-performing, integrated health network that includes VHA 
providers and facilities, other federally funded providers and 
facilities, and VHA-credentialed community providers and 
facilities. To date, VA has not articulated an overarching 
strategy to achieve such a goal, does not provide metrics to 
show progress towards achieving stated goals, and has no 
structure to identify accountable senior officials for such an 
effort. Further, the Department's efforts in this area have 
been stymied by litigation, leading to further delays. The 
Committee recognizes that the complex and transformative nature 
of creating a system capable of serving veterans in the future 
requires direct and sustained VHA leadership involvement. To 
achieve this goal, the Committee directs VHA to form a 
corporate planning function patterned after high performing 
commercial health care delivery systems. Such function must 
include representation from VHA clinical leadership, and 
leaders from VHA offices that control, oversee, or manage 
facility investments, transition, facility operations, and 
organizational change, as well as the appropriate VA offices 
that are dedicated to the planning and procurement of capital 
infrastructure, whether built or leased by VA. The corporate 
planning function shall be responsible for planning and 
implementing a high performing, integrated health network. The 
Department shall report to Congress no later than 180 days 
after enactment of this act detailing the corporate planning 
function and a plan to achieve a high-performing, integrated 
health network for the next 20 years. At a minimum, the plan 
shall clearly articulate VA's vision of a future network, 
include goals VA is working towards to achieve the vision, Key 
Performance Indicators and other metrics VA will use to judge 
success, and an organizational chart detailing the corporate 
planning function's direct reporting relationship to the Under 
Secretary of Health. The Committee recommends VA seek objective 
analysis and recommendations from organizations outside VA that 
have successfully created, implemented, or advised corporate 
planning functions at high-performing community health care 
systems. The Committee recommends VHA seek guidance from the 
leadership of the Department of Defense's Military Health 
System Facility Shared Service. Additionally, the Committee 
understands that VHA is now conducting market surveys to 
examine how VHA can develop a high-performing network by 
looking at community health care supplies and VHA services and 
capabilities. The Committee directs VHA to report back the 
findings of these market surveys within 180 days of the 
completion of the surveys.
    Healthcare Fraud Prevention.--The Committee directs VA to 
evaluate the feasibility and advisability of utilizing health 
care fraud prevention initiatives to evaluate payments made to 
private sector providers and third party administrators to 
detect and prevent fraudulent billing by collecting data that 
evaluates trends, recognizes patterns consistent with potential 
fraud, and potentially uncover schemes or bad actors the Agency 
could not otherwise identify using only its own information.
    Retrofitting Facilities to Eliminate Barriers to Care for 
Women Veterans.--The Committee is concerned about VA's lack of 
progress in addressing privacy and environment of care issues 
for women veterans, as highlighted in a 2016 GAO report. 
Therefore, not later than 180 days after enactment, the 
Committee directs VA to submit a report to the Committees on 
Appropriations and the Committees on Veterans Affairs of both 
Houses of Congress on the expenditures, including fixtures, 
materials, and other outfitting measures funded by major 
construction, minor construction, non-recurring maintenance, or 
other facilities accounts that provide for and enhance the 
privacy and environment of care for women veterans being 
treated. The report should further include a plan to address 
deficiencies in the environment of care for women veterans that 
serve as barriers to accessing the care that they have earned.

                            MEDICAL SERVICES

                     (INCLUDING TRANSFER OF FUNDS)

Appropriations, 2018\1\................................. $46,849,538,000
Advance appropriations, 2019............................  49,161,165,000
Budget estimate, 2019...................................................
Committee recommendation, 2019..........................     750,000,000
Budget estimate, advance appropriations, 2020...........  48,747,988,000
Committee recommendations, advance appropriations, 2020.  51,411,165,000

\1\Total excludes $11,075,000 in emergency funding provided in Public 
Law 115-123, the Further Additional Supplemental Appropriations for 
Disaster Relief Requirements Act, 2018.
---------------------------------------------------------------------------

                          PROGRAM DESCRIPTION

    The Medical Services account provides for medical services 
for eligible enrolled veterans and other beneficiaries in VA 
healthcare facilities, including VA medical centers and VA 
outpatient clinics.

                        COMMITTEE RECOMMENDATION

    In fiscal year 2018, the Committee provided an advance 
appropriation of $49,161,165,000 for fiscal year 2019 for the 
Medical Services account. The recommendation for fiscal year 
2019 includes an additional $750,000,000 which is $750,000,000 
above the budget request. The additional appropriation coupled 
with the advance appropriation provided for fiscal year 2019 
provides the Department with total budget authority of 
$49,911,165,000 which is $3,061,627,000 above the fiscal year 
2018 enacted amount. In addition, VA has the authority to 
retain co-payments and third-party collections, estimated to 
total $3,590,000,000 in fiscal year 2019.
    The Committee recommendation also includes an advance 
appropriation of $51,411,165,000 for Medical services for 
fiscal year 2020. This is $2,663,177,000 above the budget 
request. The Administration's budget proposed to consolidate 
the Medical Community Care account with the Medical Services 
account. The Medical Services account is used primarily for in-
house VA medical care, while the Medical Community Care account 
funds non-VA care. The proposed consolidation of these accounts 
blurs the ability to readily identify how VA is executing 
funding between in-house care and non-VA care. However, 
according to the crosswalks contained in the justifications 
accompanying the budget submission, VA intended on allocating 
$14,419,786,000 to community care programs with the remaining 
$48,747,988,000 being utilized on traditional in-house VA care. 
This represented a proposed $413,177,000 reduction for services 
provided under the current Medical Services account. In order 
to continue to provide proper budgetary oversight of these two 
important functions, the Committee recommendation rejects the 
consolidation of these two accounts and adjusts the fiscal year 
2020 advance appropriation for this account to better reflect 
current utilization rates.

                    PREVENTING VETERANS HOMELESSNESS

    The Committee remains strongly supportive of VA's homeless 
prevention programs and as such the recommendation includes 
$1,888,534,000 to support these programs. This total includes 
an additional $130,000,000 over the current estimate of 
$320,000,000 for the Supportive Services for Veterans Families 
[SSVF] program and an additional $5,000,000 over the request 
for the Justice Outreach Homeless Prevention program.
    Limited Affordable Housing.--The Committee supports the 
continued efforts of the Department to shelter homeless 
veterans by providing case management services, housing grant 
assistance and access to low and no income housing 
opportunities, through programs such as the SSVF and HUD-VASH 
voucher programs. The Department is directed to submit a report 
to the Committees on Appropriations of both Houses of Congress 
no later than 180 days after enactment of this act on the 
impacts of limited affordable housing opportunities on 
Department homelessness programs in rural communities and 
recommendations on how the Department may better partner with 
local housing entities to ensure rural access to housing 
services.
    In addition, the lack of affordable housing in many urban 
areas hindered efforts to reduce the homeless veterans 
population. Therefore, as part of the report, the Committee 
directs VA to include a section addressing the feasibility of 
piloting a demonstration through one of its existing programs 
to provide housing and supportive services to homeless veterans 
in high cost urban areas.
    Veterans Justice Outreach Program.--The goal of the 
Veterans Justice Outreach Program [VJO], authorized by section 
2022 of title 38, United States Code, is to prevent 
homelessness, and avoid the unnecessary criminalization of 
mental illness and extended incarceration among veterans. This 
is accomplished by ensuring that eligible veterans encountered 
by police, and in jails or courts, have timely access to VA 
services including: mental health, substance abuse, and 
homeless programs. In 2017, the VJO program provided services 
to over 46,500 justice-involved veterans, supported 461 
Veterans Treatment Courts and other veteran-focused court 
programs, and partnered with legal providers to offer 158 pro-
bono legal clinics to veterans on site at local VA hospitals. 
In order to assist in the success of this program, the 
Committee recommendation includes an additional $5,000,000 over 
the budget request for this program.
    Collaboration for Grant Per Diem Mix of Housing Services.--
The Committee agrees with the goal of ending veteran 
homelessness by ensuring veterans' access to permanent, 
affordable housing of their choice. However, the Committee 
recognizes that service-intensive transitional housing provided 
through the VA's Grant Per Diem Program [GPD] is an important 
programmatic option, particularly in areas with low vacancy 
rates, limited housing stock, and high market rates, and that 
substance-free and service-intensive housing may be a critical 
step for veterans at risk of relapse into substance abuse. The 
most appropriate mix of housing services for veterans should be 
determined through a collaborative process including local 
housing partners, service providers, and the Department of 
Veterans Affairs. The Department should continue to make 
funding available for GPD beds based on a collaborative process 
with the local VA Medical Centers and the Continuums of Care. 
The Department is directed to submit a report to the Committees 
on Appropriations of both Houses of Congress no later than 180 
days after enactment of this act on the contingency and 
remediation plan for veterans impacted by changes in 
availability or losses of awards of Grant Per Diem Program 
funds for current providers that serve rural or highly rural 
areas that would result in the loss of veterans' access to 
transitional housing assistance.
    Veteran Homelessness in the Greater Los Angeles Region.--
The Committee is concerned by reports that the population of 
veterans in Los Angeles experiencing homeless on any given 
night increased by 57 percent between from 2016 and 2017 from 
3,071 to 4,828. Given the increasing homeless population, in 
many areas including the Greater Los Angeles Region, the 
Committee urges the Department to ensure that additional case 
management personnel and resources are being deployed to meet 
the recommended 25-1 case management staffing ratio. Within 30 
days of enactment of this act, the Department shall provide to 
the Committees on Appropriations of both Houses of Congress a 
report outlining the cost and feasibility of contracting with 
local community-based agencies and non-profit organizations to 
provide additional case management services in regions where 
the Department does not meet is own case management ratio 
goals.
    Further, in order to better inform the Committee regarding 
HUD-VASH case management, not later than 120 days after 
enactment of this act, the Secretary shall submit to the 
Committees on Appropriations of both Houses of Congress a 
report that details the current ratio of HUD-VASH case managers 
to veterans serviced; steps taken to recruit and retain case 
managers for this program; a list of VA Medical Centers where 
HUD-VASH cases are being contracted out; and, efforts currently 
underway to assist HUD-VASH case management in highly rural 
areas.

                          TELEHEALTH SERVICES

    The Committee recommendation includes an additional 
$30,000,000 to expand VA's telehealth capabilities. The 
Department of Veterans Affairs along with the Department of 
Defense have long been leaders in the field of emerging 
technology and medicine. For VA, telehealth creates a bridge 
between rural and urban centers--providers at an urban site can 
diagnose and provide a care plan for veterans hundreds of miles 
away, allowing, VA to expand the resources of one facility by 
connecting those providers to providers in another area. 
Through telehealth, the Department has the means and 
flexibility to provide care to veterans who do not have easy 
access to a VA hospital or access to a VA hospital staffed with 
the care they need.
    Telehealth is not only allowing the Department to expand 
access to care in areas where services are limited, but 
telehealth also allows care to be provided more effectively and 
efficiently for veterans closer to home and also through direct 
in-home access. While VA is once again leading the healthcare 
industry in the expansion of in-home telehealth and remote 
patient monitoring services, these services are often limited 
by the lack of broadband service in remote and rural areas. In 
order to better leverage other Federal partners, the Department 
is directed to provide a report to the Committee on 
Appropriations of both Houses of Congress by January 31, 2019, 
regarding ongoing collaborations VA has with other Federal 
agencies in targeting remote and rural areas with veteran 
populations in order to ensure that grant programs administered 
by other Federal agencies maximize coverage areas to veterans.
    The Committee is also aware telehealth has a potential for 
significant cost savings and cost avoidance for the Department, 
and the Department is urged to maintain its focus on this type 
of care, not only to better serve veterans, but also to be a 
good steward of its financial resources. In order to ensure 
cost effectiveness and faster deployment of telehealth 
platforms, the Committee urges the Department to take advantage 
of commercial-off-the-shelf technology solutions when 
appropriate.

               MENTAL HEALTH/PREVENTING VETERANS SUICIDE

    National Center for Post-Traumatic Stress Disorder.--The 
National Center for Post-Traumatic Stress Disorder [NCPTSD] is 
the Federal Government's foremost center of expertise on 
evidence-based treatment of post-traumatic stress. The 
Committee continues to support the mission and work of the 
NCPTSD and has provided $40,000,000 to continue the center's 
advancement of the clinical care and social welfare of 
America's veterans who have experienced trauma or suffer from 
PTSD through research, education, and training in the science, 
diagnosis, and treatment of PTSD and stress-related disorders. 
The Committee supports the priorities for NCPTSD as described 
in the Congressional budget submission, and directs the 
Department to provide an assessment of the additional full time 
staff needed to carry out those priorities, as well as a hiring 
plan. Additionally, no later than 30 days after enactment of 
this act, the Department is directed to submit to the 
Committees on Appropriations of both Houses of Congress its 
plan for ensuring that all community care mental health 
providers receive information about NCPTSD and its consultation 
program.
    PTSD Treatment at VA Facilities.--Advances in evidenced-
based clinical treatments stemming from recent brain research 
have significantly increased the ability to treat veterans 
experiencing post-traumatic stress. However, the availability 
of all levels of care remains inconsistent throughout the VA 
system. Therefore, no later than 180 days after enactment of 
this act, the Department is directed to submit to the 
Committees on Appropriations of both Houses of Congress an 
itemized cost estimate for the establishment of specialized 
out-patient PTSD programs, specialized intensive PTSD programs, 
and residential PTSD treatment program at every level two or 
above VA facility.
    Mental Health Staffing.--The Committee recognizes the 
importance of maintaining the appropriate number of mental 
health staff members at the Department of Veterans Affairs to 
provide veterans timely, effective, high-quality care. 
Therefore, the Committee urges the Department of Veterans 
Affairs to sufficiently fund its Mental Health Hiring 
Initiative in order to reach the recommended staffing ratio of 
7.72 mental health outpatient staff to 1,000 veterans. Although 
the Committee is aware that the Department of Veterans Affairs 
currently seeks to increase the number of mental healthcare 
providers by 1,000 staff members. The Department is directed to 
keep the Committee apprised on a quarterly basis on meeting its 
hiring goals.
    Suicide Prevention.--The Committee recognizes that 
preventing suicide among the veteran population requires a 
comprehensive and consistent effort to enhance the quality, 
continuity, and integration of mental healthcare. The Committee 
commends the Department for strengthening its focus on suicide 
prevention and urges the Department to increase support for 
primary care-mental health integration and recovery models, 
expand telemental health services, build on the success of 
evidence-based psychotherapy initiatives, and guide treatment 
decisions by measuring the outcomes of interventions. 
Additionally, the Committee recommends VHA develop a veterans 
suicide prevention strategy that is focused on preventing 
suicide by increasing focus on ``upstream'' prevention based 
interventions in order to more appropriately target 
interventions with veterans before they are at a crisis point. 
Interventions should be data-driven and executed in general 
areas of large veteran populations in the community as well as 
populations of at-risk veterans. The new strategy should 
include training for all VA employees who interact with 
veterans, not only those in the medical community, including 
chaplains, attorneys, law enforcement, and volunteers. The 
Department should also engage non-VA sectors such as employers, 
first responders, and the healthcare industry to ensure that 
all sectors are working across systems for suicide prevention.
    Sleep Disorders.--The Committee recognizes the importance 
of sleep, including its impacts on PTSD, traumatic brain 
injury, and mental health. The Committee supports VA 
considering all treatment options for these conditions, 
including ensuring proper sleep health. The Committee continues 
to recommend the Department assign a program manager for sleep 
disorders, including sleep apnea, that affect at least 200,000 
veterans of the Persian Gulf War and Operations Iraqi Freedom 
and Enduring Freedom. The Department is directed to submit a 
report to the Committees on Appropriations of both Houses of 
Congress no later than 90 days after enactment of this act on 
the status of this recommendation.
    Trauma Management.--The Committee encourages the Secretary 
to consider establishing a Trauma Management Therapy pilot 
program utilizing exposure therapy involving virtual reality in 
combination with group therapy for the treatment of individuals 
with symptoms relating to PTSD. The Secretary shall submit a 
report to the Committees on Appropriations of both Houses of 
Congress no later than 180 days after enactment of this act 
detailing the feasibility of such a pilot program and the 
metrics required to determine the value of exposure therapy in 
treating PTSD.
    Mental Health/Suicide Prevention Best Practice Review.--The 
Committee is concerned that despite significant focus, addition 
of new programs, and increased funding, veterans suicide 
statistics are not changing. The Committee supports the 
Department's Research efforts to synthesize information about 
successful practices and initiatives across the Department, and 
would like this effort to be expanded. As such, the Committee 
directs the Department to provide a report to the Committees on 
Appropriations of both Houses of Congress within 90 days after 
enactment, including:
  --A complete list of all current and planned mental health 
        and suicide prevention programs available to veterans 
        within the VA and through community partnerships;
  --For each program, the annual amount of funding and number 
        of veterans served;
  --The number of veterans receiving treatment in each program 
        who ultimately committed suicide;
  --The metrics used by the Department to track the efficacy of 
        its mental health programs, including how those metrics 
        are tracked longitudinally;
  --Recommendations for additional metrics for VHA to better 
        measure the efficacy of each mental health program;
  --The impacts of local mental health and suicide prevention 
        programs in rural communities; and
  --Recommendations on how the Department may better partner 
        with local communities to ensure rural access to mental 
        health and suicide prevention programs.
    Further, if the VA does not have a Veterans Suicide 
Coordinator, the Committee directs the establishment of the 
roll. That position will be responsible for tracking metrics on 
suicides among veterans, annually reporting trends, and 
providing feedback to VHA that can be used to adjust 
programming for veterans' mental health and suicide prevention 
to ensure funds are going to the most effective programs.

                OPIOID REDUCTION AND SAFETY INITIATIVES

    To continue to build upon opioid reduction efforts and 
safety initiatives, Committee recommendation includes 
$400,025,000 for Opioid Prevention and Treatment programs at 
the VA. This includes $348,000,000 for prevention and treatment 
programs, $18,000,000 above the budget request and $52,025,000 
to continue implementation of the Comprehensive Addiction and 
Recovery Act of 2016. The additional resources are to be used 
to strengthen VA's Opioid Safety Initiative as well as to 
develop programs aimed at ensuring that non-VA providers 
treating veterans through the community care programs are 
informed and in compliance with all VA standards for opioid 
safety and prescription guidelines.
    Office of Patient Advocate.--The Committee urges the 
Department to prioritize continued implementation of the 
reforms made to the patient advocacy program as required by the 
Jason Simcakoski Memorial and Promise Act (Title IX, Public Law 
114-198). The Committee believes that the law's establishment 
of the Office of Patient Advocacy will ensure that patient 
advocates are independent of local facility management, truly 
work on behalf of veterans, and are properly trained according 
to national standards. Accordingly, within 30 days of 
enactment, the Committee directs VA to provide a report on its 
progress implementing the relevant sections of Public Law 114-
198, including progress on patient advocate training at each 
VAMC and any outstanding recommendations included in the 
Inspector General's March 2017 audit of the patient advocacy 
program's fiscal year 2015 operations [VA OIG 15-05379-146].
    Improvement of Opioid Safety Initiative.--The Committee 
supports VA's Opioid Safety Initiative [OSI] and encourages 
continued implementation at all VA medical facilities, as 
directed under Title IX of Public Law 114-198, the Jason 
Simcakoski Memorial and Promise Act. The Committee believes 
that it is imperative that all VA providers who prescribe 
opioids continue to consistently use the Opioid Therapy Risk 
Report tool under the OSI, including prior to initiating opioid 
therapy, to ensure safe prescribing, and to help prevent 
diversion, abuse, and double-prescribing. Under Public Law 114-
198, the Department must continue implementation of mandatory 
use of such tool for all providers prior to initiating opioid 
therapy for a patient to assess the risk for adverse outcomes; 
routine and random drug tests standards; provider use of the 
tool to access the State Prescription Drug Monitoring Program 
[PDMP]; and inclusion of information identifying when health 
care providers access the tool and the most recent urine drug 
test for each veteran. The Committee also urges VA to further 
improve the timeliness of data available in the tool to allow a 
provider to have real-time access to data on a patient who was 
prescribed opioid therapy by another facility, in another 
State, or by mail order to prevent overprescribing and abuse 
potential. Public Law 114-198 requires the Department to ensure 
VA providers can access information in the State PDMP including 
by seeking to enter into memoranda of understanding with States 
to allow shared access of such information between VA and the 
States. This is critical to ensure safe pain management care, 
as many veterans also seek care from providers in the community 
who may prescribe them medication. The Department must also 
include such information in the Opioid Therapy Risk Report tool 
and require VA providers to disclose certain veteran 
information to State controlled substance or PDMPs. The 
Department is directed to submit an updated report to the 
Committees on Appropriations of both Houses of Congress no 
later than 180 days after enactment of this act assessing 
compliance with mandatory provider use of the tool and 
utilization of and reporting to State PDMPs. The report must 
also include an assessment of the feasibility of improving the 
tool to allow for real-time tracking and feasibility of 
implementing an indication for use linked to opioid 
prescriptions in the tool to support oversight of safe opioid 
prescribing.
    Opioid Therapy Clinical Practice Guidelines and Training.--
The Committee believes that continued and robust implementation 
and dissemination of the updated 2017 VA/DoD Clinical Practice 
Guideline [CPG] for Management of Opioid Therapy for Chronic 
Pain, as required under Public Law 114-198, is critical to 
ensure that clinicians have routine access to the most updated 
information to help inform safe and quality care and improve 
pain management for veterans. In addition, to ensure that all 
providers have access to most recent scientific evidence, it is 
critical for opioid prescribing guidance to be as up to date 
and as consistent as possible across Federal agencies. As such, 
the Committee directs the Department to continue to routinely 
coordinate and consult with the Centers for Disease Control and 
Prevention and other relevant groups and Federal agencies on 
continued implementation and compliance with the CPG and latest 
scientific recommendations. As part of continued efforts to 
enhance safe pain management and education across the 
Department, the Committee directs the VA to ensure that all 
clinicians, including pharmacists, receive guidance on 
assessing the risks and benefits of critical drug interactions 
with opioids when a pharmacists overrides such interaction 
under section 913 of Public Law 114-198. The Committee further 
directs VA to provide a report within 180 days after enactment 
of this act on implementation of the new CPG, including 
education and training of providers as well as certification 
from the new pain management teams at each facility that all 
health care professionals responsible for coordinating and 
overseeing pain management therapy utilize the updated CPG.
    Opioid Control Procedures.--The Committee is aware a recent 
GAO report recommended that the Under Secretary for Health 
should ensure that VAMCs have established an additional control 
procedure, such as an alternate controlled substance 
coordinator or a pool of extra inspectors, to help coordinators 
meet their responsibilities and prevent missed inspections. The 
Committee urges the Secretary to fully implement these 
recommendations to improve oversight of the controlled 
substance inspection program and to document its progress. The 
Committee directs the Secretary to provide annual updates on 
its progress regarding its adoption of the GAO recommendations.
    Community Care Opioid Safety.--The Committee recognizes 
that VA has made important progress increasing opioid safety 
and reducing overprescribing within the VA health care system. 
However, the Department has not made comparable progress 
implementing opioid safety reforms in VA community care 
programs. The Committee believes that the July 2017 VA Office 
of Inspector General report on opioid prescribing in VA 
community care programs provides further evidence that veterans 
receiving opioid therapy from community care providers, 
including through the VA Choice program, are at significant 
risk. The Office of Inspector General found that contract 
providers are not subject to many of the opioid safety reforms 
included in Public Law 114-198, the Jason Simcakoski Memorial 
and Promise Act, and implemented at VA [VA OIG 17-01846-316]. 
Specifically, community care providers are not aware of and 
thus, not complying with, VA opioid therapy and safe 
prescribing protocols. Furthermore, VA is not consistently 
tracking opioid prescriptions from community care programs due 
to significant information exchange gaps between VA and non-VA 
providers. To ensure community care providers follow the same 
safe opioid prescribing standards and have access to the same 
up-to-date pain care information as VA practitioners, the 
Committee directs the Department to implement the 
recommendations in the OIG report, including ensuring that 
community care providers review the safe opioid prescribing 
guidelines and Opioid Safety Initiative protocols and 
implementing a process to provide community care providers a 
complete up-to-date list of medications and medical history of 
the veteran during non-VA care consults. The Committee further 
directs the Department to provide a progress report on 
implementation of such recommendations within 180 days after 
enactment of this act.
    Complementary and Integrative Health.--Expanding access to 
comprehensive pain management and complementary and integrative 
health [CIH] services is vital to improving the delivery of 
high-quality care for our veterans, especially those struggling 
with co-occurring conditions like chronic pain, mental health 
and substance use disorders. The Committee urges robust 
implementation of VA's plan to expand the scope of research, 
education, delivery, and integration of CIH into the health 
care services provided to veterans. In addition, as required 
under section 932 of Public Law 114-198, VA must continue to 
prioritize implementation of the pilot program at VA medical 
centers, including polytrauma rehabilitation centers, to assess 
the feasibility and advisability and delivery using wellness-
based programs to complement pain management and related health 
care services. The Committee has been concerned with previous 
reports of VA's dangerous opioid prescription practices at 
facilities, including at the Tomah VA Medical Center in 
Wisconsin, where such practices led to the tragic death of 
Marine veteran Jason Simcakoski in 2014. While the Committee 
supports the progress being made to reduce misuse and abuse of 
opioids and to improve pain care, the Committee believes that 
consideration of VISNs or medical centers with a history of or 
current prescription rates of opioids that are in conflict with 
or are inconsistent with the standards of appropriate and safe 
care should be given priority. The Committee encourages the 
Department to continue to expand access to CIH services as part 
of the VA's Whole Health System approach and directs VA to 
report to the Committee on the progress of the 18 flagship 
facilities being launched to effectuate this effort.
    Implementation of VA Participation in State Prescription 
Drug Monitoring Programs.--Within 90 days of enactment, VA 
shall submit a report to the Committees on Appropriations of 
both Houses of Congress regarding implementation of the VA 
Prescription Data Accountability Act of 2017 (Public Law 115-
144) that requires VA to participate in State Prescription Drug 
Monitoring Programs. The report shall indicate progress in 
participation broken out by VISN and healthcare system, 
identify with specificity impediments to participation in 
particular State Prescription Drug Monitoring Programs and 
establish benchmarks and timeframes for full participation. Not 
later than February 1, 2020, VA shall submit an update report 
to the Committees identifying progress toward full 
participation during calendar year 2019. The committee also 
encourages VA, to the maximum extent permitted by law, to share 
prescription drug information with other Federal medical 
facilities that may serve veterans, including DOD medical 
facilities and Indian Health Service facilities.

                             LONG-TERM CARE

    Long-Term Care.--The bill provides $9,024,330,000 as 
requested by the Department for long-term care. This includes 
the $6,168,524,000 for institutional care and $2,855,806,000 
for non-institutional care. The Committee supports the 
Department's efforts to broaden veterans' options regarding 
non-institutional long-term care support and services. As the 
Department realigns these programs under the Medical Community 
Care account, the Committee encourages VA to continue to 
prioritize veterans' preferences in receiving home based 
services. The Committee notes the positive results of pilot 
programs such as the Veterans Independence Program, a veterans-
directed Home and Community Based Services [HCBS] grant program 
originally created as a pilot administered jointly by VA and 
the Department of Health and Human Services [HHS]. The 
Committee encourages enhanced cooperation with HHS to expand 
and grow these programs. The Department is directed to submit a 
report to the Committees on Appropriations of both Houses of 
Congress no later than 180 days after enactment of this act on 
the cost avoidance associated with various non-institutional 
care programs. The report should include information on the 
demand for HCBS among the veteran population, the number of 
veterans currently being served by each program under HCBS, and 
the Department's plans to expand the size and scope of HCBS. 
Given the success of current HCBS pilot programs, the 
Department should include a cost analysis of growing the 
existing pilot programs prior to national expansion to leverage 
coordination with HHS, in addition to detail regarding the 
Department's efforts to coordinate with HHS on HCBS in future 
years. Given that mandatory eligibility for certain types of 
care is associated with disability levels adjudicated by VBA, 
this report should also include recommendations for modernizing 
the claims process for veterans requiring long-term care.
    Home-Based Primary Care.--The Committee supports the 
collaboration between VA and the Indian Health Service [IHS] 
and collaboration by Federal agencies with Tribes to expand 
access to care for Native veterans, including the recent 
expansion of evidence-based home-based primary care [HBPC] 
programs at 14 VA medical centers. This expansion is designed 
to reach new populations of American Indian veterans living in 
rural reservation communities, which are served by medical 
facilities operated directly by the IHS or by Tribes and Tribal 
organizations with funding provided by the IHS. The Committee 
urges the Secretary to increase funding within the Office of 
Rural Health to expand HBPC programs to additional American 
Indian reservations and to other rural areas. Furthermore, the 
Secretary should continue to improve planning coordination with 
other Federal healthcare organizations. Planning efforts should 
take into account conducting a population-based needs 
assessment and allowing sufficient time to develop trusting 
relationships with Native veterans, Tribal health and social 
service personnel, IHS and Tribal community health 
representatives, and Tribal communities. Planning efforts 
should also consider availability of IHS and Tribal resources 
for patients, as well as identify potential opportunities for 
co-management to prevent unintended duplication of effort, 
over-prescribing of medications, and other inefficiencies.

                            RURAL HEALTHCARE

    Office of Rural Health.--Veterans residing in rural and 
remote areas face unique barriers to receiving high-quality 
mental health, primary healthcare, and specialty care services. 
While enhanced community care programs offer veterans increased 
flexibility to obtain care close to home, often this same gap 
in services exists in the private market in rural and remote 
communities. Over the past 9 years, the Office of Rural Health 
and its Rural Health Initiative has played a critical role in 
assisting VA in its efforts to increase access to care. 
Therefore the Committee recommendation includes $270,000,000 
for the Office of Rural Health [ORH] and the Rural Health 
Initiative. This is $20,000,000 above the budget request.
    Through collaborations with other VA program offices, 
Federal partners, State partners, and rural communities, ORH 
works to optimize the use of available and emerging 
technologies, establish new access points to care, and employ 
strategies to increase healthcare options for all rural 
veterans. Currently, ORH identifies and implements initiatives 
that support rural clinics and rural home-based primary care, 
address barriers to access and quality of healthcare delivery 
in rural areas, develop workforce recruitment and retention 
initiatives, and accelerate and expand telehealth. ORH also 
operates Rural Health Resource Centers and works with Federal 
and non-Federal community partners to share resources and 
expand access to care for rural veterans. Given the important 
role these centers play in increasing access, the Committee 
encourages the Department to increase the number of these 
centers. Any expansion should also emphasize increasing access 
to healthcare for women veterans, treating traumatic brain 
injuries, and the recruitment and retention of healthcare 
providers to serve rural and remote areas.
    Rural Health Continuity of Care.--The Committee notes the 
Access Received Closer to Home [ARCH] pilot program was highly 
successful in some areas in providing healthcare services to 
veterans who live in the rural and highly rural States in which 
it operated, such as in northern Maine and in Kansas. During 
the pilot, VISN analysis demonstrated that more than 90 percent 
of veterans who received medical care through ARCH were 
``completely satisfied'' with their care and cited 
significantly shortened travel and wait times to receive care. 
Furthermore, the Committee is pleased the Department has made 
efforts to provide continuous, ARCH-like access to rural 
healthcare in northern Maine through the use of provider 
agreements. As the Department transitions away from the Choice 
Program to a reformed community care program, the Committee 
directs the Secretary to sustain continuity of care for rural 
veterans through provider agreements, based on previous models 
such as the ARCH program, to ensure veterans do not experience 
a lapse in existing healthcare access during the transition to 
the new community care program and any resulting integrated 
networks. The Committee continues to support enabling the 
Department to enter into provider agreements with non-VA long-
term care providers, including skilled nursing facilities, in 
lieu of the current onerous Federal contracting requirements.
    VA/Clergy Partnership for Rural Veterans.--The Committee 
supports the continuation of the efforts of the Department's 
Community Clergy Training to Support Rural Veterans Mental 
Health Initiative. The Committee urges the Department to 
increase the financial resources made available in order to 
increase accessibility of this initiative to rural communities. 
Further, the Committee directs the Department to provide a 
report to the Committees on Appropriations of both Houses of 
Congress, no later than 180 days after enactment, on the 
participation rate of rural communities in this program and 
recommendations on how the Department may better partner with 
local faith-based organizations as well as the Department of 
Defense, in conjunction with the ``Strong Bonds'' program, to 
ensure access for veterans as well as total force 
servicemembers.
    Rural Recruitment.--To improve recruitment and retention 
initiatives for healthcare providers in rural and highly rural 
areas the Committee urges the Department to conform with the 
recommendations contained in GAO report GAO-181-24. 
Specifically, that the VHA:
  --Develop and implement a process to accurately count all 
        physicians providing care at each medical center, 
        including physicians not employed by VHA;
  --Develop and issue guidance to the VAMCs on determining 
        appropriate staffing levels for all mission-critical 
        physician occupations;
  --Ensure that when multiple offices issue similar 
        productivity data on physician occupations, any 
        methodological differences are clearly communicated and 
        guidance is provided on how to interpret and reconcile 
        the data;
  --Establish a system-wide method to share information about 
        physician trainees to help fill vacancies across VAMCs; 
        and
  --Conduct a comprehensive, system-wide evaluation of the 
        physician recruitment and retention strategies used by 
        VAMCs to determine their overall effectiveness, 
        identify and implement improvements, ensure 
        coordination across VHA offices, and establish an 
        ongoing monitoring process.
    Nurse Advice Line.--Last year, the Committee directed the 
Department to pursue a pilot program for a nurse advice line 
targeting rural areas and highly rural areas with a large 
percentage of veterans. The pilot was to be based on and 
improve upon the nurse advice line implemented by DOD for 
beneficiaries under the TRICARE program. No later than 30 days 
after enactment of this act, the Department is directed to 
submit to the Committees on Appropriations of both Houses of 
Congress a report detailing where the pilot was established and 
the progress made in implementing the directive. The reports 
shall also contain information on utilization of the pilot, to 
include a description of the individuals who benefitted from 
advice; a description of any impediments in carrying out, or 
encountered by individuals accessing, the pilot program; a 
description of any cost savings to the Department, and an 
assessment of the feasibility and advisability of expanding the 
pilot program to more veterans.

                               CAREGIVERS

    The Committee recommendation includes $860,828,000 for the 
VA's Caregivers Program, $364,796,000 above the current 
estimate submitted with the budget request. The Committee 
expects VA to dedicate this funding to the program and not to 
divert the resources to other areas and notes that notification 
should be provided to the Committee of any reprogramming of 
this funding. In order to ensure proper budgetary oversight, 
the Department is directed to report to the Committees on 
Appropriations quarterly obligations for the Caregivers 
Program.
    Caregivers.--The Committee notes the robust usage of the 
post-9/11 Caregiver program with its more than 21,000 approved 
applications, as well as the consistent reviews by caregiver 
families noting that the program's stipend, respite care, 
formal training, and support structure are critical components 
to its success. Given the demonstrated success of the program, 
the Committee encourages the VA to ensure that the Caregiver 
coordinators at each Medical Center are fully resourced and, to 
the maximum extent possible, assigned designated Caregiver 
duties as their chief and only responsibility. The Department 
is also encouraged to work with the Department of Defense in 
order to develop and share best practices.
    Many caregivers for severely wounded veterans are working 
dramatically reduced hours outside the home or have left the 
workforce completely, often leading to financial hardship. This 
reduction in outside earnings results in difficulties meeting 
financial obligations, including student loan debt held by the 
caregiver. The Committee directs the VA to survey all 
caregivers currently in the program to identify the number 
possessing outstanding student loan debt and to develop a plan 
to monitor this issue, by developing methods to capture this 
data routinely. The Department shall report to the Committees 
on Appropriations of both Houses of Congress within 120 days of 
enactment of this act survey results and details for future 
monitoring.

                       WOMEN VETERANS HEALTHCARE

    Women Veterans.--Women represent 15.5 percent of today's 
active duty force and 19 percent of our National Guard and 
Reserves. Accordingly, women veterans are enrolling in VA 
healthcare at record levels, with the number of women veterans 
using VA healthcare tripling since 2001. With the upward trend 
of women serving in all branches of the Armed Forces, the 
Department must continue to aggressively expand efforts that 
address the current barriers to gender-specific healthcare 
services and plan accordingly for the type and length of the 
treatment needs of women veterans. The Committee continues to 
believe VA must be poised to address the changing demographic 
of today's and tomorrow's veterans in order to fulfill its 
mission. Toward this end, the Committee recommendation includes 
an additional $20,000,000 over the budget request for fiscal 
year 2019 to support gender-specific healthcare services. The 
Committee also encourages the Department to consider a mobile 
healthcare pilot program, prioritizing rural and high need 
areas, to provide gender-specific services, awareness of 
benefits, and outreach to women veterans utilizing mobile 
healthcare infrastructure. This innovative model is designed to 
fill the current gap in gender-specific services as VA works to 
expand infrastructure and hire the needed staff for specialty 
care.
    Female Primary Care and Mental Health Care Providers.--The 
Committee urges VA to make every effort to hire more women 
healthcare professionals and offer all women veterans the 
opportunity to choose the gender of their primary care and 
mental healthcare providers.
    Intimate Partner Violence Program.--The VA Intimate Partner 
Violence Program expands VA's screening, prevention, and 
intervention services to veterans and strengthens collaboration 
with community partners as well as the Caregivers Support 
Program and VA programs to address homelessness. The program 
focuses on developing a culture of safety and adopts a 
holistic, trauma-informed, veteran-centered approach to 
services and support for those veterans involved in a domestic 
violence situation. In recent years, VHA has run this program 
using general funds, and at times, the program has lapsed due 
to a lack of funds. The Committee directs the Department to 
fully resource this program at $17,000,000 in fiscal year 2019 
and include it as a program of interest with budget detail in 
the justifications accompanying the fiscal year 2020 budget 
submission.

                        OTHER ITEMS OF INTEREST

    Adaptive Sports.--The Committee recommendation includes 
$16,000,000 for adaptive sports programs. The Adaptive Sports 
Grant Program helps connect veterans with disabilities to 
sports programs and remains one of the most popular programs 
among veterans. Originally established to assist with training 
for Paralympic athletes, the program now supports veterans of 
all levels. The Committee recognizes that veterans have shown 
marked improvements in mental and physical health from 
participating in adaptive sports and recreational therapy and 
that veterans have expressed the need for these activities to 
be included in the healthcare services VA offers. The Committee 
also recognizes that adaptive sports and recreational therapy 
provide a low-cost alternative to other healthcare services 
that produce similar health outcomes. Therefore, the Committee 
requests that the Department provide a feasibility assessment 
for the cost of expanding the grant program to include 
recreational and lifelong sports, such as open-ocean swimming, 
surfing, outrigger canoeing, hunting, and fishing, as well as 
any legal barriers to expansion.
    The Adaptive Sports Grants Program currently awards a 
limited number of grants for equine therapy, mostly related to 
physical disabilities. Therefore, of the increase provided, 
$1,500,000 should be used by VA to increase its use of these 
grants for the purpose of equine therapy targeted to mental 
health issues.
    Equine Therapy.--The Committee recommends that the 
Department utilize funding to conduct a comprehensive program 
evaluation to ensure the continued effectiveness of equine 
therapy in addressing the mental health needs of veterans that 
participate in these programs, including through the systematic 
assessment and tracking of mental health issues and symptoms, 
and the measurement of key outcomes, such as functional 
improvement in veterans' different life domains.
    Cancer Treatment.--The Committee seeks to ensure that 
veterans have access to the highest quality cancer care 
available. The Committee, therefore, applauds the ongoing 
collaborative efforts between VA medical centers and NCI-
designated comprehensive cancer centers. The Committee supports 
these efforts, especially as they relate to providing veterans 
access to groundbreaking new treatments through clinical trials 
led by academic cancer centers, as well as the linking of VA 
oncology care with national research databases involving 
patients at multiple academic cancer centers. The Committee is 
also pleased that VA is engaged with the NCI and VA Interagency 
Group to Accelerate Trials Enrollment partnership, which will 
improve access to certain clinical trials at a number of VA 
facilities. The Committee understands that initiating new 
clinical trials is a resource-intensive process requiring 
experienced coordination staff with specialized expertise in 
data management and regulatory compliance. To improve its own 
capacity to coordinate a full range of cancer clinical trials 
with non-VA organizations, the Committee encourages VA to 
provide resources for coordination staff and continue to 
develop partnerships with non-VA organizations that have 
initiated pilot clinical trials programs. The Committee also 
requests a report, within 90 days of enactment of this act, 
which provides an overview of VA's credentialing process for 
non-VA clinical trial coordinators and recommendations, if any, 
to improve this process.
    Inpatient Drug Rehabilitation Report.--The Secretary of 
Veterans Affairs, no later than 120 days after enactment, shall 
submit to Congress a report that includes: (1) the number of VA 
inpatient drug rehabilitation beds per VA Medical Center; (2) 
Number of occurrences, per VA Medical Center, that the VA 
furnished inpatient drug rehabilitation care in the community 
in previous 24 months; and, (3) specific demographic data on 
addicted veterans.
    Beneficiary Travel.--The Committee is concerned about the 
allocation of beneficiary travel to VISNs where unconventional 
modes of travel, such as air, are the primary means for 
veterans to visit a VA hospital. The Committee directs the 
Secretary to conduct a review of the beneficiary travel program 
for VISNs that have exhausted available funds in the first or 
second quarter of the fiscal year. In conducting the review, 
the Secretary shall consider whether the traditional mileage 
reimbursement model remains appropriate for VISNs that serve 
the non-contiguous states and other rural, highly rural, and 
remote areas. The Secretary shall also report on the types of 
clinical services for which veterans are traveling and seeking 
reimbursement, and determine whether telemedicine could reduce 
the need for such travel and, if so, a plan to make those 
services available. Finally, the report shall assess how the 
beneficiary travel allocation in impacted VISNs affects timely 
reimbursements for veterans and what, if any, chilling effect 
delayed reimbursements have on veterans choosing to seek care. 
This report should be provided to the Committees on 
Appropriations of both Houses of Congress no later than 180 
days after enactment of this act.
    Blood products.--The Committee is concerned about the 
safety of blood products being transfused to veterans at VA 
medical facilities given the aging and medically fragile 
populations being treated. Therefore, the Committee urges VA to 
request that all blood product providers use FDA-approved 
pathogen reduction technology, where available, before 
providing blood products for transfusion at VHA medical 
facilities, including VA medical centers, outpatient clinics, 
community-based outpatient clinics, and community living 
centers.
    Orthotics & Prosthetics Workforce.--The Committee is 
concerned about the sustainability of the orthotics and 
prosthetics workforce treating veterans, particularly with 
retirements in an aging workforce and the lack of availability 
of advanced degree programs necessary to train new 
professionals. Reports indicate that up to 20 percent of the 
field's 7,100 clinicians nationwide are either past retirement 
age or within 5 years of retiring. The Committee recognizes the 
contributions made by the VHA's Orthotic and Prosthetic 
Residency Program to provide rotation opportunities through the 
VA system, but acknowledges this program alone is inadequate to 
ensure a sustainable workforce for the future, especially in 
light of the skill set necessary to provide the increasingly 
complex, state-of-the-art orthotics and prosthetics care for 
Iraq and Afghanistan war veterans. The Committee directs the 
VHA to explore cost effective opportunities to grow the 
workforce pipeline in order to ensure the future orthotic and 
prosthetic workforce required by the nation's new generation of 
veterans and report findings to the Committees on 
Appropriations of both Houses of Congress within 180 days of 
enactment.
    Sepsis Screening.--Sepsis is a major cause of mortality 
among veterans with spinal cord injury. The Committee believes 
that the Department, through its Center for Clinical Management 
Research and its Spinal Cord Injuries and Disorders Centers, 
can help improve the VA's diagnosis and management of Sepsis. 
The Committee urges the Department to provide a report on its 
costs related to sepsis management and how it has incorporated 
latest improvements in sepsis screening and diagnostics, 
including biomarker testing, across its healthcare facilities.
    Veterans Exposed to Open Burn Pits and Airborne Hazards.--
In order to provide full and effective medical care it is 
essential for the Department to better understand the impacts 
exposure during service has had on the health of veterans. 
Therefore the Committee includes $5,000,000 for VHA clinical 
proposals, developed in conjunction with research, focusing on 
post-deployment health for veterans exposed to airborne hazards 
and open burn pits. Additionally, the Committee directs the 
Secretary to provide an assessment of the process by which 
veterans are informed by both VA and community care providers 
about the Airborne Hazards and Open Burn Pit Registry and their 
eligibility for registering. The assessment should include an 
analysis of the process by which VA or community care providers 
for veterans who may be suffering the effects of exposure to 
airborne hazards are connected to the VA experts at the 
Airborne Hazards Center of Excellence for additional resources 
and assistance.
    The Committee is aware that the Department may be 
undertaking an effort to consolidate several health registries 
at the VA. In order to better understand the impacts this might 
have, the Department is directed to submit a report to the 
Committees on Appropriations of both Houses of Congress no 
later than 60 days after enactment of this act outlining the 
number and type of registries being consolidated. The report 
should also include how such consolidation will affect 
implementation of the recommendations included in the National 
Academies of Sciences, Engineering, and Medicine's Assessment 
of the Department of Veterans Affairs Airborne Hazards and Open 
Burn Pit Registry for improving the registry.
    Hospice Care.--From 1964 to 1975, more than nine million 
Americans served in the armed services, with more than one-
third of them having served in Vietnam. As these Vietnam-era 
veterans age, many of them are facing unique end-of-life 
challenges related to their combat experience that standard 
hospice care and palliative services are not fully equipped to 
address. These challenges include psychological and post-
traumatic stress disorders, a history of substance abuse, and 
neurological conditions resulting from toxic chemical exposure. 
While the VA provides hospice care and palliative services to 
qualified veterans, the Committee is aware that many non-profit 
organizations are developing programs designed to meet the 
specific end-of-life care needs for Vietnam-era veterans. The 
Committee also recognizes that such an approach could be 
beneficial to Iraq and Afghanistan combat veterans in the 
future.
    The Committee supports the findings of the feasibility 
study on hospice care protocols tailored to the unique needs of 
combat veterans, including Vietnam-era veterans, as required in 
fiscal year 2018. Therefore, the VA is urged to deploy a pilot 
program to develop the techniques, best practices and support 
mechanisms to serve these veterans and to further implement the 
findings of the feasibility study. The Department is encouraged 
to engage non-profit hospice and palliative care providers with 
Vietnam veteran-centric programs. The Department is directed to 
submit a report to the Committees on Appropriations of both 
Houses of Congress no later than 180 days after enactment of 
this act on this effort.
    Veterans Transportation Service.--In order to ensure the 
Veterans Transportation Service [VTS] is improving veterans' 
access to healthcare and VA's ability to provide quality care 
in a cost effective manner, the Department is directed to 
submit a report to the Committees on Appropriations of both 
Houses of Congress no later than 90 days after enactment of 
this act outlining the progress made on these metrics. At a 
minimum, the report should include analysis of the healthcare 
costs impacted by non-emergency medical transportation, the 
impact of VTS on missed appointment rates at facilities 
utilizing the program, and VTS impact on health outcomes for 
veterans.
    Center for Compassionate Innovation.--The Committee 
understands that VA has been operating a Center for 
Compassionate Innovation. The Center's stated purpose is to 
explore emerging therapies targeted to enhance veteran physical 
and mental well-being when other treatments have not been 
successful. The Committee encourages VA to always be testing 
and researching new and innovative treatments that may benefit 
veterans' lives. To more fully understand these treatments, the 
Committee directs VA to report within 180 days of the enactment 
of this act with a description of the proposals the Center 
received in fiscal year 2018 and the cost and disposition of 
such proposals. Further, the Committee directs VA to report on 
the actions the Department took regarding the data or results 
gleaned from these treatments and whether they have been 
utilized by the Department to determine the efficacy of the 
treatments.
    Physician Assistants.--The Committee is concerned that VA 
has failed to utilize existing authorities to hire and retain 
Physician Assistants [PAs]. As such, the Committee directs VA 
to accelerate the rollout of competitive pay for PAs, and 
develop a plan on how to better utilize the Health Professional 
Scholarship Program and Education Debt Reduction Program. In 
addition, the Committee believes VA would benefit from the 
creation of a staffing plan on how to utilize PAs within the 
Department and directs the Agency to develop such a model.
    Healthcare Workforce.--The Committee remains concerned with 
VHA's ability to recruit and retain quality physicians. 
Accordingly, the Committee directs the Department to fully 
comply with GAO's recommendations to improve staffing, 
recruitment, and retention strategies for physicians.
    The Committee is aware of the ongoing challenges facing the 
VA Caribbean Healthcare System as a result of the devastating 
2017 hurricane season. The Committee directs the Department to 
formulate a strategy to address the physician shortages 
currently facing the VA Caribbean Healthcare System. The 
Department is directed to submit a report to the Committees on 
Appropriations of both Houses of Congress no later than 180 
days after enactment of this act assessing the VA Caribbean 
Healthcare System's emergency response to Hurricanes Irma and 
Maria and identifying areas for improvement.
    Licensed Professional Mental Health Counselors and Marriage 
and Family Therapists.--The Committee directs VA to work with 
the Office of Personnel Management [OPM] to create an 
Occupational Series for Licensed Professional Mental Health 
Counselors [LPMHCs] and Marriage and Family Therapists [MFTs]. 
The Committee also directs VA to create a staffing plan for 
LPMHCs and MFTs to fill open positions and assess LPMHC and MFT 
shortages.
    Rehabilitation Therapy Outcomes.--The Committee believes 
that rehabilitation therapy outcomes might be improved if VA 
collected functional status data that includes; functional 
status and improvement; effectiveness and efficiency of 
treatment; and patient satisfaction. The Committee encourages 
VA to pilot the collection of such data and compare outcomes 
with a control group for which such data is not collected and 
monitored.
    Canadian Forces Base Gagetown.--The Committee is aware that 
many National Guard veterans engaged in training activities at 
Canadian Forces Base [CFB] Gagetown in the 1950s and 1960s. The 
Committee is also aware that Veterans Affairs Canada approved 
one-time, lump sum payments to eligible veterans exposed to 
Agent Orange and other defoliants who served at CFB Gagetown, 
and that American veterans who served there between June 20 and 
June 24, 1964, are currently eligible for an Agent Orange 
Registry Health Exam from the Veterans Health Administration. 
The Committee urges the Department to establish and maintain a 
health registry for American veterans who were stationed or 
underwent training at CFB Gagetown between 1956 and 2006 and 
who have subsequently experienced health problems which may be 
attributed to Agent Orange or other defoliants. The Committee 
further urges the Department to commission an independent study 
tasked with investigating the linkage between service at CFB 
Gagetown and the development of health problems and disease 
associated with exposure to Agent Orange.
    VA Special Mode Transportation.--The Committee is concerned 
that blinded veterans are being denied transportation 
assistance because their disability is not considered ``non-
ambulatory.'' The Committee directs VA to review this policy 
and report back to the Committee regarding the circumstance 
under which a denial of transportation assistance would be 
issued.
     Emergency Ambulance Reimbursement.--The Committee is 
concerned that the Department's medical documentation 
requirements for emergency ambulance services claims are 
resulting in veterans receiving bills for expenses properly 
borne by the VA. For example, the Committee is aware that the 
Health Insurance Portability and Accountability Act [HIPAA] 
frequently prevents ambulance providers from gathering the 
required medical information for submission to the VA for 
reimbursement. The Committee therefore urges the Department to 
take any necessary actions to process such claims using the 
``prudent layperson'' standard, as utilized by other Federal 
health insurance programs such as Medicare and Medicaid. The 
Department is directed to provide a brief to the Committees on 
Appropriations of both Houses of Congress no later than 90 days 
after enactment of this act to update the Committees on this 
effort.
    VA Transplant Centers.--The VA National Transplant Program 
currently maintains 13 VA transplant centers [VATCs] across the 
United States and performs approximately 300 organ transplants 
per year, with significant differences in volume and types of 
transplants being performed at the 13 facilities.
    The Committee is very concerned with the inconsistent 
volume of transplants being performed at the 13 VATCs. High 
volume, particularly for complex procedures, is associated with 
better outcomes, and research has demonstrated that there is 
strong evidence for a volume-mortality relationship for 
hospitals and physicians.
    The Committee also acknowledges the Office of Special 
Counsel's [OSC] report released in January 2018, which noted 
that VA failed to address conflicting information regarding the 
availability of transplant care in the community and the 
coverage of organ harvesting and donor care through the CHOICE 
Program.
    Therefore, the Committee directs the Secretary of the VA to 
deliver a report to the Committees on Appropriations of both 
Houses of Congress not later than 180 days after the enactment 
of this Act that addresses the following issues:
  --The fully burdened annual cost of the Department's National 
        Transplant Program over the previous five fiscal years, 
        including a per year cost breakdown for maintaining and 
        operating each transplant center;
  --A detailed accounting, by transplant center, of the number 
        of transplants, by organ type, performed over the 
        previous five fiscal years by month, indicating whether 
        or not those were performed at a VATC or at a non-VA 
        facility, and the average cost to the Department of 
        performing each type of organ transplant;
  --For those transplants performed at a non-VA facility, a 
        listing of the statutory authority by which the 
        transplants were covered by the VA;
  --A detailed accounting of the travel and lodging costs 
        associated with transporting veterans and authorized 
        support members to each of the Department's transplant 
        centers for pre-operative, operative, and post-
        operative care for the previous five fiscal years with 
        a per year breakdown;
  --VA's policy regarding the Veteran and his or her support 
        member when travel has been authorized, to include per 
        diem rates, dwelling options and travel allowances for 
        visiting home during treatment; and
  --A cost comparison by organ type of the average cost to 
        perform an organ transplant, to include pre- and post-
        operative care, for the Department versus the Centers 
        for Medicare & Medicaid Services.
    The Committee directs the Secretary of the VA to provide 
this information from the previous fiscal year to the House and 
Senate Appropriations Committees and Veterans Affairs 
Committees, on an annual basis, no later than 60 days after the 
end of the fiscal year.
    Pilot Program for Agritherapy.--An increasing number of 
States now have programs that assist veterans in starting 
farms, and many veterans turning to farming also suffer from 
PTSD. The benefits of agritherapy have been reported in the 
news media; however limited research and insufficient 
opportunities exist to offer the benefits of agritherapy to 
those suffering from PTSD. Therefore, the Department is urged 
to consider agritherapy for inclusion among VA's Complementary 
and Alternative Medicine therapies. Additionally, the Committee 
directs no less than $4,000,000, made available through the 
Office of Rural Health, toward a pilot program to train 
veterans in agricultural vocations while also tending to 
behavioral and mental health needs with behavioral healthcare 
services and treatments from licensed providers at no fewer 
than three locations. The pilot locations may be sites that 
currently have an operational construct to train veterans for 
agricultural vocations and have the potential to expand 
operations that tend to veterans medical needs while creating a 
pathway to employment in agriculture related fields.
    Hepatitis C.--The Department is directed to continue its 
quarterly updates to the Committees on Appropriations of both 
Houses of Congress detailing the expenditures and obligations 
of funding hepatitis C treatment, the number of veterans 
treated, the number of veterans deemed cured, the projection of 
spending, the number of new starts for drug treatment, and 
number of veterans who have been cured.
    Colorectal Cancer Screening.--In the explanatory statement 
accompanying Public Law 115-141, the Department was directed to 
offer all 7 colorectal cancer screening strategies recommended 
by the United States Preventive Services Task Force and adopted 
by the National Committee for Quality Assurance Healthcare 
Effectiveness Data and Information Set measures, which are used 
by more than 90 percent of U.S. health plans to measure 
performance. The Committee reminds the Department that it is to 
report to the Committees on Appropriations no later than June 
23, 2018 if it determines that it is unable to comply with this 
directive.
    Lovell FHCC.--The Committee recognizes the innovative 
collaboration between VA and DOD at the Captain James A. Lovell 
Federal Health Care Center Demonstration Project, established 
in 2010 under Public Law 111-84. Given the unique nature of 
this joint facility, the Committee notes that the Lovell 
Federal Health Care Center has significant potential to improve 
access, quality, and cost-effectiveness of healthcare delivery 
to veterans, service members, and their families. The Committee 
also recognizes that the important work of this integration 
effort must go on even as the two Departments continue to roll 
out their respective EHR programs. Therefore, the Committee 
directs the Department to provide, within 90 days of enactment, 
a comprehensive assessment of the status of integration efforts 
at Lovell FHCC, including an update on how to address ongoing 
challenges related to workforce planning and electronic health 
record and information technology systems integration, as well 
as an assessment of whether the model of a joint facility can 
be replicated in other parts of the country.

                         MEDICAL COMMUNITY CARE

Appropriations, 2018....................................  $9,828,294,000
Advance appropriations, 2019............................   8,384,704,000
Budget estimate, 2019...................................     500,000,000
Committee recommendation, 2019..........................   1,000,000,000
Budget estimate, advance appropriations, 2020...........  14,419,786,000
Committee recommendation, advance appropriations, 2020..  10,758,399,000

                          PROGRAM DESCRIPTION

    The Medical Community Care account provides for medical 
services for eligible enrolled veterans and other beneficiaries 
that is purchased from and provided by non-Department of 
Veterans Affairs facilities and providers, including contract 
hospitals, State homes, and outpatient services.

                        COMMITTEE RECOMMENDATION

    In fiscal year 2018, the Committee provided an advance 
appropriation of $8,384,704,000 for fiscal year 2019 for the 
Medical Community Care account. The recommendation for fiscal 
year 2019 includes an additional $1,000,000,000. The additional 
appropriation coupled with the advance appropriation provided 
for fiscal year 2019 provides the Department with total budget 
authority of $9,384,704,000.
    The Committee recommendation also includes an advance 
appropriation of $10,758,399,000 for Medical community care for 
fiscal year 2020.

                          VETERANS CHOICE FUND

Appropriations, 2018....................................................
Budget estimate, 2019...................................  $1,900,000,000
Committee recommendation, 2019..........................................

                          PROGRAM DESCRIPTION

    The Choice Fund was created in Public Law 113-146, the 
legislation establishing the Choice program and providing 
mandatory funding for it.

                        COMMITTEE RECOMMENDATION

    The Committee recommendation does not provide any funding 
for the Veterans Choice Fund. Since its inception, the 
authorizers have provided nearly $20,000,000,000 in mandatory 
funding, a significant portion of which was designated as an 
emergency requirement, to support the Choice program. The 
account has never received discretionary funding. The Committee 
also notes the House of Representatives and the United States 
Senate recently passed the VA MISSION Act of 2018, which 
provided an additional mandatory appropriation of 
$5,200,000,000.

                     MEDICAL SUPPORT AND COMPLIANCE

Appropriations, 2018\1\.................................  $6,754,480,000
Advance appropriations, 2019............................   7,239,156,000
Budget estimate, 2019...................................................
Committee recommendation, 2019..........................................
Budget estimate, advance appropriation, 2020............   7,106,150,000
Committee recommendation, advance appropriation, 2020...   7,239,156,000

\1\Total excludes $3,209,000 in emergency funding provided in Public Law 
115-123, the Further Additional Supplemental Appropriations for Disaster 
Relief Requirements Act, 2018.
---------------------------------------------------------------------------

                          PROGRAM DESCRIPTION

    The Medical Support and Compliance account provides funds 
for management, security, and administrative expenses within 
the VA healthcare system, in addition to providing costs 
associated with the operation of VA medical centers and 
clinics, VISN offices, and the VHA Central Office in 
Washington, DC. This appropriation also covers Chief of Staff 
and Facility Director operations, quality of care oversight, 
legal services, billing and coding activities, procurement, 
financial management, security, and human resource management.

                        COMMITTEE RECOMMENDATION

    In fiscal year 2018, the Committee provided an advance 
appropriation of $7,239,156,000 for fiscal year 2019 for the 
Medical Support and Compliance account.
    The Committee recommendation also includes an advance 
appropriation of $7,239,156,000 for Medical support and 
compliance for fiscal year 2020.

                           MEDICAL FACILITIES

Appropriations, 2018\1\.................................  $6,141,880,000
Advance appropriations, 2019............................   5,914,288,000
Budget estimate, 2019...................................................
Committee recommendation, 2019..........................     211,000,000
Budget estimate, advance appropriation, 2020............   5,276,676,000
Committee recommendation, advance appropriation, 2020...   6,141,880,000

\1\Total excludes $3,209,000 in emergency funding provided in Public Law 
115-123, the Further Additional Supplemental Appropriations for Disaster 
Relief Requirements Act, 2018.
---------------------------------------------------------------------------

                          PROGRAM DESCRIPTION

    The Medical Facilities account provides funds for the 
operation and maintenance of the VA healthcare system's vast 
capital infrastructure. This appropriation provides for costs 
associated with utilities, engineering, capital planning, 
leases, laundry, groundskeeping, housekeeping, facility repair, 
and property disposition and acquisition.

                        COMMITTEE RECOMMENDATION

    In fiscal year 2018, the Committee provided an advance 
appropriation of $5,914,288,000 for fiscal year 2019 for the 
Medical Facilities account. The recommendation for fiscal year 
2019 includes an additional $211,000,000 which is $211,000,000 
above the budget request. The additional appropriation coupled 
with the advance appropriation provided for fiscal year 2019 
provides the Department with total budget authority of 
$6,125,288,000 which is $16,592,000 below the fiscal year 2018 
enacted amount.
    For any VA renovation project for which energy systems are 
involved, the committee encourages the VA to use energy related 
Energy Savings Performance Contracting and Utility Energy 
Service Contracting in concert with appropriated funds to 
leverage more investment from the private sector.
    VA Chapels.--The Committee has provided significant 
investment for the upkeep and maintenance of Department 
infrastructure. The Department owns and is responsible for 
maintaining a variety of structures to include chapels and 
other facilities to tend to the spiritual needs of veterans. 
The Committee encourages the Secretary to prioritize funding 
for maintenance and renovation of such sites owned by the 
Department.
    Facility Assessments.--The Committee supports VA's efforts 
to obtain analysis that provides a more holistic view of VA 
facilities and thereby allows the Department to make more 
informed, data driven decisions about its facilities and 
buildings. The Committee recognizes that annual analysis and 
benchmarking across the Department's facilities will provide an 
invaluable tool for long-term system-wide planning, needs 
identification, and cost management for the Department. 
Therefore, the Committee encourages the Department to utilize 
an independent, third-party to provide facilities analysis, 
benchmarking and recommendations for all VHA hospitals, nursing 
homes, domiciliary facilities, and other necessary facilities.

                    MEDICAL AND PROSTHETIC RESEARCH

Appropriations, 2018....................................    $722,262,000
Budget estimate, 2019...................................     727,369,000
Committee recommendation................................     779,000,000

                          PROGRAM DESCRIPTION

    The Medical and Prosthetic Research account provides funds 
for medical, rehabilitative, and health services research. 
Medical research supports basic and clinical studies that 
advance knowledge leading to improvements in the prevention, 
diagnosis, and treatment of diseases and disabilities. 
Rehabilitation research focuses on rehabilitation engineering 
problems in the fields of prosthetics, orthotics, adaptive 
equipment for vehicles, sensory aids and related areas. Health 
services research focuses on improving the effectiveness and 
economy of the delivery of health services.

                        COMMITTEE RECOMMENDATION

    The Committee recommends $779,000,000 for the Medical and 
Prosthetic Research account. This is $56,738,000 above the 
fiscal year 2018 enacted level and $51,631,000 above the budget 
request.
    The Committee remains highly supportive of this program, 
and recognizes its importance both in improving healthcare 
services to veterans and recruiting and retaining high quality 
medical professionals in the Veterans Health Administration.
    Through the Department's research and development program, 
VA has implemented a comprehensive research agenda to develop 
new treatments and tools for clinicians to ease the physical 
and psychological pain of men and women returning from war 
zones, to improve access to VA healthcare services, and to 
accelerate discoveries and applications, especially for 
neurotrauma, sensory loss, amputation, polytrauma, and related 
prosthetic needs. The Committee encourages VA to continue its 
research into developing novel approaches to restoring veterans 
with amputation, central nervous system injuries, loss of sight 
or hearing, or other physical and cognitive impairments to full 
and productive lives.
    VA Cancer Moonshot Contribution.--The Committee supports 
the Beau Biden Cancer Moonshot initiative, and the Department's 
contribution utilizing advances in genomic science to provide 
targeted treatment to veterans. The Department has identified 
prostate cancer, triple-negative breast cancer, and colorectal 
cancer as areas of priority. Due to the prevalence of various 
skin cancers among service members, the Committee directs that 
skin cancer be included as well.
    Enewetak Atoll Registry Research.--The Committee is aware 
that thousands of veterans served on the Enewetak Atoll to 
clean up the island following its use for nuclear weapons 
testing. The Committee is also aware of many instances of 
veterans who conducted the cleanup suffering serious health 
problems, such as brittle bones, cancers, and birth defects in 
their children. The Committee urges the Department to study 
whether there is a connection between certain illnesses and the 
potential exposure of individuals to radiation related to 
service at Enewetak Atoll between January 1, 1977, and December 
31, 1980.
    Veterans Exposed to Open Burn Pits and Airborne Hazards.--
The Committee directs the Secretary to provide an assessment of 
the process by which veterans are informed by both VA and 
community care providers about the Airborne Hazards and Open 
Burn Pit Registry and their eligibility for registering. The 
assessment should include an analysis of the process by which 
VA or community care providers for veterans who may be 
suffering the effects of exposure to airborne hazards are 
connected to the VA experts at the Airborne Hazards Center of 
Excellence for additional resources and assistance.
    The Committee is also concerned about the need for a better 
understanding of and treatment options for rare cancers 
disproportionately impacting those who have served in the 
military. The Committee encourages the Department to support 
research to evaluate the health status of service members from 
their time of deployment to Iraq and Afghanistan over many 
years to determine their incidence of chronic diseases 
including cancers that tend not to show up for decades. The 
Committee further encourages the Department to establish a 
collaboration with the Department of Defense to examine the 
impact of rare cancers on those who serve and fund research in 
delivering treatments for rare cancers that take a platform-
agnostic approach to developing new therapeutics.
    Development of Veteran-Specific Therapies.--The Committee 
recognizes that commercial firms have expressed challenges with 
researching and developing veteran-specific therapies in light 
of the nature of service-connected diseases and the relatively 
small population served. However, the Committee believes it is 
increasingly important for VA to better understand and develop 
treatment options for veteran-specific afflictions in order to 
fulfill its promise to provide timely access to care. The 
Committee directs VA, where practicable, to leverage 
appropriate research toward development of veteran-specific 
therapies and to use existing contracting authorities to work 
with commercial firms to deliver treatments that provide relief 
for veterans with service-connected diseases.
    Gulf War Illness Studies.--The Committee recommends the 
Department continue to conduct epidemiological studies 
regarding the prevalence of Gulf War illness, morbidity, and 
mortality in Persian Gulf War veterans and the development of 
effective treatments, preventions, and cures. The Committee is 
concerned by the lack of public availability of the findings of 
all research conducted by or for the Executive Branch relating 
to the health consequences of military service in the Persian 
Gulf theater of operations during the Persian Gulf War and by 
the lack of coordination by the Department in ensuring the 
public availability of this information. The Committee urges 
the Department to publish disease-specific mortality data 
related specifically to Persian Gulf War veterans. The 
Committee remains concerned by VA's ever-evolving terminology 
for the signature adverse health outcome of the Persian Gulf 
War as recognized by the Institute of Medicine [IOM]--Gulf War 
illness--and encourages the Department to utilize the term, 
``Gulf War illness,'' as IOM has recommended. The Committee 
continues to urge the Secretary to consider revising and 
updating the Clinical Practice Guideline for Chronic Multi-
symptom Illness [CMI] consistent with the July 2011 Veterans 
Health Initiative, ``Caring for Gulf War Veterans,'' in that 
it, ``cannot be reliably ascribed to any known psychiatric 
disorder,'' and to focus on recent Gulf War illness treatment 
research findings and ongoing Gulf War illness treatment 
research direction. Furthermore, the Committee once again 
encourages VA to strengthen the training of primary, specialty, 
and mental healthcare providers on the Gulf War illness case 
definitions recommended by IOM.
    VA/Department of Energy Computing Collaboration.--As 
requested, the Committee includes $27,000,000 for VA to 
collaborate with the Department of Energy through the Advanced 
Computational and Translational Initiatives for Veterans and 
the Million Veterans Program Cohort--Computational Health 
Analytics for Medical Precision to Improve Outcomes Now [MVP-
CHAMPION] programs. The Committee encourages VA to take 
advantage of the unique high-performance resources offered by 
the Department of Energy Laboratories to address their most 
pressing issues in veteran health data. Important research 
collaborations, such as the MVP-CHAMPION project, have already 
collected protected healthcare data for 23 million veterans and 
is helping researchers better understand the role genes play in 
our health. The Committee encourages VA to continue leveraging 
the high performance computer facilities available through its 
partnership with the Department of Energy.

                 MEDICAL CARE COST RECOVERY COLLECTIONS

                      MEDICAL CARE COLLECTION FUND

Appropriations, 2018....................................  $2,507,000,000
Budget estimate, 2019...................................   3,590,000,000
Committee recommendation................................   3,590,000,000

             MEDICAL CARE COLLECTION FUND--REVENUES APPLIED

Appropriations, 2018.................................... -$2,507,000,000
Budget estimate, 2019...................................  -3,590,000,000
Committee recommendation................................  -3,590,000,000

                          PROGRAM DESCRIPTION

    The Medical Care Collection Fund [MCCF] was established by 
the Balanced Budget Act of 1997 (Public Law 105-33). In fiscal 
year 2004, Public Law 108-199 allowed the Department of 
Veterans Affairs to deposit first-party and pharmacy co-
payments; third-party insurance payments and enhanced-use 
collections; long-term care co-payments; Compensated Work 
Therapy Program collections; and Parking Program fees into the 
MCCF. The Secretary of Veterans Affairs has the authority to 
transfer funds from the MCCF to the Medical Services account.

                        COMMITTEE RECOMMENDATION

    The Committee recommendation includes the authority to 
retain co-payments and third-party collections, estimated to 
total $3,590,000,000 in fiscal year 2019.

                    National Cemetery Administration

Appropriations, 2018....................................    $306,193,000
Budget estimate, 2019...................................     315,836,000
Committee recommendation................................     315,836,000

                        ADMINISTRATION OVERVIEW

    The National Cemetery Administration was established in 
accordance with Public Law 93-94, the National Cemeteries Act 
of 1973. It has a four-fold mission: to provide for the 
interment in any national cemetery of the remains of eligible 
deceased servicemembers and discharged veterans, together with 
their spouses and certain dependents, and permanently maintain 
their graves; to provide headstones for, and to mark graves of, 
eligible persons in national, State, and private cemeteries; to 
administer the grant program for aid to States in establishing, 
expanding, or improving State veterans cemeteries; and to 
administer the Presidential Memorial Certificate Program.

                        COMMITTEE RECOMMENDATION

    The Committee recommends $315,836,000 for the National 
Cemetery Administration. This is an increase of $9,643,000 
above the fiscal year 2018 enacted level and equal to the 
budget request.
    The Committee has included bill language to make available 
through September 30, 2020, up to 10 percent of the National 
Cemetery Administration appropriation.

                      Departmental Administration

Appropriations, 2018\1\.................................  $6,508,439,000
Budget estimate, 2019...................................   8,135,377,000
Committee recommendation................................   7,746,670,000

\1\Total excludes $4,088,000 in emergency funding provided in Public Law 
115-123, the Further Additional Supplemental Appropriations for Disaster 
Relief Requirements Act, 2018.
---------------------------------------------------------------------------

                        ADMINISTRATION OVERVIEW

    Departmental Administration provides for the administration 
of veterans benefits through the Veterans Benefits 
Administration, the executive direction of the Department, 
several top level supporting offices, the Board of Contract 
Appeals, and the Board of Veterans Appeals.

                        COMMITTEE RECOMMENDATION

    The Committee recommends $7,746,670,000 for Departmental 
Administration. The amount is composed of $365,976,000 for 
General administration; $174,748,000 for the Board of Veterans 
Appeals; $4,184,571,000 for Information technology systems; 
$800,000,000 for the Electronic Health Record; $192,000,000 for 
the Office of the Inspector General; $1,127,486,000 for 
Construction, major projects; $706,889,000 for Construction, 
minor projects; $150,000,000 for Grants for construction of 
State extended care facilities; and $45,000,000 for Grants for 
the construction of State veterans cemeteries.

                         GENERAL ADMINISTRATION

                     (INCLUDING TRANSFER OF FUNDS)

Appropriations, 2018....................................    $335,891,000
Budget estimate, 2019...................................     367,629,000
Committee recommendation................................     365,976,000

                          PROGRAM DESCRIPTION

    The General Administration account provides funding for the 
Office of the Secretary, six assistant secretaries, and three 
independent staff offices.

                        COMMITTEE RECOMMENDATION

    The Committee recommends $365,976,000 for General 
Administration. This amount is $30,085,000 above the fiscal 
year 2018 enacted level and $1,653,000 below the budget 
request. The Committee has included bill language to make 
available through September 30, 2020, up to 10 percent of the 
General Administration appropriation.

                       BOARD OF VETERANS APPEALS

Appropriations, 2018....................................    $161,048,000
Budget estimate, 2019...................................     174,748,000
Committee recommendation................................     174,748,000

                          PROGRAM DESCRIPTION

    As set forth in section 7101(a) of title 38 United States 
Code, the Board of Veterans Appeals is responsible for making 
final decisions on claims for veterans benefits presented to 
the Board for appellate review. The vast majority of the 
Board's workload derives from benefit claims initiated by the 
Veterans Benefits Administration's Regional Offices. The 
appellate process has multiple steps, most of which occur at 
the local Regional Office level. If a veteran is not satisfied 
with the Regional Office determination, he or she may appeal to 
the Board for a final agency decision. The Board adjudicates 
appeals covering all areas of veterans benefits, including: 
service connection, increased disability ratings, total 
disability ratings, pensions, insurance benefits, educational 
benefits, home loan guaranties, vocational rehabilitation, 
waivers of indebtedness, fee basis medical care, and dependency 
and indemnity compensation.

                        COMMITTEE RECOMMENDATION

    The Committee recommends $174,748,000 for the Board of 
Veterans Appeals, which is $13,700,000 above fiscal year 2018 
enacted level and equal to the budget request. The Committee 
has included bill language to make available through September 
30, 2020, up to 10 percent of the Board of Veterans Appeals 
appropriation.

                     INFORMATION TECHNOLOGY SYSTEMS

Appropriations, 2018....................................  $4,055,500,000
Budget estimate, 2019...................................   4,184,571,000
Committee recommendation................................   4,184,571,000

                          PROGRAM DESCRIPTION

    The Information Technology [IT] Systems appropriation, 
along with reimbursements, funds the costs of all IT staff 
salaries and expenses, the operations and maintenance of all 
existing information technology systems, and the development of 
new projects and programs designed to improve the delivery of 
service to veterans. This appropriation also funds the costs 
associated with the Office of Information and Technology which 
oversees the functions highlighted above.

                        COMMITTEE RECOMMENDATION

    The Committee recommends $4,184,571,000 for the Information 
Technology Systems account. This amount is $129,071,000 above 
the fiscal year 2018 enacted level and equal to the budget 
request. The Committee recommendation includes $1,243,220,000 
for staff salaries and expenses, $2,560,780,000 for operation 
and maintenance of existing programs, and $380,571,000 for 
program development.
    The Committee has appropriated the Information Technology 
Systems account as three subaccounts. This funding structure 
enhances the Committee's ability to ensure funds are executed 
in a manner consistent with the Department's budget submission. 
The Committee has provided sufficient flexibility within the 
subaccounts by way of authorized carryover amounts and 
reprogramming authority to give the Office of Information 
Technology as much flexibility as possible to accomplish its 
mission and goals, while ensuring proper accountability and 
oversight. The Committee will continue to work with the 
Department to ensure the IT projects currently underway, as 
well as the projects planned for the future, have the resources 
needed for success.

               INFORMATION TECHNOLOGY DEVELOPMENT PROJECTS
                        [In thousands of dollars]
------------------------------------------------------------------------
                                      Fiscal year 2019      Committee
               Project                 budget request    recommendation
------------------------------------------------------------------------
Clinical Applications
    Access and Billing..............             5,891             5,891
    My HealtheVet...................            10,300            10,300
    Health Data Interoperability....            13,000            13,000
    Registries......................             3,228             3,228
                                     -----------------------------------
      Subtotal Clinical Applications            32,419            32,419
                                     -----------------------------------
Health Management Platform
    Digital Health Platform.........            15,682            15,682
    Community Care..................            25,303            25,303
    Patient Record System...........            14,300            14,300
    Purchased Care..................             9,076             9,076
    Telehealth......................             6,030             6,030
                                     -----------------------------------
      Subtotal Health Management                70,391            70,391
       Platform.....................
                                     -----------------------------------
Benefits Systems
    Benefits Appeals................             2,500             2,500
    Education Benefits..............            37,830            37,830
    Veterans Customer Experience....            47,564            47,564
    Veterans Benefits Management....            10,000            10,000
    Benefits Systems................            31,721            31,721
                                     -----------------------------------
      Subtotal Benefits Systems.....           129,615           129,615
                                     -----------------------------------
Memorial Affairs
    Memorials Automation............            18,800            18,800
                                     -----------------------------------
      Subtotal Memorial Affairs.....            18,800            18,800
                                     -----------------------------------
Other IT Systems
    Human Resources.................            12,600            12,600
    Financial and Acquisition                   65,971            65,971
     Management Modernization.......
                                     -----------------------------------
      Subtotal Other IT Systems.....            78,571            78,571
                                     -----------------------------------
Cyber Security......................            17,000            17,000
Information/Infrastructure
 Management
    Data Integration and Management.            33,715            33,715
                                     -----------------------------------
      Subtotal Information/                     33,715            33,715
       Infrastructure Management....
                                     -----------------------------------
      Total IT Development..........           380,511           380,511
------------------------------------------------------------------------

    Scheduling System.--For more than 15 years, the Department 
has struggled to modernize the current patient scheduling 
system and the Committee remains concerned about the lack of 
progress. While the Department has made upgrades to the VistA 
scheduling system, these modifications only provide a more user 
friendly viewing environment and do not address more functional 
problems with the current system. The Committee understands 
that a scheduling system solution will be a component of the 
new Electronic Health Record [EHR] program and that VA plans to 
deploy this new system over a 10 year period, with the first 
deployment to begin within the next 18 months. While the 
Committee supports VA's efforts to replace the antiquated EHR 
system currently in place and upgrade the deficient 
infrastructure in the field to handle the new functionality, it 
is concerning that many hospitals will not see functional 
modernization of the current scheduling system for another 10 
years. The Committee understands that VA is conducting pilot 
programs involving commercial off-the-shelf solutions 
scheduling systems to assess if they provide substantial value 
over its current interim systems and whether the benefits of 
deploying off-the-shelf technology outweighs costs during the 
decade-long deployment plan to modernize the entire EHR is 
implemented. The Committee believes that the Department must 
provide an interim solution for those hospitals and clinics 
that fall toward the end of the deployment schedule to improve 
veteran access to care, shorten veteran wait times, allow the 
VA to track and manage patient progress throughout the care 
continuum, and improve resource utilization across the VA 
healthcare system. Therefore the Committee directs the 
Department to submit a scheduling modernization plan no later 
than 60 days after enactment of this act, describing plans and 
costs of utilizing off-the-shelf technology as an interim 
solution during EHR modernization.
    Enhancing Local Control of Information Technology Needs.--
The Committee is concerned that local facilities and VISN 
leadership do not have the ability to quickly address IT issues 
causing the disruption of patient care. Further, that they do 
not have the ability to utilize the technologies they have 
identified as enhancing patient experience, due to 
centralization of IT resources. VA is therefore directed to 
produce a report on the methods by which information technology 
funds are allocated to the VISNs and to facilities, and any 
plans to increase local control.

                   VETERANS ELECTRONIC HEALTH RECORD

Appropriations, 2018....................................    $782,000,000
Budget estimate, 2019...................................   1,207,000,000
Committee recommendation, 2019..........................     800,000,000

                          PROGRAM DESCRIPTION

    The Veterans Electronic Health Record account funds all 
activities related to the acquisition, implementation, 
preparation, development, interface, management, rollout, and 
maintenance of a new electronic health record. The EHR solution 
and implementation will include program management; an 
enterprise-wide EHR system; change management; training; 
testing; deployment services; sustainment and other solutions 
encompassing the entire range of EHR requirements.

                        COMMITTEE RECOMMENDATION

    The Committee recommends $800,000,000 for the Veterans 
Electronic Health Record. This is $18,000,000 above the fiscal 
year 2018 enacted level and $407,000,000 below the budget 
request. In July 2017, the Secretary announced that Cerner 
Corporation, which had participated in the DOD EHR acquisition, 
had received the sole source contract to develop the VA EHR. In 
support of this effort, the Committee appropriated $782,000,000 
in fiscal year 2018, with the expectation that award of a 
contract was imminent, however, execution of a contract became 
delayed, with the contract not being awarded until May 2018.
    It is incumbent on the Department to present detailed 
justifications, including schedules and costs with any 
acquisition of this size and magnitude. Yet, the Department's 
justifications accompanying the budget submission lacked even 
the most basic of detail. While the Committee remains 
supportive of replacing the VA's current EHR with the same 
being acquired by DOD, the Department must address how delays 
in contracting, as well as slippage in timelines, including 
DOD's deployment schedule of MHS Genesis, will impact budgetary 
needs for fiscal year 2019 and beyond.
    VA/DOD Interoperability.--As VA and DOD plan to deploy the 
same EHR, VA must remain committed to working towards assuring 
continued VA/DOD interoperability. The Committee directs VA and 
DOD to maintain clear and agreed-upon metrics and goals for 
interoperability, to establish clear timeframes for meeting 
those goals, to ensure clinician feedback is sought and 
considered as the respective electronic medical record systems 
are modernized, and to update the VA/DOD Interagency Program 
Office guidance to reflect agreed-upon metrics and goals. The 
need for well-functioning, up-to-date electronic health record 
technology is absolutely critical.

                      OFFICE OF INSPECTOR GENERAL

Appropriations, 2018....................................    $164,000,000
Budget estimate, 2019...................................     172,054,000
Committee recommendation................................     192,000,000

                          PROGRAM DESCRIPTION

    The Office of Inspector General [OIG] was established by 
the Inspector General Act of 1978 and is responsible for the 
audit, investigation, and inspection of all Department of 
Veterans Affairs programs and operations.

                        COMMITTEE RECOMMENDATION

    The Committee recommends $192,000,000 for the Office of 
Inspector General. This is $28,000,000 above the fiscal year 
2018 enacted level and $19,946,000 above the budget request. 
The Committee has included bill language to make available 
through September 30, 2020, up to 10 percent of the Office of 
the Inspector General appropriation.

                      CONSTRUCTION, MAJOR PROJECTS

Appropriations, 2018....................................    $512,430,000
Budget estimate, 2019...................................   1,127,486,000
Committee recommendation................................   1,127,486,000

                          PROGRAM DESCRIPTION

    The Construction, Major Projects account provides for 
constructing, altering, extending, and improving any of the 
facilities (including parking projects) under the jurisdiction 
or for the use of VA, including planning, architectural and 
engineering services, needs assessment, and site acquisition 
where the estimated cost of a project is more than the amount 
set forth in 38 U.S.C. 8104(a)(3)(A). Proceeds realized from 
Enhanced Use Lease activities may be deposited into the 
Construction, Major Projects and Construction, Minor Projects 
accounts.

                        COMMITTEE RECOMMENDATION

    The Committee recommends an appropriation of $1,127,486,000 
for the construction of major projects. This is $615,056,000 
above the fiscal year 2018 enacted level and equal the budget 
request.
    The following table reflects the President's budget request 
for major construction projects and the corresponding Committee 
recommendations.

                       MAJOR CONSTRUCTION PROJECTS
                        [In thousands of dollars]
------------------------------------------------------------------------
                                      Fiscal year 2019      Committee
      Location and description         budget request    recommendation
------------------------------------------------------------------------
Veterans Health Administration
 [VHA]:
    St. Louis (JB), MO: Medical                 34,400            34,400
     Facility Improvements and
     Cemetery Expansion.............
    Canandaigua, NY: Construction              190,000           190,000
     and Renovation.................
    Dallas, TX: Spinal Cord Injury..           135,686           135,686
    North Chicago, IL: Renovate                  6,000             6,000
     Building 4.....................
    Oklahoma City, OK: New Surgical             10,800            10,800
     Intensive Care Unit............
    Advance Planning Fund...........            95,000            95,000
    Asbestos........................            15,000            15,000
    Major Construction Staff........            27,500            27,500
    Hazardous Waste.................            26,200            26,200
    Judgment Fund...................            25,000            25,000
    Non-Departmental Federal Entity             38,700            38,700
     Project Management Support.....
    Seismic Corrections Initiative..           400,000           400,000
                                     -----------------------------------
      Total VHA.....................         1,004,286         1,004,286
                                     ===================================
National Cemetery Administration
 [NCA]:
    Ohio Western Reserve, OH:                   29,000            29,000
     Gravesite Expansion, Phase 3...
    Great Lakes, MI: Gravesite                  35,200            35,200
     Expansion, Phase 2.............
    Cape Canaveral, FL: Gravesite               38,000            38,000
     Expansion Phase 2..............
    Advance Planning Fund...........            10,000            10,000
    NCA Land Acquisition Fund.......             5,000             5,000
                                     -----------------------------------
      Total NCA.....................           117,200           117,200
                                     ===================================
General Administration--Staff                    6,000             6,000
 Offices, Advance Planning Fund.....
                                     -----------------------------------
      Total Construction, Major              1,127,486         1,127,486
       Projects.....................
------------------------------------------------------------------------

                      CONSTRUCTION, MINOR PROJECTS

Appropriations, 2018\1\.................................    $342,570,000
Budget estimate, 2019...................................     706,889,000
Committee recommendation................................     706,889,000

\1\Total excludes $4,088,000 in emergency funding provided in Public Law 
115-123, the Further Additional Supplemental Appropriations for Disaster 
Relief Requirements Act, 2018.
---------------------------------------------------------------------------

                          PROGRAM DESCRIPTION

    The Construction, Minor Projects account provides for 
constructing, altering, extending, and improving any of the 
facilities (including parking) under the jurisdiction or for 
the use of VA, including planning, assessment of needs, 
architectural and engineering services, and site acquisition, 
where the estimated cost of a project is equal to or less than 
$20,000,000. Public Law 106-117, the Veterans Millennium Health 
Care and Benefits Act of 1999, gave VA authority to make 
capital contributions from minor construction in enhanced-use 
leases. Proceeds realized from enhanced-use lease activities 
may be deposited into the Construction, Major Projects and 
Construction, Minor Projects accounts.

                        COMMITTEE RECOMMENDATION

    The Committee recommends $706,889,000 for minor 
construction. This is $364,319,000 above the fiscal year 2018 
enacted level and equal to the budget request.
    The recommendation includes $449,149,000 for the Veterans 
Health Administration, $171,820,000 for the National Cemetery 
Administration, $46,820,000 for the Veterans Benefits 
Administration, and $39,100,000 for staff offices and the 
Office of Information Technology. The Department is directed to 
provide an expenditure plan to the Committees on Appropriations 
of both Houses of Congress no later than 30 days after 
enactment of this act for the amount appropriated for minor 
construction.

       GRANTS FOR CONSTRUCTION OF STATE EXTENDED CARE FACILITIES

Appropriations, 2018....................................    $110,000,000
Budget estimate, 2019...................................     150,000,000
Committee recommendation................................     150,000,000

                          PROGRAM DESCRIPTION

    This account is used to provide grants to assist States in 
acquiring or constructing State home facilities for furnishing 
domiciliary or nursing home care to veterans, and to expand, 
remodel, or alter existing buildings for furnishing 
domiciliary, nursing home, or hospital care to veterans in 
State homes. The grant may not exceed 65 percent of the total 
cost of the project. Public Law 102-585 granted permanent 
authority for this program, and Public Law 106-117 provided 
greater specificity in directing VA to prescribe regulations 
for the number of beds for which grant assistance may be 
furnished. This program has been a successful partnership 
between States and VA in meeting the long-term care needs of 
elderly veterans for decades.

                        COMMITTEE RECOMMENDATION

    The Committee recommends $150,000,000 for Grants for 
construction of State extended care facilities. This is equal 
to the budget request.
    State Extended Care Facility Construction.--The Committee 
is concerned that VA continues to approve new grants for State 
home construction projects without adequate resources to 
fulfill the Federal cost share. In fiscal year 2018, VA 
budgeted only $90,000,000 towards an outstanding list of 57 
approved projects in 25 States valued at $639,000,000. 
Recognizing this disparity, the Congress provided a one-time 
appropriation of $575,000,000 in fiscal year 2018 to assist VA 
in resolving its backlog. The Committee directs VA to provide 
an update within 180 days of enactment of this act on the 
execution of those funds, that specifically addresses the 
projected schedule of execution by priority group, including 
estimated completion dates for each project, as well as actions 
the Department will take to prevent future backlogs.

             GRANTS FOR CONSTRUCTION OF VETERANS CEMETERIES

Appropriations, 2018....................................     $45,000,000
Budget estimate, 2019...................................      45,000,000
Committee recommendation................................      45,000,000

                          PROGRAM DESCRIPTION

    Public Law 105-368 amended title 38 U.S.C. 2408 and 
established authority to provide aid to States for 
establishment, expansion, and improvement of State veterans 
cemeteries, which are operated and permanently maintained by 
the States. This statutory change increased the maximum Federal 
share from 50 percent to 100 percent in order to fund 
construction costs and initial equipment expenses when the 
cemetery is established. States remain responsible for 
providing the land and for paying all costs related to 
operation and maintenance of the cemeteries, including the 
costs for subsequent equipment purchases.

                        COMMITTEE RECOMMENDATION

    The Committee recommends $45,000,000 for Grants for 
construction of State veterans cemeteries. This is equal to the 
budget request.

                       Administrative Provisions

             (INCLUDING TRANSFERS AND RESCISSIONS OF FUNDS)

    Sec. 201. The Committee includes a provision which outlines 
transfer authority and responsibilities for the Veterans 
Benefits Administration.
    Sec. 202. The Committee includes a provision which outlines 
transfer authority and responsibilities for the Veterans Health 
Administration.
    Sec. 203. The Committee includes a provision which outlines 
the use of funds appropriated for salaries and expenses.
    Sec. 204. The Committee includes a provision mandating that 
only construction funds may be used for land procurement or the 
construction of any new hospital or home.
    Sec. 205. The Committee includes a provision allowing for 
reimbursements to the Medical Services account.
    Sec. 206. The Committee includes a provision allowing for 
payments of prior year obligations.
    Sec. 207. The Committee includes a provision which allows 
for the use of funds for prior year obligations.
    Sec. 208. The Committee includes a provision which allows 
for payments from the National Service Life Insurance Fund.
    Sec. 209. The Committee includes a provision which outlines 
the use of funds from enhanced-use lease proceeds.
    Sec. 210. The Committee includes a provision which provides 
for funds for the Office of Resolution Management, the Office 
of Employment Discrimination Complaint Adjudication, the Office 
of Accountability and Whistleblower Protection, and the Office 
of Diversity and Inclusion.
    Sec. 211. The Committee includes a provision which requires 
disclosure of third-party reimbursement information.
    Sec. 212. The Committee includes a provision which allows 
for the transfer of revenue derived from enhanced-use leases 
into the construction accounts.
    Sec. 213. The Committee includes a provision which outlines 
authorized uses for Medical Services account funds.
    Sec. 214. The Committee includes a provision which allows 
funds in the Medical Care Collection Fund to be transferred 
into the Medical Services and Medical Community Care accounts.
    Sec. 215. The Committee includes a provision which allows 
eligible veterans in the State of Alaska to obtain medical care 
services.
    Sec. 216. The Committee includes a provision which allows 
for the transfer of funds into the construction accounts.
    Sec. 217. The Committee includes a provision requiring the 
Secretary of Veterans Affairs to submit quarterly financial 
reports.
    Sec. 218. The Committee includes a provision outlining 
transfer authority for the Information Technology Systems 
account.
    Sec. 219. The Committee includes a provision allowing for 
the transfer of funds from certain accounts to the Joint 
Department of Defense/Department of Veterans Affairs Medical 
Facility Demonstration Fund, as authorized by Public Law 111-
84.
    Sec. 220. The Committee includes a provision allowing for 
the transfer of funds from certain advance appropriation 
accounts to the Joint Department of Defense/Department of 
Veterans Affairs Medical Facility Demonstration Fund, as 
authorized by Public Law 111-84.
    Sec. 221. The Committee includes a provision allowing for 
the transfer of certain funds deposited in the Medical Care 
Collections Fund to the Joint Department of Defense/Department 
of Veterans Affairs Medical Facility Demonstration Fund, as 
authorized by Public Law 111-84.
    Sec. 222. The Committee includes a provision directing a 
minimum of $15,000,000 be transferred from Medical Services, 
Medical Support and Compliance, and Medical Facilities to the 
Department of Defense/Department of Veterans Affairs Health 
Care Sharing Incentive Fund, as authorized by section 8111 of 
title 38, United States Code.
    Sec. 223. The Committee includes a provision prohibiting 
funds available to the Department in this or any other act from 
being used to replace the current system by which VISNs select 
and contract for diabetes monitoring supplies and equipment.
    Sec. 224. The Committee includes a provision requiring 
notification of all bid savings for major construction 
projects.
    Sec. 225. The Committee includes a provision restricting 
scope increases for major construction projects above that 
specified in the original project justification.
    Sec. 226. The Committee includes a provision requiring the 
Department to submit reports relating to the Veterans Benefits 
Administration on claims processing at Regional Offices.
    Sec. 227. The Committee includes a provision requiring VA 
to notify the Committee 15 days prior to any organizational 
changes within VA of 25 or more FTE.
    Sec. 228. The Committee includes a provision requiring the 
Secretary to report to the Committees each quarter about any 
single national outreach and awareness marketing campaign 
exceeding $2,000,000.
    Sec. 229. The Committee includes a provision permitting the 
transfer to the Medical Services account of fiscal year 
discretionary 2019 appropriated funds.
    Sec. 230. The Committee includes a provision permitting the 
transfer of funds between GOE, VBA and BVA.
    Sec. 231. The Committee includes a provision prohibiting 
the reprogramming of funds in excess of $7,000,000 among major 
construction projects or programs.
    Sec. 232. The Committee includes a provision mandating 
certain professional standards for the veterans crisis hotline.
    Sec. 233. The Committee includes a provision restricting 
funds from being used to close certain medical facilities in 
the absence of a national realignment strategy.
    Sec. 234. The Committee includes a provision requiring VA 
to use the mammography screening guidelines announced by the 
Secretary on May 10, 2017.
    Sec. 235. The Committee includes a provision allowing the 
use of Medical Services funding for assisted reproductive 
technology treatment and adoption reimbursement for veterans 
and their spouses if the veteran has a service-connected 
disability that results in being unable to procreate without 
such fertility treatment.
    Sec. 236. The Committee includes a provision rescinding 
funds.
    Sec. 237. The Committee includes a provision prohibiting 
any funds to be used to contract out any functions performed by 
more than 10 employees without a fair competition process.
    Sec. 238. The Committee includes a provision pertaining to 
Native Hawaiian small businesses.
    Sec. 239. The Committee includes a provision directing the 
discontinuation of the usage of social security numbers with 
the Department of Veterans Affairs.
    Sec. 240. The Committee includes a provision pertaining to 
the certification of marriage and family therapists.
    Sec. 241. The Committee includes a provision prohibiting 
the transfer of funds from the Filipino Veterans Equity 
Compensation Fund to any other VA account.
    Sec. 242. The Committee includes a provision regarding a 
childcare program.
    Sec. 243. The Committee includes a reference to a provision 
in the 2017 appropriations act identifying information which 
may be used to verify the status of coastwise merchant seamen 
who served during World War II for the purposes of eligibility 
for medals, ribbons, or other military decorations.
    Sec. 244. The Committee includes a provision ensuring 
particular ratios of veterans to full-time employment 
equivalents within any VA program of rehabilitation.
    Sec. 245. The Committee includes a provision prohibiting 
funds to be used to restrict an individual's ability to speak 
with a Member of Congress or his or her staff.
    Sec. 246. The Committee includes a provision requiring 
certain data to be included in the budget justifications for 
the Construction, Major account.
    Sec. 247. The Committee includes a provision prohibiting 
the use of canines in VA research unless: the scientific 
objectives of the study can only be met by using canines; the 
study has been directly approved by the Secretary; and the 
study is consistent with the revised VA canine research policy 
document released in December, 2017.
    Sec. 248. The Committee includes a provision providing 
$2,000,000,000 to be available until expended for VA 
infrastructure needs, of which $1,000,000,000 is for Medical 
Facilities for non-recurring maintenance; $500,000,000 is for 
Minor Construction; and $500,000,000 is for Major Construction. 
This funding is not made available until VA provides and the 
Committees approve a detailed expenditure plan.
    Sec. 249. The Committee includes a provision prohibiting 
the use of funds to interfere with the ability of veterans to 
participate in State-approved medicinal marijuana programs or 
deny service to such veterans.

                               TITLE III

                            RELATED AGENCIES

                  American Battle Monuments Commission

                                OVERVIEW

    The American Battle Monuments Commission [ABMC] was 
established by Congress in 1923 and is responsible for the 
following: designing, constructing, operating, and maintaining 
permanent American cemeteries in foreign countries; 
establishing and maintaining U.S. military memorials, 
monuments, and markers where American Armed Forces have served 
overseas since April 6, 1917, the date of the United States 
entry into World War I, and within the United States when 
directed by public law; and controlling the design and 
construction of permanent U.S. military monuments and markers 
by other U.S. citizens and organizations, both public and 
private, and encouraging their maintenance. ABMC administers, 
operates, and maintains 26 permanent American military 
cemeteries, 29 Federal memorial, monuments, and markers, and 8 
non-Federal memorials located in 15 foreign countries, the U.S. 
Commonwealth of the Northern Mariana Islands, the British 
Dependency of Gibraltar, and the United States of America.

                         SALARIES AND EXPENSES

Appropriations, 2018....................................     $79,000,000
Budget estimate, 2019...................................      75,100,000
Committee recommendation................................      81,000,000

                        COMMITTEE RECOMMENDATION

    The Committee recommends $81,000,000 for the Salaries and 
Expenses account. This amount is $2,000,000 above the fiscal 
year 2018 enacted level and $5,900,000 above the budget 
request. The recommendation includes an additional $5,900,000 
to bolster the Commission's maintenance and infrastructure 
program, including the interpretive program. The additional 
funds will restore the reduction proposed in the budget request 
for this program and provide additional funds to accelerate the 
Commission's 5-year plan, not only to maintain the cemeteries 
and monuments honoring America's war dead, but also to preserve 
and communicate these veterans' stories of courage and 
sacrifice.
    Nisei Veterans.--The Committee recognizes the legacy of the 
100th Infantry Battalion which, with the 442nd Regiment and 
Military Intelligence Service, became one the most decorated 
military units of the Second World War. The Committee is aware 
of the existence of exhibits and memorials dedicated to the 
100th Infantry Battalion/442nd Regiment. However, the Committee 
believes it is increasingly important to memorialize the 
important part they, and all Nisei veterans, have played in our 
country's history.
    Not later than 90 days after enactment of this act, the 
American Battle Monuments Commission shall conduct a 
feasibility study to determine the viability of establishing a 
national memorial in recognition of the 100th Infantry 
Battalion/442nd Regiment. In conducting the feasibility study, 
ABMC shall consider the importance of telling the story of the 
100th Infantry Battalion/442nd Regiment in the context of the 
contributions of all Nisei veterans and associated units during 
the Second World War, and the ability to adequately reach 
audiences, including Americans of Japanese ancestry, with the 
story of these Nisei veterans through existing exhibits and 
memorials.
    National Memorial Cemetery of the Pacific Visitor Center.--
The Committee is aware that the American Battle Monuments 
Commission prepared preliminary designs for a new visitors 
center at the National Memorial Cemetery of the Pacific, also 
known as the ``Punchbowl.'' The Committee understands that the 
Punchbowl is the resting place of more than 13,000 Soldiers and 
sailors who died during the Second World War and that a new 
visitor center would enhance the story of Pacific Theatre of 
the Second World War by giving context to the headstones and 
columbaria through interpretive exhibits and other displays. 
Not later than 90 days after enactment of this act, the 
Committee directs the American Battle Monuments Commission to 
report on the status of this project, including what, if any, 
funding has been programmed in its future years' budgets.

                     FOREIGN CURRENCY FLUCTUATIONS

    The Committee includes in the accompanying act, as proposed 
by the administration, such sums as necessary for the Foreign 
Currency Fluctuations account. Funding the account in this 
manner allows the Commission to maintain cemeteries regardless 
of the volatility of foreign currency fluctuations.

           United States Court of Appeals for Veterans Claims

                                OVERVIEW

    The United States Court of Appeals for Veterans Claims was 
established by the Veterans' Judicial Review Act of 1988. The 
Court is an independent judicial tribunal with exclusive 
jurisdiction to review decisions of the Board of Veterans 
Appeals. It has the authority to decide all relevant questions 
of law; interpret constitutional, statutory, and regulatory 
provisions; and determine the meaning or applicability of the 
terms of an action by the Secretary of Veterans Affairs. It is 
authorized to compel action by the Secretary. It is authorized 
to hold unconstitutional or otherwise unlawful and set aside 
decisions, findings, conclusions, rules, and regulations issued 
or adopted by the Secretary of Veterans Affairs, the Board of 
Veterans Appeals, or the Chairman of the Board that are found 
to be arbitrary or capricious. The Court's principal office 
location is Washington, DC; however, it is a national court, 
empowered to sit anywhere in the United States.

                         SALARIES AND EXPENSES

Appropriations, 2018....................................     $33,600,000
Budget estimate, 2019...................................     107,455,000
Committee recommendation................................      34,955,000

                        COMMITTEE RECOMMENDATION

    The Committee recommends $34,955,000 for the U.S. Court of 
Appeals for Veterans Claims. This amount is $1,355,000 above 
the fiscal year 2018 enacted level and $72,500,000 below the 
budget request. Public Law 115-141 included funding for a 
feasibility study regarding a new courthouse. This study is not 
complete, therefore, the Committee does not include the funds 
requested for a new courthouse.

                      Department of Defense--Civil

                       Cemeterial Expenses, Army

                                OVERVIEW

    The Secretary of the Army is responsible for the 
administration, operation, and maintenance of Arlington 
National Cemetery [ANC] and the Soldiers' and Airmen's Home 
National Cemetery. In addition to its principal function as a 
national cemetery, Arlington hosts more than 3,000 public 
wreath laying ceremonies, approximately 100 distinguished 
visitor honors wreath laying ceremonies, and approximately 
4,000,000 visitors annually.

                         SALARIES AND EXPENSES

Appropriations, 2018....................................     $80,800,000
Budget estimate, 2019...................................      70,800,000
Committee recommendation................................      80,800,000

                        COMMITTEE RECOMMENDATION

    The Committee recommends $80,800,000 for the Salaries and 
Expenses account. This amount is equal to the fiscal year 2018 
enacted level and $10,000,000 above the budget request.
    The Committee remains concerned that ANC's operating 
account has been held artificially flat for a number of years, 
and this action is beginning to have deleterious effects on the 
Cemetery's performance and ability to meet its mission.
    Arlington performs over 7,000 burial services each year for 
veterans and family members and an average of 27-30 each 
weekday. With this heavy workload, ANC cannot be under-
resourced, and accordingly, the Committee has provided an 
additional $10,000,000 to correct this problem.
    This Committee remains unwavering in its support for the 
Cemetery and the successful completion of the Cemetery's truly 
unique and honored mission. Accordingly, the Secretary of the 
Army is again directed to include this increase in the 
Cemetery's baseline budget and ensure future budget requests 
provide ample resources for Arlington National Cemetery.

                              CONSTRUCTION

Appropriations, 2018....................................    $167,000,000
Budget estimate, 2019...................................................
Committee recommendation, 2019..........................      56,600,000

                      Armed Forces Retirement Home

                               TRUST FUND

                                OVERVIEW

Appropriations, 2018....................................     $64,300,000
Budget estimate, 2019...................................      64,300,000
Committee recommendation................................      64,300,000

                        COMMITTEE RECOMMENDATION

    The Committee recommends authority to expend $64,300,000 
from the Armed Forces Retirement Home Trust Fund to operate and 
maintain the Armed Forces Retirement Home--Washington, DC, and 
the Armed Forces Retirement Home--Gulfport, Mississippi.

                        Administrative Provision

    Sec. 301. The Committee includes a provision making 
available funds as authorized by 10 U.S.C. 4727.

                                TITLE IV

                    OVERSEAS CONTINGENCY OPERATIONS

                         DEPARTMENT OF DEFENSE

    The Committee recommends title IV, Overseas Contingency 
Operations, for military construction projects related to the 
Global War on Terrorism and the European Reassurance Initiative 
that were requested by the Administration in the Fiscal Year 
2019 Overseas Contingency Operations budget request.

                      Military Construction, Army

    The Committee recommends $192,250,000 for ``Military 
Construction, Army'', as requested in the Fiscal Year 2019 
Overseas Contingency Operations budget request, for military 
construction and planning and design in support of Overseas 
Contingency Operations and the European Reassurance Initiative.

              Military Construction, Navy and Marine Corps

    The Committee recommends $227,320,000 for ``Military 
Construction, Navy and Marine Corps'', as requested in the 
Fiscal Year 2019 Overseas Contingency Operations budget 
request, for military construction and planning and design in 
support of the European Reassurance Initiative.

                    Military Construction, Air Force

    The Committee recommends $414,800,000 for ``Military 
Construction, Air Force'', as requested in the Fiscal Year 2019 
Overseas Contingency Operations budget request, for military 
construction and planning and design in support of Overseas 
Contingency Operations and the European Reassurance Initiative.

                  Military Construction, Defense-Wide

    The Committee recommends $87,050,000 for ``Military 
Construction, Defense-Wide'', as requested in the Fiscal Year 
2019 Overseas Contingency Operations budget request, for 
planning and design in support of the European Reassurance 
Initiative.

                       Administrative Provisions

    Sec. 401. The Committee includes a provision which provides 
the contingent emergency designation for the Overseas 
Contingency Operations accounts.
    Sec. 402. The agreement includes section 402 which requires 
the Department of Defense to provide a future year defense 
program for European Deterrence/Reassurance Initiative to the 
congressional defense committees.

                                TITLE V

                           GENERAL PROVISIONS

    Sec. 501. The Committee includes a provision that prohibits 
the obligation of funds beyond the current fiscal year unless 
expressly so provided.
    Sec. 502. The Committee includes a provision that prohibits 
the use of funds for programs, projects, or activities not in 
compliance with Federal law relating to risk assessment, the 
protection of private property rights, or unfunded mandates.
    Sec. 503. The Committee includes a provision that 
encourages the expansion of E-commerce technologies and 
procedures.
    Sec. 504. The Committee includes a provision that specifies 
the congressional committees that are to receive all reports 
and notifications.
    Sec. 505. The Committee includes a provision that limits 
funds from being transferred from this appropriations measure 
to any instrumentality of the United States Government without 
authority from an appropriations act.
    Sec. 506. The Committee includes a provision regarding the 
posting of congressional reports on agency Web sites.
    Sec. 507. The Committee includes a provision prohibiting 
the use of funds to establish or maintain a computer network 
unless such network blocks the viewing, downloading, and 
exchanging of pornography, except for law enforcement 
investigation, prosecution, or adjudication activities.
    Sec. 508. The Committee includes a provision prohibiting 
the use of funds for the payment of first-class travel by an 
employee of the executive branch.
    Sec. 509. The Committee includes a provision prohibiting 
the use of funds in this act for any contract where the 
contractor has not complied with E-Verify requirements.
    Sec. 510. The Committee includes a provision 511 
prohibiting the use of funds in this act by the Department of 
Defense or the Department of Veterans Affairs for the purchase 
or lease of a new vehicle except in accordance with 
Presidential Memorandum--Federal Fleet Performance, dated May 
24, 2011.
    Sec. 511. The Committee includes a provision limiting the 
construction of facilities in the United States, its 
territories, or possessions for the purposes of housing 
individuals detained at Guantanamo Bay, Cuba.

                     PROGRAM, PROJECT, AND ACTIVITY

    In fiscal year 2019, for purposes of the Balanced Budget 
and Emergency Deficit Control Act of 1985 (Public Law 99-177) 
or the Balanced Budget and Emergency Deficit Control 
Reaffirmation Act of 1987 (Public Law 100-119), the following 
information provides the definition of the term ``program, 
project, and activity'' for departments, agencies and programs 
under the jurisdiction of the Military Construction and 
Veterans Affairs, and Related Agencies subcommittee. The term 
``program, project, and activity'' shall include the most 
specific level of budget items identified in the Military 
Construction, Veterans Affairs, and Related Agencies 
Appropriations Act, 2019, the House and Senate Committee 
reports, and the conference report and accompanying joint 
explanatory statement of managers of the committee of 
conference.
    If a sequestration order is necessary, in implementing the 
Presidential order, departments, and agencies shall apply any 
percentage reduction required for fiscal year 2019 pursuant to 
the provisions of Public Law 99-177 or Public Law 100-119 to 
all items specified in the justifications submitted to the 
Committees on Appropriations of the Senate and House of 
Representatives in support of the fiscal year 2019 budget 
estimates, as amended, for such departments and agencies, as 
modified by congressional action, and in addition, for the 
Department of Defense, Military Construction, the definition 
shall include specific construction locations as identified in 
the explanatory notes.

  COMPLIANCE WITH PARAGRAPH 7, RULE XVI, OF THE STANDING RULES OF THE 
                                 SENATE

    Paragraph 7 of rule XVI requires that Committee reports 
accompanying general appropriations bills identify each 
recommended amendment which proposes an item of appropriation 
which is not made to carry out the provisions of an existing 
law, a treaty stipulation, or an act or resolution previously 
passed by the Senate during that session.
    The Committee recommends funding for the following programs 
which currently lack authorization:
Title I: Department of Defense
    Military Construction, Army
    Military Construction, Navy and Marine Corps
    Military Construction, Air Force
    Military Construction, Defense-Wide
    Military Construction, Army National Guard
    Military Construction, Air National Guard
    Military Construction, Army Reserve
    Military Construction, Navy Reserve
    Military Construction, Air Force Reserve
    North Atlantic Treaty Organization Security Investment 
Program
    Department of Defense Base Closure Account
    Family Housing Operation and Maintenance, Army
    Family Housing Operation and Maintenance, Navy and Marine 
Corps
    Family Housing Operation and Maintenance, Air Force
    Family Housing Operation and Maintenance, Defense-Wide
    Family Housing Construction, Army
    Family Housing Construction, Navy and Marine Corps
    Family Housing Construction, Air Force
    Department of Defense Family Housing Improvement Fund
    Department of Defense Military Unaccompanied Housing 
Improvement Fund
Title II: Department of Veterans Affairs
    Veterans Benefits Administration
    Veterans Health Administration
    National Cemetery Administration
    Departmental Administration
Title III: Related Agencies
    American Battle Monuments Commission
    U.S. Court of Appeals for Veterans Claims
    Cemeterial Expenses, Army
    Armed Forces Retirement Home

COMPLIANCE WITH PARAGRAPH 7(c), RULE XXVI OF THE STANDING RULES OF THE 
                                 SENATE

    Pursuant to paragraph 7(c) of rule XXVI, on June 7, 2018, 
the Committee ordered favorably reported a bill (S. 3024) 
making appropriations for military construction, the Department 
of Veterans Affairs, and related agencies for the fiscal year 
ending September 30, 2019, and for other purposes, provided, 
that the bill be subject to amendment and that the bill be 
consistent with its budget allocation, and provided that the 
Chairman of the Committee or his designee be authorized to 
offer the substance of the original bill as a Committee 
amendment in the nature of a substitute to the House companion 
measure, by a recorded vote of 31-0, a quorum being present. 
The vote was as follows:
        Yeas                          Nays
Chairman Shelby
Mr. McConnell
Mr. Alexander
Ms. Collins
Ms. Murkowski
Mr. Graham
Mr. Blunt
Mr. Moran
Mr. Hoeven
Mr. Boozman
Mrs. Capito
Mr. Lankford
Mr. Daines
Mr. Kennedy
Mr. Rubio
Mrs. Hyde-Smith
Mr. Leahy
Mrs. Murray
Mrs. Feinstein
Mr. Durbin
Mr. Reed
Mr. Tester
Mr. Udall
Mrs. Shaheen
Mr. Merkley
Mr. Coons
Mr. Schatz
Ms. Baldwin
Mr. Murphy
Mr. Manchin
Mr. Van Hollen

 COMPLIANCE WITH PARAGRAPH 12, RULE XXVI OF THE STANDING RULES OF THE 
                                 SENATE

    Paragraph 12 of rule XXVI requires that Committee reports 
on a bill or joint resolution repealing or amending any statute 
or part of any statute include ``(a) the text of the statute or 
part thereof which is proposed to be repealed; and (b) a 
comparative print of that part of the bill or joint resolution 
making the amendment and of the statute or part thereof 
proposed to be amended, showing by stricken-through type and 
italics, parallel columns, or other appropriate typographical 
devices the omissions and insertions which would be made by the 
bill or joint resolution if enacted in the form recommended by 
the committee.''
    In compliance with this rule, changes in existing law 
proposed to be made by the bill are shown as follows: existing 
law to be omitted is enclosed in black brackets; new matter is 
printed in italic; and existing law in which no change is 
proposed is shown in roman.

                CONSOLIDATED APPROPRIATIONS ACT, 2018, 
                           PUBLIC LAW 115-141


   DIVISION J--MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED 
AGENCIES APPROPRIATIONS ACT, 2018

           *       *       *       *       *       *       *



                                TITLE II


                     DEPARTMENT OF VETERANS AFFAIRS


Administrative Provisions

           *       *       *       *       *       *       *



                     [(INCLUDING TRANSFER OF FUNDS)

    Sec. 220. Of the amounts appropriated to the Department of 
Veterans Affairs which become available on October 1, 2018, for 
``Medical Services'', ``Medical Community Care'', ``Medical 
Support and Compliance'', and ``Medical Facilities'', up to 
$306,378,000, plus reimbursements, may be transferred to the 
Joint Department of Defense--Department of Veterans Affairs 
Medical Facility Demonstration Fund, established by section 
1704 of the National Defense Authorization Act for Fiscal Year 
2010 (Public Law 111-84; 123 Stat. 3571) and may be used for 
operation of the facilities designated as combined Federal 
medical facilities as described by section 706 of the Duncan 
Hunter National Defense Authorization Act for Fiscal Year 2009 
(Public Law 110-417; 122 Stat. 4500): Provided, That additional 
funds may be transferred from accounts designated in this 
section to the Joint Department of Defense--Department of 
Veterans Affairs Medical Facility Demonstration Fund upon 
written notification by the Secretary of Veterans Affairs to 
the Committees on Appropriations of both Houses of Congress.] 
Repealed.

                        BUDGETARY IMPACT OF BILL


  PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SEC. 308(a), PUBLIC LAW 93-344, AS
                                                     AMENDED
                                            [In millions of dollars]
----------------------------------------------------------------------------------------------------------------
                                                               Budget authority                 Outlays
                                                         -------------------------------------------------------
                                                            Committee    Amount  in     Committee    Amount  in
                                                           allocation       bill       allocation       bill
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with the subcommittee
 allocation for 2019: Subcommittee on Military
 Construction and Veterans Affairs, and Related
 Agencies:
    Mandatory...........................................      109,472       109,472       109,086    \1\109,086
    Discretionary.......................................       97,086        98,007        90,261     \1\90,261
        Security........................................       10,319        11,240            NA            NA
        Nonsecurity.....................................       86,767        86,767            NA            NA
Projections of outlays associated with the
 recommendation:
    2019................................................  ............  ............  ............   \2\114,799
    2020................................................  ............  ............  ............        5,486
    2021................................................  ............  ............  ............        5,216
    2022................................................  ............  ............  ............        3,202
    2023 and future years...............................  ............  ............  ............        3,590
Financial assistance to State and local governments forP           NA           277            NA         \2\59
 2019...................................................
 
----------------------------------------------------------------------------------------------------------------
\1\Includes outlays from prior-year budget authority.
\2\Excludes outlays from prior-year budget authority.
 
NA: Not applicable.
 
NOTE.--Consistent with the funding recommended in the bill for overseas contingency operations and in accordance
  with subparagraph (A)(ii) of section 251(b)(2) of the BBEDCA of 1985, the Committee anticipates that the
  Budget Committee will provide, at the appropriate time, a 302(a) allocation for the Committee on
  Appropriations reflecting an upward adjustment of $921,000,000 in budget authority plus the associated
  outlays.


                                MILITARY CONSTRUCTION PROJECT LISTING BY LOCATION
                                            [In thousands of dollars]
----------------------------------------------------------------------------------------------------------------
                                                                                                     Committee
                                                                                                  recommendation
                    Installation and project                          Budget         Committee      compared to
                                                                     estimate     recommendation      budget
                                                                                                     estimate
----------------------------------------------------------------------------------------------------------------
                             ALABAMA
 
ARMY:
    ANNISTON ARMY DEPOT:
        WEAPON MAINTENANCE SHOP.................................           5,200           5,200  ..............
                                                                 -----------------------------------------------
          TOTAL, ALABAMA........................................           5,200           5,200  ..............
 
                             ALASKA
 
AIR FORCE:
    EIELSON AFB:
        F-35 AIRCRAFT MAINTENANCE UNIT ADMIN FACILITY...........           6,800           6,800  ..............
        F-35 CONVENTIONAL MUNITIONS MAINTENANCE FACILITY........          15,500          15,500  ..............
        F-35A CATM RANGE........................................          19,000          19,000  ..............
        F-35A SCHOOL AGE FACILITY...............................          22,500          22,500  ..............
DEFENSE-WIDE:
    CLEAR AFS:
        LONG RANGE DISCRIM RADAR SYS COMPLEX PHASE 2............         174,000         174,000  ..............
 
    FORT GREELY:
        MISSILE FIELD #1 EXPANSION..............................           8,000           8,000  ..............
 
    JOINT BASE ELMENDORF-RICHARDSON:
        OPERATIONS FACILITY REPLACEMENT.........................          14,000          14,000  ..............
 
ARMY NATIONAL GUARD:
    JOINT BASE ELMENDORF-RICHARDSON:
        UNITED STATES PROPERTY & FISCAL OFFICE..................          27,000          27,000  ..............
                                                                 -----------------------------------------------
          TOTAL, ALASKA.........................................         286,800         286,800  ..............
 
                             ARIZONA
 
AIR FORCE:
    LUKE AFB:
        F-35A AIRCRAFT MAINTENANCE UNIT FACILITY................          23,000          23,000  ..............
        F-35A SQUAD OPS #6......................................          17,000          17,000  ..............
                                                                 -----------------------------------------------
          TOTAL, ARIZONA........................................          40,000          40,000  ..............
 
                            ARKANSAS
 
DEFENSE-WIDE:
    LITTLE ROCK AFB:
        HYDRANT FUEL SYSTEM ALTERATIONS.........................          14,000          14,000  ..............
                                                                 -----------------------------------------------
          TOTAL, ARKANSAS.......................................          14,000          14,000  ..............
 
                           CALIFORNIA
 
ARMY:
    FORT IRWIN:
        MULTIPURPOSE RANGE COMPLEX..............................          29,000          29,000  ..............
 
                              NAVY
 
    CAMP PENDLETON:
        AAV-ACV MAINTENANCE & WAREHOUSE FACILITY................          49,410          49,410  ..............
        ELECTRICAL UPGRADES.....................................           4,020           4,020  ..............
        FULL MOTION TRAINER FACILITY............................          10,670          10,670  ..............
        POTABLE WATER DISTRIBUTION IMPROVEMENTS.................          47,230          47,230  ..............
 
    CORONADO:
        CMV-22B AIRFIELD IMPROVEMENTS...........................          77,780          77,780  ..............
    LEMOORE:
        F-35 MAINTENANCE HANGAR.................................         112,690         112,690  ..............
    MIRAMAR:
        AIRFIELD SECURITY IMPROVEMENTS..........................          11,500          11,500  ..............
        F-35 VERTICAL LANDING PADS AND TAXIWAY..................          20,480          20,480  ..............
    POINT MUGU:
        DIRECTED ENERGY SYSTEMS INTERGRATION LAB................          22,150          22,150  ..............
    SAN DIEGO:
        HARBOR DRIVE SWITCHING STATION..........................          48,440          48,440  ..............
        PIER 8 REPLACEMENT......................................         108,100         108,100  ..............
    SAN NICOLAS ISLAND:
        MISSILE ASSEMBLY BUILD & HIGH EXPLOSIVE MAGAZINE........          31,010          31,010  ..............
    SEAL BEACH:
        CAUSEWAY, BOAT CHANNEL & TURNING BASIN..................         117,830          60,000         -57,830
DEFENSE-WIDE:
    CAMP PENDLETON:
        SOF EOD FACILITY--WEST..................................           3,547           3,547  ..............
        SOF HUMAN PERFORMANCE TRAINING CENTER-WEST..............           9,049           9,049  ..............
    CORONADO:
        SOF ATC APPLIED INSTRUCTION FACILITY....................          14,819          14,819  ..............
        SOF ATC TRAINING FACILITY...............................          18,329          18,329  ..............
        SOF CLOSE QUARTERS COMBAT FACILITY......................          12,768          12,768  ..............
        SOF NSWG-1 OPERATIONS SUPPORT FACILITY..................          25,172          25,172  ..............
    DEFENSE DISTRIBUTION DEPOT-TRACY
        MAIN ACCESS CONTROL POINT UPGRADES......................          18,800          18,800  ..............
AIR NATIONAL GUARD:
    CHANNEL ISLANDS ANGS:
        CONSTRUCT C-130J FLIGHT SIMULATOR FACILITY..............           8,000           8,000  ..............
ARMY RESERVE:
    BARSTOW:
        ECS MODIFIED TEMF / WAREHOUSE...........................          34,000          34,000  ..............
NAVY RESERVE:
    SEAL BEACH:
        RESERVE TRAINING CENTER.................................          21,740          21,740  ..............
                                                                 -----------------------------------------------
          TOTAL, CALIFORNIA.....................................         856,534         798,704         -57,830
 
                            COLORADO
 
ARMY:
    FORT CARSON:
        VEHICLE MAINTENANCE SHOP................................          77,000          77,000  ..............
 
DEFENSE-WIDE:
    FORT CARSON:
        SOF HUMAN PERFORMANCE TRAINING CENTER...................          15,297          15,297  ..............
        SOF MOUNTAINEERING FACILITY.............................           9,000           9,000  ..............
                                                                 -----------------------------------------------
          TOTAL, COLORADO.......................................         101,297         101,297  ..............
 
                      DISTRICT OF COLUMBIA
 
NAVY:
    NAVAL OBSERVATORY:
        MASTER TIME CLOCKS & OPERATIONS FACILITY................         115,600          40,000         -75,600
                                                                 -----------------------------------------------
          TOTAL, DISTRICT OF COLUMBIA...........................         115,600          40,000         -75,600
 
                             FLORIDA
 
NAVY:
    MAYPORT:
        LCS OPERATIONAL TRAINING FACILITY ADDITION..............          29,110          29,110  ..............
        LCS SUPPORT FACILITY....................................          82,350          82,350  ..............
AIR FORCE:
    EGLIN AFB:
        F-35A INTEGRATED TRNG CENTER ACADEMICS BLDG.............          34,863          34,863  ..............
        F-35A STUDENT DORMITORY II..............................          28,000          28,000  ..............
    MACDILL AFB:
        KC135 BEDDOWN ADD FLIGHT SIMULATOR TRAINING.............           3,100           3,100  ..............
                                                                 -----------------------------------------------
                  TOTAL, FLORIDA................................         177,423         177,423  ..............
 
                             GEORGIA
 
ARMY:
    FORT GORDON:
        CYBER INSTRUCTIONAL FAC AND NETWORK CTR.................          99,000          99,000  ..............
NAVY RESERVE:
    BENNING:
        RESERVE TRAINING CENTER.................................          13,630          13,630  ..............
                                                                 -----------------------------------------------
          TOTAL, GEORGIA........................................         112,630         112,630  ..............
 
                             HAWAII
 
ARMY:
    FORT SHAFTER:
        COMMAND AND CONTROL FACILITY, INCR 4....................         105,000         105,000  ..............
NAVY:
    JOINT BASE PEARL HARBOR-HICKAM:
        DRYDOCK WATERFRONT FACILITY.............................          45,000          45,000  ..............
    KANEOHE BAY:
        CORROSION CONTROL HANGAR................................          66,100          66,100  ..............
    PEARL CITY:
                WATER TRANSMISSION LINE:........................          78,320          78,320  ..............
AIR NATIONAL GUARD:
    JOINT BASE PEARL HARBOR-HICKAM:
        CONSTRUCT ADDITION TO F-22 LO/CRF B3408.................          17,000          17,000  ..............
                                                                 -----------------------------------------------
          TOTAL, HAWAII.........................................         311,420         311,420  ..............
 
                            ILLINOIS
 
ARMY NATIONAL GUARD:
    MARSEILLES:
        AUTOMATED RECORD FIRE RANGE.............................           5,000           5,000  ..............
AIR NATIONAL GUARD:
    GREATER PEORIA REGIONAL AIRPORT:
        CONSTRUCT NEW FIRE CRASH/RESCUE STATION.................           9,000           9,000  ..............
                                                                 -----------------------------------------------
          TOTAL, ILLINOIS.......................................          14,000          14,000  ..............
 
                             INDIANA
 
ARMY:
    CRANE ARMY AMMUNITION PLANT:
        RAILCAR HOLDING AREA....................................          16,000          16,000  ..............
AIR FORCE RESERVE:
    GRISSOM ARB:
        ADD/ALTER AIRCRAFT MAINTENANCE HANGAR...................          12,100          12,100  ..............
                                                                 -----------------------------------------------
          TOTAL, INDIANA........................................          28,100          28,100  ..............
 
                            KENTUCKY
 
ARMY:
    FORT CAMPBELL:
        VEHICLE MAINTENANCE SHOP................................          32,000          32,000  ..............
    FORT KNOX:
        DIGITAL AIR/GROUND INTEGRATION RANGE....................          26,000          26,000  ..............
DEFENSE-WIDE:
    FORT CAMPBELL:
        FT CAMPBELL MIDDLE SCHOOL...............................          62,634          62,634  ..............
        SOF AIR/GROUND INTEG. URBAN LIVE FIRE RANGE.............           9,091           9,091  ..............
        SOF LOGISTICS SUPPORT OPERATIONS FACILITY...............           5,435           5,435  ..............
        SOF MULTI-USE HELICOPTER TRAINING FACILITY..............           5,138           5,138  ..............
                                                                 -----------------------------------------------
          TOTAL, KENTUCKY.......................................         140,298         140,298  ..............
 
                            LOUISIANA
 
AIR NATIONAL GUARD:
    NEW ORLEANS:
        NORTHCOM--CONSTRUCT ALERT APRON.........................          15,000          15,000  ..............
                                                                 -----------------------------------------------
          TOTAL, LOUISIANA......................................          15,000          15,000  ..............
 
                              MAINE
 
NAVY:
    KITTERY:
        DRY DOCK #1 SUPERFLOOD BASIN............................         109,960         109,960  ..............
        EXTEND PORTAL CRANE RAIL................................          39,725          39,725  ..............
DEFENSE-WIDE:
    KITTERY:
        CONSOLIDATED WAREHOUSE REPLACEMENT......................          11,600          11,600  ..............
                                                                 -----------------------------------------------
          TOTAL, MAINE..........................................         161,285         161,285  ..............
 
                            MARYLAND
 
AIR FORCE:
    JOINT BASE ANDREWS:
        PAR RELOCATE HAZ CARGO PAD AND EOD RANGE................          37,000          37,000  ..............
        PRESIDENTIAL AIRCRAFT RECAP COMPLEX, INC. 2.............         154,000         129,116         -24,884
DEFENSE-WIDE:
    FORT MEADE:
        MISSION SUPPORT OPERATIONS WAREHOUSE FACILITY...........          30,000          30,000  ..............
        NSAW RECAPITALIZE BUILDING #2 INC 4.....................         218,000         218,000  ..............
        NSAW RECAPITALIZE BUILDING #3 INC 1.....................          99,000          99,000  ..............
                                                                 -----------------------------------------------
          TOTAL, MARYLAND.......................................         538,000         513,116         -24,884
 
                          MASSACHUSETTS
 
AIR FORCE:
    HANSCOM AFB:
        MIT-LINCOLN LABORATORY (WEST LAB CSL/MIF)...............         225,000          90,000        -135,000
                                                                 -----------------------------------------------
          TOTAL, MASSACHUSETTS..................................         225,000          90,000        -135,000
 
                            MINNESOTA
 
AIR FORCE RESERVE:
    MINNEAPOLIS-ST PAUL IAP:
        SMALL ARMS RANGE........................................           9,000           9,000  ..............
                                                                 -----------------------------------------------
          TOTAL, MINNESOTA......................................           9,000           9,000  ..............
 
                           MISSISSIPPI
 
AIR FORCE RESERVE:
    KEESLER AFB:
        AEROMEDICAL STAGING SQUADRON FACILITY...................           4,550           4,550  ..............
                                                                 -----------------------------------------------
          TOTAL, MISSISSIPPI....................................           4,550           4,550  ..............
 
                            MISSOURI
 
DEFENSE-WIDE:
    ST LOUIS:
        NEXT NGA WEST (N2W) COMPLEX PHASE 1 INC. 2..............         213,600         181,600         -32,000
        NEXT NGA WEST (N2W) COMPLEX PHASE 2 INC. 1..............         110,000         110,000  ..............
                                                                 -----------------------------------------------
          TOTAL, MISSOURI.......................................         323,600         291,600         -32,000
 
                             MONTANA
 
ARMY NATIONAL GUARD:
    MALTA:
        NATIONAL GUARD READINESS CENTER.........................          15,000          15,000  ..............
                                                                 -----------------------------------------------
          TOTAL, MONTANA........................................          15,000          15,000  ..............
 
                            NEBRASKA
 
AIR FORCE:
    OFFUTT AFB:
        PARKING LOT, USSTRATCOM.................................           9,500           9,500  ..............
                                                                 -----------------------------------------------
          TOTAL, NEBRASKA.......................................           9,500           9,500  ..............
 
                             NEVADA
 
AIR FORCE:
    CREECH AFB:
        MQ-9 CPIP GCS OPERATIONS FACILITY.......................          28,000          28,000  ..............
        MQ-9 CPIP OPERATIONS & COMMAND CENTER FAC...............          31,000          31,000  ..............
    NELLIS AFB:
        CRH SIMULATOR...........................................           5,900           5,900  ..............
ARMY NATIONAL GUARD:
    NORTH LAS VEGAS:
        NATIONAL GUARD READINESS CENTER.........................          32,000          32,000  ..............
                                                                 -----------------------------------------------
          TOTAL, NEVADA.........................................          96,900          96,900  ..............
 
                          NEW HAMPSHIRE
 
ARMY NATIONAL GUARD:
    PEMBROKE:
        NATIONAL GUARD READINESS CENTER.........................          12,000          12,000  ..............
                                                                 -----------------------------------------------
          TOTAL, NEW HAMPSHIRE..................................          12,000          12,000  ..............
 
                           NEW JERSEY
 
ARMY:
    PICATINNY ARSENAL:
        MUNITIONS DISASSEMBLY COMPLEX...........................          41,000          41,000  ..............
DEFENSE-WIDE:
    JOINT BASE MCGUIRE-DIX-LAKEHURST:
        HOT CARGO HYDRANT SYSTEM REPLACEMENT....................          10,200          10,200  ..............
                                                                 -----------------------------------------------
          TOTAL, NEW JERSEY.....................................          51,200          51,200  ..............
 
                           NEW MEXICO
 
ARMY:
    WHITE SANDS:
        INFORMATION SYSTEMS FACILITY............................          40,000          40,000  ..............
AIR FORCE:
    HOLLOMAN AFB:
        MQ-9 FTU OPS FACILITY...................................          85,000          85,000  ..............
                                                                 -----------------------------------------------
          TOTAL, NEW MEXICO.....................................         125,000         125,000  ..............
 
                            NEW YORK
 
ARMY:
    U.S. MILITARY ACADEMY:
        ENGINEERING CENTER......................................          95,000          95,000  ..............
        PARKING STRUCTURE.......................................          65,000          65,000  ..............
AIR NATIONAL GUARD:
    FRANCIS S. GABRESKI AIRPORT:
        SECURITY FORCES/COMM.TRAINING FACILITY..................          20,000          20,000  ..............
AIR FORCE RESERVE:
    NIAGARA FALLS IAP:
        PHYSICAL FITNESS CENTER.................................          14,000          14,000  ..............
                                                                 -----------------------------------------------
          TOTAL, NEW YORK.......................................         194,000         194,000  ..............
 
                         NORTH CAROLINA
 
 ARMY:
    FORT BRAGG:
        DINING FACILITY.........................................          10,000          10,000  ..............
NAVY:
    CHERRY POINT MARINE CORPS AIR STATION:
        AIRCRAFT MAINTENANCE HANGAR.............................         133,970          60,000         -73,970
        FLIGHTLINE UTILITY MODERNIZATION........................         106,860         106,860  ..............
DEFENSE-WIDE:
    FORT BRAGG:
        SOF REPLACE TRAINING MAZE AND TOWER.....................          12,109          12,109  ..............
        SOF SERE RESISTANCE TRAINING LAB. COMPLEX...............          20,257          20,257  ..............
    NEW RIVER:
        AMB CARE CENTER/DENTAL CLINIC REPLACEMENT...............          32,580          32,580  ..............
                                                                 -----------------------------------------------
          TOTAL, NORTH CAROLINA.................................         315,776         241,806         -73,970
 
                          NORTH DAKOTA
 
AIR FORCE:
    MINOT AFB:
        CONSOLIDATED HELO/TRF OPS/AMU AND ALERT FACILITY........          66,000          66,000  ..............
ARMY NATIONAL GUARD:
    FARGO:
        NATIONAL GUARD READINESS CENTER.........................          32,000          32,000  ..............
                                                                 -----------------------------------------------
          TOTAL, NORTH DAKOTA...................................          98,000          98,000  ..............
 
                              OHIO
 
AIR FORCE:
    WRIGHT-PATTERSON AFB:
        ADAL INTELLIGENCE PRODUCTION COMPLEX (NASIC)............         116,100         116,100  ..............
ARMY NATIONAL GUARD:
    CAMP RAVENNA:
        AUTOMATED MULTIPURPOSE MACHINE GUN RANGE................           7,400           7,400  ..............
                                                                 -----------------------------------------------
          TOTAL, OHIO...........................................         123,500         123,500  ..............
 
                            OKLAHOMA
 
AIR FORCE:
    ALTUS AFB:
        KC-46A FTU/FTC SIMULATOR FACILITY PHASE 3...............          12,000          12,000  ..............
    TINKER AFB:
        KC-46A DEPOT FUEL MAINTENANCE HANGAR....................          85,000          85,000  ..............
        KC-46A DEPOT MAINTENANCE HANGAR.........................          81,000          81,000  ..............
DEFENSE-WIDE:
    MCALESTER:
        BULK DIESEL SYSTEM REPLACEMENT..........................           7,000           7,000  ..............
                                                                 -----------------------------------------------
          TOTAL, OKLAHOMA.......................................         185,000         185,000  ..............
 
                          PENNSYLVANIA
 
NAVY:
    PHILADELPHIA:
        SUBMARINE PROPULSOR MANUFACTURING SUPPORT FACILITY......          71,050          71,050  ..............
AIR NATIONAL GUARD:
    FORT INDIANTOWN GAP:
        REPLACE OPERATIONS TRAINING/DINING HALL.................           8,000           8,000  ..............
NAVY RESERVE:
    PITTSBURGH:
        RESERVE TRAINING CENTER--PITTSBURGH, PA.................  ..............  ..............  ..............
                                                                 -----------------------------------------------
          TOTAL, PENNSYLVANIA...................................          79,050          79,050  ..............
 
                         SOUTH CAROLINA
 
ARMY:
    FORT JACKSON:
        TRAINEE BARRACKS COMPLEX 3, PHASE 2.....................          52,000          52,000  ..............
NAVY:
    BEAUFORT:
        RECYCLING/HAZARDOUS WASTE FACILITY......................           9,517           9,517  ..............
    PARRIS ISLAND:
        RANGE IMPROVEMENTS & MODERNIZATION, PHASE 2.............          35,190          35,190  ..............
AIR FORCE:
    SHAW AFB:
        CPIP MQ-9 MCE GROUP.....................................          53,000          53,000  ..............
                                                                 -----------------------------------------------
          TOTAL, SOUTH CAROLINA.................................         149,707         149,707  ..............
 
                          SOUTH DAKOTA
 
ARMY NATIONAL GUARD:
    RAPID CITY:
        NATIONAL GUARD READINESS CENTER.........................          15,000          15,000  ..............
                                                                 -----------------------------------------------
          TOTAL, SOUTH DAKOTA...................................          15,000          15,000  ..............
 
                              TEXAS
 
ARMY:
    FORT BLISS:
        SUPPLY SUPPORT ACTIVITY.................................          24,000          24,000  ..............
AIR FORCE:
    JOINT BASE SAN ANTONIO:
        BMT RECRUIT DORMITORY 6.................................          25,000          25,000  ..............
DEFENSE-WIDE:
    JOINT BASE SAN ANTONIO:
        ENERGY AEROSPACE OPERATIONS FACILITY....................          10,200          10,200  ..............
    RED RIVER ARMY DEPOT:
        GENERAL PURPOSE WAREHOUSE...............................          71,500          71,500  ..............
AIR FORCE RESERVE:
    FORT WORTH:
        MUNITIONS TRAINING/ADMIN FACILITY.......................           3,100           3,100  ..............
                                                                 -----------------------------------------------
          TOTAL, TEXAS..........................................         133,800         133,800  ..............
 
                              UTAH
 
NAVY:
    HILL AFB:
        D5 MISSILE MOTOR RECEIPT/STORAGE FACILITY...............         105,520         105,520  ..............
                                                                 -----------------------------------------------
          TOTAL, UTAH...........................................         105,520         105,520  ..............
 
                            VIRGINIA
 
NAVY:
    PORTSMOUTH:
        SHIPS MAINTENANCE FACILITY..............................          26,120          26,120  ..............
    QUANTICO:
        TBS FIRE STATION........................................          21,980  ..............         -21,980
DEFENSE-WIDE:
    DAM NECK:
        SOF MAGAZINES...........................................           8,959           8,959  ..............
    FORT A.P. HILL:
        TRAINING CAMPUS.........................................          11,734          11,734  ..............
    FORT BELVOIR:
        HUMAN PERFORMANCE TRAINING CENTER.......................           6,127           6,127  ..............
    HUMPHREYS ENGINEER CENTER:
        MAINTENANCE AND SUPPLY FACILITY.........................          20,257          20,257  ..............
    JOINT BASE LANGLEY-EUSTIS:
        FUEL FACILITIES REPLACEMENT.............................           6,900           6,900  ..............
        GROUND VEHICLE FUELING FACILITY REPLACEMENT.............           5,800           5,800  ..............
    PENTAGON:
        EXTERIOR INFRASTRUC. & SECURITY IMPROVEMENTS............          23,650          23,650  ..............
        NORTH VILLAGE VACP & FENCING............................          12,200          12,200  ..............
AIR NATIONAL GUARD:
    JOINT BASE LANGLEY-EUSTIS:
        CONSTRUCT CYBER OPS FACILITY............................          10,000          10,000  ..............
                                                                 -----------------------------------------------
          TOTAL, VIRGINIA.......................................         153,727         131,747         -21,980
 
                           WASHINGTON
 
NAVY:
    BANGOR:
        PIER AND MAINTENANCE FACILITY...........................          88,960          88,960  ..............
    WHIDBEY ISLAND:
        FLEET SUPPORT FACILITY..................................          19,450          19,450  ..............
        NEXT GENERATION JAMMER FACILITY.........................           7,930           7,930  ..............
DEFENSE-WIDE:
    JOINT BASE LEWIS-MCCHORD:
        REFUELING FACILITY......................................          26,200          26,200  ..............
                                                                 -----------------------------------------------
          TOTAL, WASHINGTON.....................................         142,540         142,540  ..............
 
                            WISCONSIN
 
ARMY RESERVE:
    FORT MCCOY:
        TRANSIENT TRAINING BARRACKS.............................          23,000          23,000  ..............
                                                                 -----------------------------------------------
          TOTAL, WISCONSIN......................................          23,000          23,000  ..............
 
                             BAHAMAS
 
NAVY:
    ANDROS ISLAND:
        AUTEC AUSTERE QUARTERS..................................          31,050          31,050  ..............
                                                                 -----------------------------------------------
          TOTAL, BAHAMAS........................................          31,050          31,050  ..............
 
                         BAHRAIN ISLAND
 
NAVY:
    SW ASIA:
        FLEET MAINTENANCE FACILITY & TOC........................          26,340          26,340  ..............
                                                                 -----------------------------------------------
          TOTAL, BAHRAIN ISLAND.................................          26,340          26,340  ..............
 
                             BELGIUM
 
DEFENSE-WIDE:
    CHIEVRES AB:
        EUROPE WEST DISTRICT SUPERINTENDENT'S OFFICE............          14,305          14,305  ..............
                                                                 -----------------------------------------------
          TOTAL, BELGIUM........................................          14,305          14,305  ..............
 
                        CONUS CLASSIFIED
 
DEFENSE-WIDE:
    CLASSIFIED LOCATION:
        BATTALION COMPLEX, PHASE 2..............................          49,222          49,222  ..............
                                                                 -----------------------------------------------
          TOTAL, CONUS CLASSIFIED...............................          49,222          49,222  ..............
 
                             GERMANY
 
ARMY:
    EAST CAMP GRAFENWOEHR:
        MISSION TRAINING COMPLEX................................          31,000          31,000  ..............
NAVY:
    PANZER KASERNE:
        MARFOREUR HQ MODERNIZATION AND EXPANSION................          43,950          43,950  ..............
DEFENSE-WIDE:
    BAUMHOLDER:
        SOF JOINT PARACHUTE RIGGING FACILITY....................          11,504          11,504  ..............
    KAISERLAUTERN AB:
        KAISERSLAUTERN MIDDLE SCHOOL............................          99,955          99,955  ..............
    RHINE ORDNANCE BARRACKS:
        MEDICAL CENTER REPLACEMENT INC. 8.......................         319,589         319,589  ..............
 
    WIESBADEN:
        CLAY KASERNE ELEMENTARY SCHOOL..........................          56,048          56,048  ..............
                                                                 -----------------------------------------------
                  TOTAL, GERMANY................................         562,046         562,046  ..............
 
                              GUAM
 
NAVY:
    JOINT REGION MARIANAS:
        ACE GYM & DINING........................................          27,910          27,910  ..............
        EARTH COVERED MAGAZINES.................................          52,270          52,270  ..............
        MACHINE GUN RANGE.......................................         141,287          50,000         -91,287
        ORDNANCE OPS............................................          22,020          22,020  ..............
        UNACCOMPANIED ENLISTED HOUSING..........................          36,170          36,170  ..............
AIR FORCE:
    JOINT REGION MARIANAS:
        HAYMAN MUNITIONS STORAGE IGLOOS MSA 2...................           9,800           9,800  ..............
                                                                 -----------------------------------------------
          TOTAL, GUAM...........................................         289,457         198,170         -91,287
 
                      GUANTANAMO BAY, CUBA
 
NAVY:
    GUANTANAMO BAY:
        SOLID WASTE MANAGEMENT FACILITY.........................          85,000          85,000  ..............
DEFENSE-WIDE:
    GUANTANAMO BAY:
        WORKING DOG TREATMENT FACILITY REPLACEMENT..............           9,080           9,080  ..............
                                                                 -----------------------------------------------
          TOTAL, GUANTANAMO BAY, CUBA...........................          94,080          94,080  ..............
 
                            HONDURAS
 
ARMY:
    SOTO CANO AB:
        BARRACKS................................................          21,000          21,000  ..............
                                                                 -----------------------------------------------
          TOTAL, HONDURAS.......................................          21,000          21,000  ..............
 
                              JAPAN
 
NAVY:
    KADENA AB:
        TACTICAL OPERATIONS CENTER..............................           9,049           9,049  ..............
DEFENSE-WIDE:
    CAMP MCTUREOUS:
        BECHTEL ELEMENTARY SCHOOL...............................          94,851          94,851  ..............
    IWAKUNI:
        FUEL PIER...............................................          33,200          33,200  ..............
    KADENA AB:
        TRUCK UNLOAD FACILITIES.................................          21,400          21,400  ..............
    YOKOSUKA:
        KINNICK HIGH SCHOOL.....................................         170,386          60,000        -110,386
                                                                 -----------------------------------------------
                  TOTAL, JAPAN..................................         328,886         218,500        -110,386
 
                              KOREA
 
ARMY:
    CAMP TANGO:
        COMMAND AND CONTROL FACILITY............................          17,500          17,500  ..............
                                                                 -----------------------------------------------
          TOTAL, KOREA..........................................          17,500          17,500  ..............
 
                             KUWAIT
 
ARMY:
    CAMP ARIFJAN:
        VEHICLE MAINTENANCE SHOP................................          44,000          44,000  ..............
                                                                 -----------------------------------------------
          TOTAL, KUWAIT.........................................          44,000          44,000  ..............
 
                         MARIANA ISLANDS
 
AIR FORCE:
    TINIAN:
        APR--CARGO PAD WITH TAXIWAY EXTENSION...................          46,000          46,000  ..............
        APR--MAINTENANCE SUPPORT FACILITY.......................           4,700           4,700  ..............
                                                                 -----------------------------------------------
          TOTAL, MARIANA ISLANDS................................          50,700          50,700  ..............
 
                              QATAR
 
AIR FORCE:
    AL UDEID:
        FLIGHTLINE SUPPORT FACILITIES...........................          30,400  ..............         -30,400
        PERSONNEL DEPLOYMENT PROCESSING FACILITY................          40,000  ..............         -40,000
                                                                 -----------------------------------------------
          TOTAL, QATAR..........................................          70,400  ..............         -70,400
 
                         UNITED KINGDOM
 
AIR FORCE:
    ROYAL AIR FORCE LAKENHEATH:
        F-35A 6 BAY HANGAR......................................          39,036          39,036  ..............
        F-35A ADAL CONVENTIONAL MUNITIONS MX....................           9,204           9,204  ..............
        F-35A ADAL PARTS STORE..................................          13,926          13,926  ..............
        F-35A AGE FACILITY......................................          12,449          12,449  ..............
        F-35A DORM..............................................          29,541          29,541  ..............
        F-35A FUEL SYSTEM MAINTENANCE DOCK 2 BAY................          16,880          16,880  ..............
        F-35A PARKING APRON.....................................          27,431          27,431  ..............
DEFENSE-WIDE:
    CROUGHTON RAF:
        AMBULATORY CARE CENTER ADDITION/ALTERATION..............          10,000  ..............         -10,000
                                                                 -----------------------------------------------
          TOTAL, UNITED KINGDOM.................................         158,467         148,467         -10,000
 
                      WORLDWIDE CLASSIFIED
 
AIR FORCE:
    CLASSIFIED LOCATION:
        TACMOR--UTILITIES AND INFRASTRUCTURE SUPPORT............          18,000          18,000  ..............
                                                                 -----------------------------------------------
          TOTAL, WORLDWIDE CLASSIFIED...........................          18,000          18,000  ..............
        NATO SECURITY INVESTMENT PROGRAM........................         171,064         171,064  ..............
 
                      WORLDWIDE UNSPECIFIED
 
ARMY:
    HOST NATION SUPPORT.........................................          34,000          34,000  ..............
    MINOR CONSTRUCTION..........................................          72,000          82,000         +10,000
    PLANNING AND DESIGN.........................................          71,068          71,068  ..............
    PLANNING AND DESIGN.........................................           5,000           5,000  ..............
NAVY:
    PLANNING AND DESIGN.........................................         185,542         185,542  ..............
    MINOR CONSTRUCTION..........................................          28,579          28,579  ..............
AIR FORCE:
    PLANNING AND DESIGN.........................................         206,577         206,577  ..............
    MINOR CONSTRUCTION..........................................          38,500          38,500  ..............
DEFENSE-WIDE:
    CONTINGENCY CONSTRUCTION....................................          10,000  ..............         -10,000
    ENERGY CONSERVATION INVESTMENT PROGRAM......................         150,000         195,000         +45,000
    PLANNING AND DESIGN:
        DEFENSE WIDE............................................          24,300          24,300  ..............
        DEFENSE HEALTH AGENCY...................................          55,699          55,699  ..............
        DEFENSE INFORMATION SYSTEMS AGENCY......................             496             496  ..............
        DEFENSE LOGISTICS AGENCY................................          42,705          42,705  ..............
        MISSILE DEFENSE AGENCY..................................          14,184          14,184  ..............
        SPECIAL OPERATIONS COMMAND..............................          55,925          55,925  ..............
        WASHINGTON HEADQUARTERS SERVICE.........................           2,036           2,036  ..............
                                                                 -----------------------------------------------
          SUBTOTAL, PLANNING AND DESIGN.........................         195,345         195,345  ..............
    UNSPECIFIED MINOR CONSTRUCTION:
        DEFENSE WIDE............................................           3,000           3,000  ..............
        DEFENSE HEALTH AGENCY...................................           5,000           5,000  ..............
        DEFENSE LOGISTICS AGENCY................................          17,366          17,366  ..............
        MISSILE DEFENSE AGENCY..................................          10,000          10,000  ..............
        SPECIAL OPERATIONS COMMAND..............................          13,642          13,642  ..............
        THE JOINT STAFF.........................................          12,479          12,479  ..............
                                                                 -----------------------------------------------
      SUBTOTAL, UNSPECIFIED MINOR CONSTRUCTION..................          61,487          61,487  ..............
 
ARMY NATIONAL GUARD:
    PLANNING AND DESIGN.........................................          16,622          16,622  ..............
    MINOR CONSTRUCTION..........................................          18,100          28,100         +10,000
AIR NATIONAL GUARD:
    PLANNING AND DESIGN.........................................          18,500          18,500  ..............
    MINOR CONSTRUCTION..........................................          23,626          33,626         +10,000
ARMY RESERVE:
    PLANNING AND DESIGN.........................................           5,855           5,855  ..............
    MINOR CONSTRUCTION..........................................           2,064           2,064  ..............
NAVY RESERVE:
    PLANNING AND DESIGN.........................................           4,695           4,695  ..............
    MINOR CONSTRUCTION..........................................           3,000           3,000  ..............
AIR FORCE RESERVE:
    PLANNING AND DESIGN.........................................           4,055           4,055  ..............
    MINOR CONSTRUCTION..........................................           3,358           3,358  ..............
 
                      FAMILY HOUSING, ARMY
 
WISCONSIN:
    FORT MCCOY:
        FAMILY HOUSING NEW CONSTRUCTION (7 units)...............           6,200           6,200  ..............
PUERTO RICO:
    FORT BUCHANAN:
        FAMILY HOUSING NEW CONSTRUCITON (26 UNITS)..............          26,000          26,000  ..............
KOREA:
    CAMP WALKER--DAEGU:
        FAMILY HOUSING REPLACEMENT CONSTRUCTION (90 UNITS)......          68,000          68,000  ..............
    CAMP HUMPHRIES:
        FAMILY HOUSING NEW CONSTRUCTION.........................          85,000          85,000  ..............
ITALY:
    VICENZA:
        FAMILY HOUSING NEW CONSTRUCTION (111 UNITS).............          95,134          95,134  ..............
GERMANY:
    BAUMHOLDER:
        CONSTRUCTION IMPROVEMENTS (72 UNITS)....................          32,000          32,000  ..............
        PLANNING AND DESIGN.....................................          18,326          18,326  ..............
                                                                 -----------------------------------------------
      SUBTOTAL, CONSTRUCTION....................................         330,660         330,660  ..............
    OPERATION AND MAINTENANCE:
        UTILITIES ACCOUNT.......................................          57,872          57,872  ..............
        SERVICES ACCOUNT........................................          10,502          10,502  ..............
        MANAGEMENT ACCOUNT......................................          36,302          36,302  ..............
        MISCELLANEOUS ACCOUNT...................................             408             408  ..............
        FURNISHINGS ACCOUNT.....................................          15,842          15,842  ..............
        LEASING.................................................         161,252         161,252  ..............
        MAINTENANCE OF REAL PROPERTY............................          75,530          75,530  ..............
            PRIVATIZATION SUPPORT COSTS.........................          18,801          18,801  ..............
                                                                 -----------------------------------------------
      SUBTOTAL, OPERATION AND MAINTENANCE.......................         376,509         376,509  ..............
 
              FAMILY HOUSING, NAVY AND MARINE CORPS
 
GUAM:
    NSA ANDERSON:
        REPLACEMENT HOUSING PHASE III...........................          83,441          83,441  ..............
JAPAN:
    IWAKUNI:
        CONSTRUCTION IMPROVEMENTS (44 UNITS)....................          16,638          16,638  ..............
        PLANNING AND DESIGN.....................................           4,502           4,502  ..............
                                                                 -----------------------------------------------
      SUBTOTAL, CONSTRUCTION....................................         104,581         104,581  ..............
OPERATION AND MAINTENANCE:
    UTILITIES ACCOUNT...........................................          60,252          60,252  ..............
    SERVICES ACCOUNT............................................          16,261          16,261  ..............
    MANAGEMENT ACCOUNT..........................................          50,870          50,870  ..............
    MISCELLANEOUS ACCOUNT.......................................             148             148  ..............
    FURNISHINGS ACCOUNT.........................................          16,395          16,395  ..............
    LEASING.....................................................          62,515          62,515  ..............
    MAINTENANCE OF REAL PROPERTY................................          86,328          86,328  ..............
    PRIVATIZATION SUPPORT COSTS.................................          21,767          21,767  ..............
                                                                 -----------------------------------------------
      SUBTOTAL, OPERATION AND MAINTENANCE.......................         314,536         314,536  ..............
 
                    FAMILY HOUSING, AIR FORCE
 
JAPAN:
    KADENA:
        CONSTRUCTION IMPROVEMENTS (130 UNITS)...................          72,129          72,129  ..............
UNITED KINGDOM:
    RAF LAKENHEATH:
        CONSTRUCTION IMPROVEMENTS...............................           3,118           3,118  ..............
LANNING AND DESIGN..............................................           3,199           3,199  ..............
                                                                 -----------------------------------------------
      SUBTOTAL, CONSTRUCTION....................................          78,446          78,446  ..............
OPERATION AND MAINTENANCE:
    UTILITIES ACCOUNT...........................................          48,566          48,566  ..............
    MANAGEMENT ACCOUNT..........................................          54,423          54,423  ..............
    SERVICES ACCOUNT............................................          13,669          13,669  ..............
    FURNISHINGS ACCOUNT.........................................          30,645          30,645  ..............
    MISCELLANEOUS ACCOUNT.......................................           2,171           2,171  ..............
    LEASING.....................................................          15,832          15,832  ..............
    MAINTENANCE.................................................         129,763         129,763  ..............
    PRIVATIZATION SUPPORT COSTS.................................          22,205          22,205  ..............
                                                                 -----------------------------------------------
      SUBTOTAL, OPERATION AND MAINTENANCE.......................         317,274         317,274  ..............
 
                  FAMILY HOUSING, DEFENSE-WIDE
 
OPERATION AND MAINTENANCE:
    NATIONAL SECURITY AGENCY:
        UTILITIES...............................................             106             106  ..............
        FURNISHING..............................................             416             416  ..............
        LEASING.................................................          13,046          13,046  ..............
        MAINTENANCE OF REAL PROPERTY............................             121             121  ..............
    DEFENSE INTELLIGENCE AGENCY:
    UTILITIES...................................................           4,100           4,100  ..............
        FURNISHINGS.............................................             643             643  ..............
        LEASING.................................................          38,232          38,232  ..............
    DEFENSE LOGISTICS AGENCY:
        UTILITIES...............................................               9               9  ..............
        FURNISHINGS.............................................               1               1  ..............
        SERVICES................................................               2               2  ..............
        MANAGEMENT..............................................             155             155  ..............
        MAINTENANCE OF REAL PROPERTY............................           1,542           1,542  ..............
                                                                 -----------------------------------------------
          SUBTOTAL, OPERATION AND MAINTENANCE...................          58,373          58,373  ..............
 
DOD MILITARY UNACCOMPANIED HOUSING IMPROVEMENT FUND.............             600             600  ..............
DOD FAMILY HOUSING IMPROVEMENT FUND.............................           1,653           1,653  ..............
    BASE REALIGNMENT AND CLOSURE:
    BASE REALIGNMENT AND CLOSURE ACCOUNT........................         267,538         277,538         +10,000
 
                    ADMINISTRATIVE PROVISIONS
 
MILITARY CONSTRUCTION, ARMY.....................................  ..............          77,600         +77,600
MILITARY CONSTRUCTION, NAVY AND MARINE CORPS....................  ..............         244,400        +244,400
MILITARY CONSTRUCTION, AIR FORCE................................  ..............         118,516        +118,516
MILITARY CONSTRUCTION, ARMY NATIONAL GUARD......................  ..............          22,000         +22,000
MILITARY CONSTRUCTION, AIR NATIONAL GUARD.......................  ..............          11,100         +11,100
MILITARY CONSTRUCTION, ARMY RESERVE.............................  ..............          10,000         +10,000
MILITARY CONSTRUCTION, AIR FORCE RESERVE........................  ..............          14,400         +14,400
MILITARY CONSTRUCTION--ENHANCING FORCE PROTECTION AND SAFETY ON   ..............  ..............  ..............
 MILITARY INSTALLATIONS (SEC. 131)..............................
DEFENSE ACCESS ROADS PROGRAM (SEC. 129).........................  ..............          30,000         +30,000
 
        RESCISSIONS FROM PRIOR YEAR UNOBLIGATED BALANCES
AIR FORCE (RESCISSION)..........................................  ..............         -31,158         -31,158
ARMY NATIONAL GUARD (RESCISSION)................................  ..............         -10,000         -10,000
42 USC 3374 (SEC. 135) (RESCISSION).............................  ..............  ..............  ..............
NATO SECURITY INVESTMENT PROGRAM (RESCISSION)...................  ..............  ..............  ..............
FAMILY HOUSING, NAVY AND MARINE CORPS (RESCISSION)..............  ..............          -2,138          -2,138
 
                              RECAP
 
ARMY............................................................       1,011,768       1,021,768         +10,000
    RESCISSION..................................................  ..............  ..............  ..............
NAVY AND MARINE CORPS...........................................       2,543,189       2,222,522        -320,667
    RESCISSION..................................................  ..............  ..............  ..............
AIR FORCE.......................................................       1,725,707       1,495,423        -230,284
    RESCISSION..................................................  ..............         -31,158         -31,158
DEFENSE-WIDE....................................................       2,693,324       2,575,938        -117,386
    RESCISSION..................................................  ..............  ..............  ..............
ARMY NATIONAL GUARD.............................................         180,122         190,122         +10,000
    RESCISSION..................................................  ..............         -10,000         -10,000
AIR NATIONAL GUARD..............................................         129,126         139,126         +10,000
    RESCISSION..................................................  ..............  ..............  ..............
ARMY RESERVE....................................................          64,919          64,919  ..............
    RESCISSION..................................................  ..............  ..............  ..............
NAVY RESERVE....................................................          43,065          43,065  ..............
    RESCISSION..................................................  ..............  ..............  ..............
AIR FORCE RESERVE...............................................          50,163          50,163  ..............
    RESCISSION..................................................  ..............  ..............  ..............
NATO............................................................         171,064         171,064  ..............
    RESCISSION..................................................  ..............  ..............  ..............
CHEMICAL DEMILITARIZATION CONSTRUCTION, DEFENSE-WIDE............  ..............  ..............  ..............
    RESCISSION..................................................  ..............  ..............  ..............
DOD UNACCOMPANIED HOUSING IMPROVEMENT FUND......................             600             600  ..............
    RESCISSION..................................................  ..............  ..............  ..............
DOD FAMILY HOUSING IMPROVEMENT FUND.............................           1,653           1,653  ..............
    RESCISSION..................................................  ..............  ..............  ..............
HOMEOWNERS ASSISTANCE PROGRAM...................................  ..............  ..............  ..............
    RESCISSION..................................................  ..............  ..............  ..............
FAMILY HOUSING, ARMY............................................         707,169         707,169  ..............
    CONSTRUCTION................................................       (330,660)       (330,660)  ..............
    OPERATION AND MAINTENANCE...................................       (376,509)       (376,509)  ..............
        RESCISSION..............................................  ..............  ..............  ..............
FAMILY HOUSING, NAVY AND MARINE CORP............................         419,117         419,117  ..............
    CONSTRUCTION................................................       (104,581)       (104,581)  ..............
    OPERATION AND MAINTENANCE...................................       (314,536)       (314,536)  ..............
        RESCISSION..............................................  ..............          -2,138          -2,138
FAMILY HOUSING, AIR FORCE.......................................         395,720         395,720  ..............
    CONSTRUCTION................................................        (78,446)        (78,446)  ..............
    OPERATION AND MAINTENANCE...................................       (317,274)       (317,274)  ..............
        RESCISSION..............................................  ..............  ..............  ..............
FAMILY HOUSING, DEFENSE-WIDE....................................          58,373          58,373  ..............
    CONSTRUCTION................................................  ..............  ..............  ..............
    OPERATION AND MAINTENANCE...................................        (58,373)        (58,373)  ..............
        RESCISSION..............................................  ..............  ..............  ..............
BRAC............................................................         267,538         277,538         +10,000
        RESCISSION..............................................  ..............  ..............  ..............
42 USC 3374 (SEC. 135)..........................................  ..............  ..............  ..............
        RESCISSION..............................................  ..............  ..............  ..............
            ADMINISTRATIVE PROVISIONS...........................  ..............         528,016        +528,016
        RESCISSION..............................................  ..............  ..............  ..............
                                                                 ===============================================
      GRAND TOTAL...............................................      10,462,617      10,319,000        -143,617
----------------------------------------------------------------------------------------------------------------


                                         OVERSEAS CONTINGENCY OPERATIONS
                                            [In thousands of dollars]
----------------------------------------------------------------------------------------------------------------
                                                                                                     Committee
                                                                                                  recommendation
                                                                      Budget         Committee      compared to
                                                                     estimate     recommendation      budget
                                                                                                     estimate
----------------------------------------------------------------------------------------------------------------
                            BULGARIA
 
ARMY:
    NEVO SELO FOS:
        EDI: AMMUNITION HOLDING AREA............................           5,200           5,200  ..............
 
                             GERMANY
 
AIR FORCE:
    RAMSTEIN AB:
        EDI: KMC DABS-FEV/RH STORAGE WAREHOUSES.................         119,000         119,000  ..............
 
                             GREECE
 
NAVY:
    SOUDA BAY:
        EDI: JOINT MOBILITY PROCESSING CENTER...................          41,650          41,650  ..............
        EDI: MARATHI LOGISTICS SUPPORT CENTER...................           6,200           6,200  ..............
 
                      GUANTANAMO BAY, CUBA
 
ARMY:
    GUANTANAMO BAY:
        OCO: HIGH VALUE DETENTION FACILITY......................          69,000  ..............         -69,000
 
                              ITALY
 
NAVY:
    SIGONELLA:
        EDI: P-8A TAXIWAY.......................................          66,050          66,050  ..............
 
                             NORWAY
 
AIR FORCE:
    RYGGE:
        EDI: CONSTRUCT TAXIWAY..................................          13,800          13,800  ..............
 
                             POLAND
 
ARMY:
    POWIDZ AB:
        EDI: AMMUNITION STORAGE FACILITY........................          52,000          52,000  ..............
        EDI: BULK FUEL STORAGE..................................          21,000          21,000  ..............
        EDI: RAIL EXTENSION & RAILHEAD..........................          14,000          14,000  ..............
    ZAGAN
        EDI: RAIL EXTENSION AND RAILHEAD........................           6,400           6,400  ..............
        EDI: STAGING AREA.......................................          51,000  ..............         -51,000
        EDI: STAGING AREA.......................................  ..............          34,000         +34,000
    DRAWSKO POMORSKI:
        EDI: STAGING AREA.......................................  ..............          17,000         +17,000
 
                              QATAR
 
AIR FORCE:
    AL UDEID
        OCO: FLIGHTLINE SUPPORT FACILITIES......................  ..............          29,000         +29,000
        OCO: PERSONNEL DEPLOYMENT PROCESSING FCILITY............  ..............          40,000         +40,000
 
DEFENSE-WIDE:
    AL UDEID
        OCO: TRANS-REGIONAL LOGISTICS COMPLEX...................          60,000          60,000  ..............
 
                             ROMANIA
 
ARMY:
    MIHAIL KOGALNICEANU
        EDI: EXPLOSIVES & AMMO LOAD/UNLOAD APRON................          21,651          21,651  ..............
 
                            SLOVAKIA
 
AIR FORCE:
    MALACKY:
        EDI: REGIONAL MUNITIONS STORAGE AREA....................          59,000          59,000  ..............
 
                              SPAIN
 
NAVY:
    ROTA:
        EDI: PORT OPERATIONS FACILITIES.........................          21,590          21,590  ..............
 
                         UNITED KINGDOM
 
NAVY:
    LOSSIEMOUTH:
        EDI: P-8 BASE IMPROVEMENTS..............................          79,130          79,130  ..............
 
AIR FORCE:
    RAF FAIRFORD:
        EDI: CONSTRUCT DABS-FEV STORAGE.........................          87,000          87,000  ..............
        EDI: MUNITIONS HOLDING AREA.............................          19,000          19,000  ..............
 
                             ESTONIA
 
DEFENSE-WIDE:
    UNSPECIFIED LOCATIONS:
        EDI: SOF OPERATIONS FACILITY............................           6,100           6,100  ..............
        EDI: SOF TRAINING FACILITY..............................           9,600           9,600  ..............
 
                      WORLDWIDE UNSPECIFIED
 
ARMY:
        EDI: PLANNING AND DESIGN................................          20,999          20,999  ..............
NAVY:
        EDI: PLANNING AND DESIGN................................          12,700          12,700  ..............
AIR FORCE:
        EDI: PLANNING & DESIGN FUNDS............................          48,000          48,000  ..............
DEFENSE-WIDE
        EDI: PLANNING AND DESIGN................................           7,100           7,100  ..............
        EDI: PLANNING AND DESIGN................................           4,250           4,250  ..............
 
                              RECAP
 
ARMY............................................................         261,250         192,250         -69,000
    RESCISSION..................................................  ..............  ..............  ..............
NAVY AND MARINE CORPS...........................................         227,320         227,320  ..............
    RESCISSION..................................................  ..............  ..............  ..............
AIR FORCE.......................................................         345,800         414,800         +69,000
    RESCISSION..................................................  ..............  ..............  ..............
DEFENSE-WIDE....................................................          87,050          87,050  ..............
    RESCISSION..................................................  ..............  ..............  ..............
                                                                 ===============================================
      GRAND TOTAL...............................................         921,420         921,420  ..............
----------------------------------------------------------------------------------------------------------------


  COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL FOR FISCAL
                                                                        YEAR 2019
                                                                [In thousands of dollars]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                         Senate Committee recommendation
                                                                                                                             compared with (+ or -)
                                Item                                       2018       Budget estimate     Committee    ---------------------------------
                                                                      appropriation                     recommendation        2018
                                                                                                                         appropriation   Budget estimate
--------------------------------------------------------------------------------------------------------------------------------------------------------
                   TITLE I--DEPARTMENT OF DEFENSE
 
Military Construction, Army........................................         923,994        1,011,768        1,021,768          +97,774          +10,000
Military Construction, Navy and Marine Corps.......................       1,553,275        2,543,189        2,222,522         +669,247         -320,667
Military Construction, Air Force...................................       1,543,558        1,725,707        1,495,423          -48,135         -230,284
Military Construction, Defense-Wide................................       2,811,513        2,693,324        2,575,938         -235,575         -117,386
                                                                    ------------------------------------------------------------------------------------
      Total, Active components.....................................       6,832,340        7,973,988        7,315,651         +483,311         -658,337
                                                                    ====================================================================================
Military Construction, Army National Guard.........................         220,652          180,122          190,122          -30,530          +10,000
Military Construction, Air National Guard..........................         171,491          129,126          139,126          -32,365          +10,000
Military Construction, Army Reserve................................          83,712           64,919           64,919          -18,793   ...............
Military Construction, Navy Reserve................................          95,271           43,065           43,065          -52,206   ...............
Military Construction, Air Force Reserve...........................          73,535           50,163           50,163          -23,372   ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Reserve components....................................         644,661          467,395          487,395         -157,266          +20,000
                                                                    ====================================================================================
North Atlantic Treaty Organization Security Investment Program              177,932          171,064          171,064           -6,868   ...............
    Chemical demilitarization construction, Defense-Wide...........  ...............  ...............  ...............  ...............  ...............
    Department of Defense Base Closure Account.....................         310,000          267,538          277,538          -32,462          +10,000
                                                                    ------------------------------------------------------------------------------------
      Total, Military Construction.................................       7,964,933        8,879,985        8,251,648         +286,715         -628,337
                                                                    ====================================================================================
Family Housing Construction, Army..................................         182,662          330,660          330,660         +147,998   ...............
Family Housing Operation and Maintenance, Army.....................         348,907          376,509          376,509          +27,602   ...............
Family Housing Construction, Navy and Marine Corps.................          83,682          104,581          104,581          +20,899   ...............
Family Housing Operation and Maintenance, Navy and Marine Corps....         328,282          314,536          314,536          -13,746   ...............
Family Housing Construction, Air Force.............................          85,062           78,446           78,446           -6,616   ...............
Family Housing Operation and Maintenance, Air Force................         318,324          317,274          317,274           -1,050   ...............
Family Housing Operation and Maintenance, Defense-Wide.............          59,169           58,373           58,373             -796   ...............
Department of Defense Family Housing Improvement Fund..............           2,726            1,653            1,653           -1,073   ...............
DoD Military Unaccompanied Housing Improvement Fund................             623              600              600              -23   ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Family Housing........................................       1,409,437        1,582,632        1,582,632         +173,195   ...............
                                                                    ====================================================================================
                     ADMINISTRATIVE PROVISIONS
 
Defense Access Roads (Sec. 132)....................................  ...............  ...............  ...............  ...............  ...............
Military Construction, Air Force (Sec. 125) (rescission)...........  ...............  ...............         -31,158          -31,158          -31,158
Military Construction, Army (Sec. 124).............................          93,800   ...............          77,600          -16,200          +77,600
Military Construction, Navy and Marine Corps (Sec. 124)............         202,130   ...............         244,400          +42,270         +244,400
Military Construction, Air National Guard (Sec. 124)...............          52,000   ...............          11,100          -40,900          +11,100
Military Construction, Army National Guard (Sec. 124)..............         113,500   ...............          22,000          -91,500          +22,000
Military Construction, Army National Guard (Sec. 125) (rescission).  ...............  ...............         -10,000          -10,000          -10,000
Military Construction, Army Reserve (Sec. 124).....................          76,000   ...............          10,000          -66,000          +10,000
NATO Security Investment Program (Sec. 125) (rescission)...........         -25,000   ...............  ...............         +25,000   ...............
42 USC 3374 (Sec. 125).............................................  ...............  ...............  ...............  ...............  ...............
Military Construction, Air Force (Sec. 124)........................         138,100   ...............         118,516          -19,584         +118,516
Military Construction, Air Force Reserve (Sec. 124)................          64,100   ...............          14,400          -49,700          +14,400
Family Housing Construction, Army (Sec. 126).......................         -18,000   ...............  ...............         +18,000   ...............
Family Housing Construction, Navy and Marine Corps (Sec. 125)......  ...............  ...............          -2,138           -2,138           -2,138
Family Housing Construction, Air Force (Sec. 126)..................  ...............  ...............  ...............  ...............  ...............
Defense Access Roads Program (Sec. 129)............................          20,000   ...............          30,000          +10,000          +30,000
                                                                    ------------------------------------------------------------------------------------
      Total, Administrative Provisions.............................         716,630   ...............         484,720         -231,910         +484,720
          Appropriations...........................................        (759,630)  ...............        (528,016)       (-231,614)       (+528,016)
          Rescissions..............................................        (-43,000)  ...............        (-43,296)           (-296)        (-43,296)
                                                                    ====================================================================================
      Total, title I, Department of Defense........................      10,091,000       10,462,617       10,319,000         +228,000         -143,617
          Appropriations...........................................     (10,134,000)     (10,462,617)     (10,362,296)       (+228,296)       (-100,321)
          Rescissions..............................................        (-43,000)  ...............        (-43,296)           (-296)        (-43,296)
                                                                    ====================================================================================
              TITLE II--DEPARTMENT OF VETERANS AFFAIRS
 
                  Veterans Benefits Administration
 
Compensation and pensions:
    Advance from prior year........................................     (90,119,449)     (95,768,462)     (95,768,462)     (+5,649,013)  ...............
    Current year request...........................................  ...............       1,410,332        1,410,332       +1,410,332   ...............
                                                                    ------------------------------------------------------------------------------------
          Subtotal, current year...................................      90,119,449       97,178,794       97,178,794       +7,059,345   ...............
 
    Advance appropriation, fiscal year 2020........................      95,768,462      107,119,807      107,119,807      +11,351,345   ...............
 
Readjustment benefits:
    Advance from prior year........................................     (13,708,648)     (11,832,175)     (11,832,175)     (-1,876,473)  ...............
                                                                    ------------------------------------------------------------------------------------
          Subtotal.................................................      13,708,648       11,832,175       11,832,175       -1,876,473   ...............
 
    Advance appropriation, fiscal year 2020........................      11,832,175       14,065,282       14,065,282       +2,233,107   ...............
 
Veterans insurance and indemnities:
    Advance from prior year........................................        (107,899)        (109,090)        (109,090)         (+1,191)  ...............
    Current year request...........................................          12,439   ...............  ...............         -12,439   ...............
                                                                    ------------------------------------------------------------------------------------
          Subtotal.................................................         120,338          109,090          109,090          -11,248   ...............
 
    Advance appropriation, fiscal year 2020........................         109,090          111,340          111,340           +2,250   ...............
 
Veterans housing benefit program fund:
    (Limitation on direct loans)...................................            (500)            (500)            (500)  ...............  ...............
    Administrative expenses........................................         178,626          200,612          200,612          +21,986   ...............
Vocational rehabilitation loans program account....................              30               39               39               +9   ...............
    (Limitation on direct loans)...................................          (2,356)          (2,037)          (2,037)           (-319)  ...............
    Administrative expenses........................................             395              396              396               +1   ...............
Native American veteran housing loan program account...............           1,163            1,149            1,163   ...............             +14
General operating expenses, VBA....................................       2,910,000        2,868,909        2,956,316          +46,316          +87,407
                                                                    ------------------------------------------------------------------------------------
      Total, Veterans Benefits Administration......................     110,812,380      125,777,866      125,865,287      +15,052,907          +87,421
        Appropriations.............................................      (3,102,653)      (4,481,437)      (4,568,858)     (+1,466,205)        (+87,421)
        Advance appropriations, fiscal year 2020...................    (107,709,727)    (121,296,429)    (121,296,429)    (+13,586,702)  ...............
        Advances from prior year appropriations....................    (103,935,996)    (107,709,727)    (107,709,727)     (+3,773,731)  ...............
                                                                    ====================================================================================
                  Veterans Health Administration:
 
Medical services:
    Advance from prior year........................................     (44,886,554)     (49,161,165)     (49,161,165)     (+4,274,611)  ...............
    Current year request\1\........................................       1,962,984   ...............         750,000       -1,212,984         +750,000
                                                                    ------------------------------------------------------------------------------------
          Subtotal.................................................      46,849,538       49,161,165       49,911,165       +3,061,627         +750,000
 
    Advance appropriation, fiscal year 2020........................      49,161,165       48,747,988       51,411,165       +2,250,000       +2,663,177
Medical community care:
    Advance from prior year........................................      (9,409,118)      (8,384,704)      (8,384,704)     (-1,024,414)  ...............
    Current year request...........................................         419,176   ...............  ...............        -419,176   ...............
    4/13/2018 Budget Amendment.....................................  ...............         500,000        1,000,000       +1,000,000         +500,000
                                                                    ------------------------------------------------------------------------------------
          Subtotal.................................................       9,828,294        8,884,704        9,384,704         -443,590         +500,000
 
    Advance appropriation, fiscal year 2020........................       8,384,704       14,419,786       10,758,399       +2,373,695       -3,661,387
    Choice Fund....................................................  ...............       1,900,000   ...............  ...............      -1,900,000
Medical support and compliance:
    Advance from prior year........................................      (6,654,480)      (7,239,156)      (7,239,156)       (+584,676)  ...............
    Current year request...........................................         100,000   ...............  ...............        -100,000   ...............
                                                                    ------------------------------------------------------------------------------------
          Subtotal.................................................       6,754,480        7,239,156        7,239,156         +484,676   ...............
 
    Advance appropriation, fiscal year 2020........................       7,239,156        7,106,150        7,239,156   ...............        +133,006
Medical facilities:
    Advance from prior year........................................      (5,434,880)      (5,914,288)      (5,914,288)       (+479,408)  ...............
    Current year request...........................................         707,000   ...............         211,000         -496,000         +211,000
                                                                    ------------------------------------------------------------------------------------
          Subtotal.................................................       6,141,880        5,914,288        6,125,288          -16,592         +211,000
 
    Advance appropriation, fiscal year 2020........................       5,914,288        5,276,676        6,141,880         +227,592         +865,204
    Medical and prosthetic research................................         722,262          727,369          779,000          +56,738          +51,631
Medical care cost recovery collections:
    Offsetting collections.........................................      -2,507,000       -3,590,000       -3,590,000       -1,083,000   ...............
    Appropriations (indefinite)....................................       2,507,000        3,590,000        3,590,000       +1,083,000   ...............
                                                                    ------------------------------------------------------------------------------------
          Subtotal.................................................  ...............  ...............  ...............  ...............  ...............
 
DoD-VA Joint Medical Funds (by transfer)...........................        (297,137)        (301,578)        (301,578)         (+4,441)  ...............
DoD-VA Health Care Sharing Incentive Fund (by transfer)                     (15,000)         (15,000)         (15,000)  ...............  ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Veterans Health Administration........................      74,610,735       78,677,969       78,290,600       +3,679,865         -387,369
          Appropriations...........................................      (3,911,422)      (3,127,369)      (2,740,000)     (-1,171,422)       (-387,369)
          (By transfer)............................................        (312,137)        (316,578)        (316,578)         (+4,441)  ...............
    Advance appropriations, fiscal year 2020.......................     (70,699,313)     (75,550,600)     (75,550,600)     (+4,851,287)  ...............
    Advances from prior year appropriations........................     (66,385,032)     (70,699,313)     (70,699,313)     (+4,314,281)  ...............
                                                                    ====================================================================================
                  National Cemetery Administration
 
National Cemetery Administration...................................         306,193          315,836          315,836           +9,643   ...............
 
                    Departmental Administration
 
General administration.............................................         335,891          367,629          365,976          +30,085           -1,653
Board of Veterans Appeals..........................................         161,048          174,748          174,748          +13,700   ...............
Information technology systems.....................................       4,055,500        4,184,571        4,184,571         +129,071   ...............
Veterans Electronic Health Record..................................         782,000        1,207,000          800,000          +18,000         -407,000
Office of Inspector General........................................         164,000          172,054          192,000          +28,000          +19,946
Construction, major projects.......................................         512,430        1,127,486        1,127,486         +615,056   ...............
Construction, minor projects.......................................         342,570          706,889          706,889         +364,319   ...............
Grants for construction of State extended care facilities..........         110,000          150,000          150,000          +40,000   ...............
Grants for the construction of veterans cemeteries.................          45,000           45,000           45,000   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Departmental Administration...........................       6,508,439        8,135,377        7,746,670       +1,238,231         -388,707
                                                                    ====================================================================================
                     Administrative Provisions
 
Mandatory disability exams language (Sec. 256).....................          25,000   ...............  ...............         -25,000   ...............
Medical Support and Compliance (Sec. 236) (rescission).............  ...............  ...............        -211,000         -211,000         -211,000
Medical services (Sec. 237) (rescission)...........................        -751,000   ...............  ...............        +751,000   ...............
VA deferred maintenance (Sec. 248).................................       2,000,000   ...............       2,000,000   ...............      +2,000,000
Construction, major projects:
    Sec. 243(a) rescission.........................................         -10,000   ...............  ...............         +10,000   ...............
    Sec. 243(b) reappropriation....................................          10,000   ...............  ...............         -10,000   ...............
    Sec. 243(c) rescission.........................................        -410,000   ...............  ...............        +410,000   ...............
    Sec. 243(d) reappropriation....................................         410,000   ...............  ...............        -410,000   ...............
                                                                    ------------------------------------------------------------------------------------
      Total Administrative Provisions..............................       1,274,000   ...............       1,789,000         +515,000       +1,789,000
                                                                    ====================================================================================
      Total, title II..............................................     193,511,747      212,907,048      214,007,393      +20,495,646       +1,100,345
          Appropriations...........................................     (15,853,707)     (16,060,019)     (17,371,364)     (+1,517,657)     (+1,311,345)
          Reappropriations.........................................        (420,000)  ...............  ...............       (-420,000)  ...............
          Emergency appropriations.................................  ...............  ...............  ...............  ...............  ...............
          Rescissions..............................................     (-1,171,000)  ...............       (-211,000)       (+960,000)       (-211,000)
          (By transfer)............................................        (312,137)        (316,578)        (316,578)         (+4,441)  ...............
                                                                    ====================================================================================
                    TITLE III--RELATED AGENCIES
 
                American Battle Monuments Commission
 
Salaries and expenses..............................................          79,000           75,100           81,000           +2,000           +5,900
Foreign currency fluctuations account..............................  ...............  ...............  ...............  ...............  ...............
                                                                    ------------------------------------------------------------------------------------
      Total, American Battle Monuments Commission..................          79,000           75,100           81,000           +2,000           +5,900
                                                                    ====================================================================================
             U.S. Court of Appeals for Veterans Claims
 
Salaries and expenses..............................................          33,600          107,455           34,955           +1,355          -72,500
    (Transfer out).................................................  ...............        (-72,500)  ...............  ...............        (+72,500)
 
                    Department of Defense--Civil
 
                     Cemeterial Expenses, Army
Salaries and expenses..............................................          80,800           70,800           80,800   ...............         +10,000
Construction.......................................................         167,000   ...............          56,600         -110,400          +56,600
                                                                    ------------------------------------------------------------------------------------
      Total, Cemeterial Expenses, Army.............................         247,800           70,800          137,400         -110,400          +66,600
                                                                    ====================================================================================
              Armed Forces Retirement Home--Trust Fund
 
Operation and maintenance..........................................          41,300           41,300           41,300   ...............  ...............
Capital program....................................................           1,000            1,000            1,000   ...............  ...............
Payment from General Fund..........................................          22,000           22,000           22,000   ...............  ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Armed Forces Retirement Home..........................          64,300           64,300           64,300   ...............  ...............
                                                                    ====================================================================================
      Total, title III.............................................         424,700          317,655          317,655         -107,045   ...............
                                                                    ====================================================================================
             TITLE IV--OVERSEAS CONTINGENCY OPERATIONS
 
                  Overseas Contingency Operations
 
Army...............................................................         130,400           69,000   ...............        -130,400          -69,000
Navy...............................................................          13,390   ...............  ...............         -13,390   ...............
Air Force..........................................................         275,522   ...............          69,000         -206,522          +69,000
Defense-Wide.......................................................          22,400           60,000           60,000          +37,600   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal.....................................................         441,712          129,000          129,000         -312,712   ...............
 
             European Deterrence/Reassurance Initiative
 
Army...............................................................          15,700          192,250          192,250         +176,550   ...............
Navy...............................................................          19,858          227,320          227,320         +207,462   ...............
Air Force..........................................................         270,830          345,800          345,800          +74,970   ...............
Defense-Wide.......................................................           1,900           27,050           27,050          +25,150   ...............
                                                                    ------------------------------------------------------------------------------------
      Subtotal.....................................................         308,288          792,420          792,420         +484,132   ...............
                                                                    ------------------------------------------------------------------------------------
      Total, title IV..............................................         750,000          921,420          921,420         +171,420   ...............
                                                                    ====================================================================================
                        OTHER APPROPRIATIONS
 
                       DEPARTMENT OF DEFENSE
 
Hurricane Supplemental (Public Law 115-123) (emergency)............         201,636   ...............  ...............        -201,636   ...............
Additional Funds (Public Law 115-96) (emergency)...................         200,000   ...............  ...............        -200,000   ...............
Hurricane Supplemental (Public Law 115-123) (emergency)............         519,345   ...............  ...............        -519,345   ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Military Construction.................................         920,981   ...............  ...............        -920,981   ...............
                                                                    ====================================================================================
                   DEPARTMENT OF VETERANS AFFAIRS
 
                   Veterans Health Administration
 
Hurricane Supplemental (Public Law 115-123) (emergency)............          11,075   ...............  ...............         -11,075   ...............
Hurricane Supplemental (Public Law 115-123) (emergency)............           4,088   ...............  ...............          -4,088   ...............
Hurricane Supplemental (Public Law 115-123) (emergency)............           3,209   ...............  ...............          -3,209   ...............
Hurricane Supplemental (Public Law 115-123) (emergency)............          75,108   ...............  ...............         -75,108   ...............
                                                                    ------------------------------------------------------------------------------------
      Total, Veterans Health Administration........................          93,480   ...............  ...............         -93,480   ...............
                                                                    ====================================================================================
      Total, Further Additional Supplemental Appropriations for           1,014,461   ...............  ...............      -1,014,461   ...............
       Disaster Relief Requirements Act, 2018......................
                                                                    ====================================================================================
      Grand total..................................................     205,791,908      224,608,740      225,565,468      +19,773,560         +956,728
          Appropriations...........................................     (26,412,407)     (26,840,291)     (28,051,315)     (+1,638,908)     (+1,211,024)
          Reappropriations.........................................        (420,000)  ...............  ...............       (-420,000)  ...............
          Rescissions..............................................     (-1,214,000)  ...............       (-254,296)       (+959,704)       (-254,296)
          Advance appropriations, fiscal year 2020.................    (178,409,040)    (196,847,029)    (196,847,029)    (+18,437,989)  ...............
          Overseas contingency operations..........................        (750,000)        (921,420)        (921,420)       (+171,420)  ...............
          Emergency appropriations.................................      (1,014,461)  ...............  ...............     (-1,014,461)  ...............
      Advances from prior year appropriations......................    (170,321,028)    (178,409,040)    (178,409,040)     (+8,088,012)  ...............
      (By transfer)................................................        (312,137)        (316,578)        (316,578)         (+4,441)  ...............
      (Limitation on direct loans).................................          (2,856)          (2,537)          (2,537)           (-319)  ...............
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\$2.1 billion in emergency funding for Medical: Services purposes was appropriated in H. J. Res. 124 in addition to these funds.






                                         [all]